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Purpose: To understand changes in purchasing behaviors and use of tobacco products such as e-cigarettes and cigarettes among different tobacco user groups during the COVID-19 pandemic using a mixed methods approach., Methods: A quantitative online survey was conducted in October-November 2020 using a national probability sample of US adults (N = 1,460) comprising exclusive cigarette smokers (n = 1,080), dual users of both cigarettes and e-cigarettes (n = 143), and exclusive e-cigarette users (n = 237). Simultaneously, ten online focus groups were conducted with 61 adults in the Atlanta, GA area including exclusive smokers (n = 16), current E-cigarette users (n = 22), and transitioning (recently quit or currently quitting) smokers and/or E-cigarette users (n = 23)., Results: From the survey, dual users vs. exclusive smokers had higher odds of buying cheaper cigarette brands (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) = 1.49, 4.20), buying cigarettes online (aOR = 2.79; 95% CI = 1.02, 7.69), buying from Indian Reservations (aOR = 3.99; 95% CI = 2.07, 7.69), buying fewer cigarettes than normal (aOR = 4.01; 95% CI = 2.42, 6.65) and buying other tobacco products (aOR = 4.44; 95% CI = 2.24, 8.79). From the focus groups, participants perceived reduced accessibility, fear of contracting COVID-19, rising prices, and convenience to influence their purchasing behaviors and tobacco use., Conclusions: Exclusive and dual users differed in their tobacco purchasing behaviors during the COVID-19 pandemic, such that dual users were more likely to change their purchasing behaviors (e.g., buying other tobacco products) than exclusive users. Educational campaigns and public health workers may promote interventions targeting dual users either to switch to reduced-risk products or quit smoking, particularly during stressful societal situations such as the COVID-19 pandemic., Implications: The findings inform public health educators and policymakers to develop policies and interventions carefully tailored for tobacco user groups targeting the perceived factors influencing purchasing behaviors during challenging situations affecting tobacco product availability., Competing Interests: We have read the journal’s policy, and the authors of this manuscript have the following competing interests: D.L.A. has received funds for work done at the World Health Organization Tobacco Free Initiative, as a Special Government Employee of the U.S. Food and Drug Administration, as a consultant for Pfizer, as an employee of Cherokee National Operational Systems and as an independent contractor for McKing Consulting. Other authors declare no conflicts of interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Kute et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Youth and young adult (YYA) use of e-cigarettes increased rapidly between 2010 and 2019 in the United States, during which exposure to e-cigarette advertising was also increased. We aimed to examine whether exposure to e-cigarette advertising among YYAs may lead to subsequent e-cigarette use. A cohort of 3886 YYAs ages 13-24 was recruited from two survey panels in 2018 and followed up until 2019. Survey data were collected online and by telephone. The primary outcome was past 30-day use of e-cigarettes at the follow-up survey. Among 2304 YYAs who retained at the follow-up survey and were not past 30-day e-cigarette users at baseline, both youth and young adults exposed to e-cigarette advertising at baseline had elevated odds of past 30-day e-cigarette use at follow-up (Youth adjusted odds ratio (aOR): 2.77, 95% CI: 1.23, 6.24; Young adults aOR: 2.34, 95% CI: 1.08, 5.11) compared with those not reporting baseline advertising exposure. The majority of YYAs reported exposure to e-cigarette advertising at baseline (Youth: 63.7%, 95% CI: 59.8, 67.4; Young adults: 58.3%, 95% CI: 53.6, 62.8). Our findings suggest that exposure to e-cigarette advertising was associated with an increase in subsequent past 30-day use of e-cigarettes among YYAs. Restricting advertising targeted at YYAs may reduce the likelihood of e-cigarette use among YYAs.

Introduction: Although heated tobacco products (HTP) have been on and off the commercial market for the past three decades (eg, Premier, Eclipse and Accord), they have not received widespread consumer acceptance as an alternative to combustible cigarettes. This may change with recent product innovations, shifts in consumer preferences and the tobacco market landscape and a US regulatory environment that may permit an internationally available HTP to be sold in the USA, possibly with a reduced exposure or risk statement. This study examined the extent of awareness and use of HTP in the USA and assessed the characteristics of those aware of and using these products., Methods: Data came from the 2016 and 2017 Tobacco Products and Risk Perceptions Surveys of national probability samples of US adults, conducted online during September-October 2016 (n=6014) and August-September 2017 (n=5992). Weighted χ 2 tests and regression analyses examined changes in awareness and use of HTP between 2016 and 2017 and characteristics associated with awareness and use., Results: From 2016 to 2017, awareness of HTP among US adults increased from 9.3% to 12.4% (p<0.001), ever use increased from 1.4% to 2.2% (p=0.005) and current use increased two fold, from 0.5% to 1.1% (p=0.004). Men and adults under age 45 years had higher rates of awareness than women and those 45 and older, respectively. Non-white adults, cigarette smokers and both current and former users of electronic nicotine delivery systems were more likely to be using HTP., Conclusions: Awareness and use of HTP in the USA are increasing. These products are more familiar to men and younger adults and may be being used disproportionately by racial/ethnic minorities. With increases in HTP availability and the potential for reduced-risk claims ahead, surveillance of patterns and consequences of use by both smokers and non-smokers is needed., Competing Interests: Competing interests: MPE receives unrestricted research funding support from Pfizer, Inc (’Diffusion of Tobacco Control Fundamentals to Other Large Chinese Cities' MPE, Principal Investigator). DLA has received funds for work done for the World Health Organization Tobacco Free Initiative and as a Special Government Employee of the US Food and Drug Administration., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: Flavored little cigars, cigarillos, and filtered cigars (LCCs) are popular and pose unique health risks. This study explored risk perceptions of flavors in LCCs and the relationship between perceptions and use among U.S. adults., Methods: Data were from the 2015 Tobacco Products and Risk Perceptions Survey of a national probability sample of 6051 adults, conducted online, August-September, 2015. The analytic sample consisted of 5105 adults aware of LCCs and 2174 who had ever used any type of LCCs., Results: Just over half of adults reported flavors in LCCs as "very" or "somewhat" risky, while more than one-third of adults reported they did not know the risks of flavors in LCCs. Younger adults, males, and users of any LCCs were more likely than older adults, females and non-users, respectively, to perceive LCC flavors as less risky. Those who perceived LCC flavors as "not at all risky" or "a little risky" were roughly twice as likely to have ever used flavored LCCs compared to those who reported not knowing the risks (AOR = 2.07, 95% CI = 1.16 to 3.69 and AOR = 1.96, 95% CI = 1.26 to 3.06). Those who reported LCC flavors as "very risky" were also more likely to have ever used flavored LCCs than those who reported not knowing the risks (AOR = 1.50, 95% CI = 1.13 to 1.98)., Conclusions: Though the proportion of adults assigning low risk to flavors in LCCs is small, these adults are more likely to use flavored LCCs. The association of use with risk perceptions of flavors in LCCs should be addressed in health risk campaigns., Implications: Flavored LCCs are popular, particularly among young adults. While understanding the impact of flavors is an FDA research priority, little is currently known about perceptions of risk associated with flavors in LCCs. This study explores the nature of risk perceptions of flavors in LCCs, and the relationship between perceptions and flavored LCC use. We conclude that perception of risk of flavors in LCCs is related to use of these products, particularly perception of less risk. Considering the relationship between use and risk perceptions would be helpful in constructing health risk messaging.

Objectives: This study assessed the awareness and use of traditional and novel tobacco products and dual use of cigarettes with electronic nicotine delivery systems (ENDS) among USA adults., Methods: Data were obtained from the 2014 Tobacco Products and Risk Perceptions Survey of a probability sample of 5717 USA adults conducted June-November, 2014., Results: Use of ENDS varied by demography and by cigarette and other tobacco use. Adults aged 25-34, non-heterosexual adults, and those reporting poorer health reported higher rates of current ENDS use. Current cigarette smokers had much greater odds of ENDS ever use than never smokers, with one-half of all cigarette smokers having used ENDS and 20.7 % currently using them. However, 22.0 % of current ENDS users were former cigarette smokers, and 10.0 % were never cigarette smokers., Conclusions: Patterns of ENDS use are evolving rapidly and merit continued surveillance. Nearly 10 % of adult ENDS usage is among never smokers. The public health challenge is how to enhance the potential that ENDS can replace combusted tobacco products without expanding nicotine use among youth, long-term ex-smokers, and other vulnerable populations.

Background: In the USA, new regulations require the collection of information on tobacco constituents by brand and variety and publication of this information in a way not likely to be misconstrued by consumers. Understanding of such information becomes increasingly important as new tobacco products are marketed and modifications are made to reduce the toxicity of some products. This pilot study assessed the current knowledge of tobacco control professionals regarding the relative harmfulness of several tobacco products, and evaluated an online educational intervention aimed at improving understanding of variations in nicotine and tobacco-specific N-nitrosamines (TSNAs)., Methods: Fifty-two tobacco control professionals participated in an online intervention which presented and discussed the results of constituent analyses of Camel Snus and Marlboro Snus compared to several conventional smokeless tobacco products. Comparisons with cigarettes were also discussed. Pre- and post-intervention questions assessed understanding of the concepts., Results: Pre-intervention responses demonstrated that 31% did not know that cigarettes are more harmful than smokeless tobacco, 67% did not know that smokeless products higher in nicotine are likely to be more effective substitutes for cigarettes, 52% did not know TSNAs are the major carcinogens in tobacco and 81% did not know new snus products tend to be lower in TSNAs than conventional spit tobacco. After intervention participation, knowledge increased on all points except one where pretest results were 100% correct., Conclusions: Public education campaigns are urgently needed for tobacco control professionals and consumers to increase awareness and understanding of the continuum of risk among tobacco products., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: In 2017, the US Food and Drug Administration (FDA) proposed lowering the amount of nicotine in combusted cigarettes to minimally addictive levels. If used, to encourage cessation and maximize the benefits of this action, the FDA needs to determine the most effective way to communicate to the public the practical impact of this nicotine tobacco product standard.Methods: Data were collected in 2018 from a nationally representative, online probability sample of 1198 adult smokers (aged ≥18 years old) in the United States. Smokers were randomly assigned one of five versions of the question regarding what they would most likely do if nicotine in cigarettes was reduced (nicotine levels were reduced by 95%; the government reduced nicotine levels by 95%; cigarettes were no longer addictive; cigarettes no longer relieved cravings; cigarettes were changed so that you would be able to quit more easily). Effects of framing on anticipated tobacco use intentions and perceived risk of very low nicotine cigarettes (VLNCs) were evaluated with multinomial logistic regressions.Results: Framing the nicotine tobacco product standard as cigarettes no longer relieved cravings resulted in the highest proportion of smokers reporting they intend to quit in response to this standard (43.9%), lowest proportions reporting anticipated intentions to continue using combusted tobacco products (45.3%), and lowest proportion believing that VLNCs are less harmful than regular cigarettes (26%).Conclusions: Different frames of nicotine reduction in cigarettes differentially affected smokers' anticipated tobacco use intentions and perceived risk of VLNCs. Presenting reduction as making cigarettes unable to relieve cravings might be particularly effective at motivating cessation. [ABSTRACT FROM AUTHOR]

Objectives: Publicity on incidents of electronic nicotine delivery systems (ENDS) exploding or catching fire may influence smokers' risk perceptions and decisions about using ENDS for quitting smoking. We examined combustible cigarette smokers' perceptions of the possibility of injury from exploding ENDS and the relationship of those perceptions to ENDS use, perceived risk relative to smoking, and perceived costs and benefits of ENDS use. Methods: We used data from the 2017 Tobacco Products and Risk Perceptions Survey of a national probability sample of US adults, conducted online in August and September 2017. The analytic sample consisted of 1181 current combustible cigarette smokers aware of ENDS. Results: Among combustible cigarette smokers aware of ENDS, a medium/high perceived risk of injury from exploding ENDS was associated with lower odds of current ENDS use (adjusted odds ratio [aOR] = 0.50; 95% confidence interval [CI], 0.30-0.86; P =.01), perceiving ENDS to be at least as harmful as cigarettes (aOR = 3.22; 95% CI, 2.11-4.93; P <.001), and feeling that the negatives of ENDS use outweighed the positives (aOR = 3.50; 95% CI, 2.00-6.14; P <.001). Conclusions: Product standards, improved product labeling, and education about how to properly use, charge, and store ENDS can help protect consumers from injury. Communication efforts should seek to fully inform combustible cigarette smokers about both the absolute health risks of ENDS, including risk of explosions, and their relative risks compared with those of cigarette smoking. [ABSTRACT FROM AUTHOR]

Objectives. Affect is an important dimension of risk perceptions, which are proximal determinants of little cigar and cigarillo (LCC) smoking. We examined the association among affect, risk perceptions, and current LCC use and susceptibility in a national probability sample of US young adults, aged 18-29. Methods. Structural equation models examined the effect of affect, via risk perceptions, on LCC current use and susceptibility for 772 young adults who took the 2015 Tobacco Products and Risk Perceptions Survey, which asked about affect for images related to LCCs and health risks of daily LCC use. Results. Positive affect toward LCCs was associated with lower perceived risks of daily LCC smoking (p < .001). Lower perceived risks were associated with higher probability of current LCC smoking (p = .008) among young adults who were aware of LCCs and with susceptibility to use among young adult never LCC users (p < .001). A direct effect of positive affect on current LCC use (p < .02) and susceptibility to use LCCs also was found. Conclusions. Future research should investigate how regulatory policy or enforcement actions can be used to regulate LCC components (eg, flavoring, advertising, etc) that influence affect and risk perceptions. [ABSTRACT FROM AUTHOR]

Objective: This study examines little cigar and cigarillo (LCC) adult user characteristics, perceived addictiveness, use and importance of flavors, intentions to continue use, and reasons for use to inform prevention efforts and regulatory policy. Methods: Data come from the 2014 Tobacco Products and Risk Perceptions Survey of a national probability sample of 5717 US adults, conducted online, June-November, 2014. The analytic sample consisted of 141 current LCC users. Results: Current LCC smokers were more likely to be male, younger, black or Hispanic, lower SES, current cigarette smokers, and to report poorer health than non-smokers. Perceived addictiveness was low overall, with 73.6% considering themselves "not at all" addicted, although female LCC users and dual users of cigarettes were more likely to consider themselves addicted to LCCs. Use of flavored LCCs was widespread. Flavors were cited as important reasons for use, especially among younger users, as were favorable comparisons with affordability and burn time of cigarettes. Conclusions: Most LCC users do not perceive themselves addicted to LCCs. Users report being influenced most by flavorings and affordability, indicating that appropriate regulations and education to improve health perceptions could help reduce use of these harmful products. [ABSTRACT FROM AUTHOR]

Introduction: Analysis of novel smokeless tobacco products purchased in Round I of the New Product Watch (NPW)—a national tobacco monitoring network—demonstrated that some tobacco constituents vary not only across various brands but also regionally and over time within the same product. In this study, we analyzed snus and dissolvable tobacco products that were purchased in Round II of the NPW. Methods: We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in snus and dissolvable tobacco products that were purchased in various regions of the country during the spring and summer of 2011. The results were compared against the Round I data, across different U.S. regions, and among products. Results: A total of 216 samples were received from different states representing 6 regions of the country. Compared with the previous analyses, TSNA levels increased significantly in Marlboro and Camel Snus and some dissolvable Camel products. The levels of unprotonated nicotine in Marlboro Snus and Camel Snus in this study were not different from Round I but varied significantly by regions; the differences between the highest and the lowest average regional levels were ~3.2-fold in Marlboro Snus ~1.7-fold in Camel Snus. Conclusions: Our results indicate that some novel smokeless tobacco products contain TSNA at the levels found in the conventional moist snuff. Observation of regional variations in unprotonated nicotine content in both Round I and Round II of NPW suggest that manufacturers may tailor the levels of this constituent consistently to different regions. [ABSTRACT FROM PUBLISHER]

Introduction: Information on chemical composition of the new oral “spitless” smokeless tobacco products is scarce, and it is not clear whether there is some variability as a function of purchase place or time due to either unintended or intended manufacturing variations or other conditions. Methods: We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in Marlboro Snus, Camel Snus, and dissolvable Camel products Orbs, Sticks, and Strips that were purchased in various regions of the country during the summer of 2010. Results: A total of 117 samples were received from different states representing six regions of the country. Levels of unprotonated nicotine in Marlboro Snus and Camel Snus varied significantly by regions, with the differences between the highest and the lowest average regional levels being relatively small in Marlboro Snus (∼1.3-fold) and large in Camel Snus (∼3-fold). Some regional variations in TSNA levels were also observed. Overall, Camel Snus had significantly higher TSNA levels than Marlboro Snus, and Camel Strips had the lowest TSNA levels among all novel products analyzed here. The amount of unprotonated nicotine in the dissolvable Camel products was comparable to the levels found in Marlboro Snus. Conclusions: Our study demonstrates some regional variations in the levels of nicotine and TSNA in Marlboro and Camel novel smokeless tobacco products. Continued monitoring of this category of products is needed as the existing products are being test marketed and modified, and new products are being introduced. This information is particularly important given its relevance to Food and Drug Administration regulation of tobacco products. [ABSTRACT FROM PUBLISHER]