Randomized trial assessing the effect of the JUUL system on switching away from cigarettes and smoking reduction among U.S. adults who smoke cigarettes.

Observational studies show high rates of switching away from cigarettes among adult purchasers of JUUL-brand electronic nicotine delivery system (ENDS); data are needed to evaluate switching with JUUL in randomized general population trials. The association of ENDS flavor availability and switching is pertinent. This study assessed switch rates and smoking reduction among participants randomized to use JUUL in a choice of flavors or tobacco-only, compared to a condition provided smoking-cessation materials. U.S. adults who smoke cigarettes (N = 837; Mage [SD] = 45.99 years [11.48]; 18.76 cigarettes/day [SD = 7.86]; 50.2% female) from an address-based representative panel were randomized to receive JUUL for 6 months (5.0% nicotine; only Virginia Tobacco [N = 285] or choice of flavors [N = 281]), or smoking-cessation materials (quit advice [QA]; N = 271). Self-reported past 30-day smoking and cigarette consumption were assessed at 1, 3, and 6 months. Repeated-measure regressions assessed differences in smoking outcomes between groups. Only 2% of participants were planning to quit smoking within 30 days. Across the 6-month intervention, participants randomized to JUUL (vs. QA) had 6.57-fold greater odds of reporting past 30-day switching (95% CI [3.72-11.63]). Participants in the JUUL (vs. QA) group smoked 27% fewer cigarettes/day versus baseline (Rate Ratio [95% CI] = 0.73 [0.68-0.77]). Over half (51.8%) of the Virginia Tobacco group used other flavors (36.7% nontobacco flavors), contaminating randomized flavor-conditions. JUUL flavor groups did not differ in smoking outcomes (p > .48). Use of JUUL products may support complete switching away from cigarettes, including among those not ready to quit smoking. Results suggest a preference for nontobacco-flavored ENDS among adults who smoke, although smoking outcomes did not differ by flavor. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pharmacokinetic and subjective assessment of prototype JUUL2 electronic nicotine delivery system in two nicotine concentrations, JUUL system, IQOS, and combustible cigarette.

RATIONALE: Electronic nicotine delivery systems and heated tobacco products are noncombustible alternatives for adult smokers. Evidence suggests sufficient nicotine delivery and satisfying effects are necessary to facilitate switching away from smoking; nicotine delivery varies across electronic nicotine delivery systems within limited nicotine concentrations. OBJECTIVES: To assess the nicotine delivery and subjective effects of prototype JUUL2 System in two nicotine concentrations, currently-marketed US JUUL System ("JUUL"), IQOS-brand heated tobacco product, and combustible cigarettes. METHODS: Adult smokers (N = 40) completed a 5-arm cross-over product-use laboratory confinement study. Nicotine pharmacokinetics and subjective effects were assessed following use of: (1) JUUL2 prototype 18 mg/mL nicotine; (2) JUUL2 prototype 40 mg/mL; (3) JUUL 59 mg/mL; (4) IQOS 18 mg/g; and (5) usual brand combustible cigarette, each evaluated during ad libitum (10 min) and controlled (5 min, 10 standardized puffs) use. RESULTS: Nicotine delivery was greatest for combustible cigarettes, followed by JUUL2 prototype 40 mg/mL, IQOS, JUUL2 prototype 18 mg/mL, and JUUL 59 mg/mL. Nicotine delivery from JUUL2 prototype 18 mg/mL was significantly greater than JUUL 59 mg/mL after ad libitum use. JUUL products were significantly more satisfying and effective at reducing craving than IQOS. JUUL2 prototype 40 mg/mL was significantly more aversive than other JUUL products. CONCLUSIONS: Prototype JUUL2 and JUUL 59 mg/mL products were rated higher than IQOS on subjective measures associated with switching away from smoking. The JUUL2 prototype 40 mg/mL produced aversive responses and would require modifications to be a viable product for adult smokers. Nicotine delivery and subjective responses to JUUL2 prototype 18 mg/mL suggest a product based on this prototype may facilitate increased switching among adult smokers.

Differences in switching away from cigarettes and JUUL use characteristics among adult menthol and nonmenthol smokers who purchased the JUUL System.

OBJECTIVES: Studies have assessed switching away from cigarettes among adult smokers who use electronic nicotine delivery systems (ENDS), but there is little data assessing differences in likelihood of switching or ENDS use characteristics by menthol smoking. METHODS: Adult (age ≥ 21) established smokers who purchased a JUUL Starter Kit (N = 15,036) completed baseline and 1-, 2-, 3-, 6-, 9- and 12-month assessments. Switching (no past-30-day cigarette smoking) and flavor use were assessed at each follow-up. Repeated-measure logistic regression models evaluated association of menthol smoking and switching across 1 year. RESULTS: Across the 6 follow-ups, more menthol smokers primarily used Menthol/Mint-flavored JUULpods (53.8%) than nonmenthol smokers (22.9%). Only 6.4% of menthol smokers primarily used Tobacco flavors (vs. 25.9% of nonmenthol smokers). Across all follow-ups menthol smokers (41.2% of sample) were more likely to switch than nonmenthol smokers (42.6% vs. 38.8%: OR [95% CI] = 1.17 [1.11, 1.23]); this association remained significant after adjustment for sociodemographic, smoking and JUUL use covariates (aOR [95% CI] = 1.13 [1.05, 1.21]). Nonmenthol smokers, but not menthol smokers, were significantly more likely to switch when primarily using Menthol/Mint-flavored (vs. Tobacco-flavored) JUULpods (aOR [95% CI] = 1.14 [1.04, 1.25]). Differences in baseline smoking characteristics between menthol and nonmenthol smokers were small in magnitude. CONCLUSIONS: Adult menthol (vs. nonmenthol) smokers using JUUL were more likely to switch. More than twice as many menthol (vs. nonmenthol) smokers primarily used Menthol/Mint-flavor JUULpods; few menthol smokers used tobacco flavors. Given these pronounced differences in flavor preferences, availability of ENDS in menthol flavors may be particularly important for menthol smokers, but may also benefit some nonmenthol smokers.

Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom.

INTRODUCTION: Electronic nicotine delivery systems (ENDS) may improve public health if they facilitate smokers switching away from cigarettes. Conceptually, switching is facilitated when ENDS provide adequate nicotine delivery. Switching rates among smokers who purchased the JUUL System ("JUUL") were compared in the United Kingdom (UK), where regulations limit nicotine concentration to 20 mg/mL versus North America (N.Am.; United States and Canada), where higher concentrations are available. AIMS AND METHODS: Adult established smokers (age ≥21, smoked ≥100 cigarettes, smoking some days or every day at baseline) who newly purchased JUUL were recruited into a longitudinal study (UK: N = 1247; N.Am.: N = 8835). Complete switching (no smoking for ≥30 days) was assessed 1, 3, and 6 months after purchase; propensity score matching (PSM) and logistic regression compared switching after adjusting for baseline characteristics. RESULTS: In both N.Am. and UK, ≥82% of participants reported using the highest JUUL nicotine concentration available (UK: 18 mg/mL; N.Am.: 59 mg/mL). Unadjusted switching rates did not differ at 1 month (17%-18%); unadjusted and adjusted rates were significantly higher in N.Am. (vs. UK) at 3 and 6 months. In the PSM sample, after additional covariate adjustment, rates were significantly higher in N.Am. (vs. UK) at 3 months (31.5% vs. 22.7%; odds ratio [95% confidence interval, CI] = 1.59 [1.25, 2.02]) and 6 months (38.0% vs. 26.0%; odds ratio [95% CI] = 1.79 [1.37, 2.35]). CONCLUSIONS: These results suggest availability of ENDS in nicotine concentrations greater than 20 mg/mL may be associated with increased switching among adult smokers. Differences in smoking and ENDS use characteristics did not explain associations of location and switching; however, between-country differences may be affected by unmeasured factors. IMPLICATIONS: Switching rates were lower among smokers who purchased the JUUL System ("JUUL") in the UK, where regulations limit nicotine concentration to 20 mg/mL versus N.Am. (United States and Canada), where higher concentrations are available-before and after controlling for differences in smoking and ENDS use characteristics. These results suggest availability of ENDS in nicotine concentrations greater than 20 mg/mL may be associated with increased switching among adult smokers. Between-country differences may be affected by unmeasured factors; future research should consider these factors and the extent to which regulatory policy environments may explain differences in switching among adult smokers.

Introduction to the Special Issue on JUUL Use.

This special issue addresses key topics relating to the public health impact of the use of electronic nicotine delivery devices (ENDS), particularly JUUL-brand ENDS. Smokers smoke for nicotine, but are harmed by the byproducts of combustion. ENDS can play a role in tobacco harm reduction offering a noncombustible alternative source of nicotine for adult smokers who would otherwise continue smoking. Papers presented here estimate the prevalence of ENDS and JUUL use among young and older adults, and document the 12-month smoking trajectories of adults who purchased a JUUL Starter Kit. Overall, smoking prevalence was halved, with most smokers switching completely as dual use declined. This held for subpopulations defined by demographics and psychiatric comorbidity. For those who did not switch, most significantly reduced (50%+) their cigarette consumption. Another study reports that dependence declines as smokers switch from smoking to using JUUL. The public health potential of ENDS is undermined by use of ENDS by nonsmokers, especially underage individuals. Some smoking was reported by adult former and never smokers, with little evidence of persistent smoking, and lower risk of smoking among those using JUUL more frequently. Regarding underage use, one paper reports that technology can ensure age-verification at point of sale. Population modeling integrating impacts on diverse populations indicates that availability of ENDS is expected to avert millions of premature deaths in the US. We believe these papers make a substantial contribution to the field of tobacco science and smoking control.

The Adult JUUL Switching and Smoking Trajectories (ADJUSST) Study: Methods and Analysis of Loss-to-Follow-up.

Objectives: The Adult JUUL System User Switching and Smoking Trajectories (ADJUSST) study assessed the smoking and JUUL use trajectories of adults who purchased JUUL. In this paper, we describe study methods, characterize the sample, and assesses potential for bias due to loss to follow-up. Methods: We entered 55,414 US adults (≥ age 21) who purchased a JUUL Starter Kit for the first time (online or at retail) in 2018 into a naturalistic, longitudinal observational study, irrespective of baseline smoking status. Participants were invited for follow-ups 1, 2, 3, 6, 9, and 12 months later, focused on assessing past-30-day smoking and JUUL use. Analyses assessed potential bias due to non-response. Results: Over 90% of participants had a history of smoking; 62.8% were past-30-day smokers; 23.3% were former smokers. Participants' average age was 30; 75% were white. Most participants (77.6%) completed some follow-ups; 25% completed all follow-ups. Baseline differences among complete responders (N = 13,729), partial responders (N = 29,252), and complete non-responders (N = 12,433) were small. When recontacted, few 12-month non-responders said their non-response was due to smoking; many reported no past-30-day smoking. Conclusions: The study may elucidate smoking trajectories of adult JUUL users. The potential for bias due to loss to follow-up in ADJUSST was limited.

Dual Use of Cigarettes and JUUL: Trajectory and Cigarette Consumption.

Objectives: Many smokers who start using ENDS engage in dual use of cigarettes and ENDS. This paper examines time trends in dual use after a JUUL Starter Kit purchase, and changes in cigarette consumption among those remaining dual users. Methods: In the ADJUSST study, a cohort of adult smokers who purchased a JUUL Starter Kit were followed naturalistically 6 times over 12 months. Trends in dual use and reported complete switching away from cigarettes (ie, no past 30-day smoking), and changes in daily average cigarettes per day from baseline at 6 and 12 months were examined. Results: Dual use declined over time as complete switching increased. By 12 months, 43.2% reported dual using, and 51.2% reported switching away from cigarettes. Among dual users, approximately 60% reduced their cigarette consumption substantially (by ≥ 50%); average reductions in cigarette consumption were > 80%. Only a small minority (3%-10%) substantially increased cigarette consumption. Conclusions: Dual use of smoking and JUUL declines over time as switching away from smoking increases. This suggests that, for most smokers, dual use is a transitional state leading to switching completely away from cigarettes. Furthermore, dual use is often marked by substantial reductions in cigarette consumption.

Switching away from Cigarettes across 12 Months among Adult Smokers Purchasing the JUUL System.

Objectives: In this study, we assessed complete switching away from cigarette smoking among adult smokers who purchased a JUUL Starter Kit (JSK). Methods: Adult (age ≥ 21) established smokers (smoked ≥ 100 lifetime cigarettes) who purchased a JSK in 2018 were invited to complete online surveys 1, 2, 3, 6, 9 and 12 months after initial JSK purchase. Point prevalence of switching (no past 30-day smoking) was assessed at each follow-up. Repeated measures logistic regression models evaluated associations of sociodemographic factors, baseline smoking characteristics and time-varying JUUL System ("JUUL") use characteristics and switching across the 12-month period. Results: Respondents (N = 17,986) were 55.0% male, 78.3% white, mean age = 32.65 years (SD = 10.81), mean baseline cigarettes/day = 11.10 (SD = 8.16). The proportion self-reporting switching increased over time: one-month (27.2%[3718/13,650]), 2-month (36.4%[4926/13,533]), 3-month (41.0%[5434/13,257]), 6-month (46.6%[5411/11,621]), 9-month (49.4%[6017/12,186]), and 12-month (51.2%[6106/11,919]); 33.1% reported switching at both 9-month and 12-month follow-ups. In prospective analyses, smokers with lower cigarette dependence, shorter smoking history, lower cigarette consumption, more frequent JUUL use, greater satisfaction from initial JUUL use, and higher JUUL dependence were significantly more likely to switch. Conclusions: Rates of switching with JUUL increased over time. Over 50% of respondents reported complete switching away from cigarettes 12 months following purchase. Greater use of and dependence on JUUL predicted switching.

Cigarette Smoking Trajectories in Adult Former Smokers Using the JUUL System.

Objective: In this study, we assessed cigarette smoking over 12 months among adult former smokers who newly purchased a JUUL Starter Kit (JSK). Methods: Prevalence of past 30-day smoking and factors associated with smoking were assessed among adult (age ≥ 21) former established smokers, stratified as recent (quitting ≤ 12 months) and long-term quitters (> 12 months), who purchased a JSK and completed ≥ 1 of 6 follow-up assessments (N = 4786). Results: Recent quitters had higher rates (16.6%-19.9%) of past 30-day smoking than long-term quitters (6.4%-9.2%) across the 12-month period; smoking prevalence did not significantly increase over time in either subgroup. Few participants (6.5% of recent quitters, 2.8% of long-term quitters) reported smoking at both 9 and 12 months, a pattern that might indicate persistent smoking. Past 30-day JUUL use remained high (≥ 87%) across the 12 months. Participants who used JUUL more frequently were less likely to smoke. Conclusions: Among former smokers who purchased JUUL, prevalence rates of smoking were low and stable across the 12-month period, suggesting there was not a growing cohort of former smokers resuming smoking. Smoking was more common in recent quitters than long-term quitters. Greater use of JUUL was associated with reduced odds of smoking resumption.

Changes in Dependence as Smokers Switch from Cigarettes to JUUL in Two Nicotine Concentrations.

Objectives: In this study, we assessed changes in dependence as smokers transitioned from cigarette smoking to exclusive use of the JUUL System ("JUUL"), contrasting users of 5.0% versus 3.0% nicotine concentration pods. Methods: Overall, 5246 adult (age ≥ 21) established smokers (> 100 cigarettes lifetime) who purchased a JUUL device completed online surveys at baseline, when smoking, and one and 3 months later; 1758 reported no past-30-day smoking ('switching') at one or both timepoints. Analyses compared dependence on cigarettes (at baseline) and JUUL (at follow-up), as assessed by the 4-item PROMIS scale (Range: 0-4). Results: Switching increased from Month 1 (18.3%) to Month 3 (28.6%); switchers at one month (Difference = 0.23) and 3 months (0.24) showed lower mean baseline cigarette dependence. Dependence decreased significantly (ps < .001) from baseline cigarette dependence to JUUL dependence at both one (from 1.82 to 1.59) and 3 months (1.97 to 1.73); changes did not significantly differ between users of 5.0% and 3.0% (ps > .43). Dependence on JUUL did not change significantly from Month 1 to Month 3. Conclusions: Dependence decreased as smokers transitioned from smoking to exclusive use of JUUL, similarly for users of both nicotine concentrations. Smokers who switch to JUUL may reduce their nicotine dependence.

Abuse liability assessment of the JUUL system in four flavors relative to combustible cigarette, nicotine gum and a comparator electronic nicotine delivery system among adult smokers.

BACKGROUND: The abuse liability of the JUUL System (JS) in four flavors were evaluated compared to combustible cigarettes, nicotine gum, and a comparator electronic nicotine delivery system (ENDS) with pharmacokinetics (PK) and subjective effects. METHODS: Adult smokers (N = 66; 50.0 % female; mean age = 41.1; 63.6 % white) completed a 7-arm within-subjects cross-over product-use study while confined to a clinical laboratory. Participants used JS in four flavors (Virginia Tobacco, Mango, Mint, Creme, [5.0 % nicotine; 59 mg/mL]), their usual brand (UB) cigarette, a comparator ENDS (VUSE Solo; 4.8 % nicotine, tobacco-flavor), and mint nicotine gum (4 mg) under controlled use conditions. After each product use, nicotine PK and subjective effects were assessed. RESULTS: Maximum plasma nicotine levels (Cmax-BL), rate of plasma nicotine rise, overall nicotine exposure (AUC0-60-BL), and subjective liking and satisfaction of JS were significantly lower than UB cigarettes. These parameters were generally greater for JS than nicotine gum; the comparator ENDS was somewhat lower but within the range of JS. Nicotine PK did not differ among the Mint, Mango, and Virginia Tobacco JS flavors. Mint and Mango were rated as more satisfying than Virginia Tobacco and Creme. CONCLUSIONS: Controlled use of JS among adult smokers resulted in nicotine delivery, product liking, and satisfaction that were less than that of combustible cigarettes but generally greater than nicotine gum. These results support the conclusion that JS has lower abuse liability than combustible cigarettes, higher abuse liability than nicotine gum, and may provide sufficient nicotine delivery and satisfying effects to support substitution for combustible cigarettes among adult smokers.

Abuse liability assessment of the JUUL system in two nicotine concentrations compared to combustible cigarette, nicotine gum and comparator electronic nicotine delivery system.

BACKGROUND: To assess the abuse liability of the JUUL System (JS) in 5.0 % (59 mg/mL) and 3.0 % (35 mg/mL) nicotine concentrations. METHODS: Adult smokers (N = 146; 45.9 % female; mean age = 41.29 years) were randomized to one of four study flavor arms and then to a within-subjects cross-over sequence for five test product categories: (1) JS 5.0 % nicotine concentration; (2) JS 3.0 % nicotine; (3) usual brand (UB) cigarette; (4) 4 mg mint nicotine gum; (5) comparator ENDS (VUSE Alto 5.0 % nicotine). Products were tested by ad libitum use (5 min for ENDS and cigarette; 30 min for gum); nicotine pharmacokinetic (PK) parameters and subjective effects were assessed following use. RESULTS: Maximum plasma nicotine concentration (Cmax-BL), rate of plasma nicotine rise and total nicotine exposure (AUC0-60-BL) of UB cigarette were significantly greater than all other test products. The comparator ENDS was significantly greater than 5.0 % and 3.0 % JS and nicotine gum on Cmax-BL, rate of plasma nicotine rise, and AUC0-60-BL; Cmax-BL of JS 5.0 % was significantly greater than JS 3.0 % and nicotine gum. Product liking and satisfying effects were significantly highest for the UB cigarette; JS products and comparator ENDS did not significantly differ and were rated higher than nicotine gum on most subjective measures. CONCLUSIONS: These results suggest that the abuse liability of both 5.0 % and 3.0 % JS is: (1) substantially lower than UB cigarette; (2) somewhat lower than comparator ENDS; and (3) higher than nicotine gum. Additionally, the abuse liability of JS 5.0 % is somewhat higher than JS 3.0 %.

A content analysis of smartphone apps for adolescent smoking cessation.

Adolescent cigarette smokers have an increased risk of sustained smoking into adulthood. Smartphone applications (apps) for smoking cessation are a promising treatment resource. However, research on apps for adolescent smoking cessation is limited. This study compared smoking cessation mobile apps targeting an adolescent audience with popular cessation apps for a general audience. Adolescent and general-audience apps were identified by searching the Google Play and Apple App Stores (November 2016). Two coders assessed each app for adherence to clinical practice guidelines for tobacco and adolescent-specific content (2016-2017) and developed a summary score that summed all adherence and adolescent content criteria. Eight adolescent apps were identified and compared with the top 38 general apps (as ranked by Apple and Google). Both general and adolescent apps commonly had adherence content related to developing a quit plan (general: 73.68 per cent; adolescent: 87.50 per cent) and enhancing motivation by describing the rewards of not smoking (general: 76.32 per cent; adolescent: 62.50 per cent). Adolescent-specific content such as peer influence on smoking was common in adolescent apps but not in general apps (general: 5.26 per cent; adolescent: 62.50 per cent). Adolescent apps had a higher general adherence content summary score [t (44) = 2.55, p = .01] and a higher adolescent content summary score [t (7.81) = 2.47, p = .04] than the general apps. On average, adolescent cessation apps included more adherence content and adolescent-specific content than general apps. Future research is needed to determine the extent to which adolescents engage with the adherence content available in these apps.

Associations Between Engagement and Outcomes in the SmokefreeTXT Program: A Growth Mixture Modeling Analysis.

INTRODUCTION: Smoking continues to be a leading cause of preventable death. Mobile health (mHealth) can extend the reach of smoking cessation programs; however, user dropout, especially in real-world implementations of these programs, limit their potential effectiveness. Research is needed to understand patterns of engagement in mHealth cessation programs. METHODS: SmokefreeTXT (SFTXT) is the National Cancer Institute's 6-8 week smoking cessation text-messaging intervention. Latent growth mixture modeling was used to identify unique classes of engagement among SFTXT users using real-world program data from 7090 SFTXT users. Survival analysis was conducted to model program dropout over time by class, and multilevel modeling was used to explore differences in abstinence over time. RESULTS: We identified four unique patterns of engagement groups. The largest percentage of users (61.6%) were in the low-engagers declining group; these users started off with low level of engagement and their engagement decreased over time. Users in this group were more likely to drop out from the program and less likely to be abstinent than users in the other groups. Users in the high engagers-maintaining group (ie, the smallest but most engaged group) were less likely to be daily smokers at baseline and were slightly older than those in the other groups. They were most likely to complete the program and report being abstinent. CONCLUSIONS: Our findings show the importance of maintaining active engagement in text-based cessation programs. Future research is needed to elucidate predictors of the various levels of engagement, and to assess whether strategies aimed at increasing engagement result in higher abstinence rates. IMPLICATIONS: The current study enabled us to investigate differing engagement patterns in non-incentivized program participants, which can help inform program modifications in real-world settings. Lack of engagement and dropout continue to impede the potential effectiveness of mHealth interventions, and understanding patterns and predictors of engagement can enhance the impact of these programs.

Level of Alcohol Consumption and Successful Smoking Cessation.

INTRODUCTION: The negative association between heavy alcohol use and likelihood of successful smoking cessation is well established. However, evidence on the effects of moderate alcohol consumption on smoking cessation is sparse. This analysis evaluated the association between alcohol use and smoking and the interaction of alcohol use and use of pharmacotherapy interventions in relation to smoking cessation. METHODS: Data from adults (n = 923) recruited through a smoking cessation website between November 2011 and March 2012 were analyzed. Data on past-year alcohol use, tobacco use, and demographics were collected at baseline. Self-reported smoking abstinence and current alcohol use data were collected at 1 and 7 months posttreatment. Chi-square and multivariate logistic regression analyses were conducted. RESULTS: At 1 month, adjusted odds of continued smoking were 1.54 times greater (95% confidence interval [CI] = 1.05% to 2.23%) for moderate drinkers and 2.59 times greater (95% CI = 1.33% to 4.28%) for heavy drinkers than nondrinkers. At 7 months, adjusted odds of continued smoking were not greater for moderate drinkers than nondrinkers, and were 2.32 times greater (95% CI = 1.35% to 3.96%) among heavy alcohol drinkers than nondrinkers. At 1 month, adjusted odds of smoking cessation were 2.33 times greater (95% CI = 1.04% to 3.09%) for alcohol users assigned to nicotine replacement therapy than for those not assigned to nicotine replacement therapy. This relationship was not observed at 7 months. CONCLUSIONS: Moderate and heavy drinking might impact smoking cessation efforts. Recent moderate drinking may be associated with short-term continued smoking and heavy drinking associated with relapse in the short and long term. IMPLICATIONS: This study suggests that moderate drinking may influence the process to quit smoking. Further study is needed to better understand the implications of moderate drinking for smoking cessation. Providing information alone may not be effective in helping people abstain from drinking during smoking cessation, especially if moderate drinkers do not perceive their behavior as reducing their chance for a successful quit attempt. Tailoring smoking cessation interventions to include strategies to reduce moderate-to-heavy alcohol consumption may improve smoking cessation outcomes among alcohol users attempting to quit smoking.

Lifetime Depression, Other Mental Illness, and Smoking Cessation.

Objectives In this study, we attempt to elucidate the relationship between lifetime mental illness (LMI), particularly a depression diagnosis, and smoking cessation. Methods Data were drawn from a previous study and include LMI, demographics, mood, and smoking cessation outcomes. We evaluated the relationship between multiple LMIs and smoking cessation at 7 months post-intervention, and depression in combination with another LMI. Results At 7 months, the adjusted odds of cessation for those with one LMI, including depression, were 0.74 (p = .102), and for those with 2+ LMIs, 0.69 (p = .037), both in comparison with participants who reported no history of LMI. Among those with 2+ LMIs, the adjusted odds of cessation for those with a depression diagnosis were 0.34 (p = .007) compared to those whose multiple LMIs did not include depression. Conclusions Among smokers seeking cessation treatment, those who had 2+ LMIs were at greater risk of relapse, an effect particularly marked in smokers with depression. This study adds to the literature examining the potential impact of LMI on smokers' ability to quit by considering the potential impact of 2+ LMIs and highlights the potential impact of depression as a risk factor for continued smoking.

The Impact of Weight and Weight-Related Perceptions on Smoking Status Among Young Adults in a Text-Messaging Cessation Program.

Introduction: Weight gain and concerns about weight can influence a smoker's ability to successfully quit, and young adults are a subgroup of smokers who are particularly concerned about the impact of quitting on their body weight. This study explored the associations between body mass index, weight perceptions, and smoking status among young adults. Methods: The sample consisted of 4027 young adults between the ages of 18 and 29 who participated in a randomized control trial of the National Cancer Institute's SmokefreeTXT program. Multivariable logistic regression models were used to examine the associations between weight related variables and smoking status. Results: Obese participants had a 0.72 lower odds (95% CI: 0.62, 0.85) of reporting smoking at the end of the program than participants of normal weight, and this difference persisted over time. Weight perceptions were also associated with smoking status. Those who perceived themselves to be slightly underweight/underweight were more likely to report smoking than those who reported being just about the right weight (OR: 1.53, 95% CI: 1.20, 1.95), and those who strongly disagreed that smoking cigarettes helps people keep their weight down were less likely to report smoking at the end of treatment than those who neither agreed nor disagreed with this statement (OR: 0.69, 95% CI: 0.54, 0.87). Conclusions: Weight related factors assessed at baseline predicted smoking status at the end of treatment and through long term follow-up. Smoking cessation programs that tailor content to addresses the specific needs of weight concerned smokers may enhance effectiveness. Implications: This study explores the association between weight related factors and smoking status among young adults, a priority population for smoking cessation efforts. This study demonstrates that both actual weight and weight perceptions (eg, perception of body weight, perception of associations between smoking and weight) are associated with smoking outcomes, and thus need to be a considered in the development of smoking cessation programs.

Using a Media Campaign to Increase Engagement With a Mobile-Based Youth Smoking Cessation Program.

PURPOSE: To describe the impact of the National Cancer Institute's promotion of its youth smoking cessation program, Smokefree Teen (SFT). DESIGN: We provide a description of campaign strategies and outcomes as a means to engage a teen audience in cessation resources using a cost-effective approach. SETTING: The campaign occurred nationally, using traditional (TV and radio), online, and social media outreach. PARTICIPANTS: Ads targeted adolescent smokers (aged 14-17). The baseline population was 42 586 and increased to 464 357 during the campaign. MEASURES: Metrics used to assess outcomes include (1) visits to SFT website from traditional and online ads, (2) cost to get an online ad clicked (cost-per-click), and (3) SmokefreeTXT program enrollments during the 8-week campaign period. ANALYSIS: We conducted a quantitative performance review of all tactics. RESULTS: The SFT campaign achieved an online ad click-through rate of 0.33%, exceeding industry averages of 0.15%. Overall, web traffic to teen.smokefree.gov increased by 980%, and the online cost-per-click for ads, including social media actions, was approximately $1 as compared with $107 for traditional ads. Additionally, the campaign increased the SmokefreeTXT program teen sign-ups by 1334%. CONCLUSION: The campaign increased engagement with evidence-informed cessation resources for teen smokers. Results show the potential of using multiple, online channels to help increase engagement with core resources.

Analysing user-reported data for enhancement of SmokefreeTXT: a national text message smoking cessation intervention.

OBJECTIVE: This observational study highlights key insights related to participant engagement and cessation among adults who voluntarily subscribed to the nationwide US-based SmokefreeTXT program, a 42-day mobile phone text message smoking cessation program. METHODS: Point prevalence abstinence rates were calculated for subscribers who initiated treatment in the program (n=18 080). The primary outcomes for this study were treatment completion and point prevalence abstinence rate at the end of the 42-day treatment. Secondary outcomes were point prevalence abstinence rates at 7 days postquit, 3 months post-treatment and 6 months post-treatment, as well as response rates to point prevalence abstinence assessments. RESULTS: Over half the sample completed the 42-day treatment (n=9686). The end-of-treatment point prevalence abstinence for subscribers who initiated treatment was 7.2%. Among those who completed the entire 42 days of treatment, the end-of-treatment point prevalence abstinence was 12.9%. For subscribers who completed treatment, point prevalence abstinence results varied: 7 days postquit (23.7%), 3 months post-treatment (7.3%) and 6 months post-treatment (3.7%). Response rates for abstinence assessment messages ranged from 4.36% to 34.48%. CONCLUSIONS: Findings from this study illuminate the need to more deeply understand reasons for subscriber non-response and opt out and, in turn, improve program engagement and our ability to increase the likelihood for participants to stop smoking and measure long-term outcomes. Patterns of opt out for the program mirror the relapse curve generally observed for smoking cessation, thus highlighting time points at which to increase efforts to retain participants and provide additional support or incentives.

Text to Quit China: An mHealth Smoking Cessation Trial.

PURPOSE: To assess the feasibility, acceptability, and efficacy of a text message-based smoking cessation intervention in China. DESIGN: Study design was a randomized control trial with a 6-month follow-up assessment of smoking status. SETTING: Zhejiang, Heilongjiang, and Shaanxi provinces in China provided the study setting. SUBJECTS: A total of 8000 adult smokers in China who used Nokia Life Tools and participated in phase 2 (smoking education via text message) of the study were included. INTERVENTION: The high-frequency text contact (HFTC) group received one to three messages daily containing smoking cessation advice, encouragement, and health education information. The low-frequency text contact (LFTC) group received one weekly message with smoking health effects information. MEASURES: Our primary outcome was smoking status at 0, 1, 3, and 6 months after intervention. Secondary outcomes include participant perceptions of the HFTC intervention, and factors associated with smoking cessation among HFTC participants. ANALYSIS: Descriptive and χ2 analyses were conducted to assess smoking status and acceptability. Factors associated with quitting were assessed using multiple logistic regression analyses. RESULTS: Quit rates were high in both the HFTC and LFTC groups (HFTC: 0 month, 27.9%; 1 month, 30.5%; 3 months, 26.7%; and 6 months, 27.7%; LFTC: 0 month, 26.7%; 1 month, 30.4%; 3 months, 28.1%; and 6 months, 27.7%), with no significant difference between the two groups in an intent-to-treat analysis. Attitudes toward the HFTC intervention were largely positive. CONCLUSION: Our findings suggest that a text message-based smoking cessation intervention can be successfully delivered in China and is acceptable to Chinese smokers, but further research is needed to assess the potential impact of this type of intervention.