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Introduction: According to the National Youth Tobacco Survey (NYTS), youth e-cigarette use (vaping) rose between 2017 and 2018. Frequency of vaping and concurrent past 30-day (p30d) use of e-cigarettes and tobacco products have not been reported., Methods: We analyzed the 2018 NYTS (N = 20 189) for vaping among all students (middle and high school; 6-12th grades; 9-19 years old) by frequency of vaping, exclusive vaping, p30d poly-product use (vaping and use of one or more tobacco product), and any past tobacco product use., Results: In 2018, 81.4% of students had not used any tobacco or vapor product in the p30d, and 86.2% had not vaped in the p30d. Among all students, of the 13.8% vaped in the p30d, just over half vaped on ≤5 days (7.0%), and roughly a quarter each vaped on 6-19 days (3.2%) and on 20+ days (3.6%). Almost three quarters of p30d vapers (9.9%) reported past or concurrent tobacco use and the remainder (3.9%) were tobacco naïve. 2.8% of students were tobacco naïve and vaped on ≤5 days; 0.7% were tobacco-naïve and vaped on 6-19 days, and 0.4% were tobacco-naïve and vaped on 20+ days., Conclusions: Vaping increased among US youth in 2018 over 2017. The increases are characterized by patterns of low p30d vaping frequency and high poly-product use, and a low prevalence of vaping among more frequent but tobacco naïve vapers., Implications: Results underscore the importance of including the full context of use patterns. The majority of vapers (60.0%-88.9% by use frequency) were concurrent p30d or ever tobacco users. About 4% of students were tobacco naïve and vaped in the p30d, but few (0.4%) vaped regularly on 20 or more days. Reporting youth vaping data with frequency and tobacco product co-use will give public health decision-makers the best possible information to protect public health., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Most youth and young adult (YA) tobacco users use flavoured products; however, little is known about specific flavours used., Methods: We report flavour types among US tobacco users from the Population Assessment of Tobacco and Health Study, wave 2, 2014-2015. At wave 2, we examined (1) flavour use and type at past 30-day use; (2) new flavoured tobacco product use and type; (3) product-specific flavour patterns across youth (ages 12-17) (n=920), YA (18-24) (n=3726) and adult (25+) (n=10 346) past 30-day and new tobacco users and (4) concordance between self-coded and expert-coded brand flavour type among all adults (18+)., Results: Prevalence of flavoured tobacco product use was highest among youth, followed by YA and adult 25+ any tobacco users. Within each age group, flavoured use was greatest among hookah, e-cigarette and snus users. Overall, menthol/mint, fruit and candy/sweet were the most prevalent flavour types at first and past 30-day use across age groups. For past 30-day use, all flavour types except menthol/mint exhibited an inverse age gradient, with more prevalent use among youth and YAs, followed by adults 25+. Prevalence of menthol/mint use was high (over 50% youth, YAs; 76% adults 25+) and exhibited a positive age gradient overall, though the reverse for cigarettes. Brand-categorised and self-reported flavour use measures among adults 18+ were moderately to substantially concordant across most products., Conclusions: Common flavours like menthol/mint, fruit and candy/sweet enhance appeal to young tobacco users. Information on flavour types used by product and age can inform tobacco flavour regulations to addess flavour appeal especially among youth., Competing Interests: Competing interests: MC has received grant funding from Pfizer, Inc, to study the impact of a hospital-based tobacco cessation intervention. MC also receives funding as an expert witness in litigation filed against the tobacco industry. No competing interests were reported by the other authors of this paper., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The purpose of this study was to identify the effects of question type, order, and inclusion of product images on tobacco use estimates in a national sample of young adults. Participants aged 18-34 years (N = 4,100) in the Truth Initiative Young Adult Cohort Study (2016) were randomized to one of five question types assessing ever and past 30-day use of tobacco products: (1) "select all that apply" list (checklist, CL); (2) breakout items for each product (B); (3) breakout + images (B + I); (4) CL and B; and (5) CL and B + I. The order of question type was randomly assigned in groups 4 and 5. Bivariate analyses estimated product-specific prevalence by question type/order. Ever cigarette and cigar use prevalence was higher and ever e-cigarette use was lower in B and B + I than in CL. Ever hookah use was higher in B + I than in CL. Past 30-day e-cigarette use was 8.3% higher and past 30-day smokeless use was 13.0% higher in B + I than in CL. In groups 4 and 5, higher prevalence of ever cigarette, cigar, hookah, and past 30-day smokeless use was observed when B was presented first. Question type, order, and inclusion of images affect prevalence estimates of tobacco use., Implications: This study identifies the effects of question type, order, and inclusion of product images on tobacco use estimates in a national sample of young adults. Ever use and past 30-day use prevalence estimates of specific products were affected by respondents answering breakout items or breakout items with images compared with respondents answering a checklist of items in the survey. Current surveys that include a "select all that apply" list format may be underestimating ever and past 30-day prevalence estimates of tobacco products., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: We examine adolescent receipt of tobacco coupons and subsequent tobacco use., Methods: Data were from the Population Assessment of Tobacco and Health (PATH) Study (2013-2015). We identified correlates of coupon receipt at Wave 1 (youth sample age 12-17 ; n = 13 651) including demographics, additional vulnerability factors that may place youth at risk of tobacco use and correlates of coupon receipt by channel. We examined associations of Wave 1 coupon receipt with Wave 2 tobacco use using weighted multivariable models., Results: Overall, 7.6% of US youth received tobacco coupons in the 6 months before Wave 1. Coupon recipients were more likely to be women, living outside urban areas, living with a tobacco user, current and former (vs never) tobacco users, having high internalising mental health symptoms and having a favourite tobacco advertisement. Coupons were received primarily through direct mail (56%), product packs (28%) and online (25%). Never tobacco users at Wave 1 who received coupons were more likely to be ever users at Wave 2 (adjusted OR (aOR)=1.42; 95% CI 1.06 to 1.91). Coupon recipients were more likely to use a new tobacco product between waves (aOR=1.67; 95% CI 1.18 to 2.36) and report past 30-day tobacco use at Wave 2 (aOR=1.81; 95% CI 1.31 to 2.49)., Conclusions: One in 13 US youth (7.6%) received coupons. Vulnerable youth had the greatest odds of coupon receipt. Coupon recipients had greater odds of tobacco use among never users, trying a new tobacco product and current use. Coupon bans, limits on youth coupon exposure, stronger age verification, pack inserts or restricting coupon redemption may help reduce tobacco use among adolescents, particularly for those at greatest risk., Competing Interests: Competing interests: None declared., (© 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.)

Background and Aims: The US Family Smoking Prevention and Tobacco Control Act provides a pathway for manufacturers to market a modified risk tobacco product (MRTP). This study examines socio-demographic and tobacco use correlates of interest in a hypothetical MRTP in a nationally representative sample of US adults., Design: Cross sectional wave 1 data from the 2013-14 Population Assessment of Tobacco and Health (PATH) Study., Setting: Household Audio-Computer Assisted Self-Interviews of US adults conducted in 2013-14., Participants: A total of 32 320 civilian, non-institutionalized adults in the United States., Measurements: Interest in using a hypothetical MRTP ('If a tobacco product made a claim that it was less harmful to health than other tobacco products, how likely would you be to use that product?'), socio-demographics, tobacco use history and mental health and substance use problems. All estimates were weighted., Findings: Overall, 16.7% [95% confidence interval (CI) = 16.28, 17.18] of US adults reported interest in a hypothetical MRTP. Tobacco use was associated significantly with interest in a hypothetical MRTP, with interest most common among current established smokers (54.4%; 95% CI = 53.31, 55.39) and least common among never tobacco users (3.0%; 95% CI = 2.49, 3.55). Interest in a hypothetical MRTP was associated with experimental e-cigarette use among current experimental, current established and former smokers. Among non-smokers, race, age, education and substance use were associated with interest in using a hypothetical MRTP., Conclusions: Among adults in the United States, interest in using a hypothetical modified risk tobacco product is low overall, and highest among current experimental and established smokers. A small percentage of non-smokers are interested in using a hypothetical hypothetical modified risk tobacco product., (© 2017 Society for the Study of Addiction.)

Introduction: E-cigarettes or electronic nicotine delivery systems (ENDS) have recently attracted considerable attention. Among some individuals there is strong debate and a polarisation of views about the public health benefits versus harms of ENDS. With little regulation, the ENDS market is evolving, and new products are introduced and marketed constantly. Rapid developments in manufacturing, marketing and consumer domains related to ENDS will warrant frequent re-evaluation, based on the state of the evolving science. The purpose of this article is to describe a protocol for an ongoing comprehensive review of the published scientific literature on ENDS., Methods and Analysis: We will undertake a systematic review of published empirical research literature on ENDS using the National Library of Medicine's PubMed electronic database to search for relevant articles. Data from included studies will be extracted into a standardised form, tables with study details and key outcomes for each article will be created, and studies will be synthesised qualitatively., Ethics and Dissemination: This review synthesises published literature and presents no primary data. Therefore, no ethical approval is required for this study. Subsequent papers will provide greater detail on results, within select categories, that represent gaps in the literature base., (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.)

IntroductionThis study examined trajectories of tobacco dependence (TD) in relationship to changes in tobacco product use, and explored the effects of product-specific adding, switching, or discontinued use on dependence over time.MethodsData were analyzed from the first three waves from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States (U.S.). Data included 9556 Wave 1 (2013/2014) adult current established tobacco users aged 18 or older who completed all three interviews and had established use at ≥2 assessments. Mutually exclusive groups included: users of cigarettes only, e-cigarettes only, cigars only, hookah only, any smokeless only, cigarette + e-cigarette dual users, and other multiple product users. A validated 16-item scale assessed TD across product users.ResultsPeople who used e-cigarettes exclusively at Wave 1 had small increases in TD through Wave 3. Wave 1 multiple product users' TD decreased across waves. TD for all other Wave 1 user groups remained about the same. For Wave 1 cigarette only smokers, switching to another product was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all product users.ConclusionsExcept for Wave 1 e-cigarette only users (who experienced small increases in TD), TD among U.S. tobacco product users was stable over time, with daily users less likely to vary from baseline.ImplicationsThe level of TD among most U.S. tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users experienced small increases in levels of TD over time, perhaps due to increases in quantity or frequency of their e-cigarette use or increasing efficiency of nicotine delivery over time.

BackgroundPrior work established a measure of tobacco dependence (TD) among adults that can be used to compare TD across different tobacco products. We extend this approach to develop a common, cross-product metric for TD among youth.MethodsOne thousand one hundred and forty-eight youth aged 12-17 who used a tobacco product in the past 30 days were identified from 13 651 youth respondents in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study.FindingsAnalyses confirmed a single primary latent construct underlying responses to TD indicators for all mutually exclusive tobacco product user groups. Differential Item Functioning analyses supported the use of 8 of 10 TD indicators for comparisons across groups. With TD levels anchored at 0.0 (standard deviation [SD] = 1.0) among cigarette only (n = 265) use group, mean TD scores were more than a full SD lower for e-cigarette only (n = 150) use group (mean = -1.09; SD = 0.64). Other single product use group (cigar, hookah, pipe, or smokeless; n = 262) on average had lower TD (mean = -0.60; SD = 0.84), and the group with the use of multiple tobacco products (n = 471) experienced similar levels of TD (mean = 0.14; SD = 0.78) as the cigarette only use group. Concurrent validity was established with product use frequency among all user groups. A subset of five TD items comprised a common metric permitting comparisons between youth and adults.ConclusionThe PATH Study Youth Wave 1 Interview provided psychometrically valid measures of TD that enable future regulatory investigations of TD across tobacco products and comparisons between youth and adult tobacco product use group.ImplicationsA measure of tobacco dependence (TD) has been established previously among adults to compare TD across tobacco products. This study established the validity of a similar, cross-product measure of TD among youth. Findings suggest a single latent TD construct underlying this measure, concurrent validity of the scale with product use frequency across different types of tobacco users, and a subset of common items that can be used to compare TD between youth and adults who use tobacco.

IntroductionThis study examined the predictive relationships between biomarkers of nicotine exposure and 16-item self-reported level of tobacco dependence (TD) and subsequent tobacco use outcomes.Aims and methodsThe Population Assessment of Tobacco and Health (PATH) Study surveyed adult current established tobacco users who provided urine biospecimens at Wave 1 (September 2013-December 2014) and completed the Wave 2 (October 2014-October 2015) interview (n = 6872). Mutually exclusive user groups at Wave 1 included: Cigarette Only, E-cigarette Only, Cigar Only, Hookah Only, Smokeless Tobacco Only, Cigarette Plus E-cigarette, multiple tobacco product users who smoked cigarettes, and multiple tobacco product users who did not smoke cigarettes. Total Nicotine Equivalents (TNE-2) and TD were measured at Wave 1. Approximate one-year outcomes included frequency/quantity used, quitting, and adding/switching to different tobacco products.ResultsFor Cigarette Only smokers and multiple tobacco product users who smoked cigarettes, higher TD and TNE-2 were associated with: a tendency to smoke more, smoking more frequently over time, decreased likelihood of switching away from cigarettes, and decreased probability of quitting after one year. For other product user groups, Wave 1 TD and/or TNE-2 were less consistently related to changes in quantity and frequency of product use, or for adding or switching products, but higher TNE-2 was more consistently predictive of decreased probability of quitting.ConclusionsSelf-reported TD and nicotine exposure assess common and independent aspects of dependence in relation to tobacco use behaviors for cigarette smokers. For other product user groups, nicotine exposure is a more consistent predictor of quitting than self-reported TD.ImplicationsThis study suggests that smoking cigarettes leads to the most coherent pattern of associations consistent with a syndrome of TD. Because cigarettes continue to be prevalent and harmful, efforts to decrease their use may be accelerated via conventional means (eg, smoking cessation interventions and treatments), but also perhaps by decreasing their dependence potential. The implications for noncombustible tobacco products are less clear as the stability of tobacco use patterns that include products such as e-cigarettes continue to evolve. TD, nicotine exposure measures, and consumption could be used in studies that attempt to understand and predict product-specific tobacco use behavioral outcomes.

Background and aimsBuilding on published work1 establishing concurrent validity of a self-report tobacco dependence (TD) index among users of different tobacco products in Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study, the current study examines prospective relationships with tobacco use behaviors to establish predictive validity of the TD index. Hypotheses suggested high levels of W1 TD would be associated with persistent tobacco use at Wave 2 (W2).ParticipantsA U.S. nationally representative sample of 32,320 adult W1 and W2 interviews focused on 11,615 W1 adults who were current established tobacco users and completed the W2 interview.FindingsHigher TD scores and greater changes in TD scores were associated with greater quantity and frequency of tobacco use at the W2 interview for Cigarette Only (n = 7068), Smokeless (smokeless or snus pouches) Only (n = 772), Cigarette plus E-Cigarette (n = 592), and Multiple Products (n = 1866) users, although not significantly so for E-Cigarette Only (n = 367), Cigar Only (traditional, cigarillo, or filtered) (n = 584), or Hookah Only (n = 366) users. Higher TD was associated with decreased odds of successful quitting for Cigarette and Multiple Product users. Higher TD was associated with increased odds of a quit attempt for those in the Hookah and Multiple Products user groups and was not associated with quit attempts or deceased odds of quit success among exclusive E-Cigarette, Cigar, Smokeless and Cigarette plus E-Cigarette users.ConclusionSupport for the predictive validity of the PATH Study measures of adult TD will enable regulatory investigations of TD across several tobacco products.

Introduction Of youth experiencing homelessness (YEH; 14–24 years old), 70%+ smoke combustible, commercial tobacco. Though many have tried to quit, most use ineffective methods. Drop-in centers for YEH are opportune places to link YEH to evidence-based treatment. Using the Phase-Based Model (PBM) for Cessation Research, the aim of this study was to identify "Motivation" phase-specific challenges impacting YEH's willingness to make a quit attempt—the goal of this cessation phase. Aims and Methods Surveys were interview administered with 96 past-week combusted tobacco users accessing drop-in services. Regression models were fit to confirm hypothesized challenges impacting YEH's willingness to quit. Results Moderate nicotine dependence was noted—a key Motivation phase cessation mechanism targeted—and was associated with population challenges including, but not limited to, replacing food with tobacco, accidental oxygen-deprivation events, and smoking to socialize. While 67.1% of participants made a past-year quit attempt, 45.8% expressed 30-day quit interest. Dimensions of coping with housing were associated with quit attempts and quit interest. Quit attempts were also associated with nicotine dependence, working, and smoking to socialize. Whereas, quit interest was associated with less endorsement of smoking to regulate affect and more endorsement to avoid danger. Conclusions Though common challenges targeted in Motivation phase cessation exist among YEH, other challenges may also need to be addressed to promote quitting. Implications Future research in optimizing evidence-based cessation access for YEH through drop-in centers may consider addressing the challenges of housing, food security, social context, violence, and neurotrauma sequela to bolster YEH willingness to make a quit attempt. [ABSTRACT FROM AUTHOR]

Introduction This study examined trajectories of tobacco dependence (TD) in relation to changes in tobacco product use and explored the effects of product-specific adding, switching, or discontinued use on dependence over time. Aims and Methods Data were analyzed from the first three waves of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States. Data included 9556 Wave 1 (2013/2014) adult current established tobacco users who completed all three interviews and had established use at ≥2 assessments. Groups included cigarettes-only users, e-cigarettes-only users, cigars-only users, hookah-only users, any smokeless-only users, cigarette + e-cigarette dual users, and multiple product users. A validated 16-item scale assessed TD across product users. Results Wave 1 e-cigarette-only users' who maintained exclusive e-cigarette use increased levels of TD through Wave 3 as did those who added or switched to another product. Wave 1 multiple product users' TD decreased across waves. TD for all other Wave 1 user groups remained about the same. For Wave 1 cigarette-only smokers, switching to another product or moving to a pattern of no established use was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all other product users. Conclusions Except for Wave 1 e-cigarette-only users, TD among US tobacco product users was stable over time, with daily users less likely to vary from baseline. Implications The level of TD among most US tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users, including those maintaining exclusive e-cigarette use, experienced increasing levels of TD over time, perhaps because of increases in quantity or frequency of their e-cigarette product use or increasing efficiency of nicotine delivery over time. [ABSTRACT FROM AUTHOR]

Research has separately established that there are disparities in tobacco use, that greater tobacco retailer density (TRD) is positively associated with tobacco use, and that TRD is greater in high poverty and high racial/ethnic minority neighborhoods. Connecting these topics, this study examined the association between disparities in TRD and disparities in the prevalence of tobacco use among adults and youth. We obtained Ohio data on tobacco use from two statewide adult surveys and two sub-state regional youth surveys (2017-2019). Licensed tobacco retailers in Ohio were geocoded within census tracts. Disparity in TRD within regions across the state was defined as the ratio of TRD in high vs. low poverty (and in high vs. low racial/ethnic minority) census tracts per region. Disparity in cigarette smoking (adults) and any tobacco use (youth) was defined as the ratio of use prevalence among socioeconomically disadvantaged vs. non-disadvantaged (and racial/ethnic minority vs. non-minority) individuals. We estimated Pearson correlation coefficients to assess the linear relationship between the TRD disparity ratios and tobacco use disparity ratios. Poverty-based and race/ethnicity-based TRD disparities were positively associated with smoking disparities among adults. Negative associations between TRD disparities and tobacco use disparities were found among youth. To our knowledge, this is the first analysis directly linking TRD disparities and tobacco use disparities. Different adult and youth findings may be due to trends by age and product preferences. For adults in particular, this analysis suggests a detrimental effect of the tobacco retail environment on disadvantaged populations. [ABSTRACT FROM AUTHOR]

Tobacco retailer density is consistently associated with poor tobacco-use outcomes. The aim of this review was to synthesize the international evidence on density reduction policies. Searches in multiple databases resulted in 31 studies covering various policy approaches evaluated for their impact on retailer density. Findings indicate that bans on tobacco sales in pharmacies reduced retailer density, but perhaps not equitably. Prohibiting sale of tobacco near schools produced greater density reductions in higher-risk neighborhoods. Policies in combination were most effective. Future studies should measure the impact of these policies on tobacco use. Density-reduction policies offer a promising approach to tobacco control. [ABSTRACT FROM AUTHOR]

Background and Aims: Building on published work1 establishing concurrent validity of a self-report tobacco dependence (TD) index among users of different tobacco products in Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study, the current study examines prospective relationships with tobacco use behaviors to establish predictive validity of the TD index. Hypotheses suggested high levels of W1 TD would be associated with persistent tobacco use at Wave 2 (W2).Participants: A U.S. nationally representative sample of 32,320 adult W1 and W2 interviews focused on 11,615 W1 adults who were current established tobacco users and completed the W2 interview.Findings: Higher TD scores and greater changes in TD scores were associated with greater quantity and frequency of tobacco use at the W2 interview for Cigarette Only (n = 7068), Smokeless (smokeless or snus pouches) Only (n = 772), Cigarette plus E-Cigarette (n = 592), and Multiple Products (n = 1866) users, although not significantly so for E-Cigarette Only (n = 367), Cigar Only (traditional, cigarillo, or filtered) (n = 584), or Hookah Only (n = 366) users. Higher TD was associated with decreased odds of successful quitting for Cigarette and Multiple Product users. Higher TD was associated with increased odds of a quit attempt for those in the Hookah and Multiple Products user groups and was not associated with quit attempts or deceased odds of quit success among exclusive E-Cigarette, Cigar, Smokeless and Cigarette plus E-Cigarette users.Conclusion: Support for the predictive validity of the PATH Study measures of adult TD will enable regulatory investigations of TD across several tobacco products. [ABSTRACT FROM AUTHOR]