2026 Funding Cycle Awardees

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

“Drivers of exclusive and dual cigarette and cigar use trajectories among U.S. adults at elevated risk of tobacco-related disease”

PI: Dr. James H. Buszkiewicz, Research Assistant Professor at University of Michigan School of Public Health

Abstract and accomplishments +

Dr. James H. BuszkiewiczUniversity of Michigan School of Public Health

Abstract

Although cigarette smoking prevalence among United States (U.S.) adults has been steadily declining, cigar use has remained stable, and differences persist among adults at elevated risk of tobacco-related disease. Cigars, a heterogeneous group of tobacco products, including traditional cigars, cigarillos, and filtered cigars, are available in a variety of flavors and sold in small packs or individually. These features, combined with the physical similarities of some cigars to cigarettes, broaden their appeal and may make them affordable alternatives when cigarettes are cost prohibitive. Understanding how policy-relevant drivers, like economic factors, flavor use, and purchasing behaviors, impact patterns of differences in exclusive and dual cigarette and cigar use can help inform data-driven policy to improve tobacco-related population health. The goal of this project is to examine the drivers of exclusive and dual cigarette and cigar use patterns among adults (18+) overall and by salient social identities to uncover actionable policy levers to curb differences in cigarette and cigar use. Using the rich data from the national longitudinal Population Assessment of Tobacco and Health, Waves 1-7 (2013–2023), I aim to:

Aim 1: Determine whether economic factors, flavor use, and purchasing behaviors drive changes between exclusive and dual cigar use among United States adults. Using Markov multistate models, I will examine whether total household income, financial hardship, affordability, flavor use, quantity purchased and coupon receipt are linked to changes between (1) never cigarette or cigar use, (2) non-current cigarette or cigar use, (3) exclusive cigarette use, (4) exclusive cigar use, and (5) dual cigarette and cigar use. Hypothesis: These factors will drive changes between exclusive cigarette use and dual cigarette and cigar use.

Aim 2: Examine whether economic factors, flavor use, and purchasing behaviors are differentially associated with changes between exclusive and dual cigar use among adults at elevated risk of tobacco-related disease. Using Markov multistate models, I will examine whether these factors vary among groups at elevated risk of tobacco-related disease through two-way interactions and stratified models. I will further model whether cigarette and cigar use differences are reduced when these are held at the same value among groups with the highest and lowest risk of tobacco-related disease. Hypothesis: The impact of these factors will be most pronounced among groups with the highest risk of tobacco-related disease.

This project will complement the existing Center for the Assessment of Tobacco Regulations (CAsToR) work aimed at understanding longitudinal differences in cigarette and cigar use. This work will enhance CAsToR simulation models by providing greater insight into how economic factors impact switching between cigarette and cigar use states among groups with the highest risk of tobacco-related disease. In addition, understanding how flavor use and purchasing behaviors influence these patterns will aid modelers in understanding how policies, such as flavor bans and minimum cigar pack size standards, might influence cigarette and cigar changes and in parameterizing these policy effects in their models. Findings from this project will also directly inform the United States Food and Drug Administration’s regulatory decision-making on cigarettes and cigars regarding flavor restrictions, minimum pack sizes, and couponing, which may lessen the appeal of these products and improve tobacco-related population health.

 

“A scoping review to investigate drivers of risk perceptions about tobacco/nicotine products among older U.S. adults”

PI: Dr. Claire L. Ma, Postdoctoral Fellow at University of Michigan

Abstract and accomplishments +

Dr. Claire L. MaUniversity of Michigan

Abstract

Risk perceptions about tobacco products may contribute to discrepancies between youth and older adults in smoking and vaping prevalence. Tobacco control is a complex policy area with strong interest group stakes, new product innovations, and continuously evolving evidence. This has contributed to an information environment that is marked by public confusion about emerging products and interventions, specifically in the case of health risks. Recent research on youth use of novel tobacco products suggests that social media sources play a major role in shaping risk perceptions among young people. Older people, however, may be engaged in a different information ecosystem. Studies on digital health literacy suggest that older adults are particularly vulnerable to misinformation. While individual studies have examined the potential for tobacco risk misperceptions among older adults, this is often not the main focus of these studies. There is no single empirical source that brings together evidence on older adults’ tobacco/nicotine product risk perceptions to inform research, policy, and clinical practice. We propose to address this issue by conducting a scoping review to identify the current evidence since 2010 on 1) sources of risk information about tobacco and nicotine products for older adults (aged 55+), 2) sources of risk perceptions among older adults, and 3) whether risk perceptions differ based on individual characteristics.

Our aims in designing, conducting, and disseminating the proposed scoping review are:
● Aim 1: We will identify and summarize the existing evidence on the range of information sources that older adults use to learn about the risks of tobacco and nicotine product use.
● Aim 2: We will identify and summarize the existing evidence that identifies causal drivers of risk perceptions among older adults.
● Aim 3: We will identify and summarize the existing evidence on how risk perceptions among older adults differ based on individual characteristics to examine potential reasons for variation in older population groups.
●Aim 4: We will identify research gaps, suggest areas for further research, and disseminate research findings through various channels including public-facing materials.

 

“Modeling switching and interrelationships among oral nicotine pouch, electronic nicotine delivery systems, and cigarette use in the United States: Evidence from the PATH study”

PI: Zhe Yuan, Biostatistician at Georgetown University and Nargiz Travis, Project Director at Georgetown University

Abstract and accomplishments +

Nargiz TravisGeorgetown University

Zhe YuanGeorgetown University

Abstract

Background: Oral nicotine pouches (ONPs) are among the fastest-growing nicotine products in the United States, with increasing use among both youth and adults. Although ONPs are often marketed as a lower-risk alternative to cigarettes and are available in a wide range of flavors and nicotine strengths, little is known about how they influence cigarette smoking and e-cigarette (ENDS) use. Existing studies are largely cross-sectional, rely on broad measures such as past 30-day use, and provide limited information about switching between products over time.

This project will use nationally representative longitudinal data from the Population Assessment of Tobacco and Health (PATH) Study to characterize ONP use patterns and examine how ONPs relate to cigarette and ENDS use among U.S. adults. By developing harmonized measures of product use and following individuals across survey waves, the study will provide new evidence on whether ONPs are associated with product switching, initiation, cessation, or continued dual use.

Specific Aims:

Aim 1: Develop harmonized measures of ONP, ENDS, and cigarette use. We will create consistent, policy-relevant measures of product use across PATH Study Waves 7 (2022–2023) and 8 (2024), capturing both prevalence and intensity of use. Measures will include multiple definitions of current use, frequency of use, and past use to facilitate comparisons across nicotine products.
Aim 2: Estimate cross-sectional relationships among ONPs, ENDS, and cigarettes. Using nationally representative Wave 7 data, we will examine how use of one product is associated with use of the others at both the individual and state levels. Analyses will account for demographic characteristics, tobacco control policies, and prior tobacco use to better characterize patterns of co-use and potential interactions among nicotine products.
Aim 3: Model longitudinal transitions in tobacco product use. Using PATH Waves 7 and 8, we will evaluate switching into and out of ONP use, including initiation, cessation, relapse, and persistent use. We will examine how changes in cigarette smoking and ENDS use are associated with ONP adoption and cessation over time, providing insight into the dynamic evolution of multiple-product use.
Aim 4: Determine whether ONPs substitute for or complement cigarette smoking and ENDS use. By integrating findings from the longitudinal analyses, we will quantify whether ONP use is associated with reductions in cigarette smoking and ENDS use (substitution) or with increased use of these products (complementarity). These findings will provide evidence to inform tobacco regulatory policy regarding the role of ONPs in the evolving nicotine marketplace.

 

“Predicting long-term health risks of e-cigarette use through biomarker trajectories: A propensity score-matching analysis with cigarette smokers”

PI: Dr. Chenlan Wang, Assistant Professor at University of North Florida

Abstract and accomplishments +

Dr. Chenlan WangUniversity of North Florida

Abstract

Electronic cigarettes present a lower-risk alternative to cigarettes and are potentially beneficial for individuals who cannot quit smoking. E-cigarettes entered the United States market in 2007, promoted both as tools for smoking cessation and as safer alternatives to traditional tobacco products. Their use has escalated rapidly over the past decade, especially among adolescents. The swift uptake of vaping products has sparked a significant public health debate about their safety and role in reducing harm compared to conventional cigarette smoking.

At the crux of the debate lies uncertainty about the long-term risks of vaping products, since there is not yet enough historical data to directly assess their population-level harms. Instead of evaluating direct harm, I plan to use biomarkers to compare the long-term harm of vaping products to that of cigarette smoking. Biomarkers, such as cotinine levels, inflammatory markers, and measures of lung function, can reveal physiological changes caused by both traditional cigarette smoking and e-cigarette use.

My study aims to compare these biomarkers between smokers and e-cigarette users, and then assess similarities and differences in exposure and health effects, thereby shedding light on potential long-term outcomes associated with vaping. To minimize selection bias in observational studies, this study will employ the propensity score method, which provides a robust approach for balancing groups and enhancing the reliability of findings and longitudinal data from the Population Assessment of Tobacco and Health (PATH) Study. PATH offers a nationally representative sample and repeated measures over time, enabling a comprehensive analysis of tobacco use patterns and related health outcomes within the U.S. population.

Aim 1: Compare changes in key health biomarkers over the first seven years of exposure among e-cigarette users and propensity score-matched cigarette smokers within the Population Assessment of Tobacco and Health (PATH) Study.

Aim 2: Project potential long-term health risks for e-cigarette users by associating 7-year biomarker trajectories and established longer-term outcomes in cigarette smokers associated with those trajectories.

 

“Trajectories of oral nicotine pouch use and their associations with changes in cigarette use behaviors”

PI: Dr. Luis Zavala Arciniega, Postdoctoral Associate at Rutgers Health Institute for Nicotine and Tobacco Studies

Abstract and accomplishments +

Dr. Luis Zavala ArciniegaRutgers Health Institute for Nicotine and Tobacco Studies

Abstract

Background: Although current ONP use is still low in the U.S. adult population (0.4% in 2022), it is increasing, particularly among adolescents (1.1% in 2022 to 1.8% in 2024) and adults who currently or formerly smoked cigarettes (4.7% in 2022 to 7.8% in 2024). The FDA has authorized the sale of more than 20 ONP products; however, it is not clear how ONP use at the population level will shape trajectories of cigarette use—the most harmful nicotine product on the market today.

Aims: Estimate transitions in ONP use among adults and assess the association between ONP use and changes in cigarette use behaviors.

Methods: We will analyze data from the Rutgers Omnibus Study, a cross-sectional study that surveys approximately 2,000 adults per wave and includes repeated participants. Recruitment relies on a convenience sampling strategy targeting adults aged 18 to 45 years in New Jersey through Amazon Mechanical Turk. Throughout the study period (2022-2025), both the survey mode and primary questions have remained consistent. The Rutgers Omnibus Study includes a comprehensive set of tobacco use behaviors and detailed sociodemographic variables. We will use multistate models because they offer a robust methodology for describing and predicting complex ONP trajectories and for estimating how ONP use could influence changes in cigarette behaviors.

Expected impact: By analyzing ONP trajectories and their associations with changes in cigarette use behaviors, this project will directly inform the FDA on how ONPs are shaping cigarette use dynamics and, consequently, enable the FDA to implement better tobacco regulatory science.