Publications
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Zhang BY, Bannon OS, Tzu-Hsuan Chen D, et al., 2024, Dual and poly-nicotine and tobacco use among adolescents in the United States from 2011 to 2022, Addictive Behaviors, Vol: 152, ISSN: 0306-4603
BACKGROUND: Adolescent nicotine and tobacco product use remains common despite declining smoking rates in the United States, likely due to the emergence of novel products. Concurrent use of multiple products may increase the risk of nicotine dependency and subsequent substance use. AIM: To identify patterns and trends of dual and poly nicotine and tobacco use among adolescents in the US and explore associations of dual and poly nicotine and tobacco use with sociodemographic factors. METHODS: 12 years of annual National Youth Tobacco Survey data (2011-2022) from 242,637 respondents were used to examine prevalence trends of different combinations of nicotine or tobacco product use among adolescents in the US using weighted point estimates for each year. Poisson regression models examined sociodemographic factors associated with different patterns of dual and poly-product use from 2011 to 2022. RESULTS: Overall, the prevalence of dual (i.e. at least two products) and poly (i.e. at least three products) use decreased between 2011 and 2021 (from 9.5 % to 2.8 % and from 5.1 % to 1.1 %, respectively), but showed signs of increase between 2021 and 2022 (3.7 % for dual and 1.7 % for poly use). The most common combinations included a combustible product with either a novel or noncombustible product. The risk for dual and poly-product use was higher among non-Hispanic Whites, males, and high school students. CONCLUSIONS: Previously declining trends in the prevalence of tobacco/nicotine dual and poly use may have been reversed. Close monitoring and targeted tobacco control policies are essential to tackle multiple product use among adolescents.
Kyriakos C, Erinoso O, Driezen P, et al., 2024, Prevalence and perceptions of flavour capsule cigarettes among adults who smoke in Brazil, Japan, Republic of Korea, Malaysia, and Mexico: Findings from the ITC Surveys, BMJ Open, ISSN: 2044-6055
Weth N, GOYAL J, Filippidis F, 2024, First experience with nicotine products and transition to regular tobacco use: a secondary data analysis in 28 European countries, BMJ Open, Vol: 14, ISSN: 2044-6055
Objective The majority of tobacco users have had their first contact with nicotine at a young age. The aim of this study was to explore the association between the first tobacco or nicotine product tried and the transition to regular product use in 28 European countries.Methods A secondary analysis of participants aged 15–40 years (n=8884) from 28 countries was conducted (Eurobarometer wave 93.2; August–September 2020). Participants who reported having ever tried tobacco or nicotine products were asked which product they tried first. Self-reported history of tobacco use determined whether they were established users (≥1 time weekly) of a range of products at any point in their life. Multilevel logistic regression was used to measure the association between first product tried and becoming a regular user of tobacco or nicotine products.Results There was large variation between countries in the proportion of participants aged ≤40 years that ever tried tobacco or nicotine; Estonia had the highest proportion of ever users (85.8%) and Poland had the lowest (38.9%). Among those who had ever tried tobacco or nicotine, boxed cigarettes were the most common first product (72.3%) and pipe was the least common (0.4%). Compared with those who first tried e-cigarettes, the odds of ever becoming a regular user of any tobacco or nicotine product were higher among those who first had hand-rolled cigarettes (adjusted OR, aOR 2.23; 95% CI 1.43 to 3.48) or boxed cigarettes (aOR 2.08; 95% CI1.43 to 3.02) and lower among those who first tried waterpipe (aOR 0.22; 95% CI 0.14 to 0.34).Conclusions Although this study cannot infer causality, the findings show that odds of becoming a regular tobacco user differs widely depending on the first product used. Better understanding of the associations between first product use and regular tobacco use could be informative to tobacco control policy-makers and help tailor prevention programmes.
Liu Y, Filippidis F, 2024, Tobacco market trends in 97 countries between 2007 and 2021, Tobacco Induced Diseases, Vol: 22, ISSN: 1617-9625
Introduction:Analysis of the tobacco market can provide valuable insights for developing tobacco control strategies. This study examines the market trends of cigarettes, cigars/cigarillos, smoking tobacco, smokeless tobacco, e-cigarettes, heated tobacco products (HTPs), and tobacco-free oral nicotine across 97 countries between 2007 and 2021.Methods:We obtained annual tobacco retail value data from Euromonitor Passport and calculated the market share for each type of tobacco product. The research examined trends in retail value and market share globally, stratified by national income level, as well as in individualcountries.Results:From 2007 to 2015, the growth of the global tobacco market was primarily driven by cigarette sales. However, starting from 2016, emerging products, including e-cigarettes, HTPs, and tobacco-free oral nicotine, as well as non-cigarette combustible products, including cigars/cigarillos and smoking tobacco, have been mostly responsible for the increases in the global tobacco retail value. High-income countries experienced the greatestincrease in the retail value of emerging products, while middle- and low-income countries still observed rises in cigarette sales.Conclusions:Trends in retail value of different tobacco products varied widely during the study period, with distinct trends observed in different income levels and within individual countries. These trends can supplement prevalence data and be used to inform local tobacco control policies.
Chen DT-H, Grigg J, Filippidis FT, et al., 2024, European Respiratory Society statement on novel nicotine and tobacco products, their role in tobacco control and "harm reduction"., Eur Respir J, Vol: 63
Vrinten C, Parnham JC, Radó MK, et al., 2023, Associations of social media use with smoking and e-cigarettes: a national longitudinal study., Lancet, Vol: 402 Suppl 1
BACKGROUND: Social media use is high among children and young people and might influence health behaviours. We examined social media use and use of tobacco and e-cigarettes in the UK. METHODS: We used data from participants aged 10-25 years from the UK Household Longitudinal Study (January 2015-January 2022). Participants were asked: "On a normal weekday, that is Monday to Friday, how many hours do you spend chatting or interacting with friends through a social website or app like that?". Specific social media platforms were not specified. Responses were none, less than 1 h, 1-3 h, 4-6 h, 7 h or more. Outcomes were current tobacco smoking and e-cigarette use. Generalised Estimating Equation (GEE) logistic regression models investigated associations of social media use with tobacco and e-cigarette use, and fixed effects analyses investigated changes in social media use with uptake of both products. Models included possible confounders such as age, sex, household income, ethnicity (White vs non-White) and use of tobacco or e-cigarettes by others within the home. All participants gave written informed consent. FINDINGS: The analytic sample included 10 808 participants with 27 962 observations (mean age 15·7 years [SD 3·8], 5080 [47%] male, 5728 [53%] female, and 7868 [73%] White). Current tobacco smoking was reported at one or more timepoints by 929 (8·6%) participants, and current e-cigarette use by 270 (2·5%) participants. In adjusted GEE models, all levels of social media use were associated with greater odds of current smoking than no use. This association was particularly apparent at higher levels of use adjusted odds ratio [aOR] 3·11, 95% CI 2·41-4·03 for ≥7 h use vs no use), with similar associations for e-cigarettes (aOR 3·04, 2·11-4·40 for ≥7 h use vs no use). Fixed effects analyses also found increased use of social media to be associated with increased uptake of both produc
Vrinten C, Parnham J, Filippidis F, et al., 2023, Patterns of cigarette and e-cigarette use among UK adolescents: a latent class analysis of the Millennium Cohort Study, European Journal of Public Health, Vol: 33, Pages: 857-863, ISSN: 1101-1262
Background Patterning of cigarette and e-cigarette use among young people remains poorlycharacterised. We aimed to describe these patterns in the UK Millennium Cohort Study atage 14 and 17 years.Methods Data on cigarette and e-cigarette use come from 9,731 adolescents. Latent class analysisassigned participants to membership of classes of product use and multinomial logisticregression analyses assessed differences in the likelihood of belonging to classes bysociodemographic (age, gender, ethnicity, household income, maternal education, countryof residence) and smoking-related social factors (caregiver tobacco use, caregiver ecigarette use, and peer smoking).ResultsWe identified four classes of use: 45.8% of adolescents continued to abstain from cigarettesor e-cigarettes; 21.3% experimented (used once or in the past but not currently) withcigarettes and/or e-cigarettes by age 17 but were not current users; 19.0% were lateadopters, characterised by low levels of use at age 14 but high levels of experimentation andcurrent use at age 17; and 13.9% were early adopters, characterised by high levels ofexperimentation and current use at ages 14 and 17. At age 17, 70.4% of early adopterssmoked cigarettes regularly plus an additional 27.3% experimented with cigarettes.Corresponding percentages for e-cigarettes were 37.9% and 58.9%. Tobacco and ecigarette use by caregivers, and cigarette use by peers, were associated with being both lateadopters and early adopters. ConclusionApproximately one in seven adolescents in the UK are early adopters of nicotine products.This highlights the need to develop and implement effective policies to prevent nicotine useuptake.
Kyriakos C, Driezen P, Fong GT, et al., 2023, Illicit purchasing and use of flavour accessories after the European Union menthol cigarette ban: Findings from the 2020-2021 ITC Netherlands Surveys, European Journal of Public Health, Vol: 33, Pages: 619-626, ISSN: 1101-1262
BackgroundThe 2020 European Union (EU) menthol cigarette ban increased quitting among pre-ban menthol smokers in the Netherlands, but some reported continuing to smoke menthol cigarettes. This study examined three possible explanations for post-ban menthol use—(i) illicit purchasing, (ii) use of flavour accessories and (iii) use of non-menthol replacement brands marketed for menthol smokers.MethodsData were from the ITC Netherlands Cohort Surveys among adult smokers before the menthol ban (Wave 1: February–March 2020, N = 2067) and after the ban (Wave 2: September–November 2020, N = 1752; Wave 3: June–July 2021, N = 1721). Bivariate, logistic regression and generalized estimating equation model analyses were conducted on weighted data.ResultsIllicit purchasing remained low from pre-ban (2.4%, 95% CI: 1.8–3.2, Wave 1) to post-ban (1.7%, 1.2–2.5%, Wave 3), with no difference between menthol and non-menthol smokers from Wave 1 to Wave 3. About 4.4% of post-ban menthol smokers last purchased their usual brand outside of the EU and 3.6% from the internet; 42.5% of post-ban menthol smokers and 4.4% of smokers overall reported using flavour accessories, with greater odds among those aged 25–39 years vs. 55+ (aOR = 3.16, P = 0.002). Approximately 70% of post-ban smokers who reported using a menthol brand were actually using a non-menthol replacement brand.ConclusionsThere was no increase in illicit purchasing or of smuggling outside the EU among menthol and non-menthol smokers in the Netherlands 1 year after the EU menthol cigarette ban. Use of flavour accessories and non-menthol replacement brands best explain post-ban menthol use, suggesting the need to ban accessories and ensure industry compliance.
Weth N, Qi D, Chang K, et al., 2023, Price differences between capsule, menthol non-capsule and unflavoured cigarettes in 65 countries in 2018, Preventive Medicine Reports, Vol: 34, Pages: 1-5, ISSN: 2211-3355
The global consumption of flavoured cigarettes, particularly capsule and menthol non-capsule cigarettes, has been rising rapidly. Their attractiveness has been fuelled by perceptions of improved palatability, along with industry marketing tactics such as lower price points in some regions. This study aimed to compare prices of unflavoured, capsule, and menthol non-capsule cigarettes across 65 countries by analysing 2018 cigarette price data from Euromonitor Passport. Median prices of capsule and menthol non-capsule cigarettes were each compared to unflavoured cigarettes at the country-level. Countries were included in the analysis if they contained price data for capsule or menthol non-capsule and unflavoured cigarettes (n = 65). The median price of capsule cigarettes was the same as unflavoured cigarettes in 12 out of 50 countries and not statistically different in another 31 countries (p > 0.05). Capsule cigarettes were more expensive than unflavoured cigarettes in five countries and cheaper in two (p < 0.05). The median price of menthol non-capsule cigarettes was the same as unflavoured cigarettes in 6 out of 51 countries and not statistically different in another 39 countries (p > 0.05). Menthol non-capsule cigarettes were more expensive than unflavoured cigarettes in five countries and cheaper in one country (p < 0.05). There was no pattern found in the pricing of capsule or menthol non-capsule cigarettes, suggesting variability in the tobacco industry’s pricing strategies across countries. Tailoring tobacco control policies to match national market conditions, particularly in countries with significant market shares of capsule and menthol non-capsule cigarettes could help address the public health threat posed by the tobacco epidemic.
Parnham JC, Vrinten C, Cheeseman H, et al., 2023, Changing awareness and sources of tobacco and e-cigarettes among children and adolescents in Great Britain, TOBACCO CONTROL, ISSN: 0964-4563
Chen DT-H, Nargis N, Fong GT, et al., 2023, A longitudinal study of transitions between smoking and smokeless tobacco use from the ITC Bangladesh Surveys: implications for tobacco control in the Southeast Asia region, The Lancet Regional Health - Southeast Asia, Vol: 14, Pages: 1-12, ISSN: 2772-3682
BackgroundIn Southeast Asia, tobacco use is a major public health threat. Tobacco users in this region may switch between or concurrently use smoked tobacco and smokeless tobacco (SLT), which makes effective tobacco control challenging. This study tracks transitions of use among different product users (cigarettes, bidis, and SLT) in Bangladesh, one of the largest consumers of tobacco in the region, and examines factors related to transitions and cessation.MethodsFour waves (2009–2015) of the International Tobacco Control (ITC) Bangladesh Survey with a cohort sample of 3245 tobacco users were analysed. Generalized Estimating Equations (GEE) models were used to explore the socioeconomic correlates of transitions from the exclusive use of cigarettes, bidis, or SLT to the use of other tobacco products or quitting over time.FindingsAmong exclusive cigarette users, most remained as exclusive cigarette users (68.1%). However, rural smokers were more likely than urban smokers to transition to bidi use (odds ratio [OR] = 3.02, 95% confidence interval [CI] = 1.45–6.29); to SLT use (OR = 2.68, 95% CI = 1.79–4.02) and to quit tobacco (OR = 1.57, 95% CI = 1.06–2.33). Among exclusive bidi users, transitional patterns were more volatile. Fewer than half (43.3%) of the exclusive bidi users maintained their status throughout the waves. Those with higher socio-economic status (SES) were more likely to quit (OR = 4.16, 95% CI = 1.08–13.12) compared to low SES smokers. Exclusive SLT users either continued using SLT or quit with minimal transitions to other products (≤2%). Nevertheless, males were more likely to switch to other tobacco products; younger (OR = 2.94, 95% CI = 1.23–6.90 vs. older), more educated (OR = 1.55, 95% CI = 1.77–3.12 vs. less educated), and urban SLT users (OR = 0.52, 95% CI = 0.30–0.86 for rural vs. urban users) were more likely to quit.InterpretationComplex transitional patterns were found among different types
Kyriakos C, Filippidis F, East KA, et al., 2023, Use of menthol cigarettes and accessories among youth who smoked after the menthol cigarette ban in England and Canada, 2021: Implications for health equity, Nicotine and Tobacco Research, ISSN: 1462-2203
Gallus S, Lugo A, Stival C, et al., 2023, Electronic cigarette use in 12 European countries. Results from the TackSHS survey, Journal of Epidemiology, Vol: 33, Pages: 276-284, ISSN: 0917-5040
BACKGROUND: Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries. METHODS: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ≥15 years in each country, provided information on electronic cigarette. RESULTS: 2.4% (95% confidence interval, CI: 2.2-2.7) of the subjects (2.5% among men and 2.4% among women; 0.4% among never, 4.4% among current- and 6.5% among ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7.2% in England. Of the 272 electronic cigarette users, 52.6% were dual users (i.e., users of both electronic and conventional cigarettes) and 58.8% used liquids with nicotine. In all, 65.1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden, in particular in workplaces (34.9%), and bars and restaurants (41.5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (p for trend <0.001) and higher among individuals with high level of education (p for trend 0.040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3.62; 95% CI: 1.80-7.30). CONCLUSIONS: Considering the whole adult population of these 12 European countries, more than 8.3 million people use electronic cigarettes. The majority of users also smoked conventional cigarettes, used electronic cigarettes with nicotine and consumed electronic cigarettes in smoke-free indoor areas.
Filippidis FT, 2023, Reducing the prevalence of smokeless tobacco in an evolving tobacco landscape, LANCET GLOBAL HEALTH, Vol: 11, Pages: E817-E818, ISSN: 2214-109X
Parnham JC, Vrinten C, Rado MK, et al., 2023, Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK, LANCET CHILD & ADOLESCENT HEALTH, Vol: 7, Pages: 297-297, ISSN: 2352-4642
Laverty AA, Li CR, Chang KC-M, et al., 2023, Cigarette taxation and price differentials in 195 countries during 2014-2018, Tobacco Control, Vol: 32, Pages: 359-365, ISSN: 0964-4563
INTRODUCTION: Raising tobacco prices via increased taxation may be undermined by tobacco industry tactics to keep budget cigarettes on the market. Price differentials between budget and premium cigarettes allow smokers to trade down in the face of average price rises thus attenuating health benefits. This study examines global trends of price differentials and associations with taxation. METHODS: Ecological analysis of country-level panel data of 195 countries' price differentials was performed and compared against total, specific excise, ad valorem and other taxation. Price differentials were expressed as the difference between budget cigarette and premium pack prices (as % of premium pack prices). Two-level linear regression models with repeated measurements (2014, 2016 and 2018) nested within each country assessed the association between country-level taxation structures and price differentials, adjusted for year, geographical region and income group. RESULTS: Worldwide, median price differential between budget and premium 20-cigarette packs was 49.4% (IQR 25.9%-70.0%) in 2014 and 44.4% (IQR 22.5%-69.4%) in 2018 with significant regional variation. The largest price differentials in 2018 were in Africa, with the lowest in Europe. Total taxation was negatively associated with price differentials (-1.5%, 95% CI -2.5% to -0.4% per +10% total taxation) as was specific excise taxation (-2.5%, 95% CI -3.7% to -1.2% per +10% specific excise tax). We found no statistically significant association between ad valorem taxation and price differentials. CONCLUSION: Total levels of taxation and specific excise taxes were associated with smaller price differentials. Implementing high specific excise taxes may reduce price differentials and improve health outcomes.
Kyriakos CN, Zatonski MZ, Filippidis FT, 2023, Marketing of flavour capsule cigarettes: a systematic review, Tobacco Control, Vol: 32, Pages: E103-E112, ISSN: 0964-4563
Objective This systematic review aims to identify marketing elements of flavour capsule variants (FCVs), cigarettes that release flavour when a capsule(s) embedded in the filter is crushed.Data sources A search of original research without restrictions in publication year, population, study design or language using a combination of cigarette and capsule terms was conducted across four databases (Medline, Embase, Web of Science and Scopus), indexed until 13 December 2021, along with a citation search.Study selection Studies were included if they presented original research relevant to marketing features of FCVs.Data extraction One author performed data extraction and coded outcomes based on ‘4Ps’ of marketing mix theory: product, place, price and promotion. The second author conducted a cross-check.Data synthesis Of 2436 unduplicated database records and 30 records from other sources, 40 studies were included in the review. Studies were published between 2009 and 2021. Study methodologies primarily included content analysis of cigarette packs/sticks, review of tobacco industry documents and content analysis of advertising information. Findings suggest FCVs are marketed using a mix of strategies, particularly characterised by product innovation, timing market launches around tobacco policies, point-of-sale advertising and packaging to communicate a high-tech, customisable and flavourful product.Conclusion Findings illuminate the marketing strategies of FCVs that are likely driving their global growth, particularly among young people and in low and middle-income countries. Comprehensive tobacco control regulations are needed to close loopholes and curb industry efforts to circumvent existing policies in order to mitigate uptake of FCVs and other product innovations.
Radu-Loghin C, Mocanu K, Al Gouhmani H, et al., 2023, EUREST-RISE: an innovative networking and training project on European Tobacco Control, Tobacco Prevention and Cessation, Vol: 9, ISSN: 2459-3087
Kyriakos CN, Zatonski MZ, Filippidis FT, 2023, Flavour capsule cigarette use and perceptions: a systematic review, Tobacco Control, Vol: 32, Pages: e83-e94, ISSN: 0964-4563
Objective This systematic review on flavour capsule cigarettes aims to examine prevalence, correlates of use, behaviours and perceptions of these products globally.Data sources A search of original, peer-reviewed research without restrictions in publication year, population, study design or language, using a combination of cigarette and capsule terms was conducted across four databases (Medline, Embase, Web of Science and Scopus), indexed until 30 April 2021.Study selection Studies were included if they presented original, human subjects research on flavour capsule cigarettes.Data extraction Two authors independently extracted data on main outcome results and assessed risk of bias using a validated quality assessment tool (QATSDD).Data synthesis Of 842 unduplicated database records and four studies from citation searching screened, 20 studies were included in the review. Studies reported data from 2009 to 2019 across eight countries, the majority of which used cross-sectional or focus group study designs. Current capsule use among smokers was highest in Chile and Mexico (40%) and was associated with younger age, and in some countries, with being female. Capsule cigarettes are perceived as tasting better, being smoother on the throat, more fun to smoke, and more attractive compared with non-capsule cigarettes, particularly among susceptible non-smokers and non-daily smokers.Conclusion Findings call for the adoption of comprehensive tobacco control policies that account for flavour capsules and similar iterations, which can increase appeal through flavours and innovative features. Continued monitoring and research of these products is critical, with particular attention to low-income and middle-income countries, which make up a disproportionately larger share of the capsule market.
Cox DW, Rodriguez L, Grigg J, et al., 2023, Statement on Tobacco 21 from the European Respiratory Society Tobacco Control Committee., Eur Respir J, Vol: 61
Chen T-H, Nargis N, Fong G, et al., 2023, Perceptions and reasons for quitting and transitioning between smoking and smokeless tobacco products: findings from four waves of the ITC Bangladesh Survey, Tobacco Induced Diseases, Vol: 21, Pages: 1-11, ISSN: 1617-9625
Introduction:Transitions between different tobacco products are frequent among tobacco users in Bangladesh; however, the reasons leading to such transitions and why they quit are not well researched. The aim of the study is to examine perceptions and reasons reported by tobacco users in Bangladesh to transition to other products or quit.Methods:Data from four waves (2009–2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130), and SLT users (n=308) to either start using other products or quit were analyzed with sampling weights. The percentages of responses across waves were used to calculate the pooled proportion data using a meta-analysis approach.Results:Common reasonsig for respondents switching to other tobacco products were influence of friends/family (73.8–86.0%), and curiosity (44.4–71.3%). The perceived calming effect of smoking cigarettes and bidis (43.2–56.9%), and the impression that bidis were less harmful (52.3%) and taste better (71.2%) were major reasons for exclusive SLT users to switch products. Health concerns (16.5– 62.7%) and disapproval from friends/family (29.8–56.4%) were generally the main reasons for quitting. For smoked tobacco users, doctor’s advice (41.6%), package warning labels (32.3%), and price (32.4%) seemed to be the major driving factors to quit.Conclusions:Results highlight that the reasons for switching between tobacco products and quitting include social factors (e.g. friends/family) and (mis) perceptions regarding the products. Tobacco control policy could emphasize cessation support, increased price and education campaigns as key policies to reduce overall tobacco use in Bangladesh. Data from four waves (2009–2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130)
Weth N, Bustamante L, Weth D, et al., 2023, Engagement with gamification elements in a smoking cessation app and short-term smoking abstinence: a quantitative assessment, JMIR Serious Games, Vol: 11, Pages: 1-7, ISSN: 2291-9279
Background:Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report.Objective:This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term.Methods:Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence.Results:In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of t
Bannon O, Radó M, Filippidis F, 2023, Cigarette price differentials and their association with infant and neonatal mortality in 140 countries: a longitudinal ecological study, Pages: 35-36
Background Exposure to cigarette smoke is a serious global public health concern that leads to tens of thousands of preventable infant and neonatal deaths globally each year, most of which occur in low- and middle-income countries. Raising tobacco taxes to increase cigarette prices is an effective measure to reduce smoking but is undermined by tobacco companies’ differential pricing strategies that maintain budget cigarette prices. Larger price differentials between premium and budget cigarettes are associated with increased infant mortality in the European Union, but this association is not understood globally. Objectives To increase understanding of the association between cigarette price differentials and infant and neonatal mortality globally. Methods Fixed-effect panel regression models were used to assess the association between cigarette price differentials and infant and neonatal mortality globally and by country-level income group using country-level aggregated data on 140 (41 high income and 99 low- and middle-income) countries between 2014 and 2020. Results A 10% cigarette price differential increase was associated with 0.76% increased infant mortality (95% CI: 0.2%-1.3%) and 0.78% increased neonatal mortality (95% CI: 0.2%-1.4%) globally. Decreasing price differentials by 10% was associated with 29,373 averted infant deaths (95% CI: 7,729-50,244), including 18,454 averted neonatal deaths (95% CI: 4,732- 33,122), globally in 2020, 98.4% of which in low-and middleincome countries. Conclusion Higher cigarette price differentials are associated with increased infant and neonatal mortality globally. Associations by income group were not detected. Conflicts of interest The authors have no conflicts of interest to disclose.
Kyriakos C, Fong G, Driezen P, et al., 2023, Lessons learned from banning menthol cigarettes in Europe: A mixed methods study examining policy implementation and impact, Pages: 55-56
Introduction Europe is a global leader in banning flavours, including menthol, in cigarettes. The 27 European Union member states, the United Kingdom, Moldova, and Turkey banned menthol as a characterising flavour in cigarettes in May 2020. Objectives As other countries aim to ban flavours of tobacco products it is critical to understand the lessons learned from Europe to ensure regulations are maximised. This mixed methods study examined implementation and impact of European menthol cigarette bans. Material and Methods Quantitative data came from the International Tobacco Control (ITC) Project Surveys among adults who smoke in the Netherlands (2020) and youth who smoke in England (2021). Qualitative data came from review of policy documents, as well conducting semi-structured interviews with key informant stakeholders in Moldova and Turkey. Outcomes examined included: factors influencing policy implementation, quitting behaviours, illicit purchasing, use of flavour accessories, and health equity. Results Key factors that were perceived by stakeholders in Moldova and Turkey to influence implementation of the menthol ban included: social climate, institutional capacity and operational effectiveness, political commitment, and tobacco industry interference. Findings from the Netherlands indicate that the menthol ban resulted in 17.3% additional quit attempts and 12.0% additional quitting among adults who smoked menthol cigarettes compared to non-menthol, while not increasing illicit purchasing. However, one-quarter of youth who smoke in England reported using menthol accessories, with disproportionately higher use among youth identifying as Black (60%). Use of ‘non-menthol’ replacement cigarette brands were also popular in England and the Netherlands. Conclusions The experiences of European countries in implementing menthol cigarette bans can support other countries in taking measures to ban products known to facilitate smoking initiation and regular use. M
Chen D, Filippidis F, 2023, Disposable e-cigarette use and associated factors among US middle and high school students in 2021 and 2022, Pages: 31-32
Background Disposable e-cigarettes have emerged in the market and gained significant popularity, especially among adolescents. This has raised concerns about the potential addiction to nicotine and the associated health effects among this age group. Objectives This study aims to investigate the prevalence of disposable e-cigarette use among middle and high school children in the United Stated, and to identify potential factors associated with usage and increased frequency of use in order to identify potential regulatory interventions. Methods Data from 48,704 U.S. middle and high school students in the 2021 and 2022 National Youth Tobacco Survey (NYTS) were pooled to estimate disposable e-cigarette use. Multivariable logistic and ordinal regression models were used to assess demographic and psychosocial factors related to disposable e-cigarette use and frequency of use (low, medium, and high). All analyses were weighted to represent the national student sample. Results The prevalence of current disposable e-cigarettes increased from 3.9% (n=744) in 2021 to 5.1% (n=1,443) in 2022 and were the most common type of e-cigarette used in both years. The modelling results indicated that, among all respondents, girls were 1.57 (95% CI:1.29-1.91) times more likely to be disposable e-cigarette users than boys, and high school students had 5.14 (95% CI: 3.96-6.67) times higher odds of being users than middle school students. Students of Hispanic, Black, Asian, and other ethnicities were less likely to use disposable e-cigarettes compared to White students (OR between 0.42 to 0.61). Among current disposable e-cigarette users, higher frequency of use was associated with self-identifying as LGBTQ+ (OR 1.41; 95% CI: 1.00-2.00 in comparison to straight), higher family affluence (OR 1.77; 95% CI: 1.16-2.71 in comparison to low), lower academic performance (OR 2.16; 95% CI: 1.15-4.07; self-reported grades of D’s in comparison to A’s), and experiencing severe psychological
Filippidis FT, Laverty AA, 2023, Tobacco, novel tobacco and nicotine products, and respiratory health, ERS Monograph, Vol: 2023, Pages: 80-88, ISSN: 2312-508X
Tobacco smoking and exposure to second-hand smoke have been shown to negatively impact human health, including, but not limited to, increased risk of lung cancer, COPD, asthma and lower respiratory tract infections. Novel tobacco and nicotine products, such as e-cigarettes and heated tobacco products, are promoted as less harmful, but whether they actually pose significantly lower health risks is contested. Use of all tobacco and nicotine products is higher among disadvantaged groups and contributes to health inequalities among people in different socioeconomic levels. Tobacco control policies have been shown to substantially lower the prevalence of tobacco use and reduce inequalities within and among countries, while different policies may be needed to address concerns regarding novel products.
Rajani N, Hoelscher J, Laverty A, et al., 2023, A multi-country analysis of transnational tobacco companies’ market share, Tobacco Induced Diseases, Vol: 21, ISSN: 1617-9625
Introduction:The international tobacco market is dominated by five transnational tobacco companies (TTCs) which continue to interfere with measures to reduce tobacco consumption. The aim of this study is to better understand the current international tobacco industry market structure by providing an overview of the market share of these five companies globally.Methods:A longitudinal multi-country study design was used to understand market share trends across 90 different countries from 2011 to 2020. Descriptive analyses were conducted based on market share and market size data obtained from Euromonitor Passport. Market share (%), maximal market share (%) and cumulative market share (%) were calculated. Maps and boxplots are used to present the descriptive analyses. Median cumulative TTC market share and interquartile ranges for each year were calculated and stratified by country income level.Results:The average maximal market share of one company in a country was 50% (IQR: 40.0–63.5) in 2020 compared to 51.5% in 2011 (IQR: 41.3–69.0). One of the five TTCs had the highest market share in 77 out of the 90 countries. Philip Morris International was the main market player in 38 countries, followed by British American Tobacco (24), Japan Tobacco International (8), Imperial Brands (6), and lastly China National Tobacco Corporation was only dominant in China. The percentage of cigarettes manufactured by one of the five TTCs remained relatively stable between 2011 (86.4%) and 2020 (85.2%). Average cumulative TTC market shares increased between 2011 and 2020 in both low- and middle-, and high-income countries.Conclusions:The international tobacco market is concentrated with a small number of large players, and this has not changed substantially between 2011 and 2020. The impact of this on the ability of the tobacco industry to resist policy changes is unknown but presents a cause for concern.
Vrinten C, Parnham JC, Filippidis FT, et al., 2022, Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study., The Lancet, Vol: 400, Pages: S57-S57, ISSN: 0140-6736
BACKGROUND: Preventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptake. METHODS: Adolescents aged 14-17 years were included in the analysis. In separate logistic regression models, we assessed associations between age, sex, ethnicity, household income, country of residence, current smoking of a caregiver, current smoking of peers and use of social media, and regular smoking (defined as smoking at least one cigarette per week) at the age of 17 years and smoking uptake between the ages of 14 and 17 years (defined as being a never-smoker at the age of 14 years and a regular smoker at the age of 17 years). We also estimated numbers of regular smoking and smoking uptake using the Office for National Statistics 2018-19 population estimates. FINDINGS: Data from 8944 adolescents aged 14-17 years with smoking data available were included, 948 (10·6%) of which were regular tobacco smokers at the age of 17 years. 488 (51·5%) of these 948 started smoking between the ages of 14 years and 17 years. Smoking uptake was more common among adolescents reporting caregiver smoking (162 [13·6%] of 1188 vs 324 [5·0%] of 6538 with non-smoking caregivers; p<0·0001); peers smoking (223 [12·6%] of 1764 vs 229 [4·3%] of 5350 without smoking peers; p<0·0001), and those reporting higher (at least 5 h/weekday) social media use (115 [9·8%] of 1176 vs 120 [4·1%] of 2947 with lower [less than 1 h/weekday] social media use; p=0·0059), among 7786 adolescents who did not smoke at age 14. We estimated that 164 313 (95% CI 146 815-181 811) adolescents were regular smokers by the age of 17 years, of whom 101 715 (85 994-117 435) took up the habit
Vrinten C, Parnham JC, Filippidis FT, et al., 2022, Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study, Publisher: ELSEVIER SCIENCE INC
Laverty AA, Millett C, Been JV, et al., 2022, A healthy future for children and adolescents, LANCET, Vol: 400, Pages: 1100-1100, ISSN: 0140-6736
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