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Aims: To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD). Design: Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008–19 public use data from the National Survey on Drug Use and Health, an annual, cross‐sectional survey. Setting: USA. Participants: A nationally representative sample of non‐institutionalized respondents aged 18–64 years (n = 448 762). Measurements Outcome variables were three measures of recent cigarette use and one measure of past‐year health insurance coverage. We compared outcomes between people with and without MH/SUD (MH disorder: past‐year mental illness, predicted from Kessler‐6 and the World Health Organization–Disability Assessment Schedule impairment scale; SUD: met survey‐based DSM‐IV criteria for past‐year alcohol, cannabis, cocaine or heroin use disorder) and over time. Findings Comparing pooled data from 2008 to 2009 and from 2018 to 2019, current smoking rates of adults with MH/SUD decreased from 37.9 to 27.9% while current smoking rates of adults without MH/SUD decreased from 21.4 to 16.3%, a significant difference in decrease of 4.9 percentage points (pts) [95% confidence interval (CI) = 3.3–6.6 pts]. Daily smoking followed similar patterns (difference in decrease of 3.9 pts (95% CI = 2.3–5.4 pts). Recent smoking abstinence rates for adults with MH/SUD increased from 7.4 to 10.9%, while recent smoking abstinence rates for adults without MH/SUD increased from 9.6 to 12.0%, a difference in increase of 1.0 pts (95% CI = −3.0 to 0.9 pts). In 2018–19, 11% of net reductions in current smoking, 12% of net reductions in daily smoking and 12% of net increases in recent smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD compared to those without MH/SUD. Conclusions: Improvements in smoking and abstinence outcomes for US adults with mental health and substance use disorders appear to be associated with increases in health insurance coverage. [ABSTRACT FROM AUTHOR]

Background and Aims: Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit. Design: Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020. Setting: This study was conducted in the United States, Canada, England and Australia. Participants: Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815). Measurements Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow‐up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow‐up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter‐wave vaping uptake was assesed between baseline and follow‐up (none, only non‐daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter‐wave vaping uptake was associated with smoking cessation at follow‐up and with planning to quit at follow‐up, each stratified by plans to quit smoking at baseline. Findings Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06–14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91–4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow‐up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17–9.59). Conclusions: Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers. [ABSTRACT FROM AUTHOR]

Aims: To estimate whether and to what extent extending indoor smoking restrictions to include electronic cigarettes (ECs) impact the use of ECs and cigarette smoking among adults in the United States. Design: Observational study using a linear probability model and applying a difference‐in‐differences analysis. Setting: United States. Participants: People aged 18–54 who lived in US counties where comprehensive indoor smoking laws in bars, restaurants and private work‐places have been in place prior to 2010 (n = 45 111 for EC use analysis, n = 75 959 for cigarette use analysis). Measurements Data on cigarette smoking, use of ECs and place of residence from the Tobacco Use Supplement of the Current Population Survey (TUS‐CPS 2010–11, 2014–15 and 2018–19) were combined with the American Nonsmokers' Rights Foundation (ANRF) database of state and local indoor smoking and vaping restriction laws. Findings Indoor vaping restriction (IVR) coverage was not significantly associated with the likelihood of adult EC use [coefficient estimate = 0.001; 95% confidence interval (CI) = −0.009, 0.013, P‐value = 0.783]. In addition, IVR coverage was not significantly associated with adult cigarette smoking (coefficient estimate = −0.00; 95% CI = −0.016, 0.015, P‐value = 0.954). The non‐significant results appeared in different socio‐demographic subgroups. Conclusions: IVRs do not appear to decrease electronic cigarette use among US adults. There is no evidence that IVRs increase or decrease cigarette smoking among US adults. [ABSTRACT FROM AUTHOR]

Aims: To examine whether polyuse of cigarettes and other smoked products (polysmoking) is predictive of quit attempts and quit success. Design: A prospective multi‐country cohort design. Setting: Australia, Canada, England and the United States. Participants: A total of 3983 adult daily cigarette smokers were surveyed in 2016 (wave 1 of data collection) and were re‐contacted in 2018 (wave 2) (i.e. waves 1–2 cohort) in the International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys; and 3736 smokers were surveyed in 2018 and re‐contacted in 2020 (wave 3) (i.e. waves 2–3 cohort). Measurements Participants were asked about their cigarette smoking and use of cigars, cigarillos, pipes and waterpipes. Outcomes were quit attempts between two survey waves and success, defined as having quit smoking all the combustible tobacco at the subsequent survey for 1 month or more. Findings Levels of polysmoking were 12.7% in the waves 1–2 cohort and 10.5% for the waves 2–3 cohort. Compared with cigarette‐only smokers, polysmokers were more likely to attempt to quit between waves 1 and 2 [54.9 versus 42.7%, adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 1.08–1.74, P < 0.01], but not between waves 2 and 3 (43.8 versus 40.1%, aOR = 0.94, 95% CI = 0.72–1.22). Polysmoking predicted reduced likelihood of success in both cohorts among attempters and the overall samples. Between waves 2 and 3 there were significantly more transitions to non‐daily smoking among the polysmokers (12.4 versus 5.3%, χ2 = 40.4, P < 0.001). Conclusions: There is a consistent association between polysmoking (use of cigarettes together with other smoked products) and reduced quit success for combustible tobacco, but it is probably due to increased likelihood of transitioning to non‐daily use rather than complete cessation. [ABSTRACT FROM AUTHOR]

Background and Aims: Although over half of United States states have passed taxes on electronic nicotine delivery systems (ENDS), recent evidence links ENDS tax rates to increases in smoking, suggesting potentially substantive health costs. Overall health implications will depend on how these taxes affect transitions from experimentation to regular smoking and vaping. Current analyses have not assessed ENDS tax rates' effects in young adulthood (ages 18–25). This study measures the relationship between ENDS and cigarette tax rates and ENDS use and smoking in young adulthood, a key period for initiation of regular tobacco use. Design: Observational study of data from the Current Population Survey's 2010–2019 Tobacco Use Supplements. Setting: The United States. Participants/Cases: A total of 38 906 18 to 25 year‐olds Measurements: Multivariable linear regressions estimated two‐way fixed effects analyses to assess ENDS and cigarette tax rates' relationships to recent and daily smoking and vaping, adjusting for an array of potential sociodemographic and policy confounders along with state and year fixed effects. Findings A $1 increase in ENDS taxes yielded significant reductions in young adults' daily vaping (β̂ = −0.025; 95% CI, −0.037, −0.014) alongside increases in recent smoking (β̂ = 0.037; 95% CI, 0.013, 0.061), primarily reflecting greater dual use (β̂ =2.078; 95% CI, 0.890, 4.852; P = 0.09). A $1 cigarette tax increase yielded 2.1 and 2.5 percentage point increases in recent and daily vaping, with 95% CIs of (0.004, 0.038) and (0.018, 0.032) respectively. Conclusions: In the United States, higher ENDS tax rates are associated with decreased ENDS use but increased cigarette smoking among 18‐ to 25‐year‐olds, with associations reversed for cigarette taxes. [ABSTRACT FROM AUTHOR]

Aims: To identify subpopulations of dual users of combustible and electronic cigarettes using current smoking and vaping behaviors. Design: Secondary analysis of baseline data from a randomized controlled trial testing a smoking cessation intervention for dual users. Finite mixture modeling of frequency, quantity, and dependence on combustible and electronic cigarettes was used to identify classes. Demographics and additional smoking and vaping variables were used to further characterize the classes. Setting: United States. Participants: A total of 2896 adults who smoked weekly for the past year and vaped weekly for the past month. Measurements Self‐report baseline measures assessed demographics and smoking and vaping behaviors and characteristics including days of use per week, frequency of use within a day, time to first use after waking, urges to smoke, smoking cessation motivation, self‐efficacy to abstain from smoking, months since vaping initiation, reasons for initiating and maintaining vaping, and future plans to stop vaping. Findings Eight probabilistic classes were identified and well‐defined (relative entropy = 0.95, Lo–Mendell–Rubin adjusted likelihood ratio test P < 0.0001; class probabilities 0.89–0.97). In general, classes crossed two levels of smoking with four levels of vaping. The largest class (31%) had relatively high levels of smoking (72% daily, 56% 11+ cigarettes per day [CPD], 96% within 30 minutes of waking) and vaping (74% daily, 100% 20+ electronic‐CPD, 74% <30 minutes). The next largest class (27%) had relatively high levels of vaping (93% daily, 100% 20+ electronic‐CPD, 82% <30 minutes) and very low levels of smoking (28% daily, 12% 11+ CPD, 0% <30 minutes). The six smaller classes (3%–13%) also had distinct smoking and vaping behaviors. All eight classes exhibited distinguishing characteristics beyond current smoking and vaping behaviors. Conclusions: Dual users of combustible and electronic cigarettes are not a homogeneous population, having eight well‐defined prospective subpopulations. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether e‐cigarette and cigarette susceptibility predict e‐cigarette and cigarette use among American youth 1 year later. Design and Setting: Longitudinal data from the Population Assessment of Tobacco and Health (PATH) Study—a four‐stage, stratified probability cohort study of youth (12–17 years old) sampled from the United States civilian, non‐institutionalized population. Multivariable logistic regression was used to estimate the association between initial product‐specific susceptibility and subsequent cigarette smoking and e‐cigarette use while controlling for sociodemographic characteristics, exposure to nicotine users, and behavioral risk factors. Participants: The sample included 8841 adolescent never nicotine users at initial survey who participated in both wave 4 (2016–2017) and wave 4.5 (2017–2018) of PATH. Measurements We measured cigarette and e‐cigarette susceptibility (defined as a lack of a firm commitment to not use cigarettes or e‐cigarettes) among never nicotine users at baseline (wave 4) as well as cigarette and e‐cigarette use at 12‐month follow‐up (wave 4.5). Findings Youth e‐cigarette susceptibility was statistically significantly (P < 0.05) associated with e‐cigarette use 1 year later, for both past 12‐month (adjusted odds ratio [aOR], 2.99; 95% CI, 2.29–3.90) and past 30‐day e‐cigarette use (aOR, 2.73; 95% CI, 1.78–4.16), but not with cigarette smoking (aOR, 1.05; 95% CI, 0.64–1.73 for past 12‐month smoking and aOR, 0.65; 95% CI, 0.29–1.45 for past 30‐day smoking. Smoking susceptibility predicted subsequent smoking in the past 12 months (aOR, 1.82; 95% CI, 1.09–3.03) and past 30 days (aOR, 3.32; 95% CI (1.33–8.29), but not e‐cigarette use in the past 12 months (aOR, 0.96; 95% CI, 0.77–1.19) or past 30 days (aOR, 1.11; 95% CI, 0.82–1.51). Conclusion: E‐cigarette and cigarette susceptibility measures appear to predict product‐specific use among youth 1 year later. [ABSTRACT FROM AUTHOR]

Background and aims: Smoking is associated with increased risk for brain aging/atrophy and dementia. Few studies have examined early associations with brain aging. This study aimed to measure whether adult men with a history of heavier smoking in early mid‐life would have older than predicted brain age 16–28 years later. Design Prospective cohort observational study, utilizing smoking pack years data from average age 40 (early mid‐life) predicting predicted brain age difference scores (PBAD) at average ages 56, 62 (later mid‐life) and 68 years (early old age). Early mid‐life alcohol use was also evaluated. Setting: Population‐based United States sample. Participants/cases: Participants were male twins of predominantly European ancestry who served in the United States military between 1965 and 1975. Structural magnetic resonance imaging (MRI) began at average age 56. Subsequent study waves included most baseline participants; attrition replacement subjects were added at later waves. Measurements Self‐reported smoking information was used to calculate pack years smoked at ages 40, 56, 62, and 68. MRIs were processed with the Brain‐Age Regression Analysis and Computation Utility software (BARACUS) program to create PBAD scores (chronological age—predicted brain age) acquired at average ages 56 (n = 493; 2002–08), 62 (n = 408; 2009–14) and 68 (n = 499; 2016–19). Findings In structural equation modeling, age 40 pack years predicted more advanced age 56 PBAD [β = −0.144, P = 0.012, 95% confidence interval (CI) = –0.257, −0.032]. Age 40 pack years did not additionally predict PBAD at later ages. Age 40 alcohol consumption, but not a smoking × alcohol interaction, predicted more advanced PBAD at age 56 (β = −0.166, P = 0.001, 95% CI = –0.261, –0.070) with additional influences at age 62 (β = −0.115, P = 0.005, 95% CI = –0.195, –0.036). Age 40 alcohol did not predict age 68 PBAD. Within‐twin‐pair analyses suggested some genetic mechanism partially underlying effects of alcohol, but not smoking, on PBAD. Conclusions: Heavier smoking and alcohol consumption by age 40 appears to predict advanced brain aging by age 56 in men. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco control policies may differentially impact smoking initiation among socio-demographic groups. We measured longitudinal associations between exposure to smoke-free laws in grade 12 (modal age 18 years) and patterns of smoking initiation in the United States. Design: Prospective longitudinal analysis. Setting and Participants: We used data on US young adults sampled at modal age 18 years from the Monitoring the Future Survey. Baseline data were collected between 2000 and 2017, with the last year of follow-up in 2018. The sample number varied by outcome and time-point, ranging from 7314 to 17 702. Measurements: Smoke-free law coverage in work-places and hospitality venues (restaurants/bars) was measured as the percentage of the county population covered by each type of law. We examined associations with any past 30-day smoking initiation and daily smoking initiation at modal ages 19/20, 21/22 and 23/24, using Poisson regression and calculating average marginal effects. We explored effect modification by sex, race/ethnicity and parental education by testing the significance of interaction terms. Findings: Work-place law coverage at modal age 18 was associated with a lower probability of daily smoking initiation at modal ages 21/22 [-2.4 percentage points (p.p.); 95% confidence interval (CI) = -3.9, -0.9] and 23/24 (-2.0 p.p.; 95% CI = -3.9, -0.2). Hospitality law coverage was associated with a lower probability of daily smoking initiation at modal ages 19/20 (-1.6 p.p.; 95% CI = -2.8, -0.4), 21/22 (-2.3 p.p.; 95% CI = -3.7, -0.9) and 23/24 (-1.8 p.p.; 95% CI = -3.6, -0.0). Findings were inconclusive with regard to associations with any past 30-day smoking initiation and with regard to effect modification, after adjusting for multiple testing. Conclusions: Exposure to smoke-free laws at age 18 appears to be prospectively associated with reduced daily smoking initiation 1-6 years later. [ABSTRACT FROM AUTHOR]

Background and aims: The vaping rate among US teenagers has doubled in the last 2 years, which may be explained in part by teenagers' optimism that they would have relatively little trouble in quitting. The aim of this study was to estimate the extent to which teenagers exhibited optimism bias, what characteristics are associated with optimism bias and which factors are related to respondents' perceptions of how hard it would be for them to quit. Design A national, on‐line, cross‐sectional survey in 2018 using quota sampling. Setting: United States. Participants: Respondents were 1610 teenagers aged 14–18 years who had ever tried or heard of JUULs or e‐cigarettes generally. Measurements Optimism bias was defined as respondents' perceptions of their own difficulty quitting vaping compared with that of an average US person of their own age. Linear regression was used to examine associations between respondents' characteristics with both optimism bias and their own perceived difficulty quitting vaping. Findings More than 60% of teenagers were optimistically biased about their ability to quit vaping. Smoking (b = −0.69, P < 0.01) and JUULing (b = −0.62, P < 0.01) were negatively associated with optimism bias but reduced‐price school lunch eligibility (0.27, P = 0.02) and school satisfaction were positively associated (b = 0.05, P = 0.02). Smoking (b = 0.85, P < 0.01) was associated with an increased perception of the difficulty of quitting. That association was negative for black respondents (b = −0.81, P = 0.01) and those eligible for reduced‐priced lunches (b = −0.48, P = 0.01), and positive for Hispanic respondents (b = 0.47, P = 0.04). Conclusions: On average, US teenagers appear to show optimism bias about their ability to quit vaping, which decreases with smoking and vaping and increases with eligibility for reduced‐price school lunches. [ABSTRACT FROM AUTHOR]

Background and aims: Non‐Hispanic African Americans (African Americans) smoke fewer cigarettes per day (CPD) and are more likely to be non‐daily smokers than non‐Hispanic whites (whites). Little is known about how changes in cigarette prices might contribute to these differences. This study aimed to measure the price‐responsiveness of smoking participation, non‐daily smoking among current smokers and smoking intensity among daily or non‐daily smokers for African Americans and compare the price‐responsiveness estimates with those for whites. Design Analysis of data from the 2009–14 National Adult Tobacco Surveys and cigarette price data from the Tax Burden on Tobacco report. Setting: United States. Participants: A total of 19 232 African American and 197 939 white adults aged 18+. Measurements We used a three‐part econometric model of cigarette demand to estimate the price‐responsiveness of smoking participation, daily versus non‐daily smoking and smoking intensity. The model controlled for secular variation, state‐level anti‐smoking sentiment and smoke‐free air laws and socio‐demographics. Findings In 2009–14, 20.2% of African Americans and 17.7% of whites identified as current smokers; 70.2% of African American smokers and 81.4% of white smokers smoked daily. The price elasticity of smoking participation was significant for whites at −0.16 [95% confidence interval (CI) = –0.23, –0.09], indicating that a 10% increase in prices would reduce smoking participation by 1.6%, but not statistically significant for African Americans, and this racial/ethnic differential price responsiveness was not statistically significant. The price elasticity of smoking intensity was statistically significant for African American daily smokers at −0.29 (95% CI = −0.42, –0.16), but not statistically significant for white daily smokers, and this racial/ethnic differential price‐responsiveness was statistically significant. The price elasticity of daily versus non‐daily smoking among current smokers, and the price elasticity of smoking intensity among non‐daily smokers were not statistically significant for either racial/ethnic group. Conclusion: In the United States, cigarette price increases may have stronger effects on decreasing daily smokers' consumption among African Americans than among non‐Hispanic whites. [ABSTRACT FROM AUTHOR]

Titus et al. add important results to the compelling evidence on the impact of smoke-free policies on youth smoking in the United States. Challenges for further research include: including and comparing various countries, understanding how these policies can be effective, defining how disadvantaged youth would benefit most and evaluating policies for smoke-free outdoor venues.