Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure.

BACKGROUND: Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies. METHODS: This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants. RESULTS: Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions. CONCLUSIONS: This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.

Development and validation of a new instrument to measure perceived risks associated with the use of tobacco and nicotine-containing products.

BACKGROUND: Making tobacco products associated with lower risks available to smokers who would otherwise continue smoking is recognized as an important strategy towards addressing smoking-related harm. Predicting use behavior is an important major component of product risk assessment. In this context, risk perception is a possible factor driving tobacco product uptake and use. As prior to market launch real-world actual product use cannot be observed, assessing risk perception can provide predictive information. Considering the lack of suitable validated self-report instruments, the development of a new instrument was undertaken to quantify perceived risks of tobacco and nicotine-containing products by adult smokers, former smokers and never-smokers. METHODS: Initial items were constructed based on a literature review, focus groups and expert opinion. Data for scale formation and assessment were obtained through two successive US-based web surveys (n = 2020 and 1640 completers, respectively). Psychometric evaluation was based on Rasch Measurement Theory and Classical Test Theory. RESULTS: Psychometric evaluation supported the formation of an 18-item Perceived Health Risk scale and a 7-item Perceived Addiction Risk scale: item response option thresholds were ordered correctly for all items; item locations in each scale were spread out (coverage range 75-87%); scale reliability was supported by high person separation indices > 0.93, Cronbach's alpha > 0.98 and Corrected Item-Total Correlations > 0.88; and no differential item functioning was present. Construct validity evaluations met expectations through inter-scale correlations and findings from known-group comparisons. CONCLUSIONS: The Perceived Risk Instrument is a psychometrically robust instrument applicable for general and personal risk perception measurement, for use in different types of products (including cigarettes, nicotine replacement therapy, potential Modified Risk Tobacco Products), and for different smoking status groups (i.e., current smokers with and without intention to quit, former smokers, never smokers).

Development and initial validation of a new self-report measure to assess perceived dependence on tobacco and nicotine products.

How nicotine is administered has evolved from cigarettes to various delivery systems. Assessing perceived dependence on nicotine-containing products now requires accounting for product specificity while allowing comparisons across products and users. This study aims to develop a new self-report measure to assess perceived dependence on tobacco and nicotine products (TNPs) among exclusive and poly-TNP users. A draft version of the new measure, the ABOUT-Dependence, was constructed based on literature review, qualitative research, and expert opinion. Data for scale formation and psychometric assessment was obtained through a US-based web survey (n = 2334) that included additional dependence measures for convergent validity assessment. Qualitative research confirmed a preliminary conceptual framework with seven sub-concepts. Following a cognitive debriefing, 19 items were considered to best represent the different sub-concepts. Psychometric findings supported a three-domain structure [i.e., behavioral impact (five items), signs and symptoms (five items), and extent/timing of use (two items)] and an overall total composite score. The data confirmed convergent and known-group validity, as well as test-retest reliability. The ABOUT-Dependence is a 12-item, psychometrically sound, self-report measure that may be used as a tool for research and further understanding of perceived dependence across the spectrum of TNP and TNP users.

How to map the affective semantic space of scents.

The investigation of the semantic space associated with subjective affective experiences or feelings linked to odour perception has recently emerged. Because of the specificity of the emotional effects of odours, the terms derived from traditional models of emotion are unlikely to optimally account for odour-associated feelings. In this study, sets of terms derived from two traditional models, basic emotions and valence by arousal by dominance dimensional emotions, were compared with a recently elaborated olfaction-specific set of terms (Geneva Emotion and Odour Scale; GEOS). Three main criteria were considered: (1) the feeling's intensity reported in response to odours; (2) the inter-rater agreement concerning the reported feelings; and (3) the power to discriminate feelings evoked by various odorous substances. The evidence strongly suggested that the set of terms proposed by GEOS outperformed the terms derived from the two classical models in measuring the subjective affective experience elicited by odours. These results are interpreted with respect to a good correspondence between the functions of olfaction and the meaning conveyed by GEOS terms.

Mapping the semantic space for the subjective experience of emotional responses to odors.

Two studies were conducted to examine the nature of the verbal labels that describe emotional effects elicited by odors. In Study 1, a list of terms selected for their relevance to describe affective feelings induced by odors was assessed while participants were exposed to a set of odorant samples. The data were submitted to a series of exploratory factor analyses to 1) reduce the set of variables to a smaller set of summary scales and 2) get a preliminary sense of the differentiation of affective feelings elicited by odors. The goal of Study 2 was to replicate the findings of Study 1 with a larger sample of odorant samples and participants and to validate the preliminary model obtained in Study 1 by using confirmatory factor analysis. Overall, the findings point to a structure of affective responses to odors that differs from the classical taxonomies of emotion such as posited by discrete or bidimensional emotion theories. These findings suggest that the subjective affective experiences or feelings induced by odors are structured around a small group of dimensions that reflect the role of olfaction in well-being, social interaction, danger prevention, arousal or relaxation sensations, and conscious recollection of emotional memories.

Sequential unfolding of novelty and pleasantness appraisals of odors: evidence from facial electromyography and autonomic reactions.

We investigated the effects of odors on appraisal processes and consequent emotional responses. The main goal was to test whether an odor is detected as novel or familiar before it is evaluated as pleasant or unpleasant. Participants performed a recognition task in which they were presented with pairs of unpleasant or pleasant odors (sample and target odors). Within a pair, the sample and target were either identical or different to assess participants' novelty detection; unpleasant and pleasant target odors were contrasted to examine participants' appraisal of intrinsic pleasantness. We measured facial expressions using electromyography and physiological reactions using electrocardiogram and electrodermal activity in response to odors. The earliest effects on facial muscles and heart rate occurred in response to novelty detection. Later effects on facial muscles and heart rate were related to pleasantness evaluation. This study is the first to demonstrate the existence of a sequence of appraisal checks for odors eliciting emotional reaction.

Potential predictors of adoption of the Tobacco Heating System by U.S. adult smokers: An actual use study.

Background: This was a pre-market, observational, actual use study with the Tobacco Heating System (THS), a candidate modified risk tobacco product. The main goal of the study was to describe THS adoption within current adult daily smokers by replicating the usage of THS in real-world conditions with participants being able to consume cigarettes, THS, and any other nicotine-containing products (e.g., e-cigarettes, cigars, etc.) ad libitum. Methods: This study assessed self-reported stick-by-stick consumption of THS compared with the use of commercial cigarettes over six weeks. The aim of the analysis was to identify potential predictors for adoption of THS using stepwise logistic regression analysis. Results: By the end of the observational period (in Week 6), 14.6% of participants (n=965) had adopted THS meaning that THS formed 70% or more of their total tobacco consumption. The main predictors of adoption were the liking of the smell, taste, aftertaste, and ease of use of THS. The proportion of adoption was higher in participants aged 44 years and older and in Hispanic or Latino adult smokers. Additionally, adoption of THS was more likely in participants who had never attempted to quit smoking and in participants who smoked up to 10 cigarettes per day. Finally, the adoption of THS was higher in participants who consumed both regular and menthol THS compared with those who consumed only one THS variant. Conclusions: The findings suggest that the introduction of THS in the U.S. has the potential to result in adoption by current adult smokers who would otherwise continue to smoke cigarettes, and that the adoption of THS is unlikely to result in an increase of tobacco consumption. Post-marketing studies will provide further insights on THS adoption and THS use patterns to allow assessment of the impact of the THS at the individual and the overall population level.

Emotional processing of odors: evidence for a nonlinear relation between pleasantness and familiarity evaluations.

Pleasantness, familiarity, and intensity are 3 interdependent dimensions commonly used to describe the perceived qualities of an odor. In particular, many empirical studies have demonstrated a positive correlation between familiarity and pleasantness. However, on the basis of both theoretical and methodological perspectives, we questioned the validity of such a relation for malodors. We report 2 studies based on subjective judgments of a large sample of odorants (Experiment 1) associated with autonomic recordings (Experiment 2). Multivariate exploratory analysis performed on the data splits the whole odorant set into 2 subsets composed, respectively, of unpleasant and pleasant odorants. Subsequent correlation analyses have shown that the relation between pleasantness and familiarity is specific for the pleasant odors in the 2 experiments. Moreover, autonomic activity was more important in response to malodors than to pleasant odors and was significantly correlated with unpleasantness ratings in the subset of unpleasant odors. These 2 studies argue in favor of a functional dissociation in the relations between both subjective and autonomic responses to odors as a function of pleasantness and indicate that researchers in the olfactory domain should consider the relations between pleasantness and familiarity as more complex than linear.

Developing fit-for-purpose self-report instruments for assessing consumer responses to tobacco and nicotine products: the ABOUT™ Toolbox initiative.

Background. Determining the public health impact of tobacco harm reduction strategies requires the assessment of consumer perception and behavior associated with tobacco and nicotine products (TNPs) with different exposure and risk profiles. In this context, rigorous methods to develop and validate psychometrically sound self-report instruments to measure consumers' responses to TNPs are needed. Methods. Consistent with best practice guidelines, including the U.S. Food and Drug Administration's "Guidance for Industry Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims," scientifically designed, fit-for-purpose, reliable, and valid instruments are now being applied to tobacco regulatory research. Results. This brief report presents the ABOUT™ Toolbox ( Assessment of Behavioral OUtcomes related to Tobacco and nicotine products) initiative. This communication: (1) describes the methodological steps followed for the development and validation of the measurement instruments included in the ABOUT™ Toolbox, (2) presents a summary of the high-priority tobacco-related domains that are currently covered in the ABOUT™ Toolbox (i.e., risk perception, dependence, product experience, health and functioning, and use history), and (3) details how the measurement instruments are made accessible to the scientific community. Conclusions. By making the ABOUT™ Toolbox available to the tobacco research and public health community, we envision a rapidly expanding knowledge base, with the goals of (1) supporting consumer perception and behavior research to allow comparisons across a wide spectrum of TNPs, (2) enabling public health and regulatory communities to make better-informed decisions for future regulation of TNPs, and (3) enhancing surveillance activities associated with the impact of TNPs on population health.

Graded structure in odour categories: a cross-cultural case study.

The existence of graded structure in fruit and flower odour categories and its stability in different cultures is examined. Groups of students from France, the United States, and Vietnam performed a typicality rating task, a similarity judgment task, a membership verification task, a recognition memory task, a familiarity rating task, and a free identification task using a set of 40 odorants (20 fruit odorants and 20 flower odorants). Overall, our results demonstrate that fruit and flower odour categories possess graded structure. Moreover, principal component analyses of the data revealed the implication of typicality in a variety of cognitive tasks where typical odours receive a preferential processing compared to atypical ones. Finally, our results suggest that typicality can be predicted to a certain extent by experiential knowledge but that other determinants play a role in odour category structure. Altogether, this study confirms that graded structure is a universal property of categories and suggests that universals and cultural specifics can both constrain the emergence of odour category structures.