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Introduction: Although the popularity of oral nicotine products (ONPs) such as ZYN and On! is growing globally, there is limited research on their marketing and advertising. This report describes recent ONP marketing communication to retailers. Promotion to retailers can provide insight into new product flavours and styles, as well as future marketing strategies targeting consumers., Methods: We obtained all unique ONP print and online advertisements (ads) (N=50) targeted towards US businesses between January 2016 and August 2022 from Vivvix (formerly Numerator Ad Intel). Two independent reviewers coded for type of ONP, brand, nicotine strength(s), flavour(s), slogan(s), claim(s) and frequency of each component., Results: Most ads featured nicotine pouches alone (52%), while 22% featured a mix of ONPs including pouches, tablets and lozenges. By brand, Rogue constituted 36% of ads, followed by Zyn and On! (16% each). Most (82%) ads featured at least one cooling flavour and 48% displayed at least one fruit flavour. Wintergreen flavour appeared most frequently (48%). Most (72%) ads contained a slogan, which frequently highlighted convenience of use (eg, ' Chew on this Anywhere… Anytime' ), bypassing current restrictions on other tobacco and nicotine products use (eg, ' Laughs at no smoking signs ') and highlighting big profit margins from sales of ONPs for retailers (eg, 'small pouches big margins' )., Conclusion: This analysis provides insight into tobacco companies' strategies for increasing ONP endorsement among retailers. Strategies include appealing to profitability, emphasising convenience of product use and primarily promoting non-tobacco flavours. These findings highlight new trends in ONP products and marketing tactics and identify important areas to monitor to inform tobacco marketing regulations., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: A recent study found that the prevalence of chronic obstructive pulmonary disease (COPD) is significantly higher among adults who began smoking cigarettes before (versus after) 15 years of age, independent of current smoking, cigarette pack years, and smoking duration. The current analysis went a step further to also account for secondhand smoke exposure, using data from U.S. adults aged 40+ years during Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study., Methods: Adults who had ever smoked cigarettes were asked at what age they began smoking fairly regularly. Multivariable Poisson regression assessed the risk of self-reported COPD diagnosis due to childhood smoking (<15 years), adjusting for current smoking, cigarette pack years or smoking duration, secondhand smoke exposure, and sociodemographic covariates., Results: Overall, 13.4% reported that they had COPD. COPD prevalence was 7.5% for adults who never smoked compared to 29.0% and 21.1% for smoking onset at age <15 and 15+ years, respectively. Adults who initiated smoking at <15 (versus 15+) years had a higher prevalence of current smoking (45.9% versus 33.3%), longer smoking duration (mean 34.2 versus 27.3 years), greater cigarette pack years (mean 48.8 versus 30.8), and greater secondhand smoke exposure ( p 's<0.05). In multivariable analysis, the relative risk for COPD for smoking onset <15 (versus 15+) years of age was 1.27 (95% confidence interval=1.06, 1.51)., Conclusion: The increased risk of COPD due to childhood smoking was independent of cigarette pack years, smoking duration, secondhand smoke exposure, and current smoking. The findings give further evidence of increased COPD risk related to childhood smoking., (JCOPDF © 2024.)

Background: Cigarette smoking is an established risk factor for lower health-related quality of life (HRQOL). Studies to date have not used comprehensive measures of tobacco exposures across the life course. We examined the association between a lifetime cigarette smoke exposure index (LCSEI) and HRQOL among older US adults., Methods: Cross-sectional analysis of N=7,001 U.S. adults ≥40y from Wave 5(2018-19) of the Population Assessment of Tobacco and Health Study. The 11-point LCSEI included heaviness of current smoking, pack-years, childhood smoking, and second-hand smoke exposure. HRQOL measures included PROMIS global physical and mental health (GPH, GMH) scores. We estimated the independent association between LCSEI scores and mean GPH or GMH separately using multivariable linear regression adjusted for sociodemographics, body mass index, geographic location, and weekly exercise., Results: Sociodemographics were reflective of the US population over 40 years; 6.7% smoked during childhood, and 16.9% currently smoked (2.1% <10cig/d, 4.8% 11-20 cig/d, and 10.0% >20 cig/d). Mean (std dev) for the LCSEI, GPH and GMH were 2.4 (2.9), 14.8 (3.1), and 14.5 (3.3) respectively, and 15% had LCSEI scores of 5 or more. In the multivariable analysis, the LCSEI retained a strong association with GPH and GMH, -0.20 (-0.23, -0.17) and -0.22 (-0.25, -0.18) respectively for each 1-point increase in the LCSEI. The LCSEI-HRQOL associations over its 11-point range (-2.14 GPH, -2.16 GMH) were significantly higher than for education (-0.44 and -0.77) and about 30% higher than for the negative influence of poverty (<25K/yr) vs. affluence (>=100K/yr) (-1.61 and -1.65). Sensitivity analysis found that associations remained significant even after further adjustment for smoking-related diseases., Conclusion: In this US sample, associations between life course cigarette smoking and both physical and mental health were as strong as associations that contrasted extremes of socioeconomic status., Competing Interests: Competing interests The authors have no competing interests to report. Additional Declarations: No competing interests reported.

Background: Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a "better alternative" to combustible cigarettes. Philip Morris International's IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration's (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International's promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy., Objective: This study aims to examine HTP-related social media discourse around important policy events., Methods: We analyzed HTP-related posts on Twitter during the time period that included IQOS's MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes., Results: Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7%), followed by news/information (862/2796, 30.8%) and direct marketing/retail (321/2796, 11%). Among personal testimonials, more tweets were positive (495/1613, 30.7%) than negative (372/1613, 23.1%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9%) or vaping products (252/1613, 15.6%). Approximately 10% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9%) discussed US and global policy, including misinterpretation about IQOS being a "safer" tobacco product after the US FDA's MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3%) and discussing policy (378/1613, 23.4%) showed the largest pairwise co-occurrence., Conclusions: Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas., (©Minji Kim, Julia Vassey, Dongmei Li, Artur Galimov, Eileen Han, Matthew G Kirkpatrick, Cassandra A Stanton, Jenny E Ozga, Sarah Lee, Jennifer B Unger. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.10.2024.)

Competing Interests: Competing interests: MM served as a paid expert witness in litigation sponsored by the Public Health Advocacy Institute against RJ Reynolds. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. No other authors have a conflict of interest to declare.