Society for Research on Nicotine and Tobacco as an Outgrowth of the 1988 Surgeon General's Report on Nicotine Addiction: Reflections of the Early Presidents.

INTRODUCTION: The Society for Research on Nicotine and Tobacco began in the United States as a scientific organization "to stimulate the generation and dissemination of new knowledge concerning nicotine and tobacco in all its manifestations." Now in its 30th year, the Society is taking on new challenges in tobacco control, nicotine vaping, product regulation, and public policy. AIMS AND METHODS: This Review describes the formative years of the Society from the perspective of researchers who were in leadership positions during that time, documenting how biobehavioral and clinical research in the first 10 years was a continuation of the scientific mission of the 1988 United States Surgeon General's Report on Nicotine Addiction and summarizing organizational innovations during each president's term of office. CONCLUSIONS: The Society's promotion of scientific research served as a catalyst for funding, policy, and regulation, setting the stage for its influence and credibility. IMPLICATIONS: This Commentary provides context and an overview of the scientific research and the organizational innovations that occurred during the early years of the Society for Research on Nicotine and Tobacco using publications and available documentation. The Society was able to thrive because biobehavioral research on nicotine addiction provided the scientific underpinnings for the tobacco control enterprise as a whole. The objective of this Commentary is to describe formative events in the Society's history based on the accomplishments of its early leaders.

Balancing Consideration of the Risks and Benefits of E-Cigarettes.

The topic of e-cigarettes is controversial. Opponents focus on e-cigarettes' risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public-including most smokers-now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers' use of e-cigarettes in quit attempts. Because evidence indicates that e-cigarette use can increase the odds of quitting smoking, many scientists, including this essay's authors, encourage the health community, media, and policymakers to more carefully weigh vaping's potential to reduce adult smoking-attributable mortality. We review the health risks of e-cigarette use, the likelihood that vaping increases smoking cessation, concerns about youth vaping, and the need to balance valid concerns about risks to youths with the potential benefits of increasing adult smoking cessation.

Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial.

BACKGROUND: Rates of smoking among those with serious mental illness (SMI) are two to three times higher than for the general population. Smoking is rarely addressed in mental health settings. Innovative outreach and treatment strategies are needed to address these disparities. The current study is a pilot study of the feasibility and acceptability of a chronic care model of tobacco cessation treatment implemented in outpatient psychiatry clinics. METHODS: Participants were recruited from two outpatient psychiatric clinics and randomly assigned to intervention (counseling and nicotine replacement for 8 weeks, plus ongoing proactive outreach calls inviting reengagement in treatment) or control (brief education and referral to the state quit line). Assessments were conducted at 8 weeks (end of initial treatment block) and 6 months (end of window for retreatment). Feasibility was assessed by enrollment rate, treatment engagement, and completion of follow-up assessments. Acceptability was assessed both quantitatively and qualitatively. Preliminary efficacy was assessed by 7-day and 30-day abstinence rates, rate of quit attempts, and cigarettes per day. Psychological health was measured to assess for changes related to treatment group or attempts to quit smoking. RESULTS: Nineteen participants were randomized to intervention and 19 to control. Recruitment proved feasible, and high rates of treatment engagement (mean of 4.5 sessions completed in initial treatment block, 89.5% uptake of nicotine replacement) and retention (94.7% of follow-up assessments completed) were observed. Treatment acceptability was high. As anticipated, there were no significant differences in abstinence between groups, but results generally favored the intervention group, including bio-verified 7-day abstinence rates of 21.1% in intervention vs. 17.6% in control and self-reported 30-day abstinence rates of 16.1% in intervention vs. 5.1% in control at 8 weeks. Significantly more intervention participants made at least one quit attempt (94.7% vs 52.6%; OR = 16.20, 95% CI: 1.79-147.01). Cigarettes per day decreased significantly more in the intervention group at 8 weeks (b = - 13.19, SE = 4.88, p = .02). CONCLUSIONS: It was feasible to recruit and retain SMI patients in a smoking cessation trial in the context of outpatient psychiatry. The novel chronic care model treatment was acceptable to patients and showed promise for efficacy. If efficacious, a chronic care model could be effective at reducing smoking among SMI patients. TRIAL REGISTRATION: ClinicalTrial.gov #: NCT03822416 (registered January 30th 2019).

Exercise for Smoking Cessation in Postmenopausal Women: A Randomized, Controlled Trial.

BACKGROUND: Postmenopausal smokers have difficulty quitting smoking and experience considerable weight gain with smoking cessation. We examined whether adjunctive smoking treatment with exercise, compared to a relaxation control condition, could improve cigarette abstinence, decrease cigarettes smoked per day (CPD), and ameliorate changes in body mass index (BMI) in postmenopausal smokers. METHODS: Women (N = 301) signed informed consent and were randomized to treatment at two sites (Universities of Connecticut and Minnesota). We randomized groups of participants to a comprehensive group treatment program that included 12 weeks of varenicline and either a moderate exercise or relaxation component for 6 months. Participants were followed for a year after medication treatment. RESULTS: Overall, 17.3% of patients reported carbon monoxide-verified continuous abstinence for the 9- to 12-week period, and 11.6% reported prolonged abstinence at 1 year, with no significant differences between treatment conditions. CPD reported at study visits showed significant main effects for time in weeks, for site, and for treatment. The Exercise condition reported smoking fewer CPD over time, and that advantage widened over time. In terms of BMI, significant effects for time in weeks, and for the interaction of Week × Treatment condition, reflected gradually increasing BMI in these women over time, but with the increase in BMI slower in the Exercise condition. CONCLUSIONS: Exercise, compared to relaxation, was associated with a reduced BMI and CPD in postmenopausal women, but did not increase end of treatment or prolonged abstinence. Further research is needed to devise exercise programs that increase smoking cessation rates in postmenopausal women. IMPLICATIONS: This study adds to the literature on the effectiveness of a moderate exercise intervention compared to a relaxation control condition as an adjunctive treatment for smoking cessation in postmenopausal women. Our exercise program did not increase end of treatment or prolonged abstinence rates in postmenopausal women; however, there was a beneficial effect on smoking reduction and reduced body mass index. Additional research is needed to devise exercise programs that increase smoking cessation rates in postmenopausal women.

Association of Tobacco Use During Pregnancy, Perceived Stress, and Depression Among Alaska Native Women Participants in the Healthy Pregnancies Project.

INTRODUCTION: In general population samples, higher levels of stress and depression have been associated with increased prevalence of smoking in pregnancy. Little is known about the association of prenatal tobacco use, stress, and depression among American Indian or Alaska Native (AI/AN) women. METHODS: The Healthy Pregnancies Project is a cluster-randomized controlled trial, evaluating a community-level intervention compared with usual care, for reducing tobacco use during pregnancy and postpartum among AN women in 16 villages in western Alaska. This cross-sectional study analyzed baseline data from enrolled pregnant women. Baseline measures included the self-reported, 7-day, point-prevalence current use of any tobacco, Perceived Stress Scale (PSS), and the Center for Epidemiological Studies-Depression (CES-D). Generalized estimating equations (GEE) analyses adjusted for village, participant age, and gestational age. RESULTS: Participants (N = 352) were on average (SD) 25.8 (5.0) years of age and at 26.8 (9.8) weeks gestation. 66.5% were current tobacco users, of which 77% used Iqmik, a homemade form of smokeless tobacco. Compared with nonusers, tobacco users reported lower PSS score (p = .020) and less clinical levels of depression (CES-D ≥ 16) (18.1% vs. 9.3%, p = .21). Findings were not accounted for by nicotine dependence severity or self-reported tobacco use before pregnancy. CONCLUSIONS: In this sample of pregnant AN women, tobacco users report less stress and clinical levels of depression than nonusers. A potential challenge with tobacco treatment for pregnant AN women is to provide alternative ways of deescalating stress and affect management instead of using tobacco. IMPLICATIONS: This study contributes novel information on the association of tobacco use, perceived stress, and depression among Alaska Native women enrolled in a clinical trial to promote healthy pregnancies. Most prior studies addressing this topic were conducted among general population samples of pregnant women who smoked cigarettes. Little is known about these associations with prenatal smokeless tobacco, or among American Indian or Alaska Native women. The results are contrary to findings reported previously, because current tobacco use was associated with less stress and depression than nonuse. The study findings have implications for cessation treatment for this tobacco-use disparity group.

Proactive outreach tobacco treatment for socioeconomically disadvantaged smokers with serious mental illness.

Smokers with serious mental illness (SMI) face individual, interpersonal, and healthcare provider barriers to cessation treatment utilization and smoking abstinence. Proactive outreach strategies are designed to address these barriers by promoting heightened contact with smokers and facilitating access to evidence-based treatments. The present study examined the effect of proactive outreach among smokers with SMI (n = 939) who were enrolled in the publicly subsidized Minnesota Health Care Programs (MHCP) and compared this effect to that observed among MHCP smokers without SMI (n = 1382). Relative to usual care, the intervention increased treatment utilization among those with SMI (52.1% vs 40.0%, p = 0.002) and without SMI (39.3% vs 25.4%, p < 0.001). The intervention also increased prolonged smoking abstinence among those with SMI (14.9% vs 9.4%, p = 0.010) and without SMI (17.7% vs 13.6%, p = 0.09). Findings suggest that implementation of proactive outreach within publicly subsidized healthcare systems may alleviate the burden of smoking in this vulnerable population. Trial Registration ClinicalTrials.gov identifier: NCT01123967.

Assessment of short reports using a human rights-based approach to tobacco control to the Commitee on Economics, Cultural and Social Rights.

BACKGROUND: The health impact of tobacco use remains a major global public health concern and a human rights issue. The Human Rights and Tobacco Control Network (HRTCN) was established to increase the visibility of tobacco as a human rights issue. HRTCN submitted short reports to the UN Committee on Economic Social and Cultural Rights evaluating individual nations' tobacco control policies and offering recommendations. METHODS: HRTCN reviewed Concluding Observations documents for nations for which the HRTCN submitted reports. If tobacco was mentioned in the Concluding Observations through acknowledging the Framework Convention on Tobacco Control ratification, policy changes or discussing tobacco in the recommendations, this was scored as a positive finding. HRTCN also reviewed Concluding Observations for nations for which HRTCN did not submit reports as a comparison. RESULTS: Thirty-eight HRTCN reports were submitted and tobacco was mentioned in Concluding Observations for 11 nations for a rate of 28.9%. In a comparison set of Concluding Observations (n=59), 7% had comments or recommendations relative to tobacco. CONCLUSIONS: This was not a controlled study and the 28.9% 'success rate' for impacting the Concluding Observations, although encouraging, is less than optimal-and leaves room for improvement. The higher rate of tobacco mentions for the cases where the HRTCN short reports were submitted provides preliminary indications that the short reports may have potential to increase the state focus on tobacco control. Future work will seek to improve the design and scope of the reports, and the specificity of the background information and recommendations offered.

Network analysis of global tobacco control collaboration: data from the World Conference on Tobacco or Health (WCTOH).

BACKGROUND: The World Conference on Tobacco or Health (WCTOH) is held every three years to foster communication and collaboration on global tobacco control. Very little is known about the nature of interactions between WCTOH attendees and their linkages to tobacco control organizations, so knowing this information could help improve tobacco control efforts. METHODS: At the 2015 WCTOH, we implemented an online survey to assess barriers to global tobacco control activities, which information sources they use for tobacco control information, and with whom they interact regarding tobacco control. RESULTS: A total of 169 respondents completed the survey, with responses from all six World Health Organization (WHO) regions. Respondents worked in all areas of tobacco control; the most common were research (29.2%) and patient care/treatment (23.3%). The top barriers faced regarding tobacco control activities were: funding is weak (56.8%), government commitment (45.0%), tobacco industry interference (43.8%), and lack of coordination (34.3%). The network analysis identified Framework Convention Alliance (FCA) and Society for Research on Nicotine and Tobacco (SRNT) as the two most prominent groups that people belonged to and where they went to exchange information and best practices. Important regional and country specific groups also appear to be growing, such as the African Tobacco Control Alliance (ATCA) and the Argentinian Association of Tabacology (ASAT). DISCUSSION: Mapping and better understanding the global tobacco control network is important for informing knowledge exchange and best practices, particularly as increasing attention is being focused on global tobacco control efforts in low- and middle-income countries in particular. CONCLUSIONS: The present study demonstrates that even a subsample of the WCTOH shows considerable collaboration. The full WCTOH network should be mapped in order to foster greater collaboration that has the the potential to improve global tobacco control efforts.

Third study on WHO MPOWER Tobacco Control Scores in Eastern Mediterranean countries 2011-2015.

This study was conducted to quantify the implementation of the MPOWER policies and to assess any possible changes across Eastern Mediterranean Region (EMR) countries. In this comparative cross-sectional study based on 10 categories mentioned in MPOWER report 2015 a checklist was designed. Seven questions were scored from 0-4 and three from 0-3. The 22 EMR countries were ranked and compared by their total score on a scale of 0-37. The highest scores were achieved by Egypt and the Islamic Republic of Iran. Pakistan, Sudan and Yemen showed progress, while Bahrain, Jordan, Kuwait, Oman, and the Syrian Arab Republic had decreased scores. The total score of the EMR countries had decreased compared to 2013. Thus, there remains a need for greater focus on tobacco taxation and smoke-free policies to address this retrograde step.

Time trend of smoking scenes in Iranian movies during the past three decades (1982-2011): a historical analysis.

BACKGROUND: Evidence from the USA and elsewhere has linked smoking depictions in movies with youth smoking initiation. Prior research has not focused on depictions in films produced in the Middle East, however. OBJECTIVE: We reviewed the 10 most commercially successful Iranian films released each year over three decades (1982-2011) to determine trends in depictions of tobacco use over time. METHODS: Each movie was reviewed in its entirety, and depictions of smoking were recorded and classified as direct (characters holding or using tobacco products) and indirect (tobacco products appearing in the frame, but not being used). Time trends in average duration of direct, indirect and total smoking depictions were analysed using linear regression and Cohen's κ coefficient. RESULTS: The mean duration of tobacco depictions in the most commercially successful Iranian films fluctuated yearly over the 3 decades, but with an overall significant upward trend (p<0.005). The proportion of movies depicting tobacco consumption during the three decades was 36% (1982-1991), 60% (1992-2001) and 74% (2002-2011), respectively. The average proportion of total movie time for these depictions (0.75%, 1.41%, 2.08%) increased significantly (p<0.005) over the 3 decades as did the average duration of smoking depictions,(39.1, 67 and 99.3 s, respectively, p<0.005). CONCLUSIONS: The significant increase in the proportion of movies depicting tobacco consumption and in the duration of smoking depictions over the past 30 years underscores the need for increased regulation of the Iranian film industry to minimise this important source of influence on tobacco initiation in young people.

Training Lay Interventionists to Support Tobacco Cessation among Teachers in India.

Despite the rapidly increasing burden of tobacco-related morbidity and mortality in low- and middle-income countries, tobacco control initiatives - especially cessation - receive little emphasis. This is true despite low-cost methods that have potential for widespread dissemination. The purpose of this paper is to provide a case study example of how lay interventionists may be trained and supported to facilitate tobacco use cessation, based on the successful Tobacco Free Teachers-Tobacco Free Society program (TFT-TFS) implemented in Bihar, India. This school-based program included multiple components, with lay interventionists having a crucial role. The lay interventionists included health educators and lead teachers, both of whom were selected based on formative research, underwent extensive training and received continuing support. We emphasized encouraging and supporting teachers to quit tobacco use and engaging both tobacco users and nonusers to create a supportive environment for cessation. We also stressed that neither the health educators nor lead teachers were being trained as counselors or as cessation experts. We focused on the importance of respecting teachers as individuals and identifying locally relevant methods of cessation. Although we cannot isolate the precise contribution of the lay interventionists to the successful TFT-TFS intervention, the abstinence findings in favor of the intervention at follow up are highly encouraging. Teachers have been neglected as lay interventionists for tobacco cessation despite the fact that they tend to be highly respected and credible. The approach used for TFT-TFS could be disseminable in multiple low- and middle-income country contexts through train-the-trainer programs targeted to teachers.

The association of military discharge variables with smoking status among homeless Veterans.

OBJECTIVE: There is a dearth of research examining the health correlates of tobacco use within the homeless population, particularly with respect to homeless Veterans. An aim of the present study was to compare homeless Veteran and homeless non-Veteran smokers across a series of socio-demographic and health variables, and to determine whether any of these variables were independently associated with Veteran status. A subsequent aim was to compare the socio-demographic and health profiles of Veteran smokers and Veteran nonsmokers, and to determine whether any of these variables were independently associated with current smoking. METHODS: Data were obtained from the 2009 Homelessness in Minnesota survey conducted by the Wilder Research Foundation. The final sample included 4750 homeless individuals living throughout Minnesota. RESULTS: The prevalence of smoking was greater among homeless Veterans (74%) than homeless non-Veterans (70%). The prevalence of physical and mental health problems was higher among homeless Veteran smokers than homeless non-Veteran smokers, although these variables were not independently associated with Veteran status after controlling for socio-demographics. Analyses of the homeless Veteran sample indicated that receipt of Veterans' benefits, type of discharge, and alcohol and/or chemical dependence were independently associated with current smoking. CONCLUSION: Homeless Veteran smokers exhibit heightened rates of physical and mental health problems compared to homeless non-Veteran smokers. Military service and discharge characteristics may contribute to this high smoking prevalence. Future efforts should focus on increasing Veterans' access to and knowledge of Veterans' health resources, and on developing innovative strategies to boost cessation in this population.

Efficacy of a tobacco quitline among adult cancer survivors.

OBJECTIVE: The purpose of the study (conducted 2010-2013) was to determine the efficacy of two common types of tobacco quitlines in adult cancer survivors who regularly smoked cigarettes. METHOD: Adult onset cancer survivors in Memphis, Tennessee (n=427, 67% female, 60% Caucasian) were randomized either to a Proactive (i.e., counselor-initiated calls) or Reactive (i.e., participant-initiated calls) quitline. Both conditions also received nicotine replacement therapy. The primary outcome was biochemically-verified (i.e., salivary cotinine) smoking cessation. RESULTS: While 12-month self-reported abstinence was consistent with other published studies of smoking cessation (22% and 26% point prevalence abstinence for Proactive and Reactive conditions, respectively), 48% of participants who were tested for cotinine failed biochemical verification, indicating a considerable falsification of self-reported cessation. Adjusted cessation rates were less than 5% in both intervention conditions. CONCLUSION: Our results are consistent with other studies indicating that traditional smoking cessation interventions are ineffective among cancer survivors. Moreover, self-reports of cessation were unreliable in cancer survivors participating in a quitline intervention, indicating that future studies should include biochemical verification. Given the importance of smoking cessation among cancer survivors and low cessation rates in the current study, it may be necessary to design alternative interventions for this population. ClinicalTrials.gov identifier: NCT00827866.

Social contextual factors and tobacco use among Indian teachers: insights from the Bihar School Teachers' Study.

OBJECTIVE: Tobacco use within India has significant effects on the global burden of tobacco-related disease. As role models and opinion leaders, teachers are at the forefront of tobacco control efforts, yet little is known about their own tobacco use. This study examines the association between factors in the social environment and tobacco use among teachers in Bihar, India. METHODS: The study was based on the Bihar School Teachers' Study baseline survey. Seventy-two Bihar government schools (grades 8-10) were randomly selected for the study and all school personnel were invited to complete the survey in June/July in 2009 and 2010. We assessed the relation between social contextual factors and current smoking/smokeless tobacco use by fitting a series of logistic regression models. RESULTS: After controlling for clustering of teachers in schools and other covariates, our results showed teachers with one or more coworkers who used tobacco were twice as likely to be smokeless tobacco users as teachers with no co-workers who used tobacco. Teachers who reported rules prohibiting smoking at home were significantly less likely to smoke than teachers without such rules. Older male teachers also had significantly greater odds of smoking/using smokeless tobacco. CONCLUSION: These findings provide direction for future interventions targeting the social context.

Banning cigarette smoking on US Navy submarines: a case study.

BACKGROUND: The military has had a long pro-tobacco tradition. Despite official policy discouraging smoking, tobacco still is widely seen as part of military culture. While active smoking has presented a particular challenge for the military, in recent years there also has been increasing concern with secondhand smoke. This is especially true in closed environments and submarines may be deployed for months at a time. The current case study describes the successful implementation by the Navy of a comprehensive ban on smoking aboard submarines. METHODS: The authors searched documents on the internet, popular media, military-based news outlets and the scientific literature. We also conducted interviews with Navy officers who were instrumental in policy implementation. FINDINGS: Data demonstrating substantial exposure of non-smokers to tobacco smoke aboard submarines had major impact on successful adoption of the policy. A systematic and extended roll out of the ban included establishing a working group, soliciting input and active engagement from submarine personnel, and offering cessation assistance. Support was enlisted from Chief Petty Officers who could have been strongly opposed but who became strong proponents. Fewer problems were encountered than had been expected. In contrast to a previous unsuccessful attempt by a Navy captain to ban smoking on his ship, the ban was adopted without apparent tobacco industry interference. CONCLUSIONS: Lessons learned included the importance of strong empirical support, effective framing of the issue, setting a realistic timeline, soliciting support from key personnel and providing appropriate resources. These lessons have implications for those considering further tobacco policy changes in the military and elsewhere.

Smoking patterns, quit behaviors, and smoking environment of workers in small manufacturing companies.

BACKGROUND: This study describes smokers employed at 47 small manufacturing companies in Minnesota, USA. METHODS: Smokers (n = 713) participating in a group-randomized trial completed a baseline survey on their smoking patterns, quit behaviors, smoking environment, workplace attitudes about smoking, and correlates of smoking. These characteristics were examined by job type and a latent class analysis (LCA) was performed to group workers with similar characteristics. RESULTS: Production workers had the highest prevalence of daily smoking (88% vs. 68% among managers), and addiction (61% vs. 26% among managers), and the highest mean level of perceived stress (6.4 vs. 4.9 among managers). The LCA identified three subgroups of smokers that differed in levels of barriers to cessation. Production workers were most likely to be in the group with greater barriers (P = 0.01). CONCLUSIONS: These results underscore the importance of targeting interventions to production workers and those who exhibit the greatest barriers to cessation.

A longitudinal analysis of cigarette prices in military retail outlets.

OBJECTIVES: We conducted a longitudinal assessment of tobacco pricing in military retail outlets, including trends within each service branch. METHODS: We determined the price of a single pack of Marlboro Red cigarettes at military retail stores located in the continental United States, Alaska, and Hawaii and at their nearest Walmarts in spring 2011 and 2013 (n = 128 for pairs available at both assessments). RESULTS: The average difference between cigarettes sold in military retail outlets and Walmarts decreased from 24.5% in 2011 to 12.5% in 2013. The decrease was partially attributable to significant price decreases at Walmarts. The largest increases in cigarette prices occurred on naval installations. Potential savings at stores on several installations remained substantial in 2013; the largest approached $6 per pack. Stores on 17 military installations decreased cigarette prices during the study period. CONCLUSIONS: Tobacco can be purchased in military retail stores at substantial savings over civilian stores. If tobacco pricing is to cease to be an incentive for use among personnel, a revised military tobacco pricing policy is needed.