Research Digest October 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: 02/10 - 29/10

Research Trawl  3 - 29 October

Smoking Status and Factors associated with COVID-19 In-hospital Mortality among U.S. Veterans

Published: 25/10/2021, Nicotine and Tobacco Research

Conclusions: In patients admitted to the hospital with SARS-CoV-2 infection, our data demonstrate that FS are at higher risk of in-hospital mortality than NS. However, this pattern was not seen among CS highlighting the need for more granular analysis with high quality smoking status data to further clarify our understanding of smoking risk and COVID-19-related mortality. Presence of comorbidities and advanced age were also associated with increased risk of in-hospital mortality.

Electronic Vaping Product Use Among Adolescents in the Era of the COVID-19 Pandemic: An Updated Scientific Review for Clinicians

Published: 01/10/2021, WMJ

Conclusions: Preclinical and theoretical models establish pulmonary harm associated with EVPs. Based on the limited epidemiological studies, the contribution of EVP use to the risk of contracting COVID-19 is mixed. EVP-associated lung injury could present as a diagnostic challenge for clinicians during COVID-19 and requires greater attention. Clinicians should effectively screen for and discourage EVP use among adolescents.

Impact of electronic cigarette ever use on lung function in adults aged 45-85: a cross-sectional analysis from the Canadian Longitudinal Study on Aging

Published: 27/10/2021, BMJ Open

Conclusions: Ever use of e-cigarettes was found to be associated with obstructive lung function impairment after adjusting for covariates, suggesting that e-cigarette use may be adding to the respiratory and other chronic disease burden in the population.

Increased smoking and e-cigarette use among Irish teenagers: a new threat to Tobacco Free Ireland 2025

Published: 25/10/2021, ERJ Open Research

Abstract: Smoking prevalence decreased in Irish teenagers in all ESPAD survey waves from 1995 until 2015. However, in ESPAD 2019, current teen smoking and e-cigarette use increased, threatening Ireland's 5% prevalence tobacco endgame strategy.

Smoking status: A tacit screen for postpartum depression in primary care settings

Published: 01/12/2021, Journal of Affective Disorders

Conclusions: Time of smoking predicts risk of Postpartum Depression (PPD) and can be used to tacitly screen for PPD with reasonable accuracy without requiring any additional time in settings with limited resources for routine screening of PPD.

Effect of a ‘tobacco-free nicotine’ claim on intentions and perceptions of Puff Bar e-cigarette use among non-tobacco-using young adults

Published: 25/10/2021, Tobacco Control

Discussion: Puff Bar’s tobacco-free nicotine claim may increase non-tobacco-using young adults’ intentions of using Puff Bar and reduce harm perceptions and negative expectancy towards using Puff Bar. The claim may also prompt the use of Puff Bar over other e-cigarette brands and types. These findings are concerning given the health effects and regulations for tobacco-free nicotine products are not immediately clear.

World Heart Federation calls for strict regulation of e-cigarettes and greater oversight of the industry’s marketing and sales strategies

Published: 18/10/2021, World Heart Federation

Overview: In a new policy brief, the World Heart Federation (WHF) is calling on governments to implement strict regulations on e-cigarettes in a determined effort to stop the e-cigarette epidemic in its tracks.

Positive Affect and Multiple-tobacco Product Use among Youth: A 3-year Longitudinal Study

Published: 30/09/2021, American Journal of Health Behaviour

Conclusion: We observed a gradient relationship between low positive affect and greater number of tobacco products used. Findings reinforce the association between poor mental health and tobacco use during adolescence. Prevention efforts may need to incorporate methods of addressing low positive affect.

Using place-based characteristics to inform FDA tobacco sales inspections: results from a multilevel propensity score model

Published: 25/10/2021, Tobacco Control

Conclusion: The multilevel propensity score model predicts the retail violation of sale to minors with a good rank order of retail violations. The model-based approach can be used to identify hot spots of retail violations and improve the sampling plan for future inspections.

Effects of brief exposure to misinformation about e-cigarette harms on twitter: a randomised controlled experiment

Published: 26/10/2021, BMJ Open

Conclusions: US and UK adult current smokers may be deterred from considering using e-cigarettes after brief exposure to tweets that e-cigarettes were just as or more harmful than smoking. Conversely, US adult current smokers may be encouraged to use e-cigarettes after exposure to tweets that e-cigarettes are completely harmless. These findings suggest that misinformation about e-cigarette harms may influence some adult smokers’ decisions to consider using e-cigarettes.

Association of Smoking Initiation and Cessation Across the Life Course and Cancer Mortality

Prospective Study of 410 000 US Adults

Published: 21/10/2021, JAMA Oncology

Outline: Smoking remains the leading cause of cancer mortality in the US.1 Prior research has shown that smokers who start younger have greater mortality risk than those who start later, and quitting (especially at younger ages) substantially reduces that risk. However, the relevance of age at smoking initiation and cessation to cancer mortality in contemporary populations, particularly across the life course, is not well established.

Research Trawl  16 - 22 October

IQOS marketing strategies in the USA before and after US FDA modified risk tobacco product authorisation

Published: 19/10/2021, Tobacco Control

Conclusions: Regulatory efforts must be informed by ongoing surveillance of IQOS marketing efforts and its impacts, particularly how specific consumer subgroups (eg, tobacco non-users, women, young people) are impacted by marketing exposure.

Cigarette taxation and price differentials in 195 countries during 2014–2018

Published: 19/10/2021, Tobacco Control

Results: Worldwide, median price differential between budget and premium 20-cigarette packs was 49.4% (IQR 25.9%–70.0%) in 2014 and 44.4% (IQR 22.5%–69.4%) in 2018 with significant regional variation. The largest price differentials in 2018 were in Africa, with the lowest in Europe. Total taxation was negatively associated with price differentials (−1.5%, 95% CI −2.5% to −0.4% per +10% total taxation) as was specific excise taxation (−2.5%, 95% CI −3.7% to −1.2% per +10% specific excise tax). We found no statistically significant association between ad valorem taxation and price differentials.

Cross-promotion of nicotine pouches by leading cigarette brands

Published: 20/10/2021, Tobacco Control

Ad Watch experpt: Tobacco-free nicotine pouches are a new class of smokeless tobacco products that experienced precipitous sales increases since their national US market entry in 2016. The pouches contain a powdered mix of nicotine, flavouring, sweeteners and binders; are used in a manner similar to snus (ie, placed between the lip and gum) and are sold in a variety of nicotine strengths and flavours. These products are marketed as containing ‘tobacco-derived’ or ‘tobacco-free’ nicotine and nicotine salts and are described in product marketing as ‘spitless’, ‘smokeless’ and ‘tobacco leaf free’. The most prominent brands in today’s marketplace are owned by leading tobacco companies.

Recently, crossover advertising of nicotine pouch products was observed among leading brands of combustible cigarettes. For example, on 4 November 2020, routine…

Indicators of dependence and efforts to quit vaping and smoking among youth in Canada, England and the USA

Published: 21/10/2021, Tobacco Control

Conclusions: Prevalence of dependence symptoms among young e-cigarette users increased between 2017 and 2019, more so in Canada and the USA compared with England. Dependence symptom prevalence was lower for e-cigarettes than smoking; however, the gap has narrowed over time.

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

Published: 21/10/2021, 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.

Youth-appealing features in popular e-cigarette brand advertising in the USA after heightened scrutiny in 2018

Published: 21/10/2021, Tobacco Control

Conclusion: Even with heightened scrutiny of e-cigarette brands, advertisements still included youth-appealing content such as flavours, fruit imagery and positive sensations. Puff Bar led in all these categories, and it rapidly gained market share after market leader JUUL limited the sales of its flavoured products. Research should continue to monitor the characteristics of e-cigarette advertisements and consider their impact on youth.

The temporary ban on tobacco sales in South Africa: lessons for endgame strategies

Published: 21/10/2021, Tobacco Control

Conclusions: The demand-side preconditions for an effective sales ban were not in place in South Africa, making a sales ban inappropriate. The South African experience suggests that supply-side factors are also important in ensuring the success of a sales ban. These are: (1) the illicit market must be under control before implementing a sales ban; and (2) an effective sales ban needs to be synchronised with a ban on the manufacture, transport and distribution of cigarettes.

Perceptions of vape product restrictions among adult vapers

Published: 21/10/2021, Tobacco Control

Letters exerpt: States and localities are considering legislation to counter the youth vaping epidemic. Since availability is linked to exposure and use, policies that reduce tobacco and vape product availability may reduce youth tobacco exposure and use. However, limited research exists on how these policies may impact adult vape users. One argument against these policies is adults who vape to reduce cigarette use will be unable to readily access these products.

This study assessed Massachusetts’ adult vapers’ attitudes towards a policy that restricts sales of vape products to adult-only stores, including how this policy may impact their ability to access vapes.

Smokeless tobacco products, supply chain and retailers’ practices in England: a multimethods study to inform policy

Published: 21/10/2021, Tobacco Control

Conclusion: ST products are widely available in England, yet non-compliant with statutory regulations. In order to safeguard consumers, in particular ethnic South Asians, stronger efforts are needed to regulate the supply chain of ST at both national and international levels.

Characterizing heated tobacco product use among adult cigarette smokers and nicotine vaping product users in the 2018 ITC Four Country Smoking & Vaping Survey

Published: 20/10/2021, Nicotine and Tobacco Research

Conclusion: HTP users in this sample tended to be younger and more affluent. Most reported concurrent use of multiple nicotine products and other substances. Those cigarette smokers who used HTPs appeared more interested in smoking cessation, while some characteristics of concurrent HTP-NVP users were suggestive of dissatisfaction with NVPs.

Global implementation of tobacco demand reduction measures specified in Framework Convention on Tobacco Control

Published: 18/10/2021, Nicotine and Tobacco Control

Conclusions: While the FCTC was followed by implementation of compliant demand reduction policies, there are still many parties that have not implemented the FCTC, particularly increasing taxes and ending tobacco advertising and promotions.

Incidence of Cigarette Smoking Relapse Among Individuals Who Switched to e-Cigarettes or Other Tobacco Products

Published: 19/10/2021, JAMA

Findings: In this cohort study of a representative sample of US adults, 9.4% of respondents who smoked cigarettes became recent former smokers 1 year later. Switching to any tobacco product including e-cigarettes was associated with an 8.5% increase in relapse to smoking over the next year; this increase in relapse was similar to that seen in individuals who switched to other tobacco products.

Meaning:  Switching to e-cigarettes is not associated with relapse prevention for cigarette smoking in US adults.

Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries

Published: November 2021, The Lancet

Interpretation: Implementation of NCD policies is uneven, but broadly improving over time. Urgent action is needed to boost implementation of policies targeting corporate vectors of NCDs, and to support countries facing high corporate permeation.

Changes in Cigarette Sales in the United States During the COVID-19 Pandemic

Published: 19/10/2021, Annals of Internal Medicine

Findings: Observed cigarette sales exceeded expected sales for all months after the onset of the COVID-19 pandemic. The estimated average difference between observed and expected cigarette sales after adjustment for all covariates indicates a monthly excess sale of 0.34 pack per capita. It represents 14.1% (CI, 9.7% to 18.5%) higher cigarette sales compared with what was expected to be sold had the pre–COVID-19 pandemic trend persisted

Research Trawl  9 - 15 October

Inequalities in smoking and quitting-related outcomes among adults with and without children in the household 2013-2019: A population survey in England

Published: 11/10/2021, Nicotine and Tobacco Research

Conclusions: Among the most disadvantaged social grade in England, smoking prevalence was higher in those with children in the household than without. To attenuate future smoking-related inequalities, there is an urgent need to target support and address barriers to quitting and promote longer term quit success.

Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes: a systematic review and network meta-analysis of randomized controlled trials

Published: 11/10/2021, Addiction

Conclusions: Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.

E-cigarette use and promotion by social media influencers during videogame play on Twitch

Published: 08/10/2021, Tobacco Control

Excerpt: We recently discovered evidence of use and promotion of e-cigarettes by influencers on Amazon-owned Twitch, a video-sharing platform, which is similar to YouTube, but caters more to live streamers as opposed to creators of stored, long-lasting content.26 Twitch is predominantly a video gaming platform, where audiences watch …

Informed choice in the context of tobacco use disorder

Published: 14/10/2021, Nicotine and Tobacco Research

[Editorial]

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

Published: 11/10/2021, Nicotine and Tobacco Research

Conclusions: Exposure to increased cigarette prices during young adulthood was associated with a 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.

Recently abstinent smokers exhibit mood-associated dopamine dysfunction in the ventral striatum compared to nonsmokers: a [11C]-(+)-PHNO PET study

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

Conclusions: In conclusion, abstinent smokers exhibited significantly less amphetamine-induced dopamine release in the ventral striatum than nonsmokers. In abstinent smokers, worse mood was significantly associated with less striatal dopamine release. Our findings highlight a potential neural mechanism that may underlie negative mood symptoms during early abstinence

Designing more effective cigar warnings: an experiment among adult cigar smokers

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

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

NIH Tobacco Research and the Emergence of Tobacco Regulatory Science

Published: 08/10/2021, Nicotine and Tobacco Research

Conclusions: In total, support for new tobacco research supported by NIH and FDA combined remained steady for the time period covered, though there was a concomitant decline in NIH tobacco projects with the increase in FDA-funded TRS projects for the activity codes studied. Despite apparent overlap in some areas, both NIH and FDA support research that is unique to their respective missions.

Comparison of smoking cessation program registration, participation, smoking cessation medication utilization and abstinence rates between smokers with and without schizophrenia, schizo-affective disorder or bipolar disorder

Published: 09/10/10, Nicotine and Tobacco Research

Conclusions: Smoking cessation programs and SCM use should be encouraged in the SMI population. Providing support during the quit attempt and adapting SCP to the needs of smokers with SMI, combined with SCM prescription promotion, should improve abstinence.

Characterizing the Chemical Landscape in Commercial E-Cigarette Liquids and Aerosols by Liquid Chromatography-High-Resolution Mass Spectrometry

Published: 05/10/2021, Chemical Research in Toxicology

Findings: The obtained findings demonstrate the potential of nontarget LC-HRMS to identify previously unknown compounds and compound classes in e-cig liquids and aerosols, which is critical for the assessment of chemical exposures resulting from vaping.

Research Trawl  2 - 8 October

Responses to reduced nicotine cigarette marketing features: a systematic review

Published: 07/10/2021, Tobacco Control

Conclusions: Commercial marketing of reduced nicotine cigarettes is appealing and may need stronger regulations or communication campaigns to accurately convey risks. Opportunities exist for future research within tobacco regulatory science.

Flavour capsule cigarette use and perceptions: a systematic review

Published: 04/10/2021, Tobacco Control

Conclusion Findings call for the adoption of comprehensive tobacco control policies that account for flavour capsules and similar iterations, which can increase appeal through flavours and innovative features. Continued monitoring and research of these products is critical, with particular attention to low-income and middle-income countries, which make up a disproportionately larger share of the capsule market.

Tobacco industry strategies for flavour capsule cigarettes: analysis of patents and internal industry documents

Published: 05/10/2021, Tobacco Control

Conclusions: To prevent tobacco companies from targeting young people and exploiting regulatory loopholes, regulations on tobacco products should ban flavours and consider the broad variety of FCV designs, additives and loose products designed to impart flavour into tobacco products.

"I smoked that cigarette, and it calmed me down": A qualitative analysis of intrapersonal, social, and environmental factors influencing decisions to smoke among youth experiencing homelessness

Published: 04/10/2021, Nicotine and Tobacco Research

Conclusions: For youth experiencing homelessness, smoking is integrated into daily life and is often used to manage stress associated with homelessness and engage socially with homeless peers. Multicomponent interventions to reduce structural stressors specific to homelessness, change social smoking norms (environmental and social context), and address stress management and nicotine dependence (intrapersonal context) are needed to support smoking cessation among youth experiencing homelessness.

“I’m bored and I’m stressed”: A qualitative study of exclusive smokers, ENDS users, and transitioning smokers or ENDS users in the time of COVID-19

Published: 05/10/2021, Nicotine and Tobacco Research

Implications: Smokers believe that cigarettes help them deal with the stresses and challenges of the COVID-19 pandemic. This needs to be counteracted by educational campaigns to increase perceived harm of smoking, alternative stress-relief strategies, and mandated changes to the combusted tobacco products to make them less appealing.

Variations in disease burden of laryngeal cancer attributable to alcohol use and smoking in 204 countries or territories, 1990-2019

Published: 07/10/2021, BCM Cancer

Results: Globally, while the ASMR of LC decreased by 1.49% per year between 1990 and 2019, the number of deaths from LC has increased 41.0% to 123.4 thousand in 2019. In 2019, 19.4 and 63.5% of total LC-related deaths were attributable to alcohol use and smoking worldwide, respectively. The ASMR of alcohol- and smoking-related LC decreased by 1.78 and 1.93% per year, whereas the corresponding death number has increased 29.2 and 25.1% during this period, respectively. The decreasing trend was more pronounced in developed countries. In some developing countries, such as Guinea and Mongolia, the LC mortality has shown an unfavorable trend

Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment

Published: 05/10/2021, Journal of Addicition Medicine

Conclusions: The findings indicated positive associations between change in use of tobacco and cannabis use. Promoting cessation among people who use tobacco may help to reduce their cannabis use.

Interventions for preventing weight gain after smoking cessation

Published: 06/10/2021, Cochrane Systematic Reviews

Authors' conclusions: Overall, there is no intervention for which there is moderate certainty of a clinically useful effect on long-term weight gain. There is also no moderate- or high-certainty evidence that interventions designed to limit weight gain reduce the chances of people achieving abstinence from smoking.

Smoking Cessation After Lung Cancer Diagnosis and the Risk of Second Primary Lung Cancer: The Multiethnic Cohort Study

Published: 23/08/2021, JCNI Cancer Spectrum

Conclusion: Lung cancer diagnosis has a statistically significant impact on smoking cessation. Quitting smoking after IPLC diagnosis may reduce the risk of developing a subsequent malignancy in the lungs.