Alternative Tobacco Product Use and Smoking Cessation: A National Study.
ABSTRACT Objectives. We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions. Methods. A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors. Results. Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes. Conclusions. Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation. Unsubstantiated overt and implied claims that alternative tobacco products aid smoking cessation should be prohibited. (Am J Public Health. Published online ahead of print March 14, 2013: e1-e8. doi:10.2105/AJPH.2012.301070).
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ABSTRACT: Other forms of tobacco use are increasing in prevalence, yet most tobacco control efforts are aimed at cigarettes. In light of this, it is important to identify individuals who are using both cigarettes and alternative tobacco products (ATPs). Most previous studies have used regression models. We conducted a traditional logistic regression model and a classification and regression tree (CART) model to illustrate and discuss the added advantages of using CART in the setting of identifying high-risk subgroups of ATP users among cigarettes smokers. The data were collected from an online cross-sectional survey administered by Survey Sampling International between July 5, 2012 and August 15, 2012. Eligible participants self-identified as current smokers, African American, White, or Latino (of any race), were English-speaking, and were at least 25 years old. The study sample included 2,376 participants and was divided into independent training and validation samples for a hold out validation. Logistic regression and CART models were used to examine the important predictors of cigarettes + ATP users. The logistic regression model identified nine important factors: gender, age, race, nicotine dependence, buying cigarettes or borrowing, whether the price of cigarettes influences the brand purchased, whether the participants set limits on cigarettes per day, alcohol use scores, and discrimination frequencies. The C-index of the logistic regression model was 0.74, indicating good discriminatory capability. The model performed well in the validation cohort also with good discrimination (c-index = 0.73) and excellent calibration (R-square = 0.96 in the calibration regression). The parsimonious CART model identified gender, age, alcohol use score, race, and discrimination frequencies to be the most important factors. It also revealed interesting partial interactions. The c-index is 0.70 for the training sample and 0.69 for the validation sample. The misclassification rate was 0.342 for the training sample and 0.346 for the validation sample. The CART model was easier to interpret and discovered target populations that possess clinical significance. This study suggests that the non-parametric CART model is parsimonious, potentially easier to interpret, and provides additional information in identifying the subgroups at high risk of ATP use among cigarette smokers.BMC Public Health 04/2015; 15(1):341. DOI:10.1186/s12889-015-1582-z · 2.32 Impact Factor
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ABSTRACT: Electronic cigarettes have become popular and are heavily promoted as a safer cigarette and an aid to quit smoking. Although they may have value in reducing cigarette use among smokers, they are of limited value in smoking cessation and pose many problems, particularly in children. Nicotine is highly addictive and affects virtually all cells in the body. It is particularly harmful to developing brains and other organs. The electronic nicotine delivery systems are largely uncontrolled and safety risks are manifold. Initiating nicotine use and increasing dependence in the population may be linked with increased tobacco and other addictive substance abuse even if the individual electronic cigarette delivers less harm than a combustible cigarette does.Pediatric Allergy, Immunology, and Pulmonology 03/2015; 28(1):2-6. DOI:10.1089/ped.2015.0490 · 0.56 Impact Factor
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ABSTRACT: Introduction: Research has shown that adults perceive that electronic (e-) cigarettes are effective for smoking cessation, yet little is known about adolescents and young adults’ perceptions of e-cigarettes for quitting cigarette smoking. This study describes middle, high school, and college students’ beliefs about, and experiences with, e-cigarettes for cigarette smoking cessation. Methods: We conducted 18 focus groups (n=127) with male and female cigarette smokers and non-smokers in 2 public colleges, 2 high schools and 1 middle school in Connecticut between November 2012 and April 2013. Participants discussed cigarette smoking cessation in relation to e-cigarettes. Verbatim transcripts were analyzed using thematic analysis. Results: All participants, regardless of age and smoking status, were aware that e-cigarettes could be used for smoking cessation. College and high school participants described different methods of how e-cigarettes could be used for smoking cessation: 1) Nicotine reduction followed by cessation; 2) Cigarette reduction/dual use; and 3) long-term exclusive e-cigarette use. However, overall, participants did not perceive that e-cigarette use led to successful quitting experiences. Participants described positive attributes (maintenance of smoking actions, “healthier” alternative to cigarettes, and parental approval) and negative attributes (persistence of craving, maintenance of addiction) of e-cigarettes for cessation. Some college students expressed distrust of marketing of e-cigarettes for smoking cessation. Conclusions: Adolescent and young adult smokers and non-smokers perceive that there are several methods of using e-cigarettes for quitting and are aware of both positive and negative aspects of the product. Future research is needed to determine the role of e-cigarettes for smoking cessation in this population.Nicotine & Tobacco Research 02/2015; In press. DOI:10.1093/ntr/ntv020 · 2.81 Impact Factor