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.

Serious Mental Illness and Smoking Cessation Treatment Utilization: the Role of Healthcare Providers.

Healthcare provider barriers to cessation resources may be undercutting quit rates for smokers with serious mental illness (SMI). The study aim was to examine how providers influence cessation treatment utilization among smokers with SMI. Data were taken from a trial conducted among smokers in Minnesota Health Care Programs. The sample was split into groups of participants with SMI (n = 939) and without SMI (n = 1382). Analyses assessed whether the association between SMI and treatment utilization was mediated by healthcare provider-delivered treatment advice and healthcare provider bias. Results revealed higher rates of treatment utilization among smokers with SMI than those without SMI (45.9% vs 31.7%, p < 0.001); treatment advice and provider bias did not mediate this association. Subsequent individual regression analyses revealed positive associations between treatment advice and treatment utilization (ß 0.21-0.25, p < 0.05), independent of SMI status. Strategies to increase low-income smokers' contacts with providers may reduce treatment utilization barriers among these smokers.

Healthy Pregnancies Project: Cluster Randomized Controlled Trial of a Community Intervention to Reduce Tobacco Use among Alaska Native Women.

Substantial gaps remain in the evidence base for prenatal tobacco use interventions among Indigenous women. Using a cluster randomized controlled trial (RCT), the Healthy Pregnancies Project evaluated a community-level intervention for Alaska Native (AN) women in rural western Alaska. Sixteen villages were randomly assigned to usual care (control, n = 8 villages) or usual care plus a community-level intervention delivered by local AN "Native Sisters" (n = 8 villages). Outcomes were tobacco use rate at delivery and at 2 and 6 months postpartum, with biochemical confirmation obtained at 6 months. The program had high reach, enrolling 73% of all eligible women screened. Of the 352 participants, 67% used tobacco at baseline. No significant differences emerged between study groups on follow-up in tobacco use rates. More intervention than control participants made a quit attempt at 2 months postpartum (70% vs. 51%, respectively, p = 0.012). Participants in both study groups reported the program helped to raise awareness of healthy pregnancies in the study villages. This trial supports the reach of a community-level intervention, but not its efficacy for reducing tobacco use during pregnancy or postpartum. Efforts to sustain early quit attempts appear warranted. The community involvement, and reported impact on raising awareness of the importance of healthy pregnancies, supports the value of the research program in this community.

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.

The Healthy Pregnancies Project: Study protocol and baseline characteristics for a cluster-randomized controlled trial of a community intervention to reduce tobacco use among Alaska Native pregnant women.

BACKGROUND: Tobacco use prevalence is high among pregnant Alaska Native (AN) women but few interventions have been evaluated for this group. The Healthy Pregnancies Project aims to evaluate a multicomponent intervention for reducing tobacco use during pregnancy and the postpartum period among AN women. This report describes the study protocol and participant baseline characteristics. DESIGN: Cluster-randomized controlled trial with village as the unit of assignment. Sixteen villages in rural southwest Alaska were stratified on village size and randomized to a multicomponent intervention (n = 8 villages) or usual care (n = 8 villages). METHODS: Pregnant AN women from the study villages were enrolled. All participants receive the usual care provided to pregnant women in this region. Participants from intervention villages additionally receive individual phone counseling on healthy pregnancies plus a social marketing campaign targeting the entire community delivered by local AN "Native Sisters." Baseline measurements for all enrolled pregnant women have been completed. Follow-up assessments are ongoing at delivery, and at 2 and 6 months postpartum. The primary outcome is biochemically verified tobacco use status at 6 months postpartum. RESULTS: Recruitment was feasible with 73% of eligible women screened enrolled. The program reached more than half (56%) of AN pregnant women from the study villages during the recruitment period. Participants are N = 352 pregnant AN women, 188 enrolled from intervention villages and 164 from control villages. At baseline, participants' mean (SD) age was 25.8 (5.0) years, they were at 26.8 (9.8) weeks gestation, and 66.5% were current tobacco users. DISCUSSION: Processes and products from this project may have relevance to other Native American populations aiming to focus on healthy pregnancies in their communities.

The relationship between smoking cessation and binge drinking, depression, and anxiety symptoms among smokers with serious mental illness.

INTRODUCTION: Concerns about the adverse effects of smoking cessation on alcohol use and mental health are a barrier to cessation for smokers with serious mental illness (SMI). The purpose of this study is to examine how incident smoking cessation affects binge drinking and symptoms of depression and anxiety among smokers with SMI. METHODS: The present study is a secondary analysis of the OPTIN trial, which demonstrated the effectiveness of proactive outreach for smoking cessation among Minnesota Health Care Programs enrollees. Participants with ICD-9 codes indicating schizophrenia spectrum disorders, psychotic disorders, bipolar disorders, or severe/recurrent major depressive disorder were categorized as having SMI (n = 939); remaining smokers were categorized as non-SMI (n = 1382). Multivariable regressions modeled the association between incident smoking cessation and binge drinking, PHQ-2 depression scores, and PROMIS anxiety scores in the two groups. RESULTS: Quitting smoking was not associated with binge drinking among those with SMI, but was associated with less binge drinking among those without SMI (p = 0.033). Quitting smoking was not associated with PHQ-2 depression scores among those with or without SMI. However, quitting smoking was associated with lower mean PROMIS anxiety scores for those with SMI (p = 0.031), but not those without SMI. CONCLUSION: Quitting smoking was not associated with heightened binge drinking or symptoms of depression and anxiety among smokers with SMI. These findings suggest that quitting smoking is not detrimental for these patients, and provide evidential support for facilitating access to cessation resources for patients with serious mental illness who smoke.

Consequences of Inconsistency in Air Force Tobacco Control Policy.

OBJECTIVES: Although the United States Air Force (USAF) has been a leader in efforts to reduce tobacco use among service members, tobacco continues to be a problem and initiatives to decrease tobacco use further require buy-in from leadership. We explored line leaderships' perspectives on tobacco. METHODS: A diverse group of 10 senior commissioned and 10 non-commissioned personnel were interviewed. RESULTS: Respondents reported substantial changes in the culture of tobacco use during their years of service, from near ubiquity to restricted use areas. They also perceived mixed messages coming from the USAF, including simultaneous discouragement of and accommodations for tobacco use, and variability in policies and enforcement. Many respondents indicated that allowing tobacco use creates conflict and undermines military discipline and suggested that a tobacco-free policy would be the best way to eliminate these contradictions. CONCLUSION: Although there has been substantial movement away from a culture of tobacco in the USAF, current policies and variable enforcement of these policies create unnecessary contradictions. Establishing a tobacco-free service would resolve these issues in addition to improving the health of service members and veterans.

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.

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.

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.

Key Policy Makers' Awareness of Tobacco Taxation Effectiveness through a Sensitization Program.

The implementation of 5 of the 6 WHO MPOWER program in Iran is satisfactory; the only notable shortcoming is the lack of tobacco taxation increases. This study was designed to increase key policy makers' awareness of tobacco taxation effectiveness through a sensitization program in Iran. This analytical and semi-experimental study in 2014 included 110 tobacco control key policy makers, who were trained and received educational materials on the importance of tobacco taxation. A valid and reliable questionnaire was completed before and three months after intervention. Data were analyzed using mean (SD), t-Test and analysis of variance. The mean (SD) scores at pre- and post-test were 2.7 ± 3 and 8.8 ± 1 out of 10, respectively. Paired t-tests demonstrated a significant difference in the pre- post-test knowledge scores. Increasing knowledge and promoting favorable attitudes of policy makers can lead to greater attention which could in turn change tobacco taxation policies.

Characteristics of Employees of Small Manufacturing Businesses by Occupation: Informing Evidence-Based Intervention Planning.

OBJECTIVES: We examined characteristics of employees in six occupational categories in small manufacturing businesses (20-150 employees). METHODS: We analyzed survey data from 47 businesses (n = 2577 employees; 86% response rate) and examined relationships between job type and sociodemographic, health, and organizational support characteristics. Analyses were adjusted for age and sex, and company as a random effect. RESULTS: Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (P <0.001). Job stress was higher for production workers and support staff than managers (P < 0.0001). Managers perceived social capital (P<0.001), safety climate (P < 0.0001) and support for smoking cessation (P < 0.001) higher than production managers, production workers, and support staff. CONCLUSIONS: Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support.

Quit Smoking Experts' Opinions toward Quality and Results of Quit Smoking Methods Provided in Tobacco Cessation Services Centers in Iran.

BACKGROUND: One of the core responsibilities of health system is to treat tobacco dependence. This treatment includes different methods such as simple medical consultation, medication, and telephone counseling. To assess physicians' opinions towards quality and result of different quit smoking methods provided in tobacco cessation services centers in Iran. METHODS: In this cross-sectional and descriptive study, random sampling of all quit centers at country level was used to obtain a representative sample size of 100 physicians. Physicians completed a self-administered questionnaire which contained 10 questions regarding the quality, cost, effect, side effects, and the results of quitting methods using a 5-point Likert-type scale. Percentages, frequencies, mean, T-test, and variance analyses were computed for all study variables. RESULTS: Most experts preferred to use combination quit smoking methods and then Nicotine Replacement Therapy (NRT) with 26 and 23, respectively. The least used methods were quit line and some methods without medication with 3 cases. The method which gained the maximum scores were telephone consultation, acupuncture, Willpower, Champix, combined method, and Interactive Voice Response (IVR) with the mean of 23.3, 23, 22.5, 22, 21.7 and 21.3, respectively. The minimum scores were related to e-cigarette, some methods without medication, and non-NRT medication with the mean of 12.3, 15.8 and 16.2, respectively. There were no significant differences in the mean of scores based on different cities (P = 0.256). Analysis of variance in mean scores showed significant differences in the means scores of different methods (P < 0.000). CONCLUSIONS: According to physicians acupuncture, personal methods and Champix are the most effective methods and these methods could be much more feasible and cost effective than other methods.

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.

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.

State-of-the-art office-based interventions to eliminate youth tobacco use: the past decade.

Tobacco use and tobacco smoke exposure are among the most important preventable causes of premature disease, disability, and death and therefore constitute a major pediatric health concern. The pediatric primary care setting offers excellent opportunities to prevent tobacco use in youth and to deliver cessation-related treatment to youth and parents who use tobacco. This report updates a "state-of-the-art" article published a decade ago on office-based interventions to address these issues. Since then there has been marked progress in understanding the nature, onset, and trajectories of tobacco use and nicotine addiction in youth with implications for clinical practice. In addition, clinicians need to remain abreast of emerging nicotine delivery systems, such as electronic cigarettes, that may influence uptake or continuation of smoking. Although evidence-based practice guidelines for treating nicotine addiction in youth are not yet available, research continues to build the evidence base toward that goal. In the interim, practical guidelines are available to assist clinicians in addressing nicotine addiction in the pediatric clinical setting. This article reports current practices in addressing tobacco in pediatric primary care settings. It reviews our increasing understanding of youth nicotine addiction, summarizes research efforts on intervention in the past decade and additional research needed going forward, and provides practical guidelines for pediatric health care providers to integrate tobacco use prevention and treatment into their clinical practice. Pediatric providers can and should play an important role in addressing tobacco use and dependence, both in the youth they care for and in parents who use tobacco.