Search

Prior research suggests that flavors can influence the pharmacological effects of nicotine. We used commercially available JUUL pods to examine whether preferred menthol versus tobacco flavor increased the addictive potential of nicotine per se. This study recruited 15 regular JUUL e-cigarette users to complete a 2 × 2 factorial crossover trial using an entirely remote video format. Participants completed a sampling baseline session to identify preferred JUUL flavor (menthol vs. tobacco) followed by four counterbalanced experimental sessions separated by ≥ 48 hr: (a) low-nicotine dose (3% JUUL)/nonpreferred flavor; (b) low dose/preferred flavor; (c) high-nicotine dose (5% JUUL)/nonpreferred flavor; and (d) high dose/preferred flavor. In each experimental session, participants completed a puffing procedure followed by subjective ratings of e-cigarette liking and wanting (ELW), urges, and reinforcement using a JUUL pod purchase task. There was a dose-by-flavor interaction for average ELW (

This pilot study tested the effect of a brief nicotine education messaging exposure on beliefs about nicotine, nicotine-replacement therapy (NRT), and e-cigarettes. Participants ages 18 and older were recruited via Amazon Mechanical Turk to complete a 20-min online survey in April/May 2020 to assess relationships between opioid use, smoking, and other behaviors. Participants with past-month extra-medical opioid use completed questions on background characteristics and literacy and then were randomized in a 2:1 ratio of two conditions: nicotine education (n = 362) or no message control (n = 181). Beliefs about nicotine, NRT, and e-cigarettes were asked of all participants; this occurred after message exposure for the nicotine education condition. Bivariate and multivariable analyses examined differences in beliefs by study condition. Brief nicotine messaging increased the probability of a correct response to "Nicotine is a cause of cancer" (false, 63% vs. 36%) and reduced the probability of a don't know response (9% vs. 17%) compared to the no message control condition. Nicotine education also reduced false beliefs about harms of long-term NRT use compared to cigarettes (p < .05). In adjusted models, participants in the nicotine education group had lower mean false beliefs about nicotine (p < .001) and to a lesser extent NRT (p = .053) compared with the control group; there was no difference in mean false beliefs about e-cigarettes (p = .547) between groups. A brief education intervention produced similar changes in nicotine beliefs in adults with past-month extra-medical opioid use as in a general adult sample. Findings support the potential for impact of nicotine public education messaging in vulnerable populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This study examined the impact of COVID-related disruptions on mental health and substance use in young people residing in a state with an initially lower COVID burden and earlier reopening of in-person learning than other states.Data come from Waves 3 (Fall 2019) and 4 (Fall 2020) of the Policy and Communication Evaluation (PACE) Vermont, an online cohort study of adolescents (ages 12-17) and young adults (ages 18-25). Participants in Wave 4 (212 adolescents; 662 young adults) completed items on COVID-related stressors, the impact of the pandemic on their substance use, brief mental health scales, and past 30-day substance use. Analyses examined correlational and longitudinal relationships between COVID-related stressors, mental health symptoms, and substance use.More than 60% of participants noted negative effects of the pandemic on their physical, emotional, and social well-being, with greater impacts of COVID-related stressors in young adults than adolescents. There were significant increases in depressive (OR 1.31, 95% CI 1.03, 1.66) and anxiety symptoms (OR 1.34; 95% CI 1.10, 1.64) in young adults between Fall 2019 and Fall 2020. Higher overall COVID Impact scores were associated with higher odds of depressive and anxiety symptoms, as well as past 30-day electronic vapor product use, in adjusted cross-sectional and longitudinal models.Robust associations between COVID-related distress, mental health, and substance use outcomes in young people signal the opportunity to increase evidence-based interventions while adding novel approaches to minimize longer-term harms of the pandemic on mental health in adolescents and young adults.

OBJECTIVE Hookah tobacco use among young adults may be driven by misperceptions of health harms and addictiveness, appealing flavors, and social use. This study examined the effects of hookah prevention messages on participants' cognitive and emotional processing in a lab setting. METHOD One hundred twenty participants (61 susceptible never-users, 59 current users) were exposed to messages representing six categories: health risks only, health risks of social use, health risks of flavors, addiction risks only, addiction risks of social use, and addiction risks of flavors. Guided by the Limited Capacity Model of Motivated Mediated Message Processing, participants' psychophysiological responses (heart rate, skin conductance, facial action coding) were recorded while participants viewed the messages. Recognition memory and counterarguing were measured postexposure. RESULTS The combination of heart rate, skin conductance, both positive and negative facial action coding, and recognition memory indicated that social themed messages were more defensively processed than the other message types. Addiction-social messages, in particular, were least likely to be encoded. Further, defensive processing indicated by the psychophysiological and recognition data did not vary according to user status. Counterarguing was higher for users than for never-users across all message themes and risks. DISCUSSION Messages about health risks and addiction, whether or not they included information on flavors, evoked relatively similar responses. But social themed messages stand out as potentially problematic, especially addiction-social messages. Using psychophysiological and self-report measures extend opportunities to identify optimal hookah tobacco public education message features. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The prevalence of current cigarette smoking is higher in people with disabilities compared to those without. However, little is known about smoking status and trends in smoking by disability functioning domain.Data from the 2015-2019 National Surveys on Drug Use and Health were used to estimate the prevalence of past-month and daily cigarette smoking, former smoking, and nicotine dependence for people with any disability and six disability functioning domains. Logistic regression models estimated the odds of each outcome by disability domain compared to no disability, adjusting for sociodemographic factors.From 2015-2019, the overall prevalence of current cigarette smoking (23.3% vs. 16.7%) and the proportion of those with nicotine dependence (14.6% vs 8.0%) was higher in people with any disability compared to those without (ps 0.001). The prevalence of current cigarette smoking decreased while the prevalence of former cigarette smoking increased from 2015 to 2019 (ps 0.05). People with any disability had higher odds of current smoking (AOR=1.20; 95% CI 1.16, 1.25) and similar odds of former smoking (AOR=1.00; 95% CI 0.95, 1.06) compared to people without disabilities. Odds of current and former smoking varied by domain.The prevalence of cigarette smoking among people with any disability decreased over time but remained higher than those without. People with any disability had similar odds of former smoking, though differences existed by disability domain. Future research should explore additional smoking and quit behaviors by disability functioning domain.

The prevalence of cigarette smoking in young adults is higher among those with socioeconomic disadvantage than those without. Low treatment-seeking among young adult smokers is compounded by few efficacious smoking cessation interventions for this group, particularly socioeconomically-disadvantaged young adults (SDYA) who smoke cigarettes. The goal of this study was to test a tailored smoking-cessation intervention for SDYA. 343 SDYA aged 18-30 living in the U.S. (85% female) who smoke cigarettes with access to a smartphone and interest in quitting smoking in the next six months were recruited online in Spring 2020 and randomized to referral to online quit resources (usual care control; n = 171) or a 12-week tailored text message smoking-cessation program with a companion web-based intervention (n = 172). Intent to treat analyses examined associations between study condition, self-reported 30-day point prevalence abstinence (PPA), and confidence to quit smoking at 12 weeks, controlling for potential confounders. Intervention group participants had greater self-reported 30-day PPA at 12-weeks than controls (adjusted relative risk 3.93, 95% CI 2.14-7.24). Among those who continued smoking, the intervention increased confidence to quit (0.81 points, 95% confidence interval 0.08-1.53). Weekly engagement in the intervention predicted greater cessation. A tailored text message intervention for SDYA increased smoking abstinence and confidence to quit at the end-of-treatment. Findings may have been influenced by recruitment at the start of the COVID pandemic but suggest that text messaging is an acceptable and efficacious cessation strategy for SDYA smokers. Future studies should examine the impact on longer-term smoking-cessation and importance of intervention tailoring for SDYA.

IntroductionThe FDA announced its intention to issue proposed product standards banning menthol as a characterizing flavor in cigarettes and cigars. The public health benefits of these product standards may be attenuated by the role of plausible substitutes in the marketplace. Therefore, the present study examined the addiction potential of plausible combustible menthol alternatives compared to usual brand menthol cigarettes (UBMC).MethodsEighty adult menthol cigarette smokers completed four visits, smoking their UBMC at the first session and 3 menthol cigarette alternatives in random order at the subsequent visits: 1) a pre-assembled menthol roll-your-own cigarette using menthol pipe tobacco and mentholated cigarette tube (mRYO), 2) a menthol filtered little cigar (mFLC), and 3) a non-menthol cigarette (NMC). Measures of smoking topography, exhaled carbon monoxide (CO), craving and withdrawal, subjective effects, and behavioral economic demand indices were assessed.ResultsCompared to UBMC, menthol cigarette alternatives resulted in similar topography and CO exposure but significantly lower levels of positive subjective experience and behavioral economic demand indices. Among the alternative products, participants reported the highest level of positive subjective experience and higher demand for mRYO, compared with mFLC and NMC. Similarly, participants were significantly more likely to want to try again, purchase, and use the mRYO product regularly compared with mFLC and NMC.Conclusions and RelevancemRYO cigarettes were the most highly rated cigarette alternative among study products, suggesting their potential appeal as a menthol cigarette substitute and needed inclusion of menthol pipe tobacco and cigarette tubes in FDA’s proposed ban.What is already known on this topicMenthol cigarettes are associated with increased smoking initiation, higher nicotine dependence, and decreased adult cessation, particularly among vulnerable populations. To address this public health issue, the FDA announced in April 2021 its intention to issue product standards banning menthol as a characterizing flavor in both cigarettes and cigars within a year. However, the public health benefits of these product standards may be attenuated by the role of plausible substitutes available in the marketplaceWhat this study addsIn this randomized cross-over design study that included 80 adult menthol cigarette smokers, each of the alternative products demonstrated the ability to significantly reduce nicotine craving and withdrawal symptoms, but the combination of mentholated pipe tobacco and tubes in a menthol roll-your-own cigarette, resulted in the highest behavioral economic demand and positive subjective experience.How this study may affect policyTo maximize the benefits of a menthol cigarette ban, restrictions should extend to plausible substitutes, particularly menthol pipe tobacco and cigarette tubes.

Background: Determine the overall, sex-, and racially/ethnically-appropriate population-level cotinine and total nicotine equivalents (TNE-2, the molar sum of the two major nicotine metabolites) cut-points to distinguish tobacco users from nonusers across multiple definitions of use (e.g., exclusive vs. polytobacco, and daily vs. non-daily). Methods: Using Wave 1 (2013–2014) of the U.S. Population Assessment of Tobacco and Health (PATH) Study, we conducted weighted Receiver Operating Characteristic (ROC) analysis to determine the optimal urinary cotinine and TNE-2 cut-points, stratified by sex and race/ethnicity. Results: For past 30-day exclusive cigarette users, the cotinine cut-point that distinguished them from nonusers was 40.5 ng/mL, with considerable variation by sex (male: 22.2 ng/mL; female: 43.1 ng/mL) and between racial/ethnic groups (non-Hispanic other: 5.2 ng/mL; non-Hispanic black: 297.0 ng/mL). A similar, but attenuated, pattern emerged when assessing polytobacco cigarette users (overall cut-point = 39.1 ng/mL, range = 5.5 ng/mL–80.4 ng/mL) and any tobacco users (overall cut-point = 39.1 ng/mL, range = 4.8 ng/mL–40.0 ng/mL). Using TNE-2, which is less impacted by racial differences in nicotine metabolism, produced a comparable pattern of results although reduced the range magnitude. Conclusions: Because of similar frequency of cigarette use among polytobacco users, overall cut-points for exclusive cigarette use were not substantially different from cut-points that included polytobacco cigarette use or any tobacco use. Results revealed important differences in sex and race/ethnicity appropriate cut-points when evaluating tobacco use status and established novel urinary TNE-2 cut-points. Impact: These cut-points may be used for biochemical verification of self-reported tobacco use in epidemiologic studies and clinical trials.

Since 2017, the Vermont Tobacco Control Program (VTCP) has worked to reduce the impact of flavored tobacco products on Vermonters. With the proposed U.S. Food and Drug Administration (FDA) rules banning menthol cigarettes and flavored cigars and proposed legislation banning sales of all menthol and flavored tobacco products in Vermont, VTCP prioritized resources to support cessation among Vermonters who use menthol tobacco products. In March 2021, VTCP began offering a tailored quitline protocol for adults who use menthol tobacco, including financial incentives, for completed coaching sessions. From March 2021 to May 2022, 66 quitline callers enrolled in the menthol incentive protocol, representing 8% of all quitline callers and 25% of participants in the state’s quitline incentive programs. A greater proportion of callers in the menthol incentive program completed three or more quitline calls (58% vs. 38%) and enrolled in phone and text support (61% vs. 32%). Quitline callers enrolled in any incentive protocols (menthol, Medicaid/uninsured, or pregnant) were more likely to request one or two forms of nicotine replacement therapy (NRT). Quitlines remain an effective, evidence-based method of tobacco cessation, especially in reaching vulnerable populations. Given the targeted marketing of menthol brands to Black and African American populations, LGBTQ+ populations, youth, and neighborhoods with lower incomes, addressing menthol cigarette use is key to improving health equity and health of Vermonters. Early data indicates that the use of financial incentives can increase engagement with a state quitline among menthol tobacco users through greater completion of cessation coaching calls, enrollment in text message support, and NRT usage.

More than 10% of U.S. young adults have smoked waterpipe tobacco in the past month and25% of those who have never smoked are susceptible. We tested messages designed to prevent and reduce waterpipe tobacco smoking (WTS).In 2020, we recruited 830 U.S. young adults (18-30 years) who had never smoked waterpipe tobacco and were susceptible or currently smoked waterpipe tobacco for an online study. We randomized participants to intervention messages about the risks of WTS or control messages unrelated to tobacco. Participants had up to four message exposures over 12 weeks and completed two-, four-, and six-month follow-ups. Outcomes were WTS initiation and curiosity (susceptible never smokers), WTS frequency, cessation, motivation to quit (those who currently smoked), and WTS risk perceptions.Intervention messages increased perceived addictiveness of WTS at two months (β = 0.27; 95% CI: 0.11, 0.43) in susceptible never smokers. There were no significant intervention effects in those who currently smoked. Exploratory analyses among intervention participants showed that higher dose of message exposure decreased WTS initiation at six months in susceptible never smokers (RR = 0.68; 95% CI: 0.48, 0.96) and decreased WTS frequency (IRR = 0.84; 95% CI: 0.73, 0.97) and increased cessation (RR = 1.31; 95% CI: 1.07, 1.59) at six months in those who smoked.Although the WTS intervention messages had few significant effects on outcomes overall, a higher dose of message exposure affected behavioral outcomes in the intervention arm. Findings highlight the need to identify effective message content and optimal message dose, especially for digital media campaigns.

IntroductionPeople with disabilities have a higher prevalence of cigarette smoking than people without disabilities. However, little information exists on smoking cessation interventions tailored to address the unique needs of people with disabilities. This paper describes a systematic review protocol to identify and evaluate tobacco smoking cessation interventions designed to improve outcomes for people with disabilities.Methods and analysisWe will conduct a systematic review of the literature using the procedures outlined by Cochrane. We will search four electronic databases (CINAHL Plus (EBSCO), Embase (Ovid), Medline (Ovid) and PsycINFO (Ovid)) with no date restriction to identify tobacco cessation interventions tailored to meet the needs of people with disabilities. We will extract data and assess risk of bias using the RoB2 and ROBINS-I for included studies using Covidence systematic review software. Quantitative and qualitative syntheses will summarise key study characteristics and outcomes with text, tables and forest plots; a meta-analysis will be conducted, if appropriate.Ethics and disseminationEthical approval is not required as there are no primary data associated with the study. Data will be disseminated through a peer-reviewed articles and conference presentations.PROSPERO registration numberCRD42022337434.

INTRODUCTION: Most adults who use electronic cigarettes (ECs) also smoke combustible cigarettes (CCs). Quitting ECs appears common among dual users but little is known regarding adult dual users' motivations and methods to quit ECs or how this relates to quitting CCs. METHODS: We used Amazon Mechanical Turk, a web-based crowd-sourcing service, to survey 366 US adults with a history of regular EC and CC use. This analysis examined motivations and methods to quit both products among a subset of 204 (55.7%) respondents with dual use and a history of one or more attempts to quit ECs. RESULTS: Most respondents (95%) were using ECs at the time of this survey and had a lifetime median of five EC quit attempts. The most common motivations to quit ECs were health (74%), money/cost (45%), and to reduce risk of COVID-19 (25%). The most common EC quit methods were cutting down (68%), getting advice from a doctor (28%), quitting 'cold turkey' (24%), nicotine replacement therapy (24%), and switching to ECs with less nicotine (24%). Most motivations and methods to quit ECs and CCs were moderately to highly correlated, suggesting similarity in dual users' approach to quitting the two products. CONCLUSIONS: Dual users had a range of motivations and methods to quit ECs, most of which were similar to their motivations and methods to quit CCs. These findings support the need to develop treatment for adults motivated to quit ECs and demonstrate that dual users may currently engage in similar strategies to quit both products.

Individuals with opioid use disorder (OUD) have high prevalence of smoking and poor cessation outcomes. Data suggest that smokers with OUD may experience heightened nicotine reinforcement and more severe tobacco withdrawal compared to smokers without OUD. The Food and Drug Administration is currently considering reducing the nicotine content of cigarettes to reduce smoking prevalence and smoking-related disease. It is critical to understand the effects of reduced nicotine content cigarettes (RNCCs) on tobacco withdrawal in this subgroup. In this secondary analysis, we investigated the ability of RNCCs to attenuate acute tobacco withdrawal and craving severity in smokers with OUD versus those without substance use disorders (SUDs). Smokers maintained on methadone or buprenorphine (opioid-maintained [OM]; n = 65) versus without other SUDs (i.e., non-SUD; n = 135) completed 5 laboratory sessions wherein they smoked their usual brand (UB) or a research cigarette varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g of tobacco) under double-blind, acute abstinence conditions. Participants completed the Minnesota Tobacco Withdrawal Scale, including a desire to smoke (craving) item, before and every 15 min for 1 hr following smoking each cigarette. Tobacco withdrawal and craving did not differ significantly by OM status in response to UB or RNCCs. In addition to the Dose × Time interaction, greater depression and cigarette dependence consistently predicted withdrawal and craving (ps < .05). Across all cigarettes, tobacco withdrawal and craving did not significantly differ by OM status, suggesting that smokers receiving opioid agonist treatment may respond favorably to RNCCs. Additional studies with larger and more diverse samples are needed to address this question more definitively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

ObjectiveTo explore the feasibility and utility of a tolerance break (T-Break) guide on young adults’ cannabis use.ParticipantsYoung adults aged 18-29 (n=125) who were current cannabis users.MethodsParticipants recruited through posters and listservs at various universities were offered the T-Break Guide—daily activities, advice, and encouragement—to help complete a 21-day cannabis break. Bivariate analyses examined associations between Guide use and follow-up measures.ResultsCompared to non-Guide users, participants who used the Guide “a lot” were more likely to complete the 21-day abstinence break (84% vs. 57%), revise their personal definition of balance to mean less cannabis (84% vs. 62%), and plan a future break (32% vs. 11%).ConclusionUse of this self-directed Guide may help young adults take a break from cannabis use and reduce future use. Further research using more rigorous designs to test the Guide’s efficacy and assess longer-term maintenance of effects is needed.

IntroductionAlthough the Food and Drug Administration banned other characterising flavours in cigarettes, menthol cigarettes are still available to consumers. Young adult new smokers are initiating with menthol cigarettes, such that the prevalence of young adults menthol versus non-menthol smokers is increasing. Experimentation with menthol cigarettes is associated with progression to regular smoking and nicotine dependence. This ongoing clinical trial in young adult smokers measures appeal and the reinforcing value of smoking menthol versus non-menthol cigarettes and the impact of these variables on changes in smoking behaviour at a 6-month follow-up.Methods and analysisReinforcement for menthol smoking is assessed in the laboratory using a validated behavioural economic choice task, and appeal is measured in the natural environment using ecological momentary assessment (EMA). Analyses will examine differences between menthol and non-menthol cigarette smoking on measures of subjective response in the laboratory and via EMA, and how subjective response mediates the association between menthol preference at baseline and smoking outcomes at follow-up.Ethics and disseminationThis protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#10581). The findings will isolate the unique effects of menthol in smoking and will help inform regulatory decisions about the abuse liability of menthol cigarettes. Findings will be disseminated through peer-reviewed journal articles and presentations at national and international conferences.Trial registration numberNCT03953508.

For the first time since Congress authorized the U.S. Food and Drug Administration (FDA) to regulate tobacco in 2009, FDA proposed two tobacco product standards on May 4, 2022. After a period of public comment and agency review, if the product standards are finalized in their current form, they will ban menthol cigarettes (U.S. Food and Drug Administration, 2022b), which comprised 37% of the U.S. cigarette market in 2019 and 2020 (Federal Trade Commission, 2021), and flavored cigars (U.S. Food and Drug Administration, 2022a), which have exceeded 50% of cigar sales since 2012 (Delnevo et al., 2021b). This commentary examines potential challenges to banning flavored cigars and highlights issues FDA and Congress should consider.

OBJECTIVE: This study aimed to identify subgroups of adults based on comorbid psychiatric conditions and to examine the correlation with current smoking. METHOD: The National Epidemiologic Survey on Alcohol and Related Conditions-III, 2012-2013, sampled, recruited, and assessed 36,309 adults, with interviews on drug use and other characteristics. The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-5 Version (AUDADIS-5) was used to identify psychiatric conditions. Latent class models were developed based on various psychiatric diagnoses. Multinomial logistic regression estimated the significance of covariates in predicting class membership. RESULTS: Four latent classes optimally distinguished the population: no comorbid conditions (63%), comorbid affective disorders (16%), those with alcohol use disorder (17%), and a highly comorbid subgroup (i.e., co-occurring affective and substance use disorders; 4%). Current smoking was about twice as prevalent in the classes defined by psychiatric conditions compared to the group with no comorbid conditions. The highly comorbid class was more likely to be current smokers than the comorbid affective disorders class and the alcohol use disorder class. Furthermore, the highly comorbid class was younger and had lower income, and the alcohol use disorder class had a higher proportion of males than the other classes. CONCLUSIONS: Cigarette smoking was higher in the nearly 40% of respondents characterized by psychiatric disorders, particularly those with substance use disorders. Correlates of membership in these classes were consistent with known vulnerabilities for smoking, highlighting the need for mental health interventions and future research to explicitly address tobacco cessation in clinical settings based on psychiatric diagnoses.

CONTEXT: Recent data suggest that the onset of cigarette smoking is now more likely during young adulthood than adolescence. Additionally, the landscape of delivering smoking-cessation interventions has changed in the past decade, with the emergence of mobile phone and web-based approaches. The objective of this study is to update a 2010 systematic review of smoking-cessation interventions for U.S. young adults (aged 18–24 years). EVIDENCE ACQUISITION: Electronic searches were conducted in CINAHL, the Cochrane Library, EMBASE, PsycInfo, PubMed, Scopus, and Sociological Abstracts to identify eligible interventions from August 31, 2009 through July 17, 2019. Two independent coders critically evaluated the methodology and findings of all retrieved articles. Data analysis was conducted in 2019. EVIDENCE SYNTHESIS: Seventeen RCTs and one non-randomized study were added to the original 14 studies meeting the inclusion criteria for this review; these studies varied with respect to sample size, intervention, assessed outcomes, and smoking measures. Of the new studies, three increased cessation in the short term, two at 6 months, and one had short-term effects on cigarette reduction. Pooled analyses supported the use of interventions employing social cognitive theory, quitline counseling, and text message programs for short-term cessation in young adults. CONCLUSIONS: Of 32 included studies, nine demonstrated efficacy of smoking cessation or reduction in U.S. young adults. There were no eligible pharmacologic interventions included in this review. Findings support the promise of three approaches for young adult cessation not included in the prior review: text message interventions, sustained quit-and-win contests, and multiple behavior interventions.

Introduction Flavored electronic nicotine delivery systems (ENDS) and tobacco products are associated with the initiation and progression of tobacco use. With recent restrictions around flavored products, it is critical to measure both the product and the flavor being used. The Tobacco Centers of Regulatory Science (TCORS) Flavored Tobacco Products Measurement Subcommittee (FTPMS) was established to develop core measures to assess flavored tobacco and ENDS product usage, facilitate data harmonization, replicability, and comparisons across studies. Aims and Methods The FTPMS used a mixed-method approach to inform the development of recommended measures (first use, current use, reasons for use) to assess tobacco and ENDS product flavors. This included reviewing existing surveys, identifying priority areas, developing new measures, cognitive testing, and finalization of recommended measures. Results Recommended measures were selected from national surveys (e.g. PATH study) and survey items used in TCORS studies to evaluate first use, current use, and reasons for use of tobacco and ENDS products. Response options were expanded for questions about specific flavors and adapted to allow for assessments relevant to recent federal policies. Supplemental measures were developed for researchers conducting more in-depth research around flavored products. Conclusions Using an expert consensus process supplemented with cognitive testing, the FTPMS developed recommendations for core and supplemental measures for flavored tobacco and ENDS products. Harmonizing data on these factors for flavored tobacco and ENDS products are critical for researchers and may provide actionable evidence to federal, state, and local regulators and policymakers, as well as support evaluations of policies restricting flavors in these products. Implications The development of core measures to assess first use, current use, and reasons for use of flavored tobacco and ENDS products will facilitate data harmonization, replicability, and comparisons across studies conducted in different samples or across communities with varying levels of regulation for these products. Use of these standardized measures will allow for a greater understanding of the role of flavors and helps to build a more robust evidence base to inform regulatory decisions to reduce tobacco and ENDS use at the population level.

Background Pervasive misperceptions about nicotine may influence uptake of quit smoking aids and the impact of policies addressing nicotine as a tobacco product constituent. Methods Latent class analyses were conducted using four items on nicotine beliefs asked of 4037 adults aged 18–40 in wave 9 (February–March 2016) of the Truth Initiative Young Adult Cohort Study. Confirmatory factor analyses identified three factors from 12 items: nicotine susceptibility (NSUS), nicotine severity (NSEV), and tobacco severity (TSEV). Analyses assessed correlations between latent classes, sociodemographics, and nicotine/tobacco factor scores. Results A four-class model of nicotine beliefs was the best fit, with the largest class believing that nicotine plays a major part in smoking risks (class 1, n = 2070; 52%). Class 2 shared that belief but also responded “Don’t know” to addiction questions (class 2, n = 382; 11%). Fewer belonged in class 3, who reported that nicotine plays a small part in health risks (n = 1277; 30%), and class 4, who perceived nicotine as not cancer causing (n = 308; 7%). Latent class membership was correlated with sociodemographics, peer smoking, and past 30-day tobacco use. Classes 1 and 2 had similar NSUS scores and classes 3 and 4 had similar NSEV and TSEV scores. Discussion Differences in the perceptions of nicotine and tobacco-related harms can be partially explained by clustering of underlying nicotine beliefs. These classes of beliefs are correlated with sociodemographic predictors of smoking. These findings may help to identify specific beliefs or groups to be targeted by public education efforts on nicotine. Implications The current study supports that underlying nicotine beliefs are associated with perceived harms of specific nicotine and tobacco products (relative to cigarettes), with greater false beliefs about nicotine correlated with greater perceived susceptibility to nicotine addiction. Two important inferences emerge from this study: first, that education to address nicotine beliefs may also reframe perceptions of the harms of nicotine and tobacco products; and second, that this type of education may differentially impact perceptions of the harms of nicotine products (e.g., nicotine replacement therapy and e-cigarettes) and tobacco products (e.g., cigars, smokeless, and hookah).

Introduction The Food and Drug Administration announced intent to reduce the nicotine content in cigarettes. There is limited evidence on how reduced nicotine content cigarette (RNC) marketing affects product beliefs and use, and research on this is needed to inform regulations. Methods In an online experiment, 426 young adult cigarette smokers (aged 18–30 years) were randomized in a 2 (implicit: red package vs. blue package) × 2 (explicit: corrective message vs. no corrective message) design to view an advertisement for previously commercially available RNCs. Outcomes were advertisement content recall, product beliefs, and use intentions. Participants’ responses to open-ended assessment of their beliefs about the stimuli were coded to identify prevailing themes. Results Red packaging and corrective messaging were independently associated with greater advertisement content recall (p = .01 and p = .04, respectively). There were no significant main or interaction effects on product beliefs or use intentions. Controlling for condition, advertisement content recall was significantly associated with less favorable product beliefs (p < .001) and favorable product beliefs were associated with intent to use the product (p < .001). Open-ended responses converged on the finding that respondents were interested in RNCs, but expressed skepticism about effectiveness and value. Conclusions Brief exposure to an RNC advertisement with red packaging and corrective messaging were each independently associated with greater advertisement content recall. The results indicate: (1) interest and confusion among young adult smokers regarding RNCs, (2) beliefs about RNCs are influenced by marketing, and (3) beliefs are associated with intention to use RNCs. Implications Findings from this study demonstrate the importance of advertising effects on beliefs about RNC products and support the need to regulate advertising and labeling alongside product regulation. More detailed study of advertisement features that affect consumers’ beliefs about RNCs and how they impact their processing of explicit messaging about product risks will be important to guide regulatory decision-making.

Introduction: Given the prevalence of electronic vapor product (EVP) use among young people in the US, there is a need for effective vaping education campaigns. This study tested 32 images for liking and perceived effectiveness (PE) to identify optimal images for a messaging campaign. Method: Images were selected from current campaigns, warning labels, and other images based on young adult reasons for use. Images were coded for the presence of (1) people, (2) vapor, (3) device, (4) color, and (5) similarity to warning label image. Young adults (n = 200) were recruited from the Amazon Mechanical Turk platform. Participants were randomly assigned to view and rate six of the 32 images on liking as well as PE, which measured the potential impact of the image to discourage vaping appeal and use. Results: Images containing vapor and/or a device or e-liquid were not well-liked but were perceived as effective in discouraging vaping (ps < 0.05). Images from warning labels were also not well-liked but were perceived as significantly more effective than those not from a warning (p < 0.01). Liking and effectiveness of features was similar for both EVP users and non-users. Discussion: Images with specific features were rated as less likable but rated as higher on PE. However, the consistency of image features rated as effective by EVP users and non-users supports the utility of similar imagery for vaping prevention and reduction efforts.

Background: Waterpipe (i.e., hookah) tobacco smoking (WTS) is one of the most prevalent types of smoking among young people, yet there is little public education communicating the risks of WTS to the population. Using self-report and psychophysiological measures, this study proposes an innovative message testing and data integration approach to choose optimal content for health communication messaging focusing on WTS. Methods: In a two-part study, we tested 12 WTS risk messages. Using crowdsourcing, participants (N = 713) rated WTS messages based on self-reported receptivity, engagement, attitudes, and negative emotions. In an in-lab study, participants (N = 120) viewed the 12 WTS risk messages while being monitored for heart rate and eye-tracking, and then completed a recognition task. Using a multi-attribute decision-making (MADM) model, we integrated data from these two methods with scenarios assigning different weights to the self-report and laboratory data to identify optimal messages. Results: We identified different optimal messages when differently weighting the importance of specific attributes or data collection method (self-report, laboratory). Across all scenarios, five messages consistently ranked in the top half: four addressed harms content, both alone and with themes regarding social use and flavors and one addiction alone message. Discussion: Results showed that the self-report and psychophysiological data did not always have the same ranking and differed based on weighting of the two methods. These findings highlight the need to formatively test messages using multiple methods and use an integrated approach when selecting content.

People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use.Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type.Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95).People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities.

Aim While accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic. Methods A web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (eg social distancing, mask wearing) were examined. Results Among 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9 ± 1.0 versus 11.6 ± 1.0; p < .001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4 ± 1.4 to 13.3 ± 1.4, p = .024) as did those with higher levels of anxiety (from 11.5 ± 1.1 to 13.6 ± 1.1, p < .001). Conclusions Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use. Implications Individuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.

Objectives: Philip Morris International's heated tobacco product, Marlboro IQOS, is available internationally and soon will be marketed in the United States (US). We examined correlates of curiosity, interest, and likelihood to use IQOS among US young adults. Methods: Young adults ages 18-30 years (N = 346) were recruited online, viewed a description of IQOS, and completed measures of socio-demographic characteristics, perceived risks, curiosity, interest, and likelihood to use IQOS. Results: Males had greater curiosity, interest, and likelihood to use IQOS than females. Individuals with household income of $50,000-$75,000 were more curious than those with household income of greater than $75,000. Cigarette smokers, e-cigarette and dual users had greater curiosity, interest, and likelihood of use than non-tobacco users. Non-white individuals and older young adults had greater likelihood of use. Greater perceived risks of IQOS were negatively associated with curiosity, interest, and likelihood of use. Conclusions: Among young adults, IQOS has greater appeal among males, non-whites, those who are older, those with household income of $50,000-$75,000, cigarette smokers, e-cigarette and dual users, and those with fewer perceived risks of IQOS. Research on public education communicating the potential risks of IQOS to vulnerable young adults is warranted.

IntroductionThe Food and Drug Administration (FDA) announced its intention to reduce the nicotine content in cigarettes as a strategy to promote cessation and reduce smoking-related harm. A low nicotine product standard will apply to all cigarettes on the market, including menthol cigarettes. In December 2021, the FDA approved a modified risk tobacco product application for menthol and non-menthol flavoured very low nicotine cigarettes (VLNC) from the 22nd Century Group. Notably, experimentation with menthol cigarettes is linked to smoking progression, as well as greater nicotine dependence relative to non-menthol cigarette use. If menthol VLNCs are perceived as more appealing than non-menthol VLNCs, this would indicate that some aspect of menthol may maintain smoking even in the absence of nicotine and FDA’s regulatory authority to ban or restrict the sale of menthol cigarettes should apply to reduced nicotine content of cigarettes. In April 2022, the FDA announced proposed rulemaking to prohibit menthol cigarettes, however it is unclear if a menthol prohibition would apply to VLNCs.Methods and analysisThis study will recruit 172 young adult menthol smokers (with a specific subsample of n=40 sexual and gender minority young adults) and measure appeal for smoking experimental menthol and non-menthol VLNCs, and the impact of proposed product standards on tobacco product purchasing behaviour using an Experimental Tobacco Marketplace. Appeal across product standards will be assessed in a controlled laboratory and using ecological momentary assessment.Ethics and disseminationThe protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#11865). Findings will examine the effects of a reduced nicotine standard and a menthol ban on young adult smoking and will be disseminated through peer-reviewed journal articles and presentations at scientific conferences.Trial registration numberNCT04340947.

Youth have been the focus of electronic vapor product (EVP) prevention efforts though young adults had similar increases in current EVP use from 2015–2019. This study tested messages to reduce EVP use in young adults. Eight messages on vaping related harms and addictiveness combined with themes on social use and flavors were selected for inclusion in an online randomized controlled trial. Vermont young adults aged 18–24 (n = 569) were randomized to view the eight vaping prevention messages (n = 295) or eight messages on sun safety (n = 274). After completing baseline measures, participants viewed study messages and completed measures on message perceptions and perceived message effectiveness (PME), EVP-related beliefs, and EVP-related harm perceptions. Participants completed EVP-related beliefs and harm perception measures again at 1-month follow-up, as well as measures on tobacco and EVP-related behavioral intentions and behavior (ever and past 30-day use). Intervention participants reported positive impacts on vaping-related message responses. However, findings suggested no effect of vaping prevention messages on EVP-related beliefs, harm perceptions, or behaviors in the full sample. Exploratory analyses in the intervention condition showed that greater PME was associated with lower odds to intent to try cigarettes in the next year at follow-up.

Introduction The heterogeneity of e-cigarette products and e-liquids pose challenges to surveillance of e-cigarette exposure. The goal of this study was to evaluate the internal consistency of e-cigarette use frequency, quantity, and duration measures in a national population-based survey. Methods Data were drawn from the 2012–2013 for the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309; NESARC-III). Adults who used e-cigarettes/e-liquid during the past year (≤18 years old; n = 1,229) were asked about their age of first use, recency of use, quantity (i.e., cartridges, drops), nicotine concentration, and duration (hours). Several internal consistency parameters were compared for e-cigarette measures in past-year (n = 750) and past 30-day e-cigarette users (n = 472) overall, and by frequency of use (i.e., infrequent [≤3 days/month], non-daily [1–6 days/week], daily). Results There were no significant differences in quantity, nicotine concentration, or duration by frequency of use in past 30-day e-cigarette users. One-third of past 30-day and almost half of past-year users did not know the nicotine concentration of their cartridge or e-liquid. Correlations between all e-cigarette use measures were low, with the highest correlations seen between e-liquid quantity and cartridge quantity in all past 30-day users (r = 0.28) and those reporting any e-liquid use (r = 0.40). Cronbach's alpha and mean interitem correlations were low across all user groups. Conclusions Low to moderate correlation across e-cigarette measures in e-cigarette users implies low internal consistency of these measures in a population survey. Findings suggest measures such as quantity and nicotine concentration might more appropriate in samples of recent experienced e-cigarette users than in general population samples.

INTRODUCTION: The current study pilot tested the effect of a single, brief exposure to nicotine education messages on beliefs about nicotine, nicotine-replacement therapy (NRT), e-cigarettes, and cigarettes with reduced nicotine content (RNC). METHODS: Five hundred twenty-one U.S. adults (aged ≥18 years) on Amazon Mechanical Turk completed a 15-minute survey in 2018. After completing items on sociodemographics, literacy, and cancer risk behaviors, participants were randomized in a 2:1:1 ratio to one of three conditions: nicotine education (n=263), sun safety education (attention control, n=128), or no message control (n=130). All participants completed items regarding nicotine, NRT, e-cigarette, and RNC cigarette beliefs, as well as norms about nicotine use, behavioral control regarding cigarette/tobacco use, and intention to use cigarettes, NRT, e-cigarettes, and RNC cigarettes in the next 12 months. Analyses were conducted in 2019. RESULTS: Following exposure, nicotine education participants reported fewer false beliefs about nicotine (p

OBJECTIVE: Marijuana use is associated with negative cognitive and health outcomes and risky driving. Given the rapidly changing policies regarding legal recreational and medicinal marijuana use, it is important to examine what types of marijuana prevention messages may be effective in minimizing such outcomes. This study examined cognitive and affective responses to anti-marijuana public health messages in a sample of adult marijuana users and nonusers to determine the correlates of perceived message effectiveness. METHOD: Participants (N = 203; mean age = 37.7 years) were adult marijuana users and nonusers recruited via Amazon Mechanical Turk (August 2017). After completing self-report measures of marijuana use, they viewed six anti-marijuana messages presented in a random order, addressing marijuana’s effects in each of three topic areas: cognitive performance, driving, and adverse health outcomes (e.g., two messages per topic). Participants completed assessments of cognitive and affective perceptions after viewing each message. For each message topic, a linear regression model was used to determine which cognitive and affective perceptions were most predictive of perceived message effectiveness. RESULTS: For all message topics, nonusers perceived the messages as more effective than did users (p < .001). In the majority of analyses, greater message effectiveness was associated with increased perceived harm of marijuana and increased liking of the message. For driving and health messages, greater message effectiveness was also significantly correlated with lower pleasant affect. CONCLUSIONS: The findings suggest that audience perceptions may be uniquely predictive of message effectiveness, depending on the topic.

BACKGROUND: In the United States (US), electronic cigarette (e-cigarette) use prevalence has increased since 2010. Few studies, however, have addressed frequency of use at the population-level. This study examines patterns and correlates of e-cigarette use frequency in a novel national sample. METHODS: Data were from 36,277 US adults interviewed between 2012 and 2013 for the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Sociodemographic characteristics, other tobacco/drug use, and psychiatric disorders were compared by e-cigarette use status (i.e. current [past-month], past, never) and e-cigarette use frequency (i.e. infrequent [≤3 days/month], moderate [1–6 days/week], daily). Multinomial logistic regression models compared correlates of e-cigarette use status and e-cigarette use frequency. RESULTS: Current e-cigarette use was low in adults (1.4%) and past e-cigarette use was 3.9%. Among current e-cigarette users, 38.1% were infrequent users, 32.9% were moderate users, and 29.0% were daily users. Compared to infrequent e-cigarette users, daily users were more likely to be male and older, but less likely to be current cigarette smokers and alcohol drinkers (p’s < .05). Compared to daily e-cigarette users, moderate users were more likely be female, current cigarette smokers, and fall into the 25–34 age group (p’s < .05). Moderate and daily e-cigarette users had higher prevalence of current extra-medical opioid use than infrequent users (p’s < .05). CONCLUSIONS/IMPORTANCE: E-cigarette users were most often infrequent users versus moderate or daily users. Compared to infrequent and moderate users, daily e-cigarette users were less likely to be current alcohol drinkers or cigarette smokers. Novel findings highlight a correlation between more frequent e-cigarette and opioid use.