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ABSTRACTS
2022
BALTIMORE • MD
March 15-18
The peer-review process for SRNT’s annual meeting entails
review by Society members of abstract submissions. Criteria
for acceptance/rejection are based upon methodological
rigor and not the funding resource or research ndings.
The views expressed by conference presenters are the
author’s own and do not necessarily represent that of SRNT.
iii
2022 SYMPOSIA .................................................................................................................................................................................................................................................................1
PAPER SESSIONS
Podium Presentation 1 ..................................................................................................................................................................................................................................XX
Paper Session 1: Engaging in Systems Science to Reduce Tobacco-Related Health Disparities and Promote Equity
Paper Session 2: Rapid Fire: Developing and Evaluating Risk Messages
Paper Session 3: Neurobiological Mechanisms Mediating Withdrawal and Cessation
Podium Presentation 2 ...................................................................................................................................................................................................................................XX
Paper Session 4: Relationships Between COVID-19 and Smoking
Paper Session 5: Committing to Inclusion and Equity in Smoking Cessation Clinical Trials
Paper Session 6: Not Just Nicotine: Product Constitutents and Drug Co-Use
Paper Session 7: Tobacco Control Policy Evaluation: Complexity and Unintended Consequences
Podium Presentation 3 ...................................................................................................................................................................................................................................XX
Paper Session 8: Bidirectional Relationship Between Mental Health and Nicotine Use
Paper Session 9: Identifying and Eliminating Enduring Disparities in Tobacco Use Among Sexual and Gender Minority Adults
Paper Session 10: Smoking Cessation for Medically Vunerable Populations
Podium Presentation 4 ....................................................................................................................................................................................................................................XX
Paper Session 11: Tackling and Transcending the Barriers of Smoking Cessation and Prevention in Priority Populations
Paper Session 12: Rapid Fire: New Trends in Packaging and Marketing to Youth and Adults
Podium Presentation 5 ....................................................................................................................................................................................................................................XX
Paper Session 13: Rapid Fire: Novel Tobacco Cessation Treatments in Adults and Teens
Paper Session 14: Cigarettes and E-Cigarettes: Toxicity and Disease
Paper Session 15: Lessons from Diverse Policy Implementation Across the Globe
POSTER SESSION 1: Poster Session 1........................................................................................................................................................................................................................ XXX
POSTER SESSION 2: Poster Session 2........................................................................................................................................................................................................................ XXX
POSTER SESSION 3: Poster Session 3........................................................................................................................................................................................................................ XXX
POSTER SESSION 4: Pre-Recorded Paper Plus .......................................................................................................................................................................................................... XXX
AUTHOR INDEX ............................................................................................................................................................................................................................................................ XXX
CONTENTS
iv
Notes
v
Notes
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2022 Symposia
2022 SYMPOSIA
SYM1-1
UNDERSTANDING TOBACCO
Patricia Nez-Henderson. Black Hills Center for American Indian Health.
The colonization of Turtle Island (North America) and nations around the world has
altered, and continues to alter our cultures, languages, and traditions and practices,
including relationships with tobacco. This presentation discusses the impacts of coloni-
zation on tobacco, the introduction of commercial, industrialised tobacco, the relationship
between tobacco and Indigenous populations, and the implications of colonization in
tobacco and nicotine research.The Background presentation will be followed by an
Introduction to Indigenous worldviews and understanding of tobacco and wellbeing.
FUNDING: Nonprot grant funding entity
SYM1-2
INDIGENOUS WORLDVIEWS AND UNDERSTANDING OF
TOBACCO AND HEALTH
Raglan Maddox. The Australian National University.
As Indigenous peoples around the world are disproportionately targeted with commercial
tobacco and nicotine marketing and impacted by commercial tobacco-related harms, a
fundamental aim of public health and commercial tobacco control must be to support
Indigenous peoples to end exposure to and use of commercial tobacco and nicotine on
our own terms. This must be seen within the context of Indigenous models of health and
wellbeing that connect physical, psychological, social and spiritual health. This common
commitment to protecting the health and wellbeing of our peoples is also consistent
with the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and
the World Health Organization’s Framework Convention on Tobacco Control (FCTC).
Indigenous peoples’ interests (and rights) and our public health and commercial tobacco
control initiatives to promote health.This Introduction presentation will be followed by an
Indigenous data sovereignty presentation as the Method for this Symposium.
SYM1-3
INDIGENOUS DATA SOVEREIGNTY
Ray Lovett, RN, BN, BHSc, MAE, PhD. ANU.
In Australia and around the world, Indigenous Data Sovereignty and Indigenous Data
Governance are terms that have become increasingly common. The concept of IDSov
has emerged from Indigenous communities concerned about extractive data practices
within communities, and the need to better honor, balance and reect Indigenous
sovereignty principles. We will discuss intellectual property and the protection of Indig-
enous / Traditional Knowledges (TK) resources and heritage in support of Indigenous
knowledges and data sovereignty in nicotine and tobacco research, science and prac-
tice. The presentation will be followed by discussion on Decolonizing tobacco - Where
to from here?
SYM1-4
DECOLONIZING TOBACCO - WHERE TO FROM HERE?
Michelle Bovill, BA (Hons) MA Social Sc1, Heather Giord2. 1The University of
Newcastle, 2Whakauae.
There is signicant potential in Indigenous peoples’ decolonizing tobacco, and conse-
quently improving health and wellbeing, by addressing this completely preventable,
industrialised and commercialised cause of morbidity and mortality. Further, bringing
attention to this issue is expected to lead to signicant benets within Indigenous com-
munities, and better informing policies and programs aimed at eliminating the harm of
commercial tobacco. While these eorts are a positive step in the decolonization pro-
cess, they must work carefully in such a way that does not continue to disenfranchise
Indigenous peoples, or restrict the use and understanding of ceremonial tobacco, but
embed and uphold the following principles and dene our own, Indigenous-led, commer-
cial tobacco ‘end game’:1.Ensure supportive and safe contexts, 2.Support Indigenous
leadership, 3.Broaden the denition of ‘science’, evidence, and knowledge, and 4.Foster
Indigenous research.The presentations will be followed by a facilitated discussion with
Discussant, Hershel Clark.
SYM2-1
THE NEED TO ADDRESS INEQUALITIES: TIME FOR MORE
TARGETED SMOKING CESSATION INTERVENTIONS
Natalie K. Walker1, Billie Bonevski2, Mohamed Hammoud3, Garrett Prestage3, Peter
Saxton4. 1NIHI, University of Auckland, 2College of Medicine and Public Health, Flinders
University, Adelaide, South Aust, 3Kirby Institute, University of New South Wales,
Sydney, New South Wales, Austral, 4University of Auckland, Auckland, New Zealand.
Throughout the world there are subgroups of the population who have signicantly
higher rates of tobacco use than the general population. These marked disparities are
apparent by, and within, sexual minority and ethnic subgroups, as well as according
to socioeconomic status and health state. The impact of smoking on population health
is correspondingly inequitable. In the USA 34% of the socioeconomic disparity in all-
cause mortality is due to smoking. Similarly in New Zealand smoking contributes to an
estimated 1020% of ethnic health inequalities and 20-30% of socioeconomic inequalities
in all-cause mortality. These ndings highlight the importance of taking a comprehen-
sive, equity-based approach to smoking cessation research to inform strategies and
policy, so that ‘no smokers are left behind’ as countries move towards a smoke-free
future. Dr Walker will set the scene for the symposium by outlining the extent of the
above disparities in various countries around the world. The presentation will include
as yet unpublished cross-sectional survey data on smoking prevalence in population
subgroups in Australia and New Zealand - both countries with strong tobacco control
policy but opposing policy around vaping as a harm reduction tool. Data will include
smoking and vaping ndings from the Flux study, an online observational study of 1896
gay and bisexual men in Australia and New Zealand. Dr Walker will then discuss the
need for interventions that have reach into these priority populations, are acceptable
and relevant, plus low cost, eective, and safe. Three presentations will then follow,
presenting clinical trial ndings for interventions designed to reduce tobacco use in
people who identify as African American (Bricker) or indigenous American Indian/
Alaska Native (Santiago-Torres), and in people from low-income populations (Kendzor).
FUNDING: Federal; Nonprot grant funding entity
SYM2-2
EFFICACY AND UTILIZATION OF AN ACCEPTANCE AND
COMMITMENT THERAPY-BASED SMARTPHONE APPLICATION
FOR SMOKING CESSATION AMONG BLACK ADULTS: ANALYSIS
OF THE ICANQUIT RANDOMIZED TRIAL
Jonathan B. Bricker, PhD1, Kristin E. Mull1, Brianna M. Sullivan1, Diana M. Kwon1,
Nicole L. Nollen2, Michael J. Zvolensky3. 1Fred Hutchinson Cancer Research Center,
2University of Kansas School of Medicine, 3University of Houston.
Background: Black adults who smoke are more likely to make quit attempts, yet less
likely to seek treatment and to succeed in quitting compared to other racial groups.
The lack of ecacious, accessible, and engaging trials for smoking cessation further
contributes to this disparity. This study aimed to determine the ecacy of an Acceptance
and Commitment Therapy (ACT)-based smartphone application (iCanQuit) vs. a US
Clinical Practice Guidelines (USCPG)-based smartphone application (QuitGuide) for
smoking cessation among Black adults. Methods: Recruitment of Black adults was
conducted through tailored Facebook ads. A total of 554 Black daily smokers recruited
from 34 U.S. states were enrolled in the iCanQuit parent trial and randomized to either
receive iCanQuit (n=274) or QuitGuide (n=280). The primary outcome was self-reported
30-day point prevalence abstinence (PPA) at 12 months. Self-reported PPA was also
collected at 3 and 6-month follow-ups. Study data retention, treatment engagement and
satisfaction, and change in ACT-based processes (acceptance and valued living) were
also compared between treatment arms. Results: Data retention rate was 89% at the
12-month follow-up with no dierential retention by study arm (OR=0.68 95% CI: 0.38,
1.20). The 30-day PPA primary outcome was 28% for iCanQuit vs. 20% for QuitGuide
participants at the 12-month follow-up (OR=1.60 95% CI: 1.03, 2.46). Increased accep-
tance of internal cues to smoke mediated the eect of treatment on smoking cessation
at the 12-month follow-up (Indirect eect: OR=0.20 95% CI: 0.05, 0.29). Compared to
QuitGuide, iCanQuit participants were signicantly more engaged with the iCanQuit
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2022 Symposia
application as measured by the number of logins from baseline to 6 months (Incident
rate ratio=3.26 95% CI: 2.58, 4.13). Conclusions: In a nationwide sample with high
data retention and participant engagement, this study provides evidence of a digital
intervention that is ecacious for helping Black adults who smoke quit. Future testing of
an iCanQuit application tailored to the unique barriers to cessation among Black adults
who smoke nationwide is warranted.
FUNDING: Federal
SYM2-3
SMALL FINANCIAL INCENTIVES PROMOTE SMOKING
CESSATION AMONG SOCIOECONOMICALLY DISADVANTAGED
ADULTS
Darla Kendzor, PhD1, Summer Frank-Pearce2, Joseph Waring2, Michael S. Businelle1,
Jocelyn M. Barton2, Sarah J. Ehlke2, Laili Kharazi Boozary2, Stefani Madison2, Michael
D. Swartz3, Adam C. Alexander1, David W. Wetter4. 1University of Oklahoma Health
Sciences Center, 2TSET Health Promotion Research Center, Stephenson Cancer
Center, Oklahoma City, 3University of Texas Health Science Center, 4University of Utah,
Huntsman Cancer Institute.
Background: Socioeconomically disadvantaged individuals are less likely to quit smoking.
A total of 320 adult daily smokers with Medicaid or without health insurance enrolled
in a randomized trial to evaluate the ecacy of oering small nancial incentives for
smoking abstinence. Methods: Study participants were randomized to Usual Care
(UC; clinic-based cessation program; N=161) or UC + abstinence-contingent nancial
incentives (UC+FI; N=159), and followed through 26 weeks post-quit-date. Partici-
pants earned a $20 gift card for biochemically-veried abstinence on the scheduled
quit day, and this amount increased by $5 weekly at each successive abstinent visit.
Participants who were non-abstinent at any visit during the rst 4 post-quit weeks were
able to earn incentives for abstinence at the next visit, though the payment was reset
to $20. Participants could earn an additional $50 incentive for abstinence at the 8 and
12 weeks post-quit follow-up visits. Results: Participants (N=320) were primarily female
(63.1%), of non-Hispanic White (60.6%), Black (25.3%), or other (10.9%) race, and 3.1%
endorsed Hispanic ethnicity. Most participants (80.3%) reported an annual household
income of <$21,000, and 19.7% had not completed a high school education. Among the
rst 275 participants (of 320 total) to complete the study, biochemically-veried 7-day
point prevalence abstinence rates in the UC+FI and UC only groups were 41.0% vs.
19.1% at 4 weeks post-quit, 33.1% vs. 16.2% at 8 weeks post-quit, 30.2% vs. 13.2%
at 12 weeks post-quit, and 15.1% vs. 10.3% at 26 weeks post-quit. UC+FI participants
earned a mean of $37.20 (of $150 possible) for abstinence during the rst 4 weeks
post-quit, and a mean of $60.47 (of $250 possible) during the rst 12 weeks post-quit.
Of note, study participation during the coronavirus pandemic appeared to adversely
impact cessation outcomes. Follow-up visits will be completed by February 2022 and
nal outcomes will be presented.Conclusions: Oering small nancial incentives for
smoking abstinence is a low-cost means to improve cessation rates among socioeco-
nomically disadvantaged adults.
FUNDING: Federal; State
SYM2-4
EXTENDED SELF-HELP SMOKING CESSATION INTERVENTION
FOR SPANISH-SPEAKING HISPANICS IN THE UNITED STATES,
OUTCOMES OF A RANDOMIZED CONTROLLED TRIAL
Patricia Medina-Ramirez, Steven K. Sutton, Margaret M. Byrne, Ursula Martinez,
Karen O. Brandon, Cathy D. Meade, Thomas H. Brandon, Vani N. Simmons. H. Lee
Mott Cancer Center & Research Institute, Tampa, FL, USA.
Signicance: Hispanics/Latinxs are the largest racial/ethnic minority group in the United
States (18%), yet relatively few culturally and language specic interventions exist specif-
ically for Hispanic/Latinx smokers. Thus, we translated and culturally adapted an eca-
cious English self-help smoking cessation intervention for Spanish preferring, Hispanic/
Latinx smokers. This intervention, Libre del Cigarrillo (LDC), was tested in a randomized
controlled trial with a nationwide sample. Methods: Participants (N=1,417) smoked
>5 cigarettes/week over the past year, resided in the US, and preferred health-related
material in Spanish. Participants were randomly assigned to Usual Care (UC; a single
self-help booklet from the National Cancer Institute) or the LDC intervention comprising
a series of 11 booklets and 9 pamphlets delivered monthly over 18 months. The primary
outcome was 7-day point prevalence abstinence assessed every 6 months for 2 years.
Multiple imputation was used to manage missing data. Generalized estimating equations
(GEE) evaluated abstinence at 6, 12, 18, and 24 months using a model with treatment,
time, and their interaction. Cost-eectiveness was also evaluated. Results: The sample
was 52% male; 39% had an annual household income less than $10,000; mean age
was 50.0 years; 81% smoked 20 or more cigarettes in the past week; mean FTND was
5.0. GEE analysis revealed a signicant linear increase in abstinence rates (p<.001)
and higher abstinence for those receiving the LDC intervention as compared to UC at
all assessments (p<.002). At 24 months, the abstinence rate for LDC was greater than
for UC (33.1% vs. 23.3%; OR=1.53 [1.12-2.10], p=.002). The incremental cost/quitter
in the LDC arm relative to the UC arm was $648 at 18 months and $684 at 24 months.
Conclusion: Results support the ecacy and cost-eectiveness of an extended self-
help smoking cessation intervention for Hispanic/Latinx smokers. This intervention has
potential to improve the reach of smoking cessation assistance to a large, underserved
population of Spanish-speaking individuals throughout the US.
FUNDING: Federal; State
SYM2-5
REDUCING SUSCEPTIBILITY TO SMOKELESS TOBACCO AMONG
RURAL BOYS WITH FDA’S THE REAL COST SMOKELESS PUBLIC
EDUCATION CAMPAIGN
Matthew Farrelly1, Nathaniel H. Taylor1, Alexandria Smith2, James Nonnemaker1,
Jessica K. Pepper1, Megan Wall2. 1RTI International, Research Triangle Park, NC, USA,
2U.S. Food and Drug Administration, Silver Spring, MD, USA.
Background: The U.S. Food and Drug Administration (FDA) expanded The Real Cost
smoking prevention campaign in 2016 to reach rural male youth at risk of smokeless
tobacco (SLT) use. The campaign targeted boys ages 12 to 17 in rural segments of 35
media markets across the United States. We examine how the campaign inuenced
intentions to use SLT in the future, overall and by age. Methods: The evaluation team
conducted a randomized controlled eld trial in 30 rural markets in the U.S. with 15 treat-
ment markets (randomly selected from the 35 campaign markets) and 15 control markets.
We surveyed a longitudinal cohort of 2,168 male youth ages 11 to 16 at baseline from
January 2016 through December 2018. We created a summary measure of susceptibility
using 3 dichotomized variables (will use SLT soon, in next year, if friend oers); any
response among never smokeless tobacco users other than “denitely not” indicates
susceptibility. We used dierence in dierence (DID) multivariate regression models
to compare changes in susceptibility over time between respondents in intervention
markets and control markets, for the full sample and stratied by age group (i.e., 11-13,
14-16). Results: In adjusted DID analysis that included both age groups, we found that
susceptibility decreased by 6.0 percentage points (pp; p=0.01) from baseline to nal
follow-up in the treatment group compared to the control. These results were driven
by decreases in susceptibility among the younger (11-13) age group (-8.8 pp; p=0.01).
Among the older group (14-16), there were no signicant dierences in susceptibility
from baseline to nal follow-up between the treatment and control group. Discussion:
The results show evidence of a signicant campaign eect on SLT susceptibility among
never-user boys overall and among younger ages (11 to 13 at baseline), suggesting
that the campaign could have an eect on SLT initiation among rural boys who have
never used SLT. In previous analyses of the whole sample, we found that the campaign
inuenced beliefs among the older age group but not the younger group. Additional
analyses are needed to understand these dierential campaign responses by age.
FUNDING: Federal
SYM3-1
THE SMOKEFREE AOTEAROA 2025 ACTION PLAN: A MAORI
PERSPECTIVE
Andrew Morehi Waa, B.Soc.Sc., MPH. University of Otago.
Aotearoa’s/New Zealand’s Smokefree goal is rooted in principles of equity and Indige-
nous self-determination. This presentation will outline the rationale for, and apply, these
principles as a lens for examining how the proposed Action Plan could address smoking
disparities and support Maori (the Indigenous peoples of Aotearoa) development. The
presentation will begin with an overview of the historical context and how Maori leaders
set in motion an overhaul of how we think about addressing harm from commercial
tobacco. New ndings will then be presented from the rst survey wave of Maori who
smoke (n=701) from the Te Ara Auahi Kore project, an Indigenous led partner project
to the ITC. Among survey participants more supported than opposed reducing the retail
availability of commercial tobacco by 95% or mandating only very low nicotine content
(VLNC) tobacco could be sold. For both measures over half reported they would quit
or cut down if they were introduced. Support for the introduction of VLNCs was asso-
ciated with a history of making more quit attempts, having greater trust in government
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2022 Symposia
and having a lower sense of control over your life. The presentation will conclude by
critiquing how the plan reects the original vision of our Maori leaders, our research
ndings and principles of equity and self-determination.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM3-2
THE SMOKEFREE AOTEAROA 2025 ACTION PLAN
Richard Edwards, MB BChir MPH MD. University of Otago, Wellington.
This presentation will provide detailed information about the Smokefree Aotearoa 2025
action plan, its current status and key features which should maximise the likelihood that
it will result in the achievement of the endgame goal. These features include: •a focus on
eliminating disparities in smoking and commitment to strengthening Maori (Indigenous)
governance in tobacco control.•acknowledgement of the need for structural measures
to change the broader environment in which people live in order to make it easier for
young people to stay smokefree and for smokers to quit.•a focus on protecting future
generations by minimising smoking initiation and uptake (as well as aiming to greatly
increase quitting among existing smokers).•the comprehensive nature of the plan, includ-
ing interventions in previously unaddressed areas in New Zealand: notably reductions
in the supply of smoked tobacco products and regulation of tobacco product design
and constituents.•inclusion of bold measures (mandated denicotinised smoked tobacco
products, large reductions in the retail availability of tobacco products, and the smokefree
generation proposal) likely to have a profound impact in achieving rapid, profound and
sustained reductions in smoking prevalence in all population groups. •additional novel
measures such as a ban on cigarette lters and a minimum price for tobacco products
•strengthening of ‘business as usual” polices and interventions such as enhanced mass
media and social media promotions, increased smoking cessation support for priority
populations, and community-based smokefree interventions•a commitment to risk
proportionate regulation with a focus on much more robust regulation and population
level policies for smoked tobacco products complemented by risk proportionate regu-
lation of alternative nicotine delivery products through a Bill and supporting regulations
introduced in 2020 and 2021.Initial consultation has been completed and a nal version
of the action plan will be presented to Cabinet later in 2021. The passage of legislation
and initiation of implementation is anticipated to begin in 2022.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM3-3
QUANTITATIVE AND QUALITATIVE RESEARCH FINDINGS ABOUT
SUPPORT AMONG PEOPLE WHO SMOKE FOR PROPOSED
MEASURES IN THE SMOKEFREE 2025 ACTION PLAN
Janet Hoek, PhD. Departments of Public Health and Marketing, University of Otago.
Critics of smokefree policy measures have argued these represent a paternalistic
top-down approach that constrains people who smoke and undermines their agency.
Endgame strategies attract even more trenchant criticism because these contain
powerful behavioural levers that will fundamentally change smoking experiences and
galvanise cessation. Yet viewing people who smoke as passive objects acted upon by
policy makers belies the strong support many have for innovative measures that will
reduce the appeal and availability of tobacco products. Drawing on data from around
1100 people in the NZ ITC study who smoke or who have recently quit, and qualitative
work with 20 people who smoke and manage high material deprivation, we present
evidence on attitudes to smoking and support for measures in the proposed Smokefree
Action Plan. The NZ ITC survey found high levels of regret (82%) among people who
smoke with 71% intending to quit (36% in the next six months); ndings were similar
for Maori and non-Maori participants. There was strong support for many measures
included in the proposed action plan including mandated very low nicotine cigarettes
(76%), the smoke-free generation proposal (78%), and increased campaigns to foster
cessation (70%) or prevent youth smoking (93%). The only measure not to receive
majority support was large reductions in retail outlets selling tobacco (36%). A qualita-
tive study of 20 people who experienced high nancial stress found strong support for
reducing nicotine to non-addictive levels and enhancing personal cessation support. All
participants wanted to become smokefree but several opposed measures they thought
would remove their ability to choose when to quit. Nonetheless, others felt stronger
policies could restore the agency smoking had removed and saw stronger regulation
as enabling, not constraining, freedom. Use of “choice” rhetoric by many participants
echoes the tobacco industry’s framing of smoking as a personal choice; challenging this
framing could decrease self-blame among people who smoke and present endgame
goals as likely to enhance agency.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM3-4
TOBACCO INDUSTRY RESPONSES AND ARGUMENTS IN
RESPONSE TO THE PROPOSED ACTION PLAN FOR NEW
ZEALAND’S SMOKEFREE 2025 GOAL
Lindsay Robertson, PhD. University of Bath.
Transnational tobacco companies (TTCs) have sought to shape stakeholder opinion
about policies through conducting and disseminating their own research, polls or peti-
tions, and via media advocacy. They have also created, co-opted or worked with third
party organisations to advance their arguments. Evidence suggests TTCs’ strategies
and arguments are largely consistent regardless of the jurisdiction or the specic pol-
icy under consideration, and this consistency has oered public health advocates the
opportunity to prepare counterarguments and strategies to protect policy-making from
TTC interference. Most evidence about TTC policy interference has been document-
ed prior to the emergence of new nicotine products and purported tobacco “industry
transformation”. To our knowledge, there are no published examples of how TTCs
have responded publicly to tobacco endgame ideas. We describe the initial response
to New Zealand’s 2025 Action Plan by TTCs, and by individuals and organisations
who appear to be working to advance industry interests. Using thematic analysis, we
draw on submissions to the 2025 Action Plan consultation, and news articles published
following the release of the Government’s proposals, to identify overarching themes and
arguments used to oppose the proposals. Preliminary analysis suggests opposition to
the proposed measures is thematically similar to well-documented TTC arguments that
predict far-reaching negative unintended consequences (e.g. measures will increase
illicit trade and organised crime, criminalise smokers, cause job losses and business
closures, create greater health harms and health system costs, breach trade laws)
while denying potential public health benets (e.g. measures unnecessary or ineective;
inadequate evidence). References to potential human rights implications, and the role
of tobacco harm reduction as an alternative to the proposals, reect the adaptation of
TTCs’ strategies to align with changing market and policy environments. We will discuss
how our ndings could be used by policy-makers and advocates to help safeguard
endgame policies and their implementation from industry inuence.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM4-1
THE IMPACT OF CANADA’S MENTHOL CIGARETTE BAN ON
QUITTING AMONG MENTHOL SMOKERS: POOLED ANALYSIS
FROM THE ITC PROJECT AND THE ONTARIO MENTHOL BAN
STUDY AND IMPLICATIONS FOR A MENTHOL BAN IN THE
UNITED STATES
Georey T. Fong, PhD1, Janet Chung-Hall1, Gang Meng1, Lorraine V. Craig1, Mary
E. Thompson1, Anne C.K. Quah1, Rob Schwartz2, Eric Soule3, Joanna Cohen4, K. M.
Cummings5, Andrew Hyland6, Richard J. O’Connor6, Maansi Bansal-Travers6, David
T. Levy7, Cristine Delnevo8, Ollie Ganz8, Michael O. Chaiton2. 1University of Waterloo,
Waterloo, ON, Canada, 2Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada, 3East Carolina University, Greenville, NC, USA, 4Bloomberg
School of Public Health, Johns Hopkins University, Baltimore, MD, USA, 5Medical
University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC, USA,
6Roswell Park Comprehensive Cancer Center, Bualo, NY, USA, 7Georgetown Univer-
sity, Washington, DC, USA, 8Rutgers School of Public Health, Piscataway, NJ, USA.
Signicance. Between 2015-18, all Canadian provinces banned menthol in cigarettes.
Two pre-post studies found that the menthol ban led to increases in quitting among
menthol smokers compared to non-menthol smokers. This study pools data from those
two cohort studies—the ITC Canada Survey and the Ontario Menthol Ban Study—which
used the same denitions of menthol smoker and of quitting at post-ban, and were con-
ducted within 1-2 months of each other at pre-ban (2016) and post-ban (2018) waves,
to derive a more precise estimate of the impact of Canada’s menthol ban on quitting
and to apply this estimate to project the impact of a proposed menthol ban in the US.
Method. We analyzed pooled pre-post data from the ITC Canada Survey across 7
provinces (83% of the Canadian population; n=1236 adult (18+) smokers, 128 pre-ban
mainly menthol smokers) and the Ontario Menthol Ban study (n=1084 adult smokers,
295 pre-ban mainly menthol smokers). Logistic analyses compared post-ban quit suc-
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2022 Symposia
cess (those reporting no longer smoking at post-ban) of menthol smokers compared to
non-menthol smokers (for daily smokers and for all smokers), controlling for common
covariates (sex, age, ethnicity, education, baseline smoking status, baseline cigarettes
per day, and province). Results. Daily menthol smokers were signicantly more likely
to quit than daily non-menthol smokers (21.2% vs. 13.2%: eect size=8.0%, p=0.005;
95% CI: 2.4%-13.7%) This was also true of all (daily and non-daily) smokers, (menthol
quitters = 22.3%; non-menthol quitters = 15.0%; eect size=7.3%, p=0.006; 95% CI:
2.1%-12.5%). There were no provincial dierences in eect sizes. Conclusions. Applying
these eect sizes to a menthol cigarette ban in the US, where menthol market share is
much higher (35-40% overall), using number of U.S. menthol smokers obtained from
NSDUH 2019, leads to the following estimates: 786,204 additional quitters among
daily smokers (95% CI: 235,861-1,346,375), and 1,357,022 additional quitters among
all smokers (95% CI: 390,376-2,323,668). The more precise, pooled estimates of
Canada’s menthol ban supports FDA’s decision to move forward in their plans to ban
menthol cigarettes.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
SYM4-2
MENTHOL SMOKERS’ QUITTING BEHAVIOURS AFTER THE
EUROPEAN UNION BAN ON MENTHOL: LONGITUDINAL
FINDINGS FROM THE 2020 ITC NETHERLANDS SURVEYS
Christina N. Kyriakos, MPH1, Pete Driezen2, Janet Chung-Hall2, Anne C.K. Quah2,
Georey T. Fong2, Marc Willemsen3, Filippos T. Filippidis1. 1Imperial College London,
London, United Kingdom, 2University of Waterloo, Waterloo, ON, Canada, 3Maastricht
University, Maastricht, Netherlands.
Signicance: In an eort to reduce the attractiveness and palatability of tobacco, the
European Union (EU) banned menthol as a characterizing avour in cigarettes in May
2020. The aim of this study was to evaluate short-term quitting behaviours among
adult smokers from the Netherlands before and after the EU menthol cigarette ban.
Methods: Longitudinal data from International Tobacco Control (ITC) cohort surveys of
adult smokers and recent quitters (N=1,732) in the Netherlands, conducted in Wave 1
(February-March 2020, pre-ban) and Wave 2 (September-November 2020, post-ban).
Bivariate and logistic regression analyses were conducted in Stata using weighted data.
Results: Prior to the menthol ban, 7.5% (95%CI: 6.3-8.9) of smokers reported menthol
as their usual avour compared with 3.8% (95%CI: 2.9-4.8) after the ban. Females were
signicantly more likely than males to smoke menthol at both waves (aORs=2.4 and
2.8, respectively). Among females, pre-ban menthol smokers were signicantly more
likely to report having quit at Wave 2 than non-menthol smokers (aOR=2.5, 95%CI: 1.0-
6.3). No signicant dierences in quitting were found overall or among males. Overall,
among pre-ban menthol smokers, 10.5% quit smoking, 46.3% switched to non-men-
thol cigarettes, and 43.2% claimed to have continued to smoke menthol cigarettes at
follow-up. Among post-ban menthol smokers, 7.5% purchased cigarettes from outside
of the EU within the last six months, while 3.4% reported buying cigarettes that may
have been smuggled. Conclusions: The use of menthol cigarettes among smokers in
the Netherlands decreased shortly after implementation of the EU menthol ban. The
menthol ban was signicantly associated with quitting among pre-ban menthol smokers
compared to non-menthol smokers, but only among females. Most smokers reported
either switching to non-menthol cigarettes or continuing to smoke menthol cigarettes.
However, for the latter, these may be products that are compliant with the ban/ menthol
‘replacement’ products. Post-ban menthol use does not appear to be due to smuggling/
illicit trade. Eorts are needed to improve cessation support and policy compliance.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM4-3
E-CIGARETTE FLAVORS, DEVICES AND BRANDS USED BY
YOUTH BEFORE AND AFTER PARTIAL FLAVOR RESTRICTIONS
IN THE US: FINDINGS FROM THE ITC YOUTH TOBACCO AND
VAPING SURVEYS IN CANADA, ENGLAND, AND THE US
David Hammond, PhD1, Jessica L. Reid1, Robin Burkhalter1, Maansi Bansal-Travers2,
Shannon Gravely1, Andrew Hyland2, Karin Kasza2, Ann McNeill3. 1University of Water-
loo, Waterloo, ON, Canada, 2Roswell Park Comprehensive Cancer Center, Bualo, NY,
USA, 3King’s College London, London, United Kingdom.
Signicance: We examined avored vaping product use among youth, including the
impact of avor restrictions implemented in the US in February 2020, which prohibited
avors other than menthol and tobacco in cartridge/pod-based e-cigarettes, as well as
restrictions implemented in some provinces in Canada beginning in 2020. Methods: Data
are from ve cross-sectional waves of the ITC Youth Surveys, conducted online with
youth aged 16-19 from consumer panels in the US, Canada, and England. Regression
models tested dierences in ‘usual’ e-cigarette avor, device type, and brand reported
by past 30-day vapers (n=9,512) before (2017-2019), during (February 2020) and after
(August 2020) implementation of US avor restrictions. Results: In August 2020, 78.7%
of vapers in the US reported using a avor prohibited in cartridges/pods (i.e., non-men-
thol or non-tobacco), compared to 86.3% in Canada (AOR=1.73, 95% CI=1.25-2.40)
and 79.8% in England (AOR=1.10, 95% CI=0.78-1.55). In August 2020, fruit remained
the most common usual avor among vapers in the US (63.5%), Canada (68.1%), and
England (63.5%), with no signicant changes before versus after the US restrictions.
Among vapers in the US, no changes were observed in the usual use of tobacco avor
(11.1% to 10.9%) or mix of tobacco avor and menthol avor (6.4% to 6.9%)—those
not subject to restrictions—before and after avor restrictions. Disposable e-cigarettes
(exempt from the avor restrictions) increased in all countries, but to a greater extent
among vapers in the US (13.2% to 36.8%) compared with Canada (7.7% to 14.2%,
AOR=2.01, 95% CI=1.33-3.04) and England (10.8% to 16.4%, AOR=2.33, 95% CI=1.52-
3.57), before versus after restrictions. In 2020, after implementation of the restrictions
on avored cartridge-based e-cigarettes, Pu Bar (a disposable e-cigarette available in
a variety of avors) emerged as the most popular brand in the US. Conclusions: Flavor
restrictions on cartridge-based e-cigarettes in the US had little or no impact on the
usual avors used by youth vapers. Youth appear to have circumvented the US avor
restrictions by using brands and devices exempt from the restrictions.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM4-4
THE ILLEGAL EXPERIMENTAL TOBACCO MARKETPLACE III:
EFFECTS OF VAPING PRODUCT BANS: FINDINGS FROM THE
2020 ITC SMOKING AND VAPING SURVEY
Warren K. Bickel, PhD, Roberta Freitas-Lemos, Jerey S. Stein, Allison N. Tegge.
Virginia Tech Carilion, Roanoke, VA, USA.
Signicance: Restrictive regulatory tobacco control policies can result in unintended
consequences such as users seeking banned products from illegal sources. To further
advance research in this context, we developed an experimental paradigm, the Illegal
Experimental Tobacco Marketplace (iETM). The iETM permits us to verify the impact
of actual or proposed restrictions on the likelihood of illegal tobacco purchases. The
present study has two aims. First, we examined the eect of a vaping ban, a total avor
vaping ban, and a partial avor vaping ban on the probability of purchasing illegal vap-
ing products among dierent local regulatory conditions (US, CA, and EN) and among
dierent user types (cigarette smokers, e-cigarette users, and dual users). Second,
we examined the relationship of prior support for bans on illegal purchases. Methods:
Participants (N=459) from the International Tobacco Control (ITC) Four Country Survey
completed hypothetical purchasing trials under the four aforementioned conditions. In
each trial, participants chose to purchase in a legal experimental tobacco marketplace
(LETM) or an iETM. Availability of vaping products in the LETM depended on the ban
in place. Results: Within-country comparisons showed that e-cigarette users and dual
users were more likely to purchase from the iETM compared to cigarette smokers when
product availability in the LETM was more restricted, with e-cigarette users being most
aected (US-OR:22725.3, CA-OR:6125.0, EN-OR:1722.6). Cross-country compari-
sons depicted that dual users from CA (OR:19.8) and e-cigarette users from the US
(OR:12.9) exhibited higher odds of illegal purchases compared to the same user type
in other countries. Moreover, increased opposition towards partial or total avor ban,
as reported in the ITC 4CV survey, was associated with increased purchasing from the
iETM in the corresponding condition. Conclusions: This study suggests that restricting
vaping products may shift tobacco users’ preference to the illegal marketplace. Finally,
this study provides evidence of the generalizability of the iETM in a large and diverse
sample and enhances its utility in tobacco regulatory science.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM4-5
THE PUBLIC HEALTH IMPACT OF A BAN ON FLAVORS IN
NICOTINE VAPING PRODUCTS
David T. Levy, PhD1, Rafael Meza2. 1Georgetown University Medical Center, Washing-
ton, DC, USA, 2University of Michigan, Ann Arbor, MI, USA.
Signicance: The US FDA is currently considering whether to restrict avors in nicotine
vaping products (NVPs). These avor restrictions are intended to reduce NVP use among
youth, but there may also be unintended negative public health impacts, such as reducing
smoking cessation. We developed a model that considers these potential transitions to
estimate the net public health impact of proposed restrictions on NVP avors. Methods:
5
2022 Symposia
We estimate the public health impact of US NVP avor restrictions using the Smoking and
Vaping Model. The modeling analysis incorporates information from systematic reviews
and empirical data analyses (PATH, ITC and other data) on toxicity, avor use patterns,
and the impact of NVP avors on NVP and smoking initiation, cessation and product
switching. We consider restrictions on specic avors (e.g., menthol vs. sweet avors)
as applied to specic devices (e.g., pod vs. tank). Due to the diculties in implementing
restrictions on avors in tank-type devices and because cartridge/pod-based NVPs are
the primary type of avored product used by youth, we focus primarily on restrictions on
the sales of avors in cartridge/pod-based devices. We model the impact of NVP avor
restrictions alone and in conjunction with a ban on menthol in combustibles. The model
projects the potential impact of avors restrictions on NVP use, cigarette smoking and
related mortality. Results: The results show the public health trade-o of NVP avor
restrictions on youth and adult NVP use. The impacts depend primarily on NVP relative
to cigarette risks, the degree to which the use of specic avors impact cigarette use
and on whether vapers substitute to other devices in order to obtain restricted avors.
Sensitivity analyses conducted on the plausible range of input parameters show wide
variation in the potential public health impacts. Conclusions: Public health impacts of
dierent types of avor bans are highly sensitive to key underlying parameters. Based
on these results, we identify the information most needed to improve the ability to gauge
the impact of avor restrictions on public health.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM4-6
SUBSTITUTION PROFILES OF MENTHOL SMOKERS IN
SIMULATED FLAVOR BANS
Amanda Quisenberry, Lovina John, Samantha Hidalgo, Abari Francis Opio. Roswell
Park Comprehensive Cancer Center, Bualo, NY, USA.
Background: The addition of avor to tobacco products increases the appeal and
abuse liability of the product. Regulations that remove characterizing avors in tobacco
products may benet public health by leading to cessation or use of an alternative and
potentially less harmful product, also called product substitution. Determining the level
of substitutability of both avored and tobacco avored e-cigarettes when menthol
cigarettes are available and unavailable will help determine if a avor ban (of either
menthol cigarettes and/or avored e-cigarettes) will lead to cessation and/or harm
reduction among current smokers. Methods: This current study evaluated avored
and unavored tobacco product abuse liability and measures of visual attention in
a 2 (menthol cigarette availability) X 2 (e-cigarette avor availability) within-subjects
laboratory experiment using the Experimental Tobacco Marketplace with simultaneous
eye-tracking measurements of visual attention. Adult menthol smokers of name brand
cigarettes (n=41) purchased tobacco products across various cigarette prices when
presented with nicotine replacement therapy, smokeless tobacco, and only: 1) menthol
cigarettes and ve avored JUULs, 2) menthol cigarettes and tobacco-avored JUUL,
3) non-menthol cigarettes and ve avored JUULs, and 4) non-menthol cigarettes
and tobacco-avored JUUL. Results: Non-linear regression results show that demand
intensity and elasticity were signicantly dierent among avor availability conditions.
For brand name smokers, demand intensity is greater in the menthol available condi-
tions (Q0=146.5; 137.0) compared to the non-menthol available conditions (Q0=85.86;
109.1; p <.001). Demand was less elastic in the menthol available conditions (α=.0013;
.0013) than in the non-menthol available conditions (α=.0028; .0024; p<.001). Within
substitution proles, menthol JUUL functioned as a substitute when available in the
marketplace. Contrary, tobacco-avored JUUL functioned as a substitute only when
menthol cigarettes and other JUUL avors were unavailable. Qualitative eye-tracking
results demonstrate a great amount of attention paid to price of cigarettes and to other
product prices at a lesser extent. Dwell time on the alternative products is consistent with
the substitutability proles and is increased when menthol cigarettes are unavailable.
Conclusions: Demand intensity and elasticity for cigarettes is greater for own brand avor
and the strength of product substitution is dependent upon cigarette avor availability.
Qualitative eye tracking results show synergy between dwell time and product choice.
FUNDING: Federal
SYM4-7
MENTHOL PREFERENCE MODERATES THE RELATIONSHIP
BETWEEN CIGARETTE NICOTINE CONTENT AND UNPLEASANT
REACTIONS IN YOUNG ADULTS WHO REPORT LOW-
FREQUENCY SMOKING
Dana Rubenstein1, Maggie Sweitzer1, Lauren Pacek1, Rachel Denlinger-Apte2, Lauren
Scroggs1, Joe McClernon1. 1Duke University Medical Center, Durham, NC, USA, 2Wake
Forest School of Medicine, Winston-Salem, NC, USA.
Signicance: Half of young adults who smoke use menthol cigarettes, which is as-
sociated with increased risk of continued smoking and greater nicotine dependence.
Additionally, early subjective reactions to cigarettes predict future use. Research shows
that menthol may blunt the sensory eects of nicotine among adult smokers. This study
thus investigates the potential moderating role of menthol on subjective reactions to
cigarette nicotine content among young adults who report low-frequency smoking.
Methods: In three counterbalanced, double-blinded sessions, young adults who use
tobacco products <15 days/month smoked xed doses from very low (VLNC) and normal
(NNC) nicotine content cigarettes, which were menthol or non-menthol depending on
participant preference. Pleasant and unpleasant subjective reactions were measured
in each session. ANOVA tests investigated whether menthol preference moderated the
eect of nicotine content on subjective reactions. Results: Participants (N=87) were
18-25 years old and 49% female. They reported smoking M=15.2 cigarettes per month
(SD=11.9) on M=8 days (SD=3.6); 35% smoked menthol cigarettes. There were no
signicant demographic dierences between the menthol versus non-menthol groups.
Menthol preference moderated the relation between nicotine content and unpleasant
subjective reactions (F(1, 85)=4.42, p=.038): non-menthol participants showed an
increase in unpleasant reactions with greater nicotine content (t(56)=4.570, p<.001),
whereas this eect was not observed for menthol participants (t(29)=.681, p=.50). There
was an eect of menthol preference on pleasant reactions (F(1, 85)=4.036, p=.048)
such that menthol participants experienced greater pleasant reactions regardless
of nicotine dose. Conclusions: Young adults who report low-frequency smoking of
menthol cigarettes did not experience as much of a dierence in unpleasant reactions
between NNCs and VLNCs as did those who smoke non-menthols. Future studies
should continue to investigate the interactive eects of menthol and nicotine content
in this population, especially considering the potential for an FDA-mandated menthol
ban or nicotine reduction policy.
FUNDING: Federal
SYM5-1
TARGETING ALPHA-2A NORADRENERGIC RECEPTORS FOR
SEX-DEPENDENT MECHANISMS IN SMOKING CESSATION
Sherry A. McKee, PhD. Yale School of Medicine.
Evidence suggests that women are more likely to smoke to regulate negative aect,
whereas men are more likely to smoke for positive reinforcement. For smoking cessation
treatment to be eective for women and men, these sex-sensitive systems need to be
targeted. Preclinical studies of noradrenergic targets demonstrate that they attenuate
stress-induced relapse to nicotine, decrease nicotine-related reinforcement, and im-
prove attention and inhibitory control. Using both preclinical and clinical strategies, our
interdisciplinary team probed the noradrenergic system’s eects on stress reactivity
and nicotine reinforcement - hypothesizing that (a) dierent brain systems modulated
by noradrenergic activity are activated by smoking in women and men and (b) guanfa-
cine, an alpha2a noradrenergic agonist, can preferentially target these sex-dependent
systems to improve smoking cessation outcomes. In this presentation, we will review
preclinical, human laboratory, neuroimaging, and Phase 2 clinical trial results generated
within our Yale-SCOR center. Across our investigations, we demonstrate that guanfacine
attenuates stress-precipitated smoking in women and nicotine-related reinforcement
in men. Further, our preclinical and neuroimaging ndings identify that mechanisms of
guanfacine are centralized in the amygdala, particularly for females. Finally, our clinical
trial ndings document that guanfacine demonstrates ecacy for smoking cessation
for both women and men, with potentially larger eects in women. Overall, our center
has highlighted the critical importance of developing sex-appropriate treatments for
tobacco use disorder which are responsive to factors which maintain addiction in women.
FUNDING: Federal
6
2022 Symposia
SYM5-2
PSILOCYBIN-FACILITATED SMOKING CESSATION:
COMPARATIVE EFFICACY VS. NICOTINE PATCH
Matthew W. Johnson, PhD. Johns Hopkins University School of Medicine.
We conducted an open-label pilot study testing psilocybin in combination with manualized
cognitive behavioral therapy (CBT) in 15 treatment-resistant smokers. Data showed no
serious adverse events attributable to psilocybin, and a very promising cotinine-veried
point-prevalence abstinence rate of 80% at 6-month follow-up. A 2.5-year follow-up
showed a cotinine-veried abstinence rate of 60%. We are currently conducting a
comparative ecacy trial randomizing treatment-resistant smokers to a single psilo-
cybin session (on their target quit date) or the transdermal nicotine patch (using FDA
guidelines, beginning 24 hours after their target quit date), both in combination with a
13-week program of manualized CBT. We report data for the 56 participants who have
completed their 12 month follow up (27 psilocybin; 29 patch). Interim results show sub-
stantially higher cotinine-veried 7-day point-prevalence abstinence rates at 12-months
with psilocybin (59%) vs. nicotine patch (28%). Continuous abstinence data also show
substantially higher 12-month abstinence rates for psilocybin (36%) vs. nicotine patch
(9%). Continuous abstinence rates show relatively little decline over time with psilocybin
(41% at 3 months and 37% at 12 months) compared to nicotine patch (28% at 3 months
and 10% at 12 months). Nicotine patch point-prevalence data show typical decline over
time (41% at 3 months and 28% at 12 months), while point-prevalence abstinence
increases slightly over time with psilocybin (52% at 3 months and 59% at 12 months).
Interim smoking cessation ecacy analyses suggest promising results for psilocybin in
comparison to transdermal nicotine patch when both are delivered in combination with
CBT. Similar to results with psilocybin in treating aective disorders, psilocybin results
for smoking cessation may be notable for their sustainability over time.
FUNDING: Nonprot grant funding entity
SYM5-3
CYTISINICLINE AS A PROMISING NEW NICOTINE CESSATION
TREATMENT
Cindy A. Jacobs, PhD, MD. Achieve Life Sciences.
Cytisinicline is a well-established smoking cessation treatment marketed for decades
in Central and Eastern Europe. Historically, 1.5 mg Cytisinicline has been administered
as a 25-day dose titration regimen. Achieve Life Sciences has redeveloped Cytisinicline
into a more convenient, longer duration treatment that may have greater benet while
retaining its excellent safety prole. Cytisinicline functions, like varenicline, as a partial
agonist at the alpha4beta2 nicotinic acetylcholine receptors and competes with nicotine
to interfere with nicotine-induced reward and satisfaction. Other receptor binding eects
at 5-HT3 receptors, resulting in nausea and vomiting, have also been identied. Dier-
ences between varenicline and Cytisinicline binding have shown Cytisinicline to be far
less potent in activating 5-HT3 receptors, explaining the signicantly less incidence of
nausea/vomiting observed with Cytisinicline compared to varenicline. Several Phase
1 and Phase 2 clinical trials have been completed for Cytisinicline.A Phase 1 study
(N=72) determined that 30mg was the maximum tolerated dose (MTD) for Cytisinicline
based on incidence of nausea/vomiting. MTD level for Cytisinicline is 10-fold higher than
varenicline’s MTD. Non-inferior ecacy with signicantly less adverse events, includ-
ing nausea, were observed for Cytisinicline compared to varenicline in the RAUORA
head-to-head trial (N=679). The ORCA-1 Phase 2b Study (N=254) demonstrated a
50% quit rate for 3mg cytisinicline administered 3 times daily (TID) compared to 10%
for placebo (P<0.001). The ORCA-1 subpopulation, who previously failed to quit on
varenicline (N=92), had a 51% quit rate when treated with Cytisinicline TID compared
to 16% for placebo (P=0.009). A Phase 3 ORCA-2 trial recently completing enrollment
at 810 participants. ORCA-2 Phase 3 results, expected in H1 2022, will evaluate the
benet and safety of the simplied 3mg TID Cytisinicline regimen for 6-week or 12-week
treatment duration as a promising new smoking cessation treatment.
FUNDING: Pharmaceutical Industry
SYM5-4
A PILOT TRIAL OF EXENATIDE ONCE-WEEKLY ADJUNCT TO
NICOTINE PATCH FOR SMOKING CESSATION AND MITIGATION
OF POST-CESSATION WEIGHT GAIN
Luba Yammine, PhD, MSN, BSN. University of Texas Health Science Center at Hous-
ton.
Smoking and obesity are the two leading causes of preventable morbidity and mortality.
Unfortunately, the majority of people who quit smoking experience unhealthy and rapid
weight gain which could attenuate some of the benecial eects of smoking cessation
and trigger smoking relapse. Glucagon-like peptide 1 receptor agonists (GLP-1RAs),
used clinically for the treatment of diabetes and obesity, can potentially attenuate this
weight gain and the rewarding eects of nicotine, as shown preclinically. Since rst
line smoking cessation therapies do not impact post-cessation weight gain and have
modest eects on abstinence, GLP-1RAs can make eective adjunct treatments.In
this double-blinded trial, 84 prediabetic and/or overweight treatment-seeking smokers
were randomized (1:1) to once-weekly placebo or exenatide, 2 mg, subcutaneously. All
participants received nicotine patches (21 mg) and brief smoking cessation counseling.
Seven-day point prevalence abstinence (expired CO level =5 ppm) and post-cessation
weight were assessed following 6 weeks of treatment. Bayesian analysis of generalized
linear models yielded posterior probabilities (PP) to quantify the evidence favoring hy-
pothesized eects of treatment on primary outcomes. Potential moderators of treatment
eects on abstinence outcomes were explored.Exenatide increased the probability of
smoking abstinence compared to placebo (46.3% and 26.8%, respectively), (RR = 1.70;
95% credible interval = [0.96, 3.27]; PP = 96.5%). Post-cessation body weight was 5.6
pounds lower in the exenatide group compared to placebo (PP=97.4%). The impact of
exenatide on abstinence was not moderated by sex, race, age, number of years smoked
or nicotine dependence. Baseline blood glucose and body mass index moderated the
impact of exenatide on abstinence, such that the eects of exenatide were greatest
among overweight, obese, and normoglycemic participants. Exenatide, in combination
with nicotine patch, improved smoking abstinence and decreased post-cessation weight
gain, suggesting that GLP-1RA strategy is worthy of further research in larger, longer
duration studies.
FUNDING: Academic Institution
SYM6-1
SCOPING REVIEW OF STUDIES EVALUATING THE IMPACT OF
LOCAL US LAWS RESTRICTING THE SALE OF FLAVORED AND
MENTHOL TOBACCO PRODUCTS: WHAT IS KNOWN ABOUT
EQUITY IMPACTS?
Todd Rogers, PhD1, Elizabeth M. Brown2, Barbara Schillo3. 1RTI International, NC,
USA, 2RTI International, 3Truth Initiative Schroeder Institute.
In the absence of comprehensive national action, more than 336 US state and local gov-
ernments have enacted sales restrictions on avored and/or menthol tobacco products
to protect vulnerable populations from tobacco-related harms. Our scoping review of
published research evaluating the eectiveness of local US laws restricting the sale of
avored and/or menthol tobacco products found moderate to high quality of evidence
associating policy implementation and reduced availability, marketing, and sales of pol-
icy-restricted products, and decreased youth and adult tobacco use of these products;
however, policy exclusions and exemptions, implementation challenges, tobacco industry
actions (e.g., marketing of concept-named products; exploitation of policy loopholes),
and consumer responses (e.g., cross-border or illicit purchasing) could mitigate intended
policy eects. Moreover, few studies have specically assessed the health equity im-
pacts of sales restrictions among population groups who disproportionately suer from
tobacco-related disease and death, such as Black Americans, persons identifying as
LGBTQ, and youth/young adults. Studies that have investigated health equity impacts
reveal for example, that: (a) the rationale for menthol tobacco sales restrictions was not
well-understood or universally supported by African American smokers in Minneapolis
and St. Paul, MN; (b) compared to White, non-Hispanic youth, Black, Hispanic, Asian,
and LGBTQ youth in various California localities with avor policies reported greater
diculty in accessing policy-restricted avored tobacco products; and (c) Black young
adults in San Francisco were more likely than other young adults to continue using
avored cigars after implementation of the avored and menthol sales restriction in
that city. Our review highlights the need for rigorously designed process and outcome
evaluation studies of avor policies that could inform improvements in policy scope and
implementation and address persistent health inequities exacerbated by the ubiquitous
availability and target marketing of avored and menthol tobacco products.
FUNDING: Nonprot grant funding entity
7
2022 Symposia
SYM6-2
WHAT DOES IT TAKE TO EMBED AN ANTI-RACISM LENS INTO
LOCAL POLICY RESTRICTING MENTHOL CIGARETTE SALES IN
LOS ANGELES COUNTY’S UNINCORPORATED COMMUNITIES?
Sabrina Lynn Smiley, PhD1, Jane Steinberg2. 1San Diego State University, 2Department
of Population and Public Health Sciences, Keck School of Medicine, Un.
Background: Menthol as a characterizing avor in cigarettes is a challenge to health
equity and racial justice. On 9/24/2019, the County of Los Angeles Board of Super-
visors approved a county ordinance restricting sales of menthol cigarettes and other
avored tobacco products in unincorporated areas, eective 5/1/2020. The Black
community must be engaged in tobacco control policies to promote health equity and
anti-racism. Methods: In 12/2020, a virtual community forum was held with approxi-
mately 100 stakeholders in Los Angeles County’s Black community. This forum, part
of an academic-community partnership, was a rst step at connecting tobacco-related
disparities, present-day inequities, and structural racism, to implications for support of
the menthol cigarette restriction ordinance. Results: We found stakeholders perceived
the ordinance through a historical and cultural lens incorporating knowledge of past and
present structural racism. This knowledge included awareness of Los Angeles County’s
history of anti-Blackness. Further, these understandings were linked to the history of
redlining and racialized segregation in Los Angeles County, driving present-day inequi-
ties, including a high density of tobacco and alcohol stores, and gentrication. Aspects
of structural racism inuenced perceptions of the ordinance in ve main ways: 1) via
the extent to which menthol cigarette smoking was experienced as institutionalized, and
normative; 2) distrust of public institutions to protect community health; 3) perceptions
that retailers in predominantly Black neighborhoods are excluded from the community
engagement process; 4) an over-emphasis on menthol cigarettes compared to other
structural issues facing Black Angelenos; and 5) counteracting the tobacco industry’s
race-based marketing. Conclusion: Community buy-in is critical to eective policymaking.
Engaging stakeholders in Los Angeles County’s Black community in tobacco control
policies to promote health equity, can start to change the conversation from one about
racial dierence, to one about dierential impact because of structural racism and
solutions that target these structural drivers.
FUNDING: State
SYM6-3
SUPPORT FOR AND BARRIERS TO PASSING AND
IMPLEMENTING COMPREHENSIVE BANS ON THE SALE OF
FLAVORED TOBACCO PRODUCTS (INCLUDING MENTHOL
CIGARETTES)
Sherry Emery, PhD1, Yoonsang Kim1, Barbara Schillo2, Phil Gardiner3. 1NORC at the
University of Chicago, 2Truth Initiative, 3African American Tobacco Control Leadership
Council.
In April 2021, the FDA announced its intention to ban menthol tobacco products,
including menthol cigarettes. Before the FDA can enact this ban, it must navigate a
lengthy process of soliciting public comments and extensive rule development. The
tobacco industry is already replicating its historically aggressive eorts to oppose the
federal menthol ban, and frame bans on menthol tobacco as discriminatory. Thus, it is
important to understand public opinion, including support for, and barriers to passing
and implementing, comprehensive bans on the sale of menthol tobacco. It is particularly
important to gain insight into whether there are dierences in support or opposition to
such policies by race/ethnicity, in light of the anticipated industry opposition, which
may be particularly resonant to the public in the context of the growing prominence
of social justice movements in the United States and related concerns around racism,
policing and white supremacy. In early 2021, we conducted nationally representative
surveys of 1,227 youth and 2,642 young adults, over-sampling for respondents who
were African-American, LatinX, and tobacco users. The surveys asked questions about
opinions of bans on avored tobacco products and menthol cigarettes. Over 70% of
youth and young adults supported a comprehensive ban on the sale of avored tobac-
co, with no dierence by race/ethnicity. A minority of youth and young adults reported
concern about increased policing of users related to avored vape product or bans of
menthol tobacco products. Fewer than 20% of youth or young adults agreed with the
statement that tobacco use is a social justice issue, with no dierences by race/ethnicity.
Findings suggest that prior to FDA’s policy announcement, there was broad support for
comprehensive avored tobacco product bans, including menthol cigarettes. It will be
important to monitor public support for these bans as the tobacco industry intensies
its public campaign to oppose them. The relatively low percentage of respondents who
recognized tobacco use as a social justice issue suggests an opportunity for message
framing to bolster support for a ban on menthol products.
FUNDING: Nonprot grant funding entity
SYM6-4
EXAMINING THE RELATIONSHIP OF FLAVORED TOBACCO
PRODUCT POLICY RESTRICTIONS AND TOBACCO PRODUCT
USE, AMONG A NATIONALLY REPRESENTATIVE SAMPLE OF US
ADOLESCENTS AND YOUNG ADULTS
Minal Patel, PhD, MPH1, Elexis C. Kierstead1, Michael Liu1, Barbara Schillo1, Shyanika
W. Rose2. 1Schroeder Institute, Truth Initiative, 2University of Kentucky.
Background: Flavored tobacco products (FTPs) are related to youth initiation and
progression to regular use and are disproportionately used and marketed in Black
communities. Federal regulation of FTPs is lacking and local action has created a het-
erogeneous policy landscape of varying comprehensiveness. This study examines the
relationship between exposure to local avor policies and any tobacco product (ATP)
use or FTP use among youth and young adults in the U.S. Little is known about equity
implications of such policies.Methods: Participants aged 15-36 (n=10,893) were surveyed
from Sept-Dec 2019 using a national, address- and probability-based sampling method.
Participants reported tobacco use, demographics, and psychosocial measures. Local
avor policies enacted as of 12/31/2019 were coded for comprehensiveness, geocoded,
and linked to participant address. Estimates from 2016 5-year American Community
Survey characterized county demographics. State-level policies, including smoke-free
air, Tobacco 21, and cigarette tax were included. Weighted cross-sectional multivari-
able logistic regression examined residence in an area covered by a comprehensive,
non-comprehensive, or no avor policy with current ATP or FTP use, controlling for
individual and county-level demographics, individual psychosocial variables, and state
policies.Results: Those covered by a comprehensive avor policy vs. no policy had lower
odds of ATP use (aOR=0.48, 95% CI=0.37-0.63) and FTP use (aOR=0.58, CI=0.37-0.93).
Participants covered by non-comprehensive policies vs. no policy had lower odds of ATP
use (aOR=0.64, CI=0.44,0.92), but not FTP use. Individuals living in counties with more
Black residents had higher odds of FTP use.Conclusion: Exposure to a comprehensive
avor restriction policy among youth and young adults is associated with lower odds of
FTP use and ATP use, and non-comprehensive policies are associated with lower odds
of ATP use. Findings support the continued need to expand local avor policies and
examine their comprehensiveness to best reduce youth tobacco use. Comprehensive
policies restricting FTPs may be most benecial in areas with more Black residents.
FUNDING: Federal; Nonprot grant funding entity
SYM7-1
DEVELOPMENTAL AND SEX DIFFERENCES IN THE EFFECTS
OF JUUL E-CIGARETTES ON PLACE CONDITIONING AND
PRECIPITATED WITHDRAWAL
Jibran Y. Khokhar, Jude Frie, Ahmad Hassan, Karling R. Luciani, Chuyun Chen, Jaiden
N. Smith, Bryana L. Hallam. University of Guelph.
Aim: Adolescent nicotine exposure is a continued concern due to the growing use of
electronic cigarettes. Thus, the aim of the following research is to assess age- and sex-
dierences in nicotine vapour-associated reward and withdrawal. Methods: Experiment
1 - adult and adolescent rats (n = 5-7/group) were exposed to either nicotine (JUUL, 5%
nicotine) or vehicle (30:70 PG:VG) vapour using OpenVape for 10 minutes at 3 doses
(2, 4, or 8 minutes of active vapour pus) in a biased conditioned place preference
task. Experiment 2 - adult and adolescent rats of both sexes (n = 7-8/group) were ex-
posed to either JUUL or vehicle vapour for 10 minutes 3 times a day for 2 weeks. Rats
received 1.5 mg/kg mecamylamine and were scored for somatic signs of withdrawal
20 minutes later. Results: Experiment 1 - A signicant eect of age, dose, and sex, as
well as a signicant dose by sex interaction were observed. Both adult and adolescent
male rats showed signicant increases in place preference for the nicotine-paired side,
with adolescents displaying signicant increases at lower doses than adults. Adult, but
not adolescent, females showed signicant place conditioning similar to adult males.
Experiment 2 - A signicant eect of treatment and sex on locomotion was also seen,
with males also showing increased locomotion and females showing no eect. There
was also a signicant eect of treatment and sex but not age on somatic withdrawal, with
8
2022 Symposia
only males showing signicant precipitated nicotine withdrawal. Conclusions: Our results
support the notion that adolescence is a period that is more sensitive to the rewarding
eects of, but not withdrawal from, nicotine, and that these eects are sex dependent.
FUNDING: Federal
SYM7-2
SEX-SPECIFIC EFFECTS OF TOBACCO/ENDS FLAVORANTS ON
REINFORCEMENT-RELATED BEHAVIOR IN A RODENT MODEL OF
VAPOR SELF-ADMINISTRATION
Skylar Y. Cooper, Montana Richardson, Brandon J. Henderson. Marshall University.
SignicanceAn estimated 12 million Americans use ENDS, with ~5 million users between
the ages of 12 and 18. Adolescent ENDS use continues to rise likely due to the 15,000+
unique avor options available as opposed to the lone avor in combustible cigarettes
(menthol). Given the dramatic rise in vaping, it is critical we determine the impact of
ENDS avorants on nAChRs in addiction-related brain circuitry. MethodsWe utilized
vapor self-administration assays with male and female mice (genetically modied to
contain uorescent a4 and a6 nAChRs) to study how green apple avor (composed of
hexyl acetate, ethyl acetate, and methylbutyl acetate) alters vaping-related behaviors.
Mice were trained to self-administer on xed-ratio 1 (FR1) and FR3 schedules to measure
acquisition and reinforcement-related behaviors. Alongside self-administration assays,
an additional cohort of mice were subjected to 10-day passive exposure of the green
apple mix and brains were extracted to determine changes in nAChR density using
confocal microscopy. Statistical dierences were determined using one- and two-way
ANOVAs with post hoc Tukey means comparisons. ResultsWe observed that male mice
were selective in their preference for their preference of green apple avorants while
female mice exhibited reward-related behavior to all green apple avorants. We also
observed that green apple-induced nAChR upregulation occurs in a region-specic
manner dependent upon sex. ConclusionsThese data support continued investigations
into sex-specic eects of vaping-related behaviors. These data also exemplify that
there may be neurobiological underpinnings that determine sex/gender-specic eects
of chemical avorants on reward- and reinforcement-related behaviors.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
SYM7-3
DEVELOPMENTAL EXPOSURE TO E-CIGARETTE NICOTINE OR
THC VAPE ALTERS CESSATION THERAPEUTIC EFFECTIVENESS
IN RATS
Yen-Chu Chen, James P. Fowler, Samantha Cheeks, Angeline J. Dukes, Jesus M.
Campos, Stephen V. Mahler, Christie D. Fowler, PhD. University of California Irvine.
Signicance: Developmental exposure to substances of abuse may alter brain neuro-
maturation into adulthood. Further, given that individuals often co-use nicotine and THC,
these substances may interact independently or synergistically on neurodevelopmental
processes. Thus, these studies sought to investigate whether adolescent vape drug
exposure alters nicotine self-administration in adulthood, and the eectiveness of the
rst-line therapeutics, varenicline and bupropion.Methods: Male and female rats were
exposed to vaporized vehicle, nicotine, and/or THC during adolescence (postnatal days
38-49). In adulthood, subjects were trained to operantly respond on an active lever to
receive food pellets. Subsequently, catheters were intravenously implanted in the right
jugular vein, and following a recovery period, rats were given access to self-administer
nicotine. Following acquisition of intravenous nicotine self-administration across 10
days, subjects were pretreated with varenicline (0, 1 or 3 mg/kg) in a within-subject
Latin square design, with >2 baseline days in between each dose. After re-baselining
again, rats were then treated chronically with the low dose of varenicline, followed by a
low dose of both varenicline and bupropion. Results: We found that all treatment groups
acquired operant food training similarly, and subjects self-administered intravenous
nicotine during adulthood. The acute, low dose of varenicline was largely ineective in
attenuating nicotine intake, whereas the higher dose was more eective. Interestingly, the
level of varenicline’s eectiveness varied based on adolescent drug exposure and sex.
Furthermore, chronic treatment with varenicline or varenicline/bupropion was eective
in decreasing nicotine intake in the control group, whereas subjects with adolescent
nicotine, THC or nicotine/THC vape exposure did not exhibit such pronounced benets
from chronic administration.Conclusions: Taken together, these ndings suggest that ad-
olescent nicotine and/or THC exposure induces long-lasting neurodevelopmental eects,
which leads to individual dierences in the eectiveness of therapeutics in adulthood.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
SYM7-4
NICOTINE SELF-ADMINISTRATION ACTIVATES ACCUMBENS
MICROGLIA IN A SEX-SPECIFIC FASHION
Emma O. Bondy, Shailesh Khatri, Erin Maher, Cassandra D. Gipson. University of
Kentucky, KY, USA.
Clinical literature indicates that women have more diculty maintaining smoking ces-
sation than men. Further, drugs of abuse can elicit neuroimmune responses including
activation of microglia, and neuroimmune processes can be sexually dimorphic. We
have previously found evidence that nucleus accumbens core (NAcore) microglia may
be activated following chronic nicotine self-administration, as we found elevations in
the microglial marker CD40. However, NAcore microglial morphology has not yet been
characterized after nicotine, and sex-specic neuroimmune mechanisms of nicotine
consumption have not yet been examined. Methods: In the current study, male and
female Long-Evans rats underwent nicotine (0.06 mg/kg/infusion) or saline self-ad-
ministration at a xed-ratio (FR)-1 schedule of reinforcement. Following a minimum of
20 sessions (or until acquisition criteria were met for nicotine animals), NAcore brain
tissue was then extracted and prepared for Iba1 immunohistochemistry and confocal
microscopy. NAcore microglia morphology was then quantied using fully automated
analyses from 3-D images (3D Morph) following nicotine self-administration in both
sexes.Results: We found that while both sexes acquired nicotine self-administration,
males consumed signicantly higher amounts of nicotine across sessions as compared
to females (p<0.05). In females, we found that the percent of brain volume surveyed
by microglia, number of endpoints, and territorial volume were all decreased following
nicotine self-administration as compared to saline (p’s<0.05). Further, sex-specic pat-
terns of microglia activation emerged whereby females displayed greater activation of
NAcore microglia as compared to males (p<0.05). Conclusions: These results indicate
that despite lower total nicotine consumption in females as compared to males, females
are more susceptible to microglial activation within the NAcore following chronic nicotine
consumption. Ongoing studies are utilizing CX3CR1-cre transgenic rats to determine
if chemogenetic activation or inhibition of microglia controls nicotine seeking and ac-
cumbens glutamate plasticity.
FUNDING: Federal; State; Academic Institution
SYM8-1
“TOBACCO FREE NICOTINE” E-CIGARETTE PRODUCTS SOLD
ONLINE
Grace Kong, PhD. Yale University School of Medicine.
Introduction: E-cigarette products that claim that they contain “tobacco free nicotine
(TFN)” or “synthetic nicotine” have entered the U.S. market and they pose a unique
regulatory challenge for the U.S. FDA because the manufacturers claim that TFN nicotine
is not derived from tobacco, and therefore not under the FDA’s jurisdiction. We aimed
to develop a better understanding of the characteristics of these products that are sold
on popular e-cigarette online retailers. Methods: To identify popular online e-cigarette
retailers, we searched for terms related to e-cigarette online shops (e.g., “online vape
store,” “buy vape online”) on Google and obtained a list of URLs on the rst 5 pages
of each search term. We then used Alexa.com to conrm their online popularity and
visited each website to determine that the online retailers were based in the U.S., did
not have a physical shop, and were not limited to only selling e-liquids. On each of the
included websites, we searched for “tobacco free nicotine” and “synthetic nicotine” and
assessed the type of TFN e-cigarette products, avors, nicotine concentration, and mar-
keting claims.Results: All 22 online retailers sold e-cigarette products that they claimed
contained TFN. We identied 12 brands that sold TFN e-liquids, 11 brands that sold TFN
disposable devices, 1 brand that sold TFN e-liquids and disposable devices, 1 brand
that sold TFN e-liquids and closed cartridge pod devices, and 1 brand that sold TFN
closed cartridge pod device. TFN nicotine was available in both freebase and nicotine
salt with a range of nicotine concentrations (0-50mg/ml) and avors (fruit, candy, dessert,
coee, vanilla, menthol, “ice,” and tobacco). The TFN brand/retailer websites claimed
that TFN was cleaner, purer, higher quality, tastier, and represented a “sophisticated
vaping experience.” Discussion: Our results indicate that popular online retail websites
are marketing and selling a variety of TFN e-cigarette products from dierent e-cigarette
manufacturers, and using marketing claims that suggest that they are superior to other
brands. The FDA must exert its regulatory authority on TFN to protect public health.
FUNDING: Federal
9
2022 Symposia
SYM8-2
SYNTHETIC NICOTINE: EMERGENCE, CHEMISTRY AND HEALTH
RISK
Nuan Ping Cheah, PhD. Health Sciences Authority, Singapore.
Objective: Naturally extracted nicotine has been used throughout the world for many
centuries. The psychoactive eects of nicotine are largely attributable to (S)-nicotine,
the predominant form that occurs in tobacco plants. Recently, synthetic nicotine, often
containing equal parts (S)-nicotine and (R)-nicotine, has emerged as an alternative
nicotine source, raising potential health and regulatory concerns. Several published pat-
ents describe processes to derive synthetic nicotine that have been adopted to produce
nicotine in bulk industrial settings. This presentation will provide an overview of nicotine
chemistry and discuss currently available processes for (a) producing synthetic nicotine
and (b) testing products to determine whether nicotine is synthetic or tobacco-derived.
Method: Databases of led and active patents (Google Patents, Espacenet, Patent-
scope, Freepatentsonline.com, and USPTO Web Patent Databases) were searched
using keywords relating to synthetic nicotine. Separately, Web of Science and Scopus
databases were searched for published articles on methodologies for distinguishing
synthetic and tobacco-derived nicotine.Findings: Technical knowledge as expressed by
patent lings is developing rapidly, with companies around the world having led patents
for nearly two dozen methods of producing, preparing, and/or rening synthetic nicotine.
Additionally, scientic publications (n=8 as of July 2021) describe several available
methodologies for analysing and quantifying the dierent forms of nicotine, including
chromatographic and mass spectrometric techniques.Conclusion: There is an urgent
need to better understand the pharmacology and toxicology of synthetic nicotine and
how it aects human health. Particularly if the use of synthetic nicotine can be used to
evade tobacco control laws, the production of synthetic nicotine will continue to rise as
technology improves and costs decline. Methodologies for testing for the presence of
synthetic nicotine (or the absence of tobacco-derived nicotine) have been developed,
but there is currently no internationally validated method to test whether nicotine is
synthetic or tobacco-derived.
FUNDING: Federal; Other
SYM8-3
EFFECTS OF A “TOBACCO-FREE NICOTINE” CLAIM ON
PERCEPTIONS OF PUFF BAR E-CIGARETTE USE AMONG
YOUNG ADULTS
Julia Cen Chen-Sankey, PhD, MPP. Rutgers Biomedical and Health Sciences.
Introduction. Pu Bar disposable e-cigarettes are now marketed with a “tobacco-free
nicotine”claim. We assessed the eect of this claim on non-tobacco-using young adults’
perceptions ofand intentions of using Pu Bar.Methods. We embedded a randomized
between-subjects experiment into a web-based survey administered among young
adults (n=1,390; ages 18-29) who were never tobacco users or infrequent tobacco ex-
perimenters. Participants viewed depictions of Pu Bar products with the claims that the
products contain “tobacco-free nicotine” (experimental group; n=697) or simply “nicotine”
(control group; n=693). Multivariable regressions were used to assess the associations
between experimental conditions and Pu Bar use intentions, harm perceptions, use
expectancies, and perceived relative use of Pu Bar vs. other e-cigarettes, controlling
for participant characteristics. Results. Compared to the control group, the experimental
group who saw the “tobacco-freenicotine” claim reported higher intentions of using Pu
Bar (adjusted relative risk=1.19, p<0.001). The experimental group had a lower likelihood
of perceiving Pu Bar use as “extremely or very harmful” (adjusted odds ratio=0.63,
p<0.001) and “strongly or somewhat” agreeing with the negative expectancy of using
Pu Bar (adjusted odds ratio=0.67, p<0.001). Additionally, the experimental group
reported being “much more or more likely” to use Pu Bar over other e-cigarettes (ad-
justed odds ratio =1.67, p<0.001).Discussion. Among young adult never tobacco users
and infrequent experimenters, Pu Bar’s “tobacco-free nicotine” claim may increase
positive expectancy and reduce negative expectancy and harm perceptions towards
using Pu Bars. The claim may also increase the likelihood for this group to initiate or
use e-cigarettes with Pu Bar products rather than other brands or types of e-cigarettes.
These ndings are concerning given little is known about the population health eects
of tobacco-free nicotine. This study can inform regulators about the potential eect of
“tobacco-free nicotine” claims on tobacco product perceptions.
FUNDING: Federal
SYM8-4
SYNTHETIC NICOTINE: LEGAL AND REGULATORY
CONSIDERATIONS
Micah L. Berman, JD. The Ohio State University.
Background: Pu Bar, a disposable e-cigarette company, withdrew from the US mar-
ket in July 2020 after receiving a warning letter from the FDA. It then restarted its US
marketing in early 2021, claiming it was using synthetic nicotine and was therefore
exempt from FDA regulation. Pu Bar is one of several recent examples of companies
seeking to prot from a lack of (or uncertainty about) synthetic nicotine regulation. This
presentation will examine the regulatory status of synthetic nicotine in countries around
the world and discuss key regulatory challenges.Methods: In June 2021, national
laws contained in the Tobacco Control Law database (tobaccocontrollaws.org) were
examined to determine whether the operative denitions included in the laws covered
synthetic nicotine products. Based on this review, countries were categorized based
on whether synthetic nicotine was (a) subject to regulation under some or all tobacco
control laws, (b) not subject to regulation, or (c) prohibited from sale. Separately, the
Tobacco Watcher tool (tobaccowatcher.globaltobaccocontrol.org) was used to search for
news articles indicating public discussion of synthetic nicotine.Results: Existing national
laws dier substantially in their treatment of synthetic nicotine. Some countries have
recently amended their tobacco control laws to extend their reach to synthetic nicotine
products (e.g., Russia, Kazakhstan). Other countries already had broad denitions
within their tobacco control laws that appear to cover synthetic nicotine products or
ban their sale (e.g., Estonia, Brazil). In countries with tobacco control laws that do not
currently cover synthetic nicotine (e.g., Kenya, South Korea, United States), there is
active public discussion about tax evasion and other regulatory challenges.Conclusion:
Problems stemming from allowing synthetic nicotine products to remain unregulated
might include false and misleading health claims, consumer confusion, tax avoidance,
and marketing to youth. In countries where a regulatory gap for synthetic nicotine exists,
governments may consider amending tobacco control laws to ensure that synthetic
nicotine products fall within their scope.
SYM9-1
CONVENIENCE STORE, PHARMACY, OR VAPE SHOP? HOW
THE DISTRIBUTION OF TOBACCO RETAILER TYPE VARIES BY
COMMUNITY CHARACTERISTICS
Megan E. Roberts, PhD, Claire F. Jenkins, Elizabeth L. Schwartz, Nathaniel J. Onnen,
Peter F. Craigmile. The Ohio State University.
Signicance: There is substantial research indicating tobacco retailer density is greater
in vulnerable neighborhoods (ie, those with high poverty, rurality, or a high prevalence
of racial/ethnic minorities). Despite sound research on tobacco retailers overall, how-
ever, little is known about how specic types of tobacco retailers vary by community
characteristics.Methods: We rst obtained data on all tobacco retailers (N=11,392) for
the state of Ohio, a large state with diverse communities. We then geocoded retailer
addresses and used spatial statistical methods to establish current disparities in retailer
density. We next coded all tobacco retailers for store type category (convenience store,
grocery store, pharmacy, etc.). In addition, all Ohio neighborhoods were coded at the
census tract level for 3 characteristics: poverty (high or low), prevalence of racial/ethnic
minorities (high or low), and urban, suburban, or rural status. Finally, to assess whether
tobacco retailer type varied by community characteristics, we ran a series of analyses
(controlling for false discovery rate) to determine whether the prevalence of a particular
retailer type varied by a particular neighborhood type.Results: For all neighborhoods,
convenience stores were the most common type of retailer selling tobacco. Yet the prev-
alence of convenience stores was higher in high-poverty urban neighborhoods than in
low-poverty urban neighborhoods. For the second-most common type of tobacco retailer
overall, discount stores, rural neighborhoods and high-minority urban neighborhoods
had among the highest prevalence. Grocery stores, pharmacies, and vape/hookah
shops generally had the highest prevalence in low-risk neighborhoods.Conclusion: Our
ndings demonstrate that the distribution of specic retailer types varies by community.
This presentation will discuss how the distribution of retailer types has implications for
product availability and price, which may subsequently impact tobacco use and ces-
sation. Novel tobacco control policies that target retailer type will also be discussed in
terms of their impact for the population overall and vulnerable populations in particular.
FUNDING: Federal
10
2022 Symposia
SYM9-2
PATTERNS OF TOBACCO RETAILER ATTRITION BY STORE TYPE
AND NEIGHBORHOOD CHARACTERISTICS IN NEW YORK CITY
Daniel P. Giovenco, PhD, MPH, Torra E. Spillane, Rachel M. Maggi. Columbia Univer-
sity Mailman School of Public Health.
SIGNIFICANCE: In 2018, New York City enacted a policy intervention to gradually
reduce the number of tobacco retailers by half across city districts. No new tobacco
retail licenses will be granted until the number falls below the 50% cap via license
attrition. This study examines patterns of and reasons for license loss in the borough
of Manhattan 2 years after policy enactment. METHODS: A longitudinal, geocoded
database of active tobacco retail licenses in Manhattan was merged with municipal
data on license surrenders, suspensions, and revocations to identify retailers that lost
their tobacco license between 2018-2019. Descriptive statistics highlighted dierenc-
es in attrition patterns by store type (categorized using historical Google Street View
imagery) and neighborhood demographic characteristics.RESULTS: Among retailers
active after policy enactment (n=2,051), 12.4% (n=254) lost their tobacco license by
the end of 2019. The vast majority of these retailers were independent convenience
stores (64.2%), followed by grocery stores (7.1%), newsstands (7.1%), and smoke/vape
shops (5.1%). License loss was more common among retailers in neighborhoods with
greater proportions of Hispanic/Latinx residents and lower median household income.
The most common reasons for attrition were license expiration/non-renewal (54.7%),
revocation (28%), surrender (8.7%), and suspension (8.7%). “Punitive” reasons for
license loss (i.e., revocation, suspension) were more common in neighborhoods with
greater proportions of non-Hispanic Black and Hispanic/Latinx residents, as well as lower
median household income.CONCLUSION: NYC’s tobacco retailer density reduction
initiative will likely help minimize persistent disparities in the tobacco retail environment,
although its mechanisms may reect economic and social inequities faced by certain
communities. This presentation will discuss how dierences in attrition patterns by store
type and neighborhood characteristics may ultimately shape the tobacco marketplace
and consumer behavior.
FUNDING: Federal
SYM9-3
DOCUMENTING THE IMPACT POTENTIAL OF A MENTHOL
CIGARETTE BAN AT POINT-OF-SALE: A PHOTOGRAPH-BASED
ANALYSIS OF THE PRESENCE AND PLACEMENT OF MENTHOL
VERSUS REGULAR CIGARETTE PACKS ON THE SHELVES OF
TOBACCO RETAIL OUTLETS IN NEW YORK CITY
Thomas R. Kirchner, PhD, Alexandra Guttentag, Avigail Vantu, Diana R. Silver. New
York University School of Global Public Health.
Signicance: This project investigated the use of novel methods for monitoring pow-
er-walls and other promotional shelf-spaces within tobacco retail outlets (TROs) across
New York City (NYC). Results provide a baseline against which comparisons can be
made in the future if and when a ban on menthol cigarettes is implemented and enforced
within NYC. Methods: Photographic surveillance methods were employed to capture
the presence and proportionate amount of all visible cigarette packs on the shelves
inside N=160 TROs. A cluster-randomized TRO selection process produced an average
of 40.0 TROs per NYC borough (Range 38-45), with an average of 4.7 TROs in each
zip-code (N=34 zip-codes; Range: 4.5 – 4.9 TROs). Statistical analyses examined the
absolute and proportionate number of menthol packs in each TRO as a function of
NYC borough and zip-code boundaries, as well as population smoking rates derived
from the NYC Community Health Survey, and other demographic indicators from the
American Community Survey.Results: The total number of cigarette packs on the shelves
of each TRO and the proportion of menthol packs varied signicantly across TROs,
averaging about one quarter of all packs displayed (M=0.274; SD=0.15), or about 16.5
+/- 17.8 menthol packs per TRO (Range 13.4 – 20.2). Modeling results indicate that the
proportion of menthol packs displayed was signicantly greater in areas with elevated
population smoking rates (OR=1.03, CI:1.01-1.06) and density of TROs per 1,000 res-
idents (OR=1.23; CI:1.01-1.49), although these associations varied in complex ways
with the proportion living under the federal poverty level and the proportion under age
18 residing within each zip code. Conclusions: Results of this study demonstrate the
utility of photograph-based TRO audit methods for objective, reliable documentation of
the presence and proportionate amount of menthol versus other cigarette pack types on
TRO shelves, and highlight the need to account for sources of variation between small
areas when examining the TRO product landscape and evaluating the eectiveness of
regulatory actions against menthol.
FUNDING: Federal; Other
SYM9-4
RETAIL MARKETING OF MENTHOL CIGARETTES IN LOS
ANGELES, CALIFORNIA: A CHALLENGE TO HEALTH EQUITY
Sabrina L. Smiley, PhD, MPH1, Junhan Cho2, Kacie C. A. Blackman3, Tess Boley Cruz2,
Mary Ann Pentz2, Jonathan M. Samet4, Lourdes Baezconde-Garbanati2. 1San Diego
State University School of Public Health, 2University of Southern California, 3California
State University, Northridge, 4Colorado School of Public Health.
Signicance: Menthol cigarette sales continue to increase, accounting for a third of the
US cigarette market. Retail marketing of menthol cigarettes is a contributing factor to
tobacco-related health disparities. To inform regulation to address associated dispari-
ties, we examined retail marketing strategies for menthol cigarettes and their features
and characteristics in relation to neighborhood racial/ethnic composition.Methods: We
used multilevel regression models to examine associations of neighborhood racial/
ethnic composition and store type with menthol cigarette sales outcomes, including
availability, exterior advertising, price promotions, and price in a sample of tobacco
retailers (N=673) in Los Angeles County neighborhoods with a median or below-median
household income. We also recorded the prices of Newport (the highest selling menthol
cigarette brand in the US) and blu disposable menthol e-cigarettes.Results: Overall,
94.5% of retailers sold menthol cigarettes, 31.2% displayed menthol price promotions,
and 30.2% displayed at least one exterior menthol advertisement. Adjusting for racial/
ethnic zip code cluster and store type, stores located in predominantly African American
neighborhoods showed signicantly higher odds in the availability of Newport cigarettes
than stores in Hispanic neighborhoods (OR=0.21; 95% CI, 0.09–0.53; P=.001) or
non-Hispanic White (OR=0.12; 95% CI, 0.05–0.31; P<.001) neighborhoods. Stores
located in predominantly African American neighborhoods displayed signicantly higher
odds of having menthol price promotions and storefront advertisements than those in
Hispanic neighborhoods (OR=0.51; 95% CI, 0.30–0.88; P=.02 and OR=0.25; 95% CI,
0.13–0.48; P<.001, respectively).Conclusion: In 2016 and 2017, menthol cigarettes
were widely available in Los Angeles County across racial/ethnic neighborhoods. We
found a disproportionate number of storefront advertisements and price promotions for
menthol in stores located in predominantly African American neighborhoods along with
the lowest advertised pack price. This evidence supports tobacco control policies that
restrict menthol cigarette sales in the retail environment.
FUNDING: Federal; State
SYM10-1
LIFETIME BURDEN OF SMOKELESS TOBACCO IN INDIA,
PAKISTAN AND BANGLADESH
Kathryn Coyle, PhD, Subhash Pokhrel. Brunel University.
The large majority (85 percent) of the over 300 million users of smokeless tobacco
(ST) globally are in South and South-East Asia. ST has been associated with increased
risk of oral cancers, cardiovascular and cerebrovascular diseases and mortality. As
the evidence base for eective interventions is built, policymakers will be faced with
decisions regarding where the most impactful investments can be made. This is part
of a larger study investigating the return on investment (ROI) of ST interventions.To
facilitate assessment of ROI, the objective of this component is to estimate the lifetime
economic burden of ST use with respect to healthcare costs and health impacts in
India, Pakistan and Bangladesh.The study uses population data on ST use, disease
prevalence, mortality and the eects of ST combined with costs and disability impacts
of disease. A Markov model was developed to project uptake, quitting and relapse to
ST over the life course of 5 year sex-specic cohorts ranging from 15 to 19 up to 70 to
74 years, assuming no change in current ST policies, versus a scenario in which no ST
is consumed. Disability attributable life years (DALYs) and healthcare costs attributable
to ST were estimated with costs and eects discounted at 3 percent per annum.The
ST attributable costs are higher in the younger cohorts (under 50 years) as compared
with older cohorts, with peak costs generally occurring in middle age. For illustration,
costs for males aged 35 to 39 in India are US dollars 1.467 billion, versus 1.143 billion
for 20 to 24 year olds and US dollars 117 million for 45 to 49 year females, versus 347
million for 20 to 24 year olds. When disease burden is measured in DALYs, a similar
age cohort pattern is observed, with higher burden in younger ages and the peak burden
occurring in middle age cohorts.This study demonstrates the substantial reduction in
disease burden and reduction in healthcare costs that could be made through reducing
the use of ST in South-East Asia. There is a clear need for investment in ecacious
interventions aimed at reducing both ST uptake and improving quitting success.
FUNDING: Academic Institution; Nonprot grant funding entity
11
2022 Symposia
SYM10-2
SMOKELESS TOBACCO USE DURING PREGNANCY IN SOUTH-
EAST ASIA
Radha Shukla, MBBS. University of York.
Introduction: Smokeless tobacco (ST) use among women is common in the South-East
Asia Region (SEAR), possibly due to easy availability and socially acceptable behaviour.
However, very little is known about its use among pregnant women. We attempted to
understand the prevalence, relative risk ratios (RRR) of ST use among pregnant women
in SEAR, and further understand the inuence of family on ST use during pregnancy.
Methods: We used the Demographic and Health Surveys (2012-2016) data from 5
SEAR countries (India, Indonesia, Myanmar, Nepal and Timor-Leste) to estimate the
prevalence of ST use and compared its use among pregnant and non-pregnant women,
adjusted for education, socio-economic status, place of residence and age. We further
conducted in-depth qualitative interviews among pregnant women in India, who used
ST at any point during their pregnancy, to understand familial and community inuence
on ST use during pregnancy. Results: Based on the data of 34,762 pregnant women,
the prevalence of ST use was 0·45% (95%CI of 0·002-2·29), with highest prevalence
of 3·2% (95%CI of 2.94-3·5) in India and lowest of 0% in Myanmar and Timor-Leste.
The regression analysis had 783,588 observations, based on which pregnant women
were 7% more likely to use ST than non-pregnant women when compared to no tobacco
use (RRR 1·07, 95% CI of 1·02-1·12). The interviews revealed that ST use within the
household had inuenced women from a very young age. However, the study also
suggested a secret behaviour of women’s ST use within the family. Furthermore, while
some women increased their ST use in pregnancy, a few also attempted to reduce it,
orquit, based on the advice from family and lady health workers. Discussion: Addressing
ST use among women in SEAR is warranted and pregnancy is possibly an opportunity
for this. The secrecy within the family is contradictory to the perceived norms and
hence the normality towards a common and acceptable behaviour of ST use among
family members is possibly changing. Familial support, combined with cessation help
from lady health workers during pregnancy might help to reduce smokeless tobacco
use in pregnant women.
FUNDING: Academic Institution; Nonprot grant funding entity
SYM10-3
THE FEASIBILITY OF CONDUCTING A COHORT STUDY AMONG
SECONDARY SCHOOLCHILDREN IN BANGLADESH, INDIA AND
PAKISTAN
Catherine Jackson, PhD1, Romaina Iqbal2, Masuma Mishu3, Mona Kanaan3, Lu Han3,
Laraib Mazhar2, Ann McNeill4. 1Valid Research Ltd, 2Aga Khan University, 3University
of York, 4Kings College London.
ObjectivesTo assess the feasibility of conducting a cohort study among secondary
schoolchildren (aged 12-16 years) in urban and rural schools in Bangladesh, India
and Pakistan, to evaluate existing tobacco control policies on smokeless and smoked
tobacco uptake and use. Here we assess:1. the feasibility of selection, recruitment
and retention of schools and participants2. the feasibility, acceptability and compre-
hensibility of the study procedure/questionnaireMethods In 2019/2020, a multi-stage
stratied random sampling strategy was used to select 8 urban/rural schools within
each country and informed consent of headteachers, parents and students in relevant
schools/classes sought. Eligible students completed a written survey.Feasibility was
assessed using mixed methods comprising qualitative interviews and focus groups
with school sta and students in participating classes (objs 1-2), quantitative records
and qualitative eld notes from researchers (objs 1-2) and quantitative survey data (obj
3). Qualitative data analysed thematically using a modied Framework approach. We
assessed numbers approached, recruitment rates/timescales, reasons for ineligibility and
suggestions for improvement.ResultsOn average, it took 5 months to secure approvals
from authorities to approach schools and then ~38 days to secure school consent. 80%
of schools approached agreed to participate. Exclusions included insucient students
or exam clashes. One school felt study inappropriate, given SLT use was not socially
acceptable for girls. Parental consent was achieved from 65.4% of consent forms given
out. Seeking parental consent (via students) was time consuming and sta suggested
holding a parents’ brieng, taking their consent simultaneously.Student assent was
95.1% of those with parental consent. Questionnaires were typically completed in
lessons taking ~70 minutes (SD: 32.5). Sta and students felt this was too long with
many unfamiliar terms used.Interviewees perceived study raised awareness of tobacco
health risks.DiscussionStudy was feasible, with suggestions for improving recruitment
and consent processes.
FUNDING: Academic Institution; Nonprot grant funding entity
SYM10-4
COMPLIANCE OF SMOKELESS TOBACCO PRODUCTS WITH
TOBACCO CONTROL REGULATIONS IN BANGLADESH, INDIA
AND PAKISTAN
Zohaib Khan, PhD1, Abdullah Sonnet2, Rumana Huque2, Mona Kanaan3, Safat Ullah1,
Suneela Garg4, Chetana Deshmukh4, Amod Borle4, Mongjam Meghachandra Singh4,
Kamran Siddiqi3. 1Khyber Medical University, 2Dhaka University, 3University of York,
4MAMC.
IntroductionOver 350 million people in South Asia use smokeless tobacco (ST) products,
yet there is very little evidence on illicit ST trade in the region. The primary objective of
our study was to assess the compliance of ST products collected from local markets in
Bangladesh, India, and Pakistan with the relevant national regulations in these countries,
rendering them illicit or otherwise.MethodsWe collected unique ST packs from local
sellers in two purposively selected districts in each of Bangladesh, India, and Pakistan
using established tobacco packs sample collection methods. Based on the relevant
national laws and guidance from the World Health Organization’s Framework Convention
on Tobacco Control, denitions of illicit ST products were agreed upon by the research
teams apriori. The parameters on which the packaging was assessed included “Market
Retail Price Disclosure”, “Pictorial Health Warning (PHW)”, “Textual Health Warning” and
“Use of Misleading Descriptors (MD)”. ResultsAlmost all ST products that were collected
in the three countries were illicit. The most common non-compliant feature of illicit ST
packs was the lack of appropriate health warnings. Around 84% of packs in Bangladesh,
93% of that in India, and 100% in Pakistan had no PHW or the size of PHW was not in
compliance with national requirements. 61% of the packs carried MD in Bangladesh.
In India and Pakistan the proportion of such packs was 32% and 42%, respectively.
ConclusionPoor enforcement and in some cases, a virtual absence of ST control
policies, are slowing the progress of and weakening the impact of ST control in South
Asia. Improving compliance and reducing the sale of cheap and illicit products require
formalising the market through business licensing and operational market monitoring.
FUNDING: Academic Institution; Nonprot grant funding entity
SYM11-1
INCREASING CANNABIS USE AND CANNABIS USE DISORDER
AMONG US INDIVIDUALS WHO SMOKE CIGARETTES, 2004-2017:
IMPACT OF CANNABIS LEGALIZATION
Renee D. Goodwin, PhD, MPH1, Katarzyna Wyka2, Andrea Weinberger3. 1City Univer-
sity of New York and Columbia University, 2City University of New York, 3Yeshiva Univer-
sity.
Cannabis legalization and increases in use are occurring rapidly in the US. Cannabis use
and cannabis use disorder (CUD) are two to three times more common among those who
smoke cigarettes, compared with those who do not. It is not clear whether legalization
of cannabis will dierentially aect cannabis use and CUD by cigarette smoking status.
As CUD among smokers is associated with lower quit rates, understanding the degree
to which legalization may be dierentially increasing among those who use cigarettes
is critical to inform tobacco control eorts. The goal of this study was to estimate
changes in the prevalence of cannabis use, daily use and CUD among individuals who
use cigarettes, relative to those who do not, to examine whether state-level cannabis
policy modies these trends from 2004 to 2017.Public and restricted-use data from
the 2004 to 2017 National Survey on Drug Use and Health, an annual cross-sectional,
nationally representative survey of US individuals, were analyzed. The prevalence of
past-30-day cannabis use, daily cannabis use and cannabis use disorder by cigarette
use status in 2017 was estimated among respondents ages =12 by sociodemographic
characteristics and state-level cannabis policy. Weighted logistic regressions with con-
tinuous year as the predictor for the linear time trend were used to examine the time
trends in cannabis use, daily use and CUD by cigarette use and cannabis law status
from 2004 to 2017.Cannabis use, daily use and CUD are substantially more common
among those who use cigarettes, and even greater in states where cannabis is legal
for medical or recreational use. Cannabis use and daily use increased signicantly over
this 13-year period, overall, and among all groups. Cannabis use, daily use and CUD
were consistently 2-10x more common among those who use cigarettes, compared
with those who do not smoke. Cannabis use and CUD are increasing among daily and
non-daily cigarette smokers, particularly among those living in states where recreational
use of cannabis is legal. Given that CUD may impede successful smoking cessation,
tobacco control eorts should address this disproportionate increase among smokers.
FUNDING: Federal
12
2022 Symposia
SYM11-2
ASSOCIATIONS BETWEEN INTENSITY AND TYPES OF TOBACCO
AND CANNABIS CO-USE ON THE SAME DAY AMONG YOUNG
ADULT SMOKERS
Nhung Nguyen, PhD1, Johannes Thrul2, Torsten B. Neilands1, Pamela Ling1. 1Univer-
sity of California, San Francisco, 2John Hopkins University.
Background: Co-use of tobacco and cannabis is common among young adults, but little
is known about associations between use of both substances within a day, which may
result in greater extent of co-use and addiction.Objectives: We examined the associ-
ations between intensity and types of tobacco and cannabis co-use on the same day.
Methods: A smartphone-based study collected 2,891 daily assessments on substance
use among 147 young adult smokers (aged 18-26; 51.7% female) during a 30-day period.
Mixed models examined day-level associations between the intensity (i.e., number of
times) and types (i.e., combustible, vaporized, and edible cannabis) of cannabis use
and the outcomes (i.e., number of cigarettes or cigars smoked, and number of times
vaping e-cigarettes), controlling for demographics, alcohol use, and time eects.Results:
Same-day co-use of tobacco and cannabis was reported in 989 daily assessments
(34.2%). Participants reported a greater intensity of cigarette (ß=0.09; 95%CI=0.05,
0.13), e-cigarette (ß=0.03, 95%CI=0.00, 0.06), and cigarillo use (ß=0.08, 95%CI=0.06,
0.09) on days they used more cannabis. Participants reported a greater intensity of
e-cigarette use on days they vaped cannabis compared to days they did not (ß=0.35;
95%CI=0.24, 0.46). Older participants reported a greater intensity of cigarette smoking
(ß=0.10; 95%CI=0.03, 0.16), while LGBTQ+ participants reported a greater intensity of
e-cigarette vaping (ß=0.34; 95%CI=0.05, 0.62).Conclusion: Findings indicated positive
associations between intensity of tobacco and cannabis co-use within a day, particularly
e-cigarettes and vaporized cannabis. Impact of same day co-use on addiction and
preventive interventions should be addressed in future research.
FUNDING: State
SYM11-3
DAYS OF CANNABIS USE AND SMOKING CESSATION
TREATMENT OUTCOMES: NONE IS BETTER, MORE IS WORSE
Christine E. Sheer, PhD1, Alina Shevorykin1, Ellen Carl1, Renee Goodwin2, Alan
Budney3, Cheryl Rivard1, Andrew Hyland1. 1Roswell Park Cancer Insittute, 2City Univer-
sity of New York, 3Dartmouth.
As the prevalence of cannabis use increases, evidence is accumulating about the
impact of cannabis use on cigarette smoking cessation. Quitlines comprise the largest
and most accessible network of smoking cessation treatment services in the US, but
little is known about how cannabis use impacts tobacco treatment outcomes among
quitline participants. This study examined the dose-response relation between days
of cannabis use and the probability of long-term abstinence after smoking cessation
treatment provided by New York State Smokers’ Quitline. Past 30 day cannabis use and
desire to reduce or stop cannabis use was assessed during routine intake assessment
from May 2018-June 2020. Participants received coaching and nicotine replacement
and provided 7-day point prevalence abstinence outcomes 7 months after intake.
Signicance testing examined characteristic dierences between cannabis users and
non-users. Generalized linear modeling (GLM) was used to examine the eect of days
of cannabis use on abstinence outcomes. Probit analysis was used to examine the
relation between days of cannabis use (dose) and abstinence outcomes (response).
Cannabis users comprised 7% (n=284) of the sample (n=4,225); were about 6 yrs
younger than non-cannabis users (51 (SD 14) vs 57 (SD 13), p<.01); were more likely
to be male (55% vs 49%, p=.03) and to live with other cigarette smokers (37% vs 27%,
p<.01); 51.4% of cannabis users expressed no desire to reduce or stop cannabis use.
GLM found that the more days participants used cannabis, the lower the probability of
abstinence, Wald ??2=5.6, p=.02, OR =.98, 95% CI (.966;.997). Probit analysis found
that the probability of abstinence decreased steadily from .31 for 0 days to .22 for 30
days of use, z=-2.064, p=.04. Every added day of use decreased the probability of
abstinence by a small amount. Cannabis use appears to negatively impact smoking
cessation among quitline participants. Even 1 day of use per month is associated with
a small decrease in the probability of abstinence. Understanding how cannabis use
impacts smoking cessation will inform cessation treatment for co-users.
FUNDING: Academic Institution
SYM11-4
INTEGRATING A MOTIVATIONAL CANNABIS INTERVENTION
INTO STATE QUITLINE COACHING TO INCREASE TOBACCO
CESSATION AMONG CO-USERS
Kelly M. Carpenter, PhD1, Johnathan Hsu1, Beatriz H. Carlini2, Denise D. Walker2.
1Optum Center for Wellbeing Research, 2University of Washington.
About 25% of those calling state tobacco quitlines (QLs) report past 30 day cannabis
use. Frequent cannabis use may contribute to failure to quit smoking. The present study
describes the design and Phase IIa Proof-of-Concept test of a novel QL intervention
for frequent cannabis users with the goal of increasing smoking cessation rates. The
Check-Up-QL intervention was developed and tested in the QL setting by experts in QL
coaching, cannabis treatment & cannabis use characteristics. Elements of the Marijuana
Check-Up, a brief Motivational Enhancement Therapy intervention, were integrated into
standard QL coaching to bring awareness to co-use habits that may impact quitting
tobacco. The Check-Up-QL intervention includes 5 coaching calls and a personalized
feedback report reviewed during call 2.Proof-of-Concept testing included coach training,
recruitment of 10 participants, treatment engagement, delity monitoring and collec-
tion of outcome data. Following development of the treatment manual, 4 QL coaches
were trained in intervention delivery, motivational strategies, and cannabis education.
Incoming callers to the Washington or Alaska state QLs March - June 2021 who were
aged >21 and who smoked > 5 cigarettes/day (CPD, n = 250) were oered a study
for co-users of cannabis and tobacco. One third agreed to be screened (n = 81), 20
(24%) were eligible, 10 were enrolled.The sample was primarily white (70%) and male
(80%), used cannabis M = 28 of past 30 days and smoked M = 12 CPD. Treatment
engagement was high: 90% had > 3 calls (M = 3.7, SD 1.25). Regarding coach delity,
100% of treatment calls 1 & 2 and 60% of calls 3-5 were coded. Individualized, written
feedback was provided on all coded calls identifying strengths and skills to improve. Two
of 4 coaches achieved high delity ratings early on; 2 improved with specic feedback.
Outcomes were collected at 8 weeks from 70% of participants: 57% reported being quit
from tobacco (40% if missing = smoking); 20% quit cannabis; and 100% were satised
or highly satised with the program. Challenges encountered during implementation of
this innovative treatment in the real world QL setting will be discussed.
FUNDING: Federal
SYM11-5
DISCUSSANT
Dustin Lee, PhD, The Johns Hopkins School of Medicine, Baltimore, MD
FUNDING: Federal
SYM11-6
KNOWLEDGE, ATTITUDES AND PRACTICES OF UK STOP
SMOKING PRACTITIONERS WHEN ADVISING CO-USERS OF
TOBACCO AND CANNABIS TO QUIT SMOKING
Dayyanah Sumodhee, Hannah Walsh, Leonie S. Brose, Ann McNeill, Maria Duaso.
King’s College London, London, United Kingdom.
Signicance The UK rate of co-use of cannabis and tobacco is high with 81% of canna-
bis users mixing cannabis with tobacco. However, both substances are rarely co-treated
in clinical interventions despite cannabis use being associated with poorer cessation
outcomes. The aim of the study is to identify the knowledge, attitudes and practices
of stop smoking practitioners when supporting tobacco cessation among cannabis
users. Methods UK stop smoking practitioners were recruited via the National Centre
for Smoking Cessation and Training (June 2021). Respondents completed an online
survey about their knowledge, condence and training relating to smoking cessation
and cannabis use, and to what extent they ask, advise and refer to specialist cannabis
services. Logistic regression was conducted to estimate odds ratios (ORs) of asking,
advising and referring. Results A total of 693 practitioners were recruited, 53% from
the community and 20% specialists. The average age was 43 and 78% were female. A
large proportion (77%) considered extremely/very important to support co-users to quit
smoking. However only 27% always/often asked clients about their cannabis use, 22%
advised and 34% referred to cannabis specialised service. 17% said they prefer not to
ask because they lack the knowledge and skills to advise co-users. Practitioners’ con-
dence signicantly increased likelihood of asking (OR=2.1 (1.65-2.7)), advising (OR=1.46
(1.06-2.00)) and referring (OR=3.70 (2.85-4.78)). Moreover, having a system in place
to record cannabis use signicantly increased the likelihood of asking (OR=1.61 (1.15-
2.24)). Almost all practitioners (95%) wanted more training on how to support co-users
13
2022 Symposia
to quit smoking as only 37% of practitioners had received some form of training on
cannabis use. Conclusions Practitioners acknowledge the importance of asking about
co-use and oering cessation support for both substances. However, the rate of asking,
advising and referring remains low. Practitioners report limited knowledge of supporting
co-users but wish to receive further training. Adequate recording systems within smoking
cessation treatment settings might facilitate the provision of such support.Funding
This work was supported by Cancer Research UK (grant number: C68935/A29849).
FUNDING: Nonprot grant funding entity
SYM12-1
CHEMICAL CHARACTERIZATION OF NOVEL TOBACCO-FREE
NICOTINE-CONTAINING ORAL PRODUCTS
Michelle K. Page, MS, Grace E. Maley, Scott D. Heldwein, Maciej L. Goniewicz.
Roswell Park Comprehensive Cancer Center.
Introduction: Nicotine-containing avored pouches and lozenges are newer products
available for tobacco users. Resembling pharmaceutical nicotine therapies, which do
not contain tobacco, these products are sold by the tobacco industry without thera-
peutic claims. Little is known about the various chemical additives used in these novel
nicotine-containing products. This study aimed to provide preliminary characteristics of
those new products, including pH and chemical content, as well as nicotine and avor-
ing concentrations.Methods: Nicotine pouches (n=25) and lozenges (n=3) in a variety
of avors were purchased online from on!, NIC-S, Revel (now Velo), Velo and ZYN.
pH was measured by sonicating pouches and dissolving lozenges in articial saliva.
All products were extracted using methanol and chemical constituents were identied
using GC-MS and mass spectral analysis. Quantitation of nicotine and 20 selected
avoring chemicals was performed with GC-MS and GC-Q/TOF, respectively. Results:
pH in nicotine pouches varied from 7.0 to 9.3, while the lozenges ranged from 5.7 to
6.9. Over 250 unique chemicals were identied in the products, including humectants:
propylene glycol (PG) and vegetable glycerin (VG) in 23 and 5 pouches, respectively.
Nearly 170 dierent avoring chemicals were found and vanillin, hydroxyacetone, and
methyl salicylate were among several frequently detected across various products.
Likewise, these chemicals were commonly found in similarly avored candy products.
Synthetic cooling compounds WS-3 and WS-23 were detected among mint- and to-
bacco-avored products and several PG acetal compounds were identied in 3 tested
pouches. In lozenges, nicotine concentrations ranged from 0.8 to 1.0mg/lozenge and
avoring chemicals menthol, ethyl vanillin and vanillin were found at concentrations of
0.18mg, 0.75mg and 0.09mg/lozenge, respectively.Conclusions: This study provides
qualitative and quantitative information about the chemical constituents of novel oral
nicotine-containing products. Findings provided here will help guide future studies in
understanding the potential health eects associated with product usage.
FUNDING: Federal
SYM12-2
NICOTINE POUCH USE PATTERNS, PERCEPTIONS, AND
MARKETING EXPOSURE AMONG CIGARETTE SMOKERS,
SMOKELESS TOBACCO USERS, AND NONUSERS
Brittney Keller-Hamilton, MPH, Lauren Long, Ce Shang, Megan E. Roberts, Theodore
Wagener, Darren Mays. The Ohio State University.
Signicance: Nicotine pouches are novel oral nicotine products that are available in a
variety of brands, avors, and nicotine strengths, marketed as tobacco-free substitutes
for cigarettes, and gaining in popularity. There is limited research on nicotine pouch use,
appeal, and factors contributing to appeal.Methods: 416 cigarette and/or smokeless
tobacco users and nonusers aged = 21 years were recruited in Ohio. Participants com-
pleted an online survey assessing tobacco use history, sociodemographics, and nicotine
pouch use history, perceptions, and marketing exposure. Given the limited evidence
on nicotine pouches, we analyzed data descriptively and using bivariate tests.Results:
Participants averaged 35.2 years of age (SD 11.8), 76% were male, 91% white race,
and 56% had less than a college education. Overall, 20% were cigarette smokers, 36%
were smokeless tobacco (SLT) users, 18% were dual cigarette/SLT users, and 26%
were non-users. In total, 68% had heard of nicotine pouches, 42% had tried them, and
23% reported current use (every day or some days). Current use was highest among
SLT users (53%) followed by dual users (36%), non-tobacco users (13%), and smokers
(5.9%, p <.001). Among nicotine pouch users, the most commonly used brand used
was Zyn (15%) and commonly used avors included wintergreen/spearmint/frost (36%),
menthol/mint (23%), and fruit (17%). SLT users (M 2.2, SE .06), dual users (M 2.4, SE
.09), and smokers (M 2.5, SE .09) endorsed lower perceived risks of health harm than
nonusers (M 3.1, SE .08, possible range 1-4, p’s <.001). Perceived substitutability for
cigarettes (M 5.2, SD 1.7) and SLT (M 5.9, SD 1.5) were moderate overall (possible
range 1-7) and did not dier signicantly by user groups. The majority (80%) reported
nicotine pouch advertising exposure in the past year, most commonly at point of sale
(30%), online (19%), and on television (11%). Conclusions: Nicotine pouch use was
relatively common in this convenience sample, especially among SLT users and dual
users. Perceived substitutability, variation in perceived risks, and high exposure to
nicotine pouch advertising may be contributing to increasing use.
FUNDING: Federal; Academic Institution
SYM12-3
PERCEPTIONS OF ORAL NICOTINE POUCHES ON REDDIT
Dongmei Li, PhD1, Yihan Shao1, Jonathan Zou1, Zidian Xie1, Rachel Grana Mayne2,
Deborah J. Ossip1, Irfan Rahman1, Scott McIntosh1. 1University of Rochester, 2Tobacco
Control Research Branch, National Cancer Institute.
Background: Oral nicotine pouches are a new form of tobacco-free nicotine products
launched in recent years with a variety of avors available in the market. This study
examined the public perceptions of oral nicotine pouches on Reddit, a popular social
media platform for sharing user experiences.Methods: Between February 15, 2019 and
February 12, 2021, 2410 Reddit posts related to oral nicotine pouches were collected.
After the removal of unrelated or commercial posts, 653 Reddit posts related to oral
nicotine pouches remained. Topics and sentiments related to oral nicotine pouches on
Reddit were manually coded.Results: The number of Reddit posts related to oral nicotine
pouches increased during the study period. Content analysis showed that the most
common topic related to oral nicotine pouches is “sharing” (56.0%), in which sharing
oral nicotine pouches products and user experiences were dominant. The next popular
topic is “asking questions” related to oral nicotine pouches (product properties and
recommendation) (17.6%), following by “quitting” vaping or smoking through use of oral
nicotine pouches or quitting the oral nicotine pouches themselves (12.7%), and “health”
symptoms or concerns related to oral nicotine pouches (11.3%). The least popular topic
was “legality/permissions” related to oral nicotine pouches (2.3%). In addition, a greater
number of Reddit posts described positive attitudes towards oral nicotine pouches than
negative attitudes toward the products, 54.2% vs. 15.5% (P-value < .0001). Conclusions:
There was an increasing trend in oral nicotine pouches discussions on Reddit. Reddit
users overall had a positive attitude towards oral nicotine pouches and were actively
sharing products and user experiences.
FUNDING: Federal
SYM12-4
CELLULAR AND METABOLIC TOXICITY OF ORAL NICOTINE
POUCH PRODUCTS IN ORAL EPITHELIAL CELLS
Sairam Jabba, PhD, Peter Silinski, Shaunacee Howell, Ana I. Caceres, Sven-Eric Jordt.
Duke University Medical Center.
Signicance: Nicotine pouches are a new smokeless tobacco product category, whose
sales rapidly increased (>300%) in the last 2 years. Nicotine pouches are tobacco- or
tobacco-leaf free, consisting of ller, nicotine or nicotine salts, sweeteners and a variety
of characteristic avors, including mint, menthol, wintergreen and sweet-associated
avors (fruity and candy avors). Though nicotine pouches are marketed with claims of
reduced risk, it is currently unknown whether the use of avored nicotine pouch products
has adverse eects on oral tissues, and, if so, what the product characteristics are that
contribute to the toxicological eects.Methods: The potential cytotoxic eects from ex-
posure to avored nicotine pouch extracts were assessed using LDH and uorescence
Live/Dead cell assays in UM-SCC-1 cells, an oral squamous cell carcinoma cell line.
Live-cell metabolic assays were carried out in UM-SCC-1 cells to determine the eects of
these avored pouch extracts on key bioenergetic parameters of mitochondrial function.
Results: Exposure to several avored nicotine pouch extracts (on! mint, wintergreen; Zyn
coee, spearmint, cinnamon) for 18-24 hours increased LDH release in UM-SCC-1 cells
by ~1.5-2.0 fold. Cells exposed to either nicotine (3 mM) or the active avor chemical
present in these products (menthol, carvone or methyl salicylate at 3 mM), produced no
signicant LDH activity over untreated control. Extracts of VELO products (Citrus and
Mint) did not increase LDH activity. In the Live/Dead assay, signicant dose-dependent
cytotoxicity was observed upon exposure to various dilutions of Zyn and VELO Cinnamon
extracts. In metabolic assays, compared with their individual constituents (nicotine, active
avor chemical), several extracts of avored Zyn, VELO and on! products diminished
key parameters of cellular energy metabolic functions, including basal respiration, ATP
14
2022 Symposia
production, and spare respiratory capacity.Conclusion: Nicotine pouch extracts have
dierential toxicological and metabolic eects, with several extracts increasing LDH
release, cell death and reducing mitochondrial function.
FUNDING: Federal
SYM13-1
INDUCING THE POSITIVE EMOTION OF GRATITUDE IN THE
CONTEXT OF ANTI-TOBACCO COMMUNICATIONS REDUCES
MOTIVATION TO SMOKE
Vaughan W. Rees, BSc, PhD1, Ke Wang2, Charles Dorison3, Emily Heckel1, Jessica
Liu1, Chelsea Zabel2, Andy Tan4, Jennifer Lerner2. 1Harvard T.H. Chan School of Public
Health, 2Harvard Kennedy School, 3Kellogg School of Management, Northwestern
University, 4University of Pennsylvania.
Signicance: Public service announcements (PSAs) constitute a cornerstone in tobac-
co control, but gaps exist in understanding how emotionally-evocative PSAs impact
smoking. Certain emotion-imbued communications can trigger unintended “boomerang”
eects, and our recent research has shown that sadness, one of the most frequent
emotions in PSAs, may paradoxically increase smokers’ craving, impatience to smoke
and actual smoking behavior. Guided by the Appraisal Tendency Framework of emotion
and decision making, we predicted that gratitude, a positive emotion rarely evoked in
PSAs, would reduce motivation to smoke. Methods: In two studies, we experimentally
induced emotions by videos and writing and measured craving to smoke. In Study 1
(N=174 smokers from Mturk), participants were randomized to gratitude or neutral
conditions, without viewing any PSA. In Study 2 (N=175 smokers from Prolic), we
tested the specicity of the gratitude eect by adding a comparison positive emotion,
amusement. We also tested variations in presenting a PSA before or after the emotion
induction using a 3 emotion (gratitude, amusement or neutral) by 2 PSA location (before
or after emotion induction) between-subjects design. We measured craving to smoke
in both studies using 3 items from the brief Questionnaire on Smoking Urges.Results:
Study 1 found that without any PSA, gratitude (vs. neutral) signicantly reduced ciga-
rette craving (d=-.45, p=.004). Study 2 replicated the nding that gratitude (vs. neutral)
signicantly reduced cigarette craving (d=-.49, p=.010) and found amusement (vs.
neutral) did not (d=-.22, p=.237), regardless of the PSA location (interaction p=.742).
Conclusions: These ndings build upon evidence showing that target emotions yield
specic eects on motivation to smoke. Unlike sadness, the positive emotion gratitude
reduces craving in smokers. The ndings were consistent across 2 studies (with and
without viewing a PSA) and regardless of whether participants viewed a PSA before
or after emotion induction. These ndings have theoretical and practical relevance for
informing the design of anti-tobacco communications.
FUNDING: Federal
SYM13-2
POPULATION-LEVEL ASSOCIATIONS SUGGEST A PROTECTIVE
INFLUENCE OF GRATITUDE ON CURRENT SMOKING STATUS
Ke Wang, BS, MA1, Vaughan W. Rees2, Charles Dorison3, Jennifer Lerner1. 1Harvard
Kennedy School, 2Harvard T.H. Chan School of Public Health, 3Kellogg School of
Management, Northwestern University.
Signicance: Anti-tobacco communications frequently use negative emotional content,
including sadness, fear and disgust, to enhance the persuasiveness and recall of mes-
sage. However, recent research has shown that sadness may paradoxically increase
motivation to smoke, whereas the positive emotion gratitude may yield the desired
outcome of decreasing craving. We conducted three studies to assess the ecological
validity of previous lab-based ndings regarding gratitude and smoking.Methods: In
Study 1, we assessed smokers’ (N=204) emotional responses to 81 segments of CDC’s
Tips from Former Smokers. In Study 2, we used data from the MacArthur Midlife in the
United States survey (N=8,540) to assess associations between self-reported positive
emotions pride, compassion and gratitude, and smoking status over ve survey waves
from 1995 to 2014. In Study 3, we assessed the association between positive emotions
and tobacco use using data from 86 countries (N=20,338) collected during the COVID-19
pandemic with the support of the Psychological Science Accelerator.Results: Study 1
found that gratitude ranked 8th among 26 positive emotions and 25th among all 43
emotions on both frequency and intensity by smokers. Study 2 found that gratitude, but
not pride or compassion, was signicantly associated with a lower likelihood of current
smoking across all ve survey waves (standardized bs range from -.21 to -.37, ps<.05),
after adjusting for socioeconomic status, age, and gender (standardized bs range from
-.13 to -.32, ps<.05 in 4 out of 5 waves). In Study 3, gratitude was signicantly correlated
with lower intentions to excessively use tobacco during COVID-19 (b= -.14, p<.001). In
contrast, other positive emotions (love, hope, serenity & inspiration) showed inconsistent
or weaker correlations. Conclusions: Gratitude is underutilized in current anti-smoking
PSAs, yet evidence from diverse countries and years suggests a potential protective
eect of gratitude on smoking status. These ndings suggest that anti-smoking public
service announcements, which predominantly induce negative emotions, could consider
inducing gratitude to motivate smoking reduction.
FUNDING: Federal
SYM13-3
THE ROLE OF DISCRETE EMOTION IN THE REASONED ACTION
MODEL OF BEHAVIORAL INTENTION: THREE EMPIRICAL TESTS
Joseph Nicholas Cappella, MA, PhD1, Hyun Suk Kim2. 1University of Pennsylvania,
2Department of Communication, Seoul National University.
The Reasoned Action Model of behavioral intention has been an extremely inuence
approach in predicting behavior and behavior change as well as guiding the selection
of beliefs to be addressed in communication campaigns targeting behavioral change.
The role of discrete emotional response in accounting for behavioral change has held
a controversial position in the model with some arguing that emotional considerations
are built into the measurement procedures or transmitted through attitudes, norms, and
ecacy while others maintain an independent path for discrete emotional response is
necessary. Data are presented from three large scale, national studies are presented:
two studies of quitting intentions involving young adult smokers 18-25 (study 1, N=450),
adult smokers (study 2, N=1100), and adults volunteering to participate in genetics re-
search (study 3, N=3700). Two of the studies involve longitudinal, behavioral outcomes
as well as behavioral intention allowing inference from discrete emotional states to
behavioral response. The robust conclusion across all three studies is that there is a
unique, independent predictive path from discrete emotional states to behavioral intention
over and above the standard reasoned action predictors (attitude, norm, and ecacy).
Study 3 is not about tobacco-related behaviors but is included to show that the role of
discrete emotions in RAM is not unique to tobacco-related behaviors. Analyses employ
Structural Equation Modeling as well as multiple regression to show best tting models
as well as the role of specic emotional states in the three contexts. Implications for
campaign design are explored.
FUNDING: Federal
SYM13-4
SMOKERS’ CURIOSITY FACILITATES RECALL OF TOBACCO-
RELATED HEALTH INFORMATION
David M. Lydon-Staley, PhD, Jaydin Clark, Asia Vincent, Xinyi Wang, Amanda L.
McGowan. University of Pennsylvania.
Curiosity is an epistemic emotion characterized by a desire to ll the knowledge gap
between what one knows and what one wants to know. States of curiosity promote
learning. Two open questions concern the extent to which tobacco smokers exhibit
curiosity about smoking-related health information and whether this curiosity can
facilitate recall of this information. Participants (n=324 smokers; n=280 non-smokers)
performed a Trivia Guessing Task wherein participants guessed the answers to general
trivia and smoking-related trivia questions and provided ratings of their curiosity prior to
viewing the answers to the questions. A subset of participants (n=121 smokers; n=97
non-smokers) completed a surprise Trivia Memory Task one-week later and answered
the previously-viewed questions. Results indicate that smokers are no less curious about
smoking-related trivia than they are about general trivia and that curiosity about the an-
swer to smoking-related trivia is associated with more accurate recall of smoking-related
trivia answers one week later. Findings suggest that engendering states of curiosity
for smoking-related information may facilitate retention of that information in smokers.
FUNDING: Federal; Nonprot grant funding entity
15
2022 Symposia
SYM14-1
A DIFFERENCE-IN-DIFFERENCE APPROACH TO EXAMINING
DISPARITIES IN THE IMPACT OF CANNABIS LEGALIZATION ON
THE CO-USE OF CIGARETTES AND CANNABIS IN THE UNITED
STATES, 2004-2017
Renee D. Goodwin, PhD, MPH1, Andrea Weinberger2. 1City University of New York and
Columbia University, 2Yeshiva University, Albert Einstein College of Medicine.
Despite the overlap in cannabis and cigarette use, the potential harms associated with
co-use, and rising cannabis use alongside rapidly expanding cannabis legalization, little
is known about how legalization might impact the co-use of cigarettes and cannabis, or
whether legalization impacts co-use dierently among demographic subgroups (e.g.,
women versus men, minoritized versus majority racial/ethnic groups, lower versus
higher socioeconomic status). This study estimated the impact of recreational and
medical marijuana laws (RML, MML) on past-month cigarette and cannabis co-use and
cigarette-only use (i.e., no cannabis use) in the United States across all individuals and
among demographic subgroups by age, gender, race/ethnicity, income, and education.
A dierence-in-dierence approach was applied to public and restricted-use data from
the 2004-2017 National Survey on Drug Use and Health (NSDUH), an annual, nationally
representative cross-sectional survey of Americans ages 12 and older (analytic sample
of n=56,276 for 2017; a total combined analytic sample for 2004-2017 of n=783,663). In
2017, 4.4% respondents reported cigarettes and cannabis co-use and 13.5% reported
cigarette-only use. Dierence-in-dierence analyses showed that MML were associated
with an increase in cigarette-cannabis co-use, but not with any change in the preva-
lence of cigarette-only use. Conversely, RML were not associated with a change in the
prevalence of cigarette and cannabis co-use, and were associated with a decline in
cigarette-only use. Dierences in the association of RML and MML and cigarette-canna-
bis co-use and cigarette only use by age, gender, race/ethnicity, income and education
groups will be presented along with implications of these results in relation to tobacco
disparities and health equity. Given the degree to which tobacco and cannabis use are
intertwined, understanding the impact of cannabis policy on cigarettes and cannabis
co-use and cigarette use is critical to mitigate potential unintended consequences of
cannabis legalization for tobacco control especially for key demographic groups that
demonstrate disparities in tobacco use and consequences.
FUNDING: Federal
SYM14-2
TRAJECTORY ANALYSIS OF PATTERNS OF YOUNG ADULT
CANNABIS AND TOBACCO USE AND CO-USE FROM 28 DAYS OF
ECOLOGICAL MOMENTARY ASSESSMENT: AN EXAMINATION OF
VULNERABILITY FACTORS
Amy M. Cohn, PhD1, Dingjing Shi2, Summer Frank-Pearce1, Robin Mermelstein3, Ryan
Vandrey4, Donald Hedeker5, Andrea Villanti6. 1University of Oklahoma Health Sciences
Center, 2University of Oklahoma, 3University of Illinois at Chicago, 4Johns Hopkins
University School of Medicine, 5The University of Chicago, 6University of Vermont Larner
College of Medicine.
Background: Cannabis and tobacco co-use is common in young adults, and is prevalent
among some vulnerable groups who have worse cannabis and tobacco health outcomes.
This study characterized daily time-varying patterns of cannabis and tobacco single
use and co-use using Interactive Voice Response (IVR) assessments, and examined
trajectory membership by race/ethnicity, gender, and socioeconomic status. Methods:
Ninety-four young adult co-users (50% White, M age = 21.3 years, 57.4% male) com-
pleted thrice daily IVR surveys of cannabis and tobacco use and co-use over 28 days
(1,481 observations), corresponding to four epochs (Morning, Afternoon, Evening, Late
Night). Latent class modeling was used to identify latent classes using model t statistics.
Latent transition analysis was used to investigate the probability of transitioning from
one class to another over time. The inuence of demographics (gender, race/ethnicity,
income), baseline mental health (depression, anxiety), and epoch on class transition
were studied. Results: Five latent classes emerged resulting in groups with primary
use of 1) no substances, 2) cannabis and tobacco co-use, 3) cannabis, 4) nicotine/
tobacco, and 5) with mixed no use and any form of substance use. The probability of
transitioning from one class to another over time was low. Participants in the mixed
group, if they were to transit, were most likely to transit to the primary “no use” group.
After adding covariates to the model, the latent classes became more distinct, with the
mixed substance use and primary cannabis use classes no longer emerging. Females
were more likely than males to transit from the primary nicotine/tobacco use group to
the primary co-use group. Those with poverty level income ($20,000/year) and higher
self-reported depression were signicantly more likely to report substance use across
all latent classes; except poverty did not inuence class membership for the primary
nicotine/tobacco use group. Conclusions: Distinct classes of users emerged based
on daily patterns. Certain vulnerability factors were linked to class membership and
increased substance use. Results have implications for disparities in co-use.
FUNDING: Federal; State
SYM14-3
SUICIDE IDEATION AND DEPRESSION SYMPTOMS AMONG
RACIAL/ETHNIC MINORITY YOUTH WHO USE/CO-USE CANNABIS
AND ELECTRONIC VAPOR PRODUCTS: AN ANALYSIS OF 2015-
2019 YRBS DATA
Wura Jacobs, PhD MS. California State University, Stanislaus.
While evidence suggests an adverse impact of cannabis on mental health, the mental
health impact of use of electronic vapor products (EVP) have been largely overshadowed
by its physical impact, particularly among racial/ethnic minority youth. We examined the
trends in prevalence and odds of reporting mental health issues among racial/ethnic
minority youth who use EVP and cannabis. Data from the 2015, 2017, and 2019 Youth
Risk Behavior Survey (YRBS) was analyzed (N=44,066). Participants reported their
past 30-day EVP and cannabis use and their race/ethnicity. The data were used to
categorize participants as single, dual, and never users, and participants that reported
non-white race were categorized as ethnic minority. Participants also reported their
past 12-month depression symptoms, suicide ideation, and suicide attempt. Multivar-
iate analyses were conducted and adjusted for sex, race/ethnicity, grade level, use of
other tobacco products, and survey year. Compared to non-ethnic minority youth who
used EVP or cannabis, ethnic minority youth who used EVP or cannabis were more
likely to attempt suicide (adjusted odds ratio [aOR]=1.46, 95% Condence Interval
[CI]=1.17-1.82) and experience injury, poisoning or overdose following a suicide attempt
(aOR=1.59, 95%CI=1.16-2.17). Compared to non-ethnic minority youth who co-used
EVP and cannabis, ethnic minority youth who co-used EVP and cannabis were also
more likely to attempt suicide (aOR=1.37, 95%CI=1.05-1.81) and report injury, poison-
ing, or overdose following a suicide attempt (aOR=1.53, 95%CI=1.04-2.26). Female
ethnic minority youth who used/co-used EVP and cannabis were also at increased risk
for suicide ideation, suicide attempt, and injury, poisoning or overdose from a suicide
attempt. Ethnic minority youth who use EVP and cannabis are at increased risk for
depression and suicide. Given increasing prevalence of EVP, cannabis, and cannabis
vaping among youth, eorts are needed to target the divergent trends of depressive
symptoms and suicidality among racial/ethnic minorities.
FUNDING: Academic Institution
SYM14-4
EXAMINING PREDICTORS OF QUITTING BEHAVIOURS AMONGST
UK VOCATIONAL COLLEGE STUDENTS WHO CO-USE TOBACCO
AND CANNABIS
Hannah Walsh, BA, MSC, MRes, RMN1, Ann McNeill2, Maria Duaso1. 1King’s College
London, 2Nicotine and Research Group, Addictions Department, Kings College London.
Background: Tobacco and cannabis are commonly co-used. Co-use may be concur-
rent or co-administered; the latter is most common in Europe. Co-use may negatively
inuence quit attempts of both substances, but few studies have explored the quitting
process in detail. The aim of this study is to examine predictors of ‘quitting behaviours’
of tobacco and/or cannabis and other aspects of quitting behaviours amongst a sample
of UK young adults attending vocational college. Methods: An online questionnaire
was distributed by three colleges in SE England. Respondents were included if they
reported current or recent use of both substances. All eligible participants provided de-
tailed demographic data and patterns of tobacco and cannabis use. A four level ordinal
variable, ‘quitting behaviour’ was created for each substance: quit/quit attempt made/
reduction or attempt made/no behaviour change. Regression analyses were performed
to assess the impact of individual variables on quitting behaviour for both substances.
Independent variables included level of dependence, frequency of use, gender, ethnicity,
disability, sexual orientation, experience of mental health problem, and socio-economic
status. Results: 141 eligible participants responded. 90% of the sample were aged 16-
20, 58% were female, 58% of Black or minority ethnicity and 31.2% identied as not
heterosexual. For both tobacco and cannabis, 20% (n=29) reported having quit in the
past 6 months, the remainder continued to use. Logistic regression analysis suggests
that being non heterosexual was signicantly associated with not making a change in
tobacco use (OR 2.37 (1.20-4.68), p=0.013), as was living in an area of high deprivation
(OR 1.23 (1.06-1.43), p=0.007). For cannabis use, no individual characteristics were
associated with quitting behaviour. Conclusions: The likelihood of making a change in
tobacco use may be lower for LGBT+ people and those living in more deprived areas,
16
2022 Symposia
who co-use. When addressing tobacco and cannabis co-use, it is important to consider
personal characteristics, in order to better understand who may be at greater risk from
persistent or problematic use of tobacco and cannabis.
FUNDING: Academic Institution
SYM15-1
USING INTERSECTIONALITY AND QUALITATIVE RESEARCH
TO BETTER INFORM RESEARCH, CLINICAL WORK, AND
POLICY RELATED TO ENDS USE DURING PREGNANCY AND
POSTPARTUM
Philip Smith, PhD. Miami University.
Philip Smith will present a synthesis of qualitative work on ENDS use during pregnancy
and postpartum, using intersectionality as an underlying paradigm. Research has a
powerful impact on the social narrative surrounding addictive behaviors during pregnancy
and post-partum, and as a consequence research helps to direct the focus of clinical
work, public health intervention, and policy. Too much focus on risks of behaviors in
research can contribute to stigma and ostracization, to the determinant of well-being.
This stigma and ostracization falls to the greatest degree upon individuals identifying
with multiply marginalized groups, contributing to staggering disparities in maternal
and birth outcomes in the United States. This talk will aim to humanize the experiences
of individuals using, and attempting to stop using, ENDS and other tobacco products
during pregnancy and postpartum. This talk will focus on how being attune to the lived
experiences of pregnant and postpartum individuals can lead to more authentically
supporting pregnant and post-partum people’s autonomy, self-determination, and
well-being, ultimately leading to greater success with stopping tobacco use. The talk
will focus on how conceptualizing research participants as experts rather than passive
sources of data can lead to better and more equitable outcomes. Using intersectionality
as a guiding paradigm, this talk will center qualitative work conducted among pregnant
and postpartum people identifying with marginalized and oppressed groups, and will
seek to identify inequitable structural forces contributing to ENDS and other tobacco
use during pregnancy and postpartum, through lived experiences. The presentation
will provide a humanizing context for, and dialectic contrast to, quantitative research
presented during the symposium.
SYM15-2
ELECTRONIC NICOTINE DELIVERY SYSTEMS (ENDS) USE
DURING PREGNANCY: COURSE OF USE AND PERINATAL
OUTCOMES
Elise E. DeVito, PhD. Elise DeVito.
The range of electronic nicotine delivery system (ENDS) products and prevalence of use
has increased substantially since their initial introduction to the US market over a decade
ago. This raises important questions about patterns of and motivations for use of ENDS
during the perinatal period, and the impact of ENDS use on perinatal outcomes. This
talk will present ndings from two recent literature reviews which synthesized ndings in
pregnant persons from population-based or cohort-based samples related to a) ENDS
use behavior during pregnancy; and b) adverse perinatal outcomes following ENDS
use during pregnancy. A minority of pregnant persons use ENDS during pregnancy
and most who do report dual use alongside combustible cigarettes (CC). Self-reported
motivations for use and perceptions of relative harm suggest that the perception of
ENDS as a lower-risk alternative to CC may contribute to ENDS use in pregnancy,
despite insucient evidence that ENDS facilitates cessation of tobacco product use
during pregnancy. Although the clinical literature is limited, evidence suggests ENDS
use (ENDS only or dual use) increases risk for some adverse perinatal outcomes (e.g.,
small for gestational age) relative to no tobacco use. Very limited data has directly mea-
sured whether ENDS reduce risk of adverse perinatal outcomes relative to CC smoking
alone. Findings underscore the need for continued caution regarding ENDS use during
pregnancy. Clinical and tobacco regulatory implications are discussed.
FUNDING: Federal
SYM15-3
IMPACT OF E-VAPOUR EXPOSURE DURING PREGNANCY ON
HEALTH OUTCOMES IN OFFSPRING
Hui Chen, MD, PhD. University of Technology Sydney.
It is well accepted that combustible cigarette smoking during pregnancy harms foetal
development, predisposing the ospring to develop several chronic diseases. We have
found that oxidative stress is the common underlying mechanism. While it remains a
challenge for pregnant women to quit smoking cigarettes due to altered nicotine me-
tabolism and the addictive properties of nicotine, electronic nicotine delivery systems
(ENDS) initially appeared to provide a viable alternative. Rather than becoming a means
to quit cigarette smoking, ENDS emerged as a new nicotine delivery device, used by
never smokers, and used in combination with cigarettes, and used by pregnant women.
However, we don’t have a good understanding of how ENDS use during pregnancy
aects the unborn child, especially the long-term health outcomes. Animal modelling
provides a unique advantage to predict the possible health sequelae in humans within
a relatively short time frame and with greater experimental precision. Using a mouse
model, we found that continuous exposure to e-vapour is harmful to the lung, liver, and
glycaemic control of the mothers. It was also detrimental to foetal development, associ-
ated with respiratory, renal and metabolic disorders. In both mothers and ospring, the
eects were not nicotine dependent. However, we did nd a slight reduction in some
disorders in the ospring if dams switched from cigarette smoke to e-vapour during
pregnancy, such as normalized brain metabolic regulators, improved lipid metabolism,
as well as some reduction in liver and kidney pathology. Nevertheless, our data do not
support the use of e-cigarettes during pregnancy. Overall, this body of work highlights
the dangers of the use of ENDS, with or without nicotine, during pregnancy.
FUNDING: Federal; Academic Institution
SYM16-1
CHANGES IN INHIBITORY SIGNALING IN CORTICOTROPIN-
RELEASING FACTOR RECEPTOR 1 (CRF1) NEURONS IN MOUSE
VENTRAL TEGMENTAL AREA FOLLOWING ELECTRONIC
NICOTINE VAPOR EXPOSURE
ManHua Zhu, Bachelor of Science, ManHua Zhu, Jasmine Jahad, Neil Rogers,
Melissa Herman. University of North Carolina Chapel Hill.
Rationale: One of the primary brain regions in the mesolimbic reward circuitry is the
ventral tegmental area (VTA). Various cell types within the VTA can modulate reward
signaling. One VTA population that is understudied is the corticotropin-releasing factor
receptor 1 (CRF1)-expressing neurons that are activated by the stress peptide CRF.
Extensive work has examined the eects of nicotine on VTA dopamine neurons, however,
much less is known about the actions of nicotine on VTA CRF1 neurons. Objectives:
Investigate the eects of electronic nicotine vapor exposure on CRF1 neurons in the
VTA.Methods: Male and female CRF1-GFP mice were used to target CRF1-expressing
neurons in the VTA. Mice were exposed to a 3-hour session of intermittent vapor delivery
(3-sec vape every 10-minutes) of either propylene glycol/vegetable glycerol (PG/VG)
control vapor or 120 mg/ml nicotine in PG/VG. Immediately following vapor exposure,
mice were sacriced for immunohistochemical (IHC) or in vitro electrophysiological
experiments. Tyrosine hydroxylase (dopamine neuron marker) and cFos (neuronal
activity marker) were labeled with IHC to examine neuronal activity in the dopamine
and CRF1 populations within the VTA. Neuronal activity and inhibitory signaling in VTA
CRF1 neurons were examined using slice electrophysiology. Results: We found that
VTA CRF1 neurons are mainly dopaminergic (~80%) and that slice application of 1uM
nicotine increases cell ring but does not alter inhibitory signaling. Following acute
nicotine vapor exposure, we found increases in cFos expression in the VTA and in TH
neurons but not in CRF1 neurons. Our electrophysiology data also show no increase in
baseline ring following in vivo nicotine vapor exposure and the 1uM nicotine-induced
increase in cell ring is dampened. Interestingly, baseline phasic inhibitory signaling
was heightened and 1uM nicotine induced tonic inhibition, likely contributing to the
diminished ring observed. Conclusions: VTA CRF1 neurons are mainly dopaminergic
and show acute nicotine-induced increases in activity. However, following nicotine vapor
exposure, we observe heightened inhibition and thus dampened activity.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
17
2022 Symposia
SYM16-2
EXAMINING THE ROLE OF NICOTINE-INDUCED VENTRAL
TEGMENTAL AREA KCC2 DOWNREGULATION IN DOPAMINE
SIGNALING AND ADDICTIVE BEHAVIORS
Alexey Ostroumov. Georgetown University.
Nicotine is a major component of tobacco and electronic cigarettes contributing to the
initiation and persistence of the addiction in humans. The development of nicotine
addiction likely arises from pathological usurpation of neuronal mechanisms that
under normal conditions mediate reward-related associative learning. The gap in our
knowledge, however, is the neuronal mechanisms underlying nicotine-induced aberrant
learning. Drug-associated maladaptive learning results in part from long-lasting changes
in the synaptic connectivity within the mesolimbic reward circuitry, which is primarily
comprised of the ventral tegmental area (VTA) and the nucleus accumbens. In animal
models, restoring basal synaptic transmission repairs neural circuitry and alleviates
some addictive behaviors, indicating that targeting drug-induced synaptic plasticity
may be a promising therapeutic tool for nicotine addiction. Here, we characterize a
novel form of nicotine-induced inhibitory synaptic plasticity in VTA GABA neurons, a
currently understudied cell type in the mesolimbic circuit. In rats, experimenter-induced
nicotine injections and volitional nicotine self-administration enhance VTA GABA neuron
activity via long-lasting downregulation of chloride transporter KCC2, which maintains
low intracellular chloride concentrations in neurons. Given that low intracellular chloride
underlies the inhibitory action of GABAA receptor activation, KCC2 hypofunction de-
creases GABAergic synaptic inhibition or even paradoxically causes excitation of VTA
GABA neurons. VTA GABA neurons are among the major sources of GABAergic input
onto dopamine neurons, yet optogenetic excitation of VTA GABA neurons can potentiate
reward-related dopamine activity and associative learning. Accordingly, nicotine-induced
KCC2 downregulation in VTA GABA neurons facilitates the formation of addictive and
reward-related behaviors. Overall, our studies suggest that KCC2 downregulation in
VTA GABA neurons represents a novel mechanism by which nicotine hijacks neuronal
circuitry underlying reward-related associative learning.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
SYM16-3
TOBACCO/ENDS FLAVORANTS ALTER MIDBRAIN DOPAMINE
AND GABA NEURON FUNCTION AND CONTRIBUTE TO
ADDICTION-RELATED BEHAVIORS
Brandon J. Henderson, PhD, Pharmacology, Brandon J. Henderson, Skylar Y.
Cooper. Marshall University.
Introduction: While nicotine is the primary addictive component in tobacco products,
additional avors have become a concern with the growing popularity of electronic
nicotine delivery systems (ENDS). For this reason, we have begun to investigate pop-
ular tobacco and ENDS avors. Here, we examined green apple avor mixture (hexyl
acetate, methylbutyl acetate, and ethyl acetate) used in many green apple ENDS
e-liquids, for its ability to produce reward-related behavior. Methods: Using male and
female 3 – 5 month old C57BL/6J mice genetically modied to contain GFP-labeled a6
nAChR subunits (a6-GFP mice) we examined how brain neurophysiology was altered by
exposure to green apple avor. To do this, mice were trained to self-administer e-liquids
in a contingent vaporized (e-Vape®) self-administration system. Following this, brains
were acutely dissected for investigation via patch-clamp electrophysiology and fast-scan
cyclic voltammetry (FSCV). Results: Male and female mice self-administer green-apple
e-liquids in the absence of nicotine. Our electrophysiological assays revealed that
green-apple exposure increases ventral tegmental area (VTA) dopamine neuron ring
frequency and this may be due to a decrease in inhibitory tone from GABA neurons. In
parallel, our FSCV assays determined that nucleus accumbens core dopamine release
is enhanced, compared to control, following both tonic and phasic stimulation proto-
cols. Conclusions: Green apple avor in mice is rewarding and reinforcing. Based on
our results, the mechanism behind this is likely due to changes in VTA dopamine and
GABA tone that results in an enhancement in nucleus accumbens dopamine release.
FUNDING: Federal; Pharmaceutical Industry; Academic Institution
SYM16-4
SEX-DEPENDENT PATTERNS IN NICOTINE SEEKING AND
EFFECTS OF NICOTINE ON THE VTA PROTEOME
Marina Picciotto, Charles B. G. Murphy Professor of Psychiatry, Angela Lee, Marina
Picciotto, Shahid Mansuri, Rashaun Wilson, Sherry McKee, TuKiet Lam, Angus Nairn.
Yale University School of Medicine.
Signicance: Women relapse to smoking at higher rates than men, especially in response
to stress. Many studies suggest underlying sex dierences in mesolimbic dopamine sig-
naling pathways contribute.Methods: We tested stress-induced reinstatement of nicotine
CPP in male and female mice and eects of nicotine on the VTA and NAc proteome.
C3H mice were evaluated for nicotine CPP, extinction and stress-induced reinstatement.
Groups of C3H and C57 mice were treated with a CPP or chronic regimen of nicotine.
VTA and NAc shell were processed with TMT10-plex tandem mass spectrometry. Fold
change and q-values were used to identify signicantly altered proteins and the STRING
database was used for bioinformatic analysis.Results: Nicotine induced signicant CPP
acquisition and stress-induced reinstatement in male and female mice, but to dierent
doses. Nicotine pairing with the initially preferred or non-preferred chamber dierentially
aected stress-induced reinstatement in male and female mice. In C3H mice, similar
numbers of proteins were dierentially regulated between sexes at baseline compared
with within each sex after sub-chronic nicotine administration. In C57 mice, more pro-
teins were regulated between sexes at baseline compared with within each sex after
chronic nicotine administration and withdrawal. GFAP and DARPP-32 were repeatedly
identied as signicantly altered proteins, especially in VTA. Network analyses showed
sex- and nicotine-dependent regulation of a number of signaling pathways, including
DA signaling. Nicotine CPP increased proteins related to DA signaling in NAc shell but
decreased them in the VTA in female mice, whereas the opposite was observed in male
mice. In contrast, DA pathways were similarly upregulated in both male and female VTA
after chronic nicotine and withdrawal.Conclusions: This study supports the hypothesis
that males are more responsive to rewarding eects of nicotine, whereas females are
more likely to seek nicotine to alleviate eects of stress or anxiety, and identies sex
dierences in the mesolimbic proteome that may help explain dierential susceptibility
to nicotine addiction in males and females.
FUNDING: Federal
SYM17-1
THE SYNTHESISED EVIDENCE ON TOBACCO ENDGAME
INTERVENTIONS
Coral E. Gartner, PhD1, Cheneal Puljevic1, Kylie Morphett1, Marita Heer2, Billie
Bonevski3, Richard Edwards4, Andrew Perusco5, David Sellars6, Georgia Carstensen1,
Md Arifuzzaman Khan7, Ron Borland8. 1The University of Queensland, 2Menzies School
of Health Research, 3Flinders University, 4University of Otago, 5Australian National
University, 6James Cook University/The University of Queensland, 7University of
Queensland, 8The University of Melbourne.
Using the JBI methodological approach for scoping reviews, we searched PubMed,
CINAHL, Scopus, Web of Science and Embase for evidence syntheses (reviews, me-
ta-analyses, simulation modelling studies, expert consensus studies, commentaries)
related to tobacco endgame interventions that were published since 1 January 1990.
Key grey literature were also included. Reviewers independently screened titles and ab-
stracts and then full texts of relevant articles. The protocol for this review was registered
with Open Science Framework (doi:10.17605/OSF.IO/H85AT). A total of 195 articles,
reports or report chapters were included across one or more of following ten topics:
denicotinised cigarette standard (n=26); tobacco product standards (n=2); substitution
with lower risk nicotine products (n=150); license or prescription requirement (n=2);
tobacco-free generation (n=5); ending tobacco sales (n=1); sinking lid (n=3); reducing
industry viability (n=1); tax increases (n=7); and retail density reduction (n=13). Study
types included narrative (traditional) reviews (n=101), systematic reviews (n=47), sys-
tematic reviews including meta-analyses (n=10) simulation modelling studies (n=26),
purpose-specic reviews (scoping; n=3), expert consensus studies (n=2), and a rapid
review (n=1). Of these, 58 (30%) articles included at least one mention of the endgame
intervention’s potential impact on populations with higher smoking prevalence than the
general population. 84 (43%) articles did not include a methods sections detailing search
strategies and/or inclusion criteria, suggesting possible bias in these reviews’ ndings.
Only two articles focused on populations from low-income countries.
FUNDING: Federal
18
2022 Symposia
SYM17-2
COULD DENICOTINISATION OF TOBACCO PRODUCTS IN NZ
ACHIEVE LESS THAN 5% BY 2025
Tony Blakely, PhD1, Driss Ait Ouakrim1, Nick Wilson2, Jennifer Summers2. 1The Univer-
sity of Melbourne, 2University of Otago.
The NZ Government is developing an Action Plan in 2021 to achieve the Government’s
stated 2025 Smokefree goal – usually interpreted as less than 5% smoking prevalence
in all demographic groups (sex by age by ethnic group), requiring overall population
prevalence to be 2% or less. The currently favoured mechanism to achieve this is a
‘backbone’ of denicotinising all tobacco, rapidly, accompanied by retail outlet reduction,
a smokefree generation and media campaigns. Our modelling assesses the feasibility
and outcomes of various packages of these interventions. The modelling is in two steps.
First, a Markov model with transitions between smoking and vaping states over each
sex by age by ethnic group cohort’s remaining lifespan. Interventions are then laid over
this business-as-usual model to generate trajectories and smoking/vaping state preva-
lences by year into the future. Second, the dierences between BAU and intervention
scenario prevalences are combined with relative risks of 16-tobacco-related diseases
as population impact fractions, that feed into a proportional multistate lifetable model to
estimate future changes in mortality, morbidity, health adjusted life years, health expen-
diture and income (the latter a measure of productivity gains of tobacco control). This
presentation will present the ndings reported to the NZ Government in 2021 (currently
under embargo), and consider how they were received (scientically and politically),
any impact, and implications for tobacco endgame strategies.
FUNDING: Federal
SYM17-3
FUTURE NICOTINE USE PREFERENCES OF CURRENT
CIGARETTE SMOKERS: FINDINGS FROM THE 2020 ITC FOUR
COUNTRY SMOKING AND VAPING SURVEY
Ron Borland, PhD1, Lin Li1, Michael Le Grande1, Coral Gartner2. 1The University of
Melbourne, 2The University of Queensland.
Aim: Successful elimination of tobacco smoking will need to consider consumer pref-
erences and quit intentions. We examined prevalence of, and factors associated with,
smoking and quitting preferences one to two years in the future. Method: Participants in
the 2020 wave of the International Tobacco Control (ITC) 4-country smoking and vaping
(USA, Canada, England and Australia) who currently smoke (N=9128) were asked if they
preferred to continue to smoke or to quit with or without an alternative nicotine product
(ANP). We also explored preferences for ANPs over nicotine abstinence.Results: Coun-
try-specic weighted data showed 21.3% preferred to continue smoking and 8.1% were
uncertain, leaving 70.6% preferring to quit: 14.0% using an ANP and 56.7% completely
quitting nicotine. Apart from low interest in quitting, main associates of not preferring to
quit were being a current vaper, aged 25-39 and smoking daily, while preferring to quit
was most associated with worry that smoking will damage their health, and believing that
vaping is a lot less harmful than smoking. Among those preferring to quit, preferring to
use ANPs was very strongly associated with being a vaper (especially daily), younger,
English, reporting strong urges to smoke, believing vaping is much less harmful than
smoking, and not strongly regretting starting or wanting to quit.Conclusions: Achieving
a tobacco endgame will need to account for a signicant minority of smokers who prefer
not to quit, at least in the medium term, although our ndings suggest that increased
acceptance of ANPS might sway more to prefer quitting using ANPs as a substitute.
FUNDING: Federal
SYM17-4
DO NICOTINE VAPING PRODUCTS INCREASE QUITTING AMONG
PRIORITY POPULATION GROUPS OVER STANDARD SMOKING
CESSATION THERAPY? A PRAGMATIC RANDOMISED PARTIAL
CROSS-OVER TRIAL
Kylie Morphett, PhD1, Mark Boyd2, Cheneal Puljevic1, Charles Gilks1, Billie Bonevski3,
Ron Borland4, Ryan Courtney5, Hayden McRobbie5, Coral Gartner1. 1The University
of Queensland, 2The University of Adelaide, 3Flinders University, 4The University of
Melbourne, 5The University of New South Wales.
Introduction: Smoking cessation interventions that are acceptable to, and ecacious
for populations with a higher smoking prevalence and lower quit rates than the general
population are needed as part of a tobacco endgame strategy. We examined if adding
a nicotine vaping intervention to standard smoking cessation treatment (SSCT) could
improve quit rates among three populations with high smoking prevalence (people
living with HIV, HCV and/or opiate dependence).Methods: A pragmatic, randomised,
partial crossover design was employed. Eligibility criteria included diagnosis with/
treatment for HIV or Hepatitis C (HCV) or receiving opioid substitution therapy (OST).
Participants were recruited in 2018-2019 and randomised to one of two arms. Arm A
participants received NVPs, nicotine patches, and referral to Quitline (NVPs as part
of rstline therapy). Arm B participants received combination NRT (patch and choice
of gum or lozenge) and referral to Quitline. Arm B participants who were smoking at 6
months were oered the NVP intervention (NVPs as secondline therapy). Results: Of
the 173 participants allocated to Arm B, 123 crossed into Arm C at 6-9 months post
baseline, to make a second quit attempt with the nicotine vaping product. At 12 months
from baseline, 35 (19.2%) in Arm A, 11 of the 50 who continued in Arm B (22.0%), and
24 (19.5%) in Arm C had not smoked a pu in the past 3 months. The result for Arm
C was similar to the 6 month cigarette quit rate (not a pu in last 3 months) in Arm A
(19.9%) and greater than that of Arm B at 6 months (5.2%). Overall, the approach of
oering participants the NVP with SSCT as rstline therapy produced similar results
for 3 months abstinence from smoking at 12 months as oering the NVP as secondline
therapy only to those who were unsuccessful in quitting with SSCT.Conclusion: Oering
NVPs either as part of rstline or as secondline therapy among these populations with
traditionally low quit rates appears to produce higher quit rates than only oering SSCT,
demonstrating potential use as part of a tobacco endgame.
FUNDING: Federal
SYM17-5
DISCUSSANT
Ruth Malone. University of CA San Francisco.
Professor Malone will provide a critical discussion of the implications of these four
studies for the tobacco endgame.
SYM18-1
USING GENOMIC AND EPIGENOMIC VARIATION ASSOCIATED
WITH NICOTINE METABOLISM TO TAILOR TOBACCO
CESSATION TREATMENT IN AMERICAN INDIAN AND ALASKA
NATIVE PEOPLE
Katrina Claw, PhD. University of Colorado Anschutz Medical Campus.
American Indian and Alaska Native (AIAN) people have the highest tobacco use rates in
the United States, with 48.4% of AIAN adults vs. 29.2% of white adults reporting smoking
in 2012. Smoking is associated with a wide range of chronic disease, including cancer,
respiratory, and cardiovascular diseases (CVD). AIAN have higher rates of tobacco-re-
lated disease and death compared to other populations. Nicotine, the primary addictive
substance in cigarettes, is metabolized predominantly by the enzyme cytochrome P450
2A6 (CYP2A6). Dierences in CYP2A6 genotype have been associated with variation
in nicotine metabolism, smoking cessation, and lung cancer risk in various populations,
with the highest nicotine metabolite ratio (NMR), a biomarker of nicotine metabolism
comparing 3-hydroxycotinine to cotinine metabolites, found in AIAN people. Previously,
we have shown that CYP2A6 genotype is associated with the biomarker NMR in AIAN
smokers, and have identied novel and varied frequencies of common CYP2A6 func-
tional variants. However, inter-ethnic variability of nicotine metabolism exists and may
be related to novel genetic/epigenetic loci that contribute to variation in nicotine metab-
olism. Associations between genome/epigenome-wide variation, nicotine metabolism,
and tobacco-related morbidity and mortality in AIAN remain understudied. We identify
novel genetic and epigenetic inuences on nicotine metabolism in AIAN smokers using
a genome-wide approach, and examine the associations with the nicotine metabolite
ratio in AIAN people. Our central hypothesis is that novel genetic/epigenetic loci and
variants associated with NMR in AIAN smokers. We predict that rapid metabolizers of
nicotine will have unique genotypes and epigenetic markers and that this will correlate
with more diculty quitting smoking and increased tobacco-related disease risk. Our
long-term goal is to use a personalized medicine approach prior to the selection of
pharmacotherapy for smoking cessation in order to improve long-term smoking quit
rates in AIAN people who smoke.
FUNDING: Federal
19
2022 Symposia
SYM18-2
ALCOHOL AND TOBACCO POLYGENIC RISK SCORE
PREDICTION WITHIN AND ACROSS DIVERSE ANCESTRIES
Gretchen Saunders, PhD. Psychology, University of Minnesota.
Most genome-wide association studies have been restricted to European only samples.
While polygenic risk scores (PRSs) derived from these GWAS summary statistics can
be applied to non-European ancestral groups, bias is introduced due to divergence from
European ancestries, making their accuracy and utility unclear within diverse groups.
We use summary statistics from the GWAS & Sequencing Consortium on Alcohol and
Nicotine use (GSCAN) of up to 3.4 million individuals from four ancestral groups: African
(AFR), American (AMR), East Asian (EAS), and European (EUR) to generate PRSs for
smoking initiation, cigarettes per day, smoking cessation, age of smoking initiation, and
drinks per week. PRSs were validated in an independent sample of individuals from
the National Longitudinal Study of Adolescent to Adult Health (Add Health; N=2,095
AFR, N=1,305 Hispanic, N=5,994 EUR, N=414 EAS, corresponding roughly to GSCAN
ancestral groups). Predictive accuracy of each PRS was estimated by the change in R2
between base and full models, where base models included sex, age, and the rst 10
principal components, and full models additionally include the PRS. Using EUR-based
summary statistics to predict alcohol and tobacco use in EUR results in incremental
R2 values ranging from 1.2-7.2%. Using summary statistics and validation samples
from the same, matched non-EUR ancestry results in incremental R2 values ranging
from 0.02-0.7% for AFR, 0.1-3.1% for EAS, and 0.3-2.6% for AMR ancestries. The
predictive accuracy of own ancestry PRS in non-EUR groups is similar to, or lower,
than EUR ancestry-based scores. Polygenic prediction in EUR remains higher than in
non-EUR ancestries, likely for several reasons, including large dierences in discovery
and validation sample sizes, lower imputation accuracy, dierences in LD structure, and
phenotypic heterogeneity. Our results highlight the increased prediction accuracy from
the use of multiple ancestry GWAS summary statistics over single ancestry polygenic
scores. We discuss the potential bias of using EUR based scores for prediction in
non-EUR cohorts, as this has implications for disparity in the utility of polygenic scores.
FUNDING: Federal
SYM18-3
GENETIC SCORES AND BIOMARKERS INFORM PRECISION
PREVENTION AND PRECISION TREATMENT
Li-Shiun Chen, MD, MPH, ScD1, Timothy Baker2, Laura Bierut1. 1Washington Univer-
sity School of Medicine, 2University of Wisconsin-Madison School of Medicine and
Public Health.
Introduction: This study aims to evaluate the potential of polygenic scores and biomarkers
to enhance the precision in predicting the benet of smoking cessation in reducing lung
cancer risk and the precision of smoking cessation treatment outcomes. Methods: For
precision prevention, we meta-analyze 18 case-control studies of lung cancer of Euro-
pean ancestry (n = 18,861 ever smokers, 11,621 cases, 7,240 controls). For precision
treatment, we evaluated bio-veried end-of-treatment abstinence among smokers in two
randomized control trials (N=1,898 including 807 in the Genetically Informed Smoking
Cessation Trial (GISC) and 1,091 in the University of Wisconsin Trial). Results: a)
Precision prevention: The polygenic risk score of lung cancer, polygenic risk score of
smoking behaviors, and CHRNA5 rs16969968 were independently associated with the
hazard of lung cancer (HR 1.06 95%CI 1.04-1.08, p=1.71×10-7; HR 1.16, 95% CI 1.11-
1.21, p=3.73×10-10; HR 1.16, 95% CI 1.12-1.2, p=2.93×10-16). Individuals having high
combined genetic risk had a six-year earlier median age of lung cancer compared with
those with low risk. Smoking cessation (former vs. current smokers) was associated with
a lower likelihood of lung cancer (HR = 0.49, 95%CI 0.43-0.55, p = 1.57×10-33), and
an 8-year delay in lung cancer diagnosis. The benecial eects of smoking cessation
were very similar in those at high or low genetic risks. b) Precision treatment: Polygenic
risk scores for delayed age of smoking initiation predict end-of-treatment abstinence
in both trials (meta-analysis OR=1.2, 95%CI=1.04-1.37, p=0.0097, N=1,592 smokers
of European Ancestry). In the GISC trial smokers of both European and non-European
Ancestry, slow nicotine metabolizers respond better to nicotine replacement vs. placebo
(OR=4.7, 95%CI=1.7, 14.9, p=0.0040), but not varenicline vs. placebo. In contrast, va-
renicline produces signicantly higher end-of-treatment abstinence than does nicotine
replacement in normal metabolizers (OR=2.0, 95%CI=1.2-3.3, p=0.0050). Conclusion:
Genetic scores and biomarkers may inform the promise of precision prevention and
precision treatment to reduce the profound health impact of smoking.
FUNDING: Federal
SYM18-4
PREDICTED NICOTINE BIOMARKERS AND TRANSLATIONAL
RESEARCH IN MULTIETHNIC POPULATIONS
Andrew Bergen, PhD1, Carolyn Ervin1, Christopher McMahan2, James Baurley1.
1BioRealm, LLC, 2School of Mathematical and Statistical Sciences, Clemson University.
Background: Smoking remains the largest modiable risk factor for morbidity and
mortality, including populations with social and health disparities. Researchers have
identied genetic contributions to epidemiologic measures of smoking behavior and to
biomarkers of nicotine metabolism and consumption. Measures related to social and
health disparities and smoking outcomes exhibit multiple associations with each other.
Genomics research in multiethnic populations presents opportunities and challenges
in characterizing biological and environmental sources of variation in clinical transla-
tional research. Methods: We developed prediction models of nicotine biomarkers from
genotypes in cigarette smokers using statistical learning. We applied these models
in cessation trial participants to explore the relationships between predicted nicotine
biomarkers and demographics with smoking measures. Results: We identied robust
internal correlations for model ensembles for the urinary total 3-hydroxycotinine and
cotinine ratio (67 percent) and for total nicotine equivalents (65 percent) in cigarette
smokers of multiple ethnicities. Nicotine biomarker model ensemble external validation
demonstrates signicant associations with smoking measures. We designed multiple
models to characterize contributions of demographics and ancestry proportions to asso-
ciations with smoking measures and nicotine biomarkers, and associations of smoking
measures and nicotine biomarlers to abstinence. Conclusion: Smoking measures and
nicotine biomarkers associated with CYP2A6 activity and total nicotine consumption dier
between smokers of dierent races/ethnicities and are associated with smoking related
disparities. Progress in improving smoking outcomes through translational research
will benet from collection, sharing and integrated analyses of diverse genomic and
non-genomic data to characterize biological and environmental contributors to disparities.
FUNDING: Federal
SYM18-5
USE OF GENOMIC RISK TO MOTIVATE BEHAVIORAL CHANGE
AMONG PEOPLE WHO SMOKE
Laura Bierut, MD, Alex Ramsey, Li-Shiun Chen. Washington University School of
Medicine.
Recent scientic advances have revealed how genomic risk information can be used
to predict important health outcomes. Returning genomic susceptibility results to
motivate positive behavior change is an area of potential growth, and the treatment
of cigarette smoking and tobacco use disorder represents a prime area for genomics
implementation. Two genes, CHRNA5 and CYP2A6, are the strongest genomic con-
tributors that alter the risk of heaviness of smoking, successful smoking cessation, and
smoking-related diseases in humans. These genomic biomarkers have proven analytic
and clinical validity, and evidence for their clinical utility continues to grow. We propose
that these biomarkers can enable the identication of elevated disease risk in smokers,
guide the personalization of smoking cessation treatments, and provide motivation for
behavioral changes.We examined the acceptability and behavior change associated
with a personalized genomically-informed risk tool (RiskProle) among current smokers.
Current smokers (n=108) were enrolled. At Visit 1, participants completed a baseline
assessment and genomic testing. At Visit 2, participants received a tailored RiskProle
that communicated personalized risks of smoking-related diseases and evidence-based
recommendations to promote smoking cessation generated from participants’ genomic
data and smoking heaviness. At Visit 3, a follow-up assessment 30 days after interven-
tion measured participants acceptability and understanding of the RiskProle and their
smoking behaviors. Of enrolled participants, 83% were retained across the three study
visits. Acceptability of RiskProle was high; at 30-day follow-up, 89% of participants
demonstrated accurate recall of key intervention messages. At follow-up, cigarettes
smoked per day decreased [11.3 vs. 9.8, dierence=1.5, 95% CI (0.6—2.4), p=.001].
This study demonstrates proof of concept for translating key basic science ndings into
a genomically-informed risk tool that can be implemented to promote progress toward
smoking cessation. Implementing genomic risk in the healthcare setting with patients
and providers has the potential of accelerating smoking cessation.
FUNDING: Federal
20
2022 Symposia
SYM19-1
CHARACTERIZING E-CIGARETTE USE, FLAVORS, AND
REASONS FOR USE BY MENTHOL CIGARETTE STATUS AND
RACE/ETHNICITY AMONG US ADULTS (PATH DATA 2016-2018)
Krysten W. Bold, PhD1, Eugenia Buta2, Asti Jackson3, Sakinah Suttiratana4, Patricia
Simon3, Ralitza Gueorguieva4, Stephanie O’Malley1, Suchitra Krishnan-Sarin3. 1Depart-
ment of Psychiatry, Yale University, 2Yale Center for Analytical Sciences, Yale Univer-
sity, 3Department of Psychiatry, Yale University School of Medicine, 4Yale School of
Public Health.
Background: Menthol cigarette use remains a large public health problem and con-
tributes to tobacco-related health disparities among Black and Hispanic populations.
E-cigarettes are available in a variety of dierent avors, including menthol, and may
be a less harmful substitute for cigarettes among adults who smoke. Yet little is known
about whether e-cigarette avor preference and reasons for use dier by race/ethnicity
among adults who smoke menthol cigarettes. Methods: We used nationally representa-
tive PATH wave 4 adult data (2016-2018) to examine associations between past-month
e-cigarette and menthol cigarette use, overall and by race/ethnicity. We also examined
regular e-cigarette avor used and reasons for e-cigarette use by menthol cigarette
use and race/ethnicity. Results: Overall, rates of current (i.e., past month) e-cigarette
use were higher among adults who smoked menthol cigarettes (22.4%) compared to
non-menthol cigarettes (16.7%), p<.0001. When examined by race/ethnicity, a similar
association was observed for those identifying as Hispanic (p=.004) and non-Hispanic
(NH) White (p<.001), but NH Black adults used e-cigarettes at similar rates regardless
of menthol (14.6%) or non-menthol (14.1%) cigarette use (p=.81). In terms of regular
e-cigarette avor used, NH Black adults reported signicantly higher rates of menthol
or mint e-cigarette use compared to NH whites regardless of menthol cigarette status.
Among those who smoke menthol cigarettes, there were signicant dierences in
reasons for e-cigarette use by race/ethnicity. For example, compared to NH White,
Hispanic individuals were less likely to endorse using e-cigarettes as a way to cut down
on smoking while Black individuals were less likely to endorse liking e-cigarette avors.
Conclusions: E-cigarette use patterns dier by race/ethnicity and menthol cigarette
use. Results can inform e-cigarette regulations by advancing the understanding of the
preferences and use of e-cigarettes among adults who smoke cigarettes.
FUNDING: Federal
SYM19-2
IMPACT OF E-LIQUID FLAVOR ON ABUSE LIABILITY AMONG
NON-HISPANIC BLACK AND WHITE MENTHOL SMOKERS
Eleanor Ladd Schneider Leavens, PhD, Leah Lambert, Nikki Nollen. University of
Kansas Medical Center.
Introduction: As a result of tobacco industry marketing, most non-Hispanic Black
(Black) smokers smoke menthol cigarettes and bear a disproportionate burden of
tobacco-related morbidity and mortality. The recently proposed combustible menthol
ban has the propensity to signicantly reduce tobacco-related disparities. However, it
remains unknown whether inclusion of menthol-avored e-liquid would improve or hinder
public health. No research has directly examined the impact of menthol vs. tobacco
avored e-liquid on acute pu patterns, subjective experience, behavioral intentions,
and craving and withdrawal among diverse menthol smokers. Methods: Black and
White nicotine-deprived menthol smokers (current N = 8; nal N = 10) completed two
in-laboratory 30-minute ad libitum vaping sessions (menthol vs. tobacco avor) in a
double-blind randomized crossover design. Questionnaires assessed reductions in
craving and withdrawal and post-session subjective experience and behavior inten-
tions. Pu topography was measured continuously throughout each vaping session.
Results: Participants showed comparable reductions in craving (tobacco M change =
-42.8, menthol M change = -48.0; p = .283) and withdrawal (tobacco M change = -1.8;
menthol M change = -4.6; p = .111) from pre- and post-session regardless of e-liquid
avor. Similarly, menthol and tobacco avored ECs were rated positively in terms of
subjective eects and intentions for future use (all p > .10). In fact, a majority (63%) of
participants reported a preference for the tobacco-avored e-liquid. Finally, measures
of pu topography did not dier signicantly by e-liquid avor (all p > .40).Discussion:
Among diverse menthol smokers in a lab-based setting, ndings suggest that menthol vs
tobacco e-liquid avor has little impact on pu patterns, subjective experience, intentions
for future use, or craving and withdrawal. Findings have implications for tobacco control
policies and provide initial evidence for implementation of a comprehensive menthol
ban, inclusive of e-cigarettes.
FUNDING: Federal; Academic Institution
SYM19-3
DOES MENTHOL FLAVORING HELP BLACK AND LATINX
ADULT MENTHOL COMBUSTIBLE CIGARETTE SMOKERS
SWITCH TO E-CIGARETTES?: SECONDARY ANALYSES FROM A
RANDOMIZED CLINICAL TRIAL
Nikki Nollen, MA, PhD1, Leah Lambert1, Eleanor Leavens1, Jasjit Ahluwalia2, Myra
Rice3, Kim Pulvers3. 1University of Kansas School of Medicine, 2Brown University School
of Public Health, 3California State University-San Marcos.
SIGNIFICANCE: A ban on menthol cigarettes in the US could have a signicant impact
on public health, but debate continues about whether enforcement priorities inclusive
of menthol avored e-liquids should be enacted. While a ban on menthol avored
e-cigarettes (EC) may reduce youth and young adult initiation, it may also discourage
adult menthol smokers, the majority of whom are racial/ethnic minorities, to switch from
tobacco cigarettes to EC. This could slow harm reduction and widen disparities among
populations already disproportionately burdened by tobacco. METHODS: This study is a
secondary analysis of African American (AA) and Latinx adult menthol smokers enrolled
in the EC arm of a 6-week randomized clinical switching trial (n=68). We compare those
who chose JUUL menthol EC (n=41) to those who chose JUUL non-menthol EC (i.e.,
mint, mango, Virginia tobacco) (n=27) on EC and cigarette use and subjective eects of
vaping to examine whether menthol avoring helps AA and Latinx adult menthol smokers
switch to EC. RESULTS: No statistically signicant dierences were found between
menthol versus non-menthol EC on any of the variables of interest. Specically, 88.0%
of participants who used a non-menthol avored EC fully or partially switched to EC at
week 6 compared to 82.1% of participants who used menthol-avored EC (p=0.75).
Further, both groups demonstrated substantial reductions in CPD from baseline to week
6 (menthol EC: -8.5 + 10.4 versus non-menthol EC: -8.8 + 5.8, p=0.87), comparable
grams of e-liquid consumed, objectively measured via pod weights (menthol EC: 9.2 +
9.8 grams versus non-menthol EC: 11.0 + 11.0 grams, p=.47), and positive subjective
eects, including ‘just right’ throat hit (menthol EC: 70.7% versus non-menthol EC: 66.7%,
p=.93) and ‘just right’ avor liking (menthol EC: 75.6% versus non-menthol EC: 66.7%,
p=.32). CONCLUSIONS: Findings provide preliminary evidence to inform regulatory
action for menthol EC that could slow youth initiation with no resulting negative impact
on switching in adult smokers transitioning to EC and no unintended consequences in
a priority population of AA and Latinx menthol smokers.
FUNDING: Federal
SYM19-4
DISCUSSANT
Suchitra Krishnan-Sarin, PhD. Yale University School of Medicine.
The discussant will synthesize the evidence presented along with new and emerging
data on the impact of e-cigarette avoring on cigarette and e-cigarette use in racial/
ethnic minority smokers. Policy implications and future directions will be discussed.
SYM20-1
DUAL USE OF CIGARETTES AND ENDS IN THE PATH
STUDY: TRANSITIONS IN DUAL USE PATTERNS, NICOTINE
DEPENDENCE, USE TRAJECTORIES, AND CESSATION (2013-
2020)
Nicolette Borek, PhD1, Heather Kimmel, PhD2, and Andrew Hyland, PhD3 on behalf
of the entire PATH Study team. 1FDA Center for Tobacco Products, 2National Institute
of Drug Abuse, 3Roswell Park Comprehensive Cancer Center.
The Population Assessment of Tobacco and Health (PATH) Study collects information
on tobacco-use patterns, risk perceptions, health outcomes, attitudes towards tobacco
products, and tobacco initiation, cessation, and relapse behaviors. This nationally
representative, longitudinal cohort study of approximately 46,000 youth and adults in
the United States began in 2013 with data collection occurring annually or biennially.
This symposium will present ndings on cigarette and electronic nicotine delivery sys-
tem (ENDS) dual use research from the PATH Study using data across Waves 1 to 5
(2013-2019). With the wealth of data collected by this longitudinal study, it is possible
to show how people change their tobacco use over time. The work presented in this
symposium addresses key transitions between cigarette smoking and ENDS across
dierent age groups that adds to our understanding of the public health implications
of these products.This symposium will 1) provide a brief overview and update on the
PATH Study focusing on the timeline, current data collection eorts, and available data;
21
2022 Symposia
2) describe overall use patterns and transitions among adult cigarette and ENDS users;
3) describe nicotine dependence among youth cigarette and ENDS users; 4) describe
cigarette and ENDS susceptibility and use trajectories in both youth and young adults;
and 5) describe the role of ENDS in quitting cigarettes among adult smokers. Dr. Ann
McNeill will serve as Symposium Discussant to summarize the PATH Study research
presented within the context of similar research conducted internationally.
FUNDING: Federal
SYM20-2
TRANSITIONS IN CIGARETTE/ENDS DUAL USE PATTERNS
AMONG ADULTS IN THE UNITED STATES, 2016 – 2019
Eva Sharma, PhD, MPH. Westat.
The Population Assessment of Tobacco and Health (PATH) Study collects information
on tobacco-use patterns, risk perceptions, health outcomes, attitudes towards tobacco
products, and tobacco initiation, cessation, and relapse behaviors. This nationally
representative, longitudinal cohort study of approximately 46,000 youth and adults in
the United States began in 2013 with data collection occurring annually or biennially.
This symposium will present ndings on cigarette and electronic nicotine delivery sys-
tem (ENDS) dual use research from the PATH Study using data across Waves 1 to 5
(2013-2019). With the wealth of data collected by this longitudinal study, it is possible
to show how people change their tobacco use over time. The work presented in this
symposium addresses key transitions between cigarette smoking and ENDS across
dierent age groups that adds to our understanding of the public health implications
of these products.This symposium will 1) provide a brief overview and update on the
PATH Study focusing on the timeline, current data collection eorts, and available data;
2) describe overall use patterns and transitions among adult cigarette and ENDS users;
3) describe nicotine dependence among youth cigarette and ENDS users; 4) describe
cigarette and ENDS susceptibility and use trajectories in both youth and young adults;
and 5) describe the role of ENDS in quitting cigarettes among adult smokers. Dr. Ann
McNeill will serve as Symposium Discussant to summarize the PATH Study research
presented within the context of similar research conducted internationally.
FUNDING: Federal
SYM20-3
INDICATORS OF TOBACCO DEPENDENCE AMONG YOUTH IN
THE UNITED STATES, 2013
David R. Strong, PhD. University of California, San Diego.
The Population Assessment of Tobacco and Health (PATH) Study collects information
on tobacco-use patterns, risk perceptions, health outcomes, attitudes towards tobacco
products, and tobacco initiation, cessation, and relapse behaviors. This nationally
representative, longitudinal cohort study of approximately 46,000 youth and adults in
the United States began in 2013 with data collection occurring annually or biennially.
This symposium will present ndings on cigarette and electronic nicotine delivery sys-
tem (ENDS) dual use research from the PATH Study using data across Waves 1 to 5
(2013-2019). With the wealth of data collected by this longitudinal study, it is possible
to show how people change their tobacco use over time. The work presented in this
symposium addresses key transitions between cigarette smoking and ENDS across
dierent age groups that adds to our understanding of the public health implications
of these products.This symposium will 1) provide a brief overview and update on the
PATH Study focusing on the timeline, current data collection eorts, and available data;
2) describe overall use patterns and transitions among adult cigarette and ENDS users;
3) describe nicotine dependence among youth cigarette and ENDS users; 4) describe
cigarette and ENDS susceptibility and use trajectories in both youth and young adults;
and 5) describe the role of ENDS in quitting cigarettes among adult smokers. Dr. Ann
McNeill will serve as Symposium Discussant to summarize the PATH Study research
presented within the context of similar research conducted internationally.
FUNDING: Federal
SYM20-4
ADOLESCENT TO YOUNG ADULT E-CIGARETTE AND CIGARETTE
USE TRAJECTORIES IN THE UNITED STATES, 2013 – 2020
Cassandra A. Stanton, PhD. Westat.
The Population Assessment of Tobacco and Health (PATH) Study collects information
on tobacco-use patterns, risk perceptions, health outcomes, attitudes towards tobacco
products, and tobacco initiation, cessation, and relapse behaviors. This nationally
representative, longitudinal cohort study of approximately 46,000 youth and adults in
the United States began in 2013 with data collection occurring annually or biennially.
This symposium will present ndings on cigarette and electronic nicotine delivery sys-
tem (ENDS) dual use research from the PATH Study using data across Waves 1 to 5
(2013-2019). With the wealth of data collected by this longitudinal study, it is possible
to show how people change their tobacco use over time. The work presented in this
symposium addresses key transitions between cigarette smoking and ENDS across
dierent age groups that adds to our understanding of the public health implications
of these products.This symposium will 1) provide a brief overview and update on the
PATH Study focusing on the timeline, current data collection eorts, and available data;
2) describe overall use patterns and transitions among adult cigarette and ENDS users;
3) describe nicotine dependence among youth cigarette and ENDS users; 4) describe
cigarette and ENDS susceptibility and use trajectories in both youth and young adults;
and 5) describe the role of ENDS in quitting cigarettes among adult smokers. Dr. Ann
McNeill will serve as Symposium Discussant to summarize the PATH Study research
presented within the context of similar research conducted internationally.
FUNDING: Federal
SYM20-5
ENDS USE AMONG ADULT CIGARETTE SMOKERS WITH NO
PLANS TO EVER QUIT SMOKING IN THE UNITED STATES, 2014 –
2019
Karin Kasza, PhD. Roswell Park Comprehensive Cancer Center.
The Population Assessment of Tobacco and Health (PATH) Study collects information
on tobacco-use patterns, risk perceptions, health outcomes, attitudes towards tobacco
products, and tobacco initiation, cessation, and relapse behaviors. This nationally
representative, longitudinal cohort study of approximately 46,000 youth and adults in
the United States began in 2013 with data collection occurring annually or biennially.
This symposium will present ndings on cigarette and electronic nicotine delivery sys-
tem (ENDS) dual use research from the PATH Study using data across Waves 1 to 5
(2013-2019). With the wealth of data collected by this longitudinal study, it is possible
to show how people change their tobacco use over time. The work presented in this
symposium addresses key transitions between cigarette smoking and ENDS across
dierent age groups that adds to our understanding of the public health implications
of these products.This symposium will 1) provide a brief overview and update on the
PATH Study focusing on the timeline, current data collection eorts, and available data;
2) describe overall use patterns and transitions among adult cigarette and ENDS users;
3) describe nicotine dependence among youth cigarette and ENDS users; 4) describe
cigarette and ENDS susceptibility and use trajectories in both youth and young adults;
and 5) describe the role of ENDS in quitting cigarettes among adult smokers. Dr. Ann
McNeill will serve as Symposium Discussant to summarize the PATH Study research
presented within the context of similar research conducted internationally.
FUNDING: Federal
SYM21-1
EXPERIENCE IN IMPLEMENTING AN OPT-OUT SMOKING
CESSATION SERVICES AT THE MEDICAL UNIVERSITY OF SOUTH
CAROLINA
K. Michael Cummings, PhD, MPH, Benjamin Toll, Graham Warren. Medical Univer-
sity of South Carolina.
Signicance: In 2014, the Medical University of South Carolina (MUSC) adopted a
policy that required all adults seen in MUSC health care facilities to be screened for
tobacco use with referral to an evidence-based treatment for patients who currently
smoke cigarettes. This presentation describes the services we’ve implemented for
hospitalized patients, oncology outpatients, and home discharged emergency depart-
ment (ED) patients.Methods: Electronic health records are utilized across MUSC health
care system to dene the prevalence of smoking in the following groups: 1) hospitalized
22
2022 Symposia
patients seen in MUSC’s ve hospitals; 2) patients seen in MUSC inpatient psychiatric
hospital; 3) patients seen in 44 MUSC aliated oncology clinics, and 4) home discharged
ED patients. Response to the oer of evidence-based treatment is tracked for people
who currently smoke cigarettes in each patient group. Follow-up data collected to as-
sess receipt of smoking cessation treatments, smoking status, and clinical outcomes
(unplanned hospital admissions, and downstream health care costs) are presented.
Results: Cigarette smoking prevalence rates the four patient groups were as follows:
1) hospitalized patients – 18% (range 12% to 30%); 2) psychiatric inpatients – 45%;
3) oncology outpatients – 9%; and 4) ED patients – 21%. Acceptance of the oer of
smoking cessation treatment were as follows: 1) hospitalized patients – 82% (range:
70%-100%); 2) psychiatric inpatients – 49%; 3) oncology outpatients – 53%; and 4) ED
patients – 22%. Most hospitalized patients relapse back to smoking after discharge,
although exposure to the treatment service doubled quit rates at 1-month. About 20% of
oncology outpatients-report not smoking at 6-months. A retrospective records study of
showed that exposure to inpatient hospital service was associated with a 9% reduction
in unplanned hospital readmissions and lower health care expenditures 12-months
after discharge from the hospital. Conclusions: Using electronic health records and
an automated process for tracking and in some cases delivering treatment options to
people who smoke is feasible to do and appears to be cost-eective.
FUNDING: Academic Institution
SYM21-2
SCALING OF OPT-OUT APPROACHES TO SMOKING CESSATION
IN CANCER CARE: EXAMPLES AT THE INSTITUTIONAL,
REGIONAL, AND NATIONAL LEVELS
Graham Warren, MD, PhD. Medical University of SC.
Smoking cessation in cancer care can improve survival, but evidence-based support is
not routinely provided. “Opt-out” could improve cancer treatment outcomes by increas-
ing access to evidence-based support, but resources, partnerships, expectations, and
outcomes can vary according to scale. Institutional implementation of ‘opt-out’ smoking
cessation was successfully achieved through consensus of design by an institutional
panel, designing annotated structured assessments, identifying key clinical partnerships,
securing medical need and institutional nancial commitment, obtaining dedicated in-
formation technology support, and maintaining regular communication between clinical
sta and cessation counselors. Regional implementation for community cancer centers
statewide required advancing approaches to obtain buy-in and commitment from state-
wide health programs, insurers, the state quitline, and academic partners. Organization
and logistical support was provided to develop centralized common information and
materials, short-term nancial incentives to support implementation, regular regional
network meetings, and coordination of site specic needs to identify tobacco use and
provide common referral mechanisms within each clinical setting. National implemen-
tation required further advancement including a national vision statement, structured
long-term nancial support, centralized expertise to assist in program design, well-de-
ned performance objectives within each province, nancial and experiential support
for national network meetings, assistance identifying and utilizing existing provincial
resources, centralized assistance for denitions of reach and eectiveness, and coor-
dinating achievable province-level performance objectives. Institutional implementation
occurred with >90% assessment and referral over 1-2 years. Regional implementation
occurred with over 80% referral over 2-3 years. National implementation occurred
over 5 years increasing access to care to 87%. Sustainability across all levels remains
challenged by common elements of sustained clinical buy-in, nancial support, and
concerns for reimbursement vs. cost savings in cancer care.
FUNDING: Federal; Academic Institution
SYM21-3
THE IMPACT OF CHANGING THE DEFAULT FOR HOSPITAL
TOBACCO TREATMENT ON PATIENT PERCEPTIONS,
TREATMENT UTILIZATION, AND ABSTINENCE
Kimber P. Richter, PhD, MPH1, Delwyn Catley2, Byron J. Gajewski1, Edward F. Eller-
beck1, Babalola Faseru1, Taneisha Scheuermann1, Laura M. Mussulman1, Niaman
Nazir1, Chauanwu Zhang3, Laura E. Martin1, Elena Shergina1. 1University of Kansas
Medical Center, 2Children’s Mercy Kansas City, 3Sano, Waltham, Massachusetts.
The current treatment default requires tobacco users to “opt in” to care by arming they
are willing to quit. This population-based Bayesian adaptive trial compared the eects
of opt-out care—presumptively providing medications/quit support to all—versus opt-in
care for smokers in a hospital setting. To minimize selection bias the study randomly
selected hospital smokers for inclusion, randomized/treated all eligible smokers, and
conducted delayed consent at 1-month follow up. The primary outcome was cessation
at 1-month post-discharge (dc). At hospital bedside, counselors screened for eligibility,
conducted baseline assessment, randomized patients to study arm, and provided opt-
out or opt-in care as randomized. Counselors/medical sta provided opt-out patients
with inpatient NRT, scripts for post-dc medications, a 2-week medication starter kit,
inpatient counseling/treatment planning, and 4 outpatient counseling calls. Patients
could opt out of any or all elements of care. Opt-in patients willing to quit were oered
each element of treatment described above. Opt-in patients unwilling to quit received
brief “5R” based counseling. Most (74%) of 1,000 randomized patients consented and
enrolled at 1-month follow up. Adaptive randomization assigned 64% to Opt-out and 36%
to Opt-in. Veried quit rates for Opt-out vs Opt-in were 22% vs 16% at month 1 and 19%
vs 18% at 6 months. The Bayesian posterior probability (BPP) that Opt-out outperformed
Opt-in was .97 at 1 month and .59 at 6 months. ITT analysis of all randomized yielded
similar BPPs. Treatment utilization for Opt-out vs Opt-in was 60% vs 34% for post-dc
cessation medication (Cohen’s d=0.59), and 89% vs 37% for completing >1 post-dc
counseling call (Cohen’s d=1.44). Opt-out patients reported stronger therapeutic alliance
with providers (3.4 vs 3.2, 4-pt scale, Cohen’s d=0.31). Opt-out care achieved better
1-month quit rates and increased the reach of evidence-based treatment by providing
more cessation-oriented care to more smokers. Rather than alienating smokers, Opt-
out care strengthened therapeutic alliance. Future trials should examine the impact of
periodic follow-up to improve long-term cessation.
FUNDING: Federal; Academic Institution
SYM21-4
A BEHAVIORAL ECONOMIC INTERVENTION TO INCREASE
PSYCHIATRIST ADHERENCE TO TOBACCO TREATMENT
GUIDELINES: A PROVIDER-RANDOMIZED TRIAL
Erin S. Rogers, BS, MPH, DrPH1, Christina Wysota1, Judith J. Prochaska2, Craig
Tenner3, Joanna Dognin3, Binhuan Wang1, Scott E. Sherman4. 1New York University
School of Medicine, 2Stanford University, 3VA NY Harbor Health Care System, 4New
York University School of Medicine, VA NY Harbor Healthcare System.
Background: People with psychiatric diagnoses are rarely treated for tobacco use.
Health care systems often use a “no treatment” default for tobacco, such that providers/
patients must actively choose (opt-in) to treat. Behavioral economics suggests that
opt-in systems may reinforce the status quo of not treating tobacco use in marginalized
populations, including those with psychiatric conditions. We conducted a pilot type III
hybrid eectiveness-implementation study to assess the feasibility and impact of an
opt-out system at increasing tobacco treatment rates and quitting in outpatient mental
health clinics.Methods: We used a cluster-randomized study design and implemented
a tobacco use clinical reminder in the electronic health record (EHR) at two Veterans
Health Administration mental health clinics. Psychiatrists (N = 21) were randomized
to: (1) Opt-In System: Psychiatrists received a reminder that encouraged them to oer
cessation medications and referral to counseling or (2) Opt-Out System: Psychiatrists
received a reminder that automated a nicotine replacement therapy (NRT) order and
a referral to counseling that could be cancelled. Psychiatrists in both arms received
tobacco treatment training. We used EHR data to calculate the percent of smokers seen
by a participating psychiatrist who were provided cessation treatment. We conducted
surveys with 140 patients who saw a participating psychiatrist within 48 hours of their
visit and 6 months later to assess use of treatment and self-reported 7-day abstinence.
Results: During the 1-year intervention, psychiatrists in the Opt-Out group were 3
times more likely to refer patients to counseling (17.5% vs. 5.9%, P < 0.001) and 1.8
times more likely to order NRT for patients (26.7% vs. 16.7%, P = 0.01). Patient-level
outcomes were promising, with 80% of patients who saw a psychiatrist in the Opt-Out
group making a quit attempt (versus 61% in the Opt-In group) and 15% of patients
reported abstinence at 6-months (versus 6% in the Opt-In group).Discussion: The
opt-out system was feasible and eective at increasing the rates at which psychiatrists
treat their patients for smoking.
FUNDING: Federal
SYM21-5
EXPANSION OF TOBACCO CESSATION TREATMENT WITHIN THE
STANFORD CANCER INSTITUTE
Judith J. Prochaska, PhD MPH1, Amy Chieng1, Maura Chandler2, Cindy Tran2, Brittany
Pike2. 1Stanford University, 2Stanford Health Care.
Background: In 2018 and 2020, Stanford Cancer Insitute received Moonshot P30
Supplements to integrate, evaluate, and expand evidence-based tobacco cessation
treatment into cancer care. The funding and technical and peer support from the C3I
23
2022 Symposia
collaboration has been instrumental in extending Stanford’s tobacco treatment service
into 20+ clinics across 3 cancer centers. Patient outcomes are being evaluated at 6- and
24-months follow-up. Aims: The Stanford tobacco treatment service aims to 1) sustain a
100% identication and referral rate of patients who use tobacco, 2) engage at least 30%
of referred patients into tobacco treatment, 3) support patients’ long-term abstinence,
and 4) serve as a national model. Methods: All patients identied as currently using
tobacco by the oncology care team are automatically referred for tobacco treatment (i.e.,
opt-out model). Providers briey advise cessation and inform patients that a tobacco
treatment specialist (TTS) will call within a week. The TTS oers patients a menu of
telehealth services including: a) cessation medication consultation with home-delivery;
b) behavioral counseling; c) virtual reality mindful exposure therapy; and d) e-referrals
(state quitline, smokefree.gov). Group and individualized counseling are provided by
supervised clinical psychology doctoral students in a clerkship model.Results: From
January 2019 – July 2021, 3,002 patients who use tobacco have been referred (100%),
2214 patients (74%) were reached by phone, and 704 patients (32%) have engaged
in cessation treatment. Patient outcomes, obtained on > 70% of patients engaged in
treatment, indicate 30% are tobacco-free at 6-months and 25% at 24-months; 70%
of patients would recommend the program to others. Conclusion: As part of the C3I
collaboration, the Stanford Cancer Institute’s integrated tobacco treatment service is
meeting its aims with high patient satisfaction. Weekly team huddles monitor process
and progress; a dedicated TTS and student training model enable personalized outreach
for engagement. New initiatives are piloting telehealth group-based care and novel
treatment technologies.
FUNDING: Federal
24
Notes
25
Notes
26
2022 Paper Sessions
PAPER SESSION 1: ENGAGING IN
SYSTEMS SCIENCE TO REDUCE
TOBACCO-RELATED HEALTH DISPARITIES
AND PROMOTE EQUITY
POD1-1
REDUCING RURAL TOBACCO DISPARITY: A LOW BURDEN
POINT OF CARE MODEL
Li-Shiun Chen1, Justin Yu2, Nina Smock2, Giang Pham2, Jingling Chen2, Alex Ramsey1,
Patricia Cavazos-Rehg2, Aimee James2. 1WA University School of Medicine, St. Louis,
MO, USA, 2Washington University School of Medicine, St. Louis, MO, USA.
Signicance: There are few trained providers, high rates of poverty, and remote lo-
cations in rural communities resulting in health inequalities and limited healthcare. To
address high unmet needs and health costs from tobacco use in rural populations with
resource constraints, this study provides data on the eect of a low-burden point of
care treatment model for tobacco use treatment in rural health centers. Methods: We
compared tobacco use and treatment in urban vs. rural healthcare systems. To design
and implement Electronic Health Record-Enabled Evidence-Based Smoking Cessation
Treatment (ELEVATE), a point-of-care model, we conducted needs assessment with
patient (N=186) and provider surveys (N=37 doctors, nurse practitioners, nurses, and
medical assistants). Pre/post and Quasi-experimental comparisons assessed reach of
the smoking cessation program in two rural primary care clinics, implemented in No-
vember of 2020. Results: (a) Rural disparity: We found a higher smoking prevalence
in the rural healthcare system than the urban healthcare system (21.1% vs. 14.6%,
z=42.5, N=78,792 vs. 562,272 patients, p<0.0001). (b) Survey results in rural health-
care: Patient survey showed a great need for tobacco treatment during point of care in
rural health centers. Most patients (80%) expressed high interest in receiving tobacco
treatment during their regular primary care visits. In provider survey, most providers
(92%) desired EHR tools to support their ecient oering of tobacco treatment. (C) Pre-
Post comparison: Six-month pre- and post-implementation data were compared. The
percentage of smokers receiving medications increased from 6.4% to 9.4% (N=2,044
vs. 1,967 patient smokers, z=3.52, p=0.00043). The percentage of smokers oered
referral to additional counseling increased from 0% to 5.6% (N=2,044 vs. 1,967 patient
smokers, z=10.8, p<0.0001). Conclusion: These results on a low-burden point of care
treatment model suggest the use of a new care paradigm to reduce the rural disparity
related to limited resources. This work may inform pragmatic strategies for many rural
health clinics where tobacco treatment is currently sub-optimal.
FUNDING: Federal; Academic Institution
POD1-2
RECIPROCAL BENEFITS OF LUNG CANCER SCREENING AND
TOBACCO TREATMENT ON UPTAKE AND EQUITY OF PRIMARY
AND SECONDARY PREVENTION
Alex Ramsey1, Christine Doroshenko1, David Gierada1, Ruben Nava1, Anne Stilinovic2,
Foluso Ademuyiwa1, Li-Shiun Chen1, Laura Bierut1. 1Washington University School of
Medicine, St. Louis, MO, USA, 2BJC HealthCare, St. Louis, MO, USA.
Signicance: There has been increased focus on the importance of integrating lung
cancer screening (LCS) and tobacco treatment (TT), yet research has not examined
the potential synergistic eects of this integration on uptake and equity of primary and
secondary prevention eorts. This study investigates two scientic gaps: (1) the extent
to which LCS settings can extend the reach of TT, both overall and among Black patients
who smoke, and (2) the extent to which engagement in TT via LCS programs predict
patient adherence to repeat follow-up LCS visits, both overall and among Black patients
who smoke. Methods: We accessed data from our comprehensive cancer center’s Lung
Cancer Screening Program dataset between 09/2016-02/2021. To address the rst gap,
we analyzed cross-sectional data on TT at initial LCS visits among patients who smoke
(N=1444). To address the second gap, we analyzed longitudinal data on adherence to
the next repeat LCS visit among patients who were ordered a follow-up screening that
was due more than 3 months prior to analysis (N=1090). Results: Role of LCS on TT
reach: We observed large unmet need and demand for TT, particularly among Black
patients; although 72% were interested in quitting smoking and 61% desired treatment,
only 20% were receiving treatment. At the initial LCS visit, 22% received TT counseling
or referral, substantially extending the reach of TT among LCS patients. Role of TT
on LCS adherence: Only 43% of patients who received a 12-month follow-up LCS
order attended that repeat screening, and Black patients were less likely than White
patients to attend this follow-up screening. Among all patients who smoke, adherence
to 12-month follow-up was only 38% when no TT was provided but increased to 53%
when TT was provided. Among Black patients who smoke, adherence to 12-month
follow-up was only 35% when no TT was provided but increased to 50% when TT was
provided. Conclusion: LCS and TT may have synergistic eects on reducing current
gaps in uptake and equity associated with both services. These ndings document the
importance of LCS to boost the reach of TT and the potential role of TT in increasing
adherence to annual LCS.
FUNDING: Federal
POD1-3
EVALUATING THE EFFICIENCY OF TOBACCO TREATMENT
PROGRAMS IN THE CANCER MOONSHOT CANCER CENTER
CESSATION INITIATIVE: DATA ENVELOPMENT ANALYSIS
Ramzi G. Salloum1, Sarah D. Hohl2, Margaret S. Nolan2, Heather D’Angelo3, Yasmin
Asvat4, Li-Shiun Chen5, Andrew T. Day6, Adam Goldstein7, Brian Hitsman8, Deborah
Hudson9, Andrea King10, Cho Lam11, Katie Lenho12, Arnold Levinson 13, Cary Presant14,
Judith Prochaska15, Kimberly A. Shoenbill16, Kathryn Taylor17, Hilary Tindle18, Elisa
Tong19, Justin S. White20, Graham Warren21, Michael Fiore22, Betsy Rolland2. 1University
of Florida, Gainesville, FL, USA, 2University of Wisconsin, Madison, WI, USA, 3University
of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 4Rush Univer-
sity, Chicago, IL, USA, 5WA University School of Medicine, St. Louis, MO, USA, 6UT
Southwestern, Dallas, TX, USA, 7University of NC, Chapel Hill, NC, USA, 8Northwestern
University, Chicago, IL, USA, 9Indiana University, Indianapolis, IN, USA, 10University
of Chicago, Chicago, IL, USA, 11Hunstman Cancer Institute, Salt Lake City, UT, USA,
12Dartmouth University, Lebanon, NH, USA, 13CO School of Public Health, Aurora, CO,
USA, 14City of Hope Cancer Center, Duarte, CA, USA, 15Stanford University, Stanford,
CA, USA, 16University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 17George-
town University Medical Center, WA, DC, USA, 18Vanderbilt University, Nashville, TN,
USA, 19University of California Davis, Sacramento, CA, USA, 20University of California
San Francisco, San Francisco, CA, USA, 21Medical University of SC, Charleston, SC,
USA, 22Center for Tobacco Research and Intervention, Madison, WI, USA.
Signicance: The Cancer Center Cessation Initiative (C3I) is an NCI Cancer Moonshot
Program that supports cancer centers in developing tobacco treatment programs for
oncology patients who smoke. C3I-funded centers have implemented evidence-based
programs that t their institutional resources and needs, oering a variety of components
including cessation counseling, quitline referrals, interactive voice response systems,
web- and text-based services, and medications. While evaluation of implementation
outcomes in the C3I is guided by RE-AIM, little is known about technical eciency - i.e.,
how inputs (e.g., program costs, sta time) inuence implementation outcomes (e.g.,
reach, eectiveness). This study demonstrates the application of data envelopment
analysis (DEA) as an implementation science tool to evaluate the technical eciency
of C3I programs. Such information will advance understanding about where and how to
prioritize implementation resources.Methods: DEA is a linear programming technique
widely-used in economics and engineering for measuring the relative performance of
production units. Output-oriented DEA was applied to model technical eciency, mea-
sured as the proportion of observed output to benchmarked output for given input levels.
The models used the variable returns-to-scale specication and featured cost-per-par-
ticipant, total full-time equivalent (FTE) eort and tobacco treatment specialist eort as
model inputs, and reach and eectiveness (quit rates) as outputs, using data from 15
C3I-funded centers reported in 2020.Results: In the DEA model featuring cost-per-par-
ticipant (input) and reach/eectiveness (outputs), programs providing treatment to ≥200
patients in a 6-month reporting period had higher eciency scores (range, 0.26-0.60),
compared to programs serving <200 patients (range, 0.05-0.21). A similar pattern was
observed in the FTE/TTS (inputs) and reach/eectiveness (outputs) models. Thus,
patterns in eciency were associated with economies of scale - i.e., as programs grow
and engage more patients who smoke, they become more ecient.Conclusion: This
study suggests DEA is a novel implementation science tool for measuring eciency by
demonstrating its appropriateness and feasibility to evaluate the relative performance
PODIUM PRESENTATION 1
27
2022 Paper Sessions
of C3I programs. DEA makes it possible to evaluate programs on the levels of outputs
they achieve relative to their input levels by dening a program’s relative eciency
status compared with the benchmarked group.
FUNDING: Federal
POD1-4
PROJECT SUN A CULTURALLY ADAPTED SMOKING CESSATION
CURRICULUM FOR AMERICAN INDIAN YOUTH
Claradina Soto, Guadalupe Ramos. University of Southern California, Los Angeles,
CA, USA.
Signicance: American Indian Alaska Native (AIAN) youth have the highest prevalence
of cigarette and other commercial tobacco product use compared to other ethnic/racial
groups in the U.S. Because tobacco use can lead to premature morbidity and mortality,
eective and culturally informed commercial tobacco product cessation programs for
AIAN youth are needed. Methods: This project studied the development, implemen-
tation, and impact of a culturally adapted version of Project EX, an evidence-based
intervention for teen smoking cessation. University and community agency partnerships
were established to coordinate the implementation of the program. Implementation
challenges resulted in a change from a three-arm to a single-arm trial. These challeng-
es related to mistrust of research institutions and research processes (e.g., collecting
specimens), competing work demands among agency sta who were also part of the
implementation process, and limited AIAN leadership support. Results: AIAN youth (N =
37) participated in an eight-week curriculum, and intent-to-treat analysis with biochemical
validation results indicated that 32% of youth quit smoking at the three-month follow-up.
Conclusion: Participants reported being satised with the program overall and enjoy-
ing the culturally adapted activities. This study also detailed the program’s adaptation
process and lessons learned during the implementation process. The lessons learned
include: incentivizing individuals who assist with implementation (even if they agree to
volunteer), limit the number of assessments utilized, and present an alternative to a
randomized controlled trial design (e.g., waitlist control) given that AIAN practices tend
to oppose exclusionary practices (as attributed to the use of control groups).
FUNDING: State; Academic Institution
POD1-5
CAN INPATIENT PHARMACISTS MOVE THE NEEDLE
ON SMOKING CESSATION? EVALUATING REACH AND
REPRESENTATIVENESS OF A PHARMACIST-LED OPT-OUT
SMOKING CESSATION INTERVENTION PROTOCOL FOR
HOSPITAL SETTINGS
Paul D. Creswell1, Danielle E. McCarthy1, Philip J. Trapskin2, Ann Sheehy3, Amy
Skora1, Rob T. Adsit1, Mark E. Zehner1, Timothy B. Baker1, Michael Fiore1. 1University
of Wiscosnin Center for Tobacco Research & Intervention, Madison, WI, USA, 2Univer-
sity of Wisconsin School of Pharmacy, Madison, WI, USA, 3University of Wisconsin
School of Medicine & Public Health, Madison, WI, USA.
Objective: Hospitalization aords an opportunity to reduce smoking, but fewer than half
of patients who smoke receive evidence-based cessation treatment during inpatient
stays. This study evaluates a pharmacist-led, electronic health record (EHR)-facilitat-
ed, opt-out smoking cessation intervention designed to address this need. Methods:
Analyses of EHR records of adult patients who smoked in the past 30 days admitted
to an academic medical center in the upper Midwest were conducted using the Reach
Eectiveness Adoption Implementation Maintenance (RE-AIM) framework. The reach
of a pharmacist-led, EHR-facilitated protocol for smoking cessation treatment was
assessed by comparing patients’ receipt of nicotine replacement therapy (NRT) and
tobacco quitline referral pre- and post-implementation. Chi-square tests, t-tests, and
multiple logistic regression models compared reach across patient demographic groups
to assess treatment disparities and representativeness of reach. Adoption of the program
by hospital services was also assessed. Results: Of the 70 hospital services invited to
implement the program, 88.6% adopted it and 78.6% had eligible admissions. Treat-
ment reach increased as rates of delivering NRT rose from 43.6% of eligible patients
pre-implementation to 50.4% post-implementation (p<0.0001) and quitline referral
rates rose from 0.9% to 11.9% (p<0.0001). Representativeness of reach by sex and
ethnicity improved post-implementation, although disparities by race and age persisted
after adjustment for demographics, insurance, and primary diagnosis. Pharmacists
addressed tobacco use for eligible patients in 62.5% of cases post-implementation.
Conclusions: Smoking cessation treatment reach and representativeness of reach
improved after implementation of a proactive, pharmacist-led, EHR-facilitated opt-out
smoking cessation treatment protocol in adult inpatient services.
FUNDING: Federal
POD1-6
SUSTAINING INPATIENT TOBACCO TREATMENT MEASURES
OUTCOMES DURING COVID-19 VIA EVIDENCE-BASED
TREATMENTS, ELECTRONIC HEALTH RECORD SOLUTIONS, AND
HIGH RELIABILITY ORGANIZATION PRINCIPLES
Dawn Floi Johnson1, Justin Iannello2. 1James A. Haley Veterans’ Hospital, Tampa,
FL, USA, 2Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.
SIGNIFICANCE: Research has shown that most people attempting to quit tobacco do
not utilize evidence-based treatments (EBTs) which leads to low rates of cessation and
multiple quit attempts. To address barriers to evidence-based tobacco cessation care,
The Joint Commission implemented inpatient tobacco treatment measures (TTMs) in
2012 to ensure integration of EBTs for tobacco users in the inpatient setting and co-
ordination of care with outpatient tobacco cessation experts. In 2016, James A. Haley
Veterans’ Hospital (JAHVH) was underperforming in the inpatient TTMs outcomes and an
interdisciplinary quality improvement (QI) team was given the task to address. The team
focused on development of a tobacco cessation care delivery program which included
standardized pathways within the Veterans Health Administrative electronic health record
(EHR) system to improve nicotine replacement therapy ordering, EBT counseling, and
improved care coordination. There was a 300% improvement in tob20 and tob40 (also
known as TOB-2 and TOB-3 within The Joint Commission’s ORYX inpatient TTM subset)
from FY 2016 through FY 2019. The 2020 COVID-19 pandemic led to an unprecedented
shift in organizational resources within the facility and resulted in a loss of progress in
the measures in particular tob40 declining to as low as 65.71% FY 2020, Quarter 3.
METHODS/RESULTS: After interdisciplinary QI team assessment, sta reassignments
during the pandemic were felt to be a primary contributor to a decline in the inpatient
TTMs outcomes. The integration of High Reliability Organization (HRO) principles
led to process modications which resulted in tob40 improvement to pre-pandemic
levels at 94.69% FY 2021 year to date. In addition, tob20 eorts have been sustained
at 97.95% FY 2021 year to date. CONCLUSIONS: The implementation of a tobacco
cessation care delivery program in 2016 consisting of EBTs, EHR solutions, and care
coordination allowed JAHVH to adapt to the unparalleled challenges of the COVID-19
pandemic via the integration of HRO principles resulting in sustained improvement in
the inpatient TTMs. This model may be an eective approach for delivery of tobacco
cessation care at other hospital systems.
FUNDING: Unfunded
28
2022 Paper Sessions
PAPER SESSION 2: RAPID FIRE:
DEVELOPING AND EVALUATING RISK
MESSAGES
POD2-1
DEVELOPING GRAPHIC MESSAGES FOR VAPING PREVENTION
AMONG BLACK AND LATINO ADOLESCENTS
Francisco Cartujano-Barrera, Chiamaka Azogini, Scott McIntosh, Deborah Ossip,
Ana Paula Cupertino. University of Rochester Medical Center, Rochester, NY, USA.
Background: As an important transition stage in human development, adolescence
is a critical window for vaping prevention. There is a substantial gap in communication
research for vaping prevention among racial and ethnic minority groups. Their repre-
sentation is essential to develop, implement, and disseminate innovative and eective
interventions for vaping prevention.Objective: Describe the participatory research (PR)
procedures with Black and Latino adolescents to develop culturally and linguistically
appropriate graphic messages for vaping prevention.Methods: This PR study utilized
a user-centered design method. We conducted a series of focus groups with sixteen
Black and Latino adolescents to develop culturally and linguistically appropriate graphic
messages for vaping prevention. The Biobehavioral Model of Nicotine Addiction provided
a framework for the development of the graphic messages. Participants met four times
each to provide iterative feedback on the graphic messages until reaching a consensus
on overall quality and content. Results: At baseline, participants’ mean age was 15.4
years old (SD 1.4), 50% were female, 87.5% were heterosexual, 56.3% were Black
or African American, and 43.8% were Hispanic or Latino. Twelve participants (75%)
chose to participate in the English sessions. Participants decided to create four types
of graphic messages: 1) nancial reward, 2) health reward, 3) social norms, and 4)
self-ecacy. Meeting four times with the four groups provided sucient opportunities
for iterative feedback on the graphic messages for reaching a consensus on overall
quality and content.Conclusions: It is feasible and practical to build PR among Black
and Latino adolescents focused on vaping prevention. Adolescents added innovation
and creativity to the development of culturally and linguistically appropriate graphic
messages for vaping prevention. Appropriate stang, funding, and approaches are
key eorts to PR among Black and Latino adolescents. Future research is needed to
evaluate the impact of the graphic messages for vaping prevention.
FUNDING: Federal
POD2-2
COGNITIVE RESPONSES TO PICTORIAL WARNING LABELS
AND THEIR ASSOCIATION WITH QUITTING MEASURES AFTER
CONTINUED EXPOSURE
Anupreet Sidhu1, Andrea C. Johnson1, Valentina Souprountchouk1, Olivia Wackowski2,
Andrew Strasser1, Melissa Mercincavage1. 1University of Pennsylvania, Philadelphia,
PA, USA, 2Rutgers School of Public Health, Piscataway, NJ, USA.
Objective: Previous research has highlighted the role of cognitive and aective media-
tors in facilitating the eectiveness of tobacco pictorial warning labels (PWLs). This study
examines smokers’ cognitive responses towards PWLs after 10 days of use on their
packs, and their associations with changes in quitting attitudes, beliefs, and intentions
during this period. Methods: Non-treatment-seeking, daily smokers completed a ran-
domized, parallel design trial. Participants were randomized to either a PWL or control
(i.e., text only or no warning label) group and received packs of their preferred brand
cigarettes axed with their assigned label for 10 days. We assessed quitting attitudes,
intentions, and beliefs at the onset and end of the study. At study end, smokers rated their
PWL on a 5-point scale for 8 cognitive attributes: memorable, understandable, shocking,
informative, oensive, boring, relevant, and interesting. Results: Mean ratings of the
PWLs were high for memorable, understandable, informative, relevant, and interesting
(range = 3.4 to 4.0), moderate for shocking (2.9), and low for oensive (1.7), and boring
(1.5). Among smokers in the PWL groups, quitting-related attitudes, positive beliefs, and
intentions increased over the study period (p < .001) and these changes were positively
associated with most cognitive measures except oensive and boring (p < .05). For the
text-only label group, attitudes and intentions increased signicantly but these changes
were not associated with any cognitive attributes. Conclusion: Smokers generally have
favorable cognitive evaluations of PWLs following repeated exposures. Further, these
evaluations are associated with increased quitting attitudes and intentions, which may
facilitate cessation attempts over longer periods of exposure.
FUNDING: Federal
POD2-3
EFFECTS OF WATERPIPE TOBACCO RISK MESSAGES AMONG
YOUNG ADULT WATERPIPE SMOKERS AND SUSCEPTIBLE
NONSMOKERS: RESULTS OF A RANDOMIZED CONTROLLED
TRIAL
Darren Mays1, Elise M. Stevens2, Glenn Leshner3, Brittney Keller-Hamilton1, Theodore
Wagener1, Abigail Shoben4, Andrea Villanti5. 1Center for Tobacco Research, The Ohio
State University Comprehensive Cancer Center, Columbus, OH, USA, 2University of
Massachusetts Medical School, Worcester, MA, USA, 3University of Oklahoma, Norman,
OK, USA, 4College of Public Health, The Ohio State University, Columbus, OH, USA,
5University of Vermont, Vermont Center on Behavior and Health, Burlington, VT, USA.
Signicance: Waterpipe (i.e., hookah) tobacco smoking (WTS) is common among
US young adults and many nonsmokers are susceptible to initiation, but research on
interventions targeting young adults’ WTS is limited. This randomized controlled trial
(NCT04252014) tested the eects of WTS risk messages for preventing initiation and
promoting cessation in young adults. Methods: Participants were US young adults aged
18 to 30 years who were current waterpipe smokers (n=551) or susceptible nonsmokers
(n=315). Participants were randomized to a WTS risk messaging arm or a control arm
after baseline measures. WTS risk messages were developed using a multimethod
process and communicated the risks of health harms and addictiveness with content
about avors or social use. Messages consisted of brief text with accompanying imagery.
Control messages were similar in format but were unrelated to tobacco. In both arms,
participants received messages online up to 4 times over 12 weeks and completed
outcome measures 2-, 4-, and 6-months later. Results: At 4 months, susceptible non-
smokers who received 3 or 4 risk messages were signicantly less likely (OR 0.15, 95%
CI 0.04, 0.58, p = .006) to initiate waterpipe tobacco smoking than those who received
no messages; this eect on initiation was sustained at 6 months (OR 0.11, 95% CI
0.03, 0.44, p = .002). There were no signicant eects of the waterpipe risk messages
on WTS risk perceptions; curiosity among susceptible nonsmokers; or motivation to
quit or cessation among smokers. Conclusions: WTS risk messages were eective at
the highest dose of exposure for preventing initiation among susceptible nonsmokers.
They did not aect risk perceptions, or motivation to quit or cessation among water-
pipe smokers. These ndings advance the science of WTS prevention interventions
and highlight important needs for future research to: 1) identify message content that
motivates young adult waterpipe smokers to quit, and 2) to determine optimal dose of
exposure for waterpipe tobacco risk messages.
FUNDING: Federal
POD2-4
THE ROLE OF AFFECTIVE REACTIVITY INDUCED BY CIGARETTE
PACKAGING INCLUDING GRAPHIC WARNING LABELS
Matthew Stone1, David Strong1, Claudiu Dimofte2, Tingyi Yang1, Samantha Hurst1, Eric
Leas1, Kim Pulvers3, John Pierce1. 1University of CA, San Diego, La Jolla, CA, USA,
2San Diego State University, San Diego, CA, USA, 3CA State University San Marcos,
San Marcos, CA, USA.
Objective: To identify whether three types of cigarette pack designs (Graphic Warning
Label [GWL] packs, Blank packs, Current US packs) dierentially elicit the type of af-
fect necessary to study how packaging inuences cognitions and behavior among US
smokers. Design: During one-on-one meetings, 324 daily smokers from San Diego,
California were asked to handle a randomized presentation of packs (3 GWLs, 1 Blank,
and 1 US) and “Think Aloud” their reactions as they examined each design. Participant
thoughts were recorded and transcribed. Six trained coders scored these transcrip-
tions on a 7-point reactivity scale (-3 to +3) and natural language processing software
quantied the text for speech polarity (-1 to +1) and emotive word frequency. Results:
Reactivity scores had excellent inter-rater reliability (agreement≥86%; ICC≥.89) and
were correlated with speech polarity (rho’s=.21-.37, p-values<.001). When considering
their own US pack, approximately two-thirds of smokers had a low (31.5%) to medium
(34.6%) positive response (reactivity=1.29; polarity=0.14) with expressed feelings of joy
and trust. Blank packaging prompted a largely (65.4%) neutral response (reactivity=0.03;
polarity=0.00). The gangrenous foot GWL provoked mostly medium (46.9%) to high
(48.1%) negative responses (reactivity=-2.44; polarity=-0.20), followed by neonatal baby
(reactivity=-1.85; polarity = -0.10) and throat cancer (reactivity=-1.76; polarity=-0.08)
warnings. GWLs varied in their elicitation of disgust, anger, fear, and sadness. Conclu-
sion: Initial reactions to three GWL packs, a blank pack, and smokers’ current US pack
reected the targeted range of positive, neutral, or negative aect enabling tests of the
role of packaging on smoking cognitions and behavior in a real-world randomized trial.
FUNDING: Federal; State
29
2022 Paper Sessions
POD2-5
DEVELOPING TOBACCO PACK WARNING LABELS TO INFORM
SMOKERS ABOUT THE MISLEADING EFFECTS OF FILTER
VENTING
Emily Brennan, PhD1, Kimberley Dunstone1, Amanda Vittiglia1, Tamara Tabbakh1,
Sarah Durkin1, Janet Hoek2, James Thrasher3, Dorothy Hatsukami4, Jonathan Samet5,
Melanie Wakeeld1. 1Cancer Council Victoria, 2University of Otago, 3University of South
Carolina, 4University of Minnesota, 5Johns Hopkins.
Background: The tobacco industry has long misled smokers about the risks of cigarettes,
including use of small holes in the lters of tailor-made cigarettes (lter-venting) to dilute
the smoke with air. Smoke from more vented cigarettes feels lighter than smoke from
cigarettes with fewer vents, and many smokers believe that lighter smoke is less harmful.
We tested the eect of novel warning labels (WLs) on smokers’ misperceptions about
the lighter-feeling smoke produced by lter-venting.Methods: We used a mixed-meth-
ods program of research (two qualitative and two quantitative studies) with Australian
adult smokers to systematically develop two WLs communicating the key messages
that smoke that feels light (i) still contains cancer causing chemicals and (ii) can still be
heavy on tar. Across the four studies we tested responses to various components of
the WLs (i.e., front- and back-of-pack headlines, and images and detailed explanatory
statements on the back), allowing us to revise each warning component in response
to smokers’ feedback.Results: We will present key learnings from each stage of WL
development and perceived eectiveness scores for the nal version of each WL. Key
learnings include: explanations about what lter venting is and how it changes the smoke
oered new information for many; explanations about the compensatory behaviours
used by some smokers aided understanding of how venting does not reduce harm;
smokers preferred the general term “cancer causing chemicals” to the specic but un-
familiar term “nitrosamines”; and smokers more favourably rated front-of-pack images
that were more literal rather than metaphorical. After multiple revisions, the warnings
tested in the nal quantitative study signicantly (p<.05) increased the proportion of
smokers who accepted the main message of each WL compared to those in a control
condition (cancer causing chemicals WL, 89% accept main message vs. 70% control;
tar WL, 89% vs. 67% control).Conclusions: Tobacco pack WLs can be used to educate
smokers about how lter venting is used to make smoke feel lighter, and to correct
misperceptions that lighter-feeling smoke is less harmful.
FUNDING: Other
POD2-6
ON-PACK MESSAGING FOR ENDS PRODUCTS: A DISCRETE
CHOICE STUDY
Janet Hoek, PhD1, Philip Gendall1, Christine Eckert2, Jordan Louviere3. 1Departments
of Public Health and Marketing, University of Otago, 2University of Sydney, 3University
of South Australia.
Background: Although people who smoke and switch to exclusive ENDS use may reduce
the risks they face, non-smokers who begin using ENDS face increased health risks.
On-pack labelling must thus attempt to encourage switching among the former group
while deterring uptake among the latter. We tested the eects of a dual-message strategy
and examined whether reduced-risk messages increased ENDS’ appeal to smokers,
and if increased-risk messages decreased ENDS’ appeal to susceptible non-smokers,
occasional and former smokers.Methods: We developed a discrete choice experiment
comprising three attributes: information message, nicotine content (0mg or 3mg), and
avour (tobacco, menthol or fruit). Our online sample included 352 current smokers,
118 occasional and former smokers, and 216 ENDS-susceptible never smokers. Smok-
ers saw reduced-risk messages (encouraging switching to ENDS); other groups saw
increased-risk messages (discouraging ENDS use). All groups saw a typical addiction
warning (i.e., status quo) and a no message condition. We estimated multinomial logit
regression and adjusted latent class analysis models.Results: When compared to the
no message condition, reduced risk-messages increased the appeal of ENDS uptake
among one class of smokers but decreased appeal among other classes. However,
among all smokers, reduced-risk messages increased preference more than an ad-
diction warning. Among occasional or former smokers, and susceptible non-smokers,
all information messages, including an addiction warning, discouraged ENDS use and
decreased preference relative to no message. Conclusions: On-pack reduced-risk
messages could make transition more attractive to smokers than the current addiction
warning featured on e-liquids. Increased-risk messages could deter ENDS use among
susceptible non-smokers, occasional and former smokers. The heterogeneity among
and between smokers and non-smokers suggests dierentiating retail channels so
specialist stores sell packs featuring with reduced risk messaging while general retailers
sell those featuring increased risk messaging could support the dual behaviours policy
makers wish to promote.
FUNDING: Other
POD2-7
EFFECT OF NICOTINE CORRECTIVE MESSAGING ON
NICOTINE-RELATED BELIEFS IN U.S. ADULTS: A RANDOMIZED
CONTROLLED TRIAL
Andrea C. Villanti1, Jerey S. Priest2, Catherine Peasley-Miklus1, Darren Mays3, Eric
Donny4, Joseph Cappella5, Andrew Strasser5. 1University of Vermont, Vermont Center
on Behavior and Health, Burlington, VT, USA, 2University of Vermont, Burlington, VT,
USA, 3The Ohio State University, Columbus, OH, USA, 4Wake Forest School of Medi-
cine, Winston-Salem, NC, USA, 5University of PA, Philadelphia, PA, USA.
SIGNIFICANCE: The public health impact of FDA’s proposed nicotine reduction policy
hinges on the extent to which tobacco users and non-users understand the harms of
nicotine in relation to specic products, including nicotine replacement therapy (NRT).
Population data, however, highlight widespread public misperceptions of the health risks
of nicotine that could undermine the public health benets of FDA’s actions. METHODS:
794 U.S. adults (aged 18+) in NORC’s AmeriSpeak Panel were enrolled in a study in
Spring 2021 to test the eect of three brief exposures to nicotine corrective messages
(NCM) on beliefs about nicotine, nicotine replacement therapy (NRT), e-cigarettes,
and reduced nicotine content (RNC) cigarettes at 1-month and 3-month follow-up.
Participants were randomized in a 1:1 ratio to the NCM (n=393) or no message control
conditions (n=401). Bivariate analyses conducted in 2021 examined the eect of study
condition on nicotine beliefs in complete cases (NCM, n=290; Control, n=319); linear
regression models examined the association between study condition and nicotine
belief scales, controlling for past 30-day cigarette smoking. RESULTS: At 3-month
follow-up, participants in the NCM condition reported fewer false beliefs about NRT
(p=0.04) and e-cigarettes (p=0.009). There was a marginal association between NCM
exposure and correctly identifying that nicotine does not cause cancer (30% NCM vs.
22% control; p=0.06). Controlling for past 30-day smoking status, exposure to NCM
was marginally associated with fewer NRT false beliefs (b=-0.39; p=0.06) and remained
associated with fewer e-cigarette false beliefs (b=-0.36; p=0.02). In crude and adjusted
analyses, there was no relationship between NCM and false beliefs scales on nicotine
itself or RNC cigarettes at 3-months. CONCLUSION: Findings from the current study
support that repeated exposures to a nicotine corrective messaging intervention may
correct misperceptions of NRT and e-cigarettes in the short-term, but dierent message
content or more intensive dose may be needed to address misperceptions of nicotine
and RNC cigarettes.
FUNDING: Federal
POD2-8
ADOLESCENT PERCEPTIONS OF VAPING PREVENTION
MESSAGES: AN EXAMINATION OF PERCEIVED MESSAGE
EFFECTIVENESS
Marcella H. Boynton, PhD1, Nora Sanzo, MPH2, Whitney Brothers3, Alex Kresovich3,
Erin L. Sutn, PhD4, Paschal Sheeran, PhD5, Seth M. Noar, PhD3. 1Division of General
Medicine and Clinical Epidemiology, Department of Medicine, University of North Caro-
lina, Chapel Hill, NC, USA, 2Lineberger Comprehensive Cancer Center, University of
North Carolina, Chapel Hill, NC, USA, 3Hussman School of Journalism and Media,
University of North Carolina, Chapel Hill, NC, USA, 4Wake Forest School of Medicine,
Winston-Salem, NC, USA, 5Department of Psychology and Neuroscience, University
of North Carolina, Chapel Hill, NC, USA.
Signicance: Although e-cigarette use among adolescents continues to be a major pub-
lic health concern, the eld currently has limited guidance as to what vaping prevention
message elements have the most potential to discourage vaping. This study aims to
help ll that gap by testing a large set of vaping prevention messages to determine how
various message elements may impact adolescent perceived message eectiveness
(PME) and vaping appeal.Methods: The study included a large, diverse set of real-world
prevention messages archived by Vaping Prevention Resource (vapingprevention.org).
Two independent coders coded 220 messages on 37 objective elements. Participants
were a national convenience sample of U.S. adolescents aged 13-17 recruited via
Qualtrics online panels (N=1,532) in October 2020. Participants rated seven randomly
assigned messages on PME and vaping appeal. Results: Content referencing nicotine
or addiction (b=.25), chemicals (b=.42), and negative health eects were associated with
greater PME (p<.05). Imagery associated with higher PME included warning symbols
30
2022 Paper Sessions
(b=.36), graphic images (b=.73), and combustible cigarettes (b=.30; p<.05). Use of a
hashtag, statistic, bright/vivid colors, memes, and use of rst-person (“I” or “we”) or the
word “teen” were linked with lower levels of PME (p<.05). Flavor content was associated
with increased levels of vaping appeal (b=.13, p<.05). Few dierences were found on
message elements by adolescent vaping status. Conclusions: Our results highlight
message content, imagery, and other features that are both more and less promising
for creating eective vaping prevention messages. Integrating this evidence-based
guidance may enhance the impact of e-cigarette prevention campaigns.
FUNDING: Federal
PAPER SESSION 3: NEUROBIOLOGICAL
MECHANISMS MEDIATING WITHDRAWAL
AND CESSATION
POD3-1
NEGATIVE SOMATIC AND AFFECTIVE NICOTINE WITHDRAWAL
BEHAVIOR ARE MEDIATED THROUGH THE LATERODORSAL
TEGMENTAL NUCLEUS
Alexis J. Monical1, Soa Bennetts2, Daniel McGehee1. 1University of Chicago, Chicago,
IL, USA, 2Pennsylvania State University, University Park, PA, USA.
SIGNIFICANCE: The aversive experience associated with nicotine withdrawal contrib-
utes to relapse behavior. Understanding how nicotine withdrawal alters excitability of key
brain areas is important for developing eective therapeutic interventions. Suppression of
ventral tegmental area (VTA) dopamine (DA) signaling is one consequence of withdrawal.
One key presynaptic regulator of VTA DA neuron activity is the laterodorsal tegmental
nucleus (LDTg). Previous data has shown GABAergic drive from the interpeducular
nucleus (IPN) to the LDTg mediates the aversive eects of acute high-dose nicotine
exposure. It is known that nicotine withdrawal also activates IPN GABA neurons, and
we hypothesize that IPN suppression of LDTg projections to VTA mediates aspects of
aversive withdrawal symptoms. METHODS: Using optogenetic inhibition of the IPN
GABAergic neurons synapsing within the LDTg, mecamylamine-precipitated nicotine
withdrawal behaviors in naïve and withdrawn GAD2-Cre mice were tested. RESULTS:
During real-time preference testing, we observed a decrease in the negative aective
state associated with nicotine withdrawal, as mice experiencing withdrawal spent more
time in the environment paired with optogenetic inhibition. This preference persists over
three days of testing, after which, animals were assessed for conditioned responses to
the previously light-paired chamber. Conditioned place testing revealed that preference
was state-dependent, as the animals preferred the previously light-paired chamber only
when they were experiencing withdrawal. In addition, we explored the impact of IPN
GABAergic projections to LDTg in withdrawal-associated behaviors. During optoge-
netic inhibition of IPN GABAergic terminals in LDTg, we observed a normalization of
exploratory behavior that is typically reduced during the withdrawal state, as measured
by open eld test, suggesting a role of this circuit in withdrawal associated anxiety. Our
results also implicate a role for IPN-LDTg GABAergic projections in physical withdrawal
symptoms, as we found a suppression of time spent performing withdrawal somatic signs
with optogenetic inhibition. CONCLUSIONS: GABAergic projections from IPN to LDTg
mediate aective and somatic nicotine withdrawal in mice, as optogenetic inhibition of
these terminals decreases severity of the withdrawal state.
FUNDING: Federal
POD3-2
NICOTINE PLUS CUE-PRIMED REINSTATEMENT AND
NATURAL REWARDS ARE SEX-DEPENDENTLY ENHANCED IN
ADOLESCENT SPRAGUE-DAWLEY RATS CONTAINING THE
HUMAN CHRNA6 3’UTR POLYMORPHISM (RS2304297) IN THE
ALPHA(Α)6 NICOTINIC ACETYLCHOLINE RECEPTOR SUBUNIT
Diana Carreno1, Shahrdad Lotpour2. 1University of California - Irvine, Irvine, CA, USA,
2UC Irvine, Irvine, CA, USA.
Background: Nearly 40 million adults in the United States are current smokers, almost
all of whom initiate during adolescence. Large-scale human candidate gene studies
have indicated that a genetic variant (rs2304297) in the alpha(α)6 nicotinic acetylcholine
receptor subunit (nAChR), encoded by Chrna6C123G, may play a key role in adolescent
smoking. We hypothesized that the polymorphism selectively enhances nicotine +
cue-primed reinstatement, but not nicotine- or cue-only reinstatement in GG (risk)
versus CC (non-risk) allele carriers, without having baseline eects on natural rewards.
Methods: Using CRISPR-Cas9 genomic engineering, we developed a humanized rat
line with the human gene variant of the CHRNA6C123G polymorphism in Sprague-Dawley
rats. Genetically modied adolescent male and female rats were food trained under
a xed-ratio (FR)1 schedule of reinforcement and progressively increased to FR5.
Animals were implanted with catheters and began nicotine self-administration (15 μg/
kg/infusion) at FR5. Upon reaching stable responding, reinforced behavior was extin-
guished by removal of drug and cues. Reinstatement testing began for cue only, nicotine
only, and nicotine + cue in a Latin Square Design. Animals were returned to extinction
conditions for 2 days minimum between testing. Results: For natural food rewards, GG
female rats had enhanced food reinforcement when compared with CC females. This
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2022 Paper Sessions
genotype eect on natural rewards was not signicant in male rats. In contrast, male
and female CC and GG-allele carriers exhibited equivalent nicotine self-administration
and extinction. Male GG rats had enhanced nicotine + cue-primed reinstatement when
compared with male CC rats. This genotype eect on reinstatement was not seen in
female rats. Conclusions: Our ndings support the in vivo functional role of the human
CHRNA6C123G genetic variant in sex-dependently enhancing natural rewards and nicotine
seeking behavior in adolescent rats. Overall, the ndings support clinical and preclinical
data highlighting a role of α6 nAChRs mediating gender heterogeneity in substance
use and related phenotypes.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
POD3-3
GENETIC DISSECTION OF NICOTINE AND LEARNING TRAITS
USING BXD RECOMBINANT INBRED MICE
Lisa R. Goldberg, Laurel Seemiller, Thomas J. Gould. Penn State University, Univer-
sity Park, PA, USA.
Cognitive decits, such as disrupted learning, are a major symptom of nicotine with-
drawal. These decits are heritable, yet the genetic basis is unknown. We recently
identied a genome-wide signicant quantitative trait locus in the BXD recombinant
inbred panel on chromosome 4 underlying nicotine withdrawal decits in learning.
Here, we aimed to investigate phenotypic and transcriptomic variation of the high and
low responders from the BXD recombinant inbred panel to further understand how
variation in nicotine and learning phenotypes may impact nicotine withdrawal decits
in learning. We assessed four strains that exhibited extreme phenotypic variation
(BXD64, BXD98, BXD56, BXD124) and the two BXD parental strains (C57BL/6J and
DBA/2J) in fear conditioning, two nicotine (NIC) sensitivity assays (n=9-21 per sex per
strain), and NIC metabolism (n=4-12 per sex per strain). NIC-induced locomotor activity
and NIC-induced hypothermia phenotypes did not segregate into the same high and
low responder groupings as the NIC withdrawal learning phenotype, providing further
evidence that the cognitive decits during NIC withdrawal are genetically independent
from other NIC-induced phenotypes. Furthermore, nicotine metabolism as assessed by a
cotinine ELISA assay did not segregate between the high and low responder groupings,
suggesting that nicotine metabolism dierences are not driving observed NIC behavioral
dierences. To expand upon these results and identify transcriptome changes associ-
ated with NIC withdrawal learning decits, hippocampal mRNA-sequencing in the BXD
lines exhibiting extreme phenotypic variation was examined.Funding: U01DA04163203
(T.J.G), T32GM108563 (L.R.S.)
FUNDING: Federal
POD3-4
ACTIVATION OF ACCUMBENS MICROGLIA AND ADENOSINE
A2A RECEPTORS CONTRIBUTES TO NICOTINE SELF-
ADMINISTRATION AND CUE-INDUCED REINSTATEMENT
Emma Bondy, Shailesh Khatri, Erin Maher, Cassandra Gipson-Reichardt. University
of Kentucky, Lexington, KY, USA.
Neuroimmune mechanisms within the nucleus accumbens core (NAcore) are involved
in nicotine seeking behavior. Further, microglia are activated following withdrawal from
experimenter-delivered nicotine, and this is a critical neuroimmunological response in the
nicotine-induced cellular signaling cascade. Adenosine 2 receptors (A2aRs) regulate the
proliferation and survival of microglia, and have been found to trigger microglial activation
and inammatory cytokine release. Systemically agonizing A2aRs eectively reduces
ethanol self-administration and cocaine reinstatement, but these receptors have not been
thoroughly studied for their role in nicotine-motivated behaviors. In the current studies,
Long Evans male and female rats underwent nicotine self-administration (0.06 mg/kg/
infusion) followed by extinction training in which rats were administered with A2a agonist
(CGS 21680, 0.4 mg/kg i.p.), A2a antagonist (SCH 58261, 0.4 mg/kg i.p.), or vehicle.
One cohort of animals were used to quantify NAcore microglia morphology following
nicotine self-administration while a second cohort received A2a agonist/antagonist
treatments through extinction and prior to cue-induced reinstatement. Results show
altered morphology indicative of microglia activation, and an increase in A2a expres-
sion within the NAcore following chronic nicotine-self administration. Pretreatment with
systemic injections of CGS 21680 resulted in the signicant decrease of cue-induced
nicotine seeking compared to SCH 58261-treated animals. These results indicate that
A2a activation counteracts nicotine seeking behavior. Ongoing studies are determining
if this is mediated by microglia.
FUNDING: Federal
POD3-5
REINSTATEMENT OF COTININE SEEKING IN RATS:
DIFFERENTIAL EFFECTS OF SEX
Zheng-Ming Ding, Elizabeth Neslund, Xiaoying Tan, Lauren Hendricks. Pennsylvania
State University College of Medicine, Hershey, PA, USA.
Signicance: Nicotine addiction is characterized by high rates of relapse following a
period of abstinence, which represents a major obstacle in cessation management.
Therefore, better understanding of relapse mechanisms will inform future treatments.
Our previous studies suggest that cotinine, the major metabolite of nicotine, may play
a role in nicotine reinforcement by supporting intravenous self-administration. However,
whether cotinine may play a role in relapse remains unknown. The objective of the
current study was to investigate potential relapse to cotinine-seeking behavior using
the well-established reinstatement of drug seeking model in rats. Methods: Adult male
and female Wistar rats were trained to self-administer cotinine at 0.03 mg/kg/infusion
in daily 2-hr sessions for 20 sessions, and underwent extinction for 10 sessions. Rats
were then tested for cue-, drug-, or stress-induced reinstatement of cotinine seeking. In
cue-induced reinstatement, light cues associated with cotinine self-administration were
presented during the reinstatement session. In drug-induced reinstatement, rats received
pretreatment with cotinine (0, 1.0, 2.0 mg/kg, s.c.) prior to reinstatement sessions.
Stress-induced reinstatement involved pretreatment with yohimbine (0, 1.25, 2.5 mg/kg,
s.c.) prior to reinstatement. Results: Presentation of light cues associated with cotinine
self-administration signicantly increased active, but not inactive, responses during
the reinstatement. In addition, the increase was more robust in female than male rats.
Compared to vehicle pretreatment, cotinine or yohimbine signicantly elevated active
responses with similar enhancement seen in male and female rats. Furthermore, an
overall analysis indicated a signicant eect of sex during cotinine self-administration and
extinction. Female rats obtained signicantly more infusions during self-administration
sessions, and were more resistant to extinction of active responses across extinction
sessions. Conclusions: These results indicate that rats trained to self-administering
cotinine displayed robust relapse to cotinine seeking, and that sex dierentially aected
cotinine self-administration, extinction, and reinstatement. These ndings suggest that
cotinine may play a role in relapse to nicotine seeking.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
POD3-6
MECHANISTIC INSIGHTS INTO NICOTINE WITHDRAWAL: ROLE
OF PURINERGIC SIGNALING IN THE MEDIAL HABENULA
Yen-Chu Chen1, Christie Fowler2. 1University of California, Irvine, Irvine, CA, USA,
2University of CA Irvine, Irvine, CA, USA.
Nicotine is considered to be the primary reinforcer of tobacco dependence, which is one
of the leading causes of preventable death worldwide. In these studies, we sought to
investigate the role of purinergic signaling on neuronal activity in the medial habenula.
Acute brain slicing is performed to obtain brain slices from both male and female mice
and the neuronal activity in the medial habenula is recorded with patch clamp electro-
physiology. Initial studies characterized the baseline ring rates and the eects of a
receptor agonist on cholinergic habenular neurons. Next, since it has been demonstrated
that the medial habenula is highly implicated in mediating symptomology associated
with nicotine withdrawal, we then examined how activation of purinergic signaling alters
neuronal activity during a state of nicotine withdrawal in both sexes. We discovered
that activation of purinergic receptors mediates neuronal ring in the medial habenula,
with dierent eects occurring during nicotine withdrawal. In conclusion, these data
have further our understanding of the factors mitigating withdrawal eects that may
underlie the nicotine dependence state. This work was supported by funding from the
NIH National Institute on Drug Abuse (DP1 DA039658 to CDF).
FUNDING: Federal
32
Notes
33
Notes
34
2022 Paper Sessions
PAPER SESSION 4: RELATIONSHIPS
BETWEEN COVID-19 AND SMOKING
POD4-1
EFFECTS OF COVID-19 SHELTER-IN-PLACE ORDERS ON
ADOLESCENT CIGARETTE AND E-CIGARETTE USE IN
CALIFORNIA
Sharon Lipperman-Kreda1, Mary Kristina Wharton2, Sabrina Islam2, Melissa Abadi3.
1Prevention Research Center, Pacic Institute for Research and Evaluation, Oakland,
CA, USA, 2Prevention Research Center, Pacic Institute for Research and Evaluation,
Berkeley, CA, USA, 3Pacic Institute for Research and Evaluation, Calverton, MD, USA.
Introduction: This study examined whether COVID-19 “shelter-in-place” (SIP) orders
inuence adolescents’ risks of cigarette and e-cigarette use and how it may dier for
adolescents of dierent racial/ethnic identities or socioeconomic status. We theorize
that SIP-related changes to adolescent home, school, and work environments and
stress levels may impact tobacco use opportunity and motivations (e.g. using to cope).
Methods: California county SIP dates were collected through press releases, spanning
March 13, 2020 through June 19, 2020. Outcomes included self-reported lifetime use of
cigarettes and e-cigarettes to get nicotine and frequency of use in the past 6 months.
Data were collected from a current longitudinal study on alcohol and other substance
use with 3 follow-up surveys beginning May 8, 2019 to December 3, 2020. The sample
included 1,249 adolescents, aged 12-16 at baseline, from 51 California counties with
3,670 total surveys over the 3 follow-up periods. The exposure was measured as whether
the participant was living under an SIP order in their county (yes/no) at participant’s
survey completion date. Multilevel mixed eects logistic and negative binomial regres-
sion models were conducted accounting for nesting of respondents within counties and
controlling for age, race, ethnicity, gender, and household income. Models including
interactions of the exposure and race/ethnicity, gender, and household income were
analyzed to evaluate dierential associations. Results: Participants were 50% female,
52% White, and 36% Hispanic/Latinx. In main eects models, current SIP status was
associated with greater number of days using cigarettes (IRR= 3.31, p less than 0.05)
and e-cigarettes (IRR= 1.71, p less than 0.01). No signicant associations were found
between SIP status and lifetime use of cigarettes or e-cigarettes. Moderation analyses
did not show signicant dierences between groups. Conclusion: Results showed that
SIP increased the frequency of cigarette and e-cigarette use for current users but was
not associated with initiation of use. Pandemic-era prevention eorts should consider
these changed environments for adolescents’ tobacco use.
FUNDING: Federal
POD4-2
CHANGES IN TOBACCO PRODUCT SALES IN THE UNITED
STATES DURING THE COVID-19 PANDEMIC
Samuel Asare, Nigar Nargis, Priti Bandi, Farhad Islami, Lee J. Westmaas, Stacey
Fedewa, Anuja Majmundar. American Cancer Society, Kennesaw, GA, USA.
Background: The impact of the COVID-19 pandemic on tobacco sales in the U.S. is
not fully known, and no study has evaluated changes in specic tobacco product sales.
This study estimated changes in tobacco product sales after the onset of the COVID-19
pandemic. Methods: Data comprised of U.S. Department of Treasury’s records of total
monthly cigarette, little and large cigar, pipe, chewing, roll-your-own, and snu tobacco
product sales per person unit observed before the onset of COVID-19 pandemic (January
2007 to February 2020) and afterward (March 2020 to April 2021). Baseline monthly sales
volume in the absence of COVID-19 (counterfactuals/expected sales) were estimated for
each type of tobacco product using an interrupted time series model and then subtracted
from the observed sales volume. The dierence was summed from March 2020 to April
2021 to obtain excess (decline in) sales. Results: Compared to expected sales, the per
capita sales in March 2020 increased for cigarettes by 9.277 (p<0.01) sticks, declined
for large cigars by 0.477 (p<0.10) sticks, and remained unchanged for other tobacco
products. After the onset of the COVID-19 pandemic, monthly per capita sales of little
and large cigars increased by 0.006 (p<0.01) and 0.145 (p<0.01) sticks, respectively,
and of chewing tobacco increased by 0.064 (p<0.01) pounds per 1000 person relative
to the expected trends. In contrast, the monthly sales trend of pipe tobacco decreased
by 0.239 (p<0.01) pounds per 1000 person. Monthly sales trends of cigarettes and
roll-your-own and snu tobacco did not change from those observed before the onset
of the COVID-19 pandemic. From March 2020 to April 2021, estimated excess sales
for cigarettes, little, and large cigars were respectively 42,884.5, 183.2, and 1,544
million sticks, and for chewing tobacco was 1.9 million pounds (average population =
330,201,196.4). Pipe tobacco sales declined by 7.2 million pounds during that period,
while roll-your-own and snu tobacco sales remained unchanged. Conclusions: The
excess sales indicate increased consumption of cigarettes and cigars, calling for stronger
action in tobacco control in the post-COVID-19 era.
POD4-3
MARIJUANA USE, SMOKING, AND COVID-19 OUTCOMES
Li-Shiun Chen1, Timothy Baker2, Nicholas Grith1, Brendan Heiden1, Nina Smock1,
Giang Pham1, Laura Bierut1. 1Washington University School of Medicine, St. Louis, MO,
USA, 2Center for Tobacco Research and Intervention, Madison, WI, USA.
Signicance: It is unclear whether marijuana use is associated with health outcomes in
patients with COVID-19 when considering known predictors including smoking. Meth-
ods: We analyzed the data from conrmed COVID-19 patients in a large healthcare
system in US Midwest between Jan 1, 2020 and April 30, 2021. We analyzed endpoints of
hospitalization, admission to intensive care unit (ICU), and death. Results: We evaluated
38,635 COVID-19 cases and health outcomes (24,178 hospitalized, 2,751 admitted to
ICU, and 1,023 deaths) in our healthcare system. All health outcomes (hospitalization,
ICU admission, and death) were associated with older age, male sex, minority race,
rural residence, and positive medical comorbidity risk covariates. There were 8.0%
current smokers, and 4.7% reported active marijuana use. (a) Smoking: When adjusted
for risk covariates, current smoking was signicantly associated with increased risk of
hospitalization (OR=1.61, 95% CI 1.46-1.77, p<0.0001), ICU admission (OR=1.34,
95% CI 1.15-1.55, p<0.0001), and mortality (OR=1.48, 95% CI 1.15-1.91, p=0.002). (b)
Marijuana use: When adjusted for age, sex, and race in model 1, marijuana use was
signicantly associated with increased risk of hospitalization (OR=2.41, 95% CI 2.12-
2.73, p<0.0001), ICU admission (OR=1.70, 95% CI 1.43-2.00, p<0.0001), and mortality
(OR=1.52, 95% CI 1.11-2.07, p=0.008). Further, when adjusted for age, sex, race,
comorbidity, rural residence, and smoking in model 2, marijuana use was signicantly
associated with increased risk of hospitalization (OR=1.79, 95% CI 1.57-2.03, p<0.0001),
ICU admission (OR=1.50, 95% CI 1.26-1.79, p<0.0001), and with borderline signicant
for mortality (OR=1.37, 95% CI 1.00-1.88, p=0.052). Conclusion: Among cases of
Covid-19, patients with positive marijuana use had poorer clinical outcomes than those
without, even when controlling for known risk factors such as comorbidity and smoking.
FUNDING: Federal
POD4-4
ASSESSMENT OF SEVERE CORONAVIRUS DISEASE 2019
OUTCOMES USING MEASURES OF SMOKING STATUS AND
SMOKING INTENSITY
E. Melinda Mahabee-Gittens1, Angelico Mendy2, Ashley L. Merianos2. 1Cincinnati Chil-
dren’s Hospital Medical Center, Cincinnati, OH, USA, 2University of Cincinnati, Cincin-
nati, OH, USA.
Signicance: Smoking status does not indicate the amount or length of tobacco use,
and thus, it is an imperfect measure to assess the associations between cigarette
smoking and severe coronavirus disease 2019 (COVID-19) outcomes. This investigation
assessed whether cigarette smoking status, intensity of smoking (i.e., average daily
packs of cigarettes smoked), duration of smoking, and pack-years of smoking were
associated with severe outcomes among adults diagnosed with COVID-19. Methods:
We conducted a retrospective, cross-sectional study in which we identied consecutive
patients diagnosed with COVID-19 at a large, midwestern university healthcare system
between March 13, 2020 and September 30, 2020 who had complete information on
smoking status, severe COVID-19 outcomes, and covariates (i.e., demographics and
comorbidities). We used logistic regression to evaluate the associations of smoking
status and intensity of smoking with COVID-19 severity dened as hospitalization,
admission to intensive care unit (ICU), or death, adjusting for sociodemographics and
comorbidities. Results: Among the 4,611 COVID-19 patients included in the analysis,
18.2% were current smokers and 20.7% were former smokers. The prevalence of
PODIUM PRESENTATION 2
35
2022 Paper Sessions
COVID-19 outcomes was 28.9% for hospitalization, 9.8% for ICU admission, and 1.4%
for death. In adjusted analysis, current smoking (AOR:1.23, 95% CI:1.02-1.49), former
smoking (AOR:1.28, 95% CI:1.07-1.54), and pack-years of smoking (AOR:1.09, 95%
CI:1.02-1.17) were associated with higher prevalence of hospitalization. Average daily
packs of cigarettes smoked was associated with higher prevalence of hospitalization
(AOR:1.30, 95% CI:1.10-1.53) and ICU admission (AOR:1.23, 95% CI: 1.04-1.44).
Conclusion: Smoking status, pack-years, and intensity of smoking were associated with
hospitalizations in patients with COVID-19 and intensity of smoking was associated with
ICU admission. Findings underscore the need for detailed information beyond smok-
ing status when evaluating smokers with COVID-19 so that the potential for adverse
sequelae may be optimally managed in at-risk patients.
FUNDING: Federal
POD4-5
RACE, COVID-19-RELATED DISCRIMINATION CONCERN, AND
CIGARETTE SMOKING BEHAVIOR: COMPARISON BETWEEN U.S.
ASIAN AND WHITE ADULTS
Tina Liu1, Lilianna Phan1, Julia Chen-Sankey2, Aniruddh Ajith3, Kiana Hacker1, Bambi
Jewett1, Kelvin Choi1. 1National Institute on Minority Health and Health Disparities,
Bethesda, MD, USA, 2Center for Tobacco Studies, Rutgers Biomedical and Health
Sciences, New Brunswick, NJ, USA, 3University of Pittsburgh School of Medicine, Pitts-
burgh, PA, USA.
Signicance: Anti-Asian discrimination incidents in the U.S. have resurged during
the COVID-19 pandemic. It is unclear if these incidents aect Asian & Asian American
(A&AA) adults in terms of concern about COVID-19-related racial discrimination and
smoking behaviors as compared to White adults. We examined A&AA vs. White dierenc-
es in COVID-19-related discrimination concern. Additionally, we examined associations
between this concern with changes in cigarette smoking behavior. Methods: Data were
from a U.S. representative sample of adult (≥21 years) recent and current commercial
tobacco users (n=1,052), collected through an online panel oversampling A&AAs, from
January-February 2021. In three items, participants reported their levels of concern,
worry, and stress that “they or their families may be discriminated against, harassed,
or treated unfairly because of the coronavirus outbreak” (0=Not at all, 4=Extremely).
Responses were averaged across three items to represent COVID-19-related discrim-
ination concern. We calculated changes in number of days smoked using self-reported
number of cigarettes smoked at 30-days prior to the survey and at 12 months prior to
the survey. We used weighted multivariable linear regression models to rst examine
race associations with discrimination concern, and then discrimination concern with
changes in number of days cigarettes smoked, adjusting for demographics. Results:
A&AA recent and current commercial tobacco users had higher COVID-19-related dis-
crimination concern (adjusted mean=1.7, 95%CI=1.2-1.9) than their White counterparts
(adjusted mean=0.60, 95%CI=0.48-0.69). During the pandemic, a higher proportion of
A&AA (17.9%) than White adults (8.7%) reported increased number of days cigarettes
smoked. Every unit increase in COVID-19-related discrimination concern was associated
with 1.1 days more days smoked (95%CI=0.30-2.0). The association did not dier by
race. Conclusion: Anti-Asian discrimination due to the COVID-19 pandemic increases
psychological stress especially among A&AA adults, and in turn could lead to increased
smoking frequency and related morbidity and mortality among A&AA adults.
FUNDING: Federal
POD4-6
FINANCIAL HARDSHIP DURING THE COVID-19 PANDEMIC AND
TOBACCO DISCOUNT COUPONS REDEMPTION AMONG U.S.
ADULTS
Kasra Zarei1, Julia Chen-Sankey2, Lilianna Phan1, Aniruddh Ajith3, Kiana Hacker1,
Bambi Jewett1, Kelvin Choi1. 1National Institute on Minority Health and Health Dispari-
ties, Bethesda, MD, USA, 2Center for Tobacco Studies, Rutgers Biomedical and Health
Sciences, New Brunswick, NJ, USA, 3University of Pittsburgh, School of Medicine,
Pittsburgh, PA, USA.
Signicance: Commercial tobacco (CT) users redeem discount coupons for CT
products to manage their CT expenditures. We examined how nancial hardships
during the COVID-19 pandemic relate to increases in coupon use among current and
recent former CT users. Methods: Data from a nationally representative sample of
U.S. adult (ages≥21) recent former and current CT users were collected in an online
panel from January-February 2021. Participants reported if they had increased use of
discount coupons/promotions to save money on CT since the pandemic. Participants
also reported nancial hardships experienced during the pandemic (e.g., losing a job or
work-related income, depleted all or most of their savings, not having enough money to
pay for food, rent or mortgage, utilities, medication, unexpected expenses, hand sanitizer,
disinfectant, and face masks). The number of nancial hardships experienced during
the COVID-19 pandemic was summed (range: 0-7). Weighted multivariable logistic
regression models were used to examine the associations between nancial hardship
experiences and increased coupon use, adjusting for demographics. Results: Overall,
8.29% of U.S. adult current and recent former CT users reported increasing CT coupon
use to save money during the pandemic. Losing any work-related income (AOR=1.73,
95%CI=1.20-2.49), losing jobs (AOR=2.02, 95%CI=1.23-3.32), having to use up all/
most of their savings (AOR=2.14, 95%CI=1.42-3.25), experiencing an increase in
debt (AOR=2.49, 95%CI=1.73-3.61), and not having enough money to pay for food
(AOR=2.35, 95%CI=1.62-3.42), rent/mortgage (AOR=2.19, 95%CI=1.51-3.18), utilities
(AOR=1.92, 95%CI=1.32-2.79), and medications (AOR=2.09, 95%CI=1.44-3.05) were
associated with increased CT coupon use. Every additional count of nancial hardships
was associated with higher odds of CT coupon use (AOR=1.19, 95%CI=1.11-1.28).
Conclusion: Current and recent former CT users increased discount coupons use to
manage their CT expenditures when facing nancial hardships during the pandemic.
This could hinder CT cessation and promote relapse. Prohibiting CT coupon redemption
may promote CT cessation rather than perpetuate use among a vulnerable group.
FUNDING: Federal
POD4-7
DISPARITIES AMONG SMOKERS DURING THE COVID-19
PANDEMIC EXAMINATION OF COVID-19 RELATED WORRIES
BY SOCIODEMOGRAPHIC VARIABLES IN A U.S. NATIONALLY
REPRESENTATIVE SURVEY
Robert T. Fairman1, Scott R. Weaver1, Amy Nyman1, Lucy Popova1, Zachary B.
Massey2, Reed Reynolds1, Claire Spears1. 1Georgia State University, Atlanta, GA, USA,
2University of Missouri, Columbia, MO, USA.
Signicance: Underserved populations may be at higher risk for elevated stress due
to the COVID-19 pandemic, including worries about nances, housing, and medical
care. This is particularly important among smokers, who are at heightened risk for
severe COVID-19 and for whom stress is a barrier to quitting. This study examined
whether experiences with stress and worry among smokers during the pandemic
diered by sociodemographic factors, and whether these factors predicted serious
psychological distress (SPD). Methods: Data came from an October-November 2020
U.S. national representative survey of 1,223 current cigarette smokers. An adapted
Domain-Specic Stress Scale assessed worries related to COVID-19 in the domains of
food and job insecurity, housing instability, nances, healthcare, isolation, and racism.
The Kessler-6 scale assessed SPD. Results: Hispanic smokers reported more worry
regarding food and jobs than smokers of other ethnicities. Smokers with less than high
school education indicated more worry in all domains except jobs and racism. Those
with household income less than $30,000 and those who were unemployed reported
greater worry in most domains. Smokers on Medicaid reported higher worry about food
insecurity, nances, and isolation/loneliness. Women reported higher worry regarding
food, money, medical appointments, ability to aord medical care, and isolation/lone-
liness. Women, those aged 30-44, those with income less than $30,000, those with
less than high school education, those not working, and those on Medicaid were more
likely to experience SPD. Each COVID-19 worry predicted higher likelihood of SPD
when controlling for sociodemographics. When all COVID-19 worries were entered
simultaneously, worries about money (aOR=2.3) and isolation/loneliness (aOR=3.0)
uniquely predicted SPD. Conclusion: Among U.S. adult smokers, those with lower SES
indicated disproportionately high worry about access to basic needs and were more
likely to be experiencing SPD. Policies and interventions that address basic needs and
mental health among marginalized populations of tobacco users are needed to address
tobacco-related health disparities.
FUNDING: Nonprot grant funding entity
36
2022 Paper Sessions
PAPER SESSION 5: COMMITTING TO
INCLUSION AND EQUITY IN SMOKING
CESSATION CLINICAL TRIALS
POD5-1
A NON-INFERIORITY TRIAL OF 25 DAYS OF CYTISINE VERSUS
84 DAYS OF VARENICLINE FOR SMOKING CESSATION - THE
CESSATE STUDY
Ryan J. Courtney1, Hayden McRobbie2, Piotr Tutka3, Natasha Weaver4, Dennis Petrie5,
Colin Mendelsohn6, Anthony Shakeshaft2, Saki Talukder2, Christel Macdonald2, Dennis
Thomas4, Benjamin Kwan2, Natalie Walker7, Coral Gartner8, Richard Mattick2, Chris-
tine Paul4, Stuart Ferguson9, Nicholas A. Zwar10, Robyn L. Richmond2, Christopher M.
Doran11, Veronica C. Boland2, Wayne Hall8, Robert West12, Michael Farrell2. 1UNSW,
NDARC, Randwick, Australia, 2UNSW, Sydney, Sydney, Australia, 3University of
Rzeszow, Rzeszow, Poland, 4University of Newcastle, Newcastle, Australia, 5Monash
University, Melbourne, Australia, 6NA, Sydney, Australia, 7University of Auckland, Auck-
land, New Zealand, 8University of Queensland, St Lucia, Australia, 9University of Tasma-
nia, Hobart, Australia, 10Bond University, Gold Coast, Australia, 11 Central Queensland
University, Brisbane, Australia, 12University College London, London, United Kingdom.
Background. Cytisine is more eective than placebo and nicotine replacement therapy
for smoking cessation. However, cytisine has not been tested against the most eective
sole smoking cessation medication, varenicline, which is associated with adverse events
known to lead to discontinuation of therapy. Aim. To examine whether standard cytisine
treatment (25 days) was at least as eective as standard varenicline treatment (84 days)
for smoking cessation. Methods. This noninferiority (NI), open-label randomized clinical
trial with allocation concealment and blinded outcome assessment was undertaken
in Australia. 1452 Australian adult daily smokers willing to make a quit attempt were
included. Data collection was conducted primarily by telephone interview, but there
was an in-person visit to validate the primary outcome. Treatments were provided in
accordance with the manufacturers’ recommended dosage: cytisine (n = 725), 1.5-mg
capsules taken 6 times daily initially then gradually reduced over the 25-day course;
varenicline (n = 727), 0.5-mg tablets titrated to 1 mg twice daily for 84 days (12 weeks). All
participants were oered referral to standard telephone behavioral support. The primary
outcome was 6-month continuous abstinence veried using a carbon monoxide breath
test at 7-month follow-up. The NI margin was set at 5% and the 1-sided signicance
threshold was set at .025. Results. Among 1452 participants who were randomized
(mean [SD] age, 42.9 [12.7] years; 742 [51.1%] women), 1108 (76.3%) completed the
trial. Veried 6-month continuous abstinence rates were 11.7% for the cytisine group and
13.3% for the varenicline group (risk dierence, −1.62% [1-sided 97.5% CI, −5.02% to
∞]; P = .03 for NI). Self-reported adverse events occurred less frequently in the cytisine
group (997 events among 482 participants) compared with the varenicline group (1206
events among 510 participants) and the incident rate ratio was 0.88 (95% CI, 0.81 to
0.95; P = .002). Conclusion. Among daily smokers willing to quit, cytisine treatment
for 25 days, compared with varenicline treatment for 84 days, failed to demonstrate NI
regarding smoking cessation.
FUNDING: Federal
POD5-2
SMOKING BEHAVIORS, HEALTH CONDITIONS,
PHARMACOTHERAPY USE, AND QUIT RATES IN BLACK
AMERICANS WITH SERIOUS MENTAL ILLNESS
Arundati Nagendra, Corinne Cather, Gladys Pachas, Kevin Potter, Melissa Mara-
vic, A. Eden Evins. MA General Hospital/ Harvard Medical School, Boston, MA, USA.
Signicance: Two communities that have been disproportionately targeted by the
tobacco industry are Black Americans and those with serious mental illnesses (SMI).
Both groups show high rates of smoking-related morbidity and mortality. While studies
have examined the independent eects of race and SMI on smoking-related behaviors
and outcomes, scarce research has evaluated the extent to which holding both identities
(i.e., being Black and having SMI) may result in compounded negative outcomes. This
study compares smoking behaviors and outcomes in non-Latinx Black and non-Latinx
white individuals with SMI who smoke. Methods: This is a secondary data analysis
of a PCORI-funded smoking cessation trial. The current sample consisted of 229
non-Latinx Black and 284 non-Latinx white people with SMI who smoked. Participants
did not need to be ready or willing to quit smoking tobacco to participate, and were
randomized to either a community health worker condition or to treatment as usual. The
sample completed baseline, one-year, and two-medication evaluations of their smoking
behaviors, health conditions, use of smoking cessation pharmacotherapy, as well as
two-year biochemically veried abstinence. In this study, we compared baseline and
longitudinal characteristics in Black versus white participants. Results: At baseline, Black
participants smoked signicantly fewer tobacco products per day than white participants
but were signicantly more likely than white participants to smoke menthol products.
There were no racial dierences in the level of nicotine dependence. Black participants
were more likely to report having diabetes but less likely to report pulmonary illnesses.
There were few racial dierences in baseline or longitudinal use of smoking cessation
medication. Overall, Black participants were 62% less likely to quit smoking than white
participants. However, this eect was driven by participants who did not use medication.
Among those who took medication, Black and white participants had comparable quit
rates between 10-15%. Discussion: Pharmacotherapy interventions appear crucial to
facilitate smoking cessation in Black Americans with SMI. This may be because Black
Americans experience more stressors due to racism, increasing the challenge of quitting
without support. Moreover, this study also highlights the importance of equitable care,
showing that when gold-standard care is provided to Black and white participants, they
show comparable outcomes. The study also had unexpected ndings that warrant
further investigation, including that white participants had more health conditions than
their Black counterparts.
FUNDING: Federal; Nonprot grant funding entity
POD5-3
THE POTENTIAL IMPACT OF LABORATORY ASSESSMENTS
OF TREATMENT MECHANISMS ON CLINICAL TRIAL
REPRESENTATIVENESS AND EQUITY -- A QUASI-EXPERIMENTAL
INVESTIGATION
Larry Hawk1, Rebecca Ashare1, Rinad Beidas2, Martin Mahoney3. 1University at Bualo,
SUNY, Bualo, NY, USA, 2University of Pennsylvania, Philadelphia, PA, USA, 3Roswell
Park Comprehensive Cancer Center, Bualo, NY, USA.
Signicance: Experimental therapeutics, which aims to uncover the mechanisms that
drive behavior change and harness them to produce more robust and ecient treat-
ments, has the potential to reduce the science-practice gap and potentially improve
population health equitably. However, our experience with a recent cessation trial
suggested that pre-treatment laboratory assessments of treatment mechanisms may
reduce trial enrollment, particularly among self-identied Black or African American
people. The COVID-19 pandemic led us to halt the lab visits partway through the trial,
allowing for a quasi-experimental test of these hypotheses. Methods: Participants were
adult treatment-seeking cigarette smokers screened for enrollment in a randomized
controlled trial (RCT; NCT03262662). Following phone and intake screening, participants
completed 6 clinic visits and received cessation counseling and varenicline/placebo.
Before the COVID-19 shutdown (4/2/20), participants also completed two 2+hour lab
visits to assess hypothesized treatment mechanisms including reinforcement and cue
reactivity (Lab Mechanism Cohort)- the rst lab visit followed intake and occurred ~1
week before starting treatment, and the second lab visit occurred after ~2.5 weeks of
treatment. Due to the pandemic, lab visits were halted for the remainder of the trial (No
Lab Cohort). Results: In the Lab Mechanism Cohort, the percentage of participants
eligible at intake who ultimately became Intent-to-Treat (ITT; i.e., attended Clinic 1) was
lower than observed in our most recent trial (Lerman et al., 2015) and was notably lower
among Black compared to White participants (65% [46/71] and 84% [196/233], respec-
tively; p=.0004). Elimination of the lab visits was associated with a higher percentage
of intake-eligible participants who became ITT (88% [21/24] and 98% [44/45] of Black
and White participants, respectively, ps=.03 and .01), and the Black-White dierence
was attenuated and no longer statistically signicant in the No Lab Cohort (p=.08).
Once treatment began, retention was strong among Black and White participants in
both cohorts (e.g., 93%-100% at Clinic 4, after 4 weeks of treatment). Conclusions:
The present ndings may reect an unintended but important cost to laboratory assess-
ments of treatment mechanisms. However, the quasi-experimental nature of the study
makes it dicult to rule out confounds. If the current patterns of pre-treatment attrition
are replicated (e.g., with experimental manipulations of assessment characteristics
such as overnight abstinence), mechanistic trials will need to work to overcome this
challenge or risk being even less relevant to real-world practice than standard RCTs,
particularly for Black or African American people who already face substantial health
disparities and are underrepresented in clinical trials.
FUNDING: Unfunded; Federal; Pharmaceutical Industry
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2022 Paper Sessions
POD5-4
ASSESSING THE HEALTH EQUITY EFFECTS OF CIGARETTE
LABELING POLICIES, A RANDOMIZED FIELD TRIAL AMONG
ADULT SMOKERS
James Thrasher1, Chung-Li Wu1, Emily Loud1, Victoria Lambert1, Norman Porticella2,
Stuart Ferguson3, James Hardin1, Je Niederdeppe2. 1University of South Carolina,
Columbia, SC, USA, 2Cornell University, Ithaca, NY, USA, 3University of Tasmania,
Hobart, Australia.
Signicance: The potential health equity eects of dierent cigarette labeling policies are
understudied. This experimental study assessed smokers’ behavioral responses to pack
inserts and pictorial health warning labels (HWLs), including dierences by education
and health literacy level. Methods: We conducted a 2X2 between-subject trial (inserts
with ecacy messages vs. no inserts; pictorial vs. text-only HWLs), randomizing 359
adults who smoked at least 10 cigarettes a day to conditions. Recruitment included
intercept strategies in disadvantaged neighborhoods. Participants received a 14-day
supply of their preferred cigarette brand with packs modied to reect their experimental
condition. Each evening, participants reported cessation-related behaviors in the prior
24 hours (i.e., forgoing cigarettes, stubbing out cigarettes, and talking about smoking
harms or cessation benets). Mixed-eects logistic models regressed these behaviors
on indicators of treatment group relative to control (i.e., no inserts, text-only HWLs),
testing interactions between treatment and both educational attainment (high school or
less vs more) and health literacy (limited vs. high literacy). Results: The sample included
42% with high school or lower education, and 30% had limited literacy. Relative to the
control group, smokers in the insert only, pictorial HWL only, and insert + pictorial HWL
groups were more likely to report forgoing cigarettes (OR=2.56, p=0.004; OR=2.10,
p=0.02; OR=2.80, p<0.001, respectively), and those in the insert only and insert +
pictorial HWL groups were more likely to report stubbing out cigarettes (OR=2.89,
p=0.02; OR=5.37, p=0.0002). No dierences were found for talking behaviors. The
only statistically signicant interaction concerned stubbing out cigarettes: high-literacy
participants were relatively less likely to report this outcome if they were in insert only
group compared to control. Conclusions: Both pack inserts and pictorial HWLs promote
cessation-related behaviors and neither appear to reduce or exacerbate smoking
disparities. Pictorial HWLs and inserts may reduce smoking, although optimal labeling
policy requires further research.
FUNDING: Federal
POD5-5
UPTAKE AND EFFICACY OF A CO-LOCATED, OPT OUT SMOKING
CESSATION SUPPORT PACKAGE DELIVERED AS PART OF A
LUNG CANCER SCREENING PROGRAMME: THE YORKSHIRE
ENHANCED STOP SMOKING STUDY (YESS)
Rachael L. Murray1, Kate Brain2, John Britton1, Harriet Quinn-Scoggins2, Sarah Lewis1,
Grace McCutchan2, Samantha L. Quaife3, Qi Wu4, Alex Ashurst5, David Baldwin6,
Philip Crosbie7, Richard Neal8, Steve Parrott4, Suzanne Rogerson5, Rebecca Thorley1,
Matthew Callister5. 1University of Nottingham, Nottingham, United Kingdom, 2Cardi
University, Cardi, United Kingdom, 3Queen Mary University London, London, United
Kingdom, 4University of York, York, United Kingdom, 5Leeds Teaching Hospitals NHS
Trust, Leeds, United Kingdom, 6Nottingham University Hospitals NHS Trust, Nottingham,
United Kingdom, 7University of Manchester, Manchester, United Kingdom, 8University
of Leeds, Leeds, United Kingdom.
Signicance: More than 85% of cases of lung cancer are caused by tobacco smoking,
and stopping smoking, at any age, signicantly reduces lung cancer risk. With the
recommendation for annual low dose computed topography (LDCT) screening in the
US and potential introduction of similar approaches across Europe oering a teach-
able moment for encouraging quit attempts in this high risk population, it is essential
that any lung cancer screening programme provides smoking cessation support for
participants. Further, doing so signicantly increases the ecacy and cost ecacy of
lung cancer screening programmes. Methods: The Yorkshire Enhanced Stop Smoking
study (YESS) oered co-located, stop smoking support comprising NRT/e-cigarettes/
varenicline and behavioural support on an opt out basis to all eligible smokers attending
for a lung health check (LHC) as part of the Yorkshire Lung Screening Trial in the UK.
This abstract reports initial ndings relating to uptake of the oer of stop smoking support
and the quit rates reported 4-weeks post LHC. Results: Of 2151 smokers eligible to
receive stop smoking support as part of YESS, 1901 (88.4%) agreed to a consultation
with a smoking cessation practitioner at the time of the LHC. Of these, 1603 (83.3%)
agreed to receive ongoing cessation support. Approximately half of smokers used an
e-cigarette to support their quit attempt, either alone or in combination with NRT. Four
weeks after the LHC, 17.7% of smokers accepting ongoing cessation support were
abstinent from smoking (13.2% of all eligible smokers attending for the LHC). Conclu-
sion: Study ndings illustrate that the provision of a co-located, opt out, specialist stop
smoking service delivered at the time of the LHC is well attended by smokers and has
the potential to support quitting in a population at high risk of developing lung cancer.
Policymakers should strongly consider recommending similar stop smoking provision
as part of any lung cancer screening programme implemented.
FUNDING: Nonprot grant funding entity
POD5-6
SUBJECTIVE EXPERIENCES, CONTEXTS, AND RISK
PERCEPTIONS OF VERY LOW NICOTINE CONTENT CIGARETTES
AND ELECTRONIC CIGARETTES AMONG PEOPLE WITH
AFFECTIVE DISORDERS WHO SMOKE
Teresa DeAtley1, Abigail Harrison1, Bianca Camacho1, Rachel Cassidy1, Caroline Kuo1,
Stephen T. HigginsPhD2, Jennifer Tidey1. 1Brown University, Providence, RI, USA,
2University of Vermont, Burlington, VT, USA.
Introduction: The FDA is considering mandating the reduction of nicotine in cigarettes
to a non-addictive level. The availability of non-combusted, full-nicotine substitutes such
as e-cigarettes may further help individuals switch from cigarettes under such a policy.
We modeled this policy in the context of a clinical trial of people with aective disorders
(ADs), who smoke at much higher rates than the general population and explored
their subjective responses to using very low nicotine content (VLNC) cigarettes with
or without e-cigarettes.Methods: We conducted semi-structured qualitative interviews
with participants (N=20) who were completing a 16-week trial of VLNC cigarettes with
or without electronic cigarettes. In-depth interviews were conducted to explore 1)
experiences with these products, 2) social and environmental contexts for use and 3)
relative risk perceptions of both products compared to usual brand cigarettes. Interviews
were transcribed and analyzed using interpretive phenomenological analysis.Results:
People with ADs were willing to use VLNC cigarettes despite negative sensory experi-
ences. E-cigarettes helped to ease the transition from usual brand cigarettes to VLNC
cigarettes. Some participants held beliefs that VLNC cigarettes could reduce cancer
risk whereas others did not. In addition, some participants expressed skepticism about
the safety of e-cigarettes whereas others felt e-cigarettes were a healthier alternative.
Smoking restrictions or the presence of non-smokers inuenced e-cigarette use in
some instances, but product preference was the overriding factor that inuenced use
and situations for use.Conclusions: If a nicotine reduction policy were to be imple-
mented, tailored messaging may be necessary to educate people with ADs about
non-combustible alternatives and inform people about the lower risks of e-cigarettes
relative to cigarettes.Role of Funding Source: This research was supported by grants
F31DA049460 and U54DA036114 from the National Institutes of Health (NIH) and the
Nora Kahn Piore Award from Brown University School of Public Health. This content is
solely the responsibility of the authors and does not necessarily represent the ocial
views of the NIH or Food and Drug Administration (FDA).
FUNDING: Federal; Academic Institution
POD5-7
A REMOTE INTEGRATED INTERVENTION FOR TREATMENT
AND SMOKING CESSATION AMONG SMOKERS LIVING WITH
HEPATITIS C - A PILOT STUDY
Irene Pericot-Valverde1, Abigail Sepansk2, Jamila Johnson2, Moonseong Heo1, Michelle
Bublitz2, Carrie Baldwin2, Prerana Roth2, Susan Cordero-Romero2, Jess Knapp2, Alain
Litwin2. 1Clemson University, Greenville, SC, USA, 2Prisma Health, Greenville, SC, USA.
Signicance. Despite the availability of highly eective direct-acting antiviral (DAA)
medications with cure rates >95%, if left untreated, mortality rates in people living
with Hepatitis C virus (HCV) remain very high and surpass other infectious diseases,
including HIV. Cigarette smoking has emerged as a leading cause of mortality among
people with HCV. This pilot study assessed the feasibility and preliminary ecacy of an
integrated smoking cessation intervention designed to treat HCV and aid smoking ces-
sation concurrently among people living with HCV.Methods. Current smokers living with
HCV received a 12-week intervention delivered via phone. The integrated intervention
consisted of weekly 30-min sessions involving: 1) medication; 2) medication adherence
support for both HCV treatment (velpatasvir+sofosbuvir) and nicotine replacement
therapy (chantix); 3)psychoeducation about both HCV and smoking; and 4) counseling.
Results. Among 52 eligible participants, 21 (40.4%) met the inclusion criteria, and 10
were enrolled in the pilot study. The sample was 70% male, 38.4 years old on average,
and all had a high school education or the equivalent. Most (70%) participants had a
history of injection drug use and were receiving buprenorphine. The majority (90%)
of participants started DAAs to treat HCV and 60% had an undetectable viral load at
38
2022 Paper Sessions
the end of treatment. Most participants (70%) started pharmacotherapy for smoking
cessation and decreased the number of cigarettes smoked per day on average from
12.6 at baseline to 8.4 at the end of treatment.Conclusions. The remotely delivered
integrated intervention for HCV and smoking resulted in a decline on both HCV viral load
and the number of cigarettes smoked per day. Future research warrants a conrmatory
study with large sample size to test the eectiveness of the intervention in a real-world
setting. Addressing both smoking and HCV can produce tremendous health benets
among people living with HCV.
FUNDING: Unfunded; Pharmaceutical Industry; Academic Institution
PAPER SESSION 6: NOT JUST NICOTINE:
PRODUCT CONSTITUTENTS AND DRUG
CO-USE
POD6-1
ALTERATION OF JUUL CONTENT IN RESPONSE TO THE US FDA
FLAVOR BAN
Amira Yassine1, Rachel El Hage1, Rola Salman1, Soha Talih1, Ahmad El-Hellani1, Nareg
Karaoghlanian1, Najat Saliba1, Alan Shihadeh1, Thomas Eissenberg2. 1American Univer-
sity of Beirut, Beirut, Lebanon, 2VA Commonwealth University, Richmond, VA, USA.
Background: Soon after its release in 2017, JUUL captured a great share of the e-ciga-
rette market in the US. JUUL was highly attractive to youth due to its sleek design, wide
social media promotion, availability of dierent avors, and “smooth” delivery of nicotine.
In response to the high popularity of JUUL and similar devices among youth, the US FDA
issued a ban on the sales of all avored cartridge/pod-based e-cigarettes in February
2020. This ban exempted tobacco and menthol-avored pods. Subsequent studies
showed that users of the now-banned avored JUUL pods (especially mint-avored)
switched to menthol-avored pods with similar satisfaction. Methods: To understand
this nding, we quantied menthol, other cooling agents, nicotine, propylene glycol (PG),
and vegetable glycerol (VG) in JUUL pods (menthol, classic menthol, and cool mint)
purchased in 2017, 2018, and 2020 (only menthol) to monitor possible dierences before
and after the ban. Also, we measured coil resistance, pod dimensions, and battery power
output. Results: Nicotine concentration was found to be the same in all the tested pods
except for menthol-avored pods purchased in 2020. The PG/VG ratio was 30/70 in all
the pods. Statistical analysis showed that menthol levels in pods purchased in 2020
were signicantly higher than all the other pods. Also, one cooling agent isomenthol
was identied by a developed GC-MS headspace method in classical menthol (2018)
and menthol pods (2018 and 2020). Besides, two other cooling agents (neomenthol
and neoisomenthol) were identied in cool mint pods (2017 and 2018). Conclusion:
This nding highlights a possible maneuver by JUUL manufacturers to attract youth to
menthol-avored pods by increasing nicotine and menthol concentrations. This work
calls for considering menthol level as a possible target for regulation.
FUNDING: Federal
POD6-2
EFFECTS OF CHERRY AND SWEET FLAVOR ORAL CUE ON
NICOTINE SELF-ADMINISTRATION IN ADOLESCENT RATS
Deniz Bagdas, Nii A. Addy. Department of Psychiatry, School of Medicine, Yale Univer-
sity, New Haven, CT, USA.
Signicance: Exposure to sweet avorants throughout childhood may inuence nic-
otine use during adolescence when those avors are combined with nicotine. Indeed,
tobacco products with sweet avors (fruit, candy) are very popular among teenagers.
The current study explores the impact of early exposure to sweet-associated avorants,
like cherry avoring (benzaldehyde) and saccharin, on later nicotine-taking behavior
in adolescent rats. Methods: Adolescent female and male Sprague Dawley rats were
given a choice to consume water, benzaldehyde (0.01%), saccharin (0.32%), or a
combination of benzaldehyde and saccharin for one week duration via two-bottle choice
paradigm by starting postnatal day (PND) 21. On PND 28-29, rats were implanted with
intraoral (IO) and intravenous (IV) catheters. On PND38, nicotine (30 μg/kg/infusion)
self-administration (SA) was initiated in the presence or absence of IO avorants.
Initiation and maintenance of drug taking behavior, and motivation to work for drug
delivery were determined. Moreover, two other cohorts were tested in avorant IOSA
or nicotine IVSA alone. Results: Rats acquired nicotine IVSA and displayed greater
lever pressing than saline IVSA subjects. While saccharin alone and benzaldehyde +
saccharin in combination demonstrated greater IOSA than water. Benzaldehyde alone
IOSA was not dierent from water IOSA. On the other hand, IO benzaldehyde alone
reduced nicotine IVSA in rats. However, IO saccharin or IO benzaldehyde + saccharin,
when combined with IV nicotine, led to increased nicotine IVSA and drug-seeking, com-
pared to IO water plus nicotine. Conclusions: Our results reveal that the characterizing
sweet avor, saccharin can increase nicotine IVSA in adolescent rats and blocked the
ability of benzaldehyde to decrease nicotine IVSA. Funding: Research reported in
this publication was supported by the National Institute on Drug Abuse of the National
39
2022 Paper Sessions
Institutes of Health under Award Number P50 DA036151 and U54 DA036151. The
content is solely the responsibility of the authors and does not necessarily represent
the ocial views of the National Institutes of Health.
FUNDING: Federal; Academic Institution
POD6-3
ALCOHOL AND VAPOURIZED NICOTINE CO-EXPOSURE DURING
ADOLESCENCE CONTRIBUTE DIFFERENTIALLY TO SEX-
SPECIFIC BEHAVIOURAL EFFECTS IN ADULTHOOD
Jessica Ruolo, Jude A. Frie, Hayley H.A Thorpe, Jibran Y. Khokhar. University of
Guelph, Guelph, ON, Canada.
Introduction: Co-occurrence of e-cigarette use and alcohol consumption during
adolescence is frequent. However, little is known about their long-lasting eects when
combined. Here, we examined whether adolescent co-exposure to alcohol drinking and
vapourized nicotine would impact reward- and cognition-related behaviours in adult male
and female rats during adulthood. Methods: Four groups of male and female Sprague
Dawley rats (n=8-11/group/sex) received either nicotine (JUUL 5% nicotine pods) or
vehicle vapour daily between postnatal days 30-46, while having continuous voluntary
access to ethanol and water during this time in a two-bottle preference design. Upon
reaching adulthood, rats underwent behavioural testing utilizing Pavlovian conditioned
approach testing, fear conditioning and a two-bottle alcohol preference test. Results:
A sex-dependent eect was found in the two-bottle preference test in adulthood such
that females had a higher intake and preference for alcohol compared to males re-
gardless of adolescent exposure; both male and female adult rats had greater alcohol
preference compared to adolescents. Male rats exposed to vapourized nicotine with or
without alcohol drinking during adolescence exhibited altered reward-related learning
in adulthood, evidenced by enhanced levels of sign-tracking behaviour. Male rats that
drank alcohol with or without nicotine vapour in adolescence showed decits in asso-
ciative fear learning and memory as adults. In contrast, these eects were not seen in
female rats exposed to alcohol and nicotine vapour during adolescence. Conclusions:
The present study provides evidence that co-exposure to alcohol and vapourized nic-
otine during adolescence in male, but not female, rats produces long-term changes in
reward- and cognition-related behaviours. Signicance: These ndings enhance our
understanding of the eects of alcohol drinking and nicotine vapour exposure in ado-
lescence. Moreover, they highlight potential sex dierences that exist in the response to
alcohol and nicotine vapour, underscoring the need for follow-up studies elucidating the
neurobiological mechanisms that drive these sex dierences, as well as the long-term
eects of alcohol and nicotine vapour use.
FUNDING: Federal; Academic Institution; Other
POD6-4
EPIGENETIC ANALYSES OF ALCOHOL CONSUMPTION IN
COMBUSTIBLE AND NON COMBUSTIBLE NICOTINE USERS
Kelsey Dawes1, Rachel Reimer2, Allan Andersen1, Robert Philibert1. 1University of Iowa,
Iowa City, IA, USA, 2Des Moines University, Des Moines, IA, USA.
Alcohol and tobacco use are highly comorbid, and exacerbate the associated morbidity
and mortality of either substance alone. However, the relationship of alcohol consumption
to the various forms of nicotine containing products is not well understood. To improve
this understanding, we examined the relationship of alcohol consumption to nicotine
product use using self-report, cotinine and two epigenetic biomarkers specic for smok-
ing (cg05575921) and drinking (Alcohol T Scores (ATS)) in n = 424 subjects. Cigarette
users had signicantly higher ATS values than the other groups (p < 2.2e-16). Using the
objective biomarkers, the intensity of nicotine and alcohol consumption was correlated
in both the cigarette and smokeless users (R = -0.66, p = 3.1e-14; R² = 0.61, p = 1.97e-
04). Building upon this idea, we used the objective nicotine biomarkers and age to build
and test a Balanced Random Forest classication model for heavy alcohol consumption
(ATS > 2.35). The model performed well with an AUC of 0.962, 89.3% sensitivity, and
85% specicity. We conclude that those who use non-combustible nicotine products
drink signicantly less than smokers, and cigarette and smokeless users drink more
with heavier nicotine use. These ndings further highlight the lack of informativeness
of self-reported alcohol consumption and suggest given the public and private health
burden of alcoholism, further research into whether using non-combustible nicotine
products as mode of treatment for dual users should be considered.
FUNDING: Academic Institution; Nonprot grant funding entity
POD6-5
SEX, AGE, AND GENOTYPIC DIFFERENCES IN THE EFFECTS OF
MENTHOL ON NICOTINE INTAKE AND PREFERENCE IN MICE
Lois Setemi Akinola1, Yumna Rahman1, Olivia Ondo1, Deniz Bagdas2, Asti Jackson2,
M. Imad Damaj1. 1Virginia Commonwealth University, Richmond, VA, USA, 2Yale Univer-
sity, New Haven, CT, USA.
Signicance: Accumulating evidence suggests that certain avor additives in tobacco
products may propagate nicotine dependence. Menthol, a commonly used avorant, has
been shown to exacerbate nicotine sensitivity in smokers, characterized by increased
dependence scores, poorer cessation outcomes, and higher relapse rates compared to
non-menthol smokers. Menthol use has also been shown to dier signicantly between
gender, age groups, and population subgroups, and although menthol has been a
component of tobacco products for decades, its role in the initiation and maintenance
of nicotine dependence is poorly understood. Comparative studies of phenotypes ex-
pressed by dierent inbred strains of mice could potentially identify neurobiological and
genetic determinants of variability in menthol sensitivity at preclinical levels. Methods:
The current study utilized adolescent (PND 21) and adult (PND 60), male and female
C57BL/6J and DBA/2J mice to investigate the sex, age, and genotypic dierences
underlying the eects of menthol in the two-bottle choice (2BC) test. We chose these
genetically distinct inbred strains due to their opposing preference to nicotine in the oral
self-administration paradigm. Lastly, we investigated the eects of menthol after systemic
administration to dissect potential mechanisms underlying menthol’s eects. Results:
Menthol (oral or systemic) signicantly enhanced oral nicotine consumption in a sex-,
age- and genotype-dependent manner, with females and adolescent C57BL/6J mice
displaying greater sensitivity to its eects. In contrast, menthol failed to enhance nicotine
preference or reduce aversion to nicotine in DBA/2J mice in the 2BC test after oral or
systemic administration. Conclusions: These ndings suggest that menthol’s eects
on nicotine intake and preference depend on the genetic background of the animal and
support the existence of genotype-specic neurobiological and genetic mechanisms that
may contribute to the variable eects of menthol in dierent populations.
FUNDING: Federal
POD6-6
CHRONIC ADMINISTRATION OF SYNTHETIC CONTRACEPTIVE
HORMONES ALTERS ETHANOL AND NICOTINE INTAKE IN A CO-
USE MODEL IN FREELY CYCLING FEMALE RATS
Erin E. Maher1, Emma O. Bondy1, Shailesh Khatri1, Olivia C. Sweatt2, William C. Grif-
n2, Jessica Weafer1, Cassandra D. Gipson1. 1University of Kentucky, Lexington, KY,
USA, 2Medical University of South Carolina, Charleston, SC, USA.
Signicance: Tobacco and alcohol use disorders (TUD and AUD) are tremendous health
liabilities, and co-use of these substances is highly prevalent. Women are particularly
at risk, as AUD is increasing at alarming rates and long-term smoking cessation is
more dicult to achieve in women than men. Ovarian hormones can aect frequency
of binge drinking, as well as cigarette craving, with increases in 17β-estradiol (E2)
and progesterone being associated with addiction risk and resilience, respectively. It
is important to consider how exogenous synthetic hormones often found in hormonal
contraceptives may inuence motivation for alcohol and nicotine. However, despite
widespread contraceptive use and the inuence of hormones on addiction vulnerability,
little is known regarding the inuence of contraceptives on nicotine and alcohol co-use.
The aim of this study is to determine the inuence of synthetic estrogen (e.g., ethinyl
estradiol, or EE) and/or progesterone (e.g., levonorgestrel, or LEVO) on nicotine and
ethanol (EtOH) intake in rats. We hypothesized that female rats given LEVO will show
lower rates of nicotine and EtOH intake, whereas rats given EE+LEVO will show higher
rates of intake of both drugs. Methods: Rats rst underwent a 4-hr drinking in the dark
(DID) paradigm in which the water bottle was replaced with 10% EtOH or vehicle (water).
Following DID, rats receive a subcutaneous injection of either LEVO, EE+LEVO, or
vehicle (sesame oil) and began nicotine SA (0.06 mg/kg/infusion) on an FR1 schedule.
Results and Conclusion: Rats that received EE+LEVO consumed more nicotine as
compared to rats that received LEVO alone or vehicle. There was no dierence in nicotine
consumption with hormone treatment in animals that drank EtOH prior to nicotine SA.
Contrary to our hypothesis, animals that received LEVO alone consumed more EtOH
then either the EE+LEVO or vehicle animals. Overall, we found EE+LEVO decreased
EtOH intake when EtOH was co-used with nicotine, whereas this combination increas-
es nicotine consumption when rats are not concurrently drinking. Taken together, we
found that LEVO enhances EtOH consumption when EtOH and nicotine are co-used,
40
2022 Paper Sessions
but decreases nicotine consumption in animals only self-administering nicotine. Thus,
these results can inform women’s care by determining safer hormonal contraceptive
use when women either only smoke, or concurrently drink and smoke.
FUNDING: Academic Institution
PAPER SESSION 7: TOBACCO CONTROL
POLICY EVALUATION: COMPLEXITY AND
UNINTENDED CONSEQUENCES
POD7-1
DOES IMPLEMENTING SMOKE-FREE PUBLIC HOUSING
INCREASE RESIDENT TURNOVER
Douglas E. Levy1, David C. Cheng1, Radhika R. Shah1, Boram Lee1, Sydney L. Gold-
berg1, Jonathan P. Winicko1, Nancy A. Rigotti2, Glory Song3, Melody Kingsley3, Jacque-
line Doane3, Patricia Henley3, Sanouri A. Ursprung3, Christopher Banthin4, Vicki C.
Fung1. 1Massachusetts General Hospital, Boston, MA, USA, 2Harvard Medical School,
Lincoln, MA, USA, 3Massachusetts Department of Public Health, Boston, MA, USA,
4Public Health Advocacy Institute, Boston, MA, USA.
BACKGROUND. Smoke-free policies (SFPs) are adopted in public (subsidized) housing
to reduce residents’ secondhand smoke exposure. While the benets of preventing
secondhand smoke exposure are well-documented, any unintended consequences of
SFPs relative to housing stability (a key social determinant of health) are not yet doc-
umented. We investigated whether housing transitions increased after Massachusetts
public housing authorities (MA PHAs) instituted SFPs. METHODS. Demographic and
tenancy data on all residents of federally-funded public housing in MA (2009-2018) were
obtained from the U.S. Department of Housing and Urban Development (67 PHAs,
48,162 households in sample). Data on SFPs were obtained from public records and
a survey of MA PHAs. We used Cox proportional hazards models including SFPs as
time-varying covariates to assess the association between SFPs and rates of transition
out of public housing within 2 years of SFP introduction among households who were
admitted prior the adoptions of SFPs. The models adjusted for PHA characteristics (size,
rurality) head of household (HOH) characteristics (age at admission, sex, race/ethnicity,
disability, year of admission), and PHA-level random eects. Subgroup analyses were
conducted by PHA funding (residence in elderly/disabled vs. family developments),
PHA size, and HOH demographics. RESULTS. The earliest SFP was instituted in 2011
and by 2018, all federally-funded PHAs in MA had instituted SFPs. Overall, there were
no signicant associations between the introduction of SFPs and housing transitions
(adjusted hazard ratio [HR] 1.03, 95%CI 0.98-1.08). After Bonferroni correction there
were no signicant associations in subgroups dened by PHA funding (family vs. elderly/
disabled) or HOH age, sex, or race. However, in PHAs that were medium sized (100-1000
units), SFPs were associated with an increased rate of tenant departure (HR 1.22, 95%CI
1.11-1.34). CONCLUSION. Overall, in a large sample of public housing residents in MA,
there is no evidence of an increase in housing transitions with the introduction of SFPs.
Further research is necessary to understand transition dynamics in particular PHAs.
FUNDING: Federal
POD7-2
TOBACCO PRODUCT TAX RATES AND EMERGING ADULT
TOBACCO USE
Michael Pesko1, Abigail Friedman2. 1Georgia State University, Atlanta, GA, USA, 2Yale
University, New Haven, CT, USA.
Signicance: While over half of US states have passed taxes on electronic nicotine
delivery systems (ENDS), recent evidence linking ENDS taxes to reduced adult smoking
cessation and increased adult smoking suggests potentially substantive health costs.
Eects on uptake of habitual use are less clear, as analyses have not assessed ENDS
tax rates’ eects on smoking in emerging adulthood (ages 18-25), when over half of daily
smokers report initiating daily use. Methods: To estimate changes in emerging adult
cigarette and ENDS use following cigarette and ENDS tax rate changes, we matched
state policy information to nine waves of nationally representative data from the 2010-
2019 Current Population Survey’s Tobacco Use Supplement. We estimate multivariable
regression models for emerging adults (ages 18-25, N=38,906) to assess ENDS and
cigarette taxes’ relationship to recent (past-30-day) and daily cigarette and ENDS use,
adjusting for nationwide time-trends, time-invariant dierences in each outcome by state,
and an array of potential sociodemographic and policy confounders. Results: Increased
ENDS taxes yielded signicant reductions in emerging adults’ daily ENDS use (-2.5
percentage points [pp]; 95% CI: -3.7, -1.4 pp) versus increases in recent cigarette use
(3.7 pp; 95% CI: 1.3, 6.1 pp) and, though marginally non-signicant, daily cigarette use
(2.5 pp; 95% CI: -0.05, 5.1 pp; p=0.054). Similarly, a one dollar increase in cigarette
taxes was associated with 2.1 and 2.5 percentage point increases in recent and daily
ENDS use, respectively. Conclusions: ENDS taxes were associated with reductions in
ENDS use but increases in cigarette use among emerging adults. As uptake of daily use
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2022 Paper Sessions
disproportionately occurs in this age-range, this result calls for care in setting tobacco
product taxes, to ensure that regulations do not inadvertently incentivize habituation of
more lethal tobacco products.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
POD7-3
THE EVALI OUTBREAK AND TOBACCO SALES IN THE UNITED
STATES, 2014—2020
Alex Liber1, Zachary Cahn2, Megan Diaz3, Emily Donovan3, Donna Vallone3, Barbara
Schillo3. 1Georgetown University, Washington, DC, USA, 2Atlanta, GA, USA, 3Truth
Initiative, Washington, DC, USA.
Signicance: The E-cigarette, or Vaping Product-Use Associated Lung Injury (EVALI)
Outbreak of 2019 hospitalized thousands of people in the US and raised perceptions
of the dangers posed to health by e-cigarettes. These illnesses along with continued
increases in youth vaping rates triggered the passage of many state and federal laws
intended to curtail the sales of avored e-cigarettes. Little is known about the impact of
these events on US electronic cigarette and cigarette sales. Methods: Using Nielsen
Scantrack sales data from January 2014 to January 2020 for 23 US states, we evaluate
the eect of the EVALI outbreak. First-dierenced xed-eects state-panel regressions
tracking unit sales of total- and category-level e-cigarettes and cigarette sales controlling
for price, time, Tobacco 21 policy coverage, product distribution, seasonality, EVALI-at-
tributable hospitalizations, and state-level e-cigarette policies aecting the availability
of e-cigarettes (non-tobacco avored and total) were employed. Results: Dollar sales
of e-cigarettes declined 34% from their pre-EVALI peak by February 2020. Sales of
e-cigarettes declined in response to the EVALI outbreak and the total e-cigarette sales
ban put in place in Massachusetts adopted in its wake, while they remained unaected
by state bans on sales of non-tobacco avor e-cigarettes. Cigarette sales were largely
unchanged by either the direct or indirect policy eects of the EVALI outbreak, except for
cigarette brands smoked by young people which rose in Massachusetts. Conclusion:
Sales of e-cigarettes declined in response to the EVALI outbreak and from the most
restrictive regulatory policies that were adopted in response, while sales of cigarettes
were largely unaected.
FUNDING: Nonprot grant funding entity
POD7-4
FLAVOURS AND FEATURES IN TOBACCO PACKS BEFORE PLAIN
PACKAGING IN URUGUAY
Laura Llambi, Mauricio Minacapilli, Valentina Gonzalez, Virginia Nuñez, Carolina
Parodi, Mary Barros. Hospital de Clinicas, Facultad de Medicina, Universidad de la
Republica, Montevideo, Uruguay.
Signicance Marketing strategies are constantly being developed by tobacco industry, to
reach new consumers such as children and youth. One of these strategies is marketing
through design appeals and avours. Uruguay is the second country to implement
plain packaging legislation for cigarettes in the Americas. This study aims to explore
avouring and design features of tobacco products available near schools immediately
before the implementation of plain package in Uruguay. Methods Fieldwork protocol
was adapted from the one developed at Johns Hopkins University and implemented
in fteen neighbourhoods in Montevideo, Uruguay, across dierent socioeconomic
areas. A high school was selected per neighbourhood as the hub, from which the
protocol was started. We surveyed retailers, purchased tobacco, and coded according
to its characteristics. Results A total of 23 unique tobacco products were purchased.
Appealing design features were found in 17 of the 23 packs, and 8 of the 23 products
were avoured cigarettes. Flavoured cigarettes lacked the child protection warning in
a greater proportion than non-avoured ones. Also, avoured products were available
in at least one retailer for across all socioeconomic levels. The most frequently found
lter designs concerned the activation of avour with ball or capsule designs (7/21), and
features meant to imitate technological symbols that appeal to youth (3/21). Conclusion
Our study shows an increase in availability of avoured cigarettes in Uruguay imme-
diately before plain packaging implementation according to previous report. However,
proliferation of avoured packs is much lower than other countries in the region, pos-
sibly attributable to the single presentation requirement. In countries developing plain
packaging legislation avour proliferation and modication of design features must be
especially monitored and addressed
FUNDING: State; Academic Institution
POD7-5
HOW DID CIGARETTE SMOKING CHANGE IN JAPAN AS HEATED
TOBACCO PRODUCTS RAPIDLY ASCENDED? FINDINGS FROM
THE 2018-2020 ITC JAPAN SURVEYS
Shaowei Xu1, Gang Meng1, Shannon Gravely1, Anne Quah1, Janine Ouimet1, Itsuro
Yoshimi2, Kota Katanoda2, Takahiro Tabuchi3, Michael Cummings4, Andrew Hyland5,
Georey Fong1. 1University of Waterloo, Waterloo, ON, Canada, 2Japan National Cancer
Center, Tokyo, Japan, 3Osaka International Cancer Institute, Osaka, Japan, 4Medical
University of SC, Charleston, SC, USA, 5Roswell Park Comprehensive Cancer Center,
Bualo, NY, USA.
Signicance: Heated tobacco products (HTPs) were launched in Japan in 2016. Since
then, cigarette sales have decreased by >40% and HTP sales now account for 30%
of total tobacco market. We examined whether the increase in HTPs in Japan was
accompanied by signicant decreases in smoking on two measures: (1) percentage of
daily smokers, and (2) cigarette consumption. Method: Data came from adult (aged 20+)
smokers (≥weekly) who participated in at least one of three ITC Japan Surveys conducted
in 2018 (Wave 1, W1; n=3810), 2018-2019 (W2, n=2728), and 2020 (W3, n=2757). The
analyses were conducted among exclusive cigarette smokers (ES) and concurrent (i.e.,
dual) users (CU: smoke and use HTPs ≥weekly). Cross-sectional analyses examined
dierences across the three waves in smoking and HTP use. Results: Among all
smokers the percentage of CU increased from 6.3% (W1) to 36.4% (W3; p<0.001),
while ES decreased from 93.7% (W1) to 63.6% (W3; p<0.001). Overall, the percentage
who smoked daily was unchanged between 2018 and 2020 (96.0% to 93.6%, p≥0.05);
however, among CU only, the percentage who smoked daily decreased signicantly
from 97% to 92% between 2018 and 2020, p<0.001. No statistical dierences in CPD
were observed overall or separately for ES or CU between 2018 and 2020. Conclusion:
From 2018 to 2020, there was a nearly six-fold increase in concurrent use. Although
the percentage of daily smokers did not change among exclusive smokers, percentage
of daily smokers decreased slightly among concurrent users. Cigarette consumption
did not change among all smokers. These ndings show that in Japan from 2018 to
2020, when HTP use continued to increase, this was not accompanied by substantial
changes in daily smoking or cigarette consumption.
FUNDING: Federal; Academic Institution
POD7-6
USING A BITE-STYLE MODEL TO EVALUATE POLAND’S
MENTHOL CIGARETTE BAN
Alex Liber1, Michal Stoklosa2, David Levy3, Christopher Cadham4, Luz Maria Sanchez-
Romero1, Michael Pesko5. 1Georgetown University, Washington, DC, USA, 2World
Health Organization, Geneva, Switzerland, 3Georgetown University Medical Center,
Silver Spring, MD, USA, 4University of Michigan, Ann Arbor, MI, USA, 5Georgia State
University, Atlanta, GA, USA.
Signicance: In May 2020, the European Union Tobacco Products Directive mandated
that EU member states, including Poland, ban the sale of menthol cigarettes. With
menthol making up 28% of cigarette sales before the ban, Poland is the country with
the largest menthol cigarette sales share in the world to ban their sale. We analyze
how this ban changed the Polish tobacco market. Methods: We use monthly NielsenIQ
sales data (May 2018—April 2021) on sales of cigarettes and roll-your-own tobacco by
menthol and standard avor in 8 regions of Poland. We set up a bite-style regression
model controlling for pre-ban menthol share, climate, border opening status, and Apple
movement data to estimate the eect of the May 2020 menthol ban. We perform an event
study to conrm whether the parallel trends assumption is met. Results: We nd that
menthol cigarette sales fell at least 97% after the menthol cigarette ban across Poland
and standard cigarette sales rose in their place. Regression modeling indicates that total
cigarette sales fell, after the ban, an average of 2.3 sticks per capita per month, equal to
a 2.9% decline, however, results were not signicant (p=.107). The bite component of
our model reveals eects were signicantly larger in regions with more pre-ban menthol
sales share. Roll-your-own tobacco sales increased by 1.1 stick-equivalents after the
ban (p=.014). Roll-your-own tobacco and cigarette prices also fell in the wake of the
menthol ban. Conclusions: In Poland, the EU state most exposed to the bloc’s menthol
cigarette sales ban, we nd mixed evidence that the ban is working as intended. Further
research is needed to understand compensatory behaviors by smokers and tobacco
companies in the face of such policies.
FUNDING: Nonprot grant funding entity
42
2022 Paper Sessions
POD7-7
IS THE EU JUUL VAPING DEVICE SUFFICIENTLY SATISFYING TO
UK SMOKERS: COMPARING THE SUBJECTIVE EFFECTS AND
NICOTINE ABSORPTION LEVELS FOLLOWING USE OF THE EU
AND THE US JUUL POD
Catherine Kimber1, Sharon Cox2, Caitlin Notley3, Steve Hunter1, Lisa Zaidell1, Lynne
Dawkins1. 1London South Bank University, London, United Kingdom, 2University College
London (UCL), London, United Kingdom, 3University of East Anglia, Norwich, United
Kingdom.
Background:Pod Vaping Devices (PVD) such as JUUL have become extremely popular
in the US and their popularity is growing in the UK. A key dierence between the US
and the UK is the nicotine strength which is typically 59mg/mL in the US but capped at
20mg/mL in the UK and EU. This may limit the ability of EU vaping devices to deliver
satisfactory nicotine levels and promote smoking cessation especially for highly nicotine
dependent smokers. The primary aim was to compare the EU JUUL (18mg/mL nico-
tine strength) with the US JUUL (59mg/mL) on daily smokers’ subjective experiences,
craving relief and blood nicotine levels. Methods: Double-blind, counter-balanced
within-participants design with 2 conditions: 18mg/mL vs. 59mg/mL. N=21 (11 Males,
10 Females) UK smokers vaped ad libitum for 60 mins and provided blood samples
at baseline 5, 15, 30 and 60 mins on 2 separate occasions. Craving and withdrawal
symptoms were measured at baseline, 10 and 60 mins and subjective eects at 10
and 60 mins. Results:Liquid consumption was doubled under the 18 versus the 59mg/
mL (p=.001) and plasma nicotine levels were signicantly higher in the 59mg/mL at all
time-points (p≤.001). There were no dierences in subjective eects including craving,
withdrawal symptoms relief or satisfaction (all ps>.05). Throat hit scores were signicantly
greater in the 59mg/mL at 10 (p=.030) and 60 mins (p=.031). Participants reported a
greater likelihood to replace their cigarettes with the device when using the 18mg/mL
compared to the 59mg/mL nicotine strength at 10 mins. Discussion: Plasmanicotine
levels were greater under the 59mg/mL despite participants vaping double the quantity
of liquid in the 18mg/mL nicotine strength. The dierences in liquid consumption suggest
an attempt to compensate for lower nicotine levels which may have been successful
at least subjectively, given scores in subjective eects (including changes in craving,
withdrawal symptoms relief and satisfaction) did not dier.
FUNDING: Nonprot grant funding entity; Academic Institution
43
Notes
44
Notes
45
2022 Paper Sessions
PAPER SESSION 8: BIDIRECTIONAL
RELATIONSHIP BETWEEN MENTAL
HEALTH AND NICOTINE USE
POD8-1
ESCALATION OF ENDS USE ACROSS YOUNG ADULTHOOD
- ASSOCIATIONS WITH DEPRESSIVE SYMPTOMS AND
SENSATION SEEKING
Xiaoyin Li1, Anna Wilkinson2, Alexandra Loukas3. 1University of TX at Austin, Austin,
TX, USA, 2University of TX Science Center at Houston, School of Public Health, Austin,
TX, USA, 3University of TX, Austin, Austin, TX, USA.
Signicance: Depressive symptoms and sensation seeking are important risk factors for
the development of tobacco use behaviors. However, the interactive eects of depressive
symptoms and sensation seeking on tobacco use changes across young adulthood have
not been explored. The purpose of this study was to 1) examine intraindividual change
in frequency of ENDS use across young adulthood, ages 18-30, and 2) determine if
depressive symptoms and sensation seeking, independently and in interaction with one
another, inuenced these changes. Methods: This study used six waves of web-based
longitudinal data (fall 2015-spring 2019) from the Marketing and Promotions Across
Colleges in Texas project (Project M-PACT). Participants were 1,298 young adults
who were 18-25 when recruited and who reported past 30-day ENDS use on at least
one wave (mean age in fall 2015 is 21.6 (SD)=1.89; 36.3% White, 56.3% Women).
We used growth curve models for an accelerated longitudinal design to examine if the
frequency of ENDS use (number of days used in the past 30 days) changed across
increasing ages. We also examined if depressive symptoms and sensation seeking,
independently and in interaction with one another, were associated with changes in
ENDS use. Results: Frequency of ENDS use increased with increasing age (b = 0.44,
p < .001). Depressive symptoms, but not sensation seeking, were independently asso-
ciated with a faster increase in ENDS use frequency across increasing age (b = 0.11, p
< .01). The two-way interaction between sensation seeking and depressive symptoms
was signicant (b = 0.21, p < .05). Probing the interaction indicated that young adults
with elevated depressive symptoms used ENDS more frequently, but only when they
had high levels of sensation seeking (b = 0.32, p = 0.02), and not low levels (b = -0.09,
p = 0.52). Conclusions: Evidence indicates that young adults high in sensation seeking
may be more sensitive to the mood-altering eects of nicotine than their peers. Those
with elevated depressive symptoms may use ENDS to alleviate negative aect, but
only when they are also high in sensation seeking. Interventions for young adults high
in both sensation seeking traits and depressive symptoms may help prevent escalation
of ENDS use over time.
FUNDING: Federal
POD8-2
STRESS AND E-CIGARETTE USE AMONG YOUTH AND YOUNG
ADULTS: A LONGITUDINAL EXAMINATION OF INITIATION,
REUPTAKE, AND CONTINUATION
Dale Mantey1, Stephanie Clendennen2, Aslesha Sumbe3, Anna Wilkinson4, Melissa
Harrell5. 1UT-Health Science Center, School of Public Health, Austin, TX, USA, 2UT
Health, School of Public Health in Austin, Austin, TX, USA, 3UTSPH, Austin, TX, USA,
4University of TX Science Center at Houston, School of Public Health, Austin, TX, USA,
5University of TX, SPH, Austin, TX, USA.
Objectives: E-cigarettes are the most commonly used tobacco product among youth
and young adults. While much is known of the relationship between e-cigarette use and
indicators of poor mental health (eg, depression), limited research has examined how
stress impacts e-cigarette use among young people. We examine the longitudinal as-
sociations between perceived stress score (PSS) and e-cigarette use behaviors among
a diverse cohort of youth and young adults. Methods: This study analyzed two waves
of data collected in Fall 2019 (baseline) and Spring 2020 (6-month follow-up) of the
Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants
were classied into three mutually exclusive subsamples: (1) n=1,177 never e-cigarette
users; (2) n=806 ever but not current (past 30-day) users (ie, former users); and (3)
n=257 current (past 30-day) e-cigarette users. Three multivariate logistic regression
models examined the relationship between stress (PSS) at baseline and: (1) initiation
among never users; (2) reuptake among former users; and (3) continuation among
current users, at 6-month follow-up. Models controlled for race/ethnicity, sex, age,
past 30-day alcohol use, and ever other tobacco use at baseline. Results: Mean age
for each subsample ranged from 18.6 to 19.4 at baseline. Hispanics were the largest
group among never (37.7%) and former (40.4%) users. Non-Hispanic Whites were the
largest group among current users (48.3%). Risk for e-cigarette initiation increased by
1.56 (95% CI: 1.04 - 2.35) for each unit increase in PSS at baseline. Risk for e-ciga-
rette reuptake increased by 1.38 (95% CI: 1.00 - 1.98) for each unit increase in PSS
at baseline. PSS at baseline was not associated with e-cigarette continuation among
current users. Conclusion: Stress predicted greater risk of e-cigarette initiation among
never users and reuptake among former users 6-months later. Research and prevention
strategies should consider stress as an important risk factor for e-cigarette use among
young people, especially as the health eects of e-cigarette use emerge, particularly
respiratory illness like EVALI and COVID-19.
FUNDING: Federal
POD8-3
INTERNALIZING AND EXTERNALIZING PROBLEMS ON THE AGE
OF E-CIGARETTE INITIATION IN THE POPULATION ASSESSMENT
OF TOBACCO AND HEALTH (PATH) USA YOUTH (2013-2017)
Meagan Bluestein1, Melissa Harrell2, Baojiang Chen3, Adriana Perez4. 1Michael &
Susan Dell Center for Healthy Living, Austin, TX, USA, 2UT Health School of Public
Health, Austin, TX, USA, 3The University of Texas Health Science Center at Houston,
School of Public Health, Austin Campus, Austin, TX, USA, 4The University of TX Health
Science Center at Houston, Austin, TX, USA.
Objective Internalizing and externalizing problems have been shown to be associated
with e-cigarette initiation in youth. Yet, it is unknown if internalizing and externalizing
problems increase the risk of an earlier age of initiation of e-cigarette use in youth.
Methods Secondary analyses of PATH youth (12-17) waves 1-4 (2013-2017) were con-
ducted. Among never e-cigarette users at the rst wave of PATH participation (n=16,143;
N=29,349,76), the age of initiation of ever and past 30-day e-cigarette use was esti-
mated using follow-up surveys in 2014-2017. The GAIN-SS is a validated measure for
internalizing and externalizing problems in youth. Youth were classied as having none/
low (0-1 symptoms), moderate (2-3 symptoms), and high (>4 symptoms) internalizing
and externalizing problems in the past year measured at the wave prior to e-cigarette
initiation for youth who become users and at the latest wave of participation for youth
who remained non-users. Four weighted interval-censored Cox proportional hazard
models were tted to estimate the relationship between internalizing and externalizing
problems and the age of initiation of each e-cigarette use outcome while adjusting for
sex, race/ethnicity, previous use of other tobacco products (cigarettes, any cigar product,
hookah, and smokeless tobacco), and psychoactive substances (alcohol, marijuana,
prescription opioid drugs, and any other substance). Weighted interval-censored survival
analyses were used to estimate the hazard function for the age of initiation of each
outcome stratied by internalizing and externalizing scores. Results Youth with high
internalizing problems had increased risk of initiating ever (AHR=1.87;95%CI=1.69-2.05)
and past 30-day (AHR=1.88;95%CI=1.58-2.18) e-cigarette use at earlier ages compared
to youth with none/low internalizing problems. Youth with high externalizing problems
had increased risk of initiating ever (AHR=2.48;95%CI=2.22-2.76) and past 30-day
(AHR=2.46;95%CI=2.05-2.98) e-cigarette use at earlier ages compared to youth with
none/low externalizing problems. Conclusion E-cigarette prevention eorts should
target youth with high internalizing or externalizing problems.
FUNDING: Federal
PODIUM PRESENTATION 3
46
2022 Paper Sessions
POD8-4
PSYCHOSOCIAL PREDICTORS OF LONGITUDINAL CHANGES IN
TOBACCO AND MARIJUANA USE AMONG YOUNG ADULTS FROM
2018 TO 2020
Katelyn F. Romm, Yan Wang, Zongshuan Duan, Breesa Bennett, Caroline Fuss, Yan
Ma, Carla J. Berg. George Washington University, Washington, DC, USA.
Signicance: Young adults decreased their use of cigarettes but increased use of
alternative tobacco products (ATPs) and marijuana in recent years. Research is needed
to examine intraindividual changes in tobacco product and marijuana use during young
adulthood, as well as related psychosocial predictors. Methods: We analyzed data from
3,006 participants (ages 18-34) in a 2-year, 5-wave longitudinal study (2018-2020),
including baseline sociodemographics, depressive symptoms, personality traits, and
adverse childhood experiences (ACEs) and waves 1-5 past 6-month use of cigarettes,
e-cigarettes, traditional cigars, little cigars, smokeless tobacco [SLT], hookah, and
marijuana. Results: Participants were, on average, 24.56 years old (SD=4.72), 54.8%
female, 31.6% sexual minority, 71.6% White, 5.3% Black, 12.2% Asian, and 11.4%
Hispanic. Baseline past 6-month use prevalence ranged from 5.2% for SLT to 47.4% for
marijuana. Latent growth modeling indicated that, on average, participants decreased
in their likelihood of using each tobacco product, but did not change in their likelihood
of using marijuana over time. After controlling for sociodemographics, predictors of less
decrease in use likelihood over time were: for cigarettes and traditional cigars, ACEs; for
e-cigarettes, extraversion; for little cigars, depressive symptoms and extraversion; for
SLT, openness; and for hookah, neuroticism. Predictors of more rapid decrease in use
were: for e-cigarettes and hookah, conscientiousness; and for marijuana, agreeableness.
Also, older age predicted slower decrease over time in use of cigarettes, cigars, and
SLT. Being White predicted slower decrease over time in e-cigarette and cigar use,
but being racial/ethnic minority was associated with slower decrease in cigarette and
marijuana use. Conclusion: While some psychosocial factors (e.g., conscientious-
ness) may promote more rapid decrease in substance use, others (e.g., extraversion,
stressful events, mental health) may dierentially impact risk for ongoing or escalating
use of tobacco products and marijuana. Intervention eorts may address such factors
to reduce young adults’ use or escalation in use.
FUNDING: Federal
POD8-5
EXAMINING THE LONGITUDINAL, INTERACTIVE ASSOCIATIONS
OF DEPRESSIVE SYMPTOMS AND PEER TOBACCO USE ON
YOUNG ADULT TOBACCO USE
Caroline North, Nathan Marti, Alexandra Loukas. University of Texas at Austin, Austin,
TX, USA.
Signicance: Previous research indicates that depressive symptoms and peer tobacco
use are independently associated with young adults’ tobacco use. Few studies, how-
ever, examine the interaction between these two factors. This study examined if peer
tobacco use moderated the longitudinal impact of depressive symptoms on subsequent
tobacco use. We hypothesized that 1) elevated levels of depressive symptoms would be
associated with a greater number of tobacco products used across ages 18-30 and 2)
this association would be stronger among those with a greater number of tobacco-using
peers compared to those with fewer tobacco-using peers. Method: Participants were
4,534 young adults participating in eight waves of Project M-PACT, spanning a 4.5-year
period (2014-2019). At Wave 1, participants were 18-25 years old (M=20.6; SD=1.81);
64.2% female; 35.2% non-Hispanic white, 31.0% Hispanic/Latino, and 33.8% another
race/ethnicity. Growth curve modeling within an accelerated longitudinal design was
used to test study hypotheses. Results: Depressive symptoms did not amplify or at-
tenuate the rate of change in number of tobacco products used as young adults aged,
however, elevated depressive symptoms were associated with a greater number of
tobacco products used concurrently (t[24,761]=6.86, p<.001) and at least six months
later (t[24,700]=6.75, p<.001). Results from the depressive symptoms X peer tobacco
interaction indicate that elevated depressive symptoms were associated with a greater
number of tobacco products used concurrently (t[24,233]=5.11, p<.001) and at least six
months later (t[24,035]=3.48, p<.001), but only amongst those with a greater number of
tobacco-using peers. Conclusions: This study extends prior research by indicating that
depressive symptoms do not elevate risk of tobacco use for all young adults. Rather,
depressive symptoms are associated with tobacco use only for young adults with a
greater number of tobacco-using peers. Those experiencing depressive symptoms
may rely on peers for emotional support. However, tobacco-using peers may encourage
and model use, and thus elevate risk for tobacco use. Results point to the continued
importance of peers in young adult tobacco use and underscore the need for prevention
and intervention programs that address young adults’ peer contexts.
FUNDING: Federal
POD8-6
DISCRIMINATION, NICOTINE WITHDRAWAL, AND THEIR
ASSOCIATIONS WITH INSOMNIA SEVERITY IN A SAMPLE OF
SMOKERS
Soa Mildrum Chana, Karen Cropsey, S. Justin Thomas, Karen Gamble. University
of Alabama at Birmingham, Birmingham, AL, USA.
SIGNIFICANCE: Insomnia is commonly associated with numerous negative health
outcomes, including cardiovascular disease, obesity, anxiety, and depression among
others. Racially underrepresented groups tend to experience more severe insomnia
and everyday discrimination has been found to drive such association. Also, ample
evidence suggests that smokers tend to experience signicant sleep problems since
nicotine interacts with neurotransmitters that alter the sleep-wake cycle. In addition,
previous research has shown a well-established positive relationship between nicotine
dependence and everyday discrimination, and some evidence suggests that discrim-
ination can also have an impact on tobacco withdrawal experiences, specically in
mood and cognitive-related aspects of withdrawal. However, no studies to date have
evaluated nicotine withdrawal as a potential mediating factor in the relationship between
discrimination and insomnia severity. METHODS: The present cross-sectional survey
of N=61 (67.2% female) current smokers investigated the indirect eects of everyday
discrimination on the daytime and nighttime components of the Insomnia Severity Index
(ISI) Scale, with nicotine withdrawal as the proposed variable mediating the relationship.
RESULTS: Multivariate analyses supported a statistically signicant indirect eect of
everyday discrimination on the total ISI score as well as each of the seven components
of the ISI scale through nicotine withdrawal. The direct eect of everyday discrimination
on certain ISI outcomes was not signicant: diculty falling asleep (p=0.37), diculty
staying asleep (p=0.20), issues waking up too early (p=0.41), and interference of sleep
problems on daily life (p=0.09). CONCLUSIONS: Smokers experiencing perceived ev-
eryday discrimination might be at increased risk of experiencing specic insomnia-related
outcomes exacerbated by nicotine withdrawal. Future work is necessary to understand
possible implications for smoking relapse and success of smoking cessation programs.
[Funding: National Institute of Drug Abuse R01DA046096]
FUNDING: Federal
47
2022 Paper Sessions
PAPER SESSION 9: IDENTIFYING AND
ELIMINATING ENDURING DISPARITIES
IN TOBACCO USE AMONG SEXUAL AND
GENDER MINORITY ADULTS
POD9-1
CHANGES IN SEXUAL IDENTITY OVER TIME AND INCREASES IN
TOBACCO USE
Rebecca Evans-Polce1, Luisa Kcomt2, Philip Veliz1, Carol Boyd1, Sean Esteban
McCabe1. 1University of Michigan, Ann Arbor, MI, USA, 2Wayne State University, Detroit,
MI, USA.
Signicance: Sexual minority individuals are at increased risk for tobacco use. How-
ever, despite considerable evidence that sexual identity changes over time for some
individuals, sexual identity is often conceptualized as static in epidemiologic studies. This
static conceptualization may mischaracterize tobacco risk groups. This study examines
associations of sexual identity uidity (i.e., at least one change in sexual identity) and
sexual identity stability (i.e., no change in sexual identity) with increases in tobacco use
and nicotine dependence. Methods: We used data from Waves 1-4 of the Population
Assessment of Tobacco and Health (2013/14- 2016/18) study (ages 14 and older; n =
25,889). Individuals were categorized into four sexual identity groups based on reported
sexual identity across four waves: heterosexual-stable, gay/lesbian-stable, bisexu-
al-stable, or uid. Using multivariable logistic regression, we examined associations of
sexual identity uidity and stability with increases in the number of tobacco products
and symptoms of nicotine dependence from Wave 1-4 among males and females.
Results: Among males, sexually uid individuals were more likely to increase the
number of tobacco products used (aOR[adjusted odds ratio]=1.50; 95% CI=1.06,2.12)
and increase nicotine dependence symptoms (aOR=1.50; 95% CI=1.04,2.17) com-
pared to heterosexual-stable individuals. Gay-stable males were less likely to increase
the number of tobacco products used (aOR=0.37; 95% CI=0.15, 0.94) compared to
heterosexual-stable males. Among females, sexually uid individuals were more likely
to increase the number of tobacco products used (aOR=1.35; 95% CI=1.06,1.71) and
increase nicotine dependence symptoms (aOR=1.34; 95% CI=1.02,1.76) compared to
heterosexual-stable individuals. Bisexual-stable and gay/lesbian-stable females were
not more likely than heterosexual-stable females to increase the number of tobacco
products or nicotine dependence symptoms. Conclusions: Sexual uidity may be a
marker of risk for increases in tobacco use for males and females. Individuals expe-
riencing changes in sexual identity may need tobacco use interventions and support
resources to prevent increases in tobacco use.
FUNDING: Federal
POD9-2
DISPARITIES IN COMBUSTIBLE TOBACCO USE ACROSS
SEXUAL IDENTITIES: COMPARISON OF GAY/LESBIAN,
BISEXUAL, AND QUESTIONING YOUTH (2015-2019)
Benjamin Aaron Cristol. University of Texas Health Science Center, Austin, TX, USA.
Signicance: Combustible tobacco use is a leading cause of death and disability in the
United States. Previous research suggests a disparity in combustible tobacco use among
sexual minority youth (SMY), or adolescents who identify as gay/lesbian, bisexual, or
not sure (“questioning”), when compared to heterosexual youth. This study aims to
explore this disparity as well as dierences in combustible tobacco use among gay/
lesbian, bisexual, and not sure (“questioning”) groups that comprise SMY. Methods:
Data were pooled from the 2015-2019 Youth Risk Behavior Surveillance Survey. Par-
ticipants were 9th through 12th grade high school students (n = 37,131). A subsample
of students who identied as gay/lesbian, bisexual, or ‘not sure’ was also analyzed
(n = 5,020). Weighted, adjusted analyses were conducted to determine associations
between sexual identity and combustible tobacco use. Results: Sexual minority youth
(SMY) had 1.76 higher odds of using combustible tobacco compared to heterosexual
youth, controlling for covariates. Subsample analyses revealed youth who identied
as gay/lesbian (aOR: 0.71) or not sure/questioning (aOR: 0.69) had lower odds of
combustible tobacco use relative to youth who identied as bisexual, controlling for
covariates. Conclusion: This study shows that sexual minority youth (SMY) status,
particularly bisexual identity, is associated with greater odds of combustible tobacco
use. Tobacco prevention and cessation interventions need to be expanded to meet the
unique needs of the SMY community.
FUNDING: Federal; Academic Institution
POD9-3
CIGARETTE AND CIGAR BRAND PREFERENCES AMONG
SEXUAL MINORITIES IN THE UNITED STATES
Ollie Ganz1, Sarah J. Ehlke2, Sabrina Steinberg3, Laurel Curry4. 1Rutgers Center for
Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA,
2TSET Health Promotion Research Center, Stephenson Cancer Center, University of
Oklahoma Health Sciences Center, Oklahoma City, OK, USA, 3Center for Public Health
Initiative, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
USA, 4RTI International, Washington, DC, USA.
Introduction: Tobacco use is higher among lesbian/gay and bisexual (LGB) adults,
relative to heterosexual adults. Tobacco companies have targeted their marketing
eorts toward the LGB community, which may inuence cigarette and cigar brand
preferences. The current study used a nationally representative sample to examine
dierences between LGB and heterosexual adults on cigarette and cigar brand prefer-
ences. Dierences between lesbian/gay and bisexual adults, as well as by sex (male vs.
female), were also examined. Methods: Data were pooled from the 2015-2019 National
Survey on Drug Use and Health (N=210,392; 7.13% LGB). Participants reported on
their past 30-day use of cigarettes and cigars (yes/no). Past 30-day users reported the
brand they most often used. Results: LGB adults were more likely to use cigarettes
and cigars in the past 30-days. Controlling for demographic covariates, multivariable
logistic regression analyses revealed that LGB adults were more likely to use Camel and
Natural American Spirit cigarettes, but less likely to use Marlboro cigarettes, relative to
heterosexual adults. There were no dierences between LGB and heterosexual adults on
cigar brand preference. Heterosexual males were more likely to use Backwoods cigars
compared to heterosexual females. Among heterosexual and bisexual participants,
females were more likely to use Swisher Sweets compared to males. Conclusions:
Tobacco marketing targeting LGB adults may impact brand preference, particularly for
cigarettes. Policies should be implemented to regulate tobacco marketing to the LGB
community in order to reduce tobacco use disparities.
FUNDING: Federal
POD9-4
PROJECT RESIST: A CASE STUDY ON LESSONS LEARNT FROM
USING A COMMUNITY-ENGAGED RESEARCH PROCESS TO
DEVELOP TAILORED ANTI-SMOKING MESSAGES FOR YOUNG
ADULT SEXUAL MINORITY WOMEN
Andy SL Tan, PhD, MPH, MBA, MBBS1, Scout ,2, Ana Machado3, Bob Gordon4, Julia
Applegate5, Ashley Sanders-Jackson6, Weiting Du6, Dominik Neumann7, Louis Schia-
vone6, Maral Zakharia6, Shoba Ramanadhan8, Jarvis Chen8, Jane Robert9, Meg Salvia8,
Elaine Hanby1, David S. Cordero1, Mary Andrews1, Oulaya Louaddi1, Gabriela Montes
de Oca1, Mitchell Lunn10, Juno Obedin-Maliver10, Jennifer Potter11, Kasisomayajula
Viswanath8. 1University of Pennsylvania, 2National LGBT Cancer Network, 3Center-
Link, 4California LGBT Tobacco Education Partnership, 5Equitas Health Institute, 6Mich-
igan State University, 7Leibniz-Institut für Wissensmedien (IWM), 8Harvard TH Chan
School of Public Health, 9Dana-Farber Cancer Institute, 10Stanford University, 11The
Fenway Institute.
Project RESIST aimed to create and evaluate tailored anti-smoking messages for young
adult sexual minority women (SMW) and engage with community partners to increase
future adoption and sustainment of the communication intervention. We present a case
study on how the community-engaged formative research process directly informed the
message design.Methods: Our approach integrates inoculation theory, minority stress
theory and resilience frameworks, community-engaged research principles, and imple-
mentation science. We used a multiphase mixed methods study design in this project.
We rst reviewed and extracted anti-smoking arguments from anti-smoking campaigns
targeting young adults and LGBTQ audiences. Next, we engaged with four LGBTQ
community leaders for input on appropriate anti-smoking arguments, visual treatments,
and representation of SMW from diverse backgrounds. We surveyed young adult SMW
to assess perceived eectiveness targetedness, and reactance quantitatively. We also
examined their qualitative emotional responses to and evaluations of draft and nalized
messages. Finally, we interviewed 22 key informants from LGBTQ-serving community
organizations to assess their needs and preferences for adopting evidence-based an-
ti-smoking communication interventions.Results: We obtained 825 unique anti-smoking
48
2022 Paper Sessions
arguments from over 1800 campaign messages. We developed and pretested 34-38
unique arguments using two surveys iteratively. We conducted two additional surveys
to compare SMW’s ratings and open-ended comments of 3 message concepts and
21 images and integrated the results to develop 30 anti-smoking messages that we
tested in a separate survey of SMW. Throughout the formative research process, we
obtained community leaders’ input on messaging decisions and organizations’ needs
and preferences to inform our selection of 20 nalized messages that will be used in
an intervention trial. Discussion: The community-engaged research process yielded
a diverse set of promising anti-smoking messages tailored for young adult SMW. We
gained new insights regarding messages more likely to be adopted by a broad range
of LGBTQ-serving community organizations.
FUNDING: Federal
POD9-5
DO LESBIAN GAY BISEXUAL TRANSGENDER AND QUEER
(LGBTQ) CUES IN MESSAGES DESIGNED FOR WOMEN IMPACT
SUPPORT FOR TOBACCO CONTROL POLICIES
Ashley Sanders-Jackson1, Dominik Neumann2, Elaine Hanby3, Andy Sl TanPhD MPH
MBA MBBS3. 1MI State University, East Lansing, MI, USA, 2Leibniz-Instut fur Weis-
senmeden, Tubingen, Germany, 3University of Pennsylvania, Philadelphia, PA, USA.
Signicance: Tobacco control policies are essential for reducing tobacco use prevalence
in the United States. We studied the impact of anti-smoking messages targeting sexual
minority women (including lesbian/gay, bisexual, or other sexual orientations) on tobacco
control policy support for sexual minority and heterosexual women because in other
contexts minoritized group cues have had negative eects on policy support. Methods:
This study was a two (cue-condition: cue absent vs. cue present) by six (message
repetition, randomly selected from 28 messages) mixed factorial design, participants
were randomly assigned to a cue present or abstence condition. Messages in the cue
condition included a tagline referencing LGBTQ health and a rainbow logo. Identical
messages in the no-cue condition referred to women’s health and used a dark pink
logo. We measured policy support before and after viewing all messages using eight
items (e.g., “Increasing taxes on tobacco products”). We asked participants whether
they favored or opposed each policy and computed the sum of policies they were in
favor of pre-exposure (M=4.64, SD=2.26) and post-exposure (M=5.77, SD=2.40).
Results: Participants (Mage=24.13, SDage=3.68, range=18-30) (N=306) identied as
either bisexual (N=74), lesbian (N=103) or heterosexual (N=125) and the majority
were non-smokers (N=275). Using an ANCOVA with post-message policy support as
the dependent variable, cue-condition as an independent variable, and adjusting for
pre-message policy support and sexual orientation, we found a signicant main eect
of the pre-exposure policy support F(1, 299) = 1,080.58, p < .001, η2 = 0.7, a signicant
main eect of cue-condition F(1, 299) = 4.00, p = .046, η2 = 0.0 such that there was
more policy support when sexual and gender minority cues were present, and a main
eect of sexual orientation F(2, 299) = 8.74, p < .001, η2 = 0.01 such that heterosexual
participants responded more favorably to policy support across conditions. Discussion:
Sexual minority women were less likely to support policies, irrespective of condition but
there were no negative impacts on support of sexual and gender minority cues being
present. Findings from this study should be replicated with a larger sample. Concerns
of tobacco policies should be considered in this community.
FUNDING: Federal
POD9-6
LGBTQ+ REACTION TO A MENTHOL CIGARETTE BAN: A
QUALITATIVE STUDY
Darcy E. Lockhart1, Rachel Denlinger-Apte2, Ashley E. Strahley2, Rachel N. Cassidy3,
Eric C. Donny1, Richard J. O’Connor4, Jennifer W. Tidey3. 1Department of Physiol-
ogy and Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, USA,
2Department of Social Sciences and Health Policy, Division of Public Health Sciences,
Wake Forest School of Medicine, Winston Salem, NC, USA, 3Department of Behav-
ioral and Social Sciences, Brown University School of Public Health, Providence, RI,
USA, 4Department of Health Behavior, Roswell Park Comprehensive Cancer Center,
Bualo, NY, USA.
Signicance: For decades, the tobacco industry targeted the LGBTQ+ community with
tailored community and print advertisements as well as sponsorship of pride events
contributing to the higher smoking prevalence observed in this population relative to
cisgender/heterosexual adults. Recently, the FDA proposed a ban on the sale of menthol
cigarettes, which are disproportionately smoked by LGBTQ+ people. Thus, the purpose
of this qualitative study was to explore menthol smoking and reactions to a potential
menthol ban among LGBTQ+ people. Methods: We conducted a multi-session lab study
using the Experimental Tobacco Marketplace (ETM). During the ETM task, participants
(N=40) could buy menthol and non-menthol cigarettes, menthol and tobacco avored
e-cigarettes, little cigars/cigarillos, smokeless tobacco, or medicinal nicotine from an
online store. Across task trials, the price of menthol cigarettes increased to simulate
potential menthol regulations including a ban while prices for the other tobacco products
(OTP) remained the same. At their highest price, menthol cigarettes were unaordable
so most had to purchase OTPs or abstain. Participants received these OTPs to use at
home. At the last visit, we completed follow-up interviews asking participants about (1)
smoking their preferred menthol cigarettes, (2) using OTPs instead of menthol cigarettes,
and (3) their attitudes towards a menthol ban. Results: LGBTQ+ participants (n=8)
were on average 28.3 years old (SD=10.2), 38% female, and smoked 15.6 (SD=6.6)
cigarettes per day. Participants reported smoking their menthol cigarettes due to enjoy-
ing the avor. Most viewed smoking as a communal social activity. Half reported their
partner also smoked and this contributed to diculty quitting. All participants took home
e-cigarettes and reacted positively to the mint/menthol e-liquid avors. The majority
said they would switch to e-cigarettes if menthol cigarettes are banned. Half of the
participants supported the ban because they felt menthol cigarettes were more harmful
than non-menthol cigarettes. Conclusions: Our ndings indicate menthol e-cigarettes
may be appealing substitution products for LGBTQ+ individuals if the FDA proceeds
with banning menthol cigarettes. However, switching completely to e-cigarettes may be
dicult due to the highly social component of smoking in the Queer community. Further
research is needed to identify methods for facilitating switching to less harmful products
and/or increasing cessation in this priority smoking population.
FUNDING: Federal
POD9-7
RESPONSE TO HYPOTHETICAL E-LIQUID FLAVOR
RESTRICTIONS AMONG SEXUAL AND GENDER MINORITY
YOUNG ADULTS
Natasha K. Sidhu1, Tristan Borosky-Armstrong1, William V. Lechner1, Alayna P. Tack-
ett2. 1Kent State University, Kent, OH, USA, 2University of Southern California Depart-
ment of Population and Public Health Sciences, Los Angeles, CA, USA.
Signicance: Sexual minority (e.g., asexual, bisexual, gay) and gender minority
(e.g., transgender, genderuid) adolescents and young adults (AYAs) may be at in-
creased risk to use e-cigarettes (ECs). This study examined EC use characteristics
and intentions to continue vaping should a hypothetical product standard limiting EC
e-liquid avor occur. Method: Participants (N=1,504) were AYA past 30-day EC users,
aged 14-21 (MAge = 18.2 years, SD = 1.9 years) from a larger, national cross-sectional
convenience sample. Participants answered questionnaires about preferred e-liquid
avor, nicotine dependence, and demographic/gender/sexual identity characteristics.
Binary logistic regression models examined yes/no responses to a hypothetical product
standard (e.g., “Would you still vape if only [tobacco/menthol] avor was available?”).
Independent-samples t-tests compared age of initiation, frequency of use, and nicotine
dependence. Results: Gender (MAge = 16.0 years, SD = 2.3 years) and sexual minority
(MAge = 16.3 years, SD = 2.1 years) AYAs reported initiating EC use signicantly earlier
than their cisgender (M = 16.6, SD = 2.0), p = 0.04) or heterosexual (M = 16.7, SD =
2.0), p < 0.001) peers. Sexual minority AYAs reported higher nicotine dependence (M
= 1.37, SD = 1.1), p = 0.03) compared to heterosexual AYAs (M = 1.26, SD = 1.06). No
dierences were observed for frequency of use or preferred current avor. Compared
to their heterosexual and cisgender peers, sexual minority AYAs were more likely to
continue vaping under the menthol hypothetical (aOR = 0.70, 95%CI: 0.55-0.90) and
gender minority AYAs were more likely to continue vaping under the tobacco hypothet-
ical (aOR = 0.38, 95% CI: 0.18-0.79) product standard. Conclusions: In this study,
compared to their cisgender and heterosexual peers, AYAs who identify as sexual or
gender minorities reported initiating EC use at an earlier age and sexual minority AYAs
reported increased nicotine dependence. Further, a avor product standard may impact
AYAs dierently. Future and more comprehensive research is needed to identify and
evaluate EC-related disparaities, particularly among young people.
FUNDING: Federal; State
49
2022 Paper Sessions
PAPER SESSION 10: SMOKING CESSATION
FOR MEDICALLY VULNERABLE
POPULATIONS
POD10-1
CONTINUOUS GLUCOSE MONITORING TO EXPLORE THE ACUTE
EFFECTS OF SMOKING CESSATION ON GLYCEMIC CONTROL
AMONG AMERICAN INDIAN SMOKERS WITH TYPE 2 DIABETES
Sydney A. Martinez1, Kayli Nail2, Afsheen Hasan1, Stephanie Ice3, Samantha Keener3,
Tara Ritter3, Douglas Nolan3. 1University of Oklahoma Health Sciences Center, Okla-
homa City, OK, USA, 2Oklahoma State University, Stillwater, OK, USA, 3Cherokee
Nation, Tahlequah, OK, USA.
Introduction: American Indian populations in Oklahoma have a higher prevalence of
type 2 diabetes mellitus (T2DM) and commercial cigarette smoking compared to other
racial groups. Smoking cessation is known to paradoxically increase HbA1c for up to
three years, but the acute eects on glycemic control are unknown. We examined the
feasibility of using continuous glucose monitoring (CGM) and mobile health (mHealth)
to understand acute eects of cessation on glycemic control. Methods: We recruited
T2DM adult current smokers in the Cherokee Nation Health System willing to make
a smoking cessation attempt. Patients wore two 14-day FreeStyle Libre Professional
CGM sensors to examine changes in mean glucose, desired time in range (TIR) de-
ned as 70-180 ml/dL, and glycemic variability (GV) two weeks pre- and two weeks
post-quit. Patients completed daily smartphone assessments using mHealth to report
cigarettes, meals, exercise, and nicotine replacement therapy. Remote carbon monoxide
(CO) sensors were used to biochemically verify abstinence. Patients also completed
an exit interview to describe experiences. Results: We enrolled 13 patients and 10
successfully made a smoking cessation attempt dened as at least a 10% reduction in
cigarette consumption. Patients who reduced consumption experienced a reduction in
mean glucose. In two weeks post-quit, we found an overall reduction in mean glucose,
a 13% absolute change in TIR, and an increase in GV. Changes varied by baseline
HbA1c, with an increase in TIR among those with HbA1c >9% and a decrease in TIR
among those with HbA1c <9% due to increased episodes of hypoglycemia. Patients
reported overall satisfaction with technology and reported the phone, CO sensor, and
CGM as easy to use. Discussion: We found CGM and mHealth to be feasible in
obtaining a granular view of acute glycemic changes during smoking cessation. In our
pilot, a decrease in cigarettes per day resulted in acute metabolic changes including
hypoglycemia. A better understanding of these acute eects could inform a tailored
smoking cessation intervention that includes monitoring and adjustments in diabetes
management to improve outcomes in this population.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
POD10-2
EFFICACY OF MAPS IN FACILITATING SMOKING ABSTINENCE
AMONG CERVICAL CANCER SURVIVORS: RCT OUTCOMES
Jennifer I. Vidrine1, David W. Wetter2, Vani N. Simmons1, Sarah R. Jones1, Steven K.
Sutton1, Ya-Chen Tina Shih3, Linda S. Elting3, Lois M. Ramondetta3, Joan L. Walker4,
Katie M. Smith5, Summer G. Frank-Pearce4, Yisheng Li3, Damon J. Vidrine1. 1Mott
Cancer Center, Tampa, FL, USA, 2Huntsman Cancer Institute and University of Utah,
Salt Lake City, UT, USA, 3The University of Texas MD Anderson Cancer Center, Hous-
ton, TX, USA, 4Stephenson Cancer Center and University of Oklahoma Health Sciences
Center, Oklahoma City, OK, USA, 5University of Oklahoma Health Sciences Center,
Oklahoma City, OK, USA.
One-third of cervical cancer survivors are current smokers. This prevalence of smoking
is higher than among any other subgroup of cancer survivors. We recently completed
an NCI-funded RCT evaluating the ecacy of a theoretically- and empirically-based
“Motivation And Problem-Solving” (MAPS) telephone counseling approach to facilitat-
ing smoking cessation among cervical cancer survivors. MAPS is a holistic, dynamic
behavior change intervention that integrates motivational interviewing (MI) with a social
cognitive theory based approach. Participants (n=202) were randomized to Standard
Treatment (ST; n=100) or MAPS+ST (n=102). ST was administered at baseline, 6 and
12 months and included quitline referral, no-cost NRT, and standard self-help materials.
MAPS comprised ST + 6 proactive counseling calls over 12 months. Participants had
a mean age of 48 years, were predominantly non-Hispanic white (75%) and generally
low-SES (41% had an annual household income <$20,000 and 37% had ≤ a high school
education/GED). Participants had a mean smoking history of 29 years, 42% smoked
within 5 minutes of waking and mean of 15 CPD. Cervical cancer stage varied: 42%
had carcinoma in situ, 33% stage I, 12% stage II, 10% stage III and 3% stage IV, 14%
preparing to start treatment, 12% in treatment and 74% post-treatment. Participants
were recruited in-clinic and online via Facebook. Results indicated that, based on an
intent-to-treat approach where missing equals smoking, MAPS was associated with a
greater than 2-fold increase in abstinence at the end of the 12-month treatment period
(22.5% vs. 10.0%; OR=2.62, 95% CI [1.18-5.84], p=.019). Unfortunately, this treatment
eect was no longer signicant at 18 months (i.e., 10.2% in MAPS vs. 11.4% in ST,
p>.05), indicating that ecacy dissipated as time from end of treatment increased. This
decline does not appear to have been driven by dropout as retention was high (82%
at 18 months; 84% in ST vs. 78% in MAPS at 18 months), which signals participants’
motivation for long-term engagement in treatment. Findings highlight the need for sus-
tained interventions to reduce smoking within this vulnerable population.
FUNDING: Federal
POD10-3
DEVELOPMENT OF A TARGETED BEHAVIORAL TREATMENT FOR
SMOKING CESSATION AMONG INDIVIDUALS WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
Amanda Mathew1, Elizabeth Avery1, Chelsea Cox2, Patrick Nwanah1, Ravi Kalhan3,
Brian Hitsman3, Lynda Powell1. 1Rush University Medical Center, Chicago, IL, USA,
2University of IL at Chicago, Chicago, IL, USA, 3Northwestern University Feinberg
School of Medicine, Chicago, IL, USA.
Signicance: Individuals with Chronic Obstructive Pulmonary Disease (COPD) face a
critical medical need to quit smoking, but commonly report diculty due to reliance on
smoking to cope with negative emotional states. Methods: In this early-phase evalu-
ation of three treatment components (Mindfulness, Practice Quitting, and Countering
Emotional Behaviors), we conducted two serial studies guided by the ORBIT model
for behavioral treatment development. Study 1 was a single-case design experiment
(N=18); Study 2 was a pilot feasibility study (N=30). In both studies, smokers with COPD
(> 5 cigarettes/day) were randomized to receive one of the three treatment modules.
Study 1 examined module-specic implementation targets, daily changes in smoking for
coping motives, 24-hour quit attempts, and changes in smoking rate. Study 2 examined
overall feasibility and participant-rated acceptability, 24-hour quit attempts, and changes
in smoking rate. Results: Study 1: Treatment implementation targets were met by 3/5
Mindfulness participants, 2/4 Practice Quitting participants, and 0/6 Countering Emotional
Behaviors participants. The Practice Quitting condition led to dramatic improvement in
daily reports of smoking for coping motives, with 100% of participants meeting the clini-
cally signicant threshold. Incidence of quit attempts ranged from 20% and 33% across
components, and smoking rate was reduced by 50% overall. Study 2: Recruitment and
retention met feasibility targets, with 97% of participants completing all four treatment
sessions. Participants reported high treatment satisfaction by qualitative responses and
rating scales (M = 4.8/ 5.0). Incidence of quit attempts ranged from 25% to 58% across
components. Participants reported a mean 56% decrease in cigarettes per day and a
41% decrease in smoking for coping motives from pre- to post-treatment. Conclusion:
These two small-N studies provide complementary ndings on internal validity and
implementation of the novel intervention. While Study 1 provided initial support for proof-
of-concept and plausibility of clinically signicant change for each component, Study 2
provided data on key feasibility parameters. Continued development of this treatment will
feature combining the three components into one intervention and extending its length.
FUNDING: Federal
50
2022 Paper Sessions
POD10-4
OPTIMIZING REACH AND EFFECTIVENESS OF TOBACCO
TREATMENT IN CANCER PATIENTS: LESSONS FROM THE
CANCER MOONSHOT CANCER CENTER CESSATION INITIATIVE
Sarah D. Hohl1, Ramzi G. SalloumPhD MA MBA2, Steven L. BernsteinMD3, Mara
Minion4, Katie Lenho5, Neely Dahl6, Hee Soon Juon7, Ursula Tsosie8, Linda Fleisher9,
Michael Fiore10, Betsy Rolland4, Heather D’Angelo11, Alex T. Ramsey12, Jamie S.
Ostro13, Kimlin T. Ashing14, Robert A. SchnollPhD15, Li-Shiun Chen12. 1University of
Wisconsin - Madison, Madison, WI, USA, 2University of Florida, Gainesville, FL, USA,
3Yale University School of Medicine, New Haven, CT, USA, 4University of Wisconsin
Madison, Madison, WI, USA, 5Dartmouth University, Hanover, NH, USA, 6University of
Virginia Cancer Center, Charlottesville, VA, USA, 7Thomas Jeerson University, Phil-
adelphia, PA, USA, 8Seattle Cancer Care Alliance, Seattle, WA, USA, 9Fox Chase
Cancer Center, Philadelphia, PA, USA, 10Center for Tobacco Research and Intervention,
Madison, WI, USA, 11National Cancer Institute, Frederick, MD, USA, 12WA University
School of Medicine, St. Louis, MO, USA, 13Memorial Sloan-Kettering Cancer Center,
NY, NY, USA, 14City of Hope, Los Angeles, CA, USA, 15University of Pennsylvania,
Philadelphia, PA, USA.
Signicance: Nearly 25% of cancer patients are current smokers at the time of diagno-
sis. Quitting smoking after diagnosis improves patients’ treatment response and health
outcomes, yet smoking is rarely addressed as part of cancer care. The Cancer Center
Cessation Initiative (C3I) supports 52 NCI-Designated Cancer Centers to integrate
tobacco treatment into routine cancer care. C3I Centers apply a multitude of imple-
mentation approaches in settings varying in program size, smoking prevalence, and
resources, thus oering an unprecedented opportunity to examine drivers of tobacco
treatment reach and eectiveness among cancer patients. Methods: This study utilizes
data from 38 C3I Centers reported 18 months after receiving NCI funding. Reach is the
proportion of smokers who received at least one evidence-based tobacco treatment
component (e.g., point-of-care counseling, telephone-based counseling, medications.)
Eectiveness is the proportion of smokers reporting 7-day point prevalence abstinence
6 months following any tobacco treatment. We calculated associations of mean reach
and eectiveness by program size (number of current smokers), resource-to-burden
score (tobacco treatment specialist FTE: number of smokers), treatment component
oered, and implementation support strategies (e.g., leadership buy-in, sta training).
Results: Over 85% of the nearly 1 million patients seen at 38 C3I Centers were screened
for smoking during the reporting period. Approximately 65,000 reported a current
smoking status. Mean reach across all centers was 24.3% (range: 2.7-76.2%); mean
eectiveness was 27.9% (n=18 centers, range: 0-64.7%). Program size was negatively
but insignicantly associated with reach and eectiveness. Higher resource-to-burden
scores were associated with higher reach but not greater eectiveness. Mean reach was
similar across Centers oering point-of-care counseling (29.5%) and telephone-based
counseling (28.3%); eectiveness was 32.3% at centers oering point-of-care counsel-
ing and 19.3% at those oering telephone counseling (19.3%). Securing IT leadership
buy in, dening the clinical workow, and training sta to implement the program were
associated with greater reach, whereas securing clinical leadership buy in was asso-
ciated with greater eectiveness.Conclusion: Understanding drivers of patient reach
and eectiveness in population-based tobacco control programs can help guide cancer
centers and community oncology practices to select and implement interventions that
t the needs and resources available and improve patient outcomes.
FUNDING: Federal
POD10-5
COMPARATIVE EFFECTIVENESS OF TWO POST-DISCHARGE
SMOKING CESSATION INTERVENTIONS FOR HOSPITAL
PATIENTS: THE HELPING HAND 4 RANDOMIZED TRIAL
Nancy A. Rigotti1, Susan Regan1, Yuchiao Chang1, Douglas E. Levy1, Esa M. Davis2,
Jennifer K. Kelley1, Thomas E. Ylioja3, Daniel E. Singer1, Hilary A. Tindle4. 1Mass
General Hospital, Harvard Medical School, Boston, MA, USA, 2University of Pittsburgh
Medical Center, Pittsburgh, PA, USA, 3National Jewish Health, Denver, CO, USA,
4Vanderbilt University Medical Center, Nashville, TN, USA.
SIGNIFICANCE: Hospital admission oers an opportunity to quit smoking. In-hospital
cessation treatment is eective if it continues after discharge, but how best to sustain
treatment post-discharge is unclear. Should hospitals provide it or refer to community
resources? METHODS: A 3-site pragmatic RCT compared 2 active strategies—Hospi-
tal-based Tobacco Care Management (HTCM) vs. Quitline eReferral (QL)—for delivering
cessation counseling and nicotine replacement (NRT) post-discharge. We enrolled
daily smokers who had in-hospital counseling and planned to quit. At discharge, HTCM
provided participants 8 weeks of free NRT (patch, gum, lozenge or a combination) and 7
interactive voice recognition (IVR) calls over 12 weeks. Each IVR call oered a callback
from a hospital tobacco coach. Participants randomized to QL were referred from the
electronic health record to the free state quitline that oered 4-8 weeks of NRT and
up to 5 counseling calls. Outcomes were assessed at 1, 3, and 6 mo post-discharge.
Primary outcome was veried 7-day tobacco abstinence at 6 mo. Analysis was ITT
with multiple imputation for missing data. RESULTS: 1409 daily smokers admitted
9/2018-3/2020 were randomly assigned to HTCM (n=706) or QL (n=703). Groups were
comparable at baseline (56% female, 15% Black, 9% Latinx, 77% White, mean age=52y;
mean cig/d=16). Follow-up survey completion at 1, 3, 6 mo was 82%, 76%, and 74%,
respectively. HTCM, vs. QL, increased smokers’ use of any medication at 1 and 3 mo
(80% vs 56%, 67% vs. 50%, respectively) and any counseling at 1 and 3 mo (44% vs
27%, 46% vs. 24%, respectively, all p<.001). Self-reported past 7-day abstinence rates
were signicantly higher for HTCM vs. QL at 1 mo (50.7% vs. 41.8%, RR 1.21, 95% CI
1.08-1.35, p=.002) and 3 mo (50.3% vs 40.8%, RR 1.23, 95% CI 1.08-1.39, p=.003)
but not at 6 mo (43.6% vs. 38.6%, RR 1.13, 95% CI 0.99-1.28, p=.079). Biochemically
veried past 7-day tobacco abstinence rates at 6 mo were 24.8% (HTCM) vs. 20.7%
(QL; RR 1.20, 95% CI, 0.95-1.49, p=.13). CONCLUSION: Among recently hospitalized
daily smokers, the health system-based HTCM initially produced higher quit rates than
eReferral to the community-based QL, but eects were non-signicant by 6 months.
FUNDING: Federal
POD10-6
EVALUATION OF AN OPT-OUT CHRONIC CARE PROGRAM TO
TREAT SMOKING IN ADULT PRIMARY CARE
Danielle E. McCarthy1, Timothy Baker1, Mark Zehner1, Rob Adsit1, Nayoung Kim1,
Deejay Zwaga1, Katherine Coates2, Hannah Wallenkamp2, Margaret Nolan1, Marga-
ret Steiner2, Amy Skora1, Christian Kastman2, Michael Fiore1. 1University of Wiscon-
sin Center for Tobacco Research and Intervention, Madison, WI, USA, 2Group Health
Cooperative of South Central Wisconsin, Madison, WI, USA.
Background: Eective smoking treatments are underused, particularly in socioeco-
nomically disadvantaged and minoritized populations. Eorts to integrate smoking
cessation treatment into routine primary care, where most people who smoke present
for health care services each year, have shown a low rate of treatment utilization and
highlighted persistent implementation challenges. Proactive, opt-out, chronic treatment
approaches that use multiple outreach strategies with immediate treatment access may
enhance treatment reach, reach equity, and abstinence rates. Methods: Six adult primary
care clinics in a healthcare cooperative launched a comprehensive tobacco cessation
intervention program (CTIP) in 3 waves in a stepped-wedge design. The opt-out CTIP
was guided and tracked via electronic health record (EHR) tools and involved: clinician
point-of-care smoking treatment; promotion of CTIP via EHR patient portal and mail
outreach, and tobacco care managers who coordinated care with primary care providers
and conducted direct telephonic outreach with immediate access to smoking cessation
treatment. Data extracted from the EHR were analyzed using chi-square and t-tests
to assess the reach and eectiveness of CTIP among 10571 adult patients over 16-
22 months. Results: Smoking cessation treatment reach increased signicantly after
CTIP launch in 5 of 6 clinics, and was signicantly higher in clinics active vs. inactive in
CTIP in the stepped-wedge design. Rates of converting from current to former smoking
status in the EHR were also signicantly higher in active vs. inactive clinics. Reach was
particularly high in historically underserved populations, including African-American,
Hispanic, and Medicaid-eligible patients. Conclusions: Implementation of a comprehen-
sive opt-out chronic-care program with multiple outreach methods was associated with
increased rates of providing smoking cessation pharmacotherapy and counseling, and
with increased smoking cessation rates, as indicated by EHR data. Proactive outreach
eectively engages many patients who do not receive cessation treatments at clinic
visits and may help reduce disparities in treatment access.
FUNDING: Federal
51
Notes
52
Notes
53
2022 Paper Sessions
PAPER SESSION 11: TACKLING AND
TRANSCENDING THE BARRIERS OF
SMOKING CESSATION AND PREVENTION
IN PRIORITY POPULATIONS
POD11-1
SYSTEMATIC REVIEW OF RECRUITMENT BIAS OF ADULTS
IN U.S. PHASE 2 AND 3 RANDOMIZED CLINICAL TRIALS FOR
SMOKING, NICOTINE, AND TOBACCO CESSATION: 2008 TO 2019
Ilana Buenstein1, Emily Taylor1, Bree Kāneakua1, Masako Matsunaga2, So Yung
Choi2, Enrique Carrazana1, Kore Kai Liow1, Jason Viereck1, Arash Ghaari-Ra3. 1Hawaii
Pacic Neuroscience, Honolulu, HI, USA, 2John A. Burns School of Medicine, Depart-
ment of Quantitative Health Sciences, Honolulu, HI, USA, 3University of California Davis,
Department of Neurological Surgery, Davis, CA, USA.
Signicance: To promote health equity in the treatment of smoking, nicotine, and to-
bacco dependence, clinical trials should strive for unbiased representation. Methods:
A systematic review of randomized phase 2 and 3 clinical trials recruiting U.S. adults
for treatment of smoking, nicotine, and tobacco dependence, and initiated between
2008 and 2019, was performed using four databases: Medline, Embase, Central, and
the U.S. Clinical Trial registry. The Cochrane Handbook of Systematic Reviews of
Interventions and PRISMA guidelines were used to identify trials. Meta-analyses were
performed to obtain summary proportions and 95% condence intervals (CI) of gender,
ethnicity, and race groups. Summary proportions were compared with the corresponding
Census proportions based on the 2010 U.S. Census. Results: We identied 75 trials
(total participants, n=24,280) related to the treatment of smoking, nicotine, and tobacco
dependence. Among them, all reported gender, 41% reported ethnicity (31 trials) and
57% reported race of the participants (43 trials). The summary proportions of females
(43.2%, 95% CI 37.7-48.8), Hispanics (7.17%, 95% CI 3.08-12.8), Asians (0.50%,
95% CI 0.15-0.98), and whites (58.7%, 95% CI 49.0-68.1) were lower than Census
proportions (51.5%, p=0.004; 14.2%, p=0.017; 5.01%, p<0.001; 79.8%, p<0.001). The
summary proportions of Native Hawaiians and Pacic Islanders (NHPI) (0.53%, 95% CI
0.36-0.77), blacks (30.2%, 95% CI 21.8-39.4), and multiracial participants (3.66%, 95%
CI 2.53-5.28) were higher than Census proportions (0.20%; 12.3%; 1.56%, ps<0.001).
Conclusions: These results highlight disparities in clinical trial recruitment for treatment
of smoking, nicotine, and tobacco dependence. More than half of the trials did not report
ethnicity. The results suggest that females, Hispanics, Asians, and whites are underrep-
resented, while NHPI, blacks, and multiracial participants are overrepresented. Overall,
trials for treatment of smoking, nicotine, and tobacco dependence may not reect the
demographics of the populations sought to be served.
FUNDING: Unfunded; Other
POD11-2
GIILANG GAWIMARRA (GATHERING STORIES) OF ABORIGINAL
AND TORRES STRAIT ISLANDER WOMEN’S SMOKING AND
QUITTING JOURNEY
Michelle Kennedy1, Eden Barrett2, Christina Heris2, Raglan Maddox2. 1The University
of Newcastle, Newcastle, Australia, 2Australian National University, Canberra, Australia.
Introduction: Commercial tobacco smoking among Aboriginal and Torres Strait Islander
peoples in Australia is intrinsically linked to colonisation, racism and dispossession.
Commercial smoking is also responsible for over a third of all Aboriginal and Torres
Strait Islander deaths. The vast majority of Aboriginal and Torres Strait Islander peoples
who smoke want to quit, and there are ongoing calls for comprehensive approaches to
support smoke-free behaviours. However, there is limited information about smoking
and pregnancy among Aboriginal and Torres Strait Islander women across diverse
language, social and nation groups. This Indigenous-led study aims to quantify and
begin to unpack the stories of Aboriginal and Torres Strait Islander women, informing
meaningful development of smoke-free supports. Methods: A national cross-sectional
survey of Aboriginal and Torres Strait Islander women of reproductive age was conduct-
ed online (July-October 2020). Survey captured demographics, smoking and quitting
characteristics, and interest in a range of support programs. Distribution of smoking
and quitting characteristics were quantied by remoteness and age. Prevalence Ratios
(PR) for sustained abstinence by selected demographic, smoking characteristics and
support program were calculated using Log Binomial regression. Results: Smoking
and quitting characteristics between women (n=428) across Australia residing in urban,
regional and remote areas were similar. A greater proportion of younger women smoked
fewer cigarettes daily, waited longer to smoke after waking, and were categorised as
low smoking dependency compared to those aged 35+ years. Older women reported
trying stop-smoking medications more than young women. Quitting suddenly, rather
than gradually was signicantly associated with sustained abstinence after adjusting
for age and remoteness (PR 1.26, 95% CI 1.10-1.45). Five of seven broad program
categories (support groups, holistic support, cultural programs, one-on-one support,
and self-directed support) were chosen by over half of participants (57.2% to 80.8%).
Women then selected their rst preference of the abovementioned programs (i.e. most
helpful), over half chose support groups or holistic support programs (31.8% and 22.2%
respectively). Conclusion: Aboriginal and Torres Strait Islander women are making quit
attempts. Suddenly quitting, rather than reducing, was associated with sustained absti-
nence. Supports should be multi-faceted, holistic and culturally safe, including support
groups. Aboriginal Community Controlled Health Services should be resourced appro-
priately to reduce tobacco use, reecting their role as a preferred health care provider.
FUNDING: Federal; Nonprot grant funding entity
POD11-3
EXPLORING POTENTIAL FOR A PERSONALIZED MEDICINE
APPROACH TO SMOKING CESSATION WITH AN AMERICAN
INDIAN TRIBE
Dana Carroll1, Sharon Murphy1, Ellen Meier2, Kristine Rhodes3, Casey Dorr1, Greg
Braaten4, Pamala Jacobson1, Rachel Tyndale5, Dorothy Hatsukami1, Carol Hernan-
dez6. 1University of Minnesota, Minneapolis, MN, USA, 2University of WI-Stevens Point,
Stevens Point, WI, USA, 3American Indian Cancer Foundation and Asemaake, LLC,
Minneapolis, MN, USA, 4Minnesota Cancer Clinical Trials Network, Minneapolis, MN,
USA, 5CAMH and University of Toronto, Toronto, ON, Canada, 6Minnesota Cancer Clin-
ical Trials, Minneapolis, MN, USA.
Signicance: One precision medicine approach to smoking cessation that is gaining
attention in research settings is tailoring pharmacological treatment to a biomarker known
as the nicotine metabolite ratio (NMR). Because the American Indian (AI) population
suers disproportionately from cigarette use and is underrepresented in this area of
research, AI adults who smoke were recruited to participate in a study that 1) examined
correlations between NMR, nicotine dependence, and smoking exposure; 2) assessed
the extent to which self-preference for cessation treatment aligns with NMR-based
recommendations; 3) explored perceptions towards using NMR to inform treatment
selection. Methods: AI adults (n=54) who smoke were recruited from a tribal clinic in
Minnesota to provide samples for assessment of salivary NMR and urinary total nicotine
equivalents (TNE) and to complete a questionnaire that assessed cigarettes per day
(CPD), Fagerstrom test for cigarette dependence (FTCD), Heaviness of smoking index
(HSI), cessation treatment preference, and perceptions of using NMR to inform treatment
selection. Results: Signicant positive correlations were observed between NMR and
FTCD (r=0.29; p-value=0.0383) and HSI (r=0.28; p-value=0.0426) which were driven by
the measure time to rst cigarette (TTFC). Non-signicant, but directionally consistent,
relationships were observed between NMR and CPD (r=0.21; p-value=0.1436) and TNE
(r=0.24; p-value=0.2906). About one-half (54%) of participants’ self-preference for ces-
sation treatment matched their NMR-based treatment recommendation. Approximately
sixty percent (62.0%) of participants supported using NMR to inform treatment selection
which is lower than prior studies among White and Black participants (97.5% support).
Conclusion: NMR appears to be related to cigarette dependence in the Tribe and since
this has not be consistently found in other populations it raises the question of how using
NMR to inform cessation treatment selection would perform in this Tribe. Results also
suggest that an NMR informed approach to cessation may not be equitably utilized and
future work could include identifying community-based solutions to mitigate concerns.
FUNDING: Federal; Academic Institution
PODIUM PRESENTATION 4
54
2022 Paper Sessions
POD11-4
SMOKING CESSATION IN LUMBEE INDIANS: A QUALITY
IMPROVEMENT PROJECT
Gina Marie Whritenour. Purdue University Global, West Lafayette, IN, USA.
Signicance: Smoking cessation is an eective method of health promotion and dis-
ease prevention. Although the 2019 United States of America (USA) federal mandate
increased the minimum age to purchase tobacco products, cigarette smoking remains
high among Americans. In the community of Robeson County, North Carolina, 2020
statistical data demonstrated that 24 percent of adults in the county smoked cigarettes,
31.5 percent of individuals in the county lived at or below the federal poverty level, and
42.3 percent of the population identied as Lumbee Indian. National data was consistent
with abnormally high health disparities for tobacco use in American Indian populations.
Methods: A quality improvement project was established at a primary care facility in the
county where a need for a smoking cessation program was identied. The project was
assessed and approved by the Institutional Review Board (IRB) prior to implementation.
Funding was obtained by direct donations from the author, and by donation from the
primary care facility owner. A low-cost intervention that utilized an evidence-based,
individualized cessation plan via the smokefree.gov website was implemented for
sixty days. Providers were educated on how to implement the plan and how to guide
patients in using a personalized cessation tool. Results: A total of four healthcare pro-
viders implemented the project. A total of eleven patients consented to participation in
the project. After project completion, data was analyzed. Evidence demonstrated that
75 percent of providers felt the project increased cessation rates, was cost-eective,
and improved the quality of healthcare provided to patients. Patient data demonstrated
a 20.9 percent decrease in daily smoking rates, which was correlated with the 90.3
percent usage rate of the project tool. Conclusion: Web-based low-cost interventions
may decrease smoking in Lumbee Indian patients and help decrease health dispari-
ties for this population. Further research is needed to determine the eectiveness of
implementing a web-based cessation plan with Lumbee Indian patients as a primary
tool for smoking cessation.
FUNDING: Unfunded
POD11-5
DISPARITIES IN THE ASSOCIATION BETWEEN “TIPS FROM
FORMER SMOKERS” CAMPAIGN AND QUIT INTENTIONS/
ATTEMPTS AMONG SEXUAL MINORITIES
Yu Wang1, Zongshuan Duan2, Shannon R. Self-Brown1, Scott R. Weaver1, Claire A.
Spears1, Pinpin Zheng3, Michael P. Eriksen1, Jidong Huang1. 1School of Public Health,
Georgia State University, Atlanta, GA, USA, 2Milken Institute School of Public Health,
George Washington University, Washington, DC, USA, 3School of Public Health, Fudan
University, Shanghai, China.
Signicance: The Tips From Former Smokers (Tips) campaign has been shown to
have a substantial impact on smoking cessation behaviors among US adult smokers.
However, its potential dierential impact among sexual minorities is not well studied.
This study aims to examine the potential disparities in the association between the
Tips campaign and quit intentions and quit attempts among sexual minority smokers.
Methods: Data were from the Population Assessment of Tobacco and Health (PATH)
Study Adult Cohort Wave 5 (Dec 2018 to Nov 2019). Study population was current
established cigarette smokers. Exposure variable was frequency of exposure to Tips in
the past 12 month, and outcomes were intention to quit within 12 months, serious quit
attempts (Yes/No), and number of serious quit attempts in the past 12 month. Multivariate
logistic and ordinal regressions were used to estimate the associations, controlling for
socio-demographic variables, e-cigarette use, other tobacco use, and state tobacco
control policies. Interactions between Tips exposure and individual characteristics were
examined to explore potential disparities. Results: Among current established smokers,
frequency of exposure to Tips were: 45.1% never, 14.6% rarely, 23.8% sometimes,
10.9% often, and 5.6% very often in the past 12 month. Exposed to Tips often or very
often was signicantly associated with stronger intention to quit and more serious quit
attempts. These associations were signicantly stronger for heterosexuals than sexual
minorities. Subgroup analysis showed that heterosexual smokers exposed to Tips
frequently were more likely to intent to quit within 12 months (aOR=1.39, 95% CI=1.18-
1.63), have serious quit attempt (aOR=1.45, 95% CI=1.23-1.71), and have more serious
quit attempts (aOR=1.42, 95% CI=1.22-1.67). In contrast, these associations were not
signicant among sexual minorities (aOR=0.85, 95% CI=0.54-1.36; aOR=0.67, 95%
CI=0.41-1.10; and aOR=0.40, 95% CI=0.40-1.03; respectively). Conclusions: Eorts
are needed to increase the coverage and exposure frequency of the Tips campaign.
More targeted contents for sexual minorities are needed to address the disparities.
FUNDING: Federal
POD11-6
EFFICACY AND UTILIZATION OF SMARTPHONE APPLICATIONS
FOR SMOKING CESSATION AMONG AMERICAN INDIANS AND
ALASKA NATIVES: RESULTS FROM THE ICANQUIT TRIAL
Margarita Santiago-Torres1, Kristin E. Mull1, Brianna M. Sullivan1, Diana M. Kwon1,
Patricia Nez Henderson2, Lonnie A. Nelson3, Christi A. Patten4, Jonathan B. Bricker1.
1Fred Hutchinson Cancer Research Center, 2Black Hills Center for American Indian
Health, 3Washington State University, 4Mayo Clinic.
Introduction: There is tremendous need for ecacious and accessible interventions for
smoking cessation among American Indians and Alaska Natives. We tested the ecacy
of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCan-
Quit) vs. US Clinical Practice Guidelines based smartphone application (QuitGuide) for
smoking cessation among American Indians and Alaska Natives.Methods: We compared
cessation, changes in ACT-based processes, engagement and satisfaction between all
American Indian and Alaska Native iCanQuit (n=89) and QuitGuide (n=80) participants
enrolled in the iCanQuit trial. The primary outcome was self-reported, complete-case,
30-day point prevalence abstinence (PPA). Follow-up timepoints were 12, 6, and
3-months. Results: Randomized American Indians and Alaska Natives from 31 US states
(70% urban, 30% rural, with 25% of participants residing on tribal land). The outcome
data retention rates were 93%, 92%, and 90% at the 12-, 6-, and 3-month follow-ups,
respectively, with no dierential retention between arms. The 30-day PPA for iCanQuit
vs. QuitGuide was 30% vs. 18% at the 12-month follow-up (OR=1.96; 95% CI: 0.90,
4.26), 25% vs. 11% at 6-months (OR=2.62; 95% CI: 1.06, 6.45), and 15% vs. 6% at
3-months (OR=2.93; 95% CI: 0.90, 9.59). Increases in acceptance of internal cues to
smoke mediated the eect of treatment on smoking cessation at 12 months. iCanQuit
arm participants were also signicantly more engaged and satised with their assigned
application.Conclusions: In a nationwide sample with high data retention and participant
engagement, this is the rst study to show that a digital intervention may be ecacious
for helping American Indians and Alaska Natives quit smoking.
FUNDING: Federal; Nonprot grant funding entity
POD11-7
WORKING TOGETHER TO REDUCE COMMERCIAL TOBACCO-
RELATED HARMS, THE SOUTHERN CALIFORNIA TRIBAL
TOBACCO COALITION
Juliet Lee1, Lisa Brucks2, Ami Admire3, Jennifer Geisler3, Michelle Nielson3, Diana
Martinez3, Monah Hanson3, Dan Calac2, Roland Moore1. 1Prevention Research Center,
PIRE-CA, Berkeley, CA, USA, 2Southern California Tribal Health Clinic* (*identity
protected), Southern California, CA, USA, 3Southern California Tribal Tobacco Coali-
tion, Southern California, CA, USA.
Signicance: Of US populations, American Indian/Alaska Natives (AIANs) report the
highest use of commercial tobacco products, including youth. More AIANs reside in
California than any other US state; and more sovereign Tribal nations are co-located
with California than any other state. A California voter-approved tax on commercial
tobacco products enabled grants to (a) research programs, (b) school-based preven-
tion programs; and (c) community-based prevention programs, including innovative
grants directly to Tribal nations. In Southern California, four Tribal nations on lands
near to each other, as well as a clinic-based research program and a school-based
program serving area tribes, each secured grants to reduce and prevent commercial
tobacco-related harms to tribal youths. All seven programs feature youth leadership.
Methods: Program sta began to meet and formed a coalition to best serve the tribal
communities by reducing redundancies in programs and outreach; providing mutual
support; and optimizing complementary programming. Due to COVID pandemic con-
ditions, all coordination took place via teleconferencing. With improved conditions, the
coalition was able to hold three commercial tobacco clean-up events outdoors at tribal
community sites, and an inaugural Inter-Tribal Tobacco Prevention Youth Summit, with
participant evaluations. Results: 6-14 youths participated in each clean-up event. For the
summit, 37 participants aged approximately 9-22 years old and 27 adult sta, parents,
and elders convened for four hours outdoors on tribal lands. Youth and sta from each
of the participating organizations led presentations on: tobacco health harms; history,
types, ingredients, and environmental impacts of commercial tobacco products; and
local tribally-specic uses of sacred tobacco and other plant medicines. Presentation
forms included posters and demonstrations. Activities included breakout groups, quizzes,
making medicine bundles, and cleaning up commercial tobacco product trash. Evaluation
surveys indicated high satisfaction, learning, and support of the programs. Conclusions:
Combining eorts of separately-funded Tribal-community based programs improved the
ability of the programs to engage with the local communities, bring together community
members across all age groups, to provide integrated messaging and engaging activi-
55
2022 Paper Sessions
ties. Tribally-specic programming promoted local knowledge of traditional/ceremonial
tobacco as a community strength, while also developing awareness of the history of and
harms related to commercial tobacco products. Combined eorts supported increased
Tribal community engagement, despite challenging COVID conditions.
FUNDING: State
PAPER SESSION 12: RAPID FIRE: NEW
TRENDS IN PACKAGING AND MARKETING
TO YOUTH AND ADULTS
POD12-1
STANDARDIZING THE SHAPE OF SMOKELESS TOBACCO PACKS
SOLD IN BANGLADESH - POTENTIAL IMPACT ON HEALTH
WARNING LABEL VISIBILITY AND HARM PERCEPTIONS
Lauren Czaplicki1, Sejal Saraf1, A.B.M Rasheduzzaman2, Laura Kroart1, Moham-
mad Shamimul Islam2, Joanna Cohen1. 1Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA, 2Bangladesh Center for Communication Programs, Dhaka,
Bangladesh.
Introduction. Smokeless tobacco (SLT) use is extensive in Bangladesh, and consumers
often view these products as less harmful than combustible tobacco. The most popular
forms of SLT - zordha and gul - are sold in a variety of pack shapes and sizes (plastic
packet, tin cylinder). Lack of standard SLT pack shape limits compliance with the
placement of graphic health warning labels (HWLs) on the top 50% of each pack side
and provides space for attractive corporate branding. The current study qualitatively
explored how HWL placement on existing SLT packs vs. a proposed standardized SLT
pack inuences harm perceptions among current and never SLT users in Bangladesh.
Methods. In February 2021, we conducted 28 focus groups across three regions of
Bangladesh: Dhaka, Sylhet, and Khulna. Groups were stratied equally by urban/rural
residence, gender, and SLT use. Each participant was given their own set of existing
zordha and gul packs, along with two mock SLT packs (one zordha, one gul) that were
manufactured to t recommended standard pack shape/size dimensions. Trained
facilitators led group discussions of HWL visibility and harm perceptions of existing vs.
standard packs. Data were collected in Bangla, translated into English, and thematically
analyzed. Results. Across groups, participants discussed the limited visibility of HWLs
on existing packs, noting that images were often distorted, printed in dark colors, and
small compared to product branding. Many groups also observed that HWLs on existing
zordha packs were placed on one side only and gul packs lacked HWLs. These factors
contributed to lower levels of perceived harm of existing packs. In contrast, most groups
discussed that standard pack HWLs seemed larger and were more visible due to their
placement at the top half of both pack sides. Given the prominence of the HWLs, all
groups discussed that the standard packs appeared more harmful than existing packs.
Discussion. Results suggest that standardizing the pack shape and size of SLT sold
in Bangladesh could increase harm perceptions of SLT use among current and never
users, which may have implications on reducing rates of use at the population level.
FUNDING: Nonprot grant funding entity
POD12-2
THE SHORT-TERM AND LONG-TERM ASSOCIATION BETWEEN
RECEIVING CIGARETTE DISCOUNTS/COUPONS AND
CIGARETTE SMOKING CESSATION BEHAVIORS AMONG US
ADULT SMOKERS WHO HAVE INTENTION TO QUIT
Zongshuan Duan1, Yu Wang2, Shannon R. Self-Brown2, Scott R. Weaver2, Claire A.
Spears2, Pinpin Zheng3, Michael P. Eriksen2, Jidong Huang2. 1Milken Institute School of
Public Health, George Washington University, Washington, DC, USA, 2School of Public
Health, Georgia State University, Atlanta, GA, USA, 3School of Public Health, Fudan
University, Shanghai, China.
Signicance: Previous studies indicate that receipt of price promotion may impact to-
bacco use behaviors. This study examines how receipt of cigarette discounts/coupons
is associated with smoking cessation behaviors among US adult smokers who have
intention to quit. Methods: Data were from the Population Assessment of Tobacco
and Health (PATH) Study Wave 3 (Oct 2015 to Oct 2016), Wave 4 (Dec 2016 to Jan
2018), and Wave 5 (Dec 2018 to Nov 2019). Wave 3 and 4 was each considered as the
baseline of its next consecutive wave, i.e., Wave 4 was the one-year follow-up of Wave
3, and Wave 5 was the two-year follow-up of Wave 4. Baseline single-wave weights
were applied. Study population was adult current established cigarette smokers who
intended to quit within one year at Wave 3 and who intended to quit at Wave 4. Exposure
is past-12-month receipt of discounts/coupons at baseline, and outcome is completely
quit smoking at follow-up. Multivariate logistic regressions were used to estimate the
one-year and two-year associates between receipt of cigarette discounts/coupons and
outcome, controlling for demographics, strength of intention to quit, cigarette depen-
56
2022 Paper Sessions
dence, use of other tobacco products, and state-level tobacco control policies. Results:
35.9% (95% CI=34.2%-37.7%) and 43.6% (95% CI=42.2%-45.1%) of smokers with
intention to quit received discounts/coupons for cigarettes in the past 12 month at Wave
3 and 4, respectively. Respondents who received discounts/coupons at baseline were
less likely to quit completely at one-year follow-up (aOR=0.67, 95% CI=0.49-0.91) and
at two-year follow-up (aOR=0.74, 95% CI=0.61-0.90). Additionally, smokers who had
stronger intention to quit, were less dependent on cigarettes, or had higher levels of
education were more likely to quit completely at follow-up. Receipt of discounts/coupons
for other tobacco products were not signicantly associated with cigarette cessation
outcome. Conclusions: Receipt of cigarette price discounts and coupons is associated
with reduced likelihood of successful quitting. Prohibition of cigarette price promotions
may help more smokers to quit.
FUNDING: Federal
POD12-3
GLOBALIZATION OF CIGARETTE MARKETING: YOUNG ADULT
SMOKERS’ SHARED PERCEPTIONS OF FLAVORED CIGARETTE
PACK DESIGN IN MEXICO AND IN THE PHILIPPINES
Graziele Grilo1, Jennifer L. Brown1, Joanna E. Cohen1, Katherine C. Smith2. 1Johns
Hopkins Bloomberg School of Public Health /IGTC, Baltimore, MD, USA, 2Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Background Reviews of tobacco industry documents uncover transnational tobacco
companies’ knowledge of a comparable young adult (YA) market across countries in
terms of attitudes and lifestyle aspirations, and the resulting standardized marketing
approach some companies took to expand their market. We examined YA smokers’
perceptions of avored cigarette packs, focusing on avor capsule variants (FCVs),
in Mexico (MX) and the Philippines (PH). Methods A secondary analysis of ve focus
groups (FGs) held in MX and four FGs held in PH with YA smokers (ages 18-24), strat-
ied by gender and socioeconomic status, was conducted. Participants interacted with
cigarette packs purchased locally. Transcribed and translated data were thematically
analyzed and compared between countries. Results Three themes emerged: FCVs
are recognizable via pack design, colors increase appeal and signal avor, and YAs
perceive avored cigarettes as youth products. Participants in MX and PH easily recog-
nized FCVs on the pack: “Those that have little dots have double capsules.”(MX)/“The
imaging... Like this one shows that when you pop this section, it would heighten the
avor.”(PH) Colors signaled avor: “By the colors, you could even deduce that this is mint
avored.”(MX)/“Most of the menthol cigarette colors are green, blue, and black.”(PH) and
were attractive: “Because these have more colors... they are eye-catching.”(MX)/“They’re
colorful and cool.”(PH) Participants said avored cigarettes are mainly used by and
appealing to youth, including themselves: “The kids, young people, the ones who are
starting to smoke regularly, smoke one of these avored ones.”(MX)/“[A capsule pack]
will appeal to millennials.”(PH) Conclusion YA smokers across countries interpreted
avored cigarette pack design similarly and agreed young people are the main audience
for these products, suggesting that a standardized marketing approach is successful at
creating shared perceptions in dierent world regions. This strengthens the argument
that local evidence on tobacco marketing may be generalizable beyond specic regions
and can support evidence-based tobacco control policies and counter-marketing globally.
Funding Part of this work was supported with funding from Bloomberg Philanthropies’
Bloomberg Initiative to Reduce Tobacco Use (bloomberg.org). JEC holds the Bloomberg
Professorship of Disease Prevention at the Johns Hopkins Bloomberg School of Public
Health; the earnings from that endowment helped to support part of this work.
FUNDING: Academic Institution; Nonprot grant funding entity
POD12-4
ELECTRONIC CIGARETTES SALES TRENDS AND MARKET
SHARE FROM SOUTH AFRICAN SALES SCANNER DATA
Olalekan A. Ayo-Yusuf1, Joyce Jakavula1, Lungile Nkosi1, Kgomotso Kali1, Israel
Agaku2. 1Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako
Makgatho Health Sciences University, Pretoria, South Africa, 2Harvard School of Dental
Medicine, Boston, MA, USA.
Signicance: Despite the introduction of electronic cigarettes (e-cigarettes) into the
South African market about ten years ago and new entries in recent times, only limited
information is available on e-cigarette market in South Africa. Hence, this study sought to
describe e-cigarette sales trends and market share using Nielsen’s sales data. Methods:
We used sales volume (L) data to calculate e-cigarette sales market share from Nielsen
market channels (excludes vape shops or online sales) during the 3-year period starting
July 2018 through the period ending June 2021. This included the period of temporary
ban in sales of tobacco and e-cigarette products (March 27, 2020 - 17th August 2020)
in response to COVID-19 pandemic in South Africa. Internet searches were used to
supplement Nielsen brand information, including labelled nicotine content, avour and
form (Prelled Cartridges or rell liquids). Results: In 2018, the top three brands were
Twisp (87% of market share), Switch (4% share) and E-Sense (2% share) - none owned
by traditional tobacco companies. By 2021, the top three brands were Twisp (acquired
by BAT in 2019), VUSE (launched by BAT in Q2 2021) and NJOY, accounting for 85%,
9% and 2% respectively of the market share. Of those with available data on labelled
nicotine, the sales of e-liquid with nicotine content between 18-24mg/ml increased from
57.4% in 2018 to 72.4% of total volume sales in 2021, while those with labelled content
between 0.5-8mg/ml nicotine dropped from 38.7% in 2018 to 21.8% in 2021. Similarly,
there was an increase in the sales of fruit avour (22.1% to 34.1%) and menthol/mint
avour (18% to 20.7%), but a decline in sales of tobacco avour (23.2% to 17.8%).
The sale of prelled cartridges, including pods, also experienced signicant growth
during 2018-2021 (21.3% to 31.1%). Conclusion: E-cigarette brand leaders are now
owned by BAT. The rapid growth in market share of VUSE, within three months of its
launch, may be a result of a combination of its availability in various avours, nicotine
salt formulation and the aggressive marketing, including recent online streaming of
youth-focused concerts - ‘festival of inspiration’. The study ndings highlight the need
for regulation of e-cigarettes in South Africa.
FUNDING: Unfunded; Nonprot grant funding entity
POD12-5
EXPOSURE TO E-CIGARETTE ADVERTISING AND ITS
ASSOCIATIONS WITH ATTITUDES AND BEHAVIORS TOWARDS
E-CIGARETTES AMONG US ADOLESCENTS, 2017-2019
Yu Wang1, Zongshuan Duan2, Shannon R. Self-Brown1, Scott R. Weaver1, Claire A.
Spears1, Pinpin Zheng3, Michael P. Eriksen1, Jidong Huang1. 1School of Public Health,
Georgia State University, Atlanta, GA, USA, 2Milken Institute School of Public Health,
George Washington University, Washington, DC, USA, 3School of Public Health, Fudan
University, Shanghai, China.
Signicance: In response to the youth vaping epidemic in the US, federal agencies
have taken steps to curb youth-targeted e-cigarette marketing since early 2018. How-
ever, studies examining the eect of such regulations are scarce. This study aims to
investigate: (1) trends of e-cigarette ad exposure from dierent channels from 2017
to 2019; (2) how e-cigarette ad exposure is associated with curiosity about using an
e-cigarette and e-cigarette use, among US adolescents. Methods: Data were from the
Population Assessment of Tobacco and Health (PATH) Study Youth Cohort Wave 4
(Dec 2016 to Jan 2018), Wave 4.5 (Dec 2017 to Dec 2018), and Wave 5 (Dec 2018
to Nov 2019). The study population was US adolescents 12-17 years old. Wave 4
cohort all-wave weights were applied to account for the sampling design and generate
national representative estimates. E-cigarette ad exposure from eight channels (stores,
billboards, print, radio, TV, events, clubs or bars, and online) was estimated. Generalized
estimating equations (GEEs) were used to estimate how e-cigarette ad exposure was
associated with contemporary curiosity about using an e-cigarette and e-cigarette use
status at 12-month follow-up, controlling for socio-demographic characteristics, mental
health status, cigarette use, other tobacco use, and survey waves. Results: During the
study period, more than 60% US adolescents were exposed to e-cigarette ads in the
past 30 days at the survey time. E-cigarette ad exposure from print media decreased
from 15.2% (95% CI=14.3%-16.0%) in 2017 to 9.1% (95% CI=8.6%-9.7%) in 2019.
Ad exposure from billboards, radio, and TV decreased from 2017 to 2018 but did not
change signicantly from 2018 to 2019. Ad exposure online did not change signicantly.
Adolescents who were exposed to e-cigarette ads were more likely to feel curious about
using an e-cigarette (aOR=1.69, 95% CI=1.56-1.83) and to be current e-cigarette users at
12-month follow-up (aOR=1.38, 95% CI=1.18-1.60). Conclusions: Continued monitoring
of e-cigarette ad exposure and its impact on e-cigarette use among adolescents are
needed. Additional eorts to reduce youth exposure to e-cigarette ads may be warranted.
FUNDING: Federal
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2022 Paper Sessions
POD12-6
DETERMINING IF PLATFORM AND FEDERAL TOBACCO
CONTROL POLICIES ALIGN WITH CURRENT INDUSTRY
PRACTICES
Linnea Laestadius1, Julia Vassey2, Anuja Majmundar3, Andrea Stroup4, Ziyad Ben Taleb5,
Helen I. Meissner6, Sherry Emery7, Dan Romer8, Tess Cruz2, Grace Kong9. 1Univer-
sity of Wisconsin Milwaukee, Milwaukee, WI, USA, 2University of Southern California,
Los Angeles, CA, USA, 3American Cancer Association, Atlanta, GA, USA, 4Westat,
Rockville, MD, USA, 5University of Texas at Arlington, Arlington, TX, USA, 6National
Institutes of Health, Bethesda, MD, USA, 7NORC at University of Chicago, Chicago,
IL, USA, 8University of Pennsylvania, Philadelphia, PA, USA, 9Yale University School
of Medicine, New Haven, CT, USA.
Signicance: Social media platforms are now frequently used to market tobacco
products. Marketing strategies include traditional approaches such as paid online
advertising, and novel approaches, such as brands/retailers posting promotional con-
tent on their own social media accounts and partnering with social media inuencers.
These marketing practices raise concerns about the suciency of existing regulatory
policies aimed at tobacco industry promotional practices on social media. Methods:
Qualitative framework analysis was used to analyze and compare: (A) Platform policies
related to tobacco product promotion (e.g., sponsored tobacco content and posts on
tobacco brand/retailer accounts) and sales on Discord, Facebook, Instagram, Pinterest,
Snapchat, TikTok, Tumblr, Twitch, Twitter, and YouTube in May 2021, and (B) Federal
policies related to the promotion of tobacco products on social media. Results: Eight
of the ten platforms prohibited paid advertising for tobacco products, although Tumblr
allowed e-cigarette marketing when legal in the target market. Twitch and Discord
lacked policies for tobacco products. Five platforms restricted posts that sell tobacco
products and three mentioned age-gating posts that promote or sell tobacco products.
Only Facebook, Instagram, and TikTok clearly prohibited sponsored content (i.e., social
inuencers) that promotes tobacco. US FDA policies applicable to tobacco marketing
online require the use of warning statements, restrict unauthorized health and risk
claims, and prohibit sales to minors. Conclusion: Most platform policies prohibited
paid tobacco advertising but failed to address more novel strategies such as sponsored/
inuencer content or promotional content on brand and retailer accounts. While federal
regulations apply to paid advertising as well as commercial and sponsored posts that
promote tobacco, there are no policies to restrict the overall proliferation of this content
on social media. There is a pressing need to ensure that platform and federal policies
reect the ever-evolving tobacco promotion landscape.
FUNDING: Unfunded; Federal
POD12-7
HOW REPETITION AFFECTS THE PERCEIVED TRUTH OF (MIS)
INFORMATION ABOUT TOBACCO PRODUCTS
Jennifer Morgan1, Joseph Cappella2. 1Annenberg School for Communication, Phila-
delphia, PA, USA, 2University of PA, Philadelphia, PA, USA.
Signicance. As concerns about the eects of health misinformation rise, understanding
how health (mis)beliefs are formed is increasingly important. Tobacco warnings con-
taining new information are perceived as less factual and misbeliefs about tobacco are
rampant (i.e. nicotine causes cancer and organic tobacco is less harmful). Numerous
studies have found that people believe repeated trivia statements more than novel
statements, an eect known as truth by repetition. This study examines how repeated
exposures to both true and false statements about heated tobacco and cigarettes aects
the perceived truthfulness of the statement claims. Methods. We recruited an online
convenience sample of 1,436 U.S. adults ages 21+ in May, 2021. In an exposure phase,
each participant rated the truthfulness of 48 randomly selected statements about tobacco
products and general knowledge trivia, half true and half false. The study had a two
(tobacco product familiarity: heated tobacco, cigarettes) by two (familiarity of statement
claim: recognizable, novel) between-subjects design. During the testing phase, partici-
pants rated the truthfulness of 24 repeated statements and 24 unseen statements. The
testing phase occurred on the same day and again three days later. Results. Repetition
of true and false statements increased their subjective truth compared to novel state-
ments (di=.36, p<.001). For recognizable false heated tobacco claims, the eect of
repetition increased the perceived truthfulness rating (di=.21, p<.01) but not true claims
(di=.05, p=.14). For novel heated tobacco claims, repetition signicantly increased
truthfulness ratings (ditrue =.15, p<.01; difalse =.31, p<.001). For cigarettes, repetition
increased perceived truth of recognizable claims (ditrue=.09, p<.01; difalse=.31, p<.001)
and novel claims (ditrue =.21, p<.001; difalse =.24, p<.001). Conclusion. The repetition
eect increases the believability of claims about tobacco, and the eect is generally
stronger for false claims compared to true claims. This underscores the importance of
strategies to inoculate people against misinformation and calls for interventions that
can stop the repetition of newly generated false claims.
FUNDING: Federal
POD12-8
TOBACCO ADVERTISING AT POINT OF SALE IN DHAKA,
BANGLADESH, IDENTIFYING TOBACCO INDUSTRY STRATEGIES
Mary Clare Rosemeyer1, Mohammad Ataur Rahman2, Mostazur Rahman2, Ahmed
Swapan Mahmud3, Zayed Ahmed Siddiki3, Claudio Tanca1, Vandana Shah1, Maria
Carmona4, Ernesto M. Sebrie5. 1Campaign for Tobacco Free Kids, Washington, DC,
USA, 2Campaign for Tobacco Free Kids, Dhaka, Bangladesh, 3Voices for Interactive
Choice & Empowerment, Dhaka, Bangladesh, 4Campaign for Tobacco Free Kids, Wash-
ington, DC, USA, 5Campaign for Tobacco-Free Kids, Washington, DC, USA.
Signicance This study demonstrates that (1) tobacco companies have a strategic
approach to inuencing the retail environments where their products are sold and (2)
tobacco product marking at point-of-sale (POS) is robust in Bangladesh. In Bangladesh,
The Smoking and Using of Tobacco Products (Control) Act, 2005 prohibits producing
or disseminating an advertisement of a tobacco product in any way at the point of sale,
including any kind of commercial activity intended to promote a tobacco product or
tobacco use either directly or indirectly. This study tracks the journey of promotional
and advertising materials from source to store and provides detailed descriptions of
tobacco companies’ retailer incentive programs, unpacking these companies’ strategies
to undermine and knowingly violate Bangladesh’s tobacco advertising, promotion, and
sponsorship (TAPS) laws. To our knowledge, this is the rst report to detail tobacco
companies’ marketing and promotional strategies across the chain of tobacco prod-
uct distribution in Dhaka, Bangladesh, from wholesalers to small vendors. Methods
Between January and February 2021, Voice Bangladesh conducted 28 key informant
interviews (KIIs) from 14 high- and 14 low- socioeconomic (SES) areas and 8 focus group
discussions in 8 high- and 8 low-SES areas among tobacco retailers (mobile vendors,
roadside tobacco stands, tea stalls, small grocers, supermalls), tobacco wholesalers,
and tobacco dealers in Dhaka, Bangladesh. Results Nearly every POS displays tobac-
co advertising or promotional materials. BAT and JTI provide more POS promotional
materials to vendors in areas of low-SES. BAT and JTI provide nancial and non-cash
incentives at all levels of distribution. Incentives dier at all levels of the distribution
chain between high- and low-SES areas. Conclusion Bangladesh does not explicitly
ban point-of-sale tobacco product displays and enforcement of other TAPS policies is
weak, particularly in low-income areas. Multinational tobacco companies exploit these
policy and enforcement gaps with routine provision of marketing and promotional ma-
terials to points of sale at all levels of product distribution. Finally, tobacco companies
exploit workers’ inadequate earnings with nancial and non-cash incentives, including
household needs such as beds, appliances, and milk.
FUNDING: Unfunded; Nonprot grant funding entity
58
Notes
59
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2022 Paper Sessions
PAPER SESSION 13: RAPID FIRE: NOVEL
TOBACCO CESSATION TREATMENTS IN
ADULTS AND TEENS
POD13-1
TESTING AUGMENTED REALITY FOR EXTINCTION OF CUE-
PROVOKED URGES TO SMOKE: INITIAL EVIDENCE FROM A
CONTROLLED EXPERIMENT
Min-Jeong Yang1, Karen O. Brandon1, Marloes Kleinjan2, Laura M. Hernandez1, Leslie
E. Sawyer1, Steven K. Sutton1, Thomas H. Brandon1, Christine Vinci1. 1H. Lee Mott
Cancer Center, Tampa, FL, USA, 2Trimbos Institute, Utrecht, Netherlands.
Background: Cue exposure therapy (CET) aims to extinguish conditioned cue reactivity
to aid in smoking cessation. However, despite achieving extinction in the lab/clinic,
the long-term ecacy of CET remains poor. A key disadvantage of CET is its limited
ability to generalize extinction to the real-world, where smoking occurs. To address this
limitation, our team developed a set of augmented reality (AR) smoking-related and
neutral cues that can appear in real-time in smokers’ natural environments as viewed
through a smartphone screen. We previously established that AR smoking cues elicit
cue reactivity. Prior to deployment as a clinical tool, the current study tested the ability
of AR smoking cues to extinguish cue reactivity in a controlled laboratory study. We
hypothesized that daily smokers who completed a single session of CET with AR smoking
cues (extinction condition) would demonstrate a decrease in cue reactivity compared
to those who completed CET with AR neutral cues (control condition). Method: Daily
smokers (N=129, 46.5% female, Mean Age = 47.6, Mean Cigarettes/Day = 19.1) in acute
abstinence were randomized to either the extinction or control condition comprising 28
AR trials. In both conditions, the same AR neutral and smoking cues were presented
at the beginning and at the end of the session to assess change in cue reactivity. Par-
ticipants rated urge to smoke following each cue presentation. Results: The results
showed the hypothesized two-way interaction (p<.05) between trial and condition. Urge
ratings signicantly increased across trials in the control condition, presumably reecting
increasing nicotine withdrawal over the course of the session, whereas no such increase
was found in extinction condition, presumably reecting extinction. Conclusion: Results
suggest that reactivity to AR cues can be extinguished in the laboratory, setting the stage
for testing their clinical ecacy in smokers’ naturalistic environments. AR-based CET
has potential as a relapse-prevention adjuvant to a range of smoking cessation inter-
ventions, including counseling, quitlines, mHealth interventions, and pharmacotherapy.
FUNDING: Federal
POD13-2
TELEHEALTH DELIVERY OF A BRIEF SAVORING INTERVENTION
FOR SMOKING CESSATION
Amanda M. Palmer1, Madeline G. Foster1, Eric L. Garland2, Nathaniel L. Baker1, Amy
S. Boatright1, Brett Froeliger3, Michael E. Saladin4, Matthew J. Carpenter4, Benjamin
A. Toll4. 1Medical University of South Carolina, Charleston, SC, USA, 2The University of
Utah, Salt Lake City, UT, USA, 3University of Missouri, Columbia, MO, USA, 4Medical
University of SC, Charleston, SC, USA.
Signicance: One aspect of behavioral interventions for tobacco use is addressing
maladaptive reward and motivational processes formed through long-term cigarette
smoking. Restructuring these processes may be accomplished by increasing the
salience of pro-social rewards through positive psychology techniques. Savoring is a
mindfulness-based technique that enhances one’s attention to positive sensations, thus
amplifying natural reward. Savoring interventions have demonstrated ecacy in reducing
opioid use, and interventions including savoring techniques have been shown to reduce
nicotine use. Methods: In the present pilot study, daily cigarette smokers interested in
quitting were provided nicotine replacement therapy (NRT) and randomized to either a
brief Savoring intervention (Savoring, n=22) or no intervention (Control, n=22) delivered
via telehealth. Participants completed daily surveys regarding smoking (cigarettes per
day [CPD]), cravings, mood, and practice of Savoring over a 28-day treatment period.
Mixed models for repeated measures evaluated the independent eects of treatment
condition and study day on CPD, cravings to smoke, and mood. Results: Analyses
showed that there was a signicant eect of treatment on CPD such that the Savoring
group smoked less (F = 14.10, p<.001). Across both treatment groups, study day was
associated with reductions in cravings (F = 1.98, p<.01). Finally, there was a signicant
eect of treatment on mood, such that the Savoring group reported higher mood scores
(F = 5.71, p<.05). Conclusions: Overall, results of this study suggest that Savoring can
be feasibly delivered via telehealth alongside NRT. Despite being a brief intervention,
participants who received Savoring had greater reductions in smoking and higher mood
ratings as compared to controls. Future studies should test Savoring in a fully-powered
clinical trial and continue to adapt this brief intervention for telehealth, which will improve
outcomes and increase access to ecacious treatment services. Funding: NIH Insti-
tutional Postdoctoral Training Grant NIH-T32-HL144470 and Hollings Cancer Center,
Charleston, SC USA (P30 CA138313).
FUNDING: Federal; Academic Institution
POD13-3
VERY LOW NICOTINE CONTENT CIGARETTES AND CUE-
PROVOKED CRAVINGS EFFECTS OF NICOTINE REDUCTION
STRATEGY AND FACILITATING EXTINCTION
Melissa R. Conn, Vani N. Simmons, Min-Jeong Yang, Steven K. Sutton, Leslie Sawyer,
Thomas H. Brandon, Marco F. Cid, David J. Drobes. Mott Cancer Center, Tampa,
FL, USA.
Background: Very low nicotine content cigarettes (VLNC) may aid smoking cessation
by decreasing reinforcement from smoking and reducing craving through extinction
processes. In a randomized controlled trial, a facilitated extinction (FE) approach (Bran-
don et al.,2018) was adapted and crossed with two 5-week schedules of pre-cessation
VLNC cigarettes. A cue reactivity (CR) task was administered pre- and post-treatment
to assess the eects of nicotine reduction schedule (immediate vs. gradual) and FE
techniques on cue-provoked cravings. We predicted CR reduction, particularly among
smokers in the immediate reduction arms and those who received the FE intervention.
Methods: 98 smokers completed the pre- and post-treatment CR task, randomized to
immediate vs. gradual reduction to the lowest nicotine level (0.44±0.01 mg/g for menthol;
0.42±0.01 mg/g for non-menthol). Half in each of the reduction groups received the FE
intervention (via written material and individual counseling) and half received a standard
(STD) cognitive-behavioral intervention. A validated picture-viewing CR paradigm was
administered at baseline (Visit 1) and at the end of the 5-week pre-cessation treatment
period (Visit 6). 12 smoking and 12 neutral images were presented (6 secs) in random
order as craving ratings were obtained. Generalized Estimating Equations tested the
eects of the intervention (FE vs. STD) and nicotine reduction schedule (gradual vs.
immediate) on craving. Results: Mean age was 52.7 years, 61% were female, mean
cigarettes/day was 20.7, and mean FTND score was 5.5. As expected, smoking cues
elicited greater craving than neutral cues (p < .05). This CR declined from pre- to
post-treatment (p < .05). However, these eects did not dier as a function of intervention
type (FE vs. STD) or nicotine reduction schedule (all interaction ps > .05). Conclusions:
As predicted, strong CR was found at baseline, with signicant reduction following
treatment. However, no dierences were observed in CR reduction as a function of
treatment condition (nicotine reduction schedule or FE intervention). These ndings
support the use of VLNC cigarettes to reduce cue-provoked cravings during smoking
cessation and suggest that this eect is robust across treatment specics. Further
research is needed to determine the optimal treatment parameters to maximize both
CR and smoking cessation outcomes using reduced nicotine cigarettes.
FUNDING: State
POD13-4
PRELIMINARY FINDINGS SUPPORT GAMIFICATION AS A
METHOD TO INCREASE ENGAGEMENT IN A SOCIAL MEDIA-
BASED SMOKING CESSATION INTERVENTION
Gary L. Humeet, John Layton, Sharon M. Hall. University of California San Francisco,
San Francisco, CA, USA.
Signicance. Digital health interventions have the potential benets of increasing access
to health-related interventions, ensuring delity of treatment, reducing costs associated
with treatment delivery, and reducing patient burden. Social media platforms, such as
PODIUM PRESENTATION 5
61
2022 Paper Sessions
Facebook (FB), may be particularly useful for smoking cessation. However, digital inter-
ventions have been criticized for generally poor treatment engagement and adherence.
The use of game design elements in non-game contexts, gamication, is an innovative
strategy to address poor engagement and retention. Methods. We a conducting a pilot
clinical trial comparing PridePosts (PP) to PP + Gamication (PP+G) with a planned sam-
ple size of 40 smokers in each condition. PP is a 6-month, FB-based, smoking cessation
intervention culturally-tailored to sexual and gender minority (SGM) cigarette smokers.
Participants receive 150 cessation-relevant posts over 180 days and weekly “live” chat
sessions. PP+G integrates a point-based reward system into the PP intervention. Gaming
elements include quiz questions, competitive polls, challenges, badges/trophies, and
social engagements. Points are converted to monetary compensation monthly. Measures
of engagement include total number of active comments/replies to posts and duration
of active participation. Smoking abstinence is assessed at 6 months (end of treatment).
Results. Preliminary ndings are based on 43 SGM smokers who have completed the
6 month intervention. Demographics - Sample is diverse. Racial/ethnic identication is
59% White, 19% Multiracial, and 13% Latinx. 41% identify as male, 30% transgender/
nonbinary/other, and 29% as female. 49% report an annual income of less than $30,000
per year. Engagement - Participants in the PP+G condition displayed signicantly higher
active engagement with the intervention with a mean of 61.9 comments/replies (SD 63.2)
while PP participants had a mean of 16.0 comments/replies (SD14.3, p=.003). Mean
duration of active participation was also higher in PP+G condition than the PP condition
(11.5 versus 8.4 weeks, n.s.) Conclusions. These preliminary ndings support the use
of gamication elements to increase engagement in digital-based interventions. Further
evaluation of the relationship of gamication to engagement and smoking abstinence
is planned once the full sample has completed the study.
FUNDING: State
POD13-5
METHODS USED TO QUIT VAPING BY TEENS AND
DEVELOPMENT OF A VIRTUAL REALITY PROGRAM TO HELP
TEENS STOP VAPING
Belinda Borrelli, PhD1, Daniel Edward Weinstein1, Lisa M. Quintiliani1, Romano
Endrighi1, Emily A. Jones1, Joy L. Hart2, Kandi L. Walker2, Scott Hadland3. 1Boston
University, 2University of Louisville, 3MassGeneral Hospital for Children / Harvard Medi-
cal School.
Immersive virtual reality (VR) has the potential to promote vaping cessation among
youth; it has the ‘cool’ factor to compete with vapes, while also providing coping skills.
This study assessed: 1) previous methods used by teens to quit vaping and future
intentions to use them, including VR, and 2) reactions to a proposed VR-based vaping
cessation program. Participants were current and former vapers aged 14-19 from var-
ious US regions (n=101, 52.5% female, 68% white) who completed an online survey
about vaping cessation methods; 29 attended Zoom focus groups about the proposed
VR vaping cessation program. Descriptive analyses for survey data and thematic
coding for focus group data were conducted. Survey data revealed that 42.9% used
ultra-high nicotine in their devices and 42.3% of teens tried to quit vaping =3 times in
their lives. The percent reporting past use of quit methods/future intentions to use quit
methods were: Cold turkey (76%/72%) counseling (7.3%/31.3%), nicotine replacement
therapy (NRT; 17.7%/41.7%), stop smoking medication (4.2%/30.2%), school program
(2.1%/15%), text messages (15.6%/30.2%), mobile app (13.5%/34.4%), friend advice
(54.2%/71.9%), and doctor ’s oce (3.1%/40.6%). Of those who tried social media to
quit (18.8%), the top three platforms used were: online forum (Reddit, Quora; 38.9%),
TikTok (77.8%) and Instagram (77.7%). Fifty percent reported prior use of a VR headset
for entertainment and 79% said they would likely use it for vaping cessation. Themes
emerging from qualitative data were: program tone (e.g., avoid teen slang), interven-
tion targets (sadness, anxiety, boredom), structure (tailor program to reasons to vape,
create story, gamication, multiplayer), and content (nding new activities, developing
coping strategies). Teens stressed the importance of not having a structured program
because ‘that’s for addicts.’ A vaping intervention delivered via VR could be an engaging
for teens, possibly paired with other quit methods such as counseling and use of NRT,
given their enthusiasm for these strategies.
FUNDING: Federal; Nonprot grant funding entity
POD13-6
OUT OF THE HAZE AND INTO YOUR DMS: CO-CREATING
AND PILOTING A VAPING CESSATION PROGRAM FOR TEENS
DELIVERED THROUGH INSTAGRAM
Danielle E. Ramo, PhD1, Patricia Price2, Michelle Bellon3, Robin Hayashi2, Denise Ho2,
Pamela Ling1. 1UC San Francisco, 2Hope Lab, 3rescue agency.
Introduction: We adapted a social media-based smoking cessation intervention to
support teens who vape and for delivery on Instagram. Method: A 30-day program
based on US Clinical Practice Guidelines for Smoking Cessation was adapted for
teens age 13 to 20 who vape in an iterative co-creation process consisting of teen
surveys (N=262), product feedback and co-creation sessions (N=26), piloting (N=195),
and revisions. A prototype was developed that was administered in Instagram private
groups. A pilot delivered through a state public health department with teens who vaped
at least once in the past 30 days surveyed teens at baseline and at intervention end (4
weeks). Feedback was used to create a nal version to evaluate in a randomized trial.
Results: Early surveys/interviews yielded three design principles to inform a prototype
intervention: (1) unrelenting hope while acknowledging the challenging vaping addiction
presence (through balancing optimism and realism in the brand and user experience);
(2) prioritizing compassion for the person behind the vape (through six program values
introduced at program start and infused throughout); (3) designing for connection and
support between the teens (through opportunities to support each other and limited role
for live coach to “nudge the conversation” along). The initial 4-week program consisted
of content sent through Instagram DMs, including messages, images, videos, and posts;
interactive discussion and questions between guide and group members; and tools to
support group connection and quitting (e.g., progress tracker, quit kit). Pilot data showed
78% engagement with the coach and/or peers in the group, 85% reported using group
material, 91% would recommend the group to friends, and increased self-ecacy to
quit vaping over 4 weeks (6.55->8.54, p<.05). Updates post pilot included extending the
program to 5 weeks, integrating an additional group quit date, and increased preparation
and support for maintaining post-group recovery. Conclusions: Findings demonstrated
the importance of iteration and co-creation with teens when aiming to build an eective
product that feels meaningful and engaging to teens.
FUNDING: Academic Institution; Nonprot grant funding entity; Other
POD13-7
A PILOT STUDY OF NICOBLOC® AS A NOVEL INTERVENTION TO
ENCOURAGE QUIT ATTEMPTS
Karen L. Cropsey, PsyD1, Keith R. Chichester1, Michelle L. Sisson1, Soa Mildrum
Chana2, Caitlin Wolford-Clevenger1, Mickeah J. Hugley1, Paige Palenski1, Angela
Nguyen1, Peter S. Hendricks1. 1University of AL at Birmingham, 2University of AL at
Birmingham, Birmingham, AL, USA.
Background: NicoBloc® is a novel, non-pharmacological liquid applied to the lter end of
a conventional cigarette that blocks 33% of tar and nicotine with one drop; three drops
blocks up to 99%. NicoBloc® allows smokers to gradually lower their nicotine levels over
the course of several weeks while continuing to use their own brand of cigarette. While
this product is available in the U.S. and internationally, few clinical trials have explored
how NicoBloc® may inuence quit attempts and cessation in comparison to conventional
smoking cessation aids.Methods: Smokers (N=45) from the community were recruited
and randomized to receive either NicoBloc® or nicotine lozenges in combination with
four weeks of in-session use of these products. Participants continued use of these
products for an additional 8 weeks and then returned for a one month follow-up session.
Primary outcomes included quit attempts and smoking reductions. Descriptive statistics
characterized the sample and t-tests were used to examine dierences between two
groups on quit attempts and reductions in CPD.Results: Participants were predominately
Black (66.7%) men (71.1%) with a mean age of 49.7 years (SD=10.7). Across all time
points, both lozenge and NicoBloc® resulted in reductions in CPD across time (NicoBloc:
14.5 CPD at BL to 7.6 CPD at 1M F/U; Lozenge: 14 CPD at BL to 2.2 CPD at 1M F/U).
Similarly, 62% of lozenge and 31% of NicoBloc® participants made a 24 hour quit attempt
at 1M F/U, although these dierences were not signicant (p=0.13).Conclusions: Both
NicoBloc® and lozenge participants reduced CPD across time and made quit attempts.
NicoBloc® represents a unique, non-pharmacological option for intervention that may
be most eective in subpopulations where pharmacological approaches are restricted,
such as pregnant smokers and teens. Alternatively, NicoBloc® may be preferred among
smokers not fully committed to quitting or who would prefer to quit gradually and not
use medication. A fully randomized clinical trial is needed to determine the ecacy of
NicoBloc® compared to conventional cessation methods such as NRT.
FUNDING: State; Pharmaceutical Industry; Academic Institution
62
2022 Paper Sessions
PAPER SESSION 14: CIGARETTES AND
E-CIGARETTES: TOXICITY AND DISEASE
POD14-1
SEX-DEPENDENT EFFECTS OF PRENATAL EXPOSURE TO
THIRDHAND SMOKE ON THROMBOSIS-BASED DISEASE STATES
Hamdy Ali1, Ahmed Alarabi1, Zubair Karim2, Victor Rodriguez2, Keziah Hernandez2,
Patricia Lozano1, Medhat El-Halawany1, Leticia Rodrigues1, Daniel Villalobos-García1,
Fatima Z. Alshbool1, Fadi T. Khasawneh1. 1Texas A&M University, Kingsville, TX, USA,
2University of Texas at El Paso, El Paso, TX, USA.
Signicance: Thirdhand smoke (THS), the persistent residue of tobacco smoke that
remains after a cigarette is extinguished, materialized as a threat for human health over
the last decade. We previously showed that THS exposure modulates platelet function
and enhances thrombogenesis in adult exposed mice. However, whether prenatal
THS exposure produces similar eects on the ospring of exposed-dams, and whether
the consequences of this exposure manifest in a sex-dependent manner, is yet to be
investigated. Methods: Using a validated approach that mimics real life THS exposure,
C57BL/6J female mice were exposed starting one week before mating, and throughout
the entire period of gestation; and the ospring were assayed at 8-10 weeks of age.
Results: Interestingly, our studies demonstrated a drastic reduction in bleeding time as
well as an increased tendency to arterial thrombosis in response to the in utero THS
exposure. Moreover, the enhanced thrombosis and hemostasis phenotype was sup-
ported by a state of platelet hyperactivity manifested as enhanced platelet aggregation,
secretion, integrin αIIbβ3 activation as well as activation of Akt, ERK and Rap1b. As for
the role of sex, interestingly, we did observe some intersex dierences at the level of
granule secretion, glycoprotein IIb-IIIa activation, phosphatidyl serine-exposure, and
Rap1b activation, but not hemostasis or thrombus formation. We also found that clot
retraction, a step critical for the solidication into a stable thrombus, is enhanced as a
result of THS. Finally and in terms of its eects on development, our analysis did reveal
a dierence between clean air and THS-exposed mice with regard to their weight, albeit
it did not reach statistical signicance. Of note, there were no dierences in the blood
cell count between THS and clean air mice. Conclusion: Taken together, our data clearly
demonstrate for the rst time- that in utero THS exposure of mice results in long-term
changes in the platelet biology of their exposed ospring, in a sex-dependent manner,
thereby making them more susceptible to cardiovascular diseases. Thus, the negative
health consequences of THS should not be underestimated, and new policies should
be enacted to vulnerable populations against exposure to this type of tobacco exposure.
FUNDING: Federal
POD14-2
POWER- VERSUS TEMPERATURE-CONTROLLED ELECTRONIC
CIGARETTES: IMPLICATIONS FOR EMISSIONS TESTING AND
EXPOSURE
Rola Salman, Soha Talih, Nareg Karaoghlanian, Alan Shihadeh. American University
of Beirut, Beirut, Lebanon.
Smoking machines are commonly used to compare toxicant yields across tobacco
products. These machines are usually programmed to execute a number of pus ac-
cording to some pre-determined regimen. Prior to the advent of temperature controlled
electronic nicotine delivery systems (ENDS), it was found that pu velocity did not
impact nicotine emissions, unlike combustible products. Nicotine emissions of a given
device and liquid were proportional to pu duration and count, but not ow rate. With
temperature-controlled devices (TCDs) such as JUUL, this assumption does not hold
in theory; physical principles suggest that for TCDs, greater ow rates result in greater
vaporization rates and toxicant emissions. Because ow rates vary widely depending
on device design, reports of toxicant yields would need to account for the ow rates at
which a given product is used. In this study we investigated how ow rate aects JUUL
emissions. We generated and sampled JUUL aerosols using the Aerosol Lab Vaping
Instrument. Ten pus of 4sec duration and 10sec interpu interval were executed for
three ows: 1, 1.5, and 2LPM. Total particulate matter was measured gravimetrically.
We found that emissions increased with ow rate; a doubling of ow rate from 1 to 2LPM
resulted in approximately a 50% increase in emissions. Unlike the case of power-con-
trolled ENDS, nicotine emissions from TCDs depend on ow rate. The results suggest
that previous estimates of JUUL ux and yield using the 1LPM CORESTA method
may have been greatly underestimated. This highlights the need to use topography
parameters appropriate to the device when measuring emissions.
FUNDING: Federal
POD14-3
EVALUATING CELLULAR TOXICITY OF CURRENT DISPOSABLE
VAPES
Alexis S. Voeller, Maria F. Sassano, Robert Tarran. University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA.
Signicance: Disposable e-cigarettes/vapes have increased in popularity. While
many avors have been banned from established e-cigarette brands such as JUUL,
disposables are marketed in a vast array of continually evolving avors, often with little
published information on ingredients or toxicity. The ongoing rise of EVALI cases demon-
strates a critical need for comprehensive toxicological assessment of all e-cigarette
products. This study aims to use high throughput screening techniques to evaluate the
cytotoxicity of disposable vapes. Methods: E-liquids were collected from 5 brands of
disposable vapes (Stig, Bidi Sticks, Hyde, Hyppe and Pu). Human alveolar A549 cells
were cultured and exposed to e-liquids at a range of concentrations (0.1-30% vol/vol)
for 24 h and stained to detect cell viability (calcein-AM) and ROS production (DCFDA).
E-liquid exposed cells were assayed using the FLIPR® Membrane Potential Blue
Assay Kit to detect changes in cell membrane potential. DNA damage was assessed
using an anti-phospho-histone H2A.X (Ser139) antibody after exposure to 0-20 “pus”
for 24 h. Results: All 65 e-liquids displayed cytotoxicity after 24 h exposure with LC50
values ranging 1.4 to 7.7 %vol/vol. The most toxic avors of each brand were Lush Ice
(Stig: LC50, 1.4 %vol/vol), Marigold (Bidi Sticks: LC50, 1.7 %vol/vol), Pink Lemonade
(Hyde: LC50, 1.7 %vol/vol), Peach Ice (Hyppe: LC50, 1.6 % vol/vol) and Neon Rain
(Pu: LC50, 2.8 %vol/vol). The eects of e-liquid exposure on cellular ROS production,
membrane potential and DNA damage are currently being evaluated. Conclusion:
This study suggests that disposable vapes are cytotoxic and maintain other properties
that are harmful to the microenvironment of airways. Cytotoxicity and DNA damage
are potential precursors to pulmonary complications. Without stronger regulation and
more research, disposable vapes are a threat to public health and cannot be deemed
as a safer alternative to cigarettes.
FUNDING: Federal
POD14-4
EXOSOMES ARE PATHOGENIC ENTITIES THAT DRIVE TISSUE
REMODELING DURING CONVENTIONAL SMOKING
Matthew Cameron Madison, Camilla Margarolli, Amit Gaggar, J, Edwin Blalock.
University of Alabama at Birmingham, Birmingham, AL, USA.
Background and Signicance: Chronic lung diseases associated with conventional
smoking continue to be leading causes of death globally and pose a heavy economic
burden worldwide. Despite the distinct strides made in our understanding of the pathol-
ogy associated with smoking, the therapies available for smoke-induced lung diseases
remain limited. Thus, investigations into drivers of the tissue destruction prompted
by smoking have the potential to expand the therapeutic arsenal for the treatment of
associated lung diseases. Exosomes are small, extracellular vesicles that are released
by most cells. While the biochemical makeup of exosomes can vary depending on cell
origin, they act as important mediators of cellular communication by carrying protein
and nucleic acid cargo to neighboring cells. In addition to these homeostatic roles,
external stimuli can alter the exosome signature among tissues to drive the initiation
and progression of disease. Methods and Results: Using proteomic techniques, our
laboratory has extensively characterized the airway exosome prole of individuals
with chronic obstructive pulmonary disease (COPD). Interestingly, we have found that
conventional smokers with or without COPD have a unique population of pathogenic
exosomes that carry surface-associated proteases. Enzymatic assays reveal that these
exosomes have increased proteolytic activity and an enhanced ability to degrade the
lung’s delicate tissue matrix. Using a murine model of smoke exposure, we have shown
that this deleterious population arises early and becomes evident at 2 weeks. The exo-
some fraction associated with smoke exposure also has the potential to recapitulate
features of chronic lung disease. Upon transferring the smoke-associated exosomes to
naïve recipient mice, we observe distinct tissue remodeling and damage. Conclusions:
Taken together, our investigations have uncovered novel drivers of smoke-associated
lung damage with the potential to inform new therapeutic strategies.
FUNDING: Federal
63
2022 Paper Sessions
POD14-5
CHRONIC HIV-1 TAT EXPOSURE ALTERS NICOTINE
DEPENDENCE IN MICE
M. Imad Damaj. Virginia Commonwealth University, Richmond, VA, USA.
Signicance. Rates of current smoking among HIV-population remain 2-3 times higher
than that of the general population. In addition, HIV patients are more likely to become
dependent on nicotine and less likely to quit than HIV-negative individuals. HIV infection
is often associated with chronic pain states, including sensory and painful neuropathy.
Recent population-based studies support a high co-occurrence of chronic pain and
smoking dependence. However, preclinical investigations modelling this interaction
between nicotine dependence and chronic pain are lacking, thus providing a major
obstacle to studying pain-related risk factors in nicotine dependence. Methods. To ad-
dress this decit in preclinical models, the present study examines nicotine withdrawal
in a HIV-induced neuropathy (mice conditionally expressing HIV Tat1-86 protein) mouse
model. Results. Nicotine withdrawal somatic and aective signs increased in intensity
and persisted longer in the transgenic mice compared to their WT controls. Plasma
nicotine and cotinine levels were not signicantly changed in the model of neuropathy.
Conclusion. Taken together, these ndings showed that mice are more susceptible
to nicotine withdrawal and possibly more susceptible to escalations in nicotine intake
when undergoing chronic neuropathic pain.
FUNDING: Federal; Academic Institution
POD14-6
COMPARATIVE TOXICOLOGICAL RISK-ASSESSMENT OF
MENTHOL AND TOBACCO FLAVORS FOR E-CIGARETTE
REGULATORY STANDARDIZATION
Thivanka Muthumalage, Irfan Rahman. University of Rochester Medical Center, Roch-
ester, NY, USA.
Rationale: Tobacco and menthol-avored e-cigs are available at various nicotine
strengths and the chemical constituents of these avors lack regulatory standardization.
We hypothesized that acute exposure to menthol and tobacco avors from dierent
brands induce an inammatory response in mice. Methods: Menthol and tobacco a-
vored ECTO and EC-Blend e-liquids were characterized for their chemical composition
by GC-MS. C57BL/6J and BALB/cJ mice of both sexes were exposed to e-cig aerosols,
PG/VG (50:50), 0 and 6 mg nicotine menthol and tobacco avors. These whole-body
exposures were performed 2 hrs/day for 3 days, using Scireq inExpose exposure
system. Inammatory mediators secreted in the bronchoalveolar lavage uid (BALF)
were measured by Luminex assay and the inammatory cells were phenotyped by ow
cytometry. Changes in lung surfactant proteins were determined by western blot analyses
in the lung homogenates. Results: Tobacco avored e-liquids contained benzyl alcohol,
ethyl maltol, eugenol, and menthol, while menthol and pulegone were predominant in
menthol avored e-liquids in varying concentrations between the two tested brands.
PG/VG ratio was approximately 50:50 in both avors in both brands. Acute exposure
to PG/VG and menthol avor increased the total cell counts in the BALF compared to
tobacco avor. PG/VG induced the highest cell inltration in BALF. Neutrophil counts
were increased in both PG/VG and menthol exposure. T-lymphocyte counts were
signicantly altered by both menthol and tobacco avors in both mouse strains. Most
signicant changes in BALF cell counts with menthol exposure were observed in BALB/
cJ strain. Menthol dierentially aected inammatory cytokines, such as MCP-1, IFNγ,
KC, TNFα, RANTES, and Eotaxin in both the mouse strains compared to the air group.
Similarly, tobacco avor exposure deferentially aected IL-3, IL-1β, TNF-α, IL-9, IFN,
KC, IL-2, IL-13, IL-6, IL-4, IL-5, IL-1a.IL-10, IL-17A, GM-CSF, MIP-1α, IL-1, and MIIP-
1β levels predominantly in C57BL/6J mice. Lung surfactant proteins (SP-A and SP-D)
were deferentially aected by the aerosol exposures. Conclusion: E-liquids of the same
avor category but dierent brands are not identical in chemical composition. Acute
exposure to PG/VG, menthol, and tobacco avors induced a Th1 driven inammatory
response with neutrophilia demonstrating potential acute lung injury. The presence of
nicotine aected chemotaxis, inammatory mediators, and increased susceptibility to
immune-toxicity in menthol and tobacco exposed mice. Our data suggest that constitu-
ents and concentrations of avoring chemicals determine the toxicity due to inhalation;
thus, it is imperative to conduct risk assessment and standardization of these avor
constituents in e-liquids for regulatory purposes. This study was supported by NIH
R01HL135613 and U54CA228110.
FUNDING: Federal
PAPER SESSION 15: LESSONS FROM
DIVERSE POLICY IMPLEMENTATION
ACROSS THE GLOBE
POD15-1
EVALUATION OF THE U.S. FEDERAL TOBACCO 21 (T21) LAW
AND LESSONS FROM STATE-WIDE T21 POLICIES: FINDINGS
FROM POPULATION-LEVEL SURVEYS
Israel Agaku1, Lungile Nkosi2, Queen Agaku3, Joy Gwar4, Tina Tsafa4. 1Harvard School
of Dental Medicine, Boston, MA, USA, 2Sefako Makgatho Health Sciences University,
Pretoria, South Africa, 3Zatum LLC, Grand Blanc, MI, USA, 4Benue State University,
Makurdi, Nigeria.
SIGNIFICANCE: On December 20, 2019, Tobacco 21 (T21) became U.S. federal law,
raising the minimum age for tobacco purchases to 21 years. We evaluated the impact
of this federal law at the one-year mark. METHODS: We examined shifts in actual
and perceived ease of access among US middle and high school students using data
from the 2011-2020 U.S. National Youth Tobacco Survey. Data were weighted to yield
representative estimates. RESULTS: The overall percentage perceiving it was easy
to buy tobacco products from a store decreased between 2019 (67.2%) and 2020
(58.9%). However, perceived ease of online purchases was high and plateaued be-
tween 2019 (86.6%) and 2020 (85.8%). Furthermore, while perceived ease of buying
tobacco products from physical stores increased with increasing grade level during
2020 (p-trend<0.001), no signicant trend was seen for perceived ease of online pur-
chases (p-trend=0.261). Non-Hispanic blacks were the only racial subgroup to report
no signicant decrease in perceived ease of buying tobacco products from a store
during 2011-2020. Overall, 10.1% of all students tried buying cigarettes from a store
within the past 30 days, down from 14.1% in 2018 (p<0.001). Only 17.0% of those who
attempted a cigarette purchase in 2020 reported that the sales clerk refused to sell it to
them because they were underaged. CONCLUSIONS: Evaluation of the federal T21
law at the one-year mark shows it has the potential to reduce ease of tobacco access,
but intensied eorts are needed with compliance. Over 4 in 5 US middle and high
school students who attempted to buy cigarettes in the past 30 days were success-
ful, underscoring the need for intensied eorts to reduce illegal sales of tobacco to
minors through enforcement of local, state, and federal access laws. Targeted eorts
are needed in minority communities as dierential enforcement of T21 policies in white
neighborhoods versus those of color may lead to uneven impact of T21 policies and
may deepen disparities in tobacco use. Funding statement: No external funding.
FUNDING: Unfunded
POD15-2
IMPLEMENTATION BARRIERS AND FACILITATORS OF THE 2019
TOBACCO FLAVOR RESTRICTION LAW IN MASSACHUSETTS
Andy SL Tan1, Jane Roberts2, Karen Emmons3, Jonathan Winicko4, Jessica Liu5,
Elaine Hanby1, Matthew Reynolds6, Daniel A. Gundersen7, Mark A. Gottlieb8. 1Univer-
sity of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA,
2Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA,
USA, 3Harvard University, TH Chan School of Public Health, Department of Social
and Behavioral Sciences, Boston, MA, USA, 4Harvard Medical School, Boston, MA,
USA, 5Harvard University, TH Chan School of Public Health, Department of Social and
Behavioral Sciences, Boston, MA, Boston, MA, USA, 6Massachusetts General Hospital,
Boston, MA, USA, 7Dana-Farber Cancer Institute, Survey and Qualitative Methods Core,
Boston, MA, USA, 8Public Health Advocacy Institute, Boston, MA, USA.
Signicance: In November 2019, the Massachusetts legislature passed the nation’s
rst statewide law to restrict retail sales of all avored (including menthol) tobacco
products. The law also increased excise taxes for e-cigarettes, penalties for sales to
minors, and coverage for tobacco cessation treatment. This study aimed to identify
the barriers and facilitators during the initial implementation of the law. Methods: We
conducted in-depth interviews with 9 public health ocials and policy advocates in
Massachusetts from March to July 2021 to explore six areas informed by the Explora-
tion, Preparation, Implementation, Sustainment Framework (i.e., sociopolitical context,
impact of funding, range of advocacy eorts, interorganizational networks, organizational
characteristics, and characteristics of decision-makers and leaders). We conducted
thematic analysis of interview transcripts using deductive codes based on the study
constructs and inductive codes of key themes emerging from the interviews. Results:
Participants described key implementation challenges including in enforcement of
64
2022 Paper Sessions
retailer compliance, navigating tobacco industry tactics around naming avors, and
health insurance coverage for tobacco use cessation programs. Also highlighted was the
potential for unintended consequences of the legislation, especially in communities of
color. Facilitators included the tenacity of legislative champions in pushing for the avor
ban and advocacy eorts particularly by youth. The autonomy of 351 municipalities’
boards of health in Massachusetts to pass local policies also had a powerful inuence
in shaping state-wide legislation starting at the local level and preventing the tobacco
industry from launching legal challenges against local policies. The COVID-19 pandemic
was an important barrier in conducting retailer compliance checks and implementing
various provisions of the new law. Conclusions: The ndings provide preliminary data
on implementation barriers and facilitators of the Massachusetts law experienced by
public health ocials and can inform the use of appropriate implementation strategies
for similar tobacco control policies in other states.
FUNDING: Federal
POD15-3
PROTECTING NONSMOKERS FROM TOBACCO SMOKE
PENETRATION IN MULTI-UNIT APARTMENT BUILDINGS -
PROGRESS VIA LITIGATION IN ISRAEL
Laura Rosen1, Amos Haunser2, Vicki Myers Gamliel3. 1Tel Aviv University, Ramat Aviv,
Israel, 2Israel Council for Smoking Prevention, Jerusalem, Israel, 3Gertner Institute,
Ramat Gan, Israel.
Signicance Tobacco smoke penetration in multi-unit apartment buildings is a signicant
public health problem in many countries. In Israel, where most of the population lives
in multi-unit housing, research conducted in 2017 and 2021 showed that about 50%
of the population is subject to this nuisance. Nonsmokers are exposed to substantial
amounts of tobacco smoke toxins, resulting in health damage and economic damage
to property value. Yet, initiatives to protect non-smokers in their own homes are often
stymied because smokers claim an alleged right to smoke anyplace in their own homes,
and to smoke on porches, even if this causes regular exposure of non-smoking neigh-
bors. Methods We review recent litigation in Israel on this topic, including a civil case
which was settled in 2019, a court ruling on a civil case with a ruling in July 2021, and
the administrative case which is currently before the Supreme Court. Results In 2019,
a civil appeal to a district court resulted in a settlement in which the smoking neighbor
was forced to move her place of smoking on her porch, without nancial charges to any
parties. By contrast, a landmark ruling in a civil case in July 2021 held smokers nan-
cially accountable; they were forced to pay compensation to the nonsmokers exposed
to secondhand smoke inside their own homes. The claims brought by the plaintis
included both health and nancial aspects. The court did not specify the extent to which
the health claims and the nancial claims contributed to the ruling. At present, a third
case, this time an administrative case, is pending in the Supreme Court. It was initiated
by the non-governmental organization (NGO), Clean Air (Avir Naki), in conjunction with
6 people who suered signicant health damage in the wake of regular and intense
exposure to tobacco smoke by neighbors who smoke. The case is against the author-
ities responsible (as opposed to individuals), namely, the Minister for the Environment,
the Minister of Health, and the Minister of Interior Security (Police), for enforcement of
existing laws which refer to air pollution. All three cases have received massive media
coverage. Conclusion Progress in protection of nonsmokers in their own homes, from
smoke penetration by neighbors’ smoking, represents a serious challenge. Recent liti-
gation in Israel suggests that courts have the power to promote the reduction and even
abolition of exposure of adults and children to secondhand smoke in their own homes,
however, serious challenges remain for further action by individuals and governments.
FUNDING: Unfunded; Academic Institution
POD15-4
THE FACILITATORS AND BARRIERS TO TOBACCO CONTROL
POLICIES AND THEIR IMPLEMENTATION IN FIVE LMIC’S- A
QUALITATIVE ANALYSIS
Mariam Ahmad Khokhar1, Anna-Marie Marshall1, Kamran Siddiqi1, Sarah Hill2, Shir-
ley Crankson3, Rashmi Mehra3, Ziauddin Islam4, Je Collins2, Helen Elsey1. 1University
of York, York, United Kingdom, 2University of Edinburgh, Edinburgh, United Kingdom,
3Brunel University, London, United Kingdom, 4National Tobacco Control Cell, Islam-
abad, Pakistan.
Signicance: With 1.2 billion tobacco users globally and >80% living in low- and mid-
dle-income countries (LMICs), concerted progress to implement WHO’s Framework
Convention on Tobacco Control (FCTC) is needed. In response, UKaid funded a £15m
programme ‘FCTC 2030’ to strengthen tobacco control mechanisms, policy and legisla-
tion, build capacity and enhance implementation of WHO FCTC in 15 LMICs.Objectives:
We undertook an independent evaluation of FCTC 2030 using multiple methods. Here
we report our qualitative ndings to highlight the facilitators and barriers to strengthen
and implement tobacco control policies in LMICs.Methods: We conducted case studies
in ve FCTC 2030 countries: Zambia, Sierra Leone, Colombia, Nepal, and Jordan using
individual interviews and document analyses. Interviewees were purposely sampled
(n=38) from civil society, government, academia, and country-level WHO FCTC focal
points (conducted Oct 2020 to Jan 2021). Document analysis veried accounts of
FCTC 2030 inputs and any advances in tobacco control.Findings: The case studies
highlighted the importance of country context, particularly the levels of tobacco indus-
try interference and operation (mainly tobacco growing), the strength of governance
structures and the extent of devolution, the role and inuence of civil society, norms of
tobacco use and strength of political will for tobacco control as key contextual inuences
in the progression towards implementation of FCTC. Given the importance of context,
FCTC 2030’s initial needs assessment and alignment of approaches to country context
were an important facilitator. The tobacco industry and lack of political will were noted
as signicant and interrelated barriers in all case study countries. In countries new to
tobacco control work, limited awareness of the dangers of tobacco was seen as a barrier,
and FCTC 2030’s support to education campaigns was found valuable.Conclusions:
The thrust of tobacco control activities was found as a return on investment of FCTC
2030. These activities were most eective where they were able to amplify existing
facilitators and counter barriers. Given the pervasiveness of industry interference, this
was frequently challenging.
FUNDING: Nonprot grant funding entity
POD15-5
AN EVALUATION OF FCTC 2030- A PROGRAMME TO
ACCELERATE THE IMPLEMENTATION OF THE WHO
FRAMEWORK CONVENTION FOR TOBACCO CONTROL IN LOW-
AND MIDDLE-INCOME COUNTRIES
Kamran Siddiqi1, Helen Elsey1, Mariam A. Khokhar1, Anna- Marie Marshall1, Subhash
Pokhrel2, Monika Arora3, Shirley Crankson2, Rashmi Mehra2, Paola Morello4, Je
Collins5, Georey T. Fong6. 1University of York, York, United Kingdom, 2Brunel Univer-
sity, London, United Kingdom, 3Public Health Foundation of India, Delhi, India, 4Minis-
try of Health, CABA, Argentina, 5University of Edinburgh, Edinburgh, United Kingdom,
6University of Waterloo, Waterloo, ON, Canada.
Signicance. Many low- and middle-income countries (LMICs) have not made sucient
progress in implementing policies of the WHO Framework Convention on Tobacco
Control (FCTC). The FCTC 2030 Programme, created by UKAid, was launched to
lay the foundation to accelerate FCTC implementation in 15 LMICs in its rst phase
(2017-2021). We evaluated the FCTC 2030 Programme in 6 domains: Governance;
Smoke Free Policies; Taxation; Packaging and Health Warnings; Tobacco Advertising,
Promotion and Sponsorship (TAPS) bans; and International and Regional Cooperation.
We also assessed if FCTC 2030 provided value for money. Methods. Our evaluation
framework was adapted in part from the evaluation framework of the FCTC Impact
Assessment Expert Group. We surveyed (Jun-Sept 2020) FCTC focal persons in 14
out of the 15 countries, which provided data on FCTC 2030 nancial and technical
inputs and on progress scores in each of the 6 domains. We computed the correlation
between the FCTC 2030 inputs and progress scores in each domain. We also conducted
a Payback Framework analysis to generate estimates of value for money.Results. FCTC
2030 oered substantial nancial and technical inputs across all six domains that were
responsive to the needs of the 15 countries. The achievements included establishing
national coordinating mechanisms, securing intersectoral support, policy amendments,
raising tobacco taxes increases, and eective policy implementation. There was a very
high and statistically signicant correlation between technical inputs and progress in 5
of the 6 domains, ranging from r=.61 for taxation to r=.91 for smoke-free policies. The
Payback Framework analysis found that FCTC 2030 did indeed provide signicant value
for money.Conclusions. In its rst phase (2017-21), the FCTC 2030 Programme—no-
tably the technical assistance provided—led to signicant progress in moving FCTC
implementation forward in the 15 LMICs. As expected, much of the progress was
in augmenting existing structures and resources for FCTC implementation. As the
Programme moves into its second phase, these advances are more likely to lead to
progress in FCTC policy implementation.
FUNDING: Nonprot grant funding entity
65
2022 Paper Sessions
POD15-6
UNREGULATED-FINDINGS FROM SMOKELESS TOBACCO
SUPPLY CHAIN RESEARCH IN PAKISTAN
Fayaz Ahmad1, Zohaib Khan1, Hajo Zeb2, Sarah Forberger2, Melanie Boeckmann3,
Muhammad Naseem Khan4, Steen Dreger2, Kamran Siddiqi5. 1Khyber Medical Univer-
sity, Peshawar, Pakistan, 2BIPS, Bremen, Germany, 3University of bielefeld, Bielefeld,
Germany, 4Health Services Academy, Islamabad, Pakistan, 5University of York, York,
United Kingdom.
Introduction An estimated 8% (18 million) people in Pakistan consumes smokeless
tobacco (ST) but despite this high prevalence, tobacco control eorts in the country have
placed little emphasis on curbing ST. Pakistan ratied the World Health Organization’s
Framework Convention on Tobacco Control (FCTC) in 2004 but has yet to align its
ST control with the relevant articles of the FCTC. The primary objective of our study
was to assess the compliance of naswar (a popular ST product in Pakistan) supply
chain actors and products with the national laws of Pakistan and to highlight the gap
between naswar sales practices and the relevant provisions of the FCTC, applicable to
Pakistan as a party. Methods We conducted a cross-sectional survey of 286 naswar
sellers and qualitative research with naswar wholesale vendors and tobacco farmers
in four districts of the Khyber Pakhtunkhwa province in Pakistan. The survey included
point-of-sale observations and vendor interviews to assess the compliance with national
laws. The qualitative methods focused on understanding why the dierent supply chain
actors engage in the business of manufacturing and selling naswar, their perceptions
of potential eects of FCTC guided ST control policies on their business and viable
alternatives. Results None of the naswar products carried written or graphical health
warning. A quarter of the respondents were aware of a ban on sale to minors, of whom
majority (75%) reported selling naswar to minors, with the practice being more common
in rural areas. Exclusive tobacco sellers were less likely to stop selling naswar compared
to general vendors, citing prot margins and huge demand of naswar as the reasons.
Land-suitability for tobacco cultivation, larger prots, and family traditions were the
main reasons for the farmers to grow tobacco. A lack of governmental support was
the main reason for the reluctance to switch to viable alternatives among the farmers.
Conclusion There is a lack of compliance with the applicable national tobacco control
laws, with indications of urban-rural disparities. Governmental support for viable alter-
natives may help naswar supply chain actors to switch to other businesses. Funding
The research was funded by the German Academic Exchange Service DAAD (project
numbers 57403010 and 57523644) and by ASTRA Global Health Research Group, which
is funded by the NIHR, using UK aid from the UK government to support global health
research (program reference 17/63/76/ Global Health Research Groups).
FUNDING: Academic Institution
POD15-7
A QUALITATIVE ANALYSIS OF SMOKING RESUMPTION AMONG
FORMER ENDS USERS
Lindsay Robertson1, Kealey-Rei Sanford2, Andrew Waa2, Janet Hoek3. 1University of
Otago, Dunedin, New Zealand, 2University of Otago, Wellington, New Zealand, 3Depart-
ment of Public Health, University of Otago, Dunedin, New Zealand.
SIGNIFICANCE: If electronic delivery systems (ENDS) are to oer population health
benets, people who smoke must switch to exclusive ENDS use. Yet although studies
suggest some ENDS users return to smoking, few have probed lived experiences of this
process, particularly among people who have had a sustained period of exclusive ENDS
use. METHODS: We conducted in-depth, semi-structured interviews with 20 people
who had smoked at least 100 cigarettes in their lifetime, reported using ENDS to stop
smoking cigarettes for at least 30 days (ideally, within the preceding six months), and
were currently smoking tobacco at least weekly. We explored participants’ experiences
of ENDS use, probed critical return-to-smoking settings and triggers, and analysed
strategies that could promote sustained smoking abstinence. We managed data using
NVivo12 and used reexive thematic analysis to interpret the transcripts. RESULTS:
We identied two linked themes that explained participants’ experiences: functionality
and authenticity, and freedom and self-regulation. While ENDS replicated some aspects
of smoking, ENDS use did not oer authentic social and aective experiences, par-
ticularly in common return-to-smoking situations, such as social settings where others
smoked and times of stress. While participants welcomed the freedom ENDS oered
from smoking restrictions, ENDS’ lack of denition required greater self-regulation and
came with the risk of increased dependence. Remaining smokefree felt precarious,
challenging, and was ultimately unable to be sustained. CONCLUSIONS: Participants
reported returning to smoking because ENDS use required eort and did not replicate
the most valued elements of smoking. Although surveys show people who smoke do
move successfully to exclusive ENDS use, those unable to make this transition require
support. Measures that reduce the burden of self-management could foster substitution
of ENDS for smoking. For example, limiting nicotine concentrations would reduce the risk
of increased dependence while replicating smoking rituals, such as using ENDS outdoors
only for limited breaks, could reduce the risk continuous usage practices will evolve.
FUNDING: Federal
66
Notes
67
Notes
68
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
POSTER SESSION 1
PS1-1
EMOTIONAL REGULATION, IMPULSIVITY, 5-HTTLPR AND
TOBACCO USE BEHAVIOR AMONG PYSCHIATRIC INPATIENTS
Anna V. Wilkinson1, Alan C. Swann2, David P. Graham3, Michele A. Patriquin2, David A.
Nielsen2, Thomas R. Kosten2. 1UTHealth School of Public Health in Austin, Austin, TX,
USA, 2Baylor College of Medicine, Houston, TX, USA, 3DeBakay VA Medical Center,
Houston, TX, USA.
The long promoter repeat of the serotonin transporter (SLC6A4) gene, 5-HTTLPR, is
associated with smoking and sensitivity to social context. E.g., among adolescents in
the general population, 5-HTTLPR moderates the association between experiencing
negative life events and smoking behavior. Less is known about interactions between
other tobacco use risk factors and 5-HTTLPR or about the role of 5-HTTLPR and to-
bacco use in psychiatric populations who have the highest rates of smoking. Therefore,
we examined interactions between 5-HTTLPR and emotional regulation in psychiatric
inpatients. Participants (506 adults) were psychiatric inpatients between 2012-16, in
Houston TX. Most were white (89%), male (55%), with a mean age of 32.3 years. Par-
ticipants completed the Diculties in Emotional Regulation Scale (DERS) at admission.
We examined interactions between DERS subscales (impulse control, lack of emotional
clarity, and emotional regulation strategies) and 5-HTTLPR, controlling for gender, race
and age. Signicant interactions were observed. The three DERS subscales and demo-
graphic covariates were simultaneously entered into a logistic regression, stratied by
5-HTTPLR genotype (L'L' vs. S'S' or S'L'). Overall, 40% reported ever using tobacco;
smoking rates were higher among those with the 5-HTPLR L'L' genotype compared to
peers carrying an S' allele (47.9% vs. 37.4%, respectively). Among participants with at
least one S' allele, males had twice the odds of tobacco use than females (OR=2.03;
95% CI: 1.28-3.22). Age was inversely related to ever tobacco use; older people were
at decreased risk (OR=0.97; 95% CI: 0.95-0.98). Impulse control diculties (OR=1.09;
95% CI: 1.03-1.14) and lack of emotion clarity (OR=1.06; 95% CI: 1.00-1.11) increased
risk for tobacco use, while accessing more ways to regulate emotion (OR=0.95; 95%
CI: 0.92-0.99) oered a protective eect against tobacco use. Neither the demographic
nor DERS covariates were associated with tobacco use among the L'L' group. Our
results reveal that poor emotional regulation exerts a stronger inuence on tobacco use
among participants carrying an S' allele of 5-HTTLPR than peers with the L'L' genotype.
FUNDING: Nonprot grant funding entity
PS1-2
PAIN SEVERITY, CIGARETTE DEPENDENCE, AND WITHDRAWAL-
RELATED COGNITIONS - INDIRECT ASSOCIATIONS VIA
DEPRESSIVE SYMPTOMS
Kyle M. White1, Lisa R. LaRowe2, Jessica M. Powers1, Julia E. Hooker1, Emma C.
Lape1, Michael B. Paladino1, Joseph W. Ditre1. 1Syracuse University, Syracuse, NY,
USA, 2Brown University, Providence, RI, USA.
An established reciprocal model posits that pain and smoking interact in the manner of
a positive feedback loop, leading to worse pain and sustained tobacco dependence.
Depression has been shown to mediate associations between pain severity and cur-
rent smoking, and smokers with depressive symptoms/disorders tend to report greater
cigarette dependence, more severe withdrawal, and greater diculty abstaining. The
goal of the current analyses was to test the hypothesis that past four-week pain severity
would be positively and indirectly associated with cigarette dependence and withdraw-
al-related cognitions via depressive symptoms. Participants included 226 daily tobacco
smokers (MCPD = 22) who participated in a laboratory study of nicotine deprivation and
pain reactivity (42.9% female; Mage = 41.4; 38.1% Black/African-American). Measures
included past four-week pain severity (rated 0-5), depressive symptoms (CES-D total
score), cigarette dependence (FTCD), intolerance of withdrawal symptoms (IDQ-S
Withdrawal Intolerance), and withdrawal expectancies (SAQ Withdrawal). Indirect
associations were examined using the PROCESS macro, employing 10,000 bootstrap
re-samplings. Separate conditional process models indicated that pain severity was
positively and indirectly associated with cigarette dependence scores, perceived intoler-
ance of withdrawal symptoms, and expectancies for more severe withdrawal, via greater
depressive symptoms (ps < .05). Although the current ndings are consistent with a
growing literature implicating depression as a mechanism in bidirectional pain-smoking
relations, it is important to note that these data are cross-sectional and thus preclude
causal interpretation. Future longitudinal research (e.g., using ecological momentary
assessment) will be needed to clarify the temporal precedence of pain, depression, and
smoking-related experiences/cognitions, and to examine the interplay of these factors
in the context of cessation.
FUNDING: Federal
PS1-3
SIMULTANEOUS QUANTITATION OF DELTA9-
TETRAHYDROCANNABINOL, CANNABIDIOL AND THEIR
METABOLITES IN HUMAN PLASMA COUPLED TO A HIGHLY
SENSITIVE METHOD FOR QUANTITATION OF TRACE AMOUNT
OF DELTA9-TETRAHYDROCANNABINOL
Guillaume Georges Marie Malik, Alan Dzerk, Kirk Newland, Timothy Sangster. Cele-
rion, Lincoln, NE, USA.
The rise of cannabis legalization in several countries increased the development of
new therapeutics to treat conditions such as epilepsy, anxiety disorders or chronic
pain. It is then of high importance to develop reliable methods for the quantitation of
cannabidiol (CBD), Delta9-tetrahydrocannabinol (Delta9-THC) and their phase 1 metab-
olites. Simultaneous quantitation of Delta9-THC, CBD, 11-hydroxy-Delta9-THC (11-OH-
Delta9-THC), 7-hydroxy-cannabidiol (7-OH-CBD) and 11-nor-9-carboxy-Delta9-THC
(11-COOH-Delta9-THC) from human plasma extract was initiated and is still ongoing.
Additionally, a derivatization step allowed for the very low detection of Delta9-THC from
plasma extract (down to 5 to 10 pg/mL). Results from these two methods will be shown
and discussed in this presentation.
FUNDING: Other
PS1-4
THE ASSESSMENT OF NICOTINE DEPENDENCE AMONG USERS
OF ELECTRONIC NICOTINE DELIVERY SYSTEMS
Alina Shevorykin1, Ellen Carl1, Bridget M. Hyland1, Brian McDonough1, Lindsey
Bensch1, Amylynn Liskiewicz1, Andrew Szeliga1, Darian Vantucci1, Edwin Ruiz Serrano1,
Maciej L. Goniewicz1, Andrew Hyland1, Christine Sheer2. 1Roswell Park Comprehen-
sive Cancer Center, Bualo, NY, USA, 2Roswell Park Cancer Insittute, Bualo, NY, USA.
An increasing number of electronic nicotine delivery systems (ENDS) users are seeking
to quit ENDS. A well-validated clinical instrument for assessing nicotine dependence
among ENDS users is needed. This study examined the principal components that
comprise 2 candidate instruments and their concurrent criterion validity with cotinine
level, a biochemical measure of nicotine intake. ENDS users who contacted the New
York State Smokers’ Quitline (NYSSQL) seeking to quit ENDS were administered the
8-item ENDS Nicotine Dependence Scale (ENDS-NDS) and the 10-item Penn State
E-Cigarette Dependence Index (PSE). Saliva samples were collected and analyzed
using liquid chromatography. Principal component analysis (PCA) was conducted on both
measures. Concurrent criterion validity with cotinine levels for the instruments and their
principal components was calculated using Pearson correlation coecients. Participants
(n=209) were 52% male and 70% white, with a mean age of 37 yrs (SD 15). All were
current or former cigarette smokers, smoking a mean of 16 cpd (SD 8) at baseline,
seeking to quit smoking ENDS. Each instrument was composed of 4 components with
eigenvalues >1.00. Mean cotinine level was 266 ng/ml (SD 173). The ENDS-NDS total
score was signicantly correlated with cotinine level (r=.22, p<.01), but the PSE total
score was not (r=.12, p=.09). Component analysis revealed that the rst component of
the ENDS-NDS and the third component of the PSE were signicantly correlated with
cotinine levels: END-NDS r=.144, p=.038, How soon after you wake up do you vape?;
How often do you vape?; How many pods, cartridges, or rells do you typically use each
week?; Do you nd it dicult to refrain from vaping in places where it is forbidden? PSE
r=.228, p=.001, Do you use an electronic cigarette now because it is really hard to quit?
On the days that you can use your electronic cigarette freely, how soon after you wake
up do you use your electronic cigarette? While the END-NDS shows signicant criterion
validity, validity might be improved by incorporating items from the third component of
the PSE and employing methods to reduce item redundancy.
FUNDING: Unfunded
69
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-5
BLACK/AFRICAN AMERICAN SMOKERS WHO ARE FAST
NICOTINE METABOLIZERS EXHIBIT WORSE LUNG FUNCTION
AND SYMPTOMOLOGY
Freda Patterson1, Aditi Satti2, Rachel Blair2, Daniel Barlow1, Elissa Hoopes1, Shannon
Mayberry2. 1University of Delaware, Newark, DE, USA, 2Temple University, Philadel-
phia, PA, USA.
Signicance: Racial dierences in the genetically informed biomarker of nicotine metab-
olism/clearance are known: BAA smokers generally have a lower nicotine metabolism
rate (NMR), and faster BAA metabolizers are less likely to compensate by smoking more
than Whites. Chronic Obstructive Pulmonary Disease (COPD) is a leading smoking-re-
lated disease where BAA smokers experience earlier diagnosis, and faster disease
progression than Whites. It is plausible that NMR may account for some variation in
the COPD trajectory. To begin to address this question, we examined the variability in
NMR within a single-race sample of BAA smokers, and, the independent association
between NMR with COPD status and symptomatology. Methods: Cross-sectional data
from 263 BAA current smokers, without sleep disordered breathing, and prodromal/
early-stage COPD (GOLD stage 0-2) were analyzed. Clinical assessments of Forced
Expired Ventilation in one second (FEV1; L), the ratio of FEV1 to Forced Vital Capacity
(FEV1/FVC; %) and self-reported dyspnea [score range 0-4 (most severe)] were the
study outcomes. The independent variable of NMR (i.e., ratio of 3’-hydroxycotinine
(3HC):cotinine) was analyzed in quartiles (Q1= slowest metabolizers). Covariates
included age, sex, measured body mass index (kg/m2), and nicotine dependence
(FTND). Separate multivariable linear regression models for each study outcome were
generated. Results: The sample were 59% female, mean age was 55.00y (SD=6.10),
and mean FTND was 3.62 (SD=2.15). Considerable variability in NMR was seen between
slow (Q1: mean=0.22; range=0.09-0.30) and fast (Q4: mean=1.15, range=0.69-3.62)
metabolizers. In fully adjusted models, BAA smokers who were fast metabolizers (Q4)
reported a 8.35L lower FEV1 (SE=4.18, p<.05), a 6% lower FEV1/FVC (SE=2.0%,
p<.05), and a self-reported 0.43 (SE=0.23, p<.05) higher (worse) dyspnea rating than
slow metabolizers (Q1). Conclusions: Considerable heterogeneity in NMR within this
sample of BAA smokers was observed. NMR may be a biomarker for COPD risk in BAA
smokers since fast nicotine metabolizers had worse lung function and symptomology
than slow metabolizers.
FUNDING: Federal
PS1-6
MOTIVATING SMOKING CESSATION AND RELAPSE PREVENTION
AMONG LUNG CANCER PATIENTS QUALITATIVE INTERVIEW
FINDINGS
Melissa R. Conn1, Jennifer I. Vidrine1, Cody Staples2, Ursula Martinez1, Sarah R.
Jones1, Kristina E. Bowles1, Vani N. Simmons1. 1Mott Cancer Center, Tampa, FL,
USA, 2University of South Florida, Tampa, FL, USA.
Background: Continued smoking following a lung cancer diagnosis has detrimental
eects on treatment outcomes and quality of life. We conducted qualitative in-depth
interviews to inform a smoking cessation intervention and relapse prevention program
for lung cancer patients regardless of their motivation to quit. We report on ndings
from in-depth interviews with lung cancer patients to guide the adaptation of an em-
pirically-based Motivation and Problem-Solving (MAPS) approach, a holistic behavior
change framework which incorporates aspects of social cognitive theory, motivational
interviewing, and wellness program development (Hoover et al., 2019; Vidrine et al.,
2013).Methods: In-depth interviews were conducted with seven lung cancer patients
who reported current smoking. Interviews were conducted via the phone and were au-
dio-recorded. Topics included: cessation motivation, attribution of diagnosis to smoking,
perspectives on how to maximize the impact of the intervention for lung cancer patients,
and components to be included in a wellness program. Interviews were transcribed
and multiple reviewers identied emerging topics and themes. Results: Most patients
were motivated to quit and had attempted cessation post- diagnosis, but subsequently
relapsed. Most patients did not attribute their diagnosis to smoking cigarettes as a primary
cause. Reported challenges for quitting smoking included exacerbation of cancer-related
stressors and overcoming the addiction. Suggestions regarding tailored treatment for
lung cancer patients included: highlighting the eects of continued smoking on cancer
prognosis and treatment, information on pharmacotherapy that is compatible with can-
cer treatment, managing smoking triggers, positive reinforcement, and social support.
Most participants noted a desire to have other smokers with lung cancer involved in the
cessation program. Suggested wellness areas included behavioral and cognitive coping
skills, stress management, nances, diet, and physical activity. Conclusions: Findings
elucidate the distinctive needs and concerns lung cancer patients have regarding
smoking cessation. These results will help to adapt the MAPS intervention for patients
with lung cancer before testing it in a randomized controlled trial.
FUNDING: Academic Institution
PS1-7
IT BLOCKS WHEN YOU CAN’T STOP, A PILOT STUDY OF
NICOBLOC AS A NOVEL SMOKING CESSATION DEVICE
Keith Chichester1, Michelle L. Sisson1, Soa Mildrum Chana1, Caitlin Wolford-Clev-
enger1, Mickeah J. Hugley1, Paige Palenski1, Karen Cropsey2. 1UAB, Birmingham, AL,
USA, 2University of AL at Birmingham, Birmingham, AL, USA.
Introduction: NicoBloc® is a novel non-pharmacological smoking cessation product
made with natural, FDA-approved food-grade ingredients (e.g., corn syrup and citric
acid). It acts as a ltration device in the form of a viscous uid that is placed on the end
of a conventional cigarette. Each drop of the uid-based solution blocks 33% of tar and
nicotine when the cigarette is smoked. In this manner, up to 99% of tar and nicotine can
be blocked without smokers having to alter their smoking habits. Methods: In an initial
pilot study, we examined the feasibility, acceptability, and initial treatment outcomes of
NicoBloc® compared to nicotine replacement therapy (nicotine lozenge) in a smoking
cessation intervention. Participants were a community sample of predominately Black
(66.7%) men (71.1%) with a mean age of 49.7 years (SD=10.7) from the Birmingham
Metro area. Both groups engaged in four weeks of smoking cessation therapy followed
by two months of independent usage with check-ins at 8 and 12 weeks to assess
medication adherence. Results: Overall, NicoBloc® was found to be comparable to
nicotine lozenge in feasibility, symptom side eects, and acceptability at one month
follow-up. Further, adherence to NicoBloc® was superior throughout the study. Con-
clusion: NicoBloc® presents a unique, non-pharmacological avenue for intervention
that may be most eective in subpopulations where pharmacological approaches are
restricted or in combination with established pharmacological methods such as nicotine
replacement therapies.
FUNDING: Academic Institution
PS1-8
INTEREST IN ELECTRONIC CIGARETTES FOR SMOKING
CESSATION AMONG ADULTS WITH OUD IN BUPRENORPHINE
TREATMENT: A MIXED-METHODS INVESTIGATION
Joanna M. Streck1, Susan Regan2, Jordan Neil3, Sara Kalkhoran4, Priya Gupta1, Benja-
min Bearnot1, Kelly Kalagher1, Elyse Park2, Sarah Wakeman1, Nancy Rigotti5. 1Massa-
chusetts General Hospital/Harvard Medical School, Boston, MA, USA, 2MA General
Hospital, Boston, MA, USA, 3University of Oklahoma Health Sciences Center, Okla-
homa City, OK, USA, 4MA General Hospital/Harvard Medical School, Boston, MA, USA,
5Harvard Medical School, Boston, MA, USA.
Signicance: Individuals in treatment for opioid use disorder (OUD) have high smoking
rates and limited success with FDA-approved cessation aids, suggesting a need for
novel approaches. Electronic cigarettes (e-cigarettes) might benet this population, but
e-cigarettes’ acceptability and ecacy for tobacco reduction or cessation among smokers
in OUD treatment is not known.Methods: Cross-sectional mixed-methods study of 222
adults in OUD treatment with buprenorphine in the Boston, MA metropolitan area in
2020. We used quantitative and qualitative data to investigate individuals’ experience
with and interest in e-cigarettes and other methods for smoking cessation and assessed
factors associated with interest in e-cigarette use. Results: 160/222 (72%) participants
were past 30-day cigarette smokers. They most frequently reported having ever used
nicotine-replacement therapy (NRT; 83%) and e-cigarettes (71%) for smoking cessation
and most often indicated interest in using NRT (71%) and e-cigarettes (44%) for future
smoking cessation. In multiple logistic regression, interest in using e-cigarettes for future
smoking cessation was independently associated with having ever used e-cigarettes
for smoking cessation, current e-cigarette use, and perceiving e-cigarettes to be less
harmful than cigarettes (p’s<0.05). In qualitative data, many current vapers/former
smokers reported that e-cigarettes had been helpful for quitting cigarettes. For current
smokers who currently or formerly vaped, commonly reported challenges in switching to
e-cigarettes were concerns about replacing one addiction with another and e-cigarettes
not adequately substituting for cigarettes. Conclusions: Use of e-cigarettes as smoking
cessation aids was acceptable to current smokers in buprenorphine treatment for OUD.
The ecacy of this approach warrants investigation.
FUNDING: Federal; Academic Institution
70
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-9
IMPROVING ASSESSMENT OF TREATMENT OUTCOME
EXPECTANCIES IN SMOKING CESSATION TRIALS - A
PSYCHOMETRIC EVALUATION OF THE STANFORD
EXPECTATIONS OF TREATMENT SCALE (SETS)
Adam C. Ferkin1, Eugene Maguin1, Sarah S. Tonkin1, Jennifer M. Wray2, Craig R.
Colder1, Stephen T. Tiany1, Martin C. Mahoney3, Larry W. Hawk, Jr.1. 1Department of
Psychology, SUNY Bualo, Bualo, NY, USA, 2Department of Psychiatry and Behavioral
Sciences, Medical University of South Carolina & Mental Health Service Line, Ralph H.
Johnson VA Medical Center, Charleston, SC, USA, 3Departments of Internal Medicine
and Health Behavior, Roswell Park Cancer Institute, Bualo, NY, USA.
SIGNIFICANCE: Patients’ beliefs about the positive and negative eects of a treatment
(i.e., treatment outcome expectancies; TOEs) can inuence adherence, side eects,
and clinical outcomes. However, TOEs are rarely assessed in the smoking cessation
literature, in part because of the lack of validated measures. Therefore, we conducted a
psychometric evaluation of a promising TOEs measure from the pain literature (Stanford
Expectations of Treatment Scale [SETS]) in the context of a smoking cessation trial.
METHODS: Participants were 243 adults enrolled in a randomized controlled trial of
extended (4-week) vs. standard (1-week) pre-quit varenicline treatment for smoking
cessation; all participants received behavioral counseling and 11 weeks of post-quit va-
renicline (clinicaltrials.gov ID: NCT03262662). We examined the factor structure, internal
consistency, and mean-level change of the SETS (assessed via ecological momentary
assessment; EMA) across the rst 3 weeks of treatment. To assess divergent validity,
correlations with abstinence self-ecacy (assessed via EMA) and positive/negative
aect (assessed at in-person visits) were examined. RESULTS: Conrmatory factor
analyses supported a 2-factor structure across weeks. Positive and negative TOEs
were each reected in 3-item subscales that exhibited acceptable internal consistency
(Cronbach’s alphas greater than or equal to .73). Evidence for divergent validity was
generally strong, with positive and negative TOEs being modestly correlated with positive
and negative aect (all |rs| less than .24). Positive TOEs were moderately to strongly
correlated with abstinence self-ecacy (rs = .45 to .63 across weeks). Positive TOEs
declined modestly from Week 2 to Week 3 (mean dierence = .244, p = .02); negative
TOEs did not signicantly change across the rst 3 weeks of treatment (linear F = .14,
p = .708; quadratic F = 3.06, p = .082). CONCLUSION: The SETS oered a valid and
reliable, brief assessment of TOEs in the current sample of adults enrolled in a smoking
cessation trial. Thus, for future work examining the roles of patient beliefs in treatment
adherence, side eects, and/or long-term smoking abstinence, the SETS appears to
be an appropriate option.
FUNDING: Federal; Pharmaceutical Industry
PS1-10
BASELINE ASSESSMENT OF FACILITATORS AND BARRIERS TO
IMPLEMENTATION OF TOBACCO CESSATION SERVICES FOR A
DIVERSE CANCER PATIENT POPULATION
Matt Kirkpatrick1, Jennifer Tsui1, Neil Bahroos1, Anthony W. Kim2, Jorge Nieva2, Raina
Pang3, Steve Sussman4, Adam Leventhal3, Caryn Lerman5. 1University of Southern
CA, Department of Population and Public Health Sciences, Los Angeles, CA, USA,
2University of Southern CA, Keck School of Medicine, Los Angeles, CA, USA, 3Univer-
sity of Southern CA, Los Angeles, CA, USA, 4University of Southern California, Los
Angeles, CA, USA, 5University of Southern CA, Norris Comprehensive Cancer Center,
Los Angeles, CA, USA.
Signicance: Tobacco use by cancer patients is causally linked to increased mortality
and poorer treatment outcomes, yet a relatively large proportion (47-60%) of tobac-
co-using cancer patients continue to use. We recently joined the NCI Cancer Center
Cessation Initiative (C3I) to build capacity and infrastructure for tobacco cessation
treatment for a diverse patient and survivor population in the greater Los Angeles
region. Methods: We rst assessed the quality of patient tobacco use screening data
documented in the electronic medical records (EMR) within a large comprehensive
cancer center in Los Angeles from Jan-Jun 2019 (N=26,030; ethnicity: 20% Hispanic/
Latino; race: 14% Asian, 4% Black, 49% White, 33% Other). Then we interviewed a
sample of health providers (i.e., physicians, nurses, medical assistants, clinic managers)
in an ambulatory care clinic to understand the contextual system-level facilitators and
barriers to systematic tobacco use screening and implementation of cessation services.
Qualitative interviews were guided by the Consolidated Framework for Implementation
Research. Results: EMR data revealed that approximately 47% of patients had missing
tobacco use information, and levels of missingness varied by race (e.g., greater missing
data in Asian Americans), gender (i.e., greater missing data in women), and insurance
status (e.g., greater missing data in uninsured). While all providers reported that tobacco
use screening for all patients was important (inner setting), stakeholders diered in
descriptions of who was responsible for screening (characteristics of individuals), how
often the screening should occur (intervention), and the priority level (characteristics
of individuals). Several barriers were noted, including limited time with each patient
(inner setting), lack of training on smoking cessation principles (inner setting), language/
cultural barriers for some patient subgroups (e.g., Chinese and Armenian) (outer
setting), and insurance coverage for cessation services (outer setting). Conclusion:
While stakeholders indicated high interest in assessment of tobacco use and providing
tobacco cessation services, EMR data missingness analysis and qualitative interviews
revealed that here was limited systematic screening for tobacco use. Implementing a
system-level sustainable tobacco cessation program will require leadership support for
change, clinic sta training on brief, low-burden screening, as well as intervention and
referral strategies that meet the needs of diverse patients.
FUNDING: Federal
PS1-11
METHODOLOGICAL CONSIDERATIONS ASSOCIATED WITH
THE DISTRIBUTION OF STUDY E-CIGARETTES IN A REMOTE
RANDOMIZED CONTROLLED TRIAL
Shaun M. Meyers, Catherine Peasley-Miklus, Elias M. Klemperer. University of
Vermont, Burlington, VT, USA.
Introduction: The COVID-19 pandemic has resulted in the need to convert in-person
randomized controlled trials (RCT) to remote procedures. In e-cigarette trials, the
distribution of study product is a major barrier to adopting remote procedures. In this
poster we describe the development of remote procedures for an RCT of e-cigarettes
and the resulting changes in recruitment. Methods: Our recent transition from in-per-
son to remote procedures for an ongoing pilot RCT required distributing e-cigarettes
by United States Postal Service (USPS). Given the 2021 Consolidated Appropriations
Act, mailing e-cigarettes is subject to the same restrictions as combustible tobacco.
Thus, mailing e-cigarettes required approval from 1) our State’s Attorney General, 2)
Department of Taxes, and 3) the USPS, in addition to 4) our Institutional Review Board
(IRB). Results: Mailing e-cigarettes in small amounts in the absence of monetary
exchange was determined to be acceptable for research purposes. We transitioned
to remote procedures and began mailing e-cigarettes to consented participants on
June 3, 2021. All e-cigarettes are mailed with USPS overnight shipping and tracked to
monitor delivery. To date, e-cigarettes have been shipped to 16 participants. Most (15)
shipments arrived within 24 hours and 1 shipment arrived within 48 hours. The transition
to remote procedures resulted in continuation of the trial without participant contact.
Additionally, remote procedures allowed for national online recruitment, which resulted
in over 1,100 completed screens per month. Conclusions: This study demonstrates
that mailing e-cigarettes to transition to remote procedures is feasible and an eective
way to comply with social distancing requirements. Such remote procedures allow for
compliance with COVID-19 restrictions and increased capacity to recruit participants
using an online advertising campaign.
FUNDING: Federal
PS1-12
EFFECTS OF A NOVEL NICOTINE REPLACEMENT THERAPY
SAMPLING INTERVENTION ON SMOKING CESSATION-RELATED
PROCESSES
Michelle L. Sisson1, Caitlin Wolford-Clevenger1, Jamie Gajos2, Keith Chichester1,
Samantha Hill1, Richard Shelton1, Peter Hendricks1, Michael Businelle3, Matthew
Carpenter4, Karen Cropsey1. 1The University of Alabama at Birmingham, Birmingham,
AL, USA, 2The University of Alabama, Tuscaloosa, AL, USA, 3University of Oklahoma
Health Sciences Center, Oklahoma City, OK, USA, 4Medical University of South Caro-
lina, Charleston, SC, USA.
Background: Although tobacco use prevalence has substantially reduced in the general
population over the past ve decades, smoking prevalence remains elevated among
individuals with low income. Despite this higher smoking prevalence, there have been
limited smoking cessation interventions tested with low-income smokers. Interventions
that promote cessation-related processes (e.g., motivation, abstinence self-ecacy,
desire to quit) and favorable attitudes toward nicotine replacement therapy (NRT) are
needed for this vulnerable population. Methods: This is a secondary analysis of a pilot
clinical trial that compared a novel, in session NRT sampling intervention (In Vivo) and
standard care (SC) smoking cessation behavioral counseling with low-income smokers
(n = 83). To assess the impact of in-person NRT use, changes in withdrawal symptoms
and cravings observed within-session were examined using paired t-tests. Dierences
in cessation-related variables by treatment group across time (from baseline to end of
71
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
treatment) were examined with generalized estimating equations (GEE) using a time X
group interaction while controlling for any demographic correlates identied. Results:
The In Vivo treatment had an early, positive impact on withdrawal symptoms, cravings,
and perceived advantages to NRT, with moderate to large eect sizes. These changes
tended to fade after Weeks 4 and 5 (when in-session sampling ended). Results also
showed the treatment had its intended eects on reducing withdrawal symptoms and
cravings in-session, with small to medium and medium to large eect sizes, respectively.
In-session reduction of withdrawal symptoms and cravings did not occur for the SC
group, with the exception of decreased withdrawal symptoms occurring during Week 4.
The In Vivo treatment did not inuence quit goal, desire to quit, abstinence self-ecacy,
perceived diculty in quitting, motivational engagement, or perceived disadvantages to
NRT. Conclusions: There is preliminary support for this NRT sampling intervention over
SC behavioral counseling in reducing withdrawal and craving, as well as for promoting
perceived advantages of NRT among low-income smokers.
FUNDING: Federal
PS1-13
EMOTION DYSREGULATION AND VAPING EXPECTANCIES
AMONG COLLEGE STUDENT E-CIGARETTE USERS
Alison C. McLeish, Joy L. Hart, Lindsey A. Wood, Kandi L. Walker. University of Louis-
ville, Louisville, KY, USA.
Signicance: As nicotine is often used to regulate aect, interest in understanding
the role of aective vulnerability factors in e-cigarette use has grown. Emerging work
examining emotion regulation diculties has found that greater emotion dysregulation
is associated with greater e-cigarette dependence and perceived barriers to cessation.
However, research has yet to examine associations between emotion dysregulation
and motivations for e-cigarette use. Therefore, the current study sought to examine
the unique predictive ability of specic emotion regulation diculties in terms of vaping
outcome expectancies. Methods: Participants were 184 college students who endorsed
past 30-day e-cigarette use (Mage = 19.97, SD = 1.98; 71.7% female; 85.9% White). On
average, participants’ e-cigarette dependence score was 9.43 (SD = 5.12), and 43.5% of
the sample were daily users. Results: After controlling for the eects of gender, race, and
e-cigarette dependency, emotion dysregulation signicantly predicted greater positive
reinforcement (16.7% variance), negative reinforcement (14.3% variance), and appetite/
weight control (8% variance) outcome expectancies, but not negative consequences.
Specically, greater diculties engaging in goal-directed behavior (t = 3.09, p = .003)
and controlling impulses (t = 2.11, p = .037) and fewer diculties using eective regu-
lation strategies when upset (t = -3.13, p = .002) were signicant predictors for positive
reinforcement, and emotional clarity signicantly predicted appetite/weight control (t =
2.78, p = .006). There were no signicant individual predictors for negative reinforcement,
but impulse control approached signicance (t = 1.98, p = .05). Conclusion: Several
domains of emotion regulation diculty are associated with the expectation that vaping
will help with appetite and weight control, increase positive aect, and reduce negative
aect. Targeting these diculties may improve cessation interventions.
FUNDING: Unfunded; Nonprot grant funding entity
PS1-14
A SIBLING COMPARISON STUDY OF PRENATAL SMOKE
EXPOSURE AND GLOBAL CHILD EXECUTIVE FUNCTION
Lauren Micalizzi1, Emily Rolan2, Kristine Marceau3, Valerie S. Knopik3. 1Brown Univer-
sity, Providence, RI, USA, 2Michigan State University, East Lansing, MI, USA, 3Purdue
University, West Lafayette, IN, USA.
SIGNIFICANCE: Maternal smoking during pregnancy (SDP) has been linked to lower
ospring executive function, but SDP does not occur independent of familial risk factors.
The sibling-comparison design enables a rigorous test of the association between SDP
and global child executive function while partially controlling for genetic and environ-
mental variables that siblings share. METHODS: 344 children (Child 1 [older sibling]
Mage=12.99; Child 2 [younger sibling] Mage=10.19) from 173 families were recruited
based on birth record report that mothers changed their smoking behavior between two
pregnancies. Mothers retrospectively reported on prenatal smoking and child-specic
severity scores for SDP (based on the quantity of SDP and SDP by trimester) were
derived. Mothers and children completed behavioral assessments of three executive
functions: set-shifting, inhibitory control, and auditory working memory. Factor analysis
was used to extract global executive function factor scores for children and mothers. The
sibling comparison approach involved a series of hierarchical linear models to account
for non-independence of data, as well as to assess the within- (potentially causal)
and between-family associations between SDP and global child executive function,
controlling for mother executive function, child IQ, and other demographic factors. RE-
SULTS: Factor analysis of global child executive function indicated one factor (RMSR =
0.00; item loadings: 0.57, 0.51, and 0.51 for set-shifting, inhibition and auditory working
memory, respectively). One factor was also indicated for mothers’ executive function
(RMSR = 0.00; item loadings: 0.68, 0.59 0.65, for set-shifting, inhibitory control, and
auditory working memory, respectively). Results from the hierarchical models suggested
a within-family association between SDP and global child executive functioning that
was robust to control for covariates. CONCLUION: SDP is associated with lower global
child executive function. Future research should identify and target factors motivating
smoking behavior change across pregnancies to reduce poorer executive function
among SDP-exposed children.
FUNDING: Federal
PS1-15
INTERNALIZING SYMPTOMS AND AFFECTIVE VULNERABILITY
IN E-CIGARETTE USERS AND NON-USERS
Alison C. McLeish, Joy L. Hart, Lindsey A. Wood, Kandi L. Walker. University of Louis-
ville, Louisville, KY, USA.
Signicance: Similar to ndings for combustible cigarette use, there are signicant
associations between e-cigarette use and psychopathology, particularly internalizing
problems (Prochaska et al., 2017; Versella et al., 2019). As a result, there has been
growing interest in understanding the role of transdiagnostic aective vulnerability factors
in e-cigarette use. This growing body of research indicates that daily e-cigarette users
report higher anxiety sensitivity than non-daily users, and dual combustible and e-ciga-
rette users report higher anxiety sensitivity and greater emotion regulation diculties than
exclusive e-cigarette users (Mayorga et al., 2019; McLeish et al., 2021). However, there
has yet to be a comparison with non-users. This information would inform theoretical
models of nicotine use and emotional vulnerability as well as allow for a more targeted
approach to intervention eorts. Therefore, the current study sought to examine dier-
ences between exclusive e-cigarette users and non-users in depression, anxiety, anxiety
sensitivity, distress tolerance, and emotion regulation diculties. Methods: Participants
included 435 undergraduates (Mage = 20.21, SD = 3.81; 72.2% female; 67.1% White)
who were divided into two groups based on e-cigarette use history: Never Users (n =
306) and Current Users (n = 129). Results: After controlling for group dierences in
race and age, results of the multivariate analyses of covariance indicated that there were
signicant group dierences in internalizing symptoms [F (2, 372) = 6.63, p = .001, ηp
2
= .034] and aective vulnerability [F (3, 336) = 5.38, p < .001, ηp
2 = .046]. Specically,
compared to non-users, current e-cigarette users reported signicantly higher depression
(M = 8.22 vs. M = 6.57) and anxiety symptoms (M = 6.71 vs. M = 4.57), greater anxiety
sensitivity (M = 41.0 vs. M = 36.9) and diculties with emotion regulation (M = 43.8 vs.
M = 36.0), and lower distress tolerance (M = 3.00 vs. M = 3.25). Conclusions: These
results suggest that e-cigarette users experience greater internalizing symptomatology
and aective vulnerability, which could motivate continued e-cigarette use and should
be targeted in cessation eorts.
FUNDING: Unfunded; Nonprot grant funding entity
PS1-16
RTMS DOSING FOR SMOKING CESSATION: PRE-COVID
PRELIMINARY RESULTS
Ellen Carl1, Alina Shevorykin1, Amylynn Liskiewicz1, Colleen Hanlon2, Warren Bickel3,
Martin Mahoney1, Matilda McDonough1, Lindsey Bensch1, Darian Vantucci1, Hannah
Thorner1, Matthew Marion1, Christine Sheer4. 1Roswell Park Comprehensive Cancer
Center, Bualo, NY, USA, 2Wake Forest School of Medicine, Winston-Salem, NC, USA,
3VA Tech Carilion Research Institute, Roanoke, VA, USA, 4Roswell Park Cancer Insit-
tute, Bualo, NY, USA.
Signicance: High frequency Repetitive Transcranial Magnetic Stimulation (rTMS) is
a promising treatment for smoking cessation, but the optimal dosing parameters for
long-term cessation are unknown. While increasing intensity and duration might improve
outcomes, this may also increase participant burden, negatively aecting outcomes.
Methods: Preliminary results from an ongoing study aimed to determine optimal 20Hz
rTMS (110% MT) dosing of the left dorsolateral prefrontal cortex for long-term smoking
cessation are presented. We examined the eect sizes of two dosing parameters,
duration (8, 12, or 16 days of stimulation) and intensity (900 or 1800 pulses per day)
on delay discounting rate (the therapeutic target), latency to relapse, and 6-month
abstinence rates among participants who received active rTMS (n=23) prior to the
pandemic. We also examined research burden among participants who received active
and sham rTMS (n=51) using the Perceived Research Burden Assessment (PeRBA).
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
We hypothesized that greater rTMS duration and intensity will result in lower discounting
rates and greater latency to relapse, abstinence rates, and research burden. Results:
Increasing the duration of rTMS showed a large eect size ($100 magnitude: F=4.50,
p=.035, η2=.429; $1000 magnitude F=5.66, p=.019, η2=.485). Increasing intensity
showed a small eect size ($100 magnitude: F=0.83, p=.78, η2=.007; $1000 magni-
tude F=5.66, p=..88, η2=.002). Increasing duration from 8 to 12 and 16 days showed
a medium and large eect size respectively for latency to relapse. The odds ratios
suggest that increasing duration increased the odds of long-term abstinence 7-8 fold,
and increasing intensity nearly doubled the odds of abstinence. Increasing duration
and intensity had a medium and small eect size, respectively, on participant burden
(F=.376, p=695,η2=.059; F=.008,p=.930,η2=.001). Conclusions: These preliminary
ndings show promise that greater duration and intensity of rTMS will result in improved
long-term smoking cessation without undue burden on participants.
FUNDING: Federal
PS1-17
SMARTPHONE-DELIVERED ATTENTIONAL BIAS MODIFICATION
TRAINING FOR SMOKERS RESULTS IN SUSTAINED REDUCTION
OF ATTENTIONAL BIAS TO SMOKING CUES
Jason D. Robinson1, Yong Cui1, Paulina Linares Abrego1, Jeery M. Engelmann2,
Alexander Prokhorov1, Damon J. Vidrine3, Sanjay Shete1, Paul M. Cinciripini1. 1UT MD
Anderson Cancer Center, Houston, TX, USA, 2Medical College of WI, Milwaukee, WI,
USA, 3Mott Cancer Center, Tampa, FL, USA.
Signicance: Cigarette smoking is thought to be at least partially maintained by the at-
tentional bias (AB) toward smoking-related cues that develops as a consequence of drug
dependence. Attentional bias modication (ABM) training has been developed to directly
reduce AB to smoking cues. This study evaluated the impact of smartphone-delivered,
in-home ABM training to reduce AB to smoking cues and to reduce smoking behavior
when used as an adjunct to conventional smoking cessation treatment. Methods: Partic-
ipants (N=246) were treatment-seeking smokers who completed up to 13 days of either
ABM designed to train attention away from smoking cues, using a modied dot-probe
task, or sham training, followed by eight weeks of nicotine replacement therapy and
counseling. Outcomes measured at baseline, 1-day post-ABM training, and 8-weeks
post-ABM training included AB to smoking images and words using the dot-probe and
smoking Stroop tasks, respectively, along with cigarettes per day, craving, and smoking
abstinence. Results: We found that ABM training reduced AB to smoking stimuli on both
the dot-probe task and the smoking Stroop task up to 8 weeks after ABM training, but
did not concurrently decrease smoking behavior or craving. Conclusions: Thirteen days
of smartphone-delivered ABM training, as an adjunct to smoking cessation treatment,
reduced AB to both modality-specic and cross-modality smoking cues but did not
impact smoking behavior. While ABM training can reduce AB to smoking cues across
modalities, it is unclear whether it has therapeutic potential as an adjunct to conventional
smoking cessation therapy.
FUNDING: Federal; Nonprot grant funding entity
PS1-18
TOBACCO TREATMENT INITIATION IN CANCER PATIENTS-A
SINGLE CENTRE EXPERIENCE
Janaki Deepak1, Julia Melamed2, Jayme Hallinan3, Niharika Khanna1. 1University of
Maryland School of Medicine, Baltimore, MD, USA, 2University of Maryland, Baltimore,
MD, USA, 3Jayme Hallinan, Baltimore, MD, USA.
Signicance: Smoking post-diagnosis linked to multiple risks. Smoking cessation reduces
risk of tobacco-related malignancies improving overall outcomes.Methods: Tobacco
Health Program (THP) in cancer center: program director MD, epidemiology students,
statisticians; Pulmonologist, CRNP, Tobacco Treatment Specialist (TTS) began during
COVID-19 pandemic. Patient intake: THP conducted educational sessions for cancer
providers/sta. TTS contacted 443 patients to oer services;24 patients enrolled on
6/1/21,began as telemedicine only, expanded to include oce visits. Results: Access
database established; EHR smart phrases made to standardize collection. Age/gender/
race/Hispanic origin/insurance, Area Deprivation Index (ADI)collected. 57.9% Black, 68%
lived in socioeconomically deprived areas (MD ADI rank 8-10); 87.5% Medicare/Medicaid
insurance suggesting that THP reaches underserved minority cancer patients. Tobacco
use history taken during intake visit. 20 patients current smokers, including 4 who were
also vaping. 4 had recently quit. Patients’ tobacco habits; cessation barriers assessed.
Subsequent encounters assessed patients’ progress; nicotine withdrawal via Minnesota
Nicotine Withdrawal Scale (MNWS).Tobacco use assessed using Cancer Tobacco Use
Questionnaire (C-TUQ). 25% current daily smokers, 44% cutting down, 12% quit 30+
days but relapsed, 19% quit. Patients followed for 6+ months. TTS outreached (233
attempts) patients by phone/text/emails to help obtain medication, reinforce education,
advise on other matters (e.g. COVID-19). All patients prescribed pharmacotherapy/
NRT. Pharmacotherapy compliance low; NRT (patch) compliance better. Popular re-
liever: nicotine inhaler. Lung cancer screening for eligible patients (USPSTF criteria).
Cardiovascular risk calculated via Framingham score. Available pulmonary function
test results reviewed; additional tests ordered if indicated. Comorbidity data collected
using diagnosis, ICD10 codes.Conclusion: In the arid landscape of cancer, tobacco
treatment makes signicant dierence. However it is challenging as patients have con-
icted priorities which could be overcome by investment and prioritization by oncology.
PS1-19
PAIN INTENSITY AND INSOMNIA AMONG ADULTS WITH
CHRONIC PAIN - THE MODERATING ROLE OF CIGARETTE AND
E-CIGARETTE DUAL USE
Julia E. Hooker, Jessica Powers, Kyle M. White, Joseph Ditre. Syracuse University,
Syracuse, NY, USA.
Signicance: Chronic pain and insomnia are highly prevalent and frequently comorbid
conditions that interact bidirectionally, leading to greater pain and increased sleep
problems over time. Rates of dual nicotine product use (commonly cigarettes + e-cig-
arettes) and dependence are signicantly higher among individuals with pain, and
nighttime nicotine withdrawal has been associated with clinically signicant insomnia.
Although nicotine/tobacco use has been associated with increased pain and insomnia,
the role of cigarette and e-cigarette dual use (vs. single-product use or non-use) in this
relationship has not been explored. The goal of the present study was to test whether
cigarette and e-cigarette dual use moderates the relationship between pain intensity
and insomnia among adults with chronic pain. Specically, we hypothesized that greater
current pain intensity would be associated with increased insomnia symptoms, and
that this relationship would be strongest among current dual users of cigarettes and
e-cigarettes (vs. single product users and non-users). Methods: Participants included
online survey respondents who endorsed past-month alcohol use and current chronic
musculoskeletal pain (N =290; 65.2% male; Mage = 38). Results: Results indicated that
pain intensity was positively associated with insomnia symptoms (p<.01), and that this
relationship was moderated by cigarette and e-cigarette use status (p<.05). Specically,
the association between pain intensity and insomnia symptoms was strongest among
dual users, followed by single-product users and non-users, respectively (ps<.01). Con-
clusions: This is the rst study to examine the moderating role of cigarette and e-cigarette
dual use in relation to pain intensity and insomnia symptoms among individuals with
chronic pain. Given that dual use of nicotine/tobacco products and chronic pain have
each been linked with greater nicotine dependence, dual users with co-occurring pain
may be especially susceptible to increasing their total nicotine consumption over time,
which in turn may contribute to greater sleep dysregulation.
FUNDING: Unfunded
PS1-20
THE ACUTE PHYSIOLOGICAL AND SUBJECTIVE EFFECTS OF
FLAVORED CIGAR USE AMONG YOUNG ADULT CIGARETTE
SMOKERS
Gabby Maldonado1, Rose Bono1, Catherine Wall2, Rebecca Lester1, Cosima Hoet-
ger1, Michaela Blankenship1, Thokozeni Lipato1, Mignonne Guy1, Thomas Eissenberg1,
Warren Bickel3, Andrew Barnes1, Caroline Cobb1. 1VA Commonwealth University, Rich-
mond, VA, USA, 2Virginia Commonwealth University, Richmond, VA, USA, 3VA Tech
Carilion Research Institute, Roanoke, VA, USA.
Background: Better understanding of the user behavior, toxicant exposure, and sub-
jective eects of avored cigars could inform regulatory eorts to reduce cigar abuse
liability and associated harms through cigar avor product standards. The present study
compared the acute eects of four avors of the popular cigar brand, Black & Mild,
among young adult cigarette smokers. Methods: Young adult (ages 18-25) cigarette
smokers (N=25) naïve to cigars attended ve Latin-square- ordered lab sessions diering
in tobacco product administered: own brand (OB) cigarette or a avored Black & Mild
cigar (original, wine, apple, and cream). During each session, participants completed
two directed 10-pu bouts (30-second inter-pu-interval) with pu topography mea-
sured. Exhaled carbon monoxide (CO), saliva nicotine, and subjective measures of
acceptability and avor sensations were measured before and after each bout. Linear
mixed models followed by pairwise Wald tests were used to test condition dierences
(p<0.05). Results: Relative to OB, participants took approximately 0.5 second longer
pus in all cigar conditions, and average pu volume was signicantly greater in the
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
original, wine, and apple cigar conditions. Compared to cigars, OB resulted in a sig-
nicantly higher nicotine boost (953 ng/mL vs. <300 ng/mL) and lower CO boost (4
ppm vs. 8-9 ppm) across bouts. Nicotine boost for the original cigars (283 ng/mL) was
signicantly higher than wine (190 ng/mL) across bouts. Overall, OB was rated more
positively than all cigar conditions, with few dierences in subjective eects observed
between cigar conditions. Wine cigars received the highest ‘dislike’ ratings, and cream
cigars had signicantly higher ratings of avor intensity and ‘harsh as OB’ than original
cigars. Conclusions: Compared with OB cigarettes, young adult smokers generally
took larger and longer pus and had lower nicotine and higher CO exposure when
using cigars. Cigar conditions had similar physiological and subjective eects with
some exceptions, suggesting consistency in acute use behavior, toxicant exposure,
and subjective eects across avors.
FUNDING: Federal
PS1-21
PERCEIVED ABILITY TO HANDLE STRESS AND DEPRESSIVE
MOOD WITHOUT SMOKING PREDICTS ABSTINENCE IN
SOCIOECONOMICALLY-DISADVANTAGED YOUNG ADULT
CIGARETTE SMOKERS
Catherine Peasley-Miklus, Elias Klemperer, Elisha LePine, Julia West, Andrea Villanti.
University of Vermont, Vermont Center on Behavior and Health, Burlington, VT, USA.
SIGNIFICANCE: Socioeconomically disadvantaged young adult (SDYA) smokers
report higher smoking prevalence than those without disadvantage and identify stress
and diculty coping without smoking as barriers to smoking cessation. The goal of the
current study was to examine the eect of baseline perceived ability to handle stress
and depressive mood without smoking on cessation outcomes in a randomized smoking
cessation trial of SDYA smokers. METHODS: SDYA cigarette smokers (n=343) aged
18-30 with an interest in quitting in the next 6 months were randomized to receive either
a 12-week web and tailored text based smoking cessation intervention (n=172) or referral
to a quit line (n=171) in Spring 2020. At baseline and 12-week follow-up, participants
completed a 1-item measure of perceived ability to handle stress and depressive mood
without smoking (1=least to 10=most ability to cope without smoking) and were assessed
for 7-day and 30-day point prevalence abstinence (PPA) at follow-up. Univariate and
bivariate analyses examined mean perceived ability to cope by study group and change
over time; multivariable logistic regression models assessed the association between
baseline perceived ability and cessation outcomes, controlling for intervention group.
RESULTS: At baseline, mean perceived ability to cope with stress and depressive
symptoms without smoking was 4.8 (SD 2.5), with no dierence between conditions.
Mean change in perceived ability to cope without smoking from baseline to follow-up was
0.69 (SD 3.2), with an increase of 1.1 (SD 3.2) in the intervention condition compared
with 0.26 (SD 3.1) in the control condition. Baseline perceived ability to handle stress
and depressive mood without smoking was associated with both 7-day PPA (OR=1.15,
95% CI 1.04-1.28) and 30-day PPA (OR=1.22, 95% CI 1.09-1.38) when controlling for
intervention group. CONCLUSION: Findings suggest that baseline perceived ability to
cope with stress and negative mood without smoking predict 7-day and 30-day PPA at
12-week follow-up, and that these perceptions are modiable for SDYA smokers through
participation in a tailored text message cessation intervention.
FUNDING: Federal
PS1-22
DELAY DISCOUNTING IS ASSOCIATED WITH SMOKING
CESSATION FOLLOWING DIAGNOSIS WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
Kenan Michaels1, Allison Tegge1, Jennifer Vaughn2, Warren Bickel3, Jeery Stein3.
1Virginia Tech Carilion School of Medicine, Roanoke, VA, USA, 2The Ohio State Univer-
sity Comprehensive Cancer Center, Columbus, OH, USA, 3Fralin Biomedical Research
Institute, Roanoke, VA, USA.
Signicance: Cigarette smoking is the leading cause of preventable death and disease
in the US and plays a strong role in the etiology of many types of illnesses, including
chronic obstructive pulmonary disease (COPD). Delay discounting (DD) describes the
process of devaluing future outcomes. Cross-sectional research demonstrates that ciga-
rette smokers grossly undervalue future rewards compared to non-smokers, suggesting
DD may play an etiological role in cigarette smoking. No work has yet examined DD
and its association with smoking cessation following diagnosis of tobacco-associated
disease. This research tests the hypothesis that smokers diagnosed with COPD within
the last ve years who show lower rates of DD at time of investigation will be more likely
to have quit smoking since diagnosis. Methods: This cross-sectional study recruited 348
participants to complete an online survey through Qualtrics. Inclusion criteria required
that participants: 1) were diagnosed with COPD in the last ve years, 2) were daily or
almost-daily cigarette smokers at time of diagnosis, and 3) were at least 18 years old.
Logistic regression was used to determine if DD was associated with smoking cessation
(dened by 7-day point prevalence abstinence). Results: On average, participants were
44.68 years old (SD 13.52), 161 were men (46.3%), 300 were white (86%), 79 were
Hispanic/Latino (22.7%), and 166 had at least a 2-year college degree (47%). Logistic
regression showed DD indeed was associated with smoking cessation (p=.0005). Using
BIC for best model selection from demographic and DD data, the logistic regression
model demonstrated that increased age (OR 1.05, p=.00015), decreased discounting
(OR 1.08, p=.015), and being Hispanic/Latino (OR 2.87, p=.0009) together were best
associated with increased odds of smoking cessation after COPD diagnosis. Conclu-
sions: This study demonstrates that DD is cross-sectionally associated with smoking
cessation following COPD diagnosis. Future research should examine the longitudinal
association between DD and smoking cessation after COPD and whether providing more
targeted smoking cessation resources for patients with high DD may more eectively
help these patients quit.
FUNDING: Academic Institution
PS1-23
EFFECTIVENESS OF TEXT MESSAGES BASED MOBILE PHONE
INTERVENTION TO PREVENT SMOKING RELAPSE AMONG
RECENT QUITTERS IN JAZAN REGION RANDOMIZED CONTROL
TRIAL
Ibtihal Ali Altalhi. MOH, Jazan, Saudi Arabia.
Background: Smoking cessation services can help smokers to quit; however, many
smoking relapse cases occur over time. Initial relapse prevention should play an
important role in achieving the goal of long-term smoking cessation.Objective: This
trial aims to determine the eectiveness of text messages based phone intervention
when used as an adjunct to the usual support provided to patients who wish to quit
smoking, compared with usual care alone.Methods: This trial is a two-group, pragmatic,
multi-center, individually randomized, controlled trial (allocation ratio 1:1), by comparing
the 6-month the rate of continuous smoking abstinent between the recent cigarettes
quitters. Participants allocation comparing usual care (ie, pharmacotherapy combined
with multisession behavioral support) (the control group) with usual care plus text-mes-
sages program intervention. Participants were recruited through primary care clinics and
talked to a smoking cessation counselor. Participants were randomized after 24 hour
of abstinence, and those allocated to the intervention group received a 60 days of text
messaging in addition to the standard support provided to all patients.RESULTS: A total
of 140 male participants of smoking cessation clinic screened. Sample composed largely
of middle aged (51.4%), married (63.6%) with highly educated level (57.8%) smokers.
There was no statistically signicant dierence between intervention and control groups
in last 7-day smoking abstinence at the 3-months primary end-point [(intervention 91.4%,
95% CI: 82.5-95.9), (control 84.1%, 95% CI = 73.6-90.8) p=0.184]. However, there was
a signicant dierence between-groups in the last 30-day smoking abstinence at the
3 months primary end-point [(intervention 72.9%, %95 CI: 61.4-81.9) (control 53.6%,
95% CI = 41.9-64.9) P= 0.019]. Also, no signicant dierences were found for in last
7-day and 30-day smoking abstinence at 6-month. Although the abstinence rate was
higher in intervention group at both 3 and 6 months (37.1% and 28.6%, respectively)
compared to control group (34.8% and 23.2%), respectively, these dierences were not
statistically signicant. The number of smoked cigarettes per day decreased signicantly
in the treatment group, with an average percent change of 26.37% from baseline com-
pared to -91.21% in the control group, p=0.022. However, the change in the number of
smoked cigarettes was not signicantly changed from baseline at 6-months and from
3-months at 6-months of follow-up. CONCLUSION: Text messages provide a promising
tool to help the recent quitters during post-quit period, thus making relative long-term
abstinence of smoking more likely after a quit attempt.
FUNDING: Unfunded
PS1-24
ASSOCIATION OF SMOKING INTENSITY AND AGE OF SMOKING
INITIATION WITH PREMATURE MORTALITY OF COPD PATIENTS
Stanislav N. Kotlyarov, Anna А Kotlyarova. Ryazan State Medical University, Ryazan,
Russian Federation.
Signicance. Smoking is the most important modiable risk factor for chronic ob-
structive pulmonary disease (COPD). It is associated with a premature decline in lung
function scores, as shown in the classic Fletcher and Peto model. When assessing the
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
smoking status, the forecast traditionally takes into account the very fact of smoking
and the smoking experience, measured by the index of pack-years. At the same time,
the age of starting smoking is usually not taken into account. Methods. To conrm the
signicance of the smoking experience and the age of involvement in smoking, we
conducted a 15-year monitoring of the course of COPD in 170 men. The average age
of patients at the time of inclusion in the study was 60.09 ± 1.31 years. The pack-years
index averaged 43.95 ± 2.09. The average age at the start of smoking was 14.73 ±
0.84 years. Results. The survival rate of patients during the observation period was
30%. The average age of smoking initiation in the group of patients who died before
60 years was 12.53 ± 0.58 years, while in the group of those who lived more than 75
years it was 15.15 ± 0.66 years (p <0.05). The analysis of the Kaplan-Meyer survival
curves shows statistically signicant dierences (p<0.001) for patients with the index
of pack-years up to 40 and more than 40, as well as in groups up to 30, 31-49 and
more than 50 pack-years. The area under the ROC curve for the pack-years index was
0.731±0.041, p<0.001, which indicates a good diagnostic signicance of the determined
parameter for assessing survival. Conclusion. Thus, the index of pack-years and the
age of starting smoking are factors of an unfavorable prognosis in COPD and should
be taken into account when developing anti-smoking programs aimed at preventing
early involvement in smoking.
PS1-25
ANHEDONIA: RELATIONS WITH WITHDRAWAL AND ABSTINENCE
DURING A SMOKING CESSATION ATTEMPT IN A RANDOMIZED
CONTROLLED TRIAL
Jessica W. Cook1, Megan E. Piper2, Danielle E. McCarthy3, Tanya R. Schlam4, Deejay
Zwaga1, Jesse T. Kaye1, Adrienne L. Johnson1, Timothy B. Baker5. 1University of WI
School of Medicine and Public Health, Madison, WI, USA, 2University of WI, Madi-
son, WI, USA, 3University of WI School of Medicine & Public Health Ctr for Tobacco
Research & Intervention, Madison, WI, USA, 4University of WI-School of Medicine and
Public Health, Madison, WI, USA, 5Center for Tobacco Research and Intervention,
Madison, WI, USA.
Signicance: Evidence from both laboratory and clinical studies shows that nicotine
abstinence following chronic exposure leads to diminished sensitivity to nondrug re-
wards (i.e., anhedonia). However, additional research is needed to evaluate whether
anhedonia during a cessation attempt 1) reects a withdrawal eect vs. an oset eect
and 2) is related to a failure to achieve and sustain abstinence. Methods: We conducted
secondary data analyses of a comparative eectiveness randomized controlled trial of
three smoking cessation pharmacotherapies (12 weeks of varenicline, nicotine patch,
or nicotine patch and lozenge) to examine: 1) whether the waveform of anhedonia
across the quit attempt conforms to a curvilinear trajectory consistent with a withdrawal
symptom (inverted u), and 2) whether pre- to postquit change in anhedonia during a
quit attempt is associated with abstinence likelihood. Adults smoking cigarettes daily
(N=1086; 52% female; 67% White; mean of 17 cigarettes smoked daily) completed
an anhedonia assessment (Snaith-Hamilton Pleasure Scale) during four study visits
(1 week prequit, target quit day, 1 week postquit, and 4 weeks postquit). Carbon
monoxide-conrmed 7-day point-prevalence abstinence was assessed at 4, 12, and
26-weeks postquit. Results: Results showed that anhedonia increased sharply on the
target quit day, peaked at 1-week postquit, and declined by 1 month postquit, consistent
with a withdrawal eect. Males and those with higher levels of nicotine dependence
reported especially large pre- to postquit increases in anhedonia. Logistic regression
analysis showed that those who experienced a greater postquit increase in anhedonia
were less likely to be abstinent at 4 and 26 weeks postquit (ps < .05 for the change
score controlling for baseline level). Participants with higher mean prequit and postquit
anhedonia were also less likely to be abstinent at 4, 12, and 26 weeks (ps < .05). The
relations between anhedonia and abstinence remained signicant when treatment was
included in the models. Conclusion: Results provide additional evidence that anhedonia
is a motivationally signicant symptom of the tobacco withdrawal syndrome.
FUNDING: Federal
PS1-26
TOBACCO ASSESSMENT AND SMOKING CESSATION
ASSISTANCE AMONG OLDER PRIMARY CARE PATIENTS BY
ETHNICITY AND LANGUAGE PREFERENCE
Steani R. Bailey, Jun Hwang, Miguel Marino, Ana R. Quiñones, Jennifer A. Lucas,
John Heintzman. Oregon Health & Science University, Portland, OR, USA.
Signicance: While smoking prevalence is lower among Latinos compared to non-Latino
Whites, smoking remains a leading cause of preventable death among older Latinos.
Smoking cessation is a critical component of cancer prevention among older adults.
Methods: Electronic health record data were extracted from the ADVANCE network
of community health centers (CHCs) from patients 55-80 years of age with at least 1
primary care visit between 1/1/2017-12/31/2018. Binary outcomes included tobacco
use assessment and, among those with at least 1 status indicating current smoking,
having a smoking cessation medication ordered. The main independent variable com-
bined ethnicity and language preference, categorized as non-Latino White (reference),
Spanish-preferring Latino and English-preferring Latino. Patient covariates included
age, gender, household income, insurance type, number of primary care visits during
study period, medical and psychiatric comorbidities and body mass index. We also
included clinic urbanity/rurality, state, and health system as covariates. Generalized
estimating equation logistic regression was used to model odds of each outcome by
ethnicity/preferred language.Results: Of the 116,328 patients with at least 1 visit to a
study clinic, 96.0% had tobacco use assessed, and among those, 21.2% indicated
current smoking. Non-Latino White patients had the highest smoking rate (27.6%) and
Spanish-preferring Latino patients had the lowest (10.4%). Compared with non-Latino
White patients, both Spanish-preferring Latino patients and English-preferring Latino
patients had lower odds of having tobacco use assessed (covariate-adjusted odds ratio
[aOR]=0.77, 95% CI=0.71-0.84; aOR=0.80, 95% CI=0.71-0.89, respectively). Among
those with current smoking indicated, Spanish- and English-preferring Latino patients
had lower odds of having a smoking cessation medication ordered (aOR=0.58, 95%
CI=0.51-0.65; aOR=0.78, 95% CI=0.69-0.88, respectively) compared with non-Latino
White patients. Conclusions: Tailored interventions may be warranted to mitigate to-
bacco-related disparities among both Spanish- and English-preferring Latino patients
in CHC primary care settings.
FUNDING: Federal
PS1-27
THE RELATIONSHIP BETWEEN ETHNIC MINORITY STATUS AND
SINGLE/DUAL/POLY USE OF E-CIGARETTES, ALCOHOL, AND
TOBACCO
Guadalupe Villanueva, Georgina Orozco, Wura Jacobs. California State University,
Stanislaus, Turlock, CA, USA.
Signicance: Electronic vapor product (EVP) use has greatly increased over the years,
especially among youth. Alcohol and tobacco use may be used concurrently with EVPs
among youth; however, limited information exists about the relationship among EVP,
alcohol, and tobacco, particularly among ethnic minority students and if there are any
sex dierences. This study examines recent data from a national youth survey that
examines health behaviors and risks. Methods: Data are from the 2019 Youth Risk
Behavior Survey (YRBS), a school-based survey of high school students (9th, 10th,
11th, 12th). Students with complete data on past 30 day use of e-cigarettes, tobacco,
and alcohol, as well as complete data for race/ethnicity, were analyzed. The race/
ethnicity variable was then recoded into the ethnic minority status variable. Descriptive
and bivariate analysis was performed to help describe the study participants and to
examine dierences by ethnic minority status, while binary logistic regression examined
the odds of product use by ethnic minority status. Results: The sample included 6571
students who identied as racial/ethnic minorities, and the majority were female (50.1%)
with a mean age of 16 (S.D. = 1.25). When analyzing the percentage of students who
use just EVP’s, alcohol, and tobacco in the past 30 days, ethnic minority students had a
lower percentages of product use. For example, single use of alcohol and EVP yielded
an adjusted OR of 0.6 (95% CI = 0.5, 0.7). The same trend was also seen in dual use
of products (dual use of EVP and alcohol yielded an adjusted OR of 0.5 (95% CI = 0.4,
0.6)), as well as poly use of all three products, when compared to non-ethnic minorities
students (3.9% vs. 6.3%). Compared to non-ethnic minorities, ethnic minorities had lower
odds of product use, including poly use (aOR = 0.6, 95% CI = 0.4, 0.8). Conclusions:
While non-ethnic minorities were less likely to use e-cigarettes, tobacco, and alcohol,
either in a singular, dual, or poly use fashion, this study highlights the need to further
examine any factors that may contribute to the lower odds of use among ethnic minority
students, such as protective factors at the familial, peer, school, or community level.
FUNDING: Academic Institution
75
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-28
EXPLORING PERCEIVED ADDICTION TO CIGAR PRODUCTS
AMONG BLACK YOUNG ADULT CIGAR SMOKERS: A SEMI-
STRUCTURED IN-DEPTH INTERVIEW STUDY
Maryam M. Elhabashy1, Aniruddh Ajith2, Aaron Broun3, Danielle A. Duarte4, Lilianna
Phan1, Bambi Jewett1, Erin L. Mead-Morse5, Kristen R. Hamilton-Moseley1, Kelvin Choi1,
Julia Chen-Sankey6. 1National Institute on Minority Health and Health Disparities, Divi-
sion of Intramural Research, Bethesda, MD, USA, 2University of Pittsburgh, Graduate
School of Public Health, Pittsburgh, PA, USA, 3George Washington University, School
of Public Health, Washington, D.C., DC, USA, 4National Cancer Institute, Division of
Cancer Epidemiology and Genetics, Bethesda, MD, USA, 5University of Connecticut,
School of Medicine, Farmington, CT, USA, 6Rutgers Biomedical and Health Sciences,
Center for Tobacco Studies, New Brunswick, NJ, USA.
INTRODUCTION In the U.S., Black young adults have one of the highest cigar smoking
prevalence rates. However, little is known about their perceived cigar addiction, which
may inuence long-term cigar smoking and cessation outcomes. This study aimed to
understand perceived cigar addiction among Black young adult cigar smokers. METH-
ODS Between May and July 2020, in-depth interviews were conducted with 40 Black
young adult cigar smokers ages 21-29 (Female n=23) to explore perceived addiction to
cigar products that they predominately smoked: blunts (n=18), cigarillos (n=16), large
cigars (n=4), and ltered cigars (n=2). Interviews were audio-recorded, transcribed, and
coded. Thematic analysis was used to assess emerging themes. RESULTS About half
of the participants believed that they were addicted to cigar products that they predomi-
nantly smoked. Specically, more than half of cigarillo smokers identied as addicted to
cigarillos because they perceived smoking cigarillos as a habit that aects their quality
of life. They also frequently described cigarillo addiction as a physical addiction because
there is nicotine in them and they experienced various health problems (e.g., headaches)
from nicotine withdrawal. The majority of blunt smokers believed that they were not
addicted to blunts because there are no harmful or addictive chemicals in cannabis.
Participants often described blunt addiction as a mental addiction because smoking
blunts helps ease their anxiety and they enjoy the feelings associated with smoking
blunts. Almost all large cigar smokers reported that they were not addicted to large
cigars because they only occasionally smoked them or smoked them for recreational
purposes. DISCUSSION Among Black young adults, perceived cigar addiction varied
by cigar product, with cigarillos reported as the most addictive. Factors that inuenced
perceived addictiveness were health consequences from smoking, perceived harm,
and frequency and purpose of smoking. Upon conrmation with future studies, public
health messages may need to address perceived cigar addiction to promote smoking
cessation and reduce cigar-related disparities among Black communities.
FUNDING: Federal
PS1-30
NON-SMOKING ADOLESCENTS’ PERCEPTIONS OF DISSUASIVE
CIGARETTES
Dirk Jan A. van Mourik1, Gera E. Nagelhout1, Nikita L. Poole1, Marc C. Willemsen1,
Crawford Moodie2, Bas van den Putte3, James F. Thrasher4, Hein de Vries1. 1Maas-
tricht University, Maastricht, Netherlands, 2University of Stirling, Stirling, United King-
dom, 3University of Amsterdam, Amsterdam, Netherlands, 4University of SC, Columbia,
SC, USA.
Signicance: For the tobacco industry, cigarette sticks are an increasingly important
means of dierentiating and promoting their products. Dissuasive cigarettes may deter
young people from smoking with unappealing colours and warnings. Methods: Two
online surveys were conducted with non-smokers (not having smoked a cigarette at
least once a month in the last six months) aged 12-17 to explore perceptions of cigarette
appeal, harm and product trial. The rst was a within-subject study which examined
perceptions of four cigarettes with dierent coloured paper, and four cigarettes displaying
a warning. In the second between-subject study, dierent respondents were randomized
to one of four cigarettes: (1) regular cigarette; (2) least favourable colour from Study 1;
(3) least favourable warning from Study 1; or (4) a combination of the least favourable
colour and warning from Study 1. Results: In Study 1, a cigarette featuring the warning
‘cancer, heart disease, stroke’ and a drab dark brown cigarette were rated lowest on
appeal and trial intentions, and highest on perceived harm. In Study 2, there were no
signicant dierences in perceptions of appeal, harm or trial intentions between the
regular and dissuasive cigarettes. Conclusions: Although dissuasive cigarettes may
be less favourable than cigarettes without o-putting health warnings and colours, in
the current study they do not appear to markedly reduce appeal or increase perceptions
of harm compared to a regular cigarette.
FUNDING: Academic Institution
PS1-31
NETWORK ANALYSIS OF VAPING INDUSTRY INFLUENCE AND
MOBILIZATION ON FACEBOOK
Michael R. Haupt1, Qing Xu2, Joshua Yang3, Mingxiang Cai2, Tim Mackey1. 1UC San
Diego, La Jolla, CA, USA, 2Global Health Policy Institute, San Diego, CA, USA, 3CA
State University, Fullerton, Fullerton, CA, USA.
Signicance: In response to recent policy eorts to regulate tobacco and vaping prod-
ucts, the vaping industry has been aggressive in mobilizing opposition using a network
of manufacturers, trade associations, tobacco user communities, and appealing to the
general public. One strategy the alternative tobacco industry uses to mobilize political
action is coordinating on social media platforms, such as the social networking site
Facebook. However, few studies have specically assessed how platforms such as
Facebook are used to inuence public sentiment and attitudes towards tobacco control
policy. This study uses social network analysis (SNA) to examine how the alternative
tobacco industry uses Facebook to mobilize online users to inuence tobacco control
policy outcomes focused on the State of California. Methods: Data was collected from
local and national alternative tobacco Facebook groups that had aliations with activities
in the State of California. Network ties were constructed based on users’ reactions to
posts (e.g., like, love) and comments to characterize political mobilization networks.
Results: Findings show that alternative tobacco industry employees were more likely
to engage within these networks and that these employees were also more likely to be
inuential (i.e., more active). Comparisons between sub-networks show that communi-
cation within the local alternative tobacco advocacy group network was less dense and
more centralized in contrast to a national advocacy group that had overall higher levels
of engagement among members. A timeline analysis found that a higher number of inu-
ential posts that disseminated widely across networks occurred during e-cigarette-related
legislative events, suggesting strategic online engagement and increased mobilization
of online activity for the purposes of inuencing policy outcomes. Conclusions: Results
from this study provide important insights into how tobacco industry-related advocacy
groups leverage the Facebook platform to mobilize their online constituents in an eort
to inuence public perceptions and coordinate to defeat tobacco control eorts at the
local, state and Federal level. Study results reveal one part of a vast network of socially
enabled alternative tobacco industry actors and constituents that use Facebook as a
mobilization point to support goals of the alternative tobacco industry.
FUNDING: State; Nonprot grant funding entity
PS1-32
AN INVESTIGATION OF INFLUENTIAL USERS IN IQOS
PROMOTION AND MARKETING ON INSTAGRAM: A SOCIAL
NETWORK ANALYSIS
Jiayan Gu, Lorien C. Abroms, David A. Broniatowski, W Douglas Evans. The George
Washington University, Washington, DC, USA.
Signicance: While an increasing body of literature has documented the exposure to
emerging tobacco products including e-cigarettes and heat-not-burn products on social
media, few studies have investigated the various stakeholders involved in the content
generation. The goal of this study is to use techniques from social network analysis
to identify and characterize inuential users who play a key role in the promotion and
marketing of IQOS, a representative heat-not-burn product, on Instagram. Methods:
This study collected public Instagram posts that contained the hashtag #iqos between
1 January 2021 and 5 April 2021, along with associated user prole data including us-
ername, bio, followed/following relationships, and whether it was a business account. A
directed social network was constructed where Instagram users who had IQOS post(s)
were represented as nodes and their followed/following relationships were represented
as directed edges. The degree centrality method was applied to identify inuential users
based on their structural positions in the IQOS network. Results: We identied 4,526
unique Instagram users (i.e., nodes) who had created 19,951 IQOS-relevant posts
during the study period. A majority of the sample (74.9%) were users with less than
1k followers, followed by 21.72% with 1k-10k followers, 2.78% with 10k-50k followers,
0.56% with 50k-500k followers and 0.04% with 500k-1m followers. Almost half of the
users are business accounts (42.05%), among which 58.95% belonged to the cate-
gory of personal goods & general merchandise stores. Japanese users accounted for
29.21% of the sample, followed by English (19.62%), Italian (13.92%), and Russian
(11.44%). Users with the top three in-degree centrality (i.e., the number of followers in
the network) were all accounts that contained “iqos” in the username. Conclusions:
Our ndings suggest that while the marketing of tobacco products is prohibited on
76
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
social media platforms including Instagram, the spread of IQOS content on Instagram
is largely driven by business accounts. Brand-relevant accounts act as key leaders in
shaping the normative messages of IQOS.
FUNDING: Unfunded
PS1-33
THE PRESENCE OF PURCHASE, USE, AND POSSESSION (PUP)
COMPONENTS IN US LOCALITIES WITH T21 POLICIES
Chris Dunlap1, Stephen R. Shamblen2, Page D. Dobbs3, Yu Lu1, Marshall K. Cheney1.
1University of Oklahoma, Norman, OK, USA, 2Pacic Institute for Research and Evalu-
ation, Louisville, KY, USA, 3University of Arkansas, Fayetteville, AR, USA.
Introduction: Prior to the 2019 US federal Tobacco 21 [T21] policy, local communities
raised the minimum legal sales age for tobacco from 18 to 21. Some local T21 policies
prohibited the purchase, use, or possession (PUP) of tobacco products for those under
a dened age (18 years or 21 years). PUP laws shift responsibility from retailers to youth
and young adults. The current study examined the presence of PUP policy components
such as age ID verication, appearance age exemption, and locality of T21 communities
prior to the federal policy. Methods: US localities that adopted T21 policies before July
1, 2019 were identied through online searches and local clerk contacts. T21 policies
(n=476) were independently coded by two trained coders using the Tobacco 21 Policy
Assessment Tool, which identied positive and negative T21 policy components. Coding
dierences were resolved then reviewed by an attorney. Localities were paired with US
census population categories from census.gov (2019 ACS 5-year) for locality size and
coded using categories of Urban Area (UA > 50,000 residents), Urban Cluster outside
of Urban Area (UC between 2,500 and 49,999 residents), and Rural (< 2,500 residents).
Results: Among T21 policies that prohibited the purchase, use, or possession of to-
bacco products (n=97), 35 policies (36.1%) lacked policy language that ensured the
verication of a purchaser’s age. Furthermore, 34 policies (35.1%) did not explain that
age verication was required for purchasers who appeared to be less than a predened
age, with 67.1% of all local T21 policies requiring retailers to verify the age of those
who appeared to be 27 years or younger (n=220). Penalties for underage purchasers
that violated PUP laws included, civil penalties that imposed a monetary ne (56.7%,
n=55) and criminal penalties that included a misdemeanor oense (10.3%, n=10). At
least one component (purchase, use, or possession) was present in 12% (n=25) of rural
communities, 19.7% (n=339) of UCs, and 24.1% (n=112) of UAs. Additionally, 11 localities
penalized only those who were younger than 18 years, exempting 18-20-year-olds from
PUP penalties. Conclusions: T21 policies that include PUP components victimize youth
and young adults who are targeted by tobacco industry marketing; local policymakers
are encouraged to remove PUP previsions and focus enforcement on tobacco retailers
instead. Some states, such as Colorado, now preempt localities from enacting PUP
laws that penalize those less than 21 years of age.
FUNDING: Academic Institution
PS1-34
BEYOND CROSS-PRICE ELASTICITY: WHAT ELSE CAN WE
LEARN FROM THE CROSS-PRICE PURCHASE TASK?
Rose S. Bono, Caroline Cobb, Cosima Hoetger, Augustus M. White, Andrew Barnes.
VA Commonwealth University, Richmond, VA, USA.
Signicance: The cross-price purchase task is used to evaluate demand for concur-
rently available products. Cross-price elasticity is typically reported, but this measure
may obscure important trends in preferences for the two products. We introduce two
additional metrics to capture demand: cross-price crossover point and dual use liability.
Methods: As part of a clinical laboratory experiment, 19 exclusive users of electronic
nicotine delivery systems (ENDS) and 17 dual users of ENDS and cigarettes completed
cross-price purchase tasks in which they reported demand for own-brand (OB) ENDS
oered at variable prices ($0-$10.24 USD/10 pus) and cigarettes oered at a xed price
of $1/10 pus. We dened cross-price crossover point as the price at which demand for
cigarettes overtakes demand for ENDS. We dened dual use liability as the percentage
of total expenditure spent on cigarettes. We compared cross-price crossover point and
dual use liability between dual and exclusive ENDS users using independent samples
t-tests and used Pearson correlations stratied by dual user status to assess the re-
lationship of the two outcomes. Results: Among exclusive ENDS users, 68% never
purchased more cigarettes than OB ENDS. The mean cross-price crossover point was
signicantly higher among exclusive ENDS users ($8.42 [SD 3.09]) than among dual
users ($2.95 [2.70]), p<0.001. Dual use liability was lower for exclusive ENDS users
(11.38% [19.58]) than for dual users (60.85% [27.69]), p<0.001. Cross-price crossover
point exhibited a strong negative correlation with dual use liability among both dual (r=-
0.82, p<0.001) and exclusive ENDS users (r=-0.98, p<0.001). Conclusion: Relative to
dual users, exclusive ENDS users have signicantly stronger preferences for OB ENDS
when cigarettes are available and have lower liability for dual use. This observation
contrasts with previously reported cross-price elasticity results indicating that cigarettes
would serve as substitutes for OB ENDS similarly among exclusive and dual ENDS
users. Researchers may consider examining cross-price crossover point and dual use
liability when examining demand for concurrently available products.
FUNDING: Federal
PS1-35
KRATOM AVAILABILITY IN CALIFORNIA VAPE SHOPS
Monika Vishwakarma1, Eric C. Leas2, Nina C. Schleicher1, Lisa Henriksen1. 1Stan-
ford University School of Medicine, Palo Alto, CA, USA, 2University of California, San
Diego, CA, USA.
Signicance: Tobacco retailers are allowed to sell psychoactive products that are not
regulated by the Controlled Substances Act or restricted by state/local policies. One
example is products derived from kratom, a tree native to Southeast Asia. Kratom leaves
contain an alkaloid that produces stimulant eects at low doses and opioid-like eects at
higher doses. The leaves and leaf extracts can be smoked, vaped, drunk, or swallowed
as pills/capsules. In an online survey of US adults, nearly half of past-year kratom users
also used tobacco. Six US states (not California) and some localities (City of San Diego)
prohibit the sale of kratom products. This study assessed their availability in California
vape shops. Methods: This is a secondary analysis of a stratied random sample of
vape shops that was designed to compare shops near and not near colleges, including
both community colleges and 4-year universities. The population of vape shops was
initially identied by querying Yelp and Google, then geocoded to determine straight-line
distance to campus boundary shapeles (within 3 miles or farther). A random sample
of stores was drawn from the two groups. In summer 2019, trained data collectors
recorded whether shops sold other tobacco products (vape-only vs. vape-and-smoke)
and kratom (n=614; completion rate=93.0%). Inter-rater reliability (n=51) was k=0.94
for other tobacco and k=0.67 for kratom. Results: Kratom was sold in 62.3% (95%
CI=58.5-66.1) of vape shops, including 81.1% (95% CI=77.2-84.4) of vape-and-smoke
shops and 11.1% (95% CI=7.5-17.3) of vape-only. Overall, availability of kratom did not
dier between stores near colleges (60.8%; 95% CI=55.2-66.0) and those farther away
(64.0%; 95% CI=58.5-0.69.2). Compliance with City of San Diego’s 2016 sales ban
was approximately 50% (12 of 26 shops sold kratom). Conclusion: Retail availability of
kratom, particularly in vape-and-smoke shops, suggests a potential for growing demand
among tobacco users. Research should examine use prevalence and dual use with
nicotine, investigate kratom advertising and cross-product promotion, and explore the
regulatory potential of state and local tobacco retail licensing.
FUNDING: Federal
PS1-36
QUIT INTENTIONS AND USE OF CESSATION RESOURCES
AMONG RESIDENTS OF LOW-INCOME HOUSING WHO SMOKE
Jessica Liu, Jessica Davine, Rebekka Lee, Lindsay Kephart, Alan Geller, Vaughan
Rees. Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Signicance:Smoke-free policies in low-income housing settings can create opportuni-
ties for cessation in a population that historically has experienced disparities in smoking
rates. High quality, low-cost smoking cessation interventions can reduce smoking rates
and are key to the success of smoke-free housing. We assessed smoking cessation
behaviors and use of cessation resources among residents of low-income housing, pre-
and post- adoption of a smoke-free policy. Methods:Adult smokers who were residents
of 12 federally subsidized housing properties in Pennsylvania, Virginia, West Virginia,
Kentucky, and Ohio completed surveys six months pre- and one month post-adoption
of a smoke-free housing policy. Surveys were administered between May 2019 and
February 2021. Participants were asked about their smoking behaviors, readiness to
quit smoking, and use of cessation resources. Results:N=117 participants completed
both surveys (74% female; 78% white). Mean cigarettes smoked per day decreased
from 13.3 pre-policy to 9.0 post-policy (p<0.001). Participants who reported a cessation
attempt in the past month increased from 41.9% to 58.8% (p<0.001). Participants who
reported an active quit attempt doubled from 15.7% to 34.1% (p=0.028). Pre-policy,
the most popular cessation pharmacotherapies were nicotine patch (23.0%), and
gum (13.8%), and Chantix (11.2%). Counseling from a health professional (18.4%),
help from friends or family (10.5%), and telephone quitline (7.9%) were the most cited
behavioral strategies. Conclusion:Residents of low-income housing reported actively
trying to quit with the introduction of a smoke-free policy. Systematic cessation support
77
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
should be applied as part of smoke-free housing policy implementation. Cessation
pharmacotherapies, including low cost or free nicotine replacement therapies (NRT),
and counseling options, should be made available to residents who are interested in
quitting. Likewise, similar support should be provided to help residents who are not ready
or able to quit to maintain compliance with the smoke-free rule by limiting smoking to
certain times and places.
FUNDING: Federal; Academic Institution
PS1-37
HAS TOBACCO REGULATORY SCIENCE EXPANDED INTEREST
IN TOBACCO RESEARCH
Helen I. Meissner, Kriti Sharma, Rachel J. Mandal, Jonathan Moyer, Kay L. Wanke,
Mary Garcia-Cazarin, Charlene Liggins. NIH, Bethesda, MD, USA.
SIGNIFICANCE: Tobacco Regulatory Science (TRS) is a relatively new eld of tobacco
control that emerged with the passage of the 2009 Family Smoking Prevention and To-
bacco Control Act granting FDA regulatory authority over tobacco products. A distinction
between FDA-funded TRS and traditional NIH-funded tobacco research is that TRS
grants must also be within scope of FDA regulatory authorities. As such, it is possible
that TRS has attracted a new or dierent pool of investigators who might otherwise not
have pursued tobacco-related research. In this analysis we explore if the emergence of
TRS as a new eld attracted investigators new to tobacco control research. METHODS:
Using an internal NIH database of awarded grants, we identied investigators receiving
1) NIH-funded tobacco grants only 2) FDA-funded TRS grants only, and 3) both NIH
tobacco and FDA-funded TRS research grants in scal years 2011-2020. Publications
from all these grants were used to generate an investigator network. We then searched
the 2001-2010 NIH research grant award histories of the FDA-only investigators. RE-
SULTS: Between 2011-2020, there were 1227 new NIH-funded tobacco grants and 255
FDA-funded grants. Of these, NIH funded 1014 unique principal investigators (PIs),
FDA funded 153 unique PIs and 91 PIs received funding from both NIH and FDA. Of
the PIs receiving only FDA funding, 62% (n=95) had not received an NIH grant in the
decade prior and 14% (n=21) were new or early stage investigators. More than half
(52%, n=30) of the FDA-only PIs with previous NIH support had not received that funding
for tobacco research. The network analysis indicated that investigators receiving both
NIH- and FDA-funded grants scored highest on various centrality measures on average,
indicating greater inuence in the network. CONCLUSION: The emergence of TRS as
a new eld has expanded the cadre of investigators conducting tobacco research by
engaging former NIH PIs to conduct TRS research and by FDA support of PIs new to
research administered by NIH. PIs holding both NIH and TRS grants exhibit more col-
laborations than investigators conducting either TRS-only or NIH-only tobacco research.
FUNDING: Federal
PS1-39
EVALUATION OF THE RELATIONSHIP BETWEEN THE NICOTINE
METABOLITE RATIO (NMR) AND LABORATORY ASSESSMENTS
OF SMOKING REINFORCEMENT AND CRAVING AMONG ADULTS
IN A SMOKING CESSATION TRIAL
Robert K. Cooper1, Schuyler C. Lawson1, Julie C. Gass2, Martin C. Mahoney3, Stephen
T. Tiany1, Rachel F. Tyndale4, Larry W. Hawk1. 1University at Bualo, SUNY, Bualo, NY,
USA, 2VA Center for Integrated Healthcare, Bualo, NY, USA, 3Roswell Park Compre-
hensive Cancer Center, Bualo, NY, USA, 4CAMH and University of Toronto, Toronto,
ON, Canada.
Signicance: In general, people who metabolize nicotine more quickly smoke more
cigarettes and are less successful at quitting. However, the behavioral mechanisms
that link variation in the nicotine metabolite ratio (NMR), a phenotypic marker of the
rate of nicotine clearance, to smoking outcomes are less clear. In the present work,
we screened two candidate behavioral mechanisms, testing the hypotheses that faster
metabolizers exhibit greater smoking reinforcement and greater cue-induced cigarette
craving (see Butler et al., 2021; DOI: 10.1093/ntr/ntab064). Methods: Participants were
247 adult cigarette smokers enrolled in a randomized controlled smoking cessation trial
(clinicaltrials.gov ID: NCT03262662). Participants were asked to abstain from cigarettes
overnight before they completed a 36-trial laboratory choice paradigm (CBUCC; Gass
and Tiany, 2017) ~1 week before the rst treatment visit, at which a saliva sample
was collected for subsequent NMR (cotinine/3-hydroxycotinine) assay. On each trial,
participants reported cigarette craving during cue presentation (cigarette, food, or water)
and spent $0.01-0.25 to have a chance (5%-95%) to sample a cue (1 pu, bite, or sip).
Results: Consistent with prior work, both spending and cigarette craving were greater
for cigarette cues compared to water cues (ps ≤ .001), and female and Caucasian par-
ticipants demonstrated faster (log-transformed) NMR than male and African-American
participants respectively (ps = .001 and .004). However, contrary to our hypotheses,
faster nicotine metabolism was not associated with greater smoking reinforcement (i.e.,
spending for cigarettes relative to water; r = -0.12) or greater cue-reactivity (i.e., cigarette
craving during cigarette cues vs. water cues; r = .03). Conclusions: The present study
replicated basic experimental eects on reinforcement and craving, as well as expected
relationships between the NMR and participant sex and race. Despite the large sample
size and rigorous laboratory assessment of smoking reinforcement and cue-reactivity,
there was no evidence that faster NMR is associated with greater smoking reinforcement
or cue reactivity in treatment-seeking smokers.
FUNDING: Federal
PS1-40
BIORELEVANT IN VITRO RELEASE TESTING OF ALTERNATIVE
NICOTINE DELIVERY SYSTEMS (ANDS)
Laure A. Keatts, Adam C. Pearcy, PhD, Matthew S. Halquist, PhD. VCU School of
Pharmacy, Richmond, VA, USA
According to the Food and Drug Administration, each day over 800 youth will try
smokeless tobacco (ST) or oral nicotine products (ONPs). Therefore, it is important to
fully characterize these products for potential exposure and toxicity, and facilitate the
regulator policy decisions to promote public health. Characterization can be considered
in two approaches, 1) characterizing the product itself, or 2) biomarkers of exposure.
Alternative nicotine delivery systems (ANDs) come in many forms but oral nicotine
products are gaining popularity among youth are as of yet, not regulated as closely as
traditional smokeless tobacco or combustible tobacco products. These oral nicotine
pouches are available in many avors, and according to referenced Nielsen data on
the truth initiative site, sales increased 470% for Zyn nicotine pouches over the rst
part of 2020. Therefore, potential exposure (i.e., nicotine release) from noncombustible
tobacco products will facilitate regulatory decisions. In vitro dissolution, release and
permeation testing is a common practice during drug product research and development.
We integrated a previously optimized bidirectional apparatus to evaluate the release
of nicotine from ONPs and compared to smokeless tobacco (ST). This novel in vitro
device, the bidirectional transmucosal apparatus (BTA), was designed and fabricated
to simulate the oral cavity and its physiological variables to evaluate ONPs and ST in
a more realistic fashion. The BTA was evaluated with various ONPs and Camel Snus.
A validation was performed using high performance liquid chromatographic (HPLC)
method with photodiode array (PDA) detection to assess in vitro nicotine release and
permeation (Linearity: 0.4 - 500 μg/mL). Further, future studies of the apparatus will
include dierent BTA parameters for their impact on in vitro rate of nicotine permeation
that can be employed for the optimization of an in vitro in vivo relationship (IVIVR) for
ONPs such as media temperature, adipose tissue simulation, articial saliva versus
hanks balanced salt solution. A multifactorial experimental design integrating these
parameters alongside ow rate variations will be tested. The application of the bidirec-
tional transmucosal apparatus for other types of ONPs including other avors will also
be further investigated.
FUNDING: Federal
PS1-41
EFFECT OF CIGARETTE SMOKING ON M1/M2 TYPE ALVEOLAR
MACROPHAGE (AM) AND THE RESTORATION OF AM BY
SMOKING CESSATION
Minoru Takeuchi1, Honami Nakata1, Mayuko Seta1, Kent E. Pinkerton2. 1Kyoto Sangyo
University, Kyoto, Japan, 2University California Davis, Davis, CA, USA.
Introduction: Cigarette smoking is the most important risk factor for pulmonary dis-
ease. Alveolar macrophages (AM) are classied into M1 or M2 type. It’s reported that
immune functions of AM are suppressed by smoking. However, the restoration of AM
after smoking cessation isn’t fully understood. Therefore, we investigated the eect of
cigarette smoking and the restoration of M1/M2 AM by smoking cessation. Materials
& Methods: 8-weeks-old female C57BL/6N mice were used. KENTUCKY Research
CIGARETTE were used. Mice were exposed to the smoke of twenty cigarettes per
day for 10 days by MIPS smoking machine. AM were recovered by Broncho Alveolar
Lavage (BAL) at 1day, from 1 to 8 weeks after smoking. Dot plots and expressions of
cell surface makers (CD11c as M1 marker, CD206 as M2 marker) were analyzed by
FACS. Ultrastructure of AM was analyzed by TEM and SEM. TNF-α mRNA expression
was evaluated by RT-PCR. H2O2 production was measured by FACS using DCF-DA.
Results: Number of AM was increased by smoking. Morphology and Dot plots of AM
were changed by smoking. However, Dot plots were restored to the level of AM in non-
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
smoked mice at 8 weeks after smoking cessation. Ultrastructure of AM was changed
by smoking and restored by smoking cessation. CD206 expression was signicantly
decreased by smoking, but it was restored by smoking cessation at 8 weeks up to
the non-smoke level. CD11c expression was almost unchanged by smoking. TNF-α
mRNA expression was signicantly decreased by smoking. H2O2 production of AM was
increased by smoking and was not restored by smoking cessation. Conclusions: Al-
though morphology and number of AM were changed by smoking, these changes were
restored by smoking cessation. CD206 positive cells as M2 type was strongly aected
but not CD11c positive cells as M1 type AM by smoking. However, H2O2 production
and TNF-αmRNA expression were not restored by smoking cessation. These results
suggest that non-restoration of functions in M1 and M2 type AM by smoking cessation
may be contribute to development in pulmonary disease by smoking.
FUNDING: Academic Institution
PS1-42
CIGARETTE AND ENDS CUE REACTIVITY DURING A GLOBAL
PANDEMIC: THE INFLUENCE OF COVID-19
Emma Brett, Zoe Lee, Andrea King. University of Chicago, Chicago, IL, USA.
Signicance: Electronic Nicotine Delivery Systems (ENDS) have evolved rapidly since
their inception, and visual exposure to their use has been shown to act as a smoking cue.
As the spread of COVID-19 has been determined to be largely by aerosol transmission,
we examined whether the strength of ENDS as smoking cues would be aected by
the pandemic. The current study examined whether visual exposure to ENDS use in
a laboratory setting increased desire for cigarettes and e-cigarettes compared with a
neutral and active control cue. Methods: The study included N=53 smokers [57% female,
mean age 35 (range 19-59 yrs)] tested from September-December 2020. They attended
two in-person sessions with an active cue (e.g., cigarette or ENDS use) or a neutral
cue (bottled water drinking) delivered in each session. The cues were 5-minute videos
showing product use (cigarette, ENDS, or water) that included identical settings and
actors. Both participant and researcher wore personal protective equipment (e.g., masks,
face shield, scrubs) and practiced social distancing. Main outcomes were pre-post cue
changes in smoking urge, cigarette and e-cigarette desire, and smoking behavior as
assessed using the Smoking Lapse Paradigm. Results: In contrast to ndings from
previous studies prior to the COVID pandemic, neither the cigarette or ENDS cue elicited
smoking urge [Mincrease = 2.0 vs. 0.8 (water), p=0.60], cigarette desire [Mincrease = 2.5 vs.
2.4, p=0.15], or e-cigarette desire [ Mincrease = -0.7 vs. 0.4, p=0.07]. Regarding smoking
behavior, 70% of smokers choosing to smoke during the Smoking Lapse Paradigm
[median latency = 19.0 minutes vs. 19.4 (post-water cue)]. Conclusions: In contrast
to prior studies, cigarette smokers tested during the pandemic were not reactive to
cigarette or ENDS cues. In light of COVID-19, changes were made to the original study
protocol to adhere to COVID safety guidelines. We speculate that the lack of potency
of ENDS, and even cigarette cues, in the study conducted during the pandemic may
be due to the more sterile environment, societal concerns about respiratory aspects of
virus transmission, and/or less frequent cues observed in everyday life.
FUNDING: Federal
PS1-43
COMPARISON OF DIFFERENT CYTOTOXICITY ASSAYS FOR THE
ASSESSMENT OF TOBACCO RELATED PRODUCT TOXICITY
Massimo Caruso1, Rosalia Emma1, Sonja Rust2, Alo Distefano1, Giuseppe Carota1,
Roberta Pulvirenti1, Riccardo Polosa3, Giovanni Li Volti1. 1University of Catania - Depart-
ment of Biomedical and Biotechnological Sciences, Catania, Italy, 2Center of Excellence
for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania,
Italy, 3University of Catania - Department of Clinical and Experimental Medicine, Cata-
nia, Italy.
Background: Electronic Nicotine Delivery Systems (ENDS), i.e., electronic-cigarettes
(e-cigs) and Tobacco Heating Products (THPs), are rapidly growing in popularity. None-
theless, comprehensive quality and safety requirements for regulatory purposes are still
under development. Cytotoxicity studies are important preliminary steps in appraising
the potential ENDS toxicity. Currently, neutral red uptake (NRU) is the most used assay
for cytotoxicity evaluation in the context of tobacco and alternative products testing.
The aim of the present study was to screen dierent in vitro cytotoxicity methods for the
assessment of ENDS toxicity.Methods: We performed NRU, MTT, Annexin V apoptosis
(AN-V), High-Content Screening (HCS) assays and Real-Time Cell Analysis (RTCA), to
compare two e-cigs and two THPs with the 1R6F reference tobacco cigarette. Human
bronchial epithelial cells (NCI-H292) were exposed to tobacco cigarette (1R6F) smoke
and ENDS vapor at air-liquid interface.Results: All tests showed reduced cell viability
following 1R6F smoke exposure, from no viable cells (by RTCA) to 61.03 ± 17.22 % of
viable cells, at 24 hours. In comparison to 1R6F smoke exposure, vapor ENDS exposure
showed an increased viability with all the methods, ranging from 26.64% to 100% cell
viability, depending on the method, at 24 hours.Conclusion: Each method used to eval-
uate cytotoxicity has its own peculiarities. AN-V and RTCA exhibited a further signicant
reduction in cell viability following 1R6F exposure. AN-V allowed to discriminate viable
cells from those in early/late apoptosis. RTCA and HCS being time-resolved analyses
elucidate the kinetic dependency parameter for toxicity of smoke/vapor chemicals on
cell viability. In conclusion, NRU assay may be considered a suitable test, especially
when combined with a time-resolved analysis, for assessing the kinetic of cytotoxicity
induced by these products. However, the use of AN-V, or similar methods to evaluate
viable/necrotic/apoptotic cells, in addition to the classic NRU assay, can increase
toxicological sensitivity.
FUNDING: Other
PS1-44
MOTIVATING CHANGE IN OLDER ADULTS: MOTIVATIONAL
CESSATION MESSAGE DEVELOPMENT FINDINGS
Adrienne L. Johnson1, Carey E. Gleason2, Jessica Cook1, Jane E. Mahoney2, Megan
E. Piper1. 1University of Wisconsin School of Medicine and Public Health - Center for
Tobacco Research and Intervention, Madison, WI, USA, 2University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA.
Signicance: 18 million American adults >45 years old smoke and are at elevated risk
for the greatest age-related fear of older adults: dementia. Compared to younger adults,
OAS are half as likely to make a quit attempt, but more likely maintain abstinence
using evidence-based smoking treatments (EBSTs), illustrating the need for motiva-
tional messages to promote cessation EBSTs. A possible message is the association
between smoking and dementia. Methods: 17 White adults, ages 50-73 years, 82.4%
women, without dementia, who smoke M=16.2 CPD (SD=10.6) completed a 2-hour
semi-structured interview and survey via telephone. We are working with community
partners to collect data from non-white OAS. We used rapid analysis of transcribed
interview recordings and descriptively analyzed self-report data to develop a motivational
message for cessation in OAS. Results: Despite awareness of multiple health-related
consequences of smoking and existing cessation ads, most OAS are unmotivated to quit
due to desire for independence, imperviousness to listed conditions, delayed benets of
quitting, and uncertainty about how to cope with stress. Most OAS were unaware of the
smoking-dementia relation, and after brief psychoeducation, some expressed frustration
of this lack of information. OAS felt this message is important to disseminate and more
motivational than past cessation ads. Most were aware of smoking cessation medication
from personal/relations past use, but previous negative side eects, cessation failure,
and cost were barriers to future use. Many had not considered cessation counseling
and were unaware how to access it. Many OAS reported willingness to use at least 1
EBST in future quit attempts. Survey data supported qualitative ndings: 11.8% agreed
smoking increased dementia risk, 5.9% believed cessation decreased dementia risk;
58% of OAS were ‘extremely likely’ to use EBSTs while quitting, but only 17.6% reported
EBSTs are ‘extremely helpful’ in quitting. Conclusion: Dementia is an important health
consequence for OAS, but the impact of smoking on dementia is unknown to them; this
relation should be disseminated as a motivating message for cessation.
FUNDING: Federal; Academic Institution
PS1-45
PROMOTION OF CIGAR PRODUCTS IN INSTAGRAM “STORIES”
Daniel P. Giovenco1, Ollie Ganz2, Torra E. Spillane1, Zeinab Sa2, Eugene Talbot2,
Olivia A. Wackowski2, Cristine D. Delnevo2, Jane Lewis2. 1Columbia University Mailman
School of Public Health, New York, NY, USA, 2Rutgers Center for Tobacco Studies,
Rutgers University, New Brunswick, NJ, USA.
SIGNIFICANCE: Cigar companies actively promote their products on Instagram, a
popular social media platform among young people. Instagram’s “stories” feature - which
displays ephemeral content that disappears after 24 hours - presents challenges for
tobacco marketing surveillance and regulatory eorts. We conducted a content analy-
sis of stories posted by leading cigar brands to identify common marketing strategies.
METHODS: In June 2021, we took daily screenshots of stories posted by 8 leading
cigar brands in the US (n=104), which had “follower” counts ranging from 3,000 to
430,000 (median: 52,000). Stories were coded for features such as: warning statements,
interactive engagement with users (e.g., polls, open-ended questions), promotion of
various product features (e.g., avors, packaging), and nature-related imagery. Analy-
ses characterized popular marketing techniques and examined dierences by brand.
79
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
RESULTS: Over half of stories were posted by the brands Dutch Masters (34%) and
Backwoods (28%). Warning statements were present on 82% of stories; of these, most
were displayed in small, oating boxes (75%) or written with the Instagram text function
(11%). Two-thirds of stories (66%) included interactive engagement features, such as
polls (35%) and quizzes (13%). Half promoted an explicitly-avored product (e.g., Ripe
Berry) and 12% featured an implicit avor (e.g., Blue Dream Fusion). Nature-related
imagery - such as beaches, mountains, and forests - was prominent in nearly a third
(32%) of stories. Less common elements included branded merchandise (13%) and
sweepstakes/giveaways (9%), although the brands Swisher Sweets, Cheyenne, and Al
Capone more often employed these tactics. CONCLUSION: Cigar companies leverage
Instagram stories to engage with consumers and promote their products - especially
avored varieties - to hundreds of thousands of platform users. Findings from this study
provide insight into ephemeral tobacco brand content on Instagram and can help inform
regulation of tobacco industry marketing on social media more generally.
FUNDING: Federal
PS1-46
ASSOCIATION OF ELECTRONIC CIGARETTE USE WITH
RESPIRATORY SYMPTOM DEVELOPMENT AMONG US YOUNG
ADULTS AGES 18-24 YEARS
Wubin Xie1, Alayna P. Tackett2, Jonathan B. Berlowitz1, Alyssa F. Harlow3, Hasmeena
Kathuria4, Panagis Galiatsatos5, Jessica Fetterman6, Junhan Cho2, Michael J. Blaha7,
Naomi M. Hamburg6, Rose Marie Robertson8, Andrew P. DeFilippis9, Michael E. Hall10,
Aruni Bhatnagar11, Emelia J. Benjamin3, Andrew Stokes1. 1Department of Global Health,
Boston University School of Public Health, Boston, MA, USA, 2Department of Preventive
Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,
USA, 3Department of Epidemiology, Boston University School of Public Health, Boston,
MA, USA, 4The Pulmonary Center, Boston University School of Medicine, Boston, MA,
USA, 5Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Balti-
more, MD, USA, 6Evans Department of Medicine and Whitaker Cardiovascular Insti-
tute, Boston University School of Medicine, Boston, MA, USA, 7Ciccarone Center for
the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Balti-
more, MD, USA, 8American Heart Association Tobacco Regulation and Addiction Center,
Dallas, TX, USA, 9Department of Medicine, Vanderbilt University Medical Center, Nash-
ville, TN, USA, 10Division of Cardiovascular Diseases, School of Medicine, University of
Mississippi Medical Center, Jackson, MS, USA, 11Department of Medicine, University
of Louisville, Louisville, KY, USA.
SIGNIFICANCE Electronic cigarette (e-cigarette) use is highly prevalent among young
adults. However, longitudinal data assessing the association between e-cigarette use
and respiratory symptoms are lacking. The study aimed to determine whether e-ciga-
rette use is associated with the development of respiratory symptoms in young adults.
METHODS Data are derived from the Population Assessment of Tobacco and Health
(PATH) Study (Wave 2, 2014-2015; Wave 3, 2015-2016; Wave 4, 2016-2018; Wave 5
2018-2019), a nationally representative cohort of US adults. Young adults aged 18-24
years at baseline with no prevalent respiratory disease or wheezing symptoms were
included in the analyses. Binary logistic regression models with a generalized estimating
equation were tested to estimate time-varying and time-lagged associations of e-ciga-
rette use during Waves 2 to 4 with respiratory symptom development about 12 months
later at Waves 3 to 5. Main outcome assessments included self-reported respiratory
symptoms in the past 12 months, including wheezing or whistling in the chest, wheezing
during exercise, dry cough at night, and a composite outcome consisting of all three
respiratory symptoms. RESULTS Of 6378 respondents included in the analyses, 3247
(49%) were women, 4076 (70%) were White, 1072 (15%) were Black, and 905 (15%)
were from other racial groups. The per-wave prevalence of former and current e-cig-
arette use was 15.2% and 5.6%, respectively. Former e-cigarette use was associated
with higher odds of developing any respiratory symptom (adjusted-Odds Ratio [aOR],
1.20; 95% CI, 1.04-1.39), and wheezing in the chest (aOR, 1.41; 95% CI, 1.08-1.83) in
multivariable adjusted models. Current e-cigarette use was associated higher odds for
any respiratory symptom (aOR, 1.32; 95% CI, 1.06-1.65), and wheezing in the chest
(aOR, 1.51; 95% CI, 1.06-2.14). Associations persisted among participants who never
smoked cigarettes. CONCLUSION In this nationally representative cohort of young
adults, former and current e-cigarette use was associated with higher odds of devel-
oping wheezing-related respiratory symptoms, after accounting for cigarette smoking
and other combustible tobacco product use. Our ndings provide new evidence of a
prospective association between e-cigarette use and respiratory symptoms, highlighting
the potential respiratory risks of e-cigarette use, with or without concurrent combustible
cigarette smoking.
FUNDING: Federal
PS1-47
SHISHA SMOKING AMONG MEDICAL AND DENTAL STUDENTS
OF ISLAMABAD MEDICAL AND DENTAL COLLEGE;
PREVALENCE, KNOWLEDGE AND PRACTICE
Rabia Tassaduq. Islamabad Medical & Dental College, Islamabad, Pakistan.
SIGNIFICANCE: Shisha smoking has known harmful eects on both general and oral
health; however, its prevalence is on the rise worldwide, particularly among college going
youth. In order to design interventions aimed at curbing this unhealthy trend, we need to
identify the factors that contribute to its propagation. More specically, whether a lack of
knowledge of its harmful eects is leading to the increase in its prevalence. Moreover,
identifying patterns related to age of initiation, inuencing factors and most popular
location will inform intervention design as well as policy making. Thus, we studied the
prevalence, knowledge and practice of shisha smoking among students of Islamabad
Medical & Dental College.METHODS: A cross-sectional survey was conducted at IMDC
in Mar-Apr 2021. A pilot tested, self-administered questionnaire was emailed to medical
(n=500) and dental (n=200) students, consisting of questions on demographics, shisha
smoking practice, shisha smoking & general health, shisha smoking and oral health,
and its association with use of other tobacco products. RESULTS:Questionnaire was
reliable (Cronbach’s alpha of 2 subscales was 0.816 & 0.773). Overall response rate
was 67.71%. The prevalence of shisha smokers was 22.6%; of whom 76.63% were
from MBBS (p-value= 0.000). None of the rst-year students reported smoking shisha.
52.34% of smokers started smoking at the age of 17 - 18 years. 94.73% of students
believed that shisha was harmful to general health and 37.13% students considered it
more dangerous than cigarette smoking. 87.12% of students believed shisha smoking
to be a risk factor for oral cancer while 82.91% considered it to be associated with
inammation of gums. The most common symptoms experienced during shisha smok-
ing included headache 16.75% and dizziness 17.48%. Twice as many MBBS students
11.78%) reported using cigarettes as compared to BDS students 4.28% (p-value =
0.023). CONCLUSION: Given the age of initiation and friends being the main inuence,
appropriate interventions based on health behavior models taking into consideration
peer inuences need to be implemented in order to curb this unhealthy trend.
FUNDING: Unfunded; Academic Institution
PS1-48
ASSOCIATIONS OF RACE AND ETHNICITY WITH TOBACCO
MESSAGING EXPOSURES AND TOBACCO USE AMONG
BISEXUAL WOMEN
Brittney Keller-Hamilton1, Elise Stevens2, Amelia Wedel3, Devin LaPolt1, Alexis
Miranda1, Theodore Wagener1, Joanne Patterson1. 1The Ohio State University, Colum-
bus, OH, USA, 2University of Massachusetts, Worcester, MA, USA, 3Syracuse Univer-
sity, Syracuse, NY, USA.
Signicance. Within the lesbian and bisexual (LB) community, bisexual women have
the highest prevalence of tobacco use, and Black and Latina LB women are much more
likely to use tobacco than their heterosexual peers. Research on tobacco use among
bisexual women is limited to descriptions of prevalence in this population. We evaluated
associations between race/ethnicity, exposure to pro- and anti-tobacco messages, and
tobacco use outcomes among bisexual women. Methods. We recruited a sample of
N=382 bisexual women in the United States using the online survey platform, Prolic,
which has similar data quality to probability samples. Participants reported sociodemo-
graphics, exposure to pro- and anti-tobacco messaging, receipt of coupons, and ever
and current use of cigarettes, e-cigarettes, and other tobacco products. We modeled
associations between race/ethnicity, pro- and anti-tobacco messaging exposures, and
tobacco use outcomes. Results. Unadjusted results indicated dierences in prevalence
of tobacco use by race/ethnicity, with White women having higher prevalence of ever
using each product, but Black women having the highest prevalence of current cigar
smoking and any tobacco use. Associations between race and tobacco use were atten-
uated in adjusted analyses. Receiving coupons was strongly associated with current use
of cigarettes (aOR=8.02; 95% CI [3.55, 18.1]), e-cigarettes (aOR=7.26; 95% CI [3.55,
14.9]), and any tobacco (aOR=5.04; 95% CI [2.44, 10.4]). Conclusions. Unadjusted
dierences in prevalence of tobacco use across race/ethnic groups were attenuated
after controlling for pro- and anti-tobacco messaging exposures. Receiving tobacco
coupons was consistently associated with current tobacco use among bisexual women.
Restrictions on coupons could promote equity.
FUNDING: Federal; Academic Institution
80
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-49
KNOWLEDGES, PRACTICES, AND REASONS OF HOOKAH
SMOKING IN THE UNITED ARAB EMIRATES
Sumer Baroud. University of Sharjah, College of Medicine, Sharjah, United Arab Emir-
ates.
Signicance, Methods, Results, and Conclusion sections Signicance: Hookah
smoking has been increasing in the past few years in the United Arab Emirates (UAE)
and has become a public health concern. The objective of the study was to assess the
knowledge, practices and reasons of hookah smoking among UAE residents. Methods:
A cross-sectional study design was implemented using a structured and validated
self-administered survey. Results: A total number of 420 participations were included
in the study, of which 54.5% (n = 229) were males. The prevalence of smoking hookah
was 37.7% (n = 158) and more prevalent among people aged 18-29 years (n = 99,
41.6%), Arab non-Emiratis (n = 112, 42.6%) and cigarette smokers (n = 54, 49.1%), p <
0.05. The most common reasons for hookah smoking were enjoyment (n = 107, 67.7%),
peer inuence (n = 99, 61.4%, n) and as an aid of stress relief (n = 41, 25.9%). Hookah
smoking was more likely to be carried out in cafés (n = 127, 80.4%), and with friends (n
= 140, 88.6%). Compared to smoking cigarettes, only 23% (n = 97) of the participants
thought that smoking hookah is more likely to cause addiction and 46.4% (n = 157)
thought that hookah contains more nicotine. Conclusion: Enjoyment and peer inuence
were the most common reasons for hookah smoking, with cafes and restaurants being
the most common places to share this practice. Hookah smoking was prevalent among
young adults with misconceptions and poor knowledge of its, solidifying the need for
health education and enforced implementations of laws to limit hookah smoking.
PS1-50
DIFFERENCES BETWEEN INTERMITTENT AND DAILY SMOKERS
IN AN URBAN MULTI-ETHNIC ASIAN POPULATION: FINDINGS
FROM SINGAPORE
Jeong Kyu Lee, Lavinia Lin. National University of Singapore, Singapore, Singapore.
Signicance: Whereas intermittent (nondaily) smokers are substantially dierent from
daily smokers with respect to individual-level characteristics (e.g., demographics, nicotine
addiction, health beliefs and quit attempts), little is known about social environmental
characteristics of intermittent smokers in a multi-ethnic Asian population. This study as-
sessed potential discrepancies in interpersonal communication, media exposure, social
capital and social norms between intermittent smokers and daily smokers in Singapore,
a multi-ethnic Asian urban state. Methods: Data from the 2019 Singapore Smokers
Survey (N=2,015, ages 19 - 69 inclusive) were used to compare intermitted smokers
(n=434) with daily smokers (n=1,581) in terms of various social environmental variables
including interpersonal communication, media exposure, social capital and social norms.
Multivariable logistic regression was carried out to examine the relationships of smoking
status (intermittent smokers vs. daily smokers) to the social environmental variables.
Using the forward entry approach (with entry probability xed at p < 0.10), we built a
parsimonious logistic regression model that estimated adjusted odds ratios (AOR) and
95% condence intervals (CI). Variables were selected for entry and/or deletion based
on the model t comparisons by utilizing the likelihood ratio tests (LRT). Results: In
this sample, 22% of adult smokers were intermittent smokers. In comparison to daily
smokers, they were characterized by stronger perceived disapproval of smoking by
their family members (AOR = 1.70; 95% CI: 0.96 - 3.02), lower perceptions of smoking
prevalence (AOR = 0.51; 95% CI: 0.40 - 0.66), and more active social participation
(AOR = 2.02; 95% CI: 1.53 - 2.58). In addition, intermittent smokers were more likely to
engage in conversations about quitting (AOR = 2.10; 95% CI: 1.61 - 2.73). Our results
also showed that they perceived lower risk of intermittent smoking compared to daily
smokers (AOR = 1.60; 95% CI: 1.27 - 2.02). Conclusion: Intermittent smokers were
found to dier from daily smokers in terms of interpersonal communication, social norms,
social participation and risk perceptions. Findings from the study provide important im-
plications for designing and implementing targeted cessation interventions and tobacco
control policies in Singapore and the region.
FUNDING: Academic Institution
PS1-51
USE AND RISK PERCEPTIONS OF LITTLE CIGARS AND
CIGARILLOS DURING COVID-19 AMONG A NATIONALLY-
REPRESENTATIVE SAMPLE OF YOUNG ADULTS
Eugenia Lee1, Stephanie P. Moore2, Kymberle Sterling1. 1University of Texas Health
Science Center at Houston, School of Public Health, Dallas, TX, USA, 2Case Western
Reserve University, Prevention Research Center for Healthy Neighborhoods, Cleve-
land, OH, USA.
Background: Understanding how the COVID-19 pandemic has changed young adults’
perceptions and the use of little cigars and cigarillos (LCCs) can inform the development
of policies and interventions to reduce LCC use. This study explored the association
between changes in LCC behaviors during pandemic and risk perceptions of having
COVID-19 due to LCC use among U.S. young adults. Methods: A nationally represen-
tative sample of 18-34-year-old (n=1,189) completed an online assessment as a part of
the Wave 2 survey administration (October to November 2020) of the C’RILLOS Project.
Weighted estimates assessed LCC use and COVID-19 risk perceptions. Results:
Among past 6-month LCC users (n=418), 14.5% had only used LCCs “as sold” with
tobacco (i.e., “CAI-only” users), 38.0% had only used LCCs as blunts (i.e., “CAB-only”
users), and 47.4% were dual users who had used LCCs both as CAI and CAB. Dual
users reported a signicantly higher level of agreement to smoking more CAI and CAB
than usual because of COVID-19 compared to CAI-only users and CAB-only users (ps
<.05), respectively. Among CAI-only users, endorsing smoking less CAI than usual and
trying to quit CAI because of COVID-19 were associated with having the perception that
occasional LCC use increases the risk of having COVID-19 (ps <.05). Among CAB-only
users, endorsing smoking less CAB than usual (p =.01) and trying to quit CAB because
of COVID-19 (p < .01) were associated with having the perception that occasional LCC
use increases the risk of having COVID-19. Conclusions: Changes in LCC behaviors
among our sample of young adults during the pandemic were signicantly associated
with risk perceptions of having COVID-19. A focused communication targeting young
adult LCC users should address the health risks of LCCs related to COVID-19. Signif-
icance: Study ndings highlight changes in LCC use behaviors among a vulnerable
subgroup during the COVID-19 pandemic. The impacts of the pandemic on LCC use
should be considered and inform the development of tobacco regulatory policies and
interventions to reduce LCC use and the burden of the pandemic.
FUNDING: Federal
PS1-52
A LONGITUDINAL EXAMINATION OF RACIAL DIFFERENCES IN
THE EFFECT OF SMOKING HISTORY ON CHANGE IN SYSTEMIC
INFLAMMATION IN OLDER ADULTS
Nancy C. Jao1, Moin Vahora2, Marcia M. Tan3. 1Warren Alpert Medical School Brown
University and The Miriam Hospital, Providence, RI, USA, 2University of Illinois Urba-
na-Champaign, Urbana, IL, USA, 3University of Chicago, Chicago, IL, USA.
Signicance: Although smoking cessation is associated with a decrease in c-reactive
protein (CRP), a biomarker for systemic inammation, CRP levels long term post-ces-
sation remain higher compared to never smokers - suggestive of increased cancer risk
despite cessation. African Americans have also been shown to have higher levels of
inammation compared to Whites in non-smokers, but the association of CRP and race
has not been examined in adults with history of smoking. Methods: The current study
examined the eect of race and cigarette smoking history on CRP in the Health and
Retirement Study, a longitudinal cohort of older adults. CRP from dried blood spots,
demographic variables, and smoking status were gathered at each assessment (2006,
2010, 2014). Linear mixed models were used to examine the eect of smoking and
race on log-transformed CRP across timepoints, controlling for education, sex, year
born, BMI, and cancer diagnosis. Results: Of the 2044 participants (Mage=64.5±9.3
years old, 47.8% Female), 13.9% identied as non-Hispanic Blacks (NHB) and 86.1%
as non-Hispanic Whites (NHW) with 37.8% and 23.7%, respectively, reporting cigarette
use in 2006. NHB had signicantly higher levels of CRP than NHW at baseline (p<.001).
Overall, multivariable analyses found no signicant eects of race (p=.499) or current
cigarette smoking (p=.120); rather sex (p<.001), smoking history (p<.001), education
(p<.001), and BMI (p=.012) predicted CRP levels, controlling for cancer status and
age. When analyzing races separately, current cigarette smoking (p=.010), smoking
history (p<.001), education (p<.001), sex (p<.001), and BMI (p=.008) were predictive
of CRP levels in NHW. However, only sex (p=.001) and BMI (p=.044) were predictive
of CRP levels in NHB. Conclusion: Race and smoking status did predict CRP levels of
systemic inammation overall, but when examining races separately, current cigarette
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
smoking was predictive of CRP levels in NHW but not in NHB. Our results suggest that
sociodemographic (i.e., sex, BMI) may be especially important in explaining inamma-
tion-related disease risk in NHB adults with a history of smoking.
FUNDING: Federal
PS1-53
USING INSTAGRAM TO REFER TEENS TO TEEN.SMOKEFREE.
GOV
Chris Hollenback1, Douglas Jorenby2. 1University of Wisconsin Center for Tobacco
Research and Intervention, Madison, WI, USA, 2University of WI Medical School, Madi-
son, WI, USA.
Signicance. After YouTube, Instagram is the platform most used by American teen-
agers (72 percent), according to the Pew Institute (2018). Teens are 2.5 times more
likely to click through Instagram ads than on other social platforms (Fortune survey).
Additionally, more teens say they use social media daily (63 percent) than watch TV
(56 percent, often sans commercials, Common Sense Survey, 2019 data). In 2020, the
National Institutes of Health (NIH) asked states to refer teens to their website: teen.
smokefree.gov. The goal was not only to steer teens to the site but also to track whether
the methodology was successful for an audience that can be challenging to reach via
traditional media methods. Methods. The University of Wisconsin placed ads on Insta-
gram. The ads featured still images and text; they linked to teen.smokefree.gov, which
features a texting program known as SmokeFreeTXT. From May 5-12, 2020, Wisconsin
teens saw one or more of three versions of the ad, created by NIH, featuring: 1) A teen
looking at her phone with a printed testimonial, “I signed up for SmokeFreeTXT. I was
skeptical, but it actually helped me keep going.” 2) A view of a teen’s phone playing
music titled, “Smokefree Jams.” 3) A vending machine depicting objects that resemble
candy bars but are labeled, “SLIP,” “Crave,” and “Mood.” Results. The vending machine
ad generated the most overall clicks (802) but was least cost-eective ($7.17 per click).
“Smokefree Jams” was the most cost-ecient ($6.30 per click) but had the second-most
total clicks (734). The testimonial ad garnered by far the least clicks (335, $7 per click).
Instagram costs-per-click are variable based on dynamic factors, so we report average
cost-per-click. In all, more than 1800 teens clicked on the ads. The campaign reached a
total of 180,096 teens and appeared on their screens a combined 2.1 million times. In
all, the campaign cost $13,285, or $7 per click. That cost per click pales in comparison
to $1,834—or the amount the University of Wisconsin estimates smoking costs one
U.S. smoker every year in healthcare costs. Conclusion. Instagram appears to be a
reasonably cost-eective way to quickly reach a lot of teens to steer them toward a
public health intervention.
FUNDING: Federal; State
PS1-54
WHY DO SMOKERS USE E-CIGARETTES? A STUDY ON
REASONS AND NICOTINE CONSUMPTION AMONG DUAL USERS
Allison A. Temourian, Anna V. Song, Deanna M. Halliday, Mariaelena Gonzalez, Anna
E. Epperson. University of California, Merced, Merced, CA, USA.
Signicance: There is minimal research that has measured motivations behind e-ciga-
rette use and the relationship to dual use of cigarette and e-cigarette use. The aim of this
study was to (1) examine extent to which motivations to use e-cigarettes varies among
dual users and (2) examine whether e-cigarette motivations are related to e-cigarette and
cigarette consumption among dual users. Methods: Adults residing in California were
recruited through social media (n = 1,762, 68.9% males, 62.9% non-Hispanic White)
to complete an online survey. Participants self-identied as combustible cigarette and
e-cigarette dual users and reported their motivations for using an e-cigarette device,
nicotine consumption, and nicotine dependence with both combustible cigarettes and
e-cigarettes. Results: A greater proportion of people reported using e-cigarettes for
enjoyment purposes than other motivations (34.2%). Motivations to use e-cigarettes to
quit were positively related to monthly cigarette consumption (IRR = 1.12, 95% CI [1.04,
1.21]). Motivations to use e-cigarettes to quit smoking were also related to smoking the
rst cigarette within 30 minutes (IRR = 0.83, 95% CI [0.72, 0,95]) and rst e-cigarette
within 30 minutes (b = -0.69, 95% CI [-0.87, -0.51]). Conclusions: Compared to those
who use e-cigarettes for enjoyment, smokers who are motivated to use e-cigarettes
for cessation purposes are more likely to have greater nicotine dependence, cigarette
consumption, and e-cigarette consumption. Future research needs to acknowledge
that not all e-cigarette users are the same; motivations and use dier and are related
to both consumption and dependence.
FUNDING: State
PS1-55
CIGARETTE SMOKING AFTER SURVIVING BREAST CANCER: A
PILOT STUDY
Ban A. Majeed, Deepak N. Ayyala, Steve Coughlin. Augusta University, Augusta, GA,
USA.
Background: Quitting smoking improves cancer survival and improves symptoms of
cancer and its treatment. Cancer diagnosis presents a powerful motivation for leading
a healthier lifestyle and embracing behavioral changes, such as quitting smoking. Many
smokers quit after a cancer diagnosis, but some survivors continue to smoke. This
study examined the characteristics associated with being a former rather than a current
smoker among women treated for breast cancer. Methods: In this pilot, cross-sectional
study, data were collected via postal surveys in women who had a history of smoking
and breast cancer (N=69). Descriptive and logistic regression analyses were conducted
to identify factors associated with smoking status. Results: Of this sample, 13 were
current smokers and 56 were former smokers. Age, race, education, and employment
status were not associated with smoking status. Women with a higher income were
signicantly more likely to have successfully quit smoking (former smoking OR= 5.94,
p<0.05). Most women were light smokers and reported intentions to quit. Conclusion:
The study attests to the addictive nature of smoking and the diculty in achieving
successful quitting even after breast cancer diagnosis. Results highlighted the role of
low income as a barrier in smoking cessation. A follow up study is warranted to uncover
potential barriers to smoking cessation in order to individualize tobacco treatment to
meet the needs of motivated light smoking cancer patients. Implications for Practice:
Intensive innovative tobacco treatment approaches are warranted, especially to cancer
patients with lower income.
FUNDING: Unfunded; Academic Institution
PS1-56
THE IMPACT OF DEMOGRAPHICS, DEPENDENCE, AND
BIOMARKERS ON TRANSITIONS IN TOBACCO PRODUCT USE IN
A COHORT OF SMOKERS AND DUAL USERS
Fatema Shae-Khorassani1, Megan Piper2, Douglas Jorenby2, Timothy Baker2, Neal
Benowitz3, Todd Hayes-Birchler2, Rafael Meza1, Andrew F. Brouwer1. 1University of
Michigan, Ann Arbor, MI, USA, 2University of Wisconsin, Madison, WI, USA, 3University
of California San Francisco, San Francisco, CA, USA.
Signicance: E-cigarettes have substantially altered patterns of tobacco product use.
Understanding whether and how transitions between cigarette, e-cigarette, and dual
use are associated with sociodemographics, dependence measures, and biomarkers
may improve smoking cessation interventions. Methods: We applied a multistate
transition model to data from 422 adult daily cigarette users and dual cigarette and
e-cigarette users who were followed every 2 months for 2 years. We estimated tran-
sition rates between non-current, exclusive cigarette, exclusive e-cigarette, and dual
use states. We estimated univariable hazard ratios (HR) and condence intervals (CI)
for demographic, dependence measures (including the Fagerstrom Test for Cigarette
Dependence (FTCD), Wisconsin Inventory of Smoking Dependence Motives (WISDM),
and their e-cigarette analogs), biomarkers, spousal behavior, and other measures. Re-
sults: Transitions from dual to exclusive cigarette use (i.e., discontinuing e-cigarettes)
were positively associated with moderate-to-high NNAL (vs low, HR 1.4, 95%CI 1.1,
1.8), high or moderate cigarette WISDM score, using e-cigarettes on only some days
compared to every day, and a high motivation to quit e-cigarettes; and were negatively
associated with having a spouse who vapes (HR 0.6, 95%CI 0.4, 0.9), a high FTCD
or e-FTCD score, vaping within 30 min of waking (HR 0.4, 95%CI 0.3, 0.5), and high
e-WISDM score. Transitions from dual to exclusive e-cigarette use (i.e., discontinuing
cigarettes) were positively associated with any psychiatric history (HR 2.8, 95%CI 1.4,
5.4) and a high motivation to quit cigarettes; and were negatively associated with hav-
ing a spouse who smokes (HR 0.3, 95%CI 0.2, 0.7), moderate-to-high NNAL (HR 0.3,
95%CI 0.2, 0.6), smoking within 30 min of waking (HR 0.2, 95%CI 0.1, 0.4), smoking
≥10 cigarettes/day (HR 0.25, 95%CI 0.1, 0.6), and a high e-cigarette nicotine concen-
tration. Conclusions: Measure of dependence, biomarkers, and spousal behavior are
associated with tobacco use transitions and may inform who is likely to achieve smoking
cessation by using e-cigarettes
FUNDING: Federal
82
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-57
ANATOMY OF TOBACCO PRODUCT USE AMONG US YOUTH:
NATIONAL YOUTH TOBACCO SURVEY, 2011-2020
Rime Jebai1, Olatokunbo Osibogun1, Wei Li1, Prem Gautam1, Zoran Bursac1, Kenneth
D. Ward2, Wasim Maziak1. 1Florida International University, Miami, FL, USA, 2University
of Memphis, Memphis, TN, USA.
Signicance: Tobacco use, which typically begins during adolescence, continues to
be the leading cause of preventable morbidity and mortality in the United States (US).
Cigarette smoking was the most common tobacco product used by US youth until
the last decade, when this quickly started to change following the introduction of new
tobacco products, including e-cigarettes and hookahs. These changes in the youth’s
tobacco use landscape require proper documentation and understanding of tobacco use
trends to devise eective strategies to address them. Therefore, this study examined
temporal trends of exclusive and concurrent use of tobacco products among youth in
the US between 2011-2020. Methods: We used multiple annual datasets from the
National Youth Tobacco Survey from 2011 to 2020 (N=193,350) to examine trends of
current (past 30-day) exclusive, dual, and poly use of tobacco products (i.e., cigarettes,
e-cigarettes, cigars, hookahs, and smokeless tobacco). Joinpoint regression models
were performed to calculate log-linear trends with annual percentage change (APC).
For each time segment, joinpoint analysis provides an estimate of the APC in preva-
lence during that period. We performed stratied joinpoint regression analyses for all
sex, race, and school level (high vs. middle) for tobacco use combinations. Results:
During the past decade, exclusive use of any tobacco product decreased, except for
e-cigarettes, which increased at an APC of 226.8 % during 2011-2014 and 14.6% during
2014-2020. This increase was more pronounced in high school students [APC: 336.6%
(2011-2014); 15.7% (2014-2020)] compared to middle school students [APC:10.4%,
2014-2020], and in males [APC: 252.8% (2011-2014); 14.8% (2014-2020)] compared
to females [13.6% (2014-2020)]. During 2011-2020, upward trends were also noticed
for dual use of e-cigarettes and cigarettes for middle school students (APC: 14.9%) and
high school students (APC: 18.2%); females (APC: 18.5%), males (APC: 13.1%) and
all race subgroups except for non-Hispanic other (APC, White non-Hispanic: 15.5%;
Hispanics: 15.6%; Black non-Hispanic: 22.5%). Poly use of e-cigarettes, cigarettes,
and any other tobacco products increased signicantly for high school students (APC:
53.2%), females (APC: 62.4%) and males (61.3%) during 2011-2014, and only for
White non-Hispanic youth [APC: 48.4% (2011-2014); 3.6% (2014-2020)]. Conclusion:
The emergence of new tobacco products like e-cigarettes in the US market has shifted
the landscape of tobacco use among youth in the last decade towards poly product
use, in which e-cigarettes are a prominent component. Our ndings underscore the
increasing complexity of tobacco use among youth in the US, and the need for strong
policies and regulations adapted to the evolving trends in cigarette and non-cigarette
tobacco products.
FUNDING: Unfunded
PS1-58
DELAY-DISCOUNTING DEMONSTRATES LOWER IMPULSIVITY
LINKED TO A HIGHER LIKELIHOOD OF SUCCEEDING AT
SMOKING CESSATION
Jerrius Jubran1, Ashley Petersen PhD2, Katherine Harrison MPH2, Sharon AllenMD
PhD2. 1Arkansas College of Osteopathic Medicine, Fort Smith, AR, USA, 2University of
Minnesota, Minneapolis, MN, USA.
Signicance: Although seven out of 10 smokers want to quit, 94% of those who attempt
to quit relapse within one year indicating a need to better understand cessation failure.
This study aims to explore the relationship between impulsivity and tobacco use through
a delay-discounting task (DDT) incongruity with a smoking cessation attempt. We hy-
pothesized that lower impulsivity will be positively associated with tobacco cessation
success.Methods: Data are from a parent cessation trial. Subjects were screened,
stratied by sex, and randomized to 12 weeks of placebo or progesterone (PRO) at
baseline with a quit date one week afterward. At weekly visits subjects biochemically
conrmed their smoking status via carbon monoxide with less than or equal to 5 ppm
and no self-reported smoking as being considered abstinent. Subjects also completed a
DDT at screening, week 4, and week 8 using a 27-item Monetary Choice Questionnaire.
This provided subjects with decisions between a small immediate reward (SIR) and a
larger delayed reward (LDR). The discounting rate k was calculated for each subject at
each time point. A larger k indicated more discounting in which the time delays strongly
decreased how much the delayed reward was valued by the participant. We analyzed
the eective delay 50 (ED50), which is the delay at which the LDR loses half its value.
A higher ED50 corresponds to a lower discounting rate. To estimate the association
between ED50 and tobacco cessation success, a logistic mixed model with a subject
random intercept was t controlling for study week, randomization, sex, and age.Results:
For the 181 participants included in the analysis, a doubling of the overall ED50 was
associated with a 1.9% increase in the odds of tobacco cessation (95% CI: 0.3-3.6%
increase; p=0.02). This association was similar regardless of the size of LDR.Conclusion:
In agreement with our hypothesis, lower impulsivity correlated to greater success with
tobacco cessation. Further analysis should investigate how the introduction of dierent
hormones on their own, i.e., PRO aects impulsivity and cessation success.
FUNDING: Federal
PS1-59
THE ASSOCIATION OF EXPOSURE TO AND ENGAGEMENT WITH
TOBACCO-RELATED SOCIAL MEDIA CONTENT WITH INITIATION
OF E-CIGARETTES AMONG USA YOUTHS IN 2013-2015
Adriana Perez, Meagan A. Bluestein, Roi-San NH’pang, Charles E. Spells, Melissa B.
Harrell. The University of Texas Health Science Center at Houston, Austin, TX, USA.
Facebook, Instagram, and Snapchat updated their policies to prohibit brand advertise-
ments for the sale of tobacco and e-cigarettes. Inuencers and tobacco users can still
upload their own posts, photos, or videos of themselves either using or promoting tobacco
product (TP) use. Social media sites have the potential to expose youth to TP-related
content as 51% of the USA teens (13-17 years) visit a social media site daily in 2018.
We sought to evaluate if exposure to and engagement with tobacco-related content on
social media increases the risk of reporting past 30-day e-cigarette and/or combustible
TP use among youth one year later. Longitudinal analyses from the 2013-2016 Popu-
lation Assessment of Tobacco and Health among youth were conducted. Youth never
users of combustible TPs and e-cigarettes in 2013-2015 who reported having a social
media account (ages 12-17; n= 5,576; N= 12,618,794) were followed-up in 2015-2016
to estimate if they initiated past 30-day (i) e-cigarette, (ii) combustible TP, and (iii)
dual combustible TP and e-cigarette use (ages 12-17; n= 5,576; N= 12,618,794). In
2014-2015, two potential risk factors were assessed: (i) “In the past 12 months, have
you seen any tobacco-related content on social media sites?”, and (ii) “In the past 12
months have you posted content about tobacco products on any social media sites?”.
Odds ratios (OR) and 95%CI adjusting for covariates were estimated from weighted
logistic regression models. Overall, 2.25% (N= 305,305), 1.81% (N= 246,943) and 2.75%
(N=342,581) of youth reported initiation of past 30-day (i) e-cigarette, (ii) combustible
TP, and (iii) dual combustible TP and e-cigarette use in 2015-2016, respectively. The
odds of past 30-day e-cigarette use was 2.08 times higher in participants who had seen
tobacco-related content on social media as compared to participants who had not seen
tobacco-related content on social media (95%CI 1.44-3.03). Similar odds ratios were
observed for past 30-day (ii) combustible TP use (1.65; 95%CI 1.10-2.46) and (iii) dual
combustible TP and e-cigarette use (1.63; 95%CI 1.12-2.38). Stronger policy-based
solutions are needed to reduce TP content on social media and its impact on TP initiation.
FUNDING: Federal
PS1-60
PERCEPTION OF HARM AND ADDICTIVENESS OF HOOKAH ON
THE AGE OF INITIATION OF HOOKAH USE AMONG USA YOUTH
Adriana Perez1, Arnold E. Kuk1, Meagan A. Bluestein1, Melissa B. Harrell2, Baojiang
Chen1. 1The University of Texas Health Science Center at Houston, Austin, TX, USA,
2The University of Texas Health Science Center at Houston, Austin, TX, USA.
Objective To examine if the interaction between perceptions of harm and addictiveness
of hookah is associated with the estimated age of initiation of hookah use among youth,
using the national PATH study. Methods Youth never hookah users at the rst wave
of PATH participation (2013-2017) were followed-up between 2014-2019 for the rst
report of three outcomes: (1) ever, (2) past 30-day, and (3) fairly regular hookah use. A
lower bound of the latest age of never use and an upper bound age of the rst report
each outcome was estimated. Two exposures measured at the rst wave of PATH
participation were considered (a) perception of harm (high versus low/medium) and
(b) perception of addictiveness (high versus low/medium). The eect of the interaction
of both perceptions was evaluated with high perception of harm and high perception
of addictiveness as the reference category. Sampling weights, 100-balance repeated
replicate weights from participants’ rst wave of participation and Fay’s factor of 0.3 were
used. Weighted interval-censored survival methods were implemented to estimate the
age of initiation of each hookah use outcome. Weighted interval-censored Cox regression
models with a piecewise constant baseline hazard function were used to evaluate the
association between the interaction of perceptions of harm and addictiveness on the
age of initiation of hookah use outcomes. Adjusted Hazard Ratios (AHR) and 95%CIs
are presented. Results After controlling for sex, race/ethnicity, and use of other tobacco
products, youth who reported both low/medium perception of harm and low/medium
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
perception of addictiveness of hookah were 139% more likely to initiate ever hookah
use (AHR=2.39 95% CI: 2.09-2.74), 125% more likely to initiate past 30-day hookah
use (AHR=2.25 95% CI: 1.65-3.09), and 104% more likely to initiate fairly regular hoo-
kah use (AHR=2.04 95% CI: 1.27-3.28) at earlier ages. Conclusions Communication
and education campaigns are needed to increase the perception of harmfulness and
addictiveness of hookah in youth to prevent earlier age of initiation of this product.
FUNDING: Federal
PS1-61
E-CIGARETTE AND CIGARETTE EXPECTANCY PROFILES
PREDICT FUTURE SMOKING AND VAPING AMONG DUAL USERS
Paul T. Harrell1, Steven Sutton2, Vani Simmons2, Thomas H. Brandon2. 1Eastern Virginia
Medical School, Norfolk, VA, USA, 2Mott Cancer Center, Tampa, FL, USA.
Signicance Beliefs about the outcomes of using e-cigs (i.e., individual e-cig expectan-
cies) are independently associated with quitting smoking. Examining e-cig and cigarette
expectancy patterns simultaneously may provide a more complete understanding, as
well as better predict outcomes of interest. We hypothesize that subpopulations with
more positive beliefs about e-cigs relative to cigs will be more likely to continue to vape,
but also more likely to quit smoking. Methods We conducted a Latent Class Analysis
in Mplus using baseline data from a self-help smoking cessation trial of dual users of
cigarettes and e-cigarettes who completed assessments both at baseline and 24 months
later (N=1618). Secondly, we examined identied classes in relation to demographics,
condition assignment, and vaping/smoking status 24 months post-assessment. We
examined ve expectancy items related to the domains of Positive Reinforcement
(PR), Negative Reinforcement (NR), Weight Control (WC), Negative Consequences
(NC), and Addiction (ADD). Each item was categorized based on scale assessment as
e-cig preference, cig preference, or no preference. The R3Step approach was used to
examine latent class associations with covariates. Results Mplus analyses revealed
a 3-class solution provided the best t as determined by sample-size adjusted Bayes-
ian Information Criteria and Lo-Mendell-Rubin: Ambivalent (AMBV, n=894.1, 55.3%);
E-cig preference (ECIG, n=382.2, 23.6%); and Cig preference (CIG, n=341.7, 21.1%).
Compared to CIG, the ECIG class was more likely to indicate e-cig preference in every
domain (e.g., NR Odds Ratio: 23.8, 95% Condence Interval: 5.7-99.4), although the
dierence for NC was not signicant. These baseline classes signicantly predicted
smoking and vaping status 2 years later, with ECIG signicantly less likely than CIG to
still be smoking, with or without adjustment for treatment condition and other covariates
(Unadjusted OR: 0.3, 95% CI: 0.2-0.5; Adjusted OR: 0.3, 95% CI: 0.2-0.5), but more than
3 times the odds of vaping (OR: 3.2, 2.0-5.2, AOR: 3.1, 1.9-5.3). Conclusion Expectancy
patterns are powerful predictors of future behavior. Positive e-cigarette expectancy pat-
terns are related to higher continued e-cigarette use, but lower cigarette smoking. These
nuanced outcomes highlight the need for careful balance in public health messaging.
Future analyses will examine changes in expectancy patterns over time. Funding: This
work was supported by the National Institute on Drug Abuse (R01DA037961) and the
National Cancer Institute (P30CA076292).
FUNDING: Federal
PS1-62
TOWARDS MORE MEANINGFUL SOCIAL MEDIA ANALYSIS:
CASE STUDY OF USING AN AGE PREDICTION ALGORITHM TO
IDENTIFY AND CODE REDDIT POSTS ABOUT E-CIGARETTES BY
YOUTH VS. ADULTS
Mario A. Navarro1, Andie Malterud1, Zachary Cahn1, Robert Chew2, Caroline Kery2,
Laura Baum2, Thomas Bukowski2, Michael Wenger2. 1Food and Drug Administration,
Silver Spring, MD, USA, 2RTI International, Research Triangle, NC, USA.
Signicance. In social media research, segmenting by user demographics is often nec-
essary to identify target audiences or assess dierences between subgroups. However,
manual identication can be time consuming and inecient. Data science and qualitative
methods can be combined to provide insights on particular audiences and populations.
The current study combines these two approaches to 1) predict Reddit users’ age into two
categories (13-20, 21-54) and 2) qualitatively code Electronic Nicotine Delivery System
[ENDS] related posts. Methods: An algorithm using Reddit metadata was developed
to classify Reddit posts as being created by 13-20 or 21-54 year old users. Three sep-
arate ENDS related search queries were conducted to pull Reddit posts from 9/2019 to
6/2020: general vaping, Tobacco 21 minimum age laws, and avor restriction policies.
The age algorithm was then used to predict Reddit users’ ages. The 25 posts with the
highest karma score (# of upvotes - # of downvotes) for each query and each predicted
age group were qualitatively coded (N = 150). Results. Across the three queries, there
were nine prominently coded themes: Tobacco 21 Policies, Flavor Restriction Policies,
Harm Perceptions, Use, Products, Memes/Jokes, COVID-19, Motivations, and Access.
Tobacco 21 Policy and Flavor Restriction posts were mentioned equally between the
13-20 and 21-54 groups. Opposition to avor restriction policies was a prominent sub-
theme for both groups, but more common in the 21-54 group. Access, in light of avor
restriction policies, was more likely to be discussed by the 13-20 group. Harm Perception
and COVID-19 discussions were more prominent among the 21-54 group than in the
13-20 group. The 13-20 group was more likely to post images without text (often memes),
post on non-tobacco subreddits, and have higher karma scores. The 21-54 group were
more likely to mention a variety of brand names. Conclusions: Users predicted to be
in the 13-20 age group and the 21-54 age group discussed dierent topics on Reddit.
These ndings suggest machine learning algorithms alongside qualitative coding can
provide insights from target audiences using social media data.
FUNDING: Federal
PS1-63
MENTIONING SMOKING CESSATION ASSISTANCE DURING
HEALTHCARE CONSULTATIONS MATTERS: FINDINGS FROM
DUTCH SURVEY RESEARCH
Naomi van Westen-Lagerweij, Jeroen Bommelé, Marc Willemsen, Esther Croes. Trim-
bos Institute, Utrecht, Netherlands.
Background: Smoking cessation assistance can help smokers to successfully quit
smoking. It is unclear to what extent hearing about smoking cessation assistance from a
healthcare professional is associated with using smoking cessation assistance during a
quit attempt. Methods: We used pooled survey data from the 2016, 2018 and 2020 Dutch
Health survey; only smokers above 18 years old were included (N=5928). Multivariate
logistic regression analyses were used to determine the association between having
heard about smoking cessation assistance from one or more healthcare professionals in
the last 12 months and the use of smoking cessation assistance during the most recent
quit attempt in the last 12 months. Healthcare professionals included: GPs, medical
specialists, dentists, and mental health professionals. Smoking cessation assistance
included: counselling, pharmacotherapy (nicotine replacement therapy or medication),
e-cigarette, online programme or app, or another method not mentioned here. We
used two models: model 1 included any type of assistance, while model 2 included
assistance typically recommended by clinical practice guidelines (i.e., counselling and
pharmacotherapy). Results: Hearing about any type of smoking cessation assistance
from a healthcare professional in the last 12 months was signicantly associated with
using any type of smoking cessation assistance during the most recent quit attempt
(OR=3.56; 95% CI 2.30-5.50; p<0.001). We found the strongest association between
hearing about any recommended type of assistance and using any recommended type
of assistance (OR = 6.91; 95% CI 4.11-11.60; p<0.001). Interaction with long-term illness
was not signicant. The odds of using any type of smoking cessation assistance was
not signicantly greater for smokers who had heard about smoking cessation assistance
from two or more healthcare compared to one healthcare professional (OR=1.38; 95%
CI 0.79-2.42; p=0.26). Conclusions: Healthcare professionals can play an important
role in stimulating the use of smoking cessation assistance, especially counselling and
pharmacotherapy, by mentioning it in consultations with smokers.
FUNDING: Federal; Nonprot grant funding entity
PS1-64
POTENTIAL EXPLANATIONS FOR CONFLICTING FINDINGS
ON ABRUPT VERSUS GRADUAL SMOKING CESSATION - A
POPULATION STUDY IN ENGLAND
Claire Garnett1, Jamie Brown1, Lion Shahab1, Toby Raupach2, Nicola Lindson3. 1Univer-
sity College London, London, United Kingdom, 2University Medical Centre Göttingen,
Göttingen, Germany, 3University of Oxford, Oxford, United Kingdom.
Signicance: Observational and trial evidence conict on the ecacy of two contrasting
behavioural approaches to quitting smoking - gradual and abrupt. Observational data
suggests an abrupt approach to quitting is superior to a gradual approach, whilst trials
show no dierence. This study aims to investigate potential explanations, including
self-selection, for these conicting ndings, for example, that people who nd it harder
to quit are more likely to attempt to quit gradually. Testing potential explanations could
provide greater insight into how to maximise the potential of smoking cessation methods.
This in turn could enrich the evidence-based options available to smokers wanting to quit.
Methods: We used observational data from a nationally representative sample of adults
aged 16+ in England from November 2006 to February 2020 who reported smoking
in the past year and had made at least one quit attempt in the past year (n=21,542).
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
We used logistic regression models to assess the association between abrupt versus
gradual quit attempts and quit success, adjusting for sociodemographic, smoking and
quit attempt characteristics. Results: Abrupt attempts were associated with improved
quit success, compared with gradual attempts in an unadjusted model (OR=2.02, 95%
CI=1.86-2.19). This association remained after adjusting for a broad range of relevant
confounders (OR=1.75, 95% CI=1.59-1.93). Conclusions: Among a representative
sample of adults who had smoked and made a quit attempt in the past year, there was
evidence of an association between abrupt quit attempts and quit success before and
after adjusting for a range of relevant confounders. This suggests that the dierences
in quit success seen between abrupt and gradual quit attempt types are not completely
driven by self-selection of gradual quitting by those less likely to quit or dierences in
the evidence-based aids used.
FUNDING: State; Academic Institution; Nonprot grant funding entity
PS1-65
HOOKAH SMOKING AND SUBSTANCE CO-USE AMONG SEXUAL
MINORITY ADULTS IN THE UNITED STATES
Mary Rezk-Hanna, Umme Shefa Warda, Mary-Lynn Brecht. University of California,
Los Angeles, Los Angeles, CA, USA.
Signicance Nationally represented data show higher rates of hookah smoking among
sexual minority (SM) adults, as compared to their heterosexual counterparts. While
hookah smoking has been shown to correlate with substance use, little is known on
substance co-use among SM hookah smokers in a national survey. Methods The
current secondary analysis examined data from Wave 1 (2013-2014) and Wave 2
(2014-2015) of the Population Assessment of Tobacco and Health Study, a nationally
representative sample of U.S. adults > 18 years of age. Weighted analyses examined
comparisons on hookah smoking patterns and substance co-use—including alcohol,
marijuana, Ritalin/ Adderall, sedatives and tranquilizers, cocaine, stimulants and other
drugs—among sexual minority adults versus their heterosexual counterparts. Results
Findings revealed that current hookah smoking among SM adults (Wave 1: 4%; Wave
2: 3%) was higher than heterosexuals (Wave 1: 1%; Wave 2: 1%; P<0.05). As compared
to heterosexual individuals, while alcohol and marijuana were the most commonly used
substances among hookah smokers, SM adults had a higher prevalence of marijuana,
Ritalin/Adderall, painkillers/sedatives, cocaine, and methamphetamine use than het-
erosexuals (p<0.05). Compared to heterosexual women, SM women hookah smokers
reported higher rates of marijuana (odds ratio [OR], 2.28; 95% CI, 1.21-4.28), pain killers/
sedatives (OR, 2.66; 95% CI, 1.19-5.96) and methamphetamine use (OR, 7.35; 95%
CI, 1.24-43.57; Wave 2). Conclusions In this population-based, representative sample
of U.S. adults, hookah smoking patterns and substance co-use diered between SM
and heterosexuals. Given hookah’s rapid growth and co-use of substances among SM
adults, our ndings highlight the importance of further research on eective interventions
for tobacco cessation and prevention approaches specic to SM hookah smokers.
FUNDING: Unfunded
PS1-66
ELECTRONIC NICOTINE DELIVERY SYSTEM DEVICES AND
LIQUID CHARACTERISTICS - DIFFERENCES IN GENDER
Alyssa K. Rudy1, Ashlee N. Sawyer1, Joanna E. Cohen2, Jerey J. Hardesty2, Madison
Combs1, Thomas E. Eissenberg1, Alison Breland1. 1Virginia Commonwealth University,
Richmond, VA, USA, 2Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, USA.
Signicance: Men are more likely to use electronic nicotine delivery system (ENDS)
devices compared to women, but little is known about how ENDS users’ gender in-
uences ENDS device/liquid characteristics. Prior to enacting ENDS regulations, it is
important to understand users’ ENDS device/liquid characteristics and subsequent health
consequences of ENDS use among dierent gender groups. Methods: Data are from
Wave 1 of a 3-year longitudinal study of adult ECIG users from a large Mid-Atlantic city.
Participants included 114 5-7 day/week ENDS users who responded to a 2020-2021
survey that assessed demographics, cigarette and ENDS use history, and ENDS device/
liquid characteristics. Results: The sample was 45% female and 74% white; 40% were
past 30-day cigarette smokers. For device type, 58% used a rellable tank-style, 28%
used a pod-style, and 14% used disposables, with no signicant dierences by gender.
There were no signicant gender dierences in nicotine concentration (M=30.7mg/ml,
SD=22.3) or device power (M=24.9W, SD=25.5). However, men were signicantly more
likely than women to report having a device with adjustable settings [X2(1)=5.25, p<0.05],
a modiable coil [X2(1)=5.64, p<0.05], and a modiable tank [X2(2)=6.70, p<0.05].
Further, among both men and women, device power and liquid nicotine concentration
were correlated inversely (r=-0.52, p<0.001). Conclusions: Women in this sample were
less likely to use devices with modiable settings or features, suggesting that men
may be more aected by policies that limit modications available on devices. Thus,
understanding gender dierences regarding users’ ENDS device characteristics can
inform policy changes; however, nationwide data is needed to determine generalizability.
FUNDING: Federal
PS1-67
INEQUALITIES IN SMOKING AND QUITTING RELATED
OUTCOMES AMONG ADULTS WITH AND WITHOUT CHILDREN
IN THE HOUSEHOLD 2013-2019: A POPULATION SURVEY IN
ENGLAND
Loren Kock1, Jamie Brown1, Lion Shahab1, Harry Tattan-Birch1, Graham Moore2,
Sharon Cox1. 1University College London, London, United Kingdom, 2Cardi Univer-
sity, Cardi, United Kingdom.
Signicance: Smoking among those who live with children is an important inuence on
smoking initiation among children. This study assessed socioeconomic inequalities in
smoking and quitting-related outcomes among all adults with and without children in
the household. Methods: Monthly repeat cross-sectional household survey of adults
(16+) from 2013-2019 in England (N=138,583). We assessed the association between
cigarette smoking and quitting-related outcomes and having children in the household,
and whether these relationships were moderated by occupational social grade (cat-
egories AB-E from most to least advantaged). Trends in smoking prevalence among
adults with and without children in the household were explored. Results: In adjusted
analysis, the association of having children in the household with smoking prevalence
depended on social grade: smoking prevalence was between 0.71 (95%CI 0.66-0.77) to
0.93 (0.88-0.98) times lower among social grades AB-D with children in the household
relative to those without. Conversely, it was 1.11 (1.05-1.16) times higher among social
grade E. Yearly prevalence declined similarly among those with and without children
(both PR: 0.98, 95%CI 0.97-0.99). Motivation to stop smoking was higher among those
with children than those without, but lower among disadvantaged than more advan-
taged groups. Social grades D-E had greater heavy smoking, but higher prevalence of
past-month quit attempts. Conclusions: Among the most disadvantaged social grade in
England, smoking prevalence was higher in those with children in the household than
without. To attenuate future smoking-related inequalities, there is an urgent need to
target support and address barriers to quitting and promote longer term quit success.
FUNDING: Academic Institution; Nonprot grant funding entity
PS1-68
PROSPECTIVE ASSOCIATION BETWEEN E-CIGARETTE
USE, YOUTH SMOKING INITIATION, AND ADULT SMOKING
ABSTINENCE: ACCOUNTING FOR TIME-VARYING EXPOSURE
AND TIME-DEPENDENT CONFOUNDING
Alyssa F. Harlow1, Andrew C. Stokes2, Daniel Brooks2, Emelia J. Benjamin3, Jessica
Barrington-Trimis1, Craig S. Ross2. 1University of Southern California, Los Angeles, CA,
USA, 2Boston University School of Public Health, Boston, MA, USA, 3Boston University
School of Medicine, Boston, MA, USA.
Signicance: To evaluate the public health impact of e-cigarettes, it is important to
balance the benet in helping adults quit cigarette smoking with the risk of increasing
youth smoking uptake. We investigate the eect of e-cigarette use on youth cigarette
smoking initiation and adult cigarette smoking abstinence accounting for time-dependent
confounding and misclassication of self-reported e-cigarette use. Methods: The study
used four waves of the Population Assessment of Tobacco and Health (2014-2018).
We rst examined the association between e-cigarette initiation and cigarette smoking
initiation among 9,583 cigarette and e-cigarette naïve youth (12-17y) at baseline. We
then examined the association between e-cigarette use frequency at two time-points
and 12-month cigarette smoking abstinence among 5,699 adults (18y+) who smoked
cigarettes at baseline. The analyses incorporated marginal structural models with inverse
probability of treatment weights to adjust for time-dependent confounding. Bias analyses
corrected for potential under- and over-reporting of self-reported e-cigarette exposure.
Results: Between 2014-2018, 5% of youth initiated cigarette smoking, and 10% of adult
smokers quit cigarette smoking. Youth who initiated e-cigarettes (vs. those who did not)
were three times as likely to subsequently initiate cigarette smoking (OR=2.9, 95% CI:
2.4-3.4). Among adults, consistent daily e-cigarette use (vs. no e-cigarette use) was
associated with four times the likelihood of 12-month combustible smoking abstinence
(RR=3.8, 95% CI 2.6-5.6). Participants who reported consistent non-daily e-cigarette
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
use were 70% less likely to achieve smoking abstinence than non-users (RR=0.3, 95%
CI 0.1-0.8). Bias analyses suggested that non-dierential misclassication of e-cigarette
exposure resulted in moderate bias towards the null. Conclusions: Findings indicate
that vaping predisposes youth to initiate combustible cigarettes, and is dierentially
associated with smoking cessation depending on the frequency of use. In addition, this
work demonstrates the application of analytic techniques for addressing methodological
challenges when evaluating longitudinal e-cigarette exposures.
FUNDING: Federal
PS1-69
ADD HEALTH YOUNG ADULT ASTHMA AND E-CIGARETTE USE
Shristi Bhochhibhoya, Yu Lu, Hairong Song, Marshall Cheney. University of OK,
Norman, OK, USA.
Signicance: Chronic disease prevalence in young adults is increasing; 15-20%
report 1 or more chronic disease, most commonly asthma. Smoking increases harmful
outcomes of chronic disease. This study examined cross-sectional and prospective
relationships between chronic disease and e-cigarette/cigarette use in young adults.
Methods: Wave 4 (w4; ages 24-34, n=15,701) and wave 5 (w5; ages 33-44, n=12,300)
of the nationally-representative Add Health Study were used. W4 and w5 cigarette use
and w5 e-cigarette use were created by dichotomizing the question on past 30-day use.
Presence of asthma diagnosed by a health care professional (yes/no) was assessed
at w4 and w5. A second non-asthmatic chronic disease (NACD) composite variable
was created using 7 additional chronic diseases measured by Add Health (diabetes,
migraine, heart problem, hepatitis B/C, high blood pressure, epilepsy, and cancer).
Logistic regression (controlling for age, race/ethnicity, and gender) was used to assess
cross-sectional associations at w4 and w5, then prospective w4 chronic disease (asth-
ma and NACD) associations with w5 cigarette and e-cigarette use. Results: Logistic
regressions showed signicant cross-sectional and prospective relationships between
asthma and cigarette use, but not e-cigarette use. Asthmatics at w4 were signicantly
more likely than those without asthma to report w4 cigarette use (AOR = 1.12, p=.016,
CI 1.02-1.23), and 7 years later at w5 (AOR = 1.15, p=0.02, CI 1.03, 1.29). At w5, asth-
matics were signicantly more likely than those without asthma to use cigarettes (AOR
= 1.12, p =.048, CI 1.001, 1.253). Those with w4 NACD were signicantly more likely to
report w4 current cigarette use than those without (AOR = 1.20, p=.00, CI 1.11, 1.29).
At w5, those with NACD were signicantly more likely to report w5 cigarette use (AOR
= 1.32, p=.00, CI 1.20, 1.45) and w5 e-cigarette use (AOR = 1.22, p=.02, CI 1.03, 1.45)
than those without NACD. Conclusion: Current and long-term associations diered
by type of chronic disease and tobacco product. The signicant relationship across 7
years for asthma and cigarette use indicates a priority area for public health intervention.
FUNDING: Academic Institution
PS1-70
ENDS FLAVOR USE BY AGE GROUP IN THE US A LONGITUDINAL
ANALYSIS
Bekir Kaplan1, Jerey J. Hardesty1, Kevin Welding1, Alison Breland2, Thomas Eissen-
berg2, Joanna E. Cohen1. 1Institute for Global Tobacco Control, Department of Health,
Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, USA, 2Center for the Study of Tobacco Products, Department of Psychology,
Virginia Commonwealth University, Richmond, VA, USA.
Signicance: Non-tobacco avored tobacco products appeal to youth and young adults.
However, there remains a paucity of nationally representative data on non-tobacco
avored electronic nicotine delivery systems (ENDS) use across age groups. This
study investigated how the use of non-tobacco avored ENDS varies for youth (12-17
years old), young adults (18-24 years old), and older adults (25+ years old) over time.
Method: We used the Population Assessment of Tobacco and Health (PATH) Study
wave 2 (2014-2015), wave 3 (2015-2016), and wave 4 (2016-2017) youth and adult data
and assessed changes in current avor use over time among ENDS users. Result: The
percentages of fruit avor use from wave 2 to 4 for youth were 70.5% (n=188), 71.2%
(n=257) and 68.0% (n=272); for young adults were 64.1% (n=282), 58.4% (n=932) and
60.8% (n=931); and for older adults were 46.4% (n=398), 34.9% (n=832) and 37.2%
(n=835), respectively. For youth and young adults, candy/desserts avor was the most
used avor after fruit in all three waves. For older adults, menthol/mint in wave 2 and
tobacco avor in waves 3 and 4 were the most used avor after fruit. Overall, 72.0%
of fruit users, 55.6% of candy users, and 61.8% of menthol/mint users in wave 2 main-
tained use of the same avor in wave 4. On average, approximately one third of fruit
users used another avor over time. Conclusion: The most used ENDS avor was fruit
among all age groups, followed by candy for youth and young adults, and menthol/mint
and tobacco avor for older adults. A majority of non-tobacco avor users maintained
use of the same avor over time.
FUNDING: Federal
PS1-71
COMPARISON OF NICOTINE DEPENDENCE BETWEEN SINGLE
AND MULTIPLE TOBACCO PRODUCT USERS AMONG SOUTH
KOREAN ADULTS
Youn Huh1, Cheol Min Lee2, Hong-Jun Cho3. 1Uijeongbu Eulji Medical Center, Gyeong-
gi-do, Korea, Republic of, 2Healthcare System Gangnam Center, Seoul, Korea, Republic
of, 3University of Ulsan Medical College, Seoul, Korea, Republic of.
Objective: The relationship between multiple tobacco products, including heated to-
bacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs),
and nicotine dependence is not well investigated. This study aimed to compare nicotine
dependence symptoms between single and multiple tobacco product users among
South Korean adults. Methods: We did an online survey of 7,000 adults aged 20-69
years old (2,300 men, 4,700 women) in November 2018. We compared the nicotine
dependency among single, dual and triple use of tobacco product use including HTP,
EC, and CC. Nicotine dependence was measured by four of the measures of addictions
in the National Adult Tobacco Survey and “time to rst use of tobacco products within
5 min.” Multivariable logistic regression analysis was performed, and odds ratios with
95% condence intervals of nicotine dependence symptoms according to the number
of tobacco products were estimated. Results: The prevalence of nicotine dependence
symptoms tended to be greater among dual and triple users of HTP, EC, and CC than
single users, except for “time to rst tobacco products use within 5 min.” Moreover,
triple users of tobacco products showed greater nicotine dependence than dual users of
tobacco products, including HTP, EC, and CC. Conclusions: Multiple tobacco product
users reported signicantly greater nicotine dependence symptoms than single users.
High nicotine dependence of multiple tobacco product users may hamper the future
cessation of tobacco products, and this can be challenging for future tobacco control
policies in South Korea.
PS1-72
CIGARETTE BRAND USE AND SEXUAL ORIENTATION
INTERSECTIONS WITH GENDER AND RACE/ETHNICITY
Alexandra Rose Budenz, Rachel Grana Mayne. National Cancer Institute, Rockville,
MD, USA.
Signicance: Lesbian, gay, and bisexual (LGB) populations have higher cigarette
smoking rates than heterosexuals. The tobacco industry has leveraged LGB, gender, and
racial/ethnic identities to establish cigarette brand preference. Therefore, we examined
cigarette brand use among smokers by sexual orientation, as well as the implications
of gender and race/ethnicity for brand use. Methods: Using the 2015-2017 National
Surveys on Drug Use and Health, we conducted weighted bivariate analyses of the
prevalence of commonly used cigarette brands (n=5) among adult smokers by sexual
orientation (n=24,310). We conducted weighted regressions to test relationships between
sexual orientation and brand use and interactions between sexual orientation, gender
and race/ethnicity. Results: Gay/lesbian and bisexual smokers were more likely to use
Camel (OR=1.7 (95% CI=1.2-2.3), OR=1.8 (95% CI=1.5-2.2), respectively) and American
Spirit cigarettes (OR=2.8 (95% CI=1.9-4.1), OR=3.2 (95% CI=2.5-4.1), respectively)
than heterosexuals. Gay/lesbian smokers had higher odds of Marlboro cigarette use
(OR=1.2; 95% CI=1.0-1.4) than heterosexuals. Bisexual smokers were more likely to
use Newport cigarettes (OR=1.7; 95% CI=1.5-2.1) than heterosexuals. Interactions
between LGB and female identities (vs. GB male) were positively associated with
Camel, Marlboro, and Newport use. The interaction between gay/lesbian and Hispanic
identities (vs. gay/lesbian White) was also positively associated with Newport use.
Conclusions: LGB smokers may be more likely to use some commonly used cigarette
brands than heterosexuals, and gender and race/ethnicity may have implications for
brand preference. Future research may examine specic contributors to brand use in
LGB smokers (e.g., tobacco marketing).
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-73
ELECTRONIC CIGARETTE USE AND COMBUSTIBLE TOBACCO
USE BEHAVIORS INSIDE OF VEHICLES
Eric Soule, Sinan Sousan, Jack Pender, Neal Patel, Alisha Thomas. East Carolina
University, Greenville, NC, USA.
Signicance: Research has shown that exposure to secondhand and thirdhand smoke
can cause negative health eects. While many cigarette smokers avoid smoking inside
of vehicles to prevent unwanted exposures, little is known about electronic cigarette
(ECIG) users’ behaviors inside of vehicles. The purpose of this study was to examine
behaviors, attitudes, and beliefs related to ECIG use inside of vehicles. Methods: Adults
(aged ≥18 years) who reported currently using ECIGs every day or some days in the
past 30 days recruited from a Qualtrics panel (n=1002; mean age=32.8; 50.4% women)
completed an online survey. Survey questions assessed demographics and tobacco use
behaviors and history. Questions also assessed ECIG/tobacco use inside of vehicles
including frequency of use inside of vehicles, ECIG/tobacco use when others were
present in vehicles, behaviors to limit harm from or exposure to secondhand aerosol
or smoke, and attitudes and beliefs regarding whether ECIG/tobacco use should be
allowed indoors. Results: Nearly two thirds (61.7%) of participants reported ECIG use
every day. Among participants who owned or leased a vehicle, 80.8% reported that they
vaped in their vehicle almost always or sometimes. When other adults were present
inside of vehicles, 79.2% of participants reported vaping inside of vehicles and 36.6%
reported vaping when children were present. Participants typically vaped in their vehicles
with the windows completely closed (25.5%) or partially opened (63.4%). Participants
believed that ECIG use inside of vehicles should always be allowed or allowed under
some conditions when other adults were present (88.9%) and when children were
present (39.1%). Fewer participants felt that smoking cigarettes or other tobacco prod-
ucts should be allowed in vehicles when other adults (64.6%) or children were present
(23.9%; ps<0.001). Conclusion: ECIG use inside of vehicles is common. ECIG users
perceive that ECIG use is more permissible than other tobacco use in vehicles when
others are present. Passengers of vehicles with ECIG users may have greater risk for
secondhand and thirdhand ECIG exposure.
FUNDING: Federal
PS1-74
A PILOT STUDY COMPARING TWO E-CIGARETTE PRODUCT
TYPES ON RELATIVE REINFORCEMENT VALUE AND TOBACCO
USE PATTERNS AMONG CURRENT SMOKERS
Elizabeth S. Hawes1, Matthew J. Carpenter2, K. Michael Cummings2, Karen Cropsey1,
Tracy T. Smith2. 1University of AL at Birmingham, Birmingham, AL, USA, 2Medical
University of SC, Charleston, SC, USA.
E-cigarettes (e-cigs) are rising in prevalence and are the most used non-cigarette
tobacco product. They emit fewer harmful chemicals than cigarettes and they could
serve as less harmful substitutes for current smokers who switch completely. Variation
in e-cig characteristics could impact product appeal and reinforcement, which may
have downstream eects on cigarette smoking patterns. Mod systems are rellable
and oer a high level of customization, while Pod systems are non-rellable systems
that operate at a low-wattage, commonly utilize salt-based nicotine e-liquids, and are
not customizable. The goal of this pilot study was to compare these device types on
reinforcement value and downstream eects on cigarette smoking. Current smokers
with minimal e-cig experience (N=30) were randomized to receive a Mod e-cig (Evolv
DNA 1.2% nicotine, variable wattage, n=11), Pod e-cig (JUUL 5% nicotine, n=13), or
no product (n=6). E-cig groups completed a preference assessment task at Baseline
and the Week 3 visit. Across 10 trials participants chose between taking 2 pus of a
cigarette, 2 pus of their assigned e-cig, and taking no pus. Participants took their
assigned e-cig home with them for 3 weeks and were told to use the e-cig and smoke
ad libitum. At the Baseline preference assessment, participants assigned to both e-cig
groups chose to use the e-cig instead of smoke an equal number of times (4.3). At Week
3, participants assigned to the Mod e-cig chose to use the e-cig instead of smoke 2.4
times (SD= 2.1), while those assigned to the Pod e-cig chose to use the e-cig instead
of smoke 4.6 times (SD=3.1), but this comparison failed to reach signicance (p>0.05).
At Week 3, reductions in CPD were largest for the Pod group (M=40.6%, SD=31.0),
followed by the Mod group (M=33.4%, SD=42.6) and the control group (M=10.0%,
SD=18.0). The reduction in CPD for the Pod group was signicantly greater than for
the control group, but all other comparisons failed to reach signicance. These data
suggest that Pod e-cigs may be more appealing and have a greater eect on cigarette
smoking than Mod e-cigs, but a larger trial is needed to fully evaluate these dierences.
FUNDING: Federal
PS1-75
SHORT AND LONG-TERM CIGARETTE AND TOBACCO
ABSTINENCE AMONG DAILY AND NON-DAILY OLDER SMOKERS
Jaqueline C. Avila1, Carla J. Berg2, Jason Robinson3, Jasjit S. Ahluwalia1. 1Brown
University School of Public Health, Providence, RI, USA, 2George Washington Univer-
sity, Washington, DC, USA, 3The University of Texas MD Anderson Cancer Center,
Houston, TX, USA.
Introduction: There is mixed evidence whether older smokers are more or less likely to
quit smoking than younger smokers. We examined age in relation to short- and long-
term abstinence from cigarette and other tobacco products and the potential moderating
eects of smoking frequency. Methods: Using data from 7,512 established smokers
at Waves 1 and 4 of the Population Assessment of Tobacco and Health (PATH) study,
weighted logistic regression models were used to examine the eects of age (18-24, 25-
34, 35-44, 45-54, and 55+) on Wave 4 30-day and 12-month abstinence for cigarettes and
for all tobacco products adjusting for sociodemographic and smoking-related covariates
(e.g. past-year quit attempt). We also tested for interactions between age and cigarette
use frequency (non-daily, light daily, heavy daily). Results: 21.6% of the sample were 55+
years old. Overall, 14.9% were nondaily smokers, 19.9% light daily, and 65.2% heavy
daily, with older smokers having a greater representation among heavy daily smokers
(p<.001). Older smokers were less likely to have a past-year cigarette quit attempt at
baseline than younger smokers 18-24 and 25-34 (19.2% vs. 24.8%, 24.8%, respectively
p<.01). At Wave 4, 16.2% of the sample reported 30-day and 10% 12-month cigarette
abstinence, with 11.3% reporting 30-day and 9.3% 12-month all tobacco abstinence.
For cigarettes, compared to older smokers, younger smokers 18-24, 35-44, and 45-54
were less likely to report 12-month abstinence (OR=0.57, 95%CI= [0.36-0.93]; OR=0.62
[0.42-0.90]; OR=0.63 [0.47-0.85], respectively), but there was no dierence for 30-day
abstinence. For all tobacco product use, similar results were observed for 12-month
abstinence, but younger smokers 35-44 were less likely to report 30-day abstinence
than older smokers. Light daily and non-daily smokers were more likely to report both
30-day and 12-month cigarette and tobacco product abstinence than heavy daily. There
was a signicant interaction between age and smoking frequency for 30-day cigarette
abstinence, such that abstinence rates for non-daily smokers signicantly decreased as
age increased, whereas the abstinence rates for light daily and heavier daily smokers
were similar across age groups. Conclusion: Older smokers were more likely to report
12-month cigarette abstinence, despite their lower frequency of quit attempts and greater
frequency of heavy daily smoking compared to younger smokers.
FUNDING: Federal; Academic Institution
PS1-76
SMOKING CESSATION IN CANCER CARE- AN ECONOMIC
EVALUATION OF THE SMOKE-FREE SUPPORT STUDY
Douglas E. Levy1, Susan Regan1, Giselle K. Perez1, Alona Muzikansky1, Emily R.
Friedman2, Julia T. Rabin3, Nancy A. Rigotti4, Colin J. Ponzani1, Jamie S. Ostro5,
Elyse R. Park1. 1MGH/Harvard Medical School, Boston, MA, USA, 2Vanderbilt Univer-
sity, Nashville, TN, USA, 3University of Cincinnati, Cincinnati, OH, USA, 4MGH/Division
of General Internal Medicine, Boston, MA, USA, 5Memorial Sloan Kettering Cancer
Center, New York, NY, USA.
BACKGROUND: Smoking cessation among individuals treated for cancer improves
cancer treatment outcomes, quality of life, and life expectancy, but tobacco treatment is
not consistently provided in this setting. The two-site Smoke-free Support Study found
that an intensive treatment (IT) intervention delivered to smokers initiating cancer care
improved cotinine-conrmed 7-day point prevalence abstinence at 6 months relative
to enhanced standard care control (ST) (34.5% vs. 21.5%, dierence 13.0%, 95% CI
3.0-23.3%). We evaluated the cost and incremental cost per quit (ICQ) of IT vs. ST, as
well as IT vs. usual care (UC) from a health system perspective to guide implementation
at cancer care sites considering the IT intervention. METHODS: IT consisted of up to
11 sessions of telephone counseling and up to 12 weeks of FDA-approved rst line
smoking cessation medication compared to ST which consisted of up to 4 sessions
of telephone counseling, medication advice, and referral to the state quitline. UC was
referral to quitline with ecacy assessed from pilot data only (abstinence rate: 14.3%).
Costs included participant recruitment, counselor training and supervision, tobacco
treatment medications (including shipping), record-keeping, communication materials,
and oce space. Costs reected the programs as used, not as designed (e.g., no cost
for unused counseling). RESULTS: Incremental costs per patient were $508 for IT vs.
ST and $2018 for IT vs. UC. Contributions to IT cost were counselor training (5%),
supervision of counselors (26%), participant recruitment (24%), counseling delivery
(19%), medications (16%), and other resources (10%). ICQ for IT vs. ST was $3916.
ICQ for IT vs. UC was $10010. Costs were higher at one site given stang (nurse
practitioner vs. dedicated tobacco treatment specialist without prescribing privileges)
87
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
and higher baseline quit rates. ICQs at the more ecient site were $2390 (IT vs. ST)
and $5675 (IT vs. UC). CONCLUSIONS: While the overall ICQ for IT vs. UC was high
compared to other health system-initiated cessation interventions, it can be delivered
cost-eectively under some circumstances.
FUNDING: Federal
PS1-77
EDUCATIONAL DISPARITIES IN NICOTINE ADDICTIVENESS AND
CANCER HARM PERCEPTIONS - A TEST OF THE KNOWLEDGE
GAP HYPOTHESIS
Emily B. Peterson, Xiaoquan Zhao, Lindsay Pitzer. Food & Drug Administration, Silver
Spring, MD, USA.
Signicance: Recent research has found widespread misperceptions about nicotine.
The knowledge gap hypothesis predicts that those with higher educational attainment will
increase their level of accurate knowledge about an issue more quickly than those with
less education. This study tests that hypothesis while distinguishing between nicotine
misperceptions (i.e., an incorrect response) and a “don’t know” (DK) response, indicating
ambivalence, uncertainty or a lack of knowledge. Methods: Data were analyzed from
the 2015, 2017 and 2019 cycles of the Health Information National Trends Survey.
Weighted multinominal logistic regression models were conducted where nicotine
addictiveness and cancer beliefs (DK, incorrect, and correct [referent] responses) were
regressed on survey year, level of educational attainment and their interaction. Anal-
yses controlled for race/ethnicity, sex, age, rurality, and tobacco experience. Results:
Overall, there were lower odds of misperceptions about addictiveness (OR=0.57 [0.40,
0.82]), but higher odds of misperceptions about cancer harm (OR=1.41 [1.15, 1.74]) in
2019 compared to 2015. For addictiveness perceptions, those with a high school (HS)
(OR=0.48 [0.31, 0.75]) and college education (OR=0.32 [0.20, 0.52]) had lower odds
of a DK response than those with less than HS education, but there were no signicant
dierences for misperceptions. For cancer beliefs, there were educational disparities
for both DK responses (HS: OR=0.45 [0.25, 0.81]; College: OR=0.22 [0.12, 0.40]) and
misperceptions (HS: N/S, College: 0.26 [0.14, 0.45]). Survey year did not moderate the
relationship between education and nicotine addictiveness or cancer harm perceptions.
Conclusions: For nicotine addictiveness perceptions, educational disparities remain,
but have not become more pronounced over time. These disparities may exist due to
a lack of knowledge or ambivalence (not established misperceptions) that may be a
result of dierences in motivation and ability to acquire health information. There are
educational disparities for both DK responses and misperceptions about cancer beliefs,
underscoring a need for future targeted intervention eorts detailing the role of nicotine
in tobacco-related cancer.
PS1-78
A QUALITATIVE ASSESSMENT OF THE IMPACT OF COVID-19 ON
YOUNG ADULT TOBACCO USE
Joshua S. Yang1, Claudia Pacheco1, Regina Merrill1, Tim K. Mackey2. 1CA State Univer-
sity, Fullerton, Fullerton, CA, USA, 2University of California, San Diego, San Diego,
CA, USA.
Early studies have suggested that self-reported vaping and tobacco use among youth
and young adults decreased during the COVID-19 pandemic. The general decline in
use, however, may obscure other transitions among products and product types. To
understand shifting patterns and pathways of tobacco use during COVID-19, 16 focus
groups (n=114) and 21 interviews were conducted with current and former tobacco
users age 18-29 in California from April to May 2021 to discuss changes in tobacco
and cannabis use during the COVID-19 pandemic. Participants were generally unaware
of any increased risk for acquiring COVID-19 or more severe symptoms as a result of
smoking or vaping, and some reported hearing that cannabis use was protective against
COVID. Changes in use patterns were a function of vaping patterns prior to COVID-19.
Those who usually smoked or vaped in social settings prior to COVID-19 reduced their
use because they found themselves in those situations less often as they adhered to
quarantine requirements. Those accustomed to smoking or vaping in small groups or
by themselves prior to COVID-19 reported increasing use because of stress, anxiety,
and boredom. Overuse was a greater concern among individuals who increased their
use of nicotine vapes as opposed to increased use of cannabis products. As COVID-19
quarantine restrictions are lifted, tobacco use prevention and cessation eorts among
young adults should be strengthened to preserve the declines in reported tobacco use
during the pandemic.
FUNDING: State
PS1-79
UNDERSTANDING ADVERSE EXPERIENCES WITH VAPING
AMONG YOUNG ADULTS
Joshua S. Yang1, Pauline Lim2, Regina Merrill1, Tim K. Mackey3. 1CA State University,
Fullerton, Fullerton, CA, USA, 2Cypress College, Cypress, CA, USA, 3University of
California, San Diego, San Diego, CA, USA.
E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) raised public
awareness of potential dangers associated with nicotine vaping. EVALI, however,
may have overshadowed other adverse symptoms that accompany e-cigarette use.
To better understand nicotine vaping-related adverse symptoms, 16 focus groups
(n=114) and 21 interviews were conducted with current and former young adults (18-29
years) e-cigarette users in California to discuss experiences with adverse symptoms
attributed to nicotine vaping. The most commonly reported adverse symptoms included
headache, nausea, dry or sore throat, lightheadedness, coughing, and dizziness. The
most common response to adverse symptoms was to temporarily cut back, which was
reported with headaches, nausea, dry or sore throat, and dizziness. No behavioral
modication was most common with lightheadedness, coughing, and throat pain; par-
ticipants considered quitting or quit most often after experiencing shortness of breath
and chest pain. Amongst infrequent e-cigarette users, those who did not experience
adverse symptoms did not express a desire to quit while those who did were likely to
experiment but not adopt e-cigarettes. Among regular e-cigarette users, those who
did not experience adverse symptoms also did not consider quitting while those who
did experience adverse symptoms expressed a desire to or had quit vaping. Adverse
symptoms attributed to e-cigarettes vary in their perceived severity and may play a role
in uptake and cessation of e-cigarettes.
FUNDING: State
PS1-80
SYNERGISTIC EFFECT OF E-CIGARETTE AND CANNABIS USE
ON CIGARETTE UPTAKE IN YOUNG ADULTS
Talat Islam, Junhan Cho, Sandrah P. Eckel, Feifei liu, Jessica L. Barrington-Trimis,
Rob McConnell. USC, Los Angeles, CA, USA.
Introduction: E-cigarette use is a known risk factor for smoking, which has underscored
the need to regulate e-cigarette to reduce the public health burden of tobacco that is
predominately due to combustible cigarette. Among high-school children, cannabis is
increasingly co-used with e-cigarette that might increase tobacco dependence leading
to combustible cigarette use in young adults. It is important to understand the extent to
which e-cigarette related risk of smoking is due to vaping alone and jointly with cannabis
use to provide additional evidence as to whether targeting e-cigarette in regulation might
reduce smoking burden. Methods: Data were drawn from a prospective cohort study
of respondents in Los Angeles, CA (N=1,164) who completed surveys in 12th grade
[(T1; Fall, 2016; Mean age[yrs]=17.5) and in October 2018-October 2019 (T2) and
May-October 2020 (T3)] after high school graduation. Past 30-day use of e-cigarettes
and cannabis was assessed at T1. Nicotine dependence (Range=0-2) and number of
days smoking cigarettes (Range=0-30) were assessed at T1 and each follow-up. Path
analysis on the mediational process linking baseline joint e-cigarette and cannabis
use to increased combustible cigarette use at follow-up via nicotine dependence was
performed. Results: In 12th grade, 7.6% of participants reported joint use of e-cigarette
and cannabis (26.1% for cannabis use only; 2.5% for e-cigarette use only; 64.0% for no
use). After adjusting for sociodemographic characteristics and baseline cigarette use,
we observed that use of e-cigarette (RR[95%CI]=2.61[1.04, 13.07]), cannabis (RR[95%-
CI]=2.58[1.43, 4.98]), and dual-use (RR[95%CI]=5.84[3.16, 12.81]) were associated
with increases in cigarette use at T3. In the mediational path analysis, cannabis use
and dual use were associated with increased nicotine dependence and cigarette use
at T2, which were associated with increases in past 30-day combustible cigarette use
at T3. Increased levels of nicotine dependence at T2 mediated 10.5% and 23.2% of the
total eects, respectively. Discussion: Here we present evidence that e-cig use alone
or with cannabis during the high-school years leads to increased cigarette uptake in
early adulthood and this is mediated by increased nicotine dependence, noting potential
causal mechanism between e-cig use and cigarette uptake.
FUNDING: Federal
88
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-81
COMBINING AGE PREDICTION ALGORITHMS AND SOCIAL
MEDIA LISTENING TO SEGMENT AND ANALYZE REDDIT AND
TWITTER CIGARETTE CONVERSATIONS AMONG YOUTH AND
ADULTS
Jamie Guillory1, Annice Kim2, Rob Chew2, Stephanie McInnis2, Margaret Moakley2,
Glen Szczypka3, Thomas Bukowski4, Mario Navarro5, Andrea Malterud5, Zachary Cahn5.
1Prime Aect Research, Dublin, Ireland, 2RTI International, Research Triangle Park,
NC, USA, 3RTI International, Chicago, IL, USA, 4RTI International, Berkeley, CA, USA,
5Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD,
USA.
SIGNIFICANCE: Social media data can provide insights into tobacco-related perceptions
and behaviors. However, being able to segment social media data by key audiences of
interest is crucial for informing campaign development. Machine learning algorithms that
predict social media user features (e.g., age) based on publicly available data can aid
in segmentation. The objective of this study was to apply an age prediction algorithm
to a sample of cigarette conversations to segment Reddit and Twitter users by age
(youth: under 21; adults: 21 and over), and explore conversation themes between the
two groups. METHODS: We developed a search boolean with cigarette terms (e.g.,
general terms, cigarette brands and slang) and used this to identify a random sample of
Twitter (N= 17,707) and Reddit (N= 23,364) accounts posting about cigarette smoking
from Jan-Feb 2021. We then ran age prediction algorithms (previously developed) on
public Twitter and Reddit, non-deleted user accounts identied using the boolean. We
restricted the sample to users with predicted probabilities greater than 0.7 of being clas-
sied into the two age groups, resulting in a nal sample of 5,598 youth and 6,347 adults
on Twitter, and 5,417 youth and 6,131 adults on Reddit. We analyzed conversations
from this nal sample to compare key themes about cigarettes between predicted youth
vs. adult Twitter and Reddit users. RESULTS: Overall, adults posted more frequently
about cigarettes than youth in our sample (Reddit: 79,600 vs. 59,160; Twitter: 25,072
vs. 9,672). Key themes identied in conversations included smoking initiation, smoking
cessation, and humor/memes. Smoking initiation was discussed by both age groups
on both platforms; predicted adults mentioned how their relationship with smoking has
changed since they initiated and predicted youth more often discussed initiation among
other people, often exhibiting confusion about why one would start smoking. Predicted
adults on both platforms were more likely to discuss cessation than predicted youth;
predicted adults framed cessation as a recovery story whereas predicted youth more
commonly sought cessation help, motivation or support. Predicted youth were more
likely than predicted adults to use humor or share memes in smoking conversations.
CONCLUSION: These results suggest that applying algorithms to predict user character-
istics (e.g., age) can aid researchers in segmenting social media analyses by audience
to provide more meaningful insights to inform campaign development.
FUNDING: Federal
PS1-82
CROSS SECTIONAL ASSOCIATIONS OF CIGARETTE,
ECIGARETTE, AND ORAL TOBACCO PRODUCT USE WITH SELF
REPORTED ADVERSE ORAL HEALTH OUTCOMES RESULTS
FROM WAVE 4 OF THE POPULATION ASSESSMENT OF
TOBACCO AND HEALTH STUDY
Connor R. Miller, Pamela A. Hershberger, Nicolas F. Schlecht, Richard J. O’Connor,
Mukund Seshadri, Maciej L. Goniewicz. Roswell Park Comprehensive Cancer Center,
Bualo, NY, USA.
Signicance: Associations between the use of alternative tobacco products and oral
health outcomes are not well understood, and few studies have evaluated associations
separately for distinct oral tobacco subtypes. This study examined cross-sectional
associations of self-reported adverse oral health outcomes with cigarette, e-cigarette,
snus and smokeless tobacco use. Methods: Data was analyzed for 16,710 Wave 4
(data collected Dec 2016-Jan 2018) PATH Study respondents (18+ years old) who
visited a dentist in the past year and were not current-established users of cigars, pipe
tobacco, or hookah/waterpipes. Survey-weighted multivariable logistic regression models
estimated associations of current-established use of cigarettes (n=3,380), e-cigarettes
(n=787), snus (n=82) and smokeless tobacco (n=452) with self-reported adverse oral
health outcomes (gum disease, bone loss around the teeth, precancerous oral lesions)
while controlling for demographic, lifestyle and medical history variables. Results are
reported as ‘(adjusted odds ratio [95% condence interval])’. Results: Current cigarette
smoking was signicantly associated with self-reported gum disease (1.61 [1.38-1.88]),
bone loss around the teeth (1.90 [1.63-2.21]), and precancerous oral lesions (1.63 [1.05-
2.51]). Current smokeless tobacco use was signicantly associated with self-reported
precancerous oral lesions (3.48 [1.62-7.45]) but not gum disease (0.95 [0.63-1.42])
or bone loss around the teeth (1.09 [0.70-1.72]). Neither current e-cigarette (gum dis-
ease: 1.13 [0.90-1.43]; bone loss around the teeth: 1.28 [0.98-1.66]; precancerous oral
lesions: 1.16 [0.66-2.05]) nor current snus use (gum disease: 1.01 [0.40-2.58]; bone
loss around the teeth: 1.16 [0.42-3.25]; precancerous oral lesions: 1.44 [0.28-7.28])
were signicantly associated with adverse oral health outcomes. Conclusion: Cigarette
smoking was consistently associated with self-reporting adverse oral health diagnoses,
and smokeless tobacco use was associated with self-reporting precancerous oral lesion
diagnosis. By contrast, no signicant associations with adverse oral health outcomes
were observed according to e-cigarette or snus status.
FUNDING: Federal
PS1-83
SOCIAL ISOLATION AND NICOTINE AND MARIJUANA VAPING
PRACTICES: PERSPECTIVES FROM YOUTH DURING THE
COVID-19 PANDEMIC
Sabrina Islam1, Kirsten Thompson2, Sharon Lipperman-Kreda3, Kristina Wharton1,
Melissa Abadi2. 1University of California, Berkeley and Prevention Research Center,
Berkeley, CA, USA, 2Pacic Institute for Research and Evaluation - Louisville Center,
Louisville, KY, USA, 3Prevention Research Center, Pacic Institute for Research and
Evaluation, Berkeley, CA, USA.
Signicance: COVID-19 safety protocols urge physical and social distancing, resulting
in isolation and minimal contact with others. As social contexts are central to the expe-
riences of vaping among youth, this study explored the vaping practices of Kentucky
youth during the pandemic. Methods: Semi-structured, telephone interviews were
conducted in August 2020 with current and past Electronic Nicotine Delivery System
(ENDS) users (N=22; ages 16-19; 63% female) recruited from a parent study. Interviews
focused on the inuence of COVID-19 on vaping and smoking beliefs, behaviors, and
health perceptions. Inductive and deductive coding approaches were used to analyze
transcripts. Results: Most participants identied the ongoing pandemic as shaping their
current vaping practices. Frequency of vaping varied during the pandemic, where some
noted increases while others noted use remaining the same or decreasing. However,
notable dierences emerged between nicotine and marijuana use related to health
measures adopted to mitigate COVID-19 spread. Nicotine-vaping was largely reduced
due to restrictions limiting social gathering and encouraging self-isolation. Specically,
participants indicated the absence of social interactions as contributing to less use,
citing reasons including lacking personal vaping devices, hesitating to share vaping
devices due to COVID-19 risks, and facilitating prior intentions to quit. Similarly, mari-
juana-vaping was attributed to social isolation but, in contrast to nicotine, participants
often reported greater use driven by intrapersonal factors associated with managing
boredom, desiring an escape, alleviating stress, and having more free time at home.
Participants, likewise, linked increases in vaping nicotine and marijuana together to
pleasure-seeking motives, describing the heightened sense of euphoria and escape
produced via simultaneous use. Conclusion: Findings suggest social isolation and at-
tentiveness to health emerging from pandemic-control measures had dierential impacts
on vaping nicotine and marijuana. Public health eorts to address vaping may require
greater attention to socio-environmental contexts of vaping that may vary by substance.
FUNDING: Federal
PS1-84
“REAL-WORLD” JUUL EMISSIONS LIKELY EXCEED
LABORATORY GENERATED EMISSIONS
Eric Soule1, Sinan Sousan1, Dillon Streuber1, Rola Salman2, Soha Talih2, Jack Pender1.
1East Carolina University, Greenville, NC, USA, 2American University of Beirut, Beirut,
Lebanon.
Introduction: Standard pung protocols are used to examine tobacco product emis-
sions. The tobacco industry has undermined these protocols and real-world cigarette
smoking can generate more emissions than generated from laboratory protocols.
Electronic cigarette (ECIG) emissions from standard protocols may also dier from
real-world emissions. This study compared particulate matter (PM) and volatile organic
compounds (VOCs) from a popular ECIG device using two procedures. Methods: We
generated ECIG aerosol using a diaphragm pump to pu a JUUL ECIG device. ECIG
aerosol was captured in a 0.5 m3 exposure chamber in two experiments. For experiment
1, we used a single JUUL device with pus at 1.5 L/min, 5 second duration, and 30
second inter-pu interval (IPI) for 60 minutes. For experiment 2, we used a single JUUL
pod, but alternated between two JUUL devices after every two pus. This represented
“real-world” pung behaviors in which many users’ bouts tend to be less than 4 pus.
For experiment 2, we pued the JUUL devices at 1.5 L/min, 4 second duration, and 30
89
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
second IPI for 30 minutes. PM 2.5 μm in diameter and smaller (PM2.5) was captured
and weighed using gravimetric analysis and real-time VOCs were measured using a
VOC sensor. Experiments were repeated three times. Results: In experiment 1, 630
µg/m3 (SD=350) of lter PM2.5 mass concentration was collected and mean real-time
PM2.5 concentration was 466 µg/m3 (SD=475). PM2.5 concentration was 2118 µg/m3
(SD=990) during the rst 4 pus and 422 µg/m3 (SD=318) for the nal 116 pus. In
experiment 2, 1390 µg/m3 (SD=250) of lter PM2.5 mass concentration was collected
and mean real-time PM2.5 concentration was 1189 µg/m3(SD=743). Mean real-time
PM2.5 concentration in experiment 2 was 2.6 times higher than during experiment 1.
Mean VOC concentration was almost 2 times higher during experiment 2 (12.0 ppm,
SD=3.0) than during experiment 1 (6.3 ppm, SD=2.0). Conclusions: Real-world JUUL
emissions likely exceed those from standard protocols. It is unknown if this dierence
results from an intentional design feature. Regulators and researchers should examine
ECIGs based on users’ real-world behaviors.
FUNDING: Federal
PS1-85
PERCEIVED BARRIERS TO PROVIDING SMOKING CESSATION
ADVICE IN SIX LATIN AMERICAN CANCER INSTITUTIONS
Irene Tami-Maury1, Hector Garcia2, Modupe Onigbogi1, Julia Ismael3, Javier Manrique4,
Vinicius Vasquez5, Paul Camacho6, Laura Suchil7. 1The University of Texas Health
Science at Houston, Houston, TX, USA, 2Cancer Institute Las Americas Auna, Medel-
lin, Colombia, 3Nacional Cancer Institute, Buenos Aires, Argentina, 4Instituto Nacio-
nal de Enfermedades Neoplasicas, Lima, Peru, 5Barretos Cancer Hospital, Barretos,
Brazil, 6FOSCAL Cancer Center, Bucaramanga, Colombia, 7Nacional Cancer Institute,
Mexico City, Mexico.
Signicance: Comprehensive treatment of tobacco use within cancer care has proven
to be cost-eective in the United States of America and Canada. However, the benets
related to smoking in the context of oncology treatment, tobacco screening, and cessation
have not been fully recognized by the rest of the Western Hemisphere. Understanding
cancer care professionals’ experiences of providing smoking cessation support in on-
cology settings in Latin America can help to inform the design of interventions, as well
as to improve prognosis in cancer care. The aim of the study was to assess perceived
barriers to providing smoking cessation advice in six Latin American cancer institutions.
Methods: A cross-sectional study was conducted among 996 cancer care providers
(CCPs) in six cancer institutions located in Colombia, Mexico, Argentina, Brazil, and Peru.
An online survey consisting of 28 close-ended questions adapted from the 2012 Inter-
national Association for the Study of Lung Cancer survey and the Global Adult Tobacco
Survey was administered. Results: The majority of CCPs, ranging from 86.1% in Mexico
to 95.9% in Brazil, agreed that smoking cessation should be integrated into cancer
treatment. However, inadequate training on smoking cessation was reported by 66.9%,
69.4%, 70.4%, 72.9%, 85.8%, 86.4% in Mexico, Colombia (Bucaramanga), Argentina,
Peru, Brazil, and Colombia (Medellin) respectively and this dierence was statistically
signicant (p < 0.001). Moreover, current cigarette smoking prevalence among CCPs
was 2.5% in Brazil (Barretos), 4.6% in Peru (Lima), 6.3% in Colombia (Bucaramanga),
10.4% in Colombia (Medellin), 11.5% in Mexico (Mexico City), and 15.1% in Argentina
(Buenos Aires) showing a statistically signicant dierence (p<0.001). Prevalence of
current and former e-cigarette use among all CCPs was 1.4% and 8.1% respectively.
Secondhand smoke exposure at work was reported by 6.5% of all CCPs ranging be-
tween 2.3% in Colombia (Bucaramanga) and 25.5% in Argentina. Conclusion: Given
the signicant impact of smoking on cancer prognosis and survival, educating Latin
American CCPs to provide smoking cessation assistance to their patients or linking
them to cessation services and/or resources will improve patients’ overall quality of life
and potentially reduce the cost of oncology treatment.
FUNDING: Academic Institution
PS1-86
SEX DIFFERENCE IN THE ASSOCIATION BETWEEN SELF-
REPORTED HYPERTENSION INCIDENCE AND E-CIGARETTE
USE - LONGITUDINAL RESULTS FROM THE POPULATION
ASSESSMENT OF TOBACCO AND HEALTH (PATH), WAVES 1-4
Hangchuan Shi1, Adam Leventhal2, Deborah Ossip1, Dongmei Li1. 1University of Roch-
ester Medical Center, Rochester, NY, USA, 2University of Southern CA, Los Angeles,
CA, USA.
Signicance: Longitudinal investigation on the association of e-cigarette (e-cig) use
with hypertension are lacking. Methods: Data from adults who were free of hypertension
at the PATH Wave 1 and completed surveys of Waves 1-4 were analyzed. Weighted
Cox regression models were used to examine the association of established e-cigs
and/or cigarettes use at Waves 1-3 (as a time-varying and time-lagging regressor)
and subsequent self-reported hypertension development across Waves 2-4. Variables
such as age, sex, race/ethnicity, education, BMI, physical activity, alcohol consumption,
diabetes mellitus, hypercholesterolemia, cardiovascular diseases, and family history of
hypertension were controlled in adjusted models. Results: Of 16,434 adult participants,
8,792 (53.5%) were female. The mean per-wave prevalence of exclusive e-cig users,
exclusive cigarette users, dual users, and non-users at Waves 1-3 was 2.0%, 28.7%,
2.9%, and 66.5%, respectively. The cumulative incidence of self-reported hypertension
by Wave 4 was 16.4% (female) vs 7.9% (male) among exclusive e-cig users, 13.2% (fe-
male) vs 13.5% (male) among exclusive cigarette users, 15.6% (female) vs 8.1% (male)
among dual users, and 8.3% (female) vs 10.4% (male) among non-users, respectively.
Among females, exclusive e-cig use vs non-use (hazard ratio, 1.70; 95%CI, 1.03-2.78;
P = .03) and exclusive cigarette use vs non-use (hazard ratio, 1.56; 95%CI, 1.20-2.01;
P < .001) were signicantly associated with subsequent self-reported hypertension
development. However, among males, hazard ratios of hypertension between exclusive
e-cig use vs non-use (1.25; 95%CI, 0.55-2.87) and between exclusive cigarette use vs
non-use (1.20; 95%CI, 0.97-1.48) were attenuated and non-signicant. Crude models
and sensitivity analyses supported the associations with similar results. No disparities
were found among dierent age groups or race/ethnicity groups. Conclusions: Estab-
lished exclusive e-cig use among females was prospectively associated with subsequent
self-reported hypertension development.
FUNDING: Federal; Academic Institution
PS1-87
ENGAGEMENT AND QUIT SUCCESS AMONG UNINSURED
TOBACCO USERS REGISTERING FOR QUITLINE SERVICES
Laura A. Beebe, Jonathan Hart, Lindsay Boeckman, Shirley James. University of Okla-
homa Health Sciences Center, Oklahoma City, OK, USA.
Signicance: Uninsured adults have high rates of tobacco use and face more barriers
to quitting than those with access to healthcare resources. While the Oklahoma Tobacco
Helpline (OTH) oers a robust set of services to uninsured tobacco users, they often
choose to register for less intensive services. Quit outcomes and factors related to
engagement by this priority population have not been systematically evaluated. Meth-
ods: OTH registrants identifying as uninsured from July 1, 2019 - June 30, 2021 were
included in this analysis to determine the extent to which they engage with the quitline,
factors associated with intensity of service utilization, and quit outcomes. Chi-square
tests and multiple logistic regression were used to analyze dierences in demographics,
tobacco use behaviors, service utilization, and cessation outcomes among uninsured
tobacco users by OTH program. P-values less than 0.05 were considered statistically
signicant. Results: Among the 17,594 uninsured tobacco users registering for services,
43.9% registered for the full benet available to them. The full benet includes up to
ve calls with a quitline coach, 8 weeks of NRT, and text/email support (multiple call
program, MC). The remaining 56.1% received less intensive services (any combination
of a 2-week NRT starter kit, web support, text and email messages). Factors associated
with selecting the MC program, while controlling for all other factors, included female
(OR=1.16; 95% CI 1.1-1.3), Hispanic ethnicity (OR=1.2; 95% CI 1.0-1.5), registration
via phone (OR=2.8; 95% CI 2.5-3.0), and reporting one or more mental health or sub-
stance abuse disorder (OR=1.3; 95% CI 1.2-1.5). At the 7-month follow-up, 35.2% of
MC participants reported 30-day abstinence, compared to 33.7% of those registering
for less intensive services. MC program participants were also less likely to be using an
e-cigarette at the 7-month follow-up, 9.6% compared to 15.5% among those using less
intensive services (p=0.02). Conclusions: There is opportunity for quitlines to better
serve uninsured, typically low SES, tobacco users by ensuring they receive the most
robust level of cessation support available to them. As demonstrated here, increasing
engagement and utilization of services has the potential to improve quit success, and
ultimately reduce disparities in tobacco use.
FUNDING: State
PS1-88
DEVELOPING AN E-CIGARETTE CESSATION SCALE TO INFORM
EFFECTIVE QUIT MESSAGING AMONG YOUTH AND YOUNG
ADULTS
Jessica M. Rath, Shreya Tulsiani, Daniel K. Stephens, Kenneshia N. Williams, Donna
M. Vallone, Elizabeth C. Hair. Truth Initiative, Washington, DC, USA.
Signicance: The truth campaign has been proven eective as a preventive tobacco
campaign for youth and young adults. In recent years, use of e-cigarettes by youth and
90
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
young adults has increased, leading to a growing need for public health campaigns
to address cessation eorts. To inform potential messaging surrounding e-cigarette
cessation, we rst need to determine what attitudes and beliefs are associated with the
increased intention to quit e-cigarettes. Methods: Two national surveys of past 30-day
e-cigarette users ages 15-24 (n=523, n=510) were conducted in May 2021 to evaluate
agreement with 148 possible items assessing knowledge, attitudes, and beliefs on
cessation of e-cigarettes. Items were eliminated if they already had high endorsement
of the desired attitude (>60% agreement on a 3-point scale). Then, using chi-square
and correlation analyses of each item agreement with the outcome of e-cigarette quit
intentions, items that did not show association for both were eliminated. A total of 27 items
remained and were subjected to chi-square analysis with e-cigarette use frequency, and
correlation analysis between items with a cuto of R=0.25. A conrmatory factor analysis
(CFA) was conducted for the nal items according to 3 expected factors: 1) attitudes
toward policy (attitudes), 2) identity, and 3) extrinsic motivation. Results: Correlations
showed increased agreement with each construct was associated with increased quit
intentions (attitudes: 0.49, identity: 0.64, extrinsic motivation: 0.52). Fit indices conrmed
a 3-factor solution. The comparative t index (CFI) = 0.94, the Tucker-Lewis t index
(TLI) = 0.88, and the RMSEA = 0.08. Conclusion: Developing message constructs that
are most correlated with increasing quit intentions is important in developing eective
e-cigarette cessation messaging. The e-cigarette cessation scale can help focus mass
media campaigns on messaging including attitudes towards policy, product use identity,
and extrinsic motivation that may inspire youth and young adult e-cigarette users to quit.
Future longitudinal research is needed to measure the causal impact of public health
messaging on quitting e-cigarette use.
FUNDING: Unfunded
PS1-89
PANDEMIC-RELATED STRESS, SUBSTANCE USE AND GENDER
IDENTITY; A BEHAVIORAL STUDY OF COLLEGE STUDENTS IN
THE SOUTHEASTERN U.S.
Julia Soulakova1, Lisa Crockett2, Mary Schmidt-Owens1, Eric Schrimshaw1. 1Univer-
sity of Central Florida College of Medicine, Orlando, FL, USA, 2University of Nebras-
ka-Lincoln, Lincoln, NE, USA.
Signicance. The study goals were to evaluate potential disparities in pandemic-related
stress associated with gender identity and determine whether pandemic-related stress
was associated with current use (in the last three months) of tobacco, alcohol and
non-medical cannabis among college students. Methods. We used the 2021 Spring
American College Health Association-National College Health Assessment data collected
at one large, southeastern university. Data collection was conducted during the rst
two weeks of March of 2021. The sample (n=659) included 18-32-year-old students.
Results. About 43% of students reported that the pandemic signicantly increased their
overall stress, and 29% of students reported that the pandemic made their nancial
situation a lot more stressful. The model-assisted odds of reporting that the pandemic
signicantly increasing the level of stress (Odds Ratio=2.5, 97.5%CI=1.6:3.9) and that
the nancial situation became a lot more stressful (Odds Ratio=1.7, 97.5%CI=1.1:2.8)
were signicantly higher among cisgender women relative to cisgender men. While the
odds for both measures of stress were higher for transgender/gender non-binary students
relative to cisgender men, the odds ratios were not signicant after adjustments for
multiplicity. Current tobacco use was not signicantly associated with increased overall
stress or nancial stress due to the pandemic. However, both current use of alcohol
(p=0.003) and cannabis (p=0.002) were signicantly more common among students
who reported that the pandemic made their nancial situation a lot more stressful (71%
and 30% respectively) relative to those students who reported that the pandemic did not
make their nancial situation a lot more stressful (59% and 17% respectively). These
disparities were most pronounced among cisgender women. Conclusion. The ndings
reinforce the importance of future monitoring of well-being and facilitating cessation of
substance use among U.S. college students, especially cisgender women, who are
more likely to be severely impacted by the pandemic (relative to the general population).
FUNDING: Unfunded
PS1-90
EXPLORING ENDS PREVENTION MESSAGES AND CONCEPTS
WITH YOUTH AND YOUNG ADULTS
Elizabeth L. Petrun Sayers1, Emily Peterson1, Alison Kulas1, Andie Malterud1, Kristen
Holtz2, Jordan Hartley2. 1U.S. Food and Drug Administration, Silver Spring, MD, USA,
2KDH Research & Communication, Atlanta, GA, USA.
Signicance: In 2014, FDA launched its rst youth tobacco prevention campaign tar-
geting at-risk youth aged 12-17 called The Real Cost (TRC). In 2018, the FDA expanded
its public education campaigns to focus on the prevention of youth electronic nicotine
delivery systems (ENDS) use. To support the next wave of the campaign, FDA’s Center
for Tobacco Products conducted a study to develop appropriate messaging to prevent
ENDS use among youth and young adults. Methods: Focus groups were completed
remotely across the United States, with a sample of 231 consisting of youth (13-17) and
young adults (18-20). Participants qualied for the study if they were identied as (1) at
risk of initiating ENDS use (susceptible) or (2) have experimented with ENDS (including
current and ever ENDS users). Recruitment also considered participant race/ethnicity,
gender, and geographical location. Nine of the focus groups included only participants
who reported Hispanic/Latino ethnicity. We conducted a qualitative content analysis of
focus group transcripts using NVivo along with quantitative analysis of pre-discussion poll
questions using Chi-square tests to examine dierences in responses across segments
to assess message eectiveness. Results: Focus groups identied promising messages,
which included statements about addiction, toxic metals (i.e., “vape aerosols contain
toxic metals”), lung damage, and DNA damage (i.e., “vape aerosols can contain toxic
chemicals that may damage your DNA”). Insights related to segments found current
users and 15-17-year-olds (compared to their younger and older counterparts) to be
more critical of stimuli. For certain messages there were no dierences between some
subgroups suggesting that some messages resonate across subgroups. A majority
(85.2%) of respondents reported campaign awareness, and (82.6%) considered TRC
to be a trusted/ credible source. Conclusions: Focus group participants oered insight
for developing appropriate messaging to prevent ENDS use among youth and young
adults. Results deepen our understanding of the target audience relationship to ENDS,
including perceptions and behaviors.
FUNDING: Federal
PS1-91
E-CIGARETTE USE IN THE WILD. NICOTINE FORMULATION AND
NICOTINE CONCENTRATION, BY DEVICE TYPE
Joanna Cohen1, Jerey Hardesty1, Qinghua Nian1, Elizabeth Crespi1, Eric Soule2,
Ryan David Kennedy1, Kevin Welding1, Joshua Sinamo1, Thomas Eissenberg3, Alison
Breland3. 1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
2East Carolina University, Greenville, NC, USA, 3VA Commonwealth University, Rich-
mond, VA, USA.
Signicance: E-cigarette device characteristics and liquid nicotine concentration
aect e-cigarette user nicotine exposure. We examined characteristics of devices and
liquids used by regular e-cigarette users in 2020. Methods: U.S. adults (21+) using
e-cigarettes at least ve days per week (n=1209) were recruited for an online survey;
many sample and data integrity strategies were implemented. Participants were asked
about the device and liquid used most often the past week and uploaded photos of their
most used device and liquid. When device or liquid characteristics were not available
from the coded photos, we used self-report data. The most prominent device/liquid
combinations of regular e-cigarette users are described. Results: The vast majority of
participants (90.7%) used devices with a rechargeable battery (n=1096). Among users
of rechargeable devices, just over half (56.3%) used devices with adjustable settings;
almost all of these (97.4%) used liquid from a rell bottle and most (77.9%) of these
used a liquid with free-base nicotine (median nicotine concentration (med_nic_con-
c)=6mg/mL). Among those who used a rechargeable device without adjustable settings
(42.8%), 61.0% used a pre-lled cartridge/pod, mostly (92.7%) with a nicotine salt liquid
(med_nic_conc=50mg/mL). Others who used a rechargeable device without adjustable
settings used liquid from a rell bottle (39.0%), half of which had a nicotine salt formula-
tion (51.4%; med_nic_conc=36mg/mL) and just under half had a free-base formulation
(45.4%; med_nic_conc=6mg/mL). Among users of disposable devices (n=113), almost
all used a nicotine salt liquid (95.6%; med_nic_conc=50mg/mL). Conclusion: Among
this sample there is much heterogeneity in the characteristics and combinations of
devices and liquids used by regular e-cigarette users. Many e-cigarette users are
able to manipulate device power and choose liquid nicotine concentration, resulting in
challenges for regulating e-cigarette users’ nicotine exposure. These challenges have
implications for understanding e-cigarette toxicity, addiction, health eects and use
behaviors at the individual and population level.
FUNDING: Federal
91
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-92
TOBACCO COMPANY AGREEMENTS WITH TOBACCO
RETAILERS FOR PRIME PLACEMENT AND PRICE DISCOUNTS, A
SCOPING REVIEW
Alexandria E. Reimold1, Joseph G.L. Lee2, Kurt M. Ribisl1. 1UNC Chapel Hill, Chapel
Hill, NC, USA, 2East Carolina University, Greenville, NC, USA.
SIGNIFICANCE. Often, the promotion of tobacco products is spurred on by secretive
contractual agreements between international tobacco manufacturers and tobacco
product retailers. These contracts ensure that tobacco products are heavily marketed
in the retail setting through placement, promotion, price, and products. We conducted
a scoping review to explore the state of the existing research and to understand the
provision in contracts between tobacco manufacturers and retailers. METHODS. The
systematic search was conducted in PubMed/MEDLINE, Web of Science, Scopus,
ProQuest Political Science Database, Business Source Premier, ProQuest Agricultural
& Environmental Science Collection, and Global Health through December 2020. We
included studies that collected and analyzed empirical data related to tobacco contracts,
tobacco manufacturers, and tobacco retailers. Two reviewers independently screened
all 2,786 studies’ title and abstract and 65 studies’ full text for inclusion. Study charac-
teristics, contract prevalence, contract requirements and incentives, and the inuence
of contracts on the retail environment were extracted from each study. We created an
evidence table and conducted a narrative review of included studies. RESULTS. Our
review resulted in 27 (0.97%) included studies. These condential contracts are com-
mon around the world and handsomely incentivize tobacco retailers in exchange for
manufacturer control of tobacco product availability, placement, pricing, and promotion
in the retail setting. Contracts allow tobacco companies to promote their products and
undermine tobacco control eorts in the retail setting through discounted prices, pro-
motions, and highly visible placement of marketing materials and products. We present
examples from prior research and sample contracts to illustrate the power contracts
have over shaping the retail environment. CONCLUSIONS. Policy recommendations
include banning tobacco manufacturer contracts and retailer incentives along with more
transparent reporting of contract incentives given to retailers.
FUNDING: Federal
PS1-93
STRUCTURED ONLINE TRAINING FOR UNIVERSITY STUDENTS
TO DELIVER PEER-LED SMOKING CESSATION COUNSELLING
FOR YOUNG SMOKERS IN CHINA: EFFICACY ON IMPROVING
KNOWLEDGE, ATTITUDE, CONFIDENCE, AND SKILLS
Tingna Liang1, William Ho Cheung Li2, Wei Xia3, Wei Lin Leung4, On Ni Yip4. 1The
University of Hong Kong, Hong Kong, Hong Kong, 2The University of Hong Kong, Hong
Kong, China, 3Sun Yat Sen University, Guangzhou, China, 4The University of Hong
Kong, Hong Kong, China.
Signicance The majority of smokers started to smoke cigarettes before 30 years
old. The harmful eects of smoking on youth can be severe and long-lasting, including
reduced lung growth, brain development, and early cardiovascular damage. Youth
who are daily cigarette smokers are less likely to quit on their own, seeking smoking
cessation support and receive advice to quit from healthcare providers. Peer support
counselling oers peer counsellors and youth smokers a common ground to share
and resonate with one another’s personal experiences. However, peers are often lack
skills and knowledge in delivering smoking cessation support to smokers. It is essential
to provide smoking cessation training for peers to be smoking cessation counsellors.
Methods A structured training program was designed for university students who have
the intention to provide support for public health. Pre-and post-training evaluations were
conducted for 94 university students who completed the training program. Results
After training, the participant’s mean score for knowledge about tobacco use (pre:7.22,
SD=1.88 VS post:8.24, SD=2.41; P=0.002), attitudes towards smoking cessation
and tobacco control (pre: 3.06,SD=0.64 VS pre: 3.44, SD=0.59; P<0.001) increased
signicantly. Their perceived condence (pre: 2.89,SD=0.41 VS post:30.4, SD=0.45;
P=0.024) and importance(pre:3.19,SD=0.48 VS post: 3.34,SD=0.48;p=0.049) increased
in delivering smoking cessation counseling. Also, their perceived eectiveness of quitline
(pre:6.65,SD=1.27 VS post:7.51,SD=1.30;p<0.001) and perceived importance of peer
counselling(pre:7.71,SD=1.14 VS. post:8.21,SD=1.11;p<0.001) in helping smokers quit
smoking increased signicantly. The training program had a medium eect on improving
participant’s knowledge of and attitude towards tobacco use(Cohen’s d=0.500), a large
eect on improving perceived eectiveness(Cohen’s d=1.156) and importance(Cohen’s
d=1.107) towards quitline in smoking cessation, a medium eect on enhancing their con-
dence, perceived importance, and reduced in delivering smoking cessation counselling.
Most of the trained participants demonstrated good counselling skills in the simulated
standardized case scenario. The participant’s mean score for the practical exam was
14.42 (SD=1.99[maximum score=19]). Conclusion The online smoking cessation
training programme signicantly improved participants’ knowledge of and attitudes
towards tobacco use. It also enhanced the condence and skills of peer counsellors in
delivering counselling to youth smokers.
FUNDING: Academic Institution
PS1-94
EFFECT OF HARM PERCEPTION ON ENDS INITIATION AMONG
US ADOLESCENTS AND YOUNG ADULTS: FINDINGS FROM THE
POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH)
STUDY, 2013-2018
Wei Li, MD, MPH, Olatokunbo Osibogun, PhD, Prem Gautam, MPH, Tan Li, PhD,
Miguel A. Cano, MPH, PhD, Matthew T. Sutherland, PhD, Wasim Maziak, PhD. Florida
International University, Miami, FL, USA.
Background: Electronic Nicotine Delivery Systems (ENDS) have become the most
popular tobacco products among youth in the United States (US). This study aims
to investigate how ENDS harm perception predicts ENDS initiation among never
ENDS users. Methods: Data were from the youth and adult sample of the Population
Assessment of Tobacco and Health (PATH) Study conducted from 2013-2018. Cox
proportional hazards regression models were used to assess the relationship between
harm perception and ENDS initiation among adolescents and young adults separately.
Weighted adjusted hazard ratios (HRs) with 95% condence intervals (CIs) were re-
ported. Results: 17.1% of the 11,633 adolescents and 25.5% of the 5,089 young adults
from baseline initiated ENDS use across four waves. Among adolescents, perceiving
ENDS as less harmful than cigarettes (HR=2.69; 95%CI: 2.21-3.27) and ENDS as no or
little harm (HR=2.78; 95%CI: 2.31-3.34) signicantly increased risks of ENDS initiation.
Young adults who perceived ENDS as less harmful than cigarettes were more likely
to initiate ENDS (HR=2.04; 95%CI: 1.73-2.41). Additionally, adolescents and young
adults who ever used any other tobacco products or substance were associated with
an increased risk of ENDS initiation. Conclusions: Among a representative longitudinal
cohort of adolescents and young adults who had never used ENDS, perceiving ENDS
as a reduced or low-harm product signicantly predicted ENDS initiation across four
waves. These ndings underscore the need for appropriate ENDS prevention projects
such as risk communication interventions targeted to young people to help curb ENDS
initiation and diminish ENDS use in the US.
FUNDING: Unfunded
PS1-95
“WHY BAN MENTHOL CIGARETTES WHEN YOU CAN SMOKE
REGULAR CIGARETTES?” - INTERVIEWS ABOUT A MENTHOL
BAN WITH PEOPLE WHO SMOKE MENTHOL CIGARETTES
Rachel L. Denlinger-Apte1, Darcy E. Lockhart1, Ashley E. Strahley1, Rachel N.
Cassidy2, Eric C. Donny1, Richard J. OConnor3, Jennifer W. Tidey2. 1Wake Forest
School of Medicine, Winston-Salem, NC, USA, 2Brown University, Providence, RI, USA,
3Roswell Park Comprehensive Cancer Center, Bualo, NY, USA.
Signicance: The US Food and Drug Administration recently announced its intention
to pursue a federal ban on menthol cigarettes. The purpose of this qualitative study was
to examine reactions to a potential menthol cigarette ban among people who smoke
menthol cigarettes. Methods: As part of a laboratory study examining menthol avor
regulations, we conducted interviews with participants who smoke menthol cigarettes
(N=35). We examined the following topics: (1) risk perceptions of menthol cigarettes;
(2) knowledge, attitudes and perceptions of menthol cigarette regulations; and (3) an-
ticipated behavior if menthol cigarettes were banned. Interviews were audio-recorded,
transcribed verbatim, double-coded, and analyzed using reexive thematic analysis.
Results: Overall, the majority of participants (n=29) said they would use other tobacco
products, including non-menthol cigarettes (n=16) or e-cigarettes (n=23), if menthol
cigarettes were not available to purchase. However, many also said a menthol ciga-
rette ban could motivate them or others to quit smoking. Several voiced skepticism or
resentment about banning only menthol cigarettes rather than all cigarettes, including
non-menthols. Some felt the policy would be ineective because people will nd a way
to obtain menthol cigarettes or simply switch to non-menthol cigarettes. Others said
banning menthol cigarettes would be good for public health because fewer people,
particularly youth, would smoke. Some participants stated that regulators wanted to
ban menthol cigarettes because they appeal to youth or because they believed that
menthol cigarettes are more harmful or addictive than non-menthol cigarettes. Conclu-
sions: Our ndings may help to explain why many surveys report minimal support for
banning menthol cigarettes. People who smoke menthol cigarettes may not understand
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
the policy’s purpose, resulting in the perception of being unfairly targeted or that the
policy with be ineective. As regulators move forward with banning menthol cigarettes,
communication campaigns explaining the public health benets, potentially focusing on
the benets for youth, should be part of the policy implementation plan.
FUNDING: Unfunded; Federal
PS1-96
COSTS AND COST-EFFECTIVENESS OF A SMOKING
CESSATION PROGRAM FOR INDIVIDUALS HOSPITALIZED WITH
PSYCHIATRIC DISORDERS
Douglas E. Levy1, Ryoko Sato1, Haruka Minami2, Jacklyn Hecht3, Kelly M. Carpenter4,
Nancy A. Rigotti5, Richard A. Brown3. 1Massachusetts General Hospital, Boston, MA,
USA, 2Fordham University, Bronx, NY, USA, 3University of Texas, Houston, TX, USA,
4Optum Center for Wellbeing, Seattle, WA, USA, 5Harvard Medical School, Lincoln,
MA, USA.
BACKGROUND. The HelpingHand3 smoking cessation randomized trial established
that among smokers discharged from a hospital after treatment for a psychiatric disor-
der, a sustained care (SusC) intervention increased 7-day point prevalence smoking
abstinence at 6 months for those receiving SusC compared to usual care (UC) control
(8.9% SusC vs. 3.5% UC, dierence 5.4% [95% CI, 0.3%-10.4%]). The present study
estimated the cost per participant and incremental cost per quit (ICQ) of implementing
the SusC intervention relative to UC. METHODS. Participants in the SusC arm were
oered the following intervention: 1) a 40-minute, in-hospital smoking cessation moti-
vational interviewing (MI) counseling session from a trained social worker, 2) a 4-week
supply of free nicotine patches, 3) an optional additional 4-week course of nicotine
patches, 4) up to 8 automated outreach messages on smoking cessation delivered by
a choice of either interactive voice recognition (IVR) or text (SMS) message according
to participant preference, 5) referral to Tobacco Quitline for cessation counseling if in-
terested. Costs, measured from a health system’s perspective, included MI counseling
(counselor training/oversight, inpatient counseling delivery), medications (with shipping),
and technology (IVR, SMS, quitline connection). Unused optional services incurred no
cost. In practice, few participants chose/engaged with IVR so an alternate cost scenario
was simulated with SMS technology only, streamlined connection to the Quitline, and
8 weeks of nicotine patches provided at discharge (necessary because IVR was used
in triaging the second 4 weeks of nicotine patches) (SusC-alt). RESULTS: The cost of
SusC as provided in the trial was $1,439/participant (5% counseling, 7% medications,
88% technology); the ICQ was $26,602 (95%CI $11,086, $168,838). SusC-alt would
cost $248/participant (32% counseling, 52% medication, 17% technology) with an ICQ of
$4,587 (95%CI $1,844, $28,980). CONCLUSION: As implemented in an RCT, SusC was
costly. However, in real-world practice, technology costs could be signicantly reduced
yielding ICQ values similar to other health system-initiated cessation interventions.
FUNDING: Federal
PS1-97
SIMULATION MODELING OF SMOKING AMONG PEOPLE WITH
AND WITHOUT SERIOUS PSYCHOLOGICAL DISTRESS IN THE US
1997-2100
Qin Xi1, Rafael Meza2, Adam Leventhal3, Jamie Tam1. 1Yale School of Public Health,
New Haven, CT, USA, 2University of Michigan School of Public Health, Ann Arbor, MI,
USA, 3University of Southern California, Los Angeles, CA, USA.
Signicance: People with serious psychological distress (SPD) continue to be dis-
proportionately harmed by smoking-related disease and death. It is unclear how this
disparity could change over time. Methods: We developed separate deterministic
smoking simulation models for the SPD and non-SPD populations with compartments
for never, current, and former smokers. Using the 1997-2018 National Health Interview
Surveys (NHIS), we calibrated parameters for annual probabilities of smoking initiation
and cessation for SPD and non-SPD populations. Mortality estimates were specic to
smoking status, age, gender, and SPD status. Baseline projections assume that current
smoking initiation and cessation probabilities remain constant 2018-2100. Results:
Simulation models correspond closely with 1997-2018 NHIS data. In the SPD popula-
tion, smoking prevalence declined from 52.3% to 35.1% among men (women: 43.7% to
30.1%). In the non-SPD population, smoking prevalence dropped from 26.1% to 14.5%
among men (women: 20.2% to 11.5%). The smoking prevalence ratio between men
with and without SPD from 1997-2018 increased from 2.0 to 2.4 (women: 2.2 to 2.6) By
2100, the ratio increased to 3.1 for men (12.3% vs. 4.0%) and 3.3 for women (10.5%
vs. 3.1%). The model estimates that under a baseline scenario, the total number of
smoking-attributable deaths among people with SPD from 2020-2100 is 873,354. The
proportion of all deaths attributed to smoking among people with SPD decreased from
14.4% in 2020 to 4.5% in 2100 for women and from 18.8% to 8.3% for men. Among
people without SPD, it decreased from 8.4% to 1.7% for women and 18.9% to 4.4%
for men. By 2100, smoking-attributable proportions of death were 1.9 times greater for
men with SPD than for men without SPD (women: 2.6 times greater). From 2020-2100,
people with SPD lost an estimated 9.7 million years of life attributed to smoking. Con-
clusion: Although smoking rates are projected to decline for people with and without
SPD over time in the absence of intervention, smoking disparities by SPD may widen,
with dierences by gender. Future research can evaluate interventions with potential
to reduce tobacco-related disparities.
FUNDING: Unfunded
PS1-98
PATTERNS OF USE AND THE CARDIOPULMONARY HEALTH
RISKS OF CIGAR PRODUCTS - A SYSTEMATIC REVIEW
Comreen Vargees1, Andrea M. Stroup2, Taylor Niznik3, Delaney Dunn3, Riley Wyatt3,
Cosima Hoetger4, Amy Cohn3, Ziyad Ben Taleb5, Caroline Cobb4, Jessica L. Fetterman6.
1New York Medical College, Valhalla, NY, USA, 2Westat, Rockville, MD, USA, 3University
of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, 4Virginia Common-
wealth University, Richmond, VA, USA, 5University of Texas at Arlington, Arlington, TX,
USA, 6Boston University School of Medicine, Boston, MA, USA.
Background: A systematic review was conducted to identify reported and perceived
cardiopulmonary health eects of cigar products. Methods: PubMed and Google Scholar
were searched for articles published between June 2014 and February 2021. Search
keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes.
Of the 782 papers identied, we excluded non-English articles, review articles, com-
mentaries, and those without empirical data on cigar products. 90 studies met inclusion
criteria and were included in the paper. Three coders independently reviewed all articles
and compared codes to resolve discrepancies. Results: Cigars have evolved from
large cigars to encompass little cigars and cigarillos (LCCs). LCCs are more frequently
used by youth, young adults, and Blacks and are often used in combination with other
tobacco products, alcohol, and marijuana. LCCs are available in an array of avors
and at a price advantage. Cigar product diversity is driven by a loophole in the Family
Smoking and Prevention Act that exempted cigars from many of the policies regulating
cigarettes. Despite limited regulation, cigars generate smoke of a similar composition
as cigarettes. A limited number of studies have evaluated the cardiopulmonary eects
of cigar use and suggest associated toxicity. Importantly, all-cause, lung cancer, and
cardiovascular disease-related mortalities are higher among cigar users compared
to non-smokers. Conclusion: Studies evaluating the cardiopulmonary health eects
associated with contemporary cigar products are extremely limited but suggest similar
health risks as conferred by cigarette smoking. With the use of LCCs and targeted
social media marketing on the rise among high-risk groups such as youth and Blacks,
it is crucial that studies moving forward evaluate the cardiopulmonary health eects
associated with contemporary cigar products.
FUNDING: Federal; Academic Institution
PS1-99
PREDICTIVE VALIDITY OF THE ORIGINAL AND EXPANDED
SUSCEPTIBILITY MEASURES FOR SMOKELESS TOBACCO
Megan Wall1, Nathaniel Taylor2, Matthew Farrelly2, Alexandria Smith1, James G.
Spinks2. 1Center for Tobacco Products, U.S. Food and Drug Administration, Silver
Spring, MD, USA, 2Center for Health Analytics, Media, and Policy, RTI International,
Research Triangle Park, NC, USA.
Background: Susceptibility to smoking is a widely used measure of intention to use
tobacco products. This study seeks to validate the original (3-item) and expanded (4-
item) susceptibility measures for smokeless tobacco (SLT) use among a longitudinal
sample of rural young boys. We also compare the predictive validity of the original and
the expanded susceptibility measures for SLT. Methods: Data are from a ve-wave
longitudinal sample of rural boys ages 11-16 at baseline in the United States. Data
were collected either in-person or online approximately twice a year from January
2016 to December 2018. We used a series of logistic regressions to identify whether
individual demographic variables, the original (will use SLT soon, in next year, if friend
oers), or the expanded (same items plus curiosity) susceptibility measures predicted
experimentation with SLT by 2018. The sensitivity (true positive rate), specicity (true
negative rate), positive predictive value (PPV), and negative predictive value (NPV) of
the original and expanded measures were also calculated to determine reliability. All
analyses were limited to 2016 never SLT users. Results: The original and the expanded
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
susceptibility measures were signicant predictors of SLT initiation by follow-up. Rural
boys who were susceptible on the original measure (AOR = 3.38 95% CI=2.71-4.22)
and the expanded measure (AOR = 3.20 CI=2.60-3.95) had increased odds of initiating
SLT within three years compared to rural boys who were non-susceptible. The original
and expanded measures both have high specicity (86.1% and 80.7% respectively),
identifying a large proportion of never users as non-susceptible. Sensitivity for the
original measure was 37.0% and increased to 44.2% for the expanded scale. The
PPV is approximately 20% for both the original and expanded measures (21.2% and
18.8%). Conclusions: These results suggest that the susceptibility measure for SLT
is a valid predictor of future SLT use. The expanded scale does not improve the overall
predictive validity of the scale but improves the sensitivity, which may be benecial for
public health professionals interested in identifying at-risk youth.
FUNDING: Federal
PS1-100
READABILITY OF VAPING INFORMATION ON THE WEB
Lindsey A. Wood, Osayande Agbonlahor, Madeline M. Tomlinson, Savannna Kerstiens,
Kolbie Vincent, Alison C. McLeish, Kandi L. Walker, Joy L. Hart. University of Louis-
ville, Louisville, KY, USA.
Signicance: Many people, especially youth and young adults, rely on the internet for
information, including information on vaping. However, for information to be useful, it
must be easily understood. The recommended reading level for U.S. adults is 6th-7th
grade, with lower levels suggested for youth. In one of the only studies to examine
readability of e-cigarette-related web content, Park et al. (2017) found that webpages
exceeded readability level recommendations and that information promoting e-cigarette
use was easier to read than information warning of dangers. This study sought to ex-
tend Park et al.’s ndings by analyzing online e-cigarette content related to addiction
and cessation and comparing information targeted to teens and parents. Methods:
Three reviewers identied the rst 100 webpages with vaping-related content using
six search terms (N=1800). After exclusion (e.g., product advertisement, duplicates),
464 webpages were analyzed using six readability measures: Flesh Kincaid Reading
Ease, Flesh Kincaid Grade Level, Gunning-Fog Score, Coleman-Liau Index, Simple
Measure of Gobbledygook (SMOG Index), and Automated Readability Index. Webpages
were categorized by target audience (e.g., teens, parents), and t-tests and ANOVA
assessed dierences. Results: Overall, webpage content was written at an 8.39 grade
level (SD 1.92). Webpages targeted to teens had lower readability scores than those
targeted to adults on three readability tests: Automated Readability Index (p=0.0093),
Coleman-Liau Index (p=0.0263), and SMOG Index (p=0.0109). Under half (48.1%)
of webpages targeted to teens and under one-third (32.7%) targeted to parents met
readability guidelines. Conclusion: Information about e-cigarettes on many webpages
exceeded readability recommendations. Although webpages that targeted teens were
more readable than those targeting parents, many teen-oriented webpages failed to
comply with readability guidelines. To eectively communicate information about e-cig-
arette risks, messaging has to be interpretable; thus, online content should be crafted
according to readability guidelines.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
PS1-101
IMPACT OF THE COVID-19 PANDEMIC ON VAPING AMONG
COLLEGE STUDENT E-CIGARETTE USERS
Alison C. McLeish, Kandi L. Walker, Lindsey A. Wood, Joy Hart. University of Louis-
ville, Louisville, KY, USA.
Signicance: While the U.S. has seen substantial declines in combustible cigarette use,
e-cigarette use has increased signicantly in recent years, especially among college
students where rates of past-month use increased from 6.1% in 2017 to 22% in 2019.
This dramatic increase is particularly alarming because emerging work suggests that
vaping increases risk for COVID-19 infection. Vaping may also increase risk for severe
COVID-19 and the need for mechanical ventilation. However, it is unclear whether
these risks have impacted college student e-cigarette users. Therefore, the current
study sought to examine how the COVID-19 pandemic may have inuenced views of
vaping risks and vaping behavior among college students. Methods: Participants were
129 current e-cigarette users (Mage = 19.68, SD = 1.84; 72% female; 85.3% White)
who completed an online survey for course credit in the Fall 2020 and Spring 2021
semesters. Participants reported an average e-cigarette dependence score of 9.37 (SD
= 4.88), and 42.6% were daily users. Results: Although 69% of participants thought
the risk of COVID-19 was somewhat or much higher for vapers than non-vapers, only
34.1% reported that their views on e-cigarettes had changed in the last six months.
Participants thought vaping increased risk of COVID-19 by only a moderate amount
(M = 3.61, SD = 1.98 on a 1-7 scale), yet 45.3% reported that their motivation to quit
vaping had increased since the pandemic’s start and 32.6% had made a quit attempt.
However, only 23.4% had decreased their use since learning about COVID-19, and
vaping was the second most commonly endorsed coping mechanism for dealing with
COVID-19-related stress behind making time to relax. Conclusions: These ndings
suggest that college student e-cigarette users hold conicting beliefs about the health
risks of e-cigarettes, and that their behaviors are not always in line with their risk
perceptions. Perhaps conicting motivations to vape to cope with stress as well as to
stop vaping to reduce health risks impede behavior change. Motivational enhancement
strategies may be useful to encourage cessation eorts in this population.
FUNDING: Unfunded
PS1-102
TRENDS OF MATERNAL TOBACCO (WATERPIPE, CIGARETTE,
AND DUAL) USE IN JORDAN. A DECADE OF LOST
OPPORTUNITIES
Khalid A. Kheirallah, Nuha Shugaa Addin, Maan Alolaimat. Medical School of Jordan
University of Science and Technology, Irbid, Jordan.
BackgroundMaternal tobacco use is a global public health problem. In the literature, the
focus was mainly on cigarette smoking, minimally on waterpipe use, and totally ignored
dual use among pregnant women. We estimated the prevalence of current maternal
tobacco use by tobacco product (cigarette, waterpipe, and dual use) over a period of
ten years (2007 to 2017), and examined the socio-demographic patterning of maternal
tobacco use.MethodsA secondary analysis of Jordan DHS four data waves was conduct-
ed for women who reported to be pregnant at the time of the survey. Current cigarette
and waterpipe tobacco use were investigated. Prevalence estimates for cigarette-only,
waterpipe-only, and dual use, as well as for cigarette, regardless of waterpipe, and
waterpipe, regardless of cigarette, were reported. The eect of independent variables
on cigarette smoking, waterpipe use, and dual use was assessed. Logistic regression
models assessed the adjusted eects of socio-demographic variables on cigarette
smoking, waterpipe use, and on dual use. For each outcome variable, a time-adjusted
and a time-unadjusted logistic models were conducted.ResultsOver the last decade,
the prevalence estimates of current cigarette-only smoking slightly decreased. The
prevalence estimates of current waterpipe-only use exceeded those for cigarette-only
after 2007 and showed a steady overall increase. Current dual use showed a continuous
rise especially after 2009. Gradual increase in cigarette smoking (4.1%, in 2007, and
5.7% in 2017) and in waterpipe use (2.5% to 6.4%) were detected. Education showed
an inverse relationship with cigarette and waterpipe smoking. Household wealth demon-
strated a positive association with cigarette and waterpipe smoking.ConclusionsTobacco
use epidemic is expanding its roots among pregnant women in Jordan through not only
waterpipe use but also dual cigarette-waterpipe smoking. Maternal and child services
should consider tobacco counseling and cessation.
FUNDING: Unfunded; Academic Institution
PS1-103
TOBACCO SMOKE IS A MAJOR SOURCE OF AROMATIC AMINE
EXPOSURE IN US ADULTS: NHANES 2013-14
Tiany Seyler, PhD, MPH1, Shrila Madzumder, MS1, Rayaj Ahamed, MS1, Lanqing
Wang2, Ben Blount3, Wanzhe Zhu1, Brittany Pine4. 1CDC, Atlanta, GA, USA, 2Center
for Disease Control and Prevention, Chamblee, GA, USA, 3Center for Disease Control,
Chamblee, GA, USA, 4Boston University, Boston, MA, USA.
Cigarette smoking increases risk of cancer and cardiovascular diseases, as well as
premature death. Aromatic amines (AAs) are found in cigarette smoke and are well-es-
tablished human bladder carcinogens. In this study, we measured the urinary levels
of 1-aminonaphthalene (1AMN), 2-aminonaphthalene (2AMN), and 4-aminobiphenyl
(4ABP) in adult exclusive cigarette smokers and adult nonusers of tobacco products
among a nationally representative sample of the non-institutionalized U.S. population,
National Health and Nutrition Examination Survey (NHANES) 2013-14 (a 1/3 sub-sample
of adults aged 18+ years old). Exclusive cigarette users are participants who answered
yes to smoking cigarettes in the past 5 days and no to smokeless tobacco products,
and other combustible tobacco products such as cigars, hookah, e-cigarettes. Total
urinary AAs were measured by isotope dilution Gas Chromatography-Triple Quad Mass
Spectrometry. Sample-weighted geometric mean concentrations of AAs in adult exclusive
cigarette smokers compared to adult nonusers of tobacco products were 30 times higher
for 1AMN and 4-6 times higher for 2AMN and 4ABP. Tobacco smoke exposure analyses
were performed using sample-weighted multiple linear regression models to control
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
for age, sex, race, and urinary creatinine. Tobacco exposure status was categorized
using serum cotinine among adult nonusers of tobacco products (SCOT ≤ 10 ng/mL)
and reported cigarette smoked per day CPD (self-reported average number of CPD in
the 5 days prior to NHANES physical exam) among exclusive cigarette users (SCOT
> 10 ng/mL). Sample-weighted regression models show total urinary 1AMN, 2AMN,
and 4ABP increased proportionally with the number of cigarettes smoked per day (p <
0.001). We also investigated the relationship between AA levels and U.S. Department of
Agriculture (USDA)dietary categories. Dietary intake was examined using the amounts
participants reported for each USDA food group in the 24-hours recall period, midnight
to midnight. Sample-weighted multiple linear regression models were t to each of the
three analytes to include demographic covariates, tobacco exposure status, as well as
24-hour dietary recall and fasting time as covariates. We observe no consistent signi-
cant association between USDA 24-hour recall dietary intake and all three AAs. To our
knowledge, this is the rst time exposure to AAs from cigarette smoking is characterized
among the adult US population, and we conrmed signicantly higher levels of 1AMN,
2AMN, and 4ABP in adult exclusive cigarette smokers.
FUNDING: Federal
PS1-104
CHARMING E-CIGARETTE USERS WITH DISTORTED SCIENCE:
EXAMINING THE IMPACT OF MISLEADING AND FALSE CLAIMS
ABOUT NICOTINE ON BELIEFS ABOUT THE TOBACCO
INDUSTRY
Nathan A. Silver, Elexis C. Kierstead, Jodie Briggs, Barbara A. Schillo. Truth Initiative,
Washington, DC, USA.
Signicance. The emergence of misleading scientic claims about the potential role of
nicotine in ghting COVID-19 emphasizes the importance of examining public discourse
about nicotine in general. This research examines the role of social media in promoting
recall and belief of distorted science about nicotine and whether recall and belief in turn
predict tobacco industry beliefs. Methods. Young adults 18-34 years (N=1225) old were
surveyed via an online Qualtrics panel. Participants responded to a survey assessing
recall and belief in three claims about nicotine and COVID-19 and three more about
nicotine in general followed by assessments of positive and negative industry beliefs and
use of various social media platforms. Ordinal logistic regression with robust standard
errors controlling for gender, race/ethnicity, education, current e-cigarette use, and
age was used to examine relationships between variables. Results. Twitter use was
associated with higher odds of both recall (OR=1.21 95% CI=1.01, 1.44) and belief
(OR=1.26 CI=1.04, 1.52) in COVID-19 specic distorted science. YouTube use was
associated with higher odds of believing COVID-19 specic distorted science (OR=1.32
CI=1.09, 1.60). Reddit use was associated with lower odds of believing COVID-19
specic distorted science (OR=0.72 CI=0.59, 0.88). Recall (OR=1.26 CI=1.07, 1.47)
and belief, (OR=1.28 CI=1.09, 1.50) in distorted science about nicotine in general as
well as belief in distorted science specic to COVID-19, (OR = 1.61 CI=1.34, 1.95) were
associated with more positive beliefs about the tobacco industry. Belief distorted science
about nicotine in general was associated with more negative beliefs about the tobacco
industry (OR=1.18 CI=1.02, 1.35). Conclusion. This study provides evidence of the role
of social media in both disseminating as well as dispelling misleading and potentially
harmful misinformation about nicotine and suggests a role for counter messaging.
Additionally, addressing misinformation about nicotine is important, as it appears to be
associated with more favorable views of the tobacco industry which may erode public
support for eective regulation.
FUNDING: Other
PS1-105
DIFFERENCES IN YOUTH E-CIGARETTE CO-USE OF CANNABIS
AND NICOTINE VS. NICOTINE ALONE IN SOUTH CAROLINA
Jaron H. King, Kankana Sengupta, Daniel J. Kilpatrick. South Carolina Department of
Health and Environmental Control, Columbia, SC, USA.
Signicance: Cannabis use in e-cigarettes is a rapidly burgeoning practice that calls
for immediate and long-term epidemiologic research. This area of research is partic-
ularly prudent given the prominent role of THC-containing products in causing severe
illness such as the 2019 EVALI outbreak. Methods: This study uses the 2019 South
Carolina Youth Tobacco Survey (YTS) to analyze potential dierences in ever-users of
e-cigarettes among a representative cross-sectional sample of high school students
(n=1267). Ever-users of e-cigarettes were dierentiated by substance vaped: with nic-
otine alone e-cigarette users (n=227) representing a larger group than those who had
vaped nicotine and cannabis (co-users) (n=116). Results: Chi-square analysis revealed
signicant dierences in lifetime cigarette use with co-users being more than twice as
likely to have smoked more than 1 cigarette than nicotine alone e-cigarette users (aOR:
2.89, 95% CI: 1.63-5.11). Signicant results were also found in heavy cigarette use,
desires to quit smoking, quit attempts, how products were obtained, and perceptions
about tobacco use among other variables. Conclusions: These results suggest that
youth use of e-cigarettes is not limited to what is legally available to adult users, and
can inform public health practitioners and policy makers in developing interventions to
prevent youth substance use.
FUNDING: Unfunded; State; Academic Institution
PS1-106
SOCIAL MEDIA EXPOSURE AND INITIATION OF VAPING
CANNABIS AMONG US ADOLESCENTS RESULTS FROM THE
POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH)
STUDY WAVES 3 AND 4
Juhan Lee, Suchitra Krishnan-Sarin, Grace Kong. Yale University School of Medicine,
New Haven, CT, USA.
BACKGROUND The prevalence of youth cannabis vaping has increased in recent
years. Engagement in social media platforms that provide pro-vaping content which
includes both vaping cannabis and nicotine may inuence youth cannabis vaping
behaviors. There have been few longitudinal examinations of these associations. We
used a nationally representative longitudinal sample of US youth to investigate the
associations between social media use and cannabis vaping initiation. METHODS This
study utilized the youth dataset from Population Assessment of Tobacco and Health
(PATH) Study Waves 3 (2015-2016) and 4 (2016-2018). Using youth respondents who
never vaped cannabis at Wave 3 (N=7,821), we conducted a multivariable logistic
regression on cannabis vaping initiation at Wave 4 (ever-used cannabis vaping) by
frequency of social media use at Wave 3 (never, non-daily, daily), after controlling
for associated covariates (e.g., demographics, current tobacco, and other substance
use, internalizing/externalizing tendencies). RESULTS Among cannabis never-vapers
at Wave 3 (n=7,821), 16.1% (weighted) reported never, 16.4% non-daily, and 67.5%
daily social media use, and 6.8% (n=540; weighted) initiated cannabis vaping at Wave
4. In the multivariable logistic regression model, daily social media use (vs. never use)
was associated with cannabis vaping initiation at Wave 4 (aOR=1.75; 95% CI=1.18,
2.60), but non-daily social media use (vs. never use) was not associated with cannabis
vaping initiation at Wave 4 (p=0.594). CONCLUSIONS Youth who use social media
daily were more likely to report initiation of cannabis vaping a year later. Multi-level
prevention eorts are needed to curve pro-vaping content on social media to reduce
youth cannabis vaping. These should include surveillance and regulation of cannabis
vaping-related content on social media.
FUNDING: Federal
PS1-107
PROMISING THEMES FOR CORRECTING PUBLIC
MISPERCEPTIONS ABOUT NICOTINE REDUCTION
M. Justin Byron, Kristen L. Jarman, Leah M. Ranney, Noel T. Brewer, Adam O. Gold-
stein. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Signicance: Half of smokers incorrectly think that very low nicotine content (VLNC)
cigarettes are less carcinogenic than current cigarettes, which could reduce the impact
of an FDA nicotine reduction policy. We sought to determine what themes and messages
are most eective in reducing the misperception that VLNC cigarettes are safer to smoke
than current cigarettes. Methods: We recruited US adult smokers in March of 2021.
They participated in a MaxDi best-worst scaling experiment to determine which themes
and messages were most promising for correcting the VLNC misperception based on
perceived message eectiveness. The 19 messages used one of seven themes: 1)
truth, 2) truth/refute- myth/truth, 3) emotion, 4) alternative cause 5) value armation
6) emphasize harm of all cigarettes, or 7) minimal. Participants viewed sets of 3 mes-
sages and selected the one they preferred most and least. Participants then rated how
much each message discouraged them from using VLNC cigarettes. MaxDi results
were analyzed using hierarchical bayes modeling to derive individual level scores for
each message, and these scores were also pooled to compute average scores overall
by message. We also computed the mean discouragement rating for each message.
Results: 508 participants enrolled in the study. Participants were 50% female, mean
age 44, 60% white, 18% Black or African American, and 18% Hispanic or Latinx. The
three best themes were: 1) emotion (6.6 MaxDi score, 3.5 mean discouragement),
2) emphasize harm of all cigarettes (6.3, 3.4), and 3) truth/refute-myth/truth (5.6, 3.3).
For an individual message, the highest MaxDi score (7.0) and mean discouragement
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
(3.6) were both for the same message in the emotion theme: “Cigarettes with less nic-
otine are as harmful as other cigarettes. Smoking will still cause cancer. If you get lung
cancer, you have an 80% chance of dying within 5 years.” The next best message was
also in the emotion theme (MaxDi score 6.5, mean discouragement 3.5): “Cigarettes
with less nicotine are as harmful as other cigarettes. Smoking will still cause cancer.
Imagine telling a loved one you have cancer.” Conclusions: The promising themes
and messages in the MaxDi experiment align with and reinforce best and promising
practices for reducing public misinformation. Future research can test the eectiveness
of the top performing messages in changing incorrect beliefs about VLNC cigarettes.
FUNDING: Federal
PS1-108
TOBACCO AS A TOOL FOR GENDER EMBODIMENT, DEFENSE,
AND SURVIVAL
Josephine T. Hinds1, Marisol McDaniel2, Lalaine Sevillano1, Sherman Chow3, Alex-
andra Loukas3. 1Steve Hicks School of Social Work, The University of Texas at Austin,
Austin, TX, USA, 2Latino Research Institute, The University of Texas at Austin, Austin,
TX, USA, 3Department of Kinesiology and Health Education, The University of Texas
at Austin, Austin, TX, USA.
Signicance: The prevalence of tobacco use disparities among transgender and
gender diverse (TGD) people are often broadly attributed to holding minoritized
gender identities, where smoking is used for perceived stress relief and to cope with
minority stressors. Usually, these explanations do not include detailed components of
TGD identity, such as identity development processes, dimensions (e.g., valence or
centrality), milestones (e.g., coming out, use of a chosen name), or the overlap of TGD
identity with other minoritized social identities. This study explored the association of
specic identity components with tobacco use among TGD young adult tobacco users
ages 18-29. Methods: Participants in 25 one-on-one semi-structured interviews were
68% (n=17) assigned female at birth and averaged 23 years old. They were 64.0%
(n=16) non-Hispanic White, 24% (n=6) Hispanic, and 12% (n=3) other or multiple race/
ethnicities. Results: Thematic, multiple-coder analyses revealed specic instances of
participants using tobacco as a tool for gender embodiment and in situations of defense
and survival. Tobacco played a role in cultivating masculine ideals for some participants,
particularly those whose identities did not match their external gender presentations.
For some, smoking was a way to increase feelings of personal safety in public, through
limited exchanges related to smoking behaviors, or as a way to ensure isolation. Identity
uncertainty and lower identity integration were associated with experiences of minority
stress, which were robustly associated with smoking. Conclusion: Multiple elements of
TGD identity appeared associated with tobacco use across a range of developmental
processes and contexts. In a variety of settings, smoking was used in identity manage-
ment, and as a way to establish personal safety. Models of TGD tobacco use should
include identity dimensions and milestones to improve our understanding of the etiology
of TGD tobacco use. Future studies should explore identity management behaviors
with larger samples across a broader range of minoritized social identities to improve
targeted smoking cessation eorts and to increase TGD health.
FUNDING: Federal
PS1-109
CORRELATES OF E-CIGARETTE USE DEPENDENCE AMONG
REGULAR ADULT E-CIGARETTE USERS
Qinghua Nian, Joshua Sinamo, Jerey J. Hardesty, Elizabeth Crespi, Kevin Welding,
Ryan D. Kennedy, Vikas Vattipally, Joanna E. Cohen. Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, USA.
Signicance: Factors such as age of initiation, use frequency and liquid nicotine
concentration are relevant to use dependence of combustible tobacco products. Less
is known about which factors are relevant in the development of use dependence with
e-cigarettes (E-CIGs), including device type, nicotine formulation and avor. We aimed
to ll the gap using data from regular adult E-CIG users. Methods: A total of 1209 US
adult (21+) participants who used E-CIGs at least ve days per week (711 exclusive
E-CIG users; 498 dual E-CIG and cigarette users) self-reported their most used E-CIG
device type and most used liquid, age of initiation of E-CIGs, and E-CIG dependence
(Patient-Reported Outcomes Measurement Information System Nicotine Dependence
Item Bank for E-CIGs: range 1-5, 5 being most dependent). Participants further uploaded
photos of their most used device and liquid. E-CIG device and liquid characteristics
were from coded photo data if available; otherwise, self-reported data were used. Data
were analyzed using bivariate correlation, independent t-test, and analysis of variance.
Results: Participants who used disposable pod/cartridge (DPC) devices reported
signicantly higher E-CIG use dependence than participants who used rellable tanks/
pods/cartridges (3.4 vs. 3.1, p<0.001). There was no signicant dierence between
exclusive E-CIG users and dual users with respect to E-CIG dependence. Dependence
was positively correlated with rst use of E-CIGs before age 21 (r=0.12, p<0.001), use of
DPC device (r=0.11, p<0.001), use of device without adjustable wattage/voltage (r=0.09,
p<0.01), greater liquid nicotine concentration (r=0.15, p<0.001), nicotine salt-containing
liquid (r=0.11, p<0.001), and use of menthol-avored liquid (r=0.08, p<0.01). Conclusion:
These ndings suggest that initiating E-CIG use at an early age, use of DPC device,
device without adjustable settings and menthol-avored liquid are correlated with higher
dependence among adults. Knowledge of correlates of E-CIG use dependence among
regular E-CIG users can inform product regulations that will impact toxicity, addiction,
and use behaviors at the individual and population level.
FUNDING: Federal
PS1-110
LABORATORY QUANTIFICATION OF GRAVIMETRIC
CORRECTION FACTORS FOR REAL-TIME MEASUREMENTS OF
ELECTRONIC CIGARETTE AEROSOL EXPOSURE
Sinan Sousan, Jack Pender, Dillon Streuber, Meaghan Haley, Will Shingleton, Eric
Soule. East Carolina University, Greenville, NC, USA.
Signicance: Electronic cigarette (ECIG) use exposes bystanders to an aerosol
containing toxicants that are associated with negative health outcomes. To examine
secondhand exposures, researchers often attempt to quantify particulate matter (PM)
generated during ECIG use with real-time optical sensors. The accuracy of these sen-
sors is variable based on the PM source and requires on-site calibration specically
for dierent PM exposures. Therefore, this study calculated the lter correction factors
needed to quantify real-time PM concentrations for dierent PM optical sensors and
ECIG devices. Methods: We generated ECIG PM using a diaphragm pump and a clock
generator for four ECIG devices inside a 0.5 m3 exposure chamber. Devices included a
box mod (VooPoo Drag 2), two disposable ECIGs (NJOY Daily and Hyde), and a “pod
mod” (JUUL). A clock generator was used to control the vaping time of the ECIG devices
with 4 seconds ON and 30 seconds OFF at dierent ow rates for each device. In ad-
dition to the real-time measurements performed by three optical sensors (MiniWRAS,
pDR, and SidePack AM520), we used gravimetric analysis to capture the true mass
concentrations using lter measurements. We measured the aerosol size distribution
by mass for the four ECIG devices during PM generation. Experiments were repeated
3 times. Results: The lter correction factors varied by PM sensor and ECIG device,
where the MiniWRAS underestimated most of the lter concentrations by 1.3-6 times.
In contrast, the pDR and SidePack overestimated the lter concentrations by 1.2-2.5
and 5-7.7 times, respectively. The mass median diameter by volume varied between
0.41 and 0.62 µm, where most particles generated from the ECIG devices were smaller
than 1 µm, except for the Hyde device, with some larger particles. Conclusion: This
study shows that concentrations of ECIG-generated aerosol may be underestimated or
overestimated depending on the ECIG device generating the aerosol and the sensor
used to measure PM concentrations. These data can provide researchers correction fac-
tors needed to provide more accurate measurements of secondhand ECIG exposures.
FUNDING: Federal
PS1-111
COVID-19 VACCINATION UPTAKE AND PERCEPTIONS AMONG
CURRENT TOBACCO USERS
Nicolle M. Krebs, Gail D’Souza, Candace Bordner, Sophia I. Allen, Andrea L. Hobkirk,
Jonathan Foulds, Jessica M. Yingst. Penn State College of Medicine, Hershey, PA, USA.
Signicance: Novel mRNA vaccines were developed and rst distributed to high-risk
individuals (including smokers) in the U.S. starting in December 2020 to combat the coro-
navirus (COVID-19) pandemic. Over one-half of the U.S. adult population has received at
least one dose of a COVID-19 vaccine, but many others have reported hesitation about
becoming vaccinated. Methods: We examined COVID-19 vaccine uptake and hesitancy
from a convenience sample of Pennsylvanian adult smokers through an online survey.
Email invitations with a unique survey link were sent to 3,509 valid email addresses
on April 21, 2021, approximately 3 months after tobacco users were eligible to receive
vaccination in the state of Pennsylvania. A logistic regression model was used to predict
vaccination status. Results: Participants (n=231) were 23.4% male, 90.5% white, and had
a mean age of 48.1 (SD=11.9) years. All participants were current tobacco users, with
the majority reporting current cigarette smoking (90.9%) with an average of 16 (SD=8.1)
cigarettes smoked per day. Nearly 60% (n=137) reported receiving at least one dose
of the vaccine and of those who did not (n=94), 84% (n=79) said they were somewhat
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
or very unlikely to get a vaccine. A logistic regression model revealed that among all
tobacco users, younger age (beta=-.05, p<.01), Hispanic ethnicity (beta=3.1, p=.01),
higher distress over COVID-19 (beta=.19, p=.04), not consuming news about COVID-19
(beta=1.7, p<.01), not endorsing COVID-19 information from the government as reliable
(beta=-1.4, p<.01), and not ever being tested for COVID-19 (beta=-1.6, p<.01) were
signicant predictors of being unvaccinated. Qualitative responses among those who
were vaccine hesitant expressed concerns about the lack of research on the vaccine
and fears about side eects. Conclusion: Understanding vaccine hesitancy among
adults who smoke and who may be at an increased risk for severe complications from
COVID-19 can help develop targeted communication strategies and directly address
concerns about COVID-19 vaccines. This study has implications for public health to better
understand and address the usage of higher health care resources during a pandemic.
FUNDING: Federal
PS1-112
HOW DO RISK-TAKING PROPENSITY AND TIME-DISCOUNTING
RELATE TO ELECTRONIC NICOTINE DELIVERY SYSTEM ABUSE
LIABILITY AND DEPENDENCE?
Rose S. Bono, Caroline Cobb, Augustus M. White, Cosima Hoetger, Andrew Barnes.
VA Commonwealth University, Richmond, VA, USA.
Signicance: An individual’s propensity for risk-taking and time-discounting (how
subjective value of rewards changes with delays in receipt) are two traits known to
increase likelihood of initiating tobacco use. How these traits intersect with predictors
of tobacco use behaviors among current users is less clear. We examined associations
of risk-taking and time-discounting with abuse liability and dependence among current
electronic nicotine delivery systems (ENDS) users. Methods: Participants were adult
ENDS users (n=19 exclusive ENDS users, n=17 dual ENDS/cigarette users). Risk-taking
was measured by responses (number of balloon pumps) on the Balloon Analog Risk
Task. Time-discounting was measured by discount rate (k) and Eective Delay-50 (ED50;
delay that reduces rewards’ subjective value by half) from the Minute Discounting Task.
A progressive ratio task (PRT) and drug purchase task (DPT) for own-brand ENDS pus
indexed ENDS abuse liability, and ENDS (all participants) and cigarette dependence
(dual users only) were indexed by the PROMIS/PROMIS-E, Penn State (PS) Ciga-
rette/E-cigarette Dependence Indices, and Fagerström Test for Nicotine Dependence
(FTND). Pearson correlations examined relationships of risk-taking and time-discounting
with abuse liability and dependence. Results: Greater risk-taking exhibited moderate
negative correlations with DPT demand elasticity (r=-0.42, p=0.01) and ENDS depen-
dence (PROMIS-E: r=-0.37, p=0.02). Time discounting (k) was positively correlated
with PRT reinforcers earned (r=0.34, p=0.04) and responses entered (r=0.41, p=0.01).
Among dual users, higher ED50 (lower time discounting) was strongly correlated with
higher cigarette dependence (PS: r=0.51, p=0.04; FTND: r=0.57, p=0.02). Conclusions:
Among dual and exclusive ENDS users, greater risk-taking and time-discounting were
associated with greater ENDS abuse liability but lower dependence. These diverging
relationships suggest dierent mechanisms by which individual traits relate to other key
predictors of tobacco use behavior among current users and warrant further research.
FUNDING: Federal
PS1-113
INTENTIONS, ATTEMPTS, AND METHODS USED TO QUIT VAPING
AMONG E-CIGARETTE USERS IN THE US AND UK
Nathalia Munck Machado, Eleanor Leavens, Kimber Richter. University of Kansas
Medical Center, Kansas City, KS, USA.
Background: Because the long-term health eects of e-cigarettes are unknown, most
health experts suggest that e-cigarette users quit at some point. Many e-cigarette users
are interested in stopping, but little data exists on factors related to e-cigarette cessa-
tion. Methods: We used the online crowdsourcing platform, Prolic, to survey current
e-cigarette users in the US and UK. Measures were drawn from existing international
surveys.Results: The study included 1064 current e-cigarette users (535 UK; 529 US).
The mean age was 34.7 years old; most were male (51%), white (85%), had a bachelor’s
degree or above (55%), and were employed (75%). Most were also ever (80.5%) or
current smokers (55.5%) and reported using e-cigarettes on a daily basis (60.9%). Few
respondents (9.5%) had been advised by a healthcare provider in the past year to quit
vaping. Respondents showed moderate interest in quitting e-cigarettes (5.3 on average).
Most (61.1%) reported they wanted to quit at some point in the future, and 22.5% had
tried to quit e-cigarettes. Among those who had made a past quit attempt, 24.7% tried
to quit once, 54% tried 2 or 3 times, and 21.3% >4 or more times. Regarding methods to
quit, 3.9% tried to quit using nicotine replacement therapy (NRT), 0.7% used Bupropion,
and 0.5% used Varenicline. A few (2.8%) reported using cigarettes to quit vaping. Very
few (less than 1% each), used either hookah, snus pouches, traditional cigars, pipe
tobacco, ltered cigars, smokeless tobacco, dissolvable tobacco, or cigarillos to quit.
We also present dierences in quit strategies by country and qualitative analyses of
responses to questions regarding reasons for quitting and what governments should do
to help adults quit e-cigarettes. Conclusion: In this online sample, current e-cigarette
users were moderately interested in quitting vaping and nearly 1 in 4 respondents had
already tried to quit. Among those who had attempted to quit, few used methods shown to
be eective for smoking cessation. A small percentage reported using cigarettes to quit.
FUNDING: Academic Institution
PS1-114
THE ELECTRONIC NICOTINE DELIVERY SYSTEM PURCHASE
TASK: ARE RESULTS SENSITIVE TO PRICE FRAMING?
Augustus White, Rose Bono, Rebecca Lester, Megan Underwood, Cosima Hoetger,
Caroline Cobb, Andrew Barnes. VA Commonwealth University, Richmond, VA, USA.
Background: Extension of the Cigarette Purchase Task (CPT) as a behavioral eco-
nomic assessment of abuse liability to electronic nicotine delivery systems (ENDS) is
complicated by the heterogenous nature of this product class (e.g., disposables, tank-,
cartridge-based systems). Ambiguity exists regarding selection of the appropriate price
frame (i.e., what the participant is purchasing - pus, mL of liquid solution, cartridges),
presenting challenges in contextualizing ndings and comparisons across studies. This
work sought to quantify the strength and direction of correlations between results from
ENDS Purchase Tasks (EPT) featuring two commonly used price frames, pus and mL
of liquid. Methods: Adult, exclusive ENDS users (N=17) and dual users of ENDS and
cigarettes (N=19) were recruited for an in-person laboratory study. Participants were
asked to complete two own-brand, 16-price point ($0.00-$10.24) EPTs. One EPT used
“10 pus” as its price frame; the other used “1 mL of liquid solution.” Five outcomes
were generated for each EPT: breakpoint, intensity, Omax, Pmax, and elasticity. Pearson
correlations among these outcomes were generated to assess within-person variation
between the two price-frames. We also stratied analyses to assess whether correlations
diered between dual and exclusive ENDS users, as well as between those that reported
their baseline consumption of ENDS liquid in mLs versus cartridges. Results: Results
suggested that EPT outcomes were highly correlated across price frames (breakpoint:
rho=0.7515 (p<0.001); intensity: rho=0.8163 (p<0.001), Omax: rho=0.6724 (p<0.001);
Pmax: rho=0.6560 (p<0.001); elasticity: rho=0.9505 (p<0.001)). Correlations between
mLs and cartridges for all outcomes were higher for exclusive ECIG users than dual
users, but did not systematically dier between those that reported baseline liquid
consumption in mLs versus cartridges. Conclusions: EPT outcomes were not sensitive
to the price frames examined, suggesting that both pus and mLs are valid EPT price
frames. Researchers should consider their population of interest and structure the EPT
to reect participants’ knowledge and purchasing behaviors.
FUNDING: Federal
PS1-115
PROPYLENE GLYCOL - A BIOMARKER OF EXPOSURE SPECIFIC
TO E-CIGARETTE CONSUMPTION
Therese Burkhardt, Nikola Pluym, Gerhard Scherer, Max Scherer. ABF GmbH,
Planegg, Germany.
For decades, measurement of biomarkers of exposure (BoE) has provided important
data for assessing the health risk from cigarette smoking. With the emergence of new
tobacco and nicotine-delivery products the tobacco landscape increasingly changed.
Especially electronic cigarettes (ECs) are proposed to be considered for tobacco harm
reduction. This reinforces the need to identify BoE specic to the EC use in order
to complement exposure compliance monitoring and risk assessment. Therefore, a
sensitive LC-MS/MS method was developed for the quantication of the main e-liquid
constituents, propylene glycol (PG) and glycerol (G), in urine and plasma. The method
was validated according to US FDA guidelines for bioanalytical method validation. PG
and G were analyzed in plasma and urine samples from a clinical study comparing ve
nicotine product user groups, namely users of combustible cigarettes (CC), electronic
cigarettes (EC), heated tobacco products (HTP), oral tobacco (OT), and oral/dermal
nicotine delivery products (used for nicotine replacement therapy, NRT) with a control
group of non-users (NU). Data clearly demonstrates signicant dierentiation of the
PG levels in urine and plasma in EC users compared to users of CC, HTP, NRT, OT as
well as NU. Elevated PG levels in EC users were observed under controlled (3 days of
connement), but also under real-life conditions (directly after admission to the clinic). In
addition, PG in plasma and urine of vapers signicantly correlated with the PG intake as
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
well as nicotine (plasma) / total nicotine equivalents (urine), biomarkers reecting product
consumption. This emphasizes the high specicity of PG as a BoE for EC consumption.
We therefore suggest the use of PG as BoE in urine and/or plasma in order to monitor
EC use compliance in exposure assessments. Concurrently, the dierentiation between
user groups of dierent tobacco/nicotine products could provide a better understanding
of the exposure pattern and related health eects.
FUNDING: Nonprot grant funding entity
PS1-116
EXAMINATION OF THE INTERACTIVE EFFECTS OF E-CIGARETTE
FLAVORS AND LIQUID NICOTINE CONCENTRATION ON TIME TO
FIRST VAPE AFTER WAKING AMONG CURRENT E-CIGARETTE
USERS
Elizabeth K. Do1, Katie O’Connor1, Jennifer M. Kreslake1, Samantha C. Friedrichsen2,
Donna M. Vallone1, Elizabeth C. Hair1. 1Truth Initiative, Washington, DC, USA, 2Profes-
sional Data Analysts, Minneapolis, MN, USA.
Signicance: Flavors have been found to enhance the rewarding and reinforcing eect
of nicotine in e-cigarettes and might also contribute to nicotine dependence. The objec-
tive of this study is to examine the relationships between e-cigarette avors, nicotine
concentration, and their interaction on a measure of nicotine dependence. Methods:
Survey data are drawn from a cross-sectional convenience sample of past 30-day
e-cigarette users aged 15 to 24 years (N=2037). Participants were asked to provide
information about the e-cigarette products they used most regularly. Only those with
available information on avors (fruit/mint, menthol, tobacco), nicotine concentration
(0-2.9%, 3-4.9%, and 5% or greater), and time to rst vape after waking (within 30
minutes, greater than 30 minutes) were included in analyses (N=1457). Generalized
linear regression models were used with log link and binary distribution to assess the
relationship between avors and nicotine dependence. Eect modication by nicotine
concentration was assessed using an interaction term for avors by nicotine concen-
tration. Models were adjusted for age, race/ethnicity, and gender. Results: Fruit/mint
and menthol avor user groups had a very similar dose-response relationship between
nicotine concentration and prevalence of vaping within 30 minutes. Both groups showed
that the prevalence of vaping within 30 minutes gradually increased as nicotine con-
centration increased. Conclusions: Results highlight the need for understanding how
e-cigarette product characteristics like avors and nicotine concentration can facilitate
nicotine dependence to e-cigarettes and suggest that comprehensive e-cigarette product
regulation of all avors, including menthol, as well as reducing nicotine concentration
will help to reduce the risk for nicotine dependence among young people.
FUNDING: Unfunded
PS1-117
NICOTINE FLUX PREDICTS NICOTINE DEPENDENCE AMONG
E-CIGARETTE USERS: RESULTS FROM A PILOT STUDY
Elizabeth K. Do1, Katie O’Connor1, Siobhan N. Perks1, Eric K. Soule2, Thomas Eissen-
berg3, Michael Amato4, Amanda Graham4, Corby Martin5, Christoph Hochsmann5,
Bernard F. Fuemmeler6. 1Truth Initiative, Washington, DC, USA, 2East Carolina Univer-
sity, Greenville, NC, USA, 3VA Commonwealth University, Richmond, VA, USA, 4Truth
Initiative, WA, DC, USA, 5Pennington Biomedical Research Center, Baton Rouge, LA,
USA, 6Virginia Commonwealth University, Richmond, VA, USA.
Signicance: E-cigarette device and liquid characteristics determine the rate at which
nicotine is emitted from the e-cigarette (i.e., nicotine ux) and thus, likely inuence users’
nicotine dependence. The aim of this study was to assess associations between nicotine
ux and the E-cigarette Dependence Scale. Methods: Data were obtained from United
States adults ages 18-65 participating in online Qualtrics panels. Participants reported
past 30 e-cigarette use and information on device type, power, nicotine concentration,
and nicotine ux (N=666). Multivariable regressions were conducted to assess the
relationship between nicotine ux and nicotine dependence, as measured by the E-cig-
arette Dependence Scale (EDS) score. Separate models were run for pod-based and
disposable device types and adjusted for age and any e-cigarette use within the past
30-days. Results: The sample was diverse in terms of race/ethnicity, as 54.3% were
non-Hispanic White, 20.7% were Hispanic, 15.6% were Black and 9.4% were Asian.
Nearly half were female and most had earned a high school diploma or greater (89.8%).
Regarding device type, 80.9% reported they used a pod-based e-cigarette. Most pod-
based e-cigarette users used a device with lower nicotine ux (range: 56.3 to <76.3
mg/s), while most users of disposable e-cigarettes used a device with a higher nicotine
ux (93.8 to 144.6 mg/s). Greater nicotine ux was associated with higher EDS scores
among users of pod-based e-cigarettes (beta = 0.19, SE = 0.09, p-value = 0.043), but not
disposables. Conclusion: Given the variability in e-cigarette characteristics inuencing
nicotine delivery, results suggest that regulation based on a single factor, such as liquid
nicotine concentration, is unlikely to control nicotine exposure and nicotine dependence.
Because nicotine ux considers the eects of power, nicotine concentration, and user
behavior, it is an important variable for consideration in research and regulation that
seeks to determine risks for nicotine dependence.
FUNDING: Federal
PS1-118
USE, APPEAL, AND RISK PERCEPTIONS OF CIGAR/CIGARILLO
FLAVORS BASED ON HISTORY OF USE IN PREGNANT WOMEN
Nancy C. Jao1, Katelyn Borba2, Jocelyn Staneld2, Lori A.J. Scott-Sheldon1, Laura R.
Stroud1. 1Warren Alpert Medical School of Brown University and The Miriam Hospital,
Providence, RI, USA, 2The Miriam Hospital, Providence, RI, USA.
Signicance: Pregnant mothers may be more vulnerable to the appeal of avorings due
to alterations in taste, cravings, and nausea during pregnancy. This study is the rst to
focus on characterizing use, preferences, and perceptions of avors of cigars/cigarillos
in pregnant women. Methods: Pregnant women (N=124, 50% smokers, 26±5 years
old, 49% ethnic/racial minority) responded to questions using 1-7 Likert-scale ratings
(1=lowest appeal/harm) about preferences (liking, attractiveness), interest (current inter-
est, postpartum intention), and perceptions of harm (general, pregnancy-specic, fetal)
for eight avor categories (e.g., menthol, spices, fruit). Analyses were used to examine
dierences in ratings for each avor between history of hookah use (never vs. lifetime
vs. pregnant users). Results: More than half (51%) reported lifetime cigar/cigarillos use,
12% reported use during pregnancy, and 37% reported never trying cigars/cigarillos.
Dual/poly tobacco use was commonly reported with 50%, 13%, and 8% reporting using
cigarettes, hookah, and e-cigarettes, respectively, during pregnancy. The most tried cigar/
cigarillo avor was fruit (37%), tobacco (36%), and alcohol (13%), with 73%, 60%, and
53%, respectively, reporting current use. Liking of spice and alcohol, interest in spice,
and postpartum intention to use alcohol avors signicantly dierentiated lifetime vs.
pregnant users (ps<.04). Liking of, attractiveness, and postpartum intentions to use spice,
fruit, alcohol, and tobacco avors also signicantly dierentiated never vs. pregnant
users (ps<.04). The only avor that did not dier between groups was menthol/mint
(ps>.05). Only signicant dierences in perceptions of harm were for fruit and candy
avors between never vs. pregnant users (ps<.02), with no dierences for any avor
between groups regarding pregnancy- or fetal-specic harm (p>.05). Conclusion: The
most used cigar/cigarillos avors in pregnant women are fruit, tobacco, and alcohol.
Dierences in perceptions of spice and alcohol avors dierentiated lifetime vs. pregnant
users, and of spice, fruit, alcohol, and tobacco avors between never vs. pregnant users.
FUNDING: Federal
PS1-119
AWARENESS, APPEAL, AND EVER USE OF NICOTINE POUCH
PRODUCTS AMONG U.S. ADULT SMOKERS, 2021
Mary Hrywna, Nishi Gonsalves, Olivia Wackowski. Rutgers Center for Tobacco Stud-
ies, New Brunswick, NJ, USA.
SIGNIFICANCE: In last few years, tobacco-free nicotine pouches have become one
of the fastest growing tobacco product categories in the U.S. market. However, there
is limited data that explores awareness, appeal or ever use of these products in the
U.S. METHODS: Data came from a web-based survey of current U.S. adult smokers
elded between January 21, 2021 and February 4, 2021 (n=1,018). Respondents
were drawn from KnowledgePanel®, a probability-based web panel designed to be
representative of the United States. Eligible respondents included adults who were
aged 18 or older and current established smokers (smoked at least 100 cigarettes in
their lifetime). Respondents were asked if they had ever seen or heard of tobacco-free
nicotine pouches, ever tried such pouches, or were interested in trying such pouches in
the next six months. Descriptive statistics were calculated overall and by demographic
and tobacco use characteristics. RESULTS: In early 2021, a total of 29.24% of adult
smokers had ever seen or heard of tobacco-free nicotine pouches. Among those who
had ever seen or heard of these products, 19.04% had ever tried nicotine pouches and
16.77% reported interest in using nicotine pouches in the next six months. Prevalence
of nicotine pouch awareness varied by age, with younger smokers reporting higher
awareness than older smokers. Prevalence of having ever tried nicotine pouches was
higher among smokers who also reported current use of smokeless tobacco compared
to those who were exclusive cigarette smokers. Interest in trying nicotine pouches was
more prevalent among smokers who had plans to quit smoking compared to those
with no plans to quit as well as smokers who also reported current use of SLT or vapes
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
relative to exclusive cigarette smokers. CONCLUSION: This study documents modest
levels of awareness, appeal, and trial of tobacco-free nicotine pouches among U.S.
adult smokers. However, these levels are likely to increase as the product category
expands and continued surveillance is warranted, including among naïve users and
users of other tobacco and nicotine products.
FUNDING: Federal
PS1-120
DECREASES IN SMOKING AND VAPING DURING COVID-19 STAY-
AT-HOME ORDERS AMONG A COHORT OF YOUNG ADULTS IN
THE UNITED STATES
Rachel L. Denlinger-Apte, Cynthia K. Suerken, Jennifer Cornacchione Ross, Beth A.
Reboussin, John Spangler, Kimberly G. Wagoner, Erin L. Sutn. Wake Forest School
of Medicine, Winston-Salem, NC, USA.
Signicance: In Spring 2020, most US states and territories implemented stay-at-
home orders to slow transmission of the novel coronavirus SARS-CoV2, the cause of
COVID-19. This societal disruption could have resulted in increased tobacco or nicotine
use due to stress, decreased exposure to tobacco-free environments, or boredom. Alter-
natively, use could have decreased due to respiratory health concerns, reduced product
access, or unwillingness to use products at home. We examined young adult smoking
and vaping behavior during the stay-at-home pandemic phase. Methods: The current
study examined participants (N=1,727) completing three recent survey waves from a
longitudinal cohort of young adults recruited in 2010: Wave 13 (Spring 2019), Wave 14
(Fall 2019), and Wave 15 (Spring 2020) to assess changes in cigarette and e-cigarette
use. We conducted logistic regression to compare the odds participants reported smok-
ing or vaping in Wave 14 relative to Wave 13 to establish if there was a trend of use
pre-pandemic. Then, we conducted logistic regression to compare the odds participants
reported smoking or vaping in Wave 15 relative to Wave 14 to determine the impact of
stay-at-home orders. Results: At Wave 15, participants were 27.6 years old (SD: 0.6);
52.1% female; 7.6% identied as Black/African American; and 6.3% as Hispanic. Most
(95%) reported living in a US state, territory or foreign country with stay-at-home policy
restrictions during Spring 2020. At Wave 15, 4.6% of participants reported past 30-day
cigarette use compared to 6.2% at Wave 13 and 6.1% at Wave 14. For e-cigarettes,
5.0% reported use at past-30 day use at Wave 15 compared to 8.1% at Wave 13 and
7.4% at Wave 14. When comparing the odds of reporting tobacco use at Wave 14 to
Wave 13, no dierences emerged (p’s > 0.05). However, when comparing tobacco
use at Wave 15 to Wave 14, participants had 40% lower odds of reporting past 30-day
cigarette use (p = 0.02) and 50% lower odds of reporting past 30-day e-cigarette use (p
< 0.01). Conclusion: Participants had lower odds of reporting cigarette and e-cigarette
use during Wave 15, which coincided with COVID-19 restrictions. The current study
provides initial evidence that young adults may have reduced their tobacco/nicotine use
during stay-at-home orders. More work is needed to determine the long-term impact of
the COVID-19 pandemic on tobacco use in this population.
FUNDING: Unfunded; Federal
PS1-121
THE RELATIONSHIP BETWEEN TOBACCO USE AND FOOD
INSECURITY AMONG DISAGGREGATED LATINX AND ASIAN
AMERICANS: RESULTS OF THE NATIONAL HEALTH INTERVIEW
SURV EYS, 2014-2019
Mahathi Vojjala1, Maariyah Kharal1, Erin S. Rogers2. 1New York University School
of Global Public Health, New York, NY, USA, 2NY University School of Medicine, NY,
NY, USA.
Background: Smoking is causally linked to food insecurity (FI) in the general popula-
tion, but there has been limited research examining the relationship between smoking
and FI in diverse Latinx and Asian American (one of the fastest growing minoritized
populations in the US) populations. Latinx Americans experience high rates of FI.
This study examined whether current smoking was independently associated with FI
among disaggregated Latinx and Asian Americans (AA). Methods: This study analyzed
cross-sectional data from 19,730 Latinx adults who participated in the 2015-2019
National Health Interview Surveys (NHIS) (N=11,587 Mexican Americans, N=1,716
Puerto Ricans, N=812 Cuban Americans, N=526 Dominican Americans, N=2,578
Central or South Americans, N=2,511 Other Latinx Americans) and 8,688 AA adults
from the 2014-2018 NHIS (N=1,814 Chinese, N=2,043 Filipino, N=1,850 Asian Indian,
N=2,981 Other Asian). Multivariable regression models estimated associations between
current cigarette smoking and FI, controlling for covariates. Models were run for the
overall Latinx and AA samples, followed by separate models for each Latinx and AA
subgroups. Results: Among Latinx participants overall, the prevalence of FI was 14.5%.
Dominican Americans had the highest rate of FI (22.1%) and Cuban Americans had the
lowest rate of FI (12.3%). Among Latinx participants overall, the prevalence of FI was
1.75 times higher among current smokers than non-smokers, after controlling for other
known determinants of FI (23.5% vs. 13.4 %; aOR=1.75; 95%CI 1.55-1.97). Among
AA participants overall, the prevalence of FI was over two times higher among current
smokers than non-smokers, after controlling for other known determinants of FI (14.4%
vs. 4.6%; aOR=2.58; 95%CI 1.99-3.34). Disaggregated Latinx and AA subgroup analyses
showed that current smokers had signicantly higher rates of FI among all Latinx and
AA subgroups except Cuban Americans and Asian Indian Americans. Conclusions:
Current smoking may be an important and modiable risk factor for FI among Latinx
Americans and AA. Public health interventions may benet from taking a coordinated
approach to reducing both smoking and FI among these adults.
PS1-122
AN END TO ENDS: YOUTH-LED INITIATIVES
Kandi L. Walker, Alison C. McLeish, Lindsey A. Wood, Osayande Agbonlahor, Made-
line M. Tomlinson, Kolbie A. Vincent, Savanna Kerstiens, Joy L. Hart. University of
Louisville, Louisville, KY, USA.
Signicance: The popularity of electronic nicotine delivery systems (ENDS) among
youth has skyrocketed, resulting in a youth vaping epidemic with current use by ap-
proximately one-fth of high schoolers in 2020 (Wang et al., 2020). Although health
campaigns strive to prevent use and encourage cessation, tobacco marketing and
advertising eorts often target youth. Additionally, promotion techniques rapidly evolve
as does the array of new products being marketed. Because youth tend to be far more
familiar with these techniques, the behavior of their peers, and popular practices than
adults, youth are in key positions to lead change in preventing tobacco use. This project
reports on youth-led activities designed to inform peers of ENDS dangers and call for
an end to youth vaping. Methods: Across the past year, youth, recruited from across the
nation, have collaborated in regular meetings and on advocacy initiatives. Working in
subteams, building on peer feedback, and using an iterative process, several products
were developed. Beyond describing the methods employed in and outcomes of these
youth-led works, we employed the constant comparative method in a content analysis
of group conversations and textual aspects of these works to identify themes. Results:
Across these works, which included a TikTok video, a public service announcement,
materials for classroom use, and digital narratives, youth interest in helping other youth
is evident. Key themes included thinking for yourself (not being fooled by tobacco
companies), knowing the facts (being “in the know”), valuing science and health, and
making smart decisions (taking care of your future). Example projects and themes
illustrate the creativity and dedication of youth leaders in preserving the health of their
peers. Conclusion: The energy, creativity, and commitment of youth are important in
increasing peer awareness of the dangers of vaping, preventing initiation, and promoting
cessation. Youth-led approaches are important in improving programs, reaching young
people, and staying abreast of trends.
FUNDING: Academic Institution; Nonprot grant funding entity
PS1-123
PREVALENCE & CORRELATES OF CANNABIS USE AMONG
CIGARETTE SMOKERS & NON-SMOKERS: AN EMERGENCY
DEPARTMENT STUDY
Carol Cunradi1, Raul Caetano1, William Ponicki1, Harrison Alter2. 1Pacic Institute for
Research and Evaluation, Berkeley, CA, USA, 2Andrew Levitt Center for Social Emer-
gency Medicine, Berkeley, CA, USA.
Significance: Compared to the general household population, elevated rates of
cannabis use and cigarette smoking are found among adults seeking care at urban
safety-net Emergency Departments (EDs). The purpose of this study is to assess the
prevalence and correlates of cannabis use among cigarette smokers and non-smokers
in an urban safety net ED population. Methods: Cross-sectional survey data on past
12-month cannabis use and past 30-day cigarette smoking, demographic and mental
health factors, and past 12-month risky drinking (females/males drank 4+/5+ drinks)
were collected from a multiracial/multiethnic sample of adult ED patients (N=1,037;
53% female; 50% Hispanic; 29% African American; mean age=35.2 years [SD 8.5]).
The sample comprised smokers without cannabis use (13.5%); cannabis users without
smoking (13.8%); cannabis/tobacco co-users (13.3%); and those who used neither
substance (59.5%). We used multinomial logistic regression to estimate factors as-
sociated with each cannabis/tobacco use outcome compared to non-use. Results:
Approximately half of cannabis users smoked cigarettes. Men had greater odds for all
cannabis and cigarette use outcomes than women. Hispanics had lower odds for all
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
cannabis and cigarette use outcomes than non-Hispanic white participants. Age was
inversely associated with using cannabis without cigarettes (aOR=0.93; 95% CI 0.91,
0.96) and co-use of cannabis and cigarettes (aOR=0.95; 95% CI 0.93, 0.98). Anxiety
was associated with using cannabis without cigarettes (aOR=1.93; 95% CI 1.20, 3.10)
and co-use of cannabis and cigarettes (aOR=3.40; 95% CI 2.04, 5.66). PTSD was
associated with using cannabis without cigarettes (aOR=1.65; 95% 1.00, 2.75). Risky
drinkers had greater odds for all cannabis and cigarette use outcomes than non-risky
drinkers. Conclusion: Over one quarter of an urban ED sample used cannabis with or
without cigarettes. The results suggest that there are distinct demographic and mental
health risk and protective factors associated with cannabis use and co-use in cigarette
smokers and non-smokers. Cannabis users who smoke cigarettes may be especially
vulnerable to mental health problems.
FUNDING: Federal
PS1-124
DO SENIORS VAPE OR SMOKE? COMPARISON OF SMOKING
AND VAPING IN THE OLDER POPULATION IN 26 EUROPEAN
COUNTRIES AND ISRAEL. DATA FROM THE SHARE SURVEY
2019/ 2020 (WAVE 8)
Josene Atzendorf1, Sören Kuitunen-Paul2, Tessa-Virginia Hannemann1. 1Munich
Center for the Economics of Aging (MEA), Max Planck Institute for Social Law and
Social Policy, Munich, Germany, 2Klinik und Poliklinik für Kinder- und Jugendpsychiatrie
und -psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dres-
den, Germany.
Signicance. Currently, only moderately informative data on the use of e-cigarettes
and tobacco products are available for Europe’s oldest population. The present study
describes the distribution of e-cigarette and tobacco product use in the elderly population
in 26 European countries and Israel. Methods. Wave 8 (release 1.0.0) of the SHARE
Survey on Health, Aging and Retirement in Europe served as data basis. A total of n
= 46,077 persons aged 50 years and older (42.6 percent male, 57.4 percent female)
were interviewed about their smoking behavior. The mean age was 71.3 years (mini-
mum = 50 years, maximum = 104 years). For the extrapolation to the population, we
used calibrated cross-sectional weights. Results. Overall, the sample’s prevalence for
e-cigarette use was 0.45 percent (extrapolated to 811,000 persons aged 50 and above
in the 26 European countries and Israel). The proportion of e-cigarette users was found
to decline with age. Among those aged 50 to 69, 0.64 percent (extrapolated to 725,000)
used e-cigarettes; among those aged 70 to 79, 0.16 percent (extrapolated to 62,000)
used e-cigarettes; and among those aged 80 and older, 0.1 percent (extrapolated to
23,000) used e-cigarettes. The overall prevalence for the use of tobacco products
was 43.9 percent in the sample (extrapolated to 80 million). Tobacco product use also
declined as age increased. For example, among those aged 50 to 69, 49.1 percent
(extrapolated to 55 million) used tobacco products; among those aged 70 to 79, 41.3
percent (extrapolated to 17 million) used tobacco products; and among those aged 80
and older, 27.7 percent (extrapolated to 8 million) used tobacco products. Conclusion.
As of late 2020, e-cigarette use is far from a mass phenomenon among older persons.
However, it could become signicant if it were suitable for the cessation of the more
widespread tobacco smoking.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
PS1-125
COMPARATIVE ANALYSIS OF HEAVY METALS IN E-LIQUIDS
PURCHASED IN 2017 AND 2018 FROM THE UNITED STATES,
ENGLAND, CANADA, AND AUSTRALIA
Ashleigh M. Coggins-Block, Noel J. Leigh, Richard J. O’Connor, Maciej L. Goniewicz.
Roswell Park Comprehensive Cancer Center, Bualo, NY, USA.
Signicance: Electronic nicotine delivery systems (ENDS) have been shown to contain
toxic heavy metals in their e-liquids. These metals originate from leaching parts of the
ENDS device rather than e-liquids. While more ENDS regulations have been enacted
over the last few years, few polices have targeted heavy metals in these products.
This study examined heavy metals found in e-liquids within four countries over two
years. Methods: ENDS e-liquid products, including rell bottles (open-system, n1) and
prelled devices (closed-system, n2), were purchased from the United States (n1=57,
n2=48), England (n1=17, n2=67), Canada (n1=42, n2=11), and Australia (n1=15, n2=0) in
2017 and 2018. These e-liquids were analyzed for heavy metal concentrations using
electrothermal atomic absorption spectroscopy (ETAAS). Metals of interest included
lead, nickel, chromium, and cadmium. Results: No open-system sample contained
quantiable levels of tested heavy metals. Only one closed-system sample, purchased
in the United States in 2017, contained cadmium (2.4 ppb). Closed-system e-liquids from
the United States had a signicant increase in average nickel concentration from 2017
(292.4 ± 233.6 ppb) to 2018 (1130.7 ± 1734.5 ppb, p = 0.0032), with a maximum nickel
concentration of 7332.7 ppb observed in a single 2018 sample. Alternatively, England’s
e-liquids had a signicant decrease in average chromium concentration from 2017 (61.3
± 90.1 ppb) to 2018 (50.6 ± 107.9 ppb, p < 0.0001). Conclusions: Open-system e-liquids
continue to not contain heavy metals as observed in previous research. Closed-system
e-liquids continue to contain metal concentrations up to 328 times higher than EPA
drinking water action levels. Little change was observed in e-liquids purchased in the
United States and England between 2017 and 2018, showing a lack of improvement
in industry standards for preventing harmful heavy metals from appearing in e-liquids.
FUNDING: Federal
PS1-126
USING MIXTURE MODELS TO IDENTIFY SMOKING CESSATION
PROFILES BASED ON SELF-EFFICACY, POSITIVE EXPECTANCY,
MOTIVATION, AND CESSATION FATIGUE: AN EXPLORATORY
LATENT PROFILE AND LATENT TRANSITION ANALYSIS
Yajnaseni Chakraborti1, Donna Coman1, Kaylee Litson2, Megan Piper3. 1Temple
University, Philadelphia, PA, USA, 2Utah State University, Logan, UT, USA, 3University
of WI, Madison, WI, USA.
Introduction: The addictive nature of tobacco makes smoking cessation a dynamic and
challenging process. Smokers who attempt to quit transition through dierent phases
based on their withdrawal symptoms, motivation, outcome expectancies, and self-ef-
cacy. Relapse risk is determined collectively by the above constructs, and the eect
of these constructs varies over time. Our study aims to identify underlying classes (or
proles) among smokers participating in a pharmacotherapy cessation program based
on withdrawal symptoms and motivational processes. Our interest further lies in exam-
ining changes in class membership over 4 weeks since the target quit day (TQD) and
its association with long-term abstinence outcomes.Methods: Our case study includes
Ecological Momentary Assessment (EMA) data from the rst 4 weeks post-TQD of a
smoking cessation study which compared the ecacy of three pharmacotherapies.
We apply Latent Prole Analysis to classify 1086 participating smokers into subgroups
based on their responses to EMA prompts that indicate latent quitting behavior at four
dierent time points (day 0 post-TQD, and end of weeks 1, 2, and 4 post-TQD). We then
determine the changes in membership over time using Latent Transition Analysis (LTA).
This analytical approach was executed separately for morning and evening prompts.
The associations between baseline covariates, smoking proles, the transition trend,
and long-term abstinence outcomes were also examined to characterize key predictors
of relapse risk. Results: A four latent class model solution is selected through a holistic
assessment of model t-statistics (BIC, VLMR LRT p-value, entropy) and interpretability
of proles. The transition probabilities estimated via the LTA model with no assumed
model structure across time show a moderate to high percentage of neutral/motivated
subjects tend to improve on their motivation or stick to the same subgroup and the
demotivated subjects transition to improved subgroups over 4 weeks. The ndings are
consistent across the morning and evening prompt-specic analyses.Conclusions:
Change in behavioral patterns due to uctuating withdrawal tendencies and motivational
processes during cessation attempts are useful in identifying vulnerable subgroups and
to target interventions to prevent relapse risk in smoking cessation trials.
FUNDING: Academic Institution
PS1-127
EVALUATION OF TRADITIONAL AND SMARTPHONE BASED
METHODS TO ASSESS VAPING AND SMOKING BEHAVIORS
Corby K. Martin1, Elizabeth Do2, Eric Soule3, Thomas Eissenberg4, Bernard Fuem-
meler4, Christoph Höchsmann1. 1Pennington Biomedical Research Center, Baton
Rouge, LA, USA, 2Truth Initiative, Washington, DC, USA, 3East Carolina University,
Greenville, NC, USA, 4VA Commonwealth University, Richmond, VA, USA.
Signicance: Accurately measuring vaping and smoking behavior in real-world settings
is important to inform tobacco regulatory science. Additionally, quantifying nicotine
ux (i.e., nicotine emission rate) from an Electronic Nicotine Delivery System (ENDS)
requires information on device(e.g., power and settings) and ENDS liquid character-
istics, as well as user behavior. This information can be collected via paper diaries or
smartphone apps, where participants report information in the app or capture images of
devices and liquids for researchers to obtain relevant details. The purpose of this study
was to assess preference for, and perceived burden of, methods to assess nicotine
intake among ENDS and combustible tobacco users. Methods: Current ENDS users
100
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
[N=129, 70% women, mean (SD) age 37.0 (12.7) years] completed an online survey
that described the following 3 methods to record ENDS device and liquid characteris-
tics: 1) paper diaries, 2) recall interviews conducted in-person or via phone, and 3) a
smartphone app that relies on pictures and drop-down menus to obtain information.
Participants ranked the 3 methods from most to least preferred and from least to most
burdensome. Current smokers [N=207, 78% women, mean (SD) age 45.5 (13.4) years]
reported their preference for recording smoking via paper diaries or an app. Results:
ENDS users’ rankings of preference and burden diered across the 3 methods, with the
app rated as less burdensome and more preferred than recall (both p=0.029). For all 3
vaping assessment methods, preference and burden ratings were highly correlated (all
Spearman’s rho ≥0.84, all p<0.001), indicating that participants preferred methods that
they perceived as less burdensome. A signicantly larger proportion of smokers preferred
an app (78.3%) over diaries (21.7%, p<0.001), yet a signicant age eect (p=0.021)
indicated that preference for an app was attenuated in older (≥65 years) participants.
Conclusions: Results suggest that personalizing assessments based on individual
participant’s perceived burden and preferences may facilitate better measurement of
ENDS use and smoking.
FUNDING: Unfunded; Federal; Academic Institution
PS1-128
ON THE TRANSMISSION OF COVID-19 THROUGH
ENVIRONMENTAL E-CIGARETTE AEROSOL
Roberto A. Sussman. National Autonomous University of Mexico, Mexico City, Mexico.
We examine the plausibility and scope of transmission of pathogens (including the
SARS-CoV-2 virus) through exhaled e-cigarette aerosol (ECA). Since there is no
experimental evidence of this transmission, we examine (i) the respiratory dynamics
of mouth breathing (ii) eects of suction and mouthpieces and (iii) hydrodynamics of
intermittent turbulent jets, to infer that exhaled ECA from most common low powered
and tank devices (used by 80% of vapers) should transport approximately a median of
30 respiratory droplet nuclei of diameters below 1 micrometer per pu, over a horizontal
distance between 1 and 2 meters. High powered devices should transport over 100
droplets nuclei per pu over 2 meters distance. Since ECA droplets are also submicron,
they act as visual tracers of the exhaled air ow. As a consequence, bystanders can
instinctively position themselves away from the vaping jet to avoid any possible direct
contagion by transported respiratory droplets.
PS1-129
LONGITUDINAL ASSOCIATIONS BETWEEN MULTIPLE TOBACCO
PRODUCT USE AND INCIDENT ASTHMA AMONG US YOUTH
Delvon T. Mattingly, Steven Cook, Jana L. Hirschtick, Nancy L. Fleischer. University
of Michigan School of Public Health, Ann Arbor, MI, USA.
Signicance: While cigarette use has declined over the last decade, use of other
products such as electronic nicotine delivery systems (ENDS) has become more
common, leading to increased complexity of tobacco product use, including dual- and
poly-tobacco use. However, little is known about the health eects of poly-tobacco use,
especially among younger populations. Methods: We followed a longitudinal cohort of
youth into adulthood from Waves 1-5 (including Wave 4.5) (2013-2019) of the Population
Assessment of Tobacco and Health Study. We examined incident diagnosed asthma at
follow-up among respondents who had no history of asthma at baseline and at least one
follow-up interview. We classied current tobacco use, dened as any use in the past
30 days, based on the following categories: 1) non-current use, 2) exclusive cigarette
use, 3) exclusive ENDS use, 4) exclusive other combustibles (OC) use, 5) cigarettes
+ ENDS or ENDS + OC use, 6) cigarettes + OC use, and 7) cigarettes + ENDS + OC
use (poly-tobacco use). Other combustibles included use of cigars/cigarillos/little ltered
cigars, traditional pipe, and hookah. Using discrete time survival models, we analyzed
the incidence of diagnosed asthma across Waves 2-5, predicted by time-varying current
tobacco product use, lagged by one wave, and adjusted for potential confounders at
baseline such as age, sex, race/ethnicity, parental education, urbanicity, secondhand
smoke exposure, household use of combustible products, and body mass index. Re-
sults: The most common use pattern among the analytic sample (n=9,140) at baseline
was non-current use (92.5%), followed by exclusive cigarette use (2.4%), exclusive OC
use (1.4%), and exclusive ENDS use (1.3%). Diagnosed asthma was reported by 574
respondents with an average annual incidence of 1.4% (range 0.3% to 2.0%, Waves
2-5). In adjusted models, exclusive cigarette users (HR: 1.71, 95% CI: 1.11-2.64) and
cigarette + OC users (HR: 2.78, 95% CI: 1.65-4.70) had higher risk of incident diagnosed
asthma, compared to non-current users. However, when compared to exclusive cigarette
users, the association between cigarette + OC use and incident diagnosed asthma was
null (HR: 1.63, 95% CI: 0.82, 3.24). Furthermore, exclusive ENDS use (HR: 1.50, 95%
CI: 0.92-2.44) and poly-tobacco use (HR: 1.95, 95% CI: 0.86-4.44) were not associated
with incident diagnosed asthma. Conclusions: From 2013 to 2019, exclusive cigarette
use and cigarette + OC dual use were associated with incident diagnosed asthma;
ENDS use, alone or in combination with other products, was not associated with incident
asthma. Youth who use cigarettes with or without other combustible products may be
at heightened risk for developing asthma. Our results emphasize the need for further
longitudinal examination of the health eects of dual- and poly-tobacco use.
FUNDING: Federal
PS1-130
PSYCHOMETRIC PROPERTIES OF SMOKELESS TOBACCO
DEPENDENCE MEASURES: A COSMIN SYSTEMATIC REVIEW
Vaibhav P. Thawal. University of Newcastle, Australia, Newcastle, Australia.
Background: A comprehensive assessment of the quality of the psychometric properties
of smokeless tobacco (SLT) dependence measures is necessary to help researchers
and health professionals choose the most appropriate measure to use when assessing
dependence and planning cessation treatment. This systematic review aimed to i) identify
measures for assessing dependence on smokeless tobacco products and ii) critically
appraise the measures using the Consensus-based Standards for the selection of health
Measurement Instruments (COSMIN) guidelines. Methods: A comprehensive search
strategy was used across MEDLINE, CINAHL, PsycINFO, EMBASE and SCOPUS
databases. English-language studies describing the development or psychometric
properties of a smokeless tobacco dependence measure were included. Two review-
ers independently extracted data and appraised risk of bias following the COSMIN
guidelines. Results: Fifteen studies, assessing 16 unique measures, were eligible.
Ten studies were conducted in the USA, two in Taiwan, one each in Sweden, Bangla-
desh and Guam. None of the sixteen measures were rated as adequate for assessing
dependence on smokeless tobacco products, with content validity being particularly
poor. Twelve measures have potential for assessing dependence although further
assessment of their psychometric properties is needed. Conclusion: This systematic
review highlights the need to further validate existing measures assessing dependence
on smokeless tobacco products. There is a clear need to develop a multidimensional,
valid and reliable measure for use by clinicians and researchers for assessing depen-
dence on smokeless tobacco products.
FUNDING: Academic Institution
PS1-131
ADDICTION AND POLYUSE OF COMBUSTIBLE CIGARETTES,
E-CIGARETTES, AND MARIJUANA
Deanna M. Halliday1, Mariaelena Gonzalez1, Bonnie L. Halpern-Felsher2, Anna V.
Song1. 1University of California, Merced, Merced, CA, USA, 2Stanford University, Stan-
ford, CA, USA.
Signicance: With the growing popularity of e-cigarettes and increased legal acces-
sibility of marijuana, cigarette smokers have new ways to supplement their smoking
behavior. Although there has been some attention paid towards dual use between
cigarettes, e-cigarettes, and marijuana, there has been very little work focused on
poly-use between all three substances. The current study describes the prevalence of
nicotine and marijuana use across single, dual, and poly-use patterns of behavior and its
relationship to cigarette addiction in a sample of rural community respondents. Methods:
The current analysis focuses on a sub-sample of 2,712 residents of California’s Central
Valley who reported smoking in the past 30 days. Participants answered questions
about their cigarette, e-cigarette, and marijuana use, as well as self-reported addiction
to cigarettes. Results: Of the cigarette smokers, 29.18% (N = 749) used combustible
cigarettes exclusively, 53.17% (N = 1,442) used both cigarettes and e-cigarettes, 0.01%
(N = 25) used cigarettes and marijuana exclusively, and 15.38% (N = 417) used all three
products in the past 30 days. Further, while 55.17% of our exclusive cigarette smokers
reported being addicted to cigarettes, 83.24% of cigarette and e-cigarette users reported
the same. Addiction was less common in our small sample of cigarette/marijuana users
(50.0%), and highest in those who used all three products (95.43%). Conclusion: In our
sample, single product use was less common than multi-product use. These ndings
suggest that higher risk of addiction is associated with dual cigarette/e-cigarette use
as well as poly-use of all three products. To understand cigarette use behavior and to
develop addiction interventions, it is essential to consider the concurrent use of both
e-cigarettes and marijuana among cigarette smokers.
FUNDING: State
101
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
PS1-132
LONGITUDINAL TRAJECTORY OF ENDS DEPENDENCE FROM
2014-2019 AMONG TEXAS YOUNG ADULTS: EXAMINING
CHANGES AFTER THE 2017 SURGE IN VAPE POD POPULARITY
Alexandra Loukas1, C. Nathan Marti2, Melissa B. Harrell3, Keryn E. Pasch1, Anna
Wilkinson3. 1University of Texas at Austin, Austin, TX, USA, 2University of Texas at
Austin, Austin, TX, USA, 3University of TX Health Science Center at Houston, School
of Public Health, Austin, TX, USA.
Signicance. ENDS use increased signicantly among U.S. young adults from 2017-
2018, after a period of decline from 2014-2017. The increase is attributed to the surge
in vape pod sales in late 2017. However, it is not known if ENDS dependence also
increased after the 2017 surge. We examined the longitudinal trajectory of ENDS
dependence among young adults from 2014-2019. Given the surge and that vape
pods contain high levels of nicotine, we expected ENDS dependence to increase sig-
nicantly after 2017. Method: Participants were part of Project M-PACT, which followed
5,482 students from 24 Texas colleges from 2014-2019. Participants completed online
surveys on eight occasions/waves; there were six bi-annual waves from 2014-2017,
and two one-year waves in 2018 and 2019. Only participants who were 18-25-years
old at wave 1 and who reported past 30-day ENDS use on at least one wave were
included in this study (n=1833). At wave 1, participants were 20.7 years old (sd=1.88)
on average; 57.3% female; 36.2% non-Hispanic, white, 33.6% Hispanic, 30.1% other
race/ethnicity. A discontinuous growth curve model was t to test the hypothesis that
the ENDS dependence trajectory would increase after 2017. The outcome variable,
ENDS dependence, was assessed at all eight waves with one item measuring use of
an ENDS product within 30 minutes of waking. The model was adjusted for participant
sex, age, and race/ethnicity. Results: Prevalence of ENDS dependence was 2.8% at
wave 1 and 8.3% at wave 8. Analyses indicated that ENDS dependence did not change
from 2014-2017, but then increased signicantly from spring 2018 to spring 2019 [z =
12.8, p < .001]. A post-hoc mixed analysis with data from spring 2018 and 2019 indicated
vape pod users were more likely than users of other device types to report ENDS use
within 30 minutes of waking [z = 2.98, p = .003]. Conclusion: Vape pods are a disruptive
technology that may have contributed to an increase in the number of young adults
addicted to ENDS. Findings underscore the need for cessation programs tailored to
young adults and also for prevention programs, as this population may be more likely
than adolescents to initiate ENDS use.
FUNDING: Federal
PS1-133
TRENDS IN SMOKING (2002 TO 2020) AND E-CIGARETTE USE
(2015 TO 2020) AMONG MEXICAN BY SEX AND AGE
Luis Zavala-Arciniega1, Luz M. Reynales-Shigematsu2, Nancy L. Fleischer1, David
Levy3, Belen Saenz de Miera-Juarez4, Luz M. Sanchez-Romero3, James Thrasher5,
Rafael Meza1. 1University of Michigan, Ann Arbor, MI, USA, 2National Institute of Public
Health, Cuernavaca, Mexico, 3Georgetown University Medical Center, Silver Spring,
MD, USA, 4Universidad Autonoma de Baja California Sur, La Paz, Mexico, 5University
of SC, Columbia, SC, USA.
Signicance: Since 2008, the sale, importation, and marketing of e-cigarettes have
been banned in Mexico. Nevertheless, e-cigarette use continues. Monitoring trends in
e-cigarette and cigarette use are important for tobacco control. This study describes
changes in e-cigarette use in Mexico between 2015 to 2020 and cigarette use between
2002 to 2020 by sex, age, and smoking status. Methods: We used data from seven
comparable nationally representative surveys (National Survey of Addictions 2002, 2011
and 2016, Global Adult Tobacco Survey 2009 and 2015, National Health and Nutrition
Survey 2018 and 2020). Current e-cigarette use includes everyday and someday use.
Smoking use was stratied by daily and nondaily use. After adjusting for sample de-
sign, prevalence estimates of current smoking, daily smoking, nondaily smoking, and
current e-cigarette use were calculated by sex and age group (15-19, 20-29, 30-39,
40-49, and 50-65). Two-sample independent t-tests were used to determine statisti-
cally signicant dierences. Results: Current e-cigarette use increased from 0.7% in
2015 to 1.5% in 2018, but did not change from 2018 to 2020 (1.5% to 1.4%). Current
e-cigarette use is higher among smokers (daily smokers: 2015 (3.3%), 2018 (6.0%),
2020 (3.6%); nondaily smokers: 2015 (1.9%), 2018 (4.6%), 2020 (3.6%)), than former
(2015 (1.0%), 2018 (1.2%), 2020 (1.2%)) and never smokers (2015 (0.2%), 2018
(0.4%), 2020 (0.6%). In addition, e-cigarette use is higher among males (2015 (1.2%),
2018 (2.3%), 2020 (1.9%)) than in females (2015 (0.3%), 2018 (0.9%), 2020 (0.9%)).
Current e-cigarette use is also higher among youth and young adults (15-19 years:
2015 (2.1%), 2018 (2.5%) 2020 (2.3%); 20-29 years: 2015 (1.0%), 2018 (2.9%), 2020
(2.2%)) than middle and older adults (30-39 years: 2015 (0.3%), 2018 (1.2%), 2020
(1.3%); 40-49 years 2015 (0.4%), 2018 (0.8%), 2020 (0.5%); 50-65 years; 2015 (0.1%),
2018 (0.5%), 2020 (0.7%) . Prevalence of current smoking decreased from (2002 to
2009 by 23% (from 21.4% to 16.6%). However, overall current smoking prevalence did
not decrease from 2009 to 2018. Nonetheless, there were decreases in daily smoking
among females and youth from 2018 to 2020. Conclusions: Most e-cigarette users
are current smokers, although the prevalence is still relatively low. E-cigarette use is
higher among males, youth, and young adults compared to females, and middle and
older adults. The greatest decrease in smoking prevalence in Mexico occurred from
2002 to 2009 before e-cigarettes were available. Smoking did not decrease since 2009
and did not change during the period in which e-cigarette use increased. Finally, from
2018 to 2020 the prevalence of smoking decreased among females and youth that may
have been aected by the COVID-19 pandemic.
FUNDING: Unfunded; E-cigarette/Alternative nicotine products Industry
PS1-134
A PROSPECTIVE EXAMINATION OF THE TIME-VARYING EFFECT
OF CIGARETTE AND ENDS USE ON SELF-REPORTED INCIDENT
HYPERTENSION AMONG US ADULTS
Steven Cook1, Jana Hirschtick1, Georey D. Barnes1, Doug A. Arenberg1, Irina V. Bond-
arinko1, Akash Patel1, Evelyn Mendoza1, Jihyoun Jeon1, David T. Levy2, Rafael Meza1,
Nancy Fleischer1. 1University of Michigan, Ann Arbor, MI, USA, 2Georgetown University,
Washington, DC, USA.
Signicance: Harm reduction advocates argue that Electronic Nicotine Delivery
Systems (ENDS) products should be part of a risk minimization strategy because they
may be less harmful than combustible cigarettes. However, ENDS products contain
potentially dangerous toxicants and chemical compounds, and little is known about their
health eects.Methods: Using adult data from Waves 1-5 (2013-2019) of the Popula-
tion Assessment of Tobacco and Health Study, we examined the risk of self-reported
incident hypertension associated with ENDS use using discrete-time survival models.
To distinguish the role of cigarettes and ENDS, we constructed a time-varying tobacco
exposure, lagged by one wave, dened as no use, exclusive established use (daily
or some days) of ENDS or cigarettes, and dual use. We controlled for demographics
(age, sex, race/ethnicity, household income), clinical risk factors (family history of heart
attack, obesity, diabetes, binge drinking) and smoking history (cigarette pack-years).
Results: The self-reported incidence of hypertension was 3.7% between Waves 2-5.
At baseline, 18% of respondents exclusively smoked cigarettes, 1.1% exclusively used
ENDS, and 1.7% were dual users. In adjusted models, exclusive cigarette use was
associated with an increased risk for self-reported incident hypertension compared to
non-use (aHR=1.21, 95% CI: 1.06-1.38), while exclusive ENDS use (aHR=1.00, 95%
CI: 0.68-1.47) and dual use (aHR=1.15, 95% CI: 0.87-1.52) were not. Conclusions:
We found that smoking increased the risk of self-reported hypertension, but ENDS
use and dual use did not. These results highlight the importance of using prospective
longitudinal data to examine the health eects of ENDS use.
FUNDING: Federal; Academic Institution
PS1-135
INVERSE CORRELATION OF ENDS DEVICE POWER AND LIQUID
NICOTINE CONCENTRATION: ARE USERS SELF REGULATING
NICOTINE EMISSIONS?
Kevin Welding1, Jerey J. Hardesty1, Joanna Cohen2, Elizabeth Crespi1, Joshua
Sinamo1, Qinghua Nian1, Ryan David Kennedy3, Alison Breland4, Thomas Eissen-
berg4. 1Johns Hopkins Institute for Global Tobacco Control, Baltimore, MD, USA, 2Johns
Hopkins Bloomberg School of P, Baltimore, MD, USA, 3Department of Health, Behavior
& Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4VA
Commonwealth University, Richmond, VA, USA.
Signicance:For electronic nicotine delivery systems (ENDS), device power (Watts, W)
and liquid nicotine concentration (mg/ml) are important predictors of nicotine emissions
and delivery to the user. We examined the relationship between device wattage and
nicotine concentration among regular ENDS users to determine the association between
these two factors. Methods:Participants (n=1209) were US adults (21+) using ENDS
5+ days per week, recruited for an online survey using Craigslist in 2020. Participants
were asked about, and submitted photos of, their most used device/liquid from the past
week. Information from photos, online research, and survey responses were combined
to reduce missing values. In some cases (n=369), wattage was estimated using a device
type-specic weighted average of a device’s minimum/maximum values. Overall and
device type (disposable(D), reusable with discardable pods/cartridges(RD), reusable with
rellable pods/cartridges(RR), reusable with tanks(T)) Pearson correlation coecients
were calculated. Results:Median wattage (29W, range:3-220W, n=822) tended to be
102
2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
higher for devices with rellable liquid [T:60W(6-220W), RR:15W(3-80W), RD:10W(6-
30W), D:10W(10-10W)]. Median nicotine concentration (18mg/mL, range:0-90mg/mL,
n=1182) tended to be lower for devices with rellable liquid [D:50mg/mL(2-60mg/mL),
RD:50mg/mL(0-80mg/mL), RR:25mg/mL(0-60mg/mL), T:6mg/mL(0-90mg/mL)]. Correla-
tions between wattage and nicotine concentration, overall (-0.574, p<0.001) and by de-
vice type [D:0(p=1.000); RD:-0.069(p=0.368); RR:-0.230(p=0.001); T:-0.221(p<0.001)],
had a weak to moderate negative relationship. Correlations were also negative when
restricting the sample to only user set wattages [n=438, overall:-0.285(p<0.001), RR:-
0.191(p=0.111), T:-0.226(p<0.001)]. Conclusion:Wattage and nicotine concentrations
varied by device type. There was a signicant, inverse relationship overall and within
some reusable device categories. While it is possible to consume high nicotine concen-
trations from high powered devices, these ndings suggest that adult regular ENDS users
tend to use lower nicotine concentrations with higher powered devices and vice versa.
FUNDING: Federal
PS1-136
ELECTRONIC NICOTINE DELIVERY SYSTEMS (ENDS) PARTICLE
SIZE DISTRIBUTION (PSD). FROM CIG-ALIKES TO VAPE-PENS,
MODS, AND PODS. INFLUENCE OF HEATING POWER, CHEMICAL
CONTENT, AND PUFFING TOPOGRAPHY
Vladimir B. Mikheev, Theodore Klupinski, Alexander Ivanov. Battelle Memorial Insti-
tute, Columbus, OH, USA.
Signicance:A common feature that strongly dierentiates ENDS aerosol emissions
from combustible tobacco smoke is the particle size distribution (PSD). Bi-modal PSD
previously measured for cig-alikes and vape-pens expanded from nanoparticles (NPs)
to submicron-micron size, and its nature is still not understood. Of a particular concern
is a signicant fraction of NPs that are often observed in ENDS aerosol and could cause
various toxicological implications such as deep penetration into the lungs, crossing into
systemic circulation, and breaking the blood-brain barrier.Methods:PSDs for various
types of ENDS including modern vape-pens, PODs, and MODs were measured using
both a real-time dierential mobility technique and an inertial impaction method. Tested
e-liquids contained propylene glycol (PG), vegetable glycerol (VG), and nicotine with
various avoring additives. Additionally, e-liquids consisted of vitamin E acetate (VEA)
and tetrahydrocannabinol (THC) mixtures in dierent proportions were also tested.
Heating power was varied, as well as pung topography. Temperature for selected
ENDS was measured using infra-red monitor. Selected aerosol samples were analyzed
by two-dimensional gas-chromatography-time-of-ight mass-spectrometry (GCx-
GC-TOFMS). Results:For all tested ENDS devices multi-modal (bi-modal or tri-modal)
PSD was typically observed when aerosol was generated from PG-VG based e-liquids
at temperature above 200 C (tests at temperatures below 150 C showed only single
mode PSD). Particle size ranged from NPs to above micron. Tri-modal PSD correlated
with the presence of avors. Many of the samples contained high concentrations of
NPs. THC-VEA aerosol showed single-mode PSD. Particles ranged from nano to sub-
micron size, and higher proportions of VEA were associated with smaller particle sizes
(down to 50 nm). Heating power increase led to particle size increase whereas pung
ow rate increase typically led to particle size decrease. New signals were detected
by GCxGC-TOFMS in the aerosol samples generated at above 200 C as compared to
e-liquid, indicating formation of new compounds. Conclusions: For the modern vape-
pens, PODs, and MODs tested, the distinction between type of PSD was consistently
correlated with the use of either PG-VG based e-liquids or THC-VEA e-liquids, which
led to multi-modal PSD or single-mode PSD, respectively. In the latter case, particle
sizes were smaller for e-liquids containing higher proportions of VEA. In the former
case, number of modes, particle size, and concentration per mode are all aected by
the e-liquid chemical content, heating power, and pung topography. Understanding the
factors that favor the formation of NPs is particularly important because of the serious
toxicological concerns presented by the inhalation of NPs.
FUNDING: Federal; Nonprot grant funding entity
PS1-137
TRENDS IN PUBLIC INTEREST IN SHOPPING AND POINT-OF-
SALES OF JUUL AND PUFF BAR 2019-2021
Ashley Xue, Senior Associate Scientist. American Cancer Society.
Background: This study investigated public interest in shopping and point-of-sales (POS)
of JUUL and Pu Bar products in the context of six regulatory, company sales policy
and other events of interest that may have inuenced the trajectory of these products
during 2019-2021. Methods: Outcome variables included relative search volume (RSV)
from Google search queries indicative of shopping interest in and aggregate dollar sales
from Nielsen POS for JUUL and Pu Bar in the U.S. from March 2019 to May 2021.
Adjusted autoregressive integrated moving average (ARIMA) assessed the observed
and predicted trends in the outcome variables and adjusted linear regression analysis
measured the relative rate of change in the outcome variables for each time period of
interest. Results: Peaks in Pu Bar’s shopping interest RSV and sales intersected with
declines in JUUL’s shopping interest RSV and sales. After the Trump administration
announced its plans to ban avored e-cigarettes and JUUL Labs, Inc.’s decision to
suspend the sales of its sweet and fruity avored products, JUUL’s shopping interest
RSV and sales declined while Pu Bar’s shopping interest RSV peaked, and its sales
increased. From the period following the FDA’s announcement of its enforcement
guidance policy on unauthorized avored cartridge-based e-cigarettes until May 2021,
JUUL’s shopping interest RSV and sales continued to decline. Pu Bar’s shopping
interest RSV increased, and its sales peaked until the House approved the avored
e-cigarette ban bill. Pu Bar ’s sales steeply declined following suspension of its sales in
February 2020. The decline, however, slowed after Pu Bar products were relaunched
as ‘synthetic nicotine’ e-cigarettes. Conclusion: Pu Bar’s unprecedented peak in the
shopping interest and sales of Pu Bar warrants continued surveillance.
PS1-139
EXPLORING THE AMOUNT AND THEMES OF NOVEL NICOTINE
SMOKELESS-RELATED MESSAGES ON TWITTER
Ganna Kostygina, PhD. NORC at the University of Chicago.
Objective. Although there is a growing body of research suggesting that social media
promotion of non-cigarette tobacco products is on the rise, digital marketing remains to
be an understudied domain in global tobacco control. Social media messages promoting
novel tobacco products are currently under-regulated, target youth and often contain
misinformation. Youth use social media at higher rates than the general population,
which potentially multiplies the eect of social media marketing. In particular, research
on novel smokeless nicotine pouch social promotion is sparse. The objective of the
present study was to assess the amount and characterize the content of novel smoke-
less-related messages on Twitter.Methods. Keyword search lters (including terms
related to novel nicotine pouches, nicotine sticks, gums, and pellets-related brands,
products, behaviors and slang) were applied to collect tweets related to novel smokeless
products from the Twitter Historical PowerTrack for the period between August 2016
and April 2020. Posts were coded for commercial content (e.g., youth and new user
targeting) using a combination of machine learning methods, keyword algorithms, and
human coding. Post metadata were analyzed to assess user geolocation and language
of the message.Results. Findings reveal that our keyword 712,269 smokeless-related
tweets posted by 437,049 users, with 142,141 (19.9%) tweets and 15,891 (3.6%) users
identied as commercial and 1,761 users being “social inuencers”. Commercial tweets
accounted for 47.1% of overall reach. There were 1,128 tweets related to novel pouched
product promotion. Promotional tweets featured such new user appeals as “spit-free,”
“easy-to-conceal,” and “sting-free” claims, nicotine product benets and reduced-harm
appeals to smokers. Conclusion. Tobacco control prevention initiatives should include
eorts to prevent and reduce novel nicotine product uptake by new users and youth
and should take into account the role of social media as a major marketing platform for
these products. The social media marketing and normalization of novel oral nicotine
products warrants urgent need for surveillance from public health.
FUNDING: Federal
PS1-140
EXAMINING THEMES RELATED TO COVID-19 AND NICOTINE ON
INSTAGRAM
Nathan Aaron Silver, PhD. Truth Initiative Schroder Institute.
Objective: The COVID-19 pandemic moved much of public life online causing people to
turn to mediated channels like social media for more of their information needs. Instagram
plays a unique role in the online information environment in being predominantly image
focused and youth driven, oering a means to reach young people with advertising and
lifestyle content related to nicotine products and to potentially leverage the platform
to promote online commerce. This ongoing research investigates the most prominent
themes associated with posts about COVID-19 and nicotine products on Instagram.
Methods: We identied posts about COVID-19 and nicotine through the presence of
keywords in either post text or hashtags between April and September 2020. A combina-
tion of human coding and LDA topic modeling was used to examine prominent themes.
Results: Keyword classication identied over 29,000 relevant posts from which 2000
were sampled for human coding. Posts containing themes of individual responsibility,
government criticism, comparison of risk posed by COVID-19 to chronic diseases, as
well as conspiracy theories and posts related to the protective role of nicotine were all
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
identied. The most prominent theme was commercial posts with over 40% of posts
using COVID-19 hashtags to capitalize on the pandemic by advertising pandemic re-
lated deals or appeals to “stay home and vape”. Discussion and Implications: Findings
suggest that to some extent discourse on Instagram compares to that on other social
media platforms like Twitter. However, unique to Instagram’s focus on images is the
clear focus on e-commerce. Without clear and enforced regulations of advertising claims
and strategies, Instagram provides an avenue for problematic advertising of nicotine
products to target a younger demographic with potential with mis and disinformation and
other predatory advertising strategies, as well as provide avenues for young people to
circumvent age restrictions through online businesses that deliver to private residences.
PS1-141
PAST YEAR VAPING QUIT ATTEMPTS AND CESSATION AMONG
US ADULTS WITH CURRENT OR PAST ELECTRONIC NICOTINE
DELIVERY SYSTEMS (ENDS) USE: FINDINGS FROM WAVE 4
(2016-2018) OF THE POPULATION ASSESSMENT OF TOBACCO
AND HEALTH STUDY
Elias M. Klemperer, PhD1, Janice Y. Bunn1, Matthew J. Carpenter2, Kenneth Michael
Cummings2, Tracy T. Smith2, Amanda M. Palmer3. 1University of Vermont, 2Medical
University of South Carolina, 3Medical University of South Carolina, Charleston, SC,
USA.
Introduction: Electronic nicotine delivery systems (ENDS) have the potential to increase
smoking cessation but approximately half of adults who use ENDS regularly continue
to smoke cigarettes and most intend to quit ENDS someday. Little is known regarding
factors associated with initiating an ENDS quit attempt versus complete cessation. In
this analysis we describe US adult users of ENDS who either 1) made no attempt to quit
ENDS (Continuers), 2) attempted to quit but continued using ENDS (Quit attempters),
or 3) completely quit ENDS (Complete ENDS quitters) in the past year.Methods: We
analyzed data from a United States nationally representative sample of 1,912 adults
who reported current or former regular ENDS use from Wave 4 (2016 to 2018) of the
Population Assessment of Tobacco and Health Study, a United States nationally rep-
resentative sample. We describe sociodemographic characteristics, ENDS use char-
acteristics, cigarette smoking, and strategies used to quit ENDS separately among 1)
ENDS Continuers, 2) Quit attempters, and 3) Complete ENDS quitters.Results: Among
adult ENDS users, 64.5% were Continuers (made no attempt to quit,) 21.9% were Quit
attempters (attempted but did not quit ENDS), and 13.6% were Complete ENDS quitters.
Neither age nor cigarette smoking status diered across the three groups. Complete
ENDS quitters had the greatest perceived harm from ENDS, the lowest likelihood of
using treatment, and, among current smokers, more cigarettes per day and the greatest
tobacco dependence (all p<.001). Most (93.8%) ENDS Quit attempters gradually cut
down to quit and 21.7% reported using a combustible tobacco product to quit ENDS.
Conclusions: Characteristics associated with completely quitting ENDS dier from
those associated with initiating a quit attempt. Among current smokers, quitting ENDS
was associated with heavier cigarette smoking than continuing ENDS and suggests
that self-selected ENDS cessation among dual users may be associated with a net
negative for harm reduction. Future prospective experimental research is needed to
determine whether treatments that promote ENDS cessation have a causal impact on
combustible tobacco smoking.
FUNDING: Federal; Other
PS1-142
QUITTING EXPERIENCES, SUCCESS, AND REASONS FOR
QUITTING OR REDUCING E-CIGARETTE USE AMONG YOUTH
WHO VAPE
Krysten W. Bold, PhD1, Meghan E. Morean1, Grace Kong1, Asti Jackson1, Danielle
R. Davis1, Deepa R. Camenga2, Lavanya Rajesh Kumar1, Juhan Lee1, Sakinah C.
Suttiratana3, Suchitra Krishnan-Sarin1. 1Department of Psychiatry, Yale University,
2Department of Emergency Medicine & Pediatrics, Yale University, 3Yale School of
Public Health.
Introduction: Many US youth are regular users of e-cigarettes. Understanding youth
experiences with quitting vaping and reasons for quitting is important for informing
youth-focused e-cigarette cessation interventions. Methods: We surveyed 1863 high
school students in Connecticut in Fall 2020 (51.7% female, 32.6% Hispanic, 45.4%
non-Hispanic White, 11.1% non-Hispanic Black, 6.3% NH Other, 4.5% NH Multiracial,
Mean age=15.6, SD=1.2) using a brief, anonymous online Qualtrics survey assessing
e-cigarette use, experiences quitting or cutting back on vaping in the past (assessed
separately), and reasons for quitting/cutting back (select all that apply). Results: In
total, 479 (25.7%) youth reported lifetime e-cigarette use. Among youth with lifetime
e-cigarette use, 62.2% (n=298) reported only vaping a few times and had no need to
quit/cut back on vaping, 19.6% (n=94) reported seriously trying to quit, 25.1% (n=120)
reported seriously trying to cut back, and 17.1% (n=82) reported both trying to quit and
cut back on vaping in the past. Among youth who tried to quit, they reported 3.3 quit
attempts on average in their lifetime (SD=2.8), and 44.7% (n=42) reported success and
quit using all nicotine products, 39.4% (n=37) reported continued vaping, and 14.9%
(n=14) reported that they quit vaping but use other tobacco products. Among youth
who reported trying to quit or cut back on vaping (n=131), the most frequently endorsed
reasons for quitting/cutting back were concerns about health (42.0%), concerns about
addiction (40.5%), cost (35.9%), aecting ability to play sports (28.2%), and to reset
tolerance (23.7%) (e.g., because they felt they had developed a tolerance to nicotine).
Conclusions: Findings indicate that although many youth are motivated to quit or cut
back on vaping, eorts are needed to help support quitting because many are not
successful. Findings also identify common reasons for quitting/cutting back on vaping
among youth that may be important when developing interventions to address issues
such as tolerance, which may be an indicator of dependence, and to help reinforce
specic motivations for quitting.
FUNDING: Federal; Nonprot grant funding entity
PS1-143
EFFECT OF A STATE-LEVEL VAPING PREVENTION CAMPAIGN
ON VAPING-RELATED BELIEFS AND BEHAVIORS IN
ADOLESCENTS AND YOUNG ADULTS
Andrea C. Villanti, PhD1, Jerey S. Priest2, Valerie S. Harder3, Catherine Peas-
ley-Miklus1, Julia C. West1, Maria L. Roemhildt4, Lisa Osbahr5, Rhonda Williams5.
1University of Vermont, Vermont Center on Behavior and Health, 2Department of Medi-
cal Biostatistics, University of Vermont, 3Vermont Child Health Improvement Program,
University of Vermont, 4Health Surveillance, Vermont Department of Health, 5Health
Promotion and Disease Prevention, Vermont Department of Health.
Introduction Vaping prevention media campaigns have promising eects on harm per-
ceptions but have yet to demonstrate impacts on vaping behaviors in young people. The
goal of this study was to evaluate the eect of Vermont’s vaping prevention targeted
digital media campaign (Unhyped) on vaping-related beliefs, harm perceptions, and
behaviors.MethodsData for the current study come from Waves 2 (Summer 2019; n =
1,173) and 3 (Fall 2019; 1,094) of the Policy and Communication Evaluation (PACE)
Vermont study, an online cohort of adolescents and young adults (AYA) ages 12-25.
Analyses examined associations between conrmed awareness (exposure) of Unhyped
and outcomes at each wave and between exposure at Wave 2 and outcomes at Wave
3. Analyses compared exposed participants to propensity score-matched controls.
ResultsConrmed awareness of Unhyped doubled over three months in 2019 (8.6%
to 19.1%). While there was no eect of Unhyped exposure on any outcome at Wave 2,
exposure at Wave 3 was positively associated with a campaign-targeted belief about
the nicotine content in a vape pod (76% exposed vs. 67% matched controls; p = 0.017)
and a greater proportion of past-year attempts to quit or cut down on vaping compared
to matched controls (75% vs. 48%; p = 0.006). Exposure to Unhyped also predicted
reductions in the number of days vaped in the past month at follow-up.Conclusions-
Vermont’s Unhyped campaign was eective in promoting short-term vaping prevention
and cessation or reduction in AYA. The PACE Vermont Study will continue to assess
short- and long-term outcomes of ongoing Unhyped campaigns as part of state-level
vaping prevention eorts.
FUNDING: Federal; State; Academic Institution
PS1-144
ARE SOME ENDS HARDER TO QUIT? THE IMPACT OF NICOTINE
FLUX ON PROXIMAL CESSATION OUTCOMES AMONG TEENS
AND YOUNG ADULTS
Michael S. Amato, PhD1, Sarah Cha1, D. Jeremy Barsell2, Amanda L. Graham1, Megan
A. Jacobs1, Mia M. Bottcher1, Shreya Tulsiani1, Eric K. Soule3, Corby K. Martin4, Chris-
toph Höchsmann4, Thomas Eissenberg2, Bernard F. Fuemmeler2, Elizabeth K. Do1.
1Truth Initiative, 2Virginia Commonwealth University, 3East Carolina University, 4Penning-
ton Biomedical Research Center.
BACKGROUND. Vaping devices dier in nicotine ux, the amount of nicotine emitted
per unit time. Dierences in ux may impact dependence and diculty quitting.OBJEC-
TIVE. Using observational data, we explored cross-sectional relationships of ux with
cessation outcomes among treatment-seeking vapers. Brand was used as a proxy for
ux based on an existing database of device characteristics our team has developed.
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We hypothesized high ux device users (Pu Bar, ux=144.7µg/s) would have worse
outcomes than low ux device users (JUUL, ux=56.3 µg/s). Since reliable estimates
of ux for other brands were not available, abstinence rates are reported but not
compared.METHODS. The sample was 1,457 young adults (YA; ages 18-24) and 638
teens (ages 13-17) who enrolled in This is Quitting, a free vaping cessation program,
between 12/20/2019 - 1/30/2020. All participants reported their primary vaping device
at enrollment and 7-day vaping abstinence at 30-days post-enrollment. Abstinence
rates were calculated among responders only.RESULTS. Distributions of devices were
similar across age groups (JUUL 69.4%, Suorin 8.8%, Vuse 6.7%, Pu Bar 5.6%, NJOY
5.1%, Smok 4.5%). The predicted relationship of brand with 7-day abstinence was
numerically observed among teens (JUUL 22.5% vs. Pu Bar 9.4%, ?2=2.3, p=0.13),
but not YA (JUUL 18.8% vs. Pu Bar 24.7%, ?2=1.7, p=0.20). Abstinence rates were
generally consistent across ages for other brands (overall: Vuse 22.7%, Suorin 14.4%,
Smok 14.6%, NJOY 13.8%).CONCLUSIONS. Teens may have more diculty quitting
when using devices with high nicotine ux than low nicotine ux. Additional research
should conrm this nding, and investigate why the predicted result was not observed
among YA. For example, other device properties (e.g. marketing demographic) or person
characteristics (e.g. tobacco use history, vaping topography) may be more important
moderators of cessation outcomes for YA. Careful assessment of devices and their usage
may further inform factors related to ENDS cessation.Results suggest nicotine ux is a
useful, parsimonious variable for estimating the population impact of nicotine products.
FUNDING: Federal; Nonprot grant funding entity
PS1-145
EXPOSURE TO DIFFERENT E-CIGARETTE ADVERTISING
CHANNELS AND E-CIGARETTE INITIATION AMONG U.S. YOUTH
BETWEEN 2016 AND 2018
Julia Cen Chen-Sankey, PhD. Rutgers Biomedical and Health Sciences.
BACKGROUND: E-cigarette use among U.S. youth rose sharply between 2017 and
2018. Exposure to e-cigarette advertising may have contributed to the surge. This study
examined the associations between e-cigarette advertising exposure through dierent
marketing channels and subsequent e-cigarette initiation. METHODS: Longitudinal
data (Wave 4: 2016-2018; and Wave 4.5: 2017-2018) of the Population Assessment
of Tobacco and Health (PATH) Study from a nationally representative sample of U.S.
youth never tobacco users (ages 12-16; n=9,405) at Wave 4 were used. Multivariable
regressions were conducted to examine the associations between e-cigarette advertising
exposure through various marketing channels at Wave 4 and e-cigarette ever initiation,
past 30-day initiation, and ever regular use at Wave 4.5, controlling for covariates.
RESULTS: At Wave 4, 60.8% of youth reported any e-cigarette advertising exposure.
Exposure mainly occurred through gas stations/stores (50.3%), television (22.2%), and
websites/social media (20.2%). At Wave 4.5, 7.8%, 3.4%, and 1.2% of youth reported
e-cigarette ever initiation, past 30-day initiation, and ever regular use, respectively. Mul-
tivariable models showed only websites/social media exposure was associated with all
e-cigarette initiation outcomes (ever initiation: AOR=1.45, 95% CI=1.19-1.76; past 30-day
initiation: AOR=1.30, 95% CI=1.01-1.71; ever regular use: AOR=1.95, 95% CI=1.19-
3.21). Billboard exposure was associated with e-cigarette ever initiation (AOR=1.37,
95% CI=1.12-1.68) and ever regular use (AOR=1.87, 95% CI=1.13-3.08). Exposure
through gas stations/stores, newspaper/magazines, and television were associated with
e-cigarette ever initiation. CONCLUSIONS: E-cigarette advertising exposure through
websites/social media, as well as traditional channels such as gas stations/stores,
televisions, newspapers/magazines, and billboards contributed to e-cigarette initiation
among youth who are tobacco naïve. Continued monitoring of e-cigarette advertising
across dierent traditional and new marketing channels is needed to inform policies
that can prevent youth initiation of e-cigarettes.
FUNDING: Federal; Nonprot grant funding entity
PS1-146
THE ROLE OF SOCIAL MEDIA IN TOBACCO USE AMONG US
ADOLESCENTS: RESULTS FROM POPULATION ASSESSMENT
OF TOBACCO AND HEALTH (PATH) STUDY
Juhan Lee, PhD. Yale School of Medicine.
BACKGROUND: To better understand the role of social media on youth tobacco use
patterns, we assessed the association between frequency of social media use and
1) tobacco use patterns using cross-sectional data, and 2) e-cigarette initiation using
longitudinal data. METHODS: We analyzed PATH Study Wave 4 (N=14793) to assess
the association between frequency of social media use and youth tobacco use patterns.
Tobacco use pattern was estimated using latent class analysis (LCA) with current use
of cigarettes, e-cigarettes, cigars, hookah, smokeless/snus, and other tobacco as
indicators. Further, to assess the role of frequency of social media use in e-cigarette
initiation, we analyzed Waves 3 and 4 of the PATH data and focused on those who never
used e-cigarettes at Wave 3 (N=7689). The outcome was e-cigarette use behaviors
at Wave 4 (non-susceptible never use, susceptible never use, ever use, current use).
Models controlled for demographics, peer/parental tobacco use, and tobacco marketing
exposure on social media. RESULTS: We found (1) among youth in Wave 4, 14.3%
never used social media, 13.7% used non-daily and 72.0% used social media in daily
basis, and we identied 4 LCA classes–e-cigarette users (3.1%), cigarette smokers
(2.7%), poly-tobacco users (0.5%), and non-users (93.7%). Higher frequency of social
media use was associated with a higher likelihood of being in the e-cigarette use class
(aOR=1.18, p=0.035), and lower likelihood of being in the poly-tobacco use class
(aOR=0.69, p<0.001), compared to being in non-use class. (2) Among never e-ciga-
rette users at Wave 3, daily social media use (vs. never) was signicantly associated
with susceptibility to e-cigarettes (aRRR=1.45; 95% CI=1.15, 1.83), ever (aRRR=3.53;
95% CI=1.64, 7.58) and current use of e-cigarettes (aRRR=2.86; 95% CI=1.26, 6.48)
at Wave 4. CONCLUSIONS: This study highlights the role of social media in youth
tobacco use, particularly in e-cigarette use. Given the high level of social media use
by youth, eorts to curtail tobacco-related content, particularly e-cigarettes, on social
media as well as e-cigarette prevention eorts directed at youth through these platforms
are urgently needed.
FUNDING: Federal
PS1-147
POPULATION CHARACTERISTICS AND DISPARITIES
ASSOCIATED WITH LOCAL T21 POLICIES
Marshall Cheney, PhD. University of Oklahoma.
BACKGROUND: In 2019, the FDA raised the federal minimum age for tobacco product
sales from 18 to 21. Prior to this, 425 local communities across 25 states had adopted
Tobacco 21 (T21) policies. This study examined aggregate dierences among the
communities that implemented T21 policies prior to the federal law versus those that
did not. METHODS: Local T21 policies eective 2012-2019 were identied through
online searches. T21 policies were coded with a validated Tobacco 21 policy tool by 2
independent coders. Single sample z-tests for proportions were used to compare the
percentage of individuals in the sample aected by the policy to the percentage ob-
served for the entire population of the state using US census data. Comparisons were
made for education (bachelor’s degree or higher), race/ethnicity (white, non-Hispanic),
and age (<18 and 65+). Sample sizes were extremely large due to individuals being
the unit of analysis, where all tests statistically signicant (p<.0001, two-tailed). Dier-
ences among rural and urban communities were also of interest, but we were unable
to directly measure or test this, due to a lack of comparable data between states as a
whole and those aected by the T21 policies. RESULTS: Individuals in localities where
T21 policies were passed tended to be more likely than the state to have a bachelor’s
degree (13% vs. 9%, z=664.08) and less likely to be white, non-Hispanic (53% vs.
58%, z=-462.31). Dierences in percentages by age were signicant but small, where
individuals aected by T21 policies were less likely to be age 65 or older (15% vs.
16%, z=-112.99) and ages 18 or younger (21.5% vs. 22.1%, z=-46.07). T21 localities
could not be directly compared to the states as a whole on urbanicity, but only .1% of
T21 localities were dened as rural, where 19.3% of the US population lives in a rural
area. CONCLUSIONS: Local T21 policies were less concentrated in communities that
were rural, had lower education, and had greater racial/ethnic diversity. Of concern,
these same populations are disproportionately targeted by tobacco industry marketing,
which could inadvertently increase tobacco use disparities among these populations.
FUNDING: Federal
PS1-148
LEVERAGING THE ASSOCIATION BETWEEN VAPING NICOTINE
AND MENTAL HEALTH TO PREVENT YOUTH E-CIGARETTE USE
Jessica M. Rath, PhD, MPH, CHES. Truth Initiative.
BACKGROUND: Young people are rightly concerned about mental health given the
strong association between nicotine and mental health disorders; e-cigarette users are
twice as likely to be diagnosed with depression compared to non-users and vaping can
worsen the symptoms of depression/anxiety. With the prevalence of mental health issues
rising among young people, they may turn to vaping nicotine, erroneously believing
it will help them manage their stress and anxiety. METHODS: This study monitored
the self-reported attitudes and beliefs on vaping nicotine and mental health among
15-24-year-old non-vapers compared to frequent vapers – dened as individuals who
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
vaped nicotine for more than 20 days in the past month. Data is from a national continu-
ous tracking survey which surveyed 300 participants per week from March 2019 – June
2021. RESULTS: More frequent vapers reported being stressed, anxious and having
poorer health compared to non-vapers. More frequent vapers (67%) reported that they
are often or sometimes unhappy, sad, or depressed, compared to non-vapers (57%).
Frequent vapers had the lowest percentage of people who reported that they had good
health (55%), compared to non-vapers (65%). More frequent vapers (45%) agreed that
it is OK to vape for stress relief, compared to non-vapers (20%). Additionally, 70% of
frequent vapers reported that they need to vape to cope with stress/anxiety, compared
to 29% of non-vapers. CONCLUSIONS: There is a strong association between vaping
nicotine and mental health in young people. Furthermore, the data suggests that vaping
may be used as a coping mechanism among youth and young adults for anxiety and
stress. Because mental health is an issue that young people care about, highlighting
its connections with vaping may be a valuable tool – in tandem with standard quitting
vaping support – to prevent young people from vaping initiation and current use.
PS1-149
SELF-REPORT MEASURES OF ELECTRONIC CIGARETTE
DEPENDENCE: COMPARISON OF PSYCHOMETRIC PROPERTIES
Andrea R. Milstred, MS1, Ashley E. Douglas, BS1, Margaret G. Childers, BS1, Nicholas
J. Felicione, PhD2, Melissa D. Blank, PhD1. 1West Virginia University, Morgantown, WV,
USA, 2Roswell Park Comprehensive Cancer Center, Bualo, NY, USA.
Background: Several electronic cigarette (ECIG) dependence measures have been
adapted from those designed for cigarette smoking, though few have been evaluated
for their psychometric properties. This study examined the reliability and validity of four
self-report dependence measures in never-smoking ECIG users. Methods: Participants
(N=134) reported less than 100 cigarettes lifetime and regular use of a nicotine-contain-
ing ECIG [mean (SD) = 6.5 (.90) days/week for 2.5 (1.4) years]. Dependence measures
were completed online: Diagnostic and Statistical Manual 5th Edition (DSM), Penn State
Electronic Cigarette Dependence Index (PSECDI), Glover Nilsson Behavioral Question-
naire (GNBQ), and E-cigarette Dependence Scale (EDS-4). Dependence was qualied
as low for EDS-4 [2.2 (.99)] and GNBQ [17.1 (8.5)], moderate for PSECDI [10.1 (4.4)],
and moderate-high for DSM (24.6% moderate and 43.3% high). Pearson correlations
and Cronbach’s alpha were used to assess internal consistency, and concurrent and
convergent validity. Results: The majority of inter-item correlations were signicant for
the PSECDI, GNBQ, and EDS-4 (mean r’s=.32, .36, and .51, respectively), while less
than half were signicant for the DSM (mean r=.27). All but one item-total correlations
were signicant across measures [mean r’s=.45 (DSM) to .79 (EDS-4)]. Internal con-
sistency was highest for the EDS-4 (Cronbach’s alpha=.88) followed by GNBQ (.75),
PSECDI (.72), and DSM (.71). Signicant correlations were observed for all measures
and the number of vaping days/week (r’s=.29 to .44, p’s<.01); PSEDCI and EDS-4
scores and vaping years (r’s=.28 and .23, respectively); and DSM scores and number
of past quit attempts and initiation age (r’s=.27 and -.25, respectively). Convergent
validity was highest for comparisons between the EDS-4 and the GNBQ (r=.73) or the
PSEDCI (r=.67), though all comparisons were signicant (r’s=.51 to .60, p’s<.001). Con-
clusions: Psychometric properties were strongest for the EDS-4, though all measures
demonstrated adequate reliability and validity. Importantly, measures dier slightly in
terms of those aspects of dependence (e.g. physiological, behavioral, social) they reect.
FUNDING: Academic Institution
PS1-150
SYNERGISTIC USE OF COMPUTER VISION AND GPS FOR
PREDICTING ENVIRONMENT-ASSOCIATED SMOKING RISK
Matthew M. Engelhard, MD, PhD1, Jason A. Oliver2, Joseph McClernon1. 1Duke Univer-
sity School of Medicine, 2Stephenson Cancer Center.
Computer vision can be applied to images of smokers’ daily environments to 1) identify
environmental determinants of smoking risk and 2) predict environment-associated
smoking risk in real time. This approach could be used to support just-in-time adaptive
interventions, or interventions focusing on coping strategies for specic high-risk en-
vironments. Alternatively, GPS coordinates can be used to identify distinct geospatial
locations and predict location-associated smoking risk. However, the relative value of
image versus GPS data for predicting environment-associated smoking risk is unknown.
Smokers (10 or more cigarettes per day) age 18+ from the Durham, NC area completed
14 days of photo-enabled ecological momentary assessment via smartphone. GPS
coordinates were recorded by smartphone and veried by GPS tracker. Participants
completed assessments each time they smoked and at 6 randomly selected times
each day. A convolutional neural network and Gaussian process classier (i.e. kriging)
were trained to predict current smoking based on images of the current location or the
current GPS coordinates, respectively. The area under the sensitivity-specicity curve
(AUC) was used to evaluate prediction performance. Models were trained using data
from days 1-10 (all participants) and evaluated using data from days 11-14. Performance
was grouped by self-reported location type. Prediction performance when indoors in
smokers’ homes was higher for images (AUC=0.74) versus GPS (AUC=0.65). Perfor-
mance when away from the home was also higher for images (AUC=0.73) versus GPS
(AUC=0.51). However, performance when outdoors at smokers’ homes was higher for
GPS (AUC=0.77) versus images (AUC=0.71). Combining predictions from both models
yielded consistent performance across all location types (AUC=0.73-0.78). Comput-
er-vision based prediction of environment-associated smoking risk is superior to GPS
prediction for indoor home environments and non-home environments, but not outdoor
home environments. Images and GPS can be used synergistically to predict smoking
risk more consistently and eectively than either data source alone.
FUNDING: Federal; Pharmaceutical Industry; Academic Institution
PS1-151
USING MACHINE LEARNING TO INFORM SMOKING CESSATION
TREATMENT
Emily T. Hebert, DrPH1, Robert Suchting2, Michael S. Businelle3, Darla E. Kendzor3.
1University of Texas Health Sciences Center, Houston, TX, USA, 2UTHealth McGovern
Medical School, 3Stephenson Cancer Center.
Mobile and electronic health record (EHR) data can provide clinicians and researchers
a wealth of information that can be used to better understand a smoker’s thoughts,
feelings, and behaviors when they undergo a quit attempt. Machine learning (ML)
methods can be applied to these data to inform treatment. The present study used two
ML models to: 1) identify baseline (pre-quit) variables associated with abstinence on
the quit date, and 2) identify the strongest momentary predictors of rst lapse following
an initial quit attempt. ML analyses of baseline psychosocial data from 570 smokers
enrolled in a tobacco treatment clinic in Oklahoma were used to create a model that
predicted biochemically-veried abstinence on the scheduled quit date (Model 1). A
subset of 320 participants used a smartphone app to complete 5 ecological momentary
assessments (EMAs) per day from 1 week pre-quit through 4 weeks post-quit. EMAs
evaluated mood, smoking urge, environmental context, and smoking lapses. Cox
proportional hazards regression models with false discovery rate multiplicity control
and a ML-based penalization/model reduction scheme were used to create a model
that included the strongest predictors of rst lapse (Model 2). ML models identied
several pre-quit variables associated with an increased likelihood of abstinence on the
quit date (e.g., rural vs. urban address, self-ecacy for quitting). EMA data revealed
several signicant predictors of time to rst lapse, including self-reported likelihood of
smoking that day, cigarette availability, feeling frustrated, and recent alcohol use. Study
results illustrate the utility of ML for predicting quit date abstinence and rst smoking
lapse. Participants identied as unlikely to successfully quit on their quit date could be
provided with additional support prior to quitting (e.g., extra counseling sessions), and
momentary predictors of imminent smoking lapse could be used to inform just-in-time
adaptive interventions that aim to prevent smoking lapse.
FUNDING: Federal; State
PS1-152
MINING ANTI-TOBACCO CAMPAIGNS ON SOCIAL MEDIA
THROUGH NATURAL LANGUAGE PROCESSING FOR EFFECTIVE
CAMPAIGN DEVELOPMENT AND IMPLEMENTATION
Shuo-Yu Lin1, Xiaoquan Zhao1, Weiyu Zhou1, Ge Song1, Gilbert Gimm1, J.Randy Koch2,
Andrew Barnes2, Rashelle Hayes2, Hong Xue1. 1George Mason University, Fairfax, VA,
USA, 2Virginia Commonwealth University, Richmond, VA, USA
Background: Anti-tobacco campaigns on social media are important channels for tobacco
use prevention and control. In the present study, we conducted content analysis of major
anti-tobacco campaigns on Facebook and examined the factors that may inuence
eective anti-smoking information dissemination and users engagement. Methods: We
collected 3,515 posts and 28,125 associated comments from seven large national and
local anti-tobacco campaigns on Facebook between 2018 and 2021 including Behind the
Haze VA, Campaign for Tobacco-Free Kids, Smoke Free US, The Real Cost, Tobacco
Prevention Toolkit, Truth Initiative, and CDC Tobacco Free. Natural language processing
methods were used for content analysis including parsimonious rule-based models for
sentiment analysis. Multinominal logistic regression models were tted to examine the
relationship of anti-smoking message framing strategies and viewer responses and
engagement. Results: Although posts from anti-smoking campaigns that were positively
framed (sentiment scores > 0.05) were 35% more likely to receive positive comments
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
than neutral posts (RRR = 1.35, 95% CI: 1.14 - 1.61, p < 0.01), posts that were more
likely to receive positive comments on average had 15.31 (95% CI: -26.90 - -3.73, p <
0.05) fewer shares compared to posts that were more likely to receive neutral comments.
On the other hand, we found that negative comments were more common (31.9 times
more common than neutral comments, 95% CI 19.18 - 44.62, p < 0.01), where numbers
of positive comments were similar to neutral comments (2.15; 95% CI -10.36 - 14.66).
Posts framed negatively had 108.51 more shares compared to neutral posts (95% CI
19.73 - 197.30, p < 0.05). Compared to neutral-framed posts, negatively framed posts
were 32% more likely to receive negative comments (RRR = 1.32, 95% CI: 1.13- 1.54, p
< 0.01). Conclusion: Although positive posts tended to receive more positive comments,
Facebook (now named META) users, in general, were more responsive to negative
posts, leaving more negative comments. Framing strategies taking into account such
negativity bias should be implemented in future campaign development.
PS1-153
PATTERNS OF CANNABIS AND TOBACCO USE IN AUSTRALIA: A
LATENT CLASS ANALYSIS AND HEALTH-RELATED CORRELATES
Carmen Lim, MSc1, Janni Leung1, Tianze Sun1, Shannon Gravely2, Vivian Chiu1, Daniel
Stjepanovic1, Jack Y. C. Chung1, Jason Connor1, Roman W. Scheurer1, Coral Gartner1,
Wayne Hall1, Gary C. K. Chan1. 1The University of Queensland, Brisbane, Australia,
2University of Waterloo, Waterloo, ON, Canada.
Signicance: The co-use of tobacco and cannabis is high in Australia. Co-use can occur
simultaneously or asynchronously and could be more harmful than the use of each sub-
stance alone. This study examined the patterns of tobacco, cannabis and co-use, and
their associations with socio-demographic correlates, health factors and poly-substance
use. Method: The nationally representative Australian 2019 National Drug Strategy and
Household Survey was used in this study (n =22,015). Latent class analysis was used
to identify subgroups of respondents based on a set of tobacco and cannabis use indi-
cators. The socio-demographic correlates, health indicators and recent substance use
of each class was examined using multinomial logistic regression. Results: A four-class
solution was identied: ‘Tobacco-only’ (7.4%), ‘Cannabis-only’ (5.6%), ‘Co-use tobacco
and cannabis’ (2.3%), and ‘Non-user’ (84.7%). Compared to non-users, respondents
in all other classes were more likely to be male, younger (<60 years), single, living in
rural regions, experiencing high level of psychological distress, and had used other
illicit substances in the last year. Within the co-use class, 79% had simultaneously
mixed tobacco and cannabis. In the co-use class, the simultaneous use of other illicit
substances (e.g., alcohol, ecstasy, cocaine) with cannabis was high. Conclusions: A
substantial proportion of respondents have used either or both tobacco and cannabis.
Interventions and policies need to target users of both substances.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
PS1-155
PREFERRED MODES OF CANNABIS DELIVERY AMONG ADULT
USERS OF TOBACCO CIGARETTES AND NICOTINE VAPING
PRODUCTS: FINDINGS FROM THE 2020 ITC FOUR COUNTRY
SMOKING AND VAPING SURVEY
Danielle M. Smith, PhD1, Pete Driezen2, Elle Wadsworth2, David M. Hammond2, Andrew
M. Hyland1, Richard J. O’Connor1, Maciej L. Goniewicz1, K. Michael Cummings3, Ann
McNeill4, Anne C.k. Quah2, Georey T. Fong2. 1Roswell Park Comprehensive Cancer
Center, Bualo, NY, USA, 2University of Waterloo, Waterloo, ON, Canada, 3Medical
University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC, USA,
4King’s College London, London, United Kingdom.
Signicance: Nicotine and cannabis are administered using similar modes of delivery
(MODs). Little is known about the degree of similarity in preferred nicotine and cannabis
MODs among co-users. We examined preferred cannabis MODs among nicotine users
across jurisdictions with varying adult-use cannabis policies.Methods: Using data from
the 2020 ITC 4 Country Smoking and Vaping Survey, we examined cannabis MODs
(e.g., smoked, vaped, edible) among adult users of cigarettes and nicotine vaping
products (NVPs) who reported past year cannabis use. Logistic regression estimated
age- and sex-standardized prevalence of cannabis MODs by nicotine user group (ex-
clusive cigarette smokers n=1635; exclusive NVP users n=416; dual users of cigarettes
+ NVPs n=1171) and jurisdiction (Canada n=1524; US: legal adult-use (n=253) and
illegal adult-use (n=499) cannabis states; England n=717; Australia n=229). Multinomial
logistic regression examined associations between nicotine user group, jurisdiction, and
preferred cannabis MOD, controlling for other factors.Results: Smoking cannabis without
tobacco was the preferred MOD across all nicotine user groups. A greater percentage
of exclusive cigarette smokers (36.2%) smoked cannabis with tobacco than dual
users (28.4%) and exclusive NVP users (12.6%). More exclusive NVP users (10.2%)
vaped cannabis oils than exclusive smokers (2.2%). Findings held after adjusting for
demographics, use of other tobacco products, cannabis use frequency, alcohol use
and indicators of depression. By country, smoking cannabis without tobacco was the
preferred MOD in Canada (55.9%), US illegal (70.8%), and US legal (61.9%) states.
Smoking cannabis with tobacco was the preferred MOD in England (68.6%) and Aus-
tralia (65.3%). Prevalence of vaping cannabis oils was highest in the US (legal:9.5%,
illegal:7.5%), followed by England (4.1%), Canada (3.1%), and Australia (1.3%).
Conclusions: Among nicotine users, smoking cannabis without tobacco is the most
popular MOD, but dierences emerged by user group and jurisdiction. Mode-specic
preferences across substances highlight cross-product interactions requiring attention
by researchers and policymakers.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
PS1-156
CANNABIS AND TOBACCO/NICOTINE CO-USE AMONG PRIMARY
CARE PATIENTS IN A STATE WITH LEGAL CANNABIS ACCESS
Erin A. McClure, PhD1, Leah Hamilton2, Theresa E. E. Matson2, Gillian L. Schauer3,
Katharine Bradley2, Gwen T. Lapham2. 1Medical University of South Carolina, Charles-
ton, SC, USA, 2Kaiser Permanente Washington Health Research Institute, Seattle, WA,
USA, 3University of Washington, Seattle, WA, USA.
Signicance: Cannabis and nicotine/tobacco co-use is prevalent, has public health
impact, and has implications for treatment. Further, cannabis and nicotine products are
widely available and have evolved rapidly in the United States (US) leading to numerous
patterns of dual use. Primary care could be utilized for cannabis and/or tobacco screening
and intervention; however, little research has evaluated co-use among primary care
patients. This secondary analysis explored the association between tobacco/nicotine
co-use status among adults who currently use cannabis on measures of cannabis use.
Methods: As part of a NIDA Clinical Trials Network (CTN) parent study, patients were
identied through visits to primary care clinics in Kaiser Permanente Washington (US)
and were oversampled based on the frequency of past-year cannabis use (indicated
in the electronic medical record) and for Black, indigenous, or other persons of color.
Patients who endorsed past 30-day cannabis use were included (N=1388). Outcomes
included cannabis use (i.e., methods of use, frequency, recreational and/or medical
use, and cannabis use disorder symptoms [CUD]) and were analyzed using unadjust-
ed bivariate correlations to compare outcomes between patients who use cannabis
only compared to those who co-used nicotine/tobacco. Results: Among primary care
patients who co-used nicotine/tobacco and cannabis (n=352; 25%), co-use status was
associated with higher rates of combustible cannabis use (p<0.001), more days of use
(p<0.05), more use episodes per day (p<0.05), and higher rates of cannabis use disorder
(p<0.001) compared to those who used cannabis only (n=1036). Conclusions: In a state
with a mature legal cannabis market, primary care patients who co-use cannabis and
nicotine/tobacco reported more days of cannabis use and had higher rates of CUD.
Interventions targeting cannabis and tobacco/nicotine co-use in primary care populations
are not well-established and research in this area is warranted given ndings of more
severe cannabis use patterns and the adverse health outcomes associated with co-use.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
PS1-157
ADVANCED LONGITUDINAL MODELS OF ABSTINENCE AND
WITHDRAWAL
George Kypriotakis, PhD, MA, BA. UT MD Anderson Cancer Center.
Despite developments in advanced longitudinal data modeling, the application of such
models to tobacco randomized controlled trials has been rather limited. Most smokers
attempt to quit smoking multiple times, entering and exiting states of smoking absti-
nence. Here, we describe the use of Markov models to jointly examine the time course
of smoking abstinence/relapse and withdrawal intensity. This approach allows for two
aspects of transitions that recur repeatedly to be taken into account: (1) how long it takes
for a smoker to transition between smoker/abstinent and abstinent/smoker; and (2) how
much of a withdrawal intensity can a smoker sustain before transitioning from abstaining
to the smoking state. We also describe use of machine learning (ML) approaches that
can discover complex interactions between smoking cessation treatments and individual-
and contextual-level characteristics and identify heterogeneity of eects that can lead
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2022 Poster Session 1 • Wednesday, March 16, 2022, 11:30 AM - 1:00 PM
to more targeted and personalized smoking cessation interventions. We hope that the
use of these new approaches will improve representation of the empirical processes of
outcomes in tobacco studies and extend the sort of questions that researchers can ask.
FUNDING: State; Academic Institution; Nonprot grant funding entity
PS1-158
SYMPTOM BURDEN, TOBACCO USE, AND QUIT INTENTIONS
AMONG INDIVIDUALS WITH CANCER: AN ANALYSIS OF THE US
FDA POPULATION ASSESSMENT OF TOBACCO AND HEALTH
(PATH) STUDY
Sarah N. Price, MA1, Amanda M. Palmer, PhD1, Lisa M. Fucito, PhD2, Evan M.
Graboyes, MD, MPH1, Nathaniel L. Baker, MS1, Benjamin A. Toll, PhD1, Alana M. Rojew-
ski, PhD1. 1Medical University of South Carolina, Charleston, SC, USA, 2Yale University
School of Medicine, New Haven, CT, USA.
Background: Understanding the relationship between symptom burden and smoking/
vaping may inform tobacco treatment interventions tailored to the needs of individuals
with cancer during and after treatment. Methods: Analyses used data from FDA PATH
Wave 5, a representative survey of US adults. Chi-square, t-tests, and linear regres-
sion were used to compare symptom burden [fatigue, pain, sleep problems, emotional
problems, quality of life (QOL)] between patients (diagnosed in past 12 months; N=605)
and survivors (in remission; N=863) and to compare symptom burden by smoking status
(current=478, former=496, never=394), vaping status (current=94, former/never=1374),
quit attempts, level of interest in quitting, and intentions among patients/survivors.
Fatigue, pain, emotional problems, and QOL were assessed with single item Likert
scales, and past month sleep problems were dichotomized. Results: Compared to
survivors, patients reported worse fatigue (mean dierence (MD)=.34, p<.0001), pain
(MD=.46, p=.02), emotional problems (MD=.22, p=.007), and perceived QOL (MD=.16,
p=.01), but no dierence in sleep problems. Among patients, current smokers reported
worse pain (MD=1.56, p<.0001), emotional problems (MD=.63, p<.0001), and QOL
(MD=.47, p=.0002) compared to former smokers, and worse fatigue (MD=.40, p=.0007),
pain (MD=2.08, p<.0001), emotional problems (MD=.37, p=.03) and QOL (MD=.73,
p<.0001) compared to never smokers. Currently vaping patients reported higher pain
(MD=1.63, p=.003), more emotional problems (MD=.68, p=.03), and more sleep prob-
lems (χ2(1)=5.35, p=.02) compared to patients not currently vaping. Among patients/
survivors, no facets of symptom burden were associated with quit attempts, interest,
or intentions, but currently smoking survivors who made a quit attempt in the past year
had higher pain (MD=.99, p=.04) and worse QOL (MD=.39, p=.04). Conclusion: Among
cancer patients and survivors alike, current tobacco use is associated with signicantly
greater symptom burden. Despite this, cancer patients and survivors expressed interest
and intentions to quit. Future research should examine the role of smoking cessation
in improving symptom burden.
FUNDING: Unfunded
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
POSTER SESSION 2
PS2-1
ELECTRONIC HEALTH RECORD CLOSED-LOOP REFERRAL
(EREFERRAL) TO A STATE TOBACCO QUITLINE: PRIMARY CARE
IMPLEMENTATION CHALLENGES AND ADAPTATIONS
Mark Zehner1, Julie A. Kirsch2, Rob Adsit1, Danielle McCarthy1, Allison Gorrilla1, Kristine
Hayden1, Amy Skora1, Marika Rosenblum3, Michael Fiore1, Timothy Baker1. 1University
of WI Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA,
2University of Wisconsin, Department of Family Medicine and Community Health and
Center for Tobacco Research and Intervention, Madison, WI, USA, 3University of Illinois
Chicago, Chicago, IL, USA.
Background: Health system changes can increase the reach of evidence-based smok-
ing cessation treatment. Proactive ask-advise-connect (AAC) referral programs, for
example, increase the rates at which patients who smoke enroll in cessation treatment.
Implementing such system changes poses many challenges, however, and adaptation to
system contexts is often required. This case study identied implementation challenges
and adaptations that were made to enhance adoption and implementation of electronic
health record (EHR)-enabled, closed-loop referral (eReferral) of adult primary care
patients to a state tobacco quitline. Methods: Twenty three primary care clinics in two
healthcare systems implemented quitline referral, starting with 1 pilot clinic per system
and then 2 phases of implementation (an experimental phase in 5-6 test clinics and then
a system-wide adoption phase). Adaptations were informed by stakeholder input from
in-person trainings, follow-up calls a month after eReferral launch, emails, and direct
observation by researchers. Implementation strategy challenges and adaptations were
assessed and characterized using RE-AIM and the FRAME-IS adaptation framework
as guides. Findings: Major challenges to implementation of closed-loop eReferral to
a tobacco quitline included: achieving interoperability between the healthcare system
EHR and the state quitline vendor platform; tailoring the eReferral program to health-
care system-specic EHR congurations; and tailoring to system- and clinic-specic
workows, roles, policies, and procedures. The two health systems used dierent
approaches to adoption, interfacing with the quitline vendor, and integrating eReferral
into clinician workows. Both health systems engaged in iterative renement of the
EHR alert prompting tobacco use intervention, the eReferral computerized physician
order entry, trainings, and AAC workows. Conclusions: System-wide implementation of
eReferral in primary care outpatient clinics is feasible but requires extensive coordination
across stakeholders, tailoring to health system EHR congurations, and sensitivity to
system- and clinic-specic workows.
FUNDING: Federal
PS2-2
EXAMINING FACILITATORS AND BARRIERS IN TOBACCO
INTERVENTION FOR PERSONS WITH SUBSTANCE USE AND
MENTAL HEALTH DISORDERS
kevin mcgirr. UCSF, San Francisco, CA, USA.
The Covid-19 pandemic provided additional challenges but also opportunities to reach
a challenging population engaged in a tenacious behavior. This presentation will focus
on the qualitative inquiry of a three-observational study that is testing a Tobacco Harm
Reduction model targeted to individuals with Substance Use and Mental Health disor-
ders. While the current three-year observational study is demonstrating some success
in facilitating subject eorts to change their tobacco use; recruitment and retention are
a challenge in a population known to have limited success and worse outcomes related
to tobacco use morbidity and mortality. This presentation will present data derived from
focus groups with subjects who demonstrated successful change eorts along with
semi-structured interviews with individuals who dropped out of the research protocol.
Complementing subject qualitative data, we also present data from semi-structured
interviews with research sta. The objective in the use of these qualitative methods is
to amplify the facilitators and barriers in engaging with this population. Endeavoring to
provide tobacco intervention with this population ultimately means competing with other
subject demands and mounting eorts to capture attention and luring individuals away
from a myriad of distractions. This overarching view will be considered and described
through the following three lens: resource challenges, e.g., housing, transportation, and
other resource limitations; communication, e.g., limited technological access and nally
existential clinical challenges, e.g., trauma, psychoses and substance use.
FUNDING: Nonprot grant funding entity; Other
PS2-3
CIGARETTE SMOKING STATUS AND HORMONE USE AMONG
ADOLESCENT AND YOUNG ADULT FEMALES WITH OPIOID USE
DISORDER
Stephanie Mallahan1, Andrea Bonny2, Brittny Manos2, Erin McKnight2, Alicia Allen1.
1University of Arizona, Tucson, AZ, USA, 2Nationwide Children’s Hospital, Columbus,
OH, USA.
Signicance: Compared to those who had quit or had never smoked, the prevalence
of OUD is higher among those who currently smoke, particularly among adolescents
and young adults (AYA). Ovarian hormones, which are altered with hormonal contra-
ceptives (HC), can aect drug-taking behaviors. This has not yet been investigated
among AYAs with OUD who also smoke. The objective of this study was to investigate
the dierences in smoking status by HC use among AYA patients with OUD. Methods:
We conducted a retrospective chart review of female patients seen from January 1,
2011 through December 31, 2019 at the Medication Treatment of Addiction (MATA) clinic
for AYA at Nationwide Children’s Hospital. Descriptive statistics were used to identify
the prevalence of smoking and hormonal contraception use among patients, and a chi
square test was conducted to formally examine this relationship. We excluded those
with a missing smoking status. Results: Patients (n=119) had a mean age of 19.2 (± 2)
years. The majority were white non-Hispanic (92%), and had public insurance (75.6%).
Overall, 79% (n=94) of patients reported current smoking, 8.4% (n=10) reported a his-
tory of smoking, and 12.6% (n=15) reported never smoking. During the study period,
17.6% (n= 21) were not prescribed any HC, while 49.6% (n=59) were prescribed two
or more types, 26.9% (n=32) were prescribed progestin-only long-acting reversible
contraceptives (predominately depot medroxyprogesterone acetate), and 5.9% (n=7)
were prescribed cyclical hormones (predominately combination oral contraceptives). A
similar distribution of smoking status group by HC use was seen; however, a chi square
test did not show a statistically signicant association between HC type and smoking
status. Conclusions: These data suggest that HC use is common among AYA females
with OUD that also smoke. Additional research is needed to further explore the potential
impact of HC use on OUD and smoking related outcomes. Future Implications may
include how these ndings can be used to promote smoking cessation eorts among
AYA with OUD.
FUNDING: Unfunded
PS2-4
TOBACCO/NICOTINE DEPENDENCE AND COVID-19: DISTINCT
AND CO-OCCURRING CONDITIONS AMONG PATIENTS IN FIVE
ACADEMIC HEALTH CENTERS
Raphael E. Cuomo1, Timothy K. Mackey2. 1UC San Diego School of Medicine, La Jolla,
CA, USA, 2UC San Diego, La Jolla, CA, USA.
Signicance: The spread of SARS-CoV-2 has led to a global pandemic clinically
characterized by severe respiratory illness. As of late July 2021, about 35 million US
adults have contracted COVID-19. During this same time, approximately 60 million
adults used a tobacco/nicotine product. The co-occurrence of COVID-19 in a population
with a highly-prevalent respiratory system stressor warrants investigation of patients
with comorbid COVID-19 and tobacco/nicotine dependence. We assessed rates of
conditions among patients with both COVID-19 and tobacco/nicotine dependence in a
large database of electronic health records.Methods: We used SQL scripts to query
the UCCORDS database, which contains anonymized health records for all patients
tested for COVID-19 by the ve health centers in the University of California system.
Output contained patient gender, race/ethnicity, and comorbidities. We identied rates
of observed conditions (using OMOP-compliant coding) for individuals with tobacco/
nicotine dependence and determined rates of these conditions for those with tobacco/
nicotine dependence (n=25,419), COVID-19 (n=25,194), and both (n=2,193).Results:
The top 10 conditions observed for patients comorbid with COVID-19 and tobacco/
nicotine dependence were essential hypertension (45.1%), abnormal ndings on di-
agnostic imaging of lung (31.7%), hyperlipidemia (30.0%), chest pain (29.7%), chronic
pain (29.2%), dyspnea (29.1%), anxiety disorder (28.2%), major depression (25.2%),
abnormal electrocardiogram (24.6%), and cough (24.1%). Patients with both COVID-19
and tobacco/nicotine dependence had higher rates of all ten conditions compared to
patients with only COVID-19 or only tobacco/nicotine dependence.Conclusion: Patients
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
with comorbid COVID-19 and tobacco/nicotine dependence are at much higher risk of
conditions common among patients with tobacco/nicotine dependence alone. While
increases in some (e.g. cough, dyspnea) appear to be driven by COVID-19, increases
in others (e.g. hyperlipidemia, chest pain, major depression), may have unique etiol-
ogies corresponding to comorbid COVID-19 and tobacco/nicotine dependence that
require further study.
FUNDING: Unfunded
PS2-5
RELATIONSHIP BETWEEN PROGESTERONE AND IMPULSIVITY
AND PERCEIVED STRESS IN CO-USERS OF MARIJUANA AND
TOBACCO
Dina Belhasan, Ashley Peterson, PhD, Katherine Harrison, MPH, Sharon Allen MD,
PhD. University of Minnesota, Minneapolis, MN, USA.
Signicance: The use of marijuana has increased over the past few decades, a trend
that is likely to continue due to the rise in decriminalization laws. Both marijuana and
tobacco use are associated with potential negative health-related consequences and
users face many challenges in the cessation process. A growing body of research
demonstrates associations between sex hormones and drug abuse behaviors; namely,
that progesterone has been shown to be associated with decreases in these behaviors.
Our lab’s previous research has also demonstrated decreased smoking-related symp-
toms, including impulsivity, during the luteal phase of the menstrual cycle, at which point
progesterone levels are high. This study seeks to build upon this research by assessing
the eect of progesterone administration on impulsivity and perceived stress measures
in marijuana and tobacco co-users.Methods: The data used in this project was obtained
from a parent randomized study examining the eect of exogenous progesterone on
impulsivity and change in marijuana use in a sample of marijuana and nicotine ciga-
rette co-users who are looking to quit. The study enrolled both males and females who
self-reported use of marijuana > 4 days per week. Participants were randomized to
active progesterone or placebo. Progesterone was administered in the form of active
micronized natural progesterone pills (generic Prometrium) or placebo. Participants took
200 mg twice daily (approximately 8am and 8pm) for ve weeks starting seven days
prior to their assigned quit date. Results: Findings indicate that co-users randomized
to exogenous progesterone had, on average, 2.24 points lower scores on Behavioral
Inhibition System (95% condence interval [CI]: 0.34-4.13 points lower; p=0.02) and
3.30 points higher scores on Brief Self-Control Scale (95% CI: 0.17-6.43 points higher;
p=0.04), compared to those randomized to the placebo. Conclusion: These results
indicate that exogenous progesterone administration leads to lower impulsivity and
higher self-control.
FUNDING: Federal; Nonprot grant funding entity
PS2-6
TOBACCO SMOKING IS ASSOCIATED WITH THE RE-ACTIVATION
OF HERPES VIRUSES
Faith Dickerson1, Robert Yolken2. 1Sheppard Pratt, Baltimore, MD, USA, 2Johns
Hopkins School of Medicine, Baltimore, MD, USA.
Signicance Infections with human herpesviruses (HHVs) are associated with a range
of adverse health consequences. Following primary infection, HHVs establish latency
and can reactivate throughout life. The factors which facilitate reactivation are related
to the T-cell arm of the immune system. Cigarette smoking is recognized as one of the
most important environmental factors which can aect T-cell functioning. The eect
of smoking on reactivation of HHVs has not been extensively studied. Methods The
study population consists of 2098 individuals from the Sheppard Pratt cohort enrolled
between 1999 and 2021. A blood sample was obtained along with demographic and
smoking information. The study population had a mean age 36.1 (SD 12.6), was 54%
female and 61.2% White. Diagnoses were schizophrenia 38%, bipolar disorder 28%,
major depressive disorder 6%, and non-psychiatric 28%. A total of 827 (39%) individ-
uals were current tobacco smokers, including 61% of those with schizophrenia. We
employed solid phase immunoassays to measure IgG antibodies to HHVs in the blood
samples including Cytomegalovirus (CMV), Epstein Barr Virus (EBV), Herpes Simplex
Virus Type 1 (HSV-1), and Varicella Zoster Virus (VZV). Associations between antibody
levels and smoking variables were determined by multivariate and ordered regression
models. Results The levels of IgG to CMV and to EBV were signicantly associated with
current smoking (coecient (co) = .185, 95% CI .072 - .297, p <.001; co.126, 95% CI
.039 -.212, p < .005). Levels of IgG antibody to CMV and to EBV were also signicantly
associated with the number of cigarettes smoked per day (co .115, 95% CI .045 -.185,
p < .001; co .289, 95% CI .123 -.455, p < .001 respectively). Antibodies to HSV-1 and
VZV were not associated with smoking variables. The correlation between IgG levels
and smoking variables were shared among the diagnostic groups. Conclusion Smoking
is associated with an increased risk for viral re-activation to CMV and EBV. It is likely
that this association is related to smoking induced alterations in T-cell function. Smoking
cessation programs may improve the immune response and lessen viral reactivation.
FUNDING: Nonprot grant funding entity
PS2-7
USING WITHDRAWAL AND CRAVING IN A RISK ESTIMATION
MODELING SYSTEM TO PREDICT POSTPARTUM CIGARETTE
SMOKING RELAPSE
Uma Nair1, Jerzy Rozenblit2, Minsik Hong2, Alicia Allen2. 1University of South Florida,
Tampa, FL, USA, 2University of Arizona, Tucson, AZ, USA.
Introduction: Approximately 90% of women, who quit smoking during pregnancy, re-
lapse within a year. To date, behavioral interventions addressing postpartum relapse to
smoking (PRS) have yielded limited success. Traditionally used in engineering settings,
dynamical system modelling is a multivariate time-varying process, where changes to
input variables (e.g., withdrawal) lead to changes in mediating variables (relapse risk) that
aect outcomes of interest (relapse). The goal of this study is to illustrate an example of
a risk simulation model based on changes in withdrawal and cravings to identify periods
of high-risk for PRS. Methods: Ecological momentary assessments data from a previous
randomized controlled trial for PRS (N=36 participants) was used. Data included daily
ratings of nicotine withdrawal, cravings, and daily cigarette smoking through 12 weeks
postpartum. Fuzzy inference system (FIS) design approach was used to check the
feasibility of our methodology. Results: Compared to raw data, the estimated risk values
using our simulation approach indicated a clear distinction in the interaction between
cravings and withdrawal between relapsed(n=19) and abstinent(n=17) participants.
Our prediction model using optimized FIS parameters identied a period of high-risk
for relapse with 72% accuracy. Specically, compared to abstinent participants, data
patterns among relapsed participants showed a high-risk period starting, on average, 18
days prior to relapse based on the craving data alone, 13 days prior to relapse based on
withdrawal data, and 20 days prior to when relapse when both craving and withdrawal
data are included. Conclusion: Our study illustrates that a dynamic risk modeling system
can be used to identify periods of high-risk and potentially, prevent PRS. Next steps
include inclusion of additional predictors to rene our model. Overall, this innovative
transdisciplinary approach has potential to inform development, timing, and frequency
of eective personalized behavioral interventions to prevent PRS
FUNDING: Unfunded; Academic Institution
PS2-8
TIME AND A GAIN, A LOSS: CHOICE BUNDLING INCREASES
VALUATION OF DELAYED LOSSES MORE THAN GAINS IN
CIGARETTE SMOKERS
Jerey S. Stein1, Gregory J. Madden2, Jeremiah M. Brown1, Allison N. Tegge1, Warren
K. Bickel1, Roberta Freitas-Lemos1. 1Fralin Biomedical Research Institute at VTC,
Roanoke, VA, USA, 2Utah State University, Logan, UT, USA.
Signicance Choice bundling, in which a single choice produces a series of repeating
consequences over time, has been shown to increase valuation of delayed monetary and
non-monetary gains. Interventions derived from this manipulation may be an eective
method for reducing the bias for immediate gratication observed in cigarette smokers.
No prior work, however, has investigated whether eects of choice bundling generalize
to reward losses. Methods In the present study, an online panel of cigarette smokers
(N=307), recruited using Ipsos, were randomly assigned to complete assessments for
either monetary gains or losses. In Step 1, participants completed a standard delay-dis-
counting task to establish Eective Delay 50 (ED50), or the delay required for a monetary
outcome to lose half of its value. In Step 2, participants completed three conditions of
an adjusting-amount task, choosing between a smaller, sooner (SS) adjusting amount
and a larger, later (LL) xed amount. The bundle size (i.e., number of consequences)
was manipulated across conditions, where a single choice produced either 1 (control),
3, or 9 consequences over time (ascending/descending order counterbalanced). The
delay to the rst LL amount in each condition, as well as the intervals between all SS
and LL amounts (where applicable), were set to individual participants’ ED50 values
from Step 1 to control for dierences in discounting of gains and losses. Results Results
from Step 1 showed signicantly higher ED50 values (i.e., less discounting) for losses
compared to gains (p<.001). Results from Step 2 showed signicant Bundle Size x
Sign (p<.001) and Bundle Size x Order (p<.05) interactions, with larger increases in LL
valuation (i.e., indierence points) observed for losses vs. gains and in the ascending
112
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
vs. descending orders. Despite these interactions, planned comparisons in all sign and
order conditions revealed greater valuation of gains and losses in bundle sizes 3 and
9 compared to 1 (all ps<.05). Conclusions These data suggest that choice bundling
increases valuation of delayed gains and losses, although larger eects are observed
for losses and ascending bundle-size orders. The potential clinical utility of these eects
will be discussed, such as development of motivational interventions that emphasize
both the bundled health gains associated with smoking cessation and the health losses
associated with continued smoking.
FUNDING: Federal; Academic Institution
PS2-9
INITIAL EVALUATION OF ACUTE SUBJECTIVE SENSORY
PERCEPTIONS OF USING IQOS VERSUS SMOKING CIGARETTES
Joshua L. Karelitz, David O. Wilson, Kenneth A. Perkins, Jian-Min Yuan. University
of Pittsburgh, Pittsburgh, PA, USA.
SIGNIFICANCE: The heated tobacco product IQOS delivers nicotine via smokeless
aerosol, reducing toxicant exposure relative to cigarette smoking. IQOS may be an ac-
ceptable tobacco harm reduction alternative if it matches cigarettes on factors known to
reect reinforcement such as sensory perceptions and use behavior. The primary aim of
this pilot study was to evaluate IQOS directly against participants’ own brand cigarettes
(OBC) to gauge relative acceptability—comparing products on acute sensory perceptions
and topography. METHODS: Adult daily smokers with no previous IQOS use (n=28)
completed a single session following ≥2 hours of abstinence. Sessions consisted of two
testing periods varying only in products presented unblinded in xed order: IQOS, OBC.
In each period, participants were instructed to use ad lib each product for up to 6 mins
(the device-mandated limit for IQOS). Immediately afterwards, participants rated pus
from each product on “Liking”, “Satisfaction”, “Nicotine”, “Flavor”, “Strong”, “Harsh”, and
“Smooth” (0-100 visual analog scale). Periods were recorded to measure topography
variables. Expired-air CO was measured pre- and post-use. RESULTS: As expected,
pre- to post-use change in CO was signicant for OBC (t(27)=11.1, p<0.001), but not
IQOS (t(27)=1.0, p=0.33). Pu number and duration of use were similar for IQOS and
OBC, t(25)=0.6, p=0.54 and t(25)=0.7, p=0.50, respectively. Using an equivalence
margin of ±25 (the distance between VAS verbal anchors), the Two One-Sided Test
procedure indicated equivalence between products on sensory ratings Nicotine, Strong,
Harsh, Flavor, and Smooth, but not Liking and Satisfying. CONCLUSIONS: IQOS was
rated lower than OBC on some pleasurable sensory items but was similar on other
perceptions and acute use behaviors. These preliminary pilot results may suggest
reasonable initial acceptability of IQOS relative to combustible smoking. Yet, additional
research directly comparing heated and smoked tobacco products used over a longer
duration of access under naturalistic conditions is needed to more thoroughly evaluate
acceptability of IQOS as a substitute for combustible cigarettes.
FUNDING: Federal
PS2-10
A COMPARISON OF DAILY AND NON-DAILY SMOKERS WITH HIV
Abner Kahan1, David Duitz2, Jack Duitz2, Geetanjali Chander3, Andrea H. Weinberger4,
Ryung Kim5, Cassandra Stanton6, Jonathan Shuter5. 1Macaulay Honors College at
Hunter College, New York, NY, USA, 2Salanter Akiba Riverdale High School, Bronx,
NY, USA, 3Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4Ferkauf
Graduate School of Psychology, Yeshiva University, Bronx, NY, USA, 5Albert Einstein
College of Medicine, Bronx, NY, USA, 6Westat, Rockville, MD, USA.
SIGNIFICANCE: Cigarette smoking is the leading killer of people with HIV (PWH),
who smoke at 3x the rate of the general US population. Non-daily smoking, observed
in about 15% of US cigarette smokers, is increasingly prevalent and associated with
signicant morbidity. However, less is known about non-daily smoking in PWH. We
sought to determine the prevalence of and factors associated with non-daily smoking
among PWH. METHODS: We aggregated results from the baseline interviews of two
smoking cessation trials for PWH, conducted between 2014 and 2020 in the Bronx, NY;
Washington DC, and Baltimore, MD (combined N=872). The primary outcome of both
trials was biochemically-veried, 7-day point-prevalence abstinence at 6 months. RE-
SULTS: The mean age of the sample was 50.4±9.8, 55.5% were Male, 20.4% Latino/a,
83.1% Black, 13.0% White, 60.8% had ≤high school education, 87.5% unemployed or
with disability, and 91.0% had a household income <$30K. Past 30 day (“current”) other
substance use: 37.7% cannabis, 19.3% cocaine, 4.9%/11.9% heroin/methadone. HIV
risk factor: 45.6% hetero-sex, 27.5% same-sex, 12.0% IDU. Baseline CD4=621±373.
Mean anxiety (GAD-7)=6.3±5.8. 13.4% of the sample reported non-daily smoking.
In univariate analysis, the following characteristics were signicantly associated with
non-daily smoking (vs daily smoking): non-White race, current cannabis use, not cur-
rently on methadone maintenance, higher motivation to quit (Readiness to Quit Ladder),
and higher anxiety score. In the multivariate adjusted model, the following associations
remained signicant: non-White race AOR=2.26[1.01-5.05], p=0.05, not currently on
methadone maintenance AOR=2.82[1.00-7.94], p=0.05, higher motivation to quit
AOR=1.28[1.08-1.53], p=0.005, and higher anxiety score AOR=1.04[1.00-1.07], p=0.05.
22.7% of non-daily smokers were abstinent at 6 months vs.12.1% of daily smokers,
OR=2.14[1.30-3.51], p=0.002. CONCLUSIONS: Non-daily smoking is common in PWH
and is associated with non-White race, not using methadone, and higher motivation to
quit and anxiety levels. PWH with non-daily smoking were signicantly more likely to
achieve 6-month abstinence than PWH with daily smoking.
FUNDING: Federal
PS2-11
THE RELATION BETWEEN PRE-QUIT INSOMNIA SEVERITY
AND SMOKING CESSATION OUTCOMES AMONG ADULTS
PARTICIPATING IN TREATMENT: A LONGITUDINAL STUDY
Karen (Chaelin) Ra1, Summer Frank-Pearce2, Sarah Ehlke1, Michael Businelle3, Darla
Kendzor3. 1TSET Health Promotion Research Center, Stephenson Cancer Center,
University of Oklahoma Health Sciences Center, OKC, OK, USA, 2Department of Biosta-
tistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma
Health Sciences Center, OK City, OK, USA, 3Department of Family and Preventive Medi-
cine, University of Oklahoma Health Sciences Center, OK City, OK, USA.
Signicance: There is preliminary evidence that experiencing insomnia is associated
with a lower likelihood of smoking cessation among those making a quit attempt. Yet,
few studies have used longitudinal data to examine the association between insomnia
and smoking cessation. Methods: Data from a community-based tobacco cessation
program for adults (N=649) were used to examine the association between pre-quit
insomnia and smoking cessation at follow-up. On the scheduled quit date, the Insomnia
Severity Index was administered to assess insomnia severity during the previous two
weeks. Biochemically-veried 7-day point prevalence abstinence was measured at
four-time points (i.e., quit date, 4-, 12-, and 26-weeks post-quit-date). Repeated mea-
sures logistic regression analyses were conducted to evaluate the odds of achieving
abstinence at each follow-up given pre-quit insomnia severity (i.e., none/subthreshold
vs. moderate/severe), after adjustment for covariates. The potential interaction between
pre-quit insomnia severity and time was evaluated in the model. Results: On average,
participants were 51.9 (SD=12.1) years old with 12.5 (SD=2.2) years of education.
Participants were predominantly female (58.1%), White (58.4%) or Black (27.3%), and
most had a household income below $21,000 (61.6%). Participants reported smoking
an average of 17.0 (SD=10.3) cigarettes per day for an average of 30.2 (SD=14.1) years
at baseline. Analyses indicated that pre-quit insomnia severity was not signicantly
associated with abstinence on the quit date (OR: 0.79, CI: 0.54-1.15) or at 4-weeks
post-quit follow-up (OR: 0.73, CI: 0.53-1.01). However, those with moderate/severe
insomnia had a signicantly lower likelihood of achieving abstinence at 12- and 26-weeks
post-quit follow-up (OR: 0.64, CI: 0.46-0.88 and OR: 0.50, CI: 0.28-0.88, respectively).
Conclusion: While insomnia severity was not related to abstinence early in treatment, it
was associated with a lower likelihood of abstinence at later follow-ups. Future research
should explore whether insomnia screening and treatment before and during a smoking
cessation attempt might increase the likelihood of smoking cessation.
FUNDING: Federal; State
PS2-12
CARDIOVASCULAR AND RESPIRATORY HEALTH EFFECTS OF
ELECTRONIC CIGARETTES: AN UMBRELLA REVIEW
Nargiz Travis1, Marie Knoll1, Christopher Cadham2, Luz Maria Sanchez-Romero1, David
Levy1. 1Lombardi Comprehensive Cancer Center, Georgetown University, Washing-
ton, DC, USA, 2University of Michigan, School of Public Health, Department of Health
Management and Policy, Ann Arbor, MI, USA.
Topic: Public Health Key Words: E-Cigarettes, Health Consequences Funding: Nation-
al Cancer Institute (NCI) and Food and Drug Administration (FDA) grant U54CA229974.
Background/Objectives: As the global e-cigarette (EC) market expands, it is essential
that the health eects of ECs are systematically understood so evidence-based regu-
latory frameworks can be implemented. Although a substantial literature has examined
dierential product health eects, there is often conicting evidence and claims. With
the increase in systematic reviews of the health eects of ECs in the last few years,
we summarize ndings of reviews on cardiovascular and pulmonary health eects.
Methods: We conducted an umbrella review of systematic reviews and meta-analyses
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
of the cardiovascular and respiratory/pulmonary health eects of ECs published through
May 27th, 2020. Evidence from both preclinical and human studies were considered.
PubMed, Web of Science MEDLINE, Embase, and Cochrane Database of Systematic
Reviews were searched with no restrictions. Results: We summarized evidence from
nine systematic reviews on cardiovascular outcomes and eight reviews on respiratory/
pulmonary outcomes of EC use. Across cellular and animal studies, EC exposure was
found to induce several negative cardiovascular and respiratory/pulmonary reactions
including oxidative stress in cardiovascular cell cultures, endothelial cell dysfunction,
reduced airway function, and impaired lung function. EC use was reported to have
minimal impact on myocardial function compared to cigarette use. Human studies
found short term EC use increased heart rate and systolic and diastolic blood pressure,
though to a lesser extent than cigarettes while there is also evidence that EC use may
increase respiratory resistance similar to cigarette smoking. Generally, reviews conclud-
ed that switching from combustible cigarettes to EC may reduce harmful health eects.
Conclusions: Evidence regarding cardiovascular and respiratory health indicates
that ECs may be a safer alternative to cigarettes but cannot be deemed harmless to
non-smokers. Evidence on the eects of EC use in dual users is also lacking and needs
to be addressed in future research.
FUNDING: Federal
PS2-13
UNDERSTANDING DYADIC PROCESSES OF FAMILY-BASED
SUPPORT FOR SMOKING CESSATION- A CROSS-LAGGED
PANEL ANALYSIS
Jin Kim-Mozeleski1, Susan Stewart2, Ginny Gildengorin3, Nancy Burke4, Joyce Cheng5,
Edgar Yu3, Tung Nguyen3, Janice Tsoh3. 1Case Western Reserve University, Cleveland,
OH, USA, 2University of California Davis, Davis, CA, USA, 3University of California San
Francisco, San Francisco, CA, USA, 4University of California Merced, Merced, CA, USA,
5Chinese Community Health Resource Center, San Francisco, CA, USA.
Signicance: Social support is considered important in enhancing smoking cessation
outcomes, but there is limited understanding of dyadic processes. We examined
dyadic processes for providing and receiving smoking cessation support, in a context
of a family-based cessation intervention designed to enhance support. Methods: We
analyzed data from an educational intervention, targeting Asian American immigrant
dyads of Chinese or Vietnamese American men who smoke daily and their non-smoking
family members. Dyads (N=340; 680 individuals) were randomly assigned to a smoking
cessation curriculum or an active control curriculum (nutrition and physical activity) deliv-
ered over 2 months, with 4 contacts. At baseline and at 3-, 6-, and 12-month follow-ups,
smoking participants reported the frequency of receiving cessation support from their
family (such as encouragement/praise), and family participants reported on parallel
items on the frequency of providing cessation support. Cross-lagged panel analyses
were used to examine support processes over time between the two treatment groups.
Results: Dyadic support processes varied by group assignment and across time. For
dyads (N=177) who received the smoking cessation curriculum, family support continued
past the intervention and into the follow-up periods, such that family participants’ provi-
sion of support predicted the smoking participants’ receipt of support at a subsequent
timepoint. For dyads (N=163) who received the control curriculum, however, family
participants’ provision of support did not predict smoking participants’ receipt of support at
a subsequent timepoint. Furthermore, there was no group dierence in veried smoking
abstinence at the 12-month follow-up. Conclusions: There was a longitudinal eect
of providing and receiving cessation support, suggesting that the intervention resulted
in continued family communications regarding cessation support. The lack of group
dierence in abstinence rates suggests multiple pathways to cessation, beyond family
support as measured here. Further research is needed to examine dyadic processes
that are most relevant for cessation and impacts on longer-term outcomes.
FUNDING: Federal
PS2-14
UTILIZATION OF E-REFERRALS TO THE MARYLAND QUITLINE IN
A LARGE HEALTH SYSTEM DURING THE COVID-19 PANDEMIC -
IMPACTS OF CLINICAL EDUCATION
Michael Dark, Elena Klyushnenkova, Niharika Khanna. University of Maryland School
of Medicine, Baltimore, MD, USA.
Signicance: The tobacco cessation e-referral process addresses a major public
health issue and overcomes challenges for providers to create links between tobacco
users and the Maryland Quitline (Quitline), an evidence-based cessation service. The
correlation between clinical tobacco education and trends in the number of e-referrals
to the Quitline made by the University of Maryland Medical System (UMMS) from
January 2020 to June 2021 are explored during the COVID-19 pandemic. Methods:
A system-wide e-referral pathway to the Quitline has been established at the UMMS
allowing for a closed-loop communication between the electronic health record (EHR)
system and the Quitline. Clinical tobacco education for clinicians on e-referral processes
did not occur throughout most of 2020 but was revived in January 2021. Patient-level
data for the number of e-referrals were extracted from the EHR quarterly and included
demographic and clinical characteristics of the referred patients. Results: Based on
quarterly patient-level Quitline reports, e-referrals to the Quitline saw a downward
trend across the UMMS from 619 e-referrals submitted in the second half of 2019 to
318 and 250 e-referrals in the rst and second half of 2020 respectively. In the rst half
of 2021, e-referrals to the Quitline saw a slight increase with 315 e-referrals submitted.
Four clinical education activities were conducted across the UMMS in 2020 and sixteen
in the rst half of 2021. Conclusion: With no clinical tobacco educator on sta during
the COVID-19 pandemic, tobacco cessation e-referrals decreased throughout 2020.
Clinicians no longer received education about the importance of tobacco cessation
and how to utilize the e-referral to the Quitline. Clinical tobacco education resumed in
October 2020 and slight increases in e-referrals were seen across the UMMS beginning
in January 2021. It will be important to further study how regular clinical education can
improve or maintain tobacco cessation eorts. Additionally, health systems should urge
clinicians to screen all patients for tobacco use at every visit and create system wide
electronic reminders to continue connecting patients to cessation resources regardless
of active educational eorts.
FUNDING: State
PS2-15
ASSOCIATIONS BETWEEN ANXIETY DISORDER SYMPTOMS
AND BARRIERS TO CESSATION AMONG AFRICAN AMERICAN
SMOKERS
Nikki S. Jafarzadeh, Adam M. Leventhal. University of Southern California, Los Ange-
les, CA, USA.
Background: Both African American smokers and smokers with mental health condi-
tions, such as anxiety disorders, have disproportionately low quit rates and experience
tobacco-related health disparities. Whether and how anxiety symptoms are a barrier to
smoking cessation among African American smokers is unknown. This cross-sectional
correlational secondary study examined the association of various types of anxiety disor-
ders symptoms and various barriers to cessation among non-treatment-seeking African
American smokers. Methods: 565 African American smokers in Los Angeles enrolled in
a clinical research study on individual dierences in tobacco addiction between 2013 and
2017. This study uses baseline visit self-reports of past two-week levels of social anxiety,
panic, and trauma-related symptoms and severity of three types of barriers to cessation:
tobacco addiction stressors (addiction barriers), environmental and social stressors
(external barriers), and aect-related stressors (internal barriers). Multiple regression
models were used to test associations between each anxiety disorder symptom scale
with each barrier to cessation, with and without adjusting for demographics, nicotine
dependence, and dysphoria. Results: All anxiety disorder symptoms were signicantly
positively associated with each barrier to cessation without adjustment (Standardized
Regression Coecients [Betas] range from .235 to .375). After covariate adjustment,
panic and trauma-related symptoms were no longer signicantly associated with any
barrier to cessation. Only social anxiety symptoms remained signicantly associated
with addiction barriers (Beta = .145), external barriers (Beta = .197), and internal
barriers (Beta = .110) in covariate-adjusted models. Conclusion: Symptoms of social
anxiety, but not trauma or panic-related symptoms, may play a unique, but modest,
role in the barriers to cessation in non-treatment-seeking African American smokers.
Future research using longitudinal and other methods is needed to determine whether
interventions targeting barriers to smoking cessation may improve quit attempts and
outcomes in socially anxious African American smokers.
FUNDING: Federal; Nonprot grant funding entity
114
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-16
LONG-TERM SMOKING CESSATION EFFICACY OF THE
FRONTLINE MEDICATIONS AND PLACEBO IN THE
MULTINATIONAL, RANDOMIZED, CONTROLLED EAGLES AND
CATS TRIAL
Robert M. Anthenelli1, Neal Benowitz2, A. Eden Evins3, David Lawrence4, Thomas
McRae4, Phillip Saccone4, Robert West5. 1University of California, San Diego, School
of Medicine, La Jolla, CA, USA, 2University of California, San Francisco, San Francisco,
CA, USA, 3Harvard Medical School, Cambridge, MA, USA, 4Pzer, Inc., New York, NY,
USA, 5University College, London, United Kingdom.
Background: The 24-week, Evaluating Adverse Events in a Global Smoking Cessation
Study (EAGLES, NCT# 01456936) and its continuing 28-week non-treatment cardio-
vascular safety extension trial (CATS, NCT# 01574703) provide a unique opportunity
to examine the long-term ecacy of the frontline smoking cessation medications in
the context of a multinational randomized controlled trial. We explored longer-term
smoking abstinence rates in a subcohort of EAGLES and CATS subjects followed up
to 40 weeks after receiving up to 12 weeks of active study medication (varenicline, bu-
propion, nicotine patch) or placebo in the parent trial. Methods: Secondary exploratory
analysis of EAGLES and CATS ecacy results in smokers with (N=2435) and without
(N=2160) psychiatric disorders. Subjects completed a standardized self-report Nicotine
Use Inventory at study visits on weeks 28, 32, 36, 40, 44, 48 and 52. Abstinence was
conrmed when expired breath carbon monoxide levels were less than or equal to 10
parts per million. Generalized linear models that included treatment classes (varenicline,
bupropion, nicotine patch, placebo); cohort (psychiatric versus non-psychiatric); and
region (US versus non-US) were performed. Results: Using a conservative approach
of classifying subjects (N=3549) who did not enter the extension trial as non-respond-
ers, varenicline-treated participants achieved higher continuous abstinence rates for
weeks 9 to 52 than those on placebo (OR, 2.54; 95% CI [1.38 to 2.23]), nicotine patch
(1.45; 1.19 to 1.77), and bupropion (1.41; 1.16 to 1.71). Those on nicotine patch and
bupropion achieved higher longer-term abstinence rates than those on placebo (OR
1.75 [1.38 to 2.23] and 1.80 [1.42 to 2.29]), respectively. Conclusions: Although the
relative rates of long-term abstinence were lower overall than those reported in the
parent EAGLES trial, varenicline was more eective than placebo, nicotine patch, and
bupropion in helping smokers sustain abstinence whereas nicotine patch and bupropion
were more eective than placebo.
FUNDING: Federal; State; Pharmaceutical Industry
PS2-17
DEVELOPMENT AND PILOT TESTING OF A MOTIVATIONAL
INTERVIEWING E-CIGARETTE REDUCTION INTERVENTION FOR
ADULT EXCLUSIVE E-CIGARETTE USERS
Rachel Rosen, Jessica Ortiz, Julia Kwiecinski, Patricia Dooley-Budsock, Anagha Babu,
Marc Steinberg. Rutgers University, NB, NJ, USA.
Signicance: While e-cigarettes may provide a harm reduction benet to combustible
cigarette smokers, many e-cigarette users wish to quit using e-cigarettes. Methods: We
developed and pilot tested a four-session, telehealth-delivered, motivational interviewing
(MI) intervention among exclusive e-cigarette users who were interested in reducing
their e-cigarette use. Participants (N=5) were oered four MI therapy sessions and up
to 10 weeks of transdermal nicotine patches. Participants were recruited and screened
for initial eligibility online. At baseline, participants provided information on demographic
characteristics and about smoking and e-cigarette use history. At each session, and
at the 3-month follow-up assessment additional information about nicotine/tobacco
product use, nicotine patch use, and treatment satisfaction was collected. Results: On
average, participants were 28.6 years old. Eighty percent were male, 60% were Asian,
and most (80%) were non-Hispanic. Forty percent of the participants were students,
40% were working full time, and 20% were unemployed. At baseline, 60% of the sample
reported using fruit avor e-liquid and the remaining participants used mint/menthol.
Participants reported picking up their e-cigarette 59 times per day on average (range
20-100) and taking 4 pus per use on average (range 2-10). On average, participants
reported 14 past serious quit attempts (range= 2-50); however, only 60% of the sample
reported ever quitting for a period of 24 hours or more. Eighty percent of the sample
attended all four treatment sessions and of those who attended all four sessions, 100%
quit e-cigarettes completely by the follow-up assessment. All participants reported that
the treatment was easy to understand and helpful. Conclusion: Findings suggest that
among those initially interested in reducing their use, motivational interviewing and
transdermal nicotine patches may help exclusive e-cigarette users to quit e-cigarettes.
Future studies should examine the ecacy of an MI intervention in a larger sample and
among other groups of e-cigarette users, including young adults, dual users, and those
not currently interested in reducing or quitting.
FUNDING: Federal; Academic Institution
PS2-18
TRANSFORMING TOBACCO CESSATION SERVICES
NECESSITATED BY COVID-19 FOR A VETERAN POPULATION LED
BY A CLINICAL PHARMACY SPECIALIST (CPS)
Dawn Floi Johnson, Lourdes Reyes-Colon, Nathalie Garza. James A. Haley Veterans’
Hospital, Tampa, FL, USA.
Signicance: Our Health care systems have had to face unprecedented challenges with
the COVID-19 epidemic. Including transforming many outpatient services from face-
to-face care to telehealth services. At the James A. Haley Veterans’ Hospital, Tampa,
Florida, traditionally tobacco cessation interventions were conducted in face-to-face
groups or individual formats, and rapidly changing to other methods of delivery was
concerning without impacting access and eectiveness of services. To address these
concerns this performance improvement project (PI) was implemented at one of the
community-based outpatient clinics led by a Clinical Pharmacy Specialist (CPS). Method:
This PI project was conducted at the beginning of the COVID-19 epidemic from 3/4/2020
to 9/30/20. The transformation occurred rapidly (< 5 days). Veterans could self-refer to
the program or providers from Patient Aligned Care Teams or Mental Health could assist
in their enrollment. The CPS provided individual services by clinical video telehealth or
telephone. The CPS assessed the Veteran’s smoking habits, willingness to quit, oered
tobacco counseling, and a plethora of interventions including pharmacotherapy as well
as educational materials. Results: 55 Veterans were seen in this PI project. Cigarettes
were the most frequent product used at 93% and the number of sessions seen M=9.
Pharmacotherapy regimens included all FDA approved medications. After 6 months
of their last known tobacco usage, Veterans’ records were reviewed for tobacco use
disorder status. It was found that 23 Veterans (41.8%) were in remission, 29 (52.7%)
were still using tobacco products, and 3 (5.45%) were still actively working on quitting.
Varenicline was the preferred medication (45.4%) and had the highest rate of success.
Conclusion: Results clearly show that the urgent modication in services demanded
by COVID-19 could still result in high rates of cessation at 6 months. This was the rst
time a CPS led tobacco cessation interventions at JAHVH. The ndings of this project
are congruent with previous literature regarding the eectiveness of CPS in providing
tobacco cessation services and supports their continued use.
FUNDING: Unfunded
PS2-19
THRESHOLD FOR SUBJECTIVE AND PHYSIOLOGICAL EFFECTS
OF NICOTINE - AN IV SELF-ADMINISTRATION STUDY IN HUMANS
R. Ross MacLean1, Ralitza Gueorguieva2, Suprit Parida2, Mehmet Sofuoglu3. 1VA
Connecticut Healthcare System, West Haven, CT, USA, 2Yale University, New Haven,
CT, USA, 3Yale University, West Haven, CT, USA.
Signicance: Reducing the nicotine content of inhaled tobacco products below the
reinforcement threshold may help reduce their addictive potential. In a recent human
laboratory study, we found that 0.1 mg nicotine was the threshold dose for subjective
drug eects and physiological responses while the 0.2 mg nicotine was the threshold
dose for nicotine self-administration (NSA). The threshold for the subjective drug eects
and physiological outcomes was determined by directed nicotine and saline doses ad-
ministered during a sampling period. This study aimed to determine if the initial response
to the positive subjective and physiological eects of nicotine, assessed in the sampling
period, was similar to those observed during the choice period. Additionally, we sought
to examine if urges to smoke and withdrawal severity, assessed at the beginning of
sessions, impacted NSA and subjective positive responses to nicotine. Methods: Young
adults (n=35; 68% male), who smoked an average of 4.5 (SD=1.3) cigarettes per day,
had 5 laboratory sessions after overnight abstinence veried by breath CO. Participants
rst sampled and rated the subjective eects of an IV dose of nicotine (0.0125, 0.025,
0.05, 0.1, or 0.2 mg/70kg) versus saline (placebo). After the sampling period, participants
completed an NSA forced-choice procedure during which they were given a total of
10 opportunities to self-administer IV dose of either nicotine or placebo. During each
administration, heart rate was recorded and participants completed self-report items rep-
resenting pleasurable, stimulatory, and aversive eects. Results: The nicotine threshold
for subjective stimulatory and pleasurable eects were 0.05 and 0.1 mg, respectively.
This was supported by a main eect of choice (nicotine vs. placebo; ps < .0001) and a
trend nicotine dose-by-choice interaction (ps < .06) in both pleasurable and stimulatory
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
eects. Nicotine threshold for increased heart rate was at 0.2 mg, supported by main
eect of choice (p < .01) and nicotine dose-by-choice interaction (p < .05). In addition,
greater urges at baseline was associated with greater number of nicotine choices at
0.2 mg nicotine condition (p < .05). No signicant relationships were found for aversive
eects or baseline withdrawal. Conclusion: Taken together, results of from the NSA
procedure complement prior ndings indicating that the threshold for positive eects
of nicotine is between 0.05 and 0.1 mg. Threshold for heart rate response was 0.2 vs.
0.1 mg of nicotine with directed dosing, suggesting tolerance development. Baseline
craving and withdrawal do not appear to greatly inuence nicotine reinforcement, but
higher baseline craving may result in greater use of nicotine at 0.2 mg. These ndings
further support the threshold dose for the positive subjective and physiological eects
of nicotine under repeated nicotine deliveries.
FUNDING: Federal; Academic Institution
PS2-20
CHANGES IN MOTIVATION AND BEHAVIORAL EXPECTANCY: A
PROSPECTIVE STUDY OF THE ASSOCIATIONS WITH SMOKING
ABSTINENCE AMONG WOMEN
Lisa R. LaRowe, Shira I. Dunsiger, David M. Williams. Brown University, Providence,
RI, USA.
Elucidating the role of acute changes in psychological determinants of smoking cessation
may inform the ongoing development/renement of smoking cessation interventions
for women. Although motivation and behavioral expectancy are established predictors
of behavior change, we are unaware of previous work testing the main and interactive
eects of dynamic changes in motivation and behavioral expectancy for smoking
cessation on smoking behavior among women. Moreover, there is reason to believe
that exercise may lead to acute increases in motivation and behavioral expectancy for
smoking cessation, and that this, in turn, may improve quit outcomes. The primary goal
of these secondary analyses was to test whether change in motivation, change in behav-
ioral expectancy, and their interaction predicted smoking abstinence (conceptual theory
test). We also tested whether exercise exerted acute eects on motivation/behavioral
expectancy (action theory test), and, consequently, improved odds of abstinence (medi-
ation). Participants included 105 women (Mage = 42.5) who participated in a RCT testing
the ecacy of aerobic exercise (vs. contact control) as an adjunct smoking cessation
treatment and completed a 12-week EMA protocol. We used a multi-level, longitudinal
mixed eects model to test all pathways simultaneously. Results indicated signicant
between-group dierences in change in motivation pre-to-post session (p = .04), but
not behavioral expectancy (p > .05). Greater increases in motivation and behavioral
expectancy were each associated with higher odds of abstinence at next session (ps
< .05), and there was a signicant interaction such that, for those with larger changes
in behavioral expectancy, larger changes in motivation were associated with greater
odds of quitting (p = .02). Finally, there was an indirect eect of exercise (vs. control)
on abstinence via changes in motivation (p < .05). This study provides initial evidence
that a single bout of exercise can increase motivation for quitting smoking, which may
improve odds of abstinence. Moreover, increasing behavioral expectancy may enhance
the eect of increased motivation on cessation.
FUNDING: Federal
PS2-21
INTEREST AMONG PREGNANT CURRENT AND FORMER
SMOKERS IN BUPROPION FOR POSTPARTUM RELAPSE
PREVENTION
Melissa Adkins-Hempel1, Sandra J. Japuntich2, Janet Thomas3, Katherine Harrison3,
Rebecca L. Emery4, Jonathan P. Winicko5, Sharon Allen3. 1Hennepin Healthcare
Research Institute, Minneapolis, MN, USA, 2Hennepin Healthcare, Minneapolis, MN,
USA, 3University of Minnesota Medical School, Minneapolis, MN, USA, 4University
of Minnesota Medical School, Duluth campus, Duluth, MN, USA, 5Harvard Medical
School, Boston, MA, USA.
Signicance: Though many women quit smoking during their pregnancy, relapse one
year postpartum is approximately 90%. The Bupropion for Postpartum Smoking Relapse
study is an ongoing randomized clinical trial. Given diculty recruiting pregnant smokers
for this trial, we interviewed pregnant smokers about their interest in participating in this
clinical trial to identify barriers. Methods: Pregnant current or recent former smokers
(n=16; 69% white) in Minnesota were interviewed. Data collection is ongoing. Interview
topics included overall knowledge of pregnancy and quitting, postpartum cessation,
participation in research, and feelings on taking medication postpartum and/or while
breastfeeding. Results: Women are aware of the risks of continuing to smoke in their
pregnancy. Regardless of quit status, many have a goal of complete abstinence during
pregnancy. They receive most of their cessation information from their providers. Most
women do not use empirically supported treatments to quit. Most women are planning
to stay quit postpartum but are aware it is challenging. Research participation is viewed
positively, but interest in the Bupropion trial is low. Women who do not want to participate
in the current study fall into three categories: those who do not want to take medications
in general, those who have concerns regarding taking a medication while breastfeeding,
and abstinent women who believe they will stay quit postpartum without intervention.
Though women identied things that would make participating in research easier, such
as remote visits, childcare, surveys rather than scheduled visits, and high payment in-
centives, most still maintained that the concerns listed above would prevent them from
participating. Conclusions: Pregnant women are aware of the challenges of staying quit
postpartum but do not believe they will relapse. Additionally, they are reluctant to take
medications regardless of breastfeeding status. Future studies should educate women
on postpartum relapse rates and assist in planning for challenges. Providers play a
critical role in understanding of risk and could address concerns regarding medication.
FUNDING: Federal
PS2-22
RECRUITMENT OF CERVICAL CANCER SURVIVORS TO A
SMOKING CESSATION TRIAL: A COMPARISON OF IN-CLINIC VS.
ONLINE APPROACHES
Cody Staples1, Sarah R. Jones2, Damon J. Vidrine2, David W. Wetter3, Ya-Chen Tina
Shih4, Steven K. Sutton2, Lois M. Ramondetta4, Linda S. Elting4, Joan L. Walker5,
Katie M. Smith6, Summer G. Frank-Pearce7, Yisheng Li4, Jennifer I. Vidrine2, Vani N.
Simmons2. 1University of South Florida, Tampa, FL, USA, 2Mott Cancer Center, Tampa,
FL, USA, 3Huntsman Cancer Institute and University of Utah, Salt Lake City, UT, USA,
4The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 5Stephen-
son Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City,
OK, USA, 6University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,
7Stephenson Cancer Center and University of Oklahoma Health Sciences Center, Okla-
homa City, OK, USA.
Smoking is a major risk factor for cervical cancer, and cervical cancer survivors have
among the highest rates of continued smoking post-diagnosis. Recruitment of cancer
patients to smoking cessation trials is challenging, and virtually all trials have recruited
from clinical settings. We describe a two-pronged recruitment strategy utilized in a re-
cently completed RCT testing the ecacy of a Motivation And Problem Solving (MAPS)
approach for facilitating smoking cessation among cervical cancer survivors. Participants
(n=202) were recruited: 1) locally from a gynecologic oncology clinic in Oklahoma City,
and 2) nationally online via Facebook. This study compared several characteristics of
participants recruited via these two dierent approaches. Independent samples t-tests
and Chi-squared tests compared participants in 4 key areas: 1) socio-demographics
(age, race/ethnicity, education, employment status, income, partner status, health lit-
eracy), 2) nicotine dependence, smoking history and number of previous quit attempts,
3) psychosocial characteristics (depression, negative/positive aect, perceived stress,
loneliness, fear of cancer recurrence, nancial strain, sense of control, subjective social
status) and 4) disease status (cancer stage, treatment status, years since diagnosis).
Less than half of participants (43.1%) were recruited in-clinic, with the remainder (56.9%)
recruited online. Results indicated that those recruited online versus in clinic were more
educated (73.1% vs. 50.6% > HS/GED, p<.01), were more likely to have cervical cancer
in situ (61% vs. 17%) in contrast to cervical cancer (p<.01), had a longer history of cancer
(17.3 vs. 6.4 years; p<.01), and had higher perceived subjective social status (5.67 vs.
5.02, p<.05). No other signicant dierences emerged. In summary, participants recruit-
ed via both approaches were similar on the vast majority of characteristics examined.
However, the few characteristics on which those recruited online versus in clinic should
be attended to in future trials. These ndings strongly suggest that online recruitment
may be suitable for reaching and engaging cancer survivors in tobacco cessation trials.
FUNDING: Federal; Other
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-23
PROXIMAL EFFECTS OF A MINDFULNESS-BASED ECOLOGICAL
MOMENTARY INTERVENTION FOR SMOKING CESSATION WITH
WEARABLE SENSORS: A MICRO-RANDOMIZED TRIAL
Min-Jeong Yang1, Steven Sutton1, David Wetter2, Santosh Kumar3, Christine Vinci1.
1Mott Cancer Center, Tampa, FL, USA, 2University of Utah, Salt Lake City, UT, USA,
3University of Memphis, Memphis, TN, USA.
Background: Determining how and when to best deliver smoking cessation interventions
at key moments during the quit smoking process is critical to enhancing treatments.
Mindfulness-based interventions may disrupt the associative learning process between
aversive aective state and craving. The current study examined the proximal eects of
a mindfulness-based ecological momentary intervention for smoking cessation delivered
via a smartphone in real time, using a micro-randomized trial design. Method: Daily
smokers motivated to quit participated in a 6-week cessation study. Over the rst 2
weeks, some key moments (negative aect and smoking behavior detected passively
via sensors) were randomized to receive either brief mindfulness strategies/motivational
messages, or no intervention up to 12 times/day. Ecological momentary assessments
(EMAs) of aect, craving, and abstinence self-ecacy were completed following the
delivery of strategies. Participants received four in-person brief cessation counseling
during these 2 weeks. Nicotine replacement therapy was provided for 6 weeks. Results:
Participants included in analyses were those who wore the sensors for at least 8 of the
14 days and completed 60% of the pushed strategies (N=13; 61.5% Female; 23.1%
Hispanic/Latinx, 69.2% White, Age M=48.5, Cigarettes/day M=15.7). Proximal eects of
pushing a strategy were analyzed using generalized estimating equations in the following
time windows: pre-quit, post-quit, and the nal week post-quit. The results indicated that
for the last week post-quit, negative aect was lower (β=-.140, p=.018) after a strategy
was pushed vs not. There were no signicant dierences for positive aect, craving,
or self-ecacy, nor were any of the outcomes signicant over other subsets of days.
Conclusion: The current study is one of the rst to show that mindfulness/motivational
strategies have a proximal impact on negative aect during a quit attempt, particularly
at the later part of the intervention. When considering that negative aect is one of the
primary relapse risk factors, these strategies delivered at specic moments during a quit
attempt may be particularly benecial. Future research should assess the dierential
eect of mindfulness strategies versus motivational messages and the ecacy of this
intervention on tobacco abstinence in a large-scale RCT.
FUNDING: Federal
PS2-24
EFFECTS OF CIGARETTE SMOKING STATUS ON ENDOGENOUS
PAIN MODULATION
Michael B. Paladino1, Jessica M. Powers1, Kyle M. White1, Emma C. Lape1, Julia
E. Hooker1, Stephen A. Maisto1, Michael J. Zvolenksy2, Joseph W. Ditre1. 1Syracuse
University, Syracuse, NY, USA, 2University of Houston, Houston, TX, USA.
Signicance: Cigarette smoking has been identied as a risk factor in the onset and
worsening of chronic pain. Dysregulated endogenous pain processing has been
implicated in the development of chronic pain. Although smokers have demonstrated
greater sensitivity to experimental pain induction, research has not examined the ef-
fect of smoking status on indices of endogenous pain modulation (EPM; ability of the
central nervous system to inhibit or facilitate pain). The goal of the current study was
to test smoking status as a predictor of EPM. Given that sex plays an important role
in EPM, and there are known sex dierences in smoking prevalence rates as well as
pain-smoking relationships, we also examined these eects among men and women,
separately. Method: Participants were 217 moderate-to-heavy alcohol users with no
current pain (42% female; 35% Black/African American; n = 100 current smokers) who
were enrolled in a primary laboratory study of pain-alcohol eects. EPM was assessed
using a MEDOC Q-Sense device, and primary outcomes included conditioned pain
modulation (CPM), oset analgesia (OA), and temporal summation (TS). The overall
eect of smoking status on EPM was tested using MANCOVA. Results: MANCOVA
revealed a main eect of smoking status on EPM (p < .05). Univariate follow-up tests
indicated this eect was driven by higher CPM scores observed among smokers (vs.
non-smokers; p < .05). Follow-up analysis further revealed that smokers who identied
as female (vs. female non-smokers) demonstrated higher CPM and TS scores (ps <
.05). Conclusion: The ndings suggest that smoking status is related to maladaptive
pain modulatory function. Dysregulation of EPM may be one mechanism by which
smoking contributes to the development and progression of chronically painful condi-
tions. In the current sample, smokers (vs. non-smokers) evinced higher CPM scores,
indicating a reduced capacity to inhibit pain. Among women, smoking was associated
with higher TS scores, indicating enhancement of pain facilitatory processes. Future
longitudinal research is needed to clarify the potential mediating role of EPM in the
eects of smoking on pain.
FUNDING: Federal
PS2-25
THE ASSOCIATION BETWEEN IN UTERO EXPOSURE TO
CIGARETTE SMOKE AND CANNABIS AND SEVERITY OF
NEONATAL ABSTINENCE SYNDROME
Alicia Allen1, Lisa Grisham2, Jocelyn Maurer2. 1University of Arizona, Tucson, AZ, USA,
2Banner University Medical Center - Tucson, Tucson, AZ, USA.
Introduction: Neonatal abstinence syndrome (NAS), which is caused by in utero expo-
sure to opioids and other substances, is exacerbated by in utero exposure to nicotine.
Currently, less is known about the role of cannabis on NAS severity. Therefore, we
sought to explore the eect of in utero exposure to cigarette smoking and/or cannabis
on NAS severity. Methods: We abstracted medical record data from substance exposed
newborns born between January 2015 to December 2020. We excluded those who
did not have data on cigarette smoking status (based on self-report) and/or cannabis
use (based on toxicology screens for tetrahydrocannabinol [THC] at birth). Patients
were classied into four groups: no in utero exposure, in utero exposure to cigarettes
only (Cig+), in utero exposure to cannabis only (THC+), and in utero exposure to both
(Cig+THC). Outcomes were maximum Finnegan Neonatal Abstinence Score (FNAS)
on day 3 and cumulative dose of morphine during hospital stay. Group dierences in
outcomes were analyzed using Poisson regression models adjusting for type of NAS
treatment. Results: Patients (n=428) included 136 infants in the no exposure group,
155 in the Cig+ group, 68 in THC+ group, and 69 in Cig+THC group. Signicant group
dierence were observed in both outcomes. Specically, infants in the Cig+ group had
the highest (more severe) FNAS score (8.4±3.3), followed by the no exposure group
(7.6±3.4), the Cig+THC group (7.3±3.4), and THC+ group (6.9±2.6; p=0.03). Cumulative
morphine dose was the greatest among the Cig+ group (8.0±20.3 mg) followed by the
no exposure group (6.4±15.8 mg), the Cig+THC group (4.5±17.3 mg), and the THC+
group (2.3±5.9; p<0.001). Conclusions: The association between cigarette smoking
and severity of NAS-related outcomes appears to vary by in utero cannabis exposure.
Additional research is needed in a larger study sample with stronger methodology to
capture in utero exposure to cigarettes and cannabis. Understanding the simultaneous
eect of in utero exposure to multiple substances on clinical outcomes in infants will
inform the development of new treatment guidelines.
FUNDING: Unfunded
PS2-26
MOTIVATING A SPECTRUM OF CANCER PATIENTS TO QUIT
SMOKING: INTERVENTION DEVELOPMENT
Ursula Martinez1, Vani Simmons1, Thomas Brandon1, Colleen M. McBride2, Graham
Warren3, Alissa Pena1. 1Mott Cancer Center, Tampa, FL, USA, 2Emory University,
Atlanta, GA, USA, 3Medical University of SC, Charleston, SC, USA.
Smoking after a cancer diagnosis is associated with poor treatment outcomes and
reduced survival across cancer types. Our previous research has shown lower smoking
cessation motivation and cessation rates among patients with a strong link to smoking
(i.e., thoracic and head and neck) compared to those with cancers that are somewhat
smoking-related (e.g., colorectal) or not smoking related (e.g., melanoma). Eorts are
needed to increase motivation among smokers diagnosed with cancers less obviously
linked to smoking. Using a systematic, iterative process, we developed a brief and easily
disseminated intervention, targeted by cancer type, to increase cessation motivation
in patients with cancers not obviously linked to smoking (e.g., bladder). We followed
a three-phase process: (1) in-depth interviews with patients (N=18) to assess their
knowledge on the association between smoking and their cancer, to identify ways to
increase cessation motivation, and to elicit preferences for intervention modalities; (2)
based on Phase 1 and existing literature, we developed intervention content guided
by the teachable moment model; (3) the initial draft of the intervention was presented
to the target population (N=22), and learner verication interviews were conducted. All
participants had a recent diagnosis of melanoma, breast, gynecological, bladder, or
colorectal cancer and smoked in the past 30 days. Examples of emerging themes from
Phase 1 interviews included: lack of knowledge about the connection of smoking and
their cancer; negative aect, habit, dependence, and weight gain as quitting barriers;
and a preference for non-judgmental content. Reactions to the intervention during the
learner verication were overall favorable. Some suggested edits included: highlighting
savings in the cost of cancer treatments; explaining how nicotine replacement therapy
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
does not maintain nicotine addiction; suggestions for photo content; and adding more
diversity in the examples and photos. The new intervention is currently being pilot tested
for acceptability and feasibility in preparation for a larger RCT.
FUNDING: Federal
PS2-27
DEEPTOBACCOWORKS AN APPLICATION OF NATURAL
LANGUAGE PROCESSING (NLP) TO ASSESS DISPARITIES IN
TOBACCO RESEARCH
Meng Ling, Shaoying Ma, Shuning Jiang, Jian Chen, Ce Shang. The Ohio State Univer-
sity, Columbus, OH, USA.
Signicance: As the tobacco research literature continues to grow, and novel prod-
ucts such as electronic cigarettes quickly gain popularity, there is an urgent need for
synthesizing published evidence to inform tobacco control policies in a timely manner.
Deep Learning and Natural Language Processing (NLP) have been increasingly used
in biomedical research, but have not been applied to facilitate almost real-time evidence
synthesizing in the framework of translational research such as tobacco control research.
This study uses tools and algorithms in Deep Learning and NLP to identify race/ethnic-
ity and gender disparities in tobacco research, and make timely recommendations to
promote health equity. Methods: We build the DeepTobaccoWorks tool to automatically
extract data from peer-reviewed tobacco research journals. We apply NLP methods to
identify, extract, and summarize data on study populations, end outcomes, and policy
(intervention) impacts from texts as well as non-textual tables and gures in published
tobacco control research papers. Results: This study contributes to the identication
of disparities in tobacco research, with respect to race/ethnicity and gender. We apply
Deep Learning and NLP techniques to identify study populations in tobacco research
literature and assess whether the published studies include vulnerable populations
such as racial minorities and women and whether they address tobacco use disparities.
The tools and algorithms that we identify are broadly reusable and highly scalable for
public health research. Conclusion: We identify race/ethnicity and gender disparities
in tobacco research, and present the application of NLP analysis using the DeepTo-
baccoWorks tool we built.
FUNDING: Academic Institution
PS2-28
A LATENT VARIABLE APPROACH TO SEXUAL ORIENTATION
DISCORDANCE AND ITS ASSOCIATION TO DISCRIMINATION AND
TOBACCO USE DISORDER SEVERITY
Carol J. Boyd, Sean Esteban McCabe, Rebecca J. Evans-Polce, Luisa Kcomt, Philip
Veliz. Center for the Study of Drugs, Alcohol, Smoking & Health, University of Michigan
School of Nursing, Ann Arbor, MI, USA.
Signicance: Studies nd that individuals who self-identify as sexual minorities are at
higher risk for tobacco use. Drawing on van Anders’s Theory of Sexual Conguration,
we examined whether Sexual Orientation Discordance (SOD) and Sexual Orientation
Discrimination (SODIS) were associated with the severity of tobacco use disorder
(TUD). Methods: The 2012-2013 National Epidemiologic Survey on Alcohol and
Related Conditions-III (NESARC-III) data were analyzed using a sample of adults who
sexually identied as gay/lesbian, bisexual or heterosexual with same-sex attraction
and/or same-sex sexual behavior (n=3,494). Two latent constructs were developed:
(1) SOD as determined with three manifest variables reecting misalignment among
identity, attraction (to opposite-sex or same-sex), and behavior (with opposite-sex or
same-sex partner); and (2) SODIS as determined by responses on the Experiences with
Discrimination scale. The outcome was TUD severity as determined by 11 symptoms
consistent with the Diagnostic and Statistical Manual of Mental Disorders-5. Structural
equation modeling assessed SOD and SODIS on the observed severity of TUD. Results:
Gay/lesbian and bisexual SOD was associated with less SODIS (β = -.342, p<.001; β
= -.102, p<.05, respectively). Gay/lesbian SOD was associated with greater severity of
TUD (β = .139, p<.001); this was not true for bisexuals (β = .053, p=.247). The eect of
gay/lesbian SOD on severity of TUD was partially mediated by SODIS (indirect eect,
β = -.030, p<.01; total eect [SOD], β = .109, p<.01). Discordant heterosexuals were
both less likely to report SODIS (β = -.119, p<.001) and they had lower TUD severity (β
= -.087, p<.05) when compared to self-identied sexual minorities. Conclusion: A social
environment that reduces discrimination may decrease risk of TUD severity because
SOD was associated with greater TUD severity for some sexual minorities. However,
for others, SOD was associated with less discrimination and lower TUD severity. This
study contributes to the theoretical literature on sexual identity and SOD, and to the
growing research corpus demonstrating risk dierences among sexual minority sub-
groups. Funding: This work was supported by grants from the National Institute on
Drug Abuse (R01DA044157, R01DA043696, R21DA051388) and the National Cancer
Institute at the National Institutes of Health (R01CA212517). The National Institutes of
Health and Food and Drug Administration Center for Tobacco Products (U54CA229974).
FUNDING: Federal
PS2-29
CIGARETTE PACK PRICE AND ITS WITHIN-PERSON
ASSOCIATION WITH SMOKING INITIATION, SMOKING
PROGRESSION, AND DISPARITIES AMONG YOUNG ADULTS
Michael Parks1, Megan Patrick2, David Levy3, James Thrasher4, Michael Elliott2, Nancy
Fleischer2. 1University of Minnesota Medical School, Minneapolis, MN, USA, 2University
of Michigan, Ann Arbor, MI, USA, 3Georgetown University Medical Center, Silver Spring,
MD, USA, 4University of South Carolina, Columbia, SC, USA.
Background: There is a dearth of research on within-person relationships between
tobacco price and cigarette smoking initiation and progression in young adulthood.
This project examines the within-person association between cigarette pack price and
smoking initiation and progression between age 18 and 21/22, focusing on dierences
across subgroups. Methods: Data came from the longitudinal Monitoring the Future
(MTF) project. MTF examines drug use behaviors with nationally representative
samples of 12th graders annually. Subsamples of 12th graders are annually selected
and followed longitudinally. Among 12th graders from baseline years 2000-2014, we
examined past 30-day cigarette smoking initiation among baseline never smokers
(N=15,280) and progression to daily smoking among youth who were not daily smokers
at baseline (N=26,998). We used hierarchical logistic regression and interaction terms
to assess dierences across sex, race/ethnicity, and parental education. Results: The
within-person relationship between pack price and smoking indicated that a one-dollar
increase in pack price corresponded with an 72% decrease in the odds of initiation
(AOR=0.28, 95% CI=0.18, 0.44) and 70% decrease in the odds of progression to daily
smoking (AOR=0.30, 95% CI=0.21, 0.44). There were no statistically signicant inter-
actions between price and demographics, making it dicult to disentangle dierences
across subgroups. Conclusions: There is a strong, within-person relationship between
cigarette prices and smoking initiation and progression among young adults: higher
prices are associated with decreased odds of both initiation and progression. Cigarette
taxation can prevent smoking initiation and progression, but it is less clear how prices
impact disparities in smoking experienced by vulnerable young adults. We could not
draw denitive conclusions about the impact of cigarette prices on tobacco-related dis-
parities. Tobacco taxes should be increased on a regular basis to ensure young adults
experience within-person increases in prices, and complementary programs geared
toward reducing tobacco-related disparities among young adults should be promoted.
FUNDING: Federal
PS2-30
SEXUAL AND GENDER MINORITY TOBACCO CESSATION AND
EMPOWERMENT THEORY
Evan Mooney1, Jaimee Hener2, Andy SL TanPhD MPH MBA MBBS3, Julia McQuoid1.
1University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, 2Fred
Hutchinson Cancer Research Center, Seattle, WA, USA, 3University of Pennsylvania,
Philadelphia, PA, USA.
SIGNIFICANCE: Sexual and Gender Minority (SGM) individuals are nearly twice as likely
to use tobacco as their non-SGM peers. SGM people report lower cessation intervention
satisfaction, participation barriers, and prefer SGM-tailored interventions. Empowerment
Theory (ET) focuses on how people gain control over their lives, democratic participation
in community, and a critical understanding of their environment (e.g., targeted tobacco
marketing). We evaluated ET’s inuence on SGM tobacco cessation intervention design
via a scoping review of its use as a theoretical intervention foundation. METHODS: We
conducted a literature review (2009-2021; Scopus, Ovid, PubMed) to identify: 1) The-
oretical frameworks, intervention components, and outcomes of existing SGM-tailored
tobacco cessation interventions, excluding articles that omitted intervention components
or outcomes; 2) Health behavior change interventions of any kind, for any population,
that incorporated ET, excluding articles that did not name an underpinning theoretical
framework. RESULTS: We found 162 publications on SGM tobacco interventions and
included 23. Most intervention delivery modes were counseling (e.g. 7 group, 3 indi-
vidual) and informational campaigns (e.g. social media, social gatherings; 7 total). The
Transtheoretical Model was the most cited (6) theory; 6 cited no theory. None on SGM
tobacco cessation cited ET. We found 4 on other types of ET-informed health behavior
change interventions. One targeted low-income, minority youth tobacco prevention. The
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
rest targeted risky sexual behavior for young Black MSM, depression for Asian American
women with interpersonal violence history, and adult diabetes-related behaviors. Their
ET-informed components promoted health education, identity pride, sense of autonomy
and control, and community engagement. CONCLUSION: Empowerment theory would
be a new approach to tailoring SGM tobacco cessation interventions. A focus on em-
powerment among marginalized groups, like SGM, may facilitate tobacco cessation by
building self-ecacy and social support for behavior change. For example, participation
in SGM advocacy work could be paired with cessation best practices.
FUNDING: Federal; State; Academic Institution
PS2-31
REASONS FOR INITIATING AND REGULAR USE OF HEATED
TOBACCO PRODUCTS IN REPUBLIC OF KOREA: FINDINGS
FROM THE 2020 ITC KOREA SURVEY
Hong Gwan Seo1, Shaowei Xu2, Grace Li2, Shannon Gravely3, Anne Quah2, Sungkyu
Lee4, Sujin Lim5, Sung-il Cho6, Yeol Kim1, Eon Sook Lee7, Georey Fong2. 1National
Cancer Center, Seoul, Korea, Republic of, 2University of Waterloo, Waterloo, ON,
Canada, 3University of Waterloo, Waterlook, ON, Canada, 4Korea Center for Tobacco
Control Research and Education, Seoul, Korea, Republic of, 5Korea Health Promotion
Institute, Seoul, Korea, Republic of, 6Seoul National University, Seoul, Korea, Republic
of, 7Inje University, Goyang, Korea, Republic of.
Signicance: Heated tobacco products (HTPs) were introduced in the Republic of Korea
in May 2017. Since then, HTP sales have increased rapidly, accounting for >10% of the
total tobacco market in 2020. Although Korea is the world’s second largest HTP market,
little is known about the reasons why current and former Korean smokers started and
regularly use HTPs. Methods: We analyzed data from the 2020 ITC Korea Survey,
adults aged 19+, consisting of 1815 current ≥weekly HTP users, of whom 1767 were
also smoking cigarettes ≥weekly; 48 HTP users were former smokers. Multivariable
regression analyses were conducted on weighted data to examine the reasons for
initiating and regularly using HTPs. HTP users who also smoked were asked if they
used HTPs to stop smoking cigarettes, reduce cigarette smoking, or not having to give
up smoking cigarettes. Results: The most common reasons for initiating HTPs were
curiosity (58.9%), family/friend using HTPs (45.5%), and attractive technology (35.9%)
and devices (33.6%). The most common reasons for regularly using HTPs were less
smelly than cigarettes (71.3%), less harmful than cigarettes (48.6%), stress reduction
(47.4%), enjoyment (44.4%), more socially acceptable than cigarettes (41.8%), less
harmful than cigarettes to others (41.7%). Among smokers, 38.2% used HTPs to reduce
smoking, 35.3% to help quit smoking, 25.3 % to help not having to give up smoking.
Former smokers were more likely than current smokers to use HTPs because of less
smelly (p<0.01), but they were less likely to initiate HTP use because of the attractiveness
of the device (p<0.01) or packaging (p<0.05). Conclusion: Findings from this study were
similar to the common reasons reported in the ITC Japan Survey except for less smelly
than cigarette and stress reduction. Although 1/3 of smokers used HTPs to help them
quit smoking, 1/4 of smokers used HTPs to not having to give up smoking. Consistent
with how Japanese smokers were concurrently using HTPs, if substantial number of
Korean smokers are using HTPs to complement rather than to quit smoking, then the
harm reduction potential of HTPs is diminished.
FUNDING: Federal; Academic Institution
PS2-32
BASELINE CHARACTERISTICS OF CITIES IN CALIFORNIA WITH
FLAVORED TOBACCO SALES RESTRICTIONS
Melanie S. Dove1, Julia Chen-Sankey2, Shichen Zheng1, Elisa Tong3. 1University of
California, Davis, Davis, CA, USA, 2Center for Tobacco Studies, Rutgers Biomedical
and Health Sciences, New Brunswick, NJ, USA, 3University of California, Davis, Sacra-
mento, CA, USA.
Signicance- Over 80% of youth tobacco users currently use avored tobacco. Fla-
vored tobacco sales restrictions (FTSRs) are implemented to reduce youth’s access to
avored tobacco products. In 2020, California passed a state FTSR, but it’s on hold until
the 2022 general election for a referendum vote. This study will compare the baseline
characteristics of cities in California with and without a FTSR. Methods - Cities in
California (n=482) were classied as having a FTSR passed before March 2021 using
data from the Truth Initiative, Campaign for Tobacco-free Kids, and Public Health Law
Center. Because most FTSRs were implemented during or after 2019, we included data
on city (or county) level covariates prior to 2019, including demographics and tobacco
metrics. The Wilcoxon-Mann-Whitney test (continuous variables) and chi-square test
(categorical variables) were used to examine dierences in characteristics between cities
with and without a FTSR. To examine which predictors were associated with FTSRs,
we calculated adjusted odds ratios using logistic regression models. Results - Ninety
California cities had a FTSR, covering 18.7% of the population. Most (62) of these
FTSRs prohibited all avors from all tobacco products, but 23 allowed menthol and 5
allowed avored products to be sold at some locations. Compared with cities without
a FTSR, cities with a policy had a higher median income, high-school e-cigarette use
prevalence, percent that voted democratic in 2016, percent Asian, and median American
Lung Association Overall Tobacco Control grade. These cities also had a lower percent
rural, percent Hispanic, percent of stores selling avored tobacco products, and adult
smoking prevalence. Adjusted for covariates, the strongest predictor of having a FTSR
was the American Lung Association Overall Tobacco Control grade (OR=1.40, 95% CI:
1.19, 1.64). Conclusion - More than 80% of the California population was not covered by
a FTSR. These policies were less likely to cover low income and Hispanic populations,
and more likely to be implemented in cities with strong tobacco control policies. A state
level policy would cover all cities in California.
FUNDING: Federal
PS2-33
PUBLIC OPINION TOWARD POLICY RESTRICTIONS TO LIMIT
TOBACCO PRODUCT PLACEMENT AND ADVERTISING AT POINT-
OF-SALE AND ON SOCIAL MEDIA
Kelly Blake1, Anna Gaysynsky2, Rachel Mayne1, Andrew Seidenberg1, Annette
Kaufman1, Heather D’Angelo1, Maria Roditis1, Bob Vollinger1. 1National Cancer Insti-
tute, Bethesda, MD, USA, 2ICF Next, Rockville, MD, USA.
BACKGROUND: The Family Smoking Prevention and Tobacco Control Act granted the
Food and Drug Administration authority to regulate tobacco advertising and promotion,
including at the retail level, and preserved state, tribal, and local tobacco advertising
and promotion authorities. Public health experts have proposed prohibiting point-of-
sale tobacco advertisements and product displays, among other tobacco advertising
restrictions. METHODS: We examined the prevalence and correlates of public support,
opposition, and neutrality toward proposed tobacco product placement and advertising
restrictions at point-of-sale and on social media utilizing the National Cancer Institute’s
2020 Health Information National Trends Survey (HINTS) (N=3865), a cross-sectional,
probability-based postal survey of U.S. addresses conducted from Feb 24, 2020 to June
15, 2020 (Bethesda, MD). Frequencies and unadjusted, weighted proportions were
calculated for support, neutrality, and opposition toward the three policies under study,
and weighted, adjusted multivariable logistic regression was employed to examine pre-
dictors of neutrality and opposition. Tests of signicance were conducted at the p<0.05
level. RESULTS: Sixty-two percent of U.S. adults supported a policy prohibiting tobacco
product advertising on social media; 55% supported a policy restricting the location
of tobacco product advertising at point-of-sale; and nearly 50% supported a policy to
keep tobacco products out of view at the checkout counter. Neutrality and opposition
varied by sociodemographic characteristics including age, sex, education, rurality, and
presence of children in the household. CONCLUSION: Understanding public opinion
toward tobacco product placement and advertising restrictions may inform policy plan-
ning and implementation.
FUNDING: Federal
PS2-34
PUBLIC SUPPORT FOR CIGARETTE PACK PICTORIAL HEALTH
WARNINGS IN THE UNITED STATES
Kelly Blake1, Heather D’Angelo1, Anna Gaysynsky2, Andrew Seidenberg1, Robert
Vollinger1, Annette Kaufman1. 1National Cancer Institute, Bethesda, MD, USA, 2ICF
Next, Rockville, MD, USA.
Objectives: To examine population-level characteristics of support, neutrality, and
opposition to cigarette pack warnings that use text and images to portray the negative
health eects of smoking. Methods: We used nationally representative data from the
National Cancer Institute’s 2020 Health Information National Trends Survey (n=3865).
Frequencies and weighted proportions were calculated for neutrality or opposition to
and support for pictorial warnings across sociodemographics and other predictors.
Weighted, multivariable logistic regression examined predictors of being neutral or
opposed versus supporting pictorial warnings. Results: In 2020, an estimated 68.3%
of US adults supported pictorial warnings, 8.9% opposed, and 20.4% neither supported
nor opposed. Current smokers had almost twice the odds of being neutral or opposed to
pictorial warnings as never smokers. Older adults and those living with children under
18 in their household were less likely to be neutral or opposed than other groups. Con-
clusions: In advance of the Food and Drug Administration’s implementation of pictorial
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
warnings on cigarette packages, over two-thirds of American adults support this policy.
Dissemination of information about the eectiveness of pictorial warnings may further
strengthen public support.
FUNDING: Federal
PS2-35
TRENDS IN FLAVORED ELECTRONIC CIGARETTE USE AMONG
NEW YORK STATE YOUTH, 2020
Liane Schneller1, Karin Kasza1, David Hammond2, Richard O’Connor1, Andrew Hyland1.
1Roswell Park Comprehensive Cancer Center, Bualo, NY, USA, 2University of Water-
loo, Waterloo, ON, Canada.
Signicance: Reducing youth e-cigarette (e-cig) use is a public health priority in New
York State (NYS). In May 2020, a statewide restriction on avored e-cigs, except tobacco
avor, was passed in NYS, and during this time, the US was experiencing the COVID-19
pandemic. The purpose of this study is to examine changes in nicotine product use
behavior and perceptions among youth before and after the statewide vaping avor
restriction policy. Methods: NYS data were analyzed cross-sectionally from Waves 3.5
(Feb 2020; N=955) and 4 (Aug 2020; N=946) of the US ITC Youth Tobacco and Vaping
Survey. Online surveys were conducted among youth 16-19 years who were recruited
from US Nielsen consumer panels. Descriptive statistics were used to describe changes
in nicotine product use behavior and perceptions and the eects of COVID-19. Results:
In Aug 2020, after the vaping avor restriction policy,15% of NYS youth reported using
e-cigs in the past 30-days compared with 20% in Feb 2020 (p=0.0198), shortly before
the restriction. Most past 30-day youth vapers in NYS reported using any non-tobacco
avored e-cig, with fruit being the most popular at both waves. Further, past 30-day
use of any non-tobacco avored e-cigs (vs. exclusive tobacco avor) was trending
downward over 6-months (99-97%), while past 30-day use of tobacco avor, either
alone or in combination with other avors, was trending upwards (10-15%). About half
of the youth surveyed in Aug 2020 reported that COVID-19 did not impact their vaping
behavior (48%) or access to e-cigs (52%); however, 36% reported that they were
vaping less, intended to quit or quit vaping, and 41% found it dicult to access their
e-cig products. Conclusions: Over a 6-month period in 2020, it appears that the youth
vaping prevalence was signicantly lower, but the vast majority of them continue to
vape avors that were restricted due to the policy. Therefore, it is important to continue
monitoring user behavior and perception changes and compliance with the restriction.
FUNDING: Federal
PS2-36
DEVELOPMENT AND APPLICATION OF A FLAVORED TOBACCO
POLICY COMPREHENSIVENESS CLASSIFICATION SCHEME
Emily Donovan1, Shanell Folger1, Maham Akbar2, Barbara Schillo1. 1Schroeder Institute
at Truth Initiative, Washington, DC, USA, 2Truth Initiative, WA, DC, USA.
Signicance: Research demonstrates that the comprehensiveness of tobacco control
policies can predict policy impact. State and local governments have increasingly enacted
avored tobacco policies (FTPs) to restrict the sale of products popular among youth;
however, little is known about the comprehensiveness of FTPs. This study describes
the development of an approach to characterize the comprehensiveness of US FTPs.
Design: We coded US state and local FTPs enacted June 2007-March 2021 for retailer,
product, and avor inclusions. Guided by FTP literature, legal resources, and consultation
with experts, we developed a six-category classication scheme - level 6 being the most
comprehensive and level 1 being the least - to characterize their comprehensiveness. We
analyzed FTP comprehensiveness using descriptive statistics and population coverage
estimates. Results: As of March 31, 2021, seven states and 327 locales enacted FTPs.
State FTPs apply to 14.4% of the US population; 11.4% of the population is covered by
level 2 (n=5, 71.4%) and 1.0% by level 1 FTPs (n=1, 14.3%), and no state FTPs are fully
comprehensive (level 6: n=0, 0%). Most state FTPs fall in level 2 because most exempt
menthol and/or apply to only one product. Local FTPs cover 9.4% of the population and
are more comprehensive than state FTPs; 2.1% of the US is covered by level 6 (n=85,
26.0%), 3.6% by level 2 (n=37, 11.3%), and 1.4% by level 1 FTPs (n=160, 48.9%).
Local FTPs are increasingly comprehensive over time, as recent policies are more
likely to apply to adult-only retailers, multiple products, and menthol products. Overall,
state and local FTP comprehensiveness is most limited by exemptions for menthol
avor (state: n=4, 57.1%; local: n=165, 50.5%), menthol cigarettes (state: n=8, 85.7%;
local: n=133, 40.7%), and adult-only retailers (state: n=1, 14.3%; local: n=133, 40.7%).
Conclusion: Little of the US population is covered by the most comprehensive FTPs;
however, increased FTP adoption and comprehensiveness over time is encouraging.
Current and future FTPs may be strengthened by including all tobacco products and
menthol products, and by avoiding exemptions for certain retailers.
FUNDING: Other
PS2-37
DEVELOPMENT AND APPLICATION OF A FLAVORED TOBACCO
POLICY COMPREHENSIVENESS CLASSIFICATION SCHEME
Emily Donovan. Schroeder Institute at Truth Initiative, Washington, DC, USA.
Signicance: Research demonstrates that the comprehensiveness of tobacco control
policies can predict policy impact. State and local governments have increasingly enacted
avored tobacco policies (FTPs) to restrict the sale of products popular among youth;
however, little is known about the comprehensiveness of FTPs. This study describes
the development of an approach to characterize the comprehensiveness of US FTPs.
Design: We coded US state and local FTPs enacted June 2007-March 2021 for retailer,
product, and avor inclusions. Guided by FTP literature, legal resources, and consultation
with experts, we developed a six-category classication scheme - level 6 being the most
comprehensive and level 1 being the least - to characterize their comprehensiveness. We
analyzed FTP comprehensiveness using descriptive statistics and population coverage
estimates. Results: As of March 31, 2021, seven states and 327 locales enacted FTPs.
State FTPs apply to 14.4% of the US population; 11.4% of the population is covered by
level 2 (n=5, 71.4%) and 1.0% by level 1 FTPs (n=1, 14.3%), and no state FTPs are fully
comprehensive (level 6: n=0, 0%). Most state FTPs fall in level 2 because most exempt
menthol and/or apply to only one product. Local FTPs cover 9.4% of the population and
are more comprehensive than state FTPs; 2.1% of the US is covered by level 6 (n=85,
26.0%), 3.6% by level 2 (n=37, 11.3%), and 1.4% by level 1 FTPs (n=160, 48.9%).
Local FTPs are increasingly comprehensive over time, as recent policies are more
likely to apply to adult-only retailers, multiple products, and menthol products. Overall,
state and local FTP comprehensiveness is most limited by exemptions for menthol
avor (state: n=4, 57.1%; local: n=165, 50.5%), menthol cigarettes (state: n=8, 85.7%;
local: n=133, 40.7%), and adult-only retailers (state: n=1, 14.3%; local: n=133, 40.7%).
Conclusion: Little of the US population is covered by the most comprehensive FTPs;
however, increased FTP adoption and comprehensiveness over time is encouraging.
Current and future FTPs may be strengthened by including all tobacco products and
menthol products, and by avoiding exemptions for certain retailers.
FUNDING: Other
PS2-38
IMPACT OF EXPOSURE TO TOBACCO RETAIL OUTLET ENDS
MARKETING ON ENDS INITIATION: DO DEPRESSIVE SYMPTOMS
EXACERBATE RISK?
Keryn E. Pasch, Jacob Thomas, C. Nathan E. Marti, Alexandra Loukas. The University
of Texas at Austin, Austin, TX, USA.
Signicance: ENDS (electronic nicotine delivery systems) marketing at tobacco retail
outlets (TRO) is linked with increased risk for ENDS use. Depressive symptoms are
also associated with ENDS use. Those with greater depressive symptoms who are
exposed to ENDS TRO marketing may be particularly at risk for ENDS use. Therefore,
this study examined if the relationship between ENDS TRO marketing exposure and
current ENDS use initiation is exacerbated/moderated by depressive symptoms among
college students. Methods: Participants were 1637 students (68.3% female; 31.7%
white; m age=20.2 [SD=2.10] at wave 1) from 24 2- and 4-year colleges in Texas par-
ticipating in an nine-wave longitudinal study (2014-2019) who had not initiated ENDS
use through wave 2 and had completed surveys from waves 1, 2, and 9. Current (past
30-day) ENDS use initiation after wave 2 was measured by classifying those who re-
ported never current ENDS use at wave 9 as non-initiators; all others were considered
initiators (11.5% of sample). ENDS TRO marketing exposure at wave 2 was measured
with an index of objective counts of ENDS marketing at TROs within a mile of each
college multiplied by each student’s weekly store visit frequency and dichotomized using
a median split. Generalized mixed-eects logistic regression analyses, with colleges as
the cluster variable, controlling for baseline sex, age, race/ethnicity, any other tobacco
product use at wave 1 and college type (four vs two-year), were used to examine the
association between ENDS marketing and subsequent current ENDS use initiation
with depressive symptoms as a moderator. Results: The interaction between ENDS
POS marketing and depressive symptoms was not signicant (p=0.45). Main eects
showed that ENDS POS marketing did predict current ENDS use initiation (OR=3.49,
95% CI=[2.49, 4.90]) while depressive symptoms was not signicant (OR=1.02, 95%
CI=[0.99, 1.06]). Conclusions: Exposure to ENDS TRO marketing puts young adults
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
at risk for ENDS initiation. However, depressive symptoms do not appear to exacerbate
ENDS marketing exposure nor do they directly impact current ENDS initiation, after
accounting for other important covariates.
FUNDING: Federal
PS2-39
RESPONSE TO RESTRICTIONS ON ELECTRONIC NICOTINE
DELIVERY SYSTEMS: A SYSTEMATIC REVIEW
Christopher Cadham1, Alex Liber2, David Levy2. 1University of Michigan, School of
Public Health, Ann Arbor, MI, USA, 2Georgetown University Medical Center, Wash-
ington, DC, USA.
Background: In 2018, the U.S. Food and Drug Administration (FDA) published an
advanced notice of proposed rule-making for restrictions on avors in electronic nicotine
delivery systems (ENDS) along with a ban of menthol in cigarettes and all avors in
cigars. There remains a limited understanding of the eects of such policies. To inform
FDA’s regulatory process, we synthesized the current literature on avor bans that
include, but are not limited to avored ENDS.Methods: We searched the international
literature using PubMed and Scopus (to July 24, 2021). We retrieved articles relevant
to the impacts of an implemented or hypothetical ENDS avor ban. We also included
studies of avor bans that included but were not limited to avored ENDS, as well as
those that solicited public support for avored ENDS bans. Results: The search identied
20 relevant studies. Ten considered the eects of implemented avor bans, while the
remainder considered hypothetical avored ENDS. Eight studies considered support
for regulation, three reported behavioural outcomes, while 10 evaluated compliance,
with one study considering both behaviour and compliance. ENDS avor bans were
frequently found to be among the least supported tobacco control policy proposed
regardless of tobacco use status. However, support appears to be increasing in recent
years. An implemented avor ban in Finland was found to reduce ENDS use among
both men and women. Two surveys on the eects of hypothetical bans suggest that
restricting avors would make ENDS use less enjoyable, however, neither asked about
cessation. Four compliance studies found persistent and increasing ENDS use in coun-
tries that restricted the sale of nicotine-containing ENDS. The remaining six studies on
compliance looked at the availability of ENDS in retail and online environments nding
mixed results depending on the jurisdiction.Conclusion: Our ndings suggest that
support for a avor ban for ENDS has been increasing, but that strong enforcement
measures to ensure compliance both at brick-and-mortar and internet retailers will be
necessary. Much more research on the behavioural eects of restrictions is needed.
FUNDING: Federal
PS2-40
E-CIGS EXHIBIT LOWER TOXICITY COMPARED TO CIGARETTES:
THE REPLICA STUDY GROUP EXPERIENCE
Massimo Caruso1, Rosalia Emma1, Alo Distefano1, Sonja Rust2, Konstantinos Poulas3,
Fahad Zadjali4, Silvia Boo5, Vladislav Volarevic6, Konstantinos Mesiakaris7, Moham-
med Al Tobi4, Antonio Giordano5, Aleksandar Arsenijevic8, Pietro Zuccarello9, Margherita
Ferrante9, Riccardo Polosa10, Giovanni Li Volti1. 1University of Catania - Department
of Biomedical and Biotechnological Sciences, Catania, Italy, 2Center of Excellence for
the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy,
3Laboratory of Molecular Biology and Immunology, Department of Pharmacy, Univer-
sity of Patras, Patras, Greece, 4College of Medicine and Health Sciences, Department
of Clinical Biochemistry, Sultan Qaboos University, Khodh, Oman, 5Sbarro Institute for
Cancer Research and Molecular Medicine, Department of Biology, College of Science
and Technology, Temple University, Philadelphia, PA, USA, 6Center for Molecular Medi-
cine and Stem Cell Research, Department of Microbiology and Immunology, Faculty of
Medical Sciences University of Kragujevac, Kragujevac, Serbia, 7Institute for Research
and Innovation, IRIS, Patras Science Park, Patras, Greece, 8Center for Molecular Medi-
cine and Stem Cell Research, Department of Microbiology and Immunology, Faculty of
Medical Sciences, University of Kragujevac, Kragujevac, Serbia, 9University of Catania,
Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingras-
sia”, Catania, Italy, 10University of Catania - Department of Clinical and Experimental
Medicine, Catania, Italy.
Background: Electronic nicotine delivery systems (ENDS) can reduce the health risks
associated with chronic smoke exposure, and their potential benets are the subject of
intense scientic debate. Creating an international research group, the Replica Study
Group, we independently replicated three relevant studies from the tobacco industry
on the cytotoxic and inammatory eects of cigarette smoke and ENDS aerosol, with
a multicentric study. Our primary goal was to establish the reliability of the results and
the robustness of the conclusions.Methods: In order to assess cytotoxicity of smoke
and aerosol, we exposed human bronchial epithelial cell (H292) to cigarette smoke and
to ENDS aerosol at air-liquid interface (ALI). Moreover, we aimed to assess dierent
inammatory and remodeling mediators release (IL-6, IL-8 and MMP-1) from cells
exposed to whole smoke (WS) and to smoke deprived of total particulate matter (va-
por phase; VP).Results: We were able to replicate the results obtained in the original
studies on cytotoxicity conrming that almost 80% of the cytotoxic eect of smoke is
due to the vapor phase of smoke. Moreover, our results substantiated the signicantly
reduced cytotoxic eects of ENDS aerosol in respect to cigarette smoke. However, our
data were notably dierent in terms of inammatory and remodeling activity triggered
by smoke, evidencing a triggered eect with a few pus, rather than with an increasing
number of pus, as reported by the original work.Conclusion: Taken all together, the
data obtained independently in dierent laboratories clearly conrm the reduced toxicity
of ENDS products (both e-cigs and THPs) compared to smoke, thus providing a valuable
tool to the harm reduction strategies in smokers. Otherwise, we were not able to replicate
and conrm the results on inammatory and remodeling mediators released from H292
cells exposed to smoke (WS and VP). This could be due to the lack of normalization
of the quantity of cytokines released, with the number of viable cells, in the original
paper, since the production of cytokines itself requires the metabolic capability of cells.
FUNDING: Other
PS2-41
EFFECT OF UNANI FORMULATION HABB-E-JAWAHAR ON
SERUM CORTICOSTERONE LEVELS IN NICOTINE DEPENDENT
RATS
Raka Jain1, Rahul Raghav1, Mohd. Waseem1, Sonali Jhanjee1, Azhar Jabeen2. 1All India
Institute of Medical Sciences, New Delhi, India, 2Jamia Hamdard, Hamdard University,
Hamdard Nagar, New Delhi, India.
Background: Habb-e-Jawahar (HJ), a classical Unani pharmacopeial drug is recom-
mended as a nervine and cardiac tonic drug. The present study evaluated the eect
of Unani compound drug Habb-e-Jawahar on plasma corticosterone levels in nicotine
dependent rats.Methods: Male adult Wistar albino rats (175-250gms) were made
physically dependent by subcutaneous infusion of nicotine (9.0mg/kg/day) via a 7 day
osmotic pump, whereas control rats received saline via osmotic pumps. Test doses of
Unani Formulation Habb-e-Jawahar (15.9, 22.5, 38.4 mg/kg) were given orally daily
for 7 days. On 7th day of infusion of pumps, nicotine withdrawal, were precipitated with
subcutaneous injection of nicotine antagonist mecamylamine (1 mg/kg), 2 hours after
the test dose. Somatic signs of withdrawal were scored for 15 mins by using the global
Gellert-Holtzman (GH) rating scale. Drug Bupropion was used as positive control.
Thereafter, blood was withdrawn from heart and serum corticosterone were assessed
by ELISA. Results: One way ANOVA revealed increase in serum corticosterone levels
during withdrawal in mecamylamine precipitated nicotine dependent rats. The post hoc
test conrmed the signicant increase in serum corticosterone levels in mecamylamine
precipitated nicotine treated rats compared with saline and Bupropion treated rats. The
rats treated with three dierent oral doses of HJ (15.9, 22.5 and 38.4 mg/kg) signicantly
suppressed the elevated corticosterone levels in mecamylamine challenged nicotine
treated rats [F (8,45)= 24.112, p < 0.001] Conclusion: These results provide evidence for
a role of corticosterone underlying nicotine dependence, suggesting Unani formulation
Habb-e-Jawahar might be an potential therapeutic agent to alleviate the symptoms
nicotine abstinence and can be used as a complementary therapy for smoking cessation
(Supported by, Ministry of AYUSH, Govt. of India, New Delhi)
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
PS2-42
HOW TO SUB-OHM? ELECTRONIC CIGARETTE MANUFACTURER
RECOMMENDATIONS FOR POWER SETTING OFTEN EXCEED
THE THRESHOLD FOR FILM BOILING AND HIGH TOXICANT
EMISSIONS
Soha Talih, Rola Salman, Rachel El Hage, Nareg Karaoghlanian, Ahmad El Hellani,
Najat Saliba, Alan Shihadeh. American University of Beirut, Beirut, Lebanon.
Sub-ohm vaping refers to the practice of using electronic nicotine delivery systems
(ENDS) whose heating coil resistance is less than 1 Ohm. These large, relatively
high-power devices were used originally by ENDS acionados with knowledge of coil
building. Today, sub-ohm devices are widely available over the counter and models
dier by geometry, materials of construction, and user input options (e.g., power setting),
all of which inuence toxicant emissions. Manufacturers generally provide users with
recommended power and/or temperature ranges, but it is unclear how these ranges
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
are obtained and how they relate to toxicant emissions. In this study, we examined the
implications to carbonyl compound emissions of following manufacturer power recom-
mendations. Carbonyl compounds (CCs) are potent pulmonary toxicants. We identied,
acquired, and reverse engineered 10 popular sub-Ohm devices. These devices were
selected based on online ranking lists. We machine-generated aerosols at the minimum,
medium, and maximum power levels recommended by the manufacturer, in addition to
a 50W power condition across devices for comparison. The machine was programmed
to execute a series of pung cycles consisting of 4sec pu duration, 8L/min ow rate,
and 10sec interpu interval. All devices were lled with a 30/70 PG/VG and 3mg/mL
freebase nicotine liquid. We found that across devices, the maximum manufacturer
recommended power was strongly correlated to the heating coil surface area, with a
mean of 600kW/m2 (power per unit area). This value is well above the 400kW/m2 lm
boiling threshold for high CC emissions that we identied previously. ECIG manufacturers
of sub-Ohm devices routinely recommend power settings that likely expose users to
highly elevated concentrations of pulmonary toxicants.
FUNDING: Federal
PS2-43
LEVELS OF SUGARS IN TOBACCO OF POPULAR U.S.
CIGARETTES: VARIATIONS ACROSS BRANDS AND OVER TIME
Katrina Yershova, MS1, Aleksandra Alcheva, MD, MPH1, Dana Caroll, PhD, MPH1,
Dorothy Hatsukami, PhD2, Irina Stepanov, PhD2. 1University of Minnesota, Masonic
Cancer Center, Minneapolis, MN, USA, 2University of MN, Minneapolis, MN, USA.
Background: Sugars in tobacco ller may contribute to the harmful properties of ciga-
rettes by enhancing smoke toxicity, palatability and appeal. In this study, we analyzed
sugar content in the tobacco ller of top 50 cigarette brands/sub-types that were regularly
used by smokers in the Wave 1 of the Population Assessment of Tobacco and Health
(PATH) Study. These data will be used in our future analyses of the relationship be-
tween sugar content in tobacco ller and biomarkers of exposure and eect in smokers.
Methods: The cigarettes were purchased at two time-points: at the time of Wave 1 of
PATH Study (batch 1) and in the summer of 2021 (batch 2). Fructose, glucose, and
sucrose content in tobacco ller of these cigarettes was analyzed by liquid chromatog-
raphy-tandem mass spectrometry using BEH Amide column. Results: Sucrose levels
varied across the brands/sub-types, ranging 0.7-33 mg/g tobacco in batch 1 and 1-45
mg/g tobacco in batch 2. There was a reduction in the levels of fructose and glucose in
batch 2 across all brands: the sum of the two sugars averaged 43(±12) and 32(±9) mg/g
tobacco in batch 1 and 2, respectively. Sucrose levels changed in an inconsistent manner
between the batches, but negatively correlated with the levels of fructose and glucose
in both. Overall, there were distinct patterns in the relative levels of individual sugars
across tested brands. The sum of fructose glucose in both batches was the highest,
and sucrose was the lowest in American Spirit cigarettes. Conclusions: Sugar levels
vary substantially across U.S. cigarette brands. The temporal variations in glucose and
fructose are likely to reect dierences in tobacco harvesting period, while the highly
variable levels of sucrose are representative of sugars added to tobacco blend during
cigarette manufacturing. If sugar levels in tobacco ller are found to aect the toxicity
and abuse liability of cigarettes, the public health impact of regulating this group of
constituents should be explored.
FUNDING: Federal
PS2-44
THE REINFORCING EFFICACY OF NICOTINE IN ADOLESCENT
SPONTANEOUSLY HYPERTENSIVE RATS, AN ANIMAL MODEL OF
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
John Smethells, Mark LeSage. Hennepin Healthcare Research Institute/Univ. of Minn.
- Dept of Medicine, Minneapolis, MN, USA.
ADHD is an independent risk factor for tobacco abuse. Individuals with ADHD start
smoking at an earlier age, are more likely to progress to daily smoking, smoke more
cigarettes per day, and become more nicotine dependent than individuals without
ADHD. In addition, adult smokers with ADHD work harder for cigarette pus under a
progressive-ratio (PR) schedule than those without ADHD, suggesting that a higher
reinforcing ecacy of cigarette smoke might mediate the relationship between ADHD
and tobacco abuse. However, it is unclear whether the reinforcing ecacy of nicotine
per se is greater among individuals with ADHD. The purpose of the present study was
to examine this issue using an animal model of ADHD, the spontaneously hypertensive
rat (SHR) strain. Adolescent SHR and Wistar (control) rats were trained to respond on a
lever under an FR 1 (week 1) and FR 2 (week 2) schedule to self-administer a 30, 4 or
0 (saline) µg/kg dose of nicotine. Demand elasticity was also evaluated at the 30 µg/kg
dose through an FR escalation procedure (e.g., FR 3, 6, 9, etc.). At the 30 µg/kg dose,
Wistar rats had, on average, higher response rates, a better active to inactive lever
discrimination, and a greater proportion of rats acquiring self-administration compared
to SHR rats. However, no strain dierence in demand elasticity (i.e., reinforcing ecacy)
was observed at that dose. In addition, no strain dierence in acquisition measures were
observed at the 4 µg/kg dose. These ndings suggest that the risk of tobacco abuse
in adolescents with ADHD may not be attributable to a greater reinforcing ecacy of
nicotine, and that other aspects of tobacco smoking (e.g., non-nicotine constituents,
sensory factors) may play a more important role in this subgroup. These ndings also
imply that a nicotine standard to reduce initiation of tobacco use among adolescents in
the general population may also be eective among those with ADHD.
FUNDING: Federal
PS2-45
RELATIONSHIP BETWEEN ORAL MICROBIOME AND TOBACCO-
ASSOSIATED ORAL CELL DNA DAMAGE IN SMOKERS WITH
KNOWN DIFFERENCES IN HEALTH RISK
Aleksandra Alcheva1, Logain Elnimeiry Elnimeiry2, Christopher Ruszczak3, Joni
Jensen4, Dorothy Hatsukami5, Andres Gomez6, Irina Stepanov7. 1Masonic Cancer
Center, University of MN, Minneapolis, MN, USA, 2College of Biological Science, Univer-
sity of Minnesota, Minneapolis, MN, USA, 3Masonic Cancer Center, University of Minne-
sota, Minneapolis, MN, USA, 4University of MN, Minneapolis, MN, USA, 5Department
of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of MN,
Minneapolis, MN, USA, 6Department of Food Science and Nutrition and Microbial and
Plant Genomics Institute, University of Minnesota, Minneapolis, MN, USA, 7Division of
Environmental Health Sciences and Masonic Cancer Center, University of Minnesota,
Minneapolis, MN, USA.
Signicance: Smoking alters the composition and function of the oral microbiome, which
in turn might have an impact on immuno-inammatory responses, metabolism of tobacco
smoke carcinogens and overall health status. In our previous study, HPB-releasing DNA
adducts (DNA damage derived from tobacco-specic nitrosamines) and mitochondrial
DNA content (mtDNA, oxidative stress-derived DNA damage) were higher in oral cells
of African American (AA, n=74) than White (WH, n=72) smokers. In this study, we inves-
tigated the potential association of the oral microbiome with the previously measured
macromolecular alterations.Methods: 16S rRNA gene sequencing (V4 region) was per-
formed on the remaining oral cell DNA, short amplicon data were processed using QIIME
to characterize taxonomic and compositional diversity, and metagenomic (functional)
content was predicted using PICRUSt. Results: Alpha-diversity metrics assessed by
observed richness, Chao1 and Shannon indexes, were signicantly higher in AA when
compared to WH smokers (Wilcoxon rank-sum tests, q-value= 0.004, q-value= 0.004,
q-value=0.03 respectively). Dierences remained signicant after controlling for age,
sex, smoking intensity (CPD and TNE) and alcohol use. Beta diversity analyses showed
higher diversity in AA when compared to WH based on Unifrac distances (unweighted,
r2=0.01, p-value=0.005, and weighted, r2=0.02 p-value=0.007) but not for Bray-Curtis
distances. Functional analysis from predicted metagenome revealed that bacterial taxa
enriched in AA had a predicted capacity for antibiotic biosynthesis and metabolism of
toluene and cyclohexane (chemicals present in tobacco smoke). There was no asso-
ciation between alpha diversity and mtDNA content. However, Shannon diversity was
negatively associated with levels of HPB-releasing DNA adducts, (p=0.01, adjusted for
race, age, sex, smoking intensity, and alcohol use).Conclusion: Together, these ndings
suggest that the complex interaction between the oral microbiome and exposures from
cigarette smoke could potentially contribute to ethnic dierences in cancer risk due to
smoking. Microbially mediated mechanisms of cellular and macromolecular responses
to harmful chemical exposures from tobacco should be further investigated.
FUNDING: Federal; Academic Institution
PS2-46
INCREASING THE ACCESSIBILITY OF EVIDENCE-BASED
TREATMENT BY TRANSITIONING THE TOBACCO TREATMENT
SPECIALIST TRAINING TO REMOTE DELIVERY
Maher Karam-Hage1, Alex Hurst1, Sherman Chow2, Hien Nguyen2, Shelley Karn2,
Tiany Winter1, Jennifer Cofer1, Paul Cinciripini1. 1The University of TX MD Anderson
Cancer Center, Houston, TX, USA, 2The University of Texas at Austin, Austin, TX, USA.
Signicance Tobacco Treatment Specialists (TTS’s) are highly skilled professionals
who provide evidence-based treatment in multiple modalities with dierent populations.
As an accredited program by the Council for Tobacco Treatment Training Programs,
MD Anderson’s training program ensures that its training exceeds established training
122
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
standards. Due to the COVID-19 pandemic, in June 2020 the course was transitioned
to be provided remotely. As a result, the program experienced an increase in providers
attending the course. Preliminary results indicate that key outcome improvements were
similar among providers who attended remote trainings compared to in-person trainings.
Methods Trainees completed three surveys, which included items on demographics,
work setting and years in profession; pre- and post-training tobacco treatment knowledge;
and satisfaction measures. Analyses included descriptive statistics and chi-square tests
of signicance to assess statistically signicant dierences in pre-test and TTS exam
scores. Results For in-person and remote trainings, there were statistically signicant
improvements between pre-test and TTS exam scores respectively on 90% and 100%
of items evaluated. Most trainees worked in hospitals or medical centers (52.6%).
Two-thirds (69.4%) of trainees had less than 1 year of tobacco treatment experience.
Pre-pandemic trainings from June 2018 to October 2019, 20.5% participants joined from
outside of Texas. During the virtual trainings from August 2020 to July 2021, 42.8%
participants joined from outside of Texas. This indicates a two-fold increase in providers
located outside of Texas. Trainees highly endorsed remote training as an alternative
to in person training and overall evaluation of the trainings remain high. Conclusion
There were more statistically signicant improvements in TTS exam knowledge upon
transitioning the training from in-person to remote delivery. The transition attracted more
health care providers from across the country. Most trainees had little experience treating
tobacco use prior to the training. We assume many were seeking to develop new tobacco
treatment services for their respective organizations and communities. By increasing
access and reducing the geographical barrier, we expect to improve the quality of to-
bacco treatment by having more trained and highly skilled tobacco treatment providers.
FUNDING: Academic Institution; Other
PS2-47
EVALUATION OF NICOTINE DEPENDENCE AMONG SMOKERS
USING ELECTRONIC CIGARETTES TO REDUCE CIGARETTE
SMOKING
Jessica Yingst1, Xi Wang1, Alexa Anderson2, Alison Breland3, Eric Soule3, Andrew
Barnes4, Joanna Cohen5, Jonathan Foulds1. 1Penn State College of Medicine, Hershey,
PA, USA, 2University of Wisconsin Milwaukee, Milwaukee, WI, USA, 3VA Common-
wealth University, Richmond, VA, USA, 4Virginia Commonwealth University, Richmond,
VA, USA, 5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Background: How nicotine dependence will be aected when current smokers initiate
electronic cigarette (e-cig) use to reduce cigarette smoking is unknown. This study
evaluated self-reported cigarette, e-cig, and total nicotine dependence over 6 months
among smokers attempting to reduce cigarette consumption by replacing with e-cigs.
Methods: Current adult cigarette smokers were randomized to one of four conditions
(36mg/ml e-cig, 8mg/ml e-cig, 0mg/ml e-cig, or cigarette-substitute) and instructed to
reduce their cigarette smoking by at least 75% at 1 month. Previous work indicated
that the 36 mg/ml e-cig could deliver cigarette-like nicotine. The Penn State Nicotine
Dependence Index (PSNDI) was utilized to measure dependence on cigarettes (PSCDI)
and e-cigs (PSECDI), independently and in total (PSCDI + PSECDI), at baseline (PSCDI
only), and 1, 3, and 6 months after initiating e-cig use. Linear mixed eects models were
conducted for each outcome and included interaction terms between visit number and
group. Last observation carried forward was utilized to address missingness. Results:
Participants (n=520) were 41.2% male, 67.3% white, and 48.0 years old (median;
IQR= [37.0, 56.0]). At baseline, the median number of cigarettes smoked per day was
17.3 (IQR = [13.3, 21.6]) and the mean PSCDI score was 13.4 (SD=3.0) (n=495),
with no signicant dierences between conditions. Those randomized to the 36mg/ml
e-cig group had signicantly lower cigarette dependence at all follow-ups, compared
with the cigarette-substitute condition. There were no dierences in cigarette or e-cig
dependence between e-cig conditions at any follow-ups nor dierences in total nicotine
dependence between any conditions. Conclusion: Use of an e-cig with cigarette-like
nicotine delivery was associated with lessened cigarette dependence, compared with
the cigarette-substitute, without signicant increases in total nicotine dependence. This
data can be used for the development evidence-based product standards which reduce
the burden of tobacco use.
FUNDING: Federal
PS2-48
ASSOCIATIONS OF PARTNER AND FAMILIAL ENCOURAGEMENT
OF SMOKING WITH HOME AND CAR SMOKING BANS
Thomas F. Northrup, Yolanda R. Villarreal, Michelle R. Klawans, Mackenzie L. Spell-
man, Angela L. Stotts. McGovern Medical School at UTHealth, Houston, TX, USA.
Environmental tobacco smoke (ETS) poses health risks to infants hospitalized in the
neonatal intensive care unit (NICU), especially after they are discharged. ETS-related
health risks may be partially mitigated by the implementation of total home and car
smoking bans. Understanding the inuence that household and extended family mem-
bers have on home and car smoking policies may inform interventions to reduce ETS
among vulnerable infants. In a cross-sectional, secondary analysis of data collected
between 2013 and 2019, mothers of NICU infants who reported smoking or living with
a smoker (N=360) were asked about whether members of 9 separate relationship types
(e.g., partner, mother, father) encouraged or discouraged smoking in the home and car.
The inuence of perceived encouragement from each relationship type on the odds of
having a total smoking ban in place was estimated. Within homes without a smoking
ban at baseline, participants reported that partners (47.7%) and siblings (33.0%) were
most likely to encourage smoking in the home and car. In a multivariate model, both
partner (p<0.0001) and sibling (p<0.0001) encouragement of indoor smoking decreased
the likelihood of having a total smoking home and car ban in place. Family members’
beliefs, attitudes, and practices toward encouraging or discouraging smoking in the
home and car were signicantly associated with household smoking practices. Innovative
family-based interventions may be needed in order to reduce ETS in this particularly
vulnerable group of infants.
FUNDING: Federal
PS2-49
UNDOING A BAD HABIT: ASSOCIATIONS BETWEEN NEGATIVE
SMOKING EVENTS, COUNTERFACTUAL THEMES, AND THE
TRANSTHEORETICAL MODEL IN SMOKERS
Kianna M. Arthur, Sherecce Fields, Rachel Smallman. Texas A&M University, College
Station, TX, USA.
To assist a client in smoking cessation, a clinician may turn to health behavior change
models to propose the most eective treatment aligning with their clients’ goals. One
of the most often used for smoking behavior is the transtheoretical model (TTM), which
incorporates self-ecacy, decisional balance, as well as behavioral and cognitive-af-
fective processes. The TTM, however, does not account for past action and how an
individual thinks about that past action, both of which have been shown to predict rel-
evant goal-pursuit behaviors (e.g., intentions). After a negative event, individuals may
think “If only...” and imagine how things could have been dierent (i.e., counterfactual
thinking). Research suggests that counterfactuals may set the stage for goal-pursuit
by highlighting causal links that lead to a better result (e.g., “If only I had started
quitting sooner, then I wouldn’t have missed out”). The functional consequences of
counterfactuals have been noted as increased self-ecacy, motivation, and behavioral
intentions; the specic content of the counterfactual (i.e., self-focused, controllable, for
a better outcome) is theorized to be crucial for these outcomes. To date there are no
known studies examining associations between past negative smoking experiences,
counterfactuals, and a health behavior model, such as the TTM. Thus, the objective
of the present study was to examine the relationship between these variables in an
online sample of self-reported smokers. Results indicate that smokers in dierent stages
reported signicantly dierent scores for various processes of change. No signicant
dierences between stages of change and negative smoking experience themes were
present. For counterfactual dierences, the types of counterfactuals generated (e.g.,
self- versus other-focused) did not dier by stage of change. However, the thematic
content of the counterfactuals by stage diered, such that those in the action and
maintenance stages reported signicantly more smoking cravings in their counterfactual
antecedents (e.g., If only I wasn’t craving a smoke...). Results from this study could be
used to inform treatments for smoking cessation.
FUNDING: Unfunded
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-50
TOBACCO SMOKE EXPOSURE AND FAMILY RESILIENCE AMONG
U.S. SCHOOL-AGED CHILDREN
Kayleigh A. Fiser1, E. Melinda Mahabee-Gittens2, Ashley L. Merianos1. 1University of
Cincinnati, Cincinnati, OH, USA, 2Cincinnati Children’s Hospital Medical Center, Cincin-
nati, OH, USA.
Signicance: Family resilience is a conceptual framework that considers resilience in
the family as a functional unit that may be impacted by their environments. Tobacco
smoke exposure (TSE) among children may be a risk factor for low family resilience.
The objective was to assess the association between TSE status and family resilience
among U.S. school-aged children. Methods: We used 2017-2018 National Survey of
Children’s Health data, and included 15,423 children ages 6-11 years. TSE status was
dened as not living with a smoker (no TSE), living with a smoker with no home TSE
(smoking not allowed inside the home), and living with a smoker with home TSE (smok-
ing allowed inside the home). Family resilience is a composite measure on whether
the child’s family demonstrates resilient qualities during dicult times including: talking
together; working together; drawing on strengths; and staying hopeful. Children with
low, moderate, and high resilience met 0-1 items, 2-3 items, and 4 items, respectively,
which was dened as most or all of the time response options. Weighted multinomial
regression analyses were conducted adjusting for child age, sex, race/ethnicity, and
health status; adverse childhood experiences; parent education; family structure; and
federal poverty level. Results: About 13% of 6-11-year-olds lived with a smoker with no
home TSE while 1.6% lived with a smoker with home TSE. Overall, 6.3%, 10.5%, and
83.2% had low, moderate, and high family resilience scores, respectively. Compared to
children with high resilience scores, children who lived with a smoker with no home TSE
were 1.82 times more likely (95%CI=1.23-2.70) to have low family resilience scores.
Children who lived with a smoker with home TSE were at increased odds to have low
(AOR=1.29, 95%CI =1.07-1.57) and moderate (AOR=1.28, 95%CI=1.10-1.49) family
resilience scores. Conclusion: Children who lived with a smoker with no home TSE
were at increased likelihood to have low family resilience, and those with home TSE
were at distinct odds of having low-to-moderate resilience. Family-level interventions
are needed to increase resilience and the adoption of smoking bans in school-aged
children’s homes.
FUNDING: Federal
PS2-51
THE IMPACT OF SOCIAL MEDIA USE AND GAMING ON
INITIATION OF SMOKELESS TOBACCO USE AMONG RURAL
MALE YOUTH
Jessica K. Pepper1, Andrea Malterud2, Matthew Farrelly1, Nathaniel Taylor1, James
Nonnemaker1, Elizabeth L. Petrun Sayers2. 1RTI International, Research Triangle Park,
NC, USA, 2U.S. Food and Drug Administration Center for Tobacco Products, Silver
Spring, MD, USA.
Background: Social media use and gaming are central to the daily lives of youth in the
U.S. More intensive use of social media is associated with risky behaviors like alcohol
and tobacco use, but less is known about the risks of gaming. There are no studies to
date examining the association of social media use and gaming with smokeless tobacco
(SLT) use. Methods: We surveyed a longitudinal cohort of 2,168 rural male youth ages
11 to 16 at baseline from January 2016 through December 2018. We used discrete
time survival analysis to examine transitions from never to ever SLT use. Key predictors
were lagged social media use (tertiles of frequency of using Facebook, Instagram,
Twitter, and Snapchat) and playing video games at least once per day. The model also
included susceptibility to SLT, age, parental rules about media use, and other personal
characteristics. The study was conducted as part of an evaluation of The Real Cost
Smokeless education campaign, and we controlled for campaign exposure. Results:
After controlling for susceptibility to SLT use, boys in the top and middle tertiles of social
media use at the previous wave had greater odds for initiating SLT use at the subse-
quent wave relative to boys in the lowest tertile of use (OR=2.92, p<.001 for top tertile;
OR=1.80, p<.05 for middle tertile). In contrast, playing video games at least once per
day at the previous wave was associated with lower odds of initiation at the subsequent
wave (OR=0.48, p<.001). Campaign exposure was not related to initiation. Conclusion:
Greater frequency of social media use prospectively predicted SLT initiation among rural
adolescent boys, whereas greater frequency of playing video games was associated
with a decreased risk. Increased social media use could result in increased exposure
to ads or programs featuring tobacco use. Alternatively, social media use and online
gaming may be proxies for risk factors and protective factors, respectively, in adolescents’
non-digital social lives. Social media platforms like Instagram may be an ecient route
to reach at-risk youth with educational messages because of their widespread reach.
FUNDING: Federal
PS2-52
PERCEIVED SENSORY CHARACTERISTICS OF FLAVOR BLENDS
AND AMBIGUOUS “CONCEPT” FLAVORS AMONG ADOLESCENT
AND YOUNG ADULT E-CIGARETTE USERS
Jennifer M. Kreslake1, Katie M. O’Connor1, Daniel Stephens1, Donna M. Vallone2, Eliz-
abeth C. Hair2. 1Truth Initiative, Washington, DC, USA, 2Truth Initiative, WA, DC, USA.
The rapid rise of e-cigarette use among youth has been attributed to the wide array of
characterizing avors oered by e-cigarette brands. This research aims to investigate
patterns of use and sensory perceptions of avor blends and ambiguously named
“concept avors” reported by adolescent and young adult e-cigarette users. Current
e-cigarette users aged 15-24 (N=2,281) completed an online convenience sample survey
(October 20, 2020-November 23, 2020). Using 9-point continuous slider scales, past
30-day users of a avor blend or concept avor rated the intensity of each according to
sensory characteristics previously established as appealing to adolescents (fruity, minty,
sweet, cooling). For each avor blend or concept avor, mean scores were calculated
for each sensory perception scale. Most respondents used at least one avor blend
(74.8%) or concept avor (57.9%) in the past 30 days. Over half of the sample (56.8%)
reported disposables as their most frequently used device type. Popular avor blends
included Iced Mango (used by 30.2% of the sample), Banana Ice (27.5%), Lush Ice
(23.8%) and Melon Ice (22.9%). Top concept avors included Tropic (used by 17.5% of
the sample), Blue Dream (16.0%), Winter (13.6%), Bahama Mama (12.9%) and Gold
(12.8%). The most commonly used avor blends were rated highly on a combination
of cooling sensation with fruit and sweet taste. Concept avors had a similar sensory
prole as avor blends. Flavor blends and concept avors are used by the majority of
young e-cigarette users, who describe these products as having fruity, sweet and cooling
avor proles. Findings from this study inform public health interventions concerning
avored e-cigarettes with the intention of curbing the rise in e-cigarette use in youth
and young adults
FUNDING: Unfunded
PS2-53
SMOKING CESSATION PATTERNS DURING PREGNANCY
Katherine Duncan1, Ashley Petersen, PhD2, Sharon Allen, MD, PhD1, Katherine Harri-
son, MPH2. 1University of Minnesota Medical School, Minneapolis, MN, USA, 2University
of Minnesota, Minneapolis, MN, USA.
Signicance: Maternal smoking during pregnancy is a well-established risk factor for
adverse neonate outcomes. Our study examined the trajectory, methods, and dicul-
ties surrounding cigarette cessation during pregnancy. We hypothesized that diculty
quitting is lowered for women during pregnancy compared to prior cessation, and that
motivation to stay abstinent postpartum is higher in women who intend to breastfeed.
Methods: Data came from a phone screen in a parent study focused on preventing
postpartum smoking relapse. Participants self-reported average daily cigarette use in
the 12 months before pregnancy and in each trimester. Diculty in achieving cessation
while pregnant and when not pregnant was measured on a scale of 1-10 (10 being the
hardest). Motivation to remain smoke-free postpartum was measured on a scale of 1-10
(10 being the highest). Subjects reported intent to breastfeed as yes, no, or maybe/
unknown. Results: The median age was 29 and most women (71%) were in their third
trimester. Of the 70 participants, 54% quit smoking during pregnancy. Of these, 79%
quit cold turkey (without nicotine replacement therapy [NRT]). Of those who quit, 34%
quit in the 1st trimester, 26% in the 2nd, and 39% in the 3rd. During the 1st trimester, 92%
of those who quit did so cold turkey, compared to 90% during the 2nd and 60% during
the 3rd. Among women who had also previously quit while not pregnant (n=23), women
found it on average 2.5 points easier (95% CI: 1.1-3.9; p=0.001) on a scale of 1-10 to
quit while pregnant than when not. Of all participants, 58% reported being motivated at a
level of 10/10 to be tobacco-free after delivery; 81% reported 8/10 or higher motivation.
Motivation did not dier by intent to breastfeed (p=0.14). Conclusions: As hypothesized,
women found it easier to quit smoking during pregnancy than when not pregnant. Intent
to breastfeed did not have a signicant inuence on motivation to remain abstinent after
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
delivery. Further research should investigate when the use of NRT during pregnancy is
benecial, the factors contributing to decreased diculty in achieving cessation during
pregnancy, and how to prevent postpartum relapse.
FUNDING: Federal
PS2-54
DISPARITIES IN DENTAL HEALTH ISSUES AND DENTAL CARE
VISITS AMONG U.S. CHILDREN WITH TOBACCO SMOKE
EXPOSURE
Melinda Mahabee-Gittens1, Harold A. Smith2, Ashley L. Merianos3. 1Cincinnati Chil-
dren’s Hospital Medical Center, Cincinnati, OH, USA, 2Dental Sleep Medicine of Indiana,
Indianapolis, IN, USA, 3University of Cincinnati, Cincinnati, OH, USA.
Signicance: Dental caries, or tooth decay, is an infectious disease and there is growing
research that TSE is associated with increased risk of development of dental caries in
children. The study objective was to assess the relationships between TSE and cur-
rent dental health and dental care visits among U.S. children ages 1-11 years overall
and within age groups. Methods: We conducted a secondary analysis of combined
data from the 2018-2019 National Survey of Children’s Health including data on TSE,
dental health, and dental care visits. Children were categorized into 3 groups based
on caregiver reports of TSE: (1) no home TSE: did not live with a smoker; (2) THS
exposure only: lived with a smoker who did not smoke inside the home; and (3) SHS
and THS exposure: lived with a smoker who smoked inside the home. We conducted
weighted multivariable logistic regression analyses among children ages 1-11 years
(N=32,214) and among subsamples of children ages 1-5 years (n=14,437) and 6-11
years (n=17,777). Results: Overall, 12% and 1.5% of children were exposed to home
THS only and home SHS and THS, respectively. Children with home SHS and THS
exposure were at increased odds of having frequent or chronic diculty with >1 oral
health problem (AOR=1.59, 95%CI=1.07-2.35) and decayed teeth or cavities (AOR=1.74,
95%CI=1.14-2.65) compared to those with no home TSE, after adjusting for child age,
sex, race/ethnicity, premature birth, caregiver education level, family structure, and
federal poverty level. Compared to 1-11-year-olds with no home TSE, children with home
SHS and THS exposure were 2.22 times more likely (95%CI=1.01-4.87) to have not
received needed dental care, but at decreased odds to have had any kind of dental care
visit (AOR=0.55, 95%CI=0.32-0.95) including a preventive dental care visit (AOR=0.60,
95%CI=0.36-0.99). Conclusion: TSE in toddlers, preschoolers, and school-aged children
places them at increased risk of dental caries and inadequate dental care visits. The
pediatric dental care visit may be an opportune time to alert caregivers of the risks of
TSE on their children’s dental health.
FUNDING: Federal
PS2-55
FEASIBILITY, ACCEPTABILITY, AND EFFECTIVENESS
OF VIRTUAL TOBACCO CESSATION INTERVENTION IN
DISADVANTAGED, URBAN SMOKERS
Ashley Vena, Abigayle Feather, Andrea King. University of Chicago, Chicago, IL, USA.
Signicance & Methods: The COVID-19 pandemic led to a rapid transformation in
health care delivery from in-person care to telemedicine. In May 2020, the tobacco
cessation group program at the University of Chicago, Courage to Quit® (CTQ) tran-
sitioned to a virtual, Zoom-based format (CTQ-Virtual). As patients are predominantly
medically-compromised, low-income Black/African American smokers with low access
to digital therapies, we evaluated the feasibility, acceptability, and eectiveness of the
program during the pandemic. Results: From May 2020-June 2021, 152 unique smok-
ers attended the program. The average age was 59 (±13 SD) years, 81% identied as
Black, 78% female, 73% did not have a college degree, and 71% were not working (i.e.,
unemployed, retired, or disabled). For smoking, 90% smoked daily and 33% smoked
more than ½ pack per day. Most patients had a major medical diagnosis including cancer,
pulmonary disease, cardiovascular illness, etc. Acceptability of CTQ-Virtual improved
over this time period. From the rst quarter to the last quarter, new enrollments increased
two-fold (4 vs 9 new patients/month) and patients attending by video increased by 15%
(34% vs 49%). Overall, retention was good, as approximately 63% of patients attended
more than one session and 36% completed the four-session program, and these rates
were higher than those of the in-person program during the year prior to the pandemic
(55% and 25%, respectively). CTQ-Virtual was eective in reducing smoking. Among
patients attending two or more sessions, mean (±SD) cigarettes smoked/day decreased
42% from the rst to last attended group (10.1±7.0 to 5.9±5.4 cigs/day) and 27% had
a successful quit attempt. Conclusion: A virtual tobacco cessation intervention is fea-
sible, acceptable, and eective among low-income, low-technology accessible Black
smokers. Notably, the virtual format improved accessibility and program completion
rates relative to the in-person format. Findings demonstrate the utility of telehealth to
improve tobacco cessation among underserved smokers as it may uniquely address
key barriers to care specic to this population.
FUNDING: Federal
PS2-56
DEMOGRAPHIC CORRELATES OF TRANSITIONS BETWEEN
SINGLE, DUAL, AND POLYTOBACCO USE STATES IN THE
POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH)
STUDY: A MULTISTATE MARKOV TRANSITION ANALYSIS
Fatema Shae-Khorassani, Andrew F. Brouwer, Jana Hirschtick, Rafael Meza, Nancy
Fleischer. University of MI, Ann Arbor, MI, USA.
Background: In this complex, multiproduct tobacco product landscape, a better under-
standing of demographic patterns of transition between single, dual, and polytobacco
product use may help improve policy intervention targeting. Methods: Hazard ratios of
transition rates between never, non-current (no past 30-day use), cigarette, e-cigarette,
other combustible (OC), smokeless tobacco (SLT), dual, and polytobacco (i.e., three or
more categories) use states in adults were estimated for age, sex, and race/ethnicity
using a multistate transition model for Waves 1-4 of the Population Assessment of
Tobacco and Health (PATH) study, accounting for complex study design. Results:
Younger age (18-24) was associated with more transient tobacco use behavior, with
higher hazards of transitioning from exclusive cigarette, e-cigarette, or SLT use to dual,
poly, or non-current use than all other age groups (25-34, 35-54, 55+). Compared to
females, males had higher hazards of transitioning from exclusive cigarette use to
dual cigarette and OC (HR 1.69, 95% CI 1.43,2.01) or SLT use (HR 6.5, 95% CI 2.80,
14.96), but lower hazard of transitioning to dual cigarette and e-cigarette use (HR 0.80,
95% CI 0.70,0.96). They also had higher hazards of transitioning from dual cigarette
and e-cigarette use to exclusive e-cigarette (HR 1.69, 95% CI 1.30,2.18) or poly-use
with cigarettes (HR 1.93, 95% CI 1.30,2.86). Black participants had lower hazards of
transitioning from exclusive cigarette use to either non-current use (HR 0.09, 95% CI
0.08,0.10) or any dual use state, and a higher hazard of transitioning from exclusive
e-cigarette or SLT use to non-current use than White participants. Conclusions:
Transitions between single, dual, and polytobacco use dier by age, sex, and race/
ethnicity, which may inuence the impact of current and future tobacco control eorts.
FUNDING: Federal
PS2-57
ADDICTION PERCEPTIONS AMONG USERS OF SMOKELESS
OR COMBUSTIBLE TOBACCO ATTENDING A TERTIARY CARE
HOSPITAL IN INDIA
Vaibhav P. Thawal. University of Newcastle, Australia, Newcastle, Australia.
Background: Addiction plays a key role in continued tobacco use. The study assessed
perceived personal addiction, the perceived addictiveness of dierent forms of tobacco
and explored whether the type of tobacco product used, demographic characteristics or
socio-cultural factors were associated with perceived addictiveness in India. Methods:
Cross-sectional survey of adult tobacco users attending a general medicine out-patient
department in Mumbai. Results: A total of 607 participants, 454 smokeless tobacco
(SLT) users and 153 combustible tobacco users completed the survey. The odds of
perceived addiction were lower among SLT users. An increase in the odds of perceived
addiction was seen as age increased and participants with secondary education and
above had higher odds of perceived addiction compared to participants with no formal
education. The odds of perceiving SLT products to be addictive was lower among SLT
users compared to combustible tobacco users. The odds of perceiving SLT products
to be addictive was lower among females. Participants with secondary education and
above had higher odds of perceiving both combustible and SLT products to be addictive
compared to no formal schooling. Conclusion: There is a need to raise awareness in
India of the addictiveness of tobacco, particularly for users of SLT, younger people and
those with less education.
FUNDING: Academic Institution
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-58
PREDICTORS OF ADHERENCE AMONG VULNERABLE
POPULATIONS OF ADULTS ASSIGNED TO SMOKE VERY LOW
NICOTINE CONTENT CIGARETTES
L. Morgan Snell1, Grace L. Reed1, Jennifer Tidey1, Janice Y. Bunn2, Roxanne F. Harf-
mann2, Sarah Heil2, Stacey Sigmon2, Diann Gaalema2, Stephen T. HigginsPhD3. 1Brown
University, Providence, RI, USA, 2University of VT, Burlington, VT, USA, 3University of
Vermont, Burlington, VT, USA.
Signicance: The U.S. Food and Drug Administration is considering a policy reducing
the nicotine content in cigarettes to a minimally addictive level. This could particularly
benet smokers from populations vulnerable to heavy smoking and diculties quitting. In
this secondary analysis, we assessed predictors of adherence to a regimen of smoking
only assigned very low nicotine content cigarettes (VLNCs) among adult smokers from
vulnerable populations in randomized clinical trials. Doing so may help identify char-
acteristics of those who may require additional assistance if a nicotine-reduction policy
were to be implemented.Methods: Data came from three populations of vulnerable adult
smokers assigned to use VLNC cigarettes (0.4 mg/g nicotine) during 12-week random-
ized controlled trials (n=286): socioeconomically disadvantaged women of reproductive
age (n=93), opioid-maintained adults (n=92), and adults with aective disorders (n=101).
Linear and logistic regression was used to assess predictors of adherence, dened as
a continuous measure of level of adherence based on changes in cotinine relative to
baseline, and as a 90% reduction in urine cotinine at Week-6 and -12 assessments
relative to baseline (full adherence: yes/no). Predictors included satisfaction with study
cigarettes, craving, nicotine-dependence severity, withdrawal, vulnerable population,
baseline aective-disorder symptoms, and sociodemographic characteristics.Results:
Dependence severity was negatively associated with both adherence measures at Week
6 (p<0.01), whereas increased satisfaction with study cigarettes and age were positively
associated with both measures at Weeks 6 and 12 (p<0.01). Opioid-maintained adults
exhibited reduced adherence and were less likely to reach full adherence at Week 12
compared to socioeconomically disadvantaged women (p<0.05).Conclusions: Factors
associated with VLNC adherence in vulnerable populations were identied and are
similar to those in the general population of smokers. Further studies are indicated
investigating nicotine supplements (e.g., NRT) to support highly dependent adults faced
with using VLNCs. Some vulnerable populations (e.g., opioid-maintained adults) may
be especially in need of supplemental, non-combusted nicotine.
FUNDING: Federal
PS2-59
THE ASSOCIATION BETWEEN ADVERSE CHILDHOOD
EXPERIENCES AND IMPULSIVITY IN TOBACCO USERS AND
TOBACCO-CANNABIS CO-USERS
Sally Jeon1, Sharon AllenMD PhD1, Ashley Petersen2, Katherine Harrison2. 1Univer-
sity of Minnesota Medical School, Minneapolis, MN, USA, 2University of Minnesota,
Minneapolis, MN, USA.
Signicance: Adverse Childhood Experiences (ACEs) are potentially traumatic child-
hood events and environments. Previous studies have established both ACEs and im-
pulsivity as predictors of increased substance use and diculty with cessation. However,
there are limited studies exploring the association between ACEs and impulsivity scores
within tobacco users. Disentangling the relationship between ACE and impulsivity can
inform future cessation interventions for tobacco users. Methods: This study investigates
whether ACEs are associated with impulsivity for two study populations: tobacco-only
users (n = 199) and tobacco-cannabis co-users (n= 57). ACEs were measured using
a 10-item screener totaling the number of ACEs experienced in the rst 18 years of
life. Impulsivity was measured utilizing the Barratt Impulsiveness Scale (BIS; 30-item
scale), Brief Self-Control Scale (BSCS; 13-item scale), and Behavioral Inhibition/Acti-
vation Scales (BIS/BAS; 4 subscales). Linear regression models with robust standard
errors were used to estimate the association between number of ACEs and impulsivity
outcomes, adjusted for sex. Models were also t with an interaction between sex and
number of ACEs to test for a varying association of ACEs and impulsivity between males
and females. Results: Tobacco-cannabis co-users with more ACEs tended to have
higher Behavioral Inhibition System scores, indicating more impulsiveness. In particular,
each additional ACE was associated with having, on average, a 0.50 points higher score
(95% condence interval [CI]: 0.11-0.90 points higher; p=0.02) on the Behavioral Inhi-
bition System. A similar association was found in tobacco-only users though it was not
statistically signicant (p=0.13). We also found some evidence of a diering association
for men vs. women among the tobacco-only users. Specically, the association diered
signicantly by sex between ACEs and BIS (p=0.03) and BSCS (p=0.03). Conclusion:
More ACEs are associated with higher BIS scores for impulsivity in both tobacco only
users and cannabis co-users, and there is evidence for diering associations by sex
between ACEs and impulsivity scores for tobacco only users.
FUNDING: Federal; State
PS2-60
TRENDS IN PAST YEAR CANNABIS USE AMONG U.S. ADULTS
WITH AND WITHOUT A HISTORY OF CANCER, 2013-2019
FINDINGS FROM THE PATH STUDY
Danielle Smith, Cheryl Rivard, Karin Kasza, Amy Case, Richard O’Connor, Eric
Hansen, Maciej Goniewicz, Andrew Hyland. Roswell Park Comprehensive Cancer
Center, Bualo, NY, USA.
Background: Cannabis is often used to manage cancer pain and treatment side eects,
formally or informally. Little is known about population-level time trends in cannabis use
among those diagnosed with cancer, how trends compare to the general population,
and whether dierences in prevalence exist between those diagnosed with tobac-
co-attributable vs non-tobacco attributable cancers. Methods: Data are from Waves 1
(2013-2014) thru 5 (2018-2019) of the PATH Study, a nationally representative survey
of non-institutionalized U.S. adults and youth. Weighted estimates of past year can-
nabis use were computed for each wave among adults (n=40,182), cancer survivors
(n=1,788), and those with no cancer history (n=38,394). Prevalence was examined
according to diagnosis with tobacco attributable (i.e., cancer of the bladder, cervix,
colon, esophagus, kidney, larynx, liver, lung, mouth, pancreas, rectum, stomach, or
throat, n=611) vs. non-tobacco attributable (n=1,159) cancers. Generalized Estimation
Equations were used to examine whether trends in use signicantly changed over
time. Results: Overall, prevalence of past year cannabis use increased by 56% (2013-
2014: 11.5% 95%CI:10.8-12.2; 2018-2019: 17.9% 95%CI:17.1-18.7; p<0.0001). Past
year cannabis use among cancer survivors was lower than for those without a cancer
diagnosis (6.6% vs. 11.8% in 2013-14); the rate of increase over time was compara-
ble between the groups (2018-2019: cancer survivors: 10.6%, those with no cancer
diagnosis: 18.6%; 61% vs. 58% increase, respectively). Among cancer survivors, past
year cannabis use was consistently higher over time among those diagnosed with to-
bacco-attributable cancers compared to non-tobacco attributable cancers (2013-2014:
8.4% for tobacco-attributable vs. 6.0% non-tobacco attributable; 2018-2019: 13.3%
tobacco-attributable vs. 9.2% non-tobacco attributable). Conclusions: While prevalence
of cannabis use is lower among those diagnosed with cancer compared to the general
population, prevalence among cancer survivors is highest among those diagnosed with
tobacco-attributable disease. Findings further inform the literature underscoring linkages
between tobacco and cannabis.
FUNDING: Unfunded
PS2-61
PSYCHOMETRIC EVALUATION OF THE SHORT-FORM
VAPING CONSEQUENCES QUESTIONNAIRE FOR USE WITH
HIGH SCHOOL ADOLESCENTS WHO USE AND DO NOT USE
E-CIGARETTES
Meghan Morean, Danielle Davis, Krysten W. Bold, Grace Kong, Asti Jackson, Juhan
Lee, Lavanya Rajeshkumar, Suchitra Krishnan-Sarin. Yale University School of Medi-
cine, New Haven, CT, USA.
Signicance. Assessing youth vaping expectancies using a psychometrically sound
measure can improve understanding of e-cigarette use as well as e-cigarette suscep-
tibility among youth without vaping experience. Methods. We evaluated psychometric
properties of the Short-Form Vaping Consequences Questionnaire (SF-VCQ), an
expectancy measure previously validated with adults, within a sample of 1,753 high
school adolescents who completed an online survey in Fall 2020 (51.6% female;
15.56[1.22] years old; 46.6% non-Hispanic white; 26.1% lifetime e-cigarette use; 9.3%
past-month e-cigarette use). Analyses included conrmatory factor analysis, internal
consistency, measurement invariance, between-group dierences, and test-criterion
relationships. Results. The 4-factor structure comprising expectancies for negative
consequences, positive reinforcement, negative reinforcement, and appetite/weight
control was conrmed and scalar invariant by lifetime and past-month vaping status,
sex, and race. All subscales were internally reliable (mean α=0.94). The subscales were
sensitive to dierences based on lifetime and past-month vaping status as well as vaping
susceptibility among never users, sex, and race. For example, students who vaped
in the past-month held weaker expectancies for negative consequences but stronger
expectancies for positive reinforcement, negative reinforcement, and appetite/weight
control compared to lifetime vapers. Unadjusted relationships within the subsamples
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
of lifetime and past-month vapers provided evidence of convergent validity. Evidence
for concurrent validity was observed for all samples after accounting for covariates.
For example, expectancies for positive reinforcement, negative reinforcement, and
appetite/weight control remained signicantly associated with past-month vaping
frequency. Conclusions. The SF-VCQ evidenced excellent internal reliability, scalar
measurement invariance, and construct, convergent, and concurrent validity in samples
of never, lifetime, and past-month adolescent e-cigarette users. Findings support using
the SF-VCQ for assessing vaping-related expectancies among youth who use and do
not use e-cigarettes.
FUNDING: Federal
PS2-62
PREVALENCE OF TOBACCO PRODUCT IMAGERY IN THE TOP
MUSIC VIDEOS OF 2020
Jennifer M. Kreslake, Katie M. O’Connor, Brenda S. Dimaya, Jessica M. Rath, Donna
M. Vallone, Elizabeth C. Hair. Truth Initiative, WA, DC, USA.
Exposure to tobacco products in on-screen entertainment has been found to be a
contributor to youth smoking initiation. This study aims to investigate the prevalence
of tobacco imagery in popular music videos in 2020. The top 10 songs of each week
of the 2020 calendar year were identied using Billboard Charts genres or categories
(Hot 100, R&B/Hip-Hop, Country, Rock & Alternative, Dance/Electronic, Pop Airplay).
Content analyses were conducted by two independent coders among the top songs with
accompanying music videos. Methodology for coding was adapted from previous work
investigating tobacco imagery in episodic television and movies. Coders identied each
instance of tobacco products (cigarettes, cigars, pipe tobacco, e-cigarettes) and mari-
juana. Of the 315 top songs, 257 had accompanying music videos. Nearly one-quarter
(23.3%, or 60 videos) contained tobacco product imagery. A total of 530 frames with
tobacco images were found across the 60 videos. Cigarettes were the most pervasive
product, composing 44.9% of occurrences counted in the coding process. More than
one-third of identied images (39.8%) were not easily distinguishable as cigars, blunts,
and/or marijuana and were classied as “other combustible products”. Clear depictions
of cigars (including large cigars or little cigars or cigarillos), comprised 10.70% of total
tobacco occurrences. Pipes, e-cigarettes, and clear depictions of marijuana, were rare,
all comprising less than 2% of total tobacco occurrences (1.9%, 1.1%, and 1.50%respec-
tively). Tobacco imagery was most pervasive in R&B/Hip-Hop and Rock & Alternative
genres. Addressing sources of tobacco imagery in popular culture is imperative in the
eort to prevent tobacco use among youth and young adults.
FUNDING: Federal
PS2-63
DIFFERENCES IN E-CIGARETTE, ALCOHOL, AND CANNABIS USE
AMONG CONNECTICUT HIGH SCHOOL STUDENTS WHO VAPE
CANNABIS VERSUS USE OTHER CANNABIS MODALITIES
Meghan Morean, Danielle Davis, Grace Kong, Krysten W. Bold, Deepa Camenga,
Sakinah Suttiratana, Lavanya Rajesh Kumar, Juhan Lee, Suchitra Krishnan-Sarin. Yale
University School of Medicine, New Haven, CT, USA.
Background. Tracking with the high rates of e-cigarette use observed among American
youth, rates of vaporizing cannabis have increased in recent years; vaping is the second
most common modality of cannabis use following smoking. While negative conse-
quences of youth combustible cannabis use are well-documented, less is known about
risks associated with using other cannabis modalities. Thus, we examined dierences
in demographics and substance use behaviors between adolescent cannabis vapers
and those using other cannabis modalities. Methods. In 2019, 4875 students from six
CT high schools completed school-wide, online surveys. Past-month cannabis users
(n=931; 52.8% female, 16.38(1.27) years old, 44.9% non-Hispanic White) reported on
cannabis modalities used (e.g., combustible, vaporizable, edible) and were classied
as cannabis vapers or non-vapers. Cannabis vapers reported on device type used to
vape cannabis: cannabis-specic device or modied/hacked e-cigarette. Unadjusted and
adjusted relationships were examined to identify demographic and substance-related
dierences by cannabis vaping status. Results. 56.3% of past-month cannabis users
reported vaping cannabis. Cannabis vapers reported using cannabis-specic vaporizers
(91.9%) and modifying/hacking e-cigarettes for use with cannabis (23.7%). Cannabis
vapers, relative to other cannabis users, were more likely to be male, non-Hispanic
White, use cannabis at a younger age; endorse past-month use of e-cigarettes, alco-
hol, and all cannabis modalities; and report using e-cigarettes at a younger age and
more frequently; consuming more drinks per drinking day; and smoking and dabbing
cannabis more frequently. Conclusions. Relative to other cannabis modalities, vap-
ing was associated with increased use of e-cigarettes, alcohol, and several cannabis
modalities. Adolescent past-month cannabis users reported modifying e-cigarettes to
vape cannabis. Findings suggest that regulations should be implemented to prevent
e-cigarettes from being modiable for use with cannabis and highlight the importance
of assessing dierent cannabis use modalities, as vaping was associated with distinct
substance-related risks.
FUNDING: Federal
PS2-65
CHEMICAL ANALYSIS OF THE LIQUIDS IN CIGARETTE FLAVOR
CAPSULES
Inti Barrientos-Gutierrez1, Sophia Mus2, José Carlos Monzón2, Joaquín Barnoya2,
Richard OConnor3, Maciej Goniewicz3, Noel Leigh3, Michelle Page3, James Thrasher4.
1National Institute of Public Health, Mexico City, Mexico, 2Instituto de Investigación y
Estudios Superiores en Salud, Universidad Rafael Landivar, Guatemala City, Guate-
mala, 3Roswell Park Cancer Institute, Bualo, NY, USA, 4University of SC, Columbia,
SC, USA.
Background Over the last decade, the market share for cigarettes with avor capsules
in the lter has grown exponentially around the globe but particularly in Latin America.
This product innovation involves consumers crushing a liquid-lled capsule while
smoking, soaking the lter and changing the smoke avor. Despite their growth, little
is known about the chemical constituents of the liquids used and their potential health
risks. Methods Based on market share estimates and availability across both countries,
31 avor capsule brand varieties were collected in Mexico and Guatemala (19 and 12,
respectively). Since some varieties includes more than 1 capsule (2 or 4) in a stick or
pack, a nal sample of 50 capsules were chemically analyzed. Gas chromatography
with quadrupole time-of-ight mass spectrometry (GC-QTOF, Agilent Inc.) were used for
qualitative analysis and gas chromatography with mass spectrometry (GC-MS, Agilent
Inc.) for quantitative analysis. Results The sample was comprised of Lucky Strike
(29.0%), Pall Mall (25.8%), Marlboro (22.6%), L&M (12.9%), and Benson & Hedges
(9.7%) varieties. Most varieties included only one capsule (52%), 42% contained two
capsules in the same lter, and 6% included single capsules in the lter, but with four
avors in the pack. All capsules contained mint/menthol with fruit avors also being
common. The qualitative analysis found 297 compounds across the dierent formula-
tions, with 10 to 68 compounds found per liquid sample. In the quantitative analysis,
L-Menthol was found in all capsule varieties; DL-Limonene in 84% of varieties (74% of
capsules); Eucalyptol in 77% of varieties (66% capsules); Pulegone in 39% of varieties
(26% capsules); and Benzyl Alcohol in 32% of varieties (42% capsules). Conclusion
The liquids in the avor capsules are dominated by menthol avorings but span a wide
variety of formulations. Some of the most used compounds (such as DL-limonene,
pulegone, and benzyl alcohol) are potentially harmful for consumers. More research is
required regarding these liquids as well as a strict regulation to avoid the use of toxic
or carcinogenic compounds.
FUNDING: Federal
PS2-66
VAPOR TAXES AND PRICING ACTIVITIES OF ONLINE VAPING
STORES
Shaoying Ma, Shuning Jiang, Meng Ling, Bo Lu, Jian Chen, Ce Shang. The Ohio State
University, Columbus, OH, USA.
Signicance: Electronic cigarette use by adolescents has increased dramatically and
raised great concern in the past decade. Tobacco control policies that curb the use of
electronic cigarettes, such as taxation, have great potential to prevent the initiation and
escalation of e-cigarette use. However, little evidence are presented on pricing activities
of online vaping stores, and how well are vapor taxes implemented during web-based
sales remains unclear. Our study collects price data from ve popular online vaping
stores through web scraping, and we also present how those stores charge vapor tax-
es based on shipping addresses in states and local jurisdictions that have e-cigarette
excise tax in place.Methods: We collect e-cigarette sales prices from online vaping
stores using web data extraction, standardize prices for e-liquid products, and present
e-liquid price distribution in the whole sample and in each store, as well as variations of
vapor taxes across states/local jurisdictions and between stores.Results: We present
descriptive analyses of data on e-liquid prices from ve online vaping stores. The data
were scraped from the store websites from February to May in 2021. We collected data
of 14,479 e-liquid products from ve stores. The average price of e-liquids is $0.25/ml,
and the median price is $0.21/ml in our sample. The price distribution is similar across
stores. E-liquid products are very aordable, and the price distribution in each store
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
is right-skewed. Vapor tax charged for a specic e-liquid product varies by store and
shipping address. Conclusion: We collect price data of e-liquid products from online
vaping stores using web data extraction, and present analyses on store pricing activi-
ties and variations of vapor taxes across states/local jurisdictions and between stores.
FUNDING: Academic Institution
PS2-67
CHANGES IN MARIJUANA AND NICOTINE VAPING PERCEPTIONS
AND USE BEHAVIORS AMONG YOUNG ADULTS SINCE THE
COVID-19 PANDEMIC
Kathleen R. Case1, Stephanie Clendennen2, Jay Shah2, Joel Tsevat1, Melissa Harrell2.
1University of Texas Health Science Center at San Antonio (UT Health San Antonio),
San Antonio, TX, USA, 2UTHealth, School of Public Health in Austin, Austin, TX, USA.
Signicance: Research is lacking on the impact of the COVID-19 pandemic on mari-
juana vaping behaviors - a notable limitation as marijuana vaping has been previously
associated with respiratory issues among young people. Furthermore, research inves-
tigating the impact of COVID-19 on nicotine vaping behaviors among young people is
equivocal, with some studies noting a decline in use, and others reporting increases
in use behaviors. The purpose of this qualitative study was to gain insight into how the
COVID-19 pandemic inuenced marijuana and nicotine vaping perceptions and behav-
iors among young adults (18 to 25 years old), as well as to explore reasons, such as
boredom and stress, for changes in use behaviors. Methods: We conducted in-depth
qualitative interviews with 50 regular marijuana vapers from September 2020 to April
2021. Individuals were eligible if they vaped marijuana at least 3-5 days per week (ex-
clusively or dual use with nicotine). Interview transcripts were analyzed using deductive
coding processes to identify themes corresponding to the items in the interview guide.
Constructs assessed included the impact of COVID-19 on 1) general daily activities, 2)
perceptions or attitudes about vaping, and 3) vaping use behaviors, including reasons
for changes in use behaviors. Results: Of the 50 participants, 20 (40%) were female,
and the mean age was 21.4 years [SD=1.89]. Twenty-one participants (42%) were
classied as regular marijuana vapers, while 29 (58%) met the criteria for regular dual
vapers. Although the pandemic negatively impacted participants’ perceptions of vaping,
this did not translate into reductions in use, as most (54%) reported increases in vaping.
Common changes in use behaviors were increases in both nicotine and marijuana
vaping, or increases in marijuana vaping with decreases in nicotine vaping, among
others. For both marijuana and nicotine vaping, boredom was a prominent theme for
increasing use. Unique to marijuana vaping, relaxation/stress reduction was a common
theme for increasing use. Lack of access to marijuana was a reason for decreasing
marijuana and increasing nicotine vaping. Conclusions: Most participants reported
increasing their vaping behaviors since the COVID-19 pandemic despite concerns
about the potential for vaping to adversely impact lung and immune health. As the U.S.
continues to battle the COVID-19 pandemic, research should assess how the identied
factors (e.g. boredom, stress, accessibility to vaping products) continue to inuence
vaping behaviors. In addition, these factors are relevant for the development of targeted
health communication messages aimed at decreasing vaping use among young people.
FUNDING: Federal
PS2-68
ISRAELI SMOKING CESSATION PRACTITIONERS’ KNOWLEDGE,
ATTITUDES AND PRACTICES REGARDING ELECTRONIC
CIGARETTES - A CROSS SECTIONAL STUDY
Marina Ben Izhak1, Yael Bar- Zeev2. 1Hadassah Medical Center, Jerusalem, Israel,
2The Hebrew University, Jerusalem, Israel.
Signicance Electronic cigarettes (e-cig) are regulated in Israel similar to combustible
cigarettes. E-cig role in smoking cessation is under scientic debate, with evidence
supporting their ability to help smokers quit, albeit concerns over continued nicotine
addiction, health harms, and “dual use”. This study aimed to: 1) explore Israeli smoking
cessation practitioners’ knowledge, attitudes, and practices regarding e-cig; 2) identify
factors associated with not recommending e-cig as a cessation aid. Methods Online
cross-sectional survey. Main outcome was whether practitioners did not recommend
using an e-cig vs recommending them in all or some circumstances. Knowledge was
measured using 10 yes/no questions, for a composite score of 0-100%. General attitudes
regarding e-cig, personal attitudes regarding practitioners’ role in discussing e-cig, and
attitudes regarding e-cig regulation were measured using Likert scale (1 does not agree
to 5 agree completely). A logistic regression explored the association between the main
outcome and socio-demographic characteristics, professional experience, knowledge,
and attitudes. Results Of 90 participants, 65.6% were female, mean age 54.7 (SD
10.6), mean years of experience 8.6 (SD 6.3). A third (36.7%) reported they would not
recommend using an e-cig, 36.7% would leave it to the clients’ decision, 16.7% stated
they neither recommend or not recommend due to lack of evidence, and 10% would
recommend e-cig under certain circumstances. Mean knowledge score was 65.4 (SD
22.5). Mean attitudes score was 2.2 for general attitudes, 3.5 for personal attitudes, and
4.3 for e-cig regulation attitudes. A higher proportion of those that do not recommend e-cig
were from a medical background (OR=6.6, 95% CI1.5-29.0), had a higher mean regu-
lation attitude score (OR=4.9, 95% CI1.1-22.5) and lower mean general attitude score
(OR=0.2, 95% CI 0.1-0.9). Conclusion A high proportion of Israeli smoking cessation
practitioners would not recommend e-cig as a cessation aid under any circumstances.
Practical clinical guidelines, with training, are needed to guide practitioners to navigate
the controversy around e-cig and better support their clients.
FUNDING: Nonprot grant funding entity
PS2-69
PRICE PROMOTIONS OF VAPING PRODUCTS IN ONLINE STORES
Shaoying Ma, Shuning Jiang, Meng Ling, Jian Chen, Ce Shang. The Ohio State Univer-
sity, Columbus, OH, USA.
Signicance: The use of electronic cigarettes by adolescents has increased dramati-
cally in the last decade. Based on the model of regulating cigarettes, e-cigarette pricing
policies (e.g., taxation and price promotion restrictions) have the greatest potential to
prevent e-cigarette use initiation and escalation. As of May 2021, 28 states, DC, and 9
local jurisdictions have imposed excise taxes on e-cigarettes. However, tax increases
may be oset by price promotions. In addition, research on evaluating pricing policies has
been hindered by the lack of price and price-promotion data from online vaping stores.
This study makes a signicant contribution to the literature on novel tobacco products by
collecting price promotion data of online vape shops, assessing price promotion practices
in online stores, and presenting components of nal purchase price paid by customers
who shop online for vaping products. Methods: To address the current knowledge gap on
the impact of e-cigarette pricing policies, we collect data on e-cigarette price promotion
activities from online stores, using web scraping. Specically, from February to May
2021, we scraped price promotion data from ve popular online vaping stores that sell
nationwide to the U.S., and obtained price promotion data for over thirteen thousand
e-liquid products in those ve stores. We present descriptive analyses of promotional
discounts on those products oered by the online stores, including distributions of price
promotion as well as after discount price, by store in box plots. Results: Price promotional
discounts on e-liquid products are prevalent in online vaping stores. 13,328 (99.24%) of
the e-liquid products in our sample had promotional discounts, and only 102 products
had no discount. Each online store on average oered from 21.14% and 48.38% o
discount for its e-liquid products. The distribution of after discount price is largely similar
across the ve stores, and there is some evidence that each store had adopted dierent
price promotion strategies. Conclusion: The eect of e-cigarette excise tax may be
oset by price promotion activities in online vape shops, and our study sheds light on
future research direction that examines pricing policies on e-cigarettes.
FUNDING: Academic Institution
PS2-70
A QUALITATIVE ANALYSIS OF ELECTRONIC NICOTINE
DELIVERY SYSTEMS USAGE AMONG ADOLESCENTS AND
YOUNG ADULTS DIAGNOSED WITH ATTENTION DEFICIT
HYPERACTIVITY DISORDER IN MONROE COUNTY, NY
Duru Erkan1, Astghik Baghinyan2, Derek Guo2, Skylar Joseph3, Manpreet Kaur2, Jean
Lee2, Matthew Quick2, Holly Widanka2, Phillip Vaughan2, Deborah J. Ossip2, Scott McIn-
tosh2. 1University of Arkansas, Fayetteville, AR, USA, 2University of Rochester Medical
Center, Rochester, NY, USA, 3Xavier University, New Orleans, LA, USA.
Background: Attention Decit Hyperactivity Disorder (ADHD) symptoms such as
hyperactive-impulsivity, poor decision making, and inattention are associated with an
increased Electronic Nicotine Delivery Systems (ENDS) use, especially among adoles-
cents and young adults. ENDS usage is 50% higher among youth with parent-reported
ADHD diagnosis than youth without ADHD. Due to this association, experts recommend
1) better ENDS screening for youth with ADHD, 2) better intervention programming to
target this at-risk population, and 3) better educating this population about the dangers
of vaping. Methods: Two young-adult vapers with ADHD, two pediatricians, and two
family-physicians were interviewed in order to explore the relationship between ENDS
use and ADHD in adolescents and young adults of Monroe County and to assess how
well expert recommendations are followed to limit the eects of this relationship. These
key informant interviews were conducted virtually, and results were analyzed qualitatively
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
through open coding thematic analysis by two independent coders based on Grounded
Theory. Results: Results indicate that physicians do not observe a relationship between
ADHD and vape use, nor do they screen specically for vaping in ADHD check-ups.
On the other hand, vapers who have ADHD stress that most of their peers with the
same condition vape, and that vaping is a method of self-medication for coping with
the symptoms that make day-to-day function dicult. As expected, both vapers and
physicians asked for better education on this topic in Monroe County schools and on
social media platforms. In addition, physicians believe that more condential and detailed
screening on vape use with ADHD patients could facilitate improved physician/patient
dialogue. Conclusion: Although there is more to be studied, there is a noteworthy and
often overlooked association between ADHD and ENDS use. Changing the language
used while screening for substance-use, raising awareness with tailored ADHD infor-
mation on tobacco cessation training websites and quit sites, and producing social
media infographics would all be inuential rst steps in limiting ENDS use in youth with
ADHD. Supported by National Cancer Institute (NCI) and the (FDA) #U54CA228110
FUNDING: Federal
PS2-71
E-LIQUID WEB IMAGES FROM ONLINE VAPING STORES
AN ANALYSIS OF WARNINGS, COLORS AND FLAVORS ON
PRODUCT PACKAGES
Shaoying Ma, Shuning Jiang, Gloria Hernandez, Meng Ling, Jian Chen, Ce Shang.
The Ohio State University, Columbus, OH, USA.
Signicance: Electronic cigarette use has increased signicantly and raised concern
in the past decade. E-cigarettes are heterogeneous in avor and device type; online
vaping stores are one of the most common outlets for e-cig users to purchase vaping
products, and over 90% of vapers reported using e-liquid products that contain nicotine.
However, there is limited evidence on the marketing strategies of online stores. This
study collects e-liquid packaging data with respect to the placement of warnings, colors
and avor descriptions from ve popular online vaping stores that sell nationwide to
the U.S. Methods: We collect data of e-liquid products from ve online vaping stores
using web data extraction. We then collect information of warnings (including locations
on package images), colors and avor descriptions from the web images of e-liquid
packages. We have between 666 to 1,569 unique weblinks to e-liquid package images
from each store. Results: We document whether the package displays warning, location
of warning, colors as well as avor descriptions on package, based on each web image
of e-liquid products. We analyze how e-liquid manufacturers present avors on packages
online, and evaluate how colors of e-liquid packages communicate avors. We classify
avor data from e-liquid web images, and present the popular avors in online vaping
stores. We also document other information on package images such as logo and
design. Conclusion: We evaluate how online stores present product information using
package images with regards to the display of warnings, colors and avor descriptions,
which could inform e-cigarette regulations.
FUNDING: Academic Institution
PS2-72
PREVALENCE OF TOBACCO USE AMONG YOUTH IN LAO
PEOPLE’S DEMOCRATIC REPUBLIC - RESULTS FROM THE
GLOBAL YOUTH TOBACCO SURVEY, 2016
Shweta Vishwas Kulkarni1, Khatthanaphone Phandouangsy2, Phonepadith Xang-
sayarath3, Dalouny Xayavong3, Chanthavy Soulaphy3, Phuc H. Le4, Thanh C. Bui5.
1University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, 2National
Tobacco Control Committee, Department of Hygiene and Health Promotion, Minis-
try of Health of Lao PDR, Vientiane, Lao People’s Democratic Republic, 3National
Center for Laboratory and Epidemiology, Ministry of Health of Lao PDR, Vientiane,
Lao People’s Democratic Republic, 4Center for Value-Based Care Research, Cleveland
Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA, 5University of Oklahoma
Health Sciences Center, College of Medicine, Department of Family and Preventive
Medicine, Oklahoma City, OK, USA.
Background: Tobacco consumption among youth is associated with sustained tobacco
use and a leading cause of premature mortality, yet there is limited published literature
about youth tobacco use in Lao People’s Democratic Republic (Lao PDR). This study
aims to examine the prevalence of and factors associated with tobacco use among Lao
youth. Methods: Data were from the 2016 Global Youth Tobacco Survey conducted in
Lao PDR. A two-stage cluster sampling design (probability proportional to school enroll-
ment size to select middle and high schools and systematic equal probability sampling
to select classes) was used to identify a representative sample of 6550 students from 78
schools nationwide. Weighting was applied to account for the complex sampling design.
Ever using tobacco included former tobacco use (used in the past but not in the last 30
days) and current tobacco use (used in the last 30 days). We used multivariable logistic
regression models to evaluate the adjusted associations between sociodemographic
characteristics and tobacco use. Results: The prevalence of tobacco use among Lao
youth was 7.8% for cigarette smoking (boys, 13.6%; girls, 2.4%), 2.2% for electronic
cigarettes (boys, 2.7%; girls, 1.7%), 1.5% for shisha (boys, 2.1%; girls, 0.8%). Adjusted
analysis showed that the prevalence of ever smoking cigarettes was higher among older
age groups (P-trend<0.001), among boys (compared with girls, odds ratio [OR], 4.15
[95% condence interval (CI): 3.55-4.85]), and among those who had an average weekly
allowance of ≥50 Kip to spend by themselves (compared with those with <50 Kip, OR,
1.93 [95% CI: 1.57-2.36]). Ever using tobacco was also associated with seeing tobacco
use on television or in movies (OR, 1.98 [95% CI: 1.64-2.38]), seeing advertisements for
tobacco products (OR, 1.69 [95% CI: 1.43-2.00]), and the belief that tobacco smoking is
not harmful (OR, 1.78 [95% CI: 1.49-2.13]). Conclusion: Cigarette smoking prevalence
among Lao youth is high compared to other countries in the region, particularly among
boys. Further national tobacco control eorts are needed to prevent smoking initiation
and support tobacco cessation for this population.
FUNDING: Federal; Nonprot grant funding entity
PS2-73
NICOTINE POUCHES: A STRATEGY TO HOOK A NEW COHORT
ON NICOTINE WHILE MAINTAINING ADDICTED SMOKERS
Leah M. Ranney1, Guido Baler1, Sonia A. Clark1, Kristen L. Jarman1, M. Justin Byron2.
1University of North Carolina at Chapel Hill, Cary, NC, USA, 2University of NC at Chapel
Hill, Chapel Hill, NC, USA.
Signicance: Nicotine pouches are an emerging segment of tobacco products. Little
is known about how these products are perceived. We qualitatively investigated the
impressions and risk perceptions of a nicotine pouch product among adults who smoke.
Methods: We conducted semi-structured Zoom interviews with 30 adults who smoke
cigarettes. We showed participants a brochure for the ‘on!’ nicotine pouch product and
a photograph of the product and asked their impressions. We coded transcripts using
a thematic content analysis approach. We then summarized participants’ perceptions
of the advertisement and product. Results: Of the 30 participants, 13 were male, 15
were female, and were 2 non-binary and the mean age was 43. Central themes that
emerged included: 1) current smokers perceived that the on! brochure and the product
targets youth and adults who smoke, and 2) participants reported hesitancy towards
using ‘on!’ because of health concerns (i.e., oral cancers), and product composition
and functionality (i.e., contents and delivery mechanism). Participants identied various
aspects of the on! brochure and product as potentially appealing to youth, including the
concealability, avor options, and colorful design. Participants also discussed how adults
who smoke may use on! as a substitute for smoking in restricted areas or potentially as
a way to quit smoking. Quite a few participants expressed hesitancy to use on! nicotine
pouches because they were concerned about oral cancer and other possible health
eects. Conclusions: Adults who smoke perceived that the on! product may appeal
to youth or may be used by adults who smoke in restricted areas. Given the possible
appeal to youth and available product avors, FDA may need to closely monitor this class
of nicotine products and enact regulations as needed to prevent a surge of youth use.
FUNDING: Federal
PS2-74
CIGARETTE SMOKING ATTRIBUTABLE INCOME LOSS IN THE
U.S., 2019: NATIONAL AND STATE-LEVEL ESTIMATES
Nigar Nargis, Samuel Asare, Ashley Xue, Anuja Majmundar, Priti Bandi, Farhad Islami,
Robin Yabro, Ahmedin Jemal. American Cancer Society, Atlanta, GA, USA.
Signicance: The economic burden of smoking is reected in health expenditures and
productivity loss from smoking-attributable morbidity and all-cause mortality. There are
also spillover eects of smoking-related risky behavior. These economic eects prop-
agate into future through past income levels imposing signicant cumulative burden.
Data on the economic burden of smoking in the U.S. are limited and dated. This study
used a comprehensive approach to provide contemporary estimates of the economic
burden of cigarette smoking in the U.S. Methods: The elasticity of per capita personal
income with respect to adult smoking prevalence was estimated using a reduced-form
Cobb-Douglas production function in a mixed-eects generalized linear model of
state-level panel data for 2011-2019, controlling for determinants of income. The annual
economic burden of smoking in 2019 by state was estimated in $2021, applying the
estimated elasticity to the counterfactual of 100% smoke-free state. The cumulative
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
burden of smoking over 2011-2019 was estimated in $2021 based on the coecient of
lagged income. The state-level estimates were summed to obtain the national estimate.
State-level smoking prevalence data were from the Behavioral Risk Factor Surveillance
System. Per capita personal income data were from the Bureau of Economic Analysis.
Results: The elasticity of per capita personal income with respect to cigarette smoking
prevalence is -0.048 (P<0.05), suggesting that a 100% reduction in smoking prevalence
can result in a 4.8% income gain. At the national level, the annual total income loss due
to cigarette smoking was $890 billion (4.1% of GDP), and the cumulative income loss
was $3.9 trillion (17.8% of GDP) in 2019. By state, annual per capita income loss ranged
from $1867 in Mississippi to $3989 in the District of Columbia. Annual total income loss
ranged from $1.6 million in Vermont to $126.3 million in California, the most populous
state. Cumulative income loss ranged from $7.7 billion in Vermont to $561.6 billion in
California. Conclusion: Income loss from smoking was substantial and far exceeded
prior estimates. Mitigating this economic loss will require stronger evidence-based
tobacco control measures.
FUNDING: Unfunded; Other
PS2-75
DAILY FLUCTUATIONS IN DRINKING INTENSITY--LINKS WITH
VAPING AND COMBUSTIBLE USE OF NICOTINE AND MARIJUANA
Michael Parks1, Jennifer Maggs2, Megan Patrick3. 1University of Minnesota Medical
School, Minneapolis, MN, USA, 2Pennsylvania State University, State College, PA, USA,
3University of Michigan, Ann Arbor, MI, USA.
Background: Dierences in alcohol use are associated with nicotine or marijuana use
between-persons, but there is less understanding about how within-person dierences
in alcohol use across days relate to nicotine or marijuana use. Modes of nicotine and
marijuana use have changed: There is a nicotine vaping epidemic among adolescents
and young adults, and marijuana vaping increased in prevalence in 2018 and 2019. Tra-
ditional modes also still deserve attention, as cigarette smoking initiation and escalation
is also increasingly occurring in young adulthood. Consequently, smoking and vaping
of nicotine or marijuana among young adults are now critical public health issues. Yet,
limited extant research uses national samples of young adults to explore how alcohol
use is associated with dierent modes of nicotine and marijuana use on the same days.
Methods: Participants were past 30-day drinkers in the U.S. nationally representative
Monitoring the Future study of 12th graders in 2018 who also reported alcohol use
during a 14-day data collection one year later in the Young Adult Daily Life Study in
2019 (N=487). Weighted multilevel modeling estimated within- and between-person
associations of drinking intensity with cigarette smoking, nicotine vaping, marijuana
smoking, and marijuana vaping. Results: Within-person increases in drinking intensity
on a given day were associated with cigarette smoking, nicotine vaping, and marijuana
smoking, but not marijuana vaping. There were signicant between-person associations
of greater means of drinking intensity (across the entire 14-day study period) and each
outcome, except for cigarette smoking. Conclusion: Drinking intensity on a given day
was associated with multiple modes of nicotine use and marijuana smoking that day.
Nicotine and marijuana use remain critical areas of concern for public health, and future
research and interventions should consider the comorbidity of drinking intensity and
modes of nicotine and marijuana use. Focusing on the same-day use of alcohol may
provide a tailored avenue for preventing and reducing nicotine and marijuana use in
young adulthood.
FUNDING: Federal
PS2-76
PROTECTIVE FACTORS FOR NICOTINE AND MARIJUANA
VAPING AMONG US ADOLESCENTS
Michael Parks1, Megan Patrick2. 1University of Minnesota Medical School, Minneapolis,
MN, USA, 2University of Michigan, Ann Arbor, MN, USA.
Introduction: Nicotine and marijuana vaping among U.S. adolescents are public health
priorities. Research has assessed demographic and risk factors related to vaping, but
there is a dearth of research on protective factors for vaping in a national sample. Based
on the healthy youth development (HYD) perspective, the developmental assets frame-
work was used to assess cumulative protective factors and vaping in a national sample
of adolescents. Methods: Data came from the nationally representative Monitoring the
Future (MTF) study, consisting of 12th graders (N=6982) from the 48 contiguous U.S.
states (2017-2019). Past 30-day nicotine and marijuana vaping and developmental
assets (low, medium, or high) were examined. Covariates included demographics and
other substance use. Weighted descriptive statistics, logistic regression, post-estimation
analyses, and multiple imputation for missing data were used. Results: Students with
higher assets had lower odds of nicotine and marijuana vaping, even after adjusting
for covariates. The odds of nicotine vaping were lower for students with medium assets
(AOR=0.65; 95% CI=0.54, 0.78) and high assets (AOR=0.22; 95% CI=0.16, 0.29)
compared to students with low assets. Similarly, the odds of marijuana vaping were
lower for youth with medium assets (AOR=0.54; 95% CI=0.42, 0.69) and high assets
(AOR=0.09; 95% CI=0.05, 0.18) compared to low assets. The individual assets of social
competence and positive peer norms were especially important as they were strongly
protective against both forms of vaping. Conclusions: The HYD perspective and the
developmental assets framework apply to the critical issues of nicotine and marijuana
vaping among U.S. adolescents. Promoting cumulative assets may help prevent vaping
among U.S. adolescents, and increasing the specic assets of social competence and
positive peer norms could be particularly fruitful.
FUNDING: Federal
PS2-77
QUITLINE AND QUITSITE RESOURCES FOR LGBT NICOTINE
USERS
Skylar Joseph1, Astghik Baghinyan2, Duru Erkan3, Derek Guo2, Manpreet Kaur2, Jean
Lee2, Matthew Quick2, Phillip Vaughan2, Holly Widanka2, Deborah Ossip2, Scott McIn-
tosh2. 1Xavier University, New Orleans, LA, USA, 2University of Rochester Medical
Center, Rochester, NY, USA, 3University of Arkansas, Fayetteville, AR, USA.
Background: The LGBTQ population has had a historically higher rate of nicotine/
tobacco product use when compared to the general population. Cigarette smoking
prevalence was 20.3% among LGBTQ adults compared to 15.3 among straight adults,
according to 2016 data. Eorts aimed at providing education on LGBTQ and tobacco
use have grown. This may come In an age where web-based media is the main form
of connecting with the world, it is important to have quality cessation support available
online because that may be the one and only contact an individual may have with a
cessation support service. An LGBTQ individual may be seeking out a service that
will support them in their unique needs, but if they do not see that, they may be less
likely to interact with that service. The dierence in tobacco use across subgroups of
the sexual minorities makes the issue more complicated. Targeted outreach eorts
have been noted, but it does not seem to be a concerted eort across all quitlines and
respective quitsites. This study aimed to assess the availability of specialized tobacco
cessation support for the LGBTQ population. Methods: A qualitative analysis of quit-
lines and quitsites was conducted to determine if LGBTQ-specic cessation support
was available. Each state quitsite was studied to determine what information was there
and in what form it was presented. Semi-structured interviews were conducted with
four representatives from North American Quitline Consortium-associated quitlines
and four physicians in Monroe County, NY. Open coding based on grounded theory
allowed for a closer analysis of interview data. Results: Only 23 of the 51 states and
districts studied had anything LGBTQ-related on their respective quitsites. Despite most
states’ quit line proles listing having LGBTQ specic material available, over half do
not have anything regarding this on their quitsites. The key informant interviews gave
a general idea of the eorts of the various quitlines to develop and improve existing
protocols and outreach programming. Emerging themes of Training/Coaching, Special
Populations, LGBTQ+, Tailored Approach, Technology/Social Media, Building Rapport,
Dialogue and Accessibility were noted across all interviews. Conclusion: The overall
study demonstrates how tobacco control eorts have branched out to focus more on
vulnerable populations, including LGBTQ. The present availability of LGBTQ-specic
material through quitsites and quitlines could be improved to include all states. Through
a collaborative eort between the quitlines, the development of a more centralized way
to convey this information could occur. Supported by National Cancer Institute (NCI)
and the (FDA) # U54CA228110.
FUNDING: Federal
PS2-78
OTHER TOBACCO PRODUCTS AND CANNABINOIDS USED BY
REGULAR E-CIGARETTE USERS
Joshua K. Sinamo, Jerey J. Hardesty, Qinghua Nian, Elizabeth Crespi, Kevin Weld-
ing, Ryan David Kennedy, Joanna Cohen. Institute for Global Tobacco Control, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Signicance: It is estimated that up to 26% of tobacco users in the U.S. use more
than one kind of tobacco product (dual or poly-use). Little is known about poly- tobacco
and/or cannabinoid use among those who use e-cigarettes. In this study we assess the
average number of and most common tobacco and cannabinoid products used by regular
e-cigarette (ECIG) users by varying cigarette smoking status. Methods: 1209 U.S. adults
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
[21+] using ECIGs 5+ days/week completed a survey between May and October 2020.
Participants were categorized into two groups: ECIG users with no concurrent cigarette
use in past 30 days [n=711] and ECIG users with concurrent cigarette use in past 30
days [n=498]. All were asked about past 30-day use of other products, including cigars,
pipes with tobacco, cigarillos/ltered cigars, chew tobacco or dip/snu/snus, hookah/
shisha, marijuana (dry herb+THC), and CBD. Descriptive analyses, Mann-Whitney
U, and Chi-squared tests were utilized. Results: 71.7% of ECIG users who smoked
cigarettes and 52.7% of ECIG users who did not smoke cigarettes used at least 1 other
product. ECIG users who smoked cigarettes co-used signicantly [p<0.0001] more
products [mean=1.50] compared to those who did not smoke cigarettes [mean=0.91].
ECIG users who smoked cigarettes were signicantly [p<0.05] more likely to use each
product compared to those who did not smoke cigarettes: marijuana (dry herb + THC)
[60.4% vs. 43.6%], CBD [49.0% vs. 30.2%], cigarillos/ltered cigars [21.9% vs. 7.5%],
hookah/shisha [9.2% vs. 5.1%], chewing tobacco or dip/snu/snus [8.8% vs. 3.1%],
cigars [8.0% vs. 3.1%], and pipes with tobacco [4.2% vs. 1.8%]. Conclusion: ECIG
users who smoked cigarettes used more tobacco/cannabinoid products on average
and were more likely to use each product individually. Marijuana and CBD were the
most widely used products by both groups. Among tobacco products, cigarillos/ltered
cigars and hookah/shisha were the most widely used for both groups, respectively.
FUNDING: Federal
PS2-79
NICOTINE/TOBACCO USE AMONG GENDER-FLUID AND
GENDER-STABLE ADOLESCENTS AND ADULTS IN THE U.S.
Luisa Kcomt1, Rebecca J. Evans-Polce2, Curtiss W. Engstrom2, Carol J. Boyd2, Philip
T. Veliz2, Brady T. West2, Sean E. McCabe2. 1Wayne State University, Detroit, MI, USA,
2University of Michigan, Ann Arbor, MI, USA.
Signicance: Prior work has shown that nicotine/tobacco use is more prevalent among
transgender populations (individuals whose gender identity diers from their assigned
sex at birth) relative to cisgender populations. Despite increased research on transgender
health in recent years, there remains a paucity of information on gender-uid individuals
(i.e., persons who experience changes in their gender identity). We aimed to estimate
the prevalence of nicotine/tobacco use among U.S. adolescents and adults who are uid
versus stable in their gender identities. Methods: We t multivariable logistic regression
models to data from Waves 2 to 4 (2014/15 to 2016/18) of the Population Assessment of
Tobacco and Health (PATH) Study (n=33,197 U.S. individuals aged 14 years and older).
We examined associations of gender stability/uidity over three waves with nicotine/
tobacco use at wave 4. Dierences in any past 30-day tobacco, cigarette, e-cigarette,
other tobacco, and poly-tobacco use were assessed among cisgender-stable, trans-
gender-stable, and gender-uid participants. We also examined tobacco use among
gender-uid subgroups (i.e., cisgender-to-transgender, transgender-to-cisgender, and
multi- or trans-to-trans uid). All models adjusted for sex, age, race/ethnicity, geographic
region, sexual stability/uidity, and past-year psychological distress. Results: Prevalence
of any past 30-day tobacco use was higher among gender-uid individuals (cisgen-
der-to-transgender, 46.0%; multi- or trans-to-trans uid, 44%; and transgender-to-cis-
gender, 38.4%) and lower among gender-stable individuals (transgender-stable, 37.8%
and cisgender-stable, 26.7%). Gender-uid individuals had signicantly increased odds
of all past 30-day tobacco use outcomes (adjusted odds ratios ranged from 1.9 to 2.9),
compared with cisgender-stable individuals. Conclusion: Gender-uid individuals are
at higher risk for nicotine/tobacco use, placing them at greater risk for smoking-related
health consequences. Creating tobacco prevention supportive of gender diversity may
reduce nicotine/tobacco use among gender-uid people.
FUNDING: Federal
PS2-80
ACTIVE SMOKERS ARE AT HIGHER RISK OF COVID-19 DEATH
Roengrudee Patanavanich, Tanatorn Siripoon, Salin Amponnavarat. Faculty of Medi-
cine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Signicance: Current evidence indicates that smoking worsens COVID-19 out-
comes. However, when studies restricted their analyses to current smokers, the risks
for COVID-19 severity and death are inconsistent. This meta-analysis explored the
association between current smoking and the risk for mortality based on the studies
that reported all three categories of smoking (current, former, and never smokers) to
overcome the limitation of the previous meta-analyses which former smokers might
have been classied as non-smokers. Methods: We searched PubMed, Embase,
and the interrelated articles up to June 2021. We included studies reporting all three
categories of smoking behaviors of COVID-19 patients and mortality outcomes. We
used a random-eects meta-analysis and meta-regression to examine relationships in
the data. Results: A total of 35 articles with 37,185 COVID-19 patients was included
in this meta-analysis. The meta-analysis conrmed the association between current
smoking (OR 1.27, 95% CI: 1.03-1.58, p<0.001), former smoking (OR 1.75, 95% CI:
1.53-2.00, p<0.001) and COVID-19 mortality. We also found that the risk for COVID-19
death in current smokers does not vary by age, but signicantly drops by age in former
smokers. Moreover, current smokers in non-high-income countries have higher risks
of COVID-19 death compared with high-income countries (OR 2.38, 95% CI: 1.59-3.56
vs. OR 1.14, 95% CI: 0.91-1.43). Conclusions: Current and former smokers are at
higher risk of dying from COVID-19. The eects seem to be lower among older adults
who had quitted smoking. Tobacco control should be strengthened to encourage current
smokers to quit and prevent the initiation of smoking. The government, physicians, and
public health professionals should take the COVID-19 pandemic as an opportunity to
promote smoking prevention and cession.
FUNDING: Unfunded
PS2-81
CHANGE IN INTERNET SEARCHES FOR SMOKING CESSATION
DURING THE COVID-19 PANDEMIC IN THE UNITED STATES
Derek DeBellis1, Elias M. Klemperer2. 1Google, Mountain View, CA, USA, 2University
of Vermont, Burlington, VT, USA.
Background: Historically, natural disasters have resulted in decreased tobacco ces-
sation, but it remains unclear how the COVID-19 pandemic is inuencing intention to
quit smoking in the United States at the population level. This research explores the
impact of the COVID-19 pandemic on smoking cessation interest using internet search
behavior in the United States. Method: Publicly available Google search trends data
were used to assess change in interest in smoking cessation. The data were a scaled
time series indicating the relative volume of search queries containing either “quit smok-
ing” or “stop smoking” in the United States. The data were compiled at weekly intervals
from January 1, 2016 to January 1, 2021. The pre-Covid onset portion of the data was
used to establish a forecast that was used to set expectations for the post-Covid onset
search trends. These expectations were then compared to the actual search trends to
evaluate the extent actual search trends dier from what would have been expected
in the absence of COVID-19. We explored 140 combinations of start dates and end
dates dening the post-onset periods (February 2, 2020 to December 20, 2020) to ac-
count for the fact that the onset of COVID-19 in the United States occurred in a series
of cascading events and not a single moment. We replicated this process using the
search term “weather” as a control for comparison. Results: In 101 (72.1%) of the 140
iterations, the volume of actual searches for “quit smoking” or “stop smoking” after the
onset of COVID-19 was lower than 90% of the respective iteration’s 1000 counterfactual
simulations of internet search volume, each representing a plausible expectation had
COVID-19 not occurred. In contrast, the actual volume of searches for “weather” after
the onset of COVID-19 deviated this dramatically from expected values in only 9% of the
140 iterations. This suggests a specic and robust attenuating eect of the COVID-19
pandemic on smoking cessation search behavior. Conclusion: These ndings suggest
that interest in smoking cessation substantially decreased as a result of the COVID-19
pandemic in the United States.
FUNDING: Unfunded; Federal; Other
PS2-82
EXAMINATION OF GENDER DIFFERENCES IN IMPACT OF
SINGLE/DUAL USE OF ELECTRONIC VAPOR PRODUCTS AND
CANNABIS ON MENTAL HEALTH SYMPTOMS
Wura Jacobs1, Georgina Orozco2, Guadalupe Villanueva2. 1California State Univer-
sity, Stanislaus, Lathrop, CA, USA, 2California State University, Stanislaus, Turlock,
CA, USA.
Signicance: Unlike traditional cigarettes and cannabis, the impact of nicotine and
cannabis vaping on adolescents’ mental health is not well-known. Recent evidence
indicates increased odds of depressive symptoms and suicide ideation among e-cigarette
and marijuana users, however, there is no indication whether these odds are similar for
male and female adolescents. To address this gap, this study aimed to identify gender
dierences in suicide ideation and depression symptoms among US adolescents who
use e-cigarettes and/or marijuana. Methods: Data from the most recent (2019) national
Youth Risk Behavior Survey were used, including 12,346 participants (51.4% female)
with complete data. Multivariable logistic regression analyses were conducted to explore
gender dierences in the associations between single or dual use of e-cigarette and
marijuana on depression and suicidal symptoms in the past 12 months adjusting for
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
grade and race/ethnicity. Results: Compared to non-use and dual-using males, female
dual users were more likely to report they felt sad/hopeless (aOR=3.21 95%CI=2.51-
4.12), considered suicide (aOR=3.53 95%CI=2.74-4.55), planned suicide (aOR=3.23
95%CI=2.64-3.95), attempted suicide (aOR=4.41 95%=3.12-6.22), and suered an
injury following a suicide attempt (aOR=6.62 95%CI=3.96-11.05). Similarly, female
single users of cannabis and EVP had increased odds (ranging from 1.88-7.43) of
reporting depression and suicidal symptoms compared to males and non-users.
Conclusion: Gender-based dierences in mental health outcomes among EVP and/or
cannabis users exists and may result from biomedical (genetic, hormonal, anatomical,
physiological), psychological (personality, coping mechanisms), or epidemiological
(population-based risk factors) indicators. Results suggest the need for targeted research
and interventions to address this problem among female users who are at most risk
for mental health issues.
FUNDING: Unfunded; Academic Institution
PS2-83
DEVELOPMENT AND PSYCHOMETRIC EVALUATION OF THE
KHAINI SMOKELESS TOBACCO DEPENDENCE SCALE (KSLTDS)
Vaibhav P. Thawal. University of Newcastle, Australia, Newcastle, Australia.
Background: There is a need for SLT scales which have been robustly developed and
tested with SLT users. Khaini is a smokeless tobacco product commonly used in the
Southeast Asia region. To assist with cessation of khaini use it is crucial to assess the
severity of dependence. No measures exist to assess dependence on khaini use and
this study aimed to develop a valid and reliable scale to serve this purpose. Methods:
The study was carried out using recommended methods for scale development in three
phases: item development, scale development and scale evaluation. Scale development
was guided by a theoretical framework, a literature review of existing measures and in-
depth interviews with 21 khaini users recruited from a tertiary care hospital in Mumbai.
The development process resulted in identication of domains for dependence and
development of an item pool. Cognitive interviews and pre-testing were conducted with
20 khaini users to assess content validity. A cross sectional survey with 323 khaini users
was conducted and exploratory factor analysis (EFA) was used to determine the factor
structure of the draft scale. A systematic reduction method using decisions based on
psychometric robustness and clinical importance was used to exclude redundant items
to develop the nal scale. Concurrent validity, criterion validity, convergent validity and
internal consistency of the total scale and sub-scales were assessed. Results: A 20
item scale, the Khaini SLT Dependence Scale (KSLTDS) was developed. EFA indicated
a three-factor structure with craving, habit and routine subscales. The KSLTDS showed
evidence of acceptable criterion validity, concurrent validity and convergent validity. The
KSLTDS showed high internal consistency (Cronbach’s alpha 0.94). Conclusion: The
KSLTDS is a valid and reliable scale for assessing dependence on khaini and can be
used for clinical and research purposes. Further studies are required to revalidate the
psychometric properties of the KSLTDS with dierent khaini user populations.
FUNDING: Academic Institution
PS2-84
DETERMINANTS OF WEIGHT CONCERNS AMONG SMOKERS IN A
PHYSICAL ACTIVITY (PA)-BASED CESSATION PROGRAM
Cheri V. Kilmurray1, Tony Lugemwa1, Mark W. Vander Weg2, Nancy Wilson1, George
Relyea1, Barbara McClanahan1, Michelle B. Stockton1, Kenneth D. Ward1. 1University
of Memphis, Memphis, TN, USA, 2The University of Iowa, Iowa City, IA, USA.
Signicance: Concern about weight gain is a barrier to smoking cessation, but how it
relates to PA behavior and perceptions is unclear. This has implications for targeting
PA as a cessation strategy. Method: Baseline data were analyzed from a cessation trial
of 392 adults who received nicotine patch and cessation counseling and were random-
ized to community-based PA or general wellness counseling. Outcomes were 1) use
of smoking to control weight (“control”; continuous score) and 2) anticipating relapse
if weight gain occurred (“relapse”; yes vs. no) using validated instruments. Exposures
were self-reported PA and PA perceptions (self-ecacy, enjoyment of organized and
unorganized PA, personal and environmental barriers). Covariates were treatment
group and known determinants of post-cessation weight concerns including socio-de-
mographics, smoking behavior, diet, and BMI. From bivariate models examining main
and sex interaction eects, signicant variables were entered into a generalized linear
regression model or a logistic regression model to identify determinants most strongly
associated with control and relapse, respectively. Results: Both control and relapse were
signicantly (p<0.05) associated with being female (standardized b= 0.52, SE=0.10),
white (-0.12, 0.05), and less motivated to quit (-0.14, 0.05). Higher control scores also
were associated with engaging in less moderate intensity physical activity (-0.10, 0.05)
and higher BMI (0.21, 0.05). A signicant interaction indicated that men with higher
BMI anticipated relapsing if weight gain occurred, but no such association was found
for women (OR=2.54, 95% CI= 1.42-4.56). No other PA behaviors or perceptions were
associated with weight concerns. Conclusion: Smoking to control weight was associated
with engaging in less moderate intensity PA, but was not associated with perceptions
about PA. Anticipating relapse if weight gain occurred was not associated with PA be-
havior or perceptions. These results indicate that concerns about post-cessation weight
gain are unlikely to inuence engagement in PA in the context of a community-based
smoking cessation program.
FUNDING: Federal
PS2-85
LONGITUDINAL TRANSITIONS IN YOUTH TOBACCO USE,
FINDINGS FROM WAVES 1-4 OF THE PATH STUDY
Margaret G. Childers1, Katelyn F. Romm2, Ashley E. Douglas1, Bethany C. Bray3, Geri
Dino4, Melissa Blank1. 1Department of Psychology, West Virginia University, Morgan-
town, WV, USA, 2Milken Institute School of Public Health, George Washington Univer-
sity, Washington, DC, USA, 3Center for Dissemination and Implementation Science, The
University of Illinois at Chicago, Chicago, IL, USA, 4WV Prevention Research Center,
West Virginia University, Morgantown, WV, USA.
Signicance: The landscape of youth tobacco use is both multifaceted and dynamic. A
latent transition analysis identied classes of tobacco use and the likelihood of transi-
tioning between classes over time. Methods: Data derive from Waves 1-4 (2013-2018)
of the Population Assessment of Tobacco and Health Study. The sample consisted
of youth aged 12-17 (54.2% male; 54.5% White, 25.3% Hispanic) who self-reported
past 30-day use of at least one tobacco product (e.g., cigarettes, electronic cigarettes
[ECIGs], smokeless tobacco [SLT]) at one or more waves (N=975). Results: Six latent
classes were identied. Four classes were consistent across waves: Nonusers, Cigarette,
ECIG, and SLT Users. The remaining classes showed variable interpretations: at early
waves, there were Hookah and Experimental Polytobacco Users, whereas later these
resolved more specically into Cigarillo and Polytobacco Users. The Nonuser class
decreased in size over time (86-25%), whereas all other classes increased over time
(e.g., ECIG: 3%-29%). Of the three consistent classes, SLT Users were most stable
in their use (50-80% of users continued use), followed by Cigarette Users (40-59%).
Considerable movement occurred among Nonusers and ECIG Users. ECIG Users were
less likely to transition to Nonusers over time (80-45%), whereas Nonusers were more
likely to transition to ECIG Users over time (8-44%). For the more variable classes, early
Hookah Users tended to remain Hookah Users or transition to Nonusers (41-59%), but
later transitioned more to Polytobacco Use (37-80%). Experimental Polytobacco Users
maintained class stability in early waves (31-57%) but later transitioned to Cigarillo Users
or Nonusers (7-81%). Conclusion: While adolescent cigarette and SLT use remained
relatively stable over time, the likelihood of continuing ECIG use increased whereas
the likelihood of remaining a nonuser decreased. These latter ndings reect recent
changes in the tobacco marketplace and demonstrate the importance of interventions
and regulations targeted toward youth ECIG use.
FUNDING: Federal
PS2-86
CUSTOM AND NON-CUSTOM E-CIGARETTE LIQUID USERS’
DEVICE/LIQUID CHARACTERISTICS AND HEALTH OUTCOMES:
IMPLICATIONS FOR E-CIGARETTE REGULATIONS
Elizabeth Crespi, Jerey J. Hardesty, Qinghua Nian, Joshua Sinamo, Kevin Welding,
Ryan David Kennedy, Joanna E. Cohen. Johns Hopkins Bloomberg School of Public
Health; Department of Health, Behavior & Society; Institute for Global Tobacco Control,
Baltimore, MD, USA.
Signicance Some e-cigarette users mix or order custom liquids for their devices.
Regulatory actions (e.g. banning avored liquids) may result in increased use of custom
liquids. Understanding device/liquid characteristics and health outcomes of custom
and non-custom e-cigarette liquid users can inform product regulation, including po-
tential unintended consequences. We examined dierences in e-cigarette device/liquid
characteristics and health outcomes of custom (CLUs) vs non-custom (NCLUs) liquid
users to understand potential consequences of e-cigarette device/liquid regulations.
Methods From May-October 2020, adults aged 21+ (n=1209) using e-cigarettes 5+
times/week responded to a survey about health outcomes and submitted photos of their
most used device and liquid. Photo data were prioritized; if unavailable, self-report data
were used. Chi-squared and Mann-Whitney U tests were used to examine dierences
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
between CLUs (n=294) and NCLUs (n=915). Results 75.7% (n=915) of the sample used
non-custom liquids, 17.3% (n=209) used custom liquids mixed by someone else, and
7% (n=85) used self-mixed custom liquids. CLUs more often used devices with adjust-
able wattage/voltage (67.7% vs 37.1%; p<0.05), adjustable airow (58.5% vs 33.6%;
p<0.05), and customizable adaptive power (27.9% vs 14%; p<0.05). CLUs used lower
nicotine concentrations (14.3 vs 30.1 mg/mL; p<0.05) and more often used free-base
nicotine (72.8% vs 39.6%; p<0.05) than NCLUs. No statistically signicant dierences
were found for e-cigarette dependence or shortness of breath between CLUs and
NCLUs. Conclusions Custom and non-custom liquid users vary in the devices, nicotine
concentrations, and formulations they use, but not in their e-cigarette dependence or
shortness of breath. Regulations may dierentially impact these two groups (e.g. nicotine
concentration limits may lead to more compensatory vaping behavior changes among
NCLUs). Future research is needed to understand other characteristics of CLUs (e.g.
demographics, smoking status, e-cigarette device and liquid sources, reasons for use)
and potential health outcomes from custom liquids (e.g. accidental skin/eye exposure).
FUNDING: Federal
PS2-87
SMOKING, E-CIGARETTES AND THE EFFECT ON RESPIRATORY
SYMPTOMS AMONG A POPULATION SAMPLE OF YOUTH
Michael Chaiton1, Martha Pienkowski1, Susan Bondy1, Joanna Cohen2, Jolene Dubray1,
Thomas Eissenberg3, Pamela Kaufman1, Matthew Stanbrook1, Robert Schwartz4.
1University of Toronto, Toronto, ON, Canada, 2Johns Hopkins Bloomberg School of P,
Baltimore, MD, USA, 3VA Commonwealth University, Richmond, VA, USA, 4ON Tobacco
Research Unit, Toronto, ON, Canada.
Signicance E-cigarettes have been steadily increasing in popularity, both as cessation
methods for smoking and for recreational and social reasons. This increase in vaping
prevalence is especially concerning in youth and non-smokers, due to avoidable nic-
otine addiction, as well as cardiovascular and respiratory risks. We aimed to assess
respiratory symptoms in youth dual users of cigarettes and e-cigarettes compared to
smokers, vapers, and non-users. Methods A cross-sectional survey design was utilized
to assess Canadian youth aged 16-25 years old. Participants were recruited from the
Ontario Tobacco Research Unit Youth and Young Adult Research Registration Panel
November 2020 to March 2021. A total of 3,082 subjects completed the baseline survey
and were included in the analysis. The exposure of interest was smoking/vaping be-
haviour, and the outcome of interest was respiratory symptoms. Respiratory symptoms
were measured using the ve-item Canadian Lung Health Test. Vaping, smoking, and
dual use behaviours were assessed based on frequency and dosage (cigarettes/pus
per session or per day). Poisson regression analyses were performed while adjusting
for demographic confounders. We assessed the association between vaping frequency
and respiratory symptoms, the interaction between cigarette smoking frequency and
vaping frequency on respiratory health, as well as vaping device type, e-liquid avour,
and years vaping. Results An increase in daily dosage by 1 pu per day increased the
rate ratio of respiratory symptoms by a factor of 1.00072 (95%CI: 1.00051-1.00093;
p<0.001). For every additional cigarette smoked per day, the rate of respiratory symptoms
increased by a factor of 1.01627 (95%CI: 1.00832-1.02428; p<0·001). Daily cigarette
smokers exhibited a rate ratio of 1.41591 (95%CI: 1.24101-1.61545; p<0.001) compared
to former smokers, while never-smokers had a decreased rate ratio by a factor of 0.74711
(95%CI: 0.68015-0.82066; p<0.001) compared to former smokers. For every additional
cigarette smoked per day, each additional e-cigarette pu per day was associated with a
decrease in rate of symptoms by a factor of 0.99995 (95%CI: 0.99991-0.99999). There
was no signicant association between vaping device or e-liquid avour and respiratory
symptoms. Each year of vaping was found to increase rate of respiratory symptoms by
a factor of 1.11722 (95%CI: 1.06542-1.17155; p<0·001). Conclusion Mediation of risk
of respiratory symptoms was found amongst dual users of e-cigarettes and cigarettes
compared to exclusive cigarette smokers, but additional analysis is necessary to assess
the eectiveness of dual use for cessation, and the mechanisms behind this interaction.
However, non-smokers should not partake in e-cigarette vaping, as vaping does carry
negative health risks of its own.
FUNDING: Federal
PS2-88
PERCEIVED MESSAGE EFFECTIVENESS AND SOURCE TRUST
FOR E-CIGARETTE AND SNUS MODIFIED RISK MESSAGES
Olivia Wackowski1, Stefanie Gratale1, Richard O’Connor2. 1Rutgers Center for Tobacco
Studies, New Brunswick, NJ, USA, 2Roswell Park Comprehensive Cancer Center,
Bualo, NY, USA.
Signicance: Modied risk tobacco product (MRTP) messages may promote harm
reduction for smokers but also unintended product appeal among young non-users. We
examined reactions to potential MRTP messages for snus and e-cigarettes in an online
experiment. Methods: In January 2021, we randomly assigned 1018 adult smokers and
1051 young adult (ages 18-29) non-smokers to view one of three MRTP messages about
snus and e-cigarettes that claimed: 1) reduced exposure to chemicals; 2) a qualitative
risk reduction (e.g., that switching can reduce health harms); or 3) a quantitative risk
reduction (“95% less harmful than smoking”). Participants rated whether the message
was understandable, believable, and made them want to learn more about the product
and use the product (“perceived eectiveness”). Participants then viewed all three
messages together and chose which would make them most interested in that product.
Participants also selected the most and least trusted potential claim source from six
options.Results: In the snus experiment, there were no dierences by claim type on
perceived eectiveness variables. For e-cigarettes, participants rated the 95% less
harmful message as least believable and the chemical message as most believable (no
other dierences were found by claim type). Regardless of message type, there was
low agreement that the message viewed made participants interested in the product
(lower for snus versus e-cigarette messages and for young adult non-smokers versus
current smokers). Across both experiments, 54-70% agreed the message viewed was
understandable, but fewer found it believable (17-39%). In the forced-choice comparison,
most (46%) selected the qualitative risk reduction claim as the most impactful for snus,
followed by the “95% less harmful” (35%) and reduced chemicals (19%) claims; for
e-cigarettes, most (46%) selected the “95% less harmful” as the most impactful claim.
Most indicated that the CDC or their doctor would be the most trusted claim source
and industry the least trusted source. Conclusions: The impact of MRTP messages
may depend on an interplay of the product, message content, source and believability.
FUNDING: Federal
PS2-89
VALIDITY OF A LITTLE CIGARS/CIGARILLOS PURCHASE TASK
IN DUAL USERS OF CIGARS AND CIGARETTES
Erin Mead-Morse1, Rachel Cassidy2, Jennifer Tidey2, Cristine Delnevo3, Mark Litt4.
1UConn Health Department of Medicine, Farmington, CT, USA, 2Brown University, Prov-
idence, RI, USA, 3Rutgers-School of Public Health, Piscatway, NJ, USA, 4UConn Health
Division of Behavioral Science and Community Health, Farmington, CT, USA.
Introduction: Little cigars and cigarillos (LCCs) have become increasingly popular in the
US, but measures of their abuse liability are needed. We sought to validate a behavioral
economic purchase task for assessing the reinforcement value of LCCs in a population
of experienced LCC smokers. Methods: At baseline, 65 young adult (18-34 years) dual
users of LCCs and cigarettes provided a breath carbon monoxide (CO) sample and
completed a usual-brand LCC purchase task (LCCPT), past 30-day cigar use, and
several LCC dependence measures. From the LCCPT we calculated four observed
demand indices: intensity (consumption at $0), breakpoint (BP, rst price at which
consumption reaches 0), Omax (maximum expenditure), and Pmax (price at which Omax
occurred). Using the exponentiated demand model we estimated two derived demand
indices from the demand curves: Q0 (predicted consumption as price approaches $0)
and elasticity (α, sensitivity of consumption to price changes). We examined Spearman
correlations between LCCPT demand indices and LCC use, dependence, and CO. Using
multivariable regression we assessed demand indices as a function of dependence.
Results: Correlations between the demand indices and smoking and dependence
variables were in expected directions. All demand indices except BP and Pmax were
correlated with LCC use, and all indices were correlated with multiple measures of
dependence. Overall, greater demand for LCCs and less sensitivity to price changes
were correlated with greater LCC use and dependence. Intensity and Omax often had
the strongest magnitudes of correlations with dependence and use. No correlations
with CO were seen. For the regression results, higher intensity, Omax, and Q0 and lower
price sensitivity (lower α) were related to higher dependence. No associations were
found for BP and Pmax. Conclusions: Our ndings support the validity of the LCCPT in
a sample of experienced LCC smokers. The purchase task was able to quantify the
reinforcement value of LCCs, and predict levels of dependence. Validated measures
of LCC abuse liability are important for determining which product characteristics (e.g.,
avor) contribute to their reinforcing value.
FUNDING: Federal; Nonprot grant funding entity
133
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-90
DO HETEROSEXUAL WOMEN RESPOND NEGATIVELY TO ANTI-
TOBACCO MESSAGING TARGETING SEXUAL MINORITY WOMEN
Ashley Sanders-Jackson1, Dominik Neumann2, Elaine Hanby3, Andy Sl TanPhD MPH
MBA MBBS3. 1Michigan State University, East Lansing, MI, USA, 2Leibniz-Instut fur
Weissenmeden, Tubingen, Germany, 3University of Pennsylvania, Philadelphia, PA,
USA.
Signicance: Targeted health campaigns intended for minoritized populations may
produce undesirable “boomerang” eects on populations outside of the focus of the
campaign. Examples of such unintended eects include lowered eectiveness or
increased negative aect. In this study, we examined the perceptions of anti-smoking
messages designed for sexual minority women among samples of heterosexual and
sexual minority women. This analysis aimed to test whether heterosexual participants
would respond more negatively to messages that were designed specically for sexual
minority women. Methods: We used a two (cue-condition: LGBTQ group cue vs. control
group cue) by six (message repetition) mixed factorial experimental design. We created
a corpus of 28 anti-smoking messages and randomly showed participants six of these
messages in each condition. Messages in the cue condition included a tagline referencing
LGBTQ health and a rainbow logo while messages in the control cue condition included
references to women’s health and a dark pink logo. Using validated scales we measured
perceived message eectiveness (PME), perceived targetedness and reactance. We
ran separate ANOVA analyses for each dependent variable, including the interaction
between cue condition and sexual orientation. Results: Participants (Mage=24.13, SDage=
3.68) were between 18 and 30 (N=306) and identied as either bisexual (N=74), lesbian
(N=103), or heterosexual (N=125). Five women were daily smokers, 22 were non-daily
smokers, and 275 were non-smokers. There were no signicant interactions between
cue condition and sexual orientation. We found a statistically signicant main eect of
sexual orientation on targetedness F(2, 269) = 5.375, p = .005, η2 = 0.017, but no other
main eects across outcomes of interest. Discussion: Our results suggest that expo-
sure to LGBTQ group cues within anti-smoking messages designed for sexual minority
women did not result in heterosexual women reporting more negative responses than
sexual minority women. Therefore, heterosexual women viewing messages designed
for sexual minority women did experience the messages as less eective.
FUNDING: Federal
PS2-91
USING THE PURCHASE TASK TO DETERMINE
SUBSTITUTABILITY OF LITTLE CIGARS/CIGARILLOS AND
CIGARETTES IN YOUNG ADULT DUAL USERS
Erin Mead-Morse1, Rachel Cassidy2, Jennifer Tidey2, Cristine Delnevo3, Mark Litt4.
1UConn Health Department of Medicine, Farmington, CT, USA, 2Brown University, Prov-
idence, RI, USA, 3Rutgers-School of Public Health, Piscatway, NJ, USA, 4UConn Health
Division of Behavioral Science and Community Health, Farmington, CT, USA.
Introduction: Little is known about the relative addiction potential of cigarettes and
little cigars/cigarillos (LCCs) among young adults who smoke both products. This study
examined demand for cigarettes and LCCs, substitutability of LCCs for cigarettes, and
factors associated with demand and substitution. Methods: At baseline, 65 dual users
ages 18-34 completed single-commodity purchase tasks (PTs) for usual brand ciga-
rettes and LCCs and a cross-price purchase task in which both products were available
simultaneously (CPT). We calculated demand intensity (consumption when free), Omax
(max daily expenditure), Pmax (price at Omax), Breakpoint (BP, highest price willing to
pay), and elasticity (α, sensitivity of consumption to price increases) for each product.
From the CPT we estimated cross-price elasticity (CPE, sensitivity of LCC consumption
to cigarette price increases). Cigarette and LCC demand indices were compared using
non-parametric tests. In multivariable regression, we examined intensity, α, and CPE as
a function of dependence, smoking, and demographics. Results: Cigarettes had greater
median demand intensity, lower Pmax and BP, and similar Omax and α relative to LCCs.
The mean (SD) CPE was 0.27 (0.49), indicating that LCCs were partial substitutes for
cigarettes. For each product, higher intensity was associated with higher smoking and
dependence. Cigarette consumption was less sensitive to price changes (lower α) with
higher cigarette dependence and intensity and lower LCC intensity. LCC consumption
was less sensitive to price changes with higher LCC intensity and lower cigarette
intensity, but was not related to dependence. As consumption of one product became
more sensitive to price increases, consumption of the other product also became more
sensitive. Substitutability of LCCs for cigarettes increased (higher CPE) with higher
LCC intensity and price sensitivity, and was higher for avored than unavored LCCs.
However, use, dependence, and cigarette demand were not associated with CPE.
Conclusions: Among young adult dual users, demand for LCCs and cigarettes were
interrelated. LCCs were substitutes for cigarettes, particularly avored LCCs. Demand
for LCCs, but not cigarettes, was associated with greater substitutability.
FUNDING: Federal; Nonprot grant funding entity
PS2-92
ATTITUDES AND PERCEPTIONS ABOUT SMOKING CESSATION
IN UK INDIVIDUALS UNDERGOING TARGETED LUNG CANCER
SCREENING WHO RECEIVED A NEGATIVE (‘CLEAR’) RESULT: A
QUALITATIVE INTERVIEW STUDY
Alice Cotton1, Samantha Quaife2, Maria Duaso1. 1King’s College London, London,
United Kingdom, 2Queen Mary University of London, London, United Kingdom.
Signicance The UK is piloting ‘targeted’ lung cancer screening in adults aged 55-75
years with 30 pack-years smoking history. Half of those who attend lung screening
continue to smoke. There is lack of agreement on how best to integrate stop smoking
services, and quit rates remain low (around 9%) following screening. Receiving abnormal
screening results appears to motivate quit attempts, yet most screening participants
receive negative (clear) results. It is important to understand factors that motivate
smoking cessation in individuals who receive a normal result following screening.
Method Qualitative study theoretically framed by the Health Belief Model. Seven par-
ticipants who attended a targeted lung screening programme in London, UK, took part
in semi-structured interviews. Framework Analysis was used to identify perceptions of
harms caused by smoking, perceived benets of quitting, motivation, and condence
to quit. Results There was some awareness of the risks and harms of smoking but a
lack of concern. Participants were either unaware of or were in denial about the critical
role smoking plays in lung cancer risk. Feeling well and having no perceptible signs of
smoking damage equated to having nothing to worry about. Receiving a clear result
conrmed this, resulting in low motivation to quit. Beyond living longer there were few
perceived benets to quitting, rather the loss of pleasure or risk of developing cancer
regardless. In the context of clear screening results, this compounded the challenge
of quitting or made it futile. Participants consistently self-identied as strong-willed in
all respects except quitting smoking. Age and nicotine addiction were viewed as insur-
mountable barriers. Conclusion In the context of a negative screening result, increas-
ing awareness about links between lung cancer, smoking and other smoking-related
diseases is important for long-term smokers to accurately assess their risk for lung
cancer. This study provides insight for screening professionals to integrate eective,
tailored smoking cessation into lung screening programmes.
FUNDING: Unfunded; Academic Institution
PS2-93
DEVELOPMENT OF A NEW PERCEIVED EFFECTIVENESS SCALE
FOR YOUTH TOBACCO PREVENTION MESSAGES
Seth M. Noar, PhD1, Nisha C. Gottfredson, PhD2, Rhyan N. Vereen, MPH1, Rachel
Kurtzman2, Jennifer Mendel Sheldon, MPH3, Elizabeth Adams1, Marissa G. Hall, PhD2,
Noel T. Brewer, PhD2. 1Hussman School of Journalism and Media, University of North
Carolina, Chapel Hill, NC, USA, 2Department of Health Behavior, Gillings School of
Global Public Health, University of North Carolina, Chapel Hill, NC, USA, 3Lineberger
Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Signicance. Tobacco prevention media campaigns are an important tool to address
youth tobacco use. We developed a theory-based perceived message eectiveness
(PME) scale to use when vetting messages for campaigns. Methods. Participants were
a national sample of n=623 US adolescents (ages 13-17) recruited from a national
probability-based panel. In an online experiment, we randomized adolescents to view
vaping or smoking prevention ads. All participants viewed an ad from the FDA The Real
Cost campaign and a control video, in a random order. After ad exposure, the survey
assessed 9 candidate PME items and variables used to assess convergent and criterion
validity. We used conrmatory factor analysis and examined the information curves to
select items for the scale. Results. Analyses identied a short PME scale with 3 items
(α=.95) that worked equally well for diverse adolescents with dierent patterns of tobacco
use. The Real Cost ads generated higher PME scores than the control videos for both
vaping and smoking (convergent validity; p<.05). Higher PME scores were associated
with greater attention, fear, cognitive elaboration, and anticipated social interactions
(convergent validity; r=.31-.66), as well as more negative attitudes toward and lower
susceptibility to vaping and smoking (criterion validity; r= -.14 - -.37). A single-item PME
measure performed similarly as the 3-item version. Conclusions. The UNC PME Scale
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
for Youth is a reliable and valid measure of the potential eectiveness of vaping and
smoking prevention ads. Employing PME scales during message development can
enhance the eectiveness of youth tobacco prevention campaigns.
FUNDING: Federal
PS2-94
NICOTINE DEPENDENCE MILESTONES IN THE NATURAL
COURSE OF ONSET OF VAPING DEPENDENCE AMONG YOUTH
AND YOUNG ADULTS- A RETROSPECTIVE COHORT SURVEY
ANALYSIS
Martha Pienkowski1, Michael Chaiton1, Susan Bondy1, Joanna Cohen2, Jolene
Dubray1, Thomas Eissenberg3, Pamela Kaufman1, Matthew Stanbrook1, Robert
Schwartz4. 1University of Toronto, Toronto, ON, Canada, 2Johns Hopkins Bloomberg
School of P, Baltimore, MD, USA, 3VA Commonwealth University, Richmond, VA, USA,
4ON Tobacco Research Unit, Toronto, ON, Canada.
Signicance Vaping dependence in adolescent and young adult non-smoking popu-
lations is a growing public health concern. In this study, we used measures of nicotine
dependence milestones to determine the natural timing of onset of vaping dependence
in cigarette-smokers and non-smokers. Methods We conducted a cross-sectional survey
of Canadian youth aged 16-25 years old. We derived dependence milestones from the
Penn State E-Cigarette Dependence Index, the E-Cigarette Dependence Scale, and
a self-perceived measure of vaping dependence. We used Kaplan-Meier analysis to
assess the number of months after vaping initiation at which the cumulative probability
of attaining each milestone was 25%. A survival analysis was conducted to assess
relative time to e-cigarette dependence milestones from initiation of vaping by cigarette
smoking status, age, and sex. Results Among 3082 participants, 2,105 were current
at-least-monthly vapers. Ever-smokers were more likely to achieve frequency-related
milestones than never smokers (p < 0.01), but less likely to attain behaviour-related
milestones compared to never-smokers (p < 0.001). Ten of the twelve behavioural
milestones were attained at 24 months, along with monthly (95%CI:24.00-24.00) and
weekly vaping (95%CI:24.00-30.33). Daily vaping and diculty resisting vaping were both
attained at 30.33 months (95%CI: 30.33-30.33). Waking at night to vape was attained
at 66.83 months (95%CI: 54.67-66.83). Conclusion Behaviour-related milestones and
symptoms of vaping dependence can occur sooner than frequency-related symptoms
but may take two years or more to be reported by youth. Future longitudinal studies
assessing onset of symptoms among never vapers are needed to assess the natural
history of vaping dependence.
FUNDING: Federal
PS2-95
A SYSTEMATIC REVIEW OF RESPONSES TO REDUCED
NICOTINE CIGARETTE MARKETING FEATURES
Andrea C. Johnson1, Melissa Mercincavage1, Valentina Souprountchouk1, Sasha
Rogelberg1, Anupreet K. Sidhu1, Cristine Delnevo2, Andrew A. Strasser1. 1University
of Pennsylvania, Philadelphia, PA, USA, 2Rutgers-School of Public Health, Piscatway,
NJ, USA.
Background: The Tobacco Control Act gave the Food and Drug Administration (FDA)
the authority to reduce nicotine levels in cigarettes. The agency is considering enacting
a reduced nicotine product standard. We systematically reviewed the literature regarding
responses to commercial and public health marketing features for reduced nicotine
cigarettes (RNC) to anticipate potential industry and regulatory actions should a RNC
product standard be issued. Methods: We searched PubMed for English language
articles using several keywords for reduced nicotine products, cigarettes, and market-
ing features published through 2020. Of 4,092 records, 26 studies were retained for
review that met criteria focusing on responses to reduced nicotine cigarette marketing
features. Search terms created by the research team were used for review and included
independent extraction and coding by two reviewers. Coding was categorized using
study design terminology, commercial and public health features in tobacco regulatory
science, and their association with individual responses outlined by several message
processing outcomes. Results: Most studies focused on current cigarette smokers
and were cross-sectional. Reactions to RNCs and attitudes and beliefs were the most
common outcomes measured. For commercial features, articles generally studied
RNC advertisements, products, and/or descriptors. For public health features, articles
studied counter-messaging (e.g., warning labels) or general descriptors about nicotine
or a reduced nicotine product standard. Commercial features were generally associated
with favorable responses. Public health features oset favorable responses across most
outcomes, though their ecacy was mixed. Contrasts in results by smoking status are
discussed. Conclusions: Commercial marketing of RNCs is appealing and may need
stronger regulations or communication campaigns to accurately convey risks. Opportu-
nities exist for future research in light of tobacco regulatory science competencies. This
research contributes to the knowledge base for understanding marketing inuences of
reduced nicotine cigarette products.
FUNDING: Federal
PS2-96
HOW ABSOLUTE HARM INFORMATION, RELATIVE HARM
INFORMATION, AND COMBINATIONS OF BOTH AFFECT
E-CIGARETTE HARM PERCEPTIONS AND MESSAGE
CREDIBILITY AMONG PEOPLE WHO SMOKE DAILY
Cassidy White, Rachel Denlinger-Apte, Eric Donny. Wake Forest School of Medicine,
Winston-Salem, NC, USA.
SIGNIFICANCE: Misperceiving e-cigarette use as equally or more harmful than cigarette
smoking may discourage some people who smoke from switching. Health messaging
about e-cigarette risk can contain absolute harm information, relative harm information
anchored to cigarettes, or combinations of both. This study investigates how altering the
presence/emphasis of absolute and relative harm statements aects acute perceptions of
harm and message credibility. METHODS: A convenience sample of U.S. based mTurk
users who smoke daily, ages 21+, viewed one of ve messages about e-cigarettes:
Absolute harm statements (AH only); Relative harm statements (RH only); Both sets of
statements, absolute harm emphasized (AH+rh); Both sets, relative harm emphasized
(ah+RH); or unrelated content (control). Emphasis was added using bolded text and
placement at the beginning and end of the message, where attention is directed when
reading. All participants then indicated their e-cigarette harm perceptions and their
strength of agreement with statements about message features such as believability.
RESULTS: 873 participants completed the survey and passed quality control valida-
tion checks. Seeing a message with relative harm information increased the likelihood
of responding that e-cigarette use is safer than smoking (message, odds ratio, 95%
CI; RH only, 7.0, 4.3-11.1; AH+rh, 8.2, 5.0-13.4; ah+RH, 8.6, 5.2-14.1) vs. the control
message, while those who saw the AH only message had a lower likelihood (0.5, 0.3-
0.8). However, those assigned to the RH only and ah+RH conditions were less likely
to agree the message was believable (RH, 0.3, 0.2-0.5; ah+RH, 0.4, 0.2-0.6) and more
likely to agree the message was manipulative (RH, 4.2, 2.6-6.8; ah+RH, 2.1, 1.2-3.4),
whereas agreement likelihood for the AH only (2.0, 1.1-3.8; 0.7, 0.4-1.3) and AH+rh
(0.6, 0.4-1.0; 1.5, 0.9-2.5) conditions did not dier from the control’s. CONCLUSIONS:
Brief exposure to relative harm information may increase the likelihood that adults who
smoke perceive e-cigarette use as less harmful than smoking. However, stand-alone
or emphasized relative harm information may be less likely to be perceived as credible.
FUNDING: Federal
PS2-97
PERCEIVED SMOKING RELATED COVID19 RISKS AND THEIR
VARIATIONS BY DEMOGRAPHICS AND SMOKING STATUS
AMONG U.S. CURRENT AND FORMER CIGARETTE SMOKERS
Kelvin Choi1, Lilianna Phan1, Julia Chen-Sankey2, Aniruddh Ajith3, Kiana Hacker1,
Bambi Jewett1. 1National Institute on Minority Health and Health Disparities, Bethesda,
MD, USA, 2Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New
Brunswick, NJ, USA, 3University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Signicance: The U.S. Centers for Disease Control and Prevention (CDC) stated that
current and former smokers have increased risks for severe COVID-19 symptoms. We
examined the correlates of U.S. adult current and recent former cigarette smokers who
believe that combustible tobacco use increases risks of contracting COVID-19 infection,
severe symptoms, hospitalization, and death. Methods: Data were from a U.S. represen-
tative sample of adult (≥21 years) current and recent former cigarette smokers (n=1,589)
from an online panel in January-February 2021. In four items, participants reported if
smoking combustible tobacco products (e.g., cigarettes, cigars) would increase risk of
contracting COVID-19 infection, having severe symptoms, hospitalization, and dying from
COVID-19. Demographic and current smoking status information was also collected.
Weighted multivariate logistic regression models were used to examine the relationship
between demographics, smoking status, and each COVID-19 risk belief. Results: Over-
all, 63.1%, 78.9%, 79.6%, and 76.9% of U.S. adult current and recent former smokers
believed that combustible tobacco use increased the risks of COVID-19 infection, severe
symptoms, hospitalization, and death. Those with high school education or less were
less likely than those with college education to believe that combustible tobacco use
increased the risk of COVID-19 severe symptoms (AOR=0.57, 95%CI=0.34-0.96),
135
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
hospitalization (AOR=0.58, 95%CI=0.34-0.99), and death (AOR=0.58 95%CI=0.36-
0.96). Additionally, compared to recent former smokers, current smokers were less
likely to believe that combustible tobacco use increased the risk of COVID-19 infection
(AOR=0.54, 95%CI=0.38-0.77), severe symptoms (AOR=0.46, 95%CI=0.31-0.70), hos-
pitalization (AOR=0.48, 95%CI=0.31-0.72), and death (AOR=0.54, 95%CI=0.37-0.80).
Conclusion: U.S. adult current smokers and those with low education were less likely
than former smokers and those with high education to agree that smoking increases
COVID-19 risks. Further research is needed to examine if these beliefs are related to
vaccination and other preventive behaviors against COVID-19.
FUNDING: Federal
PS2-98
CONTENT ANALYSIS OF NICOTINE SICKNESS/NIC SICK VIDEOS
ON TIKTOK
Cortni Bardier1, Vidya Purushothaman1, Tiana McMann2, Matthew Nali2, Zhuoran Li1,
Raphael Cuomo1, Tim Mackey1. 1UCSD, La Jolla, CA, USA, 2UCSD, La Jolla, CA, USA.
Signicance: TikTok is a micro-video social media platform experiencing exponential
growth with 60% of its monthly users between ages 16-24. Recent studies have found
that increased exposure to e-cigarette content on social media may inuence patterns
of use. However, there is limited research assessing the characteristics of nicotine poi-
soning content posted on social media. This study aims to examine the specic charac-
teristics of nicotine sickness-related content on TikTok in order to assess potential public
safety issues and health communication/outreach opportunities.Methods: The study
collected TikTok posts associated with the #nicsick hashtag and used inductive coding
to conduct content analysis for video characteristics. Videos were manually annotated
to generate a codebook of nicotine sickness-related themes. Statistical analysis was
used to compare continuous characteristics of videos with and without active nicotine
sickness TikTok topics.Results: A total of 132 TikTok videos with the hashtag #nicsick
were manually coded, with 52.3% (n=69) identied as discussing rst-hand and sec-
ond-hand reports of suspected nicotine poisoning symptoms. Among these videos were
users who documented their experiences with adverse events, users actively vaping;
trends; and story times. Videos depicting adverse events and/or nicotine poisoning
symptoms were longer in duration than those for other #nicsick-related topics (p=0.08).
Conclusion: Exposure to promotional e-cigarette social media content may facilitate
overconsumption of nicotine, leading to nicotine poisoning. The appeal of “going viral”
may encourage TikTok users to spread novel and potentially dangerous e-cigarette use
patterns in addition to discussions and experiences with nicotine poisoning.
FUNDING: State
PS2-99
FACILITATORS OF SMOKING CESSATION LAPSE AMONG YOUTH
EXPERIENCING HOMELESSNESS
Joanne G. Patterson, Joseph M. Macisco, Allison M. Glasser, Lauren M. Miller, Juli-
anna M. Nemeth. The Ohio State University College of Public Health, Columbus, OH,
USA.
Signicance: In the United States, nearly three times more youth (aged 14-24) experi-
encing homelessness smoke cigarettes compared to the general population. Many youth
experiencing homelessness report past quit attempts; however, little is known about
the contextual factors inuencing cessation lapse in this population. This study, part of
a larger project to develop an optimized smoking cessation intervention for homeless
youth, aimed to describe how opportunity, stress, and coping inuence cessation lapse
among youth experiencing homelessness. Methods: Thirty-six youth experiencing home-
lessness aged 14-24 and who reported smoking combustible tobacco within the past
week were recruited from a drop-in center in Ohio. Our analytic sample comprised the
26 study participants who reported a past quit attempt. We conducted semi-structured
qualitative interviews with the intent to describe structural and psychosocial factors
contributing to cessation lapse following participants’ most recent quit attempt. Team-
based thematic coding followed deductive template and inductive approaches. Results:
Most youth described smoking reexively in-the-moment to cope with stressful and
traumatic life events (e.g., loss and death of family members; employment instability).
Reexive stress coping was exacerbated by nicotine dependence. Some participants
described actively choosing to smoke to regulate stress-induced emotions and in lieu of
engaging in other harmful behavior (e.g., physical violence). Social and environmental
opportunities provided easy access to tobacco, which facilitated cessation lapse inde-
pendently and also during stressful events. Conclusions: Stress was a primary driver
of cessation lapse among youth experiencing homelessness; however, easy access to
tobacco also thwarted quit attempts. Interventions to prevent cessation lapse among
youth experiencing homelessness should target sources of stress, coping skills, nicotine
dependence, and the social environment.
FUNDING: Federal; Academic Institution
PS2-100
RETROSPECTIVE ANALYSIS AND INFOVEILLANCE OF NICOTINE
SICKNESS/NIC SICK TWEETS
Vidya Purushothaman1, Cortni Bardier1, Tiana McMann1, Zhuoran Li2, Raphael
Cuomo1, Tim Mackey1. 1UCSD, La Jolla, CA, USA, 2UCSD, La Jo, CA, USA.
Signicance: Social media exposure to tobacco marketing and online trends such as
vape challenges can lead to overconsumption of various nicotine products increasing
the likelihood of possible nicotine poisoning and overdose. Surveillance of social media
platforms can help in assessing the volume of user-generated content discussing sus-
pected nicotine poisoning, which may not be reported to poison control centers. This
study aims to examine trends and distinct characteristics of nicotine sickness content
on Twitter between 2018 and 2020.Methods: Tweets were collected retrospectively
from the Twitter Academic Research Application Programming Interface (API) stream
ltered for keywords “nic sick”, “nicsick”, “vape sick”, and “vapesick” between 2018-2020.
The collected tweets were manually annotated to identify reports of suspected nicotine
sickness and related themes using an inductive coding approach. The Augmented
Dickey-Fuller (ADF) test was used to assess stationarity in the monthly variation of
the volume of tweets reporting suspected nicotine sickness between 2018 and 2020.
Results: A total of 5,651 tweets that contained nicotine-sickness-related keywords were
manually annotated, with 18.29% (n=1,034) tweets reporting one or more suspected
nicotine sickness symptoms of varied severity such as vomiting, nausea, headache,
burning sensation in throat, and fatigue. The volume of tweets reporting suspected
nicotine sickness increased throughout the study period, except between February-April
2020. Stationarity in the volume of “nicsick” tweets between 2018-2020 was not statis-
tically signicant (Dickey-Fuller = -0.32, p=0.98) indicating a non-stationary change in
the volume of tweets. These tweets were grouped into three main categories including
rst- and secondhand reports of symptoms, intentional excessive use of nicotine (“nic
buzz”), and users seeking help for symptoms after nicotine use.Conclusions: Increasing
volume of user-reported nicotine sickness and intentional overdose of nicotine high-
lights the need for targeted health communication strategies and eective anti-tobacco
campaigns against impulsive behaviors among vape users on social media platforms.
FUNDING: State
PS2-101
HOW MEDIA STORIES IN LOW- AND MIDDLE-INCOME
COUNTRIES (LMICS) DISCUSSED THE FDA’S AUTHORIZATION
OF THE MARKETING OF IQOS AS A MODIFIED RISK TOBACCO
PRODUCT WITH “REDUCED EXPOSURE” INFORMATION
Meagan O. Robichaud, Tyler Puryear, Joanna E. Cohen, Ryan David Kennedy. Depart-
ment of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA.
Signicance: On July 7, 2020, the US Food and Drug Administration (FDA) authorized
the marketing of Philip Morris Products S.A’s IQOS Tobacco Heating System as a
modied risk tobacco product (MRTP), the rst tobacco product to receive “exposure
modication” orders. We examined how the FDA’s authorization was presented in media
in low- and middle-income countries (LMICs). Methods: News articles published between
7/7/2020 and 1/7/2021 were obtained by systematically searching Tobacco Watcher
(www.tobaccowatcher.org), a surveillance platform that compiles tobacco-related news.
Articles were considered eligible if they mentioned the FDA authorization about IQOS and
were published in an LMIC. Articles not in English were professionally translated. Articles
were coded by two coders to identify country of origin, use of the term MRTP as well
as presence of reduced risk language or reduced exposure language when discussing
the FDA authorization, and presence of quotes from tobacco industry employees and/or
public health or medical professionals. Results: We identied 50 unique eligible articles
published in 20 LMICs, including in all 6 WHO regions. 36 articles (72%) used the term
‘modied risk tobacco product’ or ‘MRTP’, 26 (52%) included reduced exposure language
only, 4 (8%) included reduced risk language only, and 8 (16%) included both reduced
risk and reduced exposure language. 30 articles (60%) included only tobacco industry
quotes, 7 (14%) included only quotes from public health or medical professionals, and
2 (4%) included quotes from both tobacco industry and public health or medical profes-
sionals. Conclusion: Our study found that the FDA authorization to market IQOS as an
MRTP was discussed in LMICs around the world; almost one quarter (24%) of articles
136
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
reviewed misrepresented the FDA’s authorization by incorrectly suggesting that the FDA
determined that IQOS is less harmful than cigarettes. Most articles did not include a
quote from a public health or medical professional, while the majority (64%) included
tobacco industry quotes. Future research should assess the public’s understanding of
the distinction between reduced exposure and reduced risk.
FUNDING: Nonprot grant funding entity
PS2-102
TOBACCO RETAIL OUTLETS AND NEIGHBORHOOD
DEPRIVATION AND THE RISK OF PRENATAL SMOKE EXPOSURE
Duc-Thi Jeremy Barsell1, David C. Wheeler1, Joseph Boyle1, Shaun R. Jones2, Rachel
L. Maguire3, Jason A. Oliver4, Bassam Dahman1, Jim Zhang5, Susan K. Murphy3, Cath-
rine Hoyo6, Shelley Golden7, Chris Baggett7, Kurt Ribisl8, Joe McClernon3, Bernard F.
Fuemmeler1. 1Virginia Commonwealth University, Richmond, VA, USA, 2Duke University,
Durham, NC, USA, 3Duke University Medical Center, Durham, NC, USA, 4Stephenson
Cancer Center, Oklahoma City, OK, USA, 5Duke Global Health Institute, Durham, VA,
USA, 6North Carolina State University, Raleigh, NC, USA, 7University of North Caro-
lina at Chapel Hill, Chapel Hill, NC, USA, 8University of NC Chapel Hill, Chapel Hill,
NC, USA.
BACKGROUND. Tobacco retail outlets (TRO) and neighborhood deprivation are
important environmental factors that inuence smoking behaviors and potentially
secondhand smoke exposure. Few studies have examined these associations among
pregnant women, a vulnerable population with heightened risk for health complications
due to smoke exposure. OBJECTIVE. Our goal was to estimate the individual and
combined associations of TROs and area-level neighborhood deprivation factors with
smoke exposure among pregnant mothers as measured by cotinine assayed from
prenatal blood samples. METHODS. The sample included n=1,055 pregnant mothers
with available prenatal cotinine blood measures and covariate data from the Newborn
Epigenetics Study (NEST) - a pre-birth cohort recruited from Duke University. We geo-
coded TROs and estimated a neighborhood deprivation index (NDI) using sociodemo-
graphic variables at the block group level. Bayesian index models were used to relate
TROs and NDI to cotinine levels controlling for individual level covariates (age, race/
ethnicity, education, marital status). RESULTS. Results showed a signicant positive
association between TRO exposure (beta = 0.008, 95% credible interval (CI) = [0.003,
0.013]) and log cotinine after adjusting for individual covariates. TRO exposure was not
signicant after including the NDI, which was signicantly associated with log cotinine
(beta = 0.143, 95% CI = [0.030, 0.267]). However, in a low cotinine stratum indicating
passive smoke exposure, TRO exposure was signicantly associated with log cotinine
(beta = 0.005, 95% CI = [0.001, 0.009]), while the NDI was signicantly associated with
log cotinine (beta = 0.176, 95% CI = [0.005, 0.372]) in high cotinine stratum indicating
active smoking. CONCLUSIONS. Our data provide novel evidence in support for TROs
increasing cotinine concentrations through passive smoke exposure, in contrast to
neighborhood deprivation being associated with active smoke exposure. Additionally,
our study supports evidence suggesting that educational attainment and neighborhood
racial composition are important factors for smoke exposure during pregnancy.
FUNDING: Federal
PS2-103
EVALUATING THE MODERATING ROLE OF EDUCATIONAL
ATTAINMENT BETWEEN FINANCIAL STRESS AND SMOKING
ABSTINENCE AMONG WHITE AND AFRICAN AMERICAN
SMOKERS
Dale Dagar Maglalang1, Jaqueline Avila1, Jasjit S. Ahluwalia1, Cara Murphy1, Adam
C. Alexander2, Nikki Nollen3. 1Brown University School of Public Health, Providence,
RI, USA, 2University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,
3University of KS School of Medicine, KS City, KS, USA.
Background: Financial stress has been associated with lower smoking abstinence
rates and higher chances of relapse after cessation. A potential moderator to smoking
abstinence is educational attainment which has been found to be a protective factor
from smoking. However, the Minorities’ Diminished Returns (MDRs) theory posits that
educational attainment may have a weaker eect among racial minorities than White
individuals. Objective: Examine the moderating role of educational attainment on the
relationship between nancial stress and smoking abstinence among White and African
American smokers. Methods: We drew data from the Quit2Live study (N=449), an in-
tervention among White (n=225) and African American (n=224) smokers. Our outcome
was cotinine-veried smoking abstinence at week 12 (end of treatment) and week 26.
Our primary explanatory variable was nancial stress measured as having some mon-
ey left, just enough money to make ends meet, and not enough money to make ends
meet at the end of the month. Our moderating variable was educational attainment. A
series of logistic regressions were conducted, including educational attainment, race,
and relevant demographic covariates, to determine the association between nancial
stress and smoking abstinence. We also conducted a two-way interaction on nancial
stress and educational attainment. Results: Participants who consistently do not have
enough money had decreased odds of abstinence at week 12 in the unadjusted and
adjusted models accounting for educational attainment and race. In the fully adjusted
model, this eect was no longer present. However, there was a signicant two-way
interaction, where participants who had enough money to make ends meet and a college
degree had increased odds of smoking abstinence at week 26. Conclusion: Contrary
to MDR, there were no dierences in the protective factor of educational attainment
between White and African American smokers. However, smokers experiencing nancial
stress who had higher educational attainment had higher odds of abstinence relative
to smokers experiencing nancial stress with lower levels of educational attainment.
FUNDING: Federal
PS2-104
ADHERENCE TO PROVIDER REFERRALS FOR LUNG CANCER
SCREENING WITH LOW DOSE COMPUTED TOMOGRAPHY
BEFORE AND DURING COVID-19 PANDEMIC
Jiang Li, Cheryl D. Stults, Su-Ying Liang, Meghan C. Martinez. Palo Alto Medical Foun-
dation Research Institute, Palo Alto, CA, USA.
Signicance Tobacco use is the leading risk factor for lung cancer and causes almost
90% of lung cancers. Despite Medicare coverage for lung cancer screening (LCS) with
low-dose computed tomography beginning in 2015, LCS-LDCT uptake remains low due
to complex, multi-step processes for patients, providers, and health systems. This study
assesses trends in adherence to provider referrals for LCS-LDCT among LCS-eligible/
in-eligible patients before and during the COVID-19 pandemic and the multilevel factors
inuencing completion rate of LCS-LDCT orders. Methods We analyzed electronic health
record data from a large healthcare system in Northern California between December
2013 and December 2020. For any patient with LCS-LDCT order, trends in the proportion
of screening guideline eligible vs. ineligible patients and screening completion rates
were compared. Multilevel factors associated with completion of the LCS-LDCT order
were explored using Hierarchical Generalized Linear Models. Results There were
12,469 LCS-LDCT orders. LCS-LDCT orders increased from 2013 to 2019, dropped
dramatically at the start of COVID-19 pandemic, and then slowly increased again in
June 2020. The completion rate increased from 0% in December 2013 to almost 70%
in 2018-2019 and then declined to 50-60% in 2020 during COVID-19 pandemic. The
completion rate of LCS-LDCT was lower for ineligible patients. Patients with severe
major comorbidities and those who smoked fewer than 30 pack-years were signicantly
less likely to complete an order than those without any major comorbidity and or who
had smoked 30 pack-years or more. Patients who received the LCS-LDCT order at a
Medicare wellness visit or saw a provider with prior experience with LCS-LDCT were
more likely to complete LCS-LDCT orders. Conclusion LCS-LDCT program should
ensure ecient resource utilization and safely manage patients during the COVID-19
pandemic. Those who received orders at Medicare wellness visits, had no major comor-
bidities, and providers having prior experience were more likely to complete an order
suggest opportunities to improve LCS-LDCT process and inuence clinical practice at
patient, provider, and systems levels.
FUNDING: State
PS2-105
SOCIODEMOGRAPHIC CORRELATES OF TRANSITIONS IN
TOBACCO USE PROFILES AMONG ADOLESCENTS: RESULTS
FROM THE POPULATION ASSESSMENT OF TOBACCO AND
HEALTH (PATH) STUDY WAVES 3 AND 4
Katelyn F. Romm1, Margaret Childers2, Ashley E. Douglas2, Bethany C. Bray3, Geri
Dino2, Melissa D. Blank2. 1George Washington University, Washington, DC, USA, 2West
Virginia University, Morgantown, WV, USA, 3University of Illinois at Chicago, Chicago,
IL, USA.
Signicance: Polytobacco use remains common among adolescents; however, little
work has examined how adolescents transition in their patterns of polytobacco use over
time or which adolescents are at risk for transitioning to proles of greater versus less
risk. Methods: Data derive from Waves 3-4 (2015-2018) of the Population Assessment
of Tobacco and Health Study. Participants were adolescents who used at least one
tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos,
137
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
ltered cigars, snus, smokeless tobacco [SLT], hookah) at either Wave 3 or 4 and had
Wave 1 data (N=1,072; Mage=13.71, SD=1.71, 46.4% female; 56.6% White, 23.2% His-
panic). Results: Five latent classes were identied: Low Users, ECIG Users, Cigarette
Users, SLT Users, and Polytobacco Users. Cigarette Users and SLT Users were most
likely to maintain class stability (66.0%, 59.0% of users, respectively, continued use).
Low Users were most likely to transition to ECIG Users (46.0%) or Cigarette Users
(27.0%); Polytobacco Users were most likely to transition to Low Users (54.0%); and
ECIG Users were most likely to transition to Low Users (41.0%) or Cigarette Users
(27.0%). Adolescents who were older were more likely to remain Cigarette Users than
transition to Low Users or ECIG Users. Non-Hispanic White adolescents were less likely
to transition to Low Users than to remain ECIG Users (versus Black or Hispanic), SLT
Users (versus Black), and Polytobacco Users (versus Hispanic). Conclusion: While
adolescents were likely to maintain their membership in cigarette or SLT classes, ado-
lescents also showed high probabilities for transitioning from classes characterized by
less risk to those dominated by ECIG or cigarette use, and from classes characterized
by ECIG use to those characterized by cigarette use. As the tobacco market continues
to expand, change over time in adolescents’ combinations of polytobacco use should
be considered carefully as regulations and interventions are implemented.
FUNDING: Federal
PS2-106
MEASURING DUAL-VAPING OF NICOTINE AND CANNABIS
AMONG ADOLESCENTS IN FIVE NEW ENGLAND STATES
Jessica Liu1, Daniel Gundersen2, Jane Roberts2, Karen Emmons1, Jonathan Winick-
o3, Elaine Hanby4, Matthew J. Reynolds5, Mark Gottlieb6, Melody Kingsley7, Andy
Tan4. 1Harvard University, TH Chan School of Public Health, Department of Social and
Behavioral Sciences, Boston, MA, USA, 2Dana-Farber Cancer Institute, Survey and
Qualitative Methods Core, Boston, MA, USA, 3Harvard Medical School, Boston, MA,
USA, 4University of Pennsylvania, Annenberg School for Communication, Philadelphia,
PA, USA, 5Massachusetts General Hospital, Boston, MA, USA, 6Public Health Advocacy
Insitute, Boston, MA, USA, 7Massachusetts Tobacco Cessation and Prevention Program
(MTCP), Massachusetts Department of Public Health, Boston, MA, USA.
Signicance: The current adolescent vaping culture includes vaping of both nicotine
and cannabis (dual-vaping). Improved survey measures could help establish what
substances adolescents are vaping and to what extent they may be dual using. This
study describes the use of new survey questions that ask more specically whether
adolescents who vape are vaping nicotine, cannabis, cannabidiol (CBD), or another
substance. Methods: We recruited adolescents ages 13-17 from Massachusetts, New
Hampshire, Vermont, Connecticut, and Rhode Island through the Prodege online sur-
vey panel from April to July 2021. Survey questions included standard vaping behavior
measures (eg. ever and current use of vape products, types of vape products used)
and new measures to ask what substances adolescents were vaping, such as “Have
you ever vaped any of the following substances in the past 30 days?” with the possible
responses of nicotine, cannabis, CBD, other, and don’t know. Dual-vaping of both nicotine
and cannabis was dened as vaping of both nicotine and cannabis and/or CBD in the
past 30 days, operationalized as a dichotomous outcome. Results: The analytic sample
included N=497 adolescent participants (mean age 15.2 years, 51.4% female, 80.6%
White, 79.4% heterosexual). Over one in four (27.8% (n=133)) participants reported they
ever vaped, 17.1% (n=82) vaped in the past 30 days, and 7.1% (n=34) had dual-vaped
in the past 30 days. Among those who ever vaped, 25.6% were dual-vapers. Among
those who currently vaped, 41.5% were dual vapers. Among those who ever vaped,
6% of all participants reported vaping “other” and 6% reported “don’t know” in the past
30 days. Discussion: Our ndings show that a sizable proportion of a sample of New
England adolescents who currently vape are dual-vaping nicotine and cannabis. Our
study addresses a key gap in adequate survey measures for assessing adolescent
vaping of multiple substances and can help in better characterizing and targeting future
surveillance and intervention eorts for adolescent vaping.
FUNDING: Federal
PS2-107
CIGARILLO PURCHASE TASK COMPARISON OF SEXUAL
GENDER MINORITY WOMEN AND THEIR COUNTERPARTS
Amanda Quisenberry1, Elizabeth G. Klein2, Erika Trapl3. 1Roswell Park Comprehen-
sive Cancer Center, Bualo, NY, USA, 2Ohio State University, College of Public Health,
Columbus, OH, USA, 3Case Western Reserve University, Cleveland, OH, USA.
Signicance: Sexual and gender minorities (SGM), deemed a priority population by
Center for Tobacco Products, engage in more risk behaviors than their heterosexual
counterparts, including tobacco use, putting them at higher risk for tobacco-related health
problems. SGM women have far greater odds of using tobacco products compared
to SGM men and heterosexuals. The disparity appears far greater for cigar products.
Bisexual and lesbian cisgender women have at least 1.5 times the odds of using cigar
products compared to cisgender gay males and gender minorities. To investigate this
disparity, we used a cigarillo purchase task, a behavioral economic method used to
determine the valuation and demand for cigarillos. Methods: 201 SGM young adult
women and 385 young adult participants consisting of other groups completed a novel
cigarillo purchase task as part of an online survey. Data were checked for consistency
and analyzed using a nonlinear regression equation. Results: The nal analytic sample
of n=299 (n=93 SGM and n=206 other) excluded those with inconsistent purchase task
data (n=108 from the SGM sample and n=179 from the other sample). Contrary to the
hypothesis, SGM women showed less demand and valuation for cigarillos (alpha=.03,
Q0=4.88) compared to the overall sample (alpha=.04, Q0=7.35; F(3,12)=49.49, p<.001).
Conclusions: Despite a higher prevalence of cigarillo use by SGM women, our sample
purchased fewer cigarillos in a purchase task suggesting that though more SGM women
use cigarillos, they may be using fewer cigarillos than other groups. Understanding the
characteristics associated with use that dier between SGM women and their hetero-
sexual counterparts is integral to informing policy that will decrease consumption of
harmful tobacco products among the population most likely to use them.
FUNDING: Federal
PS2-108
IDENTIFYING PUBLIC HEALTH TOPICS AND USER EXPERIENCES
IN VAPING RELATED POSTS ON TWITTER AND REDDIT: AN
INTERDISCIPLINARY EXAMINATION
Erin Kasson1, Avineet Kumar Singh2, Yang Ren2, Li-Shiun Chen1, Ming Huang3, Dezhi
Wu2, Patricia Cavazos-Rehg1. 1Washington University School of Medicine, St. Louis,
MO, USA, 2University of South Carolina, Columbia, SC, USA, 3Mayo Clinic, Roches-
ter, MN, USA.
Signicance: Vaping among US youth has been identied as a public health epidemic.
Social media platforms, including Twitter and Reddit, have been used in previous litera-
ture for surveillance of public sentiment and health concerns related to vaping. Methods:
This study leverages an interdisciplinary method including topic modeling and human
manual coding to identify and compare themes found on Twitter and Reddit during the
outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) in 2019.
A total of 794,620 vaping-related tweets were extracted across 2019, and signicant
increases in the number of tweets in July, August, and September informed additional
data collection of 17,320 Reddit posts among 1,016 subreddits from these three months.
Results: Topic modeling approaches revealed dierent patterns of discussions around
1) health issues, 2) products/ingredients, 3) marketing, and 4) age groups between
platforms. Human coding on a sample of tweets (n=583) and Reddit posts (n=614)
from July, August, September 2019 also indicated that the frequency with which themes
were mentioned diered between Twitter and Reddit. While mentions of adverse health
outcomes outweighed positive health outcomes on both platforms, Reddit posts reected
more perceived positive health outcomes from vaping (32% vs. 23%), but also more
concerns with addiction to vaping products (21% vs. 10%). Interest in quitting vaping was
mentioned nearly three times more frequently on Reddit (22% vs. 6%), and mentions of
vaping marijuana/unregulated products were also much more common (36% vs. 13%).
Both platforms mentioned teens and young adults in the context of vaping (29% Reddit,
23% Twitter); however, posts on Reddit related to personal use, while tweets were
more often related to news/policies surrounding vaping products. Conclusions: Results
from both topic modeling and human coding approaches reected a similar pattern
of population-level public health monitoring on Twitter and user-level experiences on
Reddit. The diering strengths of both platforms support the potential feasibility of their
use in developing real-time public health surveillance related to vaping and automated
detection and outreach models for youth interested in vaping cessation.
FUNDING: Federal; Academic Institution
138
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-109
LONGITUDINAL ASSOCIATION OF EXCLUSIVE AND DUAL USE
OF ENDS AND CIGARETTES WITH ASTHMA AMONG US YOUTH -
POPULATION ASSESSMENT OF TOBACCO AND HEALTH STUDY
WAVES 1-5 (2013-2019)
Akash Patel, Steven Cook, Nancy Fleischer, Jana Hirschtick. University of Michigan,
Ann Arbor, MI, USA.
Signicance: The increasing prevalence of electronic nicotine delivery systems
(ENDS) use among youth in the United States is concerning, especially given that the
long-term health eects of ENDS use are not known. Understanding the prospective
association between ENDS use and asthma, a common respiratory condition for youth,
is of particular importance. Methods: Using data from Waves 1-5 (2013-2019) of the
Population Assessment of Tobacco and Health (PATH) study, we followed youth aged
12-17 at baseline who had not been diagnosed with asthma. We ran discrete time
survival models to analyze the association between time-varying tobacco product use
and incident diagnosed asthma. The time-varying exposure variable was lagged by
one wave and categorized respondents by current use status (1+ days in the past 30
days): non-users, exclusive ENDS or cigarette users, and dual users. We controlled for
sociodemographic (age, sex, race/ethnicity, parental education) and other risk factors
(urban/rural setting, secondhand smoking, household combustible tobacco use, body
mass index (BMI-for-age)). Results: The analytic sample (n=9140) was half female
(50.2%) and predominantly non-Hispanic White (55.3%) with a mean age of 14.5 years
at baseline. Also at baseline, 3.1% of respondents exclusively smoked cigarettes, 1.7%
exclusively used ENDS, and 1.3% used both products. The average annual incidence of
diagnosed asthma was 1.4% over the follow-up period examined. Compared to non-use,
exclusive cigarette use was associated with increased risk of incident asthma (aHR:
1.68, 95% CI: 1.21-2.32), while exclusive ENDS use (aHR: 1.25, 95% CI: 0.77- 2.04) and
dual use (aHR: 1.54, 95% CI: 0.92-2.57) were not. Conclusion: Over a ve-year period,
the risk of incident asthma was higher among youth who used cigarettes exclusively,
but not among those who used ENDS, either exclusively or with cigarettes. Strategies
aimed at reducing youth cigarette smoking and continual monitoring of youth cigarette
and ENDS use prevalence are necessary.
FUNDING: Federal
PS2-110
COST EFFECTIVENESS OF A SMOKING CESSATION
INTERVENTION FOR DUAL USERS OF COMBUSTIBLE AND
ELECTRONIC CIGARETTES
Margaret Byrne1, Vani Simmons1, Ursula Martinez2, Steven Sutton3, Karen Brandon3,
Thomas Brandon1. 1Mott Cancer Center, Tampa, FL, USA, 2H. Lee Mott Cancer
Center and Research Institute, Tampa, FL, USA, 3H. Lee Mott Cancer Center, Tampa,
FL, USA.
Signicance: Although smokers often initiate vaping with the goal of quitting smoking,
many remain users of both products. The ecacy and cost eectiveness of smoking
cessation interventions for dual users are largely unstudied. Here we report cost ef-
fectiveness from our 3-arm randomized controlled trial of self-help smoking cessation
interventions for dual users. Methods: We randomized dual users to assessment only
(ASSESS; n=575), generic self-help smoking cessation (GENERIC; n=1154), or self-
help targeted for dual users (eTARGET; n=1167). Those in the latter two arms received
monthly cessation materials for 18 months, with assessments every 6 months through 24
months. We calculated incremental cost eectiveness ratios comparing our GENERIC
and eTARGET interventions to ASSESS using smoking abstinence and cost data from
our RCT (Martinez et al., 2021, Lancet Public Health) along with the literature on quality
of life and mortality reduction from quitting smoking. 24-month smoking status was used
as a proxy for continuing smoking status. Results: The total intervention cost/participant
was $0 for ASSESS, $52 for GENERIC, and $52 for eTARGET. The incremental cost/
quitter compared to ASSESS was $2369 for GENERIC and $2253 for eTARGET. The
average quitter gained 10 expected life years. Given 24-month post-baseline quit rates
of 40.0%, 42.2%, and 42.3% in the 3 arms, the average life years gained per participant
were 4.00, 4.22, and 4.23. Quality adjusted life years (QALYs) gained for quitters was a
combination of increased survival (8.8 QALYs) and increases in quality of life for other
years (2.3 QALYs). Thus, compared to ASSESS, the incremental cost per life year
gained at 24 months was $237 for GENERIC and $225 for eTARGET. The incremental
cost per QALY gained was $213 and $202, respectively. Conclusions: Despite modest
ecacy by 24 months, these low-cost and easily disseminated self-help interventions for
smoking cessation among dual users produced extremely favorable cost eectiveness
estimates. As ecacy increases with further treatment renement, cost-eectiveness
should continue to improve.
FUNDING: Federal
PS2-111
E-CIGARETTE PRICE PROMOTION RECEIPT AND SUBSEQUENT
E-CIGARETTE AND CIGARETTE USE STATUS AMONG U.S.
ADULT CIGARETTE SMOKERS
Julia Chen-Sankey1, Raul Cruz-Cano2, Olivia Wackowski1. 1Center for Tobacco Studies,
Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA, 2School of Public
Health, University of Maryland College Park, College Park, MD, USA.
Background: For cigarette smokers, receiving e-cigarette price promotions may prompt
smoking cessation trials and outcomes through using e-cigarettes. This study explored
the associations between receiving e-cigarette price promotions and subsequent e-cig-
arette, cigarette, and dual use status one year later. Methods: Longitudinal data (Wave
3: 2015-2016; and Wave 4: 2016-2018) of the Population Assessment of Tobacco and
Health (PATH) Study from a nationally representatively sample of U.S. adult current
established cigarette smokers (n=7,670) at Wave 3 were used. Multivariate regressions
were conducted to examine the associations between receiving e-cigarette price pro-
motions at Wave 3 and current e-cigarette, cigarette, and dual use status as well as
past-year cigarette quit attempts and quitting using e-cigarettes at Wave 4, controlling
for covariates including socio-demographic backgrounds, tobacco use status, tobacco
marketing exposure, nicotine dependence, and past-year quit attempts at Wave 3. Re-
sults: At Wave 3, 4.0% of respondents received e-cigarette price promotions. At Wave
4, 89.4%, 12.6%, and 11.0% of respondents were current cigarette smokers, e-ciga-
rette users, and dual users, respectively. Multivariable regressions show that receiving
e-cigarette price promotions at Wave 3 was associated with an increased likelihood of
current use of cigarettes (AOR=1.57; 95% CI=1.07, 2.30), e-cigarettes (AOR=1.68, 95%
CI=1.16, 2.42), and both products (AOR=1.65; 95% CI=1.14, 2.38) at Wave 4. Among
those who continued to smoke cigarettes at Wave 4 (n=6,889), receiving e-cigarette
price promotions at Wave 3 was not associated with having smoking quit attempts
(AOR=1.09; 95% CI=0.80, 1.49) or using e-cigarettes to quit smoking (AOR=1.30; 95%
CI=0.74, 2.26) in the past year at Wave 4. Conclusions: Receiving e-cigarette price
promotions may promote or sustain the use of e-cigarettes, cigarettes, and co-use of
both products among adult cigarette smokers. It may not increase smokers’ attempts to
quit cigarettes or using e-cigarettes to quit smoking. Overall, e-cigarette price promotions
may not promote cigarette smoking cessation outcomes or trials among adult smokers.
FUNDING: Federal
PS2-112
CIGARETTE SMOKERS’ AND ELECTRONIC NICOTINE DEVICE
USERS’ PERCEPTIONS OF AND INTENTIONS TO USE IQOS: A
QUALITATIVE ANALYSIS
Scott R. Weaver1, Claire A. Spears1, David L. Ashley1, Meridith Fritz2, Carla Berg3, Nikita
Kute1, Terry F. Pechacek4. 1GA State University, Atlanta, GA, USA, 2Battelle Memorial,
Baltimore, MD, USA, 3Georgia Washington University, Washington, GA, USA, 4GA State
University, School of Public Health, Atlanta, GA, USA.
Introduction: Since the FDA authorized the marketing of the IQOS Tobacco Heating
System in 2019, IQOS has entered markets throughout Georgia, Virginia, North Carolina,
and South Carolina with 1300 retail locations. The objectives of this qualitative study
of current/former smokers with varied ENDS use histories was to examine (1) prior
awareness and perceptions of IQOS, (2) intentions to try IQOS, and (3) reactions to a
reduced-risk exposure statement. Methods: Participants were 61 adults representing
four subpopulations of U.S. adults recruited from three U.S. cities and dened by their
cigarette and ENDS use: current smokers who never used ENDS (Never Triers); current
smokers who discontinued ENDS (Rejectors); current dual users of cigarettes and ENDS
(Dual Users); and former smokers who switched to ENDS (Switchers). Focus group
participants were shown IQOS marketing material and probed on awareness, knowledge,
and perceptions of IQOS; intentions to try IQOS; and a reduced exposure statement.
A hybrid inductive/deductive approach was used to identify and code themes. Results:
Awareness and knowledge of IQOS was low with impressions varying by subgroup.
Never Triers reacted mostly negatively to IQOS, Switchers were disinterested in returning
to “real tobacco” use, Dual Users were curious but had mixed feelings, and Rejectors
exhibited the greatest interest but were concerned about its perceived cost. All groups
expressed uncertainty about IQOS, how it works, and its health eects. Reactions to
the reduced exposure statement were mixed across groups, with some viewing it as a
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
meaningful endorsement of harm reduction benets while others were highly skeptical.
Conclusions: These ndings present a mixed picture of smokers’ interest and inclination
to try IQOS and by extension, in their potential as a complete substitute for combustible
cigarettes. IQOS may be adopted by smokers with ENDS use history, but its entry cost
will likely be a barrier to uptake.
FUNDING: Federal
PS2-113
CONTENT ANALYSIS OF YOUTUBE VAPING VIDEOS RELATED
TO COVID-19
John Lee1, Hassan Dashtian2, Dhiraj Murthy2, Jackson Haile3, Grace Kong1. 1Yale
University School of Medicine, New Haven, CT, USA, 2University of Texas at Austin,
School of Journalism and Media, Department of Sociology, Austin, TX, USA, 3University
of Colorado Boulder, Aerospace Engineering, Boulder, CO, USA.
BACKGROUND E-cigarettes are frequently portrayed on YouTube videos. Despite
the growing body of research on how e-cigarettes are portrayed on YouTube, none
of the previous studies analyzed YouTube videos related to Covid-19. Understanding
e-cigarette content related to Covid-19 on YouTube may inform tobacco regulatory
action such as correcting misinformation on e-cigarette use and identifying marketing
and sales strategies used during the pandemic. This study identied the themes of the
Covid-19-related e-cigarette YouTube videos. METHODS We searched for “e-cigarettes”,
“vape” along with “corona”, “covid”, and “Wuhan” on YouTube’s API which uses the
relevance algorithm, in July 2021. We randomly selected videos to identify the themes
related to e-cigarettes and Covid-19. RESULTS The main themes of videos related to
e-cigarette and Covid-19 were: (1) health information related to the risk and benet of
e-cigarette use and Covid-19 (e.g., e-cigarette use may increase the risk of Covid-19;
or e-cigarette use may protect one contracting Covid-19), (2) instructions for vaping
safely to reduce the spread of Covid-19 (e.g., how to sanitize the device), (3) mask
and e-cigarette use (e.g., conduct vape tricks involving masks), (4) e-cigarette sales
and access issues during the pandemic (e.g., in-person vape shops are closed during
the pandemic). CONCLUSION This study identied themes related to e-cigarettes and
Covid-19 on YouTube. Themes included a variety of topic areas including health (mis)
information and instructional videos that may increase (vape tricks inside the mask) or
decrease (sanitizing the devices) health risks, as well as issues related to accessing
and purchasing e-cigarettes during the pandemic. These ndings suggest that com-
munication eorts need to focus on accurate health information regarding e-cigarettes
and Covid-19 to reduce harm from both Covid-19 and e-cigarette use. Understanding
e-cigarette purchasing/access behaviors during the pandemic is important to inform
regulations in this new ennvironment.
FUNDING: Federal
PS2-114
JUUL VS CIGARETTES’ IMPACT ON VASCULAR FUNCTION LUNG
FUNCTION AND SUBJECTIVE EXPERIENCES
Danny Dabroy1, John Akins1, Jeremiah Campbell1, Farjana Yesmin1, Mohammad Ebra-
himi Kalan2, Matthew Brothers1, Ziyad Ben Taleb1. 1University of Texas at Arlington,
Arlington, TX, USA, 2Florida International University, Miami, FL, USA.
Signicance The increasing rates of electronic cigarette (e-cigarettes) use among youth
in the US have been largely attributed to the recent emergence of the high-nicotine-de-
livery pod-based devices such as JUUL. While these devices continue to be promoted
as safer alternatives to combustible cigarettes, their impact on on vascular function, lung
function and subjective experiences remains almost entirely unknown. This study aim
to assess the impact of JULL vaping on lung function, vascular function and subjective
experiences compared with combustible cigarette among adult smokers. Methods: A
total of 14 adult smokers (21-39 yrs) attended two instructed smoking/vaping sessions
(cigarette vs e-cigarette) in a crossover design study. Participants completed a battery of
questions assessing subjective smoking experiences. Endothelial function (via Femoral
Mediated Dilation (FMD)), cerebral function using (via Transcranial Doppler (TCD)) and
lung function (via spirometer) were assessed before and after each sessions. Results:
There was a signicant reduction in lung-function both after smoking and vaping (P<0.05)
with no signicant dierences between the two study conditions. Similarly, there was
a signicant reduction in FMD and TCD both after JUUL and combustible cigarette
use (Ps<0.05). Participants scored higher for measures of satisfaction, enjoyment and
suppression of craving after smoking the combustible cigarette compared with JUUL.
Conclusions: Our results indicate that similar to combustible cigarette, acute exposure
to JUUL is associated with a decrease in lung and vascular function, while providing a
reduced subjective experience than cigarette among regular smokers. Therefore our
pilot study suggest that JUUL vaping may not be a safe alternative to cigarette smoking.
There is a need for longitudinal design studies to assess the long-term impact of JUUL
use on cardiopulmonary function compared with cigarette.
FUNDING: Unfunded; Academic Institution
PS2-115
THE ROLES OF TOBACCO AND CANNABIS USE IN YOUNG
ADULTS’ EVERYDAY LIVES: TWO QUALITATIVE STUDIES FROM
NORTHERN CALIFORNIA
Julia McQuoid1, Johannes Thrul2, Julia S. Oehlers3, Vaishnavi N. Kumar3, Marshall
K. Cheney3, Kekoa Lopez-Paguyo4, Pamela Ling5. 1University of Oklahoma Health
Sciences Center, Oklahoma City, OK, USA, 2Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA, 3University of Oklahoma, Norman, OK, USA, 4University
of California, Berkeley, Berkeley, CA, USA, 5University of CA, San Francisco, San
Francisco, CA, USA.
Signicance: Regular use of tobacco and cannabis is prevalent among young people.
Most tobacco treatment programs do not focus on tobacco’s interplay with cannabis,
possibly reducing treatment ecacy for co-using groups. We draw from two qualitative
studies to compare the integrated and complementary roles of cannabis and tobacco use
in young adults’ everyday lives. Methods: Participants (n=66) were ages 18-30, lived in
Northern California, and reported past month current use of both cannabis and tobacco
(Study 1: n=32; Study 2: n=34). In both studies: (i) In-depth interviews explored partici-
pants’ routines and everyday use contexts; and (ii) a tandem transcript reading method
identied a priori and emergent themes regarding roles and experiences of tobacco and
cannabis use in everyday life. Results: Young adults described tobacco and cannabis
as serving many shared roles, including: coping with overwhelming emotion, pleasure/
fun, transitioning between activities, facilitating social interaction and/or belonging, and
self-soothing (e.g., from boredom). Tobacco’s uniquely prominent roles were: structuring
activities (e.g., stabilizing routines), satisfying addiction, and providing protected breaks.
Cannabis’ uniquely prominent roles were: therapeutic/medicinal, enhancing experience
(e.g., feeling a stereo bass), lowering inhibitions, perceived tobacco cessation aid, and
use in tobacco-prohibited settings. When combined, tobacco complemented cannabis
by controlling psychoactive eects and economizing cannabis consumption. Conclu-
sion: The diverse and complementary roles that cannabis and tobacco play in young
adults’ lives seem to relate to mitigating the characteristic everyday challenges of young
adulthood: learning to navigate diculties independently, nding a community after
transitioning out of the childhood home, and making due on limited budgets. Substance
use interventions should address the roles of cannabis and tobacco dual use as they
relate to the developmental experiences of young adulthood.
FUNDING: Federal; State; Academic Institution
PS2-116
TOBACCO 21 MISCOMMUNICATION AND LOOPHOLES, TWITTER
DISCUSSIONS BEFORE ENACTMENT OF THE FEDERAL LAW
Page D. Dobbs1, Jason B. Colditz2, Eric Schisler1, Brian A. Primack1. 1University of
Arkansas, Fayetteville, AR, USA, 2University of Pittsburgh School of Medicine, Pitts-
burgh, PA, USA.
Signicance. The U.S. restricts the minimum legal sales age (MLSA) of tobacco prod-
ucts to those under 21 years of age, a policy commonly referred to as Tobacco 21.
While Tobacco 21 policies are credited with decreasing tobacco use and sales among
youth, these MLSA laws are often confused with purchase, use, and possession (PUP)
laws that impose a penalty on the underage purchaser rather than the retailer. The
objective of this study is to explore Twitter discussions about Tobacco 21 leading up
to and immediately after the federal Tobacco 21 law was enacted. Methods. Twitter
messages (tweets) about Tobacco 21 posted between September-December 2019 were
independently reviewed by two coders using a content analysis approach. All codes
were found to have acceptable agreement (κ values ranged from 0.673 to 1.00), and
discrepancies were discussed among both coders and an adjudicator until consensus
was met. Results. Findings included three primary categories: Miscommunication
Spread by the News, Youth and Young Adults, and Methods of Avoiding the Law. Most
News-related tweets incorrectly described the law as a purchase law (54.7%). About
one-fourth (27%) of tweets involved youth and young adults, with some discussing young
audiences’ use of and addiction to novel tobacco products. Further, Twitter discussions
included policy loopholes that allow these addicted youth and young adults to access
tobacco products. Albeit few (2.5%), some Twitter users discussed methods of avoiding
the Tobacco 21 law by buying tobacco for someone who was under 21 years, asking
someone else to buy tobacco products for them, or by attempting to purchase tobacco
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
products with or without a fake identication. Conclusions. Tobacco 21 is a sales law
that penalizes tobacco retailers who sell to underage purchasers rather than a PUP
law, as described by most news articles. PUP laws have shown to have mixed results
when examining ecacy to reduce youth purchase and use of tobacco products. They
also create health disparities by disproportionally putting vulnerable populations at
risk of racial discrimination and brutality. Claims that youth will circumvent Tobacco
21 laws by simply purchasing from older peers have been propagated by the tobacco
industry as justication for not passing such laws; however, decreasing the availability
and accessibility of tobacco has been found to eectively reduce the use and sales of
tobacco products to those under 21. Our ndings suggest that policy enactment should
be coupled with communication strategies to maximize policy compliance.
FUNDING: Federal
PS2-117
AN IMPROVED ESTIMATION FOR THE AGE OF INITIATION
OF TOBACCO AMONG U.S. YOUTH: FINDING FROM THE
POPULATION ASSESSMENT OF TOBACCO AND HEALTH STUDY
Folefac Atem1, Arnold Kuk2, Meagan Bluestein2, Kymberle L. Sterling3, Charles E.
Spells2, Sarah E. Messiah3, Melissa Harrell4, Adriana Perez5. 1University of Texas Health
Science Center School of Public Health, Houston, TX, USA, 2University of Texas Health
Science Center School of Public Health, Austin, TX, USA, 3University of Texas Health
Science Center School of Public Health, Dallas, TX, USA, 4University of TX, SPH,
Austin, TX, USA, 5The University of TX Health Science Center at Houston, Austin,
TX, USA.
Objectives: Using the Population Assessment of Tobacco and Health (PATH) youth
dataset (wave 1-4), we conducted a novel analysis using advanced statistical methods
that incorporated users and non-users to provide an improved estimation of the age
of initiation of ever use of several tobacco products. Methods: We combined “left
truncated”(users) and “right censored” (non-users) at wave of entry to estimate the
age of initiation of ever use of cigarettes, e-cigarettes, and cigarillos. Combining infor-
mation collected from these users and non-users, the age of initiation of these tobacco
products was estimated using weighted interval-censored survival analyses. Then,
weighted interval censoring Cox-proportional hazards regression models was used to
assess the dierences in the age of initiation of ever use of these tobacco products by
sex, race/ethnicity, and ever use of the tobacco product at wave of entry. This unique
statistical method is possible because the PATH data recorded the participants’ age
and the number of weeks between relevant subsequent waves to provide an estimate
of age of initiation among non-users; and the recalled age of initiation of ever use of
these tobacco products among users. Results: Our results showed substantial increase
in ever use of all tobacco products after the age of 14. At age 14, 9.1% (CI:7.9, 10.2),
7.1% (CI:4.6, 9.5) and 2.3% (CI:1.1, 3.5) ever use e-cigarettes, cigarettes and cigarillos
respectively. By age 18, the cumulative incidence increased to 49.9% (CI:46.3, 53.5),
37.1% (CI:34.3, 40.0) and 15.9% (CI:14.8, 17.0) ever use of e-cigarettes, cigarettes and
cigarillos respectively. The adjusted Cox model showed that boys had an earlier age of
initiation than girls for all tobacco products. Similarly, non-Hispanic Whites had earlier
age of initiation for each of these tobacco products compared to Hispanics, non-Hispanic
Blacks, and non-Hispanic Other. Conclusion: Our results showed higher proportion of
initiation at every age as compared to previously published studies that were limited
to non-users at wave of entry. These analyses can help elucidate population selection
criteria for estimating the age of initiation of tobacco products.
FUNDING: Federal
PS2-118
DISPARITIES IN SPATIAL PROXIMITY TO VAPE AND TOBACCO
OUTLETS: AN ANALYSIS OF CALIFORNIA MIDDLE AND HIGH
SCHOOLS
Raphael E. Cuomo1, Vidya Purushothaman1, Joshua Yang2, Tim K. Mackey1. 1UC San
Diego, La Jolla, CA, USA, 2CA State University, Fullerton, Fullerton, CA, USA.
Signicance: Previous literature suggests that proximity of schools to tobacco and
vaping storefronts encourages students to initiate use of tobacco/vaping products and
to use these products more frequently. The association of school/community charac-
teristics with proximity to tobacco/vaping storefronts may encourage disparities and
risks associated with tobacco use. We sought to determine the school and community
characteristics associated with proximity to tobacco and vaping storefronts within a
0.5-kilometer radius in California. Methods: A list of licensed tobacco retailers was
obtained from the California Department of Tax and Fee Administration; retailer names
and addresses were used to scrape Yelp in order to determine sub-categorization of
business as a “Vape Shop” or “Tobacco Shop.” US Census Bureau data was used to
assess community characteristics at the census tract level, and the California Depart-
ment of Education provided school characteristics. Logistic regression with backward
selection was used to assess associations of these characteristics. Results: The
nal regression model included six community variables which were all negatively
associated with retailer proximity (percent male, percent age 5-10, percent age 15-20,
percent age 25-30, percent age 55-60, and percent age 60-65) as well as four school
characteristics which were all positively associated (percent female students, percent
Hispanic students, percent White students, percent eligible for free and reduced priced
meals [FRPM]). Identied risk characteristics were geospatially assessed for the Los
Angeles Basin area due to its population size and variation in school density. Conclu-
sions: In our multivariable model, variation in demographics (among both students
and the school community) reected most of the risk associated with school proximity
to tobacco/vaping storefronts. FRPM was also associated with storefront proximity
indicating that schools with a higher burden of lower socioeconomic status may be at
higher exposure to tobacco retailing. Further studies are needed to conrm how retail
density may exacerbate socioeconomic disparities in tobacco/vape use.
FUNDING: State
PS2-119
E-CIGARETTE DEPENDENCE IN YOUTH
Martha Pienkowski1, Michael Chaiton1, Jolene Dubray1, Robert Schwartz2. 1University
of Toronto, Toronto, ON, Canada, 2ON Tobacco Research Unit, Toronto, ON, Canada.
Signicance: The majority of e-cigarette smoking youth use nicotine when vaping. Some
then become dependent on the nicotine, resulting in increased concentrations and
frequency of use, which can then result in subsequent respiratory and cardiovascular
health eects. There has been limited evaluation of convergent validity of e-cigarette
dependence measures for use specically in youth. The objective of this study was to
investigate and validate the eectiveness of various e-cigarette dependence measures
for use specically in adolescent and young adult populations. Methods: A cross-sectional
survey design was used to recruit and assess subjects via social media from August
2020 to February 2021. The study sample included 3,082 Canadian subjects aged 16-
24 who had completed the recruitment and baseline surveys. Of those 3,082, 1,205
reported vaping at least monthly and were thus included in this study and assessed for
e-cigarette dependence. E-cigarette dependence was assessed using a modied 11-item
Penn-State Electronic Cigarette Dependence Index (PS-ECDI), the 4-item E-Cigarette
Dependence Scale (EDS), and a 1-item self-perceived vaping dependence question.
Demographic and vaping behaviour data were also collected. Results: Both the PS-ECDI
and the EDS exhibited a good degree of internal consistency (α= 0.8472 and 0.8405,
respectively). All three measures exhibited convergent validity against each other and
against time to rst vape upon waking (p<0.001). Concurrent validity between each of the
three measures and vaping frequency and nicotine use was signicant (p<0.001 for all
measures). When controlling for demographic variables and combustible cigarette smok-
ing status, the PS-ECDI was superior to both the EDS and the self-perceived measure
when predicting vaping frequency and nicotine use, while the self-perceived measure
was superior to the EDS only when predicting monthly vaping frequency and nicotine
concentrations among nicotine users. Conclusion: All three measures exhibit convergent
and concurrent validity, as well as internal consistency (where applicable). Depending
on the needs of the study, it would be appropriate to use any of these measures when
assessing e-cigarette dependence in adolescent and young adult populations. While the
PS-ECDI is a better predictor of vaping frequency and nicotine use when controlling for
demographic variables, the self-perceived measure still exhibited sucient convergent
and concurrent validity. Thus, the one-item self-perceived measure of dependence is
appropriate for use and preferable to the 10-item PS-ECDI or the 4-item EDS in situations
of limited time or where subjects are at risk of respondent fatigue.
FUNDING: Federal
PS2-120
SWITCHING SMOKERS TO UNFILTERED CIGARETTES
PERCEPTIONS, ADDICTION, AND BEHAVIORAL EFFECTS IN A
CROSS-OVER RANDOMIZED CONTROLLED TRIAL
Kim Pulvers1, LaRee Tracy2, Thomas Novotny2, Adam Hunn2, Devan Romero1, Nathan
Dodder2, Nora Satybaldiyeva2, Jose Magraner2, Eyal Oren2. 1CA State University San
Marcos, San Marcos, CA, USA, 2San Diego State University, San Diego, CA, USA.
Signicance: Despite no evidence that cigarette lters reduce harms for smokers,
99% of commercially sold cigarettes in the United States are ltered. Consequently,
cigarette lters are the most toxic littered item globally each year. Banning the sale of
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
ltered cigarettes as an environmental intervention may change smokers’ perceptions
and behaviors to reduce cigarette consumption and hence support behavioral eorts
toward the tobacco endgame. This is the rst randomized clinical trial testing the eects
of ltered compared to unltered cigarettes on smokers’ cigarette perceptions, nicotine
dependence, and smoking behavior. Method: This cross-over trial involved 43 ltered
cigarette smokers (41.9% women, mean age 36.7 years). Participants were provided
two weeks supply of ltered cigarettes, two-weeks of the same brand of unltered cig-
arettes, and randomly assigned to starting conditions. Measures included the Modied
Cigarette Evaluation Questionnaire; single-item cigarette perception questions; Fager-
ström Test of Nicotine Dependence; seven-day cigarette consumption, urinary cotinine,
and intention to quit. Statistical analysis included linear and ordinal repeated measures
mixed eects models and paired t-tests. Results: Filtered cigarettes were perceived as
better tasting, more satisfying, more enjoyable, less aversive, less harsh, less potent,
and less negatively reinforcing than unltered cigarettes (p<0.05). Filtered cigarettes
were smoked at a higher rate during the trial than unltered cigarettes (p<0.05). There
was no dierence in urinary cotinine, dependence, or intention to quit between ltered
vs. unltered cigarette conditions (p >0.05). Conclusion: Smokers perceived unltered
cigarettes as having greater nicotine eects and less desirable sensory eects than
ltered cigarettes, and they smoked fewer of these during the trial. Although cotinine,
dependence, and intention to quit were similar for smoking unltered and ltered ciga-
rettes in this small trial, results suggest that banning the sale of ltered cigarettes might
make smoking less attractive to smokers in the long run.
FUNDING: State
PS2-121
APPEALING CHARACTERISTICS OF RETAIL AND ONLINE
E-CIGARETTE MARKETING FOR ADOLESCENTS AND YOUNG
ADULTS
Shivani M. Gaiha, Bonnie Halpern-Felsher. Stanford REACH Lab, Division of Adoles-
cent Medicine, Department of Pediatrics, Stanford University, California, Palo Alto, CA,
USA.
Background: Nearly 3.6 million U.S. adolescents use e-cigarettes, despite known health
harms and laws prohibiting sales to people below 21 years. Adolescents and young adults
(AYAs) report purchasing e-cigarettes from retail stores and online. Although studies
show that e-cigarette marketing appeals to AYAs, these studies have not directly asked
AYAs to identify characteristics of retail, online and social media e-cigarette marketing
that they nd most appealing and inuential in determining e-cigarette purchases.
Methods: 90-minute, online focus groups with 14-19 year olds (May-Aug 2021). Pho-
tographs were used to help participants recall e-cigarette marketing. Participants were
recruited through an Instagram post targeting 30 major U.S. cities (n=25 recruited in 3
focus groups from across 10 cities thus far; recruitment ongoing). Thematic analysis
was used to identify themes related to appealing marketing characteristics. Results:
In addition to bright colors of e-cigarette advertising and names of avors, participants
described appealing e-cigarette marketing characteristics. Appealing characteristics in
retails stores: pricing coupons, free smelling samples, individual brands displayed in
separate containers, displays at the checkout counter (e.g., “there’s a big dierence
between being at the counter, where you can pick it up yourself, and being behind the
counter because I don’t want to have to ask the person at the Walgreens -‘can you
hand me that?’”). On social media: AYAs were attracted by youth/inuencers explaining
product safety (e.g., “A lot of inuencers market like ‘Oh yeah, they don’t have any can-
cer-causing chemicals”); and inability to trace messages (e.g., Snapchat). Participants
also listed ways to purchase e-cigarettes using gift cards, debit cards and using fake
or other people’s IDs. Conclusion: Our data show that specic appealing e-cigarette
marketing characteristics in retail stores and online can and should inform FDA, state,
and local regulation. Notications on social media, similar to those created to combat
misinformation about COVID-19 vaccines, may be developed and tested to prevent
AYAs from accessing e-cigarette-related misinformation.
FUNDING: Academic Institution; Nonprot grant funding entity
PS2-122
WHICH SOCIODEMOGRAPHIC FACTORS ARE RELATED TO
ADOLESCENTS’ AND YOUNG ADULTS’ SUSCEPTIBILITY, USE
AND FUTURE USE OF DIFFERENT E-CIGARETTE DEVICES?
Shivani M. Gaiha1, Poonam Rao2, Bonnie Halpern-Felsher1. 1Stanford REACH Lab,
Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Califor-
nia, Palo Alto, CA, USA, 2Division of Cardiology, Center for Tobacco Control Research
and Education, University of California, San Francisco, CA, USA.
Background: Adolescent and young adult (AYA) e-cigarette use is a major public
health concern. Studies have examined sociodemographic factors associated with
AYAs’ susceptibility and use of JUUL and other e-cigarettes. However, no studies re-
port sociodemographic factors associated with initiation, experimentation, and current
use by device types (e.g., disposables, pod-based, tanks). Such research can inform
targeted AYA e-cigarette prevention. Methods: An online cross-sectional survey of
13-24 year olds (n=4,351; 50:50 e-cigarette ever-users/never-users). We assessed
sociodemographic factors associated with AYA: 1) susceptibility among never users,
2) ever vs. never use, 3) former use (ever users who did not use in the past 30 days)
vs. past-30-day use among ever-users, and 4) intent to use in the next six months
among ever users, by a. former users and b. past 30-day users, by device types (any;
pod-based; disposable; other). Results: Our sample included 2,168 never users and
2,183 ever-users. Among ever-users, 912 were former users and 1092 were past 30-
day e-cigarette users. 32.5% of never-users were susceptible to using in the future,
66.3% of former users and 94.5% of 1034 past-30-day-users intended to use in the next
six months. Never users’ susceptibility to use all device types increased among AYAs
identifying as LGBTQ compared to others and among non-Hispanic African American
(AA)/Black AYAs compared to non-Hispanic White AYAs. AYAs identifying as LGBTQ
compared to others were more likely to ever-use a pod-based device (aOR=2.38, 1.07-
5.30) and AYAs aged 13-20 versus 21-24 years-old were less likely to use other devices
(aOR=0.60, 0.43-0.85). Across devices, AYAs were less likely to be past 30-day users
compared to former users if they were younger, female, and non-Hispanic multi-race/
other compared to non-Hispanic White. Future use intent among past 30-day users
was lower among non-Hispanic AA/Black AYAs for disposables and other devices.
Conclusion: Sociodemographic factors are related to initiation, experimentation and
past-30-day use of dierent devices. However, sociodemographic factors have limited
inuence on past-30-day users’ intent to use in the future, where the role of stress,
avors and e-cigarette marketing may be more important.
FUNDING: Federal; Nonprot grant funding entity
PS2-123
INTENTION TO QUIT VAPING AMONG CANADIAN YOUTH AND
YOUNG ADULTS- A MACHINE LEARNING APPROACH
Martha Pienkowski, Michael Chaiton, Rui Fu. University of Toronto, Toronto, ON,
Canada.
Introduction: Vaping has been increasing in prevalence and popularity in recent years,
especially amongst youth and young adults. It is essential to develop our understanding
of inuential factors that impact one’s intention to quit vaping to drive tailored and targeted
treatment development that will be most successful in those with an existing intention
to quit, to maximize quit attempts and quitting success. We developed a random forest
algorithm to predict intention to quit vaping within six months among Canadian youth
and young adults, followed by examination of predictor importance. Methods: This
cross-sectional study used a representative sample of 1,068 Canadian youth and young
adults aged 16-25 that reported vaping at least monthly. Participants were assessed
via a survey on their intention to quit vaping within six months. Using cross-validation,
we developed random forest algorithms to predict the intention to quit vaping, with
model performance evaluated via the AUC. The top 10 most inuential variables on
intention to quit were identied by relative importance score calculation. Results: 31.8%
of participants reported an intention to quit vaping within six months. The random forest
algorithm achieved good performance with ROC-AUC over 0.60. The top 10 predictors
of intention to quit vaping within six months were related to vaping frequency, vaping
expenses, cannabis use, or perceived risks of vaping. Conclusion: Machine learning
is a promising methodology to identify inuential variables on intention to quit vaping.
Knowledge of factors that inuence one’s intention to quit vaping, and thus openness
to treatment, will be of benet in the development and tailoring of targeted treatment
options for e-cigarette dependent vapers.
FUNDING: Federal
142
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-124
CHANGING PATTERNS AND CORRELATES OF POLYTOBACCO
USE AMONG NATIONALLY REPRESENTATIVE SAMPLES OF US
ADOLESCENTS OVER 6 YEARS: A LATENT CLASS ANALYSIS
Tianze Sun, Carmen Lim, Janni Leung, Coral Gartner, Wayne Hall, Jason Connor, Gary
Chan. The University of Queensland, Brisbane, Australia.
Introduction and Aims: Youth polytobacco use of multiple product types is associated
with increased risks of adverse health eects and nicotine dependence. We identied
changes in patterns of polytobacco use among US youth between 2014 and 2020.
Design and Methods: Repeated cross-sectional data of the National Youth Tobacco
Survey from 2014-2020 (Ntotal >100,000) were used. Latent class models identied
classes based on past-month use of nine tobacco products (e.g. cigarettes, cigars,
chewing tobacco/snu, hookah, e-cigarettes, pipe, snus, dissolvable and bidis). We
tested if patterns of polytobacco use changed over time. The demographic and to-
bacco-related characteristics of each class were examined using multinomial logistic
regression. Results: We identied three distinct classes of polytobacco use: ‘Non-use’
(NU, ~90.17 %), ‘occasional e-cigarette, cigarette, cigar, and hookah use’ (ECCCH: ~
8.8 %), and ‘Extended range polytobacco use’ (POLY, ~1.04 %), There was a decrease
in combustible cigarette use in all classes (p < 0.05), while e-cigarette use increased
in all classes (p < 0.05). Factors associated with both ECCCH, and POLY included
being male, diculties in concentrating, remembering, or making decisions, tobacco
use at home, and perceiving tobacco products as harmless. Discussions and Con-
clusions: Our ndings are consistent with recent shifts in adolescent tobacco product
use, demonstrating the decrease in combustible cigarette smoking, and the increase in
e-cigarette use among all three groups, over time. Continuous monitoring of the patterns
and correlates of tobacco use is warranted for interventions targeting youth tobacco
control. Implications for Practice or Policy: Public health interventions to discourage
the uptake of e-cigarettes to consume nicotine in youth are warranted.
FUNDING: Academic Institution
PS2-125
USING TOBACCO AND OTHER SUBSTANCES IN THE PAST 30
DAYS: WHAT IS ASSOCIATED WITH DEPRESSION?
Shivani M. Gaiha, Bonnie Halpern-Felsher. Stanford REACH Lab, Division of Adoles-
cent Medicine, Department of Pediatrics, Stanford University, California, Palo Alto, CA,
USA.
Background: Adolescents and young adults (AYAs) report that stress is a key reason
for using dierent types of substances, including tobacco, alcohol and cannabis. How-
ever, since adolescents may have used a range of substances in the past 30 days, it
is unknown as to whether the odds of depression are greater among those who used
particular products. Methods: We conducted an online cross-sectional survey of 13-24
year olds in May 2020 (50:50 e-cigarette ever-users/never-users). We used a weighted
ordered logistic regression to examine whether depression (Patient Health Question-
naire-2 scores>3) was associated with past 30-day use of 8 substances (cigarettes;
e-cigarettes; little cigars, cigarillos and cigars; smoked marijuana; edible marijuana;
blunts; alcohol; and hookah), including covariates of age, sex, LGBTQ, race/ethnicity
and whether participants were complying with sheltering-in-place orders since staying
at home may be correlated with feeling depressed. Results: In our sample of 4,315
AYAs, 1,449 (33.6%) were depressed, including 442 13-17-year-olds, 937 females,
377 AYAs identifying as LGBTQ, 230 non-Hispanic African American/Black and 819
non-Hispanic Whites. Percentage of AYAs who were depressed out of the whole sample
of 4,315 participants, by substance use status: 1) cigarettes: 839 never-users (19.4%),
262 used but not in the past 30 days (former users) (6.1%) and 327 past 30-day users
(7.6%); 2) e-cigarettes: 585 never-users (13.5%), 355 former users (8.2%) and 509
past 30-day users (11.8%); 3) little cigars, cigarillos and cigars: 1,021 never-users
(23.7%), 188 former users (4.3%) and 219 past 30-day users (5.1%); 4) smoked mar-
ijuana: 702 never-users (16.3%), 266 former users (6.1%) and 458 past 30-day users
(10.6%); edible marijuana: 840 never-users (19.5%), 266 former users (6.1%) and 319
past 30-day users (7.4%); blunts: 810 never-users (18.8%), 481 former users (11.1%)
and 131 past 30-day users (3.0%); alcohol: 400 never-users (9.3%), 341 former users
(7.9%) and 691 past 30-day users (16.0%); and hookah: 1,006 never-users (23.3%),
201 former users (4.6%) and 219 past 30-day users (5.1%). In a model including past
30-day-use of eight substances, depression was more likely among those who used
e-cigarettes in the past 30-days compared to never users (aOR=6.90, 1.74-27.38)
and was less likely among non-Hispanic Asian American Pacic Islander (aOR=0.05,
<0.01-0.97). Depression was not associated with past 30-day-use of any other sub-
stances or other sociodemographic factors in this model. Conclusion: From a range
of substances used by AYAs in the past 30 days, past 30-day-use of e-cigarettes was
particularly associated with depression. Thus, while substance use issues should be
co-investigated with depression, for e-cigarette cessation among past-30-day users
mental health needs should be addressed.
FUNDING: Federal; Nonprot grant funding entity
PS2-126
ELECTRONIC CIGARETTE DEPENDENCE- ASSOCIATION WITH
DEVICE AND USER CHARACTERISTICS
Ashley E. Douglas1, Margaret G. Childers1, Miranda Signorelli1, Abigail Barton2, Nicho-
las J. Felicione3, Jenny E. Ozga4, Eric Soule5, Melissa D. Blank1. 1West Virginia Univer-
sity, Morgantown, WV, USA, 2Marshall University, Huntington, WV, USA, 3Roswell Park
Comprehensive Cancer Center, Bualo, NY, USA, 4Westat, Rockville, MD, USA, 5East
Carolina University, Greenville, NC, USA.
Signicance: The ability of an electronic cigarette (ECIG) to produce dependence
likely varies as a function of its ability to deliver nicotine. Consequently, ECIG depen-
dence may be associated with device/liquid and user characteristics that have shown
to impact nicotine delivery. This study examined the association between ECIG device
and liquid characteristics and ECIG dependence among non-smoking ECIG users.
Methods: Daily users of a nicotine-containing ECIG who smoked <100 cigarettes in
their lifetime (N=134) completed an online survey between November 2020 and May
2021. Respondents answered questions about their ECIG device type (e.g., vape pen,
pod-based system, mod, disposable) and individual characteristics (e.g., rechargeable,
rellable, adjustable power), and uploaded a picture of their device/liquid for verication
of survey responses. They also reported on their ECIG use behaviors (e.g., duration
and frequency of use) and completed the Penn State Electronic Cigarette Dependence
Index. Multivariable linear regressions examined these device and user features as
predictors of dependence, controlling for demographic factors (i.e., age, gender, race/
ethnicity). Results: Participants had a mean age of 23.4 (SD=5.6) years, and identied
largely as White (79.9%) and women (56.7%). Preferred ECIG device types were pod-
based systems (56.0%), disposables (20.1%), mods (15.7%), and vape pens (3.7%).
Higher ECIG dependence scores were associated signicantly with longer durations of
use (B=1.03, SE=0.25), more use days/week (B=1.90 SE=0.39), as well as using pods
(B=2.76, SE=.97) or disposables (B=2.82, SE=1.17) relative to mods (all p’s<.05). No
individual device/liquid features signicantly predicted dependence level. Conclusions:
Findings reect the complexity of the ECIG marketplace, which is inundated with an
abundance of device and liquid characteristics that combine in dierent ways to deter-
mine nicotine delivery. To reduce the dependence potential of ECIGs via restricting their
nicotine delivery ability, regulatory eorts might focus on the nicotine emissions of these
products regardless of their combination of device and liquid features.
FUNDING: Academic Institution
PS2-127
SALIENT BEHAVIORAL BELIEFS UNDERLYING FLAVORED
E-CIGARETTE USE: RESULTS FROM AN ELICITATION SURVEY
WITH YOUNG ADULT VAPERS
Rebekah Wicke, Allison Worsdale, Jiaying Liu. University of Georgia, Athens, GA, USA.
Signicance: The tobacco industry’s marketing eorts on promoting avored e-ciga-
rettes have successfully recruited a new generation of tobacco users, with > 70% of
young adults (YAs) being current users of avored vapes, and 60% reporting avors as a
reason for continued use. Media campaigns continue to be an eective and cost-ecient
approach to remedy the strong negative marketing inuence. Identifying the salient
beliefs underlying YAs’ avored e-cigarette use serves as the rst step of eective
anti-vaping campaign message design. Methods: An elicitation survey was conducted
among 396 18-25-year-old (M=19.66, SD=1.45) ever vapers, with the majority (70.3%)
having vaped in the past 6 months. Participants were asked to list in open-ended format
the advantages and disadvantages of using avored vapes, yielding a total of 3,641
belief items. Thematic analysis was conducted by two coders (alphas=0.81-1.00) to
identify commonly held and novel themes. Results: Among a total of 28 themes identi-
ed, the most commonly shared benet was enjoyment and mood (i.e., avoring better
facilitates stress relief; 33.1%), followed by pleasurable sensations (e.g., the various
pleasing orosensory and olfactory stimulations generated by vaping avors; 31.9%) and
the perceived lower risk compared to other substance use (10%). The most frequently
noted concerns that may dissuade YAs from using avored vapes included negative
physical health eects (43.3%), followed by the loss of independence and control caused
by addiction (25.1%) and the nancial/time costs associated with purchasing avored
e-liquids (13.6%). Amidst the backdrop of the global pandemic, concerns about hygiene
and spreading germs through sharing avored vapes were also saliently noted among
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
vapers. Conclusion: The ndings of this study provide a comprehensive list of potentially
promising anti-vaping campaign themes targeting e-cigarette avors among YAs, with
a priority ranking based on prevalence. Novel, salient beliefs generated directly from
the target audience also provide fresh, innovative angles to fuel eective prevention
eorts to counter the powerful allure of appealing avors.
FUNDING: Federal; Academic Institution
PS2-128
THE USE OF PROTECTIVE BEHAVIORAL STRATEGIES FOR
E-CIGARETTE USE AMONG COLLEGE STUDENTS
Denise D. Tran1, Mark A. Prince2, Reagan E. Fitzke1, Jordan P. Davis1, Eric R. Peder-
sen1. 1University of Southern California, Los Angeles, CA, USA, 2Colorado State Univer-
sity, Fort Collins, CO, USA.
Signicance: Prevalence of e-cigarette use (i.e., vaping) among young adults (YAs)
has risen exponentially, sparking widespread concern as vaping is often YAs’ rst
introduction to nicotine. Exploring factors that may help mitigate the harms associated
with vaping among YAs, such as addiction potential and transition to cigarette smoking,
may provide insights for prevention/intervention eorts. The use of protective behavioral
strategies (PBS) has been explored for YA cannabis and alcohol use. Those who use
PBS more often experience fewer harms from alcohol and cannabis use, and promotion
of PBS use can clinically help youth adopt these harm-reduction practices. However,
information about PBS for vaping have yet to be gathered. This exploratory study
sought to identify PBS that undergraduate college students use for vaping. Methods:
A sample of 277 students responded to measures of vaping frequency and provided
open-ended reports on strategies that they use to avoid or limit vaping. Similar strategies
were grouped together into categories created by two independent coders. Results:
35.4% of respondents reported past 30-day use, using e-cigarettes on an average of
17.0 days (SD=12.0). The most reported strategies for avoiding vaping were “refusal
to use” (e.g., “not accept oers to vape,” 33.9%), “avoiding vape products” (e.g., “don’t
buy them,” 15.2%), and “selective about social circle” (e.g., “avoid people who vape,”
13.0%). The most reported strategies for limiting vaping were “refusal to use” (11.6%),
“not carrying vape products/keeping them out of sight” (e.g., “don’t leave the house with
my vape,” 10.8%), and “limiting use to certain contexts” (e.g., “don’t vape on weekdays,”
9.4%). Among those who vaped in the past 30 days, “avoiding vape products” and “not
carrying vape products/keeping them out of sight” were the most used PBS to avoid
or limit vaping. Conclusion: This work is the rst step toward generating an item pool
for a PBS for vaping scale that will be tested in follow-up work. Such a measure could
be used as a clinical tool to assess for PBS use among heavy users, which may then
inform intervention eorts for youth.
FUNDING: Federal
PS2-129
THE EFFECT OF TOBACCO TAXATION ON PRICES, RECENT
EVIDENCE FROM MEXICO
Belen Saenz-de-Miera1, Vicente Lopez1, Daniela Arce1, Luz Myriam Reynales2. 1Auton-
omous University of Baja California Sur, La Paz, Mexico, 2National Institute of Public
Health, Cuernavaca, Mexico.
Signicance. There is ample evidence on the eectiveness of tobacco taxation to
reduce consumption. This eectiveness, however, depends on the extent to which tax
increases are passed on to consumers through higher prices. Since the tobacco industry
is highly concentrated, the pass-through of excise taxes can vary between countries,
periods, and brands. This study analyzed the most recent tobacco tax increases in
Mexico (January 2020 and 2021) to provide evidence on the eect of excise taxes on
prices in the presence of a duopoly.Methods. Monthly cigarette prices from January
2011 to April 2021 for 46 main cities came from the National Institute of Statistics and
Geography (INEGI). This information is part of that collected by INEGI to calculate the
national consumer price index (INPC). Prices for packs of dierent sizes were used to
estimate standardized average prices per cigarette, city, and month for the seven most
common brands. Panel models regressed prices per cigarette on a linear trend and
dummy variables for January 2020, January 2021, January, brand, and city. Interactions
terms were also considered. Standard tests were used to determine whether xed or
random eects were more appropriate, as well as the presence of unit roots. Results.
The analysis of unit roots suggested that a dynamic specication with the rst lag of the
dependent variable as a regressor was necessary. Likewise, the tests to contrast xed
and random eects indicated the former were more adequate. Both the 14.44 cents and
the 1.64 cents excise tax increases implemented in January 2020 and January 2021
increased cigarette prices (17.3 cents and 3.6 on average, respectively). Price increases
were not homogeneous across brands, however (p<0.01). In January 2020, premium
brands (Benson, Camel, Marlboro) had the highest price increases (between 19 to 24
cents), followed by discount brands (Chestereld, Montana; 16 cents). Mid-segment
brands (Pall Mall, Lucky Strike) had the lowest increases (13 and 12 cents, respectively).
Something similar was observed in January 2021.Conclusions. Recent tax increases
in Mexico show that the tobacco industry implements pricing strategies to try to mod-
erate their impact. In particular, tax increases for mid-segment brands, those with the
fastest growth in the past decade, were partly absorbed to maintain their market share.
FUNDING: Nonprot grant funding entity
PS2-130
ASSOCIATIONS OF CHANGES IN SMOKING-RELATED
PRACTICES WITH SMOKING REDUCTION AND QUIT ATTEMPTS
AMID THE COVID-19 PANDEMIC
Tzu Tsun Luk1, Man Ping Wang1, Xue Weng1, Yingpei Zeng1, Henry Sau-chai Tong2,
Vienna Wai-yin Lai2, Tai Hing Lam3. 1School of Nursing, The University of Hong Kong,
Hong Kong, Hong Kong, 2Hong Kong Council on Smoking and Health, Hong Kong,
Hong Kong, 3School of Public Health, The University of Hong Kong, Hong Kong, Hong
Kong.
Signicance: The implementation of social-distancing measures to contain the COVID-19
pandemic has disrupted daily life activities, including smoking-related practices in
smokers. We examined the associations of changes in smoking-related practices
with smoking reduction and quit attempts since the outbreak. Methods: Data were
collected from 659 current smokers who responded to a telephone survey conducted
from May to June 2020 in Hong Kong. During this period, the Hong Kong government
has implemented social-distancing restrictions but no lockdown. Participants reported
if they have reduced their smoking consumption, made a quit attempt, and changed
several smoking-related practices since the COVID-19 outbreak. We estimated the
prevalence ratio (PR) of smoking reduction and quit attempts in relation to changes
in the smoking-related practices, adjusting for sex, age, education, chronic disease
status, heaviness of smoking, and perceived risk of COVID-19 and mutual adjustment.
Results: Since the outbreak, 26.2% of the participants had reduced smoking and 17.9%
made a quit attempt; 60.4% reported having avoided smoking on the street, 51.7%
avoided smoking with other smokers, 34.3% reduced going out to buy cigarettes, 25.4%
increased smoking at home, and 20.0% stockpiled tobacco products. Multivariable
models showed that having reduced going out to buy cigarettes was signicantly asso-
ciated with smoking reduction (PR 2.67; 95% CI 1.93-3.68; P<0.001); having avoided
smoking on the street (PR 1.93; 95% CI 1.20-3.10; P<0.006) and reduced going out
to buy cigarettes (PR 1.97; 95% CI 1.36-2.86; P<0.001) were signicantly associated
with making a quit attempt; no association between other changes in smoking-related
practices and smoking reduction or quit attempt was observed (PR ranges from 0.84
to 1.20; all P>0.05). Conclusion: Many participants reported changes in their smok-
ing-related practices since the COVID-19 outbreak; some changes were associated
with smoking reduction and quit attempt, suggesting the outbreak to be an opportune
time to promote smoking cessation.
FUNDING: Unfunded
PS2-131
BARRIERS AND CHALLENGES IN CONDUCTING RESEARCH
ON TOBACCO USE AMONG YOUTH IN SCHOOLS OF INDIA- A
GROUNDED THEORY APPROACH
Suneela Garg1, Chetana Deshmukh2, Mongjam Meghachandra Singh2, Amod Laxmi-
kant Borle3, Nidhi M. Bhatnagar3, Ravi Kaushik3, Kamran Siddiqi4, Ravi Mehrotra5, Ravi
Mehrotra5. 1Maulana Azad Medical College, New Delhi, India, New Delhi, India, 2Maulana
Azad Medical College,Delhi, Delhi, India, 3Maulana Azad Medical College,Delhi, New
Delhi, India, 4University of York, York, United Kingdom, 5India Cancer Research Consor-
tium–ICMR, New Delhi, India, New Delhi, India.
Introduction: Educational institutions provide important settings for tobacco control
interventions. However, tobacco-related issues remain neglected due to their absence
in school curriculum. This study is panned to understand the dynamics in research
among youth and the confounding factors in the process of conducting the research
from the perspective of students and teachers. Methods: Cross sectional qualitative
study was planned in eight schools selected by purposive sampling. In depth inter-
views were conducted for 30 teachers involved in conducting tobacco related study
with students and four FGDs were conducted among students. Inductive analysis of
the qualitative data was done with grounded theory-based analysis in which repeating
themes were identied, grouping the codes were grouped into concepts hierarchically
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
and then categorization of the concepts was done through relationship. Results: The
teachers involved in conducting study related to tobacco focused on administrative
challenges from school authorities and refraining attitude of parents especially for their
girl child. Students were totally aware of tobacco products and were in favour of con-
ducting tobacco related studies in schools. They suggested innovative ideas regarding
study settings, method of conducting tobacco studies and agreed to be messengers
of tobacco free initiatives in community. Three perspectives of teachers, parents and
students were evolved for tobacco related study which will be help in improving further
research. Conclusion: Behavioural research on attitudes, perceptions and beliefs re-
garding tobacco-related issues among youth, their parents as well as their teachers in
schools are helpful to design appropriate research, strategies and contents for tobacco
education. Community approaches incorporating behavioural change communication
aimed at reducing tobacco use among youth would be critical.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
PS2-132
AN ONLINE EXPERIMENTAL STUDY TESTING THE EFFECT OF
PICTORIAL WATERPIPE-SPECIFIC HEALTH WARNING LABELS
BASED ON THEIR PLACEMENT IN TUNISIA
Nadia Ben Mansour1, Rime Jebai2, Ichrak B. Hamida3, Habiba Ben Romdhane3, Wasim
Maziak2, Taghrid Asfar4. 1Faculty of Medecine of Tunis, National Institute of Health,
Tunis, Tunisia, 2Florida International University, Miami, FL, USA, 3Faculty of Medecine
of Tunis, Tunis, Tunisia, 4University of Miami, Miami, FL, USA.
Introduction: Waterpipe (WP) smoking is rapidly increasing among youth in Tunisia.
Pictorial health warning labels (HWLs) on tobacco products have been eective in
communicating health risks associated with tobacco smoking. However, WP’s mul-
tiple-components, limited portability, yet long use sessions (≈1 hour) create a unique
product conguration and use setting that have not been addressed in implementing
HWLs for the WP. This study aimed to test the eectiveness of pictorial HWL versus
text-only. HWLs placed on tobacco only versus all WP components (device, tobacco,
charcoal). Methods: We conducted a factorial online experimental study among young
adults in Tunisia (n=100; 64% female; age 18-34 years) to test 4 pictorial HWLs de-
veloped in focus group study. Participants were randomly assigned to 3 experimental
conditions: 1) pictorial HWL on tobacco, pictorial HWL on all components, or text-only
HWL on tobacco (control). Participants evaluated the HWLs on attention, perceived
message eectiveness, negative aect, aective risk, experiential risk, reactance, social
interaction, avoidance, and perceived HWL eectiveness on others. General linear
mixed model (GLMM) were used to analyze outcome data. The models included xed
eects for between-subjects’ factors (label placement) and a random intercept was t
with subjects nested within the between-subjects’ factors. We also tested interaction
between placement and HWLs conditions. A two-tailed alpha level 0.05 was considered
signicant. Results: Overall, 71.7% of participants were non-smokers. Pictorial HWLs
on tobacco were signicantly more eective than text-only warnings for the following out-
comes: attention (OR: 0.83 95%CI [1.09; 0.58]), believability (0.34 [0.56; 0.11]), negative
aect (0.75 [0.97; 0.54]), aective risk (0.38 [0.63; 0.13]), experiential risk (0.53 [0.77;
0.28]) and reactance (0.38 [0.57; 0.18]). Participants rated attention and believability
less favorably for pictorial HWL on all components vs. Tobacco only (-0.5 [-0.75; -0.24];
-0.27 [-0.5; - 0.05], respectively). No signicant interaction was noted according to HWL
conditions. Conclusion: This is the rst experiment examining pictorial HWLs specic
to WP in Tunisia. Findings from this study provided important evidence that pictorial
HWLs are more eective than text-only, for six communication outcomes. Nevertheless,
we were not able to show the eectiveness of pictorial HWL on all WP components vs.
Tobacco only. The online design of the study may have aected our results.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
PS2-133
HOME TOBACCO USE POLICIES AND EXPOSURE TO
SECONDHAND TOBACCO SMOKE: FINDINGS FROM WAVES 1
THROUGH 4 OF THE POPULATION ASSESSMENT OF TOBACCO
AND HEALTH (PATH) STUDY
Cheryl Rivard, Anthony Brown, Karin Kasza, Maansi Bansal-Travers, Andrew Hyland.
Roswell Park Comprehensive Cancer Center, Bualo, NY, USA.
Signicance: The 2006 Surgeon General’s Report recommended the elimination of
smoking in homes as an eective protective measure against the harmful eects of
secondhand tobacco smoke exposure. This study examines trends in the prevalence and
levels of adoption of home tobacco use policies specically for cigarettes, e-cigarettes,
smokeless tobacco, and the relationships between home tobacco use policies and
self-reported exposure to secondhand tobacco smoke. Methods: This study utilizes data
from Wave 1 (2013-2014) through Wave 4 (2016-2018) of the Population Assessment of
Tobacco and Health (PATH) Study, a large prospective cohort study of youth and adults
in the United States, which collected information about both smoke-free and tobacco-free
home policies. We present weighted population-based self-reported prevalence of home
tobacco use policies overall and by product, the average number of self-reported hours
of secondhand smoke (SHS) exposure by levels of home tobacco policy and by survey
wave, and we examine characteristics of those who adopted (yes/no) a home tobacco
use ban between survey waves. Results: We found a high prevalence of complete
tobacco-free home policies (69.5%). However, 10.6% of adults allow the use of any
type of tobacco product inside their home, and 19.8% have a policy allowing the use of
some types of tobacco products and banning the use of others. Adults with a complete
tobacco use ban inside their home were more likely to be nonusers of tobacco (79.9%),
living with children in the home (71.8%), at or above the poverty level (70.8%), non-
white (76.0%), Hispanic (82.7%), and age 45 or older (71.9%). The adoption of 100%
tobacco-free home policies is associated with a 64% decrease in secondhand smoke
exposure among youth and a 69% decrease in exposure among adults. Conclusions:
Most US adults have implemented tobacco-free home policies; however, there is still
exposure to SHS in the home, for both adults and children, particularly in the homes of
tobacco users. Additional research should investigate tobacco-free home policies for
dierent types of products and what eect this has on future tobacco use behaviors.
FUNDING: Unfunded; Nonprot grant funding entity
PS2-134
PROVIDING TOBACCO CESSATION SERVICES TO
ADOLESCENTS IN VULNERABLE SITUATIONS DURING
COVID-19: EXPERIENCES FROM MUMBAI, INDIA
Himanshu A. Gupte1, Gauri Mandal2. 1Narotam Sekhsaria Foundation, Mumbai, India,
2Salaam Bombay Foundation, Mumbai, India.
Background: Use of tobacco products increases the risk of coronavirus infection and
its spread. World Health Organization recommends and highlights the need to oer help
to tobacco users and strengthen cessation measures during pandemic. Emergence of
COVID-19 has led implementers to adapt virtual methods to reach the beneciaries.
Is virtual method the solution to reach adolescents residing in slum areas with limited
access to mobile phones and internet services and provide accessible cessation support
during the pandemic? Methods: In 2019-2020, LifeFirst implemented an in-school six-
month tobacco and areca-nut cessation programme for students of slum-based schools.
that oered six theme-based in-person group counseling sessions. On 25th March 2020,
the Government of India announced a nationwide lockdown in response to COVID-19
pandemic. To address this situation LifeFirst modied the programme and adapted
telephonic communication to reach the students. Individual telephonic sessions were
conducted to sensitize, identify tobacco/areca nut users and register them for counselling
services. Six-month telephonic counselling sessions were provided to the registered
users. Results: From April 2019-March 2020, 5986 students were sensitized and 2236
(37%) of them registered for counseling sessions. From April 2020-March 2021, 4509
students were sensitized and 30 students registered for the counselling sessions. This
low reporting of tobacco use could be due to: • Diculty in building rapport and gaining
trust of students in a short time over telephone. • Most of the students spoke with the
counsellors from their homes in presence of their parents and were reluctant to talk
about their tobacco habit. • Tobacco consumption had reduced due to inaccessibility of
tobacco products due to lockdown restrictions (shops closed, increased cost). • Tobacco
and areca-nut use is a peer group activity and lack of interactions with peers caused a
decrease in use. Conclusion: Providing telephonic cessation services to adolescents
is a challenge. Implementers need to design and create innovative methods to adapt
the situation. Evaluation of new adapted strategies is required.
FUNDING: Unfunded
PS2-135
SMOKING CESSATION TREATMENT OUTCOMES AMONG
QUITLINE PARTICIPANTS WITH PHYSICAL AND MENTAL
CONDITIONS
Cheryl Rivard1, Christine Sheer2, Renee Goodwin3, Andrew Hyland1. 1Roswell Park
Comprehensive Cancer Center, Bualo, NY, USA, 2Roswell Park Cancer Institute,
Bualo, NY, USA, 3City University of NY and Columbia University, NY, NY, USA.
Signicance: Research suggests that physical and mental health conditions are as-
sociated with higher smoking prevalence. This study examined inuence of physical
and mental health conditions on smoking cessation among callers to the New York
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
State Smokers Quitline (NYSSQL). Methods: Participants (n=15,018) included adult
tobacco users who contacted the NYSSQL and completed an intake assessment.
Physical health status was measured with 6 standard items assessing serious diculty
hearing; seeing; concentrating, remembering, or making decisions; walking or climbing
stairs; dressing or bathing; doing errands alone. The Kessler Psychological Distress
Scale (K6) was used to assess level of psychological distress as a proxy for mental
health status. Serious psychological distress (SPD) was dened as K6 score of ≥13;
moderate to low psychological distress (MLPD) was dened as K6 score of <13. Sev-
en-day point prevalence abstinence outcome assessments were conducted by email
and phone after 7 months. Logistic regression was used to examine the inuence of
health status accounting for demographics and cigarettes smoked per day. Results:
Over one-third of callers (34.5%) reported at least one physical health conditions and
one in ten (11.8%) met criteria for SPD. Among the 1,921 callers (13.2% of participants)
who completed the outcome assessment, those reporting no physical health conditions
(37.3%) were more likely to be abstinent from smoking compared with participants
reporting at least 1 (30.4%) (chi square p-value=0.002). Those with MLPD (35.6%)
were more likely to be abstinent from smoking compared with participants with SPD
(27.5%) (chi square p-value=0.02). After controlling for demographics and cigarettes
per day, SPD was associated with lower abstinence rates from smoking compared to
MLPD (OR=0.67; 95% CI=0.48-0.95). Conclusions: Among callers to the NYSSQL,
physical and mental health conditions are common and associated with poorer tobacco
treatment outcomes. These ndings highlight the unmet need for addressing physical
and mental health conditions common among Quitline callers as a next step in making
successful treatment possible for all smokers.
FUNDING: State
PS2-136
TESTING AN INTEGRATED THEORY OF VAPING INITIATION IN
HISPANIC YOUTH
Steven Branstetter1, Kimberly Horn2. 1The PA State University, University Park, PA,
USA, 2VA Tech, Roanoke, VA, USA.
Signicance. Despite a reduction in overall cigarette smoking rates in the last several
decades, recent increases in the use of electronic nicotine delivery systems (ENDS),
such as e-cigarettes and Juul devices, prompted the Surgeon General to declare the
use of such products to be an “epidemic.” Among the increasing rates of vaping, there
exist important disparities: for example, Latinx youth may be particularly vulnerable to
early initiation. There is evidence, however, that parental inuences such as commu-
nication and modeling may be uniquely protective against smoking initiation in these
vulnerable populations. The present study sought to test an integrated health behavior
theory model of early adolescent Hispanic vaping initiation that includes parental and
peer inuences, perceived norms, risks, and intent to use ENDS. Methods. Data from
waves 3 and 4 of the Population Assessment of Tobacco and Health (PATH) were used
to create and test a longitudinal analysis of covariance structures model examining the
inuences of parental modeling, communication, and rule-setting on harm perceptions,
norm perceptions (*), curiosity and intent-to-use on the initiation of ENDS use one
year later. Multigroup model comparisons with non-Hispanic youth were completed
and alternative models including peer inuences were also tested. Results: Findings
suggest that ENDS use among parents, household restrictions, and talking about ENDS
all increase the perceived harm of ENDS use among Hispanic use; perceptions of harm
were directly related to intent to use and use one year later . In non-Hispanic youth,
parental use of ENDS and parent-child talks about ENDS use increased youth curiosity
to use, which was related to both intent to use and use one year later. Conclusions:
Dierences between parental inuence on ENDS use between Hispanic and non-His-
panic youth may inform interventions that are ethnically tailored and include parental
involvement. Further research into the the many sub-groups included under the general
term “Hispanic” are warranted.
FUNDING: Federal
PS2-137
DIFFERENCES IN CIGARETTE SMOKING AND OTHER
COMBUSTIBLE TOBACCO USE BY PATTERNS OF ENDS USE
ACROSS ADOLESCENCE
Melissa Harrell1, Baojiang Chen1, Stephanie Clendennen1, Aslesha Sumbe1, Adriana
Perez1, Kathleen Case2, Anna Wilkinson1, Alexandra Loukas3. 1UTHealth, SPH, Austin,
TX, USA, 2UTHealth, San Antonio, San Antonio, TX, USA, 3University of TX, Austin,
Austin, TX, USA.
Signcance. A limited number of studies have modeled stable trajectories of and
patterns in ENDS use across adolescence. It is unknown whether and how these
trajectories and patterns of ENDS use are related to cigarette smoking and other
combustible tobacco product use. Methods. This is a longitudinal analysis of tobacco
use surveys from the Texas Adolescent Tobacco and Marketing Surveillance System
(TATAMS), collected every 6 months from 2014 to 2019 from 3 cohorts of adolescents
[n(students)=3,899; N(observations)=24,492]. Growth mixture models (GMMs) were
applied to identify stable patterns in trajectories of past 30-day ENDS use, from 11 to 19
years of age. Then, dierences in past 30-day cigarette smoking and past 30-day other
combustible tobacco product use (cigar products, hookah) from 11 to 19 years of age
were examined by patterns in ENDS use using generalized estimating equation methods.
All models were adjusted for sex, race/ethnicity, SES, cohort, and survey wave. Results.
Four stable trajectories of past 30-day ENDS use were identied, from 11 to 19 years
of age: (a) non-users (74%) and those whose ENDS use started and then escalated in
(b) early (6%), (c) middle (13%), and (d) late (6%) adolescence. Past 30-day cigarette
smoking remained negligible among ENDS non-users across adolescence, but escalated
rapidly and exponentially for all other ENDS use patterns. By age 19, compared to ENDS
non-users (p<0.05), the mean number of days of cigarette smoking in the past 30 was
signicantly higher among participants who started ENDS use early in adolescence,
followed by those who started ENDS use in middle and late adolescence. Similar
patterns were observed for past 30-day use of other combustible tobacco products,
though dierences in the escalation of tobacco use later in adolescence, by ENDS use
pattern, were less steep. Conclusion. Past 30-day cigarette smoking and combustible
tobacco product use varies in important ways across adolescence, given patterns in
the onset and progression of ENDS use across this same period. Although ENDS are
increasingly prevalent, prevention programs should target all types of tobacco products.
FUNDING: Federal
PS2-138
PERCEPTIONS OF IQOS HEATED TOBACCO PRODUCT ON
TWITTER IN THE UNITED STATES
Canruo Zou, Xueting Wang, Zidian Xie, Dongmei Li. University of Rochester, Roch-
ester, NY, USA.
Signicance: After the approval of the sales of IQOS in the United States market, dis-
cussions about IQOS have become active on social media. Twitter is a popular social
media platform to understand public opinions toward IQOS. This study aims to explore
public perceptions toward IQOS on Twitter in the United States. Methods: IQOS related
tweets from the United States between November 19, 2019 and August 24, 2020 were
collected using a Twitter streaming application programming interface (API). Sentiment
analysis was performed to determine whether the public perceptions towards IQOS
were positive, neutral, or negative. In addition, topics discussed in these tweets were
manually coded. Results: From November 2019 to August 2020, the number of tweets
discussing IQOS was relatively constant except for a peak starting from July 7, 2020
that lasted for four days. Among IQOS tweets with positive sentiments, the most popular
topic is “IQOS is safer than cigarettes”, followed by “IQOS help quit smoking”. Among
tweets with negative sentiments, the most popular topic is “illegal marketing/selling to
youth”, followed by “health risks/re hazards”. “FDA approval/regulation” is the most
popular topic for tweets with neutral sentiments. After the announcement of the United
States Food and Drug Administration (FDA) enforcement policy on unauthorized avored
e-cigarette products on January 2, 2020, the proportion of tweets with positive attitudes
toward IQOS signicantly increased while the proportion of negative tweets signicantly
decreased. Conclusion: Our study showed that the public perception of IQOS in the
United States became more positive after the FDA enforcement policy on avored
e-cigarettes. While many Twitter users thought IQOS is safer than cigarettes and help
quit smoking, some Twitter users complained about the illegal marketing and health
risks of IQOS. These ndings provide useful information on future tobacco regulation.
FUNDING: Federal
146
2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-139
THE GERMANY-SMOKING AND VAPING MODEL. EXAMINING THE
APPLICATION OF A FLEXIBLE NICOTINE VAPING PRODUCT USE
SIMULATION MODEL
Luz Sanchez Romero1, Yameng Li1, Alex Liber1, Jihyoun Jeon2, Jamie Tam3, Zhe
Yuan1, Nargiz Travis1, Rafael Meza2, David T. Levy1. 1Georgetown University, Wash-
ington, DC, USA, 2University of Michigan, Ann Arbor, MI, USA, 3Yale University, New
Haven, CT, USA.
Signicance: Nicotine vaping products (NVPs), such as e-cigarettes, are changing the
tobacco use landscape. Simulation modeling provides a tool for examining potential
public health outcomes of novel tobacco products use. The Smoking and Vaping Model
(SAVM) is a generic simulation model, accessible to non-expert modelers, that projects
the impact of NVPs on smoking trends and associated deaths of a given population. We
illustrate SAVM’s adaptation for German population, the Germany-SAVM. Methods:
Germany-SAVM is a cohort-based discrete-time simulation model, that projects the
impact of NVP use from 2012 to 2060 by comparing No-NVP and NVP scenarios. The
No-NVP scenario projects smoking rates in the absence of NVPs using German data
on population, deaths, life expectancy, and 2012 smoking prevalence. Smoking initiation
and cessation rates for the German population were estimated by scaling US rates of
age and sex-specic smoking prevalence using the ratio of German and US smoking
prevalence in 2012. The NVP scenario models smoking and vaping prevalence once
NVPs are introduced using NVP mortality risk at 5% of the smoking risk in the No-NVP
scenario, smoking initiation at 75%, NVP initiation at 50%, and cessation at 100% of the
No-NVP scenario rates and US derived NVP switching rates. The public health impact is
derived as the dierence between smoking-attributable deaths in the No-NVP scenario
and smoking- and vaping-attributable deaths (SVADs) in the NVP scenario and the
dierence of life years lost (LYLs) between these two scenarios. Germany-SAVM was
validated using smoking data from the 2017 German Microcensus. Results: Germa-
ny-SAVM slightly underestimated the 2017 smoking prevalence for adult males aged
18+ years (Microcensus: 26.4% vs. SAVM: 25.7%) but overestimated female smoking
prevalence (Microcensus: 18.6% vs. SAVM: 20.4%). Compared to the No-NVP scenario,
from 2012 to 2060, the NVP scenario projects a decline in smoking prevalence of 81.7%
(14.2% to 2.6%) for males and 68.6% (11.8% to 3.7%) for females, and a cumulative
total of 0.9 million fewer SVADs and 13.7 million fewer LYLs. Conclusions: SAVM is a
simulation tool that is easily adaptable for dierent countries, requires minimum data, and
can be used by non-experts. Its evidence will help researchers, policymakers, and other
public health stakeholders to analyze the potential population health eects of NVP use.
FUNDING: Federal
PS2-140
DEVELOPMENT OF THE STANFORD VAPING INFORMATION,
SOLUTIONS, AND INTERVENTIONS TOOLKIT (VISIT) FOR
HEALTHCARE PROVIDERS
Bonnie Halpern-Felsher, PhD, Adrienne Lazaro, Richard Daniel Ceballos, Marcia
Monica Zorrilla, Bradley Zicherman, Arash Anoshiravani. Stanford University.
Background: Adolescent and young adult (AYA) vaping remains a signicant public health
issue, yet few evidence-informed resources exist to help healthcare providers prevent
and stop youth from vaping, and fewer exist using a community-based participatory
research (CBPR) approach. Methods: Using CBPR approaches, we conducted two
focus groups with 15 healthcare providers (including physicians, nurses, and therapists),
and identied themes and resources they found most important and needed in a new
vaping prevention Toolkit. Using these themes and a review of the literature, we drafted
the website, which was then given to 10 healthcare clinicians to provide feedback. The
goals of the resulting Stanford Vaping Information, Solutions, and Interventions Toolkit
(VISIT) for Healthcare Providers are to provide AYA Healthcare Providers with (1) the
most up-to-date and relevant information on vaping; (2) youth-friendly printouts for the
clinical setting; (3) information to screening, counsel, and support young people who are
using e-cigarettes/vapes; and (4) easy-to-share resources for young people ready to quit
and families wanting to support them. VISIT is now being disseminated and evaluated.
Results: VISIT (https://med.stanford.edu/visit.html) is a free, online set of information,
scripts, and resources to help providers. VISIT provides essential information to teach
clinicians about vaping, information specic to the clinical encounter including What to
Ask, How to ask about Vaping, and What to do if the patient screens positive for vaping.
Resources include information on motivational interviewing, prescribing nicotine replace-
ment therapy, and how to ensure a condential visit. VISIT has been disseminated to
healthcare providers in a few states and hospitals. Early evaluations suggest that VISIT
is acceptable and feasible. Additional data are being collected and will be presented.
Discussion: VISIT is an evolving Toolkit based on the needs of health-care providers.
The initial evaluations show that the materials are eective, and that developing tools
with input from clinicians is ideal.
FUNDING: Federal; Other
PS2-141
SUPPORTING YOUTH E-CIGARETTE CESSATION: NCI’S
SMOKEFREE.GOV RESOURCES
Meredith Grady1, Yvonne Prutzman1, Maria Roditis1, Joseph Ciccolo1, Brian Kee2.
1NCI, 2ICF.
E-cigarette use among youth is a critical public health concern. In recent years, NCI’s
Smokefree.gov Initiative (SFGI) and FDA’s The Real Cost (TRC) campaign have ex-
perienced a noticeable and sustained increase in youth seeking e-cigarette cessation
guidance. In response to this emergent need, NCI, in collaboration with FDA, developed
a collection of digital e-cigarette resources for the SFGI’s SmokefreeTeen website (www.
teensmokefree.gov/quit-vaping) that inform youth about the dangers of e-cigarettes
and provide support for youth e-cigarette cessation.The e-cigarette cessation content
collection, launched in July 2019, consists of 7 webpages with information and advice
related to quitting including nicotine addiction and withdrawal, handling triggers and
cravings, and managing moods. Content development relied on clinical best practices
for treating nicotine dependence, grounded in principles of cognitive behavioral therapy
and motivational interviewing. In July 2020, a companion, interactive quit plan builder
tool was added. This tool guides users step-by-step to create a personalized plan for
quitting e-cigarettes. A robust analytics program was implemented to measure the reach
and performance of these resources. Since launch, the e-cigarette content collection
has received 2,085,785 page views and has been accessed by 1,330,329 unique users.
Integration of the quit plan builder tool resulted in an immediate spike in engagement
with 5,612 plans completed in the rst month following launch. Quit plan completions
have remained at roughly the same level over time (4,000-6,000 monthly). Furthermore,
of the unique visits to the quit plan builder since inception (54,010), a high proportion
(55%) were completed. User trac to the SmokefreeTeen resources was driven primarily
by organic search queries (e.g., Google) followed by TRC campaign referrals.The rapid
and sustained uptake of SmokefreeTeen’s e-cigarette cessation resources demonstrate
teen’s desire for these resources and their resonance with youth. To date, these digital
e-cigarette resources have reached millions of youth seeking help to quit e-cigarettes.
FUNDING: Federal
PS2-142
A USABILITY STUDY OF TEENS’ EXPERIENCES WITH AN
INTERACTIVE, ONLINE VAPING QUIT PLAN BUILDER
Alexandra Rose Budenz, DrPH, MA1, Yvonne Prutzman1, Meredith Grady1, Becca Xu2,
Annie Beach2, Laura Vercammen2. 1National Cancer Institute, 2ICF.
Signicance: In response to the public health burden posed by increasing youth
e-cigarette use, the National Cancer Institute developed an online teen Vaping Quit
Plan Builder (VQPB) to address the need for an interactive tool to support e-cigarette
cessation among youth. The VQPB guides users step-by-step to create a personalized
plan for quitting e-cigarettes. This qualitative user testing study aimed to assess teens’
perceptions about the functionality and usability of the VQPB to inform actionable
optimizations to the VQPB.Methods: Qualitative interviews were conducted between
August and September 2020 with 33 teens who reported current e-cigarette use. The
interviews included a participatory design session, during which participants used the
VQPB and provided real-time feedback on their perceptions about the functionality and
usability of the VQPB.Results: Teens reported positive usability experiences, citing the
organization and straightforward layout of the VQPB as facilitators to usability. VQPB
features received positively by teens included a calendar function to aid in choosing a
quit date and a calculator that showed how much money teens would potentially save
by quitting e-cigarettes. Teens also reported feeling that the design of the VQPB was
age appropriate and that the integration of visuals (photos, graphics) into the VQPB
design enhanced user experience. Identied areas for optimization of the VQPB were
decreasing the length of text sections, removing redundant information to streamline
quitting recommendations, and increasing the number of visual elements integrated
throughout the quit plan. Conclusion: Usability testing of the VQPB with teens showed
positive user experiences with the VQPB and appreciation for interactive features of
the VQPB that facilitated the selection of a quit date and allowed them to visualize the
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
monetary benets of quitting. The usability testing also revealed opportunities to opti-
mize the VQPB by streamlining text sections and quitting recommendations, as well as
increasing integration of photos and graphics to enhance user experience.
FUNDING: Federal
PS2-143
REAL-TIME EXPOSURE TO ANTI-TOBACCO MESSAGING AMONG
YOUNG ADULTS
Jennifer Cantrell, DrPH1, Susan Westneat, MA2, Judy van de Venne, PhD3, Andrew
Anesetti-Rothermel, PhD4, Shanell Folger, BA5, Basmah Rahman, MPH5, Charles
Debnam, MCHES6, Kurt Ribisl, PhD7, Amy Cohn, PhD8, Shyanika Rose, PhD2. 1New
York University School of Global Public Health, NY, NY, USA, 2University of Kentucky
College of Medicine Department of Behavioral Science and Center for Health Equity
Transformation, Lexington, KY, USA, 3Markey Cancer Center, Lexington, KY, USA,
4Center for Tobacco Products, US Food and Drug Administration, Washington, DC,
USA, 5Truth Initiative Schroeder Institute, Washington, DC, USA, 6Community Wellness
Alliance, Washington, DC, USA, 7University of North Carolina at Chapel Hill, Gillings
School of Global Public Health, Department of Health Behavior, Chapel Hill, NC, USA,
8University of Oklahoma Health Sciences Center, Health Promotion Research Center,
Stephenson Cancer Center, Oklahoma City, OK, USA.
Objective: The tobacco industry has become increasingly adept at marketing targeted
to young adults (YAs) that engage in high-risk activities (i.e., on social media), in high-
risk locations (i.e., near a tobacco retail outlet), and in minority neighborhoods. Little
is known about whether anti-tobacco marketing is reaching young people exposed to
such messaging in environments at high risk for this pro-tobacco marketing. This study
used ecological momentary assessment (EMA) to assess demographic and real-time
correlates of exposure to anti-tobacco marketing among YAs. Methods: This study
used EMA data to assess context (e.g., location and activity) of anti-tobacco marketing
exposure using four mini-surveys per day over two weeks. YA non-current tobacco users
living in Washington D.C. (n=145; ages 18-24) recorded 5,219 surveys, including 19
participants (13.1%) living in neighborhoods with high proportions of racial/ethnic minority
residents, and high smoking rates. Adjusted multilevel regression models assessed the
association between exposure to anti-tobacco marketing, demographics and real-time
contextual variables. Results: A total of 61 respondents reported at least one exposure
to anti-tobacco marketing, for 141 exposures over the EMA period. In adjusted analyses,
odds of exposure were higher for those living in a minority neighborhood (aOR=4.3,
all p’s<.05), in the presence of someone using tobacco products (aOR=1.7), at work/
school (aOR=2.3), outside/in transit (aOR=2.1) and online/social media (aOR=1.9) vs.
home. There were no signicant dierences in anti-tobacco exposure by age, sex, race/
ethnicity or education, or for other locations and activities (i.e., at a bar/restaurant, clubs,
or in a retail store) vs. at home. Conclusion: Almost 43% of YA non-current tobacco
users were exposed to anti-tobacco messaging in their daily lives. Findings suggest
anti-tobacco marketing is reaching young adults in minority neighborhoods and during
some high-risk activities like online. Yet improved targeting is needed to reach this
population with messages to counter industry marketing when in high-risk environments
such as at bars/restaurants and in retail stores.
FUNDING: Federal
PS2-144
EFFECTIVE ONLINE RECRUITMENT AND RETENTION
STRATEGIES FOR NEW ADOPTERS OF ENDS WITH RECENT
SMOKING HISTORY: THE ADULT CONSUMERS OF TOBACCO
STUDY (ACTS)
Scott R. Weaver, PhD. Georgia State University.
Introduction: Intensive longitudinal research of dual cigarette/ENDS users is needed to
better understand the causal factors and dynamic processes that determine tobacco
use trajectories. However, recruiting smokers early in their use of ENDS is challenging.
We will describe the approaches and outcomes for the recruitment and retention of US
adult smokers who have recently initiated ENDS for a longitudinal study.Methods: Paid
advertisements via multiple social/online media platforms (Facebook/Instagram-FB,
Twitter-TW, YouTube-YT, Reddit-RD, Craigslist-CL) were employed December 2020
– August 2021 to recruit US adult (21+) recent or current smokers who initiated ENDS
within the past month for an online survey study involving 12 weekly surveys and fol-
low-up surveys at 6-, 9-, and 12-months. Multiple strategies were used to detect survey
fraud.Results: More than 10,000 were screened with 3.3 eligible and 1.7 enrolled per
100 screened. Recruitment metrics (ad reach, impressions, & costs; screening, survey
fraud, eligibility, and enrollment rates; and respondent demographics) varied by platform
and ad parameters. While FB ads yielded the highest eligibility (6.4) and enrollment (4.0)
rates and lower fraud (10.5%), demographics skewed white (82%) and female (62%)
despite eorts to target ads. FB ad performance was inconsistent, and misapplied FB
tobacco policies resulted in multiple ad rejections and account restrictions. TW, RD
and YT generated a combined 2 enrolled, and 17% of RD/YT were fraudulent. CL ads
quickly yielded >3500 screened and more males (43%) with modest eligibility (2.3) and
enrollment (0.6) rates but was labor-intensive and had greater fraud (24%). Participants
varied in ENDS device type: 15% cig-a-like, 16% vape pen, 19% mod, 24% recharge-
able pod, 14% disposable pod, 11% other. 74% of those screened were enrolled, and
95% of enrolled have been retained through the 6-month survey.Conclusions: Results
demonstrate the feasibility of recruiting and retaining a diverse sample of dual users
during their initial ENDS initiation phase using a combination of social and online plat-
forms with strong fraud prevention and data quality controls.
FUNDING: Federal
PS2-145
USING QUALTRICS PANELS TO RECRUIT YOUTH FOR ONLINE
SURVEYS OF TOBACCO USE
Bonnie Halpern-Felsher, PhD. Stanford University.
Background: Many studies examining adolescents’ and young adults’ (AYAs) tobac-
co-related perceptions, reasons for, marketing, and actual use often rely on school-
based, community-based, clinic-based or other methods of convenience sampling.
Other studies have used online survey recruitment and implementation platforms
(e.g., Amazon mTurk, social media). Since school closures and introduction of hybrid
teaching due to the COVID-19 pandemic, we recruited a sample of AYAs from across
the U.S. by using Qualtrics panels.Methods: We used Qualtrics to recruit a national,
online sample of AYAs. Quota sampling used for age (1:1:1 ratio for age groups of
13-18, 19-20, and 21-24), and sex and race/ethnicity per the US Census. To ensure
adequate past-30-day e-cigarette users, we purposively recruited 50% of the sample to
be e-cigarette ever-users.Results: Strengths: Successfully recruited a cross-sectional
sample, in a relatively short time frame (4,315 AYAs: 1,442 13-17 years; 1,810 18-20
y/o, and 1,063 21-24 y/o). In a typical sample of 4,315 participants, we would expect
~870 past 30-day users (assuming the prevalence of e-cigarette use as 19.6% among
high school students), and <300 past 30-day adolescent users (13-17 year-olds; 1/3rd
of the total past 30-day users). By oversampling for e-cigarette ever-users, we were
able to achieve relatively higher Ns (n=2,167 e-cigarette users) through the Qualtrics
sample, thus allowing us to examine research questions in relation to AYAs’ recent
e-cigarette use. The cost and eort to recruit was signicantly lower than recruiting from
local connections. Limitations: Qualtrics panels are still a convenience sample; question
over whether the sample can be made more representative through weighting strate-
gies; diculty calculating response rates as hard to know how many people “saw” the
invitation to participate; and longitudinal studies using Qualtrics panels are more dicult.
Conclusions: Recruiting samples through online survey platforms is a cost-ecient and
eective way of obtaining a national, online sample. However, there are considerations
of representativeness as with any convenience sample.
FUNDING: Federal; Academic Institution
PS2-146
CROWDSOURCING TOBACCO RESEARCH ON AMAZON’S
MECHANICAL TURK: STRATEGIES TO COLLECT VALID DATA
QUICKLY
Augustus White, BS. Virginia Commonwealth University, Richmond, VA, USA.
Background. Crowdsourcing on Amazon’s Mechanical Turk (mTurk) to collect data is
quick, convenient and aordable. However, uncertainty about who is in “the crowd”
and loss of control over the data collection setting is a concern. This presentation de-
scribes the mTurk platform and strategies to increase the validity of crowdsourced data
for tobacco research.Methods for identifying bots and tobacco users. mTurk workers
(“Turkers”) are predominately from the US and India and veried by Amazon. However,
a large number of “bots” exist on the site that researchers should be mindful of. Methods
for detecting bots include analyzing time spent per question, using attention-check
questions, reviewing free-response answers, and RECAPTCHA tools. Catching bots is
best accomplished with a “swiss-cheese approach” –layering multiple forms of protec-
tion. We excluded over 100 suspected bots using these methods. To identify tobacco
users, requesters can select a “premium qualication” that only allows turkers veried
by Amazon as being a tobacco user to view a HIT. This is associated with additional
fees and may substantially restrict the sample of interest. Alternatively, researchers
can identify tobacco users using a screening survey. In our studies recruiting current
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
tobacco users, this screening approach resulted in 53% meeting initial eligibility criteria
(n=1200). Screening payments (to ineligibles) were <2% of participant costs.Mturk data
collection optimization. Although mTurk has a survey builder, researchers commonly
direct turkers to better survey tools (Qualtrics/REDCap/etc.) to collect data. However,
the process of reviewing responses, assigning qualications, and sending payments
are time-intensive. Fortunately, researchers can write scripts to automate many of these
tasks. Our own Python scripts were used to pay >2000 turkers in minutes. Addressing
turker complaints is also important, as ratings can impact whether turkers complete a
HIT. Forums on Slack, Reddit, and other social media sites can be used to advertise
HITs to turkers.Summary. With proper precautions and workow, mTurk is a powerful
tool to collect valid data from tobacco users.
FUNDING: Federal
PS2-147
BOTS AND PROFESSIONAL SURVEY TAKERS: RECRUITMENT
CHALLENGES FOR TOBACCO REGULATORY SCIENCE ONLINE
SURVEYS
Jerey J. Hardesty, MPH. Johns Hopkins Bloomberg School of Public Health, Balti-
more, MD, USA.
Background: Online surveys are increasingly common due to lower cost and increased
convenience. However, bots that automate survey completions and professional sur-
vey takers present recruitment challenges. We describe issues encountered and risk
mitigation strategies employed by the Vaping and Patterns of E-cigarette use Research
(VAPER) Study.Methods: The VAPER Study is an online cohort survey that recruits adults
(21+) who use e-cigarettes 5+ days/week. Initially, we aimed to recruit 1200 participants
using social media (e.g., Facebook) ads in three U.S. cities. The survey was anonymous,
incentives were delivered by email with minimal review, and fraud detection software
was used to prevent multiple completions by each participant.Results: Recruitment
began slowly but accelerated quickly, raising concerns that halted data collection. Survey
submissions (n=1624) were investigated for evidence of bots or professional survey
takers; 363 survey completions were assessed to be valid. We subsequently restarted
recruitment and implemented a risk mitigation strategy. Participants were required to
undergo identity verication using LexisNexis, CAPTCHA, two-factor authentication,
data quality reviews, and were mailed their incentive (via USPS). High costs and slow
recruitment also forced a transition to Craigslist postings (125 locations). Subsequently,
recruitment pace stabilized and data quality was high. Despite these eorts, a so-
phisticated bot breached our procedures, in part, by using personal information likely
obtained from the dark web; these submissions were removed. Additional mitigation
procedures included requiring a photo of participants’ e-cigarettes, verifying photos
were unique and authentic, and regularly reviewing open-ended responses. We have
since completed two waves (53% follow-up rate).Conclusions: Online data collection
is a promising methodology but strong risk mitigation strategies must be implemented
to ensure data quality. Regulators and researchers can have condence in the data
online surveys provide when these strategies are applied.
FUNDING: Federal
PS2-148
INVESTIGATING NON-CIGARETTE TOBACCO MARKETING
INFLUENCES AND NON-CIGARETTE TOBACCO PRODUCT USE
BEHAVIORS AMONG BLACK ADULTS
Asti Jackson, PhD1, Mary B. Fleischli2, Angela Haeny1, Meg Gerrard3, Frederick X.
Gibbons3. 1Department of Psychiatry, Yale School of Medicine, 2Institute for Collabora-
tion on Health, Intervention, and Policy (InCHIP), 3Department of Psychological Studies,
University of Connecticut.
Objective: Black communities are targeted by more cigarette advertisements than White
communities, however, little is known about non-cigarette advertisement exposure. This
study aims to understand the impact of marketing of non-cigarette tobacco products on
non-cigarette tobacco use among Black people. Methods: Participants were 533 Black
adults who participated in The Family and Community Health Study in 2016. Partici-
pants were asked if they have seen ads on TV or in stores for non-cigarette products
(e-cigarettes, snus pouches, ltered cigars, traditional cigars, cigarillos, dissolvable
tobacco, smokeless tobacco, hookah and tobacco pipe) and if they have used these
products in the past month. For each product, we performed a regression to evaluate
the association between usage and seeing ads and the moderation of this relationship
by socioeconomic status, age, sex and racial discrimination. Results: Seeing ads on TV
or in stores was associated with product use for all products (rs[148 to 507] > .11, ps <
.05) except e-cigarettes and dissolvable tobacco. People who were older (p=.006) and
experienced more racial discrimination (p=.011) were more likely to have a relationship
between seeing ads and cigarillo use. Use of snus was more strongly related to seeing
ads in males than females (p< .001). Cigarette smokers had a stronger relationship
between seeing ads and using ltered cigars and tobacco pipes (ps < .001) than non-cig-
arette smokers. Conclusions: The exposure to various non-cigarette tobacco product
ads was associated with use of those non-cigarette tobacco products. Importantly, these
relationships were inuenced by demographic variables and in regard to cigarillos, racial
discrimination. Eorts to reduce non-cigarette tobacco marketing in Black communities
may aid in eliminating tobacco-related health disparities.
FUNDING: Federal
PS2-149
ACTUAL AND PERCEIVED TOBACCO INDUSTRY TARGETING OF
THE LATINO/A/X COMMUNITY
Meghan B. Moran, PhD1, Fernanda Alonso1, Jennifer Cantrell2, Susana Ramirez3,
Ashton Jordan1, Jessica Rath4. 1Johns Hopkins Bloomberg School of Public Health,
2New York University School of Global Public Health, 3University of California, Merced,
4Truth Initiative.
Latino/a/x youth have high levels of susceptibility to tobacco use, and approximately
one-fth of Hispanic adolescents and young adults (AYAs) have used tobacco. Latino/a/x
youth are a target of the tobacco industry, and as a result, these youth are more likely
to be exposed to tobacco marketing than non-Hispanic white youth. The current study
sought to examine both the content of Latino/a/x targeted tobacco marketing, and youth
perceptions of this marketing.We conducted a content analysis of tobacco advertise-
ments run between 2019-2020. Ads were coded by two trained graduate coders for spe-
cic targeting practices, such as use of Spanish-language, use of Latino/a/x celebrities,
and other cultural references (e.g., foods, music). Concurrently, we hosted qualitative
online discussion boards in which 92 youth aged 15-21 were asked their thoughts
about the tobacco industry and asked to respond to two advertisements targeting the
Latino/a/x community. Data were qualitatively coded by two trained graduate coders and
reviewed by a third investigator.The tobacco industry commonly uses tactics such as
Spanish-language ads and Latino/a/x characters in their ads to target this community.
Many youth note that they are upset with the tobacco industry for making a product that
is “killing people”. However, few youth perceived that the tobacco industry specically
targeted their ethnic group. More commonly, while several noted that the industry saw
the Latino/a/x community as an “easy target”, the tobacco industry sees “all groups as a
way to make money and don’t really care who buys them.” Aligned with this, few youth
perceived the two tobacco ads they viewed to be specically targeting the Latino/a/x
community, even though both ads leveraged Latino culture (via a musical reference and
use of a public gure). Many Latino/a/x youth do not perceive the tobacco industry to be
targeting their community. Tobacco countermarketing campaigns that resonate with this
population may be a useful way to illustrate the targeted tobacco marketing techniques
identied in our content analysis, and reduce tobacco use among this population.
FUNDING: Federal
PS2-150
THE PASS-THROUGH OF EXCISE TAXES TO MARKET PRICES
OF HEATED TOBACCO (HTPS) AND CIGARETTES - A CROSS-
COUNTRY ANALYSIS
Ce Shang, PhD1, Estelle Dauchy2. 1The Ohio State University Wexner Medical Center,
2Campaign for Tobacco Free Kids.
Background and Objective: The market of heated tobacco products (HTPs) has grown
exponentially in recent years and many governments have started to tax HTPs to reg-
ulate its use. Currently, there is a debate over how HTPs should be taxed, especially
whether at the same or lower rates than cigarettes, considering its potential harm re-
duction impact. As most HTP brands are manufactured and marketed by large cigarette
manufacturers the eectiveness of tax policy also depends on companies’ strategies
for products that are perceived as substitutes by consumers. This study evaluates the
combined tax pass-thru of taxes to prices of both products.Data and Methods: We use
a unique database on statutory HTP and cigarettes taxes and retail prices of Marlboro
branded heated tobacco units and cigarettes from 2014 to 2021, developed by the
Campaign of Tobacco Free Kids, in all countries where HTPs are sold. In the majority
of countries, HTPs have been taxed at lower rates than cigarettes, yet sold at similar
prices, suggesting highly concentrated markets where taxes have little impacts on
prices of goods that are sold with extra prot margins (HTPs). To estimate the pass-thru
of taxes to prices we use a seemingly unrelated regressions model. We also use an
event study to test the impact of introducing HTPs on the cigarette market, as well as
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
the introduction of HTPs in countries tax codes.Results/Policy Implications: The direct
pass-through rates of HTP taxes to prices is much smaller than that of cigarettes in the
current nicotine-tobacco market. We also nd that the pass through of cigarette taxes
to cigarettes prices is larger than unity. The combined pass-through (direct and indirect)
of taxes to prices is smaller than unity for HTPs and cigarettes, with a much smaller
pass-through for HTPs. Only half of the tax incidence gap is transmitted to the price
gap, suggesting that tax policy incentives that favor HTPs over cigarettes to encourage
smokers to switch from cigarettes to HTPs are unlikely to be eective. The results overall
suggest that increasing taxes on both products and taxing them equivalently could be
an option to raise additional tax revenue.
FUNDING: State; Academic Institution; Nonprot grant funding entity
PS2-151
IMPACT OF TAX AND PRICE REFORMS ON COMPANIES’ PRICES
IN A COMPLEX CIGARETTE TAX SYSTEM
Estelle P. Dauchy, PhD1, Vid Adrison2. 1Campaign for Tobacco Free Kids, 2University
of Indonesia.
This study evaluates how changes in various aspects of excise tax systems, including
minimum pricelaws, dierential price tiers for tax across characteristics and products
inuence rms’ pricing decisions.We apply our model to Indonesia, where the excise tax
system is particularly complex for tobacco, withseveral tax tiers and cigarette types. We
use a large database of prices over the past decade for all tobaccoproducts currently sold
in Indonesia, obtained from the Customs and estimate a model where variousaspects
of the tax system jointly explain prices. We nd that pricing decisions are signicantly
aectedby taxes, but this result hides important or larger contribution of other pricing
policies that are typicallyignored in research that essentially focus on the tax impacts
or aggregates all cigarette types. In particularminimum price policies have a larger
impact than excise taxes on tobacco pricing for machine-madeclove cigarettes (kretek)
while tax changes have a larger eect on prices for machine-made non-clove(white)
cigarettes. For cigarette types and brands that are more likely to be consumed by a very
elasticdemand (kretek), companies keep prices close to the minimum price to maintain
large market shares, butcompensate with larger tax-pass-thru and higher prot margins
for cigarette types that are less elastic toprice changes (white cigarettes). The results
imply that a multi-tiered, multi-products tobacco tax systemlikely generates important
distortions that likely limit the objective of the government.
FUNDING: State; Nonprot grant funding entity
PS2-152
HOW VAPING PRODUCTS ARE PRICED BASED ON PRODUCT
CHARACTERISTICS: EVIDENCE FROM ONLINE VAPE SHOPS
Shaoying Ma, PhD1, Shuning Jiang2, Meng Ling2, Theodore Wagener3, Jian Chen2,
Ce Shang3. 1The Ohio State University Wexner Medical Center, OH, USA, 2The Ohio
State University, 3The Ohio State University Wexner Medical Center.
Background: The use of electronic cigarettes has increased in the past decade and
raised great concern. Online stores are one of the most commonly used outlets for
e-cigarette users to purchase vaping products, and over 90% of vapers reported using
e-liquid products that contain nicotine. The US Food and Drug Administration has the
authority to regulate product characteristics such as avors and nicotine levels. However,
there is limited evidence on how vaping products are priced based on characteristics
in online vaping stores.Methods: We collected data on e-liquid sales prices and prod-
uct attributes, including bottle volume (in ml), nicotine concentration (in mg), VG/PG
ratio and product avor(s), from online vaping stores using web data extraction. We
standardized prices for e-liquid products (standardized to $/ml), and used the hedonic
pricing model to assess the associations between e-liquid standardized prices and nic-
otine concentration, product VG/PG ratio, and avors. In total, we have data of 10,870
e-liquid products from four popular online vaping stores that sell nationwide across the
U.S.Results: Higher e-liquid prices are associated with higher nicotine concentrations.
E-liquid products with fruit avors are associated with higher sales prices. E-liquid prices
are higher when VG/PG ratio deviates from 70/30 except for 90/10: the prices of e-liquid
products with a 90/10 VG/PG ratio are lower than the prices of products with a 70/30
ratio. All of the ndings above are statistically signicant at a 5% level.Conclusions:
Higher nicotine concentration and fruit avors are associated with higher e-liquid prices
in national online vaping stores, suggesting that these are popular attributes. The FDA
regulation over these popular attributes will reduce the desirability of vaping products.
FUNDING: Academic Institution
PS2-153
IT TAKES A QUITTER TO MAKE A QUITTER: LEVERAGING
INSIGHTS FROM CESSATION PROGRAM PARTICIPANTS TO
INFORM RECRUITMENT CAMPAIGNS
Megan Jacobs, Elizabeth C. Hair, Jessica M. Rath, Tia Taer, Amanda L. Graham.
Truth Initiative.
Traditional formative research methods (TFRM) (e.g., fact testing, quant/qual concept
testing, pre-market testing) have informed truth® campaign social media marketing to
promote tobacco prevention messaging to teens and young adults. In FY20, TFRM was
used to incorporate tobacco cessation messaging for the rst time in the campaign’s
history. Optimization eorts in FY21 leveraged novel qualitative data gathered from a
widely-used, proven-eective cessation text message program, This is Quitting (TIQ).
The objective of this research is to explore if marrying qualitative insights from cessation
program participants with TFRM ndings would increase the eectiveness of social
media marketing promoting cessation program enrollment (“lead generation”) to 15-24
year-olds. The FY20 lead generation campaign, “Ditch Juul (DJ),” used TFRM only. A
new FY21 campaign promoting TIQ, “Quitting Tweets (QT),” added insights gleaned
from TIQ participants about barriers to quitting (e.g., seeing peers vaping), user-sub-
mitted quitting tips/support messages (e.g., “It’ll feel amazing after u quit!”), and the
overall sentiment that users liked seeing others quitting. Conversion rate (proportion
of website visitors who submitted TIQ signup information) was the primary outcome.
Both campaigns were deployed across a similar marketing mix, driving young people
online to www.thetruth.com to enroll in TIQ. QT amplied real and poignant tweets
that reected core program value propositions identied through TFRM. Although DJ
drove more website visits than QT (N=6,175,651 vs N=1,983,325), the conversion rate
for QT was 821% higher (DJ=0.60% conversion rate; 37,222 enrolled vs QT=5.53%
conversion rate; 109,645 enrolled). Synthesizing qualitative insights from young people
in the process of quitting with TFRM may boost cessation campaign eectiveness. Quit
program designers should keep marketing intentions in mind when considering oppor-
tunities to solicit user-generated content. Future analyses should explore the impact
of social media ads using native platform lead generation forms to enroll participants
(e.g., Snapchat Swipe-to-Text) and in multivariable models.
PS2-154
EARLY EVIDENCE OF EFFECTIVE MASS MEDIA CAMPAIGN
APPROACHES TO PREVENT E-CIGARETTE USE AND PROMOTE
CESSATION AMONG YOUTH AND YOUNG ADULTS
Elizabeth C. Hair, PhD, Jennifer M. Kreslake, Jessica M. Rath, Donna M. Vallone.
Truth Initiative.
This study aims to evaluate the early eectiveness of a national mass media campaign
to inuence e-cigarette-related knowledge, attitudes and beliefs in a social environment
where e-cigarette use is increasing. National samples of respondents aged 15-24 years
were drawn from a repeated cross-sectional online panel survey of approximately 250
participants per week following the launch of the truth® anti-e-cigarette campaign in
October 2018. Separate analyses were conducted for all respondents (n=8,125) and
current vape users (n=1,456) to determine the eects of dierent campaign approaches
among targeted audiences. Campaign exposure was measured by self-reported ad
awareness aided by a collage. Logistic regression analyses were conducted on individu-
al-level, cross-sectional relationships between ad awareness and outcomes. Outcomes
were agreement with facts about e-cigarettes presented in the campaign (knowledge);
perceived norms about young people quitting e-cigarette use; and attitudes about
e-cigarette product harm, social unacceptability, appeal, and anti-industry sentiments.
Covariates include respondent demographics, sensation-seeking score, mental health
status, current or ever e-cigarette use, and growth in e-cigarette sales. A signicant
dose-response relationship was observed between ad awareness and knowledge of
e-cigarette facts targeted by the truth campaign. High awareness of truth anti-e-cigarette
ads was associated with signicantly associated with greater perceptions of product
harm, social unacceptability, and anti-industry attitudes about e-cigarette companies.
Among current vape users, a signicant dose-response relationship was observed
between level of ad awareness and knowledge of free programs to help people quit
vaping as well as intentions to quit e-cigarette use, and high ad awareness was signi-
cantly associated with greater perceptions that young people are quitting e-cigarette
use. Mass media campaign exposure is associated with targeted knowledge, attitudes
and beliefs about e-cigarette use among youth and young adults, even during a phase
of growth in e-cigarette sales and popularity among young people.
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2022 Poster Session 2 • Wednesday, March 16, 2022, 4:30 PM - 6:00 PM
PS2-155
EFFECTIVENESS OF CROSS-PRODUCT NICOTINE MESSAGING:
EVIDENCE OF A NATIONAL TOBACCO PUBLIC EDUCATION
CAMPAIGN ON YOUTHS’ RISK PERCEPTIONS AND BELIEFS
ABOUT E-CIGARETTES AND SMOKING
Tesfa N. Alexander. United States Food and Drug Administration.
This study aims to assess the relationship between youth’s exposure to the U.S. Food
and Drug Administration’s national tobacco public education campaign, The Real
Cost, and changes in campaign-targeted e-cigarette and cigarette risk perceptions
and beliefs. A nationally representative cohort study of 4,039 youth was conducted
during June 2018 to July 2019, consisting of a baseline and two follow-up surveys. We
performed logistic regressions to examine the association between campaign exposure
and beliefs. Exposure was measured by self-report as the frequency of exposure to
individual campaign advertisements about the health consequences of e-cigarette use
and of smoking cigarettes. We found that increased levels of exposure to campaign
advertising were associated with a signicant increase in the odds of reporting agree-
ment with campaign-targeted beliefs. For example, those who were exposed to the
campaign ad “Rehacked” (prevention messaging on e-cigarette and cigarette) on had
an 18% increase in the odds of agreeing with the belief “The nicotine in vapes may
hack your brain” (adjusted odds ratio [aOR] = 1.18, p<.001). Positive patterns of ndings
were found across multiple items targeted by specic ads, whereas non-related beliefs
were not associated with ad exposure. A sustained national tobacco public education
campaign can change beliefs about the harms of e-cigarette use and smoking among
youth. This study provides early evidence of the eectiveness of one of the rst national
youth e cigarette prevention campaigns and evidence of the continued eectiveness
of cigarette prevention under the same campaign brand. Combined with other ndings
from The Real Cost, evaluation, this evidence indicates that prevention mass media
campaigns continue to be an eective and cost-ecient approach to reduce the health
and nancial burden of tobacco use in the United States.
FUNDING: Federal
PS2-156
DESIGN ISSUES RELATED TO LONGITUDINAL MODELS: GOING
BEYOND THE TRADITIONAL RANDOMIZED CONTROLLED TRIAL
James Dziura, PhD. Yale University School of Medicine.
Traditional tobacco cessation trials compare a primary outcome such as abstinence
at a single point in time following fully-formed interventions. Although these trials have
demonstrated success answering research questions about the ecacy of these inter-
ventions, they may not translate into optimal long-term personalized care for a chronic
relapsing condition such as tobacco dependence. Alternative designs are available to
expand the types of research questions that we can answer in cessation trials. The goal
of this talk is to introduce novel approaches to the design of clinical trials, such as MOST
and SMART, that address research questions aimed at adapting treatment strategies
or optimizing combinations of treatments. Multiphase Optimization Strategy (MOST)
studies provide a framework to evaluate questions about which individual components
should be used in a multifactorial intervention. Stepped care trials address questions
about adapting interventions for non-responders by incrementally increasing aspects
of the intervention (i.e., increasing dose/frequency or adding components). Sequential,
multiple assignment, randomized trials (SMARTs) allow the researcher to ask multiple
questions such as: what intervention should we provide initially or what intervention do
we use if a patient does or does not initially respond? As research questions and trial
design inform statistical analyses, this talk will bring together considerations related both
to the design and analysis of clinical trials for tobacco dependence.
PS2-157
SYNTHETIC COOLING AGENTS IN US-MARKETED E-CIGARETTE
REFILL LIQUIDS AND DISPOSABLE E CIGARETTES: CHEMICAL
ANALYSIS AND RISK ASSESSMENT
Sairam V. Jabba, DMV, PhD1, Hanno Erythropel2, Deyri Garcia-Torres2, Lauren
Delgado2, Paul T. Anastas2, Julie Zimmerman2, Sven-Eric Jordt1. 1Duke University
Medical Center, 2Yale University.
Signicance: Menthol, through its cooling sensory eects, facilitates smoking and tobac-
co product initiation, which is reected by the high popularity of mint/menthol-avored
E-cigarettes. More recently, E-cigarette vendors started marketing synthetic cooling
agents as additives that impart a cooling eect but lack a characteristic minty odor.
Knowledge about content of synthetic coolants in US-marketed E-cigarette products
and associated health risks is limited.Methods: E-liquid vendor sites were searched
with the terms “koolada”, “kool/cool”, “ice”, or WS-3/WS-23, denoting individual cooling
agents, and relevant rell E-liquids were purchased. “Ice” avor varieties of Pubar, the
popular disposable E-cigarette brand, were compared with non-“Ice” varieties. E-liquids
were characterized, and synthetic coolants quantied using GC/MS. Cellular calcium
imaging experiments were conducted to evaluate the modulation of airway-sensory
ion-channels (TRPM8/TRPA1) by synthetic coolants and E-liquids that contain synthetic
coolants. Margin of exposure (MOE), a risk assessment parameter, was calculated
to assess the risk associated with synthetic coolant exposure from E-cigarette use.
Results: WS-3 was detected in 24/25 of the identied rell E-liquids. Almost all Pubar
disposables avor varieties contained WS-23 (13/14), with 5/14 also containing WS-3,
in both “Ice”- and non-“Ice” avors. Synthetic coolants and E-liquids that contain cool-
ants, including several Pubars, robustly activated TRPM8 (Cold/Menthol receptor) and
TRPA1 (Acrolein receptor). Modeling exposure to WS-3 from vaped E-liquids resulted in
MOEs below the safe margin of 100 for most daily use scenarios (3-mL:14/25 E-liquids;5-
mL:18/25;10-mL:20/25). MOEs for WS-23 from 11/13 Pubar products were <100 in all
use scenarios.Conclusions: Synthetic cooling agents (WS-3, WS-23) were present in
US-marketed E-cigarettes, at levels that may result in consumer exposures exceeding
safety thresholds set by regulatory agencies. Synthetic cooling agents pharmacologically
modulate airway-sensory receptors and were found in both mint-or menthol-avored
and fruit- and candy-avored products
FUNDING: Federal
PS2-158
PREVALENCE AND CORRELATES OF ICE FLAVORED
E-CIGARETTE USE IN YOUNG PEOPLE
Adam M. Leventhal, PhD1, Hongying (Daisy) Dai2, Alayna P. Tackett1, Jessica L.
Barrington-Trimis1, Steve Sussman1. 1University of Southern California, 2University of
Nebraska Medical Center.
Signicance: ’Ice’ e-cigarette avors—marketed as hybrid avors combining fruity/sweet
and cooling properties (e.g., ’blueberry ice’)—recently emerged. This talk reviews two
cross-sectional studies on the prevalence and correlates of ice-avored e-cigarette
use in young people. Methods: In May-August 2020, web surveys assessed most
commonly used e-cigarette avor and other factors (e.g., device type, use frequency,
dependence, combustible tobacco use) among: (Study 1) past 30-day e-cigarette using
young adults from Los Angeles (n=344; M[SD]=21.2[0.4] years old); and (Study 2) a
U.S. national, sample of adolescent and young adult e-cigarette current users (n=1516;
M[SD]=18.9[1.6] years-old). Results: In Study 1, 48.8% reported using ice-hybrid avors
most often, 33.7% used (non-ice) fruit/sweet, and 17.4% used menthol/mint. Ice hy-
brid-avor use was associated with reporting more past-30-day vaping days vs. menthol/
mint (b[95%CI]=4.4[1.0-7.7]) and fruit/sweet (b[95%CI]=3.6[0.8-6.4]) users and more
episodes per vaping day vs. fruit/sweet users (b[95%CI]=2.4[0.5-4.3]). Ice hybrid-avor
users were less likely than menthol/mint users to use JUUL/cartridge-based recharge-
able (OR[95%CI]=0.1[0.03-0.45]) more likely than sweet/fruit users to use disposable
non-cartridge (OR[95%CI]=3.9[2.1-7.4]) devices than rellable/rechargeable tank/pen
or other devices. Ice users had greater odds of past 30-day combustible tobacco use
vs. menthol/mint users (OR[95%CI]=2.7[1.3-5.7]) and vaping dependence symptoms
vs. sweet/ fruit users (OR[95%CI]=2.6[1.5-4.4]). In Study 2, the most commonly used
e-cigarette avor was fruit (46%), followed by ice-hybrid avors (30%), mint (11%),
menthol (10%), and tobacco (3%). E-cigarette users who primarily used disposable
e-cigarettes compared to other device types (closed/open-cartridge, tank/box mod) were
more likely to predominately use ice-hybrid (58%) vs. fruit avors. Conclusions: Use of
ice avored e-cigarettes may be common and positively associated with combustible
tobacco use, nicotine vaping frequency, and dependence. Further study of the prev-
alence, determinants, and health eects of ice avored e-cigarette use is warranted.
FUNDING: Federal
151
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS2-159
COMPARING USERS OF ICE AND NON-ICE E-CIGARETTE
FLAVORS: DEVICE CHARACTERISTICS, PUFFING TOPOGRAPHY,
NICOTINE INTAKE, PULMONARY FUNCTIONS, AND
BIOMARKERS OF POTENTIAL HARM
Nicholas J. Felicione, PhD1, Lisa Kaiser1, Connor Martin1, Michelle Page1, Bradley
Schurr1, Noel Leigh1, Stephanie Podguski1, Shikha Sharma1, Qixin Wang1, Gagandeep
Kaur1, Irfan Rahman2, Richard O’Connor1, Maciej Goniewicz1. 1Roswell Park Compre-
hensive Cancer Center, 2University of Rochester Medical Center.
Background: “Ice” e-cigarette avors, or combinations of fruit/sweet and cooling
attributes, have gained prominence recently, particularly among young adults. Little
is known about this emerging avor category. This study compared adult users of ice
and non-ice avors on e-cigarette characteristics, pulmonary function, nicotine intake,
pung topography, and biomarkers of potential harm.Methods: Data are from the ini-
tial visit of 114 adult e-cigarette users [26 ice (e.g., Pineapple Ice, Grape Freeze); 88
non-ice] enrolled in an ongoing cohort study. Participants self-reported demographics,
cigarette/e-cigarette history, and daily use patterns. Participants were assessed on tests
of pulmonary function (e.g., spirometry, FeNO) and provided urine, blood, and saliva
samples that were analyzed for biomarkers of nicotine exposure, oxidative stress, and
inammation (n=10 ice, n=40 non-ice). Pung topography was captured using a CReSS
Micro during an ad lib pung bout. Chi-square and independent samples t-tests were
utilized to analyze dierences between ice and non-ice participants.Results: Ice and
non-ice users did not dier on demographics or smoking history. Disposable e-cigarettes
were more common among ice than non-ice users (53.9% vs 8.0%), but groups did not
dier in nicotine content or e-cigarette consumption. Ice and non-ice users did not dier
in nicotine exposure, pulmonary functioning, or pu topography. Ice users, compared
to non-ice, had signicantly lower levels of HT 8-oxodG (geometric means: 82.07 vs
128.16nM, p=.038), IL-6 (1.00 vs 4.44pg/ml, p<.001), and IL-1ß (24.55 vs 64.31pg/
ml, p=.029), but did not dier for F2-Isoprostanes, IL-8, PGE2, MPO, or TXB2. Eects
remained signicant when controlling for device type.Conclusions: These data provide
preliminary evidence of reduced systemic inammation markers in users of ice avors
compared to non-ice avors. Further monitoring of these avors is essential to under-
standing their constituents and impacts on e-cigarette user health and behavior to make
informed regulatory decisions regarding this emerging avor category.
FUNDING: Federal
PS2-160
QUITTING MATTERS: TAILORING AN MHEALTH SMOKING
CESSATION INTERVENTION FOR PEOPLE WITH HIV USING A
USER-CENTERED DESIGN APPROACH
Roger Vilardaga, Patricia Sabo, Anthony DeVito, Lauren Pacek, Joseph McClernon.
Duke University.
Background: Cigarette smoking is disproportionately prevalent among people with
HIV (PWH), and is signicant contributor to morbidity and mortality in this population.
Historically, facilitating cessation among PWH has been challenging. Mobile health
applications tailored to PWH can potentially address their low quit rates and provide
wider reaching evidence-based treatments for this population. Objective: To develop a
smoking cessation app tailored to the needs of PWH, based on an existing app (“Learn
to Quit”) and conduct a pilot randomized control trial (RCT) to evaluate the feasibility,
acceptability, and preliminary ecacy of the new app. Methods: We conducted a
user-centered (UX) design study with PWH who smoke to ideate and sketch a new
app prototype, then developed a new tailored app (“LTQ-H”) in collaboration with an
app development partner. We then initiated a pilot RCT to evaluate the feasibility, ac-
ceptability, and ecacy of LTQ-H as compared to a standard of care mobile app (NCI
QuitGuide).Results: In the UX study, self-reported levels of usability were high: Users’
average on the System Usability Scale was 85 (SD=12.2). Key feedback elements
suggested the need for modication of the app to better address concerns of the PWH
population, including: adding more HIV-specic content; using more relatable words
and examples; simplifying the interpretability of data summary screens. Modications
were integrated by our app development partner and LTQ-H was deployed on the iOS
and Android app stores. Pilot RCT recruitment was initiated. To date, enrollment has
remained steady at approximately n=4/month; n=29 have been enrolled and n=25 have
been randomized (n=13 to LTQ-H; n=12 to NCI QuitGuide). Average System Usability
Scale scores were high and comparable across the two apps (LTQ-H: 79 [SD=12.4]; NCI
QuitGuide: 76 [SD=17.7]) at the 4-week follow-up timepoint. Data collection for the pilot
RCT is ongoing.Conclusions: While data collection is still ongoing, our ndings highlight
the value of tailoring cessation interventions to a specic population.
FUNDING: Federal
PS2-161
CHRONIC DISEASE MANAGEMENT, POINT OF CARE
BIOCHEMISTRY ASSAYS, AND THE TITRATION OF TOBACCO
TREATMENT MEDICATIONS INCREASES QUIT RATES
Matthew Peter Bars. IntelliQuit, Mahwah, NJ, USA.
Signicance: Tobacco dependence has been accurately described as a life-threaten-
ing, chronic disease. Yet, one aspect of chronic disease management and treatment,
specically the eective and ecient titration of tobacco treatment medications ad
eect is underutilized. Methods: Total Nicotine Equivalents (TNEs) and expired breath
carbon monoxide (EtCO) measures both combustible and non-combustible sources of
nicotine. Point of care testing based on biochemical nicotine consumption and individual
clinical response empowers adaptive treatment protocols. Eective medication titration
minimizes withdrawal symptoms and increases quit rates. Results: The biochemical
measurement of tobacco and nicotine consumption and resulting medication titration,
enabled the Fire Department of the City of New York (FDNY) tobacco treatment pro-
gram to enjoy a long-term quit rate of 70%. Conclusion: This poster will describe a
treatment algorithm emphasizing intake and follow-up visit urinary TNEs, EtCO, tobacco
consumption and withdrawal symptoms increasing quit rates. The poster will discuss
chronic disease management best practices from the FDNY and the American College
of Chest Physicians. Special emphasis will be given to the assessment and treatment
of dual users, e-cigarette vapers and Heat not Burn tobacco products.
FUNDING: Unfunded
152
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154
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
POSTER SESSION 3
PS3-1
ASSOCIATION BETWEEN TOBACCO USE AND USE OF OTHER
SUBSTANCES WITH SLEEP DISTURBANCES
Alicia Allen1, Briana DeAngelis2, Uma Nair3, Mustafa al Absi4. 1University of Arizona,
Tucson, AZ, USA, 2University of Minnesota Medical School Duluth, Duluth, MN, USA,
3University of AZ, Tucson, AZ, USA, 4University of MN Medical School, Duluth, MN,
USA.
Introduction: Sleep problems, including sleep disturbance, are associated with sub-
stance use (e.g., nicotine, cannabis), though the directionality of this association varies
by substance. It is currently less clear how the use of several substances may impact
sleep disturbance. The goal of this secondary-data analysis project is to explore the
relationship between sleep disturbance with polysubstance use (tobacco, alcohol,
cannabis, and pain medications) utilizing data from a recent cross-sectional national,
online survey. Methods: Using Facebook to recruit, respondents included individuals
who were at least 18 years of age and residing within the United States. Qualtrics was
used to collect self-reported information on demographics, substance use (classied
as any use versus no use during the last 30 days), and sleep disturbance (using
PROMIS version 4a). Analyses included t-tests and logistic regression models. Results:
Participants (n=1327) were mostly white (90%), female (67%), and, on average, were
41.9±15.0 years of age. While the use of tobacco within the past 30 days was not
associated with sleep disturbance (any use: 25.8±0.4; no use: 25.3±0.4; p=0.3), sleep
disturbance was less in those who reported use of alcohol (any use: 25.0±0.3; no use:
26.5±0.3; p<0.01) and cannabis (any use: 24.9±0.3; no use: 27.6±0.4; p<0.01) and higher
in those who reported use of pain medication (any use: 26.3±0.3; no use: 23.1±0.5;
p<0.01). Overall, when considered together, past 30 day use of tobacco (β=1.03±0.51,
p-value=0.043) and pain medication (β=2.83±0.58, p-value<0.001) were associated with
greater sleep disturbance whereas use of alcohol (β=-1.41±0.45, p-value=0.002) and
cannabis (β=-2.65±0.52, p-value<0.001) were associated with less sleep disturbance.
Conclusions: While tobacco use within the past 30 days alone was not related to sleep
disturbance, when use of other substances was taken into consideration, tobacco use
was associated with an increase in sleep disturbance. Additional research is needed
to explore the temporality of this relationship as well as to explore how it may relate to
cessation outcomes.
FUNDING: Federal
PS3-2
PERCEIVED CONTROL OVER ANXIETY RELATED EVENTS AND
NICOTINE WITHDRAWAL AMONG ADOLESCENT SMOKERS
Lavanya Rajeshkumar, Grace Kong, Charla Nich, Theresa Babuscio, Suchitra Krish-
nan-Sarin. Yale University School of Medicine, New Haven, CT, USA.
Nicotine withdrawal symptoms, commonly reported by youth when they try to stop
smoking, can negatively aect smoking cessation attempts. A factor which might aid in
managing withdrawal is perceived control over anxiety related events (PC), which is one’s
perception of their ability to regulate or control their anxiety. In this study, we examined
the potential association of PC and withdrawal symptoms among adolescent smokers.
207 high school aged adolescents from the New Haven area participated in a behavioral
smoking cessation intervention. The analytic sample consisted of 81 participants who
had complete data for all the variables of interest (46% female, 89% non-Hispanic White,
4.9% Hispanic, 2.5% Black, 2.5% Asian, and 1.2% Native American, mean age=16.4,
SD=1.3). Participants comprised of adolescents who smoked 10 or more cigarettes on
a daily basis for at least 6 months, were seeking treatment for smoking cessation, and
had a baseline urine cotinine levels above 500 ng/ml. Since withdrawal symptoms are
known to peak within 24-48 hours after initiation of abstinence, we assessed withdrawal
symptoms using the Minnesota Nicotine Withdrawal Scale one day after their quit day.
Multiple regression analysis examined the association between PC obtained at baseline
and withdrawal symptoms, controlling for sex, trait anxiety, nicotine dependence, treat-
ment condition, and self-reported abstinence one day after quitting. Overall, 82.7% of the
participants (89% of the females and 77% of the males) self-reported being abstinent on
the day after the quit day. PC (Mean = 92.22, SD = 18.38) was signicantly associated
with withdrawal (Mean = 8.44, SD = 5.26) (β = -0.07, t(73) = -2.01, p = 0.048) even
after accounting for the covariates. Findings indicate that higher PC is associated with
lower withdrawal symptoms. Developing higher perceived control over anxiety-related
events could help youth deal with withdrawal symptoms. Strategies to improve PC could
be included in smoking cessation programs to improve withdrawal coping and alleviate
the negative impact of withdrawal on smoking cessation attempts.
FUNDING: Federal
PS3-3
AN IDIOGRAPHIC ANALYSIS OF BREATH CO TESTING
WITHIN A CONTINGENCY MANAGEMENT INTERVENTION FOR
PRESURGICAL CANCER PATIENTS
Brandon T. Sanford1, Benjamin A. Toll2, Lisa M. Fucito3, Nathaniel L. Baker1, Suchitra
Krishnan-Sarin3, Matthew J. Carpenter2, Steven L. BernsteinMD3, Alana M. Rojewski2.
1Medical University of South Carolina, Charleston, SC, USA, 2Medical University of
SC, Charleston, SC, USA, 3Yale University School of Medicine, New Haven, CT, USA.
Background: Contingency Management (CM) interventions deliver monetary reinforcers
contingent upon biochemically veried abstinence from smoking. While CM has been
found to be eective, less is known about the varied idiographic behavior patterns un-
derlying group-level ndings. The present analysis seeks to characterize and compare
these patterns within and between groups receiving CM and treatment as usual. Meth-
ods: This is a secondary analysis of a randomized controlled pilot trial of presurgical
cancer patients who smoke (RCT N=40). Participants were current everyday smokers
diagnosed or suspected to have cancer and scheduled for surgery. All participants were
enrolled in cessation counseling, oered NRT, and submitted breath CO testing 3 times
per week for 2-5 weeks. Participants randomized to the CM group received monetary
reinforcers for breath CO ≤6 ppm on an escalating schedule of reinforcement with a
reset for positive samples. Sucient breath CO data exist for 26 participants (i.e. 3 or
more CO tests completed; CM = 12; TAU = 14). Results: Analysis of available breath CO
data indicate that participants randomized to the CM group achieved abstinence more
quickly (d=1.22), had a lower percentage of positive tests (d = .95), and experienced
fewer lapses following abstinence (d=1.26). While 8 of 12 participants in the CM group
achieved abstinence without subsequent lapse by their third breath test, this was only
true for 2 of the 14 TAU participants. Additionally, 9 of 10 participants in the CM group
who achieved abstinence on a single test maintained that abstinence for the reminder
of the trial, this was true for only 4 of the 10 in the TAU condition. Conclusions: Those
assigned to CM appear to achieve abstinence more quickly and with fewer lapses than
those engaged in TAU. This speaks to the ecacy of nancial reinforcement within CM
interventions. While group-level ndings support the ecacy of CM as an intervention,
this idiographic secondary analysis provides insight into the behavior patterns underlying
successful abstinence within the CM condition.
FUNDING: Unfunded
PS3-4
CLINICIANS WHO PROVIDE MORE CHRONIC AND FREQUENT
PRIMARY CARE TO ADULT PATIENTS ADOPT AND IMPLEMENT
COMPREHENSIVE CHRONIC TOBACCO TREATMENT AT HIGHER
RATES
Deejay Zwaga1, Danielle E. McCarthy1, Timothy B. Baker1, Mark E. Zehner1, Robert
T. Adsit1, Amy Skora1, Christian Kastman2, Hannah Wallenkamp2, Katherine Coates2,
Michael C. Fiore1. 1University of WI Center for Tobacco Research and Intervention
(UW-CTRI), Madison, WI, USA, 2Group Health Cooperative of South Central Wiscon-
sin, Madison, WI, USA.
Signicance: Primary care providers (PCPs) vary in their willingness and/or ability to
adopt and implement tobacco dependence treatments. Identifying factors associated
with clinician adoption and implementation of smoking cessation treatment may facilitate
renement or targeting of implementation strategies. Methods: Secondary analyses of
data extracted from electronic health records (EHR) from six primary care clinics that
adopted a comprehensive tobacco use treatment system were conducted to identify
factors associated with clinician adoption and implementation of EHR tools designed
to support the treatment program. Adoption was dened as ever using program tools
(i.e., addressing an EHR alert, ordering cessation pharmacotherapy, setting a quit date,
providing brief counseling, referring to counseling). Implementation was dened as the
proportion of encounters in which patients eligible for the program received treatment.
Clinician-level predictors were: mean duration (months) clinicians were the designated
PCP for patients, mean number of visits clinicians had with patients, mean proportion
of visits at which the BPA last red with that clinician, and the proportion of patients who
activated their patient portal accounts. Results: Rates of adopting and implementing
quit-date setting, counseling, pharmacotherapy, and referral were positively associated
with average number of months patients were assigned to the PCP, proportion of visits
155
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
with the PCP vs. other clinicians, and proportion of patients who activated their EHR
patient portal. Rates of implementing cessation treatments were also higher among
clinicians with a greater average number of visits with their patients. Conclusions:
PCPs with more stable and engaged patient panels adopt and implement chronic,
comprehensive smoking cessation treatment at higher rates than do their colleagues
with less frequent or sustained contact with patients. Chronic tobacco treatment may
be more readily integrated into the practice of PCPs who see patients consistently and
frequently over time.
FUNDING: Federal; Academic Institution
PS3-5
CHARACTERISTICS ASSOCIATED WITH SMOKING DURING
PREGNANCY: STUDY METHODS AND BASELINE DATA FROM A
COHORT STUDY
Erica Nichols Cruvinel1, Kimber P. Richter1, Kathryn Pollak2, Edward F. Ellerbeck1,
Nikki Nollen1, Byron J. Gajewski1, Chuanwu Zhang1, Zoe Sullivan-Blum1, Taneisha
Scheuermann1. 1University of Kansas Medical Center, Kansas City, KS, USA, 2Duke
University, Durham, NC, USA.
SIGNIFICANCE: One in 10 women smoke during pregnancy in the U.S.; most women
who quit return to smoking by one year postpartum. No investigators have prospec-
tively examined mutual changes in risk factors and women’s smoking trajectory during
pregnancy and postpartum. The aim of this presentation is to describe the methods
used to assemble a cohort to examine smoking, determinants of smoking, and quality
of tobacco treatment during pregnancy and postpartum and to compare socio-demo-
graphic and tobacco-related characteristics among current smokers and recent quitters
at baseline. METHODS: We recruited current or recent quitters (smoked 6 months prior
to pregnancy), aged ≥ 18, during any stage of pregnancy from obstetrics clinics. We
screened participants for eligibility via phone and enrolled women who completed an
emailed baseline survey. Follow up assessments included emailed surveys and weekly
texts up to one year postpartum. Analyses included Chi-square and independent sample
t-tests using Cohen’s d (to indicate eect size). RESULTS: We enrolled 62 women (41
current smokers and 21 recent quitters). Compared to current smokers, more recent
quitters were White (52.4% vs 26.8%: Cohen’s d=0.61) and employed full time (71% vs
36%: Cohen’s d=0.81). Current smokers reported diculties in having money to pay rent
(34.15% vs 9.52%: Cohen’s d=0.88) and buy food (34.15% vs 9.52%: Cohen’s d=0.88)
relative to recent quitters. Current smokers reported co-use of marijuana (27.03% vs
10%: Cohen’s d=0.66), alcohol (19.51% vs 4.47%: Cohen’s d=0.87) and other tobac-
co products during pregnancy (24.39% vs 9.52%, Cohen’s d=0.62) relative to recent
quitters. The proportion of women using e-cigarettes was slightly higher among recent
quitters (14.29% vs 9.76%: Cohen’s d=0.24). CONCLUSIONS: Women who smoke
during pregnancy are coping with multiple social determinants of health including
housing, food insecurity, and other substance use. Follow up surveys and weekly texts
assessing smoking will provide information on socio-demographic changes over time
and can be used to inform just-in-time interventions to reduce barriers to cessation
during pregnancy and postpartum.
FUNDING: Federal
PS3-6
SMOKING AND VAPING BEHAVIORS, EXPECTANCIES, AND
CESSATION OUTCOMES OF BISEXUAL AND HETEROSEXUAL
INDIVIDUALS
Ursula Martinez1, Vani Simmons1, Karen Brandon1, Gwendolyn Quinn2, Thomas Bran-
don1. 1Mott Cancer Center, Tampa, FL, USA, 2New York University Grossman School
of Medicine, New York, NY, USA.
Signicance: Bisexual individuals have a higher prevalence of smoking and vaping
than heterosexual individuals, which can contribute to health disparities. We compared
294 bisexual and 2412 heterosexual participants in an RCT testing a smoking cessa-
tion intervention for dual users of combustible and electronic cigarettes on baseline
smoking and vaping characteristics and expectancies, as well as follow-up smoking/
vaping status. Methods: Participants were recruited nationwide and self-reported
smoking, vaping, and expectancies regarding smoking and vaping. We analyzed
7-day point prevalence smoking and vaping abstinence at 3, 12, and 24 months. Re-
sults: Compared to heterosexual participants, bisexual participants were more likely
(ps<.05) to be younger (26.0 v 30.5 years), female (70.4% v 30.8%), and low income
(67.4% v 55.0%). Bisexual participants also reported shorter smoking histories (10.3
v 11.0 years), fewer cigarettes per day pre-vaping (17.8 v 19.6), lower motivation to
quit smoking (Contemplation Ladder=5.5 v 5.8), and were less likely to initiate vap-
ing to quit smoking (68.9% v 75.7%), but statistical signicance was not maintained
when controlling for age. When including all the previous variables as covariates,
bisexual individuals reported more positive vaping expectancies than heterosexual
individuals regarding satisfaction (β=0.073;p<.001), withdrawal (β=0.043;p=.043),
craving reduction (β=0.052;p=.012), cost (β=0.057;p=.006), negative aect reduction
(β=0.059;p=.005), taste (β=0.058;p=.005), social facilitation (β=0.058;p=.006), health
risks (β=-0.055;p=.009), and stress reduction (β=0.053;p=.013). Bisexual individuals
also reported greater positive smoking expectancies than heterosexual individuals on
negative aect reduction (β=0.054;p=.010) and stimulation (β=0.044;p=.035). The only
dierence between groups on smoking or vaping was on vaping at 3 months with bisexual
individuals being more likely to abstain from vaping than heterosexual individuals (19.1%
vs. 10.4%, p=.0002), but signicance was not retained when controlling for covariates
(study condition, demographic, smoking and vaping variables). Conclusion: Despite
bisexual participants reported greater positive expectancies regarding smoking and
vaping than heterosexual participants, rates of smoking, vaping, and dual use were
similar over time. There may be greater utility in targeting the disparities via prevention
eorts over targeted cessation eorts.
FUNDING: Federal
PS3-7
MEDIATORS OF INITIAL ABSTINENCE FOR AN EXTENDED SELF-
HELP SMOKING CESSATION INTERVENTION WITH DUAL USERS
OF COMBUSTIBLE AND ELECTRONIC CIGARETTES
L. Robert Gore, Steven K. Sutton, Ursula Martinez, Karen O. Brandon, Vani N.
Simmons, Thomas H. Brandon. H. Lee Mott Cancer Center & University of South
Florida, Tampa, FL, USA.
Introduction: Approximately 10% of current smokers are dual users of electronic and
combustible cigarettes. We recently reported on the ecacy of an extended (18 months)
self-help intervention targeting dual users (ETARGET) compared to an assessment only
condition (ASSESS; Martinez et al., The Lancet Public Health, 2021). The present study
analyzed motivational and self-ecacy variables, assessed at baseline and 6 months,
as prospective mediators of the ecacy of ETARGET on initial smoking abstinence at
9 months. Method: Participants from the parent study who (1) returned at least one
of the surveys at 3, 6, or 9 months and (2) did not report smoking abstinence at 3 or
6 months were included (ETARGET n=653, ASSESS n=386). Four mediators were
evaluated: readiness to quit (Contemplation Ladder), commitment to a smoke-free life
(single item, 1-5 scale), condence in ability to quit cigarettes (single item, 1-5 scale),
and cessation self-ecacy (Smoking Self-Ecacy scale). Models (implemented in Mplus)
evaluated change in the proposed mediator from baseline to 6 months on smoking
status at 9 months (self-reported 7-day point prevalence), with change assessed using
the regression approach. The indirect path was evaluated using the product method.
Parallel analyses were performed for 3 dierent approaches to manage missing data:
full information maximum likelihood (FIML, n=1039), complete case (n’s=527-655), and
missing imputed as smoking (n’s=683-846). Results: The full sample had the following
characteristics: mean age was 31.1 years, mean FTND was 3.9, 59% were male, and
88% were White. Using the FIML approach, the specic indirect eect was statistically
signicant for readiness to quit (b=.220, SE=.078, p=.005) and commitment (b=.124,
SE=.049, p=.012), but not for condence (b=.024, SE=.049, p=.624) or self-ecacy
(b=.074, SE=.047, p=.115). The pattern of results was the same when using the complete
case and the missing equals smoking approaches. Conclusion: Increases from baseline
to 6 months in readiness to quit and commitment to being smoke-free mediated the
eect of the extended self-help intervention on initial smoking abstinence at 9 months,
whereas condence and self-ecacy did not. These ndings suggest that motivational
enhancement may have been more important than skills training as interventional
processes. Funding: This work was supported by the National Institute on Drug Abuse
(R01DA037961) and the National Cancer Institute (P30CA076292).
FUNDING: Federal
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-8
EFFECTS OF THETA-BURST STIMULATION ON FUNCTIONAL
CONNECTIVITY, CRAVING AND CIGARETTE SMOKING
Spencer Upton, Brett Froeliger. University of Missouri, Columbia, MO, USA.
Background: Nicotine addiction is associated with disturbances in prefrontal mediated
attentional control. Theta-burst rTMS (TBS) has been shown to improve attentional con-
trol and reduce symptoms in clinical samples; however, the eects of TBS on attentional
control brain mechanisms and behavior among smokers remains poorly characterized.
The current study tested the eects of two TBS protocols (cTBS, iTBS) to the right inferior
frontal gyrus (rIFG) on brain network connectivity, inhibitory control (IC) and craving.
Methods: Adult (N=37; age=47.6 ± 9.5; female: n=17) nicotine dependent (FTND=5.4
± 2.1) tobacco smokers (CPD=18.8 ± 5.7; 30 ± 9.8 years) performed a baseline IC
task during fMRI. Baseline rIFG IC BOLD was used for neuronavigation and then, in a
crossover, repeated measures fMRI assessment, the eects of TBS were assessed on:
1) functional connectivity, 2) task performance and, 3) craving 24hrs. post TBS. Results:
A signicant condition x time interaction of TBS on FC between right fronto-parietal
and visual circuitry was observed: cTBS increased and iTBS decreased FC between
right lateral PFC (rLPFC) and the occipital pole (OP) (p=.026; ηp
2 =.130); and between
right posterior parietal cortex (rPPC) and OP (p=.028; ηp
2=.127). Overall, the eect of
TBS on rLPFC-OP FC was positively associated with eects on IC task performance
(p=.019, R2=.075; cTBS p=.107, R2=.046; iTBS p=.444, R2=.017). Over the post 24hr
cTBS period, rPPC-OP FC displayed a negative association with craving (p=.126,
R2=.04). No eect of iTBS changes in FC were associated with smoking outcomes.
Conclusions: Previous works show that smokers exhibit disrupted function in right
parietal-visual circuitry during attentional tasks and right fronto-parietal circuitry during
probes of attentional control in the face of emotional distractors. Among nonsmokers,
strength of frontoparietal-visual FC corresponds with better performance during tasks of
attention and vigilance. Current study ndings suggest that TBS may improve prefrontal
mediated attentional control and reduce smoking urges. Findings will be discussed in
the context of using TBS to improve executive control and reduce craving.
FUNDING: Federal; Nonprot grant funding entity
PS3-9
CONVENTIONAL CIGARETTE POLYGENIC SCORE IS
ASSOCIATED WITH E-CIGARETTE USE IN YOUTH
Megan E. Cooke1, James S. Cliord2, Elizabeth K. Do2, Jodi M. Gilman1, Hermine H.
Maes2, Roseann E. Peterson2, Elizabeth C. Prom-Wormley2, A. Eden Evins1, Randi
Melissa Schuster1. 1Massachusetts General Hospital, Boston, MA, USA, 2Virginia
Commonwealth University, Richmond, VA, USA.
Signicance: Prevalence of electronic cigarette use has escalated rapidly in recent
years, particularly among youth. Little is known about the genetic inuences on
e-cigarette use. We aimed to determine whether genetic risk for initiation of regular
smoking of conventional cigarettes and average cigarettes smoked per day confers
risk for e-cigarette initiation and vaping frequency. Methods: Polygenic scores (PGS)
of smoking initiation and cigarettes per day were constructed using summary statistics
from the two largest available GWAS meta-analysis of conventional cigarette use in
European and East Asian ancestry. We tested whether the PGS of smoking tested
whether the PGS of regular smoking initiation or cigarettes per day predicted lifetime
e-cigarette initiation and frequency of past 30-day e-cigarette use among 9,541 young
adults (n=2,034 African (AFR), n=1,196 Admixed American (AMR), n=928 East Asian
(EAS), n=4,562 European (EUR), and n=821 South Asian (SAS) ancestry) from the Spit
for Science longitudinal cohort study (2011-2019). Results: The smoking initiation PGS
was associated with e-cigarette initiation in the EUR subsample (OR: 1.27, 95% CI:
1.19 - 1.36, p=7.53x10-12). There was no signicant association between the smoking
initiation PGS and e-cigarette initiation in other subsamples (p’s > 0.12). The PGS for
cigarettes per day was not associated with e-cigarette initiation. The PGS for regular
smoking initiation and cigarettes per day were not associated past 30-day e-cigarette
use in any of the subsamples (p’s>0.05). Conclusions: Genetic factors associated with
regular smoking initiation predict initiation of e-cigarettes in youth of European ancestry.
However, shared genetic factors do not appear to inuence heaviness of conventional
cigarette use and e-cigarette initiation and heaviness of recent use.
FUNDING: Unfunded; Federal; Nonprot grant funding entity
PS3-10
CESSATION OUTCOMES FOR EXCLUSIVE VAPERS AND
EXCLUSIVE SMOKERS WHO CALL EMPLOYER-SPONSORED
TOBACCO QUITLINES IN THE UNITED STATES
Katrina Vickerman1, Etta Short2, Kelly Carpenter1, Kristina Mullis1, Chelsea Nash3.
1Optum Center for Wellbeing Research, Seattle, WA, USA, 2RallyHealth, Seattle, WA,
USA, 3Optum, Seattle, WA, USA.
SIGNIFICANCE: Most e-cigarette users in the US are dual users of e-cigarettes and
combustible cigarettes. However, the number of exclusive e-cigarettes users (EECUs)
is increasing, including the number of callers to tobacco quitlines (QLs) for help quitting
vaping. Numerous studies have supported the eectiveness and cost-eectiveness of
QLs for smoking cessation, but the eectiveness of QLs for vaping cessation is yet
to be established. METHODS: This secondary data analysis of real-world QL data
examined participants in employer-sponsored QLs in the US run by Optum who were
EECUs or exclusive smokers (ESs) at the time of program registration from January
2017 through October 2020. QL treatment included 5 coaching calls, free nicotine re-
placement therapy (NRT), and access to integrated text and online cessation support.
Participant demographics and tobacco use were collected at program registration.
Participant record systems captured program engagement data. Self-reported smoking
and vaping 30-day point prevalence abstinence (30dppa) outcomes were collected via
an evaluation survey after 6 months. RESULTS: 1194 EECUs and 22,845 ESs enrolled
and received QL treatment. EECUs were more likely to be male (EECUs: 60.3%; ESs:
43.2%; p<0.001), were younger on average (EECUs: M=43.0, SD=11.7; ESs: M=49.5,
SD=11.2; p<0.001), completed a higher number of coaching calls on average (EECUs:
M=3.8, SD=1.7; ESs: M=3.2, SD=1.8; p<0.001) and were less likely to be mailed NRT
from the QL program (EECUs: 43.8%; ESs: 69.8%; p<0.001). 488 (40.9%) and 8,382
(36.7%) of EECUs and ESs responded to the 6-month survey, respectively (p<0.01).
The respondent 30dppa for EECUs was 62.5% (305/488) and for ESs was 58.5%
(4,900/8,382), p=0.08. Assuming those lost to follow-up were continued users, 30dppa
for EECUs was 25.5% (305/1194) and for ESs was 21.4% (4,900/22,845), p<0.001.
CONCLUSION: Dierences exist in demographics and QL treatment engagement
for EECUs compared to ESs in this sample. Outcome data suggest QL protocols are
eective at supporting EECUs trying to quit vaping. Given the existing infrastructure,
QLs have the potential for meaningful vaping cessation reach and impact.
FUNDING: Unfunded
PS3-11
A BEHAVIORAL-ECONOMIC EXAMINATION OF DIFFERENCES IN
THE RELATIVE REINFORCING VALUE OF CIGARETTE SMOKING
AMONG THOSE WITH CUMULATIVE VULNERABILITIES
Tyler G. Erath1, Stephen T. Higgins1, Michael DeSarno1, Diann E. Gaalema1, Adam
Leventhal2, Stacey Sigmon1, Sarah Heil1, Jennifer Tidey3. 1University of Vermont, Burl-
ington, VT, USA, 2University of Southern California, Los Angeles, CA, USA, 3Brown
University, Providence, RI, USA.
Introduction: Risk for smoking varies in an orderly, cumulative manner in association
with the presence of co-occurring vulnerabilities. An important question examined in the
present study is how the relative reinforcing eects of smoking vary across individuals
with varying levels of cumulative vulnerability. Reinforcement is widely recognized to be
the behavioral process underpinning chronic smoking. Methods: We used data from 775
adult, daily smokers who participated in a 12-week multisite controlled trial evaluating the
addiction potential of cigarettes diering in nicotine content. Vulnerabilities included rural
residence, current substance use disorder, current aective disorder, low educational
attainment, poverty, unemployment, physical disability. Participants were categorized
as having 0-1 (low), 2-3 (moderate), or 4-5 (high) cumulative vulnerabilities. We used
the hypothetical cigarette purchase task (CPT) to characterize the relative reinforcing
eects of participant usual-brand cigarettes at a trial baseline assessment. The CPT is a
valid behavioral-economic measure of the relative reinforcing eects of smoking in which
participants estimate how much they would smoke (demand) in a 24-hr period under
escalating constraints on cigarettes (price). Demand is characterized using two factors:
Amplitude (demand under minimal cost) and Persistence (demand despite increasing
cost). Analysis of covariance was used to analyze study results. Results: Demand
Amplitude (F[2,709]=16.04,p<.0001, η2=.04) and Persistence (F[2,709]=8.35,p=.0003,
η2=.02) each increased corresponding to increasing cumulative vulnerability, but eect
size was larger for Amplitude compared to Persistence. With Amplitude, demand dif-
fered signicantly between each level of cumulative vulnerability in post-hoc testing.
With Persistence, the low and moderate groups each diered from the highest level but
not each other. Conclusions: Cumulative vulnerability is associated with a pervasive
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
increase in the relative reinforcing eects of smoking encompassing demand Amplitude
and Persistence, although changes in Amplitude are especially robust and may be an
important clinical target for reducing smoking in vulnerable populations.
FUNDING: Federal
PS3-12
A SCOPING REVIEW OF THE USE OF REMOTE BIOCHEMICAL
VERIFICATION METHODS OF SMOKING STATUS
Johannes Thrul1, Janardan Devkota1, Carol Howe2, Alicia Allen2, Adam Alexander3,
Michael Businelle3, Emily Hebert4, Jaimee Hener5, Darla Kendzor3, Chaelin Ra3, Judith
Gordon2. 1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
2University of Arizona, Tucson, AZ, USA, 3University of Oklahoma, Oklahoma City, OK,
USA, 4University of Texas Health Science Center at Houston, Houston, TX, USA, 5Fred
Hutchinson Cancer Research Center, Seattle, WA, USA.
Signicance: Biochemical verication of smoking status is considered the “gold standard”
in smoking cessation research. An increasing trend in cessation research is remote
collection of cessation outcome data, but little is known about which methods of remote
biochemical verication of smoking status are most feasible and accurate. Methods: We
conducted a scoping review of studies using remote biochemical verication of smoking
status. Publications were included if they reported on remotely obtained (not in-person)
biochemical conrmation of smoking status for participants in their study and addressed
combustible tobacco use. A medical librarian searched 6 databases from their inception
until January 6, 2020. Two independent reviewers screened the titles and abstracts of
each of the articles, reviewed full-text articles, and extracted data of included articles.
Disagreements were resolved by consensus between the two reviewers or by a third
reviewer. Results: We found 7591 articles, and 60 articles met the study criteria and
were included in this review. Most studies were smoking cessation intervention studies
(83%), which included a large number of contingency management studies (36% of
intervention studies). The remaining studies were feasibility and cross-sectional studies
(17%). The most frequently collected sample types were saliva (53%), expired air (42%),
and urine (7%); the most commonly used biomarkers were cotinine (60%) and carbon
monoxide (42%); and the most commonly used conrmation strategies were mail-in
samples analyzed in a laboratory (50%) and videos (38%). The rate of returned samples
ranged widely from 100% to 24%. A total of 55% of studies provided information on
both self-reported and biochemically veried smoking abstinence rates. Biochemically
veried abstinence rates in these studies frequently were around only 50% of self-re-
ported ones, but in some examples were up to 5 times lower than self-reported ones.
Conclusions: Considering the increase in remote delivery of interventions and data
collection in tobacco research, remote biochemical verication of smoking status is of
increasing importance to the eld. Recommendations for the use of these methods in
future studies will be provided in this presentation.
FUNDING: Unfunded; Federal
PS3-13
ASSOCIATION OF PAIN CATASTROPHIZING WITH SMOKING
DEPENDENCE MOTIVES IN AFRICAN AMERICANS
Naosuke Yamaguchi, Mariel S. Bello, Reid C. Whaley, Adam M. Leventhal. University
of Southern California, Los Angeles, CA, USA.
Signicance: Chronic pain and cigarette smoking both disproportionately impact African
American health. While pain-smoking comorbidity is well-documented, its mechanisms
are poorly understood, particularly in African Americans. The present cross-sectional
study investigated associations of multiple dimensions of pain catastrophizing (cogni-
tive-aective component of pain) with various smoking dependence motives in African
American smokers. Methods: Non-treatment-seeking African American smokers
from Los Angeles (N=508, 41.1% female, M[SD]: age=48.0[11.3], cigs/day=15.2)
participated in a clinical laboratory study on individual dierences in tobacco addiction.
Questionnaires assessing pain catastrophizing, smoking dependence motives, and
other covariates were assessed and used in this secondary analysis study. Regression
analyses examined associations of rumination (constantly thinking about pain), magni-
cation (heightening pain perception), and helplessness (feeling that pain will persist)
with each of 11 dependence motives in separate models with and without adjusting
for demographic, psychiatric, and pain severity covariates. Results: All 3 dimensions
of pain catastrophizing were signicantly associated with all 11 smoking dependence
motive subscales without covariate adjustment (beta range: .13-.25). After covariate
adjustment, pain rumination and helplessness were associated with all primary motives
indicative of heavy, ritualistic, and compulsive dependent smoking (Automaticity, Craving,
Tolerance, Loss of Control; beta range: .11-.19), and magnication was associated with
Automaticity (beta =.13) and Craving (beta =.16) motives. Other secondary motives
were weakly, but signicantly, associated with some subscales in a non-systematic
fashion. Conclusion: Heightened pain catastrophizing may have modest, but statisti-
cally unique, associations with heavy and compulsive smoking dependence motives in
African Americans over and above other co-factors. If these ndings were conrmed in
experimental or longitudinal designs and clinical populations, they could point to pain
catastrophizing as a possible target for further clinical and scientic work dedicated to
pain-smoking comorbidity in African Americans.
FUNDING: Federal
PS3-14
PREDICTORS OF ADHERENCE TO SMOKING CESSATION
MEDICATIONS AMONG CURRENT AND EX-SMOKERS IN
AUSTRALIA: FINDINGS FROM A NATIONAL CROSS-SECTIONAL
SURVEY
Amanual Getnet Mersha, Michelle Bovill, Parivash Eftekhari, Gillian Sandra Gould.
University of Newcastle, Newcastle, Australia.
Background: Adherence to smoking cessation medications improves the rate of suc-
cessful quitting. This study aimed to evaluate the level of adherence to smoking cessa-
tion medications and associated factors among smokers and ex-smokers in Australia.
Method: A cross-sectional study using an online survey was conducted in Australia from
January 2021 to July 2021. Data entered and analysed using Stata software (V16, Stata
Corp LP, College Station, TX). Descriptive statistics using frequency and percentage
were used to present the overall characteristics of participants. Cross-tabulation with
Pearson’s chi-square test was done to evaluate the possible association between
factors. Univariate and multivariable logistic regressions were employed to explore
barriers and facilitators of adherence to smoking cessation medications and a P-value
of 0.05 was used as a cut-o point to declare signicant association. Results: Among
the participants, 28.4% participants were found to be adherent to smoking cessation
medications. Participants with good social support during their quit attempt were more
likely to be adherent (AOR=3.28, 95% CI of 2.30-6.27). Participants who did not ex-
perience anxiety symptoms during their quit attempt were more adherent compared to
smokers who had anxiety symptoms (AOR=4.41, 95% CI of 3.64-14.68). Having previous
experience of using the medications improved adherence by four-fold (AOR=3.87, 95%
CI of 1.11-13.44). The level of nicotine dependence showed a positive association with
medication adherence (AOR=3.53, 95% CI of 1.40-8.95). Not relapsing while on the
medications improved adherence (AOR=2.88, 95% CI of 1.21-6.88). Discussion: The
rate of adherence to smoking cessation medications is found to be low in Australia.
Adherence was associated with social, psychological, smoking, and medication-related
factors. Smoking cessation interventions are recommended to include strategies that
can address medication adherence. Keywords: adherence, factors, quitting, smoking
cessation medications
PS3-15
DIGITAL METHYLATION ASSESSMENTS DEMONSTRATE
SIGNIFICANT UNDER REPORTING OF SMOKING AND ALCOHOL
CONSUMPTION IN AFRICAN AMERICAN YOUNG ADULTS
Robert A. Philibert1, Steven R.H. Beach2, Rick Gibbons3, Meg Gerrard3, Man-Kit
Lei2. 1University of Iowa, Iowa City, IA, USA, 2University of Georgia, Athens, GA, USA,
3University of Connecticut, Storrs, CT, USA.
African Americans have elevated levels of both cardiovascular disease and cancer that
are not well explained by self-reported rates of smoking and alcohol use. In the current
investigation, we examined the possibility that rates of some risk behaviors, such as
smoking and drinking, may be higher in African Americans than their self-report data
indicate. To test that hypothesis, using cutting edge epigenetic technologies and data
from a subset of a large longitudinal cohort of 30 year-old African American subjects
from Iowa and Georgia (FACHS), we compared the self-reported and objective rates of
smoking and heavy alcohol consumption (HAC). In the rst 190 subjects from FACHS,
using digital DNA methylation testing, > 50% of the participants had evidence of signif-
icant demethylation at cg05575921, a CpG site whose methylation status is sensitive
and specic for smoking. In contrast, the rate of self-reported smoking tobacco and/
or cannabis was only 35%. Furthermore, only 4% of the participants reported drinking
three or more drinks per day one or more times per week, but a digital epigenetic test
for HAC, using the newly published Alcohol T Score (ATS) metric, found that 10% of the
rst 190 had ATS >5, 20% had ATS>3.5, and 32% had ATS > 2.35, which are cut-points
for diagnosis, suggestive of problem use, and an optimal classier for HAC, respectively.
Finally, consistent with prior epigenetically informed studies showing that heavy drinking
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
and heavy smoking are highly associated, methylation status at cg05575921 and ATS
were highly correlated (r = -0.60), providing convergent validity for both assessments.
These data add further evidence that underreporting of health-relevant behaviors is
common and may be substantial in communities under particular stress or with potential
concerns about reporting substance-use related behavior. Indeed, substantial underre-
porting of problematic health behavior is likely the norm in all populations. As a result,
enhanced, non-self-report assessment of health-relevant behaviors may help account
for illness outcomes and may provide a framework for understanding and addressing
health promotion challenges.
FUNDING: Federal
PS3-16
IMPACT OF TREATING INSOMNIA SYMPTOMS ON ABSTINENCE
FROM SMOKING
Vijay Nitturi, George Kypriotakis, Diane Beneventi, Jennifer Minnix, Janice Blalock,
Jason Robinson, Roberto Gonzalez, Paul Cinciripini, Maher Karam-Hage. UT MD
Anderson Cancer Center, Houston, TX, USA.
Signicance: Quitting smoking is the single most impactful health strategy to prevent
cancer. Even quitting at the time of diagnosis can increase cancer patients’ survivorship
by 30-40%. Insomnia symptoms can hinder quit attempts. However, no studies have
conrmed if treating insomnia symptoms would increase abstinence rates. We set out to
assess the impact of treating insomnia on the ability to abstain from smoking. Methods:
Data were extracted from the electronic health records of patients who participated in
a cancer center’s tobacco treatment program. Initial, middle, and late insomnia were
assessed with the Jenkins sleep questionnaire, abstinence was based on subject re-
port, and severity of nicotine dependence was assessed using the Fagerström Test of
Cigarette Dependence. We report abstinence according to 7-day point prevalence at 3,
6, and 9 months after starting the tobacco treatment program. The relationship between
insomnia score and abstinence was evaluated after participants were propensity score
matched on age, sex, race, nicotine dependence, alcohol use, panic disorder, depres-
sion, and severity of insomnia. Results: Patients treated for insomnia were more likely
to abstain from smoking than patients not treated for insomnia 9 months after the start
of tobacco cessation treatment (p = 0.013). However, at 9 months, patients treated for
severe insomnia (sleep scores greater than 14) had lower abstinence rates than patients
not treated for insomnia. At 3 and 6 months, treatment for insomnia did not signicantly
improve abstinence rates compared with the nontreatment group. Conclusion: Treating
patients with mild/moderate levels of insomnia could benet their tobacco abstinence,
resulting in decreased incidence of cancer and improved outcomes for cancer survivors.
Future analyses will aim to control for the co-occurrence of other psychiatric disorders
and their impact on the severity of insomnia and therefore the ability to quit smoking.
FUNDING: Federal; State; Academic Institution
PS3-17
DUAL USERS IN THE HEALTHCARE SYSTEM: DO THEY QUIT
SMOKING OR BENEFIT FROM TREATMENT?
Li-Shiun Chen1, Brendan Heiden1, Nina Smock1, Jingling Chen1, Timothy Baker2, Laura
Bierut1. 1Washington University School of Medicine, St. Louis, MO, USA, 2Center for
Tobacco Research and Intervention, Madison, WI, USA.
Signicance: It is unclear whether dual use compared with smoking is associated
with smoking cessation and whether tobacco treatment increases smoking cessation
among dual users. Methods: We analyzed the electronic health record (EHR) data
from 193,846 smokers and 2,894 dual users in a large healthcare system in US Mid-
west between June 2, 2018 and June 30, 2021. We analyze the endpoints, including
smoking cessation in the following 12 months. Results: First, dual use was increasingly
documented in the EHR during outpatient visits (396 patients in 6-12/2018, 578 pa-
tients in 1-6/2019, 839 patients in 7-12/2019, and 1,081 patients in 1-6/2020 reported
dual use of electronic and combustible cigarettes). Second, dual users, compared
with smokers, had higher smoking cessation likelihood in the next 12 months (22.0%
vs. 16.6%, z=6.32, p<0.00001). Third, among dual users (N=2,894), 314 patients
(12.1%) received evidence-based tobacco treatment. Treated dual users, compared
with untreated dual users, had higher smoking cessation in the next 12 months (30.7%
vs. 19.7%, z=4.05, p=0.000052). Conclusion: Real world data suggest that dual use
may promote smoking cessation and that dual users appear to benet from tobacco
treatment. These ndings may inform future tobacco treatment but interpretation must
consider the nonrandomized nature of dual use.
FUNDING: Federal; Academic Institution
PS3-18
EVER AND CURRENT USE OF E-CIGARETTES AMONG ADULT
SMOKERS PARTICIPATING IN AN OUTPATIENT HOSPITAL
TOBACCO TREATMENT SERVICE RELATIONS WITH TOBACCO
USE OUTCOMES
Lisa Fucito1, Stephen Baldassarri2, Stephanie O’Malley1, Steven L. Bernstein3. 1Yale
University School of Medicine, New Haven, CT, USA, 2Yale School of Medicine, New
Haven, CT, USA, 3Dartmouth School of Medicine, Hanover, NH, USA.
Background. E-cigarettes may promote smoking cessation and their use may be
increasing among smokers with co-morbid medical conditions. Nevertheless, e-cig-
arettes have typically been discouraged in this population. More research is needed
to understand their e-cigarette use and the link with tobacco use behavior. Methods.
Exploratory analysis of e-cigarette use among new patients (N=234) enrolled in the
Smilow Cancer Hospital Tobacco Treatment Service between January and June 2020
using electronic health record data. Chi-square and Mann Whitney U tests conducted
using SPSS 28. Results. Patients were 59% female, 65.4% White, 22.2% Black, 18.8%
Hispanic, with a median age of 58.0. They reported smoking a median of 15.0 cigarettes
daily at their intake visit. Most (78.8%) had a history of cancer, respiratory disease, and/
or cardiovascular disease. Nearly a third reported ever use of e-cigarettes; 11 (4.7%)
reported current use. Compared to patients who never used e-cigarettes, those who used
were signicantly younger (Mann-Whitney U=4926.0, n=234, p=.04) and less likely to
have a history of cancer, respiratory, and/or cardiovascular disease (X2(1)=5.1, p=.02).
In fact, having 2 or more conditions was associated with a lower likelihood of trying
e-cigarettes compared to having none or 1 (X2(2)=8.7, p=.01). Ever use was signicantly
associated with attending more TTS visits (Mann-Whitney U=7499.0, n=234, p<.001).
However, there was no dierence in the amount of smoking reduction between those
who had ever tried e-cigarettes versus those who did not during treatment. Of the 11
patients who reported current e-cigarette use: 3 stopped and 2 reduced cigarette use,
and 1 switched to a device with no nicotine.Conclusions: E-cigarette use is common
among medical patients seeking tobacco treatment, but less so among those with more
complex medical histories. The ndings have important implications for tobacco treat-
ment. Medical patients who tried e-cigarettes may be open to tobacco treatment and
a range of treatment options. Patients with more co-morbid medical conditions may be
less likely to take advantage of the potential harm reduction opportunity of e-cigarettes.
FUNDING: Federal
PS3-19
GENDER EFFECTS IN PREDICTORS OF SMOKING ABSTINENCE
AND NEUROPSYCHIATRIC ADVERSE EVENTS IN THE EAGLES
TRIAL
Sherry A. McKee1, David E. Lawrence2, Phillip Saccone2, Thomas McRae2, Robert
M. Anthenelli3. 1Yale School of Medicine, New Haven, CT, USA, 2Pzer, New York, NY,
USA, 3University of CA, San Diego, School of Medicine, La Jolla, CA, USA.
SIGNIFICANCE: Gender eects have been demonstrated in abstinence outcomes
across all smoking cessation medications, but there is limited information regarding
gender eects on cessation-related neuropsychiatric adverse events (NPSAEs) or inter-
actions with smokers’ psychiatric status. METHODS: We conducted a secondary analysis
of data from EAGLES of 8144 smokers randomized to varenicline, bupropion, nicotine
patch or placebo; 8058 received 1 dose or more of treatment. Design characteristics
included region (within/outside US), psychiatric cohort (absent/present), and treatment.
Baseline characteristics included gender, age, race, BMI, nicotine dependence, anxiety,
depression, aggression, cigarettes per day (CPD), suicidality, psychotropic medication
use, prior use of smoking cessation medications, age started to smoke, lives with
smoking, contact with smoker, and alcohol or substance use disorder. Design char-
acteristics were forced into logistic regressions models, and then interactions among
gender, design elements, and baseline characteristics were evaluated for NPSAEs
and 6-month cessation outcomes. RESULTS: Findings demonstrated a signicant
interaction of gender and race (p<02); black women were more likely to report NPSAEs
than black men. There were signicant interactions between gender and baseline CPD
(p<.03) and gender and prior use of varenicline (p<.04). Women vs men with higher
baseline levels of smoking had lower odds of continuous abstinence. Women vs men
who used varenicline previously had lower odds of prolonged abstinence. For 6-month
point prevalence, gender interacted with baseline cigarettes per day (p<.01) similar to
the interaction for continuous abstinence. Gender interacted with medication (p<.03),
such that women vs men had relatively greater success at achieving point prevalence
abstinence on varenicline. Odds ratios (95%CI’s) highlighting signicant female vs
male interactions will be presented. CONCLUSIONS: Overall, results demonstrated
important racial dierences in NPSAEs, but psychiatric status did not interact with
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
gender on treatment outcomes. Findings did support prior work demonstrating relative
increased ecacy of varenicline for women. FUNDING: EAGLES was funded by Pzer
and GlaxoSmithKline. Support also provided by NIH grants U54AA027989 (to SAM).
FUNDING: Federal; Pharmaceutical Industry
PS3-20
COHORT PROFILE FOR THE LOMA LINDA UNIVERSITY HEALTH
BREATHE STUDY OF CONTINUOUSLY INCENTIVIZED EMPLOYEE
SMOKING CESSATION
Pramil Singh1, Olivia Moses2, Anne Berit Petersen1. 1Transdisciplinary Tobacco
Research Program, Loma Linda University Cancer Center, Loma Linda, CA, USA,
2Risk Management, Loma Linda University Health, Loma Linda, CA, USA.
Signicance: Financial incentives are frequently used to enhance the ecacy of
workplace smoking cessation programs. The purpose of the LLUH BREATHE Cohort
is to test the ecacy of a novel method of continuously incentivizing participation in
workplace smoking cessation on participation, long term abstinence, health outcomes,
healthcare costs, and health care utilization. Methods: In 2014, Loma Linda University
Health (LLUH) - a US academic medical center and university - incentivized participa-
tion in a workplace smoking cessation program (LLUH BREATHE) by lowering health
plan costs. Specically, LLUH introduced a Wholeness Health Plan (WHP) option that,
for the smokers, continuously incentivizes participation in nicotine screening and the
LLUH BREATHE smoking cessation program by oering an “opt-in wellness discount”
that consisted of 50-53% lower out of pocket health plan costs (i.e. monthly employee
premiums, co-payments). This novel “continuously incentivized” model lowers annual
health plan costs for smokers who, on an annual basis, attempt or maintain cessation
from tobacco use. The annual WHP cost savings for smokers far exceeds the value of
short term incentives that have been tested in workplace cessation trials to date. This
ongoing health plan option oered to over 16,000 employees has created an open,
dynamic LLUH BREATHE cohort of current and former smokers (n=1,092). Results:
Our prole of the LLUH BREATHE cohort indicates that after ve years of follow-up in
a prospective cohort study (2014-2019), continuously incentivized smoking cessation
produced a 74% participation (95% condence interval=[71% to 77%]) in employer
sponsored smoking cessation attempts that were occurring less than a year after the
incentive was oered. This participation rate exceeds norms (median of 28%) in more
than 20 studies of employee smoking cessation programs in auent nations. Conclusion:
A novel continuously incentivized employee smoking cessation model substantially
increased participation of employee smokers. The LLUH BREATHE cohort can be
purposed to examine the eect of the continuously incentivized model on cessation
outcomes, health plan utilization/costs, use of electronic nicotine delivery systems, and
COVID-19 outcomes.
FUNDING: Academic Institution
PS3-21
VALIDATION OF SMOKING-RELATED SELF-EVALUATIONS IN A
SAMPLE OF PEOPLE LIVING WITH HIV/AIDS IN NAIROBI, KENYA
Julia F. Cohen1, Jonathan Shuter2, Seth S. Himelhoch3, Sylvia A. Ojoo4, Emily Koech5,
Deborah R. Medo6, Wendy Potts6, Melanie Bennet6, Helgar Musyoki7, Mercy Karanja8,
Caroline Ngunu9, Andrea H. WeinbergerPhD1. 1Ferkauf Graduate School of Psychology,
Yeshiva University, Bronx, NY, USA, 2Albert Einstein College of Medicine, New Rochelle,
NY, USA, 3University of Kentucky College of Medicine, Lexington, KY, USA, 4Center for
Global Health Practice and Impact, Georgetown University Medical Center, Washington
DC, USA, 5Center for Global Engagement, University of Maryland Baltimore, Baltimore,
MD, USA, 6University of Maryland School of Medicine, Baltimore, MD, USA, 7Ministry
of Health, National AIDS and STI Control Program, Nairobi, Kenya, 8Ministry of Health,
Nairobi, Kenya, 9Ministry of Public Health and Sanitation, Nairobi, Kenya.
INTRODUCTION: The cigarette smoking prevalence for people living with HIV/AIDS
(PLWHA) is high especially in developing countries like Kenya. Smoking-related self-eval-
uations (e.g., self-ecacy, self-concept) are related to smoking cessation outcomes
yet most of the work on self-evaluations, including validation of these measures, has
been done in developed counties. This study is the rst to examine the psychometrics
of self-evaluation measures for PLWHA in Kenya. METHODS: Participants were 50
PLWHA who smoke cigarettes recruited from HIV care clinics and methadone clinics
in Nairobi, Kenya (68% male, 96% African). Participants completed measures of
self-ecacy (adaptation of the Self-Ecacy Questionnaire, SE), self-concept (Smoker
and Abstainer Self-Concept Questionnaire, SC), and locus of control (adaptation of the
Drinking-Related Locus of Control Scale, LOC). Factor loadings were determined using
Horn’s parallel analysis and factor analysis, and reliability coecients were calculated.
RESULTS: The internal consistency reliability for the SE (alpha=0.85) and LOC (al-
pha=0.85) measures were high and were lower for the SC measure (overall alpha=0.43,
smoker SC alpha=0.78, abstainer SC alpha=0.57). The SE questionnaire was found to
have a three-factor solution accounting for 51.2% of the overall variance which is similar
to the three factors found in previous research. The SC measure was found to have
a three-factor solution accounting for 65.49% of the overall which includes an overall
smoker SC factor and two abstainer SC factors. The LOC questionnaire was found to
have an eight-factor solution accounting for 69.75% of the overall variance, which diered
from the three-factor solution found in previous research. CONCLUSION: While the
factor structure of the SE questionnaire had similar results to previous research, there
were signicant dierences in the factor structures for the SC and LOC questionnaires.
These dierences may be useful in identifying cultural dierences in smoking-related
self-evaluations in Kenya versus other countries. These results will also be important
for future smoking research on PLWHA from developing countries.
FUNDING: Federal
PS3-22
DESCRIPTION OF A TREATMENT PROTOCOL FOR OPT OUT
TOBACCO COUNSELING AND EXAMINATION OF TREATMENT
PROCESS OUTCOMES
Tresza D. Hutcheson1, Kimber P. Richter1, Taneisha S. Scheuermann1, Delwyn Catley2.
1University of Kansas School of Medicine, Kansas City, KS, USA, 2Children’s Mercy
Hospital, KS City, MO, USA.
Signicance. Opt out treatment for tobacco use could increase the reach of evi-
dence-based care, but could alienate patients who are not interested in quitting. Meth-
ods. We describe the treatment protocol for a clinical trial of the Opt Out approach,
in which patients are provided tobacco treatment regardless of their stated intention
to quit versus a standard Opt In approach. We report on therapeutic relationship and
treatment utilization by study arm and willingness to quit. Using an adaptive design,
685 hospitalized patients were randomized to receive either Opt Out (n= 440) or Opt In
(n= 245) style counseling. Results. Two thirds of participants in both study arms stated
they were willing to try to stay quit post-discharge. Two-way ANOVA found a signicant
interaction between the eects of counseling approach and willingness to quit on ther-
apeutic alliance, F (1, 663) = 4.20, p = .041. Therapeutic alliance was lower in Opt In
compared to Opt Out. The dierence was more drastic among those not willing to quit
compared to those willing to quit. Simple main eects show that those who are willing
to quit compared to not willing form a stronger therapeutic alliance and the Opt Out
approach leads to higher therapeutic alliance compared to Opt In (p<.001). Satisfaction
with the inpatient clinical encounter was high (9.2 out of 10, SD = 1.56) and did not dier
by either counseling approach or willingness to quit. When asked about feeling “coerced”
into quitting, 1 in 5 felt ‘forced’ to try to quit. Conversely, 88% endorsed feeling in control
of whether they quit. These ratings did not dier by counseling approach or willingness to
quit. For all 4 treatment outcomes (i.e., arranging inpatient and outpatient medications,
completing a treatment plan and accepting outpatient follow-up counseling), the Opt Out
approach signicantly increased the odds of the patient accepting treatment, both for
those who were willing to quit, as well as for those who were not willing to quit (p<0001).
Conclusion. Regardless of willingness to quit, the Opt-out approach formed a stronger
therapeutic alliance and did not lead to decreased satisfaction or feelings of coercion.
FUNDING: Federal
PS3-23
SMOKING, OBESITY, AND REINFORCER PATHOLOGY: THE
IMPACT OF BODY MASS INDEX ON DEMAND FOR CIGARETTES
AND DISCOUNTING OF DELAYED REWARDS AMONG
CIGARETTE SMOKERS
Cara M. Murphy1, Monika M. Stojek2, Damaris J. Rohsenow1, Jasjit S. Ahluwalia1,
James MacKillop3. 1Brown University, Providence, RI, USA, 2University of Silesia, Kato-
wice, Poland, 3McMaster University, Hamilton, ON, Canada.
Signicance: The life expectancy of smokers with obesity is considerably shorter
than that of normal weight smokers due to the synergistic eects of smoking-related
and obesity-related morbidity. This study aimed to determine the impact of Body Mass
Index (BMI) on demand for cigarettes and delay discounting among smokers. Methods:
Demand for cigarettes was measured using a Cigarette Purchase Task that asked how
many cigarettes would be purchased at escalating prices with three demand indices
generated: intensity (number of cigarettes desired if they were free), breakpoint (lowest
price at which no cigarettes would be purchased), and Omax (the maximum amount
of money allocated to cigarettes). The Monetary Choice Questionnaire assessed
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
preferences between smaller amounts of money available now or larger amounts of
money available after a delay (i.e., delay discounting). Participants were categorized
as obese (BMI 30 or greater), overweight (BMI 25-29.9), or neither overweight/obese
(BMI below 25) using self-reported weight and height. ANOVA was used to compare
dierences in demand and delay discounting across groups. Regression analyses were
used to determine whether BMI was associated with demand and delay discounting
when adjusting for relevant demographic variables (e.g., race, age, gender, education).
Results: Among cigarette smokers (n=1,051), 23% were classied as obese, 26% were
overweight, and 51% were neither overweight/obese. Individuals categorized as either
overweight or obese reported higher cigarette valuation (higher intensity and Omax) and
a greater preference for immediate rewards than those who were neither overweight/
obese. In adjusted models, BMI continued to account for a signicant amount of vari-
ance in intensity of demand only. Conclusions: Cigarette smokers with overweight or
obesity had greater demand for cigarettes evidenced by a desire to consume a greater
number of cigarettes when available at no cost. While it is possible that smokers with
obesity have a greater preference for immediate rewards, current ndings suggest this
is only the case when other relevant demographic characteristics are not considered.
FUNDING: Federal
PS3-24
EXAMINING THE VALIDITY OF TWO TYPES OF SELF-
ADMINISTERED ELECTRODERMAL STIMULATION BEHAVIORS
AS BEHAVIORAL MEASURES OF SENSATION SEEKING IN
NICOTINE-DEPENDENT EMERGING ADULTS
Bethany Luanne Harris1, Sherecce A. Fields2. 1Texas A&M University, College Station,
TX, USA, 2TX A&M University, College Station, TX, USA.
Signicance: Although research has investigated relations between nicotine use in its
various forms and self-reported sensation seeking tendencies, no research to date has
examined relations between nicotine dependence and self-administered electrodermal
stimulation (SAES) in an experimental setting. This research not only examines dier-
ences in SAES behaviors in nicotine-dependent individuals compared to a non-clin-
ical sample, but also contributes to clinical research by validating a trans-diagnostic
behavioral measure of sensation seeking through the examination of the validity and
utility of two types of SAES behaviors: shock and vibration. Methods: Our between
groups design will include 200 participants across two groups: nicotine dependent (n
= 100) and healthy control subjects (n = 100), aged 18-25 years. Participant smoking
status will be determined using cotinine saliva test strips and analyzed levels exhaled
carbon monoxide. Participants will complete self-report measures of sensation seeking,
nicotine use, and psychopathology. Participants will then be instructed to sit in a room
for 15 minutes with no form of entertainment or stimulation other than the option to
self-administer additional electrodermal stimulation pulses following the administration of
test stimulations prior to both conditions (i.e., shock and vibration). Analyses: Receiver
operating characteristic (ROC) analyses will be used to evaluate the ability of the SAES
behaviors to dierentiate between nicotine dependent and non-nicotine dependent
participants. Ordinary least squares regression analyses will be utilized to examine
associations between self-reported sensation seeking and SAES behaviors. Finally,
ROC analyses will be used to evaluate the ability of the SAES behaviors to dierentiate
between high and low scorers on self-report measures of sensation seeking. Results:
Results are pending. Data collection is anticipated to be complete in October 2021.
FUNDING: Unfunded; Academic Institution
PS3-25
IMPACT OF COVID-19 PANDEMIC ON ASSESSING SMOKING
STATUS IN COMMUNITY HEALTH CENTERS
Susan Flocke, Steani Bailey, Nathalie Huguet. Oregon Health & Science University,
Portland, OR, USA.
Signicance: The COVID-19 pandemic dramatically altered patterns of health care
seeking and delivery. In primary care settings, in-person visits plummeted, video and
telephone visits increased. Given the relevance of smoking as an exacerbating risk factor
for chronic conditions like heart disease and diabetes, and for contracting and more
severe symptoms of COVID-19, it is important to understand how the pandemic aected
smoking assessment. This is particularly important in the context of Community Health
Centers (CHC). CHCs care for patients that are more likely to be poor, non-white, and
to smoke. This study describes the COVID-19 pandemic’s impact on the assessment
of smoking status among patients cared for at Community Health Centers (CHC).
Methods: Electronic health record (EHR) data from 224 CHCs from the OCHIN Network
were examined from January 1, 2019 to July 31, 2021. Data include both telemedicine
(phone, web-based) and in-person primary care visits for more than a million adult pa-
tients (18 years of age or older) from CHCs across the United States. Monthly rates of
smoking assessment per 1000 patients were calculated. Results: Across the network,
telemedicine visit rates increased by 1237% at the onset of the pandemic. From January
2019-February 2020, rates of smoking assessment per 1,000 patients was 128.9. In
March-May 2020, rates of tobacco assessment declined to 61.4 per 1000 patients, a
52% reduction. In June 2020-May 2021, rates of smoking assessment increased but
remained 37.5% lower than pre-pandemic levels. Conclusion: The decline in rate of
smoking assessment during the rst wave of the COVID-19 pandemic was substantial
and rates have not returned to pre-pandemic levels. These ndings are signicant given
the relevance of smoking to increased severity of COVID-19 and that smoking assess-
ment and provision of assistance in the form of counseling and cessation medications
do not require face-to-face interaction with health providers and can be conducted
virtually. Careful examination of procedural changes, including the increased use of
telemedicine, that promote or impede assessment of smoking is needed.
FUNDING: Federal
PS3-26
DETERMINING PRIORITY POPULATIONS IN PUBLIC HEALTH - A
PRINCIPLED, PRACTICAL APPROACH TO ADDRESS HEALTH
DISPARITIES
Arnold H. Levinson1, Nicole Zwick1, Michelle Lynch2, Jill Bednarek3, Carsten Baumann2,
Natalya Verscheure2, Sara Cooper1. 1University of Colorado, School of Public Health,
Aurora, CO, USA, 2Colorado Department of Public Health and Environment, Denver,
CO, USA, 3Colorado Department of Public Health and Environment, Denver, CO, USA.
State and local public health agencies face dicult decisions when allocating limited
public health resources among populations with widely ranging health statuses, in-
cluding health disparities. We are unaware of national guidance for these decisions.
A population’s size presumably inuences state and local resource decisions, and the
size of nationally recognized populations with health disparities varies widely from state
to state. For example, nearly one in ve Mississippians (19.6%) but fewer than one
in 13 New Hampshirites (7.3%) lived in poverty in 2019; in those same states, Black
residents comprised 37.8% and 1.8% of the population, respectively - and less than
one percent in Montana. Even wider variation exists at county and municipal levels. A
population’s health burden level also presumably inuences resource decisions, and the
burden can be considered in either absolute or relative terms with diering implications.
Priority designations among populations with health disparities thus inevitably lie along
a size-burden continuum, where decision-makers must balance available resources
among more burdened but smaller population groups and less burdened but larger
population groups. We have developed a set of multi-dimensional criteria that the State
of Colorado is using to guide priority-setting in addressing health disparities in tobacco
use and chronic disease prevention. The rst two criteria are social justice and relative
health burden. Populations with disparities in both dimensions are further assessed to
determine programming feasibility and potential impact, using criteria of accessibility,
reachability, potential partnerships, and size. These criteria combine practical and
ethical considerations. We describe the rationale, limitations, and future directions of
this initiative that seeks to translate the goal of reducing health disparities into action.
FUNDING: State
PS3-27
DECONSTRUCTING THE CESSATION PATHWAY TO ADDRESS
ELEVATED SMOKING PREVALENCE AMONG POPULATIONS
WITH HEALTH DISPARITIES
Arnold H. Levinson1, Nicole Zwick1, Yaqiang Li1, Michelle Lynch2, Jill Bednarek2,
Carsten Baumann2, Natalya Verschuere2, Sara Cooper1. 1University of Colorado, School
of Public Health, Aurora, CO, USA, 2Colorado Department of Public Health and Envi-
ronment, Denver, CO, USA.
Signicance. U.S. public health agencies assign priority to populations that have ele-
vated rates of disease incidence, prevalence, morbidity, or mortality. Cigarette smoking
prevalence, an antecedent of increased morbidity and mortality, remains elevated among
most nationally designated populations with health disparities. We analyzed six waves of
a state’s population-level data (n~75,000) from a triennial adult health survey, to quantify
each population’s participation in steps that characterize the smoking cessation process.
The objectives were to identify decits aecting multiple populations and specic to
each population. Methods. Measures included quit intentions, condence and attempts;
clinical interactions and telephone coaching; use of cessation medications; co-residence
with other smokers; secondhand smoke policies and exposures, and cessation success
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
(past-12-month quit attempt and ≥ 3 months self-reported abstinence). We estimated
rates (2018) and trends (2001-2018), dening populations with health disparities as
each racial, ethnic, and sexual orientation minority; people with self-reported mental
illness diagnoses, and Medicaid beneciaries. Reference populations for racial/ethnic
minorities were white adults; for other groupings, the reference population was white
adults without the dening characteristic. We signied disparities using one standard
deviation (nominally lower or higher) or two standard deviations (signicantly lower or
higher). Results. Smokers in all populations with health disparities had higher rates of
quit attempts than their reference populations; Spanish-dominant Hispanic smokers had
worse rates on most metrics; English- and Spanish-dominant Hispanics consistently
used nicotine replacement therapy at lower rates; Black smokers had lower cessation
success rates despite comparable use of most evidence-based treatments. Conclusion.
Quantifying steps in the cessation process among populations with health disparities
yields potentially actionable information to address persistently elevated smoking
prevalence. The methodology may also be applicable to chronic disease disparities.
FUNDING: State
PS3-28
IMPLEMENTATION OF A TRAIN-THE-TRAINER PROGRAM
AT BEHAVIORAL HEALTH TREATMENT CENTERS AS A
MECHANISM TO MAINTAIN ORGANIZATIONAL CAPACITY TO
ADDRESS TOBACCO USE FOLLOWING PARTICIPATION IN A
COMPREHENSIVE TOBACCO-FREE WORKPLACE PROGRAM
Vijay Nitturi1, Tzuan A. Chen1, Isabel Martinez Leal1, Virmarie Correa-Fernández1, Kelli
Drenner1, Bryce Kyburz2, Teresa Williams3, Ezemenari M. Obasi1, Maggie Britton1, Molly
Howard4, Rogelio Rangel5, Jeni Sharp4, Shelley Smith6, Lorraine R. Reitzel1. 1Univer-
sity of Houston, Houston, TX, USA, 2Integral Care, Austin, TX, USA, 3Integral Care,
Houston, TX, USA, 4Heart of Texas Region Mental Health Mental Retardation, Waco,
TX, USA, 5Border Region Behavioral Health Center, Laredo, TX, USA, 6West Texas
Centers, Big Springs, TX, USA.
Signicance: Patients with behavioral health disorders are a tobacco health disparities
group targeted by Taking Texas Tobacco Free (TTTF), an evidence-based tobacco-free
workplace program. Despite prior successful implementation of TTTF in local mental
health authorities (LMHAs), post-implementation employee attrition necessitated continu-
ing education on tobacco-free policies and tobacco treatment practices. Here, we report
on the processes and outcomes of a TTTF train-the-trainer program in which “champi-
ons” from LMHAs were trained to deliver tobacco cessation education at their centers.
Methods: Three LMHAs participated in program implementation (to be described in
the presentation) via 10 champions. TTTF iteratively trained and coached the cham-
pions. Measures administered evaluated 4 goals: 1) increase champions’ self-ecacy
in delivering trainings, 2) achieve program delity via TTTF sta evaluation of trainer
eectiveness and knowledge increases among attending employees, 3) achieve program
acceptability by stakeholders, and 4) achieve program adoption via an increase over
baseline in the trainings delivered during follow-up. Results: Champions’ self-ecacy
increased from baseline throughout TTTF training. TTTF sta ratings of champion-led
trainings met the targeted “very good” to “excellent” for trainer eectiveness; employees
had a signicant 29 percent knowledge increase from pre- to post-training. Employees
rated the champions’ training delivery as “very good” to “excellent”; both champions
and employees were “very satised” to “extremely satised” with the curriculum and
training received, meeting pre-set goals. There was an increase over baseline in trainings
delivered during follow-up. Conclusion: The TTTF train-the-trainer program was eec-
tive and acceptable to the targeted stakeholders, tackled the problem of high turnover
contributing to organizational knowledge loss, and increased the delivery of tobacco
trainings. Ultimately, program implementation supports the sustention of tobacco-free
workplace policies and practices. A step-by-step implementation guide is available for
dissemination to facilitate designing future programs.
FUNDING: State; Academic Institution; Nonprot grant funding entity
PS3-29
HEARING ABOUT AND HAVING CONCERN FOR POLICE
BRUTALITY AND CHANGES IN CIGARETTE USE ACROSS U.S.
RACIAL/ETHNIC GROUPS
Kiana J. Hacker1, Julia Chen-Sankey2, Lilianna Phan1, Aniruddh Ajith3, Bambi Jewett1,
Kelvin Choi4. 1National Institute on Minority Health and Health Disparities, Bethesda,
MD, USA, 2Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New
Brunswick, NJ, USA, 3University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,
4National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
SIGNIFICANCE: Recent incidents of police brutality have spawned concerns in the
U.S. This study examined associations between race/ethnicity, hearing about these
incidents, concerns for being victims of police brutality, and changes in cigarette use.
METHODS: Data were from a U.S. nationally representative sample of current and
recent former (<12 months) commercial tobacco users (age≥21; N=1,700), collected in
Jan.-Feb., 2021. Participants reported if they had heard stories about someone being
discriminated, harassed, treated unfairly, or killed by the police (yes/no), and in three
items, their level of concern/worry/stress about themselves or their families becoming
victims of police brutality (1=Not at all, 5=Extremely); items were then averaged to
represent concern for police brutality. Using multivariable linear regression models, we
assessed the associations of race/ethnicity with concern for police brutality and concern
for police brutality with changes in number of days smoking cigarettes during the past
12 months. We also tested interactions with race/ethnicity in these regression models.
All analyses were weighted and adjusted for demographics. RESULTS: Overall, 69.7%
of Black, 62.5% of Hispanic, 59.1% of Asian, 57.6% of White, and 44.3% of other-race
participants heard stories of police brutality. Black, Asian, and Hispanic individuals had
higher levels of concern for police brutality than White individuals (adjusted means=2.80,
2.27, 2.22, and 1.60, respectively; p<0.05). Association between hearing these stories
and concerns for police brutality was stronger among Black (ARC=1.25, 95%CI=0.88-
1.61) than White individuals (ARC=0.39, 95%CI=0.21-0.56; race/ethnicity*heard stories
p<0.01). An increment increase in concern for police brutality was associated with a 1.03-
day increase (95%CI=0.36, 1.70) in past-30-day number of days smoking cigarettes,
which did not vary by ethnicity. CONCLUSION: U.S. racial/ethnic minorities are more
concerned about police brutality, which may increase cigarette use. Future research
should evaluate if police reforms reduce concern for police brutality and cigarette use
among racial/ethnic minorities.
FUNDING: Federal; Academic Institution
PS3-30
DOES EXPOSURE TO TOBACCO MARKETING AT TOBACCO
RETAIL OUTLETS HAVE CROSS-PRODUCT EFFECTS?
Keryn E. Pasch, C. Nathan Marti, Alexandra Loukas. The University of Texas at Austin,
Austin, TX, USA.
Signicance: Tobacco retail outlet (TRO) marketing for a specic product is a strong
predictor of tobacco use behaviors of the same product. However, little work has exam-
ined how exposure to marketing at TROs for one product impacts use of other products.
This study examined if TRO marketing has cross-product eects, specically does TRO
cigarette marketing predict initiation of current ENDS use and vice versa. Methods:
Participants were 1310 students (67.3% female; 32.6% white; m age=19.8 [SD=1.66]
at wave 1) from 24 2- and 4-year colleges in Texas participating in an nine-wave longi-
tudinal study (2014-2019) who had not initiated ENDS or cigarette use through wave
2 and had completed surveys from waves 1, 2, and 9. Current (past 30-day) product
initiation after wave 2 was measured by classifying those who reported never initiation
of current use at wave 9 as non-initiators; all others were considered initiators (4.8%
and 8.8% for cigarettes and ENDS respectively). TRO marketing exposure at wave 2
was measured with an index of objective counts of product marketing at TROs (cigarette
or ENDS) within a mile of each college multiplied by each student’s weekly store visit
frequency and dichotomized using a median split. Generalized mixed-eects logistic
regression analyses, with colleges as the cluster variable, controlling for baseline sex,
age, race/ethnicity, depressive symptoms, any other tobacco product use at wave 1
and college type (four vs two-year), examined the association between TRO marketing
for each product and subsequent initiation of current product use for the other product.
Results: ENDS TRO marketing predicted initiation of current cigarette use (OR=2.52,
95% CI=[1.42, 4.48] even after controlling for covariates. Cigarette TRO marketing did
not predict current ENDS use initiation (OR=1.44, 95% CI=[0.96, 2.18]. Conclusions:
Exposure to ENDS TRO marketing increases the risk for cigarette initiation. This may
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
suggest a pathway for the increased risk of cigarette initiation found among ENDS users.
Regulations should take into account the impact of ENDS marketing not only on ENDS
use but also on the initiation of cigarette use.
FUNDING: Federal
PS3-31
TEEN SMOKING IS A CHALLENGE TO IRELAND’S TOBACCO
FREE ENDGAME
Salome Sunday, Luke Clancy, Joan Hanan. TobaccoFree Research Institute Ireland,
Dublin, Ireland.
IntroductionSmoking decreased in each of six waves of Irish 16year-olds ESPAD sur-
veys from 1995 to 2015 (1-3). In 2019 teen smoking increased for the rst time in 28
years to 14.4% .This increase means that the vision of a Tobacco Free Ireland which
demands that the prevalence of tobacco smoking in Ireland be less than 5% by 2025
(4,5) may not be achievable in this group. Objective1) To examine the factors associ-
ated with recent increased smoking in Irish teens2) To oer an explanation for the rise
and advice on prevention. MethodsData were drawn from the 2015 and 2019 waves
of the Irish ESPAD survey. The sample included a total of 3,421 16-year-old students
comprising of 1,493 students in 2015 and 1,949 students in 2019. Adjusted poisson
regression models were used to examine the prevalence and factors associated with
current smoking between the two samples. ResultsAdolescents who were current
smokers were signicantly more likely to have missed 5 or more days of school (IRR
1.53, 95% CI: 1.32, 1.78), and to have friends who smoke (IRR 1.20, 95% CI:1.06, 1.35).
Adolescents from two parent and blended families were signicantly less likely to be
current smokers (IRR 0.90, 95% CI 0.83, 0.98 for two parents; IRR 0.84, 95% CI 0.71,
0.99 for blended families)The risks of current smoking were signicantly higher among
ever- e-cigarette users (IRR 1.27, 95% CI: 1.16, 1.40) and current e-cigarette users
(IRR 1.4, 95% CI 1.31, 1.61). ConclusionAs in our previous studies we found signicant
associations between e-cigarette use, truancy, household composition, peer smoking
and current smoking (2,6). These risks did not increase and mostly decreased over
the years. E-cigarette use greatly increased between 2015 and 2019 and is associated
with increased smoking.We suggest that these ndings highlight the negative impact
of e-cigarette use on teenage smoking and the need to address this factor in ongoing
policy and legislative initiatives at national, local, and school levels as well as the other
risk factors in order to achieve the Tobacco free Ireland’s policy target.
FUNDING: Unfunded; Nonprot grant funding entity; Other
PS3-32
IMPACT OF COVID-19 PANDEMIC ON TOBACCO SALES AND
NATIONAL SMOKING CESSATION SERVICE IN KOREA
Sungkyu Lee, Jinyoung Kim. Korea Center for Tobacco Control Research and Educa-
tion, Seoul, Korea, Republic of.
The purpose of this study was to describe the impact of the COVID-19 pandemic on
tobacco use among the Korean population, particularly, on tobacco consumption and
the national smoking cessation service. We obtained a quarterly tobacco sales data
from the Ministry of Finance and data of the number of smokers who visited the national
smoking cessation clinic in public health centers after the pandemic was obtained from a
member of the National Assembly. The COVID-19 pandemic increased tobacco sales in
Korea. Unlike the UK where quitting smoking increased, the Korean population smoked
more during the pandemic and less people tried to quit smoking during the pandemic
in Korea. The number of smokers who visited the national smoking cessation clinic in
public health centers sharply decreased in the rst half of 2020 with less than 90,000
smokers visiting the centers, whereas in 2017 more than 400,000 smokers participated
in the smoking cessation clinics. In addition, 6-months success quit rate also decreased
from 38.5% in 2017 to 22.3% in the rst half of 2020. During the COVID-19 pandemic,
Korean smokers were more likely to increase their consumption, due to the fact that
they had more time to smoke while working from home. In addition, the pandemic
has led to an increase in the use of heated tobacco products (HTPs) and electronic
cigarettes (e-cigs) because people were smoking more during the pandemic and more
people were using tobacco products due to working from home. The tobacco industry
has never missed this chance to promote their novel tobacco products. The industry
has marketed their HTPs with the claim that smokers stayed indoors more and thus
more smokers considered quitting due to COVID-19; thus they might want to switch
their tobacco products from conventional cigarettes to HTPs to reduce health risks to
themselves and the people around them. The pandemic presents an unprecedented
opportunity to provide comprehensive smoking cessation services to smokers and
also provide opportunity to reinforce tobacco control policies. It is recognized that a
comprehensive smoking cessation service and stronger tobacco control policies are
important during the COVID-19 pandemic.
FUNDING: Unfunded
PS3-33
YOUTH ACCESS TO ONLINE SALES OF E-JUICE IN CANADA
Shawn O’Connor, Emily Taylor, Robert Schwartz. Ontario Tobacco Research Unit,
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Signicance: Youth access to electronic cigarettes is a concern to many jurisdictions
including Canada. Recent survey data suggest that among the retail sources youth
use to purchase e-cigarettes in Ontario, Canada, internet purchases accounted for
14% of sales. To gain a greater understanding of internet sales, e-liquid products from
internet-based retailers from across Canada were purchased to examine compliance
with federal regulations on the sale of e-liquids including age verication processes
from the initial visit to an online store, to sale, and to delivery. Method: Our sample
comprised 20 online retail vape shops spread across Canada including western (8
stores), central (6 stores) and eastern Canada (6 stores), selected by querying a
popular search engine for the “best vape shop in [city].” All purchases were made
online by a 16-year old confederate, in the presence of an adult researcher. For any
given purchase attempt, we made note of what kind of age-restriction protocol was in
place when entering the site, whether the youth confederate was able to purchase an
e-juice product without age verication, and whether age verication was used by the
delivery agent upon delivery. Results: Upon landing on a sites’ homepage, the majority
had some sort of age-restriction message displayed (19 of 20 retailers or 95%), which
typically required a visitor to input their birth date or check a box indicating they were
of age. Only 2 of 20 stores prevented our youth confederate from purchasing an e-liq-
uid product (in contrast, 90% of stores completed the sale). Eleven packages (61%)
included a statement on the mailing label about requiring an age verication signature.
Among deliveries in which such a mailing label was present, 82% of agents asked for a
signature. Among all 18 deliveries, delivery agents conrmed age for 50% of packages,
with another agent giving a package to a parent without checking the addressees age
(the youth confederate). Conclusion: the majority of online stores (61%) were relying
on the delivery agent to conrm age appropriate ID. While this step is necessary, it is
not sucient and underscores that retail education/enforcement is needed on both the
duty to check age at purchase and to convey to the delivery agent that the product is
age restricted and requires an age approved signature.
FUNDING: Federal
PS3-34
EVALUATING A TOBACCO RETAILER E-LEARNING PROGRAM
THAT EMPLOYS FDA GUIDANCE AND DEEP LEARNING
PRINCIPLES
Les Hagen, MSM1, Fadi Hammal MB MSc2. 1ASH Canada, Edmonton, AB, Canada,
2University of Alberta School of Public Health, Edmonton, AB, Canada.
Signicance Merchant education is a key element of an eective strategy to reduce
tobacco sales to minors. This study examines the implementation of a tobacco retailer
e-learning intervention that employs FDA retail training guidance and the principles
of deep learning. Our initial review did not reveal the pre-existence of any retailer
training programs that combined best practices in e-learning, adult education and
evidence-based retail training guidance. Methods We evaluated a newly-developed
tobacco retaining training program that reects best practices in e-learning, adult
education, and tobacco retailer training including established compliance factors. The
Tobacco Retailer Advanced Compliance (TRAC) training module was produced for the
Alberta government to provide an eective, evidence-based online tobacco retailer
training program for all retailers in the province. The evaluation involved pre- and
post-testing of competency scores among participants before and after completing the
eLearning modules among a convenience sample of 75 retail sta in 15 convenience
stores. Additionally, acceptability, usability, and function were evaluated among a subset
of the retail managers who participated using both quantitative (survey) and qualitative
(interview) methods. Results Participants found the training to be easy to navigate,
engaging, informative, and benecial to their daily work. Paired t-tests revealed sig-
nicantly higher post-training test scores compared with the pre-training test score. A
higher number of participants achieved the passing score of 80% in the post training
test in all groups. Conclusion E-learning is an eective, readily accessible and inex-
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
pensive way to deliver evidence-based retail training that reects FDA guidelines and
deep learning principles. Further evaluation is needed to measure long-term impact on
retailer knowledge, behavior and compliance rates among retailers.
FUNDING: State
PS3-35
EXCLUSIVE E CIGARETTE USER PERCEPTIONS AND USAGE
OF FLAVORS BEFORE AND AFTER IMPLEMENTATION OF NEW
YORK STATE’S FLAVOR BAN, FINDINGS FROM THE CROFT
STUDY
Srivaishnavi Popuri, Connor R. Miller, Maciej L. Goniewicz. Roswell Park Comprehen-
sive Cancer Center, Bualo, NY, USA.
Signicance: E-cigarette avor bans are under consideration or have been implemented
in many jurisdictions. How adult e-cigarette users perceive and respond to avor bans
remains understudied. We evaluated how a cohort of adult exclusive e-cigarette users
thought they would respond to a forthcoming avor ban, and subsequently compared
actual avor use patterns before and after implementation of a avor ban. Methods:
Data (collected 2019-2021) from a prospective study of 114 adult daily exclusive e-cig-
arette users based in Western New York was analyzed. Perceptions towards tobac-
co-avored e-cigarettes and purported reactions to a forthcoming ban on avors other
than tobacco or menthol were assessed at baseline visits. Responses were examined
among participants enrolled prior to the May 2020 implementation of New York State’s
(NYS) ban on non-tobacco e-cigarette avors (n=52). At subsequent monthly clinical
visits, participants reported their most used avor over the past 30-days (P30D). Pre-
post comparisons for most used avor were conducted among those who completed
a study visit approximately two months before and two months after May 2020 (n=19).
Results: Of 52 participants enrolled before May 2020, 40.8% indicated they would
nd a workaround to continue using avors under a forthcoming ban. Less than half
(44.1%) indicated they like or could tolerate tobacco avored e-liquid, and 23.1% said
they would revert to cigarette smoking before using tobacco avored e-liquids. Of 19
participants completing study visits two months before and after May 2020, 78.9% and
84.0% reported their P30D most used e-cigarette avor was candy or fruit before and
after avor ban implementation, respectively. Conclusions: Perceptions of adult exclusive
e-cigarette users prior to implementation of the NYS avor ban suggested low levels
of planned compliance and limited tolerance for tobacco-avored e-cigarettes. Use of
banned avors remained common two months after NYS avor ban implementation.
Future research is warranted examining e-cigarette avor usage at a later timepoint
beyond NYS avor ban implementation.
FUNDING: Federal
PS3-36
CHARACTERIZING DISCUSSION OF FLAVORED ELECTRONIC
CIGARETTE PRODUCT SALES RESTRICTION WORKAROUNDS
ON REDDIT
Ganna Kostygina1, Nathan Silver2, Elexis Kierstead2, Jennifer Kreslake2, Mateusz
Borowiecki1, Sherry Emery1, Barbara Schillo2. 1NORC at the University of Chicago,
Chicago, IL, USA, 2Truth Initiative, Washington, DC, USA.
Signicance: In the aftermath of the 2019 electronic cigarette and vaping-related lung
injury outbreak, the regulatory environment around the sales of vaping products has
been rapidly evolving on both the state and federal levels to protect public health. In
particular sales of avored cartridge-based and disposable electronic cigarettes has been
increasingly restricted. Little is known about the consumer perceptions and response
to the new policies as well as the potential strategies used by the manufacturers and
vendors to evade these regulations. Analysis of policy-related social media discourse
may serve as an eective and unobtrusive way of understanding public and industry
response to the bans. We aimed to assess the amount and characterize the themes
of messages related to avored nicotine product sales restrictions on Reddit. Meth-
ods: Keyword rules were used to collect avored electronic cigarette sales restriction
workaround-related posts from the Reddit from an existing third-party archive of Reddit
content, pushshift.io API, from 05/01/2019 to 05/31/20202. The amount of relevant
posts from the Teenager and JUUL subreddits was calculated to determine discussion
trends over time. A sample of posts stratied by month was further coded to identify
specic workaround strategies. The number of users cross-posting on Teenager and
JUUL subreddits was identied. Results: Keyword lters captured 7,429 ban work-
around-related JUUL subreddit messages and 255 Teenager subreddit posts related
to the discussion of avor restriction loopholes and workaround strategies posted over
the period of data collection. There were 254 “cross-posters” or users who posted policy
evasion messages on both the JUUL and Teenager subreddits. The amount of discussion
peaked in September 2019 with the increased media coverage of vaping-related lung
injuries and emerging state-level regulation of avored nicotine and tobacco products.
The amount of discussion continued to rise with increased regulations limiting avored
cartridge-based products sales in the following months. Analysis of a sample relevant
posts revealed that the regulation evasion strategies included accessing avored
products online, purchasing products from abroad, seeking advice and information on
local store availability of specic avors; and seeking advice on disposable/rellable
substitutes, especially for mango and mint-avored products. Conclusion: Reddit is an
important information sharing platform for electronic cigarette consumers and vendors,
and is also used by youth. Social media surveillance can enhance understanding of
public health needs and policy compliance, as well as inform strategies for correcting
misinformation and prevent policy evasion.
FUNDING: Nonprot grant funding entity
PS3-37
YES IT’S THE PERFECT TIME: SINGLES AND LOOSE TOBACCO
PRODUCTS BAN IN INDIA DURING COVID-19
Shivam Kapoor1, Rashmi Mehra2, Amit Yadav1, Pranay Lal1, Rana J. Singh1. 1Inter-
national Union Against Tuberculosis and Lung Disease (The Union), South-East Asia
Oce, New Delhi, India, 2Independent Researcher, New Delhi, India.
Signicance: Globally, coronavirus disease (COVID-19) has unduly aected marginal-
ized populations thereby making them more susceptible to the use of economical and
more accessible alternatives of loose cigarettes/beedis/other tobacco products. This
paper reviews review the past and current tobacco control policy responses in terms
of banning loose tobacco products in India and identify areas of opportunity for policy
priorities in context of the ongoing pandemic. Methods: Existing policy documents
(notications/orders/letters) banning the loose tobacco products (in any form), were
analyzed for their content since the inception of the tobacco control laws in the country
(2003). Results: In the absence of a national level policy regarding banning singles and
loose tobacco products in the country, there are 47 sub-national documents existing in
13 Indian states. While only one notication was issued during the spread of COVID-19
pandemic within the country and 3 documents detail about punishment/penalty of any
sort. The analyzed documents have mainly focused on the sales, supply, production and
distribution of loose cigarette, and other tobacco products. Conclusion: Although it is
premature to estimate the impact of restricting singles and/or any other loose tobacco
products’ trade, sale, and use on the transmission and severity of COVID19; however,
this analysis appreciates the eorts made at the subnational level. Urgent need for
furthering this cause and development of a nationwide unied policy against ban on
loose tobacco products (in any form) or “kiddy packs” is suggested.
PS3-38
POTENTIAL BIOMARKERS OF ELECTRONIC CIGARETTE
EXPOSURES IN VITRO AND IN VIVO
Indu Sinha, Zachary T. Bitzer, Neil Trushin, Lisa Reinhart, Todd M. Umstead, E. Scott
Halstead, John P. Richie Jr., Raghu Sinha. Penn State College of Medicine, Hershey,
PA, USA.
SIGNIFICANCE: Long-term health eects of electronic cigarettes (E-Cigs) remain
unknown despite their recent rise in popularity. We have found that E-Cigs produce
highly reactive free radicals that could produce damage in exposed tissues. Our cur-
rent goal is to examine this further by developing novel in vitro and in vivo biomarkers
of E-Cig exposure. METHODS: E-Cig exposure was modeled in vitro using human
bronchial epithelial cells (BEAS-2B) growing in medium exposed to E-Cig aerosols and
in vivo using nose-only exposures to C57BL/6 mice. For all studies, E-liquid (60:40;
PG:VG) aerosols were compared to cigarette smoke (NRC-102 and 1R6F) and sham
(compressed air) controls. Charcoal lters were used to eliminate gas phase radicals
from smoke. Oxidative stress biomarkers (REDD1 and GSK3β) and their down-stream
(RPS6) as well as up-stream (AKT) target proteins in addition to H2AX were measured
by Western blot analysis. Lung function in mice were assessed by exiVent. RESULTS:
Increases in REDD1, pGSK3β and pH2AX levels were observed for cigarette smoke
exposures compared to air-alone while only low to moderate changes were observed in
E-Cigs following exposure to same number of pus (N=30). When gas phase radicals
were removed from smoke by charcoal, a decrease in REDD1 protein expression in
BEAS-2B cells was observed. In mice, preliminary data showed a decreased trend in
the inspiratory capacity by E-Cig aerosols (N=40 and 80 pus) compared to compressed
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
air. CONCLUSIONS: Dierentially expressed oxidative stress/damage-related pathways
from in vitro and in vivo exposures to E-Cig aerosols vs. tobacco smoke can be an eec-
tive strategy for identifying E-Cig relevant biomarkers of exposure and potential harm.
FUNDING: Federal
PS3-39
THE IMPACT OF USER BEHAVIOR ON IQOS EMISSIONS
Ola Ardati, Malak El- Kaassamani, Amira Yassine, Ayomipo Emmanuel Adeniji, Rola
Salman, Rachel El Hage, Mario El- Hourani, Nareg Karaoghlanian, Najat Saliba, Alan
Shihadeh, Ahmad El- Hellani. American University of Beirut, Beirut, Lebanon.
Background. Alternative products to combustible cigarettes have been developed
for decades. These tobacco products rely on the central concept of delivering the
dependence-producing drug, nicotine while minimizing users’ exposure to toxicants in
comparison to cigarette smokers. A signicant approach to achieve this is by heating
tobacco instead of combusting it. One recently introduced heated tobacco product
(HTP) that gained remarkable attention and was widely advertised is the IQOS device
introduced by Philip Morris International (PMI). However, it is known that toxic emissions
from tobacco products do not only depend on product characteristics but also user be-
havior. This study assessed the inuence of user behavior, namely device cleaning and
pung regimen, on the emission of toxicants in IQOS aerosol. Methods. Two cleaning
protocols (after each stick or after 20 sticks) and several pung regimens (including
International Organization of Standardization (ISO), Health Canada Intense (HCI), and
other regimens) were randomized to test the inuence of user behavior on the emission
of carbonyls and phenols as markers of pyrolysis of IQOS stick constituents. Also, IQOS
aerosols generated under selected conditions were directed towards a trapping system
constituted of a lter pad and two cryogenic traps for non-targeted analysis on GC-MS.
Results. Per previous literature, less frequent cleaning of the device led to residue
build-up in the heating chamber of IQOS devices. In progress data analysis will show
if less frequent device cleaning and/or harsh pung conditions will lead to the higher
formation of carbonyls and phenols, and if new toxicants will form from the break-down
of residue build-up on the heating blade. Conclusion. The US FDA authorized PMI to
make reduced-exposure (but not risk) claims for their IQOS product. This work highlights
the necessity to consider the inuence of user behavior on tobacco product emissions
to ensure a consistent reduction of exposure.
FUNDING: Federal
PS3-40
BLOCKADE OF DOPAMINE D1 AND D1/D2 RECEPTORS
DECREASES NICOTINE SELF-ADMINISTRATION IN ADULT MALE
AND FEMALE RATS
Adriaan Bruijnzeel1, Azin Behnood-Rod2, Ryann Wilson2, Grace King2, Marcella
Ruppert-Gomez2, Alexandria Teter2, Ranjithkumar Chellian2. 1University of FL, Gains-
ville, FL, USA, 2University of Florida, Gainesville, FL, USA.
Signicance: The rewarding eects of nicotine are partly mediated by dopamine release
in the brain reward system. Administration of dopamine D1 receptor antagonists reduces
nicotine self-administration in rats. Studies in humans and rodents indicate that there
are sex dierences in dopaminergic transmission. Therefore, we investigated the eects
of selective dopamine D1 and D2 receptor agonists and antagonists on nicotine intake
in male and female rats. Methods: Adult male and female Wistar rats were trained to
respond for food pellets and were implanted with a catheter in the right jugular vein.
The rats were allowed to self-administer nicotine (0.06 mg/kg/inf) for six sessions. Then
the eects of SCH-23390 (D1 antagonist; 0, 0.003, 0.01, 0.03 mg/kg, sc), L-741,626
(D2 antagonist; 0, 0.3, 1, 3 mg/kg, sc), upentixol (D1/D2 antagonist; 0, 0.5, 0.75, 1
mg/kg, ip), and A77636 (D1 agonist; 0, 0.1, 0.3, 1 mg/kg, sc) on nicotine intake were
investigated in 1-h daily nicotine self-administration sessions. In a separate study, the
eects of these compounds on operant responding for food pellets (20 min sessions/day)
was investigated. Results: The D1 antagonist SCH-23390 and the D1/D2 antagonist
upentixol dose-dependently decreased nicotine intake in male and female rats. In con-
trast, the D2 antagonist L-741,626 and the D1 agonist A77636 did not aect the nicotine
intake in male and female rats. SCH-23390 and L-741,626 decreased responding for
food pellets in males and females, but upentixol only decreased responding for food
pellets in male rats. The D1 agonist A77636 did not aect food responding in males and
females. Conclusions: Blockade of D1 or D1/D2 receptors induced a similar decrease
in nicotine intake in males and females. Blockade of D2 receptors or stimulation of D1
receptors did not aect nicotine intake. There were no sex dierences in the eects
of the dopamine agonists/antagonists on nicotine intake. Drug doses that decreased
nicotine intake also decreased food responding, except for upentixol in females, which
decreased nicotine intake but not food intake.
FUNDING: Federal
PS3-41
NITRATE LEVELS IN TOBACCO INFLUENCE FREE RADICAL
PRODUCTION
Zachary T. Bitzer, Leanne Mocniak, Michael Smith, Jr., Neil Trushin, John Richie, Jr.
Pennsylvania State University – College of Medicine, Hershey, PA, USA.
Signicance/Background: Cigarette smoke contains highly reactive free radicals
thought to play an important role in tobacco smoke-induced harm. We found that free
radical production varied greatly by tobacco variety and cigarette brand; however, the
mechanisms responsible for variation is not understood. Previously, variation in NNK
levels in tobacco varieties were found to be dependent upon nitrate concentration.
Since nitric oxide is a primary radical produced from burning tobacco, we hypothesized
that free radical production may also be dependent upon tobacco nitrate levels. Thus,
our current objective was to determine the impact of nitrate on production of radicals
and other toxicants in smoke from dierent varieties of whole leaf and reconstituted
tobacco. Methods: Dierent varieties of tobacco were shredded and levels of nitrate
were measured. Shredded tobacco was machine packed into single blend cigarettes
and smoked according to the Canadian Intense Pung regiment. Mainstream smoke
was analyzed for gas- and particulate-phase radicals using electron paramagnetic
resonance. Particulate phase nicotine and NNK were analyzed by GC/FID and LC/
MS respectively. In other experiments, dierent concentrations of nitrate solutions
were sprayed onto shredded tobacco before being packed, smoked, and analyzed as
described above. Results: Despite being manufactured under the same conditions, the
pu and smoldering rates varied widely between varieties. NNK, nicotine, and gas-phase
radicals varied 210-, 14-, and 7-fold, respectively, by variety. Gas-phase radicals per
gram of smoked tobacco were highest in burley tobacco followed by oriental and bright
tobacco. Particulate-phase radicals did not dier substantially by variety. Both NNK
and gas-phase radicals were strongly correlated with nitrate levels (r=0.84 and r=0.91
respectively). When dierent levels of nitrate were added to the tobacco, gas-phase
radical production increased in a linear fashion. Conclusions: Tobacco nitrate levels
appear to be a key determinant of gas phase radical production, as well as NNK, in the
burning cigarette. Hence, cigarette blends which contain higher nitrate tobaccos (e.g.
burley) may pose a greater to smoker due to higher toxicant exposures.
FUNDING: Federal
PS3-42
THIRDHAND WATERPIPE SMOKE IS A THREAT TO
CARDIOVASCULAR HUMAN HEALTH
Ahmed Alarabi1, Zubair Karim2, Patricia Lozano1, Keziah Hernandez2, Fadi T.
Khasawneh1, Fatima Alshbool1. 1Texas A&M University, Kingsville, TX, USA, 2Univer-
sity of Texas at El Paso, El Paso, TX, USA.
Signicance: Even though cigarette smoking (CS) has declined, the popularity of other
forms of tobacco, such as waterpipe or hookah continues to increase. This is attributed,
at least in part, to the misconception that waterpipes are safe/safer than CS. However,
we have recently shown that exposure to waterpipe smoke produces negative car-
diovascular health eects, namely thrombogenesis; as was observed with CS. In this
connection, we have also provided evidence that thirdhand smoke (THS)-which is a
new risk that results from the residual tobacco smoke contaminants that remain after a
cigarette is extinguished- increases the risk of thrombotic events. Nonetheless, whether
thirdhand waterpipe smoke (THWPS) exposure produces similar negative health eects
is not yet known, but warrants investigation. Methods: This was addressed by utilizing a
novel exposure protocol, in which mice were exposed to THWPS starting at 10 weeks
of age for three months. Two sets of material were exposed to waterpipe smoke in an
alternating manner, for one week each time, before the material is placed in the cages
to start the THWPS exposure. The exposure waterpipe smoke was as per the Beirut
protocol, which is as follows: one-hour session of 171 pus of 530 mL volume, each
pu is 2.6 s duration, and there are a 17 s interpu interval. Results: Consistent with the
notion that our model does indeed result in the exposure of animals to “tobacco”, the
marker cotinine was detected at signicant levels in the urine of the THWPS-exposed
mice, but not in that of the controls. In terms of its impact on live animals (in vivo),
THWPS was found to enhance hemostasis and elevate the risk of thrombus formation,
as documented by the decrease in bleeding and occlusion times; which was the case
despite THWPS exerting no apparent eects on the number of blood cells. In terms
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
of a potential mechanism, our in vitro analysis showed that agonist-induced platelet
aggregation, as well as dense and alpha granules secretion responses are potentiated
as a result of THWPS exposure. In addition, we also found that integrin activation, and
phosphatidylserine exposure are also enhanced. With regard to biochemical evidence
of enhanced platelet activation, Akt and ERK activation/phosphorylation was found
to be elevated in the THWPS platelets; which is consistent with the aforementioned
ndings. Conclusion: Our results demonstrate, for the rst time, that THWPS is a real
threat to human health, as it triggers a state of thrombogenesis. Additionally, our ndings
indicate that this is attributed, at least in part, to enhanced platelet activation. Based
on these consideration, the negative health consequences of THWPS should not be
underestimated, and warrant further investigation. These ndings should not only guide
therapeutic approaches but also inform means to regulate exposure to waterpipe smoke.
FUNDING: Federal; Academic Institution
PS3-43
THE EFFECTS OF THE MINOR TOBACCO ALKALOIDS
NORNICOTINE AND ANATABINE ON ENERGY BALANCE IN RATS
DEPENDS ON SEX AND DIET TYPE
Patricia Bunney, Michaela Jones, Vijay Mavanji, Martha Grace, Catherine Kotz. Minne-
apolis VA Medical Center, Minneapolis, MN, USA.
Signicance: Tobacco products prevent weight gain, due primarily to nicotine’s eects
on appetite. Minor tobacco alkaloids (MTAs), such as anatabine (ANAT), anabasine and
nornicotine (NORNIC), are found in low levels in tobacco products and activate nicotinic
acetylecholine receptors within the brain. They are much less addictive than nicotine
and reduce food intake (FI), making them good candidates for obesity pharmacotherapy.
We hypothesized that MTA administration could prevent weight gain, with dierences
between male and female rats and varying as a function of diet type. Method: Study 1:
we administered saline, nicotine (0.5mg/kg), NORNIC (6.0mg/kg), ANAT, (3.0mg/kg), and
anabasine (3.0mg/kg) to male rats for 7d (i.p; n = 10/group). Study 2: we administered
ANAT or NORNIC for 4 weeks in male and female rats (n = 8-10 per group) on chow
diet. Study 3: we administered ANAT for 4wks to male and female rats on high fat and
high sucrose diets (n = 8-10 per group). Studies were conducted in metabolic cages
(Sable Promethion); food intake, weight gain, body composition, physical activity, and
energy expenditure were measured. Results: Study 1: All compounds reduced weight
gain and FI in male rats (p<0.01). The greatest delays in weight gain and reductions in
fat mass were seen with NORNIC and ANAT. Study 2: In males and females, ANAT and
NORNIC slowed weight gain (p<0.01). Administration of both MTAs reduced fat mass in
males and females (p<0.01). Food intake was reduced in males with both MTAs (p<0.05).
In females, FI was only reduced during the week 1 of ANAT (p<0.05), and NORNIC
had no eect. In males and females, both MTAs increased physical activity (p<0.01),
with NORNIC eects lasting longer. Both MTAs increased EE in males, while only
ANAT increased EE in females (p<0.01). Females were more sensitive to MTA eects
on PA and EE (p<0.05). Study 3: ANAT administration in males prevented weight gain
alongside a high sucrose but not high fat diet, whereas ANAT had no eect on weight
gain of females with access to diets high in fat and sucrose. Conclusion: These results
demonstrate that NORNIC and ANAT are potential pharmacotherapy targets for obesity.
FUNDING: Federal
PS3-44
FETAL EXPOSURES WITH VAPING DURING PREGNANCY- A
NOVEL PREGNANT OVINE MODEL
Sara Berkelhamer1, Noel Leigh2, Thomas Wood1, Maciej Goniewicz2. 1University of
Washington, Seattle, WA, USA, 2Roswell Park Cancer Institute, Bualo, NY, USA.
Signicance: EC use is rapidly increasing among women of reproductive age with
misperceptions that these products are safer than tobacco during pregnancy. Epidemi-
ological studies identify high rates of dual use as well as a cohort who switch to vaping
during pregnancy. However, fetal exposure to nicotine salts, avoring and non-avor
chemicals present in ECs remains poorly characterized. A pregnant ovine inhalational
exposure model with paired fetal and maternal blood sampling was utilized to evaluate
trans-placental exposures and fetal hemodynamics. Methods: Pregnant ewes were
anesthetized and ventilated at term gestation for fetal delivery by cesarean. Fetal lambs
were maintained on placenta but partially exteriorized for instrumentation including
placement of invasive catheters for serial blood sampling and hemodynamic monitoring.
10 x 70 ml pus of aerosolized vapor generated from a menthol-avored JUUL device
were subsequently delivered over 5 minutes to the ewe via a closed ventilator circuit
(n=4). Additional ewes were treated with sham control or PGVG alone (n=5). Maternal
and fetal blood samples were obtained at baseline and every 5 minutes following
initiation of aerosol delivery for analysis by UPLC and GCMS. Data from continuous
hemodynamic monitoring of the fetus was collected. Results: Ecient transplacental
transfer of nicotine occurred with peak levels at 5 minutes in both the ewe and fetus.
Fetal nicotine levels were comparable to maternal (106% ± 62% at 5 min, 130% ± 77%
at 10 min), although fetal half-life was prolonged (19.4 vs 4.6 min). Fetal cotinine levels
stabilized at 61-66% of maternal at 30-60 min. GCMS identied benzoic acid (a key
component of JUUL nicotine salts) and numerous avoring chemicals in paired mater-
nal and fetal samples. Select avoring chemicals were found only in maternal or fetal
serum. Continuous fetal monitoring identied comparable hemodynamics as compared
to controls. Conclusion: Gestation exposure to EC aerosol results in ecient transfer
of nicotine, non-avoring and avoring chemicals to the fetus. Despite limitations of
the ovine model, our data suggest slow metabolism of nicotine salts in the fetus and
variable transfer of avoring chemicals. We suggest that chemicals which fail to cross
the placenta may be safer options for use in pregnancy.
FUNDING: Unfunded
PS3-45
TESTING THE EFFECTS OF A YOUTH-TARGETED ANTI-VAPING
PSA UPON ADULT SMOKERS
Leslie E. Sawyer1, Ashly Cobos2, Thomas H. Brandon3. 1Mott Cancer Center/ Univer-
sity of South Florida, Tampa, FL, USA, 2University of South Florida, Tampa, FL, USA,
3University of South Florida/Mott Cancer Center, Tampa, FL, USA.
A great deal of controversy surrounds e-cigarettes, with some arguing that protection
of youth and non-users is paramount and others maintaining that these products are
benecial from a harm reduction perspective for use by adult smokers for switching
from combustible cigarettes and for smoking cessation. Opponents of e-cigarettes have
allocated tremendous funds toward advertising campaigns aimed at youth deterrence;
however, to date, the eects of these ads upon adult smokers have yet to be examined.
The current study used a between-subjects experimental design to investigate the
eects of an FDA-distributed youth-targeted anti-vaping PSA, “Vaping is an Epidemic,”
upon adult smokers who view it. The PSA shows teens vaping and, upon inhalation,
parasite-like organisms invading their organs and skin. We hypothesized that the FDA
ad - compared to a matched control video - would increase negative health-related
expectancies, and because the ad conveys that e-cigarettes are very powerful, it
would also increase expectancies concerning potency. We also hypothesized that the
anti-vaping PSA would impact other general expectancies of e-cigarettes and additional
variables reecting motivation to quit smoking (i.e., switch to vaping). We found that
viewing the PSA produced increases in both health harm and potency expectancies (ps
< .01), which were correlated (p < .001). We also found signicant group dierences (ps
< .05) such that viewing the PSA resulted in overall more negative expectancies about
e-cigarettes and all other variables related to harm reduction usage. Those who viewed
the PSA rated e-cigarettes as more harmful and less eective compared to those who
saw the control video. Viewing the PSA also resulted in lower switching motivation (i.e.,
switching from combustible to e-cigarettes). Overall, our ndings indicated that adult
smokers who viewed the PSA were less likely to consider e-cigarettes for smoking ces-
sation, thus reducing access to a cessation aid with growing empirical support. Findings
suggest that youth-oriented anti-vaping messages may have unintended public health
consequences upon adult audiences.
FUNDING: Academic Institution
PS3-46
NORMATIVE REFERENTS, TYPICAL USER ATTRIBUTES, AND
SOCIAL IMPLICATIONS OF FLAVORED VAPING: A QUALITATIVE
EXPLORATION OF YOUNG ADULT VAPERS’ EXPERIENCES
Rebekah Wicke, Allison Worsdale, Jiaying Liu. University of Georgia, Athens, GA, USA.
Signicance: Flavored vaping is on the rise in young adults (YA). Risky social inuence
becomes more salient during the critical developmental stage of young adulthood.
Through a qualitative study, we sought to understand YA vapers’ perceptions about
the normative referents, typical user attributes, and social implications associated with
vaping avored e-cigarettes. Method: Between March-May 2021, an open-ended elic-
itation survey was distributed to YA ever vapers (N=396; mean age=19.66, SD=1.45),
with the majority (90%) reporting using avored e-cigarettes. Participants were asked
to indicate social referent groups who they consider as most or least likely to use a
avored vape, typical situational triggers that prompt use, and their perceived social
implications attached to vaping avors. Participants’ responses were qualitatively an-
alyzed and coded by two coders (alphas=0.81-1.00). Results: Participants listed their
peers (48.3%) as the most typical users of avored vapes, followed by siblings (6.8%),
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
high school students (5.5%), and Greek life members (5.5%). Parents (21.1%), senior
family members (18.1%), studious peers (9.2%), and educators (7.5%) were considered
typical non-users. Participants tended to use attributes such as “party-goers,” “social,”
“fun,” “popular,” “rebellious,” “laid back,” and “youthful,” to portray the typical users. They
considered social bonding with and gaining respect from their vaper friends through
sharing and oering avored vapes as the leading social benet (41.4%). They perceived
being liked more when they used avored vapes (36.2%) and considered it a prevalent
behavior (19.9%; e.g., “everyone does it”). Conclusions: Normative appeals are proven
eective strategies to curb tobacco use acquisition and escalation among YAs. Our
ndings contribute to revealing the glorious social perceptions YA vapers held about the
risky behavior of using avored vapes, while pinpointing the opportunities of leveraging
perceived social disapproval from important family members and respectable role models
to enhance the ecacy of intervention and campaign eorts utilizing normative appeals.
FUNDING: Federal; Academic Institution
PS3-47
ASSOCIATION BETWEEN QUITTING SMOKING AND SURVIVAL IN
CANCER PATIENTS
Taylor Simmons, Janice Blalock, Paul Cinciripini, Diane M. Beneventi, Jennifer Minnix,
Maher Karam-Hage, Jason Robinson, George Kypriotakis. UT MD Anderson Cancer
Center, Houston, TX, USA.
The current study explored the association between smoking abstinence and survival
in a large sample who received tobacco cessation treatment at MD Anderson Cancer
Center Tobacco Treatment Program (TTP). We hypothesized that cancer patients who
quit smoking would have better survival outcomes compared to those who do not quit,
and that this eect would vary by cancer diagnosis. We used data from the TTP electronic
health records to compare survival outcomes between abstainers versus non-abstainers
in the cessation program. To examine associations between smoking abstinence status
and 5-year survivorship, we performed survival analysis on N = 4,356 patients using the
Cox proportional hazards model controlling for cancer diagnosis, age, sex, depression,
anxiety, positive and negative eect, nicotine dependence and years smoked, and
time from diagnosis to TTP participation. Those who abstained from smoking had a
signicantly lower hazard of dying compared to those who did not abstain (HR = 0.65;
p < 0.001). The interaction of cancer diagnosis with abstinence status was also signif-
icant. Specically, the eect of abstinence on survival was signicant for lung cancer
(HR= 0.51; p < 0.001), for breast cancer (HR = 0.74; p = 0.040) for hematologic (HR =
0.68; p = 0.036) and for abdominal cancer (HR = 0.44; p = 0.002). Quitting smoking is
associated with improved survival in cancer patients. We found that the benets are not
homogeneous across cancer diagnosis groups. Patients with specic cancer diagnoses,
such as lung or abdominal cancer, may benet the most from quitting.
FUNDING: Federal
PS3-48
PERCEPTIONS OF HARMFULNESS AND ADDICTIVENESS OF
E-CIGARETTE ON THE AGE OF E-CIGARETTE INITIATION IN THE
POPULATION ASSESSMENT OF TOBACCO AND HEALTH YOUTH
(2013-2017)
Meagan Bluestein1, Baojiang Chen1, Arnold Kuk1, Melissa Harrell2, Kymberle Sterling3,
Adriana Perez4. 1The University of Texas Health Science Center at Houston, School of
Public Health, Austin Campus, Austin, TX, USA, 2UT Health School of Public Health,
Austin, TX, USA, 3University of TX School of Public Health, Dallas, TX, USA, 4The
University of TX Health Science Center at Houston, Austin, TX, USA.
Objective It is unknown if perceptions of harmfulness and addictiveness increase the
risk of an earlier age of e-cigarette initiation in youth. Methods Secondary analyses of
PATH youth (12-17) waves 1-4 (2013-2017) were conducted. Among never e-cigarette
users at the rst wave of PATH participation (n=16,143;N=29,349,76), the age of initiation
of ever and past 30-day e-cigarette use was calculated from follow-up waves in 2014-
2017. Exposures considered: (1) e-cigarette harmfulness (no/little harm, some harm, a
lot of harm, don’t know, and never heard of e-cigs), (2) e-cigarette addictiveness (very/
somewhat unlikely, neither likely/unlikely, somewhat/very likely, don’t know, and never
heard of e-cigs), (3) the interaction of harm and addiction (neither harmful nor addictive,
harmful but not addictive, addictive but not harmful, and both harmful and addictive;
youth who answered “don’t know” and “never heard of e-cigarettes” were excluded).
Weighted interval-censored Cox proportional hazard models were used to estimate the
associations of each exposure with the age of initiation of each e-cigarette outcome while
adjusting for sex, race/ethnicity, and previous use of other tobacco products. Results
Youth who perceive e-cigarettes to be of no/little harm had increased risk of an earlier
age of ever (AHR=2.0; 95%CI=1.7-2.4) and past 30-day (AHR=2.6; 95%CI=2.1-3.4)
e-cigarette use compared to youth who perceive e-cigarettes to be of a lot of harm. Youth
who perceive e-cigarettes to be very/somewhat unlikely to be addictive had increased
risk of an earlier age of ever (AHR=1.3; 95%CI=1.1-1.5) and past 30-day (AHR=1.4;
95%CI=1.1-1.8) e-cigarette initiation compared to youth who perceive e-cigarettes to be
somewhat/very likely to be addictive. Youth who perceive e-cigarettes as neither harmful
nor addictive had increased risk of initiating past 30-day (AHR=1.7; 95%CI=1.2-2.5)
e-cigarette use at earlier ages compared to youth who perceive e-cigarettes as both
harmful and addictive. Conclusion Prevention eorts should include messaging on
adverse health outcomes associated with e-cigarette use, as well as addiction potential
to dissuade youth from initiating e-cigarettes.
FUNDING: Federal
PS3-49
STRESS, DEPENDENCE, AND COVID-19-RELATED CHANGES
IN PAST 30-DAY MARIJUANA, ELECTRONIC CIGARETTE, AND
CIGARETTE USE AMONG YOUTH AND YOUNG ADULTS
Stephanie L. Clendennen1, Kathleen R. Case2, Aslesha Sumbe1, Dale Mantey1, Emily
J. Mason1, Melissa Harrell1. 1UTHealth, School of Public Health in Austin, Austin, TX,
USA, 2Center for Research to Advance Community Health (ReACH), UTHealth San
Antonio, San Antonio, TX, USA.
Signicance: Studies show substance use increases risk of contracting and worse
symptoms of COVID-19. This study examines whether past 30-day youth and young
adult users of marijuana, e-cigarettes, and cigarettes self-reported changes in their use
of these substances due to the COVID-19 pandemic; and cross-sectional associations
between perceived stress, nicotine or marijuana dependence, and COVID-19 related
changes in use. Methods: Participants were 709 past 30-day self-reported substance
users from the Texas Adolescent Tobacco and Marketing Surveillance study, TATAMS
(mean age=19; 56% female; 38% Hispanic, 35% white). Multiple logistic regression mod-
els assessed associations between perceived stress and dependence and increased,
decreased, or sustained past 30-day use of marijuana, e-cigarettes, and cigarettes due
to COVID-19 (e.g., “Has your marijuana use changed due to the COVID-19 outbreak?”).
Covariates included age, race/ethnicity, SES, dependence (exposure: stress), and stress
(exposure: dependence). Results: Most participants reported sustained (41%, 43%,
49%) or increased (37%, 34%, 25%) use of marijuana, e-cigarettes, and cigarettes
due to COVID-19, respectively. Participants who reported symptoms of dependence
were signicantly more likely than their non-dependent peers to report increasing their
marijuana (AOR:1.66; 95%CI: 1.15-2.39) and e-cigarette (AOR: 2.57; 95%CI: 1.38-
4.77) use. Those who reported higher perceived stress were signicantly more likely
to report increasing their marijuana use (AOR: 1.55; 95%CI: 1.00-2.42). Conclusion:
Most youth and young adults did not decrease their substance use amid a global,
respiratory disease pandemic. Health messaging and interventions that address the
health eects of substance use, and factors like dependence and stress that may be
barriers to decreasing use are vital during public health crises like COVID-19, as well
as other potential respiratory infections like EVALI.
FUNDING: Federal
PS3-50
IMPROVING PROVIDER COUNSELING FOR YOUNG PEOPLE
WHO VAPE: A MIXED METHODS APPROACH
Leah M. Ranney1, Sarah D. Kowitt2, Kathleen M. Mottus2, Susan McDowell3, Amber
Beane3, Sheri Denslow3, Kit Sturm3, Blake Fagan3, Ilona Jaspers2, Noah Rice4, Jacquie
Halladay2. 1University of North Carolina at Chapel Hill, Cary, NC, USA, 2University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3Mountain Area Health Education
Center (MAHEC), Asheville, NC, USA, 4University of North Carolina Asheville, Ashe-
ville, NC, USA.
Signicance: Vaping is an epidemic among young people, but there is little guidance for
how medical providers should counsel youth and young adults about vaping. To address
this gap, we examined how electronic medical record (EMR) systems prompt providers
to collect vaping data and interviewed young adults about vaping communications with
providers. Methods: We collected survey data from 10 rural primary care practices in
North Carolina August - November, 2020. This survey asked about prompts and data
elds regarding vaping in EMRs. We also interviewed 17 young adults, stratied by
vaping status (cessation or prevention) from Western and Central NC. We conducted,
audio recorded, and transcribed Zoom interviews. Participants reviewed resources
including a copyrighted 2-page discussion aid. We developed a codebook and coded
transcripts for thematic analysis. Results: From the survey data, we found that EMRs
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
lacked required vaping prompts; only 5 of 10 EMRs had a eld to record responses.
Of the 17 interviewees, 10 were female and 14 were White with a mean age of 19.6.
Two central themes emerged: 1) youth were open to condential, non-confrontational
interactions with providers and highly supported the 2-page resource, questionnaires
about vaping, and information in waiting rooms, and 2) youth wanted prevention and ces-
sation resources to be age appropriate, include medical facts from a trusted source and
disseminated via social media platforms used by youth. Additional themes included: a)
youth perceived vaping prevalence as high while youth knowledge of the consequences
and contents of vaping were low, and b) provider materials should specically discuss
vaping not just tobacco use. Conclusions: We found a gap in EMR functionalities,
which may result in young people not receiving vaping counseling. Young adults report
a willingness to communicate with providers and learn about vaping through trusted
resources and dissemination of medical facts via social media. High perceptions of
peer vaping with limited knowledge of health consequences suggest a need to update
EMR prompts for vaping use.
FUNDING: Unfunded; State; Academic Institution
PS3-51
EXAMINING THE INFLUENCE OF FLAVOR RESTRICTIONS
ON E-CIGARETTE ABUSE LIABILITY USING HYPOTHETICAL
PURCHASE TASKS
Danielle R. Davis1, Cecilia L. Bergeria2, Suchitra Krishnan-Sarin1. 1Yale University
School of Medicine, New Haven, CT, USA, 2Johns Hopkins University, Baltimore, MD,
USA.
Introduction: Thus far, federal e-cigarette avor restrictions have been e-cigarette
device specic and have allowed availability of menthol, while restricting similar avors
like mint. The aim of the current study is to examine how device-wide e-cigarette avor
restrictions impact e-cigarette abuse liability and if removal of mint, but not menthol, has
a meaningful eect on abuse liability. E-cigarette purchase tasks (eCPT), questionnaires
in which indices of demand are produced by estimating consumption across increasing
prices, are used to assess this. Methods: Adult current e-cigarette users with no regular
other tobacco use (n=155) completed anonymous online surveys. Surveys included four
eCPTs, each representing a dierent potential e-cigarette avor regulation; (1) where
all e-cigarette avors were available, (2) where only menthol, mint, tobacco avored
e-cigarettes were available, (3) where only menthol and tobacco avored e-cigarettes
were available, and (4) where only tobacco avored e-cigarettes were available. Within
subjects’ dierences by eCPT condition were determined for the ve demand indices
produced by the eCPT tasks; demand intensity (consumption when free), Omax (maximum
spent), Pmax (price Omax occurs), breakpoint (price consumption decreases to zero), and
elasticity (sensitivity to change) using mixed eects models. Results: Across all ve
demand indices, ratings for the menthol/mint/tobacco eCPT and menthol/tobacco eCPT
did not signicantly dier from each other indicating no dierence in abuse liability. The
tobacco only eCPT had signicantly lower values of intensity, Omax, Pmax, and breakpoint
and increased elasticity (i.e. more sensitive to price) compared to the menthol/mint/
tobacco eCPT and the menthol/tobacco eCPT. For all avors available eCPT, ratings of
intensity, breakpoint were signicantly higher and elasticity was signicantly lower (i.e.
less sensitive to price) compared to other eCPTs. Conclusion: Restricting mint, but not
menthol avor does not appear to signicantly shift e-cigarette abuse liability. Availability
of only tobacco avor produces the greatest decrease in e-cigarette abuse liability.
FUNDING: Federal
PS3-52
DO CIGARETTE AND E-CIGARETTE USERS ALLOW TOBACCO
USE IN THEIR CARS?
Mariaelena Gonzalez, Katie Alegria, Selina Espinoza, Anna Epperson, Anna V. Song.
University of California, Merced, Merced, CA, USA.
INTRODUCTION: Smoking in cars exposes passengers to secondhand smoke and
individuals in the car to third hand smoke. This study examines if (a) cigarette users
and (b) e-cigarette users (i.e., vapers) living in a rural and agricultural region of Cal-
ifornia were more likely to allow smoking, vaping, or both in their car as compared
to not allowing both smoking and vaping in their vehicle.METHODS: A convenience
sample of 681 adults living in a 11-county rural and agricultural region were solicited
at well attended events from May-November, 2019. Respondents were classied as
(1) not allowing either cigarette or e-cigarette use, (2) only allowing smoking, (3) only
allowing vaping, and (4) allowing both vaping and smoking in their car. Cigarette users
were dened as individuals who only smoked combustible cigarettes. E-cigarette users
were dened as individuals who reported that they only engaged in vaping. Fourteen
respondents reported that they used both tobacco products and were excluded from
the analysis. A multinomial logistic regression was used to obtain the relative risk ratio.
RESULTS: Cigarette users are more likely than non-tobacco users to allow people to
smoke (RRR=89.65, 95% CI: 26.92, 298.59) or both vape and smoke (RRR=57.38,
95% CI: 20.30, 162.14, as opposed to not allowing either smoking or vaping) in their
car. E-cigarette users are more likely than non-tobacco users to allow people to vape
(RRR=10.14, 95% CI: 1.90, 11.03) or to use both products (RRR=6.36, 95% CI: 1.19,
34.01, as compared to not allowing either vaping or smoking) in their car. There was
no relationship between using e-cigarettes and only allowing cigarette useCONCLU-
SION: Individuals who are riding in a car driven by a cigarette or e-cigarette user are
at risk of exposure to cigarette smoke and e-cigarette vapor. Educating cigarette and
e-cigarette users about the need to keep their car smoke-free is needed in rural and
agricultural regions of California.
FUNDING: State
PS3-53
COMPARING BRAIN ACTIVATION BY ANTI-VAPING MESSAGE
APPEALS AMONG YOUNG ADULT VAPERS
Joshua T. McMains, Jiaying Liu, Jessica L. Fabbricatore, Erin C. Jones, Allison Wors-
dale, Rebekah S. Wicke, Lawrence H. Sweet. University of Georgia, Athens, GA, USA.
Signicance: Young adults (YA) are increasingly introduced to nicotine products
through e-cigarettes. Anti-vaping public service announcements (PSAs) are meant to
dissuade individuals from vaping by imparting knowledge about (cognitive appeals)
or eliciting aective reactions towards (emotional appeals) negative consequences
of vaping. Methods: We examined whole-brain functional MRI responses to PSAs
with cognitive or emotional appeals compared to a scrambled image baseline in 38
YA (M=20.34, SD=1.51) vapers. Functionally dened regions of interest (ROIs) were
identied based on clusters of signicant response (p<.005, size>156mm3) during each
PSA type using “or” logic. These included the right lingual gyrus (RLG), right anterior
cingulate cortex (RACC), left fusiform gyrus (LFG), rostral right middle frontal gyrus
(RRMFG), left hippocampus (LH), supplementary motor area (SMA), and left inferior
premotor cortex (LIPMC). One-sample t-tests were used to determine if ROIs responded
signicantly to PSAs; contrasts of PSA type were then conducted with paired-sample
t-tests. Results: All 7 ROIs responded signicantly (p<.005) to both PSA types. RLG,
LFG, LH, SMA, and LIPMC were more active and the RACC and RRMFG were less
active than baseline. In both deactivated ROIs, emotional PSAs elicited greater relative
deactivation (t(37)=-4.098, p<.001; t(37)=-3.995, p<.001). Emotional PSAs elicited
a greater response in the RLG (t(37)=3.423, p=.002) and cognitive PSAs elicited a
greater response in the SMA (t(37)=2.895, p=.006). There were no PSA-type eects
in LFG, LH or LIPMC (p>.05). Conclusion: Both PSA types produced similar brain
responses, with all regions responding signicantly and in the same direction across
type, yet response magnitude diered by message type in more than half. Compared to
cognitive PSAs, emotional PSAs further suppressed frontal relative deactivation (RACC,
RRMFG), resulted in attenuated frontal activation (SMA), and elicited more activation in
primary visual cortices (RLG). The pattern of cognitive PSAs engaging frontal regions
more than emotional PSAs is consistent with frontal lobe functions overall and may be
a neuromarker of ecacy.
FUNDING: Federal; Academic Institution
PS3-54
EXAMINING THE ASSOCIATION BETWEEN FLAVOR CATEGORIES
OF ELECTRONIC NICOTINE DELIVERY SYSTEMS (ENDS) AND
SMOKING CESSATION AMONG U.S. WOMEN OF REPRODUCTIVE
AGE, PREGNANT AND NOT-PREGNANT
Sulamunn R. M. Coleman, Janice Y. Bunn, Andrea Villanti, Stephen T. Higgins. Univer-
sity of Vermont, Vermont Center on Behavior and Health, Burlington, VT, USA.
Signicance: Accumulating evidence indicates that many women of reproductive age
(WRA) who smoke combusted cigarettes are turning to electronic nicotine delivery
systems (ENDS) in an eort to reduce or quit smoking. As avors may be of special
appeal to this population, determining the extent to which use of avored ENDS predicts
quitting smoking represents an opportunity for enhanced tobacco regulation. Methods:
This study examined whether use of avored ENDS predicted quitting current use of
conventional cigarettes among WRA (n=501; 22 pregnant women, 479 not pregnant
women) in Waves 3 (W3) and 4 (W4) of the Population Assessment for Tobacco and
Health Study - a U.S. national longitudinal cohort study examining use of tobacco
products in the non-institutionalized population. The WRA W3 sample included all
women who reported dual use (i.e., users of combusted cigarettes and ENDS), includ-
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
ing women who did and did not endorse using ENDS to quit or cut down on smoking
in W3. Results: WRA who reported regular use of avored ENDS were more likely to
report having quit current smoking by W4 compared to those who reported using only
tobacco-avored ENDS in W3 (Wald Chi-Square=12.61, p<.001). That relationship was
observed among women who were pregnant in W4 (49.6% quit [95%CI=17.5-82.0%]
vs. 0.0% [95%CI=0.0-0.2%] p=.001) and not-pregnant (12.3% quit [95%CI=7.7-19.0%]
vs. 2.3% [95%CI=0.5-9.5%] p=.02). Conclusion: This study indicates that among WRA
who report dual use of combusted cigarettes and ENDS, those who report using avored
ENDS are more likely to report quitting in the following year than those who report using
only tobacco-avored ENDS. Importantly, these results pertain both to WRA who do
and do not report using ENDS to quit or cut down on smoking, and have potential to
inform policies regulating the availability of avored ENDS.
FUNDING: Federal
PS3-55
URINARY LEVELS OF ARSENIC, LEAD, AND CADMIUM IN
AFRICAN-AMERICAN AND WHITE SMOKERS
Francisco Gomez1, Shannon Cigan2, Joni Jensen3, Dorothy Hatsukami3, Irina
Stepanov1. 1Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA,
2Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA, 3Tobacco
Research Programs, University of Minnesota, Minneapolis, MN, USA.
Background: African-American (AA) smokers are at higher risk for developing lung
cancer than White (WH) smokers. In our previous study, we found that levels of urinary
cadmium - a known lung carcinogen present in cigarette smoke - were signicantly
higher in AA than in WH smokers, even after adjustment for age, sex, and urinary total
nicotine equivalents (TNE, a biomarker of smoking dose). However, urinary cadmium
has a long half-life (6—38 years), and our analyses suggested a potential contribution of
environmental exposures to its levels in our cohort of smokers. In this study, we analyzed
urine of the same smokers for arsenic (also lung carcinogen) and lead (neurotoxicant
and probable gastric carcinogen), which are also present in cigarette smoke but have
much shorter half-lives than cadmium (4 days and 1—2 months, respectively). Methods:
Urine of 87 AA and 82 WH smokers was analyzed by inductively coupled plasma mass
spectrometry. Values were log-transformed using the natural log to approximate a normal
distribution. Urinary levels of biomarkers were compared between AA and WH smokers
and the potential eect of tobacco use history, socio-demographic characteristics, and
employment status was investigated. Results: Urinary arsenic levels had a geometric
mean (GM) of 5.85 ng/mL (95% Condence Interval, CI: 4.93, 6.93 ng/mL); urinary
lead had a GM of 0.60 ng/mL (95% CI: 0.53, 0.69 ng/mL). Both biomarkers signicantly
correlated with urinary cadmium measured in the same smokers: rho(N=167)=0.26,
p=0.001 and rho(N=167)=0.48, p<0.001, respectively. Urinary arsenic and lead were
positively associated with TNE after controlling for sex, age, race, and cigarettes per
day (p=0.006 and p<0.001, respectively). However, in contrast to previous results for
urinary cadmium, urinary arsenic and lead were not associated with either race or em-
ployment status. Conclusions: Urinary arsenic and lead, which reect recent exposure,
were associated with smoking dose, but did not dier by race. These results reinforce
the signicance of cadmium as a key contributor to the observed racial dierences in
lung cancer risk among smokers.
FUNDING: Federal
PS3-56
ASSOCIATION BETWEEN TOBACCO USE AND COVID-19
SEVERITY IN AMBULATORY PATIENTS
Elizabeth McMahon, Elena Klyushnenkova, Adam Gaynor, Amrita Ahuja, Niharika
Khanna. University of Maryland School of Medicine, Baltimore, MD, USA.
Signicance: Association between COVID-19 and tobacco use is not completely under-
stood. Tobacco use has detrimental eects on health. Tobacco-related illnesses, such
as serious pulmonary or heart conditions reduce lung capacity and impair the immune
system and inuence the ability to ght COVID-19. Purpose: To explore an association
between COVID-19 severity and tobacco use and to identify potential risk factors in
ambulatory care at the rst presentation of COVID-19. Methods: De-identied data
were extracted from Epic EHR across 13 hospitals at University of Maryland Medical
System (UMMS) using the algorithm shared by NCI through the University of Wisconsin
Center for Tobacco Research and Intervention. Data for 22,823 ambulatory patients
tested COVID-19 positive between February 2020-April 2021 at rst encounter were
analyzed. COVID-19 severity was classied based on no symptoms present, symptoms
but no shortness of breath or pneumonia, symptoms and/or shortness of breath and
pneumonia. CDC/ATSDR Social Vulnerability Index (SVI) data were used to assess
social economic status in patients at the zip code level. Results: Among ambulatory
patients, 48% were White, 32% Black, 14% Hispanic. Twenty percent were in the top
25th percentile based on SVI. Majority of patients (13,863, 85.5%) showed no symptoms,
1,713 (10.6%) showed signs, but did not have any shortness of breath, and 449 (2.8%)
experienced signs and shortness of breath. In the bivariate analysis, COVID-19 severity
was positively associated with cigarette use status (p=0.0003) and age (p<0.0001).
Outcomes to be reported: Association between COVID-19 severity and tobacco use
will be assessed by ordinal multivariable logistic regression modeling. Co-variates will
include demographics, socio-economic, and clinical factors.
FUNDING: Federal; Academic Institution
PS3-57
FRAMING OF GRAPHIC WARNING LABELS AND SMOKING
CESSATION AMONG WOMEN OF REPRODUCTIVE AGE
Joseph M. Macisco, Elizabeth G. Klein. Ohio State University, College of Public Health,
Columbus, OH, USA.
Signicance: The 2001 Surgeon General’s Report recommends reporting gender-spe-
cic cessation data to better understand potential dierences in smoking cessation
between genders. It is generally understood that women tend to have some poorer
smoking cessation outcomes when compared to men, including lower long-term ces-
sation rates. Little research on communication and cessation messaging has focused
on gender-specic reporting. This study aimed to better understand the potential eects
of warning label topics and framing on the quit process for women of reproductive age.
Methods: Women of reproductive age currently using some form of tobacco product
at least some days every week were recruited from Amazon Mechanical Turk (n= 149).
Participants were shown 24 textual and image-based warning messages, half of which
described the negative consequences of smoking (loss-frame) and the other half the
benets of not smoking (gain-frame). Participants’ responses were rated for perceived
eectiveness using a validated and reliable scale, including ve subscales, including
negative and positive aect, attention to the label, relevance to self, and intention to quit.
Demographics were collected at the end of the survey. Results: Data were analyzed
by assessing an overall eect of frame on subscales and by comparing loss-frame and
gain-frame pairs of labels. Label topics were also ranked based on the mean participant
responses for the intention to quit subscale. Paired two-sample t-tests show loss-framed
messages elicited greater negative aect (p <.001) and more attention (p = .002),
whereas gain-framed messages elicited greater positive aect (p < .001). Although
loss-framed messages tended to perform better, gain-framed messages that were highly
detailed, about normative beliefs, or encouraged utilizing a doctor performed the best
overall. Warning label topics about children’s health, smoking during pregnancy, and
risks to a fetus during pregnancy tended to perform the worst overall. Conclusions:
There is evidence to suggest that using a combination of loss-frame and gain-frame
messages may be an eective tool for encouraging smoking cessation among women
of reproductive age. Further research is needed to assess the best intervention strategy
for communicating the risks at the intersection of smoking and pregnancy.
FUNDING: Federal
PS3-58
ASSESSING THE IMPACT OF MESSAGE THEME AND FORMAT
ON COGNITIVE AND AFFECTIVE RESPONSES TO E-CIGARETTE
HEALTH MESSAGES AMONG YOUNG ADULT SEXUAL MINORITY
WOMEN
Joanne G. Patterson1, Brittney Keller-Hamilton2, Amelia Wedel3, Theodore L. Wage-
ner2, Elise M. Stevens4. 1The Ohio State University College of Public Health, Columbus,
OH, USA, 2Center for Tobacco Research, The Ohio State University Comprehensive
Cancer Center, Columbus, OH, USA, 3Syracuse University, Syracuse, NY, USA, 4Univer-
sity of Massachusetts Medical School, Worcester, MA, USA.
Introduction: Young adult sexual minority women (i.e., self-identify as lesbian, bisexual,
or other non-heterosexual identity; YSMW) disproportionately use e-cigarettes (ECs)
compared to their heterosexual peers. This is concerning as EC use in young adulthood
may increase uptake of combustible tobacco smoking, thus, widening existing tobacco
disparities between heterosexual women and YSMW. Generally, sexual minorities re-
port markedly low tobacco harm perceptions, which are prospectively associated with
increased curiosity, susceptibility, and use of ECs. Thus, increasing EC harm perceptions
should be a goal of population-level health communications for YSMW. We tested the
eect of culturally targeted EC health messages with varying themes and image formats
on YSMW’s attitudes and intentions to use ECs. Methods: We recruited N=501 YSMW
(18-30 years-old) via Prolic into an online experiment. Consented participants were
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
directed to a Qualtrics survey where they were randomized into a control or one of nine
experimental conditions in a 3 (theme: harms, wellness, pride) by 3 (image format:
individual, couple, cartoon) study design. We modeled associations between message
condition and message eectiveness, discouragement from EC use, change in feelings
toward EC use, perceived threat, and intentions to abstain from EC use. Results: Harm
and wellness themes discouraged EC use more than pride-themed messages (p’s <
.001) . Participants who viewed harms messages self-reported feeling worse about
vaping than those who viewed wellness themed messages (p = .02) and pride themed
messages (p < .001). Current EC users reported greater intentions to abstain from ECs
when they viewed harms-themed messages compared to the control (p < .001), pride
(p = .001), and the wellness (p < .001) conditions. Images of couples were perceived
as more eective than cartoon images. Current EC users reported greater readiness
to avoid ECs and higher intentions to abstain from EC use after viewing images of
individuals than the couple or cartoon conditions (p’s <0.001). Conclusion: Message
theme and image format were associated with YSMW’s EC attitudes and behavioral
intentions. Future studies should evaluate how to optimize harms messages; including
how to re-frame wellness or pride messages to better aect YSMW’s EC use.
FUNDING: Federal; Academic Institution
PS3-59
CANNABIS VAPING AMONG YOUTH AND YOUNG ADULTS-A
SCOPING REVIEW
Melissa B. Harrell1, Aslesha Sumbe1, Kathleen R. Case2, Dale S. Mantey1, Sunaina
Swan1, Stephanie L. Clendennen1. 1UTHealth School of Public Health, Austin, TX, USA,
2UTHealth San Antonio, San Antonio, TX, USA.
Signicance: The last decade has seen a steep increase in e-cigarette use among
young people, and young people are increasingly using cannabis products in these
devices -- a trend that was brought into the limelight with the outbreak of EVALI. The
aim of this study was to synthesize ndings from a comprehensive scoping review
of published scientic literature on cannabis vaping. Methods: Three peer-reviewed
databases (PubMed, Embase, Web of Science) were systematically searched using
a detailed MeSH term strategy for literature on cannabis vaping among adolescents
and young adults (< 30 years old) published between January 2007 - June 2021. 1170
abstracts and titles were screened for inclusion, followed by 397 full-text reviews. Each
was reviewed by two reviewers and any conicts were resolved by a third reviewer.
Studies were tagged as belonging to at least one of ve mutually inclusive research areas
(Epidemiology, Health Eects, Etiology, Marketing/Advertising, Intervention Strategies).
Results: 186 articles that met the inclusion criteria were included in the nal review.
Most of the articles were published from 2019 onward, with 94 publications in 2020.
The articles consisted of case-reports, case-series, qualitative studies, observational
studies, and randomized trials. The majority of the studies examined epidemiological
characteristics and use patterns (66%), followed by physical and mental health eects
(50%) and etiology (26%) of cannabis vaping; 12 studies (7%) examined marketing
and advertising while 9 studies (5%) examined vaping related policies and intervention
strategies. Narrative summaries from each of these pools of literature will be reported.
Conclusion: Studies indicate increasing use of vaporized cannabis in e-cigarettes
among youth and young adults, posing a signicant risk to health, especially vaping
associated lung injury (EVALI). More studies are needed to examine the risk factors
and the role of digital media and advertisement in cannabis vaping among youth. These
studies can guide regulatory policies and targeted interventions for use among young
people and the sale of cannabis and e-cigarette products.
FUNDING: Federal
PS3-60
CORRELATES OF YOUTH POLY-E-CIGARETTE DEVICE USE
Nina Homeyer1, Alice Hinton1, Theodore L. Wagener1, Alayna P. Tackett2. 1The Ohio
State University, Columbus, OH, USA, 2University of Southern California, Los Ange-
les, CA, USA.
Signicance: Electronic cigarettes (EC) remain the most common tobacco product
used by youth in the United States. The US market remains saturated with numerous
EC types, allowing youth EC users to engage in the use of multiple types of EC devices
(i.e., ‘poly-EC device use’). While polytobacco use among youth is well documented
and associated with greater perceived social acceptability of tobacco use, younger
age of tobacco initiation, household tobacco use, and greater nicotine dependence,
the correlates associated with exclusive poly-EC device use (versus single device
use) is lacking. Methods: A convenience sample of 861 exclusive EC users (81%
female; 69% White) aged 14-21 (M=18.7 years) were surveyed to identify correlates of
poly-EC device use, including self-reported nicotine dependence, sociodemographic
characteristics, and social perceptions of EC use. Results: 56% of the sample report-
ed poly-EC device use. Poly-EC device use was associated with higher self-reported
nicotine dependence (p<0.001). Participants who began EC use before the age of 18
were 35% more likely to be poly-EC device users than those who began use at an older
age (95% CI: 1.00 - 1.81) and those who had all 5 of their closest friends use ECs were
twice as likely to be poly-EC device users than those who had less than 5 friends use
(Odds Ratio (OR): 2.07, 95% CI: 1.44 - 2.97). Users of cartridge based rellable EC
were twice as likely to be poly-EC device users (OR: 2.17, 95% CI: 1.38 - 3.41). Users
with higher or lower perceived SES were approximately 50% more likely to be poly-EC
device users compared to users who perceived SES to be similar to others (OR: 1.56,
95% CI: 1.13 - 2.17; OR: 1.51, 95% CI: 1.04 - 2.19, respectively). Conclusion: Young
poly-EC device users were more likely to begin using at a younger age, have close
friends who were EC users, and report greater nicotine dependence. Future research
should examine poly-EC device use in prospective surveillance monitoring to further
evaluate the longitudinal implications on use and dependence.
FUNDING: Federal; State; Academic Institution
PS3-61
YOUTH EXPOSURE TO VAPING RELATED ADS AND POSTS ON
SOCIAL MEDIA PLATFORMS AND VAPING STATUS
Lavanya Rajeshkumar1, Grace Kong2, Meghan Rabbitt Morean1, Krysten W. Bold3,
Deepa Camenga4, Dana Cavallo3, Asti Jackson3, Danielle Davis5, Suchitra Krishnan-Sa-
rin2. 1Yale University School of Medicine, New-Haven, CT, USA, 2Yale University School
of Medicine, New Haven, CT, USA, 3Yale University, New Haven, CT, USA, 4Yale School
of Medicine, New Haven, CT, USA, 5Yale University School of Medicine, New Haven,
CT, USA.
Social media use is associated with youth vaping and vaping susceptibility, yet it is
unknown which social media platforms and exposure formats (posts / advertisements
[ads]) contribute to these relationships. We investigated the association of exposure to
vaping-related posts and ads, respectively, on 11 dierent social media platforms, with
lifetime (LT) and past month (PM) vaping, and, among never users, susceptibility (SUS)
to vaping. 1863 high school students from 2 CT schools (51.7% female; ages 13-19)
completed an anonymous survey in Fall 2020 (vaping status: LT=27.4%, PM=12.7%,
SUS never users=28.3%). We ran separate regression models for ads and posts for
each of the 3 vaping variables/DVs (SUS, LT, PM) with social media platforms as IVs.
Age and sex were included as covariates. Bonferroni correction was performed to
account for multiple comparisons. With reference to ads on social media, exposure to
ads on YouTube (vs. no exposure) was associated with increased odds of being SUS to
vaping (AOR 1.59, 95% CI=1.17-2.15) but decreased odds of both LT (AOR 0.46, 95% CI
=0.33-0.62) and PM vaping (AOR 0.48, 95% CI =0.32-0.72). No signicant associations
with ads on other social media platforms were observed. With respect to social media
posts, exposure to Snapchat posts (vs. no exposure) was associated with increased
odds of being SUS to vaping (AOR 1.55, 95% CI =1.14-2.12), LT vaping (AOR 1.86, 95%
CI =1.39-2.48), and PM vaping (AOR 2.25, 95% CI =1.54-3.29). In contrast, exposure
to YouTube posts was associated with decreased odds of LT vaping (AOR 0.57, 95%
CI =0.43-0.76). No signicant associations with posts on other social media platforms
were observed. Our ndings suggest advertisements and posts on certain social media
platforms are uniquely related to youth vaping status. Further studies are required to
examine the content of ads and posts on dierent social media platforms to better
understand their dierential eects on youth vaping behaviors. This would be critical
to regulation of marketing and development of vaping prevention programs for youth.
FUNDING: Federal
PS3-62
INCREASED NICOTINE VAPING DURING THE COVID-19
PANDEMIC AMONG US YOUNG ADULTS: ASSOCIATIONS WITH
NICOTINE DEPENDENCE, CURRENT VAPING, AND REASONS
FOR USE
Michael Parks1, Megan Patrick2. 1University of Minnesota Medical School, Minneapolis,
MN, USA, 2University of Michigan, Ann Arbor, MI, USA.
Background: It is currently unknown whether and how many young adults (YAs) may
have increased nicotine vaping during the pandemic, and there is no research on
how this increased vaping predicts vaping-related outcomes. Longitudinal, national
data are needed to answer these questions. Methods: Data came from the Monitoring
the Future (MTF) Vaping Supplement collected from September to November 2020
(N=1244), which include a nationally-representative sample of US 12th-grade students
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
who participated in MTF in spring 2019. We oversampled those who reported vaping
in 12th grade (modal age 18), and we surveyed participants one year after 12th grade
(modal age 19). Approximately 35% (N=440) reported past-year nicotine vaping in 2020
and were included in the current analysis. Past-year vapers were asked, “How has the
COVID-19 pandemic impacted how much you vape?” We examined how increased
vaping (1=“I vaped more”, 0=other) was related to any nicotine dependence symptom
(1=yes, 0=no), any and regular (>5 days) nicotine vaping in past 30 days, and 12
dierent reasons for vaping. We used weighted descriptive analyses and multivariable
logistic regression. Results: At total of 16.8% young adults reported pandemic-related
increased vaping. Those who reported increased vaping (vs. not) had higher odds of
current nicotine dependence symptoms (AOR=2.28; 95% CI=1.02, 5.09), any nicotine
vaping (AOR=10.75; 95% CI=2.94, 39.19), and regular nicotine vaping (AOR=5.03; 95%
CI=2.31, 10.95) in 2020. Results were identical in sensitivity analyses that controlled
for level of vaping in 2019. Increased vaping was positively and signicantly associated
with 3 reasons to vape: to cope, to get high, and boredom. Conclusion: Most YAs did
not report pandemic-related vaping increases; however, about one in six reported more
vaping in response to the pandemic. Increased vaping was associated with current
nicotine dependence and use. It is possible that increased vaping was a form of coping
with pandemic-related stressors, evidenced by reasons to vape including to cope, for
boredom, and to get high. Interventions and future research should target those who
increased vaping during the pandemic.
FUNDING: Federal
PS3-63
SMOKELESS TOBACCO USE AND DEPENDENCE AMONG
AMERICAN INDIAN ADULTS
Nasir Mushtaq1, Kate Kouplen2, Laura A. Beebe3. 1University of Oklahoma Health
Sciences Center, Tulsa, OK, USA, 2Oklahoma State University, Stillwater, OK, USA,
3University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Introduction: Public health burden of tobacco is disproportionately high among Amer-
ican Indians (AIs) because of inequalities in prevalence, tobacco-induced disease, and
sociocultural factors. AIs have the highest prevalence of ST use compared to all other
racial/ethnic groups in the US. In addition, they have relatively low tobacco cessation
rates. Despite their high ST use prevalence, there is limited research focused on ST
dependence in AIs. The aim of this study is to examine ST dependence among AI
adult males and to identify sociodemographic factors and tobacco use characteristics
associated with their ST dependence. Methods: Study was based on cross-sectional
data collected from a community-based sample of 120 adult male AI exclusive ST
users in Oklahoma. Sociodemographic characteristics, tobacco use behavior, and ST
dependence were obtained through phone surveys. Tobacco Dependence Screener
(TDS-ST) was used to measure ST dependence and classify ST users according
to their dependence status. Descriptive statistics were calculated for all the study
variables. Association of ST dependence with sociodemographic and tobacco use
characteristics was evaluated using linear and logistic regression analyses. Odds ratio
(OR) and 95% condence intervals (CI) were calculated. Results: Mean (+SD) age of
the study participants was 41.6+13.3 years. The majority of participants were obese
(70.0%), had some college or a college education (56.7%), and rural area of residence
(60.0%). Mean duration of ST use was 24.9+13.8 years. 96.7% were everyday ST users
whereas, 10.0% reported traditional tobacco use. Mean TDS-ST score was 6.2+2.4 and
63.3% of the study participants had ST dependence. Tobacco use frequency, quantity,
and age of onset of ST use were signicantly associated with TDS-ST score (p=0.027,
p=0.004, and p=0.0001, respectively). Those who had ST dependence were 5 times
more likely to have ever made a quit attempt (OR: 5.2, 95% CI:2.1,12.9). Conclusion:
AI adult ST users have high prevalence of ST dependence. Findings related to tobacco
use characteristics associated with ST dependence can assist in formulating eective
tobacco control interventions.
FUNDING: Academic Institution
PS3-64
LONGITUDINAL ASSOCIATIONS BETWEEN EXCLUSIVE AND
DUAL USE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS
AND CIGARETTES AND BRONCHITIS, PNEUMONIA OR CHRONIC
COUGH AMONG YOUTH
Richa Mukerjee, Steven Cook, Nancy Fleischer, Jana Hirschtick. University of Mich-
igan, Ann Arbor, MI, USA.
Signicance: This study assessed the association of electronic nicotine delivery
systems (ENDS) use exclusively or in combination with cigarettes, with incident diag-
nosis of bronchitis, pneumonia or chronic cough among youth using six waves of the
Population Assessment of Tobacco and Health (PATH) study (2013-19). Methods: The
sample consisted of youth aged 12-17 years at baseline who participated in at least one
follow-up wave of PATH. A four-category exposure variable captured past 30-day prod-
uct use for the wave preceding the outcome, and included exclusive ENDS, exclusive
cigarettes, dual use and no current use of these products. The outcome variable was
dened as incident diagnosis of bronchitis, pneumonia or chronic cough. Discrete-time
survival analysis was used to estimate risk of the outcome from waves 2 to 5, adjusting
for sociodemographic factors (age, sex, race/ethnicity, parental education and rural/
urban residence) and risk factors (body mass index, household use of combustible
products and secondhand smoke exposure) at baseline. Results: At baseline the
sample (n=9,426) was majority male (51.5%), non-Hispanic White (54.4%), and resid-
ed in an urban area (79.7%). 2% of all participants used cigarettes exclusively, while
1.3% used ENDS exclusively and 0.9% used both products. Hazard rate estimates
indicated that the conditional probability of diagnosis of the outcome was lower than
5% in each wave. In the adjusted model, exclusive cigarette use (aHR = 1.84, 95% CI
1.3-2.58) and dual use of cigarettes and ENDS (aHR = 2.55, 95% CI 1.53-4.24) were
statistically signicantly associated with higher risk of incident diagnosis of bronchitis,
pneumonia, or chronic cough, while exclusive ENDS use shared a positive relationship
with the outcome though it was not signicant (aHR = 1.5, 95% CI 0.9-2.4). Non-His-
panic White participants were also signicantly more likely to be diagnosed with the
outcome than respondents of Black (aHR = 0.6, 95% CI 0.5-0.8), Hispanic (aHR = 0.6,
95% CI 0.51-0.81) and other race/ethnicities (aHR = 0.7, 95% CI 0.6-1.0). Lastly, the
risk of diagnosing the outcome was signicantly higher among obese respondents (aHR
= 1.5, 95% CI 1.3-1.9) relative to those who were not. Remaining sociodemographic
factors (age, sex, parental education, rural/urban residence) and risk factors (household
combustible product use and secondhand smoke exposure) did not share a signicant
relationship with the outcome. Conclusion: Exclusive cigarette use and dual use of
ENDS with cigarettes increased the risk of incident diagnosis of bronchitis, pneumonia
and chronic cough among youth, whereas exclusive ENDS use did not.
FUNDING: Federal
PS3-65
LONGITUDINAL ASSOCIATIONS BETWEEN E-CIGARETTE USE
AND ONSET OF MULTIPLE MODES OF CANNABIS USE AMONG
U.S. ADOLESCENTS
Yu Wang1, Zongshuan Duan2, Shannon R. Self-Brown1, Scott R. Weaver1, Claire A.
Spears1, Pinpin Zheng3, Michael P. Eriksen1, Jidong Huang1. 1School of Public Health,
Georgia State University, Atlanta, GA, USA, 2Milken Institute School of Public Health,
George Washington University, Washington, DC, USA, 3School of Public Health, Fudan
University, Shanghai, China.
Signicance: Previous studies investigating the association between e-cigarette use
and cannabis use primarily focused on overall cannabis use, which may mask e-cig-
arettes’ potential dierential impacts on the initiation of dierent modes of cannabis
use. This study examines the prospective associations between baseline e-cigarette
use and onset of multiple modes of cannabis use during a 12-month follow-up period
among cannabis-naïve US adolescents (12-17 years). Methods: Data were from the
Population Assessment of Tobacco and Health (PATH) Study Wave 4 (December 2016
to January 2018) and Wave 4.5 (December 2017 to December 2018). The outcomes are
past-12-month cannabis vaping, blunting, smoking cannabis with hookah, any cannabis
use, and past-30-day cannabis use at Wave 4.5. Multivariate logistic regressions were
used to estimate the weighted associations between the outcomes and baseline (Wave
4) past-30-day e-cigarette use, controlling for other tobacco use, socio-demographic
factors, mental health status, and state recreational cannabis legalization status. Re-
sults: Baseline e-cigarette use and other tobacco use were signicantly associated
with onset of cannabis vaping, blunting, and smoking cannabis with hookah among US
adolescents (aOR=5.74, 7.97, and 4.60 for e-cigarette use, respectively; and aOR=4.34,
3.75, and 4.30 for other tobacco use, respectively). Non-Hispanic Black was more likely
to report past-12-month blunting (aOR=1.47, 95% CI=1.02-2.13) and smoking cannabis
with hookah (aOR=2.74, 95% CI=1.03-7.25) compared with non-Hispanic White. In
addition, living in states with laws permitting adult recreational cannabis use was signi-
cantly associated with past-12-month cannabis vaping (aOR=1.36, 95% CI=1.07-1.73)
and past-30-day cannabis use (aOR=1.40, 95% CI=1.03-1.89). Conclusions: Using
e-cigarettes and other tobacco products was associated with increased likelihoods of
multiple modes of subsequent cannabis use among US adolescents. Interventions to
prevent youth cannabis onset can be enhanced by targeting youth who use e-cigarettes
and other tobacco products, racial/ethnic minorities and youth living in states with more
lenient cannabis laws.
FUNDING: Federal
171
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-66
EXTRINSIC AND INTRINSIC CORRELATES OF CANNABIS
USE AMONG LOW-INCOME EMERGING ADULTS DURING THE
COVID-19 PANDEMIC
Wura Jacobs1, Erika Westling2, Kwonchan Jeon3, Daniel S. Shaw4, Melvin N. Wilson5.
1California State University, Stanislaus, Turlock, CA, USA, 2OR Research Institute,
Eugene, OR, USA, 3Salisbury University, Salisbury, MD, USA, 4University of Pittsburgh,
Pittsburgh, PA, USA, 5University of Virginia, Charlottesville, VA, USA.
Background: The COVID-19 pandemic and accompanying mitigation eorts have
negatively impacted emerging adults’ mental health, employment, and nances, at a
time when they were just gaining autonomy. Reports indicate an increase in emerging
adult cannabis use during the pandemic, even when socially isolated. Particularly among
low-income emerging adults, it is unclear what factors are associated with this increase
in cannabis use. This study examined the association of COVID-19-related extrinsic
(nancial diculties) and intrinsic (job anxieties) factors with cannabis use in low-income
emerging adults. Methods: Data were obtained via online surveys in January/February
2021, from a diverse sample of emerging adults participating in the Early Steps Multisite
Study. Participants reported their frequency of cannabis use since March 2020, as well as
pandemic-related job anxieties and nancial stress. Those who indicated cannabis use
at least once were categorized as users. We used bivariate and multivariable analyses
to assess the association of COVID-19-related job anxieties and nancial diculties
with cannabis use, adjusting for highest level of education, gender, and age. Results:
Almost 40% of participants (N=320; 58.4% female, Mage=18.67 years, SD=0.57) reported
cannabis use since March 2020. There was a signicant association between experi-
encing COVID-19-related job anxiety (χ2 (2) =16.09, p<0.01) and nancial diculties
(χ2 (2) =9.19, p=0.01) with cannabis use. Compared to adolescents who reported not
experiencing job-related anxiety during the pandemic, those who did were about three
times (aOR=2.92, 95%CI=1.66-5.13) more likely to report cannabis use; similarly, those
who experienced pandemic-related nancial diculties were twice as likely (aOR=1.99,
95%CI=1.12-3.53) to report cannabis use. Conclusions: Pandemic-related job anxieties
and nancial diculties are associated with increased cannabis use among low-income
emerging adults; this may be related to limited employment opportunities, as low-wage
essential workers, and/or to the abrupt pandemic-related disruption to all aspects of
their life during a key transition to adulthood.
FUNDING: Federal; State; Academic Institution
PS3-67
QUALITATIVE EXAMINATION OF MULTIPLE TOBACCO PRODUCT
USE AMONG LOW-INCOME AFRICAN AMERICAN ADULTS
DURING THE COVID-19 PANDEMIC
Cherell Cottrell-Daniels, Angelique Willis, Marsha Wright, Josephine Mhende, Ayee-
sha Sayyad, Terry Pechacek, Dawn Aycock, Claire Spears. Georgia State University,
Atlanta, GA, USA.
Signicance: Low-income and African American populations experience severe to-
bacco-related health disparities. Concurrent use of multiple tobacco products is also
disproportionately common in these populations. Research is needed to understand
both risk and protective factors for use of multiple tobacco products in the current
sociopolitical climate, which has been characterized by high stress and unemployment
related to COVID-19 as well as protests and heightened awareness of systemic racism.
This qualitative study explored perceptions and experiences of low-income African
American adult tobacco users in this context. Methods: Twenty African American adult
cigarette smokers (who also used at least one other combustible tobacco product) from
metro Atlanta, GA completed individual, in-depth virtual interviews. Interviews covered
perceptions of various tobacco products; experiences with the COVID-19 pandemic;
thoughts about recent protests and social justice issues; and any changes in tobacco
use related to these issues. Results: Participants had a median age of 38.5 years
and were mostly male (59.1%) with annual household incomes of less than $30,000
(72.7%). In addition to cigarettes, most (86.4%) used little cigars/cigarillos (LCCs); almost
half also used traditional cigars (45.5%) and/or hookah (45.5%). Overall, participants
expressed low risk perceptions of little cigars and cigarillos (LCCs) LCCs compared
to cigarettes, especially when used with marijuana. They indicated greater desire to
reduce or stop smoking cigarettes (perceived as “harsher”) than other products like
LCCs, cigars and hookah. Most (60%) reported an increase in their tobacco use since
the COVID-19 pandemic, which was attributed to higher stress related to the pandemic
and sociopolitical climate. Specic stressors included nancial insecurity, job loss,
isolation, changes in living situation, uncertainty of post-pandemic life, and anger and
sadness related to racism and social injustice. A lack of knowledge regarding tobacco
use and susceptibility to coronavirus was also observed. The presentation will include
illustrative participant quotes. Conclusion: Multi-level interventions are needed to address
structural determinants of health, systemic racism, social norms related to tobacco use,
perceptions of various tobacco products, and strategies for coping with stress among
low-income African American tobacco product users.
FUNDING: Academic Institution
PS3-68
PREVALENCE OF ‘TOBACCO-FREE’ ORAL NICOTINE PRODUCTS
AND CORRELATES OF USE AMONG YOUTH AND YOUNG
ADULTS IN THE US: FINDINGS FROM THE ITC YOUTH TOBACCO
AND VAPING SURVEY
Liane Schneller1, Nicholas Felicione2, David Hammond3, Maciej Goniewicz2, Richard
O’Connor1. 1Roswell Park Cancer Institute, Bualo, NY, USA, 2Roswell Park Compre-
hensive Cancer Center, Bualo, NY, USA, 3University of Waterloo, Waterloo, ON,
Canada.
Signicance: Recently, many tobacco companies have converged on the theme of
harm reduction by moving away from combustible products with nicotine vaping prod-
ucts (NVPs), smokeless tobacco (SLT), and novel ‘tobacco-free’ oral nicotine products
(ONPs). Since the advent of ONPs in 2016, sales have increased, but little is known
about the use of ONPs. The purpose of this study is to examine trends in prevalence
and correlates of ONP use among US youth and young adults. Methods: Cross-sec-
tional US data were analyzed from Waves (W) 3 (Aug 2019; N=3,981), 3.5 (Feb 2020;
N=5,132), and 4 (Aug 2020; N=6,936) of the ITC Youth Tobacco and Vaping Survey.
Online surveys were conducted among youth 16-19 years in W3 and 3.5, and youth
and young adults 16-29 years at W4 who were recruited from US Nielsen consumer
panels. Descriptive statistics and logistics regressions were used to describe changes
in prevalence over time and predict correlates at all waves, including demographics
and tobacco product use, of ever and past 30-day ONP use. Models were adjusted for
response wave, age, sex, race/ethnicity, perceived family socioeconomic status, and
past 30-day use of SLT, cigarettes, and NVPs. Results: From Aug 2019 to Aug 2020,
ONP ever use signicantly increased (3.5-5.3%, p=0.0014), as did past 30-day use
(1.5-2.5%, p=0.0107) while the use of SLT, cigarettes, and NVPs trended downward.
Those who were 21-29 years were signicantly more likely to ever use and currently
use ONPs when compared to those who were 16-20 years. Further, females were
less likely to ever use ONPs. Those who currently used cigarettes, NVPs, and SLT,
in particular, were more likely to ever use and currently use NVPs. The demographic
characteristics of ONP users were similar to those of SLT users Conclusions: Although
ONPs are among the least prevalent products used among US youth and young adults,
their prevalence of use may be trending upward. ONP users are more likely to be a
user of other nicotine products, but the availability of avors and easy to conceal design
of ONPs may be appealing to those who may not use nicotine products. Researchers
should continue to observe behaviors associated with ONP use to inform the need for
future regulatory eorts.
FUNDING: Federal
PS3-69
DELAY DISCOUNTING MEDIATES THE RELATIONSHIP BETWEEN
CIGARETTE PERCEPTION AND NUMBER OF CIGARETTES
SMOKED PER DAY IN EXCLUSIVE CIGARETTE SMOKERS
Roberta Freitas-Lemos, Allison N. Tegge, Jerey S. Stein, Warren K. Bickel. Fralin
Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
Concerns about the eect of smokers’ misperceptions associated with cigarette de-
scriptors on tobacco use have been raised in the literature. Moreover, tobacco use has
been associated with delay discounting (DD). Understanding how smokers’ perceptions
about their cigarettes and DD impact their smoking behavior is warranted. This study
examines the relationship between smokers’ perceptions about their usual cigarette,
DD, and the number of cigarettes smoked per day. A crowdsourced sample (N=996)
of smokers of high lter ventilation (>20% ventilation; N=546) and low lter ventilation
(<10% ventilation; N=450) cigarettes identied their usual cigarette to be “light” or “full
avor”, reported the average number of cigarettes they smoke per day, and completed
an adjusting amount DD task. Linear regressions tested for associations among these
three measures and a mediation analysis tested the role of DD in mediating the re-
lationship between cigarette perception and number of cigarettes smoked per day. In
smokers of high-ventilation cigarettes, 292 (53.48%) individuals perceived their usual
cigarette as light and 254 (46.52%) individuals perceived them as full avor. In smokers
of low-ventilation cigarettes, 184 (40.89%) individuals perceived their usual cigarette
as light and 266 (59.11%) individuals perceived them as full avor. Participants who
thought they smoked light cigarettes on average smoked 2.5 cigarettes more per day
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
compared to participants who thought they smoked full avor cigarettes (p=0.006).
This relationship was mediated by an individual’s DD rate (indirect eect: p=0.004)
with higher discounters reporting higher numbers of cigarettes smoked per day. No
signicant dierences were observed in the number of cigarettes per day between
high-ventilation cigarette smokers and low-ventilation cigarette smokers (p=0.066).
Smokers’ perceptions about their usual cigarette, but not their actual ventilation status,
predicted the number of cigarettes smoked per day via a direct eect and an indirect
eect through an individual’s DD rate. These ndings may inform tobacco cessation
programs and health communication strategies for tobacco control.
FUNDING: Federal
PS3-70
QUALITATIVE EVALUATION OF THE CIGARILLO PURCHASE
TASK: RECOMMENDATIONS FOR FUTURE USE
Amanda Quisenberry1, Sarah Koopman2, Elizabeth G. Klein3, Erika Trapl4. 1Roswell
Park Comprehensive Cancer Center, Bualo, NY, USA, 2Case Western Reserve Univer-
sity, Cleveland, OH, USA, 3Ohio State University, College of Public Health, Columbus,
OH, USA, 4Case Western Reserve University, Cleveland, OH, USA.
Signicance: The cigarillo purchase task is a novel procedure modeled after the cigarette
purchase task and used to assess the value of cigarillos among users of the product.
Great utility exists in using this task: it is simple, straightforward, and takes little time
to complete. However, little research has used the cigarillo purchase task and no
validation studies have been published. The aim of the current study was to evaluate
understanding of and thoughts about a nine-price cigarillo purchase task using in depth
semi-structured interviews and to use the ndings to recommend parameters for use of
the cigarillo purchase task. Methods: A convenience sample of young adults ages 21-28
(n=29) were recruited online between May-August 2020 to participate in semi-structured
interviews about cigarillo and e-cigarette perceptions and use. The analysis presented
here included responses from participants who were current users of cigarillos (n=7)
or currently used both cigarillos and e-cigarettes (n=8). Audio-recorded interviews
were conducted remotely. Verbatim transcripts were coded by two researchers and a
thematic analysis was used to examine responses to a purchase task. Results: Themes
that emerged from the qualitative interviews were related to: purchasing price, budget,
normal cigarillo usage, cigarillo pack size, and time frame of use. Five participants
mentioned that they would increase their use when products were free, while one
commented that smoking more in a day wouldn’t be enjoyable. Others were inclined
to wait until the 24 hour period was over before buying cigarillos at expensive prices.
Comments were also made that budget is important and using a calculator during the
task is helpful. Finally, some commented that selling in individual units wasn’t realistic
and made it more dicult to purchase according to their normal usage and budget.
Conclusions: Results suggest modications to the task used here, including depiction
of cigarillo pack size and use of a budget calculator. These enhancements are likely to
support usability and replicability of results when using this novel purchase task tool.
FUNDING: Federal
PS3-71
TOBACCO USE DISPARITIES AMONG SEXUAL AND GENDER
MINORITY GROUPS AMONG YOUNG ADULTS AND ADULTS FROM
WAVE 5 OF THE POPULATION ASSESSMENT OF TOBACCO AND
HEALTH (PATH) STUDY
Adam C. Warren1, Sixia C. Chen1, Sarah C. Ehlke2, Amy M. Cohn2. 1OU Hudson
College of Public Health, Oklahoma City, OK, USA, 2Health Promotion Research Center
at University of Oklahoma Health, Oklahoma City, OK, USA.
Signicance: Sexual and gender minority individuals have rates of tobacco use that
dier from their majority counter parts. This study investigates tobacco use disparities
for young adults (18 to 24, n = 11053) and older adults (25+, n = 20960) by sexual
and gender identify groups separately using PATH wave 5 data. Methods: Analyses
examined prevalence of ever and past 30-day use of 5 dierent tobacco products (cig-
arettes, e-cigarettes, cigar products, hookah, and smokeless tobacco) across sexual
minority group (SMG) males and females as well as transgender (TG) and cisgender
individuals, separately by age group. Results: TG young adults showed no dierence
in tobacco use of any product from their cisgender counterparts. A higher percentage of
SMG females reported ever use (77.6%) and past 30-day use (45.1%) of any tobacco
products, compared to heterosexual females (ever: 61.5%; past 30-days: 30.7%, p’s
<.0001). For SMG males, their only dierence in tobacco use compared to heterosexual
males was in ever hookah use (38.9% vs 29.3%, p = 0.0035). TG older Adults were
more likely to have used at least one tobacco product in the past 30 days than cisgender
adults (62.2% vs 47.5%, p = 0.0236). SMG females were also more likely than their
straight female participants to have ever used (90.9% vs 83.4%) or have past 30-day
use (54.9% vs 41.9%) of any tobacco product (p <.0004 and p <.0001). SMG males
did not signicantly dierentiate from heterosexual males in terms of ever use or past
30-day use of any tobacco product. Conclusion: Similar to previous ndings, sexual
and gender minority groups use more tobacco products, as well as use at a higher rate,
than their non-minority peers. Results disseminated from this study show tobacco use
disparities are based on age, gender, and sexual or gender identity. Understanding
these groups relationships with tobacco use could be helpful in tailoring public health
messages designed to reduce tobacco use in these groups, developing specic tobacco
cessation treatments, or a starting point for future research.
FUNDING: Federal; Academic Institution
PS3-72
WHAT IS THE BEST WAY TO MEASURE PEER CROWD
IDENTIFICATION FOR TOBACCO PREVENTION CAMPAIGNS
COMPARING OPEN-ENDED, SINGLE BEST AND SLIDING SCALE
METHODS
Julia C. West1, Meghan Moran2, S Elisha Lepine1, Britta Egeland1, Mega Trutor3, Maria
Roemhildt4, Rhonda Williams5, Andrea Villanti1. 1University of VT, VT Center on Behavior
and Health, Burlington, VT, USA, 2Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA, 3Alcohol & Drug Abuse Programs, VT Department of Health,
Montpelier, VT, USA, 4Health Surveillance, VT Department of Health, Montpelier, VT,
USA, 5Health Promotion & Disease Prevention, VT Department of Health, Montpelier,
VT, USA.
SIGNIFICANCE: Because identication with specic peer crowds (also known as social
types or subcultures, e.g., alternative) increases a young person’s risk of tobacco use,
peer crowds have been used to target tobacco prevention media campaigns (e.g., FDA’s
Fresh Empire). The ability to implement such campaigns relies on a valid way to assess
peer crowd identication; however, little research has empirically examined the utility of
these measures. The objective of this study was to identify utility of these measures for
peer crowd identication and predicting tobacco use. METHODS: Data collected in Wave
1 (Spring 2019) of the PACE Vermont study, an online cohort of adolescents (n=480)
and young adults (n=1,037) ages 12-25, assessed peer crowd identication with three
measures: 1) open-ended (OE), 2) sliding scale (SS), and 3) single best crowd (SB). The
SS and SB measures used 11 pre-identied crowds from the literature. We examined
the distribution of crowd identication across measures and concordance in participants’
responses across measures. Cross-sectional analyses examined correlations between
peer crowd identication, cigarette, and electronic vapor product (EVP) use. RESULTS:
The distribution of crowds was similar across the 3 measures. However, the OE measure
identied ten emergent crowds (e.g., athlete, hippie) not identied in the SS and SB
items. Concordance was low between the OE and SB crowd measures (<50%), but in
all cases, the crowd selected as the SB also held the highest average score for that
crowd on the SS. All three measures were correlated with higher past 30-day use for two
of the pre-specied crowds (cigarettes: Alternative, Burnouts; EVP: Burnouts, Social).
The SB and SS measures were correlated with higher past 30-day cigarette use for
County and Social crowds. The OE item alone was correlated with higher past 30-day
EVP use in the Country crowd. CONCLUSIONS: The OE measure can identify crowds
within a population not previously captured but may not uniquely predict substance
use. The single-best measure is easiest to implement and analyze, but likely misses
salient crowds for prevention eorts. An SS item with an open-ended response option
may be the optimal way to identify priority crowds for tobacco prevention campaigns.
FUNDING: Federal; State; Academic Institution
PS3-73
TOBACCO QUIT INTENTIONS AND AWARENESS OF COVID 19
PANDEMIC AMONG SMOKELESS TOBACCO USERS IN INDIA
Mongjam Meghachandra Singh1, Amod Laxmikant Borle2, Suneela Garg2, Nidhi Bhat-
nagar2, Chetana Deshmukh2, Ravi Kaushik2, Ravi Mehrotra3, Kamran Siddiqi4. 1Maulana
Azad Medical College, New Delhi, India, 2Maulana Azad Medical College, Delhi, New
Delhi, India, 3India Cancer Research Consortium - ICMR, New Delhi, United Kingdom,
4University of York, York, United Kingdom.
Introduction: Tobacco consumption is major public health concerns in India. Smokeless
tobacco (ST) addiction was likely to worsen the progression and prognosis of COVID-19.
The use of ST increased transmission of infection by public spitting, hand-to-mouth
contact, and sharing of tobacco. Hence, this study was conducted to assess the
knowledge of COVID 19 & quitting intentions among ST users. Methods: Community
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based cross-sectional study was conducted in two districts of Delhi. Simple random
sampling was done from shops. As per the GATS survey factsheet 2016-17 of India there
are 21.4% (p) of SLT users in India, at 95% condence level(z =1.96), and margin of
allowable error of 5.85%(e) sample size of 209 subjects were interviewed. Continuous
variables were summarized with mean (SD) and median (IQR) based on the distribution
of data. The categorical variables were summarized using frequencies. McNemar Chi
square test was used to compare the quitting intention during and before COVID 19.
Results: Majority of the ST users were from age group of 31- 40 years, studied up to
12 class or less, unskilled workers and belonging to lower socio-economic class. The
knowledge about symptoms like fever, dry cough, running nose, loss of taste increased
with increasing education (p=0.001), professional skilled work (p=0.005) and higher
socioeconomic status (p= 0.001). Higher socioeconomic classes of ST users were
aware of transmission of virus via handshakes (p=0.002), via droplets (p=0.05) and via
fomites (p= 0.008). During COVID-19 pandemic only 83 (39.7%) SLT users had quitting
intention. Quitting intention was signicantly reduced among all age groups irrespective
of literacy level or socioeconomic class of ST users during pandemic as compared
to before pandemic. (p=0.000) Conclusion: Majority of the ST users were aware of
symptoms, modes of transmission and preventive measures of COVID 19 which were
higher among educated and higher socio-economic background. Reduction in quitting
intention was found among ST users due to COVID 19 pandemic.
FUNDING: Federal; State; Academic Institution; Nonprot grant funding entity
PS3-74
EFFECTS OF PG/VG RATIO, NICOTINE CONCENTRATION,
PARTICLE SIZE DISTRIBUTION, AND FREEBASE/PROTONATED
NICOTINE FRACTION ON THEORETICAL “THROAT HIT” FROM
ELECTRONIC CIGARETTE AEROSOLS
Mario El Hourani1, Issam Lakkis1, Laleh Golshahi2, Maram Ammar1, Sana Hosseini2,
Alan Shihadeh1. 1American University of Beirut, Beirut, Lebanon, 2Virginia Common-
wealth University, Richmond, VA, USA.
“Throat hit” is a harsh sensation of short duration felt by a smoker when a bolus of
aerosol containing nicotine is inhaled. The harsh sensation is thought to derive from
absorption of nicotine in the region of the glossopharyngeal nerve at the back of the
throat. Tobacco products that have very high freebase nicotine concentrations such as
cigars are dicult to inhale due to excessive throat hit, while products with relatively
lower concentrations are experienced as smooth and easy to inhale. Throat hit appears
to play a role in the psychological reward of tobacco smoke, with some degree of hit
considered desirable by long-term users of tobacco products. It may also aect the pu
topography of a given tobacco product, with greater throat hit resulting in shorter and
fewer pus due to building irritation during use. Nicotine gas phase concentration is a
function of the nicotine concentration in the aerosol particles as well as its form (salt
versus freebase). In recent years, electronic cigarette (ECIG) manufacturers have shifted
liquid compositions towards salt-based nicotine, allowing higher liquid concentrations
to be employed. In this study, we examined the eects of nicotine concentration, form,
propylene glycol/vegetable glycerin ratio, and particle size on predicted gas phase
nicotine absorption at the back of the throat. To do so we developed a mathematical
model of a multicomponent monodisperse aerosol owing through the upper airway of
the respiratory tract. The model accounts for the simultaneous heat transfer and vapor
mass absorption in the upper airways, in addition to the evaporation and condensation
processes occurring between aerosol particles and surrounding vapors. Simulation re-
sults show that nicotine absorption ux, dened as the mass of nicotine absorbed in the
throat per unit time, increases with higher fractions of free base nicotine in the aerosol.
Moreover, for a given nicotine form, liquids with higher total nicotine concentrations dis-
played higher absorption uxes that did not vary signicantly with liquid PG/VG ratio. This
indicates a tradeo between nicotine concentration and form with respect to harshness,
with signicant implications for delivery. In addition, for a given mass of inhaled nicotine,
smaller particle diameters exhibited greater absorption ux, but the eect was small
relative to nicotine form and concentration. These ndings can inform interpretation of
clinical data and design of future studies and suggest opportunities for public health
regulations centered around the concept of upper airway nicotine absorption.
FUNDING: Federal
PS3-75
USE AND PERCEPTIONS OF CIGARETTES AND E-CIGARETTES
AMONG GUATEMALAN ADOLESCENTS BEFORE AND DURING
COVID
Julia R. Budiongan1, Emily Loud1, Victoria Lambert1, José C.M. Fuentes2, Sophia Mus2,
Joaquin Barnoya2, James Thrasher1. 1University of South Carolina, Columbia, SC, USA,
2Universidad Rafael Landivar, Guatemala City, Guatemala.
Signicance: Guatemala is one of a few countries where the sale of e-cigarettes
(ecigs) is unregulated, and before COVID-19, e-cigarettes use was much more popular
than smoking among adolescents. This study aimed to evaluate the changes in use
and perceptions of cigarettes and ecigs among Guatemalan adolescents from 2019 to
2020, during the height of the COVID-19 pandemic. Methods: High school students
in Guatemala City were surveyed May-September 2019 and August-December 2020.
Students reported use of and susceptibility to use cigarettes and ecigs, with responses
combined to categorize participants into 4-level use status variables for each product:
non-susceptible never smokers/vapers (reference group); susceptible never smokers/
vapers; tried but not current smokers/vapers; and current smokers/vapers. Students were
asked about the harm, addictiveness, and social acceptability of ecigs and smoking,
assessed separately. By subtracting the response for ecigs from that for cigarettes, we
derived measures of relative harm, relative addictiveness, and relative social acceptabil-
ity. Separate logistic models that adjusted for school clustering regressed the prevalence
of smoking and ecig use on survey year. Separate linear models regressed each of the
perceived relative harm, addictiveness, and social acceptability measures on survey
year, while including as covariates sociodemographics, cigarette and ecig use, friend
and parent use, and sensation seeking. Results: From 2019 (n=2700) to 2020 (n=1836),
the prevalence of current smokers (8% to 3%, p=<0.001) and ecig use (27% to 14%,
p=<0.001) decreased. Also, students interviewed in 2020 vs 2019 thought that ecigs
were more harmful than cigarettes (b=-.13, p<.01) and more addictive than cigarettes
(b=-.06, p<.05). The relative harm (52% to 48%, p=0.003), addictiveness (28% to 22%,
p<0.001), and social acceptability (7% to 5%, p=0.015) of cigarettes compared to ecigs
decreased from 2019 to 2020. Compared to non-susceptible students, susceptibility
to and use of ecigs was positively associated with perceiving that cigarettes are more
harmful, more addictive, and less socially acceptable than ecigs. Smokers perceived
ecigs as relatively more addictive and less socially acceptable than cigarettes. Conclu-
sion: The COVID-19 pandemic appears to have reduced smoking and ecig use among
Guatemalan adolescents. As students return to school, interventions may be needed
to ensure that tobacco use does not increase.
FUNDING: Federal
PS3-76
LATENT TRANSITION ANALYSIS OF TOBACCO USE
FREQUENCIES FOR MULTIPLE PRODUCTS IN US ADULTS
Ritesh Mistry1, Irina Bondarenko1, Rafael Meza1, Andrew F. Brouwer1, Jihyoun
Jeon1, David Levy2, Michael R. Elliott1, Jeremy M. G. Taylor1, Jana Hirschtick1, Nancy
Fleischer3. 1University of Michigan, Ann Arbor, MI, USA, 2Georgetown University Medical
Center, Silver Spring, MD, USA, 3University of MI, Ann Arbor, MI, USA.
Background: Given the evolving market of various tobacco and nicotine products, re-
search is needed to understand population-based transitions in tobacco use frequencies
across many products. Methods: We used Waves 1-4 PATH Study data for adult ever
established tobacco users at baseline (n=12,358), accounting for survey design and
weights. We conducted latent transition analysis of current use frequencies for nine
tobacco products: cigarettes, traditional cigars, cigarillos, ltered cigars, pipes, e-prod-
ucts, traditional smokeless tobacco (loose snus, moist snu, dip, spit, and chewing
tobacco), snus pouches, and hookah. We identied latent states of use and one-wave
transitions. Multinomial logistic regression identied demographic factors associated
with transitions. Results: We identied seven latent states: non-current=42%; daily cig-
arette=29.7%; non-daily cigarette=9.8%; daily cigarette and polytobacco (DCPT=7.4%),
daily smokeless tobacco (SLT)=4.9%; non-daily cigar=3.2%; and daily e-product
and non-daily cigarette (DENC=2.4%). Non-current use was most persistent (98.8%
remained non-current), followed by daily SLT (96.2%) and daily cigarette (93%) use.
Among daily cigarette use, 2.2% transitioned to non-daily cigarettes, 1.7% to DENC, and
2.2% to non-current use. Among DENC, 87.4% did not transition, 7.3% transitioned to
daily cigarette, and 3.8% to non-current use. Non-daily cigarette use was less persistent
(83.0% did not transition); 4.6% transitioned to daily cigarette and 10.9% to non-cur-
rent use. DCPT was least persistent (75.7% did not transition); 15.6% transitioned to
daily cigarette, and 0.3% to non-current use. Young adults were more likely than older
adults to transition from daily cigarette or DCPT to DENC and less likely to transition to
non-daily cigarette or non-current use. Lower socioeconomic status groups were less
likely to transition from daily cigarette or DCPT to non-daily cigarette use or DENC and
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
more likely to relapse. Non-Hispanic Blacks were more likely than whites to transition
from daily cigarette to DCPT and less likely to transition to DENC. Conclusions: Latent
states consisted of primary cigarette, cigar, ENDS and SLT use, secondary cigarette
use, and polytobacco use. We identied important transitions, which were associated
with demographics and may inuence disparities.
FUNDING: Federal
PS3-77
ASSOCIATIONS OF SENSATION-SEEKING AND CANNABIS
INTOXICATION TO DAILY “CHASING” OF CANNABIS WITH
TOBACCO
Delaney Dunn1, Sixia Chen2, Summer Frank-Pearce3, Robin Mermelstein4, Ryan
Vandrey5, Donald Hedeker6, Andrea Villanti7, Amy Cohn3. 1Oklahoma State Univer-
sity, Stillwater, OK, USA, 2University of Oklahoma Health Sciences Center, Oklahoma
City, OK, USA, 3TSET Health Promotion Research Center, Oklahoma City, OK, USA,
4Institute for Health Research and Policy, Chicago, IL, USA, 5Johns Hopkins University,
Baltimore, MD, USA, 6The University of Chicago, Chicago, IL, USA, 7University of VT,
VT Center on Behavior and Health, Burlington, VT, USA.
Signicance: Cannabis and tobacco co-use has increased among young adults,
however factors associated with dierent types and patterns of co-use are still not well
understood. Using tobacco shortly after cannabis (i.e., chasing) has been hypothesized to
prolong and/or intensify the cannabis high. Personality characteristics that are associated
with cannabis and tobacco use, like sensation-seeking, may inuence types of co-use.
This study assessed the association of baseline sensation-seeking characteristics
with episode-level cannabis chasing and the association between cannabis chasing
with episode-level cannabis intoxication ratings. Method: Ninety-seven young adult
co-users (Mage = 21.3 years, 57.7% male, 49.5% White) completed the 4-item Brief
Sensation-Seeking Scale at baseline and thrice daily Interactive Voice Response (IVR)
surveys of cannabis and tobacco use and co-use for 28 consecutive days, corresponding
to four epochs (Morning, Afternoon, Evening and Late Night). IVR surveys asked about
order of tobacco and cannabis use and perceived cannabis intoxication in each episode
of use. Chasing was dened as reporting tobacco use after cannabis use in episodes
when co-use was reported. Sequential multiple imputation was used to account for
missing data. Models were t using imputed data les, regressing the total number of
chasing episodes on sensation-seeking and episode-level cannabis intoxication on
chasing. Results: Baseline sensation seeking did not predict chasing, b = 0.57, p =
0.40 and chasing did not predict increased episode-level intoxication, b = -0.15, p = .49.
In exploratory analysis, cigarette smoking in an episode was associated with increased
odds of reporting chasing in that episode (OR = 3.01, p < .01). Conclusion: Young adults
who are high and low in sensation-seeking are equally likely to engage in chasing and,
counter to theory, chasing did not increase self-reported cannabis intoxication ratings
obtained during real-time daily monitoring. Findings reveal cigarettes are largely the
product used in chasing and nding may inform messaging to reduce tobacco use and
prevent initiation of tobacco use among young adults who use cannabis.
FUNDING: Federal
PS3-78
CO-OCCURING CANCER RISK BEHAVIORS AMONG SEXUAL AND
GENDER MINORITY CIGARETTE SMOKERS
Christopher W. Wheldon, Jordan Howe, Caitriona Carolan, Maria Rincon. Temple
University, Philadelphia, PA, USA.
Signicance: Sexual and gender minority (SGM) populations use tobacco at higher rates
than their heterosexual peers. The degree to which cancer risk behaviors occur more
generally among SGM populations is not well understood. The purpose of this study was
to identify prevalent cancer risk behaviors among SGM smokers and determine factors
predictive of higher risk. Methods: This was a secondary analysis of the Pennsylvania
LGBTQ Health Needs Assessment. The survey was elded between March and May
of 2020 through a non-probability community-based sampling of LGBTQ adolescents
and adults in Pennsylvania. Standard measures of current cigarette use were used.
Other standard measures of cancer risk behaviors including (1) alcohol use, (2) fruit/
vegetable consumption, (3) physical inactivity, (4) overweight status, and (5) use of
tanning beds were applied and dichotomized into an index ranging from 0-5. This index
was regressed on predictor variables (demographic, substance use, mental health) using
OLS regression. Results: The analytic sample (N=5,308) was primarily non-Hispanic
white (85.4%), cisgender (70.8%), and identied as gay/lesbian (53.5%). Approximately
14.5% were current smokers. The prevalence of heavy alcohol use (51.4% vs. 31.7%),
inadequate fruit/vegetable consumption (92.1% vs. 85.1%), physical inactivity (83.6%
vs. 79.4%), and tanning (9.7% vs. 4.8%) were greater among smokers compared to
non-smokers. On average, respondents reported 3 out of 5 risk behaviors. Non-binary
gender (vs. cis-man) (beta = -.12, p<.01), current marijuana use (beta = .08, p=.03),
and use of avored tobacco (beta = .11, p=.01) were independently associated with
the number of cancer risk behaviors among current cigarette smokers. Mental health
variables were uncorrelated with the cancer risk index. Conclusion: Cancer risk behav-
iors co-occurred among SGM cigarette smokers. The use of multiple health behavior
change interventions are needed and should address other substance use behaviors
(e.g., marijuana and avored tobacco).
FUNDING: Unfunded
PS3-79
TOBACCO WHACK-A-MOLE - ASSESSING CIGAR AND
OTHER COMBUSTIBLE TOBACCO PRODUCT USE AMONG A
NATIONALLY-REPRESENTATIVE SAMPLE OF YOUNG ADULTS
Kymberle Landrum Sterling1, Katherine Masyn2, Stephanie Pike Moore3, Eugenia
Lee1, Erika Trapl3, Craig Fryer4, Doug Gunzler3, Ce Shang5. 1University of Texas Health
Sciences Center, School of Public Health, Dallas, TX, USA, 2Georgia State University
School of Public Health, Atlanta, GA, USA, 3Case Western Reserve University, Cleve-
land, OH, USA, 4University of MD College School of Public Health, College Park, MD,
USA, 5The Ohio State University, Columbus, OH, USA.
Signicance. Little ltered cigars and cigarillos (LCCs) are often consumed infrequently,
co-administered with marijuana, and concurrently used with other tobacco products.
Relying on estimates of past 30-day prevalence, which often captures single-product
use and guides regulatory policy actions, may under-estimate the dynamic and complex
pattern of intermittent LCC use and co-use with other tobacco products. Using broader
recency (i.e., time since last use) categories and assessing product use modality (e.g.,
“blunt” with marijuana) may more accurately capture the variability in young adults’ LCC
use patterns and inform tobacco regulatory policy decisions. Methods. We estimated
the weighted prevalence of distinct LCC user groups across product modality and
recency (i.e., within the past 1 - 6 months) using data from a nationally representative
sample of 1063 young adults (mean age=26, range 18 to 34) who were a part of the
C’RILLOS Project. Additionally, we estimated the joint occurrence of LCC and other
combustible tobacco product use (CTP, i.e., cigarettes, large cigars) across recency
categories. Results. Overall, 15 mutually exclusive groups of LCC users were observed.
Additionally, 16 ever use patterns of LCC, and other CTP were observed. Of those, the
polytobacco use pattern of LCCs used with its tobacco, LCCs as “blunts”, and cigarettes
(21%) was the most common. Additionally, the data revealed “on-o” patterns of LCC
and other CTP use. Among our sample of past 30-day LCC users (n=195), 17.4%
reported LCC-only use. Over half (50.3%) reported dual use of LCCs with cigarettes or
large cigars during the past 30-days. Further, over a third (32.4%) of past 30-day LCC
users reported smoking cigarettes or large cigars within the past 3-6 months before
the survey. Conclusions. Our sample of young adults had unique proles of LCC use
behaviors and dynamic cycles of product use, discontinuation, and re-uptake. Smoking
behavior assessment can impact tobacco policy decisions. Product standards enact-
ed on a single product may have downstream eects on the assessment and use of
another product (i.e., Tobacco Whack-a-mole). Surveillance measures that accurately
capture the dynamic nature of multiple tobacco product use behaviors in young adults
are needed to inform policy eorts.
FUNDING: Federal
PS3-80
THE EFFECT OF RACE ON THE ASSOCIATION BETWEEN
ADVERSE CHILDHOOD EXPERIENCE (ACES) AND SMOKING
CESSATION OUTCOMES
Laili K. Boozary1, Sarah J. Ehlke2, Hairong Song1, Chaelin K. Ra2, Adam C. Alexan-
der2, Jasmin Kurien2, Michael S. Businelle2, Darla E. Kendzor2. 1University of Oklahoma,
Norman, OK, USA, 2University of Oklahoma Health Sciences Center, Oklahoma City,
OK, USA.
Signicance: Adverse childhood experiences (ACEs) are linked with poor smoking
cessation outcomes. However, little is known about the interrelations among race, ACEs,
and smoking cessation. Methods: Participants (N=275) were adults who enrolled in the
same standard tobacco cessation treatment, the Tobacco Treatment Research Program.
At baseline, participants self-reported their sociodemographic characteristics, tobacco
use history, the Heaviness of Smoking Index (HSI), and the ACEs questionnaire which
assesses 8 domains of abuse and dysfunction experienced before 18 years of age [0-8].
Self-reported, carbon-monoxide veried 7-day smoking abstinence was assessed at 4,
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
12, and 26 weeks after a scheduled cessation attempt. Generalized mixed eect model
was employed to evaluate the impact of race and ACEs on smoking cessation over
time. Results: Participants were primarily female (58.5%), high school educated or less
(50.9%), non-Hispanic White race (57.8%; 29.8% Black), and had a mean age of 51.5
years (SD=12.2). Participants’ mean ACEs score was 3.0 (SD=2.1), and 38.9% reported
a score of ≥4; neither diered by race. Results showed a signicant main eect of ACEs
on cessation (p=0.05) such that higher ACEs was associated with a lower likelihood of
achieving abstinence. Race was also signicantly associated with cessation (p=0.04),
such that Whites had a higher probability of achieving abstinence than non-Whites.
Results showed a signicant ACEs by race interaction (p=0.04), such that non-Whites
with higher ACEs had an increased probability of abstinence, whereas higher ACEs
among Whites was associated with a greater probability of non-abstinence. Notably,
Whites had signicantly higher HSI scores and were more likely to endorse substance
abuse in the household compared with non-Whites. Conclusions: The positive relation
between non-White race and smoking cessation may be related to racial dierences in
dependence and the types of ACEs endorsed. Further research is needed to characterize
culturally unique factors, such as lower exposure to household substance abuse, which
may attenuate the adverse impact of ACEs on smoking cessation.
FUNDING: Federal; State
PS3-81
CROSS-SECTIONAL ASSOCIATIONS OF ANXIETY SYMPTOMS
WITH MENTHOL CIGARETTES AND E-LIQUIDS AMONG YOUNG
ADULT E-CIGARETTE USERS
Sam Cwalina1, Jessica Barrington-Trimis1, Lauren Pacek2, Jennifer Unger1, Mary Ann
Pentz1. 1University of Southern CA - Keck School of Medicine, Los Angeles, CA, USA,
2Duke University School of Medicine, Durham, NC, USA.
Signicance: Menthol tobacco use is associated with anxiety symptoms among young
adults (YAs), but it is not clear whether this association is consistent across products.
It is possible that YAs use nicotine to self-medicate anxiety symptoms and that men-
thol enhances the desired eects of nicotine. To better understand this relationship,
we evaluated the association of anxiety symptoms with use of menthol e-cigarettes
(e-liquids) and cigarettes, the two most commonly used tobacco products among YAs.
Methods: U.S. YA past 30-day e-cigarette users (18-25 years old; 47% female; 62%
non-Hispanic white) were recruited via Amazon MTurk to provide anonymous survey
data between May-July 2019 (n=2339). Logistic regression evaluated the associations
of menthol e-liquid (vs. non-menthol) and menthol cigarettes (vs. non-menthol) with
anxiety symptoms (GAD-7), adjusting for gender, sexual orientation, race/ethnicity,
subjective nancial situation, other tobacco product use, nicotine dependence, canna-
bis use, alcohol use, and frequency of e-cigarette use. Results: Overall, 35% (n=813)
reported any anxiety symptoms. Nearly half (43%; n=1013) used menthol e-liquids;
among cigarette smokers (N=1435, 61% of the sample), 67% (n=955) used menthol cig-
arettes. Menthol cigarette use (vs. non-menthol) was associated with anxiety symptoms
(aOR=1.32 [95% CI: 1.03-1.70]); menthol e-liquid use was not associated with anxiety
symptoms (aOR=0.89 [95% CI: 0.74-1.08]). Conclusions: Use of menthol cigarettes,
but not menthol e-liquids, was associated with anxiety symptoms. It is possible that
factors other than self-medication may explain the signicant association with menthol
cigarettes, such as sensory properties unique to combustion or exposure to menthol
cigarette advertising.
FUNDING: Federal; State
PS3-82
DID YOUTH AND YOUNG ADULT E-CIGARETTE USERS SWITCH
TO MENTHOL FLAVOR AFTER FEDERAL RESTRICTIONS ON
FLAVORED CLOSED-SYSTEM E-CIGARETTES? RESULTS FROM
A LONGITUDINAL STUDY
Jennifer M. Kreslake, Katie M. O’Connor, Daniel Stephens, Donna M. Vallone, Eliza-
beth C. Hair. Truth Initiative, WA, DC, USA.
In February 2020, FDA implemented guidance to restrict avors in closed system e-cig-
arettes to menthol and tobacco only, banning other characterizing avors such as fruit,
mint, or candy. This study followed avor selections in a longitudinal cohort of youth and
young adult e-cigarette users to identify avor-switching behaviors following the imple-
mentation of FDA guidance. A sample of 203 respondents aged 15-24 who were current
users of mint-, fruit-, candy- or other non-menthol avored (“characterizing-avored”)
e-cigarettes at baseline (February-May 2019 or September-December 2019) completed
a follow-up survey after the implementation of FDA guidance on avored e-cigarettes
(September 2020-March 2021). Latent class analysis was used to detect the probability
of within-subject change from non-menthol characterizing-avored e-cigarettes into
one of 4 classes: (1) continued non-menthol characterizing-avored e-cigarette use;
(2) continued non-menthol characterizing-avored e-cigarette use with the addition of
menthol e-cigarettes; (3) switch to menthol e-cigarettes only (no other characterizing
avors); (4) cessation of e-cigarette use. Bootstrap likelihood ratio tests were used to
determine the number of classes in the model (entropy for 4 classes = 0.903). Of the
203 non-menthol characterizing avored e-cigarette users at baseline, 190 continued
to use non-characterizing avors at follow-up, but not menthol. Only 6% of respondents
made any changes to their avor use by follow-up: 7 switched to menthol avor only; 3
continued non-menthol characterizing avor use with the addition of menthol; and 3 had
stopped using e-cigarettes. Results suggest that the 2020 FDA restriction on avors in
closed-system e-cigarettes is not eective in preventing e-cigarette use among youth
and young adults. Flavor bans should be extended to all e-cigarette device types to
prevent the sale of products with youth appeal.
FUNDING: Unfunded
PS3-83
PROSPECTIVE ASSOCIATION BETWEEN EXCLUSIVE USE
OF E-CIGARETTES OR NICOTINE REPLACEMENT THERAPY
BY PAST-YEAR EX-SMOKERS WITH SMOKING STATUS AND
RELAPSE AT ONE YEAR: FINDINGS FROM THE SMOKING
TOOLKIT STUDY
Lion Shahab, Sarah E. Jackson, Claire Garnett, Emma Beard, Jamie Brown. University
College London, London, United Kingdom.
Signicance: Long-term e-cigarettes (EC) use by ex-smokers is increasing. This could
reduce smoking relapse risk, by satisfying ex-smokers’ need to obtain nicotine from
other sources, or it may promote relapse by maintaining nicotine dependence and
through its behavioral similarity to smoking. This study aimed to assess associations
between exclusive EC use by past-year ex-smokers with smoking status/relapse at
1-year follow-up compared with (i) a behavioral control group, past-year ex-smokers
with exclusive nicotine replacement therapy (NRT) use, and (ii) past-year ex-smokers
with no product (NP) use. Methods: Data came from representative baseline surveys
of adults in England, collected monthly from 04/2015 to 06/2020, with follow-up 1 year
later. Eligible participants were past-year ex-smokers with exclusive EC (N=83), NRT
(28) or NP (122) use at baseline, with follow-up data. Main outcomes were smoking
(current/ex-smoker) and (intermittent) relapse (relapsers/continuous abstainer) status
at 1 year follow-up. Multiple logistic regressions compared groups on outcomes,
adjusted for baseline socio-demographic, smoking and quit-attempt related charac-
teristics. Results: Of past-year ex-smokers, with median abstinence of 3-6 months at
baseline, 42.2% (95%CI 32.1-52.9) with exclusive EC use, 39.3% (95%CI 23.6-57.6)
with exclusive NRT and 32.0% (95%CI 24.3-40.7) with NP use were smokers at 1 year
follow-up. Further, 51.8% (95%CI 41.2-62.2) of baseline ex-smokers with exclusive EC
use, 60.7% (95%CI 42.4-76.4) with exclusive NRT use and 44.3% (95%CI 35.8-53.1)
with NP use had a relapse since baseline. There were no signicant dierences between
groups for either outcome in adjusted analysis, although data were insensitive (Bayes
factors 0.58-1.39). Being a smoker or relapser at 1-year follow up was independently
associated with greater urges to smoke (aORs 1.72/1.54, p<0.001) and shorter quit
attempt length (aORs 0.77/0.64, p<0.05). Conclusion: In England, exclusive use of
EC by ex-smokers was not independently associated with a greater risk of smoking or
relapse one year later compared with NRT or NP use. However, data were insensitive
to rule out associations with relapse reported in the literature.
FUNDING: Nonprot grant funding entity
PS3-84
POPULATION-LEVEL ASSOCIATIONS BETWEEN E-CIGARETTE
DESIGN FEATURES AND CIGARETTE INITIATION BEHAVIORS
AMONG YOUTH IN THE UNITED STATES: LONGITUDINAL
FINDINGS FROM THE PATH STUDY 2013-2019
Karin Kasza1, Young Sik Seo1, David Hammond2, Cheryl Rivard1, K. Michael
Cummings3, Maciej Goniewicz1, Georey Fong2, Andrew Hyland1. 1Roswell Park
Comprehensive Cancer Center, Bualo, NY, USA, 2University of Waterloo, Waterloo,
ON, Canada, 3Medical University of South Carolina, Charleston, SC, USA.
Signicance: The population-level impact of e-cigarettes depends in large part on their
eects on combustible tobacco cigarette smoking. We evaluated whether e-cigarette
design features are related to cigarette smoking initiation among youth e-cigarette users
in the US between 2013-2019. Methods: Data were from youth (ages 12-17) noncurrent
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
cigarette smokers who used e-cigarettes in the past 30 days and participated in the
PATH Study (n=983 observations). Outcomes were initiation of past 30-day cigarette
smoking (i.e., transition from noncurrent smoking/never smoking to past 30-day smoking)
and initiation of frequent cigarette smoking (i.e., transition from noncurrent smoking to
smoking on 20+ days in the past 30 days). E-cigarette design feature predictors were
avor (tobacco; menthol/mint; nontobacco, nonmenthol/mint; combination of tobacco,
menthol/mint, other avors), device type (disposable, cartridge, tank), and year of
assessment (categorical variable, used as a proxy for nicotine concentration/formu-
lation). We used generalized estimating equations to evaluate associations between
e-cigarette design features and cigarette initiation using multiple pairs of assessments,
adjusted for demographic characteristics, and weighted to be nationally representative.
Results: Among youth noncurrent smokers who used e-cigarettes in the US, use of only
non-tobacco, non-menthol/mint avor e-cigarettes (compared to use of only tobacco
avor e-cigarettes) was associated with lower rates of initiating past 30-day cigarette
smoking (16% vs 44% initiation among all noncurrent smokers; AOR=0.21, 95%CI: 0.06-
0.71; 12% vs 31% initiation among the subset of never smokers; AOR=0.31, 95%CI:
0.03-2.89), and with lower rates of initiating frequent cigarette smoking (2% vs 4%
among all noncurrent smokers; AOR=0.30, 95%CI: 0.05-1.64). Conclusion: Findings
suggest that future research should examine if use of non-tobacco, non-menthol/mint
avor e-cigarettes among youth e-cigarette users may be protective against initiating
cigarette smoking, alongside consideration of population data showing that non-tobacco
avoring in e-cigarettes is strongly associated with initiation of e-cigarette use itself.
Funding: This research was supported by the National Institute On Drug Abuse of the
National Institutes of Health under Award Number R21DA051446. The content is solely
the responsibility of the authors and does not necessarily represent the ocial views of
the National Institutes of Health.
FUNDING: Federal
PS3-85
SOCIODEMOGRAPHIC AND SMOKING CHARACTERISTICS
ASSOCIATED WITH BELIEF THAT ORGANIC TOBACCO
PRODUCTS ARE LESS HARMFUL THAN CONVENTIONAL
TOBACCO PRODUCTS AMONG US ADULTS AND SMOKERS -
RESULTS FROM WAVE 4 OF THE PATH STUDY
Cara Drake1, Olivia Wackowski2, Stefanie K. Gratale3, Ollie Ganz3, Pamela
Ohman-Strickland3, Jennifer Pearson1. 1University of Nevada, Reno School of Public
Health, Reno, NV, USA, 2Rutgers School of Public Health, Piscataway, NJ, USA,
3Rutgers University, New Brunswick, NJ, USA.
SIGNIFICANCE: Previous research has established that “organic” descriptors on
cigarette packaging and advertising convey misleading reduced harm messages to
consumers. This study describes the prevalence and sociodemographic/psychosocial
correlates of the misbelief that organic tobacco products are less harmful than conven-
tional tobacco products among US adults, US cigarette smokers, and Natural American
Spirit (NAS) cigarette smokers, a brand that uses the “organic” descriptor. METHODS:
Data were drawn from Wave 4 (2017/18) of the Population Assessment of Tobacco and
Health (PATH) Study (n= 33,822 adults ages 18+). We used cross-sectional weights to
generate point estimates and logistic regressions to model the odds of belief that organic
tobacco are “less harmful” vs. “about the same” or “more harmful”. RESULTS: Overall,
11.3% (95% CI: 10.7, 11.8) of all adults, 19.7% (95% CI 18.6, 20.9) of all smokers, and
37.3% (95% CI: 33.1, 41.6) of NAS smokers believe that organic tobacco products are
less harmful than regular tobacco products. Men were more likely than women (aOR
1.10, 95% CI: 1.04,1.17) and former (aOR 1.45, 95% CI: 1.33,1.58) and current smokers
(aOR 2.07, 95% CI: 1.90,2.25) were more likely than non-smokers to hold this belief.
After controlling for sociodemographics, smokers who believe their own brand might
be less harmful (aOR 2.84, 95% CI: 2.45, 3.31), believe some types of cigarettes are
less harmful (aOR 4.40, 95% CI: 3.92, 4.93), or who smoke NAS (aOR 2.5, 95% CI:
2.06, 3.22) had higher odds of believing that organic tobacco products are less harmful.
Among NAS smokers, women had two times higher odds of holding this belief than
men (95% CI: 1.27, 3.14) and those who believe NAS might be less harmful than other
brands had 11 times higher odds (95% CI: 7.39, 18.47) of this belief. CONCLUSIONS:
A signicant proportion of US adults, US smokers, and especially NAS smokers believe
that organic tobacco products are less harmful. This misunderstanding is associated
with similar false beliefs (i.e., that one’s own brand is less harmful than other brands),
and consistent with the conclusion that the “organic” descriptor is misleading.
FUNDING: Federal
PS3-86
SOCIAL MEDIA INFLUENCERS PROMOTING VAPES -
ADOLESCENT EXPOSURE AND ASSOCIATIONS WITH DEGREE
OF USE
Kristen Holtz, Andrew Simkus, Eric Twombly, Morgan Fleming, Nicole Wanty. KDH
Research & Communication, Atlanta, GA, USA.
In this presentation, we explore the extent to which adolescents are exposed to inu-
encers promoting electronic nicotine devices (ENDS) on social media despite bans
implemented on several platforms, as research shows that marketing exposure to
ENDS may predict future initiation. We also sought to determine whether the frequen-
cy of this exposure is associated with higher degrees of ENDS use and susceptibility
to ENDS initiation. Our study population included 1,100 adolescents, aged 13-17
across the United States, who participated in an online survey we created to explore
vape-related attitudes and behaviors, including social media use. We found that 49%
of respondents reported seeing vape promotions at least a few times in the past month,
and 25% reported weekly exposure. Further, of the 183 respondents who reported only
regularly checking Facebook and Instagram, which have established bans in place,
23% still reported weekly exposure in the past month. These percentages reveal the
pervasiveness of a marketing strategy which exploits restriction loopholes and highlights
the persisting need for clear, robust policies and regulations against such inuencer
posts. To assess whether exposure to inuencers promoting ENDS varied incrementally
with increased degrees of ENDS use, we ran pairwise t-tests between four proles of
varying degrees of reported ENDS usage: Never-users, who reported no likelihood of
initiation; Susceptible-users, who reported any likelihood of future initiation; Light-users,
who reported vaping nine or fewer days in the past month; and Regular-users, who
reported vaping ten or more days in the past month. We found that susceptible-users,
light-users, and regular-users were all signicantly more likely to be exposed to weekly
promotion of ENDS by inuencers than never-users, all with (p< 0.001). While limited
to association rather than causality, it is probable that adolescents who are more curi-
ous about vaping or have already initiated ENDS use may be more likely to seek out
inuencers promoting ENDS. It is also probable that ENDS manufacturers target more
susceptible youth to expand their market.
FUNDING: Federal
PS3-87
A PILOT RANDOMIZED CONTROLLED TRIAL OF AN AUTOMATED
AND COUNSELOR-DELIVERED TEXT MESSAGING PROGRAM
FOR VAPING CESSATION
Lorien Abroms1, Nandita Krishnan2, Daisy Le2, Amanda Graham3, Jasjit Ahluwalia4,
Carla Berg2. 1George WA University, WA, DC, USA, 2GWU, Washington, DC, USA,
3Truth Initiative, WA, DC, USA, 4Brown University School of Public Health, Providence,
RI, USA.
Introduction: There is a paucity of evidence-based interventions for vaping cessation.
Automated text messaging programs are eective for smoking cessation, and initial ev-
idence indicates for vaping cessation. Methods: This pilot 3-arm randomized controlled
trial tested the feasibility and acceptability of Quit the Vape (QTV), a text messaging
program for vaping cessation informed by social cognitive theory. One intervention arm
consisted of daily automated text messages (QTV); the other included both automated
and counselor texts (QTV-C), which were sent out twice/week by a trained counselor
in addition to the automated ones; the control group received 1 text. We randomized
46 participants from a young adult cohort to QTV (n=15), QTV-C (n=15), or a control
text (n=16). Primary outcomes of were measured at 1-month. Results: The average
age of participants was 27.5 years. The majority were male (52.2%), white (65.2%),
and past 30-day cigarette smokers (55.3%). Average number of days of e-cigarette use
was 26.3 days per month (SD=6.8). QTV-C participants interacted with the program an
average of 9.3 times (SD=13.4) while QTV participants interacted 4.9 times (SD=5.9)
(dierences were not signicant (n.s.). Opt-out rates were low for all programs (QTV:
n=3; QTV-C: n=1; control: n=1). A higher proportion of QTV participants (53.9%) found
the messages triggering than QTV-C (13.3%) or control (25%) (n.s.). Overall program
satisfaction was higher for QTV-C (53.3%) and QTV (57.1%) than for control (14.3%)
(p<.05). A higher proportion of QTV-C participants made a quit attempt (66.7%) compared
with QTV (42.9%) and control (50.0%) and a greater number reported 7-day vaping
point prevalence abstinence (26.7%) than QTV (7.1%) or control (7.1%) (n.s.). Con-
clusions: Both programs were feasible, and participants reported signicantly higher
satisfaction with the intervention programs than control. QTV-C trended towards higher
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
engagement and more favorable quitting outcomes than QTV, but dierences were not
signicant. A larger trial is needed to assess the eectiveness of various types of text
messaging for vaping cessation.
FUNDING: Unfunded
PS3-88
CHARACTERIZING TWITTER CONVERSATION ABOUT
E-CIGARETTE USE PREVENTION CAMPAIGNS
Miao Feng, Sherry Emery, Anna Kostygina, Hy Tran. NORC at the University of
Chicago, Chicago, IL, USA.
Although smoking rates in the US have decreased, the declines in cigarette sales are
oset by sharp increases in the consumption of other tobacco products including vaping
products. The prevalence of e-cigarette use among youth and young adults (YYA) now
exceeds that of combustible cigarettes. One of the reasons behind the rapid increase
in YYA e-cigarette use is the extensive and eective marketing of these products.
These products are increasingly aggressively marketed on social media, which are
disproportionately popular among this hard-to-reach at-risk age group. We assessed
the amount, content, sources, and engagement of Twitter content related to recent
prevention campaigns discouraging e-cigarette use. We analyze Twitter conversations
between January 2014 to October 2020 about 14 state campaigns and one national
campaign—“The Real Cost” launched by the Food and Drug Administration. Textual
analysis was employed to understand the support of and opposition to those campaigns
and explore the major themes of the tweets. Prole analysis is employed to identify
the sources of information. Lastly, we aim to understand the diusion of various types
of messages among dierent sources. In total, we collected 145,969 tweets about the
state campaigns and 472,996 tweets about the national campaign. Those messages
had a potential reach of over 2 billion Twitter users. Results indicate that awareness
of large campaigns like The Real Cost was prominent on Twitter. We nd that most
campaign messages feature health risk references and policy advocacy but mixed with
an inux of e-cigarette product promotion, and advocacy for e-cigarette, and misinfor-
mation about e-cigarette use. Results also demonstrate that e-cigarette advocates are
committed to disruptions of e-cigarette use prevention public health campaigns and
use sophisticated methods to further their goals. The study ndings provide insights for
public health agencies to develop concepts and technologies to create eective social
media campaigns preventing e-cigarette use among young adults.
FUNDING: Federal; Academic Institution
PS3-89
POPULATION-LEVEL ASSOCIATIONS BETWEEN E-CIGARETTE
DESIGN FEATURES AND CIGARETTE CESSATION BEHAVIORS
AMONG ADULTS IN THE UNITED STATES: LONGITUDINAL
FINDINGS FROM THE PATH STUDY 2013-2019
Karin Kasza1, Cheryl Rivard1, Maciej Goniewicz1, Young Sik Seo1, David Hammond2,
Georey Fong2, K. Michael Cummings3, Andrew Hyland1. 1Roswell Park Comprehen-
sive Cancer Center, Bualo, NY, USA, 2University of Waterloo, Waterloo, ON, Canada,
3Medical University of South Carolina, Charleston, SC, USA.
Signicance: The population-level impact of e-cigarettes depends in large part on their
eects on combustible tobacco cigarette smoking. We evaluated whether e-cigarette
design features are related to cigarette cessation behaviors among adult cigarette
smokers who used e-cigarettes in the US between 2013-2019. Methods: Data were from
adult (ages 18+) past 30-day cigarette smokers (at baseline) who used e-cigarettes in
the past 30 days (at baseline or follow-up) and participated in the PATH Study (n=7646
observations). Outcomes were discontinuing past 30-day cigarette smoking, making a
quit attempt, and quitting among attempters. E-cigarette design feature predictors were
avor, device type, nicotine concentration and formulation (salt-based/free-based/no
nicotine). We used generalized estimating equations to evaluate associations between
e-cigarette design features and cigarette cessation using multiple pairs of assessments
weighted to be nationally representative. Results: Daily use of e-cigarettes versus
non-daily use (at baseline or follow-up) was consistently positively associated with
cigarette cessation among adult smokers in the US. Findings for avor and device type
were generally not signicant. Relationships between nicotine concentration/formulation
and cigarette cessation varied depending on baseline/follow-up assessment; when
assessed at baseline, 22% (95%CI: 18-26%) of those using zero nicotine e-cigarettes
discontinued smoking compared to 9% (95%CI: 4-20%) of those using salt-based nic-
otine e-cigarettes; when assessed at follow-up, 13% (95%CI: 11-16%) of those using
zero nicotine e-cigarettes discontinued smoking compared to 36% (95%CI: 29-44%)
of those using salt-based nicotine e-cigarettes. Year of the study period was positively
related to cessation behaviors; rates of discontinuing smoking increased from 12%
(95%CI: 10-14%) in 2013/14 to 22% (95%CI: 20-25%) in 2018/19. Conclusion: Findings
underscore that daily use of e-cigarettes (compared to nondaily use) is associated with
greater cigarette cessation rates at the population-level in the US. Further, associations
between some e-cigarette features and cigarette cessation may depend on whether
features are assessed at baseline or follow-up, calling for assessment of inter-wave
vaping in population studies. Funding: This research was supported by the National
Institute On Drug Abuse of the National Institutes of Health under Award Number
R21DA051446. The content is solely the responsibility of the authors and does not
necessarily represent the ocial views of the National Institutes of Health.
FUNDING: Federal
PS3-90
ADOLESCENTS’ PERCEPTIONS OF NICOTINE VAPING-RELATED
SOCIAL MEDIA CONTENT AND ITS EFFECTS: A QUALITATIVE
INVESTIGATION
Erin A. Vogel1, Rhana Hashemi2, Judith J. Prochaska2. 1University of Southern Califor-
nia, Los Angeles, CA, USA, 2Stanford University, Stanford, CA, USA.
Background: Nicotine vaping content on social media is common. We interviewed
adolescents about their perceptions of nicotine vaping-related social media content and
its eects. Methods: Participants (analytic sample N=30, age 13-18, in California, 40%
male) were recruited from social media for online semi-structured interviews. Initial codes
were derived from the interview questions. Two authors discussed emerging themes in
the transcripts and revised the coding guide in an iterative process until saturation was
reached. The rst author coded the transcripts; the second author independently coded
a randomly selected 30%. Theme intercoder agreements ranged from 98.3%-99.7%.
Results: Few (8/30) reported ever vaping, most (22/30) reported exposure to vaping
in-person (e.g., in school restrooms), and most (22/30) reported exposure to vaping
on social media. Exposure to pro-vaping content was common (27/30), especially
transient content (e.g., “stories;” 13/27). Participants identied three main purposes
of social media vaping posts: showing o (21/30), documenting normal daily activity
(11/30), and selling products (7/30). Perceived eects of vaping-related content on social
media included normalization of vaping and other substance use (24/30) and increased
access to vaping products (i.e., through direct sales or by providing information about
obtaining vaping products; 3/30). Many participants (20/30) spoke of social media content
aecting others, not themselves. Adolescents’ reactions to vaping-related posts were
multiple and included indierence (22/30), disapproval (21/30), and curiosity (8/30). In
addition to pro-vaping content, most participants (20/30) had seen ads on social media
warning against the consequences of vaping and other substance use. One in 3 (10/30)
recalled seeing social media ads for vaping products. Conclusions: Among a sample of
adolescents in California, most of whom had never vaped, exposure to vaping-related
social media content was common. Non-vaping adolescents may become curious about
vaping after frequent exposure to social media content. Pro-vaping content should be
restricted on social media platforms to protect adolescents.
FUNDING: State
PS3-91
EXAMINING THE EFFECTS OF INTERNALIZING AND
EXTERNALIZING SYMPTOMS, AND GENDER, ON SUBSEQUENT
TOBACCO PRODUCT USE
Ahmad Kittaneh, Savanah Insana, William V. Lechner. Kent State University, Depart-
ment of Psychological Sciences, Kent, OH, USA.
Adolescents have demonstrated alarming rates of tobacco product use, including el-
evated rates of e-cigarette use. Past studies have examined the association between
internalizing and externalizing symptoms and tobacco initiation and past 30-day use
among adolescents. However, examining sustained tobacco use patterns may provide
insight into the relationship between internalizing and externalizing symptoms and more
problematic tobacco use patterns. The current study examined whether these variables
predict both tobacco initiation and sustained use over time across multiple tobacco
products in adolescents. 6170 tobacco-naïve youth participants were drawn from the
Population Assessment of Tobacco and Health Study, which assessed tobacco use
in young adults. Past-month internalizing symptoms were associated with increased
odds of initiating combustible cigarettes (OR = 1.27, 95% C.I. = 1.05-1.54), e-cigarettes
(1.13, 95% C.I. = 1.04-1.22), and poly-tobacco product use (1.13, 95% C.I. = 1.04-1.22).
Past-month externalizing symptoms predicted increased odds of initiating e-cigarettes
(OR = 1.20, 95% C.I. = 1.13-1.28) and poly-tobacco products (OR = 1.33, 95% C.I.
= 1.24-1.42). We observed signicant interactions between gender and internalizing
178
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
symptom scores, such that internalizing symptoms were associated with increased odds
of initiating e-cigarettes (OR = 1.26, 95% C.I. = 1.07-1.49) and poly-tobacco products
(OR = 1.29, 95% C.I. = 1.08-1.54) for females only. Internalizing symptoms were as-
sociated with increased odds of sustained combustible cigarette use (OR = 1.46, 95%
C.I. = 1.11-1.92) and poly-tobacco use (OR = 1.26, 95% C.I. = 1.06-1.50). A signicant
interaction was found between externalizing symptoms and gender, such that females
who reported greater externalizing symptoms were more likely to sustain other tobacco
product (e.g., cigar, hookah, pipe, smokeless tobacco, bidis, and kreteks) use across
multiple years (OR = 1.75, 95% C.I. = 1.13-2.72). Our ndings indicate that internalizing
and externalizing symptoms dierentially predict tobacco initiation and sustained use
across multiple tobacco products in adolescent boys and girls.
PS3-92
EXAMINING THE EFFICACY OF CONTENT REGULATION MODELS
ON TIKTOK
Brienna Rutherford1, Janni Leung2, Daniel Stjepanovic1, Gary C.K. Chan1. 1National
Centre for Youth Substance Use Research, St. Lucia, Australia, 2National Centre for
Youth Substance Use Research, St Lucia, Australia.
Introduction and Aims: User-generated vaping-related content on the social media
platform, TikTok, may inuence adolescent’s perceptions towards vaping and e-ciga-
rette use. We aimed to examine how eective TikTok’s content regulation model is at
identifying and removing content that promotes vaping.Method / Approach: Data were
collected from TikTok accounts using hashtag-based keywords on vaping related videos
(n = 802) in November, 2020. Researchers used the URLs to access these videos again,
in August, 2021, to determine whether the content was still publicly available. Results:
Of the 802 videos in the original sample, 562 (70.07%) were still publicly available.
These videos had a mean view count of 2,061,940 (SD = ±2,877,891), a mean ‘likes’
count of 297,504 (SD = ±549,551) and a mean of 2,052 (SD = ±6262) comments. This
reects a growth in viewer engagement of 1.49% for gross views and 1.05% for gross
likes. Whilst 240 (29.93%) videos were not publicly available, 33 (13.75%) of these had
been privatised by the content creator and not removed by TikTok’s content regulation
algorithms. Discussions and Conclusions: From our sample of vaping related videos,
more than half were still publicly accessible which indicates that TikTok’s current content
regulation model is awed and ineective. With previous research demonstrating that
adolescent and young adult exposure to vaping related content may have consequences
on adolescent attitudes and subsequent use, it is imperative that better content regu-
lations are implemented. Disclosure of Interest Statement: Authors have no conict
of interest to declare.
PS3-93
E-CIGARETTE PERCEPTIONS IN THE GENERAL POPULATION : A
SYSTEMATIC REVIEW
Anne-Fleur Guillemin, Philémon Aurouet, Jérôme Foucaud. French National Cancer
Institute, Boulogne-Billancourt, France.
Background: As e-cigarette (EC) use rises in the USA and EU among smokers and
non-smokers, policy issues are emerging. Several studies have shown how perceptions
inuence behavior: there have been systematic reviews on EC, but none on perceptions
with recent data on the general population, despite signicant growth in the literature
since 2016. Objectives: A systematic review of studies on EC perceptions in the gen-
eral population in the EU and USA. Methods: In line with PRISMA 2020, a search was
carried out in PubMed and PsycArticle between January 1, 2006, and May 11, 2021,
and references in previous reviews were checked. Index terms such as “EC”, “vape”,
“perception” and “beliefs” were used to locate articles in English in peer-reviewed jour-
nals. Two reviewers worked independently to screen articles on the following criteria:
documenting perceptions; general population; not industry-funded. They then extracted
data from all the studies. CASP Cohort and NIH cross-sectional study tools were used
to assess study quality. Results: The search yielded 5386 records, 51 were screened
for full text and 17 met eligibility criteria. The studies were conducted in the EU and
US, cross-sectional, ranged from 527 to 32320 participants, and mostly compared
perceptions of smokers and non-smokers. CASP and NIH found study quality to be
heterogeneous. The results show four aspects of EC perceptions: harmfulness, addiction,
health eects, and expected general benets. On harmfulness and addiction potential,
perceptions vary in time and by socio-demographic and smoking status. Perceptions of
health eects and general benets were assessed through dierent methods, limiting our
results. Conclusion: This systematic review is the rst to focus on perceptions of EC in
the general population. It contributes to reection on the dierent trajectories of vaping
users and provides insights into perceptions of EC among smokers and non-smokers.
Finally, it identies avenues of work for a larger study in France with a new analysis
grid on the general population’s perception of EC.
PS3-94
IDENTIFYING A TYPOLOGY OF TOBACCO FLAVOUR
PREFERENCES AMONG ADULT SMOKERS IN SINGAPORE
Jeong Kyu Lee. National University of Singapore, Singapore, Singapore.
Signicance: While many consumers of tobacco products have dierent avour prefer-
ences, little is known about their prevalence and patterns of tobacco avour preferences
in a multi-ethnic Asian population. The primary aim of the study is to identify a typology of
tobacco avour preferences among adult smokers in Singapore using latent class anal-
ysis (LCA). Methods: Data were from the 2019 Singapore Smokers Survey (N =2,015,
ages 19 - 69 inclusive). Latent class analysis was performed to dierentiate subgroups
of smokers using eight dichotomous items (yes/no) on tobacco avour preferences
(full or strong, mild, menthol, cooling sensation, capsule, fruity, sweet, clove). Further,
multinomial logistic regression analysis was used to assess correlates of the tobacco
avour preference class membership. Socio-demographic characteristics (gender, age,
ethnicity, education, housing type, and marital status), health status and smoking status
(daily versus occasional smoking) were entered into the regression model to examine
as correlates of the class membership. Results: Results indicated four classes (sub-
groups) of tobacco avour preferences among adult smokers in Singapore: 1) multiple
avour preference, 2) mild avour preference, 3) full and strong avour preference,
and 4) menthol avour preference. Menthol Flavour class was the biggest subgroup of
smokers (50%), followed by Full and Strong Flavour class (23%) and Mild Flavour class
(21%). Multiple Flavour class (6%) was the smallest subgroup that prefers a range of
avours including menthol, cooling sensation, fruity and sweet avour. The multinomial
logistic regression analysis found that gender, age, ethnicity and smoking status were
unique predictors of the tobacco avour preference class membership. Conclusion:
This study provides novel evidence for heterogeneous subgroups of adult smokers who
prefer dierent tobacco avour preferences. The ndings oer important implications
for future policies to enact robust regulations regarding avoured tobacco products
particularly in multi-ethnic Asian settings.
FUNDING: Academic Institution
PS3-95
NEWS MEDIA COVERAGE OF COVID-19 LOCKDOWN BAN IN
SOUTH AFRICA
Catherine O. Egbe1, Senamile P. Ngobese1, Hannah Barca2, Eric Crosbie2. 1Alcohol,
Tobacco and Other Drug Research Unit, South African Medical Research Council,
Pretoria, South Africa, 2School of Community Health Sciences, University of Nevada,
Reno, NV, USA.
Signicance: The South African government imposed a strict COVID-19, which included
a temporary ban on the sale of tobacco/nicotine products for 20 weeks (27 March to
August 17, 2020). The initial reason for placing the ban was due to the classication
of tobacco/nicotine products as non-essential items. Early ndings of a link between
tobacco smoking and COVID-19 severity led to extension of the ban in order to protect
the country’s fragile health system. This study investigates news media coverage of
arguments and activities in relation to the lockdown tobacco ban. Methods: We collected
and reviewed 187 news media articles in Google published between 26 March to 15
August 2020 using standard snowball searches. We conducted a thematic analysis using
NVivo version 12.Results: Eight major themes were identied in the data: controversy
surrounding the classication of tobacco products, anti-tobacco sales ban arguments
and activities, pro-tobacco sales ban arguments and activities, tobacco companies’
tactics during the ban, tobacco/nicotine products marketing during ban, coverage of
litigation brought against the ban, legal problems during the ban and issues consid-
ered in placing/lifting the ban. Anti-sales ban arguments include the adverse eect of
nicotine withdrawal symptoms on smokers, loss of jobs and the expansion of the illicit
cigarette markets. Pro-sales ban arguments include the importance of protecting the
health system from collapse as a result of rising COVID-19 hospitalization, benets of
cessation, and the need for non-smokers to be protected from exposure to secondhand
smoke. Conclusion: There was more reporting on the negative eects of the ban and
the agitation to lift the ban than its benets. The media was used as a tool to mobilize
citizens against the ban. The benets of the ban, including smoking cessation did not
receive enough support in the media. Health interventions should strategically include
the use of the media to educate and get citizens’ support.
FUNDING: Academic Institution
179
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-96
TERMS TOBACCO USERS EMPLOY TO DESCRIBE E-CIGARETTE
AEROSOL
Mohammad Ebrahimi Kalan, Allison J. Lazard, Jennifer Mendel Sheldon, Callie A.
Whitesell, Marissa G. Hall, Kurt M. Ribisl, Noel T. Brewer. University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA.
Background. The scientic term for the material inhaled from a vaping device is
aerosol, but it is unclear whether the public uses this term. To inform tobacco control
communication eorts, we sought to understand what tobacco users call e-cigarette
aerosols. Methods. Participants were a national convenience sample of 1,562 US adults
who used e-cigarettes, cigarettes, or both (dual users). Conducted in spring 2021, the
online survey asked participants to describe what “people inhale and exhale when they
vape” And to evaluate FDA’s required nicotine addiction warning for e-cigarettes. The
survey then randomly assigned participants to see warning statements containing the
term aerosol or vapor (e.g., “E-cigarette aerosol/vapor contains nicotine, which can
lead to seizures”). Results. In open-ended responses, the most common terms were
vapor (28%) and smoke (20%), but rarely aerosol (0.2%). In close-ended responses,
the most common terms were again vapor (57%) and smoke (22%), but infrequently
aerosol (2%). In closed-ended responses, use of the term vapor was more common
among people who were older, white, gay or bisexual, college-educated, or non-smok-
ers (all p<.05). People who chose term vapor over smoke found the FDA warning to
be less on three measures (discouragement, negative aect, and social interaction; all
p<.05). In our experiment, warnings using the terms aerosol and vapor were equally
eective (all p>.05). Conclusions. Educational eorts and warnings using the term
vapor may resonate more with tobacco users. FDA may consider using familiar termi-
nology and language understood and used by consumers to enable extensive eects
of vaping-specic warning statements.
FUNDING: Federal
PS3-97
THE USE OF TOBACCO INDUSTRY VAPING PRODUCTS IN THE
UK AND PRODUCT CHARACTERISTICS: A CROSS-SECTIONAL
SURVEY
Elliot Cornish, Leonie S. Brose, Ann McNeill. King’s College London, London, United
Kingdom.
Signicance: Tobacco industry (TI) companies have entered the global e-cigarette
(‘vaping’) market in recent years. However, their motives and ambitions for doing so
have been questioned. Little is known about dierences between TI and independent
products and in their usage. This study in the UK explored 1) how popular TI vaping
products are and who uses them, and 2) how do vapers’ use of TI products dier
from their use of independent products? Methods: Secondary analysis of data from
a longitudinal web-based survey of smokers, ex-smokers and vapers (n=3883) in the
UK in 2019. The main study sample consisted of daily and non-daily vapers, who were
current or ex-cigarette smokers, and had stated the brand of their preferred e-cigarette
device (n=1202). 1) Proportions using TI and independent brands were calculated
and regression analysis assessed associations with socio-demographic and smoking/
vaping characteristics between vapers of TI and independent products. 2) Chi-square
tests were used to analyse dierences between TI and independent products. Results:
Among those stating a preferred e-cigarette device, 12 were from the TI and 49 from the
independent industry. Overall, 53.4% used TI products. A university education (67.6%;
Adjusted OR=1.54; 95% CI, 1.140-2.088), non-daily vaping (68.2%; AOR=1.39; CI,
1.029-1.880), and cigarette dependence (moderate, strong and very strong urges to
smoke) were associated with using TI vaping brands. TI products used were less likely
to be rellable (‘open’) than independent brands (60.9% vs. 18.3%, chi-square=228.98,
p<0.001), more likely to use nicotine salts (16.7% vs. 8.6%, chi-square=25.04, p<0.001)
and tobacco avours (23.8% vs. 17.9%, chi-square=12.65, p<0001). Conclusion: TI
vaping products were popular in the UK. Associations with product and user character-
istics suggest that TI products may be less conducive to smoking cessation, although
the ndings were not always consistent. Restricting vaping product types to closed
devices could favour TI products.
FUNDING: State; Nonprot grant funding entity
PS3-98
THE ROLE OF DEPRESSIVE SYMPTOMS IN ENDS DEPENDENCE
AMONG TEXAS YOUNG ADULTS
Alexandra Loukas, C. Nathan Marti. University of Texas at Austin, Austin, TX, USA.
Signicance: Depressive symptoms elevate risk for use of electronic nicotine delivery
systems (ENDS) among young adults. But, it is not known if depressive symptoms
contribute to symptoms of ENDS dependence among young adult ENDS users.
Similarly, the role of depressive symptoms in ENDS dependence following the surge
in vape pod (e.g., JUUL) sales in late 2017 is not known. The purpose of the present
study was to assess if depressive symptoms were associated with ENDS dependence
symptoms across a one-year period from 2018 to 2019 among young adults. Vape pod
use was included as a covariate to determine if depressive symptoms contributed to
ENDS dependence, over and above type of ENDS device used. Method: Participants
were from a multi-wave, online study, Project M-PACT, that recruited students from 24
Texas colleges in fall 2014/spring 2015. Data were from the spring 2018 and spring
2019 waves. Only participants who reported past 30-day use of any ENDS product in
2018 or 2019 were included (n=741). In spring 2018, the 741 participants were 22-30
years old (m=24.0; sd=1.79); 53.6% female; 38.5% non-Hispanic, white, 29.8% Hispanic,
31.8% other race/ethnicity. ENDS dependence was assessed at both waves with one
item measuring use of an ENDS product within 30 minutes of waking, and depressive
symptoms were assessed at both waves with the CES-D-10. A mixed eects regression
analysis was used to test if depressive symptoms predicted ENDS dependence, over
and above device type (vape pod vs. all others). Other covariates included cigarette
dependence and socio-demographics. Results: The prevalence of using ENDS within
30 minutes of waking increased across the one-year period from 14.4% to 21.3%%
(z=2.48, p=.013). Depressive symptoms (z=2.21, p=.027) and vape pod use (z=2.53,
p = .011) were signicantly and positively associated with depressive symptoms, even
after accounting for the other covariates. Conclusions: Depressive symptoms elevate
risk for ENDS dependence, irrespective of the type of device used. Findings underscore
the need for ENDS prevention and cessation interventions during young adulthood, the
developmental period when regular tobacco use is established.
FUNDING: Unfunded; Federal
PS3-99
EXPLORING THE LATENT FACTOR STRUCTURE OF A
CIGARETTE PURCHASE TASK AMONG PREGNANT WOMEN WHO
SMOKE
Carolyn G. Evemy, Joan Skelly, Allison N. Kurti, Stephen T. HigginsPhD. University of
Vermont, Burlington, VT, USA.
Introduction: The cigarette purchase task (CPT) is a valid behavioral-economic measure
of demand that has smokers estimate hypothetical cigarette consumption under a range
of escalating prices. The task involves no experimenter exposure of participants to smok-
ing. CPT demand is measured in terms of ve indices: Intensity (cigarettes consumed
at $0), Omax (the highest expenditure a participant will incur), Pmax (the nancial price
associated with peak expenditure), Breakpoint (a price at which one would quit smoking
rather than incur the cost), and Elasticity (the change of consumption as a function of
increasing price). Out of concerns for collinearity, several prior studies have investigated
a more parsimonious CPT latent-factor structure for these 5 derived indices reporting a
two-factor solution. The present study examined whether that two latent-factor solution
extends to pregnant women who smoke, a unique and highly vulnerable population
of smokers due to the additional stigma and adverse eects associated with smoking
during pregnancy. To our knowledge, this study is the rst to examine this question with
pregnant women. Methods: 665 women completed the CPT as part of recruitment for
a remote contingency management intervention to promote smoking cessation among
pregnant women. A principal component analysis with a standard regression coecient
> 0.40 on any particular factor was used to determine the loading pattern for the current
analysis. Results: Factor analysis conrmed a two-factor solution to the CPT account-
ing for 87% of the variance in the CPT indices with demand Intensity and Omax loading
onto one factor (i.e., Amplitude or volumetric consumption independent of price) and
Omax, Pmax, Breakpoint, and Elasticity loading onto the second factor (i.e., Persistence
or consumption as a function of price). Discussion: These results are consistent with
prior CPT studies reporting a two-factor solution in other populations and extend them
to pregnant women. These results further support the potential utility of using the CPT
to examine individual dierences in smoking among pregnant women in an ecient
and ethical manner.
FUNDING: Federal; Academic Institution
180
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-100
E-CIGARETTE USE AMONG ADOLESCENT NEVER TOBACCO
USERS AND SUBSEQUENT COMBUSTIBLE TOBACCO SMOKING
Ruoyan Sun1, David Mendez2, Kenneth Warner3. 1University of Alabama at Birming-
ham, Birmingham, AL, USA, 2University of Michigan, Ann Arbor, MI, USA, 3University
of MI School of Public Health, Traverse City, MI, USA.
Signicance: Previous studies have found strong longitudinal associations between
youth ever e-cigarette use and subsequent cigarette smoking, but few distinguished
the dierence between past and current vaping. Less is known about the association
between youth vaping and subsequent cigar or hookah use. Methods: We analyzed two
recent waves of the Population Assessment of Tobacco and Health (PATH) Study (wave
4, 2016-2017; and wave 4.5, 2017-2018). Our sample included youth who had never
used any tobacco product (except for e-cigarettes) by wave 4 (N = 9,432), observing how
their vaping behaviors in wave 4 are associated with subsequent combustible tobacco
smoking in wave 4.5. We conducted multivariable logistic regressions to calculate the
association between vaping and cigarette, cigar, or hookah use a year later, controlling
for sociodemographic, environmental, and behavioral risk factors. We examined both
current vaping (vaped in the past 30 days) and past vaping (ever vaped but no current
vaping). Our outcome variables in wave 4.5 included initiation (past 12-month use) and
current use (past 30-day use). Results: Controlling for potential risk factors, adoles-
cents who are past vapers exhibit non-signicant increases a year later in the odds of
initiating cigarette (aOR = 1.43, 95% CI, 0.89-2.32 ) and hookah use (aOR = 2.29, 95%
CI, 0.96-5.48) and non-signicant change in initiating cigar use (aOR = 0.97, 95% CI,
0.40-2.32). Youth who are current vapers report statistically higher odds in subsequent
cigarette (aOR = 1.98, 95% CI, 1.01-3.92) and cigar initiation (aOR = 3.28, 95% CI,
1.47-7.32) but not initiation of hookah (aOR = 0.85, 95% CI, 0.17-4.17). Neither past
nor current vaping is signicantly associated with subsequent current use of cigarettes,
cigars or hookah. Conclusion: Compared with never tobacco users, including never
e-cigarette users, past vapers who have never used any other tobacco products at
baseline exhibited non-signicant changes in subsequent initiation or current smoking
of cigarettes, cigars, and hookah. Current vapers at baseline showed signicantly
increased odds in initiating cigarettes and cigars, but not in initiating hookah or current
use of any combustible tobacco products.
PS3-101
ACCEPTABILITY AND EFFICACY OF A TOBACCO TREATMENT
TRAINING PROGRAM FOR ONCOLOGY CARE PROVIDERS
Noshin Haque, Kemi Ganey, Maureen O’Brien, Suhana DeLeon-Sanchez, C. William
Whitlock, Lisa Carter-Harris, Chris Kotsen, Smita Banerjee, Elizabeth Schoeld, Jamie
Ostro. Memorial Sloan Kettering Cancer Center, NY, NY, USA.
Introduction: Although persistent smoking after a cancer diagnosis is linked to adverse
eects on mortality, treatment eectiveness, and quality of life, up to two-thirds of
cancer patients continue to smoke after diagnosis. Despite signicant progress having
been made in disseminating clinical guidelines for tobacco cessation, most oncology
settings still have not yet established tobacco use assessment and treatment (TUAT)
as standard care. Oncology care providers have identied lack of sta training and
inadequate knowledge of smoking cessation medications as barriers for TUAT imple-
mentation, supporting the need for oncology-specic provider training tailored to the
needs of tobacco-dependent cancer patients in order to accelerate TUAT in cancer
care settings. Methods: We developed and implemented a tobacco treatment training
program for multidisciplinary oncology care providers (Tobacco Treatment Training-On-
cology; TTT-O), consisting of a two-day didactic and experiential workshop followed by
six monthly collaboratory videoconference calls supporting providers in their eorts to
implement NCCN guidelines in their oncology settings. Process and outcome evaluation
data was collected from ten cohorts of TTT-O participants who completed the workshop,
course evaluations, baseline, and follow-up assessments. Results: Participants (n=219)
included NPs and other APPs (33.1%), oncology RNs (19.9%), social workers (12.3%),
and other clinicians including physicians, psycho-oncologists, and respiratory therapists
working in cancer settings. Trainees rated didactic presentations and interactive sim-
ulated patient roleplays as highly favorable and reported signicant pre- post-training
gains in self-ecacy in their ability to assess and treat tobacco dependence. Participants
also demonstrated signicant (p < .001) improvements in implementation of TUAT in
their cancer settings, including provision of sta training and implementation of reach
and eectiveness of tobacco use treatment services. Conclusions: The TTT-O program
increased participants’ tobacco treatment skills, self-ecacy, and delivery of TUAT with
successful integration of didactic knowledge combined with innovative simulated patient
roleplay exercises for TUAT skill development. This training model can be adopted in
diverse cancer care settings to improve tobacco treatment delivery.
FUNDING: Federal
PS3-102
DEGRADATION OF FLAVORING CHEMICAL COMPOUNDS IN
FLAVORED NICOTINE SOLUTIONS USED IN E-CIGARETTES
Andreea Merzianu, Michelle Page, Noel Leigh, Maciej Goniewicz. Roswell Park
Comprehensive Cancer Center, Bualo, NY, USA.
Signicance: Flavored liquids used in e-cigarettes contain various avoring chemicals
along with nicotine and solvents (PG and VG). Little is known about their stability in
these solutions. With proposed legislation to ban avored e-cigarette products nationally,
the stability of these avoring chemicals becomes increasingly concerning as users
may begin to purchase and store avored products. This study aimed to determine
the eects of time and storage conditions on the stability of twenty popular avoring
chemicals used in e-cigarettes. Methods: Reference solutions independently contain-
ing 1mg/mL of each avoring chemical and 40mg/mL nicotine were prepared in 50:50
PG/VG. Commercial Blu pods with avors “Cherry,” “Blueberry,” and “Melon Time”
were purchased online. All products were placed in ambient light, dark, and 4°C dark
conditions. Aliquots were taken initially at preparation and at intervals of 1, 3, 6, and 12
months. Samples were analyzed using an Agilent 7890B/7250 GC/Q-TOF and avoring
chemicals of concern were quantied. Results: In both the reference and commercial
liquids, decreased concentrations of several avoring chemicals were observed over
12 months, most notably in solutions exposed to ambient light. For example, recoveries
of benzaldehyde, vanillin, triacetin and maltol were 5%, 3%, 2% and 1%, respectively
compared to initial concentration in the reference solutions. In Blu liquids, a 6-, 5-, 2- and
1.7-fold loss, respectively for these avoring chemicals were observed at 12 months.
Preliminary evidence shows an increasing presence of potential reactionary byproducts
where chemical structures indicate probable oxidation of these chemicals over time.
Conclusions: Benzaldehyde, vanillin, triacetin, and maltol degraded substantially in
e-cigarette solutions over one year. Understanding the chemical reactionary byproducts
is important to determine the potential health eects associated with degraded liquids.
Implementation of expiration dates or regulation of packaging to reduce exposure to
light and heat may be necessary for user protection.
FUNDING: Federal
PS3-103
THE ROLE OF SOCIAL CONNECTIONS IN DRIVING INTENTION
TO USE DIFFERENT TOBACCO PRODUCTS
Georges Khalil, David McLean, Amanda Harrison, Biswadeep Dhar, Claudia Corbo.
The University of Florida, College of Medicine, Department of Health Outcomes and
Biomedical Informatics, Gainesville, FL, USA.
Background: Tobacco use has been on the rise among American adolescents, mainly
due to vaping. As a result, adolescence is a pivotal time during which tobacco preven-
tion is critical. Social network studies indicate that negative inuence from friends is
a potent predictor of future tobacco use among adolescents. However, little is known
about the role of positive inuence and support from friends. We aim to examine how
positive social inuence (PSI) measured through social network data and loneliness are
associated with intentions to use dierent types of tobacco products, including vaping
products, cigarettes, cigars, hookah, and dip.Methods: We conducted a cross-sectional
survey with 83 adolescents from after-school organizations (Boys and Girls Clubs in
Northeast and Central Florida) in the summer of 2021. In this survey, loneliness was
measured with the UCLA loneliness scale. To measure PSI, adolescents were asked
to nominate 6 of their best friends from their after-school organization, and they re-
ported which tobacco products they would try if oered by each of their best friends.
Tobacco products included e-cigarette/vape, cigarettes, cigars/little cigars/cigarillos,
hookah, chewing tobacco/dip. Also, on a 5-point Likert scale, participants were asked
to report how likely they are to avoid any type of tobacco product if advised by their
6 best friends. Intention to use each tobacco product was measured as a continuous
form of the susceptibility to use scale. Pearson correlations and path analysis were
conducted for data analysis.Results: Pearson correlations indicated that PSI is related
to lower intention to use social products (vaping products, hookah, and dip). Through
path analysis, PSI predicted lower intention to use vaping products only (Beta=-0.23,
p<0.05), while loneliness was found to be related to higher intention to use combustible
products only (cigarettes, Beta=0.24, p<0.05, cigars, Beta=0.27, p<0.05 and hookah,
Beta=0.34, p<0.01). Conclusion: Loneliness may play a role in adolescents’ intention to
use combustible products, while PSI played a particular role in predicting lower intention
to vape, supporting the social ritual of vaping.
FUNDING: Federal
181
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-104
LOW INTENSITY DAILY SMOKING AND MORTALITY RISK AMONG
WOMEN IN THE MEXICAN TEACHERS COHORT (MTC) STUDY
Daniela Sarahí Gutiérrez-Torres1, Marion Brochier2, Juan Eugenio Hernández-Ávila3,
Evangelina Morales-Carmona3, Martin Lajous2, Neal Freedman1. 1NCI/NIH, Rockville,
MD, USA, 2National Institute of Public Health, Mexico City, Mexico, 3National Institute
of Public Health, Cuernavaca, Mexico.
Signicance: Current epidemiologic studies have shown that smoking even a few
cigarettes per day (CPD) leads to substantially elevated disease and mortality risks. In
Mexico, the average daily smoker smokes less than 10 CPD (mean: women=6, men=8).
Yet, it is important to evaluate the mortality risk associated with this low intensity pat-
tern. Methods: We examined this association among 109,756 female participants of
the Mexican Teachers Cohort (MTC) Study, who completed a baseline questionnaire
in 2006-2008 and were followed for mortality through 2019. Baseline smoking status
was dened by self-report and participants were classied as current, former and never
smokers. Current smokers were categorized according to the number of cigarettes they
smoked per day (1-2CPD and >=3CPD). Deaths were identied through employer and
pension-fund management databases and next-of-kin reports and cross-linked to two
mortality registries. Hazard ratios (HRs) and 95% condence intervals (95%CI) were
estimated using Cox proportional hazards regression models, with follow-up time as
the underlying time metric and adjusted for marriage, teaching at rural school, speaking
indigenous language, socioeconomic status, health care provider, physical activity, hours
watching television per week, and alcohol consumption. Results: In the MTC study,
75.7% (n=83,053) were never smokers, 10.1% (n=11,082) were former smokers, and
14.2% (n=15,620) were current smokers (CPD median=3, interquartile range=1-5).
Relative to never smokers, current smokers had higher risk of all-cause mortality (1-
2CPD HR=1.36, 95%CI=1.11-1.68; >=3CPD HR=1.42, 95%CI=1.19, 1.69) and cancer
mortality (1-2CPD HR=1.45, 95%CI=1.05-2.01; >=3CPD HR=1.47. 95%CI=1.10-1.96).
Yet, compared to never smokers, risk of cardiovascular disease mortality was higher
among the women who smoked >=3CPD (HR=1.58, 95%CI=1.10-2.28; 1-2CPD
HR=0.97, 95%CI=0.56-1.66). Conclusion: Smoking as low as 1-2 CPD was associated
with higher mortality risk among Mexican women. It is important to raise awareness
about the risks of low intensity smoking and to promote cessation in Mexico and in other
countries where such pattern is common.
FUNDING: Federal
PS3-105
EFFECT OF THE RECENT PEAK IN THE COVID-19 PANDEMIC ON
CIGARETTE SMOKING USAGE AMONG VETERANS
Javad J. Fatollahi, Sean Bentley, Neal Doran, Arthur L. Brody. UCSD, San Diego,
CA, USA.
Signicance: The prevalence of tobacco use increases in times of stress, however,
during the initial stage of the COVID-19 pandemic, tobacco use rates stayed the same
in most populations. Previous work has focused on the initial months of the pandemic
while this study sought to evaluate whether there was a change in tobacco use during
a peak period of the pandemic, either overall or for specic subgroups. Methods: We
used data from 61,852 visits to the VA San Diego Healthcare System from November
2019 to February 2021, divided into pre-, early, and peak pandemic periods. Binary
logistic regression was used to test whether the odds of being a daily or non-daily user
varied over time. Results: Women had a greater reduction than men in the odds of daily
use during the pandemic’s peak. The prevalence of non-daily use declined between
the early and peak periods for younger Veterans. Individuals with Substance Use
Disorder and Serious Mental Illness diagnoses were more likely to report tobacco use,
but psychiatric diagnoses did not predict change in use over time. Conclusion: These
ndings demonstrate factors that potentially contribute to changes in tobacco use during
a public health crisis and may help guide future cessation and relapse prevention eorts.
FUNDING: Federal; Academic Institution
PS3-106
SMOKING CESSATION AMONG PSYCHIATRIC AND SUBSTANCE
USE PATIENTS WITH COMORBID OPIOID USE DISORDERS A
REVIEW
Robert Kagabo1, Karina Geranios2. 1Department of Family & Preventive Medicine,
University of Utah, Salt Lake City, UT, USA, 2Dixie State University, St. George, UT,
USA.
BACKGROUND. The rate of cigarette smoking is high among individuals with psychiatric
illness and substance use compared to the general population. Individuals living with
a psychiatric illness also experience high rates of opioid use disorders, with about 90
percent of opioid-dependent patients smoking cigarettes, a rate almost six times that of
the general population. Cigarette smoking among psychiatric and substance use patients
with comorbid opioid use disorders is a public health concern. This review examines
smoking cessation interventions among psychiatric and substance use patients with
opioid use disorders. METHODS. We used narrative overview guidelines to search
PubMed and PsycINFO for intervention studies published between 1960 and 2020.
Studies used in this review study must have comprised participants with a psychiatric
or substance use diagnosis with comorbid opioid use disorders. Search term examples
included: smoking cessation among psychiatric patients, opioid use among psychiatric
patients, smoking cessation and opioid use, smoking cessation in substance use set-
tings, and mental health. RESULTS. Based on the inclusion and exclusion criteria, ten
studies were used. Participants in the studies were 50-60 percent male and smoked at
least 10 cigarettes per day. Individuals with severe mental illness or substance use were
generally excluded in cessation programs. Treatment periods were generally 8 weeks
long and included behavioral and pharmacological interventions. One study reported an
8.6 percent cessation among participants. Opioid-maintained clinics have populations
such as methadone-maintained patients and are prime locations for smoking cessation
interventions among this population with comorbid psychiatric and substance use di-
agnoses. CONCLUSION. Despite high smoking rates among patients with intersecting
diagnoses of psychiatry or substance use and opioid use disorders, interventions are rare
to help them quit. This population with comorbid diagnoses is generally excluded from
smoking cessation interventions. A need therefore exists for evidence-based smoking
cessation interventions tailored to this unique vulnerable population.
FUNDING: Unfunded
PS3-107
CHARACTERIZING USER-REPORTED APPEAL AND SENSORY
ATTRIBUTES OF 10 DIFFERENT FLAVORED E-CIGARETTE
SOLUTIONS IN A HUMAN LABORATORY EXPERIMENT
Marissa K. Anderson, Adam M. Leventhal. University of Southern California, Los Ange-
les, CA, USA.
Signicance: Characterizing the avor of various e-cigarette solutions is challenged by
the hundreds of dierent e-cigarette products available on the market and the thousands
of unique chemical avoring constituents used. Controlled administration of avored
e-cigarette products under double-blind conditions can be used to isolate the eects of
avorings on the appeal and sensory qualities of dierent e-cigarette solutions. Methods:
Nicotine/tobacco product users (N=119) self-administered standardized pus of 10 dif-
ferent e-cigarette avors, including 2 fruit, 2 dessert, 2 menthol, 2 mint, and 2 tobacco
avored solutions. After pung each solution, participants rated appeal and 5 sensory
attributes (sweetness, bitterness, smoothness, harshness, coolness) (0-100 scale).
Multi-level models calculated the dierence in appeal and sensory attributes of each
avor relative to the mean ratings of the 9 other avors. The constituent composition of
the study e-cigarette solutions was empirically determined using gas chromatography
and mass spectrometry. Results: Constituent analyses revealed that certain constituents
were used in dierent avors from distinct avor categories (e.g. vanillin was found in
solutions with fruit, dessert, and tobacco characterizing names). Strawberry was the
most appealing avor (B=7.07), followed by, in order of relative appeal, Vanilla (B=6.29),
Peppermint (B=5.57), Menthol (B=2.24), Green Apple (B=1.71), Spearmint (B=-1.07),
Koolada (B=-2.03), Subtle Tobacco (B=-4.59), Full Flavored Tobacco (B=-6.16), and
Dark Chocolate (B=-9.00). Vanilla yielded the highest sweetness ratings (B=14.44). Full
Flavored Tobacco (B=-8.34) and Subtle Tobacco (B=5.69) ranked highest in bitterness
and harshness, respectively. Peppermint scored highest in smoothness (B=6.98) and
coolness (B=29.25). Conclusions: The 10 avored e-cigarette solutions tested produced
a diversity of dierent appeal and sensory proles. In general, higher ratings of appeal
aligned with higher-than-average ratings of sweetness, smoothness, and coolness,
while lower ratings of appeal were associated with higher ratings of bitterness and
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
harshness. The characterization of e-cigarette avors based on appeal and sensory
qualities can complement other descriptors (i.e., avor names, avoring constituents)
and may be a useful paradigm to inform future avored e-cigarette product regulation.
FUNDING: Federal
PS3-108
THE IMPACT OF COVID-19 ON HOSPITAL-BASED TOBACCO
CESSATION SERVICES IN MUMBAI, INDIA
Himanshu Gupte, Dinesh Dilip Jagiasi. Narotam Sekhsaria Foundation, Mumbai, India.
Background: LifeFirst, a tobacco dependence treatment programme is implemented in
healthcare settings like hospitals and primary care facilities providing cessation service
to the lower socioeconomic section of the society in Mumbai, India. The COVID-19
pandemic resulted in challenges in implementation of the service due to the lockdown
and other restrictions aecting the tobacco users along with changing hospital priorities.
We aim to compare the characteristics of patients registering for cessation and their
cessation-related behaviour before and during the COVID-19 pandemic. Methods:
Before the pandemic, LifeFirst protocol included a detailed, in-person rst counselling
session, with six follow-ups conducted telephonically over six months. As an adaptation
to the pandemic, counselling services were converted to completely-telephonic instead of
in-person rst-session by the counsellors (after receiving referrals from the same health-
care settings, screening and consent process). Enrolment and follow-up data of patients
registered one year before the pandemic (April 2019 to March 2020) was compared to
one year of modied implementation during the pandemic (April 2020 to March 2021).
Observations: 1. Enrolment of tobacco users for tobacco cessation counselling in the
same healthcare facilities has reduced from 689 to 297 in COVID period. 2. Daily ex-
penditure on tobacco products has increased by 30%. 3. Patients’ adherence to LifeFirst
counselling follow-up improved. Proportion of cases lost to follow-up reduced to 5% from
13%. 4. 7-day point prevalence abstinence (PPA) at six months increased from 63% to
78%. Conclusion: COVID-19 has resulted in decreased proportion of smokers among
all enrolled tobacco users. Patients who enrol for cessation have higher adherence
and abstinence rates. While these ndings may be due to awareness of association of
tobacco use, particularly smoking, with COVID-19; utilisation of and access to cessation
services has reduced during the pandemic. Awareness about this association should be
further strengthened and restrictions on tobacco use should be implemented. Awareness
about referral to cessation services among providers is essential.
FUNDING: Unfunded
PS3-109
LONGITUDINAL TRAJECTORIES OF NICOTINE PRODUCT USE
IN ADOLESCENTS IN THE POPULATION ASSESSMENT OF
TOBACCO AND HEALTH (PATH) STUDY
Patricia Simon1, Yannuo Jiang2, Eugenia Buta2, Carolyn Sartor1, Suchitra Krishnan-Sa-
rin1, Ralitza Gueorguieva2. 1Yale University School of Medicine, New Haven, CT, USA,
2Yale University School of Public Health, New Haven, CT, USA.
Signicance: Adolescent polytobacco use (PTU) is a signicant public health concern.
Much remains unknown about the patterns of multiple tobacco product use in youth
and about the role of socioecological factors in the progression in use of multiple to-
bacco products. The PATH data is a nationally representative survey that provides the
unique opportunity to identify patterns of PTU and correlated risk factors. Methods:
Data were drawn from the 10,086 youth (ages 12-17) with longitudinal weights avail-
able at Waves 2 - 4. Outcome variables were days of use of four tobacco products:
cigarettes, e-cigarettes, cigars and smokeless tobacco. Predictors collected at Wave
1included sociodemographic factors, impulsivity measures, internalizing and external-
izing symptoms, rules about tobacco use at home, tobacco accessibility and exposure
to advertising. Multitrajectory latent class growth analysis was used to identify distinct
subgroups with similar patterns of use over time. Multinomial logistic regression models
were used to investigate predictors of class membership. Weights were used to account
for the complex survey design. Results: We identied six trajectory classes: “Non-user
all products” (78.2%), “Experimenter all products” (9.8%), “Increasing e-cigarette use”
(4.0%), “Increasing combustible product use” (3.3%), “Decreasing combustible products
and e-cigarette use” (3.2%) and “Consistent smokeless tobacco use” (1.6%). The older
age cohort (15-17 years old), males, non-Hispanic whites, adolescents with externalizing
problems, exposure to tobacco advertising, relaxed rules about tobacco use at home and
other person tobacco use at home were more likely to be classied in the use classes.
Very dicult access to tobacco was associated with lower odds of membership in the
“Increasing combustible product use” class. Conclusion: The results highlight the
heterogeneity of longitudinal pathways of multiple tobacco product use in adolescents
in the US. Understanding changes in use patterns and associated risk factors provides
targets for regulatory policies as well as prevention programs directed at Youth.
FUNDING: Federal
PS3-110
TOBACCO INDUSTRY DENORMALIZATION BELIEFS IN
RELATION TO USE OF HEATED TOBACCO PRODUCTS IN HONG
KONG ADULTS
Xiaoyu Zhang1, Yuying Sun1, Yee Tak Derek Cheung2, Man Ping Wang2, Yongda Wu2,
Jianjiu Chen1, Lok Tung Leung1, William H. C Li2, Tai Hing Lam1, Sai Yin Ho1. 1School
of Public Health, The University of Hong Kong, Hong Kong, China, 2School of Nursing,
The University of Hong Kong, Hong Kong, China.
Signicance: Cigarette smokers are known to have weaker tobacco industry denor-
malization (TID) beliefs. However, the association of heated tobacco products (HTP)
use with TID beliefs is unclear. Methods: A total of 8090 participants (weighted age of
47.6 (SD 17.4) years, 52.8% male) from a household survey (n=7090) and a smoking
hotspot survey (n=1000) reported their cigarette and HTP use status. TID beliefs were
measured by four random items with each having a 50% chance of being used. The
items included: (1) the tobacco industry (TI) tries to hide and downplay the dangers of
smoking; 2) the TI tries to get youth to smoke; 3) the TI lies; and 4) the TI takes people’s
lives for money. Overall perception towards the TI was assessed using a 0-10 Likert
scale, with higher scores indicating stronger negative perceptions. The association
of ever HTP use with the above beliefs and perception were examined using logistic
regression in cigarette smokers and non-smokers. Results: The weighted proportions
of agreement for the TID items ranged from 39.8% (TI takes people’s lives for mon-
ey) to 75.8% (TI hides and downplays the dangers of smoking). The mean score of
the overall perception towards the TI was 7.4 (SD 2.2). In non-smokers, having one
more TID belief and a higher score of overall negative perception towards the TI were
reversely associated with ever HTP use (adjusted odds ratio: 0.62, 95% condence
interval: 0.51-0.75; and 0.75, 0.69-0.81). By contrast, in current smokers, a higher score
of negative perception towards the TI was associated with 21% higher odds of ever
HTP use (1.21, 1.15-1.27). Conclusion: Hong Kong adults in general had a negative
perception towards the TI. TID beliefs were reversely associated with ever HTP use in
non-smokers, but stronger negative perception towards the TI was associated with ever
HTP use in current smokers. Whether TID beliefs would predict HTP use in cigarette
smokers should be examined using prospective studies.
FUNDING: Nonprot grant funding entity
PS3-111
CHALLENGES OF RECRUITING RURAL ADOLESCENTS TO
PARTICIPATE IN E-CIGARETTE RESEARCH
Hailey Bomar1, Abigail A. Lee1, Shannon L. Watkins1, Trisha Welter2, Mark Vander
Weg1, Rima A1. 1University of Iowa College of Public Health, Iowa City, IA, USA,
2University of Iowa, Oce of Student Wellness, Iowa City, IA, USA.
Signicance: Adolescents have been leading adopters of e-cigarettes, and the poten-
tial harms of their e-cigarette use are signicant. Patterns of e-cigarette use by rural
adolescents are still unclear, and rural areas have fewer resources for tobacco control.
Methods: Our research aims to engage rural adolescents in qualitative research to
map the context(s) of e-cigarette use with the intent to identify contexts amenable to
intervention. Over the past two years, we have found enrolling rural adolescents in Iowa
to be challenging. Our recruitment strategies evolved from working with school systems
to contacting youth-serving organizations, and then expanding to a larger audience
using the mass email system at the University of Iowa. Results: This presentation uses
Bronfenbrenner’s Ecological Systems Theory to frame the various challenges we faced
at the micro, meso, exo, macro and chrono systems in order to inform future research
with rural adolescents, an important but hard-to-reach population. In the exosystem,
and unique to the timing of our work, the COVID-19 pandemic aected all aspects of our
research including recruitment and data collection strategies. The environmental disaster
of the August 2020 inland hurricane (i.e., Derecho) further reduced community capacity
to engage in research, particularly in rural areas. At the meso level, school principals
we contacted in 2020 were overwhelmed with the pandemic response and prioritizing
student wellbeing and learning; we received little response. We then reached out to
youth-serving organizations in 2021 also with little success; given our rural focus, some
of these organizations were deep in the planning for state agriculture fairs, leaving little
bandwidth for other topics. We consider the IRB to also be part of the meso system:
our IRB required active parental consent for this research, which impeded our ability
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
to ‘speak’ directly to youth. The micro system consists of the adolescents themselves.
Conclusion: Innovative tools are needed to reach rural adolescents, however for them
to work, ethical review boards must shift their paradigm to accommodate out-of-the-box
methods for minors, particularly when exploring stigmatized behaviors like e-cigarette
use. This presentation will describe our challenges in more depth, providing insight for
teams endeavoring to do this work.
FUNDING: Federal; State; Academic Institution
PS3-112
EVALUATING & DEVELOPING TOBACCO HARM REDUCTION
STRATEGIES AMONG SMOKERS IN KATHMANDU, NEPAL
Ashok Pandey, Ayuska Parajuli. Public Health Research Society Nepal, Kathmandu,
Nepal.
Background: Tobacco harm reduction refers to strategies designed to reduce the health
risks associated with tobacco smoking but which may involve the continued use of nico-
tine. The ultimate aim of the action, research is to establish tobacco harm reduction clinics
in densely populated cities of Nepal. Methods: Action research includes key in-depth
interviews focus group discussions, transient walks, and stakeholder analysis was done
to evaluating & developing tobacco harm reduction strategies among smokers in Nepal.
The participants involved in this study are slum dwellers, students, public health experts,
and stakeholders of Kathmandu, Nepal. Results: Most of the participants are positive
about the use of ANDS products. They stated that it is not possible to stop the use of
tobacco products without safer alternatives. Therefore, it is wiser to oer an alternative
product that would reduce harm. They mentioned that ANDS products must be easily
and suciently available in the market at an aordable price. Stakeholder analysis
shows that the National health education information and communication center, local
governments and advocacy organizations should have managed closely for the estab-
lishment of tobacco harm reduction clinics. Conclusions: The ndings show it is urgent
to think about tobacco harm reduction. Smokers are searching for safer alternatives.
Most of the participants mentioned e-cigarette should be made suciently available
in the market at an aordable price. For instance, the establishment of tobacco harm
reduction clinics will benet more to solve the problems for smokers. Keywords: ANDS
products; Electronic cigarettes; Nepal; Tobacco harm reduction
FUNDING: Unfunded; Nonprot grant funding entity
PS3-113
SELF-REPORTED ELECTRONIC CIGARETTE DEVICE AND LIQUID
CHARACTERISTICS- INACCURACIES AND INCONSISTENCIES
Ashley E. Douglas1, Nicholas J. Felicione2, Andrea Milstred1, Margaret G. Childers1,
Miranda Signorelli1, Abigail Barton3, Jenny E. Ozga4, Melissa D. Blank1. 1West Virginia
University, Morgantown, WV, USA, 2Roswell Park Comprehensive Cancer Center,
Bualo, NY, USA, 3Marshall University, Huntington, WV, USA, 4Westat, Rockville, MD,
USA.
Background: Electronic cigarette (ECIG) technology, and the language used to describe
it, continues to evolve. Reliance on users’ self-reports of their device/liquid characteristics
requires that those reports be accurate and consistent with terminology used by re-
searchers. This study compared the classication of device/liquid characteristics between
users’ self-reports and product pictures. Methods: Participants (N=134) reported daily
use of a nicotine-containing ECIG for at least 3 months. They answered questions (yes/
no/don’t know) about their individual ECIG characteristics (e.g. disposable, rellable).
They also chose the term that best described their device (cigalike, pen, mod, pod)
and the picture that best resembled their device (cigalike, pen, box mod, USB-shaped
pod, teardrop-shaped pod, none of the pictures). Respondents provided a picture of
their device/liquid, which was used by independent raters to classify products according
to these same features. Agreement was examined with Cohen’s kappa (k). Results:
Agreement was excellent for individual features of rellable (k=.94) and disposable
(k=.83); good for adjustable power (k=.68); and poor for nicotine salt (k=.18). Incorrect
responses were provided by 12.6% and 19.3% of participants for adjustable power and
nicotine salt, respectively. Also, 31.1% provided a “don’t know” response for nicotine
salt. Agreement was moderate for questions that probed “picture that resembles device”
(k=.44) and “term used to describe device” (k=.51). Nearly 15% of participants said
that none of the pictures resembled their device; raters classied the devices as pens
(5.2%), box mods (15.8%), and USB-shaped pods (74.7%). For participants who chose
the term “pen” (24.3%) or “mod” (20.6%) to describe their device, raters classied their
devices as a “pod” (73.1% and 22.7%, respectively) using the same terms. Conclusions:
Findings highlight ECIG users’ lack of knowledge about certain product characteristics,
and discrepancies between how products are described and viewed by users versus
researchers. Surveillance eorts may be improved by supplementing users’ self-reports
with pictures of their device/liquid.
FUNDING: Academic Institution
PS3-114
CHARACTERIZING YOUNG ADULT ELECTRONIC NICOTINE
DELIVERY SYSTEM USERS
Deepti Agarwal1, Alexandra Loukas1, Keryn E. Pasch1, Anna V. Wilkinson2, Carole K.
Holahan1. 1The University of Texas at Austin, Austin, TX, USA, 2The University of Texas
Health Science Center at Houston, School of Public Health-Austin Regional Campus,
Austin, TX, USA.
Signicance. Despite the increasing popularity of Electronic Nicotine Delivery Systems
(ENDS), research is lacking on patterns of young adult current (i.e., past 30-day) ENDS
use. The aim of this study was to examine classes of young adult current ENDS users
and determine common characteristics of these classes among a cohort of young adults
in Texas. Methods. Participants were 463 young adults aged 19-31 years, who were
drawn from wave 4 (April-May 2016) of the Marketing and Promotions across Colleges
in Texas project (Project M-PACT), which collected data every 6 months beginning
November 2014 to February 2015 from a larger cohort of college students across
Texas. Latent Class Analysis with six indicator variables, which are, 1) self-identifying
as a social ENDS user, 2) frequency of ENDS use, 3) ENDS nicotine dependence
symptoms, 4) binge alcohol use, 5) marijuana use, and 6) current cigarette use, was
used to discern classes of young adult current ENDS users. Other tobacco use and
socio-demographics were examined as covariates contributing to the membership
within various ENDS user classes. Results. Findings identied three distinct classes
of users, including non-nicotine dependent social ENDS users, high-risk poly-tobacco
and substance users, and nicotine dependent ENDS users. Conclusion. Results un-
derscore the heterogeneity among young adult current ENDS users and the need for
development of distinct tobacco control messaging and intervention strategies tailored
to dierent sub-groups of young adult ENDS users.
FUNDING: Federal; Academic Institution
PS3-115
RACIAL/ETHNIC DISPARITIES IN MENTHOL CIGARETTE
SMOKING, UNITED STATES, 2004-2019
Priti Bandi, Samuel Asare, J Lee Westmaas, Farhad Islami, Nigar Nargis, Ahmedin
Jemal, Stacey Fedewa. American Cancer Society, Kennesaw, GA, USA.
Signicance: Menthol use promotes youth and young adult smoking initiation and
hinders successful cessation. Black persons have disproportionately high menthol
cigarette use, but studies suggest rising use among other race/ethnic groups until
2014. Contemporary data on racial/ethnic dierences in menthol cigarette smoking
are unknown. Methods: Annual nationally representative cross-sectional data from the
National Survey on Drug Use and Health from 2004 to 2019 were pooled to estimate
4-year (2004-2007; 2008-2011; 2012-2015; 2016-2019) menthol cigarette smoking
prevalence by age-group (adolescents, 12-17 years; young adults YAs, 18-25 years;
adults, 25-34, 35-49, 50+ years) and race/ethnicity (persons who identify as White;
Black; American Indian/Alaska Native, AI/AN; Native Hawaiian/Pacic Islander, NH/PI;
Asian; Hispanic; or more than one race). Adjusted logistic regression models were used
to assess dierences and polynomial temporal trends in menthol cigarette smoking by
age-group and race/ethnicity. Results: Menthol smoking prevalence declined (linear
and quadratic p<0.001) particularly from 2012-2015 in adolescents (2004-2007:4.5%,
2008-2011:4.2%; 2012-2015:2.7%; 2016-2019:1.4%) and YAs (13.5%, 15.3%, 14.5%,
10%), with similar trends across race/ethnic groups except for AI/AN YAs (13.9%, 18.8%,
20.8%, 15.1%). Among adults, menthol smoking increased among AI/AN persons aged
35-49 years (4.8% to 13%); White (7% to 11.1%) and Hispanic (8.3% to 10.4%) persons
aged 25-34 years; but declined quadratically among Black persons aged 25-34 (24%,
28%, 28%, 22%) and 35-49 (26%, 22%, 21.7%, 20.4%) years. While Black persons had
higher prevalence relative to most other groups in 2004-2007, by 2016-2019 there was
no prevalence dierence between AI/AN and Black persons in 18-24 years (14.8% and
12% respectively) and 25-34 years (21.8% and 20.3%). Among persons who smoke,
the largest absolute and relative increase of menthol smoking over the study period was
among AI/AN (25% to 35%), NH/PI (47% to 69%), and Hispanic persons (32% to 47%),
while remaining the highest and stable in Black persons (81% to 85%). Conclusion:
Despite declines in most age-groups, menthol smoking in Black persons continues to
be 2-to-5 times higher than other race/ethnic groups overall. However, there is a shifting
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
burden in use to AI/AN YAs and middle-aged adults. These disparities reinforce the
importance of the Food and Drug Administration’s planned policy to ban all-avored
tobacco products, including menthol cigarettes.
FUNDING: Academic Institution
PS3-116
PATTERNS OF EXCLUSIVE AND DUAL ENDS USE AMONG US
ADULTS
Joy Bohyun Jang, Amy Pienta, Chelsea Samples-Steele, Alison Sweet, Michal Kirk-
wood, Jennifer Koski, Valyn Dall. University of Michigan, Ann Arbor, MI, USA.
While most individuals mature out of the peak use of substances (including Electronic
Nicotine Delivery Systems (ENDS)) after young adulthood, some remain at risk or
progress to problematic use in adulthood (e.g., Chassin et al., 2004; Sher et al., 2011).
As problematic substance use contributes to numerous public health burdens (e.g.,
Miller, 2008; Whiteford et al., 2013), understanding the use patterns over the life course
is a critical public health issue. The ENDS use has notably increased in recent years,
however, our understanding of the ENDS use among middle-aged adults is limited. We
investigate the prevalence of ENDS use with cigarette smoking by age. Data were from
the Public-Use Files from the Population Assessment and Tobacco and Health (PATH)
Study downloaded from the National Addiction and HIV Data Archive Program (NAHDAP)
(https://www.icpsr.umich.edu/web/NAHDAP/series/606). Analyses included Wave 4 of
the PATH Study data from 8,132 individuals who reported using ENDS and/or cigarettes
but no other tobacco products. Exclusive ENDS users included currently established
(regularly using any ENDS in the past and some days/every day) or experimental
users (not using ENDS regularly in the past, but using some days/every day) (9.0%).
Exclusive cigarette smokers included currently established (smoking 100+ cigarettes
lifetime and smoking some days/every day) and experimental smokers (smoking <100
cigarettes lifetime, but smoking some days/every day) who did not use ENDS (80.0%).
Dual users included respondents who reported current established/experimental ENDS
use and current established/experimental cigarette use (11.0%). Survey-weighted mul-
tinomial logistic regression models show that middle-aged adults (aged 35-54) were
less likely than young adults (aged 18-34) to be exclusive ENDS users (Relative Risk
Ratio [RRR]=0.43, p<.001) and were more likely than older adults (aged 55+) to be
dual users (RRR=1.96, p<.001), both compared to exclusive cigarette smoking. Our
ndings show that the risk of dual use (ENDS use with conventional cigarette smoking)
among middle-aged adults may appear similar to that of young adults, which warrants
further attention to the group.
FUNDING: Unfunded; Federal
PS3-117
THE ASSOCIATION OF SOCIAL AND FINANCIAL SUPPORT
WITH SMOKING CESSATION IN A SAMPLE OF SURVIVORS OF
INTERPERSONAL VIOLENCE
Michelle R. Goulette, Amina Alio, Diane S. Morse, Scott McIntosh. University of Roch-
ester Medical Center, Rochester, NY, USA.
Signicance: Tobacco use, particularly smoking cigarettes, is a leading cause of mor-
bidity and mortality worldwide. Existing literature has shown that there is a correlation
between interpersonal violence (IPV) victimization and cigarette smoking. IPV is a leading
public health concern that aects a broad range of women in diverse socioeconomic
and ethnic groups. It has been estimated that 4% to 23% of all women in the United
States have been victims of IPV. Few studies address the social determinants of health
associated with smoking cessation among women who have suered from IPV. The
primary objective of this secondary data analysis is to understand if social and nancial
support are associated with willingness to quit smoking. The secondary objective is to
understand if, in the presence of social support, depression and anxiety are associated
with willingness to quit smoking. Methods: The sample comprises of 232 individuals
with a recent self-reported incident of IPV and at least mild depression (phq-9 score
>=5). Chi square tests were performed with race, ethnicity, sexual orientation, education
and income level to investigate whether any of these variables are associated with
willingness to quit smoking (Y/N). T-tests were performed to investigate whether social
support, nancial support, anxiety or depression were associated with willingness to
quit. Finally, logistic regression was performed on willingness to quit smoking with social
support, anxiety, depression and relevant covariates. Results: Out of 232 patients with
reported IPV, 98 individuals (42%) identied as smokers. Of these, 35 (36%) expressed
willingness to quit smoking, indicating no association between anxiety and depression
and a willingness to quit smoking in this sample. There was not a statistically signicant
association between those who were willing to quit smoking (vs. those who were not) on
self-reported social support. Conclusion: This study provides some insights into barriers
to tobacco cessation in survivors of IPV. The rates for willingness to quit smoking are
much lower than the national average, which may indicate an opportunity to increase
outreach to and information for this group. Ongoing research on nicotine addiction in
survivors of interpersonal violence is needed.
FUNDING: Unfunded
PS3-118
NORTH AMERICAN QUITLINE CONSORTIUM VAPING CESSATION
RESOURCES AUDIT
Manpreet Kaur, Matthew Quick, Derek Guo, Drusilla Talawa, Deborah J. Ossip, Scott
McIntosh. University of Rochester Medical Center, Rochester, NY, USA.
Signicance: Vaping (e-cigarette use) among youth has reached epidemic proportions
despite steady declines in traditional smoking. Research increasingly indicates that
many of the appealing vaping product avorings are toxic, but dissemination of these
harms remains limited. More resources for vaping cessation are needed to combat this
epidemic of nicotine addiction among youth. Currently, there are additional concerns that
e-cigarette users may be at greater risk for succumbing to Covid-19, which is an acute
respiratory disease that attacks the lungs. Methods: Previous studies have focused on
examining all NAQC (North American Quitline Consortium) member “quitsites” to identify
and characterize information pertaining to vaping cessation across all 50 U.S. states,
all 13 Canadian provinces, 3 U.S. territories and Washington D.C. The quitlines were
also thoroughly examined to determine whether or not quit sites provide information
about COVID-19 concerns in relation to vaping. The present study further analyzed
the NACQ quitsites to identify updates to information and resources related to vaping
cessation. Results: Although many quitsites presented information on the harms of
vaping (76%), not enough include messaging to indicate that avors are harmful (27%)
or recommended speaking to a health care provider (41%). Further updates to these
results will be presented in the poster. Conclusion: Ongoing research is needed to
track this trend, however, there is an increase in the number of quitsites that include
information on the harms of vaping (and specically vaping avors) and resources for
vaping cessation was observed. Next steps may include creating tailored guides for
individual quitlines for updates of their quitsites. Supported by National Cancer Institute
(NCI) and the (FDA) # U54CA228110.
FUNDING: Federal
PS3-119
THE RETURN TO NORMALCY- CONCERNS ABOUT RETURNING
TO WORK ASSOCIATED WITH COVID-19
Jacqueline Attia1, Liane Schneller2, Phillip Vaughan1, Scott Steele1, Scott McIntosh3,
Richard O’Connor4, Maansi Bansal-Travers5, Deborah Ossip1. 1University of Rochester
Medical Center, Rochester, NY, USA, 2Roswell Park Cancer Institute, Bualo, NY, USA,
3Dr. Scott McIntosh, Rochester, NY, USA, 4Roswell Comprehensive Cancer Center,
Bualo, NY, USA, 5Roswell Park Comprehensive Cancer Center, Bualo, NY, USA.
Background: The pandemic resulted in challenges to Tobacco Centers of Regulatory
Science (TCORS) trainees and early/junior/new (EJN) investigators, including lab
shutdowns, movement to remote research and learning, and needs to juggle remote
and changing work situations with personal and logistical concerns. Similarly, return
to on-site work may raise concerns. This analysis focuses on the latter, as institutions
began resuming on-site research and training. Methods: Data were collected using
a REDCap survey that was distributed to 202 TCORS trainees and EJN investigators
through the Center for Coordination of Analytics, Science, Enhancement, and Logistics
(CASEL) from April 5 - May 10, 2021. Qualitative and bivariate analyses were conducted
to assess concerns about returning to work and the COVID-19 vaccine. Results: The
54 respondents (26.7% response rate) included 14 graduate students, 19 postdocs,
and 21 EJN investigators. About one third of graduate students (35.7%) and postdocs
(36.8%) reported concerns about returning to work. Most graduate students had returned
(61.5%) while most postdocs had not (61.1%). Over half of EJN investigators expressed
concerns about returning to work (57.9%), and most had not returned (68.4%). Signi-
cantly more trainees and EJN investigators doing lab and data research returned to
work. Common themes for concerns about returning to work included increased risk
of exposure from resuming taking public transportation and returning to an enclosed
environment, and losing productivity. Concerns did not signicantly dier by change in
work environment (e.g., moving from remote to in-person), by institutional reopening,
type of research, vaccine access or gender identity. 20.4% reported concerns about the
vaccine with the most common themes related to short and long-term vaccine eec-
tiveness. Conclusion: COVID-related restrictions have redened work environments.
185
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
A meaningful percentage of trainees and EJN investigators expressed concerns about
returning to on-site work, particularly regarding personal safety and productivity loss.
Recognizing and addressing concerns are important for supporting career development
of this cohort of trainees and investigators.
FUNDING: Federal
PS3-120
POSITIVE AFFECT AND MULTIPLE TOBACCO PRODUCT USE
AMONG YOUTH: A 3-YEAR LONGITUDINAL STUDY
Stephanie Clendennen1, Dale Mantey2, Aslesha Sumbe3, Anna Wilkinson4, Melissa
Harrell5. 1UT Health, School of Public Health in Austin, Austin, TX, USA, 2UT-Health
Science Center, School of Public Health, Austin, TX, USA, 3UTSPH, Austin, TX, USA,
4University of TX Science Center at Houston, School of Public Health, Austin, TX, USA,
5University of TX, SPH, Austin, TX, USA.
Objectives: Multiple tobacco product (MTP) use is common among adolescent tobacco
users. Low positive aect is a risk factor for e-cigarette use and combustible tobacco
smoking. We examine the longitudinal relationship between positive aect and MTP
use among a diverse cohort of adolescents in Texas. Methods: We analyzed six waves
of biannual data (Fall 2014-Spring 2017) from the Texas Adolescent Tobacco and
Marketing Surveillance (TATAMS) system. Participants were n=3,868 6th, 8th, and 10th
grade students in urban Texas, at enrollment. Multinomial logistic regression models
examined longitudinal associations between positive aect score (range: 1-5; low-high)
and categories of MTP use (non-users, single products users, dual-users (2 products),
and poly users (3 or more products) of ve tobacco products: cigarettes, e-cigarettes,
hookah, cigars, and smokeless tobacco. Data were aggregated across six waves such
that 3,868 participants provided 17,348 total observations. Models controlled for sex,
race/ethnicity, past 30-day alcohol use, cohort, survey wave, and peer tobacco use. All
variables were assessed and analyzed at each wave (i.e., time-varying), except sex
and race/ethnicity, and cohort which were time-invariant. Results: The sample was
4.6% single product users, 1.7% dual users, and 0.7% poly users. Each unit decrease
in positive aect was associated with increased risk for single (RRR: 1.29; 95%CI: 1.16-
1.44), dual (RRR: 1.35; 95%CI: 1.11-1.64), and poly (RRR: 1.98; 95%CI: 1.54-2.54)
tobacco use, relative to non-use. Similarly, each unit decrease in positive aect was also
associated with increased risk for poly tobacco use (RRR: 1.53; 95%CI: 1.19-1.97) and
(RRR: 1.47; 95%CI: 1.11-1.95), relative to single and dual use, respectively. Conclusion:
We observed a gradient relationship between low positive aect and greater number of
tobacco products used. Findings reinforce the association between poor mental health
and tobacco use during adolescence. Tobacco prevention eorts should incorporate
methods of addressing low positive aect, for example, activities that increase positive
emotions like physical activity.
FUNDING: Federal
PS3-121
A SUBSTANTIAL PROPORTION OF YOUNGER ADULTS ENDORSE
EVER USE OF FLAVORED DISPOSABLE POD DEVICES
Kevin Madden, Sumner Sydeman. Northern Arizona University, Flagsta, AZ, USA.
Signicance: Pod devices are the most recent “fourth generation” of electronic vaping
products (EVPs). In 2018, the United States Food and Drug Administration (FDA) passed
regulations prohibiting avors in pod devices other than tobacco, mint, or menthol. How-
ever, these regulations applied only to rechargeable pod devices. In 2019, disposable
pod devices, sold in a wide variety of avors, appeared on the market in the U.S. in an
apparent response to this FDA rechargeable pod device avor ban. To date, there are
no published survey studies that have queried specically about use of disposable pod
devices. Method: The current study utilized a cross-sectional design with a sample of
634 younger adults (18-35) residing in the U.S. (Mean age 29.6; 48.6% female; 77.9%
Non-Hispanic White). Data was collected in May of 2021 using Amazon’s Mechanical
Turk. Participants were queried about disposable pod device knowledge/awareness,
ever use, 30-day use, specic brands/models used, avor most used, and reasons for
use. Never users were asked about susceptibility to future use. Results: A substantial
48.1% of participants endorsed knowledge/awareness of disposable pod devices,
27% of the sample reported ever use, and 44.6% of ever users endorsed past 30-day
use. For ever users, the three devices used most commonly were Pu Plus (38.5%),
Pu Bar (35.5%), and Pu Nano (20.1%). The most commonly endorsed reason for
disposable pod use was availability of avors (40%), and the two most frequently used
avor categories were fruit (30.3%) and sweet avors (15.4%). Among never users,
55.1% were categorized as susceptible to future use. Conclusion: It appears that the
FDA regulation banning avors in rechargeable pod devices was quickly followed by
the introduction of disposable pod devices to the market. Nearly half of young adults
in the current sample were aware of disposable pod devices, 27% of participants were
lifetime users, the most cited reason for use was availability of avors, and over half of
never users were susceptible to future use. These results suggest that the FDA con-
sider taking immediate action to ban avored disposable pod devices from the market.
FUNDING: Unfunded
PS3-122
MONITORING THE TREND OF THE U.S. SMOKING CESSATION
RATE AND ITS IMPLICATION FOR FUTURE SMOKING
PREVALENCE
Thuy Le, Kenneth Warner, David Mendez. University of Michigan School of Public
Health, Ann Arbor, MI, USA.
Objectives:To calculate the adult smoking cessation rate for the 2014-2019 period using
NHIS and NSDUH prevalence data and compare it to the previously estimated cessation
rate for 2008-2013 and the projected value for 2014-2019 derived from extending the
1990-2013 estimated trend. Methods:We repeated the analysis presented in the 2017
article by Mendez et al., extending the analysis period to 2019. As in the previous work,
we employed data from the National Health Interview Survey (NHIS) and the National
Survey on Drug Use and Health (NSDUH) to estimate the adult cessation rate in six-year
intervals. We used weighted non-linear least squares to perform the estimation. We then
employed a meta-regression model to test whether the cessation rate has increased
beyond expectations. Results:The annual cessation rate has increased 29% (from
4.2% in 2008-2013 to 5.4% in 2014-2019) according to the NHIS data, and 33% (from
4.2% in 2008-2013 to 5.6% in 2014-2019) according to the NSDUH data over the last
six years. The increase in cessation was signicant according to the meta-regression
results (signicant positive slope, p-value = 4.63 x 10-7). Our results also show that the
increase in cessation between 2008-2013 and 2014-2019 is responsible for 60% of
the extra fall in prevalence. The remaining 40% can be attributed to the decrease in
the initiation rate between those periods.Conclusions:The smoking cessation rate in
the U.S. continued to increase during 2014 - 2019. Our NHIS and NSDUH results are
practically identical, making it very unlikely that our ndings are a product of chance.
The larger share of prevalence drop (60%) during 2014-2019 can be attributable to the
increased cessation, which is encouraging since the positive health eects of cessation
happen much sooner than those derived from a decrease in initiation. Going forward,
that upward trend of the smoking cessation rate suggests that the CDC Healthy People
goal of 5% adult smoking prevalence in 2030, while still ambitious, is attainable.
FUNDING: Federal
PS3-123
THE IMPORTANCE OF PEER IMITATION ON SMOKING
CESSATION OVER TIME - A DYMANICAL SYSTEMS APPROACH
David Mendez, Carl P. Simon. University of Michigan, Ann Arbor, MI, USA.
A recent Institute of Medicine Report calls for explicit modeling of smoking initiation,
cessation, and addiction processes. We introduce a model of smoking initiation that
explicitly teases out the percentage of initiation due to social pressures, which we call
“peer-imitation,” and the percentage due to other factors, such as media ads, family
smoking, and psychological factors, which we call “self-initiation.” We propose a dynamic
non-linear behavioral contagion model of smoking initiation and employ data from the
National Survey on Drug Use and Health (NSDUH) to estimate the relative contribu-
tions of imitation and self-initiation to the overall smoking initiation process. Although
the percentage of total smoking due to peer imitation has been trending downward
over time, it remains higher than the percent due to self-initiation. This suggests that
targeting peer-pressure spread would be more eective than targeting self-initiation
spread in anti-smoking campaigns. We discuss possible implications for interventions
and the spread of e-cigarettes.
FUNDING: Federal
186
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-124
USER CHARACTERISTICS, E-CIGARETTE AND COMBUSTIBLE
CIGARETTE USE, AND NICOTINE INTAKE AMONG POD-MOD
USERS IN THE SAN FRANCISCO BAY AREA
Jeremy Giberson1, Natalie Nardone1, Newton Addo1, Sameera Khan2, Peyton Jacob,
III1, Neal Benowitz3, Gideon St.Helen4. 1University of CA, San Francisco, CA, USA,
2UC-Berkeley, Berkeley, CA, USA, 3University of CA San Francisco, San Francisco, CA,
USA, 4University of CA, San Francisco, San Francisco, CA, USA.
Aim: To describe demographic characteristics, e-cigarette use patterns, tobacco cig-
arette use, and nicotine intake among users of pod-mods. Method: One hundred (n =
100) pod-mod users (64% male, 71% in the 18-34 age group, 45% white) participated in
an observational study in the San Francisco Bay Area in 2019-2020. Before the COVID
pandemic, questionnaires were administered, and urine samples were collected at a
research facility. During the pandemic, participants completed the questionnaires at
home and samples were picked up by research personnel. Total nicotine equivalents
(TNE) and total NNAL were measured by LC-MS/MS. Descriptive statistics were com-
puted for the full sample, across pod-mod types, avor types, nicotine concentration of
e-liquid and other variables. Results: Of the 100 participants enrolled, 59 used JUUL,
13 used Pu Bar, and 28 used other brands of pod-mods. Participants’ most-often-used
avors were fruit (40%), tobacco (30%) and menthol/mint avors (30%). Participants
used e-cigarettes an average of 25.5 (SD = 6.3) days a month, 10.2 (SD = 14.2) times
a day, used <1 pod/cartridge per day (77%) and 1-2 pods/cartridges per week (40%).
Number of times e-cigarette used per day and the number of days vaped in the last 30
days were correlated with TNE (Spearman correlation coecient 0.42, p<0.001 and 0.55,
p<0.001 respectively). In multivariate analysis, e-cigarette brand (JUUL vs Non-JUUL),
number of pods/cartridges per day (<1 vs 1+), days vaped in the last 30 days and total
NNAL levels were all signicantly associated with TNE levels. Self-reported CPD was
not found to be predictive of TNE. Average TNE levels for nonsmoking pod-mod users
(i.e., NNAL ≤ 10 pg/mg creatinine as a cutpoint) were signicantly lower than that of
pod-mod users who smoke (dual users) (NNAL >10 pg/mg creatinine) (TNE of 38.1
(95% CI 31.8-44.5) nmol/mg creatinine vs 45.7 (95% CI 40.7-50.8) nmol/mg creatinine).
Conclusions: Predictors of daily nicotine intake among pod-mod users include number
of times e-cigarettes are used during the day, number of pods vaped, and days vaped in
the past 30 days. These measures can be included in instruments to better understand
pod-mod use and nicotine intake in the general population.
FUNDING: Federal
PS3-125
THE ASSOCIATION BETWEEN NICOTINE DEPENDENCE AND THE
DESIRE TO QUIT, MOTIVATION TO CHANGE, QUIT ATTEMPTS,
AND BARRIERS TO TOBACCO TREATMENT AMONG SAUDI
SMOKERS
Abdullah M. Alanazi1, Nada Alfahadi2, Sadeem Alsayari2, Foton Alkhonain2, Norah
Alsulami2, Taha T. Ismaeil2. 1King Saud bin Abdulaziz University for Health Sciences,
Riaydh, Saudi Arabia, 2King Saud bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia.
Background: Saudi Arabia has a higher smoking prevalence (19.2%) in comparison to
the global prevalence of smoking (17.0%). Despite the advancement in tobacco control
and smoking treatment services in the country, tobacco smoking remains challenging
especially among hardcore smokers. Our purpose, therefore, was to assess how nicotine
dependence among Saudi smokers is associated with the desire to quit, motivation to
change, quit attempts, and barriers to tobacco treatment.Method: In a cross-sectional
study, 518 current tobacco smokers answered questions related to nicotine dependence
(Fagerstrom Test For Nicotine Dependence), desire to quit in the future, motivation to
change (The Motivation to Change Scale), and barriers to tobacco treatment. Linear
regression was tested to assess how nicotine dependence among smokers associates
with desire to quit, motivation to change, quit attempts, and barriers to tobacco treatment.
Results: Nicotine dependence was signicantly associated with lower motivation to
change (β = - 0.197, t = - 3.308, p ≤ 0.005) and fewer barriers to tobacco treatment (β
= - 0.501, t = 9.384, p ≤ 0.005). Desire to quit tobacco smoking (β = - 0.002, t = - 0.034,
p = 0.973) and quit tobacco smoking in the past (β = - 0.023, t = - 0.427, p = 0.670)
were not signicantly associated with nicotine dependence among Saudi smokers.
Gender, age, educational attainment, income, and occupational status were controlled
as covariates in the model.Conclusion: We revealed that nicotine dependence among
Saudi smokers aects the degree to which smokers are motivated to change and per-
ceive the barriers of tobacco treatments. Tobacco treatment services in Saudi Arabia
have been disseminated every smoker; however, hardcore smokers remain unlikely
to change even if they perceive lower barriers to tobacco treatment services. Tailored
tobacco treatment and behavioral intervention might be a key to increase the motivation
to change among hardcore smokers.
PS3-126
IQOS KNOWLEDGE/AWARENESS, PERCEIVED HARM,
PERCEIVED ADDICTIVENESS, USE, AND SUSCEPTIBILITY IN
YOUNGER ADULTS IN THE UNITED STATES
Kevin Madden, Sumner Sydeman. Northern Arizona University, Flagsta, AZ, USA.
Signicance: Heated tobacco products (HTPs) are battery operated and heat tobacco
rather than combusting it to create an aerosol vapor. IQOS was approved by the U.S.
Food and Drug Administration (FDA) for sale in the United States in 2019 and is currently
available for sale in four states: Georgia, Virginia, North Carolina, and South Carolina.
However, the national launch of IQOS has been hampered by COVID as well as a
patent-infringement lawsuit. The published survey research in the U.S. assessing use
and susceptibility to future IQOS use is hampered by design limitations such as survey
questions about HTPs in general rather than IQOS specically and samples gathered
from single states in the U.S. Method: The current observational, cross-sectional study
used Amazon’s Mechanical Turk for data collection, which occurred in May of 2021. The
sample consisted of 127 United States younger adults aged 18 to 35 (Mean age 29.7;
48% female; 81.9% Non-Hispanic White). Participants were provided a picture and text
description of IQOS, then were surveyed about IQOS knowledge/awareness, perceived
harm, perceived addictiveness, and use. Never users were assessed for susceptibility
to future use. Results: A total of 29.1% of participants reported IQOS knowledge/
awareness. A substantial 24.6% of the sample endorsed IQOS lifetime use, with 67.7%
of ever users reporting past 30-day use. The majority of participants (65.6%) believed
IQOS was about as harmful as cigarettes, while an even greater proportion (71.8%)
believed that IQOS was about as addictive as cigarettes. Finally, among IQOS never
users, 49.5% were classied as susceptible to future use. Conclusion: The proportion
of participants endorsing ever use of IQOS was unexpectedly high at roughly 25% of
the entire sample, which is substantially higher than ever use estimates reported in the
extant published data on IQOS use in the U.S. Further, given the high rates of IQOS
susceptibility among never users, ongoing monitoring of IQOS is warranted, as well as
public health IQOS prevention eorts focusing on younger adults, both smokers and
non-smokers, especially before the product is nationally released.
FUNDING: Unfunded
PS3-127
EXPOSURE TO E-CIGARETTE CONTENT ON SOCIAL MEDIA
AMONG 6TH GRADE STUDENTS IN TEXAS
Dale Mantey1, Omega-Njemnobi Onyinye2, Felisa A. Ruiz2, Andrew E. Springer2, Steve
Kelder3. 1UT-Health Science Center, School of Public Health, Austin, TX, USA, 2UTSPH,
Austin, TX, USA, 3UT SPH Austin Regional Campus, Austin, TX, USA.
Background: Social media is an inexpensive and largely unregulated marketing plat-
form. E-cigarette companies (e.g., JUUL; Pu Bar) utilize social media to market their
products to young people. This study examines exposure to e-cigarette content on social
media platforms among Texan 6th grade students. Methods: We analyzed baseline data
from n=983 6th grade students enrolled in the CATCH My Breath E-Cigarette Prevention
program. Data were collected in Spring 2021. Multileveled, multivariate logistic regres-
sion models examined the assocation between self-reported exposure to e-cigarette con-
tent on social media and e-cigarette susceptibility, social norms, outcome expectations,
and perceived acceptability. Exposure to e-cigarette content on social media include
seeing peers and/or inuencers/celebrities post, share, or comment about e-cigarettes
on social media sites (e.g. Facebook; Instagram; Twitter, etc.). Analyses controlled for
sex, race/ethnicity, class settings (online, in person, both), academic performance, and
living with an e-cigarette user. School was included as a random-eect to account for
nesting within schools. Results: Overall, 53.1% of 6th grade students reported exposure
to e-cigarette content on social media. Lifetime exposure was signicantly associated
with e-cigarette susceptibility among never users (aOR: 1.78) as well as greater odds
of perceived use among peers (1) in their middle school used e-cigarettes (aOR: 2.11),
(2) their age used e-cigarettes (aOR: 2.95), and (3) in high school used e-cigarettes
(aOR: 2.07). Exposure was signicantly associated with increased positive outcome
expectations of e-cigarette use (β = 0.178); and (5) increased perceived acceptability
about e-cigarette use (β = 0.12). Conclusions: Texas 6th grade students reported
exposure to e-cigarette content on social media. This exposure was linked to psycho-
social determinants of e-cigarette use among 6th graders. This is the rst study to report
187
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
prevalence and these signicant associations among such a young age-group. Findings
indicate the need to introduce e-cigarette prevention and counter-messing eorts early,
that combat the normalization of e-cigarette content on social media.
FUNDING: Federal
PS3-128
ASSOCIATION OF CLASS SETTINGS AND E-CIGARETTE USE
BEHAVIOR AMONG 6TH GRADE STUDENTS IN TEXAS DURING
COVID-19 PANDEMIC
Dale Mantey1, Onyinye Omega-Njemnobi2, Felisa Ruiz2, Andrew E. Springer2, Steve
Kelder3. 1UT-Health Science Center, School of Public Health, Austin, TX, USA, 2UTSPH,
Austin, TX, USA, 3UT SPH Austin Regional Campus, Austin, TX, USA.
Background: In response to the novel coronavirus SARS-CoV2 (COVID-19) pandemic,
school districts incorporated remote learning as a mitigating strategy. We examined the
association between how lessons where taught/ delivered to students in class settings
(i.e. remote versus on-campus/hybrid learning) and e-cigarette use/susceptibility among
6th grade students in Texas. Methods: We analyzed baseline data of n=985 students
enrolled in the CATCH My Breath E-Cigarette Prevention Program, an NIH funded
study. Data was collected in Spring 2021. Participants were recruited from 3 school
districts located in the Dallas/Fort Worth and El Paso, Texas. A multinomial logistic
regression model examined the association between class settings (i.e. on-campus
versus remote learning) and categories of e-cigarette use behavior. Categories were: (1)
non- susceptible never e-cigarette users (referent); (2) susceptible never users; and (3)
ever e-cigarette users. Covariates included sex, race/ethnicity, academic achievement,
perceived school connectedness, and self-reported exposure to positive e-cigarette
content on social media, Results: Overall, 32.7% of the sample were susceptible never
users and 3.6% were ever e-cigarette users. For class modality, 55.0% were on-campus
learners and 45.0% were virtual. Multinomial logistic regression revealed that on-campus
learners were more likely to be susceptible to e-cigarettes (RRR: 1.54; 95% CI: 1.14
- 2.07) and ever e-cigarette users (RRR: 2.15; 95% CI: 1.01 - 4.59), relative to those
who were remote learning Conclusions: This study found that 6th grade students who
received classes on-campus during the Spring 2021 semester were more susceptible
to e-cigarettes use and more likely to be ever e-cigarette users. These ndings have
signicant implications for public health. As school districts prepare to return to on-cam-
pus learning in Fall 2021, a more stringent approach is needed to prevent e-cigarette
access and use on school campus.
FUNDING: Federal
PS3-129
STUDENT-SCHOOL CONNECTEDNESS AND E-CIGARETTE
SUSCEPTIBILITY AND USE AMONG A DIVERSE SAMPLE OF 6TH
GRADE STUDENTS IN TEXAS
Andrew Springer1, Dale Mantey2, Onyinye Omega-Njemnobi1, Felisa A. Ruiz1, Steve
Kelder3. 1UTSPH, Austin, TX, USA, 2UT-Health Science Center, School of Public Health,
Austin, TX, USA, 3UT SPH Austin Regional Campus, Austin, TX, USA.
Background: The emotional connectedness a young person experiences with their
school, including feelings of attachment and support with peers and teachers and
feeling a part of one’s school, is protective against multiple health risk behaviors. While
student-school connectedness has been consistently associated with reduced risk of
adolescent smoking, research is lacking on its role in the prevention of e-cigarette use.
This study examined the association between student-school connectedness and e-cig-
arette susceptibility/use among an ethnically and socio-economically diverse sample
of 6th grade students in Texas. Methods: We conducted a cross-sectional analysis of
baseline data from the CATCH My Breath study, an NIH-funded study aimed at reducing
e-cigarette use among public middle school students. The sample was n=985 6th graders
from 21 public schools in Texas. Student-school connectedness (4- item scale; content
described in rst sentence) was based on National Longitudinal Study of Adolescent
Health measures. E-cigarette use was categorized as: (1) non-susceptible never users
(referent); (2) susceptible never users; and (3) ever e-cigarette users. Multinomial logistic
regression analyses were conducted, adjusting for sex, race/ethnicity, class modality,
academic performance, secondhand e-cigarette exposure, and language spoken at
home. Results: This diverse sample was 57.6% Hispanic, 21.2% non-Hispanic White,
and 9.3% African American; approximately 48% were bilingual. Overall, 63.8% were
non-susceptible never users, 32.7% were susceptible never users, and 3.6% were
ever users. As student-school connectedness increased, students were signicantly
less likely to be susceptible to e-cigarette use (RRR: 0.33; 95% CI: 0.25 - 0.43) or to
be ever e-cigarette users (RRR: 0.34; 95% CI: 0.18 - 0.62), relative to non-susceptible
never users. Conclusion: Student-school connectedness was found to be protective
against e-cigarette susceptibility and ever use among a diverse sample of Texas 6th grade
students. These ndings provide important foundation for further research on the role of
student-school connectedness in reducing e-cigarette use among young adolescents.
FUNDING: Federal
PS3-130
SUGAR PROFILES IN FLAVORED AND UNFLAVORED
WATERPIPE AND POTENTIAL MECHANISMS OF SUGAR
DEGRADATION DURING WATERPIPE TOBACCO SMOKING
Marielle C. Brinkman1, Clark W. Wilson2, Brittney Keller-Hamilton3, Nada O F Kassem4,
Theodore L. Wagener1. 1Ohio State University, Columbus, OH, USA, 2Ohio State Univer-
sity, Columbus, OH, USA, 3The OH State University, Columbus, OH, USA, 4San Diego
State University, San Diego, CA, USA.
Signicance: In the 30 years since its introduction, sweetened waterpipe (WP) tobacco
(“ma’assel”) is now smoked by >0.5M middle and high school children and 1.2M young
adults in the U.S. The mass ratio of sweet additives to nicotine in WP tobacco is signi-
cantly higher than any other combustible tobacco product, making WP the perfect “starter
product” for nicotine initiation. Sweet additives comprise the bulk of WP tobacco and can
degrade to form carcinogens and respiratory toxicants that are subsequently inhaled
by the smoker. To dene the eects of WP tobacco’s primary chemical additives with
respect to toxicant exposure, WP tobacco that diers only in concentrations of sugars
and humectants was examined. Methods: The concentrations of sugars and semivolatile
furans in a avored and unavored WP tobacco that was fortied with two ecologically
valid levels of sugars and humectants (high and medium) were determined using HPLC.
Results were compared with extant data on molasses, honey, and high fructose corn
syrups. Semivolatile furan mainstream smoke yields for the tobaccos were determined
using machine smoking and a human-derived pung regimen. Results: The mass of
semivolatile furans in mainstream smoke exceeded the mass in the tobacco by 3-14
times, depending on the sugar content of the tobacco. Extant data indicate sugars in WP
tobacco result from added high fructose corn syrups. Conclusions: These data provide
supporting evidence that the added sugars in WP tobacco thermally degrade during
smoking to form high concentrations carcinogens and respiratory toxicants. Statement
of Relevance to CTP Regulatory Authorities: A human study will determine how
specic WP tobacco additives aect users pung behavior, liking, harm perceptions,
and estimate the quantities of toxicants they inhale. These data are needed to inform
the development of evidenced-based product standards, or limits to additives in WP
tobacco, designed to reduce smoking-related death and disease.
FUNDING: Federal
PS3-131
A QUALITATIVE ASSESSMENT OF KNOWLEDGE, ATTITUDES,
AND BELIEFS ABOUT FLAVORS AND FLAVORED ELECTRONIC
NICOTINE PRODUCTS AMONG USERS
Maansi Bansal-Travers1, Christopher Frye1, Kristie June1, Phillip Vaughn2, Scott McIn-
tosh2, Richard O’Connor1. 1Roswell Park Comprehensive Cancer Center, Bualo, NY,
USA, 2University of Rochester, Rochester, NY, USA.
Background: Flavors in electronic nicotine delivery systems (ENDS) contribute to uptake
and continuation of ENDS use among youth and adults. Local, state, and federal govern-
ments have increased restrictions of avored ENDS to reduce youth use. In May 2020,
New York enacted a statewide ban on the sale of all avored ENDS with the exception of
tobacco avor and unavored products. This study examined ENDS users’ perceptions
and behaviors around avors. Methods: Focus groups and structured interviews were
conducted in Western NY among ENDS users before and after implementation of the
avored ENDS restriction. 100 ENDS users (aged 18+, everyday use over past 7 days)
were primarily recruited through Facebook (focus groups N=80; structured interviews
N=20). Baseline questionnaires assessed demographic and tobacco use characteristics.
Semi-structured discussions focused on avored ENDS use, motivations for use, harm
perceptions, marketing, packaging, and eects of the avor ban on use patterns. All
responses were recorded, transcribed, and then theme-coded for analysis. Results: The
majority of participants were former cigarette smokers or current dual users (cigarettes
and ENDS) who reported avored ENDS use to quit/reduce cigarette smoking. Flavors
were reported as appealing, while avor-switching and sampling multiple avors were
frequently mentioned behaviors. Users reported preferring either rellable tank systems
or prelled systems, with greater trust in local vape shops versus international tobacco
companies. Some users mentioned vaping to address symptoms of mental health diag-
noses, including ADHD. Prior to the restriction, most users preferred avored ENDS and
188
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
a majority were opposed to restrictions on availability. Despite restrictions on online and
retail sales in NY, many users reported continued use of avored ENDS.Conclusions:
The qualitative results suggest that avored ENDS are appealing to users, many users
frequently use and switch between multiple avors, users use ENDS to reduce smoking,
and some vape as self-medication. The ndings also suggest that users continued to
procure these products after restrictions went into eect.
FUNDING: Federal
PS3-132
QUALITATIVE ANALYSIS OF IQOS POPULARITY IN THE U.S.
Anastasiya Ferrell, Alana Seaman, Linda Haddad, Dana El Hajj. University of North
Carolina Wilmington, Wilmington, NC, USA.
Signicance: IQOS, a type of Heated Tobacco Product (HTP), is widely sold on inter-
national markets, and, starting in 2019, it is the only HTP brand allowed to sell in the
United States of America (U.S.). IQOS is only sold in a few states, and exceedingly
little is known about the public’s perception of this product in the U.S. Methods: This
study employed qualitative content analysis of reviews about IQOS stores and social
media posts made to the Phillip Morris IQOS ocial Facebook page to examine how
the product is currently being considered by U.S. consumers. Results: Findings reveal
that geography and availability, certain perceptions about the barriers and benets of
purchase and use, the technology and aesthetics of the product and where they are
sold, and store employees were signicant in molding people’s perceptions of the IQOS
device. Conclusions: While the Food and Drug Administration’s regulation of IQOS
marketing appears to have been largely successful as relatively little information was
being exchanged amongst the platforms investigated, the dearth of information available
and geographic limitations may fuel interest through notions of exclusivity.
FUNDING: Unfunded
PS3-133
INTERSECTIONALITY OF TOBACCO USE WITH ALCOHOL,
POVERTY, AND AGE IN LAO PDR
Anne Berit Petersen1, Sharn Singh2, Robert M. Semakula1, Pramil N. Singh2. 1School
of Nursing, Loma Linda University, Loma Linda, CA, USA, 2Center for Health Research,
Loma Linda University, Loma Linda, CA, USA.
Signicance. Globally, tobacco and alcohol abuse are the most highly prevalent ad-
dictive behaviors and rank in the top ten addictive substances. In the Western Pacic
Region, there is emerging data that cigarette smoking and alcohol use is a “polydrug”
behavior among young men, and their initiation is occurring at about the same age.
Such trends raise the possibility of targeting risk factors in prevention programs at the
community and individual levels. We considered the association between alcohol and
tobacco in the rst nationally representative tobacco survey of Lao People’s Democratic
Republic. Methods. Lao PDR’s National Adult Tobacco Survey (NATSL) was the rst
nationally representative prevalence survey of adult tobacco use in Lao PDR. It was
completed in 2013 by the Lao Statistics Bureau, Ministry of Health (CIEH Oce), and
Loma Linda University under funding from Fogarty International Center of the US NIH.
NATSL investigators conducted a stratied, multi-stage cluster sampling that selected
9,706 subjects from 2,822 households located in all 17 provinces and used the 2010
census as the sampling frame. The tobacco items were adapted from the Global Adult
Tobacco Survey format and administered to all adults ages 15 years and older. Results.
Alcohol was measured in number of drinks over a 7-day interval as beer, wine, liquor,
and palm liquor that was made at home for some rural subjects. Alcohol abuse (more
than 14 drinks per week) was evident in 8.9% (95% CI 8.4% to 9.5%) of adults, and
primarily due to beer consumption at this level (6.1% [95% CI 5.6% to 6.5%]). We found
alcohol abuse (more than 14 drinks per week) was strongly associated with current daily
cigarette smoking (OR = 2.26 [95% CI 1.89 to 2.713]) among all adults, and a signicant
4% increase in odds of being a smoker per drink consumed each week (OR= 1.04 [95%
CI 1.03 to 1.05]). Conclusion. Smoking and alcohol use are strongly associated in a
national sample of adults in Lao PDR, and the nding raises the possibility of targeting
both risk factors in culturally tailored interventions.
FUNDING: Federal
PS3-134
SYNTHETIC NICOTINE HAS ARRIVED - HISTORY, PATENTS AND
MARKETING
Sven-Eric Jordt. Duke University, School of Medicine, Durham, NC, USA.
The introduction of a new product line of the popular disposable electronic cigarette
brand Pubar, advertised as containing synthetic nicotine, has drawn attention to the
increasing use of synthetic nicotine in marketed products and its uncertain regulatory
status. A search of the Truth Tobacco Industry Documents revealed that the industry
considered using synthetic nicotine already in the 1960s, eorts that were abandoned
due to high costs and insucient purity. Recent patents revealed renewed eorts to
develop more ecient strategies for the synthesis of nicotine. Nicotine exists as two
stereoisomers, S-nicotine and R-nicotine. While Snicotine is the prevalent (>99%) form
of nicotine in tobacco, a market-leading form of synthetic nicotine contains both stereo-
isomers at equal amounts, raising concerns about inaccurate labeling and the poorly
understood health eects of R-nicotine. Other manufacturers, including a leading vendor
of pharmaceutical grade nicotine, developed stereospecic strategies to synthesize
pure Snicotine, now added to Ecigarette products marketed in the US and UK. While
S-nicotine and R-nicotine can be dierentiated by enantioselective HPLC, dierentiation
of synthetic (fossil-derived) from tobacco-derived S-nicotine will require development of
methods to measure carbon isotope (14C or 13C) content. Vendors claim that the FDA
has no authority to regulate synthetic nicotine as a tobacco product, allowing them to
circumvent the premarket tobacco product application (PMTA) process. Synthetic nic-
otine is not only marketed in electronic cigarettes, but also in the novel nicotine pouch
category. These products are currently marketed through non-traditional sales channels,
including Amazon.com . Manufacturers claim that the FDA has no authority to regulate
synthetic nicotine as a tobacco product, allowing them to avoid the premarket tobacco
product application (PMTA) process. However, legal analysis suggests that FDA may
have the authority to regulate synthetic nicotine as a drug. Alternatively, Congress
needs to include nicotine from any source within the legal denition of tobacco products.
FUNDING: Federal
PS3-135
A MULTIWAVE CROSS SECTIONAL SURVEY OF SECONDHAND
SMOKE EXPOSURE IN HONG KONG WORKPLACES, TREND AND
ASSOCIATIONS WITH FACTORS AND RESPIRATORY SYMPTOMS
Yee Tak Derek Cheung1, Qi Wang1, Tai Hin Lam2, Man Ping Wang1, Sai Yin Daniel Ho2.
1School of Nursing, LKS Fculty of Medicine, The University of Hong Kong, Hong Kong,
Hong Kong, 2School of Public Health, University of Hong Kong, Hong Kong, Hong Kong.
Background Smoking has declined in Hong Kong, but little is known about the trend
of second-hand smoke (SHS) exposure at workplaces. We examined the trend and
associations of such exposure with factors and respiratory symptoms. Study design
This study is a secondary data analysis of a multi-wave cross-sectional survey. Meth-
ods The data were collected from eight waves (2013 to 2019) of Tobacco Control
Policy-related Survey (TCPS) with a representative sample of 35,753 people aged
15 and above with over-sampling of current and former smokers. Two-stage landline
random digit dialing was used. Respondents reported exposure to SHS within 3 meters
at workplace in the past 7 days and frequent respiratory symptoms (e.g. cough, sore
throat for at least 3 months) in the past 12 months. 15,832 working respondents were
eligible for the present study, including 5,320 who were randomly selected to report
their respiratory symptoms. The trend of exposure, related factors, and association with
respiratory symptoms were examined using passion regression and adjusted risk ratios
(ARRs). Results Exposure to SHS at workplace declined 14.3% from 48.1% in 2013 to
33.8% in 2019 in Hong Kong. More current smokers (52.9%) were exposed than former
smokers (37.8%) and never smokers (20.2%). Younger age, being male, lower education
level, and workplace environment (mainly outdoor and both indoor and outdoor) were
signicantly associated with exposure in never, former and current smokers. In former
smokers, manual jobs were signicantly associated with exposure. SHS exposure at
workplace was marginally signicantly associated with respiratory symptoms in never
smokers (ARR 1.39, 95% condence interval 1.00-1.94, P=0.051) and the association
was signicant among former smokers (1.51, 1.11-2.04, P<0.01) and all respondents
(1.37, 1.14-1.66, P<0.01). Conclusion SHS exposure at workplace was declining but
remained high in Hong Kong. Such exposure was signicantly associated with outdoor
and manual jobs and was independently associated with frequent respiratory symptoms
in non-smokers. Funding: Hong Kong Council on Smoking and Health.
FUNDING: Nonprot grant funding entity
189
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-136
STORM HEROES A GAME-BASED TOBACCO PREVENTION
INTERVENTION THAT PROMOTES PEER TO PEER INTERACTION
AMONG ADOLESCENTS
Georges Khalil. The University of Florida, College of Medicine, Department of Health
Outcomes and Biomedical Informatics, Gainesville, FL, USA.
Background: Adolescent tobacco use remains a public health concern. While several
computer-based tobacco prevention programs for adolescents have shown some level
of success, they do not yet promote peer-to-peer interaction in order to counteract the
potential eect of negative inuence or peer pressure. Considering the role of social
interaction in driving adolescents’ tobacco use, we have developed a model that seeks
to examine a game-based social intervention alongside a computer-based tobacco
prevention program known as A Smoking Prevention Interactive Experience (ASPIRE).
We aim to examine the short-term user experience of our game-based tobacco use
prevention intervention called STORM HEROES. Methods: The intervention implements
game play in order to enhance learning processes via the promotion of social interac-
tion through an entertaining and interactive environment. We conducted a randomized
comparative study with 47 adolescents from 4 after-school organizations in Florida who
engaged in either the intervention (social game-play with ASPIRE) or ASPIRE alone.
A series of one-way analyses of variance comparing the two groups were conducted
for data analysis. Results: As expected, there were no group dierences with respect
to recall of intervention content, paying attention to the program, or being motivated
to have a conversation with others about the program. However, adolescents who
received STORM HEROES were more likely to express higher positive attitude toward
the program compared to those who received ASPIRE alone (F=5.11, P<0.05). Also,
adolescents who received STORM HEROES were more likely to express enjoyment of
the storyline (F=6.19, p<0.05), express creative freedom (F=7.16, p<0.05), and engage
in social interactions with their peers during the program (F=5.13, p<0.05).Discussion:
Our results indicate that STORM HEROES can improve peer-to-peer interaction with
conversations against tobacco use. Our next logical step is to evaluate this program’s
eectiveness in preventing tobacco use with a larger number of adolescents.
FUNDING: Federal
PS3-137
RELATIONSHIP BETWEEN SMOKING AID USE AND PERCEIVED
BARRIERS TO USE BY GENDER MINORITY AND SEXUAL
MINORITY STATUS
Jennifer Pearson1, Prati Lodha2, Alana Cataldo2, Matthew L. Broussard2, Anthony
Sablan2, Scott Leischow2. 1University of NV, Reno, Reno, NV, USA, 2Arizona State
University, Phoenix, AZ, USA.
SIGNIFICANCE: Gender and sexual minority people (e.g., trans men and women; gen-
der diverse individuals; and lesbian, gay, bisexual, queer [LGBQ] people) smoke more
cigarettes than heterosexual and cisgender people in the US. This study’s aim was to
describe the relationship between smoking cessation aid use and perceived barriers to
use by gender and/or sexual minority status, focusing on use of varenicline. METHODS:
Data are from an online survey of 1,111 adult daily smokers in the US, using quotas to
gather an adequate sample of smokers by sexual/gender minority status. RESULTS:
Overall, the sample consisted of 71.8% cisgender heterosexual, (CH) 11.9% trans
heterosexual (TH), 10.7% cisgender LGB (CLGB), and 5.6% trans LGB (TLGB) daily
smokers. CH and LGB smokers’ sociodemographic and smoking characteristics were
comparable; trans participants were more likely to be men (77.4% vs. 43.6%) and to
be of higher SES (e.g., report a “comfortable” income [80.4% vs. 32.3%], have at least
a bachelor’s degree [71.1% vs. 35.1%], and have health insurance [95.4% vs. 82.9%])
than cisgender participants (p’s <0.001). Current depression increased with the number
of stigmatized identities, from CH (43.4%), to CLGB (52.1%), TH (65.2%), and TLGB
(69.4%) people. While lifetime and past 12-month quit method use were similar for CH
and CLGB participants, trans participants were 2.7 times more likely to use varenicline
during their last attempt (p<0.001). However, among varenicline never users , trans
people were ~2 times more likely than cisgender people to cite structural barriers to
access (e.g. expense or not being able to get a prescription). TLGB people were the
most likely to report structural barriers to access compared to CH people (aOR 3.0;
p=.002). CONCLUSIONS: Despite trans participants’ greater material wealth, structural
barriers to using varenicline persist for trans smokers and highlight a mechanism to
reduce disparities in smoking prevalence by gender identity.
FUNDING: Federal
PS3-138
AMOUNT AND THEMES OF SMOKELESS TOBACCO-RELATED
MESSAGES ON INSTAGRAM
Ganna Kostygina1, Hy Tran1, Yoonsang Kim1, Andrew Norris1, Shyanika Rose2, Sherry
Emery1. 1NORC at the University of Chicago, Chicago, IL, USA, 2University of Kentucky,
Lexington, KY, USA.
Signicance: Social media promotion of non-cigarette tobacco products is on the rise,
yet digital marketing remains to be an understudied domain in tobacco control. Vendor
and inuencer messages promoting tobacco products on social media are currently
under-regulated, target youth and often contain misinformation. The objective of the
present study was to assess the amount and characterize the content of smokeless-re-
lated commercial and organic messages on Instagram. Methods: Keyword rules were
used to collect smokeless-related Instagram posts from the CrowdTangle platform from
01/08/2016 to 04/30/2020. Posts were coded for commercial content and promotional
strategies (e.g., youth and new user targeting) using a combination of machine learning
methods, keyword algorithms, and human coding. Post metadata were analyzed to
assess post engagement. Additional exploratory analyses using topic modeling were
performed to discover major discussion themes. Non-English messages were excluded
from the analysis. Results: Keyword lters captured 21,119 smokeless-related posts,
with 12,203 messages (57%) classied as commercial. Approximately 9,675 posts
originated from the U.S., with the remaining posts containing no geolocation reference.
Promotional messages featured lifestyle, sports and patriotism-themed appeals, as well
as such new user appeals as “tobacco-free” and “synthetic nicotine” claims, avored
product references, and giveaways. In addition, high-nicotine references and reduced
harm appeals to smokers were present. Posts by inuencer accounts, including celebrity,
meme, and community users (e.g., Copenhagen Nation) generated the highest level of
engagement (likes and comments). Conclusion: Tobacco control prevention initiatives
should include eorts to prevent and reduce smokeless uptake by new users and youth
and should take into account the role of social media as a major marketing platform for
these products. The social media marketing and sale of smokeless products warrants
urgent need for surveillance and serious attention from public health.
FUNDING: Federal
PS3-139
ADVERTISING AND SOCIAL MEDIA EXPOSURE TO CIGARETTE,
VAPE, AND MARIJUANA CONTENT AMONG CALIFORNIA HIGH
SCHOOL STUDENTS
Nora Satybaldiyeva, Shu-Hong Zhu. University of California San Diego, La Jolla,
CA, USA.
Signicance: Tobacco and marijuana manufacturers have recently turned to new media
types, such as digital technology and social media, to appeal to a younger audience.
However, very few studies have examined this rapidly changing relationship between
advertisements, social media, and substance use among adolescents. We carried
out a descriptive study to estimate the prevalence of cigarette, vape, and marijuana
advertisement and social media exposure among California youth. Methods: The study
sample consisted of students who participated in the 2019-2020 California Student
Tobacco Survey: a large, cross-sectional random sample of 10th and 12th graders
(N=147,757). Descriptive analyses examined cigarette, vape, and marijuana adver-
tisement prevalence and exposure to people using these products on social media by
student demographics. Results: Students reported that most of the cigarette and vape
advertisements they encountered discouraged the use of those products (60.5% and
60.3%, respectively). However, the percentage of ads discouraging the use of marijuana
(31.9%) was nearly half that of cigarette and vape ads; in fact, more students reported
seeing advertisements promoting marijuana use (35.8%) than discouraging it (31.9%).
An overwhelming majority of students reported never/rarely seeing someone on social
media smoking cigarettes (72.2%), while only 41.3% and 44.4% of students reported
never/rarely seeing someone on social media vaping or using marijuana, respectively.
Conclusions: Students reported seeing more negative ads that discouraged rather than
promoted smoking and vaping, while marijuana ads were found to be almost evenly
distributed between negative, positive, and neutral messages. This study also found that
students were more likely to encounter marijuana content on a frequent basis on social
media compared to vaping and smoking, which held true even among nonusers. These
ndings indicate that students may be receiving more messaging around marijuana,
that in turn is more positive and neutral, compared to vaping and smoking, which could
serve to increasingly normalize cannabis use to adolescents.
FUNDING: Academic Institution
190
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-140
A RANDOMIZED, CROSSOVER, CLINICAL STUDY TO ASSESS
NICOTINE PHARMACOKINETICS AND SUBJECTIVE EFFECTS
OF THE BIDI STICK ENDS COMPARED WITH COMBUSTIBLE
CIGARETTES AND A COMPARATOR ENDS IN ADULT SMOKERS
Ian M. Fearon1, Karin M. Gilligan2, Ryan G. N. Seltzer3, Willie J. McKinney4. 1whatIF?
Consulting Ltd, Harwell, United Kingdom, 2Grey Manor Consulting, Moseley, VA, USA,
3Safety in Numbers, LLC, Tucson, AZ, USA, 4McKinney Regulatory Science Advisors,
LLC, Henrico, VA, USA.
Background: Nicotine pharmacokinetic assessments of electronic nicotine delivery
systems (ENDS) are crucial to understand their ability to provide an alternative to ciga-
rette smoking. Subjective e!ects data also strongly contribute to this understanding. The
BIDI® Stick is a disposable ENDS product which contains 6% nicotine benzoate salt
and various avours. Methods: In this study we assessed nicotine pharmacokinetics
and subjective e!ects of BIDI® Stick ENDS in adult smokers, compared to cigarettes
and a comparator ENDS product. During each of eight (8) study visits, volunteer smoker
subjects randomly used one of either their usual brand (UB) of cigarette, a BIDI® Stick
ENDS, or a comparator ENDS (JUUL 5% with Virginia Tobacco avour), during both
dened (10 pu!s, 30 seconds apart) and ad libitum pu"ng sessions. Blood samples were
collected at various time points and subjective e!ects questionnaires were administered.
Results: Plasma nicotine Cmax0-120 was not signicantly di!erent between BIDI®
Stick ENDS with any avour (range 15.3 (9.90) ng/ml for BIDI® Stick Winter to 17.6
(9.00) ng/ml for BIDI® Stick Classic) and UB cigarettes [16.2 (9.17) ng/ml]. AUC0-120
and Tmax0-120 values were also not signicantly di!erent between BIDI® Stick ENDS
and UB cigarettes, while subjective e!ects measures were also similar between BIDI®
Stick ENDS and UB cigarettes. Conclusions: BIDI® Stick ENDS delivered nicotine to
users comparably to their UB combustible cigaretteand also elicited similar subjective
e!ects such as satisfaction and relief. Thus, the BIDI® Stick ENDS may be a satisfying
alternative to cigarettes among current smokers and may support their transitioning
away from cigarette smoking.
FUNDING: E-cigarette Alternative Industry; E-Cigarette Company
PS3-141
A SYSTEMATIC REVIEW AND META-ANALYSIS OF
INTERVENTIONS TO INDUCE ATTEMPTS TO QUIT TOBACCO
AMONG ADULTS NOT READY TO QUIT
Elias M. Klemperer, PhD1, Joanna M. Streck2, Nicola Lindson3, Matthew J. Carpenter4.
1University of Vermont, 2Massachusetts General Hospital, Boston, MA, USA, 3University
of Oxford, 4Medical University of South Carolina.
Background: The prevalence of past year cigarette cessation remains below 10% in
the US and most people who smoke are not ready to quit in the near future. Cessation
requires both initiating a quit attempt (QA) and maintaining abstinence. Most treatment
research has focused on abstinence among people already motivated to quit. We
systematically reviewed interventions to promote QAs among people not ready to quit
tobacco. Methods: We searched PubMed, CENTRAL, PsycINFO, Embase and personal
libraries for randomized trials of tobacco interventions that reported QAs among adults
not ready to quit. Two independent reviewers screened 2,418 articles and extracted
data from eligible studies. We meta-analyzed ndings when =2 studies tested the same
intervention and comparison conditions. Studies’ odds ratios (OR) were log transformed
before being pooled in Mantel-Haenszel, xed eect meta-analyses. Reported estimates
and their condence intervals are back-transformations. Results: We included 23 trials
of interventions to induce QAs. Motivational interventions without medication increased
QAs more than no treatment (trials=2; n=463; OR=3.9; 95% CI=1.5, 9.9) but not more
than brief advice to quit (trials=5; n=1,027; OR=1.3; 95% CI=0.9, 1.8). Reduction inter-
ventions without medication did not increase QAs compared to brief advice (trials=2;
n=474; OR=1.0; 95% CI=0.4, 2.5). Relative to no treatment, nicotine replacement
therapy (NRT) with reduction counseling appeared to increase QAs (trials=2; n=557;
OR=2.5; 95% CI=1.02, 6.0), but not without counseling (trials=3; n=1,625; OR=1.1;
95% CI=0.8, 1.6). Switching to very low nicotine cigarettes increased QAs more than
normal nicotine cigarettes (trials=3; n=487; OR=2.2; 95% CI=1.1, 4.2). Conclusions:
Interventions to induce QAs varied substantially and thus ndings are limited by small
samples. Motivational counseling, NRT aided reduction, and very low nicotine cigarettes
appeared to increase QAs compared to no treatment, but not in comparison to brief
advice. More studies are needed before concluding which interventions are eective
for adults not ready to quit smoking, and could change our interpretation of eects.
FUNDING: Federal
PS3-142
SMOKING CESSATION TREATMENT MECHANISMS: EVALUATING
WITHDRAWAL RELIEF AS A MEDIATOR OF VARENICLINE
EFFICACY
Sarah Suzanne Tonkin1, Craig Colder1, Martin Mahoney2, Gary Swan3, Paul Cinciri-
pini4, Robert Schnoll5, Tony George6, Rachel Tyndale6, Caryn Lerman7, Larry Hawk1.
1SUNY Bualo, 2Roswell Park Cancer Institute, 3Stanford University, 4MD Anderson
Cancer Center, 5University of Pennsylvania, 6University of Toronto, 7University of South-
ern California.
Negative reinforcement models of addiction posit that cessation-induced withdrawal
drives relapse back to smoking. Varenicline is hypothesized to aid cessation, in part, by
attenuating withdrawal facets; however, this mediational pathway has not been formally
evaluated in placebo-controlled trials. The present research used latent growth curves to
model trajectories of withdrawal facets (craving, negative/positive aect [NA, PA], sleep
problems) and tested the eect of varenicline on these changes (path a in the proposed
mediational chain), the relationship between the trajectories and bio-veried smoking
status at end of treatment (11 weeks post-quit; path b), and the degree to which these
candidate mediators account for the eect of varenicline treatment on smoking status
(indirect eect, a × b). Secondary data analysis was conducted on 828 treatment-seeking,
cigarette using adults assigned to varenicline or placebo in a randomized controlled trial
(NCT01314001). Self-reported craving, NA, PA, and sleep problems were assessed
1 week pre-quit, on the target quit day (TQD), and 1 and 4 weeks post-TQD. Across
time, craving declined, NA and sleep problems peaked 1 week post-quit (ps < .05),
and PA did not change. Lower elevations in NA trajectories during the rst month of
treatment modestly mediated the relationship between varenicline and higher cessation
rates (Indirect eect 95% CI: 0.002 to 0.07; Model R2 = 0.13). Lower craving 1 week
post-quit mediated the relationship between varenicline and higher cessation rates
(CI: 0.08 to 0.30; R2 = 0.13). PA and sleep problems were not signicant mediators.
Sex and race moderated the mediated eect of NA with the eect being signicant for
females (CI: 0.33 to 1.55) and Caucasians (CI: 0.002 to 0.58) and non-signicant for
males (CI: -0.05 to 0.16) and people of color (CI: -0.14 to 0.32). The present research
provides modest support for the hypothesis that varenicline improves cessation rates
via withdrawal-reduction, claries the relative importance of specic withdrawal facets
for relapse, and suggests mechanisms of varenicline therapy vary depending on key
participant characteristics (sex, race).
FUNDING: Federal; Academic Institution
PS3-143
A VIRTUAL REALITY SCENARIO ON THE HEALTH
CONSEQUENCES OF SMOKING: A PILOT RANDOMISED TRIAL
WITH SMOKERS UNMOTIVATED TO QUIT
Olga Perski, BSc, MSc, PhD, Dimitra Kale, Trupti Jambharunkar, Jamie Brown. Univer-
sity College London.
Background: Individual-level interventions for smokers unmotivated to quit remain scarce
and have had limited success. Little is known about the potential of virtual reality (VR) for
delivering messaging to smokers unmotivated to quit. This pilot trial aimed to evaluate
the feasibility and acceptability of a brief, theory-informed VR scenario, and estimate its
likely eect on proximal quitting outcomes. Methods: Unmotivated smokers (recruited in
February-July 2021) aged 18+ years who had access to, or were willing to receive via
post, a VR headset were randomly assigned (1:1) using block randomisation to view
the intervention or a ‘sham’ VR scenario with a researcher present via teleconferencing
software. The primary outcome was feasibility of recruitment (i.e., achieving the target
sample size of 60 participants within 3 months from the trial start date). Secondary
outcomes included acceptability (i.e., positive aective and cognitive attitudes), quitting
self-ecacy and intention to stop smoking (i.e., clicking on a weblink with additional stop
smoking information). We report point estimates and 95% condence intervals (CIs).
The study protocol was pre-registered (osf.io/95tus). Results: We randomly assigned
57 participants to the intervention (n=27) or control (n=30) arm within 6 months (34 of
whom were recruited within 2 months following an amendment to send headsets via
post). The mean (SD) age of participants was 33.8 (11.9) years, with 47.4% identifying
as female. The mean (SD) cigarettes per day was 9.4 (6.8). The intervention (85.2%,
95% CI=66.3%-95.8%) and control (93.3%, 95% CI=77.9%-99.2%) scenarios were rated
as acceptable. Quitting self-ecacy and intention to stop smoking in the intervention
(14.8%, 95% CI=4.2%-33.7%; 3.7%, 95% CI=0.1%-19%) and control (26.7%, 95%
CI=12.3%-45.9%; 0%, 95% CI=0%-11.6%) arm were comparable. Discussion: A brief
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
VR scenario appeared acceptable to smokers unmotivated to quit. The target sample
size was not achieved within the feasibility window; however, an amendment to send
free headsets via post appeared promising.
FUNDING: Federal; Nonprot grant funding entity
PS3-144
MECHANISMS OF SMARTPHONE APPLICATIONS FOR
CIGARETTE SMOKING CESSATION: RESULTS OF A SERIAL
MEDIATION MODEL FROM THE ICANQUIT RANDOMIZED TRIAL
Jonathan Bricker, PhD1, Michael E. Levin2, Raimo Lappalainen3, Kristin E. Mull1,
Brianna Sullivan1, Margarita Santiago-Torres1. 1Fred Hutchinson Cancer Research
Center, 2Utah State University, 3University of Jyväskylä.
Background: Engagement with digital interventions is a well-known predictor of treatment
outcome but this knowledge has had limited actionable value. Instead, learning why
engagement with digital interventions impact treatment outcome can lead to targeted
improvements in their ecacy. Objective: To test a serial mediation model of an Accep-
tance & Commitment Therapy (ACT) smartphone intervention for smoking cessation.
Methods: In this randomized controlled trial (N=2,415), participants from 50 US States
were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison
smartphone intervention (QuitGuide). Their engagement with the applications (primary
measure: number of logins) was measured during the rst three months, ACT processes
were measured at baseline and three months (acceptance of internal cues to smoke,
valued living to motivate quitting smoking), and smoking cessation was measured at
12-months with 87% follow-up retention. Results: There was a signicant serial media-
tion eect of iCanQuit on smoking cessation through multiple indicators of intervention
engagement (i.e., total number of logins, p<.001; total number of minutes used, p<.001;
and total number of unique days of use, p<.001 and in turn through baseline to three
months changes in mean acceptance of internal cues to smoke (p<.001). Analyses
of the acceptance subscales showed that the mediation was through acceptance
of physical sensations (p<.001) and emotions that cue smoking (p.05). There was
no evidence that the eect of the iCanQuit intervention was mediated by changes in
valued living (p >.05). Conclusions: In this rst study of mediators underlying the e-
cacy of smartphone applications for smoking cessation, results suggest the eect of
the iCanQuit ACT-based smartphone application on smoking cessation was mediated
through multiple indicators of engagement and in turn through increases in acceptance
of physical sensations and emotions.
FUNDING: Federal
PS3-145
GREATER PAIN IS ASSOCIATED WITH LIKELIHOOD OF
E-CIGARETTE USE AMONG YOUNG ADULTS
Emily L. Zale, PhD, Callon M. Williams, Ashley L. Shayya. Binghamton University.
Youth e-cigarette use remains at epidemic levels, and over 20% of young adults (YA;
age 18-24) report recent e-cigarette use. More than 1.3 million YA are introduced to
nicotine through e-cigarettes annually, and YA who use e-cigarettes are three times
more likely to try cigarette smoking in the next year. Although pain is understudied in
YA, emerging evidence suggests that young adulthood may be a critical developmental
period for the onset of chronic pain. An increasingly large body of evidence indicates
that pain may promote nicotine use in adults, but little is known about associations
between pain and e-cigarette use in YA. Participants were 695 YA attending at a large
Northeastern University (74% female; Mage = 18.81; 70% White) who completed an
online survey of substance use and health for course credit. Half (51%) of participants
reported lifetime e-cigarette use, nearly 30% reported current e-cigarette use, and 8%
reported daily use. On average, participants reported that their worst pain in the past
3-months was 5/10, and 72% reported experiencing at least moderate pain (>=4/10)
at some point during the past 3-months. Approximately 11% of the sample reported
experiencing pain that persisted for greater than 90 of the past 180 days. Logistic
regression, controlling for sociodemographic and college enrollment characteristics,
revealed that for every one-point increase in pain, the likelihood of reporting current
e-cigarette use increased by 10% (p = .008). When models were run separately for
males and females, every one-point increase in pain was associated with a 17% greater
likelihood of current e-cigarette use among males (p = .041). The association between
pain and e-cigarette use was not signicant for females (p = .094). Results demonstrate
the high prevalence of both e-cigarette use and pain among young adults. Consistent
with prior research that has demonstrated pain-nicotine associations are stronger among
male adults, ndings suggest YA males, but not females, who experience pain are more
likely to report e-cigarette use. Results indicate that pain may be an important factor to
consider when studying and treating e-cigarette use among YA.
PS3-146
ASSOCIATIONS BETWEEN SMOKING AND PAIN IN EARLY
RECOVERY IN RESIDENTIAL TREATMENT SEEKERS
Je Boissoneault, PhD, Shelby Blaes, Ben Lewis, Scott Teitelbaum. University of
Florida.
A growing literature indicates bidirectional associations between pain and tobacco use.
Cigarette smokers are at increased risk for chronic pain, and observational and experi-
mental studies indicate that pain increases motivation to smoke. Tobacco use disorder
frequently co-occurs with other substance use disorders, which are also associated with
chronic pain vulnerability. Although smoking cessation is a common element of residential
substance use treatment programs, many treatment seekers either sustain or increase
smoking over the course of treatment. Despite evidence that pain signicantly predicts
smoking and relapse, associations between smoking history/trajectory and changes in
pain over the course of treatment have not been characterized. In this study, 230 adult
smokers in residential substance use treatment in North Central Florida completed
questionnaires assessing cigarette use and pain intensity/interference at treatment
entry and discharge (Mean=80.3 days, SD=25.6). Most participants were diagnosed
with alcohol use disorder (66.1%). Opioid (27.9%) and cannabis use disorder (29.6%)
were also common. Participants were grouped by whether their smoking increased
(n=38), decreased (n=48), or stayed the same (n=144) from entry to discharge. Results
indicated a positive association between pack years and pain intensity at both baseline
and discharge (r=.21, p=.006). Smoking trajectory was associated with pack years, with
those who decreased smoking having greater pack years than those who sustained
or reduced use (F7,145=7.00, p=.001, ?2p=.09). Repeated measures GLM indicated
pain intensity (F1,212=44.51, p<.0001, ?2p=.17) and interference (F1,212=41.30,
p<.0001, ?2p=.16) decreased signicantly over time. However, there was no main or
interactive eect of smoking trajectory with pain intensity. Overall, results indicate that
smoking history is signicantly associated with pain in residential treatment seekers,
and, encouragingly, that pain decreases over the course of early abstinence. However,
changes in smoking behavior do not appear to meaningfully alter pain trajectory, or vice
versa, during residential treatment.
FUNDING: Academic Institution
PS3-147
UTILIZATION AND RELIABILITY OF SMARTPHONE-ENABLED
CARBON MONOXIDE DEVICES IN A REMOTE SMOKING
CESSATION TRIAL
Yong Cui, PhD1, Jason Robinson1, Charels Green2, Jennifer Minnix1, Maher Karam-
Hage1, Paul Cinciripini1. 1UT MD Anderson Cancer Center, Houston, TX, USA, 2UT
Health Science Center at Houston, Houston, TX, USA.
Signicance: Researchers have increasingly taken advantage of smartphones to
collect data, particularly in studies conducted remotely. Unlike conventional clinical
studies, many “remote” studies do not require participants to attend in-person visits. A
critical challenge in conducting remote smoking studies is the biochemical verication
of smoking and abstinence status. Smartphone-enabled mobile carbon monoxide (CO)
devices have become available to address this issue. Laboratory research has indicated
that these devices provide reliable CO measures for verifying smoking and abstinence
status. However, little is known about the real-world utilization and reliability of mobile
CO devices in a treatment study. Methods: To ll this gap, we examined mobile CO
device data from an ongoing remote smoking cessation trial (NCT04604509). Each
participant received a smartphone for counseling and completing questionnaires, a
mobile CO device, and cessation medications. Participants were instructed to mea-
sure CO levels 3 times during the 12-week treatment but were allowed to take extra
CO measures during this time. Results: Among the 219 participants included in this
analysis, we found that on average, participants submitted almost 6 CO measures with
over 190 participants submitting > 3 measures. Participants submitted about 3 times
more measures during the day than during the night. Participants also showed interest
in tracking their CO records: on average, participants viewed their CO records over
6 times. In terms of reliability, we found that participants' CO levels were signicantly
correlated with their self-reported cigarette consumptions (Pearson’s r > 0.5). Moreover,
with the assumption that self-reported consumptions were true values, using a cuto of
< 6 ppm as abstinent, the CO measures could dierentiate abstinent status with desired
specicity and sensitivity (both around 0.85). Conclusion: To conclude, participants
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2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
in a remote smoking study were utilizing smartphone-enabled CO devices to a greater
extent than required by the study protocol, and CO measures derived from the devices
were reliable to identify smoking and abstinence status.
FUNDING: Federal; Academic Institution
PS3-148
THE IMPORTANCE OF CIGARILLO PRODUCT CHARACTERISTICS
AMONG YOUNG ADULT CIGARILLO USERS: DIFFERENCES
BY DEMOGRAPHICS, CIGARILLO USE AND OTHER TOBACCO/
SUBSTANCE USE BEHAVIORS
Ollie Ganz, DrPH. Rutgers Center for Tobacco Studies.
BACKGROUND: Consumption of cigar products has increased in the U.S.— cigarillos
in particular, which are disproportionately used by young adults. Cigarillo product char-
acteristics can inuence consumer perceptions and the appeal of these characteristics
can vary by subgroup. Yet, existing research has only focused on dierences based
on one demographic characteristic (e.g., race) and has not examined how preferences
dier based on cigar and other tobacco use characteristics. The goal of this study was to
examine product characteristics important to young adult cigarillo users and to examine
dierences based on demographics and cigarillo and other tobacco/substance use
behaviors. METHODS: In 2016, a convenience sample of 628 past-year cigarillo users
rated the importance of the following cigarillo product characteristics when choosing
a cigarillo to smoke tobacco: brand, quality of the tobacco ller, quality of the tobacco
wrap, avors, price, graphic design of the packaging and number of cigars in the pack.
Demographic, cigarillo use and other tobacco/substance use characteristics were also
assessed. Dierences in mean importance were analyzed using t-tests and ANOVA
tests. RESULTS: The most important cigarillo product characteristics were price, quality
of tobacco wrap, and avors. The lowest scored characteristic was graphic design of
packaging. There were dierences in importance by demographics and/or cigar and
other tobacco/substance use behaviors for all product characteristics. In particular, pack
size was rated as more important among current cigarillo users, users of foil pouches
(2-3 cigarillos) or cardboard/paper boxes or other packaging styles and current users of
cigarettes, blunts and marijuana. Price was rated as more important among Hispanic/
Latino and lower income smokers, as well as current cigarette and blunt smokers.
DISCUSSION: Findings suggest that various cigar-related policies, such as those that
ban avors or set minimum pack sizes, could impact sub-populations of cigarillo users
dierently, however, research is needed to examine this.
FUNDING: Federal
PS3-149
SELLING PROPOSITIONS & FLAVORS: PERSUASIVE
STRATEGIES USED BY SWISHER SWEETS ON INSTAGRAM
Jennifer J. Cornacchione Ross, PhD. Wake Forest School of Medicine.
Introduction: Price promotions (e.g., discounts) and other selling incentives (e.g.,
product scarcity), as well as the promotion of appealing avors, inuence product
appeal and consumer behaviors, such as purchasing, but little is known about whether
or how these types of strategies are used in cigarillo digital marketing. Methods: We
conducted a content analysis of all posts on the ocial Swisher Sweets Instagram
account, selected because they are one of the highest-selling cigarillo brands and
have an active Instagram account. Two research assistants coded all text and visual
elements in each post for selling propositions used by Swisher Sweets, including: price
promotions, product scarcity, merchandise, and purchasing links. We also coded for
avors promoted, including the presence of distinct (e.g., Grape) and concept (e.g.,
Black) avors.Results: All posts from January 23, 2013-December 31, 2019 were coded
(N=1233). One third (34.6%, n=427) included price/nancial incentives, such as “save on
2 cigars” or “free.” Also, 11.4% (n=140) presented product scarcity, such as promoting
limited edition avors that were available for a limited time. Product merchandise was
in 10.1% of posts (n=125), and a link to purchase the product or merchandise was in
several posts (7.8%, n=96). Cigarillo avors were depicted in 487 posts (39.5%), with
327 (67.1%) posts containing concept avors and 232 posts (47.6%) containing dis-
tinct avors. The avor names frequently appeared in multiple locations within a single
post (n=299, 60.2%), such as an image of the packaging, in hashtags, or in the post
caption. The majority of avors belonged to a specic avor collection (n=471, 96.7%),
including “Classics”, “Limited Editions”, and “Encore Edition”.Discussion: The cigarillo
industry is using well-established and largely eective marketing tactics, including price
promotions and incentives, and avors, to recruit and retain consumers. Future research
should examine the direct association between these strategies and actual purchasing
of products, which could lead to potential product characteristic regulations, including
banning avors and price promotions.
FUNDING: Academic Institution
PS3-150
IDENTIFYING AND CHARACTERIZING LOCAL CIGAR MINIMUM
PACK SIZE AND PRICE POLICIES
Jessica L. King, PhD. University of Utah.
Municipalities across the US have adopted minimum cigar pack size and price policies
in an eort to increase cigar prices and reduce youth access. The purpose of this study
was to identify and measure local cigar pack size policies across the US. We used a
systematic 14-step process to identify and code 294 local cigar pack policies in ve states
and DC. For three states (CA, MN, MA) known to have multiple policies, municipal codes
were reviewed by two team members for all municipalities within the state. We worked
with state-level tobacco control sta in all 50 states to conrm policies identied by our
team. Policies were double-coded for adopted, eective, and enforcement dates, cigar
denitions, minimum pack size, price oor, dierences in pack size/price by cigar type,
adjustments or automatic increases in price, whether discounts were accounted for in
determining price oor, policy exclusions, compliance, and penalties. We identied 259
municipalities with policies, 35 of which changed the minimum size requirements after
initial policy adoption, resulting in 294 policies. Policies specied 8 dierent pack size
requirements ranging from 2 to 20; most prevalent were minimums of 2-packs (N=163;
55.4%) and 4-packs (N=24; 8.2%). Minimum price ranged from $2.00 to $10.00 per
cigar (N=196). Most policies (N=238; 91.9%) excluded cigars priced above a specied
amount ($2.50-$10.00), and 33 (11.2%) excluded cigars sold at adult-only or tobacco
retailers. This is the rst comprehensive list of cigar pack size and price policies within
the US. Policies vary widely across assessed criteria, both between and within states.
In Fall 2021, we will analyze the impact of these policies on youth and adult cigar and
cigarette use, based on the identied dierences in policy characteristics.
FUNDING: Federal
PS3-151
THE HYPOTHETICAL IMPACT OF CIGAR PRICE INCREASE ON
TOBACCO USE BEHAVIOR CHANGE INTENTIONS AMONG ADULT
CIGAR SMOKERS
Julia Cen Chen-Sankey, PhD. National Institute on Minority Health and Health Dispar-
ities, Bethesda, MD, USA.
Background: Increasing cigar prices through setting minimal prices and pack sizes,
eliminating price promotions, or raising taxes may help reduce cigar smoking. This study
examined the correlates of tobacco use change intentions given cigar price increases
among adult cigar smokers. Methods: Data from a nationally representative sample of
adult current cigar smokers (n=456; mean age=39.8) were collected online in 2021.
Respondents were asked, given a hypothetical cigar price increase, whether they would
be willing to pay more for cigars, cut down cigar smoking, use cheaper cigars, or use
other tobacco products. Weighted multivariable regressions were conducted to assess
the correlates of each intended behavior change outcome. Results: Given a hypothetical
cigar price increase, 77.2% of respondents would be willing to pay more for cigars, and
44.7%, 39.9%, and 17.1% would cut down cigar smoking, use other tobacco products,
and use cheaper cigars, respectively. Cigarillo smokers (vs. non-cigarillo smokers) were
more likely to intend to pay more for cigars (AOR=2.57; 95% CI=1.30-5.08) and use
other tobacco products (AOR=2.27; 95% CI=1.21-4.26). Those who used rst tobacco
within 5-29 minutes of waking (vs. >60 minutes) were also more likely to intend to pay
more (AOR=2.54, 95% CI=1.09-5.88). While premium cigar smokers (vs. non-premium
cigar smokers) were less likely to intend to use cheaper cigars (AOR=0.37, 95% CI=0.15-
0.87), those who used tobacco within 5 minutes of waking (vs. >60 minutes) were more
likely to intend to use cheaper cigars (AOR=6.81, 95% CI=1.64-12.67). Conclusion:
Almost half of cigar smokers may cut down cigar smoking given cigar price increase.
The impact of this policy may depend on the cigar type smoked and smokers’ nicotine
dependence levels. For example, cigarillo smokers may continue to purchase cigarillos
or transition to use other tobacco products; those who are more nicotine dependent
may pay more or use cheaper cigars to sustain cigar smoking than those who are
less dependent. This study can help inform regulations for increasing cigar prices and
develop measures for evaluating such policies.
FUNDING: Federal
193
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-152
CREATING COHESION: THOUGHTS ON DEVELOPING A GLOBAL
ENDGAME MOVEMENT
Marita Heer, MPH, PhD. Menzies School of Health Research.
Expanding and strengthening the global tobacco endgame initiative, Project Sunset.
PS3-153
BRIEF OVERVIEW OF ENDGAME DISCOURSE AND GLOBAL
PROGRESS
April Roeseler. California Tobacco Control Program.
Tobacco endgame planning and policies are spreading globally. The speaker will review
progress and summarize how the tobacco control community discussion has shifted.
PS3-154
ADDRESSING GLOBAL HEALTH EQUITY AND DISPARITIES
THROUGH ENDGAME
Carol McGruder. African American Tobacco Control Leadership Council.
Speaker will discuss the promise of tobacco endgame policies in addressing health
disparities among communities left behind in tobacco control eorts.
PS3-155
CANNABIS PREVALENCE, MISUSE, AND PROBLEMS BY US
STATE-LEVEL CANNABIS LEGALITY
Kim Pulvers, Daniell Derry Garlejo. California State University San Marcos, San
Marcos, CA, USA.
Signicance: Cannabis use among young adults is at a record level. Many who use
cannabis also use tobacco, a pattern linked with higher toxicant exposure, greater
dependence, and worse cessation outcomes. As more US states make cannabis use
legal, there is concern that cannabis use, misuse, and problems may increase. The
present study investigates how cannabis use, misuse, and problems vary by US state
cannabis legality. Methods: Young adults aged 18 to 25 years (N=1,039; mean age=20.9
years; 52.9% annual income < $35,000; 54.3% students) were surveyed from February
16 to May 1, 2021 through a Qualtrics panel. Recruitment focused on states where
marijuana was fully legal (n=524) or fully illegal (n=515) for at least four years preceding
data collection. Fully legal was dened as both medical and non-medical cannabis use
permitted for adults 21 and over, while fully illegal was neither medical nor non-medical
cannabis use permitted. Sampling was stratied by race/ethnicity (approximately one
third of sample Hispanic, non-Hispanic Black, and non-Hispanic white) and gender
(approximately half male and half female). Cannabis misuse was measured with the
Cannabis Use Disorder Identication Test-Revised. Marijuana problems were measured
with the Marijuana Problems Scale. Results: In legal states, current cannabis use was
reported by 46.6% and in illegal states by 41%, X2 (1,1,039)=3.8, p=.05. Cannabis misuse
scores were 11.7 (SD=7.9) for those in legal states, and 12.6 (SD=7.0) for illegal states,
t(504)=1.3, p=.2. The number of marijuana problems was 6.3 (SD=6.2) for those in legal
states, and number of problems was 7.6 (SD=6.6) for those in illegal states, t(498)=2.3,
p=.02. Severity of problems was 8.1 (SD=8.9) for those in legal states, and severity
was 10.1 (SD=9.4) for those in illegal states, t(498)=2.1, p=.03. Conclusion: Cannabis
use and misuse were comparable in states in which cannabis was legal compared to
illegal, while cannabis problems and severity were lower in legal states. The state-level
macro-environment legality of cannabis may contribute to greater problems associated
with cannabis use, some of which are external (e.g., jobs, relationships).
FUNDING: Academic Institution
PS3-156
DEVELOPING A MHEALTH INTERVENTION FOR HIV+ SMOKERS
AMBIVALENT ABOUT QUITTING: AN ITERATIVE, MULTI-MODAL
JOURNEY
Jennifer B. McClure1, Jaimee Hener2, Sophia Y. Mun1, Predrag Klasnja3, Sheryl L.
Catz4. 1Kaiser Permanente, 2Fred Hutchinson Cancer Research Center, 3University of
Michigan, 4University of California, Davis.
More smokers living with HIV (SLWH) now die from tobacco-related disease than from
HIV. Reducing smoking in this population is critical, but it is complicated by the fact that
most SLWH are ambivalent about quitting: they want to quit someday, but aren’t yet
ready to quit. As a result, they don’t seek and may not be oered cessation treatment.
Novel intervention strategies are needed to reach, engage, and support this population
through the quit process. mHealth apps are an ideal platform for this given their con-
venience, low cost, and ability to provide 24/7 support. But to be eective, these apps
need to balance design elements and content that are engaging to ambivalent SLWH
(which diers from what is engaging to smokers ready to quit) with intervention content
grounded in sound theory and empirically-based evidence. In this symposium, we will
present an overview of our new mHealth app for ambivalent SLWH. We will discuss
the underlying theory and how the intervention content and design were developed
using an iterative, multi-modal process including user-centered design interviews
with HIV+ and non-HIV+ ambivalent smokers, expert opinion, and lessons learned
from our programmatic research, including a recent prospective, randomized pilot trial
testing a similar mHealth intervention among non-HIV+ ambivalent smokers (n = 57;
17.5% non-white; 15% LGBTQ+; 72% no college degree; 58% with household income
<$45,000). The nal app for SLWH uses a sequential series of discrete exercises to
help ambivalent smokers clarify their values and learn basic cognitive and behavioral
skills that can help them either cut-back or quit smoking—when they are ready to make
a change. Other key features include gamication, peer testimonials, HIV-relevant risk
and benet information, and standard, best-practice tobacco treatment components.
The intervention is designed to support individuals’ motivation, condence, and skill
mastery, while also encouraging quit attempts and connecting SLWH with access to
evidence-based treatment. The development process and app design may serve as a
model for others interested in creating motivational digital health interventions.
FUNDING: Federal
PS3-157
FUNCTIONAL CONNECTIVITY IDENTIFIED PREFRONTAL TMS
TARGET FOR SMOKING CESSATION IN SCHIZOPHRENIA
Xiaoming Du1, William Regenold2, Elliot Hong1. 1University of Maryland School of Medi-
cine, 2NIMH/NIH.
With the high rate of smoking, nicotine addiction is one of the most damaging comorbidi-
ties in schizophrenia spectrum disorders (SSD). Mortality from smoking-related diseases
is 2 to 6 times higher in SSD than in healthy controls. Recent neuroimaging research
has addressed an essential role of brain circuitries between prefrontal cortex (PFC) and
several subcortical structures in both pathology of SSD and nicotine addiction, likely
explaining the high rate of smoking in SSD. To correct these circuits in SSD smokers,
we conducted a randomized, sham-controlled and rater-blinded trial: 20 sessions of
daily 10 Hz repetitive transcranial magnetic stimulation (rTMS) were applied over
circuitry-dened dorsomedial PFC in 30 SSD patient smokers using a 2:1 active rTMS
vs. sham rTMS ratio. Functional MRI data were collected before, during and after the
treatment. Preliminary results showed that active rTMS increased the rsFC identied
to be related to both SSD and nicotine addiction compared with sham at a trend level.
Nicotine addiction severity, indexed by the Fagerstrom Test for Nicotine Dependence
(FTND), was reduced after 15 and 20 sessions of active rTMS compared with sham
(p=0.05). Although cigarette per day (CPD) reduction was not signicant compared to
sham in this small sample, more increase of rsFC by rTMS predicted more reduction
of CPD (p<0.05) and FTND morning withdrawal symptoms (p<0.05) in patients who
received active rTMS. In further exploratory analysis, participants in active rTMS group
were median split into a more responsive subgroup (n=8) and a less responsive subgroup
(n=8) based on rsFC enhancement and reduction of CPD. The more responsive sub-
group showed more reduction in overall symptoms indexed by Brief Psychiatric Rating
Scale (BPRS) total score than the less responsive subgroup (p<0.05). Most previous
studies of TMS treatment for smoking cessation used dorsolateral PFC as the primary
target. The present results suggest that rTMS targeting an alternative circuitry-dened
site at the dorsomedial area of the PFC may modulate the neural circuitry mechanisms
of nicotine addiction and facilitate smoking cessation in patients with schizophrenia.
FUNDING: Federal
194
2022 Poster Session 3 • Thursday, March 17, 2022, 11:30 AM - 1:00 PM
PS3-158
CIGARETTE SMOKING IN RESPONSE TO COVID-19: EXAMINING
CO-MORBID MEDICAL CONDITIONS, COPING, AND RISK
PERCEPTIONS
Alison Serrantino, BA, Rebecca Marrero, BS, Krysten W. Bold, PhD, Sydney Cannon,
BA, Stephanie O'Malley, PhD, Lisa Fucito, PhD. Yale University School of Medicine,
New Haven, CT, USA.
Introduction: During the initial wave of the Coronavirus Disease 2019 (COVID-19)
pandemic in the U.S., information was mixed about relative COVID-19 risks and po-
tential benets associated with cigarette smoking. Therefore, we sought to understand
individual dierences in the impact of COVID-19 on cigarette smoking in a sample of
adults who reported recent use, with a particular focus on general strategies to cope
with the pandemic and chronic medical conditions likely associated with increased
COVID-19 risk. Methods: Participants completed an anonymous, online Qualtrics
survey of these constructs as well as smoking behavior, demographic variables, and
COVID-19 risk perceptions between July and August 2020 (N=287). These factors were
examined using multivariable logistical regression models of smoking in response to
the pandemic. Participants were recruited through paid advertisements on Facebook
and Instagram. Separate ads targeted specic age groups to achieve similar numbers
of each group: (1) ages 18-30; (2) ages 31-40; (3) ages 41-50: (4) ages 51-60; (5) ages
≥ 61 years of age. We ran ads longer for the last two categories to oversample older
participants for whom medical co-morbidities are more common. Results: In models
evaluating reduced smoking, greater COVID-19 risk perceptions was associated with
higher odds of reducing (OR=1.30, 95%:1.05-1.61, p=.02) whereas using avoidant cop-
ing strategies was associated with lower odds (OR=.45, 95%:23-.91, p=.03). Conversely,
having at least one co-morbid medical condition was related to higher odds of increased
smoking (OR=1.91, 95%: 1.01-3.63, p=.048). Conclusions: Following the rst wave of
the COVID-19 pandemic in the U.S., greater perceived risks from COVID-19 and the
ability to cope more eectively with the unique challenges of the pandemic appeared to
promote reductions in cigarette use for some. Though people with co-morbid medical
conditions perceived greater COVID-19 risks, they were less likely to decrease their use.
The results have important implications for tobacco cessation treatment and preventive
healthcare during public health threats.
FUNDING: Federal
PS3-159
EFFECTS OF TBS ON NEURAL MECHANISMS MEDIATING
INHIBITORY CONTROL AND SMOKING RELAPSE
VULNERABILITY
Brett Froeliger1, Spencer Upton1, Alex Brown1, Roger Newman-Norlund2, Jim Priscian-
daro3, Greg Sahlem4, Muaid Ithman1. 1University of Missouri - Columbia, 2University of
South Carolina, 3Medical University of South Carolina, 4Stanford University.
Tobacco use disorder (TUD) is associated with decits in prefrontal mediated inhibitory
control (IC). We previously reported ndings showing that IC task-state functional con-
nectivity (tsFC) in corticothalamic circuitry mediates the association between successful
IC task performance and smoking relapse vulnerability. We’ve also demonstrated
that theta burst stimulation (TBS) to the r.IFG modulates IC task performance among
individuals with TUD. The current study examined the eects of TBS to the r.IFG on:
a) corticothalamic tsFC; b) IC task performance; and c) smoking related variables.
Adult (N =37; age = 47.6 ± 9.5; female: n = 17) nicotine dependent (FTND = 5.4 ± 2.1)
tobacco smokers (18.8 ± 5.7 cigarettes per day for 30 ± 9.8 years) performed a base-
line IC task during fMRI data collection. Baseline task-related r.IFG BOLD response
was used to establish each individual’s stimulation target and then, in a crossover,
within-session repeated-measures fMRI assessment (pre and post TBS condition),
the eects of continuous (cTBS) and intermittent (iTBS) TBS on each outcome listed
above were assessed. Safety and tolerability were also assessed. A signicant main
eect of TBS condition was observed for IC task performance (t = 2.85, p = .007): cTBS
improved performance (M = 3.78% ± 12.2), whereas iTBS led to worse performance
(M = -3.08% ± 9.49). Over the 24-hr. post TBS period, cTBS produced a signicant
reduction in cigarettes per day (CPD) (p=.004) and self-reported urge to smoke (p <
.05); whereas iTBS only reduced CPD (p = .04), relative to baseline. Moreover, cTBS
induced strengthening of tsFC between the r.IFG and SMA was associated with the
reduction in CPD (r= -.336, p=.048). No eects of iTBS on associations between brain
and behavior were observed. These novel ndings provide early evidence to suggest
cTBS to the r.IFG may help treat corticothalamic mediated inhibitory control and smoking
(re)lapse vulnerability and bolster the need for further research examining the potential
of repeated cTBS treatments as a potential therapeutic intervention for treating TUD.
FUNDING: Federal
PS3-160
EPISODIC FUTURE THINKING AS AN INTERVENTION FOR
DEPENDENT E-CIGARETTE USERS
Bruce E. Turnquist, BS, Emily McLean, Yajna Jowaheer, BS, Jacquie Lee, BA, Laura
M. Juliano, PhD. American University, Washington, DC, USA.
Signicance: There has been an alarming increase in e-cigarette use and dependence
among young people, many of whom would like to quit using e-cigarettes but are nd-
ing it dicult to do so. Impulsivity is associated with drug taking across many dierent
types of drugs including nicotine. In prior research with cigarette smokers, cognitive
interventions designed to reduce impulsivity, such as Episodic Future Thinking (EFT),
have been shown to reduce cigarette demand and self-administration. The aim of
the present study was to test if a brief EFT intervention decreases nicotine craving,
impulsivity, and smoking choice among daily young adult e-cigarette users. Methods:
Participants (N = 24; M = 21 years of age; ~50% female; M = 12 e-cig uses per day)
attended three within-subjects experimental sessions administered via Zoom. After
a baseline acclimation session, participants attended two experimental sessions in
counterbalanced order: 1) EFT in which they pre-experienced and described positive
future events and 2) A control intervention in which they described their experiences
watching three short videos. Measures of craving, mood, and delay discounting across
three commodities: money, e-cigarette products, and food were completed before and
after the manipulations. Results: Within-subjects repeated measures ANOVAs revealed
decreases in craving and mood in response to the manipulations, but no dierences
between EFT and control on any self-report measures. At the end of each session,
participants also took part in a 40-minute vaping vs. money choice task. Approximately
30% of participants chose to smoke after the EFT condition compared to ~40% after the
control condition. Conclusions: EFT may be an eective brief intervention for helping
e-cigarette users increase their ability to abstain. Additional ndings, methodological
issues, and future directions will be discussed. Funding: American University CAS
Graduate Research Fund Awards - Spring & Fall 2021.
FUNDING: Academic Institution
195
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
POSTER SESSION 4:
PRE-RECORDED PAPER PLUS
PP-1
A PILOT RANDOMISED TRIAL OF A BRIEF VIRTUAL REALITY
SCENARIO IN SMOKERS UNMOTIVATED TO QUIT: ASSESSING
THE FEASIBILITY OF RECRUITMENT
Olga Perski, BSc, MSc, PhD, Trupti Jambharunkar, BSc, MSc, Jamie Brown, Dimitra
Kale, BSc, MSc, PhD. University College London, London, United Kingdom.
Signicance: Individual-level interventions for smokers unmotivated to quit remain
scarce and have had limited success. Little is known about the potential of virtual reality
(VR) for delivering messaging to smokers unmotivated to quit. This pilot trial aimed to
assess the feasibility of recruitment and acceptability of a brief, theory-informed VR
scenario and estimate proximal quitting outcomes. Methods: Unmotivated smokers
(recruited between February-August 2021) aged 18+ years who had access to, or were
willing to receive via post, a VR headset were randomly assigned (1:1) using block
randomisation to view the intervention (i.e., a hospital-based scenario with motivational
stop smoking messaging) or a ‘sham’ VR scenario (i.e., a scenario about the human
body without any smoking-specic messaging) with a researcher present via telecon-
ferencing software. The primary outcome was feasibility of recruitment (i.e., achieving
the target sample size of 60 participants within 3 months of recruitment). Secondary
outcomes included acceptability (i.e., positive aective and cognitive attitudes), quitting
self-ecacy and intention to stop smoking (i.e., clicking on a weblink with additional stop
smoking information). We report point estimates and 95% condence intervals (CIs).
The study protocol was pre-registered (osf.io/95tus). Results: A total of 60 participants
were randomised within 6 months (intervention: n=30; control: n=30), 37 of whom were
recruited within a 2-month period of active recruitment following an amendment to gift
inexpensive (£7) cardboard VR headsets via post. The mean (SD) age of participants
was 34.4 (12.1) years, with 46.7% identifying as female. The mean (SD) cigarettes
smoked per day was 9.8 (7.2). The intervention (86.7%, 95% CI=69.3%-96.2%) and
control (93.3%, 95% CI=77.9%-99.2%) scenarios were rated as acceptable. Quitting
self-ecacy and intention to stop smoking in the intervention (13.3%, 95% CI=3.7%-
30.7%; 3.3%, 95% CI=0.1%-17.2%) and control (26.7%, 95% CI=12.3%-45.9%; 0%,
95% CI=0%-11.6%) arm were comparable. Conclusions: The target sample size was
not achieved within the feasibility window; however, an amendment to gift inexpensive
headsets via post appeared feasible. The brief VR scenario appeared acceptable to
smokers unmotivated to quit.
FUNDING: State; Nonprot grant funding entity
PP-2
RANDOMIZED CONTROLLED TRIAL OF A TAILORED WEB AND
TEXT MESSAGE INTERVENTION FOR SMOKING CESSATION
IN SOCIOECONOMICALLY-DISADVANTAGED YOUNG ADULT
CIGARETTE SMOKERS
Andrea C. Villanti1, Catherine Peasley-Miklus1, Elias M. Klemperer1, S. Elisha LePine1,
Julia C. West1, Sarah Cha2, Darren Mays3, Robin Mermelstein4, Stephen T. Higgins1,
Amanda L. Graham2. 1University of Vermont, Vermont Center on Behavior and Health,
Burlington, VT, USA, 2Truth Initiative, Washington, DC, USA, 3The Ohio State Univer-
sity, Columbus, OH, USA, 4Institute for Health Research and Policy, Chicago, IL, USA.
SIGNIFICANCE The prevalence of cigarette smoking in young adults (YA) is signicantly
higher among those with socioeconomic disadvantage than those without. Low treat-
ment-seeking among YA smokers is compounded by a dearth of ecacious smoking
cessation interventions targeted to this group, particularly socioeconomically-disad-
vantaged young adult (SDYA) smokers. The goal of this study was to test a tailored
smoking cessation intervention for SDYA smokers. METHODS 343 SDYA smokers
aged 18-30 with access to a smartphone and interest in quitting in the next six months
were recruited nationally from online ads and randomized in Spring 2020 to referral
to a quitline (control; n=171) or a 12-week web and text message smoking cessation
intervention (n=172; NCT04379388). Intervention participants received up to 5 text
messages daily that addressed cessation themes identied in formative work with SDYA
smokers; they also received a weekly check-in quiz. Primary outcomes were self-re-
ported past 30-day point prevalence abstinence (PPA) and condence to quit smoking
assessed in all participants at 12-weeks; secondary outcomes included past 7-day PPA
and readiness rulers. Intent to treat analyses examined bivariate relationships between
study condition and outcomes at 12 weeks. RESULTS Retention was 81% (n=139) in
intervention and 87% (n=149) in controls. Participants in the intervention group had
nearly four-fold higher 30-day PPA at 12-weeks compared to control (26.2% vs. 7.0%;
RR 3.73, 95% CI 2.04-6.80); ndings were similar for 7-day PPA (39.5% vs. 12.9%;
RR 3.07, 95% CI 2.00-4.73). Intervention exposure also increased mean condence to
quit (10-point scale; 1.56 points, 95% CI 0.93-2.19) and readiness to quit (0.87 points,
95% CI 0.33-1.41). There was no eect of the intervention on the importance to quit
scale (0.31, 95% CI -0.10-0.72). CONCLUSION A tailored text message intervention for
SDYA smokers increased abstinence, condence, and motivation to quit at the end of
treatment. Findings may have been inuenced by recruitment at the start of the COVID
pandemic, but suggest that text messaging is an acceptable and ecacious cessation
strategy for SDYA smokers.
FUNDING: Federal
PP-3
RELAPSE TO SMOKING IS ASSOCIATED WITH INCREASED PAIN
SENSITIVITY
Motohiro Nakajima, Mustafa al'Absi. University of MN Medical School, Duluth, MN,
USA.
Signicance: This study examined the relationships between smoking relapse, sex dif-
ference, and pain perception. Methods: Nicotine dependent men and women interested
in cessation participated in a prospective study that included 3 laboratory sessions
(during ad lib smoking, 24 hr after the quit day, 4 weeks after the quit day). This study
also included nonsmokers who completed the same protocol as smokers except for the
tobacco use. Abstinence from smoking was conrmed by self-reported measures and
expired carbon monoxide. Relapse was dened as smoking 7 consecutive days after
the quit day. To assess pain perception, the cold pressor test (CPT) was administered
in each lab session. In the CPT, participants were instructed to place their hand into a
container lled with an ice-water slurry. Participants rated their pain every 15 sec during
90 sec of CPT exposure (6 periods) and then every 15 sec during 90 sec of post-CPT
recovery (6 periods). Results: Repeated measures ANOVAs, including smoking status
(relapser [n=55], abstainer [n=52], nonsmoker [n=49]) and sex (males [n=83], males
[n=73]) as predictors, showed expected increase in pain ratings across assessment
periods during CPT and decrease in ratings over time after CPT in all sessions (p <
.001). Females had greater pain than men (p < .05). Pain ratings during CPT were higher
in relapsers than nonsmokers in all sessions (p < .01). In the post-quit lab, relapsers
had greater pain than nonsmokers during the last three periods whereas abstainers
had greater pain than nonsmokers during the last two periods (p < .005). Regarding
pain ratings post-CPT, there was a smoking main eect in the quit day lab, indicating
lower pain in relapsers than in other conditions (p < .05). Conclusion: These results
extend previous ndings that chronic smoking is related to increased pain perception
regardless of withdrawal.
FUNDING: Federal
PP-4
DO HARM PERCEPTIONS OF NICOTINE REPLACEMENT
THERAPY RELATIVE TO CIGARETTE SMOKING PREDICT ITS
USE AS AN AID FOR SMOKING CESSATION? FINDINGS FROM
THE ITC FOUR COUNTRY SMOKING AND VAPING SURVEYS
Hua Yong1, Scott Tagliaferri1, Shannon Gravely2, Ron Borland3, Michael Cummings4,
Katherine East2, Andrew Hyland5, Maansi Bansal-Travers5, Georey Fong2. 1Deakin
University, Melbourne, Australia, 2University of Waterloo, Waterloo, ON, Canada, 3The
University of Melbourne, Melbourne, Australia, 4Medical University of SC, Charleston,
SC, USA, 5Roswell Park Comprehensive Cancer Center, Bualo, NY, USA.
Signicance: Nicotine replacement therapy (NRT) is a government-approved medical
therapy for smoking cessation in many countries and is recommended in clinical practice
guidelines as a safe and eective smoking cessation aid. However, some smokers do not
perceive NRT as much less harmful than cigarettes, which could hinder quit attempts and
success. This study examined whether harm perceptions of NRT relative to cigarettes
were associated with subsequent use of NRT during their last quit attempt (LQA) among
current smokers. Methods: A prospective cohort study of 2,030 current smokers at Wave
1 (2016) who made a quit attempt by Wave 2 (2018) in the ITC Four Country Smoking
and Vaping Surveys (Australia, Canada, England, US). Multivariable logistic regression
examined whether less harmful perceptions of NRT relative to cigarettes predicted NRT
use during LQA, controlling for socio-demographics and potential confounders. Results:
Overall, 34% of smokers believed NRT is much less harmful than smoking, 39% believed
it is somewhat less harmful, 15% believed it is equally or more harmful, and 12% did
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
not know. Compared to smokers who perceived NRT as equally or more harmful than
cigarette smoking, those who perceived NRT as much less harmful were more likely to
use NRT during their LQA (OR=2.00, 95% CI=1.38-2.90, p=0.000), but not those who
perceived it as somewhat less harmful (OR=1.22, 95% CI=0.86-1.74, p=0.265). The
perception-behaviour association did not show any between-country variation, although
overall misperceiving NRT as equally or more harmful than smoking was highest in
the US (22%) and lowest in England (10%) with Canada (16%) and Australia (12%) in
between. Conclusions: A substantial number of smokers from all four study countries
continue to hold misperceptions about the harmfulness of NRT, possibly undermining
the use of this eective smoking cessation aid. Comprehensive education about the
risk prole of dierent nicotine products is needed to enable smokers to make accurate
estimates of their relative harmfulness so that they can make informed choices about
the use of NRT as an aid for smoking cessation.
FUNDING: Federal; Academic Institution
PP-5
DIFFERENCES BETWEEN DAILY SMOKERS WHO DO AND
DO NOT CO-USE CANNABIS: FINDINGS FROM THE 2020 ITC
SMOKING AND VAPING SURVEY
Shannon Gravely, PhD1, Pete Driezen1, Erin McClure2, Georey T. Fong1, Gary Chan3,
Eric N. Lindblom4, Andrew Hyland5, David Hammond1, K. Michael Cummings2, Ron
Borland6, Ann McNeill7, Anne C.K. Quah1, Gillian L. Schauer8, Danielle M. Smith5.
1University of Waterloo, Waterloo, ON, Canada, 2Medical University of South Caro-
lina (MUSC), Hollings Cancer Center, SC, USA, 3National Centre for Youth Substance
Use Research, The University of Queensland, Brisbane, Australia, 4Georgetown Law’s
O’Neill Inst. for National & Global Health Law, Washington, DC, USA, 5Roswell Park
Comprehensive Cancer Center, Bualo, NY, USA, 6University of Melbourne, Australia,
7King’s College London, London, United Kingdom, 8University of Washington, Seattle,
WA, USA.
Signicance: Cannabis and tobacco are often used together. Co-use of cigarettes
and cannabis (particularly smoked cannabis) has been shown to be associated with
increased toxicant exposure and poorer health outcomes relative to exclusive use
of either product. However, it is not clear if adult co-users dier from cigarette-only
smokers (e.g., sociodemographics, cigarette-dependence, depressive symptoms,
use of other nicotine products, and frequency of alcohol use). This study describes
dierences between cigarette smokers who use cannabis and cigarette-only smokers.
Methods: Respondents included 7061 adult daily smokers from the 2020 ITC Smoking
and Vaping Survey conducted in the US, Canada, Australia, and England. Respondents
were categorized as: (1) cigarette-only smokers (never used cannabis/did not use in
the last 12 months); (2) occasional co-users (used cannabis in the last 12 months, but
less than weekly); and (3) regular co-users (use cannabis at least weekly). Multivariable
logistic regression analyses were conducted on weighted data. Results: 19.4% of daily
smokers used cannabis at least weekly and 11.9% used cannabis occasionally (68.7%
smoked cigarettes only). Nearly all co-users (90.5%) reported smoking cannabis. Regular
co-users were signicantly more likely than cigarette-only smokers to be male, and all
co-users were signicantly more likely than cigarette-only smokers to be younger, have
lower income, have depressive symptoms, use alcohol more frequently, and use multiple
tobacco/nicotine products. All co-users were signicantly less likely than cigarette-only
smokers to have smoked cigarettes for longer than ve years. There were no dierences
on any of the cigarette-dependence measures (e.g., plans to quit smoking, a recent
quit attempt, perceived addiction to cigarettes, cigarettes smoked/day). Conclusions:
Among adult daily cigarette smokers, cannabis use was not associated with dierences
in cigarette-dependence. There are, however, other implications of co-use that warrant
further research as they may be related to worse outcomes, such as continued cigarette
smoking, higher levels of depression, and more frequent alcohol use.
FUNDING: Federal; Academic Institution; Nonprot grant funding entity
PP-6
CARCINOGENIC AND TOBACCO SMOKE DERIVED PARTICULATE
MATTER BIOMARKER UPTAKE AND ASSOCIATED HEALTHCARE
PATTERNS AMONG PEDIATRIC EMERGENCY DEPARTMENT
PATIENTS
Ashley L. Merianos1, Roman A. Jandarov1, E. Melinda Mahabee-Gittens2. 1Univer-
sity of Cincinnati, Cincinnati, OH, USA, 2Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA.
Signicance: Children with higher cotinine levels have higher healthcare utilization pat-
terns, but cotinine may underestimate tobacco smoke exposure (TSE). Less is known on
the associations of children’s levels of tobacco-specic carcinogenic biomarkers (e.g.,
4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL)) and particulate matter biomarkers
(e.g., nicotelline N-oxides). The objective was to assess the associations of children’s
urinary cotinine, NNAL, and N-oxides levels, and parent-reported smoking and child
TSE patterns with total hospital visits, pediatric emergency department (PED) visits,
urgent care (UC) visits, revisits, and hospital admissions among 0-9-year-olds who lived
with a smoker. Methods: PED/UC patients (N=242) who had baseline urine samples
assayed for the TSE biomarkers were included. Biomarker levels were log-transformed,
and linear and Poisson regression models were built while adjusting for child socio-
demographics (age, sex, race, ethnicity, insurance), past medical histories, baseline
visit season and year, and parent sex. Results: The geometric means of child cotinine,
creatinine-adjusted NNAL, and N-oxides levels were 11.2ng/ml, 30.9pg/mg creatinine,
and 24.1pg/ml, respectively. The mean (SD) number of daily cigarettes smoked by par-
ents was 10.2 (6.1). Each one-unit increase in log-NNAL levels was associated with an
increase in total UC visits (aRR=1.68, 95%CI=1.18-2.39) among 0-9-year-olds, and an
increase in total hospital visits (aRR=1.88, 95%CI=1.13-3.13) and UC visits (aRR=5.64,
95%CI=2.15-14.82) among 5-9-year-olds over 6-months following their baseline PED/
UC visits. Each one-unit increase in child log-NNAL/cotinine ratio (x103) values was
associated with an increase in total hospital visits (aRR=1.39, 95%CI=1.10-1.75) and UC
visits (aRR=1.56, 95%CI=1.14-2.13) among 0-9-year-olds over 6-months. Conclusion:
Higher urinary NNAL levels in individual and ratio form with cotinine increased young
children’s risk for healthcare visits over 6-months. Systematic screening for child TSE
and the comprehensive assessment of TSE biomarkers during all healthcare visits
should be considered to objectively measure young children’s exposure.
FUNDING: Federal
PP-7
SMOKING CESSATION TREATMENT MECHANISMS- EVALUATING
WITHDRAWAL RELIEF AS A MEDIATOR OF VARENICLINE
EFFICACY
Sarah Tonkin1, Craig Colder1, Martin Mahoney2, Gary Swan3, Paul Cinciripini4, Robert
A. Schnoll5, Tony P. George6, Rachel Tyndale6, Caryn Lerman7, Larry Hawk1. 1SUNY
University at Bualo, Bualo, NY, USA, 2Departments of Internal Medicine and Health
Behavior, Roswell Park Cancer Institute, Bualo, NY, USA, 3Stanford Prevention
Research Center, Los Altos, CA, USA, 4UT MD Anderson Cancer Center, Houston,
TX, USA, 5University of Pennsylvania, Philadelphia, PA, USA, 6CAMH and University
of Toronto, Toronto, ON, Canada, 7USC Norris Comprehensive Cancer Center, Keck
School of Medicine, University of Southern California, Los Angeles, CA, USA.
Negative reinforcement models of addiction posit that cessation-induced withdrawal
drives relapse back to smoking. Varenicline is hypothesized to aid cessation, in part, by
attenuating withdrawal facets; however, this mediational pathway has not been formally
evaluated in placebo-controlled trials. The present research used latent growth curves to
model trajectories of withdrawal facets (craving, negative/positive aect [NA, PA], sleep
problems) and tested the eect of varenicline on these changes (path a in the proposed
mediational chain), the relationship between the trajectories and bio-veried smoking
status at end of treatment (11 weeks post-quit; path b), and the degree to which these
candidate mediators account for the eect of varenicline treatment on smoking status
(indirect eect, a × b). Secondary data analysis was conducted on 828 treatment-seeking,
cigarette using adults assigned to varenicline or placebo in a randomized controlled trial
(NCT01314001). Self-reported craving, NA, PA, and sleep problems were assessed
1 week pre-quit, on the target quit day (TQD), and 1 and 4 weeks post-TQD. Across
time, craving declined, NA and sleep problems peaked 1 week post-quit (ps < .05),
and PA did not change. Lower elevations in NA trajectories during the rst month of
treatment modestly mediated the relationship between varenicline and higher cessation
rates (Indirect eect 95% CI: 0.002 to 0.07; Model R2 = 0.13). Lower craving 1 week
post-quit mediated the relationship between varenicline and higher cessation rates
(CI: 0.08 to 0.30; R2 = 0.13). PA and sleep problems were not signicant mediators.
Sex and race moderated the mediated eect of NA with the eect being signicant for
females (CI: 0.33 to 1.55) and Caucasians (CI: 0.002 to 0.58) and non-signicant for
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
males (CI: -0.05 to 0.16) and people of color (CI: -0.14 to 0.32). The present research
provides modest support for the hypothesis that varenicline improves cessation rates
via withdrawal-reduction, claries the relative importance of specic withdrawal facets
for relapse, and suggests mechanisms of varenicline therapy vary depending on key
participant characteristics (sex, race).
FUNDING: Federal
PP-8
RESULTS OF THE OASIS TRIAL: IMPLEMENTATION OF SMOKING
CESSATION SERVICES WITHIN NCORP COMMUNITY SITES WITH
ORGANIZED LUNG CANCER SCREENING PROGRAMS
Kristie Foley, PhD1, Kathryn Weaver1, Emily Dressler2, Carol Kittel3, David Miller3, Erin
Sutn3, Christina Bellinger3, John Spangler3, Rebecca Stone3, Glenn Lesser1, Caroline
Chiles3. 1Wake Forest School of Medicine, 2Wake Forest Baptist Health, Wake Forest,
NC, USA, 3Wake Forest Baptist Health.
Background: CMS mandates that smokers undergoing lung cancer screening (LCS)
be oered tobacco use treatment (TUT). How best to implement TUT during LCS is
unknown. Methods: OaSiS is an eectiveness-implementation, cluster randomized
trial of imaging clinics aliated with the NCI Community Oncology Research Program
(WF-20817CD). Eligible sites had 6 month LCS volume of >50 patients and a program
champion to support implementation; eligible patients were current smokers presenting
for LCS. Intervention sites received TUT training and co-developed a strategic plan
for embedding systems-level changes and TUT into the workow. Usual care sites
received no training nor implementation support. Clinics were encouraged to adopt
feasible and appropriate strategies, given existing or attainable imaging clinic and
health system resources. The researchers provided no TUT services. The primary
eectiveness outcome is 7-day tobacco use prevalence at 6-months. Multilevel logistic
regression models adjusting for randomization, time and the random eect of site used
an intent-to-treat analysis. Results: 26 imaging sites were randomized; 1 control and 1
intervention site withdrew. 1,100 participants were enrolled, of which 1,094 completed
baseline and 956 completed 6-month surveys. 11.7% of participants reported no tobacco
use at 6 months. The time trend was signicant but tobacco use did not dier by arm
(OR=0.96, 95%CI 0.62-1.51). Quit rates varied considerably across sites (0% -27%).
The number of cessation services increased in the intervention arm (6.08 to 7.17) and
decreased in the control arm (4.92 to 4.42) from baseline to follow-up, but dierences
were not signicant. In both arms, patients were more likely to report being asked and
advised to quit and receive self-help materials than to receive the most eective TUTs
(pharmacotherapy, counseling). Conclusions: Given heterogeneity across sites in quit
rates at 6 months and several high performing sites, further exploration of TUT adop-
tion, delity and sustainability and their impact on patient outcomes will yield valuable
information for scaling TUT in LCS.
FUNDING: Federal
PP-9
A SMART TRIAL OF SMOKING CESSATION INTERVENTIONS IN
THE CONTEXT OF LUNG CANCER SCREENING: PLUTO STUDY
RESULTS
Anne Joseph, MD, MPH1, Steven Fu2, Alex Rothman2, Abbie Begnaud2, Bruce Lind-
gren2, Kelsey Schertz2, David Vock2, David Haynes1, Anne Melzer2. 1University of Minne-
sota Medical School, 2University of Minnesota.
Introduction. The objective of the Program for LUng cancer screening and TObacco
cessation study (PLUTO) was to identify the optimal sequence of smoking cessation
treatments for smokers who respond incompletely and completely to rst-line treatment
(8 weeks of counseling with NRT), conducted in the setting of lung cancer screening
(LCS). Methods. PLUTO was a multisite sequential, multiple assignment, randomized
trial (SMART). Enrolled participants were currently smoking and met criteria for LCS –
patients aged 55-79 with a cumulative smoking history of =30 pack-years (n=643). All
participants received tobacco longitudinal care (TLC) for one year, dened as phone
coaching and NRT. Participants with initial incomplete treatment response (any smok-
ing after quit date) were randomized to continued TLC vs. TLC+Medication Therapy
Management (TLC+MTM) to add prescription smoking cessation medications (e.g.,
varenicline or bupropion). Initial treatment responders were randomized to continued
TLC monthly (TLC-M) vs. TLC quarterly (TLC-Q). Analysis of complete cases included
7-day point prevalent (PP) abstinence and 6-month prolonged abstinence at 18 months
(primary outcome). Abstinence rates are adjusted for age, CPD, and site. Results.
82% of participants were retained at 18 months (n=529). Among incomplete treatment
responders (n=416) 7-day PP abstinence for TLC vs. TLC+MTM was 27.4% vs 29.8%
(p=0.59). 6-month prolonged abstinence for TLC vs. TLC+MTM was 16.4% vs. 17.8%
(p=0.70). Among complete responders (n=113) 7-day PP abstinence for TMC-M vs.
TLC-Q was 69.0% vs. 58.2% (p=0.25). 6-month prolonged abstinence for TLC-M vs.
TLC-Q was 58.6% vs. 43.6% (p=0.11). Conclusions. For incomplete responders to initial
treatment adding prescription medications to TLC did not yield further benet. For those
with a good initial treatment response monthly follow up showed a nonsignicant benet.
Overall, TLC yielded high quit rates, even for initial incomplete treatment responders.
Results from this SMART inform decisions regarding the intensity and sequence of
smoking cessation treatments for millions of current smokers who will undergo annual
low-dose CT scanning for LCS.
FUNDING: Federal
PP-10
NCI SMOKING CESSATION AT LUNG EXAMINATION (SCALE)
TRIALS: BASELINE CHARACTERISTICS AND COMPARISON WITH
THE US GENERAL POPULATION OF LUNG CANCER SCREENING
ELIGIBLE PATIENTS
Rafael Meza, PhD1, Jihyoun Jeon2, Evelyn Jimenez-Mendoza2, Yoonseo Mok3, Pianpian
Cao3, Kristie Foley4, Caroline Chiles4, Jamie Ostro5, Paul M. Cinciripini6, Jennifer
Minnix7, Nancy Rigotti8, Jennifer Haas9, Kathryn Taylor10, Randi Williams10, Benjamin
Toll11, Anne Joseph12. 1University Of Michigan Rogel Cancer Center, MI, USA, 2University
Of Michigan, Ann Arbor, MI, USA, 3University Of Michigan, 4Wake Forest Baptist Health,
5Memorial Sloan Kettering Cancer Center, 6MD Anderson Cancer Center, Huston, TX,
USA, 7MD Anderson Cancer Center, 8Massachusetts General Hospital, Boston, MA,
USA, 9Harvard University, 10Georgetown University, Washington DC, USA, 11Medical
University of South Carolina, Charlston, SC, USA, 12University of Minnesota.
Objective. The NCI SCALE collaboration consists of 8 clinical trials that are testing
smoking cessation interventions in the context of lung cancer screening (LCS). This
investigation compared the pooled demographic and smoking parameters of SCALE
trial participants to LCS eligible smokers in the US general population (US POP-LCS
ELIG SM). Methods. Baseline variables from the SCALE Special Measures Collection
(age, gender, race, ethnicity, education, income, cigarettes per day [CPD], and time
to rst cigarette) from 3614 smokers enrolled in SCALE trials as of September 2020
were compared to pooled data from TUS-CPS (2018-19), NHIS (2017-2018), and PATH
(Wave 4–2017) from US POP-LCS ELIG SM (age 55-80, 30 pack-year smoking history,
n=4,803) and smokers in the general population age 55-80 (n=13,141). Standardized
sample weights were used in analyses of pooled national data. Results. The average
age of SCALE participants is 63.5 years (SD 6.0) vs. 63.3 (SD 6.3) in US POP-LCS
ELIG SM. There is a higher proportion of males than females in SCALE (51.6%) and
US POP-LCS ELIG SM (57.1%). Race and ethnicity distributions were similar in SCALE
vs. US POP-LCS ELIG SM (85.4% vs. 88.5% White, 11.6% vs. 8.1% Black, 0.5% vs.
0.6% Asian, 2.5% vs. 2.8% other race/multi-racial, 3.2% vs. 3.4% Hispanic). Regarding
education, 40.6% of SCALE participants vs. 59.9% in US POP-LCS ELIG SM had
graduated HS/GED or less. Approximately half in both groups earned 73% smoked
within 30 minutes of waking). LCS eligible smokers in SCALE and US POP-LCS ELIG
SM had higher CPD and a shorter time to rst cigarette than age-matched smokers
in the general population. Conclusions. SCALE participants smoke slightly less than
US POP-LCS ELIG SM but are otherwise quite representative. Therefore, SCALE trial
results will be generalizable to the US population of LCS eligible smokers.
FUNDING: Federal
PP-11
READINESS AND CAPACITY OF LUNG CANCER SCREENING
SITES TO DELIVER TOBACCO USE TREATMENT
Jamie Ostro, PhD1, Donna Shelley2, Kathryn Taylor3, Randi Williams3, Emily Dressler4,
Carol Kittel5, Kathryn Weaver5, Kristie Foley5. 1Memorial Sloan-Kettering Cancer Center,
NY, USA, 2New York University, 3Georgetown University, Washington DC, USA, 4Wake
Forest Baptist Health, Winston-Salem, NC, USA, 5Wake Forest Baptist Health.
Background: Lung cancer screening (LCS) provides an unprecedented opportunity to
deliver evidence-based tobacco use treatment (TUT) interventions; however, little is
known about the current practices and readiness of LCS programs to deliver TUT. The
NCI-funded SCALE Collaboration includes 8 clinical trials examining the eectiveness
and implementation of TUT interventions during LCS. Methods: Key stakeholders
representing 49 nationwide LCS sites completed baseline surveys (1/site) prior to trial
enrollment. Survey items assessed organizational characteristics (location, payor mix,
screening volume, and type of facility), frequency of 10 evidence-based TUT practices
(always/mostly vs. sometimes/rarely/never) and 4 items about organizational priority for
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TUT. Sites that reported always/mostly delivery of Ask, Advise, and Assist with medication
and counseling were considered to provide high quality TUT. Results: Imaging sites were
predominantly hospital owned (53%), in urban areas (94%), and screened an average
of 262 patients in the past 6 months. 16 (33%) had a tobacco treatment specialist
(TTS) onsite. Most sites reported routinely asking patients about current smoking status
(86%) and routinely advising smokers to quit (76%) during LCS. However, less than half
reported routine delivery of tobacco treatment assistance, such as providing: self-help
materials (47%), quitline referrals (42%), individual counseling (39%), and cessation
medication (31%). 13 of 49 sites oered high quality TUT (27%). Despite these gaps,
most (61%) sites indicated that integrating TUT best practices is a top priority; strong
TUT endorsement was more likely among the sites with an embedded TTS (79% vs.
52%, p=.15). Sites with an embedded TTS were also more likely (44% vs 18%, OR=3.5,
p=.09) to oer high quality TUT services. Conclusions: Findings reveal gaps in delivery
of high quality TUT in LCS and underscore the importance of addressing barriers for
TUT in LCS settings. Findings suggest having access to a TUT specialist supports high
quality cessation support and provide a benchmark for subsequent implementation
eorts to improve TUT delivery in routine LCS.
FUNDING: Federal
PP-12
CHARACTERISTICS OF REGISTERED CLINICAL TRIALS
EVALUATING THE ROLE OF E-CIGARETTES IN CESSATION OR
REDUCTION OF CIGARETTE SMOKING
Krysten W. Bold1, Felicia Y. Hung2, Joshua D. Wallach2, Stephanie S. O’Malley1. 1Yale
University School of Medicine, New Haven, CT, USA, 2Yale University School of Public
Health, New Haven, CT, USA.
Signicance: Although e-cigarettes have been proposed as a less harmful substitute for
cigarettes that could promote smoking cessation or reduction, a recent meta-analysis
review concluded the published evidence is imprecise, subject to study design biases,
and that little is known about the eects of newer types of e-cigarettes, such as pod
devices, that may deliver nicotine more eectively. Therefore, an important question is
whether new and ongoing studies will address these gaps and help improve our un-
derstanding of the eects of e-cigarettes on smoking cessation or reduction. Methods:
We searched all clinical trials registered in the WHO Registry Network in January 2021
to identify trials studying the eects of e-cigarettes on smoking cessation or reduction.
Search results were screened manually to locate English-language records for trials
studying e-cigarette use with primary or secondary outcomes of smoking cessation,
reduction, or related biomarkers. For eligible trials, we recorded information about par-
ticipants, study design, primary/secondary outcomes, and e-cigarette characteristics
(e.g., device, nicotine concentration, avor). Results: We identied 29 completed and
37 ongoing trials on 4 registries. About half (35, 53%) of the 66 completed and ongoing
trials were recruiting individuals motivated to quit smoking, but only 23 (35%) included
behavioral support for cessation. Although completed and ongoing trials had similar
sample sizes (median 140), durations (median 12 weeks), comparators (e.g., Nicotine
Replacement Therapy [23/66, 35%]), and outcomes, ongoing trials were less likely
to assess outcomes at 6 months or longer (ongoing, 14/37 [38%]; completed, 21/29
[72%], ꭓ2(N=66)=7.80, P=.005). Regarding e-cigarette device characteristics, none of
the completed trials reported studying newer pod devices and only a small proportion
of ongoing trials did (6/37, 16%). Conclusions: Our evaluation suggests that additional
studies will be needed to address important questions about the degree to which e-cig-
arettes, especially newer devices, inuence cigarette cessation.
FUNDING: Federal; Nonprot grant funding entity
PP-13
GENOME-WIDE METHYLATION OF SMOKERS AND EX-SMOKERS
IS ASSOCIATED WITH COGNITIVE PERFORMANCE
Merideth Addicott1, Ping-Ching Hsu1, Joseph Su1, Stacey Daughters2, Daniel Ache-
ampong1, Michael Bauer1. 1UAMS, Little Rock, AR, USA, 2University of North Carolina,
Chapel Hill, NC, USA.
Signicance: DNA methylation is an epigenetic regulator of gene expression critical
to normal cellular development. Alterations in DNA methylation proles have been
associated with cancer and can also be inuenced by environmental factors such as
nutrition, stress/trauma, toxicant exposure, and smoking. A small but growing literature
indicates there are reproducible and robust dierences in methylation among smok-
ers, never-smokers, and ex-smokers. Here, we compared DNA methylation patterns
among current and ex-smokers (at least 2 years abstinent). Methods: Smokers (n =
26) and ex-smokers (n = 30) provided detailed smoking histories, completed the Paced
Auditory Serial Addition Test (PASAT), and submitted a saliva sample. Whole-genome
DNA methylation from saliva was performed using the Innium MethylationEPIC 850K
BeadChip. An ANCOVA model and a receiver operating characteristic (ROC) curve
analyzed the dierence between groups and the performance of signicant CpG
sites. Results: After controlling for race, age, and gender, smokers had signicantly
lower methylation levels than ex-smokers in two CpG sites: cg05575921 (AHRR) and
cg21566642 (ALPPL2). Based on the ROC analyses, both CpGs had strong classi-
cation potentials (cg05575921 AUC = 0.97 and cg21566642 AUC = 0.93). Across all
subjects, the percent methylation of cg05575921 (AHRR) positively correlated with
the length of the last quit attempt (r = 0.65, p < .001) and PASAT accuracy (r = 0.29,
p = .03). Conclusions: AHRR, the aryl hydrocarbon receptor repressor gene, plays
an important role in inammation, cell dierentiation, and cell cycle control. In spite of
the small sample size, our results replicate previously reported dierences in AHRR
hypomethylation among smokers. Furthermore, we show that duration of smoking
abstinence is associated with a recovery of methylation in ex-smokers, which may be
a linked to reduced risk of smoking-associated diseases. The association with cognitive
performance suggests that the hypomethylation of AHRR in saliva may reect systemic
exposure to cigarette-related toxicants that negatively aect brain function.
FUNDING: Federal; State; Academic Institution
PP-14
TOBACCO TREATMENT OUTCOMES FOR HOSPITAL PATIENTS
WITH AND WITHOUT MENTAL HEALTH DIAGNOSES
Brandon T. Sanford1, Alana M. Rojewski2, Madeline G. Foster1, Amanda M. Palmer1,
Michael Cummings2, Stephanie Stansell1, Benjamin A. Toll2. 1Medical University of South
Carolina, Charleston, SC, USA, 2Medical University of SC, Charleston, SC, USA.
Background: Despite signicantly higher prevalence of tobacco use, those with
diagnosed mental health disorders are understudied within general inpatient hospital
settings. The current study seeks to examine the eectiveness of a brief opt-out inpatient
tobacco treatment intervention for those with mental health diagnoses as compared to
those without, as well as evaluate associations of mental health conditions on smoking
characteristics. Methods: Data included 4517 admitted patients from July 2014-De-
cember 2019 who completed a tobacco treatment visit. Post-discharge abstinence was
obtained via an automated Interactive Voice Response (IVR) phone system. Logistic
regressions were conducted using electronic medical recorded-documented mental
health diagnoses, smoking status and history, and post-discharge abstinence. Results:
Among those who responded to IVR calls, logistic regression analysis indicated poorer
response to treatment for those with mental health diagnoses compared to those without
such diagnoses (38% abstinence vs 48%). Those with documented psychopathology
were 31.5% less likely to be abstinent at follow-up (B = -.378, p < .01). A second logistic
linear regression was run using total number of mental health diagnoses on cigarettes
per day. Results of this analysis indicated that daily smoking rates increase with the
presence of mental health problems (B = 1.13, p < .001). Increases in mental health
diagnoses were also associated with decreased self-reported importance of quitting
(r=-.10; p < .001), and less self-ecacy related to quitting (r=-.11; p < .001). Conclu-
sions: Brief inpatient tobacco treatment interventions are less eective for those with
psychopathology. These patients are more likely to use tobacco following discharge,
and report being less motivated and less able to quit. Future research is needed to
develop brief, eective tobacco treatment for hospital patients with comorbid mental
health diagnoses, while also facilitating bridges to outpatient care.
FUNDING: Unfunded
PP-15
PAIN INTENSITY AS A PREDICTOR OF CIGARETTE AND
E-CIGARETTE USE/CO-USE ACROSS WAVES 1-4 OF THE
POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH)
STUDY: THE MODERATING ROLE OF SEX
Jessica Powers, MS1, Stephen A. Maisto1, Michael J. Zvolensky2, Joseph W. Ditre1.
1Syracuse University, 2University of Houston.
Signicance: Pain has been implicated in the onset and maintenance of nicotine addiction
(LaRowe & Ditre, 2020), and there is emerging cross-sectional evidence of covariation
between the experience of pain and use/co-use of cigarettes and e-cigarettes (Powers
et al., 2020; 2021). Although men have been shown to demonstrate greater nicotine
analgesia and women with pain tend to report greater nicotine dependence, we are not
aware of any previous research that examined the role of sex in pain-cigarette/e-cigarette
relations. The goals of the current project were to (1) prospectively test pain intensity as
a predictor of initiating co-use of cigarettes and e-cigarettes, (2) examine associations
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between pain intensity and likelihood of endorsing exclusive e-cigarette use, exclusive
cigarette use, or co-use of cigarettes + e-cigarettes, and (3) examine sex as a moderator
of proposed associations. Method: Data were drawn from Waves 1-4 of the PATH Study
(2013-2018). Past-week pain was assessed using a 0-10 numerical scale. Population
weights were applied for all models. Survival analysis and generalized estimating equa-
tion models were conducted (controlling for relevant sociodemographic factors). Results:
Among exclusive cigarette users (n = 7,719), pain intensity at Wave 1 was positively
associated with likelihood of initiating e-cigarette co-use at a subsequent wave (p < .05).
A signicant pain x sex interaction (p < .05) revealed this prospective relationship was
stronger among female respondents. Cross-sectional Wave 4 analyses (n = 33,822)
revealed a signicant pain x sex interaction, such that pain was more strongly associ-
ated with likelihood of exclusive cigarette use, exclusive e-cigarette use, and co-use
of cigarettes/e-cigarettes among female respondents (ps < .001). Conclusion: These
ndings build upon an accumulating, yet largely cross-sectional, literature indicating
that pain may serve as a risk factor in the onset and maintenance of cigarette and
e-cigarette use/co-use. Future prospective research is needed to examine trajectories
and temporal precedence of pain in relation to use/co-use of cigarettes, e-cigarettes,
and other nicotine products.
FUNDING: Academic Institution
PP-16
A META-ANALYSIS OF THE EFFICACY OF SMOKELESS
TOBACCO FOR SMOKING CESSATION
Daniel Stjepanovic, Preeti Phartiyal, Janni Leung, Carmen Lim, Tianze Sun, Jack
Chung, Coral Gartner, Wayne Hall, Gary C. K. Chan. The University of Queensland,
Brisbane, Australia.
Signicance: Despite rigorous tobacco control strategies implemented globally, tobac-
co addiction and smoking remain prevalent. Swedish snus, a type of low-nitrosamine
smokeless tobacco, could reduce harms from tobacco addiction due to smoking. Sci-
entic evaluations of the ecacy of smokeless tobacco appear conicted. The present
study aimed to systematically review the ndings of studies assessing the ecacy of
these products in smoking cessation. Methods: Randomised controlled trials (RCTs),
longitudinal and cross-sectional studies that evaluated the eectiveness of Swedish snus
and other low-nitrosamine smokeless tobacco products were identied using PubMed,
Web of Science and PsycINFO. Random eect meta-analytic models were used to
test the eect of smokeless tobacco for smoking cessation in RCTs, longitudinal, and
cross-sectional studies. Results: Use of smokeless tobacco products such as Swedish
snus was associated with increased abstinence in longitudinal (RR = 1.38, 95% CI
[1.05, 1.82], p = .022) and cross-sectional (OR = 1.87, 95% CI [1.29, 2.72], p = .001)
studies. Leave-one-out analysis determined that the signicant association in longitudi-
nal studies was mainly driven by one nding, the removal of which yielded statistically
non-signicant results. Lastly, participants in RCTs that were randomised to receive
smokeless tobacco did not have higher rates of abstinence when contrasted against
those receiving nicotine replacement therapy or a nicotine-free control. Conclusion:
There is weak evidence for the ecacy of smokeless tobacco in smoking cessation.
Most of the evidence for support of smokeless tobacco was from cross-sectional studies
conducted in Scandinavian countries. Wider adoption of Swedish snus is unlikely to
signicantly reduce smoking and tobacco addiction.
FUNDING: Federal
PP-17
UTILIZATION AND EFFICACY OF SMARTPHONE APPLICATIONS
FOR SMOKING CESSATION AMONG LOW-INCOME SMOKERS.
ANALYSIS OF THE ICANQUIT RANDOMIZED CONTROLLED
TRIAL
Margarita Santiago-Torres1, Kristin E. Mull1, Brianna M. Sullivan1, Diana M. Kwon1,
Darla E. Kendzor2, Jonathan B. Bricker1. 1Fred Hutchinson Cancer Research Center,
Seattle, WA, USA, 2University of OK Health Sciences Center, OK City, OK, USA.
Background: Limited access to evidence-based smoking cessation interventions
among low-income individuals contributes to high rates of cigarette smoking and poor
cessation outcomes. Yet, evidence of digital smoking interventions that are accessible
and ecacious among low-income individuals is scarce. In a secondary analysis, data
from the two-arm randomized iCanQuit parent trial was used to determine the utilization
and ecacy of an Acceptance and Commitment Therapy (ACT)-based smartphone ap-
plication (iCanQuit) vs. a US Clinical Practice Guidelines (USCPG)-based smartphone
application (QuitGuide) for smoking cessation among low-income adults. Methods:
Individuals who smoked at least 5 cigarettes/day with smartphone access were enrolled
between May 2017 and September 2018. Participants (n=863) were randomized 1:1 to
either iCanQuit (n=416) or QuitGuide (n=447) for 12-months. The primary outcome was
self-reported complete-case 30-day point prevalence abstinence (PPA) at 12-months. All
participants provided consent online and were compensated to up to $105 for completing
study data collection. Study retention, treatment utilization and satisfaction, and change
in ACT-theory based processes were also compared between arms. Results: Among
low-income trial participants (n=863) recruited from 48 U.S. states, 24% resided in a
rural area, 39% were non-White, and 10% were Hispanic. Data retention was 88% at
12-months and did not dier by arm (p>.05). The 30-day PPA was 27% for iCanQuit vs.
20% for QuitGuide at 12-months (OR=1.46 95% CI: 1.04, 2.06). Increased acceptance
of internal cues to smoke mediated the eect of treatment on cessation. iCanQuit partici-
pants were signicantly more engaged and satised with the iCanQuit application relative
to QuitGuide. Conclusions: In a racially/ethnically diverse sample with high retention
rates and participant engagement, this study showed that an accessible smartphone
application was ecacious for smoking cessation among low-income individuals. To
address smoking-related disparities among socioeconomically disadvantaged smokers,
a dissemination trial of the iCanQuit application for smoking cessation is warranted.
FUNDING: Nonprot grant funding entity
PP-18
EXAMINING THE IMPACT OF ECOLOGICAL MOMENTARY
ASSESSMENT ON SMOKING CESSATION IN A PUBLICLY
AVAILABLE CESSATION SMARTPHONE APPLICATION
Kara P. Wiseman1, Alexandra Budenz2, Jessica Smith1, Leeann Nicole Siegel2, Yvonne
Prutzman3. 1University of Virginia, Charlottesville, VA, USA, 2National Cancer Institute,
Bethesda, MD, USA, 3National Cancer Institute, Tobacco Control Research Branch,
Rockville, MD, USA.
Signicance: Smoking remains a leading cause of cancer and cancer-related mortality.
Smartphone-based cessation applications (apps) can eectively support smoking ces-
sation. However, little is known about the inuence of specic app features on cessation.
One feature that provides insight into smoking behavior and can provide personalized
support is app-based ecological momentary assessments (EMAs). EMAs have been
integrated into commonly used in cessation apps, but less understood is whether EMA
participation impacts cessation outcomes. Prior studies that have included EMAs have
not had a non-EMA comparator and were not conducted in a real-world setting. The
goal of this study was to examine the impact of inuencing app-based EMA participation
on short-term smoking cessation. Methods: N=152 participants were randomized into
an EMA incentivized arm (EMA arm) or a non-EMA incentivized arm (i.e., only survey
completion was incentivized). All participants downloaded and used quitSTART, a publicly
available app oered through Smokefree.gov, which sends three EMA prompts a day
for two weeks as part of normal app functionality (n=42 total prompts). All participants
were asked to complete a baseline survey, and follow-up surveys at two and four weeks
to assess smoking status. EMA participation was calculated as mean EMAs completed
per group and compared using a t-test. Seven-day point prevalence abstinence by
arm was compared using chi-square tests with an intention to treat approach. Results:
Mean EMAs completed in the EMA arm was 13.3 (SD=11.2, range=0-40) compared
to 4.7 (SD=5.8, range=0-28) in the survey only arm (p<0.001). Seven-day abstinence
rates were 9.0% and 20.3% at two-weeks (p=0.062), and 17.5% and 36.6% at four-
weeks (p=0.013) in the EMA arm and survey only arm, respectively. Conclusions: This
study successfully incentivized EMA completion within a cessation app yet, cessation
rates were higher in the survey only arm at 4 weeks. The results of this study help us
understand the role of EMA when oered within a publicly available setting. It appears
that autonomy to use the app as desired resulted in higher short-term cessation rates.
Ongoing analyses are exploring other patterns of app use to provide additional context
for these initial ndings.
FUNDING: Federal
PP-19
DEVELOPMENT OF AN AUTOMATED VIDEO-ASSISTED SMOKING
TREATMENT FOR PEOPLE WITH HIV
Damon Vidrine, DrPH1, Thanh C. Bui2, Kristina Bowles1, Jennifer I. Vidrine1. 1Mott
Cancer Center, 2Oklahoma University College of Medicine.
Eorts to develop, evaluate and implement smoking cessation treatment for people with
HIV are a public health priority. We describe the development of an mHealth intervention
consisting of dynamically tailored automated video-assisted smoking treatment (AVAST).
Data from the team’s earlier trials were used to inform decisions about treatment modality,
dose, and duration. Next, 2 pilot studies among PWH were conducted: 1) qualitative
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
interviews (n=10) to evaluate user interface, treatment content, and platform stability;
and 2) pilot RCT (n=20) to evaluate feasibility, acceptability and preliminary ecacy at
a 3-month follow-up. A phase III RCT (n=474) compared a 12-week intervention of cell
phone counseling and reminder text messages to standard care. A signicant treatment
eect was observed (OR=2.46, 95% CI: 1.03, 5.94) but relapse rates at 12-months
were high. A second RCT (n=624) evaluated the utility of automated and dynamically
tailored text messaging. Participants who received text messages + counseling were
twice as likely to be abstinent (vs. standard care or text messages alone) at 6-months.
An implementation trial with approximately 1400 PWH who smoke found that participants
preferred an automated mHealth cessation intervention over traditional phone counseling
(92% vs. 8%). Findings from our pilot with AVAST established the technical stability of
the new mobile application, while also informing an algorithm-based treatment content
selection approach. The pilot RCT showed that engagement (i.e., completed sessions)
was higher among PWH who received AVAST (12) versus the human-delivered control
group (2.5). Abstinence rates at month 3 were greater in the AVAST group vs. the control
group (30% vs. 10%). Our ndings demonstrated: 1) traditional cessation treatment
produced modest (5%) long-term abstinence among PWH; 2) text messaging alone (vs.
standard care) did not increase abstinence; 3) PWH preferred automated mHealth (vs.
human-delivered) treatment; and 4) our new AVAST intervention produced promising
feasibility and preliminary ecacy ndings. A fully powered 2-group RCT to evaluate
AVAST among PWH in Florida is ongoing.
FUNDING: Federal
PP-20
‘LOVE MY LUNGS’ - A SMOKE-FREE HOME INTERVENTION FOR
FAMILIES OF BABIES ADMITTED TO NEONATAL INTENSIVE
CARE
Caitlin Notley, Emma Ward. University of East Anglia, Norwich, United Kingdom.
Signicance: Tobacco smoking has a severe detrimental impact on parental and child
health. Pregnant women who smoke are more likely to give birth to a low birthweight or
premature baby, requiring admission to neonatal intensive care (NICU). Preterm birth
oers a ‘teachable moment’ to support parents to quit smoking, remain smokefree, and
maintain smokefree environments. UK guidance recommends support for smoke-free
strategies in secondary care settings during pregnancy and after childbirth, but inter-
ventions are not routinely oered in NICU. Methods: This study took a theory-based
approach to intervention development, being underpinned by a logic model derived from
existing evidence and qualitative development work. Focus groups and interviews with
parents and family members of babies admitted to NICUs (n=60) sought feedback on
potential intervention approaches, considering ‘who’ might introduce, ‘what’ might be the
content, and ‘when’ an intervention might be delivered. A nal phase of person-centred
intervention development (n=10) working with NICU parents who smoke, assisted
with rening ‘how’ the intervention might best be implemented. Results: Parents were
amenable to smoking cessation and surprised that it was not oered. Support might
best be delivered by a NICU nurse with specialist training, reinforced by a Doctor or
Consultant, taking a ‘whole unit’ approach. Support with cessation and relapse pre-
vention through information about smoke-free homes, and support to use nicotine in
less harmful ways were identied as important. Parents wanted health messages to
be hard hitting, give factual advice about the harms of smoking on vulnerable infants
specically, come from the perspective of the baby, and wanted information to be de-
livered in novel ways. Conclusions: A complex intervention comprising sta training
to facilitate active acknowledgement of smoking status of parents of babies on NICU,
timely support, and educational messages delivered by innovative virtual reality (VR)
short clips is presented. The intervention will be made widely available across UK NICUs
with ongoing implementation evaluation.
FUNDING: Nonprot grant funding entity
PP-21
DEVELOPMENT AND ANALYSIS OF TOBACCO TREATMENT
MEASURES FOR CANCER REGISTRIES FOR LONGER-TERM
QUALITY IMPROVEMENT
Tresza D. Hutcheson1, Tim Metcalf2, Lisa Sanderson Cox1, Edward F. Ellerbeck1,
Kimber P. Richter1. 1University of Kansas School of Medicine, Kansas City, KS, USA,
2University of Kansas Cancer Center, Kansas City, LA, USA.
Signicance. Treating tobacco use is a rm recommendation for best practices in
cancer care due to the negative impact of continued tobacco use both during and after
cancer treatment. The lack of regular tracking/reporting of tobacco treatment metrics
may contribute to a failure to provide systematic and comprehensive tobacco treatment
in cancer care settings. Methods. As part of the C3i quality improvement initiative to
improve tobacco treatment in NCI-designated cancer centers, we developed two new
tobacco treatment measures for our local organization’s cancer registry to track provision
of behavioral support and pharmacotherapy. Tobacco treatment was compared by year,
cancer type, and whether or not the cancer type was one of 12 tobacco-related cancers
(TRC). These data were used to create feedback reports for cancer center leadership.
Results. Of 17,735 cancer cases in the registry from 2017-2019, both measures were
captured on 99.5% of patients, with 3,091 (17.4%) identied as tobacco users. Overall,
557 (18.0%) of tobacco users received either a tobacco medication or behavioral support;
with 478 (15.5%) receiving behavioral counseling, 352 (11.4%) receiving medication,
and 273 (8.8%) receiving both. The odds of receiving any type of tobacco treatment
was 93% higher (OR=1.93, 95% CI=1.59-2.34, p<0.0001) if the patient had a TRC.
Comparing total tobacco treatment by those who had a TRC or a non-tobacco related
cancer (NTRC), respectively, 22.2% vs. 12.9% received any type of treatment; 11.3%
vs. 5.8% received both types of treatment; 14.3% vs 7.9% received a medication and
19.3% vs 10.8% received behavioral support. The odds of receiving gold standard treat-
ment including both a medication and behavioral support increased from 4.8% in 2017
to 10.8% in 2019 (OR=2.37, 95% CI=1.63-3.46, p<0.0001); but improvements varied
substantially across cancer types. Conclusion. Tobacco treatment can be captured as
part of a cancer registry and used to identify opportunities for improvement and track
the changes over time. Patients with TRC are more likely to receive treatment, but there
are opportunities to improve tobacco treatment across all cancer types.
FUNDING: Federal
PP-22
RANDOMIZED CONTROLLED TRIAL OF A MINIMUM VIABLE
PRODUCT (MVP) DIGITAL THERAPEUTIC FOR SMOKING
CESSATION
Erika Litvin Bloom, PhD1, Brian Iacoviello, PhD1,2, Olya Besedina, MS1, Shaheen E.
Lakhan, MD, PhD, FAAN1,3. 1Click Therapeutics, New York, NY, USA, 2Ichan School
of Medicine at Mount Sinai, New York, NY, USA, 3Virginia Tech, Blacksburg, VA, USA.
Signicance: Few smartphone apps for smoking cessation have undergone rigorous
evaluation. A minimum viable product (MVP) is a digital software application that con-
tains the minimal feature set necessary to meet users’ needs and establish ecacy.
Clickotine®-MVP (CKT-M) is a digital therapeutic that delivers the essential elements
of the U.S. Clinical Practice Guidelines for smoking cessation in a series of daily brief
“missions.” CKT-M also provides users with supportive 1-way text messages and other
content based on cognitive behavioral therapy. Methods: We conducted a randomized
controlled trial of CKT-M vs. QuitGuide (QG), a free app from the National Cancer
Institute that also delivers content consistent with clinical guidelines. Participants (N =
158) were U.S. adults (68% female) who smoked at least 5 cigarettes daily and wanted
to quit within the next 30 days. They were recruited from social media and mail sent to
people covered by a value-based care program. After completing a baseline survey,
participants were randomized to CKT-M or QG. To minimize bias, participants and
investigators were blinded to app assignment and the study sponsor was not revealed
until the study was over. Self-reported smoking and breath carbon monoxide (CO)
were assessed after 8 weeks of use. Results: There were no statistically signicant
dierences between CKT-M and QG in 7-day (30.4% vs. 31.6%) or 30-day (12.7%
vs. 16.5%) self-reported abstinence, nor in mean CO (all p’s > .05). Additionally, there
were no signicant dierences between the apps in ratings (5-pt scales) of satisfaction,
ease of use, or helpfulness (all p’s > .05). More participants in QG (29.1%) dropped out
than in CKT-M (16.5%) (p = .09). There were no adverse events related to use of either
app. Conclusion: CKT-M is likely to meet the criteria for an MVP. CKT-M serves as a
stable (“version-locked”), internal benchmark to inform development of novel current
versions of CKT with features such as adaptive, personalized engagement messaging
using articial intelligence (AI), AI-supported 2-way text messaging with licensed clinical
social workers, and integrated access to nicotine replacement therapy.
FUNDING: Federal; Other: Click Therapeutics
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
PP-23
EMISSIONS FROM CONVENTIONAL CIGARETTES AND IQOS
HEETS: A COMPARATIVE STUDY ASSESSING THE IMPACT
OF MORE INTENSE SMOKING PARAMETERS ON EMISSION
COMPOSITION
Michele Davigo1, Walther N.M. Klerx2, Antoon Opperhuizen1, Reinskje Talhout2, Freder-
ik-Jan van Schooten1, Alexander H. Remels1. 1Maastricht University, Maastricht, Neth-
erlands, 2RIVM, Bilthoven, Netherlands.
Signicance: iQOS is gaining more and more popularity worldwide, due to the indus-
try claims of reduced toxicity. However, a detailed chemical characterization of iQOS
emissions is lacking. Moreover, the impact of dierent smoking topographies on iQOS
aerosol composition is still unknown. In this study, emissions from two conventional
cigarettes (CCs) and from nine iQOS HEETS were compared applying Health Canada
Intense (HCI) and a total of four more intense smoking topographies. Methods: Emis-
sions were generated using a linear smoking machine (for CCs) and a linear vaping
machine (for iQOS HEETS). HCI smoking parameters were systematically changed
in the more intense smoking regimes (pu volume from 55mL to 90mL,pu duration
from 2s to 4s and pu frequency from 30s to 15s). All extraction and determination
procedures were in accordance with WHO Tobacco Laboratory Network (TobLabNet)
Standard Operating Procedures. Nicotine was measured by GC-FID. Tobacco-specic
nitrosamines (TSNAs) were quantied with LC-MS, while carbonyls were assessed with
HPLC-DAD. Results: Nicotine delivery from iQOS HEETS was 38% lower than from
CCs. A clear topography eect was observed for all products: higher pu volume and
pu duration caused a mean 22% increase in nicotine release and a 21% increase in
TSNAs delivery compared to HCI. Of note, aerosols from the assessed iQOS HEETS
showed signicant dierences in TSNAs levels: mainstream emissions from iQOS Si-
enna and iQOS Amber contained the highest TSNAs concentrations, on average 26%
higher than from the other iQOS HEETS. Higher pu volume and pu duration majorly
impacted iQOS HEETS emissions, whereas CCs emissions were mainly aected by
higher pu frequency. Conclusions: The observed dierences in toxicant levels delivery
from iQOS HEETS resemble their dierent product composition, thus distinct tobacco
blends and avoring additives. The more intense smoking parameters induced higher
nicotine, TSNAs and carbonyls release in all the analyzed products. As more intense
smoking regimes better mirror real-life smoking behaviors, this study shows the inad-
equacy of HCI as standard smoking regime in laboratory settings.
FUNDING: Federal; Academic Institution
PP-26
SEX/GENDER DIFFERENCES IN TRIGGERS FOR THINKING
ABOUT QUITTING SMOKING. FINDINGS FROM THE
INTERNATIONAL TOBACCO CONTROL (ITC) NETHERLANDS
SURVEY
Gera Nagelhout1, Nikita Poole1, Cloé Geboers2, Tessa Magnée3, Anne Marije Kaag4,
Floor van den Brand5, Bas van den Putte6, Hein de Vries5, Georey Fong7, Marc Willem-
sen2. 1Maastricht University and IVO Research Institute, the Netherlands, Maastricht,
Netherlands, 2Maastricht University and Trimbos Institute, the Netherlands, Maastricht,
Netherlands, 3Erasmus University Rotterdam, the Netherlands, Rotterdam, Netherlands,
4VU Amsterdam, the Netherlands, Amsterdam, Netherlands, 5Maastricht University,
the Netherlands, Maastricht, Netherlands, 6University of Amsterdam, the Netherlands,
Amsterdam, Netherlands, 7University of Waterloo, Canada, Waterloo, ON, Canada.
Signicance: Studies have identied dierences in smoking cessation between women
and men, e.g. women have more diculty with remaining quit than men. Most studies
have only examined dierences between women and men and have ignored sex/gender
minority populations. The rst aim of this study is to examine dierences between women,
men, and sex/gender minority populations in triggers for thinking about quitting smoking.
The second aim is to examine interactions with age group, education, and income.
Methods: We used cross-sectional data from the International Tobacco Control (ITC)
Netherlands Survey conducted in 2020. We measured sex assigned at birth, current
gender identity, and the extent to which respondents felt masculine or feminine. We
distinguished between individuals who (1) were born as female and identied as women
and feminine (referred to as women, n=670), (2) were born as male and identied as
men and masculine (referred to as men, n=897), and (3) all others (referred to as sex/
gender minorities, n=220). We used a list of 15 items and asked respondents whether
each of these led them to think about quitting in the past six months. Results: For most
triggers we found no signicant dierences between women, men, and sex/gender
minorities. There were no signicant interactions with age group, education, or income.
Sex/gender minorities were signicantly more likely to report the following triggers: quit
advice from a doctor, an anti-smoking message or campaign, smoking restrictions at
work, and the availability of a telephone helpline. Men were signicantly less likely to
report the price of cigarettes and the coronavirus outbreak as trigger than women, but
these dierences were not signicant in adjusted models. Conclusion: For most triggers
for thinking about quitting smoking there were no (or only small) dierences between
women, men, and sex/gender minority populations. Sex/gender minority populations
were more likely to report a number of triggers. A possible explanation is that they feel
marginalized, which causes a desire for social inclusion. Such a desire can make one
more receptive for all kinds of triggers to quit smoking.
FUNDING: Nonprot grant funding entity
PP-27
PREVALENCE OF CURRENT LARGE CIGAR VERSUS LITTLE
CIGAR/CIGARILLO SMOKING AT THE INTERSECTION OF AGE
AND RACE/ETHNICITY AMONG U.S. ADULTS, 2018-2019
Lilianna Phan1, Timothy S. McNeel2, Kelvin Choi1. 1National Institute on Minority Health
and Health Disparities, Bethesda, MD, USA, 2Information Management Services, Inc.,
Calverton, MD, USA.
Signicance: Cigar smoking is increasing among non-Hispanic Black adults in the
U.S. We examined the prevalence of large cigar vs. little cigar/cigarillo (LCC) smoking
by age and race/ethnicity, and as well as at their intersection. Methods: We analyzed
data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey
(n=134,900). We examined age and race/ethnicity associations with current large cigar
and LCC smoking vs. non-cigar smoking in a multivariable multinomial logistic regression
model and also examined the age*race/ethnicity interaction. A multivariable logistic re-
gression model was then used to examine these associations for LCC smoking vs. large
cigar smoking among cigar smokers. We stratied these models by age and examined
associations between race/ethnicity and type of cigar smoking. We adjusted for other
sociodemographic variables and other tobacco use in the models. Results: Overall,
1.1% and 0.8% of U.S. adults currently smoked large cigars and LCCs. Younger adults
(vs. 61+ years-old) were more likely to smoke large cigars vs. not smoke any cigars
(e.g., Prevalence[18-30 years-old]=1.2%, Prevalence[61+ years-old]=0.8%; AOR=1.3,
95% CI=1.1-1.6) and LCCs (e.g., Prevalence[18-30 years-old]=1.0%, Prevalence[61+
years-old]=0.4%; AOR=1.9, 95% CI=1.5-2.4). Non-Hispanic Black adults were more
likely than non-Hispanic White adults to smoke LCCs vs. not smoke cigars (1.9% vs.
0.6%; AOR=2.9, 95% CI= 2.3-3.5). We found an age*race/ethnicity interaction on cigar
smoking (p<0.01), and that LCC smoking prevalence was the highest among non-His-
panic Black young adults (18-30 years-old; 2.7%) and lowest among non-Hispanic
other race 61+ years-old (0.2%). Compared to 61+ years-old, younger non-Hispanic
Black adults were more likely to smoke LCCs vs. not smoke cigars (e.g., 18-30 years-
old AOR=3.9 95% CI=2.5-6.1) and vs. large cigars (e.g., 18-30 years-old AOR=4.8
95% CI=2.4-9.7). Conclusion: LCC smoking is most prevalent among non-Hispanic
Black young adults, while a pattern of large cigar smoking is less clear. LCC smoking
prevention and cessation eorts should prioritize non-Hispanic Black young adults, who
are disproportionately aected.
FUNDING: Federal
PP-28
U.S. TOBACCO USE DISPARITIES AND THE HEALTH OF
VULNERABLE PATIENTS IN THE TOBACCO ENDGAME
Douglas E. Levy, Stephanie S. Lee, Fatma M. Shebl, Yiqi Qian, Sydney L. Goldberg,
Emily P. Hyle, Jessica E. Becker, Krishna P. Reddy. Massachusetts General Hospital,
Boston, MA, USA.
BACKGROUND. Smoking prevalence is declining in the U.S. (currently ~14%), but
remains high/is declining more slowly in “vulnerable” populations. We used the Simu-
lation of Tobacco and Nicotine Outcomes and Policy (STOP) microsimulation model to
estimate the impact of tobacco use disparities on vulnerable populations’ health on the
way to achieving the tobacco “endgame.” METHODS. In the STOP model, we simulated
cohorts of people representative of the non-institutionalized U.S. population aged ≥20y
starting in 2018, with new 20-year-olds joining annually. We modeled four subgroups:
those with low socioeconomic status (SES; income <100% the US federal poverty level,
<high school education, or Medicaid participation; smoking prevalence=21%) vs. not,
or serious psychological distress (SPD; Kessler6 score≥13; smoking prevalence=32%)
vs. not. (Low SES and SPD comparisons were not mutually exclusive). In the model,
individuals transition monthly between never/former/current smoking based on rates
of initiation, cessation, and relapse. They face tobacco use and subgroup-stratied
all-cause mortality. Most input parameter data were derived from the National Health
Interview Survey. We assumed smoking prevalence will decline over time due to trends
in reduced initiation, ongoing cessation at current rates, and smokers dying. We sim-
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
ulated each subgroup until reaching 5% smoking prevalence (a common “endgame”
threshold), tracking cumulative years of life lived. RESULTS. We projected that those
with low SES will achieve 5% smoking prevalence in 33 years, 12 years later than those
with higher SES. Those with SPD will reach the 5% threshold in 41 years, 14 years
later than those without SPD. If baseline smoking prevalence and declines in smoking
initiation for vulnerable populations were to equal those of less vulnerable populations,
there would be 22 million (1.2%) (low SES) and 8 million (3.5%) (SPD) more years of life
lived than under the status quo. CONCLUSIONS. Absent major eorts to reduce tobacco
use disparities, vulnerable populations will suer substantial tobacco-related health
consequences for many years after they have been minimized for less vulnerable groups.
FUNDING: Federal
PP-29
SOCIODEMOGRAPHIC DISPARITIES IN TOBACCO RETAILER
DENSITY IN THE UNITED STATES, 2000 - 2017
Sarah D. Mills1, Amanda Y. Kong2, Alexandria E. Reimold1, Chris D. Baggett3, Christo-
pher A. Wiesen4, Shelley D. Golden1. 1Department of Health Behavior, Gillings School
of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA,
2Department of Family and Preventive Medicine, The University of Oklahoma Health
Sciences Center, Oklahoma City, OK, USA, 3Department of Epidemiology, Gillings
School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill,
NC, USA, 4Odum Institute, University of North Carolina, Chapel Hill, Chapel Hill, NC,
USA.
Signicance: Studies nd dierences in tobacco retailer density according to neigh-
borhood sociodemographic characteristics, raising issues of social justice, but not all
research is consistent. This study examined associations between tobacco retailer
density and neighborhood sociodemographic characteristics in the United States (US)
at four timepoints (2000, 2007, 2012, 2017) and investigated if associations remained
stable over time. Methods: Data on tobacco retailers came from the National Estab-
lishment Time-Series Database. Adjusted mixed-eects linear models examined the
relationship between census tract retailer density and census tract sociodemographic
characteristics (% non-Hispanic Black [Black], % Hispanic, % vacant housing units,
median household income), controlling for percentage of youth, urbanicity and US
region. To examine whether the relationship between density and sociodemographic
characteristics changed over time, additional models were estimated with interaction
terms between each sociodemographic characteristic and year. Results: Tobacco
retailer density ranged from 1.2-1.4 retailers/1,000 persons from 2000 to 2017. In each
year, there were signicant, positive relationships between tobacco retailer density and
the percentage of Black (b = 0.02 [0.01, 0.02] to 0.03 [0.02, 0.03]) and Hispanic (b =
0.03 [0.02, 0.04] to 0.04 [0.03, 0.05]) residents and the percentage of vacant housing
units (b = 0.13 [0.12, 0.14] to 0.20 [0.18, 0.21]) in a census tract. Retailer density was
negatively associated with income (b = -0.10 [-0.11, -0.10] to -0.06 [-0.06, -0.06]) in a
census tract. From 2000 to 2017, the relationship between retailer density and income
and vacant housing units became weaker. Conclusions: Despite the weakening of
some associations, there are sociodemographic disparities in tobacco retailer density
from 2000 to 2017, which research has shown may contribute to inequities in smoking.
FUNDING: Federal
PP-30
SOCIOECONOMIC STATUS ACROSS THE LIFE COURSE AND
SMOKING TRAJECTORIES OF OLDER ADULT SMOKERS IN THE
U.S.
Jaqueline C. Avila1, Ezinwa Osuoha2, Sangah Lee1, Dale Dagar Maglalang1, Alexander
Sokolovsky1, Jasjit S. Ahluwalia1. 1Brown University School of Public Health, Providence,
RI, USA, 2Cornell University, Ithaca, NY, USA.
Signicance: Socioeconomic status (SES) at dierent stages of the life course impacts
late-life health. However, whether SES across the life course impacts smoking trajec-
tories in late life is not known. The objective of this study is to assess how lifetime SES
impacts smoking cessation among older smokers in the U.S. Methods: We identied
6,058 current smokers 50 years and older from the 1998-2018 waves of the Health and
Retirement Study (HRS). The HRS is a nationally representative longitudinal study of
older adults in the U.S. The outcome was smoking cessation, dened as a self-reported
change from current smoker to former smoker between study waves. The main inde-
pendent predictor was lifetime SES, dened as: low child and low adult SES (persistent
low); low child, high adult SES; high child, low adult SES; and high child, high adult
SES (persistent high). Two latent variables were created to operationalize child and
adult SES. Child SES was measured by the level of parental educational attainment,
father’s occupation, being born in southern U.S., and growing up in a rural area. Adult
SES was measured by respondent’s educational attainment, longest job occupation,
labor force status, household income, and household wealth. Demographic, health and
smoking characteristics were compared by lifetime SES at baseline using chi-square
tests. Multilevel mixed-eect logistic model was used to examine how lifetime SES
predicts smoking cessation at age 65 and over time (interaction between lifetime SES
and age), adjusted by sex, marital status, health insurance, race/ethnicity, visit to the
doctor in the previous 12 months, chronic diseases and number of cigarettes per day.
Results: The majority of older smokers had persistent high SES (60.3%), followed by
high child/low adult SES (18.7%), persistent low SES (15.5%) and low child/high adult
SES (5.6%). Compared to those with persistent high SES, those with persistent low SES
were more likely to be women (49.2% vs. 45.2%, p=.004), Hispanic (25.9% vs. 3.0%,
p<.001) or non-Hispanic Black (22.7% vs. 8.7%, p<.001), respectively. The adjusted
results showed that at age 65, compared to those with persistent high SES, those with
persistent low SES (OR=0.42, 95% CI= [0.31-0.56]), low child/high adult SES (OR=0.37,
[0.24-0.55]), and low adult/high child SES (OR=0.53, [0.40-0.70]) were less likely to
quit. Similar results were observed over time for those with persistent low SES and low
adult/high child SES. However, there was no signicant dierence for those with low
child/high adult SES. Conclusion: Older smokers that have both high child and adult
SES are more likely to quit than those with changes in SES across the life course. While
those with low child/high adult SES are a minority, they are signicantly less likely to
quit than those with persistent high SES at age 65, demonstrating the enduring eect
of low childhood SES on late life smoking trajectories.
FUNDING: Federal; Academic Institution
PP-31
THE DIFFERENTIAL IMPACT OF THE 2000 CANADIAN GRAPHIC
WARNING LABEL POLICIES ON SMOKING PREVALENCE BY
SEX AND EDUCATION - A DIFFERENCE-IN-DIFFERENCE-IN-
DIFFERENCE MODEL
Bukola Usidame1, Gang Meng2, James Thrasher3, Mary E. Thompson2, Georey Fong2,
Nancy Fleischer1. 1University of Michigan, Ann Arbor, MI, USA, 2University of Waterloo,
Waterloo, ON, Canada, 3University of SC, Columbia, SC, USA.
Signicance: Graphic warning labels (GWLs) have been shown to reduce overall smoking
rates but there is limited evidence of their dierential impact on smoking prevalence
by sex or education. Using a quasi-experimental design, we compared the impact
of the 2000 Canadian introduction of GWLs on smoking prevalence, to the United
States (US), where no GWLs were introduced, with a specic focus on whether the
impact diered by sex and education.Methods: We pooled data collected from 1999-
2004 from the Canadian Tobacco Use Monitoring Survey and the US Behavioral Risk
Factor Surveillance System. We used a dierence-in-dierence model (DD) to assess
the causal impact of the Canadian policy intervention on smoking prevalence, and a
dierence-in-dierence-in-dierence (DDD) model to examine dierences in the policy
impact by sex and education, comparing Canada (the treatment group) with the US
(the control group). Results: In Canada, smoking prevalence decreased from 21.7% in
2000, before GWLs were introduced, to 18.9% in 2002, after their introduction. In the
US, smoking prevalence increased from 20.7% in 2000 to 22.4% in 2002. Results from
the DD regression models showed that Canadian respondents reported lower odds of
being a current smoker compared to the US respondents, following the 2000 policy
intervention (OR= 0.84, 95 % CI 0.74-0.94). The DDD model showed that there were
no signicant dierences in the impact of GWL on current smoking by sex or education,
comparing both countries, after the 2000 policy intervention.Conclusion: The 2000
Canadian GWL policy was an eective tobacco control measure that reduced smoking
prevalence overall; the impact was the same for males and females, and across edu-
cation levels. Although GWL policies can reduce smoking prevalence, they may not be
sucient to reduce existing inequities in smoking by education.
FUNDING: Unfunded; Federal; Nonprot grant funding entity
PP-32
EXAMINING THE IMPACT OF SMOKING CESSATION
SMARTPHONE APPS ON TREATMENT UTILIZATION IN
CIGARETTE SMOKERS
Schuyler Christopher Lawson1, Danielle Smith2, Gregory Homish1. 1University at
Bualo, Bualo, NY, USA, 2Roswell Park Cancer Institute, Bualo, NY, USA.
Signicance: African American cigarette smokers have lower rates of treatment utiliza-
tion than their White American counterparts due to various treatment access barriers.
There is a growing literature on smoking cessation smartphone apps (SCSAs), with
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
a handful of randomized clinical trials suggesting that SCSAs can increase quit rates
and improve continuous abstinence rates. We sought to determine if previous SCSA
use was associated with past year treatment utilization and if race moderated this rela-
tionship using a nationally representative sample. Methods: The sample consisted of
cross-sectional data from Wave 4 of the Population Assessment of Tobacco and Health
Study (2016-2018, N = 9,802) which included established cigarette smokers aged 18
to 65 years old. We used logistic and negative binomial regression models to examine
the main eect of previous SCSA use on past year treatment utilization and duration of
utilization, respectively. Then, we examined the interaction eects of race and previous
SCSA use on past year treatment utilization and duration. The nal models controlled
for age, sex, education, and total household income. Results: Overall, prevalence of
past year SCSA was 4.44% with some variation between White American and African
American smokers,4.19% and 5.95%, respectively X2(1, N = 9,727) = 7.10, p < 0.01).
Our logistic main eects model revealed that previous SCSA use was associated with
greater odds of past year NRT (AOR = 2.79, 95% CI:1.87,4.17, p < 0.01) and pre-
scription drug use (AOR = 3.25, 95% CI:2.27,4.66, p < 0.01). Likewise, our negative
binomial main eects model revealed that previous SCSA use was associated with a
decrease in days of NRT used (IRR = 0.29,95% CI:0.12,0.74, p < 0.05). Conclusion:
Our results demonstrate that previous SCSA app use is associated with greater past
year use of NRTs and prescription drugs and shorter treatment duration for cigarette
smokers, regardless of their racial group. These ndings highlight the potential of SCSAs
to address treatment access disparities in African American smokers. Future studies
should investigate the impact of apps on nicotine dependence and motivation to quit.
FUNDING: Federal; State; Academic Institution
PP-33
CORRELATES OF AWARENESS AND SUPPORT FOR
E-CIGARETTE AND HTPS BANS AMONG MEXICAN SMOKERS
Lizeth Cruz-Jiménez1, Inti Barrientos-Gutiérrez1, Katia Gallegos-Carrillo2, Edna Aril-
lo-Santillán3, Rosibel Rodríguez-Bolaños3, James F. Thrasher4. 1National Institute of
Public Health, Mexico City, Mexico, 2Mexican Institute of Social Security, Cuernavaca,
Morelos, Mexico, 3National Institute of Public Health, Cuernavaca, Morelos, Mexico,
4Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Background: As in many Latin American countries, Mexico bans the distribution,
marketing, and sales of heated tobacco products (HTPs) and e-cigarettes. We assess
the level and correlates of smokers’ awareness and support of each of these bans.
Methods: Our sample included 2,302 Mexican adult smokers, including 885 who also
used e-cigarettes (i.e, dual users) and 1,119 who were aware of HTPs and, therefore,
answered HTP-related questions. Multilevel mixed-eects logistic regression models
were used to estimate crude and adjusted odds ratios (OR & AOR) for the likelihood of
being aware of and having support for the ban of each product, analyzed separately.
Correlates of interest included: sociodemographics, cigarette and e-cigarette use fre-
quency, recent quit attempts, and intentions to quit cigarettes, perception of e-cigarette
and HTPs harmfulness, e-cigarette and HTP use by family/friends, last month exposure
to ads/information related to e-cigarettes and HTPs; and perceived valence of infor-
mation about e-cigarettes and HTPs. Results: Awareness of the e-cigarette and HTP
bans was 32.3% and 34.9%, respectively, and support for each ban was 17.4% and
21.2%. Awareness was positively associated with use of the banned product, whether
for e-cigarettes (e.g., AORfrequent dual users vs. exclusive smokers =1.76) or HTPs use (AOR yes vs. no
=2.27), as was negative perceived valence of information about each device (AORnegative
vs. positive=6.17 & AORnegative vs. positive =2.36, respectively). Awareness of each prohibition
was positively associated with support the e-cigarette ban (AOR =2.33) and HTP ban
(AOR =2.42), as was intention to quit smoking (AOR=2.46 & AOR=2.21), and negative
perceived valence of information about each device (AORnegative vs. positive =4.24 & AOR
negative vs positive =4.46). Support for each ban was inversely associated with perceived
harmfulness of e-cigarettes relative to cigarettes (AOR=0.48) and of HTPs relative to
cigarettes (AOR =0.28). Conclusion: Smokers’ awareness and support for Mexico’s
e-cigarette and HTP bans were low. This may help explain the increasingly widespread
use of these illegal products.
FUNDING: Federal
PP-34
DIFFERENCES IN RESPONSES TO A MENTHOL CIGARETTE
BAN ACROSS MENTHOL AND NON-MENTHOL YOUNG ADULT
CIGARETTE SMOKERS AND VULNERABLE SUB-GROUPS OF
MENTHOL SMOKERS
Taylor Niznik1, Sarah J. Ehlke1, Janet Audrain-McGovern2, James G. Murphy3, Delaney
Dunn1, Whitney Cotten1, Riley Wyatt1, Michael A. Smith1, Wallace Pickworth4, Andrea
Villanti5, Amy M. Cohn1. 1University of Oklahoma Health Sciences Center, Oklahoma
City, OK, USA, 2Perelman School of Medicine of the University of Pennsylvania, Phila-
delphia, PA, USA, 3University of Memphis, Memphis, TN, USA, 4Battelle, Baltimore, MD,
USA, 5University of VT, VT Larner College of Medicine, Burlington, VT, USA.
Introduction: In April 2021, the FDA announced renewed interest in banning menthol
cigarettes. Menthol cigarettes are disproportionately used by Black and Hispanic smok-
ers, females, and sexual/gender minorities (SGM). This study examined how these
vulnerable sub-groups would respond to a menthol cigarette ban. Methods: Data are
from n = 72 young adult menthol and non-menthol smokers (M age = 24; 50% male;
61.6% White; 26.4% SGM; 24.7% menthol smokers) enrolled in an ongoing clinical
trial assessing the reinforcing eects of smoking menthol and non-menthol cigarettes.
At baseline, participants provided demographic information and were asked to “select
all that apply” to a single item with 15-response options about how they would respond
to a menthol ban. Results: Menthol and non-menthol smokers did not dier by SGM
status or race/ethnicity. The most frequently endorsed items in the full sample were “I
would continue to smoke cigarettes about the same as I do now, just a dierent brand”
(18.1%), “I would switch to another cigarette brand that does not have menthol” (16.7%),
and “I would try to quit smoking” (15.3%). Compared to non-menthol smokers, menthol
smokers were more likely to endorse quitting smoking (36.4% vs 4.3%), smoking less
(28% vs 4.3%), switching to menthol e-cigarettes (20% vs 4.3%), switching to some
other menthol avored product (24% vs 0%), switching to a non-menthol cigarette brand
(32% vs 8.5%), and purchasing menthol cigarettes on the black market (20% vs 2.2%;
all p’s < .01). Responses to a menthol cigarette ban did not dier by SGM status or
race/ethnicity. Conclusion: While more menthol than non-menthol smokers indicated
they would nd a way to buy a menthol cigarette brand following a menthol ban, most
menthol smokers endorsed smoking reduction or cessation. However, SGM and racial/
ethnic minority smokers were no dierent in their responses to a menthol ban. Findings
suggest that a menthol cigarette ban may help reduce cigarette smoking among young
adult menthol smokers overall, with similar eects across vulnerable sub-groups with
high rates of menthol cigarette use.
FUNDING: Federal
PP-35
PREEMPTION IN U.S. STATE MLSA LAWS, 2021 UPDATE
Page D. Dobbs1, Ginny Chadwick2, Renae Merrill1, Eric Schisler1, Lisa Henriksen3.
1University of Arkansas, Fayetteville, AR, USA, 2University of MO, Columbia, MO, USA,
3Stanford Prevention Research Center, Palo Alto, CA, USA.
Signicance. Preemption language in tobacco minimum legal sales age (MLSA) laws
is used to prohibit local jurisdictions from enacting stricter laws than state statutes. In
2014, 19 states preempted local jurisdictions from passing tobacco MLSA restrictions,
and eight states clearly granted local authority by expressing that the state law did not
preempt local MLSA laws. Since this time, 39 states and the federal government have
enacted Tobacco 21, a law that raised the MLSA to 21 years. The current study provides
an updated comprehensive assessment of state-level preemption of MLSA laws in the
U.S. Methods. Two coders independently analyzed language about preemption included
within the 39 state Tobacco 21 laws enacted between September 2020 and August 2021
along with the remaining 11 state MLSA statutes. After determining acceptable inter-rater
reliability (ᴋ = 0.70), discrepancies were discussed until consensus was met. Results.
Among all 50 states, 24 state laws preempted local governments from enacting stricter
MLSA laws than the state. Further, seven statutes explicitly expressed that the law did
not preempt local ordinances, and 19 statutes did not mention preemption. Over the past
decade, the number of MLSA state laws that included preemption increased; ve states
(Arkansas, Florida, Massachusetts, Texas, and Utah) expanded language to restrict local
control. Alternatively, Colorado prohibited localities from passing purchase policies that
set the age below 21 years. Conclusions. While the public health community applauds
the enactment of 39 state Tobacco 21 laws, preemption of MSLA laws could slow or
prohibit the diusion of comprehensive tobacco control. Preempting local governments
from enacting stricter MLSA laws creates barriers to optimal enforcement of Tobacco
21 (e.g., the inclusion of a tobacco retail license, suspending and revoking the license
of repeated violators) and further expansion of age restriction policy components (e.g.,
prohibiting avors, vending machines, and sales at pharmacies) at state and federal
levels. To reduce inequitable enforcement, state policymakers can preempt localities
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
from enacting and enforcing purchase, use, and possession laws that ensure tobacco
retailers, not underage purchasers, are health accountable for underage tobacco sales.
Policymakers in 11 states that have not yet adopted Tobacco 21 and those seeking to
amend their state’s MLSA should remove preemptive language and clarify that state
law does not preempt local authority of tobacco control.
FUNDING: Federal
PP-36
IMPACT OF E-CIGARETTE USE ON CIGARETTE QUITTING
BEHAVIORS IN BLACK SMOKERS
Asti Jackson1, Mary E. Fleischli2, Angela Haeny1, Meg Gerrard2, Frederick X. Gibbons2.
1Yale University, New Haven, CT, USA, 2University of Connecticut, Storrs, CT, USA.
Signicance: Black people are more likely to die from tobacco related diseases and
e-cigarettes may be a potential harm reduction tool. This study aimed to examine
factors related to trying e-cigarettes to quit cigarette smoking and quitting success with
e-cigarettes compared to other approaches. Methods: 231 Black cigarette ever users
who participated in The Family and Community Health Study in 2016 were asked: 1)
if they quit using cigarettes, 2) which methods they have used to quit (select all that
apply) and 3) if the method worked (e.g. e-cigarettes, nicotine patch or gum, Quitline or
hotline, Chantix or bupropion, cold turkey). Separate logistic regressions predicted: 1)
trying to quit with e-cigarettes vs other methods; 2) success of quitting for any method;
3) success of quitting with e-cigarettes vs other methods. Predictors included age, sex,
socioeconomic status (SES), experiences of perceived racial discrimination, health
insurance status and endorsement of avoiding going to the doctor because fear of being
treated poorly. Results: E-cigarette use was the second most endorsed method used to
try to quit (25%) after cold turkey (80%). Logistic regression revealed that smokers who
were more likely to try an e-cigarette to quit were more likely to report that they avoid
going to the doctor because they thought they’d be treated poorly (p < .02). Greater
SES was associated with higher quitting success (p < .03). 20% of ever smokers who
tried to quit with e-cigarettes reported that e-cigarettes were a successful method and
were no longer smoking. However, ever smokers were 3 times more likely to be suc-
cessful at quitting if they used a method other than e-cigarettes (p=.002). Conclusion:
E-cigarette use was a less successful method for quitting cigarette smoking in Black
people compared to other methods. Of importance, utilization of e-cigarettes as a
smoking cessation aid was related to avoiding going to the doctor because of expected
negative experiences. Eorts to understand and improve relationships between medical
professionals and Black smokers may encourage the uptake of smoking cessation aids
that are more successful than e-cigarettes. Funding Sources: Research reported in
this publication was supported by the National Institute on Drug Abuse of the National
Institutes of Health R01DA021898 the Food and Drug Administration 1K01DA051882-01
and the National Cancer Institute R01CA153154, R01CA220254. This content is solely
the responsibility of the authors and does not necessarily represent the ocial views of
the National Institutes of Health or the Food and Drug Administration
FUNDING: Federal
PP-37
HETEROGENEITY IN E-CIGARETTE USE AMONG ASIAN
AMERICAN ADOLESCENTS IN MINNESOTA
April K. Wilhelm1, Steven Fu2, Patrick Hammett2, Marla E. Eisenberg1, Rebekah J.
Pratt1, Michele L. Allen1. 1University of Minnesota Medical School, Minneapolis, MN,
USA, 2VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, MN,
USA.
Signicance: Asian Americans are an increasingly diverse racial group in the United
States, yet little research has described how patterns of tobacco use, particularly of
newer products such as e-cigarettes, vary among subpopulations of Asian adolescents.
This study aimed to characterize the tobacco use patterns of Asian American adolescent
subpopulations in Minnesota. Methods: We examined subpopulation dierences in the
past 30-day use of cigarettes, e-cigarettes, cigars, hookah, chewing tobacco, dual/poly
use (2 or more products), and any tobacco use among 8th, 9th, and 11th grade Asian
American respondents to the 2019 Minnesota Student Survey. Subpopulations included
Asian Indian, Chinese, Filipino, Hmong, Karen, Burmese, Korean, Laotian, Vietnamese,
other; multi-ethnic (more than one of the previous Asian ethnicities); and multi-racial
(Asian and any other racial group). GLM regressions adjusting for sex, grade, and
metropolitan residence and post-hoc Tukey tests were used to compare tobacco use
across groups. Results: Of the 10,482 Asian respondents, 9.0% identied as Indian,
0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean,
2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multi-ethnic, and 21.6% multi-racial.
E-cigarettes were the predominant form of tobacco use reported by all groups and the
prevalence of e-cigarette use varied signicantly by ethnic group (p<0.0001). In unad-
justed models, Laotian and multi-racial groups reported the highest use of e-cigarettes
(16.6% and 16.3%, respectively) whereas Chinese and Asian Indian groups reported
the lowest levels of e-cigarette use (4.7% and 5.0%). Adjusted models demonstrated
similar patterns of e-cigarette use. All other tobacco use collectively accounted for
between 0 and 1.4% of reported past 30-day tobacco use across the groups. Conclu-
sions: E-cigarettes are the most prevalent tobacco product used by Asian American
adolescents in Minnesota. However, signicant heterogeneity in e-cigarette use exists
among Asian subpopulations, underscoring the importance of disaggregating tobacco
product use by ethnicity to inform tailored tobacco prevention and control strategies.
FUNDING: Academic Institution
PP-38
THE IMPACT OF CAREGIVER’S TOBACCO PRODUCT USE ON
E-CIGARETTE USE AMONG BLACK ADULTS
Angela Haeny1, Mary Fleischli2, Asti Jackson3, Stephanie O’Malley4, Meg Gerrard2,
Rick Gibbons2, Abigail Friedman3. 1Yale School of Medicine, New Haven, CT, USA,
2University of Connecticut, Storrs, CT, USA, 3Yale University, New Haven, CT, USA,
4Yale University School of Medicine, New Haven, CT, USA.
Signicance: While caregiver smoking is one of the strongest predictors of adoles-
cent smoking initiation, its relationship to young adulthood tobacco and e-cigarette
use remains unclear. This study investigated whether tobacco product use by one’s
childhood caregiver predicted past month use of e-cigarettes and use of e-cigarettes to
quit cigarette smoking among 27-31-year-old Black adults who had reported smoking
cigarettes in their lifetime. Methods: The data were drawn from the Family and Com-
munity Health Study (FACHS), an ongoing longitudinal study of over 800 Black families.
Participants with a child in 5th grade who identied as Black (referred to as targets) were
recruited from Iowa and Georgia in 1996. Multivariable logistic regressions identied
whether caregivers’ use of any tobacco product (e.g., cigarettes, cigars, pipes, chewing
tobacco) at Waves 3 or 4 (targets’ mean age = 15.5, SD = .78; 18.5, SD = .94 years,
respectively) predicted targets’ use of e-cigarettes in the past month or to quit cigarette
smoking at wave 7 (n = 233; mean age = 28.90, SD = 0.88). All models were adjusted
for targets’ age, sex, and state of residence. Results: At Wave 7, 36 targets reported
using e-cigarettes in the past month and 50 targets reported using e-cigarettes to quit
smoking in their lifetime. Targets with a caregiver who smoked at Waves 3 and 4 had
3.6 (p < .001) and 2.3 (p < .022) times greater odds, respectively, of trying an e-cigarette
to quit smoking relative to those who did not have a caregiver who smoked. Notably,
20% of targets who tried to quit using e-cigarettes were successful. Caregivers’ smoking
status at Waves 3 and 4 did not predict targets’ past month e-cigarette use at Wave 7.
Conclusions: Among Black young adults who ever smoked, adolescent exposure to
caregiver smoking was associated with a signicantly higher odds of trying e-cigarettes
to quit smoking. This nding suggests that young adults whose caregivers smoked
during their adolescence may be more willing to try alternative nicotine products to quit
cigarette smoking. Further work is needed to clarify what drives these relationships and
whether they generalize to a nationally representative sample.
FUNDING: Unfunded; Federal
PP-39
TACTICS USED SYSTEMATICALLY BY BIG TOBACCO THAT
ATTRACT CHILDREN AND YOUTH AT TOBACCO POINTS-OF-
SALE
Jennifer L. Brown1, Debra Rosen2, Maria Carmona2, Mark Hurley2, Natalia Parra2,
Joanna E. Cohen1. 1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
USA, 2Campaign for Tobacco-Free Kids, Washington, DC, USA.
Signicance Tobacco companies have historically targeted children and youth with
tobacco advertising. Most literature on tobacco advertising and promotions used at point-
of-sale (POS) focuses on high-income countries. We examined tobacco advertising and
promotional practices at POS, focusing primarily on low- and middle-income countries.
Methods Data were collected on cigarette advertising and promotional tactics at POS
within 100-250 meters of schools and playgrounds in 42 countries, spanning all six WHO
regions. Monitoring in most of the countries utilized a mobile application (others used
paper forms) populated with an observational checklist. Results Tobacco companies
used four consistent strategies. The display of cigarettes near sweets, snacks, and
sugary drinks was observed at POS in 90% (n=38) of the countries examined. The
display of cigarette ads at the eye-level of children, roughly one meter o the ground,
was observed at POS in 100% (n=42) of countries. Large assortments of avored cig-
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
arettes and/or avored cigarette ads were observed at POS in 76% (n=32) of countries.
Sale of single cigarettes was observed at POS in 78% (n=33) of countries. In the 15
countries where they were monitored, power walls were observed in 93% and digital
screens advertising cigarettes and/or use of lights to illuminate ads or cigarettes were
observed in 87% of countries. Conclusion In many of the countries where these tactics
were observed, existing regulations and the spirit of laws meant to protect customers
from exposure to tobacco marketing are being violated. In others, tobacco advertising,
promotion, and sponsorship (TAPS) regulations are not comprehensive. Widespread
use of these cigarette advertising and promotional tactics at POS and the commonali-
ties in their deployment around the world suggest they are part of a coordinated eort
to expose youth to multinational cigarette brands. The most eective way to combat
this is for governments to enact and enforce measures supported by the WHO FCTC,
which include comprehensive bans on all TAPS, including POS display; bans on single
cigarette sales; and regulation of avoring.
FUNDING: Nonprot grant funding entity
PP-40
UNDERSTANDING DISPARITIES IN LUNG CANCER SCREENING
AMONG LOW-INCOME SMOKERS IN AN URBAN HEALTH
CENTER IN SOUTHERN CALIFORNIA
David R. Strong1, Elizabeth Brighton2, Aaron Tam3, Job Godino3, Kimberly Brouwer4,
Charles Smoot3, Eva Matthews3, Paloma Mohn5, Carrie Kirby6, Shu-Hong Zhu7, Jie Liu3.
1University of California, San Diego, La Jolla, CA, USA, 2Moores Cancer Center, UC
San Diego, La Jolla, CA, USA, 3Family Health Centers of San Diego, San Diego, CA,
USA, 4Herbert Wertheim School of Public Health and Human Longevity Science, UC
San Diego, La Jolla, CA, USA, 5Family Health Centers of San Diego, San Doego, CA,
USA, 6University of CA, San Diego, La Jolla, CA, USA, 7University of CA San Diego,
La Jolla, CA, USA.
SIGNIFICANCE: Tobacco related diseases impact low-income communities dispropor-
tionately and motivated examination of barriers to preventive lung cancer screening
(LCS) and tobacco treatment interventions in a federally qualied health center (FQHC)
that provides primary medical care. METHOD: A retrospective analysis of EHR data
from 2019 reviewed patients who were 55-64 years old with 30+ pack years and had
“tobacco use” as an active problem. The proportion of 1) those referred for LCS; 2)
those who completed LCS given referral; 3) smokers receiving referral to tobacco
treatments. Demographic characteristics and comorbidities associated with referral
types and uptake of services were estimated using mixed-eects logistic or multinomi-
al regression models. RESULTS: Among 2459 eligible patients, 1237 (50.3%) had a
recorded referral for LCS. Among the 1237 referred patients, 573 (46%) had a record
of completing the referral for lung cancer screening (overall screening rate 573/2459
= 23%). Having one or more psychiatric (AOR = 1.62, 95%CI: 1.28 - 2.05) or medical
(AOR = 1.54, 95%CI: 1.30 - 1.82) problem was associated with higher odds of referral.
When compared to smokers with Medicare, the odds of completing LCS referrals were
lower for smokers with Medical (AOR = 0.76, 95%CI: 0.57 - 0.99) and the uninsured
(AOR = 0.55, 95%CI: 0.35- 0.85). Completed referrals for LCS were lower for smokers
who were Black (AOR = 0.62, 95%CI: 0.43-0.88) than for non-Hispanic White smokers.
For smokers who were referred for LCS, the odds of receiving tobacco treatment at
the FQHC were 2.13 (95%CI: 1.66-2.74) times higher than for eligible smokers who
were not referred for LCS. CONCLUSION: Systems designed to enhance identication
of eligible smokers, cues to attract provider attention to referral actions, and tracking
of provider and patient behavior with use of an electronic health record can facilitate
reach of LCS. Overcoming economic and racial barriers remain a high priority for im-
proving rates of LCS. Most (70%) low-income smokers see their PCPs at least once
a year, making FQHCs excellent settings to promote LCS and tobacco treatment in
low-income communities.
FUNDING: State
PP-41
NEIGHBORHOOD TOBACCO RETAIL ACCESS AND COGNITIVE
TOBACCO USE RISK FACTORS IN YOUNG ADOLESCENTS IN
URBAN INDIA
Ritesh Mistry1, Mike J. Kleinsasser1, Namrata Puntambekar2, Prakash C. Gupta2,
William J. McCarthy3, Trivellore Raghunathan1, Keyuri Adhikari2, Sameer Narake2,
Hsing-Fang Hsieh1, Maruti Desai2, Shervin Assari4, Joseph Alberts1, Mangesh S.
Pednekar2. 1University of Michigan, Ann Arbor, MI, USA, 2Healis Sekhsaria Institute for
Public Health, Navi Mumbai, India, 3University of California, Los Angeles, CA, USA,
4Charles R. Drew University of Medicine and Sciences, Los Angeles, CA, USA.
Background: Neighborhood tobacco retail access may inuence adolescent tobacco
use. In India, we examined the association between neighborhood tobacco retail access
and cognitive risks for tobacco use during early adolescence. Methods: In 2019-2020, a
population-based sample (n=1759) of 13-15-year-old adolescents were surveyed from
26 neighborhoods in Mumbai and 26 neighborhoods in Kolkata, which were canvassed,
and each tobacco retailer was recorded into a Geographic Information System (GIS).
Neighborhood tobacco retail access was measured as the frequency of visits to tobacco
retailers, perceived tobacco retailer density, and mapped tobacco retailer density. We
estimated associations between neighborhood tobacco retail access and cognitive risks
for tobacco use (perceived ease of access to tobacco, perceived peer tobacco use,
and intention to use tobacco). Results: There was high neighborhood tobacco retail
access with nearly 100 retailers present per community on average and well over 50% of
adolescents reporting weekly or more visits to tobacco retailers. The density of retailers
was higher in lower-income neighborhoods (p<0.001). Adolescent frequency of visits to
retailers was positively associated with cognitive tobacco use risks. Mapped tobacco
retailer density was associated with perceived ease of access in Kolkata (p<0.05) but
not in Mumbai, and it was not associated with perceived peer tobacco use nor inten-
tion. Perceived tobacco retailer density was associated with perceived ease of access
and perceived peer use (p’s<0.05), but not with intention. In Kolkata, higher perceived
retailer density and frequency of tobacco retailer visits were negatively associated with
perceived ease of access (p’s<0.01). Conclusions: The frequency of tobacco retailer
visits and perceived tobacco retail density increased cognitive risks of use, with some
exceptions in Kolkata that further research may explain. A decrease in tobacco retailer
access in India may reduce cognitive tobacco use risk factors in young adolescents.
Future research should aim to understand how contextual factors inuence the rela-
tionship between tobacco retail access and tobacco use initiation.
FUNDING: Federal
PP-42
TOBACCO USE IN MIDDLE-CLASS PEOPLE OF COLOR: FROM
SOCIAL EPIDEMIOLOGY TO BRAIN CIRCUITS
Shervin Assari. Charles R Drew University of Medicine and Science, Lakewood, CA,
USA.
Background: The protective eect of high socioeconomic status (SES) against tobacco
use is very well-established. In the current study, we explored the role of diminished
returns of SES as an underlying mechanism behind social inequalities in tobacco use
and dependence in youths and adults in the United States. Methods: This study was built
on the Marginalization-related Diminished Returns (MDRs) framework. This framework
suggests the protective eects of SES indicators for marginalized populations are weaker
than for socially privileged populations due to systemic disadvantages marginalized
populations face. We conducted a secondary analysis of the following existing national
data sets: PATH, NHIS, HINTS, HRS, MTF, and ABCD. The independent variables
were parental education, own education, income, and employment. The outcomes
were lifetime or current use of cigarettes, Hookah, e-cigarettes, as well as tobacco
dependence. Moderators were race, ethnicity, nativity, or sexual orientation. Results:
Analysis of cross-sectional and longitudinal data revealed weaker protective eects
of SES indicators on the use of cigarettes, Hookah, e-cigarettes, as well as tobacco
dependence for marginalized populations, broadly dened, compared to US-born,
heterosexual, non-Latino White people. These diminishing returns were found for all
SES indicators in our analysis, however, they were more robust for parental and own
education. Although these patterns existed for all marginalized groups such as Latino,
Asian American, LGBT, and immigrant populations, they were most pronounced for
Black youth and adults. We also found some evidence suggesting that poor quality
of education in urban schools, school and residential segregation, discrimination, and
predatory marketing partially explains these MDRs. Analysis of brain circuits also
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
conrmed weaker SES eects on brain regions with implications for substance use.
Conclusions: Due to the weaker-than-expected eects of SES indicators, we observe
higher-than-expected tobacco use in middle-class youths and adults of color.
FUNDING: Federal
PP-43
CIGARETTE PRICES BEFORE AND AFTER STATE AND LOCAL
TOBACCO TAX AND PRICE POLICIES IN BAY AREA CITIES 2014-
2020
Vira Pravosud1, Louisa Holmes2, Lauren Lempert1, Pamela Ling1. 1University of CA,
San Francisco, San Francisco, CA, USA, 2Pennsylvania State University, University
Park, PA, USA.
SIGNIFICANCE: Enactment of tobacco tax and pricing policies can reduce the demand
for tobacco products. California Proposition 56 increased the state tobacco tax by $2
per cigarette pack eective April 1, 2017. In addition, between 2015-2020 some cities
in Alameda county passed ordinances establishing minimum retail prices or prohibiting
coupons and discounts on tobacco products. The city and county of San Francisco (SF)
also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in
2020. We aimed to compare the magnitude of change in cigarette prices before and
after the enactment of pricing policies in SF vs. Alameda county, which has larger racial\
ethnic minority groups and more people living in poverty, to inform understanding of public
policies’ impact on tobacco inequities. METHODS: We performed audits of a proportional
random sample of SF and Alameda county tobacco retailers, by city, before (2015) and
after (2019/20) the implementation of tobacco tax and pricing policies. Using Student’s t
tests and two-way ANOVA with Tukey-Kramer adjustment for multiple comparisons, we
compared ination-adjusted average prices of the cheapest cigarette pack in 2015 vs.
2019/20 samples overall and among 3 groups: 202 retailers in SF; 41 retailers located
in 4 Alameda county cities that enacted any pricing policies between 2015-2020; and
220 retailers in 12 Alameda county cities without pricing policies eective before Janu-
ary 2020. RESULTS: From 2015 to 2020, the average price for the cheapest cigarette
pack in all cities increased signicantly [mean=$5.8(SD=$1.2) vs. $9.2($2.4), a +$3.4
increase overall] and in each policy group (SF:+$4.6; any policy:+$1.9; no policy:+$2.6).
Retailers in SF and Oakland had the highest percent change in average price (+76%
and +70%), and Fremont and Union City had the lowest increases: (+12% and +10%).
The increase in average price of the cheapest cigarette pack in SF (+$4.6) and some
Alameda county cities (Castro Valley, Livermore, Oakland, Pleasanton, and San Leandro)
exceeded the $2 increase in the California state excise tax (range: +$2.1 to +$3.7).
Other Alameda county cities increased less than $2 in the average price (range: +$0.6
to +$1.8). Post-hoc analyses indicated a signicantly higher 2019 average price for SF:
$10.7($2.5), with +$2.7 and +$2.0 greater dierences in price change than retailers in
Alameda cities with and without pricing policies. CONCLUSION: We observed smaller
increases in cigarette prices among retailers in Alameda vs. SF county regardless of
local pricing policy status. This may be due to dierences in implementation of policies;
equitable implementation will be important to address tobacco disparities, especially
among price-sensitive youth, minorities, and people of lower SES.
FUNDING: State
PP-45
HOW TALKING ABOUT CIGARETTE WARNING LABELS
INFLUENCES SUBSEQUENT QUIT ATTEMPTS. A MEDIATION
ANALYSIS OF TOPICS OF CONVERSATIONS AMONG MEXICAN
SMOKERS
Katia Gallegos-Carrillo1, Edna Judith Arillo-Santillan2, Inti Barrientos-Gutierrez3, Lizeth
Cruz-Jiménez3, Rosibel Rodríguez-Bolaños2, James Thrasher4. 1Mexican Social Secu-
rity Institute, Cuernavaca, Mexico, 2National Institute of Public Health, Cuernavaca,
Mexico, 3National Institute of Public Health, Mexico City, Mexico, 4University of SC,
Columbia, SC, USA.
Background: Interpersonal communication about health warning labels (HWLs) helps
explain HWL eects on quit attempts. This longitudinal study evaluated the topics of
these conversations as mediators of the relationship between interpersonal commu-
nications about HWLs and smoking cessation behaviors. Methods: Cohort of adult
smokers recruited from an online consumer panel surveyed every four months across
8 surveys from November 2018 to March 2021. The analytic sample included 2210
smokers who participated in at least two consecutive surveys (n=4537 observations).
Participants reported frequency of talking to others about HWLs in the last month (not at
all, sometimes, frequently), topics of conversations (smoking harms, cessation benets,
lack of message credibility/utility), as well as socio-demographic and smoking-related
variables (e.g., quit intention, smoking frequency). At four-month follow-up (time “t+1”),
two transitions were estimated: a) quit attempt for less than 30 days and b) sustained
attempt for at least 30 days over the 4 months period between surveys. Logistic re-
gression models using a Generalized Estimating Equation (GEE) to consider repeated
measures regressed transitions (ref=no transition) on study variables (time “t”), along
with a bootstrap procedure to assess whether HWL communication topics mediated
eects of talking frequency on transitions. Results: Most participants reported talking
about HWLs sometimes (46.9%) or frequently (15.5%). Of those who talked about HWLs,
80.4% reported conversations about smoking harms, 58.1 % cessation benets, and
9.9% lack of message credibility/utility. At follow-up, 27.3% reported a quit attempt for less
than 30 days and 23.6% for at least 30 days. In adjusted models, greater frequency of
talking about HWLs and benets of quitting and harms from smoking were independently
associated with a greater likelihood of both these outcomes. Mediation models indicated
that talking about cessation benets and about the smoking harms both explained the
eect of talking frequency on these outcomes in roughly equal measure. Conclusion:
Conversation topics around HWLs appear to matter in promoting smoking cessation.
As Mexican HWLs primarily focus on smoking harms, more research is needed to as-
sess the optimal mix of HWL message content, including messages that best prompt
discussions and messages that address cessation benets.
FUNDING: Federal
PP-46
RESISTANCE SELF EFFICACY MEDIATES THE RELATIONSHIPS
BETWEEN TOBACCO SMOKING OUTCOME EXPECTANCY AND
THE DESIRE TO QUIT TOBACCO SMOKING AMONG SAUDI GIRLS
Abdullah M. Alanazi1, Shahad F. Almutairi2, Alanoud A. Alsarami2, Fay J. Alanazi2, Lama
H. Alqahtani2. 1King Saud bin Abdulaziz University for Health Sciences, Riaydh, Saudi
Arabia, 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Background: Smoking is one of the major preventable causes of morbidity and
mortality, it has been associated with numerous illnesses. While smoking is prevailing
among women, the characteristics of the smoking behavior among Saudi girls related
to resistance self ecacy and outcome expectancies are unknown. Therefore, our study
purpose is to test whether resistance self ecacy mediates the relationship between
tobacco smoking outcome expectancy and the desire to quit tobacco in the future
among Saudi girls who smoke tobacco. Methods: This is a cross sectional study. The
sample was collected by a convenience non-probability sampling of 211 Saudi females
who smoke tobacco. A self-administered questionnaire was used to examine several
variables that include resistance self ecacy, tobacco smoking outcome expectancy,
and desire to quit tobacco smoking in the future. A regression-based mediation analysis
was used to answer our research question. We estimated the indirect eects through
the bootstrapping of 10,000.Results: All the four constructs of outcome expectancies
(negative consequences, positive reinforcement, negative reinforcement, and appetite
and weight control) were associated with lower resistance self ecacy and desire to quit
tobacco smoking. In the mediation analysis, the indirect eect of negative consequences
(unstandardized beta = - 0.015, SE = 0.008, 95% CI [- 0.034, - 0.002]), negative rein-
forcement (unstandardized beta = - 0.014, SE = 0.006, 95% CI [- 0.027, - 0.002]), and
appetite and weight control (unstandardized beta = - 0.009, SE = 0.006, 95% CI [- 0.022,
- 0.002]) through resistance self ecacy were signicant, suggesting mediation, in the
relationship between tobacco smoking outcome expectancy and desire to quit tobacco
smoking in the future.Conclusion: We identied cognitive mechanisms that may explain
the lower rate of quitting tobacco smoking among Saudi girls. Although longitudinal
studies are needed to determine relationships prospectively, targeted interventions
that reduce tobacco smoking outcome expectancies and boost resistance self ecacy
skills to quit tobacco smoking may further reduce tobacco smoking among Saudi girls.
FUNDING: Unfunded
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
PP-47
TOBACCO PRODUCT DISPLAY IN RETAIL SETTINGS IN SILIGURI,
INDIA
Ryan David Kennedy1, Sejal Saraf2, Kathy Wright3, Joshua Sinamo2, Nidhi Sejpal
Pouranik4, Ashish Pandey3, Rana Jugdeep Singh4, Joanna Cohen5. 1Department of
Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Balti-
more, MD, USA, 2Johns Hopkins University, Baltimore, MD, USA, 3The International
Union Against Tuberculosis and Lung Disease, New York, NY, USA, 4The Interna-
tional Union Against Tuberculosis and Lung Disease, New Delhi, India, 5Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA.
Signicance: In India, the national tobacco control law prohibits tobacco advertising at
the point-of-sale (POS). Tobacco products can be displayed but are not permitted to be
placed within the reach of a minor. Tobacco retail settings vary greatly in India including
permanent structures (bricks-and-mortar shops or permanent kiosks), and temporary
structures (movable kiosks, and street vendors). The city government in Siliguri, West
Bengal, is developing local policies to support tobacco control, including tobacco vendor
licensing. This study identied tobacco vendors throughout Siliguri to assess if tobacco
products were on display and if they were displayed within the reach of a minor. Meth-
ods: Stretches of road (500-1000m) with retailers were identied in each of Siliguri’s 47
wards. From Nov-Dec 2020, data collectors conducted observations in these pre-de-
termined environments. Tobacco vendors were identied and classied based on their
physical features (permanent or temporary). Data collectors noted if tobacco products
were on display including smokeless and combustible tobacco products. If tobacco
products were on display data collectors noted if these products were within reach of a
minor (approximately 1m from the ground or less, and products not kept behind glass).
Results: The study identied N=567 tobacco vendors across the 47 wards in Siliguri
including 405 permanent vendors and 162 temporary vendors. Tobacco products were
on display at 87% (n=493) of tobacco vendors, including 84% of permanent vendors
and 94% of temporary vendors. Of the vendors with tobacco products on display, 68%
had tobacco placed within reach of minors including 63% of permanent vendors and
79% of temporary vendors. Conclusions: Most tobacco vendors observed in this
study displayed tobacco products at the POS and had tobacco products within reach
of a minor; tobacco vendors that operated out of temporary structures were more likely
to have products on display and more likely to have tobacco products within reach of
a minor. The city of Siliguri could consider banning product display as a provision of
obtaining a tobacco vendor license.
FUNDING: Nonprot grant funding entity
PP-48
USING PUBLIC INVOLVEMENT TO QUALITATIVELY EXPLORE LAY
PERSPECTIVES ON A CHANGING LANDSCAPE OF TOBACCO
AND NICOTINE USE AND TOBACCO CONTROL POLICIES
Sharon Cox1, Jamie Brown1, Loren Kock1, Lesley Miller1, Caitlin Notley2, Kizzy Rich-
ards1, Lion Shahab1. 1University College London, London, United Kingdom, 2University
of East Anglia, London, United Kingdom.
Signicance: Together, public involvement (PI) and qualitative methods can provide
insights into nicotine and tobacco use that are not easily ascertained from researchers
acting alone. This study was co-produced with members of the UCL tobacco and
alcohol research PI group. The aim was to qualitatively explore lay perspectives on
the changing landscape of tobacco and nicotine use in England, and perceptions of
tobacco control policies of the past and ideas for the future. Methods: The PI group
(n=9, 5 female; mean age = 44.2 years) shaped the research questions, topic guide
and assisted with data analysis. Sixty-ve participants formed of never, former and
current smokers and current vapers (Mean age=39.7 years) took part in a series of
online focus groups. Groups were facilitated by a topic guide; discussion was prompted
using slides on the changing trends in smoking and nicotine use in England from the
Smoking Toolkit Study (STS). Groups were audio-recorded and transcribed. Data were
analysed deductively and inductively via Iterative Categorization. Results: UK smoking
prevalence was overestimated; the groups were surprised by the 15% gure. Vaping
was commonly confused with smoking and may have contributed to this overestimation.
Smoking and vaping were linked to specic age groups - smoking believed to be more
prevalent within older adults and vaping within youth, as part of a ‘permissive bygone
era’ and a passing trend, respectively. There was a consensus that credible evidence
on vaping was lacking, and the ‘post truth era’ meant information sources were ques-
tioned. Although the NHS and some cancer charities were seen as trusted sources of
information because of a lack of nancial investment in smoking. There was support
for past tobacco control policies (e.g., adverts) but concern about the stigmatisation
these caused for loved ones. There was less consensus on what would work in the
future, higher taxation was especially divisive. Conclusion: The inclusion of PI alongside
qualitative methods and data from the STS allowed for the triangulation of several data
sources. The main results suggest incongruence between population level data and
participant observations. Participants viewed themselves as ‘passive observers’ to
tobacco science, lacking trusted sources of information.
FUNDING: Nonprot grant funding entity
PP-49
VAPING PRODUCTS AND PROMOTIONAL AND LABELLING
PRACTICES IN CANADA BEFORE AND AFTER PROVINCIAL
RESTRICTIONS ON NICOTINE CONCENTRATION AND
FLAVOURS: A SCAN OF THE ONLINE RETAIL MARKET
Katherine East, Kimberly D’Mello, Danielle Wiggers, Syed Mahamad, David Hammond.
University of Waterloo, Waterloo, ON, Canada.
SIGNIFICANCE. The promotion and sale of vaping products was liberalised in Canada
in 2018. However, in the past year several provinces have restricted nicotine limits and
avours. There is little available market data on vaping products (including nicotine
concentration, avours, and packaging/labelling) post-liberalisation in Canada, or how
the market has responded to recent provincial restrictions. Such data are important
to understand the range of products available, how these products are promoted and
how their attributes are communicated to consumers, and how regulations impact the
market. METHODS. A scan of 31 online vaping retailers was conducted to identify vaping
devices and e-liquids available for sale in Canada. Images of products and information
on websites were coded and analysed. The scan was conducted from Jan-Sept 2020
and repeated from Jan-May 2021. RESULTS. In the 2020 scan, a total of 560 vaping
devices, consisting of 3,204 varieties, and 1,778 e-liquids were identied. E-liquids
were available in a range of avours, with fruit being the most common (44%), followed
by candy/desserts (28%) and non-alcoholic drinks (12%). Half of e-liquids were ‘free-
base’/‘regular’ (53%) or ‘salt’-based (47%), and a few (0.2%) ‘hybrid’. Among e-liquids
containing nicotine, the mean nicotine concentration of salt-base (3.4%) was higher
than freebase (0.6%; p<.001). The presence of labels/warnings on the principal display
area of e-liquid packaging was inconsistent: 63.2% had labels indicating the presence of
nicotine, 73.7% displayed nicotine concentration, and 58.9% displayed health warnings.
E-liquids and devices were available in numerous colours and ‘themes’ (e.g., minimal,
geometric, lifestyle). Device ‘skins’ and other accessories that can enhance product
packaging were also identied. Data from the 2021 scan will be presented to examine
changes in the market following provincial regulations on nicotine limits and avours.
CONCLUSION. The ndings depict an incredibly diverse market in Canada in 2020 with
respect to the types of products available and packaging/labelling practices. The 2021
scan will illustrate the market’s response to provincial regulatory changes.
FUNDING: Federal; Nonprot grant funding entity
PP-50
IMPLEMENTATION STRATEGIES FOR SMOKE-FREE PUBLIC
HOUSING TO PROMOTE BETTER OUTCOMES
Boram Lee1, Vicki C. Fung1, Jonathan P. Winicko1, Nancy Rigotti2, David C. Cheng1,
Radhika R. Shah1, Claire McGlave1, Sydney L. Goldberg1, Glory Song3, Jacqueline
Doane3, Melody Kingsley3, Patricia Henley3, Sanouri A. Ursprung3, Christopher Banthin4,
Douglas E. Levy1. 1Massachusetts General Hospital, Boston, MA, USA, 2Harvard Medi-
cal School, Lincoln, MA, USA, 3Massachusetts Department of Public Health, Boston,
MA, USA, 4Public Health Advocacy Institute, Boston, MA, USA.
BACKGROUND: In Aug. 2018, smoking was prohibited in federally-funded public hous-
ing in the United States. Little is known about how public housing authorities (PHAs) have
implemented smoke-free policies (SFPs). METHODS: We surveyed all Massachusetts
(MA) PHAs in 2018 asking each if they had an SFP and if so, what strategies were
used to implement it: information sessions with residents, soliciting resident input on
SFP implementation, providing sta training, seeking technical assistance from outside
groups, using the US Department of Housing and Urban Development (HUD) toolkit,
oering treatment or referral for help with smoking cessation, and/or providing outdoor
smoking areas. In PHAs with SFPs in place ≥1yr, we used multivariable regression to
investigate associations between implementation strategies and PHAs’ self-reports of
resident satisfaction, complaints about smoking, and number of violations. Multivariable
models included implementation strategies that were related to outcomes at p<0.25 in
bivariate assessments as well as PHA size and years since enactment. RESULTS: The
survey had a 93% response rate (204/218 PHAs). Among 161 PHAs that had a SFP
prior to 2018, common implementation activities were oering treatment or referral for
smoking cessation (89%), information sessions with residents (85%) and partnering with
outside groups (65%). Most (84%) reported residents mostly or completely supported
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
the SFP; information sessions with residents were associated with higher resident
support (adjusted odds ratio [AOR] 4.3; p=.02). Few (14%) PHAs reported a reduction
in complaints about smoking. Training sta for implementation (AOR 6.3; p=.03) was
associated with report of reduced complaints. On average, 5 violations/100 units/year
were reported, but we were unable to detect associations between implementation
activities and reports of violations. CONCLUSION: Experience in MA suggests that at
minimum hosting resident information sessions and sta training are associated with
better outcomes following the introduction of SFPs.
FUNDING: Federal
PP-51
THE HYPOTHETICAL IMPACT OF VAPING PRODUCT
REGULATIONS ON VAPE SHOP CUSTOMER BEHAVIOR CHANGE
INTENTIONS: OPINIONS OF VAPE SHOP RETAILERS IN LOS
ANGELES COUNTY
Olena Les1, Heesung Shin, PhD1, Nichelle Brown, MPH2, Sabrina L. Smiley, PhD,
MPH3. 1Keck School of Medicine of USC, Los Angeles, CA, USA, 2San Diego Diego
State University School of Public Health, San Diego, CA, USA, 3San Diego State Univer-
sity, San Diego, CA, USA.
Signicance: Understanding vape shop retailers’ opinions of regulation is critical
to inform U.S. Food and Drug Administration (FDA) enforcement, and to anticipate
regulatory impact on the vape shop industry, including consumer behavior. This study
examined vape shop retailers’ perceived customer behavior change intentions given
the hypothetical impact of FDA regulations. Methods: We conducted phone-based
structured interviews of 46 vape shop owners/managers in Los Angeles County during
December 2019 to October 2020. Respondents were asked, “For each proposal, please
tell me whether you (1) favor it strongly, (2) favor it somewhat, (3) oppose it somewhat,
or (4) oppose it strongly. Also, please give me your opinion on how customers would
respond to each proposal.” Linear regressions were conducted to assess the correlates
of each perceived customer behavior change intention outcome, adjusting for vape
shop position (i.e., owner, manager). Results: Participants were predominantly male
(87%), and average age was 31.9 years (SD=8.5). Most participants (43.5%) were
managers, followed by owners (26.1%) and clerks (26.1%). Most participants (87%)
strongly opposed rules such that only tobacco avored juices were allowed at all vape
shops. Opposition to such rules was associated with opinions that customers would
likely not purchase tobacco avored e-liquids (B=-0.44, p<0.01), and would likely use
smokable tobacco products (B=0.47, p<0.05). More than half of participants (52%)
strongly opposed rules such that all vape products must be standard, pre-set, or xed
size, and you could not make changes to the device such as watts, volts. Opposition
to such rules was associated with opinions that customers would likely not purchase
tobacco avored e-liquids (B=-0.36, p<0.01) and would likely not continue to vape
(B=-0.23, p<0.10). Nearly half of participants (39%) strongly opposed rules such that
no price deals would be allowed on vape products and e-liquids. Opposition to such
rules was associated with opinions that customers would likely not continue to vape
(B=-0.19, p<0.10) and would likely smokable tobacco (B=0.23, p<0.10). Conclusion:
This study found that vape shop retailers in Los Angeles County report potential FDA
regulations, including tobacco-avored e-liquids only or banning price promotions, would
have negative impacts on customer behaviors (e.g., not purchasing tobacco-avored
e-liquids, consuming combustible tobacco). Current ndings could inform future FDA
regulatory actions.
FUNDING: Federal; FDA CTP
PP-52
OUTDOOR SMOKING AS A NUISANCE TO NON-SMOKERS. THE
CASE FOR SMOKE-FREE OUTDOOR PUBLIC SPACES IN URBAN
AREAS
Jeroen Bommelé, Bethany Hipple Walters, Saskia Van Dorsselaer, Marc Willemsen.
Trimbos Institute, Utrecht, Netherlands.
Signicance. Despite the growing number of smokefree spaces, many nonsmokers
continue to be involuntarily exposed to tobacco smoke. Both theory and research sug-
gest that people living in densely populated urban areas are more likely to smoke than
those living in less densely populated areas. Consequently, nonsmokers in densely
populated urban areas might be more likely to encounter smokers in public spaces and
feel bothered or annoyed by their tobacco smoke. We investigated whether the extent to
which nonsmokers feel annoyed by tobacco smoke exposure in outdoor public spaces
is related to urban population density. Methods. We used survey data from the Dutch
‘Module Substance Use’ survey. This is a nationally representative sample of the Dutch
adult population. Using logistic regression models, we investigated whether urban pop-
ulation density predicts both smoking and nonsmokers annoyance to exposure to other
people’s tobacco smoke outdoors. Results. Survey data show that smoking rates were
associated with urban population density. In the Netherlands, people living in extremely
population-dense urban areas were more likely to smoke than those living in non-urban
areas. Feeling annoyed by tobacco smoke outdoors was also associated with urban
population density: nonsmokers living in extremely population-dense urban areas were
more likely to be annoyed than respondents living in non-urban areas. Conclusion.
These results highlight the importance of comprehensive local tobacco control policy
programs that include creating smokefree outdoor public spaces. This need for such
smokefree outdoor public spaces might be particularly strong in densely populated areas.
FUNDING: State
PP-53
TOBACCO SERVICES AND SMOKE-FREE POLICIES IN MENTAL
HEALTH AND SUBSTANCE ABUSE TREATMENT FACILITIES IN
THE MIDWEST
Nathalia Munck Machado1, Rick Cagan2, Tony Stelter3, Janet Jackson3, Kimber Rich-
ter1. 1University of Kansas Medical Center, Kansas City, KS, USA, 2National Alliance
on Mental Illness- NAMI Kansas, Topeka, KS, USA, 3Oklahoma Department of Mental
Health and Substance Abuse Services, Oklahoma, OK, USA.
Background: Many smokers with mental health (MH) and substance use disorders
(SUD) want to stop smoking and can quit, but few facilities provide treatment. Methods:
We describe services and policies in behavioral health facilities in Midwestern states
not yet adopting Medicaid expansion. We used 2014-2019 data from two SAMHSA na-
tional surveys of MH and SUD facilities (N-MHSS & N-SSATS), which are administered
annually to around 13,390 US facilities. We shared comparative data and interviewed
administrators and advocates from each state to determine policies associated with
higher service provision.Results: On average, across all 5 years, the percentage of MH
facilities that screened for tobacco use was 46% in Kansas, 66% in Nebraska, 73% in
Missouri, and 86% in Oklahoma. The US national average was 56%. The 5-year average
rate of counseling provision was 24%, 34%, 50%, 68%, and 37% in KS, NE, MO, OK,
and the US, respectively. Nicotine replacement therapy (NRT) was oered by 19%,
21%, 39%, 40%, and 25% of facilities in KS, NE, MO, OK, and the US. Non-nicotine
medication provision rates averaged 20%, 21%, 34%, 42%, and 23% in KS, NE, MO,
OK, and the US. Rates of tobacco service provision in SUD facilities mirrored cross-
state dierences found in mental health facilities but were in general lower across all
services.The 5-year average rate of MH facilities with smoke-free campuses was 46%,
43%, 57%, 80% and 49% in KS, NE, MO, OK, and the US. In SUD facilities, rates
were 22%, 34%, 28%, 72%, and 35% in KS, NE, MO, OK, and the US.State leaders
associated several policies with high performance: a) requiring programs contracting
with the state to have screening, counseling, and smoke-free campuses (OK); b) state-
based collection of service provision data (incl. tobacco services) (OK); c) providing
facilities free NRT for clients (OK); d) setting benchmarks for service provision (OK);
e) liberal Medicaid coverage of cessation medications (MO). Conclusion: Screening,
counseling, and smoke-free campuses in Oklahoma nearly doubled that of other states.
Regardless of state/policy, SUD programs lagged behind MH programs. State policies
can have a large impact on services.
FUNDING: Academic Institution
PP-54
PUBLIC PERCEPTIONS OF TOBACCO RETAIL REDUCTION
POLICIES IN NEW ZEALAND
Louise Marsh, Robib Quigg, Jerram Bateman. University of Otago, Dunedin, New
Zealand.
Signicance: Understanding public perceptions on policies can help progress tobacco
control. Public attitudes toward tobacco and the ways in which it is sold may inuence
the development and introduction of tobacco retail policies. Quantitative studies suggest
that the New Zealand public are supportive of policies designed to restrict the availability
of tobacco to achieve Smokefree 2025. This qualitative study aimed to explore how the
New Zealand public perceives ve specic policy options designed to reduce the retail
availability of tobacco. Methods: Through in-depth interviews with 26 participants, this
study used thematic analysis to explore adults’ opinions of policies to reduce the avail-
ability of tobacco, including: i) prohibiting the sale of tobacco within 500m of any school;
ii) prohibiting tobacco sales at alcohol on-license premises; iii) only allowing tobacco to
be sold at liquor stores; iv) only allowing tobacco to be sold at pharmacies; v) restricting
the sale of tobacco to tobacco-only stores. Results: While participants were supportive
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
of reducing the availability of tobacco, there was not universal support for any of the
proposals alone. The key themes included impact of the policy on reducing availability,
quitting, young people, equity, barriers and stigma, business implications for retailers,
opportunity for culture change around how tobacco is sold, and eect of the policy on
the link between tobacco and alcohol. Participants generally felt that each policy would
contribute to achieving Smokefree 2025, but thought that each would need to be imple-
mented as part of a broader approach. Conclusions: This study indicates that there
is public support for reducing the number of tobacco retail outlets in New Zealand, but
identied positive and negative implications for each policy presented, highlighting the
complexity of reducing the supply of tobacco. While no singular policy was universally
supported, this study uncovered a number of themes that could be useful in informing
alternative policy options, and framing them to achieve public support.
FUNDING: Academic Institution
PP-55
IQOS MARKETING STRATEGIES AT POINT-OF-SALES - A CROSS-
SECTIONAL SURVEY WITH RETAILERS
Yael Bar-Zeev1, Carla Berg2, Amal Khayat1, Katelyn F. Romm2, Christina N. Wysota2,
Lorien C. Abroms2, Daniel Elbaz1, Hagai Levine1. 1The Hebrew University, Jerusalem,
Israel, 2George Washington University, Washington, DC, USA.
Signicance IQOS, with corresponding HEETS sticks, is the leading heated tobacco
product globally; emerging in Israel, one of its rst markets, in 2016. Given limited re-
search on heated tobacco products’ marketing, this study aimed to assess point-of-sale
(POS) IQOS marketing in Israel and Philip Morris International’s (PMI) involvement in it.
Methods POS locations in 5 cities (n=712) were identied from IQOS’ Israel website.
Research sta searched the web for corresponding phone numbers (n=528) and called
to conrm eligibility for an online/phone survey (ever sold IQOS or HEETS). Excluding
phone numbers that were disconnected/incorrect/no answer/not eligible (n=357), 43/171
(25.1%) completed the survey. Measures included: 1) POS characteristics; 2) IQOS/
HEETS products sold; 3) attitudes toward IQOS; and 4) marketing strategies. Bivariate
analysis assessed dierences between POS selling only HEETS to those selling both
HEETS and the IQOS device. Results POS (n=43) included convenience (22, 51.1%),
grocery (13, 30.2%), liquor (4, 9.3%) and tobacco (4, 9.3%) stores. Most (72.1%) ex-
pressed at least one positive attitude toward IQOS, most commonly believing it to be
less harmful than cigarettes. The most common form of promotions oered to retailers
were nancial incentives based on HEETS sales (34.9%). Almost half (48.8%) men-
tioned receiving instructions from PMI regarding IQOS or HEETS placement, targeting
consumers, and strategies for communication with customers (e.g. emphasizing how
IQOS compares to other tobacco products). A higher proportion of POS selling the de-
vice (n=15, 34.9%), compared to those selling only HEETS, were located in industrial/
high tech areas (26.7% vs 10.7%), were tobacco shops (26.7% vs 0%), had special
displays (100% vs 17.9%), sold at least 4 HEETS colors (100% vs 55.6%), received
incentives based on sales (50% vs 7.7%), and received instructions from PMI (83.3%
vs 44%), p<.01 for all. Conclusion Findings suggest that specic marketing strategies
are employed at the POS to promote IQOS and dierentiate IQOS and HEETS from
combustible tobacco products. Tobacco control measures should tackle industry-se-
lective promotion strategies.
FUNDING: Federal; Nonprot grant funding entity
PP-56
A THEMATIC ANALYSIS OF ARGUMENTS ADVANCED IN TWEETS
PROMOTING WORLD VAPE DAY 2020
Lindsay Robertson1, Ell Lee2, Elizabeth Fenton3, Ayush Joshi4, Karen Evans-Reeves4,
Janet Hoek5. 1University of Otago, Dunedin, New Zealand, 2School of Medicine, Univer-
sity of Otago, Dunedin, New Zealand, 3Centre for Bioethics, University of Otago, Dune-
din, New Zealand, 4University of Bath, Bath, United Kingdom, 5Department of Public
Health, University of Otago, Dunedin, New Zealand.
SIGNIFICANCE: Use of Twitter as an advocacy platform that potentially reaches reg-
ulators has increased. In 2020, World Vape Day (WVD), held on May 30 immediately
before World No Tobacco Day, used dedicated social media accounts to disseminate
WVD-branded images with campaign messages. Analysing these messages provides
important insights into the arguments used to promote liberal ENDS policies. METHODS:
Using automated scraping, we downloaded a dataset of tweets posted between 26 May
and 3 June 2020 that included the hashtag #WorldVapeDay. We used descriptive anal-
ysis to classify tweet content and thematic analysis to code arguments contained in a
random sample (n=2,200) of just over half the original English language tweets (n=4,387).
RESULTS: We categorised arguments regarding ENDS into four overall themes: harm
reduction, smoking cessation, rights and justice, and opposition. Tweets criticised actors
perceived as opposing liberal ENDS regulation, and used personal testimonials to frame
ENDS as a harm reduction tool and lifesaving smoking cessation aid. Rights-based
arguments included consumer sovereignty claims that advocated greater recognition
of consumers’ voices, which were presented as unanimously pro-ENDS, and called on
regulators to involve consumers in decision making. A further rights-oriented sub-theme
privileged adults’ rights over children’s rights, claimed youth experimentation could not
be prevented, and refuted concern over ENDS use among young people. However,
arguments against prioritising children’s interests because adults who smoke typically
began as children imply perpetuating a cycle of nicotine dependence that begins in
childhood is ethically preferable to preventing that dependence in the long-term. CON-
CLUSIONS: World Vape Day tweets presented a one-sided pro-ENDS narrative that
did not depict the spectrum of experiences individuals have with ENDS. Widespread
use of rights-based arguments attempted to imbue tweets with moral authority. Further
analyses that identify and critically assess pro-ENDS arguments will help policy actors
assess the merits of assertions used to promote liberal ENDS policies.
FUNDING: Federal; Nonprot grant funding entity
PP-57
A SOCIAL NETWORK ANALYSIS OF E-CIGARETTE BRANDS AND
SOCIAL MEDIA INFLUENCERS ON INSTAGRAM
Julia Vassey1, Joshua Barker1, Thomas Valente1, Cassandra Stanton2, Dongmei Li3,
Linnea Laestadius4, Tess Boley Cruz1, Jennifer Unger1. 1University of Southern Califor-
nia, Los Angeles, CA, USA, 2Westat, Rockville, MD, USA, 3University of Rochester Medi-
cal Center, New York, NY, USA, 4University of Wisconsin-Madison, Madison, WI, USA.
Signicance: Exposure to visual posts featuring e-cigarette products on social media
is associated with increased e-cigarette use among U.S. adolescents. Instagram is
the largest source of e-cigarette social media marketing, where inuencers - who also
describe themselves as, e.g., models, bloggers, brand ambassadors - post promotional
materials on behalf of e-cigarette brands for monetary compensation or other rewards.
This study analyzed the network of e-cigarette brand-inuencers on Instagram, charac-
terizing the most central players in e-cigarette social media marketing. Methods: From
October to December 2020, we tracked inuencers with public proles on Instagram
who posted promotional e-cigarette content at least once a month in 2020, had over
1,000 followers and high user engagement (ratio of likes and comments to followers).
By conducting a social network analysis, we identied the most central inuencers and
the most central e-cigarette brands the inuencers collaborated with. We also char-
acterized the inuencers by their user engagement and the number of their underage
followers (13 to 17 years old). Finally, we assessed the inuencers’ age verication
practices to restrict youth access to their e-cigarette content on Instagram. Results:
There was a highly interconnected network of engaging e-cigarette inuencers (n=55)
worldwide, primarily from the U.S., Asia, and Europe, who collaborated with over 600
e-cigarette brands in 2020. The Asian and U.S. inuencers had 5 to 6 times more
underage followers compared to the European inuencers. The e-cigarette content
posted by the Asian inuencers was 2-3 times more engaging than that posted by the
U.S. and European inuencers. 75% of the inuencers did not use an age verication
tool available on Instagram to restrict youth-access to their promotional content on this
platform. The brands Voopotech, Innokin, Geekvape, Lost Vape, Smok and Vaporesso
collaborated with the largest number of inuencers (mean n = 20) and hired predom-
inantly the same inuencers. Conclusions: It is important to understand the impact
of inuencers on the U.S. and international youth to better monitor and regulate social
media e-cigarette marketing.
FUNDING: Federal
PP-58
NEW TOBACCO AND NICOTINE PRODUCTS IN LATIN AMERICA
AND THE CARIBBEAN: ASSESSING THE MARKET AND
REGULATORY ENVIRONMENT
Gianella Severini1, Eric Crosbie2, Alexandra Beem3, Brian Tran2, Ernesto M. Sebrie3.
1Campaign for Tobacco-Free Kids, Cordoba, Argentina, 2University of Nevada, Reno,
NV, USA, 3Campaign for Tobacco-Free Kids, Washington, DC, USA.
SIGNIFICANCE: Over the past two decades, the Latin American and the Caribbean
(LAC) region has experienced some great success in adopting and implementing many
WHO FCTC-based comprehensive tobacco control policies. However, several countries
have either adopted these policies before new tobacco and nicotine products (NTNPs)
entered their markets or have not formally included them explicitly into their regulatory
frameworks. As a result of an increasing aggressive tobacco industry eorts to subvert
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
this progress, presence, and prevalence of electronic nicotine delivery systems (ENDS)
and heated tobacco products (HTPs) are rising in LAC, especially amongst youth,
threatening tobacco control progress. The goal of this study is to document the market
and regulatory environment of NTNPs in LAC. METHODS: Review of market research
databases, regulatory websites, and reports from Euromonitor International, GlobalData,
ECigIntelligence, TobaccoIntelligence, Campaign for Tobacco-Free Kids, and the 2021
WHO Report on the Global Tobacco Epidemic. RESULTS: ENDS entered the LAC
market in 2014 but are now available in most LAC countries. Consumer spending on
ENDS in LAC has grown 80% (2015-2021) and is expected to grow another 45% (2021-
2025). A majority of LAC countries (n=18) have either banned the commercialization of
ENDS (n=7), or regulated ENDS as tobacco products (n=7), medicinal products (n=1),
or consumer products (n=3). The remaining LAC countries (n=15) do not ban or have
any regulations for ENDS. HTPs were rst introduced in 2017 and have been ocially
launched in ve countries (Colombia, Guatemala, Dominican Republic, Mexico, and
Costa Rica). Although relatively new, HTPs are also growing in the LAC market. Few
countries have banned HTP commercialization (n=3) and regulated commercialization
and use (n=7) while the majority of countries have legislation that applies to HTPs (n=19).
A few countries (n=4) have no tobacco control legislation. CONCLUSION: NTNPs are
rapidly growing in the LAC region causing concern about their use, especially amongst
youth. Governments should follow the FCTC and ban or regulate them as tobacco
products otherwise NTNPs could create a new generation of tobacco and nicotine users.
FUNDING: Academic Institution; Nonprot grant funding entity
PP-59
WHAT IMPACT DOES A TOBACCO RETAILER PROXIMITY LIMIT
HAVE ON TOBACCO AVAILABILITY IN NEW ZEALAND?
Louise Marsh1, Crile Doscher2, Ella Iosua1, Robin Quigg1, Melanie Tomintz3. 1Univer-
sity of Otago, Dunedin, New Zealand, 2Lincoln University, Christchurch, New Zealand,
3University of Canterbury, Christchurch, New Zealand.
Signicance: Tobacco outlet density can be reduced through a range of mechanisms,
including restricting the distance retailers can be located to each other. This type of
policy has been implemented in a small number of jurisdictions, however, no New
Zealand (NZ) research has been done to examine the impact of this type of policy.
We use a geospatial approach applying a proximity limit of 150m, 300m and 450m
between tobacco retailers looking at deprived communities, density of retailers around
secondary schools, and urban and rural access to tobacco. Methods: A Python script
was developed to randomly remove tobacco retailers based on a minimum distance
between retailers of 150m, 300m and 450m until there were zero retailers present within
each selected scenario. The script was run 100 times for each scenario to create an
ensemble of outputs that were summarised statistically. Results: The implementation
of either a 150m, 300m, or 450m distance restriction between tobacco retailers would
decrease retailer density by an average of 35%, 49% or 58% respectively, and increase
the current median distance to the closest retailer from 110m to 377m, 568m, or 718m
respectively. The average median distance to the closest school also increases across
the three proximity limits. The percentage of retail outlets in each of the low, medium,
and high socio-economic deciles would change from 10%, 39%, and 51% to 13%, 42%,
and 45% respectively. The proportion of retailers situated in a small/medium urban
area would remain relatively consistent under all three scenarios. There is, however, a
progressive increase in the proportion of retailers located in rural areas as the proxim-
ity limit increases, corresponding to a decrease in those located in large/major urban
areas. Conclusions: The density of tobacco retailers decreases under each of the
proximity limit scenarios, with the largest distance of 450m resulting in a 58% reduction
and an increase in the average distance between retailers by 608m. A reduction in the
density of tobacco retailers and increased travel distance between the consumer and
the retailer can have a positive impact on smoking rates through increased search and
purchase costs. A number of studies have identied that a threshold level of reduction
is needed to have an eect on smoking behaviour. A proximity limit of 450m between
tobacco retailers would not, as a standalone policy, realise the NZ Smokefree 2025
goal, therefore a combination of retail reduction policies is needed.
FUNDING: Nonprot grant funding entity
PP-60
HEATED TOBACCO PRODUCT USE OVER TIME, ITS
CORRELATES, AND REASONS FOR USE AMONG MEXICAN
SMOKERS AND VAPERS
Lizeth Cruz-Jiménez1, Inti Barrientos-Gutiérrez1, Luis Zavala-Arciniega2, Edna Aril-
lo-Santillán3, Katia Gallegos-Carrillo4, Rosibel Rodríguez-Bolaños3, Shannon Gravely5,
James F. Thrasher6. 1National Institute of Public Health, Mexico City, Mexico, 2Univer-
sity of Michigan, Ann Arbor, MI, USA, 3National Institute of Public Health, Cuernavaca,
Morelos, Mexico, 4Mexican Institute of Social Security, Cuernavaca, Morelos, Mexico,
5Department of Psychology, University of Waterloo, Waterloo, ON, Canada, 6Arnold
School of Public Health, University of South Carolina, Columbia, SC, USA.
Background: Little is known about the use of novel heated tobacco products (HTPs)
in low- and middle-income countries. We examined among smokers in Mexico (1) the
prevalence and correlates of HTPs use and (2) reasons for using HTPs.Methods: We
analyzed data from ve online surveys (November 2019-March 2021) of an open cohort
of adult smokers (n=6,500), including an oversample of those who also use e-cigarettes
(n=2,273). Self-reported measures included: sociodemographics, current use of HTPs,
smoking and vaping frequency (i.e., dual sporadic and frequent user, e-cigarettes use
less than once a week and at least once a week, respectively), recent quit attempt and
intentions to quit smoking, smoking, vaping and HTPs use by partners/family and friends,
perception of HTPs harmfulness relative to cigarettes, exposition to information related
to HTPs. Multilevel mixed-eects multinomial logistic models regressed current HTP
use or prior HTP trial without current use (vs. never tried) on study variables, weighting
observations to reect the sociodemographic characteristics of the general population
of smokers.Results: The overall weighted prevalence of current HTP use was 1.1%
which was stable over time. Independent correlates of current HTP use include greater
smoking frequency, intention to quit, frequent e-cigarette use, having a partners/family
who use e-cigarettes or HTPs, lower perceived harm of HTPs relative to cigarettes, and
exposure to HTP information online or outside shops where tobacco is sold. Having tried
HTPs (and not using currently) was more likely among smokers with a partners/family
who use e-cigarettes or HTPs and exposure to HTPs information outside shops and on
newspapers/magazines. Among current users, the top two reasons for using HTPs were
greater social acceptability (50.2%) and lower perceived harm (40.0%).Conclusions:
Uptake of HTPs appears relatively low among Mexican smokers, and correlates of use
are similar to those for e-cigarette use, which is also a strong correlate. Further research
is needed to determine whether using HTPs promotes smoking cessation.
FUNDING: Federal
PP-61
IT IS REALLY GROSS, BUT IN A GOOD WAY, IT GETS THE
MESSAGE ACROSS, THIS COULD BE YOU - EVALUATING
WATERPIPE SPECIFIC HEALTH WARNING LABELS AMONG
YOUNG PEOPLE IN THE US: A FOCUS GROUP STUDY
Taghrid Asfar. Department of Public Health Sciences, University of Miami Miller School
of Medicine, Coral Gables, FL, USA.
Objectives: Waterpipe (WP) smoking has increased dramatically among young adults in
the US mainly due to the misperception that it is safer than cigarette smoking. Mounting
evidence show that WP smoking is addictive and harmful. Pictorial Health Warning
Labels (HWLs) are eective in communicating smoking-related risks. This study aims
to adapt 24 WP pictorial HWLs recently developed by an international expert panel in a
Delphi study. HWLs were grouped into 6 themes (T): T1-Addiction, T2-Harm compared
to cigarettes, T3-Harm to others, T4-Health eects, T5-Quitting, and T6-Specic harms.
Methods: We conducted 8 focus groups combined with a brief survey among regular WP
smokers (used WP at least once/week in the past 6 months) (n=21; 57% females; age
18-35 years). Participants completed a brief survey to rate and rank the HWLs based
on attention, reaction, and overall eectiveness. Then, participants provided in-depth
feedback on HWLs’ design/content in term of attention, reaction (fear, avoidance), eect
(e.g., harm perception, intention to quit), and improvement (e.g., relatedness, clarity, text
synergy with images). We also explored the optimal placement of the HWLs. Sessions
were audio-taped, transcribed verbatim, and analyzed thematically. Results: The top
ranked HWLs were becoming lonely as a sign of addiction (T1), oral and lung cancer
(T2 & 4), child with asthma (T3), spreading COVID-19 due to WP sharing (T4), quitting
WP during pregnancy (T5), and rat poison (T6). Focus group discussion revealed that
the ranking was mainly based on eliciting shock, fear, disgust, and concern about the
negative eect of WP smoking. Suggestions for improvement were to use a shorter text,
add statistics, and add the source of the information (e.g., CDC). Participants preferred
images that were realistic, graphic, gross, and congruent to the text. Participants rec-
ommended placing HWLs mainly on the WP device and using text-only HWLs in WP
213
2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
café entrances and menus. Conclusion: This study is the rst in the US to attempt to
advance WP policy by developing an innovative set of WP pictorial HWLs based on
feedback from young WP users. Emotion provoking HWLs were the top ranked HWLs.
FUNDING: Federal; State; Academic Institution
PP-62
HARM PERCEPTIONS AND BEHAVIORAL INTENTIONS IN
RESPONSE TO SMOKELESS TOBACCO GRAPHIC HEALTH
WARNING LABELS IN BANGLADESH
Laura E. Kroart1, Lauren Czaplicki1, Sejal Saraf1, A.B.M. Rasheduzzaman2, Moham-
mad Shamimul Islam2, Joanna Cohen1. 1Institute for Global Tobacco Control, Depart-
ment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA, 2Bangladesh Center for Communication Programs, Dhaka,
Bangladesh.
Signicance: Smokeless tobacco (SLT) use has increased in Bangladesh over the last
twenty years, and rates of use are highest among women. Evidence from Bangladesh
shows that SLT graphic health warning labels (HWLs) are eective in communicating
SLT-related harms, but more limited data are available on the inuence of dierent
graphic HWLs on current and never SLT user behavioral intentions. This qualitative
study explored perceptions of the two current SLT graphic HWLs among adults in
Bangladesh. Methods: In February 2021, we conducted 28 focus groups in three
cities in Bangladesh: Dhaka, Sylhet, and Khulna. Groups were stratied equally by
urbanicity, gender, and SLT use. Focus group participants were shown SLT products
with the two dierent graphic HWLs: images of (1) a baby on a nasal oxygen cannula
and (2) a woman with oral cancer. Trained facilitators led group discussions on the
inuence of the HWLs on harm perceptions and behavior change. Data were collected
in Bangla, translated into English, and analyzed thematically. Results: Both graphic
HWLs generated strong responses concerning perceived harm across all groups. In
particular, the image of the baby prompted strong, emotional responses about harm
to children, especially from women, who also discussed perceived harm to pregnancy.
For example: “If consumed, it’s harmful for health. And if [a] pregnant woman consumes
it, her baby will be aected as well.” For both men and women, many groups agreed
on the potential for both images to impact reduced use and cessation for SLT users,
citing that adults may see the images and reduce SLT use “because the children are
suering.” Conclusion: Findings from this study indicate the current SLT graphic HWLs
in Bangladesh resonate with viewers and are eective in producing strong emotional
responses, which can inuence SLT harm perceptions and behavioral intentions. Future
development of graphic HWLs should incorporate images as eective as the current
SLT graphic HWLs in Bangladesh.
FUNDING: Federal; Nonprot grant funding entity
PP-63
PERCEIVED EFFECTIVENESS OF WATERPIPE-SPECIFIC
HEALTH WARNING LABELS AMONG YOUNG ADULTS IN THE US:
RESULTS FROM AN ONLINE SURVEY
Taghrid Asfar. Department of Public Health Sciences, University of Miami Miller School
of Medicine, Coral Gables, FL, USA.
Objectives: This study aimed to test 24 waterpipe (WP) pictorial health warning labels
(HWLs) among young adults. HWLs were grouped into 6 Themes (T): T1-Addiction,
T2-Harm compared to cigarettes, T3-Harm to others, T4-Health eects, T5-Quitting,
and T6-Specic harms. Methods: We conducted an online survey among regular WP
smokers (used WP at least once/week in the past 6 months) (n=44; 58.5% females;
age 18-35 years). Participants were instructed to rate HWLs on several communication
outcomes (risk perceptions, intention to quit, preventing youth from starting WP use,
overall eectiveness) using a scale from 1=least eective, to 10=most eective, and then
to rank HWLs in each theme from most to least eective. ANOVA tests or Kruskal-Wallis
tests were used to test dierence in eectiveness between HWLs within each theme.
The pairwise dierence in eectiveness between two HWLs within the same theme
was established by Wilcoxon signed rank test with Bonferroni adjustment for multiple
comparisons. Friedman test (p < 0.05) was used to evaluate dierence in HWL rankings
within each theme. Results: HWL5 (oral cancer) was the top rated in T2 in preventing
youth from starting WP smoking (8.3 + SD [1.8]) and overall eectiveness (8.5 + [1.5]).
HWL13 (lung cancer) was the top rated in T4 in motivating smokers to quit (8.1 + [1.7]),
preventing youth from starting WP smoking (7.9 + [1.7]), and overall eectiveness (8.0
+ [1.6]). HWL20 (pregnant women cutting the WP hose shown as the umbilical cord)
was the top rated in T5 in overall eectiveness (6.5 + [1.7]). HWL21 (mouth disease
from WP sharing) was the top rated in T6 in motivating smokers to quit (7.9 + [1.7]),
preventing youth from starting WP smoking (7.5 + [1.9]), and overall eectiveness (7.9
+ [1.6]) (p<0.05 for all). The overall top ranked HWLs were HWL5 (71.8%), followed
by HWL9 (T3-low weight newborn baby; 53.9%), and HWL21 (51.3%). Conclusion:
HWLs are promising regulatory approaches for addressing the spread of WP smoking
among young adults in the USA. Results will inform the selection of the top 12 ranked
HWLs for further adaptations, improvement, and testing in experimental study design.
FUNDING: Federal; State
PP-64
BEHAVIORAL INTENTIONS IN RESPONSE TO A POTENTIAL
MENTHOL BAN A STUDY OF MENTHOL SMOKERS LIVING IN
PUBLIC HOUSING
Craig Deareld1, Kimberly Horn2, Ian Crandell3, Debra Bernat1. 1Milken Institute School
of Public Health, George Washington University, Washington, DC, USA, 2Virginia
Tech-Carilion Fralin Biomedical Research Institute, Roanoke, VA, USA, 3Virginia
Tech-Center for Biostatistics and Health Data Sciences, Roanoke, VA, USA.
Signcance: Local, state, and national policies are being proposed to ban the sale of
menthol-avored tobacco products to improve quit rates and address health disparities.
This study examined public housing residents’ behavioral intentions if menthol cigarettes
were no longer sold. Public housing residents may be uniquely aected by a menthol
ban because rates of smoking are higher in public housing than in the general population
(33% vs. 15%). Methods: Data were collected between March 2019 and March 2021
from 221 District of Columbia Housing Authority residents ages 18-80 who reported
smoking menthol cigarettes (83.3% African American/Black). Descriptive statistics and
logistic regression models were used to examine quitting and switching intentions as
well as the association between quit intentions and resident characteristics. Results:
Nearly one-half (48.0%) of residents said they intended to quit smoking if menthol cig-
arettes were banned, 27.2% were unsure, and 24.9% said they would not quit. Older
residents (OR=0.94 per year, 95% CI=0.91, 0.97), senior/disabled building versus
family building residents (OR=0.50, 95% CI=0.25, 0.97), those who smoked within 30
minutes of waking (OR=0.48, 95% CI=0.23, 0.98), and daily smokers (OR=0.42, 95%
CI=0.21, 0.84) had lower odds of reporting quit intentions associated with a menthol
ban. Of those not intending to quit, 40.7% indicated they would switch to non-menthol
cigarettes and 20.4% would switch to another non-menthol product. One-third of resi-
dents indicated switching to menthol e-cigarettes (13.0%) or another menthol product
(20.4%). Conclusions: Nearly three-quarters of residents indicated a possibility of
quitting smoking with a menthol ban. Resources and supports should be provided to
help menthol smokers quit when bans are enacted. In addition, bans that include avors
for all tobacco products may be more eective, as one-third of residents who did not
intend to quit, indicated switching to another menthol product.
FUNDING: Federal; Academic Institution
PP-65
DISPARITIES IN CIGARETTE, E-CIGARETTE AND CIGAR USE
AT THE INTERSECTION OF MULTIPLE IDENTITIES IN THE U.S.
ADULT POPULATION. RESULTS FROM THE TUS-CPS 2018-2019
SURVEY
Luis Zavala-Arciniega, Rafael Meza, Jana L. Hirschtick, Nancy L. Fleischer. University
of Michigan, Ann Arbor, MI, USA.
Signicance: Sociodemographic disparities in tobacco use have been identied in the
U.S. population. Nevertheless, few studies have examined disparities in tobacco use
from an intersectionality perspective. This study aims to identify disparities in cigarette,
e-cigarette, and cigar use at the intersection of multiple identities and develop a visual-
ization tool to aid characterization and interpretation. Methods: We analyzed data from
the 2018-2019 Tobacco Use Supplement to the Current Population Survey (n=137,471).
We estimate the prevalence of cigarette, e-cigarettes, and cigars at the intersection of
age (18-34, 35-54, 55+ years), sex (male, female), race/ethnicity (NH Whites (NHW), NH
Blacks (NHB), Hispanics, NH Others (NHO)), and annual household income (<$50,000,
$50,000-$99,999, ≥$100,000), resulting in 72 sociodemographic combinations. All
estimates were adjusted for the sample design. Results: NHW males (30.7%) and
females (29.7%) aged 35-54 years making <$50,000 had the highest cigarette use
prevalence, while NHB females aged 35-54 years making ≥$100,000 had the lowest
(1.6%). For e-cigarettes, adults aged 18-34 years had the highest prevalence within
each of the three income groups (i.e., male/NHW/18-34years/<$50,000 (8.8%), male/
NHW/18-34years/$50,000-$99,999 (6.5%), female/NHW/18-34years/<$50,000 (6.2%)
and male/Hispanic/18-34years/≥$100,000 (5.6%). The highest cigar use prevalence
was among young and middle-aged males NHBs and NHWs, regardless of income
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
(male/NHB/35-54years/<$50,000 (6.6%), male/NHB/35-54/$50,000-$99,999 (5.6%),
and male/NHW/18-34years/≥$100,000 (4.8%)). Conclusion: Our visualization tool
allows detailed characterization of disparities in cigarette, e-cigarette, and cigar use
at the intersection of age, sex, race/ethnicity, and income. This information is critical
for surveillance and for the implementation of tobacco control policies that can reduce
inequalities in tobacco use.
FUNDING: Federal
PP-66
THE IMPACT OF STATE-LEVEL FLAVOR RESTRICTIONS ON
TOBACCO PRODUCT SALES
Megan C. Diaz1, Adrian Bertrand1, Daniel K. Stephens1, Tyra Satchell2, Laurie P. Whit-
sel2, Barbara Schillo1. 1Truth Initiative, Washington, DC, USA, 2American Heart Asso-
ciation, Washington, DC, USA.
Introduction: Several states restricted sales of various tobacco products in response to
EVALI outbreaks. Massachusetts restricted the sale of avored vape products in Decem-
ber 2019, followed by further restrictions on the sale of avored combustible cigarettes
and other tobacco products in June 2020. In New Jersey, a ban on non-tobacco avored
vape products began in April 2020. Few studies have explored the impact of state-wide
avored tobacco sales policies on retail sales of tobacco products. Methods: We used
NielsenIQ Retail Scanner data to construct four log per capita dependent variables:
e-liquid milliliters, cigarette packs, cigars, and smokeless tobacco ounces for products
avored as fruit, menthol, mint, tobacco and other. All models use dierence-in-dierence
(DID) regressions and use Virginia (with no avored policies) as a control. We control
for state level product prices, population percentages by race/ethnicity, proportion male,
median household income, unemployment rate, minimum legal sales age, tobacco 21
policies, and cumulative cases and deaths of COVID-19. Due to perfect collinearity
we only controlled for vape-free air laws in the e-cigarette models. We account for
time-specic factors by using 4-week period xed-eects. Results: In MA, all avored
per capita sales of e-cigarettes (measured by milliliters of e-liquid) decreased by 85-99%
(p<0.001) compared to only a 51% (p<0.001) decrease in fruit-avored e-cigarettes in
NJ. Sales of menthol-avored cigarette packs per capita decreased 89% (p<0.001) in
MA and did not decrease at all in NJ. In MA, all avored per capita smokeless tobacco
ounces decreased by 40-82% (p<0.001) compared to 14-52% (p<0.001) increases
in NJ. Lastly, in MA, all avored per capita cigars sales decreased 16-74% (p<0.001)
compared to 7-23% (p<0.001) increases in NJ. Conclusions: A comprehensive federal
ban of all avors on tobacco products, such as the one passed in MA, is needed to help
reduce youth initiation and support tobacco cessation. Comprehensive bans appear
more eective than e-cigarette-specic avored policies such as those passed in NJ in
reducing the accessibility of avored tobacco.
FUNDING: Other
PP-67
CHARACTERIZING THE US CIGAR MARKET AHEAD OF THE
FDA’S PROPOSED RULE TO REMOVE FLAVORED CIGARS
Emily Donovan1, Stephanie Yoon1, Megan Diaz1, Maham Akbar2, Barbara Schillo1.
1Schroeder Institute at Truth Initiative, Washington, DC, USA, 2Truth Initiative, WA,
DC, USA.
Signicance: The 2009 Tobacco Control Act prohibited the sale of non-menthol avored
cigarettes only. Since then, menthol cigarette and avored little cigar and cigarillo (LCC)
use has surged - particularly among Black youth, who are disproportionately targeted
by advertising and price promotions of these products. For many years, the FDA has
stated its intent to ban these products, most recently again in April 2021, but has not
issued a proposed rule to date. This analysis describes the current cigar market and
how it could be impacted by the potential proposed rule. Methods: We analyzed US
cigar sales using Nielsen Retail Scanner Data from October 2013 through September
2020. Ination-adjusted sales dollars were classied into cigar products (little cigars,
cigarillos, and large cigars) and avors (fruit/sweet, menthol, mint, tobacco, and other).
Results: From October 2013 to September 2020, cigar sales increased by 70.6%.
During this period, cigarillo sales increased by 96.2%, large cigar sales increased by
21.3%, and little cigar sales changed little. As of September 2020, the composition
of the cigar market was 79.5% cigarillos, 13.9% large cigars, and 6.6% little cigars.
About half of all cigars sold throughout 2013-2020 were a avor other than tobacco,
with over half of cigarillos sold at any point being a non-tobacco avor. In September
2020, the most popular non-tobacco cigarillo and large cigar avors were fruit/sweet
(cigarillos: 21.4%; large cigars: 40.9%) and other (cigarillos: 12.0%; large cigars: 1.59%),
while the most popular non-tobacco little cigar avors were fruit/sweet (23.6%) and
menthol (14.6%). Conclusion: The proposed rule would restrict the sale of nearly half
of the current cigar market, with cigarillos being most impacted. It is important that the
proposed rule includes removing menthol cigarettes and avored LCCs at the same
time, as products like menthol little cigars closely resemble menthol cigarettes. Given
the growth of the cigar market and the proliferation of avored cigars in particular, the
proposed rule holds great potential in restricting products that are attractive to youth
and in reducing health disparities.
FUNDING: Other
PP-68
FUTURE PROSPECTS FOR THE DEVELOPEMENT OF ANTI-
SMOKING RESEARCH IN FRANCE: RESULTS OF A QUALITATIVE
STUDY
Anne-Fleur Guillemin, Jérôme Foucaud. French National Cancer Institute,
Boulogne-Billancourt, France.
In France, tobacco is the number one risk factor associated with avoidable cancers.
Combating smoking is at the core of public health policy. Taxes have been imposed on
tobacco products in order to fund research in this eld, and funding structures have been
put in place. With a view to ensuring that these structures are compatible with the needs
of researchers, it is now necessary to analyse the expectations and perceptions of the
researchers with regard to this topic: such is the objective of this qualitative study. We
conducted a qualitative survey using open-ended questions. The questions sought to
ascertain the expectations of researchers with regard to research on tobacco, and the
development of funding policies and strategies in this eld of research. We constructed
a sociologically-representative (Michelat 1975) sample of 30 researchers from dierent
disciplines of humanities and the social sciences concerned with matters of public
health. The survey was conducted between February and April 2019, in France. We
then conducted thematic categorical analysis on the whole corpus of responses (Bardin
2013). We provide extracts from the responses to illustrate the results. Our analysis of
the interviews reveals a problem of information overload. Researchers’ expectations
are largely concerned with the structuring of calls for projects and the development of
scientic elds with the help of dedicated structures and funds devoted to: electronic
cigarettes, specic groups, the role of the tobacco industry and lobbying. Finally, one of
the most pertinent ndings concerns their perceptions. For a majority of respondents,
tobacco research is considered unattractive and oers “little potential for innovation,”
since “there is nothing left to say on the matter.” We include a typology of researchers
to illustrate these perceptions. In conclusion, this study provides concrete indications on
how to improve the support available to research focusing on tobacco: make the eld
more attractive, clarify its scientic contours and the priority issues to be addressed,
create a new forum for reection.
PP-69
A LONGITUDINAL ANALYSIS OF MPOWER IMPLEMENTATION
FROM 2008 TO 2018
Les Hagen MSM1, Gholamreza Heydari MD, PhD2, Fadi Hammal MB MSc3. 1ASH
Canada, Edmonton, AB, Canada, 2Tobacco Prevention & Control Research Center,
National Research Institute of Tuberculosis & Lung Diseases, Shahid Beheshti Univer-
sity of Medical Sciences, Tehran, Iran, Islamic Republic of, 3University of Alberta School
of Public Health, Edmonton, AB, Canada.
Signicance This study is the rst to report 10-year longitudinal results of MPOWER im-
plementation with full numerical results provided for 195 countries including breakdowns
by region and national income levels with analysis of several covariates. Methods The
numerical MPOWER data tables for 195 countries and all reporting periods from 2008 to
2018 were obtained from the WHO. The data reects the seven MPOWER measurable
variables. The scores of each country were prepared and assembled according to the
six zones of the WHO and by the four national income gradients established by the
World Bank. The data were analyzed for correlations with several potential covariates.
Results Longitudinal national results from 2008 to 2018. A total of 176 out of 195
countries increased their MPOWER scores between 2008 and 2018. Twenty-three (23)
countries recorded a minimum MPOWER scoring increase of 10 points out of a possible
maximum of 34 between 2008 and 2018 representing a population of 840 million or 11.2%
of the global population. Two countries achieved a perfect score of 34. Six (6) countries
recorded a decline in MPOWER scores between 2008 and 2018, and 13 countries
recorded no change in scoring. The mean point change rankings of WHO regions from
highest to lowest are (1) South Asian, (2) East Asia, (3) Europe and Central Asia, (4)
North America, (5) Latin America and Caribbean, (6) Middle East and North Africa and
(7) Sub-Saharan Africa. The highest mean point change rankings according to national
income levels are (1) lower-middle income; (2) upper-middle income; (3) high income
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
and and (4) low income. The highest degree of implementation of MPOWER elements
between 2008 and 2018 was (1) Warn (packaging), followed by (2) Protect, (3) Enforce
(advertising ban), (4) Oer, (5) Raise, (6) Warn (mass media), and (7) Monitor. Selected
covariates that were positively associated with MPOWER implementation included
reduced cigarette aordability, the existence of national tobacco control objectives, the
human development index score, the national corruption index score, and the political
regime index score. Conclusion More work is needed to improve national MPOWER
implementation, especially among low-income countries including measures to Raise
(taxes), Warn (mass media) and Oer (help to quit). A number of social, economic and
political indicators appear to inuence MPOWER progress including national income,
human development and government structure. Future eorts to improve MPOWER
implementation should take these factors into consideration.
FUNDING: Unfunded
PP-70
DOES SELF-REPORTED EXPOSURE TO TOBACCO MARKETING
AT TOBACCO RETAIL OUTLETS INFLUENCE THE TRAJECTORY
OF TOBACCO USE AMONG YOUTH?
Keryn E. Pasch1, Jacob E. Thomas1, Melissa B. Harrell2. 1The University of Texas at
Austin, Austin, TX, USA, 2UT Health School of Public Health, Austin, TX, USA.
Signicance: Marketing at tobacco retail outlets (TRO) has been found to inuence
cigarette and e-cigarette use among youth. However, much of the previous work has
been cross-sectional or limited to two time points and has not examined this relation-
ship over the course of adolescence. This study examined the relationship between
self-reported exposure to cigarette and e-cigarette TRO marketing and current use
of these products across adolescence from ages 11-18. Methods: Participants were
3,130 students (56.9% female; 36% Hispanic, 15% Black, 49% White/other race-eth-
nicity; m age=13.44 [SD=1.61] at wave 1) from 111 schools in Texas participating in a
longitudinal study (2014-2017). Current product use (past 30-day) was measured at
each wave with one item each for cigarettes and e-cigarettes (coded as 1=any use,
0=no use). Self-reported TRO marketing exposure for each product was measured by
multiplying each student’s response about how often they remembered see marketing
at TROs (including gas stations, drug stores, grocery stores) for each product separately
(responses ranged from never to every time) by each student’s self-reported weekly
store visit frequency. For this study, waves 2, 4, 5, and 6 were used (spring 2015 through
spring 2017). Growth curve models, with age as the time variable and school as the
cluster variable, controlling for baseline sex, age, race/ethnicity, socioeconomic status,
and any other tobacco product use at wave 1, and also including both participant and
wave as random eects, examined the association between self-reported exposure to
TRO marketing for each product and current product use. Results: Both cigarette and
e-cigarette use increased across adolescence. Self-reported exposure to cigarette
TRO marketing was signicantly associated with the growth in cigarette use (β=5.49,
95% C.I.=4.28-6.69). Self-reported exposure to e-cigarette TRO marketing was also
signicantly associated with the growth in e-cigarette use (β=3.26, 95% C.I.=2.65-3.87).
Conclusions: Exposure to TRO marketing continues to be an important risk factor for
tobacco use. Longitudinal studies such as this document the importance of enacting
regulations that reduce exposure to tobacco marketing at retail outlets.
FUNDING: Federal
PP-71
SUPPORT FOR NICOTINE REDUCTION IN TOBACCO PRODUCTS
FINDINGS FROM THE 2016-2020 ITC FOUR COUNTRY SMOKING
AND VAPING SURVEYS
Robert T. Fairman1, Yoojin Cho2, Lucy Popova1, Michael Cummings3, Georges
Nahhas3, Tracy Smith3, Janet Chung Hall4, Georey Fong4, Ron Borland5, Ann McNeill6,
James Thrasher2. 1GA State University, Atlanta, GA, USA, 2University of SC, Columbia,
SC, USA, 3Medical University of SC, Charleston, SC, USA, 4University of Waterloo,
Waterloo, ON, Canada, 5Cancer Council Victoria, Melbourne, Australia, 6King’s College
London, London, United Kingdom.
Background: Countries such as the United States, Canada, and Australia have pro-
posed or shown interest in reducing nicotine levels in combustible cigarettes or e-cig-
arettes to little or no nicotine. The current study aims to examine support for nicotine
reduction in cigarettes and e-cigarettes and change in support over time. Methods:
Data were drawn from the 2016-2020 ITC Four Country Smoking and Vaping Surveys
conducted in Australia, Canada, England, and the United States. The analytic sample
was restricted to adult smokers, vapers, and former smokers who reported their support
for a law that limits nicotine levels in cigarettes (n= 12,087 in 2016, n=3,757 in 2018,
n=5,665 in 2020) and in e-cigarettes/e-liquid (n= 24,914 in 2016 and 2018). In logistic
models, support for each law was regressed on socio-demographics, country, smoking/
vaping status, perceived harm of nicotine and warning labels, social norms, adjusted for
sampling weights. Results: More than half of respondents supported nicotine reduction
in cigarettes (US = 57%, England = 61%, Canada = 70%, Australia = 61%), averaged
across the years. Fewer respondents supported nicotine reduction in e-cigarettes (US =
47%, England = 53%, Canada = 66%, Australia = 47%). When asked about their likely
response to reduced nicotine policy in 2018, 49% responded they would quit entirely,
compared to 25% in 2016, and those trying the non-nicotine cigarette dropped from
51% in 2016 to 14% in 2018. Those worried about the eects of nicotine on their health
were more likely to support nicotine reduction in cigarettes (AOR=1.5 for very worried
vs. not at all), as well as e-cigarettes/e-liquids (AOR=1.3 for very worried vs. not at all).
Compared to exclusive smokers, former smokers were more likely to support nicotine
reduction in cigarettes (AOR=1.6). Dual users (AOR=.75) and exclusive e-cigarette
users (AOR=.58) were less likely to support nicotine reduction in e-cigarettes than
exclusive smokers. Conclusions: Most tobacco product users support laws limiting
nicotine levels in cigarettes and e-cigarettes, and support changes over time. Eorts to
adopt and implement these regulations should consider these ndings.
FUNDING: Federal; Nonprot grant funding entity
PP-72
THE CREDIBILITY OF TOBACCO CONTROL AND PREFERENCE
OF SMOKING CESSATION PROGRAMS AMONG SAUDI SMOKERS
Abdullah M. Alanazi, Nada Alfahadi, Sadeem Alsayari, Foton Alkhonain, Norah Alsu-
lami, Taha T. Ismaeil. King Saud bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia.
Background: Saudi Arabia has extensively reformed its tobacco control policies and
extended its smoking cessation services in recent years. A public rhotic among smokers
was witnessed especially after the implementation of plain cigarette packaging and
signicant eort of tobacco treatment services was observed. However, we are not
aware of how the perceived credibility of tobacco control and preference of smoking
cessation programs among Saudi smokers might aect their quit attempts, use of nic-
otine replacement therapy, and desire to quit. Method: Saudi current tobacco smokers
(n = 518) were recruited through a cross-sectional sampling. The smokers were asked
questions related to the credibility of tobacco control (Modied FDA Tobacco Credibil-
ity Scale), preferences of smoking cessation program (not smoker provider, religious
provide, gender of the provider, and service settings), quit attempts in the past, use
of nicotine replacement therapy in the past, and the desire to quit tobacco smoking in
the future. Logistic and linear regression models were used in the analysis. Results:
The higher credibility of tobacco control, but not the preferences of smoking cessation
program, was signicantly associated with quitting tobacco smoking in the past (β =
1.011, 95%CI = 1.000 - 1.022) and the desire to quit tobacco smoking in the future (β =
0.277, t = 4.788, p = ≤ 0.005. All the models were controlled for gender, age, educational
attainment, income, and occupational status. Conclusion: The perceived credibility of
the tobacco control program among Saudi smokers showed a signicant impact on
quitting tobacco smoking in the past and the desire to quit tobacco smoking in the future.
Tobacco control policies may be perceived as aggressive; therefore, signicant eorts
of health communication should be disseminated to increase smokers’ acceptance of
such policies to increase their attempts and desire to quit tobacco.
PP-73
EXTRACTION OF COTININE IN URINE USING A MOLECULARLY
IMPRINTED POLYMER
Haley A. Mulder, Adam C. Pearcy, Matthew S. Halquist. Virginia Commonwealth
University, Richmond, VA, USA.
Signicance: Molecularly imprinted polymers (MIPs) are synthetic polymers that are de-
signed to selectively capture an analyte based on its size, shape, and functional groups.
MIPs are commonly used in place of traditional solid phase extraction (SPE) sorbents for
the separation of an analyte from matrix. Commercial MIPs have been designed for the
selective extraction of tobacco specic nitrosamines (TSNAs) in urine, but literature has
demonstrated that TSNAs have some level of cross-reactivity with the TSNA metabolite
4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). Cotinine, nicotine’s main urinary
metabolite, has a similar size, shape, and functional group chemistry to TSNAs. The
purpose of this project was to determine if the TSNA MIP columns could be used for
the extraction of cotinine in urine. Methods: A modied TSNA MIP extraction protocol
was used for the extraction of cotinine in urine and water. Recoveries of cotinine with
MIP and a non-imprinted polymer (NIP) were measured in water via HPLC-PDA, and
the selective interaction with the MIP material was determined. Cotinine recovery was
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
also measured in the presence of commonly encountered nicotine/tobacco constituents,
n-nitrosonornicotine, nicotine, and trans-3-hydroxycotinine. Cotinine recovery and matrix
eects in urine at low, medium, and high concentrations was measured via LC-MS/
MS. Results: The average recovery of cotinine with the MIP material was 85%, and
the selectivity coecient of the MIP vs the NIP was > 1, suggesting that the cotinine
recovery was due to specic interaction with the imprinted material. The recovery of
cotinine with the imprinted polymer was not signicantly aected by the presence of
other analytes (p > 0.05). Average recovery of cotinine in urine at 10, 100, and 1000
µg/mL ranged from 95-106% with matrix eects of -7.8%. Conclusions: The successful
recovery of cotinine with the commercial TSNA MIP suggests that the TSNA imprinted
polymers can be used for simultaneous detection of multiple biomarkers of exposure to
nicotine and tobacco products. Funding: Matthew Halquist was funded as the PI of the
Bioanalytical Core Laboratory, The Central Virginia Center on Drug Abuse Research,
NIDA, 2P30DA033934-08
PP-74
ASSESSING THE TOXICITY OF DIY ADDITIVES IN RESPONSE TO
A FLAVOR BAN IN ECIG LIQUIDS
Ahmad El-Hellani1, Eric K. Soule2, Soha Talih1, Rola Salman1, Rachel El Hage1, Najat
Saliba1, Alan Shihadeh1. 1American University of Beirut, Beirut, Lebanon, 2East Carolina
University, Greenville, NC, USA.
Signicance. Electronic cigarettes (ECIGs) aerosolize liquids that contain nicotine,
propylene glycol (PG), vegetable glycerin (VG), and appealing avors. In the U.S.,
regulations have been proposed and implemented that may limit the availability of
non-tobacco avors in ECIG liquids. Research demonstrates that some ECIG users
may attempt to make their own liquids (i.e., do-it-yourself (DIY) liquids) in response to
a avor ban. This study examined the toxicity of DIY avored ECIG liquids. Methods.
DIY liquid additives were identied by reviewing ECIG users’ reported responses to a
hypothetical avor ban and a review of 15 ECIG internet forums to include essential oils,
cannabidiol oil (CBD), sucralose, ethyl maltol. Concentrations of additives and PG/VG
ratio were based on popular recipes identied in ECIG forums or DIY websites. A total
of 27 liquids containing dierent levels and combinations of sucralose, CBD, essential
oil, nicotine, and tobacco and menthol avors were prepared. These liquids were used
to assess reactive oxygen species (ROS) emissions in machine-generated aerosols.
DIY avor concentrates and commercially available avored liquids were tested for
comparison. Results. Data showed that aerosols generated from DIY avor concentrates
or from menthol and tobacco avors mixed with DIY additives yielded similar ROS levels
compared to commercially available avored liquids. Moreover, mixing menthol avor
with CBD or essential oil yielded signicantly higher, while sucralose yielded lower, ROS
emissions than menthol or PG/VG liquid. Only CBD yielded signicantly higher ROS with
tobacco avor. Varying sucralose concentration in the liquid yielded the same levels of
ROS as PG/VG base liquid. However, increasing power within the same concentration
condition yielded signicantly higher ROS. Interestingly, nicotine form aected ROS
emissions from a liquid containing sucralose. Conclusion. Our data showed that DIY
liquids may be as toxic as commercially available avored ECIG liquids. Restricting
avor availability while keeping DIY concentrates and DIY additives available for ECIG
users reduces the impact of the introduced policy.
FUNDING: Federal; FDA CTP
PP-75
DEPRESSED MOOD AND COGNITIVE IMPAIRMENT ARE
ASSOCIATED WITH STRIATAL DOPAMINE DYSFUNCTION
AND BETA2*-NACHR AVAILABILITY IN RECENTLY ABSTINENT
TOBACCO SMOKERS
Katina C. Calakos, Ansel T. Hillmer, Gustavo A. Angarita, Stephen Baldassarri, David
Matuskey, MingQiang Zheng, Michael Kapinos, Yiyun Huang, Kelly P. Cosgrove. Yale
University, New Haven, CT, USA.
Signicance. Chronic nicotine in animals increases the number of beta2*-subunit
containing nicotinic acetylcholine receptors (b2*-nAChRs) and reduces the striatal
dopamine (DA) response. This human positron emission tomography (PET) imaging
study examined b2*-nAChR availability, striatal DA function, and neural correlates of
cognition and mood in recently abstinent tobacco smokers and nonsmokers. Methods.
27 smokers receiving contingency management (9F; aged 38+/-10 y; FTND: 5.9+/-2.1;
14+/-11 pack-years) and 28 nonsmokers (11F; aged 30+/-11 y) participated. PET scans
measuring b2*-nAChR availability were acquired 90-120 min after bolus-infusion of
254.9+/-44.9 MBq [18F]Flubatine (Kbol=360 min) from 14 smokers (6+/-2 d abstinent)
and 19 nonsmokers. PET scans of DA D2/3 receptor availability were acquired from 19
smokers (11+/-9 d abstinent) and 18 nonsmokers after bolus injections of [11C]PHNO
before (443.1+/-156.6 MBq) and 3 h after (424.6+/-168.4 MBq) amphetamine (0.5 mg/
kg, PO). Subjects completed the 1-back working memory task and Center for Epide-
miologic Studies Depression scale (CES-D) on scan days. Regional [18F]Flubatine free
fraction corrected distribution volumes (VT/fp) at equilibrium (b2*-nAChR availability) and
amphetamine-induced percent change in [11C]PHNO non-displaceable binding potential
BPND (DA release) were estimated. Two-sample tests and correlations evaluated group
eects on, and associations of cognition and mood with, PET estimates. Results.
Preliminarily, there were no group dierences in frontal cortex, caudate, or putamen
b2*-nAChR availability. Abstinent smokers had less percent change in ventral striatum
BPND (less DA release) than nonsmokers (p=0.02). Higher frontal b2*-nAChR availability
and less striatal DA release was associated with higher mean reaction time for correct
1-back responses (worse working memory) (n=13, r=0.68, p=0.01) and higher CES-D
scores (worse mood) (n=15, r=-0.63, p=0.03), respectively, in abstinent smokers only.
Conclusions. Abstinent smokers exhibited less striatal DA release than nonsmokers,
consistent with ‘blunted’ DA release in other substance use disorders. Higher frontal
cortex b2*-nAChR availability and less striatal amphetamine-induced DA release were
associated with worse working memory and mood in abstinent smokers, suggesting
potential neural correlates of cognitive impairment and anhedonia during quit attempts.
Elucidation of within-subject relationships between b2*-nAChR availability and DA
function is ongoing.
FUNDING: Federal
PP-76
POWER- VERSUS TEMPERATURE-CONTROLLED ELECTRONIC
CIGARETTES: IMPLICATIONS FOR EMISSIONS TESTING AND
EXPOSURE
Rola Salman, Soha Talih, Nareg Karaoghlanian, Alan Shihadeh. American University
of Beirut, Beirut, Lebanon.
Smoking machines are commonly used to compare toxicant yields across tobacco
products. These machines are usually programmed to execute a number of pus ac-
cording to some pre-determined regimen. Prior to the advent of temperature controlled
electronic nicotine delivery systems (ENDS), it was found that pu velocity did not
impact nicotine emissions, unlike combustible products. Nicotine emissions of a given
device and liquid were proportional to pu duration and count, but not ow rate. With
temperature-controlled devices (TCDs) such as JUUL, this assumption does not hold
in theory; physical principles suggest that for TCDs, greater ow rates result in greater
vaporization rates and toxicant emissions. Because ow rates vary widely depending
on device design, reports of toxicant yields would need to account for the ow rates at
which a given product is used. In this study we investigated how ow rate aects JUUL
emissions. We generated and sampled JUUL aerosols using the Aerosol Lab Vaping
Instrument. Ten pus of 4sec duration and 10sec interpu interval were executed for
three ows: 1, 1.5, and 2LPM. Total particulate matter was measured gravimetrically.
We found that emissions increased with ow rate; a doubling of ow rate from 1 to 2LPM
resulted in approximately a 50% increase in emissions. Unlike the case of power-con-
trolled ENDS, nicotine emissions from TCDs depend on ow rate. The results suggest
that previous estimates of JUUL ux and yield using the 1LPM CORESTA method
may have been greatly underestimated. This highlights the need to use topography
parameters appropriate to the device when measuring emissions.
FUNDING: Federal
PP-77
DUAL USERS’ PERCEPTIONS OF THE ADDICTIVE PROPERTIES
OF CIGARETTES VS. E-CIGARETTES
Robin N. Perry, Jane P. Girgulis, Sarah L. Harrison, Sean P. Barrett. Dalhousie Univer-
sity, Halifax, NS, Canada.
Signicance: Electronic cigarettes (“e-cigarettes”) are commonly promoted as an alter-
native to combustible cigarettes, yet many individuals concurrently use both products
(e.g. “dual users”). Little is known about the extent to which dual users’ perceptions of
the addictive properties of these products dier, or to what extent there are similarities
or dierences in the situational and aective factors that elicit craving for each product.
Methods: An online survey was used to assess the situations and aective states
that evoke craving, and perceptions of the addictive properties of both cigarettes and
e-cigarettes in a sample of Canadian adult dual users (n = 175; 79 female). Results:
Dual users rated cigarettes as more addictive than e-cigarettes and reported higher
levels of craving for cigarettes across a number of negative aective states and situ-
ational cues (e.g., being in the presence of others’ smoking, drinking alcohol). While
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
the addictive properties of combustible cigarettes were largely attributed to nicotine,
non-nicotine factors (e.g. avouring, other non-nicotine ingredients) were believed to
make a stronger contribution to the addictive properties of e-cigarettes. Conclusions:
Dual users perceive cigarettes to be more addictive than e-cigarettes and attribute the
addictive properties of each product to dierent factors (e.g. nicotine vs. non-nicotine
ingredients). Further, craving for combustible cigarettes appears to be more strongly
linked to negative aective states and certain situational cues elicit stronger craving
for cigarettes, relative to e-cigarettes. Implications: An improved understanding of dual
users’ perceptions of the reinforcing and addictive properties of e-cigarettes vs. ciga-
rettes represents an important step toward developing more eective prevention and
cessation eorts. Findings from this study suggest there may be limited substitutability
between combustible and electronic cigarettes, and that the use of e-cigarettes alone
may be insucient for some smokers for cessation purposes.
FUNDING: Federal
PP-78
EFFECTS OF COMPUTED NICOTINE FLUX AND PROTONATION
ON PUFF TOPOGRAPHY AND PLASMA NICOTINE EXPOSURE
Soha Talih1, Rola Salman1, Miao-Shan Yen2, Nareg Karaoghlanian1, Alison Breland2,
Thomas Eissenberg2, Alan Shihadeh1. 1American University of Beirut, Beirut, Lebanon,
2VA Commonwealth University, Richmond, VA, USA.
Regulating electronic nicotine delivery systems (ENDSs) is a public health priority.
Previous regulatory eorts focused on restricting liquid nicotine concentration. How-
ever, these eorts are unlikely to succeed because ENDS nicotine emissions depend
on multiple variables in combination (e.g., device power, liquid composition, pung
behavior). Therefore, to achieve the intended eect, regulations targeting addiction must
focus on nicotine delivery. While nicotine delivery cannot be regulated directly, nicotine
ux, the rate at which ENDSs emit nicotine, is a readily computed metric that can be
regulated. In this study, we tested whether nicotine ux can predict plasma nicotine
concentration.Plasma nicotine concentration measurements were obtained from four
clinical studies that tested the eects of ENDS use conditions on nicotine delivery and
pung behavior in 10-pu directed (N=394) and 60 min ad lib use episodes (N=205).
Pu topography was measured using the AUB eTop pu topography instrument. The
conditions examined span 15 dierent nicotine uxes ranging from 10 to 108µg/sec and
included protonated and freebase nicotine. General linear models (GLMs) were used to
examine the associations between computed nicotine ux with plasma nicotine concen-
trations. A random eect was included to account for within-subject dependence. GLMs
were also used to examine the associations between ux and nicotine form with pu
topography. Analyses were stratied by session type (directed; ad lib).Baseline-adjusted
plasma nicotine concentrations in directed and ad lib ENDS use episodes increased
with nicotine ux. In ad lib episodes, pu duration decreased with increasing ux; pu
number and ow rate were unrelated to ux. Interestingly, nicotine form was associated
signicantly with pu duration; protonated nicotine resulted in a 1 sec increase in pu
duration.This study shows that nicotine ux is a powerful regulatory lever because it
can predict nicotine delivery to the blood, a key factor in abuse liability.
FUNDING: Federal
PP-79
VAPING-INDUCED PROTEOLYSIS CAUSES AIRWAY
DEHYDRATION
Arunava Ghosh, Raymond D. Coakley, Neil E. Alexis, Robert Tarran. University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Signicance: Proteases play important roles in pulmonary health and help regulate
lung hydration, via their control of the epithelial sodium channel (ENaC). Impaired airway
hydration contributes to mucus stasis in the lung, which is causal for increased infec-
tion and inammation. Indeed, lung dehydration is a key aspect of chronic obstructive
pulmonary disease (COPD) which contributes to the disease severity. Previously, we
have demonstrated that vaping increased proteases (neutrophil elastase and matrix
metalloproteases) in the lung. Proteases cleave and activate ENaC causing airway
dehydration. Our current study explores the impact of increased protease activity in
vapers’ airway secretions on airway dehydration and ENaC cleavage. Methods: Human
bronchial epithelial cells were cultured at air-liquid interface and exposed to pooled bron-
choalveolar lavage uid (BALF) from age and sex-matched non-smokers, smokers and
vapers. Airway surface liquid (ASL) height was monitored over time using confocal micro-
scopic imaging. ENaC subunits were expressed in human embryonic kidney (HEK293T)
cells and subsequently treated with elastase to identify ENaC cleavage products by
Western blot. Results: Neutrophil elastase cleaved ENaC subunits in HEK293T cells.
Accordingly, concentrated BALFs from smokers and vapers also caused cleavage of
ENaC indicating increased protease activity in tobacco product users’ lungs may cause
airway dehydration. Further, BALFs from smokers and vapers signicantly decreased
ASL height compared to the non-smokers’, indicating ASL dehydration. The ASL height
decrease was ENaC-dependent and was prevented by protease-inhibitors, conrming
that increased proteolysis in vapers and smokers BALFs caused the ASL dehydration.
Conclusions: The current study demonstrated that the elevated protease levels in
vapers airways may have functional signicance, and that they can cleave and activate
ENaC, resulting in airway dehydration. Airway dehydration is associated with a decline
in lung function, development of pulmonary diseases, and increased mortality. Hence,
more research is required before we can say that e-cigarettes do not cause COPD-like
lung disease. Acknowledgements: Funded by HL120100, HL135642 and HL153698.
FUNDING: Federal
PP-80
EVALUATION OF EARLY INFLAMMATORY AND IMMUNE CELL
RESPONSES IN THE MURINE LARYNX FOLLOWING SUBACUTE
LOW AND HIGH DOSE WHOLE-BODY CIGARETTE SMOKE
EXPOSURE
Meena Easwaran, Joshua D. Martinez, Juyong Brian Kim, Elizabeth Erickson-DiRenzo.
Stanford University - School of Medicine, Stanford, CA, USA.
Signicance: The larynx is a multifunctional organ situated at the upper-lower airway
divergence that plays a vital role in swallowing, breathing, coughing, and voice produc-
tion. Despite well-documented cigarette smoke (CS) induced laryngeal histopathological
changes in animal and human subjects, the underlying immunopathological mechanisms
remain largely unexplored. The goal of this study was to examine the early immuno-
logical responses of the CS-exposed laryngeal mucosa. Specically, we investigated
inammatory and immune cell responses in the murine larynx after subacute low and
high dose whole-body mainstream CS exposure (CSE). Methods: Adult C57BL/6
male mice were assigned to air-exposed control, low (LD; 1h/day), and high (HD; 4h/
day) dose CSE groups. Mice were euthanized after 4 weeks of exposure. Laryngeal
tissues were harvested for mRNA expression using a Nanostring inammation panel
and immunohistochemical staining. Global and dierential gene expression analyses
were performed. Biological interpretation of the dierentially expressed genes (DEG)
was performed via StringDB protein-protein interaction (PPI) network analysis, KEGG
pathway enrichment, and Ingenuity Pathway Analysis (IPA). Macrophages, neutrophils,
and T-cells were quantied via immunohistochemistry (IHC). Results: Global gene ex-
pression analysis revealed a unique gene expression prole in HD, as compared to LD
and control mice. Dierential gene expression and bioinformatic analysis identied 26
DEG only in the HD group associated with various proinammatory pathways including
TNF, MAPK, TLR, and IL-17. Furthermore, inammatory responses remained inhibited
in conjunction with predicted activated states of anti-inammatory regulators like PPARG
and Nrf2. Immune cell recruitment responses remained inhibited as corroborated by IHC
outcomes. Conclusion: Overall, subacute high dose CSE was anti-inammatory and
immunosuppressive. Longer time assessments are needed to see when CS-induced
inammatory and immune cell responses sustain and become pathologic. Furthermore,
the identication of biomarkers can help improve future therapeutic interventions of
CS-induced laryngeal diseases.
FUNDING: Federal; Academic Institution
PP-81
EFFECTS OF CIGARETTE SMOKE AND E-CIGARETTE AEROSOL
EXTRACT ON INTRACRANIAL SELF-STIMULATION IN RATS
Andrew Harris1, Peter Muelken1, Aleksandra Alcheva2, Irina Stepanov2, Mark LeSage1.
1Hennepin Healthcare Research Institute, Minneapolis, MN, USA, 2University of Minne-
sota, Minneapolis, MN, USA.
Signicance. Conventional tobacco cigarettes have greater abuse liability than non-com-
busted products such as electronic cigarettes (ECs) and nicotine replacement therapy
(NRT). This may be due to the higher levels of behaviorally active non-nicotine constit-
uents (e.g, volatile organic compounds (VOCs) such as acetaldehyde, minor tobacco
alkaloids such as nornicotine) in cigarette smoke (CS) compared to non-combusted
products. Evaluating this hypothesis could lead to identication of new Harmful or
Potentially Harmful Constituents and development of addiction-related product stan-
dards that extend beyond the FDA’s current focus on nicotine. To this end, the current
studies compared the relative abuse liability of CS and EC aerosol extracts to that of
nicotine alone (NRT analog) using intracranial self-stimulation (ICSS) in rats. Methods
and Results. Chemical analyses indicated that CS extract contained higher levels of
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
several behaviorally active non-nicotine constituents (e.g., acetaldehyde, nornicotine)
than EC extract. Nicotine alone reduced ICSS thresholds at a moderate nicotine dose,
suggesting a reinforcement-enhancing eect that may promote abuse liability, and
elevated ICSS thresholds at a high nicotine dose, suggesting an aversive/anhedonic
eect that may limit abuse liability. In contrast, CS extract did not lower ICSS thresholds
at any nicotine dose, and produced greater elevations in ICSS thresholds than nicotine
alone at high nicotine doses. Eects of EC extract on ICSS did not dier from those of
nicotine alone. These ndings demonstrate lower abuse liability of CS extract, but not
EC extract, compared to nicotine alone as measured using ICSS. Conclusion. Together
these ndings suggest that the centrally-mediated eects of non-nicotine constituents
may not contribute to the greater abuse liability of cigarettes compared to non-combusted
products, and that other factors (e.g., sensory eects, etc.) may play a more important
role. Further work to identify the non-nicotine constituent(s) mediating the eects of CS
extracts in this study could help clarify the role of non-nicotine constituents in tobacco
use and inform FDA product standards.
FUNDING: Federal; Nonprot grant funding entity
PP-82
ADOLESCENT NICOTINE TREATMENT ENHANCES THE
MOTIVATION TO SELF-ADMINISTER NICOTINE IN RATS: A
BEHAVIORAL ECONOMICS APPROACH
Ranjith kumar Chellian, Azin Behnood-Rod, Ryann Wilson, Adriaan W. Bruijnzeel.
Department of Psychiatry, University of Florida, Gainesville, FL, USA.
Signicance: Tobacco use is on the decline among US adults, but e-cigarettes use
has increased alarmingly among young people in recent years. Adolescent nicotine use
increases the risk for becoming a regular smoker and developing a nicotine addiction
later in life. The FDA has the authority to regulate the sale and marketing of tobacco
products to protect public health. An increase in the price of cigarettes reduces smoking.
Therefore, we investigated if adolescent nicotine exposure enhances the motivation
for nicotine self-administration in adulthood using a behavioral economics approach.
Methods: Adolescent male Wistar rats were treated with saline or nicotine (0.4 mg/kg,
sc) from postnatal day (P) 24-42. Nicotine-induced locomotor sensitization was studied in
the small open eld test (OFT) after the 1st, 2nd, and 6thnicotine injection. During adulthood
(>P75), locomotor activity was measured in the OFT in a drug-free state and then a
catheter was implanted in the jugular vein. The acquisition of intravenous nicotine (0.03
mg/kg/inf) self-administration (3h/day) was measured for 12 days under a xed ratio
(FR) 1 and FR 2 reinforcement schedule. After this, the price of nicotine was gradually
increased by increasing the response requirements (FR 2-480). A behavioral economics
approach (demand curve analysis) was used to estimate the elasticity of demand for
nicotine. Results: Repeated nicotine administration increased locomotor activity over
time and did not aect locomotor activity in a drug-free state in adulthood. During the
acquisition phase, the nicotine-treated rats self-administered the same amount of nicotine
as the saline-treated controls. When the response requirements (price) were increased,
nicotine intake declined. The demand for nicotine was less elastic in the nicotine-treated
rats than in saline-treated controls. Conclusion: These results indicate that adolescent
nicotine treatment enhances the motivation for nicotine self-administration in adulthood.
Therefore, the use of nicotine products during adolescence may make it more dicult
to quit using tobacco or e-cigarettes in adulthood.
FUNDING: Federal
PP-83
MODELING CHRONIC NICOTINE EXPOSURE IN MICE USING AN
ELECTRONIC NICOTINE DELIVERY SYSTEM
Laura B. Murdaugh, Cristina Miliano, Christine L. Faunce, Irene Chen, Nicholas M.
Russel, Ann M. Gregus, Matthew Buczynski. Virginia Tech, Blacksburg, VA, USA.
Signicance: Nicotine dependence is among the leading causes of preventable death
worldwide, with high relapse rates in those attempting to quit. Electronic Nicotine Delivery
Systems (ENDS) represent a novel approach to create preclinical animal models of
nicotine dependence via inhalation. The aim of this study was to validate a new model
of chronic nicotine exposure in mice using an ENDS. Methods: We chronically exposed
the mice to either nicotine (20 mg/ml), vehicle (propylene glycol:glycerol, 50:50), or
room air during 8-hour daily sessions for 5 days per week (M-F) for up to 10 weeks,
and produced a dose-response curve using dierent inter-vape frequencies (5, 10, 15,
or 60 min). Results: First, we validated vapor chambers (La Jolla Vapor) by performing
a pharmacokinetic study using ultra performance liquid chromatography tandem mass
spectrometry (UPLC-MS/MS) to quantify nicotine and cotinine levels in blood. Next,
we assessed the eect of dierent exposure doses on body weight, locomotor activity,
and physical signs of nicotine dependence (spontaneous somatic signs and tactile al-
lodynia). At a dose that produces signs of nicotine dependence (10 min frequency), we
evaluated the eect of nicotine abstinence on anxiety-like behaviors (open eld test and
light/dark box) and depressive-like behaviors (splash test and sucrose preference test).
Conclusions: These results indicate that ENDS produce dose-dependent molecular
and behavioral eects in mice that recapitulate nicotine dependence.
FUNDING: Federal
PP-84
EFFECTS OF E CIGARETTE AEROSOL EXPOSURE ON THE
MUCOCILIARY AIRWAY EPITHELIUM
Arunima Purkayastha1, Chadani Sen2, Abdo Durra2, Cody Aros2, David Shia2, Tammy
Rickabaugh2, Steven Jonas2, Brigitte Gomperts2. 1University of California, Los Angeles,
Los Angeles, CA, USA, 2UCLA, Los Angeles, CA, USA.
The last decade has witnessed a rapid increase in the use of e-cigarettes (e-cig),
especially among teenagers and young adults. It is a serious public health concern
because we do not yet know the extent of the possible health eects. The market for
e-cigs is not well regulated and that is compounded by the fact that very little is known
about the potential adverse eects of e-cigs on the airway. In this study we used an
in vitro culture system to test e-cig aerosol components. We used primary human and
mouse airway basal stem cells (ABSCs) to generate air-liquid interface cultures with
a well dierentiated mucociliary airway epithelium and subsequently tested the eects
of e-cig aerosol components on ABSC proliferation and the percentage of mucus and
ciliated cells. We found that the aerosol carriers, propylene glycol (PG) and vegetable
glycerin (VG) with or without nicotine increased ABSC proliferation rates and reduced
the percentage of ciliated cells. The addition of 3% and 5% nicotine to PG/VG induced
more mucus cells. However, the most striking eect was seen with the addition of four
dierent Juul avors. Of the four dierent avors tested, each had slightly dierent eects
on the repair and regeneration process. It is interesting to note that the mango, mint
and classic tobacco avors showed very similar eects to combustible cigarette smoke
in terms of increased ABSC proliferation, loss of ciliated cells and increased Muc5AC+
mucus cells. Staining of the mucociliary epithelium with dihydroethidium (DHE) dye for
reactive oxygen species (ROS) revealed that ROS levels were increased to dierent
levels with aerosols from the four dierent Juul avors. Overall, our data suggests that
there could be signicant deleterious health eects on mucociliary clearance induced by
e-cigs and that these could be similar to the airway health eects seen with traditional
combustible cigarettes.
FUNDING: State; Nonprot grant funding entity
PP-85
OVER ONE YEAR LATER - EVALI AWARENESS, KNOWLEDGE
AND IMPACT ON E-CIGARETTE USE INTEREST AMONG
SMOKERS AND YOUNG ADULT NON-SMOKERS
Olivia Wackowski1, Stefanie Gratale1, Michelle Jeong1, Cristine Delnevo1, Michael
Steinberg1, Richard O’Connor2. 1Rutgers Center for Tobacco Studies, New Brunswick,
NJ, USA, 2Roswell Park Comprehensive Cancer Center, Bualo, NY, USA.
Signicance: The e-cigarette or vaping product use-associated lung injury (EVALI) out-
break caused serious lung injuries in over 2800 people in fall 2019. By February 2020,
most cases were determined as being linked with vaping tetrahydrocannabinol (THC),
including black market products using vitamin E acetate. However, public knowledge
about the determinants of EVALI is unclear. This study examined EVALI awareness,
knowledge and perceived impact on e-cigarette interest approximately 16 months after
its peak. Methods: Between January-February 2021, we surveyed 1018 adult smokers
and 1051 young adult (YA) non-smokers (ages 18-29) from a nationally representative
US research panel. Participants were asked if they had heard about EVALI prior to
COVID-19, knew its main cause, and if EVALI had impacted their interest in future
e-cigarette use.Results: Approximately 54% of smokers and YA non-smokers had heard
of EVALI. Among those who had heard of EVALI (n=1111), about one-third believed its
main cause was e-cigarettes used to vape nicotine, like JUUL. Fewer (15.3%) thought
the main cause was products for vaping marijuana/THC, and 19.1% did not know. About
27% had heard vitamin E acetate was associated with EVALI, and 47.1% indicated
EVALI made them less interested in using e-cigarettes in the future (including over 50%
of those who had ever used e-cigarettes before). Smokers who were less interested
in e-cigarettes because of EVALI had a lower prevalence of past 30-day use of e-cig-
arettes (33.4%) relative to those who said it had no impact on their interest (53.1%)
(p=0.01). EVALI awareness was also associated with a higher prevalence of perceiving
e-cigarettes as being as or more harmful than smoking (p<.01).Conclusions: Despite
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
the passage of time, considerable lack of knowledge and misperceptions about EVALI
remain. Our ndings suggest the need for cross-sectoral collaboration to promote better
understanding of EVALI and appropriate behavioral and policy responses.
FUNDING: Federal
PP-86
BLUNTS AND BLACK AND MILDS: UNPACKING LITTLE CIGAR
AND CIGARILLO TERMINOLOGY AMONG AFRICAN AMERICAN/
BLACK AND HISPANIC/LATINO TEENS
Emily C. Sanders1, Dawnyéa Jackson2, Megan Wall1, Mario Navarro1, Molly Barry2,
Dana Wagner2. 1FDA, Silver Spring, MD, USA, 2Rescue Agency, San Diego, CA, USA.
Signicance: Despite recent decreases in the use of little cigars and cigarillos (LCCs),
African American/Black and Hispanic/Latino teens remain disproportionately more
susceptible and likely to use these products compared to White teens. Addressing this
disparity requires a clear understanding of the way current and susceptible users refer
to and categorize LCCs. Prior research among adults has revealed key dierences in
the terminology used by researchers and policy makers compared to users of LCC
products which can hinder public health eorts. This study, funded by the Food and Drug
Administration, adds to the literature by looking at terminology used by teens. Methods:
Twenty-eight virtual focus groups with teens ages 13-17 (n = 105) were conducted
across the U.S. Groups were split by race/ethnicity, with 14 African American/Black and
14 Hispanic/Latino groups, and further divided by LCC experimenters and susceptible
users. Topics covered during focus groups included LCC use behaviors, harm and risk
perceptions, and knowledge, attitudes, and beliefs. Participants also completed an
online survey about tobacco use behaviors and risk perceptions. Demographic and use
pattern information from survey data along with transcripts were reviewed and analyzed.
Results: When shown photos of LCC products during focus group discussions, teens
across groups identied and labeled these products into three subcategories. Untipped
cigarillos were commonly identied as “blunts” or specic brand names (e.g., Dutches,
Backwoods), and categorized as cannabis products. Tipped cigarillo products were
often synonymous with the brand Black and Mild and categorized as tobacco products.
Little cigars were generally unfamiliar and sometimes confused with cigarettes. While
results were comparable across groups, susceptible Hispanic/Latino teens were more
unfamiliar with LCCs compared to susceptible African American teens. Conclusions: The
current study underscores the need to rethink the terminology of LCCs to better align
with the language used by teens in order to strengthen future research and surveillance,
instrument design and public health messaging.
FUNDING: Federal
PP-87
E-CIGARETTES FOR SMOKING CESSATION AND THEIR
LONG TERM USE IN THIS POPULATION. COCHRANE LIVING
SYSTEMATIC REVIEW
Ailsa R. Butler1, Annika Theodoulou1, Nicola Lindson1, Hayden McRobbie2, Chris
Bullen3, Rachna Begh1, Caitlin Notley4, Nancy Rigotti5, Tari Turner6, Thomas Fanshawe1,
Peter Hajek7, Jamie Hartmann-Boyce1. 1University of Oxford, Oxford, United Kingdom,
2University of New South Wales, Sydney, Australia, 3University of Auckland, Auckland,
New Zealand, 4University of East Anglia, Norwich, United Kingdom, 5Massachusetts
General Hospital and Harvard Medical School, Boston, MA, USA, 6Monash University,
Melbourne, Australia, 7Queen Mary University of London, London, United Kingdom.
Signicance: There is interest in both whether e-cigarettes (EC) help people to quit
smoking and how long people continue to use EC or other pharmacotherapy after
quitting. We incorporate this new outcome into our Cochrane living systematic review
of EC for smoking cessation after feedback from readers and stakeholders. We also
assess the evidence on the eectiveness, tolerability and safety of using EC to help
people who smoke achieve long-term smoking abstinence and now also present nd-
ings on the proportion of people still using study product, EC or pharmacotherapy, at
study end or longest follow up (FU). Methods: We searched monthly for studies that
tested EC interventions in people who smoke. Studies had to report abstinence from
cigarettes at 6 months or longer and/or data on adverse events or other markers of
safety at a week or longer. Results: We include 63 studies (n=16,944) in the analysis.
We found moderate-certainty evidence that ECs with nicotine increase quit rates
compared to ECs without nicotine and compared to NRT. Evidence comparing nicotine
EC with usual care/no treatment also suggests benet, but is less certain. We did not
detect any clear evidence of harm from nicotine EC, but longest FU was two years
and the overall number of studies was small. Where available we extracted data on
the proportion of people still using study product at longest FU. Studies of nicotine EC
vs NRT gave diering results, one found no dierence in the proportion of participants
still using study product at longest follow-up, and the other found signicantly higher
levels of EC use than NRT. In studies comparing nicotine EC with non-nicotine EC,
there was no evidence of a dierence in proportion of people still using EC at longest
FU. Of the included studies which reported study product use at 6 months or longer 8
of 12 reported 50% or more participants still using EC at longest follow up. Conclusion:
Data consistently signal benet of nicotine EC for smoking cessation and we did not
detect any clear evidence of harm. In many studies, more than half the participants who
were using EC continued to use EC at longest FU. Funding: This work is supported by
Cancer research UK (CRUK)
FUNDING: Nonprot grant funding entity
PP-88
COMMUNITY WIC SYSTEM-INITIATED MULTILEVEL
INTERVENTION IMPROVES MATERNAL SMOKERS’ BIOVERIFIED
ABSTINENCE, BABIES LIVING SAFE AND SMOKEFREE RCT
Bradley N. Collins1, Stephen Lepore2, Brian Egleston3. 1Temple University, Philadel-
phia, PA, USA, 2Temple University, College of Public Health, Philadelphia, PA, USA,
3Fox Chase Cancer Center, Philadelphia, PA, USA.
Signicance: Low-income maternal smokers experience greater diculty quitting than
other smokers. More intensive treatment than standard care is necessary to facilitate
long-term abstinence. This study tested the ecacy of Babies Living Safe & Smoke-
free (BLiSS), a translatable multilevel intervention initiated in an urban WIC system
oering safety net health promotion programs. BLiSS applied a behavioral ecological
framework to guide multiple strategies promoting child tobacco smoke exposure (TSE)
reduction as an initial step toward long-term smoking abstinence. Methods: This RCT
used a parallel 2 group design with assessments at baseline, 3-mo end of treatment
and 12-mo follow-up. Participants were gt17 years old, daily smokers with children lt 6.
All participants received brief, clinic-based intervention from WIC nutrition professionals
trained to follow pediatrics’ best practice guidelines for tobacco intervention (Ask, Advise,
Refer/AAR). After AAR, mothers were randomized to the multimodal BLiSS behavioral
intervention (AAR+MBI, n=199) or an attention control nutrition intervention (AAR+Con-
trol, n=197). Results: There was a signicant treatment eect on bioveried (cotinine)
abstinence through 12-month follow-up (OR 9.55, 95%CI 1.54 59.30, p=.015) favoring
AAR+MBI. There were signicant eects of time and condition x time (p’s lt .001) on
reported child TSE through 12 months favoring AAR+MBI, but no group dierences in
child cotinine. Higher baseline tobacco dependence was signicantly associated with
greater reported child TSE, higher child cotinine and lower likelihood of maternal absti-
nence. Conclusions: The BLiSS intervention was acceptable, feasible and ecacious
in a population with elevated challenges to smoking behavior change. The abstinence
outcome is particularly notable. Future directions will be discussed.
FUNDING: Federal
PP-89
PERCEPTIONS OF HARM AND ADDICTION ON THE AGE OF
INITIATION OF CIGAR USE AMONG YOUTH-FINDINGS FROM THE
POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH)
STUDY, 2013-2017
Baojiang Chen1, Kymberle Sterling2, Meagan Bluestein1, Arnold Kuk1, Melissa Harrell1,
Folefac Atem2, Adriana Perez1. 1University of Texas Health Center at Houston, Austin,
TX, USA, 2University of Texas Health Center at Houston, Dallas, TX, USA.
Objective To examine if perceptions of harmfulness and addictiveness of cigar prod-
ucts are associated with the age of initiation of any cigar product use among youth.
Methods Youth (12-17 years old) never users of any cigar product at their rst wave
of PATH participation in waves 1-2 (2013-2015) were included in the analysis. Partic-
ipants had their age of initiation followed-up in waves 2-4 (2014-2017) for (i) ever, (ii)
past 30-day, and (iii) fairly regular use of any cigar product (cigarillo, ltered cigar or
traditional cigar). An upper and a lower age bound was specied, between which the
initiation of each outcome occurred. Two exposures measuring perceptions of harm and
addictiveness at the rst wave of PATH participation were used. The interval-censored
Cox proportional hazards models with the piecewise constant baseline hazard function
were used to study the interaction of perceptions of harm (high vs low/medium) and
addiction (high vs low/medium) on the age of initiation of any cigar product use, adjusting
for sex, race/ethnicity, and the total number of other tobacco products used previously.
Results Youth who perceived any cigar to be low/medium harmful and high addictive
(HR: 1.33, 95% CI: 1.15-1.53), and low/medium harmful and low/medium addictive
(HR: 1.60, 95% CI: 1.36-1.89) were more likely to initiate ever any cigar product use at
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
earlier ages than those who perceived any cigar to be high harmful and high addictive.
Youth who perceived any cigar to be low/medium harmful and low/medium addictive
(HR: 1.46, 95% CI: 1.14-1.86) were also more likely to initiate past 30-day use of any
cigar product at earlier ages than those who perceived any cigar to be high harmful
and high addictive. Youth who perceived any cigar to be high harmful and low/medium
addictive (HR: 0.24, 95% CI: 0.07-0.83) were less likely to initiate fairly regular use of
any cigar at earlier ages than those who perceived any cigar to be high harmful and
high addictive. Conclusions The perceptions of harmfulness and addictiveness of cigar
products should be addressed in education campaigns for youth to prevent earlier age
of initiation of all cigar products.
FUNDING: Federal
PP-90
LONGITUDINAL ASSOCIATIONS BETWEEN EXCLUSIVE AND
DUAL USE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS
AND CIGARETTES AND CARDIOVASCULAR DISEASE AMONG
ADULTS
Jana L. Hirschtick1, Steven Cook1, Akash Patel1, Georey D. Barnes1, Douglas Aren-
berg1, Irina Bondarenko1, David T. Levy2, Jihyoun Jeon1, Evelyn Jimenez Mendoza1,
Rafael Meza1, Nancy L. Fleischer1. 1University of Michigan, Ann Arbor, MI, USA,
2Georgetown University Medical Center, Silver Spring, MD, USA.
Signicance: The cardiovascular health eects of electronic nicotine delivery systems
(ENDS) use are not well characterized, making it dicult to assess the potential of
ENDS use as a harm reduction tool for adults who use cigarettes. Methods: Using
waves 1-5 of the Population Assessment of Tobacco & Health Study, we analyzed
the risk of incident myocardial infarction (MI) and stroke associated with ENDS and/or
cigarette use among adults aged 40 and older using discrete time survival models. We
employed a time-varying tobacco product exposure lagged by one wave, dened as
exclusive or dual established use of ENDS and/or cigarettes every day or some days.
We controlled for demographics (age, sex, race/ethnicity, educational attainment),
clinical factors (hypertension, diabetes, family history of premature heart disease), and
past smoking history (cigarette pack-years). Results: The analytic sample (n=11,031)
was predominantly female (55%) and non-Hispanic White (71%) with a mean age of 58
years. At baseline, 14% of respondents exclusively smoked cigarettes, 0.6% exclusively
used ENDS, and 1.0% used both products. Incident MI and stroke were rare during
the ve-year follow-up period (<1% at each wave). Compared to no cigarette or ENDS
use, exclusive cigarette use increased the risk of MI (aHR 1.99, 95% CI 1.40-2.84) and
stroke (aHR 2.26, 95% CI 1.51-3.39), while exclusive ENDS use (MI: aHR 0.61, 95%
CI 0.12-3.04; stroke: aHR 1.74, 95% CI 0.55-5.49) and dual use (MI: aHR 1.84, 95% CI
0.64-5.30; stroke: aHR 1.12, 95% CI 0.33-3.79) were not signicantly associated with
the risk of either outcome. Conclusions: While exclusive cigarette use increased the
risk of incident diagnosed cardiovascular disease over a ve-year period compared to
non-use, ENDS use did not. For adults using cigarettes, transitioning to exclusive ENDS
use would decrease the short-term risk of cardiovascular disease.
FUNDING: Federal
PP-91
CO-DESIGNING NOVEL VAPING CESSATION INTERVENTIONS
WITH YOUTH AND YOUNG ADULTS: THE STOP VAPING
CHALLENGE AND POSTCARDS FROM THE FUTURE
Sherald Sanchez1, Patrick Feng1, Pamela Kaufman1, Bruce Baskerville2, Robert
Schwartz1, Michael Chaiton1. 1University of Toronto, Toronto, ON, Canada, 2Canadian
Institutes of Health Research, Ottawa, ON, Canada.
Signicance: In 2020, the US Surgeon General’s Report on Smoking Cessation iden-
tied the development of vaping cessation interventions as a research priority. To this
end, we recruited help-seeking youth in the co-design of vaping cessation interventions.
Meaningful co-design in applied health services research has been shown to benet
researchers and end users, as well as the research process and research outcomes.
We present evaluation ndings of the co-design process and explore its impact on the
development of two novel vaping cessation interventions. Methods: Between May
and June 2020, we held two intensive design activities aimed at developing vaping
cessation interventions: a weekend ‘hackathon’ with young adults (ages 19-29) and a
series of longitudinal asynchronous activities with youth (ages 16-18). The implemen-
tation of the co-design process was evaluated using anonymous evaluation forms and
condential phone interviews (total n = 35). Responses were coded using a ve-step
constant comparative analysis approach. Due to COVID-19, all data collection activities
were conducted remotely through various Internet-based research platforms. Results:
The co-design events demonstrated that frameworks used for smoking cessation are
insucient when applied to vaping and that novel interventions are needed. Insights from
participants led to several proposed interventions, two of which were identied for further
development and production: Stop Vaping Challenge and Postcards from the Future.
Evaluation data demonstrated high satisfaction with the engagement process. Notably,
some participants reported changing their behaviour as a result of their participation
in the design process and the self-reection this engendered. Conclusions: There is
an urgent need for vaping cessation interventions developed for and by young people
that take into account their subjective experiences and the dierences from smoking
cessation paradigms. Meaningful co-design research is a promising approach to devel-
oping eective interventions that capture the complexities of health behaviour change.
FUNDING: Federal
PP-92
PATTERNS OF DAILY CIGARETTE AND E-CIGARETTE USE
AMONG US YOUTH AND YOUNG ADULTS: INSIGHTS FROM THE
TRUTH LONGITUDINAL COHORT BETWEEN 2018 AND 2019
Elizabeth C. Hair1, Elizabeth K. Do1, Michael Liu1, Tarik Benmarhnia2, John Pierce2.
1Truth Initiative, Washington, DC, USA, 2University of California San Diego, La Jolla,
CA, USA.
Signicance: Patterns of experimentation with tobacco products has changed con-
siderably over the past decade, with more youth and young adults experimenting with
multiple tobacco products. A recently conducted study, using the nationally PATH Study
data, suggested that youth who use e-cigarettes are at markedly increased risk of later
daily cigarette smoking. However, this study was undertaken prior to the introduction
of JUUL, a high nicotine e-cigarette that has gained market predominance. Methods:
This study examines temporal patterns of daily cigarette and e-cigarette use among ever
tobacco users from the Truth Longitudinal Cohort (TLC). The TLC includes youth and
young adults surveyed at six-month intervals. The analytic sample (N=7891) includes
individuals aged 15-36 years, who had ever used any tobacco product at wave 7 (2018)
and provided information about daily tobacco use at wave 9 (2019). Results: At Wave
7, 12.6% indicated that they were daily tobacco users and 18 months later, an additional
3.0% became new daily users. By Wave 9, 45% of daily cigarette smokers only used
cigarettes and 56% of daily e-cigarette users only used e-cigarettes. An estimated
27.2% of e-cigarette experimenters at Wave 7 had transitioned to become daily cigarette
smokers at Wave 9 - a much smaller proportion than that seen in the PATH Study. This
may be attributed to the predominance of JUUL, as two thirds of all e-cigarette users
at Wave 9 used JUUL products. Furthermore, new daily users were more likely to be
under 21 years old and to have less than a high school education. Patterns of daily
use changed across age groups, as >60% of daily users were under 21 years, 39.7%
among those 22-24 years, 32.7% among those 25-28 years, and 25.9% among those
29-36 years. Conclusion: These are the rst results to show that the epidemic of JUUL
experimentation among adolescents in recent years has led to high rates of addiction to
e-cigarettes, while conrming that over a quarter of e-cigarette experimenters become
daily cigarette smokers. Results suggest that policies and public education focused
on reducing nicotine use among youth and young adults are essential to change the
trajectory of this epidemic.
FUNDING: Unfunded
PP-93
TOBACCO AND E-CIGARETTE USE BEHAVIOR TRANSITIONS
AMONG A YOUTH AND YOUNG ADULT SAMPLE
Elizabeth K. Do, Shreya Tulsiani, Donna M. Vallone, Elizabeth C. Hair. Truth Initiative,
Washington, DC, USA.
Signicance: Several cross-sectional and longitudinal studies demonstrate signicant
associations between e-cigarette use and future combustible use, as well as continued
use of e-cigarettes. Though, information on patterns of use across time remains lim-
ited. The purpose of this study was to characterize patterns of use across cigarettes,
e-cigarettes, and little cigars, cigarillos, and cigars (LCCs) and determine trajectories
of these use patterns using latent class and latent transition analyses. Methods: Sur-
vey data were drawn from the Truth Longitudinal Cohort, a nationally representative,
probability-based cohort which includes youth and young adults (15-27 years). To be
included in this study, participants had to have indicated that they had ever used ciga-
rettes, e-cigarettes, or LCCs at wave 7 (2018) of data collection. Participants also had
to have provided information on past 30 day use of these tobacco products at waves 7,
8, and 9 (N = 5748, 2018-2019). Results: Four latent classes characterizing use were
identied: noncurrent users, infrequent polytobacco users, frequent cigarette users,
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
and frequent e-cigarette users. Although users tended to retain their latent status over
time (91% of noncurrent users, 64% of infrequent polytobacco users, 62% of frequent
cigarette users, and 68% of frequent e-cigarette users from wave 7 to wave 8), tran-
sitions from one latent class to another also occurred. The probability of transitioning
from noncurrent user to frequent e-cigarette user was 7%, infrequent polytobacco user
to frequent e-cigarette user was 9%, and frequent cigarette user to frequent e-cigarette
user was 15% from Time 1 (2018) to Time 2 (Early 2019). During the same time, the
probability of transitioning from noncurrent tobacco user to frequent cigarette user was
1%, infrequent polytobacco user to frequent cigarette user was 11%, and frequent
e-cigarette user to frequent cigarette user was 4%. Similar patterns are found for the
transition from Time 2 (Early 2019) to Time 3 (Late 2019). Conclusion: Results suggest
that although users remained loyal to their initial product, a considerable proportion of
tobacco users transitioned to e-cigarette use. More research is needed to determine
predictors of changes in tobacco product use across time and how these transitions
inuence product cessation.
FUNDING: Unfunded
PP-94
NICOTINE DEPENDENCE, OTHER TOBACCO USE, AND
CANNABIS USE: DIFFERENCES AMONG LIGHT AND HEAVY
ADOLESCENT AND YOUNG ADULT E-CIGARETTE USERS
Jill M. Singer1, Alayna P. Tackett 2, Theodore L. Wagener1, Marielle Brinkman1, Bo Lu1,
Miranda B. Kinsell1, Clara Rykaczewski1, Megan E. Roberts1. 1The Ohio State Univer-
sity, Columbus, OH, USA, 2University of Southern California, Los Angeles, CA, USA.
Signicance: Among adolescents and young adults (AYAs), current use of e-cigarettes
(EC) is commonly dened as any use in the past 30 days. However, few studies have
examined dierences between users within that broad category. Understanding how
current EC users may dier based on the frequency of use is important to inform more
targeted intervention and cessation eorts. This study examined characteristics (e.g.,
nicotine dependence, other tobacco product use, cannabis use) of AYAs who used
ECs infrequently (light users) and those who used ECs more frequently (heavy users).
Methods: Our analysis included nearly 500 Ohio AYAs between the ages 15-24 who
reported using an EC to vape nicotine in the past 3 months. Using previous literature to
dene frequency of use, participants who used an EC ≤ 19/30 days were classied as
light users and 20-30 days were classied as heavy EC users. Participants completed
online measures assessing characteristics outlined above. Two-sample t-tests and
chi-square tests were used to detect dierences between the user groups. Results:
Heavy EC users had higher nicotine dependence scores, assessed by the e-cigarette
dependence scale (EDS), (p<.001), were more likely to have tried cigarettes as their
rst tobacco product (p=.01), were more likely to know what type of nicotine was in
their EC (p<.001), and were more likely to have used cannabis (any form) in the past
30 days (p=.02) than light users. No dierence was observed between light vs. heavy
EC users with co-use of another tobacco product (e.g., cigarettes). Conclusion: Our
results suggest that frequency of use is an important characteristic in understanding
EC use among AYAs, suggesting any past 30 day use may not be a sensitive enough
measurement for understanding dependence among this population. Monitoring co-
use of cannabis will be important in understanding how this relates to EC use among
AYAs. Characterizing current EC users by their frequency of use may provide mean-
ingful information that allows public health professionals to better target intervention
and cessation eorts to AYAs.Funding: This study was funded by the American Heart
Association (20YVNR35490079).
FUNDING: Federal
PP-95
INVESTIGATING THE SUBSTITUTABILITY OF ALTERNATIVE
TOBACCO AND NICOTINE PRODUCTS FOR CONVENTIONAL
CIGARETTES IN THE EXPERIMENTAL TOBACCO MARKETPLACE
AMONG VULNERABLE POPULATIONS
Kaitlyn O. Browning1, Tyler Nighbor1, Anthony C. Oliver1, Ellaina N. Reed1, Michael J.
DeSarno1, Warren K. Bickel2, Stephen T. Higgins1. 1University of Vermont, Burlington,
VT, USA, 2VA Tech Carilion Research Institute, Roanoke, VA, USA.
The experimental tobacco marketplace (ETM) is an online marketplace wherein,
through increasing the price of cigarettes, one can investigate the substitutability of
other xed-price nicotine and tobacco products (e.g., e-cigarettes) for cigarettes. As
such, the ETM is useful for modeling the eects of potential policy changes on use
of various concurrently available products. To our knowledge, the ETM has not been
used to investigate cigarette demand and product substitutability among populations
especially vulnerable to smoking. In this study, participants were 22 adult daily smokers
with comorbid psychiatric conditions or socioeconomic disadvantage. In each session,
cigarette prices increased ($0.12, $0.25, $0.50, $1.00, $2.00 per cigarette) while prices
for other products (JUUL e-cigarettes, little cigars and cigarillos (LCCs), snus, chew, gum,
lozenges) remained xed. Across three ETM sessions, either all products, all products
except LCCs, or all products except JUUL were available. Linear regression was per-
formed on group mean data as a function of log-transformed cigarette price to determine
demand and substitution. Cigarette demand decreased as a function of increasing price
in all sessions, as evident by signicant non-zero slopes (ps≤.001). When all products
were available, JUUL substituted for cigarettes. That is, JUUL purchasing increased
as a function of increasing cigarette price, as evident by a positive, signicant non-zero
slope (p=.002). When JUUL was unavailable, LCCs did not substitute for cigarettes,
with a slope not signicantly dierent than zero (p=.47). When LCCs were unavailable,
the JUUL slope remained positive, but not signicantly so (p=.06). Participants rarely
purchased other products. Overall, JUUL was the preferred substitute when constraints
on cigarettes increased in the current study with vulnerable populations, suggesting
that JUUL availability could be an important moderator of the eect of tobacco regu-
latory policies on conventional combusted cigarettes. We saw no evidence that LCCs
substituted for cigarettes, but that observation should be interpreted cautiously pending
further investigation. Funding: Centers of Biomedical Research Excellence (COBRE)
NIGMS NIH award P20GM103644; Tobacco Centers of Regulatory Science (TCORS)
NIDA and FDA award U54DA036114
FUNDING: Federal
PP-96
EFFECTIVENESS OF WHATSAPP ONLINE GROUP DISCUSSION
FOR SMOKING RELAPSE PREVENTION: A PRAGMATIC
RANDOMIZED CONTROLLED TRIAL
Yee-Tak Derek Cheung1, Qi Wang1, Ching Han Helen Chan2, Michael Conway3, Carlos
King Ho Wong4, Man Ping Wang1, William Ho Cheung Li5, Tai Hing Lam6. 1School of
Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, 2Tung
Wah Group of Hospitals Integrated Centre on Smoking Cessation, Hong Kong, Hong
Kong, 3Department of Biomedical Informatics, University of Utah, Salt Lake City, UT,
USA, 4Department of Family Medicine and Primary Care, The University of Hong Kong,
Hong Kong, 5The Nethersole School of Nursing, Faculty of Medicine, The Chinese
University of Hong Kong, Hong Kong, 6School of Public Health, The University of Hong
Kong, Hong Kong.
Study aims This study aims to examine the eectiveness of WhatsApp group discussion
intervention for smoking relapse prevention compared with SMS (short message service)
text messages. Design This is a 2-arm open-labeled pragmatic randomized controlled
trial. Setting The recruitment sites were smoking cessation clinics in Hong Kong.
Participants Smokers who smoke at least one cigarette per day at the service intake
and no smoking for 3 to 30 days before enrolment in the study (n=928; 79.7% male).
Interventions Participants were randomized to receive 8-week standardized messages
about relapse prevention in a WhatsApp discussion group led by trained moderators
(experimental, n=469) or SMS with similar content for 8-weeks (3 messages each week,
control, n=459). The messages sent in the experimental and control groups were based
on the US Clinical Practice Guidelines on Treating Tobacco Use and Dependence.
Measurements The primary outcome is biochemically validated tobacco abstinence at
12-month follow-up. Secondary outcomes include the prevalence of self-reported 7-day
and continuous abstinence over the study period and relapse rate. Text-mining of the
WhatsApp group conversations were conducted by using structural topic modelling. Re-
sults By intention to treat, the experimental group (13.6% and 11.5% at 6- and 12-month
follow-up) and the control group (13.9% and 11.3% at 6- and 12-month follow-up) showed
a similar rate of biochemically validated quit rate (RR (risk ratio) =0.98 and 1.02 for the
6- and 12-month follow-up, respectively, all p-values > 0.05). The self-reported 7-day quit
rate (RR=0.97, 0.91 and 0.91 for 3-, 6-, 12-month follow-ups, respectively, all p-values
> 0.05), continuous abstinence and relapse rate were similar in both groups. The text
mining showed that the WhatApp groups facilitated moderators’ delivery of quitting
methods and psychological encouragement. Quitters were more likely than smokers to
share experience in seeking help from healthcare proviers and quitting methods. The
unsupervised text mining showed similar classications as the pre-dened contextual
lexicons in the heat-map visualization. Discussion The study's ndings showed that
the WhatsApp group intervention did not signicantly improve relapse prevention results
compared with the SMS messages. The unsupervised text mining apparently showed its
validity in classifying posts as our pre-dened contextual lexicons, supporting its future
application to analyze online health-related group conversation.
FUNDING: Other: Health and Medical Research Fund of Hong Kong
222
2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
PP-97
ELECTRONIC NICOTINE DELIVERY SYSTEMS (ENDS) USE
DURING A SIX-YEAR PERIOD IS NOT ASSOCIATED WITH SELF-
REPORTED CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD) AFTER PROPER ADJUSTMENT OF CIGARETTE SMOKING
HISTORY; A LONGITUDINAL ANALYSIS OF PATH DATA
Rafael Meza1, Steven Cook1, Jihyoun Jeon1, David Levy2, Jana Hirschtick1, Nancy
Fleischer1. 1University of Michigan, Ann Arbor, MI, USA, 2Georgetown University Medi-
cal Center, Silver Spring, MD, USA.
Signicance: Understanding the relationship between electronic nicotine delivery
systems (ENDS) use and chronic obstructive pulmonary disease (COPD) and other
respiratory conditions is critical. However, previous studies have not adequately con-
trolled for history of cigarette smoking. Methods: Using waves 1-5 of the PATH study,
we examined the association between ENDS use and self-reported incident diagnosed
COPD among adults aged 40+ using discrete time survival models. Current ENDS use
was measured as a time-varying covariate, lagged by one wave, dened as 1+ days
used in the past 30 days. We controlled for baseline demographics (age, sex, race/
ethnicity, education), health characteristics (asthma, obesity, exposure to second-hand
smoke), and smoking history (smoking status, cigarette pack-years and years since
quit). Results: Incident COPD was self-reported by 926 respondents during the ve-year
follow-up period. At baseline, 1.4% of respondents reported past 30-day ENDS use.
Prior to adjusting for other covariates, time-varying ENDS use nearly doubled the risk
of incident COPD (HR 1.98, 95% CI 1.44-2.73). However, ENDS use was no longer sig-
nicantly associated with COPD (aHR 1.11, 95% CI 0.79-1.57) after adjusting for current
cigarette smoking (aHR 2.93, 95% CI 2.43-3.65). The risk of self-reported incident COPD
increased with the log of cigarette-pack-years and was higher for older respondents,
females, less educated, and those with baseline asthma and obesity. Conclusions:
ENDS use did not signicantly increase the risk of self-reported incident COPD over a
ve-year period once current smoking status and cigarette pack-years were included
in multivariable models. Cigarette pack-years, on the other hand, was associated with
a net increase in the risk of diagnosed COPD. These ndings highlight the importance
of using prospective longitudinal data and properly controlling for cigarette smoking
history to assess the independent health eects of ENDS use. Funding Statement:
Supported by NIH/FDA grant U54CA229974. The content is solely the responsibility of
the authors and does not necessarily represent the ocial views of the NIH or the FDA.
FUNDING: Federal
PP-98
CHANGES IN PERCEPTIONS OF HARMFULNESS OF HEATED
TOBACCO PRODUCTS COMPARED TO COMBUSTIBLE
CIGARETTES: FINDINGS FROM THE 2018-2020 ITC JAPAN
SURVEYS
Edward Sutanto1, Connor R. Miller1, Danielle M. Smith1, Shannon Gravely2, Steve
S. Xu2, Janine Ouimet2, Anne C.K Quah2, Georey T. Fong2, Takahiro Tabuchi3, Itsuro
Yoshimi4, Katanoda Kota4, Maciej L. Goniewicz1. 1Roswell Park Comprehensive Cancer
Center, Bualo, NY, USA, 2University of Waterloo, Waterloo, ON, Canada, 3Osaka
International Cancer Institute, Osaka, Japan, 4National Cancer Center, Tokyo, Japan.
Signicance: Heated tobacco products (HTPs) are often advertised by their manufactur-
ers as signicantly less harmful than combustible cigarettes. Currently, there are only a
few studies that have examined public perception of the relative harm of HTPs, and none
have examined how public perception may change over time. Methods: We analyzed
longitudinal data from the ITC Japan Survey, a nationally representative web cohort
survey of individuals aged 20 and older who participated in all 3 waves (2018, 2019,
2020). In 2018, the cohort was comprised of exclusive smokers (n=1,403), exclusive
HTP users (n=43), concurrent cigarette-HTP users (n=230), and non-users (n=215).
Weighted estimates of HTP harm perceptions relative to cigarettes were computed.
Generalized estimating equations examined correlates of perceived relative harm of
HTPs with sociodemographics, survey year, and nicotine use status (current [at least
monthly] use of cigarettes and/or HTPs). Results: There was a signicant decrease
in the proportion of Japanese adults who perceived HTPs as less harmful than cig-
arettes—from 47.1% (95% CI: 39.5-54.8%) in 2018, 48.1% (40.8-55.5%) in 2019, to
28.3% (22.8-34.5%) in 2020, and a corresponding signicant increase in perceiving
HTPs as equally harmful, or more harmful, than cigarettes—from 30.0% (23.1-38.0%)
in 2018, 25.7% (19.8-32.6%) in 2019, to 46.0% (38.8-53.3%) in 2020. No signicant
changes were observed in the proportion of Japanese adults who were uncertain of
perceived relative harms of HTPs (22.9% [17.1-29.9%] in 2018, 26.2% [19.9-33.6%]
in 2019, 25.7% [20.1-32.2%] in 2020). Respondents in 2020 had lower odds of per-
ceiving HTPs as less harmful than cigarettes compared to 2018, while exclusive HTP
users and concurrent cigarette-HTP users had higher odds of perceiving lower harm
compared to non-users. Conclusion: From 2018/2019 to 2020, there was a substantial
reduction in the proportion of Japanese adults who believed HTPs to be less harmful
than combustible cigarettes. In addition to continued monitoring of public perception
of HTPs, further study examining relationships between relative harm perceptions and
use of HTPs over time is warranted.
FUNDING: Federal; Nonprot grant funding entity
PP-99
TRENDS IN PRICE MINIMIZING BEHAVIORS BY SMOKERS
IN EUROPE BETWEEN 2006 - 2020. EVIDENCE FROM THE
INTERNATIONAL TOBACCO CONTROL (ITC) PROJECT
Cloé Geboers1, Gera E. Nagelhout1, Hein de Vries1, Math J.J.M. Candel1, Pete
Driezen2, Ute Mons3, Raphaël Andler4, Ann McNeill5, Georey Fong2, Marc Willem-
sen1. 1Maastricht University, Maastricht, Netherlands, 2University of Waterloo, Water-
loo, ON, Canada, 3University of Cologne, Cologne, Germany, 4Santé publique France,
Saint-Maurice, France, 5King’s College London, London, United Kingdom.
Signicance Eectiveness of tobacco taxation can be undermined through smokers
applying price-minimizing behaviors rather than quitting or reducing consumption. Com-
mon legal price-minimizing strategies are buying cheaper tobacco (discount brands or
roll-your-own tobacco), bulk buying per carton and cross-border purchasing. This study
analyzes trends in and factors associated with such behaviors in four European countries
from 2006-2020. Methods Data came from adult smokers participating in the Interna-
tional Tobacco Control (ITC) surveys conducted between 2006 and 2020 in England (9
waves, n=768-4149), France (4 waves, n=1415-1735), Germany (5 waves, n=513-1515),
and the Netherlands (10 waves, n=1191-2177). Country-specic generalized estimating
equation regression models were t to assess trends in and characteristics associated
with buying roll-your-own tobacco, discount brands, in bulk, and cross-border purchas-
ing within the European Union. Results Buying cheaper tobacco was the most used
strategy in all countries. Except for buying discount brands, recent prevalences were
highest in France (2019: RYO=35.1%, discount brands=37.0%, bulk buying=30.6%,
cross-border purchasing=34.3%), and lowest in Germany (2018: RYO=19.2%, discount
brands=38.1%, bulk buying=10.6%, cross-border purchasing=10.2%). Direction and
magnitude of trends diered by country and behavior. Low-income individuals were more
likely to buy cheap tobacco, and less likely to buy in bulk or across borders. Young people
were more likely to buy RYO tobacco, and less likely to smoke discount brands and buy
in bulk. Conclusion Smoking cheaper tobacco is the most common price-minimizing
strategy, and more likely applied by young and low-income individuals. Harmonizing
prices should be prioritized to discourage individuals from switching to cheaper tobacco.
FUNDING: Federal; Nonprot grant funding entity
PP-100
PREVALENCE OF USE AND REAL WORLD EFFECTIVENESS OF
SMOKING CESSATION AIDS DURING THE COVID-19 PANDEMIC
Sarah E. Jackson, Sharon Cox, Lion Shahab, Jamie Brown. University College London,
London, United Kingdom.
Signicance: This study examined whether the prevalence of use and real-world eec-
tiveness of dierent smoking cessation aids has changed in England since the Covid-19
pandemic. Methods: Data were from representative cross-sectional surveys of adults
in England, collected monthly between Jan 2015 and Jun 2021. Eligible participants
were 7300 adults (≥18y) who had smoked in the past 12 months and made at least one
quit attempt during that period. The independent variable was the Covid-19 pandemic
(pre-pandemic [Jan 2015-Feb 2020] vs. pandemic [Apr 2020-Jun 2021]). We analysed
(i) the association between the pandemic and self-reported use (vs. non-use) during
the most recent quit attempt of: prescription medication (NRT/varenicline/bupropion),
NRT bought over-the-counter, e-cigarettes, standard behavioural and remote (tele-
phone/written self-help materials/websites) support; and (ii) the interaction between the
pandemic and use of these aids on self-reported abstinence from quit date to survey.
Covariates included age, sex, social grade, cigarette addiction, and characteristics
related to the quit attempt. Results: Relative to the pre-pandemic period, there was a
signicant increase in the prevalence of use of standard remote support (5.9% vs. 3.5%;
OR 1.75 [95%CI 1.36-2.26]) - specically telephone support (1.4% vs. 0.5%; OR 3.17
[1.79-5.61]) and websites (4.1% vs. 2.1%; OR 2.06 [1.51-2.80]). There was a signicant
reduction in the use of e-cigarettes (28.8% vs. 33.4%; OR 0.80 [0.71-0.91]). Use of
other cessation aids did not change signicantly. There was no signicant interaction
between the pandemic and use of any cessation aid on abstinence, after adjustment
for covariates and use of the other aids, although the data were insensitive (Bayes
factors 0.56-1.21). Conclusion: In England, the Covid-19 pandemic was associated
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
with an increase in use of remote support for smoking cessation and a reduction in
use of e-cigarettes by smokers in a quit attempt. The data were inconclusive regarding
an association between the pandemic and changes in the real-world eectiveness of
popular smoking cessation aids.
FUNDING: Nonprot grant funding entity
PP-101
COMPARING PREDICTORS OF ELECTRONIC NICOTINE
PRODUCT QUIT ATTEMPTS AND CESSATION - ANALYSIS OF
WAVES 3 AND 4 OF THE PATH STUDY
Nandita Krishnan, Lorien C. Abroms, Carla J. Berg. George Washington University,
Washington, DC, USA.
Signicance: Nicotine cessation is a complex process. Understanding how sociocon-
textual and individual predictors of electronic nicotine product (ENP) quit attempts dier
from predictors of successful cessation can optimize interventions designed to target
ENP users at dierent stages of the quitting process. Methods: We analyzed waves (W)
3 and 4 from the PATH study. Among W3 adult ENP users (n=1,136, 4.0% of sample),
we used logistic regression to identify W3 predictors (sociodemographics; tobacco, ENP
and substance use characteristics; psychosocial and environmental factors) of W4 ENP
quit attempts. Among those making a quit attempt (n=497, weighted %: 41.3%), we
examined predictors of successful cessation (n=411, weighted %: 85.6%). All analyses
used sample and replicate weights to account for the complex survey design. Results:
This sample was 48.7% ages 25-44, 57.3% male, and 78.8% non-Hispanic White; 56.2%
and 26.0% concurrently used cigarettes and marijuana, respectively. In multivariable
analyses, W3 predictors of increased W4 odds of a quit attempt included being 18-24
(vs. 45+; OR=1.61), current smoking (vs. non-smoking, OR=1.94), non-combustible
tobacco use (OR=2.42), past 30-day marijuana use (OR=1.64), lower ENP dependence
(OR=1.35), using a disposable device (OR=2.04), higher interest in quitting (OR=1.1.6),
higher self-ecacy (OR=1.37), and living in home not allowing ENP use (OR=1.54; all
p’s <0.05). Among those making a quit attempt, predictors of greater odds of cessation
included greater self-ecacy (OR=1.46) and less exposure to ENP advertising (OR=1.96,
p’s <0.05). Conclusions: Concurrent use of other combustible and noncombustible
tobacco and marijuana, as well as vape-free homes, increased odds of attempting to
quit but not successful cessation. However, higher self-ecacy led to quit attempts and
successful cessation. These ndings underscore the need to understand the dierential
role in catalysts for cessation attempts vs. success, particularly with regard to concur-
rent other product use, given the potential harm reduction, substitution, and synergistic
eects concurrent use may imply.
FUNDING: Unfunded
PP-102
CORRELATES OF AWARENESS AND USE OF ‘TOBACCO-
FREE’ ORAL NICOTINE PRODUCTS AMONG SMOKERS AND
VAPERS IN THE UNITED STATES: FINDINGS FROM THE 2020
INTERNATIONAL TOBACCO CONTROL FOUR COUNTRY
SMOKING AND VAPING SURVEY
Nicholas J. Felicione1, Liane Schneller1, Maciej L. Goniewicz1, Andrew Hyland1, K.
Michael Cummings2, Georey T. Fong3, Richard J. O’Connor1. 1Roswell Park Compre-
hensive Cancer Center, Bualo, NY, USA, 2Medical University of South Carolina,
Charleston, SC, USA, 3University of Waterloo, Waterloo, ON, Canada.
Signicance: ‘Tobacco-free’ oral nicotine products (ONPs) are an emerging class of
non-combustible nicotine products. ONP sales have increased since 2016, but few
research studies have been conducted on ONPs. This study examined correlates of
ONP awareness and use in the United States (US). Methods: Data are from 5014
US cigarette smokers and nicotine vaping product (NVP) users in Wave 3 (2020) of
the International Tobacco Control Four Country Smoking and Vaping Survey. Primary
outcomes included ONP awareness, ever use, and current use, in comparison to other
alternative nicotine products such as NVPs and heated tobacco products. Correlates
of use included demographics, tobacco product use, and quit attempts. Chi-squared
analyses were used to test for dierence in ONP awareness and use by these correlates;
binary logistic regressions were used to predict ONP awareness and lifetime use based
on these correlates. Results: 18.9% were aware of ONPs, 2.9% reported ever use,
and 0.8% were current users, all lower than NVPs (99.3% awareness, 65.8% ever use,
17.2% current use) and heated tobacco products (23.9% awareness, 8.2% ever use,
2.4% current use). ONP awareness and use was higher among never and non-daily
smokers than among daily and former smokers, whereas it was higher among never and
non-daily vapers than former and never vapers. ONP use was more common among
dual cigarette-NVP users than among exclusive product users and non-users. ONP use
was higher among those who made quit attempts in the past two years. Ever use of
ONPs was more common among younger ages (e.g., 18-24 years), males, and users
of smokeless tobacco and NVPs. Conclusion: ONP use prevalence was low among
smokers and vapers in the US. ONP users were similar demographically to smokeless
tobacco users, and ONP use was most common among dual tobacco users. Continued
surveillance of ONPs is essential to determine if use is increasing over time and to the
extent to which their use is associated with use of other tobacco and nicotine products.
Studies spanning a breadth of methodological approaches should be conducted to
examine the use of ONPs to inform evidence-based approaches to their regulation.
FUNDING: Federal
PP-103
TRENDS IN RURAL AND URBAN CIGARETTE SMOKING QUIT
RATIOS IN THE UNITED STATES, 2010-2019
Maria A. Parker1, Andrea H. Weinberger2, Andrea C. Villanti3. 1Indiana University,
Bloomington, IN, USA, 2Ferkauf Graduate School of Psychology, Yeshiva University,
Bronx, NY, USA, 3University of VT, VT Center on Behavior and Health, Burlington, VT,
USA.
Signicance: Cigarette smoking prevalence is higher in rural versus urban areas of the
United States (US) and the dierence in smoking prevalence between these groups
has widened over time. It is unknown whether there is a similar trend for a rural/urban
dierence in smoking cessation. The current study examined rural and urban cigarette
quit ratios from 2010-2019 among US individuals. Methods: Data were derived from the
2010-2019 National Surveys on Drug Use and Health, annual cross-sectional surveys of
the non-institutionalized US population 12 years or older. Yearly rural and urban quit ratios
(i.e., the proportion of former smokers among ever-smokers) were estimated from 2010-
2019. Linear regression estimated trends in quit ratios over time. Results: In 2019, the
past-month smoking prevalence was higher for individuals living in rural areas (26.4%;
95% CI 24.4%, 28.4%) compared to urban areas (18.2%; 95% CI: 17.6%, 18.9%). In
addition, quit ratios for those in rural areas (44.4%; 95% CI: 41.1%, 47.7%) were lower
than the quit ratios for persons in urban areas (50.9%; 95% CI: 49.5%, 52.2%). Rural
quit ratios were lower than urban quit ratios from 2010-2019 (OR: 0.90; 95% CI: 0.81,
0.99). After adjusting for background characteristics, the quit ratio did not change for
rural individuals from 2010-2019 (p-value=0.73), while there was a non-linear increase
in quit ratios for urban individuals (p-value=0.03). Conclusions: Smoking prevalence has
decreased in urban populations, consistent with increases in quit ratios over time. Quit
ratios for individuals in rural areas were lower than those in urban areas and have not
changed over the past decade in the US. These ndings highlight important rural-urban
dierences in smoking cessation that may contribute to dierences in smoking preva-
lence. Interventions to increase cessation in rural areas are needed to stem disparities
in tobacco use and its eects on the health of rural populations.
FUNDING: Federal; Academic Institution
PP-104
CHANGING AGE PATTERNS OF CIGARETTE AND ENDS
TRANSITIONS IN THE PATH STUDY: A MULTISTATE TRANSITION
MODEL ANALYSIS OF ADULTS AND YOUTH BEFORE (WAVES 1-4)
AND AFTER (WAVES 4-5) 2017
Andrew Brouwer1, Jihyoun Jeon1, Evelyn Jimenez-Mendoza1, Stephanie Land2,
Ritesh Mistry1, David Levy3, Rafael Meza1. 1University of Michigan, Ann Arbor, MI, USA,
2National Cancer Institute, Rockville, MD, USA, 3Georgetown University Medical Center,
Silver Spring, MD, USA.
Signicance. The landscape of electronic nicotine delivery systems (ENDS) has changed
dramatically, particularly with the rise of pods and disposables, starting in late 2017. It
is not known how these changes have impacted transitions between cigarette, ENDS,
and dual use and how those changes depend on age. Methods. A multistate transition
model was applied to 24,306 adults and 12,168 youth in Waves 1-4 (2013-2017) of
the Population Assessment of Tobacco and Health (PATH) Study and 23,709 adults
and 12,217 youth in Waves 4-5 (2017-2019). One-year transition probabilities between
product use were estimated for Wave 1-4 vs 4-5 as a function of age group and of con-
tinuous age (splines). Results. Among youth, the 1-year probability of ENDS initiation
increased after 2017 from 1.4% (95%CI: 1.2-1.7%) to 2.6% (95%CI: 2.4-2.9). There was
no signicant change in ENDS initiation among adults. Persistence of sole ENDS use
(the 1-year probability of not transitioning) increased after 2017 for youth from 42.4%
(95%CI: 36.9-47.9%) to 70.5% (95%CI: 65.1-75.8%) and for adults from 56.9% (95%CI:
224
2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
53.7-59.9%) to 78.5% (95%CI: 76.0-80.9%). After 2017, youth sole cigarette users were
more likely to transitions to dual use (with 13.5% (95%CI: 7.6-19.3%) transitioning in
1-year before 2017 compared to 28.2% (95%CI: 17.2-39.2) after 2017), while dual users
were more likely to transition to sole ENDS use (transition probability increased from
5.8% (95%CI: 1.5-10.1%) to 19.0% (95%CI: 5.4-32.7%)). For adults, there was little
change after 2017 in the transitions of sole cigarette users, but dual use became more
persistent (from 41.0% (95%CI: 38.7-43.4%) remaining after 1 year to 63.9% (95%CI:
60.0-67.8%)). Conclusions. Adult dual users have become less likely to return to sole
cigarette use but not more likely to discontinue cigarettes. Youth cigarette or ENDS
users have become more likely to become sole ENDS users.
FUNDING: Federal; FDA CTP
PP-105
QUITTING VAPING FROM THE PERSPECTIVES OF REDDIT
USERS
Laura Louise Struik1, Youjin (Christine) Yang2. 1University of British Columbia, Kelowna,
BC, Canada, 2University of British Columbia Okanagan, Kelowna, BC, Canada.
Signicance: Despite an increasingly larger number of e-cigarette users who want to
quit, there are few cessation resources unique to vaping. Understanding e-cigarette
users’ experiences with cessation is critical to informing the development of relevant
resources and interventions that are specic to e-cigarette use. Social media forums,
like Reddit, provide opportunities to understand the experiences of behavior change,
like quitting vaping, from the perspectives of end users. The aim of this study, therefore,
was to examine a quit vaping subreddit to understand how e-cigarette users’ were ap-
proaching quitting, their reasons for quitting, and experienced barriers and facilitators
to quitting. Methods: A total of 1228 posts were collected. Using conventional content
analysis, the posts were inductively coded to generate categories and subcategories.
Data was analyzed using NVivo 12 qualitative data analytic software. Results: Most
users reported a preference for gradual reduction in use as their approach to quitting,
particularly through tapering the nicotine content in their own devices. Their reasons for
quitting primarily related to experiencing negative physical consequences associated with
vaping, especially in relation to their lungs (e.g., tight chest), and tired of feeling “stuck
to the vape”. The top barriers to quitting related to withdrawal symptoms and intensity
of addiction. The top facilitators to quitting related to employing distraction techniques
(e.g., hobby, gaming, mindfulness exercises), as well as having a positive mindset.
Conclusions: The ndings of this study reveal unique aspects that encompass the
process of quitting vaping. These ndings have signicant implications for both policy
and intervention development.
FUNDING: Academic Institution
PP-106
VALIDATION OF A MEASURE OF CIGARETTE PACKAGING
BRAND APPEAL
Matthew Stone1, John Pierce1, Eric Leas1, Claudiu Dimofte2, Kim Pulvers3, David
Strong1. 1University of CA, San Diego, La Jolla, CA, USA, 2San Diego State Univer-
sity, San Diego, CA, USA, 3CA State University San Marcos, San Marcos, CA, USA.
Background: Tobacco industry marketing is used to generate appeal for branded
cigarettes. Assessing the eectiveness of Graphic Warning Labels (GWLs) that aim to
reduce product appeal will require a measure with demonstrated reliability and validity
to estimate the impact this regulatory action has on cognitions and smoking behavior.
Methods: Psychometric evaluations of a 6-item measure of cigarette brand appeal were
conducted among 357 adult daily smokers. Dierential item functioning was examined
for biological sex. After viewing GWLs, smokers’ reactivity to current US packaging and
brand perceptions (i.e., harshness, healthiness, and aordability) were used to establish
concurrent validity. Conditional mixed eects models assessed predictive associations
with weekly ratings of appeal. Results: Given factor analytic support for a single primary
construct with no item-level dierences for biological sex we describe eective option
response characteristics using a graded item response model. The Omega-hierarchical
reliability was 0.84 and coecient alpha was 0.92. Concurrent validity regressions with
covariate adjustment suggested positive reactivity to US branded packaging (β=0.32
[95%CI=0.19, 0.46], p<.001) and expected brand harshness (β=-0.29 [95%CI=-0.39,
-0.19], p<.001) maintained signicant independent relationships with levels of brand
appeal. Increasing levels of initial brand appeal were associated with subsequent ratings
of appeal across 4 weeks of assessment (β=0.12 [95%CI=0.07, 0.16], p<.001). Conclu-
sions: We found strong scalability, reliability, and validity of a 6-item measure of brand
appeal. Attractive packaging attributes may reinforce socially desirable characteristics
and forecast subjective eects of smoking. Thus, branding that generates appeal may
directly motivate persistent tobacco use behavior.
FUNDING: Federal; State
PP-107
A COMPARISON OF RESPIRATORY SYMPTOMS AMONG ADULT
CANNABIS USERS, TOBACCO USERS, CO-USERS, AND NON-
USERS
Riley J. Wyatt, Sarah J. Ehlke, Michael A. Smith, Taylor Niznik, Delaney Dunn, Darla
E. Kendzor, Amy M. Cohn. University of Oklahoma Health Sciences Center, Oklahoma
City, OK, USA.
Background: Despite the recent increases in the co-use of cannabis and tobacco, the
health eects of co-use, relative to the use of either product alone, remain unclear. The
purpose of this study was to compare respiratory symptoms of 1) tobacco-only users, 2)
cannabis-only users, 3) tobacco-cannabis co-users, and 4) non-users. Methods: A sam-
ple of 1,912 adults (70.9% White, 37.8% male, M age = 38.2) completed a cross-sectional
survey in September/October 2020 that examined the correlates of medical cannabis
legalization in Oklahoma. Participants reported their past 30-day use of cannabis and
tobacco, their current respiratory symptoms via the 8-item American Thoracic Society
Questionnaire (ATSQ), and demographics (age, race/ethnicity, gender). Results: The
sample was comprised of 44.6% non-users, 26.4% tobacco-cannabis co-users, 19.5%
tobacco-only users, and 9.4% cannabis-only users. Chi-square results indicated the
groups diered by race/ethnicity, gender, and age (p’s <.01). Tobacco-only users had
the highest proportion of non-Hispanic individuals of “other” race (19%) compared to
other groups; while cannabis-only and co-users had the highest proportions of non-His-
panic-Black and younger participants compared to other groups. Non-users had the
highest proportion of White participants and were also of the greatest age. The proportion
of female cannabis-only users was more than two times higher than the proportion of
male cannabis-only users. A one-way ANOVA indicated signicant dierences in ATSQ
scores across the four groups (p < 0.001). A Tukey’s post-hoc test revealed co-users
had signicantly higher ATSQ scores (M =17.0) than non-users (M = 13.4) and canna-
bis-only users (M = 14.5). Tobacco-only users (M = 16.6) had signicantly higher ATSQ
scores than non-users (all p’s < 0.001). Conclusion: Tobacco and cannabis co-use was
associated with greater respiratory symptoms compared to cannabis use alone, though
respiratory symptoms did not dier from tobacco use alone. Respiratory symptoms of
cannabis-only users did not dier signicantly from non-users. Taken together, ndings
suggest tobacco use may be the key inuence of respiratory symptoms.
FUNDING: Federal; State; Academic Institution
PP-108
THE EFFECTS OF CIGARETTE LABELING POLICIES
ON CONVERSATIONS ABOUT SMOKING HARMS AND
CESSATION: ASSESSING MODERATION BY SOCIAL NETWORK
CHARACTERISTICS
Victoria C. Lambert, Chung-Li Wu, James F. Thrasher. University of South Carolina,
Columbia, SC, USA.
Signicance: Smokers who discuss anti-smoking messages are more likely to attempt
to quit, yet little is known about whether social network characteristics inuence these
conversations. This study assessed whether network size and smokers interact with
cigarette labeling policy congurations to aect conversations about smoking harms,
cessation, and cessation messages. Methods: We conducted a two-week 2X2 be-
tween-subject randomized trial (inserts with ecacy messages vs. no inserts; pictorial
vs. text-only HWLs) with 359 adult smokers. At baseline, participants named up to ve
close network ties with whom they communicated frequently, providing smoking status
for each tie. Participants received a 14-day supply of their preferred brand of cigarettes
with packs modied to reect experimental condition. Each evening, participants
reported conversations in the prior 24 hours about smoking harms, quitting benets,
and informativeness of the messages. Among participants reporting conversations,
zero-inated negative binomial models regressed frequency of conversations about
each topic on experimental condition relative to control (no inserts and text-only HWLs),
testing interactions between condition and network characteristics (size and number
of smokers). Models were stratied by condition when F-tests indicated signicant in-
teractions. Results: Around half of participants reported conversations about smoking
harms (48%) and quitting benets (54%), while fewer discussed message informative-
ness (25%). Relative to control, participants in the group that received both ecacy
inserts and pictorial HWLs had more conversations about message informativeness
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2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
(b=1.05, p=0.01). Experimental conditions were otherwise unassociated with conver-
sation frequency. Signicant interactions between number of network smokers and
message condition (F-tests: p=0.04 and <.01 for informativeness and quitting benets,
respectively) indicated a positive association between number of network smokers and
frequency of conversations about message informativeness (b=0.87 p<.01) and quitting
benets (b=0.42 p=0.03) in the control group but no association in experimental groups.
Conclusion: Having more smoking ties appears to encourage more conversations
about message informativeness and quitting benets under the current US labeling
policy but not under stronger policies. Future research should investigate the smoking
status of conversation partners under dierent network and labeling conditions and
their impact on cessation.
FUNDING: Federal
PP-109
EXPLORING VARIATION IN HOW MEDIA DEPICTIONS OF
TOBACCO USE AFFECT NORM PERCEPTIONS: THE ROLES OF
PERCEIVED AND DESIRED SIMILARITY
Leeann Nicole Siegel. University of Pennsylvania, Philadelphia, PA, USA.
Signicance. Normative perceptions can aect smoking behavior. Exposure to re-
peated depictions of smoking in media can impact young people’s smoking-related
norm perceptions, yet prior research has shown heterogeneity in exposure eects.
We tested whether heterogeneity of exposure eects was contingent on how similar
young people perceive themselves to be (perceived similarity) or want to be (desired
similarity) to smokers depicted in YouTube videos. Methods. First, 290 young (aged
18-28) non-tobacco users recruited from Amazon Mechanical Turk (MTurk) rated 49
YouTube videos featuring smoking depictions for their perceived and desired similarity
to the smoker in each. Each video was rated by ~19 dierent people and assigned the
average participant’s perceived and desired similarity to the depicted smoker. In the
subsequent experiment, we randomly assigned 351 young non-tobacco users recruit-
ed from MTurk to 1 of 3 conditions. Each participant in the two exposure conditions
watched a stratied random sample of 6 videos either drawn from those videos with
higher (HS) or lower (LS) similarity ratings in the prior study, and then reported their
smoking-related injunctive and descriptive norm perceptions. The control condition only
answered the norm perception questions. Results. The HS and LS conditions didn’t
dier from one another on any outcome. Likewise, the HS condition didn’t dier from
the control condition. Participants in the LS condition diered from participants in the
control condition in their injunctive norm perceptions. As expected, participants in the LS
condition reported that their friends would be less approving of them smoking (B= -.3,
p=.02). In contrast, participants in the LS condition reported higher perceived approval
of smoking in society in general (B= .24, p=.04). Conclusions. The dierences found
between the LS and control conditions in their injunctive norm perceptions warrant
further study. Intriguingly, the contrasting eects we saw for dierent injunctive norm
perception measures raise the possibility that perceived and desired similarity may have
dierent eects on dierent types of norm perceptions.
FUNDING: Federal
PP-110
FACTORS MOTIVATING YOUNG ADULTS’ CONTINUED VERSUS
REDUCED USE OF FLAVORED E-CIGARETTES
Rebekah Wicke, Allison Worsdale, Jiaying Liu. University of Georgia, Athens, GA, USA.
Signicance: In recent years, young adults (YAs) are using avored e-cigarettes at
alarming rates, making it a pressing public health concern. Using qualitative data from
vapers, this study aimed to identify respective factors that drive YA vapers’ sustained and
reduced use of avored vapes. The ndings from this study will help inform anti-vaping
campaign strategies. Method: We distributed an open-ended survey to YA ever vapers
(N=396; mean age=19.66, SD=1.45). Participants were queried to identify factors that
may inuence people’s decisions to vape avored e-cigarettes. Factors were identied
and coded qualitatively by two coders (alphas=0.81-1.00). Results: Of the factors that
sustain the use of avored vapes, 47.0% mentioned situational triggers, including being
in a social setting (e.g., at parties, in bars), or in situations that elicit boredom (e.g.,
being at home alone, driving) or stress (e.g., doing schoolwork). Marketing inuence,
such as the appealing, vivid ad images of the avored products was the second most
cited factor (15.3%). Participants also frequently noted enjoyment and mood (7.9%) as
a motivating factor, with many describing vaping as relaxing and stress-relieving. For
factors that motivate reduction or cessation of vaping, participants cited negative health
eects (e.g., “nic sick”; 35.3%), nancial/time costs (15.8%), and hearing about others’
negative experiences (11.2%). Notably, a non-trivial number of participants perceived
there to be a limited amount of research about avored vaping, noting that if there was
scientic consensus that avored vapes were harmful, they would be motivated to quit
(10.0%). Conclusion: Anti-vaping messages addressing e-cigarette avors can focus
on 1) addressing powerful situational triggers by enhancing YAs’ refusal ecacy in
social settings, and guiding them with healthier alternatives to manage boredom and
stress; 2) increasing the reach of scientic ndings through media channels commonly
used by YAs; and 3) amplifying demotivating factors through the utilization of exemplars
narrating their negative experience with avored vapes and emphasizing the high costs
incurred by use.
FUNDING: Federal; Academic Institution
PP-111
NEURAL MARKERS OF CRITICAL THINKING AND VAPING
FREQUENCY FOLLOWING ANTI-VAPING CAMPAIGN MESSAGE
EXPOSURE IN YOUNG ADULT VAPERS
Jiaying Liu, Joshua T. McMains, Jessica L. Fabbricatore, Erin C. Jones, Allison Wors-
dale, Rebekah S. Wicke, Lawrence H. Sweet. University of Georgia, Athens, GA, USA.
Signicance: Anti-vaping public service announcements (PSAs) often utilize cognitive
and emotional appeals. However, evidence regarding the mechanism and utility of each
message type is sparse. We used fMRI to determine if neural response to PSA appeals
reects critical thinking response and predict one-month vaping frequency. Methods:
38 young adult vapers (<25yrs; >15 days/month) viewed visual PSAs with cognitive
or emotional appeals during whole-brain fMRI. Participants rated the degree to which
PSAs engaged critical thinking about vaping. Subsequent weekly vaping was averaged
over 4 weeks. 7 functionally dened regions of interest (ROIs) were identied using
clusters of signicant neural response (p<.005, size>156mm3) during either PSA type
relative to a scrambled image baseline and then combined across type using disjunctive
(“or”) logic. ROI responses to each PSA type were then conrmed using one-sample
t-tests and predictive utility was assessed using OLS. Results: The right lingual gyrus
(RLG), left fusiform gyrus, left hippocampus (LH), supplementary motor area (SMA),
and left inferior premotor cortex exhibited signicant activation responses, while the
right anterior cingulate cortex and rostral right middle frontal gyrus exhibited signicant
relative deactivation responses to both PSA types (ps<.01). OLS results indicated
stronger activation response in the RLG and LH were associated with fewer critical
thoughts against cognitive (BetaRLG=-.41, p<.01; BetaLH=-.36, p=.02) and emotional
PSAs (BetaRLG=-.44, p<.01; BetaLH=-.39, p=.03). Except for the SMA, greater response
in each ROI to cognitive PSAs was signicantly associated with lower one-month vaping
frequency (Betas>-.36, ps<.04). Responses to emotional PSAs were not. Conclusion:
Stronger PSA response in the primary visual (RLG) and declarative memory (LH) regions
predicted less self-reported critical thinking, while stronger response to cognitive, but not
emotional PSAs, predicted lower one-month vaping frequency. Findings demonstrate
the potential of fMRI to identify neuromarkers of message receptiveness and guide
ecacious anti-vaping campaign eorts targeting resistant audiences.
FUNDING: Federal; Academic Institution
PP-112
INTERNALIZING AND EXTERNALIZING PROBLEMS ON THE AGE
OF E-CIGARETTE INITIATION IN THE POPULATION ASSESSMENT
OF TOBACCO AND HEALTH (PATH) USA YOUTH (2013-2017)
Meagan Bluestein1, Melissa Harrell2, Baojiang Chen3, Adriana Perez4. 1Michael &
Susan Dell Center for Healthy Living, Austin, TX, USA, 2UT Health School of Public
Health, Austin, TX, USA, 3The University of Texas Health Science Center at Houston,
School of Public Health, Austin Campus, Austin, TX, USA, 4The University of TX Health
Science Center at Houston, Austin, TX, USA.
Objective Internalizing and externalizing problems have been shown to be associated
with e-cigarette initiation in youth. Yet, it is unknown if internalizing and externalizing
problems increase the risk of an earlier age of initiation of e-cigarette use in youth.
Methods Secondary analyses of PATH youth (12-17) waves 1-4 (2013-2017) were con-
ducted. Among never e-cigarette users at the rst wave of PATH participation (n=16,143;
N=29,349,76), the age of initiation of ever and past 30-day e-cigarette use was esti-
mated using follow-up surveys in 2014-2017. The GAIN-SS is a validated measure for
internalizing and externalizing problems in youth. Youth were classied as having none/
low (0-1 symptoms), moderate (2-3 symptoms), and high (>4 symptoms) internalizing
and externalizing problems in the past year measured at the wave prior to e-cigarette
initiation for youth who become users and at the latest wave of participation for youth
who remained non-users. Four weighted interval-censored Cox proportional hazard
models were tted to estimate the relationship between internalizing and externalizing
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problems and the age of initiation of each e-cigarette use outcome while adjusting for
sex, race/ethnicity, previous use of other tobacco products (cigarettes, any cigar product,
hookah, and smokeless tobacco), and psychoactive substances (alcohol, marijuana,
prescription opioid drugs, and any other substance). Weighted interval-censored survival
analyses were used to estimate the hazard function for the age of initiation of each
outcome stratied by internalizing and externalizing scores. Results Youth with high
internalizing problems had increased risk of initiating ever (AHR=1.87;95%CI=1.69-2.05)
and past 30-day (AHR=1.88;95%CI=1.58-2.18) e-cigarette use at earlier ages compared
to youth with none/low internalizing problems. Youth with high externalizing problems
had increased risk of initiating ever (AHR=2.48;95%CI=2.22-2.76) and past 30-day
(AHR=2.46;95%CI=2.05-2.98) e-cigarette use at earlier ages compared to youth with
none/low externalizing problems. Conclusion E-cigarette prevention eorts should
target youth with high internalizing or externalizing problems.
FUNDING: Federal
PP-113
REAL-TIME EXPOSURE TO ANTI-TOBACCO MESSAGING AMONG
A DIVERSE POPULATION OF YOUNG ADULTS
Jennifer Cantrell, DrPH1, Susan Westneat2, Judy Van den Venne2, Andrew Aneset-
ti-Rothermel3, Shanell Folger4, Basmah Rahman4, Charles Debnam5, Kurt Ribisl6, Amy
Cohn7, Shyanika Rose2. 1New York University School of Global Public Health, 2Univer-
sity of Kentucky College of Medicine, 3Center for Tobacco Products, US Food and Drug
Administration, 4Truth Initiative, 5Community Wellness Alliance, 6University of North
Carolina at Chapel Hill, Gillings School of Global Public He, 7University of Oklahoma
Health Sciences Center, Health Promotion Research Center.
The tobacco industry is adept at targeting young adults (YAs) engaged in activities at
high-risk for advertising exposure (e.g., on social media), or are in high-risk locations
(e.g., near a tobacco retail outlet) and in minority neighborhoods. Little is known about
whether anti-tobacco marketing is reaching YAs who are at high risk for exposure to
pro-tobacco marketing. This study used ecological momentary assessment (EMA) to
assess demographic and real-time correlates of anti-tobacco marketing exposure among
a largely Black and Hispanic population of YAs. This study used EMA data to assess
context (e.g., location, activity) of anti-tobacco marketing exposure using 4 mini-surveys
per day over 2 weeks. YA non-current tobacco users living in Washington D.C. (n=145;
ages 18–24) recorded 5,219 surveys, including 19 participants (13.1%) in neighbor-
hoods with high proportions of racial/ethnic minority residents, and high smoking rates.
Adjusted multilevel regression models assessed the association between exposure to
anti-tobacco marketing, demographics and real-time contextual variables. A total of 61
respondents reported at least one exposure to anti-tobacco marketing, for 141 exposures
over the EMA period. In adjusted analyses, odds of exposure were higher for those living
in a minority neighborhood (aOR=4.3, all p’s<.05), in the presence of someone using
tobacco products (aOR=1.7), at work/school (aOR=2.3), outside/in transit (aOR=2.1)
and online/social media (aOR=1.9) vs. home. There were no signicant dierences in
anti-tobacco exposure by age, sex, race/ethnicity or education, or for other locations and
activities (e.g., at a bar/restaurant, clubs, or in a retail store) vs. at home. Almost 43%
of YA non-current tobacco users were exposed to anti-tobacco messaging in their daily
lives. Findings suggest anti-tobacco marketing is reaching Black and Latinx YAs, YAs in
minority neighborhoods and during some high-risk activities such as on social media. Yet
improved targeting is needed to reach this population with messages to counter industry
marketing when in high-risk environments such as at bars/restaurants and retail stores.
FUNDING: Federal
PP-114
CONNECTING ANTI-TOBACCO MESSAGES WITH AT-RISK LATINX
YOUNG ADULTS
Jessica M. Rath, PhD1, Meera Ammu1, Susanah Ramirez2, Fernanda Alonso3, Eliza-
beth Hair1, Meghan Moran3. 1Truth Initiative, 2University of California, Merced, 3Johns
Hopkins Bloomberg School of Public Health.
Objective: The Latinx community is more likely to be exposed to tobacco product mar-
keting than non-Latinx groups and has high rates of susceptibility to use. Mass media
campaigns are an eective tool to reduce health disparities, but many campaigns fail
to resonate with at-risk groups. We assessed response to messages from a national
campaign among Latinx youth. Methods: Participants in two studies were exposed to
anti-tobacco ads that were part of a national campaign. These ads focused on Big Tobac-
co targeting the Black community and those suering from mental health disorders and
were not specically designed for the Latinx community. Study 1 (N=1,003; 168 Latinx)
utilized pre-market testing data which was conducted before advertisements aired. A
cross-sectional online sample of 15-24-year-olds were randomly assigned to 1 of 2 ads
in December 2016-January 2017. Study 2 included facilitated qualitative discussion
boards conducted among 92 Latinx participants ages 15-21 years in October 2020 in
which youth were exposed to the same 2 ads. Results: The majority of the participants
in Study 2 responded positively to the messages and understood the main messages
about racial proling communities of color and other vulnerable populations as market
priorities. Most felt that they should take action by talking to family/friends about it, posting
on social media, writing to tobacco companies and/or starting a petition. The pre-market
data from Study 1 indicated that among the general population, the ads were likeable
(72-78% like it a lot/somewhat) the message was easy to understand (85-92%), recall of
the main idea was high (69-76%) and the ads resonated with the audience (“for people
like me” = 66-69%). Conclusions: Campaigners strive to balance reaching at-risk groups
with remaining relevant to the general population. These ndings demonstrate that
Latinx participants were able to relate the targeting of market priorities to the targeting
of minority groups like themselves. Mass media social marketing campaigns will not
dilute their messages by allocating portions of their resources to reach at-risk groups.
FUNDING: Federal; Nonprot grant funding entity
PP-115
IDENTIFYING NOVEL MOTIVATION PHASE-SPECIFIC CESSATION
TARGETS FOR YOUTH EXPERIENCING HOMELESSNESS
Julianna Nemeth1, Allison Glasser1, Joseph Macisco1, Alice Hinton1, Amy Wermert1,
Joanne Patterson2, Ana Sucaldito1, Carra Gilson1, Hannah Kemble1, Ellen Garbsch1,
Jacob Caponi1. 1The Ohio State University College of Public Health, Columbus, OH,
USA, 2The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Signicance: 70%+ of youth experiencing homelessness smoke combustible tobacco.
Population specic barriers restrict their ability to engage in supported cessation. Using
Baker et al.’s Phase-Based Approach to Cessation and guided by the Capability-Oppor-
tunity-Motivation-Behavior system (COM-B) framework for intervention development, the
aim of this study was to identify challenges associated with “Motivation” phase-specic
cessation mechanisms (i.e., nicotine dependence) and treatment targets (i.e., # of past-
year quit attempts, 30-day quit interest) for youth experiencing homelessness—with the
intent of identifying novel targets and intervention components to be tested in a future
optimization trial. Methods: 96 youth (14-24 years old) attending an Ohio drop-in center
who used ≥1 combustible tobacco products in the past week and were not currently
making a quit attempt completed interview-administered surveys (early 2020). Multi-
variable regression models were t to assess psychosocial correlates of # of past-year
quit attempts, interest in quitting smoking in the next 30 days, and nicotine dependence
(Hooked on Nicotine Checklist). Results: 67.1% of participants attempted to quit in
the past year. 45.8% expressed 30-day quit interest. Moderate nicotine dependence
was noted (mean HONC = 5.8). Dimensions of coping with housing were associated
with both quit attempts and quit interest. Whereas higher nicotine dependence and
working were associated with increased numbers of quit attempts, endorsing smoking
to socialize and to keep hands busy were associated with decreased rates. 30-day
quit interest was associated with less endorsement of smoking to regulate aect and
more endorsement of smoking to avoid getting out of danger. Nicotine dependence
was associated with habitual and social smoking, smoking to keep one’s hands busy,
replacing food with tobacco, accidental oxygen deprivation events, and less condence
in quitting. Conclusions: Addressing housing, food security, violence, aect regulation,
social context, and accommodating hypoxic-anoxic brain injury may benet homeless
youth’s ability to engage cessation.
FUNDING: Federal
PP-116
A SURVIVAL ANALYSIS APPROACH TO UNDERSTANDING
DIRECTIONALITY IN THE RELATIONSHIP BETWEEN CIGARETTE
USE AND DEPRESSION DURING YOUNG ADULTHOOD
Jacob E. Thomas, Keryn E. Pasch, Alexandra Loukas. The University of Texas at
Austin, Austin, TX, USA.
Signicance. Cigarette use and depression are among the leading causes of morbidity
and mortality, worldwide. Young adulthood is an important period for establishing lifespan
mental health and tobacco use trajectories. Research has demonstrated positive asso-
ciations between smoking and depression; however, the literature is mixed regarding
their temporal directionality. The purpose of this study is to investigate the directional
eects of cigarette smoking and depression during young adulthood using a survival
analysis approach. Methods. In this study of 5,073 young adults (wave 1 mean age =
20, 64% female, 65% non-white, 12% LGBTQ+) from 24 colleges in Texas collected
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over 9 waves between 2014 and 2019, we used two survival analysis models. Multiple
Cox regression models were specied with age as the time variable and controlled for
wave, sex, race/ethnicity, and LGBTQ+ identities. Model 1 tested the eect of depressive
symptoms on smoking initiation, dened as the transition from being a never smoker
to an ever smoker. Model 2 tested the eect of current cigarette use on new-onset
depressive symptoms, dened as a score of >10 on the Center for Epidemiological
Studies Depression Scale for the rst time during the study period. Results. Through
the end of the study, 34% of the sample initiated smoking and 65% developed new-on-
set depressive symptoms. Results for model 1 showed that depressive symptoms
increased the hazard of smoking initiation (HR=1.20, 95% CI= 1.08-1.32). However,
results from model 2 found that smoking did not signicantly increase the hazard of
new-onset depressive symptoms (HR=1.11, 95% CI= 0.99-1.25). Conclusion. This study
provides evidence that elevated depressive symptoms increase the hazard of smoking
initiation during young adulthood. Smoking did not increase the hazard for new-onset
depressive symptoms, suggesting that during young adulthood, the association between
smoking and depression is one-directional. Future work is needed to examine these
relationships in younger samples. Mental health clinics serving young adults should
provide smoking prevention resources to their patients, especially never-smokers who
are receiving treatment for depression.
FUNDING: Federal
PP-117
ESTIMATING OWN AND CROSS ELASTICITY OF CIGARETTE BY
PRICE TIERS IN BANGLADESH
Shaun Nahin Shimul, AKM Ghulam Hussain. University of Dhaka, Dhaka, Bangla-
desh.
Background: Bangladesh’s tiered tax structure encourages brand-switching, i.e., switch-
ing from higher-price cigarette brands to lower-price ones, which can be a signicant
barrier to reducing cigarette consumption. However, research evidence on brand switch-
ing behavior in response to tax and price increases are not available for Bangladesh.
Methodology: Using four waves of International Tobacco Control (ITC) survey data for
Bangladesh collected over 2009-2015, this study examines the determinants of tobacco
usages, the choice of cigarette brand, and brand switching behavior of consumers and
measure corresponding price sensitivity/elasticity. To estimate elasticities, the study
applies various econometric tools such as panel probit models, seemingly unrelated
regression models, and instrumental variable-based probit models. In addition, a robust-
ness check has also been performed. Findings: The primary result of the study suggests
that there is a negative own-price and positive cross-price elasticity indicating price
increase of own brand decreases demand while price increase in the high and premium
brand cigarettes induces people to switch to lower prices cigarettes. In addition, some
socio-demographic factors are found to be signicant in determining prevalence and
elasticities. For instance, from the probit model, we nd that 1% increase in the price of
high-priced cigarettes increases by more than 1% increase in the demand of low-priced
cigarettes, i.e., brand switching is evident. In addition, it is found that an increase in the
price of lower-priced cigarettes decreases the prevalence of cigarettes consumption,
while the price of the high or premium brands has no impact on the prevalence. High-
er-income and higher educated people tend to consume more lower-tiered cigarettes
while older aged people tend to use more lower-priced cigarettes. The results remain
fairly consistent among various estimation techniques and specications. Conclusion
and policy implications: The study concludes that the presence of tiered tax system
induces people to switch brands with changes in prices. Hence, the government should
increase the prices of low-tiered cigarettes to thwart the chance of switching.
FUNDING: Unfunded; Academic Institution
PP-118
PERCEIVED PARENTAL KNOWLEDGE REDUCES RISK
FOR INITIATION OF NICOTINE AND CANNABIS VAPING: A
LONGITUDINAL STUDY OF ADOLESCENTS
Dale Mantey1, Andrew E. Springer2, Stephanie Clendennen3, Melissa Harrell4.
1UT-Health Science Center, School of Public Health, Austin, TX, USA, 2UTSPH, Austin,
TX, USA, 3UT Health, School of Public Health in Austin, Austin, TX, USA, 4University
of TX, SPH, Austin, TX, USA.
Background: E-cigarettes are the most commonly used nicotine product and the fastest
growing method of cannabis use among adolescents in the US. Exposure to nicotine
and cannabis during adolescence has been linked to impaired brain development
and increased risk for use disorder in adulthood. Adolescents who self-report that
their parents/guardians know their location, activities, and peer groups (i.e., Parental
Knowledge) have signicantly lower risk for using combustible forms of nicotine (e.g.,
cigarettes; cigars) and cannabis. This study examines the longitudinal relationship
between Perceived Parental Knowledge and initiation of nicotine and cannabis vaping
among a diverse cohort of adolescents in Texas. Methods: Data were from Waves
4-6 of the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system, a
population-based study of youth in urban areas of Texas. Participants were adolescents
who self-reported never using e-cigarette to vape nicotine (n=1,907) or vape cannabis
(n=2,212) at baseline (Spring 2016). Initiation of nicotine vaping and cannabis vaping
were examined as independent outcomes, each assessed at 6-month (Fall 2016) and
12-month (Spring 2017) follow-up. Weighted multivariate logistic regression models
controlled for age, sex, race/ethnicity, and other tobacco use. Results: Initiation rates
were 5.9% for nicotine vaping and 8.6% for cannabis vaping, at 12-month follow-up
overall. Higher perceived parental knowledge was associated with lower odds of nicotine
vaping initiation at 6-months (adjOR: 0.67; 95%CI: 0.48-0.92) and 12-months (adjOR:
0.71; 95%CI: 0.55-0.93). Similarly, higher perceived parental knowledge was associ-
ated with lower odds of cannabis vaping initiation at 6-months (adjOR: 0.58; 95%CI:
0.37-0.89) and 12-months (adjOR: 0.56; 95%CI: 0.41-0.76). Conclusions: Studying
ndings reveal parental knowledge may be an important factor in preventing adolescent
nicotine and cannabis vaping. E-cigarette prevention eorts directed at adolescents
should incorporate parent engagement strategies as a method of increasing actual
and perceived parental knowledge of their child’s location, activities and peer groups.
FUNDING: Federal
PP-119
ASSESSING THE IMPACT OF DIFFERENT PHARMACY
TOBACCO RETAIL DISPLAYS ON SMOKERS’ AWARENESS
AND PERCEPTIONS OF TOBACCO PRODUCTS AND SMOKING
CESSATION MEDICATIONS--A MOBILE EYETRACKING STUDY
Christopher Frye1, Kristie June1, Richard O’Connor1, Lisa Henriksen2, Maansi
Bansal-Travers1. 1Roswell Park Comprehensive Cancer Center, Bualo, NY, USA,
2Stanford Prevention Research Center, Palo Alto, CA, USA.
Background: Tobacco retail displays and promotions constitute a majority of U.S. tobac-
co industry marketing expenditures. Retail displays are associated with youth smoking
initiation, increases in craving and relapse, unplanned purchases, and inuences on
social norms, perceived access, and brand switching. Pharmacies play a signicant
role in healthcare. Although CVS voluntarily ending tobacco sales, replacing the retail
displays with tobacco cessation messages and medications, was associated with greater
odds of quit attempts among smokers, Walgreens and Rite Aid continued to sell. In
January 2019, Erie County, NY implemented a ban on all tobacco sales in pharmacies.
This study was designed to better understand consumer perceptions of dierences in
retail advertising for using and quitting tobacco. Methods: Tobacco users ages 18-65
(n=27) were recruited between 2017-2019 from Bualo, NY and randomized to visit a
pharmacy (Walgreens, Rite Aid, or CVS) for a one-time mobile eye-tracking session.
Each participant completed a demographic and tobacco use survey and a researcher
calibrated the mobile eye-tracking headset before leading them to the assigned pharmacy
nearby for a shopping task. Participants were provided $25, asked to purchase at least
one food item, one beverage, and one other item of their choosing, and then completed
a brief post-task survey measuring cravings, intention to quit, impulse purchases, and
recall of ads. Results: Among the 17 participants recruited prior to the Erie County
ban, signicant dierences existed in mean dwell times on the retail display between
CVS (5.6 sec) and Rite Aid (26.7 sec) and Walgreens (20.1 sec). After the ban, mean
dwell times on the displays decreased for all three pharmacies (CVS 3.8 sec, Rite Aid
6.3 sec, Walgreens 1.7 sec). Although not expressly asked to refrain, no participants
chose to purchase tobacco products during the study session. Conclusions: Findings
from this study suggest that removing tobacco retail displays signicantly decreases
attention paid and tobacco purchases among users. Replacing these displays with
tobacco cessation messages and medications may increase quitting among smokers.
FUNDING: Federal
228
2022 Poster Session 4 • Thursday, March 17, 2022, 4:45 PM - 6:15 PM
PP-120
FLAVORED TOBACCO AND ELECTRONIC NICOTINE PRODUCT
USE AMONG ADULTS IN NEW YORK STATE FOLLOWING
IMPLEMENTATION OF A STATEWIDE RESTRICTION ON FLAVORS
Maansi Bansal-Travers, Andrew Hyland, Brian Fix, Cheryl Rivard, Liane Schneller,
Christopher Frye, Destiny Diaz, Akshika Sharma, Richard O’Connor. Roswell Park
Comprehensive Cancer Center, Bualo, NY, USA.
Background: The study was completed during the COVID-19 pandemic and was
launched after implementation of restrictions on both retail sale (except tobacco avor
and unavored) electronic nicotine delivery systems (ENDS; May 20, 2020) and online
sales of avored ENDS (July 1, 2020) in New York. The two main aims for the study
included 1) assessing and describing health behaviors, including tobacco use, and 2)
support for a policy restricting the sale of avored ENDS in a representative sample of NY
adults. Methods: A Web-based survey was conducted among a sample of 946 NY adults
(18 years+) from July 13-October 15, 2020, shortly after the avored ENDS restriction
policy took eect. Participants were recruited with a letter mailed to an address-based
sample of 30,000 randomly selected NY residents; data are weighted to represent the
state. Survey questions assessed health beliefs and behaviors related to tobacco and
ENDS use, particularly avored ENDS after the restrictions, and knowledge, attitudes,
and support for current and hypothetical tobacco control policies. Results: Among
respondents, 7.8% smoked only cigarettes, 5.3% used only ENDS, 3.4% reported
both smoking cigarettes and using ENDS, and 83.5% reported noncurrent tobacco
product use. Flavors remained popular among ENDS users. When current ENDS/
ENDS+cigarette users (n=81) were asked about ENDS use after the restriction on
avors, 39.5% reported continuing to purchase avored e-liquids, 21% reported vaping
tobacco-avored e-liquids, 7.4% reported quitting vaping and not smoking cigarettes,
4.9% of dual users reported quitting vaping and continuing to smoke cigarettes, and
27.7% reported something else (e.g., out of state, stocked up); none of the current
ENDS users reported new smoking initiation. Among those who continued to purchase
avored e-liquids, 68.7% reported purchasing from a retail outlet or online. Results also
found support among users and nonusers for policies restricting avors, access, and
availability of tobacco and ENDS products. Conclusions: Additional eorts to improve
compliance of current restrictions on avored vaping products and continued evaluation
of the impact of restrictions on retail and online sales of these products are critical in
understanding the long-term impact on use patterns and behaviors.
FUNDING: Federal
PP-121
THE IMPACTS OF INCLUDING INFORMATION ABOUT THE
NUMBER OF CARCINOGENS IN TOBACCO SMOKE ON
STANDARDISED CIGARETTE PACKS IN THE UNITED KINGDOM
Crawford Moodie, PhD1, Catherine Best1, Nathan Critchlow1, Sara Hitchman2, Martine
Stead1, Ann McNeill3. 1University of Stirling, 2University of Zurich, 3King’s College
London.
Background: Since May 2017, after a twelve-month transition period, standardised
packaging has been mandatory in the UK. Aside from being drab brown with large
pictorial warnings on the primary display areas, standardised packs must also have an
‘information message’ explaining that there are more than 70 carcinogens in tobacco
smoke on one of the secondary display areas. Methods: Three waves of a longitudinal
online survey in the UK with smokers pre-standardised packaging (Wave 1: April-May
2016) and followed up post-standardised packaging (Wave 2: September-November
2017, Wave 3: May-July 2019). Of the 6233 smokers at Wave 1, 4293 responded at
Wave 2 and 3175 at Wave 3. We explored knowledge of the number of carcinogens in
smoke, and whether knowing that smoke contains more than 70 carcinogens mediated
change in the belief that the dangers of smoking are exaggerated (risk perception),
stubbing out cigarettes, quit intentions, and quitting. As the information message is
larger on roll-your-own packs than on cigarette packs, as the packs are larger, we
also explored whether there was any dierence in knowing that smoke contains more
than 70 carcinogens between exclusive cigarette smokers and exclusive roll-your-own
smokers. Results: Knowledge that there are over 70 carcinogens in tobacco smoke
increased among smokers across waves, with the increase from Waves 1 to 3 greater
for exclusive roll-your-own smokers than exclusive cigarette smokers (adjusted Odds
Ratio=1.44; 95% CI 1.03-2.03). Knowledge that there are over 70 carcinogens in tobacco
smoke mediated higher risk perception but not stubbing cigarettes out, quit intentions
or quitting. Conclusions: The information message improved knowledge of how many
carcinogens are in smoke, particularly among exclusive roll-your-own smokers, and
this was linked to higher risk perception.
FUNDING: Other
PP-122
STRENGTHENING CONNECTIVITY: LEVERAGING GAME-PLAY
AND SOCIAL NETWORKS TO PREVENT ADOLESCENT TOBACCO
USE
Georges Khalil, MPH, PhD1, Dave McLean1, Ross Shegog2, Kayo Fujimoto2, Alexander
V. Prokhorov2. 1University of Florida, 2The University of Texas.
Background: Negative inuence from peers is a potent predictor of adolescent tobacco
initiation, yet little has been done to leverage positive inuence and social support to
prevent tobacco use. We propose two strategies to promote positive inuence: game-
play and social network analysis. We present qualitative ndings that informed the
development of a game-based social intervention for tobacco prevention through a
participatory design (PD) approach.Methods: First, we implemented a series of focus
groups and paired interviews with 40 adolescents to capture adolescent preferences
for intervention features and contents. We also conducted a series of design activities
with 15 adolescent members of a youth participatory team and an expert advisory board
composed of a game designer, a senior researcher in adolescent tobacco prevention, and
an expert in health communication. Based on social exposure principles, we developed
a social network algorithm to strategically group adolescents based on their friendships
as they engage in the social intervention. Results: This approach led to the design of
an intervention in the form of a board game called STORM HEROES. We rst obtained
367 unique anti-tobacco messages based on the transtheoretical model. The messag-
es addressed tobacco content, tobacco consequences, social norms, environmental
outcomes, and advocacy against tobacco. By applying a game design principle of data
merging, our messages were then embedded within the board game. During the PD
approach, adolescents developed empathetic content that addresses perceived social
norms, self-ecacy to resisting tobacco use, and advocacy against tobacco. Supporting
the experiential learning theory, adolescents preferred a combination of cooperative and
competitive game play. In STORM HEROES, adolescents work in groups to save an
island from a storm that carries tobacco products and their contents. Conclusion: Our
PD approach revealed key design and tobacco content preferences among adolescents.
This research yielded a promising game-based intervention that strategically engages
adolescents based on their friendships, age, culture, and risk level.
FUNDING: Federal
229
Notes
230
Notes
231
Author Index
A
Abadi, Melissa .................................... PS1-83, POD4-1
Abroms, Lorien .................................................. PS3-87
Abroms, Lorien C. ....................PP-55, PP-101, PS1-32
Acheampong, Daniel ........................................... PP-13
Adams, Elizabeth ...............................................PS2-93
Addicott, Merideth ................................................PP-13
Addo, Newton .................................................. PS3-124
Addy, Nii A. ....................................................... POD6-2
Ademuyiwa, Foluso .......................................... POD1-2
Adeniji, Ayomipo E. ............................................ PS3-39
Adhikari, Keyuri ...................................................PP-41
Adkins-Hempel, Melissa .................................... PS2-21
Admire, Ami .................................................... POD11-7
Adrison, Vid .....................................................PS2-151
Adsit, Rob ........................................... PS2-1, POD10-6
Adsit, Rob T. .....................................................POD1-5
Adsit, Robert T. ....................................................PS3-4
A, Rima .........................................................PS3-111
Agaku, Israel ...................................................POD12-4
Agarwal, Deepti ............................................... PS3-114
Agbonlahor, Osayande ....................PS1-100, PS1-122
Ahluwalia, Jasjit ................................ PS3-87, SYM19-3
Ahluwalia, Jasjit S. ...PP-30, PS1-75, PS2-103, PS3-23
Ahmad, Fayaz ................................................POD15-6
Ahuja, Amrita ..................................................... PS3-56
Ait Ouakrim, Driss ...........................................SYM17-2
Ajith, Aniruddh ....... PS1-28, PS2-97, PS3-29, POD4-5,
POD4-6
Akbar, Maham .......................................PP-67, PS2-36
Akinola, Lois S. ................................................. POD6-5
Akins, John ...................................................... PS2-114
al Absi, Mustafa ...................................................PS3-1
Alanazi, Abdullah M. ................PP-46, PP-72, PS3-125
Alanazi, Fay J. ..................................................... PP-46
Alarabi, Ahmed ................................. PS3-42, POD14-1
Alberts, Joseph .................................................... PP-41
Alcheva, Aleksandra ................ PP-81, PS2-43, PS2-45
Alegria, Katie ..................................................... PS3-52
Alexander, Adam ............................................... PS3-12
Alexander, Adam C. ............ SYM2-4, PS2-103, PS3-80
Alexander, Tesfa N. .........................................PS2-155
Alexis, Neil E. ......................................................PP-79
Alfahadi, Nada ..................................... PP-72, PS3-125
Ali, Hamdy ...................................................... POD14-1
Alio, Amina ....................................................... PS3-117
Alkhonain, Foton ..................................PP-72, PS3-125
Allen, Alicia ...... PS2-3, PS2-7, PS2-25, PS3-1, PS3-12
Allen, Michele L. .................................................. PP-37
Allen, Sharon ............ PS1-58, PS2-5, PS2-21, PS2-53,
PS2-59
Allen, Sophia I. .................................................PS1-111
Almutairi, Shahad F. ............................................ PP-46
Alolaimat, Maan ............................................... PS1-102
Alonso, Fernanda .............................. PP-114, PS2-149
Alqahtani, Lama H. .............................................. PP-46
Alsarami, Alanoud A. ........................................... PP-46
Alsayari, Sadeem ................................ PP-72, PS3-125
Alshbool, Fatima ................................................ PS3-42
Alshbool, Fatima Z. .........................................POD14-1
Alsulami, Norah ................................... PP-72, PS3-125
Altalhi, Ibtihal A. .................................................PS1-23
Alter, Harrison ..................................................PS1-123
Al Tobi, Mohammed ........................................... PS2-40
Amato, Michael ................................................ PS1-117
Amato, Michael S. ...........................................PS1-144
Ammar, Maram ..................................................PS3-74
Ammu, Meera .................................................... PP-114
Amponnavarat, Salin ......................................... PS2-80
Anastas, Paul T. ...............................................PS2-157
Andersen, Allan ................................................ POD6-4
Anderson, Alexa ................................................ PS2-47
Anderson, Marissa K. ...................................... PS3-107
Andler, Raphaël ...................................................PP-99
Andrews, Mary ..................................................POD9-4
Anesetti-Rothermel, Andrew .............................. PP-113
Angarita, Gustavo A. ............................................ PP-75
Anoshiravani, Arash ......................................... PS2-140
Anthenelli, Robert M. ........................... PS2-16, PS3-19
Applegate, Julia ................................................ POD9-4
Arce, Daniela ................................................... PS2-129
Ardati, Ola ..........................................................PS3-39
Arenberg, Doug A. ...........................................PS1-134
Arenberg, Douglas ...............................................PP-90
Arillo-Santillán, Edna ............................... PP-33, PP-60
Arillo-Santillan, Edna Judith .................................PP-45
Arora, Monika ................................................. POD15-5
Aros, Cody ........................................................... PP-84
Arsenijevic, Aleksandar ..................................... PS2-40
Arthur, Kianna M. ...............................................PS2-49
Asare, Samuel .................... PS2-74, PS3-115, POD4-2
Asfar, Taghrid ........................... PP-61, PP-63, PS2-132
Ashare, Rebecca .............................................. POD5-3
Ashing, Kimlin T. .............................................POD10-4
Ashley, David L. ............................................... PS2-112
Ashurst, Alex ..................................................... POD5-5
Assari, Shervin ........................................ PP-41, PP-42
Asvat, Yasmin ...................................................POD1-3
Atem, Folefac ...................................... PP-89, PS2-117
Attia, Jacqueline .............................................. PS3-119
Atzendorf, Josene .......................................... PS1-124
Audrain-McGovern, Janet ....................................PP-34
Aurouet, Philémon ............................................. PS3-93
Author, Test ........................................................ PS1-38
Avery, Elizabeth ..............................................POD10-3
Avila, Jaqueline ...............................................PS2-103
Avila, Jaqueline C. .................................PP-30, PS1-75
Aycock, Dawn ....................................................PS3-67
Ayo-Yusuf, Olalekan A. ................................... POD12-4
Ayyala, Deepak N. .............................................PS1-55
Azogini, Chiamaka ............................................POD2-1
B
Babu, Anagha .................................................... PS2-17
Babuscio, Theresa ...............................................PS3-2
Baezconde-Garbanati, Lourdes ........................SYM9-4
Bagdas, Deniz ................................... POD6-2, POD6-5
Baggett, Chris .................................................. PS2-102
Baggett, Chris D. ................................................. PP-29
Baghinyan, Astghik .............................. PS2-70, PS2-77
Bahroos, Neil ..................................................... PS1-10
Bailey, Steani ...................................................PS3-25
Bailey, Steani R. ..............................................PS1-26
Baker, Nathaniel L. .............................PS3-3, POD13-2
Baker, Timothy .........PS1-56, PS2-1, PS3-17, POD4-3,
POD10-6, SYM18-3
Baker, Timothy B. ...................POD1-5, PS1-25, PS3-4
Baldassarri, Stephen ............................. PP-75, PS3-18
Baldwin, Carrie ................................................. POD5-7
Baldwin, David .................................................. POD5-5
Baler, Guido .......................................................PS2-73
Bandi, Priti .......................... PS2-74, PS3-115, POD4-2
Banerjee, Smita ............................................... PS3-101
Bansal-Travers, Maansi ............ PP-4, PP-119, PP-120,
PS2-133, PS3-119, PS3-131, SYM4-1, SYM4-3
Banthin, Christopher ............................. PP-50, POD7-1
Barca, Hannah ...................................................PS3-95
Bardier, Cortni ....................................PS2-98, PS2-100
Barker, Joshua .....................................................PP-57
Barlow, Daniel ......................................................PS1-5
Barnes, Andrew .................. PS1-20, PS1-34, PS1-112,
PS1-114, PS2-47
Barnes, Georey D. ............................. PP-90, PS1-134
Barnoya, Joaquín .............................................. PS2-65
Barnoya, Joaquin ...............................................PS3-75
Baroud, Sumer .................................................. PS1-49
Barrett, Eden .................................................. POD11-2
Barrett, Sean P. ...................................................PP-77
Barrientos-Gutierrez, Inti ....................... PP-45, PS2-65
Barrientos-Gutiérrez, Inti ......................... PP-33, PP-60
Barrington-Trimis, Jessica ...................PS1-68, PS3-81
Barrington-Trimis, Jessica L. .............PS1-80, PS2-158
Barros, Mary ..................................................... POD7-4
Barry, Molly ..........................................................PP-86
Bars, Matthew P. .............................................. PS2-161
Barsell, D. J. .................................................... PS1-144
Barsell, Duc-Thi J. ........................................... PS2-102
Barton, Abigail ................................. PS2-126, PS3-113
Barton, Jocelyn M. ............................................ SYM2-4
Bar-Zeev, Yael .......................................PP-55, PS2-68
Baskerville, Bruce ................................................ PP-91
Bateman, Jerram ................................................. PP-54
Bauer, Michael .....................................................PP-13
Baum, Laura ...................................................... PS1-62
Baumann, Carsten ...............................PS3-26, PS3-27
Baurley, James ...............................................SYM18-4
Beach, Annie ................................................... PS2-142
Beach, Steven R. ...............................................PS3-15
Beane, Amber .................................................... PS3-50
Beard, Emma .....................................................PS3-83
Bearnot, Benjamin ............................................... PS1-8
Becker, Jessica E. ...............................................PP-28
Bednarek, Jill ....................................... PS3-26, PS3-27
Beebe, Laura A. ...................................PS1-87, PS3-63
Beem, Alexandra ................................................. PP-58
Begh, Rachna ...................................................... PP-87
Begnaud, Abbie ..................................................... PP-9
Behnood-Rod, Azin ................................ PP-82, PS3-40
Beidas, Rinad ................................................... POD5-3
Belhasan, Dina .................................................... PS2-5
Bellinger, Christina .................................................PP-8
Bello, Mariel S. ..................................................PS3-13
Bellon, Michelle .............................................. POD13-6
Beneventi, Diane ............................................... PS3-16
Beneventi, Diane M. .......................................... PS3-47
Ben Izhak, Marina ..............................................PS2-68
Benjamin, Emelia J. ............................. PS1-46, PS1-68
Benmarhnia, Tarik ................................................ PP-92
Bennet, Melanie .................................................PS3-21
Bennett, Breesa ................................................ POD8-4
Bennetts, Soa ................................................. POD3-1
Benowitz, Neal .....................PS1-56, PS2-16, PS3-124
Bensch, Lindsey .................................................. PS1-4
Ben Taleb, Ziyad ............... PS1-98, PS2-114, POD12-6
232
Author Index
Bentley, Sean ..................................................PS3-105
Berg, Carla ............................ PP-55, PS2-112, PS3-87
Berg, Carla J. ........................PP-101, PS1-75, POD8-4
Bergen, Andrew .............................................. SYM18-4
Bergeria, Cecilia L. ............................................ PS3-51
Berkelhamer, Sara .............................................PS3-44
Berlowitz, Jonathan B. ....................................... PS1-46
Berman, Micah L. ............................................. SYM8-4
Bernat, Debra ...................................................... PP-64
Bernstein, Steven L. ............. PS3-3, PS3-18, POD10-4
Bertrand, Adrian ................................................... PP-66
Best, Catherine .................................................. PP-121
Bhatnagar, Aruni ................................................ PS1-46
Bhatnagar, Nidhi ................................................PS3-73
Bhatnagar, Nidhi M. .........................................PS2-131
Bhochhibhoya, Shristi ........................................ PS1-69
Bickel, Warren .....................................PS1-20, PS1-22
Bickel, Warren K. ........PP-95, PS2-8, PS3-69, SYM4-4
Bierut, Laura ...... POD1-2, PS3-17, POD4-3, SYM18-3,
SYM18-5
Bitzer, Zachary T. .................................PS3-38, PS3-41
Blackman, Kacie C. .......................................... SYM9-4
Blaes, Shelby ...................................................PS3-146
Blaha, Michael J. ............................................... PS1-46
Blair, Rachel ........................................................PS1-5
Blake, Kelly .......................................... PS2-33, PS2-34
Blakely, Tony ................................................... SYM17-2
Blalock, J, Edwin ............................................ POD14-4
Blalock, Janice .....................................PS3-16, PS3-47
Blank, Melissa ...................................................PS2-85
Blank, Melissa D. ............. PS2-105, PS2-126, PS3-113
Blankenship, Michaela .......................................PS1-20
Bluestein, Meagan .................PP-89, PP-112, PS2-117,
PS3-48, POD8-3
Bluestein, Meagan A. ........................... PS1-59, PS1-60
Boatright, Amy S. ............................................POD13-2
Boeckman, Lindsay ........................................... PS1-87
Boeckmann, Melanie ...................................... POD15-6
Boo, Silvia ........................................................ PS2-40
Boissoneault, Je ............................................ PS3-146
Boland, Veronica C. ..........................................POD5-1
Bold, Krysten W. .....PP-12, PS1-142, PS2-61, PS2-63,
PS3-61, SYM19-1
Boley Cruz, Tess ...............................................SYM9-4
Bomar, Hailey ...................................................PS3-111
Bommelé, Jeroen .................................. PP-52, PS1-63
Bondarenko, Irina .................................. PP-90, PS3-76
Bondarinko, Irina V. .........................................PS1-134
Bondy, Emma ...................................................POD3-4
Bondy, Emma O. ...............................POD6-6, SYM7-4
Bondy, Susan ......................................PS2-87, PS2-94
Bonevski, Billie ............... SYM2-1, SYM17-1, SYM17-4
Bonny, Andrea .....................................................PS2-3
Bono, Rose ........................................ PS1-20, PS1-114
Bono, Rose S. ................................... PS1-34, PS1-112
Boozary, Laili K. .................................................PS3-80
Borba, Katelyn ................................................. PS1-118
Bordner, Candace .............................................PS1-111
Borland, Ron ..................PP-4, PP-5, PP-71, SYM17-1,
SYM17-3, SYM17-4
Borle, Amod .................................................... SYM10-4
Borle, Amod L. ...................................PS2-131, PS3-73
Borosky-Armstrong, Tristan ..............................POD9-7
Borowiecki, Mateusz ..........................................PS3-36
Borrelli, Belinda .............................................. POD13-5
Bottcher, Mia M. ...............................................PS1-144
Bovill, Michelle .................................... SYM1-4, PS3-14
Bowles, Kristina ................................................... PP-19
Bowles, Kristina E. ...............................................PS1-6
Boyd, Carol ....................................................... POD9-1
Boyd, Carol J. ...................................... PS2-28, PS2-79
Boyd, Mark .....................................................SYM17-4
Boyle, Joseph .................................................. PS2-102
Boynton, Marcella H. ........................................ POD2-8
Braaten, Greg ................................................. POD11-3
Bradley, Katharine ...........................................PS1-156
Brain, Kate ........................................................ POD5-5
Brandon, Karen ................................... PS2-110, PS3-6
Brandon, Karen O. ...............SYM2-3, PS3-7, POD13-1
Brandon, Thomas .................. PS2-26, PS2-110, PS3-6
Brandon, Thomas H. ............. PS1-61, SYM2-3, PS3-7,
PS3-45, POD13-1, POD13-3
Branstetter, Steven ..........................................PS2-136
Bray, Bethany C. ................................PS2-85, PS2-105
Brecht, Mary-Lynn .............................................PS1-65
Breland, Alison .......... PP-78, PS1-66, PS1-70, PS1-91,
PS1-135, PS2-47
Brennan, Emily ................................................. POD2-5
Brett, Emma .......................................................PS1-42
Brewer, Noel T. ....................PS1-107, PS2-93, PS3-96
Bricker, Jonathan .............................................PS3-144
Bricker, Jonathan B. ............ PP-17, SYM2-2, POD11-6
Briggs, Jodie .................................................... PS1-104
Brighton, Elizabeth .............................................. PP-40
Brinkman, Marielle ............................................... PP-94
Brinkman, Marielle C. ...................................... PS3-130
Britton, John ..................................................... POD5-5
Britton, Maggie .................................................. PS3-28
Brochier, Marion ..............................................PS3-104
Brody, Arthur L. ................................................ PS3-105
Broniatowski, David A. .......................................PS1-32
Brooks, Daniel ................................................... PS1-68
Brose, Leonie S. ............................... PS3-97, SYM11-6
Brothers, Matthew ........................................... PS2-114
Brothers, Whitney ............................................. POD2-8
Broun, Aaron ...................................................... PS1-28
Broussard, Matthew L. .....................................PS3-137
Brouwer, Andrew F. ................ PS1-56, PS2-56, PS3-76
Brouwer, Kimberly ...............................................PP-40
Brown, Alex ...................................................... PS3-159
Brown, Anthony ............................................... PS2-133
Brown, Elizabeth M. ..........................................SYM6-1
Brown, Jamie ............ PP-48, PP-100, PS1-64, PS1-67,
PS3-83, PS3-143
Brown, Jennifer L. ...............................PP-39, POD12-3
Brown, Jeremiah M. .............................................PS2-8
Brown, Richard A. ..............................................PS1-96
Browning, Kaitlyn O. ............................................ PP-95
Brucks, Lisa .................................................... POD11-7
Bruijnzeel, Adriaan ............................................. PS3-40
Bublitz, Michelle ................................................POD5-7
Buczynski, Matthew ............................................. PP-83
Budenz, Alexandra .............................................. PP-18
Budenz, Alexandra R. ........................PS1-72, PS2-142
Budiongan, Julia R. ........................................... PS3-75
Budney, Alan ................................................... SYM11-3
Buenstein, Ilana ............................................ POD11-1
Bui, Thanh C. ......................................... PP-19, PS2-72
Bukowski, Thomas .............................. PS1-62, PS1-81
Bullen, Chris ........................................................ PP-87
Bunn, Janice Y. .................... PS1-141, PS2-58, PS3-54
Bunney, Patricia .................................................PS3-43
Burke, Nancy ..................................................... PS2-13
Burkhalter, Robin ..............................................SYM4-3
Burkhardt, Therese .......................................... PS1-115
Bursac, Zoran .................................................... PS1-57
Businelle, Michael .................. PS1-12, PS2-11, PS3-12
Businelle, Michael S. .......... PS1-151, SYM2-4, PS3-80
Buta, Eugenia ................................. PS3-109, SYM19-1
Butler, Ailsa R. ..................................................... PP-87
Byrne, Margaret ............................................... PS2-110
Byrne, Margaret M. ........................................... SYM2-3
Byron, M. Justin ................................. PS1-107, PS2-73
C
Caceres, Ana I. ...............................................SYM12-4
Cadham, Christopher ........... PS2-12, PS2-39, POD7-6
Caetano, Raul ..................................................PS1-123
Cagan, Rick ......................................................... PP-53
Cahn, Zachary ...................... PS1-62, PS1-81, POD7-3
Cai, Mingxiang ................................................... PS1-31
Calac, Dan ...................................................... POD11-7
Calakos, Katina C. ............................................... PP-75
Callister, Matthew .............................................POD5-5
Camacho, Bianca ............................................. POD5-6
Camacho, Paul .................................................. PS1-85
Camenga, Deepa ................................ PS2-63, PS3-61
Camenga, Deepa R. ........................................ PS1-142
Campbell, Jeremiah ......................................... PS2-114
Campos, Jesus M. ............................................ SYM7-3
Candel, Math J. ................................................... PP-99
Cantrell, Jennifer ............................... PP-113, PS2-149
Cao, Pianpian ...................................................... PP-10
Caponi, Jacob .................................................... PP-115
Cappella, Joseph ............................. POD2-7, POD12-7
Cappella, Joseph N. ....................................... SYM13-3
Carl, Ellen ........................................... PS1-4, SYM11-3
Carlini, Beatriz H. ............................................ SYM11-4
Carmona, Maria .................................. PP-39, POD12-8
Carolan, Caitriona ..............................................PS3-78
Caroll, Dana .......................................................PS2-43
Carota, Giuseppe .............................................. PS1-43
Carpenter, Kelly .................................................PS3-10
Carpenter, Kelly M. ........................... PS1-96, SYM11-4
Carpenter, Matthew ...........................................PS1-12
Carpenter, Matthew J. ..........PS1-74, PS1-141, PS3-3,
PS3-141, POD13-2
Carrazana, Enrique ........................................ POD11-1
Carreno, Diana ................................................. POD3-2
Carroll, Dana .................................................. POD11-3
Carstensen, Georgia ...................................... SYM17-1
Carter-Harris, Lisa ........................................... PS3-101
Cartujano-Barrera, Francisco ........................... POD2-1
Caruso, Massimo .................................PS1-43, PS2-40
Casas, Alejandra ..................................... PP-61, PP-63
Case, Amy ......................................................... PS2-60
Case, Kathleen ................................................ PS2-137
Case, Kathleen R. ................. PS2-67, PS3-49, PS3-59
Cassidy, Rachel ....................PS2-89, PS2-91, POD5-6
Cassidy, Rachel N. .............................PS1-95, POD9-6
Cataldo, Alana ................................................. PS3-137
Cather, Corinne ................................................POD5-2
Catley, Delwyn ..................................PS3-22, SYM21-3
Catz, Sheryl L. ................................................. PS3-156
Cavallo, Dana .................................................... PS3-61
233
Author Index
Cavazos-Rehg, Patricia .................... POD1-1, PS2-108
Ceballos, Richard D. ........................................PS2-140
Cha, Sarah ............................................ PP-2, PS1-144
Chadwick, Ginny ..................................................PP-35
Chaiton, Michael ..... PP-91, PS2-87, PS2-94, PS2-119,
PS2-123
Chaiton, Michael O. .......................................... SYM4-1
Chakraborti, Yajnaseni ....................................PS1-126
Chan, Gary ............................................ PP-5, PS2-124
Chan, Gary C. ........................................PP-16, PS3-92
Chan, Gary C. K. ............................................. PS1-153
Chander, Geetanjali ...........................................PS2-10
Chandler, Maura .............................................SYM21-5
Chang, Yuchiao ..............................................POD10-5
Cheah, Nuan Ping ............................................ SYM8-2
Cheeks, Samantha ........................................... SYM7-3
Chellian, Ranjith kumar ....................................... PP-82
Chellian, Ranjithkumar ...................................... PS3-40
Chen, Baojiang ....... PP-89, PP-112, PS1-60, PS2-137,
PS3-48, POD8-3
Chen, Chuyun ...................................................SYM7-1
Chen, Hui ........................................................SYM15-3
Chen, Irene .......................................................... PP-83
Chen, Jarvis ......................................................POD9-4
Chen, Jian .............. PS2-27, PS2-66, PS2-69, PS2-71,
PS2-152
Chen, Jianjiu .................................................... PS3-110
Chen, Jingling ..................................... POD1-1, PS3-17
Chen, Li-Shiun ................... POD1-1, POD1-2, POD1-3,
PS2-108, PS3-17, POD4-3, POD10-4, SYM18-3,
SYM18-5
Chen, Sixia ........................................................ PS3-77
Chen, Sixia C. ....................................................PS3-71
Chen, Tzuan A. .................................................. PS3-28
Chen, Yen-Chu ..................................POD3-6, SYM7-3
Cheney, Marshall ...............................PS1-69, PS1-147
Cheney, Marshall K. ..........................PS1-33, PS2-115
Cheng, David C. ................................... PP-50, POD7-1
Cheng, Joyce .....................................................PS2-13
Chen-Sankey, Julia .............................PS1-28, PS2-32,
PS2-97, PS2-111, PS3-29, POD4-5, POD4-6
Chen-Sankey, Julia C. ......PS1-145, PS3-151, SYM8-3
Cheung, Yee Tak Derek ................... PS3-110, PS3-135
Chew, Rob .........................................................PS1-81
Chew, Robert .....................................................PS1-62
Chichester, Keith ...................................PS1-7, PS1-12
Chichester, Keith R. ........................................POD13-7
Chieng, Amy ................................................... SYM21-5
Childers, Margaret ........................................... PS2-105
Childers, Margaret G. ........ PS2-85, PS2-126, PS3-113
Chiles, Caroline ......................................... PP-8, PP-10
Chiu, Vivian .....................................................PS1-153
Cho, Hong-Jun .................................................. PS1-71
Cho, Junhan ......................... PS1-46, PS1-80, SYM9-4
Cho, Sung-il ....................................................... PS2-31
Cho, Yoojin ..........................................................PP-71
Choi, Kelvin .............. PP-27, PS1-28, PS2-97, PS3-29,
POD4-5, POD4-6
Choi, So Yung ................................................. POD11-1
Chow, Sherman .................................PS1-108, PS2-46
Chung, Jack .........................................................PP-16
Chung, Jack Y. C. ............................................ PS1-153
Chung Hall, Janet ................................................ PP-71
Chung-Hall, Janet .............................. SYM4-1, SYM4-2
Ciccolo, Joseph ............................................... PS2-141
Cid, Marco F. .................................................. POD13-3
Cigan, Shannon ................................................. PS3-55
Cinciripini, Paul ........... PP-7, PS2-46, PS3-16, PS3-47,
PS3-142
Cinciripini, Paul M. ................................. PP-10, PS1-17
Clancy, Luke ......................................................PS3-31
Clark, Jaydin ................................................... SYM13-4
Clark, Sonia A. ...................................................PS2-73
Claw, Katrina ..................................................SYM18-1
Clendennen, Stephanie ...... PP-118, PS2-67, PS2-137,
PS3-120, POD8-2
Clendennen, Stephanie L. ................... PS3-49, PS3-59
Cliord, James S. ................................................ PS3-9
Coakley, Raymond D. ..........................................PP-79
Coates, Katherine ............................... PS3-4, POD10-6
Cobb, Caroline ...... PS1-20, PS1-34, PS1-98, PS1-112,
PS1-114
Cobos, Ashly ...................................................... PS3-45
Cofer, Jennifer ...................................................PS2-46
Coman, Donna ..............................................PS1-126
Coggins-Block, Ashleigh M. .............................PS1-125
Cohen, Joanna ......... PP-47, PP-62, PS1-91, PS1-135,
PS2-47, PS2-78, PS2-87, PS2-94, SYM4-1,
POD12-1
Cohen, Joanna E. ... PP-39, PS1-66, PS1-70, PS1-109,
PS2-86, PS2-101, POD12-3
Cohen, Julia F. ................................................... PS3-21
Cohn, Amy ............................. PP-113, PS1-98, PS3-77
Cohn, Amy M. .........PP-34, PP-107, PS3-71, SYM14-2
Colder, Craig ..........................................PP-7, PS3-142
Colder, Craig R. ...................................................PS1-9
Colditz, Jason B. .............................................. PS2-116
Coleman, Sulamunn R. ..................................... PS3-54
Collins, Bradley N. ............................................... PP-88
Collins, Je .................................... POD15-4, POD15-5
Combs, Madison ................................................PS1-66
Conn, Melissa R. ................................ PS1-6, POD13-3
Connor, Jason .................................PS1-153, PS2-124
Cook, Jessica .................................................... PS1-44
Cook, Jessica W. ...............................................PS1-25
Cook, Steven .......... PP-90, PP-97, PS1-129, PS1-134,
PS2-109, PS3-64
Cooke, Megan E. ................................................. PS3-9
Cooper, Robert K. ..............................................PS1-39
Cooper, Sara .......................................PS3-26, PS3-27
Cooper, Skylar Y. ............................. SYM7-2, SYM16-3
Corbo, Claudia .................................................PS3-103
Cordero, David S. ............................................. POD9-4
Cordero-Romero, Susan .................................. POD5-7
Cornacchione Ross, Jennifer .......................... PS1-120
Cornacchione Ross, Jennifer J. .......................PS3-149
Cornish, Elliot ....................................................PS3-97
Correa-Fernández, Virmarie ..............................PS3-28
Cosgrove, Kelly P. ...............................................PP-75
Cotten, Whitney ................................................... PP-34
Cotton, Alice ...................................................... PS2-92
Cottrell-Daniels, Cherell .....................................PS3-67
Coughlin, Steve ................................................. PS1-55
Courtney, Ryan ...............................................SYM17-4
Courtney, Ryan J. .............................................POD5-1
Cox, Chelsea .................................................. POD10-3
Cox, Lisa Sanderson ........................................... PP-21
Cox, Sharon ..............PP-48, PP-100, PS1-67, POD7-7
Coyle, Kathryn ................................................ SYM10-1
Craig, Lorraine V. ..............................................SYM4-1
Craigmile, Peter F. ............................................ SYM9-1
Crandell, Ian ........................................................ PP-64
Crankson, Shirley .......................... POD15-4, POD15-5
Crespi, Elizabeth .............. PS1-91, PS1-109, PS1-135,
PS2-78, PS2-86
Creswell, Paul D. .............................................. POD1-5
Cristol, Benjamin A. ..........................................POD9-2
Critchlow, Nathan ..............................................PP-121
Crockett, Lisa .....................................................PS1-89
Croes, Esther .....................................................PS1-63
Cropsey, Karen .........PS1-7, PS1-12, PS1-74, POD8-6
Cropsey, Karen L. ...........................................POD13-7
Crosbie, Eric .......................................... PP-58, PS3-95
Crosbie, Philip .................................................. POD5-5
Cruvinel, Erica N. .................................................PS3-5
Cruz, Tess ....................................................... POD12-6
Cruz, Tess Boley .................................................. PP-57
Cruz-Cano, Raul ...............................................PS2-111
Cruz-Jiménez, Lizeth ................... PP-33, PP-45, PP-60
Cui, Yong ...........................................................PS1-17
Cummings, K. M. .... PS1-74, PS3-84, PS3-89, SYM4-1
Cummings, K. Michael ............PP-5, PP-102, PS1-155,
SYM21-1
Cummings, Kenneth M. ................................... PS1-141
Cummings, Michael ........ PP-4, PP-14, PP-71, POD7-5
Cunradi, Carol .................................................PS1-123
Cuomo, Raphael ................................PS2-98, PS2-100
Cuomo, Raphael E. ............................. PS2-4, PS2-118
Cupertino, Ana Paula ........................................ POD2-1
Curry, Laurel .....................................................POD9-3
Cwalina, Sam ....................................................PS3-81
Czaplicki, Lauren ................................ PP-62, POD12-1
D
Dabroy, Danny ................................................. PS2-114
Dahl, Neely ..................................................... POD10-4
Dahman, Bassam ............................................ PS2-102
Dai, Hongying (Daisy) ......................................PS2-158
Dall, Valyn ........................................................ PS3-116
Damaj, M. Imad .............................................. POD14-5
Damaj, M. Imad ................................................ POD6-5
D’Angelo, Heather ............... POD1-3, PS2-33, PS2-34,
POD10-4
Dark, Michael .....................................................PS2-14
Dashtian, Hassan ............................................ PS2-113
Dauchy, Estelle ................................................PS2-150
Dauchy, Estelle P. ............................................ PS2-151
Daughters, Stacey ............................................... PP-13
Davigo, Michele ................................................... PP-23
Davine, Jessica .................................................PS1-36
Davis, Danielle .......................PS2-61, PS2-63, PS3-61
Davis, Danielle R. .............................. PS1-142, PS3-51
Davis, Esa M. .................................................POD10-5
Davis, Jordan P. ............................................... PS2-128
Dawes, Kelsey .................................................. POD6-4
Dawkins, Lynne ................................................POD7-7
Day, Andrew T. ..................................................POD1-3
DeAngelis, Briana ................................................ PS3-1
Deareld, Craig ....................................................PP-64
DeAtley, Teresa ................................................ POD5-6
DeBellis, Derek .................................................. PS2-81
Debnam, Charles ............................................... PP-113
Deepak, Janaki .................................................. PS1-18
DeFilippis, Andrew P. .........................................PS1-46
DeLeon-Sanchez, Suhana .............................. PS3-101
234
Author Index
Delgado, Lauren .............................................. PS2-157
Delnevo, Cristine ...... PP-85, PS2-89, PS2-91, PS2-95,
SYM4-1
Delnevo, Cristine D. ...........................................PS1-45
Denlinger-Apte, Rachel ....... PS2-96, SYM4-7, POD9-6
Denlinger-Apte, Rachel L. ................. PS1-95, PS1-120
Denslow, Sheri ...................................................PS3-50
Desai, Maruti .......................................................PP-41
DeSarno, Michael .............................................. PS3-11
DeSarno, Michael J. ............................................ PP-95
Deshmukh, Chetana ......... PS2-131, PS3-73, SYM10-4
DeVito, Anthony ............................................... PS2-160
DeVito, Elise E. ...............................................SYM15-2
Devkota, Janardan ............................................ PS3-12
de Vries, Hein ............................PP-26, PP-99, PS1-30
Dhar, Biswadeep .............................................PS3-103
Diaz, Destiny .....................................................PP-120
Diaz, Megan ......................................... PP-67, POD7-3
Diaz, Megan C. .................................................... PP-66
Dickerson, Faith ...................................................PS2-6
Dimaya, Brenda S. ............................................ PS2-62
Dimofte, Claudiu ................................. PP-106, POD2-4
Ding, Zheng-Ming ............................................. POD3-5
Dino, Geri ..........................................PS2-85, PS2-105
Distefano, Alo .....................................PS1-43, PS2-40
Ditre, Joseph .....................................................PS1-19
Ditre, Joseph W. ........................PP-15, PS1-2, PS2-24
D’Mello, Kimberly .................................................PP-49
Do, Elizabeth ................................................... PS1-127
Do, Elizabeth K. .......PP-92, PP-93, PS1-116, PS1-117,
PS3-9
Do, Elizaeth K. ................................................. PS1-144
Doane, Jacqueline ................................ PP-50, POD7-1
Dobbs, Page D. ..................... PP-35, PS1-33, PS2-116
Dodder, Nathan ...............................................PS2-120
Dognin, Joanna .............................................. SYM21-4
Donny, Eric .........................................POD2-7, PS2-96
Donny, Eric C. .....................................PS1-95, POD9-6
Donovan, Emily ........ PP-67, PS2-36, PS2-37, POD7-3
Dooley-Budsock, Patricia .................................. PS2-17
Doran, Christopher M. ...................................... POD5-1
Doran, Neal .....................................................PS3-105
Dorison, Charles ............................ SYM13-1, SYM13-2
Doroshenko, Christine ...................................... POD1-2
Dorr, Casey .....................................................POD11-3
Doscher, Crile ......................................................PP-59
Douglas, Ashley E. ...........PS2-85, PS2-105, PS2-126,
PS3-113
Dove, Melanie S. ............................................... PS2-32
Drake, Cara ....................................................... PS3-85
Dreger, Steen ...............................................POD15-6
Drenner, Kelli .....................................................PS3-28
Dressler, Emily ...........................................PP-8, PP-11
Driezen, Pete .............. PP-5, PP-99, PS1-155, SYM4-2
Drobes, David J. ............................................. POD13-3
D’Souza, Gail ....................................................PS1-111
Du, Weiting .......................................................POD9-4
Du, Xiaoming ................................................... PS3-157
Duan, Zongshuan ............. PS3-65, POD8-4, POD11-5,
POD12-2, POD12-5
Duarte, Danielle A. .............................................PS1-28
Duaso, Maria ................... PS2-92, SYM11-6, SYM14-4
Dubray, Jolene ..................... PS2-87, PS2-94, PS2-119
Duitz, David ....................................................... PS2-10
Duitz, Jack ......................................................... PS2-10
Dukes, Angeline J. ............................................SYM7-3
Duncan, Katherine ............................................. PS2-53
Dunlap, Chris ..................................................... PS1-33
Dunn, Delaney ........... PP-34, PP-107, PS1-98, PS3-77
Dunsiger, Shira I. ...............................................PS2-20
Dunstone, Kimberley ........................................ POD2-5
Durkin, Sarah ....................................................POD2-5
Durra, Abdo ......................................................... PP-84
Dzerk, Alan .......................................................... PS1-3
Dziura, James ..................................................PS2-156
E
East, Katherine .......................................... PP-4, PP-49
Easwaran, Meena ................................................PP-80
Ebrahimi Kalan, Mohammad ............. PS2-114, PS3-96
Eckel, Sandrah P. .............................................. PS1-80
Eckert, Christine ............................................... POD2-6
Edwards, Richard ............................ SYM3-2, SYM17-1
Eftekhari, Parivash ............................................ PS3-14
Egbe, Catherine O. ............................................ PS3-95
Egeland, Britta ................................................... PS3-72
Egleston, Brian .................................................... PP-88
Ehlke, Sarah ...................................................... PS2-11
Ehlke, Sarah C. ................................................. PS3-71
Ehlke, Sarah J. ........ PP-34, PP-107, SYM2-4, PS3-80,
POD9-3
Eisenberg, Marla E. ............................................. PP-37
Eissenberg, Thomas ...............PP-78, PS1-20, PS1-70,
PS1-91, PS1-117, PS1-127, PS1-135, PS1-144,
PS2-87, PS2-94, POD6-1
Eissenberg, Thomas E. ..................................... PS1-66
Elbaz, Daniel ....................................................... PP-55
Elhabashy, Maryam M. ......................................PS1-28
El Hage, Rachel ....................PS2-42, PS3-39, POD6-1
El Hajj, Dana ....................................................PS3-132
El-Halawany, Medhat ......................................POD14-1
El Hellani, Ahmad ..............................................PS2-42
El-Hellani, Ahmad ............................................. POD6-1
El Hourani, Mario ............................................... PS3-74
Ellerbeck, Edward F. ............... PP-21, PS3-5, SYM21-3
Elliott, Michael ...................................................PS2-29
Elliott, Michael R. ............................................... PS3-76
Elnimeiry, Logain Elnimeiry ...............................PS2-45
Elsey, Helen ...................................POD15-4, POD15-5
Elting, Linda S. ................................. PS2-22, POD10-2
Emery, Rebecca L. ............................................PS2-21
Emery, Sherry ......PS3-36, PS3-88, PS3-138, SYM6-3,
POD12-6
Emma, Rosalia .................................... PS1-43, PS2-40
Emmons, Karen .............................. PS2-106, POD15-2
Endrighi, Romano ........................................... POD13-5
Engelhard, Matthew M. ....................................PS1-150
Engelmann, Jeery M. ....................................... PS1-17
Engstrom, Curtiss W. .........................................PS2-79
Epperson, Anna ................................................. PS3-52
Epperson, Anna E. ............................................. PS1-54
Erath, Tyler G. ................................................... PS3-11
Erickson-DiRenzo, Elizabeth ............................... PP-80
Eriksen, Michael P. ......... PS3-65, POD11-5, POD12-2,
POD12-5
Erkan, Duru .........................................PS2-70, PS2-77
Ervin, Carolyn ................................................. SYM18-4
Erythropel, Hanno ............................................PS2-157
Espinoza, Selina ................................................ PS3-52
Evans, W D. .......................................................PS1-32
Evans-Polce, Rebecca ..................................... POD9-1
Evans-Polce, Rebecca J. .................... PS2-28, PS2-79
Evans-Reeves, Karen ..........................................PP-56
Evemy, Carolyn G. .............................................PS3-99
Evins, A. Eden ........................PS2-16, PS3-9, POD5-2
F
Fabbricatore, Jessica L. .......................PP-111, PS3-53
Fagan, Blake .....................................................PS3-50
Fairman, Robert T. ................................PP-71, POD4-7
Fanshawe, Thomas ............................................. PP-87
Farrell, Michael ................................................. POD5-1
Farrelly, Matthew ..................PS1-99, SYM2-5, PS2-51
Faseru, Babalola ............................................ SYM21-3
Fatollahi, Javad J. ............................................PS3-105
Faunce, Christine L. ............................................ PP-83
Feather, Abigayle ............................................... PS2-55
Fedewa, Stacey ................................ PS3-115, POD4-2
Felicione, Nicholas ............................................ PS3-68
Felicione, Nicholas J. ........PP-102, PS2-126, PS2-159,
PS3-113
Feng, Miao .........................................................PS3-88
Feng, Patrick .......................................................PP-91
Fenton, Elizabeth .................................................PP-56
Ferguson, Stuart ................................ POD5-1, POD5-4
Ferkin, Adam C. ...................................................PS1-9
Ferrante, Margherita .......................................... PS2-40
Ferrell, Anastasiya ........................................... PS3-132
Fetterman, Jessica ............................................ PS1-46
Fetterman, Jessica L. ........................................ PS1-98
Fields, Sherecce ................................................ PS2-49
Fields, Sherecce A. ............................................PS3-24
Filippidis, Filippos T. .........................................SYM4-2
Fiore, Michael ...... POD1-3, POD1-5, PS2-1, POD10-4,
POD10-6
Fiore, Michael C. .................................................PS3-4
Fiser, Kayleigh A. ............................................... PS2-50
Fitzke, Reagan E. ............................................ PS2-128
Fix, Brian ...........................................................PP-120
Fleischer, Nancy .......PP-31, PP-97, PS1-134, PS2-29,
PS2-56, PS2-109, PS3-64, PS3-76
Fleischer, Nancy L. .................PP-65, PP-90, PS1-129,
PS1-133
Fleischli, Mary ......................................................PP-38
Fleischli, Mary B. ............................................. PS2-148
Fleischli, Mary E. ................................................. PP-36
Fleisher, Linda ................................................POD10-4
Fleming, Morgan ................................................PS3-86
Flocke, Susan .................................................... PS3-25
Foley, Kristie .................................. PP-8, PP-10, PP-11
Folger, Shanell .....................................PP-113, PS2-36
Fong, Georey ...... PP-4, PP-26, PP-31, PP-71, PP-99,
PS2-31, PS3-84, PS3-89, POD7-5
Fong, Georey T. ........ PP-5, PP-98, PP-102, PS1-155,
SYM4-1, SYM4-2, POD15-5
Forberger, Sarah ............................................POD15-6
Foster, Madeline G. ............................PP-14, POD13-2
Foucaud, Jérôme ...................................PP-68, PS3-93
Foulds, Jonathan ................................PS1-111, PS2-47
Fowler, Christie .................................................POD3-6
Fowler, Christie D. ............................................SYM7-3
Fowler, James P. .............................................. SYM7-3
Frank-Pearce, Summer ....... SYM2-4, PS2-11, PS3-77,
SYM14-2
Frank-Pearce, Summer G. ............... PS2-22, POD10-2
235
Author Index
Freedman, Neal ............................................... PS3-104
Freitas-Lemos, Roberta .......... PS2-8, PS3-69, SYM4-4
Frie, Jude ..........................................................SYM7-1
Frie, Jude A. .....................................................POD6-3
Friedman, Abigail ................................................. PP-38
Friedman, Abigal ............................................... POD7-2
Friedman, Emily R. ............................................ PS1-76
Friedrichsen, Samantha C. .............................. PS1-116
Fritz, Meridith ................................................... PS2-112
Froeliger, Brett ....................PS3-8, PS3-159, POD13-2
Frye, Christopher ................. PP-119, PP-120, PS3-131
Fryer, Craig ........................................................PS3-79
Fu, Rui ............................................................. PS2-123
Fu, Steven ................................................. PP-9, PP-37
Fucito, Lisa ........................................................ PS3-18
Fucito, Lisa M. ..................................................... PS3-3
Fuemmeler, Bernard ........................................PS1-127
Fuemmeler, Bernard F. .... PS1-117, PS1-144, PS2-102
Fuentes, José C. ............................................... PS3-75
Fujimoto, Kayo ...................................................PP-122
Fung, Vicki C. .......................................PP-50, POD7-1
Fuss, Caroline .................................................. POD8-4
G
Gaalema, Diann .................................................PS2-58
Gaalema, Diann E. ............................................ PS3-11
Ganey, Kemi ..................................................PS3-101
Gaggar, Amit ................................................... POD14-4
Gaiha, Shivani M. ............ PS2-121, PS2-122, PS2-125
Gajewski, Byron J. .............................. PS3-5, SYM21-3
Gajos, Jamie ......................................................PS1-12
Galiatsatos, Panagis ..........................................PS1-46
Gallegos-Carrillo, Katia ................PP-33, PP-45, PP-60
Gamble, Karen ................................................. POD8-6
Ganz, Ollie ........... PS1-45, PS3-85, PS3-148, SYM4-1,
POD9-3
Garbsch, Ellen ................................................... PP-115
Garcia, Hector ...................................................PS1-85
Garcia-Cazarin, Mary ........................................ PS1-37
Garcia-Torres, Deyri ........................................ PS2-157
Gardiner, Phil ....................................................SYM6-3
Garg, Suneela .................. PS2-131, PS3-73, SYM10-4
Garland, Eric L. ...............................................POD13-2
Garnett, Claire ..................................... PS1-64, PS3-83
Gartner, Coral ......PP-16, PS1-153, PS2-124, POD5-1,
SYM17-3, SYM17-4
Gartner, Coral E. .............................................SYM17-1
Garza, Nathalie ..................................................PS2-18
Gass, Julie C. .................................................... PS1-39
Gautam, Prem ................................................... PS1-57
Gaynor, Adam .................................................... PS3-56
Gaysynsky, Anna .................................PS2-33, PS2-34
Geboers, Cloé ......................................... PP-26, PP-99
Geisler, Jennifer ..............................................POD11-7
Geller, Alan ........................................................ PS1-36
Gendall, Philip .................................................. POD2-6
George, Tony ................................................... PS3-142
George, Tony P. .....................................................PP-7
Geranios, Karina ..............................................PS3-106
Gerrard, Meg ............. PP-36, PP-38, PS2-148, PS3-15
Ghaari-Ra, Arash ........................................ POD11-1
Ghosh, Arunava ................................................... PP-79
Gibbons, Frederick X. .......................... PP-36, PS2-148
Gibbons, Rick ........................................ PP-38, PS3-15
Giberson, Jeremy ............................................ PS3-124
Gierada, David ..................................................POD1-2
Giord, Heather ................................................ SYM1-4
Gildengorin, Ginny ............................................. PS2-13
Gilks, Charles ................................................. SYM17-4
Gilman, Jodi M. ....................................................PS3-9
Gilson, Carra ..................................................... PP-115
Giordano, Antonio .............................................. PS2-40
Giovenco, Daniel P. ............................ PS1-45, SYM9-2
Gipson, Cassandra D. ....................... POD6-6, SYM7-4
Gipson-Reichardt, Cassandra .......................... POD3-4
Girgulis, Jane P. ................................................... PP-77
Glasser, Allison .................................................. PP-115
Glasser, Allison M. ............................................. PS2-99
Gleason, Carey E. ............................................. PS1-44
Godino, Job ......................................................... PP-40
Goldberg, Lisa R. ..............................................POD3-3
Goldberg, Sydney L. ................. PP-28, PP-50, POD7-1
Golden, Shelley ............................................... PS2-102
Golden, Shelley D. ...............................................PP-29
Goldstein, Adam ............................................... POD1-3
Goldstein, Adam O. .........................................PS1-107
Golshahi, Laleh ..................................................PS3-74
Gomez, Andres .................................................. PS2-45
Gomez, Francisco .............................................PS3-55
Gomperts, Brigitte ................................................PP-84
Goniewicz, Maciej ...............PS2-60, PS2-65, PS2-159,
PS3-44, PS3-68, PS3-84, PS3-89, PS3-102
Goniewicz, Maciej L. ...PP-98, PP-102, PS1-4, PS1-82,
PS1-125, PS3-35, SYM12-1
Goniewicz, Maciej L. ........................................PS1-155
Gonsalves, Nishi .............................................. PS1-119
Gonzalez, Mariaelena ..........PS1-54, PS1-131, PS3-52
Gonzalez, Roberto .............................................PS3-16
Gonzalez, Valentina ..........................................POD7-4
Goodwin, Renee ............................. PS2-135, SYM11-3
Goodwin, Renee D. ....................... SYM11-1, SYM14-1
Gordon, Bob ..................................................... POD9-4
Gordon, Judith ................................................... PS3-12
Gore, L. R. ........................................................... PS3-7
Gorrilla, Allison ..................................................... PS2-1
Gottfredson, Nisha C. ........................................ PS2-93
Gottlieb, Mark .................................................. PS2-106
Gottlieb, Mark A. .............................................POD15-2
Gould, Gillian S. .................................................PS3-14
Gould, Thomas J. ............................................. POD3-3
Goulette, Michelle R. ....................................... PS3-117
Grace, Martha ....................................................PS3-43
Grady, Meredith ...............................PS2-141, PS2-142
Graham, Amanda .............................. PS1-117, PS3-87
Graham, Amanda L. ..............PP-2, PS1-144, PS2-153
Graham, David P. ................................................PS1-1
Grana Mayne, Rachel .......................PS1-72, SYM12-3
Gratale, Stefanie ....................................PP-85, PS2-88
Gratale, Stefanie K. ........................................... PS3-85
Gravely, Shannon ...............PP-4, PP-5, PP-60, PP-98,
PS1-153, PS2-31, SYM4-3, POD7-5
Gregus, Ann M. ....................................................PP-83
Grin, William C. .............................................. POD6-6
Grith, Nicholas ............................................... POD4-3
Grilo, Graziele .................................................POD12-3
Grisham, Lisa ....................................................PS2-25
Gu, Jiayan .........................................................PS1-32
Gueorguieva, Ralitza ........ PS2-19, PS3-109, SYM19-1
Guillemin, Anne-Fleur ............................ PP-68, PS3-93
Guillory, Jamie ...................................................PS1-81
Gundersen, Daniel ...........................................PS2-106
Gundersen, Daniel A. .....................................POD15-2
Gunzler, Doug ....................................................PS3-79
Guo, Derek .......................... PS2-70, PS2-77, PS3-118
Gupta, Prakash C. ............................................... PP-41
Gupta, Priya .........................................................PS1-8
Gupte, Himanshu .............................................PS3-108
Gupte, Himanshu A. ........................................PS2-134
Gutiérrez-Torres, Daniela S. ............................ PS3-104
Guttentag, Alexandra ........................................ SYM9-3
Guy, Mignonne ..................................................PS1-20
H
Haas, Jennifer ..................................................... PP-10
Hacker, Kiana ......................PS2-97, POD4-5, POD4-6
Hacker, Kiana J. ................................................PS3-29
Haddad, Linda ................................................. PS3-132
Hadland, Scott ................................................ POD13-5
Haeny, Angela .........................PP-36, PP-38, PS2-148
Hagen, MSM, Les .............................................. PS3-34
Hagen MSM, Les ................................................. PP-69
Haile, Jackson ................................................. PS2-113
Hair, Elizabeth ................................................... PP-114
Hair, Elizabeth C. ...... PP-92, PP-93, PS1-88, PS1-116,
PS2-52, PS2-62, PS2-153, PS2-154, PS3-82
Hajek, Peter ......................................................... PP-87
Haley, Meaghan ............................................... PS1-110
Hall, Marissa G. ................................... PS2-93, PS3-96
Hall, Michael E. ..................................................PS1-46
Hall, Sharon M. ............................................... POD13-4
Hall, Wayne ..........PP-16, PS1-153, PS2-124, POD5-1
Halladay, Jacquie ..............................................PS3-50
Hallam, Bryana L. ............................................. SYM7-1
Halliday, Deanna M. ..........................PS1-54, PS1-131
Hallinan, Jayme ................................................. PS1-18
Halpern-Felsher, Bonnie .................PS2-121, PS2-122,
PS2-125, PS2-140, PS2-145
Halpern-Felsher, Bonnie L. ..............................PS1-131
Halquist, Matthew S. ............................................PP-73
Halstead, E. Scott .............................................. PS3-38
Hamburg, Naomi M. ..........................................PS1-46
Hamida, Ichrak B. ............................................ PS2-132
Hamilton, Leah ................................................ PS1-156
Hamilton-Moseley, Kristen R. ............................PS1-28
Hammal MB MSc, Fadi ..........................PP-69, PS3-34
Hammett, Patrick ................................................. PP-37
Hammond, David .......... PP-5, PP-49, PS2-35, PS3-68,
PS3-84, PS3-89, SYM4-3
Hammond, David M. ........................................ PS1-155
Hammoud, Mohamed ....................................... SYM2-1
Han, Lu ........................................................... SYM10-3
Hanan, Joan .................................................... PS3-31
Hanby, Elaine .....PS2-90, PS2-106, POD9-4, POD9-5,
POD15-2
Hannemann, Tessa-Virginia ............................ PS1-124
Hansen, Eric ...................................................... PS2-60
Hanson, Monah .............................................. POD11-7
Haque, Noshin ................................................. PS3-101
Harder, Valerie S. ............................................PS1-143
Hardesty, Jerey ................................................PS1-91
Hardesty, Jerey J. .............PS1-66, PS1-70, PS1-109,
PS1-135, PS2-78, PS2-86, PS2-147
Hardin, James .................................................. POD5-4
Harfmann, Roxanne F. ....................................... PS2-58
Harlow, Alyssa F. ................................. PS1-46, PS1-68
236
Author Index
Harrell, Melissa ..........PP-89, PP-112, PP-118, PS2-67,
PS2-117, PS2-137, PS3-48, PS3-49, PS3-120,
POD8-2, POD8-3
Harrell, Melissa B. .................. PP-70, PS1-59, PS1-60,
PS1-132, PS3-59
Harrell, Paul T. ...................................................PS1-61
Harris, Andrew ..................................................... PP-81
Harris, Bethany L. .............................................. PS3-24
Harrison, Abigail ............................................... POD5-6
Harrison, Amanda ............................................ PS3-103
Harrison, Katherine .................PS1-58, PS2-5, PS2-21,
PS2-53, PS2-59
Harrison, Sarah L. ............................................... PP-77
Hart, Jonathan ................................................... PS1-87
Hart, Joy .......................................................... PS1-101
Hart, Joy L. ......... PS1-13, PS1-15, PS1-100, PS1-122,
POD13-5
Hartley, Jordan ..................................................PS1-90
Hartmann-Boyce, Jamie ...................................... PP-87
Hasan, Afsheen .............................................. POD10-1
Hashemi, Rhana ................................................ PS3-90
Hassan, Ahmad ................................................ SYM7-1
Hatsukami, Dorothy ............. POD2-5, PS2-43, PS2-45,
PS3-55, POD11-3
Haunser, Amos ............................................... POD15-3
Haupt, Michael R. .............................................. PS1-31
Hawes, Elizabeth S. .......................................... PS1-74
Hawk, Larry ............................ PP-7, PS3-142, POD5-3
Hawk, Larry W. ..................................................PS1-39
Hawk, Jr., Larry W. .............................................. PS1-9
Hayashi, Robin ............................................... POD13-6
Hayden, Kristine .................................................. PS2-1
Hayes-Birchler, Todd ......................................... PS1-56
Haynes, David ....................................................... PP-9
Hebert, Emily ..................................................... PS3-12
Hebert, Emily T. ...............................................PS1-151
Hecht, Jacklyn ................................................... PS1-96
Heckel, Emily .................................................. SYM13-1
Hedeker, Donald ...............................PS3-77, SYM14-2
Hener, Jaimee ...................PS2-30, PS3-12, PS3-156
Heer, Marita ..................................PS3-152, SYM17-1
Heiden, Brendan .................................PS3-17, POD4-3
Heil, Sarah ........................................... PS2-58, PS3-11
Heintzman, John ................................................PS1-26
Heldwein, Scott D. .......................................... SYM12-1
Hellani, Ahmad E. ..............................................PS3-39
Henderson, Brandon J. ...SYM7-2, SYM16-3, SYM16-3
Henderson, Patricia Nez ................................. POD11-6
Hendricks, Lauren ............................................ POD3-5
Hendricks, Peter ................................................ PS1-12
Hendricks, Peter S. .........................................POD13-7
Henley, Patricia .....................................PP-50, POD7-1
Henriksen, Lisa ........................ PP-35, PP-119, PS1-35
Heo, Moonseong .............................................. POD5-7
Heris, Christina ............................................... POD11-2
Herman, Melissa .............................................SYM16-1
Hernandez, Carol ........................................... POD11-3
Hernandez, Gloria ............................................. PS2-71
Hernandez, Keziah ........................... PS3-42, POD14-1
Hernandez, Laura M. ...................................... POD13-1
Hernández-Ávila, Juan Eugenio ...................... PS3-104
Hershberger, Pamela A. .................................... PS1-82
Heydari, Gholamreza ...........................................PP-69
Hidalgo, Samantha ........................................... SYM4-6
Higgins, Stephen T. ......PP-2, PP-95, PS2-58, PS3-11,
PS3-54, PS3-99, POD5-6
Hill, Samantha ................................................... PS1-12
Hill, Sarah ....................................................... POD15-4
Hillmer, Ansel T. ................................................... PP-75
Himelhoch, Seth S. ............................................ PS3-21
Hinds, Josephine T. .........................................PS1-108
Hinton, Alice ......................................... PP-115, PS3-60
Hipple Walters, Bethany ......................................PP-52
Hirschtick, Jana .... PP-97, PS1-134, PS2-56, PS2-109,
PS3-64, PS3-76
Hirschtick, Jana L. ................... PP-65, PP-90, PS1-129
Hitchman, Sara .................................................. PP-121
Hitsman, Brian ................................. POD1-3, POD10-3
Ho, Denise ...................................................... POD13-6
Ho, Sai Yin ....................................................... PS3-110
Ho, Sai Yin Daniel ............................................PS3-135
Hobkirk, Andrea L. ............................................PS1-111
Hochsmann, Christoph .................................... PS1-117
Höchsmann, Christoph .................... PS1-127, PS1-144
Hoek, Janet ........... PP-56, POD2-5, POD2-6, SYM3-3,
POD15-7
Hoetger, Cosima ... PS1-20, PS1-34, PS1-98, PS1-112,
PS1-114
Homeyer, Nina .................................................PS3-60
Hohl, Sarah D. ................................. POD1-3, POD10-4
Holahan, Carole K. .......................................... PS3-114
Hollenback, Chris .............................................. PS1-53
Holmes, Louisa .................................................... PP-43
Holtz, Kristen ....................................... PS1-90, PS3-86
Homish, Gregory .................................................PP-32
Hong, Elliot ...................................................... PS3-157
Hong, Minsik ........................................................ PS2-7
Hooker, Julia E. .......................PS1-2, PS1-19, PS2-24
Hoopes, Elissa .....................................................PS1-5
Horn, Kimberly ..................................... PP-64, PS2-136
Hosseini, Sana .................................................. PS3-74
Hourani, Mario E. ...............................................PS3-39
Howard, Molly .................................................... PS3-28
Howe, Carol ....................................................... PS3-12
Howe, Jordan .................................................... PS3-78
Howell, Shaunacee .........................................SYM12-4
Hoyo, Cathrine .................................................PS2-102
Hrywna, Mary .................................................. PS1-119
Hsieh, Hsing-Fang ............................................... PP-41
Hsu, Johnathan .............................................. SYM11-4
Hsu, Ping-Ching .................................................. PP-13
Huang, Jidong ................ PS3-65, POD11-5, POD12-2,
POD12-5
Huang, Ming .................................................... PS2-108
Huang, Yiyun .......................................................PP-75
Hudson, Deborah ............................................. POD1-3
Hugley, Mickeah J. .............................PS1-7, POD13-7
Huguet, Nathalie ................................................ PS3-25
Huh, Youn ..........................................................PS1-71
Humeet, Gary L. ........................................... POD13-4
Hung, Felicia Y. .................................................... PP-12
Hunn, Adam ..................................................... PS2-120
Hunter, Steve ....................................................POD7-7
Huque, Rumana ............................................. SYM10-4
Hurley, Mark ........................................................PP-39
Hurst, Alex ......................................................... PS2-46
Hurst, Samantha ...............................................POD2-4
Hussain, AKM Ghulam ...................................... PP-117
Hutcheson, Tresza D. ............................ PP-21, PS3-22
Hwang, Jun ........................................................PS1-26
Hyland, Andrew .............. PP-4, PP-5, PP-102, PP-120,
PS1-4, PS2-35, PS2-60, PS2-133, PS2-135,
PS3-84, PS3-89, SYM4-1, SYM4-3, POD7-5,
SYM11-3, SYM20-1
Hyland, Andrew M. ..........................................PS1-155
Hyland, Bridget M. ............................................... PS1-4
Hyle, Emily P. ....................................................... PP-28
I
Iannello, Justin ..................................................POD1-6
Ice, Stephanie .................................................POD10-1
Insana, Savanah ................................................PS3-91
Iosua, Ella ............................................................ PP-59
Iqbal, Romaina ............................................... SYM10-3
Islam, Mohammad S. ......................................POD12-1
Islam, Mohammad Shamimul .............................. PP-62
Islam, Sabrina .....................................PS1-83, POD4-1
Islam, Talat ........................................................ PS1-80
Islam, Ziauddin ............................................... POD15-4
Islami, Farhad ..................... PS2-74, PS3-115, POD4-2
Ismaeil, Taha T. ....................................PP-72, PS3-125
Ismael, Julia .......................................................PS1-85
Ithman, Muaid .................................................. PS3-159
Ivanov, Alexander ............................................PS1-136
J
Jabba, Sairam ................................................ SYM12-4
Jabba, Sairam V. .............................................PS2-157
Jabeen, Azhar .................................................... PS2-41
Jackson, Asti ............. PP-36, PP-38, PS1-142, PS2-61,
PS2-148, PS3-61, POD6-5, SYM19-1
Jackson, Catherine ......................................... SYM10-3
Jackson, Dawnyéa .............................................. PP-86
Jackson, Janet .....................................................PP-53
Jackson, Sarah E. ............................... PP-100, PS3-83
Jacob, III, Peyton ............................................. PS3-124
Jacobs, Cindy A. ...............................................SYM5-3
Jacobs, Megan ................................................ PS2-153
Jacobs, Megan A. ............................................PS1-144
Jacobs, Wura ........PS1-27, PS2-82, PS3-66, SYM14-3
Jacobson, Pamala .......................................... POD11-3
Jafarzadeh, Nikki S. ...........................................PS2-15
Jagiasi, Dinesh D. ............................................PS3-108
Jahad, Jasmine .............................................. SYM16-1
Jain, Raka ..........................................................PS2-41
Jakavula, Joyce .............................................. POD12-4
Jambharunkar, Trupti .......................................PS3-143
James, Aimee ................................................... POD1-1
James, Shirley ................................................... PS1-87
Jandarov, Roman A. .............................................. PP-6
Jang, Joy Bohyun ............................................ PS3-116
Jao, Nancy C. .................................... PS1-52, PS1-118
Japuntich, Sandra J. .......................................... PS2-21
Jarman, Kristen L. ............................. PS1-107, PS2-73
Jaspers, Ilona .................................................... PS3-50
Jebai, Rime ........................................PS1-57, PS2-132
Jemal, Ahmedin ................................. PS2-74, PS3-115
Jenkins, Claire F. .............................................. SYM9-1
Jensen, Joni ........................................ PS2-45, PS3-55
Jeon, Jihyoun ............. PP-10, PP-90, PP-97, PS1-134,
PS2-139, PS3-76
Jeon, Kwonchan ................................................ PS3-66
Jeon, Sally ......................................................... PS2-59
Jeong, Michelle ....................................................PP-85
237
Author Index
Jewett, Bambi ........ PS1-28, PS2-97, PS3-29, POD4-5,
POD4-6
Jhanjee, Sonali .................................................. PS2-41
Jiang, Shuning ........ PS2-27, PS2-66, PS2-69, PS2-71,
PS2-152
Jiang, Yannuo ..................................................PS3-109
Jimenez Mendoza, Evelyn ...................................PP-90
Jimenez-Mendoza, Evelyn .................................. PP-10
John, Lovina ..................................................... SYM4-6
Johnson, Adrienne L. ...........................PS1-25, PS1-44
Johnson, Andrea C. ............................POD2-2, PS2-95
Johnson, Dawn F. ............................... POD1-6, PS2-18
Johnson, Jamila ................................................POD5-7
Johnson, Matthew W. .......................................SYM5-2
Jonas, Steven ...................................................... PP-84
Jones, Emily A. ...............................................POD13-5
Jones, Erin C. .......................................PP-111, PS3-53
Jones, Michaela .................................................PS3-43
Jones, Sarah R. .................... PS1-6, PS2-22, POD10-2
Jones, Shaun R. .............................................. PS2-102
Jordan, Ashton ................................................. PS2-149
Jordt, Sven-Eric .............. PS2-157, PS3-134, SYM12-4
Jorenby, Douglas .................................PS1-53, PS1-56
Joseph, Anne ............................................. PP-9, PP-10
Joseph, Skylar ..................................... PS2-70, PS2-77
Joshi, Ayush ........................................................ PP-56
Jubran, Jerrius ................................................... PS1-58
June, Kristie ....................................... PP-119, PS3-131
Juon, Hee Soon .............................................. POD10-4
K
Kaag, Anne Marije ...............................................PP-26
Kaassamani, Malak E. ....................................... PS3-39
Kagabo, Robert ............................................... PS3-106
Kahan, Abner ..................................................... PS2-10
Kaiser, Lisa ......................................................PS2-159
Kalagher, Kelly .....................................................PS1-8
Kale, Dimitra .................................................... PS3-143
Kalhan, Ravi ................................................... POD10-3
Kali, Kgomotso ............................................... POD12-4
Kalkhoran, Sara ................................................... PS1-8
Kanaan, Mona ............................... SYM10-3, SYM10-4
Kapinos, Michael ................................................. PP-75
Kaplan, Bekir ..................................................... PS1-70
Kapoor, Shivam .................................................PS3-37
Karam-Hage, Maher .............. PS2-46, PS3-16, PS3-47
Karanja, Mercy ..................................................PS3-21
Karaoghlanian, Nareg ...............PP-76, PP-78, PS2-42,
PS3-39, POD6-1, POD14-2
Karelitz, Joshua L. ............................................... PS2-9
Karim, Zubair .................................... PS3-42, POD14-1
Karn, Shelley ..................................................... PS2-46
Kassem, Nada O. ............................................ PS3-130
Kasson, Erin .................................................... PS2-108
Kastman, Christian ............................. PS3-4, POD10-6
Kasza, Karin ......... PS2-35, PS2-60, PS2-133, PS3-84,
PS3-89, SYM4-3, SYM20-5
Katanoda, Kota ................................................. POD7-5
Kathuria, Hasmeena .......................................... PS1-46
Kaufman, Annette ................................ PS2-33, PS2-34
Kaufman, Pamela .................... PP-91, PS2-87, PS2-94
Kaur, Gagandeep ............................................PS2-159
Kaur, Manpreet .................... PS2-70, PS2-77, PS3-118
Kaushik, Ravi .....................................PS2-131, PS3-73
Kaye, Jesse T. ...................................................PS1-25
Kcomt, Luisa ......................... PS2-28, PS2-79, POD9-1
Keener, Samantha ..........................................POD10-1
Kee, Brian ...................................................... PS2-141
Kelder, Steve ...................PS3-127, PS3-128, PS3-129
Keller-Hamilton, Brittney ...... PS1-48, POD2-3, PS3-58,
PS3-130, SYM12-2
Kelley, Jennifer K. ...........................................POD10-5
Kemble, Hannah ................................................ PP-115
Kendzor, Darla ...................... SYM2-4, PS2-11, PS3-12
Kendzor, Darla E. ....PP-17, PP-107, PS1-151, PS3-80
Kennedy, Michelle ..........................................POD11-2
Kennedy, Ryan D. ............................................PS1-109
Kennedy, Ryan David ...........PP-47, PS1-91, PS1-135,
PS2-78, PS2-86, PS2-101
Kephart, Lindsay ................................................PS1-36
Kerstiens, Savanna ......................................... PS1-122
Kerstiens, Savannna ....................................... PS1-100
Kery, Caroline ....................................................PS1-62
Khalil, Georges .................. PP-122, PS3-103, PS3-136
Khan, Md Arifuzzaman ...................................SYM17-1
Khan, Muhammad N. ......................................POD15-6
Khan, Sameera ................................................PS3-124
Khan, Zohaib ................................. SYM10-4, POD15-6
Khanna, Niharika ................... PS1-18, PS2-14, PS3-56
Kharal, Maariyah ............................................. PS1-121
Kharazi Boozary, Laili .......................................SYM2-4
Khasawneh, Fadi T. ..........................PS3-42, POD14-1
Khatri, Shailesh .................. POD3-4, POD6-6, SYM7-4
Khayat, Amal ....................................................... PP-55
Kheirallah, Khalid A. ........................................PS1-102
Khokhar, Jibran Y. .............................. POD6-3, SYM7-1
Khokhar, Mariam A. ....................... POD15-4, POD15-5
Kierstead, Elexis ................................................ PS3-36
Kierstead, Elexis C. .......................... PS1-104, SYM6-4
Kilpatrick, Daniel J. .......................................... PS1-105
Kim, Annice ........................................................ PS1-81
Kim, Anthony W. ................................................ PS1-10
Kim, Hyun Suk ................................................ SYM13-3
Kim, Jinyoung .................................................... PS3-32
Kim, Juyong B. ....................................................PP-80
Kim, Nayoung ................................................. POD10-6
Kim, Ryung ........................................................ PS2-10
Kim, Yeol ............................................................PS2-31
Kim, Yoonsang ..................................PS3-138, SYM6-3
Kimber, Catherine .............................................POD7-7
Kim-Mozeleski, Jin .............................................PS2-13
King, Andrea ......................... POD1-3, PS1-42, PS2-55
King, Grace ........................................................PS3-40
King, Jaron H. .................................................. PS1-105
King, Jessica L. ............................................... PS3-150
Kingsley, Melody ...................PP-50, PS2-106, POD7-1
Kinsell, Miranda B. ...............................................PP-94
Kirby, Carrie .........................................................PP-40
Kirchner, Thomas R. .........................................SYM9-3
Kirkpatrick, Matt ................................................. PS1-10
Kirkwood, Michal ............................................. PS3-116
Kirsch, Julie A. .....................................................PS2-1
Kittaneh, Ahmad ................................................ PS3-91
Kittel, Carol ................................................ PP-8, PP-11
Klasnja, Predrag .............................................. PS3-156
Klawans, Michelle R. ......................................... PS2-48
Klein, Elizabeth G. ............... PS2-107, PS3-57, PS3-70
Kleinjan, Marloes ............................................ POD13-1
Kleinsasser, Mike J. .............................................PP-41
Klemperer, Elias ................................................PS1-21
Klemperer, Elias M. ................ PP-2, PS1-11, PS1-141,
PS2-81, PS3-141
Klerx, Walther N. .................................................PP-23
Klupinski, Theodore ......................................... PS1-136
Klyushnenkova, Elena ......................... PS2-14, PS3-56
Knapp, Jess ...................................................... POD5-7
Kāneakua, Bree .............................................. POD11-1
Knoll, Marie ........................................................PS2-12
Knopik, Valerie S. ..............................................PS1-14
Kock, Loren ........................................... PP-48, PS1-67
Koech, Emily ......................................................PS3-21
Kong, Amanda Y. .................................................PP-29
Kong, Grace ..... PS1-106, PS1-138, PS1-142, PS2-61,
PS2-63, PS2-113, PS3-2, PS3-61, SYM8-1,
POD12-6
Koopman, Sarah ................................................PS3-70
Koski, Jennifer ................................................. PS3-116
Kosten, Thomas R. .............................................. PS1-1
Kostygina, Anna ................................................. PS3-88
Kostygina, Ganna .............. PS1-139, PS3-36, PS3-138
Kota, Katanoda .................................................... PP-98
Kotlyarov, Stanislav N. .......................................PS1-24
Kotlyarova, Anna &. ...........................................PS1-24
Kotsen, Chris ................................................... PS3-101
Kotz, Catherine .................................................. PS3-43
Kouplen, Kate .................................................... PS3-63
Kowitt, Sarah D. .................................................PS3-50
Krebs, Nicolle M. .............................................PS1-111
Kreslake, Jennifer .............................................. PS3-36
Kreslake, Jennifer M. .......... PS1-116, PS2-52, PS2-62,
PS2-154, PS3-82
Kresovich, Alex ................................................. POD2-8
Krishnan, Nandita ................................ PP-101, PS3-87
Krishnan-Sarin, Suchitra .................PS1-106, PS1-142,
PS2-61, PS2-63, PS3-2, PS3-3, PS3-51, PS3-61,
PS3-109, SYM19-1, SYM19-4
Kroart, Laura ...................................................POD12-1
Kroart, Laura E. ................................................... PP-62
Kuitunen-Paul, Sören ...................................... PS1-124
Kuk, Arnold ............................ PP-89, PS2-117, PS3-48
Kuk, Arnold E. ....................................................PS1-60
Kulas, Alison ...................................................... PS1-90
Kulkarni, Shweta V. ...........................................PS2-72
Kumar, Santosh .................................................PS2-23
Kumar, Vaishnavi N. ........................................ PS2-115
Kuo, Caroline .................................................... POD5-6
Kurien, Jasmin ................................................... PS3-80
Kurti, Allison N. ..................................................PS3-99
Kurtzman, Rachel .............................................. PS2-93
Kute, Nikita ...................................................... PS2-112
Kwan, Benjamin ................................................POD5-1
Kwiecinski, Julia ................................................ PS2-17
Kwon, Diana M. ................... PP-17, SYM2-2, POD11-6
Kyburz, Bryce .................................................... PS3-28
Kypriotakis, George ............. PS1-157, PS3-16, PS3-47
Kyriakos, Christina N. ....................................... SYM4-2
L
Laestadius, Linnea ............................. PP-57, POD12-6
Lai, Vienna W. .................................................PS2-130
Lajous, Martin .................................................. PS3-104
Lakkis, Issam ..................................................... PS3-74
Lal, Pranay ........................................................PS3-37
Lam, Cho .......................................................... POD1-3
Lam, Tai Hin ..................................................... PS3-135
238
Author Index
Lam, Tai Hing ................................... PS2-130, PS3-110
Lam, TuKiet ....................................................SYM16-4
Lambert, Leah ............................... SYM19-2, SYM19-3
Lambert, Victoria ................................PS3-75, POD5-4
Lambert, Victoria C. ...........................................PP-108
Lape, Emma C. ......................................PS1-2, PS2-24
Lapham, Gwen T. ............................................PS1-156
LaPolt, Devin ..................................................... PS1-48
Lappalainen, Raimo .........................................PS3-144
LaRowe, Lisa R. .................................... PS1-2, PS2-20
Lawrence, David ................................................ PS2-16
Lawrence, David E. ........................................... PS3-19
Lawson, Schuyler C. ..............................PP-32, PS1-39
Layton, John ................................................... POD13-4
Lazard, Allison J. ...............................................PS3-96
Lazaro, Adrienne ............................................. PS2-140
Le, Daisy ............................................................PS3-87
Le, Phuc H. ........................................................ PS2-72
Le, Thuy ...........................................................PS3-122
Leas, Eric ............................................PP-106, POD2-4
Leas, Eric C. ...................................................... PS1-35
Leavens, Eleanor ............................ PS1-113, SYM19-3
Leavens, Eleanor L. ........................................SYM19-2
Lechner, William V. ............................. PS3-91, POD9-7
Lee, Abigail A. ...................................................PS3-111
Lee, Angela ..................................................... SYM16-4
Lee, Boram ........................................... PP-50, POD7-1
Lee, Cheol Min .................................................. PS1-71
Lee, Dustin C. ................................................. SYM11-5
Lee, Ell .................................................................PP-56
Lee, Eon Sook ................................................... PS2-31
Lee, Eugenia ....................................... PS1-51, PS3-79
Lee, Jean ............................................. PS2-70, PS2-77
Lee, Jeong Kyu ....................................PS1-50, PS3-94
Lee, John ......................................................... PS2-113
Lee, Joseph G. .................................................. PS1-92
Lee, Juhan ........ PS1-106, PS1-142, PS1-146, PS2-61,
PS2-63
Lee, Juliet ....................................................... POD11-7
Lee, Rebekka .................................................... PS1-36
Lee, Sangah ........................................................ PP-30
Lee, Stephanie S. ................................................ PP-28
Lee, Sungkyu .......................................PS2-31, PS3-32
Lee, Zoe ............................................................PS1-42
Le Grande, Michael ........................................ SYM17-3
Lei, Man-Kit .......................................................PS3-15
Leigh, Noel .......... PS2-65, PS2-159, PS3-44, PS3-102
Leigh, Noel J. ...................................................PS1-125
Leischow, Scott ................................................PS3-137
Lempert, Lauren .................................................. PP-43
Lenho, Katie ..................................POD1-3, POD10-4
LePine, Elisha ....................................................PS1-21
Lepine, S E. ....................................................... PS3-72
LePine, S. Elisha ................................................... PP-2
Lepore, Stephen .................................................. PP-88
Lerman, Caryn ......................... PP-7, PS1-10, PS3-142
Lerner, Jennifer ..............................SYM13-1, SYM13-2
LeSage, Mark ........................................ PP-81, PS2-44
Leshner, Glenn .................................................POD2-3
Lesser, Glenn ........................................................PP-8
Lester, Rebecca .................................PS1-20, PS1-114
Leung, Janni .......... PP-16, PS1-153, PS2-124, PS3-92
Leung, Lok Tung .............................................. PS3-110
Leung, Wei Lin ...................................................PS1-93
Leventhal, Adam ...... PS1-10, PS1-86, PS1-97, PS3-11
Leventhal, Adam M. ............PS2-15, PS2-158, PS3-13,
PS3-107
Levin, Michael E. ............................................. PS3-144
Levine, Hagai .......................................................PP-55
Levinson, Arnold ............................................... POD1-3
Levinson, Arnold H. .............................PS3-26, PS3-27
Levy, David .............PP-97, PS1-133, PS2-12, PS2-29,
PS2-39, PS3-76, POD7-6
Levy, David T. ...................... PP-90, PS1-134, PS2-139
Levy, David T. .................................... SYM4-1, SYM4-5
Levy, Douglas E. .........PP-28, PP-50, PS1-76, PS1-96,
POD7-1, POD10-5
Lewis, Ben ....................................................... PS3-146
Lewis, Jane ........................................................PS1-45
Lewis, Sarah ..................................................... POD5-5
Li, Dongmei .......... PP-57, PS1-86, PS2-138, SYM12-3
Li, Grace ............................................................ PS2-31
Li, Jiang ........................................................... PS2-104
Li, Lin .............................................................. SYM17-3
Li, Wei ................................................................PS1-57
Li, William H. C ................................................ PS3-110
Li, William Ho Cheung ....................................... PS1-93
Li, Xiaoyin ......................................................... POD8-1
Li, Yameng .......................................................PS2-139
Li, Yaqiang .........................................................PS3-27
Li, Yisheng ........................................PS2-22, POD10-2
Li, Zhuoran ........................................ PS2-98, PS2-100
Liang, Su-Ying .................................................PS2-104
Liang, Tingna .....................................................PS1-93
Liber, Alex ............ PS2-39, PS2-139, POD7-3, POD7-6
Liggins, Charlene ...............................................PS1-37
Lim, Carmen ........................ PP-16, PS1-153, PS2-124
Lim, Pauline ....................................................... PS1-79
Lim, Sujin ........................................................... PS2-31
Lin, Lavinia ........................................................PS1-50
Linares Abrego, Paulina ....................................PS1-17
Lindblom, Eric N. ................................................... PP-5
Lindgren, Bruce ..................................................... PP-9
Lindson, Nicola ...................... PP-87, PS1-64, PS3-141
Ling, Meng .............. PS2-27, PS2-66, PS2-69, PS2-71,
PS2-152
Ling, Pamela .......PP-43, PS2-115, SYM11-2, POD13-6
Liow, Kore Kai .................................................POD11-1
Lipato, Thokozeni .............................................. PS1-20
Lipperman-Kreda, Sharon .................. PS1-83, POD4-1
Liskiewicz, Amylynn ............................................. PS1-4
Litson, Kaylee .................................................. PS1-126
Litt, Mark .............................................. PS2-89, PS2-91
Litwin, Alain ....................................................... POD5-7
Liu, Feifei ........................................................... PS1-80
Liu, Jessica ...... PS1-36, PS2-106, SYM13-1, POD15-2
Liu, Jiaying .............PP-110, PP-111, PS2-127, PS3-46,
PS3-53
Liu, Jie ................................................................. PP-40
Liu, Michael .......................................... PP-92, SYM6-4
Liu, Tina ............................................................POD4-5
Li Volti, Giovanni ..................................PS1-43, PS2-40
Llambi, Laura .................................................... POD7-4
Lockhart, Darcy E. .............................. PS1-95, POD9-6
Lodha, Prati ..................................................... PS3-137
Long, Lauren .................................................. SYM12-2
Lopez, Vicente .................................................PS2-129
Lopez-Paguyo, Kekoa ..................................... PS2-115
Lotpour, Shahrdad ..........................................POD3-2
Louaddi, Oulaya ............................................... POD9-4
Loud, Emily ......................................... PS3-75, POD5-4
Loukas, Alexandra ............ PP-116, PS1-108, PS1-132,
PS2-38, PS2-137, PS3-30, PS3-98, PS3-114,
POD8-1, POD8-5
Louviere, Jordan ............................................... POD2-6
Lovett, Ray .......................................................SYM1-3
Lozano, Patricia ................................ PS3-42, POD14-1
Lu, Bo .................................................... PP-94, PS2-66
Lu, Yu ..................................................PS1-33, PS1-69
Lucas, Jennifer A. ..............................................PS1-26
Luciani, Karling R. ............................................ SYM7-1
Luk, Tzu Tsun .................................................. PS2-130
Lunn, Mitchell ................................................... POD9-4
Lydon-Staley, David M. ................................... SYM13-4
Lynch, Michelle ....................................PS3-26, PS3-27
M
Ma, Shaoying ..........PS2-27, PS2-66, PS2-69, PS2-71,
PS2-152
Ma, Yan ............................................................POD8-4
Macdonald, Christel .......................................... POD5-1
Machado, Ana ................................................... POD9-4
Machado, Nathalia M. .......................... PP-53, PS1-113
Macisco, Joseph ................................................ PP-115
Macisco, Joseph M. ............................. PS2-99, PS3-57
Mackey, Tim ......................... PS1-31, PS2-98, PS2-100
Mackey, Tim K. .................... PS1-78, PS1-79, PS2-118
Mackey, Timothy K. ............................................. PS2-4
MacKillop, James .............................................. PS3-23
MacLean, R. Ross ............................................. PS2-19
Madden, Gregory J. ............................................. PS2-8
Madden, Kevin .................................PS3-121, PS3-126
Maddox, Raglan .............................. SYM1-2, POD11-2
Madison, Matthew C. ...................................... POD14-4
Madison, Stefani ............................................... SYM2-4
Maes, Hermine H. ................................................PS3-9
Maggi, Rachel M. ..............................................SYM9-2
Maggs, Jennifer ................................................. PS2-75
Maglalang, Dale Dagar ........................ PP-30, PS2-103
Magnée, Tessa .................................................... PP-26
Magraner, Jose ................................................PS2-120
Maguin, Eugene .................................................. PS1-9
Maguire, Rachel L. .......................................... PS2-102
Mahabee-Gittens, E. Melinda ... PP-6, PS2-50, POD4-4
Mahabee-Gittens, Melinda ................................ PS2-54
Mahamad, Syed .................................................. PP-49
Maher, Erin ........................................POD3-4, SYM7-4
Maher, Erin E. ...................................................POD6-6
Mahler, Stephen V. ........................................... SYM7-3
Mahmud, Ahmed S. ........................................POD12-8
Mahoney, Jane E. ..............................................PS1-44
Mahoney, Martin .....................PP-7, PS3-142, POD5-3
Mahoney, Martin C. ...............................PS1-9, PS1-39
Maisto, Stephen A. ................................PP-15, PS2-24
Majeed, Ban A. ..................................................PS1-55
Majmundar, Anuja .............................. PS2-74, POD4-2,
POD12-6
Maldonado, Gabby ............................................ PS1-20
Maley, Grace E. ..............................................SYM12-1
Malik, Guillaume G. ............................................. PS1-3
Mallahan, Stephanie ............................................ PS2-3
Malone, Ruth .................................................. SYM17-5
Malterud, Andie .................................... PS1-62, PS1-90
Malterud, Andrea ................................. PS1-81, PS2-51
Mandal, Gauri .................................................. PS2-134
239
Author Index
Mandal, Rachel J. .............................................. PS1-37
Manos, Brittny ......................................................PS2-3
Manrique, Javier ................................................ PS1-85
Mansour, Nadia B. ...........................................PS2-132
Mansuri, Shahid ..............................................SYM16-4
Mantey, Dale ....... PP-118, PS3-49, PS3-120, PS3-127,
PS3-128, PS3-129, POD8-2
Mantey, Dale S. .................................................PS3-59
Maravic, Melissa ............................................... POD5-2
Marceau, Kristine ...............................................PS1-14
Margarolli, Camilla .......................................... POD14-4
Marino, Miguel ................................................... PS1-26
Marsh, Louise .......................................... PP-54, PP-59
Marshall, Anna-Marie ..................... POD15-4, POD15-5
Marti, C. Nathan .................. PS1-132, PS3-30, PS3-98
Marti, C. Nathan E. ............................................ PS2-38
Marti, Nathan .................................................... POD8-5
Martin, Connor ................................................. PS2-159
Martin, Corby ................................................... PS1-117
Martin, Corby K. ...............................PS1-127, PS1-144
Martin, Laura E. .............................................. SYM21-3
Martinez, Diana .............................................. POD11-7
Martinez, Joshua D. .............................................PP-80
Martinez, Meghan C. ....................................... PS2-104
Martinez, Sydney A. ........................................ POD10-1
Martinez, Ursula .... PS1-6, SYM2-3, PS2-26, PS2-110,
PS3-6, PS3-7
Martinez Leal, Isabel ......................................... PS3-28
Mason, Emily J. ................................................. PS3-49
Massey, Zachary B. ..........................................POD4-7
Masyn, Katherine ...............................................PS3-79
Mathew, Amanda ............................................ POD10-3
Matson, Theresa E. E. .....................................PS1-156
Matsunaga, Masako ....................................... POD11-1
Matthews, Eva ..................................................... PP-40
Mattick, Richard ................................................ POD5-1
Mattingly, Delvon T. ......................................... PS1-129
Matuskey, David ..................................................PP-75
Maurer, Jocelyn .................................................PS2-25
Mavanji, Vijay ....................................................PS3-43
Mayberry, Shannon .............................................PS1-5
Mayne, Rachel ...................................................PS2-33
Mays, Darren .......... PP-2, POD2-3, POD2-7, SYM12-2
Mazhar, Laraib ................................................SYM10-3
Maziak, Wasim ..................................PS1-57, PS2-132
McBride, Colleen M. .......................................... PS2-26
McCabe, Sean E. ................................ PS2-28, PS2-79
McCabe, Sean Esteban ....................................POD9-1
McCarthy, Danielle ..............................................PS2-1
McCarthy, Danielle E. ............POD1-5, PS1-25, PS3-4,
POD10-6
McCarthy, William J. ............................................PP-41
McClernon, Joe ................................ PS2-102, SYM4-7
McClernon, Joseph ..........................PS1-150, PS2-160
McClure, Erin ......................................................... PP-5
McClure, Erin A. ...............................................PS1-156
McClure, Jennifer B. ........................................ PS3-156
McConnell, Rob ................................................. PS1-80
McCutchan, Grace ............................................POD5-5
McDaniel, Marisol ............................................ PS1-108
McDonough, Brian ............................................... PS1-4
McDowell, Susan ............................................... PS3-50
McGehee, Daniel .............................................. POD3-1
McGirr, Kevin .......................................................PS2-2
McGlave, Claire ................................................... PP-50
McGowan, Amanda L. ....................................SYM13-4
McGruder, Carol ..............................................PS3-154
McInnis, Stephanie ............................................ PS1-81
McIntosh, Scott .... POD2-1, PS2-70, PS2-77, PS3-117,
PS3-118, PS3-119, PS3-131, SYM12-3
McKee, Sherry ................................................ SYM16-4
McKee, Sherry A. ................................PS3-19, SYM5-1
McKnight, Erin ..................................................... PS2-3
McLean, Dave ................................................... PP-122
McLean, David .................................................PS3-103
McLeish, Alison C. ..............PS1-13, PS1-15, PS1-100,
PS1-101, PS1-122
McMahan, Christopher ................................... SYM18-4
McMahon, Elizabeth .......................................... PS3-56
McMains, Joshua T. ..............................PP-111, PS3-53
McMann, Tiana ..................................PS2-98, PS2-100
McNeel, Timothy S. .............................................PP-27
McNeill, Ann .... PP-5, PP-71, PP-99, PP-121, PS1-155,
PS3-97, SYM4-3, SYM10-3, SYM11-6, SYM14-4
McQuoid, Julia ................................... PS2-30, PS2-115
McRae, Thomas .................................. PS2-16, PS3-19
McRobbie, Hayden .............. PP-87, POD5-1, SYM17-4
Meade, Cathy D. ...............................................SYM2-3
Mead-Morse, Erin ................................ PS2-89, PS2-91
Mead-Morse, Erin L. .......................................... PS1-28
Medina-Ramirez, Patricia ................................. SYM2-3
Medo, Deborah R. ........................................... PS3-21
Mehra, Rashmi ................ PS3-37, POD15-4, POD15-5
Mehrotra, Ravi ................... PS2-131, PS2-131, PS3-73
Meier, Ellen ..................................................... POD11-3
Meissner, Helen I. .............................PS1-37, POD12-6
Melamed, Julia ..................................................PS1-18
Melzer, Anne .......................................................... PP-9
Mendel Sheldon, Jennifer .................... PS2-93, PS3-96
Mendelsohn, Colin ............................................ POD5-1
Mendez, David .................PS3-100, PS3-122, PS3-123
Mendoza, Evelyn ............................................. PS1-134
Mendy, Angelico ...............................................POD4-4
Meng, Gang ........................... PP-31, SYM4-1, POD7-5
Mercincavage, Melissa ....................... POD2-2, PS2-95
Merianos, Ashley L. ....PP-6, PS2-50, PS2-54, POD4-4
Mermelstein, Robin .................PP-2, PS3-77, SYM14-2
Merrill, Regina .....................................PS1-78, PS1-79
Merrill, Renae ...................................................... PP-35
Mersha, Amanual G. ..........................................PS3-14
Merzianu, Andreea .......................................... PS3-102
Mesiakaris, Konstantinos ...................................PS2-40
Messiah, Sarah E. ........................................... PS2-117
Metcalf, Tim .........................................................PP-21
Meyers, Shaun M. ............................................. PS1-11
Meza, Rafael .... PP-10, PP-65, PP-90, PP-97, PS1-56,
PS1-97, PS1-133, PS1-134, PS2-56, PS2-139,
PS3-76, SYM4-5
Mhende, Josephine ........................................... PS3-67
Micalizzi, Lauren ................................................ PS1-14
Michaels, Kenan ................................................ PS1-22
Mikheev, Vladimir B. ........................................PS1-136
Mildrum Chana, Soa .......... PS1-7, POD8-6, POD13-7
Miliano, Cristina ................................................... PP-83
Miller, Connor R. ......................PP-98, PS1-82, PS3-35
Miller, David ...........................................................PP-8
Miller, Lauren M. ................................................PS2-99
Miller, Lesley ........................................................PP-48
Mills, Sarah D. ..................................................... PP-29
Milstred, Andrea ............................................... PS3-113
Minacapilli, Mauricio ......................................... POD7-4
Minami, Haruka .................................................PS1-96
Minion, Mara ................................................... POD10-4
Minnix, Jennifer ....................... PP-10, PS3-16, PS3-47
Miranda, Alexis .................................................. PS1-48
Mishu, Masuma .............................................. SYM10-3
Mistry, Ritesh .........................................PP-41, PS3-76
Moakley, Margaret .............................................PS1-81
Mocniak, Leanne ............................................... PS3-41
Mohn, Paloma ..................................................... PP-40
Mok, Yoonseo ......................................................PP-10
Monical, Alexis J. ..............................................POD3-1
Mons, Ute ............................................................ PP-99
Montes de Oca, Gabriela ..................................POD9-4
Monzón, José Carlos ......................................... PS2-65
Moodie, Crawford ................................ PP-121, PS1-30
Mooney, Evan ....................................................PS2-30
Moore, Graham .................................................PS1-67
Moore, Roland ................................................ POD11-7
Moore, Stephanie P. ............................ PS1-51, PS3-79
Morales-Carmona, Evangelina ........................ PS3-104
Moran, Meghan ................................... PP-114, PS3-72
Moran, Meghan B. ........................................... PS2-149
Morean, Meghan ................................. PS2-61, PS2-63
Morean, Meghan E. ......................................... PS1-142
Morello, Paola .................................................POD15-5
Morgan, Jennifer .............................................POD12-7
Morphett, Kylie ...............................SYM17-1, SYM17-4
Morse, Diane S. ............................................... PS3-117
Moses, Olivia ..................................................... PS3-20
Mottus, Kathleen M. ...........................................PS3-50
Moyer, Jonathan ................................................PS1-37
Muelken, Peter .................................................... PP-81
Mukerjee, Richa .................................................PS3-64
Mulder, Haley A. .................................................. PP-73
Mull, Kristin E. ...... PP-17, SYM2-2, PS3-144, POD11-6
Mullis, Kristina ...................................................PS3-10
Mun, Sophia Y. ................................................ PS3-156
Murdaugh, Laura B. ............................................. PP-83
Murphy, Cara ...................................................PS2-103
Murphy, Cara M. ................................................PS3-23
Murphy, James G. ...............................................PP-34
Murphy, Sharon .............................................. POD11-3
Murphy, Susan K. ............................................PS2-102
Murray, Rachael L. ...........................................POD5-5
Murthy, Dhiraj ..................................................PS2-113
Mus, Sophia .........................................PS2-65, PS3-75
Mushtaq, Nasir ..................................................PS3-63
Mussulman, Laura M. ..................................... SYM21-3
Musyoki, Helgar ................................................. PS3-21
Muthumalage, Thivanka ................................. POD14-6
Muzikansky, Alona .............................................PS1-76
Myers Gamliel, Vicki .......................................POD15-3
N
Nagelhout, Gera .................................................. PP-26
Nagelhout, Gera E. ................................ PP-99, PS1-30
Nagendra, Arundati ........................................... POD5-2
Nahhas, Georges ................................................ PP-71
Nail, Kayli ........................................................POD10-1
Nair, Uma .................................................PS2-7, PS3-1
Nairn, Angus ................................................... SYM16-4
Nakata, Honami ................................................. PS1-41
Nali, Matthew ..................................................... PS2-98
Narake, Sameer .................................................. PP-41
240
Author Index
Nardone, Natalie ..............................................PS3-124
Nargis, Nigar ....................... PS2-74, PS3-115, POD4-2
Nash, Chelsea ................................................... PS3-10
Nava, Ruben .....................................................POD1-2
Navarro, Mario ....................................... PP-86, PS1-81
Navarro, Mario A. ...............................................PS1-62
Nazir, Niaman .................................................SYM21-3
Neal, Richard .................................................... POD5-5
Neil, Jordan .........................................................PS1-8
Neilands, Torsten B. ....................................... SYM11-2
Nelson, Lonnie A. ........................................... POD11-6
Nemeth, Julianna ............................................... PP-115
Nemeth, Julianna M. ..........................................PS2-99
Neslund, Elizabeth ............................................POD3-5
Neumann, Dominik .............. PS2-90, POD9-4, POD9-5
Newland, Kirk ......................................................PS1-3
Newman-Norlund, Roger ................................. PS3-159
Nez-Henderson, Patricia .................................. SYM1-1
Ngobese, Senamile P. ....................................... PS3-95
Ngunu, Caroline .................................................PS3-21
Nguyen, Angela .............................................. POD13-7
Nguyen, Hien ..................................................... PS2-46
Nguyen, Nhung ............................................... SYM11-2
Nguyen, Tung ....................................................PS2-13
NH’pang, Roi-San ..............................................PS1-59
Nian, Qinghua .....PS1-91, PS1-109, PS1-135, PS2-78,
PS2-86
Nich, Charla ......................................................... PS3-2
Niederdeppe, Je ............................................. POD5-4
Nielsen, David A. .................................................PS1-1
Nielson, Michelle ............................................ POD11-7
Nieva, Jorge ......................................................PS1-10
Nighbor, Tyler ...................................................... PP-95
Nitturi, Vijay .........................................PS3-16, PS3-28
Niznik, Taylor ........................... PP-34, PP-107, PS1-98
Nkosi, Lungile ................................................. POD12-4
Noar, Seth M. ......................................POD2-8, PS2-93
Nolan, Douglas ............................................... POD10-1
Nolan, Margaret .............................................. POD10-6
Nolan, Margaret S. ........................................... POD1-3
Nollen, Nicole L. ............................................... SYM2-2
Nollen, Nikki .......PS2-103, PS3-5, SYM19-2, SYM19-3
Nonnemaker, James ...........................SYM2-5, PS2-51
Norris, Andrew ................................................. PS3-138
North, Caroline ................................................. POD8-5
Northrup, Thomas F. ..........................................PS2-48
Notley, Caitlin ................PP-20, PP-48, PP-87, POD7-7
Novotny, Thomas .............................................PS2-120
Nuñez, Virginia .................................................POD7-4
Nwanah, Patrick ............................................. POD10-3
Nyman, Amy ..................................................... POD4-7
O
Obasi, Ezemenari M. ......................................... PS3-28
Obedin-Maliver, Juno ........................................POD9-4
O’Brien, Maureen ............................................ PS3-101
O’Connor, Katie ................................PS1-116, PS1-117
O’Connor, Katie M. ................PS2-52, PS2-62, PS3-82
O’Connor, Richard .... PP-85, PP-119, PP-120, PS2-35,
PS2-60, PS2-65, PS2-88, PS2-159, PS3-68,
PS3-119, PS3-131
O’Connor, Richard J. ............PP-102, PS1-82, PS1-95,
PS1-125, PS1-155, POD9-6, SYM4-1
O’Connor, Shawn ..............................................PS3-33
Oehlers, Julia S. .............................................. PS2-115
Ohman-Strickland, Pamela ................................PS3-85
Ojoo, Sylvia A. ...................................................PS3-21
Oliver, Anthony C. ................................................ PP-95
Oliver, Jason A. ................................ PS1-150, PS2-102
O’Malley, Stephanie ..............PP-38, PS3-18, SYM19-1
O’Malley, Stephanie S. ........................................PP-12
Omega-Njemnobi, Onyinye ............. PS3-128, PS3-129
Ondo, Olivia ...................................................... POD6-5
Onigbogi, Modupe ............................................. PS1-85
Onnen, Nathaniel J. .......................................... SYM9-1
Onyinye, Omega-Njemnobi ............................. PS3-127
Opio, Abari Francis ...........................................SYM4-6
Opperhuizen, Antoon ........................................... PP-23
Oren, Eyal ........................................................PS2-120
Orozco, Georgina ................................ PS1-27, PS2-82
Ortiz, Jessica ..................................................... PS2-17
Osbahr, Lisa ....................................................PS1-143
Osibogun, Olatokunbo ....................................... PS1-57
Ossip, Deborah ..... PS1-86, POD2-1, PS2-77, PS3-119
Ossip, Deborah J. ............. PS2-70, PS3-118, SYM12-3
Ostro, Jamie .......................... PP-10, PP-11, PS3-101
Ostro, Jamie S. ............................... PS1-76, POD10-4
Ostroumov, Alexey .........................SYM16-2, SYM16-2
Osuoha, Ezinwa .................................................. PP-30
Ouimet, Janine ..................................... PP-98, POD7-5
Ozga, Jenny E. ................................ PS2-126, PS3-113
P
Pacek, Lauren .................... PS2-160, PS3-81, SYM4-7
Pachas, Gladys ................................................ POD5-2
Pacheco, Claudia .............................................. PS1-78
Page, Michelle ................... PS2-65, PS2-159, PS3-102
Page, Michelle K. ............................................SYM12-1
Paladino, Michael B. .............................. PS1-2, PS2-24
Palenski, Paige ................................... PS1-7, POD13-7
Palmer, Amanda M. ............ PP-14, PS1-141, POD13-2
Pandey, Ashish ....................................................PP-47
Pandey, Ashok ................................................. PS3-112
Pang, Raina ....................................................... PS1-10
Parajuli, Ayuska ............................................... PS3-112
Parida, Suprit ..................................................... PS2-19
Park, Elyse ..........................................................PS1-8
Park, Elyse R. .................................................... PS1-76
Parker, Maria A. ................................................. PP-103
Parks, Michael ......... PS2-29, PS2-75, PS2-76, PS3-62
Parodi, Carolina ................................................ POD7-4
Parra, Natalia .......................................................PP-39
Parrott, Steve ....................................................POD5-5
Pasch, Keryn E. ...... PP-70, PP-116, PS1-132, PS2-38,
PS3-30, PS3-114
Patanavanich, Roengrudee ............................... PS2-80
Patel, Akash ......................... PP-90, PS1-134, PS2-109
Patel, Minal ....................................................... SYM6-4
Patel, Neal ......................................................... PS1-73
Patrick, Megan .........PS2-29, PS2-75, PS2-76, PS3-62
Patriquin, Michele A. ............................................PS1-1
Patten, Christi A. ............................................. POD11-6
Patterson, Freda .................................................. PS1-5
Patterson, Joanne ............................... PP-115, PS1-48
Patterson, Joanne G. ...........................PS2-99, PS3-58
Paul, Christine .................................................. POD5-1
Pearcy, Adam C. .................................................. PP-73
Pearson, Jennifer .............................. PS3-85, PS3-137
Peasley-Miklus, Catherine ........ PP-2, PS1-11, PS1-21,
PS1-143, POD2-7
Pechacek, Terry ................................................. PS3-67
Pechacek, Terry F. ........................................... PS2-112
Pedersen, Eric R. ............................................PS2-128
Pednekar, Mangesh S. ........................................PP-41
Pena, Alissa ....................................................... PS2-26
Pender, Jack ........................ PS1-73, PS1-84, PS1-110
Pentz, Mary Ann .................................PS3-81, SYM9-4
Pepper, Jessica K. ..............................SYM2-5, PS2-51
Perez, Adriana .......... PP-89, PP-112, PS1-59, PS1-60,
PS2-117, PS2-137, PS3-48, POD8-3
Perez, Giselle K. ................................................ PS1-76
Pericot-Valverde, Irene .....................................POD5-7
Perkins, Kenneth A. .............................................PS2-9
Perks, Siobhan N. ............................................ PS1-117
Perry, Robin N. ....................................................PP-77
Perski, Olga ..................................................... PS3-143
Perusco, Andrew ............................................ SYM17-1
Pesko, Michael .................................. POD7-2, POD7-6
Petersen, Anne Berit .......................... PS3-20, PS3-133
Petersen, Ashley .................... PS1-58, PS2-53, PS2-59
Peterson, Emily .................................................PS1-90
Peterson, Emily B. ............................................. PS1-77
Peterson, Roseann E. ......................................... PS3-9
Petrie, Dennis ................................................... POD5-1
Petrun Sayers, Elizabeth L. ................. PS1-90, PS2-51
Pham, Giang ......................................POD1-1, POD4-3
Phan, Lilianna ........... PP-27, PS1-28, PS2-97, PS3-29,
POD4-5, POD4-6
Phandouangsy, Khatthanaphone ......................PS2-72
Phartiyal, Preeti ................................................... PP-16
Philibert, Robert ................................................ POD6-4
Philibert, Robert A. .............................................PS3-15
Picciotto, Marina ............................ SYM16-4, SYM16-4
Pickworth, Wallace ..............................................PP-34
Pienkowski, Martha ............ PS2-87, PS2-94, PS2-119,
PS2-123
Pienta, Amy ..................................................... PS3-116
Pierce, John ............................PP-92, PP-106, POD2-4
Pike, Brittany ..................................................SYM21-5
Pinkerton, Kent E. ..............................................PS1-41
Piper, Megan .....................................PS1-56, PS1-126
Piper, Megan E. ...................................PS1-25, PS1-44
Pitzer, Lindsay ...................................................PS1-77
Pluym, Nikola ................................................... PS1-115
Podguski, Stephanie ........................................PS2-159
Pokhrel, Subhash .......................... SYM10-1, POD15-5
Pollak, Kathryn .................................................... PS3-5
Polosa, Riccardo ................................. PS1-43, PS2-40
Ponicki, William ...............................................PS1-123
Ponzani, Colin J. ................................................PS1-76
Poole, Nikita ........................................................PP-26
Poole, Nikita L. .................................................. PS1-30
Popova, Lucy ........................................ PP-71, POD4-7
Popuri, Srivaishnavi ........................................... PS3-35
Porticella, Norman ............................................ POD5-4
Potter, Jennifer .................................................POD9-4
Potter, Kevin .....................................................POD5-2
Potts, Wendy .....................................................PS3-21
Poulas, Konstantinos ......................................... PS2-40
Pouranik, Nidhi S. ................................................ PP-47
Powell, Lynda .................................................POD10-3
Powers, Jessica .....................................PP-15, PS1-19
Powers, Jessica M. ................................PS1-2, PS2-24
Pratt, Rebekah J. ................................................. PP-37
Pravosud, Vira .....................................................PP-43
241
Author Index
Presant, Cary ....................................................POD1-3
Prestage, Garrett .............................................. SYM2-1
Price, Patricia .................................................POD13-6
Priest, Jerey S. ............................... PS1-143, POD2-7
Primack, Brian A. ............................................. PS2-116
Prince, Mark A. ................................................PS2-128
Prisciandaro, Jim ............................................. PS3-159
Prochaska, Judith ............................................. POD1-3
Prochaska, Judith J. ........ PS3-90, SYM21-4, SYM21-5
Prokhorov, Alexander ........................................PS1-17
Prokhorov, Alexander V. .................................... PP-122
Prom-Wormley, Elizabeth C. ...............................PS3-9
Prutzman, Yvonne ...............PP-18, PS2-141, PS2-142
Puljevic, Cheneal ........................... SYM17-1, SYM17-4
Pulvers, Kim ...... PP-106, POD2-4, PS2-120, SYM19-3
Pulvirenti, Roberta ............................................. PS1-43
Puntambekar, Namrata ........................................PP-41
Purkayastha, Arunima ......................................... PP-84
Purushothaman, Vidya ...... PS2-98, PS2-100, PS2-118
Puryear, Tyler .................................................. PS2-101
Q
Qian, Yiqi .............................................................PP-28
Quah, Anne ......................................... PS2-31, POD7-5
Quah, Anne C. .....................................PP-98, PS1-155
Quah, Anne C.K. ...................... PP-5, SYM4-1, SYM4-2
Quaife, Samantha ..............................................PS2-92
Quaife, Samantha L. .........................................POD5-5
Quick, Matthew .................... PS2-70, PS2-77, PS3-118
Quigg, Robib ........................................................PP-54
Quigg, Robin ........................................................PP-59
Quinn, Gwendolyn ............................................... PS3-6
Quinn-Scoggins, Harriet ................................... POD5-5
Quiñones, Ana R. ..............................................PS1-26
Quintiliani, Lisa M. .......................................... POD13-5
Quisenberry, Amanda .........PS2-107, PS3-70, SYM4-6
R
Ra, Chaelin ........................................................ PS3-12
Ra, Chaelin K. ................................................... PS3-80
Ra, Karen (Chaelin) ........................................... PS2-11
Rabbitt Morean, Meghan ................................... PS3-61
Rabin, Julia T. ....................................................PS1-76
Raghav, Rahul ...................................................PS2-41
Raghunathan, Trivellore ......................................PP-41
Rahman, Basmah .............................................. PP-113
Rahman, Irfan ................ PS2-159, SYM12-3, POD14-6
Rahman, Mohammad A. .................................POD12-8
Rahman, Mostazur ....................................... POD12-8
Rahman, Yumna ...............................................POD6-5
Rajesh Kumar, Lavanya ..................................PS1-142
Rajeshkumar, Lavanya ...........PS2-61, PS2-63, PS3-2,
PS3-61
Ramanadhan, Shoba ........................................POD9-4
Ramirez, Susana ............................................. PS2-149
Ramirez, Susanah ............................................. PP-114
Ramo, Danielle E. ...........................................POD13-6
Ramondetta, Lois M. ........................ PS2-22, POD10-2
Ramos, Guadalupe ...........................................POD1-4
Ramsey, Alex ....................POD1-1, POD1-2, SYM18-5
Ramsey, Alex T. ..............................................POD10-4
Rangel, Rogelio ................................................. PS3-28
Ranney, Leah M. .................PS1-107, PS2-73, PS3-50
Rao, Poonam ...................................................PS2-122
Rasheduzzaman, A.B.M. .................... PP-62, POD12-1
Rath, Jessica ................................................... PS2-149
Rath, Jessica M. ... PP-114, PS1-88, PS1-148, PS2-62,
PS2-153, PS2-154
Raupach, Toby ................................................... PS1-64
Reboussin, Beth A. ..........................................PS1-120
Reddy, Krishna P. ................................................ PP-28
Reed, Ellaina N. ...................................................PP-95
Reed, Grace L. .................................................. PS2-58
Rees, Vaughan ..................................................PS1-36
Rees, Vaughan W. ......................... SYM13-1, SYM13-2
Regan, Susan ....................... PS1-8, PS1-76, POD10-5
Regenold, William ............................................PS3-157
Reid, Jessica L. ................................................ SYM4-3
Reimer, Rachel .................................................POD6-4
Reimold, Alexandria E. ..........................PP-29, PS1-92
Reinhart, Lisa .................................................... PS3-38
Reitzel, Lorraine R. ............................................ PS3-28
Remels, Alexander H. ..........................................PP-23
Ren, Yang ........................................................PS2-108
Reyes-Colon, Lourdes ....................................... PS2-18
Reynales, Luz Myriam ..................................... PS2-129
Reynales-Shigematsu, Luz M. .........................PS1-133
Reynolds, Matthew ......................................... POD15-2
Reynolds, Matthew J. ...................................... PS2-106
Reynolds, Reed ................................................ POD4-7
Rezk-Hanna, Mary .............................................PS1-65
Rhodes, Kristine ............................................. POD11-3
Ribisl, Kurt ......................................... PP-113, PS2-102
Ribisl, Kurt M. ...................................... PS1-92, PS3-96
Rice, Myra ......................................................SYM19-3
Rice, Noah ......................................................... PS3-50
Richards, Kizzy .................................................... PP-48
Richardson, Montana ....................................... SYM7-2
Richie, Jr., John .................................................PS3-41
Richie Jr., John P. .............................................. PS3-38
Richmond, Robyn L. ......................................... POD5-1
Richter, Kimber .................................... PP-53, PS1-113
Richter, Kimber P. ..... PP-21, PS3-5, PS3-22, SYM21-3
Rickabaugh, Tammy ............................................ PP-84
Rigotti, Nancy .................. PP-10, PP-50, PP-87, PS1-8
Rigotti, Nancy A. ..................PS1-76, PS1-96, POD7-1,
POD10-5
Rincon, Maria ....................................................PS3-78
Ritter, Tara ...................................................... POD10-1
Rivard, Cheryl ..... PP-120, PS2-60, PS2-133, PS2-135,
PS3-84, PS3-89, SYM11-3
Robert, Jane ..................................................... POD9-4
Roberts, Jane ................................. PS2-106, POD15-2
Roberts, Megan E. ...............PP-94, SYM9-1, SYM12-2
Robertson, Lindsay ..............PP-56, SYM3-4, POD15-7
Robertson, Rose Marie ......................................PS1-46
Robichaud, Meagan O. ....................................PS2-101
Robinson, Jason .................... PS1-75, PS3-16, PS3-47
Robinson, Jason D. ........................................... PS1-17
Roditis, Maria .....................................PS2-33, PS2-141
Rodrigues, Leticia ........................................... POD14-1
Rodriguez, Victor ............................................POD14-1
Rodríguez-Bolaños, Rosibel ........ PP-33, PP-45, PP-60
Roemhildt, Maria ............................................... PS3-72
Roemhildt, Maria L. ......................................... PS1-143
Roeseler, April ................................................. PS3-153
Rogelberg, Sasha .............................................. PS2-95
Rogers, Erin S. ............................... PS1-121, SYM21-4
Rogers, Neil .................................................... SYM16-1
Rogers, Todd .................................................... SYM6-1
Rogerson, Suzanne .......................................... POD5-5
Rohsenow, Damaris J. .......................................PS3-23
Rojewski, Alana M. ..................................PP-14, PS3-3
Rolan, Emily ......................................................PS1-14
Rolland, Betsy ................................. POD1-3, POD10-4
Romdhane, Habiba B. ..................................... PS2-132
Romer, Dan ....................................................POD12-6
Romero, Devan ...............................................PS2-120
Romm, Katelyn F. ... PP-55, PS2-85, PS2-105, POD8-4
Rose, Shyanika ................................. PP-113, PS3-138
Rose, Shyanika W. ...........................................SYM6-4
Rosemeyer, Mary Clare ..................................POD12-8
Rosen, Debra ...................................................... PP-39
Rosen, Laura .................................................. POD15-3
Rosen, Rachel ................................................... PS2-17
Rosenblum, Marika ..............................................PS2-1
Ross, Craig S. ...................................................PS1-68
Roth, Prerana ................................................... POD5-7
Rothman, Alex ....................................................... PP-9
Rozenblit, Jerzy ................................................... PS2-7
Rubenstein, Dana ............................................. SYM4-7
Rudy, Alyssa K. .................................................. PS1-66
Ruolo, Jessica ................................................ POD6-3
Ruiz, Felisa ...................................................... PS3-128
Ruiz, Felisa A. ..................................PS3-127, PS3-129
Ruiz Serrano, Edwin ............................................ PS1-4
Ruppert-Gomez, Marcella ................................. PS3-40
Russel, Nicholas M. ............................................. PP-83
Rust, Sonja .......................................... PS1-43, PS2-40
Ruszczak, Christopher ...................................... PS2-45
Rutherford, Brienna ........................................... PS3-92
Rykaczewski, Clara ............................................. PP-94
S
Sablan, Anthony .............................................. PS3-137
Sabo, Patricia .................................................. PS2-160
Saccone, Phillip ................................... PS2-16, PS3-19
Saenz-de-Miera, Belen .................................... PS2-129
Saenz de Miera-Juarez, Belen ........................ PS1-133
Sa, Zeinab .......................................................PS1-45
Sahlem, Greg ..................................................PS3-159
Saladin, Michael E. ......................................... POD13-2
Saliba, Najat ......................... PS2-42, PS3-39, POD6-1
Salloum, Ramzi G. ...........................POD1-3, POD10-4
Salman, Rola .............. PP-76, PP-78, PS1-84, PS2-42,
PS3-39, POD6-1, POD14-2
Salvia, Meg ....................................................... POD9-4
Samet, Jonathan .............................................. POD2-5
Samet, Jonathan M. ......................................... SYM9-4
Samples-Steele, Chelsea ................................ PS3-116
Sanchez, Sherald ................................................ PP-91
Sanchez Romero, Luz ..................................... PS2-139
Sanchez-Romero, Luz M. ................................ PS1-133
Sanchez-Romero, Luz Maria .............. PS2-12, POD7-6
Sanders, Emily C. ................................................ PP-86
Sanders-Jackson, Ashley .... PS2-90, POD9-4, POD9-5
Sanford, Brandon T. .................................PP-14, PS3-3
Sanford, Kealey-Rei ....................................... POD15-7
Sangster, Timothy ................................................PS1-3
Santiago-Torres, Margarita ................. PP-17, PS3-144,
POD11-6
Sanzo, Nora ......................................................POD2-8
Saraf, Sejal ............................. PP-47, PP-62, POD12-1
Sartor, Carolyn .................................................PS3-109
Sassano, Maria F. ........................................... POD14-3
242
Author Index
Satchell, Tyra .......................................................PP-66
Sato, Ryoko ....................................................... PS1-96
Satti, Aditi ............................................................. PS1-5
Satybaldiyeva, Nora ........................ PS2-120, PS3-139
Saunders, Gretchen ....................................... SYM18-2
Sawyer, Ashlee N. ............................................. PS1-66
Sawyer, Leslie ................................................POD13-3
Sawyer, Leslie E. ..............................PS3-45, POD13-1
Saxton, Peter .................................................... SYM2-1
Sayyad, Ayeesha ............................................... PS3-67
Schauer, Gillian L. .................................PP-5, PS1-156
Scherer, Gerhard ............................................. PS1-115
Scherer, Max ................................................... PS1-115
Schertz, Kelsey ......................................................PP-9
Scheuermann, Taneisha ..................... PS3-5, SYM21-3
Scheuermann, Taneisha S. ............................... PS3-22
Scheurer, Roman W. ....................................... PS1-153
Schiavone, Louis .............................................. POD9-4
Schillo, Barbara .......... PP-66, PP-67, PS2-36, PS3-36,
SYM6-1, SYM6-3, SYM6-4, POD7-3
Schillo, Barbara A. ...........................................PS1-104
Schisler, Eric ........................................ PP-35, PS2-116
Schlam, Tanya R. .............................................. PS1-25
Schlecht, Nicolas F. ........................................... PS1-82
Schleicher, Nina C. ............................................PS1-35
Schmidt-Owens, Mary ....................................... PS1-89
Schneller, Liane ......PP-102, PP-120, PS2-35, PS3-68,
PS3-119
Schnoll, Robert ................................................ PS3-142
Schnoll, Robert A. .................................PP-7, POD10-4
Schoeld, Elizabeth ......................................... PS3-101
Schrimshaw, Eric ...............................................PS1-89
Schurr, Bradley ................................................PS2-159
Schuster, Randi M. ..............................................PS3-9
Schwartz, Elizabeth L. ...................................... SYM9-1
Schwartz, Rob .................................................. SYM4-1
Schwartz, Robert .... PP-91, PS2-87, PS2-94, PS2-119,
PS3-33
Scott-Sheldon, Lori A. ...................................... PS1-118
Scroggs, Lauren ............................................... SYM4-7
Scout ................................................................POD9-4
Seaman, Alana ................................................ PS3-132
Sebrie, Ernesto M. .............................. PP-58, POD12-8
Seemiller, Laurel ...............................................POD3-3
Seidenberg, Andrew ............................ PS2-33, PS2-34
Self-Brown, Shannon R. .................. PS3-65, POD11-5,
POD12-2, POD12-5
Sellars, David ................................................. SYM17-1
Semakula, Robert M. ....................................... PS3-133
Sen, Chadani ....................................................... PP-84
Sengupta, Kankana ......................................... PS1-105
Seo, Hong Gwan ............................................... PS2-31
Seo, Young S. ......................................PS3-84, PS3-89
Sepansk, Abigail ............................................... POD5-7
Seshadri, Mukund ..............................................PS1-82
Seta, Mayuko .....................................................PS1-41
Severini, Gianella ................................................ PP-58
Sevillano, Lalaine ............................................ PS1-108
Shae-Khorassani, Fatema ................. PS1-56, PS2-56
Shah, Jay ...........................................................PS2-67
Shah, Radhika R. ................................. PP-50, POD7-1
Shah, Vandana ...............................................POD12-8
Shahab, Lion ............ PP-48, PP-100, PS1-64, PS1-67,
PS3-83
Shakeshaft, Anthony ......................................... POD5-1
Shamblen, Stephen R. ...................................... PS1-33
Shang, Ce ...............PS2-27, PS2-66, PS2-69, PS2-71,
PS2-150, PS2-152, PS3-79, SYM12-2
Shao, Yihan ....................................................SYM12-3
Sharma, Akshika ................................................ PP-120
Sharma, Eva ................................................... SYM20-2
Sharma, Kriti ...................................................... PS1-37
Sharma, Shikha ............................................... PS2-159
Sharp, Jeni ........................................................PS3-28
Shaw, Daniel S. .................................................PS3-66
Shayya, Ashley L. ............................................PS3-145
Shebl, Fatma M. .................................................. PP-28
Sheehy, Ann .....................................................POD1-5
Sheeran, Paschal ............................................. POD2-8
Sheer, Christine .................................PS1-4, PS2-135
Sheer, Christine E. ........................................SYM11-3
Shegog, Ross .................................................... PP-122
Shelley, Donna ....................................................PP-11
Shelton, Richard ................................................ PS1-12
Shergina, Elena .............................................. SYM21-3
Sherman, Scott E. .......................................... SYM21-4
Shete, Sanjay .................................................... PS1-17
Shevorykin, Alina ................................ PS1-4, SYM11-3
Shi, Dingjing ................................................... SYM14-2
Shi, Hangchuan ................................................. PS1-86
Shia, David .......................................................... PP-84
Shih, Ya-Chen Tina ........................... PS2-22, POD10-2
Shihadeh, Alan ........... PP-76, PP-78, PS2-42, PS3-39,
PS3-74, POD6-1, POD14-2
Shimul, Shaun N. ............................................. PP-117
Shingleton, Will ................................................ PS1-110
Shoben, Abigail ................................................. POD2-3
Shoenbill, Kimberly A. .......................................POD1-3
Short, Etta ..........................................................PS3-10
Shugaa Addin, Nuha ........................................ PS1-102
Shukla, Radha ................................................ SYM10-2
Shuter, Jonathan .................................PS2-10, PS3-21
Siddiki, Zayed A. .............................................POD12-8
Siddiqi, Kamran ............... PS2-131, PS3-73, SYM10-4,
POD15-4, POD15-5, POD15-6
Sidhu, Anupreet ................................................ POD2-2
Sidhu, Anupreet K. ............................................. PS2-95
Sidhu, Natasha K. .............................................POD9-7
Siegel, Leeann N. .................................. PP-18, PP-109
Sigmon, Stacey ................................... PS2-58, PS3-11
Signorelli, Miranda ........................... PS2-126, PS3-113
Silinski, Peter .................................................. SYM12-4
Silver, Diana R. .................................................SYM9-3
Silver, Nathan ....................................................PS3-36
Silver, Nathan A. .............................. PS1-104, PS1-140
Simkus, Andrew ................................................. PS3-86
Simmons, Taylor ................................................ PS3-47
Simmons, Vani ......... PS1-61, PS2-26, PS2-110, PS3-6
Simmons, Vani N. ......PS1-6, SYM2-3, PS2-22, PS3-7,
POD10-2, POD13-3
Simon, Carl P. .................................................. PS3-123
Simon, Patricia ............................... PS3-109, SYM19-1
Sinamo, Joshua .... PP-47, PS1-91, PS1-109, PS1-135,
PS2-86
Sinamo, Joshua K. ............................................ PS2-78
Singer, Daniel E. .............................................POD10-5
Singer, Jill M. .......................................................PP-94
Singh, Avineet K. ............................................. PS2-108
Singh, Mongjam M. ...........................PS3-73, SYM10-4
Singh, Mongjam Meghachandra ......................PS2-131
Singh, Pramil ..................................................... PS3-20
Singh, Pramil N. ...............................................PS3-133
Singh, Rana J. ....................................... PP-47, PS3-37
Singh, Sharn .................................................... PS3-133
Sinha, Indu ........................................................ PS3-38
Sinha, Raghu ..................................................... PS3-38
Siripoon, Tanatorn ............................................. PS2-80
Sisson, Michelle L. ................PS1-7, PS1-12, POD13-7
Skelly, Joan .......................................................PS3-99
Skora, Amy .............. POD1-5, PS2-1, PS3-4, POD10-6
Smallman, Rachel ............................................. PS2-49
Smethells, John ................................................. PS2-44
Smiley, Sabrina L. ..............................SYM6-2, SYM9-4
Smith, Alexandria ................................ PS1-99, SYM2-5
Smith, Danielle ...................................... PP-32, PS2-60
Smith, Danielle M. ..................... PP-5, PP-98, PS1-155
Smith, Harold A. .................................................PS2-54
Smith, Jaiden N. ............................................... SYM7-1
Smith, Jessica .....................................................PP-18
Smith, Katherine C. ........................................ POD12-3
Smith, Katie M. ................................. PS2-22, POD10-2
Smith, Michael A. ...................................PP-34, PP-107
Smith, Philip ....................................................SYM15-1
Smith, Shelley ....................................................PS3-28
Smith, Tracy .........................................................PP-71
Smith, Tracy T. ...................................PS1-74, PS1-141
Smith, Jr., Michael .............................................PS3-41
Smock, Nina ........................ POD1-1, PS3-17, POD4-3
Smoot, Charles .................................................... PP-40
Snell, L. Morgan ................................................ PS2-58
Sofuoglu, Mehmet ............................................. PS2-19
Sokolovsky, Alexander .........................................PP-30
Song, Anna V. ...................... PS1-54, PS1-131, PS3-52
Song, Glory ...........................................PP-50, POD7-1
Song, Hairong ......................................PS1-69, PS3-80
Sonnet, Abdullah ............................................ SYM10-4
Soto, Claradina ................................................. POD1-4
Soulakova, Julia ................................................ PS1-89
Soulaphy, Chanthavy .........................................PS2-72
Soule, Eric ............ PS1-73, PS1-84, PS1-91, PS1-110,
PS1-127, PS2-47, PS2-126, SYM4-1
Soule, Eric K. ................................... PS1-117, PS1-144
Souprountchouk, Valentina .................POD2-2, PS2-95
Sousan, Sinan ..................... PS1-73, PS1-84, PS1-110
Spangler, John .......................................PP-8, PS1-120
Spears, Claire ..................................... PS3-67, POD4-7
Spears, Claire A. ...............PS2-112, PS3-65, POD11-5,
POD12-2, POD12-5
Spellman, Mackenzie L. .................................... PS2-48
Spells, Charles E. .............................. PS1-59, PS2-117
Spillane, Torra E. ................................ PS1-45, SYM9-2
Spinks, James G. ..............................................PS1-99
Springer, Andrew ............................................. PS3-129
Springer, Andrew E. ........... PP-118, PS3-127, PS3-128
Stanbrook, Matthew .............................PS2-87, PS2-94
Staneld, Jocelyn ............................................ PS1-118
Stansell, Stephanie ..............................................PP-14
Stanton, Cassandra ............................... PP-57, PS2-10
Stanton, Cassandra A. .................................... SYM20-4
Staples, Cody ........................................ PS1-6, PS2-22
Stead, Martine ................................................... PP-121
Steele, Scott .................................................... PS3-119
Stein, Jeery ...................................................... PS1-22
Stein, Jerey S. ...................... PS2-8, PS3-69, SYM4-4
Steinberg, Jane ................................................ SYM6-2
243
Author Index
Steinberg, Marc ................................................. PS2-17
Steinberg, Michael ............................................... PP-85
Steinberg, Sabrina ............................................ POD9-3
Steiner, Margaret ............................................POD10-6
Stelter, Tony ......................................................... PP-53
Stepanov, Irina ...........PP-81, PS2-43, PS2-45, PS3-55
Stephens, Daniel ................................. PS2-52, PS3-82
Stephens, Daniel K. ............................... PP-66, PS1-88
Sterling, Kymberle ................... PP-89, PS1-51, PS3-48
Sterling, Kymberle L. ......................... PS2-117, PS3-79
Stevens, Elise .................................................... PS1-48
Stevens, Elise M. ................................ POD2-3, PS3-58
Stewart, Susan .................................................. PS2-13
St.Helen, Gideon ............................................. PS3-124
Stilinovic, Anne ................................................. POD1-2
Stjepanovic, Daniel ................ PP-16, PS1-153, PS3-92
Stoeer, Bill .......................................................PS1-38
Stojek, Monika M. .............................................. PS3-23
Stokes, Andrew .................................................. PS1-46
Stokes, Andrew C. .............................................PS1-68
Stoklosa, Michal ............................................... POD7-6
Stone, Matthew ...................................PP-106, POD2-4
Stone, Rebecca ..................................................... PP-8
Stotts, Angela L. ................................................PS2-48
Strahley, Ashley E. .............................. PS1-95, POD9-6
Strasser, Andrew ............................... POD2-2, POD2-7
Strasser, Andrew A. ........................................... PS2-95
Streck, Joanna M. ................................PS1-8, PS3-141
Streuber, Dillon .................................. PS1-84, PS1-110
Strong, David ...................................... PP-106, POD2-4
Strong, David R. ................................. PP-40, SYM20-3
Stroud, Laura R. .............................................. PS1-118
Stroup, Andrea ................................................ POD12-6
Stroup, Andrea M. .............................................. PS1-98
Struik, Laura L. .................................................. PP-105
Stults, Cheryl D. ...............................................PS2-104
Sturm, Kit ........................................................... PS3-50
Su, Joseph ...........................................................PP-13
Sucaldito, Ana .................................................... PP-115
Suchil, Laura ......................................................PS1-85
Suchting, Robert .............................................. PS1-151
Suerken, Cynthia K. .........................................PS1-120
Sullivan, Brianna ..............................................PS3-144
Sullivan, Brianna M. ............. PP-17, SYM2-2, POD11-6
Sullivan-Blum, Zoe .............................................. PS3-5
Sumbe, Aslesha .................. PS2-137, PS3-49, PS3-59,
PS3-120, POD8-2
Summers, Jennifer ......................................... SYM17-2
Sumodhee, Dayyanah .................................... SYM11-6
Sun, Ruoyan .................................................... PS3-100
Sun, Tianze ..........................PP-16, PS1-153, PS2-124
Sun, Yuying ..................................................... PS3-110
Sunday, Salome ................................................PS3-31
Sussman, Roberto A. ....................................... PS1-128
Sussman, Steve ................................ PS1-10, PS2-158
Sutanto, Edward .................................................. PP-98
Sutn, Erin ............................................................. PP-8
Sutn, Erin L. .................................... POD2-8, PS1-120
Suttiratana, Sakinah ......................... PS2-63, SYM19-1
Suttiratana, Sakinah C. ....................................PS1-142
Sutton, Steven ..................... PS1-61, PS2-23, PS2-110
Sutton, Steven K. ...................SYM2-3, PS2-22, PS3-7,
POD10-2, POD13-1, POD13-3
Swan, Gary ............................................ PP-7, PS3-142
Swan, Sunaina .................................................. PS3-59
Swann, Alan C. ....................................................PS1-1
Swartz, Michael D. ............................................SYM2-4
Sweatt, Olivia C. ............................................... POD6-6
Sweet, Alison ................................................... PS3-116
Sweet, Lawrence H. .............................PP-111, PS3-53
Sweitzer, Maggie ..............................................SYM4-7
Sydeman, Sumner ........................... PS3-121, PS3-126
Szczypka, Glen ..................................................PS1-81
Szeliga, Andrew ................................................... PS1-4
T
Tabbakh, Tamara ..............................................POD2-5
Tabuchi, Takahiro ..................................PP-98, POD7-5
Tackett, Alayna P. .................PP-94, PS1-46, PS2-158,
PS3-60, POD9-7
Taer, Tia .........................................................PS2-153
Tagliaferri, Scott ..................................................... PP-4
Takeuchi, Minoru ............................................... PS1-41
Talawa, Drusilla ............................................... PS3-118
Talbot, Eugene ...................................................PS1-45
Talhout, Reinskje ................................................. PP-23
Talih, Soha ... PP-76, PP-78, PS1-84, PS2-42, POD6-1,
POD14-2
Talukder, Saki ...................................................POD5-1
Tam, Aaron .......................................................... PP-40
Tam, Jamie ........................................ PS1-97, PS2-139
Tami-Maury, Irene ..............................................PS1-85
Tan, Andy ........................................ PS2-106, SYM13-1
Tan, Andy S. .........PS2-30, PS2-90, POD9-4, POD9-5,
POD15-2
Tan, Marcia M. ................................................... PS1-52
Tan, Xiaoying .................................................... POD3-5
Tanca, Claudio ................................................ POD12-8
Tarran, Robert ..................................... PP-79, POD14-3
Tassaduq, Rabia ................................................ PS1-47
Tattan-Birch, Harry ............................................. PS1-67
Taylor, Emily ..................................... PS3-33, POD11-1
Taylor, Jeremy M. ..............................................PS3-76
Taylor, Kathryn .......................... PP-10, PP-11, POD1-3
Taylor, Nathaniel ..................................PS1-99, PS2-51
Taylor, Nathaniel H. ..........................................SYM2-5
Tegge, Allison .................................................... PS1-22
Tegge, Allison N. .....................PS2-8, PS3-69, SYM4-4
Teitelbaum, Scott ............................................. PS3-146
Temourian, Allison A. ......................................... PS1-54
Tenner, Craig ..................................................SYM21-4
Teter, Alexandria ................................................ PS3-40
Thawal, Vaibhav P. .............. PS1-130, PS2-57, PS2-83
Theodoulou, Annika ............................................. PP-87
Thomas, Alisha .................................................. PS1-73
Thomas, Dennis ............................................... POD5-1
Thomas, Jacob .................................................. PS2-38
Thomas, Jacob E. .................................. PP-70, PP-116
Thomas, Janet ................................................... PS2-21
Thomas, S. J. ...................................................POD8-6
Thompson, Kirsten ............................................ PS1-83
Thompson, Mary E. ............................................. PP-31
Thompson, Mary E. .......................................... SYM4-1
Thorley, Rebecca ..............................................POD5-5
Thorpe, Hayley H. .............................................POD6-3
Thrasher, James .........PP-31, PP-45, PP-71, PS1-133,
POD2-5, PS2-29, PS2-65, PS3-75, POD5-4
Thrasher, James F. .............................. PP-108, PS1-30
Thrasher, James F. .................................. PP-33, PP-60
Thrul, Johannes .................PS2-115, PS3-12, SYM11-2
Tidey, Jennifer ........ PS2-58, PS2-89, PS2-91, PS3-11,
POD5-6
Tidey, Jennifer W. ...............................PS1-95, POD9-6
Tiany, Stephen T. .................................PS1-9, PS1-39
Tindle, Hilary .....................................................POD1-3
Tindle, Hilary A. .............................................. POD10-5
Toll, Benjamin ..................................... PP-10, SYM21-1
Toll, Benjamin A. .....................PP-14, PS3-3, POD13-2
Tomintz, Melanie .................................................. PP-59
Tomlinson, Madeline M. ................... PS1-100, PS1-122
Tong, Elisa .......................................... POD1-3, PS2-32
Tong, Henry S. ................................................. PS2-130
Tonkin, Sarah .........................................................PP-7
Tonkin, Sarah S. .................................. PS1-9, PS3-142
Tracy, LaRee ................................................... PS2-120
Tran, Brian ...........................................................PP-58
Tran, Cindy .....................................................SYM21-5
Tran, Denise D. ...............................................PS2-128
Tran, Hy .............................................PS3-88, PS3-138
Trapl, Erika ..........................PS2-107, PS3-70, PS3-79
Trapskin, Philip J. .............................................POD1-5
Travis, Nargiz ....................................PS2-12, PS2-139
Trushin, Neil ........................................PS3-38, PS3-41
Trutor, Mega ......................................................PS3-72
Tsevat, Joel ........................................................PS2-67
Tsoh, Janice .......................................................PS2-13
Tsosie, Ursula ................................................. POD10-4
Tsui, Jennifer ..................................................... PS1-10
Tulsiani, Shreya .....................PP-93, PS1-88, PS1-144
Turner, Tari ........................................................... PP-87
Tutka, Piotr .......................................................POD5-1
Twombly, Eric ....................................................PS3-86
Tyndale, Rachel .................... PP-7, PS3-142, POD11-3
Tyndale, Rachel F. ............................................. PS1-39
U
Ullah, Safat ..................................................... SYM10-4
Umstead, Todd M. ............................................. PS3-38
Underwood, Megan ......................................... PS1-114
Unger, Jennifer ......................................PP-57, PS3-81
Upton, Spencer ....................................PS3-8, PS3-159
Ursprung, Sanouri A. ............................PP-50, POD7-1
Usidame, Bukola ................................................. PP-31
V
Vahora, Moin .....................................................PS1-52
Valente, Thomas ..................................................PP-57
Vallone, Donna .................................................POD7-3
Vallone, Donna M. ................ PP-93, PS1-88, PS1-116,
PS2-52, PS2-62, PS2-154, PS3-82
van den Brand, Floor ........................................... PP-26
van den Putte, Bas ................................ PP-26, PS1-30
Van den Venne, Judy ......................................... PP-113
Vander Weg, Mark ............................................PS3-111
Van Dorsselaer, Saskia .......................................PP-52
Vandrey, Ryan .................................. PS3-77, SYM14-2
van Mourik, Dirk Jan A. ......................................PS1-30
van Schooten, Frederik-Jan ................................ PP-23
Vantu, Avigail ....................................................SYM9-3
Vantucci, Darian ..................................................PS1-4
van Westen-Lagerweij, Naomi ...........................PS1-63
Vargees, Comreen .............................................PS1-98
Vasquez, Vinicius ..............................................PS1-85
Vassey, Julia ....................................... PP-57, POD12-6
244
Author Index
Vattipally, Vikas ................................................ PS1-109
Vaughan, Phillip ................... PS2-70, PS2-77, PS3-119
Vaughn, Jennifer ................................................PS1-22
Vaughn, Phillip .................................................PS3-131
Veliz, Philip .........................................PS2-28, POD9-1
Veliz, Philip T. ....................................................PS2-79
Vena, Ashley ...................................................... PS2-55
Vercammen, Laura ..........................................PS2-142
Vereen, Rhyan N. ..............................................PS2-93
Verscheure, Natalya ..........................................PS3-26
Verschuere, Natalya ..........................................PS3-27
Vickerman, Katrina ............................................PS3-10
Vidrine, Damon ....................................................PP-19
Vidrine, Damon J. ...............PS1-17, PS2-22, POD10-2
Vidrine, Jennifer I. .....PP-19, PS1-6, PS2-22, POD10-2
Viereck, Jason ................................................ POD11-1
Vilardaga, Roger ..............................................PS2-160
Villalobos-García, Daniel ................................POD14-1
Villanti, Andrea ......... PP-34, PS1-21, POD2-3, PS3-54,
PS3-72, PS3-77, SYM14-2
Villanti, Andrea C. ..... PP-2, PP-103, PS1-143, POD2-7
Villanueva, Guadalupe ........................PS1-27, PS2-82
Villarreal, Yolanda R. ......................................... PS2-48
Vincent, Asia ................................................... SYM13-4
Vincent, Kolbie .................................................PS1-100
Vincent, Kolbie A. ............................................ PS1-122
Vinci, Christine ..................................PS2-23, POD13-1
Vishwakarma, Monika .......................................PS1-35
Viswanath, Kasisomayajula ..............................POD9-4
Vittiglia, Amanda ............................................... POD2-5
Vock, David ............................................................PP-9
Voeller, Alexis S. .............................................POD14-3
Vogel, Erin A. ..................................................... PS3-90
Vojjala, Mahathi ...............................................PS1-121
Volarevic, Vladislav ............................................PS2-40
Vollinger, Bob .....................................................PS2-33
Vollinger, Robert ................................................ PS2-34
W
Waa, Andrew .................................................. POD15-7
Waa, Andrew M. ............................................... SYM3-1
Wackowski, Olivia ................ PP-85, PS1-119, POD2-2,
PS2-88, PS2-111, PS3-85
Wackowski, Olivia A. ......................................... PS1-45
Wadsworth, Elle ...............................................PS1-155
Wagener, Theodore ...........PS1-48, POD2-3, PS2-152,
SYM12-2
Wagener, Theodore L. ............PP-94, PS3-58, PS3-60,
PS3-130
Wagner, Dana ......................................................PP-86
Wagoner, Kimberly G. .....................................PS1-120
Wakeeld, Melanie ...........................................POD2-5
Wakeman, Sarah .................................................PS1-8
Walker, Denise D. ...........................................SYM11-4
Walker, Joan L. .................................PS2-22, POD10-2
Walker, Kandi L. .................PS1-13, PS1-15, PS1-100,
PS1-101, PS1-122, POD13-5
Walker, Natalie .................................................POD5-1
Walker, Natalie K. .............................................SYM2-1
Wall, Catherine ..................................................PS1-20
Wall, Megan ............................PP-86, PS1-99, SYM2-5
Wallach, Joshua D. ..............................................PP-12
Wallenkamp, Hannah .........................PS3-4, POD10-6
Walsh, Hannah .............................. SYM11-6, SYM14-4
Wang, Binhuan ...............................................SYM21-4
Wang, Ke .......................................SYM13-1, SYM13-2
Wang, Man Ping .............. PS2-130, PS3-110, PS3-135
Wang, Qi ..........................................................PS3-135
Wang, Qixin .....................................................PS2-159
Wang, Xi ............................................................PS2-47
Wang, Xinyi ....................................................SYM13-4
Wang, Xueting .................................................PS2-138
Wang, Yan ........................................................ POD8-4
Wang, Yu ........ PS3-65, POD11-5, POD12-2, POD12-5
Wanke, Kay L. ...................................................PS1-37
Wanty, Nicole ..................................................... PS3-86
Ward, Emma ........................................................PP-20
Ward, Kenneth D. ..............................................PS1-57
Warda, Umme S. ...............................................PS1-65
Waring, Joseph .................................................SYM2-4
Warner, Kenneth ..............................PS3-100, PS3-122
Warren, Adam C. ............................................... PS3-71
Warren, Graham POD1-3, PS2-26, SYM21-1, SYM21-2
Waseem, Mohd. ................................................PS2-41
Watkins, Shannon L. ........................................PS3-111
W. Bruijnzeel, Adriaan ......................................... PP-82
Weafer, Jessica ................................................POD6-6
Weaver, Kathryn ........................................ PP-8, PP-11
Weaver, Natasha ..............................................POD5-1
Weaver, Scott R. ............... PS2-112, PS2-144, PS3-65,
POD4-7, POD11-5, POD12-2, POD12-5
Wedel, Amelia ...................................... PS1-48, PS3-58
Weinberger, Andrea ....................... SYM11-1, SYM14-1
Weinberger, Andrea H. .......... PP-103, PS2-10, PS3-21
Weinstein, Daniel E. .......................................POD13-5
Welding, Kevin ....PS1-70, PS1-91, PS1-109, PS1-135,
PS2-78, PS2-86
Welter, Trisha ....................................................PS3-111
Weng, Xue .......................................................PS2-130
Wenger, Michael ................................................PS1-62
Wermert, Amy .................................................... PP-115
West, Brady T. ................................................... PS2-79
West, Julia .........................................................PS1-21
West, Julia C. ..........................PP-2, PS1-143, PS3-72
West, Robert .......................................PS2-16, POD5-1
Westling, Erika ...................................................PS3-66
Westmaas, J Lee ............................................. PS3-115
Westmaas, Lee J. .............................................POD4-2
Westneat, Susan ............................................... PP-113
Wetter, David .....................................................PS2-23
Wetter, David W. ................ SYM2-4, PS2-22, POD10-2
Whaley, Reid C. .................................................PS3-13
Wharton, Kristina ............................................... PS1-83
Wharton, Mary K. ..............................................POD4-1
Wheeler, David C. ............................................PS2-102
Wheldon, Christopher W. ...................................PS3-78
White, Augustus ............................... PS1-114, PS2-146
White, Augustus M. ............................ PS1-34, PS1-112
White, Cassidy ...................................................PS2-96
White, Justin S. .................................................POD1-3
White, Kyle M. .........................PS1-2, PS1-19, PS2-24
Whitesell, Callie A. .............................................PS3-96
Whitlock, C. William ......................................... PS3-101
Whitsel, Laurie P. ................................................. PP-66
Whritenour, Gina M. ........................................POD11-4
Wicke, Rebekah .................. PP-110, PS2-127, PS3-46
Wicke, Rebekah S. ...............................PP-111, PS3-53
Widanka, Holly .....................................PS2-70, PS2-77
Wiesen, Christopher A. ........................................PP-29
Wiggers, Danielle ................................................ PP-49
Wilhelm, April K. ..................................................PP-37
Wilkinson, Anna .............. PS1-132, PS2-137, PS3-120,
POD8-1, POD8-2
Wilkinson, Anna V. ............................... PS1-1, PS3-114
Willemsen, Marc ........... PP-26, PP-52, PP-99, PS1-63,
SYM4-2
Willemsen, Marc C. ...........................................PS1-30
Williams, Callon M. .......................................... PS3-145
Williams, David M. ............................................. PS2-20
Williams, Kenneshia N. ......................................PS1-88
Williams, Randi ........................................ PP-10, PP-11
Williams, Rhonda ...............................PS1-143, PS3-72
Williams, Teresa ................................................ PS3-28
Willis, Angelique ................................................ PS3-67
Wilson, Clark W. ..............................................PS3-130
Wilson, David O. .................................................. PS2-9
Wilson, Melvin N. ............................................... PS3-66
Wilson, Nick .................................................... SYM17-2
Wilson, Rashaun ............................................ SYM16-4
Wilson, Ryann ....................................... PP-82, PS3-40
Winicko, Jonathan ........................ PS2-106, POD15-2
Winicko, Jonathan P. ............ PP-50, PS2-21, POD7-1
Winter, Tiany .................................................... PS2-46
Wiseman, Kara P. ................................................ PP-18
Wolford-Clevenger, Caitlin ....PS1-7, PS1-12, POD13-7
Wood, Lindsey A. ................ PS1-13, PS1-15, PS1-100,
PS1-101, PS1-122
Wood, Thomas .................................................. PS3-44
Worsdale, Allison ...PP-110, PP-111, PS2-127, PS3-46,
PS3-53
Wray, Jennifer M. .................................................PS1-9
Wright, Kathy .......................................................PP-47
Wright, Marsha ..................................................PS3-67
Wu, Chung-Li ......................................PP-108, POD5-4
Wu, Dezhi ........................................................PS2-108
Wu, Qi ...............................................................POD5-5
Wu, Yongda ..................................................... PS3-110
Wyatt, Riley ...........................................PP-34, PS1-98
Wyatt, Riley J. ....................................................PP-107
Wyka, Katarzyna ............................................ SYM11-1
Wysota, Christina ...........................................SYM21-4
Wysota, Christina N. ............................................PP-55
X
Xangsayarath, Phonepadith .............................. PS2-72
Xayavong, Dalouny ........................................... PS2-72
Xi, Qin ................................................................ PS1-97
Xia, Wei .............................................................PS1-93
Xie, Wubin .........................................................PS1-46
Xie, Zidian .......................................PS2-138, SYM12-3
Xu, Becca ........................................................ PS2-142
Xu, Qing .............................................................PS1-31
Xu, Shaowei ....................................... PS2-31, POD7-5
Xu, Steve S. .........................................................PP-98
Xue, Ashley ........................................ PS1-137, PS2-74
Y
Yabro, Robin ....................................................PS2-74
Yadav, Amit ........................................................PS3-37
Yamaguchi, Naosuke .........................................PS3-13
Yammine, Luba .................................................SYM5-4
Yang, Joshua ..................................... PS1-31, PS2-118
Yang, Joshua S. ..................................PS1-78, PS1-79
Yang, Min-Jeong ..............PS2-23, POD13-1, POD13-3
245
Author Index
Yang, Tingyi ...................................................... POD2-4
Yang, Youjin (Christine) .....................................PP-105
Yassine, Amira ....................................PS3-39, POD6-1
Yen, Miao-Shan ...................................................PP-78
Yershova, MS, Katrina .......................................PS2-43
Yesmin, Farjana ...............................................PS2-114
Yingst, Jessica ...................................................PS2-47
Yingst, Jessica M. .............................................PS1-111
Yip, On Ni ..........................................................PS1-93
Ylioja, Thomas E. ........................................... POD10-5
Yolken, Robert .....................................................PS2-6
Yong, Hua ..............................................................PP-4
Yoon, Stephanie ..................................................PP-67
Yoshimi, Itsuro ......................................PP-98, POD7-5
Yu, Edgar ...........................................................PS2-13
Yu, Justin ..........................................................POD1-1
Yuan, Jian-Min .....................................................PS2-9
Yuan, Zhe ........................................................PS2-139
Z
Zabel, Chelsea ............................................... SYM13-1
Zadjali, Fahad .................................................... PS2-40
Zaidell, Lisa ......................................................POD7-7
Zakharia, Maral .................................................POD9-4
Zale, Emily L. ................................................... PS3-145
Zarei, Kasra ...................................................... POD4-6
Zavala-Arciniega, Luis ............. PP-60, PP-65, PS1-133
Zeb, Hajo ........................................................ POD15-6
Zehner, Mark ......................................PS2-1, POD10-6
Zehner, Mark E. ....................................POD1-5, PS3-4
Zeng, Yingpei ...................................................PS2-130
Zhang, Chauanwu .......................................... SYM21-3
Zhang, Chuanwu ................................................. PS3-5
Zhang, Jim ....................................................... PS2-102
Zhang, Xiaoyu ................................................. PS3-110
Zhao, Xiaoquan ................................................. PS1-77
Zheng, MingQiang ............................................... PP-75
Zheng, Pinpin ................. PS3-65, POD11-5, POD12-2,
POD12-5
Zheng, Shichen ................................................. PS2-32
Zhu, ManHua ................................. SYM16-1, SYM16-1
Zhu, Shu-Hong .................................... PP-40, PS3-139
Zicherman, Bradley ......................................... PS2-140
Zimmerman, Julie ............................................ PS2-157
Zorrilla, Marcia M. ............................................ PS2-140
Zou, Canruo .....................................................PS2-138
Zou, Jonathan .................................................SYM12-3
Zuccarello, Pietro ...............................................PS2-40
Zvolenksy, Michael J. ........................................PS2-24
Zvolensky, Michael J. ...........................PP-15, SYM2-2
Zwaga, Deejay ......................PS1-25, PS3-4, POD10-6
Zwar, Nicholas A. .............................................. POD5-1
Zwick, Nicole .......................................PS3-26, PS3-27