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Introduction: Electronic nicotine delivery systems (ENDS) may improve public health if they facilitate smokers switching away from cigarettes. Conceptually, switching is facilitated when ENDS provide adequate nicotine delivery. Switching rates among smokers who purchased the JUUL System ("JUUL") were compared in the United Kingdom (UK), where regulations limit nicotine concentration to 20 mg/mL versus North America (N.Am.; United States and Canada), where higher concentrations are available.Aims and Methods: Adult established smokers (age ≥21, smoked ≥100 cigarettes, smoking some days or every day at baseline) who newly purchased JUUL were recruited into a longitudinal study (UK: N = 1247; N.Am.: N = 8835). Complete switching (no smoking for ≥30 days) was assessed 1, 3, and 6 months after purchase; propensity score matching (PSM) and logistic regression compared switching after adjusting for baseline characteristics.Results: In both N.Am. and UK, ≥82% of participants reported using the highest JUUL nicotine concentration available (UK: 18 mg/mL; N.Am.: 59 mg/mL). Unadjusted switching rates did not differ at 1 month (17%-18%); unadjusted and adjusted rates were significantly higher in N.Am. (vs. UK) at 3 and 6 months. In the PSM sample, after additional covariate adjustment, rates were significantly higher in N.Am. (vs. UK) at 3 months (31.5% vs. 22.7%; odds ratio [95% confidence interval, CI] = 1.59 [1.25, 2.02]) and 6 months (38.0% vs. 26.0%; odds ratio [95% CI] = 1.79 [1.37, 2.35]).Conclusions: These results suggest availability of ENDS in nicotine concentrations greater than 20 mg/mL may be associated with increased switching among adult smokers. Differences in smoking and ENDS use characteristics did not explain associations of location and switching; however, between-country differences may be affected by unmeasured factors.Implications: Switching rates were lower among smokers who purchased the JUUL System ("JUUL") in the UK, where regulations limit nicotine concentration to 20 mg/mL versus N.Am. (United States and Canada), where higher concentrations are available-before and after controlling for differences in smoking and ENDS use characteristics. These results suggest availability of ENDS in nicotine concentrations greater than 20 mg/mL may be associated with increased switching among adult smokers. Between-country differences may be affected by unmeasured factors; future research should consider these factors and the extent to which regulatory policy environments may explain differences in switching among adult smokers. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we assessed changes in dependence as smokers transitioned from cigarette smoking to exclusive use of the JUUL System ("JUUL"), contrasting users of 5.0% versus 3.0% nicotine concentration pods. Methods: Overall, 5246 adult (age = 21) established smokers (> 100 cigarettes lifetime) who purchased a JUUL device completed online surveys at baseline, when smoking, and one and 3 months later; 1758 reported no past-30-day smoking ('switching') at one or both timepoints. Analyses compared dependence on cigarettes (at baseline) and JUUL (at follow-up), as assessed by the 4-item PROMIS scale (Range: 0-4). Results: Switching increased from Month 1 (18.3%) to Month 3 (28.6%); switchers at one month (Difference = 0.23) and 3 months (0.24) showed lower mean baseline cigarette dependence. Dependence decreased significantly (ps < .001) from baseline cigarette dependence to JUUL dependence at both one (from 1.82 to 1.59) and 3 months (1.97 to 1.73); changes did not significantly differ between users of 5.0% and 3.0% (ps > .43). Dependence on JUUL did not change significantly from Month 1 to Month 3. Conclusions: Dependence decreased as smokers transitioned from smoking to exclusive use of JUUL, similarly for users of both nicotine concentrations. Smokers who switch to JUUL may reduce their nicotine dependence. ACKNOWLEDGMENT & CONFLICT OF INTEREST STATEMENT: Funding for this study was provided by Juul Labs Inc. Through Pinney Associates, Saul Shiffman provides consulting services on tobacco harm reduction on an exclusive basis to Juul Labs Inc. In that role, he acted as internal editor and coordinator for the papers in this special issue. Erik Augustson is a full-time employee of Juul Labs Inc. As Senior Director of Behavioral Affairs at JLI, he oversaw the conduct of the behavioral research reported in this special issue. [ABSTRACT FROM AUTHOR]

Objectives: The Adult JUUL System User Switching and Smoking Trajectories (ADJUSST) study assessed the smoking and JUUL use trajectories of adults who purchased JUUL. In this paper, we describe study methods, characterize the sample, and assesses potential for bias due to loss to follow-up. Methods: We entered 55,414 US adults (= age 21) who purchased a JUUL Starter Kit for the first time (online or at retail) in 2018 into a naturalistic, longitudinal observational study, irrespective of baseline smoking status. Participants were invited for follow-ups 1, 2, 3, 6, 9, and 12 months later, focused on assessing past-30-day smoking and JUUL use. Analyses assessed potential bias due to non-response. Results: Over 90% of participants had a history of smoking; 62.8% were past-30-day smokers; 23.3% were former smokers. Participants' average age was 30; 75% were white. Most participants (77.6%) completed some follow-ups; 25% completed all follow-ups. Baseline differences among complete responders (N = 13,729), partial responders (N = 29,252), and complete non-responders (N = 12,433) were small. When recontacted, few 12-month non-responders said their non-response was due to smoking; many reported no past- 30-day smoking. Conclusions: The study may elucidate smoking trajectories of adult JUUL users. The potential for bias due to loss to follow-up in ADJUSST was limited. ACKNOWLEDGMENT & CONFLICT OF INTEREST STATEMENT: Funding for this study was provided by Juul Labs Inc. Through Pinney Associates, Saul Shiffman provides consulting services on tobacco harm reduction on an exclusive basis to Juul Labs Inc. In that role, he acted as internal editor and coordinator for the papers in this special issue. Erik Augustson is a full-time employee of Juul Labs Inc. As Senior Director of Behavioral Affairs at JLI, he oversaw the conduct of the behavioral research reported in this special issue. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we attempt to elucidate the relationship between lifetime mental illness (LMI), particularly a depression diagnosis, and smoking cessation. Methods: Data were drawn from a previous study and include LMI, demographics, mood, and smoking cessation outcomes. We evaluated the relationship between multiple LMIs and smoking cessation at 7 months post-intervention, and depression in combination with another LMI. Results: At 7 months, the adjusted odds of cessation for those with one LMI, including depression, were 0.74 (p = .102), and for those with 2+ LMIs, 0.69 (p = .037), both in comparison with participants who reported no history of LMI. Among those with 2+ LMIs, the adjusted odds of cessation for those with a depression diagnosis were 0.34 (p = .007) compared to those whose multiple LMIs did not include depression. Conclusions: Among smokers seeking cessation treatment, those who had 2+ LMIs were at greater risk of relapse, an effect particularly marked in smokers with depression. This study adds to the literature examining the potential impact of LMI on smokers' ability to quit by considering the potential impact of 2+ LMIs and highlights the potential impact of depression as a risk factor for continued smoking. [ABSTRACT FROM AUTHOR]

There is a positive correlation between recall of tobacco-related television news and perceived risks of smoking and thoughts about quitting. The authors used Cision US, Inc., to create a sampling frame (N = 61,027) of local and national television news coverage of tobacco from October 1, 2008, to September 30, 2009, and to draw a nationally representative sample (N = 730) for content analysis. The authors conducted a descriptive study to determine the frequency and proportion of stories containing specified tobacco topics, frames, sources, and action messages, and the valence of the coverage. Valence was generally neutral; 68% of stories took a balanced stance, with 26% having a tenor supportive of tobacco control and 6% opposing tobacco control. The most frequently covered topics included smoking bans (n = 195) and cessation (n = 156). The least covered topics included hookah (n = 1) and menthol (n = 0). The majority of coverage lacked quoting any source (n = 345); government officials (n = 144) were the most quoted sources. Coverage lacked action messages or resources; 29 stories (<4%) included a message about cessation or advocacy, and 8 stories (1%) contained a resource such as a quitline. Television news can be leveraged by health communication professionals to increase awareness of underrepresented topics in tobacco control. [ABSTRACT FROM PUBLISHER]

Objectives: To examine the relationship between a belief about Food and Drug Administration (FDA) safety evaluation of cigarettes and smoking risk perceptions. Methods: A nationally representative, random-digit-dialed telephone survey of 1046 adult current cigarette smokers. Results: Smokers reporting that the FDA does not evaluate cigarettes for safety (46.1%), exhibited greater comprehension of the health risks of smoking and were more likely (48.5%) than other participants (33.6%) to report quit intentions. Risk perceptions partially mediated the relationship between FDA evaluation belief and quit intentions. Conclusions: These findings highlight the need for proactive, effective communication to the public about the aims of new tobacco product regulations. [ABSTRACT FROM AUTHOR]

Objective To conduct analyses to determine the extent to which YouTube videos posted specific to smoking cessation were actually about quitting smoking and if so, whether or not they portrayed evidence-based practices (EBPs). Methods In August 2008, researchers identified YouTube videos by search strategies, 'relevance' and 'view count' using the following three search terms: 'stop smoking', 'quit smoking' and 'smoking cessation (n=296 for full sample and n=191 for unique videos). Results Overall, almost 60% of videos contained a message about quitting smoking. Differences were found across search terms for videos about quitting smoking, with 'stop smoking' yielding the highest percentage (80.8%) of videos about quitting smoking. Almost half of the videos (48.9%) contained EBPs for cessation strategies; however, a significant portion contained either non-EBPs (28.4%) or both EBPs and non-EBPs (22.7%). The number of views per an individual video across the six categories ranged from a low of 8 in the 'relevance' strategy and 'smoking cessation' search term to a high of 1 247 540 in the 'view count' strategy and 'stop smoking' search term. Of the top three most viewed videos by strategy and search term, 66.7% included a specific mention of quitting smoking and, of these, the majority included EBPs. Conclusion Results highlight the need to develop and upload videos containing EBPs both to increase the overall proportion of EBP videos in all categories, particularly in 'quit smoking' and 'stop smoking.' Research is needed to study whether YouTube videos influence knowledge, attitudes and behaviours regarding quitting smoking. [ABSTRACT FROM AUTHOR]

Objective: Although a number of studies have examined the respiratory impact of marijuana smoking, such studies have generally used convenience samples of marijuana and tobacco users. The current study examined respiratory effects of marijuana and tobacco use in a nationally representative sample while controlling for age, gender, and current asthma.Design: Analysis of the nationally representative third National Health and Nutrition Examination Survey (NHANES III).Setting: U.S. households.Participants: A total of 6,728 adults age 20 to 59 who completed the drug, tobacco, and health sections of the NHANES III questionnaire in 1988 and 1994. Current marijuana use was defined as self-reported 100+ lifetime use and at least 1 day of use in the past month.Measurements and Main Results: Self-reported respiratory symptoms included chronic bronchitis, frequent phlegm, shortness of breath, frequent wheezing, chest sounds without a cold, and pneumonia. A medical exam also provided an overall chest finding and a measure of reduced pulmonary functioning. Marijuana use was associated with respiratory symptoms of chronic bronchitis (P=.02), coughing on most days (P=.001), phlegm production (P=.0005), wheezing (P<.0001), and chest sounds without a cold (P=.02).Conclusion: The impact of marijuana smoking on respiratory health has some significant similarities to that of tobacco smoking. Efforts to prevent and reduce marijuana use, such as advising patients to quit and providing referrals for support and assistance, may have substantial public health benefits associated with decreased respiratory health problems. [ABSTRACT FROM AUTHOR]