Piloting a clinical laboratory method to evaluate the influence of potential modified risk tobacco products on smokers' quit-related motivation, choice, and behavior.

Research methods are needed that can predict whether the availability of potential modified risk tobacco products (MRTPs) may influence smokers' quit-related motivation, choice, and behavior. This pilot study assessed the primary outcomes of feasibility and adherence to address this need using an electronic cigarette (ECIG) as a model MRTP. Cigarette smokers were randomly assigned to use only their own brand of cigarettes (OB-only) or a second-generation ECIG (18 ng/ml nicotine) plus their OB cigarettes (ECIG+OB) ad libitum for four weeks. Participants logged products using a mobile device, collected used cigarette filters, and provided saliva samples every day for analysis of cotinine. They returned to the lab once per week to provide a breath sample and accept or decline a choice to quit all tobacco products (i.e., cigarettes and/or ECIGs). They also returned for a one-month follow-up visit. Of those participants randomized (n = 60), 56.7% completed the 4-week intervention and 40.0% completed the follow-up visit. The primary reason for withdrawal was poor adherence with mobile device use. Comparable numbers of participants in each group chose to make a quit attempt, although more OB-only participants chose to quit during the first two weeks and more ECIG+OB participants during the last two weeks. With protocol modifications to reduce participation burden, the current method might ultimately be used by regulators to predict how smokers' quit-related motivation, choice, and behavior are influenced by current and future MRTPs.

Protecting West Virginians from secondhand smoke through regulation at the local level.

West Virginia's communities have made substantial progress in protecting citizens from secondhand smoke exposure (SHS) through adoption of local regulations through county boards of health. The EPA and the U.S. Surgeon General have confirmed exposure to SHS causes serious disease and death in nonsmoking adults and children. The Centers for Disease Control and Prevention recommends enactment of federal, state and local policies to reduce exposure among nonsmokers and to reduce smoking prevalence. West Virginia's local boards of health have regulated smoking in workplaces and public spaces since 1992 and their authority to do so has been affirmed in state courts. Early smoke free regulations covered primarily non-hospitality workplaces. Mounting evidence of the public health risk of SHS exposure accelerated local efforts to prohibit smoking in all workplaces and public establishments. Every West Virginia county has adopted a smoke free regulation, though levels of protection vary. Forty-seven counties comprising 90.2% of the population, prohibit smoking in non-hospitality workplaces and restaurants. Twenty-six counties, (52% of the population), prohibit smoking in all workplaces, including restaurants, bars and gaming establishments. In the presence of strong smoking bans, the state has observed a decline in hospital admissions for acute coronary syndrome, a reduction in smoking prevalence among youth, and changes in beliefs and behaviors regarding secondhand smoke among adults. To build on West Virginia's success in this area of public health, increased state and community efforts are needed to strengthen and maintain existing smoke free policies.