Mentholated cigarettes and smoking habits in whites and blacks

OBJECTIVE: To determine if cigarette mentholation is associated with the frequency of smoking and with quitting, and whether mentholation explains racial differences in these two smoking behaviours. DESIGN: Cross sectional analysis of case-control data on smoking and lung cancer. SUBJECTS: Limited to 19 545 current and former cigarette smokers. MAIN OUTCOME MEASURES: Smoking > 20 cigarettes per day (cpd) versus < or = 20 cpd, and continued smoking versus quit smoking. RESULTS: Among blacks, the prevalence odds ratio (POR) of heavy smoking (> or = 21 cpd) associated with mentholated cigarettes versus non-mentholated cigarettes was 0.7 (95% confidence interval (CI) 0.5 to 0.9) in current smokers and 0.6 (95% CI 0.4 to 0.9) in former smokers. Among whites, the corresponding POR were 0.9 (95% CI 0.8 to 1.0) and 0.9 (95% CI 0.8 to 1.0). Blacks were less likely to have been heavy smokers than whites, but the difference was unrelated to cigarette mentholation. The POR of continued smoking versus quitting, associated with mentholated cigarettes was 1.1 (95% CI 1.0 to 1.2) for both blacks and whites. CONCLUSION: Smoking > 20 cpd was independently associated with white race. Among blacks, smoking < or = 20 cpd was independently associated with mentholated cigarettes. The risk of quitting was not associated with cigarette menthol flavour.     

Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia

OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems.




     

Release of carbon granules from cigarettes with charcoal filters

OBJECTIVE: To inspect cigarettes with a triple granular filter for charcoal granules on the cut filter surface and, if present, to determine whether the charcoal granules on the filter are released during smoking. DESIGN: 400 Lark cigarettes in 20 packs were examined individually by each of three investigators for the presence of charcoal granules on the cut surface of the cellulose acetate filter. Without removing the cigarettes from the pack, the filters were examined with a stereo zoom microscope for charcoal granules. The percentage of cigarettes that had charcoal granules was defined, and charcoal granules on each filter were counted. Randomly selected cigarettes were then smoked by consenting adult smokers to assess whether the charcoal granules were released during smoking. Lark cigarettes were smoked with a conventional cigarette holder that had been configured to contain an in-line membrane. After smoking, the membrane was analysed microscopically for charcoal granules and other components of the filter that had been released during smoking. RESULTS: Charcoal granules were observed in 79.8% (319/400) of the cigarettes examined. The number of granules per cigarette was 3.3 (SD 3.7). Gaps between the tipping papers--the wrapping papers that surround the filter--were often seen (70%; 242 (71); n = 400 cigarettes). Further, the charcoal cavity was about 60% empty. For all smokers (n = 8/8), charcoal granules were released during smoking. The number of charcoal granules captured on the membranes was 22.5 (16.2) per cigarette. CONCLUSIONS: Charcoal granules are incorporated into cigarette filters to aid in removing toxins in cigarette smoke. In studies of Lark, a popular American cigarette with a charcoal filter, charcoal granules were observed on the filter surface, and were released from the filter when the cigarettes were smoked. During smoking, the toxin-containing charcoal granules are inhaled or ingested. The specific adverse health effects of inhaling or ingesting carbon granules have not been addressed; nevertheless, the smoker, as an educated consumer, should be informed of the possible health risks.


     

Delayed compensatory cigarette consumption after a workplace smoking ban

OBJECTIVES: To evaluate the impact of workplace smoking bans on cigarette consumption among continuing smokers over a two-year period. DESIGN: Two cross-sectional surveys and a longitudinal sample of smokers questioned about their smoking behaviour six months and two years after implementation of a workplace smoking ban. SUBJECTS: Workers in 46 government offices in Australia. The cross-sectional survey six months after the ban included 3388 workers, whereas the survey two years after the ban included 3982 workers. The longitudinal cohort study included 107 workers who were identified as current smokers in both surveys. MAIN OUTCOME MEASURES: Smokers were asked to report usual daily cigarette consumption on both workdays and leisure days one month before implementation of the ban, and six months, and two years afterwards. RESULTS: From six months to two years after the ban, the cross-sectional data showed an increase in cigarette consumption of 1.3 cigarettes per day. The longitudinal sample of smokers reported an increase in workday cigarette consumption of 1.7 cigarettes per day. A previous study of workers in the same worksites found a reduction in consumption of 5.2 cigarettes per day from before the ban to six months after. Over a two-year period we estimate that the net effect of the workplace smoking ban was to reduce cigarette consumption by about 3.5 cigarettes per day. CONCLUSIONS: Reductions in cigarette consumption among smokers frequently seen after implementation of a worksite smoking ban may diminish over time. This effect is more likely to occur when the initial response to a smoking ban is a large reduction in cigarette consumption.


     

Homelessness and smoking cessation: insights from focus groups.

Smoking prevalence among homeless persons is approximately 70%, yet little is known about tobacco use patterns or smoking cessation practices in this population. We assessed smoking attitudes and behaviors, psychosocial and environmental influences on smoking, barriers to and interest in quitting, and preferred methods for cessation among some homeless smokers. Six 90-min focus groups of current smokers (N = 62) were conducted at homeless service facilities. Participants had a mean age of 41.5 years (SD = 9.3), were predominantly male (69.4%) and African American (59%), and smoked an average of 18.3 cigarettes/day. Although most reported that they were motivated to quit, a number of barriers to quitting were identified. Participants reported that the pervasiveness and social acceptance of tobacco use in homeless settings contributed to smoking more cigarettes per day, adopting alternative smoking behaviors such as smoking cigarette butts and making their own cigarettes, and experiencing difficulty in quitting. High levels of boredom and stress also were cited as reasons for continued smoking. Smoking frequently occurred in combination with alcohol or illicit drug use or to achieve a substitute "high." Most participants (76%) reported that they planned to quit smoking in the next 6 months. Many were interested in using pharmacotherapy in combination with behavioral treatments. Results suggest that, although motivated to quit smoking, homeless smokers are faced with unique social and environmental barriers that make quitting more difficult. Interventions must be flexible and innovative to address the unique needs of homeless smokers. Smoking restrictions at homeless service facilities and funding for smoking cessation assistance in this underserved population may help to reduce prevalence.     

Comparison of cigarette and water pipe smoking among female university students in Egypt.

This study investigated behavioral and sociodemographic factors associated with tobacco use among female university students patronizing water pipe cafes in Cairo, Egypt. We interviewed two groups of female university student smokers (100 and 96 students from a public and a private university, respectively). The interviews took place in nine water pipe cafes near the two universities. A logistic regression model was developed to analyze the relationship between tobacco-related knowledge and beliefs and the choice between smoking water pipe or cigarettes. Among these smokers, 27% smoked cigarettes only, 37.8% smoked water pipe only, and 35.2% smoked both types of tobacco. Most of the water pipe smokers (74.1%) preferred this method because they believe it to be less harmful than smoking cigarettes. More than half of the subjects were encouraged to start smoking by other females (56.6%). Curiosity was a significant factor for initiation (OR = 2.8, 95% CI = 1.3-6.2, p<.01). We found no significant differences between water pipe and cigarette smokers regarding current age, age at initiation, quit attempts, knowledge about the hazards of smoking, wanting to be fashionable, or smoking with friends. About one in four (23.7%) attempted to quit, with health cited as a major reason. An urgent need exists for correction of the misperception among this study population that water pipe smoking is safe and less harmful than cigarette smoking.     

Quitting smoking: why, how, and what might help

OBJECTIVE: To examine reasons for quitting smoking, methods used in quitting, reasons for continuing smoking and potential aids to quitting in the population of Ontario, Canada. DESIGN: Two population-based, telephone interview surveys, conducted by random-digit dialing. SUBJECTS: Adults aged 18 years of age and older in 1983 (n = 1383) and 1991 (n = 1421). MAIN OUTCOME MEASURES: Information was obtained from former smokers on why and how they quit smoking, and from continuing smokers on why they smoked and what might help them quit. RESULTS: The proportion of current smokers in the population decreased from 35.5% in 1983 to 27.2% in 1991. In both surveys, former smokers cited a variety of reasons for quitting, including personal health concerns, social and environmental factors, personal attitude factors, cost, and health education messages. Responses concerning the most important reason also revealed a range of factors; "advice of a physician" was not prominent among them. When questioned about methods used in quitting, most former smokers in both surveys responded that they "just decided to quit". Very few reported using other aids such as cessation clinics or nicotine gum. More smokers in 1991 than in 1983 reported that they continued smoking for enjoyment, to satisfy a craving or addiction, and for relaxation. With regard to what might help them quit, continuing smokers in both surveys cited a wide variety of potential aids, including information on harmful effects, more restrictions on smoking and on sales, cessation clinics, programmes on radio/TV, and higher taxes. CONCLUSIONS: These findings support a multifaceted approach to tobacco control.


     

Smokers are unaware of the filter vents now on most cigarettes: results of a national survey

OBJECTIVE: To evaluate awareness and knowledge of cigarette filter ventilation in a national probability sample of smokers of Ultra-light, Light, and regular cigarettes. DESIGN: Random-digit-dialling and computer-assisted telephone interviewing was used on a probability sample of daily cigarette smokers (ages 18 and above). SUBJECTS AND SETTING: 218 Smokers of Ultra-light cigarettes, 360 smokers of Light cigarettes, and 210 smokers of Regular cigarettes living in the continental United States. MAIN OUTCOME MEASURES: Percentage of respondents indicating knowledge of the presence of filter vents and the consequences of behavioural blocking of vents. RESULTS: Many smokers had not heard about or seen the filter holes: 43% (95% CI = 36 to 50%) of smokers of Ultra-lights, 39% (95% CI = 34 to 44%) of smokers of Lights, and 47% (95% CI = 40 to 54%) of smokers of Regulars. About two in three smokers either did not know of the existence of rings of small holes on the filters of some cigarettes, or did not know that blocking increases tar yields: 69% (95% CI = 63 to 75%) of Ultra- lights, 66% (95% CI = 61 to 71%) of Lights, and 69% (95% CI = 63 to 75%) of Regulars. CONCLUSIONS: Smokers are generally unaware of the presence and function of filter vents-a major design feature subject to behavioural blocking by smokers and now present on most cigarettes in the United States. Smokers and policy-makers need to be informed about the presence of filter vents and how vent blocking increases tar and nicotine yields from ostensibly very low-yield cigarettes.


     

Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults

OBJECTIVE—To examine the factors that determine whether or not smokers become long-term quitters, and to study whether determinants of successful cessation differ with levels of motivation to stop.
DESIGN—In a cohort of men and women, aged 30-60 years at first examination in 1982/1984, smoking behaviour was evaluated from questionnaires at baseline and at follow up 10 years later.
SETTING—County of Copenhagen, Denmark
PARTICIPANTS—2554 subjects from the original sample of 4581 were successfully followed. This study deals with the 1365 subjects who were smokers at the first examination.
MAIN OUTCOME MEASURE—Smoking status (abstinent for one year or more) at follow up.
RESULTS—At follow up 15% of the baseline smokers had been abstinent for one year or more. In multivariate analysis, successful smoking cessation was associated with older age, high social status, low prior tobacco consumption, baseline motivation to stop smoking, and having a non-smoking spouse/cohabitant. The same result was obtained when the analyses were repeated separately for smokers with and without motivation to stop.
CONCLUSIONS—Smokers motivated to stop are more likely to quit and remain abstinent than smokers with no such motivation. Age, social status, spouse/cohabitant's smoking behaviour, and the daily consumption of tobacco predict success in smoking cessation, irrespective of smokers' former motivation to stop.


Keywords: smoking cessation predictors; Denmark     

Survey of sociodemographic characteristics of tobacco use among 99,598 individuals in Bombay, India using handheld computers

OBJECTIVES: To study the diversity and sociodemographic characteristics of tobacco use in Bombay, India. DESIGN: Population-based, cross- sectional, house-to-house survey with face-to-face interviews in the city of Bombay during 1992-94. Data was input directly into a programmed, handheld computer (electronic diary). PARTICIPANTS: Permanent residents of the city of Bombay aged 35 years and older. MAIN OUTCOME MEASURES: Tobacco use in various smoking and smokeless forms. RESULTS: 99598 individuals were interviewed (60% women, 40% men). Among women, prevalence of tobacco use was high (57.5%) but almost solely in the smokeless form. Among men, 69.3% reported current tobacco use and 23.6% were smokers. The most common smokeless tobacco practice among women was mishri use (44.5% of smokeless users) and among men betel quid with tobacco (27.1%). About half of smokers used bidi and half smoked cigarettes. Chewing areca nut without tobacco was rare (< 0.5% of smokeless users). Educational level was inversely associated with tobacco use of all kinds except cigarette smoking. CONCLUSIONS: The pattern of tobacco use varies across India and, in Bombay, is very different from other areas. Using handheld computers to collect data in the field was successful.


     

Poverty status and cigarette smoking prevalence and cessation in the United States, 1983-1993: the independent risk of being poor

OBJECTIVE: To analyse the independent relations between poverty status and cigarette smoking prevalence and cessation in the United States, 1983-1993. DESIGN: An analysis of eight cross-sectional national surveys. SETTING: The United States, 1983-1993. PARTICIPANTS: 236,311 civilian, non-institutionalised adult residents of the United States, aged 18 years and older. MAIN OUTCOME MEASURES: Probability of current cigarette smoking and proportion of former smokers among ever-smokers (quit ratio) in surveyed subjects below the poverty threshold, compared with those at or above the poverty threshold. RESULTS: The odds ratio for current smoking among persons below the poverty threshold ranged from a low of 1.10 in 1985 to a high of 1.45 in 1990, and remained between 1.26 and 1.30 during 1991-1993. The odds ratio for smoking cessation (quit ratio) among persons below the poverty threshold ranged from 0.81 in 1985 to 0.64 in 1991, and remained between 0.73 and 0.66 during 1991-1993. These measures of the relations between poverty status and smoking were derived using multiple logistic regression models, which adjusted for the effects of sex, age, education, race, employment status, marital status, and geographic region. CONCLUSIONS: Persons below the poverty threshold continue to be more likely than those at or above the threshold both to be current smokers and not to have quit. Poverty may be an indicator of underparticipation in the changing social norms regarding smoking behaviour in recent years. Individuals below the poverty threshold may need focused efforts to help achieve the Healthy People 2000 objectives for reducing adult smoking prevalence. Further understanding of the relation between poverty and smoking is essential to develop effective programmes for this vulnerable population subgroup.


     

Mentholated cigarettes and smoking cessation: findings from COMMIT. Community Intervention Trial for Smoking Cessation

OBJECTIVE: To examine the association between the use of menthol cigarettes and smoking cessation, amount smoked, and time to first cigarette in the morning. BACKGROUND: The majority of African American smokers smoke mentholated cigarettes. Some evidence suggests that African Americans may be more nicotine dependent than whites. One theory is that menthol in cigarettes is responsible for enhancing the dependence producing capacity of cigarettes; however, few studies have prospectively examined the association between menthol use and indicators of nicotine dependence. METHODS: Baseline smokers from the Community Intervention Trial for Smoking Cessation (COMMIT) completed a telephone tobacco use survey in 1988 and were re-interviewed in 1993. Use of mentholated cigarettes was assessed by self report at baseline. Indicators of dependence examined were six month cessation in 1993, amount smoked among continuing smokers in 1993, and time to first cigarette in the morning in 1988. Multivariate regression techniques were used to assess the association of baseline menthol use with these outcomes while controlling for other factors related to dependence. RESULTS: Overall, 24% of the sample smoked a mentholated brand in 1988. No consistent associations were observed for menthol use and indicators of dependence in both overall and race specific analyses. Factors significantly associated with increased menthol use were female sex, age 25-34 years, African American and Asian race/ethnicity, greater education, greater than 60 minutes to the first cigarette in the morning, two or more past quit attempts, and use of premium brand cigarettes. Canadian respondents and those who smoked 15-24 cigarettes per day had lower rates of menthol use. Use of mentholated cigarettes was not associated with quitting, amount smoked, or time to first cigarette in the morning. CONCLUSION: Future work is needed to clarify the physiological and sociocultural mechanisms involved in mentholated cigarette smoking.     

Menthol cigarettes and smoking cessation during an aided quit attempt.

Menthol may make cigarettes more addictive and rates of menthol cigarette smoking are disproportionately higher among Black. However, few studies have examined the association between menthol cigarette smoking and cessation, and the studies to date have produced conflicting findings. The present study examines the effect of menthol cigarette smoking on cessation among a multi-ethnic sample of smokers making a pharmacotherapy-aided quit attempt. We hypothesized that menthol cigarette smoking would be associated with lower smoking abstinence rates and conducted a secondary analysis of data from a multi-site randomized controlled trial of an intervention designed to facilitate repeat tobacco cessation treatment (N = 1,343). The intervention consisted of a patient phone call and a computerized provider prompt. The primary outcome for this analysis was 7-day point prevalence smoking abstinence. The average age of the sample was 56 years old. Overall, 25% of the sample smoked menthol cigarettes: 19% of Whites, 62% of Blacks, and 25% of other ethnicity (p<.001). We observed no significant effects for menthol cigarette smoking or ethnicity on smoking abstinence rates. In conclusion, combined with findings from previous research, this study suggests that smoking menthol cigarettes does not decrease smoking cessation among older smokers during a quit attempt aided with pharmacotherapy.     

Smokers' reactions to reduced ignition propensity cigarettes

Background

On 28 June 2004, New York State (NY) became the first jurisdiction to require cigarettes to meet a reduced ignition propensity (RIP) standard. This law resulted in cigarette manufacturers modifying nearly all of their brands sold in NY. However, the same cigarette brands sold in other states were not modified to meet the RIP standard.

Objectives

This paper examines relationships between the RIP law and smokers'' awareness of changes in the performance of their cigarettes (that is, going out more frequently, change in taste), and smoking behaviour.

Methods

Data for this analysis come from a nationwide survey of 2088 adult smokers (> 18 years of age) conducted in the USA between July and December 2004. 143 of the smokers included in the survey were residents of NY while the remainder were from other states (n  =  1945). Survey participants were asked whether their cigarettes “ever go out between puffs” and whether they had noticed any change in the taste of their cigarettes in the past 12 months.

Results

NY smokers were three times more likely than smokers in other states to report that their cigarettes often went out between puffs (17.3% v 5.6%). However, NY smokers appeared no more likely to report noticing differences in cigarette taste, an intention to quit smoking, or to have made quit attempts.

Conclusions

A significant minority of smokers in NY reported noticing changes in the performance of their cigarettes following the RIP law, as would be expected. However, the RIP law appears to have had no impact on the smoking habits of New Yorkers, countering arguments made by cigarette manufacturers that the law would impact consumer acceptability.     

Roll-your-own smoke yields: theoretical and practical aspects

OBJECTIVE—To identify the key parameters that influence smoke yields from roll-your-own (RYO) cigarettes and to compare smoke yields of cigarettes made under laboratory conditions with those made by habitual RYO consumers.
DESIGN AND SETTING—One-way parametric variations in the laboratory-based production of RYO cigarettes complemented by a consumer survey conducted in a busy street at Romford, Essex, United Kingdom.
SUBJECTS—26 habitual RYO consumers.
MAIN OUTCOME MEASURES—Cigarette weights, puff numbers, and yields (carbon monoxide, nicotine, and tar).
RESULTS—Smoke yields vary for specimen changes in weight of tobacco used, paper porosity, and the incorporation of a filter in the cigarette. Yields of cigarettes produced by 26 RYO smokers ranged from 9.9 to 21.0 mg tar per cigarette and from 0.9 to 1.8 mg nicotine per cigarette, and were generally lower than yields of laboratory-produced RYO cigarettes.
CONCLUSIONS—Laboratory studies can provide useful information concerning the parameters that affect smoke yields of RYO cigarettes such as the incorporation of a filter to reduce yields. However, such studies must be complemented by surveys of cigarettes made by actual current RYO smokers. In one such investigation, it was found that the mean tar yields from cigarettes produced by 57% of the smokers were above the current maximum of 15 mg per cigarette for manufactured cigarettes. Currently 8% of manufactured cigarettes in the UK have a declared nicotine yield of greater than 1.1 mg per cigarette whereas 77% of RYO smokers produced cigarettes with a nicotine yield greater than this value.


Keywords: roll-your-own cigarettes; smoke yield; carbon monoxide; tar; nicotine     

Which smokers use the smoking cessation Quitline in Hong Kong,and how effective is the Quitline?

Objective: To describe the characteristics of the Chinese subjects who utilised the first telephone smoking cessation service in Hong Kong, and to evaluate its effectiveness.

Methods: The Quitline provided Hong Kong residents with free telephone smoking cessation services which was publicised through a press conference, media reports, pamphlets, and posters at public and private hospitals and clinics. Callers who completed an initial interview from 13 December 2000 to 31 May 2002 were included. Smokers were interviewed using a structured record sheet and provided with stage matched counselling. A follow up interview was carried out after six months. Analysis was conducted by intention-to-treat.

Results: Of the 1120 callers who completed initial assessments, 1047 were current smokers and 872 consented to follow ups. Compared to the general smoking population, the Quitline attracted more of those who were female, younger, single, unemployed, higher educated, smoking more than 20 cigarettes per day, and those with quitting experience. At six months, 12% (95% confidence interval 10% to 15%) of the participants reported that they had not smoked a cigarette for the past seven days. A stepwise logistic regression model showed that the use of nicotine replacement therapy at the present attempt to quit, having made one or more serious attempts to quit in the past, perceiving less difficulties in quitting, and smoking the first cigarette at age 15 years or above were significant predictors of quitting.

Conclusion: This first Quitline in Asia appears to be acceptable to Chinese smokers, with quit rate comparable to those of better funded Quitlines in the West. A low cost Quitline is a promising model for smoking cessation services in the East.

     

Smoking, standard of living, and poverty in China

Objectives: To analyse differences in smoking behaviour and smoking expenditures among low and high income households in China and the impact of smoking on standard of living of low income households in China. Methods: About 3400 urban and rural households from 36 townships/districts in southwest China were interviewed in 2002. Cross tabulations and regression analysis were used to examine the differences in major household expenditures, including food, housing, clothing, and education between households with smokers and without smokers. Results: Lower income households with smokers paid less per pack and smoked fewer cigarettes than higher income households with smokers. Poor urban households spent an average of 6.6% of their total expenditures on cigarettes; poor rural households spent 11.3% of their total expenditures on cigarettes. Conclusion: Reducing cigarette expenditures could release household resources to spend on food, housing, and other goods that improve living standards.     

Prevalence and correlates of internet cigarette purchasing among adult smokers in New Jersey

Objective: To examine the prevalence and correlates of internet cigarette purchasing among adult smokers.

Design: Analysis of internet purchasing in data from a population based telephone survey of New Jersey households. Logistic regression was used to determine factors associated with internet cigarette purchasing, adjusting for year, demographic, and smoking behaviour variables.

Participants: 3447 current cigarette smokers pooled from three cross sectional surveys conducted in 2000, 2001, and 2002.

Main outcome measures: Ever purchasing tobacco and usually buying cigarettes via the internet.

Results: Among all current cigarette smokers, ever having purchased tobacco via the internet increased from 1.1% in 2000 to 6.7% in 2002 and usually buying cigarettes via the internet increased from 0.8% in 2000 to 3.1% in 2002. Among current cigarette smokers with internet access, ever having purchased tobacco via the internet was higher among those who reported smoking 31 or more cigarettes per day (adjusted odds ratio (OR) 3.9, 95% confidence interval (CI) 1.5 to 10.2) and those without a past year quit attempt (adjusted OR 1.8, 95% CI 1.1 to 3.0). Usually purchasing cigarettes via the internet was higher among those aged 45–64 years (adjusted OR 4.4, 95% CI 1.1 to 17.1) and who reported having their first cigarette 30 minutes after waking (adjusted OR 3.3, 95% CI 1.2 to 9.2).

Conclusions: Although higher prices are known to reduce the demand for cigarettes, internet cigarette purchasing is likely to weaken this effect, particularly among heavy, more dependent smokers who are less interested in quitting.

     

Non-ceremonial tobacco use among southwestern rural American Indians: the New Mexico American Indian Behavioural Risk Factor Survey

OBJECTIVES—To ascertain non-ceremonial tobacco use among rural American Indians in New Mexico (United States).
DESIGN—A geographically targeted telephone survey.
SETTING—Rural New Mexico.
PARTICIPANTS—American Indian residents aged 18 years and older.
MAIN OUTCOME MEASURES—Prevalence of ever-smokers and current smokers of cigarettes and ever-users and current users of smokeless tobacco, number of cigarettes smoked, and prevalence of cigarette smoking quitting behaviour.
RESULTS—Of the 1266 respondents, 38.5% (95% confidence interval (CI) = 34.5% to 42.1%) reported ever smoking, and 16.3% (95% CI = 13.5% to 19.0%) reported being current smokers. Current smokers averaged 7.6 (95% CI = 6.0 to 9.3) cigarettes per day. Current smoking prevalence was highest among men and lowest among college graduates. Prevalence of smokeless tobacco use was 24.1% for ever-use and 7.2% for current use and showed a strong male predominance of use.
CONCLUSIONS—The prevalence of current smokers among rural American Indians in New Mexico was lower than among American Indians of other regions in the United States, all New Mexicans, and the national population as a whole. Although smoking prevalence was lower among American Indians in New Mexico, variation by sex and education followed the same patterns as reported among American Indians of other regions.


Keywords: American Indians; tobacco use; smokeless tobacco     

Smokers' expectancies for nicotine replacement therapy vs. cigarettes.

Smokers (N=188) recruited from the local community completed a questionnaire that measured expected outcomes of using cigarettes, nicotine gum, nicotine patch, and nicotine nasal spray. Expectancy questions relating to negative affect, craving, weight, and health risks were derived from the Smoking Consequences Questionnaire-Adult. As predicted, smokers held much greater expectancies that cigarettes help control negative affect, craving, and weight relative to nicotine replacement therapy (NRT). All NRT products were expected to cause fewer health risks than cigarette smoking. As predicted, smokers held strong negative affect reduction expectancies for cigarette smoking. For NRT, although still relatively low, craving reduction was the strongest expectancy. Individuals who had experience using the nicotine patch had greater positive expectancies for NRT. Greater positive expectancies for NRT were correlated with more immediate plans to quit smoking. In summary, cigarette smokers' positive expectancies about cigarettes do not appear to generalize to NRT products, which may limit their use and effectiveness.