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

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

Kierstead, E. C., Harvey, E., Sanchez, D., Horn, K., Abroms, L. C., Spielberg, F., Stanton, C. A., Debnam, C., Cohn, A. M., Gray, T., Magnus, M., Patel, M., Niaura, R., & Elf, J. L.

Publication year

2021

Journal title

BMC research notes

Volume

14

Issue

1
Abstract
Abstract
Objective: Morbidity and mortality from smoking-related diseases among people living with HIV (PLWH) in the U.S. surpasses that due to HIV itself. Conventional smoking cessation treatments have not demonstrated strong efficacy among PLWH. We conducted a pilot randomized controlled trial (RCT) to evaluate a tailored smoking cessation intervention based on the minority stress model. We compared standard of care counseling (SOC) to a tailored intervention (TI) including one face-to-face counseling session incorporating cognitive behavioral therapy to build resilience, and 30 days of 2-way text messaging. Results: The primary outcome was smoking cessation. Secondary outcomes included cigarettes per day (CPD), exhaled carbon monoxide (CO), and cessation self-efficacy. A total of 25 participants were enrolled (TI:11, SOC:14), and 2 were lost to follow-up. There were no significant differences in quit rates between study groups. However, there was a significantly greater decrease in CPD in the TI versus SOC (13.5 vs. 0.0, p-value:0.036). Additionally, self-efficacy increased in both groups (TI p-value:0.012, SOC p-value:0.049) and CO decreased in both groups (TI p-value: < 0.001, SOC p-value:0.049). This intervention shows promise to support smoking cessation among PLWH. A larger study is needed to fully evaluate the efficacy of this approach. Clinical trial: Trial Registration: Retrospectively registered (10/20/2020) NCT04594109.

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.

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)

878-879

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

Johnson, A. C., Luta, G., Tercyak, K. P., Niaura, R. S., & Mays, D.

Publication year

2021

Journal title

Addictive Behaviors

Volume

120
Abstract
Abstract
Introduction: Pictorial warning labels and standardized “plain” packaging are policy interventions to reduce smoking, in part, by making cigarette packs and smoking less appealing. To inform potential policy decisions, this study examined the relative effects of message text framing (gain vs. loss) and cigarette packaging (standardized vs. branded) on appeal in a sample of young adult cigarette smokers. Methods: Cigarette smokers (N = 339) ages 18–30 completed two within-subjects experimental tasks. Tasks assessed the effects of message text framing (gain vs. loss) and packaging (standardized vs. branded) on cigarette packaging appeal. Task 1 was a 2 × 2 discrete choice experiment, where participants chose between each experimental pack and a standard branded cigarette pack without a pictorial warning label. Task 2 was a ranking task where participants ranked all packs on measures of appeal. Results: In Task 1, there were no significant differences in measures of appeal between packs displaying gain- vs. loss-framed message text, but all packs with pictorial warning labels significantly decreased appeal relative to standard branded packs without pictorial warning labels. Standardized packs with pictorial warning labels significantly reduced appeal relative to branded packs with pictorial warning labels and standard branded packs without pictorial warning labels. Task 2 pack rankings showed similar effects of pictorial warning labels and standardized packaging on appeal. Conclusions: Pictorial warning labels with gain- and loss-framed text were equally powerful at reducing appeal of cigarette packs in young adult smokers relative to branded packs without pictorial warning labels, especially when combined with standardized packaging.

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

Olonoff, M., Niaura, R. S., Ciecierski, C. C., Ciolino, J. D., & Hitsman, B.

Publication year

2021

Journal title

Journal of American College Health
Abstract
Abstract
Objective: The purpose of this study was to examine Electronic Nicotine Delivery Systems (ENDS) use among nonusers in diverse college students. Participants: Participants were college students enrolled at a Hispanic-Serving University in Chicago, IL, USA in December 2017. Methods: An online survey was administered using questions about ENDS-use behaviors, device characteristics, and knowledge of their own device, and ENDS attitudes. ENDS attitudes included questions about health, susceptibility, and quit characteristics. Results: The prevalence rate of ENDS use was 7%, and 39% of ENDS users identified all device characteristics. Nonusers categorize ENDS as a healthier alternative to cigarettes and as quit devices. Finally, cigarette use, age, health factor, and social proximity are correlated with ENDS susceptibility. Conclusions: These ENDS users lack awareness of their devices and tobacco use plays a key role in ENDS susceptibility. Future studies should continue to study the role ENDS has in dependence and cigarette use.

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.

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

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.

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

Farsalinos, K., Bagos, P. G., Giannouchos, T., Niaura, R., Barbouni, A., & Poulas, K.

Publication year

2021

Journal title

Harm Reduction Journal

Volume

18

Issue

1
Abstract
Abstract
Background: There is a lot of debate about the effects of smoking on COVID-19. A recent fixed-effects meta-analysis found smoking to be associated with disease severity among hospitalized patients, but other studies report an unusually low prevalence of smoking among hospitalized patients. The purpose of this study was to expand the analysis by calculating the prevalence odds ratio (POR) of smoking among hospitalized COVID-19 patients, while the association between smoking and disease severity and mortality was examined by random-effects meta-analyses considering the highly heterogeneous study populations. Methods: The same studies as examined in the previous meta-analysis were analyzed (N = 22, 20 studies from China and 2 from USA). The POR relative to the expected smoking prevalence was calculated using gender and age-adjusted population smoking rates. Random-effects meta-analyses were used for all other associations. Results: A total of 7162 patients were included, with 482 being smokers. The POR was 0.24 (95%CI 0.19–0.30). Unlike the original study, the association between smoking and disease severity was not statistically significant using random-effects meta-analysis (OR 1.40, 95%CI 0.98–1.98). In agreement with the original study, no statistically significant association was found between smoking and mortality (OR 1.86, 95%CI 0.88–3.94). Conclusion: An unusually low prevalence of smoking, approximately 1/4th the expected prevalence, was observed among hospitalized COVID-19 patients. Any association between smoking and COVID-19 severity cannot be generalized but should refer to the seemingly low proportion of smokers who develop severe COVID-19 that requires hospitalization. Smokers should be advised to quit due to long-term health risks, but pharmaceutical nicotine or other nicotinic cholinergic agonists should be explored as potential therapeutic options, based on a recently presented hypothesis.

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.

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

Farsalinos, K., Abrams, D., & Niaura, R. In American journal of preventive medicine.

Publication year

2020

Volume

58

Issue

6

Page(s)

895-896

Current smoking, former smoking, and adverse outcome among hospitalized COVID-19 patients: a systematic review and meta-analysis

Farsalinos, K., Barbouni, A., Poulas, K., Polosa, R., Caponnetto, P., & Niaura, R.

Publication year

2020

Journal title

Therapeutic Advances in Chronic Disease

Volume

11
Abstract
Abstract
Background: 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

Farsalinos, K. E., & Niaura, R.

Publication year

2020

Journal title

Nicotine and Tobacco Research

Volume

22

Issue

5

Page(s)

655-662
Abstract
Abstract
Introduction: 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.

Publication year

2020

Journal title

Toxicology Reports

Volume

7

Page(s)

658-663

Predictive validity of the adult tobacco dependence index: Findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study

Strong, 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.

Publication year

2020

Journal title

Drug and alcohol dependence

Volume

214
Abstract
Abstract
Background 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

Villanti, A. C., Naud, S., West, J. C., Pearson, J. L., Wackowski, O. A., Hair, E., Niaura, R. S., & Rath, J. M.

Publication year

2020

Journal title

Preventive Medicine

Volume

140
Abstract
Abstract
Low 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.

Contact

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