Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002–2019

SignificanceCannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The current study estimated the prevalence of cigarette dependence among US individuals who smoke cigarettes by cannabis use status, and investigated trends in cigarette dependence from 2002 to 2019 among cigarette smokers by cannabis use status and cigarette consumption (ie, cigarettes per day, CPD).MethodsData were drawn from the 2002–2019 annual National Survey on Drug Use and Health and included US individuals aged 12+ years who used cigarettes at least once in the past month (n=231 572). Logistic regression was used to estimate the prevalence of cigarette dependence, measured as time to first cigarette <30 min, by past-month cannabis use (no use, non-daily use, daily use), and to estimate trends in cigarette dependence from 2002 to 2019 overall and stratified by cannabis use and smoking level (light, 1–5 CPD; moderate, 6–15 CPD; heavy, 16+ CPD).ResultsAcross all levels of cigarette use, cigarette dependence was significantly more common among individuals with daily cannabis use compared with those with non-daily or no cannabis use. From 2002 to 2019, cigarette dependence increased among cigarette smokers with non-daily cannabis use, and among light and moderate cigarette smokers with no cannabis use.ConclusionsUS individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who use cigarettes and do not use cannabis at virtually all levels of cigarette consumption. Further, cigarette dependence is increasing in the USA both among those who use and do not use cannabis. Given the increase in cannabis use among those using cigarettes, efforts to elucidate the nature of the association between cannabis and cigarette dependence are needed.

Profile of menthol cigarette smokers in the months following the removal of these products from the market: a cross-sectional population survey in England

IntroductionIn May 2020, the EU Tobacco Products Directive ban on the sale of menthol cigarettes was implemented in England. This study examined the prevalence of menthol cigarette smoking after the ban, according to sociodemographic and smoking characteristics.MethodsCross-sectional data came from a representative survey of current smokers (18+) in England (unweighted n=2681) between July 2020 and June 2021. The weighted prevalence of menthol cigarette smoking as a proportion of total cigarette smoking was calculated, log-binomial regression explored trends over time, and χ2 statistics assessed the relationship between menthol smoking, sociodemographic and smoking characteristics. Sources of purchase of menthol cigarettes were explored.ResultsBetween July 2020 and June 2021, 15.7% (95% CI 14.5 to 17.1) of smokers reported smoking menthol cigarettes. The fitted non-linear trend supported no initial change followed by a possible reduction across April–June 2021 and fit the data better than linear and null (no change) models (χ2(2)=2519.7, p=0.06; χ2(3)=2519.7, p=0.006). Menthol cigarette smoking was more common among younger groups (16–24=25.2%; 25–34=19.9%) and women (19.4%). Menthol cigarette smokers showed lower cigarette dependence compared with other smokers. Past-6-month purchases of menthol cigarettes from any illicit or cross-border source declined from 30.1% in the last 6 months of 2020 to 17.5% in the first 6 months of 2021.ConclusionsA substantial minority of current smokers in England reported menthol cigarette smoking between July 2020 and June 2021, despite the ban, possibly reflecting mitigation of restrictions by a variety of licit means, such as legal menthol accessories. The reduction in menthol smoking across April–June 2021 warrants further monitoring.

Change in cigarette dependence among a cohort of smokers following COVID-19 diagnosis in Kashmir valley: An observational follow-up study

Background: COVID-19 diagnosis should serve as an impetus for smokers to discontinue its use. The study was conducted to estimate the change in cigarette dependence among newly diagnosed COVID-19 cases. Aims and Objectives: COVID-19 diagnosis should serve as an impetus for smokers to discontinue its use. The study was conducted to estimate change in cigarette dependence among newly diagnosed COVID-19 cases. Materials and Methods: Study was conducted between October and December 2020 and newly diagnosed male COVID-19 patients who were current smokers at diagnosis were recruited from two hospitals involved in testing and treatment of COVID-19. Baseline socioclinical information was recorded at diagnosis in addition to the estimation of cigarette dependence using Fagerstrom Test for Nicotine Dependence (FTND) and health status using Post-COVID-19 Functional Scale (PCFS). Follow-up was done at 2 weeks after recovery using both FTND and PCFS scales. Wilcoxon signed-rank test, paired t-test, and ANOVA were used for univariate analysis and multivariate regression was done. Results: A total of 171 subjects with mean age of 43.79 years were included in the study. FTND scores decreased significantly from the day of diagnosis to follow-up visit with 79% of subjects reporting a decrease. On univariate analysis, decrease in FTND had a significant association with presence of comorbidity, any symptoms, presence of respiratory symptoms, and if supplemental oxygen was administered. On multivariate analysis, symptomatic COVID-19 disease, higher age, PCFS at baseline, and PCFS at follow-up had a significant association with decreased PCFS values at follow-up. Conclusion: COVID-19 diagnosis was followed by significant decrease in FTND score, particularly for symptomatic and older subjects. Post-COVID follow-up visits should be used asan opportunity by health providers to ensure its sustainability and for achieving cessation.

Pilot Ecological Momentary Assessment Study of Subjective and Contextual Factors Surrounding E-Cigarette and Combustible Tobacco Product Use among Young Adults

Background: Dual use of e-cigarettes and combustible tobacco products is common in young adults. We aimed to explore how ratings of subjective and contextual factors differed between discrete episodes of e-cigarette use vs. combustible tobacco product smoking among a sample of young adults. Methods: Young adults (N = 29, ages 18–30) who used e-cigarettes and ≥1 combustible tobacco product at least once weekly completed a 1-week smartphone-based ecological momentary assessment (EMA). Twice daily random prompts assessed past-15-min use of tobacco products, ratings of subjective factors (e.g., negative affect, craving), and contextual factors related to activity, location, and companionship. A multivariable GEE model assessed whether subjective or contextual factors were associated with e-cigarette vs. combustible tobacco product episodes. Results: 184 tobacco use episodes were reported (39.7% e-cigarette, 60.3% combustible tobacco product). High baseline cigarette dependence, as measured by the Fagerström Test for Cigarette Dependence, was associated with lower odds of e-cigarette vs. combustible tobacco product episodes (aOR 0.01, 95% CI (0.002–0.08); p < 0.001). Neither between- or within-subjects negative affect or craving scores were associated with e-cigarette use. Activities of eating/drinking (aOR 0.20, 95% CI (0.08–0.49); p = 0.001) and being in the companionship of a person who smoked cigarettes (aOR 0.13, 95% CI (0.04–0.43); p = 0.001) were associated with lower odds of e-cigarette vs. combustible tobacco product use episodes. However, traveling (aOR 12.02, 95% CI (3.77–38.26); p ≤ 0.001) and being in a public space (aOR 2.76, 95% CI (1.10–6.96); p = 0.03) were associated with higher odds of e-cigarette than combustible tobacco product use episodes. Conclusions: This pilot data suggests that unique contextual factors may be associated with e-cigarette use, compared to combustible tobacco smoking in a sample of young adults who use both e-cigarettes and combustible tobacco products. Future research with larger samples is needed to better characterize varying contexts and cues for tobacco use among young adults who are dual users.

Predictors of Greater Vaping Dependence and Higher Vaping Frequencies among Canadian Youth and Young Adults over 12-Month

Background: The prevalence of electronic cigarette use has doubled among Canadian youth and young adults in recent years. However, little is known about the predictors of greater vaping nicotine dependence. This study identifies variables associated with greater Penn-State Electronic Cigarette Dependence Index (PS-ECDI) scores and higher vaping sessions per month (SPM) among this population. Methods: Data were drawn from a longitudinal study that recruited 1048 Canadian participants aged 16-26 in 2018. Quota sampling was used to ensure enough regular e-cigarette users were recruited. The current study restricted analyses to the 459 participants who were baseline vapers and have completed both the baseline and 12-month follow-up surveys. Linear regression analyses were employed, with the use of the best subset modelling strategy to obtain reduced models. Results: Baseline vapers who were ≥ 18 and married or cohabiting, had used other tobacco products, had 30 or more puffs per vaping session, started vaping at an earlier age, vaped to quit/reduce smoking, and had used a disposable cigarette-like vaping device and/or an advanced box or tubular device and/or a pod vape in the last 6-month were associated with greater PS-ECDI scores compared to their respective counterparts. Additionally, baseline vapers who were ≥18 and married or cohabiting, had used cannabis, had 30 or more puffs per vaping session; vaped to reduce/quit smoking and/or because friends vape; had used a pod vape in the last 6-month were more likely to have higher SPM at the 12-month follow-up compared to their respective counterparts. Conclusion: 11% of the participants were classified as high vaping nicotine dependence and 42% of the participants had increased their SPM over 1 year. The findings provide targets for vaping reduce or cessation programs and potential policy change in the regulation and sales of pod vape.

E-Cigarette Dependence and Weight-Related Attitudes/Behaviors Associated With Eating Disorders in Adolescent Girls

Background: Although numerous motivations for vaping have been identified in adolescents, no study to date has examined a possible link between vaping and attitudes/behaviors that are associated with eating disorders in adolescent females. Examining this question in adolescent females is especially relevant given the higher prevalence of eating disorders in adolescent girls and women compared to adolescent boys and men.Methods: We recruited 299 girls (between 13 to 17 years old) via Facebook advertisement to complete a REDCap survey, which included the Electronic Cigarette Dependence Index (ECDI), Minnesota Eating Behavior Survey (MEBS), and demographic questions. Data were analyzed using nonparametric Spearman rank correlation test in R.Results: Electronic Cigarette Dependence Index (ECDI) scores were correlated with weight preoccupation (WP), binge eating (BE) and compensatory behavior (CB), but not body dissatisfaction (BD). The following were the results of Spearman correlation tests: (1) WP: rho = 0.13, p = 0.02; (2) BD: rho = 0.06, p = 0.28; (3) BE: rho = 0.15, p = 0.0095; (4) CB: rho = 0.021, p = 0.00027.Conclusion: The present study adds to the current literature examining motivations for e-cigarette use in adolescent girls. As eating disorders and e-cigarette dependence are significant public health concerns, our results highlight the need for intervention development.

The profile of menthol cigarette smokers in the months following the removal of these products from the market: a cross-sectional population survey in England

IntroductionIn May 2020 the EU Tobacco Products Directive ban on the sale of menthol cigarettes was implemented in England. This study examined the prevalence of menthol cigarette smoking after the ban, according to sociodemographic and smoking characteristics.MethodsCross-sectional data came from a representative survey of current smokers (18+) in England (unweighted n = 2,681) between July/2020 and June/2021. The weighted prevalence of menthol cigarette smoking as a proportion of total cigarette smoking was calculated, log-binomial regression explored trends over time, and chi-squared statistics assessed the relationship between menthol smoking, sociodemographic and smoking characteristics. Sources of purchase of menthol cigarettes were explored.ResultsBetween July 2020 and June 2021, 15.7% (95%CI 14.5–17.1) of smokers reported smoking menthol cigarettes. The fitted non-linear trend supported no initial change followed by a possible reduction across April-June 2021 and fit the data better than linear and null (no change) models (χ2(2) = 2519.7, P = 0.06; χ2(3) = 2519.7, P = 0.006). Menthol cigarette smoking was more common among younger groups (16–24 = 25.2%; 25–34 = 19.9%) and women (19.4%). Menthol cigarette smokers showed lower cigarette dependence compared with other smokers. Past six-month purchases of menthol cigarettes from any illicit source declined from 30.1% in the last 6 months of 2020 to 17.5% in the first 6 months of 2021.ConclusionsA substantial minority of current smokers in England reported menthol cigarette smoking between July/2020 and June/2021, despite the ban, possibly reflecting mitigation of restrictions by a variety of licit means, such as legal menthol accessories. The reduction in menthol smoking across April-June 2021 warrants further monitoring.