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  1. Article ; Online: Assessment of Electronic Nicotine Delivery Systems With Cigarette Use and Self-reported Wheezing in the US Adult Population.

    Sánchez-Romero, Luz M / Bondarenko, Irina / Knoll, Marie / Hirschtick, Jana L / Cook, Steven / Fleischer, Nancy L / Levy, David T

    JAMA network open

    2023  Volume 6, Issue 4, Page(s) e236247

    Abstract: Importance: The prevalence of electronic nicotine delivery systems (ENDS) use has increased, leading to a concern about their respiratory health outcomes. It is unclear whether ENDS use increases the risk of wheezing, a common symptom of respiratory ... ...

    Abstract Importance: The prevalence of electronic nicotine delivery systems (ENDS) use has increased, leading to a concern about their respiratory health outcomes. It is unclear whether ENDS use increases the risk of wheezing, a common symptom of respiratory conditions.
    Objective: To provide an analysis of the longitudinal association between ENDS and cigarette use and self-reported wheezing among US adults.
    Design, setting, and participants: The US nationally representative Population Assessment of Tobacco and Health (PATH) Study was used. Longitudinal data for adults 18 years or older from wave 1 (2013-2014) to wave 5 (2018-2019) were analyzed. Data were analyzed from August 2021 to January 2023.
    Main outcomes and measures: The prevalence of self-reported wheezing (waves 2-5) was estimated for 6 strata of tobacco product use (never cigarette and noncurrent ENDS use, never cigarette and current ENDS use, current cigarette and noncurrent ENDS use, current cigarette and current ENDS use, former cigarette and noncurrent ENDS use, and former cigarette and current ENDS use). A generalized estimating equations framework evaluated the association between cigarette and ENDS use and self-reported wheezing at the subsequent wave. An interaction term between cigarette and ENDS use was added to estimate the association between joint cigarette and ENDS use categories and the association of ENDS within strata of cigarette use.
    Results: The analytical sample consisted of 17 075 US adults with a mean (SD) age of 45.4 (17) years, of whom 8922 (51%) were female and 10 242 (66%) were Non-Hispanic White. When compared with never cigarette and noncurrent ENDS use, the greatest association in reporting wheezing was for current cigarette and current ENDS use (adjusted odds ratio [AOR], 3.26; 95% CI, 2.82-3.77), which was similar to current cigarette and noncurrent ENDS use (AOR, 3.20; 95% CI, 2.91-3.51) and substantially greater than former cigarette and current ENDS use (AOR, 1.94; 95% CI, 1.57-2.41). Associations were small and not statistically significant for the odds of self-reported wheezing among never cigarette and current ENDS use when compared with never cigarette and noncurrent ENDS use (AOR, 1.20; 95% CI, 0.83-1.72), and for odds of wheezing and current cigarette and current ENDS use when compared with current cigarette and noncurrent ENDS use (AOR, 1.02; 95% CI, 0.91-1.15).
    Conclusions and relevance: In this cohort study, exclusive ENDS use was not associated with an increase in the risk of self-reported wheezing. However, a small increase in risk between ENDS use and wheezing was reported by individuals who use cigarettes. This study adds to the literature about the potential health effects associated with ENDS use.
    MeSH term(s) Humans ; Adult ; Female ; Middle Aged ; Male ; Electronic Nicotine Delivery Systems ; Cohort Studies ; Self Report ; Respiratory Sounds/etiology ; Tobacco Products ; Prevalence
    Language English
    Publishing date 2023-04-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2023.6247
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  2. Article ; Online: The role of flavored electronic nicotine delivery systems in smoking cessation: A systematic review.

    Liber, Alex C / Knoll, Marie / Cadham, Christopher J / Issabakhsh, Mona / Oh, Hayoung / Cook, Steve / Warner, Kenneth E / Mistry, Ritesh / Levy, David T

    Drug and alcohol dependence reports

    2023  Volume 7, Page(s) 100143

    Abstract: Background: Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation.: Methods: We searched EMBASE OVID, PsychInfo, ... ...

    Abstract Background: Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation.
    Methods: We searched EMBASE OVID, PsychInfo, and Medline databases for studies that: 1) examined cigarette cessation outcomes for persons using ENDS (intent, attempts, and success) and 2) reported results separated by respondent's ENDS flavor used. We extracted crude and adjusted odds ratios for associations between cessation outcomes and types of ENDS flavors used (nontobacco vs. tobacco/unflavored; nontobacco and nonmenthol vs. tobacco/unflavored and menthol). We did not consider cessation outcomes among people not using ENDS. We evaluated the evidence using the GRADE approach, focusing on consistency and reliability of findings across studies.
    Results: 29 studies met inclusion criteria, producing 36 odds ratios (ORs) comparing cessation outcomes across ENDS flavor groups. Three ORs examined quit intent, five examined quit attempts, and 28 examined quit success. Using GRADE, we reached Low levels of certainty that there was not an association between ENDS flavor use and intention to quit smoking or making a quit attempt. There were Very Low levels of certainty that nontobacco flavored versus tobacco/unflavored ENDS use was not associated with smoking cessation success, with similar findings for nonmenthol and nontobacco compared to tobacco and menthol flavored ENDS.
    Conclusion: The evidence about the role of different flavored ENDS use and smoking cessation outcomes is inconclusive, reflecting highly heterogeneous study definitions and methodological limitations. More high-quality evidence, ideally from randomized controlled trials, is required.
    Language English
    Publishing date 2023-03-16
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 2772-7246
    ISSN (online) 2772-7246
    DOI 10.1016/j.dadr.2023.100143
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  3. Article ; Online: Chemical Profiles and Toxicity of Electronic Cigarettes: An Umbrella Review and Methodological Considerations.

    Travis, Nargiz / Knoll, Marie / Cook, Steven / Oh, Hayoung / Cadham, Christopher J / Sánchez-Romero, Luz María / Levy, David T

    International journal of environmental research and public health

    2023  Volume 20, Issue 3

    Abstract: Background: Electronic cigarettes (ECs) are often marketed as a safer alternative to combustible tobacco products. The global EC market has rapidly expanded since their introduction, creating an urgent need for research describing the toxicity and ... ...

    Abstract Background: Electronic cigarettes (ECs) are often marketed as a safer alternative to combustible tobacco products. The global EC market has rapidly expanded since their introduction, creating an urgent need for research describing the toxicity and chemical composition of ECs. We conducted an umbrella review to summarize the evidence from existing systematic reviews (SRs).
    Methods: The search for SRs was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool.
    Results: Twenty-five SRs were included in our umbrella review. Chemical profiles widely varied across studies included in the reviews, which was mainly attributed to the lack of standardized protocols investigating the constituents, and differences in EC devices and e-liquids tested. Metals were more abundant in some EC aerosols than cigarettes, while carbonyls were typically found at lower levels. There was consistent evidence of in vitro toxicity from EC aerosol and e-liquid exposure. AMSTAR-2 revealed important limitations across reviews.
    Conclusions: While most reviews concluded that ECs were likely less harmful than cigarettes, there was hesitancy to draw clear conclusions due to variable analytical procedures and inconsistent findings among the included studies. Future SRs with improved methodology and reporting are needed to adequately inform tobacco regulatory actions.
    MeSH term(s) Electronic Nicotine Delivery Systems ; Aerosols/toxicity ; Metals
    Chemical Substances Aerosols ; Metals
    Language English
    Publishing date 2023-01-20
    Publishing country Switzerland
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph20031908
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  4. Article ; Online: Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations.

    Travis, Nargiz / Knoll, Marie / Cadham, Christopher J / Cook, Steven / Warner, Kenneth E / Fleischer, Nancy L / Douglas, Clifford E / Sánchez-Romero, Luz María / Mistry, Ritesh / Meza, Rafael / Hirschtick, Jana L / Levy, David T

    International journal of environmental research and public health

    2022  Volume 19, Issue 15

    Abstract: E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and ... ...

    Abstract E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and carcinogenic risks of e-cigarette use, distinguishing between short-term and long-term health effects. The search for systematic reviews was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Seventeen systematic reviews, including five meta-analyses, were included in our umbrella review. There was a clear underreporting of e-cigarette devices and e-liquid types, e-cigarette and cigarette exposure, and the health and smoking status of study participants. Overall, the findings suggest that short-term use of e-cigarettes may be associated with acute cardiopulmonary risks, although to a lesser extent than cigarette use. Long-term e-cigarette use may have pulmonary/respiratory benefits in those who switch from chronic cigarette smoking, particularly in individuals with asthma and chronic obstructive pulmonary disease (COPD). Evidence on intermediate and long-term carcinogenic effects is lacking. This umbrella review underscores the urgent need for systematic reviews with better adherence to established reporting guidelines, consistent definitions of duration of e-cigarette use, a focus on newer devices, and accounting for the impacts of former or current smoking.
    MeSH term(s) Carcinogens ; Cigarette Smoking ; Electronic Nicotine Delivery Systems ; Humans ; Systematic Reviews as Topic ; Tobacco Products ; Vaping
    Chemical Substances Carcinogens
    Language English
    Publishing date 2022-07-25
    Publishing country Switzerland
    Document type Journal Article ; Review ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph19159054
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  5. Article ; Online: The Use of Expert Elicitation among Computational Modeling Studies in Health Research: A Systematic Review.

    Cadham, Christopher J / Knoll, Marie / Sánchez-Romero, Luz María / Cummings, K Michael / Douglas, Clifford E / Liber, Alex / Mendez, David / Meza, Rafael / Mistry, Ritesh / Sertkaya, Aylin / Travis, Nargiz / Levy, David T

    Medical decision making : an international journal of the Society for Medical Decision Making

    2021  Volume 42, Issue 5, Page(s) 684–703

    Abstract: Background: Expert elicitation (EE) has been used across disciplines to estimate input parameters for computational modeling research when information is sparse or conflictual.: Objectives: We conducted a systematic review to compare EE methods used ... ...

    Abstract Background: Expert elicitation (EE) has been used across disciplines to estimate input parameters for computational modeling research when information is sparse or conflictual.
    Objectives: We conducted a systematic review to compare EE methods used to generate model input parameters in health research.
    Data sources: PubMed and Web of Science.
    Study eligibility: Modeling studies that reported the use of EE as the source for model input probabilities were included if they were published in English before June 2021 and reported health outcomes.
    Data abstraction and synthesis: Studies were classified as "formal" EE methods if they explicitly reported details of their elicitation process. Those that stated use of expert opinion but provided limited information were classified as "indeterminate" methods. In both groups, we abstracted citation details, study design, modeling methodology, a description of elicited parameters, and elicitation methods. Comparisons were made between elicitation methods.
    Study appraisal: Studies that conducted a formal EE were appraised on the reporting quality of the EE. Quality appraisal was not conducted for studies of indeterminate methods.
    Results: The search identified 1520 articles, of which 152 were included. Of the included studies, 40 were classified as formal EE and 112 as indeterminate methods. Most studies were cost-effectiveness analyses (77.6%). Forty-seven indeterminate method studies provided no information on methods for generating estimates. Among formal EEs, the average reporting quality score was 9 out of 16.
    Limitations: Elicitations on nonhealth topics and those reported in the gray literature were not included.
    Conclusions: We found poor reporting of EE methods used in modeling studies, making it difficult to discern meaningful differences in approaches. Improved quality standards for EEs would improve the validity and replicability of computational models.
    Highlights: We find extensive use of expert elicitation for the development of model input parameters, but most studies do not provide adequate details of their elicitation methods.Lack of reporting hinders greater discussion of the merits and challenges of using expert elicitation for model input parameter development.There is a need to establish expert elicitation best practices and reporting guidelines.
    MeSH term(s) Computer Simulation ; Cost-Benefit Analysis ; Expert Testimony ; Humans ; Probability ; Research Design
    Language English
    Publishing date 2021-10-25
    Publishing country United States
    Document type Journal Article ; Systematic Review ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 604497-9
    ISSN 1552-681X ; 0272-989X
    ISSN (online) 1552-681X
    ISSN 0272-989X
    DOI 10.1177/0272989X211053794
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  6. Article ; Online: An Expert Elicitation on the Effects of a Ban on Menthol Cigarettes and Cigars in the United States.

    Levy, David T / Cadham, Christopher J / Sanchez-Romero, Luz Maria / Knoll, Marie / Travis, Nargiz / Yuan, Zhe / Li, Yameng / Mistry, Ritesh / Douglas, Clifford E / Tam, Jamie / Sertkaya, Aylin / Warner, Kenneth E / Meza, Rafael

    Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco

    2021  Volume 23, Issue 11, Page(s) 1911–1920

    Abstract: Introduction: The US Food and Drug Administration announced its intention to ban menthol in cigarettes. However, information is needed on how a federal ban would affect population health.: Aims and methods: We conducted an expert elicitation to gauge ...

    Abstract Introduction: The US Food and Drug Administration announced its intention to ban menthol in cigarettes. However, information is needed on how a federal ban would affect population health.
    Aims and methods: We conducted an expert elicitation to gauge the impact of a menthol cigarette and cigar ban in the United States. We developed and pilot tested a questionnaire that focused on tobacco use transitions of current smokers (age 18-24 menthol, age 35-54 menthol, and age 35-54 nonmenthol) and potential menthol smokers (age 12-24). Using a structured expert elicitation, we estimated mean net transitions under a ban from cigarette use to combustible tobacco product, smokeless tobacco, novel nicotine delivery product (NNDPs, such as e-cigarettes) use, or no tobacco use.
    Results: Eleven experts provided responses. Of those ages 12-24 who would have initiated menthol cigarette use in the absence of a ban, the experts estimated that 41% would still initiate combustible products under a ban, while 18% would initiate with NNDPs and 39% would not initiate regular tobacco use. Combustible use by menthol smokers ages 35-54 was expected to decline by 20% postban relative to preban rates, half switching to NNDPs and half quitting all tobacco use. Menthol smokers ages 18-24 were expected to reduce combustible use by 30%, with 16% switching to NNDPs. Greater reductions in combustible use were estimated for African Americans across the three age groups. Negligible impacts were expected for current adult nonmenthol smokers.
    Conclusions: According to expert opinion, a menthol ban is expected to substantially reduce smoking initiation and combustible tobacco product use among current menthol smokers.
    Implications: The US Food and Drug Administration recently announced its intention to ban menthol in cigarettes, but information on the potential impact on smoking and other nicotine product use is limited. We conducted an expert elicitation to gauge the impact of a menthol cigarette and cigar ban in the United States. A panel of experts estimated that menthol smokers ages 35-54 would reduce combustible tobacco use by 20%, with half switching to e-cigarettes and half quitting all nicotine use. Larger reductions were expected at younger ages, and menthol smoking initiation was reduced by 59% with 18% instead using e-cigarettes. African Americans were expected to have greater reductions in combustible tobacco use than the rest of the population.
    MeSH term(s) Adolescent ; Adult ; Child ; Electronic Nicotine Delivery Systems ; Humans ; Menthol ; Middle Aged ; Smoking ; Smoking Cessation ; Tobacco Products ; United States/epidemiology ; Young Adult
    Chemical Substances Menthol (1490-04-6)
    Language English
    Publishing date 2021-06-07
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1452315-2
    ISSN 1469-994X ; 1462-2203
    ISSN (online) 1469-994X
    ISSN 1462-2203
    DOI 10.1093/ntr/ntab121
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    Zs.A 5789: Show issues Location:
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  7. Article ; Online: The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States.

    Zahnd, Whitney E / Murphy, Cathryn / Knoll, Marie / Benavidez, Gabriel A / Day, Kelsey R / Ranganathan, Radhika / Luke, Parthenia / Zgodic, Anja / Shi, Kewei / Merrell, Melinda A / Crouch, Elizabeth L / Brandt, Heather M / Eberth, Jan M

    International journal of environmental research and public health

    2021  Volume 18, Issue 4

    Abstract: One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority ... ...

    Abstract One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
    MeSH term(s) African Americans ; Ethnic Groups ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Minority Groups ; Neoplasms ; Rural Population ; United States/epidemiology
    Language English
    Publishing date 2021-02-03
    Publishing country Switzerland
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Review
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph18041384
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  8. Article ; Online: Public health impact of a US ban on menthol in cigarettes and cigars: a simulation study.

    Levy, David T / Meza, Rafael / Yuan, Zhe / Li, Yameng / Cadham, Christopher / Sanchez-Romero, Luz Maria / Travis, Nargiz / Knoll, Marie / Liber, Alex C / Mistry, Ritesh / Hirschtick, Jana L / Fleischer, Nancy L / Skolnick, Sarah / Brouwer, Andrew F / Douglas, Cliff / Jeon, Jihyoun / Cook, Steven / Warner, Kenneth E

    Tobacco control

    2021  Volume 32, Issue e1, Page(s) e37–e44

    Abstract: Introduction: The US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper ... ...

    Abstract Introduction: The US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper simulates the potential public health impact of a ban on menthol in cigarettes and cigars through its impacts on smoking initiation, smoking cessation and switching to nicotine vaping products (NVPs).
    Methods: After calibrating an established US simulation model to reflect recent use trends in cigarette and NVP use, we extended the model to incorporate menthol and non-menthol cigarette use under a status quo scenario. Applying estimates from a recent expert elicitation on the behavioural impacts of a menthol ban, we developed a menthol ban scenario with the ban starting in 2021. We estimated the public health impact as the difference between smoking and vaping-attributable deaths and life-years lost in the status quo scenario and the menthol ban scenario from 2021 to 2060.
    Results: As a result of the ban, overall smoking was estimated to decline by 15% as early as 2026 due to menthol smokers quitting both NVP and combustible use or switching to NVPs. These transitions are projected to reduce cumulative smoking and vaping-attributable deaths from 2021 to 2060 by 5% (650 000 in total) and reduce life-years lost by 8.8% (11.3 million). Sensitivity analyses showed appreciable public health benefits across different parameter specifications.
    Conclusions and relevance: Our findings strongly support the implementation of a ban on menthol in cigarettes and cigars.
    MeSH term(s) Humans ; Menthol ; Public Health ; Tobacco Products ; Smoking/epidemiology ; Smoking Cessation ; Nicotine ; Vaping ; Electronic Nicotine Delivery Systems
    Chemical Substances Menthol (1490-04-6) ; Nicotine (6M3C89ZY6R)
    Language English
    Publishing date 2021-09-02
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1146554-2
    ISSN 1468-3318 ; 0964-4563
    ISSN (online) 1468-3318
    ISSN 0964-4563
    DOI 10.1136/tobaccocontrol-2021-056604
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