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Background and aimsThe ubiquity of tobacco retailers helps to sustain the tobacco epidemic. A tobacco retail reduction approach that has not been tried is transitioning tobacco sales to state-controlled alcohol stores (TTS), which are limited in number and operate under some restrictions, e.g. regarding opening hours or marketing materials. This study summarizes policy experts' and advocates' views of TTS, including (1) advantages and disadvantages; (2) feasibility; and (3) potential implementation obstacles.DesignThis study was a qualitative content analysis of semi-structured interviews.SettingTen US states with alcoholic beverage control systems were included.ParticipantsThe participants comprised a total of 103 tobacco control advocates and professionals, public health officials, alcohol policy experts and alcohol control system representatives, including two tribal community representatives.MeasurementsInterviewees' perspectives on their state's alcoholic beverage control agency (ABC, the agency that oversees or operates a state alcohol monopoly) and on TTS were assessed.FindingsInterviewees thought TTS offered potential advantages, including reduced access to tobacco products, less exposure to tobacco advertising and a greater likelihood of successful smoking cessation. Some saw potential long-term health benefits for communities of color, due to the smaller number of state alcohol stores in those communities. Interviewees also raised concerns regarding TTS, including ABCs' limited focus on public health and emphasis on revenue generation, which could conflict with tobacco use reduction efforts. Some interviewees thought TTS could enhance the power of the tobacco and alcohol industries, increase calls for alcohol system privatization or create difficulties for those in recovery.ConclusionsIn the United States, transitioning tobacco sales to state-controlled alcohol stores (TTS) could have a positive public health impact by reducing tobacco availability, marketing exposure and, ultimately, tobacco use. However, tensions exist between alcohol control system goals of providing revenue to the state and protecting public health. Should a state decide to pursue TTS, several guardrails should be established, including building into the legislation an explicit goal of reducing tobacco consumption.

The 2001 report by the US National Academy of Sciences titled "Clearing the Smoke: assessing the Science Base for tobacco harm reduction" examined the potential of tobacco harm reduction (THR) and found that abstaining from smoking could reduce many negative health effects. Since then, cigarette smoking rates in the US have decreased, and new tobacco products like e-cigarettes and oral nicotine products have emerged, which aim to reduce tobacco-related cancers and cardiovascular diseases while maintaining nicotine addiction. The report emphasized the need for research on the effectiveness and public health implications of these reduced-exposure products (PREPs) and expressed concerns about their marketing and use. The debate on tobacco harm reduction continues, with differing opinions on the safety and effectiveness of products like e-cigarettes. The text also discusses the use of snus, a treated tobacco product that has shown success in reducing smoking rates and tobacco-related cancers in Sweden and Norway. It mentions the emergence of nicotine pouches as a new oral nicotine product and criticizes opponents of e-cigarettes for opposing all oral tobacco and nicotine products, despite evidence of their effectiveness in reducing tobacco-related diseases. The author of the text is solely responsible for its content. [Extracted from the article]

Background and Aims: Nicotine vaping products (NVPs) can potentially help adult tobacco users quit smoking. This study evaluated how adult consumers compare the costs between NVPs and cigarettes. Method: We used data from the US arm of the 2016–2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys to perform a multinomial logit model with two‐way fixed effects to measure how perceived cost comparisons are associated with NVP and cigarette taxes, use patterns, NVP device types and individual sociodemographic factors. Results: Higher cigarette taxes are associated with a greater likelihood of perceiving NVPs and cigarettes as costing the same for the overall population and among people who exclusively smoke, and a lower likelihood of perceiving NVPs as more expensive among people who exclusively vape, compared with lower cigarette taxes. Pre‐filled cartridge and tank users are more likely to perceive NVPs as less expensive than cigarettes, compared with people who use other types of NVPs. The associations between taxes and perceived cost comparison were more pronounced among males, younger and low‐income populations. Conclusions: Higher cigarette taxes are associated with perceived financial incentives for nicotine vaping products (NVPs) over cigarettes, whereas NVP taxes are not associated with perceived cost comparison between NVPs and cigarettes. [ABSTRACT FROM AUTHOR]

Background and aims: It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so‐called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors. Design and setting: A repeated cross‐sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross‐sections of 15‐ to 16‐year‐old students between 1999 and 2019 in Finland. Participants: A total of 11 377 males and 12 247 females. Measurements: The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self‐reported. Findings Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23–6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61–14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between‐group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019). Conclusions: Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others. [ABSTRACT FROM AUTHOR]

Background and aims: Oral nicotine pouches (ONPs) probably offer reduced harm compared with cigarettes, but independent data concerning their misuse liability are lacking. We compared nicotine delivery and craving relief from ONPs with different nicotine concentrations to cigarettes. Design: This was a single‐blind, three‐visit (≥ 48‐hour washout), randomized‐cross‐over study. Participants were encouraged to complete all study visits in less than 1 month. Setting: The study took place in Rural/Appalachian Ohio. Participants: Participants comprised 30 adults who smoke cigarettes. Participants (meanage = 34.5) were 60% men and 90% White. Intervention: Participants who were ≥ 12‐hour tobacco‐abstinent used: (1) a 3‐mg nicotine concentration ONP, (2) a 6‐mg nicotine concentration ONP and (3) usual brand cigarette in separate visits. ONPs (wintergreen Zyn) were used for 30 minutes; cigarettes were puffed every 30 sec for 5 minutes. Measurements Plasma nicotine and self‐reported craving were assessed at t = 0, 5, 15, 30, 60 and 90 minutes. The primary outcome was plasma nicotine concentration at t = 30 minutes. A secondary outcome was craving relief at t = 5 minutes. Findings At t = 30, mean [95% confidence interval (CI)] plasma nicotine was 9.5 ng/ml (95% CI = 7.1, 11.9 ng/ml) for the 3 mg nicotine ONP, 17.5 ng/ml (95% CI = 13.7, 21.3) for the 6 mg nicotine ONP and 11.4 ng/ml (95% CI = 9.2, 13.6 ng/ml) for the cigarette. Mean plasma nicotine at t = 30 minutes differed between the 3‐ and 6‐mg nicotine ONPs (P = 0.001) and between the 6‐mg nicotine ONP and cigarette (P = 0.002). Mean (95% CI) craving at t = 5 minutes was lower for the cigarette (mean = 1.00, 95% CI = 0.61, 1.39) than either the 3 mg (mean = 2.25, 95% CI = 1.68, 2.82; P < 0.0001) or 6 mg nicotine (mean = 2.19, 95% CI = 1.60, 2.79; P < 0.0001) ONP. Conclusions: Among adult smokers, using 6‐mg nicotine concentration oral nicotine pouches (ONPs) was associated with greater plasma nicotine delivery at 30 minutes than 3‐mg ONPs or cigarettes, but neither ONP relieved craving symptoms at 5 minutes as strongly as a cigarette. Accelerating the speed of nicotine delivery in ONPs might increase their misuse liability relative to cigarettes. [ABSTRACT FROM AUTHOR]

Background and aims: US tobacco companies owned leading US food companies from 1980 to 2001. We measured whether hyper‐palatable foods (HPF) were disproportionately developed in tobacco‐owned food companies, resulting in substantial tobacco‐related influence on the US food system. Design: The study involved a review of primary industry documents to identify food brands that were tobacco company‐owned. Data sets from the US Department of Agriculture were integrated to facilitate longitudinal analyses estimating the degree to which foods were formulated to be hyper‐palatable, based on tobacco ownership. Setting and cases: United States Department of Agriculture data sets were used to identify HPF foods that were (n = 105) and were not (n = 587) owned by US tobacco companies from 1988 to 2001. Measurements: A standardized definition from Fazzino et al. (2019) was used to identify HPF. HPF items were identified overall and by HPF group: fat and sodium HPF, fat and sugar HPF and carbohydrates and sodium HPF. Findings Tobacco‐owned foods were 29% more likely to be classified as fat and sodium HPF and 80% more likely to be classified as carbohydrate and sodium HPF than foods that were not tobacco‐owned between 1988 and 2001 (P‐values = 0.005–0.009). The availability of fat and sodium HPF (> 57%) and carbohydrate and sodium HPF (> 17%) was high in 2018 regardless of prior tobacco‐ownership status, suggesting widespread saturation into the food system. Conclusions: Tobacco companies appear to have selectively disseminated hyper‐palatable foods into the US food system between 1988 and 2001. [ABSTRACT FROM AUTHOR]

Background and aims: Exposure to chemicals contributes to harm from nicotine products, and e‐cigarette communications often refer to chemicals. However, while e‐cigarette studies commonly measure perceived harmfulness of e‐cigarettes relative to cigarettes, few have assessed comparative perceptions about chemicals. This study measured perceived levels of harmful chemicals in e‐cigarettes compared with cigarettes and associations with e‐cigarette/cigarette relative harm perceptions, e‐cigarette use and interest. Design, setting and participants: This was an on‐line cross‐sectional survey of adults/young adults from a nationally representative research panel in the United States conducted in January 2021. Participants were independent samples of 1018 adults who smoked cigarettes and 1051 young adult non‐smokers (aged 18–29 years). Measurements: Participants were asked their perceptions of the level of harmful chemicals in e‐cigarettes versus cigarettes (fewer/about the same/more/do not know), perceived harmfulness of using e‐cigarette versus cigarettes (less/about the same/more/do not know) and their current e‐cigarette use and use interest. Findings Approximately 20% of all participants (18.1% of adult smokers, and 21.0% of young adult non‐smokers) believed e‐cigarettes contain fewer harmful chemicals than cigarettes, while 35.6% of adult smokers and 24.9% of young adult non‐smokers responded 'do not know'. Participants more frequently reported 'do not know' to the chemicals item than the harm item. Approximately half (51.0–55.7%) of those who believed e‐cigarettes contain fewer harmful chemicals also believed e‐cigarettes are less harmful than cigarettes. Both beliefs were associated with higher odds of interest in using e‐cigarettes [less harmful belief, odds ratio (OR) = 5.53, 95% confidence interval (CI = 2.93–10.43); fewer chemicals belief, OR = 2.45, 95% CI = 1.40–4.29] and past 30‐day e‐cigarette use (less harmful belief, OR = 2.53, 95% CI = 1.17–5.44; fewer chemicals belief, OR = 5.09, 95% CI = 2.31–11.19) for adults who smoke, but not young adult non‐smokers. Conclusions: In the United States, most adults who smoke cigarettes and young adult non‐smokers do not appear to think that e‐cigarettes have fewer harmful chemicals than cigarettes, and many are uncertain about how these levels compare. [ABSTRACT FROM AUTHOR]

Aims: To evaluate statewide policies restricting e‐cigarette nicotine strength. Design: A difference‐in‐difference regression analysis was used to compare e‐cigarette sales in states that restrict nicotine strength with states with no restrictions. Because flavor restrictions might affect sales and nicotine strength, states with flavor restrictions were also assessed. Setting and cases: United States e‐cigarette retail sales data during January 2017 to March 2022 were licensed from Information Resources Incorporated. States with restrictions included Massachusetts (restricted maximum nicotine strength to 3.5% and nontobacco flavored e‐cigarette sales in December 2019); Utah (restricted nicotine strength to 3.6% in September 2021); and Rhode Island, New York and Washington (restricted nontobacco flavor sales in October 2019, May 2020 and October 2019 to January 2020, respectively). These were compared with data from 34 states with no e‐cigarette nicotine strength or flavor restrictions. Measurements Weighted mean nicotine strength and total unit sales. Total unit sales per 1000 state population were summed into 4‐week periods by state. Models controlled for emergency responses, state demographics, tobacco control policies, time and state fixed effects. Findings Restricting both nicotine strength and flavors in Massachusetts was associated with a 2.04 percentage point (pp) reduction in mean nicotine strength and 86.76‐unit reduction in monthly unit sales per 1000 persons compared with states with no restrictions (all P < 0.01). Restricting nicotine strength only in Utah was associated with a 1.77 pp (P < 0.01) reduction in mean nicotine strength; however, there was no impact on unit sales. Restricting nontobacco flavor sales only in Rhode Island, New York and Washington slightly reduced mean nicotine strength (0.21, 0.62 and 0.19 pp, respectively) and sales (36.66, 34.51 and 16.37 units, respectively) (all P < 0.01). Conclusions: United States statewide policies restricting e‐cigarette nicotine strength appear to be associated with reductions in average nicotine strength in sales within that state; however, there appears to be no impact on unit sales. When these policies are implemented along with flavor restrictions; reductions in average nicotine strength occur in addition to reduced unit sales. [ABSTRACT FROM AUTHOR]

Background and Aims: Heated tobacco products (HTPs) are electronic devices that heat process tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on world‐wide HTP use prevalence. This meta‐analytic review estimated the prevalence of HTP use by country, World Health Organization (WHO) region, year, sex/gender and age. Methods: Five databases (Web of Science, Scopus, Embase, PubMed and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post‐modern HTP device market entry (2015). A random‐effects meta‐analysis was used to estimate overall prevalence for life‐time, current and daily HTP use. Results: Forty‐five studies (n = 1 096 076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for life‐time, current and daily HTP use was 4.87% [95% confidence interval (CI) = 4.16, 5.63], 1.53% (95% CI = 1.22, 1.87) and 0.79% (95% CI = 0.48, 1.18), respectively, across all years (2015–22). Life‐time HTP use prevalence significantly increased by 3.39% for WPR [0.52% (95% CI = 0.25, 0.88) in 2015 to 3.91% (95% CI = 2.30, 5.92) in 2019] and 5.58% for EUR [1.13% (95% CI = 0.59, 1.97) in 2016 to 6.98% (95% CI = 5.69, 8.39) in 2020]. Current HTP use increased by 10.45% for WPR [0.12% (95% CI = 0, 0.37) in 2015 to 10.57% (95% CI = 5.59, 16.88) in 2020] and 1.15% for EUR [0% (95% CI = 0, 0.35) in 2016 to 1.15% (95% CI = 0.87, 1.47) in 2020]. Meta‐regression revealed higher current HTP use in WPR [3.80% (95% CI = 2.88, 4.98)] compared with EUR [1.40% (95% CI = 1.09, 1.74)] and AMR [0.81% (95% CI = 0.46, 1.26)] and for males [3.45% (95% CI = 2.56, 4.47)] compared with females [1.82% (95% CI = 1.39, 2.29)]. Adolescents had higher life‐time HTP use prevalence [5.25% (95% CI = 4.36, 6.21) than adults [2.45% (95% CI = 0.79, 4.97)]. Most studies scored a low risk of sampling bias due to their nationally representative sampling. Conclusion: The prevalence of HTPs use increased in the EUR and WPR between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period. [ABSTRACT FROM AUTHOR]

Background and aimsFrequent experiences of discrimination could increase vulnerability to tobacco withdrawal and smoking lapse in populations subject to tobacco-related health disparities. This laboratory study (2013-17) examined whether individual differences in perceived exposure to discrimination in one's daily life predicted tobacco withdrawal symptoms and smoking lapse behavior following acute tobacco deprivation in African American smokers.DesignMixed design with the between-subjects continuous variable of perceived discrimination crossed with the within-subject variable of tobacco deprivation status (deprived versus non-deprived).SettingAcademic medical center in Los Angeles, CA, USA.ParticipantsAfrican American non-treatment seeking daily cigarette smokers (n = 607, ≥ 10 cig/day).MeasurementsAt a baseline visit, self-reported frequency of perceived exposure to discrimination in one's daily life was measured [everyday discrimination scale (EDDS)]. At two subsequent counterbalanced experimental visits (16-hour tobacco deprivation versus ad-libitum smoking), self-report assessments of various tobacco withdrawal symptom domains [Brief Questionnaire of Smoking Urges), Wisconsin Smoking Withdrawal Scale (WSWS), Profile of Mood States (POMS), Snaith-Hamilton Pleasure Scale (SHAPS) and Current Impulsivity Scale (CIS)) and a behavioral smoking lapse analogue task were measured.FindingsAdjusted models demonstrated that greater frequency of perceived exposure to discrimination was associated with larger deprivation-induced increases in acute urges to smoke to alleviate negative mood, several negative mood states and subjective cognitive functioning-effect sizes were small in magnitude (βs = 0.09-0.13; Ps

This commentary discusses the complexity of evidence and policy in relation to tobacco and e-cigarette use in different countries. The authors highlight the importance of historical context, regional government, and the intended beneficiaries of policy decisions. They compare the use of snus in Scandinavian countries, the role of the European Union, and the differing approaches to harm reduction in England, Australia, and the United States. The commentaries also address the impact of colonial history on e-cigarette policies in New Zealand and the evolving nature of tobacco harm reduction strategies. Overall, the authors emphasize the need for a comprehensive understanding of the factors influencing policy decisions in this area. [Extracted from the article]

The article discusses the need for more practical regulation of e-cigarettes in Australia. The author argues that Australia's current prescription model, which requires a prescription for e-cigarette use, has not been effective and has led to negative consequences such as increased social inequality and the growth of the illicit market. The author suggests replacing the prescription model with a tightly regulated consumer sales model that restricts sales to adults. The article also addresses different perspectives on the issue, including concerns about the addictive and harmful nature of e-cigarettes and the rejection of the prescription model by the pharmacy profession. The author concludes by expressing hope for a more practical model that allows adult smokers to access e-cigarettes while minimizing adolescent access. [Extracted from the article]

This article discusses a tobacco control policy analysis framework that focuses on the introduction and dissemination of tobacco-like products, particularly among young people. The authors examine regulatory policies from England, Australia, and the United States, highlighting the role of differing national contexts and histories in shaping tobacco regulation. The framework can provide insights into the factors influencing modern policy and may be used to inform future regulations. The article also discusses the specific case of Japan, where heated tobacco products have become popular, and the need for a tobacco control policy that prioritizes young people. [Extracted from the article]

The article discusses a study by O. A. Wackowski et al which suggested opportunities that exist to educate adult smokers on the relative risks of tobacco products, particularly e-cigarettes. Topics include variation in the regulation of tobacco and nicotine products across countries, factors to consider when developing and implementing strategies to educate adult smokers on the risks of tobacco products, and opportunities that exist to educate adult smokers about the risks of tobacco products.

Background and Aims: Smokeless tobacco is a heterogeneous product group with diverse composition and prevalence globally. Tobacco use during pregnancy is concerning due to the risk of adverse pregnancy outcomes and effects on child health. Nicotine may mediate several of these effects. This systematic review measured health outcomes from Swedish smokeless tobacco (snus) use during pregnancy. Method: Literature search was conducted by an information specialist in May 2022. We included human studies of snus use during pregnancy compared with no tobacco use, assessed risk of bias, conducted a meta‐analysis and assessed confidence in effect‐estimates using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results: We included 18 cohort studies (42 to 1 006 398 participants). Snus use during pregnancy probably (moderate confidence in risk estimates) increase the risk of neonatal apnea, adjusted odds ratio 95% confidence interval [aOR (95% CI)] 1.96 (1.30 to 2.96). Snus use during pregnancy possibly (low confidence in risk estimates) increase the risk of stillbirths aOR 1.43 (1.02 to 1.99), extremely premature births aOR 1.69 (1.17 to 2.45), moderately premature birth aOR 1.26 (1.15 to 1.38), SGA aOR 1.26 (1.09 to 1.46), reduced birth weight mean difference of 72.47 g (110.58 g to 34.35 g reduction) and oral cleft malformations aOR 1.48 (1.00 to 2.21). It is uncertain (low confidence in risk estimates, CI crossing 1) whether snus use during pregnancy affects risk of preeclampsia aOR 1.11 (0.97 to 1.28), antenatal bleeding aOR 1.15 (0.92 to 1.44) and very premature birth aOR 1.26 (0.95 to 1.66). Risk of early neonatal mortality and altered heart rate variability is uncertain, very low confidence. Snus using mothers had increased prevalence of caesarean sections, low confidence. Conclusions: This systematic review reveals that use of smokeless tobacco (snus) during pregnancy may adversely impact the developing child. [ABSTRACT FROM AUTHOR]

Background and Aims: Graphic warning labels (GWLs) on cigarette packs have been adopted by many jurisdictions world‐wide. In the United States, the introduction of GWLs has been delayed by claims that their high level of negative emotional arousal unnecessarily infringed upon the tobacco manufacturers' free speech. This study aimed to provide experimental data on the contribution of emotional arousal to GWL efficacy. Design: Observational study using long‐term naturalistic exposure and functional magnetic resonance imaging. Setting: Research university in Philadelphia, PA, USA. Participants: A total of 168 adult smokers. Measurements For 4 weeks, participants received cigarettes in packs that carried either high‐arousal or low‐arousal GWLs (n = 84 versus 84). Smoking behavior, quitting‐related cognitions and GWL‐induced brain response were measured before and after the 4‐week exposure. The amygdala and medial prefrontal cortex served as regions of interest. Findings Compared with the high‐arousal group, the low‐arousal group smoked fewer cigarettes [log10‐transformed, 1.076 versus 1.019; difference = 0.056, 95% confidence interval (CI) = 0.027, 0.085, χ2(1) = 14.21, P < 0.001] and showed stronger intention to quit (2.527 versus 2.810; difference = −0.283, 95% CI = −0.468, –0.098, χ2(1) = 8.921, P = 0.007) and endorsement of the GWLs' textual component (4.805 versus 5.503; difference = −0.698, 95% CI = −1.016, −0.380, χ2(1) = 18.47, P < 0.001). High‐arousal GWLs induced greater amygdala response than low‐arousal GWLs (0.157 versus 0.052; difference = 0.105, 95% CI = 0.049, 0.161, χ2(1) = 23.52, P < 0.001), although the response to high‐arousal GWLs declined over time (slope = −0.087 versus 0.016; difference = −0.103, 95% CI = −0.198, –0.009, χ2(1) = 6.370, P = 0.046). Greater baseline amygdala response was associated with more smoking at 4 weeks in the high‐arousal group, but less smoking in the low‐arousal group (slope = 0.179 versus −0.122; difference = 0.287, 95% CI = 0.076, 0.498, χ2(1) = 7.086, P = 0.008). Medial prefrontal response did not differ significantly between groups. Conclusions: High‐arousal cigarette graphic warning labels (GWLs) appear to be less efficacious than low‐arousal GWLs. The high emotional reaction that high‐arousal GWLs elicit wanes over time. Baseline amygdala response negatively predicts efficacy of high‐arousal GWLs and positively predicts efficacy of low‐arousal GWLs. High emotional arousal may not be required for sustained GWL efficacy. [ABSTRACT FROM AUTHOR]

The authors applaud the Surgeon General of the U.S. for launching an initiative to reduce health misinformation about electronic cigarettes (e-cigarettes). They talk about examples that continue to be propagated by the U.S. public health officials, issue that the CDC lacks, and the SG-sponsored public information website about e-cigarettes entitled "Know the Risks: E-cigarettes and Young People."

Aims: This study aims to identify adolescent patterns of polytobacco use and measure transitions between patterns over time. Design: Longitudinal analysis using data derived from waves 1–4 (2013–18) of the Population Assessment of Tobacco and Health (PATH) study. Transitions in tobacco use patterns were examined via latent transition analysis, and then, socio‐demographic characteristics were used to predict transitions via logistic regression. Setting: United States. Participants: Participants included 975 adolescents who used at least one tobacco product at any wave (W1 mean age = 13.29, standard deviation = 0.86; W4 54.2% male; 54.5% white, 25.9% Hispanic). Measurements Measurements included past 30‐day use of cigarettes, electronic cigarettes (e‐cigs), traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco (SLT) or hookah. Findings Six latent classes were identified. Cigarette users (43.5–58.8%) and SLT users (50.8–79.6%) tended to persist in their use over time. E‐cig users began to probably transition to non‐users (80.0%), but became more likely to persist in this use over time (31.1%). Non‐users at a given wave were most likely to transition to e‐cig users (8.5–43.7%) or cigarette users (6.7–28.6%). Cigarillo/poly‐users and hookah/poly‐users displayed more variable transition patterns. Adolescents were more likely to transition to non‐use (versus become/remain e‐cig users) if they were older (cigarette users, SLT users), younger (e‐cig users), other race (SLT users), male (SLT users) or had less‐educated parents (SLT users) compared with their counterparts. Hispanic (versus white) cigarette users were more likely to transition to non‐users than to persist in this use. Conclusions: Among adolescents in the United States, patterns of tobacco use characterized by the use, mainly, of single, specific products appear to be stable, particularly by late adolescence. In contrast, patterns characterized by polytobacco use appear to be more variable and may represent experimentation without specialization. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco smoking is a risk factor for impaired brain function, but its causal effect on white matter brain aging remains unclear. This study aimed to measure the causal effect of tobacco smoking on white matter brain aging. Design: Mendelian randomization (MR) analysis using two non‐overlapping data sets (with and without neuroimaging data) from UK Biobank (UKB). The group exposed to smoking and control group consisted of current smokers and never smokers, respectively. Our main method was generalized weighted linear regression with other methods also included as sensitivity analysis. Setting: United Kingdom. Participants: The study cohort included 23 624 subjects [10 665 males and 12 959 females with a mean age of 54.18 years, 95% confidence interval (CI) = 54.08, 54.28]. Measurements Genetic variants were selected as instrumental variables under the MR analysis assumptions: (1) associated with the exposure; (2) influenced outcome only via exposure; and (3) not associated with confounders. The exposure smoking status (current versus never smokers) was measured by questionnaires at the initial visit (2006–10). The other exposure, cigarettes per day (CPD), measured the average number of cigarettes smoked per day for current tobacco users over the life‐time. The outcome was the 'brain age gap' (BAG), the difference between predicted brain age and chronological age, computed by training machine learning model on a non‐overlapping set of never smokers. Findings The estimated BAG had a mean of 0.10 (95% CI = 0.06, 0.14) years. The MR analysis showed evidence of positive causal effect of smoking behaviors on BAG: the effect of smoking is 0.21 (in years, 95% CI = 6.5 × 10−3, 0.41; P‐value = 0.04), and the effect of CPD is 0.16 year/cigarette (UKB: 95% CI = 0.06, 0.26; P‐value = 1.3 × 10−3; GSCAN: 95% CI = 0.02, 0.31; P‐value = 0.03). The sensitivity analyses showed consistent results. Conclusions: There appears to be a significant causal effect of smoking on the brain age gap, which suggests that smoking prevention can be an effective intervention for accelerated brain aging and the age‐related decline in cognitive function. [ABSTRACT FROM AUTHOR]

AIMS: It is not known whether the machine-smoked nicotine yield of usual brand of cigarette smoked is associated with the chances of success of quit attempts. This study aimed to assess this association. DESIGN: Prospective study. SETTING: Republic of Korea. PARTICIPANTS: A total of 16 808 male smokers registered for the Quitline between 7 April 2006 and 31 December 2013. Of these, 13 176 participants who were > 19 years of age and provided data on their demographic characteristics, smoking-related behaviors, nicotine dependence, tobacco brands used and self-efficacy were included in this study. MEASUREMENTS: Machine-smoked nicotine yield was based on information provided by tobacco companies on cigarette packages that smokers reported as their usual brand. Ultra-low nicotine yield was defined as ≤ 0.1 mg machine-smoked nicotine yield per cigarette, whereas higher nicotine yield was defined as > 0.1 mg machine-smoked nicotine yield. Participant personal information and self-reported continuous abstinence at 1-month, 6-month and 1-year follow-up were recorded in electronic databases. FINDINGS: Continuous abstinence rates in the ultra-low nicotine yield versus higher nicotine yield groups were, respectively, 40.7 versus 34.6% at 1 month [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.12-1.33], 22.7 versus 18.8% at 6 months (OR = 1.20, 95% CI = 1.08-1.32) and 19.5 versus 16.6% (OR = 1.19, 95% CI = 1.10-1.29) at 1 year. The association between ultra-low nicotine yield cigarette smoking and successful quitting was stronger among the smokers with higher cigarette dependence. CONCLUSIONS: Male smokers who use the Korean Quitline are more likely to quit successfully if they smoke ultra-low nicotine yield cigarettes than if they smoke higher nicotine yield cigarettes.

Background and aimsRelative pharmacological effects of e-cigarettes and cigarettes during 24 hours of ad-libitum use have not been described. In this study, 24-hour blood plasma nicotine concentrations and 48-hour subjective effects with use of cigarettes and e-cigarettes were measured among dual users.DesignTwo-arm within-subject cross-over design with preferred e-cigarette or cigarette ad-libitum use over 48 hours.SettingHospital research ward in San Francisco, California, USA.ParticipantsThirty-six healthy dual users of e-cigarettes and cigarettes (n = 8, 25% females).MeasurementsTwenty-four-hour blood plasma nicotine and cotinine concentrations and 48-hour self-reported nicotine withdrawal symptoms and rewarding effects.FindingsAnalyses used analysis of variance (ANOVA)-based mixed models with order of product (e-cigarette or cigarette) and product type (combustible cigarette or type of e-cigarette) as fixed effects, and subject as a repeated effect. During a 24-hour period, e-cigarettes produced lower nicotine exposure than cigarettes for the majority of users, although 25% received more nicotine from e-cigarettes, which was predicted by more frequent e-cigarette use or greater dependence. Compared to cigarette smoking, nicotine exposure for variable-power tank users was similar, while cig-a-like (t(30)  = 2.71, P = 0.011, d = 0.745) and fixed-power tank users (t(30)  = 3.37, P = 0.002, d = 0.993) were exposed to less nicotine. Cigarettes were rated higher than e-cigarettes on some desirable subjective effects (e.g. psychological reward, t(322)  = 7.24 P

AimTo describe systemic nicotine exposure and subjective effects of electronic cigarettes (e-cigarettes) in people who use both e-cigarettes and cigarettes (dual users), including within-subject comparisons of e-cigarette and cigarette use.DesignTwo-arm, counterbalanced cross-over study. Participants used their usual brand of e-cigarette or cigarette during a standardized session in a 2-week study.SettingHospital research ward, San Francisco, CA, USA.ParticipantsThirty-six healthy (eight women, 28 men) participants.MeasurementsPlasma nicotine was analyzed by gas chromatography-tandem mass spectrometry; nicotine withdrawal, urge to smoke and vape, affective states, craving, satisfaction and psychological reward were measured by standardized questionnaires.FindingsCompared with cigarettes, average maximum plasma nicotine concentration (Cmax ) was lower with e-cigarettes [6.1 ± 5.5 ng/ml, mean ± standard deviation (SD) versus 20.2 ± 11.1 ng/ml, P

AimA previous study showed significantly greater reductions in number of cigarettes smoked and biomarkers of toxicant and carcinogen exposure in smokers assigned to immediate reduction of nicotine in cigarettes to very low levels versus gradually over time or continued smoking of normal nicotine content cigarettes. This study examines the effects of these approaches on selected biomarkers associated with harmful biological effects.DesignThree-arm, randomized controlled trial.SettingTen United States academic institutional sites.ParticipantsDaily smokers uninterested in quitting smoking with a mean age of 45.1 [standard deviation (SD) = 13.4)] years and smoking 17.1 (SD = 8.5) cigarettes/day; 43.9% (549 of 1250) female; 60.6% (758 of 1250) white ethnicity.Interventions(1) Smoking cigarettes where nicotine content was immediately reduced to very low levels (n = 503); (2) smoking cigarettes where nicotine content was gradually reduced, with dose changes occurring monthly (n = 498); and (3) continued smoking with normal nicotine content cigarettes (n = 249).MeasurementsSmokers were assessed at baseline while smoking their usual brand cigarettes, and again at 4, 8, 12, 16 and 20 weeks. Outcomes were areas under the concentration time curve (AUC) for the period of study of biomarkers of inflammation, oxidative stress and hematological parameters.FindingsNo consistent significant differences were observed across groups (Bayes factors showing data to be insensitive), with the only exception being red blood cell size variability, which was observed to be lower in the immediate versus gradual nicotine reduction [mean difference =  -0.11; 95% confidence interval (CI) = -0.18, -0.04, P = 0.004] and normal nicotine control groups (mean difference = - 0.15, 95% CI = -0.23, -0.06, P = 0.001).ConclusionIt remains unclear whether switching to very low nicotine cigarettes leads to a short-term reduction in biomarkers of tobacco-related harm.

Aims: Exposure to tobacco products and advertising at the point of sale may be associated with pro‐smoking cognitions. However, previous studies on this topic measured exposure based on self‐report and did not include European countries. The aim of this study was to assess the association between objectively measured exposure to tobacco outlets and non‐smoking adolescents' smoking attitudes, beliefs and norms. Design: This cross‐sectional study combined survey data with Global Positioning Systems data using geographic information system. Setting: The four Dutch cities of Amsterdam, Eindhoven, Haarlem and Zwolle. Participants: We retrieved data of 308 13 to 17‐year‐old non‐smoking adolescents, mainly girls (61%), adolescents attending pre‐university secondary education (71%) and without smoking friends (58%). Measurements Exposure was measured with a smartphone app registering for 2 weeks how often participants were within 10 m of a tobacco outlet. We distinguished between outlets without visible tobacco promotion (i.e. supermarkets), with only internal visibility and with both internal and external visibility. Participants' reported smoking cognitions were dichotomised into pro‐smoking or anti‐smoking. We applied multi‐level logistic regression analyses and adjusted for age, sex, educational level and smoking friends. Findings On average, adolescents were exposed to 1.18 (SD = 1.23) tobacco outlets per day. Higher exposure to tobacco outlets was associated with higher odds of pro‐smoking injunctive norm (OR = 1.35, 95% CI = 1.04–1.75). Associations with attitude (OR = 1.12, 95% CI = 0.91–1.38), social beliefs (OR = 1.15, 95% CI = 0.93–1.43), health beliefs (OR = 1.18, 95% CI = 0.97–1.44) and descriptive norm (OR = 1.15, 95% CI = 0.91–1.44) were also positive, but non‐significant. Overall, associations were strongest for outlets with internal visibility, for instance, for injunctive norm (OR = 1.37, 95% CI = 1.03–1.81). Conclusions: Global Positioning Systems‐measured exposure to tobacco outlets was associated with pro‐smoking cognitions among non‐smoking adolescents in the Netherlands. [ABSTRACT FROM AUTHOR]

Aims: Most extant evidence has addressed between‐person differences, short‐term or cross‐sectional associations of electronic nicotine delivery systems (ENDS) use with other substance use, the majority focusing on current rather than escalated use. The present study aimed to examine within‐person changes in escalated ENDS use and their associations with individual and combined substance use over a 6‐year period. Design, Setting and Participants: This study used a longitudinal cohort design with US young adults. A generalized linear mixed‐model approach was employed to fit a series of weighted logistic regression models. Data were drawn from waves 1–5 of the Population Assessment of Tobacco and Health (PATH) study in the United States. Of the 9110 young adults at baseline, aged 18–24 years, a total of 5042 individuals had matched data across all five waves of assessments. Measurements: Escalated ENDS use was computed by subtracting the number of days of ENDS use within the past 30 days at wave w−1 from that at wave w and coded as 1 = escalated, if the value was greater than zero (otherwise, coded as 0 = not escalated). Findings Escalated ENDS use gradually decreased over time, with the lowest prevalence at wave 4 (4.0%) but sharply increasing at wave 5 (8.4%). Escalated ENDS use was associated with increased odds of using each substance (binge drinking, marijuana use, marijuana vaping, prescription and illicit drugs) and different combinations of polysubstance use between cigarette smoking, binge drinking and marijuana use (Ps < 0.05). In addition, sweet/fruit flavor use (versus menthol/mint) was associated with increased likelihood of reporting co‐use of cigarettes and marijuana. Conclusions: In the United States, the prevalence of young adults using electronic nicotine delivery systems appears to have increased steadily between 2013 and 2019, although the rate of increase may have started to accelerate in recent years. Escalated electronic nicotine delivery systems use and time‐lagged established electronic nicotine delivery systems use appear to be prospectively associated with individual and combined substance use, particularly between cigarettes, alcohol and marijuana. Among established electronic nicotine delivery systems users, sweet/fruit flavor appears to be associated with increased risk of co‐using cigarettes and marijuana. [ABSTRACT FROM AUTHOR]

Background and aims: We aimed to create a basic set of definitions and relationships for identity‐related constructs, as part of the Addiction Ontology and E‐Cigarette Ontology projects, that could be used by researchers with diverse theoretical positions and so facilitate evidence synthesis and interoperability. Methods: We reviewed the use of identity‐related constructs in psychological and social sciences and how these have been applied to addiction with a focus on nicotine and tobacco research. We, then, used an iterative process of adaptation and review to arrive at a basic set of identity‐related classes with labels, definitions and relationships that could provide a common framework for research. Results: We propose that 'identity' be used to refer to 'a cognitive representation by a person or group of themselves', with 'self‐identity' referring to an individual's identity and 'group identity' referring to an identity held by a social group. Identities can then be classified at any level of granularity based on the content of the representations (e.g. 'tobacco smoker identity', 'cigarette smoker identity' and 'vaper identity'). We propose distinguishing identity from 'self‐appraisal' to capture the distinction between the representation of oneself (e.g. as an 'ex‐smoker') and (i) the importance and (ii) the positive or negative evaluation that we attach to what is represented. We label an identity that is appraised as enduring as a 'core identity', related to 'strong identity' because of the appraisal as important. Identities that are appraised positively or negatively involve 'positive self‐appraisal' and 'negative self‐appraisal' respectively. This allows us to create 'logically defined classes' of identity by combining them (e.g. 'positive core cigarette smoker identity' to refer to a cigarette smoker self‐identity that is both positive and important). We refer to the totality of self‐identities of a person as a 'composite self‐identity'. Conclusions: An ontology of identity constructs may assist in improving clarity when discussing theories and evidence relating to this construct in addiction research. [ABSTRACT FROM AUTHOR]

Aims: This study aims to compare biomarkers of potential harm between people switching from smoking combustible cigarettes (CC) completely to electronic cigarettes (EC), continuing to smoke CC, using both EC and CC (dual users) and using neither (abstainers), based on behaviour during EC intervention studies. Design: Secondary analysis following systematic review, incorporating inverse variance random‐effects meta‐analysis and effect direction plots. Setting: This study was conducted in Greece, Italy, Poland, the United Kingdom and the United States. Participants: A total of 1299 adults smoking CC (nine studies) and provided EC. Measurements Measurements were conducted using carbon monoxide (CO) and 26 other biomarkers. Findings In pooled analyses, exhaled CO (eCO) was lower in EC versus EC + CC [mean difference (MD) = −4.40 parts per million (p.p.m.), 95% confidence interval (CI) = −12.04 to 3.24, two studies] and CC (MD = −9.57 p.p.m., 95% CI = −17.30 to −1.83, three studies). eCO was lower in dual users versus CC only (MD = −1.91 p.p.m., 95% CI = −3.38 to −0.45, two studies). Magnitude rather than direction of effect drove substantial statistical heterogeneity. Effect direction plots were used for other biomarkers. Comparing EC with CC, 12 of 13 biomarkers were significantly lower in EC users, with no difference for the 13th. Comparing EC with dual users, 12 of the 25 biomarkers were lower for EC, and five were lower for dual use. For the remaining eight measures, single studies did not detect statistically significant differences, or the multiple studies contributing to the outcome had inconsistent results. Only one study provided data comparing dual use with CC; of the 13 biomarkers measured, 12 were significantly lower in the dual use group, with no statistically significant difference detected for the 13th. Only one study provided data on abstainers. Conclusions: Switching from smoking to vaping or dual use appears to reduce levels of biomarkers of potential harm significantly. [ABSTRACT FROM AUTHOR]

Background and Aims: Smoking fewer cigarettes per day may increase the chances of stopping smoking. Capping the number of cigarettes per pack is a promising policy option, but the causal impact of such a change is unknown. This study aimed to test the hypothesis that lowering cigarette pack sizes from 25 to 20 reduces the number of cigarettes smoked. Design: This randomized controlled cross‐over trial had two 14‐day intervention periods with an intervening 7‐day period of usual behaviour. Participants purchased their own cigarettes. They were instructed to smoke their usual brand from either one of two sizes of pack in each of two 14‐day intervention periods: (a) 25 cigarettes and (b) 20 cigarettes. Participants were randomized to the order in which they smoked from the two pack sizes (a–b; b–a). Setting: Canada. Participants: Participants were adult smokers who smoked from pack sizes of 25, recruited between July 2020 and June 2021. Of 252 randomized, 240 (95%) completed the study and 236 (94%) provided sufficient data for the primary analysis. Measurements Cigarettes smoked per participant per day. Findings Participants smoked fewer cigarettes per day from packs of 20 cigarettes [n = 234, mean = 15.7 standard deviation (SD) = 7.1] than from packs of 25 (n = 235, mean = 16.9, SD = 7.1). After adjusting for pre‐specified covariates (baseline consumption and heaviness of smoking), modelling estimated that participants smoked 1.3 fewer cigarettes per day [95% confidence interval (CI) = −1.7 to −0.9], equivalent to 7.6% fewer (95% CI = −10.1 to −5.2%) from packs of 20 cigarettes. Conclusions: Smoking from packs of 20 compared with 25 cigarettes reduced the number of cigarettes smoked per day. [ABSTRACT FROM AUTHOR]

Background and aims: Tobacco and nicotine marketplaces have diversified over the past decade, including with the introduction of heated tobacco products (HTPs), such as the brand IQOS. HTPs typically heat tobacco to generate an aerosol that is inhaled. HTP nomenclature is lacking, and how HTP users define and identify themselves remains understudied. Research in this area is important because language can construct identity, and identity can shape behaviour. This study aimed to explore users' language choice when describing IQOS use, and how language relates to user identity. Methods: Qualitative interviews in London, United Kingdom, with 30 adult current and former IQOS users. Analyses were guided by Iterative Categorization. Results: Overall, participants expressed confusion and a lack of suitable terminology for how to describe IQOS use. Verbs such as heating and IQOSing were rarely endorsed. Most often, participants reverted to smoking when describing IQOS use and commonly referred to HEETS (tobacco sticks) as cigarettes. Yet the lack of combustion, electronic device, cleaner experience and perceived reductions in health risks led some to frame IQOS as distinct from smoking. Vaping was generally considered inappropriate for describing IQOS use. Participants also manipulated language to suit their circumstances and manage their identity, whereas some IQOS users embraced the terms smoking and smoker, most were eager to distinguish between using IQOS and being labelled a smoker because of the associated negative connotations and to align with perceptions of IQOS use as a better, less harmful behaviour. Instead, when describing their identity, IQOS users more willingly identified as vapers, or ex‐smokers, or created new identities (e.g. HEET user). Conclusions: People who use or have used IQOS (a brand of heated tobacco product) are ambiguous about IQOS terminology. Participants in this study commonly referred to IQOS use as smoking for lack of a more suitable term, but also resisted being labelled as smokers, a choice that may influence smoking cessation. Clear terminology must be used in surveys and by healthcare professionals when asking about cigarette smoking and e‐cigarette and heated tobacco product use. [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 measure longitudinal trajectories of marijuana use in four tobacco/nicotine products (hand‐rolled cigarettes/spliffs, cigars/blunts, hookah, and e‐cigarettes) among young adult Texas college students from 2015 to 2019. Design: This study used six consecutive waves of data from the marketing and promotions across colleges in Texas project (Project M‐PACT), a longitudinal study of the tobacco behaviors of young adult college students. The first four waves were collected every 6 months (fall 2015‐spring 2017), and the final two waves were conducted yearly (spring 2018 and 2019). Growth curve models measured trajectories of marijuana use in tobacco products across the 3.5‐year period. Setting and Participants: A total of 4857 young adults from 24 colleges in the largest metropolitan areas of Texas, United States (Austin, Dallas, Houston, and San Antonio): mean age = 21.0, SD = 2.3; 64.2% assigned female; 36.1% non‐Hispanic white, 31.0% Hispanic, and 33.0% other or combination race/ethnicity. Measurements Participants completed online surveys assessing their past 6‐month use of marijuana in four tobacco products of interest (spliffs, blunts, hookah, and e‐cigarettes) and socio‐demographic variables (sex, race/ethnicity, age, 2‐year/4‐year college attendance, and sexual and gender minority identity). Findings Observed vaping marijuana in e‐cigarettes approximately doubled between the spring of 2015 and the spring of 2019, from 11.8% to 23.9% following a quadratic time trend (linear OR = 0.84, 95% CI = 0.73–0.97, quadratic OR = 1.18, CI = 1.13–1.22). This same time period saw a quadratic decline in using marijuana in hookah (P < 0.001) and no changes in using hand‐rolled cigarettes/spliffs or cigars/blunts for marijuana delivery. Conclusions: The popularity of nicotine e‐cigarettes appears to be expanding the avenues for marijuana delivery among young adults in Texas, United States. [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: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper‐level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Results: Overlapping, but distinct classes were developed: 'tobacco‐containing product', 'nicotine‐containing product' and 'vaping device'. Subclasses of tobacco‐containing products are 'combustible tobacco‐containing product', 'heated tobacco product' and 'smokeless tobacco‐containing product'. Subclasses of combustible tobacco‐containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine‐smoked nicotine yield' and 'machine‐smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine‐containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e‐cigarette'. E‐cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e‐liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Conclusions: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice. [ABSTRACT FROM AUTHOR]

The article comments on the Mendelian randomization (MR) study by G.D. Carrasquilla and colleagues which examined the link between smoking and abdominal obesity. Topics discussed include the role of smoking initiation and lifetime smoking in increasing abdominal adiposity, ways in which the study differ from other MR research, and the triangulation of results from an MR analysis with findings from other methods to strengthen evidence on causality.

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 measure the prevalence and changes in smokers' discussions with health professionals (HPs) about nicotine vaping products (NVPs) and HPs' recommendations about NVPs between 2016 and 2020, and their associations with tobacco product use transitions. Design: Cohort study using multinomial logistic regression analyses on data from waves 1 (2016), 2 (2018) and 3 (2020) from the International Tobacco Control Four Country Smoking and Vaping Surveys. Setting: Four countries with varying NVP regulatory environments: 'most restrictive' (Australia), 'somewhat restrictive' (Canada) and 'less restrictive' (England and the United States). Participants: Adult exclusive daily smokers who did not report NVP use at the time of their baseline survey and had visited a HP in the last 12–24 months. Prevalence data came from 4125, 4503 and 4277 respondents, respectively, for each year. Longitudinal data were from 4859 respondents who participated in at least two consecutive surveys. Measurements Prevalence of self‐reported discussions with HPs and recommendations from HPs about NVPs. Longitudinal transitions from smoking to vaping (either exclusively or concurrently with smoking) and quitting (regardless of NVP uptake). Findings The prevalence of NVP discussions was low among countries with varying regulatory environments and study waves (range = 1.4–6.2%). In 2020, a low percentage of smokers who discussed NVPs with a HP reported that their HPs recommended they use NVPs in the United States (14.7%), Australia (20.2%), Canada (25.7%), with a higher percentage in England (55.7%) where clinical guidelines for smoking cessation include NVPs. Compared with 12.0% of smokers who reported no discussion, 37.0% of those whose HPs recommended NVPs transitioned to vaping at follow‐up. Transition to quitting was 9.6% with HPs' recommendation of NVPs versus 13.5% without discussion, a non‐significant difference. Conclusions: In Australia, Canada, England and the United States between 2016 and 2020, health professionals' discussions with smokers about nicotine vaping products (NVPs) were infrequent. NVP discussions were associated with NVP uptake, but not with quitting smoking. [ABSTRACT FROM AUTHOR]

Background and Aims: Representative data on e‐cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country‐specific correlates among European students. Design: Cross‐sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16‐year‐old students. Setting: A total of 35 European countries, 25–30 with Tobacco Control Scale (TCS) and TCS components Participants: A total of 99 648 students (49.1% males) turning 16 years in the survey year. Measurements Data on current cigarette and e‐cigarette use were gathered through a self‐administered questionnaire which also collected socio‐demographics and individual and family characteristics. ESPAD data were integrated with country‐level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e‐cigarette use. Findings Of the 99 648 participating students, 12.4% were current e‐cigarette users, from 5.5% in Serbia to 41.4% in Monaco; 19.3% current smokers, from 5.1% in Iceland to 32.4% in Italy. Compared with non‐users, current e‐cigarette users less frequently came from an average well‐off family [odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.80–0.90] and lived in countries with higher cigarette prices (OR = 0.71, 95% CI = 0.50–0.99), restrictive measures on tobacco advertising and promotion (OR = 0.79, 95% CI = 0.63–0.99) and intermediate implementation of tobacco control measures (OR = 0.57, 95% CI = 0.38–0.85). Current vapers were more frequently life ever smokers (OR = 7.31, 95% CI = 6.47–8.25), were early smokers (OR = 4.35, 95% CI = 3.66–5.17), males (OR = 1.61, 95% CI = 1.55–1.67), from non‐traditional families (OR = 1.43, 95% CI = 1.34–1.53), with relatively low parental education (OR = 1.15, 95% CI = 1.10–1.20). Compared with non‐smokers, current smokers had similar family characteristics to vapers, and were less likely to live in countries with higher cigarette prices (OR = 0.70, 95% CI = 0.49–0.99) and higher spending on public anti‐tobacco media campaigns (OR = 0.23, 95% CI = 0.10–0.50). Conclusions: E‐cigarette use among European adolescents is associated with weaker tobacco control measures, particularly on tobacco price, advertising and promotion. Besides preventing tobacco smoking, the adoption of governmental tobacco control policies in European countries also seems to contribute to the prevention of vaping among adolescents. [ABSTRACT FROM AUTHOR]

The article offers a review of the recommendations made by the Society for Research on Nicotine and Tobacco's (SRNT) Racial Equity Task Force (RETF) aimed to address racism and promote racial equity within academia and within the field of commercial tobacco and nicotine science. Topics covered include the relevance of the recommendations to addiction science and academia, and its attempt to acknowledge, address, or mitigate the racist history of commercial tobacco in the U.S.

Background and aim: The prevalence of tobacco smoking has declined in most high‐income countries, while cannabis use has been rising. Moreover, cannabis use has been found to have increased among cigarette smokers in recent years in jurisdictions where it has been either decriminalized or legalized. This study measured trends in cannabis, tobacco and the co‐use of cannabis and tobacco in Australia. Design: Age–period–cohort analysis. Setting and participants: Participants were n = 143 344 individuals aged 18–80 years who participated in Australia's National Drug Strategy Household Surveys (NDSHS) between 2001 and 2019. Measurements Regular (weekly/more frequently): (1) tobacco smoking only, (2) cannabis use only and (3) the co‐use of cannabis and tobacco. Findings Prevalence of only smoking tobacco decreased in all age groups (P < 0.001) and birth cohorts between 2001 and 2019, but the co‐use of cannabis and tobacco did not. Younger cohorts were much less likely to co‐use tobacco and cannabis (P = 0.02). Period trends showed that both cannabis use only and the co‐use of cannabis and tobacco have increased since 2013. Conclusion: There has been a consistent decrease in exclusive tobacco smoking across age, period and birth cohorts between 2001 and 2019 in Australia, although there is a recent increasing period trend in cannabis use with or without tobacco. The non‐decreasing trend of co‐use may reflect the strong tobacco control policies introduced over the period and changing attitudes towards cannabis use in Australia. [ABSTRACT FROM AUTHOR]

Aims: To (i) define the characteristics of snus users compared with non‐users and smokers and (ii) define the relationship between snus use and self‐reported anxiety and depression and compare it with the relation between smoking and anxiety and depression. Design, setting and participants: A cross‐sectional study based on data from the Norwegian population‐based survey, the Tromsø Study (2015–16). A total of 32 591 people aged 40 years and older in the municipality of Tromsø were invited to attend. There were 21 083 respondents, giving a 65% attendance rate. Measurements: Tobacco use was assessed by current and previous use of snus or cigarettes. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Findings Snus users were more often male, were younger and had higher income and higher alcohol consumption than smokers and non‐users of snus. In a linear regression analysis, we found no significant association between current snus use and anxiety and depression after adjusting for background variables. However, there was a positive association between previous snus use and anxiety among males [adjusted beta = 0.258; 99% confidence interval (CI) = 0.023–0.492]. Regarding anxiety, the adjusted beta‐coefficients for current smoking were 0.425 (99% CI = 0.184–0.666) for females and 0.303 (99% CI = 0.084–0.522) for males. Concerning depression, the adjusted beta coefficients for current smoking were 0.569 (99% CI = 0.358–0.780) for females and 0.281 (99% CI = 0.060–0.503) for males. Conclusions: In Norway, current snus users differ from current smokers by having a higher socio‐economic status and no detectable association with anxiety and depression. This suggests that the relationship between tobacco use and anxiety and depression is associated with the administration method. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "A Framework for Evaluating the Public Health Impact of E-cigarettes and Other Vaporized Nicotine Products," which appeared in the 2017 issue of the magazine.

A correction is presented to the article "Changes From 2017 to 2018 in E-cigarette Use and in Ever Marijuana Use With E-cigarettes Among US Adolescents: Analysis of the National Youth Tobacco Survey," which appeared in the 2021 issue of the magazine.

A correction is presented to the article "Adult Interest in Using a Hypothetical Modified Risk Robacco Product: Findings From Wave 1 of the Population Assessment of Tobacco and Health Study (2013-14)," which appeared in the 2018 issue of the magazine.

A correction is presented to the article "The Need for a Comprehensive Framework," which appeared in the 2017 issue of the magazine.

Aims: This study aimed to evaluate the impact of announcement of tax increases on factory‐made (FM) and roll‐your own (RYO) cigarettes in England. Design, Setting and Participants: Autoregressive integrated moving average with exogeneous input (ARIMAX) time–series modelling in England, UK. Data were aggregated monthly on 274 890 participants between 2007 and 2019 taking part in the Smoking Toolkit Study (STS). Measurements: The association of sustained step level changes for tax rises for FM cigarettes and temporary pulse effects for tax rises for RYO cigarettes with smoking, quit attempt and quit success prevalence as well as per‐capita self‐reported cigarette consumption and cost per cigarette was assessed. Findings A 10% rise in tax on RYO cigarettes was associated with a temporary 21.1% decline [95% confidence interval (CI) = –30.4 to −10.7] in smoking prevalence, and 20.7% decline (95% CI = –32.4 to −7.0) in per‐capita self‐reported cigarette consumption; while a 3% rise of tax on RYO cigarettes was associated with a temporary 20.7% decline (95% CI = –33.3 to −5.8) in the amount paid per RYO cigarette. For tax increases on FM cigarettes, a 5% above inflation tax rise was associated with a step‐level increase of 33.1% (95% CI = 18.4–49.5) in quit success rates. However, some of the findings were sensitive to model specification and temporally specific. Conclusion: The announcements of tax increases for cigarettes in England between 2010 and 2019 were inconsistently associated with temporary reductions in smoking prevalence, per‐capita self‐reported cigarette consumption and improved quit success. Paradoxically, reductions in the cost for roll‐your‐own cigarettes were also found. The results were not robust in all sensitivity analyses. [ABSTRACT FROM AUTHOR]

Aim: To quantify the trends in frequent and occasional cannabis vaping, demographic differences and concurrent nicotine and alcohol use. Design: Observational study. Survey‐weighted multinomial logistic regression models assessed trends and disparities in past 30‐day cannabis use. Trends were assessed overall and by sex, race/ethnicity, parental education and urbanicity. Multinomial logistic regression models also estimated associations of cannabis use (none, use without vaping, use with vaping) with past 2‐week binge drinking and past 30‐day nicotine/tobacco use. Setting: United States, 2017–19. Participants: Participants in the national Monitoring the Future (n = 51 052) survey. Measurements Past 30‐day frequent cannabis use (six or more times/30 days) and past 30‐day occasional use (one to five times/30 days), with and without vaping. Findings Past 30‐day frequent cannabis use with vaping and occasional use with vaping rose from 2017 to 2019. Past 30‐day frequent and occasional cannabis use without vaping declined. Certain groups, such as Hispanic/Latino or lower socio‐economic status adolescents, experienced particularly notable increases in frequent cannabis use with vaping (e.g. prevalence among Hispanic/Latino adolescents). Adolescents who reported smoking and vaping nicotine, and 10+ occasions of binge drinking, were 42.28 [95% confidence interval (CI) = 33.14–53.93] and 10.09 (95% CI = 4.51–22.53) times more likely to report past 30‐day cannabis use with vaping, respectively, compared with no use. Discussion Cannabis use without vaping appears to be declining among adolescents in the United States, while cannabis use with vaping is accelerating; frequent cannabis vaping is especially increasing, with consistent increases across almost all adolescent demographic groups. Cannabis use among US adolescents remains highly associated with other substance use. [ABSTRACT FROM AUTHOR]

Aim: To (i) estimate the prevalence of adolescent vaping in 47 lower‐middle, upper‐middle and high‐income countries, and (ii) test the association between implementation of World Health Organisation (WHO) tobacco control policies and adolescent e‐cigarette use (also known as vaping) in 44 countries where implementation data were available. Design: Cross‐sectional surveys. Settings A total of 47 lower‐middle, upper‐middle and high‐income countries. Participants: A total of 151 960 adolescents (typically ages 13–15) who participated in WHO's Global Youth Tobacco Survey between 2015 and 2018. Measurements Prevalence of past‐30‐day vaping and past 30‐day frequent vaping (≥10 days) were estimated from the surveys. Data on the implementation of six tobacco control measures including monitoring, smoke‐free policies, cessation programs, warning about the dangers of tobacco, advertising bans and taxation were taken from WHO's report on global tobacco epidemic. Findings The overall weighted prevalence of adolescent vaping and frequent vaping in the past 30 days was 8.6% (95% CI, 8.3‐8.9) and 1.7% (95% CI, 1.6‐1.8), respectively. For five of WHO's policies (monitoring, smoking‐free environment, cessation programs, health warning and advertising bans), their association with adolescent vaping was inconclusive because of large variation of their effects across countries. Higher tax on combustible tobacco products was associated with higher adolescent vaping (> = 75% tax vs < 25% tax; odds ratio = 2.58; 95% CI, 1.25‐5.21). Conclusion: In 47 lower‐middle, upper‐middle and high‐income countries from 2015 to 2018, ~1 in 12 (8.6%) adolescents reported vaping in the past 30 days, but prevalence of frequent vaping was low (1 in 60; 1.7%). A higher tobacco tax was associated with higher adolescent vaping. [ABSTRACT FROM AUTHOR]

Background and aims: Variation in the TAS2R38 taste receptor gene alters the ability to taste bitter compounds. We tested whether TAS2R38 variation influences early smoking behaviours in adolescence, a critical period of acquisition when taste may influence the natural course of tobacco use. Design and participants: Observational study (Nicotine Dependence in Teens [NDIT]). Cox proportional hazards models were conducted using data from European ancestry adolescent participants who initiated smoking during follow‐up (n = 219, i.e. incident smokers). In young adulthood, cross‐sectional analyses were restricted to European ancestry self‐reported current smokers at age 24 (n = 148). Setting: Montréal, Canada. Measurements: In adolescents, the rates of attaining early smoking milestones were estimated for tasters {PAV diplotypes (i.e. PAV/PAV or PAV/AVI)} versus non‐tasters {AVI diplotype (i.e. AVI/AVI)}. In young adults, associations between tasting status and a nicotine intake biomarker (cotinine + 3'hydroxycotinine) and past‐week cigarette consumption were assessed. Findings Among incident smokers, similar rates to first whole cigarette were found between the diplotype groups (hazard ratio [HR], 1.05; 95% confidence interval (CI), 0.75–1.48; P = 0.765). However, smokers with the PAV (vs AVI) diplotypes attained monthly smoking more rapidly (HR, 1.55; 95% CI, 1.04–2.32; P = 0.033) and had faster conversion to three different measures of tobacco dependence (International Classification of Diseases: HR, 2.29; 95% CI, 0.99–5.28; P = 0.052; modified Fagerström Tolerance Questionnaire: HR, 3.02, 95% CI, 1.04–8.79; P = 0.043; Hooked on Nicotine Checklist: HR, 1.87; 95% CI, 0.98–3.60; P = 0.059). At age 24, those with PAV (vs AVI) diplotypes had higher mean cotinine + 3'hydroxycotinine (197 vs 143 ng/mL; P = 0.053). Conclusions: Adolescents with a genetic variation increasing their ability to taste bitter compounds appear to escalate more quickly to monthly smoking and tobacco dependence during adolescence and have higher nicotine intake in young adulthood versus those without that genetic variation. [ABSTRACT FROM AUTHOR]

Aim: To test whether intrapersonal growth in e‐cigarette advertising exposure over time is associated with growth in e‐cigarette use and/or cigarette smoking. Design Longitudinal study using four waves of data were collected in 6‐month intervals between 2018 and 2020. Setting and participants: Participants were 2327 young adults recruited from colleges in Hawaii, USA. Measurements Data were collected on demographics, e‐cigarette advertising exposure measured using the cued‐ recall method and recent (past 30‐day) cigarette and e‐cigarette use. Findings The average trajectory for e‐cigarette advertising exposure over time was significant and upward [M slope = 0.18 (0.14–0.22), P < 0.0001]. However, average trajectories for e‐cigarette [M slope = −0.08 (−0.18 to 0.02), P = 0.09] and cigarette [M slope = −0.14 (−0.30 to 0.02), P = 0.07] use were not. There were significant differences in individual level trajectories across participants for advertising exposure [σ2 = 0.12 (0.10–0.14), P < 0.0001], e‐cigarette use [σ2 = 0.22 (0.14–0.30), and cigarette smoking (σ2 = 0.17 [0.09–0.25], P < 0.0001). Individuals with an increasing rate of advertising exposure showed an increasing rate of e‐cigarette use [B = 0.63 (0.36–0.90), P < 0.0001). Neither initial level of, nor rate of change in, advertising exposure was significantly associated with cigarette smoking growth factors (P > 0.05). Higher initial level of e‐cigarette use was associated with higher initial level of cigarette smoking [B = 0.89 (0.69–1.09), P < 0.0001] but decreased rate of cigarette smoking over time [B = −0.12 (−0.20 to –0.04) P = 0.003]. Rate of change in e‐cigarette use was not associated with the rate of change in cigarette smoking (P > 0.05). Conclusions: Increased exposure to e‐cigarette advertising appears to be associated with increased e‐cigarette use but not with increased cigarette smoking. Higher initial level of e‐cigarette use appears to be associated with higher initial level of cigarette smoking but may be associated with a decreasing rate of cigarette smoking over time. [ABSTRACT FROM AUTHOR]

The article comments on a study by B. Keller-Hamilton and colleagues about the effect of nicotine concentration on smokers' nicotine intake and appeal of oral nicotine pouches. Topics discussed include controversy and concerns surrounding electronic cigarettes, the cancer risk of tobacco specific nitrosamines found in nicotine pouches, and the use of nicotine pouches as a route for tobacco harm reduction.