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In June 2020, Massachusetts implemented a first in the nation statewide law that restricts sales of menthol and other flavored tobacco. Since implementation, sales data indicate high retailer compliance. Drastic decreases were seen in sales of all flavored tobacco. Most neighboring states did not see increases in overall tobacco sales, although New Hampshire saw an initial increase in menthol sales, which was not sustained. We found that menthol restrictions are effective and that federal-level legislation is important, as some cross-border sales highlight. (Am J Public Health. 2022;112(8):1147–1150. https://doi.org/10.2105/AJPH.2022.306879 )

The impact of tobacco cigarette (TCIG) smoking and electronic cigarette (ECIG) vaping on the risk of development of severe COVID-19 is controversial. The present study investigated levels of proteins important for SARS-CoV-2 pathogenesis present in plasma because of ectodomain shedding in smokers, ECIG vapers, and non-smokers (NSs). Protein levels of soluble angiotensin-converting enzyme 2 (ACE2), angiotensin (Ang) II (the ligand of ACE2), Ang 1-7 (the main peptide generated from Ang II by ACE2 activity), furin (a protease that increases the affinity of the SARS-CoV-2 spike protein for ACE2), and products of ADAM17 shedding activity that predict morbidity in COVID-19 (IL-6/IL-6R alpha (IL-6/IL-6Rα) complex, soluble CD163 (sCD163), L-selectin) were determined in plasma from 45 NSs, 30 ECIG vapers, and 29 TCIG smokers using ELISA. Baseline characteristics of study participants did not differ among groups. TCIG smokers had increased sCD163, L-selectin compared to NSs and ECIG vapers (p 0.1 for all comparisons). Further studies are needed to determine if increased furin activity and ADAM17 shedding activity that is associated with increased plasma levels of sCD163 and L-selectin in healthy young TCIG smokers may contribute to the future development of severe COVID-19 and cardiovascular complications of post-acute COVID-19 syndrome.

Despite laws prohibiting sale of e-cigarettes to individuals aged less than 21 years, many underage young adults purchase e-cigarettes from retail stores, which may increase likelihood of continued use due to a greater access to vaping products and exposure to point-of-sale marketing.Data are from a prospective cohort of young adults aged 18-20 years in Los Angeles who had ever used e-cigarettes at baseline (N = 1,029). We evaluated the association of underage e-cigarette purchasing behavior (owned and purchased vs. owned but never purchased vs. never owned an e-cigarette) with subsequent vaping frequency, intensity, and dependence symptoms one year later, adjusting for vaping behaviors prior to baseline; additional models evaluated whether associations differed by purchase location or product type.At baseline, 332 (32%) had purchased e-cigarettes while underage, 227 (22%) owned but never purchased e-cigarettes themselves, and 470 (46%) never owned an e-cigarette. Compared to never owning e-cigarettes, those who had purchased their own e-cigarettes vaped more days in the past month (rate ratio [RR] = 2.97; 95% confidence interval [CI]: 2.15-4.09), had more vaping episodes per day (RR: 2.58; 95% CI: 2.12-3.14), vaped more puffs per vaping episode (RR: 1.90; 95% CI: 1.61-2.23), and had greater odds of dependence (odds ratio: 3.68; 95% CI: 2.51-5.40); elevated estimates were also observed for those who owned but never purchased e-cigarettes (vs. never owned). Vaping dependence was greatest among participants who purchased JUULs or other pod-mods.Participants who purchased e-cigarettes underage subsequently vaped more intensely and had greater vaping dependence. Regulations that reduce underage retail access to e-cigarettes may help prevent vaping progression among those most at risk of dependence.

This manuscript is part of the project Joint Action 761297/JATC and 101035968/JA-01-2020/JATC2, which has received funding from the European Union’s Health Program. Yes

Policy Points The commercial determinants of health (CDoH) concept, which currently focuses on markets that harm health, should be expanded to refer to the interface between commerce and health, which can sometimes have positive public health consequences. The regulatory stances framework helps us classify public health preferences for regulating specific markets related to CDoH, based on the intended effects of regulations on market size. The regulatory stances a jurisdiction can adopt can be classified as ranging from prohibitionist through contractionist, permissive, and expansionist, to universalist. The regulatory stances framework increases the usefulness of the CDoH concept by expanding the conversation beyond negative determinants of health and providing a fuller view of the tools at the disposal of society to alter markets and improve health.The effects of commerce on the public health are omnipresent. The commercial determinants of health (CDoH) represent a burgeoning area of scholarly debate and activist policymaking to redress markets that adversely affect public health. The CDoH debate is a logical extension of the tobacco control movement, but, to its detriment, the CDoH conversation remains primarily focused policies and proposals that are analogous to historical tobacco control strategies.This paper argues that for the CDoH to develop further and broaden its appeal, it should expand to cover markets with conditional and positive impacts on health. To explain and order this conversation, a comparative framework for regulatory policy is introduced: the regulatory stances. The regulatory stances classify a regulatory policy based on the intended effect of policy on the size of a market in the future relative to the present.Some markets that interface between commerce and health do not inherently harm health. Regulatory policy toward these markets should be different in intent than regulatory policy for markets with negative health effects.By using the regulatory stances framework to encompass markets that have positive or conditional effects on health as well as those that have adverse health effects, the CDoH conversation can shift away from the exclusive focus on strategies to shrink markets with adverse health impacts to consider a wider array of policy options.

Most adults return to smoking after enforced tobacco abstinence when incarcerated in US prisons. Little is known about the specific relapse triggers on reentry. This study examines situational, affective, and motivational antecedents of return to smoking immediately after release from a tobacco-free prison.Assessments were administered before release and 1 and 7 days after release to 190 incarcerated adults who were smokers before incarceration. Those reporting smoking within 7 days after release were asked about circumstances surrounding their first cigarette.Two-thirds reported smoking in the 7 days after release (76% of those in the first day) with the first cigarette smoked 21 hours after release on average. Smoking occurred more quickly for women than men and for those who planned to smoke after release ( P values from 0.05 to 0.001). Forty-one percent of participants smoked while waiting for a ride or on the way home, 68% were given their first cigarette, 28% reported first smoking when reuniting with others, 42% first smoked with smokers, and 26% first smoked as celebration. The moods most reported before smoking were happy (60%) or excited (41.5%). Factors reported that could have prevented smoking were avoiding other smokers (27%), avoiding stress (16%), not drinking/using drugs (12%), and not having access to cigarettes (11%).High rates of return to smoking occurred rapidly when around other smokers, using other substances, and in a positive mood. Interventions that focus specifically on these factors and can be immediately accessed upon release are required to help sustain people's desired abstinence.

ImportanceExposure to tobacco-related content on social media may foster positive attitudes toward tobacco products and brands, and influence the likelihood of initiating or continuing use of tobacco, especially among adolescents and young adults.ObjectiveTo perform the first systematic review and meta-analysis, to our knowledge, on studies that examined the association between exposure to tobacco content on social media and lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users.Data sourcesTobacco, social media, and marketing search terms were entered into online databases, including MEDLINE, ISI Web of Science, Scopus, and PsychINFO. Study characteristics, including research design and methods, sampling strategy, and demographics, were assessed for each study.Study selectionStudies reporting odds ratios (ORs) for self-reported exposure to, or experimentally manipulated, tobacco content on social media and lifetime tobacco use, past 30-day tobacco, and susceptibility to use tobacco among never users. The systematic search produced 897 independent articles, of which 29 studies met inclusion criteria.Data extraction and synthesisA 3-level random-effects meta-analysis was used to estimate ORs, 95% CIs, and heterogeneity (I2) for each tobacco use outcome. Study quality and publication bias were assessed.Main outcomes and measuresLifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Tobacco use included e-cigarettes, cigarettes, and other (cigar, hookah, smokeless tobacco).ResultsThe total sample size across the 24 included datasets was 139 624, including 100 666 adolescents (72%), 20 710 young adults (15%), and 18 248 adults (13%). Participants who were exposed to tobacco content on social media, compared with those who were not exposed, had greater odds of reporting lifetime tobacco use (OR, 2.18; 95% CI, 1.54-3.08; I2 = 94%), past 30-day tobacco use (OR, 2.19; 95% CI, 1.79-2.67; I2 = 84%), and susceptibility to use tobacco among never users (OR, 2.08; 95% CI, 1.65-2.63; I2 = 73%). Subgroup analyses showed similar associations for tobacco promotions, active engagement, passive engagement, lifetime exposure to tobacco content, exposure to tobacco content on more than 2 platforms, and exposure to tobacco content among adolescents and young adults.Conclusions and relevanceFindings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators. Such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors.

Some adolescents report using e-cigarettes (EC) for weight-related reasons, but longitudinal studies are lacking. This study examined associations between tobacco weight control beliefs and body mass index (BMI) with EC use patterns over one year.Data from Waves 1 and 2 (September 2013 to October 2015) of the Population Assessment of Tobacco and Health (PATH) study were used. Questions about tobacco weight control beliefs, EC use patterns (never, ever, never to current, ever to current, current to current), cigarette and other tobacco product use, demographics, and BMI were examined among adolescent respondents across Wave 1 and Wave 2.Most adolescents were never EC users (85.8%). Prevalence of EC use patterns was low across categories of use (0.6%-5.3%). Higher BMI was associated with transition from ever but not current use at Wave 1 to current use at Wave 2. Greater baseline tobacco weight control beliefs and increases in tobacco weight control beliefs were associated with most EC use patterns compared to never use.Greater tobacco weight control beliefs were risk factors for e-cigarette initiation and maintenance among a nationally representative sample of adolescents. BMI was minimally associated with e-cigarette use patterns. Additional studies are needed to replicate and further examine these preliminary prospective associations between weight control beliefs and EC use.

While tobacco products (such as combustible cigarettes and nicotine vaping products) and cannabis use rates remain high in the general United States (U.S.) population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at high risk of high rates of cannabis and tobacco use. Co-use of tobacco and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the U.S. However, little is understood about the prevalence rates of tobacco and cannabis co-use among U.S. veterans and its associations with mental health symptomology. The current study conducted a preliminary analysis of co-use patterns of tobacco and cannabis and associated mental health outcomes among a sample of Iraq/Afghanistan (i.e. OEF/OIF) veterans (N= 1,230). Results indicated high rates of lifetime and past 30-day use of both substances. Past 30-day co-users endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Results suggest that the addition of cannabis use in conjunction with tobacco use may be associated with greater mental health symptoms among veterans. Findings indicate veteran tobacco and cannabis co-users may benefit from mental health care to help mitigate poor mental health symptoms.

The present study investigated alcohol consumption and cigarettes per day in relation to smoking outcome expectancies among Spanish-speaking Latinx daily smokers (n = 371). There was a significant interaction between alcohol consumption and number of cigarettes per day on positive smoking expectancies. Specifically, alcohol consumption has a stronger association with positive expectancies for smoking at lower rates of cigarettes per day. No such interaction was evident for negative consequence smoking expectancies. The current study highlights the potential importance of alcohol consumption and smoking rate for better understanding smoking outcome expectancies among Latinx smokers.

Youth e-cigarette use is associated with the initiation of combustible cigarette smoking, but prior studies have rarely accounted for time-varying measures of e-cigarette exposure or time-dependent confounding of e-cigarette use and smoking initiation.Using five waves of the Population Assessment of Tobacco and Health (2013-2019), we estimated marginal structural models with inverse probability of treatment and censoring weights to examine the association between time-varying e-cigarette initiation and subsequent cigarette smoking initiation among e-cigarette- and cigarette-naïve youth (12-17 years) at baseline. Time-dependent confounders used as predictors in inverse probability weights included tobacco-related attitudes or beliefs, mental health symptoms, substance use, and tobacco-marketing exposure.Among 9,584 youth at baseline, those who initiated e-cigarettes were 2.4 times as likely to subsequently initiate cigarette smoking as youth who did not initiate e-cigarettes (risk ratio = 2.4, 95% confidence interval [CI] = 2.1, 2.7), after accounting for time-dependent confounding and selection bias. Among youth who initiated e-cigarettes, more frequent vaping was associated with greater risk of smoking initiation (risk ratio ≥3 days/month = 1.8, 95% CI = 1.4, 2.2; 1-2 days/month = 1.2; 95% CI = 0.93, 1.6 vs. 0 days/month). Weighted marginal structural model estimates were moderately attenuated compared with unweighted estimates adjusted for baseline-only confounders. At the US population level, we estimated over half a million youth initiated cigarette smoking because of prior e-cigarette use over follow-up.The association between youth vaping and combustible cigarette smoking persisted after accounting for time-dependent confounding. We estimate that e-cigarette use accounts for a considerable share of cigarette initiation among US youth. See video abstract at, http://links.lww.com/EDE/B937.

IntroductionLocal e-cigarette sales restrictions (ESRs) may impact e-cigarette use. This study examined the associations between living in localities with various ESR policies and changes in e-cigarette use among young adults in Los Angeles (LA) County, California, USA.MethodsData were from a cohort of LA County young adults (18–21 years; n=2100) who completed two waves of surveys (Fall 2018–Summer 2019 and Summer–Fall 2020). Local flavoured (n=9) and comprehensive (n=2) ESRs in LA County implemented between June 2019 and May 2020 were identified, coded and merged with the baseline data. Multivariable logistic regressions were used to examine the associations between living in ESR localities and e-cigarette use at follow-up, controlling for covariates and stratified by cigarette smoking at baseline.ResultsOverall, 20.9% and 14.3% of participants lived in localities with flavoured and comprehensive ESRs, respectively. Participants who were non-Hispanic, had higher socioeconomic statuses and were currently using e-cigarettes were generally more likely to live in ESR localities than their counterparts. The associations between living in ESR localities and e-cigarette use at follow-up were not found among baseline non-e-cigarette users regardless of their cigarette smoking status; a positive relationship was found among baseline e-cigarette users who also smoked cigarettes but not among non-smokers.DiscussionParticipants who lived in localities with various ESR policies were different in their baseline e-cigarette use and socioeconomic backgrounds. Future research examining the potential impact of ESRs on e-cigarette use change should consider the localities’ overall sociodemographic and tobacco-using characteristics and individuals’ cigarette smoking histories.

IntroductionThis study aims to investigate electronic cigarette (e-cigarette) use behaviour changes after the implementation of the US Food and Drug Administration (FDA) restriction on the sale of all unauthorised flavoured cartridge-based e-cigarettes other than tobacco and menthol flavour on 6 February 2020, as well as factors associated with these changes.MethodsThrough Amazon’s Mechanical Turk service, 3533 current adult flavoured e-cigarette users (who were not exclusive tobacco-flavoured or menthol-flavoured e-cigarette users) were recruited for an online survey from 8 July to 29 July 2021. Multiple logistic regression models were used to identify significant factors associated with quitting e-cigarette use, switching to other flavoured electronic nicotine delivery system (ENDS) products, switching to combustible tobacco products, switching to menthol-flavoured e-cigarettes and switching to tobacco-flavoured e-cigarettes.ResultsResulting from the FDA flavour enforcement policy, the top four e-cigarette use behaviour changes were: (1) switching to other flavoured ENDS products such as the tank system or disposable e-cigarettes (29.24%), (2) switching to menthol-flavoured pod systems (18.09%), (3) switching to combustible tobacco products (14.12%) and (4) switching to tobacco-flavoured pod systems (12.03%). There were 4.9% participants who indicated that they quit e-cigarette use. Overall, multiple factors, especially past 30-day use of certain flavours, were associated with different behaviour changes.ConclusionsThe implementation of the FDA flavour enforcement policy on cartridge-based e-cigarette was associated with significant e-cigarette behaviour changes, with multiple factors being associated with these changes. These results provide important information for future regulations of flavoured e-cigarette products.

BackgroundRegulations have been proposed to limit e-cigarette flavours, but limited research has examined potential impacts of such policies. This study examined adult e-cigarette users’ reactions to a hypothetical e-cigarette flavour ban.MethodsIn 2019, a convenience sample of current e-cigarette users in the USA (n=81, 53.1% women, mean age=37.6, 59.3% dual users of cigarettes) completed an online concept mapping study. Participants provided statements describing anticipated reactions to a hypothetical policy in which only tobacco, menthol or unflavoured e-cigarettes were available for purchase. Seventy-one unique statements were generated. Participants sorted statements into thematic groups and rated statements on how likely they would be to have each reaction. Multidimensional scaling was used to identify thematic clusters of statements.ResultsTwelve clusters were identified: negative reaction, take action against flavour limitation, youth prevention effectiveness perception, tolerance, acceptance, willingness to try new flavours, maintain vaping, reduce vaping, new flavours as vaping cessation transition, alternative sources for banned flavours, do-it-yourself mixing behaviours and alternative tobacco products. The highest rated cluster (negative reaction) described being angry or upset that flavours were banned, while the lowest rated clusters related to quitting/reducing e-cigarette use or switching to other tobacco products. Non-tobacco or non-menthol/mint flavoured e-cigarette users had higher ratings for clusters describing negative sentiment for the hypothetical policy.ConclusionsSome e-cigarette users may dislike an e-cigarette flavour ban; however, some e-cigarette users would likely be willing to use tobacco, menthol or unflavoured e-cigarette liquids with lower likelihood of quitting vaping or switching to other tobacco products.

Younger age of initiating cigar smoking is associated with greater nicotine dependence and current use. Age of initiating cigarette smoking has increased over time, whereas trends in age of initiating cigar smoking remain understudied. These trends were examined by race/ethnicity, by education, and at their intersection.The analytic sample included U.S. Hispanic, Black, and White cigar-ever-smokers aged 24‒25 years (n=29,715) from the 2002‒2019 National Survey on Drug Use and Health. Participants reported their age, race/ethnicity, sex, education (≤high school; some college; ≥bachelor's degree), age of initiating cannabis use, and cigar smoking. Weighted multivariable linear regressions adjusted for sex and age of cannabis use initiation were used to examine trends in age of initiating cigar smoking by race/ethnicity, education, and education Χ year interactions within racial/ethnic groups. Age of initiating cigar smoking comparisons across race/ethnicity and education were examined using the most recent 2019 data.During 2002‒2019, across education, White cigar-ever-smokers started smoking cigars at an older age, whereas it remained unchanged among Hispanic cigar-ever-smokers. Among Black cigar-ever-smokers, age of initiating cigar smoking did not change among those with ≤high school and some college, and was older among those with ≥bachelor's degree. In 2019, age of initiating cigar smoking did not vary by educational level among Hispanic and White cigar-ever-smokers. Black cigar-ever-smokers with ≥bachelor's degree initiated cigar smoking at older ages than their White counterparts.Black individuals experienced widening education-related disparities, and Hispanic individuals had no progress in delaying age of initiating cigar smoking. Regulatory action banning cigar flavors may impact these trends.

Tobacco-free oral nicotine products are an emerging class of noncombustible nicotine products. Oral nicotine product sales have increased since 2016, although little research has investigated consumer awareness, use, or correlates of oral nicotine product use. The purpose of this analysis was to assess the prevalence and correlates of oral nicotine product awareness and use.This paper is a cross-sectional analysis of 2,507 U.S. participants from Wave 3 (February-June 2020) of the International Tobacco Control Four Country Smoking and Vaping Survey, a population-based survey of current and former cigarette smokers and nicotine vaping product users in the U.S. Oral nicotine product awareness and use prevalence were compared with those of heated tobacco products. Analyses conducted in late 2021 assessed the correlates of oral nicotine product awareness and use such as demographic characteristics, tobacco use (cigarettes, nicotine vaping products, smokeless tobacco), and tobacco quit attempts.Almost 1 in 5 respondents claimed to have heard of oral nicotine products, 3.0% reported ever use, and 0.9% were current users, all of which were lower than for heated tobacco products. Ever use of oral nicotine products was more common among younger adults (e.g., aged 18-24 years), males, and current users of smokeless tobacco. Oral nicotine product prevalence was higher among those who reported having made attempts to stop smoking or vaping.Oral nicotine product use was low among current and former smokers and nicotine vaping product users. Oral nicotine product users were demographically similar to use among individuals who smoke/vape and also use smokeless tobacco. Future studies are needed to understand emerging oral nicotine products, particularly whether they are being used as product supplements (dual use), replacements (switching), or cessation aids (quitting).

BACKGROUND: Many smokers report attempting to quit each year, yet most relapse, in part due to exposure to smoking-related cues. It is hypothesized that extinction of the cue-drug association could be facilitated through random nicotine delivery (RND), thus making it easier for smokers to quit. The current study aimed to evaluate the effects of RND on smoking cessation-related outcomes including cigarettes per day (CPD) and exhaled carbon monoxide (CO). METHODS: Participants were current smokers (>9 CPD) interested in quitting. Novel trans-mucosal, orally dissolving nicotine films, developed by Bionex Pharmaceuticals, were used in the study. The pharmacokinetic profile of these films was assessed in single (Experiment 1) and multiple-dose (Experiment 2) administrations prior to the smoking cessation study (Experiment 3). In Experiment 3, participants were randomized 1:1:1 to recieve 4 nicotine films per day of either: placebo delivery (0 mg), steady-state delivery (2 mg), or random nicotine delivery (RND) (0 mg or 4 mg). After two weeks, participants were advised to quit (target quit date, TQD) and were followed up 4 weeks later to collect CPD and CO and to measure dependence (Penn State Cigarette Dependence Index; PSCDI) and craving (Questionnaire of Smoking Urges; QSU-Brief). Means and frequencies were used to describe the data and repeated measures ANOVA was used to determine differences between groups. RESULTS: The pharmacokinetic studies (Experiment 1 and 2) demonstrated that the films designed for this study delivered nicotine as expected, with the 4 mg film delivering a nicotine boost of approximately 12.4 ng/mL across both the single and the multiple dose administration studies. The films reduced craving for a cigarette and were well-tolerated, overall, and caused no changes in blood pressure or heart rate. Using these films in the cessation study (Experiment 3) (n = 45), there was a significant overall reduction in cigarettes smoked per day (CPD) and in exhaled CO, with no significant differences across groups (placebo, steady-state, RND). In addition, there were no group differences in dependence or craving. Adverse events included heartburn, hiccups, nausea, and to a lesser extent, vomiting and anxiety and there were no differences across groups. CONCLUSION: Overall, this pilot study found that RND via orally dissolving films was feasible and well tolerated by participants. However, RND participants did not experience a greater reduction in self-reported CPD and exhaled CO, compared with participants in the steady-state and placebo delivery groups. Future studies to evaluate optimal RND parameters with larger sample sizes are needed to fully understand the effect of RND on smoking cessation-related outcomes.

This study aims to determine the impact of cigarette display settings on cigarette sales in the stores in Semarang City.br /br /Methods: The research was conducted in August-October 2020 using a quasi-experimental study approach. It was conducted by setting the cigarette display in 3 methods where (1) the cigarette display was opened for 35 days in 5 stores, (2) the cigarettes display was covered with cloth for a pre and post-intervention period of 15 and 30 days, respectively, at five stores and (3) the cigarette display was hidden for a pre and post-intervention period of 15 and 30 days, respectively, at three stores. Cigarette sales were recorded based on how many packs or sticks were sold per day, and a visit to the store was made every two or three days without prior notification to the store owner to ensure the cigarette display was appropriate and recorded data. The sales data was descriptively evaluated using a paired t-test with a 95% confidence level.br /br /Result: The results showed that one hidden cigarette display store (R3-1) experienced a significant decrease in sales, three hidden/covered display stores had a less significant decrease in cigarette sales and four hidden/covered display stores didn't have any decline in cigarette sales while the average decline in cigarette consumption in stores was -1.4packs/day. From the analysis of sales per day and the paired pre-post intervention test, the store with a covered display showed no difference in the pre-post intervention sales, while the stores with hidden displays showed differences.br /br /Conclusion: Thus, covered displays did not affect stores and cigarette sales, while stores with hidden displays showed differences in sales.

African Americans (AA) have historically been targeted by the tobacco industry and have the highest rates of current cigar use among racial/ethnic groups in the U.S. Yet, there is limited evidence on other factors influencing cigar use. Amongst a sample of 78 AA current cigar (any type) smokers, log-linear regression models examined correlates of cigar demand obtained from a validated behavioral economic purchase task. Mean intensity, or cigar demand when free, was 6.68 cigars (standard deviation [SD]: 8.17), while mean breakpoint, or the highest price a participant was willing to pay, was $4.62 (SD: 3.88). Mean maximum daily expenditure, Omax was $15.20 (SD: 25.73) and Pmax, the price at Omax was $5.25 (SD: 3.95). Participants aged 21 to 30 years compared to those aged 18 to 20 years, those with higher levels of dependence, and females compared to males, had a significantly higher intensity. Participants with cannabis use above the sample median in the last 30 days (4 + days) had significantly higher intensity and Omax than those below the median. Further, participants with a high school education or more had a significantly lower intensity, breakpoint, and Omax than those with less than high school education. Individuals with income below the federal poverty line (FPL) also had a significantly lower breakpoint and Omax than those above. Finally, tobacco harm perceptions were inversely associated with Pmax. Stricter policies on cigar products, such as higher taxes and product-specific harm messaging, may have an immediate and sustained impact on health disparities related to cigar use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Combustible cigarettes produce many toxic substances that have been linked to diseases, such as lung cancer and chronic obstructive pulmonary disease. For those smokers unable or unwilling to quit, electronic cigarettes (e-cigarettes) could be used as an alternative to cigarettes. However, the effects and mechanisms of e-cigarette aerosol (ECA) on respiratory function have not been fully elucidated, and in vivo studies of its safety are limited compared to cigarette smoke (CS). In this article, we chose nicotine levels as dosing references and C57BL/6 mice for a 10-week subchronic inhalation toxicity study. A comprehensive set of toxicological endpoints was used to study the effect of exposure. Both CS (6 mg/kg) and ECA (6 or 12 mg/kg) inhalation had decreased the animal's lung function and increased levels of inflammation markers, along with pathological changes in the airways and lungs, with ECA displaying a relatively small effect at the same dose. Proteomic analysis of lung tissue showed greater overall protein changes by CS than that of ECA, with more severe inflammatory network perturbations. Compared with ECA, KEGG analysis of CS revealed upregulation of more inflammatory and virus-related pathways. Protein-protein interactions (PPI) showed that both ECA and CS significantly changed ribosome and complement system-related proteins in mouse lung tissue. The results support that e-cigarette aerosol is less harmful to the respiratory system than cigarette smoke at the same dose using this animal model, thus providing additional evidence for the relative safety of e-cigarettes.

Inexpensive drinks and price promotions increase alcohol consumption and have been observed at on-premise drinking establishments near large colleges. Some bars may sell tobacco products and allow indoor tobacco use to encourage patrons to stay and drink more. This study examined drink prices/specials and associated practices of on-premise drinking establishments including tobacco sales and policies regarding tobacco use.In 2018, telephone calls about prices/practices were made to 403 randomly selected bars/nightclubs within 2 miles of large residential universities in each U.S. state. The Alcohol Policy Information System provided data on state-level alcohol laws. Multivariable linear and logistic regression models examined associations between alcohol prices/specials, state laws, and establishment practices.The average price for the least expensive draft beer and a vodka shot at each location were $3.62 (SD = $1.15) and $4.77 (SD = $1.16), respectively. Most establishments (65%) had happy hour specials, 6% had 2-for-1 specials, 91% sold food, 9% sold cigarettes, 8% allowed smoking indoors, and 18% permitted electronic cigarette (e-cigarette) use indoors. Allowing e-cigarette use indoors (b = -0.54) and selling cigarettes (b = -0.79) were associated with lower vodka prices; allowing cigarette smoking indoors (b = -0.46) was associated with lower beer prices. Lower beer prices (OR = 1.38), selling food (OR = 2.97), and no state law banning happy hour specials altogether (OR = 4.24) or with full-day price reduction exemptions (OR = 12.74) were associated with higher odds of having happy hour specials. Allowing e-cigarette use indoors was associated with having 2-for-1 specials (OR = 6.38).In bars near large public universities, beers and shots were often available for less than $5 and drink specials were prevalent. Further, some establishments allowed tobacco use indoors and/or sold cigarettes. Laws that increase alcohol taxes, set minimum drink prices, and ban the sale and indoor use of tobacco products at on-premise drinking locations are important harm reduction tools.

Objective: Following AMSTAR 2 and PRISMA guidelines, in this synthesis of evidence we sought to identify and characterize any associations between e-cigarette use among cigarette smokers and cigarette smoking quit attempts. Methods: We queried 3 databases from January 1, 2007 to January 5, 2021. Search results were screened using the PICOS review method. Included studies examined e-cigarette use and cigarette smoking quit attempts across e-cigarette use statuses. Risk of bias was assessed according to the Agency for Healthcare Research and Quality Evidence-Based Practice Center approach. Finally, 4 random-effects models compared e-cigarette users and non- e-cigarette-users in terms of past year and prospective (6 to 12 months) cigarette smoking quit attempts. Results: We qualitatively synthesized 17 adjusted studies for this review. Two meta-analyses showed past year quit attempts were significantly associated with current e-cigarette users and 2 prospective data analyses found no significant association. Conclusions: The results of the meta- analyses emphasize temporality in the association between e-cigarette use and cigarette smoking quit attempts. Numerous methodological limitations, including inadequate definitions of e-cigarette use and non-adjustment for confounding variables, limit the confidence in conclusions that can be drawn on the causal association between e-cigarette use and cigarettes smoking quit attempts.

Background: Menthol's effect on cigarette smoking behaviors is an intensely scrutinized US public health issue. This systematic review and meta-analysis examined the question: Does menthol cigarette use have a differential impact on smoking dependence compared with non-menthol cigarette use? Methods: We consulted 6 databases from inception to October 15, 2021. We included articles comparing menthol versus non-menthol cigarette smokers against predefined smoking dependence outcomes. Risk of bias was assessed using the AHRQ Evidence-Based Practice Center approach. We applied a random-effects model to pool adjusted odds ratios. Results: We synthesized 37 demographically adjusted studies. Meta-analytic results suggested non-menthol smokers were equally/more likely to report daily versus non-daily smoking; menthol use was associated with needing a cigarette within one hour; cigarettes per day was not associated with menthol use; menthol use was associated with a low (vs high) Heaviness of Smoking Index score; and results were either non-significant or associated menthol use with lower TTFC. Conclusions: Despite consistently good or fair quality adjusted studies across several measures, results were discordant depending on measures used and means of measurement. Overall, the evidence is insufficient to draw clear conclusions on a differential association between menthol (vs non-menthol) cigarette use and smoking dependence.

Developing a comprehensive understanding of tobacco product use among adolescents requires information about the use of conventional cigarettes; electronic cigarettes (e-cigarettes); other tobacco products such as cigars, little cigars, and cigarillos (CCLCs); and smokeless tobacco. In particular, the use of products other than cigarettes may have important implications for additional smoking-related behaviors and the health of students and adolescents.The National Youth Tobacco Surveys for 2017, 2018, and 2019 were aggregated to analyze the characteristics of middle school and high school students who had used tobacco products, such as CCLCs. Information collected included age, sex, race, and perceptions about harm and addiction related to tobacco products. Multiple logistic regression models were used to evaluate the associations between having used conventional/e-cigarettes and having used CCLCs, while adjusting for the perceived harm of conventional/e-cigarettes, sex, age, and other risk factors.These combined surveys included 50,172 responses; 6836 respondents (13.6%) had tried CCLCs. Male students used these products more frequently than female students. Students in older age groups (15, 16, 17, and 18 and older,) had used these products more frequently than younger students. The odds for students in this CCLCs subgroup trying conventional cigarettes decreased in those who thought that conventional cigarettes could cause "some harm" or "a lot of harm." The odds for having tried e-cigarettes in the CCLCs subgroup decreased in those who thought that e-cigarettes could cause harm and increased in those who thought that conventional cigarettes could cause "little harm" or "a lot of harm."More than 10% of middle school and high school students have used CCLCs. The majority of students in this subgroup also have used either conventional cigarettes or e-cigarettes. Understanding possible harm with cigarette use is significantly associated with the reduced use of conventional and e-cigarettes, and using CCLCs independently contributes to the increased risk of using conventional and e-cigarettes. The frequent use of several tobacco products makes surveys in this age group more complicated and indicates that educational efforts and public policies regarding tobacco need to include all tobacco products.

The aim of this study is to examine US youths' harm perceptions toward nondaily use of e-cigarettes, cigarettes, cigars, smokeless tobacco, and hookahs.The nationally representative, cross-sectional National Youth Tobacco Survey annually assessed the following: "How much do you think people harm themselves when they [use tobacco products] some days but not every day?" Weighted estimates for 2020 were generated overall (grades 6-12) and by select demographics. Multivariable regression examined linear and quadratic changes during 2016-2020 (excluding cigars).In 2020, the prevalence of middle and high school students reporting "no" or "little" harm (vs. "some" or "a lot") was 20.1% for e-cigarettes, 17.4% for hookahs, 14.6% for cigars, 13.5% for smokeless tobacco, and 11.0% for cigarettes. During 2016-2020, perceptions of "no" or "little" harm decreased for e-cigarettes, increased for cigarettes and smokeless tobacco, and exhibited nonlinear changes for hookahs.Most youth are aware of tobacco product harms, but opportunities exist to educate youth about the harms of nondaily tobacco product use.

Young adults’ perceptions and use of heated tobacco products (HTPs) are understudied. This mixed methods study analyzed (i) Fall 2020 survey data from 2470 US young adults (meanage = 24.67; 19.5% and 25.2% past-month cigarette and e-cigarette use; 4.1% ever HTP use) assessing HTP use intentions and perceptions (1 = not at all to 7 = extremely) and (ii) Spring 2021 interview data regarding IQOS (most widely available HTP) in a subset of 40 e-cigarette users. Among survey participants, HTPs versus cigarettes and e-cigarettes showed lower use intentions (mean = 1.27 vs. mean = 1.73, mean = 2.16) but were perceived as less addictive (mean = 5.11 vs. mean = 6.28, mean = 5.82) and harmful (mean = 5.37 vs. mean = 6.65, mean = 5.62). HTPs were perceived more socially acceptable than cigarettes but less than e-cigarettes (mean = 3.39 vs. mean = 3.13, mean = 4.37). Among interviewees, most reported limited HTP knowledge. A few perceived IQOS as a hybrid of traditional cigarettes and e-cigarettes. Most perceived IQOS as harmful but less harmful than cigarettes and were uncertain in relation to e-cigarettes. Over half reported minimal interest in trying IQOS; common reasons included IQOS containing tobacco, limited flavors and use complexity. The varied perceptions of IQOS versus cigarettes and e-cigarettes underscore the need for continued surveillance of perceptions, use and marketing of IQOS to inform regulatory oversight and potential interventions.

N´-Nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) – which always occur together and are present exclusively in tobacco products – are classified as “carcinogenic to humans” (Group 1) by the International Agency for Research on Cancer. While 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) serves as an excellent biomarker for NNK exposure, the currently available biomarker for NNN exposure is urinary “total NNN” (free NNN plus its N-glucuronide). Quantitation of urinary NNN requires extensive precautions to prevent artifactual formation of NNN resulting from nitrosation of nornicotine during analysis. NNN itself can also be formed endogenously by the same nitrosation reaction which may sometimes cause overestimation of exposure to preformed NNN. It is thus important to develop an alternative biomarker to specifically reflect NNN metabolic fate and facilitate relevant cancer etiology studies. In this study, we report the first detection of N´-nitrosonornicotine-1N-oxide (NNN-N-oxide) in human urine. Using a highly specific and sensitive MS(3) transition-based method, NNN-N-oxide was quantified with a mean level of 8.40 ± 6.04 fmol/mL in the urine of 10 out of 32 cigarette smokers. It occurred in a substantially higher level in the urine of 13 out of 14 smokeless tobacco users, amounting to a mean concentration of 85.2 ± 96.3 fmol/mL urine. No NNN-N-oxide was detected in any of the non-smoker urine samples analyzed (n = 20). The possible artifactual formation of NNN-N-oxide during sample preparation steps was excluded by experiments using added ammonium sulfamate. The low levels of NNN-N-oxide in the urine of tobacco users indicate that the pyridine N-oxidation pathway represents a minor detoxification pathway of NNN, which further supports the importance of the α-hydroxylation pathway of NNN metabolic activation in humans.

Assessing public support of health policies designed to reduce cancer risk is important for policy implementation. This study aimed to identify support for cancer prevention policies and factors associated with support. Data were obtained from the Health Information National Trends Survey. Support for three types of cancer prevention policies were evaluated: tobacco, alcohol, and junk food regulations. Linear and logistic regression analyses were employed to assess the relationship between support for the different types of policies and sociodemographic, lifestyle behaviors, and cancer beliefs. Certain policies, such as providing warning labels on cigarettes (69.9% support) and requiring specific health warnings on alcohol containers (65.1% support), were popular. Banning outdoor advertising of alcohol was not popular (34.4% support). There were individual differences associated with policy support. For example, respondents who were 75 years or older (B = 0.61, p.001) or female (B = 0.14, p.008) were more likely to support tobacco polices compared to their counterparts (i.e., younger or male). Respondents who identified as politically conservative (B = -0.20, p.004) or those who endorsed high cancer fatalistic beliefs (e.g., there's not much you can do to lower your chances of getting cancer, B = -0.07, p.012) were less likely to support alcohol policies compared to those who were liberal or had lower cancer fatalistic beliefs. Generally, support was high for most policy questions. However, support varied by different individual factors. The findings also highlight that there may be opportunities to increase understanding and awareness about cancer prevention policies, especially among some segments of the population.It is important to assess public support of cancer preventive health policies and to know which factors, such as individual characteristics (e.g., gender and political orientation) health behaviors, and cancer beliefs, are associated with support. In this study, we assessed support of cancer prevention policies and examined different factors possibly associated with support. We analyzed data from the Health Information National Trends Survey, a nationally representative dataset. Since there were multiple questions related to support of tobacco and alcohol policies, we combined each set of questions to create two combined scores, with higher scores indicating more support. We examined the policy related to junk food individually. We found certain policies, such as including warning labels on cigarettes, were popular, with over 60% support. However, there were group differences. For example, women and those aged 55 years or older were more supportive of policies, while politically conservative respondents were less supportive of policies. Beliefs about cancer were also associated with policy support. For example, those who believed “there’s not much you can do to lower your chances of getting cancer” were less supportive compared to those without that belief. These findings may help inform future policy research and public health campaigns.

Abstract Young adults are increasingly using non-cigarette products, such as hookahs, since they are perceived as healthier alternatives to cigarette smoking. However, hookah users are exposed to not only carcinogenic compounds but also microorganisms that may play an active role in the development of both infectious and chronic diseases among users. Nevertheless, existing hookah research in this area has focused only on microorganisms that may be transferred to users through the smoking apparatus and not on bacterial communities associated with hookah tobacco. To address this knowledge gap, we conducted time-series experiments on commercially available hookah brands (Al Fakher (flavors: two apple, mint, and watermelon) and Fumari (flavors: white gummy bear, ambrosia, and mint chocolate chill)) stored under three different temperature and relative humidity conditions over 14 days. To characterize bacterial communities, the total DNA was extracted on days 0, 5, 9, and 14, PCR-amplified for the V3V4 region of the bacterial 16S rRNA gene, sequenced on the Illumina HiSeq platform, and analyzed using R. Diversity (alpha and beta) analyses revealed that the microbiotas of Fumari and Al Fakher products differed significantly and that flavor had a significant effect on the hookah microbiota. Overall, Pseudomonas, Bacillus, Sphingomonas, and Methylobacterium were the predominant bacterial taxa across all products. Additionally, we observed compositional differences between hookah brands across the 14-day incubation. These data suggest that the bacterial communities of hookah tobacco are diverse and differ across brands and flavors, which may have critical implications regarding exposures to specific bacteria among hookah users. Key points • Commercial hookah products harbor diverse bacterial communities. • Brands and flavors impact the diversity of these communities. • Research on their viability and transmission to users’ respiratory tracts is needed. Graphical abstract

Introduction There is increasing recognition that non-daily cigarette smoking is common in early adulthood but less is known about its stability over time, or what influences transitions to heavier or nonsmoking. We examined the stability of non-daily smoking in a sample of young adults, and tested whether social and cognitive factors predicted transitions to other smoking patterns over time. Aims and Methods Participants were 579 young adults (18–24 years old at enrollment, 52% male) who were non-daily and never-daily cigarette smokers and California residents. Participants completed 13 waves of assessment over 3 years. We used descriptive statistics to evaluate the frequency of consistent abstinence, defined as no cigarette use at two consecutive waves and no cigarette use at any subsequent waves. Cox and logistic regression were used to test predictors of consistent abstinence. Results We found that 55% of participants smoked intermittently throughout the study, while 43% were consistently abstinent by the end of the study; few transitioned to daily smoking. Stopping smoking was associated with having fewer smoking friends, smoking less in social situations, having lower positive reinforcement expectancies for smoking, and having stronger intent to quit. Post hoc analyses indicated those who stopped smoking tended to report reductions in positive reinforcement expectancies and increased intent to quit in the 6 months before stopping. Conclusions Findings suggest a substantial minority of young adult non-daily smokers may stop on their own, but that the majority continue smoking and may require intervention. Interventions for this population should address social motives and reinforcement expectancies. Implications The majority of young adults who are non-daily cigarette smokers appear to maintain this habit over an extended period and may require intervention. Interventions that focus on reducing expectancies for positive effects of and social motives for cigarette use and on increasing intent to quit smoking may be most effective.

The current study examined e-cigarette users' risk information avoidance (i.e., RIA), which is a significant challenge to e-cigarette risk communication. Applying and extending previous RIA studies and the risk information seeking and processing (RISP) model, this study identified the predictors of e-cigarette users' RIA with a comprehensive model that incorporated new roles for scientific uncertainty and relevant channel beliefs. Responses collected from an online survey were analyzed (

It is unknown how U.S. adults' relative harm perceptions of E-cigarettes versus cigarettes and associated behaviors changed during the E-cigarette or vaping product use‒associated lung injury epidemic (late 2019) and COVID-19 pandemic (since early 2020).Data from cross-sectional nationally representative Health Information National Trends Survey collected in 2018 (n=3,360), 2019 (n=3,217), and 2020 (n=3,677) (analyzed in 2021) were used to estimate changes in relative harm perceptions of E-cigarettes versus cigarettes (less harmful, as harmful, more harmful, don't know as a measure of uncertainty). In addition, changes in exclusive cigarette smoking, exclusive E-cigarette use, and dual use were estimated for each relative harm perception level.Perceptions of E-cigarettes as more harmful than cigarettes doubled year on year, increasing most between 2019 and 2020 (2018: 6.8%, 2019: 12.8%, 2020: 28.3%), whereas uncertainty in relative harm declined (2018: 38.2%, 2019: 34.2%, 2020: 24.7%). Less harmful relative perceptions declined (2018:17.6%, 2019:15.3%, 2020:11.4%), whereas as harmful perceptions remained steady (2018: 37.4%, 2019: 37.7%, 2020: 35.6%). Exclusive cigarette smoking increased between 2019 and 2020 among those who perceived E-cigarettes as relatively more harmful (2018: 18.5%; 2019: 8.4%; 2020: 16.3%), exclusive E-cigarette use increased linearly among those who perceived them as relatively less harmful (7.9%, 15.3%, 26.7%), and dual use increased linearly in those who perceived them relatively as harmful (0.1%, 1.4%, 2.9%).Perceptions of E-cigarettes as more harmful than cigarettes increased sharply between 2019 and 2020. Increases in tobacco product use were potentially guided by product-specific relative harm perceptions because changes occurred primarily in individuals who perceived their preferred product as relatively less harmful, suggesting the need for accurate messaging of relative and absolute product risks.

Crowdsourcing platforms allow researchers to quickly recruit and collect behavioral economic measures in substance-using populations, such as cigarette smokers. Despite the broad utility and flexibility, data quality issues have been an object of concern. In two separate studies recruiting cigarette smokers, we sought to investigate the association between a practical quality control measure (accuracy on an instruction quiz), on internal consistency of number of cigarettes smoked per day and purchasing patterns of tobacco products in an experimental tobacco marketplace (ETM; Study 1), and in a cigarette purchase task (CPT; Study 2). Participants (N = 312 in Study 1; N = 119 in Study 2) were recruited from Amazon mechanical turk. Both studies included task instructions, a quiz, a purchase task, cigarette usage and dependence questions, and demographics. The results show that participants who answered all instruction items correctly: (a) reported the number of cigarettes per day more consistently (partial η² = 0.11, p.001, Study 1; partial η² = 0.09, p = .016, Study 2), (b) demonstrated increased model fit among the cigarette demand curves (partial η² = 0.23, p.001, Study 1; partial η² = 0.08, p = .002, Study 2), and purchased tobacco products in the ETM more consistently with their current usage. We conclude that instruction quizzes before purchase tasks may be useful for researchers evaluating demand data. Instruction quizzes with multiple items may allow researchers to choose the level of data quality appropriate for their studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Transcranial direct current stimulation (tDCS) has been demonstrated to modulate neural activity and related brain functions. In clinical studies, tDCS has been shown to reduce craving in various substance use disorders including cocaine, heroin and nicotine. Our previous report suggested that cathodal tDCS on the frontal-parietal-temporal (FPT) brain areas reduced cigarette consumption in moderate smokers. However, whether it is effective in smokers with history of drug use is unknown. This study investigated the effects of bilateral FPT areas cathodal tDCS on smokers with history of heroin use. 22 abstinent heroin users were recruited and randomly assigned to sham group and tDCS group. The sham group received 30 s tDCS treatment and tDCS group received normal tDCS (one trial of 20 min, 1 mA, cathodal electrodes were placed bilaterally on the FPT areas). The average of daily cigarettes consumption was recorded for the week before the tDCS and the following day after tDCS. In addition, pupil light reflex was measured right before and after tDCS treatment. One trial of tDCS stimulation significantly reduced daily cigarette consumption in smokers who had heroin use history. This reducing effect was also observed in heavy smokers. In addition, this effect on cigarette consumption lasted at least 48 h after the stimulation. Furthermore, it has been shown that opiates decrease pupillary size in humans, we found detectable changes of the dynamic pupil light reflex after bilateral tDCS stimulation. These findings suggest that FPT cathodal tDCS may be an effective approach to reduce cigarette craving in heroin users.

To assess the factors associated with support for reducing tobacco retail availability and ending the legal sale of cigarettes in Australia and New Zealand (NZ).Cross-sectional surveys were conducted in NZ (eight universities, n=1,932) and Queensland (University of Queensland or UQ, n=5,172). Participants were asked how much they agreed or disagreed with reducing the number of places allowed to sell cigarettes/tobacco and ending the legal sale of cigarettes within 10 years. Multinomial logistic regression models assessed associations between support with student characteristics.More than half the respondents in both samples supported reducing the number of tobacco outlets (NZ 69.3%; UQ 62.3%), and ending the legal sale of cigarettes within 10 years (NZ 53.3%; UQ 51.6%) with marginally more support among NZ students. Men and students who smoked or vaped had lower odds of supporting both strategies compared with women and non-users.The results suggest widespread support for reducing tobacco retail availability among university students in NZ and Queensland, and sex, and smoking and vaping status were strong predictors for support. Around half supported phasing out tobacco sales within 10 years.Collaborative research should be encouraged to enhance cross-country approaches on tobacco control.

Objective: To test the mechanisms by which exposure to point-of-sale (POS) e-cigarette marketing mediate the relationship between an ethnic minority group highly vulnerable for tobacco product use, namely Native Hawaiian/Other Pacific Islander (NHPI), and increased future e-cigarette use through explicit (positive outcome expectancies) and implicit (spontaneous positive reactions) pathways. Method: Four waves of data were collected in 6-month intervals from 2,327 multiethnic young adults (Mage = 21.2, SD = 2.2; 54% women) enrolled across two 4-year and four 2-year colleges belonging to a University system in Hawaii. POS e-cigarette marketing exposure was assessed with an objective measure involving store visit patterns and store audits, as well as a measure of self-reported exposure. Spontaneous reactions were assessed with an implicit measure, namely Affect Misattribution Procedure (AMP). Path analyses were used to test the hypotheses. Results: In a model employing the objective measure of POS exposure, a statistically significant pathway was found from NHPI ethnicity to increased current e-cigarette use at Wave 4 mediated through increased POS exposure at Wave 2, and increased affect regulation expectancies at Wave 3. Similar indirect effects on prospective e-cigarette use were found for Asian ethnicity. The dual process model of the effects of POS exposure on e-cigarette use was not fully supported, although the implicit measure was found to independently predict e-cigarette use. Conclusions: Differential exposure to POS marketing may explain some of the ethnic disparities in tobacco product use behavior such as e-cigarette use. POS marketing may affect e-cigarette use behavior mainly through the explicit pathway, notably affect regulation expectancies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Describe racial/ethnic patterns of flavored tobacco use to illuminate equity implications of flavored tobacco policies.Using data on US young adults (ages 18-34; n = 8,114) in the Population Assessment of Tobacco and Health Study Wave 5 (2018-2019) and survey-weighted logistic regression, we estimated any flavors (regular brand) and mint/menthol (vs. other flavors) use by race/ethnicity among cigarette, e-cigarette, cigar, blunt, hookah, smokeless tobacco, and any tobacco product users.Any flavored tobacco use was common and was significantly higher for Black (75.1%; OR: 1.4; 95% CI: 1.2, 1.7) and Hispanic/Latinx (77.2%; OR: 1.4; 95% CI: 1.1, 1.7) users than White users (73.5%). The most pronounced difference across products was in menthol cigarette use between Black and White smokers (OR: 4.5; 95% CI: 3.5, 5.9). Among flavored product users, mint/menthol use was significantly higher for Latinx blunt and hookah users.Racial/ethnic disparities in flavored tobacco use include and extend beyond menthol cigarettes. Comprehensive flavored tobacco restrictions that include mint/menthol and non-cigarette products will likely have more equitable impact.

To determine the geographical location and characteristics of on-demand delivery services operating in New Zealand.We systematically searched the web and application (app) stores for on-demand services offering rapid delivery of food, alcohol, cigarettes or vaping products in New Zealand and mapped their geographic location as of May 2021. Using desktop review, data on service characteristics were collected and stratified including: types of commodities available, promotion strategies, and the legal aspects of access to age-restricted items.On-demand services for food, alcohol and nicotine products operate across urban and rural New Zealand. All services offered personal memberships and 97% used promotions. All services offering restricted items had an age verification process, however, only 87% had birth date entry and 73% had an 18+ message pop-up on website entry. Only 60% of services appeared to have number limits on restricted items.Much of New Zealand is serviced by on-demand delivery services.The trend towards on-demand delivery services may increase unhealthy food, alcohol and nicotine-related harms and it undermines current government actions, e.g. the Smokefree 2025 goal. This research informs policy to reduce the future health burden.

Background: Smoking is declining, except among current menthol cigarette smokers. This study examines menthol cigarette smoking in the United States. Methods: Cross-sectional data from 35,279 self-respondent current adult smokers who selected menthol cigarettes as their usual type, across the 2003, 2006–2007, 2010–2011, 2014–2015, and 2018–2019 waves of the nationally-representative Tobacco Use Supplement to the Current Population Survey, were analyzed in SAS/SUDAAN. Menthol cigarette smoking among current smokers was assessed by sex, age, race/ethnicity, employment, geography, and educational attainment. Linear contrasts were used to assess trends. Results: Overall cigarette smoking (12.6% in 2018–2019 from 17.3% in 2003) and menthol cigarette smoking (4.0% in 2018–2019 from 4.7% in 2003) in the population decreased in 2018–2019 from 2003 (both P < 0.001). Using predicted marginals, adjusted by demographics, menthol smoking among current smokers increased to 33.8% in 2018–2019 from 27.9% in 2003 (P < 0.001). Among current smoking adults, increases in menthol smoking were observed among non-Hispanic Black persons (76.8% in 2018–2019 from 73.0% in 2003), young adults (37.7% in 2018–2019 from 31.7% in 2003), and women (39.6% in 2018–2019 from 32.1% in 2003). Conclusions: Smoking and menthol smoking in the population has decreased, yet menthol smoking among current smokers increased from 2003 to 2018–2019. Young adult, female, and non-Hispanic Black current smokers were more likely to use menthol cigarettes than their counterparts; these differences have persisted. Impact: Increased menthol smoking among current smokers, notably young adults, women, and non-Hispanic Black individuals, highlights the need for targeted tobacco control interventions for these health disparity populations.

The popularity of disposable fourth-generation electronic cigarettes (ECs) among young adults and adolescents has been increasing since the ban on flavored cartridge EC products such as JUUL. Although the constituents and toxicity of some cartridge-based fourth-generation ECs, such as JUUL, have been studied, limited data exist for other disposable ECs such as Puff. The purpose of this study was to determine flavor chemicals, synthetic coolants, and nicotine concentrations in 16 disposable Puff devices, evaluate the cytotoxicity of the different flavors from the Puff brand using in vitro assays, and investigate the health risks of synthetic coolants in EC products. Gas chromatography/mass spectrometry was used to identify and quantify chemicals in Puff EC fluids. One hundred and twenty-six flavor chemicals were identified in Puff fluids, and 16 were >1 mg/mL. WS-23 (2-isopropyl-N,2,3-trimethylbutyramide) was present in all products, and concentrations ranged from 0.8 to 45.1 mg/mL. WS-3 (N-ethyl-p-menthane-3-carboxamide) concentrations ranged from 1.5 to 16.4 mg/mL in 6/16 products. Nicotine concentrations ranged from 40.6 to 52.4 (average 44.8 mg/mL). All unvaped fluids were cytotoxic at dilutions between 0.1 and 10% in the MTT and neutral red uptake assays when tested with BEAS-2B lung epithelial cells. The cytotoxicity of Puff fluids was highly correlated with total chemical concentrations, nicotine, WS-23, both synthetic coolants, and synthetic coolants plus ethyl maltol. Lower concentrations of WS-23 than those in the fluids adversely affected cell growth and morphology. Concentrations of synthetic coolants exceeded levels used in consumer products. The margin of exposure data showed that WS-3 and WS-23 concentrations were high enough in Puff products to present a health hazard. Our study demonstrates that disposable Puff ECs have high levels of cytotoxic chemicals. The data support the regulation of flavor chemicals and synthetic coolants in ECs to limit potentially harmful health effects.

E-cigarette use has been increasing globally over the past decade. Many use e-cigarettes as an alternative or method to quit cigarette smoking, whereas others use these products recreationally. As technology has advanced, many individuals have reported symptoms of dependence on these products and continue to use them beyond achieving abstinence from smoking. Despite individuals reporting interest in quitting, little is known about e-cigarette cessation. This systematic review sought to identify and evaluate all human subjects literature published on the outcome of e-cigarette cessation through September 2021. Of the 79 articles identified, 56 were cross-sectional, 6 were qualitative, 5 were cohort studies, 3 were experimental, 2 were mixed methods, and 7 reported intervention or case studies of e-cigarette cessation. Results showed youth generally had high intent to quit e-cigarettes, whereas results were mixed with adult samples. Youth were motivated to quit e-cigarettes by health concerns, whereas adults were motivated to quit e-cigarettes by cost, lack of satisfaction, and psychologic factors. Adults were more likely to report past e-cigarette quit attempts, most commonly “cold turkey.” Few interventions tested strategies for e-cigarette cessation, with a majority targeted for youth. Given the lack of information on e-cigarette cessation, recommendations for future studies are outlined.

Introduction Many people incorrectly think that very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes. This risk misperception by people who smoke could reduce motivation to quit under a nicotine reduction policy. We qualitatively examined perspectives on campaign messages designed to reduce misperceptions. Aims and Methods Adults who smoke from North Carolina participated in online interviews. After being introduced to the idea of a VLNC policy, participants were shown VLNC messages and asked about their perceptions on the clarity, understandability, persuasiveness, and meaning of the messages. We conducted a thematic content analysis of the transcripts. Results Thirty adults who smoke cigarettes participated (15 females, 13 males, 2 nonbinary) with a mean age of 43 years. Central themes that emerged were: (1) Confusion about the proposed VLNC cigarette policy affected how messages were interpreted; (2) Messages that promote self-efficacy for quitting rather than guilt or fear were better received; and (3) Direct and succinct messages were seen as more able to grab attention and inform people who smoke. Some participant concerns focused on whether VLNC cigarettes would relieve their nicotine cravings and whether they would need to smoke more VLNC cigarettes to feel satisfied. Conclusion Campaign messages to educate the public about the harmful effects of smoking VLNC cigarettes may be more effective if people who smoke are informed about the policy’s rationale to understand why nicotine is removed rather than the other harmful chemicals. Messages should also acknowledge the difficulty of quitting and be short and direct to capture attention. Implications Adults who smoke have some confusion about nicotine reduction in cigarettes and this affects how they perceive potential communication campaign messages about the risk of smoking VLNC cigarettes. In our qualitative research, we found that adults who smoke prefer messages about VLNC cigarettes that acknowledge the challenge of quitting and that are direct and succinct. With further development, campaign messages may be able to reduce misperceptions about VLNC cigarettes and maximize the public health benefit of a nicotine reduction policy.

BACKGROUND: Cigar use, including little cigars and cigarillos (LCCs) and large traditional cigars, continues to harm young adults. Research on harm beliefs about cigars, particularly large cigars, is sparse. The current study examined cigar harm beliefs and associations with cigar use. METHODS: Data are from a 2019 survey of a young adult cohort study recruited in fall 2010. Participants were asked questions about their beliefs about the harm of LCC and large cigar use. Those reporting ever use of cigars were asked how frequently they inhale the smoke into their lungs. RESULTS: Participants (N = 1910) were 51.9% female with a mean age of 26.7 (SD = 0.6). Ever cigar use was 44.2% for large cigars and 43% for LCCs. Compared to those who have never used large cigars or LCCs, those reporting ever use of large cigars or LCCs reported lower harm beliefs about inhaling harmful chemicals and becoming addicted (ps