The latest medical research on Addiction Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about addiction medicine gathered by our medical AI research bot.

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Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1-4): multistate transition modelling accounting for complex survey design.

Tobacco Control

Even prior to 2018, electronic nicotine delivery systems (ENDS) began to dramatically change the landscape of tobacco products and product use patterns in the USA.

Using a Markov multistate transition model accounting for complex survey design, transition rates between never, non-current, cigarette, ENDS and dual use states were estimated for 23 253 adult participants in waves 1-4 (approximately 2013-2017) of the Population Assessment of Tobacco and Health study. We made short-term transition projections and estimated HRs for age, sex, race/ethnicity, education and income.

Cigarette use was persistent among adults, with 89.7% (95% CI 89.1% to 90.3%) of exclusive cigarette users and 86.1% (95% CI 84.4% to 87.9%) of dual users remaining cigarette users (either exclusive or dual) after one wave. In contrast, ENDS use was less persistent, with 72.1% (95% CI 69.6% to 74.6%) of exclusive ENDS users and 50.5% (95% CI 47.8% to 53.3%) of dual users remaining ENDS users (with or without cigarettes) after one wave. Exclusive ENDS users were more likely to start cigarette use after one wave than either never users (HR 25.2; 95% CI 20.9 to 30.5) or non-current users (HR 5.0; 95% CI 4.3 to 5.8). Dual users of ENDS and cigarettes were more likely to stop using cigarettes than exclusive cigarette users (HR 1.9; 95% CI 1.6 to 2.3). Transition rates varied among sociodemographic groups.

Multistate transition models are an effective tool for uncovering and characterising longitudinal patterns and determinants of tobacco use from complex survey data. ENDS use among US adults was less persistent than cigarette use prior to 2018.

Use of heated tobacco products in smoke-free locations in Japan: the JASTIS 2019 study.

Tobacco Control

We aimed to examine the use of heated tobacco products (HTPs) in locations where cigarette smoking was not allowed, and to explore the factors associated with such use among Japanese HTP users.

An internet-based self-reported questionnaire survey was conducted in 2019 as part of the Japan Society and New Tobacco Internet Survey. The study subjects were respondents who self-reported having used HTPs in the last year. The proportions of those who had ever used or frequently used HTPs in locations where tobacco smoking was not allowed in the last year were calculated. These locations included home, restaurants and workplaces. Furthermore, potential factors associated with HTP use in such smoke-free locations were examined using multivariable logistic regression analyses.

The proportion of HTP users who had ever used HTPs in smoke-free locations in the last year was 20.7% (148/716) at home, 11.8% (128/1081) in restaurants and 11.9% (113/950) in workplaces. The proportion of those who had frequently used HTPs in those locations was 9.5% (68/716) at home, 4.8% (52/1081) in restaurants and 8.0% (76/950) in workplaces. The statistically significant factors associated with HTP use varied by location. Generally, respondents who thought HTP use was not forbidden in places where tobacco smoking is forbidden were likely to use HTPs in such locations.

In Japan, a considerable number of people used HTPs in locations where tobacco smoking was not allowed. Policymakers should establish clear rules about use of HTPs in smoke-free environments.

Creating a market for IQOS: analysis of Philip Morris' strategy to introduce heated tobacco products to the Australian consumer market.

Tobacco Control

Philip Morris International has made efforts to expand the sale of its heated tobacco product, IQOS, into new domestic markets globally. In Australia, where heated tobacco products are prohibited, the company recently attempted to overturn Australian legislation in order to permit their sale. In light of this recent move, this study presents a case study of the company's strategies to legalise and distribute IQOS in the Australian market.

To assess Philip Morris' lobbying activities and corporate strategies, a case study approach was used by triangulating data from three sources: interviews with former Philip Morris employees, news articles reporting Philip Morris' lobbying activities or plans for IQOS in Australia, and submissions to relevant government inquiries and reviews from 2015 to 2020.

Philip Morris has actively lobbied Australian policy-makers to overturn bans on nicotine-containing products. Information obtained from key informants and Philip Morris' government submissions indicates that the company's goal is for heated tobacco products in Australia to be regulated in a new product category, exempt from tobacco control laws. Informants revealed that Philip Morris was also working to establish a network of upmarket pubs, clubs and bars where they could sell IQOS once legalisation was achieved.

Philip Morris has strongly lobbied the Australian government to legalise heated tobacco products, while simultaneously making plans to sell IQOS at young adult-friendly premises such as bars, clubs and pubs if its proposed legislative changes are made. This case study provides valuable insights for other countries where Philip Morris may be replicating similar strategies to weaken tobacco control legislation.

Cross-validation of four different survey methods used to estimate illicit cigarette consumption in Brazil.

Tobacco Control

To cross-validate estimates of the size of the illicit cigarette trade based on the results of four different survey methods.

In 2018/2019, four non-industry-funded, large-scale studies were conducted in selected Brazilian cities: packs discarded in household garbage/PDG (1 city), packs littered in the streets/PLS (5 cities), a phone survey of tobacco users' purchase behaviors/VIGITEL (5 cities), and a face-to-face household survey of tobacco users' purchase behaviors/FTF-household (2 cities). The proportions of illicit cigarettes consumed were based on the price paid by smokers in their last purchase (VIGITEL or FTF-household) and/or direct observation of brand names and health warnings (PDG, PLS or FTF-household).

Based on PLS, the share of packs that avoided taxation ranged from 30.4% (95% CI 25.6% to 35.7%) in Rio de Janeiro to 70.1% (95% CI 64.6% to 75.0%) in Campo Grande; and PDG conducted in Rio de Janeiro found an even lower proportion point estimate of illicit cigarette use (26.8%, 95% CI 25.1% to 28.6%). In FTF-household, the share of illicit cigarette consumption based on the self-reported price ranged from 29.1% (95% CI 22.4% to 35.7%) in Rio de Janeiro to 37.5% (95% CI 31.2% to 43.7%) in São Paulo, while estimates based on pack observation ranged from 29.9% (95% CI 23.3% to 36.5%) in Rio de Janeiro to 40.7% (95% CI 34.3% to 47.0%) in São Paulo. For all cities, VIGITEL presented the lowest levels of illicit consumption, and most illicit brands were produced in Paraguay.

Small differences in the estimated levels of illicit trade across methods were found, except for the phone survey. The cross-validation of estimates from independent studies is important to help effectively implement tobacco excise tax policy in Brazil and other low-income and middle-income countries.

Exploring the Twitter activity around the eighth meeting of the Conference of the Parties to the WHO Framework Convention on Tobacco Control.

Tobacco Control

Tobacco companies' intentions to influence the WHO Framework Convention on Tobacco Control (FCTC) via the Conference of Parties (COP; the official biannual meeting where Parties review the Convention) are well documented. We aimed to analyse Twitter data to gain insights into tobacco industry tactics, arguments and allies.

We retrieved 9089 tweets that included #COP8FCTC between 1 and 9 October 2018. We categorised the tweets' content and sentiment through manual coding and machine learning. We used an investigative procedure using publicly available information to categorise the most active Twitter users and investigate tobacco industry links. Network analysis was used to visualise interactions and detect communities.

Most tweets were about next-generation products (NGPs) or 'harm reduction' (54%) and tended to argue in support of NGPs; around one-quarter were critical of tobacco control (24%). The largest proportion of most active tweeters were NGP advocates, and slightly over half of those had either links to the Philip Morris International (PMI) funded Foundation for a Smoke-Free World (FSFW) and/or to the International Network of Nicotine Consumer Organisations, a network to whom the FSFW granted US$100 300 in 2018. PMI was the most active transnational tobacco company during COP8.

The nature of the activity on Twitter around COP8, including a substantial online presence by PMI executives and NGP advocates with links to organisations funded directly and indirectly by PMI, is highly consistent with PMI's 2014 corporate affairs strategy, which described engaging tobacco harm reduction advocates to 'amplify and leverage the debate on harm reduction' around events such as the COP.

Menthol cigarette use in substance use disorder treatment before and after implementation of a county-wide flavoured tobacco ban.

Tobacco Control

This study examined the impact of a San Francisco City and County ban on all flavoured tobacco products, including menthol cigarettes, among clients in residential substance use disorder (SUD) treatment.

We conducted cross-sectional surveys of clients at two residential SUD programmes before the County began enforcing the ban (n=160) and twice after enforcement began (n=102, n=120). The samples were compared on demographic characteristics, smoking status, smoking behaviours and the proportion reporting menthol as their usual cigarette. Menthol smokers were asked whether they smoked only menthol cigarettes, mostly menthol, both menthol and non-menthol or mostly non-menthol. Post-ban samples were asked about awareness of the ban and access to menthol cigarettes.

In multivariate analyses, we found no evidence that the ban was associated with decreased number of cigarettes per day or increased readiness to quit among current smokers. However, odds were lower post-ban for reporting menthol as the usual cigarette (OR=0.80, 95% CI 0.72 to 0.90), and for smoking only menthol cigarettes (OR=0.19, 95% CI 0.18 to 0.19). Perhaps most importantly, and with the ability to influence all other findings, 50% of self-identified menthol smokers reported purchasing menthol cigarettes in San Francisco nearly 1 year after the ban was implemented.

In subgroups where smoking has remained elevated, like those receiving SUD treatment, local menthol bans may have only modest impacts on smoking behaviour. Broader regional, state or national bans, that effectively restrict access to menthol products, may be needed to show stronger effects on smoking behaviour.

Switching stories: user testimonials on juul.com continue to contradict JUUL's switch ≠ cessation narrative.

Tobacco Control

In January 2019, electronic nicotine delivery systems (ENDS) market leader Juul Labs (JUUL) launched an advertising campaign encouraging adult smokers to 'make the switch' from combustible cigarettes to JUUL. Our primary aim was to describe consumer perceptions of JUUL as communicated by members of JUUL's online social community via testimonials promoted on JUUL's website.

User testimonials that were displayed on the JUUL website in December 2019 and January 2020 were collected and coded by three reviewers. A total of 220 testimonials were coded for primary and secondary themes (eight codes within four broader themes).

Testimonial writers were, on average, 43.0 years old (range 28 to 74) and reported using JUUL for an average of 21.8 months (range 9 to 59 months). The most prominent theme, present in nearly half of the testimonials, was a description of how to use JUUL, with a mention of JUUL's benefits and tips on how to use the product. Nearly four in 10 statements encouraged smokers to give JUUL a try or noted that JUUL is a better product compared with cigarettes. About one in 10 statements focused on switching from smoking cigarettes to using JUUL.

This study presents a foundation for understanding how adult users describe JUUL, including their experiences using JUUL to 'switch' or stop smoking. Currently, the effectiveness of ENDS for smoking cessation is not supported by substantial evidence; however, if cessation is defined as 'quitting combustible tobacco products', then regulators should be aware that switch and cessation messages may not be distinct.

Macroeconomic impacts of cigarette consumption in Pakistan.

Tobacco Control

Pakistan has a large population of tobacco users, with about 24 million adults consuming tobacco products in one form or another. There is a dearth of research on the impact of a reduction in tobacco use on Pakistan's economy which can inform policy-makers on the extent that tobacco control measures would affect macroeconomic indicators such as output and employment.

The objective of this study is to quantify the changes in output, income and employment resulting from changes in cigarette consumption and to quantify the impact of such changes on the overall economy.

The study uses the input-output table for the fiscal year 2010-2011 for Pakistan's economy, to estimate the output, income and employment multipliers. The Leontief input-output model is used to estimate the sectorwise multiplier effects. It estimates direct, indirect and consumption-induced effects of changes in tobacco use on the economy.

The cigarette industry's share in large-scale manufacturing and industrial employment is 1.1% and 0.3%, respectively. The estimates of gross output, income and employment multipliers for the cigarette industry have relatively small magnitudes indicating minimal impact on the economy. A simulation analysis based on the latest estimates of price elasticity of cigarette and input-output multipliers, shows that a 10% increase in price will lead to an 11% reduction in cigarette consumption, which translates into annual savings of Pakistani Rupees (Rs) 16 billion by households. Reduction in cigarette consumption will allow individuals to spend their savings on other commodities. For example, spending this amount on food items will lead to a net increase of Rs 40 billion annual output of the economy.

Reduction in tobacco consumption will lead to initial losses to the economy but there will be considerable gains in output, employment and income due to redistribution of tobacco expenditures.

Simulating the density reduction and equity impact of potential tobacco retail control policies.

Tobacco Control

Reducing the provision of tobacco is important for decreasing inequalities in smoking and smoking-related harm. Various policies have been proposed to achieve this, but their impacts-particularly on equity-are often unknown. Here, using national-level data, we simulate the impacts of potential policies designed to reduce tobacco outlet density (TOD).

Tobacco retailer locations (n=9030) were geocoded from Scotland's national register, forming a baseline. Twelve policies were developed in three types: (1) regulating type of retailer selling tobacco, (2) regulating location of tobacco sales, and (3) area-based TOD caps. Density reduction was measured as mean percentage reduction in TOD across data zones and number of retailers nationally. Equity impact was measured using regression-based Relative Index of Inequality (RII) across income deprivation quintiles.

Policies restricting tobacco sales to a single outlet type ('Supermarket'; 'Liquor store'; 'Pharmacy') caused >80% TOD reduction and >90% reduction in the number of tobacco outlets nationally. However, RIIs indicated that two of these policies ('Liquor store', 'Pharmacy') increased socioeconomic inequalities in TOD. Equity-promoting policies included 'Minimum spacing' and exclusion zones around 'Child spaces'. The only policy to remove statistically significant TOD inequalities was the one deliberately targeted to do so ('Reduce clusters').

Using spatial simulations, we show that all selected policies reduced provision of tobacco retailing to varying degrees. However, the most 'successful' at doing so also increased inequalities. Consequently, policy-makers should consider how the methods by which tobacco retail density is reduced, and success measured, align with policy aims.

Potential impact of eliminating illicit trade in cigarettes: a demand-side perspective.

Tobacco Control

The Protocol to Eliminate Illicit Trade in Tobacco Products (the Protocol) entered into force in September 2018, and commits Parties to implement a package of measures to combat this global problem. The aim of this study is to assess the potential impact of eliminating illicit cigarettes on consumption, use and tax revenues.

We identified 36 countries where an independent (non-industry sponsored) study of the illicit cigarette market was available. We developed a conceptual framework for describing how the elimination of illicit cigarettes might impact on demand (consumption and use) and applied this framework to our sample of countries to assess the impact of eliminating illicit cigarettes across different settings.

Illicit cigarettes account on average for 11.2% of the market in these 36 countries. The elimination of illicit cigarettes would reduce total cigarette consumption by 1.9% across these countries. The decrease in 'group A' countries-where illicit cigarettes are >15% of the market-would average 4.1%. The smoking rate would decrease by 1.0% in relative terms including by 2.2% in group A countries. Tax revenues from the legal sale of cigarettes would increase by 11.2% including by 25.1% in group A countries.

The illicit cigarette market reflects a complex interplay between supply and demand, with an array of different country conditions. Regardless of the situation, our study highlights the contribution that the elimination of illicit trade can make to tobacco control through demand reduction while at the same time generating significant tax revenues.

Australian smokers' experiences and perceptions of recessed and firm filter cigarettes.

Tobacco Control

While cigarette filter modifications have long been used to increase product appeal and assuage health concerns, tighter marketing restrictions, including plain packaging, have further spurred the growth of filter variants. We explored and assessed experiences and perceptions of smokers who had tried and/or currently use recessed filter cigarettes (RFCs) and firm filter cigarettes (FFCs).

In November 2018, we undertook eight exploratory focus groups of Australian adult factory-made cigarette smokers (total n=56). In July 2019, we surveyed 999 smokers aged 18-69 years to quantify ever and current use of these products and associated beliefs and sensory experiences.

Focus group and survey findings were consistent. Among 988 smokers who had at least tried factory-made cigarettes, 28.9% had tried FFCs and 11.1% currently smoked these, while 36.4% had tried RFCs and 7.5% currently smoked these. Smokers in both studies believed these filters may reduce harm and that FFCs increase appeal. In the survey, 58.9% of RFC triers agreed these hide the filter's brown stain and 48.9% agreed that RFCs keep harmful substances away from the mouth. Similarly, 58.4% of FFC triers agreed these trap more harmful substances than standard filters. Relative to standard filter cigarettes, more smokers experienced FFCs and RFCs as feeling clean (p=0.03) and more current FFC users experienced these as feeling smooth (p=0.01).

RFCs and FFCs undermine plain packaging legislation, which aims to reduce appeal and minimise misperceptions about the relative harms of different tobacco products. Like other filter modifications, these filter variants should be disallowed.

Changes in responses to nicotine vaping product warnings and leaflets in England compared with Canada, the US and Australia: findings from the 2016-2018 ITC Four Country Smoking and Vaping Surveys.

Tobacco Control

In May 2017, black-and-white text nicotine addiction warning labels ('warnings') and health and safety leaflets ('leaflets') became mandatory for nicotine vaping products (NVPs) in England, in accordance with the European Union's Tobacco Products Directive. We compared changes over time in noticing warnings and leaflets, recall of warnings about nicotine and concerns about using NVP due to noticing warnings in England, compared with Canada, the US and Australia, where no warnings and leaflets were mandated.

19 005 adult (aged 18+) NVP users, smokers and quitters of cigarettes and NVP from the 2016 and 2018 International Tobacco Control Four Country Smoking and Vaping Surveys in England, Canada, the US and Australia, recruited via probability and non-probability sampling.

Noticing warnings increased in England from 4.9% (2016) to 9.4% (2018) (adjusted OR/AOR=1.64, 95% CI=1.15-2.36); this change was larger than changes in Canada (AOR=2.51, 95% CI=1.71-3.69) and the US (AOR=2.22, 95% CI=1.45-3.39). Recall of a nicotine warning increased in England from 86% (2016) to 94.9% (2018) (AOR=5.50, 95% CI=1.57-19.27) but not significantly elsewhere. Noticing leaflets increased in England from 14.6% (2016) to 19.1% (2018) (AOR=1.42, 95% CI=1.15-1.74); this change was larger than in Canada (AOR=1.42, 95% CI=1.12-1.79), the US (AOR=1.55, 95% CI=1.17-2.06) and Australia (AOR=1.51, 95% CI=1.02-2.22). Among those noticing warnings, concern about NVP use did not change significantly between 2016 and 2018 (all countries p>0.081).

Introduction of mandatory NVP warnings and leaflets in England was associated with small increases in noticing them but not with changes in concerns about NVP use.