Evaluating Cigarette Relighting Behavior: Prevalence, Correlates, Toxicant Exposure, and Implications for Cessation

尽管吸烟率已经下降，但仍有3400多万美国人继续吸烟。被剥夺权利的群体越来越多地构成了剩余的吸烟人口，而重新吸烟的人可能是一些最被剥夺权利的群体（例如，社会经济地位低）。重燃是指熄灭、保存，再重燃未完成的香烟。研究表明，44-73%的吸烟者普遍吸烟，其中17-21%的吸烟者表示他们“经常”或“经常”吸烟，因此影响了数百万美国人。重新吸烟的明显原因包括成本、对健康和戒烟的预期好处以及禁烟令。这种行为可能会增加对吸烟者的危害，如肺癌和慢性支气管炎。例如，如果戒烟者（往往是高度依赖尼古丁的人）因为认为自己是在尽量减少吸烟量而对完全戒烟的动机较低，重新吸烟可能会导致更糟糕的戒烟和健康结果。他们也可能没有得到充分的治疗和临床医生的建议，因为与非再燃者相比，他们似乎不那么依赖或每天吸烟的数量更少（CPD），尽管他们每天吸烟的次数更多，接触的有毒物质也更多。这可能导致药物治疗剂量不足。考虑到重新吸烟的原因包括卷烟成本的增加，重新吸烟的流行在未来可能会增加（特别是在这次经济危机期间），并可能继续不成比例地影响那些目前与烟草有关的差距更大的人。需要更多的研究来解决这些挑战，调查哪些人戒烟，为什么戒烟，以及戒烟对烟草依赖、戒烟和健康的潜在影响。了解复吸至关重要，因为：1)目前的评估（即CPD）可能低估了复吸者的有毒物质暴露和尼古丁依赖；2)如果复吸继续在很大程度上被提供者忽视，很大比例的吸烟者可能得不到充分治疗。这个为期四年的项目的具体目标是：1)在全国调查中建立重新照明的标准和原因，以及患病率，频率和相关性；2)利用地形分析和毒物分析评估重新照明的潜在毒性影响；3)通过在全国范围内的烟草处理项目中观察烟草处理和再点燃者的结果，调查再点燃的潜在影响。初步研究需要在更严格、更全面和更大规模上进行复制和扩展，以解决许多遗留问题，为理解重燃对个人和公共健康的影响奠定基础。这项研究将提供关于这种未被充分研究的行为的程度、频率、环境因素和潜在危险的重要信息。这项研究对监测和治疗都有启示，例如在临床和人口调查中筛查重燃的新措施，以及潜在地告知临床医生为重燃者开出适当强度的治疗处方。综上所述，来自拟议具体目标的数据将更清楚地说明香烟重燃的程度和影响。

Although smoking prevalence has decreased, more than 34 million Americans continue to smoke. Disenfranchised groups increasingly comprise the remaining smoking population, and cigarette relighters may be some of the most disenfranchised (e.g., low socioeconomic status). Relighting refers to extinguishing, saving, and later relighting unfinished cigarettes. Research suggests this is a prevalent behavior engaged in by 44-73% of smokers, with 17-21% of smokers reporting they relight ‘usually’ or ‘frequently’, thus impacting millions of Americans. Apparent reasons for relighting include cost, perceived benefits for health and cessation, and smoking bans. This behavior may increase harms to smokers such as lung cancer and chronic bronchitis. For example, relighting could contribute to worse cessation and health outcomes if relighters (who tend to be highly nicotine-dependent) have lower motivation toward total abstinence because they believe they are minimizing the amount they smoke. They may also be inadequately treated and advised by clinicians because they appear to be less dependent or smoke fewer numbers of cigarettes per day (CPD) compared to non-relighters, despite a greater number of smoking sessions per day and exposure to toxicants. This could lead to under-dosing of pharmacotherapy. Given that reasons for relighting include the increasing cost of cigarettes, prevalence of relighting may grow in the future (especially during this economic crisis) and may continue to impact disproportionately those with greater existing tobacco-related disparities. More research is needed to address these challenges by investigating who relights and why, and potential effects of relighting on tobacco dependence, cessation, and health. Understanding relighting is critical because: 1) current assessments (i.e., CPD) may underestimate toxicant exposure and nicotine dependence among relighters and 2) if relighting continues to be largely ignored by providers, a high proportion of smokers may be undertreated. Specific aims of this four-year project are to: 1) Establish criteria and reasons for, as well as prevalence, frequency, and correlates of relighting in a national survey; 2) Evaluate potential toxic effects of relighting using topography and toxicant analyses; 3) Investigate the potential impact of relighting by observing tobacco treatment and outcomes of relighters in a state-wide tobacco treatment program. Preliminary studies need to be replicated and extended to be more rigorous, comprehensive, and on a larger scale to address numerous remaining questions that would lay the groundwork for understanding the individual and public health impact of relighting. This study will provide important information about the extent, frequency, contextual factors, and potential dangers of this understudied behavior. The study has implications for both surveillance and treatment such as new measures to screen for relighting clinically and in population surveys as well as potentially informing clinicians in prescribing appropriate-intensity treatments for relighters. Together, data from the proposed specific aims will provide a clearer picture of the extent and impact of cigarette relighting.