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Background: Waterpipe (WP) smoking has become a global public health problem in recent decades and growing evidence indicates that it can cause nicotine dependence. Most evidence on WP dependence to date has been derived from survey-or laboratorybased studies. This study employed qualitative methods to explore WP users' perceptions of dependence in Aleppo, Syria. Methods: A total of 15 focus groups were conducted with 64 adult WP smokers (51 males and 13 females) using a semi-structured interview. All focus group discussions were audiotaped, transcribed, and coded using directed content analysis. Findings: Several WP dependence features were consistent with those commonly reported by cigarette smokers. These included positively reinforced features, such as smoking's association with social gatherings and cultural connectedness, and negatively reinforced features including relief of withdrawal symptoms, stress, and boredom. Although interest in quitting was low, many users perceived quitting WP to be difficult and an indicator of loss of control over smoking, a common marker of dependence. Several observed dependence features were specific to WP, including transitioning from social smoking to smoking alone, and adapting one's behavior to the considerable effort normally required to engage in WP smoking despite inconvenience or cost, and often at the expense of other reinforcers such as social interaction. Conclusion: The general and specific features of WP dependence need to be considered in developing instruments to measure WP dependence, in clinical assessment of WP dependence, and in developing cessation programs. [ABSTRACT FROM AUTHOR]

Electronic nicotine delivery systems (ENDSs) are used by some smokers to reduce cigarette consumption, but their effectiveness is uncertain. We aimed to examine the extent to which ENDSs or a non-nicotine cigarette substitute influence tobacco-related toxicant exposure and cigarette consumption in smokers interested in smoking reduction. We did a four-arm, parallel-group, randomised controlled trial at two sites in the USA (Penn State University, Hershey, PA, and Virginia Commonwealth University, Richmond, VA). We enrolled adults aged 21–65 years who smoked more than nine cigarettes per day (for at least the past year), with exhaled CO of more than 9 parts per million at screening, who were not currently using an ENDS, and who were interested in reducing smoking but not quitting. Participants were randomised (site-specific with allocation concealment; 1:1:1:1) to receive either a cartomiser-based, pen-style ENDS (eGo-style) paired with 0, 8, or 36 mg/mL liquid nicotine (participants and researchers masked to concentration) or a non-ENDS cigarette-shaped plastic tube that delivered no nicotine or aerosol (cigarette substitute; unmasked) for 24 weeks. Conditions were chosen to reflect a range of nicotine delivery including none (cigarette substitute and 0 mg/mL ENDS), low (8 mg/mL), and cigarette-like (36 mg/mL), and all conditions were paired with smoking reduction instructions. The primary outcome was concentration of the tobacco-specific carcinogen metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; urinary total) collected at randomisation and at 4, 12, and 24 weeks. Multiple imputation with and without covariate adjustment was used in addition to sensitivity analyses. This trial is registered with ClinicalTrials.gov , NCT02342795. Between July 22, 2015, and Nov 16, 2017, 684 individuals were screened and 520 (76%) were enrolled and randomised. 188 (36%) of 520 participants were lost to follow-up by week 24; attrition did not differ by study group (39 [30%] of 130 in the cigarette substitute group, 56 [43%] of 130 in the ENDS with 0 mg/mL nicotine group, 49 [38%] of 130 in the ENDS 8 mg/mL group, and 44 [34%] of 130 in the ENDS 36 mg/mL group). Urinary total NNAL at 24 weeks in the ENDS with 36 mg/mL nicotine group was 210·80 pg/mg creatinine (95% CI 163·03–274·42) compared with 346·09 pg/mg creatinine (265·00–455·32) in the cigarette substitute group (p=0·0061). No other significant differences between groups were observed for any time point for urinary total NNAL. Serious adverse event frequency was similar across groups (12 events in 12 participants [9%] in the ENDS with 36 mg/mL nicotine group, seven events in six participants [5%] in the 8 mg/mL group, 11 events in ten participants [8%] in the 0 mg/mL group, and 13 events in 13 participants [10%] in the cigarette substitute group), and all of these were deemed unrelated or unlikely to be related to study product use. There was one death between randomisation and 24 weeks (suicide; in the ENDS with 0 mg/mL nicotine group). Use of an ENDS with cigarette-like nicotine delivery can reduce exposure to a major pulmonary carcinogen, NNAL, even with concurrent smoking. Future ENDS trials should involve products with well characterised nicotine delivery, including those with nicotine delivery approaching that of a cigarette. National Institutes of Health, US Food and Drug Administration. [ABSTRACT FROM AUTHOR]

Objectives: E-cigarettes are increasingly being used by cigarette smokers as a cessation aid. In this study, we used concept mapping to identify the full spectrum of experiences of smokers who have tried vaping to quit. Methods: In 2018, adult cigarette smokers who tried vaping to quit were recruited to complete a survey and concept mapping tasks. Participants (N = 98) generated statements by responding to a prompt. Participants then sorted and rated each of the unique statements generated during brainstorming. Multidimensional scaling and hierarchical cluster analysis were used to create a map of thematic clusters describing smokers' experiences. Mean cluster ratings were compared by reported success in quitting. Results: We identified 7 clusters. Mean cluster ratings ranged from 4.81 (SD = 0.64) for Positive Attributes to a low of 3.31 (SD = 0.78) for Health Concerns. The Positive Outcomes, Positive Attributes, and Positive Relationship clusters were rated higher among those who self-reported successfully quitting relative to non-successful quitters (ps <.05). Those who did not report quitting success rated the clusters related to limitations higher than self-reported quitters (ps <.05). Conclusions: Smokers who self-reported successful quitting had more positive experiences while vaping to quit than did those who failed to quit. [ABSTRACT FROM AUTHOR]

Objectives: The province of Ontario, Canada banned menthol in cigarettes and other tobacco products effective January 1, 2017 thereby adding to an existing flavor ban. However, there was an exemption for all flavored e-cigarettes, flavored cigars larger than 6 grams, and alcohol flavored cigars without filters over 1.4 grams. In this paper, we examine the association between use of flavored non-cigarette products and self-reported cigarette smoking cessation after the ban. Methods: We recruited current past-30 day cigarette smokers (N = 913) who were 16 years or older and living in Ontario during September-December 2016 and re-contacted January-August 2018. Results: Both daily and occasional pre-ban menthol cigarette smokers were more likely to use flavored cigar products (adjusted relative rate, RR = 1.53, 95% confidence interval, CI = 1.01, 2.31; adjusted RR = 1.57, 95% CI = 1.06, 2.30) after the ban, while occasional pre-ban menthol cigarette smokers were more likely to use other tobacco products (adjusted RR = 1.25, 95% CI = 1.02, 1.53) or flavored other tobacco products (adjusted RR = 1.56, 95% CI = 1.09, 2.24), conditional on prior use. Conclusions: Menthol smokers prior to the ban were more likely to use other tobacco products, or flavored tobacco products, after the ban. These results suggest that comprehensive menthol bans could be more effective without the option of using flavored tobacco or nicotine products as substitutes. [ABSTRACT FROM AUTHOR]

Background: The capability of electronic cigarette devices (e-cigs) to deliver nicotine is key to their potential to replace combustible cigarettes. We compared nicotine delivery and subjective effects associated with the use of two classes of e-cigarettes and cigarettes. Methods: 14 e-cigarette users were instructed to vape their own e-cigarette device every 20 seconds for 10 minutes while blood was drawn at 1, 2, 4, 6, 8, 10,12, and 15 minutes after initiating vaping. Users rated withdrawal symptoms and side effects before and after vaping. E-cigarette devices were classified as first-generation (same size as cigarette, no activation button) or advanced (larger than cigarette with an activation button). Separately, 10 cigarette smokers completed a similar protocol. Fisher’s Exact Test and two-sided t-tests were used as appropriate to determine differences in outcomes between first-generation e-cigarette users, advanced e-cigarette users, and smokers. Results: Compared to first-generation devices, advanced devices were associated with greater serum nicotine Cmax (ng/ml) (11.5 v. 2.8, p = 0.0231) and greater nicotine boost (ng/ml) (10.8 v. 1.8, p = 0.0177). Overall, e-cigarettes users experienced a significant reduction in withdrawal and craving, although there were no significant differences between users of first-generation and advanced devices. Comparing e-cigarettes overall to cigarettes, cigarettes were associated with greater Cmax (25.9 v. 9.0, p = 0.0043) and greater nicotine boost (21.0 v. 8.2, p = 0.0128). Conclusions: Advanced e-cigarettes delivered significantly more nicotine than first-generation devices but less than combustible cigarettes. Overall, e-cigarette use was associated with a reduction in withdrawal and craving with no reported side effects. The wide variation in nicotine absorption from different e-cigarette devices should be considered in studies of e-cigarettes for smoking cessation. [ABSTRACT FROM AUTHOR]

Objective: We examined menthol cigarette smokers' reactions to Ontario's menthol cigarette ban. Methods: In April 2017, past-year adult menthol cigarette smokers from Ontario, Canada (N = 67; 64.2% women) participated in an online study. Participants generated statements describing their reactions to the ban. Researchers reviewed statements continuously until reaching content saturation, and then removed duplicate statements. Participants sorted the final 79 statements by content similarity and rated each statement from 1 (Definitely NOT true) to 7 (Definitely true). Multidimensional scaling of sorting data generated a cluster map and mean cluster ratings were compared. Results: Seven statement clusters describing reactions to the menthol ban were generated: thoughts about the ban, perceiving the ban as ineffective, emotional reactions to the ban, smoking non-menthol cigarettes, smoking cessation or reduction, alternative menthol cigarette purchasing behaviors, and alternative tobacco use behaviors. Participants rated the thoughts about the ban cluster highest (most true) and alternative tobacco use behaviors cluster lowest (least true). Participants who smoked menthol cigarettes before the ban every day or most days rated clusters higher than pre-ban occasional or rare menthol smokers. Conclusions: Banning menthol cigarettes resulted in reactions including negative feelings about the ban, smoking cessation attempts, and behaviors to find menthol cigarette alternatives. [ABSTRACT FROM AUTHOR]

In this case-control study, the influence of waterpipe tobacco smoking on the plasma and saliva levels of cadmium, lead and zinc was examined in participants who were waterpipe tobacco smokers (WS) or never-smokers (NS). The concentration of metals was higher in WS relative to NS. The mean (SEM) cadmium concentration in plasma was 3.3 (0.18) µg/dL in WS versus 0.82 (0.09) µg/L in NS (p < .001) and in saliva was 5.1 (0.36) µg/L in WS versus 0.64 (0.2) µg/L in NS (p < .001). The mean (SEM) lead concentration in plasma was 5.2 (0.25) µg/dL in WS versus 3.4 (0.41) µg/dL in NS (p < .01) and in saliva was 4.8 (0.58) µg/L in WS versus 2.8 (0.27) µg/L in NS (p < .05). Similarly, a significant difference in zinc concentration was observed, with a mean of 2.0 (0.17) µg/mL in WS plasma versus 1.49 (0.16) µg/mL in NS (p < .05) and a mean 0.94 (0.07) µg/mL in WS saliva versus 0.45 (0.06) µg/mL in NS (p < .01). In conclusion, waterpipe tobacco smoking is associated with elevated levels of metals in body fluids. These results provide another demonstration of how waterpipe tobacco smoking exposes smokers to harmful toxicants. [ABSTRACT FROM AUTHOR]

Objectives: We measured e-cigarettes' abuse liability compared to conventional tobacco cigarettes under flavor and message conditions amenable to regulation. Methods: Two studies used 2 x 2 within-subjects designs with factors of e-cigarette flavor (Study 1: tobacco vs menthol; Study 2: cherry vs unflavored) and message (Study 1: reduced harm vs no message; Study 2: reduced exposure to carcinogens vs no message) with cigarette smokers (N(total) = 36). Linear mixed effects models assessed abuse liability for tobacco products. Outcomes included the price after which consumption is zero (the maximum amount participants would pay for a tobacco product) from the multiple-choice procedure (MCP) and cigarette purchase task (CPT) and demand elasticity (price sensitivity) from the CPT. Results: In the MCP, the price where consumption reached zero was significantly lower in all e-cigarette conditions except tobacco flavor (message or no message) compared to cigarettes (ps < .05). Demand elasticity was significantly higher for menthol/no message and unflavored/reduced exposure message conditions relative to cigarettes (ps < .05). Conclusions: Flavors and modified risk messages included with e-cigarettes may affect e-cigarette abuse liability among smokers, suggesting regulatory pathways to influence demand for conventional and alternative tobacco products. [ABSTRACT FROM AUTHOR]

Introduction: Increased consumption of little cigars and cigarillos (LCCs) among late adolescent and young adult African American smokers is an emerging public health concern. Despite a growing body of epidemiological evidence, there is scant research on systematic variations in LCC use among young adult African Americans. This study aimed to disaggregate African American Black & Mild (B&M) smokers and to identify subgroups of cigarillo smokers' behaviors and associated characteristics.Methods: Using telephone screening data for a NIH-funded clinical laboratory study of toxicant exposure associated with B&M use, latent class analysis (LCA) was used to classify 331 African American B&M smokers' based on daily use, average daily consumption, preference for flavors, preference for product design tips, and product modification behaviors.Results: Results showed five classes, three of which (Daily-Hypers, Daily-Flavored, and Heavy-Daily-Hypers) reflected daily use and average daily consumption rate ranging between 2.7 and 8.9 B&M cigarillos per day. Non-Daily-Hypers and Non-Daily-Flavored classes represented non-daily use patterns and averaged less than 1.0 B&M cigarillo per day. Both sets of classes defined by daily users and non-daily users included smokers who preferred flavored tobacco and who practiced product modification techniques involving hyping and blunting.Conclusions: Latent class analysis is a useful method to detect subtle differences in B&M product preferences and smoking behaviors among African Americans. Study findings highlight the importance of developing tailored interventions that consider within group differences in order to reduce the prevalence of cigarillo smoking among those with the greatest burden.Implications: The current study is the first to identify unique subgroups of African American B&M smokers based on cigarillo use behaviors and associated characteristics. Latent class analyses may prove useful for understanding other subgroups of tobacco users. Current findings concerning patterns of LCC use illustrate how future tobacco cessation and prevention interventions may be tailored for African American smokers. [ABSTRACT FROM AUTHOR]

Introduction: Electronic cigarettes (ECIGs) aerosolize a liquid that usually contains propylene glycol and/or vegetable glycerin, flavorants, and the dependence-producing drug nicotine in various concentrations. This study examined the extent to which ECIG liquid nicotine concentration is related to user plasma nicotine concentration in ECIG-naïve tobacco cigarette smokers.Methods: Sixteen ECIG-naïve cigarette smokers completed four laboratory sessions that differed by the nicotine concentration of the liquid (0, 8, 18, or 36 mg/ml) that was placed into a 1.5 Ohm, dual coil "cartomizer" powered by a 3.3V battery. In each session, participants completed two, 10-puff ECIG use bouts with a 30-second inter-puff interval; bouts were separated by 60 minutes. Venous blood was sampled before and after bouts for later analysis of plasma nicotine concentration; puff duration, volume, and average flow rate were measured during each bout.Results: In bout 1, relative to the 0mg/ml nicotine condition (mean = 3.8 ng/ml, SD = 3.3), plasma nicotine concentration increased significantly immediately after the bout for the 8 (mean = 8.8 ng/ml, SD = 6.3), 18 (mean = 13.2 ng/ml, SD = 13.2), and 36 mg/ml (mean = 17.0 ng/ml, SD = 17.9) liquid concentration. A similar pattern was observed after bout 2. Average puff duration in the 36 mg/ml condition was significantly shorter compared to the 0mg/ml nicotine condition. Puff volume increased during the second bout for 8 and 18 mg/ml conditions.Conclusions: For a given ECIG device, nicotine delivery may be directly related to liquid concentration. ECIG-naïve cigarette smokers can, from their first use bout, attain cigarette-like nicotine delivery profiles with some currently available ECIG products.Implications: Liquid nicotine concentration can influence plasma nicotine concentration in ECIG-naïve cigarette smokers, and, at some concentrations, the nicotine delivery profile of a 3.3V ECIG with a dual coil, 1.5-Ohm cartomizer approaches that of a combustible tobacco cigarette in this population. Finding a product that delivers nicotine as effectively as a tobacco cigarette, as we report here, may be essential for smokers who want to replace completely their combustible tobacco cigarettes with ECIGs. [ABSTRACT FROM AUTHOR]

Electronic cigarettes (ECIGs) comprise an aerosolized nicotine delivery product category that provides consumers with probably unprecedented control over extensive features and operating conditions, allowing a wide range of nicotine yields to be obtained. Depending on the combination of such ECIG variables as electrical power input, geometry, liquid composition, and puff behavior, ECIG users can extract in a few puffs far more or far less nicotine than with a conventional combustible cigarette. These features of ECIG design and use present challenges for public health policy, central among which is the question of how to regulate nicotine delivery. In this commentary, we propose a conceptual framework intended to provide a convenient approach for evaluating and regulating the nicotine emitted from ECIGs. This framework employs nicotine flux to account for the total dose and rate at which nicotine reaches the user, 2 key factors in drug abuse liability. The nicotine flux is the nicotine emitted per puff second (e.g., mg/s) by a given ECIG design under given use conditions, and it can be predicted accurately using physical principles. We speculate that if the flux is too low, users likely will abandon the device and maintain conventional tobacco product use. Also, we speculate that if the flux is too high, individuals may suffer toxic side effects and/or the device may have higher-than-necessary abuse liability. By considering ECIG design, operation conditions, liquid composition, and puff behavior variables in combination, we illustrate how ECIG specifications can be realistically mandated to result in a target flux range. [ABSTRACT FROM AUTHOR]

Introduction: Electronic cigarettes (ECIGs) heat a nicotine-containing solution; the resulting aerosol is inhaled by the user. Nicotine delivery may be affected by users’ puffing behavior (puff topography), and little is known about the puff topography of ECIG users. Puff topography can be measured using mouthpiece-based computerized systems. However, the extent to which a mouthpiece influences nicotine delivery and subjective effects in ECIG users is unknown. Methods: Plasma nicotine concentration, heart rate, and subjective effects were measured in 13 experienced ECIG users who used their preferred ECIG and liquid (≥12mg/ml nicotine) during 2 sessions (with or without a mouthpiece). In both sessions, participants completed an ECIG use session in which they were instructed to take 10 puffs with 30-second inter-puff intervals. Puff topography was recorded in the mouthpiece condition. Results: Almost all measures of the effects of ECIG use were independent of topography measurement. Collapsed across session, mean plasma nicotine concentration increased by 16.8ng/ml, and mean heart rate increased by 8.5 bpm (ps < .05). Withdrawal symptoms decreased significantly after ECIG use. Participants reported that the mouthpiece affected awareness and made ECIG use more difficult. Relative to previously reported data for tobacco cigarette smokers using similar topography measurement equipment, ECIG-using participants took larger and longer puffs with lower flow rates. Conclusions: In experienced ECIG users, measuring ECIG topography did not influence ECIG-associated nicotine delivery or most measures of withdrawal suppression. Topography measurement systems will need to account for the low flow rates observed for ECIG users. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarettes (e-cigarettes) represent an emerging public health issue. These devices deliver nicotine along with other constituents, including flavorants, via an inhalable aerosol. Their uptake is rapidly increasing in both adults and youths, primarily among current smokers. Public debate is increasing on how these devices should be regulated and used, yet only limited peer-reviewed research exists. To develop a informed policy for e-cigarettes, their effects on human behavior, physiology, and health need to be understood. Purpose: This paper describes proceedings from a National Institutes of Health–sponsored workshop, which was held in November 2013, to identify research needs related to the effects of e-cigarettes. Discussion topics included e-cigarette risks and abuse potential; the potential role for e-cigarettes in harm reduction and smoking cessation; unintended consequences of e-cigarette use, such as becoming a gateway to conventional cigarettes; and dual use of both e-cigarettes and conventional cigarettes. Results and Conclusions: The research needs identified by the workshop participants included the following: standards to measure the contents and emissions of e-cigarettes; biomarkers of exposure; physiological effects of e-cigarettes on tissues and organ systems, including pulmonary and cardiovascular; information on e-cigarette users, how the devices are used, and identification of the best tools to assess these measures; factors that drive use and influence patterns of use; and appropriate methods for evaluating a potential role for e-cigarettes in smoking or nicotine cessation. To understand fully the challenges and the opportunities that e-cigarettes represent, expertise will be needed in basic, behavioral, translational, and clinical sciences. [ABSTRACT FROM AUTHOR]

Introduction: Some electronic cigarette (ECIG) users attain tobacco cigarette–like plasma nicotine concentrations while others do not. Understanding the factors that influence ECIG aerosol nicotine delivery is relevant to regulation, including product labeling and abuse liability. These factors may include user puff topography, ECIG liquid composition, and ECIG design features. This study addresses how these factors can influence ECIG nicotine yield. Methods: Aerosols were machine generated with 1 type of ECIG cartridge (V4L CoolCart) using 5 distinct puff profiles representing a tobacco cigarette smoker (2-s puff duration, 33-ml/s puff velocity), a slow average ECIG user (4 s, 17 ml/s), a fast average user (4 s, 33 ml/s), a slow extreme user (8 s, 17 ml/s), and a fast extreme user (8 s, 33 ml/s). Output voltage (3.3–5.2 V or 3.0–7.5 W) and e-liquid nicotine concentration (18–36 mg/ml labeled concentration) were varied. A theoretical model was also developed to simulate the ECIG aerosol production process and to provide insight into the empirical observations. Results: Nicotine yields from 15 puffs varied by more than 50-fold across conditions. Experienced ECIG user profiles (longer puffs) resulted in higher nicotine yields relative to the tobacco smoker (shorter puffs). Puff velocity had no effect on nicotine yield. Higher nicotine concentration and higher voltages resulted in higher nicotine yields. These results were predicted well by the theoretical model (R2 = 0.99). Conclusions: Depending on puff conditions and product features, 15 puffs from an ECIG can provide far less or far more nicotine than a single tobacco cigarette. ECIG emissions can be predicted using physical principles, with knowledge of puff topography and a few ECIG device design parameters. [ABSTRACT FROM AUTHOR]

Introduction: Electronic cigarettes (e-cigs) are becoming increasingly popular, but little is known about their dependence potential. This study aimed to assess ratings of dependence on electronic cigarettes and retrospectively compare them with rated dependence on tobacco cigarettes among a large sample of ex-smokers who switched to e-cigs. Methods: A total of 3,609 current users of e-cigs who were ex-cigarette smokers completed a 158-item online survey about their e-cig use, including 10 items designed to assess their previous dependence on cigarettes and 10 almost identical items, worded to assess their current dependence on e-cigs (range 0–20). Results: Scores on the 10-item Penn State (PS) Cigarette Dependence Index were significantly higher than on the comparable PS Electronic Cigarette Dependence Index (14.5 vs. 8.1, p < .0001). In multivariate analysis, those who had used e-cigs longer had higher e-cig dependence scores, as did those using more advanced e-cigs that were larger than a cigarette and had a manual button. Those using zero nicotine liquid had significantly lower e-cig dependence scores than those using 1–12mg/ml, who scored significantly lower than those using 13 or greater mg/ml nicotine liquid (p < .003). Conclusions: Current e-cigarette users reported being less dependent on e-cigarettes than they retrospectively reported having been dependent on cigarettes prior to switching. E-cig dependence appears to vary by product characteristics and liquid nicotine concentration, and it may increase over time. [ABSTRACT FROM AUTHOR]

Background: Tobacco cigarette smoking is a global health problem that kills millions each year. Recently, tobacco smoking using a waterpipe (WP) has become popular worldwide. However, unlike cigarettes, the cardiovascular (CV) risks associated with WP smoking are uncertain. In this study, the immediate effects of WP smoking on central and peripheral CV indices were evaluated in 53 young healthy smokers. Materials and methods: Strain-gauge plethysmography was used to measure forearm blood flow (Bf), vascular resistance (Vr), and venous capacitance (Vc) and outflow (Vf) at rest (R) and after occlusion (Oc), whereas heart rate (HR) and blood pressure (BP) were measured using standard automated auscultatory methods immediately before and after a 30-min WP smoking session. Results: Smoking resulted in HR, diastolic BP, mean arterial BP, rate pressure product and OcVr increases ( p < 0.05) 6.6, 3.6, 2.5, 8.0 and 16%, respectively, whereas OcBf and OcVf decreased ( p < 0.05) 8.8 and 14.3%, respectively. Additionally, smoking-induced changes in the central CV components correlated ( p < 0.05) with changes in the periphery. Conclusion: These results demonstrated changes in the CV central and peripheral components immediately after WP smoking. The correlations between the changes in these components suggest that the periphery is controlled, at least partially, by the same mechanism(s) affecting the central CV components during WP smoking. [ABSTRACT FROM AUTHOR]

Introduction: To date research on tobacco smoking with a waterpipe (hookah, narghile, and shisha) has focused primarily on the individual user in a laboratory setting. Yet, waterpipe tobacco smoking is often a social practice that occurs in cafés, homes, and other natural settings. This observational study examined the behavior of waterpipe tobacco smokers and the social and contextual features of waterpipe use among groups in their natural environment. Methods: Trained observers visited urban waterpipe cafés on multiple occasions during an 8-month period. Observations of 241 individual users in naturally formed groups were made on smoking topography (puff frequency, duration, and interpuff interval [IPI]) and engagement in other activities (e.g., food and drink consumption, other tobacco use, and media viewing). Results: Most users were male in group sizes of 3–4 persons, on average, and each table had 1 waterpipe, on average. The predominant social features during observational periods were conversation and nonalcoholic drinking. Greater puff number was associated with smaller group sizes and more waterpipes per group, while longer IPIs were associated with larger group sizes and fewer waterpipes per group. Additionally, greater puff frequency was observed during media viewing and in the absence of other tobacco use. Conclusions: Overall, the results suggest that waterpipe smoking behavior is affected by group size and by certain social activities. Discussion focuses on how these findings enhance our understanding of factors that may influence exposure to waterpipe tobacco smoke toxicants in naturalistic environments. [ABSTRACT FROM PUBLISHER]

Introduction: Tobacco use remains a major public health problem worldwide. Water-pipe smoking is spreading rapidly and threatening to undermine the successes achieved in tobacco control. Methods: A school-based longitudinal study in the city of Irbid, Jordan, was performed from 2008 to 2010. All seventh-grade students in 19 randomly selected schools, out of a total of 60 schools in the city, were enrolled at baseline and surveyed annually. Results: Of the 1781 students enrolled at baseline 1,701 (95.5%) were still in the study at the end of the second year of follow-up (869 boys, median age at baseline 13 years). Ever and current water-pipe smoking were higher than those of cigarette smoking at baseline (ever smoking: 25.9% vs. 17.6% and current smoking: 13.3% vs. 5.3% for water-pipe and cigarette smoking, respectively; p < .01 for both) but cigarette smoking caught up by the second year of follow-up (ever smoking: 46.4% vs. 44.7%; p = .32 and current smoking: 18.9% vs. 14.9%; p < .01). Water pipe–only smokers at baseline were twice as likely to become current cigarette smokers after 2 years compared with never smokers (relative risk (RR) = 2.1; 95% CI = 1.2, 3.4). A similar pattern was observed for cigarette-only smokers at baseline (RR = 2.0; 95% CI = 0.9, 4.8). Conclusions: Prevalence of water-pipe and cigarette smoking increased dramatically over the 2-year follow-up period with similar patterns in boys and girls, although girls had lower prevalence in all categories. Water-pipe smoking at baseline predicted the progress to cigarette smoking in the future and vice versa. [ABSTRACT FROM PUBLISHER]

Introduction: The spread of waterpipe tobacco use among youth may be due in part to perceptions that waterpipe tobacco use is safer than other tobacco products, such as cigarettes. In two pilot studies, we sought to modify college waterpipe smokers’ perceived risks and worry about waterpipe tobacco smoking. Methods: We conducted two web-based studies that varied whether college waterpipe users received information on (a) spread of and use of flavored tobacco in waterpipe and (b) harms of waterpipe smoking. Study 1 (N = 91) tested the “incremental” effects on perceptions of risk and worry of adding information about harms of waterpipe smoking to information on the spread of waterpipe and use of flavorings in the tobacco. Study 2 (N = 112) tested the effects on perceptions of risk and worry of reviewing information about harms of waterpipe smoking compared to a no information control group. In Study 1 only, we assessed as part of a 6-month follow-up (n = 70) the percentage of participants who reported no longer using waterpipe. Results: Pooling data from both studies, participants who received information about the harms of waterpipe smoking reported greater perceived risk and worry about harm and addiction and expressed a stronger desire to quit. In Study 1, 62% of participants in the experimental group versus 33% in the control group reported having stopped waterpipe use. Conclusions: These are the first studies to show that perceptions of addiction and harm from waterpipe use can be modified using minimally intensive interventions; such interventions show promise at decreasing waterpipe use. [ABSTRACT FROM AUTHOR]

Abstract: This study''s objective is to examine the relative effectiveness of cigarettes and waterpipe (WP) in reducing tobacco abstinence symptoms in dual cigarette/WP smokers. Sixty-one dual cigarette/WP smokers participated (mean age±SD 22.0±2.6year; mean cigarettes/day 22.4±10.1; mean WPs/week 5.2±5.6). After 12-hour abstinence participants completed two smoking sessions (WP or cigarette), while they responded to subjective measures of withdrawal, craving, and nicotine effects administered before smoking and 5, 15, 30 and 45min thereafter. For both tobacco use methods, scores on measures of withdrawal and craving were high at the beginning of session (i.e., before smoking) and were reduced significantly and comparably during smoking. Analysis of smoking and recovery (post-smoking) phases showed similarity in the way both tobacco use methods suppressed withdrawal and craving, but the recovery of some of these symptoms can be faster with cigarette use. This study is the first to show the ability of WP to suppress abstinence effects comparably to cigarettes, and its potential to thwart cigarette cessation. [Copyright &y& Elsevier]

Introduction:: Although water pipe tobacco smoking is common in Lebanon and Syria, prevalence in neighboring Jordan is uncertain. The purposes of this study were (a) to assess the prevalence of water pipe tobacco smoking among university students in Jordan and (b) to determine associations between sociodemographic variables and water pipe tobacco smoking in this population. [ABSTRACT FROM PUBLISHER]

Introduction:: Potential-reduced exposure products (PREPs) are marketed as a way for smokers to continue using tobacco while possibly lessening their tobacco toxicant intake. Some tobacco-based PREPs are combustible and intended to be smoked, while others are noncombustible and intended to be administered orally (e.g., Camel Snus [CS] tobacco sachets and Ariva tobacco tablets). The ability of these noncombustible PREPs to reduce smokers’ exposure to cigarette-delivered toxicants and suppress tobacco abstinence symptoms effectively is unclear. Clinical laboratory methods have been used to measure combustible PREP-associated toxicant exposure and abstinence symptom suppression and could be applied to evaluating the effects of orally administered noncombustible PREPs. [ABSTRACT FROM PUBLISHER]

Although cigarette smoking remains the most prevalent form of tobacco use in girls and in women of reproductive age globally, use of non-cigarette forms of tobacco is prevalent or gaining in popularity in many parts of the world, especially in low- and middle-income countries. Sparse but growing evidence suggests that the use of some non-cigarette tobacco products during pregnancy increases the risk of adverse pregnancy outcomes. In this paper we review the literature on the prevalence of non-cigarette tobacco product use in pregnant women and in women of reproductive age in high-, middle-, and low-income countries and the evidence that maternal use of these products during pregnancy has adverse health effects. In addition, we communicate findings from an international group of perinatal and tobacco experts that was convened to establish research priorities concerning the use of non-cigarette tobacco products during pregnancy. The working group concluded that attempts to develop a public health response to non-cigarette tobacco use in women are hindered by a lack of data on the epidemiology of use in many parts of the world and by our limited understanding of the type and magnitude of the health effects of these products. We highlight research gaps and provide recommendations for a global research agenda. [ABSTRACT FROM AUTHOR]

Introduction:: Waterpipe tobacco smoking is increasing in popularity though the toxicant exposure and effects associated with this tobacco use method are not well understood. [ABSTRACT FROM PUBLISHER]

Several potential reduced exposure products (PREPs) for smokeless tobacco (SLT) users are marketed in the United States, though their effects are largely unknown. These products include some that are low in tobacco-specific nitrosamines (TSNs), like Stonewall, a pressed tobacco tablet, and General snus, a moist snuff product produced in Sweden. Methodology assessing the toxicant exposure and effects of cigarette-like PREPs for smokers has been developed, and might be modified for use in evaluating PREPs for SLT users. This report describes two studies examining the toxicant exposure and effects of two PREPs for SLT users. Study 1 (n = 13) consisted of four 4.5-hr laboratory sessions where SLT products (own brand, Stonewall, General snus, and tobacco-free placebo) were used for four 30-min episodes and nicotine exposure and tobacco/nicotine abstinence symptoms were measured. Study 2 (n = 19) consisted of four 5-day ad libitum use periods when participants used own brand, Stonewall, General snus, or no SLT and urinary levels of metabolites of nicotine (cotinine) and the TSN 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNAL) and abstinence symptoms were measured. Compared with own brand, Stonewall was associated with lower levels of cotinine and NNAL, while General snus was associated with similar levels of cotinine and lower levels of NNAL. Abstinence symptoms generally did not differ across tobacco conditions. These results show that clinical laboratory methods can be used to evaluate the toxicant exposure and abstinence symptom suppression associated with PREPs for SLT users. [ABSTRACT FROM AUTHOR]

Although waterpipe tobacco smoking seems to be increasing on U.S. university campuses, these data have come from convenience samples. We aimed to determine the prevalence of and associations with waterpipe tobacco smoking among a random sample of students. We surveyed a random sample of graduate and undergraduate students at a large, urban university. We used multivariate modeling to determine independent associations between belief-related predictors and waterpipe tobacco smoking. Of the 647 respondents, waterpipe smoking was reported in 40.5%, over the past year in 30.6%, and over the past 30 days in 9.5%. Over half of the sample (52.1%) perceived that tobacco smoking from a waterpipe was less addictive than cigarette smoking. In fully adjusted multivariate models, 1-year waterpipe smoking was associated with low perceived harm (OR = 2.54, 95% CI = 1.68, 3.83), low perceived addictiveness (OR = 4.64, 95% CI = 3.03, 7.10), perception of high social acceptability (OR = 20.00, 95% CI = 6.03, 66.30), and high perception of popularity (OR = 4.72, 95% CI = 2.85, 7.82). In this sample, lifetime waterpipe use was as common as lifetime cigarette use. Perception of harm, perception of addictiveness, social acceptability, and popularity were all strongly related to waterpipe smoking. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility of implementing cessation interventions in Syria. Methods: We randomized 50 smokers to either a brief or intensive behavioral cessation intervention. Adherence to treatment and cessation through 3 months postcessation were calculated. Results: Adherence in the intensive group was only moderate and was associated with smoking for more years and higher self-efficacy. Cessation rates in the brief and intensive intervention groups were 16% and 4%, respectively. Nicotine dependence predicted abstinence at 3 months. Conclusion: Important barriers to cessation included perceived dependence, lack of access to pharmacotherapy, poor social support, and water pipe smoking. [ABSTRACT FROM AUTHOR]

Waterpipe tobacco smoking is increasingly common worldwide, and evidence about its harmful effects to smokers is emerging. However, no studies have investigated the potential exposure of nonsmokers to waterpipe smoke. We measured particulate matter (PM) emissions (PM2.5, PM10) before and during laboratory sessions in which 20 individuals used a waterpipe to smoke tobacco and 20 individuals smoked a cigarette (10 for each particle-size/smoking-method), as well as 10 waterpipe and 10 cigarette smoldering sessions (i.e., without a smoker). A TSI-SidePak aerosol monitor obtained PM2.5, PM10 background, smoking, and maximum levels. Mean PM2.5 rose 447% for waterpipe (from 48 µg/m3 background to 264 µg/m3 smoking), and by 501% for cigarettes (from 44 µg/m3 to 267 µg/m3), whereas mean PM10 rose by 563% for waterpipe (from 55 µg/m3 to 365 µg/m3), and by 447% for cigarettes (from 52 µg/m3 to 287 µg/m3) (p<.05 for all). The increase in PM during cigarette smoking was due primarily to PM2.5, given that the proportion of PM2.5 from total PM10 increase was 95% compared with 70% for waterpipe (p<.05). Maximum PM2.5 was 908 µg/m3 for waterpipe and 575 µg/m3 for cigarettes, whereas maximum PM10 was 1052 µg/m3 for waterpipe and 653 µg/m3 for cigarettes. Mean PM2.5 and PM10 smoldering levels did not differ from background for waterpipe but were significantly higher for cigarettes (PM2.5: 33-190 µg/m3; PM10: 42-220 µg/m3). Policymakers considering clean air regulations should include waterpipe tobacco smoking, and the public should be warned about this source of smoke exposure. [ABSTRACT FROM AUTHOR]

The tobacco industry markets potential reduced exposure products (PREPs) to smokers, including oral products that are intended to be used in situations where cigarettes cannot. For example, Ariva, marketed by Star Scientific, is a tablet made from compressed tobacco powder and is intended for "adult smokers in situations where they cannot or choose not to smoke." No objective data are available regarding Ariva's effects in smokers, including its nicotine delivery, cardiovascular profile, or subjective effects. In this single-session, clinical laboratory study, 10 overnight-abstinent cigarette smokers were administered one Ariva tablet, followed 90 min later by two Ariva tablets, followed 90 min later by three Ariva tablets. Participants allowed each dose to dissolve in their mouths according to package instructions. Blood was sampled, heart rate monitored, and subjective effects assessed regularly. Ariva delivered nicotine in a dose-dependent manner; mean (SD) nicotine levels increased from 2.4 ng/ml (0.9) at baseline, to 3.4 ng/ml (1.4) 45 min post-1 tablet, 7.3 ng/ml (4.0) 45 min post-2 tablets, and 9.7 ng/ml (4.4) 45 min post-3 tablets. Heart rate increased after tablet administration, independent of dose. The tablets also significantly decreased subjective ratings of craving and urge, and increased ratings of nausea. Based on this short-term laboratory evaluation, Ariva exposes users to nicotine and may suppress some symptoms of tobacco abstinence, though its nausea-inducing characteristics may limit initial acceptability. [ABSTRACT FROM AUTHOR]

Abstract: Retrospective self-report data indicate that early cigarette use episodes may be important predictors of smoking. Unfortunately, recall of early experiences are confounded with current smoking. The current study is the first to examine early cigarette use episodes (EUEs) prospectively in novice smokers (less than 15 lifetime cigarettes). Smoking amount, context and subjective experiences for up to five of the first cigarette episodes during their first year of college were collected using weekly internet-based questionnaires and structured interviews. Data were obtained on 538 EUEs from 163 students. EUEs generally occurred within a social/party context; over 90% of EUEs occurred when participants were with other people who were smoking and over 65% occurred while participants were drinking alcohol. Subjective effects across episodes were reported as generally mild and factor analysis yielded Positive, Negative and Sensory/Peripheral effects scales. Subjective effects were related to the amount smoked and inhalation, whereas EUE context, including alcohol use and social context, was not. This study demonstrates that it is possible to study EUEs in college students within days or weeks of their occurrence and that most of these occur in social settings with the concurrent use of alcohol. [Copyright &y& Elsevier]

Smoking‐related cancer and other disease account for more than 400,000 U.S. deaths annually. Smoking cessation reduces smoking‐related disease rates, but relapse rates are high. Thus, interest in reducing the harm of continued smoking is growing. Potential reduced exposure products (PREPs) are marketed to reduce smokers' exposure to smoke toxicants such as carbon monoxide (CO) and carcinogens and may be harm reduction tools. New PREPs are proliferating, but past experience with “low‐yield” cigarettes that failed to reduce smokers' toxicant exposure suggests that comprehensive evaluation is necessary to predict if these new products are likely to alter the harm caused by smoking. The purpose of the study was to develop clinical laboratory methods for PREP evaluation. Smokers (N = 35) completed four, 5‐day conditions that differed by product used: Advance, Eclipse, own brand cigarettes, or no cigarettes. Carcinogen (as assessed by one nitrosamine and one polycyclic aromatic hydrocarbon biomarker) and nicotine exposure were assessed via thrice‐weekly urine sampling. Withdrawal symptoms were measured daily, and smoking behavior was assessed on the first and last day of each condition. Relative to own brand, Advance reduced exposure to the nitrosamine NNK and CO, and Eclipse reduced exposure to nicotine and the nitrosamine NNK, increased exposure to CO, and resulted in larger, longer, and more frequent puffs. No smoking reduced exposure to the nitrosamine NNK, CO, and nicotine, whereas withdrawal was elevated (all p values <.05). Clinical laboratory evaluation of PREPs for smokers is valuable for measuring users' smoke toxicant exposure, withdrawal, and smoking behavior and should be incorporated into a comprehensive PREP evaluation strategy. [ABSTRACT FROM AUTHOR]

Cigarette smoking causes cancer and disease, yet people find quitting difficult due to aversive symptoms that accompany tobacco abstinence. Understanding how to suppress these symptoms is critical in developing effective smoking cessation treatments. Pharmacologically, pure nicotine suppresses tobacco abstinence symptoms partially, and non-nicotine, smoking-related stimuli suppress these abstinence symptoms fully, at least for 24 hours. The current study was designed to clarify the impact of smoking-related stimuli on tobacco withdrawal, and to explore the duration of their ability to suppress withdrawal in smokers.Three double-blind, within-subjects, Latin square-ordered, 5-day conditions in which participants smoked nicotinized, denicotinized or no cigarettes.Out-patient laboratory at Virginia Commonwealth University.Thirteen women and 19 men.Subjective, physiological and performance measures were collected daily and compliance with study conditions was verified objectively.Smoking-related stimuli are sufficient for suppressing some symptoms of tobacco abstinence over a 5-day period[i.e. Questionnaire of Smoking Urges (QSU) factor 1,‘Desire for sweets’,‘Hunger’ and‘Urges to smoke’], while in this study a combination of nicotine and smoking-related stimuli suppressed other symptoms (i.e.‘Difficulty concentrating’,‘Increased eating’,‘Restlessness’ and‘Impatient’).These results indicate that, while some tobacco abstinence symptoms may be suppressed with nicotine, suppressing others may also require strategies that address the absence of smoking-related stimuli. [ABSTRACT FROM AUTHOR]

Waterpipe smoking has increased dramatically worldwide in recent years, with an estimated 100 million daily users. Research on this traditional Middle Eastern tobacco use method is in its infancy, and little is known about users' cessation-related attitudes and experiences. A random sample of 268 narghile (waterpipe) smokers (40% female; mean age?=?30 years; range?=?18–68) was obtained from cafes and restaurants in Aleppo, Syria. The majority of users (86.5%) believed they could quit using waterpipes at any time, but that belief was inversely related to perceived dependence, with only 48.7% of those who thought they were “very hooked” believing they could quit. Interest in quitting was expressed by 28.4% of subjects, with the majority (89.2%) reporting health concerns as a primary reason, and 59.2% having made an unsuccessful quit attempt in the past year. In a logistic regression model, independent predictors of interest in quitting included being married, having smoked for fewer years, not increasing the frequency of smoking over time, and having family members who do not smoke a waterpipe and disapprove of its use. Results indicate that a sizable percentage of waterpipe users express interest in quitting and have tried unsuccessfully in the past to quit. Waterpipe use needs to be considered in developing effective tobacco use cessation programs in the Middle East. [ABSTRACT FROM AUTHOR]

Background: To compare patterns of use, beliefs, and attitudes related to waterpipe smoking between university students (beginning smokers) and café customers (established smokers) in Aleppo Syria, in order to explore the evolution of this smoking method. Methods: Two cross-sectional surveys were conducted among representative samples of university students (total 587, 48.4% men, mean age 22 years), and waterpipe users among cafe' customers (total 268, 60% men, mean age 30 years) in Aleppo, Syria. We used interviewer-administered questionnaire inquiring about pattern of waterpipe smoking (initiation, frequency), situational characteristics of use (partner, place, sharing), beliefs related to waterpipe smoking (harmful/addictive properties of waterpipe), attitudes related to waterpipe smoking (confidence in quitting, will to quit, motivation for quitting, past year quit attempt), and cigarette smoking. Results: Daily and regular patterns of smoking become more prevalent with increased duration of smoking, but intermittent smoking remains the predominant pattern of waterpipe use. Women seem to be drawn later to the habit, which seem to escape the usual taboo against women's cigarette smoking. Patterns and context of waterpipe use tend to change with progress of the practice affecting frequency, setting, and sharing of waterpipe. Unlike beginners, established waterpipe smokers seem more smoking-method oriented, more hooked on the habit, less willing to quit, and less likely to foresee challenges to quitting. Conclusion: Use patterns and attitudes related to waterpipe smoking evolve to accommodate the change in dependence and life circumstances of the smoker. Most of use features, beliefs, attitudes, as well as time-course seem unique to this smoking method requiring novel approach to intervention. [ABSTRACT FROM AUTHOR]

Tobacco smoking is associated with many health risks, all of which are decreased by smoking cessation. Tobacco companies are marketing novel products (e.g., Phillip Morris' Accord®, R.J. Reynolds' Eclipse®) intended to reduce these risks. Evaluation of these products is necessary to determine if they increase, decrease, or fail to change smoking's health risks. This study examines the acute effects of the Accord® system on cigarette smokers; the study extends a previous preliminary evaluation by controlling for the system's eight-puff/cigarette limit, smokers' brand preference, and the act of smoking. Smokers of light or ultra-light cigarette brands (≥ 10 cigarettes/day, 16 men and 16 women) participated in this within-subjects protocol. Prior to each of the four, Latin-square ordered, approximately 2.5-h sessions, subjects abstained from smoking for at least 8 h. In each session, subjects smoked eight puffs, at 30-min intervals, from either their own brand of cigarettes, a marketed brand that was not their own, de-nicotinized tobacco cigarettes, or the novel smoking system. Subjective and physiological effects were assessed regularly. Results confirmed previous observations that the withdrawal suppression, CO intake, and tachycardia produced by the novel system are all less than that produced by normally marketed cigarette brands, even controlling for the system's eight-puff limitation and for brand preference. Incomplete withdrawal suppression may increase smoking frequency, thus potentially offsetting any decreased risks associated with Accord® use. Laboratory studies of the acute effects of novel smoking systems are an important part of a comprehensive evaluation program. [ABSTRACT FROM AUTHOR]

Abstract Rationale: Although adolescent smokers appear to display some of the hallmark features of dependence, the biological and behavioral effects of smoking in this population are poorly understood. Objectives: This study aimed to define empirically the effects of abstinence and smoking in adolescent smokers, using indices validated in adult smokers. Methods: Subjects were 16 young novice smokers (five male, 11 female), ages 14-18 years. A modified Stroop task measured the ability to inhibit attention to smoking-related cues; the classic Stroop task measured the ability to inhibit a pre-potent response (i.e. reading a word); a rapid information processing (RIP) task measured vigilance. Results: Abstinence increased and smoking decreased the intrusiveness of smoking cues. Parallel effects were seen in commission errors on the RIP task. These effects were restricted to heavier smokers (>11 cigarettes/day). Subjective withdrawal effects predicted the intrusiveness of smoking words during abstinence. The number of cigarettes smoked per day predicted the beneficial effect of smoking on the classic as well as modified Stroop tasks. The physiological effects of abstinence and smoking predicted RIP performance. Conclusions: Abstinence impairs and smoking improves inhibitory information processing in young novice smokers in a manner similar to adult smokers. Daily frequency of smoking is a critical moderator of these effects. [ABSTRACT FROM AUTHOR]

Tobacco companies are responding to public pressure to market less dangerous and aversive products by developing novel smoking systems. The short- and long-term effects of these systems must be evaluated to determine the risks inherent in their use. One such system, the Accord, uses a hand-held device to heat tobacco electronically and is marketed as a means to reduce second-hand smoke. In this study 10 cigarette smokers (> or = 10 cigarettes per day) were recruited to evaluate the short-term effects produced when using this system. Subjects abstained from smoking for at least 8 h before participating in two experimental sessions where they smoked either their usual brand or used the Accord at 30-min intervals for 2 hours. Subject-rated measures of tobacco withdrawal and craving, physiological measures, and smoking behavior were assessed within each session. Results show that, when using the Accord, the magnitude of smoking-induced craving reductions and the physiological effects of smoking were less, and puff volume and frequency were greater than when subjects smoked their own brand of cigarettes. The expired air carbon monoxide increases observed after smoking own brand cigarettes did not occur after using the Accord. The novel system does not provide maximal withdrawal suppression and produces little increase in expired air carbon monoxide; physiological data suggest that the novel system may deliver nicotine less efficiently than normally marketed cigarettes. Smokers using the Accord system may smoke more often or more intensely to compensate for decreased withdrawal suppression and/or nicotine delivery. [ABSTRACT FROM AUTHOR]

Smoking tobacco cigarettes results in characteristic subject-rated and physiological effects in regular tobacco smokers. Few reports have investigated potential sex differences in the physiological and subjective effects produced by tobacco smoking, though previous reports indicate that men and women differ in their tobacco smoking behavior. Sex differences in the subjective and/or physiological effects of smoking may help determine why women find quitting smoking more difficult than men and may help guide gender-specific treatment when planning smoking cessation. This laboratory study investigated sex differences in the subjective and physiological effects of cigarette smoking and smoking behavior in men (n = 38) and women (n = 30) before, during, and after they smoked two of their usual brand of cigarettes through a flowmeter-type puff topography measurement device. Results showed that the reduction in 'desire to smoke' produced by cigarette smoking was greater in women than in men, that the physiological effects of smoking were independent of smokers' sex, and that women take smaller and shorter puffs than men. These results suggest that women may be more sensitive than men to some of the subjective but not the physiological effects of smoking. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence on how cigarette smokers use electronic cigarettes (ECIGs) for smoking cessation and reduction. This study used concept mapping, a participatory mixed-methods research approach, to identify ECIG use behaviors and device characteristics perceived to be associated with cigarette smoking cessation or reduction.Methods: Current ECIG users aged 18-64 were recruited from seven cities selected randomly from U.S. census tract regions. Participants were invited to complete concept mapping tasks: brainstorming, sorting and rating (n=72). During brainstorming, participants generated statements in response to a focus prompt ("A SPECIFIC WAY I HAVE USED electronic cigarettes to reduce my cigarette smoking or a SPECIFIC WAY electronic cigarettes help me reduce my cigarette smoking is…") and then sorted and rated the statements. Multidimensional scaling and hierarchical cluster analyses were used to generate a cluster map that was interpreted by the research team.Results: Eight thematic clusters were identified: Convenience, Perceived Health Effects, Ease of Use, Versatility and Variety, Advantages of ECIGs over Cigarettes, Cigarette Substitutability, Reducing Harms to Self and Others, and Social Benefits. Participants generated several statements that related to specific behavioral strategies used when using ECIGs for smoking reduction/complete switching behaviors such as making rapid transitions from smoking to ECIG use or using certain ECIG liquids or devices. Former smokers rated the Perceived Health Effects cluster and several behavioral strategy statements higher than current smokers.Conclusions: These results help to identify ECIG use behaviors and characteristics perceived by ECIG users to aid in cigarette smoking cessation or reduction. [ABSTRACT FROM AUTHOR]

Abstract: Aims : To assess exposure to ETS among nonsmokers in the community and examine the relation between various subjective and objective measures of exposure to ETS in a developing country''s setting. Methods : An interviewer-administered population-based survey of adults 18–65 years residing in Aleppo, Syria. From a total number of 2038 participants, a sub-sample of 419 nonsmokers (27.2% men, 72.8% women, mean age 34 years) underwent subjective and objective assessment of exposure to ETS (saliva cotinine, breath CO, self-reported measures of exposure combined into ETS exposure scale). Results : Overall, 97.6% of adults nonsmokers assessed in this study, 72.9% of whom were women, have detectable saliva cotinine levels (mean ± SD 1.7 ± 1.5 ng/ml). Correlation between self-reported exposure measures and saliva cotinine was moderate with the strongest observed for number of cigarette smokers in the house, average number of cigarettes smoked daily in the house, house policy regarding smoking, and total ETS score (r 0.3–0.4). These same variables were among the best predictors of saliva cotinine according to stepwise linear regression analysis, but their individual relevance differed between men and women reflecting underlying differences in gender-based behavior–mobility patterns. Generally, subjective measures could explain 22% of the variability in cotinine levels in men and 19% in women. Conclusions : Exposure to ETS is universal among adult nonsmokers in Syria. Saliva cotinine correlated moderately with self-reported measures, whereby selected subjective measures can be as informative as composite scores incorporating multiple measures. Even in this environment of omnipresence of smoking, household restrictions seem to offer protection against ETS exposure. [Copyright &y& Elsevier]

• Nicotine/drug-related subjective effects driven by ECIG nicotine content. • Acceptability results not related consistently to ECIG nicotine/flavor content. • Little evidence that ECIG flavors masked/enhanced subjective effects. A rapidly evolving tobacco marketplace highlights the timeliness of the FDA's authority to regulate tobacco, specifically the role that flavorings in nicotine-containing electronic cigarette (ECIG) liquids have on public health. This study aimed to evaluate the extent to which ECIG liquid flavor and nicotine concentration influenced subjective measures of abuse liability among young adult cigarette (cig) smokers. Young adult (18–21 y.o.) smokers (M = 10.1 cig/day, no regular ECIG use history) completed 7 Latin-square ordered conditions each preceded by 12 h. nicotine/tobacco abstinence. Conditions were own brand cig (OB) and eGo-style ECIG paired with three liquid flavors (cream, tropical fruit, tobacco/menthol) varying in nicotine concentration (0 or 36 mg/ml). Products were administered in two 10-puff bouts in each condition. Heart rate/blood pressure (HR/BP) and tobacco/nicotine abstinence symptoms, nicotine/general drug effects, and acceptability measures were assessed repeatedly throughout sessions. Mixed linear models were followed-up with Tukey's HSD t -tests. HR/BP indicated nicotine exposure during nicotine-containing conditions. OB and tobacco/menthol 36 mg/ml conditions produced significant decreases in ratings of cig smoking urges. Nicotine/drug effects were elevated significantly for OB and 36 mg/ml ECIG conditions with one exception noted for the tobacco/menthol 0 mg/ml condition. OB had the highest acceptability ratings, and ECIG condition results varied by acceptability item. Among young adult smokers, ECIG conditions containing nicotine were positively associated with several subjective measures of abuse liability but not all. Flavors did not consistently mask/enhance effects observed. Results reinforce continued examination of ECIG-delivered nicotine and liquid flavors in relationship to abuse liability. [ABSTRACT FROM AUTHOR]

Some individuals who try electronic cigarettes (e-cigarettes) continue to use long-term. Previous research has investigated the safety of e-cigarettes and their potential for use in smoking cessation, but comparatively little research has explored chronic or habitual e-cigarette use. In particular, the relationship between e-cigarette cues and craving is unknown. We sought to bridge this gap by developing a novel set of e-cigarette (salient) and electronic toothbrush (neutral) videos for use in cue-reactivity paradigms. Additionally, we demonstrate the utility of this approach in a pilot fMRI study of 7 experienced e-cigarette users. Participants were scanned while viewing the cue videos before and after 10 min use of their own e-cigarettes (producing an 11.7 ng/ml increase in plasma nicotine concentration). A significant session (pre- and post-use) by video type (salient and neutral) interaction was exhibited in many sensorimotor areas commonly activated in other cue-reactivity paradigms. We did not detect significant cue-related activity in other brain regions notable in the craving literature. Possible reasons for this discrepancy are discussed, including the importance of matching cue stimuli to participants' experiences. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Alternative tobacco use among adolescents who smoke cigarettes is a growing public health concern, and evidence suggests that patterns of alternative tobacco use varies with respect to cigarette consumption and frequency of cigarette use. This study aimed to examine (a) whether variations in adolescent cigarette smoking and alternative tobacco use can be explained by underlying subtypes and (b) if these subtypes differ in their demographic and psychosocial characteristics. Methods: Using data from the 2009 National Youth Tobacco Survey, latent class analysis (LCA) was used to identify patterns of cigarette smoking and alternative tobacco use among 2746 current (past 30-day) smokers. After identification, classes were analyzed using multinomial logistic regression to examine differences based on demographics and smoking-related characteristics. Results: Four of the six latent classes identified (non-daily light smokers, chippers, chippers-Indulgent, intermittent smokers) reflected consumption, frequency, and history of cigarette use characteristics commonly attributed to light and intermittent smokers, and the remaining two classes (daily smokers, daily smokers-Indulgent) presented cigarette use behaviors commonly attributed to daily smokers. There were clear class differences in levels of alternative tobacco product use, demographics, and psychosocial characteristics. Conclusions: Study findings are consistent with previous work demonstrating demographic and psychosocial differences between cigarette smokers based on their alternative tobacco use. The six latent classes identified highlight the importance of including measures of alternative tobacco use when characterizing adolescent cigarette smokers as well as recognizing and tailoring interventions toward these different groups of tobacco users. [Copyright &y& Elsevier]

Corrigendum to "Influence of electronic cigarette liquid flavors and nicotine concentration on subjective measures of abuse liability in young adult cigarette smokers" [Drug Alcohol Depend. [Extracted from the article]

Introduction: E-cigarettes may have the potential to be an effective cessation aid for some cigarette smokers. However, the extent to which smokers' experiences using e-cigarettes (vaping) to quit smoking impact their cessation outcomes is unclear. In this cross-sectional survey study, we develop a multidimensional measure of vaping experiences in adults who quit smoking by vaping and test its association with perceived success in smoking cessation.Methods: In 2019, recruitment invitations were emailed to adult past-year smokers who had accessed cessation services across Ontario, Canada. Respondents who tried vaping to quit smoking in the past year completed a detailed online survey. Factor analysis was performed on ratings of 45 vaping experiences items to identify dimensions of vaping experiences. Factor scores were entered into logistic regressions to test if vaping experiences dimensions had differential impact on perceived success in smoking cessation.Results: Of the 889 participants, 56.0% were female, 81.1% were Caucasian, and the mean age was 37.7 ± 11.9 years. Twenty percent (19.6%) reported having successfully quit smoking by vaping in the past year. Among the six vaping experiences factors, better experiences in five factors-Relationships, Flexibility of Vaping, Side Effects, Vaping Devices, and Sensory Functions-were each independently and positively associated with improved odds of successful quitting. Notably, Relationships [OR = 2.01, 95% CI: 1.61-2.64] and Side Effects [OR = 1.95; 95% CI 1.54-2.29] were the strongest correlates of perceived success in smoking cessation.Conclusions: These findings indicate an opportunity to increase cessation rates by improving the experiences of smokers who vape to quit smoking. [ABSTRACT FROM AUTHOR]

Objective: Identifying the factors associated with nicotine dependence (ND) is essential to prevent initiation and continued use, and to promote cessation among youth. This study aims to document the predictors of the appearance of initial ND symptoms and full ND syndrome among adolescent waterpipe (WP) and cigarette smokers.Methods: A 6-year longitudinal study was conducted among 8th and 9th graders from 38 schools in Lebanon. The analysis sample included exclusive-WP (n = 228) and exclusive-cigarette smokers (n = 139). Weighted Cox proportional hazards models were used to characterizing predictors of initial ND symptoms and full ND syndrome.Results: Predictors of experiencing initial ND symptoms among WP smokers included low maternal educational level, having a sibling who smoked WP, low physical activity, high body mass index (BMI), smoking initiation at a younger age. For cigarette smokers these were being male, younger, having lower BMI, having a sibling who smoked cigarettes, living in a crowded household, and smoking daily. Among WP smokers, predictors of developing full ND syndrome include being younger, believing that WP smokers have more friends, depression, high levels of impulsivity, and initiating smoking at a younger age. For cigarette smokers, predictors of full ND syndrome were being younger and initiating smoking at a younger age.Conclusion: Smoking cessation and prevention interventions targeting youth should address modifiable, and tobacco use-specific factors that influence the development of ND among young WP and cigarette smokers. They also need to start at a younger age to target those most vulnerable to developing life-long addiction to tobacco products. [ABSTRACT FROM AUTHOR]

Introduction: Some HIV-positive smokers report ambivalence about quitting. Switching to electronic cigarettes (ECs) may be a viable option to reduce the negative health effects for smokers who are unable or unwilling to quit smoking combustible cigarettes (CCs). This study examined the acceptability and health-related effects of ECs in HIV-positive smokers who were not seeking smoking cessation treatment.Methods: HIV-positive smokers (N = 19) were enrolled and followed for 12 weeks. Cartridge-based ECs were provided at baseline, and E-liquid was provided weekly for 8 weeks. At baseline, weeks 1-8, and week 12, EC and CC use, cardiopulmonary function, respiratory symptoms, and carbon monoxide (CO) levels were measured.Results: At week 8, cigarettes per day (CPD) were reduced by more than 80%, with reduction maintained at week 12 (p's < .001). Cigarette dependence scores were 40% lower at week 8 than at baseline (p <  .001). Seven (36.8%) participants reported transitioning completely from CCs to ECs. Mean CO decreased significantly from BL to week 8 (p < .05) and remained significantly lower at week 12 (p <  .001). Intention to quit increased significantly over time.Conclusions: Switching from CCs to ECs in HIV-positive smokers who are not ready to quit smoking in the next 30 days appears to be feasible. Beneficial effects were seen, such as reduced CPD, reduced CO and CC dependence, and increased motivation to quit. ECs may be promising as a harm reduction approach among HIV-positive smokers who are unable or unwilling to quit smoking. [ABSTRACT FROM AUTHOR]