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

尽管吸烟率有所下降，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剩余的吸烟人口，而点烟者可能是被剥夺权利最多的群体之一（例如，社会经济地位低）。重新点燃指的是熄灭、储存和随后重新点燃未完成的香烟。研究表明，这是44-73%的吸烟者的普遍行为，17-21%的吸烟者报告他们“通常”或“经常”重新点燃，从而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益处以及禁烟令。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，如果重新点燃者（往往高度依赖尼古丁）因为相信自己正在最大限度地减少吸烟量而对完全戒烟的动机较低，那么重新点燃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，因为他们似乎是较少的依赖或吸烟数量较少的香烟每天（CPD）相比，非打火机，尽管有更多的吸烟会议每天和暴露于有毒物质。这可能导致药物治疗剂量不足。鉴于重新点燃的原因包括香烟成本的增加，重新点燃的流行率可能在未来（特别是在这次经济危机期间）增加，并可能继续不成比例地影响那些与烟草有关的现有差距更大的人。需要更多的研究来应对这些挑战，调查谁重新吸烟，为什么，以及重新吸烟对烟草依赖，戒烟和健康的潜在影响。理解重新照明至关重要，因为：1）当前评估（即，CPD）可能低估了再点燃者的有毒物质暴露和尼古丁依赖，2）如果再点燃继续在很大程度上被供应商忽视，很高比例的吸烟者可能治疗不足。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点燃的标准和原因，以及流行率，频率和相关因素; 2）使用地形和毒物分析评估重新点燃的潜在毒性效应; 3）通过观察烟草治疗和全州烟草治疗计划中重新点燃者的结果来调查重新点燃的潜在影响。初步研究需要复制和扩展，以更严格，更全面，更大规模地解决许多剩余的问题，为理解重新照明对个人和公共卫生的影响奠定基础。这项研究将提供重要的信息的程度，频率，背景因素，以及这种未充分研究的行为的潜在危险。该研究对监测和治疗都有意义，例如在临床和人口调查中筛选重新点燃的新措施，以及可能告知临床医生为点燃者开出适当强度的治疗。总之，从拟议的具体目标的数据将提供一个更清晰的范围和香烟重新点燃的影响。

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.