Search

Background and Aims The province of Ontario, Canada, banned the use of menthol-flavored tobacco products as of January 1, 2017. This study aims to assess the longer-term impact of a menthol ban on smoking behavior at 2 years, which is unknown. Methods Population cohort study with baseline survey (n = 1821) conducted September–December 2016 and follow-up survey January–August 2019 among current smokers in Ontario (16+) prior to the menthol ban. Poisson regression was used to assess the probability of quitting smoking by pre-ban menthol status, controlling for differences in smoking and demographic characteristics, with multiple imputations used to address missing data. Findings Menthol smokers were more likely to report having quit smoking (12% [daily menthol] and 10% [occasional menthol] vs. 3% [non-menthol]; p < .001) than non-menthol smokers in the 2 years after a menthol ban. After adjustment for smoking and demographic characteristics, daily menthol smokers had higher likelihood of quitting smoking (adjusted relative risk [ARR] 2.08; 95% confidence interval [CI] 1.20–3.61) and reported more quit attempts (ARR 1.45; 95% CI 1.15–1.82). Among those who attempted to quit, menthol smoking was not associated with relapse (daily ARR = 0.96; 95% CI: 0.86, 1.07; occasional ARR = 0.99; 95% CI: 0.90, 1.08). However, there was a statistically significant interaction among menthol users who reported using other flavored tobacco products 1 year after the ban (ARR = 0.26 [95% CI: 0.08, 0.90]) Conclusions The study found increased probability of quitting among daily menthol smokers and more quit attempts among daily and occasional menthol smokers compared with non-menthol smokers in Ontario 2 years after the implementation of a menthol ban. Implications This study examines quitting behavior 2 years after a menthol ban in Ontario, Canada. Those who were daily menthol smokers prior to the ban were more likely to quit smoking and make more quit attempts in the 2 years after the ban. While there was no difference in the likelihood of relapse between menthol and non-menthol smokers among those who attempt to quit, there were indications that pre-ban daily menthol smokers who used other tobacco products after the ban were likely to quit.

Yue Hu,1 Qihui Chen,2 Bo Zhang3 1College of Economics and Management, China Agricultural University, Beijing, People’s Republic of China; 2Beijing Food Safety Policy & Strategy Research Base, China Agricultural University, Beijing, People’s Republic of China; 3Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Qihui Chen Email chen1006@umn.eduBackground: Tobacco consumption is one of the world’s largest public health threats. Yet little is known about how chronic disease diagnoses affect individuals’ smoking behavior in China, where the world’s largest smoking population resides.Methods: This study analyzes an unbalanced panel dataset on 2986 Chinese males aged 50 or above from the China Health and Nutrition Survey, a household survey covering nine Chinese provinces. We adopt a zero-inflated negative binomial (ZINB) regression framework to account for the count-data nature of the outcome variable of interest, the number of cigarettes one smokes per day. Logit regressions are also adopted to predict one’s likelihood of smoking cessation.Results: First, the estimated ZINB model suggests that the number of chronic disease diagnoses only affects whether one smokes, but conditional on one being a smoker, it does not affect the number of cigarettes one smokes per day. Logit estimates suggest that an additional diagnosed chronic disease is associated with a 4.8 percentage-point increase in the likelihood of smoking cessation. Second, while the diagnoses of all four chronic conditions examined are found to increase the likelihood of smoking cessation, the diagnosis of myocardial infarction has the largest impact, followed by diabetes diagnosis.Conclusion: While chronic disease diagnoses reduce smoking in China, their effects are small. Healthcare policies and relevant measures (such as helping smoking patients switch to a diet with more foods enriched with antioxidants) are thus needed to reduce the adverse effects that continued smoking might impose on their health.Keywords: chronic disease, diagnosis, smoking, count-data models, China

Objectives: Smoking cessation interventions with sex considerations have been found to effectively increase cessation rates. However, evidence is limited and weak. This study examined sex differences in the use of smoking cessation services or resources among Ontario adults. Methods: Data are from the Smokers’ Panel, an ongoing online survey of Ontario adult smokers and recent quitters. The analysis included 1009 male and 1765 female participants. Bivariate analysis was used to examine differences in sociodemographic characteristics and smoking-related variables by use of cessation services/resources. Logistic regression was then used to identify sociodemographic characteristics and smoking-related variables associated with the use of cessation services/resources. Results: The analysis shows that there were significant sex differences in the use of individual interventions. Female participants were more likely to use nicotine patch (63% vs 58%; adjusted odds ratio, AOR: 1.39, 95% confidence interval [CI]: 1.16-1.67), varenicline (29% vs 24%; AOR: 1.37, 95% CI: 1.13-1.66), Smokers’ Helpline phone (14% vs 10%; AOR: 1.39, 95% CI: 1.07-1.79), Smokers’ Helpline online (27% vs 21%; AOR 1.43, 95% CI: 1.18-1.74), self-help materials (23% vs 16%; AOR: 1.81 95% CI: 1.46-2.26), and alternative methods (23% vs 19%; AOR: 1.40, 95% CI: 1.14-1.73) compared with male participants, after adjusting for covariates. Conclusion: Consistent with other findings, the study shows sex differences in the use of smoking cessation services or resources among adult smokers. Women are more likely to use recommended cessation resources such as nicotine patch, varenicline, and Smokers’ Helpline than men. Health professionals should use this increased willingness to help female smokers quit. However, men may be underserved and more men-specific interventions need to be developed and evaluated.

BACKGROUND Clinical trials show the efficacy of dentists' counseling in smoking cessation. However, little is known about the effectiveness of such advice in the general population of smokers. OBJECTIVE To examine the association between dentists' advice, use of cessation medications and quitting behaviours in the general population of adult smokers in Ontario, Canada. METHODS Data were from the Ontario Tobacco Survey panel study, which followed people who were smokers in July 2005 semi-annually for up to 3 years until June 2011. Baseline smokers, who were seen by a dentist during the study, were included in the analysis (n = 2714 with 7549 observations). Logistic regression analysis with generalized estimating equations was used to examine associations among dentists' advice, use of cessation medications and quitting outcomes (quit attempts and short-term quitting ≥ 30 days). RESULTS Those who received dentists' advice were more addicted to tobacco, compared with those who did not receive dentists' advice (self-perceived addiction to tobacco: 96% vs. 89%, p < 0.001). Dentists' advice alone was not associated with making an attempt to quit smoking or short-term quitting. However, receiving dentists' advice in conjunction with cessation medications was associated with a higher likelihood of quit attempts (adjusted odds ratio [OR] 9.85, 95% confidence interval [CI] 7.77-12.47) and short-term quitting (adjusted OR 3.19, 95% CI 2.20-4.62), compared with not receiving dentists' advice and not using cessation medications. CONCLUSION Dentists play an important role in smoking cessation, because they can encourage patients to stop smoking and promote success by advising patients to use cessation medications.

ObjectivesThe province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of 1 January 2017. The long-term impact of a menthol ban on smoking behaviour has not been previously evaluated.MethodsPopulation cohort study with baseline survey conducted September–December 2016 and follow-up January–August 2018 among residents of Ontario, Canada, 16 years old and over who reported current smoking (past 30 days) at baseline survey and completed follow-up (n=913) including 187 reporting smoking menthol cigarettes daily, 420 reported smoking menthol cigarettes occasionally, and 306 were non-menthol cigarette smokers. Relative rates of making a quit attempt and being a non-smoker at follow-up were estimated with Poisson regression controlling for smoking and demographic characteristics at baseline.ResultsAt follow-up, 63% of daily menthol smokers reported making a quit attempt since the ban compared with 62% of occasional menthol smokers and 43% of non-menthol smokers (adjusted relative rate (ARR) for daily menthol smokers compared with non-menthol smokers: 1.25; 95% CI 1.03 to 1.50). At follow-up, 24% of daily menthol smokers reported making a quit since the ban compared with 20% of occasional menthol smokers and 14% of non-menthol smokers (ARR for daily menthol smokers compared with non-menthol smokers: 1.62; 95% CI 1.08 to 2.42).ConclusionsThe study found higher rates of quitting among daily and occasional menthol smokers in Ontario 1 year after the implementation of a menthol ban compared with non-menthol smokers. Our findings suggest that restrictions on menthol may lead to substantial improvements in public health.

Clinical trials show the efficacy of dentists' counseling in smoking cessation. However, little is known about the effectiveness of such advice in the general population of smokers.To examine the association between dentists' advice, use of cessation medications and quitting behaviours in the general population of adult smokers in Ontario, Canada.Data were from the Ontario Tobacco Survey panel study, which followed people who were smokers in July 2005 semi-annually for up to 3 years until June 2011. Baseline smokers, who were seen by a dentist during the study, were included in the analysis (n = 2714 with 7549 observations). Logistic regression analysis with generalized estimating equations was used to examine associations among dentists' advice, use of cessation medications and quitting outcomes (quit attempts and short-term quitting ≥ 30 days).Those who received dentists' advice were more addicted to tobacco, compared with those who did not receive dentists' advice (self-perceived addiction to tobacco: 96% vs. 89%, p0.001). Dentists' advice alone was not associated with making an attempt to quit smoking or short-term quitting. However, receiving dentists' advice in conjunction with cessation medications was associated with a higher likelihood of quit attempts (adjusted odds ratio [OR] 9.85, 95% confidence interval [CI] 7.77-12.47) and short-term quitting (adjusted OR 3.19, 95% CI 2.20-4.62), compared with not receiving dentists' advice and not using cessation medications.Dentists play an important role in smoking cessation, because they can encourage patients to stop smoking and promote success by advising patients to use cessation medications.

In the present study, we examined the association between duration of nicotine replacement therapy (NRT) use and smoking cessation using data from the Ontario Tobacco Survey longitudinal study (3 waves of data collected between July 2005 and December 2009). We used logistic regression with generalized estimating equations to examine the association between NRT use (any use and

Background:Smoking cessation reduces the risk of cardiovascular disease (CVD) and improves clinical outcomes in public health. We studied the effect of smoking cessation on high-density lipoprotein (HDL) functionality.Methods and Results:We randomly treated 32 smokers with varenicline or a transdermal nicotine patch as part of a 12-week smoking cessation program (The VN-SEESAW Study). The plasma lipid profiles, plasma and HDL malondialdehyde (MDA) levels, HDL subfractions as analyzed by capillary isotachophoresis, cholesterol efflux capacity, and antiinflammatory activity of HDL were measured before and after the anti-smoking intervention. After smoking cessation, HDL-C, apoA-I levels and HDL subfractions were not significantly different from the respective baseline values. However, cholesterol efflux capacity and the HDL inflammatory index (HII) were significantly improved after smoking cessation. The changes in both parameters (%∆ cholesterol efflux capacity and ∆HII) were also significantly improved in the successful smoking cessation group compared with the unsuccessful group. The changes in cholesterol efflux capacity and HII also correlated with those in end-expiratory CO concentration and MDA in HDL, respectively.Conclusions:Our findings indicate that smoking cessation leads to improved HDL functionality, increased cholesterol efflux capacity and decreased HII, without changing HDL-C or apoA-I levels or HDL subfractions. This may be one of the mechanisms by which smoking cessation improves the risk of CVD. (Circ J 2014; 78: 2955–2962)

The mediating role of cessation medications in the association between health professional advice and quitting behaviors is unclear.Data were from the Ontario Tobacco Survey longitudinal study, collected between July 2005 and June 2011 in Ontario, Canada. The analytic sample included 3437 baseline smokers who were seen by health professionals during follow-up. Logistic regression with generalized estimating equations and mediation analysis techniques were used to examine the impact of advice and medications on quitting outcomes (making a quit attempt, short-term quitting 1-6months and long-term quitting6months).Those who received advice to quit smoking were more likely to use cessation medications than those who did not receive advice (21% vs. 13%, P0.001). Receiving advice was associated with making a quit attempt (adjusted odds ratio (OR) 1.25, 95% confidence interval (CI) 1.10-1.41) and long-term quitting (adjusted OR 1.49, 95% CI 1.10-2.02), but not with short-term quitting. Use of cessation medications was associated with making a quit attempt (adjusted OR 11.83, 95% CI 9.93-14.08), short-term quitting (adjusted OR 3.69, 95% CI 2.90-4.68), and long-term quitting (adjusted OR 2.73, 95% CI 1.95-3.82). Using prescription medications was associated with a higher likelihood of quitting short-term (adjusted OR 2.43, 95% CI 2.59-3.74) and long-term (adjusted OR 2.27, 95% CI 1.23-4.17) than using NRT. Use of cessation medications was a significant mediator in the pathway from receiving advice to quitting.Health professionals should advise smokers to quit and encourage them to use cessation medications, especially prescription medications when trying to quit.

Objective: To evaluate the impact of an indoor smoke-free bylaw in Toronto, Ontario, implemented June 2004. Methods: We used a pre-post comparison design to assess secondhand smoke (SHS) exposure among 79 eligible bar workers in Toronto, Ontario (bylaw enacted), and 49 eligible bar workers in a control community, Windsor, Ontario (no bylaw change), at four times: preban, and 1, 2, and 9 months postban. Results: SHS exposure time and urinary cotinine level were substantially reduced in Toronto bar workers immediately after the ban by 94% (from 7.8 to 0.5 hours) and 68% (from 24.2 to 7.8 ng/mL), respectively. The reduction was sustained throughout follow-up. There was no change among Windsor bar workers before and after the ban. Conclusions: Compliance with the ban was high, and the ban led to a substantial reduction in SHS exposure.

Smoking cessation reduces the risk of cardiovascular disease (CVD) and improves clinical outcomes in public health. We studied the effect of smoking cessation on high-density lipoprotein (HDL) functionality. METHODS AND RESULTS: We randomly treated 32 smokers with varenicline or a transdermal nicotine patch as part of a 12-week smoking cessation program (The VN-SEESAW Study). The plasma lipid profiles, plasma and HDL malondialdehyde (MDA) levels, HDL subfractions as analyzed by capillary isotachophoresis, cholesterol efflux capacity, and antiinflammatory activity of HDL were measured before and after the anti-smoking intervention. After smoking cessation, HDL-C, apoA-I levels and HDL subfractions were not significantly different from the respective baseline values. However, cholesterol efflux capacity and the HDL inflammatory index (HII) were significantly improved after smoking cessation. The changes in both parameters (%∆ cholesterol efflux capacity and ∆HII) were also significantly improved in the successful smoking cessation group compared with the unsuccessful group. The changes in cholesterol efflux capacity and HII also correlated with those in end-expiratory CO concentration and MDA in HDL, respectively.Our findings indicate that smoking cessation leads to improved HDL functionality, increased cholesterol efflux capacity and decreased HII, without changing HDL-C or apoA-I levels or HDL subfractions. This may be one of the mechanisms by which smoking cessation improves the risk of CVD.

Objectives Smoke-free policies not only reduce harm to non-smokers, they may also reduce harm to smokers by decreasing the number of cigarettes smoked and increasing the likelihood of a successful quit attempt. However, little is known about the impact of exposure to smoking on patios on smoking behaviour. Design and participants Smokers from the Ontario Tobacco Survey, a longitudinal population representative cohort of smokers (2005–2011). There were 3460 current smokers who had completed one to six follow-ups and were asked at each follow-up whether or not they had been exposed to smoking on patios in the month. Main outcome measures Generalised estimating equations and survival analysis were used to examine the association between exposure to patio smoking and smoking behaviour changes (making a quit attempt and time to relapse after a quit attempt), controlling for potential confounders. Results Smokers who were exposed to smoking on patios (adjusted incident rate ratio (aIRR) = 0.89; 95% CI 0.81 to 0.97) or had been to a patio (aIRR = 0.86; 95% CI 0.74 to 0.99) were less likely to have made a quit attempt than smokers who had not visited a patio. Smokers who were exposed to smoking on patios were more likely to relapse (adjusted HR=2.40; 95% CI 1.07 to 5.40)) after making a quit attempt than those who visited a patio but were not exposed to smoking. Conclusions Exposure to smoking on patios of a bar or restaurant is associated with a lower likelihood of success in a quit attempt. Instituting smoke-free patio regulations may help smokers avoid relapse after quitting.

Purpose To determine the impact of smoking cessation on lung cancer mortality among women. Methods Survival analysis is used to assess the effect of smoking cessation on lung cancer death in the dietary cohort of 49,165 women aged 40 to 59 years enrolled in the Canadian National Breast Screening Study. Results During an average of 10.3 years of follow-up, 106 women died of lung cancer. The risk of lung cancer mortality among women who quit before age 50 (HR = 0.26; 95% CI, 0.13–0.55 among women who quit at ages 40–49) or quit in the previous 10 years (HR = 0.39; 95% CI, 0.22–0.69) is substantially lower than the risk among current smokers. Women who quit after age 40 or have quit for less than 20 years are at substantially higher risk of lung cancer mortality compared with never smokers. Both duration of smoking cessation and age at quitting have independent effects on lung cancer mortality, after controlling for number of cigarettes smoked per day and number of years smoked, as well as other potential confounding variables. Conclusion These findings suggest that programs and policies to promote early cessation of smoking and prevention of relapse should be a public health priority.

filled for an antidepressant; 4.6% had at least two prescriptions filled; and 2.7% had six or more prescriptions filled. In 2002, these rates were 16.6%, 13.2%, and 8.4% respectively. The average annual increases for each category were 1.5%, 1.2%, and 0.81%, respectively. Overall, 32% of the women had a prescription filled at least one time during the seven-year period. CONCLUSION: Our results are comparable to those reported for studies from other countries. Although it is not clear what is driving this trend, it has potential public health and economic implications. Future studies are needed to explore the possible sources of these trends.