Are Americans receptive to smokefree bars?

It is not known whether the American public accepts smokefree bars and restaurants. Anticipating public displeasure with these ordinances, tobacco, liquor and restaurant industry trade associations have helped to stall efforts to pass laws curbing bar and restaurant smoking in the expectation that diminished patronage would inevitably result. This cross-sectional trend study uses data from the May 1993 and January 1999 Current Population Surveys, Tobacco Use Supplements to compare tobacco-control attitudes among American bar and restaurant workers, all other workers, smokers and nonsmokers (total n = 90,661). It was found that by 1999, smokefree workplaces were widely accepted by two-thirds of adults, with half favoring completely smokefree restaurants. Completely smokefree bars remained less popular, with nearly equal numbers (about 30%) preferring them or favoring unrestricted bar smoking. Even among bar and restaurant industry workers less than 10% favored unrestricted restaurant smoking. Greater acceptances of smokefree bars are now taking hold, especially in places like California, where acceptance rose 15% in six years, and 45% preferred them. Opponents to smokefree bars and restaurants may have underestimated the levels of support and growing acceptance of smokefree living areas now taking hold among the general public.     

Nicotine in hair of bar and restaurant workers

AIM: To measure the relation between workplace smoking policies and exposures to Environmental Tobacco Smoke (ETS) of workers in bars and restaurants. METHODS: 114 workers in Wellington and Auckland were questioned about sources of exposure to ETS and smoking habits, and details of the smoke-free policy in their work place were recorded. A hair sample was collected from each participant and tested for nicotine. RESULTS: Among non-smoking workers, hair nicotine levels varied strongly according to the smoke free policy at their place of work (Kruskall-Wallis, chi2 = 26.38, p < 0.0001). Those working in 100% smoke free restaurants had much lower levels than staff working in bars with no restrictions on smoking, and levels were intermediate for staff working in places with a partial smoking ban. These findings were not changed when adjustments were made for other sources of ETS exposure. Hair nicotine levels among nonsmokers working in places with no restriction on smoking were similar to hair nicotine levels of active smokers. CONCLUSION: The present New Zealand Smoke Free Environment Act does not protect workers in the hospitality industry from exposure to ETS. The findings from this study highlight the substantial levels of exposure of bar and restaurant staff from patrons' smoking.     

Environmental tobacco smoke: views from the Dunedin hospitality industry on prohibition of smoking in licensed premises

AIMS: To describe Dunedin hospitality industry perceptions of difficulties in enforcement of a prohibition on smoking in licensed premises, and possible effects on staff, customers and business. To identify any need for education to assist transition and reduce compliance difficulties with smoke-free legislation. METHODS: A reply paid questionnaire was mailed to all 311 licensed premises registered with the Dunedin District Licensing Agency, operational in May 1999. RESULTS: overall response rate (67%) differed significantly by type of premises (bar, club, restaurant and off-licence). Overall, a smoking ban was considered likely to be difficult to enforce (82%), upset customers (74%), reduce business (59%) and negatively effect employees (51%). On each issue, there was a consistent pattern of increasing concern from off-licenses (least concern) through restaurants, to clubs and bars (most concern). CONCLUSIONS: Considerable concern exists in the hospitality industry about the effects of extending smoke-free status to licensed premises. To assist transition and future compliance, there is a need to address these concerns and provide reliable information to calm unnecessary fears and develop appreciation of the need for change.     

Occupational exposure to environmental tobacco smoke: a study in Lisbon restaurants

Environmental tobacco smoke (ETS), also referred to as secondhand smoke (SHS), is a major threat to public health and is increasingly recognized as an occupational hazard to workers in the hospitality industry. Therefore, several countries have implemented smoke-free regulations at hospitality industry sites. In Portugal, since 2008, legislation partially banned smoking in restaurants and bars but until now no data have been made available on levels of indoor ETS pollution/exposure at these locations. The aim of this study was to examine the occupational exposure to ETS/SHS in several restaurants in Lisbon, measured by indoor fine particles (PM(2.5)) and urinary cotinine concentration in workers, after the partial smoking ban in Portugal. Results showed that the PM(2.5) median level in smoking designated areas was 253 μg/m3, eightfold higher than levels recorded in canteens or outdoor. The nonsmoking rooms of mixed restaurants exhibited PM(2.5) median level of 88 μg/m3, which is higher than all smoke-free locations studied, approximately threefold greater than those found in canteens. Importantly, urinary cotinine concentrations were significantly higher in nonsmoker employees working in those smoking designated areas, confirming exposure to ETS. The proportion of smokers in those rooms was found to be significantly positively correlated with nonsmoker urinary cotinine and indoor PM(2.5) levels, establishing that both markers were occupational-ETS derived. The use of reinforced ventilation systems seemed not to be sufficient to decrease the observed ETS pollution/exposure in those smoking locations. Taken together, these findings demonstrate that the partial restrictions on smoking in Portuguese venues failed to provide adequate protection to their employees, irrespective of protective measures used. Therefore, a smoke-free legislation protecting individuals from exposure to ETS/SHS in all public places and workplaces is urgently needed in Portugal.     

Assessing the Validity of On-Premise Alcohol License Data in Six Communities in California: Operating Characteristics and Outlet Densities

This study evaluated State of California alcohol license records as a measure of businesses selling alcohol for consumption on premise. In 2008, researchers attempted to visit all 799 licensed restaurants, bars, and pubs in six medium-sized cities near San Francisco. Surveys collected detailed business characteristics for a subsample of 151 bars or restaurants that included a separate bar area. Results suggest inaccuracies of official records regarding license locations and types (bar/pub vs. restaurant). Analyses also indicate that establishment characteristics are related to local alcohol outlet densities. Study implications and limitations are discussed.     

Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample

Background

Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health benefits of smoke-free policies extend to drinking behaviors. However, no prior study has examined whether tobacco legislation impacts the likelihood of alcohol use disorders (AUDs) over time. The current study addresses this gap in the literature using a large, prospective U.S. sample.

Method

Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we utilized logistic regression to examine whether the implementation of state-wide smoke-free legislation in bars and restaurants between Waves I (2001–2002) and II (2004–2005) predicted changes in DSM-IV AUD status (remission, onset, recurrence) in current drinkers at Wave I (n = 19,763) and participants who drank in public ≥once per month (n = 5913).

Results

Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups.

Discussion

These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs.     

Assertive communication about others' smoking and vaping in public venues: Results from a National Survey of US adults

IntroductionThis study describes prevalence and correlates of US adults' intentions to engage in assertive communication (i.e., speak up) about others' smoking and vaping in public venues. Methods: Participants from a nationally representative online survey of 1551 US adults conducted October–December 2013 reported intentions to ask others not to smoke/vape in three types of public venues (restaurants, bars/casinos/nightclubs, and parks). We examined weighted prevalence of intentions and conducted weighted logistic regression. Results: Fifty-two percent of participants reported being likely to ask someone not to smoke in at least one venue compared with 19% for vaping. Assertive communication intentions for smoking in restaurants (48%), bars/casinos/nightclubs (35%), and parks (32%) were higher than for vaping (16%, 14%, and 12%, respectively). Significant correlates of assertive communication intentions in one or more venues were current smoking status, ever trying e-cigarettes, gender, age, health status, political ideology, and party identification. Conclusions: US adults were more willing to ask others not to smoke than vape. Intentions to speak up about smoking and vaping differed by venue, demographics, and cigarette/e-cigarette use. These findings help establish an evidence base to inform policymakers in developing strategies to promote compliance with smoke-free and vape-free laws.     

Behavioral effects of nicotine exposure from secondhand tobacco smoke among bar and restaurant workers

This study explores the behavioral effects of nicotine exposure from secondhand tobacco smoke (SHS) on bar and restaurant workers. Baseline data were obtained from a longitudinal study of 105 bar and restaurant workers. Hair nicotine, self-reported SHS exposure, smoking status, symptoms of nicotine exposure after being exposed to a smoky environment, and nicotine dependence were assessed. Nonsmokers reporting four or more symptoms of nicotine exposure had higher hair nicotine levels than those reporting less than four symptoms. Nonsmokers with higher hair nicotine levels were 2.2 times more likely to report 4 or more behavioral symptoms. Self-reported secondhand tobacco smoke exposure and hair nicotine were not predictive of nicotine dependence among smokers. Nicotine exposure from secondhand tobacco smoke may have important behavioral outcomes in nonsmokers. This study provides further evidence for the importance of prohibiting smoking in hospitality venues to protect the health of workers.     

Smoking in outdoor areas of bars and cafés: Large differences between midday and evening prevalences

Aim: There have been only two studies of the smoking prevalence outside bars/cafés worldwide, both undertaken in Australia. The aim of this study was to further develop the assessment of the prevalence of smoking outside bars/cafés in a busy urban area. It is important for smokefree places policymaking to have baseline data on smoking visibility at these places, so as to be able to gauge the effects of policy changes that may alter levels of smoking.

Methods: Researchers observed smoking during eight 15-minute periods (during 12–1?pm and 7–8?pm) in April 2013 at 14?bar/café locations in central Wellington, New Zealand.

Results: Of 2600 people observed in the outdoor areas of bars/cafés, 15.8% were observed smoking (95% confidence interval (CI): 14.5%–17.5%); 18.5% in the evening (95% CI: 16.8%–20.4%) compared to 9.1% at midday (95% CI: 7.2%–11.4%).

Conclusion: Smoking was observed in the outdoor areas of the bars/cafés at a prevalence of double that found in the previous Australian studies. This may be accounted for by observation method or observation times, or may be due to a much wider range of premises in the Australian cities with outdoor areas, which are open later, or a much wider variety of patrons who used such areas, compared to in Wellington. We found twice the prevalence of smoking outside bars/cafés in evenings compared to midday. Such differences may be related to a greater consumption of alcohol in evenings or to a different patronage then. Smokefree policies covering these settings could help denormalize smoking.     

Positive impact of the Portuguese smoking law on respiratory health of restaurant workers

The impact of smoke-free law on the respiratory and sensory symptoms among restaurant workers was evaluated. Fifty-two workers in 10 Portuguese restaurants were interviewed before and 2 years after implementation of the smoke-free law. A significant reduction in self-reported workplace environmental tobacco smoke (ETS) exposure was observed after the enforcement of the law, as well as a marked reduction in adverse respiratory and sensory symptoms such as dry, itching, irritated, or watery eyes, nasal problems, and sore or dry throat or cough, between pre- and post-ban. This study demonstrates that the smoking ban was effective in diminishing the exposure symptoms among workers and consequently in improving their respiratory health. These observations may have implications for policymakers and legislators in other countries currently considering the nature and extent of their smoke-free workplace legislation.     

Smoking Susceptibility and Attitudes Toward Smoking Among Chinese and Vietnamese American Adolescents

Abstract

In California, 641 Chinese and 629 Vietnamese age 12–17 participated in a longitudinal telephone study from 1999 to 2001. Four attitude scales were constructed: acceptance of smokers, addictive nature of smoking, psychosocial reasons to smoke, and gender roles and smoking. Vietnamese American adolescents had more pro-smoking attitudes than Chinese American adolescents. Male gender, having friends who smoked, and baseline smoking were associated with smoking susceptibility at follow-up. Those factors, U.S. birthplace, and the acceptance and psychosocial scales were associated with smoking. Smoking prevention efforts targeting Chinese and Vietnamese American adolescents should focus on gender, birthplace, peer smoking, and attitudes.     

Cultural investment: providing opportunities to reduce risky behavior among gay American Indian males

Many gay American Indian (GAI) men feel alienated from their tribal, ceremonial and social communities because of homophobia and heterosexism. As a result, they often turn to their local gay community for social participation and sex opportunities. It is no secret that a significant aspect of some gay communities is socializing in local bars and clubs. The gay bar scene makes healthy living difficult for Native American gay men. This is especially the case for those who are in alcohol or drug recovery. In response, gay Native men's support groups are attempting to make available a cultural alternative to the double bind of alienation from one's Native community and exposure to substance abuse by providing alcohol and substance free opportunities for ceremonial and social involvement. The hope is that the men will go to bars less frequently and instead turn to Native cultural activities in men's groups for social, spiritual and emotional support. The logic of this approach assumes that individuals who are culturally invested in a community will gain a level of self and social acceptance, making them less likely to abuse substances and put themselves at risk for HIV infection. The information presented in this article comes from over six years of ethnographic research among GAI men concerning self and social acceptance, HIV/AIDS and American Indian GLBT identity.     

餐饮食品中沙门氏菌的危害分析、污染调查与防控

目的调查了解餐饮消费环节熟肉制品和凉拌菜中沙门氏菌的污染状况,分析沙门氏菌的危害和污染分布特点,提出针对性防控措施建议,为餐饮服务环节食品安全的科学监管提供参考。方法采用文献综述、采样检测、结果分析评价并导出结论和建议的方法。结果在调查采集的371份样本中,检出沙门氏菌36株,检出率9.70%（其中,熟肉检出率为14.75%,凉拌菜检出率为7.23%）;在凉拌菜品种中,凉拌荤菜的检出率为8.40%,凉拌素菜的检出率为5.93%,差异无统计学意义（χ2=0.562,P〉0.05）;按被采样单位所属业态比较,小吃店检出率最高,为24.39%,其次是小型餐馆17.57%,快餐店和学校食堂的样本均未检出沙门氏菌,不同业态的检出率有极显著差异（χ2=21.028,P=0.001）;按被采样单位卫生等级比较,C级餐饮服务单位沙门氏菌检出率最高,为28.13%,与A、B级餐饮服务单位的检出率有极显著差异（χ2=24.607,P=0.000）。结论餐饮服务单位的熟肉和凉拌菜存在一定程度的沙门氏菌污染,小吃店、小型餐馆和C级餐饮服务单位熟肉和凉拌菜的污染水平较高;建议监管部门进一步加大监督检查力度,采取持续监测及推进餐饮企业建立食品安全控制体系等综合措施,有效防范沙门氏菌污染导致的食物中毒,保障公众饮食安全。     

Tobacco policies and on-premise smoking in bars and clubs that cater to young African Americans following the Maryland Clean Indoor Air Act of 2007

African American young adults ages 18–25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18–25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues—selected on the basis of youth reports of popular venues—were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.     

Risks for heart disease and lung cancer from passive smoking by workers in the catering industry.

Workers in the catering industry are at greater risk of exposure to secondhand smoke (SHS) when smoke-free workplace policies are not in force. We determined the exposure of catering workers to SHS in Hong Kong and their risk of death from heart disease and lung cancer. Nonsmoking catering workers were provided with screening at their workplaces and at a central clinic. Participants reported workplace, home, and leisure time exposure to SHS. Urinary cotinine was estimated by enzyme immunoassay. Catering facilities were classified into three types: nonsmoking, partially restricted smoking (with nonsmoking areas), and unrestricted smoking. Mean urinary cotinine levels ranged from 3.3 ng/ml in a control group of 16 university staff through 6.4 ng/ml (nonsmoking), 6.1 ng/ml (partially restricted), and 15.9 ng/ml (unrestricted smoking) in 104 workers who had no exposures outside of work. Workers in nonsmoking facilities had exposures to other smoking staff. We modeled workers' mortality risks using average cotinine levels, estimates of workplace respirable particulates, risk data for cancer and heart disease from cohort studies, and national (US) and regional (Hong Kong) mortality for heart disease and lung cancer. We estimated that deaths in the Hong Kong catering workforce of 200,000 occur at the rate of 150 per year for a 40-year working-lifetime exposure to SHS. When compared with the current outdoor air quality standards for particulates in Hong Kong, 30% of workers exceeded the 24-h and 98% exceeded the annual air quality objectives due to workplace SHS exposures.     

Factors related to frequency of narghile (waterpipe) use: the first insights on tobacco dependence in narghile users

AIMS: To evaluate factors related to level of narghile (waterpipe) use as a first step towards modeling tobacco dependence among narghile users. DESIGN: Cross sectional survey done in 2003 using interviewer-administered anonymous questionnaires. SETTING: Cafes/restaurants serving narghiles in Aleppo, Syria. PARTICIPANTS: Narghile smokers (161 men and 107 women; mean age, 30.1 +/- 10.2, 161; age range, 18-68 years; response rate, 95.3%) randomly selected from the 17 cafes/restaurants sampled. MEASUREMENTS: Frequency of narghile use (daily, weekly, monthly) was assessed as a function of several factors potentially indicative of dependence, including situational characteristics (where, when, and with whom smoking occurs; seasonality of use, and sharing of narghile), attitudes, and experience with quitting narghile use, escalation of use over time, future intentions regarding use, perception of being "hooked" on narghile, and cognitions/behaviors engaged in to support use (carrying one's own narghile; think of narghile when it is not available; considering narghile for selection of cafes/restaurants). FINDINGS: Frequency of narghile use was strongly correlated with participant's subjective judgment of how hooked they are on narghile (coefficient, 0.5). Predictors of narghile use frequency according to multinomial logistic regression were: male gender, smoking mainly alone versus with others; smoking mainly at home versus outside; smoking more frequently since initiation, being hooked on narghile, carrying narghile, and considering it for cafe/restaurant choice. CONCLUSIONS: Our data reveal two main domains of a tobacco dependence syndrome likely to be relevant to narghile; the first reflects the effects of nicotine contained in narghile tobacco, and is not very different from what is seen with other tobacco products, and the second is unique to narghile and is related mainly to its social dimension, with more intensive smokers showing an increasingly individual pattern of narghile smoking.     

At risk alcohol consumption with smoking by national background: Results from the Hispanic community health study/study of Latinos

IntroductionTobacco smoking and binge or excess drinking are unhealthy behaviors that frequently co-occur. Studies of Hispanics/Latinos have mostly been of Mexican Americans although there are substantial differences in smoking and drinking by heritage background. Associated with co-use by 5 subpopulations.MethodsCross-sectional data of 16,412 Hispanics/Latinos from Miami, the Bronx, Chicago and San Diego collected between 2008 and 2011 as part of the HCHS/SOL were analyzed. Smoking and alcohol consumption and demographic data were measured by self-report. Prevalence of smoking and alcohol consumption and co-use were reported. Logistic regression models examined the odds of co-use of smoking and binge or excess alcohol use by Hispanic/Latino background group.ResultsMen of Cuban (10.3%), Puerto Rican (8.9%), and Mexican (8.9%) background had the highest prevalence of co-use of smoking and binge drinking compared to men of Central American (6.1%) and Dominican (6.6%) background. Women of Dominican (16.4%) and Puerto Rican (19.7%) background had the highest prevalence of binge drinking compared to women of Central American (10%) and Cuban (8%) background and Puerto Rican (34.1%) and Cuban (21.8%) women were the most likely to report current smoking compared to women of Central American (8.3%) and Mexican (10.4%) background. Acculturation was not associated with co-use among men and women. Elevated depressive symptoms were positively associated with smoking and binge drinking among men, OR = 1.5 [1.2–2.0], and women, OR = 1.5 [1.1–2.2]. Puerto Rican women had increased odds of co-use of smoking and binge or excess drinking compared to Mexican American women, OR = 3.2 [1.5–6.6].ConclusionsPuerto Rican and Dominican Latinas and Central American and South American men have a higher prevalence of co-use.     

Pharmacy workers’ perceptions and acceptance of bar-coded medication technology in a pediatric hospital

BackgroundThe safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology.Objectives(1) To describe pharmacy workers’ perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA.MethodsPharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital’s implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians’ self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models.ResultsThe BCMA system’s perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA.ConclusionsTo promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians’ acceptance and elucidating perceptions and other factors that shape acceptance.     

Trends in alternative tobacco use among light, moderate, and heavy smokers in adolescence, 1999-2009

ObjectiveTo examine trends in alternative tobacco product (ATP) use (smokeless tobacco, cigars, and bidis/cloves) among a national sample of adolescent cigarette smokers (light, moderate, and heavy) during 1999–2009.MethodA secondary analysis of data from the 1999–2009 National Youth Tobacco Survey was performed to investigate the tobacco behaviors of 6th through 12th graders enrolled in public and private schools in the United States. Long-term trends in ATP use were analyzed using logistic regression – controlling for sex, grade, and race/ethnicity – and simultaneously assessing linear and higher order time effects and their interaction with cigarette smoking status.ResultsDuring 1999–2009, increases in smokeless tobacco use and decreases in bidis/cloves use were observed across all smoking groups. For cigars, declines were observed for heavy and moderate smokers, but levels returned to baseline levels in 2009. Cigar use among light smokers was less variable. Rates of any ATP were highest among heavy smokers and lowest among light smokers.ConclusionTrends in cigarette and SLT use increased dramatically in the past decade, and this increase is evident across all cigarette smoker types. Implications for tobacco surveillance, prevention and cessation programs, and tobacco control policies are discussed.     

Young adults report increased pleasure from using e-cigarettes and smoking tobacco cigarettes when drinking alcohol

BackgroundCigarettes share a high rate of co-use with alcohol, particularly among young adults. Studies have demonstrated greater perceived pleasure from smoking cigarettes when drinking alcohol. However, little is known about co-use of electronic cigarettes (e-cigs) and alcohol. The current study sought to compare extent of use and perceived pleasure from cigarettes and e-cigs when drinking alcohol.MethodsYoung adult bar patrons in California cities (San Diego, Los Angeles, and San Francisco) were recruited in 2015–16 using randomized time-location sampling. Participants completed cross-sectional surveys in bars, reporting the percent of cigarette smoking/e-cig use that occurred under the influence of alcohol, and reported if pleasure from smoking cigarettes/using e-cigs changed when drinking alcohol. Analyses are limited to participants reporting current (past 30-day) use of cigarettes, e-cigs, and alcohol (N = 269; M age = 24.1; 40.1% female, 36.1% Non-Hispanic White).ResultsParticipants reported a greater percentage of cigarette smoking compared to e-cig use under the influence of alcohol (cigarettes M = 63.6%; e-cigs M = 46.7%; p < .001). Participants also reported increased pleasure both from smoking cigarettes (M = 3.9; [compared to midpoint of scale 3 - “no change”] p < .001) and using e-cigs (M = 3.3; p < .001) when drinking alcohol. The increase in pleasure was more pronounced for cigarettes compared to e-cigs (p < .001).ConclusionsDrinking alcohol is associated with increases in perceived rewarding effects of both cigarettes and e-cigs and thus may increase their abuse liability. This effect may be stronger for cigarettes, which could be an important barrier to switching completely from smoking cigarettes to using e-cigs, or quitting both entirely.