- Theme 1: Biological determinants of tobacco-induced addiction and disease
- Theme 2: Social and behavioral determinants and interventions for tobacco addiction
- Theme 3: The tobacco industry as a disease vector and strategies to block it
Nicotine Levels, Toxicant Exposure, and Tobacco Biomarkers
Neal Benowitz, PhD used biochemical data in large multi-center trials of smokers to study compliance to smoking reduced nicotine cigarettes and the impact of rapid vs. slow nicotine reduction. Despite high non-compliance, smokers reduced their nicotine intake by an average of 60%, supporting the feasibility of mandated nicotine reduction. These data were critical to the FDA’s recently-announced comprehensive tobacco regulatory plan, which includes a decision to regulate nicotine content of cigarettes. Furthermore, Benowitz’s work studying smokers using electronic cigarettes (e-cigarettes) supports the idea that if smokers can completely switch from regular cigarettes to e-cigarettes, risks to health are likely to be markedly reduced, supporting the concept of nicotine harm reduction for recalcitrant smokers.3.4 With Gideon St. Helen, PhD and Peyton Jacob III, PhD, Benowitz published a study of screening urine samples of minority and low-income adolescents at Zuckerberg San Francisco General Hospital (ZSFG) for exposure to tobacco.5 Urinary cotinine measures showed that 87% of adolescents were exposed to tobacco, including 12% who were active smokers, 46% with significant secondhand smoke (SHS) exposure and 30% with light SHS or third-hand smoke exposure. These data suggest that routine screening for such exposure is recommended to improve the health of children in urban hospitals that serve minority and economically disadvantaged populations.
Social Marketing to Reduce Young Adult Tobacco Use
Pamela Ling, MD works to reduce tobacco use among young adults using social marketing and digital technologies. Young adults (age 18-25) have the highest smoking prevalence of any age group, and cessation by age 30 avoids nearly all the long-term ill effects of smoking. Using lessons learned from tobacco industry marketing strategies, Ling now uses branded social and lifestyle activities to decrease associations between youth culture and smoking, in order to compete with tobacco marketing. She has published results of four large-scale pilot studies of social branding interventions in four states in the Journal of Adolescent Health,6 all of which have found significant decreases in daily smoking during the intervention. Ling is now leading a multicenter controlled trial of social branding interventions in four cities. The social branding strategy has been adopted by the FDA for its mass media educational campaigns targeting youth priority populations (Hip Hop, Rural/Country, and LGBT). The social branding strategy is also being applied to promote young adult smoking cessation in San Francisco as part of the HDFCCC SF CAN initiative. In this work, Ling’s social brand is deployed to promote and tailor the Facebook intervention designed by Danielle Ramo, PhD to encourage young adult hipsters to enroll in evidence-based smoking cessation services.
Tobacco Regulatory Science
The UCSF Tobacco Center of Regulatory Science (TCORS) is one of 14 centers nationally, funded as part of a first-of-its-kind tobacco science regulatory program by the NIH with funds passed on from the US FDA. Stanton Glantz, PhD is PI for this four-year $20M grant (P50CA0180890), now in preparation as a competing renewal with a September 2018 funding date. The UCSF TCORS brings together TO Program researchers with the goal of developing models to inform tobacco product regulatory strategies that integrate economic impacts of tobacco use on health costs, consumer responses to pro-tobacco marketing and anti-tobacco messages, and rapid changes in risk due to tobacco use and secondhand smoke exposure. The work of the TCORS supports each of the three TO Program themes. Related to Theme 2, Benjamin Chaffee, MPH, PhD, DDS found that rural male youth are at high risk for tobacco use, particularly smokeless tobacco, often in dual- and poly-use patterns with other tobacco products. He found a very strong preference for flavored smokeless tobacco, suggesting that regulation to limit or eliminate flavored smokeless tobacco would likely reduce youth use. In relation to Theme 3, which aims to understand the tobacco industry as a disease vector and develop strategies to block it, Wendy Max, PhD uses microeconomic models to estimate healthcare costs attributable to the use of different tobacco products. Her work, which is submitted and under review, estimated the total annual US healthcare cost attributable to cigar use at $5.5 billion8, and the cost attributable to smokeless tobacco use at $3.5B.