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INTRODUCTION Heated tobacco products (HTPs) and nicotine vaping products (NVPs) both are legal consumer products in the Republic of Korea. Little is known about perceptions of harmfulness of HTPs and NVPs relative to cigarettes in South Korea among adults who smoke, and how exposure to marketing may be associated with harmfulness perceptions. METHODS This study used data from the 2020 International Tobacco Control (ITC) Korea Survey, and included 3713 adult (aged 19 years) cigarette smokers who were: 1) exclusive smokers (n=1845); 2) dual HTP + cigarette consumers (n=1130); 3) dual NVP + cigarette consumers (n=224); and 4) triple consumers (all three products, n=514). Weighted multinomial regression models were conducted to estimate smokers' perceptions of harmfulness of HTPs and NVPs compared to cigarettes, NVPs to HTPs, and self-reported exposure to HTP/NVP advertising. Analyses compared the perceptions of harmfulness between the four different consumer groups, and tested whether exposure to HTP/NVP advertising was associated with perceptions of lower relative harm. RESULTS Among all respondents, 27.5% believe that HTPs are less harmful than cigarettes and 23.4% believe that NVPs are less harmful than cigarettes. Exclusive cigarettes smokers were significantly less likely to perceive that HTPs and NVPs are less harmful than cigarettes compared to dual HTP + cigarette consumers, dual NVP + cigarette consumers, and triple consumers (all p<0.001). Half of respondents perceive NVPs as equally harmful as HTPs (14.1% perceive NVPs as more harmful than HTPs). Exposure to HTP/NVP advertising was associated with perceiving these products as less harmful than cigarettes. CONCLUSIONS About one-quarter of Korean cigarette smokers perceive HTPs and NVPs as less harmful than cigarettes. Further investigation is required to understand how harm perceptions and HTP/NVP advertising are related to changes in product use, such as switching between products, using multiple products, or discontinuing all product use. [ABSTRACT FROM AUTHOR]

INTRODUCTION In March 2020, the US Food and Drug Administration (FDA) finalized new pictorial health warnings (PHWs), covering 50% of the front and back of the pack; however, legal challenges from cigarette manufacturers have prevented the new warnings from being implemented. About 70% of adults in the general US population support PHWs. This study assessed support for PHWs in 2016, 2018 and 2020 among US adults (aged ≥18 years) who currently smoke or formerly smoked cigarettes. We also assessed factors related to support. METHODS Respondents included adults who currently or formerly smoked cigarettes and participated in at least one wave of the US ITC Smoking and Vaping Surveys: Wave 1 (2016, n=2557); Wave 2 (2018, n=2685); and Wave 3 (2020, n=1112). We assessed changes in support for PHWs between 2016 and 2020, and assessed factors related to support (support vs oppose/don't know). Analyses were conducted on weighted data. RESULTS Overall, 38.0% of respondents supported PHWs in 2016, with a significant increase to 44.7% in 2018 (p<0.001), and leveling off to 45.0% in 2020 (2018 vs 2020, p=0.91). Support was highest among former smokers and lowest among daily smokers in all three survey years. Support for PHWs at all survey years was significantly higher among those who formerly smoked, were younger (aged 18-39 vs ≥40 years), those who identified as Black (vs White), and planned to quit smoking (vs not planning to quit). There were no differences by income level, education level, or sex. CONCLUSIONS Nearly half of US adults who smoke cigarettes or quit smoking supported PHWs in 2020, with support being higher among younger adults, ethnic minorities, and those who formerly smoked. Support increased between 2016 and 2018, but not between 2018 and 2020. Similar to other studies, fewer current and former smokers supported PHWs compared to the US adult general population. [ABSTRACT FROM AUTHOR]

Objectives. To examine the impact of US restrictions implemented in February 2020 prohibiting flavors other than menthol and tobacco in cartridge-based e-cigarettes. Methods. We analyzed 5 cross-sectional waves of the International Tobacco Control Policy Evaluation Project Youth Tobacco and Vaping Surveys, conducted online with youths aged 16 to 19 years in the United States, Canada, and England, for differences in usual e-cigarette flavor, device, and brand reported by past-30-day vapers (n = 9512) before (2017, 2018, 2019), during (February 2020), and after (August 2020) implementation of US flavor restrictions. Results. In August 2020, 78.7% of vapers in the United States reported using a flavor prohibited in cartridges or pods, versus 86.3% in Canada (adjusted odds ratio [AOR] = 1.73; 95% CI = 1.25, 1.40) and 79.8% in England (AOR = 1.10; 95% CI = 0.78, 1.55). Disposable e-cigarettes (exempt from flavor restrictions) increased to a greater extent among vapers in the United States (13.2% to 36.8%) versus Canada (7.7% to 14.2%; AOR = 2.01; 95% CI = 1.33, 3.04) and England (10.8% to 16.4%; AOR = 2.33; 95% CI = 1.52, 3.57). Puff Bar (disposable) emerged as the most popular brand in the United States. Conclusions. Usual flavors used by youth vapers in the United States were unchanged after 2020 restrictions on cartridge-based e-cigarettes. Youths used brands and devices exempt from the restrictions. (Am J Public Health. 2022;112(7):1014–1024. https://doi.org/10.2105/AJPH.2022.306780) [ABSTRACT FROM AUTHOR]

Background and Aims: The prevalence of hookah smoking has increased in the United States since at least 2010, especially among youth and young adults. This study assessed self‐reported reasons for hookah smoking cessation and transition to or maintenance of high‐frequency hookah smoking among current hookah smokers. Design Separately analyzed data from the Population Assessment of Tobacco and Health (PATH) study, a longitudinal cohort study. Frequency of and reasons for hookah smoking were ascertained at wave 1 (2013–14); frequency of hookah smoking and past‐year cessation were ascertained at wave 2 (2014–15). Weighted multivariable logistic and ordinal logistic regression models were fitted to predict hookah smoking cessation and frequency of hookah smoking at wave 2, respectively, accounting for demographic and behavioral risk factors, reasons for hookah smoking and frequency of hookah smoking at wave 1. Setting: United States. Participants: A total of 693 youth and 4400 adult past‐year hookah smokers. Measurements Self‐reported tobacco‐use patterns and associated health behaviors were measured via audio computer‐assisted self‐interviews (ACASI). Findings At wave 1, 5.9% of youth and 7.5% of adults were past‐year hookah smokers. Among all age groups, the leading reasons for hookah smoking were enjoyment of socializing while smoking, the availability of appealing flavors and believing that it was less harmful than cigarette smoking. The odds of cessation were lower for adults who liked hookah flavors [adjusted odds ratio (aOR) = 0.40; 95% confidence interval (CI) = 0.26–0.62] compared with adults who did not like hookah flavors. The odds of transitioning to, or maintaining, monthly or more frequent hookah smoking at wave 2, compared with cessation or less than monthly smoking, were higher for adults who liked hookah flavors [adjusted proportional odds ratio (aPOR) = 2.10; 95% CI = 1.48–2.99 and enjoyed socializing while smoking hookah (aPOR = 1.82; 95% CI =1.13–2.94) compared with adults who did not like hookah flavors or socializing. Conclusion: The availability of appealing flavors, affordability and socialization while smoking hookah in the United States are associated with reduced likelihood of cessation and increased likelihood of high‐frequency hookah smoking. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we identified differences in cessation, nicotine dependence, and quit attempts between smokers using non-menthol cigarettes and smokers using menthol cigarettes differing in menthol delivery method (eg, menthol in the tobacco only, crushable capsules only or both). Methods: We analyzed data from the Population Assessment of Tobacco and Health Study, Waves 1 and 2 (W1 and W2), to determine associations of delivery method of menthol with cessation, nicotine dependence, and quit attempts among current adult cigarette smokers. Results: Nearly 40% of US smokers reported using a mentholated cigarette product with most using a product mentholated in the tobacco only. Smokers included in this analysis had a moderate to low heaviness of smoking index score. The lowest average score was among those using products mentholated in a filter capsule only (1.3, SE = .10), and the highest among those using non-mentholated products (2.4, SE = .03). About 12% of smokers quit between W1 and W2. Cessation, nicotine dependence, and quit attempts at W2 were not associated with delivery method of menthol at W1. Conclusions: Method of menthol delivery did not impact cessation, nicotine dependence, and quit attempts. [ABSTRACT FROM AUTHOR]

Background: Numeracy is one's ability to use numbers in context and influence's decision making and perceptions of health risk. Worry about lung cancer is an indicator of perceived risk (PR) and is related to interest in cessation and cancer screening. Purpose: The analysis sought to explore underlying relationships among worry about lung cancer, smoking-related disease risk perceptions, and numeracy in a web-based panel. Methods: A Web-based survey, including a numeracy measure, was completed by 1,682 participants aged 18–65 recruited in 2014. Former and current smokers were asked about LC worry and current smokers were asked their PR of diseases associated with smoking. Results: Females (m = 25.64, 95% CI [24.67, 26.61]), respondents aged 45–65 (m = 26.15, 95% CI [24.89, 27.41]), those who worry "all the time" about LC (m = 27.62, 95% CI [25.66, 29.58]), and respondents perceiving a higher risk of LC compared to other smokers (m = 28.84, 95% CI [27.66, 30.01]) expressed significantly higher PR means. Higher household income (OR = 1.20, 95% CI [1.08, 1.34]), age (OR = 0.86, 95% CI [0.77, 0.98]), and comparative LC risk (OR = 2.52, 95% CI [2.01, 3.17]) were significantly associated with greater worry about LC. As PR increases by one unit, the probability of worrying increases by 4.6%. For numeracy scores, odds ratio showed that as scores increased by one unit, the probability of worrying decreased by 11.9%. Discussion: In this study, we have shown that PR has a positive association with LC worry and that numeracy has a negative association with LC worry. Translation to Health Education Practice: This information can be used to target subpopulations with low PR and numeracy about their risks for lung cancer and to develop tailored messages to educate these people. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

Background: Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked. Objectives: This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. Methods: Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used. Results: Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product. Conclusions: The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted. [ABSTRACT FROM AUTHOR]

Objectives: In this study, the aim was to document trends of ever, past 30-day and frequent (use on ⩾ 10 days/month) hookah use among New Jersey (NJ) high school students. Methods: Data were analyzed from the 2008-2014 waves of the NJ Youth Tobacco Survey, a biennial survey of public high school students in grades 9-12 with a mean age of 15 years. Multivariable logistic regressions assessed trends and correlates of hookah use. Descriptive statistics were used to summarize the use of cigarettes, electronic cigarettes and other tobacco products (including cigars, smokeless tobacco and bidis). Results: In 2014, past 30-day hookah use (11.8%) was as high as e-cigarette use (12.1%) and higher than other tobacco products. The adjusted odds of ever, past 30-day and frequent hookah use were significantly higher in 2014 than 2008. Past 30-day hookah use was more common among users of other tobacco products. Conclusions: Effective strategies have been used in cigarette tobacco control and cigarette consumption has decreased as a result. Similar strategies should be employed to encompass emerging tobacco products, with necessary modifications to reduce the prevalence of all tobacco use among youth. [ABSTRACT FROM AUTHOR]

Guided by the extended parallel process model (EPPM) and reactance theory, this study examined the relationship between efficacy beliefs, reactance, and adult smokers' responses to pictorial health warning labels (HWL) on cigarette packaging, including whether efficacy beliefs or reactance modify the relationship between HWL responses and subsequent smoking cessation behavior. Four waves of data were analyzed from prospective cohorts of smokers in Australia and Canada (n = 7,120 observations) over a period of time after implementation of more prominent, pictorial HWLs. Three types of HWL responses were studied: psychological threat responses (i.e., thinking about risks from smoking), forgoing cigarettes due to HWLs, and avoiding HWLs. The results from Generalized Estimating Equation models indicated that stronger efficacy beliefs and lower trait reactance were significantly associated with greater psychological threat responses to HWLs. Similar results were found for models predicting forgoing behavior, although response efficacy was inversely associated with it. Only response efficacy was significantly associated with avoiding HWLs, showing a positive relationship. Higher self-efficacy and stronger responses to HWLs, no matter the type, were associated with attempting to quit in the followup period; reactance was unassociated. No statistically significant interactions were found. These results suggest that stronger efficacy beliefs and lower trait reactance are associated with some stronger responses to fear-arousing HWL responses; however, these HWL responses appear no less likely to lead to cessation attempts among smokers with different levels of self-efficacy to quit, of response efficacy beliefs, or of trait reactance against attempts to control their behavior. [ABSTRACT FROM AUTHOR]

The article discusses research which indicates that a modified Smokeless Tobacco Expectancies Questionnaire (STEQ) is a valid measure of Swedish-style smokeless tobacco (snus)-related outcome expectancies, and it mentions STEQ's impact on self-reported tobacco use and the effort to identify groups that are susceptible to snus initiation and use. Consumers' perceptions about tobacco products are addressed, along with research involving the views of adolescents, young adults, and adults.

Background: Smoking regret differs by smoker characteristics (dependence) and may be linked to delay discounting (DD), where smaller immediate rewards are preferred to larger delayed rewards. It is hypothesized that those who exhibit stronger tendencies to delay rewards also express fewer future health concerns and possibly less regret about smoking. Objectives: The objective is to determine the interrelationships of regret, dependence, and delay discounting among current smokers. Methods: In July 2010, 1062 smokers completed a 45-minute at-home web based survey and answered questions including regret, dependence (Fagerstrom Test for Cigarette Dependence), and delay discounting (Monetary Choice Questionnaire). Relationships among these variables and perceived future health effects were analyzed using correlations, repeated measures analysis of variance, and generalized linear models. Results: Most smokers (85%) regretted smoking. FTCD and log-k (DD) scores were positively associated (rs = 0.15, p <.001). Though a strong decline in log-k was shown as reward increased (p's <.001), there were no differences in discounting by regret. Regret was positively associated with worries concerning health effects, quality of life, and finances (p's <.001). Little association was found between DD and future health concerns. Conclusions/Importance: Though this study confirms that regret for smoking is associated with perceived future risks as well as supports previous findings between FTCD and DD, it shows little association between DD and perceived future risks. [ABSTRACT FROM AUTHOR]

Background Recent studies have suggested that about 1 in 5 smokers report switching brands per year. However, these studies only report switching between brands. The current study estimated the rates of switching both within and between brand families and examining factors associated with brand and brand style switching. Methods Data for this analysis are from the International Tobacco Control 2006-2011 US adult smoker cohort survey waves 5-8 (N=3248). A switch between brands was defined as reporting two different cigarette brand names for two successive waves, while switching within brand was defined as reporting the same brand name, but a different brand style. Repeated measures regression was used to determine factors associated with both switch types. Results A total of 1475 participants reported at least two successive waves of data with complete information on brand name and style. Overall switching increased from 44.9% in 2007-2008 to 58.4% in 2010-2011. Switching between brand names increased from 16% to 29%, while switches within the same brand name to a different style ranged from 29% to 33%. Between-brand switching was associated with younger age, lower income, non-white racial group and use of a discount brand, whereas, within-brand switching was associated with younger age and the use of a premium brand cigarette. Conclusions Nearly half of smokers in the USA switched their cigarette brand or brand style within a year. Switching between brands may be more price motivated, while switching within brands may be motivated by price and other brand characteristics such as product length. [ABSTRACT FROM AUTHOR]

Objective The purpose of this paper was to examine trends in the use of premium and discount cigarette brands and determine correlates of type of brand used and brand switching. Methods Data from the International Tobacco Control (ITC) US adult smoker cohort survey were analysed. The total study sample included 6669 adult cigarette smokers recruited and followed from 2002 to 2011 over eight different survey waves. Each survey wave included an average of 1700 smokers per survey with replenishment of those lost to follow-up. Results Over the eight survey waves, a total of 260 different cigarette brands were reported by smokers, of which 17% were classified as premium and 83% as discount brands. Marlboro, Newport, and Camel were the most popular premium brands reported by smokers in our sample over all eight survey waves. The percentage of smokers using discount brands increased between 2002 and 2011, with a marked increase in brand switching from premium to discount cigarettes observed after 2009 corresponding to the $0.61 increase in the federal excise tax on cigarettes. Cigarette brand preferences varied by age group and income levels with younger, higher income smokers more likely to report smoking premium brand cigarettes, while older, middle and lower income, heavier smokers were more likely to report using discount brands. Conclusions Our data suggest that demographic and smoking trends favour the continued growth of low priced cigarette brands. From a tobacco control perspective, the findings from this study suggest that governments should consider enacting stronger minimum pricing laws in order to keep the base price of cigarettes high, since aggressive price marketing will likely continue to be used by manufacturers to compete for the shrinking pool of remaining smokers in the population. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated how advertising for alternative nicotine products affects demand for these products in a group of cigarette smokers. It acknowledges proliferation of smokeless tobacco (ST) products such as dissolvables, snus and lozenges which aim to reduce tobacco addiction or just renormalize tobacco use. It reports recruitment of cigarette smokers for survey and viewing of selected advertisements, data analysis performed and demographics analysis.

Introduction Health warning labels (HWLs) on tobacco packaging can be used to provide smoking cessation information, but the impact of this information is not well understood. Methods Online consumer panels of adult smokers from Canada, Australia and Mexico were surveyed in September 2012, January 2013 and May 2013; replenishment was used to maintain sample sizes of 1000 participants in each country at each wave. Country-stratified logistic Generalised Estimating Equation (GEE) models were estimated to assess correlates of citing HWLs as a source of information on quitlines and cessation websites. GEE models also regressed having called the quitline, and having visited a cessation website, on awareness of these resources because of HWLs. Results At baseline, citing HWLs as a source of information about quitlines was highest in Canada, followed by Australia and Mexico (33%, 19% and 16%, respectively). Significant increases over time were only evident in Australia and Mexico. In all countries, citing HWLs as a source of quitline information was significantly associated with self-report of having called a quitline. At baseline, citing HWLs as a source of information about cessation websites was higher in Canada than in Australia (14% and 6%, respectively; Mexico was excluded because HWLs do not include website information), but no significant changes over time were found for either country. Citing HWLs as a source of information about cessation websites was significantly associated with having visited a website in both Canada and Australia. Conclusions HWLs are an important source of cessation information. [ABSTRACT FROM AUTHOR]

Aim To evaluate the population effectiveness of stop-smoking medications while accounting for potential recall bias by controlling for quit attempt recency. Design Prospective cohort survey. Setting United Kingdom, Canada, Australia and the United States. Participants A total of 7436 adult smokers (18+ years) selected via random digit dialling and interviewed as part of the International Tobacco Control Four Country Survey ( ITC-4) between 2002 and 2009. Primary analyses utilized the subset of respondents who participated in 2006 or later ( n = 2550). Measurements Continuous abstinence from smoking for 1 month/6 months. Findings Among participants who recalled making a quit attempt within 1 month of interview, those who reported using varenicline, bupropion or nicotine patch were more likely to maintain 6-month continuous abstinence from smoking compared to those who attempted to quit without medication [adjusted odds ratio ( OR) 5.84, 95% confidence interval ( CI) (2.12-16.12), 3.94 (0.87-17.80), 4.09 (1.72-9.74), respectively]; there were no clear effects for oral NRT use. Those who did not use any medication when attempting to quit tended to be younger, to be racial/ethnic minorities, to have lower incomes and to believe that medications do not make quitting easier. Conclusions Consistent with evidence from randomized controlled trials, smokers in the United Kingdom, Canada, Australia and the United States are more likely to succeed in quit attempts if they use varenicline, bupropion or nicotine patch. Previous population studies that failed to find an effect failed to control adequately for important sources of bias. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims The US Food and Drug Administration must consider whether to ban the use of menthol in cigarettes. This study examines how current smokers might respond to such a ban on menthol cigarettes. Design Convenience sample of adolescent and adult smokers recruited from an online survey panel. Setting United States, 2010. Participants A total of 471 adolescent and adult current cigarette smokers. Measurements Respondents were asked a series of questions about how they might react if menthol cigarettes were banned. In addition, participants completed a simulation purchase task to estimate the demand for menthol and non-menthol cigarettes across a range of prices. Findings Overall, 36.1% of respondents said they always (18.9%) or usually (17.2%) smoked menthol cigarettes. When asked how they might respond to a ban on menthol cigarettes, 35% of current menthol smokers said they would stop smoking, and 25% said they would 'find a way to buy a menthol brand'. Those who reported they might quit tended to have greater current intentions to quit [odds ratio (OR) = 4.47], while those who reported that they might seek illicit menthol cigarettes were far less likely to report current intentions to quit (OR = 0.06). Estimates for demand elasticity for preferred cigarette type were similar for menthol (α = 0.0051) and non-menthol (α = 0.0049) smokers. Demand elasticity and peak consumption were related to usual cigarette type and cigarettes smoked per day, but did not appear to differ by race, gender or age. Conclusions Preliminary evidence suggests that a significant minority of smokers of menthol cigarettes in the United States would try to stop smoking altogether if such cigarettes were banned. [ABSTRACT FROM AUTHOR]