David B Abrams

Professor of Social and Behavioral Sciences

Professional overview

Dr. David Abrams' career focuses on systems and social learning frameworks to inform population health enhancement. He has experience in testing theory, research design, measuring mechanisms of behavior change and outcome, and evaluating clinical trials (behavioral and pharmacological). His interests span topics from basic bio-behavioral mechanisms and clinical treatments to policy across risk factors and behaviors (e.g. tobacco/nicotine; alcohol, obesity, co-morbidity of medical and mental health), disease states (cancer; cardiovascular; HIV-AIDS), levels (biological, individual, organizational, worksite, community, global, and internet based), populations and disparities. His interests converge in the domain of implementation science to cost-efficiently inform evidence-based public health practice and policymaking.

Through transdisciplinary and translational research strategies, Dr. Abrams provides scientific leadership in tobacco control. His current focus is in strengthening global and United States tobacco and nicotine management strategies. Deaths of 1 billion smokers are estimated by 2100 caused overwhelmingly by use of combustible (smoked) tobacco products, not nicotine. Harm minimization is a key overarching systems strategy to speed the net public health benefit of emergent disruptive technologies for cleaner nicotine delivery. The goal is more rapid elimination of preventable deaths, disease burdens, and the widening gap in health disparities driven disproportionately by disparities in smoking.

Dr. Abrams was a professor and founding director of the Centers for Behavioral and Preventive Medicine at Brown University Medical School. He then directed the Office of Behavioral and Social Sciences Research at the National Institutes of Health (NIH). Until 2017, he was Professor of Health Behavior and Society at Johns Hopkins Bloomberg School of Public Health and the founding Executive Director of the Schroeder National Institute of Tobacco Research and Policy Studies at Truth Initiative (formerly the American Legacy Foundation).

Dr. Abrams has published over 250 peer reviewed scholarly articles and been a Principal Investigator on numerous NIH grants. He is lead author of The Tobacco Dependence Treatment Handbook: A Guide to Best Practices. He has served on expert panels at NIH and National Academies of Sciences, Engineering and Medicine on Obesity, Alcohol Misuse and Ending the Tobacco Problem: A Blueprint for the Nation. He has also served on the Board of Scientific Advisors of the National Cancer Institute (NIH-NCI) and was President of the Society of Behavioral Medicine.

For a complete list of Dr. Abrams' published work, click here.

Education

BSc (Hons), Psychology and Computer Science, University of the Witwatersrand, Johannesburg, South Africa

MS, Clinical Psychology, Rutgers University, New Brunswick, NJ

PhD, Clinical Psychology, Rutgers University, New Brunswick, NJ

Postdoctoral Fellow, Brown Medical School, Providence, RI

Honors and awards

Research Laureate Award, American Academy of Health Behavior (2014)

Joseph W. Cullen Memorial Award for Tobacco Research, American Society for Preventive Oncology (2008)

Distinguished Alumni Award: Rutgers University, The Graduate School, New Brunswick, NJ (2007)

The Musiker-Miranda Distinguished Service Award, American Psychological Association (2006)

Distinguished Service Award, Society of Behavioral Medicine (2006)

Outstanding Research Mentor Award, Society of Behavioral Medicine (2006)

Book of the Year Award: Tobacco Dependence Treatment Handbook. American Journal of Nursing (2005)

Distinguished Scientist Award, Society of Behavioral Medicine (1998)

Areas of research and study

Behavioral Science

Chronic Diseases

Evaluations

Implementation and Impact of Public Health Regulations

Implementation science

Population Health

Public Health Pedagogy

Public Health Systems

Research Design

Systems Integration

Systems Interventions

Tobacco Control

Translational science

Publications

Publications

Estimating the population health impact of recently introduced modified risk tobacco products : A comparison of different approaches

Abrams, D., Lee, P. N., Abrams, D. S., Bachand, A., Baker, G., Black, R., Camacho, O., Curtin, G., Djurdjevic, S., Hill, A., Mendez, D., Muhammad-Kah, R. S., Murillo, J. L., Niaura, R. S., Pithawalla, Y. B., Poland, B., Sulsky, S., Wei, L., & Weitkunat, R. (n.d.).

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

426-437

10.1093/ntr/ntaa102

Abstract

Abstract

Introduction: Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP). Aims and Methods: We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018. Results: Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the "null scenario"or joint smoking and MRTP habits in an "alternative scenario". The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized. Conclusions: Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction. Implications: There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.

Intensive Longitudinal Study of the Relationship between Cigalike E-cigarette Use and Cigarette Smoking among Adult Cigarette Smokers without Immediate Plans to Quit Smoking

Abrams, D., Pearson, J. L., Zhou, Y., Smiley, S. L., Rubin, L. F., Harvey, E., Koch, B., Niaura, R. S., & Abrams, D. B. (n.d.).

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

527-534

10.1093/ntr/ntaa086

Abstract

Abstract

Introduction: This study examined the association between the introduction of an e-cigarette and subsequent change in cigarette smoking among smokers who were not immediately interested in quitting. Aims and Methods: The Moment Study was a 21-day intensive longitudinal study with an online follow-up survey at 30 days. After observing baseline cigarette smoking for 1 week, participants received 10 cigalike e-cigarettes on study days 6 and 13. Participants reported cigarettes per day, e-cigarette puffs per day, and e-cigarette satisfaction using text-message-based surveys. Results: The sample of 96 daily smokers was majority female (53.1%), African American (67.7%), and non-Hispanic (95.8%). When e-cigarettes were provided (day 6), average cigarettes per day dropped by 1.82 cigarettes (p

Menthol and Mint Cigarettes and Cigars : Initiation and Progression in Youth, Young Adults and Adults in Waves 1-4 of the PATH Study, 2013-2017

Abrams, D., Villanti, A. C., Johnson, A. L., Halenar, M. J., Sharma, E., Cummings, K. M., Stanton, C. A., Delnevo, C. D., Wackowski, O. A., Bansal-Travers, M., Pearson, J. L., Abrams, D. B., Niaura, R. S., Fong, G. T., Elton-Marshall, T., Hatsukami, D., Trinidad, D. R., Kaufman, A., Sawdey, M. D., … Hyland, A. (n.d.).

Publication year

2021

Journal title

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco

Volume

23

Issue

8

Page(s)

1318-1326

10.1093/ntr/ntaa224

Abstract

Abstract

INTRODUCTION: This study examined in youth (12-17 years), young adults (18-24 years), and adults (25+ years): (1) the prevalence of the first menthol cigarette and menthol/mint cigar use among new tobacco users; (2) association between the first menthol/mint use, subsequent tobacco use, and nicotine dependence ~1 year later compared with the first non-menthol/mint use. AIMS AND METHODS: Longitudinal analysis of data from Waves 1 to 4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2017; 10 086 youth and 21 281 adults). Main outcome measures were past 12-month and past 30-day cigarette and cigar use, and nicotine dependence. RESULTS: Youth and young adult new cigarette users are more likely to smoke a menthol cigarette or indicate that they do not know the flavor compared with adults aged 25+. A greater proportion of adults aged 25+ first used menthol/mint-flavored cigars (13.4%) compared with youth (8.5%) and young adults (7.4%). Among young adults, first use of a menthol cigarette is associated with past 12-month use of cigarettes at the subsequent wave and first use of any menthol/mint-flavored cigars is associated with past 30-day use of these products at the subsequent wave in both youth and young adults. In youth and adults, there were no significant relationships between first use of a menthol/mint cigarette or cigar and nicotine dependence scores at a subsequent wave in multivariable analyses. CONCLUSIONS: The first use of menthol/mint cigarettes and cigars is associated with subsequent cigarette and cigar use in young people aged 12-24. IMPLICATIONS: This study examined the relationship between initiation with menthol cigarettes and menthol/mint cigars, subsequent tobacco use, and nicotine dependence in US youth, young adults, and adults who participated in Waves 1-4 of the Population Assessment of Tobacco and Health study. New use of menthol cigarettes was associated with greater past 12-month cigarette use in young adults and new use of menthol/mint-flavored cigars was associated with greater past 30-day cigar use in youth and young adults compared with non-menthol use. Initiation with menthol/mint cigarette and cigar products may lead to subsequent use of those products.

Patterns of E-cigarette use and subsequent cigarette smoking cessation over 2 Years (2013/2014-2015/2016) in the population assessment of tobacco and health study

Abrams, D., Glasser, A. M., Vojjala, M., Cantrell, J., Levy, D. T., Giovenco, D. P., Abrams, D. S., & Niaura, R. S. (n.d.).

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

4

Page(s)

669-677

10.1093/ntr/ntaa182

Abstract

Abstract

Introduction: Understanding the population impact of e-cigarettes requires determining their effect on cigarette smoking cessation. Methods: Using the US Population Assessment of Tobacco and Health cohort, we examined smoking cessation among adult current cigarette smokers at Wave 1 with follow-up data at Waves 2 and 3 (n = 9724). Results: By Wave 3 (2015/2016), 17.3% of smokers had quit smoking. Smokers using e-cigarettes daily or who increased to daily use over the three waves were two to four times more likely to have quit in the short term (

Predictors of attrition in a smoking cessation trial conducted in the lung cancer screening setting

Abrams, D. (n.d.).

Publication year

2021

Journal title

Contemporary Clinical Trials

Volume

106

10.1016/j.cct.2021.106429

Abstract

Abstract

Significance: Although it is a requirement that tobacco treatment is offered to cigarette smokers undergoing low-dose computed tomographic lung cancer screening (LCS), not all smokers engage in treatment. To understand the barriers to tobacco treatment in this setting, we evaluated predictors of attrition in a smoking cessation trial among individuals undergoing LCS. Methods: Prior to LCS, 926 participants, 50–80 years old, completed the baseline (T0) phone assessment, including demographic, clinical, tobacco, and psychological characteristics. Following LCS and receipt of the results, participants completed the pre-randomization (T1) assessment. Results: At the T1 assessment, 735 (79%) participants were retained and 191 (21%) dropped out. In multivariable analyses, attrition was higher among those who: smoked >1 pack per day (OR = 1.44, CI 1.01, 2.06) or had undergone their first (vs. annual) LCS scan (OR = 1.70, CI 1.20, 2.42). Attrition was lower among those with: more education (associates (OR = 0.67, CI = 0.46, 0.98) or bachelor's degree (OR = 0.56, CI 0.35, 0.91) vs. high school/GED), some (vs. none/a little) worry about lung cancer (OR = 0.60, CI 0.39, 0.92), or a screening result that was benign (OR = 0.57, CI 0.39, 0.82) or probably benign (OR = 0.38, CI 0.16, 0.90) vs. negative. Conclusions: This study illuminated several LCS-related factors that contributed to trial attrition. Increasing tobacco treatment in this setting will require targeted strategies for those who report little lung cancer worry, are undergoing their first LCS exam, and/or who have a negative LCS result. Addressing attrition and reducing barriers to tobacco treatment will increase the likelihood of cessation, thereby reducing the risk of developing lung cancer.

Youth Vaping and Tobacco Use in Context in the United States : Results from the 2018 National Youth Tobacco Survey

Abrams, D., Glasser, A. M., Johnson, A. L., Niaura, R. S., Abrams, D. B., & Pearson, J. L. (n.d.).

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

447-453

10.1093/ntr/ntaa010

Abstract

Abstract

Introduction: According to the National Youth Tobacco Survey (NYTS), youth e-cigarette use (vaping) rose between 2017 and 2018. Frequency of vaping and concurrent past 30-day (p30d) use of e-cigarettes and tobacco products have not been reported. Methods: We analyzed the 2018 NYTS (N = 20 189) for vaping among all students (middle and high school; 6-12th grades; 9-19 years old) by frequency of vaping, exclusive vaping, p30d poly-product use (vaping and use of one or more tobacco product), and any past tobacco product use. Results: In 2018, 81.4% of students had not used any tobacco or vapor product in the p30d, and 86.2% had not vaped in the p30d. Among all students, of the 13.8% vaped in the p30d, just over half vaped on ≤5 days (7.0%), and roughly a quarter each vaped on 6-19 days (3.2%) and on 20+ days (3.6%). Almost three quarters of p30d vapers (9.9%) reported past or concurrent tobacco use and the remainder (3.9%) were tobacco naïve. 2.8% of students were tobacco naïve and vaped on ≤5 days; 0.7% were tobacco-naïve and vaped on 6-19 days, and 0.4% were tobacco-naïve and vaped on 20+ days. Conclusions: Vaping increased among US youth in 2018 over 2017. The increases are characterized by patterns of low p30d vaping frequency and high poly-product use, and a low prevalence of vaping among more frequent but tobacco naïve vapers. Implications: Results underscore the importance of including the full context of use patterns. The majority of vapers (60.0%-88.9% by use frequency) were concurrent p30d or ever tobacco users. About 4% of students were tobacco naïve and vaped in the p30d, but few (0.4%) vaped regularly on 20 or more days. Reporting youth vaping data with frequency and tobacco product co-use will give public health decision-makers the best possible information to protect public health.

Association of Electronic Nicotine Delivery System Use With Cigarette Smoking Progression or Reduction Among Young Adults

Abrams, D., Pearson, J. L., Sharma, E., Rui, N., Halenar, M. J., Johnson, A. L., Cummings, K. M., Hammad, H. T., Kaufman, A. R., Tworek, C., Goniewicz, M. L., Kimmel, H. L., Tanski, S., Compton, W. M., Day, H., Ambrose, B. K., Bansal-Travers, M., Silveira, M. L., Abrams, D. S., … Stanton, C. A. (n.d.).

Publication year

2020

Journal title

JAMA network open

Volume

3

Issue

11

Page(s)

e2015893

10.1001/jamanetworkopen.2020.15893

Abstract

Abstract

Importance: The prevalence of electronic nicotine delivery systems (ENDS) use, including e-cigarettes, among US young adults (YAs) has raised questions about how these products may affect future tobacco and nicotine use among YAs. Given this prevalence and that young adulthood is a critical period for the establishment of tobacco and nicotine use, it is important to consider the association between ENDS use and cigarette smoking specifically in this age group. Objective: To examine whether ENDS use frequency or intensity is associated with changes in cigarette smoking among US YA ever smokers during 1 year. Design, Setting, and Participants: This cohort study used 3 waves of data (2013-2014, 2014-2015, and 2015-2016) from the Population Assessment of Tobacco and Health (PATH) Study, an ongoing longitudinal cohort study of adults and youth. Unweighted 1:6 propensity score matching was used to match participants on wave 1 risk factors for ENDS use at wave 2. The changes in smoking between wave 2 and wave 3 were assessed using the matched sample. In total, 1096 ENDS-naive, ever cigarette-smoking YAs (18-24 years of age) at wave 1 who participated in wave 2 and wave 3 and who had complete data in the PATH Study were included in the analyses, which were conducted from August 2018 to October 2019. Exposures: Never ENDS use (n = 987), any previous 30-day ENDS use (n = 109), 1 to 5 days of ENDS use in the previous 30 days (n = 75), and 6 or more days ENDS use in the previous 30 days at wave 2 (n = 34). Main Outcomes and Measures: The analytic sample was selected using multiple variables based on peer-reviewed literature supporting associations with ENDS use. The main outcomes-changes in cigarette smoking behavior between wave 2 and wave 3-were defined using 2 measures: (1) change in smoking frequency, defined as the number of smoking days in the previous 30 days at wave 3 vs wave 2, and (2) change in smoking intensity, defined as the number smoking days in the previous 30 days multiplied by the mean number of cigarettes consumed on smoking days at wave 3 vs wave 2. Results: The present cohort analyses included 1096 YA ever smokers who were ENDS naive at wave 1. The majority of the sample were women (609 [55.6%]) and White individuals (698 [63.7%]), and the mean (SD) age was 21.4 (1.9) years. In wave 1, 161 YAs (14.7%) were daily smokers in the previous 30 days. After propensity score matching, no statistically significant associations were observed between any definition of wave 2 ENDS use and changes in either the frequency or intensity of smoking at wave 3. Conclusions and Relevance: In this cohort study of US YA ever smokers, ENDS use was not associated with either decreased or increased cigarette smoking during a 1-year period. However, it is possible that the rapidly evolving marketplace of vaping products may lead to different trajectories of YA cigarette and ENDS use in the future.

Can the Association Between Electronic-Cigarette Use and Stroke Be Interpreted as Risk of Stroke?

Abrams, D., Farsalinos, K., Abrams, D. S., & Niaura, R. S. (n.d.).

Publication year

2020

Journal title

American journal of preventive medicine

Volume

58

Issue

6

Page(s)

895-896

10.1016/j.amepre.2020.01.020

Abstract

Abstract

~

Hookah use patterns, social influence and associated other substance use among a sample of New York City public university students

Abrams, D., El Shahawy, O., Park, S. H., Rogers, E. S., Shearston, J. A., Thompson, A. B., Cooper, S. C., Freudenberg, N., Ball, S. A., Abrams, D. S., Shelley, D., & Sherman, S. E. (n.d.).

Publication year

2020

Journal title

Substance Abuse: Treatment, Prevention, and Policy

Volume

15

Issue

1

10.1186/s13011-020-00283-5

Abstract

Abstract

Background: Most hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students. Methods: A cross-sectional survey of 2460 students (aged 18-25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns. Results: Among current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001. Conclusions: The socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.

Is Nicotine Reduction in Cigarettes Enough?

Abrams, D., Abrams, D. B., & Notley, C. (n.d.).

Publication year

2020

Journal title

JAMA network open

Volume

3

Issue

10

Page(s)

e2019367

10.1001/jamanetworkopen.2020.19367

Abstract

Abstract

~

Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking : The PATH Study 2013-16

Abrams, D., Pierce, J. P., Benmarhnia, T., Chen, R., White, M., Abrams, D. B., Ambrose, B. K., Blanco, C., Borek, N., Choi, K., Coleman, B., Compton, W. M., Michael Cummings, K., Delnevo, C. D., Elton-Marshall, T., Goniewicz, M. L., Gravely, S., Fong, G. T., Hatsukami, D., … Messer, K. (n.d.).

Publication year

2020

Journal title

PloS one

Volume

15

Issue

9

10.1371/journal.pone.0237938

Abstract

Abstract

Background More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy. Objective To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use. Design Cohort study of US sample, with annual follow-up. Participants US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443). Exposures Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2. Analysis Propensity score matching (PSM) of groups using different methods to quit. Outcome measures 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome. Results Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products. Limitations The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA. Conclusion Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.

Young Adult Tobacco and E-cigarette Use Transitions : Examining Stability Using Multistate Modeling

Abrams, D., Niaura, R. S., Rich, I., Johnson, A. L., Villanti, A. C., Romberg, A. R., Hair, E. C., Vallone, D. M., & Abrams, D. B. (n.d.).

Publication year

2020

Journal title

Nicotine and Tobacco Research

Volume

22

Issue

5

Page(s)

647-654

10.1093/ntr/ntz030

Abstract

Abstract

Introduction: The objective of this study was to describe tobacco and nicotine product use state transition probabilities among youth and young adults over time. Methods: A national sample of young adult tobacco product users and nonusers between the ages of 18 and 34 years at baseline was surveyed at 6-month intervals for 3 years. Use and nonuse states were defined as mutually exclusive categories based on self-reported, past 30-day use of the various products. Never use, noncurrent use, and current use of combustible, noncombustible tobacco, and electronic cigarette (e-cigarette) products was assessed at each interval. A multistate model was fit to estimate transition probabilities between states and length of stay within each state. Results: After 6 months, same-state transition probabilities were high for all use states (0.76-0.96), except for dual product use (0.48). After 3 years, transition probabilities were smaller and tended to converge toward combustible product use for baseline e-cigarette (0.42), combustible (0.51), and dual product users (0.52). Age was inversely associated with transition risk from never or noncurrent use to use of combustible or e-cigarette products. Conclusions: Never and noncurrent users, followed by combustible product users, were most likely to remain in those states throughout the 3-year observation interval. Users of any tobacco or e-cigarette product at baseline were most likely to transition to combustible product use or noncurrent use by the final follow-up. Implications: This study describes the probability of transitioning between various states of tobacco product use, including never and no current use, over a span of 3 years in a sample of young adults. This type of longitudinal description, which includes all tobacco product use states, is lacking in most studies that tend to focus on one or only a few products. The results suggest that it is important to assess outcomes over a sufficiently long period to capture true variability in patterns of product use.

Associations of risk factors of e-cigarette and cigarette use and susceptibility to use among baseline PATH study youth participants (2013–2014)

Abrams, D., Sawdey, M. D., Day, H. R., Coleman, B., Gardner, L. D., Johnson, S. E., Limpert, J., Hammad, H. T., Goniewicz, M. L., Abrams, D. B., Stanton, C. A., Pearson, J. L., Kaufman, A. R., Kimmel, H. L., Delnevo, C. D., Compton, W. M., Bansal-Travers, M., Niaura, R. S., Hyland, A., & Ambrose, B. K. (n.d.).

Publication year

2019

Journal title

Addictive Behaviors

Volume

91

Page(s)

51-60

10.1016/j.addbeh.2018.11.027

Abstract

Abstract

Introduction: Improved understanding of the distribution of traditional risk factors of cigarette smoking among youth who have ever used or are susceptible to e-cigarettes and cigarettes will inform future longitudinal studies examining transitions in use. Methods: Multiple logistic regression analysis was conducted using data from youth (ages 12–17 years) who had ever heard of e-cigarettes at baseline of the PATH Study (n = 12,460) to compare the distribution of risk factors for cigarette smoking among seven mutually exclusive groups based on ever cigarette/e-cigarette use and susceptibility status. Results: Compared to committed never users, youth susceptible to e-cigarettes, cigarettes, or both had increasing odds of risk factors for cigarette smoking, with those susceptible to both products at highest risk, followed by cigarettes and e-cigarettes. Compared to e-cigarette only users, dual users had higher odds of nearly all risk factors (aOR range = 1.6–6.8) and cigarette only smokers had higher odds of other (non-e-cigarette) tobacco use (aOR range = 1.5–2.3), marijuana use (aOR = 1.9, 95%CI = 1.4–2.5), a high GAIN substance use score (aOR = 1.9, 95%CI = 1.1–3.4), low academic achievement (aOR range = 1.6–3.4), and exposure to smoking (aOR range = 1.8–2.1). No differences were observed for externalizing factors (depression, anxiety, etc.), sensation seeking, or household use of non-cigarette tobacco. Conclusions: Among ever cigarette and e-cigarette users, dual users had higher odds of reporting traditional risk factors for smoking, followed by single product cigarette smokers and e-cigarette users. Understanding how e-cigarette and cigarette users differ may inform youth tobacco use prevention efforts and advise future studies assessing probability of progression of cigarette and e-cigarette use.

Ethnic and Socioeconomic Disparities in Recalled Exposure to and Self-Reported Impact of Tobacco Marketing and Promotions

Abrams, D., Moran, M. B., Heley, K., Pierce, J. P., Niaura, R., Strong, D., & Abrams, D. S. (n.d.).

Publication year

2019

Journal title

Health Communication

Volume

34

Issue

3

Page(s)

280-289

10.1080/10410236.2017.1407227

Abstract

Abstract

The role of tobacco marketing in tobacco use, particularly among the vulnerable ethnic and socioeconomic sub-populations is a regulatory priority of the U.S. Food and Drug Administration. There currently exist both ethnic and socioeconomic disparities in the use of tobacco products. Monitoring such inequalities in exposure to tobacco marketing is essential to inform tobacco regulatory policy that may reduce known tobacco-related health disparities. We use data from the Population Assessment of Tobacco and Health (PATH) Wave 1 youth survey to examine (1) recalled exposure to and liking of tobacco marketing for cigarettes, non-large cigars, and e-cigarettes, (2) self-reported exposure to specific tobacco marketing tactics, namely coupons, sweepstakes, and free samples, and (3) self-reported impact of tobacco marketing and promotions on product use. Findings indicate that African Americans and those of lower SES were more likely to recall having seen cigarette and non-large cigar ads. Reported exposure to coupons, sweepstakes and free samples also varied ethnically and socioeconomically. African Americans and those of lower SES were more likely than other respondents to report that marketing and promotions as played a role in their tobacco product use. Better understanding of communication inequalities and their influence on product use is needed to inform tobacco regulatory action that may reduce tobacco company efforts to target vulnerable groups. Tobacco education communication campaigns focusing on disproportionately affected groups could help counter the effects of targeted industry marketing.

Evidence, alarm, and the debate over e-cigarettes

Abrams, D., Fairchild, A., Healton, C., Curran, J., Abrams, D. S., & Bayer, R. (n.d.).

Publication year

2019

Journal title

Science

Volume

366

Issue

6471

Page(s)

1318-1320

10.1126/science.aba0032

Abstract

Abstract

~

Longitudinal e-Cigarette and cigarette use among US Youth in the PATH Study (2013-2015)

Abrams, D., Stanton, C. A., Bansal-Travers, M., Johnson, A. L., Sharma, E., Katz, L., Ambrose, B. K., Silveira, M. L., Day, H., Sargent, J., Borek, N., Compton, W. M., Johnson, S. E., Kimmel, H. L., Kaufman, A. R., Limpert, J., Abrams, D. S., Cummings, K. M., Goniewicz, M. L., … Pearson, J. L. (n.d.).

Publication year

2019

Journal title

Journal of the National Cancer Institute

Volume

111

Issue

10

Page(s)

1088-1096

10.1093/jnci/djz006

Abstract

Abstract

Background: Evidence is accumulating that youth who try Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) may go on to try cigarettes. This analysis examines the bidirectional patterns of ENDS and cigarette use among US youth over one year and uses propensity score matching (PSM) to examine frequency of ENDS use on changes in cigarette smoking. Methods: Our analysis included 11 996 participants who had two waves of available data (Wave 1 [W1] 2013-2014; Wave 2 [W2] 2014-2015) drawn from the longitudinal Population Assessment of Tobacco and Health Study. Cross-sectional weighted prevalence estimates are reported for cigarettes and ENDS. We used PSM to estimate the likelihood of ENDS use at W1 and to draw matched analytic samples, then used regression (logistic or linear) models to examine the effect of W1 ENDS use on W2 cigarette smoking. All statistical tests were two-sided. Results: In weighted analyses, 69.3% of W1 past-30-day cigarette smokers exhibited past-30-day smoking at W2; 42.2% of W1 past-30-day ENDS users were using ENDS at W2. W1 ever use of either product was similarly associated with W2 new use of the other product. Unweighted PSM models indicated W1 cigarette-naïve ENDS use was associated with W2 ever-cigarette smoking (n = 676; adjusted odds ratio = 3.21, 95% confidence interval [CI] = 1.95 to 5.45, P

Longitudinal tobacco use transitions among adolescents and young adults : 2014-2016

Abrams, D., Hair, E. C., Romberg, A. R., Niaura, R. S., Abrams, D. B., Bennett, M. A., Xiao, H., Rath, J. M., Pitzer, L., & Vallone, D. (n.d.).

Publication year

2019

Journal title

Nicotine and Tobacco Research

Volume

21

Issue

4

Page(s)

458-468

10.1093/ntr/ntx285

Abstract

Abstract

Introduction: Among youth, the frequency and prevalence of using more than one tobacco (small cigar, cigarette, and hookah) or nicotine-containing product (e-cigarettes-ENDS) are changing. These shifts pose challenges for regulation, intervention, and prevention campaigns because of scant longitudinal data on the stability of use patterns in this changing product landscape. Methods: A nationally representative longitudinal survey of 15- to 21-year olds (n = 15,275) was used to describe transitions between never use, noncurrent use, and past 30-day use of combustible tobacco, e-cigarettes (ENDS), and dual use of both kinds of products. A multistate model was fit to observations collected every 6 months across 2.5 years to estimate the probability of transitions between states (TPs), the average time in state (sojourn time), and the effect of age on transitions. Results: Current state strongly predicted future state over time intervals of 1 year or less, but only weakly predicted future state at longer intervals: TP to noncurrent use was higher for ENDS-only than combustible-only users over a 6-month interval but was similar for both groups over a 2-year interval. Sojourn time was significantly longer for combustible-only (0.52 years) and dual use (0.55 years) than ENDS-only use (0.27 years); older youth were more likely than younger youth to stay combustible tobacco users or noncurrent users. Conclusions: The dynamics of transitions between combustible tobacco products and ENDS in a population of youth and young adults suggest that policy and prevention efforts must consider the frequent changes and instability over a 1-year or less time period in use patterns among young people. Implications: The study addresses an urgent need in public health for timely information on how youth and young adults use tobacco and nicotine products. We found that youth, particularly adolescents, moved frequently between using ENDS and combustible tobacco products either alone or together. Importantly, the utility of current-use states for predicting future use states declined for time horizons longer than 1 year. Our results demonstrate a need for caution in interpreting product transitions. Longitudinal data with frequent observations and coverage of a wide range of possible product types is required to fully characterize usage patterns in youth.

Prevalence and Correlates of Snuff Use, and its Association with Tuberculosis, among Women Living with HIV in South Africa

Abrams, D., Elf, J. L., Variava, E., Chon, S., Lebina, L., Motlhaoleng, K., Gupte, N., Niaura, R. S., Abrams, D. S., Martinson, N., & Golub, J. E. (n.d.).

Publication year

2019

Journal title

Nicotine and Tobacco Research

Volume

21

Issue

8

Page(s)

1087-1092

10.1093/ntr/nty137

Abstract

Abstract

Introduction: A higher proportion of people living with HIV (PLWH) smoke compared to the general population, but little information exists about the prevalence and correlates of smokeless tobacco use among PLWH. In South Africa, dry powdered tobacco is inhaled nasally as snuff. Methods: A cross-sectional survey among PLWH attending three HIV clinics was conducted. Snuff use was assessed via self-report and urine cotinine. Results: Given the low (3%) prevalence of snuff use among men, analysis was restricted to n = 606 nonsmoking women living with HIV. Half (n = 298, 49%) were snuff users, the majority of whom (n = 244, 84%) had a positive urine cotinine test. In adjusted analysis, snuff use was negatively associated with higher education (relative risk [RR] 0.55; 95% confidence interval [CI]: 0.39, 0.77) and mobile phone ownership (RR 0.83; 95% CI: 0.71, 0.98), and positively associated with ever having tuberculosis (TB) (RR 1.22; 95% CI: 1.03, 1.45). In adjusted analysis, with current TB as the outcome, snuff use was marginally statistically significantly associated with a twofold increase in odds of a current TB diagnosis (odds ratio [OR] 1.99; 95% CI: 0.98, 4.15). Discussion: A high proportion of nonsmoking South African women living with HIV use snuff, which was a risk factor for TB. Additional research is needed to understand the relationship between snuff, TB, and other potential health risks. Implications: PLWH have a higher prevalence of smoking than their seronegative peers, but there is a paucity of research on smokeless tobacco use in this population, especially in low-resource settings. TB is the leading cause of death among PLWH, and with improvements to HIV treatment and care, PLWH are at greater risk of tobacco-related diseases. We report an extremely high prevalence of snuff use among women living with HIV in South Africa. Further, in this population snuff use is positively associated with ever having a TB diagnosis, as well as currently having TB.

Preventing Smoking Progression in Young Adults : the Concept of Prevescalation

Abrams, D., Villanti, A. C., Niaura, R. S., Abrams, D. B., & Mermelstein, R. (n.d.).

Publication year

2019

Journal title

Prevention Science

Volume

20

Issue

3

Page(s)

377-384

10.1007/s11121-018-0880-y

Abstract

Abstract

As adolescents cross the threshold to young adulthood, they encounter more opportunities to engage in or accelerate previously discouraged or prohibited behaviors. Young adults, therefore, are more apt to initiate cigarette smoking and, more importantly, to accelerate their use if they tried and experimented as an adolescent. Preventing the escalation and entrenchment of smoking in the young adult years is critically important to reducing tobacco’s long-term health toll. However, traditional interventions for youth have focused on preventing smoking initiation, and interventions for adults have focused on smoking cessation; both have failed to address the needs of young adults. We introduce the concept of “prevescalation” to capture the need and opportunity to prevent the escalation of risk behaviors that typically occur during young adulthood, with a focus on the example of cigarette smoking. Prevescalation negates the notion that prevention has failed if tobacco experimentation occurs during adolescence and focuses on understanding and interrupting transitions between experimentation with tobacco products and established tobacco use that largely occur during young adulthood. However, since risk behaviors often co-occur in young people, the core concept of prevescalation may apply to other behaviors that co-occur and become harder to change in later adulthood. We present a new framework for conceptualizing, developing, and evaluating interventions that better fit the unique behavioral, psychosocial, and socio-environmental characteristics of the young adult years. We discuss the need to target this transitional phase, what we know about behavioral pathways and predictors of cigarette smoking, potential intervention considerations, and research challenges.

Re : Disregarding the impact of nicotine on the developing brain when evaluating costs and benefits of noncombustible nicotine products

Abrams, D., Abrams, D. B., Glasser, A. M., Villanti, A. C., Pearson, J. L., Rose, S., & Niaura, R. S. (n.d.).

Publication year

2019

Journal title

Preventive Medicine

Volume

120

Page(s)

158-159

10.1016/j.ypmed.2018.12.027

Abstract

Abstract

This Letter to the Editor is in response to a letter from Ms. Flannery, titled, “Disregarding the impact of nicotine on the developing brain when evaluating costs and benefits of noncombustible nicotine products”. In our response, we address some concerns raised by Ms. Flannery, and reiterate our position in our original article. In particular, we underline the importance of a rational public health calculus that weighs beneficial and harmful consequences of policies related to noncombustible nicotine product (NNP) use. We further emphasize the need to correct misperceptions about relative risk of different products to encourage smokers to switch to NNPs. Lastly, we are explicit about our assertion that no use of any nicotine-containing products is the only way to avoid harm at any age, but that we must view this issue pragmatically for the benefit of public health.

Smoking Trajectory Classes and Impact of Social Smoking Identity in Two Cohorts of U.S. Young Adults

Abrams, D., Johnson, A. L., Villanti, A. C., Williams, V., Rath, J. M., Vallone, D. M., Abrams, D. B., Hedeker, D., & Mermelstein, R. J. (n.d.).

Publication year

2019

Journal title

Emerging Adulthood

Volume

7

Issue

4

Page(s)

258-269

10.1177/2167696818763949

Abstract

Abstract

This study describes cigarette smoking trajectories, the influence of social smoker self-identification (SSID), and correlates of these trajectories in two cohorts of U.S. young adults: a sample from the Chicago metropolitan area (Social Emotional Contexts of Adolescent and Young Adult Smoking Patterns [SECAP], n = 893) and a national sample (Truth Initiative Young Adult Cohort Study [YA Cohort], n = 1,491). Using latent class growth analyses and growth mixture models, five smoking trajectories were identified in each sample: in SECAP: nonsmoking (n = 658, 73.7%), declining smoking (n = 20, 2.2%), moderate/stable smoking (n = 114, 12.8%), high/stable smoking (n = 79, 8.9%), and escalating smoking (n = 22, 2.5%); and in YA Cohort: nonsmoking (n = 1,215, 81.5%), slowly declining smoking (n = 52, 3.5%), rapidly declining smoking (n = 50, 3.4%), stable smoking (n = 139, 9%), and escalating smoking (n = 35, 2.4%). SSID was most prevalent in moderate/stable smoking (35.5% SECAP), rapidly declining smoking (25.2% YA Cohort), and nonsmoking. Understanding nuances of how smoking identity is formed and used to limit or facilitate smoking behavior in young adults will allow for more effective interventions to reduce tobacco use.

Study protocol for a telephone-based smoking cessation randomized controlled trial in the lung cancer screening setting : The lung screening, tobacco, and health trial

Abrams, D., Taylor, K. L., Deros, D. E., Fallon, S., Stephens, J., Kim, E., Lobo, T., Davis, K. M., Luta, G., Jayasekera, J., Meza, R., Stanton, C. A., Niaura, R. S., Abrams, D. B., McKee, B., Howell, J., Ramsaier, M., Batlle, J., Dornelas, E., … Anderson, E. (n.d.).

Publication year

2019

Journal title

Contemporary Clinical Trials

Volume

82

Page(s)

25-35

10.1016/j.cct.2019.05.006

Abstract

Abstract

Lung cancer mortality can be reduced by 20% via low dose CT lung cancer screening (LCS) and treatment of early-stage disease. Providing tobacco use treatment to high risk cigarette smokers in the LCS setting may result in health benefits beyond the impact of LCS. As one of the nine trials in the National Cancer Institute's Smoking Cessation at Lung Examination (SCALE) collaboration, the goal of the Lung Screening, Tobacco, and Health (LSTH) trial is to develop a scalable and cost-effective cessation intervention for subsequent implementation by LCS programs. Guided by the RE-AIM Framework, the LSTH trial is a two-arm RCT (N = 1330) enrolling English- and Spanish-speaking smokers registered for LCS at one of seven collaborating sites. Participants are randomly assigned to Usual Care (UC; three proactive telephone counseling sessions/two weeks of nicotine patches) vs. Intensive Telephone Counseling (ITC; eight proactive sessions/eight weeks of nicotine patches, plus discussion of the LCS results to increase motivation to quit). Telephone counseling is provided by tobacco treatment specialists. To increase continuity of care, referring physicians are notified of participant enrollment and smoking status following the intervention. Outcomes include: 1) self-reported 7-day, 30-day, and sustained abstinence, and biochemically-verified at 3-, 6-, and 12-months post-randomization, 2) reach and engagement of the interventions, and 3) cost-effectiveness of the interventions. The Cancer Intervention and Surveillance Modeling Network (CISNET) will model long-term impacts of six SCALE trials on the cost per life year saved, quality-adjusted life years saved, lung cancer mortality reduction, and population mortality. Clinical trials registration: The trial is registered at clinical trials.gov: NCT03200236.

Transitions in electronic cigarette use among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1 and 2 (2013-2015)

Abrams, D., Coleman, B., Rostron, B., Johnson, S. E., Persoskie, A., Pearson, J., Stanton, C., Choi, K., Anic, G., Goniewicz, M. L., Cummings, K. M., Kasza, K. A., Silveira, M. L., Delnevo, C., Niaura, R. S., Abrams, D. B., Kimmel, H. L., Borek, N., Compton, W. M., & Hyland, A. (n.d.).

Publication year

2019

Journal title

Tobacco control

Volume

28

Issue

1

Page(s)

50-59

10.1136/tobaccocontrol-2017-054174

Abstract

Abstract

Introduction This study assessed patterns of e-cigarette and cigarette use from Wave 1 to Wave 2 among adult e-cigarette users at Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Methods We examined changes in e-cigarette use frequency at Wave 2 among adult e-cigarette users at Wave 1 (unweighted n=2835). Adjusted prevalence ratios (aPR) were calculated using a predicted marginal probability approach to assess correlates of e-cigarette discontinuance and smoking abstinence at Wave 2. Results Half (48.8%) of adult e-cigarette users at Wave 1 discontinued their use of e-cigarettes at Wave 2. Among dual users of e-cigarettes and cigarettes at Wave 1, 44.3% maintained dual use, 43.5% discontinued e-cigarette use and maintained cigarette smoking and 12.1% discontinued cigarette use at Wave 2, either by abstaining from cigarette smoking only (5.1%) or discontinuing both products (7.0%). Among dual users at Wave 1, daily e-cigarette users were more likely than non-daily users to report smoking abstinence at Wave 2 (aPR=1.40, 95% CI 1.02 to 1.91). Using a customisable device (rather than a non-customisable one) was not significantly related to smoking abstinence at Wave 2 (aPR=1.14, 95% CI 0.81 to 1.60). Conclusions This study suggests that e-cigarette use patterns are highly variable over a 1-year period. This analysis provides the first nationally representative estimates of transitions among US adult e-cigarette users. Future research, including additional waves of the PATH Study, can provide further insight into long-term patterns of e-cigarette use critical to understanding the net population health impact of e-cigarettes in USA.

Adult interest in using a hypothetical modified risk tobacco product : findings from wave 1 of the Population Assessment of Tobacco and Health Study (2013–14)

Abrams, D., Pearson, J. L., Johnson, A. L., Johnson, S. E., Stanton, C. A., Villanti, A. C., Niaura, R. S., Glasser, A. M., Wang, B., Abrams, D. B., Cummings, K. M., & Hyland, A. (n.d.).

Publication year

2018

Journal title

Addiction

Volume

113

Issue

1

Page(s)

113-124

10.1111/add.13952

Abstract

Abstract

Background and aims: The US Family Smoking Prevention and Tobacco Control Act provides a pathway for manufacturers to market a modified risk tobacco product (MRTP). This study examines socio-demographic and tobacco use correlates of interest in a hypothetical MRTP in a nationally representative sample of US adults. Design: Cross sectional wave 1 data from the 2013–14 Population Assessment of Tobacco and Health (PATH) Study. Setting: Household Audio-Computer Assisted Self-Interviews of US adults conducted in 2013–14. Participants: A total of 32 320 civilian, non-institutionalized adults in the United States. Measurements: Interest in using a hypothetical MRTP (‘If a tobacco product made a claim that it was less harmful to health than other tobacco products, how likely would you be to use that product?’), socio-demographics, tobacco use history and mental health and substance use problems. All estimates were weighted. Findings: Overall, 16.7% [95% confidence interval (CI) = 16.28, 17.18] of US adults reported interest in a hypothetical MRTP. Tobacco use was associated significantly with interest in a hypothetical MRTP, with interest most common among current established smokers (54.4%; 95% CI = 53.31, 55.39) and least common among never tobacco users (3.0%; 95% CI = 2.49, 3.55). Interest in a hypothetical MRTP was associated with experimental e-cigarette use among current experimental, current established and former smokers. Among non-smokers, race, age, education and substance use were associated with interest in using a hypothetical MRTP. Conclusions: Among adults in the United States, interest in using a hypothetical modified risk tobacco product is low overall, and highest among current experimental and established smokers. A small percentage of non-smokers are interested in using a hypothetical hypothetical modified risk tobacco product.

Correlates of transitions in tobacco product use by u.S. adult tobacco users between 2013–2014 and 2014–2015 : Findings from the path study wave 1 and wave 2

Abrams, D., Kasza, K. A., Coleman, B., Sharma, E., Conway, K. P., Cummings, K. M., Goniewicz, M. L., Niaura, R. S., Lambert, E. Y., Schneller, L. M., Feirman, S. P., Donaldson, E. A., Cheng, Y. C., Murphy, I., Pearson, J. L., Trinidad, D. R., Bansal-Travers, M., Elton-Marshall, T., Gundersen, D. A., … Hyland, A. J. (n.d.).

Publication year

2018

Journal title

International journal of environmental research and public health

Volume

15

Issue

11

10.3390/ijerph15112556

Abstract

Abstract

More than half of adult tobacco users in the United States (U.S.) transitioned in tobacco product use between 2013–2014 and 2014–2015. We examine how characteristics of adult tobacco users in the U.S. relate to transitions in tobacco product use. Population Assessment of Tobacco and Health (PATH) Study data were analyzed from 12,862 adult current tobacco users who participated in Wave 1 (W1, 2013–2014) and Wave 2 (W2, 2014–2015). Three types of transitions were examined—(1) adding tobacco product(s); (2) switching to non-cigarette tobacco product(s); and (3) discontinuing all tobacco use—among those currently using: (1) any tobacco product; (2) cigarettes only (i.e., exclusive cigarette); and (3) cigarettes plus another tobacco product(s) (i.e., poly-cigarette). Multinomial logistic regression analyses determined relative risk of type of transition versus no transition as a function of demographic and tobacco use characteristics. Transitions in tobacco product use among adult tobacco users were common overall, but varied among different demographic groups, including by age, sex, sexual orientation, race/ethnicity, educational attainment, and poverty level. Further, cigarette smokers with higher dependence scores were more likely to add product(s) and less likely to discontinue tobacco use compared to those with low dependence scores. That high nicotine dependence is a barrier to discontinuing tobacco use adds evidence to support policy to lower nicotine content of cigarettes and to evaluate new products for their potential to reduce cigarette use.