TCORS: Publications, Preprints + Posters

Publications, Preprints + Posters

Publications by Scientific Domain

Impact Analysis

Understanding impact of potential FDA regulatory actions

64

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Health Effects

Understanding the short and long term health effects of tobacco products

58

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Behavior

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

120

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Publication: Behavior, Health Effects, Impact Analysis

Oral Nicotine Pouches and Public Health: Evidence from an Updated Scoping Review AUTHORS: Nargiz Travis, Kenneth E. Warner, Jamie Hartmann-Boyce, Maciej L. Goniewicz, Claire Ma, Rafael Meza, David T. Levy JOURNAL: Nicotine & tobacco research DESCRIPTION: Introduction: The popularity of oral nicotine pouches (ONPs) is rising in the US and worldwide. This review provides an update on their potential public health impact. Methods: We searched six electronic databases for ONP-related empirical studies through September 30, 2025, updating an earlier review. Outcomes included ONP product characteristics, use patterns, beliefs, perceptions, toxicity, sales, and marketing. Results: We identified 73 new studies published since our previous review (majority conducted in the US; 12 industry-funded). Nationally representative US surveys indicate a slow but steady increase in current ONP use prevalence among youth, ranging between 1.8% and 2.6% in 2024. Current use among adults was relatively low in 2022–2023 (0.4%-0.8%), with higher use among ages 18–44 and current tobacco users. US sales have more than tripled between 2021 and 2024...

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Publication: Health Effects

The Burden of Chronic Obstructive Pulmonary Disease in the US: A Systematic Review of Nationally Representative Health Surveys AUTHORS: Maria Robayo, Peggy-Ita Obeng-Nyarkoh, Jamie Hartmann-Boyce, Maria E Valentín-Figueroa, Steven Cook, Luz M Sánchez-Romero JOURNAL: International journal of chronic obstructive pulmonary disease DESCRIPTION: Consistent assessment methods across surveys are necessary to better understand and address the real burden of COPD across the diverse US population, supporting more effective surveillance while informing public health policy and prevention efforts.

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Publication: Health Effects, Impact Analysis

Impact of reducing nicotine in cigarettes on mortality, economic costs and major depression in the USA AUTHORS: Sarah Rivero Skolnick, Andrew F Brouwer, Chialing Cheng, Jamie Tam JOURNAL: Tobacco control DESCRIPTION: Timely implementation of a nicotine reduction strategy, either through a federal product standard or state-level sales restrictions, is cost-effective and could prevent millions of premature deaths while reducing smoking disparities by MD status.

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Publication: Behavior, Health Effects

Urinary tobacco and nicotine exposure biomarkers as predictors of transitions between cigarette and e-cigarette use in the Exhale longitudinal cohort study AUTHORS: Andrew F Brouwer, Fatema Shafie-Khorassani, Neal Benowitz, Nan Shi, Timothy B Baker, Todd Hayes-Birchler, Megan E Piper JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: Urinary tobacco biomarkers were non-linearly associated with transitions in tobacco product use and may guide the development of clinical interventions to promote harm-reducing product use transitions.

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Publication: Health Effects

Lung cancer incidence trends by histology and individual- and county-level sociodemographic characteristics in the United States from 2000 to 2019 AUTHORS: Jihyoun Jeon, PhD, MS; Pianpian Cao, PhD, MPH; Rafael Meza, PhD JOURNAL: Journal of the National Cancer Institute Monographs DESCRIPTION: Lung cancer incidence has been decreasing in the United States, largely due to smoking reductions. However, adenocarcinoma incidence has been relatively stable compared with other histological subtypes. Histology-specific lung cancer incidence varies by key sociodemographic characteristics, but trends are not well characterized.

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Publication: Behavior, Health Effects

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults AUTHORS: Delvon T Mattingly, Briana Mezuk, Michael R Elliott, Harold W Neighbors, Nancy L Fleischer JOURNAL: Journal of racial and ethnic health disparities DESCRIPTION: Introduction: Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear. Methods: We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other ...

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Publication: Health Effects

Longitudinal association of exclusive and dual use of cigarettes and cigars with asthma exacerbation among US adults: a cohort study AUTHORS: Akash Patel, James H Buszkiewicz, Steven Cook, Douglas A Arenberg, Nancy L Fleischer JOURNAL: Respiratory research DESCRIPTION: We found no association between exclusive cigar use and self-reported asthma exacerbation. However, exclusive cigarette use and dual cigarette and cigar use were associated with higher incidence rates of self-reported asthma exacerbation compared to non-established use. Studies should evaluate strategies to improve cigarette and cigar smoking cessation among adults with asthma who continue to smoke.

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Publication: Health Effects

Longitudinal associations between exclusive, dual and polytobacco use and respiratory illness among youth AUTHORS: Luis Zavala-Arciniega, Steven Cook, Jana L Hirschtick, Yanmei Xie, Richa Mukerjee, Douglas Arenberg, Geoffrey D Barnes, David T Levy, Rafael Meza, Nancy L Fleischer JOURNAL: BMC public health DESCRIPTION: We found that exclusive, dual, and poly tobacco use were all associated with higher risk of bronchitis, pneumonia, or chronic cough compared to non-current use.

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Publication: Behavior, Health Effects, Impact Analysis

The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review AUTHORS: Nargiz Travis, Kenneth E Warner, Maciej L Goniewicz, Hayoung Oh, Radhika Ranganathan, Rafael Meza, Jamie Hartmann-Boyce, David T Levy JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users, although key data are mainly available from industry-funded studies. Data from independent research is critically needed. Industry marketing of ONPs may encourage initiation in youth and situational and dual use in adults.

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Publication: Health Effects

The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007-2012 AUTHORS: Christopher J Cadham, Hayoung Oh, MeiLan K Han, David Mannino, Steven Cook, Rafael Meza, David T Levy, Luz María Sánchez-Romero JOURNAL: Respiratory research DESCRIPTION: The prevalence of COPD and PRISm remained stable from 2007-2012. Greater attention should be paid to the potential impacts of PRISm due to its higher prevalence in minority groups and its associations with mortality across various causes including cancer.

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Publication: Behavior, Health Effects

Association between cigar use, with and without cigarettes, and incident diagnosed COPD: a longitudinal cohort study AUTHORS: Steven Cook, James Buskiewicz, David T Levy, Rafael Meza, Nancy L Fleischer JOURNAL: Respiratory research DESCRIPTION: Exclusive cigarette use and dual cigar/cigarette use were associated with diagnosed incident COPD. These results suggest that cigars, when used in combination with cigarettes, may be associated with poorer COPD health outcomes. Dual use may promote a higher likelihood of inhaling cigar smoke, and future research would benefit from examining whether inhalation of cigar smoke increases COPD risk.

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Publication: Health Effects, Impact Analysis

New Estimates of Smoking-Attributable Mortality in the U.S. from 2020 through 2035 AUTHORS: Thuy T T Le, David Méndez, Kenneth E Warner JOURNAL: American journal of preventive medicine DESCRIPTION: These findings suggest that the CDC estimate of the annual mortality burden of smoking remains valid. Despite US population growth and the ageing of the smoking population, substantial reductions in smoking will finally produce a steady, if gradual, decline in SADs beginning around 2030.

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Publication: Health Effects

ENDS, Cigarettes, and Respiratory Illness: Longitudinal Associations Among U.S. Youth AUTHORS: Richa Mukerjee, Jana L Hirschtick, Luis Zavala Arciniega, Yanmei Xie, Geoffrey D Barnes, Douglas A Arenberg, David T Levy, Rafael Meza, Nancy L Fleischer, Steven F Cook JOURNAL: American journal of preventive medicine DESCRIPTION: These results suggest that ENDS and cigarettes, used exclusively or jointly, increased the risk of diagnosed bronchitis, pneumonia, or chronic cough among U.S. youth. However, dual use was associated with the highest risk. Targeted policies aimed at continuing to reduce cigarette smoking and ENDS use among youth, especially among those with dual use, are needed.

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Publication: Health Effects

Longitudinal Association Between Exclusive and Dual Use of Cigarettes and Electronic Nicotine Delivery Systems and Asthma Among U.S. Adolescents AUTHORS: Akash Patel M.P.H., Steven Cook Ph.D., Delvon T. Mattingly M.S., Geoffrey D. Barnes M.D., M.Sc., Douglas A. Arenberg M.D., David T. Levy Ph.D., Rafael Meza Ph.D., Nancy L. Fleischer Ph.D., Jana L. Hirschtick Ph.D. JOURNAL: Journal of Adolescent Health DESCRIPTION: Purpose: Electronic Nicotine Delivery Systems (ENDS) use among adolescents has increased greatly over the past decade, but its impact on chronic respiratory health conditions, like asthma, is not fully understood. Methods: We examined data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study using discrete time hazard models to analyze the association between time-varying tobacco product use and incident diagnosed asthma among adolescents aged 12–17 years at ...

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Publication: Health Effects

Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study AUTHORS: Steven Cook, Jana L Hirschtick, Geoffrey Barnes, Douglas Arenberg, Irina Bondarenko, Akash Patel, Evelyn Jiminez Mendoza, Jihyoun Jeon, David Levy, Rafael Meza, Nancy L Fleischer JOURNAL: BMJ Open DESCRIPTION: Objective: Electronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known about their health effects. The aim of the present study was to examine the prospective association between cigarette and ENDS use on self-reported incident hypertension. Design: Longitudinal cohort study. Setting: Nationally representative sample of the civilian, ...

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Publication: Health Effects

Longitudinal associations between exclusive, dual, and polytobacco use and asthma among US youth AUTHORS: Delvon T. Mattingly, Steven Cook, Jana L. Hirschtick, Akash Patel, Douglas A. Arenberg, Geoffrey D. Barnes, David T. Levy, Rafael Meza, Nancy L. Fleischer JOURNAL: Preventive Medicine DESCRIPTION: Little is known about the respiratory health effects of dual (two products) and polytobacco (three or more products) use among youth in the United States. Thus, we followed a longitudinal cohort of youth into adulthood using data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study, examining incident asthma at each follow-up (Waves 2–5). We classified past 30-day tobacco use as 1) no products (never/former use), 2) exclusive cigarettes, 3) exclusive electronic ...

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Publication: Health Effects

Assessment of Electronic Nicotine Delivery Systems With Cigarette Use and Self-reported Wheezing in the US Adult Population AUTHORS: Luz M. Sánchez-Romero, PhD, Irina Bondarenko, MS, Marie Knoll, MS, Jana L. Hirschtick, PhD, Steven Cook, PhD, Nancy L. Fleischer, PhD, David T. Levy, PhD JOURNAL: JAMA Network Open DESCRIPTION: Question What is the association between cigarettes, electronic nicotine delivery systems (ENDS) use, and self-reported wheezing symptoms among the US adult population? Findings Using 2013 to 2019 data from a cohort study of 17?075 participants in the US, this study found that ENDS use is not associated with increased odds of reporting wheezing independent of cigarette smoking. Meaning These findings suggest ENDS use may not be solely responsible for increasing the odds of reporting wheezing, ...

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Publication: Behavior, Health Effects

Mortality Relative Risks by Smoking, Race/Ethnicity, and Education AUTHORS: Jihyoun Jeon, Maki Inoue-Choi, Yoonseo Mok, Timothy S McNeel, Jamie Tam, Neal D Freedman, Rafael Meza JOURNAL: American journal of preventive medicine DESCRIPTION: Introduction: The impact of cigarette smoking on mortality is well studied, with estimates of the relative mortality risks for the overall population widely available. However, age-specific mortality estimates for different sociodemographic groups in the U.S. are lacking. Methods: Using the 1987-2018 National Health Interview Survey Linked Mortality Files through 2019, all-cause mortality relative risks (RRs) were estimated for current smokers or recent quitters and long-term quitters compared with ...

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Publication: Health Effects

Cigarettes, ENDS Use, and Chronic Obstructive Pulmonary Disease Incidence: A Prospective Longitudinal Study AUTHORS: Steven F. Cook PhD, Jana L. Hirschtick PhD, Nancy L. Fleischer PhD, Douglas A. Arenberg MD, Geoffrey D. Barnes MD, MSc, David T. Levy PhD, Luz Maria Sanchez-Romero PhD, Jihyoun Jeon PhD, Rafael Meza PhD JOURNAL: American Journal of Preventive Medicine DESCRIPTION: Introduction: Understanding the relationship between ENDS use and chronic obstructive pulmonary disease and other respiratory conditions is critical. However, most previous studies have not fully adjusted for cigarette smoking history.

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Publication: Behavior, Health Effects

Modeling cigarette smoking disparities between people with and without serious psychological distress in the US, 1997–2100 AUTHORS: Qin Xi, Rafael Meza, Adam Leventhal, Jamie Tam JOURNAL: Preventive Medicine DESCRIPTION: Highlights: First tobacco simulation model of population with serious psychological distress. • 609,000 smoking-attributable deaths to occur in this population through 2100. • Up to 386,000 of these premature deaths could be averted in the population. • Trends in disparities depend on the type of metric used: absolute or relative. • Improving cessation for this group leads to large, short-term public health benefit.

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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, Steven Cook, Akash Patel, Geoffrey D Barnes, MD, Douglas Arenberg, MD, Irina Bondarenko, MS, David T Levy, Jihyoun Jeon, MS, Evelyn Jimenez Mendoza, MS, Rafael Meza, Nancy L Fleischer 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 ...

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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 ...

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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 ...

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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 ...

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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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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, Jihyoun Jeon, James F. Thrasher, David Hammond, Theodore R. Holford, David T. Levy, Rafael Meza 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 ...

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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, ...

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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 ...

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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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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 ...

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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 ...

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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

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 ...

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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 ...

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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 ...

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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, ...

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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 ...

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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, K Michael Cummings, Bryan W Heckman, Yameng Li, MS, Zhe Yuan, MS, Tracy T Smith, Rafael Meza 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 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 ...

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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 Maria Sanchez-Romero, Yameng Li, Zhe Yuan, Jihyoun Jeon, Rafael Meza 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 ...

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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 ...

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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, ...

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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 ...

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Publication: Behavior, Health Effects

Parental Educational Attainment and Black-White Adolescents’ Achievement Gap: Blacks’ Diminished Returns AUTHORS: Assari S, Boyce S, Caldwell C, Bazargan M JOURNAL: Open journal of social sciences DESCRIPTION: Recent research has documented Minorities' Diminished Returns (MDRs), defined as weaker protective effects of parental educational attainment and other socioeconomic status (SES) indicators for racial and ethnic minority groups. To explore racial differences in the associations between parental educational attainment and youth educational outcomes among American high schoolers. This cross-sectional study used baseline data from the Education Longitudinal Study (ELS-2002), a nationally representative ...

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Publication: Behavior, Health Effects

Parental educational attainment and relatives’ substance use of American youth: Hispanics Diminished Returns AUTHORS: Assari S, Caldwell C, Bazargan M JOURNAL: Journal of biosciences and medicines DESCRIPTION: Research on Minorities’ Diminished Returns (MDRs) has shown higher than expected substance use (tobacco and alcohol use) in middle-class Hispanic and Black youth and adults. In theory, some of this more than expected risk might be due to the high substance use problem of the social network. To better understand the role of social network as an explanatory mechanism behind higher than expected substance use of middle-class Hispanic and Black youth, this study tested MDRs of parental educational ...

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Publication: Behavior, Health Effects

Second-Hand Smoke Exposure at Home in the United States; Minorities’ Diminished Returns AUTHORS: Assari S, Bazargan M JOURNAL: International journal of travel medicine and global health DESCRIPTION: Educational attainment and poverty status are two strong socioeconomic status (SES) indicators that protect individuals against exposure to second-hand smoke. Minorities' Diminished Returns (MDRs), however, refer to smaller protective effects of SES indicators among ethnic minority groups such as Hispanics and Blacks, compared to non-Hispanic Whites. This study explored ethnic differences in the effects of educational attainment and poverty status on second-hand smoke exposure in the homes of American ...

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Publication: Behavior, Health Effects

Educational Attainment and Self-Rated Oral Health among American Older Adults: Hispanics’ Diminished Returns AUTHORS: Assari S, Bazargan M JOURNAL: Dentistry journal DESCRIPTION: Background: Minorities' diminished returns (MDRs) refer to systemically weaker effects of socioeconomic status (SES), particularly educational attainment, on the health of non-Whites compared to Whites. Aim: Using a nationally representative sample, we aimed to investigate ethnic differences in the effect of SES (educational attainment) on the self-rated oral health of Hispanic older adults in the US. Methods: This study analyzed the University of Michigan National Poll on Healthy Aging (UM-NPHA) ...

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Publication: Behavior, Health Effects

Unequal Protective Effects of Parental Educational Attainment on the Body Mass Index of Black and White Youth. AUTHORS: Assari S, Boyce S, Bazargan M, Mincy R, Caldwell CH JOURNAL: International journal of environmental research and public health DESCRIPTION: Parental educational attainment is shown to be protective against health problems; the Minorities’ Diminished Returns theory, however, posits that these protective effects tend to be smaller for socially marginalized groups particularly blacks than whites.

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Publication: Behavior, Health Effects

Educational Attainment Better Increases the Chance of Breast Physical Exam for Non-Hispanic Than Hispanic American Women: National Health Interview Survey AUTHORS: Assari S, Bazargan M JOURNAL: Hospital practices and research DESCRIPTION: Background: The Minorities' Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. Objective: The current study explored the racial and ethnic differences in the association between educational attainment and breast physical exam (BPE) among women in the U.S. Methods: The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic ...

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Publication: Behavior, Health Effects

Unequal Effects of Educational Attainment on Workplace Exposure to Second-Hand Smoke by Race and Ethnicity; Minorities’ Diminished Returns in the National Health Interview Survey (NHIS) AUTHORS: Assari S, Bazargan M JOURNAL: Journal of Medical Research and Innovation DESCRIPTION: One of the mechanisms by which high educational attainment promotes populations’ health is through reducing exposure to environmental risk factors such as second-hand smoke. Minorities’ Diminished Returns theory, however, posits that the protective effect of educational attainment may be smaller for racial and ethnic minority individuals particularly Blacks and Hispanics compared to Whites.

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Publication: Behavior, Health Effects

Social Determinants of Polypharmacy in First Generation Mexican Immigrants in the United States AUTHORS: Assari S, Saqib M, Wisseh C, Bazargan M JOURNAL: International journal of travel medicine and global health DESCRIPTION: Introduction: Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults. Methods: Data was obtained from the Sacramento Area Latino Study ...

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