Saul Shiffman

University of Pittsburgh | Pitt · Psychology

Background If US adults who smoke cigarettes are switching to e-cigarettes, the effect may be observable at the population level: smoking prevalence should decline as e-cigarette prevalence increases, especially in sub-populations with highest e-cigarette use. This study aimed to assess such effects in recent nationally-representative data. Method...

Background: This is authors' reply to the Commentary on our publication entitled "Adult smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months after Initially Purchasing a JUUL e-Cigarette." Methods and results: Analyses addressed questions about follow-up rates and missed responses in the Adult JUUL Switching and Smoking Trajec...

The ability of Electronic Nicotine Delivery Systems (ENDS) to deliver nicotine is central to their function to substitute for cigarettes, allowing people who smoke to switch away from smoking, thus reducing their exposure to harmful chemicals in cigarette smoke. The nicotine concentration in ENDS e‐liquid has proved to be a poor predictor of nicoti...

OBJECTIVES Electronic nicotine delivery systems (ENDS) can reduce tobacco-related health risks for adults who smoke cigarettes (AWS) by facilitating complete switching away from cigarettes. However, little is known about ENDS use and switching among subpopulations that have been disproportionately affected by smoking. METHODS AWS (age≥21 years) we...

Informing adults who smoke (AWS) that completely switching to e-cigarettes reduces their exposures to harmful chemicals could prompt them to switch to e-cigarettes. But it would be problematic if such messages prompted e-cigarette use by adults not using tobacco (Nonusers). This study assessed the effect of a reduced-exposure message on behavioral...

Background: Electronic nicotine delivery systems (ENDS) have the potential to benefit public health if smokers completely switch from cigarettes to ENDS. Methods: A cohort of adult smokers (age ≥ 21) who purchased a JUUL Starter Kit was followed for 12 months after the initial purchase. We defined "switching" as past-30-day abstinence from smoking...

Adults who smoke (AWS) who switch completely to e-cigarettes reduce their exposures to many harmful chemicals, suggesting that switching could reduce risk. AWS who believe e-cigarettes are less harmful than cigarettes are more likely to use e-cigarettes to switch away from smoking. Yet most AWS believe e-cigarettes are at least as harmful as cigare...

Observational studies show high rates of switching away from cigarettes among adult purchasers of JUUL-brand electronic nicotine delivery system (ENDS); data are needed to evaluate switching with JUUL in randomized general population trials. The association of ENDS flavor availability and switching is pertinent. This study assessed switch rates and...

Switching from cigarette smoking to electronic nicotine delivery systems (ENDS) reduces exposure to toxic substances. Yet, many smokers believe ENDS are at least as harmful as smoking, making them less likely to switch from cigarettes to ENDS. Effectively communicating reduced-exposure information is critical, but such messages must be properly und...

OBJECTIVES: Electronic nicotine delivery systems (ENDS) can reduce tobacco-related risks for adults who smoke cigarettes (AWS) by facilitating complete switching away from combustible cigarettes. However, little is known about ENDS use and switching among subpopulations that have been disproportionately affected by smoking, which could contribute t...

Background: Youth use of electronic cigarettes ("e-cigarettes") is an ongoing concern. Vaping is usually assumed to be of nicotine, but survey responses may also include vaping of non-nicotine substances (particularly cannabis), which can impose different risks. The current study quantifies the proportions of nicotine-specific and cannabis-specifi...

Objectives Real-world evidence on exposure to harmful and potentially harmful constituents (HPHCs) and on biological effects in cigarette smokers who switch to electronic nicotine delivery systems (ENDS) can inform the health effects of switching. Aims and Methods This cross-sectional, observational study assessed adults who had smoked ≥10 cigaret...

Background Evidence indicates that electronic nicotine delivery systems (ENDS) pose lower risk than cigarettes; however, many smokers harbor misperceptions that ENDS are equally or more harmful, possibly deterring them from switching. This study examines whether comparative risk perceptions of JUUL vs. smoking are associated with subsequent switchi...

This comment is to express concern about an article by Wang et al. [...]

Background: Studies have suggested that some US adult smokers are switching away from smoking to e-cigarette use. Nationally representative data may reflect such changes in smoking by assessing trends in cigarette and e-cigarette prevalence. The objective of this study is to assess whether and how much smoking prevalence differs from expectations s...

Some smokers switch away from smoking using e-cigarettes, but guidelines recommend trying approved medications first. We analyzed switching in adult smokers using JUUL by their recent history of quit attempts and use of smoking cessation medications. Participants were 8511 adult (21+) established smokers (at baseline), in which 50.3% are daily smok...

Introduction: Youth use of electronic nicotine delivery systems (ENDS) is a continuing concern, making it important to assess evolving patterns, especially as non-tobacco, non-menthol (NTM) flavors were withdrawn for pod-based (but not disposable) ENDS in February 2020. Methods: Trends in past-30-day (P30D) ENDS use and smoking prevalence, usual...

The harm caused by cigarette smoking is overwhelmingly due to byproducts of tobacco combustion. Electronic Nicotine Delivery Systems (ENDS) provide nicotine to users without combustion, and may support tobacco harm reduction among cigarette smokers who would not otherwise quit in the near term. Analyses of Wave 5 of the Population Assessment of Tob...

Background: Smokers often experience respiratory symptoms (eg, morning cough), and those who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in symptoms. Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are i...

INTRODUCTION: Youth use of electronic nicotine delivery systems (ENDS) is a continuing concern, making it important to assess evolving patterns, especially as non-tobacco, non-menthol (NTM) flavors were withdrawn for pod-based (but not disposable) ENDS in February 2020. METHODS: Trends in past-30-day (P30D) ENDS use and smoking prevalence, usual de...

Background: Evidence indicates that electronic nicotine delivery systems (ENDS) pose lower risk than cigarettes; however, many smokers misperceive ENDS to be equally ormore harmful, possibly deterring them from switching. This study examines whether relative risk perceptions of JUUL vs. smoking are associated with subsequent switching, among smoker...

Background: Electronic nicotine delivery systems (ENDS) are substitute sources of nicotine for adults who smoke cigarettes. Understanding changes in dependence as people switch from cigarettes to ENDS is relevant to public health. This study assessed changes in dependence among adults who switched completely or partially (dual users) from cigarett...

Purpose To examine the association between intensive, longitudinal ecological momentary assessment (EMA) and self-reported eating behaviors. Methods Secondary analysis of the EMPOWER study—a 12-month observational study that examined the microprocesses of relapse following intentional weight loss using smartphone-administered EMA—was conducted. Pa...

Introduction: More real-world evidence on exposure to harmful and potentially harmful constituents (HPHCs) and on biological effects when cigarette smokers switch to e-cigarettes would be useful. Methods: This cross-sectional, observational study assessed adults who had smoked ≥ 10 cigarettes/day for ≥ 10 years, comparing 124 continuing cigarette s...

Unlabelled: Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product which could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS' potential benefits. This study examines...

BACKGROUND Smokers who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in respiratory symptoms (e.g., cough). Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are intended for patient populations, such as thos...

Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product that could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS’ potential benefits. This study examines whether increa...

Background Studies have suggested that some US adult smokers are switching away from smoking to e-cigarette use. Nationally representative data may reflect such changes in smoking by assessing trends in cigarette and e-cigarette prevalence. The objective of this study is to assess whether and how much smoking prevalence differs from expectations si...

Purpose To examine the association between intensive, longitudinal ecological momentary assessment (EMA) and self-reported eating behaviors. Methods Secondary analysis of the EMPOWER study—a 12-month observational study that examined the microprocesses of relapse following intentional weight loss using smartphone-administered EMA—was conducted. Pa...

Background Perceived risk reduction motivates smokers to switch to electronic nicotine delivery systems (ENDS). This research examines US smokers’ relative risk perceptions and their prospective association with various behavioral stages of switching to ENDS. Methods Data from the nationally representative, longitudinal Population Assessment of To...

Background Studies have suggested that some US adult smokers are switching away from smoking to e-cigarette use. Nationally representative data may reflect such changes in smoking by assessing trends in cigarette and e-cigarette prevalence. The objective of this study is to assess whether and how much smoking prevalence differs from expectations si...

Background: Electronic nicotine delivery systems (ENDS) have the potential to benefit public health if smokers completely switch from cigarettes to ENDS. Methods: A cohort of adult smokers (age≥21) who purchased a JUUL Starter Kit was followed for 12 months after the initial purchase. We examined factors associated with achievement and maintenance...

Rationale Electronic nicotine delivery systems and heated tobacco products are noncombustible alternatives for adult smokers. Evidence suggests sufficient nicotine delivery and satisfying effects are necessary to facilitate switching away from smoking; nicotine delivery varies across electronic nicotine delivery systems within limited nicotine conc...

Background: Smokers who switch completely to electronic nicotine delivery systems (ENDS) may experience reductions in respiratory symptoms (e.g., cough, wheezing). Assessing such symptoms among smokers without respiratory disease using existing respiratory symptom questionnaires is challenging, as these questionnaires are intended for patient popul...

OBJECTIVES Studies have assessed switching away from cigarettes among adult smokers who use electronic nicotine delivery systems (ENDS), but there is little data assessing differences in likelihood of switching or ENDS use characteristics by menthol smoking METHODS Adult (age≥21) established smokers who purchased a JUUL Starter Kit (N=15,036) comp...

RATIONALE: Electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) are noncombustible alternatives for adult smokers. Evidence suggests sufficient nicotine delivery is necessary to facilitate switching away from smoking; nicotine delivery varies across ENDS within limited nicotine concentrations. OBJECTIVES: To assess the nico...

Background Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association betwee...

Introduction Evidence suggests that cigarette smokers who switch to electronic nicotine delivery systems (ENDS) reduce their exposure to harmful toxicants and carcinogens. It is unclear if dual use is associated with decreases in exposure to toxicants. Methods This parallel-group confinement study assessed changes in biomarkers of exposure (BOEs)...

Introduction Electronic nicotine delivery systems (ENDS) may improve public health if they facilitate smokers switching away from cigarettes. Conceptually, switching is facilitated when ENDS provide adequate nicotine delivery. Switching rates among smokers who purchased the JUUL System (“JUUL”) were compared in the United Kingdom (UK), where regula...

Objectives: In this study, we assessed changes in dependence as smokers transitioned from cigarette smoking to exclusive use of the JUUL System ("JUUL"), contrasting users of 5.0% versus 3.0% nicotine concentration pods. Methods: Overall, 5246 adult (age ≥ 21) established smokers (> 100 cigarettes lifetime) who purchased a JUUL device completed onl...

Objectives: We assessed adult never smokers' trajectories of smoking over 12 months after a first-time JUUL Starter Kit (JSK) purchase. Methods: Adult (≥ 21) never smokers (N = 3853) who purchased a JSK were recruited into an observational naturalistic study. Analyses distinguished those who had previously used ENDS (NS+E, N = 2848) from those who...

Objectives: In this study, we prospectively assessed changes in smoking a year after US adults' first-time purchase of a JUUL Starter Kit (JSK). Methods: Descriptive analyses assessed transitions in smoking status at 12 months among adult (age ≥21) JSK purchasers providing baseline and 12-month follow-up data (N = 27,164 [49.0% of baseline]), strat...

This special issue addresses key topics relating to the public health impact of the use of electronic nicotine delivery devices (ENDS), particularly JUUL-brand ENDS. Smokers smoke for nicotine, but are harmed by the byproducts of combustion. ENDS can play a role in tobacco harm reduction offering a noncombustible alternative source of nicotine for...

Objectives: Those underage should not use tobacco products, including electronic nicotine delivery systems. A technologically-based solution developed by Juul Labs Inc to restrict underage access seeks to automate transactions, structurally mandate age-verification, and limit the quantity of JUUL products purchased per transaction. A pilot of this...

Objectives: In this study, we examined complete switching away from cigarettes across various medico-socio-demographic subpopulations of adult smokers who purchased a JUUL Starter Kit (JSK) electronic nicotine delivery system. Methods: We analyzed trajectories of smoking over 12 months in 17,986 adult smokers who purchased a JSK. Populations of spe...

Objective: In this study, we assessed cigarette smoking over 12 months among adult former smokers who newly purchased a JUUL Starter Kit (JSK). Methods: Prevalence of past 30-day smoking and factors associated with smoking were assessed among adult (age ≥ 21) former established smokers, stratified as recent (quitting ≤ 12 months) and long-term quit...

Objectives: Many smokers who start using ENDS engage in dual use of cigarettes and ENDS. This paper examines time trends in dual use after a JUUL Starter Kit purchase, and changes in cigarette consumption among those remaining dual users. Methods: In the ADJUSST study, a cohort of adult smokers who purchased a JUUL Starter Kit were followed natural...

Objectives: In this study, we assessed complete switching away from cigarette smoking among adult smokers who purchased a JUUL Starter Kit (JSK). Methods: Adult (age ≥ 21) established smokers (smoked ≥ 100 lifetime cigarettes) who purchased a JSK in 2018 were invited to complete online surveys 1, 2, 3, 6, 9 and 12 months after initial JSK purchase....

Objectives: The Adult JUUL System User Switching and Smoking Trajectories (ADJUSST) study assessed the smoking and JUUL use trajectories of adults who purchased JUUL. In this paper, we describe study methods, characterize the sample, and assesses potential for bias due to loss to follow-up. Methods: We entered 55,414 US adults (≥ age 21) who purcha...

Objectives: In this paper, we estimate the prevalence of electronic nicotine delivery systems (ENDS) and JUUL brand ENDS use among adults in the US, overall and by smoking history. Methods: We obtained 2019 cross-sectional online surveys assessing smoking, use of any ENDS, and JUUL specifically, in a national probability sample of 11,833 US adults....

In this brief peer review, we argue that the data reported by Gaiha et al (https://doi.org/10.1016/j.jadohealth.2020.07.002) regarding associations between vaping and COVID-19 testing are so suspect that any conclusions drawn from it cannot be relied upon. We discuss six main areas of concern and conclude that the paper should be retracted.

Ecological momentary assessment (EMA) studies investigate intensive repeated observations of the current behavior and experiences of subjects in real time. In particular, such studies aim to minimize recall bias and maximize ecological validity, thereby strengthening the investigation and inference of microprocesses that influence behavior in real-...

RationaleLittle is known about relapse among non-daily, intermittent smokers (ITS), who have difficulty quitting, despite a lack of dependence.Objectives To analyze situations associated with temptations to smoke and smoking lapses among ITS trying to maintain abstinence.Methods Participants were 130 initially abstinent ITS in the placebo arm of a...

Background and aims Non‐daily smokers (NDS) comprise a large fraction of US smokers. Despite little or no dependence, as typically assessed, ITS have difficulty quitting smoking. A randomized clinical trial comparing the effect of nicotine gum with placebo on quitting smoking in non‐daily smokers did not find an effect on overall abstinence. We und...

Background and Aims Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e‐cigarette use. This study assesses dependence among current and former adult e‐cigarette users on cigarettes and e‐cigarettes, compared with depend...

Introduction: Non-daily intermittent smokers (ITS) comprise 30% of US adult smokers. ITS smoke for nicotine and have trouble quitting, but tend to smoke in particular situations. This study tested the effect of nicotine gum, used to prevent or react to situational temptations, for helping ITS quit. Methods: ITS (smoking 4-27 days/month) seeking...

Introduction Snus, a low nitrosamine smokeless tobacco product, presents less risks to health than cigarettes. Effectively communicating such risk information could facilitate smokers switching completely to snus, thereby benefiting public health. Methods This study assessed comprehension and perceptions of modified-risk information regarding snus...

Background: There is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. Here, we take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior. Method: A sample of 194 daily smokers, who were not attempting to quit...

Background: Alcohol consumption promotes lapses to smoking among smokers trying to quit, perhaps particularly among smokers with lower dependence. We assessed how the role of alcohol in lapses varies over time. Methods: This is a secondary analysis of ecological momentary assessment data collected from 159 daily smokers (mean age = 43.90 (SD = 1...

This study examines how well exposure in topography sessions correlates with exposure when smoking ad libitum in the field, by measuring material deposited on the filters of cigarettes smoked in the lab and in the field. The data were collected in a study of the effect of very low-nicotine-content versus normal-nicotine-content cigarettes in nondai...

Introduction: Switching from cigarettes to snus by smokers unlikely to quit would be expected to benefit overall population health, with any potential benefit needing to be weighed against potential harms from snus use by tobacco non-users and smokers likely to quit. This study evaluates likelihood of snus use among tobacco users and non-users pro...

Background The US Food and Drug Administration is considering reductions in the nicotine content of cigarettes to reduce smoking and tobacco dependence. A randomized study showed that even non-daily, intermittent smokers (ITS) reduced their cigarette consumption when switched to very-low-nicotine-content cigarettes (VLNCCs). This paper assesses whe...

Temporal patterns of acetaminophen use exceeding the recommended daily maximum dosage of 4 g over a 5‐year period (4/1/2011–3/31/2016) were evaluated in an online 1‐week diary study of 14 434 adult acetaminophen users who also reported acetaminophen use in the previous month. Specific medications taken were identified by list‐based prompting; respo...

Researchers are sometimes interested in predicting a distal or external outcome (such as smoking cessation at follow-up) from the trajectory of an intensively recorded longitudinal variable (such as urge to smoke). This can be done in a semiparametric way via scalar-on-function regression. However, the resulting fitted coefficient regression functi...

Rationale The Food and Drug Administration is considering severely restricting the nicotine in cigarettes, to reduce smoking. A study showed that non-daily, intermittent smokers (ITS) randomized to very-low-nicotine-content cigarettes (VLNCCs) reduced their cigarette consumption. Objectives To assess whether increased smoking intensity of VLNCCs c...

Understanding social disadvantage and smoking through the experience of daily stress

Objective Studies on situation and Person × Situation interaction effects often use only one method of measurement, so that the extent to which the effects may be method‐specific cannot be determined. We introduce a new multimethod latent state–trait model for random and fixed situations (MM‐LST‐RF), which allows examining person, situation, and Pe...

Purpose/objective: The purpose of this report is to provide rehabilitation researchers with an explanation of multilevel item response theory (MLIRT), specifically applied to data collected using ecological momentary assessment (EMA) methods. Design: This is a didactic brief report of a statistical method. The advantages of the method are illust...

Objectives We assessed the psychometric properties of the Relapse Situation Efficacy Questionnaire - Weight (RSEQ-W) including internal consistency reliability, criterion-related validity (concurrent and predictive validity) and construct validity (convergent validity and factor analysis). Methods We administered the RSEQ-W at baseline, and at 6 an...

Objectives: To assess whether there are differences in the likelihood of exceeding the daily limit of 4 grams of acetaminophen when using different formulations (325 mg, 500 mg, 650 mg) of OTC single-ingredient (SI) acetaminophen medications. Design and setting: Multiyear observational study of acetaminophen use via daily online acetaminophen-us...

Objectives: Users should know the active ingredients and dosing directions to optimize the safe use of acetaminophen-containing medications. The aim of this work was to examine knowledge of acetaminophen-containing medication directions among current users. Design, setting, and participants: An Internet panel diary study (2012-2016) of 1-week us...

Importance The US Food and Drug Administration is considering limiting cigarettes to very low nicotine levels. Cigarette consumption of nondaily intermittent smokers (ITS), who compose one-third of US adult smokers, could feasibly increase or could be unaffected if their smoking is not motivated by nicotine seeking. Objective To compare cigarette...

Ethnic differences in smoking patterns and dependence have been observed between Caucasian and African American smokers: African Americans who smoke are more likely to be intermittent smokers (ITS), and daily smokers (DS) consume fewer cigarettes yet report more dependence. Participants’ (N = 482, 67% Caucasian, 54% ITS) dependence was assessed by...

Aims: To estimate prevalence of excess intake of acetaminophen, and investigate seasonal variations therein. Methods: Between 2011 and 2016, 14,481 US adults who used acetaminophen in the preceding 30 days were sampled from national online panels and completed a detailed online daily diary of acetaminophen medication use for 7 days. Respondents...