Perceived Truthfulness of Reduced Lung Cancer Risk Advertising Claims Influences Consumers' Intention to try and to Purchase Snus.

The objective of the current study was to evaluate the impact of a reduced risk claim about lung cancer, presented in various formats, on smokers' and non-smokers' interest in trying Camel Snus and intention to purchase Camel Snus. We varied claim formats by varying advertising messages for Camel Snus in 4 ways (1) text only; (2) bar chart; (3) text/testimonial; and (4) bar chart/testimonial. 3001 participants were recruited from a web-based consumer specialty panel via an email invitation. In 2015, a second study was conducted, using similar methods, where 3001 additional participants were recruited. Overall, controlling for other factors, the presence of an MRTP claim was not significantly related to interest in trying snus [X2 (4) = 8.567, P = .073], or purchase intentions [X2 (4) = 1.148, P = .887]. Relative to a control ad where no explicit health risk claim was made, the Graphic + testimonial [OR = 1.29] or Text only [OR = 1.41] claims did significantly increase interest in trying Camel Snus. However, the adverting format did not impact interest in purchasing Camel Snus. While current smokeless tobacco users (95%) and smokers (59%) expressed interest in trying Camel Snus, non-tobacco users (7%) showed low interest in trying or purchasing Camel Snus (P < .001). Interest in trying Camel Snus was stronger in younger smokers compared to older smokers. Among current smokers, worry about lung cancer (the key focus of the reduced risk claim) was not associated with interest in trying Camel Snus or with purchase intention [OR = .91, 95% CI: .72, 1.14] or intention to purchase snus [OR = 1.07, 95% CI: .86, 1.32]. Future research should evaluate how claim and messaging formats influence perceived truthfulness and whether this effect differs among sub-groups of consumers, such as adolescents, those with tobacco-related disease, and former smokers. It will also be helpful to understand whether perceptions of ad truthfulness result in changes in product use patterns over time. In sum, giving people truthful, credible information about relative product risks, such as through authorized MRTP claims, is important, but such information is likely insufficient to get smokers to switch.

Exploring the psychometric properties of a tripartite model of risk perception (TRIRISK) in a general U.S. population sample.

Objective: Risk perceptions are key constructs in some theories of health behavior. A tripartite model of risk perception, the TRIRISK model, was developed to assess deliberative, affective, and experiential components of risk perception. The current paper attempts to replicate the factor structure of the TRIRISK measure for cancer and extend the structure to respiratory illness. Methods and Measures: Participants 18 or older were recruited using an address-based sample in New York State to participate in a Web-based survey. We employed the TRIRISK questionnaire with respect to cancer and respiratory illness. Confirmatory Factor Analyses were conducted in Mplus to validate the TRIRISK model in our sample. TRIRISK model fit across demographic and behavioral groups was tested using multiple-group models. Results: Of the 704 people included in the analysis, the mean age of participants was 46.9, the majority reported being female (58.5%), and most were White (81.7%). For cancer and respiratory illness, items loaded on the respective constructs as expected. Overall, the TRIRISK model framework fits well across differing subgroups, suggesting that this is a valid model of risk perception to use in a general population sample. Conclusion: These results provide further evidence that the TRIRISK model is a good model to use for risk perceptions in tobacco control research. The TRIRISK model can be used to communicate risk to encourage positive health behaviors among most sociodemographic groups.

Stigmatizing attitudes about lung cancer among individuals who smoke cigarettes.

INTRODUCTION: Many individuals with lung cancer report experiencing stigma associated with their diagnosis. The objective of this study was to explore how different factors, including smoking status, lung cancer concern, and thoughts on smoking behaviors, were associated with increased stigmatizing attitudes towards people with lung cancer. METHODS: In 2015, a Web-based survey was completed by people who currently smoked. Participants (n=1419) aged 18-65 years were randomly assigned to one of three scenarios in which the character who was diagnosed with lung cancer currently, formerly, or never smoked cigarettes. Two aspects of stigma were assessed: blaming the victim and negative attributions about people with lung cancer. RESULTS: For blaming the victim and negative attributions, lung cancer stigma differed by scenario (described smoking status, p<0.0001), when adjusting for race, sex, education level, age, income, nicotine dependence, quit intentions, and quit attempts. Higher levels of lung cancer concern were associated with greater blaming the victim (p=0.001), when adjusting for scenario and other significant correlates. CONCLUSIONS: The findings suggest that stigmatizing attitudes from people who smoke towards people with lung cancer may be reflective of how they feel about their own smoking habits. We suggest that specific messaging guidelines that avoid an over emphasis on an individual's smoking status, cessation interventions that address stigma, and screening messages tailored to smoking status, may help to lessen the burden of lung cancer stigma.

Modes of delivery in concurrent nicotine and cannabis use ("co-use") among youth: Findings from the International Tobacco Control (ITC) Survey.

BACKGROUND: Cannabis use is more common among nicotine users than non-users. This study characterized concurrent use of nicotine and cannabis ("co-use") among 12,064 youth aged 16-19 years residing in Canada, the United States, and England in 2017. Methods: Data were from the ITC Youth Tobacco & Vaping Survey (Wave 1). Seven modes of cannabis delivery (MOD) were characterized by country of residence and past 30-day use of combusted tobacco and electronic cigarettes. Weighted multivariable regression models were fitted to assess the correlates of co-use and each cannabis MOD. Results: Seventy percent of cannabis users reported nicotine use. Co-users exhibited behavioral and demographic differences compared to exclusive users of either substance. "Smoking cannabis without tobacco" was the most popular form of use (78%). Use of nicotine-containing e-cigarettes was associated with "using an e-cigarette to vape cannabis oil/liquid" (aOR: 4.96, 95%CI: 2.23-11.06). Combustible tobacco use was associated with "smoking cannabis with tobacco in a joint/blunt" (aOR: 2.93, 95%CI: 1.89-4.56). Country-level differences were detected. Conclusions: Nicotine use is substantial among cannabis users, and associations exist between modes of delivery for both drugs. Results underscore the importance of studying cannabis and nicotine use concurrently, and the need to address the use of both substances in developing interventions for youth users.

Characteristics of nicotine vaping products used by participants in the 2016 ITC Four Country Smoking and Vaping Survey.

BACKGROUND AND AIMS: The regulatory environment for nicotine vaping products (NVPs) varies widely across countries and this will probably affect the devices used, nicotine content and usage, and hence the ability of NVPs to substitute for cigarettes. We aimed to describe the types of NVPs used by current vapers in four countries with varying regulatory and enforcement approaches toward the marketing and sale of NVPs. METHODS: Data are from wave 1 (July-November 2016) of the ITC Four Country Smoking and Vaping Survey (4CV1), conducted among a cohort of current and former smokers, and current NVP users (n = 5147 adults; ≥ 18 years) in Australia (AU), Canada (CA), England (EN) and the United States (US) reporting either current daily, weekly or occasional NVP use. Devices were described by type, brand, voltage variability and refill capacity. Refill solutions were described by flavour and nicotine content. Descriptive statistics and bivariate analyses were conducted on the overall sample and stratified by country. A multinomial logistic regression examined factors associated with device preference across the whole sample. RESULTS: The types of NVPs used differed by pattern of use and country. Exclusive, daily vapers were more likely to use refillable pen-shaped devices [odds ratio (OR) = 10.0] or refillable box-shaped devices (OR = 5.4) than disposable cigalike devices, when compared with other (non-daily/dual) users. Nearly all respondents reported using flavoured NVPs, fruit (28.3%) being the most common flavour. Refillable devices were the most popular: refillable box-shaped devices were more commonly reported by vapers in AU (36.8%) and US (31.4%), whereas in EN (47.4%) and CA (29.7%), vapers more often reported using refillable pen-style devices. Most users also reported that their products contained nicotine, even in CA (87.8%) and AU (91.2%), where vaping products containing nicotine were technically illegal. CONCLUSIONS: In Australia, Canada, England and the United States in 2016, refillable nicotine vaping products were the most common type of nicotine vaping products used by daily vapers. Most daily vapers reported using flavoured e-liquids/refills (with variance across countries) and most reported using products that contain nicotine, even where vaping products with nicotine were banned.

Situational and Demographic Factors in the Sudden Growth of Pall Mall, 2002-2014.

Objective: Pall Mall gained significant brand share in the cigarette market between 2002 and 2013. We sought to determine whether demographic shifts occurred among the participants reporting Pall Mall as their usual brand during this time span. Method: We examined National Survey of Drug Use and Health (NSDUH) data from 2002-2014. Demographic characteristics included age, education, ethnicity, income, and cigarette use (cigarettes per day, daily/non-daily smoking, and nicotine dependence). We also examined RJ Reynolds investor reports and shareholder documents to determine the impact of tobacco marketing on the growth of Pall Mall. Results: Over 2002-2014, Pall Mall has gained among smokers 26 to 34 years of age. More Pall Mall smokers in 2014 report higher incomes (over $75000), and also report lower scores on measures of cigarette dependence, compared to 2002. Pall Mall smokers over time seem to share characteristics of premium cigarette brands smokers. Conclusion: The profile of the typical Pall Mall smoker has changed as the brand has gained market share. An association exists between brand positioning and economic forces, which has contributed to an increase in the market share for Pall Mall. Implications: It is well known that cigarette marketing drives the sale of tobacco products. The growth in the market share of Pall Mall serves as an excellent example to demonstrate how economic uncertainty paired with brand positioning and advertising worked together to serve as a catalyst for the rapid growth observed for this brand. This paper also looked at various demographic changes that occurred among Pall Mall smokers over a 12 year period and compared them to smokers of all other cigarette brands. The results of this analysis demonstrate the importance of monitoring trends over time among cigarette smokers.

Nicotine Metabolite Ratio (NMR) Prospectively Predicts Smoking Relapse: Longitudinal Findings From ITC Surveys in Five Countries.

INTRODUCTION: The ratio of trans 3'-hydroxycotinine (3HC) to cotinine (nicotine metabolite ratio [NMR]) is a biomarker of the rate of nicotine metabolism, with higher NMR indicating faster metabolism. Higher NMR has been found to be associated with higher daily cigarette consumption and less success stopping smoking in cessation trials. This study examines differences in NMR among population-based samples of smokers in the five countries and explores the relationship between NMR and smoking abstinence. METHODS: Participants (N = 874) provided saliva samples during International Tobacco Control (ITC) surveys in the United States, United Kingdom, Mauritius, Mexico, and Thailand conducted in 2010/2011 with follow-up surveys in 2012/2013. When all samples were received, they were sent to a common laboratory for analysis using liquid chromatography and tandem mass spectroscopy. RESULTS: There was significant variation in NMR across countries (F = 15.49, p < .001). Those who reported smoking at follow-up had a mean NMR of 0.32, compared to a mean NMR of 0.42 in participants who reported that they had stopped (F = 8.93; p = .003). Higher mean NMR values were also associated with longer quit duration (p = .007). There was no substantial difference in NMR between current smokers who made a failed quit attempt and those who made no attempt-both had significantly lower NMR compared to those who quit and remained abstinent. Smokers with a higher NMR were more likely to report that they stopped smoking compared to those with a lower NMR (odds ratio = 2.67; 95% confidence interval: 1.25 to 5.68). CONCLUSIONS: These results suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking. IMPLICATIONS: Results of this study suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking.

Trends in market share of leading cigarette brands in the USA: national survey on drug use and health 2002-2013.

OBJECTIVES: The main objective of this study is to examine trends in market share for leading cigarette brands, both before (2002-2008) and after (2009-2013) Food and Drug Administration (FDA) regulation of tobacco products.Design Data come from the annual National Survey on Drug Use and Health from 2002 through 2013. Descriptive statistics, cross tabulations, and logistic regression were employed. Data were weighted to the US population and adjusted for cigarette consumption. Our analysis is restricted to 164,343 current cigarette smokers who were at least 12 years of age or older, had smoked at least one cigarette in the 30 days prior to the survey, and reported a usual cigarette brand at the time of the survey. RESULTS: Over 12 years, 14 brands comprised over 77% of the cigarette market. Marlboro consistently held over 38% of the market. Newport held the second highest market share, and increased from 7.2% in 2002 to 10.9% by 2013. Market share of Pall Mall grew by over 400% (1.7% in 2002 vs 8.9% in 2013), likely aided by the 2009 Federal excise tax increase. No clear associations of changes in market share with the implementation of FDA's regulatory authority over tobacco in 2009 were noted. CONCLUSIONS: Tracking market share trends offers clues about brand marketing changing preferences of consumers. Rapidly growing cigarette brands should be monitored to determine if specific marketing practices or design changes are drivers, as these could represent public health concerns. Monitoring trends in cigarette market share could inform regulatory decision-making efforts related to marketing and advertising.

Differences in cigarette design and metal content across five countries: results from the International Tobacco Control (ITC) Project.

OBJECTIVES: The current study examines physical cigarette design characteristics and tobacco metal content of cigarettes obtained from 5 countries to determine how these properties vary for cigarette brands, both within and across countries with different dominant manufacturers. METHODS: Cigarette packs were collected from International Tobacco Control Policy Evaluation Survey (ITC) participants in the U.S., the U.K., Mauritius, Mexico, and Thailand. Cigarettes were assessed for physical and design properties (eg, ventilation, pressure drop, rod density, weight) by published methods, and for metal content (As, Cd, Ni, Pb) by X-ray fluorescence spectrometry. RESULTS: Significant differences in cigarette design and toxic metal concentrations were observed between countries and between manufacturers within countries. Filter ventilation, which is strongly predictive of machine-measured tar and nicotine levels, varied most widely across countries. Ni and Cd were highest in Thailand (2.23ug/g and 1.64ug/g, respectively); As was highest in Mexico (0.29ug/g) and Pb was highest in the U.K. (0.43 ug/g). CONCLUSIONS: Parties to the FCTC should consider the adoption of uniform product standards related to cigarette design, emissions, and tobacco content that would reduce population health risks.

Sex differences among college students in awareness of the human papillomavirus vaccine and vaccine options.

OBJECTIVES: To explore awareness of human papillomavirus (HPV) and use of HPV vaccines (Gardasil and Cervarix) by college students. PARTICIPANTS: The sample was composed of 817 undergraduates at 2 northeastern US universities; they participated between February and May 2010. METHODS: Students were provided with a link to an anonymous, self-administered, Web-based survey comprised of 76 questions. The survey included questions about health behaviors, awareness, and knowledge of HPV and the 2 HPV vaccines, and vaccine uptake. RESULTS: Results indicate high levels of awareness of HPV as well as marked sex differences related to vaccine awareness and uptake. Both sexes are largely unaware of Cervarix and the differences between Cervarix and Gardasil. CONCLUSION: The study affirms the importance of a clinician's recommendation for HPV vaccination. Public health messaging should become more inclusive of adolescent and young adult males. College students' awareness of HPV vaccine options mirrors Gardasil's market dominance in the United States.

Patterns and correlates of polytobacco use in the United States over a decade: NSDUH 2002-2011.

BACKGROUND: Few studies have examined the patterns and correlates of polytobacco use among a large, nationally representative population over an extended period of time. METHODS: This study examined 10years of data from the National Survey on Drug Use and Health (NSDUH) to establish time trends and correlates for exclusive and mixed use of cigarettes, smokeless tobacco (SLT), cigars, and pipes. RESULTS: Results show that rates of polytobacco use were essentially unchanged from 2002 to 2011 (8.7% to 7.4%), though some product combinations, including cigarettes and SLT, cigars and SLT, and use of more than two products have increased. In tobacco users under age 26, the proportion of polytobacco use increased, even as overall tobacco use declined. The factors associated with polytobacco use among tobacco users included sex, income, education, risk taking/seeking behaviors, and outward indicators of 'risk-liability'. CONCLUSIONS: Findings provide a snapshot of trends of single and polytobacco product use as well as trends in combinations of product use. Longitudinal studies are needed to examine the sequence of individual patterns of tobacco product use and to identify whether polytobacco use results in greater nicotine dependence, increased exposure to harmful and potentially harmful constituents and/or greater risk of tobacco related disease.

A novel approach to estimating the prevalence of untaxed cigarettes in the USA: findings from the 2009 and 2010 international tobacco control surveys.

BACKGROUND: Increases in tobacco taxes are effective in reducing tobacco consumption, but because of the addictive nature of cigarettes, smokers often seek out less expensive sources of cigarettes. The objective of this study is to estimate the prevalence of cigarette packs that are untaxed by the state in which the participant resides in a sample of US smokers at two time points. METHODS: Data for this study were taken from the 2009 and 2010 waves of the International Tobacco Control United States Survey. Members of this nationally representative cohort of smokers were invited to send us an unopened pack of their usual brand of cigarettes. RESULTS: In 2009, 318 packs were received from 401 eligible participants (79%). In 2010, 366 packs were received from 491 eligible participants (75%). In total, 20% of the packs in 2009 and 21% in 2010 were classified as untaxed by the participant's state of residence. The prevalence of untaxed cigarettes was higher in states with higher-excise taxes. Smokers who do not have a plan to quit were significantly more likely to have sent back a pack that was classified as untaxed by the participant's state of residence. CONCLUSIONS: One in five packs were untaxed with rates higher in states with higher-excise taxes. It is unclear whether these estimates differ from the actual prevalence of cigarettes that are untaxed by a smoker's state of residence. Harmonisation of excise tax rates across all 50 US states might be one method of reducing or eliminating the incentive to avoid or evade these taxes.

Relationship of cigarette-related perceptions to cigarette design features: findings from the 2009 ITC U.S. Survey.

INTRODUCTION: Many governments around the world have banned the use of misleading cigarette descriptors such as "light" and "mild" because the cigarettes so labeled were found not to reduce smokers' health risks. However, underlying cigarette design features, which are retained in many brands, likely contribute to ongoing belief that these cigarettes are less harmful by producing perceptions of lightness/smoothness through lighter taste and reduced harshness and irritation. METHODS: Participants (N = 320) were recruited from the International Tobacco Control U.S. Survey conducted in 2009 and 2010, when they answered questions about smoking behavior, attitudes and beliefs about tobacco products, and key mediators and moderators of tobacco use behaviors. Participants also submitted an unopened pack of their usual brand of cigarettes for analysis using established methods. RESULTS: Own-brand filter ventilation level (M 29%, range 0%-71%) was consistently associated with perceived lightness (p < .001) and smoothness (p = .005) of own brand. Those whose brand bore a light/mild label (55% of participants) were more likely to report their cigarettes were lighter [71.9% vs. 41.9%; χ(2)(2) = 38.1, p < .001] and smoother than other brands [75.5% vs. 68.7%; χ(2)(2) = 7.8, p = .020]. CONCLUSION: Product design features, particularly filter ventilation, influence smokers' beliefs about product attributes such as lightness and smoothness, independent of package labels. Regulation of cigarette design features such as filter ventilation should be considered as a complement to removal of misleading terms in order to reduce smokers' misperceptions regarding product risks.

Effectiveness of stop-smoking medications: findings from the International Tobacco Control (ITC) Four Country Survey.

AIM: To evaluate the population effectiveness of stop-smoking medications while accounting for potential recall bias by controlling for quit attempt recency. DESIGN: Prospective cohort survey. SETTING: United Kingdom, Canada, Australia and the United States. PARTICIPANTS: A total of 7436 adult smokers (18+ years) selected via random digit dialling and interviewed as part of the International Tobacco Control Four Country Survey (ITC-4) between 2002 and 2009. Primary analyses utilized the subset of respondents who participated in 2006 or later (n = 2550). MEASUREMENTS: Continuous abstinence from smoking for 1 month/6 months. FINDINGS: Among participants who recalled making a quit attempt within 1 month of interview, those who reported using varenicline, bupropion or nicotine patch were more likely to maintain 6-month continuous abstinence from smoking compared to those who attempted to quit without medication [adjusted odds ratio (OR) 5.84, 95% confidence interval (CI) (2.12-16.12), 3.94 (0.87-17.80), 4.09 (1.72-9.74), respectively]; there were no clear effects for oral NRT use. Those who did not use any medication when attempting to quit tended to be younger, to be racial/ethnic minorities, to have lower incomes and to believe that medications do not make quitting easier. CONCLUSIONS: Consistent with evidence from randomized controlled trials, smokers in the United Kingdom, Canada, Australia and the United States are more likely to succeed in quit attempts if they use varenicline, bupropion or nicotine patch. Previous population studies that failed to find an effect failed to control adequately for important sources of bias.

Smokers' reactions to FDA regulation of tobacco products: findings from the 2009 ITC United States survey.

BACKGROUND: On June 22, 2009, the US FDA was granted the authority to regulate tobacco products through the Family Smoking Prevention and Tobacco Control Act (FSPTCA). The intent is to improve public health through regulations on tobacco product marketing and tobacco products themselves. This manuscript reports baseline data on smokers' attitudes and beliefs on specific issues relevant to the FSPTCA. METHOD: Between November 2009 and January 2010, a telephone survey among a nationally representative sample of n = 678 smokers in the US was performed as part of the International Tobacco Control (ITC) United States Survey. Participants answered a battery of questions on their attitudes and beliefs about aspects of the FSPTCA. RESULTS: Most smokers were unaware of the new FDA tobacco regulations. Smokers indicated support for banning cigarette promotion and nearly a quarter supported requiring tobacco companies to sell cigarettes in plain packaging. Seventy two percent of smokers supported reducing nicotine levels to make cigarettes less addictive if nicotine was made easily available in non-cigarette form. CONCLUSION: Most smokers were limited in their understanding of efforts to regulate tobacco products in general. Smokers were supportive of efforts to better inform the public about health risks, restrict advertising, and make tobacco products less addictive.

What do cigarette pack colors communicate to smokers in the U.S.?

BACKGROUND: New legislation in the U.S. prohibits tobacco companies from labeling cigarette packs with terms such as light, mild, or low after June 2010. However, experience from countries that have removed these descriptors suggests that different terms, colors, or numbers communicating the same messages may replace them. PURPOSE: The main purpose of this study was to examine how cigarette pack colors are perceived by smokers to correspond to different descriptive terms. METHODS: Newspaper advertisements and CraigsList.org postings directed interested current smokers to a survey website. Eligible participants were shown an array of six cigarette packages (altered to remove all descriptive terms) and asked to link package images with their corresponding descriptive terms. Participants were then asked to identify which pack in the array they would choose if they were concerned with health, tar, nicotine, image, and taste. RESULTS: A total of 193 participants completed the survey from February to March 2008 (data were analyzed from May 2008 through November 2010). Participants were more accurate in matching descriptors to pack images for Marlboro brand cigarettes than for unfamiliar Peter Jackson brand (sold in Australia). Smokers overwhelmingly chose the "whitest" pack if they were concerned about health, tar, and nicotine. CONCLUSIONS: Smokers in the U.S. associate brand descriptors with colors. Further, white packaging appears to most influence perceptions of safety. Removal of descriptor terms but not the associated colors will be insufficient in eliminating misperceptions about the risks from smoking communicated to smokers through packaging.

Usage patterns of stop smoking medications in Australia, Canada, the United Kingdom, and the United States: findings from the 2006-2008 International Tobacco Control (ITC) Four Country Survey.

Varenicline is a new prescription stop smoking medication (SSM) that has been available in the United States since August 1, 2006, in the United Kingdom and other European Union countries since December 5, 2006, in Canada since April 12, 2007, and in Australia since January 1, 2008. There are few population-based studies that have examined use rates of varenicline and other stop smoking medications. We report data from the ITC Four Country survey conducted with smokers in the US, UK, Canada, and Australia who reported an attempt to quit smoking in past year in the 2006 survey (n = 4,022 participants), 2007 (n = 3,790 participants), and 2008 surveys (n = 2,735 participants) Respondents reported use of various stop smoking medications to quit smoking at each survey wave, along with demographic and smoker characteristics. The self-reported use of any stop smoking medication has increased significantly over the 3 year period in all 4 countries, with the sharpest increase occurring in the United States. Varenicline has become the second most used stop smoking medication, behind NRT, in all 4 countries since being introduced. Between 2006 and 2008, varenicline use rates increased from 0.4% to 21.7% in the US, 0.0% to 14.8% in Canada, 0.0% to 14.5% in Australia, and 0.0% to 4.4% in the UK. In contrast, use of NRT and bupropion remained constant in each country. Males and non-whites were significantly less likely to report using any SSM, while more educated smokers were significantly more likely to use any SSM, including varenicline. Our findings suggest that the introduction of varenicline led to an increase in the number of smokers who used evidence-based treatment during their quit attempts, rather than simply gaining market share at the expense of other medications. From a public health perspective, messages regarding increased success rates among medication users and the relative safety of stop smoking medications should be disseminated widely so as to reach all smokers of all socioeconomic classifications equally.

The impact of reduced ignition propensity cigarette regulation on smoking behaviour in a cohort of Ontario smokers.

This study examined the degree to which legislation intended to reduce the incidence of cigarette-caused fires influenced the behaviours of a cohort of smokers in Ontario. A random digit dialled telephone survey of adult smokers residing in Ontario was conducted in 2005, ending 1 month prior to the reduced ignition propensity (RIP) regulation's implementation date. A follow-up survey was conducted one year later. Of the baseline participants, 73.0% (n=435) completed the follow-up survey. The frequency of fire risk behaviours was similar across both surveys. At baseline, only 3.7% of smokers interviewed reported that their cigarettes went out on their own 'often' while smoking. Following the implementation of the reduced ignition propensity legislation, this increased significantly to 14.7%. Results suggest that the proportion of Ontario smokers who reported engaging in behaviour such as leaving a cigarette burning unattended and smoking in bed actually declined, although these declines were not statistically significant across all measures of fire risk.

Does the number of free nicotine patches given to smokers calling a quitline influence quit rates: results from a quasi-experimental study.

BACKGROUND: The offer of free nicotine replacement therapy (NRT) can be a cost-effective marketing strategy to induce smokers to call a telephone quitline for quitting assistance. However, the most cost-effective supply of free NRT to provide to smokers who call a quitline remains unknown. This study tests the hypothesis that smokers who call a telephone quitline and are given more free nicotine patches would report higher quit rates upon follow-up 12 months later. METHODS: A quasi-experimental design was used to assess nicotine patch usage patterns and quit rates among five groups of smokers who called the New York State Smokers' Quitline (NYSSQL) between April 2003 and May 2006 and were mailed 2-, 4-, 6- or 8-week supplies of free nicotine patches. The study population included 2,442 adult (aged 18 years or older) current daily smokers of 10 or more cigarettes per day, who were willing to make a quit attempt, and reported no contraindications for using the nicotine patch. Outcome variables assessed included the percentage of smokers who reported that they had not smoked for at least 7-days at the time of a 12 months telephone follow-up survey, sustained quitting, delayed quitting and nicotine patch use. RESULTS: Quit rates measured at 12 months were higher for smokers in the groups who received either 2, 6, or 8 weeks of free patches. The lowest quit rate was observed among the group of Medicaid/uninsured smokers who were eligible to receive up to six weeks of free patches. The quit rate for the 4-week supply group did not differ significantly from the 6-week or 8-week groups. These patterns remained similar in an intent-to-treat analysis of 12-month quit rates and in an analysis of sustained quitting. CONCLUSION: No clear cut dose response relationship was observed between the number of free nicotine patches sent to smokers and smoking outcomes. Baseline differences in the characteristics of the groups compared could account for the null findings, and a more definitive randomized trial is warranted.