Impacts of COVID-19 on cigarette use, smoking behaviors, and tobacco purchasing behaviors.

BACKGROUND: The COVID-19 pandemic has had a significant global impact. As a respiratory illness, COVID-19 may pose unique risks to cigarette smokers. This study used concept mapping, a mixed-method participatory approach, to identify impacts of COVID-19 on cigarette smokers. METHODS: Cigarette smokers across the United States (U.S.) were recruited to complete this online, multi-step study. Of the 126 participants who were invited to participate in this study, 91 participants (mean age = 40.9; SD = 11.3) completed at least one of the three study tasks (i.e., brainstorming, sorting, and rating). Participants completed a brief demographic survey and brainstormed statements that completed a focus prompt: "A specific way that Coronavirus/COVID-19 has impacted/affected my cigarette use, smoking behaviors, tobacco purchasing behaviors, and/or other tobacco-related behaviors is." After duplicate statements were removed, participants sorted the final list of 87 statements by similarity of content and rated how true statements were from them (1-Definitely NOT true to 7-Definitely true). RESULTS: Nine thematic clusters were identified: Smoking More, Smoking to Cope/Reduce Stress, Change in Smoking Behaviors Due to COVID-19, Concerns about Smoking and COVID-19 Risk, Social Impacts, Maintaining and Rationing Cigarette Supply, Impacts on Obtaining Cigarettes, Use of Other Tobacco Products/Drugs, and Minimal/No Impacts/Concerns of COVID-19. The highest rated cluster (i.e., most true) was the Smoking More cluster followed by the Concerns about Smoking and COVID-19 Risk cluster. The highest rated statement in the study was the statement "Smoking keeps me calm". CONCLUSIONS: Cigarette smokers may endure additional impacts of COVID-19, such as increased COVID-19 health burdens, stressors related to risk of exposure, social stigma and isolation, financial burdens, and increased toxicant exposure from increased smoking frequency.

Comparison of puff topography, toxicant exposure, and subjective effects in low- and high-frequency waterpipe users: a double-blind, placebo-control study.

INTRODUCTION: Clinical laboratory work among intermittent and daily waterpipe tobacco smokers has revealed significant risks for tobacco dependence and disease associated with waterpipe tobacco smoking (WTS). No studies have compared these groups directly. This study examined whether WTS frequency was associated with differential puff topography, toxicant exposure, and subjective response using a placebo-control design. METHODS: Eighty participants reporting WTS of 2-5 episodes (LOW; n = 63) or ≥20 episodes (HIGH; n = 17) per month for ≥6 months completed 2 double-blind, counterbalanced 2-hr sessions that were preceded by ≥12hr of tobacco abstinence. Sessions differed by product smoked ad libitum for 45+ min: preferred brand/flavor of waterpipe tobacco (active) or a flavor-matched tobacco-free waterpipe product (placebo). Outcomes included puff topography, plasma nicotine, carboxyhemoglobin (COHb), and subjective response. RESULTS: HIGH users had more puffs, shorter inter-puff-intervals, and a higher total puff volume for placebo relative to active, as well as relative to LOW users during placebo. Plasma nicotine concentrations increased when smoking active (but not placebo) with no significant differences between groups at 25min post-product administration. COHb increased significantly during all conditions; the largest increase was for HIGH users when smoking placebo. There was some evidence of higher baseline scores for nicotine/tobacco nicotine abstinence symptomology. CONCLUSIONS: Higher frequency waterpipe users may be more sensitive to the effects of waterpipe smoke nicotine content. Among HIGH users, higher baseline nicotine/tobacco abstinence symptoms may indicate greater nicotine dependence. These data support continued surveillance of WTS and development of dependence measures specific to this product.

Acute effects of waterpipe tobacco smoking: a double-blind, placebo-control study.

BACKGROUND: Waterpipe tobacco smoking usually involves heating flavored tobacco with charcoal and inhaling the resulting smoke after it has passed through water. Waterpipe tobacco smoking increases heart rate and produces subjective effects similar to those reported by cigarette smokers. These responses are thought to be nicotine-mediated, though no placebo-control studies exist. Accordingly, this double-blind, placebo-control study compared the acute physiological and subjective effects of waterpipe tobacco smoking to those produced when participants used a waterpipe to smoke a flavor-matched, tobacco-free preparation. METHODS: Occasional waterpipe tobacco smokers (n = 37; 2-5 monthly smoking episodes for ≥ 6 months) completed two double-blind, counterbalanced sessions that differed by product: preferred brand/flavor of waterpipe tobacco or flavor-matched, tobacco-free preparation. For each 45-min, ad lib smoking episode blood and expired air CO were sampled, cardiovascular and respiratory response were measured, and subjective response was assessed. RESULTS: Waterpipe tobacco smoking significantly increased mean (± SEM) plasma nicotine concentration (3.6 ± 0.7 ng/ml) and heart rate (8.6 ± 1.4 bpm) while placebo did not (0.1 ± 0.0 ng/ml; 1.3 ± 0.9b pm). For carboxyhemoglobin (COHb) and expired air CO, significant increases were observed for tobacco (3.8 ± 0.4%; 27.9 ± 2.6 ppm) and for placebo (3.9 ± 0.4%; 27.7 ± 3.3 ppm) with no differences across condition. Independent of condition, symptoms of nicotine/tobacco abstinence (e.g., "urges to smoke", "anxious") were reduced and direct effects (e.g., "dizzy", "satisfy") increased. DISCUSSION: These results from the first placebo-control study of waterpipe tobacco smoking demonstrate that waterpipe-induced heart rate increases are almost certainly mediated by nicotine though the subjective effects observed in these occasional smokers were not.