by Allen Lo Hok Wai and Adolf Ho Ping Yau. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1981. / Bibliography: leaves 133-134.

Background: Current smoking-cessation medicines can assist smokers to quit, but have limited efficacy. Supplementing them with a replacement for the sensory and behavioural aspects of smoking, which are hypothesised to act as secondary reinforcers, could in theory help to alleviate urges to smoke and withdrawal, and may assist smoking cessation. Methods: Three studies were conducted to examine sensorimotor replacement (SMR) effects. The first two employed a cross-over design to assess the effects of two SMR products, nicotine-free electronic cigarettes (ECs) and de-nicotinised cigarettes (DNCs), on short-term withdrawal, urges to smoke, and user acceptability. Study 1 (N= 35), compared EC to a stress ball (SB) to control for behavioural distraction and Study 2 (N=41) tested whether SMR effects were ‘dose dependent’ by comparing DNCs with ECs. The final study was part of a randomised controlled trial (N= 200) of DNCs in combination with standard treatment. It examined whether SMR effects on abstinence are moderated by scores on a ‘behavioural’ dependence measure (GN-SBQ). Results: The EC was preferred over the SB, and alleviated urge to smoke more than SB, but the effect was modest and short-lived. The DNC and EC had similar effects acutely, but DNC suppressed urges to smoke and withdrawal to a somewhat greater extent over a day of abstinence. DNCs combined with standard smoking-cessation treatment improved short-term abstinence regardless of GN-SBQ scores. Conclusion: SMR effects on urge and withdrawal alleviation were modest and a ‘dose response’ effect was not clearly established. An attempt to identify smokers for whom SMR may be of particular benefit was not successful. SMR however, was perceived as helpful and appealing, and results from the trial suggest that adding SMR may enhance existing treatments. It was proposed that rather than directly alleviating urges/withdrawal, SMR may operate as a coping tool in ‘high-risk’ situations, by providing an alternative to smoking.

The aim is to provide a comprehensive view of the market of tobacco products. Focus is mainly on cigarette market, where I will zoom on the possibilities of DanCzek Teplice a.s., which is supplier of own brand cigarettes. Seeking answers to questions that will help company gain competitive advantage through creative solutions. The work includes a situation analysis, segmentation of target group customers, own recommendations to marketing activities. All advices must compete in real market enviroment and comply with legislative requirements.

Little is known about how electronic cigarette (EC) users manipulate device parameters, what factors drive their use, and how non-nicotine ingredients influence the stimulus effects of EC aerosols. The ingredients propylene glycol (PG) or vegetable glycerin (VG) serve as the base for virtually all electronic cigarette liquids, and information on how they affect the using experience would provide important groundwork for the study of other ingredients. In this dissertation, results from a survey and laboratory study focused on the stimulus effects of ECs, and the influence of PG and VG, will be discussed. A total of 522 regular EC users completed a survey comprised of an electronic cigarette dependence questionnaire, questions on tobacco and electronic cigarette use, and device and liquid preferences. This was followed by a laboratory study with sixteen electronic cigarette users completing five test days (one practice and four assessment days). In the laboratory study, following one hour of nicotine deprivation, two sampling puffs from liquid formulations containing 100/0, 75/25, 50/50, 25/75, and 0/100% PG/VG concentrations were administered in random order during five assessments, each separated by 20 min. Primary outcome measures were self-reported stimulus characteristics and breakpoint on a multiple-choice procedure. Survey results indicated that ability to change device voltage, and level of resistance, was significantly associated with level of nicotine dependence, as was amount of liquid consumed, nicotine concentration, and milligrams of nicotine used per week. Participants also rated 'good taste' as the most important consideration when purchasing and using liquids, and PG was associated with undesirable effects and VG with desirable effects. Laboratory results indicated that greater VG content was associated with greater reports of visibility of the exhalant (i.e. “cloud”). Liquids with mixtures of PG or VG were associated with conventional cigarette smoking sensations and greater reductions of systolic blood pressure compared to formulations with only PG or VG. There was no significant effect of liquid formulation on the multiple-choice procedure, but puffs were rarely chosen over even the smallest monetary option ($0.05), suggesting minimal reinforcing efficacy. In conclusion, survey data indicate that a wide range device parameter settings and liquid ingredients are preferred by daily e-cigarette users, and that individuals with greater nicotine dependence favor voltage control devices, and lower resistance heating elements. Survey data also indicated that taste is a key factor for EC liquid selection, and relative concentrations of propylene glycol and vegetable glycerin may have a significant impact on the reinforcing effects of liquids. In contrast, laboratory data suggests that PG or VG do not significantly impact the abuse liability of EC liquids, though reinforcing effects of these ingredients was unclear in the laboratory study.

Use of electronic cigarettes (e-cigarettes) is rapidly growing around the world. E-cigarettes are commonly used as an alternative nicotine delivery system, and have been advocated as generating lower levels of harmful chemicals compared to conventional cigarettes. Cigarette smoke-like aerosols are generated when e-cigarettes heat e-liquids. The main components of e-cigarette liquids are propylene glycol (PG) and glycerol (GL) in a varying ratio, plus nicotine and flavor chemicals. Both PG and GL are considered safe to ingest in foods and beverages, but the toxicity of these chemicals in aerosols is unknown. Current studies of e-cigarettes have mainly focused on dehydration and oxidation products of PG and GL. In this study, the other degradation products that can be generated during the vaping process are discussed. In addition, the gas/particle partitioning of chemicals in vaping aerosols is determined. This work finds that the formation of benzene in electronic cigarettes depends on the wattage, types of coils, and devices. To simulate commerical e-cigarette liquids, mixtures containing equal parts of PG and GL by volume were made with the following added components: benzoic acid (BA), benzoic acid with nicotine (Nic), benzaldehyde (BZ), band enzaldehyde with nicotine. PG only, GL only, and PG and GL mixtures were also made for comparison. The data presented here demonstrate that more benzene is generated as the wattage of a device increases. The results also seem to support the importance of ventilation in the generation of benzene. More benzene is generated from the mixtures containing benzoic acid when using the EVOD device with a smaller vent. However, benzaldehyde yields more benzene when using the Subtank Nano device with a larger vent. Findings also indicate that more benzene is produced from GL rather than PG. This thesis also addresses the chemical formation pathways of degradation compounds found in the aerosols formed from isotopically labeled e-cigarette liquids. Mixtures of both 13C-labeled and unlabeled PG as well as GL were made. The mixtures were vaped and gas-phase samples were collected to determine which chemicals were in the gas-phase portion of the aerosols. With the use of GC/MS methods, these isotopic labeling experiments provided evidence that the majority of the benzene, acetaldehyde, 2,3-butanedione, toluene, xylene, acrolein, and furan found in e-cigarette aerosols originates from GL in the PG plus GL mixtures. It was also shown that the majority of propanal is derived from PG: while hydroxyacetone can be formed from both PG and GL. Possible mechanisms for the formation of acetaldehyde, benzene, 2,3-butanedione, toluene, and xylene formation are proposed. Last, this study investigated the gas/particle partitioning of nicotine and flavor-related chemicals in e-cigarette fluids. The gas/particle partitioning behavior of chemicals in e-cigarettes fluids is highly dependent on the chemical volatility. A total of 37 compounds were examined. The target compounds were divided into 3 groups based on their vapor pressures: high, medium, and low. Headspace gas samples were collected and analyzed to determine the concentration of a compound in equilibrium with the liquid phase. The gas and liquid concentrations were used to calculate the gas/particle partitioning constant (Kp) for each compound. In an e-cigarette aerosol, volatile compounds have smaller Kp values and tend to be found in greater proportion in the gas-phase, whereas the less volatile compounds are likely to stay in the particle phase. General agreement with theory was found for compounds with known activity coefficients in PG and GL, indicating that theory can be used to predict Kp values for other compounds.

Smoking cigarettes is the most preventable cause of death in the US. Smokers are often unsuccessful at quitting because they are dependent. Reducing nicotine could be one way to reduce dependence. Currently, reducing cigarettes per day (CPD) is the most common strategy to reduce nicotine intake. However, some have proposed switching to very low nicotine content (VLNC) cigarettes to reduce nicotine and dependence. Both reducing CPD and switching to VLNC cigarettes aim to reduce nicotine but do so in different ways. I conducted a randomized trial to compare the degree to which switching to VLNC cigarettes vs reducing CPD 1) is more acceptable and 2) decreases dependence more among smokers not ready to quit. Sixty-eight adult smokers of ≥ 10 cigarettes/day who were not ready to quit smoked full nicotine study cigarettes ad-lib for 1 week (week 0). I provided all participants with nicotine replacement therapy (NRT) patches and instructions to gradually reduce over the next 4 weeks by either 1) switching to lower nicotine content VLNC cigarettes or 2) reducing the number of full nicotine CPD. I provided VLNC participants with their usual number of cigarettes throughout the study but cigarettes contained only 70% of their usual nicotine at week 1, 35% at week 2, 15% at week 3, and 3% at week 4. I provided CPD participants with full nicotine cigarettes throughout the study but only 70% of their usual number of cigarettes at week 1, 35% at week 2, 15% at week 3, and 3% at week 4. I instructed participants to attempt to smoke only study cigarettes and report use of all (study + non-study) cigarettes via nightly surveys. I used participants’ percent non-study cigarettes/day as a proxy for acceptability and the Nicotine Dependence Syndrome Scale as my primary measure of dependence. Participants completed self-report measures and provided breath and urine samples at weekly visits during the 5-week study period. I tested between-group differences, within-participant change over time, and group by time interactions using multi-level modeling. Switching to VLNC cigarettes was more acceptable than reducing CPD (F=5.0 p<.05). Acceptability declined over time for CPD participants as they were instructed to reduce more nicotine (F=42.2, p<.001) but this was not true for VLNC participants (F=29.5, p<.001). Dependence declined over time for both VLNC (F=10.5, p<001) and CPD (F=5.0, p<.01) participants but declined more over time for VLNC than CPD participants (F=3.2, p<.05). This is the first trial to directly compare switching to VLNC cigarettes vs reducing CPD. Large reductions were more acceptable and effective at decreasing dependence among participants who switched to VLNC cigarettes than those who reduced CPD when all were aided by NRT. My findings suggest that regulatory policy that promotes a gradual transition to VLNC cigarettes could be more acceptable and effective at decreasing dependence than the common strategy of reducing CPD. Furthermore, NRT-aided transitions to VLNC cigarettes could be a useful and acceptable component for clinical interventions to reduce nicotine dependence among smokers not ready to quit and thereby make it more likely for smokers to quit and succeed.

Becoming more physically active is associated with increased confidence to maintain smoking abstinence as well as success at stopping smoking. The purpose of the current study was to assess the effects of two different types of exercise (cardiovascular and Hatha yoga) on general and cue-elicited craving for a cigarette. Participants were 76 smokers ages 18-45 (mean=29) who smoked at least 10 cigarettes per day (mean=20) for at least one year. Participants were randomly assigned to engage in 30 minutes of cardiovascular activity (walking on a treadmill), yoga, or to view a video about exercise (control). Participants completed a self-report measure of craving (Questionnaire of Smoking Urges-Brief [QSU-brief]; Cox, Tiffany, & Christen, 2001) and a brief mood form, as well as a picture-based cue reactivity assessment before and approximately five minutes after the activity. Results demonstrated that participants in both exercise groups reported a significant decrease in anticipation of pleasure from smoking following exercise as compared to the control group, as measured by Factor 1 of the QSU-brief (p < .05) up to 20 minutes following exercise. Participants in both exercise groups also reported significant decrease in smoking to relieve negative affect or withdrawal only 20 minutes after exercising, as measured by Factor 2 of the QSU-brief (p < .05). There was also a trend toward a significant group x time interaction effect for the QSU-brief Global scale (p = .053) immediately following exercise and a significant decrease in craving 20 minutes after exercise (p = .040). These effects were fully mediated by both an increase in positive mood and a decrease in negative mood following exercise (ps < .05) and a decrease in negative mood 20 minutes after exercise. Following activity, the cardiovascular group had a significant decrease in craving towards smoking pictures and an increase in craving towards neutral pictures, the yoga group demonstrated a significant decrease towards both smoking and neutral cues, and the control group had an increase in craving over time for both types of cues (ps < .05). Overall, these findings suggest that both cardiovascular activity and yoga may reduce urges to smoke following exercise, but that cardio exercise may be specifically associated with reduced cue-elicited craving. Future studies should examine the relationship between acute and long-term effects of exercise on cravings and smoking behavior. This can inform the potential application of exercise regimens within smoking cessation programs.

A grounded theory approach was used to explore the reasons why staff who work in alcohol and drug treatment services smoke cigarettes. Eleven in-depth interviews were conducted with staff in Victoria across a variety of service types and roles. Data gathered from the interviews were analysed and grouped into categories. From analysis of the interviews it appeared that cigarette smoking is given legitimacy in the alcohol and drug treatment field that reinforces its place in these services. Legitimacy was evident in three main ways - Permission, a Therapeutic Tool and Rewards. Permission to smoke was communicated by means which included the opportunity to smoke at work, the provision of smoking areas, the absence of no-smoking rules and policies, and an acceptance of smoking. Smoking was seen as a therapeutic tool that enhanced the treatment provided to clients. Some smokers saw cigarettes as a tool to convey empathy, develop rapport, promote a feeling of engagement and manage difficult clients. Smokers also received some rewards to reinforce their behaviour. There was a benefit of feeling an increased acceptance by other staff, increased socialising, work breaks, a reduction in perceived stress levels and the opportunity to readily satisfy cravings for nicotine that reinforced the smoking behaviour. Punishments, or negative rewards, for smoking were also described. These included being recipients of harassment or pressure from non-smoking staff and concerns about the impact of smoking on their health. These three categories of permission, therapeutic tool and rewards contribute to the legitimacy of smoking in this field and support the continued presence of this behaviour.

Tobacco remains the leading preventable cause of death in the world, and 5 million people worldwide continue to smoke. Further adding to the problem is the fact that smoking cessation rates are very low, and there are some smokers for whom quitting smoking is extremely difficult. Many smokers find nicotine replacement therapy (NRT) products unappealing, and even when used as directed NRTs only achieve modest cessation rates. Smokeless tobacco (ST) may be more appealing than NRT and deliver nicotine in a more palatable way to cigarette smokers. ST is also far less harmful than smoking. It is for these reasons that many scientists and health professionals have suggested the use of ST as a substitute for smoking to reduce tobacco-related harm. Although the health risk posed by ST appears to be much less than conventional cigarettes, the extent to which ST may serve as a harm reduction product is highly contentious. Furthermore, although ST products are legal and widely available, it remains unclear whether conventional cigarette smokers in Canada will use ST products as a substitute for cigarettes or as a cessation aid, if at all. And despite the strong evidence for the effectiveness of cigarette warning labels, there is little research on ST health warning labels. The current study investigated perceptions of ST products with and without HWLs and relative health risk messages among 611 young adult Canadian smokers aged 18-30. The study sought to examine the impact of ST health warning labels (HWLs) on appeal, willingness to use, and perceived health risk and addictiveness. Participants completed a survey during which they were asked to view and provide their opinions on a series of ST packages that were digitally altered according to each of six experimental conditions: (1) "standard" packages of leading ST brands, (2) "standard" packages + a relative risk message about the harm of cigarettes compared to ST added, (3) "Standard" packages + text HWL, (4) "Standard" packages + text HWL and relative risk message, (5) "Standard" packages + picture HWL, and (6) "Standard" packages + picture HWL and relative risk message. The findings indicate that many smokers are unaware that ST is less harmful to health compared to smoking. Despite this, approximately half of young adult Canadian smokers indicated that iv they were willing to try ST as a substitute for smoking and to help quit smoking. Picture warnings increased misperceptions about the health risk of ST and decreased smokers‘ willingness to try ST, whereas text warnings did not. Similarly, adding a relative health risk message to the warning label that communicates the lower risk of ST compared to cigarettes increased willingness to try ST when added to text warnings, and decreased willingness to try ST even further when added to picture warnings. This study is among the first to examine ST warning labels, and is the first to examine the impact of picture warning labels on ST. Overall, the findings suggest picture warnings may make it more difficult to communicate the differences in risk between ST and cigarettes.

Tobacco remains the leading preventable cause of death in the world, and 5 million people worldwide continue to smoke. Further adding to the problem is the fact that smoking cessation rates are very low, and there are some smokers for whom quitting smoking is extremely difficult. Many smokers find nicotine replacement therapy (NRT) products unappealing, and even when used as directed NRTs only achieve modest cessation rates. Smokeless tobacco (ST) may be more appealing than NRT and deliver nicotine in a more palatable way to cigarette smokers. ST is also far less harmful than smoking. It is for these reasons that many scientists and health professionals have suggested the use of ST as a substitute for smoking to reduce tobacco-related harm. Although the health risk posed by ST appears to be much less than conventional cigarettes, the extent to which ST may serve as a harm reduction product is highly contentious. Furthermore, although ST products are legal and widely available, it remains unclear whether conventional cigarette smokers in Canada will use ST products as a substitute for cigarettes or as a cessation aid, if at all. And despite the strong evidence for the effectiveness of cigarette warning labels, there is little research on ST health warning labels. The current study investigated perceptions of ST products with and without HWLs and relative health risk messages among 611 young adult Canadian smokers aged 18-30. The study sought to examine the impact of ST health warning labels (HWLs) on appeal, willingness to use, and perceived health risk and addictiveness. Participants completed a survey during which they were asked to view and provide their opinions on a series of ST packages that were digitally altered according to each of six experimental conditions: (1) "standard" packages of leading ST brands, (2) "standard" packages + a relative risk message about the harm of cigarettes compared to ST added, (3) "Standard" packages + text HWL, (4) "Standard" packages + text HWL and relative risk message, (5) "Standard" packages + picture HWL, and (6) "Standard" packages + picture HWL and relative risk message. The findings indicate that many smokers are unaware that ST is less harmful to health compared to smoking. Despite this, approximately half of young adult Canadian smokers indicated that iv they were willing to try ST as a substitute for smoking and to help quit smoking. Picture warnings increased misperceptions about the health risk of ST and decreased smokers‘ willingness to try ST, whereas text warnings did not. Similarly, adding a relative health risk message to the warning label that communicates the lower risk of ST compared to cigarettes increased willingness to try ST when added to text warnings, and decreased willingness to try ST even further when added to picture warnings. This study is among the first to examine ST warning labels, and is the first to examine the impact of picture warning labels on ST. Overall, the findings suggest picture warnings may make it more difficult to communicate the differences in risk between ST and cigarettes.