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Objectives: E-cigarettes are not FDA-approved smoking cessation aids. Nevertheless, content analyses have shown that e-cigarette companies make claims about cessation efficacy. Some advertisements are explicit (directly mentioning their product can help smokers quit or stop smoking), whereas others are implicit (not containing cessation-related language, but implying cessation efficacy through subtle wording and imagery). This is the first study to examine directly how adolescents and young adults (AYAs) perceived these ads, and specifically whether they identify the cessation claims in e-cigarette advertisements. Methods: A total of 248 AYAs in California viewed 4 e-cigarette advertisements with cessation claims, then selected claims made by each advertisement. Descriptive statistics and multi-level logistic regression models were used to examine the relationship between the type of claims and perception. Results: The claim "helps me quit smoking" was most frequently selected after viewing advertisements with explicit cessation claims, but not after viewing implicit claims. We found no statistically significant effect of tobacco use and age on claim selection. Conclusions: E-cigarette manufacturers make claims about cessation efficacy, and AYAs can identify such claims in advertisements, especially the explicit ones. FDA should regulate these advertisements as making therapeutic claims. [ABSTRACT FROM AUTHOR]

Objectives: We used focus groups to understand cigar product features that increase the appeal of blunts (hollowed out cigars filled with marijuana) among adolescents and young adults. Methods: With a standardized focus group guide, we assessed cigar use behaviors and perceptions among lifetime cigar users (N = 47; 8 focus groups separated by sex and age group [adolescents, young adults]) in 2016. We analyzed data related to blunts. Results: Overall, 85.5% of the participants had smoked a blunt in the past 30 days (38% used daily). Participants perceived that cheap cigar brands were used primarily for blunts. Cigar product features that made them useful for blunts included wide availability, easy accessibility (easy to bypass underage purchasing restrictions), attractive flavors, inexpensive cost, perforated wrappers that make cigars easy to open, and ability to remove the inner wrapper (also referred to as "cancer paper") to reduce the risk of harm. Conclusions: Various product features of cigars make it easy for adolescents and young adults to manipulate them to create blunts. Tobacco regulations that include restrictions on product characteristics, as well as enforcement of prohibition of sales of cigars to underage minors are needed. Youth also need to be educated about harms of blunt use. [ABSTRACT FROM AUTHOR]

Objective: In this paper, we examine whether a slowdown in implementing tobacco control policies in California after 2000 influenced trends in smoking behavior. Methods: We assessed the strength of state tobacco control policies using excise tax data (1990-2014), tobacco control expenditures per capita, and workplace and home smoking restrictions (from the Tobacco Use Supplement of the Current Population Survey, 1992-2015). Smoking prevalence was assessed with the National Health Interview Survey, 1985-2015. We compared trends between California and the rest of the US using split regression models with a knot at 2000. Results: Throughout the 1990s, compared to the rest of the US, California had higher cigarette excise taxes, higher expenditures on tobacco control, more smoke-free workplaces, and more smokers with smokefree homes. Except for smoke-free homes, these differences disappeared after 2000. During the 1990s, smoking prevalence declined much faster in California than in the rest of the US, but the decline slowed significantly after 2000. Conclusions: Smoking prevalence is sensitive to continued implementation of tobacco control policies. [ABSTRACT FROM AUTHOR]

Objectives: This study provides global evidence on the association between cigarette point-ofsale (POS) advertising bans and adult cigarette smoking during 2007-2014. Methods: Data on POS advertising bans, cigarette prices, tobacco control environment, and countries' economic conditions came from the WHO MPOWER datasets and the World Bank database. Data on annual smoking prevalence and cigarette consumption were from Euromonitor International tobacco country reports. Country and year identifiers were used to link the datasets. Fractional logit regression and ordinary least squares methods were used to examine the associations between POS advertising bans and smoking prevalence and cigarette consumption. Analyses controlled for country-level GDP per capita, cigarette prices, percentages of population aged 15-64 and 65 and over, tobacco control environment, year indicators, and country fixed-effects. Results: POS advertising bans were associated with a 0.7 percentage point decrease in adult smoking prevalence and significantly associated with reduced cigarette consumption. Countries with POS advertising bans decreased by 128-154 sticks of cigarettes in per capita consumption per year compared to countries without such bans. Conclusions: Restricting cigarette advertising in the retail environment may reduce adult cigarette smoking. [ABSTRACT FROM AUTHOR]

Objectives: In 2016 the US Food and Drug Administration (FDA) and Santa Fe Natural Tobacco Company entered into a settlement agreement restricting use of the terms "additive free" and "natural" in American Spirit ads. American Spirit uses a variety of other tactics that could contribute to inaccurate reduced risk perceptions; yet, no research has examined the effects of these tactics. The current study examines the effect of the phrase 'tobacco and water', references to eco-friendly business practices, and plant imagery on young adults' perceptions of product harm, addictiveness, and nicotine content. Methods: We conducted a between-subjects experiment that randomized the presentation of 5 ad tactics (control, 'tobacco and water', eco-friendly reference, plant imagery, or all 3 tactics present) in 2 brands (American Spirit vs Marlboro) with a sample of 3054 18-24 year-old US young adults recruited via Amazon Mechanical Turk. Results: When used in an American Spirit ad, adding eco-friendly language (OR = 1.50, AOR = 1.51) or "tobacco and water" (OR = 1.48, AOR = 1.1.6) was associated with greater odds of misperceiving reduced harm compared to the control condition. Conclusions: Our findings provide additional support for FDA enforcement actions against tobacco companies using these misleading tactics. [ABSTRACT FROM AUTHOR]

Objectives: We tested how variations of the warning message on e-cigarette packages influenced risk and ambiguity perceptions, and whether including a modified risk statement on the package influenced how the warning label was perceived. Method: A 4 (warning text) x 2 (modified risk statement), plus control, experiment (N = 451) was conducted. Results: Smoking status, sex, and the language used in the warning statements interacted to influence risk perceptions. For example, non-smoking women perceived e-cigarettes with the FDA text at 30% of the package as riskier than the FDA text at 12-point type. Additionally, including a modified risk statement on the package increased ambiguity among non-smokers, as did an abstract warning label. Conclusions: When evaluating the effectiveness of warning label text, it is important to consider smoking status and sex. Additionally, including modified risk statements on the package with the warning label could potentially increase ambiguity among non-smokers. [ABSTRACT FROM AUTHOR]

Objectives: Multi-unit housing environments remain significant sources of secondhand smoke (SHS) exposure, especially for vulnerable populations in subsidized housing. In Philadelphia, the largest US housing authority to implement smoke-free policies, we measured baseline resident smoking-related behaviors and attitudes, and longitudinal exposures to airborne nicotine, during policy development and implementation. Methods: In 4 communities, we collected data in 2013, 2014, and 2016, before and after introduction of comprehensive smoke-free policies, interviewing persons in 172 households, and monitoring air-borne nicotine in non-smoking homes and public areas. Average nicotine level differences across years were estimated with multi-level models. Results: Fifty-six percent of respondents smoked. Only 37% of households were smokefree, with another 41% restricting smoking by area or time of day. The number of locations with detectable nicotine did not differ before and after policy implementation, with approximately 20% of non-smoking homes and 70%-80% of public areas having detectable nicotine. However, public area nicotine levels were lower in 2016, after policy implementation, than in 2013 and 2014 (-0.19 μg/m3, p = .03). Conclusions: Findings suggest that initial policy implementation was associated with reduced SHS exposure in Philadelphia. As HUD strengthens smoke-free policies, SHS monitoring can be useful to educate stakeholders and build support for policy enforcement. [ABSTRACT FROM AUTHOR]

Objective: This study compares the cigarette and smokeless tobacco (SLT) markets in Texas and the United States (US) as a whole. Methods: Nielsen convenience store sales data from 2014 were obtained for Dallas, Houston, San Antonio/Austin, and the total US. Descriptive statistics highlighted market share differences in Texas compared to the US overall. Results: Marlboro and Copenhagen dominated the cigarette (58.9%) and SLT markets (44.8%) in Texas and had substantially higher relative market shares in Texas than nationally (46.7% and 29.8%, respectively). Camel, with sales driven largely by its Camel Crush variety, held second place in Texas (9.8%), outselling Newport (6.6%), despite Newport's status as second best-selling brand in the US (11.5%). Copenhagen led the SLT market in Texas, outselling Grizzly 2 to 1, yet the brands hold roughly equivalent shares nationally. Whereas flavored SLT products made up nearly 60% of the US SLT market, unflavored SLT (58.6%) dominated in Texas markets. Finally, sales of fine-cut SLT in Texas were more than triple their national market share. Conclusions: Regional tobacco market share differences are likely influenced by multiple factors such as marketing, population demographics, culture, and neighboring communities. Policymakers are encouraged to develop local tobacco control policies and programs within the context of this knowledge. [ABSTRACT FROM AUTHOR]

Objectives: This study measures sociodemographic disparities in perceived effectiveness of pictorial health warnings on cigarette packs. Methods: A cross-sectional study in 2011 tested 20 pictorial warnings among 1517 adults across Lebanon. Participants evaluated the effectiveness of the current text-only warning, and 2 pictorial warnings. Health warnings were thematically grouped. Logistic regression models evaluated associations between the perceived effectiveness of themes and sociodemographic characteristics. Results: Perceived effectiveness of the current warning was 15.0% (95% CI 13.2%-16.9%). All pictorial warnings were perceived to be more effective than the current warning, including those about the long-term consequences of smoking (78.1%, 95% CI 74.9%-81.3%) and second-hand smoke (79.2%, 95% CI 74.3%-84.2%). Men had lower odds of perceiving warnings about dependence and second-hand smoke as being effective (AOR 0.30, 95% 0.14-0.65; AOR 0.22, 95% CI 0.10-0.50, respectively). Older respondents had lower odds of perceiving warnings about reproductive health, but higher odds of perceiving warnings about cessation, as effective (AOR 0.35, 95% CI 0.14-0.88; AOR 3.30 95% CI 1.26-8.64, respectively). Other sociodemographic disparities are described. Conclusions: Pictorial warnings are perceived to be more effective than text-only warnings in Lebanon, and should be implemented considering sociodemographic disparities. [ABSTRACT FROM AUTHOR]

Objectives: Behavior change campaigns typically try to change beliefs that influence behaviors, with targeted beliefs comprising the campaign theme. We present an empirical approach for choosing among a large number of potential themes, and results from the implementation of this approach for campaigns aimed at 4 behavioral targets: (1) preventing smoking initiation among youth, and (2) preventing initiation, (3) stopping progression to daily smoking and (4) encouraging cessation among young adults. Methods: An online survey of 13- to 17-yearolds and 18- to 25-year-olds in the United States (US), in which 20 potential campaign themes were represented by 154 beliefs. For each behavioral target, themes were ranked based on the strength of belief-intention and belief-behavior associations and size of the population not already endorsing the beliefs. Results: The most promising themes varied across behavioral targets but 3 were consistently promising: consequences of smoking for mood, social acceptance and social popularity. Conclusions: Using a robust and systematic approach, this study provides campaign developers with empirical data to inform their selection of promising themes. Findings related to the campaign to prevent initiation among youth informed the development of the US Food and Drug Administration's "The Real Cost" campaign. [ABSTRACT FROM AUTHOR]