25th AnniversarySan Francisco, CA

February 20-23, 2019

ABSTRACTS

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The peer-review process for SRNT’s annual meeting entails review by society members of abstract submissions. Criteria for acceptance/rejection are based upon methodological rigor and not the funding resource or research findings. The views expressed by conference presenters are the author’s own and do not necessarily represent that of SRNT.

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2019 SYMPOSIA .........................................................................................................................................................................................1

PAPER SESSIONS

Podium Presentation 1 ................................................................................................................................................................ 39 Paper Session 1: Nicotinic Reinforcement: New Evidence From Basic Science Paper Session 2: Genetic Basis Of Addiction And Tobacco-Related Diseases Paper Session 3: Smoking, Cessation, And Mental Health

Podium Presentation 2 ................................................................................................................................................................ 47 Paper Session 4: Pulmonary Toxicity Of Electronic Cigarettes And Combustible Cigarettes Paper Session 5: Assessing The Promise Of Novel Pharmacologic And Neurostimulator Therapies Paper Session 6: Nuances In Nicotine Reduction

Podium Presentation 3 ................................................................................................................................................................ 56 Paper Session 7: Health Warnings: History And How They Work Paper Session 8: Impact Of Tobacco Control Policies On Behavior Paper Session 9: Association Of E-Cigarette Use With Smoking And Cessation

Podium Presentation 4................................................................................................................................................................. 64 PaperSession10:BiologicalAndCognitiveEffectsOfNicotine Paper Session 11: Improving Cessation Treatment For Young Smokers

Podium Presentation 5 ................................................................................................................................................................ 70 Paper Session 12: Using Mobile Health To Target Hard-To-Reach Subgroups Paper Session 13: Cannabis And Tobacco Co-Use: Behavior And Biomarkers Paper Session 14: Improving Cessation In Vulnerable Smokers: Addressing Racial And Socioeconomic Disparities

Podium Presentation 6................................................................................................................................................................. 78 Paper Session 15: Emerging Evidence On E-Cigarette Toxicity Paper Session 16: Cigar Use: Implications For Program And Policy PaperSession17:EffectsOfAntitobaccoMassMediaInterventions

POSTER SESSION 1: Policy & Pre-Clinical ............................................................................................................................................. 87

POSTER SESSION 2: Public Health (Session 1) ................................................................................................................................... 138

POSTER SESSION 3: Clinical ................................................................................................................................................................ 186

POSTER SESSION 4: Public Health (Session 2) ................................................................................................................................... 233

AUTHOR INDEX ..................................................................................................................................................................................... 281

CONTENTS

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Notes

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2019 SYMPOSIA

SYM1FDA CENTER FOR TOBACCO PRODUCTS: AN UPDATE ON FDA’S COMPREHENSIVE PLAN FOR TOBACCO AND NICOTINE REGULATION

Mitch Zeller, JD, Director, FDA Center for Tobacco Products; Deirdre Lawrence Kit-tner,PhD,MPH,DeputyDirector,OfficeofScience;GemBenoza,SupervisoryHealthCommunicationsOfficer,OfficeofHealthCommunicationsandEducation,FDACenterfor Tobacco Products

Announced by the FDA Commissioner in 2017, the Comprehensive Plan for Tobacco and Nicotine Regulation places nicotine, and the issue of addiction, at the center of the Agency’s tobacco regulatory activities. During this SRNT session, Center for Tobacco Products (CTP) speakers will address the multi-year roadmap to better protect youth andhelpaddictedadultsmokersquit;significantlyreducingtobacco-relateddiseaseanddeath in the U.S. in the years to come. Topics to be covered include Regulatory Policies on Addiction, Appeal, and Cessation; Science-Based Review of Tobacco Products; and the Youth Tobacco Prevention Plan. Regulatory Policies on Addiction, Appeal, and Cessation will address seeking evidence and public comment on potential FDA regula-tions; increasing access to, and use of, medicinal nicotine products to help people quit; and educating the public and correcting misperceptions about nicotine. Science-Based ReviewofTobaccoProductswillincludeanupdateonModified-RiskTobaccoProductApplications and research to inform FDA’s regulatory activities and decisions. Data from CTP funded studies, including the PATH Study, will be presented highlighting recent findingsto informspecificregulatoryareas.TheYouthTobaccoPreventionplanwilladdress three main strategies: 1) preventing youth access, 2) curbing the marketing of products, and 3) educating youth and their families. This session will also address the changes to FDA’s tobacco and nicotine policy framework announced in November 2018thatfocusesonflavoredtobaccoproductsincludingENDSproductsmarketedtoyouth,flavoredENDSproducts,flavoredcigars,andmentholincombustibleproducts,including cigarettes and cigars.

SYM2‘BACK TO SCHOOL WITH JUUL’: UNDERSTANDING EMERGING TRENDS IN VAPORIZED NICOTINE PRODUCTS

Maciej Lukasz Goniewicz, PhD, PharmD. Roswell Park Comprehensive Cancer Center, USA.

E-cigarette design has evolved over the past decade, from the small devices that resembled tobacco cigarettes (cig-a-likes) to larger tank systems (mods). Pods, the newestgenerationofthesevaporizednicotineproducts,haveincreasedinpopularityin recent years, most notably with the product JUUL. Use of JUUL products (‘juuling’) among youth in the U.S. has led to concerns among parents, teachers and the general public. However, some adult cigarettes smokers view the product as a viable cessation aid. During this multi-disciplinary symposium, we will explore factors that may explain why these new products are so appealing to young people and adult smokers. First, Dr King (Co-chair) will present retail sales data assessing the meteoric rise in e-cigarette dollar sales in the U.S. during 2013-2017. Since these increasingly popular pods contain nicotine salt solutions, they appear to be easier to inhale, as users report less respiratory irritation when compared with other products containing high nicotine concentrations. To addressthistopic,DrGoniewicz(Co-chair)willpresentresultsfromchemicalanalysisof pod products, including all JUUL pods. Pods are also available in a wide range of flavors.Toexplorethesehealthimplications,DrRahmanwilldiscusspotentialrespiratoryconsequencesofinhalingflavoredaerosolsgeneratedfrompodsystems.Additionally,while youth often do not identify nicotine as a reason for choosing these products, nicotine likely plays a role in the continued use of e-cigarettes. Therefore, Dr Boykan will present novel data on nicotine exposure and signs of addiction in adolescents using pods. Finally, although clinicians, regulators, and public health professional must be aware of the l risks of these products among young people, it is also important to con-siderthepotentialbenefitsofusingpodproductsforsmokingcessation.Accordingly,DrCaponnettowillpresentresultsfromaprospectivestudyassessingeffectsofJUULuseonsmokingdisplacementinadultsmokerswithschizophrenia.DrBenowitz(Dis-cussant) will lead a discussion on implications of the presented data for public health policy, planning, and practice.

SYM2ATHE RISE OF THE POD MOD: TRENDS IN E-CIGARETTE SALES IN THE UNITED STATES, 2013-2017

Brian King, PhD, MPH1, Doris Gammon2, Ellen M. Coats2, Kristy Marynak1, Brett Loomis2, Todd Rogers3. 1Centers for Disease Control and Prevention, USA, 2RTI Inter-national, USA, 3RTI International, USA, Research Triangle Park, NC, USA.

Significance:Thetobaccoproductlandscapehasdiversifiedtoincludeavarietyofelec-tronic products, including recently introduced ‘pod mod’ e-cigarettes. Population-based surveys traditionally provide annual estimates of tobacco product use. However, e-cigarettes are a rapidly evolving product class, and retail sales data can comple-ment population-based surveys and identify sub-annual, emerging trends. This study assessed e-cigarette dollar sales in the U.S. during 2013-2017.Methods: E-cigarette retail sales data were licensed from Nielsen for convenience, club, and discount stores, mass merchandisers, supermarkets, pharmacies, and military commissaries. Sales data reflectalldocumentedsalesintheassessedstoretypes;Internetand‘vapeshop’salesare not captured. Data came in 4-week aggregates, from December 16, 2012 through January 8, 2018, for the 48 contiguous states and D.C. Dollar sales were assessed for thefivetop-sellingmanufacturersbasedon2017salesandbrandownership.Allothermanufacturers were grouped into an ‘other’ category.Results: In early 2013, ‘other’ manufacturers had the highest e-cigarette dollar sales; however, sales rapidly increased corresponding to the introduction of new products by Imperial Tobacco (blu) in mid-2013, Altria (MarkTen) and British American Tobacco (Vuse) in mid-2014, and JUUL Labora-tories in mid-2015. In 2013, Imperial Tobacco held 41% of total e-cigarette sales. From mid-2014 through mid-2017, British American Tobacco held 34% of total sales. During 2016-2017, JUUL Laboratories’ sales increased 701%, from $42 million to $337 million, giving it the greatest proportion of total e-cigarette dollar sales by December 2017 (50%).Conclusions: E-cigarette dollar sales were volatile in the U.S. during 2013-2017, with increased sales corresponding to new product introductions by manufacturers. By late 2017, JUUL Laboratories held the greatest portion of e-cigarette sales, which was due toa‘podmod’e-cigarettecalledJUUL.Givene-cigarettes’potentialtobothbenefitandharm the public’s health, continued monitoring of e-cigarette sales and use is critical to inform public health policy and practice.

FUNDING: Federal

SYM2BCHEMICAL CHARACTERIZATION OF ‘POD’ PRODUCTS

Maciej L. Goniewicz, PhD, PharmD, Liam-Gavin Dell, Mary N. Plumbo, Taylor S. Vanderbush, Noel J. Leigh. Roswell Park Comprehensive Cancer Center, USA.

Significance:E-cigarettedesignhasevolvedoverthepastfewyears,fromthesmalldevices that resembled conventional tobacco cigarettes (‘cig-a-likes’) to larger tank systems (‘mods’). ‘Pods’, the newest generation of these vaporizer devices, havesoared in popularity in the past year, most notably, one brand, JUUL. Pods are compact, lightweight, ultra-portable, and easy to use inconspicuously.Methods: We measured total nicotine concentration in pod products, purchased online, that were popular among youth. We also measured total nicotine yields in aerosols generated from these productsusingasmokingmachineandstandardizedlaboratorypuffingprotocol(70mlpuffvolume;2secpuffduration;puffintervalsof10sec).Weusedgaschromatog-raphy-massspectroscopyto identifytypeofnicotinesalt,humectants,andflavoringchemicals used in pod products.Results: All tested products contained high nicotine concentrations,from21.8to56.2mg/mlinaformofsaltwithbenzoicacid(nicotinebenzoate)orlevulinicacid(nicotinelevulinate)dissolvedinamixtureofpropyleneglycoland vegetable glycerin. The average pH of e-liquids used in pod systems was 5.8±0.3. Weestimatedthatusersofprefilledpodsystems(JUUL,Bo,Phix)mayinhalewith10puffsfrom0.77to0.85mgofnicotine,considerablyhigherthanpreviouslyreportedinoldergenerationsofe-cigarettes(0.02–0.51mg/10puffs).Massspectroscopyanalysisofpodproductscommonlyusedbyyouthrevealedthepresenceofnumerousflavoringchemicals,includingseveralrespiratoryirritantslikebenzaldehyde,vanillin,andamylacetate.Conclusions: Results from product testing presented above suggest that pods give users cigarette-like nicotine delivery. Toxic compounds, as detailed above, have beenidentifiedinaerosolsfrompodsandtherisksofrepeatedinhalationofhighdosesof nicotine salts are unknown. Although the exact physiological mechanisms of nicotine

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salts have not been studied in detail, these compounds are believed to increase the amountandrateofnicotineuptakeinecigaretteusers,effectivelyincreasingthedoseof nicotine delivered to the central nervous system.

FUNDING: Federal

SYM2CEXPOSURE TO JUUL FLAVORS GENERATES REACTIVE OXYGEN SPECIES, POTENTIALLY ELICITING DIFFERENTIAL CYTOTOXIC AND INFLAMMATORY RESPONSES

Irfan Rahman, PhD, Thomas R. Lamb, Thivanka Muthumalage. University of Roch-ester, USA.

Background:ThehealtheffectscausedbytheconstituentsofJUULiscurrentlyun-known.Wehypothesized thatJUULconstituents,primarily theflavoringagents,willhavesimilartoxiceffectsasobservedine-juices.MaterialsandMethods:InordertodetermineifJUULflavoringagentshavepotentialtoxiceffects,acellularandcellularexperiments were conducted. To determine the reactive oxygen species (ROS) levels foundinJUULvapors,differentJUULflavors,coolmint,crèmebrulee,fruitmedley,andVirginiatobacco,werebubbledthroughafluorescentdye,DCFH-DAbasedonvapingtopography, and the generated ROS levels were expressed as hydrogen peroxide equivalents.ThepotentialtocauseoxidativestressbytheseJUULflavorswasassessedby thedepletionof totalglutathione(GSH)concentrations.Cellulareffectsbyacuteexposure to JUUL was measured in lung epithelial cells, Beas 2B, and in macrophages, U937.Cytotoxicityandtheinflammatoryresponsewasmeasuredbyassessingthecellviabilityandtheinflammatorycytokinelevelssuchasinterleukin8(IL-8).Results:AllJUULflavorsproducedsignificantlyincreasedlevelsofROSinadependentmannercompared to the control air exposed group, with cool mint producing the highest levels ofROS.JUULflavorsalsohaddifferentialeffectsontotalGSHconcentration,depletingGSHlevelssignificantlycomparedtothecontrolairexposedgroup.Thetestedflavorsdidnotcauseasignificantdecreaseincellviability,butinduceddifferentialIL-8levelsin the exposed cells compared to unexposed counterparts.Conclusions: Our data has shownthatdifferentJUULflavorsproducevaryingamountsofROSandarecapableof decreasing the total GSH levels. Hence, it can be deduced that JUUL can cause oxidativestressandinduceaninflammatoryresponse.Ourdatasuggestthatexposureto JUUL vapors is not a risk-free method of vaping and may have comparable health effectscausedbyexposuretootherENDSande-juices.Currently,weareconductingfurther validation experiments in vitro as well as in vivo using surrogate mouse models.

FUNDING: Federal; Academic Institution

SYM2DNICOTINE EXPOSURE AND SIGNS OF ADDICTION IN ADOLESCENTS USING PODS: AN IMPERATIVE FOR CLINICIANS TO ACT NOW!

Rachel Boykan, MD1, Catherine R. Messina1,Maciej L.Goniewicz2. 1Stony Brook University, USA, 2Roswell Park Comprehensive Cancer Center, USA.

Background:Adolescent use of high content nicotine vaporizers, ’pods’, has risendramatically in the past year. Little is known about the nicotine exposure from these products in teenagers.Methods: Adolescent patients, ages 12-21, were recruited from three Stony Brook Children’s Hospital outpatient clinics (Long Island, NY), between 4/2017–4/2018. Participants completed a 60-item anonymous questionnaire about theiruseofe-cigarettes,includingspecificproducttypesandbrands,andprovidedaspot urine sample. We estimated nicotine exposure in our participants who reported exclusive use of pods (i.e., no combusted tobacco use) by measuring cotinine in collected urine samples.Results: Of 506 participants, 7.3% (n=37) reported current daily or someday use of pods (PU). Mean age of PU was 16.7±1.7 years. The most popular pod brands were JUUL (79.7% of PU), Bo (36.4%), Phix (18.2%), and Sourin (12.1%)(multipleanswersallowed).Preferredflavorswerementhol/mint(24.2%),fruit(21.2%), and candy, desserts/other sweets (18.2%). We compared PU (n=37) with non-pod using e-cigarette users (ECU)(n= 54). Almost half of PU (46.9%) used their devices several times/day, compared with 2.9% of ECU; while more than half of ECU (58.9%) used their devices between once/week and once/month compared with 21.8% of PU (p

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to address smoking in the context of pain increased motivation to quit and subsequent engagement of cessation treatment among smokers with chronic pain. Fourth, Mr. Rogers will present proof of concept case series data from a new integrated treatment that addresses pain-related anxiety (a transdiagnostic vulnerability factor implicated in the maintenance of nicotine dependence) among smokers with chronic low back pain. Finally,Dr.Bevinswilldiscussthesefindingsandhowfuturetranslationalworkcanaidintheidentificationofclinically-relevantmechanismsincomplexpain-nicotine/tobaccointeractions. This symposium was contributed by the Basic Science Network.

SYM3ANEUROPATHIC PAIN IMPACTS NICOTINE DEPENDENCE IN MICE

M. Imad Damaj, PhD, Yasmin Alkhlaif. VA Commonwealth University.

Population-based studies support a high co-occurrence of chronic pain and smoking dependence. There is also evidence that nicotine can induce acute analgesia, and that nicotine abstinence/withdrawal can induce hyperalgesia. Recently, evidence from Ditre and Brandon (2008) suggested that pain can be a potent motivator of smoking. However, preclinical investigations modelling this interaction between nicotine dependence and pain are lacking, thus providing a major obstacle to studying the mechanisms of pain-re-latednicotinedependence.Toaddressthisdeficitinpreclinicalmodels,thepresentstudyexamines nicotine withdrawal and reward using the conditioned place preference (CPP) test in two mouse models of chronic neuropathic pain: chemotherapy-induced periph-eral neuropathy (paclitaxel-induced neuropathy) and HIV-induced neuropathy (mice conditionally expressing HIV Tat1-86 protein) mice. Nicotine withdrawal somatic and affectivesignsincreasedinintensityinbothmodelsofneuropathy.Inaddition,nicotineCPP was reduced in paclitaxel-induced neuropathy model in a time-dependent manner. Plasmanicotineandcotininelevelswerenotsignificantlychangedinthesemodelsofneuropathy.Takentogether,thesefindingsshowedthatmicearemoresusceptibletonicotine withdrawal and possibly more susceptible to escalations in nicotine intake when undergoing chronic neuropathic pain.

FUNDING: Federal

SYM3BPAIN STATUS AS A PREDICTOR OF SMOKING CESSATION INITIATION, LAPSE, AND RELAPSE

Lisa R. LaRowe, MS1, Joseph W. Ditre1, Jessica M. Powers1, Bryan W. Heckman2. 1Syracuse University, 2Medical University of SC.

Pain and tobacco cigarette smoking are both highly prevalent and co-occurring condi-tions. Despite accumulating evidence that the experience of pain can undermine smok-ing cessation, we are not aware of any previous work that directly tested prospective associationsbetweenpainstatusandsmokingcessationmilestones.Thefirstaimofthis longitudinal study was to examine past two-week pain status (yes/no) as a predic-tor of initiating a quit attempt and achieving 7-day point prevalence abstinence (PPA), among a sample of 301 smokers who were motivated to quit. The second aim was to examine past two-week pain status as a predictor of lapse and/or relapse to smoking, among a separate sample of 242 former smokers who had initiated a quit attempt within the past 5 weeks. Data were collected online, with pain status assessed at baseline and cessation outcomes assessed biweekly over a two-month follow-up period. Cox proportionalhazardsmodelsandlogisticregressionscontrolledforrelevantsociodemo-graphic and smoking characteristics. Aim 1 results indicated that smokers who did not endorse past two-week pain were 2 times more likely to make a quit attempt, nearly 4 times more likely to achieve 7-day PPA, and 10 times more likely to report 7-day PPA at two-month follow-up (ps < .01). Aim 2 results indicated that former smokers who endorsed past two-week pain were 9 times more likely to report a lapse, and nearly 22 times more likely to report a relapse to smoking over the course of two months (ps < .05). Moreover, former smokers who did not endorse pain were 75 times more likely to report7-dayPPAattwo-monthfollow-up(p<.01).Thisis,toourknowledge,thefirststudy to demonstrate that the presence of co-occurring pain prospectively predicts poor outcomes across a range of important smoking cessation milestones. Discussion will address clinical implications, directions for future research, and the utility of considering pain in the context of smoking cessation.

FUNDING: Academic Institution

SYM3CA NOVEL INTERVENTION TAILORED FOR SMOKERS WITH CHRONIC PAIN INCREASED MOTIVATION TO QUIT AND SUBSEQUENT CESSATION TREATMENT ENGAGEMENT

Emily L. Zale, PhD1, Lisa R. LaRowe2, Jesse D. Kosiba2, Joseph W. Ditre2. 1Bingham-ton University, 2Syracuse University.

Tobacco cigarette smokers are at increased risk for developing chronic pain and poorer paintreatmentoutcomes.Smokerswithco-occurringpaintendtoreportgreaterdifficultyandlessconfidenceinquitting,faceuniquecessationchallenges,andmaybenefitfromtailoredinterventions.Wetestedtheeffectsofanovelmotivationalinterventionaimedatincreasing knowledge of pain-smoking interrelations, motivation to quit, and cessation treatment engagement among smokers with chronic pain. Intervention components includedpersonalizedfeedbackandpain-smokingpsychoeducationtohelpdevelopdiscrepancy between continued smoking and desired pain outcomes. Non-treatment seeking daily cigarette smokers with chronic pain (N = 76, 58% Female, 42% Black/AfricanAmerican,Mcpd=18)were randomized toeither the tailoredpain-smokingintervention or a 3As control treatment. Results indicated that the tailored intervention (relative to control) increased knowledge of pain-smoking interrelations (p < .001) and multiple indices of cessation motivation (contemplation ladder, desire to quit, expected success in quitting, and willingness to learning about cessation treatment options, intention to engage cessation treatment; ps < .01). Increased knowledge of pain-smok-inginterrelationsmediatedeffectsofthetailoredinterventiononwillingnesstolearnabout cessation treatments. At one-month follow-up, treatment gains in knowledge of pain-smoking interrelations were maintained (p = .009), and participants who received the tailored intervention were 4 times more likely to report having subsequently talked to their doctor about quitting (p = .034). These data suggest that smokers with co-occurring painareamenabletopain-smokingpsychoeducationandmaybenefitfromtreatmentsthathavebeentailoredtoaddresssmokinginthecontextofpain.Thesefindingsfurthersuggest that smokers may become more motivated to engage cessation treatment as they become increasingly aware of how continued smoking may exacerbate their pain or impede recovery.

FUNDING: Federal

SYM3DINTEGRATING GRADED PAIN EXPOSURE INTO STANDARD COGNITIVE BEHAVIORAL THERAPY FOR SMOKING: A PROOF-OF-CONCEPT CASE SERIES

Andrew H. Rogers, B.A.1, Joseph W. Ditre2, Michael J. Zvolensky3. 1University of Houston, 2Syracuse University, 3University of Houston; University of Texas MD Ander-son Cancer Center.

Cigarette smoking is the leading cause of death and disability in the United States (U.S.), contributing to over 480,000 deaths each year. Smokers with chronic pain represent a highly prevalent major health disparity population in the U.S. whose unique healthcare needsarenotbeingmet.Tobaccocigarettesmokinghasbeenidentifiedasauniquecasual factor in the onset and progression of chronic low back pain (CLBP), the most common source of chronic pain among U.S. adults.Indeed, there is a pressing public health need to develop an integrated intervention that can reduce cigarette smoking amongsmokerswithcomorbidchronicpaintooffsetcancerandrelateddiseaseburdeninthis high-risk group. Yet, targeted therapeutic tactics are absent for smokers with chronic pain. Such neglect is unfortunate, as pain symptoms and chronic disorders: frequently co-occur in smokers, are among the most common groups of psychosomatic disorders, and share common (transdiagnostic) vulnerability processes implicated in the etiology of smoking (e.g., pain-related anxiety). We therefore seek to build upon our past work by developing a new treatment protocol (Pain-Anxiety Smoking Cessation Treatment; PASC-ST) that integrates standard smoking cessation treatment (ST) strategies and nicotine replacement therapy with therapeutic tactics to reduce pain-related anxiety.This new treatment integrates standard cognitive behavioral therapy for smoking with Graded In-Vivo Pain exposure to target pain-related fear in the context of cigarette use. We illustrate this integrated treatment on a case series of smokers with chronic low back pain.Resultsindicatedasignificantreductioninpain-relatedanxietyandbiochemicallyverifiedcigaretteabstinenceat2monthfollow-up.

FUNDING: Unfunded

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SYM4POLICY RESEARCH NETWORK SYMPOSIUM: ADVANCING THE TOBACCO ENDGAME

Joanna E. Cohen, PhD. Johns Hopkins Bloomberg School of Public Health

The tobacco endgame describes the ultimate goal of ending the global burden of tobacco use.Achievingthisaimrequiressignificantandlastingchangestothestructural,political,and social dynamics that fuel the epidemic. This session will include presentations of new research on the tobacco endgame and a facilitated discussion, led by Dr. Joanna Cohen, about the implications of this evidence in the context of developing and enhancing tobaccoendgamestrategies.Dr.Cohenwillbrieflyintroducethesessionandmoderatediscussion of the work presented. Dr. Smith of the Medical University of South Caro-lina will present research relevant to the proposed U.S. policy mandating a reduction inthenicotinecontent incigarettes.Specifically,thisstudyexaminedcompensatorybehaviors of smokers using very low nicotine cigarettes in a controlled environment. From here, panelists will discuss endgame goals and strategies in the international context. Dr. Richard Edwards of the University of Otago, Wellington will examine key facilitators of and barriers to achieving endgame goals in six countries that have adopted government-endorsed endgame strategies. Dr. David Timberlake of the University of California, Irvine, will describe the plan to end tobacco use in Finland, and the prospect of achieving this aimwith the country’s proposedmeasures. Finally,Drs.GeoffreyFongandRobertSchwartzfromtheUniversityofWaterlooandUniversityofToronto,respectively,willdescribehowscientificevidenceisinformingtheCanadianendgamestrategy of achieving a tobacco use prevalence of less than 5% by 2035. Dr. Fong will presentfindingsfroma2016surveyof3,215adultsmokersinCanadaregardingtheirsupportforavarietyofendgamepolicieswhileDr.Schwartzwillfocusontheroleofresearch in supporting endgame initiatives as well as identifying limitations. Together, thesepresentationswillprovideinsightintoseveralspecificendgamestrategies,andelucidatetheroleofresearchindefiningandsupportingfuturepolicyefforts.

SYM4ATHE IMPACT OF EXCLUSIVE USE OF VERY LOW NICOTINE CIGARETTES ON COMPENSATORY SMOKING

Tracy T. Smith, PhD1, Eric Donny2, Joseph Koopmeiners3, Cassidy White4, Rachel L. Denlinger-Apte5, Lauren R. Pacek6, Dorothy K. Hatsukami3,NealL.Benowitz7, Mat-thew J. Carpenter1. 1Medical University of South Carolina, 2Wake Forest School of Medicine, 3University of Minnesota, 4Wake Forest School of Medicine, Winston Salem, NC, USA, 5Brown University School of Public Health, Providence, RI, USA, 6Duke University School of Medicine, 7University of California San Francisco.

Background: The FDA is considering a federally mandated reduction in the nicotine content of cigarettes. One critical concern is whether this policy would result in compen-satory smoking. Published clinical trials on nicotine reduction have shown a decrease, rather than an increase, in smoking behavior. However, most participants use non-study normal nicotine content (NNC) cigarettes despite instructions to exclusively use the very low nicotine content (VLNC) cigarettes provided to them. Thus, it is unknown whether smokers would engage in compensatory smoking if they were unable to access NNC cigarettes. The present study uses an innovative design to investigate the impact of nicotine reduction when smokers are unable to access NNC cigarettes. Methods: In a within-subjects crossover design, a cohort of daily smokers completed two four-night hotel stays, in which either VLNC or NNC are exclusively available for “purchase” using a study bank. To mimic a real-world regulatory environment, participants were told the nicotine content of their assigned cigarette each week. Results: Six daily cigarette smokers have completed the study protocol. Compared to the NNC week, there was a temporary increase (of at least 10 percent) in cigarettes smoked per day (CPD) during theVLNCweekforthreeparticipants,butbythefinaldaytheseparticipantsshowedcomparable CPD across conditions. Two participants showed an early decrease (of at least 10 percent) in CPD during the VLNC condition, which persisted across all days. Datacollectionforanadditionalcohortisongoing,withafinalsamplesizeof20partic-ipants.OutcomeswillbepresentedonchangesinCPD,expiredcarbonmonoxide,pufftopography, withdrawal, craving, and more. Conclusions: Using an innovative method to control access to tobacco products, we can rigorously assess compensatory smoking. These data will provide critical information about the potential for compensatory smoking in a post-regulation marketplace where only VLNCs are available for legal purchase.

FUNDING: Federal

SYM4BEVIDENCE AND THE ENDGAME: OPPORTUNITIES AND CHALLENGES

Robert M. Schwartz, PhD1, Michael Chaiton2. 1Ontario Tobacco Research Unit, 2Uni-versity of Toronto.

TheOntarioTobaccoResearchUnit (OTRU)seizedon twoopportunities toanchorendgame proposals in evidence from research. 1) In 2016, a collaborative of not-for-profitandacademicorganizationscreatedCanada’sNationalEndgameInitiativewhichculminated in a 100 person summit based on a background report that laid out policy alternatives for reaching less than 5% tobacco use by 2035. 2) In 2017, the Ontario MinisterofHealthandLong-termCareappointedrepresentativesfromnot-for-profitandacademicorganizationstotheExecutiveSteeringCommitteefortheModernizationofOntario’s Tobacco Control Strategy. The Committee adopted an Endgame framing and produced an evidence informed roadmap for reaching less than 5% tobacco use by 2035. Researchers played key roles in providing several lines of evidence to inform the Endgame blueprints emanating from these initiatives, including: 1) SimSmoke modeling demonstrating the need for dramatic additional measures; 2) morbidity, mortality and costs modeling demonstrating savings at decreasing tobacco use; 3) reviews of reviews andindividualstudiesontheimpactsofdifferentlevelsofimplementingknowntobaccocontrol interventions; 4) extrapolations of potential impacts of novel endgame measures for which there is no tobacco control evidence. A key challenge was the lack of strong evidence about the potential impact of supply-side oriented Endgame measures such as: imposing quotas on the amount of tobacco to be made available for sale, payer pays initiatives, and decreasing availability through retail restrictions. Environmental changes, including in the market for alternative tobacco and nicotine products and the legalizationofrecreationalcannabis,makeitparticularlydifficulttoassesstheimpactof tobacco control measures moving forward. These examples demonstrate the vital role of evidence in supporting Endgame initiatives as well as limitations. There is a need for researchers to exercise caution and not to over-promise on what existing evidence demonstrates. There is a need to develop robust systems for predicting the impact of large scale environmental and supply side Endgame interventions.

FUNDING: Unfunded

SYM4CASSESSING CANADIAN SMOKERS’ SUPPORT FOR TOBACCO ENDGAME MEASURES: A CASE STUDY OF ITC RESEARCH AND DISSEMINATION TO ADVANCE ENDGAME POLICIES IN CANADA

Geoffrey T. Fong, PhD,JanetChungHall,PeteDriezen,LorraineV.Craig.Universityof Waterloo.

Since 2002, the International Tobacco Control Policy Evaluation Project (the ITC Project) has conducted longitudinal cohort surveys across 29 countries covering over two-thirds of the world’s tobacco users. A central objective of the ITC Project is to evaluate the behavioral and psychosocial impact of national-level tobacco control policies of the WHO Framework Convention on Tobacco Control (FCTC) and to disseminate research findingsthatsupportgovernmentsinmakingeffectivetobaccocontrolpolicydecisions.In 2015, the ITC Project was invited to collaborate with leading health and policy experts to explore novel ideas on how to achieve a tobacco endgame in Canada. To respond to the evidence needs for a presentation and informed discussions on endgame options at the 2016 Canadian Tobacco Endgame Summit, the ITC Project expanded the content of its surveys of smokers in Canada, the US, Australia, and the UK (in the 2016 ITC Four Country Smoking and Vaping Survey). New survey questions were added to broaden measures to assess smokers’ support for a variety of endgame policies, including tobacco marketing and sales bans; restrictions on the contents of tobacco products; restrictions on access to tobacco products/alternative nicotine products; and restrictions on e-ciga-rette youth access, content, use in smoke-free places, and promotion. This presentation willdiscussfindingsfromthe2016surveyof3,215currentsmokers(18+years)in10Canadian provinces on levels of support for 14 endgame policies and key predictors of support. The data show that the majority of Canadian smokers favour novel policies to reduce tobacco use. More than half of smokers support making cigarettes less addictive by lowering nicotine levels, and increasing access to alternative nicotine products. The presentationwilldescribehowtheresearchfindingshavebeendisseminatedtoinformpolicyeffortsbytheCanadiangovernmenttoachieveanendgametargetoflessthan5% tobacco use prevalence by 2035.

FUNDING: Federal

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SYM4DEMERGING LESSONS FROM COUNTRIES WITH TOBACCO ENDGAME GOALS. FINDINGS FROM THE INSPIRED PROJECT

Richard Edwards, MPH MD1, Louise Thornley1,RobertSchwartz2, Mervi Hara3, David Evans4,SheilaDuffy5, Hans Gilljam6. 1University of Otago, Wellington, Wellington, New Zealand, 2ON Tobacco Research Unit, Toronto, ON, Canada, 3ASH Finland, Helsinki, Finland, 4Health Service Executive West, Galway, Ireland, 5ASH Scotland, Edinburgh, United Kingdom, 6Karolinska institutet, Stockholm, Sweden.

Significance ‘Endgame’ thinking is increasingly influential in international tobaccocontrol. Six countries (Canada, Ireland, Finland, New Zealand, Scotland and Sweden) adopted government-endorsed endgame goals between 2010 and 2018. We present an overview of the emerging lessons, based on the current status and experiences of these countries. Methods We collected data using a structured template on the nature of the endgame goal and context, current status, activities and learnings from each country. The template was completed iteratively through review of relevant documents by the New Zealand coordinating team and through information gathered from in-country key informants (tobacco control experts, researchers, advocates and policy-makers). Data were analysed and synthesised to identify key lessons learnt, including enablers and barriers for achieving endgame goals. Outcomes The nature of the endgame goal varied greatly, for example in the target date and approach to non-smoked tobacco products and e-cigarettes. Finland’s endgame goal, for example, is unique in its aim to eventually eliminate all nicotine products. The goals of the other countries are focused on tobacco products. The six countries have fully or partially implemented most core tobaccocontrolinterventions,andfivecountrieshaveanationaltobaccocontrolstrategy.However, other than some restrictions on additives to tobacco products, none of the countries has implemented, or has plan to implement, radical proposed endgame strate-gies such as major reductions in supply of tobacco products or mandated denicotinised cigarettes.Keyenablersfortheendgamegoalsidentifiedincludedpublicandpoliticalsupport, government commitment, strong NGOs and NGO advocacy, and high levels of cross-sector collaboration and supporting structures. Major barriers included competing political priorities, limited resources and capacity, lack of unity in the tobacco control sector, and tobacco industry tactics and interference. Progress on reducing disparities in smoking was a major challenge for all six countries. Conclusions Learning from the experienceofcountrieswithendgamegoalshasimportanceglobally.Thefindingswillhelp other countries decide whether to adopt an endgame goal for smoking, and provide useful, evidence-informed information for how best to achieve such a goal.

FUNDING: Academic Institution

SYM4ECAN FINLAND ACHIEVE THE GOAL OF ITS TOBACCO ENDGAME WITH EFFECTIVE BUT CONVENTIONAL MEASURES

David Timberlake1, Ulla Laitinen2, Jaana Kinnunen2, Arja Rimpela2. 1University of California, Irvine, Irvine, CA, USA, 2University of Tampere, Finland, Tampere, Finland.

Significance: Finland boldly legislated the end of tobacco use in its 2010 Tobacco Act. This step was heralded by the international press as a pioneering initiative, raising the question “Can Finland spark a tobacco-free world?”. In 2014, Finland’s Ministry of SocialAffairsandHealthpublisheditsActionPlantoachievetheendgamegoal,whichincluded comprehensive but conventional measures to prevent tobacco initiation, promote cessation, and protect against exposure to secondhand smoke. The current study aimed to assess the reasons for excluding novel strategies and the prospect of achieving Finland’s endgame goal with proposed conventional measures. Methods: Study participants were selected through snowball sampling based on their expertise in either policy or practice of tobacco control (n=32). Semi-structured interviews, conducted in 2017 and 2018, covered a host of topics ranging from consensus among stakeholders to Finland’s ranking on the 2016 Tobacco Control Scale. The framework method was chosen foranalyzing thecontentof the interviews.Results: Reasons for excluding novel, endgame strategies included practical limitations (e.g., political/legal barriers); endorsement of the stepwise approach to policy; and stymied innovation arising from Finland’s prior success in tobacco control. The objective of nicotine- vs. smoke-free Finland had almost unanimous support, challenged by contrarians who opined for an internal discussion on harm reduction. Themes pertaining to the barriers to achieving theendgamegoalincludedthedefactoroleofNGOsintobaccocontrol;theeffectofinstitutionalpracticesontobaccodisparities;lackofconsensusonmobilizingthepop-ulaceagainsttobaccothroughmassmedia;andorganizationaldeficienciesinsmokingcessation. Conclusions: Finland has instituted a number of progressive measures through policy (e.g., display ban), but, may need emerging leaders to institute a bold,

robust measure to achieve its endgame goal. Otherwise, Finland will need to improve integrationofNGOsintothehealthcaresystem,developaunifiedmediastrategy,andsystematizesmokingcessationservices.

FUNDING:AcademicInstitution;Nonprofitgrantfundingentity

SYM5ADVANCES IN SMARTPHONE AND SMARTWATCH APPLICATIONS FOR CESSATION

Jonathan B. Bricker, PhD. Fred Hutchinson Cancer Research Center.

Symposium Summary: With two thirds of the 38 million US smokers owning smart-phones, there are now over 500 mobile apps for smoking cessation (“apps”) downloaded over 8 million times per year. Similarly, with over 53% of the 360 million smokers in China owning smartphones, smoking cessation apps in China are growing in popularity. In addition, there is emerging potential for smartwatches to impact cessation: 18% of the US population own a smartwatch and there are at least 6 apps now developed for smoking cessation. Given their growing reach, the potential population level impact of smartphone and smartwatch apps is high. Responding to these trends and their potential impact,overthepastfiveyears,therehasbeenrisinginterestamongtobaccocontrolresearchers to develop and test smoking cessation apps. Indeed, NIH total funding for research on smoking cessation apps has exponentially increased from $1 million USD in 2013 to $18 million USD in 2018. The burgeoning activity of tobacco control researchers in this domain have yielded major technological advances to address a longstanding problemwithallmobile-deliveredinterventionsthatseverelylimitstheireffectiveness:lowuserengagement.Thissymposiumshowsfivediverseandnovelapproachestoincrease smartphone and smartwatch app user engagement in the cessation process. Dr.BrickerwillfirstpresentthedesignanddevelopmentoftheiCanQuitapp,whichusesavirtualcoachtocreateatherapeuticrelationshipandgamificationtoincreaseprogression through the program. Dr. Sridharhan will present an mhealth intervention that applies Dr. Carol Dweck’s growth mindset theory to smokers’ beliefs about addic-tion as a new approach to engaging in smoking cessation treatment. Dr. Businelle with present the Smart-T app which uses ecological momentary assessment to assess risk for imminent relapse along with tailored messaging to prevent the lapse. Dr. Bullen will present the Chinese SCAMPI app, which runs on the WeChat social media platform (reaches 1 billion Chinese annually), that combines the COM-B and Behavior Change Techniques models to engage male Chinese smokers. Dr. Sherry McKee will present outcomesfromanRCTevaluatingajust-in-timesmartwatchappinterventionutilizingwearable biosensors which detect wrist movement in 3-D space. Each of these talks will presentrecruitment,baseline,retention,anduserengagementdatafromtherandomizedtrialstestingeachofthesefivenewsmokingcessationapps.Dr.ErikAugustsonwillsynthesizethetalksandtheirimplicationsforthefield.

SYM5ADESIGN OF THE ICANQUIT APP FOR SMOKING CESSATION AND UPDATE ON ITS EVALUATION IN A LARGE US RANDOMIZED CONTROLLED TRIAL

Jonathan B. Bricker, PhD, Noreen Watson, Kristin Mull, Jaimee Heffner. FredHutchinson Cancer Research Center.

Significance:Ascurrentstandardmhealthinterventionsarelimitedbylowuserengage-ment,wedesignedtheiCanQuitappwithagoalofboostinguserengagement.ThispresentationdescribesthemethodsthatyieldedtheiCanQuitappforsmokingcessationand a progress update on the large RCT testing the app. Methods: A comprehensive user-centered design framework included review of results from previous trials of mhealth apps, surveys and in-person interviews of smokers, consultation with app developers, and internal team review. We conducted eight rounds of user testing to develop and prototype potential core features with 5 smokers in each round (total N = 40). After initial developmentofiCanQuit,weconducteda7-daydiarystudyof7smokerstoidentifytechnicalissuesandfinalchanges.Followingincorporationofdiarystudyfindingsintotheapp,welaunchedtheiCanQuitrandomizedtrialinJuly2017.Trialdesign:randomizea national sample of 2500 adult daily smokers (at least 30% minority) wanting to quit to eitheriCanQuitoracurrentstandardapp,theNCI’sQuitGuideapp(branded“iCanQuit”for blinding), and cessation outcome survey follow-ups at 3, 6, and 12 months. Results: User testing showed that three core features were most engaging: (1) virtual coach, (2) gamification,and(3)on-demandurgehelp.RegardingtheRCT,todate,11,605werescreened,6,424eligible,and2,460randomized.Baselinecharacteristics:Meanage= 38.2 (11.8), 70% female, 35% minority, 42% high school or less education, Mean cigarettes/day = 18.0 (14.0). There were no imbalances across arms for any baseline variables (all p >.05). To date, the 3, 6, 12-month cessation outcome survey follow-up

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rates are 87.4%, 88.5%, and 85.0%, respectively, with no imbalances by treatment arm (allp>.05).Conclusions:iCanQuitisacomprehensiveresearch-engineeredappwithfeatures aimed at increasing engagement. Trial enrollment and retention have been asuccess,andhaveminimizedpotentialbiasfrommissingoutcomedata—whichisproblematic in mhealth studies. RCT intervention engagement results will be available at the presentation and cessation results in 2020.

FUNDING: Federal

SYM5BDOES A GROWTH MINDSET INTERVENTION ENHANCE ENGAGEMENT AND EFFECTIVENESS OF A SMARTPHONE APP FOR SMOKING CESSATION? A PILOT RANDOMIZED CONTROLLED TRIAL

Vasundhara Sridharan, PhD1, Yuichi Shoda2, JaimeeHeffner1, Jonathan Bricker1. 1Fred Hutchinson Cancer Research Center, 2University of Washington.

Significance:Thereisneedforinnovativetheory-drivenapproacheswiththepotentialtoenhancetheengagementandeffectivenessofsmartphoneappsforsmokingcessa-tion. One novel approach is to apply growth mindset theory to smokers’ beliefs about the permanence of addiction. The current study investigated whether the addition of a growth mindset intervention for addiction would enhance engagement and cessation rates of an established smartphone app for smoking cessation. Methods: Nationally recruited current daily smokers (N = 398) were randomly assigned to receive either a web-delivered growth mindset intervention plus a validated smoking-cessation smartphoneapp(SmartQuit)orthesmartphoneappalone.Theprimaryoutcomewasengagement: number of logins to the quit smoking app. The secondary outcome was cessation: 30-day point prevalence abstinence at two-month follow-up. Results: The two-monthoutcomedataretentionratewas92%(364/398).Thetwoarmsdidnotdifferon number of logins to the quit-smoking app (p =.38). The growth mindset plus app arm had cessation rates which trended higher than the app only arm (17% vs. 13%; p = .10). The per-protocol analysis showed that the growth mindset plus app arm had significantlyhighercessationrates(21%vs13%;p=.03)butnothigherengagementthan the comparison arm (p = .55). Conclusions: The addition of a growth mindset inter-vention for addiction might increase cessation rates of an established smartphone app for smoking cessation, thought it does not appear to enhance the app’s engagement. A fullypoweredrandomizedtrialwithlongtermfollow-upisnowneededtofurthervalidatethefindingsofthispilottrial.

FUNDING:Nonprofitgrantfundingentity

SYM5CRANDOMIZED CLINICAL TRIAL OF AN AUTOMATED SMARTPHONE BASED SMOKING CESSATION TREATMENT

Michael S. Businelle, PhD,EmilyT.Hebert,DarlaKendzor,DamonJ.Vidrine.Okla-homa Tobacco Research Ctr., Univ. of Oklahoma.

Significance:Smartphoneappscouldovercomemanyofthebarriersthathaveham-pereduseof traditionalempirically-basedsmokingcessation treatmentsbyofferingeasily accessible, highly tailored, and intensive interventions at a fraction of the cost of traditional smoking cessation counseling. We have shown that momentary changes in key variables can be tracked using ecological momentary assessments (EMA), and used to initiate just-in-time adaptive interventions (JITAI).Methods: This 3-armed pilot randomizedclinicaltrial(RCT)aimedtoassesstheinitialutilityofanautomatedsmart-phone-based smoking cessation intervention (Smart-T2) relative to standard in-person smokingcessationcliniccareandthefreeNCIQuitGuideapp.TheSmart-TappusesEMAs to assess risk for imminent smoking lapse, and tailors treatment messages based on risk of lapse and reported symptoms. The Smart-T app also advises participants to chew a piece of nicotine gum when risk for smoking lapse is elevated. Smokers who attendedaclinicbasedtobaccocessationprogramwererandomizedtogroupsandfollowed for 13 weeks (1 week pre-quit through 12 weeks post-quit). All participants were asked to complete EMAs on study provided smartphones for 5 weeks.Results: On average, participants (N=84) were 49 years old and smoked 22 cigarettes per day at baseline. Participants were 49% female, 68% White, 18% Black, and 8% Native Amer-ican. To date, 64 participants have reached the 12 week post-quit follow-up visit. A total of26%ofSmart-T,14%ofQuitGuide,and21%ofin-personparticipantshaveachievedbiochemicallyconfirmed7-daypointprevalenceabstinenceatthe12weekpost-quitvisit. All Smart-T participants have reported that the tailored messages were helpful and 86% reported that they used a piece of nicotine gum, at least “sometimes,” when

advised to do so by the app. App design (e.g., which variables were intervened upon and when, on demand and prompted intervention content), engagement with app features, andfinalstudyoutcomeswillbediscussed.Conclusions:Dynamicsmartphone-basedJITAIs may increase user engagement and exposure to treatment related materials.

FUNDING: Academic Institution

SYM5DSCAMPI: A WECHAT-BASED APP TO SUPPORT CHINESE MEN TO QUIT SMOKING

Chen Jinsong, MPH1, Elsie Ho2. 1University of Auckland, Auckland, New Zealand, 2University of Auckland.

Significance:HalfofallmeninChinasmoketobaccobutreachingthemwithsupportto quit smoking is challenging. We sought to reach and engage them with a program (SCAMPI), that operates within the most widely used social media app in China, WeChat (1.04 billion subscribers; 200 million regular users).Methods: Using a program devel-opment questionnaire based on reviewing smoking research literature in China’s male smokersandonsmokingbehaviourchangemodels(specifically,Michie’sCOM-Bmodeland Behaviour Change Theories), we conducted an iterative, collaborative prototype app development process with 20 male smokers in China, participating remotely using WeChat. We elicited their preferences for smoking cessation app user interface and userexperiencefeaturesandincorporatedthemintothefinalappdesign.Wethencom-menced a digital randomised controlled trial (N= 320), with participants being recruited, randomised and followed up weekly over 3 months, exclusively via WeChat. Control participants receive information about smoking cessation care available in China, and all participants receive micro-incentive payments for providing data on their smoking throughout the trial.Results: In one month of collaborative development, the SCAMPI prototype app recorded 948 visits, 272 mentions in WeChat users’ conversations, and 80 social media shares on WeChat. Engagement was optimised by the interactive, iterative development process with potential end-users and integration within the widely used WeChat platform. Cessation outcomes from the RCT will be available at the presentation in February, 2019. Conclusions: It is feasible to engage smokers to co-develop a theory-based culturally adapted cessation app and conduct a fully digital RCToftheappwithintheWeChatsocialmediaplatform.Iftheresultsforefficacyaresupportive, this program will be available to millions of Chinese men who smoke and use WeChat, at no cost.

FUNDING: Academic Institution

SYM5ERANDOMIZED CLINICAL TRIAL OF A JUST IN TIME INTERVENTION BASED ON WEARABLE BIOSENSORS DETECTING SMOKING GESTURES

Sherry McKee, PhD1, Abhinav Parate, PhD2, Akshaya Shanmugam, PhD2, Deepak Ganesan, PhD3. 1Yale School of Medicine, New Haven, CT, USA, 2Lumme Inc, Am-herst, MA, USA, 3University of Massachusetts, Amherst, MA, USA.

SIGNIFICANCE: Technological advances in wearable biosensors and advanced machine learning algorithms have made it possible to wirelessly and passively detect smoking in real time. With such hardware and software innovations, we are now able to build treatment platforms that are seamlessly integrated into smokers’ lives. In this presentation, outcomes from an NCI-funded SBIR grant will be presented reporting on thedevelopmentandefficacyoftheLummeplatform.METHODS:TheLummeplatformcontinuouslymonitorssmokingbehaviorusinganenergy-efficientandhighlyaccurategesturerecognitionalgorithmwhichutilizestheinertialsensorsincommerciallyavailablesmart watches with 98% accuracy. After smokers wear the system for 2 weeks passively capturing smoking behavior and related contextual information (e.g., activity, social context, location, and time of day), the system can predict future smoking episodes with a 6-minute prediction window. We developed an 8-week just-in-time intervention basedonthistechnologywheresmokersreceivedpersonalizedmotivationalandskill-basedtextmessageswhentheyareinhigh-risksituations.Toevaluatetheefficacyofthe system, we recruited n=140 daily smokers (>10 CPD) from across the United States tocompleteadouble-blindrandomizedcontroltrialcomparingtheLummejust-in-timeintervention with the NCI-supported text message platform Smokefree TXT. Participants had a 2-week count-down to quit, and following the quit day, had a 6-week intervention period.RESULTS: Analysis examining end-of-treatment point prevalence demonstrated significantdifferences in ratesofquitting.Ratesofquittingwith theLummesystemwere 49.2% and rates of quitting with the Smokefree TXT platform were 30.2%. Rates

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of treatment completion were similar across conditions.CONCLUSIONS: Results to date are highly promising and support that just-in-time interventions are now possible. Tobacco smoking continues to be the leading cause of preventable morbidity and mortality and such interventions have the potential to be easily scalable to address this public health concern.

FUNDING: Federal

SYM6MULTIPLE ROLES FOR NICOTINE IN REINFORCEMENT AND ADDICTION

Matthew Palmatier. East TN State University, Johnson City, TN, USA.

Uncertainty about the role of nicotine in tobacco dependence has historically centered onitsweakprimaryreinforcingeffectsinnon-humananimals.Nicotinemaintainslowrates of self-administration in rats and non-human primates, which is inconsistent with the robust self-administration of nicotine in human smokers. However, over the past 15yearspreclinical researchhasdemonstratedanothereffectofnicotine thatmayresolve this uncertainty - nicotine potently increases responding for non-nicotine re-wards.Thiseffectofnicotinecanleadtohighratesofoperantbehavior,apatternthatis much more consistent with human smoking. The goal of this symposium is to bring togetheraninterdisciplinarygroupofscientiststopresentnew,translationalfindingson the interactions between nicotine and non-nicotine stimuli, the variety of circum-stancesunderwhichtheinteractiveeffectsareobserved,andthepotentiallong-termimpactoftheseeffectsonbehavior.Dr.MattPalmatierwillpresentfindingsshowingthelong-termeffectsofnicotineonPavlovianconditionedapproachandtheimpactofnicotine-enhanced conditioned stimuli on subsequent cocaine-seeking behavior. Dr. Paul Clarke will present the results of new studies showing that the reinforcement enhancing effectsofnicotineareobservedatlowbloodconcentrations,andareindependentofhabituation to responding for the non-nicotine reward. Dr. Scott Barrett will present new researchinvestigatingtheenhancingeffectsofnicotineonalcoholreinforcementandtheessentialvalueofalcoholinrats.Dr.KenPerkinswillpresentfindingsshowingthatthereinforcementenhancingeffectsofnicotinearealsoobservedinhumanswhennicotineis administered via tobacco cigarettes and, to lesser extents (possibly due to dosing), viaelectroniccigarettes,nicotinepatch,andnasalspray.Dr.Bevinswillsummarizetheworkpresented,anddiscussnewavenuesforresearchontheseeffectsofnicotine.This symposium was contributed by the SRNT Basic Science Network.

SYM6ANICOTINE INCREASES SIGN TRACKING BUT NOT GOAL TRACKING: EFFECTS ON SUBSEQUENT REWARD SEEKING

Matthew I. Palmatier, Ph. D., Chloe T. Majors, Amanda L. Smith. East Tennessee State University.

Nicotine increases Pavlovian conditioned approach (PCA) to reward associated cues (‘sign-tracking’), suggesting that nicotine enhances the attribution of incentive salience to reward-predictive stimuli. The goal of the present studies was to investigate whether nicotineeffectedanenduringchangeinincentivesalienceofthestimulus.Ratswererandomly assigned to nicotine (NIC, 0.4 mg/kg) or saline (SAL) PCA groups (n=15/group). Rats were injected subcutaneously with their assigned solution 15 min before each PCA test. During PCA sessions a conditioned stimulus (CS, 15s lever-extension and cue-light illumination) was paired with sucrose (20% w/v in a liquid dipper/recep-tacle).Duringacquisition(29PCAsessions),theNICgroupshowedasignificantbiastoward the sign relative to the SAL group; lever contacts and presses were increased and latency to contact the lever was reduced. Rats were then separated into two ex-periments – saline substitution (n=12/group), or IV cocaine self-administration (CSA; n=3/group). In the saline substitution experiment, nicotine pre-treatments (NIC group) were replaced with saline. However, the NIC group maintained their approach to the CS acrossall9testsessions;levercontactsandpressesweresignificantlyhigherthantheSAL group throughout testing. In the CSA experiment, IV cocaine infusions (0.125 mg/kg/inf) were delivered for meeting the schedule of reinforcement on the CS lever from PCA sessions. IV cocaine infusions were accompanied by 15 s presentation of the cue lightfromPCAtests.TheNICgrouphadsignificantlyhigherratesofoperantrespondingandcocaineintakeonthefirsttest,relativetotheSALgroup.Thesefindingsconfirmthatnicotine can potently increase the salience of non-nicotine stimuli that predict reward. The increased salience imparted by nicotine is enduring, and this enduring change in salience may promote maladaptive behaviors in other contexts.

FUNDING: Academic Institution

SYM6BREINFORCEMENT ENHANCEMENT BY NICOTINE IN ADULT RATS: PHARMACOLOGICAL AND BEHAVIOURAL ASPECTS

Paul Clarke, Ph. D.,AnnieConstantin,JenniferM.Wright,SuelynRen,TszManVa-nessa Chan, Doran Satanove. McGill University.

Nicotine has been shown to enhance the impact of several primary and conditioned reinforcers. However, nicotine doses used in animal studies have often exceeded smoking-associated levels of exposure, and reinforcement enhancement has not always beendifferentiatedfromamoregeneralizedbehaviouralactivation.Inaddition,whethernicotine enhances non-nicotine reinforcers via a habituation-related mechanism has been little explored. In all experiments, adult male rats pressed an “active” lever to produce a reinforcing visual stimulus (brief cue light illumination), during daily 60-min sessions. Pressing on either the active or inactive lever retracted both levers for 60 s. Nicotine was tested in a range of doses (0.025-0.2 mg/kg), given either by continuous intravenous (IV) infusion, or in regularly-spaced IV pulses (of 3-s or 30-s duration), or pre-sessionsubcutaneous (SC) injection. Inotherexperiments, theacuteeffectsofnicotine and d-amphetamine were directly compared, and we also determined whether reinforcement enhancement by nicotine could be prevented by acute systemic injection of various receptor antagonists. We found that nicotine selectively increased responding forthelightcue,confirmingpreviousreports.Thiseffectoccurredreliablyatdosesaslow as 0.1 mg/kg SC or IV, corresponding to measured serum levels of around 25 ng/ml.Intravenousnicotinewasequallyeffectivewhetherdeliveredbycontinuousinfusionor in a pulsatile fashion.Nicotineandd-amphetaminewere similarly effective, andneither drug appeared to slow habituation to the visual reinforcer. In tests with receptor blockers, reinforcement enhancement by nicotine was abolished by the broad-spectrum nicotinic antagonist mecamylamine and by a D1 dopaminergic antagonist. In conclusion, reinforcement enhancement by nicotine was evident across several modes of drug delivery, and occurred even at serum levels lying within the daytime range of moderate cigarettesmokers.Furthermore,thereinforcementenhancingeffectofnicotinewasaslarge as that produced by d-amphetamine, occurred independent of habituation, and depended on dopaminergic transmission.

FUNDING: Federal

SYM6CEXTENDING THE REINFORCEMENT-ENHANCING EFFECTS OF NICOTINE TO ALCOHOL REINFORCEMENT THROUGH BEHAVIORAL ECONOMICS

Scott T. Barrett, Ph. D.1, Brady M. Thompson1, Jessica R. Emory1, David A. Kwan1, Chris E. Larson1, Rick A. Bevins2. 1University of Nebraska-Lincoln, 2University of NE-Lincoln.

Nicotine-dependence and alcohol-dependence are highly correlated: up to 80% of alco-hol-dependent persons in the US are regular smokers, and risk of alcohol-dependence is four times higher among people who are nicotine-dependent. Additionally, there are differencesintheprevalenceandnatureofnicotine-andalcohol-dependencebetweenthesexes.Researchindicatesthatnicotineproducesreinforcement-enhancingeffectson the value of sensory and appetitive reinforcers, and this may extend to alcohol reinforcement.Additionally,manyeffectivesmokingcessationpharmacotherapeuticshavealsobeendemonstratedtoproduceenhancementeffectscomparabletothoseofnicotine,whichmaypartiallyaccountfortheirefficacyintreatment.Wepresentaseriesofbehavioraleconomicinvestigationsoftheroleofthereinforcement-enhancingeffectsof nicotine in facilitating alcohol self-administration using reinforcer demand methods. Inseparatestudies,theeffectsofnicotinedose,biologicalsex,reinforcerquality,andadministration of smoking cessation pharmacotherapeutics (bupropion, varenicline and sazetidine-A)wereevaluated.Ineachofthesestudies,maleandfemaleWistarratsweretrained to self-administer alcohol using a brief sucrose-fading procedure. Subsequently, lever-pressing was maintained by 12-15% ethanol solution in brief self-administration sessions. Over blocks of several sessions, the response requirement per ethanol-dipper presentation was systematically increased, during which injections of saline or nicotine (alsobupropion,varenicline,orsazetidine-A,inonestudy)wereadministeredwithineach cost-condition. Ethanol consumption as a function of the response-cost to obtain ethanolwasanalyzedusinganexponentialreinforcerdemandmodel,andtheeffectsofbiological sex and drug administration to alter these demand functions was evaluated. Together, these studies indicate the nicotine (and some smoking cessation pharmaco-therapeutics)enhancesthereinforcementvalueofalcoholbydecreasingtheeffectofincreasing response-cost to constrain alcohol self-administration.

FUNDING:Federal;State;Nonprofitgrantfundingentity

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SYM6DNICOTINE ENHANCES THE REINFORCING EFFECTS OF NON-DRUG REWARDS IN HUMANS

Kenneth Perkins, Ph. D.1,JoshuaKarelitz2. 1WPIC University of Pittsburgh, 2Univer-sity of Pittsburgh.

Preclinical research documents that, aside from the direct primary and secondary reinforcingeffectsofnicotine,nicotinealsoacutelyenhancesthereinforcingefficacyof other reinforcers (“rewards”) not directly associated with stimuli tied to drug intake itself.Studyoftheseeffectsinhumanshaslargelybeenoverlooked,butrecentfindingssuggest they may have clinical implications for more fully understanding the persistence of tobacco dependence. This presentation describes methods and results from the limited controlled researchspecificallyassessingnicotine’sacute reinforcementenhancingeffects inhumans,particularlyas they relate tosucheffects innon-humanmodels.Within-subjectdesignscomparednicotinevs.placeboeffectsonrespondingreinforcedbydifferentnon-drugrewardsvs.norewardcontrol,andprocedureswereexplicitlybasedonthosefrompreclinicalstudies.Reinforcementenhancingeffectshavebeenfound in nicotine administered via tobacco cigarettes and, to lesser extents (possibly due to dosing), via electronic cigarettes and nicotine medications of patch and nasal spray. This research indicates that nicotine per se increases responding in humans that is reinforced by some rewards (auditory stimuli via music, visual stimuli via video) but perhapsnotbyothers(e.g.money).Thispatternoffindingscouldsuggestdifferentialdose-dependencyofnicotine’sreinforcementenhancingeffectsacrossavailabletypesofrewards.Theseeffects,seenindependentandnon-dependentsmokers,reflectpos-itive reinforcement due to nicotine, not negative reinforcement due to withdrawal relief. After detailing these relatively few human studies, we address potential consequences oftheseeffectsfordependenceandtobaccocessationefforts,includingthepossiblysimilareffectsofnon-nicotinecessationmedicationsinquittingsmokers.Futureclinicalresearch should examine factors determining which types of rewards are (or are not) enhancedbynicotine,consequencesofthelossofthesenicotineeffectsafterquittingsmoking,andpotentialindividualdifferencesintheseeffects.

FUNDING: Federal

SYM7LEVERAGING EPIDEMIOLOGICAL, ECOLOGICAL, AND CLINICAL DATA TO IMPROVE SMOKING CESSATION RATES AMONG HEAVY DRINKING SMOKERS

Sarah S. Dermody, PhD. Oregon State University.

Cigarette use is prevalent in heavy drinkers. Furthermore, heavy drinking smokers have a substantially lower cessation rate than non-heavy drinking smokers. This symposium will present and integrate data on how to promote smoking cessation among alcohol users, emphasizing heavy drinkers.Datawill be presented frommultiple levels ofanalysis, including epidemiological, ecological, and clinical laboratory-based investi-gations of the complex associations between alcohol and tobacco use during smoking cessation. The clinical implications of results will be discussed. First, Dr. Weinberger will present epidemiological data of the associations of problematic alcohol use (e.g., alcohol use disorder, heavy alcohol use) with cigarette smoking and quit rates over time. Next, focusing on ecological momentary associations, Dr. Dermody will share results from smokers who drink to show that the association between alcohol use on smoking lapses changes over the course of a smoking cessation attempt. Dr. Kaye will then presentfindingsfromasmokingcessationcomparativeeffectivenesstrialofvareniclinevsnicotinepatchvscombo-NRTconcerningtheinfluenceofbaselinealcoholuseonsmoking cessation outcomes and how those associations vary as a function of treatment condition. Using data from the same trial, Dr. Johnson will focus on the associations between alcohol and other drug use disorders on cessation success, withdrawal and nicotinedependence,andresponsetotreatment.Then,Dr.Fucitowilldiscussfindingsfrom a 16-week clinical trial of varenicline in combination with medical management and support for changing drinking in order to examine predictors of early response to varenicline in smokers with alcohol use disorder. Lastly, using data from the same trial, Dr. Bold will present longitudinal post-treatment alcohol and smoking outcomes (12 monthfollow-up)insmokerswithalcoholusedisorder,anddiscusshowtheseeffectsmaydifferbysex.Thediscussant,Dr.McKee,willendthesymposiumbysynthesizingtheresultsfromthefivepresentationsanddiscussingtheimplicationsofthesedataforimproving smoking cessation among heavy drinking smokers.

SYM7ARELATIONSHIPS BETWEEN PROBLEMATIC ALCOHOL USE AND CIGARETTE SMOKING AMONG INDIVIDUALS IN THE UNITED STATES: EPIDEMIOLOGICAL INVESTIGATIONS

Andrea H. Weinberger, PhD1, Renee D. Goodwin2. 1Ferkauf Graduate School of Psy-chology, Yeshiva University, 2City University of NY and Columbia University.

Alcohol and tobacco use are two of the leading causes of morbidity and mortality in the United States (US) and globally. Alcohol and cigarette use are commonly linked and individuals who use both alcohol and cigarettes experience greater health risks than those who use either substance alone. The prevalence of cigarette smoking has decreased and cigarette smoking quit rates have increased over time in the general US population. However, there is evidence that smoking remains higher, and quit rates remains lower, for some subgroups such as persons with problematic alcohol use (e.g., heavy alcohol use, alcohol use disorders). Epidemiologic investigations can identify subgroups of smokers who are disproportionally impacted by smoking behavior and whowouldbenefitfromtargetedresearchandtreatmentefforts.Thistalkwillpresentresults from a series of epidemiologic investigations into the relationship of problematic alcohol use and cigarette smoking in representative samples of the US adult population using data from the National Survey on Drug Use and Health (NSDUH) and the National EpidemiologicSurveyonAlcoholandRelatedConditions(NESARC).Specifically,datawill be presented on trends in cigarette smoking prevalence and smoking quit rates over time by alcohol use status as well as the relationship between smoking behavior and alcohol use and alcohol use disorders among persons with past alcohol use disorders. Tosummarize,personswithproblematicalcoholusedemonstratepersistentlyhigherprevalences of smoking and lower cigarette quit rates than persons without problematic alcohol use over time. Further, cigarette smoking is associated with alcohol use and alcohol use disorder relapse among persons with past alcohol use disorders. Individuals with problematic alcohol use may need additional resources and interventions to help reduce the prevalence of smoking and increase quit rates. Reducing the prevalence of smoking among persons with problematic alcohol use may help reduce the negative consequences of smoking as well as improve alcohol treatment outcomes.

FUNDING: Federal

SYM7BTHE TIME-VARYING EFFECT OF ALCOHOL USE ON CIGARETTE SMOKING RELAPSE RISK

Sarah S. Dermody, PhD1,SaulShiffman2. 1Oregon State University, 2University of Pittsburgh.

Background: Ecological momentary assessment (EMA) data suggest that 2 of 5 smoking lapses occur when drinking alcohol. Our analyses aimed to identify when in the quitting process alcohol leads to lapses and strong temptations to smoke. Methods: Using EMA, intensive data was collected from 159 daily smokers (mean age=43.90 (SD=10.41), 56.60% female) who drink with respect to the timing of smoking lapses, temptations to smoke,andrecent(past15minutes)alcoholuse.Alogistictime-varyingeffectmodel(TVEM) modeled lapses during the 4 weeks following a successful quit attempt (i.e., quit >24 hours) as a function of concurrently-assessed recent alcohol use. Analyses controlledforweekend/weekday,gender,andtimetofirstcigarette(moredependent:5 minutes). Time was continuous, based on the day/time of electronic diary completion. Analyses were repeated with temptation to smoke as the outcome for observations when smoking did not occur. Results: Recent alcohol use was associated with smoking lapse for less nicotine dependent individuals only, and the association wastime-varying.Alcoholusebecameasignificantpredictoroflapsebytheendofthefirstdayquit.Then,theassociationincreasedinstrengthuntilday7.Thisassociationsubsequently decreased such that alcohol use was no longer associated with lapse riskbytheendofday20ofthequitattempt.Therewerenogenderdifferences.Alcoholusewaspositivelyassociatedwithtemptationtosmokeforwomenfromthefirstdayquituntilday17,afterwhichtheassociationdecreasedandbecamenon-significant.Asimilar time-varying pattern was seen for less dependent individuals. Alcohol use was unrelated to temptation to smoke for men and more dependent individuals throughout the quit attempt. Conclusions: The association between drinking and smoking tempta-tions and lapses varies over time, peaking early in abstinence and declining thereafter. Thiscouldreflectprogressiverelapseofmostvulnerableindividualsorhabituationtoalcohol as a smoking cue. Interventions to prevent alcohol-related lapsing are most relevant early in the quit period.

FUNDING: Federal

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2019 Symposia

SYM7CSMOKING CESSATION OUTCOMES FOR HEAVY DRINKING SMOKERS USING VARENICLINE, NICOTINE PATCH, OR COMBINATION NICOTINE REPLACEMENT THERAPY

Jesse T. Kaye, PhD1, Megan E. Piper1, Timothy B. Baker1, Jessica W. Cook2. 1Univer-sity of Wisconsin, 2University of WI School of Medicine and Public Health.

SIGNIFICANCE:A sizeable group of smokers also drink heavily.Heavy drinkingsmokers are at particular risk for a wide array of health concerns and are less likely to successfully quit smoking relative to moderate drinkers. Preliminary evidence suggests that varenicline may be particularly useful in aiding heavy drinking smokers to quit smoking.Weperformedsecondarydataanalysisofalargecomparativeeffectivenesstrial of smoking cessation pharmacotherapies to: 1) evaluate the relations between baseline alcohol use patterns (heavy drinker, moderate drinker, and non/infrequent drinker)andpoint-prevalenceabstinenceat26weeks,and2)explorewhetherdifferentpharmacotherapiesareespeciallyeffectiveforheavydrinkers.METHODS:Smokersmotivatedtoquit(N=1086)wererandomizedtoreceivevarenicline,nicotinepatch,orcombinationnicotinereplacementtherapy(C-NRT;nicotinepatch+nicotinelozenge)in a 12-week open-label smoking cessation trial. RESULTS: Results showed that 27% ofparticipantswereclassifiedasheavydrinkers(>1binge/monthinpastyear),39%as moderate drinkers (>1day/month in past year but did not meet criteria for heavy drinking), and 34% as non/infrequent drinkers (< 1/month in past year). Heavy drinkers reported the lowest 6-month abstinence rates (21%), compared to moderate (27%) and non/infrequent(25%)drinkers,butthisdidnotreachstatisticalsignificance(p=.057).Unexpectedly, heavy drinkers using varenicline reported the lowest rate of abstinence (18%), followed by C-NRT (21%) and patch (24%). Moderate drinkers, on the other hand, reported the lowest rates of abstinence when using patch (25%), followed by varenicline (26%)andC-NRT(29%).Non/infrequentdrinkerswerealsomostlikelytobenefitfromusing C-NRT, followed by varenicline and then patch (28%, 24%, 19%, respectively). CONCLUSION:Resultssuggestthatdrinkingstatusmaymoderatetheeffectivenessof smoking cessation pharmacotherapy. Additional research is needed to develop and enhance targeted interventions for smokers who drink heavily.

FUNDING: Federal

SYM7DTHE RELATIVE IMPACT OF ALCOHOL, SUBSTANCE, AND COMORBID USE DISORDERS ON SMOKING CESSATION SUCCESS AND RELATED CONSTRUCTS

Adrienne L. Johnson, PhD, Timothy B. Baker, Megan E. Piper. University of Wis-consin.

Psychiatric comorbidity is both prevalent and problematic in terms of cigarette smoking and cessation success. Dual alcohol and tobacco use rates are particularly high, and are associated with decreased smoking cessation success as well as increased nicotine dependence and withdrawal symptoms. Further, pathological alcohol (i.e., Alcohol Use Disorder [AUD]) and substance (i.e., Substance Use Disorder [SUD]) use are associated with greater tobacco use and nicotine dependence. Despite the co-occurrence and negative impact of these disorders, limited research has evaluated the independent effectsofAUDand/orSUDonsmokingcessationsuccesswithinlarge,rigorouscessationtrials. This study examined the relative impact of past-year and lifetime AUD and SUD on early and sustained smoking cessation success as well as nicotine withdrawal and dependence.Adultdailysmokers(n=1051;52.5%female)participatedinarandomized,comparativeeffectivenesssmokingcessationtrial.Participantscompletedastructuredclinicalinterview(CIDI)andwerecategorizedinto:1)nolifetimehistoryofAUD/SUD(n=405), 2) only AUD (n=292), 3) only SUD (n=102), and 4) comorbid AUD/SUD (n=252). Results indicated that, compared to smokers with no history of AUD/SUD, smokers with comorbidlifetimeSUD/AUDweresignificantlymorelikelytobesmokingat8weekspost-quit(OR=1.4;p=.04),butthisdifferencedidnotremainsignificantat6months.Therewerenosignificantdifferencesbetweentheremaininggroupsateithertimepoint.Conversely,forpastyeardiagnoses,onlysmokerswithSUD(n=34)weresignificantlymore likely to be smoking at 6 months compared to those without any AUD/SUD history (n=405;OR=3.8;p=.04).Cessationfindingsremainedunchangedaftercontrollingforgender, race, and treatment condition. Smokers with past year SUD and lifetime AUD/SUD also reported higher nicotine dependence and withdrawal symptoms one week post-quit (p’s.13), but varenicline produced higher rates of PA vs. placebo at4,9,and12months(p

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2019 Symposia

SYM8EXAMINING AND ADDRESSING COMMUNICATION INEQUALITIES IN TOBACCO CONTROL

Andy Tan, PhD, MPH, MBA, MBBS. Dana-Farber Cancer Institute.

Communication inequalities in tobacco marketing and countermarketing exposure, at-tention, and information processing among vulnerable populations are important factors thatinfluencetobacco-relatedhealthdisparities.It isthereforeimportanttoexaminewhether communication inequalities are present among populations disproportionately harmedbytobaccouseandtominimizethesecommunicationinequalities,ifpresent.This symposium presents population-based research from the U.S., Canada, Australia, andMexicothatexaminethepresenceandeffectsofcommunicationinequalitiesas-sociatedwithtobacco-relatedhealthdisparitiesutilizingavarietyofresearchmethods.Andy Tan, chair, will introduce the symposium and present an overview of a conceptual framework of communication inequalities in tobacco control research and practice draw-ingfromtheStructuralInfluenceModelofCommunicationandtheNCIMonographonSocioecological Approach to Addressing Tobacco-Related Health Disparities. Meghan Moran will present results from a large online survey among U.S. youth and young adultsdemonstratingdifferencesintheappealofvarioustobaccomarketingtactics(e.g.,branding, promotional tactics, advertising themes) across socioeconomic status (SES), race/ethnicityandLGBTQstatus.KelvinChoiwillpresentfindingsfrom12focusgroupdiscussionamongU.S.youngadultsmokersfromlowerSESanddifferentracial/ethnicbackgrounds to compare their reactions to recent anti-smoking messages including the Tips from a Former Smoker (TIPS) and Every Try Counts (ETC) campaigns. Third, EmilyBrennanwillpresentanevaluationstudyutilizingarollingcross-sectionalsurveydesign to assess the reach and impact of a media campaign strategy targeted at low SES smokers in Australia. James Thrasher will present data from experimental studies comparing the effects tobacco package inserts andgraphicwarning labels acrosspopulation subgroups in Canada and Mexico, respectively. Jessica Rath, discussant, willsynthesizetheseresultsanddiscussimplicationsonfutureresearchandpracticeto reduce communication inequalities among vulnerable populations.

SYM8ACONCEPTUAL FRAMEWORK OF COMMUNICATION INEQUALITIES IN TOBACCO CONTROL RESEARCH AND PRACTICES

Andy SL Tan, PhD, MPH, MBA, MBBS. Dana-Farber Cancer Institute.

Thispresentationoutlinesaconceptualframeworkofthedeterminantsandeffectsofcommunication inequalities in the context of tobacco control research and practice. The conceptualframeworkisinformedbytheStructuralInfluenceModelofCommunicationand the NCI Monograph 22 (A Socioecological Approach to Addressing Tobacco-Re-latedHealthDisparities).Communicationinequalitiesaredefinedasdifferencesintheability to generate, manipulate, and distribute information as well as to access, process, andactonthatinformationamongsocialgroups.Theyarehypothesizedasimportantmediators throughwhich social determinants influence tobacco-related knowledge,attitudes, beliefs, and behaviors. Communication inequalities occur at the individual and systems or institutional levels. For instance, at the individual-level, chronic stresses due to discrimination, lower socioeconomic position, and belonging to racial, ethnic, sexual and gender minority groups are linked with targeted tobacco industry marketing and have higher exposure to pro-tobacco product messaging, which is in turn associated with higher susceptibility and uptake of tobacco products in certain vulnerable groups. At the systems or institutional level, lack of social support and availability of cultural-ly-appropriate community-bases resources for tobacco treatment may mean that certain groups are disadvantaged in accessing treatment information, leading to disparities in successful tobacco cessation. Tobacco control policies including tobacco packaging warning labels, anti-tobacco media campaigns through social media, and reliance on digital technology to deliver tobacco cessation treatment may further exacerbate existing tobacco-related health disparities if vulnerable populations are less likely to be exposed to anti-tobacco information or perceive these information as less relevant for them through these channels. This framework provides a useful model to develop testable research hypotheses of the role of communication and generate intervention effortstominimizecommunicationinequalitiesandultimatelyeliminatetobaccorelatedhealth disparities in vulnerable populations.

FUNDING: Unfunded

SYM8BDISPARITIES IN THE APPEAL OF CIGARETTE ADVERTISING FEATURES BY RACE, SOCIOECONOMIC STATUS AND SEXUAL ORIENTATION

Meghan Moran, PhD. Johns Hopkins Bloomberg School of Public Health.

Background: There are well-established disparities in exposure to cigarette marketing bysocioeconomicstatus,race/ethnicityandLGBTQstatus.However,themechanismsthrough which exposure to this marketing might contribute to these disparities in ciga-retteusearelessclear.Thecurrentstudysoughttoidentifydifferencesintheappealof various tobacco marketing tactics (e.g., branding, promotional tactics, advertising themes)acrosssocioeconomicstatus,race/ethnicityandLGBTQstatus.Methods:Anonline survey was given to a national sample of 2,619 12-17 and 2,625 18-24 year-olds. Participants were shown and reported perceptions of a cigarette ad randomly selected from a set of 50 ads. Ads were content coded and seven commonly used tactics were identified:coupons,sweepstakes,outdoorsthemes,environmentalthemes,funthemes,floraimageryandoutdoorssettings.Likingandcuriosityabouttheadvertisedproductweretheprimaryoutcomesofinterest.Mixedeffectslogitmodelswithadidentifierasarandomeffectandparticipantandadcharacteristicsasfixedeffectswereconducted.Models included interaction terms between ad features and sociodemographic variables totestfordifferencesacrossgroups.Toexaminetheeffectofadbrandonliking,par-ticipants were asked if they had a favorite tobacco ad and the brand of the ad.Results: Sweepstakes was associated with increased ad appeal across all groups. Outdoors themes (AOR=.51) and settings (AOR=.64) were less likely to appeal to non-white (vs. white) youth. Swisher Sweets was more likely to be named as a favorite ad among black and Hispanic youth and LGBT youth. Among black youth, Newport and Black & Mild were more likely to be named as the brand of favorite ad, while Marlboro, Camel, and American Spirit were less likely to be named as favorite. Newport was more likely to be named as favorite ad among lower SES youth. Conclusions: Understanding the brandsandadvertisingstrategiesthatappealtodifferentsub-groupsofyouthcaninformcountermarketing campaigns and marketing restrictions.

FUNDING: Federal

SYM8CREACTIONS TO TWO RECENT NATIONAL ANTI-SMOKING MESSAGES AMONG LOWER-SOCIOECONOMIC HISPANIC, NON-HISPANIC BLACK, AND NON-HISPANIC WHITE YOUNG ADULT SMOKERS

Kelvin Choi, PhD, MPH. National Institute on Minority Health and Health Disparities.

Background: Anti-smoking campaigns are an important strategy to promote smoking cessation. We explored how lower socioeconomic-status (SES) young adult smokers ofdifferentracial/ethnicbackgroundsreacttorecentanti-smokingmessages.Methods:Lower SES (

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2019 Symposia

SYM8DHOW TO DESIGN AND DELIVER MASS MEDIA CAMPAIGNS TO AVOID COMMUNICATION INEQUALITIES IN TOBACCO CONTROL: EVIDENCE FROM AUSTRALIA

Emily Brennan, PhD. Cancer Council Victoria.

Background: Despite substantial progress in reducing smoking prevalence in Australia, people living with social and economic disadvantage continue to be more likely to smoke. Mass media campaigns have played a central role in Australia’s comprehensive tobacco controlprogram.Givenevidenceofdifferencesbysocioeconomicstatus(SES)inthereach of certain media channels and the impact of certain message types, these cam-paigns need to be carefully implemented to avoid exacerbating existing disparities. In the state of Victoria, Australia, the campaign strategy has included: formative research and message pre-testing with lower SES smokers; development of highly emotional messages known to work well with lower SES smokers; and targeting media buys towards those channels most frequently used by lower SES smokers. In this study, we examinedthesuccessofthisstrategyinreachingandinfluencingsmokersacrossSESgroups.Methods: A weekly cross-sectional telephone survey was conducted among 7,841 Victorian adult smokers between 2012 and 2015. Logistic regression analyses examined associations between exposure to anti-tobacco advertisements categorised as being predominantly fear-, sadness-, combined negative emotion-, or hope-evoking, andadvertisementrecall,quitting-relatedthoughts,confidence,intentionsandsocialnorms. Interaction terms tested whether these associations varied by SES (low; mid; high;definedusingacombinationofindividual-leveleducationandarea-leveldisad-vantage).Results: Broadcast of predominantly fear-evoking advertisements led to the highestlevelsofadvertisementrecall,increasedquittingthoughts,confidence,inten-tions,andperceiveddisapprovalandembarrassmentaboutbeingasmoker.Effectswereconsistentacrosssmokersfromlow,midandhighSESgroups.Effectsforotheremotive-evoking advertisements were mixed or null and showed no variation across SES groups.Conclusions: Careful design and implementation can ensure that tobacco control mass media campaigns do not exacerbate existing SES disparities. Campaigns thatpredominantlyevokefeararemosteffectiveforallSESgroups.

FUNDING: Federal

SYM8EASSESSING THE HEALTH EQUITY IMPACT OF CIGARETTE WARNING POLICIES: RESULTS FROM LONGITUDINAL STUDIES OF ADULT SMOKERS IN CANADA AND MEXICO

James Thrasher, PhD. University of SC.

BACKGROUND: Prominent pictorial warning labels (PWLs) promote smoking cessation; yet their potential health equity impact has been assessed mostly in brief experimental studies. This study assessed whether smokers’ responses to PWLs and inserts vary by socioeconomic status (SES) in Mexico and Canada, the only country whose PWL policy includes package insertswith cessation tips and benefits.METHODS:DatawereanalyzedfromonlinecohortsofadultsmokersinCanada(n=3,506)andMexico(n=3,801)whorespondedtoatleast1of7surveysfrom2012to2014.Generalizedestimating equation (GEE) models regressed attention to PWLs and, for Canada, to inserts on SES indicators (i.e., education=high school or less, some college, univer-sityormore;andincome=tertiles).GEEmodelsalsoregressedself-efficacyandriskperceptions on attention variables and SES, testing for interactions between them. Finally, GEE models regressed quit attempts and sustained quit attempts (30 days or morewithoutsmoking) fromsubsequentsurveys (t+1)onattentionvariables,SES,and interactions, as assessed at the prior survey (t). All models adjusted for covariates (age, sex, smoking intensity, quit intentions, quit attempts), with additional covariates incessationmodels(self-efficacy,riskperceptions).RESULTS:InmodelsforattentioninCanadaandMexico,theonlysignificantSEScorrelatewashigherincome’spositiveassociationwithattentiontoinsertsinCanada.InCanadaandMexico,self-efficacywasunassociated with SES, but those with stronger risk perceptions had higher income in both countries and higher education in Mexico. In Canada, cessation outcomes were associated with greater attention to inserts, but not with attention to PWLs or with SES, except for a positive association between quit attempts and education. In Mexico, quit attempts were associated with greater attention to PWLs and lesser income. Interactions betweenSESandattentionwerenotsignificantinanymodels.CONCLUSIONS:PWLpoliciesappeartohavesimilareffectsamongsmokersatdifferentSESlevels.FutureresearchshouldassessopportunitiestoreducedisparitieswithspecificPWLpolicies.

FUNDING: Federal

SYM9THE HEAT IS ON: STATE OF THE SCIENCE ON HEATED TOBACCO PRODUCTS AND CONSIDERATIONS FOR FUTURE RESEARCH

Maciej L. Goniewicz, PhD, PharmD. Roswell Park Comprehensive Cancer Center, Buffalo,NY,USA.

With the introduction of the ‘Heat-not-Burn’ (HnB) products, the landscape of tobacco productexposurehaschangedyetagain.Claimsof lowered riskorhealthbenefitsfor heated