The Effect of Public Health Measures during the COVID-19 Pandemic on Smoking Dependence & Passive Smoking

Background: According to increasing concern about the COVID-19 pandemic and the risk of smoking this study was conducted to find the effect of health measures during the COVID-19 pandemic on smoking dependence & passive smoking. Methods: A cross-sectional study was conducted in September 2020, by using a valid and reliable questionnaire, the data were analyzed by using SPSS, version 20 software. Results: The study showed 16.9% of participants increased their nicotine use and 12.4% decreased their nicotine use. Despite no significant change in smoking dependence, we found that smokers who used to smoke more than 30 cigarettes per day before the quarantine increased by two folds. In addition, we found that smokers who awaken at night sometimes to have cigarettes before quarantine had increased markedly by 50% during quarantine. Furthermore, smokers who had an extreme urge to smoke over the week before the quarantine have elevated markedly during the quarantine from 31 smokers to 60. Also, over 35.2 % of surveyed individuals experienced a rise in smoking desire during the quarantine. Regarding passive smoking, the surveyed individuals reported a generally slight decline in exposure to secondhand smoking. However, the number of exposed individuals to smoking for more than 8 hours increased by 27%. Conclusion: During the lockdown, individuals smoked marginally more cigarettes compared to the periods before the lockdown with no significant change in smoking dependence. There was a slight decline in exposure to secondhand smoking. However, the number of exposed individuals to household smoking for more than 8 hours had been increased.

Nicotine delivery and relief of craving after consumption of European JUUL e-cigarettes prior and after pod modification

The emergence of e-cigarettes on the consumer market led to a tremendous rise in e-cigarette consumption among adolescents in the United States. The success of JUUL and other pod systems was linked to its high nicotine delivery capacity. In compliance with the European Tobacco Product directive, liquid nicotine contents in the European JUUL variants are limited to 20 mg/mL or below. A short time after launching the initial version in Europe, JUUL pods have been modified in terms of the wick material used. This modification has been demonstrated previously to lead to an elevated aerosol generation, consequently, to a larger amount of nicotine per puff generated. The present study was designed to assess whether the mentioned differences between the “initial” and “modified” JUUL versions may cause a significant difference during consumption, and how nicotine delivery compares with tobacco cigarettes. In this single-center three-arm study, nicotine pharmacokinetics and influence on urge to smoke/vape were compared for tobacco cigarettes, the “initial” version of the European JUUL, and the “modified” version of the European JUUL. Participants, 15 active smokers and 17 active e-cigarette users, were instructed to consume their study product according to a pre-directed puffing protocol. Venous blood was sampled for nicotine analysis to cover the acute phase and the first 30 min after starting. Nicotine delivery and the reduction of urge to smoke/vape upon usage of both European JUUL variants were lower in comparison to tobacco cigarettes. This suggests a lower addictive potential. Modification of the pod design did not result in significant differences at the first ten puffs, as confirmed by a vaping machine experiment. Apparently, the limitations by the initially used wick material only come into effect after longer usage time.

Perceived vulnerability to COVID-19, dispositional optimism and intention to adopt preventive health behaviour: an experiment with anti-smoking advertising

Purpose High dispositional optimism is often associated with people engaging in behaviour that has adverse effects on their health such as smoking. This study aims to investigate people’s intention to adopt preventive health behaviour by observing the effectiveness of anti-smoking ads during the ongoing coronavirus (COVID-19) pandemic. Design/methodology/approach Two studies have been carried out, first with a UK sample and second with the US sample. The studies examined the effectiveness of anti-smoking ad (appeal: high fear vs low fear), smoking behaviour elicited perception of vulnerability to COVID-19 and dispositional optimism on lowering people’s urge to smoke. Findings The study findings revealed a high fear appeal ad is more effective in lowering people’s urge to smoke. However, this association is significantly mediated by perception of vulnerability to COVID-19. Further, high dispositional optimism was found to moderate the effect of the anti-smoking ad on the perception of vulnerability to COVID-19, although a comparatively smaller effect was observed for the UK sample. Finally, high dispositional optimism significantly moderated the mediation of vulnerability to COVID-19 on lower urge to smoke only for the US sample. Originality/value The study highlights a need for a greater collaborative effort by the public, government, firms in the business of nicotine replacement solutions, socially responsible cigarette and tobacco manufacturing firms and health agencies that may lead to increased preventive health behaviour during the ongoing pandemic.

A study on the agents that reduces the nicotine induced nicotinic receptor density in wistar rats

The most important substance causing addiction towards cigarette is nicotine. Nicotine abstinence causes withdrawal symptoms in smokers. It is not just nicotine, along with it is the upregulation of nicotinic receptor density (NRD) that leads to addiction. All together makes nicotine deaddiction the most difficult aspect. Nicotine receptor density increases as long as the person is exposed to nicotine. When once the NRD is initiated by nicotine, later though you stop smoking, the increased nicotine receptors create an urge to smoke. Hence the person feels to smoke for satisfying the nicotine receptors. The smokers may attempt to quit smoking but the NRD will create an urge for nicotine again. One cannot completely quit smoking or cannot stop taking nicotine, until the NRD is reduced to normal. In our present study we have studied the effect of citric acid and tyrosine on decreasing nicotinic receptor density. We have induced the nicotinic receptor density to raise and studied the citric acid and tyrosine’s effect in maintaining the NRD closer to normal. The study concludes that citric acid and tyrosine have reduced the NRD significantly. This can control withdrawal symptoms and can stop craving for nicotine and finally can lead to cessation of smoking and from taking nicotine therapy.

Augmented Reality for Smoking Cessation: Development and Usability Study

Background The recent widespread availability of augmented reality via smartphone offers an opportunity to translate cue exposure therapy for smoking cessation from the laboratory to the real world. Despite significant reductions in the smoking rates in the last decade, approximately 13.7% of the adults in the United States continue to smoke. Smoking-related cue exposure has demonstrated promise as an adjuvant therapy in the laboratory, but practical limitations have prevented its success in the real world. Augmented reality technology presents an innovative approach to overcome these limitations. Objective The aim of this study was to develop a smartphone app that presents smoking-related augmented reality images for cue exposure. Smokers provided feedback on the images and reported on the perceived urge to smoke, qualities of reality/coexistence, and general feedback about quality and functioning. The feedback was used to refine the augmented reality images within the app. Methods In collaboration with an augmented reality design company, we developed 6 smoking-related images (cigarette, lighter, ashtray, lit cigarette in ashtray, etc) and 6 neutral images similar in size or complexity for comparison (pen, eraser, notebook, soda bottle with droplets, etc). Ten smokers completed a survey of demographic characteristics, smoking history and behavior, dependence on nicotine, motivation to quit smoking, and familiarity with augmented reality technology. Then, participants viewed each augmented reality image and provided ratings on 10-point Likert scales for urge to smoke and reality/coexistence of the image into the scene. Participants were also queried with open-ended questions regarding the features of the images. Results Of the 10 participants, 5 (50%) had experienced augmented reality prior to the laboratory visit, but only 4 of those 5 participants used augmented reality at least weekly. Although the sample was small (N=10), smokers reported significantly higher urge to smoke after viewing the smoking-related augmented reality images (median 4.58, SD 3.49) versus the neutral images (median 1.42, SD 3.01) (Z=–2.14, P=.03; d=0.70). The average reality and coexistence ratings of the images did not differ between smoking-related and neutral images (all P>.29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting). Conclusions All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed.

Testing augmented reality for Eliciting cue-Provoked Urges to smoke: toward moving cue-exposure into the real world

Background Cue exposure for extinguishing conditioned urges to smoking cues has been promising in the laboratory, but difficult to implement in natural environments. The recent availability of augmented reality (AR) via smartphone provides an opportunity to overcome this limitation. Testing the ability of AR to elicit cue-provoked urges to smoke (i.e., cue reactivity [CR]) is the first step to systemically testing the efficacy of AR for cue exposure therapy. Objectives To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues. Methods A 2 x 2 within-subject design comparing cue content (smoking vs. neutral) and presentation modality (AR vs. in vivo) on urge response. Seventeen smokers viewed six smoking-related and six neutral cues via AR smartphone app and also six smoking and six neutral in vivo cues. Participants rated their urge to smoke and reality/co-existence of the cue. Results Average urge to smoke was higher following smoking-related AR images (Median=7.50) than neutral images (Median=3.33) (Z=−3.44; P=.001; d=1.37). Similarly, average urge ratings for in vivo smoking-related cues (Median=8.12) were higher than for neutral cues (Median=2.12) (Z=-3.44; P=.001; d=1.64). Also, greater CR was observed for in vivo cues than to AR cues (Z=-2.67, P=.008; d=.36). AR cues were generally perceived as being realistic and well-integrated. Conclusions CR was demonstrated with very large effect sizes in response to AR smoking cues, although slightly smaller than with in vivo smoking cues. This satisfies the first criterion for the potential use of AR for exposure therapy.

Augmented Reality for Smoking Cessation: Development and Usability Study (Preprint)

BACKGROUND The recent widespread availability of augmented reality via smartphone offers an opportunity to translate cue exposure therapy for smoking cessation from the laboratory to the real world. Despite significant reductions in the smoking rates in the last decade, approximately 13.7% of the adults in the United States continue to smoke. Smoking-related cue exposure has demonstrated promise as an adjuvant therapy in the laboratory, but practical limitations have prevented its success in the real world. Augmented reality technology presents an innovative approach to overcome these limitations. OBJECTIVE The aim of this study was to develop a smartphone app that presents smoking-related augmented reality images for cue exposure. Smokers provided feedback on the images and reported on the perceived urge to smoke, qualities of reality/coexistence, and general feedback about quality and functioning. The feedback was used to refine the augmented reality images within the app. METHODS In collaboration with an augmented reality design company, we developed 6 smoking-related images (cigarette, lighter, ashtray, lit cigarette in ashtray, etc) and 6 neutral images similar in size or complexity for comparison (pen, eraser, notebook, soda bottle with droplets, etc). Ten smokers completed a survey of demographic characteristics, smoking history and behavior, dependence on nicotine, motivation to quit smoking, and familiarity with augmented reality technology. Then, participants viewed each augmented reality image and provided ratings on 10-point Likert scales for urge to smoke and reality/coexistence of the image into the scene. Participants were also queried with open-ended questions regarding the features of the images. RESULTS Of the 10 participants, 5 (50%) had experienced augmented reality prior to the laboratory visit, but only 4 of those 5 participants used augmented reality at least weekly. Although the sample was small (N=10), smokers reported significantly higher urge to smoke after viewing the smoking-related augmented reality images (median 4.58, SD 3.49) versus the neutral images (median 1.42, SD 3.01) (Z=–2.14, <i>P</i>=.03; <i>d</i>=0.70). The average reality and coexistence ratings of the images did not differ between smoking-related and neutral images (all <i>P</i>&gt;.29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting). CONCLUSIONS All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed.

Tobacco and electronic cigarette cues for smoking and vaping: an online experimental study

Objective This study examined whether exposure to smoking and vaping cues the urge to smoke or vape. It extends previous studies on first-generation cigalikes (visually similar to cigarettes) and second-generation devices (visually similar to pens) by including third-generation tank system devices (larger bulky units). In an online experiment, participants were randomly assigned to view one of four videos, which included smoking, vaping (cigalike or tank system), or neutral cues. The primary outcome was urge to smoke. Secondary outcomes were urge to vape, desire to smoke and vape, and intention to quit or remain abstinent from smoking.Results UK adults varying in smoking (current or former) and vaping (user or non-user) status (n=1120) completed the study: 184 (16%) failed study attention checks meaning 936 were included in the final analysis. Urges to smoke were similar across cue groups. Urges to vape were higher following exposure to vaping compared to neutral cues. There was no clear evidence of an interaction between cue group and smoking or vaping status. The lack of cueing effects on smoking urges is inconsistent with previous research, raising questions about the ability to assess craving in online settings.

Tobacco and electronic cigarette cues for smoking and vaping: an online experimental study

Objective This study examined whether exposure to smoking and vaping cues the urge to smoke or vape. It extends previous studies on first-generation cigalikes (visually similar to cigarettes) and second-generation devices (visually similar to pens) by including third-generation tank system devices (larger bulky units). In an online experiment, participants were randomly assigned to view one of four videos, which included smoking, vaping (cigalike or tank system), or neutral cues. The primary outcome was urge to smoke. Secondary outcomes were urge to vape, desire to smoke and vape, and intention to quit or remain abstinent from smoking.Results UK adults varying in smoking (current or former) and vaping (user or non-user) status (n=1120) completed the study: 184 (16%) failed study attention checks meaning 936 were included in the final analysis. Urges to smoke were similar across cue groups. Urges to vape were higher following exposure to vaping compared to neutral cues. There was no clear evidence of an interaction between cue group and smoking or vaping status. The lack of cueing effects on smoking urges is inconsistent with previous research, raising questions about the ability to assess craving in online settings.