Promotions on Newport and Marlboro Cigarette Packages: A National Study.

INTRODUCTION: While cigarette pack designs are part of integrated marketing efforts, it is unclear the degree to which packs are used to advertise promotions and whether the tobacco retailers' neighborhood characteristics influence the likelihood and type of pack-based promotion in the United States. METHODS: Between June and October 2012, data collectors purchased packs of either Marlboro Red (n = 1090) or Newport Green (n = 1057) cigarettes at 2147 stores that were part of a national sample of tobacco retailers in the contiguous US. Coders rated packs for the presence of an exterior and interior pack promotion, placement of exterior promotion (eg, front, back), presentation of exterior promotion (eg, onsert, tear strip), and nature of the promotion (eg, contest/give/away). Using Census tract data, we examined the association of pack promotions with tobacco retailers' neighborhood demographic characteristics. RESULTS: Marlboro packs were approximately twice as likely to have promotions as Newport packs (31.7% vs. 14.7%). Fewer Marlboro packs (14.6%) and no Newport packs had interior promotions. The majority of exterior promotions were for contests (>80% for both brands), while almost all interior Marlboro promotions (97.5%) were for a discounted price. There were few differences in presence or type of promotion by tobacco retailers' neighborhood characteristics. CONCLUSIONS: Exterior packs promotions, in particular, were fairly common and may contribute to the allure of tobacco products. IMPLICATIONS: Use of promotions on the interior and exterior of cigarette packs are a mechanism that the tobacco industry uses to sell its products and should be continually assessed for their influence on consumer behavior.

Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review.

OBJECTIVE: This systematic review examines the impact of non-menthol flavours in tobacco products on tobacco use perceptions and behaviours among youth, young adults and adults. DATA SOURCES: English-language peer-reviewed publications indexed in 4 databases were searched through April 2016. STUDY SELECTION: A search strategy was developed related to tobacco products and flavours. Of 1688 articles identified, we excluded articles that were not English-language, were not peer-reviewed, were qualitative, assessed menthol-flavoured tobacco products only and did not contain original data on outcomes that assessed the impact of flavours in tobacco products on perceptions and use behaviour. DATA EXTRACTION: Outcome measures were identified and tabulated. 2 researchers extracted the data independently and used a validated quality assessment tool to assess study quality. DATA SYNTHESIS: 40 studies met the inclusion criteria. Data showed that tobacco product packaging with flavour descriptors tended to be rated as more appealing and as less harmful by tobacco users and non-users. Many tobacco product users, especially adolescents, reported experimenting, initiating and continuing to use flavoured products because of the taste and variety of the flavours. Users of many flavoured tobacco products also showed decreased likelihood of intentions to quit compared with non-flavoured tobacco product users. CONCLUSIONS: Flavours in most tobacco products appear to play a key role in how users and non-users, especially youth, perceive, initiate, progress and continue using tobacco products. Banning non-menthol flavours from tobacco products may ultimately protect public health by reducing tobacco use, particularly among youth.

American Spirit Pack Descriptors and Perceptions of Harm: A Crowdsourced Comparison of Modified Packs.

INTRODUCTION: In 2015, the Food and Drug Administration issued warnings to three tobacco manufacturers who label their cigarettes as "additive-free" and/or "natural" on the grounds that they make unauthorized reduced risk claims. The goal of this study was to examine US adults' perceptions of three American Spirit (AS) pack descriptors ("Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown Tobacco") to assess if they communicate reduced risk. METHODS: In September 2012, three cross-sectional surveys were posted on Amazon Mechanical Turk. Adult participants evaluated the relative harm of a Marlboro Red pack versus three different AS packs with the descriptors "Made with Organic Tobacco," "100% Additive-Free," or "100% US Grown Tobacco" (Survey 1; n = 461); a Marlboro Red pack versus these AS packs modified to exclude descriptors (Survey 2; n = 857); and unmodified versus modified AS pack images (Survey 3; n = 1001). RESULTS: The majority of Survey 1 participants rated the unmodified AS packs as less harmful than the Marlboro Red pack; 35.4%-58.8% of Survey 2 participants also rated the modified (no claims) packs as less harmful than Marlboro Red. In these surveys, prior use of AS cigarettes was associated with reduced perceptions of risk (adjusted odds ratio [AOR] 1.59-2.40). "Made with Organic Tobacco" and "100% Additive-Free" were associated with reduced perceptions of risk when comparing the modified versus the unmodified AS packs (Survey 3). CONCLUSIONS: Data suggest that these AS pack descriptors communicate reduced harm messages to consumers. Findings have implications for regulatory actions related to product labeling and packaging. IMPLICATIONS: These findings provide additional evidence that the "Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown" descriptors, as well as other aspects of the AS pack design, communicate reduced harm to non-, current, and former smokers. Additionally, they provide support for the importance of FDA's 2015 warning to Santa Fe Natural Tobacco Company on "100% Additive Free" as an unauthorized modified risk claim.

Impact of Exposure to Electronic Cigarette Advertising on Susceptibility and Trial of Electronic Cigarettes and Cigarettes in US Young Adults: A Randomized Controlled Trial.

INTRODUCTION: This study assessed the impact of brief exposure to four electronic cigarette (e-cigarette) print advertisements (ads) on perceptions, intention, and subsequent use of e-cigarettes and cigarettes in US young adults. METHODS: A randomized controlled trial was conducted in a national sample of young adults from an online panel survey in 2013. Participants were randomized to ad exposure or control. Curiosity, intentions, and perceptions regarding e-cigarettes were assessed post-exposure and e-cigarette and cigarette use at 6-month follow-up. Analyses were conducted in 2014. RESULTS: Approximately 6% of young adults who had never used an e-cigarette at baseline tried an e-cigarette at 6-month follow-up, half of whom were current cigarette smokers at baseline. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette (18.3% exposed vs. 11.3% unexposed, AOR = 1.63, 95% CI = 1.18, 2.26) among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up (3.6% exposed vs. 1.2% unexposed, AOR = 2.85; 95% CI = 1.07, 7.61) among never users of cigarettes and e-cigarettes. Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users, nor cigarette use among smokers over time. Curiosity mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users. CONCLUSIONS: Exposure to e-cigarette ads may enhance curiosity and limited trial of e-cigarettes in never users. Future studies are needed to examine the net effect of curiosity and trial of e-cigarettes on longer-term patterns of tobacco use. IMPLICATIONS: This randomized trial provides the first evidence of the effect of e-cigarette advertising on a behavioral outcome in young adults. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up in a small number of never e-cigarette users and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes.

The Other Combustible Products: Prevalence and Correlates of Little Cigar/Cigarillo Use Among Cigarette Smokers.

BACKGROUND: Despite the increasing consumption of little cigars and cigarillos (LCCs), few studies have examined unique predictors and correlates of LCC use among adult cigarette smokers. This study explored differences between cigarette smokers with and without a history of LCC use on harm perceptions, use of other tobacco products (chewing tobacco, snus, e-cigarettes, and dissolvables), cigarette smoking/cessation-related behaviors/cognitions, and mental health and substance use disorder symptoms. METHODS: A geographically diverse sample of current cigarette smokers were included in analyses (n = 1270). Frequencies of LCC use, awareness, purchase, and harm perceptions were examined and logistic regression models investigated differences between LCC ever and never users on a variety of factors, controlling for demographics. RESULTS: Bivariate analyses showed that LCC users were more likely to be male, younger, have lower income, have tried other tobacco products, perceive LCCs as less harmful than cigarettes, and endorse lifetime substance disorder symptoms. Menthol and other tobacco product use were the only significant correlates of LCC use in logistic regression models. Post-hoc analyses showed that other tobacco product use partially mediated an association between substance use disorder symptoms and LCC use. CONCLUSIONS: A third of the sample had tried LCCs, and LCC users were more likely to have experimented with other tobacco products and used menthol. The high degree of co-use of cigarette smoking and LCCs with other tobacco products and the association of LCC use to substance use suggests that these users have unique risk factors and deserve specific targeting in public health campaigns.

Patterns of Longitudinal Transitions in Menthol Use Among US Young Adult Smokers.

INTRODUCTION: Menthol is the only characterizing flavor in cigarettes that was not banned as part of the 2009 Family Smoking Prevention and Tobacco Control Act. This longitudinal study explores the role of menthol in smoking initiation and progression. Purpose (a) to examine young adult patterns of menthol cigarette use including switching between menthol and non-menthol and (b) to describe associations between these patterns of menthol use and cessation related intentions and behaviors. Additional data on the role of menthol in cigarettes on smoking uptake and maintenance is needed to inform proposed policy making at the local, state, and national levels. METHODS: Using 3 time points from a longitudinal national sample of young adults aged 18-34 years (N = 267 smokers), patterns of menthol use over 1 year were defined among smokers as: (a) remained menthol smoker; (b) remained non-menthol smoker; (c) switched from menthol to non-menthol; and (d) switched from non-menthol to menthol. Associations were assessed between current menthol cigarette use and cessation intentions and behaviors. RESULTS: Significant predictors of current menthol cigarette use at 1 year included initiation with menthol (OR = 8.26), Black race (OR = 23.60), and higher scores on the Allen menthol taste subscale (OR = 1.53). Menthol smokers were more likely to report intention to quit but no differences existed between menthol and non-menthol users in ever making a quit attempt. CONCLUSIONS: Most young adults stay with the product that they start smoking with. Menthol smokers were interested in quitting, but less interested in next 30-day action than non-menthol smokers.

Tobacco on the web: surveillance and characterisation of online tobacco and e-cigarette advertising.

BACKGROUND: Despite the internet's broad reach and potential to influence consumer behaviour, there has been little examination of the volume, characteristics, and target audience of online tobacco and e-cigarette advertisements. METHODS: A full-service advertising firm was used to collect all online banner/video advertisements occurring in the USA and Canada between 1 April 2012 and 1 April 2013. The advertisement and associated meta-data on brand, date range observed, first market, and spend were downloaded and summarised. Characteristics and themes of advertisements, as well as topic area and target demographics of websites on which advertisements appeared, were also examined. RESULTS: Over a 1-year period, almost $2 million were spent by the e-cigarette and tobacco industries on the placement of their online product advertisements in the USA and Canada. Most was spent promoting two brands: NJOY e-cigarettes and Swedish Snus. There was almost no advertising of cigarettes. About 30% of all advertisements mentioned a price promotion, discount coupon or price break. e-Cigarette advertisements were most likely to feature messages of harm reduction (38%) or use for cessation (21%). Certain brands advertised on websites that contained up to 35% of youth (<18 years) as their audience. CONCLUSIONS: Online banner/video advertising is a tactic used mainly to advertise e-cigarettes and cigars rather than cigarettes, some with unproven claims about benefits to health. Given the reach and accessibility of online advertising to vulnerable populations such as youth and the potential for health claims to be misinterpreted, online advertisements need to be closely monitored.

How the industry is marketing menthol cigarettes: the audience, the message and the medium.

BACKGROUND: Despite declines in overall US cigarette consumption, the menthol cigarette market share has increased in recent years. Advertising contributes to menthol initiation and use, but little has been done to characterise menthol cigarette advertising outside of the point of sale. METHODS: Two full-service advertising firms were used to develop a library of menthol cigarette advertisements (ads) over a 9-month period (June 2012-February 2013) in the USA. The volume of ads, media channel (direct mail, print, online, email), estimated spend and households reached was summarised overall and by brand in 2013. Direct mail, email and print ads were coded for content and the target audience of print publications was examined. RESULTS: Over the study period, 205 menthol cigarette ads were identified with estimated expenditures exceeding US$31 million, with 70% spent on direct mail ads. Over 90% of ads promoted Camel, Marlboro and Newport menthol cigarettes. A majority (87%) of direct mail ads contained coupons or other incentives known to appeal to price-sensitive customers. Only two brands' print ads appeared during this period: Newport ads focused on themes of sociability and sexuality, and were placed in magazines targeting African-Americans and younger consumers; American Spirit print ads were placed in general interest magazines and predominantly stressed the 'natural' aspects of their brand. DISCUSSION: The tobacco industry continues to spend millions of dollars promoting menthol cigarettes through channels that preferentially target vulnerable subgroups, such as African-Americans and younger consumers. Public health campaigns to educate and combat the influence of menthol advertising are needed.

The next generation of users: prevalence and longitudinal patterns of tobacco use among US young adults.

OBJECTIVES: We monitored the prevalence and patterns of use of the array of tobacco products available to young adults, who are at risk for initiation and progression to established tobacco use. METHODS: We used data from waves 1 to 3 of GfK's KnowledgePanel (2011-2012), a nationally representative cohort of young adults aged 18 to 34 years (n = 2144). We examined prevalence and patterns of tobacco product use over time, associated demographics, and state-level tobacco policy. We used multivariable logistic regression to determine predictors of initiation of cigarettes as well as noncombustible and other combustible products. RESULTS: The prevalence of ever tobacco use rose from 57.28% at wave 1 to 67.43% at wave 3. Use of multiple products was the most common pattern (66.39% of tobacco users by wave 3). Predictors of initiation differed by product type and included age, race/ethnicity, policy, and use of other tobacco products. CONCLUSIONS: Tobacco use is high among young adults and many are using multiple products. Efforts to implement policy and educate young adults about the risks associated with new and emerging products are critical to prevent increased initiation of tobacco use.

Prevalence, harm perceptions, and reasons for using noncombustible tobacco products among current and former smokers.

OBJECTIVES: We provided estimates of noncombustible tobacco product (electronic nicotine delivery systems [ENDS]; snus; chewing tobacco, dip, or snuff; and dissolvables) use among current and former smokers and examined harm perceptions of noncombustible tobacco products and reasons for their use. METHODS: We assessed awareness of, prevalence of, purchase of, harm perceptions of, and reasons for using noncombustible tobacco products among 1487 current and former smokers from 8 US designated market areas. We used adjusted logistic regression to identify correlates of noncombustible tobacco product use. RESULTS: Of the sample, 96% were aware of at least 1 noncombustible tobacco product, but only 33% had used and 21% had purchased one. Noncombustible tobacco product use was associated with being male, non-Hispanic White, younger, and more nicotine dependent. Respondents used noncombustible tobacco products to cut down or quit cigarettes, but only snus was associated with a higher likelihood of making a quit attempt. Users of noncombustible tobacco products, particularly ENDS, were most likely to endorse the product as less harmful than cigarettes. CONCLUSIONS: Smokers may use noncombustible tobacco products to cut down or quit smoking. However, noncombustible tobacco product use was not associated with a reduction in cigarettes per day or cessation.

Noncombustible tobacco product advertising: how companies are selling the new face of tobacco.

BACKGROUND: With declining cigarette sales, increasing restrictions, and recent Food and Drug Administration (FDA) regulation of cigarettes, there has been a dramatic rise in the marketing of noncombustible tobacco products (NCPs). However, little is known about how NCPs are advertised and to whom. METHODS: Two full-service advertising firms were used to systematically collect all U.S. advertisements for NCPs (e-cigarettes, snus, dissolvables, and chew/dip/snuff,) running between June 1 and September 1, 2012. The advertisement and associated metadata (brand, media channel, observations, spend, and estimated reach) were examined. Attributes of print advertisements were examined relative to target demographics of the publications in which they ran. RESULTS: Over 3 months, almost $20 million was spent advertising NCPs. Although the greatest amount spent was on the promotion of smokeless (~$8 million) and snus (~$10 million), e-cigarette advertisements were the most widely circulated. Print advertisements, the majority of which were e-cigarettes and chew/dip/snuff, were heavily tailored to middle-aged White males. Many e-cigarette print ads suggested harm reduction and use when one cannot smoke (poly-use), while chew/dip/snuff focused on masculinity. CONCLUSIONS: Robust ongoing surveillance of NCP advertising is critical to inform the FDA and to protect public health. Both commercial advertising and public health media campaigns must ensure that content is not misleading and that it educates consumers about harm based on the available science. The way messages are framed have the potential to decrease tobacco use by promoting rather than undermining cessation of combusted products and/or by encouraging exclusive use of less harmful NCPs rather than poly-use of combusted and NCPs.

YouTube: a promotional vehicle for little cigars and cigarillos?

OBJECTIVE: As the third most popular website in the world, messages embedded in the video-sharing site, YouTube, have the potential to influence tobacco-related attitudes, beliefs and behaviours. Despite the growing number of videos depicting little cigars/cigarillos (LCCs), there has been no examination of the portrayal of these products on YouTube. METHODS: Researchers identified up to the top 20 search results on YouTube by relevance and view count for the following search terms: 'little cigars', 'cigarillos', 'Black and Mild', 'Swisher Sweets', 'White owl', 'Garcia y Vega', and 'Winchester'. Reviewers rated whether videos were 'pro', 'anti' or 'neutral' to the use of LCCs, and documented statistics on the reach and viewer demographics. Several main themes around LCCs were noted, as was video quality (amateur vs professional) and demographics of video participants. RESULTS: Of the 196 videos retrieved, only 56 were unique, eligible videos. The majority of these (n=43) were 'pro' LCCs, 11 were 'neutral', and only two were 'anti' LCCs. Videos were primarily viewed by males in the USA and Canada and most were amateur. Common themes included where to purchase LCCs, their candy flavours, and that they are cheap or cheaper than cigarettes, and 'smooth'. CONCLUSIONS: The vast majority of information on YouTube about LCCs promotes their use. It is critical to monitor content on LCCs posted on YouTube, and develop appropriate health messages to counter pro-LCC content, and appropriately inform potential consumers of the harms associated with their use.

Direct Synthesis and Characterization of Hydrophilic Cu-Deficient Copper Indium Sulfide Quantum Dots.

Copper indium sulfide (CIS) nanocrystals constitute a promising alternative to cadmium- and lead-containing nanoparticles. We report a synthetic method that yields hydrophilic, core-only CIS quantum dots, exhibiting size-dependent, copper-deficient composition and optical properties that are suitable for direct coupling to biomolecules and nonradiative energy transfer applications. To assist such applications, we complemented previous studies covering the femtosecond-picosecond time scale with the investigation of slower radiative and nonradiative processes on the nanosecond time scale, using both time-resolved emission and transient absorption. As expected for core particles, relaxation occurs mainly nonradiatively, resulting in low, size-dependent photoluminescence quantum yield. The nonradiative relaxation from the first excited band is wavelength-dependent with lifetimes between 25 and 150 ns, reflecting the size distribution of the particles. Approximately constant lifetimes of around 65 ns were observed for nonradiative relaxation from the defect states at lower energies. The photoluminescence exhibited a large Stokes shift. The band gap emission decays on the order of 10 ns, while the defect emission is further red-shifted, and the lifetimes are on the order of 100 ns. Both sets of radiative lifetimes are wavelength-dependent, increasing toward longer wavelengths. Despite the low radiative quantum yield, the aqueous solubility and long lifetimes of the defect states are compatible with the proposed role of CIS quantum dots as excitation energy donors to biological molecules.

Patient-report and caregiver-report measures of rehabilitation service use following acquired brain injury: a systematic review.

OBJECTIVE: To review patient-report/caregiver-report measures of rehabilitation service use following acquired brain injury (ABI). DATA SOURCES: Medline, APA PsycINFO, Embase and CINAHL were searched on November 2021 and November 2022. Authors were contacted if measures were not included in manuscripts/appendices. STUDY SELECTION: Included articles were empirical research or a research protocol, available in English and described measures of patient report/caregiver report of rehabilitation service use post-ABI via quantitative or qualitative methods. Two reviewers independently screened 5290 records using DistillerSR. Discrepancies were resolved by team adjudication. DATA EXTRACTION: Data extraction was piloted with high levels of agreement (k=.94). Data were extracted by a single member with team meetings to seek guidance as needed. Data included administration characteristics (reporter, mode of administration, recall period), psychometric evidence and dimensions assessed (types of services, setting, frequency, duration, intensity, qualitative aspects). DATA SYNTHESIS: One hundred and fifty-two measures were identified from 85 quantitative, 56 qualitative and 3 psychometric studies. Psychometric properties were reported for four measures, all of which focused on satisfaction. Most measures inquired about the type of rehabilitation services used, with more than half assessing functional (eg, physical therapy) and behavioural health rehabilitation services, but fewer than half assessing community and academic reintegration (eg, special education, vocational rehabilitation) or cognitive (eg, neuropsychology) services. Fewer than half assessed qualitative aspects (eg, satisfaction). Recall periods ranged from 1 month to 'since the ABI event' or focused on current use. Of measures that could be accessed (n=71), many included a limited checklist of types of services used. Very few measures assessed setting, frequency, intensity or duration. CONCLUSIONS: Despite widespread interest, the vast majority of measures have not been validated and are limited in scope. Use of gold-standard psychometric methods to develop and validate a comprehensive patient-report/caregiver-report measure of rehabilitation service use would have wide-ranging implications for improving rehabilitation research in ABI.

Using a Rapid Learning Health System for Stratified Care in Emerging Adult Mental Health Services: Protocol for the Implementation of Patient-Reported Outcome Measures.

BACKGROUND: Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies. OBJECTIVE: The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults. METHODS: This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services. RESULTS: This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes. CONCLUSIONS: This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/51667.

Public support for mandated nicotine reduction in cigarettes.

OBJECTIVES: We assessed public support for a potential Food and Drug Administration (FDA)-mandated reduction in cigarette nicotine content. METHODS: We used nationally representative data from a June 2010 cross-sectional survey of US adults (n = 2649) to obtain weighted point estimates and correlates of support for mandated nicotine reduction. We also assessed the potential role of political ideology in support of FDA regulation of nicotine. RESULTS: Nearly 50% of the public supported mandated cigarette nicotine reduction, with another 28% having no strong opinion concerning this potential FDA regulation. Support for nicotine reduction was highest among Hispanics, African Americans, and those with less than a high school education. Among smokers, the odds of supporting FDA nicotine regulation were 2.77 times higher among smokers who intended to quit in the next 6 months than among those with no plans to quit. CONCLUSIONS: Mandating nicotine reduction in cigarettes to nonaddictive levels may reduce youth initiation and facilitate adult cessation. The reasons behind nicotine regulation need to be communicated to the public to preempt tobacco industry efforts to impede such a regulation.

Primary and dual users of little cigars/cigarillos and large cigars: demographic and tobacco use profiles.

BACKGROUND: Although cigarettes are regulated through the Family Smoking Prevention and Tobacco Control Act, cigars are currently not regulated and tend to be lower in price. Despite the rising use of cigars in the United States, little is known about the prevalence of use of little cigars/cigarillos (LCCs) versus large cigars (LCs) and the profile of these distinct cigar users. METHODS: This study uses data from Legacy's Young Adult Cohort, a nationally representative study of 4,215 young adults, ages 18-34. Cigar use was divided into three groups: ever use of LCCs only, ever use of LCs only, and ever dual users. Multinomial regression was used to determine the differential demographic characteristics and tobacco use behaviors associated with the three cigar-use groups. RESULTS: Ever cigar use was reported by 37.9% (n = 1,596) of the young adult cohort. Of the cigar smokers, 21.5% (n = 344) had used only LCCs, 32.3% (n = 515) had used only LCs, and 46.2% (n = 737) were dual users of both. In comparison with LC-only users, LCC-only users were more like to be younger (relative risk ratio [RRR] = 0.40, p < .001 for 25-34 vs. 18-24 years), female (RRR = 4.92, p < .001), non-Hispanic Black (RRR = 2.91, p < .001), and smoke cigarettes daily. Dual users were more likely than LC-only users to be female (RRR = 1.61, p = .03), non-Hispanic Black (RRR = 2.06, p = .04), and use a higher numbers of tobacco products (RRR = 4.44, p < .001). CONCLUSIONS: Cigar use is prevalent among young adults with the highest proportion using both LCCs and LCs. Interventions to curb use should consider the differential demographic and tobacco use patterns of cigar users.

Engagement promotes abstinence in a web-based cessation intervention: cohort study.

BACKGROUND: Web-based smoking cessation interventions can have a public health impact because they are both effective in promoting cessation and can reach large numbers of smokers in a cost-efficient manner. Their potential impact, however, has not been realized. It is still unclear how such interventions promote cessation, who benefits most, and how to improve their population impact. OBJECTIVE: To examine the effectiveness of a highly promoted Web-based smoking cessation intervention to promote quit behavior over time, identify the most effective features, and understand who is most likely to use those features by using unweighted and weighted analyses to estimate the impact in the broader pool of registered site users. METHODS: A sample of 1033 new adult registrants was recruited from a Web-based smoking cessation intervention by using an automated study management system. Abstinence was assessed by self-report through a mixed-mode follow-up (online survey with telephone follow-up for nonrespondents) at 1, 3, and 6 months. Software tracked respondents' online activity. Generalized estimating equations (GEE) were used to examine predictors of website utilization and how utilization promoted abstinence using unweighted and weighted data. RESULTS: The 7-day point prevalence abstinence rates at 6 months ranged from 20.68% to 11.13% in the responder and intent-to-treat samples, respectively. Predictors of abstinence in unweighted analyses included number of visits to the website as well as accessing specific interactive or engaging features. In weighted analyses, only number of visits was predictive of abstinence. Motivation to quit was a key predictor of website utilization, whereas negative partner support decreased the likelihood of increasing visits or accessing engaging features. CONCLUSIONS: Engagement is critical to promoting smoking cessation. The next generation of Web-based smoking cessation interventions needs to maximize the initial engagement of all new visitors and work to retain those smokers who proceed to register on the site.

Feasibility and acceptability of a brief, online transdiagnostic psychotherapy for young adults.

Background: The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a flexible form of cognitive behavioural therapy targeting diverse mental health disorders in children and adults. Objective: The goal was to develop a brief version of UP tailored to the unique needs of young adults that could be administered in an online therapist-directed, group format. Method: Nineteen young adults (age 18-23) receiving mental health services from a community agency or a specialty clinic were enrolled in a feasibility test of the novel transdiagnostic, online intervention (five sessions, 90 minutes each). Qualitative interviews were conducted with participants after each session they attended and upon study completion (n = 80 interviews with n = 17 participants). Standardized quantitative mental health measures were collected at baseline (n = 19), end of treatment (5 weeks; n = 15) and at follow-up (12 weeks; n = 14). Results: Thirteen of the 18 participants (72%) who began treatment attended at least four of the five sessions. During the qualitative interviews, participants noted that core UP concepts such as understanding of emotions, mindfulness, cognitive flexibility, and behavioural activation are applicable in their day-to-day lives. Quantitative data showed a significant reduction in anxiety-related life impairment at follow-up compared to baseline, but not end of treatment compared to baseline. Reductions in global anxiety and depression symptoms were not statistically significant. Conclusions: This novel, brief version of the UP may be a feasible online intervention for young adults seen at mental health clinics for diverse mental health issues and warrants further study to demonstrate effectiveness.

Contexte: Le protocole unifié (PU) pour le traitement transdiagnostique des troubles émotionnels est une forme flexible de thérapie cognitivo-comportementale ciblant divers troubles de santé mentale flexible chez les enfants et les adultes. Objectif: Le but était d'élaborer une version abrégée du PU adaptée aux besoins uniques des jeunes adultes qui pourrait être administrée à un format de groupe en ligne dirigé par un thérapeute. Méthode: Dix-neuf jeunes adultes (18­23 ans) recevant des services de santé mentale d'un organisme communautaire ou d'une clinique spécialisée ont été inscrits à un test de faisabilité de la nouvelle intervention transdiagnostique en ligne (cinq séances, 90 minutes chacune). Des entrevues qualitatives ont été menées auprès des participants après chaque séance à laquelle ils ont assisté et à la fin de l'étude (n = 80 entrevues avec n = 17 participants). Les mesures de santé mentale standardisée quantitative ont été recueillies à la base (n = 19), à la fin du traitement (5 semaines; n = 15) et au suivi (12 semaines; n = 14). Résultats: Treize des 18 participants (72 %) qui ont commencé le traitement ont assisté à au moins quatre des cinq séances. Durant les entrevues qualitatives, les participants ont noté que les principaux concepts du PU comme la compréhension des émotions, la pleine conscience, la flexibilité cognitive et l'activation comportementale sont applicables dans leur vie quotidienne. Les données quantitatives indiquaient une réduction significative dans les troubles de la vie liés à l'anxiété au suivi comparé à la base, mais pas à la fin du traitement comparé à la base. Les réductions de l'anxiété générale et des symptômes de dépression n'étaient pas statistiquement significatives. Conclusions: Cette nouvelle version abrégée du PU peut être une intervention faisable en ligne pour les jeunes adultes vus dans des cliniques de santé mentale pour divers problèmes de santé mentale et demande plus d'étude pour en démontrer l'efficacité.

A ban on menthol cigarettes: impact on public opinion and smokers' intention to quit.

OBJECTIVES: We assessed support for a ban by the Food and Drug Administration on menthol in cigarettes and behavioral intentions among menthol smokers in the event of such a ban. METHODS: We surveyed 2649 never, former, and current smokers and used ordinal logistic regression to calculate weighted point estimates and predictors of support for a menthol ban among the adult population and menthol smokers only. For menthol smokers, we also calculated weighted point estimates and predictors of behavioral intentions. RESULTS: Overall, 28.2% of adults opposed, 20.0% supported, and 51.9% lacked a strong opinion about a menthol ban. Support was highest among Hispanics (36.4%), African Americans (29.0%), never smokers (26.8%), and respondents with less than a high school education (28.8%). Nearly 40% of menthol smokers said they would quit if menthol cigarettes were no longer available, 12.5% would switch to a nonmenthol brand, and 25.2% would both switch and try to quit. CONCLUSIONS: Support for a menthol ban is strongest among populations with the highest prevalence of menthol cigarette use. A menthol ban might motivate many menthol smokers to quit.