David Abrams

David Abrams

David Abrams

Professor of Social and Behavioral Sciences

Professional overview

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

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

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

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

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

Education

BSc (Hons), Psychology and Computer Science, University of the Witwatersrand, Johannesburg, South Africa
MS, Clinical Psychology, Rutgers University, New Brunswick, NJ
PhD, Clinical Psychology, Rutgers University, New Brunswick, NJ
Postdoctoral Fellow, Brown Medical School, Providence, RI

Honors and awards

Research Laureate Award, American Academy of Health Behavior (2014)
Joseph W. Cullen Memorial Award for Tobacco Research, American Society for Preventive Oncology (2008)
Distinguished Alumni Award: Rutgers University, The Graduate School, New Brunswick, NJ (2007)
The Musiker-Miranda Distinguished Service Award, American Psychological Association (2006)
Distinguished Service Award, Society of Behavioral Medicine (2006)
Outstanding Research Mentor Award, Society of Behavioral Medicine (2006)
Book of the Year Award: Tobacco Dependence Treatment Handbook. American Journal of Nursing (2005)
Distinguished Scientist Award, Society of Behavioral Medicine (1998)

Areas of research and study

Behavioral Science
Chronic Diseases
Evaluations
Population Health
Public Health Pedagogy
Public Health Systems
Research Design
Systems Integration
Systems Interventions
Tobacco Control

Publications

A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products

Levy, D.T., Cummings, K.M., Villanti, A.C., Niaura, R., Abrams, D., Fong, G.T., & Borland, R.

Publication year

2017

Journal title

Addiction

Volume

112

Page(s)

8-17
10.1111/add.13394
Abstract

The use of vaporized nicotine products (VNPs), especially e-cigarettes and, to a lesser extent, pressurized aerosol nicotine products and heat-not-burn tobacco products, are being adopted increasingly as an alternative to smoking combusted products, primarily cigarettes. Considerable controversy has accompanied their marketing and use. We propose a framework that describes and incorporates patterns of VNP and combustible cigarette use in determining the total amount of toxic exposure effects on population health. We begin by considering toxicity and the outcomes relevant to population health. We then present the framework and define different measures of VNP use; namely, trial and long-term use for exclusive cigarette smokers, exclusive VNP and dual (cigarette and VNP) use. Using a systems thinking framework and decision theory we considered potential pathways for current, former and never users of VNPs. We then consider the evidence to date and the probable impacts of VNP use on public health, the potential effects of different policy approaches and the possible influence of the tobacco industry on VNP and cigarette use.

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

Pearson, J.L., Johnson, A.L., Johnson, S.E., Stanton, C.A., Villanti, A.C., Niaura, R., … Hyland, A.

Publication year

2017

Journal title

Addiction
10.1111/add.13952
Abstract

Background and aims: The US Family Smoking Prevention and Tobacco Control Act provides a pathway for manufacturers to market a modified risk tobacco product (MRTP). This study examines socio-demographic and tobacco use correlates of interest in a hypothetical MRTP in a nationally representative sample of US adults. Design: Cross sectional wave 1 data from the 2013-14 Population Assessment of Tobacco and Health (PATH) Study. Setting: Household Audio-Computer Assisted Self-Interviews of US adults conducted in 2013-14. Participants: A total of 32320 civilian, non-institutionalized adults in the United States. Measurements: Interest in using a hypothetical MRTP ('If a tobacco product made a claim that it was less harmful to health than other tobacco products, how likely would you be to use that product?'), socio-demographics, tobacco use history and mental health and substance use problems. All estimates were weighted. Findings: Overall, 16.7% [95% confidence interval (CI) = 16.28, 17.18] of US adults reported interest in a hypothetical MRTP. Tobacco use was associated significantly with interest in a hypothetical MRTP, with interest most common among current established smokers (54.4%; 95% CI = 53.31, 55.39) and least common among never tobacco users (3.0%; 95% CI = 2.49, 3.55). Interest in a hypothetical MRTP was associated with experimental e-cigarette use among current experimental, current established and former smokers. Among non-smokers, race, age, education and substance use were associated with interest in using a hypothetical MRTP. Conclusions: Among adults in the United States, interest in using a hypothetical modified risk tobacco product is low overall, and highest among current experimental and established smokers. A small percentage of non-smokers are interested in using a hypothetical hypothetical modified risk tobacco product.

Analysis of E-cigarette use in the 2014 Eurobarometer survey: calling out deficiencies in epidemiology methods

Polosa, R., Caponnetto, P., Niaura, R., & Abrams, D.

Publication year

2017

Journal title

Internal and Emergency Medicine

Volume

12

Page(s)

733-735
10.1007/s11739-017-1667-z

Computational models used to assess US tobacco control policies

Feirman, S.P., Glasser, A.M., Rose, S., Niaura, R., Abrams, D., Teplitskaya, L., & Villanti, A.C.

Publication year

2017

Journal title

Nicotine and Tobacco Research

Volume

19

Page(s)

1257-1267
10.1093/ntr/ntx017
Abstract

Introduction: Simulation models can be used to evaluate existing and potential tobacco control interventions, including policies. The purpose of this systematic review was to synthesize evidence from computational models used to project population-level effects of tobacco control interventions. We provide recommendations to strengthen simulation models that evaluate tobacco control interventions. Methods: Studies were eligible for review if they employed a computational model to predict the expected effects of a non-clinical US-based tobacco control intervention. We searched five electronic databases on July 1, 2013 with no date restrictions and synthesized studies qualitatively. Results: Six primary non-clinical intervention types were examined across the 40 studies: taxation, youth prevention, smoke-free policies, mass media campaigns, marketing/advertising restrictions, and product regulation. Simulation models demonstrated the independent and combined effects of these interventions on decreasing projected future smoking prevalence. Taxation effects were the most robust, as studies examining other interventions exhibited substantial heterogeneity with regard to the outcomes and specific policies examined across models. Conclusions: Models should project the impact of interventions on overall tobacco use, including nicotine delivery product use, to estimate preventable health and cost-saving outcomes. Model validation, transparency, more sophisticated models, and modeling policy interactions are also needed to inform policymakers to make decisions that will minimize harm and maximize health. Implications: In this systematic review, evidence from multiple studies demonstrated the independent effect of taxation on decreasing future smoking prevalence, and models for other tobacco control interventions showed that these strategies are expected to decrease smoking, benefit population health, and are reasonable to implement from a cost perspective. Our recommendations aim to help policymakers and researchers minimize harm and maximize overall populationlevel health benefits by considering the real-world context in which tobacco control interventions are implemented.

Design and methods of the Population Assessment of Tobacco and Health (PATH) Study

Hyland, A., Ambrose, B.K., Conway, K.P., Borek, N., Lambert, E., Carusi, C., … Compton, W.M.

Publication year

2017

Journal title

Tobacco Control

Volume

26

Page(s)

371-378
10.1136/tobaccocontrol-2016-052934
Abstract

Background This paper describes the methods and conceptual framework for Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study data collection. The National Institutes of Health, through the National Institute on Drug Abuse, is partnering with the Food and Drug Administration’s (FDA) Center for Tobacco Products to conduct the PATH Study under a contract with Westat. Methods The PATH Study is a nationally representative, longitudinal cohort study of 45 971 adults and youth in the USA, aged 12 years and older. Wave 1 was conducted from 12 September 2013 to 15 December 2014 using Audio Computer-Assisted Self-Interviewing to collect information on tobacco-use patterns, risk perceptions and attitudes towards current and newly emerging tobacco products, tobacco initiation, cessation, relapse behaviours and health outcomes. The PATH Study’s design allows for the longitudinal assessment of patterns of use of a spectrum of tobacco products, including initiation, cessation, relapse and transitions between products, as well as factors associated with use patterns. Additionally, the PATH Study collects biospecimens from consenting adults aged 18 years and older and measures biomarkers of exposure and potential harm related to tobacco use. Conclusions The cumulative, population-based data generated over time by the PATH Study will contribute to the evidence base to inform FDA’s regulatory mission under the Family Smoking Prevention and Tobacco Control Act and efforts to reduce the Nation’s burden of tobacco-related death and disease.

Developing consistent and transparent models of E-cigarette use: Reply to Glantz and Soneji et al.

Levy, D.T., Borland, R., Fong, G.T., Villanti, A.C., Niaura, R., Meza, R., … Abrams, D.

Publication year

2017

Journal title

Nicotine and Tobacco Research

Volume

19

Page(s)

268-270
10.1093/ntr/ntw236

Electronic cigarette use among US adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014

Coleman, B.N., Rostron, B., Johnson, S.E., Ambrose, B.K., Pearson, J., Stanton, C.A., … Hyland, A.

Publication year

2017

Journal title

Tobacco Control
10.1136/tobaccocontrol-2016-053462
Abstract

Background: Electronic cigarette (e-cigarette) use in the USA is increasing. As such, it is critical to understand who uses e-cigarettes, how e-cigarettes are used and what types of products are prevalent. This study assesses patterns of current e-cigarette use among daily and non-daily adult users in the 2013-2014 Population Assessment of Tobacco and Health (PATH) Study.Methods: We examined the proportion of current adult e-cigarette users (n=3642) reporting infrequent use (use on 'some days' and use on 0-2 of the past 30 days), moderate use (use on 'some days' and use on >2 of the past 30 days) and daily use. We examined demographic characteristics, use of other tobacco products and e-cigarette product characteristics overall and by use category. Adjusted prevalence ratios (aPRs) were calculated using Poisson regression to assess correlates of daily e-cigarette use.Results: Among the 5.5% of adult current e-cigarette users in the PATH Study, 42.2% reported infrequent use, 36.5% reported moderate use and 21.3% reported daily use. Cigarette smokers who quit in the past year were more likely to report daily e-cigarette use, compared with current smokers (aPR=3.21, 95% CI=2.75 to 3.76). Those who reported using rechargeable or refillable devices were more likely to report daily use compared with those who did not use these devices (aPR=1.95, 95% CI=1.44 to 2.65 and aPR=2.10, 95% CI=1.75 to 2.52, respectively).Conclusions: The majority of e-cigarette users in this study reported less than daily use. Compared with non-daily use, daily use was associated with being a former smoker; however, cross-sectional data limits our ability to establish the temporality or directionality of such associations.

Erratum to: Analysis of E-cigarette use in the 2014 Eurobarometer survey: calling out deficiencies in epidemiology methods (Intern Emerg Med, 10.1007/s11739-017-1667-z)

Polosa, R., Caponnetto, P., Niaura, R., & Abrams, D.

Publication year

2017

Journal title

Internal and Emergency Medicine

Volume

12
10.1007/s11739-017-1685-x
Abstract

The article Analysis of E-cigarette use in the 2014 Eurobarometer survey: calling out deficiencies in epidemiology methods, written by Riccardo Polosa, Pasquale Caponnetto, Ray Niaura, David Abrams, was originally published electronically on the publisher’s internet portal (currently SpringerLink) on May 5, 2017 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the updated version is of June 30, 2017

Erratum to: Complying with the framework convention for tobacco control: An application of the Abridged SimSmoke model to Israel. [Israel Journal of Health Policy Research. 5, (2016), (41)] DOI: 10.1186/s13584-016-0101-8

Levy, D.T., Abrams, D., Levy, J., & Rosen, L.

Publication year

2017

Journal title

Israel Journal of Health Policy Research

Volume

6
10.1186/s13584-016-0121-4
Abstract

There was a minor calculation error in the original version of this paper [1]. The correct numbers are as follows: Abstract results: The first two sentences should read: "We estimate that between 547 and 711 thousand smokers of the current 1.1 million Israeli smokers will prematurely die due smoking. Within 40 years, complete implementation of MPOWER policies is projected to reduce smoking prevalence among current smokers by 34% and avert between 187 and 243 thousand deaths." Results: The 4th sentence in the first paragraph under 'Results' on page 5 should read: "Based on numbers of smokers, the number of smoking-attributable deaths is projected as 547 thousand (349.5 thousand male and 197.1 thousand female) as a lower estimate and 711 thousand (454.3 thousand male and 256.2 thousand female) as an upper estimate of the smokers alive in 2014. Results: On page 7, in the first column the sentence before DISCUSSION should read: "As a result, between 187 thousand (119.7 thousand male and 67.5 thousand female) and 243 thousand (155.6 thousand male and 87.8 thousand female) premature deaths of current smokers alive in 2015 are projected to be averted. Discussion: The first column, first sentence on page 7 has been changed to: "Among smokers alive in 2014 in Israel, between 547 and 711 thousand premature deaths are predicted. Discussion: In the first column on page 7, the fourth sentence of the Discussion section has been changed to: "With a complete implementation of policies, Israel is predicted to reach the goal of reducing the goal of smoking rates by 23% in the next 5 years..." Discussion: On page 7, in the second column: The paper by Ginsberg and Geva is noted three times. Ginsberg has been spelled incorrectly. Also within the Discussion section, on page 7, second column, middle has been corrected to: "Ginsberg and Geva [34,35]estimated the number of smoking-attributable deaths from active smoking at 7,025 per year, implying about 350,000 deaths over 50 years" Finally, the following sentence at the end of the second column on page 7 has been amended: "|In addition to the 7000 and 7850 smoking attributable deaths each year..." has been replaced with "In addition to the 7,025 smoking-attributable annual deaths due to active smoking and 793 deaths due to passive smoking...." (Data source: Israel Center for Disease Control) has been added to Reference 21.

Frequency of youth e-cigarette and tobacco use patterns in the United States: Measurement precision is critical to inform public health

Villanti, A.C., Pearson, J.L., Glasser, A.M., Johnson, A.L., Collins, L.K., Niaura, R., & Abrams, D.

Publication year

2017

Journal title

Nicotine and Tobacco Research

Volume

19

Page(s)

1345-1350
10.1093/ntr/ntw388
Abstract

Introduction: E-cigarette use occurs with tobacco product use in youth. Methods: Using the 2014 National Youth Tobacco Survey (NYTS), we examined past 30-day frequency of cigarette, cigar, smokeless, and e-cigarette use in the context of past 30-day and ever tobacco product use in US middle and high school students (N = 22 007). Frequency of productspecific use was examined by exclusive versus concurrent use with another product in the past 30 days (poly-use). Results: In 2014, the majority (83%) of US middle and high school students had not used tobacco or e-cigarettes in the past 30 days. In the 9.3% of youth reporting any past 30-day e-cigarette use, 63% also reported using a tobacco product; among the 3.3% past 30-day exclusive e-cigarette users, about two-thirds (2.1%) had ever used combustible or non-combustible tobacco products and one-third (1.2%) had not. Few never tobacco users had used e-cigarettes on 10 or more days in the past month (absolute percent < 0.1%). Among past 30-day cigarette and smokeless users, the two highest frequency categories were 1-2 days and daily use; among past 30-day e-cigarette and cigar users, prevalence decreased with increasing frequency of use. The majority of past 30-day cigarette, cigar, smokeless, and e-cigarette users reported poly-use. Conclusions: Prevalence estimates for a single product mask the complex patterns of frequency, temporality, and poly-use in youth. Two-thirds of past 30-day exclusive e-cigarette users have ever used tobacco. Poly-use is the dominant pattern of tobacco and e-cigarette use among US middle and high school students. Implications: Our study highlights the complexity of tobacco use patterns in US middle and high school students. Future studies addressing the full public health impact of movement into or out of combustible tobacco use will require longitudinal data with appropriate measures of tobacco and e-cigarette product-specific use (eg, frequency and intensity), as well as adequate sample size and a sufficient number of waves to determine how use of individual products, like e-cigarettes, impact progression into or out of more stable patterns of tobacco and e-cigarette use.

Frequency of youth e-cigarette, tobacco, and poly-use in the United States, 2015: Update to Villanti et al., "frequency of youth e-cigarette and tobacco use patterns in the United States: Measurement precision is critical to inform public health"

Collins, L.K., Villanti, A.C., Pearson, J.L., Glasser, A.M., Johnson, A.L., Niaura, R., & Abrams, D.

Publication year

2017

Journal title

Nicotine and Tobacco Research

Volume

19

Page(s)

1253-1254
10.1093/ntr/ntx073

Identifying “social smoking” U.S. young adults using an empirically-driven approach

Villanti, A.C., Johnson, A.L., Rath, J.M., Williams, V., Vallone, D.M., Abrams, D., … Mermelstein, R.J.

Publication year

2017

Journal title

Addictive Behaviors

Volume

70

Page(s)

83-89
10.1016/j.addbeh.2017.02.004
Abstract

The phenomenon of “social smoking” emerged in the past decade as an important area of research, largely due to its high prevalence in young adults. The purpose of this study was to identify classes of young adult ever smokers based on measures of social and contextual influences on tobacco use. Latent class models were developed using social smoking measures, and not the frequency or quantity of tobacco use. Data come from a national sample of young adult ever smokers aged 18–24 (Truth Initiative Young Adult Cohort Study, N = 1564). The optimal models identified three latent classes: Class 1 – nonsmokers (52%); Class 2 – social smokers (18%); and Class 3 – smokers (30%). Nearly 60% of the “social smoker” class self-identified as a social smoker, 30% as an ex-smoker/tried smoking, and 12% as a non-smoker. The “social smoker” class was most likely to report using tobacco mainly or only with others. Past 30-day cigarette use was highest in the “smoker” class. Hookah use was highest in the “social smoker” class. Other tobacco and e-cigarette use was similar in the “social smoker” and “smoker” classes. Past 30-day tobacco and e-cigarette use was present for all products in the “non-smoker” class. Young adult social smokers emerge empirically as a sizable, distinct class from other smokers, even without accounting for tobacco use frequency or intensity. The prevalence of hookah use in “social smokers” indicates a group for which the social aspect of tobacco use could drive experimentation and progression to regular use.

Improving adherence to smoking cessation treatment: Intervention effects in a web-based randomized trial

Graham, A.L., Papandonatos, G.D., Cha, S., Erar, B., Amato, M.S., Cobb, N.K., … Abrams, D.

Publication year

2017

Journal title

Nicotine and Tobacco Research

Volume

19

Page(s)

324-332
10.1093/ntr/ntw282
Abstract

Background: Web-based smoking cessation interventions can deliver evidence-based treatments to a wide swath of the population, but effectiveness is often limited by insufficient adherence to proven treatment components. This study evaluated the impact of a social network (SN) intervention and free nicotine replacement therapy (NRT) on adherence to evidence-based components of smoking cessation treatment in the context of a Web-based intervention. Methods: A sample of adult U.S. smokers (N = 5290) was recruited via BecomeAnEX.org, a free smoking cessation Web site. Smokers were randomized to one of four arms: (1) an interactive, evidence-based smoking cessation Web site (WEB) alone; (2) WEB in conjunction with an SN intervention designed to integrate participants into the online community (WEB+SN); (3) WEB plus free NRT (WEB+NRT); and (4) the combination of all treatments (WEB+SN+NRT). Adherence outcomes assessed at 3-month follow-up were as follows: Web site utilization metrics, use of skills training components, intratreatment social support, and pharmacotherapy use. Results: WEB+SN+NRT outperformed all others on Web site utilization metrics, use of practical counseling tools, intratreatment social support, and NRT use. It was the only intervention to promote the sending of private messages and the viewing of community pages over WEB alone. Both social network arms outperformed WEB on most metrics of online community engagement. Both NRT arms showed higher medication use compared to WEB alone. Conclusions: This study demonstrated the effectiveness of two approaches for improving adherence to evidence-based components of smoking cessation treatment. Integrated approaches to medication provision and social network engagement can enhance adherence to components known to improve cessation. Implications: This study demonstrated that an integrated approach to medication provision and social network integration, when delivered through an online program, can enhance adherence across all three recommended components of an evidence-based smoking cessation program (skills training, social support, and pharmacotherapy use). Nicotine replacement therapy-when provided as part of an integrated program-increases adherence to other program elements, which in turn augment its own therapeutic effects. An explicit focus on approaches to improve treatment adherence is an important first step to identifying leverage points for optimizing intervention effectiveness.

Indicators of dependence for different types of tobacco product users: Descriptive findings from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) study

Strong, D.R., Pearson, J., Ehlke, S., Kirchner, T., Abrams, D., Taylor, K., … Niaura, R.

Publication year

2017

Journal title

Drug and Alcohol Dependence

Volume

178

Page(s)

257-266
10.1016/j.drugalcdep.2017.05.010
Abstract

Background and aims With no established standard for assessing tobacco dependence (TD) across tobacco products in surveys, the Population Assessment of Tobacco and Health (PATH) Study provides a unique platform for examining the psychometric properties and validity of multiple indicators of tobacco dependence across a range of tobacco products. Participants A U.S. nationally representative sample from the 32,320 adult Wave 1 interviews with analyses focused on 14,287 respondents who were current established users of tobacco products. Findings This analysis confirms a single primary latent construct underlying responses to TD indicators for cigarettes, e-cigarettes, cigars, hookah, and smokeless tobacco products. Mutually exclusive past year tobacco-user groups included: cigarette only (n = 8689), e-cigarette only (n = 437), cigar only (traditional, cigarillo, or filtered) (n = 706), hookah only (n = 461), smokeless tobacco only (n = 971), cigarette plus e-cigarette (n = 709), and multiple tobacco product users (n = 2314). Differential Item Functioning (DIF) analyses supported use of 16 of the 24 examined TD indicators for comparisons across tobacco users. With cigarette users as a reference (mean = 0.0, SD = 1.0), we observed a range of TD with hookah (mean = −1.71) and cigar (mean = −1.92) only users being the lowest, and cigarette plus e-cigarette product users being the highest (mean = 0.35). Regression models including sociodemographic factors supported concurrent validity with increased product use frequency and TD among cigarette-only (p < 0.001), e-cigarette only (p < 0.002), cigar (p < 0.001), hookah only (p < 0.001), and smokeless tobacco users (p < 0.001). Conclusion The PATH Study Adult Wave 1 Questionnaire provided psychometrically valid measures of TD that enables future regulatory investigations of nicotine dependence across tobacco products.

Menthol cigarettes and the public health standard: A systematic review

Villanti, A.C., Collins, L.K., Niaura, R., Gagosian, S.Y., & Abrams, D.

Publication year

2017

Journal title

BMC Public Health

Volume

17
10.1186/s12889-017-4987-z
Abstract

Background: Although menthol was not banned under the Tobacco Control Act, the law made it clear that this did not prevent the Food and Drug Administration from issuing a product standard to ban menthol to protect public health. The purpose of this review was to update the evidence synthesis regarding the role of menthol in initiation, dependence and cessation. Methods: A systematic review of the peer-reviewed literature on menthol cigarettes via a PubMed search through May 9, 2017. The National Cancer Institute's Bibliography of Literature on Menthol and Tobacco and the FDA's 2011 report and 2013 addendum were reviewed for additional publications. Included articles addressing initiation, dependence, and cessation were synthesized based on study design and quality, consistency of evidence across populations and over time, coherence of findings across studies, and plausibility of the findings. Results: Eighty-two studies on menthol cigarette initiation (n = 46), dependence (n = 14), and cessation (n = 34) were included. Large, representative studies show an association between menthol and youth smoking that is consistent in magnitude and direction. One longitudinal and eight cross-sectional studies demonstrate that menthol smokers report increased nicotine dependence compared to non-menthol smokers. Ten studies support the temporal relationship between menthol and reduced smoking cessation, as they measure cessation success at follow-up. Conclusions: The strength and consistency of the associations in these studies support that the removal of menthol from cigarettes is likely to reduce youth smoking initiation, improve smoking cessation outcomes in adult smokers, and in turn, benefit public health.

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

Glasser, A.M., Collins, L., Pearson, J.L., Abudayyeh, H., Niaura, R., Abrams, D., & Villanti, A.C.

Publication year

2017

Journal title

American Journal of Preventive Medicine

Volume

52

Page(s)

e33-e66
10.1016/j.amepre.2016.10.036
Abstract

Context Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. Evidence acquisition The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. Evidence synthesis There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. Conclusions Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.

Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: A randomized clinical trial

Taylor, K.L., Hagerman, C.J., Luta, G., Bellini, P.G., Stanton, C., Abrams, D., … Ramsaier, M.

Publication year

2017

Journal title

Lung Cancer

Volume

108

Page(s)

242-246
10.1016/j.lungcan.2017.01.020
Abstract

Incorporating effective smoking cessation interventions into lung cancer screening (LCS) programs will be essential to realizing the full benefit of screening. We conducted a pilot randomized trial to determine the feasibility and efficacy of a telephone-counseling (TC) smoking cessation intervention vs. usual care (UC) in the LCS setting. In collaboration with 3 geographically diverse LCS programs, we enrolled current smokers (61.5% participation rate) who were: registered to undergo LCS, 50–77 years old, and had a 20+ pack-year smoking history. Eligibility was not based on readiness to quit. Participants completed pre-LCS (T0) and post-LCS (T1) telephone assessments, were randomized to TC (N = 46) vs. UC (N = 46), and completed a final 3-month telephone assessment (T2). Both study arms received a list of evidence-based cessation resources. TC participants also received up to 6 brief counseling calls with a trained cessation counselor. Counseling calls incorporated motivational interviewing and utilized the screening result as a motivator for quitting. The outcome was biochemically verified 7-day point prevalence cessation at 3-months post-randomization. Participants (56.5% female) were 60.2 (SD = 5.4) years old and reported 47.1 (SD = 22.2) pack years; 30% were ready to stop smoking in the next 30 days. TC participants completed an average of 4.4 (SD = 2.3) sessions. Using intent-to-treat analyses, biochemically verified quit rates were 17.4% (TC) vs. 4.3% (UC), p < .05. This study provides preliminary evidence that telephone-based cessation counseling is feasible and efficacious in the LCS setting. As millions of current smokers are now eligible for lung cancer screening, this setting represents an important opportunity to exert a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related diseases. If this evidence-based, brief, and scalable intervention is replicated, TC could help to improve the overall cost-effectiveness of LCS. Trial registration NCT02267096, https://clinicaltrials.gov

The application of a decision-theoretic model to estimate the public health impact of vaporized nicotine product initiation in the United States

Levy, D.T., Borland, R., Villanti, A.C., Niaura, R., Yuan, Z., Zhang, Y., … Abrams, D.

Publication year

2017

Journal title

Nicotine and Tobacco Research

Volume

19

Page(s)

149-159
10.1093/ntr/ntw158
Abstract

Introduction: The public health impact of vaporized nicotine products (VNPs) such as e-cigarettes is unknown at this time. VNP uptake may encourage or deflect progression to cigarette smoking in those who would not have otherwise smoked, thereby undermining or accelerating reductions in smoking prevalence seen in recent years. Methods: The public health impact of VNP use are modeled in terms of how it alters smoking patterns among those who would have otherwise smoked cigarettes and among those who would not have otherwise smoked cigarettes in the absence of VNPs. The model incorporates transitions from trial to established VNP use, transitions to exclusive VNP and dual use, and the effects of cessation at later ages. Public health impact on deaths and life years lost is estimated for a recent birth cohort incorporating evidence-informed parameter estimates. Results: Based on current use patterns and conservative assumptions, we project a reduction of 21% in smoking-attributable deaths and of 20% in life years lost as a result of VNP use by the 1997 US birth cohort compared to a scenario without VNPs. In sensitivity analysis, health gains from VNP use are especially sensitive to VNP risks and VNP use rates among those likely to smoke cigarettes. Conclusions: Under most plausible scenarios, VNP use generally has a positive public health impact. However, very high VNP use rates could result in net harms. More accurate projections of VNP impacts will require better longitudinal measures of transitions into and out of VNP, cigarette and dual use. Implications: Previous models of VNP use do not incorporate whether youth and young adults initiating VNP would have been likely to have been a smoker in the absence of VNPs. This study provides a decision-theoretic model of VNP use in a young cohort that incorporates tendencies toward smoking and shows that, under most plausible scenarios, VNP use yields public health gains. The model makes explicit the type of surveillance information needed to better estimate the effect of new products and thereby inform public policy.

The need for a comprehensive framework

Levy, D.T., Fong, G.T., Cummings, K.M., Borland, R., Abrams, D., Villanti, A.C., & Niaura, R.

Publication year

2017

Journal title

Addiction

Volume

112

Page(s)

22-24
10.1111/add.13600

Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014

Villanti, A.C., Mowery, P.D., Delnevo, C.D., Niaura, R., Abrams, D., & Giovino, G.A.

Publication year

2016

Journal title

Tobacco Control

Volume

25

Page(s)

ii14-ii20
10.1136/tobaccocontrol-2016-053329
Abstract

Introduction National data from 2004 to 2010 showed that despite decreases in non-menthol cigarette use prevalence, menthol cigarette use prevalence remained constant in adolescents and adults and increased in young adults. The purpose of the current study was to extend these analyses through 2014. Methods We estimated the prevalence of menthol cigarette smoking in the USA during 2004-2014 using annual cross-sectional data on persons aged ≥12 years from the National Survey on Drug Use and Health. Self-reported menthol status for selected brands that were either exclusively menthol or non-menthol were adjusted based on retail sales data. Data were weighted to provide national estimates. Results Although overall smoking prevalence has decreased, the proportion of past 30-day cigarette smokers using menthol cigarettes was higher (39%) in 2012-2014 compared to 2008-2010 (35%). Youth smokers remain the most likely group to use menthol cigarettes compared to all other age groups. Menthol cigarette prevalence has increased in white, Asian and Hispanic smokers since 2010. Menthol cigarette prevalence exceeded non-menthol cigarette prevalence in youth and young adult smokers in 2014. Among smokers, menthol cigarette use was positively correlated with co-use of cigars. Menthol cigarette and smokeless tobacco co-use also increased from 2004 to 2014. Conclusions The youngest smokers are most likely to use menthol cigarettes. Among smokers, increases in overall menthol cigarette use and menthol cigarette use in whites, Asians and Hispanics since 2010 are of concern. There is tremendous urgency to limit the impact of menthol cigarettes on public health, particularly the health of youth and young adults.

Complying with the framework convention for tobacco control: An application of the Abridged SimSmoke model to Israel

Levy, D., Abrams, D., Levy, J., & Rosen, L.

Publication year

2016

Journal title

Israel Journal of Health Policy Research

Volume

5
10.1186/s13584-016-0101-8
Abstract

Background: The World Health Organization Framework Convention for Tobacco Control (FCTC) established the MPOWER policy package to provide practical country-level guidance on implementing effective policies to reduce smoking rates. The Abridged SimSmoke tobacco control policy simulation model is applied to Israel to estimate the effects on reducing smoking-attributable mortality resulting from full implementation of MPOWER policies. Methods: Smoking prevalence from the 2014 Israel National Health Interview Survey 3 and population data from the Israel Central Bureau of Statistics were used to calculate the number of current smokers. The status of current Israeli policy was determined using information from MPOWER 2015 and from local sources. Based on existing knowledge that between 50 % and 65 % of smokers will die prematurely from smoking, the model is used to determine mortality reductions among current smokers from full implementation of MPOWER policies. Results: We estimate that between 550 and 710 thousand smokers of the current 1.1 million Israeli smokers will prematurely die due to smoking. Within 40 years, complete implementation of MPOWER policies is projected to reduce smoking prevalence among current smokers by 34 % and avert between 188 and 245 thousand deaths among current smokers. Taxes, smoke-free air laws, marketing restrictions and media campaigns each reduce smoking by about 5 % within 5 years. Improved cessation treatment and health warnings each have smaller effects in the next five years, but their effects grow rapidly over time. Conclusions: Israel Abridged SimSmoke shows that complete implementation of the MPOWER strategies has the potential to substantially reduce smoking prevalence, and avert premature deaths due to smoking. Additional benefits are also expected from reduced morbidity, reduced initiation among nonsmokers, and reduction in exposure of nonsmokers to tobacco smoke.

Impact of Exposure to Electronic Cigarette Advertising on Susceptibility and Trial of Electronic Cigarettes and Cigarettes in US Young Adults: A Randomized Controlled Trial

Villanti, A.C., Rath, J.M., Williams, V.F., Pearson, J.L., Richardson, A., Abrams, D., … Vallone, D.M.

Publication year

2016

Journal title

Nicotine and Tobacco Research

Volume

18

Page(s)

1331-1339
10.1093/ntr/ntv235
Abstract

Introduction: This study assessed the impact of brief exposure to four electronic cigarette (e-cigarette) print advertisements (ads) on perceptions, intention, and subsequent use of e-cigarettes and cigarettes in US young adults. Methods: A randomized controlled trial was conducted in a national sample of young adults from an online panel survey in 2013. Participants were randomized to ad exposure or control. Curiosity, intentions, and perceptions regarding e-cigarettes were assessed post-exposure and e-cigarette and cigarette use at 6-month follow-up. Analyses were conducted in 2014. Results: Approximately 6% of young adults who had never used an e-cigarette at baseline tried an e-cigarette at 6-month follow-up, half of whom were current cigarette smokers at baseline. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette (18.3% exposed vs. 11.3% unexposed, AOR = 1.63, 95% CI = 1.18, 2.26) among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up (3.6% exposed vs. 1.2% unexposed, AOR = 2.85; 95% CI = 1.07, 7.61) among never users of cigarettes and e-cigarettes. Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users, nor cigarette use among smokers over time. Curiosity mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users. Conclusions: Exposure to e-cigarette ads may enhance curiosity and limited trial of e-cigarettes in never users. Future studies are needed to examine the net effect of curiosity and trial of e-cigarettes on longer-term patterns of tobacco use. Implications: This randomized trial provides the first evidence of the effect of e-cigarette advertising on a behavioral outcome in young adults. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up in a small number of never e-cigarette users and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes. 2015

Mathematical modeling in tobacco control research: Initial Results From a Systematic Review

Feirman, S.P., Donaldson, E., Glasser, A.M., Pearson, J.L., Niaura, R., Rose, S.W., … Villanti, A.C.

Publication year

2016

Journal title

Nicotine and Tobacco Research

Volume

18

Page(s)

229-242
10.1093/ntr/ntv104
Abstract

Objectives: The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models. Methods: We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies. Results: The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobaccorelated morbidity or mortality, and economic impact). Eighteen models were used across 118 studies. Conclusions: This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.

Medical costs and quality-adjusted life years associated with smoking: A systematic review

Feirman, S.P., Glasser, A.M., Teplitskaya, L., Holtgrave, D.R., Abrams, D., Niaura, R., & Villanti, A.C.

Publication year

2016

Journal title

BMC Public Health

Volume

16
10.1186/s12889-016-3319-z
Abstract

Background: Estimated medical costs ("T") and QALYs ("Q") associated with smoking are frequently used in cost-utility analyses of tobacco control interventions. The goal of this study was to understand how researchers have addressed the methodological challenges involved in estimating these parameters. Methods: Data were collected as part of a systematic review of tobacco modeling studies. We searched five electronic databases on July 1, 2013 with no date restrictions and synthesized studies qualitatively. Studies were eligible for the current analysis if they were U.S.-based, provided an estimate for Q, and used a societal perspective and lifetime analytic horizon to estimate T. We identified common methods and frequently cited sources used to obtain these estimates. Results: Across all 18 studies included in this review, 50 % cited a 1992 source to estimate the medical costs associated with smoking and 56 % cited a 1996 study to derive the estimate for QALYs saved by quitting or preventing smoking. Approaches for estimating T varied dramatically among the studies included in this review. T was valued as a positive number, negative number and $0; five studies did not include estimates for T in their analyses. The most commonly cited source for Q based its estimate on the Health Utilities Index (HUI). Several papers also cited sources that based their estimates for Q on the Quality of Well-Being Scale and the EuroQol five dimensions questionnaire (EQ-5D). Conclusions: Current estimates of the lifetime medical care costs and the QALYs associated with smoking are dated and do not reflect the latest evidence on the health effects of smoking, nor the current costs and benefits of smoking cessation and prevention. Given these limitations, we recommend that researchers conducting economic evaluations of tobacco control interventions perform extensive sensitivity analyses around these parameter estimates.

Obsolete tobacco control themes can be hazardous to public health: The need for updating views on absolute product risks and harm reduction

Kozlowski, L.T., & Abrams, D.

Publication year

2016

Journal title

BMC Public Health

Volume

16
10.1186/s12889-016-3079-9
Abstract

Background: Leading themes have guided tobacco control efforts, and these themes have changed over the decades. When questions arose about health risks of tobacco, they focused on two key themes: 1) how bad is the problem (i.e., absolute risk) and 2) what can be done to reduce the risk without cessation (i.e., prospects for harm reduction). Using the United States since 1964 as an example, we outline the leading themes that have arisen in response to these two questions. Initially, there was the recognition that "cigarettes are hazardous to health" and an acceptance of safer alternative tobacco products (cigars, pipes, light/lower-tar cigarettes). In the 1980s there was the creation of the seminal theme that "Cigarettes are lethal when used as intended and kill more people than heroin, cocaine, alcohol, AIDS, fires, homicide, suicide, and automobile crashes combined." By around 2000, support for a less-dangerous light/lower tar cigarette was gone, and harm reduction claims were avoided for products like cigars and even for smokeless tobacco which were summarized as "unsafe" or "not a safe alternative to cigarettes." Discussion: The Surgeon General in 2014 concluded that by far the greatest danger to public health was from cigarettes and other combusted products. At the same time the evidence base for smokeless tobacco and alternative nicotine delivery systems (ANDS) had grown. Product innovation and tobacco/nicotine bio-behavioral, epidemiological and public health sciences demonstrate that low nitrosamine smokeless tobacco (e.g., Swedish snus), and ANDS have substantially lower harms than cigarettes. Going forward, it is important to sharpen themes and key messages of tobacco control, while continuing to emphasize the extreme lethality of the inhaled smoke from cigarettes or from use of any combusting tobacco product. Summary: Implications of updating the leading themes for regulation, policymaking and advocacy in tobacco control are proposed as an important next step. A new reframing can align action plans to more powerfully and rapidly achieve population-level benefit and minimize harm to eliminate in our lifetime the use of the most deadly combustible tobacco products and thus prevent the premature deaths of 1 billion people projected to occur worldwide by 2100.

Contact

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