TCORS: Publications, Preprints + Posters

Publications, Preprints + Posters

Publications by Scientific Domain

Impact Analysis

Understanding impact of potential FDA regulatory actions

62

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Health Effects

Understanding the short and long term health effects of tobacco products

57

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Behavior

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

118

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Publication: Impact Analysis

The Lifetime Mortality Implications of Vaping and Smoking Initiated During Adolescence AUTHORS: Kenneth E Warner, Ruoyan Sun, Andrew F Brouwer, David Méndez JOURNAL: American journal of preventive medicine DESCRIPTION: If youth vaping affects lifetime premature mortality, the increase or decrease is projected to be very small.

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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: Impact Analysis

Electronic cigarettes for smoking cessation AUTHORS: Nicola Lindson, Jonathan Livingstone-Banks, Ailsa R Butler, Hayden McRobbie, Christopher R Bullen, Peter Hajek, Angela Difeng Wu, Rachna Begh, Annika Theodoulou, Caitlin Notley, 4 more JOURNAL: The Cochrane database of systematic reviews DESCRIPTION: RATIONALE: Electronic cigarettes (EC) are handheld electronic vaping devices that produce an aerosol by heating a liquid. People who smoke, healthcare providers, and regulators want to know if EC can help people quit smoking, and if they are safe to use for this purpose. This review update was conducted as part of a living systematic review.

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Publication: Impact Analysis

Lifecycle Management as a Roadmap to the Tobacco Endgame AUTHORS: Shervin Assari, John Ashley Pallera, Mahmoud Efatmaneshnik JOURNAL: World journal of clinical medicine research DESCRIPTION: Seeing tobacco control as a complex enterprise that operates under a lifecycle model may offer a roadmap for achieving and sustaining the tobacco endgame. Using this approach may enhance policy coherence, resource efficiency, and adaptability, ensuring tobacco endgame is achieved.

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Publication: Impact Analysis

SimSmoke simulation models distinguished by race/ethnicity: past and future trends and the potential role of policy AUTHORS: David T Levy, PhD; James H Buszkiewicz, PhD; Zhe Yuan, MSc; Yameng Li, MSc; Rafael Meza, PhD; Nancy L Fleischer, PhD JOURNAL: Journal of the National Cancer Institute Monographs DESCRIPTION: Policy interventions to reduce racial/ethnic cigarette smoking and related health disparities are needed to improve health equity. Simulation models can be useful in gauging the impact of tobacco control policies on trends in smoking-related outcomes, but few have systematically analyzed the impact of tobacco control policies across racial/ethnic groups.

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Publication: Impact Analysis

Impact of state cigarette and e-cigarette flavors bans on smoking, vaping and dual use in the United States AUTHORS: John Buckell, Jamie Tam, Evelyn Jimenez Mendoza, Rafael Meza, Jody Sindelar JOURNAL: Drug and Alcohol Dependence DESCRIPTION: Highlights: • An online survey measured impacts of bans on flavored tobacco products among US young adults; • Those who dual use appeared to reduce vaping in response to e-cigarette flavors bans; • Those who dual use in Massachusetts appeared to reduce vaping and smoking. Background and Aims: Some states have banned flavors in various tobacco products. This can reduce use of banned products and induce substitution towards non-banned products. The net impact must be determined empirically. The aim of this study is to evaluate the impacts of these bans on both use and substitution

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Publication: Impact Analysis

The impacts of e-cigarette flavours: An overview of systematic reviews AUTHORS: Jonathan Livingstone-Banks, Nargiz Travis, Monserrat Conde, Yixian Crystal Chen, Padmo Zi, Holly Jarman, Nicola Lindson, Jamie Hartmann-Boyce JOURNAL: Addiction (Abingdon, England) DESCRIPTION: Non-tobacco flavourings for e-cigarettes may increase e-cigarette appeal and harms; this increase may vary by flavour and apply across different population groups. The impacts of e-cigarette flavours on e-cigarette and cigarette use are inconclusive.

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Publication: Impact Analysis

Tobacco product flavour policies in the USA AUTHORS: Travis R Whitacre, Alyssa Crippen, Mayah Monthrope, Tanisha Narine, Alex C Liber, Abigail S Friedman JOURNAL: Tobacco control DESCRIPTION: While state and local adoption of restrictions on flavoured tobacco product sales has proliferated, flavour policy coverage for combustible tobacco products lags well behind that for ENDS. If this leads some people who vape flavoured ENDS to substitute towards flavoured cigars and/or menthol cigarettes, this policy combination could harm population health.

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Publication: Impact Analysis

Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use AUTHORS: Abigail S Friedman, Michael F Pesko, Travis R Whitacre JOURNAL: JAMA Health Forum DESCRIPTION: Importance: More than one-quarter of US residents live in states or localities that restrict sales of flavored electronic nicotine delivery systems (ENDS), often as a means to reduce youth vaping. Yet, how these policies affect young adult vaping and smoking remains unclear. Objective: To estimate the effects of ENDS flavor restrictions on ENDS use and cigarette smoking among young adults (age 18-29 years) in the US.

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Publication: Impact Analysis

US Tobacco 21 Policies and Potential Mortality Reductions by State AUTHORS: Jamie Tam, Alyssa Crippen, Abigail Friedman, Jihyoun Jeon, David C Colston, Nancy L Fleischer, Catherine A Vander Woude, Megan A Boelter, Theodore R Holford, David T Levy, 1 more JOURNAL: JAMA health forum DESCRIPTION: CONCLUSIONS AND RELEVANCE: This study found that early adoption and implementation of T21 policies maximizes potential premature mortality reductions. However, the strength of T21 policies and enforcement varies widely across states. Enforcement of the federal T21 law is critical in the 8 states without state-level T21 cigarette policies of their own.

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Publication: Behavior, Impact Analysis

Potential Policy Targets to Reduce Vaping Among Youths AUTHORS: Andrew F Brouwer, Jamie Hartmann-Boyce, Abigail S Friedman JOURNAL: JAMA network open DESCRIPTION: This cross-sectional study uses Population Assessment of Tobacco and Health study data to estimate the association between different policy targets and electronic nicotine delivery system use among US youths compared with adults.

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Publication: Behavior, Impact Analysis

The longitudinal association between coupon receipt and established cigarette smoking initiation among young adults in USA AUTHORS: Leeann Nicole Siegel, Steven Cook, Hayoung Oh, Alex C Liber, David T Levy, Nancy L Fleischer JOURNAL: Tobacco control DESCRIPTION: These findings show that receiving tobacco coupons may increase the likelihood that young adults will initiate established cigarette smoking, underscoring the need to address the effects of this tobacco marketing tactic.

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Publication: Impact Analysis

MRTP claim authorisation and General Snus sales in the USA: evidence from a difference-in-differences model AUTHORS: Alex C Liber, Andrew B Seidenberg, Michael F Pesko JOURNAL: Tobacco control DESCRIPTION: Background: The 2009 Tobacco Control Act granted the US Food and Drug Administration (FDA) regulatory authority over tobacco products, including the ability to authorise modified-risk tobacco product (MRTP) claims. In October 2019, the FDA authorised the first-ever MRTP claim for General Snus, which allowed the product to be marketed as reduced risk (relative to cigarettes). MRTP authorisation may increase otherwise low rates of snus use in the USA (

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Publication: Behavior, Impact Analysis

Cigarette Smoking Relapse Among People Who Switched to E-cigarettes or Other Tobacco Products AUTHORS: Ruoyan Sun, David Mendez, Kenneth E Warner JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: Compared with respondents who had recently quit and were tobacco-free at follow-up 1, those who switched to non-cigarette tobacco products may be more likely to slip but showed no difference in the likelihood of relapse when employing a relapse definition less strict than any smoking in the past 12 months.

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Publication: Behavior, Impact Analysis

Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of adults in the PATH Study in 2017-2019 vs 2019-2021 AUTHORS: Andrew F Brouwer, Jihyoun Jeon, Evelyn Jimenez-Mendoza, Stephanie R Land, Theodore R Holford, Abigail S Friedman, Jamie Tam, Ritesh Mistry, David T Levy, Rafael Meza JOURNAL: Tobacco control DESCRIPTION: The persistence of ENDS use among adults remained high in 2019-2021, but a larger fraction of dual users transitioned to ENDS-only use compared with 2017-2019. Because the fraction of cigarette-only users switching to dual use remained low, especially among older adults, the public health implications of this change are minimal.

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Publication: Behavior, Impact Analysis

Responses to Real-World and Hypothetical E-Cigarette Flavor Bans Among US Young Adults Who Use Flavored E-Cigarettes AUTHORS: Jamie Tam, Evelyn Jimenez-Mendoza, John Buckell, Jody Sindelar, Rafael Meza JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: Young adults who vape flavored e-cigarettes have mixed responses to e-cigarette flavor bans. Under both real-world and hypothetical e-cigarette flavor bans, most who use flavored e-cigarettes continue vaping. Under a real-world ban, the second most common response among those who exclusively vape is to switch to smoking; under a hypothetical federal ban, it is to quit all tobacco.

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Publication: Impact Analysis

How Complete Are Tobacco Sales Data? Assessing the Comprehensiveness of US Tobacco Product Retail Sales Data Through Comparisons to Excise Tax Collections AUTHORS: Alex C Liber, Maryam Faraji, Radhika Ranganathan, Abigail S Friedman JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: IRI and Nielsen sales data capture almost the entire US cigarette market and a substantial but lower portion of the US ENDS market. With proper care to address shortcomings, sales data analyses can capture changes in the US market for these tobacco products.

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Publication: Impact Analysis

Cross-State Border Nicotine Vaping Products Purchase-Early Evidence From State Emergency Sales Restrictions in 2019 AUTHORS: Kai-Wen Cheng, Alex C Liber, David T Levy JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: Our study identified significant cross-state border NVP purchases in all studied states to circumvent NVP emergency sales restrictions in response to the EVALI outbreak. Policymakers should factor in these purchasing behaviors to evade sales restrictions when evaluating any future potential policies at the state or local levels.

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Publication: Behavior, Impact Analysis

The Public Health Impact of a Ban on Flavored Cigars: A Decision-Theoretic Policy Framework AUTHORS: David T Levy, Christopher Cadham, Yoonseo Mok, Nargiz Travis, James H Buszkiewicz, Jihyoun Jeon, Nancy L Fleischer, Rafael Meza JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: INTRODUCTION: Half of adult cigar users report flavored cigars as their usual brand. The FDA proposed prohibiting "all characterizing flavors in cigars" and "menthol… in cigarettes." We provide evidence on cigar and cigarette transitions and a framework to assess the impact of a U.S. flavored cigar ban.

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Publication: Impact Analysis

The Benefits of Quitting Smoking at Different Ages AUTHORS: Thuy T T Le, David Mendez, Kenneth E Warner JOURNAL: American journal of preventive medicine DESCRIPTION: Quitting smoking early will avoid most years otherwise lost due to smoking. Even those who quit at ages 65 and above can still meaningfully increase their life expectancy.

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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: Behavior, Impact Analysis

Responses to Real-World and Hypothetical Menthol Flavor Bans Among US Young Adults Who Smoke Menthol Cigarettes AUTHORS: Jamie Tam, Evelyn Jimenez-Mendoza, John Buckell, Jody Sindelar, Rafael Meza JOURNAL: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco DESCRIPTION: Under real-world and hypothetical menthol cigarette bans, most respondents continued smoking. However, more young adults continued smoking following real-world bans, reflecting the limitations of local/state restrictions when menthol cigarettes are available in other jurisdictions.

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Publication: Impact Analysis

Would banning menthol cigarettes, flavored cigars, and flavored e-cigarettes prompt users to seek illicit channels for obtaining them in the United States? AUTHORS: Yong Yang, Eric N Lindblom, Kenneth D Ward, Ramzi G Salloum JOURNAL: Preventive medicine DESCRIPTION: A significant proportion of users of flavored tobacco and nicotine products would not reject using illicit banned products. Tailored programs are needed to apply to the groups with a higher risk of seeking illicit channels for banned products.

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Publication: Impact Analysis

Should menthol e-cigarettes be banned? Reaction of adult smokers and users of e-cigarettes to hypothetical bans AUTHORS: Yong Yang, Eric N Lindblom, Kenneth D Ward, Ramzi G Salloum JOURNAL: Tobacco Control DESCRIPTION: Introduction: This study examines how current smokers using menthol cigarettes or flavoured cigars, and current users of flavoured e-cigarettes may respond to three hypothetical flavour-ban scenarios: (1) banning only menthol cigarettes and flavoured cigars; (2) also banning e-cigarettes with any non-tobacco flavours except menthol; and (3) also banning e-cigarettes with any non-tobacco flavours, including menthol. Methods: Recruited from mTurk, respondents were asked if they would quit all tobacco-nicotine ...

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Publication: Impact Analysis

E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales AUTHORS: Abigail Friedman, Alex C. Liber, Alyssa Crippen, Michael Pesko JOURNAL: SSRN DESCRIPTION: Over 375 US localities and 7 states have adopted permanent restrictions on sales of flavored electronic nicotine delivery systems (“ENDS”). These policies’ effects on combustible cigarette use (“smoking”), a more lethal habit, remain unclear. Matching new flavor policy data to retail sales data, we find a tradeoff of 15 additional cigarettes for every 1 less 0.7 mL ENDS pod sold due to ENDS flavor restrictions. Further, cigarette sales increase even among brands disproportionately used ...

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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: Behavior, Impact Analysis

Characterization of trajectories of physical activity and cigarette smoking from early adolescence to adulthood AUTHORS: Iris Yuefan Shao, Shakira F Suglia, Weihua An, David Mendez, Viola Vaccarino, Alvaro Alonso JOURNAL: BMC public health DESCRIPTION: There are three distinct subgroups of individuals sharing similar PA and cigarette smoking behavioral profile respectively from adolescence to adulthood in the Add Health study population. Behavioral interventions that focus on neighborhood environment (e.g. establish community-based activity center) and relationship to peers during adolescence (e.g. peer counseling) could be key to long-term PA promotion and cigarette smoking cessation.

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Publication: Impact Analysis

Potential Implications for Tobacco Industry Transformation of the Acquisition of Swedish Match by Philip Morris International AUTHORS: David T Levy, Kenneth E Warner, Alex C Liber, Nargiz Travis, David T Sweanor, Rafael Meza, K Michael Cummings JOURNAL: Nicotine & tobacco research DESCRIPTION: Philip Morris International's recent purchase of Swedish Match may prove to be a vital tobacco industry development. We focus on PMI's potential progress in moving from primarily selling cigarettes towards primarily selling non-combustible nicotine delivery products (NCNDPs). We also consider the potential contribution of the acquisition to industry transformation whereby other cigarette firms may potentially move towards primarily selling NCNDPs. We examine the potential impact on non-combustible ...

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Publication: Behavior, Impact Analysis

Longitudinal transitions in initiation, cessation, and relapse of cigarette smoking and e-cigarette use among US youth and adults: Validation of a microsimulation model AUTHORS: Eli Schwamm, Farzad Noubary, Nancy A Rigotti, Krishna P Reddy JOURNAL: Public Library of Science (PLoS One) DESCRIPTION: Introduction: Estimates of initiation, cessation, and relapse rates of tobacco cigarette smoking and e-cigarette use can facilitate projections of longer-term impact of their use. We aimed to derive transition rates and apply them to validate a microsimulation model of tobacco that newly incorporated e-cigarettes. Methods: We fit a Markov multi-state model (MMSM) for participants in Waves 1-4.5 of the Population Assessment of Tobacco and Health (PATH) longitudinal study. The MMSM had nine cigarette ...

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Publication: Behavior, Impact Analysis

Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of youth and adults in the PATH Study in 2015-2017 vs 2017-2019 AUTHORS: Andrew F Brouwer, Jihyoun Jeon, Evelyn Jimenez-Mendoza, Stephanie R Land, Theodore R Holford, Abigail S Friedman, Jamie Tam, Ritesh Mistry, David T Levy, Rafael Meza JOURNAL: Tobacco control DESCRIPTION: Introduction: It is unknown how recent changes in the tobacco product marketplace have impacted transitions in cigarette and electronic nicotine delivery system (ENDS) use. Methods: A multistate transition model was applied to 24 242 adults and 12 067 youth in waves 2-4 (2015-2017) and 28 061 adults and 12 538 youth in waves 4 and 5 (2017-2019) of the Population Assessment of Tobacco and Health Study. Transition rates for initiation, cessation and product transitions were estimated in multivariable ...

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Publication: Behavior, Impact Analysis

The Role of Flavored Electronic Nicotine Delivery Systems in Smoking Cessation: A Systematic Review AUTHORS: Alex C. Liber, Marie Knoll, Christopher J. Cadham, Mona Issabakhsh, Hayoung Oh, Steve Cook, Kenneth E. Warner, Ritesh Mistry, David T. Levy JOURNAL: Drug and Alcohol Dependence Reports DESCRIPTION: Background Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation. Methods We searched EMBASE OVID, PsychInfo, and Medline databases for studies that: 1) examined cigarette cessation outcomes for persons using ENDS (intent, attempts, and success) and 2) reported results separated by respondent's ENDS flavor used. We extracted crude and adjusted odds ratios for associations ...

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Publication: Impact Analysis

Do Tobacco Companies Have an Incentive to Promote “Harm Reduction” Products?: The Role of Competition AUTHORS: David T Levy, Frances Thirlway, David Sweanor, Alex Liber, Luz Maria Sanchez-Romero, Rafael Meza, Clifford E Douglas, K Michael Cummings JOURNAL: Nicotine & tobacco research DESCRIPTION: Background: Some cigarette companies have started to talk about replacing cigarettes with less harmful alternatives, which might include nicotine vaping products (NVPs), heated tobacco products (HTPs) and oral nicotine delivery products (ONDPs). We consider market competition as a primary driver of whether cigarette companies follow through on their stated intentions. Methods: We focus on the behavior of cigarette companies in the US. We compare competition in the pre- and post-2012 time periods, ...

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Publication: Impact Analysis

Chemical Profiles and Toxicity of Electronic Cigarettes: An Umbrella Review and Methodological Considerations AUTHORS: Nargiz Travis, Marie Knoll, Steven Cook, Hayoung Oh, Christopher J. Cadham, Luz María Sánchez-Romero, David T. Levy JOURNAL: International Journal of Environmental Research and Public Health DESCRIPTION: Background: Electronic cigarettes (ECs) are often marketed as a safer alternative to combustible tobacco products. The global EC market has rapidly expanded since their introduction, creating an urgent need for research describing the toxicity and chemical composition of ECs. We conducted an umbrella review to summarize the evidence from existing systematic reviews (SRs). Methods: The search for SRs was conducted across four electronic databases through 25 January 2022. Methodological quality was ...

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Publication: Impact Analysis

Reactions to hypothetical flavor bans among current users of flavored e-cigarettes AUTHORS: Yong Yang, Eric N Lindblom, Kenneth D Ward, Ramzi G Salloum JOURNAL: Translational behavioral medicine DESCRIPTION: Banning flavors in e-cigarettes and other tobacco products may decrease their use. To examine how current users of flavored e-cigarettes might react to a ban on flavored e-cigarettes when: (i) menthol flavor is banned together with other flavors, or (ii) this ban on e-cigarettes is combined with a ban on menthol cigarettes and flavored cigars. A national cross-sectional survey of 2,347 current users of flavored e-cigarettes was conducted in May 2022. For each hypothetical ban scenario, respondents ...

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Publication: Impact Analysis

United States public health officials need to correct e-cigarette health misinformation AUTHORS: Michael F. Pesko, K. Michael Cummings, Clifford E. Douglas, Jonathan Foulds, Thomas Miller, Nancy A. Rigotti, Kenneth E. Warner JOURNAL: Addiction DESCRIPTION: Health misinformation is harmful as it can cause confusion and sow mistrust regarding the adoption of public health recommendations and policies. We provide examples of e-cigarette misinformation promoted by the United States public health officials, which have persisted despite new data challenging the validity of the original assertions. The Surgeon General of the United States (SG) recently launched an initiative to reduce health misinformation. In an advisory [1], he wrote: ‘Health misinformation ...

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Publication: Impact Analysis

The actual and anticipated effects of restrictions on flavoured electronic nicotine delivery systems: a scoping review AUTHORS: Christopher J. Cadham, Alex C. Liber, Luz María Sánchez-Romero, Mona Issabakhsh, Kenneth E. Warner, Rafael Meza, David T. Levy JOURNAL: BMC Public Health DESCRIPTION: Objective: To synthesize the outcomes of policy evaluations of flavoured electronic nicotine delivery systems (ENDS) restrictions. Data sources: PubMed, Scopus, Embase and Web of Science before May 3, 2022. Study selection: Studies that report sales, behaviour, or compliance outcomes related to implemented or hypothetical ENDS flavour restrictions.

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Publication: Impact Analysis

Assessing toxicant emissions from e-liquids with DIY additives used in response to a potential flavour ban in e-cigarettes AUTHORS: Ahmad El-Hellani, Eric K Soule, Mohammad Daoud, Rola Salman, Rachel El Hage, Ola Ardati, Malak El-Kaassamani, Amira Yassine, Nareg Karaoghlanian, Soha Talih, Najat Saliba, Alan Shihadeh JOURNAL: Tobacco Control DESCRIPTION: Significance: Electronic cigarettes (e-cigarettes) aerosolise liquids that contain nicotine, propylene glycol, glycerol and appealing flavours. In the USA, regulations have limited the availability of flavoured e-cigarettes in pod-based systems, and further tightening is expected. In response, some e-cigarette users may attempt to make their e-liquids (do-it-yourself, DIY). This study examined toxicant emissions from several aerosolised DIY e-liquids.

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Publication: Impact Analysis

A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products AUTHORS: David T. Levy, Christopher J. Cadham, Yameng Li, Zhe Yuan, Alex C. Liber, Hayoung Oh, Nargiz Travis, Mona Issabakhsh, David T. Sweanor, Luz Maria Sánchez-Romero, Rafael Meza, K. Michael Cummings JOURNAL: International Journal of Environmental Research and Public Health DESCRIPTION: Abstract: Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by ...

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Publication: Impact Analysis

A Proposed Policy Agenda For Electronic Cigarettes In The US: Product, Price, Place, And Promotion AUTHORS: Kenneth E. Warner, Karalyn A. Kiessling, Clifford E. Douglas, Alex C. Liber JOURNAL: Health Affairs DESCRIPTION: Growth in the market for electronic cigarettes (e-cigarettes) raises complex questions about the devices’ public health implications and, hence, challenging policy issues. We propose a policy agenda addressing concerns about preventing youth uptake of e-cigarettes and the desire to realize the potential of e-cigarettes to increase adult cigarette smoking cessation. We organize interventions according to the “four Ps” of marketing: product, price, place, and promotion. Policies include decreasing ...

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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, 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. ...

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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 ...

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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 ...

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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 ...

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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 ...

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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, 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: 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 ...

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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, 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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