Changes in Retail Tobacco Product Availability Following a Chicago City Ordinance Restricting Sales of Menthol and Other Flavored Tobacco Products Near Schools.

BACKGROUND: In April 2016, the City of Chicago implemented an ordinance restricting the sale of all flavored (including menthol) tobacco products (FTPs), including electronic cigarettes, at retailers located within 500 feet of any public, private, or alternative elementary, middle ("primary"), or high ("secondary") school. We examined changes in retail availability of FTPs from before to after policy implementation among policy-affected retailers compared with retailers not subject to the policy. METHOD: Observational data were collected in June to September 2015 (Wave 1; pre-policy) and November to December 2016 (Wave 2; post-policy) from a panel of 194 randomly selected policy-area stores (located within 500 feet of a school), and a panel of 199 randomly selected comparison-area stores (located more than 500 feet from a school). Using generalized estimation equation regression, we assessed differences in FTP availability changes across study areas. RESULTS: We observed a statistically significant policy effect on FTP availability (Area × Wave interaction, p < .05); however, more than half of policy-area retailers continued to display at least one FTP after policy implementation (87.11% at Wave 1, 57.73% at Wave 2, p < .05). Similar reductions were seen for the availability of flavored cigarillos/little cigars and menthol cigarettes, while policy effects varied across store types. DISCUSSION: FTP availability reductions appear to be associated with policy implementation, but FTPs remained readily available at retailers subject to the policy. This study contributes to the evidence base indicating that policies with exclusions or exemptions for certain flavors, products, store types, or retailer locations have a limited effect on retail availability of FTPs.

Development of a panel of U.S. adult tobacco users to inform tobacco regulatory science.

The National Panel of Tobacco Consumer Studies (TCS Panel) is a probability-based panel of about 4,000 U.S. adult cigarette, cigar, and smokeless tobacco users developed by the U.S. Food and Drug Administration's Center for Tobacco Products to conduct observational and experimental studies to inform tobacco regulatory activities. This paper describes the methods and characteristics of the current panel. The TCS Panel employed a stratified 4-stage sample design and in-person screening of U.S. sampled households. Selected eligible adults participated in an enrollment interview and completed a baseline survey assessing tobacco use behaviors to enroll in the Panel; 3,893 individuals were enrolled from September 2016-August 2017. Replenishment occurred from July 2019-December 2019 with 2,260 new members, for a current panel of 3,929 members. Demographic and tobacco use characteristics of the current panel were analyzed in 2020. Most demographic characteristics of the TCS Panel are similar to those of U.S. tobacco users in the 2018 National Health Interview Survey, suggesting a lack of systematic bias in the Panel. Small, but statistically significant, differences were observed in the proportion of 18- to 25-year-olds; high school diploma and bachelor's degree/higher; never married and married (p < 0.05 for all). The TCS Panel appears to be representative of U.S. cigarette, cigar, and smokeless tobacco users; such panels can be a feasible method for conducting tobacco regulatory science research. The TCS Panel has been used to field studies examining purchasing behaviors, receipt and use of free samples/coupons, and the impact of a hypothetical tobacco product standard.

Compliance with a Sales Policy on Flavored Non-cigarette Tobacco Products.

OBJECTIVES: We assessed the effect of the New York City (NYC) policy restricting sales of flavored non-cigarette tobacco products on retail sales using a quasi-experimental comparison design. We also studied possible cross-border purchasing and product substitution by consumers. METHODS: We compiled retail scanner data for January 2010-January 2014 for NYC, a proximal comparison area (PCA) surrounding NYC, and the US. We used regression models to assess trends in sales of flavored cigars, smokeless tobacco (SLT), loose tobacco (RYO), and total cigars in all areas. RESULTS: Sales of flavored cigars (-22.3%), SLT (-97.6%), and RYO (-42.5%) declined following policy implementation (all ps < .01). Flavored cigar sales declined nonsignificantly in the comparison areas. An average 7.4% reduction in total cigar sales was seen in NYC following the policy (p < .01), as cigar sales increased 12% nationally, suggesting that NYC consumers did not substitute flavored cigars with non-flavored varieties. CONCLUSIONS: Implementation of the NYC policy was associated with significant reductions in sales of all restricted products, both absolutely and relative to comparison areas. Despite persistent sales of flavored cigars, overall cigar sales in NYC declined following the policy, although more intensive enforcement is needed to ensure greater policy compliance.

Public Health and Social Desirability in Kazakhstan: Methodological Considerations.

BACKGROUND: As the Republic of Kazakhstan undertakes new public health efforts to promote healthy lifestyles among its citizens, the local perceptions of health and health behaviors need to be examined and understood from the sociocultural and historical perspectives. The primary aim of this study is to examine the association between perception of control on one's health and engagement in good and bad health behaviors. METHODS: Students enrolled in a health communication course surveyed 310 citizens of Kazakhstan on their perceptions of control over their own health and multiple health behaviors (i.e. smoking status, physical activity, etc.). Twenty-seven students were divided into groups and approached every third passerby as a potential participant during common shopping hours in nine popular marketplaces in Astana, Kazakhstan. Perception of control on one's health was measured using a validated measure of health control: the multidimensional health locus of control scale (MHLC), developed by Wallston and colleagues. The MHLC measures three separate loci of control: internal, chance, and powerful others. RESULTS: Participants perceived themselves as having highest control over their health (MHLC subscale internal: 29.70±0.64), powerful others had second highest control (MHLC subscale power others: 23.72±0.77), and chance had the lowest but still some control on their health (MHLC subscale chance: 20.82±0.85). Most participants rated their current health as very good (18.1%), good (45.0%), or moderate (32.3%). Approximately 23.4% of participants were smokers, and 22.2% consumed alcohol. Physical activity averaged 3.63 days in the past week, and fruit and vegetable consumption averaged 2 servings of each per day. Tobacco and the powerful others subscale were significantly negatively correlated (r=-0.17, p<0.05). CONCLUSIONS: Participant reports regarding personal health behaviors and lifestyle did not reflect the national reports regarding lifestyle behaviors. The relationship between powerful others subscale and tobacco smoking indicate that using healthcare providers may open up avenues to lowering tobacco use through patient education; however, social desirability is a notable concern for public health interventions. More importantly, the surveys uncovered future questions for conducting public health research with the general public, including issues of trust in the healthcare system and social desirability bias. Additional factors such as distrust in healthcare and government also may play a role in the public's participation in social scientific research. The students who conducted the surveys reported a general skepticism from the public ranging from unfamiliarity with survey research to explicit distrust in the intentions and purpose of the research itself.

Prevalence and correlates of quitline awareness and utilization in the United States: an update from the 2009-2010 National Adult Tobacco Survey.

INTRODUCTION: Tobacco quitlines are evidence-based cessation resources that have been underutilized. The purpose of this study is to provide population-level data about quitline awareness and utilization in the United States and to assess correlates of awareness and utilization. METHODS: Data were from the 2009-2010 National Adult Tobacco Survey. Descriptive statistics were produced for national- and state-level quitline awareness and for national quitline utilization. Bivariate and multivariable logistic regressions were used to identify correlates of quitline awareness and utilization. RESULTS: Quitline awareness among the total sample was 33.9% (current smokers 53.9%, former smokers 34.0%, never-smokers 27.0%). Awareness varied by state (range: 35.8%-84.6% for current smokers). Among current smokers who tried to quit in the past year, correlates of lower awareness included being Black, non-Hispanic, and making <$50,000 annually; correlates of higher awareness included having seen a health professional, higher state tobacco program expenditures, and being female. Among smokers who made at least one quit attempt in the previous year and were aware of the quitline, quitline utilization was 7.8%. Higher state tobacco program expenditure, health professional advice, and being Black, non-Hispanic were correlated with higher utilization; older age was correlated with lower utilization. Awareness was significantly associated with use at the state level (r = .98, p < .01). CONCLUSION: Although the majority of smokers in the United States are aware of quitlines, only a small percentage of those trying to quit utilize them. State tobacco program expenditures and receipt of advice from a health professional were associated with both higher quitline awareness and higher utilization.

Tobacco use screening and counseling during physician office visits among adults--National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005-2009.

Tobacco use continues to be the leading cause of preventable disease and death in the United States; cigarette smoking accounts for approximately 443,000 premature deaths annually. In 2009, the prevalence of smoking among U.S. adults was 20.6% (46 million smokers), with no significant change since 2005 (20.9%). In 2010, approximately 69% of smokers in the United States reported that they wanted to quit smoking. Approximately 44% reported that they tried to quit in the past year for ≥1 day; however, only 4%-7% were successful each year. Tobacco dependence has many features of a chronic disease: most patients do not achieve abstinence after their first attempt to quit, they have periods of relapse, and they often require repeated cessation interventions. At least 70% of smokers visit a physician each year, and other smokers visit other health-care professionals, providing key opportunities for intervention. The 2008 update to the U.S. Public Health Service (PHS) Clinical Practice Guideline: Treating Tobacco Use and Dependence recommends that clinicians and health-care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health-care setting using the 5 A's model: 1) ask about tobacco use, 2) advise tobacco users to quit, 3) assess willingness to make a quit attempt, 4) assist in quit attempt, and 5) arrange for follow-up. The PHS guideline also recommends the following as effective methods for increasing successful cessation attempts: individual, group, and telephone counseling; any of the seven first-line medications for tobacco dependence that are approved by the Food and Drug Administration (FDA); and provision of coverage for these treatments by health-care systems, insurers, and purchasers. However, clinicians and health-care systems often do not screen for and treat tobacco use consistently and effectively.

Clinical factors associated with cancer-related fatigue in patients being treated for leukemia and non-Hodgkin's lymphoma.

PURPOSE: To describe fatigue severity, fatigue interference, and associated factors in hematologic malignancies. PATIENTS AND METHODS: Patients being treated for leukemia and non-Hodgkin's lymphoma (n = 228) completed the Brief Fatigue Inventory to rate fatigue severity and functional interference caused by fatigue. Data on patient demographics, Eastern Cooperative Oncology Group performance status, other physical symptoms, current treatments, and laboratory values were also collected. Descriptive statistics, bivariate correlation, and logistic regression were used for data analysis. RESULTS: Fifty percent of the sample reported severe fatigue, which was defined as a "fatigue worst" rating of 7 or greater. More patients with acute leukemia (61%) reported severe fatigue compared with those with chronic leukemia (47%) and non-Hodgkin's lymphoma (46%). Increased fatigue severity significantly compromised patients' general activity, work, enjoyment of life, mood, walking, and relationships with others. Fatigue severity was strongly associated with performance status, use of opioids, blood transfusions, gastrointestinal symptoms, and sleep disturbance items, as well as with low serum hemoglobin and albumin levels. Regression analysis indicated that nausea was the significant clinical predictor of severe fatigue (odds ratio, 13), and low serum albumin was the significant laboratory value predictor (odds ratio, 3.8). CONCLUSION: Disabling fatigue occurs with high frequency in hematologic malignancy, supporting a need to develop better methods of fatigue management. Better control of gastrointestinal and other symptoms may be of benefit. The mechanism and relationship between low albumin and severe fatigue needs to be investigated further, and longitudinal studies of the effects of treatment, host factors, and other symptoms are needed.