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Natural American Spirit (NAS), a leading cigarette brand in the USA,1 markets its products using descriptors such as ‘organic’ and ‘tobacco & water’. Consumers believe that cigarettes with these and similar descriptors are more appealing, healthier and/or less harmful than cigarettes without these descriptors.2–11 Moreover, NAS advertising prominently features nature-related imagery, highlights the brand’s sustainable farming practices and exploits Native American symbolism, all of which may also misrepresent product risk.12–15 This combination of brand characteristics has yielded a consumer base that, compared with those who smoke other brands, is more likely to misunderstand the relative harm of NAS compared with other cigarettes.16 There is no evidence that smoking NAS cigarettes reduces disease risk, and emission studies find substantial variability in exposure to harmful constituents in NAS cigarettes depending on the NAS variety tested, the study’s methods and the compounds under investigation.17–23 Federal regulators have recognised that NAS uses deceptive marketing tactics and have taken limited regulatory action against the brand, resulting in the addition of disclaimer statements on packs and advertisements about the relative harm of ‘natural’ or ‘organic’ commercial tobacco, and the removal of ‘additive-free’ and some instances of ‘natural’ from NAS labelling and marketing.24 The US Food and Drug Administration’s (FDA) Center for Tobacco Products has not publicly initiated regulatory action against the use of ‘organic’, perhaps because the descriptor’s use …

Introduction Tobacco product packaging is an influential industry marketing tool, but research on cigar packaging characteristics is limited. This study leveraged a pack archive of the top-selling, mass-market cigar products in the US and their corresponding sales data to assess the prevalence of common pack features in the marketplace. Methods The 50 cigar products with the highest national unit sales in 2018 were identified using Nielsen’s Scantrack data. A content analysis captured common packaging features within four domains: physical, textual, graphical, and promotional elements. Descriptive statistics, weighted by each pack’s 2018 unit sales, documented the market share of pack characteristics overall and by brand. Results Products in the sample constituted 62% of all convenience store cigar sales in 2018. Black & Mild, the most popular brand, did not display warning labels on its single stick, cellophane-wrapped products, which constituted nearly all of its sales (96.3%). Resealable foil pouches were the most common packaging style across other brands, and were most often sold in predominantly red, green, or silver packaging. Common flavor categories included concept (eg, “Jazz”, 32.4%), fruit (15.7%), and sweet (14.5%). Prepricing (eg, “2 for 99 cents”) was a popular promotional strategy, appearing on 74% of all packs sold. Conclusions Cigar packaging features such as small pack sizes, innovative materials, flavor names, bright colors, and cost-saving promotions are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help reduce appeal and potentially curb cigar use. Implications Sales of mass-market cigars in the US have remained strong over the past decade, propelled by lax product regulations. This study demonstrated that cigar packaging features that may enhance consumer appeal, such as small pack sizes, flavor names, sensory descriptors, bright colors, and cost-saving promotions, are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help curb cigar use, reduce youth appeal, and potentially minimize existing disparities in cigar use.

IntroductionIQOS is a heated tobacco product that was authorised as a modified risk tobacco product (MRTP) in July 2020. While it was removed from the US market in 2021 for legal reasons, as the first tobacco product to receive an ‘exposure modification’ MRTP order, surveillance of IQOS marketing is needed to inform regulation and policy for future MRTPs. The purpose of this study is to expand the current research on IQOS advertising in the USA by examining content and readership characteristics of IQOS ads in print magazines before and after US Food and Drug Administration MRTP authorisation.MethodsWe merged content analysis data with Kantar Media data on magazine placement and expenditures. Magazine readership data were obtained from MRI-Simmons. We compared data from pre-MRTP authorisation with data post-MRTP authorisation. This study was conducted in 2021.ResultsThere was one unique ad and there were 13 observations pre-MRTP, and eight unique ads and 132 observations post-MRTP. Compared with pre-MRTP ads, more post-MRTP ads featured Marlboro HeatSticks, including Amber HeatSticks, and featured people. All ads contained a warning label—most warning labels were cigarette specific. IQOS ads were featured in magazines that are especially popular among women.ConclusionsAfter receiving MRTP authorisation, IQOS increased ad expenditures in print magazines with a readership comprised of primarily women. If IQOS returns to the US market, it will be important for tobacco control to monitor their advertisement content, placement, and expenditures.

BackgroundAudits of tobacco retail stores can identify marketing patterns as newer tobacco products are introduced in the US. Our study examined store and neighborhood correlates of availability of nicotine pouches and disposable e-cigarettes in four US sites.MethodsWe conducted standardized store audits of n=242 tobacco retailers in 2021 in different states: New Jersey, Kentucky, North Carolina, and New York. Store audits focused on availability of nicotine pouches and disposable e-cigarettes. We geocoded stores linking them with census tract demographics. We conducted unadjusted and adjusted Poisson regression of availability of each product with correlates of the proportion of Non-Hispanic White residents, households under poverty, proximity to schools, site, and store type.ResultsNicotine pouches and disposable e-cigarettes were each available in around half the stores, but availability differed across sites. In adjusted analyses, nicotine pouches were less likely to be available in each store type vs. chain convenience and more likely in stores in census tracts with more non-Hispanic White residents. In contrast, disposable e-cigarettes were more likely to be available in tobacco store/vape shops than convenience stores and less likely in non-specialty store types like groceries.ConclusionsThe availability of newer tobacco products like nicotine pouches and disposable e-cigarettes were widely available in stores across sites, but retail marketing patterns appear to differ. As these product types become subject to increased regulation as they go through the FDA pre-market authorization process, understanding changes in their retail environment is critical to inform potential policies regulating their sale and marketing.

IntroductionUnderstanding the population impact of e-cigarettes requires determining their effect on cigarette smoking cessation.MethodsUsing the US Population Assessment of Tobacco and Health cohort, we examined smoking cessation among adult current cigarette smokers at Wave 1 with follow-up data at Waves 2 and 3 (n = 9724).ResultsBy Wave 3 (2015/2016), 17.3% of smokers had quit smoking. Smokers using e-cigarettes daily or who increased to daily use over the three waves were two to four times more likely to have quit in the short term (ConclusionSmoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices. Less frequent, unstable, past, or never e-cigarette users were less likely to quit smoking. Monitoring the relationship between patterns of e-cigarette and cigarette use is complex but critical for gauging the potential of e-cigarettes as a harm reduction tool.ImplicationsThis study suggests that consistent and frequent e-cigarette use over time is associated with cigarette smoking cessation among adults in the United States. In addition, findings suggest that flavored e-cigarette use and use of rechargeable e-cigarette devices can facilitate smoking cessation. These results underscore the importance of carefully defining and characterizing e-cigarette exposure patterns, potential confounders, and use of e-cigarettes to quit smoking, as well as variations in length of the smoking cessation.

Introduction Direct emissions of nicotine and harmful chemicals from electronic cigarettes (e-cigarettes) have been intensively studied, but secondhand and thirdhand e-cigarette aerosol (THA) exposures in indoor environments are understudied. Aims and Methods Indoor CO2, NO2, particulate matter (PM2.5), aldehydes, and airborne nicotine were measured in five vape-shops to assess secondhand exposures. Nicotine and tobacco-specific nitrosamines were measured on vape-shop surfaces and materials (glass, paper, clothing, rubber, and fur ball) placed in the vape-shops (14 days) to study thirdhand exposures. Results Airborne PM2.5, formaldehyde, acetaldehyde, and nicotine concentrations during shop opening hours were 21, 3.3, 4.0, and 3.8 times higher than the levels during shop closing hours, respectively. PM2.5 concentrations were correlated with the number of e-cigarette users present in vape-shops (ρ = 0.366–0.761, p < .001). Surface nicotine, 4-(N-methyl-N-nitrosamino)-4-(3-pyridyl)butanal (NNA), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) were also detected at levels of 223.6 ± 313.2 µg/m2, 4.78 ± 11.8 ng/m2, and 44.8 ± 102.3 ng/m2, respectively. Substantial amounts of nicotine (up to 2073 µg/m2) deposited on the materials placed within the vape-shops, and NNA (up to 474.4 ng/m2) and NNK (up to 184.0 ng/m2) were also formed on these materials. The deposited nicotine concentrations were strongly correlated with the median number of active vapers present in a vape-shop per hour (ρ = 0.894–0.949, p = .04–.051). NNK levels on the material surfaces were significantly associated with surface nicotine levels (ρ=0.645, p = .037). Conclusions Indoor vaping leads to secondhand and THA exposures. Thirdhand exposures induced by e-cigarette vaping are comparable or higher than that induced by cigarette smoking. Long-term studies in various microenvironments are needed to improve our understanding of secondhand and THA exposures. Implications This study adds new convincing evidence that e-cigarette vaping can cause secondhand and THA exposures. Our findings can inform Occupational Safety and Health Administration, state authorities, and other government agencies regarding indoor air policies related to e-cigarette use, particularly in vape-shops. There is an urgent need to ensure that vape-shops maintain suitable ventilation systems and cleaning practices to protect customers, employees, and bystanders. Our study also demonstrates that nicotine can deposit or be adsorbed on baby’s clothes and toys, and that tobacco-specific nitrosamines can form and retain on baby’s clothes, highlighting children’s exposure to environmental e-cigarette aerosol and THA at home is of a particular concern.

Pack size is an important pricing strategy for the tobacco industry, but there is limited data on how users differ based on preferred pack size for cigar products. Using data from Wave 4 of the Population Assessment of Tobacco and Health Study, this study identified differences in adult cigar user characteristics based on pack size purchasing behavior among users of a top cigar brand, Black and Mild. Weighted chi-square tests were used to examine the associations between Black and Mild pack size and sociodemographic, cigar and other substance use characteristics. Overall, our study found that users of Black and Mild cigars differ by demographic, cigar and other tobacco use characteristics based on preferred pack size, with smaller packs appealing to younger, female, less-experienced and less-established smokers, and larger packs appealing to older, male, more experienced, and more dependent cigar smokers. Dual use of cigarettes and cigars was also higher among users of smaller packs. While this study is cross-sectional, findings suggest that minimum packaging laws for cigars may impact younger adults who are purchasing smaller pack sizes and likely experimenting with new cigar products and styles.

In the United States (US), racial/ethnic groups differ in cigarette smoking behaviors. We examined changes in cigarette prevalence and quit ratios over 15 years by racial/ethnic group (Non-Hispanic (NH) White, NH Black, Hispanic, NH Other). Data were drawn from the 2002–2016 National Survey on Drug Use and Health (NSDUH) public use data files and analyzed in 2018. Linear time trends of the prevalence of daily, nondaily, and menthol cigarette use and quit ratios (i.e., proportion of former smokers among lifetime smokers) were assessed using logistic regression models. 19.35% of NH White persons were daily smokers in 2016; this prevalence was significantly higher than all other groups (NH Black 10.99%, Hispanic 6.81%, NH Other 9.10%). Menthol use was significantly more common among NH Black individuals than all other groups in every year from 2002 to 2016 (2016: NH Black 23.38%, NH White 14.52%, Hispanic 10.49%, NH Other 8.97%). From 2002 to 2016, daily and nondaily smoking decreased significantly among all groups. The rate of decline of nondaily smoking was more rapid among Hispanic than NH White individuals while the rate of menthol smoking decline was more rapid among NH White than among Hispanic individuals. The quit ratio did not change significantly from 2002 to 2016 among NH Black individuals (31% to 35%) in contrast to a significant increase among NH White (2002, 45%; 2016, 50%) and Hispanic (2002, 33%; 2016, 41%) individuals. Further progress in tobacco control for vulnerable groups may need to include innovative strategies to address these concerning trends.

Tobacco companies in the U.S. spend billions of dollars advertising at the point-of-sale. Using photographs of storefront tobacco ads in New York City (NYC), we conducted a content analysis to describe the prevalence of common features across four product categories and illuminate ways in which they may influence behavior. In 2017, data collectors photographed exterior ads from a representative sample of tobacco retailers in NYC (n = 796). We coded each ad (n = 976) for the presence of various characteristics (e.g., brand, price displays, warning labels, menthol/flavors, size, location). Chi-square tests examined differences by product type. Most ads were for cigarettes (40%), followed by electronic nicotine delivery systems (ENDS, 27.9%), cigars (26.9%), and smokeless tobacco (5.2%). Over half of cigarette and smokeless tobacco ads promoted a menthol or flavored style (61% each), compared to about a quarter of cigar (25.9%) and ENDS ads (30.3%, p .0001). Cigar and ENDS ads, however, were more frequently placed directly on the door of entry (49.4% and 46.7%, respectively, p .001). Only 5% of ENDS ads displayed a standard warning label. Notably, a quarter of all tobacco ads (23.4%) were for the brand Newport. Cigarette ads still dominate at the point-of-sale with regard to volume and size. Across all products, ad features did not always align with local and federal policies (e.g., flavor bans, warning label mandates). Continued surveillance of advertising strategies and policy compliance can help provide the evidence base needed to inform marketing regulations that reduce the deadly burden of tobacco use.

Smoke-free housing policy in multi-unit housing has emerged as a promising tobacco control initiative, yet full compliance remains elusive and is a critical impediment to policy effectiveness. There is a gap in existing research on potential factors preventing optimal smoke-free policy adoption and corresponding solutions. Using qualitative and quantitative data from resident surveys (N = 115) as well as key informant interviews, a focus group, and observational fieldwork, this study 1) assesses smoking behaviors and experience with secondhand smoke in buildings after adoption of a smoke-free policy; 2) examines resident and property management perceptions of the policy; and 3) identifies socioecological factors that influence the policy's effectiveness in affordable housing settings in New York City. Findings indicate that residents view smoking regulations within the context of broader relationships with the housing provider and other residents. We argue that these “social contracts” strongly influence the effectiveness of smoke-free housing policies and must be acknowledged to maximize compliance.

Introduction Tobacco smoking prevalence in Indonesia is among the highest in the world. Research worldwide identifies that physical access to tobacco through retail outlets is related to increased tobacco smoking. Tobacco outlet density is very high in many Indonesian cities, so tobacco access may contribute to the high prevalence of tobacco use in that country. The aim of this study was to examine distributions of tobacco outlets in one Indonesian city, Yogyakarta, in relation to social and physical environmental conditions. Methods For this cross-sectional ecological study, we virtually audited randomly selected street segments (n = 1099) using Google Street View. The outcome of interest was a count of tobacco advertising banners (indicating the presence of retail outlets). Exposures were physical environmental conditions (scales of main roads, physical decay, presence of schools, mosques, churches) and social conditions measured at the neighbourhood level (concentrated disadvantage, age composition, population density). Results Tobacco banners were present on 36.4% of sampled street segments, including 55 (37%) of 147 streets with schools; a total of 1381 banners were identified. Multilevel negative binomial regression models for street segments nested within neighbourhoods found the prevalence of tobacco banners per 100 m was lower near schools (RR = 0.66, 95% CI 0.45, 0.97) and was not associated with other exposure measures. Discussion and conclusions Retail tobacco outlets are ubiquitous in Yogyakarta. Although they are relatively less prevalent on streets with schools, the high absolute values and wide spatial distribution means all residents of Yogyakarta are exposed to tobacco outlets.

Background The COVID-19 pandemic and associated public health prevention measures (e.g., “stay at home” orders) may impact tobacco supply and demand among consumers. This qualitative study identified multi-level drivers of shifts in inhaled tobacco product use and access patterns during the initial COVID-19 “lockdown” period in the United States. Methods Between April and May 2020, we conducted semi-structured telephone interviews (n = 44) with adults who use cigarettes and/or electronic nicotine delivery systems (ENDS). Transcripts were thematically analyzed using a socioecological framework. Results Nearly all participants reported changes in their product use during lockdown, though patterns varied. Increased use was most common and was predominantly driven by individual-level factors: pandemic-related anxiety, boredom, and irregular routines. Decreased use was common among social users who cited fewer interpersonal interactions and fear of sharing products. At the community level, retail access impacted cigarette and ENDS use differently. While cigarettes were universally accessible, ENDS access was more limited, driving some to purchase products online. Delayed deliveries led some ENDS users to compensate with readily-available cigarettes. Conclusion To mitigate ways that the COVID-19 pandemic may exacerbate an existing public health crisis, multi-level policy strategies, such as expanded virtual cessation services and implementation and enforcement of smoke-free home rules, can better support population health during this critical period. Policies that facilitate access to lower risk products can help minimize harm among those who cannot or do not want to quit smoking.

In the face of increasingly restrictive policies regulating how cigarette companies can advertise, the pack itself has become one of the industry’s primary promotional tools.1 2 A large body of research demonstrates that pack features, such as size, colour and descriptors, can implicitly communicate product information and influence perceptions of taste, smoking experience and health risks.1 3 4 To date, 13 countries have fully implemented ‘plain packaging’ laws to reduce the attractiveness of cigarettes, but millions around the globe are still exposed to packaging elements that may increase consumer demand. While exterior pack characteristics and their impact on product appeal have been studied previously,4 the ways in which the tobacco industry may leverage pack interiors to communicate with smokers remain obscure. Prior research has documented the ubiquity of branding on the cigarette itself—another form of marketing ‘real estate’ …

Objective Tobacco use remains disproportionately common among adults with internalizing problems. The rising prevalence of flavored tobacco use among this population may be a contributing factor. Using data from Wave 4 of the Population Assessment of Tobacco and Health study, this study examined differences across adult ever tobacco users reporting internalizing problems, in initiation of tobacco use with a flavored product and past 30-day (current) flavored tobacco use (n =27,425). Severity of internalizing problems was measured using the Global Appraisal of Individual Needs–Short Screener Internalizing Disorder Screener. The tobacco use variables were initiation with or current use of a flavored product, assessed separately for each product. Weighted chi-square tests and multivariable modified Poisson regression models were used to examine the associations between severity of internalizing problems and each outcome. Results Controlling for covariates, ever users with severe internalizing problems were more likely to have initiated with flavors for cigarettes (adjusted prevalence ratio [aPR]: 1.16, 95% confidence interval [CI]: 1.09,1.24), cigarillos (aPR: 1.09, 95% CI: 1.03, 1.16), electronic nicotine products (aPR: 1.08, 95% CI: 1.03, 1.13) and smokeless tobacco (aPR: 1.15, 95% CI: 1.04, 1.27), relative to those with low internalizing problems. Ever users with severe internalizing problems were more likely to currently use a flavored tobacco product for cigarettes (aPR: 1.15, 95% CI: 1.07, 1.24), cigarillos (aPR: 1.15, 95% CI: 1.04, 1.28) and smokeless tobacco (aPR: 1.04, 95% CI: 1.02, 1.05). Conclusions Flavored tobacco use seems disproportionately common among tobacco users with severe internalizing problems, across a variety of measures.

BackgroundIn 2018, New York City (NYC) implemented a tobacco-free pharmacy law as part of a comprehensive policy approach to curb tobacco use. This study models the reduction in tobacco retailer density following the ban to examine differences in the policy’s impact across neighbourhoods.MethodsTobacco retailer density per 1000 residents was calculated in July 2017 for each of NYC’s Neighborhood Tabulation Areas (NTAs, n=188) before and after removing pharmacies as licensed tobacco retailers. Pearson correlations and linear regression (with predictors scaled to 10 unit increments) measured associations between the projected change in retailer density after the ban and NTA demographic characteristics.ResultsOn average, retailer density decreased by 6.8% across neighbourhoods (SD: 6.3), with 17 NTAs experiencing reductions over 15%. Density reduction was greater in NTAs with higher median household income (r: 0.41, B: 1.00, pConclusionsNYC’s tobacco-free pharmacy law substantially reduces tobacco retailer density overall, but the impact is not equal across neighbourhoods. In order to minimise disparities in the tobacco retail environment, local governments considering a similar ban should supplement this strategy with other retailer restrictions to achieve equitable outcomes.

Introduction Amid decreasing rates of cigarette smoking and a rise in e-cigarette use, there is a need to understand population patterns of use to inform tobacco control efforts and evaluate whether e-cigarettes may play a role in tobacco harm reduction. Methods This study merged data from the 2014 and 2015 National Health Interview Survey (NHIS) and restricted the sample to recent smokers [i.e., current smokers and former smokers who quit in 2010 or later (n = 15,532)]. Log-binomial regression estimated adjusted prevalence ratios (aPR) for being quit by e-cigarette use status (i.e., daily, some day, former trier, never). All analyses controlled for factors traditionally correlated with smoking cessation. Results A quarter of the sample (25.2%) were former smokers. The prevalence of being quit was significantly higher among daily e-cigarette users compared to those who had never used e-cigarettes [52.2% vs. 28.2%, aPR: 3.15 (2.66, 3.73)]. Those who used e-cigarettes on some days were least likely to be former smokers (12.1%). These relationships held even after accounting for making a quit attempt and use of other tobacco products. Conclusions Among those with a recent history of smoking, daily e-cigarette use was the strongest correlate of being quit at the time of the survey, suggesting that some smokers may have quit with frequent e-cigarette use or are using the products regularly to prevent smoking relapse. However, the low prevalence of cessation among infrequent e-cigarette users highlights the need to better understand this subgroup, including the individual factors and/or product characteristics that may inhibit cessation.

Since 2009, flavours other than menthol have been prohibited in cigarettes in the USA.1 Meanwhile, flavours remain available in other tobacco products, such as cigars, and continue to be produced and sold in the USA. In recent years, cigar sales have risen;2 notably, sales of flavoured cigars have increased by nearly 50% since the signing of the Tobacco Control Act.3 In 2018, the Food and Drug Administration announced their intent to move forward with proposed rulemaking to ban menthol in cigarettes and all flavours in cigars; however, action has yet to be taken following this announcement.4 As such, cigar manufacturers have taken advantage of the lack of regulation and continue to create flavoured products that appeal to young people.5 White Owl is a cigar brand owned by Swedish Match North America and promotes a wide range …

Tobacco-free nicotine pouches are a new class of smokeless tobacco products that experienced precipitous sales1 increases since their national US market entry in 2016.2 Between 2016 and 2019, annual unit sales of nicotine pouches increased from approximately 100 000 to over 46 million. The pouches contain a powdered mix of nicotine, flavouring, sweeteners and binders; are used in a manner similar to snus (ie, placed between the lip and gum) and are sold in a variety of nicotine strengths and flavours. These products are marketed as containing ‘tobacco-derived’ or ‘tobacco-free’ nicotine and nicotine salts and are described in product marketing as ‘spitless’, ‘smokeless’ and ‘tobacco leaf free’.3 The most prominent brands in today’s marketplace are owned by leading tobacco companies:4 Swedish Match owns Zyn, British American Tobacco sells Lyft and VELO5 (soon to be consolidated under the single branding VELO) and Rogue is owned by Swisher International. In 2019, Altria acquired and began international marketing of the brand on!6 Recently, crossover advertising of nicotine pouch products was observed among leading brands of combustible cigarettes. For example, on 4 November 2020, routine …

Objectives This study identifies the specific product characteristics driving mass-merchandise cigar sales in the context of the changing regulatory environment. Methods Cigar sales data in US convenience stores during 2008-2015 were purchased from Nielsen's Convenience Track system. Descriptive statistics highlight changes in the cigar market over time. Results Sales of flavored cigars increased by nearly 50% since 2008 and now make up over half of the cigar market. Fruit remains the most popular flavor group, but the sale of non-descript flavors such as "Jazz" and "Green" has grown substantially. Inexpensive 2- and 3-packs made up less than 1% of cigar sales in 2008, but by 2015 this packaging style held 40% of the market share. Black & Mild and Swisher Sweets dominate the convenience store channel and together are responsible for nearly 60% of total mass-merchandise cigar sales. Conclusions Cigar companies take advantage of features recently banned for cigarettes, such as flavorings and small pack sizes to maintain strong sales. Given the appeal of mass-merchandise cigars to youth and young adults, the FDA and other governing bodies should regulate the manufacturing and promotion of cigars in the same way they have regulated cigarettes.

Accurate surveillance is critical for monitoring the epidemiology of emerging tobacco products in the United States, and survey science suggests that survey response format can impact prevalence estimates. We utilized data from the 2014 New Jersey Youth Tobacco Survey (n = 3,909) to compare estimates of the prevalence of 4 behaviors (ever hookah use, current hookah use, ever e-cigarette use, and current e-cigarette use) among New Jersey high school students, as assessed using "check-all-that-apply" questions, with estimates measured by means of "forced-choice" questions. Measurement discrepancies were apparent for all 4 outcomes, with the forced-choice questions yielding prevalence estimates approximately twice those of the check-all-that-apply questions, and agreement was fair to moderate. The sensitivity of the check-all-that-apply questions, treating the forced-choice format as the "gold standard," ranged from 38.1% (current hookah use) to 58.3% (ever e-cigarette use), indicating substantial false-negative rates. These findings highlight the impact of question response format on prevalence estimates of emerging tobacco products among youth and suggest that estimates generated by means of check-all-that-apply questions may be biased downward. Alternative survey designs should be considered to avoid check-all-that-apply response formats, and researchers should use caution when interpreting tobacco use data obtained from check-all-that-apply formats.

Purpose Electronic cigarettes (e-cigarettes) are now the most popular tobacco product among youth. Little is known about the relationship between exposure to e-cigarette marketing at the point-of-sale and youth e-cigarette use. Methods Research staff collected data on e-cigarette availability and promotion in tobacco retailers within a half-mile of 41 schools participating in the 2014 New Jersey Youth Tobacco Survey. These data were linked with participant responses from the New Jersey Youth Tobacco Survey (n = 3,909) and log-Poisson regression models estimated adjusted prevalence ratios for ever and past-month e-cigarette use. Results Nearly a quarter of high school students in New Jersey have tried e-cigarettes (24.1%) and 12.1% were past-month users. Prevalence was highest among males, non-Hispanic whites, and students who have used other tobacco products. After controlling for covariates and the clustered nature of the data, e-cigarette retailer density around schools was positively associated with ever and past-month use of e-cigarettes ( p p = .031). Conclusions This study suggests that the point-of-sale environment around schools may contribute to e-cigarette use among youth. Policy efforts to restrict tobacco promotion at the point-of-sale may play a role in reducing the use of e-cigarettes.

OBJECTIVES: Measurement properties of key constructs used in tobacco retailer audit studies are infrequently examined. We used diagnostic testing metrics to assess the predictive validity of product advertising and availability. METHODS: In 2017, we documented tobacco product advertising and availability in a sample of New York City and New Jersey retailers (N = 987). We calculated positive predictive values (PPV, ie, probability of availability given advertising is present) and sensitivity scores (ie, probability of advertising given product is available) for cigarettes, cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS). RESULTS: Advertising presence was an imprecise indicator of availability for ENDS (PPV: 82.3%) and smokeless tobacco (PPV: 88.2%), particularly in non-chain convenience stores. Cigars were least likely to be advertised, if available (sensitivity: 27.8%), compared to other product types (sensitivity range: 43.8% - 57.9%). CONCLUSIONS: The suboptimal predictive validity of advertising for certain products suggests that this measure does not necessarily reflect product accessibility in communities. Moreover, differences in sensitivity scores suggest that some product classes rely on strategies other than physical ads to recruit and retain consumers. A better understanding of these constructs and their influence on behavior can help inform more effective retail-based regulatory approaches.

Background Individuals with alcohol use disorders (AUDs) who smoke cigarettes experience greater health risks than those using either substance alone. Further, disparities exist in AUDs and smoking by race/ethnicity. Although smoking has declined in the general population, it is not known whether the smoking prevalence has changed over time for individuals with AUDs. The current study used representative U.S. data to estimate the prevalence of current cigarette use from 2002 to 2016 by AUD status and severity overall and by race/ethnicity. Methods Data were drawn from the National Survey on Drug Use and Health, an annual cross-sectional study of U.S. individuals, from 2002 to 2016 (total analytic sample n = 837,326). Cigarette smoking prevalence was calculated annually among those with and without past-year AUD and by AUD severity level (mild, moderate, severe AUD). Time trends in smoking prevalence by AUD status and severity were tested using logistic regression for the overall sample and significant interactions were subsequently stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, NH Other). Results Cigarette use was persistently over twice as common among those with AUDs compared to without AUDs (2016: 37.84% vs. 16.29%). Cigarette use was also more common among those at each level of AUD severity criteria (2016: mild AUD 34.59%; moderate AUD 35.35%; severe AUD 52.23%). Approximately half of NH Black respondents with AUDs, and three-quarters of NH Black respondents with severe AUDs, reported smoking in 2016. The prevalence of smoking decreased significantly over time among respondents with and without AUDs; however, there were differences by race. There was no decline in smoking prevalence among NH Black respondents with AUDs over time in contrast to a significant decrease for every other racial/ethnic group with and without AUDs. Conclusions Individuals with AUDs may need additional resources and interventions to quit smoking, especially NH Black individuals.

Research demonstrates that characteristics of cigarette packaging influence consumer product perceptions, yet the current literature on the impact of cigar packaging is limited. This study aims to examine how different cigarillo packaging features influence young adult cigar smokers’ perceptions. In 2016, we recruited past-year cigar users aged 18–34 from Amazon Mechanical Turk (N = 1260). We utilized a 2 × 2 × 3 × 2 between-subjects factorial design, randomly assigning participants to view one of 24 images of a cigarillo package that varied by brand (Black &amp, Mild vs. Swisher Sweets), brand name (full vs. abbreviated), color (brown vs. green vs. purple), and price promotion (present vs. absent). Participants rated the product on several perceptions and purchase intentions, and they reported on cigar use and demographics. Overall, color and brand name influenced perceptions, but effects varied by brand. For Swisher Sweets, only price promotions influenced perceptions (e.g., taste, use for marijuana), for Black &amp, Mild, all packaging features influenced perceptions (e.g., harshness, tobacco quality), and price promotions increased purchase intentions. Our findings also raise questions that product features may interact with one another, with certain features, such as color, overpowering other attributes. More research is needed to understand the impact of other packaging features, such as warning labels, on product perceptions across a variety of brands.

Background Cannabis vaporizer companies leverage social media to market their products, but little is known about the content of the messages being delivered to consumers. This study describes characteristics of Instagram posts from three popular cannabis vaporizer brands in the U.S. Methods A content analysis was performed on posts uploaded between October 2017 and October 2018 by the brands Kandypens (n = 731), G Pen (n = 454), and Pax (n = 71). Posts were coded for: characteristics of individuals pictured, health and risk statements, references to cannabis, co-marketing activities, cartoon images, and product price. Descriptive statistics highlight the prevalence of these characteristics and between-brand differences. Results Posts had a wide reach, with a total of 467,700 followers across brands. Two-thirds (68.0 %) of posts depicted someone using the product. Among posts featuring a person, (83.9 %) depicted female users. Overall, cannabis was rarely mentioned (8.9 %) or depicted (10.0 %) in posts. “Tagging” social media influencers (34.3 % of posts) and other companies or their products (31.9 % of posts) were popular promotional strategies. Few posts mentioned age restrictions (0.3 %), health risks (5.2 %), or health benefits (0.2 %). Conclusions Cannabis vaporizer companies reach thousands of consumers through brand-owned social media accounts. Strategies to promote their products on these channels include posts that may appeal to sociodemographic groups and leveraging social media influencers and other companies to increase overall reach. As legalized recreational cannabis expands and a range of consumption methods become popular, an understanding of brands’ social media marketing practices is needed to inform policies and interventions that promote population health.

An abundance of evidence suggests that the tobacco industry’s response to increased regulation imposed on cigarettes has been the development of little cigars and filtered cigars which are tobacco products that are merely cigarettes in disguise. Emphasising these products’ physical attributes, the tobacco industry has offered cigar products to its consumers as pseudo-cigarettes. For decades, tobacco manufacturers’ response to increased cigarette regulation and taxation has been to exploit policy loopholes by offering these little cigars and filtered cigars pseudo-cigarettes that are exempted from this regulatory oversight. As a result, in spite of increased regulations and taxes on cigarettes, smokers can purchase cigars that are almost physically indistinguishable from their cigarettes at a lower cost. This commentary describes the recent evolution of the cigar market in response to federal regulation, and highlights historical cigar industry attempts to evade taxation, capitalise on product features that are off-limits to cigarettes, and capture the shrinking market of cigarette smokers. We present the case that little cigars and filtered cigars, differing very little physically from cigarettes, are products deserving the same regulatory scrutiny.

Objective: To explore the feasibility of a random-digit dial (RDD) cellular phone survey in order to reach a national and representative sample of college students. Methods: Demographic distributions from the 2011 National Young Adult Health Survey (NYAHS) were benchmarked against enrollment numbers from the Integrated Postsecondary Education System (IPEDS). The sample quality was compared with the Harvard School of Public Health College Alcohol Study (1993), National College Health Risk Behavior Survey (1995), and National College Health Assessment (2011). Results: Overall, the NYAHS performed as well, if not better, than previous college health surveys at reaching important demographic subgroups. Conclusions: Cellular phone RDD is one feasible approach for studies of the general population of college students that can potentially generate national estimates of health behavior.

Background Tobacco advertising in retailers influences smoking, but little research has examined how this relationship differs among population subgroups. This study merged data on neighborhood cigarette advertising with geocoded survey data to assess the association between advertising prevalence and current smoking among New York City (NYC) residents, and whether demographic and psychological characteristics moderate this relationship. Methods Audit data from a stratified, random sample of 796 NYC tobacco retailers generated neighborhood prevalence estimates of cigarette advertising, which were linked with unweighted 2017 NYC Community Health Survey data (n = 7837 adult respondents with residential geocodes). Multilevel regression estimated adjusted odds ratios (aOR) of current smoking by level of neighborhood cigarette advertising (quartiles). Interactions assessed differences in this relationship by demographic characteristics and current depression (analyses conducted in 2019). Results There was no main effect of advertising on smoking status or significant interactions with demographic variables, but current depression was an effect modifier (p = 0.045). Cigarette advertising was associated with current smoking among those with current depression (p = 0.023), not those without (p = 0.920). Specifically, respondents with depression who resided in neighborhoods in the highest quartile for cigarette advertising prevalence had higher odds of current smoking, compared to those living in the lowest advertising quartile [aOR: 1.72 (1.04, 2.86)]. Conclusion Retail cigarette advertising may serve as an environmental cue to smoke among adults with depression. Efforts to restrict or counteract this practice, such as the development of community-level public health interventions and counter-marketing programs, may particularly benefit those with depression and, perhaps, other mental health disorders.

Background Medical marijuana laws (MMLs) can impact marijuana and opioid use, but the relationship between MMLs and other drugs, such as prescription stimulants, remains unexamined. Because lesbian, gay and bisexual (LGB) individuals report higher levels of prescription stimulant use than heterosexuals, we explored the relationship between MMLs and past-year medical and non-medical stimulant use by sexual identity and gender. Methods We pooled 2015–2017 National Survey on Drug Use and Health data for adults (n = 126 463), and used survey-weighted multinomial logistic regression to estimate odds of past-year (a) medical prescription stimulant use, (b) non-medical prescription stimulant use and (c) non-medical versus medical stimulant use. We stratified by gender, adjusted for sociodemographic characteristics, and tested the interaction between MML state residence and sexual identity. Results Bisexual men had higher medical (6.4% versus 4.1%; aROR=1.93[1.29–2.88]) and non-medical stimulant use 6.6% versus 2.4%; aROR=2.23[1.44–3.44]) than heterosexual men. Bisexual women had higher non-medical stimulant use (6.8% versus 1.6%; aROR=1.54[1.23–2.93] than heterosexual women. Female (aROR=0.70[0.62–0.78]) and male (aROR=0.74[0.66–0.82]) heterosexuals in MML states had lower odds of medical stimulant use than in non-MML states. Bisexual men in MML states had lower odds of medical (aROR=0.36[0.21–0.61]) and non-medical stimulant use (aROR=0.48[0.29–0.81]) than bisexual men in non-MML states. Similar patterns emerged for bisexual women's non-medical use (aROR=0.57[0.40–0.81]). Conclusion Prescription stimulant use was higher in non-MML states for most LGB subgroups. MMLs may differentially impact stimulant use, primarily for bisexual men and women. States enacting MMLs should consider potential impacts on drugs other than marijuana, especially among LGB populations.

This cross-sectional study examines trends in menthol cigarette use compared with nonmenthol cigarette use in the US.

Dual-users of cigarettes and e-cigarettes are commonly treated as a single group. Our study applied a more nuanced classification of this complex behavior to examine its associations with future tobacco use behaviors using data from Waves 1 and 3 of the Population Assessment of Tobacco and Health. Dual-users at Wave 1 (n = 1,665) were categorized into 4 groups based on the frequency with which they used each product (i.e., some days, daily). Analyses identified sociodemographic correlates of group membership and the prevalence of (1) completely switching to e-cigarettes and (2) quitting both products by Wave 3. Dual-users who smoked cigarettes every day and used e-cigarettes some days (69.6%) were the majority and more likely to have lower education (p .001). Although some day smoking and daily e-cigarette use was the least common category (5.9%), these individuals were most likely to have completely switched to e-cigarettes by Wave 3 (aOR = 6.19, 95% CI = 3.91, 9.79). Dual-users who smoked and used e-cigarettes some days were most likely to have completely quit tobacco by Wave 3 (aOR = 3.98, 95% CI = 2.93, 5.40). In general, dual-users who had higher education or income were more likely to have completely switched to e-cigarettes or quit tobacco use by Wave 3. Adults who concurrently use cigarettes and e-cigarettes exhibit considerable heterogeneity in their use of these tobacco products. Dual-users that are higher on the socioeconomic gradient are more likely to engage in plausibly less harmful dual-use behaviors, which are more strongly associated with harm reduction and cessation behaviors. Future research should consider this variation to more accurately characterize the public health impact of dual-use.

Under pressure from the US Food and Drug Administration (FDA), JUUL Labs suspended sale of cucumber, creme, fruit and mango flavoured pods in US brick and mortar retail stores in November 2018 as part of the company’s plan to prevent youth e-cigarette use. Subsequently, mint flavour surged in popularity, against a backdrop of continued increases in youth e-cigarette prevalence.1 In October 2019, JUUL Labs halted sales of most of their flavoured pods, including mint, in retail stores and online, with the exception of menthol and tobacco. Other companies quickly capitalised on these actions and produced JUUL-compatible pods in a variety of flavours, including the most popular JUUL flavours (eg, mango, cucumber).2 In September 2019, we received anecdotal reports that a new vaping product—a disposable ‘pod-mod’, closely resembling JUUL—was popular among college students at a Kean university. We subsequently searched a sub-Reddit forum dedicated to JUUL to find mention of disposable ‘pod-mods’ which began appearing late Spring 2019. Brands mentioned in these threads included ‘Posh’, ‘Eon Stik’ and ‘Mr. Vapor,” and comments focused on tasting similar to JUUL flavours, lasting longer than …

Introduction Alternative tobacco products (ATPs), such as cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS), have a strong presence in the US retail environment amid declining cigarette consumption. This study documented the promotion of ATPs in tobacco retailers in New York City and examined associations with neighborhood demographics. Methods Data on product availability and advertising were collected from a stratified, random sample of tobacco retailers in 2017 (n = 796). Multilevel models estimated adjusted prevalence ratios (aPRs) for each outcome by neighborhood racial/ethnic composition and median household income. Results Nearly half (49.8%) of retailers carried 99-cent cigarillos, but availability was significantly greater in neighborhoods in the highest (vs. lowest) quartile for the percentage of Black residents [68.2%, aPR: 1.59 (1.19, 2.11)] and in the lowest (vs. highest) income quartile [67.3%, aPR: 1.56 (1.04, 2.35)]. Conversely, retailers in neighborhoods with the highest percentage of White residents were significantly more likely to carry ENDS [66.4%, aPR: 1.71 (1.11, 2.62)]. Advertisements for ENDS were less common in neighborhoods in the highest (vs. lowest) quartiles for the percentage of Black and Hispanic residents [20.3%, aPR: 0.64 (0.41, 0.99); 22.9%, aPR: 0.62 (0.40, 0.98)]. Conclusions The marketing of inexpensive, combusted tobacco products disproportionately saturates low-income, minority communities, while potentially lower risk, noncombusted products are more accessible in largely White and higher income neighborhoods. This pattern may exacerbate tobacco-related inequities. Public health policies should prioritize reducing the appeal and affordability of the most harmful tobacco products to help reduce health disparities. Implications Although cigarette promotion at the point-of-sale is well documented in the literature, questions remain about the ways in which alternative tobacco products (ATPs) are marketed in communities. Importantly, these products fall on a continuum of harm, with combusted tobacco overwhelmingly responsible for tobacco-related death and disease. We found that retailers in minority and low-income communities were more likely to carry and advertise inexpensive ATPs such as cigarillos, while potentially less risky, noncombusted products such as smokeless tobacco and e-cigarettes were more accessible in higher income and predominantly White neighborhoods. Policies aligned with product risk may help reduce health disparities.

Cigars are among the most heavily flavoured of all tobacco products.1 Flavoured cigars, particularly cigarillos, appeal to young people and are also associated with blunt use.2–4 Of note, young adults cite brands and flavours as important factors influencing the selection of cigars used for blunts.4 With the growing social acceptance of recreational marijuana use, tobacco control researchers have noted in the past year the explicit co-marketing of cigars and marijuana.5 6 This nascent research was limited as it focused on one brand, Splitarillos5 or a subset of 10 marijuana-related flavours available at the point-of-sale in California.6 We add to the literature on marijuana–cigar co-marketing by analysing Nielsen’s convenience store (C-Track) retail scanner data. Nielsen’s C-Track is representative of all convenience store types and includes chain stores, non-chain and independent convenience stores, as well as gas stations. Cigar …

Objectives. To investigate use of electronic nicotine delivery systems (ENDS) among priority populations. Methods. Using 2016 through 2017 US nationally representative surveys (n = 11 688), we examined ENDS use by sociodemographic variables (age, education, poverty status, insurance, employment, race/ethnicity, sexual orientation) and combustible tobacco use. Results. Among individuals who currently use noncigarette combustible tobacco, those from certain backgrounds (young adults, those living below the poverty level, those less educated, sexual minorities, Blacks, Hispanics, and those without health insurance) were more likely to use ENDS. Among current cigarette smokers, those who were younger, living at or above poverty (ever use), with higher education (current use), sexual minority, and non-Black were more likely to use ENDS. Conclusions. Associations between sociodemographic variables and ENDS use varied depending on combustible tobacco use status, highlighting the need to consider multiple types of tobacco products to understand ENDS use among priority populations. The impact on tobacco disparities will ultimately depend on whether ENDS are used to transition completely away from combustible tobacco products and how this may differ across priority populations who use diverse tobacco products.

Electronic cigarettes, battery-powered nicotine delivery devices, have been increasingly used in the past decade. This critical review provides a qualitative research synthesis of the human health risks associated with E-vapor inhalation in the peer-reviewed literature and our own preliminary experimental results. E-cigarettes may be as efficient as traditional cigarettes in nicotine delivery, especially for experienced users, and studies suggest lower emissions of air toxics from E-cigarette vapor and lower second- and third-hand vapor exposures. Some toxic emissions may however surpass those of traditional cigarettes, especially under high voltage vaping conditions. Experimentally, E-vapor/E-liquid exposures reduce cell viability and promote pro-inflammatory cytokine release. User vulnerability to concomitant environmental agent exposures, such as viruses and bacteria, may potentially be increased. While evidence to date suggests that E-cigarettes release fewer toxins and carcinogens compared to...

Introduction E-cigarette sales continue to increase in the United States. To date, little surveillance research has documented the specific product attributes driving growth. This study uses national market scanner data to describe sales trends in traditional U.S. tobacco retail channels between 2012 and 2013 and identifies product features associated with sales increases. Methods Data on e-cigarette sales in convenience stores, drug stores, grocery stores, and mass merchandisers in the United States were obtained from the Nielsen Company. Each product was coded for attributes such as brand, flavor, and unit size. Total sales volume, market share, and percent growth were calculated for various product attributes. Results E-cigarette sales more than doubled between 2012 and 2013, from $273.6 million to $636.2 million, respectively. Growth was particularly strong in the convenience store channel. Blu eCigs quickly emerged as the best-selling brand and in 2013 constituted nearly half (44.1%) of overall sales. Although fruit-flavored and other flavored products experienced marked growth, unflavored and menthol e-cigarettes overwhelmingly dominated the market. Sales of single unit products (likely disposable e-cigarettes) increased by 216.4%, a much faster rate than multi-unit packs and cartridge refills. Conclusions In traditional U.S. retail channels, particularly the convenience store channel, sales of e-cigarettes continue to grow, with brands like blu and disposable products as the likely drivers. Given the rapidly-changing market, expanded surveillance is needed to monitor sales not only in traditional retail locations, but sales online and in specialty "vape shops," as well.

Background Nearly half of marijuana users in the United States also smoke cigarillos, with many using the products as marijuana “blunts.” The relationship between marijuana legalization and tobacco retail has not yet been examined. This study uses tobacco sales data to compare the cigarillo marketplace in states with legalized recreational marijuana to the overall U.S. marketplace in 2016. Methods Cigarillo sales data from 2016 were obtained from the Nielsen Research Company in the following market regions: Denver, CO; Seattle, WA; Portland, OR; and the overall U.S. Descriptive statistics highlighted differences in the market share of various product features (e.g., flavors, brand, pack size) across regions. Results Characteristics such as fruit flavors, single sticks, and 2–3 packs were more popular in legal marijuana regions compared to the overall U.S. Black & Mild, a brand not traditionally used for blunts, was the top brand nationally (32.8% market share), but Swisher was the top brand in legal marijuana regions. In Seattle and Portland, for example, over half of cigarillo sales were for Swisher products (59.1% and 52.1%, respectively). Cigarillo wraps (i.e., no tobacco filler) were particularly popular in Denver, constituting 11.4% all cigarillo sales versus 2.8% nationally. Conclusions Cigarillo product characteristics traditionally associated with blunt use may shape the tobacco market in legal marijuana regions. As more states continue to legalize recreational marijuana, state and local governments should anticipate the potential impact on the tobacco marketplace and implement tobacco control policies (e.g., flavor bans, minimum pack sizes) that discourage product use.

The study by Dutra and Glantz examined cigarette and electronic cigarette (e-cigarette) trends among US middle and high school students via an interrupted time-series analysis of the National Youth Tobacco Survey (NYTS). The authors concluded that the rate of decline in smoking prevalence did not change after the introduction of e-cigarettes into the US market. We vehemently disagree with their choice to test change in slope at 2009 and note additional problems with their methodology and subsequent interpretations. An interrupted time-series study design, “requires a clear differentiation of the preintervention period and the postintervention period…. This does not necessarily require the intervention to be … E-mail: michelle.manderski{at}rutgers.edu

OBJECTIVE This study compares the cigarette and smokeless tobacco (SLT) markets in Texas and the United States (US) as a whole. METHODS Nielsen convenience store sales data from 2014 were obtained for Dallas, Houston, San Antonio/Austin, and the total US. Descriptive statistics highlighted market share differences in Texas compared to the US overall. RESULTS Marlboro and Copenhagen dominated the cigarette (58.9%) and SLT markets (44.8%) in Texas and had substantially higher relative market shares in Texas than nationally (46.7% and 29.8%, respectively). Camel, with sales driven largely by its Camel Crush variety, held second place in Texas (9.8%), outselling Newport (6.6%), despite Newport's status as second best-selling brand in the US (11.5%). Copenhagen led the SLT market in Texas, outselling Grizzly 2 to 1, yet the brands hold roughly equivalent shares nationally. Whereas flavored SLT products made up nearly 60% of the US SLT market, unflavored SLT (58.6%) dominated in Texas markets. Finally, sales of fine-cut SLT in Texas were more than triple their national market share. CONCLUSIONS Regional tobacco market share differences are likely influenced by multiple factors such as marketing, population demographics, culture, and neighboring communities. Policymakers are encouraged to develop local tobacco control policies and programs within the context of this knowledge.

Background Coverage of e-cigarettes in the news media may shape public perceptions about them but little is known about such news content. This content analysis characterized discussion of e-cigarettes in leading print and online US news sources in 2015. Methods We searched Access World News and Factiva databases for e-cigarette-related news articles appearing in the top 30 circulating newspapers, 4 newswires, and 4 online news sources in the United States in 2015 (n = 295). Coders identified the presence of various e-cigarette topics (e.g. regulation), and benefit and risk statements. Results Nearly half of articles (45.1%) focused primarily on e-cigarette policy/regulatory issues, although e-cigarette prevalence (21.0%) and health effects (21.7%) were common main topics. Concerns about youth were frequently mentioned, including the rise in youth e-cigarette use (45.4%), gateway to smoking potential (33.9%) and appeal of flavors (22.4%). Youth e-cigarette prevalence was more frequently mentioned than adult prevalence in articles discussing FDA regulation (61% vs. 13.5%, respectively). News articles more frequently discussed potential e-cigarette risks or concerns (80%) than benefits (45.4%), such as smoking harm-reduction. Quoted physicians, researchers, and government representatives were more likely to refer to e-cigarette risks than benefits. Conclusions In 2015, rising rates of e-cigarette use among youth and policy strategies to address e-cigarettes dominated US e-cigarette news stories, leading up to their FDA regulation in 2016. Statements about e-cigarettes' potential risks were frequently attributed to trusted sources such as physicians, and outnumbered claims about their harm-reduction benefits. Such coverage may impact e-cigarette risk perceptions, use intentions and policy support. Implications In the year leading up to the FDA's Deeming Rule, concerns about youth use or potential use were frequently discussed in e-cigarette news. News articles more frequently discussed potential e-cigarette risks/concerns compared to potential harm-reduction benefits relative to tobacco cigarettes. While such coverage may inform the public about potential e-cigarette risks, they may also contribute to increasing perceptions that e-cigarettes are as harmful as tobacco cigarettes. E-cigarette risk and benefit statements were most frequently made by or attributed to researchers and physicians in articles, which is significant given that they may be particularly trusted sources of e-cigarette risk information.

Background Few national surveys document the prevalence of e-cigarette use in the U.S. The existing metric to assess current use likely identifies individuals who have recently tried an e-cigarette but do not continue to use the product. Purpose To document the prevalence of e-cigarette ever use, current use, and established use in a nationally representative survey of current and former cigarette smokers in the U.S. Methods A random sample of current and former cigarette smokers completed a web-based survey in June 2013 ( n =2,136). Data were analyzed in November 2013. Multivariate logistic regression identified demographic and smoking-related factors associated with each use category. Point estimates with 95% CIs described e-cigarette use behaviors (e.g., preferred brand, purchasing patterns) for each group. Results Almost half of respondents had tried e-cigarettes (46.8%), but prevalence of established use remained low (3.8%). Although trial of e-cigarettes was highest among daily smokers, the odds of being an established e-cigarette user were greater for former smokers (OR=3.24, 95% CI=1.13, 9.30, p Conclusions Improved survey measures for e-cigarette use are needed. The identification of established e-cigarette users may provide insight to product features or other individual factors that are associated with sustained use of e-cigarettes.