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BackgroundAs user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking. ObjectiveThis study aimed to analyze the content of YouTube videos depicting modifications of ENDS. MethodsYouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos. ResultsVideos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative). ConclusionsThis study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications.

BackgroundMobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. ObjectiveWe investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. MethodsThe Apple and Google Play app stores were searched using the terms “cannabis” and “marijuana.” Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. ResultsTotal apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated “17+” years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated “high maturity” (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment. ConclusionsCannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations.

How people make perceived message effectiveness (PME) judgments remains mostly unexplored. This study assessed whether people need to spontaneously think about message effectiveness to report the message as effective on rating scales and investigated emotions as precursors to PME. After viewing one of four e-cigarette prevention messages, 1,968 adult current and former smokers and nonsmokers freely expressed thoughts about the messages in an open-ended question and answered close-ended PME items. Four expressed PME variables (positive message perceptions, negative message perceptions, positive effect perceptions, and negative effect perceptions) were coded (1 = present, 0 = absent) in the open-ended responses, and all were significantly associated with measured PME. Positive and negative emotions predicted both expressed and measured PME. Negative message perceptions was the only expressed PME construct that mediated the relationships between emotions and measured PME and outcomes (perceived risk and behavioral intentions). This suggests that messages may not need to induce effectiveness thoughts to be reported as effective, but thoughts of message ineffectiveness are a useful indicator deserving further research.

Purpose: To understand changes in purchasing behaviors and use of tobacco products such as e-cigarettes and cigarettes among different tobacco user groups during the COVID-19 pandemic using a mixed methods approach. Methods: A quantitative online survey was conducted in October-November 2020 using a national probability sample of US adults (N = 1,460) comprising exclusive cigarette smokers (n = 1,080), dual users of both cigarettes and e-cigarettes (n = 143), and exclusive e-cigarette users (n = 237). Simultaneously, ten online focus groups were conducted with 61 adults in the Atlanta, GA area including exclusive smokers (n = 16), current E-cigarette users (n = 22), and transitioning (recently quit or currently quitting) smokers and/or E-cigarette users (n = 23). Results: From the survey, dual users vs. exclusive smokers had higher odds of buying cheaper cigarette brands (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) = 1.49, 4.20), buying cigarettes online (aOR = 2.79; 95% CI = 1.02, 7.69), buying from Indian Reservations (aOR = 3.99; 95% CI = 2.07, 7.69), buying fewer cigarettes than normal (aOR = 4.01; 95% CI = 2.42, 6.65) and buying other tobacco products (aOR = 4.44; 95% CI = 2.24, 8.79). From the focus groups, participants perceived reduced accessibility, fear of contracting COVID-19, rising prices, and convenience to influence their purchasing behaviors and tobacco use. Conclusions: Exclusive and dual users differed in their tobacco purchasing behaviors during the COVID-19 pandemic, such that dual users were more likely to change their purchasing behaviors (e.g., buying other tobacco products) than exclusive users. Educational campaigns and public health workers may promote interventions targeting dual users either to switch to reduced-risk products or quit smoking, particularly during stressful societal situations such as the COVID-19 pandemic. Implications: The findings inform public health educators and policymakers to develop policies and interventions carefully tailored for tobacco user groups targeting the perceived factors influencing purchasing behaviors during challenging situations affecting tobacco product availability. [ABSTRACT FROM AUTHOR]

Background: Emotions are important in smoking-related communications, but the role of discrete positive and negative emotions in comparative risk messages about combusted and electronic cigarettes (e-cigarettes) is unclear. Method: In an online experiment, 1,202 U.S. adult current smokers or recent quitters were randomized to view one of six messages about comparative risk of e-cigarettes and cigarettes. Participants reported their feelings of hope, happiness, fear, guilt, disgust, and anger and risk perceptions and behavioral intentions about e-cigarettes and cigarettes. Results: Hope was associated with higher perceived absolute cigarette risk, lower perceived absolute and comparative e-cigarette risk, and stronger intentions to quit smoking, seek quit help, use nicotine replacement therapy (NRT), switch to e-cigarettes, and use e-cigarettes exclusively versus dual use. Happiness was related to stronger intentions to seek quit help, use NRT, and switch to e-cigarettes but higher perceived comparative risk of e-cigarettes. Fear was associated with stronger intentions to quit smoking, seek quit help, use NRT, and switch to e-cigarettes. Guilt was related to higher perceived absolute cigarette risk, lower perceived comparative e-cigarette risk, and stronger intentions to use NRT. Disgust was associated with higher absolute and comparative e-cigarette risk and stronger intentions to quit smoking, seek quit help, and use e-cigarettes exclusively versus dual use. Anger was related to lower perceived absolute cigarette risk, higher perceived comparative e-cigarette risk, and weaker intentions to quit smoking. Conclusion: Comparative risk messages about e-cigarettes that arouse hope, fear, and guilt and avoid anger might be particularly likely to have positive impact on smokers.

Significance: For decades, tobacco advertisements and promotions have been common in mass media and public places in China. In 2015, China amended the Advertising Law to prohibit the distribution of tobacco advertising, while also initiating waves of tobacco control media campaigns. This study investigates the associations between exposure to anti- and pro-smoking messages, smoking status, and people's smoking-related beliefs and willingness to support tobacco control policies. Methods: A secondary data analysis was performed with the 2018 Global Adult Tobacco Survey of 19,376 adults aged ≥15 years in China. Anti- and pro-smoking message exposures were measured as the sum of sources (media or places) where respondents have seen the messages. Multivariable logistic regression analyses were conducted to examine the relationships among smoking status, message exposure, and the outcome variables (health harm beliefs, support for increasing tax on cigarettes, support for using part of the increased tax on tobacco control) controlling for smoking status and demographic differences. Results: Overall, 63.3% of the respondents reported being exposed to anti-smoking messages from at least 1 source, while 18.1% were exposed to pro-smoking messages from at least 1 source. Adults who currently, formerly, and never smoked differed in their beliefs about smoking and willingness to support tobacco control policies. Greater reported exposure to anti-smoking messages was positively associated with belief that smoking is harmful, support for increased cigarette tax, and support for using increased tax revenue for tobacco control measures. Meanwhile, greater reported exposure to pro-smoking messages was negatively related to willingness to support cigarette tax increases. Conclusions: While national and local tobacco control campaigns in China have reached a large proportion of the adult population, there is still room for improvement. China might consider expanding anti-tobacco campaigns, as reported exposure to these messages is associated with increased public awareness of the health hazards of smoking and support for increasing cigarette taxes. [ABSTRACT FROM AUTHOR]

This study examined the associations of emotions, cognitions, and behavioral intentions in response to exposure to news stories reporting on the arrival of Omicron variant in Vietnam. Outcomes included fear, anxiety, anger, comparative optimism, intentions to conduct prevention behavior (wash hands with soap), detection behavior (test for Omicron infection), and share health information. Two experiments were conducted with participants being randomized to either low-risk or high-risk condition that contained information promoting hand-washing with soap (Experiment 1, N = 303), or information promoting COVID-19 testing (Experiment 2, N = 303). Results indicated that viewing high-risk news stories led to higher fear, anxiety, and anger than low-risk news stories. Fear fully mediated the effect of news exposure on intentions to test for Omicron infection and share health information. Comparative optimism moderated the indirect effect of news exposure on intentions to wash hands with soap and share information about COVID-19 testing. Theoretical and practical implications were discussed. [ABSTRACT FROM AUTHOR]

INTRODUCTION Although shisha smoking is banned in Senegal, it has become increasingly popular, especially among youth. Despite the health risks associated with shisha smoking, there are few studies on shisha smoking in West Africa and none in Senegal. Our study assessed the prevalence and factors associated with shisha smoking among students aged 13-15 years in Senegal. METHODS We used the 2020 Global Youth Tobacco Survey (GYTS) Senegal data from 2524 students aged 13-15 years. We calculated the weighted prevalence of ever and current (past 30 days) shisha smoking. Multivariable logistic regression analyses identified factors associated with ever and current shisha smoking among students. RESULTS The prevalences of ever and current shisha smoking were 9.8% (95% CI: 7.7-12.3) and 2.2% (95% CI: 1.5-3.1), respectively. Ever shisha smoking was significantly associated with being male (AOR=1.97; 95% CI: 1.33-2.92), current cigarette smoking (AOR=7.54; 95% CI: 2.95-19.29), higher class grade (AOR=2.27; 95% CI:1.10-4.67), more weekly pocket money (AOR=3.29; 95% CI:1.36-7.95), current use of smokeless tobacco (AOR=11.53; 95% CI: 4.98-26.72), and exposure to secondhand cigarette smoke in public (AOR=1.55; 95% CI: 1.00-2.41). Current shisha smoking was significantly associated with current cigarette smoking (AOR=21.75; 95% CI: 6.08-77.78), more weekly pocket money (AOR=8.91; 95% CI: 1.75-45.40), current use of smokeless tobacco (AOR=8.26; 95% CI: 2.07-33.04), and fathers' smoking (AOR=3.34; 95% CI: 1.24-8.96). CONCLUSIONS One in 10 students aged 13-15 years have ever smoked shisha and 2.2% were currently smoking it, suggesting that shisha smoking is a public health concern in Senegal. Senegal might consider offering students more education on the harms of shisha, both in schools and through comprehensive media campaigns that address all tobacco products. [ABSTRACT FROM AUTHOR]

Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone. [ABSTRACT FROM AUTHOR]

Background: Exposure to advertisements for tobacco products and tobacco warning labels evokes emotions. This study evaluated the association of discrete positive and negative emotions with interest in alternative tobacco products. Method: In 2013, 1,226 U.S. adult nonsmokers and current smokers viewed advertisements for moist snuff, snus, and electronic cigarettes (e-cigarettes) with various warning labels and then indicated their emotional responses in terms of anger, anxiety, sadness, guilt, disgust, discouragement, hope, and contentment. Outcomes were openness to using moist snuff, snus, and e-cigarettes in the future and interest in a free sample of each product. Data were analyzed in 2016. Results: Hope was positively associated with openness and interest across all alternative tobacco products as was contentment for moist snuff and snus. Anger was negatively associated with openness to moist snuff and e-cigarettes, disgust negatively to moist snuff and snus, and anxiety negatively to e-cigarettes. Being a current smoker, ever trying a corresponding product, being male, and younger age were associated with greater openness to and interest in moist snuff and snus. For e-cigarettes, being a current smoker, ever trying e-cigarettes, and being female were associated with greater openness, and being a current smoker was associated with greater odds of selecting a free sample. Conclusions: Positive emotions, particularly hope, were consistently positively associated with interest in alternative tobacco products. Hope is widely used by tobacco and e-cigarette companies to advertise their products. Antitobacco messages should aim to lower hope associated with tobacco products but increase hope for cessation or life without tobacco.

The aim of this paper is to provide context for the quantitative content analyses of gender roles that are to be included in both parts of this special issue. First, a timeline of historical uses of the content analysis methodology is presented. Second, research objectives that frequently drive content analysis of gender roles are described; these include: to support feminist claims, to compare media with real life, to predict effects on audiences, and to detect effects of media producers on content. Third, previous content analyses published in Sex Roles and other gender-focused journals are reviewed and categorized in terms of medium, genre, time span, gender, and nationality. Finally, contributions of each of the articles in this special issue are outlined.

Introduction The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. This qualitative study documents reactions to messages communicating this policy among people who use little cigars and cigarillos (LCCs). Aims and Methods We conducted eight focus groups with participants from four populations with the highest prevalence of cigar use (African American males and females, white males and females). Participants described their reactions to eight messages about the policy: Three messages about the equal risk of LCCs with regular and low nicotine levels; three quit efficacy messages about low nicotine LCCs being easier to quit; one "compensation" message to correct misperceptions about the policy causing people to smoke more to get desired nicotine; and one message about using alternative nicotine sources (eg, e-cigarettes). Results Participants perceived risk messages as the most motivating to quit, whereas efficacy messages made some participants feel that the policy would cause former users of LCCs to relapse. Many participants expressed favorable responses to the compensation message. The message about using alternative nicotine sources sparked intense responses, with many participants expressing outrage and mistrust of the message. Participants' beliefs that they were not addicted to LCCs dampened their perceptions of the effectiveness of the policy. Conclusions Perceptions of the addictiveness and relative harms of LCCS influenced responses to policy messages. The FDA should consider using different messages to communicate with people who use LCCs because they perceive LCCs as different from cigarettes. Implications This is the first study to document affective and cognitive responses to the FDA's reduced nicotine policy among people who use LCCs. The false belief that cigar products are less harmful than cigarettes may be influencing people's lack of support for the reduced nicotine policy and difficulty in understanding its potential positive impact. To maximize the public health benefit of the reduced nicotine policy, the FDA should include LCC products in the policy; however, it is crucial that they use educational messaging to clarify misperceptions regarding nicotine and harm as it applies to LCCs. [ABSTRACT FROM AUTHOR]

Introduction Youth in the United States are using electronic nicotine delivery systems (ENDS) at a high rate. Modifications to ENDS by youth can introduce additional health hazards which have not been previously considered. To better understand these risks, we need more information on what these modifications are, the motivations behind them, and the sources of information on modifications. Aims and Methods Utilizing a trained moderator, in 2020–2021, we conducted one-on-one interviews with 19 youth ENDS users aged 16–17 living in the United States and analyzed their responses using a qualitative description approach. Results The most prominent modification was to the e-liquid; youth indicated they mixed e-juices to create new flavors and added substances not intended for vaping, including illicit drugs such as cannabis and cocaine. Few youths from our sample were interested in achieving a specific nicotine level to vape, and modifications to the battery, coil and wick were less frequently mentioned. Some of these modifications were motivated by a desire to achieve specific experiences with their device. At other times, modifications were made due to necessity because of limited access to ENDS devices and supplies. YouTube and peers were the main sources of information about modifying. Conclusions Youth are making modifications that are both intended and unintended by the manufacturer. Adding illicit drugs and other substances not made for vaping is of particular concern. Understanding how youth modify ENDS and how that changes their use is important to guide regulatory policy intended to reduce harm to youth from ENDS use. Implications Youth from our study indicated that they make modifications to the ENDS devices, specifically to the e-liquid. These modifications are both intended by the manufacturer, such as changing the e-liquid and replacing coils, and unintended, such as adding substances not meant for vaping. Future policies aimed at reducing youth ENDS use should consider mandating better safeguards against modifications that appeal to youth. [ABSTRACT FROM AUTHOR]

Cigarette companies increasingly promote novel smokeless tobacco products to smokers, encouraging them to use smokeless tobacco in smoke-free environments. New messages may counteract this promotion. We developed 12 initial anti-smokeless message ideas and tested them in eight online focus groups with 75 US smokers. Those smokers who never tried smokeless tobacco were unaware of health risks of novel smokeless tobacco products, perceived scary messages as effective and acknowledged the addictive nature of nicotine. Smokers who had tried smokeless tobacco shared their personal (mainly negative) experiences with smokeless tobacco, were aware of health risks of novel smokeless tobacco products, but denied personal addiction, and misinterpreted or disregarded more threatening messages. Portraying women as smokeless tobacco users was perceived as unbelievable, and emphasizing the lack of appeal of novel smokeless tobacco products was perceived as encouraging continued smoking. Future ads should educate smokers about risks of novel smokeless tobacco products, but past users and never users may require different message strategies.

INTRODUCTION Access to tobacco plays a strong role in smoking initiation among youth. This study aimed to quantify successful purchase of cigarettes and assess the factors associated with cigarette purchase access among students aged 11--17 years in The Gambia. METHODS We used the 2017 Global Youth Tobacco Survey (GYTS) of 12585 students, aged 11--17 years from The Gambia. The analysis was restricted to 2951 students aged 11--17 years who bought and/or attempted to buy cigarettes within the past 30 days regardless of smoking status. Our outcome was purchasing access, defined as successfully purchasing cigarettes within the past 30 days. We report a weighted prevalence of successful purchase attempt. Multivariable logistic regression assessed the factors associated with successful purchase of cigarettes and was adjusted for non-response and the complex survey design. RESULTS Most students (59.4%, 95% CI: 55.4--63.3) who attempted to purchase cigarettes were successful, most of whom were boys (61.3%, 95% CI: 57.8--64.6). However, there was no significant difference in successful attempts to purchase cigarettes between boys (59.3%, 95% CI: 54.2--64.2) and girls (59.4%, 95% CI: 55.4-- 63.3). Older age (AOR=2.45; 95% CI: 1.25--4.78), higher school grade (AOR=1.53; 95% CI: 1.09--2.16) and current cigarettes smoking (AOR=1.41; 95% CI: 1.08--1.85) were significantly associated with successful attempt to purchase cigarettes. Sex, parents' smoking status and students' weekly pocket money were not associated with successful cigarettes purchase attempt. Among students who currently smoke cigarettes, 55.6% (95% CI: 47.7--63.2) bought them from a store, shop, street vendor, or canteen; 12.2% (95% CI: 8.3--17.5) obtained them from someone else, and 6.7% (95% CI: 4.4--10.0) used other means the last time they smoked. CONCLUSIONS Students in The Gambia can purchase cigarettes without much hinderance despite the restrictions. Our research findings can guide the implementation of policies, programs, and public health strategies including more efforts toward implementing tobacco control laws and regulations that protect children from exposure and use of all forms of tobacco products. [ABSTRACT FROM AUTHOR]

E-cigarettes (electronic cigarettes) have been the most used tobacco product among US youth since 2014, reaching a plateau during the COVID-19 pandemic. Youth e-cigarette use is associated with negative health consequences such as impaired cognitive functioning. For many, the COVID-19 pandemic altered social interactions, harm perceptions, and product availability. This changed the frequency and locations in which youth use e-cigarettes. To better understand youth e-cigarette use, we need more information on factors that can alter e-cigarette use, specifically, how the pandemic changed e-cigarette use among youth. In 2020-2021, we conducted online, individual interviews with 19 youth (aged 13-17) e-cigarette users living in the US to explore how COVID-19 impacted their e-cigarette use. Youth described a progression of e-cigarette use from initial experimentation, regular social use, and ultimately to nicotine addiction demonstrated by individual use in isolation. Many youth initiated e-cigarette use due to influences by friends or family members. Youth discussed progression to social use, with social interactions as an important reason for use and an avenue for expanding one's knowledge of e-cigarettes. After a period of time, youth began to recognize that the social interactions mattered less, suggesting to them that they had become addicted. This realization became more apparent during COVID-19, which changed how youth used e-cigarettes, especially around where use was occurring, health concerns, and use behavior and frequency. In our interviews, youth trajectory began with an initiation with family and friends, progressed to social use, and eventually developed to addiction, at which point social use was no longer the primary motivation for e-cigarette use. Understanding the trajectory of e-cigarette use will allow for effective interventions that reduce harm to youth from e-cigarette use. [ABSTRACT FROM AUTHOR]

This article examines constructs, propositions, and assumptions of the extended parallel process model (EPPM). Review of the EPPM literature reveals that its theoretical concepts are thoroughly developed, but the theory lacks consistency in operational definitions of some of its constructs. Out of the 12 propositions of the EPPM, a few have not been tested explicitly and not a single one received unequivocal empirical support. This article proposes alternative operationalization for some of the constructs and examines some assumptions of this theory, such as additive relationship between the constructs, the role of time and issue of thresholds, and disregard for the existing state of the audience. Finally, the role of the EPPM as a potential foundation for a general theory of negative emotional appeals is addressed. (Contains 1 figure and 3 tables.)

Background To better understand the various influences of COVID-19 on tobacco use, we examined three different tobacco user groups using qualitative methods. Methods Ten online focus groups with 61 adults from the Atlanta, GA area were held in October–November 2020: four with exclusive smokers (n = 16), three with Electronic Nicotine Delivery System (ENDS) users (dual and exclusive, n = 22), and three with transitioning (recently quit or currently quitting) smokers and/or ENDS users (n = 23). Results Exclusive smokers reported smoking more frequently, driven by COVID-19-related stress, time at home, and boredom. They were not motivated to quit during the pandemic, and some considered smoking to be protective against COVID-19. ENDS users reported vaping less, with dual users often increasing their smoking; many were concerned about health effects of smoking and ENDS use during the pandemic. Transitioning smokers/ENDS users worried about their health and wanted to quit, but many found the stress of COVID-19 unbearable without tobacco use. Conclusions There were some similarities among the groups, but also pronounced differences. Educational campaigns should capitalize on the teachable moment of COVID-19 to increase perceived risk of smoking. Smokers need access to more adaptive ways to deal with stress (such as mindfulness training) in lieu of smoking and systems-level approaches should address structural determinants of health that cause high levels of stress. The proposed policy to lower nicotine in combusted tobacco products might help smokers choose other means of coping instead of cigarettes by reducing the stress-relieving properties of smoking particularly salient during the pandemic. Implications Smokers believe that cigarettes help them deal with the stresses and challenges of the COVID-19 pandemic. This needs to be counteracted by educational campaigns to increase perceived harm of smoking, alternative stress-relief strategies, and mandated changes to the combusted tobacco products to make them less appealing. [ABSTRACT FROM AUTHOR]

Thus, despite policy prohibiting free tobacco product samples, findings highlight how the cigar industry circumvents these marketing restrictions through cigar festivals and similar events. Although prohibitions on tobacco company sponsorship of events exist, it is clear that premium cigar manufacturers will continue to sponsor and promote their products at cigar festivals and events in the absence of product-specific enforcement under the TCA. For instance, how often does cigar festival marketing on social media circumvent social media tobacco marketing restrictions given that it is marketing an event and not a commercial tobacco product?. [Extracted from the article]

Introduction: Several countries are considering a reduced nicotine policy that would make cigarettes minimally or nonaddictive. This qualitative study documents reactions to the policy that should be addressed by future communication efforts.Methods: In 2020, we recruited participants in Atlanta, GA and San Francisco, CA (27 people who exclusively smoke, 25 who dual use cigarettes and e-cigarettes, 32 who formerly smoked, and 31 young adults who do not smoke). We held 16 focus groups: 2 focus groups for each smoking status in each city. Participants viewed messages about very low nicotine content cigarettes (VLNCs) and were asked about their reactions to each message and their overall response to the reduced nicotine policy.Results: While responses to the policy were predominantly positive, focus group discussion also revealed concerns, questions, and misunderstandings (referred to here collectively as "perceptions") that may need to be addressed if a reduced nicotine policy is enacted. Participants expressed perceptions related to the policy intent, including that the FDA has ulterior motives, adoption/ implementation, including that nicotine would have to be replaced with other chemicals if removed or that the policy would be unfeasible to implement, and effectiveness, including concern that VLNCs would still be addictive or the policy would backfire.Conclusions: Addressing perceptions about reduced nicotine policy intent, adoption/implementation, and effectiveness could be key in creating public support and political motivation to move forward with such a policy. Countries contemplating adopting such a policy should consider pairing it with communications that address these perceptions.Implications: This study is one of very few to use qualitative methods to explore potentially problematic perceptions about nicotine reduction policy among US adults. Results illuminated new policy-specific concerns, questions, and misunderstandings about the reduced nicotine policy intent, adoption/implementation, and effectiveness. Identifying, studying, and addressing relevant perceptions may play a key role in generating support in countries contemplating such a policy. [ABSTRACT FROM AUTHOR]