Cigar Cessation Prevalence and Trends by Demographic Characteristics Among US Adults, TUS-CPS, 2010-2019.

INTRODUCTION: Disproportionate rates of cigar smoking across demographic groups can contribute to tobacco-related health disparities in the United States. We assessed overall and demographic-specific cigar cessation rates from 2010 to 2019. AIMS AND METHODS: To characterize cessation prevalence among selected demographic groups over time, we analyzed data from the 2010-2011, 2014-2015, and 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Individuals who reported either (1) current cigar smoking for at least 2 years or (2) quitting cigar smoking within the past 12 months were included in the study (n = 5262 in 2010-2011; n = 4741 in 2014-2015; n = 3741 in 2018-2019). Among this group, individuals who reported not smoking a cigar within the past 6 months were considered cigar quitters. Chi-square tests were used to test differences in cessation prevalence between the two survey waves within demographic groups as well as between different groups within survey waves. RESULTS: The prevalence of cigar cessation decreased from 2010-2011 to 2018-2019 for non-Hispanic (NH) White individuals, Hispanic individuals, and both males and females. (p < .05 for all groups). NH White individuals had significantly higher cessation prevalence than individuals who identified as NH Black (33.8% vs. 25.0%, respectively, in 2010-2011; 33.4% vs. 20.4% in 2014-2015; 31.1% vs. 22.3% in 2018-2019; p < .05 for all differences). CONCLUSIONS: Overall cigar cessation prevalence significantly decreased from 2010-2011 to 2018-2019. Findings from the study could provide an opportunity to implement strategies that promote cessation strategies targeting certain subpopulations. IMPLICATIONS: Cigar cessation patterns are starkly different across different demographic groups, which leads to a disproportionate burden of health-related effects of continued use of these products. These results can inform policy actions around cigar cessation efforts. Future research to close this disparity should be focused on populations that have lower cessation prevalence.

Tobacco Product Use Among Adults - United States, 2021.

Commercial cigarette smoking among U.S. adults has declined during the preceding 5 decades (1,2); however, tobacco product use remains the leading cause of preventable disease and death in the United States, and some populations continue to be disproportionately affected by tobacco use (1,2). To assess recent national estimates of commercial tobacco use among U.S. persons aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute analyzed 2021 National Health Interview Survey (NHIS) data. In 2021, an estimated 46 million U.S. adults (18.7%) reported currently using any tobacco product, including cigarettes (11.5%), e-cigarettes (4.5%), cigars (3.5%), smokeless tobacco (2.1%), and pipes (including hookah)* (0.9%).† Among those who used tobacco products, 77.5% reported using combustible products (cigarettes, cigars, or pipes), and 18.1% reported using two or more tobacco products.§ The prevalence of current use of any tobacco product use was higher among the following groups: men; persons aged <65 years; persons of non-Hispanic other races; non-Hispanic White (White) persons¶; residents of rural (nonmetropolitan) areas; financially disadvantaged (income-to-poverty ratio = 0-1.99); lesbian, gay, or bisexual (LGB) persons; those uninsured or enrolled in Medicaid; adults whose highest level of education was a general educational development (GED) certificate; who had a disability; and who had serious psychological distress. Continued surveillance of tobacco product use, implementation of evidence-based tobacco control strategies (e.g., hard-hitting media campaigns, smoke-free policies, and tobacco price increases), conducting linguistically and culturally appropriate educational campaigns, and FDA regulation of tobacco products will aid in reducing tobacco-related disease, death, and disparities among U.S. adults (3,4).

A Longitudinal Analysis of Respiratory Illness and Tobacco Use Transitions.

INTRODUCTION: Among individuals with chronic respiratory conditions, transitions between patterns of tobacco product use are not well understood. This study examines how transitions, including quitting altogether, differ over time between those who do and do not have chronic respiratory conditions. METHODS: Data from youth and adult participants of the longitudinal Population Assessment of Tobacco and Health Study (2013-2018) were analyzed. Youth aged 12-17 years were included if they had aged into the adult sample by Wave 4. Stratified polytomous regression models built under a first-order Markov assumption modeled the probability of transitioning between different states/patterns of tobacco product use (exclusive current E-cigarette use, exclusive current combustible tobacco product use, current dual use of combustible products and E-cigarettes, and no current tobacco product use) at each wave. Marginal transition probabilities were computed as a function of ever or past-year diagnosis of a respiratory condition (separately for asthma and a composite variable representing chronic bronchitis, emphysema, and/or chronic obstructive pulmonary disease). Analyses were conducted in 2020-2021. RESULTS: Most individuals, regardless of respiratory condition, maintained the same pattern of tobacco use between waves. Exclusive combustible tobacco product users, including those with or without a respiratory condition, were not likely to become exclusive E-cigarette users or to quit using tobacco entirely. CONCLUSIONS: Although combustible tobacco use negatively impacts the management and prognosis of respiratory illnesses, combustible tobacco users who were recently diagnosed with a chronic respiratory condition were not likely to quit using tobacco. Efforts to encourage and support cessation in this medically vulnerable population should be increased.

Characteristics and Patterns of Cigarette Smoking and Vaping By Past-Year Smokers Who Reported Using Electronic Nicotine Delivery System to Help Quit Smoking in the Past Year: Findings From the 2018-2019 Tobacco Use Supplement to the Current Population Survey.

INTRODUCTION: Cigarette smoking has declined, while electronic nicotine delivery system (ENDS) use has increased in the United States. Understanding the role of ENDS in adult smoking quit attempts and cessation is important for estimating their population health impact. AIMS AND METHODS: We used data from 2018 to 2019 tobacco use supplement to the current population survey to examine demographic characteristics and ENDS use patterns among adult ENDS users who reported quitting smoking in the past year by trying to switch to ENDS ("switchers") and smokers who did or did not make a quit attempt in the past year. χ2 tests of proportions and t-tests were used to compare characteristics between groups. RESULTS: In 2018-2019, about three-quarters of switchers reported daily use of ENDS compared to only one-third of dual users with a recent quit attempt by trying to switch to ENDS. Compared to dual users who made a quit attempt by trying to switch to ENDS, switchers were more likely to use menthol/mint-flavored ENDS exclusively (5.6% vs. 13.1%; p = .004) but less likely to use tobacco-flavored ENDS exclusively (21.2% vs. 13.7%; p = .01). CONCLUSIONS: ENDS users who quit smoking in the past year and reported trying to quit by switching to ENDS were more likely to use menthol/mint flavors exclusively and use ENDS daily compared to dual users who made a quit attempt by trying to switch to ENDS. Longer-term prospective data may better clarify the role of ENDS in smoking quit attempts and cessation. IMPLICATIONS: This study provides information on patterns of ENDS use in former smokers and current smokers who tried to quit smoking by switching to ENDS in a national sample of U.S. adults. These results can inform policy actions concerning ENDS products.

Racial Disparities in Cigarette Smoking Behaviors and Differences Stratified by Metropolitan Area of Residence.

BACKGROUND: Black cigarette smokers experience a disproportionate burden of non-small cell lung cancer (NSCLC) compared to other racial and ethnic groups, despite starting to smoke later in life, smoking less frequently, and smoking fewer cigarettes per day compared with White smokers. Research has shown that these disparities in NSCLC are wider in rural areas. OBJECTIVE: To examine differences in smoking behaviors between Black and White individuals living in non-metropolitan areas and metropolitan areas. METHODS: Using harmonized data from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) years 2010-2011, 2014-2015, and 2018-2019, we compared smoking behaviors between Black and White current and former smokers by metropolitan status (i.e., whether an individual lives in a densely populated area or not) and by both metropolitan status and sex. RESULTS: Smoking prevalence was higher among White participants living in non-metropolitan versus Black participants. Further, in non-metropolitan areas, Black individuals reported smoking fewer cigarettes per day, fewer years of smoking, and a later age of initiation compared to White individuals. Additionally, Black individuals, especially men, were more likely than White individuals to be current non-daily smokers. CONCLUSIONS: Our findings show that Black individuals living in non-metropolitan areas do not, in aggregate, have more cigarette smoking exposure relative to White individuals. Additional research is needed to further understand smoking-related exposures and other factors that may contribute to lung cancer disparities, especially in non-metropolitan areas.

Blunt and Non-Blunt Cannabis Use and Risk of Subsequent Combustible Tobacco Product Use Among Adolescents.

INTRODUCTION: Cannabis-including blunts (cannabis rolled in tobacco-containing cigar casing) -is commonly the first substance used among adolescents and may increase the likelihood of subsequent initiation of combustible tobacco products. AIMS AND METHODS: Data were pooled from two prospective studies of adolescents in California and Connecticut (total N = 4594). Logistic regression models assessed the association of baseline ever blunt use and ever non-blunt cannabis use (vs. never cannabis use) with subsequent initiation of any combustible tobacco-only product (ie, cigarettes, cigars, or cigarillos) by 1-year follow-up after adjustment for demographic characteristics and other tobacco product use at baseline. We also assessed whether estimates differed by prior e-cigarette or hookah use at baseline. RESULTS: Among never combustible tobacco-only product users (N = 2973), 221 (7.4%) had ever used a blunt and 114 (3.8%) had ever used only non-blunt cannabis at baseline. Blunt use (adjusted odds ratio [AOR] = 1.98, 95% confidence interval [CI]: 1.30 to 3.01) and non-blunt cannabis use (AOR = 2.38, 95% CI: 1.41 to 4.00) were independently associated with greater odds of combustible tobacco-only product initiation by follow-up. Among those who had not tried e-cigarettes or who had not tried hookah, blunt use and non-blunt cannabis use were associated with significantly increased odds of combustible tobacco product initiation; among those who had tried e-cigarettes or hookah, the association was not significant. CONCLUSIONS: We found blunt and non-blunt cannabis use to be associated with subsequent combustible tobacco-only product initiation, particularly among adolescents who had not also tried other products containing nicotine. IMPLICATIONS: Adolescent-focused tobacco prevention efforts should consider incorporating cannabis products, including blunts. More research is needed to understand how blunt use and cannabis use more broadly are associated with initiation of tobacco products.

Harm Perceptions of Alternative Tobacco Products among US Adolescents.

OBJECTIVES: In this study, we identified groups of adolescents who share similar awareness and perceptions of harm regarding e-cigarettes, cigars, hookah, and smokeless tobacco. METHODS: We used latent class analyses (LCA) with the data from Wave 1 (2013-14) of the Population Assessment of Tobacco and Health youth and parent survey (PATH; N = 13,650) to address the research goal. Multinomial logistic regression analysis assessed the associations between identified classes with demographic characteristics and tobacco use. RESULTS: LCA identified 5 classes: (1) perceived harm across all alternative tobacco products (36.6%); (2) perceived harm for e-cigarettes and smokeless tobacco but never heard of cigars and hookah (48.2%); (3) never heard of alternative tobacco products (8.6%); (4) mix of no harm and harm across alternative tobacco products (5.2%); and (5) "don't know" the harm across alternative tobacco products (1.4%). Relative to the class who perceived harm across all alternative tobacco products, classes of adolescents who were unaware of the products or did not know the harms were more likely to be non-white, younger, have lower parental education, and less likely to have tried an alternative tobacco product. CONCLUSIONS: Tobacco prevention should target vulnerable youth, such as adolescents who are non-white, young, and have low parental education.

Tobacco use increases risk of food insecurity: An analysis of continuous NHANES data from 1999 to 2014.

Tobacco use is a major health disparities issue in the United States; it is much more common in less-educated and lower-income groups. These groups also experience a higher prevalence of food insecurity. Previous studies analyzing the association between tobacco use and food insecurity have focused on only cigarettes. We assessed the relationship between food insecurity and use of cigarettes, alternative tobacco products (cigars, electronic cigarettes, smokeless tobacco), any tobacco product, and multiple tobacco products. Using National Health and Nutrition Examination Survey data from 1999 to 2014, we built multinomial logistic regression models predicting degree of food security (i.e., food security, low food security, very low food security) for use of different tobacco product types, any product, and multiple products. After adjustment, use of any product, relative to no use, was significantly associated with increased odds of both food insecurity outcomes: low (adjusted odds ratio (AOR) = 1.2, 95% confidence interval (CI): 1.0-1.4) and very low (AOR = 1.8, 95% CI: 1.6-2.2) food security. In a separate model, single product use, relative to no use, was significantly associated with increased odds of low (AOR = 1.5, 95% CI: 1.3-1.7) and very low (AOR = 2.2, 95% CI: 1.9-2.6) food security. For multiple product use the magnitude of association was higher for very low food security (AOR = 2.7, 95% CI: 1.8-4.0). The significant associations identified here can inform researchers and policymakers developing interventions to prevent tobacco- and food insecurity-related diseases. To be effective in reducing either health risk, interventions may need to target both tobacco use and food insecurity.

Ethnic Differences in Patterns of Cigarette and E-Cigarette Use Over Time Among Adolescents.

PURPOSE: Little is known about whether adolescent cigarette and e-cigarette use patterns over time differ by ethnicity. METHODS: Data were pooled from three prospective cohort studies of adolescents in California and Connecticut (baseline: 2013-2014; 12-month follow-up: 2014-2015; N = 6,258). Adjusted polytomous regression models evaluated the association of baseline exclusive ever e-cigarette use, exclusive ever cigarette use, ever use of both e-cigarettes and cigarettes (dual use) with past 30-day use at follow-up (exclusively e-cigarettes, exclusively cigarettes, dual use; no use at baseline/follow-up were the referent groups). Interaction analyses evaluated differences by race/ethnicity (Hispanic white [HW], non-Hispanic white [NHW], Other). RESULTS: A significant global interaction was observed for the association of baseline with follow-up tobacco use by ethnicity (p = .009). Among NHW participants, ever e-cigarette or cigarette users at baseline (vs. never users) had significantly higher odds of every past 30-day use tobacco use pattern at follow-up. Among HW participants, compared with never users, exclusive e-cigarette users at baseline had increased odds of continued e-cigarette use (ORexclusive e-cigarettes = 5.22; 95% confidence interval [CI]: 3.50, 7.79; ORdual use = 3.64; 95% CI: 1.62, 8.18) but not of transition to exclusive cigarette use at follow-up (ORexclusive cigarettes = 1.27; 95% CI: .47, 3.46), and HW exclusive cigarette users at baseline had greater odds of continued cigarette use (ORexclusive e-cigarettes = 12.3; 95% CI: 5.87, 25.8; ORdual use = 3.82; 95% CI: 1.06, 13.7) but not of transition to exclusive e-cigarette use at follow-up (ORexclusive cigarettes = 1.61; 95% CI: .62, 4.18). CONCLUSIONS: Findings that NHW youth report more transitional use patterns and HW youth report more stable use patterns suggest a potential for differential impacts of e-cigarettes, by ethnicity, in increasing subsequent transition to or cessation from cigarette smoking.

Longitudinal associations between use and co-use of cigars and cigarettes: A pooled analysis of three adolescent cohorts.

INTRODUCTION: Patterns of adolescent tobacco product use are evolving rapidly and need examination. We assessed whether ever use of cigars (i.e., lifetime use) was related to an increased risk of subsequent cigarette initiation and dual use of cigars and cigarettes. METHODS: Leveraging data from three prospective cohort studies of adolescents (n = 6258), we assessed the odds of initiating cigarettes at one-year follow-up among ever cigar users at baseline, relative to never cigar users, after adjusting for demographics and e-cigarette use. We also assessed patterns of transition between exclusive use of cigars, exclusive use of cigarettes, and dual use of both cigars and cigarettes between baseline and follow-up and whether these associations differed by e-cigarette use. RESULTS: Among never cigarette smokers (n = 4876; 79.3% of the total sample), 3.4% reported ever cigar use by baseline. Ever cigar use by baseline was associated with higher likelihood of initiating cigarettes by follow-up (31.3%) relative to never cigar use at baseline (8.4%; adjusted odds ratio = 2.26, 95% confidence interval: 1.52, 3.35). Effect estimates were stronger if e-cigarette was used by baseline. Furthermore, exclusive ever cigar use by baseline was associated with a 2-4-fold increase in the odds of transition to exclusive cigar, exclusive cigarette, and dual use at follow-up relative to non-users of either product by baseline. CONCLUSIONS: Comprehensive tobacco regulations and early prevention efforts focused on reducing youth appeal of cigars may be warranted, as cigar use may place youth at risk for subsequent cigarette use as well as dual use of cigars and cigarettes.

E-cigarette Use and Subsequent Smoking Frequency Among Adolescents.

: media-1vid110.1542/5839992666001PEDS-VA_2018-0486Video Abstract BACKGROUND AND OBJECTIVES: Electronic cigarette (e-cigarette) use is associated with cigarette initiation among adolescents. However, it is unclear whether e-cigarette use is associated with more frequent cigarette use after initiation. Also, the extent to which cigarette or dual cigarette and e-cigarette users transition to exclusive e-cigarette use or to the nonuse of either product is not yet known. METHODS: Data were pooled from 3 prospective cohort studies in California and Connecticut (baseline: 2013-2014; follow-up: 2014-2016; N = 6258). Polytomous regression models were used to evaluate the association of baseline e-cigarette use (never or ever) with cigarette use frequency at follow-up (experimental: initiation but no past-30-day use; infrequent: 1-2 of the past 30 days; frequent: 3-5 or more of the past 30 days). Polytomous regression models were also used to evaluate transitions between baseline ever or past-30-day single or dual product use and past-30-day single or dual product use at follow-up. RESULTS: Among baseline never smokers, e-cigarette users had greater odds of subsequent experimental (odds ratio [OR] = 4.58; 95% confidence interval [CI]: 3.56-5.88), infrequent (OR = 4.27; 95% CI: 2.75-6.62) or frequent (OR = 3.51; 95% CI: 1.97-6.24) cigarette use; the 3 OR estimates were not significantly different. Baseline past-30-day exclusive cigarette use was associated with higher odds at follow-up of exclusive cigarette or dual product use than of exclusive e-cigarette use. CONCLUSIONS: Tobacco control policy to reduce adolescent use of both e-cigarettes and cigarettes is needed to prevent progression to more frequent tobacco use patterns and reduce combustible cigarette use (with or without concurrent e-cigarette use) to lessen the adverse public health impact of e-cigarettes.

Education, employment, and independent living of young adults who are deaf and hard of hearing.

Little information is available on the education, employment, and independent living status of young deaf and hard of hearing adults who have transitioned from high school. The present article reports postsecondary outcomes of 46 young adults who had attended for at least 4 years a non-public agency school in the northwestern United States specializing in deaf education. School administrators had developed a specific philosophy and operationalized it in an academic and literacy-based curriculum incorporating a grammatically accurate signing system. The researchers found that most or all participants had finished high school, had earned a college degree, were employed, and were living independently. Findings are discussed in terms of the available literature and the study's contribution to a limited body of recent research on young postsecondary deaf and hard of hearing adults.

Coping with connectivity.

When evaluating scripting products, hospitals should consider these factors: match business requirements to functionality; choose a standalone product that offers a full range of features; make sure the product is interoperable with different types of applications, systems, file types, data formats, and messaging types; verify that the company will provide the training necessary for hospital staff to get the most out of the product.