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Smokers of menthol cigarettes have a harder time quitting, large new study finds

By Claudia López Lloreda

A new study published Tuesday finds that smoking menthol cigarettes versus unflavored cigarettes is associated with reduced success in quitting among people who smoke nearly every day.

In recent years, the FDA has moved to ban almost all flavored cigarettes and cigars, but menthol has remained the lone holdout. Even so, the agency proposed such a ban in April, and researchers say the new findings support this ban.

In the study published in Tobacco Control, a BMJ journal, researchers at the University of California, San Diego found that menthol-cigarette smokers — who made up nearly 40% of those in the study — had a significantly harder time quitting than non-menthol smokers. Use of menthol cigarettes prior to attempting to quit decreased the probability of a smoker being able to abstain for more than one month by 28%, and for more than one year by 53%, compared to those who didn’t smoke menthol cigarettes.

“This [current study] is the best data we have so far from an observational study,” said Eric Leas, an assistant professor at the University of California, San Diego and first author of the study. “It’s confirming [the FDA’s] choice” to ban menthol.

Cigarette makers began adding menthol — known for its cooling and numbing properties — to cigarettes in the 1920s as a way to reduce the irritation caused by cigarette smoke. For years, menthol use has worried public health experts who say it makes it easier for young people to start smoking and leads smokers to potentially consume more tobacco and nicotine, increasing the risk of addiction.

Health experts have also been concerned about the disproportionate impact on certain minority groups. For instance, 85% of Black smokers use menthol cigarettes compared to 30% of white smokers. Black smokers also tend to have lower quitting rates, which is one of the reasons the researchers behind the new study decided to explore the link between menthol use and smoking cessation in vulnerable populations, said Leas. “It’s a clear signal in the data.”

Previous studies had examined the effect of menthol in cigarettes and similarly found that menthol makes it harder for smokers who quit to stay off smoking, but these were largely conducted in smaller groups. This new study, however, looked at this relationship in one of the largest cohorts — roughly 46,000 individuals — studied for tobacco use.

The scientists used data from an FDA-funded nationwide survey called Population Assessment of Tobacco and Health to examine the probability of people abstaining from smoking for 30 days and 12 months. The people in the nationally representative sample — 17% of whom were Black Americans — were surveyed four times between 2013 and 2018, allowing researchers to track smoking habits in specific individuals. This design also allowed the researchers to identify transitions between menthol and non-menthol use and the factors that might have contributed to the continued use of cigarettes.

The researchers found that individuals who switched from menthol cigarettes to unflavored cigarettes had a higher likelihood of quitting than those who maintained menthol use. Participants were considered to have attempted to quit if they reported doing so by trying to gradually scale back the number of cigarettes smoked, or by trying to quit entirely.

The study also found that the association between menthol use and difficulty quitting was more pronounced in non-Hispanic Black smokers. This finding “indicates the continued threat that menthol poses for the health of Black Americans,” said Geoffrey Fong, chief principal investigator of the International Tobacco Control Policy Evaluation Project and a professor at University of Waterloo in Canada.

The new study “would be another reason why the FDA should go ahead with their plan in the next year and go through regulations to ban menthol cigarettes,” said Fong, who was not involved with the study but was part of the group that conceived the PATH survey.

Such bans have shown success elsewhere. Canada, for instance, enacted a similar ban on menthol-flavored tobacco products in 2017, and followup studies have validated the effectiveness of the ban, showing that more smokers quit.

R.J. Reynolds Tobacco Co., the maker of Newport cigarettes, the best-selling menthol brand in the U.S., did not immediately respond to a request for comment.

The study’s authors say that they next plan to assess whether menthol use could also impact other aspects of smoking, such as initiation, which would be critical for young smokers. “The scientific evidence is very clear about the benefits of a ban and the continued greater devastation among those who are smoking menthol,” said Fong. “Menthol is not a good thing to have in cigarettes.”

CDC Report Warns E-Cigarettes Are Causing Smoking Rates To Increase In The U.S.

Weekly / November 20, 2020 / 69(46);1736–1742

Monica E. Cornelius, PhD1; Teresa W. Wang, PhD1; Ahmed Jamal, MBBS1; Caitlin G. Loretan, MPH1; Linda J. Neff, PhD1 (View author affiliations)

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What is already known about this topic?

Cigarette smoking remains the leading cause of preventable disease and death in the United States; however, a variety of new combustible, noncombustible, and electronic tobacco products are available in the United States.

What is added by this report?

In 2019, approximately 20.8% of U.S. adults (50.6 million) currently used any tobacco product. Cigarettes were the most commonly used tobacco product among adults, and e-cigarettes were the most commonly used noncigarette tobacco product (4.5%). The highest prevalence of e-cigarette use was among smokers aged 18–24 years (9.3%), with over half (56.0%) of these young adults reporting that they had never smoked cigarettes.

What are the implications for public health practice?

The implementation of comprehensive, evidence-based, population-level interventions, combined with targeted strategies, in coordination with regulation of tobacco products, can reduce tobacco-related disease and death in the United States. As part of a comprehensive approach, targeted interventions are also warranted to reach subpopulations with the greatest use, which might vary by tobacco product type.

Full Report Link.

Vapers Who Don’t Smoke Tobacco Still Have High Chances of Developing a Respiratory Disease

Some cigarette smokers who are trying to quit, transition to vaping, which could have significantly less or no levels of nicotine. Although other vapers are healthy non-smokers, there is still an increased risk of developing a respiratory condition.

The study by Boston University recently published in the journal JAMA Network Open tracked adults who were long-term vapers. Results showed that although they did not smoke tobacco products, e-cigarette users have an increased risk of developing a respiratory disease.

E-cigarettes have increased in popularity, typically advertised as harmful compared to cigarettes. However, there has also been piling evidence that vaping can still result in harming health.

Risk of Respiratory Illnesses

The researchers gathered information from 21,618 adults from the Population Assessment of Tobacco and Health (PATH) study. They were asked a series of questions about their former and current use of e-cigarettes, rated their current health and medical history, and if they have been previously diagnosed with a respiratory illness.

Results showed that former e-cigarette user has a 21% chance of developing a respiratory illness while current users had a 43% increased risk. Understanding these risks, wrote the authors, are “critical for informing state and federal regulatory standards for product safety.”

Data from the PATH study is also the largest, long-term analysis of how vaping affects the respiratory system for those who are healthy. Most previous research typically uses animal or cell models. Human clinical studies usually include those who have already developed acute conditions. The researchers also made sure that the participants were solely vapers or former users and did not switch from cigarette smoking or other tobacco products such as cigars or hookah.

The study is among the “the very first longitudinal” evidence of how harmful vaping can be, said Professor Dr. Andrew Stokes. In the past few years, there has been a dramatic increase in vape use among young adults and minors “which threatens to reverse decades of hard-fought gains.”

Read Also: Vape Causes Characteristic Lung Injury Patterns on CT Scans

International Classification of Diseases Codes

Some of the main outcomes of vaping, the researchers determined, included chronic obstructive pulmonary diseases, asthma, chronic bronchitis, and emphysema. E-cigarettes are also known to have other harmful ingredients such as heavy metals and volatile organic compounds that could result in damaging the immune system.

The researchers wrote in the study that “outcomes associated with e-cigarette use may vary according to specific respiratory conditions.” For example, asthma often develops during childhood while COPD typically develops in adulthood. How e-cigarette use is linked to each specific respiratory condition needs further investigation.

Dr. Hasmeena Kathuria concluded that more and more studies are revealing the health risks associated with vaping. Results highlight how critical it is to standardize e-cigarette product use in electronic health records. Moreover, the Centers for Disease Control and Prevention should develop “International Classification of Diseases codes for e-cigarette product use so that providers can facilitate cessation discussions and identify adverse events related to e-cigarette use,” Kathuria suggest. 

Read Also: Possibility of Link Between Vaping and COVID-19? Doctors Discuss It 

Check out more news and information on Vaping on Science Times.

Hannah C. Nov 13, 2020 04:00 PM EST


Online popularity of JUUL and Puff Bars in the USA: 2019–2020


Background The US Food and Drug Administration (FDA) announced a flavour ban on cartridge-based e-cigarettes in January 2020. It is unclear whether e-cigarette users will switch to disposable vaping products with a variety of kids-appealing flavours available.

Methods We performed piece-wise regression and autoregressive integrated moving average (ARIMA) algorithms to compare the relative search volume (RSV) of JUUL and Puff Bar (a disposable vaping product) using the 1-year Google Trends data from 24 February 2019 to 20 February 2020, separated by three events that may have spurred changes in RSV for each product.

Results The RSV for JUUL was relatively stable before Trump Administration announced plans to ban flavoured e-cigarettes. After that, the RSV for JUUL dropped sharply (rate of change=8.8 per week) from 11 September 2019 to 17 October 2019 when JUUL Labs announced to halt online sales of some flavoured products, and the RSV resumed the decreasing trend after FDA announced enforcement policy of cartridge-based e-cigarettes on 2 January 2020. In comparison, the RSV for Puff Bar started to increase after 11 September 2019 with a low rate of change (0.6) until 17 October 2019. After that, the increase in RSV for Puff Bar accelerated. The RSV of puff bars surpassed that of JUUL during the week of 2 February 2020.

Conclusion The popularity of Puff Bar on Google Search suggests that users may replace cartridge-based vaping products with disposable e-cigarettes in the circumvention of the partial flavour ban. Continuous surveillance and further assessment are needed to prevent potential loopholes in tobacco regulation.

Parents less aware when their kids vape than when they smoke

UCSF study says strict household rules are best way to prevent tobacco use

Most parents know or suspect when their child smokes, but they are much more likely to be in the dark if the child vapes or uses other tobacco products, according to a large national study by researchers at UC San Francisco.

The study, which tracked more than 23,000 participants aged 12 to 17 years old, found that parents or guardians were substantially less likely to report knowing or suspecting that their child had used tobacco if the child used only e-cigarettes, non-cigarette combustible products or smokeless tobacco, compared to smoking cigarettes or using multiple tobacco products.

The researchers also found that when parents set strong household rules about not using tobacco – applying to all residents – their children were less likely to start tobacco use. Just talking to kids about not smoking was far less effective. The study publishes at 9:01 p.m. PT, Oct. 4, 2020, in Pediatrics.

“We know that tobacco-free homes are a key tool to help prevent smoking by kids,” said corresponding and senior author Benjamin Chaffee, DDS, MPH, PhD, an associate professor at the UCSF School of Dentistry. “What studies haven’t examined is how tobacco-free homes stack up against other approaches and how much tobacco-free home rules might help with other tobacco products beyond smoking.

“Tobacco use by children is troubling, and dentists, like all healthcare providers, should be concerned about preventing youth tobacco use,” Chaffee said.

Over the last decade, the smoking landscape has dramatically changed, especially among youth, for whom cigarette smoking has declined while use of electronic cigarettes soared. Last year, the Centers for Disease Control and Prevention reported that more than 1 in 4 high school students was vaping.

The new study used data from the Population Assessment of Tobacco and Health (PATH) Study to investigate parental awareness of youth tobacco use and the role of household tobacco rules in preventing smoking. In addition to cigarettes and e-cigarettes, the study looked at non-cigarette combustible products (including cigars, pipes, hookahs, and bidis), and smokeless tobacco (including snuff, chewing tobacco, snus, and dissolvable tobacco).

It found that parents were more likely to know or suspect that their child was using a tobacco or nicotine product if the child was older, male, identified as white, and lived with a tobacco user, as well as if the parents were less educated. Mothers were singled out as more aware than fathers.

The researchers also found that teens and tweens living in homes with the strictest rules prohibiting tobacco use were 20-26 percent less likely to start using tobacco, compared to youth living in the most permissive homes.

The investigators suggest that parents:

  • Don’t smoke;
  • Create tobacco-free home environments that include all parts of the home;
  • Establish strict rules against all tobacco use that apply to all members of the household;
  • Have high-quality, clear communication with youth about not using tobacco.

“Low parental awareness of e-cigarette use belies rising public attention to youth vaping,” said co-author Tsu-Shuan Wu, a student at the UCSF School of Dentistry. “Youth tobacco use is a considerable public health concern, regardless of the tobacco product used, and parents play a very important role in tobacco prevention.

“Creating tobacco-free home environments is one approach parents can use to set norms and expectations about tobacco use,” she said. “And for healthcare providers, raising parental awareness should be part of overall guidance and tobacco-prevention support.”


Funding: Support was provided by the National Institutes of Health grant number U54HL147127 and the Delta Dental Community Care Foundation.