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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Tobacco manufacturer lobbying to undercut minimum price laws: an analysis of internal industry documents.

Tobacco Control

Increasing the price of tobacco products has the potential to reduce tobacco consumption. As other forms of promotion have been increasingly restricted over time, tobacco manufacturers have relied more on trade discounts. Minimum price laws that prevented the use of manufacturer promotions were once common; however in most US jurisdictions these discounts are now legally protected.

We collected tobacco industry documents, state legislation and court cases between 1987 and 2016 to review tobacco manufacturer strategies to change minimum price laws in the USA.

Beginning in 2000, tobacco manufacturers lobbied to amend minimum price legislation after state regulators indicated that manufacturer promotions were illegal under existing laws. Companies viewed changing these laws as critical to maintaining tobacco sales, and after the initiation of an industry lobbying campaign, at least 20 states changed the way they calculated tobacco prices.

Modifying existing minimum price laws so that manufacturer discounts are no longer protected, and implementing new minimum price policies with comparable scope, would likely increase prices and reduce tobacco use.

Factors that influence smokers' and ex-smokers' use of IQOS: a qualitative study of IQOS users and ex-users in the UK.

Tobacco Control

One of the most widely available heated tobacco products is IQOS by Philip Morris International. However, there is a lack of independent research exploring IQOS initiation and subsequent use among smokers and ex-smokers.

To (1) explore the reasons why smokers and ex-smokers use and continue/discontinue IQOS and (2) consider implications for future research and policy.

Qualitative interview study in London, UK.

Six main factors influenced initiation and use of IQOS: (1) Health-wanting to reduce/quit smoking and perceptions of reduced harm (while understanding IQOS was not risk-free). Branded packaging, absence of pictorial warnings and physical health improvements conveyed reduced harm. (2) Financial-including high start-up costs, but cheaper ongoing costs than smoking. (3) Physical-mixed views on enjoyment and satisfaction. Sensory experiences influenced use including discreetness, cleanliness, reduced smell and tactile similarities relative to combustible cigarettes. (4) Practical-issues of accessibility, shortcomings with maintenance/operation limited ongoing use, whereas use in smoke-free places increased use. (5) Psychological-similarities in rituals and routines, although new practices developed to charge and clean; some liked trailblazing new technology. (6) Social-improved social interactions from using IQOS instead of smoking, but with more limited shared social experiences for some.

For some, IQOS facilitated smoking substitution. Factors such as packaging, labelling, risk communication, price and smoke-free policies appear to influence initiation and use.

LGBT young adults' awareness of and receptivity to the This Free Life tobacco public education campaign.

Tobacco Control

This study measures awareness of and receptivity to the Food and Drug Administration's This Free Life campaign seeking to change tobacco-related attitudes and beliefs among lesbian, gay, bisexual and/or transgender (LGBT) young adults.

Participants were young adults who self-identify as LGBT. The evaluation uses a treatment-control design. This study includes data from four survey rounds with participants from each round invited to participate in subsequent rounds and new participants invited to account for attrition. Bivariate analyses assess treatment-control differences in campaign awareness by round. We used multivariable logistic regression models with a time×treatment interaction and covariates to assess whether increases in awareness were greater in treatment than control from follow-ups 1 to 4. Descriptive statistics describe perceived effectiveness and models explore covariates of perceived effectiveness.

At each round, an increasing number of participants in treatment were brand aware (25%-67%) and reported high (16%-34%) and medium (16%-25%) video awareness compared with control (all p<0.001). Regressions revealed interactions in brand and video awareness, wherein the effect of treatment on awareness increased more over time, with significant treatment-control differences in change from follow-up 1 to 4 (all p<0.05). Reactions to all but one ad were positive (one neutral) with mean perceived effectiveness scores from 3.21 to 3.92 ('neither disagree nor agree' to 'agree' on 5-point scale). Perceived effectiveness differed by LGBT identity (all p<0.05).

At follow-up 4, This Free Life reached most of the campaign audience in treatment markets and has achieved higher awareness in treatment than control markets, at individual survey rounds and over time.

The great decline in adolescent cigarette smoking since 2000: consequences for drug use among US adolescents.

Tobacco Control

Adolescent cigarette smoking declined steadily and substantially from 2000 to 2018. This paper considers the potential consequences of this 'great decline' for the prevalence of other drug use among adolescents.

Data are annual, cross-sectional, nationally representative Monitoring the Future surveys of more than 1.2 million US students in 12th, 10th and 8th grades from 2000 to 2018. Analyses include trends in the past 12 months' non-medical amphetamine, tranquillisers and opioid use overall, among ever and never cigarette smokers, and projected if adolescent cigarette smoking levels had remained at 2000 levels.

Within groups of ever and never cigarette smokers, the prevalence for each of the three substances has either changed little or overall increased in 2018 as compared with 2000. When the two groups were combined into one pool, the overall prevalence for each of the drugs declined by about half. The decline resulted from the growing group of never smokers, whose levels of non-medical drug use over the study period were at least four times lower than the levels of ever smokers.

The results support the 'gateway' prediction that declines in cigarette smoking among adolescents pull downward their non-medical use of amphetamines, tranquillisers and opioids. Continuing to reduce adolescent smoking through policy and programmatic prevention efforts should have further positive spillover effects on adolescent drug use.

Cigarette and cigar sales in Hawaii before and after implementation of a Tobacco 21 Law.

Tobacco Control

On 1 January 2016, Hawaii raised the minimum legal age for tobacco access from 18 to 21 years ('Tobacco 21 (T21)') statewide, with no special population exemptions. We assessed the impact of Hawaii's T21 policy on sales of cigarettes and large cigars/cigarillos in civilian food stores, including menthol/flavoured product sales share.

Cigarette and large cigar/cigarillo sales and menthol/flavoured sales share were assessed in Hawaii, California (implemented T21 in June 2016 with a military exemption), and the US mainland using the only Nielsen data consistently available for each geographical area. Approximate monthly sales data from large-scale food stores with sales greater than US$2 million/year covered June 2012 to February 2017. Segmented regression analyses estimated changes in sales from prepolicy to postpolicy implementation periods.

Following T21 in Hawaii, average monthly cigarette unit sales dropped significantly (-4.4%, p<0.01) coupled with a significant decrease in menthol market share (-0.8, p<0.01). This combination of effects was not observed in comparison areas. Unit sales of large cigars/cigarillos decreased significantly in each region following T21 implementation. T21 policies in Hawaii and California showed no association with flavoured/menthol cigar sales share, but there was a significant increase in flavoured/menthol cigar sales share in the USA (7.1%, p<0.01) relative to Hawaii's implementation date, suggesting T21 may have attenuated an otherwise upward trend.

As part of a comprehensive approach to prevent or delay tobacco use initiation, T21 laws may help to reduce sales of cigarette and large cigar products most preferred by US youth and young adults.

Inequities in tobacco advertising exposure among young adult sexual, racial and ethnic minorities: examining intersectionality of sexual orientation with race and ethnicity.

Tobacco Control

This study examined sexual orientation differences in encoded exposure to tobacco product ads and intersections with race and ethnicity.

We analysed data from young adults (18-24) from the US Population Assessment of Tobacco and Health Study in 2013 and 2014 (N=9110). First, we compared encoded exposure to cigarette, electronic cigarette (e-cigarette), cigar and smokeless tobacco ads between sexual minorities (lesbian/gay, bisexual and something else) versus heterosexual young adults. We then analysed encoded ad exposure across sexual orientation, racial and ethnic subgroups. Analyses controlled for demographic and tobacco use variables.

Bisexual women had significantly higher prevalence of encoded exposure to cigarette and cigar ads compared with heterosexual women, and significantly higher prevalence of encoded e-cigarette ad exposure compared with both heterosexual and lesbian/gay women. There were no significant differences in encoded ad exposure between lesbian versus heterosexual women and between gay or bisexual men versus heterosexual men. Compared with heterosexual white counterparts, increased encoded ad exposures were reported by heterosexual black women (cigarette and cigar ads), black heterosexual men (cigar ads) and bisexual black women (cigarette and cigar ads). Compared with heterosexual non- Hispanic counterparts, increased encoded ad exposures were reported by bisexual Hispanic women (cigarette, e-cigarette and cigar ads) and heterosexual Hispanic men (cigarettes and cigar ads).

Sexual minority women of colour and black heterosexual women and men have increased encoded exposure to certain forms of tobacco ads. Further research is needed to address the impact of tobacco ads among multiple minority individuals based on sex, sexual orientation, race and ethnicity.

Policy options for endgame planning in tobacco control: a simulation modelling study.

Tobacco Control

To investigate the potential impacts of several tobacco control interventions on adult daily smoking prevalence in the Australian state of Queensland, using a system dynamics model codeveloped with local and national stakeholders.

Eight intervention scenarios were simulated and compared with a reference scenario (business as usual), in which all tobacco control measures currently in place are maintained unchanged until the end of the simulation period (31 December 2037).

Under the business as usual scenario, adult daily smoking prevalence is projected to decline from 11.8% in 2017 to 5.58% in 2037. A sustained 50% increase in antismoking advertising exposure from 2018 reduces projected prevalence in 2037 by 0.80 percentage points. Similar reductions are projected with the introduction of tobacco wholesaler and retailer licensing schemes that either permit or prohibit tobacco sales by alcohol-licensed venues (0.65 and 1.73 percentage points, respectively). Increasing the minimum age of legal supply of tobacco products substantially reduces adolescent initiation, but has minimal impact on smoking prevalence in the adult population over the simulation period. Sustained reductions in antismoking advertising exposure of 50% and 100% from 2018 increase projected adult daily smoking prevalence in 2037 by 0.88 and 1.98 percentage points, respectively.

These results suggest that any prudent approach to endgame planning should seek to build on rather than replace existing tobacco control measures that have proved effective to date. Additional interventions that can promote cessation are expected to be more successful in reducing smoking prevalence than interventions focussing exclusively on preventing initiation.

Immune modulation by chronic exposure to waterpipe smoke and immediate-early gene regulation in murine lungs.

Tobacco Control

We investigated the effects of chronic waterpipe (WP) smoke on pulmonary function and immune response in a murine model using a research-grade WP and the effects of acute exposure on the regulation of immediate-early genes (IEGs).

WP smoke was generated using three WP smoke puffing regimens based on the Beirut regimen. WP smoke samples generated under these puffing regimens were quantified for nicotine concentration. Mice were chronically exposed for 6 months followed by assessment of pulmonary function and airway inflammation. Transcriptomic analysis using RNAseq was conducted after acute exposure to characterise the IEG response. These biomarkers were then compared with those generated after exposure to dry smoke (without water added to the WP bowl).

We determined that nicotine composition in WP smoke ranged from 0.4 to 2.5 mg per puffing session. The lung immune response was sensitive to the incremental severity of chronic exposure, with modest decreases in airway inflammatory cells and chemokine levels compared with air-exposed controls. Pulmonary function was unmodified by chronic WP exposure. Acute WP exposure was found to activate the immune response and identified known and novel IEG as potential biomarkers of WP exposure.

Chronic exposure to WP smoke leads to immune suppression without significant changes to pulmonary function. Transcriptomic analysis of the lung after acute exposure to WP smoke showed activation of the immune response and revealed IEGs that are common to WP and dry smoke, as well as pools of IEGs unique to each exposure, identifying potential biomarkers specific to WP exposure.

Sensory attributes of e-cigarette flavours and nicotine as mediators of interproduct differences in appeal among young adults.

Tobacco Control

To estimate the extent to which specific sensory attributes, for example, smoothness, mediate differences in electronic cigarette (e-cigarette) appeal between products in non-tobacco versus tobacco flavours and varying nicotine content in young adults.

E-cigarette users (n=100; aged 18-34 years) administered standardised two-puff e-cigarette doses of different products varying in a flavour (fruit, menthol, tobacco) × nicotine (nicotine-containing (6 mg/mL freebase), nicotine-free) within-subject design. Participants rated sensory attributes (sweetness, bitterness, smoothness and harshness) and appeal on 100-unit visual analogue scales after administering each product. Sensory ratings were tested as simultaneous mediators of flavour, nicotine and flavour × nicotine effects on appeal.

Appeal preferences for fruit versus tobacco flavours were mediated by sweetness-enhancing (βindirect=0.092), smoothness-enhancing (βindirect=0.045) and bitterness-reducing (βindirect=0.072) effects of fruit flavours. Appeal preferences for menthol versus tobacco flavours were mediated by menthol's smoothness-enhancing (βindirect=0.039) and bitterness-reducing (βindirect=0.034) effects. Lower appeal of nicotine-containing versus nicotine-free products was mediated by nicotine's sweetness-reducing (βindirect=-0.036), smoothness-reducing (βindirect=-0.156) and bitterness-increasing (βindirect=0.045) effects. Flavour × nicotine interaction effects on appeal were explained by menthol-related suppression of nicotine's bitterness-enhancing and sweetness-reducing mediation pathways and fruit-related suppression of nicotine's bitterness-enhancing mediation pathway. Harshness did not mediate appeal after adjusting for other sensory attributes.

Bitterness and smoothness may be cross-cutting mediators of interproduct variation in the effects of types of non-tobacco flavours and nicotine on e-cigarette appeal in young adults. Sweetness may also mediate appeal-enhancing effects of fruit and appeal-reducing effects of nicotine. Non-tobacco flavours may suppress appeal-reducing effects of nicotine in e-cigarettes through attenuation of nicotine's aversive taste attributes.

Tobacco industry access to policy elites and the implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control.

Tobacco Control

Article 5.3 WHO Framework Convention on Tobacco Control (FCTC) aims to prevent tobacco industry interference with public health policy. The degree of protection depends on several factors: the interpretation of Article 5.3 by governments; the presence of codes of practice; and the effectiveness of industry lobbying versus public health advocacy. We examine these factors with reference to the Dutch government's interpretation of Article 5.3.

We searched the Dutch Tobacco Industry Special Collection, part of the Truth Tobacco Industry Documents archive, containing more than 1100 Dutch government documents.

Between 2007 and 2012, under consistent pressure from the industry, an initial strict view of Article 5.3 gave way to increased contact with the industry. The industry tried to shift the governance of tobacco policy back to the Ministry of Economic Affairs. Around 2010, Dutch public health advocates began to use Article 5.3. Efforts included naming and shaming government contact with the industry, parliamentary questions about industry-government contact, a report outlining how Article 5.3 should be observed and, most importantly, a court case. In response to this, the government produced a formal code of practice, which was used to prevent industry involvement in the development of a new National Prevention Accord.

The Dutch government's initial decision not to codify Article 5.3 created an administrative environment in which health ministers' interpretation of Article 5.3 was able to shift according to their political beliefs. The findings support the recommendation that Parties to the FCTC take a strict approach and formally codify Article 5.3 to ensure effective implementation.

Nicotine in tobacco product aerosols: 'It's déjà vu all over again'.

Tobacco Control

The distribution of nicotine among its free-base (fb) and protonated forms in aerosolised nicotine affects inhalability. It has been manipulated in tobacco smoke and now in electronic cigarettes by the use of acids to de-freebase nicotine and form 'nicotine salts'.

Measurements on electronic cigarette fluids (e-liquids) were carried out to determine (1) the fraction of nicotine in the free-base form (αfb) and (2) the levels of organic acid(s) and nicotine. Samples included JUUL 'pods', 'look-a-like/knock-off' pods and some bottled 'nicotine salt' and 'non-salt' e-liquids.

αfb= 0.12 ±0.01 at 40°C (≈ 37°C) for 10 JUUL products, which contain benzoic acid; nicotine protonation is extensive but incomplete.

First-generation e-liquids have αfb ≈ 1. At cigarette-like total nicotine concentration (Nictot) values of ~60 mg/mL, e-liquid aerosol droplets with αfb≈ 1 are harsh upon inhalation. The design evolution for e-liquids has paralleled that for smoked tobacco, giving a 'déjà vu' trajectory for αfb. For 17th-century 'air-cured' tobacco, αfb in the smoke particles was likely ≥ 0.5. The product αfbNictot in the smoke particles was high. 'Flue-curing' retains higher levels of leaf sugars, which are precursors for organic acids in tobacco smoke, resulting in αfb ≈ 0.02 and lowered harshness. Some tobacco cigarette formulations/designs have been adjusted to restore some nicotine sensory 'kick/impact' with αfb≈ 0.1, as for Marlboro. Overall, for tobacco smoke, the de-freebasing trajectory was αfb ≥ 0.5 → ~0 →~0.1, as compared with αfb= ~1 →~0.1 for e-cigarettes. For JUUL, the result has been, perhaps, an optimised, flavoured nicotine delivery system. The design evolution for e-cigarettes has made them more effective as substitutes to get smokers off combustibles. However, this evolution has likely made e-cigarette products vastly more addictive for never-smokers.

Exposure to tobacco marketing in bars predicts subsequent use of multiple tobacco products among non-tobacco-using college students.

Tobacco Control

Due to other marketing restrictions, one venue where tobacco companies concentrate their marketing efforts to reach young adults is bars/nightclubs.

This study examined the relationship between exposure to tobacco marketing in bars/nightclubs and number of alternative tobacco/nicotine products used 6 months later among college students.

Participants were 1,406 students aged 18-29 years old who reported going to bars or nightclubs at least rarely (M age=21.95; 67% female; 46% non-Hispanic white). Students completed an online survey in fall 2014/spring 2015 (wave 1) and again 6 months later (wave 2). Multilevel Poisson regression models were used to assess the relationship between exposure to three types of marketing at bars/nightclubs at wave 1 (tobacco/nicotine product advertisements; free samples; industry representatives) and number of tobacco products used (range=0-5) at wave 2, controlling for school type (2 year vs 4 year), age, sex, race/ethnicity and frequency of bar visits. An interaction between the number of wave 1 products and each marketing variable was tested.

Greater exposure to free samples and tobacco industry representatives at bars/nightclubs predicted a greater number of products used 6 months later, but only among wave 1 non-tobacco users and not among tobacco users. Exposure to advertisements at bars/nightclubs did not predict the number of products used 6 months later.

Tobacco companies claim that marketing is targeted to those who already use the product, not to non-users. However, the current study indicates tobacco marketing in bars and nightclubs may encourage use among non-users and has no influence on current users.