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Background: There are no clinical practice guidelines addressing the treatment of tobacco-cannabis co-use and a dearth of studies to inform treatment for co-use. This narrative review aims to (1) summarize promising intervention components used in published co-use treatment studies, (2) describe key gaps and emerging issues in co-use, and (3) provide recommendations and considerations in the development and evaluation of co-use interventions., Methods: We conducted a literature search in June 2024 across several databases to update previous reviews on tobacco-cannabis co-use treatment. We found 9 published intervention studies that specifically addressed treatment for both substances. Data from these studies were manually extracted and summarized., Results: Most of the 9 included studies (1) focused on acceptability and/or feasibility, (2) provided both psychosocial/behavioral and pharmacotherapy intervention components, (3) were conducted in adults, and (4) were delivered in-person, with some having digital asynchronous components, for a 5-to-12-week duration. The most common psychosocial/behavioral strategies used were Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management; while the most common pharmacotherapy was Nicotine Replacement Therapy. There was no evidence of compensatory use of tobacco or cannabis when providing simultaneous treatment for both substances., Conclusions: The literature to date provides support for well-integrated multi-component interventions of psychosocial/behavioral and pharmacotherapy strategies for co-use treatment. This review reinforces an urgent need for treatments targeting tobacco and cannabis co-use. Future interventions should address key gaps, including co-use of vaporized products among youth and young adults, tailored interventions for priority populations, and digital applications to increase reach and advance health equity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Introduction: Many adults who smoke cigarettes report trying e-cigarettes to quit smoking. Understanding the use of e-cigarettes for smoking cessation and the type of support that adults desire when trying to quit smoking is important for supporting cessation attempts and maximizing smoking abstinence., Methods: In summer 2021, an online survey of 857 adults who reported a history of regular cigarette smoking and endorsed using e-cigarettes in a recent smoking cessation attempt was conducted. Survey items assessed reasons for using e-cigarettes to quit smoking, what was helpful about e-cigarettes, and what information participants desired when using e-cigarettes to quit smoking., Results: Common reasons for using e-cigarettes to quit smoking included beliefs that vaping would be helpful for quitting (53.6%), vaping is safer than smoking (50.5%), and favorable comparisons relative to other nicotine replacement treatment (NRT) like nicotine patches and gum (24.7%). 23.8% selected e-cigarettes because they were cheaper than other smoking cessation aids. 89% of participants reported still smoking cigarettes at the time of survey. The most common information people wanted when quitting was advice on how to gradually reduce nicotine over time to become nicotine-free (46.3%), how different vaping devices work (39.7%), and what nicotine concentration to start with (37.7%)., Conclusions: Findings identified common beliefs about e-cigarettes as a smoking cessation aid and how they compare to other treatments including NRT. Understanding factors that support cessation are critical especially due to high relapse rates. Results may help to inform support programs, especially for individuals who are interested in using e-cigarettes to quit smoking., Implications: Despite greater reporting, there is a limited understanding of e-cigarette use for quitting among those who smoke cigarettes.Our study highlights the reasons for using e-cigarettes among those who have recently tried e-cigarettes for quitting smoking, and the components of e-cigarette that were helpful.We also examined the desired support in a program designed to use e-cigarettes for quitting smoking. Majority of participants who attempted to quit smoking using an e-cigarette relapsed to smoking, indicating the gap in cessation support that can be filled with greater understanding of the desired support., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Polysubstance use (i.e., the use of more than one substance) is a major public health concern in the US that disproportionately hinders those from marginalized groups by sexual identity and age. Little research has examined this concern among lesbian, gay, and bisexual (LGB) older adults, and no study has measured past-30 day polysubstance use prevalence among these groups. The objective was to examine polysubstance use among older LGB adults compared to their heterosexual same-age peers and younger LGB counterparts., Methods: We used the National Survey of Drug Use and Health 2021 and 2022 datasets with an analytic sample of 86,254 participants . Past-30 day polysubstance use prevalence was survey-weighted and adjusted by sociodemographic factors. We constructed Weighted multinomial models to compare polysubstance use between older LGB adults (65+ years old) with their same-age heterosexual and younger LGB counterparts., Results: Older Gay/Lesbian adults had a significantly higher polysubstance use prevalence than their heterosexual counterparts (OR = 27.94; p <0.001) while heterosexual participants showed a decline in polysubstance use with age (OR = 0.27; p < 0.001). Polysubstance use among gay/lesbian (OR = 0.67; p = 0.491) and bisexual (OR = 1.04; p = 0.969) older adults did not significantly differ from their younger counterparts., Conclusions: Polysubstance use is a public health concern for older gay/lesbian adults. Interventions are needed to address polysubstance use for older LGB adults, including early detection of polysubstance use and prevention strategies that are age and LGB inclusive., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: Youth e-cigarette use remains a public health concern and many youth want to quit. However, cannabis use is common among youth who use e-cigarettes, which may interfere with nicotine cessation efforts. This study aimed to investigate cannabis use among youth who vape nicotine and are motivated to quit nicotine., Methods: Connecticut youth (N=223, M age  = 17.3 [SD=1.7] years) who completed an intake for a vaping cessation study reported on their nicotine vaping, cannabis products used, reasons for use, frequency of use, and readiness to quit cannabis. Descriptives characterized population. Regressions were used to examine association of cannabis use and nicotine vaping., Results: Most reported cannabis use (lifetime: 92.4 %; past-month: 68.6 %). Cannabis smoking and vaping were highly prevalent (smoking: lifetime - 90.8 %, current - 63.6 %; vaping: lifetime - 90.8 %, current - 63.1 %). Most reported preferring smoking cannabis (58.7 %) over other routes of administration. Common reasons for cannabis use, were psychoactive (e.g., getting high), physical (e.g., improving sleep), and social (e.g., partying). Cannabis use frequency and preferring smoking cannabis (vs. other modes) was positively associated with more frequent nicotine vaping (ps < 0.05). Participants averaged 6.3 (of 10) on a readiness to quit cannabis scale, a moderate desire to quit., Conclusions: Cannabis use across multiple routes of administration was common among youth seeking help quitting vaping nicotine. Heaviness of cannabis and nicotine use appear to be associated, raising interesting harm-reduction challenges for those seeking to quit nicotine vaping. Understanding cannabis and nicotine co-use is important for targeting treatment for use of both substances., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: E-cigarette flavors that produce cooling sensations may reduce nicotine harshness and enhance appeal among youth. While previous research has shown that use of cooling flavors is associated with more frequent vaping among youth, it is unknown whether the same holds true for e-cigarette dependence. This study examines the relationship between cooling flavor use and e-cigarette dependence among youth accounting for vaping frequency., Methods: In Fall 2022, a survey was conducted among Connecticut high school students to assess past-month nicotine e-cigarette use, ever use of cooling flavors, cooling flavor types (e.g., fruit-cooling), and e-cigarette dependence. Analyses were restricted to those with past-month nicotine and nicotine-free e-cigarette use and complete data (n=204). Multivariable linear regressions were run to examine the association between cooling flavor use and e-cigarette dependence, adjusting for demographics, e-cigarette use characteristics, and other tobacco product use., Results: 78.4% of the sample used cooling e-cigarette flavors, with 55.0% using mint-cooling flavors and 52.5% using fruit-cooling flavors. Regression results observed that cooling flavor use was associated with higher e-cigarette dependence (ꞵ=1.53, SE=0.63, p=0.017), with those who used cooling flavors having higher e-cigarette dependence than those who did not (M=5.78 [SD=5.33] vs. 2.84 [3.19])., Conclusions: Our results suggest that cooling flavor use is significantly associated with e-cigarette dependence among youth. While regulations often target menthol flavor, tobacco control agencies should consider restricting any flavor that can produce cooling sensations, even if they are not traditional menthol products, as cooling flavors is associated with youth e-cigarette dependence., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Effective tobacco policies are important for reducing the harm of tobacco use and can have a broad impact at the population level. This review provides an overview of how clinical science can inform tobacco policies with a focus on policies related to flavored tobacco products, using menthol cigarettes as an illustrative example. Specifically, this review summarizes the role of flavors in tobacco use and the history of regulation of flavored tobacco products by the US Food and Drug Administration (FDA), provides an overview of clinical research methods used to contribute to the scientific evidence to inform FDA tobacco policies, discusses key findings related to menthol tobacco products using these methods, and proposes future directions for clinical research. As the tobacco marketplace continues to evolve with new products and flavor chemicals, ongoing clinical science will be essential for establishing evidence-based policies to protect public health and reduce tobacco-related health disparities.

Background: E-cigarette flavors can create sensations of sweetness and coolness while masking the aversiveness of nicotine. Recently, non-tobacco nicotine (NTN) products were introduced to the market, but little is known about flavors in NTN e-cigarette use. We examined associations between flavors (i.e., sweet, mint/menthol) and susceptibility to and use of NTN e-cigarettes., Methods: 1239 US young adults (18-25 years) completed an anonymous, online survey in Fall 2021. The analytic sample included 520 participants who had used e-cigarettes and heard of NTN. Multinomial logistic regression models analyzed associations of flavored e-cigarette use (sweet and mint/menthol) with NTN e-cigarette use status (i.e., current [past-month] use, past [ever but not current] use, susceptible to use, and non-susceptible to use [reference])., Results: Overall, 46.2% of participants reported current NTN use, 14.8% reported past use, 16.7% were susceptible to use, and 22.3% reported no susceptibility. Participants reported dual-use of sweet and mint/menthol NTN e-cigarette flavors (56.5%), sweet flavors use (24.8%), and mint/menthol flavor use (1.7%). Ever dual use of sweet and mint/menthol flavors was associated with current (OR = 9.64, 95%CI: 3.21-28.98) and past NTN e-cigarette use (8.30, [2.10-32.80]). Ever sweet flavor use was associated with current NTN use (3.80, 95%CI: 1.44-10.03) and susceptibility to future use (4.25, [1.53-11.81]). Similar findings were observed for mint/menthol flavors (current: 5.03, [1.41-17.99]; susceptible: 5.65, [1.64-19.51])., Conclusion: The use of sweet and mint/menthol flavors was significantly associated with NTN e-cigarette use among US young adults, highlighting the need for ongoing surveillance of flavored NTN e-cigarettes and appropriate regulations to discourage use., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests or conflicts., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: E-cigarettes are the most-used nicotine product among adolescents, but limited psychometrically-sound, e-cigarette-relevant measures exist for adolescents. We examined psychometric properties of the Self-Report Habit Index (SRHI) for assessing adolescents' habitual e-cigarette use., Methods: During Fall 2022, 4855 students from eight Connecticut high schools completed an anonymous survey. The analytic sample comprised 491 students who reported past-month e-cigarette use and completed the SRHI (Age M=15.94, SD=1.24 years, 56 % female, 37.1 % Hispanic, 57.6 % White). We examined the SRHI's latent factor structure; internal reliability; measurement invariance and between-groups differences (e.g., nicotine vs. nicotine-free vaping); and associations with total e-cigarette flavors used in the past month, past-30-day vaping frequency, and e-cigarette dependence., Results: The SRHI's 6-item, 1-factor structure was confirmed. Internal reliability was excellent. The SRHI was scalar invariant for all subgroups tested. Nicotine (vs. nicotine-free) and daily (vs. non-daily) e-cigarette use were associated with greater habitual e-cigarette use behavior. In adjusted models, habitual e-cigarette use was associated with using more e-cigarette flavors, vaping more frequently, and greater e-cigarette dependence. Habitual e-cigarette use incrementally accounted for variance in past-month flavors used and vaping frequency beyond dependence., Conclusions: The SRHI evidenced solid psychometric properties for assessing habitual e-cigarette use behavior among high school students. Relationships between habitual use and frequency of use, e-cigarette flavors, and dependence might be expected as these constructs are associated with the three characterizing features of habitual behaviors: frequent repetition, cue-driven elicitation, and automaticity. Future prospective research can clarify the temporal ordering of habitual e-cigarette use and dependence in adolescents., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Conceptualizing tobacco dependence as a chronic relapsing condition suggests the need to use analytic strategies that reflect that premise. However, clinical trials for smoking cessation typically define the primary endpoint as a measure of abstinence at a single timepoint distal to the intervention, typically 3-12 months. This reinforces the concept of tobacco outcomes as a dichotomous state-one is, or is not, abstinent. Fortunately, there are several approaches available to handle longitudinal data that reflect the relapsing and remitting nature of tobacco use during treatment studies. In this paper, sponsored by the Society for Research on Nicotine and Tobacco's Treatment Research Network, we present an introductory overview of these techniques and their application in smoking cessation clinical trials. Topics discussed include models to examine abstinence outcomes (eg, trajectory models of abstinence, models for transitions in smoking behavior, models for time to event), models that examine reductions in tobacco use, and models to examine joint outcomes (eg, examining changes in the use of more than one tobacco product). Finally, we discuss three additional relevant topics (ie, heterogeneity of effects, handling missing data, and power and sample size) and provide summary information about the type of model that can be used based on the type of data collected and the focus of the study. We encourage investigators to familiarize themselves with these techniques and use them in the analysis of data from clinical trials of smoking cessation treatment. Implications Clinical trials of tobacco dependence treatment typically measure abstinence 3-12 months after participant enrollment. However, because smoking is a chronic relapsing condition, these measures of intervention success may not accurately reflect the common trajectories of tobacco abstinence and relapse. Several analytical techniques facilitate this type of outcome modeling. This paper is meant to be an introduction to these concepts and techniques to the global nicotine and tobacco research community including which techniques can be used for different research questions with visual summaries of which types of models can be used for different types of data and research questions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: The Electronic Nicotine Delivery Systems (ENDS) industry recently introduced non-tobacco nicotine (NTN), which is not tobacco-derived and is often marketed as "tobacco-free nicotine." Given its novelty, it is important to understand where young adults learn about NTN ENDS. This study examined sources of exposure to NTN ENDS and relationships with NTN ENDS use and susceptibility., Methods: We analyzed online survey data collected in Fall 2021 from 642 young adults (18-25 years) who had heard of NTN ENDS. We assessed 9 sources of NTN ENDS exposure (e.g., retail stores, social media) and examined associations between sources of exposure and NTN current (past-month) use, lifetime (non-current) use, and susceptibility to use, adjusting for demographics and other tobacco product use., Results: Participants reported current NTN ENDS use (37.4%), lifetime use (12.0%), susceptibility (18.5%), or no susceptibility to use (32.1%). The most common sources of NTN ENDS exposure were retail stores (87.7%) and social media (81.0%). Exposure to NTN ENDS via social media was associated with greater odds of current NTN ENDS use (vs. no susceptibility) (aOR = 1.83, 95%CI: 1.02-3.28). Exposure via online streaming platforms was associated with greater odds of current (aOR = 1.75, 95%CI: 1.08-2.82) and lifetime NTN ENDS use (aOR = 2.42, 95%CI: 1.25-4.68)., Conclusions: Young adults were exposed to and learned about NTN ENDS from diverse sources, primarily retail shops and social media. Further, exposure via social media and streaming platforms were associated with NTN ENDS use. Future studies should explore the content of NTN information from various sources to inform prevention efforts., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: To determine whether personalized gain-framed messaging and biomarker feedback related to tobacco cessation or reduction decrease smoking behavior in patients undergoing or eligible for lung cancer screening., Methods: Between 2016 and 2020, 188 patients were enrolled in a two-phase, sequential, randomized controlled trial. Phase 1 evaluated whether standard of care (SC) (five in-person counseling sessions and 8 weeks of nicotine patch) plus gain-framed messaging (GFM) versus SC would increase 8-week biochemically verified smoking cessation rates. In 143 participants randomized in phase 2, we tested whether feedback on smoking-related biomarkers would reduce 6-month self-reported number of cigarettes smoked per day compared with a no feedback control. Chi-square test and mixed effects repeated measures analyses were used to evaluate group differences., Results: Participants were 62.5 ± 5.6 (mean ± SD) years of age, had a 50.3 ± 21 pack-year smoking history, and were smoking 16.9 ± 9.9 cigarettes per day. At 8 weeks, there was no difference in quit rates between those randomized to SC plus GFM (n = 15 of 93, 16.1%) and those randomized to SC (n = 16 of 95, 16.8%), with p equals to 0.90. At the 6-month post-randomization follow-up, number of cigarettes smoked per day was similar in the feedback (least-squares mean = 7.5, 95% confidence interval: 6.0-9.1) and no feedback arms (7.7, 95% confidence interval: 6.2-9.3), with p equals to 0.87., Conclusions: Gain-framed messaging and health feedback did not significantly improve quit rates relative to comprehensive standard of care. Nevertheless, the overall program achieved clinically meaningful smoking quit rates in this older high pack-year cohort, highlighting the importance of intensive tobacco treatment for patients undergoing lung cancer screening. CLINICAL TRIAL REGISTERED WITH CLINICALTRIALS.GOV: NCT02658032., (Copyright © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: None declare.

Background: Menthol cigarette use remains a large public health problem and disproportionately affects Black adults in the United States. The Food and Drug Administration has proposed prohibiting menthol flavor in cigarettes to protect public health. However, e-cigarettes are available in menthol flavor and are a popular alternative product adults might switch to if menthol is prohibited in cigarettes. Research is needed to understand how availability of menthol (vs. tobacco) flavored e-cigarettes could impact cigarette use among adults who smoke menthol cigarettes., Methods: We will recruit 150 adults who currently smoke menthol cigarettes and will randomize them to 1 of 3 conditions modeling different regulatory scenarios. We will recruit equal numbers of participants identifying as Black vs. non-Black and will stratify randomization by race. To promote standardization and adherence, cigarette and e-cigarette products will be provided for 8 weeks based on the assigned condition: (A) no menthol restriction (menthol cigarette and menthol flavored e-cigarette), (B) menthol prohibited in cigarettes only (non-menthol cigarette and menthol flavored e-cigarette), (C) menthol prohibited in both cigarettes and e-cigarettes (non-menthol cigarette and tobacco flavored e-cigarette). A follow-up visit will occur at week 12 to assess tobacco use status. The study aims are to (1) examine the impact of prohibiting menthol flavor in cigarettes and e-cigarettes on smoking behavior and (2) investigate whether outcomes differ by race to understand the impact of menthol policies on Black (vs. non-Black) individuals given high rates of menthol cigarette use in this population. The primary outcome will evaluate changes in the number of cigarettes smoked per day during the 8-week study period and will examine differences by regulatory scenario. Secondary outcomes will compare percent days smoke-free, changes in nicotine dependence, and motivation, confidence, and intentions to quit smoking by the regulatory scenarios. We will examine whether changes in the outcomes differ by Black vs. non-Black participants to compare the magnitude of the effect of the various menthol policy scenarios by race., Discussion: Results will contribute critical information regarding menthol in cigarettes and e-cigarettes to inform regulatory policies that maximize reductions in cigarette smoking and reduce tobacco-related health disparities., Trial Registration: NCT05259566. Yale IRB protocol #2000032211, last approved 12/8/2023., (© 2024. The Author(s).)

Background: Tobacco-free nicotine (TFN) is often marketed as being better tasting and healthier than tobacco-derived nicotine (TDN). Studies have yet to systematically characterize subjective experiences using TFN e-cigarettes. This qualitative study explored young adults' reasons for using TFN e-cigarettes and perceptions of differences between using TFN and TDN e-cigarettes., Method: We conducted a national online Qualtrics survey of U.S. young adults aged 18-25 years in October 2021. Respondents who reported lifetime TFN e-cigarette use (n = 317, mean age: 20.8 (SD:2.2), 53.9 % female) provided write-in responses to open-ended questions assessing reasons for using TFN e-cigarettes and perceptions of differences between TFN and TDN e-cigarettes. Responses from participants were thematically analyzed by independent raters., Results: Reasons for using TFN e-cigarettes included product taste/flavor, health reasons (e.g. believing TFN was healthy), and product accessibility. Perceptions of differences between TFN and TDN e-cigarettes included differences in taste/ flavor and acute psychoactive and physical effects (e.g., nicotine buzz, throat hit), with TFN e-cigarettes being described as generally stronger and superior relative to TDN e-cigarettes., Conclusion: These qualitative data suggest that taste and perceived health benefits are primary reasons that young adults try TFN e-cigarettes. Compared to TDN, young adults perceive TFN as better tasting with different psychoactive and less aversive effects. Determining if these perceived reasons for use and differences occur in blinded human experimental studies is a necessary next step to understanding TFN e-cigarette use. Additionally, understanding why young adults use TFN e-cigarettes is important in the development of prevention communication about these products., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The Sensory E-cigarette Expectancies Scale (SEES) has demonstrated solid psychometric properties for use with adults. It assesses expectancies for enjoying the taste and smell of vaping, experiencing pleasurable physical sensations, and enjoying creating vapor clouds. We evaluated psychometric properties of the SEES for use with adolescents., Methods: In Fall 2022, 4,855 students from eight Connecticut high schools completed an anonymous, cross-sectional, online survey. Our analytic sample (n = 724) endorsed lifetime e-cigarette use and completed the SEES. Psychometric analyses included factor analyses, internal reliability, measurement invariance, between-groups differences, and relationships with vaping outcomes., Results: The three-factor SEES structure was confirmed. Internal reliability of each subscale was excellent (range: 0.88-0.95). The SEES was invariant by sex (male/female), race (Black/White/Other), Hispanic ethnicity (no/yes), nicotine e-cigarette use (no/yes), any past-month vaping (no/yes), daily vaping (no/yes), and vaping status (a variable created based on the distribution of past-month vaping frequency [0; 1-4; 5-20; 21+ days]). Those who reported using nicotine e-cigarettes, past-month vaping, daily vaping, and vaping on 21+ days in the past month reported stronger scores on each subscale compared to their respective counterparts. In adjusted models, expecting Pleasurable Physical Sensations was associated with total flavors used, past-month vaping frequency, and e-cigarette dependence. Enjoyment of Taste and Smell was positively associated with total flavors used and e-cigarette dependence. Enjoyment of Vapor Clouds was positively associated with total flavors used and past-month vaping frequency., Conclusions: Given its strong psychometric properties, the SEES can be used in future research to assess sensory-related vaping expectancies in youth., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Black people are disproportionately burdened by tobacco-related diseases and are less successful at cigarette cessation with current treatments. We know little about the effectiveness of e-cigarettes as a smoking cessation method compared to currently approved methods in Black adults who smoke. Many Black adults report experiencing racial discrimination in health care, but if discrimination is related to utilization of smoking cessation aids including e-cigarettes and success with smoking cessation in this population is unclear. Therefore, this exploratory study aimed to understand how negative experiences and racial discrimination in health care influence use of e-cigarettes for cigarette cessation and success with cigarette cessation among Black adults., Methods: The study interviewed 201 Black adults who used cigarettes and tried to quit in their lifetime from the Family and Community Health Study in 2016. The study asked if they had tried and successfully quit cigarettes with e-cigarettes vs. other methods (support groups, medications, nicotine replacement therapies, call-in help lines, cold turkey [quit on their own], counseling) and asked about their negative experiences and racial discrimination in health care. We performed separate logistic regressions that evaluated the association of negative experiences and racial discrimination in health care with 1) use of e-cigarettes for cigarette cessation vs. other quitting methods and 2) success with cigarette cessation using any method among Black adults while controlling for age, sex, socioeconomic status, health insurance status, and age of onset of cigarette use., Results: More reported negative experiences and racial discrimination in health care were associated with ever trying to quit with e-cigarettes compared to other methods (OR:1.75, 95 % CI [1.05-2.91]), but negative experiences and racial discrimination in health care were not associated with cigarette quitting success. Interestingly, trying e-cigarettes was associated with being less successful at quitting compared to using other methods to quit smoking (OR: 0.40, 95 % CI [0.20, 0.81])., Conclusions: These results suggest that educating health care professionals that anticipated discrimination in health care settings may be driving Black adults who smoke to engage in non-evidence-based smoking cessation practices, such as e-cigarettes instead of those that are evidence-based, and may be more effective in this population., Competing Interests: Declaration of competing interest The authors have no disclosures to report., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Attention-deficit/hyperactivity disorder (ADHD) is a common condition that often persists into adulthood, although data suggest that the current diagnostic criteria may not represent how the condition presents in adults. We aimed to use qualitative methods to better understand ADHD symptomatology in young adults, especially regarding attentional and emotional dysregulation., Methods: Nine focus groups involving young adults (aged 18-35 years; N = 43; 84% female; 86% US and Canada) with diagnoses of ADHD were conducted. Participants were asked about their perceptions of the current diagnostic criteria and how their symptoms have presented and changed over time. Data were analyzed using an interpretive phenomenological analysis framework., Results: Most participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD. They reported struggling with attention dysregulation, including hyperfocusing, and emotional dysregulation, including rejection-sensitive dysphoria. Many participants believed that their changing environments and behavioral adaptations influenced how their symptoms presented into adulthood., Conclusion: Current diagnostic criteria for ADHD may not capture the range of symptoms present in young adults. More research is needed to characterize attentional and emotional dysregulation in this population., Competing Interests: The authors report no conflicts of interest with the topic of this work. Marc N. Potenza has consulted for and advised Opiant Pharmaceuticals, Idorsia Pharmaceuticals, Baria-Tek, AXA, Game Day Data and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; has received research support from the Mohegan Sun Casino and Connecticut Council on Problem Gambling; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors report no disclosures., (Copyright: © 2023 Ginapp et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Empirical evidence about the effectiveness of using e-cigarettes to quit smoking cigarettes remains inconclusive, yet e-cigarettes are commonly used for smoking cessation. Moreover, people who have longer duration quit attempts are likely to have even longer quit attempts in the future. Researchers analyzed 40 qualitative interviews to assess adults' experiences using e-cigarettes during their longest duration quit attempt. Interviewees quit smoking for ≥ one month (n = 20) or for shorter durations (n = 20). Thematic and comparative content analyses were used to analyze interview transcripts for factors facilitating or impeding the duration of quit attempts when using e-cigarettes. Participant narratives were mostly similar irrespective of their quit attempt duration. Six themes common across groups as well as themes more often discussed by people with shorter quit attempts are described. Most participants discussed using e-cigarette devices and flavors to either replace sensations similar to smoking combustible cigarettes (e.g., inhaling from a cylindrical object) or to distract themselves from cravings to smoke. E-cigarettes also were described by the majority of participants as useful for smoking cessation because they approximate combustible cigarette use, potentially reduce health-related harms, save money, and lead to reduced social stigma compared to smoking cigarettes. Those who reported shorter duration quit attempts shared e-cigarette product challenges, health concerns, needs for support. Study findings demonstrate the need for additional research on the factors that may increase the likelihood that using e-cigarettes will result in longer and sustained e-cigarette-based quit attempts among adults., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Historically, blunt use constituted tobacco-cannabis co-use based on the products available for creating blunts (e.g., hollowed-out cigars filled with cannabis). With the introduction of tobacco-free blunt wraps (e.g., hemp wraps), blunt use now may constitute tobacco-cannabis co-use or exclusive cannabis use. We examined adolescents' use of tobacco and tobacco-free blunt products and highlighted how misclassification of tobacco-cannabis co-use versus exclusive cannabis use may occur if products used to make blunts are not assessed., Methods: 4855 students from eight Connecticut high schools completed an online survey in 2022. Use of tobacco products for making blunts (e.g., cigarillos, tobacco blunt wraps) and tobacco-free blunt wraps were assessed as was the use of other tobacco products (e.g., e-cigarettes, cigarettes, hookah). The analytic sample comprised 475 students who endorsed lifetime blunt use., Results: Tobacco-free blunt wraps (72.6%) were the most popular product for making blunts, followed by cigarillos (56.5%), tobacco blunt wraps (49.2%), and large cigars (13.0%). When classified into mutually exclusive groups, students reported exclusive tobacco-free blunt use (32.3%), exclusive tobacco product blunt use (27.4%), or use of both tobacco product and tobacco-free blunts (40.3%). Among those exclusively using tobacco-free blunts, 13.4% endorsed no tobacco product use., Conclusions: Tobacco-free blunt wraps were very popular among high school adolescents, highlighting the importance of assessing products used for making blunts. Assuming that blunts contain tobacco without considering tobacco-free blunts can lead to misclassification of blunt use as tobacco-cannabis co-use when it actually reflects exclusive cannabis use, potentially leading to inflated estimates of tobacco use., Data Availability: Data will be made available upon reasonable request to the corresponding author., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare related to the current study., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Cigarette smoking is a leading cause of preventable death, and identifying novel treatment approaches to promote smoking cessation is critical for improving public health. With the rise of digital health and mobile apps, these tools offer potential opportunities to address smoking cessation, yet the functionality of these apps and whether they offer scientifically based support for smoking cessation are unknown., Objective: The goal of this research was to use the American Psychiatric Association app evaluation model to evaluate the top-returned apps from Android and Apple app store platforms related to smoking cessation and investigate the common app features available for end users., Methods: We conducted a search of both Android and iOS app stores in July 2021 for apps related to the keywords "smoking," "tobacco," "smoke," and "cigarette" to evaluate apps for smoking cessation. Apps were screened for relevance, and trained raters identified and analyzed features, including accessibility (ie, cost), privacy, clinical foundation, and features of the apps, using a systematic framework of 105 objective questions from the American Psychiatric Association app evaluation model. All app rating data were deposited in mindapps, a publicly accessible database that is continuously updated every 6 months given the dynamic nature of apps available in the marketplace. We characterized apps available in July 2021 and November 2022., Results: We initially identified 389 apps, excluded 161 due to irrelevance and nonfunctioning, and rated 228, including 152 available for Android platforms and 120 available for iOS platforms. Some of the top-returned apps (71/228, 31%) in 2021 were no longer functioning in 2022. Our analysis of rated apps revealed limitations in accessibility and features. While most apps (179/228, 78%) were free to download, over half had costs associated with in-app purchases or full use. Less than 65% (149/228) had a privacy policy addressing the data collected in the app. In terms of intervention features, more than 56% (128/228) of apps allowed the user to set and check in on goals, and more than 46% (106/228) of them provided psychoeducation, although few apps provided evidence-based support for smoking cessation, such as peer support or skill training, including mindfulness and deep breathing, and even fewer provided evidence-based interventions, such as acceptance and commitment therapy or cognitive behavioral therapy. Only 12 apps in 2021 and 11 in 2022 had published studies supporting the feasibility or efficacy for smoking cessation., Conclusions: Numerous smoking cessation apps were identified, but analysis revealed limitations, including high rates of irrelevant and nonfunctioning apps, high rates of turnover, and few apps providing evidence-based support for smoking cessation. Thus, it may be challenging for consumers to identify relevant, evidence-based apps to support smoking cessation in the app store, and a comprehensive evaluation system of mental health apps is critically important., (©Krysten W Bold, Kathleen A Garrison, Angela DeLucia, Mark Horvath, Milton Nguyen, Erica Camacho, John Torous. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.07.2023.)

Competing Interests: Declaration of competing interest The authors report no conflicts of interest with the topic of this work. Marc N. Potenza has consulted for and advised Opiant Pharmaceuticals, Idorsia Pharmaceuticals, Baria-Tek, AXA, Game Day Data and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; has received research support from the Mohegan Sun Casino and Connecticut Council on Problem Gambling; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders. The other authors report no disclosures.

This study examines the demographic factors associated with youths' first product tried (i.e., cigarettes, e-cigarettes, cigars, hookah, or smokeless tobacco). This study also evaluates whether the first product tried is associated with future nicotine product use (i.e., no use, single product use, and multiple product use) and nicotine dependence. Participants were 1999 youths (ages 12-17 years) who had ever tried a nicotine product and completed the Population Assessment of Tobacco Health study's Wave 1 (2013-2014) and Wave 4 (2016-2018) assessments. Two separate multinomial logistic regression models examined the association between 1) demographic factors and the first product tried at Wave 1 and 2) the first product tried at Wave 1 and past-30-day product use status at Wave 4. A two-part multivariable model examined the association between the first product tried and nicotine dependence, with part 1 modeling the presence (or absence) of any symptom of dependence and part 2 modeling the degree of dependence among those with any symptom of dependence. The first product tried was associated with sex, race, urbanicity, and parent education. First trying smokeless tobacco (vs. e-cigarettes) was associated with a greater likelihood of multiple product use (vs. no use and vs. single product use). Regarding the degree of nicotine dependence (n = 713), first trying smokeless tobacco (vs. e-cigarettes) was associated with higher nicotine dependence scores among those with any symptom of dependence. Youths who first try smokeless tobacco (vs. e-cigarettes) may be at higher risk for future multiple product use and more symptoms nicotine dependence. Research should explore tailored interventions for smokeless tobacco users., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: E-cigarettes are increasingly being marketed as containing tobacco-free nicotine (TFN). There is no data examining use of TFN e-cigarettes by young adults and how use may differ from non-TFN e-cigarettes. The current study aims to characterize young adult TFN e-cigarette use and examine differences between those who report using TFN and non-TFN e-cigarettes., Method: U.S. young adults (18-25) with lifetime e-cigarette use (n = 927) were recruited via online panels in Fall 2021 and answered questions about TFN and non-TFN e-cigarettes. Participants were categorized by lifetime TFN e-cigarette use status (yes vs. no; 34% yes). Bivariate comparisons examined differences in e-cigarette characteristics (device type, flavors, nicotine concentration) between the TFN and non-TFN groups. Binary logistic regression models examined associations between lifetime frequency of vaping (<100 vs. ≥100 times), and other tobacco product, cannabis, and/or alcohol use and lifetime TFN e-cigarette use (yes vs. no). Adjusted models include age, race/ethnicity, vaping onset age, and sex., Results: In multivariable adjusted models, lifetime TFN e-cigarette use was associated with younger age, greater lifetime vaping, and nicotine pouch use. Young adults who used TFN e-cigarettes were more likely to report fruit, mint, menthol, and beverage flavors and know their e-liquid nicotine concentration compared with those who used non-TFN e-cigarettes., Conclusion: Among young adults who have used e-cigarettes, more frequent e-cigarette use and use of nicotine pouches, which can also contain TFN, were associated with TFN e-cigarette use. Understanding behaviors and characteristics of those using TFN e-cigarettes is critical to regulation of TFN containing products., Implications: This study characterizes young adults who report experience with tobacco free nicotine (TFN) e-cigarettes and compares them to those who have not used TFN e-cigarettes. Young adults with more frequent e-cigarette use and use of nicotine pouches are more likely to report TFN e-cigarette use., (© The Author(s) 2022. 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: Oral nicotine pouches (NPs) that contain nicotine but no tobacco leaves are rapidly gaining popularity. However, there is limited research on NPs, including within priority populations. In the current study, we examined awareness of, susceptibility to, and use of NPs in young adults as well as comparative risk perceptions with smokeless tobacco., Methods: In 2021, 609 young adults (18-25 years) completed an online survey. Participants reported on NP awareness, susceptibility, and use as well as on comparative product perceptions for NPs versus smokeless tobacco. We ran unadjusted between-groups comparisons and an adjusted multinomial logistic regression to identify relationships between product perceptions and NP susceptibility and use., Results: 41.5% of participants had heard of NPs before. Participants were non-susceptible (66.2%), susceptible (23.5%), or had used NPs (10.3%). Comparative product perceptions between NPs and smokeless tobacco suggested that young adults, as a whole, expressed uncertainty about the relative risk/benefit of using NPs versus smokeless tobacco. However, as expected, unadjusted and adjusted findings indicated that favorable perceptions of NPs versus smokeless tobacco were disproportionately observed among susceptible participants and NP users compared to non-susceptible individuals. Demographic differences were also observed (e.g., NP users were more likely than non-susceptible and susceptible individuals to have used smokeless tobacco)., Conclusions: Young adults reported awareness of, susceptibility to, and use of NPs, with findings indicating that favorable perceptions of NPs versus smokeless tobacco may contribute to NP susceptibility and use beyond known correlates like smokeless tobacco use. However, further research is needed to understand the full range of factors that are associated with NP susceptibility and use. It will be important to disentangle factors that are associated with potential positive public health impacts (e.g., switching from smokeless tobacco to exclusive NP use) from those associated with negative public health impacts (e.g., initiation among nicotine naïve individuals)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Morean et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Background: Nicotine pouches containing synthetic nicotine or tobacco-derived nicotine (TDN) are available in the United States. Synthetic nicotine pouches are often marketed as "tobacco-free nicotine" (TFN), which may alter risk perceptions and product appeal. This study examined young adults' perceptions of TFN versus TDN pouches and the associations between product perceptions and TFN pouch awareness, susceptibility, and use, respectively., Aims and Methods: In total 630 young adults (18-25 years) completed an online Qualtrics panels survey in 2021. Participants were informed that TFN pouches contain synthetic nicotine as opposed to TDN. Participants reported on comparative risk perceptions for TFN versus TDN pouches and on TFN pouch awareness, susceptibility, and use. Unadjusted between-group comparisons and adjusted binary logistic regressions were run to examine relationships between product perceptions and TFN pouch awareness, susceptibility, and use., Results: Participants were aware of (37.3%), susceptible to (29.2%), or had used TFN pouches (3.8%). In unadjusted comparisons, TFN pouch awareness, susceptibility, and use were associated with disproportionately perceiving TFN pouches as less harmful or otherwise better than TDN pouches. In adjusted models, relationships between favorable perceptions and both TFN pouch awareness and susceptibility remained significant., Conclusions: The descriptor "tobacco-free" may impact risk perceptions and the appeal of nicotine pouches among young adults. While no direct relationship was observed between TFN perceptions and TFN pouch use in the adjusted model, perceptions remained related to product awareness and susceptibility, which may be linked to future use. Continued surveillance is needed to fully determine how the term "tobacco-free" on product packaging and advertising impacts longitudinal public health outcomes., Implications: Nicotine pouches originally contained TDN. Today, numerous brands of synthetic nicotine pouches, which are often marketed as "tobacco-free," are available on the market. We informed participants that "tobacco-free nicotine" pouches contain synthetic nicotine and examined comparative risk perceptions (i.e. tobacco-free vs. TDN pouches) and TFN pouch awareness, susceptibility, and use. Perceiving tobacco-free nicotine pouches as less harmful than tobacco-derived pouches was associated with product awareness, susceptibility, and use in unadjusted models and with awareness and susceptibility in adjusted models. Restricting the term "tobacco-free" may become necessary if the term inaccurately reduces product risk perceptions or increases product appeal., (© The Author(s) 2022. 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.)

Purpose of Review: E-cigarette use (vaping) among adults has increased, and various patterns of concurrent smoking and vaping (i.e., "dual use") have emerged. Understanding dual use is important for mitigating tobacco-related harm. This narrative review summarizes recent research on dual use, including prevalence and types of dual use, sociodemographic and psychiatric characteristics, nicotine dependence, reasons for dual use, harm perceptions, toxicant exposure, trajectories of dual use, and emerging treatments for dual use., Recent Findings: Nearly half of e-cigarette users concurrently use cigarettes, and many smoke more frequently than they use e-cigarettes. This is concerning because dual users are exposed to both cigarette and potential e-cigarette toxicants and the data are mixed regarding the ability of e-cigarettes to promote smoking cessation., Summary: Further work is needed to identify ways to increase complete smoking abstinence and optimize harm reduction among dual users, including strategies to encourage e-cigarette cessation after stopping smoking.

Background: The Modified Cigarette Evaluation Questionnaire (MCEQ) measures self-reported, subjective reinforcing and aversive effects of smoking. The MCEQ is proposed as comprising five factors. However, its latent factor structure has been confirmed in only one published study, and key psychometric properties like measurement invariance and test-criterion validity have not been formally examined., Methods: We examined the latent structure of the MCEQ using confirmatory and exploratory factor analysis and evaluated internal consistency, measurement invariance, between-group differences, and relationships with smoking-related characteristics in a sample of 764 adults who smoke cigarettes. As a secondary test of construct validity, we fit identified latent factor structures to a sample of 131 adults from a prior trial who were biochemically-confirmed to currently smoke., Results: A four-factor structure that recently was validated for an e-cigarette-adapted version of the MCEQ outperformed the originally-proposed five-factor structure in several ways: it uniquely evidenced good model fit both within the primary and replication samples, reached scalar invariance for all participant subgroups tested, was sensitive to detecting numerous between-groups differences in subsamples of interest, and each of its subscales was associated with at least one smoking characteristic assessed., Conclusions: The four-factor MCEQ structure evidenced stronger psychometric properties in our sample than did the original five-factor MCEQ. However, until additional research is conducted on the utility of the five- and four-factor solutions in other samples, neither the five- nor the four-factor MCEQ structure should be assumed. In the meantime, researchers should examine the MECQ's latent structure in their data prior to conducting subsequent analyses., Competing Interests: Conflict of interest Drs. Morean and Bold have no conflicts of interest to declare related to the current study., (Copyright © 2022. Published by Elsevier B.V.)

Introduction: Restricting available e-cigarette flavours to only tobacco and menthol may reduce appeal among youth; it is unknown how flavour restrictions impact adults using e-cigarettes to quit smoking cigarettes., Methods: Online US survey data were collected in summer 2021 from 857 adults who reported using e-cigarettes in a recent attempt to quit smoking. Survey items assessed e-cigarette flavours used during their quit attempt, whether e-cigarette flavour bans restricted access to flavours they like, and what impact the restrictions had on e-cigarette behaviour. Multivariable logistic regression models were used to examine the associations of flavour bans with success quitting smoking for 1 month or longer., Results: 30.2% (N=259) reported restricted access to e-cigarette flavours they like. During their quit attempt, 64.9% (N=168) used tobacco or menthol-flavoured e-cigarettes, and 90.7% (N=235) used another flavour that could be affected by restrictions, most commonly fruit, mint, and candy/dessert. Responses to flavour restrictions included switching devices to continue using preferred flavours (39.4%), using the same device only with available flavours (35.9%), buying preferred flavours elsewhere (eg, online) (19.3%), making flavours (3.5%) and 'other' (eg, no longer using e-cigarettes) (1.9%). The odds of quitting smoking for 1 month or longer were not significantly different between those experiencing flavour restrictions (vs not), preferring tobacco/menthol (vs restricted) flavour, or switching flavours in response to the bans (vs finding another way to obtain restricted flavours) (p>0.11)., Conclusion: Experiencing e-cigarette flavour restrictions was not associated with success quitting smoking among adults using e-cigarettes to try to quit., Competing Interests: Competing interests: Outside of the submitted work, SO reports being a member of the American Society of Clinical Psychopharmacology’s (ASCP) Alcohol Clinical Trials Initiative, supported by Alkermes, Dicerna, Ethypharm, Lundbeck, Mitsubishi Tanabe, Otsuka; consultant/advisory board member, Alkermes, Dicerna, Opiant; medication supplies, Novartis; DSMB member for NIDA Clinical Trials Network, Emmes Corporation; and has been involved in a patent application with Novartis and Yale. The other authors have no disclosures to report., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Given high youth e-cigarette use, it is important to investigate how traits, like impulsivity, may be associated with youth e-cigarette use behaviors. The study aim is to determine if impulsivity is associated with trying more e-cigarette flavors and device types, and greater frequency of e-cigarette use., Method: Cross sectional survey data from CT high schoolers (n = 4875, 6 schools) were collected in 2019. Lifetime (ever) e-cigarette users (n = 2313) completed the Brief Barrett Impulsivity Scale, which contains two subscales; behavioral impulsivity and impaired self-control. Among lifetime users, associations between impulsivity subscales and number of e-cigarette flavors tried, e-cigarette devices tried, and past 30-day frequency of e-cigarette use were examined using regression models. Additionally, associations of impulsivity and use frequency were examined among only current e-cigarette users (≥1 day of use in past 30; n = 1327). School, age, race/ethnicity, vaping initiation age, other tobacco product use, and sex were included as covariates in models., Results: Higher behavioral impulsivity was associated with greater number of e-cigarette flavors tried (AOR: 1.06, 95% CI: 1.02, 1.11, p <.008) and higher frequency of past 30-day use both among ever and current e-cigarette users (AOR: 1.26, 95%CI:1.10,1.44, p <.001; AOR: 1.12, 95%CI:1.02,1.22, p <.02), but not number of e-cigarette devices tried. Impaired self-control was not associated with any outcomes., Conclusion: Youth with higher behavioral impulsivity may be more at risk for using more e-cigarette flavors and using e-cigarettes more frequently. Regulations aimed at reducing flavor availability among youth and interventions targeting impulsive behavior may be important for this population., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

This study determined whether young adults perceptions of how tobacco free nicotine (TFN) compared to tobacco-derived nicotine (TDN) were associated with curiosity to try or use TFN e-cigarettes. U.S. young adults aged 18-25 years (n = 1176) completed an online survey in October 2021. Survey questions assessed TFN awareness, curiosity, use, and perceptions of how flavor, taste, ease of access, cost, and harm compared between TFN and TDN. Participants were categorized into 3 groups: not curious to try TFN (n = 511, 43.5%), curious to try TFN (n = 348, 29.6%), and ever used TFN (n = 317, 27%). Multinomial logistic regression measured associations between perceptions and TFN curiosity and use (vs. not curious to try), with total number tobacco products used and demographics as covariates. Compared to young adults who were not curious to try TFN e-cigarettes, those who were curious perceived TFN as less addictive than TDN (aOR = 2.27; 95% CI =1.34-3.86). Those who had used TFN e-cigarettes perceived TFN as having flavors that tasted better (aOR = 1.80; 95% CI = 1.63-1.99), "smoother" (aOR = 1.88; 95% CI =1.18-2.99), and less like tobacco (aOR 1.94; 95% CI 1.23-3.05). Adjusted models did not show differences in perceptions between those who had tried TFN and those who were curious to try TFN. Young adults who were curious to try or had used TFN had more positive perceptions of TFN. As it is currently unclear whether synthetic nicotine carries the same health risks as TDN, ongoing surveillance of TFN uptake among young adults is warranted., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to report., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood, although research and diagnostic criteria are focused on how the condition presents in children. We aimed to review qualitative research on lived experiences of adults with ADHD to characterize potential ADHD symptomatology in adulthood and provide perspectives on how needs might be better met. We searched three databases for qualitative studies on ADHD. Studies ( n = 35) in English that included data on the lived experiences of adults with ADHD were included. These studies covered experiences of receiving a diagnosis as an adult, symptomatology of adult ADHD, skills used to adapt to these symptoms, relationships between ADHD and substance use, patients' self-perceptions, and participants' experiences interacting with society. Many of the ADHD symptoms reported in these studies had overlap with other psychiatric conditions and may contribute to misdiagnosis and delays in diagnosis. Understanding symptomatology of ADHD in adults may inform future diagnostic criteria and guide interventions to improve quality of life., Competing Interests: MP has consulted for and advised Opiant Pharmaceuticals, Idorsia Pharmaceuticals, BariaTek, AXA, Game Day Data, and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; has received research support from the Mohegan Sun Casino and Connecticut Council on Problem Gambling; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ginapp, Macdonald-Gagnon, Angarita, Bold and Potenza.)

Introduction: The subjective experience of positive and negative effects likely contributes to e-cigarette use, and the Modified Cigarette Evaluation Questionnaire (MCEQ) previously has been adapted to assess the reinforcing and aversive effects of vaping. However, the psychometric properties of the MCEQ for use with e-cigarettes have not been established., Aims and Methods: We examined the psychometric properties of the Modified E-cigarette Evaluation Questionnaire (MECEQ) within a sample of 857 adults who recently used e-cigarettes in a smoking cessation attempt (52.4% male; 40.84 [12.25] years old; 62.8% non-Hispanic white; 22.4% daily e-cigarette users). Analyses included confirmatory factor analysis of the original structure, exploratory/confirmatory factor analyses to identify the alternate latent structure(s), internal consistency, measurement invariance, between-group differences, and test-criterion relationships with vaping-related outcomes., Results: The original five-factor structure and a novel four-factor structure were supported. Each was scalar invariant across several participant subgroups (eg, current smoking status, daily vaping status). All multi-item subscales were internally consistent. Both versions detected several between-group differences. For example, current smokers reported stronger aversive effects than did exclusive e-cigarette users. Finally, adjusted relationships between both MECEQ versions and vaping-related outcomes provided evidence for concurrent validity., Conclusions: The five-factor and four-factor versions of the MECEQ evidenced good-to-excellent internal consistency, scalar measurement invariance, and concurrent relationships with vaping-related outcomes. While both versions could be used to assess subjective vaping effects in adults with histories of cigarette smoking and vaping, additional research is needed to evaluate the applicability of these factor structures to other samples (eg, e-cigarette users with no smoking history, youth)., Implications: Although the MCEQ has been adapted in previously published studies to assess the subjective reinforcing and aversive effects of vaping, the psychometric foundation necessary for doing so had not been established. We showed that the MECEQ can be scored using the original five-factor MCEQ format or using a newly identified four-factor structure. Both versions evidenced construct validity, internal consistency, measurement invariance (permitting between-group comparisons), and concurrent validity with vaping-related outcomes. Results strengthen the interpretability of previously published work using the five-factor MCEQ structure and provide an alternative scoring approach for vaping-specific subjective effects., (© The Author(s) 2022. 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.)

Tobacco use disorder (TUD) is a major threat to health among people with HIV (PWH), but it is often untreated. Among HIV clinicians and staff, we sought to characterize practices, attitudes, and confidence addressing TUD among PWH to identify potential opportunities to enhance provision of care. Cross-sectional deidentified, web-based surveys were administered from November 4, 2020 through December 15, 2020 in HIV clinics in three health systems in the United States Northeast. Surveys assessed provider characteristics and experience, reported practices addressing tobacco use, and knowledge and attitudes regarding medications for TUD. Chi-square tests or Fisher's exact tests were used to examine differences in responses between clinicians and staff who were prescribers versus nonprescribers and to examine factors associated with frequency of prescribing TUD medications. Among 118 survey respondents (56% prescribers), only 50% reported receiving prior training on brief smoking cessation interventions. Examining reported practices identified gaps in the delivery of TUD care, including counseling patients on the impact of smoking on HIV, knowledge of clinical practice guidelines, and implementation of assessment and brief interventions for smoking. Among prescribers, first-line medications for TUD were infrequently prescribed and concerns about medication side effects and interaction with antiretroviral treatments were associated with low frequency of prescribing. HIV clinicians and staff reported addressable gaps in their knowledge, understanding, and practices related to tobacco treatment. Additional work is needed to identify ways to ensure adequate training for providers to enhance the delivery of TUD treatment in HIV clinic settings., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

During the initial wave of the Coronavirus Disease 2019 (COVID-19) pandemic in the U.S., information was mixed about the relative COVID-19 risks and potential benefits associated with cigarette smoking. Therefore, we sought to understand individual differences in the impact of COVID-19 on cigarette smoking in a sample of adults who reported recent use, with a particular focus on chronic medical conditions likely associated with increased COVID-19 risk. Participants completed an online survey of smoking behavior, demographic variables, medical history, and COVID-19 risk perceptions between July and August 2020 (N = 286). We examined whether medical conditions, COVID-19 risk perceptions and/or demographic characteristics were related to smoking changes in response to the pandemic (i.e., no change, decrease, increase) using multinomial logistical regression. Younger age, higher COVID-19 risk perceptions and Black versus White race were associated with greater odds of decreased smoking compared to no smoking change. Moreover, having at least one chronic medical condition was associated with greater odds of increased smoking relative to no change. The results have important implications for tobacco cessation treatment and preventive healthcare during the ongoing COVID-19 pandemic and other public health threats.

Introduction: Menthol cigarette use contributes to disproportionate tobacco-related health disparities amongst minoritized race/ethnic groups. E-cigarettes are available in flavors such as menthol and may be a less harmful substitute among adults who smoke. Yet little is known about e-cigarette flavor preference and reasons for use by race/ethnicity among adults who smoke menthol cigarettes., Methods: Nationally representative PATH wave 4 adult data (Dec. 2016-Jan. 2018) were used to examine how menthol cigarette status and race/ethnicity were associated with past 30-day e-cigarette use, flavors used, and reasons for use with adjusted logistic regression models., Results: Menthol (vs. non-menthol) cigarette use was associated with higher odds of e-cigarette use (AOR=1.33, 95%CI=1.16-1.52). However, non-Hispanic (NH) Black and Hispanic individuals (vs. NH White) had lower odds of e-cigarette use (p's ≤ 0.004). In terms of flavor used, adults smoking menthol cigarettes and NH Black and Hispanic individuals had greater odds of using menthol/mint-flavored e-cigarettes (p's ≤ 0.02), and older adults (vs. 18-24-year-olds) had lower odds of using sweet-flavored e-cigarettes (p's < 0.0001). Regarding reasons for use, adults smoking menthol cigarettes had higher odds of reporting using e-cigarettes due to liking flavors (AOR=1.63, 95%CI=1.30-2.04), while NH Black adults had lower odds of liking flavors (AOR=0.64, 95%CI=0.43-0.96), and Hispanic adults had lower odds of using e-cigarettes to cut down on cigarette smoking (AOR=0.59, 95%CI=0.42-0.83)., Conclusions: Findings suggest menthol flavored e-cigarettes may be important for adults who smoke menthol cigarettes, although racial disparities in current e-cigarette use and reasons for use may exacerbate tobacco-related health disparities., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: "Tobacco-free" nicotine (TFN) e-cigarettes and nicotine pouches containing synthetic nicotine are increasingly available. The term TFN may lead to reduced risk perceptions and increased use intentions relative to tobacco-derived nicotine products. Effectively communicating messages about TFN may depend on the public's ability to differentiate TFN from tobacco-derived nicotine. Our goals were to examine knowledge about the source(s) of nicotine in commonly used products and beliefs about what TFN means., Methods: In 2021 we surveyed 2464 young adults (18-25 years) online. Participants reported whether cigarettes, smokeless tobacco, e-cigarettes, and nicotine pouches contain nicotine that comes from tobacco (always, sometimes, never). Correct responses were "always" for cigarettes/smokeless and "sometimes" for e-cigarettes/pouches. Participants also reported "what [they] think TFN e-cigarettes/vapes contain" (nicotine only; tobacco only; both nicotine and tobacco; neither nicotine nor tobacco). We ran unadjusted and adjusted models examining correct responses for nicotine source and TFN contents by past-month product use status (cigarettes, smokeless, e-cigarettes, pouches)., Results: Rates of correctly identifying nicotine source were modest (23.6% pouches-61.9% cigarettes). Except smokeless tobacco, using a given product was associated with identifying its nicotine source correctly in unadjusted models. Participants reported "TFN" means a product contains nicotine only (57.8%), tobacco only (10.8%), both (14.1%), or neither (17.1%)., Conclusions: There is confusion about the source of nicotine in products, and many young adults incorrectly interpreted TFN to mean something other than containing nicotine but no tobacco. Regulatory efforts may be needed to restrict using the term "tobacco-free nicotine" on product labeling and advertising., Competing Interests: The authors have declared that no competing interests exist.

The US Preventive Services Task Force recommends annual lung cancer screening for patients at high risk based on age and smoking history. Understanding the characteristics of patients attending lung cancer screening, including potential barriers to quitting smoking, may inform ways to engage these high-risk patients in tobacco treatment and address health disparities. Patients attending lung cancer screening who currently smoke cigarettes completed a survey at Smilow Cancer Hospital at Yale-New Haven (N = 74) and the Medical University of South Carolina (N = 73) at the time of their appointment. The survey assessed demographics, smoking history, and perceptions and concerns about quitting smoking., Patients were 55 to 76 years old (mean = 63.3, SD = 5.3), N = 64 (43.5%) female, and N = 31 (21.1%) non-Hispanic Black. Patients smoked 16.3 cigarettes per day on average (SD = 9.2) and rated interest in quitting smoking in the next month as moderate (mean = 5.6, SD = 3.1, measured from 0 = "very definitely no" to 10 = "very definitely yes"). The most frequently endorsed concerns about quitting smoking were missing smoking (70.7%), worry about having strong urges to smoke (63.9%), and concerns about withdrawal symptoms (59.9%). In comparison with other races/ethnicities, Black patients were less likely to report concerns about withdrawal symptoms and more likely to report smoking less now and perceiving no need to quit. Findings identified specific barriers for tobacco treatment and differences by race/ethnicity among patients attending lung cancer screening, including concerns about withdrawal symptoms and perceived need to quit. Identifying ways to promote tobacco treatment is important for reducing morbidity and mortality among this high-risk population., Prevention Relevance: The current study examines patient characteristics and tobacco treatment perceptions and barriers among patients attending lung cancer screening who continue to smoke cigarettes that may help inform ways to increase treatment engagement and address tobacco-related health disparities to reduce morbidity and mortality from smoking., (©2022 American Association for Cancer Research.)

Background: Nicotine vaping and cannabis use are common among youth. Among youth who use e-cigarettes, little is known about how and why they use cannabis and patterns of cannabis and nicotine co-use. Given the popularity of both products among youth, the study aim is to utilize qualitative data to better understand cannabis use among youth who use e-cigarettes., Method: Six focus groups of high schoolers who reported past-month e-cigarette use (N = 50; 52% male) were conducted to inform e-cigarette cessation programming. We conducted secondary data analysis examining report of cannabis use during focus groups. Transcripts were examined for report of cannabis use, reasons for use, and nicotine and cannabis co-use., Results: In focus groups, cannabis was commonly discussed. Youth reported vaping cannabis, however other forms of cannabis delivery were common (e.g. blunts, joints). Themes related to reasons for simultaneous use of nicotine and cannabis were to experience stronger psychoactive effects than using either product alone and needing to use less nicotine product overall. Reasons for liking cannabis were positive psychoactive effects and stress relief. Reasons for disliking were related to health concerns. Notably, when youth reported disliking cannabis due to health concerns, a common discussion was strategies to acquire and continue cannabis use in ways that they perceived mitigated health concerns., Conclusion: Qualitative evidence identified associations between e-cigarette use and cannabis use among youth. Research and interventions targeting youth using e-cigarettes should consider how to address dual use of these products., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: Assessing youth vaping expectancies using a psychometrically sound measure can improve understanding of e-cigarette susceptibility and use., Aims and Methods: We evaluated the psychometric properties of the Short-Form Vaping Consequences Questionnaire (SF-VCQ), an expectancy measure previously validated with adults, within a sample of 1753 high school adolescents who completed an online, school-based survey in Fall 2020 (51.6% female; 15.56 [1.22] years old; 46.6% non-Hispanic white; 26.9% reported lifetime but no past-30-day vaping; 12.6% reported past-30-day vaping). Analyses included confirmatory factor analysis, internal consistency, measurement invariance, between-group differences, and test-criterion relationships., Results: The four-factor structure was confirmed and was scalar invariant by lifetime and past-month vaping status, sex, and race. All subscales were internally reliable (mean α = 0.94). The subscales were sensitive to differences based on sex, race, vaping susceptibility among never users, and lifetime and past-month vaping status. For example, students who vaped in the past-month held weaker expectancies for negative consequences but stronger expectancies for positive reinforcement, negative reinforcement, and appetite/weight control compared to lifetime vapers. Unadjusted relationships within the subsamples of lifetime and past-month vapers provided evidence of convergent validity. Evidence for concurrent validity was observed for all samples after accounting for covariates. For example, expectancies for positive reinforcement, negative reinforcement, and appetite/weight control remained significantly associated with past-month vaping frequency., Conclusions: The SF-VCQ evidenced excellent internal reliability, scalar measurement invariance, and construct, convergent, and concurrent validity in samples of never, lifetime, and past-month adolescent e-cigarette users. Findings support using the SF-VCQ for assessing youths' vaping-related expectancies., Implications: The current study established the psychometric properties of the SF-VCQ for use among adolescents with and without vaping experience, including measurement invariance that permits direct comparisons of expectancies across these two groups. When considered in concert with previously published research in adults, the SF-VCQ provides researchers with a measure that can be used with both youth and adult samples. Observed relationships between positive expectancies and vaping susceptibility in vaping naïve youth and indices of vaping frequency in youth with vaping experience suggest that challenging positive expectancies may be a valuable addition to prevention and intervention efforts to reduce youth vaping., (© The Author(s) 2021. 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: Tobacco use disorder is a leading threat to the health of persons with HIV (PWH) on antiretroviral treatment and identifying optimal treatment approaches to promote abstinence is critical. We describe the rationale, aims, and design for a new study, "A SMART Approach to Treating Tobacco Use Disorder in Persons with HIV (SMARTTT)," a sequential multiple assignment randomized trial., Methods: In HIV clinics within three health systems in the northeastern United States, PWH with tobacco use disorder are randomized to nicotine replacement therapy (NRT) with or without contingency management (NRT vs. NRT + CM). Participants with response (defined as exhaled carbon monoxide (eCO)-confirmed smoking abstinence at week 12), continue the same treatment for another 12 weeks. Participants with non-response, are re-randomized to either switch medications from NRT to varenicline or intensify treatment to a higher CM reward schedule. Interventions are delivered by clinical pharmacists embedded in HIV clinics. The primary outcome is eCO-confirmed smoking abstinence; secondary outcomes include CD4 cell count, HIV viral load suppression, and the Veterans Aging Cohort Study (VACS) Index 2.0 score (a validated measure of morbidity and mortality based on laboratory data). Consistent with a hybrid type 1 effectiveness-implementation design and grounded in implementation science frameworks, we will conduct an implementation-focused process evaluation in parallel. Study protocol adaptations related to the COVID-19 pandemic have been made., Conclusions: SMARTTT is expected to generate novel findings regarding the impact, cost, and implementation of an adaptive clinical pharmacist-delivered intervention involving medications and CM to promote smoking abstinence among PWH. ClinicalTrials.govidentifier:NCT04490057., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Varenicline is an FDA-approved medication for smoking cessation and has demonstrated promise in reducing alcohol use. This study sought to compare the efficacy of varenicline in reducing smoking and drinking among Black and White people seeking alcohol treatment., Methods: Linear mixed modeling was conducted using data from two multi-site placebo-controlled randomized clinical trials examining the effects of varenicline for treatment of Alcohol Use Disorder (AUD; O'Malley et al., 2018; Litten et al., 2013) among Black and White adults with AUD and co-occurring cigarette smoking. The primary analyses were conducted in a sample of 117 adults (O'Malley trial: 29.1% female, 55.2% Black), and replicated in an independent sample of 73 adults (Litten trial: 23.3% female, 45.2% Black)., Results: Black participants smoked fewer cigarettes per day compared to White participants (O'Malley trial: F 1,116  = 8.95, p = .003; Litten trial: F 1,68.9  = 4.74p = .03). Linear mixed models revealed a marginal effect of varenicline on reducing cigarettes smoked per day regardless of race in the O'Malley trial (F 1,109  = 3.34, p = .07), which was replicated in the Litten trial (F 1,67.1  = 20.77p < .0001). Participants reduced the number of drinks consumed regardless of treatment condition or race in both trials (O'Malley trial: F 1,98  = 131.69, p < .0001; Litten trial:F 1,69  = 60.36, p < .0001)., Conclusions: Our adjusted model findings suggest varenicline reduced smoking among Black and White people with AUD and co-occurring cigarette smoking. However, these findings should be replicated in a larger sample., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Vaping is the second most common modality of using cannabis following smoking. We examined differences in demographics and substance use behaviors between adolescent cannabis vapers and those exclusively using other cannabis modalities., Methods: In 2019, 4875 students from six Connecticut high schools completed school-wide, online surveys. Past-month cannabis users (n = 931; 52.8% female, 16.38(1.27) years old, 44.9% non-Hispanic White) reported on cannabis modalities used (e.g., combustible, vaporizable, edible) and were classified as cannabis vapers or non-vapers. Cannabis vapers reported on device type used to vape cannabis: a cannabis-specific device or modified/hacked e-cigarette. Unadjusted and adjusted relationships were examined to identify demographic and substance-related differences between cannabis vapers and non-vapers., Results: 56.3% of past-month cannabis users reported vaping cannabis. Cannabis vapers reported using both cannabis-specific vaporizers (91.9%) and modifying/hacking e-cigarettes (23.7%). Cannabis vapers, relative to other cannabis users, were more likely to be male, White, initiate cannabis use at a younger age; endorse past-month use of all cannabis modalities, alcohol, and e-cigarettes; and report smoking and dabbing cannabis more frequently; consuming more drinks per drinking day; and using e-cigarettes at a younger age and more frequently., Conclusions: Relative to other cannabis modalities, vaping was associated with increased use of several cannabis products and other substances. Adolescent past-month cannabis users reported modifying e-cigarettes to vape cannabis. Findings suggest that regulations should be implemented to prevent e-cigarettes from being modifiable for use with cannabis and highlight the importance of assessing different cannabis use modalities, as vaping was associated with distinct substance-related risks., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Dual use of e-cigarettes and combustible tobacco products is common in young adults. We aimed to explore how ratings of subjective and contextual factors differed between discrete episodes of e-cigarette use vs. combustible tobacco product smoking among a sample of young adults., Methods: Young adults (N = 29, ages 18-30) who used e-cigarettes and ≥1 combustible tobacco product at least once weekly completed a 1-week smartphone-based ecological momentary assessment (EMA). Twice daily random prompts assessed past-15-min use of tobacco products, ratings of subjective factors (e.g., negative affect, craving), and contextual factors related to activity, location, and companionship. A multivariable GEE model assessed whether subjective or contextual factors were associated with e-cigarette vs. combustible tobacco product episodes., Results: 184 tobacco use episodes were reported (39.7% e-cigarette, 60.3% combustible tobacco product). High baseline cigarette dependence, as measured by the Fagerström Test for Cigarette Dependence, was associated with lower odds of e-cigarette vs. combustible tobacco product episodes (aOR 0.01, 95% CI (0.002-0.08); p < 0.001). Neither between- or within-subjects negative affect or craving scores were associated with e-cigarette use. Activities of eating/drinking (aOR 0.20, 95% CI (0.08-0.49); p = 0.001) and being in the companionship of a person who smoked cigarettes (aOR 0.13, 95% CI (0.04-0.43); p = 0.001) were associated with lower odds of e-cigarette vs. combustible tobacco product use episodes. However, traveling (aOR 12.02, 95% CI (3.77-38.26); p ≤ 0.001) and being in a public space (aOR 2.76, 95% CI (1.10-6.96); p = 0.03) were associated with higher odds of e-cigarette than combustible tobacco product use episodes., Conclusions: This pilot data suggests that unique contextual factors may be associated with e-cigarette use, compared to combustible tobacco smoking in a sample of young adults who use both e-cigarettes and combustible tobacco products. Future research with larger samples is needed to better characterize varying contexts and cues for tobacco use among young adults who are dual users.

Introduction: E-liquid flavor is typically presented by flavor category (e.g. menthol, mint, fruit, dessert). Cooling sensations produced by flavor additives such as menthol enhance appeal of e-cigarettes among youth, but not all e-liquids that produce cooling sensations are labeled as menthol. Sensory experiences produced by flavors may allow for a new way to capture e-cigarette flavor use. This study aims to examine use of flavors that produce cooling sensations among youth and its association with e-cigarette use behaviors., Methods: A 2019 survey of high school students (n = 4875) examined use of e-cigarette flavors that produced cooling sensations (cooling flavors) among past 30-day e-cigarette users. E-cigarette use behaviors (flavor use, nicotine use, frequency of use) were examined between those who did and did not use cooling flavors. A binary logistic regression was used to examine associations between vaping frequency, nicotine (vs. non-nicotine) use, and vaping cooling flavors while controlling for demographics, number of flavors vaped in the past month, and vaping age of onset., Results: 51.6% (n = 473/916) of the analytic sample endorsed vaping cooling flavors. There were no demographic differences by vaping cooling flavors. Vaping cooling flavors was associated with vaping more frequently (AOR:1.04,95% CI:1.03,1.05) and vaping nicotine (AOR:2.37,95% CI:1.53,3.67)., Conclusion: Vaping cooling flavors was associated with greater nicotine vaping and frequency of e-cigarette use. Assessing sensory experience, such as cooling, in addition to flavor category may more fully capture e-cigarette flavor use and its impacts on youth e-cigarette use behaviors., Competing Interests: The authors have declared that no competing interests exist.

Aims: Theory-driven, exploratory study to: (i) identify a reward drinking phenotype in young adults; (ii) evaluate this phenotype as a predictor of naltrexone response; and (iii) examine mechanisms of naltrexone in reward drinkers., Design: Secondary analysis of a randomized controlled trial., Setting: USA., Participants: A total of 128 young adult (ages 18-25) heavy drinkers., Interventions: Naltrexone versus placebo., Measurements: Daily surveys assessed affect, urge, drinking, and context. The Drinking Motives Questionnaire was used to identify phenotypes based on reward (enhancement motives) and relief (coping motives) drinking., Findings: We identified three profiles: "Low reward/Low relief" (14.1%; low enhancement/low coping motives); "Reward drinkers" (62.2%; high enhancement/low coping motives); and "High reward/High relief" (22.7%; high enhancement/high coping motives). Among reward drinkers (versus low profile), naltrexone significantly reduced percent days drinking to intoxication (blood alcohol concentration [BAC] ≥0.08) (PDI) (d = 0.56; 95% CI [0.17, 0.96]) and percent high intensity drinking days (PHID) (8/10 drinks for women/men) (d = 0.32; 95% CI [0.01, 0.68]). Among the high reward/high relief profile drinkers (versus low profile), naltrexone reduced PHID (d = 0.69; 95% CI [0.02, 1.50]). Using profile-informed cutoffs and observed scores (for clinical applicability): (i) among cutoff-derived reward drinkers, we found a medium-to-large (d = 0.66; 95% CI [0.24, 1.16]) and small effect (d = 0.28; 95% CI [0.04, 0.72]) of naltrexone in reducing PDI and PHID, respectively; and (ii) among the cutoff-derived high reward/high relief subgroup, we found a medium-to-large effect (d = 0.63; 95% CI [0.05, 1.1]) of naltrexone in reducing PHID. Among reward drinkers (not other profiles), naltrexone reduced drinking on days a drinking event occurred by weakening the within-day association between positive affect and urges (P < 0.05)., Conclusions: Naltrexone has pronounced effects in reducing risky drinking among young adult reward drinkers (high reward/low relief) by reducing urges on days when individuals have higher positive affect and are exposed to a drinking event. Naltrexone also appears to reduce risky drinking among young adult high reward/high relief drinkers, but not via the same mechanism., (© 2021 Society for the Study of Addiction.)

Given accumulating evidence that electronic nicotine delivery systems (ENDS) may be a harm-reduction alternative to combustible tobacco products, it is important to understand the real-world implications of these devices in the populations that may benefit from them the most. We surveyed the use, perceptions of, and interest in using ENDS among patients attending their initial low-dose CT scan (LDCT) for lung cancer screening (LCS) who reported current smoking, a cohort of older individuals at high-risk for lung cancer and other smoking-related illnesses due to their heavy smoking history (30 or more pack years). Participants (N = 107) completed the survey in clinic immediately before their shared decision-making visit for lung cancer screening on the day of their LDCT. Approximately a quarter of participants reported ever use of ENDS in the past; nearly a third expressed a willingness to try switching to them in the future. Prior ENDS use was significantly associated with willingness to try switching to ENDS in the future. The most common reasons to consider switching included smoking cessation and harm reduction. Only about a third were aware that ENDS are not approved by the FDA for smoking cessation; knowledge significantly varied by demographic and clinical characteristics. These findings have important implications for ENDS public health campaigns and tobacco harm reduction strategies for older individuals who smoke., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Introduction: JUUL, a closed system e-cigarette with disposable pods, is popular among youth, with positive attributes of this product linked to current use by youth. However, many youth try JUUL and do not continue using; understanding differences in the appeal of this device between current users and those who chose not to continue use can inform regulation and prevention efforts. The aim of the current study is to compare JUUL appeal in youth among past users (ie, used, but not in past month) and current users (ie, used in past month)., Methods: A cross-sectional survey was conducted in four Connecticut high schools in Spring 2018. This survey assessed JUUL use and reasons for liking/disliking JUUL, including its' pharmacological effects (eg, nicotine "buzz"), product characteristics (eg, flavors), peer influence, appeal compared to other e-cigarettes, and concealability. Logistic regressions were conducted to examine differences in liking/disliking JUUL by use status (past vs. current)., Results: Among JUUL users (N = 1374; 43% of total sample), 30.4% were past users and 69.6% were current users. Compared to current users, past users were less likely to like JUUL for positive pharmacological effects (eg, nicotine "buzz"), product characteristics (eg, flavors), and peer use and more likely to dislike JUUL for the adverse pharmacological effects (eg, headache), product characteristics (eg, flavors), and for "other" reasons (open-ended response; eg, perceived harm)., Conclusions: Findings suggest that altering JUUL appeal through regulating nicotine content and flavors may be key in policy aimed at shifting youth to become past JUUL users., Implications: This study investigates how current and past youth JUUL users differ in their report of the appeal of JUUL. Past users are less likely to report experiencing positive pharmacological effects and product characteristics of JUUL and are less likely to report appeal due to peer use. Understanding how appeal of JUUL may differ among past and current users can aid in our understanding of how to regulate these products so that they are less appealing to current youth users., (© 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.)