TCORS 2.0: Publications, Preprints + Posters

Publications, Preprints + Posters

Publications by Scientific Domain

Impact Analysis

Understanding impact of potential FDA regulatory actions

24

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Health Effects

Understanding the short and long term health effects of tobacco products

39

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Behavior

Understanding the knowledge, attitudes and behaviors related to tobacco product use and changes in tobacco product characteristics

55

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Publication: Health Effects

Longitudinal associations between exclusive and dual use of electronic nicotine delivery systems and cigarettes and self-reported incident diagnosed cardiovascular disease among adults AUTHORS: Jana L Hirschtick, PhD, MPH, Steven Cook, PhD, Akash Patel, MPH, Geoffrey D Barnes, MD, MSc, Douglas Arenberg, MD, Irina Bondarenko, MS, David T Levy, PhD, Jihyoun Jeon, PhD, MS, Evelyn Jimenez Mendoza, MS, Rafael Meza, PhD, Nancy L Fleischer, PhD, MPH JOURNAL: Nicotine & Tobacco Research DESCRIPTION: Introduction: The cardiovascular health effects of electronic nicotine delivery systems (ENDS) use are not well characterized, making it difficult to assess ENDS as a potential harm reduction tool for adults who use cigarettes. Methods: Using waves 1-5 of the Population Assessment of Tobacco & Health Study (2013-2019), we analyzed the risk of self-reported incident diagnosed myocardial infarction (MI; 280 incident cases) and stroke (186 incident cases) associated with ENDS and/or cigarette use among adults aged 40+ using discrete time survival models. We employed a time-varying exposure lagged ...

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Publication: Health Effects

Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations AUTHORS: Nargiz Travis, Marie Knoll, Christopher J. Cadham, Steven Cook, Kenneth E. Warner, Nancy L. Fleischer, Clifford E. Douglas, Luz María Sánchez-Romero, Ritesh Mistry, Rafael Meza, Jana L. Hirschtick, David T. Levy JOURNAL: International Journal of Environmental Research and Public Health DESCRIPTION: E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and carcinogenic risks of e-cigarette use, distinguishing between short-term and long-term health effects. The search for systematic reviews was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Seventeen systematic reviews, including five meta-analyses, were included ...

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Publication: Behavior

Perceived racial discrimination and polysubstance use among African American and Afro-Caribbean adults: Results from the National Survey of American Life AUTHORS: Delvon T Mattingly, Nancy L Fleischer, David C Colston, Briana Mezuk JOURNAL: Journal of ethnicity in substance abuse DESCRIPTION: This study examined the relationship between perceived racial discrimination (PRD) and patterns of substance use. Data come from the 2001-2003 National Survey of American Life (N = 3,589). PRD was derived from the Major Experiences of Discrimination Scale. Multinomial logistic regression estimated the relationship between PRD and patterns of substance use (i.e., never/former, single-substance, dual-substance, and polysubstance [3+ substances]) based on six substances; effect modification by ethnicity and sex was assessed by stratification. Study findings indicated that PRD was associated with greater ...

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Publication: Behavior

The impact of current tobacco product use definitions on estimates of transitions between cigarette and ENDS use AUTHORS: Andrew F Brouwer, David T Levy, Jihyoun Jeon, Evelyn Jimenez-Mendoza, Luz María Sanchez-Romero, Ritesh Mistry, Rafael Meza JOURNAL: Nicotine & tobacco research DESCRIPTION: Introduction: Definitions of current tobacco and nicotine delivery product use vary and depend on frequency of use, established use criteria, and the product type. Previous research has not considered how transition rates between current use of different products depend on the current use definition.

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Publication: Impact Analysis

An analysis of cigarette sales during Poland’s menthol cigarette sales ban: small effects with large policy implications AUTHORS: Alex C Liber, Michal Stoklosa, David T Levy, Luz María Sánchez-Romero, Christopher J Cadham, Michael F Pesko JOURNAL: European journal of public health DESCRIPTION: Background: In May 2020, the European Union Tobacco Products Directive mandated that EU member states, including Poland, ban the sale of menthol cigarettes. With menthol making up 28% of cigarette sales before the ban, Poland is the country with likely the largest menthol cigarette sales share in the world to ban their sale. We analyze how this ban changed the Polish tobacco market.

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Publication: Impact Analysis

Public health impact of a US menthol cigarette ban on the non-Hispanic black population: a simulation study AUTHORS: Mona Issabakhsh, Rafael Meza, Yameng Li, Zhe Yuan, Luz Maria Sanchez-Romero, David T Levy JOURNAL: Tobacco control. DESCRIPTION: Introduction: With the US Food and Drug Administration recently proposing to implement a ban on menthol cigarettes, it is critical to estimate the potential public health effects of such a ban. With high rates of menthol cigarette use and important smoking-related health disparity implications, the impact of the ban on the non-Hispanic black (NHB) population merits strong consideration.

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Publication: Behavior

Sexual Orientation Discrimination and Exclusive, Dual, and Polytobacco Use among Sexual Minority Adults in the United States. AUTHORS: Delvon T Mattingly, Andrea R Titus, Jana L Hirschtick, Nancy L Fleischer JOURNAL: International journal of environmental research and public health DESCRIPTION: Research on whether sexual orientation discrimination is associated with multiple tobacco product use among sexual minority (SM) adults is limited. Thus, we explored the associations between sexual orientation discrimination and exclusive, dual, and polyuse among a subset of SM adults (18+) (n = 3453) using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. We evaluated six indicators of prior-to-past-year sexual orientation discrimination separately and as a summary scale and defined past-year exclusive, dual, and polyuse based on cigarette, electronic nicotine ...

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Publication: Behavior

Flavoring Patterns of Exclusive and Dual-Use of Cigarettes and E-Cigarettes Among US Adults: Results from the TUS-CPS 2018-2019 AUTHORS: Luis Zavala-Arciniega, Jana L Hirschtick, Rafael Meza, Nancy L Fleischer JOURNAL: American Journal of Health Promotion DESCRIPTION: Purpose: To describe patterns of menthol/non-menthol cigarettes with flavored e-cigarettes (tobacco, menthol, sweet/spicy, and other flavorings) use. Design: We used cross-sectional data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Setting: United States. Subjects: Adults over 18 years old. Sample: A nationally representative sample (n = 135 329).

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Publication: Behavior

Tobacco Use among Gender-Varying and Gender-Stable Adolescents and Adults Living in the U.S. AUTHORS: Luisa Kcomt, Rebecca J Evans-Polce, Curtiss W Engstrom, Carol J Boyd, Philip T Veliz, Brady T West, Sean Esteban McCabe JOURNAL: Nicotine & tobacco research DESCRIPTION: Introduction: This study examines the proportion of U.S. adolescents and adults who are variable (i.e., at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates. Methods: We fit multivariable logistic regression models to data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n=33,197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability ...

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Publication

Increased nicotine vaping due to the COVID-19 pandemic among US young adults: Associations with nicotine dependence, vaping frequency, and reasons for use AUTHORS: Michael J Parks, Nancy L Fleischer, Megan E Patrick JOURNAL: Preventive medicine DESCRIPTION: Previous research has not examined increased vaping because of the pandemic using a national sample of young adults (YAs), which is a critical gap because pandemic-related increases in vaping among YAs could have important implications for nicotine dependence, prolonged regular use, and using substances to cope with stress. We examined self-reported increased vaping attributed to the COVID-19 pandemic among YAs, and its associations with outcomes that have important implications for future nicotine use. Data came from the Monitoring the Future (MTF) Vaping Supplement. Participants were selected ...

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Publication

The association between smoking behaviors and prices and taxes per cigarette pack in the United States from 2000 through 2019 AUTHORS: Thuy T T Le, Mohammed A Jaffri JOURNAL: BMC public health DESCRIPTION: Objective: The conclusions on how tax and price increases affect smoking behaviors are mixed. This work is devoted to re-evaluating the relationship between cigarette prices and taxes and smoking behaviors. Methods: Using 2000-2019 Behavioral Risk Factor Surveillance System data, we employed linear mixed-effect models to re-examine the impact of cigarette prices and taxes on smoking prevalence and the proportion of current smokers having tried to quit smoking in the past 12 months. All the analyses were conducted for the general population, then by age group, gender, race/ethnicity, and income ...

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Publication: Behavior, Impact Analysis

Monitoring the Increase in the U.S. Smoking Cessation Rate and its Implication for Future Smoking Prevalence AUTHORS: David Méndez, Thuy T T Le, Kenneth E Warner JOURNAL: Nicotine & tobacco research DESCRIPTION: Introduction: We calculate the U.S. adult smoking cessation rate for 2014-2019, compare it to the historical trend, and estimate the implication for future smoking prevalence. Methods: We repeated an earlier analysis, which examined the cessation rate from 1990-2014, extending the period to 2019. Employing National Health Interview Survey (NHIS) and National Survey on Drug Use and Health (NSDUH) data, we estimated the adult cessation rate in six-year intervals, using weighted non-linear least squares. We then employed a meta-regression model to test whether the cessation rate has increased beyond ...

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Publication: Impact Analysis

How Smokers of Menthol Cigarettes and Flavored Cigars Might Respond to FDA's Proposed Bans AUTHORS: Yong Yang, Eric N Lindblom, Kenneth D Ward, Ramzi G Salloum JOURNAL: Nicotine and tobacco research DESCRIPTION: Introduction: We aimed to examine the response of current smokers to a hypothetical ban on menthol cigarettes and flavored cigars. Methods: Current smokers were recruited online and reported the alternative products that they may switch to under a hypothetical ban, if they would try to obtain the banned products from illicit channels, and their support to the ban. Results: 51% of current smokers would use non-flavored cigarettes and cigars as alternatives, 45% would switch to flavored heated tobacco products or e-cigarettes or quit smoking. 17% would try to obtain the banned flavored products ...

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Oral Presentation — Slides

Thumbnail for Poland’s Menthol Cigarette Ban: Small
Effects with Large Policy Implications poster

Poland’s Menthol Cigarette Ban: Small Effects with Large Policy Implications AUTHORS: Luz María Sánchez-Romero, Alex C. Liber DESCRIPTION: In May 2020 menthol cigarette sales ended across the EU. § All other flavors except menthol had been removed in May 2016. In Poland, menthol cigarette sales shares were 28%, the highest of any EU country. § Prior analyses of the effects of menthol cigarette sales bans have come from areas with low menthol cigarette sales shares or small areas with legal access to menthol cigarettes elsewhere. § OBJECTIVE: measure whether cigarette sales declined after ...

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Oral Presentation — Slides

Thumbnail for Electronic Nicotine Delivery Systems (ENDS) use
during a six-year period is not associated with
self-reported chronic obstructive pulmonary
disease (COPD) after proper adjustment of
cigarette smoking history: A longitudinal analysis
of PATH data poster

Electronic Nicotine Delivery Systems (ENDS) use during a six-year period is not associated with self-reported chronic obstructive pulmonary disease (COPD) after proper adjustment of cigarette smoking history: A longitudinal analysis of PATH data AUTHORS: Rafael Meza, Steven Cook, Jihyoun Jeon, David T. Levy, Jana Hirschtick, Nancy L. Fleischer DESCRIPTION: Chronic Obstructive Pulmonary Disease (COPD) is a chronic and progressive disease encompassing emphysema and chronic bronchitis. • COPD is characterized by restrictive airflow to the lungs and an abnormal inflammatory response, usually caused by exposure to noxious particles or gases. • COPD is the fourth leading cause of mortality in the US. • COPD is projected to be responsible for 9.4 million COPD-attributable deaths and more than $800 billion ...

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Oral Presentation — Slides

Thumbnail for The EVALI Outbreak and US Tobacco Sales poster

The EVALI Outbreak and US Tobacco Sales AUTHORS: Alex C. Liber PhD DESCRIPTION: Vitamin E Acetate containing cannabis vaping products were responsible Media attention on e-cigarettes was the strongest ever recorded 2807 hospitalizations and 68 deaths by February 2020. FDA combined concern for EVALI with concern over rising youth e-cigarette usage rates to propose federal ban on flavored e-cig sales • 7 states proposed, 5 implemented temporary bans on sale of nontobacco flavored e-cigs • Massachusetts banned sales of all e-cigarettes ...

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Poster

Thumbnail for Short-term ENDS use is not associated with self-reported COPD after adjusting for cigarette
smoking history: A longitudinal analysis of PATH data poster

Short-term ENDS use is not associated with self-reported COPD after adjusting for cigarette smoking history: A longitudinal analysis of PATH data AUTHORS: Rafael Meza, Steven Cook, Jihyoun Jeon, David T. Levy, Jana L. Hirschtick, Nancy L. Fleischer DESCRIPTION: Understanding the relationship between electronic nicotine delivery systems (ENDS) and chronic obstructive pulmonary disease (COPD) and other respiratory conditions is critical • However, previous studies have not fully controlled for history of cigarette smoking

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Poster

Thumbnail for The impact of demographics, dependence, and biomarkers on transitions in tobacco product use in a cohort
of smokers and dual users poster

The impact of demographics, dependence, and biomarkers on transitions in tobacco product use in a cohort of smokers and dual users AUTHORS: Fatema Shafie-Khorassani, Megan E. Piper, Douglas E. Jorenby, Timothy B. Baker, Neal L. Benowitz, Todd Hayes-Birchler, Rafael Meza, Andrew F. Brouwer DESCRIPTION: Electronic nicotine delivery systems (ENDS) have the potential to help people who smoke cigarettes transition to a less harmful product. It is uncertain whether and to what extent ENDS facilitate cigarette cessation in real-world settings. A better understanding of what personal and product characteristics are associated with ENDS-facilitated cigarette cessation could improve tobacco control interventions.

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Poster

Thumbnail for Changing age patterns of cigarette and ENDS transitions in the PATH study:
a multistate transition model analysis of adults and youth through 2017 (Waves 1–4) vs after 2017 (Waves 4–5) poster

Changing age patterns of cigarette and ENDS transitions in the PATH study: a multistate transition model analysis of adults and youth through 2017 (Waves 1–4) vs after 2017 (Waves 4–5) AUTHORS: Andrew F. Brouwer, Jiyhoun Jeon, Evelyn Jimenez-Mendoza, Stephanie R Land, Ritesh Mistry, David T. Levy, Rafael Meza DESCRIPTION: Sales of ENDS, particularly JUUL, rose substantially in late 2017 and 2018. Did transitions between cigarette, ENDS, and dual use change over this period? Were adult and youth transitions affected differently?

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Poster

Thumbnail for Demographic Correlates of Tobacco Poly-Use in the Population Assessment of Tobacco
and Health Study: A Multistate Markov Transition Analysis poster

Demographic Correlates of Tobacco Poly-Use in the Population Assessment of Tobacco and Health Study: A Multistate Markov Transition Analysis AUTHORS: Fatema Shafie Khorassani, Andrew F. Brouwer, Jana L. Hirschtick, Rafael Meza, Nancy L. Fleischer DESCRIPTION: Goal: Estimate transition rates between single, dual, and poly tobacco use over time to help identify areas for policy intervention. Compare between sex, race/ethnicity, and age groups. Data: Waves 1-4 of the Population Assessment of Tobacco and Health (PATH) study, 2013-2017

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Poster

Thumbnail for Trends in Smoking (2002 to 2020) and E-cigarette use (2015 to 2020) in Mexico, a
country that bans the sale and distribution of E-cigarettes poster

Trends in Smoking (2002 to 2020) and E-cigarette use (2015 to 2020) in Mexico, a country that bans the sale and distribution of E-cigarettes AUTHORS: Luis Zavala-Arciniega, Luz Myriam Reynales-Shigematsu, Nancy L. Fleischer, David T. Levy, Belén Sáenz de Miera-Juárez, Luz María Sánchez-Romero, James F. Thrasher, Rafael Meza DESCRIPTION: This study describe changes in ecigarette use in Mexico between 2015 to 2020 and cigarette use between 2002 to 2020 by sex, age, and smoking.

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Poster

Thumbnail for Disparities in cigarettes and e-cigarettes at the Intersection of
Multiple Identities in the U.S Adult Population: Results from the TUS-CPS 2018-19 poster

Disparities in cigarettes and e-cigarettes at the Intersection of Multiple Identities in the U.S Adult Population: Results from the TUS-CPS 2018-19 AUTHORS: Luis Zavala-Arciniega, Rafael Meza, Jana L. Hirschtick, Nancy L. Fleischer DESCRIPTION: To estimate the prevalence of cigarettes and e-cigarettes at the intersection of age, sex, race/ethnicity and income, and to develop a visualization tool to aid characterization and interpretation.

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Poster

Thumbnail for Monitoring the Increase in the U.S. Smoking Cessation Rate
and its Implication for Future Smoking Prevalence poster

Monitoring the Increase in the U.S. Smoking Cessation Rate and its Implication for Future Smoking Prevalence AUTHORS: David Mendez, Ph.D., Thuy T. T. Le, Ph.D., Kenneth E. Warner, Ph.D. DESCRIPTION: In this study, we extend the analysis presented in a 2017 article by Mendez et al., extending the analysis period to 2019. The aim of this work is three-fold. First, we want to estimate the most up-to-date value for the adult cessation rate. This figure is helpful as an indicator of the country's progress in combating the smoking epidemic and as a necessary parameter to evaluate potential future scenarios of the trajectory of smoking prevalence. Second, ...

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Poster

Thumbnail for Health
Effects of Electronic Cigarettes:
An Umbrella Review and Methodological Considerations poster

Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations AUTHORS: Nargiz Travis, MSPH, Marie Knoll, MSPH, Christopher Cadham , MPH, Luz María Sánchez Romero, PhD, David T. Levy, PhD DESCRIPTION: E cigarettes are often marketed as a safer alternative to combustible cigarettes, however their health effects, especially those associated with long term use, remain largely uncertain. We conduct an umbrella review of cardiopulmonary and carcinogenic risks of e cigarette use, distinguishing between their short term and long term health effects and considering both the absolute harm of e cigarettes and their harm/benefits relative to smoking.

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Poster

Thumbnail for Longitudinal Associations Between Multiple Tobacco Product Use
and Incident Asthma Among US Youth poster

Longitudinal Associations Between Multiple Tobacco Product Use and Incident Asthma Among US Youth AUTHORS: Delvon T. Mattingly, Steven Cook, Jana L. Hirschtick, Nancy L. Fleischer DESCRIPTION: Use of non-cigarette tobacco products, including ENDS, have become more common over the last decade. While the health effects of cigarettes are well-documented, little is known about the effects of ENDS use and dual/poly use

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Poster

Thumbnail for Exclusive, dual, and poly tobacco use is associated with the incidence of acute
bronchitis among youth poster

Exclusive, dual, and poly tobacco use is associated with the incidence of acute bronchitis among youth AUTHORS: Luis Zavala-Arciniega, Yanmei Xie, Steven Cook, Jana L. Hirschtick, Richa Mukerjee, Douglas Arenberg, Geoffrey D. Barnes, Rafael Meza, Nancy L. Fleischer DESCRIPTION: Exclusive cigarette, exclusive ENDS, dual use, and polyuse increased the risk of diagnosed acute bronchitis, pneumonia, or chronic cough among youth.

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Poster

Thumbnail for Longitudinal Association of Exclusive and Dual Use of ENDS and Cigarettes with Asthma among
US Youth Population Assessment of Tobacco and Health Study Waves 1-5 (2013-2019) poster

Longitudinal Association of Exclusive and Dual Use of ENDS and Cigarettes with Asthma among US Youth Population Assessment of Tobacco and Health Study Waves 1-5 (2013-2019) AUTHORS: Akash Patel, Steven Cook, Nancy L. Fleischer, Jana Hirschtick DESCRIPTION: Adolescents who exclusively smoked cigarettes, but not those who used ENDS, had higher risk of incident diagnosed asthma over a five year follow up period. CONCLUSIONS

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Poster

Thumbnail for Response to Restrictions on Electronic
Nicotine Delivery Systems: A
Systematic Review poster

Response to Restrictions on Electronic Nicotine Delivery Systems: A Systematic Review AUTHORS: Chris Cadham DESCRIPTION: The effects of ENDS flavour restrictions on tobacco use remain unclear. Study results are heterogenous and vary depending on jurisdiction level. Retail compliance with restrictions was high.

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Poster

Thumbnail for Nicotine/tobacco use among gender-fluid and gender-stable adolescents and adults in the U.S. poster

Nicotine/tobacco use among gender-fluid and gender-stable adolescents and adults in the U.S. AUTHORS: Luisa Kcomt, PhD, Rebecca J. Evans-Polce, PhD, Curtiss W. Engstrom, MS, Carol J. Boyd, PhD, Philip T. Veliz, PhD, Brady T. West, PhD, Sean Esteban McCabe, PhD DESCRIPTION: This longitudinal study found gender-fluid individuals areat higher risk for nicotine/tobacco use, placing them at greater risk for smoking-related health consequences.

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Publication: Behavior

Sociodemographic Patterns of Exclusive and Dual Combustible Tobacco and E-Cigarette Use among US Adolescents—A Nationally Representative Study (2017–2020) AUTHORS: Bukola Usidame, Jana L. Hirschtick, Delvon T. Mattingly, Akash Patel, Megan E. Patrick, Nancy L. Fleischer JOURNAL: International Journal of Environmental Research and Public Health DESCRIPTION: This study assessed the sociodemographic predictors of exclusive and dual use of the most frequently used nicotine/tobacco products, e-cigarettes, and combustible tobacco among adolescents. Cross-sectional data was from the 2017–2020 Monitoring the Future nationally representative study of eighth, tenth, and twelfth-grade students. We coded past 30 day nicotine/tobacco use into four mutually exclusive categories: no use, e-cigarette use only, combustible use (cigarette or cigar) only, and dual use (e-cigarette and combustible). We pooled the 2017–2020 data to examine the relationship between ...

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Publication: Behavior

E-cigarette characteristics and cigarette smoking cessation behaviors among U.S. Adult dual users of cigarettes and e-cigarettes AUTHORS: Luis Zavala-Arciniega, Jana L. Hirschtick, Rafael Meza, Nancy L. Fleischer JOURNAL: Preventive Medicine Reports DESCRIPTION: It is critical to understand determinants of cigarette smoking cessation in the current tobacco product landscape. This study assesses the roles of e-cigarette flavoring, device type, and use frequency on cigarette smoking cessation behaviors among US adult dual users of cigarettes and e-cigarettes. We analyzed a sample of 1,038 adult dual users of cigarettes and e-cigarettes from the 2018–2019 Tobacco Use Supplement-Current Population Survey. We defined three smoking cessation behavior stages in current smokers: pre-contemplation, contemplation, and preparation to quit smoking. Multinomial ...

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Publication: Behavior, Health Effects

Sociodemographic differences in patterns of nicotine and cannabis vaping among US adults AUTHORS: Mattingly DT, Patel A, Hirschtick JL, Fleischer NL JOURNAL: Preventive Medicine Reports DESCRIPTION: Nicotine and cannabis vaping has increased over the past several years. While patterns of cigarette and cannabis co-use are well-documented, less is known about the intersection between nicotine and cannabis vaping, especially among adults. Thus, we categorized nicotine and cannabis vaping among adults (18+) who currently (past 30-day) used electronic vapor products (EVPs) from Wave 4 of the Population Assessment of Tobacco and Health Study (n = 3795) as: 1) nicotine only, 2) cannabis only, 3) nicotine and cannabis, and 4) non-nicotine/non-cannabis e-liquid. We calculated vaping pattern proportions ...

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Publication: Behavior

A Machine Learning Approach to Identify Predictors of Frequent Vaping and Vulnerable Californian Youth Subgroups. AUTHORS: Fu R, Shi J, Chaiton M, Leventhal AM, Unger JB, Barrington-Trimis JL JOURNAL: Nicotine and tobacco research DESCRIPTION: Introduction: Machine learning presents a unique opportunity to improve electronic cigarette (vaping) monitoring in youth. Here we built a random forest model to predict frequent vaping status among Californian youth and to identify contributing factors and vulnerable populations. Methods: In this prospective cohort study, 1,281 ever-vaping twelfth-grade students from metropolitan Los Angeles were surveyed in Fall and in 6-month in Spring. Frequent vaping was measured at the 6-month follow-up as nicotine-containing vaping on 20 or more days in past 30 days. Predictors (n=131) encompassed sociodemographic ...

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Publication: Behavior

Relationships Between E-cigarette Use and Subsequent Cigarette Initiation Among Adolescents in the PATH Study: an Entropy Balancing Propensity Score Analysis. AUTHORS: Xu S, Coffman DL, Liu B, Xu Y, He J, Niaura RS JOURNAL: Prevention Science DESCRIPTION: This study aimed to examine the relationship between electronic cigarette use and subsequent combustible cigarette use, controlling for confounding by using a propensity score method approach. Data from the first three annual waves of the Population Assessment of Tobacco and Health study were analyzed (n = 6309). Participants were tobacco-naïve at Wave 1; used e-cigarettes exclusively (n = 414), used combustible cigarettes exclusively (n = 46), or not used any tobacco products (n = 5849) at Wave 2. We conducted entropy balancing propensity score analysis to examine the association between exclusive ...

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Publication: Behavior, Impact Analysis

Tobacco Couponing: A Systematic Review of Exposures and Effects on Tobacco Initiation and Cessation AUTHORS: Alex C Liber PhD, Luz María Sánchez-Romero PhD, Christopher J Cadham MPH, Zhe Yuan MS, Yameng Li MS, Hayoung Oh BA, Steven Cook PhD, Kenneth E Warner PhD, Lisa Henriksen PhD, Ritesh Mistry PhD, Rafael Meza PhD, Nancy L Fleischer PhD, David T Levy PhD JOURNAL: Nicotine & Tobacco Research DESCRIPTION: Background: Tobacco couponing continues to be part of contemporary tobacco marketing in the US. We performed a systematic review of the evidence of tobacco product coupon receipt and redemption to inform regulation. Methods: We searched EMBASE OVID and Medline databases for observational (cross-sectional and longitudinal) studies that examined the prevalence of tobacco coupon receipt and coupon redemption across different subpopulations, as well as studies of the association between coupon receipt and redemption with tobacco initiation and cessation at follow-up. We extracted unadjusted and ...

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Publication: Behavior

Short communication: Racial/ethnic disparities in cigar and cigarette exclusive, dual, and polyuse among adults AUTHORS: Jana L. Hirschtick, Richa Mukerjee, Ritesh Mistry, Delvon Mattingly, Nancy L. Fleischer JOURNAL: Addictive behaviors DESCRIPTION: Background: Despite documented racial/ethnic differences in cigar use, disparities in the context of dual and polyuse with cigarettes are unclear. Methods: Using the Population Assessment of Tobacco and Health Study (2016–18), we examined prevalence and intensity of use patterns among adults (18+) who were Non-Hispanic (NH) Black, NH White, Hispanic, or another race/ethnicity: exclusive cigarillo, filtered cigar, traditional cigar, or cigarette use; dual use of each cigar product with cigarettes; dual or polyuse of cigars without cigarettes; and cigar and cigarette polyuse. We used multinomial ...

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Publication: Behavior, Impact Analysis

Responses to potential nicotine vaping product flavor restrictions among regular vapers using non-tobacco flavors: Findings from the 2020 ITC Smoking and Vaping Survey in Canada, England and the United States. AUTHORS: Gravely S, Smith DM, Liber AC, Cummings KM, East KA, Hammond D, Hyland A, O’Connor RJ, Kasza KA, Quah ACK, Loewen R, Martin N, Meng G, Ouimet J, Thompson ME, Boudreau C, McNeill A, Sweanor DT, Fong GT JOURNAL: Addictive behaviors DESCRIPTION: Introduction: Some jurisdictions have implemented nicotine vaping product (NVP) flavor restrictions because of concerns about rising adolescent use. However, little is known how these restrictions may impact adult vapers. This study describes the level of support and predictive behavioral responses to a hypothetical NVP ban on non-tobacco flavors among regular adult vapers who only use flavors that would be banned.

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Publication: Impact Analysis

Follow the money: a closer look at US tobacco industry marketing expenditures AUTHORS: David T Levy, Alex C Liber, Christopher Cadham, Luz Maria Sanchez-Romero, Andrew Hyland, Michael Cummings, Cliff Douglas, Rafael Meza, Lisa Henriksen JOURNAL: Tobacco Control DESCRIPTION: In the 1980s, famed American investor Warren Buffet said, ‘I’ll tell you why I like the cigarette business… It costs a penny to make. Sell it for a dollar. It’s addictive. And there’s fantastic brand loyalty.’ While the retail price of cigarettes has gone up, the relative magnitude between manufacturer’s cost of production and marketing, tax burden and retail price has not markedly changed. The large profits achieved by cigarette companies are the result of decades of strategic marketing activities, designed to increase and maintain consumer demand for their products. Much of tobacco ...

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Publication: Behavior

Trends in Exclusive, Dual and Polytobacco Use among U.S. Adults, 2014–2019: Results from Two Nationally Representative Surveys AUTHORS: Delvon T. Mattingly, Luis Zavala-Arciniega, Jana L. Hirschtick, Rafael Meza, David T. Levy, Nancy L. Fleischer JOURNAL: International Journal of Environmental Research and Public Health DESCRIPTION: Although increases in the variety of tobacco products available to consumers have led to investigations of dual/polytobacco use patterns, few studies have documented trends in these patterns over time. We used data from the 2014/2015 and 2018/2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) and the 2015–2019 National Health Interview Survey (NHIS) to estimate trends in the following use patterns: exclusive use of cigarettes, electronic nicotine delivery systems (ENDS), other combustibles (cigars/cigarillos/little filtered cigars and traditional pipes/hookah), and smokeless ...

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Publication: Health Effects

Self-Reported Quit Aids and Assistance Used By Smokers At Their Most Recent Quit Attempt: Findings from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey AUTHORS: Shannon Gravely, K Michael Cummings, David Hammond, Ron Borland, Ann McNeill, Katherine A East, Ruth Loewen, Nadia Martin, Hua-Hie Yong, Lin Li, Alex Liber, David T Levy, Anne C K Quah, Janine Ouimet, Sara C Hitchman, Mary E Thompson, Christian Boudreau, Geoffrey T Fong JOURNAL: Nicotine & tobacco research DESCRIPTION: Introduction: This study retrospectively describes smoking cessation aids, cessation services, and other types of assistance used by current and ex-smokers at their last quit attempt in four high-income countries. Aims and methods: Data are from the Wave 3 (2020) International Tobacco Control Four Country Smoking and Vaping Survey in Australia, Canada, England, and the United States (US). Eligible respondents were daily smokers or past-daily recent ex-smokers who made a quit attempt/quit smoking in the last 24-months, resulting in 3614 respondents. Self-reported quit aids/assistance included: ...

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Publication: Health Effects

A longitudinal study of menthol cigarette use and smoking cessation among adult smokers in the US: Assessing the roles of racial disparities and E-cigarette use AUTHORS: Steven Cook, Jana L. Hirschtick, Akash Patel, Andrew Brouwer, Jihyoun Jeon, David T. Levy, Rafael Meza, Nancy L. Fleischer JOURNAL: Preventive Medicine DESCRIPTION: Highlights: • We found disparities in smoking cessation among adults who smoke menthol cigarettes. • Non-Hispanic Black menthol smokers had low odds of smoking cessation. • Smoking cessation was higher for menthol smokers who used e-cigarettes.

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Oral Presentation — Slides

Thumbnail for An Estimation of the Harm of Menthol Cigarettes in the United States from 1980-2018 poster

An Estimation of the Harm of Menthol Cigarettes in the United States from 1980-2018 AUTHORS: Thuy Le, David Mendez DESCRIPTION: Objective: To quantify the harm caused by menthol cigarettes, we estimate the excess smoking prevalence, smoking initiation, and mortality in the US, from 1980 through 2018, that can be attributed to menthol cigarettes. Methods: Figure 1. The dynamics of the menthol cigarettes model (see the TPSAC menthol report). § Used data from various published sources, for example menthol and nonmenthol smoking prevalence data from the 1980-2018 National Health Interview Surveys (NHIS) § Developed a simulation scenario using retrospective NHIS data to reproduce the US smoking trends from 1980 through ...

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Oral Presentation — Slides

Thumbnail for Modeling public health impacts of vaping poster

Modeling public health impacts of vaping AUTHORS: Ken Warner (Avedis Donabedian Distinguished University Professor Emeritus of Public Health; Professor Emeritus of Health Management & Policy; Dean Emeritus of Public Health) DESCRIPTION: Presented to the Scientific Advisory Board on Vaping Products November 1, 2021

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Publication: Behavior

The Impact of Menthol Cigarette Flavor in the U.S.: Cigarette and ENDS Transitions by Sociodemographic Group AUTHORS: Andrew F.Brouwer PhD, Jihyoun Jeon PhD, Steven F.Cook PhD, Bukola Usidame PhD, Jana L. Hirschtick PhD, Evelyn Jimenez-Mendoza MSc, Ritesh Mistry PhD, Nancy L. Fleischer PhD, Theodore R. Holford PhD, David Mendez PhD, David T. Levy PhD, Rafael Meza PhD JOURNAL: American Journal of Preventive Medicine DESCRIPTION: Introduction: A better understanding of how menthol cigarette flavoring and ENDS impact smoking initiation, cessation, and transitions between tobacco products could help elucidate the potential impact of a U.S. menthol ban on combustible tobacco products. Conclusions: Sociodemographic differences in product transitions should be accounted for when estimating the potential impact of a menthol ban.

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Oral Presentation — Slides

Thumbnail for Demographic Correlates of
Polytobacco Transitions poster

Demographic Correlates of Polytobacco Transitions AUTHORS: Fatema Shafie-Khorassani, Andrew F. Brouwer, Jana L. Hirschtick, Rafael Meza, Nancy L. Fleischer DESCRIPTION: Markov Transition Analysis: Goal: transition analysis using multiple products (cigs, e-cigs, combustible, smokeless) and compare hazards of transition between: • Male and female sex • Age groups • Race/ethnicity groups Current use definition: now uses product everyday or some days Data: Population Assessment of Tobacco and Health (PATH) study • Weighted to represent the US population • Waves 1-4: 2013-2018

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Oral Presentation — Slides

Thumbnail for A machine learning approach to identify
product characteristics that contribute to
increased risk of frequent vaping and
vulnerable youth populations poster

A machine learning approach to identify product characteristics that contribute to increased risk of frequent vaping and vulnerable youth populations AUTHORS: Rui Fu (Ray), Post‐doctoral Fellow DESCRIPTION: Implications for FDA’s tobacco regulatory authorities • Nicotine use / dependence as the primary predictor of becoming frequent vapers in 6 months • Scoring >= 1 on the Hooked on Vaping Checklist predicts a higher risk • Vulnerable youth subpopulations • Younger students with high levels of perceived discrimination and/or belong to certain racial/ethnical minority groups • Potentials of using machine learning to predict vaping behaviour progression in youth

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Oral Presentation — Slides

Thumbnail for Tobacco Transitions Tool: Development of a Web Aid to Facilitate Exploration of Tobacco Use Patterns and Transitions in PATH poster

Tobacco Transitions Tool: Development of a Web Aid to Facilitate Exploration of Tobacco Use Patterns and Transitions in PATH AUTHORS: Jihyoun Jeon, Andrew Brouwer, Evelyn Jimenez-Mendoza, Ritesh Mistry, Rafael Meza DESCRIPTION: To understand how tobacco use patterns are changing in the US - New and emerging tobacco products such as electronic nicotine delivery systems (ENDS) - Provide insights into tobacco regulatory research • To monitor the dynamics of tobacco use and estimate transition ratesacross product use categories - May vary depending on use definitions, type of products, sociodemographic factors - Interactive web aid tools to facilitate exploration of tobacco use patterns • Population Assessment of Tobacco and Health Study (PATH) - Nationally representative longitudinal data for US ...

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Oral Presentation — Slides

Thumbnail for Latent Transition Analysis of Tobacco Use Frequencies for Multiple Products in US Adults poster

Latent Transition Analysis of Tobacco Use Frequencies for Multiple Products in US Adults AUTHORS: Ritesh Mistry, Irina Bondarenko, Rafael Meza, Andrew F. Brouwer, Jihyoun Jeon, David T. Levy, Michael R. Elliott, Jeremy M. G. Taylor, Jana Hirschtick, Nancy L. Fleischer DESCRIPTION: In the context of multi-tobacco products, there are practical and computational challenges in characterizing the complexity and dynamism in tobacco use behaviors over time. • There is particular interest in transitions between tobacco use products and behaviors. • transitions between single, dual and poly tobacco use • transitions in frequency and intensity of use, product switching, cessation and relapse.

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Poster

Thumbnail for The impact of demographics, dependence, and biomarkers on transitions in tobacco product use in a cohort of smokers and dual users poster

The impact of demographics, dependence, and biomarkers on transitions in tobacco product use in a cohort of smokers and dual users AUTHORS: Fatema Shafie-Khorassani, Megan E. Piper, Douglas E. Jorenby, Timothy B. Baker, Neal L. Benowitz, Todd Hayes-Birchler, Rafael Meza, Andrew F. Brouwer DESCRIPTION: Electronic nicotine delivery systems (ENDS) have the potential to help people who smoke cigarettes transition to a less harmful product. • It is uncertain how much ENDS facilitate cigarette cessation in real-world settings. • A better understanding of what personal and product characteristics are associated with ENDS-facilitated cigarette cessation could improve tobacco control interventions.

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Poster

Thumbnail for Sociodemographic Differences in Patterns of Nicotine and
Marijuana Vaping Among US Adults poster

Sociodemographic Differences in Patterns of Nicotine and Marijuana Vaping Among US Adults AUTHORS: Delvon T. Mattingly, Akash Patel, Jana L. Hirschtick, Nancy L. Fleischer DESCRIPTION: Vaping is a public health concern and electronic nicotine delivery systems (ENDS) can be used to consume not only nicotine but also marijuana. However, patterns of nicotine and marijuana vaping among US adults are not well understood.

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Publication: Impact Analysis

The Use of Expert Elicitation among Computational Modeling Studies in Health Research: A Systematic Review AUTHORS: Christopher J. Cadham, Marie Knoll, Luz María Sánchez-Romero, Clifford E. Douglas, Alex Liber, David Mendez, Rafael Meza, Ritesh Mistry, Aylin Sertkaya, Nargiz Travis, David T. Levy JOURNAL: Medical Decision Making DESCRIPTION: Expert elicitation (EE) has been used across disciplines to estimate input parameters for computational modeling research when information is sparse or conflictual. We conducted a systematic review to compare EE methods used to generate model input parameters in health research. We find extensive use of expert elicitation for the development of model input parameters, but most studies do not provide adequate details of their elicitation methods. Lack of reporting hinders greater discussion of the merits and challenges of using expert elicitation for model input parameter development. There is ...

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Publication: Behavior

The importance of peer imitation on smoking initiation over time: a dynamical systems approach AUTHORS: Carl Simon, David Mendez JOURNAL: Health Care Management Science DESCRIPTION: A recent Institute of Medicine Report calls for explicit modeling of smoking initiation, cessation and addiction processes. We introduce a model of smoking initiation that explicitly teases out the percentage of initiation due to social pressures, which we call “peer-imitation,” and the percentage due to other factors, such as media ads, family smoking, and psychological factors, which we call “self-initiation.” We propose a dynamic non-linear behavioral contagion model of smoking initiation and employ data from the National Survey on Drug Use and Health to estimate the relative contributions ...

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Publication: Health Effects, Impact Analysis

Estimated Prevalence of Smoking and Smoking-Attributable Mortality Associated With Graphic Health Warnings on Cigarette Packages in the US From 2022 to 2100 AUTHORS: Jamie Tam, PhD, Jihyoun Jeon, PhD, James F. Thrasher, PhD, David Hammond, PhD, Theodore R. Holford, PhD, David T. Levy, PhD, Rafael Meza, PhD JOURNAL: JAMA Health Forum DESCRIPTION: What are the estimated population health outcomes associated with implementation of graphic health warnings on cigarette packages in 2022 and with delayed implementation of the warnings since 2012, as originally planned, in the US? In this decision analytical model using simulation modeling of smoking prevalence and smoking-attributable mortality in the US from 2012 to 2100, graphic health warnings, if implemented from 2022 to 2100, would be associated with 539,000 smoking-attributable deaths averted and 7.9 million life-years gained, and if implemented in 2012, with 718 000 deaths averted and ...

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Publication: Behavior

Exclusive and dual menthol/non-menthol cigarette use with ENDS among adults, 2013–2019 AUTHORS: Bukola Usidame, Jana Hirschtick, Luis Zavala-Arciniega, Delvon T. Mattingly, Akash Patel, Rafael Meza, David T. Levy, Nancy L. Fleischer JOURNAL: Preventive Medicine Reports DESCRIPTION: This study examines patterns of use for menthol/non-menthol cigarettes and Electronic Nicotine Delivery Systems (ENDS) from 2013 to 2019 among U.S. adults. We calculated the weighted population prevalence of current exclusive and dual use for each product (i.e., menthol/non-menthol cigarettes and ENDS) stratified by age, sex, race/ethnicity, household income, and education in all surveys using data from three nationally representative surveys: the Population Assessment of Tobacco and Health (PATH) Study Waves 1–4 (W1-W4), 2013–2018; the National Health Interview Survey (NHIS) 2015; and the ...

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Publication: Health Effects, Impact Analysis

Consequences of a match made in hell: the harm caused by menthol smoking to the African American population over 1980–2018 AUTHORS: David Mendez, Thuy Tt Le JOURNAL: Tobacco control DESCRIPTION: Background For many years, national surveys have shown a consistently disproportionately high prevalence of menthol smokers among African Americans compared with the general population. However, to our knowledge, no prior study has quantified the harm that menthol smoking has caused on that population. In this work, we estimate the public health harm that menthol cigarettes have caused to the African American community over the last four decades. Methods Using National Health Interview Survey data, we employed a well-established simulation model to reproduce the observed smoking trajectory over ...

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Publication: Health Effects, Impact Analysis

Public health impact of a US ban on menthol in cigarettes and cigars: a simulation study AUTHORS: David T Levy, Rafael Meza, Zhe Yuan, Yameng Li, Christopher Cadham, Luz Maria Sanchez-Romero, Nargiz Travis, Marie Knoll, Alex C Liber, Ritesh Mistry, Jana L Hirschtick, Nancy L Fleischer, Sarah Skolnick, Andrew F Brouwer, Cliff Douglas, Jihyoun Jeon, Steven Cook, Kenneth E Warner JOURNAL: Tobacco control DESCRIPTION: Introduction: The US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper simulates the potential public health impact of a ban on menthol in cigarettes and cigars through its impacts on smoking initiation, smoking cessation and switching to nicotine vaping products (NVPs). Methods: After calibrating an established US simulation model to reflect recent use trends in cigarette and NVP use, we extended the model to incorporate ...

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Publication: Behavior, Health Effects

Trends in Nicotine Product Use Among US Adolescents, 1999-2020 AUTHORS: Ruoyan Sun, David Mendez, Kenneth E Warner JOURNAL: JAMA network open DESCRIPTION: Importance: With increasing e-cigarette use among US adolescents and decreasing use of other tobacco products, it is unclear how total use of nicotine products, and its long-term health risks, have changed. The Centers for Disease Control and Prevention's standard measure-any tobacco product use in the past 30 days-considers neither frequency of use nor product risk implications.

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Preprint: Behavior

Longitudinal Transitions in Initiation, Cessation, and Relapse of Smoking and E-Cigarette Use Among US Youth and Adults AUTHORS: Eli Schwamm, Farzad Noubary, Nancy A. Rigotti, Krishna P. Reddy JOURNAL: medRxiv DESCRIPTION: Introduction: Longitudinal surveys provide data to estimate transition probabilities between cigarette smoking, e-cigarette use, and dual use of both, facilitating projections of future use and the impact of policies. Methods: We fit a continuous time Markov multi-state model for youth (ages 12-17y) and adults (≥18y) in Waves 1-4.5 of the Population Assessment of Tobacco and Health (PATH) longitudinal survey and estimated smoking and e-cigarette transition frequencies, including initiation, cessation, and relapse. We validated transition frequency results in a microsimulation model by projecting ...

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Publication: Behavior

Latent class analysis of use frequencies for multiple tobacco products in US adults AUTHORS: Ritesh Mistry, Irina Bondarenko, Jihyoun Jeon, Andrew F Brouwer, Delvon T Mattingly, Jana L Hirschtick, Evelyn Jimenez-Mendoza, David T Levy, Stephanie R Land, Michael R Elliott, Jeremy M G Taylor, Rafael Meza, Nancy L Fleischer JOURNAL: Preventive medicine DESCRIPTION: A persistent challenge is characterizing patterns of tobacco use in terms of product combinations and frequency. Using Wave 4 (2016-17) Population Assessment of Tobacco and Health Study adult data, we conducted latent class analyses (LCA) of past 30-day frequency of use for 9 tobacco products. One-step LCA with joint multinomial logistic regression models compared sociodemographic factors between users (n = 13,716) and non-users (n = 17,457), and between latent classes of users. We accounted for survey design and weights. Our analyses identified 6 classes: in addition to non-users class (C0: 75.7%), ...

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Publication: Behavior

Sociodemographic Patterns of Exclusive and Dual Use of ENDS and Menthol/Non-Menthol Cigarettes among US Youth (Ages 15–17) Using Two Nationally Representative Surveys (2013–2017) AUTHORS: Akash Patel, Jana L. Hirschtick, Steven Cook, Bukola Usidame, Ritesh Mistry, David T. Levy, Rafael Meza, Nancy L. Fleischer JOURNAL: International Journal of Environmental Research and Public Health DESCRIPTION: The use of electronic nicotine delivery systems (ENDS) among youth in the United States has increased rapidly in the past decade. Simultaneously, while youth cigarette smoking has declined considerably, youth are still more likely to use menthol cigarettes than any other age group. We used nationally representative data on 15–17-year-olds from the Population Assessment of Tobacco and Health (PATH) Study and the National Youth Tobacco Survey (NYTS) (2013–2017) to better understand current cigarette (by menthol flavoring) and ENDS use in the US. We calculated weighted population prevalence estimates ...

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Publication: Behavior, Health Effects, Impact Analysis

The Potential Impact of Widespread Cessation Treatment for Smokers With Depression AUTHORS: Jamie Tam, Kenneth E.Warner, Kara Zivin, Gemma M.J.Taylor, Rafael Meza JOURNAL: American Journal of Preventive Medicine DESCRIPTION: Introduction: Experts recommend integrating smoking-cessation treatments within U.S. mental health settings, but the population health benefits of doing so have not been estimated. This study simulates the impact of widespread cessation treatment for patients with depression under best-case treatment and maximum potential cessation scenarios. Methods: Cessation interventions were simulated for U.S. adult smokers seeing a health professional for depression from 2020 to 2100. Interventions included (1) Any Treatment (behavioral counseling, pharmacological, combination) and (2) Pharmacological Treatment ...

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Publication: Behavior, Health Effects, Impact Analysis

Modeling smoking-attributable mortality among adults with major depression in the United States AUTHORS: Jamie Tam, Gemma M J Taylor, Kara Zivin, Kenneth E Warner, Rafael Meza JOURNAL: Preventive medicine. DESCRIPTION: Tobacco-related health disparities disproportionately affect smokers with major depression (MD). Although tobacco simulation models have been applied to general populations, to date they have not considered populations with a comorbid mental health condition. We developed and calibrated a simulation model of smoking and MD comorbidity for the US adult population using the 2005-2018 National Surveys on Drug Use and Health. We use this model to evaluate trends in smoking prevalence, smoking-attributable mortality and life-years lost among adults with MD, and changes in smoking prevalence by mental ...

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Publication: Behavior

A comparison of tobacco product prevalence by different frequency of use thresholds across three US surveys AUTHORS: Luz María Sánchez-Romero, Christopher J Cadham, Jana L Hirschtick, Delvon T Mattingly, Beomyoung Cho, Nancy L Fleischer, Andrew Brouwer, Ritesh Mistry, Stephanie R Land, Jihyoun Jeon, Rafael Meza, David T Levy JOURNAL: BMC Public Health DESCRIPTION: Background: With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends. Methods: Using three US surveys (2014/15 TUS-CPS, NHIS and PATH), we compared the adult (age 18+) prevalence of four product groups (cigarettes, other combustibles, smokeless tobacco, and e-cigarettes) based on three past 30-day frequency of use thresholds: 1+, 10+, and 25+ days. We also examined mutually exclusive single, dual, and polytobacco users as a percentage of total users for each product group.

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Publication: Impact Analysis

An Expert Elicitation on the Effects of a Ban on Menthol Cigarettes and Cigars in the United States AUTHORS: David T Levy, Christopher J Cadham, Luz Maria Sanchez-Romero, Marie Knoll, Nargiz Travis, Zhe Yuan, Yameng Li, Ritesh Mistry, Clifford E Douglas, Jamie Tam, Aylin Sertkaya, Kenneth E Warner, Rafael Meza JOURNAL: Nicotine and tobacco research DESCRIPTION: Introduction: The US FDA announced its intention to ban menthol in cigarettes. However, information is needed on how a federal ban would affect population health. We conducted an expert elicitation to gauge the impact of a menthol cigarette and cigar ban in the US. Methods: We developed and pilot tested a questionnaire that focused on tobacco use transitions of current smokers (age 18-24 menthol, age 35-54 menthol, and age 35-54 non-menthol) and potential menthol smokers (age 12-24). Using a structured expert elicitation, we estimated mean net transitions under a ban from cigarette use to combustible ...

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Publication: Health Effects

Time-varying survival effects for squamous cell carcinomas at oropharyngeal and nonoropharyngeal head and neck sites in the United States, 1973-2015 AUTHORS: Andrew F. Brouwer, Kevin He, Steven B Chinn, Alison M Mondul, Christina H Chapman, Marc D Ryser, Mousumi Banerjee, Marisa C Eisenberg, Rafael Meza, Jeremy M G Taylor JOURNAL: Cancer DESCRIPTION: Background: Anatomical site is strongly associated with head and neck cancer etiology, and etiology and patient sociodemographic characteristics are prognostic factors for survival. It is not known whether the effects of these predictors persist over the postdiagnosis period or are strongest proximal to the time of diagnosis.

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Publication: Health Effects, Impact Analysis

US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths AUTHORS: David T. Levy, Luz María Sánchez-Romero, Nargiz Travis, Zhe Yuan, Yameng Li, Sarah Skolnick, Jihyoun Jeon, Jamie Tam, Rafael Meza JOURNAL: International Journal of Environmental Research and Public Health DESCRIPTION: The public health impact of nicotine vaping products (NVPs) is subject to a complex set of uncertain transitions between NVP and cigarette use. Instead, we apply an indirect method to gauge the impact of NVP use on smoking prevalence and smoking-attributable deaths (SADs) using the well-established SimSmoke tobacco control policy simulation model.

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Publication: Health Effects

Respiratory Symptom Incidence Among People Using Electronic Cigarettes, Combustible Tobacco, or Both AUTHORS: Krishna P Reddy, Eli Schwamm, Sara Kalkhoran, Farzad Noubary, Rochelle P Walensky, Nancy A Rigotti JOURNAL: American journal of respiratory and critical care medicine DESCRIPTION: Keywords: electronic cigarettes; tobacco; smoking; respiratory symptoms

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Publication: Health Effects, Impact Analysis

Public health implications of vaping in the USA: the smoking and vaping simulation model AUTHORS: David T Levy, Jamie Tam, Luz María Sanchez-Romero, Yameng Li, Zhe Yuan, Jihyoun Jeon, Rafael Meza JOURNAL: Population health metrics. DESCRIPTION: Background: Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), a user-friendly model which estimates the public health implications of NVPs in the USA.

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Poster

Thumbnail for Sociodemographic Patterns of Exclusive and Dual Use of Menthol/Non
Menthol Cigarettes and ENDS among
US Youth (Ages 15 17) Population Assessment of Tobacco and Health Study (2013 2017) poster

Sociodemographic Patterns of Exclusive and Dual Use of Menthol/Non Menthol Cigarettes and ENDS among US Youth (Ages 15 17) Population Assessment of Tobacco and Health Study (2013 2017) AUTHORS: Akash Patel, Jana Hirschtick, Bukola Usidame, Nancy L. Fleischer DESCRIPTION: Sociodemographic patterns of exclusive and dual use of menthol/non menthol cigarettes and ENDS can reveal disproportionately affected populations and inform future research, policies, and strategies.

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Poster

Thumbnail for Patterns of Tobacco Poly-Use in the Population Assessment of Tobacco and Health Study:
A Multistate Markov Transition Analysis poster

Patterns of Tobacco Poly-Use in the Population Assessment of Tobacco and Health Study: A Multistate Markov Transition Analysis AUTHORS: Fatema Shafie Khorassani, Andrew F. Brouwer, Jana L. Hirschtick, Rafael Meza, Nancy L. Fleischer DESCRIPTION: Goal: Estimate transition rates between single, dual, and poly tobacco use categories over time to help identify areas for policy intervention. Data: Waves 1-4 of the Population Assessment of Tobacco and Health (PATH) study, 2013-2017

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Poster

Thumbnail for Trends in single-, dual-, and poly-tobacco use among US adults, 2014-2019:
Results from two nationally representative surveys poster

Trends in single-, dual-, and poly-tobacco use among US adults, 2014-2019: Results from two nationally representative surveys AUTHORS: Delvon T. Mattingly, Luis Zavala-Arciniega, Jana L. Hirschtick, Nancy L. Fleischer DESCRIPTION: While numerous investigations of patterns of dual- and poly-tobacco use exist, trends in patterns of tobacco product use over time are not well documented.

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Poster

Thumbnail for Correlates of smoking cessation behaviors among dual users of cigarettes
and e-cigarettes. Results from the TUS-CPS 2018-2019 poster

Correlates of smoking cessation behaviors among dual users of cigarettes and e-cigarettes. Results from the TUS-CPS 2018-2019 AUTHORS: Luis Zavala-Arciniega, Nancy L. Fleischer, Jana L. Hirschtick, Rafael Meza DESCRIPTION: Few studies have examined the roles of e-cigarette frequency of use and device type in cigarette smoking cessation.. • Our study examines how e-cigarette frequency of use, device type, and flavorings affect the stages of cigarette smoking cessation among a national sample of dual users.

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Poster

Thumbnail for Flavoring patterns of exclusive and dual-use of cigarettes and e-cigarettes
among US adults. Results from the TUS-CPS 2018-2019 poster

Flavoring patterns of exclusive and dual-use of cigarettes and e-cigarettes among US adults. Results from the TUS-CPS 2018-2019 AUTHORS: Luis Zavala-Arciniega, Rafael Meza, Jana L. Hirschtick, Nancy L. Fleischer DESCRIPTION: Describe the patterns of use of menthol/non-menthol cigarettes with flavored e-cigarettes (tobacco, menthol, sweet/spice/fruit, and other flavorings) among US adults.

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Poster

Thumbnail for Racial/ethnic disparities in cigarette and cigar prevalence and intensity
of use among exclusive, dual, and polyusers poster

Racial/ethnic disparities in cigarette and cigar prevalence and intensity of use among exclusive, dual, and polyusers AUTHORS: Jana L. Hirschtick, Akash Patel, Jihyoun Jeon, Nancy L. Fleischer DESCRIPTION: Racial/ethnic disparities in cigar prevalence and intensity of use are unclear in the context of exclusive use or concurrent use with cigarettes.

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Oral Presentation — Slides

Thumbnail for Expert Elicitation on the
Effects of a Federal
Menthol Ban poster

Expert Elicitation on the Effects of a Federal Menthol Ban AUTHORS: Christopher Cadham DESCRIPTION: • FDA announced its intention to ban menthol in cigarettes, effects remain unknown • Expert Elicitation can be used to quantify uncertainty • Has been used by FDA, EPA, NASA, and IPCC among others

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Oral Presentation — Slides

Thumbnail for The impact of current tobacco
product use definitions on estimates
of transitions between cigarette and
e-cigarette use poster

The impact of current tobacco product use definitions on estimates of transitions between cigarette and e-cigarette use AUTHORS: Andrew F. Brouwer, David T. Levy, Jihyoun Jeon, Evelyn Jimenez-Mendoza, Luz María Sánchez-Romero, Ritesh Mistry, Rafael Meza

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Oral Presentation — Slides

Thumbnail for Retail availability of tobacco and cigarette
and e-cigarette use among youth and
adults: a scoping review. poster

Retail availability of tobacco and cigarette and e-cigarette use among youth and adults: a scoping review. AUTHORS: Nargiz Travis, MSPH DESCRIPTION: Current state of research • Limiting tobacco retailer availability may be an effective tobacco control strategy to reduce smoking and improve public health in the population • Understanding the relationship between retailer exposure and tobacco use patterns in both youth and adult populations is essential for evidence-based policy making • Evidence on the associations between tobacco retailer density/proximity and smoking outcomes is mixed • There are inconsistencies in measures of retailer exposure and tobacco use outcomes across studies

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Publication: Health Effects

Prediction of COPD risk accounting for time-varying smoking exposures AUTHORS: Joanne T Chang, Rafael Meza, David T Levy, Douglas Arenberg, Jihyoun Jeon JOURNAL: Public Library of Science (PLoS One) DESCRIPTION: Rationale: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States. Studies have primarily assessed the relationship between smoking on COPD risk focusing on summary measures, like smoking status. Objective: Develop a COPD risk prediction model incorporating individual time-varying smoking exposures. Methods: The Nurses' Health Study (N = 86,711) and the Health Professionals Follow-up Study (N = 39,817) data was used to develop a COPD risk prediction model. Data was randomly split in 50-50 samples for model building and validation. Cox regression ...

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Publication: Health Effects, Impact Analysis

Evaluation of the Benefits and Harms of Lung Cancer Screening With Low-Dose Computed Tomography: Modeling Study for the US Preventive Services Task Force AUTHORS: Rafael Meza, Jihyoun Jeon, Iakovos Toumazis, Kevin Ten Haaf, Pianpian Cao, Mehrad Bastani, Summer S Han, Erik F Blom, Daniel E Jonas, Eric J Feuer, Sylvia K Plevritis, Harry J de Koning, Chung Yin Kong JOURNAL: Journal of the American Medical Association (JAMA) DESCRIPTION: Importance: The US Preventive Services Task Force (USPSTF) is updating its 2013 lung cancer screening guidelines, which recommend annual screening for adults aged 55 through 80 years who have a smoking history of at least 30 pack-years and currently smoke or have quit within the past 15 years. Objective: To inform the USPSTF guidelines by estimating the benefits and harms associated with various low-dose computed tomography (LDCT) screening strategies. Design, setting, and participants: Comparative simulation modeling with 4 lung cancer natural history models for individuals from the 1950 ...

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Publication: Behavior

Comparison of e-cigarette use prevalence and frequency by smoking status among youth in the United States, 2014-19 AUTHORS: Jamie Tam, Andrew F Brouwer JOURNAL: Addiction DESCRIPTION: Background and aims: Reports of youth e-cigarette use often do not disaggregate by underlying smoking status. This study compared annual 2014-19 youth estimates of past 30-day e-cigarette use prevalence and frequency by smoking status in the United States. Design: Nationally representative, cross-sectional, school-based survey [National Youth Tobacco Surveys (NYTS)]. General linear models accounting for complex survey design compared e-cigarette use prevalence by smoking status by year, overall and stratified by frequency, separately for high school (HS) and middle school (MS) students. The ...

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Publication: Health Effects, Impact Analysis

An estimation of the harm of menthol cigarettes in the United States from 1980 to 2018 AUTHORS: Thuy Tt Le, David Mendez JOURNAL: Tobacco control DESCRIPTION: Background: Menthol cigarettes are thought to encourage smoking initiation among youths and young adults and make it more difficult for smokers to quit, thus increasing cigarette harm. However, no study to date has quantified the damage that menthol cigarettes have caused the US population. Objective: To estimate the excess smoking prevalence, smoking initiation, and mortality in the US from 1980 through 2018 that can be attributed to menthol cigarettes. Methods: Using a well-established simulation model of smoking prevalence and health effects and data from the National Health Interview ...

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Publication: Behavior

Trends in prevalence and sociodemographic and geographic patterns of current menthol cigarette use among U.S. adults, 2005-2015 AUTHORS: Delvon T Mattingly, Jana L Hirschtick, Rafael Meza, Nancy L Fleischer JOURNAL: Preventive medicine reports DESCRIPTION: Despite overall reductions in U.S. smoking prevalence, prior evidence suggests similar reductions may not have occurred for menthol cigarette users. This study examines nationally representative current menthol and non-menthol cigarette use prevalence and trends for adults (18+) overall and by sociodemographic and geographic characteristics using the 2005 (n = 31,132), 2010 (n = 26,967), and 2015 (n = 33,541) National Health Interview Survey. Between 2005 and 2015, non-menthol cigarette use decreased overall (14.7% to 9.6%, p < 0.001) and within all sociodemographic and geographic subgroups analyzed ...

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Publication: Behavior

Sociodemographic Patterns of Exclusive, Dual, and Polytobacco Use Among U.S. High School Students: A Comparison of Three Nationally Representative Surveys AUTHORS: Beomyoung Cho, Jana L. Hirschtick, Bukola Usidame, Rafael Meza, Ritesh Mistry, Stephanie R. Land, David T. Levy, Theodore Holford, Nancy L. Fleischer JOURNAL: Journal of Adolescent Health DESCRIPTION: Purpose: This study examines sociodemographic patterns of exclusive/dual/polytobacco use among U.S. high school students using multiple national surveys. Methods: Using three national youth surveys (Population Assessment of Tobacco and Health [PATH] Wave 4 [2016–2017], 2017 Youth Risk Behavior Survey, and 2017 National Youth Tobacco Survey), we classified tobacco products into four groups: (1) electronic nicotine delivery systems (ENDS), (2) conventional cigarettes (CCs), (3) other combustible tobacco products, and (4) smokeless tobacco products. We created 16 categories of non/exclusive/dual/polytobacco ...

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Publication: Behavior

Trends in tobacco use among adolescents by grade, sex and race, 1991-2019 AUTHORS: Rafael Meza, Evelyn Jimenez-Mendoza, David T Levy JOURNAL: JAMA network open DESCRIPTION: QUESTION: How have trends in cigarettes and smokeless tobacco use among adolescents changed in recent years as e-cigarette use increased? FINDINGS: In this cross-sectional study of 1,297,362 US adolescents surveyed between 2011 and 2019, past 30-day and daily use of cigarettes and smokeless tobacco decreased more rapidly since 2012 as e-cigarette use began to increase. Smoking and smokeless tobacco use reached historically low levels among adolescents in the US. MEANING: Despite it’s recent increase in popularity, e-cigarette use does not seem to be counteracting the decreases in other ...

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Publication: Behavior

Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1-4): multistate transition modelling accounting for complex survey design AUTHORS: Andrew F Brouwer, Jihyoun Jeon, Jana L Hirschtick, Evelyn Jimenez-Mendoza, Ritesh Mistry, Irina V Bondarenko, Stephanie R Land, Theodore R Holford, David T Levy, Jeremy M G Taylor, Nancy L Fleischer, Rafael Meza JOURNAL: Tobacco Control DESCRIPTION: Introduction: Even prior to 2018, electronic nicotine delivery systems (ENDS) began to dramatically change the landscape of tobacco products and product use patterns in the USA. Methods: Using a Markov multistate transition model accounting for complex survey design, transition rates between never, non-current, cigarette, ENDS and dual use states were estimated for 23 253 adult participants in waves 1-4 (approximately 2013-2017) of the Population Assessment of Tobacco and Health study. We made short-term transition projections and estimated HRs for age, sex, race/ethnicity, education and income. Results: ...

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Publication: Behavior

Exclusive, Dual, and Polytobacco Use Among US Adults by Sociodemographic Factors: Results From 3 Nationally Representative Surveys AUTHORS: Jana L Hirschtick, Delvon T Mattingly, Beomyoung Cho, Luis Zavala Arciniega, David T Levy, Luz Maria Sanchez-Romero, Jihyoun Jeon, Stephanie R Land, Ritesh Mistry, Rafael Meza, Nancy L Fleischer JOURNAL: American journal of health promotion DESCRIPTION: Purpose: To provide tobacco product use patterns for US adults by sociodemographic group. Design: A secondary analysis of Tobacco Use Supplement to the Current Population Survey (2014-15), National Health Interview Survey (2015), and Population Assessment of Tobacco and Health (2015-16). Setting: United States. Sample: Three nationally representative samples of adults (N = 28,070-155,067). Measures: All possible combinations of cigarette, Electronic Nicotine Delivery Systems (ENDS), other combustible product, and smokeless tobacco use, defined as current ...

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Publication: Behavior

Unpacking the Non-Hispanic Other Category: Differences in Patterns of Tobacco Product Use Among Youth and Adults in the United States, 2009-2018 AUTHORS: Delvon T Mattingly, Jana L Hirschtick, Nancy L Fleischer JOURNAL: Journal of Immigrant and Minority Health DESCRIPTION: Studies investigating patterns of tobacco use by race often aggregate non-Black and non-Hispanic racial minorities into the “Other” category, masking important differences. Pooling 10 years (2009-2018) of National Survey on Drug Use and Health data (n = 52,424), we estimated the prevalence and proportion of individual tobacco product use and patterns of single, dual, and polytobacco use overall and by sex for youth (12-17) and adult (18 +) non-Hispanic Asian, American Indian/Alaska Native (AI/AN), Native Hawaiian/other Pacific Islander (NH/PI), and multiracial respondents. Cigarette ...

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Publication: Health Effects, Impact Analysis

A magic bullet? The potential impact of e-cigarettes on the toll of cigarette smoking AUTHORS: David Mendez, Kenneth E Warner JOURNAL: Nicotine & Tobacco Research DESCRIPTION: Introduction: We examine the proportion of U.S. smoking-produced mortality that e-cigarettes might eliminate under assumptions regarding vaping’s ability to increase smoking cessation, vaping’s health risks, and the possibility that vaping will increase smoking among young people. Methods: We employ a dynamic population simulation model that tracks individuals from ages 0-110, differentiated by gender and smoking status. Using data from the U.S. Census, the National Vital Statistics Reports, Cancer Prevention Study II, and the National Health Interview Survey, we estimate the number of smoking-related ...

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Publication: Health Effects, Impact Analysis

Actual and Anticipated Effects of a Menthol Cigarette Ban: A Scoping Review AUTHORS: Christopher J. Cadham, Luz Maria Sanchez-Romero, Nancy L. Fleischer, Ritesh Mistry, Jana L. Hirschtick, Rafael Meza, David T. Levy JOURNAL: BMC Public Health DESCRIPTION: The United States (US) Food and Drug Administration (FDA), under the 2009 Family Smoking Prevention and Tobacco Control Act, banned characterizing flavors in cigarettes; however, mentholated tobacco products were exempt. Since 2009, over 20 US jurisdictions and numerous countries around the world have extended this restriction to menthol. Currently, the FDA is reconsidering its position on a nation-wide menthol cigarette ban. However, the effects of such a ban remain unclear. We conducted a scoping review to explore the impact of a menthol cigarette ban on individual behaviors (initiation, ...

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Publication: Health Effects, Impact Analysis

The Public Health Gains Had Cigarette Companies Chosen to Sell Very Low Nicotine Cigarettes AUTHORS: David T Levy, PhD, K Michael Cummings, PhD, MPH, Bryan W Heckman, PhD, Yameng Li, MS, Zhe Yuan, MS, Tracy T Smith, PhD, Rafael Meza, PhD JOURNAL: Nicotine & Tobacco Research DESCRIPTION: The US Food and Drug Administration has proposed lowering the nicotine content of cigarettes to a minimally addictive level to increase smoking cessation and reduce initiation. This study has two aims: 1) to determine when cigarette manufacturers had the technical capability to reduce cigarette nicotine content; and 2) to estimate the lost public health benefits of implementing a standard in 1965, 1975, or 1985.

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Commentary: Health Effects, Impact Analysis

An Analysis of the FTC’s Attempt to Stop the Altria-Juul Labs Deal AUTHORS: David T Levy, Clifford E. Douglas, Luz Maria Sanchez-Romero, K. Michael Cummings, David T. Sweanor JOURNAL: Tobacco Regulatory Science DESCRIPTION: On 20 December 2018, Altria, the largest US cigarette company, announced an offer for a 35% share of the large and rapidly growing vaping product company, Juul Labs. On 2 April, 2020, the Federal Trade Commission issued a complaint that the deal was anticompetitive and should be voided. This paper analyzes the deal. We find that the deal gives Altria market power in the e-cigarette market through its support of Juul in retail stores and through the agreement not to otherwise compete in the e-cigarette market. The deal also has implications for its marketing of heated tobacco product IQOS and generally ...

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Preprint: Health Effects, Impact Analysis

Public Health Implications of Vaping in the US: The Smoking and Vaping Simulation Model AUTHORS: David T Levy, PhD, Jamie Tam, Luz Maria Sanchez-Romero, Yameng Li, Zhe Yuan, Jihyoun Jeon, Rafael Meza JOURNAL: Population Health Metrics DESCRIPTION: Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), which estimates the public health implications of NVPs in the US.

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Publication: Health Effects, Impact Analysis

How much of the future mortality toll of smoking can be avoided? AUTHORS: Kenneth E Warner, David Mendez JOURNAL: Tobacco Control DESCRIPTION: Employing a dynamic population simulation model, we estimate smoking’s expected mortality burden in the USA, measured as life-years lost (LYL), in a status-quo scenario run from 2018 through 2100. We then estimate LYL attributable to past smoking assuming that all smoking ceases at the end of 2017. We calculate the potential avoidable LYL, which we call the maximum potential reduction in premature mortality (MPRPM), as the difference between the two. We use data from the US Census Bureau, National Vital Statistics Reports, the National Health Interview Survey and Cancer Prevention Study II.

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Publication: Behavior, Health Effects

Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences AUTHORS: Shervin Assari JOURNAL: Children (Basel, Switzerland) DESCRIPTION: Background: Minorities' diminished returns (MDRs) refer to weaker effects of socioeconomic status (SES) indicators such as parental educational attainment and family income in generating tangible childhood outcomes for racial and ethnic minorities compared to the majority group, a pattern prevalent in the US. Our existing knowledge is minimal, however, about diminished returns of family SES on reducing exposure to childhood trauma.

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Publication: Behavior, Health Effects

Protective Effects of Parental Education Against Youth Cigarette Smoking: Diminished Returns of Blacks and Hispanics AUTHORS: Assari S, Mistry R, Caldwell CH, Bazargan M JOURNAL: Adolescent health, medicine and therapeutics DESCRIPTION: High parental educational attainment is protective against youth health risk behaviors such as tobacco use. According to the Marginalization-related Diminished Returns (MDRs) theory, however, higher parental education is less protective for marginalized groups relative to non-Hispanic Whites.

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Publication: Behavior, Health Effects

Parental Education and Youth Inhibitory Control in the Adolescent Brain Cognitive Development (ABCD) Study: Blacks’ Diminished Returns. AUTHORS: Assari S JOURNAL: Brain sciences DESCRIPTION: Non-Hispanic Black (NHB) youth are at a higher risk of high-risk behaviors compared to non-Hispanic White (NHW) youth. Some of this racial gap is shown to be due to weaker effects of parental educational attainment on reducing the prevalence of behavioral risk factors such as impulsivity, substance use, aggression, obesity, and poor school performance for NHBs, a pattern called Minorities' Diminished Returns. These diminishing returns may be due to lower than expected effects of parental education on inhibitory control.

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Publication: Behavior, Health Effects

Minorities’ Diminished Returns of Parental Educational Attainment on Adolescents’ Social, Emotional, and Behavioral Problems AUTHORS: Assari S, Boyce S, Caldwell CH, Bazargan M JOURNAL: Children (Basel, Switzerland) DESCRIPTION: Aim: To compare racial groups for the effect of parental educational attainment on adolescents' social, emotional, and behavioral problems. Methods: In this cross-sectional study, 10,762 youth from the Adolescent Brain Cognitive Development (ABCD) study were included. The independent variable was parental educational attainment. The main outcomes were 1) anxious and depressed mood, 2) withdrawn and depressed affect, 3) somatic complaints, 4) social and interpersonal problems, 5) thought problems, 6) rule-breaking behaviors, 7) attention problems, and 8) violent and aggressive behaviors. These scores ...

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Publication: Behavior, Health Effects

Diminished Returns of Educational Attainment on Heart Disease Among Black Americans AUTHORS: Assari S, Cobb S, Saqib M, Bazargan M JOURNAL: The open cardiovascular medicine journal DESCRIPTION: Socioeconomic Status (SES) indicators, such as educational attainment, are social determinants of heart disease. Marginalization related Diminished Returns (MDRs) refer to smaller health benefits of high SES for racial and ethnic minorities compared to the majority group. It is still unknown, however, if MDRs also apply to the effects of education on heart disease.

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Publication: Behavior, Health Effects

Place-Based Diminished Returns of Parental Educational Attainment on School Performance of Non-Hispanic White Youth AUTHORS: Shervin Assari, Shanika Boyce, Mohsen Bazargan, Cleopatra H Caldwell, Marc A Zimmerman JOURNAL: Frontiers in education. DESCRIPTION: Background: Youth educational outcomes are a function of a wide range of factors including parental education level. This effect, however, is shown to be smaller for African American, Hispanic, and Asian American youth, a pattern called Marginalization-related Diminished Returns (MDRs). It is, however, unknown if it is race/ethnicity or other conditions associated with race/ethnicity (e.g., poor neighborhood quality) which reduces the marginal returns of parental education for youth.

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Publication: Behavior, Health Effects

Combined Effects of Ethnicity and Education on Burden of Depressive Symptoms over 24 Years in Middle-Aged and Older Adults in the United States AUTHORS: Assari S JOURNAL: Brain sciences DESCRIPTION: Ethnicity and educational attainment are among the major social determinants of depression in the general population. While high education credentials protect individuals against depressive symptoms, this protection may be weaker for ethnic minority groups such as Hispanic Whites compared to the majority group (non-Hispanic Whites). Built on marginalization-related diminished returns (MDRs), the current study used 24-year follow-up data from a nationally representative sample of middle-aged and older adults to explore ethnic variation in the protective effect of education levels against the burden ...

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