Editor’s Note: These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen. They were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Today’s post features recent research on international government controls on tobacco advertising and on quitting or altering individual use patterns. For more information, contact Dr. Erlen through the link above.
Sources of Variation in Nicotine Metabolism and Associations with Smoking Abstinence in Adolescents and Adults
Author: Chenoweth, Meghan Jo-Ann
Abstract: Smoking remains a major public health concern; worldwide, approximately one billion people smoke. Despite the fact that many smokers are motivated to quit, only a small minority of those making quit attempts successfully quit each year. Variation in the rate of nicotine metabolic inactivation influences a number of smoking behaviours, including cessation. Thus, we sought to characterize genetic, environmental, and demographic sources of variability in the rate of nicotine metabolism, and resultant influences on smoking behaviours. Variation in the activity of the major nicotine-metabolizing enzyme, cytochrome P450 2A6 (CYP2A6) changes nicotine clearance and is associated with altered smoking behaviours, including cessation, in adults. We demonstrate here that slow (versus normal) nicotine metabolizers are more likely to achieve prolonged abstinence in adolescence, as in adulthood. We further demonstrate that in clinical trials, adult slow (versus normal) nicotine metabolizers are more likely to achieve early abstinence. We also investigated additional sources of genetic variability in the rate of nicotine metabolism and their potential influences on smoking. We demonstrate that genetic variation in an additional nicotine-metabolizing enzyme (i.e., FMO3 ), and a cytochrome P450 co-enzyme (i.e., POR ), does not substantially alter nicotine metabolism, CYP2A6 activity, or tobacco consumption. We further demonstrate that environmental and demographic sources of variability in CYP2A6 activity, such as gender and ethnicity, explain only a small proportion of the total variation in CYP2A6 activity; however, these factors may have unique impacts on smoking behaviours and thus should be further investigated in studies of smoking. Overall, our findings provide additional information regarding the role of variation in nicotine metabolism rate in cessation outcomes in both adolescents and adults. A greater understanding of the factors that influence smoking cessation will help optimize treatment outcomes and reduce the burden of tobacco-related disease.
Publication year: 2016
Advisor: Tyndale, Rachel F.
University/institution: University of Toronto (Canada)
Constraining government regulatory authority: Tobacco industry trade threats and challenges to cigarette package health warning labels
Author: Crosbie, Eric
Abstract: This dissertation investigates the rising authority of non-state actors vis-à-vis the state by examining how tobacco companies are using trade agreements to constrain governments from implementing progressive public health policies that require placing pictorial health warning labels (HWLs) on cigarette packages. In particular, the dissertation seeks to address two different but related puzzles. First, despite being developed countries and global health leaders, it is unclear why Australia has implemented strong HWLs on cigarette packages while New Zealand has delayed its HWL proposal. Second, it is unknown why Uruguay, a developing country, has implemented strong HWLs while New Zealand, a developed country, has delayed its proposal. Informed by archival research of previously secret tobacco industry documents, interviews conducted with policymakers and health advocates closely involved in the policymaking process, and applying a most-similar and most-different systems design, this research demonstrates that tobacco industry trade threats are causing a chilling effect by delaying strong HWLs in New Zealand, but not in Australia and Uruguay and that the key factor in determining the implementation of strong HWLs lies in the governments’ reception to these trade threats. The findings suggest that leftist governments, continued bureaucratic leadership and capacity in the Health Ministry, and independent and confident tobacco control and trade advocacy are necessary conditions in explaining how governments can shape the reception of tobacco industry trade threats and properly implement progressive HWL policies without being weakened or delayed. Given the limitations of using existing trade agreements to globally preempt strong HWLs in Australia and Uruguay, this analysis also examines the evolving nature of global trade and health governance to demonstrate how tobacco companies are aggressively attempting to shape the pending Trans-Pacific Partnership Agreement (TPP) to further distance decision-making authority away from governments. These efforts have succeeded in securing trade mechanisms, including trade promotion authority, aimed at eliminating the policy space for health advocates to lobby for public health exemptions in trade agreements, but have failed to secure the investor-state dispute settlement (ISDS) mechanism in the TPP to directly challenge tobacco control policies in TPP member states. The results of this research will assist governments to properly implement strong HWLs without being weakened or delayed, which will dramatically help reduce smoking initiation and cessation rates, lower government health expenditures and tobacco industry profits, and help accelerate the global diffusion of strong HWLs. These results also have important implications for future regulations of alcohol, food, and medicine, which are increasingly being targeted through trade agreements.
Degree date: 2016
Advisor: Schoenman, Roger
Committee members: Eaton, Kent; Pasotti, Eleonora
University/institution: University of California, Santa Cruz
The Role of Attidudinal Ambivalence in the Relationship between E-Cigarette Messages and E-Cigarette Benefit and Harm Perceptions
Author: Majmundar, Anuja Anand
Abstract: Background: Young adults are navigating contradictory claims about e-cigarettes as alternatives for regular cigarettes. While marketing messages promote e-cigarettes as superior alternatives, public agencies issue cautionary health warnings about possible harms of e-cigarette use. As a result, youth may experience attitudinal ambivalence, which is an equal amount of positive and negative attitudes, toward e-cigarette use. While research has indicated that exposure and receptivity to e-cigarette marketing influences product use, no work has examined the extent to which this ambivalence about the harms and benefits of e-cigarettes leaves consumers vulnerable to the effects of e-cigarette marketing. This study addresses this gap and seeks to understand the interrelationships between: (a) e-cigarette use perceptions (b) attitudinal ambivalence regarding e-cigarette use, and (c) exposure and receptivity to e-cigarette messages. Methods: A sample of 350 undergraduate students participated in an online experimental design, in which they were randomly assigned to pretest-posttest condition or posttest only condition. Participants were randomly exposed to one of the e-cigarette message conditions: (1) message argument supporting possible benefits of e-cigarette smoking, (2) message argument harms of e-cigarette smoking, (3) ambiguous message with one argument each for benefit and one harm of e-cigarette smoking. Results: Message condition has no significant effect on e-cigarette use perceptions. Message receptivity has a strong influence on e-cigarette benefit perceptions of e-cigarette use posttest attitudinal ambivalence. Pretest attitudinal ambivalence has persisting carryover effects on posttest attitudinal ambivalence. Asian population reported the least harm perceptions of e-cigarette use in comparison to other ethnic groups. Discussion: The vulnerability of young people lies in them harboring highly pliable benefit perceptions of e-cigarettes that are influenced more by message receptivity than message condition. Attitudinal ambivalence about e-cigarette use emerges as an attitude that is resilient to any message condition. Practitioners should investigate simulated or real word of mouth campaigns using narrative messaging or social media initiatives, to help youth transition to a stage of informed univalence. Future theoretic work should explore ambivalence as a multi-dimensional attitude that prolongs vulnerability to risk behavior.
Publication year: 2016
Advisor: Pauley, Perry
University/institution: San Diego State University