E-cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers' views

Objective: Concerns exist that e-cigarettes may be a gateway to traditional cigarettes and/or (re)normalise teenage smoking. This qualitative study explores how teenagers in the UK currently perceive e-cigarettes and how and why they do or do not use them. Design: 16 focus groups were conducted across the UK between November 2014 and February 2015, with 83 teenagers aged 14–17. All discussions were digitally recorded, transcribed verbatim, imported into NVivo 10 and thematically analysed. Results: Teenagers generally agreed that e-cigarettes are useful products for smokers, including teenage smokers, to quit or reduce traditional cigarette use. Concerns were expressed about lack of information on their precise ingredients and any unknown risks for users and bystanders. However, teenagers typically viewed e-cigarettes as substantially less harmful than traditional cigarettes. They perceived e-cigarettes as attractive, with products described as ‘fun’ and having ‘great flavourings’. Seeing websites or social media featuring e-cigarettes, especially YouTube ‘vaping tricks’, prompted some experimentation and imitation. E-cigarettes were used in a variety of situations, including at parties or when they could not smoke traditional cigarettes. A very few participants suggested covert use was a possibility and that e-cigarettes might help maintain a fledgling nicotine habit. Conclusions: Teenagers support the use of e-cigarettes as smoking cessation aids for established adult smokers. However, they engage with these products differently from adults, with the novel hypothesis that covert use could potentially reinforce traditional cigarette smoking requiring further investigation. Policy responses should more clearly meet the needs of young people, as well as helping established adult smokers

Prevalence, Reasons for Use, and Risk Perception of Electronic Cigarettes among Post-Acute Coronary Syndrome Smokers

Purpose—The use of electronic cigarettes (e-cigarettes) has risen dramatically in recent years. However, there is currently no published data on use of e-cigarettes among cardiac patients. The current study reports on the prevalence, reasons for use, and perceived risks of e-cigarettes among post-Acute Coronary Syndrome (ACS) patients. The relationship between e-cigarette use and post- ACS tobacco smoking cessation is also explored. Methods—Participants were drawn from a randomized trial of smoking cessation treatments following hospitalization for ACS. The current study focuses on 49 participants that completed e- cigarette questions at 24 weeks post-ACS. Results—51.0% of participants reported ever use of an e-cigarette and 26.5% reported using an e-cigarette at some time during the 24 weeks post-ACS. Ever use and post-ACS use were both significantly associated with lower rates of abstinence from tobacco cigarettes. Participants perceived e-cigarettes as less harmful to cardiac health than tobacco use and Chantix, and similarly harmful as nicotine replacement therapy. Participant perceived likelihood of experiencing a heart attack in the next year was 34.6% if they were to regularly use e-cigarettes only, significantly lower than perceived risk of recurrence if they were to regularly smoke only tobacco cigarettes (56.2%) and significantly higher than perceived risk of recurrence if they were to use no nicotine (15.2%). Conclusions—A significant minority of patients are using e-cigarettes post-ACS. Providers should be prepared to discuss potential discrepancies between patient beliefs about the safety of e- cigarettes and the current state of the science

Comparing The Effects Of Menthol Status On The Behavioral Pharmacology Of Smoking Reduced Nicotine Content Cigarettes

Introduction: An active area of tobacco regulatory science research focuses on examining the effects of varying the nicotine content of cigarettes as part of a potential national policy to lower their nicotine content levels to reduce addiction potential. The present study examines differences in the behavioral effects of reduced nicotine content cigarettes related to their menthol status. Menthol is the only cigarette flavoring that is still legally permissible according to Food and Drug administration regulations. Methods: Participants were 26 current adult smokers from three populations especially vulnerable to tobacco use and addiction (economically disadvantaged women, opioid-dependent individuals, individuals with affective disorders) dichotomized as menthol (n=11) or non-menthol (n=15) smokers. Participants completed 14 experimental sessions following acute smoking abstinence (CO\u3c50% baseline level). Across sessions, participants smoked four Spectrum research cigarettes (22nd Century Group, Clarence, NY) with varying nicotine content levels (0.4mg/g, 2.4 mg/g, 5.2 mg/g, 15.8 mg/g) or their usual brand cigarette. Research cigarettes were mentholated or non-mentholated corresponding to participants usual brand. Upon completion of smoking, participants completed tasks measuring reinforcing efficacy, subjective effects, topography, and withdrawal and craving measures. Repeated Measures Analysis of Variance was used for all analyses (p\u3c.05). Results: Main effects of menthol status, as well as interactions of nicotine dose and menthol were noted across subscales of subjective effects and direct assessments of reinforcing efficacy. Usual brand mentholated cigarettes produced a profile of equal or greater relative reinforcing effects than usual brand non-mentholated cigarettes, while mentholated research cigarettes produced a profile of effects that fell below (i.e., lower relative reinforcing effects compared to usual brand or non-mentholated cigarettes) those of non-mentholated research cigarettes. Conclusions: Mentholated research cigarettes produce a lower profile of reinforcing and subjective effects, without discernible differences in smoking topography. The potential impact of mentholation on reinforcing efficacy and subjective effects should be considered when using Spectrum research cigarettes

The Role of Compensation in Nicotine Reduction.

The available research on switching from normal nicotine to very low nicotine content cigarettes shows minimal evidence of compensatory smoking. Mathematical estimations suggest that substantial compensation after switching to very low nicotine cigarettes would be impossible. It is likely that smokers who are unable to tolerate the extent of proposed nicotine reduction would switch to other sources of nicotine, rather than try to compensate by smoking more very low nicotine content cigarettes more intensely

Cigarette and Tobacco Receipts Report, September 2011

This is a report for the Iowa Department of Revenue and Finance about the receipts on cigarettes and tobacco for each month of the year. This receipt is the tax of each sale of cigarettes and tobacco

Cigarette consumption in The Netherlands 1970-1995 - Does tax policy encourage the use of hand-rolling tobacco?

Background: Tax rises to reduce cigarette consumption are a major feature of European tobacco control policies. In many countries, hand-rolling tobacco is much cheaper than manufactured cigarettes. We Investigated whether changes in price differentials between manufactured and hand-rolled cigarettes influenced cigarette consumption in The Netherlands. Method: We developed regression models to explain changes in the consumption of the two cigarette types. Price elasticities, the percentage changes in consumption for a 1% change in price, are calculated from Netherlands data for 1970-1980 and 1985-1995. Results: The ratio of manufactured to hand-rolled cigarette prices changed little during 1970-1980 but varied subsequently. On multivariate analysis, manufactured cigarette consumption in 1970-1980 decreased as its price rose (elasticity = -0.74). In 1985-1995, manufactured cigarette consumption fell with increases in both its own price (elasticity = -0.54) and in the price differential between manufactured and hand-rolled cigarettes (elasticity = -0.60). During 1985-1995, roll-your-own consumption fell as the price ratio of manufactured to hand rolled cigarettes fell (elasticity = +1.0). Conclusion: When the price rise for hand-rolling tobacco is greater than the price rise for manufactured cigarettes, the fall in manufactured cigarette consumption is accompanied by a fall in roll-your-own use. Cigarette smokers are deterred from switching to hand rolled cigarettes instead of stopping smoking. This increases the health benefits of raising taxes on manufactured cigarettes, discourages the use of even more harmful forms of tobacco and may reduce inequalities in health

Cigarette and Tobacco Receipts Report, May 2013 REVISED

This is a report for the Iowa Department of Revenue and Finance about the receipts on cigarettes and tobacco for each month of the year. This receipt is the tax of each sale of cigarettes and tobacco. REVISE

Effectively Regulating E-Cigarettes and Their Advertising—and the First Amendment

If tobacco smoking did not exist in the United States, there would be no reason, from a public health perspective, to allow addictive, nicotine-containing e-cigarettes to be marketed and sold. Because e-cigarette use, by itself, is neither beneficial nor benign to users and nonusers, the only public health justification for allowing e-cigarettes in the existing U.S. market would be if doing so would not sustain or increase existing smoking levels but would help smokers quit completely or provide addicted smokers a less harmful way to obtain the nicotine they crave. Yet e-cigarettes are now pervasive in the U.S. market, being sold with unnecessary harmful characteristics and being advertised in ways that encourage youth experimentation and use. Unless effectively regulated, e-cigarette use will be more harmful than necessary and their advertising will work to: (a) increase initiation among both youth and non-tobacco-using adults; (b) prompt former smokers to relapse back into addicted nicotine use; (c) encourage smokers to use e-cigarettes where they cannot smoke; and (d) prompt smokers to switch to e-cigarettes instead of quitting all tobacco and nicotine use. This paper proposes a viable way to regulate e-cigarettes and their advertising both to minimize the health harms they might cause and to allow e-cigarettes to fulfill their potential as cessation aids or harm-reduction products. Normally, any efforts by FDA to establish effective advertising restrictions must accommodate considerable constraints from the First Amendment’s commercial speech protections. However, because of existing text in the Tobacco Control Act, on the effective date of the final FDA deeming rule that puts e-cigarettes under FDA’s active tobacco product jurisdiction all nicotine-containing e-cigarettes will be on the U.S. market illegally until they can obtain permissive orders from FDA. That situation should reduce applicable First Amendment constraints, providing FDA with a tremendous opportunity to place the kinds of substantial restrictions and requirements on e-cigarette advertising necessary to minimize their harmful aspects and maximize their potential to produce substantial net public health benefits

The Impact of Lending, Borrowing, and Anti-Smoking Policies on Cigarette Consumption by Teens

A major factor contributing to smoking initiation and experimentation by teenagers is the ability to 'bum' cigarettes. Yet research until now has ignored the impact of a lending/borrowing market on the smoking decisions of teenagers. In this paper, we develop a theoretical model where smoking decisions are determined by an individual's utility maximization process that includes an incentive to lend cigarettes. Predictions from this model are tested using data from the Youth Risk Behavior Surveys that can distinguish between teens who primarily buy and those who primarily bum their cigarettes. We show the ways in which price and restrictions on smoking will impact the decision to buy or bum cigarettes, as well as the impact on the allocation of purchased cigarettes between those self-consumed and those lent to others. Key results indicate that as prices and restrictions increase, teenagers are less likely to be regular smokers who purchase cigarettes and are more likely to consume smaller quantities obtained via the lending market. The basic conclusions are that anti-smoking policies have significant effects on the quantity of cigarettes consumed by teens and that these policies can help reduce the number of teens that escalate from experimental to regular smoking.

Consumer Response to Cigarette Excise Tax Changes

We use a rich dataset of weekly cigarette sales to examine how consumers adapt their behavior before and after excise tax increases--whether by reducing demand, stockpiling, traveling to low-tax jurisdictions, or substituting towards lower-cost brands. Consumer response varies substantially for different types of cigarettes. Stockpiling primarily occurs for discount cigarettes and is most pronounced at stores far from lower-tax jurisdictions. Border-crossing is greatest at stores close to low-tax jurisdictions and occurs primarily for cigarettes sold by the carton. Finally, we find modest short-run substitution towards lower-cost brands following a tax-increase, consistent with consumers smoothing the transition to higher cigarette taxes. These differences in consumer behavior lead to meaningful differences in tax incidence--pass-through is higher for discount cigarettes which have more inelastic demand. Pass-through is lower near low-tax borders, especially for cigarettes sold by the carton for which cross-border evasion is greatest.