Devan R. Romero

Tobacco Use, Quitting Behavior, and Health Characteristics Among Current Electronic Cigarette Users in a National Tri-Ethnic Adult Stable Smoker Sample

INTRODUCTION The present study characterizes the tobacco use, quitting behaviors, and health characteristics of cigarette smokers who did not change their smoking pattern over the past 6 months and have used electronic cigarettes (ECs) in the past 30 days. This is an important subpopulation to characterize if EC dual use with cigarettes continues to grow. METHODS Participants (N = 2,376) from a research survey panel completed an online cross-sectional survey between June and August 2012. Sampling was stratified to recruit equal numbers of cigarette smoking participants by race/ethnicity (Black, Hispanic, and Caucasian) and smoking frequency (nondaily and daily). All displayed a stable rate of smoking for the past 6 months and were not currently in treatment. Bivariate and multivariate analyses were used to examine correlates of current EC use (any use within the past 30 days). RESULTS Current EC use was reported by 9.2% (n = 219) of the total sample. Of current EC users, 44% reported having used ECs as a quit method. Bivariate and multivariate analyses showed that current EC use was significantly associated with greater nicotine dependence, concurrent poly-tobacco use, more past-year quit attempts, past use of multiple cessation methods, and more depressive symptoms. No demographic variables were significantly associated with current EC use. CONCLUSIONS This study suggests that stable smokers who currently use ECs possess characteristics that are associated with difficulty in achieving smoking cessation. These characteristics should be considered when examining the effectiveness of ECs on cessation and in designing future cessation trials using ECs.

Tobacco Consumption and Toxicant Exposure of Cigarette Smokers Using Electronic Cigarettes

Background There is considerable debate about the benefits and risks of electronic cigarettes (ECs). To better understand the risk-benefit ratio of ECs, more information is needed about net nicotine consumption and toxicant exposure of cigarette smokers switching to ECs. Methods Forty cigarette smokers (≥1 year of smoking) interested in switching to ECs but not necessarily quitting smoking were enrolled in a 4-week observational study and provided an e-Go C non-variable battery and refillable atomizers and choice of eight flavors in 12 or 24 mg nicotine dosage. Measurement of urinary cotinine (metabolite of nicotine), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; a pulmonary carcinogen), and eight volatile organic compounds (VOCs) that are toxic tobacco smoke constituents was conducted at baseline and week 4. Results All participants with follow-up data (92.5%) reported using the study EC. Of the 40 smokers, 16 reported no cigarettes at week 2 (40%) and six continued to report no cigarettes at week 4 (15%). Change in nicotine intake over the 4 weeks was non-significant (p = .90). Carbon monoxide (p < .001), NNAL (p < .01) and metabolites of benzene (p < .01) and acrylonitrile (p = .001) were significantly decreased in the study sample. Smokers switching exclusively to ECs for at least half of the study period demonstrated significant reductions in metabolites of ethylene oxide (p = .03) and acrylamide (p < .01). Conclusion Smokers using ECs over 4 weeks maintained cotinine levels and experienced significant reductions in carbon monoxide, NNAL, and two out of eight measured VOC metabolites. Those who switched exclusively to ECs for at least half of the study period significantly reduced two additional VOCs. Implications This study extends current literature by measuring change in smoking dependence and disease-associated biomarkers, NNAL and a panel of eight common VOCs that are toxic tobacco smoke constituents in smokers who switch to ECs. The findings support the idea of harm reduction, however some levels of toxicant exposure are still of clinical concern, particularly for dual users. Extrapolation of these results must be careful to separate the different toxic exposure results for exclusive switchers versus dual cigarette + EC users, and not to equate harm reduction with the idea that using ECs is harmless.

Perceived Harm of Tobacco Products and Individual Schemas of a Smoker in Relation to Change in Tobacco Product Use Over One Year Among Young Adults

Introduction: Given increases in nondaily smoking and alternative tobacco use among young adults, we examined the nature of change of various tobacco product use among college students over a year and predictors of use at one-year follow-up. Methods: An online survey was administered to students at six Southeast colleges and universities (N = 4,840; response rate = 20.1%) in Fall 2010, with attempts to follow up in Fall 2011 with a random subsample of 2,000 participants (N = 718; response rate = 35.9%). Data were analyzed from 698 participants with complete data regarding tobacco, marijuana, and alcohol use over a one-year period, perceived harm of tobacco use, and schemas of a “smoker” (as per the Classifying a Smoker Scale). Results: Baseline predictors of current smoking at follow-up included being White (p = .001), frequency of smoking (p < .001), alternative tobacco use (p < .001), and perceived harm of smoking (p = .02); marginally significant predictors included marijuana use (p = .06) and lower scores on the Classifying a Smoker Scale (p = .07). Baseline predictors of current smoking at follow-up among baseline nondaily smokers included more frequent smoking (p = .008); lower Classifying a Smoker Scale score was a marginally significant predictor (p = .06). Baseline predictors of alternative tobacco use at follow-up included being male (p = .007), frequency of smoking (p = .04), alternative tobacco use (p < .001), and frequency of alcohol use (p = .003); marginally significant predictors included marijuana use (p = .07) and lower perceived harm of smokeless tobacco (p = .06) and cigar products (p = .08). Conclusions: Tobacco control campaigns and interventions might target schemas of a smoker and perceived risks of using various tobacco products, even at low levels.

Light and intermittent smoking among California Black, Hispanic/Latino, and non-Hispanic White men and women.

INTRODUCTION The prevalence of light and intermittent smoking (LITS) is increasing as the prevalence of heavier smoking continues to fall. The purpose of this study was to examine changes in LITS over time among Blacks, Hispanic/Latinos (Latinos) and non-Hispanic Whites (Whites). METHODS Data from the California Tobacco Surveys from 1990, 1992, and 1996 (Time 1 [T1]) were combined and compared to combined data from 1999, 2002, 2005, and 2008 (Time 2 [T2]). T1 participants (N = 50,424) included Blacks (n = 3,029), Latinos (n = 7,910), and Whites (n = 39,485). T2 participants (N = 53,005) included Blacks (n = 5,460), Latinos (n = 14,273), and Whites (n = 33,246). RESULTS LITS increased by a factor of 12.9% to a rate of 79.6% (76.0-83.2) among Latinos, by 19.4% to a rate of 74.4% (70.9-77.9) among Blacks, and by 51.7% to a rate of 48.9% (47.5-50.3) among Whites. In unadjusted analyses at T1, females were more likely to be LITS than males across ethnic groups. At T2, this sex difference was maintained among Whites, but not Blacks and Latinos. Females were significantly more likely to be LITS than males when controlling for demographic variables. CONCLUSIONS The present study found that LITS rates increased over time for male and female Black, Latino and White adults. There is a need for increased tobacco control attention to LITS across all ethnic groups, but with additional focus on Blacks, Latinos, and women who have the highest rates of LITS.

Classifying a Smoker Scale in Adult Daily and Nondaily Smokers

INTRODUCTION Smoker identity, or the strength of beliefs about oneself as a smoker, is a robust marker of smoking behavior. However, many nondaily smokers do not identify as smokers, underestimating their risk for tobacco-related disease and resulting in missed intervention opportunities. Assessing underlying beliefs about characteristics used to classify smokers may help explain the discrepancy between smoking behavior and smoker identity. This study examines the factor structure, reliability, and validity of the Classifying a Smoker scale among a racially diverse sample of adult smokers. METHODS A cross-sectional survey was administered through an online panel survey service to 2,376 current smokers who were at least 25 years of age. The sample was stratified to obtain equal numbers of 3 racial/ethnic groups (African American, Latino, and White) across smoking level (nondaily and daily smoking). RESULTS The Classifying a Smoker scale displayed a single factor structure and excellent internal consistency (α = .91). Classifying a Smoker scores significantly increased at each level of smoking, F(3,2375) = 23.68, p < .0001. Those with higher scores had a stronger smoker identity, stronger dependence on cigarettes, greater health risk perceptions, more smoking friends, and were more likely to carry cigarettes. Classifying a Smoker scores explained unique variance in smoking variables above and beyond that explained by smoker identity. CONCLUSIONS The present study supports the use of the Classifying a Smoker scale among diverse, experienced smokers. Stronger endorsement of characteristics used to classify a smoker (i.e., stricter criteria) was positively associated with heavier smoking and related characteristics. Prospective studies are needed to inform prevention and treatment efforts.

Disparities in the Population Distribution of African American and Non-Hispanic White Smokers Along the Quitting Continuum

Purpose. To examine disparities and changes over time in the population-level distribution of smokers along a cigarette quitting continuum among African American smokers compared with non-Hispanic Whites. Methods. Secondary data analyses of the 1999, 2002, 2005, and 2008 California Tobacco Surveys (CTS). The CTS are large, random-digit-dialed, population-based surveys designed to assess changes in tobacco use in California. The number of survey respondents ranged from n = 6,744 to n = 12,876 across CTS years. Current smoking behavior (daily or nondaily smoking), number of cigarettes smoked per day, intention to quit in the next 6 months, length of most recent quit attempt among current smokers, and total length of time quit among former smokers were assessed and used to recreate the quitting continuum model. Results. While current smoking rates were significantly higher among African Americans compared with non-Hispanic Whites across all years, cigarette consumption rates were lower among African Americans in all years. There were significant increases in the proportion of former smokers who had been quit for at least 12 months from 1999 (African Americans, 26.8% ± 5.5%; non-Hispanic Whites, 36.8% ± 1.6%) to 2008 (African Americans, 43.6% ± 4.1%; non-Hispanic Whites, 57.4% ± 2.9%). The proportion of African American former smokers in each CTS year was significantly lower than that of non-Hispanic Whites. Conclusions. Despite positive progression along the quitting continuum for both African American and non-Hispanic White smokers, the overall distribution was less favorable for African Americans. The lower smoking consumption levels among African Americans, combined with the lower rates of successful smoking cessation, suggest that cigarette addiction and the quitting process may be different for African American smokers.

Cardiovascular Disease Risk Perception and Knowledge: A Comparison of Hispanic and White College Students in a Hispanic-Serving Institution.

There are clear health conditions that disproportionately affect the Hispanic population. One hundred twenty-four (45%) Hispanic and 153 (55%) White college students completed a questionnaire on cardiovascular disease (CVD) awareness, knowledge, and perceptions of risk. Results indicated that Hispanic students rated themselves as poorer in health, more overweight, poorer in nutrition, and less knowledgeable about CVD risk than did White students. Practitioners would benefit from developing CVD prevention programs that targeted the Hispanic population.

Tobacco use disparities by racial/ethnic groups: California compared to the United States

Racial/ethnic disparities in cigarette use and cessation persist. This study compared cigarette consumption and former smoking trends in California (CA) with the rest of the United States (US) by racial/ethnic categories of non-Hispanic White, Black, Hispanic/Latino, and Asian/Pacific Islander groups. Data were analyzed from the 1992 to 2011 Tobacco Use Supplement to the Current Population Survey. Consumption levels across decades were examined and adjusted logistic regression models were fit to compare across CA and US. Results indicated steady declines in ever smoking prevalence for all groups with much lower magnitudes of change among US Blacks and Whites compared to their CA counterparts. After controlling for age, gender, and education, CA had significantly fewer heavy smokers (OR=0.45, 95% CI:0.38-0.54), more light and intermittent smokers (LITS; OR=1.68, 95%CI: 1.45-1.93), and a greater proportion of former smokers (OR=1.35, 95%CI: 1.24-1.48) than the rest of US. Data were stratified by race/ethnicity and the patterns shown were mostly consistent with CA performing statistically better than their US counterparts with the exception of Black LITS and Asian/Pacific Islander former smokers. Californias success in reducing tobacco use disparities may serve as a prime example of tobacco control policy for the country. CA and the US will need to continue to address tobacco use and cessation in the context of the growing diversity of the population.

Cigarette Smoking Among Asian American and Pacific Islander College Students Implications for College Health Promotion

Asian Americans (AA) and Pacific Islanders (PI) are an understudied population for health and tobacco use, which is alarming for a fast growing U.S. population. Research in smoking among AA and PI college students is limited, despite 50% of AA and 20% of PI having obtained a college degree. A cross-sectional tobacco survey was administered in a large racially diverse Southern California university (N = 490) that examined smoking behavior, psychosocial, and perceptual factors related to smoking among AA and PI compared with Caucasians. Overall, 19% of participants were smokers. The prevalence of current smoking by race was 26% PI, 19% AA, and 17% Caucasian. AA and PI are light, infrequent smokers who smoke mainly for social reasons and in social locations. Most AA and PI made quit attempts and reported intention to quit smoking. Low to moderate risk perceptions for addiction, disease and difficulty in quitting were observed. Social norms center on family influences, therefore it is recommended that cessation approaches target cigarette smoking norms within this social environment to increase perceptual risks of smoking. Smoking cessation should be placed in college health outreach programs based on culturally tailored approaches for AA and PI that target their unique smoking characteristics.

Psychosocial and Behavioral Characteristics Among Subgroups of Nondaily College Student Smokers

Nondaily smoking is becoming common in young adults and there appear to be different characteristics associated with past month smoking frequency among nondaily smokers. The present study examines behavioral and psychosocial correlates of smoking among subgroups of nondaily college student smokers (N = 80; 18–25 years of age) attending a large, public university. Nondaily smokers were categorized based on the frequency of days smoked in the past month and were divided into two subgroups: 1–5 days and 6–29 days. A quarter of nondaily smokers considered themselves as a smoker and significantly more 6–29 nondaily smokers were identified as a smoker and smoked more cigarettes per day (CPD). Almost half (45%) of nondaily smokers have attempted to quit smoking completely and 71% of the 6–29 nondaily smokers reported significantly higher quit attempts. The 6–29 nondaily smokers had significantly higher perceived risk related to smoking. Self-efficacy to abstain from smoking was significantly higher for 1–5 nondaily smokers. These results suggest heterogeneity among subgroups of nondaily college student smokers exists in a number of behavioral and psychosocial factors. Prevention and cessation strategies may be improved by considering frequency of nondaily smoking and targeting subgroups differently.