Janet Audrain-McGovern

Introduction: Research on lifestyle modification interventions for smoking cessation often focuses on physical activity and calorie restriction, with little research exploring whether dietary macronutrient modifications may relate to smoking abstinence. The current study examined associations...

Introduction: Converging lines of research indicate that the public misinterprets the relative harms associated with different tobacco and nicotine products. These misperceptions may contribute to persistent tobacco-related health disparities. To inform regulatory actions in a growing tobacco market, it is essential to understand how harm perceptions differ across tobacco and nicotine products among racial and ethnic groups to ultimately decrease disparities. Methods: An online sample (n=897) of US adults completed a discrete choice experiment, known as a Maximum Difference Likelihood task, which is an orthogonally balanced approach designed to assess harm perceptions of 18 tobacco products that span a risk continuum. Participants selected the most and least harmful products. We estimated probability-scaled relative harm perception scores using a multinomial logit hierarchical Bayesian analysis. We then conducted linear regressions to look at differences by race and ethnicity using estimated marginal means and contrasts for each product while controlling for smoking status, age and sex. Results: The analyses revealed that participants’ harm perceptions do not align with the established scientific literature for combustibles, smokeless tobacco and non-combustible tobacco products. We observed low harm perceptions for products with high population rates of use, such as cigarillos and little cigars for non-Hispanic (NH) Black or African American, and Latino individuals. We observed high harm perceptions for products with low population use, such as plug tobacco for NH Asian individuals, e-cigarettes for NH Black or African American and Latino individuals and nicotine replacement therapy for NH Black or African Americans. Conclusion: Given the known tobacco-related health disparities among people of color, our results underscore the need to correct the tobacco product harm misperceptions among certain races and ethnicities, such as NH Black or African Americans, Latinos, NH Asians and NH Indigenous or mixed-race individuals.

Introduction This study investigated whether IQOS, a heated tobacco product, can fully substitute for combustible cigarettes and the factors that promote substitution. Methods Adults who smoked cigarettes daily (N=90; 21–65 years) completed a baseline ad-lib smoking period (days 1–5), two laboratory visits (days 6–7) and a 2-week period where they were instructed to switch from smoking cigarettes to using IQOS 3.0 (days 8–21). Mixed-effect modelling estimated the changes in cigarettes per day (CPD) and the percentage of baseline CPD substituted by HeatSticks during the switch period. Predictors included IQOS-associated subjective reward, relative reinforcing value, craving relief and withdrawal relief. Results Participants reduced their CPD to about 30% of their baseline smoking rate by the end of the 14-day switch period (pConclusions IQOS fully substituted for cigarettes in ~20% of people who were not immediately interested in quitting smoking while the remainder significantly reduced their smoking. Positive reinforcing effects of IQOS foster use and the transition away from combustible cigarettes. Trial registration number NCT05076708.

Introduction: Cigarillos dominate the US cigar market, and young adults largely drive use. While young adults prefer flavoured to non-flavoured cigarillos, especially those flavoured to taste like fruit or other sweets, the factors that underlie this preference have received little attention. We sought to determine if key indicators of abuse liability, the rewarding and reinforcing effects, are greater for sweet versus non-flavoured cigarillos. Methods: Young adults (18–24 years old) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerised choice task) and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavoured versus non-flavoured cigarillos. General linear regression models were fit with the appropriate family link for each outcome measure. Results: Young adults rated sweet-flavoured cigarillos as more rewarding (estimated marginal mean (EMM) =4.52, 95% CI 4.00 to 5.03) than the non-flavoured cigarillo (EMM=3.31, 95% CI 2.80 to 3.83; B=1.20, 95% CI 0.80 to 1.60, p< 0.001). Conclusions: Sweet flavouring increases the abuse liability of cigarillos among young adults as reflected in greater liking, motivation to use and actual use. Banning sweet flavouring in cigarillos may diminish their use in young adults. Trial registration number CT.gov ( NCT05092919 ).

Research suggests consumers may misunderstand modified risk tobacco product (MRTP) claims. We examined the effects of nicotine content across four tobacco products with and without MRTP claims among a racially and ethnically diverse sample of adults who do and do not smoke. Adults (n = 1484) aged 21–65 completed an online experiment using a 2 × 2 × 4 mixed factorial design to examine the effects of tobacco product (Classic White Snus, IQOS, JUUL e-cigarette, and VLN cigarette) and nicotine content (high vs. low) stratified by MRTP claim (present vs. absent) across four outcomes: (1) likely to try (2) serious disease if used regularly, (3) least addictive, and (4) ease of quitting smoking. Not including an MRTP claim resulted in an increased likelihood of trying a product, decreased concern of serious disease, lower perceived addictiveness, and increased ease of quitting smoking. Participants selected low nicotine IQOS without a claim as the least likely to cause serious disease. Low nicotine JUUL, without a claim, was selected as least addictive and most likely to facilitate quitting. Intentions to try were highest for low nicotine JUUL. Participants selected low-nicotine products as less addictive than high nicotine products. Regulatory efforts should consider how MRTP claims interact with different product characteristics. Subtle differences exist across outcomes between racial and ethnic groups, which indicates that further research is warranted.