Aims: To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD).
Design: Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008-19 public use data from the National Survey on Drug Use and Health, an annual, cross-sectional survey.
Setting: USA.
Objective: Individuals with substance use disorder (SUD) smoke cigarettes at a rate that is more than double the rate of the general population. Tobacco dependence treatment (TDT) is effective at reducing smoking, yet it is unclear whether expanding insurance coverage of these services increases TDT use among Medicaid beneficiaries with SUD.
Data Source: 2009-2013 Medicaid data in all 50 states and Washington DC.
Objectives: To conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012.
Methods: Systematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria.
Objective: To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment.
Study Design: We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination).
Findings: Compared with whites, blacks and Latinos had less initiation and adequacy of care.
Background: Human puffing topography promotes tobacco dependence by ensuring nicotine delivery, but the factors that determine puffing behavior are not well explained by existing models. Chemosensory cues generated by variations in cigarette product design features may serve as conditioned cues to allow the smoker to optimize nicotine delivery by adjusting puffing topography. Internal tobacco industry research documents were reviewed to understand the influence of sensory cues on puffing topography, and to examine how the tobacco industry has designed cigarettes, including modified risk tobacco products (MRTPs), to enhance puffing behavior to optimize nicotine delivery and product acceptability.
View Article and Find Full Text PDFInt J Environ Res Public Health
January 2011
Japan presents an excellent case-study of a nation with low female smoking rates and a negligible menthol market which changed after the cigarette market was opened to foreign competition. Internal tobacco industry documents demonstrate the intent of tobacco manufacturers to increase initiation among young females through development and marketing of menthol brands. Japanese menthol market share rose rapidly from less than 1% in 1980 to 20% in 2008.
View Article and Find Full Text PDFObjective: To determine the extent and implications of internal human electroencephalography (EEG) research conducted by the tobacco industry.
Methods: This study analysed internal documents that describe the results of human EEG studies conducted by tobacco manufacturers. Emphasis was placed on documents that pertain to the application of EEG to product evaluation efforts.
For more than a half century, tobacco manufacturers have conducted sophisticated internal research to evaluate nicotine delivery, and modified their products to ensure availability of nicotine to smokers and to optimize its effects. Tobacco has proven to be a particularly effective vehicle for nicotine, enabling manipulation of smoke chemistry and of mechanisms of delivery, and providing sensory cues that critically inform patterns of smoking behavior as well as reinforce the impact of nicotine. A range of physical and chemical product design changes provide precise control over the quantity, form, and perception of nicotine dose, and support compensatory behavior, which is driven by the smoker's addiction to nicotine.
View Article and Find Full Text PDFCancer Epidemiol Biomarkers Prev
November 2008
Objective: Potential Reduced Exposure tobacco Products (PREP) are intended to lower human exposure to toxic constituents of tobacco smoke, but rigorous clinical evaluations are required to assess such claims. The present study assessed human smoking behavior and short-term exposure to a new carbon-filtered PREP, Marlboro UltraSmooth (MUS). Two MUS prototypes with filter carbon loads of 120 and 180 mg were compared with low and ultralow-yield conventional cigarettes.
View Article and Find Full Text PDFObjectives: We examined whether tobacco manufacturers manipulate the menthol content of cigarettes in an effort to target adolescents and young adults.
Methods: We analyzed data from tobacco industry documents describing menthol product development, results of laboratory testing of US menthol brands, market research reports, and the 2006 National Survey on Drug Use and Health.
Results: The tobacco industry attracted new smokers by promoting cigarettes with lower menthol content, which were popular with adolescents and young adults, and provided cigarettes with higher menthol content to long-term smokers.
The use of menthol in cigarettes is actively promoted by the tobacco industry for its perceived sensory benefits, and smokers of menthol cigarettes commonly differ from nonmenthol smokers in markers of smoking behavior and addiction. In this study, we analyzed internal tobacco industry documents to describe the relationships between sensory perception and the attitudes, preferences, and patterns of cigarette use among menthol smokers. Two unique types of menthol smoker emerged from this analysis: those who cannot tolerate the harshness and irritation associated with smoking nonmenthol cigarettes, and those who seek out the specific menthol flavor and associated physical sensation.
View Article and Find Full Text PDFOver the past half-century of cigarette design, tobacco manufacturers have prioritized efficiency of delivery alongside ease of inhalation and use. As a result, the modern cigarette is uniquely effective at facilitating the absorption of nicotine as well as carcinogens and other toxins. The present study draws on internal tobacco company documents to assess industry consideration of the role of smoke particle size as a potentially controllable influence over inhalation patterns and lung exposure.
View Article and Find Full Text PDFPotential reduced exposure products (PREPs) purport to lower toxicant emissions, but without clinical and long-term health outcome data, claims for reduced harm status of PREPs depend heavily on standard machine yield smoke constituent data. Two prototypes of the new carbon-filtered PREP Marlboro UltraSmooth (MUS) were investigated using both standard (FTC/ISO) and intensive (Health Canada) machine methods to measure gas/vapor- and particulate-phase smoke constituents. Basic physical design characteristics that may influence smoke constituent yields, such as ventilation, pressure drop (resistance to draw), quantity of tobacco, and quantity and type of carbon, were measured.
View Article and Find Full Text PDFEvidence has shown that factors other than the central pharmacological effects of nicotine are important in promoting smoking behavior. One such non-nicotine effect includes sensory stimulation, which may promote smoking by developing learned associations with nicotine's rewarding effects, or by constituting a rewarding experience independent of nicotine. The present study used internal tobacco industry documents to examine industry efforts to understand and manipulate stimulation of the sensory nerves by tobacco smoke, and the influence of sensory stimulation on smoker behavior.
View Article and Find Full Text PDFObjectives: To determine whether nicotine yields in the smoke of cigarettes would show an overall increase over time or an increasing trend limited to any particular market category (eg, full flavour vs light, medium (mild) or ultralight; mentholated vs non-mentholated), manufacturer, or brand family or brand style, and whether nicotine yields in smoke would be associated with measurable trends in cigarette design.
Methods: Machine-based measures of nicotine yield in smoke and measures of cigarette design features related to nicotine delivery (ventilation, nicotine content in the tobacco rod and number of puffs), as well as market category descriptors, were obtained from annual reports filed with the Massachusetts Department of Public by tobacco manufacturers for 1997-2005. Trends in nicotine yield and its relationship with design features and market parameters were analysed with multilevel mixed-effects regression modelling procedures.
Aims: To examine tobacco industry research on smoking-related sensory effects, including differences in sensory perception across smoker groups, and to determine whether this research informed targeted product development and impacted the development of commercial tobacco products.
Design: We searched previously secret internal tobacco industry documents available online through document databases housed at Tobacco Documents Online, the British American Tobacco Document Archive and the Legacy Tobacco Documents Library. We identified relevant documents using a snowball sampling method to first search the databases using an initial set of key words and to then establish further search terms.
Objective: To identify patterns in trial testimony that may reflect on the intentions or expectations of tobacco manufacturers with regard to the introduction of potential reduced exposure products (PREPs).
Design: Research was conducted using the Deposition and Trial Testimony Archive (DATTA) collection of trial testimony and depositions housed online at Tobacco Documents Online (www.tobaccodocuments.
Tobacco manufacturers have recently introduced a proliferation of exotic brands featuring candylike flavors. We reviewed internal tobacco industry documents and patents to assess the role of flavored cigarettes in the targeting of young smokers. This research revealed the development of flavor delivery technologies hidden from consumers and public health professionals, including the use of a plastic pellet placed in the cigarette filter.
View Article and Find Full Text PDFMore than 25% of cigarettes sold in the United States are branded as mentholated, and these cigarettes are smoked disproportionately among populations with disparate tobacco-related health outcomes. This study is the first (independent of the tobacco industry) to report menthol for 48 popular commercially available mentholated cigarette sub-brands. The dependent variable "menthol per cigarette" was obtained by gas chromatography-mass spectrometer assay, whereas average per-cigarette milligram weight of tobacco filler ("tobacco per cigarette") was determined gravimetrically.
View Article and Find Full Text PDFAims: To examine internal tobacco industry research on female smoking patterns and product preferences, and how this research has informed the design of female-targeted cigarettes and impacted smoking behavior among this target population.
Design: Research was conducted through a systematic web-based search of previously secret industry documents made publicly available through the 1998 Master Settlement Agreement.
Findings: This study provides evidence that the tobacco industry has conducted extensive research on female smoking patterns, needs and product preferences, and has intentionally modified product design for promotion of cigarette smoking among women.
The recent availability of internal tobacco industry documents provides a significant resource for evaluating industry understanding of the pharmacological, psychosocial, and behavioral mechanisms underlying tobacco dependence. In this study, we catalog the range of efforts undertaken by tobacco manufacturers seeking knowledge of these mechanisms. Some areas of industry research, such as cellular and molecular studies of nicotine and its effects, are widely available in the open literature.
View Article and Find Full Text PDFAims: To identify whether the tobacco industry has targeted cigarette product design towards individuals with varying psychological/psychosocial needs.
Design: Internal industry documents were identified through searches of an online archival document research tool database using relevancy criteria of consumer segmentation and needs assessment.
Findings: The industry segmented consumer markets based on psychological needs (stress relief, behavioral arousal, performance enhancement, obesity reduction) and psychosocial needs (social acceptance, personal image).