The objectives of this study were to determine: 1) the feasibility of expanding interim methadone treatment (IM); (2) the impact of IM on heroin and cocaine use; and (3) the effect of charging a modest fee for IM. Six clinics provided daily methadone plus emergency counseling only (IM) to heroin addicts on a waiting list for treatment. IM was provided for up to 120 days before transfer to regular methadone treatment. Drug testing was conducted at admission to IM and at transfer to MTP. Half the patients were charged $10/week for IM. Logistic regression analysis was utilized to determine the effect of fee status and other variables on transfer. Of 1,000 patients enrolled in IM, 762 patients (76.2%) were admitted to a regular MTP. For those who transferred (n = 762), opioid positive tests decreased from 89.6% to 38.4%; cocaine, from 49.9% to 44.9% from admission to transfer. Logistic regression analysis indicated that fee status at baseline was not significantly associated with transfer. When limited public resources create waiting lists, IM can allow additional patients to sharply reduce heroin use while waiting for admission to MTP.

To date no study has reported U.S. nationally representative estimates of current ENDS users by device category (“open” vs. “closed” systems) nor their detailed use behaviors. We examined the proportion of current adult ENDS users (unweighted n = 2671) using either “closed” or “open” systems during Wave 3 (2015–2016) of the Population Assessment of Tobacco and Health (PATH) Study. Demographic characteristics, use patterns, and device characteristics were examined overall and by device type. Among the 5.0% of current users at Wave 3, 43.9% used closed systems and 53.7% used open systems. Compared to closed system users, open system users were more likely to be male (60.7% vs. 48.4%), aged 18–24 (30.4% vs. 21.4%), and non-Hispanic White (76.2% vs. 65.4%), recent former (9.9% vs. 5.6%) or long-term former (20.2% vs. 10.9%) smokers, and use ENDS daily (44.1% vs. 22.5%); they were less likely to be to be current daily smokers (31.7% vs. 48.0%) or never smokers (15.2% vs. 19.5%). Adult ENDS users were nearly evenly split on their use of closed versus open systems; however, several group differences were observed. Disentangling the relationship between device selection and subsequent use patterns remains a public health priority.

Background: While smokeless tobacco (ST) causes oral cancer and is associated with cardiovascular diseases, less is known about how its effects differ from other tobacco use. Biomarkers of potential harm (BOPH) can measure short-term health effects such as inflammation and oxidative stress. Methods: We compared BOPH concentrations [IL6, high-sensitivity C-reactive protein, fibrinogen, soluble intercellular adhesion molecule-1 (sICAM-1), and F2-isoprostane] across 3,460 adults in wave 1 of the Population Assessment of Tobacco and Health study (2013–2014) by tobacco use groups: primary ST users (current exclusive ST use among never smokers), secondary ST users (current exclusive ST use among former smokers), exclusive cigarette smokers, dual users of ST and cigarettes, former smokers, and never tobacco users. We estimated geometric mean ratios using never tobacco users, cigarette smokers, and former smokers as referents, adjusting for demographic and health conditions, creatinine (for F2-isoprostane), and pack-years in smoker referent models. Results: BOPH levels among primary ST users were similar to both never tobacco users and former smokers. Most BOPH levels were lower among ST users compared with current smokers. Compared with never tobacco users, dual users had significantly higher sICAM-1, IL6, and F2-isoprostane. However, compared with smokers, dual users had similar biomarker levels. Former smokers and secondary ST users had similar levels of all five biomarkers. Conclusions: ST users have lower levels of inflammatory and oxidative stress biomarkers than smokers. Impact: ST use alone and in combination with smoking may result in different levels of inflammatory and oxidative stress levels.

Introduction: Adequate evaluation of novel tobacco products must include investigation of consumers' psychological response to such products. Traditionally, subjective scales of product liking have been used to assess consumer acceptability of tobacco products. However, subjective scales may miss cognitive changes that can only be captured by direct neurophysiological assessment. The present investigation explored the viability of using electroencephalography (EEG), in combination with traditional subjective measures, to assess consumer acceptability of five smokeless tobacco products. Given previous work linking product liking to arousal/attentional (executive function) enhancement, we focused on EEG measures of attention/arousal to objectively characterize cognitive changes associated with tobacco product use. Methods: During five separate laboratory visits, smokeless tobacco users used Verve discs, Ariva dissolvables, Skoal snuff, Camel snus, or Nicorette lozenges. The N2 and P3b event-related potential components elicited by an oddball task were used to index attentional changes before/after product usage. Additionally, resting state alpha band EEG activity was analyzed before/after product usage to index cortical arousal. Results: Although analyses of the subjective results provided limited inference, analyses of the electrophysiological measures, particularly the alpha suppression measure, revealed robust differences between products. Skoal elicited significantly enhanced alpha suppression compared to all four other products tested. Additionally, alpha suppression was found to correlate positively with subjective measures of satisfaction and psychological reward, but was unrelated to perceived aversion. Conclusions:The present results provide evidence that electrophysiological measures can yield important insights into consumer acceptability of novel tobacco products and are a valuable complement to subjective measures. Implications: This study is the first to employ a combination of electrophysiological measures and traditional subjective assays in order to assess the consumer acceptability of smokeless tobacco products. The results highlight the importance of adopting a multidimensional/multi-method approach to studying the consumer acceptability of tobacco products.