TCORS: Center for the Assessment of Tobacco Regulations (CAsToR)

Pilot + Feasibility

2021 Funding Cycle Awardees

View other award years: 2022202120202019

Please note: Listing describes appointments and affiliations at the time of award. Please check our Trainees page for current appointments and affiliations.

Title: “A Longitudinal Investigation of the Contribution of Menthol Cigarettes to Disparities in Smoking Cessation and Transitions to Nicotine Vaping Products by Race, Sex, and Socioeconomic Status Using the ITC US Surveys, 2002-2020”
PI: Dr. Pete Driezen, Research Assistant Professor at University of Waterloo
Abstract and accomplishments +
Dr. Pete Driezen
Dr. Pete DriezenUniversity of Waterloo
Abstract
Introduction: The targeted marketing of menthol cigarettes in the United States (US) influences disparities in the prevalence of menthol smoking across demographic groups. Using nationally representative survey data from 12 waves of the US arm of the International Tobacco Control (ITC) Survey, this research examined disparities in the use of menthol cigarettes among adults who smoke by geographic region and demographic subgroup. It also examined how disparities might influence transitions to non-menthol cigarettes and smoking cessation. Aims: Aim 1: Estimate longitudinal trends in the use of menthol cigarettes among adults who smoke from 2002 to 2020 in each of the nine US census divisions by sex, age group, and race/ethnicity using statistical small area estimation methods. Aim 2: Model transitions in menthol use from 2002 to 2020 and whether smoking cessation rates changed over time by use of menthol cigarettes Key Findings: Key Findings Aim 1: Among adults who smoke, the prevalence of menthol use increased in each census division from 2002 to 2020. In 2020, prevalence was highest in the Middle Atlantic (46.3%) and lowest in the Pacific (25.9%) and Mountain (24.2%) divisions. Prevalence exceeded 80% among non-Hispanic Black adults who smoke from the Middle Atlantic, East North Central, West North Central, and South Atlantic divisions in all years but was only 59.0% in the Mountain division in 2020. Prevalence varied most among Hispanic adults who smoke, ranging from 26.5% in the Pacific to 55.3% in New England in 2020. Key Findings Aim 2: From 2002 to 2020, 7.4% of adults smoking menthol cigarettes had switched by the subsequent wave compared to 3.8% of adults smoking non-menthol brands (p<0.01). Cessation rates did not differ by whether people initially smoked menthol (9.7%) or non-menthol (9.3%) brands (p=0.65). Switching and cessation were not modified by sex (p=0.32) or age (p=0.78) but differed significantly by race/ethnicity (p<0.01). Non-Hispanic Black adults who smoked non-menthol brands had 13.7 times the odds of switching to menthol across all waves compared to non-Hispanic White adults who smoked non-menthol brands (95% CI:8.5-22.0). Non-Hispanic Black adults who smoked menthol were also less likely to quit smoking compared to non-Hispanic White adults who smoked menthol.
Accomplishments
March 2023: Findings from this pilot project have been presented as part of the CAsToR Lightning Talk Sessions, to the broader group of global ITC researchers, and at the Society for Research on Nicotine and Tobacco (SRNT) Annual Meeting in San Antonio, Texas (March 2023). Click here for Dr. Driezen’s SRNT podium presentation and click here for Dr. Driezen’s SRNT poster presentation.
April 2024: Dr. Driezen was lead author of an article resulting from his pilot project work. The article, published in Population Health Metrics, is entitled “Prevalence of menthol cigarette use among adults who smoke from the United States by census division and demographic subgroup, 2002-2020: findings from the International Tobacco Control (ITC) project.” The SAS and R syntax files are publicly available here.
 
Title: “Automating the detection of American adolescents at risk of e-cigarette dependence using machine learning”
PI: Dr. Rui Fu (Ray), Postdoctoral Fellow at University of Toronto
Abstract and accomplishments +
Dr. Rui Fu (Ray)
Dr. Rui Fu (Ray)University of Toronto
Abstract
Introduction: American adolescents are showing a concerning trend in frequent e-cigarette use (vaping) that might indicate signs of dependence. Although risk factors for vaping dependence have been assessed using conventional regression, these approaches have limitations when dealing with a large number of potential predictors and complex non-linear interactions. Furthermore, a practical model capable of accurately identifying adolescents at risk of vaping dependence has yet to be developed to allow for a timely intervention. As such, the overarching aim of this project is to develop and validate a random forest-based machine learning model to predict the status of frequent vaping—defined as nicotine-containing vaping in 20 or more days in the past 30 days—in 6 months after baseline. Using this model, we further identify the top predictors of frequent vaping and important interactions formed by sociodemographic variables to characterize vulnerable subgroups. Methods: We partnered with the Happiness and Health Study team at the University of Southern California to conduct machine learning analysis on youth use of electronic cigarettes (e-cigarettes or vaping). Using random forests, we studied the risk of being a frequent vaper over a course of 6 months (use of nicotine-containing vaping on 20 or more days in past 30 days) among Californian high school students who had ever tried vaping prior to the beginning of 12th grade. KEY FINDINGS: According to our analysis, higher past-month nicotine concentration in vape, more daily vaping sessions, and greater nicotine dependence were the top three of the ten most important predictors of becoming a frequent vaper over a course of 6 months. Interactions were found between age and perceived discrimination, and between age and race/ethnicity, as those who were younger than their classmates and either reported experiencing discrimination frequently or identified as Asian, Native American, or Pacific Islander were at an increased risk of reporting to be frequent vapers. Implications: These findings suggest that vaping prevention efforts should be developed in concert with anti-discrimination and anti-bully initiatives, with a focus on younger students.
Accomplishments
June 2022: Dr. Fu was the lead author of an article resulting from her pilot project work. The article, published in Nicotine & Tobacco Research, is entitled “A Machine Learning Approach to Identify Predictors of Frequent Vaping and Vulnerable Californian Youth Subgroups.”
April 2023: These results were disseminated with various knowledge users at the TRS 2022 Fall Meeting and at the CAsToR Pilot Project Lightning Talk (January 2023). We have applied similar methodology to study vaping initiation in high school students, vaping dependence among daily vs. non-daily vaping youth in the COVID-19 era, and the experimentation of cigarettes following vaping in young adults.
May 2023: Dr. Fu was co-author of an article resulting from her pilot project work. The article, published in Healthcare, is entitled “A machine learning approach reveals distinct predictors of vaping dependence for adolescent daily and non-daily vapers in the COVID-19 era.”
 
Title: “Trajectories of Tobacco Use, Stress, and Health among U.S. Transgender Youth and Adults”
PI: Dr. Luisa Kcomt, Assistant Professor at Wayne State University
Abstract and accomplishments +
Dr. Luisa Kcomt
Dr. Luisa KcomtWayne State University
Abstract
Introduction: Despite the growing body of research on transgender health in recent years, there remains limited understanding about gender-fluid individuals (i.e., people who experience changes in gender identity over time) because of conventional conceptualizations of gender and the inability of cross-sectional studies to assess gender fluidity. No studies to date have examined how multi-level factors may influence nicotine/tobacco use among gender-fluid individuals. Aims: Aim 1: Explore potential differences between gender-fluid vs. gender-stable individuals in their nicotine/tobacco use (any tobacco, combustible cigarettes, e-cigarettes, other tobacco use, and poly-tobacco use) and examine trajectories of nicotine/tobacco product use as a function of gender stability/fluidity over time. Aim 2: Guided by the Social Ecological Model, assess individual-, interpersonal-, community-, and policy-level factors hypothesized to influence trajectories of nicotine/tobacco product use among gender-fluid and gender-stable participants over time. Methods: Data were from Waves 2-4 (2014/15—2016/18) of the Population Assessment of Tobacco and Health study (PATH, n=33,197 U.S. adolescents and adults aged ≥14 years). We used multivariable logistic regression to examine associations of gender stability/fluidity over three waves with tobacco use at wave 4. We integrated state-level policy data related to gender minorities from the Movement Advancement Project into our analyses. Results: An estimated 1.0% of adolescents and adults were classified as gender-fluid. Gender-fluid participants had significant increased odds of past 30-day nicotine/tobacco use compared to gender-stable individuals. Multilevel factors influenced nicotine/tobacco use among gender-fluid and gender-stable participants. Implications: Gender-fluid individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for smoking-related health consequences. Multi-level prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-fluid and gender-stable individuals.
Accomplishments
August 2022: Dr. Kcomt was the lead author of an article resulting from her pilot project work. The article, published in Nicotine & Tobacco Research, is entitled “Tobacco Use among Gender-Varying and Gender-Stable Adolescents and Adults Living in the U.S.
February 2023: Dr. Kcomt was co-author of an article resulting from her pilot project work. The article, published in the American Journal of Preventive Medicine, is entitled “Sexual identity differences in tobacco (re)uptake: Testing mediation by internalizing and externalizing symptoms.”
March 2023: Dr. Kcomt was co-author of an article resulting from her pilot project work. The article, published in Addictive Behaviors, is entitled “Examining sexual identity stability and change over time and association with tobacco use in a nationally representative US sample.
November 2023: Dr. Kcomt was the lead author of an article resulting from her pilot project work. The article, published in the Annals of Behavioral Medicine, is entitled “Social Ecological Influences on Nicotine/Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults in the USA.
 

Selected pilot project

Title: “A Content Analysis of Electronic Cigarette Advertisements on Twitter: Topics and Flavors”
PI: Dr. Ruoyan Sun, Assistant Professor at University of Alabama at Birmingham
Abstract and accomplishments +
Dr. Ruoyan Sun
Dr. Ruoyan SunUniversity of Alabama at Birmingham
Abstract
Introduction: Due to the rapid increase of e-cigarette use, the Food and Drug Administration (FDA) announced an e-cigarette flavor enforcement policy on January 2, 2020, to prohibit the sale and distribution of cartridge-based flavored e-cigarette products (except for tobacco and menthol flavors) in the US. Online conversation from social media offers a unique opportunity to understand how e-cigarette companies are responding to the FDA flavor enforcement policy. Methods: By analyzing e-cigarette advertisements on Twitter, we evaluated the impact of the FDA flavor enforcement policy and identified potential emerging products. We downloaded tweets before the enforcement policy from 1/1/2019 to 12/31/2019 (pre-period) and after the enforcement policy from 1/1/2021-12/31/2021 (post-period). Five main themes were identified: advertisement, URL link, flavor, sale, and cannabis. We also categorized tweets by geolocation information found in the user profile. Results: Comparing tweets between the pre- and post-periods, we saw a substantial decrease in the number of e-cigarette advertisements and the proportion of advertisements posted by US accounts. Among the e-cigarette advertisements, however, there was a slight increase in the proportion that mentioned flavor and sale information. Compared with other countries, tweets posted in the US experienced substantial decreases both in the absolute number and proportion of advertisements. There were also larger increases in the proportion of advertisement tweets mentioning flavor and sale information in other countries. An emerging product we observed from US advertisement tweets is cannabis. Around one-third of all US advertisements in the post-period mentioned cannabis or related products, almost a ten-fold increase. This is rather unique since other countries saw only marginal increases in the proportion of advertisements mentioning cannabis.
Accomplishments
Coming Soon!
 
Title: “Disparities in flavoring patterns of exclusive, dual, and polytobacco use among youth and adults in the U.S.”
PI: Luis Zavala, Doctoral Student at University of Michigan
Abstract and accomplishments +
Luis Zavala
Luis ZavalaUniversity of Michigan
Abstract
Introduction: The U.S. has made progress in tobacco control, the prevalence of smoking and tobacco use continues decreasing, but many challenges remain. Tobacco use continues to be a leading cause of premature death in the U.S. population. Moreover, the tobacco industry has continued evolving and currently offers a wide variety of options for tobacco products. Previous studies have identified disparities in tobacco use by different sociodemographic variables. However, most of the research on tobacco use disparities has focused on one or two social constructs at a time, with limited knowledge about tobacco use disparities at the intersection of multiple sociodemographic variables or across product types. Therefore, the current study estimated patterns of tobacco use, including the use of flavors in the context of multiple products (single, dual, and poly tobacco use) at the intersection of multiple identities (age, sex, income, and race and ethnicity). In addition, we created an interactive visualization tool that allows displaying these results. Aims: Aim 1: We estimated the prevalence of cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of age, sex, race/ethnicity, and income. Aim 2: We estimated the prevalence of dual and polytobacco use at the intersection of age, sex, race/ethnicity, and income and presented these results using an intersectionality visualization tool. Aim 3: We estimated patterns of menthol and menthol cigarette use and flavor and unflavored cigar use at the intersection of these four sociodemographic variables. Key Findings: Our visualization tool helps uncover complex patterns of menthol and non-menthol cigarette use and flavor and unflavored cigar use, as well patterns of exclusive, dual and polytobacco use, which was helpful to identify high-risk population groups that would otherwise be masked. These results could be used to implement tobacco control policies targeted at factors that promote or sustain tobacco use disparities.
Accomplishments
March 2023: Findings from this project were presented at the 2022 and 2023 Society for Research on Nicotine and Tobacco Annual Meetings.
 

View other award years: 2022202120202019