Raymond S Niaura
Raymond S Niaura
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Interim Chair of the Department of Epidemiology
Professor of Social and Behavioral Sciences
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Professional overview
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Dr. Raymond Niaura is a psychologist and an expert on tobacco dependence and treatment, as well as substance use and addiction to alcohol. Dr. Niaura researches the biobehavioral substrates of tobacco dependence, including factors that influence adolescent and early adult tobacco use trajectories. He also evaluates behavioral and pharmacological treatments for tobacco cessation, with a particular interest in cessation in disadvantaged population to address public health disparities in tobacco-related burdens of illness and disability.
For eight year, Dr. Niaura was the Director of Science and Training at the Schroeder Institute (SI) for Tobacco Research and Policy Studies at the Truth Initiative, where he also supervised the pre- and post-doctoral training programs. Dr. Niaura has previously taught and conducted research at Brown University, Johns Hopkins Bloomberg School of Public Health, the Georgetown Medical Center, and the School of Public Health at University of Maryland. He was also a former President of the Society for Research on Nicotine and Tobacco and is a Deputy Editor of the Nicotine and Tobacco Research.
With grants from the National Institutes of Health, numerous foundations, and private industry, Dr. Niaura has published over 400 peer-reviewed articles, commentaries, and book chapters, including the book The Tobacco Dependence Treatment Handbook: A Guide to Best Practices.
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Education
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BA, Psychology (First Class Honors), McGill University, Montreal, CanadaMS, Psychology, Rutgers University, New Brunswick, NJPhD, Psychology, Rutgers University, New Brunswick, NJ
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Honors and awards
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Research Laureate, American Academy of Health Behavior (2009)University Scholar Award, McGill University (1979)
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Areas of research and study
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Alcohol, Tobacco and Driving PoliciesEvaluationsHealth DisparitiesSubstance AbuseTobacco Control
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Publications
Publications
Urinary cotinine and cotinine + trans-30-hydroxycotinine (TNE-2) cut-points for distinguishing tobacco use from nonuse in the United States: PATH study (2013-2014)
AbstractEdwards, K. C., Naz, T., Stanton, C. A., Goniewicz, M. L., Hatsukami, D. K., Smith, D. M., Wang, L., Villanti, A., Pearson, J., Blount, B. C., Bansal-Travers, M., Feng, J., Niaura, R., Bover Manderski, M. T., Sosnoff, C. S., Delnevo, C. D., Duffy, K., Del Valle-Pinero, A. Y., Rostron, B. L., … Hyland, A. (n.d.).Publication year
2021Journal title
Cancer Epidemiology Biomarkers and PreventionVolume
30Issue
6Page(s)
1175-1184AbstractBackground: Determine the overall, sex-, and racially/ethnically-appropriate population-level cotinine and total nicotine equivalents (TNE-2, the molar sum of the two major nicotine metabolites) cut-points to distinguish tobacco users from nonusers across multiple definitions of use (e.g., exclusive vs. polytobacco, and daily vs. non-daily). Methods: Using Wave 1 (2013-2014) of the U.S. Population Assessment of Tobacco and Health (PATH) Study, we conducted weighted Receiver Operating Characteristic (ROC) analysis to determine the optimal urinary cotinine and TNE-2 cut-points, stratified by sex and race/ethnicity. Results: For past 30-day exclusive cigarette users, the cotinine cut-point that distinguished them from nonusers was 40.5 ng/mL, with considerable variation by sex (male: 22.2 ng/mL; female: 43.1 ng/mL) and between racial/ethnic groups (non-Hispanic other: 5.2 ng/mL; non-Hispanic black: 297.0 ng/mL). A similar, but attenuated, pattern emerged when assessing polytobacco cigarette users (overall cut-point ¼ 39.1 ng/mL, range ¼ 5.5 ng/mL-80.4 ng/mL) and any tobacco users (overall cut-point ¼ 39.1 ng/mL, range ¼ 4.8 ng/mL-40.0 ng/mL). Using TNE-2, which is less impacted by racial differences in nicotine metabolism, produced a comparable pattern of results although reduced the range magnitude. Conclusions: Because of similar frequency of cigarette use among polytobacco users, overall cut-points for exclusive cigarette use were not substantially different from cut-points that included polytobacco cigarette use or any tobacco use. Results revealed important differences in sex and race/ethnicity appropriate cut-points when evaluating tobacco use status and established novel urinary TNE-2 cut-points. Impact: These cut-points may be used for biochemical verification of self-reported tobacco use in epidemiologic studies and clinical trials.Validation of an Index for Functionally Important Respiratory Symptoms among Adults in the Nationally Representative Population Assessment of Tobacco and Health Study, 2014-2016
AbstractHalenar, M. J., Sargent, J. D., Edwards, K. C., Woloshin, S., Schwartz, L., Emond, J., Tanski, S., Pierce, J. P., Taylor, K. A., Lauten, K., Goniewicz, M. L., Niaura, R., Anic, G., Chen, Y., Callahan-Lyon, P., Gardner, L. D., Thekkudan, T., Borek, N., Kimmel, H. L., … Brunette, M. F. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
18AbstractThe purpose of this study is to validate the seven-item wheezing module from the International Study of Asthma and Allergies in Children (ISAAC) in the nationally representative Population Assessment of Tobacco and Health Study. Adult participants with complete Wave 2–3 data were selected, including those with asthma but excluding those with COPD and other respiratory diseases (n = 16,295). We created a nine-point respiratory symptom index from the ISAAC questions, assessed the reliability of the index, and examined associations with self-reported asthma diagnosis. Threshold values were assessed for association with functional outcomes. The weighted prevalence for one or more respiratory symptom was 18.0% (SE = 0.5) for adults without asthma, 70.1% (SE = 1.3) for those with lifetime asthma, 75.7% (SE = 3.7) for adults with past-year asthma not on medi-cations, and 92.6% (SE = 1.6) for those on medications. Cronbach’s alpha for the respiratory symptom index was 0.86. Index scores of ≥2 or ≥3 yielded functionally important respiratory symptom prevalence of 7–10%, adequate sensitivity and specificity for identifying asthma, and consistent in-dependent associations with all functional outcomes and tobacco use variables. Respiratory symptom index scores of ≥2 or ≥3 are indicative of functionally important respiratory symptoms and could be used to assess the relationship between tobacco use and respiratory health.Youth Vaping and Tobacco Use in Context in the United States: Results from the 2018 National Youth Tobacco Survey
AbstractGlasser, A. M., Johnson, A. L., Niaura, R. S., Abrams, D. B., & Pearson, J. L. (n.d.).Publication year
2021Journal title
Nicotine and Tobacco ResearchVolume
23Issue
3Page(s)
447-453AbstractIntroduction: 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.Biomarkers of exposure among adult smokeless tobacco users in the population assessment of Tobacco and health study (WAVE 1, 2013-2014)
AbstractCheng, Y. C., Reyes-Guzman, C. M., Christensen, C. H., Rostron, B. L., Edwards, K. C., Wang, L., Feng, J., Jarrett, J. M., Ward, C. D., Xia, B., Kimmel, H. L., Conway, K., Leggett, C., Taylor, K., Lawrence, C., Niaura, R., Travers, M. J., Hyland, A., Hecht, S. S., … Van Bemmel, D. M. (n.d.).Publication year
2020Journal title
Cancer Epidemiology Biomarkers and PreventionVolume
29Issue
3Page(s)
659-667AbstractBackground: Monitoring population-level toxicant exposures from smokeless tobacco (SLT) use is important for assessing population health risks due to product use. In this study, we assessed tobacco biomarkers of exposure (BOE) among SLT users from the Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Methods: Urinary biospecimens were collected from adults ages 18 and older. Biomarkers of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), metals, and inorganic arsenic were analyzed and reported among exclusive current established SLT users in comparison with exclusive current established cigarette smokers, dual SLT and cigarette users, and never tobacco users. Results: In general, SLT users (n ¼ 448) have significantly higher concentrations of BOE to nicotine, TSNAs, and PAHs compared with never tobacco users; significant dose-response relationships between frequency of SLT use and biomarker concentrations were also reported among exclusive SLT daily users. Exclusive SLT daily users have higher geometric mean concentrations of total nicotine equivalent-2 (TNE2) and TSNAs than exclusive cigarette daily smokers. In contrast, geometric mean concentrations of PAHs and VOCs were substantially lower among exclusive SLT daily users than exclusive cigarette daily smokers. Conclusions: Our study produced a comprehensive assessment of SLT product use and 52 biomarkers of tobacco exposure. Compared with cigarette smokers, SLT users experience greater concentrations of some tobacco toxicants, including nicotine and TSNAs. Impact: Our data add information on the risk assessment of exposure to SLT-related toxicants. High levels of harmful constituents in SLT remain a health concern.Can the Association Between Electronic-Cigarette Use and Stroke Be Interpreted as Risk of Stroke?
Farsalinos, K., Abrams, D., & Niaura, R. (n.d.). In American journal of preventive medicine (1–).Publication year
2020Volume
58Issue
6Page(s)
895-896Current smoking, former smoking, and adverse outcome among hospitalized COVID-19 patients: a systematic review and meta-analysis
AbstractFarsalinos, K., Barbouni, A., Poulas, K., Polosa, R., Caponnetto, P., & Niaura, R. (n.d.).Publication year
2020Journal title
Therapeutic Advances in Chronic DiseaseVolume
11AbstractBackground: The purpose of this study was to examine the prevalence and effects of current smoking on adverse outcomes among hospitalized COVID-19 patients. Methods: A systematic review of the literature (PubMed) identified 18 (from a total of 1398) relevant studies. Pooled current smoking prevalence was compared with the gender-adjusted and gender and age-adjusted, population-based expected prevalence by calculating prevalence odds ratio (POR). The association between current, compared with non-current and former, smoking and adverse outcome was examined. A secondary analysis was performed by including 12 pre-publications (30 studies in total). All analyses were performed using random-effects meta-analysis. Results: Among 6515 patients, the pooled prevalence of current smoking was 6.8% [95% confidence interval (CI): 4.8–9.1%]. The gender-adjusted POR was 0.20 (95% CI: 0.16–0.25, p < 0.001), and the gender and age-adjusted POR was 0.24 (95% CI: 0.19–0.30, p < 0.001). Current smokers were more likely to have an adverse outcome compared with non-current smokers [odds ratio (OR): 1.53, 95%CI: 1.06–2.20, p = 0.022] but less likely compared with former smokers (OR: 0.42, 95% CI: 0.27–0.74, p = 0.003). When pre-publications were added (n = 10,631), the gender-adjusted POR was 0.27 (95% CI: 0.19–0.38, p < 0.001) and the gender and age-adjusted POR was 0.34 (95% CI: 0.24–0.48, p < 0.001). Conclusion: This meta-analysis of retrospective observational case series found an unexpectedly low prevalence of current smoking among hospitalized patients with COVID-19. Hospitalized current smokers had higher odds compared with non-current smokers but lower odds compared with former smokers for an adverse outcome. Smoking cannot be considered a protective measure for COVID-19. However, the hypothesis that nicotine may have a protective effect in COVID-19 that is partially masked by smoking-related toxicity and by the abrupt cessation of nicotine intake when smokers are hospitalized should be explored in laboratory studies and clinical trials using pharmaceutical nicotine products.E-cigarettes and Smoking Cessation in the United States According to Frequency of E-cigarette Use and Quitting Duration: Analysis of the 2016 and 2017 National Health Interview Surveys
AbstractFarsalinos, K. E., & Niaura, R. (n.d.).Publication year
2020Journal title
Nicotine and Tobacco ResearchVolume
22Issue
5Page(s)
655-662AbstractIntroduction: The purpose of this study was to examine the association between electronic cigarette (e-cigarette) use and smoking cessation among US adults. Duration of smoking cessation was taken into consideration because e-cigarette awareness and use were low in the United States before 2010. Methods: A pooled analysis of the 2016 and 2017 National Health Interview Surveys on current (N = 9935) and former smokers (N = 14 754) was performed. Adjusted prevalence ratios (aPRs), for sociodemographic factors, were calculated. Findings: Current e-cigarette use was reported by 10.5% (95% CI = 9.8% to 11.3%) of current smokers and 4.5% (95% CI = 4.0% to 5.0%) of former smokers. Prevalence was high in former smokers of less than 1 year (16.8%, 95% CI = 13.9% to 20.2%), 1-3 years (15.0%, 95% CI = 13.0% to 17.3%), and 4-6 years (10.5%, 95% CI = 8.6% to 12.7%), and very low in former smokers of more than 6 years (0.7%, 95% CI = 0.5% to 0.9%). Similar patterns were observed for daily e-cigarette use. Current e-cigarette use was negatively associated with being a former smoker when quit duration was ignored (aPR = 0.64, 95% CI = 0.59 to 0.69) but was positively associated with being a former smoker of less than 1 year (aPR = 1.44, 95% CI = 1.12 to 1.84) and 1-3 years (aPR = 1.21, 95% CI = 1.03 to 1.42). Daily e-cigarette use was not associated with being a former smoker when quit duration was ignored but was positively associated with being a former smoker of less than 1 year (aPR = 3.44, 95% CI = 2.63 to 4.49), 1-3 years (aPR = 2.51, 95% CI = 2.13 to 2.95), and 4-6 years (aPR = 1.84, 95% CI = 1.49 to 2.26). Conclusions: Daily e-cigarette use is strongly associated with recent smoking cessation (≤6 years) among US adults. Frequency of e-cigarette use and smoking cessation duration are important parameters when analyzing the effects of e-cigarettes in population surveys. Implications: There is controversy on whether e-cigarettes promote or prevent smoking cessation. This study presents a detailed analysis of the association between e-cigarette use and smoking cessation in the United States considering frequency of e-cigarette use and duration of smoking cessation. The latter was considered appropriate because e-cigarette awareness and use were low in the United States before 2010. Daily e-cigarette use is strongly associated with recent (≤6 years) smoking cessation in the United States. Both frequency of e-cigarette use and duration of smoking cessation are important factors in determining the effects of e-cigarettes in population studies.Editorial: Nicotine and SARS-CoV-2: COVID-19 may be a disease of the nicotinic cholinergic system
Farsalinos, K., Niaura, R., Le Houezec, J., Barbouni, A., Tsatsakis, A., Kouretas, D., Vantarakis, A., & Poulas, K. (n.d.).Publication year
2020Journal title
Toxicology ReportsVolume
7Page(s)
658-663Predictive validity of the adult tobacco dependence index: Findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study
AbstractStrong, D. R., Leas, E., Noble, M., White, M., Frissell, K. C., Glasser, A., Katz, L., Taylor, K., Compton, W. M., Conway, K. P., Lambert, E., Kimmel, H. L., Silveira, M. L., Green, V., Hull, L. C., Cummings, K. M., Hyland, A., & Niaura, R. (n.d.).Publication year
2020Journal title
Drug and alcohol dependenceVolume
214AbstractBackground and aims: Building on published work1 establishing concurrent validity of a self-report tobacco dependence (TD) index among users of different tobacco products in Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study, the current study examines prospective relationships with tobacco use behaviors to establish predictive validity of the TD index. Hypotheses suggested high levels of W1 TD would be associated with persistent tobacco use at Wave 2 (W2). Participants: A U.S. nationally representative sample of 32,320 adult W1 and W2 interviews focused on 11,615 W1 adults who were current established tobacco users and completed the W2 interview. Findings: Higher TD scores and greater changes in TD scores were associated with greater quantity and frequency of tobacco use at the W2 interview for Cigarette Only (n = 7068), Smokeless (smokeless or snus pouches) Only (n = 772), Cigarette plus E-Cigarette (n = 592), and Multiple Products (n = 1866) users, although not significantly so for E-Cigarette Only (n = 367), Cigar Only (traditional, cigarillo, or filtered) (n = 584), or Hookah Only (n = 366) users. Higher TD was associated with decreased odds of successful quitting for Cigarette and Multiple Product users. Higher TD was associated with increased odds of a quit attempt for those in the Hookah and Multiple Products user groups and was not associated with quit attempts or deceased odds of quit success among exclusive E-Cigarette, Cigar, Smokeless and Cigarette plus E-Cigarette users. Conclusion: Support for the predictive validity of the PATH Study measures of adult TD will enable regulatory investigations of TD across several tobacco products.Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults
AbstractVillanti, A. C., Naud, S., West, J. C., Pearson, J. L., Wackowski, O. A., Hair, E., Niaura, R. S., & Rath, J. M. (n.d.).Publication year
2020Journal title
Preventive MedicineVolume
140AbstractLow harm perceptions of tobacco products have been associated with use of those products in youth and adults, but this relationship has not been assessed for nicotine beliefs. This study used data from a national sample of adults aged 18–40 in Wave 9 (Spring 2016) of the Truth Initiative Young Adult Cohort Study to examine correlations and prospective associations between the latent classes of nicotine beliefs and susceptibility, curiosity, and use of tobacco products in 3122 adults who also completed Wave 10 (Fall 2016). At Wave 9, four latent classes of beliefs characterized the role of nicotine in the health risks of smoking: Class 1, large role, 51%; Class 2, large role/don't know, 9.4%; Class 3, small role in health, 32.5%; and Class 4, none/small role in cancer, 7.5%. Latent classes of nicotine beliefs were highly correlated with susceptibility and curiosity to use cigarettes, e-cigarettes, and hookah, as well as past 30-day use of a range of tobacco products at Wave 9 among never users. Classes 3 and 4 had the highest prevalence of past 30-day tobacco use; never users in these classes reported the greatest susceptibility to try cigarettes, hookah, and e-cigarettes at Wave 9. Class 4 had higher odds of increased e-cigarettes use at follow-up compared to Class 1. There were few prospective associations between nicotine beliefs latent class, susceptibility, and curiosity at Wave 10. Nicotine beliefs are associated with tobacco-related outcomes and, if assessed, may provide novel information to guide tobacco prevention and intervention efforts.Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16
AbstractPierce, 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., Henrie, J., … Messer, K. (n.d.).Publication year
2020Journal title
PloS oneVolume
15Issue
9AbstractBackground 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.Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?
AbstractFarsalinos, K., Barbouni, A., & Niaura, R. (n.d.).Publication year
2020Journal title
Internal and Emergency MedicineVolume
15Issue
5Page(s)
845-852AbstractThe effects of smoking on Corona Virus Disease 2019 (COVID-19) are currently unknown. The purpose of this study was to systematically examine the prevalence of current smoking among hospitalized patients with COVID-19 in China, considering the high-population smoking prevalence in China (26.6%). A systematic review of the literature (PubMed) was performed on April 1. Thirteen studies examining the clinical characteristics of hospitalized COVID-19 patients in China and presenting data on the smoking status were found. The pooled prevalence of current smoking from all studies was calculated by random-effect meta-analysis. To address the possibility that some smokers had quit shortly before hospitalization and were classified as former smokers on admission to the hospital, we performed a secondary analysis in which all former smokers were classified as current smokers. A total of 5960 patients were included in the studies identified. The current smoking prevalence ranged from 1.4% (95% CI 0.0–3.4%) to 12.6% (95% CI 10.6–14.6%). An unusually low prevalence of current smoking was observed from the pooled analysis (6.5%, 95% CI 4.9–8.2%) as compared to population smoking prevalence in China. The secondary analysis, classifying former smokers as current smokers, found a pooled estimate of 7.3% (95% CI 5.7–8.9%). In conclusion, an unexpectedly low prevalence of current smoking was observed among patients with COVID-19 in China, which was approximately 1/4th the population smoking prevalence. Although the generalized advice to quit smoking as a measure to reduce health risk remains valid, the findings, together with the well-established immunomodulatory effects of nicotine, suggest that pharmaceutical nicotine should be considered as a potential treatment option in COVID-19.The scope of tobacco cessation randomized controlled trials in low- to middle-income countries: Protocol for a scoping review
AbstractKumar, N., Ainooson, J., Billings, A., Chen, G., Cueto, L., Janmohamed, K., Jiang, J., Niaura, R., & Zhang, A. (n.d.).Publication year
2020Journal title
Systematic reviewsVolume
9Issue
1AbstractBackground: Tobacco consumption is the leading cause of preventable death globally. The global mortality burden of tobacco use lies predominantly in low- to middle-income countries (LMICs). There is much evidence on the effectiveness of tobacco cessation RCTs in high-income nations. However, the evidence base in LMICs is far more limited. To effectively design randomized controlled trials (RCTs) that mitigate tobacco-related harms in LMICs, further understanding of RCTs in this environment will be helpful. We will provide quality evidence regarding the scope of tobacco cessation RCTs in LMICs. Methods: A scoping review of tobacco cessation RCTs will be conducted. MEDLINE, Embase, PsycINFO, Global Health, Web of Science and Sociological Abstracts will be searched to capture current literature. We will review RCTs that have already been done on tobacco cessation in the LMICs. The key outcome will be tobacco cessation in adults. Examples of the key outcome include smoking abstinence and reduction of tobacco use. Study selection will conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and study quality assessed with a modified version of the Cochrane Collaboration's instrument. Discussion: As researchers attempt to minimize the harms from tobacco in LMICs, they need to be aware of scientific evidence to develop RCTs to achieve their aim. The review will complement the evidence base on tobacco cessation in LMICs.Young adult correlates of iqos curiosity, interest, and likelihood of use
AbstractPhan, L., Strasser, A. A., Johnson, A. C., Villanti, A. C., Niaura, R. S., Rehberg, K., & Mays, D. (n.d.).Publication year
2020Journal title
Tobacco Regulatory ScienceVolume
6Issue
2Page(s)
81-90AbstractObjectives: Philip Morris International’s heated tobacco product, Marlboro IQOS, is available internationally and soon will be marketed in the United States (US). We examined correlates of curiosity, interest, and likelihood to use IQOS among US young adults. Methods: Young adults ages 18-30 years (N = 346) were recruited online, viewed a description of IQOS, and completed measures of socio-demographic characteristics, perceived risks, curiosity, interest, and likelihood to use IQOS. Results: Males had greater curiosity, interest, and likelihood to use IQOS than females. Individuals with household income of $50,000-$75,000 were more curious than those with household income of greater than $75,000. Cigarette smokers, e-cigarette and dual users had greater curiosity, interest, and likelihood of use than non-tobacco users. Non-white individuals and older young adults had greater likelihood of use. Greater perceived risks of IQOS were negatively associated with curiosity, interest, and likelihood of use. Conclusions: Among young adults, IQOS has greater appeal among males, non-whites, those who are older, those with household income of $50,000-$75,000, cigarette smokers, e-cigarette and dual users, and those with fewer perceived risks of IQOS. Research on public education communicating the potential risks of IQOS to vulnerable young adults is warranted.Young Adult Tobacco and E-cigarette Use Transitions: Examining Stability Using Multistate Modeling
AbstractNiaura, R., Rich, I., Johnson, A. L., Villanti, A. C., Romberg, A. R., Hair, E. C., Vallone, D. M., & Abrams, D. B. (n.d.).Publication year
2020Journal title
Nicotine and Tobacco ResearchVolume
22Issue
5Page(s)
647-654AbstractIntroduction: 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."electronic Cigarettes" Are Not Cigarettes, and Why That Matters
AbstractOlonoff, M., Niaura, R., & Hitsman, B. (n.d.).Publication year
2019Journal title
Nicotine and Tobacco ResearchVolume
21Issue
10Page(s)
1441-1444AbstractAs the prevalence rates of cigarette use have declined over the past decade, use of electronic cigarettes (e-cigarettes) continues to increase, and companies are heavily invested in manufacturing new e-cigarette products. Scientists are therefore studying e-cigarette use at a rapid rate, generally by conceptualizing e-cigarettes as similar to traditional cigarettes in their use and effects. Thinking of e-cigarettes as largely comparable with cigarettes, however, fails to capture the unique e-cigarette capabilities, user experiences, and effects on nicotine dependence and even health. Assuming that e-cigarette users puff on their devices as they do cigarettes to attain doses of nicotine comparable in magnitude and asking questions about e-cigarette use modeled after how smoking behavior has been usually assessed (eg, puff number, duration, number of cigarettes per day) may miss important differences. A greater appreciation of the distinct uniqueness of e-cigarettes, as compared with cigarettes, will help to accelerate innovative research on e-cigarettes and other electronic devices, leading to new theoretical models and behavioral measures. Implications: With research about electronic cigarettes (e-cigarettes) rapidly increasing, this commentary addresses the conceptualization of e-cigarettes as similar to traditional cigarettes. The more we attempt to understand and measure e-cigarettes as equivalent to cigarettes, the more likely research may err in conclusions about these unique devices. Our commentary notes how using unique conceptualizations and measures for e-cigarettes will help accelerate new research.A pilot randomized trial examining the feasibility and acceptability of a culturally tailored and adherence-enhancing intervention for Latino smokers in the U.S.
AbstractDe Dios, M. A., Cano, M. Ángel, Vaughan, E. L., Childress, S. D., McNeel, M. M., Harvey, L. M., & Niaura, R. S. (n.d.).Publication year
2019Journal title
PloS oneVolume
14Issue
1AbstractLatino smokers in the United States (US) are known to experience smoking cessation treatment disparities due to their under-utilization of services, limited access to health care, and poor smoking cessation treatment outcomes. A limited number of studies have focused on developing and testing smoking cessation treatments for Latino smokers in the US. The objectives of this study were to conduct a feasibility pilot randomized trial testing three smoking cessation interventions for Latinos. Twenty-five adult Latino smokers were randomized to one of three groups: Culturally-Tailored Smoking Cessation plus Adherence Enhancement (CT+AE), Culturally-Tailored Smoking Cessation (CTSC), and a Health Education (HE) control group. All participants received three counseling sessions along with nicotine replacement therapy (NRT). Data relating to intervention acceptability and NRT adherence were collected. Self-reported 7-day point prevalence smoking was collected at 3 and 6 month follow-up and biochemically verified with expired carbon monoxide testing. Overall, the interventions demonstrated high levels of feasibility and acceptability. Days of nicotine patch use were found to be higher in the CT+AE group (mean (M) = 81.3;standard deviation (SD) = 3.32) than the CTSC (M = 68.6;SD = 13.66) and HE (M = 64;SD = 17.70) groups. At 3-month follow-up, approximately 50% of the CT+AE group were smoking abstinent, 25% of the CTSC group, and 44% of the HE group. At 6-month follow-up, 37.5% of the CT+AE group were abstinent, 25% of the CTSC group, and 44.4% of the HE group. This study is the first to target Latino smokers in the US with a culturally-tailored intervention that addresses treatment adherence. Results support the preliminary feasibility and acceptability of the CT+AE intervention.An African-specific haplotype in MRGPRX4 is associated with menthol cigarette smoking
AbstractKozlitina, J., Risso, D., Lansu, K., Olsen, R. H. J., Sainz, E., Luiselli, D., Barik, A., Frigerio-Domingues, C., Pagani, L., Wooding, S., Kirchner, T., Niaura, R., Roth, B., & Drayna, D. (n.d.).Publication year
2019Journal title
PLoS geneticsVolume
15Issue
2AbstractIn the U.S., more than 80% of African-American smokers use mentholated cigarettes, compared to less than 30% of Caucasian smokers. The reasons for these differences are not well understood. To determine if genetic variation contributes to mentholated cigarette smoking, we performed an exome-wide association analysis in a multiethnic population-based sample from Dallas, TX (N = 561). Findings were replicated in an independent cohort of African Americans from Washington, DC (N = 741). We identified a haplotype of MRGPRX4 (composed of rs7102322[G], encoding N245S, and rs61733596[G], T43T), that was associated with a 5-to-8 fold increase in the odds of menthol cigarette smoking. The variants are present solely in persons of African ancestry. Functional studies indicated that the variant G protein-coupled receptor encoded by MRGPRX4 displays reduced agonism in both arrestin-based and G protein-based assays, and alteration of agonism by menthol. These data indicate that genetic variation in MRGPRX4 contributes to inter-individual and inter-ethnic differences in the preference for mentholated cigarettes, and that the existence of genetic factors predisposing vulnerable populations to mentholated cigarette smoking can inform tobacco control and public health policies.Associations of risk factors of e-cigarette and cigarette use and susceptibility to use among baseline PATH study youth participants (2013–2014)
AbstractSawdey, 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
2019Journal title
Addictive BehaviorsVolume
91Page(s)
51-60AbstractIntroduction: 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.E-cigarette Use and Myocardial Infarction: Association Versus Causal Inference
Farsalinos, K., & Niaura, R. (n.d.). In American journal of preventive medicine (1–).Publication year
2019Volume
56Issue
4Page(s)
626-627Ethnic and Socioeconomic Disparities in Recalled Exposure to and Self-Reported Impact of Tobacco Marketing and Promotions
AbstractMoran, M. B., Heley, K., Pierce, J. P., Niaura, R., Strong, D., & Abrams, D. (n.d.).Publication year
2019Journal title
Health CommunicationVolume
34Issue
3Page(s)
280-289AbstractThe 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.Is e-cigarette use associated with coronary heart disease and myocardial infarction? Insights from the 2016 and 2017 National Health Interview Surveys
AbstractFarsalinos, K. E., Polosa, R., Cibella, F., & Niaura, R. (n.d.).Publication year
2019Journal title
Therapeutic Advances in Chronic DiseaseVolume
10AbstractBackground: This study analyzed the National Health Interview Surveys (NHIS) of 2016 (n = 33,028) and 2017 (n = 26,742) to examine whether e-cigarette use is consistently associated with myocardial infarction (MI) and coronary heart disease (CHD). Methods: Surveys were examined separately and pooled. Logistic regression analysis was used, with demographics, e-cigarette use, smoking and risk factors for CHD (hypertension, hypercholesterolemia, and diabetes) being independent variables. Former smokers were subclassified according to quit duration (⩽ 6 and > 6 years). Results: For MI, an association was observed with some days e-cigarette (but not daily) use in the 2017 survey (OR: 2.11, 95% CI: 1.14–3.88, p = 0.017). No statistically significant association was observed in the pooled analysis (daily e-cigarette use: OR: 1.35, 95% CI: 0.80–2.27, p = 0.267). For CHD, an association was observed with daily e-cigarette use in the 2016 survey (OR: 1.89, 95% CI: 1.01–3.53, p = 0.047). From the pooled analysis, no association was found between any pattern of e-cigarette use and CHD. In single-year and pooled analysis, both MI and CHD were strongly associated with all patterns of smoking, hypertension, hypercholesterolemia, diabetes, and age. Conclusions: The pooled analysis of the 2016 and 2017 NHIS showed no association between e-cigarette use and MI or CHD. The associations between established risk factors, including smoking, and both conditions were remarkably consistent. The inconsistent associations observed in single-year surveys and the cross-sectional design of the NHIS cannot substantiate any link between e-cigarette use and an elevated risk for MI or CHD. Longitudinal studies are needed to explore the effects of e-cigarette use on cardiovascular disease.Latent Classes of Nicotine Beliefs Correlate with Perceived Susceptibility and Severity of Nicotine and Tobacco Products in US Young Adults
AbstractVillanti, A. C., Naud, S., West, J. C., Pearson, J. L., Wackowski, O. A., Hair, E., Rath, J. M., & Niaura, R. S. (n.d.).Publication year
2019Journal title
Nicotine and Tobacco ResearchVolume
21Page(s)
S91-S100AbstractBackground: Pervasive misperceptions about nicotine may influence uptake of quit smoking aids and the impact of policies addressing nicotine as a tobacco product constituent. Methods: Latent class analyses were conducted using four items on nicotine beliefs asked of 4037 adults aged 18-40 in wave 9 (February-March 2016) of the Truth Initiative Young Adult Cohort Study. Confirmatory factor analyses identified three factors from 12 items: nicotine susceptibility (NSUS), nicotine severity (NSEV), and tobacco severity (TSEV). Analyses assessed correlations between latent classes, sociodemographics, and nicotine/tobacco factor scores. Results: A four-class model of nicotine beliefs was the best fit, with the largest class believing that nicotine plays a major part in smoking risks (class 1, n = 2070; 52%). Class 2 shared that belief but also responded "Don't know" to addiction questions (class 2, n = 382; 11%). Fewer belonged in class 3, who reported that nicotine plays a small part in health risks (n = 1277; 30%), and class 4, who perceived nicotine as not cancer causing (n = 308; 7%). Latent class membership was correlated with sociodemographics, peer smoking, and past 30-day tobacco use. Classes 1 and 2 had similar NSUS scores and classes 3 and 4 had similar NSEV and TSEV scores. Discussion: Differences in the perceptions of nicotine and tobacco-related harms can be partially explained by clustering of underlying nicotine beliefs. These classes of beliefs are correlated with sociodemographic predictors of smoking. These findings may help to identify specific beliefs or groups to be targeted by public education efforts on nicotine. Implications: The current study supports that underlying nicotine beliefs are associated with perceived harms of specific nicotine and tobacco products (relative to cigarettes), with greater false beliefs about nicotine correlated with greater perceived susceptibility to nicotine addiction. Two important inferences emerge from this study: first, that education to address nicotine beliefs may also reframe perceptions of the harms of nicotine and tobacco products; and second, that this type of education may differentially impact perceptions of the harms of nicotine products (e.g., nicotine replacement therapy and e-cigarettes) and tobacco products (e.g., cigars, smokeless, and hookah).Longitudinal tobacco use transitions among adolescents and young adults: 2014-2016
AbstractHair, E. C., Romberg, A. R., Niaura, R., Abrams, D. B., Bennett, M. A., Xiao, H., Rath, J. M., Pitzer, L., & Vallone, D. (n.d.).Publication year
2019Journal title
Nicotine and Tobacco ResearchVolume
21Issue
4Page(s)
458-468AbstractIntroduction: 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.Marketing Influences on Perceptions of Reduced Nicotine Content Cigarettes
AbstractJohnson, A. C., Mays, D., Villanti, A. C., Niaura, R. S., Rehberg, K., Phan, L., Mercincavage, M., Luta, G., & Strasser, A. A. (n.d.).Publication year
2019Journal title
Nicotine and Tobacco ResearchVolume
21Page(s)
S117-S124AbstractINTRODUCTION: The Food and Drug Administration announced intent to reduce the nicotine content in cigarettes. There is limited evidence on how reduced nicotine content cigarette (RNC) marketing affects product beliefs and use, and research on this is needed to inform regulations.METHODS: In an online experiment, 426 young adult cigarette smokers (aged 18-30 years) were randomized in a 2 (implicit: red package vs. blue package) × 2 (explicit: corrective message vs. no corrective message) design to view an advertisement for previously commercially available RNCs. Outcomes were advertisement content recall, product beliefs, and use intentions. Participants' responses to open-ended assessment of their beliefs about the stimuli were coded to identify prevailing themes.RESULTS: Red packaging and corrective messaging were independently associated with greater advertisement content recall (p = .01 and p = .04, respectively). There were no significant main or interaction effects on product beliefs or use intentions. Controlling for condition, advertisement content recall was significantly associated with less favorable product beliefs (p < .001) and favorable product beliefs were associated with intent to use the product (p < .001). Open-ended responses converged on the finding that respondents were interested in RNCs, but expressed skepticism about effectiveness and value.CONCLUSIONS: Brief exposure to an RNC advertisement with red packaging and corrective messaging were each independently associated with greater advertisement content recall. The results indicate: (1) interest and confusion among young adult smokers regarding RNCs, (2) beliefs about RNCs are influenced by marketing, and (3) beliefs are associated with intention to use RNCs.IMPLICATIONS: Findings from this study demonstrate the importance of advertising effects on beliefs about RNC products and support the need to regulate advertising and labeling alongside product regulation. More detailed study of advertisement features that affect consumers' beliefs about RNCs and how they impact their processing of explicit messaging about product risks will be important to guide regulatory decision-making.