Jane A. Allen

Epidemiology of menthol cigarette use

Approximately one-fourth of all cigarettes sold in the United States are mentholated. An understanding of the consequences, patterns, and correlates of menthol cigarette use can guide the development and implementation of strategies to reduce smoking prevalence and smoking-attributable morbidity and mortality. This paper summarizes the literature on the health effects of mentholated cigarettes and describes various patterns of use as indicated by consumption and survey data from the United States and other nations. The epidemiological literature on menthol cigarettes and cancer risk is inconclusive regarding whether these cigarettes confer a risk for cancer above that of nonmentholated varieties. Available data indicate that mentholated cigarettes are at least as dangerous as their nonmentholated counterparts. In addition, because mentholation improves the taste of cigarettes for a substantial segment of the smoking population and appears to mask disease symptoms, this additive may facilitate initiation or inhibit quitting. Menthol market share is high in the Philippines (60%), Cameroon (35%-40%), Hong Kong (26%), the United States (26%), and Singapore (22%). Newport has become the leading menthol brand in the United States. Surveys from four nations indicate that menthol use among adult smokers is more common among females than males. Among U.S. smokers, 68.9% of Blacks, 29.2% of Hispanics, and 22.4% of Whites reported smoking a mentholated variety. Research is needed to better explain factors that may influence menthol preference, such as marketing, risk perceptions, brand formulation, and taste preferences. Such research would guide the development of potentially more effective programs and policies.

Are menthol cigarettes a starter product for youth

This study assessed the relationship between menthol use and nicotine dependence. Data from the National Youth Tobacco Survey indicated that menthol cigarette use was significantly more common among newer, younger smokers. Additionally, youth who smoked menthol cigarettes had significantly higher scores on a scale of nicotine dependence compared with nonmenthol smokers, controlling for demographic background and the length, frequency, and level of smoking. The study suggests that menthol cigarettes are a starter product that may be associated with smoking uptake by youth.

Effects of Race/Ethnicity and Socioeconomic Status on Health Information-Seeking, Confidence, and Trust

Introduction. It is critical continually to monitor the influence of race/ethnicity and socioeconomic status in health information-seeking, confidence, and trust to ensure that health messages reach those most in need. Methods. Using data from the 2007 Health Information National Trends Survey (HINTS), multivariable logistic regression assessed the effects of race/ethnicity, education, and income on health information-seeking, confidence in obtaining health information, and trust of information sources. Results. Respondents of lower education were less likely to seek health information, and along with those of lower incomes had decreased confidence in their ability to obtain health information. Blacks, Hispanics, and those of lower income endorsed a lower level of trust in doctors and other health care professionals than non-Hispanic Whites and those of higher income, respectively. Conclusions. Improving the development and delivery of health information intended for minority and vulnerable populations may help reduce existing disparities in health information-seeking and care.

Providing accurate safety information may increase a smoker's willingness to use nicotine replacement therapy as part of a quit attempt.

AIM Previous studies have reported that smokers who are misinformed about the safety of Nicotine Replacement Therapy (NRT) are less likely to report using it. In this study, we examined whether providing information that counters these concerns might impact on intentions to use NRT. PARTICIPANTS 900 smokers recruited from a market research database. DESIGN AND SETTING Participants completed an online survey that asked about their views about NRT. Smokers with safety and efficacy concerns were queried to determine whether accurate information might increase their interest in using NRT. FINDINGS Misperceptions of NRT safety were common: 93% of smokers did not know that smoking while wearing the nicotine patch does not cause heart attacks; 76% that nicotine gum/lozenge are not as addictive as cigarettes; and 69% that NRT products are not as dangerous as cigarettes. Over half of the smokers with misperceptions reported that they would be more likely to use NRT to help them quit smoking if they were exposed to information correcting their concerns (53%, 58% and 66%, respectively, for each of the misperceptions). CONCLUSIONS These data suggest that while a sizeable proportion of smokers are still misinformed about the safety of NRT, misinformed smokers would increase consideration of NRT if these misperceptions are addressed by corrective information.

The Use of Social Media by State Tobacco Control Programs to Promote Smoking Cessation: A Cross-Sectional Study

Background The promotion of evidence-based cessation services through social media sites may increase their utilization by smokers. Data on social media adoption and use within tobacco control programs (TCPs) have not been reported. Objective This study examines TCP use of and activity levels on social media, the reach of TCP sites, and the level of engagement with the content on sites. Methods A cross-sectional descriptive study of state TCP social media sites and their content was conducted. Results In 2013, 60% (30/50) of TCPs were using social media. Approximately one-quarter (26%, 13/50) of all TCPs used 3 or more social media sites, 24% (12/50) used 2, and 10% (5/50) used 1 site. Overall, 60% (30/50) had a Facebook page, 36% (18/50) had a Twitter page, and 40% (20/50) had a YouTube channel. The reach of social media was different across each site and varied widely by state. Among TCPs with a Facebook page, 73% (22/30) had less than 100 likes per 100,000 adults in the state, and 13% (4/30) had more than 400 likes per 100,000 adults. Among TCPs with a Twitter page, 61% (11/18) had less than 10 followers per 100,000 adults, and just 1 state had more than 100 followers per 100,000 adults. Seven states (23%, 7/30) updated their social media sites daily. The most frequent social media activities focused on the dissemination of information rather than interaction with site users. Social media resources from a national cessation media campaign were promoted infrequently. Conclusions The current reach of state TCP social media sites is low and most TCPs are not promoting existing cessation services or capitalizing on social media’s interactive potential. TCPs should create an online environment that increases participation and 2-way communication with smokers to promote free cessation services.

Reported exposure to pro-tobacco messages in the media: trends among youth in the United States, 2000-2004.

Purpose. Document changes from 2000 to 2004 in youth reports of exposure to pro-tobacco messages in the mass media, including images of smoking and tobacco advertising. Design. Comparison of cross-sectional data from three waves of the school-based National Youth Tobacco Surveys conducted in 2000 (N = 33,772), 2002 (N = 23,439), and 2004 (N = 23,540). Setting. Public and private middle schools and high schools across the United States. Subjects. Students in grades 6 through 12. Measures. Smoking status; exposure to images of smoking on television and in movies; exposure to advertisements for tobacco products in stores, on the Internet, and in newspapers and magazines; demographic data. Results. Youth exposure to pro-tobacco messages declined within all media channels studied from 2000 to 2004, except the Internet. Despite these declines, most youth in the United States remain exposed to pro-tobacco messages: 81% saw images of smoking on television or in movies (down from 90%), 85% saw tobacco ads in stores (down from 88%), 50% saw tobacco ads in newspapers and magazines (down from 66%), and 33% saw tobacco ads on the Internet (up from 22%). Conclusion. Despite recent progress in this area, most youth in the United States are still at increased risk of smoking as a result of exposure to pro-tobacco messages in the mass media.

Using Mass Media Campaigns to Reduce Youth Tobacco Use: A Review:

Objective. This review synthesizes the published literature on using mass media campaigns to reduce youth tobacco use, with particular focus on effects within population subgroups and the relative effectiveness of campaign characteristics. Data Source. A search of PubMed and PsycINFO conducted in March of 2014 yielded 397 studies with 34 suitable for inclusion. Study Inclusion and Exclusion Criteria. Included were quantitative studies that evaluate an antitobacco media campaign intended to influence youth cognitions or behavior or explore the relative effectiveness of campaign characteristics among youth. Data Extraction. An automated search and assessment of suitability for inclusion was done. Data Synthesis. Study outcomes were compared and synthesized. Results. Antitobacco media campaigns can be effective across racial/ethnic populations, although the size of the campaign effect may differ by race/ethnicity. Evidence is insufficient to determine whether campaign outcomes differ by socioeconomic status (SES) and population density. Youth are more likely to recall and think about advertising that includes personal testimonials; a surprising narrative; and intense images, sound, and editing. Evidence in support of using a health consequences message theme is mixed; an industry manipulation theme may be effective in combination with a health consequences message. Research is insufficient to determine whether advertising with a secondhand smoke or social norms theme influences youth tobacco use. Conclusion. Our recommendation is to develop antitobacco campaigns designed to reach all at-risk youth, which can be effective across racial/ethnic populations. Research priorities include assessing campaign influence among lower SES and rural youth, disentangling the effects of message characteristics, and assessing the degree to which this body of evidence may have changed as a result of changes in youth culture and communication technology.

Is socioeconomic status associated with awareness of and receptivity to the truth ® Campaign?

BACKGROUND The truth campaign is credited with preventing approximately 450,000 youth from starting to smoke, from 2000 through 2004 [Farrelly, M.C., Nonnemaker, J., Davis, K.C., Hussin, A., 2009. The Influence of the National Truth Campaign on Smoking Initiation. Am. J. Prev. Med. February 9 [Epub ahead of print]]. However, no research has been conducted to determine whether lower socioeconomic status (SES) youth benefit equally from the campaign. This study examines whether socioeconomic status is associated with awareness of and receptivity to the truth campaign among youth ages 12-17. METHODS This study is based on seven waves of Legacy Media Tracking Survey (LMTS) data, collected from September 2000 through January 2004 (n=30,512). LMTS is a nationally representative, cross-sectional telephone survey. Median household income and median household education at the zip code level were appended to the LMTS data. RESULTS Females had lower levels of confirmed awareness of the truth campaign as compared with males. Youth who lived in lower education zip codes were less likely to have confirmed campaign awareness as compared with those in higher education zip codes. Zip code level median household income was not associated with confirmed awareness. Receptivity to the campaign was not associated with zip code level median household income or education. CONCLUSIONS These findings suggest that the effectiveness of the truth campaign could be enhanced by developing strategies to increase campaign awareness among females and youth from lower education zip codes. Increased campaign exposure within these populations could result in lower smoking rates and, ultimately, lower rates of tobacco-related disease.

Giving infants a great start: launching a national smoking cessation program for pregnant women.

Data suggest that 12%-22% of women smoke during pregnancy. The link between smoking during pregnancy and adverse health and reproductive outcomes has been well documented. Great Start is a public education and smoking cessation program developed especially for pregnant women. Launched in December 2001, Great Start was the first national program focused on providing free and confidential smoking cessation counseling to pregnant women through a toll-free quitline. Great Start consisted of a media campaign to raise awareness and direct women to telephone counseling tailored for the pregnant smoker, and educational materials designed to support pregnant women through cessation counseling. The program was evaluated to assess the ability of the television ads to reach pregnant smokers and the effectiveness of a quitline for increasing cessation rates among pregnant women. Great Start demonstrates that it is possible to reach pregnant smokers through television ads that provide information about the consequences of smoking while pregnant, are affirming in tone, and provide direction for women to take action. Initial response to the program indicates that pregnant women want to quit and confirms the need for programs designed specifically to address the needs of this population.

The Influence of Antismoking Television Advertisements on Cessation by Race/Ethnicity, Socioeconomic Status, and Mental Health Status

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State’s antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.