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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Who sells tobacco, who stops? A comparison across different tobacco retailing schemes.

Tobacco Control

Licensing of tobacco retailers has been proposed as a mechanism to encourage retailers to stop selling tobacco. However, previous studies of tobacco licensing and/or of retailers who have stopped selling have been restricted to one legislative environment. This study examines patterns of tobacco retailing across three legislative environments with three different licensing schemes (an annual fee-based licence, a zero-cost, one-off notification scheme and no notification/licensing scheme).

A telephone survey was conducted of 2928 potential tobacco retailers who could personally choose whether or not to sell tobacco (rather than the decision being made at a head office).

Unexpectedly, the annual licence fee to sell tobacco was not significantly associated with a lower rate of selling tobacco or a higher rate of stopping. After allowing for other factors, probability of selling, stopping selling and reported importance of tobacco sales varied across outlet types (p<0.001 for all three outcomes), and according to the remoteness of the retailer (p<0.001, p trend=0.041 and p=0.025 respectively).

A fee of $A286 was not associated with a lower rate of selling, or a higher rate of stopping. The effect of licensing on retailer numbers will presumably be greater for higher licence fees, but will also depend on the perceived importance of tobacco sales to the retailer. In turn, importance of tobacco sales appears to depend on market factors, including proximity to major urban centres and low-cost competitors. A higher licence fee is likely to have a larger effect on discouraging retailers from selling.

Association between federal and California state policy violation among vape shops and neighbourhood composition in Southern California.

Tobacco Control

Past studies have documented disparities in regulation compliance among tobacco retailers with respect to ethnic diversity in neighbourhoods. This study investigated the association between compliance with the Food and Drug Administration (FDA) and California state rules and neighbourhood ethnic composition of a vape shop location.

We recruited 122 vape shops located in 'ethnic enclave' neighbourhoods in Southern California. Trained teams of data collectors visited each of the consented vape shops and coded items in the shops that were visible and on display. Location data for the percentages of ethnic composition for a given city were obtained from the U.S. Census Bureau, American FactFinder. Multilevel logistic regression models examined the relationship between the city-level neighbourhood ethnic composition and vape shop rule violation status: not displaying Ask4ID sign and offering free samples.

Vape shops located in neighbourhoods/communities with more white residents were significantly less likely to not display Ask4ID sign (p=0.03) and less likely to offer free sampling (p=0.009), controlling for other neighbourhood ethnic characteristics.

Greater enforcement for proper signage display is needed for vape shops located in racial/ethnic minority locations to ensure that minors are discouraged from purchasing e-products.

Analysis of FDA's IQOS marketing authorisation and its policy impacts.

Tobacco Control

Philip Morris Products SA (PMPSA) submitted a premarket tobacco application (PMTA) to US Food and Drug Administration (FDA) seeking an order permitting it to market IQOS in the USA. US law requires FDA to deny marketing authorisation if applicants fail to demonstrate that their product is 'appropriate for the protection of the public health'. FDA issued a marketing order for IQOS in April 2019, which Philip Morris is using to promote IQOS outside the USA.

We analysed FDA's Technical Project Lead Review and marketing order for IQOS, relevant law and guidance on PMTAs and independent research on the health impacts of IQOS.

FDA found that the evidence PMPSA submitted did not demonstrate reduction in long-term disease risks and that IQOS aerosol emits toxins with carcinogenic and genotoxic potential, some at higher levels than conventional cigarettes. PMPSA did not appropriately consider the health impacts of dual use, the product's attractiveness to youth or data showing that consumers do not accurately perceive the addiction risks of IQOS. Despite FDA's own scientists' recommendations and independent research showing that IQOS presents serious risks to users including cytotoxic, genotoxic, hepatotoxic, cardiovascular and pulmonary risks, FDA concluded that IQOS is 'appropriate for the protection of the public health'.

FDA's decision allowing IQOS to be marketed in the USA disregarded valid scientific evidence and misapplied the public health standard mandated by law. This decision may have important health impacts, influence marketing IQOS outside the USA and erode public confidence in FDA's future PMTA decisions.

Simulating future public health benefits of tobacco control interventions: a systematic review of models.

Tobacco Control

To prioritise tobacco control interventions, simulating their health impacts is valuable. We undertook a systematic review of tobacco intervention simulation models to assess model structure and input variations that may render model outputs non-comparable.

We applied a Medline search with keywords intersecting modelling and tobacco. Papers were limited to those modelling health outputs (eg, mortality, health-adjusted life years), and at least two of cancer, cardiovascular and respiratory diseases. Data were extracted for each simulation model with ≥3 arising papers, including: model type, untimed or with time steps and trends in business-as-usual (BAU) tobacco prevalence and epidemiology.

Of 1911 papers, 186 met the inclusion criteria, including 13 eligible simulation models. The SimSmoke model had the largest number of publications (n=46), followed by Benefits of Smoking Cessation on Outcomes (n=12) and Tobacco Policy Model (n=10). Two of 13 models only estimated deaths averted, 1 had no time steps, 5 had no future trends in BAU tobacco prevalence, 9 had no future trends in BAU disease epidemiology and 7 had no time lags from quitting tobacco to reversal of health harm.

Considerable heterogeneity exists in simulation models, making outputs substantively non-comparable between models. Ranking of interventions by one model may be valid. However, this may not be true if, for example, interventions that differentially affect age groups (eg, a tobacco-free generation policy vs increased cessation among adults) do not account for plausible future trends. Greater standardisation of model structures and outputs will allow comparison across models and countries, and for comparisons of the impact of tobacco control interventions with other preventive interventions.

Voltage and e-liquid composition affect nicotine deposition within the oral cavity and carbonyl formation.

Tobacco Control

The diversity of e-liquids along with higher powered e-cigarette nicotine delivery devices are increasing. This study evaluated the effect of voltage and e-liquid composition on particle size, nicotine deposition in a human oral-trachea cast model and generation of carbonyls.

Nineteen e-liquids were evaluated for 30 common chemicals by gas chromatography-mass spectrometry (GC-MS). E-cigarette aerosols containing nicotine (1.2%) were generated at 4 and 5 volts for assessment of particle size distribution using Aerodynamic Particle Sizer (APS), Fast Mobility Particle Size (FMPS) and an In-Tox cascade impactor and nicotine deposition by GC-MS. Carbonyl formation in aerosols was assessed by liquid chromatography tandem triple-quad mass spectrometry.

Total chemical burden ranged from 0.35 to 14.6 mg/mL with ethyl maltol present in all e-liquids. Increasing voltage was associated with an increase in median size of aerosol particles and the deposition of nicotine in the oral cast. Two e-liquids caused a 2.5-fold to 5-fold increase in nicotine deposition independent of particle size and voltage. Increasing voltage caused an increase in formaldehyde, acetaldehyde and acrolein in the presence and absence of nicotine. Most striking, aerosols from several e-liquids significantly increased levels of acetaldehyde and acrolein compared with unflavoured.

Increasing voltage and composition of e-liquid can increase the exposure of the oral pharynx and bronchial airways to carbonyls that can react with DNA to generate adducts, induce oxidative stress, inflammation and cell death. The elevated nicotine and carbonyls readily enter the circulation where they can also cause cardiovascular stress. The growing popularity of higher voltage e-cigarette delivery devices will likely further elevate health risks from chronic exposure to these complex aerosols.

Questioning the regressivity of tobacco taxes: a distributional accounting impact model of increased tobacco taxation.

Tobacco Control

Tobacco taxes, as with other 'sin taxes', are generally regarded as a highly cost-effective mechanism to reduce consumption but are often considered by policymakers to be regressive, undermining efforts to fully implement them at levels recommended by the WHO due to concerns of fairness. We aim to demonstrate whether there are circumstances in which the impacts of additional tobacco taxes are not regressive, using a standard income-share accounting definition of tax burden.

We apply mathematical modelling and explore the hypothetical distributions in the net change in tobacco taxes and cigarette expenditures by income group, following an increase in tobacco taxation. The hypothetical distribution per income group of additional taxes and cigarette expenditures borne by individuals following tobacco tax hikes was calculated with respect to a selection of parameters including: the change in the retail price of cigarettes, the price elasticity of demand for tobacco, smoking prevalence, cigarette consumption and individual income. We determine the range of hypothetical parameter values for which increased tobacco taxation should not be considered to penalise the poorest income groups when examining marginal cigarette consumption expenditures and using an accounting definition of tax burden.

Our findings question the doctrine that tobacco taxes are uniformly regressive from a standard income-share accounting view and point to the importance of the specific features of tax policy to shape a progressive approach to tobacco taxation: tobacco tax increases are less likely to be regressive when accompanied by a broad framework of demand-side measures that enhance the capacity of low-income smokers to quit tobacco use.

Price and expenditure elasticity of cigarette demand in El Salvador: a household-level analysis and simulation of a tax increase.

Tobacco Control

In El Salvador, 8.8% of adults 15 years and older smoke cigarettes. Little is known about the sensitivity of cigarette consumption among the adults in El Salvador to tax and price increases and income growth.

Elasticities are estimated using Deaton's Almost Ideal Demand System model applied to data from the National Household Income and Expenditure Survey 2005/2006 for the total population and separately for income groups. The estimates are then used to simulate the effects of a proposed change in tobacco tax policy on cigarette consumption and tax revenue.

The estimated price elasticities (-0.77 for the total population) are within the range of price elasticity estimates available for low and middle-income countries. Given the estimated elasticities, a tobacco tax increase is expected to reduce the number of smokers (by almost 20%) and increase tobacco tax revenue (by more than 50%).

Increasing tobacco taxes has the potential to decrease consumption in El Salvador and raise fiscal revenues. The tobacco tax burden in El Salvador is one of the lowest in Latin America and the social costs of tobacco consumption largely exceed the tobacco tax revenues. An increase in tobacco tax could significantly decrease the number of smokers and reduce the burden of tobacco-related diseases and deaths.

How much of the future mortality toll of smoking can be avoided?

Tobacco Control

To determine how much future smoking-related mortality in the USA can be prevented, recognising that some of that future mortality results from past smoking.

Employing a dynamic population simulation model, we estimate smoking's expected mortality burden in the USA, measured as life-years lost (LYL), in a status-quo scenario run from 2018 through 2100. We then estimate LYL attributable to past smoking assuming that all smoking ceases at the end of 2017. We calculate the potential avoidable LYL, which we call the maximum potential reduction in premature mortality (MPRPM), as the difference between the two. We use data from the US Census Bureau, National Vital Statistics Reports, the National Health Interview Survey and Cancer Prevention Study II.

Under status-quo assumptions, smoking will claim 305 million LYL in the US from 2018 to 2100. If all smoking ceased at the end of 2017, past smoking would be responsible for 191.8 million LYL. Thus, avoidable LYL by 2100-the MPRPM-would be 113.2 million, 37% of the expected toll of smoking. A sensitivity analysis finds that were the annual smoking initiation rate 3% instead of 7.8%, the MPRPM would be 13-14% lower. Were the annual permanent smoking cessation rate twice our status-quo estimate of 4.35%, the MPRPM would be 38-39% lower.

Public health can address only the future toll of future smoking. Smoking's MPRPM is the reduction in the mortality burden of smoking that tobacco control can strive to achieve.

Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia.

Tobacco Control

Little is known about the health harms associated with low-intensity smoking in Asians who, on average, smoke fewer cigarettes and start smoking at a later age than their Western counterparts.

In this pooled analysis of 738 013 Asians from 16 prospective cohorts, we quantified the associations of low-intensity (<5 cigarettes/day) and late initiation (≥35 years) of smoking with mortality outcomes. HRs and 95% CIs were estimated for each cohort by Cox regression. Cohort-specific HRs were pooled using random-effects meta-analysis.

During a mean follow-up of 11.3 years, 92 068 deaths were ascertained. Compared with never smokers, current smokers who consumed <5 cigarettes/day or started smoking after age 35 years had a 16%-41% increased risk of all-cause, cardiovascular disease (CVD), respiratory disease mortality and a >twofold risk of lung cancer mortality. Furthermore, current smokers who started smoking after age 35 and smoked <5 cigarettes/day had significantly elevated risks of all-cause (HRs (95% CIs)=1.14 (1.05 to 1.23)), CVD (1.27 (1.08 to 1.49)) and respiratory disease (1.54 (1.17 to 2.01)) mortality. Even smokers who smoked <5 cigarettes/day but quit smoking before the age of 45 years had a 16% elevated risk of all-cause mortality; however, the risk declined further with increasing duration of abstinence.

Our study showed that smokers who smoked a small number of cigarettes or started smoking later in life also experienced significantly elevated all-cause and major cause-specific mortality but benefited from cessation. There is no safe way to smoke-not smoking is always the best choice.

Perceived risk of electronic cigarettes compared with combustible cigarettes: direct versus indirect questioning.

Tobacco Control

Tobacco companies claim that a large proportion of the population perceives potential modified risk tobacco products as equally or more harmful than cigarettes, and argue misperceptions need to be corrected using modified risk claims. However, the studies they cite predominantly use one specific measurement of comparative risk. We analysed a representative sample of US adult smokers and non-smokers to examine whether the proportion who report e-cigarettes as less harmful than regular cigarettes differs depending on how the comparative risk questions were presented.

We analysed data from the 2017 Tobacco Products and Risk Perceptions Survey. Comparative risk of cigarettes and e-cigarettes was measured in two ways: direct (single question) and indirect (by measuring perceived risk of both in separate questions and then subtracting the scores from each other).

When asked to compare harms of e-cigarettes and cigarettes directly (single question), 33.9% of participants identified e-cigarettes as less harmful than cigarettes, 36.4% reported equal harm, 4.3% said e-cigarettes were more harmful and 25.3% said 'I don't know'. When asked indirectly (separate questions), 42.1% identified e-cigarettes as less harmful than cigarettes, 23.8% said they were of equal harm, 7.1% perceived e-cigarettes to be more harmful and 27.1% did not know.

Our study offers evidence to suggest the need to use both direct and indirect risk questions when assessing the public's perceptions of harms associated with novel tobacco products.

Associations between cigarette prices and consumption in Europe 2004-2014.

Tobacco Control

Increases in tobacco price are known to reduce smoking prevalence, but these correlations may be blunted by the availability of budget cigarettes, promoted by the tobacco industry to maintain profits.

To investigate the effect of budget cigarettes on cigarette consumption using data from Europe 2004-2014.

Data on the annual population-weighted cigarette consumption per adult come from the International Cigarette Consumption Database. Data on the annual tobacco price come from Euromonitor International for 23 European countries. Median prices and price differentials (operationalised as percentages obtained by dividing the difference between median and minimum prices by the median price) were examined. A linear random-effects model was used to assess associations between median prices and price differentials with cigarette consumption within 1 year and with a 1-year time lag.

Cigarette consumption per capita declined over the study period (-29.5 cigarettes per capita per year, 95% confidence interval -46.8 to -12.1). The analysis suggests that increases in cigarette price differentials, a marker of opportunities for smokers to switch to less expensive cigarettes, may be associated with greater consumption in the same year (6.4 for a 10% increase in differential, -40.0 to 52.6) and are associated with greater consumption in the following year (67.6, 25.8 to 109.5).

These analyses suggest that even in Europe, where tobacco taxes are relatively high compared with other regions, differential cigarette pricing strategies may undermine tobacco control. Further research is needed on links between tobacco price structures and consumption, and policy design to maximise the effectiveness of tobacco taxation.

Might limiting liquid nicotine concentration result in more toxic electronic cigarette aerosols?

Tobacco Control

Some jurisdictions have instituted limits on electronic cigarette (ECIG) liquid nicotine concentration, in an effort to control ECIG nicotine yield...