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SCTC June 2016 Digest (archived)




June 22, 2016


Dear NCI SCTC Research Initiative partners,


Welcome to the National Cancer Institute State and Community Tobacco Control (SCTC) Research Initiative June 2016 digest.


As a reminder, the purpose of this digest is to inform key tobacco control partners such as yourself of our work so that you can in turn share the information relevant to your constituents through your normal means of communication. If you see any released publications or products that could be useful for your constituents, feel free to share them in your newsletters. Additionally, if you see any upcoming publications or briefs with which you would like to coordinate program activities or news releases, do not hesitate to get in touch with us at the Coordinating Center or the listed authors and principal investigators.


We welcome feedback on ways we can improve the format, content, and delivery of this digest to make it easier to use. Please send any feedback to


Thank for your support of the NCI SCTC Research Initiative.




The State and Community Tobacco Control Research Initiative Coordinating Center


PI: Matthew C. Farrelly, PhD

Co-PIs: Carol Schmitt, PhD, and Todd Rogers, PhD


New Publications

Cummins, S., Leischow, S., Bailey, L., Bush, T., Wassum, K., Copeland, L., Zhu, S. H. (2016). Knowledge and beliefs about electronic cigarettes among quitline cessation staff.Addiction Behavior, 60, 78-83.



This study assesses how quitline counselors perceive e-cigarettes and what type of feedback they provide to callers when asked about the products. Researchers conducted an online cross-sectional survey in 2014 with 418 quitline counselors in the United States and Canada. The survey measured counselors’ perceptions of e-cigarette use as it relates to use as a quitting aid, safety, professional guidance provided to callers and organizational guidance received, and regulation.

The study further tests whether the regulatory environments for e-cigarettes is associated with different perceptions of the products by comparing responses from counselors in Canada, where e-cigarettes containing nicotine are restricted, to those in the United States, where e-cigarettes were largely unregulated at the time of publication.


Value added

Many smokers turn to quitlines, rather than their health care providers, for help with quitting. This study adds to the literature by providing a baseline understanding about how quitlines and quitline counselors in North America perceive e-cigarettes and how they answer questions from smokers who use them.


Study findings

  • Nearly 70% of counselors believed that e-cigarettes are not effective quitting aids.
  • Most (87%) believed that e-cigarettes are addictive and that secondhand exposure to vapor is harmful (71%).
  • Counselors reported that callers ask for advice about e-cigarettes, but only 4% of counselors recommended their use.
  • Most counselors (97%) reported being instructed by quitline employers to explain to clients that e-cigarettes are not FDA-approved as a cessation aid; 74% were told to recommend approved quitting aids instead.
  • Most counselors (87%) believed that e-cigarettes should be regulated like cigarettes in terms of advertising, taxation, access by minors, and use in public places.


As research continues to accumulate about the potential benefits and harms of e-cigarettes, it is important that quitlines stay informed about the evidence to communicate about these products in ways that best serve individuals who are trying to quit smoking.

Chen, C., Zhuang, Y.-L., & Zhu, S.-H. (2016).  E-cigarette design preference and smoking cessation: A U.S. population study. doi:



E-cigarettes can generally be grouped into two models: closed and open systems. Closed systems are disposable or reloadable with cartridges of pre-filled solution. Closed systems do not allow users to fill their devices with third-party “e-liquids,” or nicotine-containing solutions. Open systems feature a more prominent tank and can be refilled with liquids. These systems allow users to select from a greater range of nicotine concentrations and to purchase basic ingredients and mix their own customized liquid. Open system devices are reported to be more effective in reducing withdrawal symptoms, and online surveys of e-cigarette users have found them to be preferable to closed systems. This study examines whether the preference for an open or a closed system e-cigarette is associated with success in quitting smoking.


The research team compared website content to determine which forums had the most discussion about contextual factors related to product use. The research team also identified common topics that appeared in forums about combustible cigarette, e-cigarette, and hookah use to highlight the similarities and differences in how people discussed their experiences using these products, health concerns, and other themes.

Value added

Unlike other studies of preferences, which use convenience samples or e-cigarette forums, this study was based on a nationally representative sample of U.S. adults. It examines the 926 current e-cigarette users who were current or former smokers to assess their e-cigarette design preference and their success in quitting smoking.

Study findings

  • Most e-cigarette users used only one type of device, with 41.1% using open systems exclusively and 51.4% using closed systems exclusively. Only 7.4% of the current and former smokers who currently use e-cigarettes used both closed and open system devices.
  • Former smokers were significantly more likely than current smokers to use open systems (53.8% vs. 35.2%) and less likely to use closed systems (41.4% vs. 56.1%).
  • Current smokers who had tried to quit were more likely to use open systems than those who had not tried to quit (41.1% vs. 27.7%). Conversely, current smokers who had made no attempts to quit were more likely to use closed system devices than those who had tried to quit (65.0% vs. 48.9%).


This study found that the use of open systems is associated with a greater chance of quitting smoking. The U.S. Food and Drug Administration recently released its proposed deeming rule that will bring a variety of products, including e-cigarettes, under its regulatory authority. Understanding how the design of e-cigarette devices can facilitate quitting smoking is important information to consider as policies and regulations are being developed.


Guillory, J., Lisha, N., Lee, Y. O., & Ling, P. M. (2016). phantom smoking among young adult bar patrons. Tobacco Control. doi:10.1136/tobaccocontrol-2015-052821


Despite the steady decrease in smoking rates, nondaily smoking (i.e., smoking on 1 to 29 days of the past 30 days) is becoming increasingly common among young adults. Tobacco control advocates have successfully cast tobacco use as being outside of accepted social norms. However, this strategy has likely contributed to a phenomenon known as “phantom smoking,” in which a person reports smoking cigarettes but does not identify as a smoker. Because many young adult, nondaily smokers are phantom smokers, current surveillance systems may underestimate the number of young adult smokers.


This study explores phantom smoking among a large sample of bar-going young adults between the ages of 18 and 30. It examines the prevalence and sociodemographic makeup of phantom smokers compared with self-identifying smokers to more accurately assess young adult prevalence of smoking and to better inform and target cessation messaging to this population.


Value added

Data from this study capture a wider range of educational backgrounds and ages of young adult smokers than previous studies. In addition, the study includes data from seven U.S. cities, allowing for the exploration of patterns of phantom smoking among a national sample of young adults.

Study findings

  • Phantom smokers accounted for 43% of the current smokers in the study sample.
  • Compared with smokers, phantom smokers were more likely to be college graduates, women, and to identify themselves as social smokers.
  • Phantom smokers had lower odds of smoking while drinking, being nicotine dependent, and having quit for at least 1 day in the last year, compared with smokers. These findings are consistent with previous studies that show phantom smoking is associated with fewer quit attempts and lower levels of motivation or desire to quit.


The messaging and content about cessation typically directed toward heavier, daily smokers may not work for this population. Specific campaigns and strategies are needed to target individuals who smoke at lower levels. Public health campaigns for young adults need to be cautious in developing their cessation messaging, because references to quitting may trigger the perception among phantom smokers that to quit, one needs to identify as a smoker. Special efforts may be needed to reach female, college-educated young adults, who are more likely to be phantom smokers.

Center for Public Health Systems Science. (2016). Point-of-sale report to the nation: Realizing the power of states and communities to change the tobacco retail and policy landscape. St. Louis, MO: Center for Public Health Systems Science at the Brown School at Washington University in St. Louis and the National Cancer Institute, State and Community Tobacco Control Research Initiative.


Advancing Science and Policy in the Retail Environment (ASPiRE), a consortium of researchers from the Center for Public Health Systems Science at Washington University in St. Louis, the Stanford Prevention Research Center, and the University of North Carolina Gillings School of Global Public Health, recently published this report, the third in a series of Point of Sale Reports to the Nation. ASPiRE is a 5-year research project funded by the National Cancer Institute’s SCTC Research Initiative. Previous reports were published in 2014 and 2015.

The 2016 report provides new findings on tobacco retailer density, retail tobacco policy activity, and product availability and marketing and promotion in states and communities across the nation. The authors describe barriers to retail policy activity, provide examples of recent policy successes, and offer a series of strategies to demonstrate how states and communities are changing the tobacco retail and policy landscape.


Value added

This report provides important information about the retail environment and potential policy solutions to support state and local tobacco prevention and control efforts.


Study findings

Key highlights from the report include the following:

  • In just 2 years, the percentage of retailers selling e-cigarettes and other electronic nicotine delivery systems doubled, from 34% in 2012 to 70% in 2014.
  • Menthol cigarettes are the most common product advertised outside of stores, with nearly half (48%) of stores displaying an outdoor ad for these products.
  • Three-quarters of stores (76%) featured power walls by Marlboro, and one-third featured power walls by Copenhagen, underscoring the influence of tobacco conglomerate Philip Morris (the owner of both brands) in controlling promotional content in stores.
  • Tobacco control policy activity among states and localities increased significantly between 2012 and 2015. Popular policies for states and localities between 2012 and 2015 included:

-          increasing licensing fees,

-          restricting sales in youth locales,

-          setting a minimum legal sales age for e-cigarettes, and

-          banning self-service display ads for e-cigarettes and other tobacco products.

  • Although state and local program leaders reported fewer barriers to retail policy activity in 2015 compared to 2012, obstacles still remain. The top three barriers reported were a lack of political will, industry activity, and low awareness of the tobacco retail problem.


States and communities can look to this report to understand the changing tobacco retail landscape and learn about innovative policy solutions. The roadmap outlined in this report, which includes four action categories (monitor, assess, implement, and evaluate), will help state and communities build on these successes.