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| ID | Type | Description | Link |
|---|---|---|---|
| U01DA045537 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Drug Abuse (NIDA) | NIH |
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The overall aim of the study is to evaluate the provision of e-cigarette (EC) versus NRT on smoking behavior, product use patterns and continued use, and iCO, a biomarker of toxicant exposure, among a sample of recent QL treatment failures. We will randomly assign N=372 smokers (targeted accrual) to EC (n=186) or QL treatment as usual with combination nicotine replacement therapy (NRT; n=186). All participants will receive three calls from QL coaches and EC and NRT will be provided at no cost for 8 weeks. The final follow-up will occur 12-weeks post baseline.
There remains a lack of prospective and controlled research on the behavioral, toxicological, and physiological effects of electronic cigarettes (ECs) to help the public health community come to a clear and accurate consensus on their risk-benefit. In order to successfully execute the proposed study, the investigators plan to recruit and enroll recent smoking cessation treatment failures from a state QL, which predominately serves priority populations (e.g., low socioeconomic status, high levels of mental health conditions). The proposed study will randomly assign smokers who were recent QL treatment failures to a) EC (JUUL 5%) or b) QL treatment as usual with combination nicotine replacement therapy control (NRT).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| E-cigarette | Experimental | 5% nicotine JUUL e-cigarette (Tobacco or Menthol flavor). Will also receive counseling. |
|
| Treatment As Usual | Active Comparator | Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard assessments. Will also receive counseling. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| JUUL | Device | Participants randomized to the JUUL group will receive either tobacco or menthol flavored JUUL with 5% nicotine. Will also receive counseling. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of Participants With Self-Reported 7-day Point Prevalence Abstinence From Cigarettes | Self-Reported 7-day Point Prevalence Abstinence from Cigarettes to assess complete product switching/substitution. | Daily for 12 weeks |
| Proportion of Participants With iCO (Portable Carbon Monoxide Monitor) Verified Abstinence | Intent to treat biochemically verified abstinence rates - participants reporting both 7-day point prevalence abstinence and an iCO reading less than or equal to 8. A portable exhaled carbon monoxide detector confirms daily smoking status. Used to evaluate changes iCO, a biomarker of tobacco constituent exposure and other health effects. | 12 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Sociodemographic Questionnaire - Age | Assess participant age from the sociodemographic questionnaire | Baseline |
| Sociodemographic Questionnaire - Sex | Assess participant sex from the sociodemographic questionnaire |
| Measure | Description | Time Frame |
|---|---|---|
| Tobacco Use History Questionnaire - Years of Smoking | Assess years of smoking from the tobacco use history questionnaire | Week 1 (baseline) |
| Tobacco Use History Questionnaire - Cigarettes Per Day | Assess average number of cigarettes per day with the tobacco use history questionnaire |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Theodore L Wagener, PhD | Ohio State Comprehensive Cancer Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ohio State University Comprehensive Cancer Center | Columbus | Ohio | 43210 | United States |
De-identified and aggregated data will be shared through poster presentations and published manuscripts.
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| ID | Title | Description |
|---|---|---|
| FG000 | E-cigarette | 5% nicotine JUUL e-cigarette (Tobacco or Menthol flavor). Will also receive counseling. JUUL: Participants randomized to the JUUL group will receive either tobacco or menthol flavored JUUL with 5% nicotine. Will also receive counseling. |
| FG001 | Treatment As Usual | Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard assessments. Will also receive counseling. Treatment As Usual: Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard quitline counseling. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | E-cigarette | 5% nicotine JUUL e-cigarette (Tobacco or Menthol flavor). Will also receive counseling. JUUL: Participants randomized to the JUUL group will receive either tobacco or menthol flavored JUUL with 5% nicotine. Will also receive counseling. |
| BG001 | Treatment As Usual |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Age was not collected for 4 participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Proportion of Participants With Self-Reported 7-day Point Prevalence Abstinence From Cigarettes | Self-Reported 7-day Point Prevalence Abstinence from Cigarettes to assess complete product switching/substitution. | Posted | Count of Participants | Participants | Daily for 12 weeks |
|
12 weeks
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | E-cigarette | 5% nicotine JUUL e-cigarette (Tobacco or Menthol flavor). Will also receive counseling. JUUL: Participants randomized to the JUUL group will receive either tobacco or menthol flavored JUUL with 5% nicotine. Will also receive counseling. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Breast Cancer | Reproductive system and breast disorders | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Allergies | Immune system disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Theodore L. Wagener | OhioSUCCC | 614-366-4265 | Theodore.Wagener@osumc.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP_ICF | Yes | Yes | Yes | Study Protocol, Statistical Analysis Plan, and Informed Consent Form | Jan 11, 2022 | Mar 24, 2023 | Prot_SAP_ICF_000.pdf |
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| ID | Term |
|---|---|
| D000073865 | Cigarette Smoking |
| D000072137 | Vaping |
| D040261 | Harm Reduction |
| D012907 | Smoking |
| ID | Term |
|---|---|
| D000073869 | Tobacco Smoking |
| D001519 | Behavior |
| D064424 | Tobacco Use |
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| ID | Term |
|---|---|
| D013812 | Therapeutics |
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Participants will be assigned to one of two conditions randomly.
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This study is a comparative randomized study.
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| Treatment As Usual | Other | Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard quitline counseling. |
|
| Baseline |
| Sociodemographic Questionnaire - Marital Status | Assess participant marital status from the sociodemographic questionnaire | Baseline |
| Sociodemographic Questionnaire - Ethnicity | Assess participant ethnicity from the sociodemographic questionnaire | Baseline |
| Sociodemographic Questionnaire - Employment Status | Assess participant employment status from the sociodemographic questionnaire | Baseline |
| Sociodemographic Questionnaire - Socioeconomic Status | Assess participant socioeconomic status via yearly household income | Baseline |
| Cigarette/EC Dependency Scale | Assess e-cigarette and cigarette dependence. Scores range from 5 to 25 with higher scores indicating a greater level of dependence. | 12 weeks |
| Drug Effects/Liking Questionnaire | Assess the desire and liking of products, positive and negative effects (i.e., side effects), and perceived strength and effectiveness Scores range from 1 to 5 with higher scores indicating greater strength (effect from smoking cigarettes/vaping e-cigarettes) or liking (liking of effect from smoking cigarettes/vaping e-cigarettes) | 12 weeks |
| Cigarette Purchase Task - Breakpoint | Asks participants how much they would be willing to pay (ranging from 0¢ to $1,120) for a puff of their own brand cigarette. Specifically they will be asked, "How much would you be willing to pay for a puff of your usual cigarette brand?". | Week 1 (Baseline) |
| Tiffany-Drobes Questionnaire of Smoking Urges: Brief Form (QSU) | Smoking and vaping urges/craving will be measured using the Tiffany-Drobes Questionnaire of Smoking Urges: Brief Form with a modified version (replacing the word "cigarette" with "e-cigarette") for EC users. This is a 10-item measure where participants rate smoking/vaping-related items on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Similar to previous studies, we will collapse the items into two previously identified factors (Factor 1: strong desire and intention to smoke/vape; Factor 2: anticipation of relief from withdrawal symptoms). Scores are calculated by summing the items and range from 5 to 35 for each of the factors with higher scores indicating greater craving to smoke/vape. | 12 Weeks |
| Minnesota Nicotine Withdrawal Scale | Asses Nicotine withdrawal and smoking craving, anger/irritability, anxiety, depressed mood, restlessness/difficulty concentrating, increased appetite, sleep problems, and somatic symptoms (nausea, constipation, sore throat, dizziness, coughing). Scores range from 0 to 4 with higher scores indicating greater levels of withdrawal (MNWS) or more craving to smoke (MNWS Craving). | 12 Weeks |
| Change in Motivation Rulers (Scale) From Baseline to Week 12 | Assess for changes in motivation from baseline to week 12 among participants who continue to smoke. Rulers including importance, confidence, and readiness to quit smoking (3-items total, with a scale ranging from 0 "not at all important/confident/ready" to 10 "extremely important/confident/ready"). Medians reported are change from baseline [week 12 score - baseline score] where negative values indicate a decrease in motivation over time and positive values indicate an increase in motivation over time. | 12 Weeks |
| Week 1 (baseline) |
| Tobacco Use History Questionnaire - 24-hour Quit Attempts | Assess number of previous 24-hour quit attempts with the tobacco use history questionnaire | Week 1 (baseline) |
| Tobacco Use History Questionnaire - Number of Smokers in the Household | Assess number of smokers in the household with the tobacco use history questionnaire | Week 1 (baseline) |
| Tobacco Use History Questionnaire - Cigarette Expectance Effects | Assess cigarette expectance effects with the tobacco use history questionnaire | Week 1 (baseline) |
| Tobacco Use History Questionnaire | Assess frequency of use all of nicotine/tobacco products including cigars, cigarillos, little cigars, smokeless tobacco, EC, and hookah. | Week 1 (Baseline) |
| Study Team Decision |
|
| Withdrawal by Subject |
|
| Death |
|
Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard assessments. Will also receive counseling. Treatment As Usual: Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard quitline counseling. |
| BG002 | Total | Total of all reporting groups |
| Mean |
| Standard Deviation |
| years |
|
| Sex: Female, Male | Sex was not collected for 4 participants | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Cigarettes Smoked per Day | 5 Participants were missing data on cigarettes per day smoked at baseline | Mean | Standard Deviation | cigarettes per day |
|
|
|
| Primary | Proportion of Participants With iCO (Portable Carbon Monoxide Monitor) Verified Abstinence | Intent to treat biochemically verified abstinence rates - participants reporting both 7-day point prevalence abstinence and an iCO reading less than or equal to 8. A portable exhaled carbon monoxide detector confirms daily smoking status. Used to evaluate changes iCO, a biomarker of tobacco constituent exposure and other health effects. | Posted | Count of Participants | Participants | 12 weeks |
|
|
|
| Secondary | Sociodemographic Questionnaire - Age | Assess participant age from the sociodemographic questionnaire | Participants who completed the baseline survey; age was not collected for 4 participants | Posted | Mean | Standard Deviation | years | Baseline |
|
|
|
| Secondary | Sociodemographic Questionnaire - Sex | Assess participant sex from the sociodemographic questionnaire | Participants who completed the baseline survey; sex was not collected for 4 participants | Posted | Count of Participants | Participants | Baseline |
|
|
|
| Secondary | Sociodemographic Questionnaire - Marital Status | Assess participant marital status from the sociodemographic questionnaire | Participants who completed the baseline survey; marital status was not collected for 4 participants | Posted | Count of Participants | Participants | Baseline |
|
|
|
| Secondary | Sociodemographic Questionnaire - Ethnicity | Assess participant ethnicity from the sociodemographic questionnaire | Posted | Count of Participants | Participants | Baseline |
|
|
|
| Secondary | Sociodemographic Questionnaire - Employment Status | Assess participant employment status from the sociodemographic questionnaire | Participants who completed the baseline survey; employment data was not collected for 4 participants; 2 additional participants refused to answer the employment items | Posted | Count of Participants | Participants | Baseline |
|
|
|
| Secondary | Sociodemographic Questionnaire - Socioeconomic Status | Assess participant socioeconomic status via yearly household income | Participants who completed the baseline survey; household income was not collected for 4 participants; 7 additional participants refused to answer the income item | Posted | Count of Participants | Participants | Baseline |
|
|
|
| Secondary | Cigarette/EC Dependency Scale | Assess e-cigarette and cigarette dependence. Scores range from 5 to 25 with higher scores indicating a greater level of dependence. | Participants who completed their 12 week visit and provided responses to each item on the cigarette/e-cigarette dependency scale questionnaire. Participants in the treatment as usual arm were not assessed with the e-cigarette dependence scale as it is only applicable to the e-cigarette arm. | Posted | Mean | Standard Deviation | units on a scale | 12 weeks |
|
|
|
| Secondary | Drug Effects/Liking Questionnaire | Assess the desire and liking of products, positive and negative effects (i.e., side effects), and perceived strength and effectiveness Scores range from 1 to 5 with higher scores indicating greater strength (effect from smoking cigarettes/vaping e-cigarettes) or liking (liking of effect from smoking cigarettes/vaping e-cigarettes) | Participants who responded to the drug effects liking questionnaire within 1 week of their week 12 visit. Participants in the treatment as usual arm were not assessed with the e-cigarette drug effects and liking questionnaires as they are only applicable to the e-cigarette arm. | Posted | Mean | Standard Deviation | score on a scale | 12 weeks |
|
|
|
| Secondary | Cigarette Purchase Task - Breakpoint | Asks participants how much they would be willing to pay (ranging from 0¢ to $1,120) for a puff of their own brand cigarette. Specifically they will be asked, "How much would you be willing to pay for a puff of your usual cigarette brand?". | Participants who completed the cigarette purchase task at baseline. | Posted | Mean | Standard Deviation | Dollars | Week 1 (Baseline) |
|
|
|
| Secondary | Tiffany-Drobes Questionnaire of Smoking Urges: Brief Form (QSU) | Smoking and vaping urges/craving will be measured using the Tiffany-Drobes Questionnaire of Smoking Urges: Brief Form with a modified version (replacing the word "cigarette" with "e-cigarette") for EC users. This is a 10-item measure where participants rate smoking/vaping-related items on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Similar to previous studies, we will collapse the items into two previously identified factors (Factor 1: strong desire and intention to smoke/vape; Factor 2: anticipation of relief from withdrawal symptoms). Scores are calculated by summing the items and range from 5 to 35 for each of the factors with higher scores indicating greater craving to smoke/vape. | Participants who completed their 12 week visit. Participants in the treatment as usual arm were not assessed with the e-cigarette QSU questionnaire as it is only applicable to the e-cigarette arm. Participants in the e-cigarette arm were not assessed with the NRT QSU questionnaire as it is only applicable to the treatment as usual arm. | Posted | Mean | Standard Deviation | score on a scale | 12 Weeks |
|
|
|
| Secondary | Minnesota Nicotine Withdrawal Scale | Asses Nicotine withdrawal and smoking craving, anger/irritability, anxiety, depressed mood, restlessness/difficulty concentrating, increased appetite, sleep problems, and somatic symptoms (nausea, constipation, sore throat, dizziness, coughing). Scores range from 0 to 4 with higher scores indicating greater levels of withdrawal (MNWS) or more craving to smoke (MNWS Craving). | Participants who completed their 12 week visit | Posted | Mean | Standard Deviation | score on a scale | 12 Weeks |
|
|
|
| Secondary | Change in Motivation Rulers (Scale) From Baseline to Week 12 | Assess for changes in motivation from baseline to week 12 among participants who continue to smoke. Rulers including importance, confidence, and readiness to quit smoking (3-items total, with a scale ranging from 0 "not at all important/confident/ready" to 10 "extremely important/confident/ready"). Medians reported are change from baseline [week 12 score - baseline score] where negative values indicate a decrease in motivation over time and positive values indicate an increase in motivation over time. | Participants who continued to smoke cigarettes at their week 12 visit and provided responses to both the baseline and 12 week motivation ruler questionnaire. | Posted | Median | Inter-Quartile Range | score on a scale | 12 Weeks |
|
|
|
| Other Pre-specified | Tobacco Use History Questionnaire - Years of Smoking | Assess years of smoking from the tobacco use history questionnaire | Participants who completed the tobacco use history questionnaire at baseline | Posted | Mean | Standard Deviation | years | Week 1 (baseline) |
|
|
|
| Other Pre-specified | Tobacco Use History Questionnaire - Cigarettes Per Day | Assess average number of cigarettes per day with the tobacco use history questionnaire | Participants who completed the tobacco use history questionnaire at baseline | Posted | Mean | Standard Deviation | cigarettes per day | Week 1 (baseline) |
|
|
|
| Other Pre-specified | Tobacco Use History Questionnaire - 24-hour Quit Attempts | Assess number of previous 24-hour quit attempts with the tobacco use history questionnaire | Participants who completed the tobacco use history questionnaire at baseline | Posted | Mean | Standard Deviation | quit attempts | Week 1 (baseline) |
|
|
|
| Other Pre-specified | Tobacco Use History Questionnaire - Number of Smokers in the Household | Assess number of smokers in the household with the tobacco use history questionnaire | Participants who completed the tobacco use history questionnaire at baseline | Posted | Mean | Standard Deviation | people | Week 1 (baseline) |
|
|
|
| Other Pre-specified | Tobacco Use History Questionnaire - Cigarette Expectance Effects | Assess cigarette expectance effects with the tobacco use history questionnaire | Participants who completed the baseline survey | Posted | Count of Participants | Participants | Week 1 (baseline) |
|
|
|
| Other Pre-specified | Tobacco Use History Questionnaire | Assess frequency of use all of nicotine/tobacco products including cigars, cigarillos, little cigars, smokeless tobacco, EC, and hookah. | Participants who completed the baseline survey | Posted | Count of Participants | Participants | Week 1 (Baseline) |
|
|
|
| 0 |
| 175 |
| 18 |
| 175 |
| 93 |
| 175 |
| EG001 | Treatment As Usual | Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard assessments. Will also receive counseling. Treatment As Usual: Nicotine Replacement Therapy consisting of nicotine patches and lozenge along with standard quitline counseling. | 2 | 175 | 10 | 175 | 87 | 175 |
| Breathing Difficulties | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Broken Back | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Carotid Endarterectomy Surgery | Surgical and medical procedures | Systematic Assessment |
|
| Chest Pain | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Chest Pain | Cardiac disorders | Systematic Assessment |
|
| Chest Pain | General disorders | Systematic Assessment |
|
| Cuff Repair Surgery | Blood and lymphatic system disorders | Systematic Assessment |
|
| Dental Problems | Surgical and medical procedures | Systematic Assessment |
|
| Depression | Psychiatric disorders | Systematic Assessment |
|
| Diarrhea | Gastrointestinal disorders | Systematic Assessment |
|
| Dizziness | Nervous system disorders | Systematic Assessment |
|
| Essential Tremor Worsening | Nervous system disorders | Systematic Assessment |
|
| Exploratory Larynx Surgery | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Gallbladder Problems | Hepatobiliary disorders | Systematic Assessment |
|
| Gastrointestinal Problems | Gastrointestinal disorders | Systematic Assessment |
|
| Headache | Nervous system disorders | Systematic Assessment |
|
| Heart Condition | Cardiac disorders | Systematic Assessment |
|
| Heart Palpitations | Cardiac disorders | Systematic Assessment |
|
| Hernia | Surgical and medical procedures | Systematic Assessment |
|
| Myocardial Infarction | Cardiac disorders | Systematic Assessment |
|
| Needed Medication Adjustment for Bipolar Schizoaffective Disorder | Psychiatric disorders | Systematic Assessment |
|
| Pancreatic Pain | Gastrointestinal disorders | Systematic Assessment |
|
| Pneumonia | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Seizure | Nervous system disorders | Systematic Assessment |
|
| Suicidal Thoughts | Psychiatric disorders | Systematic Assessment |
|
| Ulcer | Gastrointestinal disorders | Systematic Assessment |
|
| Wound Abscess | Infections and infestations | Systematic Assessment |
|
| Breathing Difficulties | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Cough | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Dizziness | Nervous system disorders | Systematic Assessment |
|
| Headache | Blood and lymphatic system disorders | Systematic Assessment |
|
| Mouth or Tongue Sores or Inflammation | Gastrointestinal disorders | Systematic Assessment |
|
| Sleeplessness | Psychiatric disorders | Systematic Assessment |
|
| Sore or Dry Mouth and Throat | Gastrointestinal disorders | Systematic Assessment |
|
| Sleepiness | Nervous system disorders | Systematic Assessment |
|
| Sleeplessness | Nervous system disorders | Systematic Assessment |
|
Not provided
Not provided
| Unknown or Not Reported |
|
| Widowed |
|
| Not married, but living with romantic partner |
|
| Romantic partner (not living with) |
|
| Never married and not in current romantic relationship |
|
| Unknown or Not Reported |
|
| Self-employed |
|
| Out of work |
|
| Homemaker |
|
| Retired |
|
| Unable to work/Disabled |
|
| e-Cigarette Dependence Scale |
|
|
| Liking of effect after smoking cigarettes |
|
|
| Effect from vaping e-cigarette |
|
|
| Liking of effect from vaping e-cigarette |
|
|
| QSU Relief (cigarette) |
|
|
| QSU Desire (e-cigarette) |
|
|
| QSU Relief (e-cigarette) |
|
|
| QSU Desire (NRT) |
|
|
| QSU Relief (NRT) |
|
|
| Readiness |
|
|
| Confidence |
|
|
| Agree a little |
|
| Agree |
|
| Refuse to answer / Don't know |
|
| Cigarettes are good for dealing with boredom |
|
| Smoking keeps my weight down |
|
| When I'm upset with someone, a cigarette helps me cope |
|
| If I have nothing to do, a smoke can help kill time |
|
| When I'm feeling down, a cigarette can really make me feel good |
|
| Cigarettes keep me from eating more than I should |
|
| When I'm alone, a cigarette can help me pass the time |
|
| Smoking cigarettes calms me down when I feel nervous |
|
| Smoking helps me control my weight |
|
| Less than weekly, but at least once a month |
|
| Less than monthly |
|
| Not at all |
|
| Refuse to answer/Don't know |
|
| Cigar |
|
| Cigarillo |
|
| Little Cigar |
|
| Smokeless Tobacco |
|
| Hookah |
|