Raymond S Niaura

Raymond Niaura
Raymond S Niaura

Interim Chair of the Department of Epidemiology

Professor of Social and Behavioral Sciences

Professional overview

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.

Education

BA, Psychology (First Class Honors), McGill University, Montreal, Canada
MS, Psychology, Rutgers University, New Brunswick, NJ
PhD, Psychology, Rutgers University, New Brunswick, NJ

Honors and awards

Research Laureate, American Academy of Health Behavior (2009)
University Scholar Award, McGill University (1979)

Areas of research and study

Alcohol, Tobacco and Driving Policies
Evaluations
Health Disparities
Substance Abuse
Tobacco Control

Publications

Publications

E-cigarette use and change in plans to quit cigarette smoking among adult smokers in the United States: Longitudinal findings from the PATH Study 2014–2019

A pilot randomized controlled trial of a tailored smoking cessation program for people living with HIV in the Washington, D.C. metropolitan area

A scoping review of studies on the health impact of electronic nicotine delivery systems

Article validation of an index for functionally important respiratory symptoms among adults in the nationally representative population assessment of tobacco and health study, 2014–2016

Halenar, 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., Cummings, K. M., Hyland, A., & Brunette, M. F.

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

18
Abstract
Abstract
The 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.

Change in amount smoked and readiness to quit among patients undergoing lung cancer screening

Deros, D. E., Hagerman, C. J., Kramer, J. A., Anderson, E. D., Regis, S., McKee, A. B., McKee, B. J., Stanton, C. A., Niaura, R., Abrams, D. B., Ramsaier, M., Fallon, S., Harper, H., & Taylor, K. L.

Publication year

2021

Journal title

Journal of Thoracic Disease

Volume

13

Issue

8

Page(s)

4947-4955
Abstract
Abstract
Background: There is mixed evidence regarding whether undergoing computed tomography lung cancer screening (LCS) can serve as a "teachable moment" that impacts smoking behavior and attitudes. The study aim was to assess whether the standard procedures of undergoing LCS and receiving free and low-cost evidence-based cessation resources impacted short-term smoking-related outcomes. Methods: Participants were smokers (N=87) who were registered to undergo lung screening and were enrolled in a cessation intervention trial. We conducted two phone interviews, both preceding trial randomization: the first interview was conducted prior to lung screening, and the second interview followed lung screening (median =12.5 days post-screening) and participants' receipt of their screening results. The interviews assessed demographic characteristics, interest in evidence-based cessation intervention methods, and tobacco-related characteristics, including cigarettes per day and readiness to quit. Participants received minimal evidence-based cessation resources following the pre-lung screening interview. Results: Participants were 60.3 years old, 56.3% female, and reported a median of 40 pack-years. Participants were interested in using several evidence-based strategies, including counseling from a healthcare provider (76.7%) and receiving nicotine replacement therapy (69.8%). Pre-lung screening, 25.3% smoked =10 cigarettes per day, and 29.9% were ready to quit in the next 30 days. We conducted two McNemar binomial distribution tests to assess change from pre- to post-screening. At the post-lung screening assessment, approximately three-quarters reported no change on these variables. However, 23.3% reported smoking fewer cigarettes per day, whereas 4.7% reported smoking more cigarettes per day (McNemar P=0.002), and 17.2% reported increased readiness to quit, whereas 6.9% reported decreased readiness to quit (McNemar P=0.078). Conclusions: Following receipt of cessation resources and completion of lung screening, most participants reported no change in smoking outcomes. However, there was a significant reduction in cigarettes per day, and there was a trend for increased readiness to quit. This setting may provide a potential "teachable moment" and an opportunity to assist smokers with quitting. However, more proactive and intensive interventions will be necessary to capitalize on these changes and to support abstinence in the long-term.

Changes from 2017 to 2018 in e-cigarette use and in ever marijuana use with e-cigarettes among US adolescents: analysis of the National Youth Tobacco Survey

Farsalinos, K., Barbouni, A., & Niaura, R.

Publication year

2021

Journal title

Addiction

Volume

116

Issue

1

Page(s)

139-149
Abstract
Abstract
Aims: To examine changes from 2017 to 2018 in e-cigarette use and ever marijuana use with e-cigarettes among US adolescents. Design: Analysis of data from the 2017 and 2018 National Youth Tobacco Survey (NYTS), cross-sectional surveys of US middle school (grades 6–8) and high school (grades 9–12) students. Setting: United States. Participants: US adolescent population from middle school, with mean age = 12.7 [standard deviation (SD) = 1.0] years, and high school, with mean age = 16.1 (SD = 1.3) years. Measurements: Analysis of e-cigarette use and ever use of marijuana with e-cigarettes according to frequency of use and smoking status, comparing 2017 with 2018. Frequent smoking and e-cigarette use was defined as use for ≥ 20 of the past 30 days. Findings: Past 30 days e-cigarette use was reported by 33.1% [95% confidence interval (CI) = 29.1–37.4%] of ever/no past 30 days smokers, 68.6% (95% CI = 64.1–72.7%) of past 30 days smokers and 7.2% (95% CI = 6.3–8.2%) of never smokers in 2018 and by 19.3% (95% CI = 16.1–23.1%), 53.0% (95% CI = 46.9–58.9%) and 3.3% (95% CI = 2.7–4.4%) in 2017, respectively (all P < 0.001). Prevalence of past 30 days e-cigarette use was higher among frequent smokers (69.8%, 95% CI = 62.3–76.5% in 2018; 53.8%, 95% CI = 44.1–63.2% in 2017, P < 0.001) and lower among never smokers. Most of the latter were infrequent users, while frequent and daily e-cigarette use was 18- and 24-fold lower compared with ever smokers, respectively. Approximately half of past 30 days and 70% of frequent e-cigarette users reported ever marijuana use with e-cigarettes in both years. Past 30 days smokers were more likely to report past 30 days e-cigarette use [odds ratio (OR) = 15.79, 95% CI = 12.58–19.83 in 2018; OR = 16.11, 95% CI = 12.44–20.86 in 2017) compared with adolescents reporting no past 30 days smoking. Conclusions: Among US adolescents, e-cigarette use increased in all smoking groups in 2018 compared with 2017. Frequent and daily e-cigarette use was far lower in never-smokers compared with ever-smokers. High prevalence of ever marijuana use with e-cigarettes was observed.

E-Cigarette Use and COVID-19: Questioning Data Reliability

Farsalinos, K., & Niaura, R. In Journal of Adolescent Health.

Publication year

2021

Volume

68

Issue

1

Page(s)

213

E-cigarettes and Cessation: Asking Different Questions Requires Different Methods

Glasser, A., Giovenco, D. P., Levy, D. T., Vojjala, M., Cantrell, J., Abrams, D., & Niaura, R. In Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

Publication year

2021

Volume

23

Issue

5

Page(s)

878-879

Effects of pictorial warning label message framing and standardized packaging on cigarette packaging appeal among young adult smokers

Electronic nicotine delivery systems: use, knowledge, and attitudes among diverse college students

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

Lee, P. N., Abrams, D., 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., Pithawalla, Y. B., Poland, B., Sulsky, S., Wei, L., & Weitkunat, R.

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

426-437
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.

Exposure to Nicotine and Toxicants Among Dual Users of Tobacco Cigarettes and E-Cigarettes: Population Assessment of Tobacco and Health (PATH) Study, 2013-2014

Smith, D. M., Christensen, C., Van Bemmel, D., Borek, N., Ambrose, B., Erives, G., Niaura, R., Edwards, K. C., Stanton, C. A., Blount, B. C., Wang, L., Feng, J., Jarrett, J. M., Ward, C. D., Hatsukami, D., Hecht, S. S., Kimmel, H. L., Travers, M., Hyland, A., & Goniewicz, M. L.

Publication year

2021

Journal title

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

Volume

23

Issue

5

Page(s)

790-797
Abstract
Abstract
INTRODUCTION: Concurrent use of tobacco cigarettes and e-cigarettes ("dual use") is common among tobacco users. Little is known about differences in demographics and toxicant exposure among subsets of dual users. AIMS AND METHODS: We analyzed data from adult dual users (current every/some day users of tobacco cigarettes and e-cigarettes, n = 792) included in the PATH Study Wave 1 (2013-2014) and provided urine samples. Samples were analyzed for biomarkers of exposure to nicotine and selected toxicants (tobacco-specific nitrosamine NNK [NNAL], lead, cadmium, naphthalene [2-naphthol], pyrene [1-hydroxypyrene], acrylonitrile [CYMA], acrolein [CEMA], and acrylamide [AAMA]). Subsets of dual users were compared on demographic, behavioral, and biomarker measures to exclusive cigarette smokers (n = 2411) and exclusive e-cigarette users (n = 247). RESULTS: Most dual users were predominant cigarette smokers (70%), followed by daily dual users (13%), non-daily concurrent dual users (10%), and predominant vapers (7%). Dual users who smoked daily showed significantly higher biomarker concentrations compared with those who did not smoke daily. Patterns of e-cigarette use had little effect on toxicant exposure. Dual users with high toxicant exposure were generally older, female, and smoked more cigarettes per day. Dual users who had low levels of biomarkers of exposure were generally younger, male, and smoked non-daily. CONCLUSIONS: In 2013-2014, most dual users smoked cigarettes daily and used e-cigarettes occasionally. Cigarette smoking appears to be the primary driver of toxicant exposure among dual users, with little-to-no effect of e-cigarette use on biomarker levels. Results reinforce the need for dual users to stop smoking tobacco cigarettes to reduce toxicant exposure. IMPLICATIONS: With considerable dual use of tobacco cigarettes and e-cigarettes in the United States, it is important to understand differences in toxicant exposure among subsets of dual users, and how these differences align with user demographics. Findings suggest most dual users smoke daily and use e-cigarettes intermittently. Low exposure to toxicants was most common among younger users, males, and intermittent smokers; high exposure to toxicants was most common among older users, females, and heavier cigarette smokers. Results underscore the heterogeneity occurring within dual users, and the need to quit smoking cigarettes completely in order to reduce toxicant exposure.

High rates of menthol cigarette use among pregnant smokers: Preliminary findings and call for future research

Stroud, L. R., Vergara-Lopez, C., McCallum, M., Gaffey, A. E., Corey, A., & Niaura, R.

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

22

Issue

10

Page(s)

1711-1717
Abstract
Abstract
Introduction: Smoking during pregnancy remains widespread and is causally associated with infant morbidity and mortality. Despite links between menthol cigarette use and decreased smoking cessation, little is known regarding rates or characteristics of pregnant menthol cigarette smokers. Methods: Participants were drawn from two low-income, racially/ethnically diverse cohorts of pregnant smokers recruited from 2006 to 2015 (N = 166, Mage = 25 ± 5). Demographics, menthol cigarette use, daily cigarette use, quit status, and consecutive weeks quit were assessed by prospective interviews. Nicotine dependence was assessed using the Fagerström Test of Nicotine Dependence. Nicotine levels were assessed via saliva cotinine. Results: High rates of menthol use were found in both cohorts (85% and 87%). Across both cohorts, menthol smokers were more likely to identify as racial/ethnic minorities, were less educated, and reported lower income than non-menthol smokers (ps < .03). Menthol smokers also reported fewer continuous weeks quit (8.4 vs. 14.5 weeks quit; p < .03) and a tendency toward decreased likelihood of quitting smoking over pregnancy (29% vs. 48%; p < .08) in unadjusted but not in covariate-adjusted analyses. No differences emerged in cigarettes per day, nicotine dependence or nicotine exposure. Conclusions: We found very high rates of menthol cigarette use in pregnant smokers-particularly among racial/ethnic minority and low socioeconomic status smokers-and some evidence for associations with reduced smoking cessation in pregnancy. Consideration of pregnant smokers as a uniquely vulnerable population is warranted in evaluating regulation of menthol in cigarettes. Further research is needed regarding the impact of menthol on smoking persistence in pregnancy and on maternal and infant health outcomes.

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

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

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

527-534
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 <. 0001). The within-person e-cigarette puff effect on daily cigarette smoking was significantly negative (β =-0.023; p =. 005); a participant who consumed 100 more e-cigarette puffs in a day than usual for that person was expected to smoke 2.3 fewer cigarettes that day, but this was only true for non-menthol smokers (p =. 006). Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps <. 05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up. Conclusions: Giving e-cigarettes to smokers who did not intend to quit reduced their cigarette smoking on days when they used e-cigarette more frequently, but this relationship did not hold for menthol smokers. Satisfaction with e-cigarette use was predictive of continued use 30 days later. Implications: A greater amount of cigalike e-cigarette use resulted in less smoking among adult daily smokers without immediate plans to quit, but a lack of nicotine delivery and satisfaction for these devices may have limited their utility as a replacement for cigarette smoking, especially among menthol smokers. The global concept of "satisfaction"may be an important driver of e-cigarette use among adult smokers.

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

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., Taylor, E. V., Slavit, W. I., Rass, O., Compton, W. M., & Hyland, A.

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
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

Glasser, A. M., Vojjala, M., Cantrell, J., Levy, D. T., Giovenco, D. P., Abrams, D., & Niaura, R.

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

4

Page(s)

669-677
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 (<1 year) and long term (1+ years) compared with never e-cigarette users (p <. 001). E-cigarette use in the last quit attempt was associated with a higher likelihood of short-term (<1 year) quitting at Wave 3 (adjusted relative risk ratio: 1.33; 95% confidence interval: 1.04, 1.71) compared with smokers who did not use an e-cigarette in their last quit attempt. Noncurrent (no use in any wave) e-cigarette users and users who were unstable in use frequency were 33% and 47% less likely to quit in the short-term, respectively (p <. 001). Flavored (vs nonflavored) and using a rechargeable (vs disposable) e-cigarette device was associated with an increased likelihood of both short- and long-term quitting. Conclusion: Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices. Less frequent, unstable, past, or never e-cigarette users were less likely to quit smoking. Monitoring the relationship between patterns of e-cigarette and cigarette use is complex but critical for gauging the potential of e-cigarettes as a harm reduction tool. Implications: This study suggests that consistent and frequent e-cigarette use over time is associated with cigarette smoking cessation among adults in the United States. In addition, findings suggest that flavored e-cigarette use and use of rechargeable e-cigarette devices can facilitate smoking cessation. These results underscore the importance of carefully defining and characterizing e-cigarette exposure patterns, potential confounders, and use of e-cigarettes to quit smoking, as well as variations in length of the smoking cessation.

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

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Publication year

2021

Journal title

Contemporary Clinical Trials

Volume

106
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.

Relationships Between E-cigarette Use and Subsequent Cigarette Initiation Among Adolescents in the PATH Study: an Entropy Balancing Propensity Score Analysis

Xu, S., Coffman, D. L., Liu, B., Xu, Y., He, J., & Niaura, R. S.

Publication year

2021

Journal title

Prevention Science
Abstract
Abstract
This study aimed to examine the relationship between electronic cigarette use and subsequent combustible cigarette use, controlling for confounding by using a propensity score method approach. Data from the first three annual waves of the Population Assessment of Tobacco and Health study were analyzed (n = 6309). Participants were tobacco-naïve at Wave 1; used e-cigarettes exclusively (n = 414), used combustible cigarettes exclusively (n = 46), or not used any tobacco products (n = 5849) at Wave 2. We conducted entropy balancing propensity score analysis to examine the association between exclusive e-cigarette or cigarette initiation and subsequent cigarette use at Wave 3, adjusting for non-response bias, sampling bias, and confounding. Among tobacco-naïve youth, exclusive e-cigarette use was associated with greater risk for subsequent combustible cigarette smoking initiation (OR = 3.42, 95% CI = (1.99, 5.93)) and past 30-day combustible cigarette use (OR = 2.88, 95% CI = (1.22, 6.86)) in the following year. However, the latter risk was comparatively lower than the risk if youth started with a combustible cigarette (OR = 25.79, 95% CI = (9.68, 68.72)). Results of sensitivity analyses indicated that estimated effects were robust to unmeasured confounding. Use of e-cigarettes in tobacco-naïve youth is associated with increased risk of subsequent past 30-day combustible cigarette use but the risk is an order of magnitude higher if they start with a combustible cigarette.

Smoking prevalence among hospitalized COVID-19 patients and its association with disease severity and mortality: an expanded re-analysis of a recent publication

Speculation vs. evidence in the association between e-cigarette use and COVID-19: A response to Soule et al

Farsalinos, K., & Niaura, R. In Preventive Medicine Reports.

Publication year

2021

Volume

23

Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option? Reply

Farsalinos, K., Barbouni, A., & Niaura, R. In Internal and Emergency Medicine.

Publication year

2021

Volume

16

Issue

1

Page(s)

235-236

Tobacco cessation in low- to middle-income countries: A scoping review of randomized controlled trials

Kumar, N., Janmohamed, K., Jiang, J., Ainooson, J., Billings, A., Chen, G. Q., Chumo, F., Cueto, L., Niaura, R., & Zhang, A.

Publication year

2021

Journal title

Addictive Behaviors

Volume

112
Abstract
Abstract
Objective: The growing prevalence of tobacco use in low “to middle” income countries (LMICs) and the hurdles of conducting tobacco cessation in that context necessitates a focus on the scope of randomized controlled trials (RCTs) in LMICs to guide tobacco cessation in this environment. We conducted a scoping review to identify LMIC tobacco cessation RCTs. Methods: Consistent with PRISMA-ScR guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, PsycINFO, articles published since inception, latest searches in March 2020) and gray literature (clinical trials registries, searches between September and December 2019). We searched for data on RCT type, outcome significance and intervention description. Inclusion: research conducted in LMICs; tobacco cessation; RCT. Exclusion: research conducted in high income countries; non-RCT; studies involving only those aged <18. Data was extracted from published reports. We generated narrative summaries of each LMIC's tobacco cessation RCT research environment. Results: Of 8404 articles screened, we identified 92 studies. Tobacco cessation RCTs were recorded in 16 of 138 countries/territories in LMICs. Evidence was weak in quality and severely limited. Most RCTs were psychosocial, with limited behavioral and pharmacological variants. Conclusions: Tobacco control within LMICs is essential to reduce the tobacco mortality burden. Researchers should be cognizant that tobacco cessation in LMICs is still not an environment where best practice has been established. We suggest that developing solutions specific for LMICs is key to effective tobacco control in LMICs.

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)

Edwards, 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., Everard, C., Kimmel, H. L., Van Bemmel, D. M., & Hyland, A.

Publication year

2021

Journal title

Cancer Epidemiology Biomarkers and Prevention

Volume

30

Issue

6

Page(s)

1175-1184
Abstract
Abstract
Background: 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.

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

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

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

447-453
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.

Biomarkers of exposure among adult smokeless tobacco users in the population assessment of Tobacco and health study (WAVE 1, 2013-2014)

Cheng, 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., Hatsukami, D. K., Goniewicz, M. L., Borek, N., Blount, B. C., & Van Bemmel, D. M.

Publication year

2020

Journal title

Cancer Epidemiology Biomarkers and Prevention

Volume

29

Issue

3

Page(s)

659-667
Abstract
Abstract
Background: 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.

Contact

rn54@nyu.edu 708 Broadway 6FL New York, NY, 10003