David B Abrams

Professor of Social and Behavioral Sciences

Professional overview

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

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

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

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

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

Education

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

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

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

Postdoctoral Fellow, Brown Medical School, Providence, RI

Honors and awards

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

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

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

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

Distinguished Service Award, Society of Behavioral Medicine (2006)

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

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

Distinguished Scientist Award, Society of Behavioral Medicine (1998)

Areas of research and study

Behavioral Science

Chronic Diseases

Evaluations

Implementation and Impact of Public Health Regulations

Implementation science

Population Health

Public Health Pedagogy

Public Health Systems

Research Design

Systems Integration

Systems Interventions

Tobacco Control

Translational science

Publications

Publications

A Cross-Sectional Analysis of the Nicotine Metabolite Ratio and Its Association with Sociodemographic and Smoking Characteristics among People with HIV Who Smoke in South Africa

Keke, C., Wilson, Z., Lebina, L., Motlhaoleng, K., Abrams, D., Variava, E., Gupte, N., Niaura, R., Martinson, N., Golub, J. E., & Elf, J. L. (n.d.).

Publication year

2023

Journal title

International journal of environmental research and public health

Volume

20

Issue

6

10.3390/ijerph20065090

Abstract

Abstract

The nicotine metabolite ratio (NMR) is associated with race/ethnicity but has not been evaluated among smokers in the African region. We conducted a cross-sectional analysis of baseline data from a large randomized, controlled trial for smoking cessation among people with HIV (PWH) in South Africa. Urine samples were analyzed for the NMR and evaluated as a binary variable using a cutoff value of the fourth quartile to determine the fastest metabolizers. The median NMR was 0.31 (IQR: 0.31, 0.32; range: 0.29, 0.57); the cut-point for fast metabolizers was ≥0.3174 ng/mL. A high NMR was not associated with the number of cigarettes per day (OR = 1.10, 95% CI: 0.71, 1.70, p = 0.66) but was associated with 40% lower odds of a quit attempt in the past year (OR = 0.69; 95% CI: 0.44, 1.07, p = 0.09) and alcohol use (OR = 0.59, 95% CI: 0.32, 1.06, p = 0.07). No association was seen with marijuana or HIV clinical characteristics. As we found only minimal variability in the NMR and minimal associations with intensity of smoking, NMR may be of limited clinical value in this population, although it may inform which individuals are less likely to make a quit attempt.

Changes in Tobacco Dependence and Association with Onset and Progression of Use by Product Type from Wave 1 to Wave 3 of the Population Assessment of Tobacco and Health (PATH) Study

Strong, D. R., Pierce, J. P., White, M., Stone, M. D., Abrams, D. B., Glasser, A. M., Wackowski, O. A., Cummings, K. M., Hyland, A., Taylor, K., Edwards, K. C., Silveira, M. L., Kimmel, H. L., Lambert, E. Y., Compton, W. M., Hull, L. C., & Niaura, R. (n.d.).

Publication year

2023

Journal title

Nicotine and Tobacco Research

Volume

25

Issue

3

Page(s)

571-579

10.1093/ntr/ntac167

Abstract

Abstract

Introduction: This study examined trajectories of tobacco dependence (TD) in relation to changes in tobacco product use and explored the effects of product-specific adding, switching, or discontinued use on dependence over time. Aims and Methods: Data were analyzed from the first three waves of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States. Data included 9556 Wave 1 (2013/2014) adult current established tobacco users who completed all three interviews and had established use at ≥2 assessments. Groups included cigarettes-only users, e-cigarettes-only users, cigars-only users, hookah-only users, any smokeless-only users, cigarette + e-cigarette dual users, and multiple product users. A validated 16-item scale assessed TD across product users. Results: Wave 1 e-cigarette-only users' who maintained exclusive e-cigarette use increased levels of TD through Wave 3 as did those who added or switched to another product. Wave 1 multiple product users' TD decreased across waves. TD for all other Wave 1 user groups remained about the same. For Wave 1 cigarette-only smokers, switching to another product or moving to a pattern of no established use was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all other product users. Conclusions: Except for Wave 1 e-cigarette-only users, TD among US tobacco product users was stable over time, with daily users less likely to vary from baseline. Implications: The level of TD among most US tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users, including those maintaining exclusive e-cigarette use, experienced increasing levels of TD over time, perhaps because of increases in quantity or frequency of their e-cigarette product use or increasing efficiency of nicotine delivery over time.

Changes in Tobacco Dependence and Association With Onset and Progression of Use by Product Type From Waves 1 to 3 of the Population Assessment of Tobacco and Health (PATH) Study

Strong, D. R., Pierce, J. P., White, M., Stone, M. D., Abrams, D. B., Glasser, A. M., Wackowski, O. A., Cummings, K. M., Hyland, A., Taylor, K., Edwards, K. C., Silveira, M. L., Kimmel, H. L., Compton, W. M., Hull, L. C., & Niaura, R. (n.d.).

Publication year

2023

Journal title

Nicotine and Tobacco Research

Volume

25

Issue

11

Page(s)

1781-1790

10.1093/ntr/ntad107

Abstract

Abstract

Introduction: This study examined trajectories of tobacco dependence (TD) in relationship to changes in tobacco product use, and explored the effects of product-specific adding, switching, or discontinued use on dependence over time. Aims and Methods: Data were analyzed from the first three waves from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States. Data included 9556 wave 1 (2013–2014) adult current established tobacco users aged 18 or older who completed all three interviews and had established use at ≥2 assessments. Mutually exclusive groups included: users of cigarettes only, e-cigarettes only, cigars only, hookah only, any smokeless only, cigarette + e-cigarette dual users, and other multiple product users. A validated 16-item scale assessed TD across product users. Results: People who used e-cigarettes exclusively at wave 1 had small increases in TD through wave 3. Wave 1 multiple product users’ TD decreased across waves. TD for all other wave 1 user groups remained about the same. For wave 1 cigarette only smokers, switching to another product was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all product users. Conclusions: Except for wave 1 e-cigarette only users (who experienced small increases in TD), TD among U.S. tobacco product users was stable over time, with daily users less likely to vary from baseline. Implications: The level of TD among most U.S. tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users experienced small increases in levels of TD over time, perhaps due to increases in quantity or frequency of their e-cigarette use or increasing efficiency of nicotine delivery over time.

Indicators of Tobacco Dependence Among Youth: Findings From Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study

Strong, D. R., Glasser, A. M., Leas, E. C., Pierce, J. P., Abrams, D. B., Hrywna, M., Hyland, A., Cummings, K. M., Hatsukami, D. K., Fong, G. T., Elton-Marshall, T., Sharma, E., Edwards, K. C., Stanton, C. A., Sawdey, M. D., Ramôa, C. P., Silveira, M. L., Kimmel, H. L., & Niaura, R. S. (n.d.).

Publication year

2023

Journal title

Nicotine and Tobacco Research

Volume

25

Issue

9

Page(s)

1565-1574

10.1093/ntr/ntad072

Abstract

Abstract

Background: Prior work established a measure of tobacco dependence (TD) among adults that can be used to compare TD across different tobacco products. We extend this approach to develop a common, cross-product metric for TD among youth. Methods: One thousand one hundred and forty-eight youth aged 12-17 who used a tobacco product in the past 30 days were identified from 13 651 youth respondents in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Findings: Analyses confirmed a single primary latent construct underlying responses to TD indicators for all mutually exclusive tobacco product user groups. Differential Item Functioning analyses supported the use of 8 of 10 TD indicators for comparisons across groups. With TD levels anchored at 0.0 (standard deviation [SD] = 1.0) among cigarette only (n = 265) use group, mean TD scores were more than a full SD lower for e-cigarette only (n = 150) use group (mean = -1.09; SD = 0.64). Other single product use group (cigar, hookah, pipe, or smokeless; n = 262) on average had lower TD (mean = -0.60; SD = 0.84), and the group with the use of multiple tobacco products (n = 471) experienced similar levels of TD (mean = 0.14; SD = 0.78) as the cigarette only use group. Concurrent validity was established with product use frequency among all user groups. A subset of five TD items comprised a common metric permitting comparisons between youth and adults. Conclusion: The PATH Study Youth Wave 1 Interview provided psychometrically valid measures of TD that enable future regulatory investigations of TD across tobacco products and comparisons between youth and adult tobacco product use group. Implications: A measure of tobacco dependence (TD) has been established previously among adults to compare TD across tobacco products. This study established the validity of a similar, cross-product measure of TD among youth. Findings suggest a single latent TD construct underlying this measure, concurrent validity of the scale with product use frequency across different types of tobacco users, and a subset of common items that can be used to compare TD between youth and adults who use tobacco.

A Randomized Trial of Telephone-Based Smoking Cessation Treatment in the Lung Cancer Screening Setting

Taylor, K. L., Williams, R. M., Li, T., Luta, G., Smith, L., Davis, K. M., Stanton, C. A., Niaura, R., Abrams, D., Lobo, T., Mandelblatt, J., Jayasekera, J., Meza, R., Jeon, J., Cao, P., & Anderson, E. D. (n.d.).

Publication year

2022

Journal title

Journal of the National Cancer Institute

Volume

114

Issue

10

Page(s)

1410-1419

10.1093/jnci/djac127

Abstract

Abstract

Background: Lung cancer mortality is reduced via low-dose computed tomography screening and treatment of early-stage disease. Evidence-based smoking cessation treatment in the lung screening setting can further reduce mortality. We report the results of a cessation trial from the National Cancer Institute's Smoking Cessation at Lung Examination collaboration. Methods: Eligible patients (n = 818) aged 50-80 years were randomly assigned (May 2017-January 2021) to the intensive vs minimal arms (8 vs 3 phone sessions plus 8 vs 2 weeks of nicotine patches, respectively). Bio-verified (primary) and self-reported 7-day abstinence rates were assessed at 3, 6, and 12 months post random assignment. Logistic regression analyses evaluated the effects of study arm. All statistical tests were 2-sided. Results: Participants reported 48.0 (SD = 17.2) pack-years, and 51.6% were not ready to quit in less than 30 days. Self-reported 3-month quit rates were statistically significantly higher in the intensive vs minimal arm (14.3% vs 7.9%; odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.26 to 3.18). Bio-verified abstinence was lower but with similar relative differences between arms (9.1% vs 3.9%; OR = 2.70, 95% CI = 1.44 to 5.08). Compared with the minimal arm, the intensive arm was more effective among those with greater nicotine dependence (OR = 3.47, 95% CI = 1.55 to 7.76), normal screening results (OR = 2.58, 95% CI = 1.32 to 5.03), high engagement in counseling (OR = 3.03, 95% CI = 1.50 to 6.14), and patch use (OR = 2.81, 95% CI = 1.39 to 5.68). Abstinence rates did not differ statistically significantly between arms at 6 months (OR = 1.2, 95% CI = 0.68 to 2.11) or 12 months (OR = 1.4, 95% CI = 0.82 to 2.42). Conclusions: Delivering intensive telephone counseling and nicotine replacement with lung screening is an effective strategy to increase short-term smoking cessation. Methods to maintain short-term effects are needed. Even with modest quit rates, integrating cessation treatment into lung screening programs may have a large impact on tobacco-related mortality.

Factors associated with changes in flavored tobacco products used: Findings from wave 2 and wave 3 (2014–2016) of the population assessment of tobacco and health (PATH) study

Bansal-Travers, M., Rivard, C., Silveira, M. L., Kimmel, H., Poonai, K., Bernat, J. K., Jackson, K., Rudy, S., Johnson, A., Cullen, K. A., Goniewicz, M., Travers, M., Hyland, A., Villanti, A., Hrywna, M., Abrams, D., Fong, G., Elton-Marshall, T., Stanton, C., & Sharma, E. (n.d.).

Publication year

2022

Journal title

Addictive Behaviors

Volume

130

10.1016/j.addbeh.2022.107290

Abstract

Abstract

Introduction: Flavored non-cigarette tobacco product use is widespread in the U.S. The availability of flavor options could be playing a role in recent increases in use, especially for non-cigarette tobacco products, among youth and young adults. Little is known about specific flavor preferences of youth and adult flavored tobacco product users, as well as how preferences may change over time. Methods: This study analyzes PATH Study data from completed Wave 2 (2014–2015) and Wave 3 (2015–2016) youth (12–17 years), and adult (18 + years) interviews to estimate the prevalence of flavored non-cigarette tobacco product use. We assess flavor switching by examining changes between flavors and characteristics of those who changed flavors between waves. Results: Across age groups, and at both waves, fruit-flavored products were the most frequently used flavor by past 30-day electronic nicotine delivery systems (ENDS), cigar, cigarillo, and hookah users. In the past 30 days, a higher proportion of youth and young adults used candy/sweets-flavored ENDS than adults. Among adult ENDS users, the odds of changing flavors were highest among younger users and decreased with increasing age. Conclusions: Flavored tobacco product use is prevalent across non-cigarette tobacco products. Stability in the number of flavors used, as well as specific flavors, is higher among adult tobacco users, while the use of multiple flavors, and change in specific flavor, is more prevalent among youth tobacco users. Additional longitudinal research can further examine the role flavors play in appeal, product trial, and switching.

Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment

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Publication year

2022

Journal title

Cancer

Volume

128

Issue

10

Page(s)

1976-1986

10.1002/cncr.34133

Abstract

Abstract

Background: For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smoking-related outcomes. Methods: In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]). Results: Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P <.001). Motivation to quit increased (P <.05) and CPD decreased between assessments (P <.001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P <.001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5). Conclusions: During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.

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

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

Publication year

2021

Journal title

Journal of Thoracic Disease

Volume

13

Issue

8

Page(s)

4947-4955

10.21037/jtd-20-3267

Abstract

Abstract

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

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. (n.d.). In Nicotine and Tobacco Research (1–).

Publication year

2021

Volume

23

Issue

5

Page(s)

878-879

10.1093/ntr/ntaa249

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. (n.d.).

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

426-437

10.1093/ntr/ntaa102

Abstract

Abstract

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

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

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

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

527-534

10.1093/ntr/ntaa086

Abstract

Abstract

Introduction: This study examined the association between the introduction of an e-cigarette and subsequent change in cigarette smoking among smokers who were not immediately interested in quitting. Aims and Methods: The Moment Study was a 21-day intensive longitudinal study with an online follow-up survey at 30 days. After observing baseline cigarette smoking for 1 week, participants received 10 cigalike e-cigarettes on study days 6 and 13. Participants reported cigarettes per day, e-cigarette puffs per day, and e-cigarette satisfaction using text-message-based surveys. Results: The sample of 96 daily smokers was majority female (53.1%), African American (67.7%), and non-Hispanic (95.8%). When e-cigarettes were provided (day 6), average cigarettes per day dropped by 1.82 cigarettes (p <. 0001). The within-person e-cigarette puff effect on daily cigarette smoking was significantly negative (β =-0.023; p =. 005); a participant who consumed 100 more e-cigarette puffs in a day than usual for that person was expected to smoke 2.3 fewer cigarettes that day, but this was only true for non-menthol smokers (p =. 006). Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps <. 05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up. Conclusions: Giving e-cigarettes to smokers who did not intend to quit reduced their cigarette smoking on days when they used e-cigarette more frequently, but this relationship did not hold for menthol smokers. Satisfaction with e-cigarette use was predictive of continued use 30 days later. Implications: A greater amount of cigalike e-cigarette use resulted in less smoking among adult daily smokers without immediate plans to quit, but a lack of nicotine delivery and satisfaction for these devices may have limited their utility as a replacement for cigarette smoking, especially among menthol smokers. The global concept of "satisfaction"may be an important driver of e-cigarette use among adult smokers.

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

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

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

8

Page(s)

1318-1326

10.1093/ntr/ntaa224

Abstract

Abstract

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

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

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

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

4

Page(s)

669-677

10.1093/ntr/ntaa182

Abstract

Abstract

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

Failed generating bibliography.

Publication year

2021

Journal title

Contemporary Clinical Trials

Volume

106

10.1016/j.cct.2021.106429

Abstract

Abstract

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

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

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

Publication year

2021

Journal title

Nicotine and Tobacco Research

Volume

23

Issue

3

Page(s)

447-453

10.1093/ntr/ntaa010

Abstract

Abstract

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

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

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

Publication year

2020

Journal title

JAMA network open

Volume

3

Issue

11

Page(s)

E2015893

10.1001/jamanetworkopen.2020.15893

Abstract

Abstract

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

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

Farsalinos, K., Abrams, D., & Niaura, R. (n.d.). In American journal of preventive medicine (1–).

Publication year

2020

Volume

58

Issue

6

Page(s)

895-896

10.1016/j.amepre.2020.01.020

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

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

Publication year

2020

Journal title

Substance Abuse: Treatment, Prevention, and Policy

Volume

15

Issue

1

10.1186/s13011-020-00283-5

Abstract

Abstract

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

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

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

Publication year

2020

Journal title

PloS one

Volume

15

Issue

9

10.1371/journal.pone.0237938

Abstract

Abstract

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

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

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

Publication year

2020

Journal title

Nicotine and Tobacco Research

Volume

22

Issue

5

Page(s)

647-654

10.1093/ntr/ntz030

Abstract

Abstract

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

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

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

Publication year

2019

Journal title

Addictive Behaviors

Volume

91

Page(s)

51-60

10.1016/j.addbeh.2018.11.027

Abstract

Abstract

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

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

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

Publication year

2019

Journal title

Health Communication

Volume

34

Issue

3

Page(s)

280-289

10.1080/10410236.2017.1407227

Abstract

Abstract

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

Evidence, alarm, and the debate over e-cigarettes

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

Publication year

2019

Journal title

Science

Volume

366

Issue

6471

Page(s)

1318-1320

10.1126/science.aba0032

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

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

Publication year

2019

Journal title

Journal of the National Cancer Institute

Volume

111

Issue

10

Page(s)

1088-1096

10.1093/jnci/djz006

Abstract

Abstract

Background: Evidence is accumulating that youth who try Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) may go on to try cigarettes. This analysis examines the bidirectional patterns of ENDS and cigarette use among US youth over one year and uses propensity score matching (PSM) to examine frequency of ENDS use on changes in cigarette smoking. Methods: Our analysis included 11 996 participants who had two waves of available data (Wave 1 [W1] 2013-2014; Wave 2 [W2] 2014-2015) drawn from the longitudinal Population Assessment of Tobacco and Health Study. Cross-sectional weighted prevalence estimates are reported for cigarettes and ENDS. We used PSM to estimate the likelihood of ENDS use at W1 and to draw matched analytic samples, then used regression (logistic or linear) models to examine the effect of W1 ENDS use on W2 cigarette smoking. All statistical tests were two-sided. Results: In weighted analyses, 69.3% of W1 past-30-day cigarette smokers exhibited past-30-day smoking at W2; 42.2% of W1 past-30-day ENDS users were using ENDS at W2. W1 ever use of either product was similarly associated with W2 new use of the other product. Unweighted PSM models indicated W1 cigarette-naïve ENDS use was associated with W2 ever-cigarette smoking (n = 676; adjusted odds ratio = 3.21, 95% confidence interval [CI] = 1.95 to 5.45, P <. 001); W1 ever-ENDS use did not affect change in cigarette frequency at W2 (n = 1020, beta = 0.31, 95% CI = -0.76 to 1.39, P =. 57); 1-5 days ENDS use compared with ever, no past-30-day ENDS use was associated with a statistically significant decrease of W2 smoking days (n = 256, beta = -2.64, 95% CI = -4.96 to -0.32; P =. 03); and W1 6+ day ENDS users did not show a decrease in frequency of cigarette smoking. Conclusions: Ever-ENDS use predicts future cigarette smoking, and frequency of ENDS use has a differential impact on subsequent cigarette smoking uptake or reduction. These results suggest that both cigarettes and ENDS should be targeted in early tobacco prevention efforts with youth.

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

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

Publication year

2019

Journal title

Nicotine and Tobacco Research

Volume

21

Issue

4

Page(s)

458-468

10.1093/ntr/ntx285

Abstract

Abstract

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