Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-30 (of 34 Records) |
Query Trace: McAfee T[original query] |
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Differences in quitline registrants' characteristics during national radio versus television antismoking campaigns
Zhang L , Rodes R , Mann N , Thompson J , McAfee T , Murphy R , Frank R , Davis K , Babb S . Am J Prev Med 2021 60 S107-S112 Introduction: The Centers for Disease Control and Prevention's Tips From Former Smokers campaign encourages smokers to get help with quitting smoking by promoting 1-800-QUIT-NOW. Campaign advertisements featuring an offer of help with obtaining free cessation medication aired nationally on radio for 2 weeks in 2016. Similar advertisements aired nationally on TV for 3 weeks in 2017. The comparison period of 2016 radio campaign and 2017 TV campaign was used to examine the characteristics of quitline registrants by a media referral source (TV or radio). Method(s): Data on the number and demographics of quitline registrants in 2016 and 2017 were obtained from the Centers for Disease Control and Prevention's National Quitline Data Warehouse. The investigators conducted t-tests to assess the demographic differences between registrants who heard about the quitline through the radio advertisements and those who heard about it through the TV advertisements during the comparison period. This analysis was conducted in 2019. Result(s): The registrants who heard about the quitline from radio advertisements were more likely to be male, younger, and have more years of education. However, the registrants who heard about the quitline from TV advertisements were more likely to be Black, non-Hispanic, and have fewer years of education. Conclusion(s): The findings suggest that the demographic profiles of quitline registrants vary significantly based on how registrants hear about the quitline (via radio or TV). These differences in the characteristics of registrants can help inform the tobacco control mass media purchasing strategies and may enable media efforts to target the specific subgroups of smokers in a better way. |
Systemic absorption of nicotine following acute secondhand exposure to electronic cigarette aerosol in a realistic social setting
Melstrom P , Sosnoff C , Koszowski B , King BA , Bunnell R , Le G , Wang L , Thanner MH , Kenemer B , Cox S , DeCastro BR , McAfee T . Int J Hyg Environ Health 2018 221 (5) 816-822 Evidence suggests exposure of nicotine-containing e-cigarette aerosol to nonusers leads to systemic absorption of nicotine. However, no studies have examined acute secondhand exposures that occur in public settings. Here, we measured the serum, saliva and urine of nonusers pre- and post-exposure to nicotine via e-cigarette aerosol. Secondarily, we recorded factors affecting the exposure. Six nonusers of nicotine-containing products were exposed to secondhand aerosol from ad libitum e-cigarette use by three e-cigarette users for 2h during two separate sessions (disposables, tank-style). Pre-exposure (baseline) and post-exposure peak levels (Cmax) of cotinine were measured in nonusers' serum, saliva, and urine over a 6-hour follow-up, plus a saliva sample the following morning. We also measured solution consumption, nicotine concentration, and pH, along with use behavior. Baseline cotinine levels were higher than typical for the US population (median serum session one=0.089ng/ml; session two=0.052ng/ml). Systemic absorption of nicotine occurred in nonusers with baselines indicative of no/low tobacco exposure, but not in nonusers with elevated baselines. Median changes in cotinine for disposable exposure were 0.007ng/ml serum, 0.033ng/ml saliva, and 0.316ng/mg creatinine in urine. For tank-style exposure they were 0.041ng/ml serum, 0.060ng/ml saliva, and 0.948ng/mg creatinine in urine. Finally, we measured substantial differences in solution nicotine concentrations, pH, use behavior and consumption. Our data show that although exposures may vary considerably, nonusers can systemically absorb nicotine following acute exposure to secondhand e-cigarette aerosol. This can particularly affect sensitive subpopulations, such as children and women of reproductive age. |
Evaluation of a federally funded mass media campaign and smoking cessation in pregnant women: a population-based study in three states
England L , Tong VT , Rockhill K , Hsia J , McAfee T , Patel D , Rupp K , Conrey EJ , Valdivieso C , Davis KC . BMJ Open 2017 7 (12) e016826 OBJECTIVES: In 2012, theCenters for Disease Control and Prevention initiated a national anti-smoking campaign, Tips from Former Smokers (Tips). As a result of the campaign, quit attempts among smokers increased in the general population by 3.7 percentage points. In the current study, we assessed the effects of Tips on smoking cessation in pregnant women. METHODS: We used 2009-2013 certificates of live births in three US states: Indiana, Kentucky and Ohio. Smoking cessation by the third trimester of pregnancy was examined among women who smoked in the 3 months prepregnancy. Campaign exposure was defined as overlap between the airing of Tips 2012 (March 19-June 10) and the prepregnancy and pregnancy periods. Women who delivered before Tips 2012 were not exposed. Adjusted logistic regression was used to determine whether exposure to Tips was independently associated with smoking cessation. RESULTS: Cessation rates were stable during 2009-2011 but increased at the time Tips 2012 aired and remained elevated. Overall, 32.9% of unexposed and 34.7% of exposed smokers quit by the third trimester (p<0.001). Exposure to Tips 2012 was associated with increased cessation (adjusted OR: 1.07, 95% CI 1.05 to 1.10). CONCLUSIONS: Exposure to a national anti-smoking campaign for a general audience was associated with smoking cessation in pregnant women. |
Prevalence, correlates, and trends in tobacco use and cessation among current, former, and never adult marijuana users with a history of tobacco use, 2005-2014
Schauer GL , King BA , McAfee TA . Addict Behav 2017 73 165-171 BACKGROUND: Approximately 70% of current (past 30-day) adult marijuana users are current tobacco users, which may complicate tobacco cessation. We assessed prevalence and trends in tobacco cessation among adult ever tobacco users, by marijuana use status. METHODS: Data came from the National Survey on Drug Use and Health, a cross-sectional, nationally representative, household survey of U.S. civilians. Analyses included current, former, and never marijuana users aged≥18 reporting ever tobacco use (cigarette, cigar, chew/snuff). We computed weighted estimates (2013-2014) of current tobacco use, recent tobacco cessation (quit 30days to 12months), and sustained tobacco cessation (quit>12months) and adjusted trends in tobacco use and cessation (2005-2014) by marijuana use status. We also assessed the association between marijuana and tobacco use status. RESULTS: In 2013-2014, among current adult marijuana users reporting ever tobacco use, 69.1% were current tobacco users (vs. 38.5% of former marijuana users, p<0.0001, and 28.2% of never marijuana users, p<0.0001); 9.1% reported recent tobacco cessation (vs. 8.4% of former marijuana users, p<0.01, and 6.3% of never marijuana users, p<0.001), and 21.8% reported sustained tobacco cessation (vs. 53.1% of former marijuana users, p<0.01, and 65.5% of never marijuana users, p<0.0001). Between 2005 and 2014, current tobacco use declined and sustained tobacco cessation increased among all marijuana use groups. CONCLUSIONS: Current marijuana users who ever used tobacco had double the prevalence (vs. never-marijuana users) of current tobacco use, and significantly lower sustained abstinence. Interventions addressing tobacco cessation in the context of use of marijuana and other substances may be warranted. |
Quit methods used by US adult cigarette smokers, 2014-2016
Caraballo RS , Shafer PR , Patel D , Davis KC , McAfee TA . Prev Chronic Dis 2017 14 E32 To quantify the prevalence of 10 quit methods commonly used by adult cigarette smokers, we used data from a nationally representative longitudinal (2014-2016) online survey of US adult cigarette smokers (n = 15,943). Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt. Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62.0%) were the most prevalent methods. Substituting some cigarettes with e-cigarettes was used by a greater percentage of smokers than the nicotine patch, nicotine gum, or other cessation aids approved by the US Food and Drug Administration. Further research into the effectiveness of e-cigarettes as a cessation aid is warranted. |
Patterns of marijuana and tobacco use associated with suboptimal self-rated health among US adult ever users of marijuana
Tsai J , Rolle IV , Singh T , Boulet SL , McAfee TA , Grant AM . Prev Med Rep 2017 6 251-257 The purpose of this study was to examine the patterns of marijuana and tobacco use and their associations with suboptimal self-rated health (SRH) among US adults who reported "ever, even once, using marijuana or hashish." Data came from the 2009-2012 National Health and Nutrition Examination Survey, restricting to respondents aged 20 years and older who reported using marijuana at least once in their lifetime (n = 3,210). We assessed the age-adjusted prevalence of mutually exclusive groups of regular (at least once a month for more than one year) and non-regular marijuana smoking by current (serum cotinine ≥ 3.08 ng/mL) and not current use of tobacco. Suboptimal SRH status was defined as "fair" or "poor" in response to the question "Would you say that in general your health is excellent, very good, good, fair, or poor?" We produced prevalence ratios with multivariable log-linear regression models. Among ever users of marijuana, the age-adjusted prevalence of regular marijuana smoking with current tobacco use, non-regular marijuana smoking with current tobacco use, and regular marijuana smoking without current tobacco use was 24.7%, 15.2%, and 21.1%, respectively. When compared to non-regular marijuana smokers without current tobacco use, the adjusted prevalence ratio for reporting suboptimal SRH was 1.98 (95% CI: 1.50-2.61), 1.82 (95% CI: 1.40-2.37), and 1.34 (95% CI: 1.05-1.69), respectively. In conclusion, among adult ever users of marijuana, current tobacco use is high and strongly associated with suboptimal SRH; regular marijuana smoking with or without current tobacco use is significantly associated with suboptimal SRH. |
Measuring PM2.5, ultrafine particles, air nicotine and wipe samples following the use of electronic cigarettes
Melstrom P , Koszowski B , Thanner MH , Hoh E , King B , Bunnell R , McAfee T . Nicotine Tob Res 2017 19 (9) 1055-1061 Background: Few studies have examined the extent of inhalation or dermal contact among bystanders following short-term, secondhand e-cigarette exposure. Objective: Measure PM2.5 (particles <2.5 microns), UF (ultrafine particles <100nm), and nicotine in air and deposited on surfaces and clothing pre-/during/post- a short-term (two-hour) e-cigarette exposure. Methods: E-cigarettes were used ad libitum by three experienced users for two hours during two separate sessions (disposable e-cigarettes, then tank-style e-cigarettes, or "tanks") in a 1858ft3 room. We recorded: uncorrected PM2.5 (using SidePak(R)); UF (using P-Trak(R)); air nicotine concentrations (using air samplers; SKC(R) XAD-4 canisters); ambient air exchange rate (using an air capture hood). Wipe samples were taken by wiping 100cm2 room surfaces pre- and post- both sessions, and clean cloth wipes were worn during the exposure and collected at the end. Results: Uncorrected PM2.5 and UF were higher (p<0.0001) during sessions than before or after. Median PM2.5 during exposure was higher using tanks (0.515mg/m3) than disposables (0.035mg/m3)(p<0.0001). Median UF during exposure was higher using disposables (31,200particles/cm3) than tanks (25,200particles/cm3)(p<0.0001). Median air nicotine levels were higher (p<0.05) during both sessions (disposables=0.697ng/L, tanks=1.833ng/L) than before (disposables=0.004ng/L, tanks=0.010ng/L) or after (disposables=0.115ng/L, tanks=0.147ng/L). Median accumulation rates of nicotine on surface samples were 2.1ng/100cm2/hr using disposables and 4.0ng/100cm2/hr using tanks; for cloth samples, it was 44.4ng/100cm2/hr using disposables and 69.6ng/100cm2/hr using tanks (p<0.01). Mean room ventilation rate was ~5 air changes per hour during both sessions. Conclusions: Short-term e-cigarette use can produce: elevated PM2.5; elevated UF; nicotine in the air; and accumulation of nicotine on surfaces and clothing. Implications: * Short-term indoor e-cigarette use produced accumulation of nicotine on surfaces and clothing, which could lead to dermal exposure to nicotine. * Short-term e-cigarette use produced elevated PM2.5 and ultrafine particles, which could lead to secondhand inhalation of these particles and any chemicals associated with them by bystanders. * We measured significant differences in PM2.5 and ultrafine particles between disposable e-cigarettes and tank-style e-cigarettes, suggesting a difference in the exposure profiles of e-cigarette products. |
National estimates of marijuana use and related indicators - National Survey on Drug Use and Health, United States, 2002-2014
Azofeifa A , Mattson ME , Schauer G , McAfee T , Grant A , Lyerla R . MMWR Surveill Summ 2016 65 (11) 1-28 PROBLEM/CONDITION: In the United States, marijuana is the most commonly used illicit drug. In 2013, 7.5% (19.8 million) of the U.S. population aged ≥12 years reported using marijuana during the preceding month. Because of certain state-level policies that have legalized marijuana for medical or recreational use, population-based data on marijuana use and other related indicators are needed to help monitor behavioral health changes in the United States. PERIOD COVERED: 2002-2014. DESCRIPTION OF SYSTEM: The National Survey on Drug Use and Health (NSDUH) is a national- and state-level survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects information about the use of illicit drugs, alcohol, and tobacco; initiation of substance use; frequency of substance use; substance dependence and abuse; perception of substance harm risk or no risk; and other related behavioral health indicators. This report describes national trends for selected marijuana use and related indicators, including prevalence of marijuana use; initiation; perception of harm risk, approval, and attitudes; perception of availability and mode of acquisition; dependence and abuse; and perception of legal penalty for marijuana possession. RESULTS: In 2014, a total of 2.5 million persons aged ≥12 years had used marijuana for the first time during the preceding 12 months, an average of approximately 7,000 new users each day. During 2002-2014, the prevalence of marijuana use during the past month, past year, and daily or almost daily increased among persons aged ≥18 years, but not among those aged 12-17 years. Among persons aged ≥12 years, the prevalence of perceived great risk from smoking marijuana once or twice a week and once a month decreased and the prevalence of perceived no risk increased. The prevalence of past year marijuana dependence and abuse decreased, except among persons aged ≥26 years. Among persons aged ≥12 years, the percentage reporting that marijuana was fairly easy or very easy to obtain increased. The percentage of persons aged ≥12 reporting the mode of acquisition of marijuana was buying it and growing it increased versus getting it for free and sharing it. The percentage of persons aged ≥12 years reporting that the perceived maximum legal penalty for the possession of an ounce or less of marijuana in their state is a fine and no penalty increased versus probation, community service, possible prison sentence, and mandatory prison sentence. INTERPRETATION: Since 2002, marijuana use in the United States has increased among persons aged ≥18 years, but not among those aged 12-17 years. A decrease in the perception of great risk from smoking marijuana combined with increases in the perception of availability (i.e., fairly easy or very easy to obtain marijuana) and fewer punitive legal penalties (e.g., no penalty) for the possession of marijuana for personal use might play a role in increased use among adults. PUBLIC HEALTH ACTION: National- and state-level data can help federal, state, and local public health officials develop targeted prevention activities to reduce youth initiation of marijuana use, prevent marijuana dependence and abuse, and prevent adverse health effects. As state-level laws on medical and recreational marijuana use change, modifications might be needed to national- and state-level surveys and more timely and comprehensive surveillance systems might be necessary to provide these data. Marijuana use in younger age groups is a particular public health concern, and changing the perception of harm risk from smoking marijuana is needed. |
Increasing the dose of television advertising in a national antismoking media campaign: results from a randomised field trial
McAfee T , Davis KC , Shafer P , Patel D , Alexander R , Bunnell R . Tob Control 2015 26 (1) 19-28 BACKGROUND: While antismoking media campaigns have demonstrated effectiveness, less is known about the country-level effects of increased media dosing. The 2012 US Tips From Former Smokers (Tips) campaign generated approximately 1.6 million quit attempts overall; however, the specific dose-response from the campaign was only assessed by self-report. OBJECTIVE: Assess the impact of higher ad exposure during the 2013 Tips campaign on quit-related behaviours and intentions, campaign awareness, communication about campaign, and disease knowledge. METHODS: A 3-month national media buy was supplemented within 67 (of 190) randomly selected local media markets. Higher-dose markets received media buys 3 times that of standard-dose markets. We compared outcomes of interest using data collected via web-based surveys from nationally representative, address-based probability samples of 5733 cigarette smokers and 2843 non-smokers. RESULTS: In higher-dose markets, 87.2% of smokers and 83.9% of non-smokers recalled television campaign exposure versus 75.0% of smokers and 73.9% of non-smokers in standard-dose markets. Among smokers overall, the relative quit attempt rate was 11% higher in higher-dose markets (38.8% vs 34.9%; p<0.04). The higher-dose increase was larger in African-Americans (50.9% vs 31.8%; p<0.01). Smokers in higher-dose markets without a mental health condition, with a chronic health condition, or with only some college education made quit attempts at a higher rate than those in standard-dose markets. Non-smokers in higher-dose markets were more likely to talk with family or friends about smoking dangers (43.1% vs 35.7%; p<0.01) and had greater knowledge of smoking-related diseases. CONCLUSIONS: The US 2013 Tips antismoking media campaign compared standard and higher doses by randomisation of local media markets. Results demonstrate the effectiveness of a higher dose for engaging non-smokers and further increasing quit attempts among smokers, especially African-Americans. |
Cigarette, cigar, and marijuana use among high school students - United States, 1997-2013
Rolle IV , Kennedy SM , Agaku I , Jones SE , Bunnell R , Caraballo R , Xu X , Schauer G , McAfee T . MMWR Morb Mortal Wkly Rep 2015 64 (40) 1136-41 What is already known on this topic? Since 2010, the proportion of U.S. 12th grade students who reported using marijuana during the preceding 30 days (21.4%) has surpassed the proportion reporting use of cigarettes during the preceding 30 days (19.2%).What is added by this report? During 1997-2013, the proportion of white, black, and Hispanic high school students overall who were exclusive cigarette or cigar users decreased 64%, from 20.5% to 7.4%. The proportion of white, black, and Hispanic students who were exclusive marijuana users more than doubled from 4.2% to 10.2%, and among cigarette or cigar users, marijuana use increased, with considerable increases identified among black and Hispanic students toward the end of the study period.What are the implications for public health practice? Despite significant declines since 1997, approximately 30% of white, black, and Hispanic U.S. high school students were current users of cigarettes, cigars, or marijuana in 2013. Policy and programmatic efforts might benefit from integrated approaches that focus on reducing the use of tobacco and marijuana among youths. |
Google searches or quit attempts as a success measure for an antismoking campaign
McAfee T , Davis KC , Cox SN , Beistle DM . Am J Prev Med 2015 49 (6) e131-2 In a recent study by Ayers et al.,1 the authors analyzed Google search patterns associated with health conditions depicted in CDC’s national tobacco education campaign, Tips From Former Smokers (Tips). Although examining search trends to inform the effectiveness of health campaigns holds promise, the authors make a number of statements that we, as the principal scientists and campaign managers, disagree with. | First, the authors state that “Tips is the nation’s most costly tobacco control initiative.” To put the cost of Tips (approximately $50 million annually) into perspective, this amount represents less than 2 days of what the tobacco industry spends in a year ($8 billion) on tobacco promotion. States also spend approximately $500 million yearly on integrated tobacco control. A recent study2 demonstrated that the Tips campaign was a highly cost-effective initiative, based on often-used benchmarks for public health interventions. | Second, the authors state that “little is known about [the Tips campaign’s] effectiveness,” citing a 2013 study published in Lancet.3 However, this study was a rigorous evaluation of campaign effectiveness, based on a large, nationally representative, longitudinal cohort of smokers and nonsmokers in the U.S. The campaign was responsible for approximately 1.6 million new quit attempts, with an estimated 100,000 of these sustained for at least 6 months. In addition, the 2012 Tips campaign was associated with increased knowledge of the health conditions featured in Tips ads, increased motivation to quit, and increased smoking-related concerns about health.4 | Third, the authors posit that Tips was no longer effective in 2013. CDC has closely tracked calls to the 1-800-QUIT-NOW quitline, which showed increases directly associated with campaign tags in 2012 and 2013.5 In 2013, there were marked increases in calls in the alternating weeks the campaign was on the air (Figure 1). In addition, an independent prospective cohort study of smokers found that 71% saw at least one 2013 Tips ad and the campaign increased awareness of health risks and cessation resources.6 |
Toking, vaping, and eating for health or fun: marijuana use patterns in adults, U.S., 2014
Schauer GL , King BA , Bunnell RE , Promoff G , McAfee TA . Am J Prev Med 2015 50 (1) 1-8 INTRODUCTION: Policies legalizing marijuana for medical and recreational use have been increasing in the U.S. Considering the potential impact of these policies, important knowledge gaps exist, including information about the prevalence of various modes of marijuana use (e.g., smoked in joints, bowls, bongs; consumed in edibles or drinks) and about medical versus recreational use. Accordingly, this study assessed (1) prevalence and correlates of modes of current and ever marijuana use and (2) prevalence of medicinal and recreational marijuana use in U.S. adults. METHODS: Data came from Summer Styles (n=4,269), a nationally representative consumer panel survey of adults aged ≥18 years, collected in 2014. The survey asked about past 30-day (current) and ever mode of marijuana use and current reason for use (medicinal, recreational, both). Weighted prevalence estimates were computed and correlates were assessed in 2014 using logistic regression. RESULTS: Overall, 7.2% of respondents reported current marijuana use; 34.5% reported ever use. Among current users, 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. Use of bowl or pipe (49.5%) and joint (49.2%) predominated among current marijuana users, with lesser use of bong, water pipe, or hookah (21.7%); blunts (20.3%); edibles/drinks (16.1%); and vaporizers (7.6%); 92.1% of the sample reported combusted-only marijuana use. CONCLUSION: Combusted modes of marijuana use are most prevalent among U.S. adults, with a majority using marijuana for recreation. In light of changing policies and patterns of use, improved marijuana surveillance is critical for public health planning. |
Warning about the harms of tobacco use in 22 countries: findings from a cross-sectional household survey
Chiosi JJ , Andes L , Asma S , Palipudi K , McAfee T . Tob Control 2015 25 (4) 393-401 BACKGROUND: Knowledge about the harms of tobacco use deters initiation and is associated with cessation. Most studies on this knowledge in the general population have been in high-income countries, but the tobacco use burden is increasing in low-income and middle-income countries. We sought to estimate levels of knowledge about tobacco-related diseases in 22 countries and determine the factors associated with differences in knowledge. METHODS: We used data from the Global Adult Tobacco Survey (GATS), a nationally representative survey of persons aged ≥15 years. GATSs were conducted from 2008 to 2013 in 22 low-income and middle-income countries. Information was gathered on tobacco-related knowledge and noticing of antismoking mass media messages and health warning labels on cigarette packages. We constructed a four-point knowledge scale and performed multivariate regression analyses. RESULTS: Median country values for the proportion of adults who believed smoking causes a specific illness were 95.9% for lung cancer, 82.5% for heart attack and 74.0% for stroke. Knowledge scores ranged from 2.1 to 3.8. In multivariate regressions, adults scored significantly higher on the knowledge scale if they noticed antismoking media messages (22 countries) or health warning labels (17 countries). Significantly higher knowledge scores occurred in all 9 countries with pictorial health warning labels compared with only 8 out of 13 countries with text-only warning labels. CONCLUSIONS: Antismoking media messages appear effective for warning the public about the harms from tobacco use in all 22 countries, while warning labels are effective in the majority of these countries. Our findings suggest opportunities to motivate smoking cessation globally. |
Tobacco use among middle and high school students - United States, 2011-2014
Arrazola RA , Singh T , Corey CG , Husten CG , Neff LJ , Apelberg BJ , Bunnell RE , Choiniere CJ , King BA , Cox S , McAfee T , Caraballo RS . MMWR Morb Mortal Wkly Rep 2015 64 (14) 381-385 Tobacco use and addiction most often begin during youth and young adulthood. Youth use of tobacco in any form is unsafe. To determine the prevalence and trends of current (past 30-day) use of nine tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, tobacco pipes, snus, dissolvable tobacco, and bidis) among U.S. middle (grades 6-8) and high school (grades 9-12) students, CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2014 National Youth Tobacco Surveys (NYTS). In 2014, e-cigarettes were the most commonly used tobacco product among middle (3.9%) and high (13.4%) school students. Between 2011 and 2014, statistically significant increases were observed among these students for current use of both e-cigarettes and hookahs (p<0.05), while decreases were observed for current use of more traditional products, such as cigarettes and cigars, resulting in no change in overall tobacco use. Consequently, 4.6 million middle and high school students continue to be exposed to harmful tobacco product constituents, including nicotine. Nicotine exposure during adolescence, a critical window for brain development, might have lasting adverse consequences for brain development, causes addiction, and might lead to sustained tobacco use. For this reason, comprehensive and sustained strategies are needed to prevent and reduce the use of all tobacco products among youths in the United States. |
Nicotine and the developing human: a neglected element in the electronic cigarette debate
England LJ , Bunnell RE , Pechacek TF , Tong VT , McAfee TA . Am J Prev Med 2015 49 (2) 286-93 The elimination of cigarettes and other combusted tobacco products in the U.S. would prevent tens of millions of tobacco-related deaths. It has been suggested that the introduction of less harmful nicotine delivery devices, such as electronic cigarettes or other electronic nicotine delivery systems, will accelerate progress toward ending combustible cigarette use. However, careful consideration of the potential adverse health effects from nicotine itself is often absent from public health debates. Human and animal data support that nicotine exposure during periods of developmental vulnerability (fetal through adolescent stages) has multiple adverse health consequences, including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents. Measures to protect the health of pregnant women and children are needed and could include (1) strong prohibitions on marketing that increase youth uptake; (2) youth access laws similar to those in effect for other tobacco products; (3) appropriate health warnings for vulnerable populations; (4) packaging to prevent accidental poisonings; (5) protection of non-users from exposure to secondhand electronic cigarette aerosol; (6) pricing that helps minimize youth initiation and use; (7) regulations to reduce product addiction potential and appeal for youth; and (8) the age of legal sale. |
State laws prohibiting sales to minors and indoor use of electronic nicotine delivery systems - United States, November 2014
Marynak K , Holmes CB , King BA , Promoff G , Bunnell R , McAfee T . MMWR Morb Mortal Wkly Rep 2014 63 (49) 1145-50 Electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes) and other devices such as electronic hookahs, electronic cigars, and vape pens, are battery-powered devices capable of delivering aerosolized nicotine and additives to the user. Experimentation with and current use of e-cigarettes has risen sharply among youths and adults in the United States. Youth access to and use of ENDS is of particular concern given the potential adverse effects of nicotine on adolescent brain development. Additionally, ENDS use in public indoor areas might passively expose bystanders (e.g., children, pregnant women, and other nontobacco users) to nicotine and other potentially harmful constituents. ENDS use could have the potential to renormalize tobacco use and complicate enforcement of smoke-free policies. State governments can regulate the sales of ENDS and their use in indoor areas where nonusers might be involuntarily exposed to secondhand aerosol. To learn the current status of state laws regulating the sales and use of ENDS, CDC assessed state laws that prohibit ENDS sales to minors and laws that include ENDS use in conventional smoking prohibitions in indoor areas of private worksites, restaurants, and bars. Findings indicate that as of November 30, 2014, 40 states prohibited ENDS sales to minors, but only three states prohibited ENDS use in private worksites, restaurants, and bars. Of the 40 states that prohibited ENDS sales to minors, 21 did not prohibit ENDS use or conventional smoking in private worksites, restaurants, and bars. Three states had no statewide laws prohibiting ENDS sales to minors and no statewide laws prohibiting ENDS use or conventional smoking in private worksites, restaurants, and bars. According to the Surgeon General, ENDS have the potential for public health harm or public health benefit. The possibility of public health benefit from ENDS could arise only if 1) current smokers use these devices to switch completely from combustible tobacco products and 2) the availability and use of combustible tobacco products are rapidly reduced. Therefore, when addressing potential public health harms associated with ENDS, it is important to simultaneously uphold and accelerate strategies found by the Surgeon General to prevent and reduce combustible tobacco use, including tobacco price increases, comprehensive smoke-free laws, high-impact media campaigns, barrier-free cessation treatment and services, and comprehensive statewide tobacco control programs. |
Addressing the social determinants of health to reduce tobacco-related disparities
Garrett BE , Dube SR , Babb S , McAfee T . Nicotine Tob Res 2014 17 (8) 892-7 Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smoking; e.g., those with lower education and incomes. Education and income are the two main social determinants of health that negatively impact health, however, there are other related social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This paper will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. |
A cost-effectiveness analysis of the first federally funded antismoking campaign
Xu X , Alexander RL Jr , Simpson SA , Goates S , Nonnemaker JM , Davis KC , McAfee T . Am J Prev Med 2014 48 (3) 318-25 BACKGROUND: In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. PURPOSE: Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency's perspective. METHODS: Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated. RESULTS: Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained. CONCLUSIONS: Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention. |
Helping smokers quit - opportunities created by the Affordable Care Act
McAfee T , Babb S , McNabb S , Fiore MC . N Engl J Med 2014 372 (1) 5-7 In its review of tobacco-dependence treatments, the 2008 clinical practice guideline of the U.S. Public Health Service concluded, "Indeed, it is difficult to identify any other condition that presents such a mix of lethality, prevalence, and neglect, despite effective and readily available interventions." The low utilization of clinical cessation interventions by smokers and physicians alike is partly attributable to inadequate insurance coverage: many health insurers still fail to cover the evidence-based counseling and medication treatments recommended in the 2008 guideline. Even when these treatments are covered, barriers to utilization such as copayments and prior-authorization requirements make obtaining them costly and inconvenient. |
Increases in smoking cessation interventions after a feedback and improvement initiative using electronic health records - 19 community health centers, New York City, October 2010-March 2012
Silfen SL , Farley SM , Shih SC , Duquaine DC , Ricci JM , Kansagra SM , Edwards SM , Babb S , McAfee T . MMWR Morb Mortal Wkly Rep 2014 63 (41) 921-4 Quitting smoking substantially reduces smokers' risk for smoking-related morbidity and mortality and can increase life expectancy by up to a decade. Most smokers want to quit and make at least one medical provider visit annually. Health care providers can play an important role in helping smokers quit by documenting patients' tobacco use, advising smokers to quit, and providing evidence-based cessation treatments or referrals for treatment, but many providers and practices do not regularly take these actions. Systems to increase provider screening and delivery of cessation interventions are available; in particular, electronic health records (EHRs) can be powerful tools to facilitate increased cessation interventions. This analysis reports on an EHR-based pay-for-improvement initiative in 19 community health centers (CHCs) in New York City (NYC) that sought to increase smoking status documentation and cessation interventions. At the end of the initiative, the mean proportion of patients who were documented as smokers in CHCs had increased from 24% to 27%, whereas the mean proportion of documented smokers who received a cessation intervention had increased from 23% to 54%. Public health programs and health systems should consider implementing strategies to equip and train clinical providers to use information technology to increase delivery of cessation interventions. |
The impact of smoking on women's health
McAfee T , Burnette D . J Womens Health (Larchmt) 2014 23 (11) 881-5 Despite half a century of public health efforts, smoking remains the single largest cause of preventable disease and death in the United States, killing 480,000 people a year and inflicting chronic disease on 16 million. Since the early part of the 20th century, tobacco companies' success in aggressively marketing their products to women has resulted in steady increases in smoking-related disease risk for women. Today, women smokers have caught up with their male counterparts and are just as likely to die from lung cancer, heart disease, and chronic obstructive pulmonary disease (COPD) as are men who smoke. Women's risk for developing smoking-related heart disease or dying from COPD now exceeds men's risk. |
Lung cancer incidence trends
Henley SJ , Richards TB , Underwood JM , Eheman CR , Plescia M , McAfee TA . Oncol Times 2014 36 (12) 64-66 Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer (excluding skin cancer) among men and women in the United States. Although lung cancer can be caused by environmental exposures, most efforts to prevent lung cancer emphasize tobacco control because 80%-90% of lung cancers are attributed to cigarette smoking and secondhand smoke. One sentinel health consequence of tobacco use is lung cancer, and one way to measure the impact of tobacco control is by examining trends in lung cancer incidence rates, particularly among younger adults. Changes in lung cancer rates among younger adults likely reflect recent changes in risk exposure. To assess lung cancer incidence and trends among men and women by age group, CDC used data from the National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the period 2005-2009, the most recent data available. During the study period, lung cancer incidence decreased among men in all age groups except <35 years and decreased among women aged 35-44 years and 54-64 years. Lung cancer incidence decreased more rapidly among men than among women and more rapidly among adults aged 35-44 years than among other age groups. To further reduce lung cancer incidence in the United States, proven population-based tobacco prevention and control strategies should receive sustained attention and support. |
Lung cancer incidence trends among men and women - United States, 2005-2009
Henley JS , Richards TB , Underwood MJ , Sunderam CR , Plescia M , McAfee TA . MMWR Morb Mortal Wkly Rep 2014 63 (1) 1-5 Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer (excluding skin cancer) among men and women in the United States. Although lung cancer can be caused by environmental exposures, most efforts to prevent lung cancer emphasize tobacco control because 80%-90% of lung cancers are attributed to cigarette smoking and secondhand smoke. One sentinel health consequence of tobacco use is lung cancer, and one way to measure the impact of tobacco control is by examining trends in lung cancer incidence rates, particularly among younger adults. Changes in lung cancer rates among younger adults likely reflect recent changes in risk exposure. To assess lung cancer incidence and trends among men and women by age group, CDC used data from the National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the period 2005-2009, the most recent data available. During the study period, lung cancer incidence decreased among men in all age groups except <35 years and decreased among women aged 35-44 years and 54-64 years. Lung cancer incidence decreased more rapidly among men than among women and more rapidly among adults aged 35-44 years than among other age groups. To further reduce lung cancer incidence in the United States, proven population-based tobacco prevention and control strategies should receive sustained attention and support. |
Effect of the first federally funded US antismoking national media campaign
McAfee T , Davis KC , Alexander RL Jr , Pechacek TF , Bunnell R . Lancet 2013 382 (9909) 2003-11 BACKGROUND: Every year, smoking kills more than 5 million people globally, including 440,000 people in the USA, where the long-term decline in smoking prevalence has slowed. The US Centers for Disease Control and Prevention (CDC) delivered a national, 3-month antismoking campaign called Tips From Former Smokers (Tips) that started in March, 2012, in which hard-hitting, emotionally evocative television advertising was featured, depicting smoking-related suffering in real people. We aimed to assess the effects of the Tips campaign. METHODS: We undertook baseline and follow-up surveys of nationally representative cohorts of adult smokers and non-smokers. The national effect of the Tips campaign was estimated by applying rates of change in the cohort before and after the campaign to US census data. FINDINGS: 3051 smokers and 2220 non-smokers completed baseline and follow-up assessments. 2395 (78%) smokers and 1632 (74%) non-smokers recalled seeing at least one Tips advertisement on television during the 3-month campaign. Quit attempts among smokers rose from 31.1% (95% CI 30.3-31.9) at baseline to 34.8% (34.0-35.7) at follow-up, a 12% relative increase. The prevalence of abstinence at follow-up among smokers who made a quit attempt was 13.4% (95% CI 9.7-17.2). Nationally, an estimated 1.64 million additional smokers made a quit attempt, and 220,000 (95% CI 159,000-282,000) remained abstinent at follow-up. Recommendations by non-smokers to quit grew from 2.6% at baseline to 5.1% at follow-up, and the prevalence of people talking with friends and family about the dangers of smoking rose from 31.9% (95% CI 31.3-32.5) to 35.2% (34.6-35.9), resulting in an estimated 4.7 million additional non-smokers recommending cessation services and more than 6 million talking about the dangers of smoking. INTERPRETATION: The high-exposure Tips media campaign was effective at increasing population-level quit attempts. The growth in smokers who quit and became sustained quitters could have added from a third to almost half a million quality-adjusted life-years to the US population. Expanded implementation of similar campaigns globally could accelerate progress on the WHO Framework Convention on Tobacco Control and reduce smoking prevalence globally. FUNDING: CDC, US Department of Health and Human Services. |
Patient-reported recall of smoking cessation interventions from a health professional
King BA , Dube SR , Babb SD , McAfee TA . Prev Med 2013 57 (5) 715-7 OBJECTIVE: To determine the prevalence and characteristics of current cigarette smokers who report receiving health care provider interventions ('5A's': ask, advise, assess, assist, arrange) for smoking cessation. METHODS: Data came from the 2009-2010 National Adult Tobacco Survey, a telephone survey of United States adults aged ≥18years. Among current cigarette smokers who reported visiting a health professional in the past year (n=16,542), estimates were calculated overall and by sex, age, race/ethnicity, education, income, health insurance coverage, and sexual orientation. RESULTS: Among smokers who visited a health professional (75.2%), 87.9% were asked if they used tobacco, 65.8% were advised to quit, and 42.6% were asked if they wanted to quit. Among those wanting to quit, 78.2% were offered assistance and 17.5% had follow-up arranged. Receipt of the 'ask' component was lower among males and uninsured individuals. Receipt of the 'advise' and 'assess' components was lower among those aged 18-24 and uninsured individuals. Receipt of the 'assist' component was lower among non-Hispanic blacks. No differences were observed for the 'arrange' component. CONCLUSIONS: Many current smokers report receiving health care provider interventions for smoking cessation. Continued efforts to educate, encourage, and support all health professionals to provide effective, comprehensive tobacco cessation interventions to their patients may be beneficial. |
Encouraging smokers to talk with their physicians about quitting
McAfee T . JAMA 2013 309 (22) 2329-30 Over the next few months, physicians may see an increase in patients asking for help in quitting smoking. Why? The Office on Smoking and Health at the Centers for Disease Control and Prevention recently launched the second stage of its national media campaign, Tips from Former Smokers (Tips).1 Some of the ads include a new call to action with the message, “You can quit. Talk with your doctor for help.”1 This “talk with your doctor” initiative provides physicians with a golden opportunity to help more patients quit smoking. | The Tips campaign motivates smokers to quit and directs smokers who want help to evidence-based cessation resources. The campaign ads feature real stories from former smokers about how serious smoking-related diseases have affected their lives and their families. The campaign includes both well-known consequences of smoking such as lung cancer and chronic obstructive pulmonary disease, as well as lesser-known consequences such as stroke, heart disease, head and neck cancer, Buerger disease, and exacerbation of asthma and diabetes. Stories emphasize the morbidity caused by smoking, rather than mortality, based on what we heard from smokers during formative testing. The campaign includes ads for television, radio, billboards, newspapers, and magazines, as well as for digital and social media channels. |
Enhancing tobacco quitline effectiveness: identifying a superior pharmacotherapy adjuvant
Smith SS , Keller PA , Kobinsky KH , Baker TB , Fraser DL , Bush T , Magnusson B , Zbikowski SM , McAfee TA , Fiore MC . Nicotine Tob Res 2013 15 (3) 718-28 INTRODUCTION: Telephone tobacco quitlines are effective and are widely used, with more than 500,000 U.S. callers in 2010. This study investigated the clinical effectiveness and cost-effectiveness of 3 different quitline enhancements: combination nicotine replacement therapy (NRT), longer duration of NRT, and counseling to increase NRT adherence. METHODS: In this study, 987 quitline callers were randomized to a combination of quitline treatments in a 2x2 x 2 factorial design: NRT duration (2 vs. 6 weeks), NRT type (nicotine patch only vs. patch plus nicotine gum), and standard 4-call counseling (SC) versus SC plus medication adherence counseling (MAC). The primary outcome was 7-day point-prevalence abstinence (PPA) at 6 months postquit in intention-to-treat (ITT) analyses. RESULTS: Combination NRT for 6 weeks yielded the highest 6-month PPA rate (51.6%) compared with 2 weeks of nicotine patch (38.4%), odds ratios [OR] = 1.71 (95% confidence interval [CI]:1.20-2.45). A similar result was found for 2 weeks of combination NRT (48.2%), OR = 1.49 (95% CI: 1.04-2.14) but not for 6 weeks of nicotine patch alone (46.2%), OR = 1.38 (95% CI: 0.96-1.97). The MAC intervention effect was nonsignificant. Cost analyses showed that the 2-week combination NRT group had the lowest cost per quit ($442 vs. $464 for 2-week patch only, $505 for 6-week patch only, and $675 for 6-week combination NRT). CONCLUSIONS: Combination NRT for 2 or 6 weeks increased 6-month abstinence rates by 10% and 13%, respectively, over rates produced by 2 weeks of nicotine patch when offered with quitline counseling. A 10% improvement would potentially yield an additional 50,000 quitters annually, assuming 500,000 callers to U.S. quitlines per year. |
21st-century hazards of smoking and benefits of cessation in the United States
Jha P , Ramasundarahettige C , Landsman V , Rostron B , Thun M , Anderson RN , McAfee T , Peto R . N Engl J Med 2013 368 (4) 341-50 BACKGROUND: Extrapolation from studies in the 1980s suggests that smoking causes 25% of deaths among women and men 35 to 69 years of age in the United States. Nationally representative measurements of the current risks of smoking and the benefits of cessation at various ages are unavailable. METHODS: We obtained smoking and smoking-cessation histories from 113,752 women and 88,496 men 25 years of age or older who were interviewed between 1997 and 2004 in the U.S. National Health Interview Survey and related these data to the causes of deaths that occurred by December 31, 2006 (8236 deaths in women and 7479 in men). Hazard ratios for death among current smokers, as compared with those who had never smoked, were adjusted for age, educational level, adiposity, and alcohol consumption. RESULTS: For participants who were 25 to 79 years of age, the rate of death from any cause among current smokers was about three times that among those who had never smoked (hazard ratio for women, 3.0; 99% confidence interval [CI], 2.7 to 3.3; hazard ratio for men, 2.8; 99% CI, 2.4 to 3.1). Most of the excess mortality among smokers was due to neoplastic, vascular, respiratory, and other diseases that can be caused by smoking. The probability of surviving from 25 to 79 years of age was about twice as great in those who had never smoked as in current smokers (70% vs. 38% among women and 61% vs. 26% among men). Life expectancy was shortened by more than 10 years among the current smokers, as compared with those who had never smoked. Adults who had quit smoking at 25 to 34, 35 to 44, or 45 to 54 years of age gained about 10, 9, and 6 years of life, respectively, as compared with those who continued to smoke. CONCLUSIONS: Smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%. |
Tobacco use patterns
McAfee TA , Kruger J . J Environ Public Health 2012 2012 564390 The use of combustible tobacco products (e.g., cigarettes, cigars, pipe, bidis, kreteks, and hookah) among adults remains widespread around the world. Unless dramatic progress is made diminishing the initiation and increasing cessation of combustible tobacco product use, a billion preventable deaths will occur in the 21st century [1]. These deaths will be accompanied by unimaginable human suffering and unaffordable economic loss from both preventable healthcare expenditures and loss of productivity from early death and disease. Health risks not only impact the smoker, but also hundreds of millions of individuals who inhale secondhand smoke from combustible tobacco products. In addition to the risks associated with smoking tobacco products, there are important concerns associated with the use of noncombustible tobacco products (e.g., chew, dip, snus, Gutka, and Ikmik). Concerns include both direct health effects from high-toxicant products, particularly in Southern Asia that account for the majority of global noncombustible use and the impact of dual use of noncombustible products with smoked tobacco products [2, 3]. This is a pattern being seen in youth, young adults [4, 5], and adults in the United States (as in the paper of R. McMillen et al. “Use of emerging tobacco products in the United States”), potentially increasing initiation and prolonging smoking. | In order to successfully tackle the immense challenges ahead, it is critical that public health workers and others committed to eradicating the harm caused by the tobacco epidemic have a full understanding of what is actually happening. Questions need to be answered such as: How are tobacco use patterns evolving? How are changes in the design of tobacco products impacting health outcomes? How are emerging tobacco products being marketed? and, How is their use impacting the use of combustible tobacco products? Which tobacco control policies and interventions work for different populations and use patterns? Few health risks have received as much attention from researchers and policy makers as the use of tobacco products. Articles recently published in the Journal of Environmental and Public Health can inform health policy decisions in several ways: by providing information on specific populations who use these products, by targeting interventions to products and users, and by identifying and characterizing emerging products developed and marketed by the tobacco industry. Scientific research, surveillance, and evaluation are valuable tools for informing health policy decisions because they can identify the introduction of new products, offer insight as to the prevalence of use of those products, and provide information on the effectiveness of specific interventions and tobacco control policy. |
Smoking in movies: a new Centers for Disease Control and Prevention core surveillance indicator
McAfee T , Tynan M . Prev Chronic Dis 2012 9 E162 Youth who are heavily exposed to onscreen smoking are approximately 2 to 3 times as likely to begin smoking as youth who are lightly exposed (1), and the Surgeon General concluded that there is a causal relationship between depictions of smoking in the movies and smoking initiation among young people (2). Among the 3 major motion picture companies with policies aimed at reducing tobacco-use incidents in their movies, the number of onscreen incidents per youth-rated movie (rated G, PG, or PG-13 by the Motion Picture Association of America) decreased 95.8% from 2005 through 2010 (3). These results appeared to indicate that movie companies were making progress at reducing smoking depictions in youth-oriented movies and that a company-by-company approach of adopting voluntary policies could be effective in nearly eliminating youth exposure to tobacco imagery in movies. However, new data from 2011 published by Glantz and colleagues (4) in Preventing Chronic Disease raise serious concerns about this individual company approach. | Glantz and colleagues found that in 2011, depictions of tobacco use per youth-rated movie rebounded; estimated instances of tobacco use in 2011 were more than one-third higher than in 2010 (4). Furthermore, the authors found that the largest increase in tobacco-use incidents in youth-rated movies was among the 3 movie companies that had produced the dramatic decline from 1995 through 2010 and had policies designed to discourage depictions of smoking in their movies. As a result of this sharp rebound, the difference in tobacco-use incidents per youth-rated movie between companies with policies and companies without policies diminished in 2011 (4). This difference suggests that individual company policies may not be sufficient to sustain a reduction in youth exposure to tobacco-use and other pro-tobacco imagery in movies and that more formal, industry-wide policies are needed. |
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