Examining Hookah as an Introduction to Nicotine Products among College Students.

BACKGROUND: Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked. OBJECTIVES: This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. METHODS: Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used. RESULTS: Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product. CONCLUSIONS: The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.

Nicotine withdrawal and dependence among smokers with a history of childhood abuse.

INTRODUCTION: Previous studies have found that those with a history of childhood abuse are more likely to smoke cigarettes than those without a history of abuse. Mechanisms underlying this greater prevalence are unclear. We examined whether current smokers with a history of childhood abuse reported greater levels of nicotine dependence and more severe nicotine withdrawal symptoms. METHODS: We analyzed data from a 2-wave, national, random-digit-dial survey of adult cigarette smokers (n = 751). We examined whether childhood physical, emotional, and sexual abuse were associated with greater levels of nicotine dependence. Among those who made a quit attempt (n = 368), we examined whether abuse was associated with more severe withdrawal symptoms recalled during the 14 months between surveys. For both dependence and withdrawal, we tested a mediation pathway through current serious mental illness (SMI). RESULTS: All 3 types of childhood abuse were associated with more severe withdrawal symptoms. These associations were partially mediated by SMI. Sexual abuse and physical abuse were directly associated with dependence, whereas emotional abuse was indirectly associated with dependence through SMI. CONCLUSIONS: All 3 forms of childhood abuse were associated with both dependence and withdrawal. The greater prevalence of smoking found among those with a history of childhood abuse may be explained by heightened vulnerability to nicotine dependence and withdrawal and may be partially due to comorbid mental illness.

Reduced nicotine content cigarette advertising: How false beliefs and subjective ratings affect smoking behavior.

INTRODUCTION: Tobacco advertising can create false beliefs about health harms that are reinforced by product design features. Reduced nicotine content (RNC) cigarettes may reduce harm, but research has not addressed advertising influences. This study examined RNC cigarette advertising effects on false harm beliefs, and how these beliefs - along with initial subjective ratings of RNC cigarettes - affect subsequent smoking behaviors. We further explored whether subjective ratings moderate associations between false beliefs and behavior. METHODS: Seventy-seven daily, non-treatment-seeking smokers (66.2% male) participated in the first 15days of a randomized, controlled, open-label RNC cigarette trial. Participants viewed an RNC cigarette advertisement at baseline before completing a 5-day period of preferred brand cigarette use, followed by a 10-day period of RNC cigarette use (0.6mg nicotine yield). Participants provided pre- and post-advertisement beliefs, and subjective ratings and smoking behaviors for cigarettes smoked during laboratory visits. RESULTS: Viewing the advertisement increased beliefs that RNC cigarettes contain less nicotine and are healthier than regular cigarettes (p's<0.001 and 0.011), and decreased the belief that they are less likely to cause cancer (p=0.046). Neither false beliefs nor subjective ratings directly affected smoking behaviors. Significant interactions of strength and taste ratings with beliefs (p's<0.001), however, indicated that among smokers with less negative initial subjective ratings, greater false beliefs were associated with greater RNC cigarette consumption. CONCLUSIONS: Smokers may misconstrue RNC cigarettes as less harmful than regular cigarettes. These beliefs, in conjunction with favorable subjective ratings, may increase product use.

The Importance of Filter Collection for Accurate Measurement of Cigarette Smoking.

OBJECTIVES: We examined the impact of cigarette filter collection on reports of cigarettes per day (CPD) versus self-reported CPD and to assess the utility of a pre-intervention baseline period in smoking studies. METHODS: Using baseline data from 522 non-treatment seeking smokers, we assessed differences in self-reported CPD via phone screen (CPD PS) and during baseline (CPD BL). We analyzed self-reported cigarette measures to predict carbon monoxide (CO), a measure of smoke exposure. RESULTS: On average, CPD PS was 2.8 CPD more than CPD BL, and reporting multiples of 10 were more often found in CPD PS compared with CPD BL (54.7% vs17.2%, respectively). CPD BL was more strongly associated with CO than self-report CPD. Number of cigarettes smoked today, time since last cigarette, and nicotine dependence were significantly associated with CO. CONCLUSIONS: CPD BL using filter collection is a more accurate measure of cigarette consumption than self-report, which may have implications for assessment of nicotine dependence. When feasible, studies should include a pre-intervention baseline period for comparison data with study outcomes. In addition to CPD BL, studies should assess time since last cigarette and the number of cigarettes smoked today when using CO as a biological measure of smoke exposure.

Attrition during a randomized controlled trial of reduced nicotine content cigarettes as a proxy for understanding acceptability of nicotine product standards.

AIMS: To determine (1) if nicotine content affects study attrition-a potential behavioral measure of acceptability-in a trial that required compliance with three levels of reduced nicotine content (RNC) cigarettes, and (2) if attrition is associated with subjective and behavioral responses to RNC cigarettes. DESIGN: Secondary analysis of a 35-day, parallel-design, open-label, randomized controlled trial. After a 5-day baseline period, participants were randomized to smoke for three 10-day periods: their preferred brand (control group) or RNC cigarettes with three nicotine levels in a within-subject stepdown (one group: high-moderate-low) or non-stepdown (five groups: high-low-moderate, low-moderate-high, low-high-moderate, moderate-low-high, moderate-high-low) fashion. SETTING: A single site in Philadelphia, PA, USA. PARTICIPANTS: A total of 246 non-treatment-seeking daily smokers [mean age = 39.52, cigarettes per day (CPD) = 20.95, 68.3% white] were recruited from October 2007 to June 2013. MEASUREMENTS: The primary outcome was attrition. Key predictors were nicotine content transition and study period. Exploratory predictors were taste and strength subjective ratings, total puff volume and carbon monoxide (CO) boost. Covariates included: age, gender, race, education and nicotine dependence. FINDINGS: Overall attrition was 31.3% (n = 77): 24.1% of the control and 25.0% of the stepdown RNC cigarette groups dropped out versus 44.6% of non-stepdown groups (P = 0.006). Compared with controls, attrition odds were 4.5 and 4.7 times greater among smokers transitioning from preferred and the highest RNC cigarettes to the lowest RNC cigarettes, respectively (P = 0.001 and 0.003). Providing more favorable initial taste ratings of study cigarettes decreased attrition odds by 2% (P = 0.012). CONCLUSIONS: The majority of participants completed a 35-day trial of varying levels of reduced nicotine content cigarettes. Participant dropout was greater for cigarettes with lower nicotine content and less in smokers reporting more favorable subjective ratings of the cigarettes.

The relationship between childhood physical and emotional abuse and smoking cessation among U.S. women and men.

Childhood maltreatment is associated with increased likelihood of smoking. The purpose of the current investigation was to compare quitting motives, quit attempts, and quit success between U.S. adult smokers with or without childhood maltreatment (physical or emotional abuse), and those with or without serious psychological distress (SPD). We also examined whether SPD mediated associations between childhood maltreatment and all outcomes. We analyzed data from a 2-wave cohort telephone survey of a national U.S. sample of current cigarette smokers (n = 751). We used generalized path modeling to examine associations between maltreatment/SPD and concerns about smoking, motivation to quit, quit attempts, and smoking cessation (among the overall sample and selecting for those who made at least 1 quit attempt between waves; n = 368). Among women, maltreatment and SPD were associated with lower likelihood of quitting as well as making a successful quit attempt. SPD mediated the association between maltreatment and likelihood of successfully quitting. Women with maltreatment also had stronger concerns about smoking and motivation to quit than those without maltreatment, although there were no differences in actual quit attempts made. Neither childhood maltreatment nor SPD was associated with smoking outcomes among men. Findings suggest that female smokers with a history of childhood maltreatment are motivated to quit smoking; however, they may have more difficulty quitting smoking as a result of SPD. (PsycINFO Database Record