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INTRODUCTION: We previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global regional differences in individual-level and country-level epidemiological, economic and tobacco regulatory factors that may affect cessation outcomes. METHODS: EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) was a randomised controlled trial that evaluated first-line cessation medications and placebo in 8144 smokers with and without psychiatric disorders from 16 countries across seven regions. Generalised linear and stepwise logistic regression models that considered pharmacotherapy treatment, psychiatric diagnoses, traditional individual-level predictors (eg, demographic and smoking characteristics) and country-specific smoking prevalence rates, gross domestic product (GDP) per capita, relative cigarette cost and WHO-derived MPOWER scores were used to predict 7-day point prevalence abstinence at the end of treatment. RESULTS: In addition to several traditional predictors, three of four country-level variables predicted short-term abstinence: GDP (0.54 (95% CI 0.47, 0.63)), cigarette relative income price (0.62 (95% CI 0.53, 0.72)) and MPOWER score (1.03 (95% CI 1.01, 1.06)). Quit rates varied across regions (22.0% in Australasia to 55.9% in Mexico). With northern North America (USA and Canada) as the referent, the likelihood of achieving short-term abstinence was significantly higher in Western Europe (OR 1.4 (95% CI 1.14, 1.61)), but significantly lower in Eastern Europe (0.39 (95% CI 0.22, 0.69)) and South America (0.17 (95% CI 0.08, 0.35)). CONCLUSIONS: Increased tobacco regulation was associated with enhanced quitting among participants in the EAGLES trial. Paradoxically, lower GDP, and more affordable cigarette pricing relative to a countrys GDP, were also associated with higher odds of quitting. Geographical region was also a significant independent predictor. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT01456936.

Background and aimsThe ubiquity of tobacco retailers helps to sustain the tobacco epidemic. A tobacco retail reduction approach that has not been tried is transitioning tobacco sales to state-controlled alcohol stores (TTS), which are limited in number and operate under some restrictions, e.g. regarding opening hours or marketing materials. This study summarizes policy experts' and advocates' views of TTS, including (1) advantages and disadvantages; (2) feasibility; and (3) potential implementation obstacles.DesignThis study was a qualitative content analysis of semi-structured interviews.SettingTen US states with alcoholic beverage control systems were included.ParticipantsThe participants comprised a total of 103 tobacco control advocates and professionals, public health officials, alcohol policy experts and alcohol control system representatives, including two tribal community representatives.MeasurementsInterviewees' perspectives on their state's alcoholic beverage control agency (ABC, the agency that oversees or operates a state alcohol monopoly) and on TTS were assessed.FindingsInterviewees thought TTS offered potential advantages, including reduced access to tobacco products, less exposure to tobacco advertising and a greater likelihood of successful smoking cessation. Some saw potential long-term health benefits for communities of color, due to the smaller number of state alcohol stores in those communities. Interviewees also raised concerns regarding TTS, including ABCs' limited focus on public health and emphasis on revenue generation, which could conflict with tobacco use reduction efforts. Some interviewees thought TTS could enhance the power of the tobacco and alcohol industries, increase calls for alcohol system privatization or create difficulties for those in recovery.ConclusionsIn the United States, transitioning tobacco sales to state-controlled alcohol stores (TTS) could have a positive public health impact by reducing tobacco availability, marketing exposure and, ultimately, tobacco use. However, tensions exist between alcohol control system goals of providing revenue to the state and protecting public health. Should a state decide to pursue TTS, several guardrails should be established, including building into the legislation an explicit goal of reducing tobacco consumption.

IntroductionFactors that impact flavored tobacco sales restriction (flavor restrictions) effectiveness on youth e-cigarette behavior are unclear. Tobacco retailer density (retailer density) is a health equity issue with greater retailer density in high-minority, low-income areas. We examined the association between flavor restrictions and youth e-cigarette behavior by retailer density across diverse communities in the California Bay Area.Aims and methodsWe analyzed data from the California Healthy Kids Survey using a difference-in-differences (DID) strategy. We compared pre- and post-policy changes in e-cigarette access and use one-year post-implementation among high school students in the Bay Area with a flavor restriction (n = 20 832) versus without (n = 66 126). Separate analyses were conducted for students in cities with low and high retailer density, with a median cutoff of 3.3 tobacco retailers/square mile.ResultsStudents with high retailer density were more likely to identify as a minority and have parents with lower education. Among students with low retailer density, flavor restrictions were associated with 24% lower odds in the pre- to post-policy increase in ease of access relative to unexposed students (DID = 0.76, 95% CI: 0.58, 0.99). Among students with high retailer density, flavor restrictions were associated with 26% higher odds in ease of access (DID: 1.26, 95% CI: 1.02, 1.56) and 57% higher odds of current use (DID = 1.57, 95% CI: 1.31, 1.87).ConclusionsFlavor restrictions had positive impacts on youth e-cigarette access in low, but not high retailer density cities. From a health equity perspective, our results underscore how flavor restrictions may have uneven effects among vulnerable groups.ImplicationsIn diverse communities in the California Bay Area, our results suggest a protective association between flavored tobacco sales restrictions and youth access to e-cigarettes in low, but not high tobacco retailer density cities one-year post-implementation. These results underscore how flavor restrictions may have uneven effects, and when implemented in high retailer density areas, may disproportionately place already vulnerable groups at heightened exposure to e-cigarette use and access. In high retailer density areas, additional tobacco control efforts may need to be included with flavor restriction implementation, such as increased education, youth prevention and cessation programs, policies to reduce tobacco retailer density, or stronger tobacco retailer enforcement or compliance monitoring.

To reduce youth access to tobacco products, the California Tobacco Prevention Program funded local tobacco prevention programs from July 2017 through December 2021 to address its Communities of Excellence Indicator 3.2.9: the number of jurisdictions with a policy eliminating or restricting the sale and/or distribution of any mentholated cigarettes and other flavored tobacco products, and paraphernalia. We examined the strategies by which community coalitions attempted to limit the number of stores selling flavored tobacco across California. Thirty-six final evaluation reports (FERs) were used for our analysis. We examined certain elements or factors as primary areas of interest because of their apparent link to successful outcomes in analyses of FERs in the past. Over half (19 of 36) of FERs reported successfully passing at least 1 policy to regulate the sale of flavored tobacco products. Urban communities passed more policies (16 of 18) compared with rural communities (3 of 18). Successful campaigns tended to involve youth, demonstrate illegal sales to minors and public support for a ban, and identify a champion. Barriers included the COVID-19 pandemic, California wildfires, staffing shortages, and conservative political climates. This evaluation offers insights into the successes and challenges faced by local coalitions seeking policy changes for tobacco use prevention, which can be different for urban and rural communities. The evaluation also indicates the necessity of adopting flexible tactical plans for overcoming environmental factors that affected intervention and evaluation activities.

IntroductionE-cigarettes and heated tobacco products (HTPs) may serve as potential options for harm reduction for smokers if they possess reward profiles similar to cigarettes. Little is known about the abuse liability of HTPs and e-cigarettes versus cigarettes in racial/ethnic minority smokers.Aims and methodsTwenty-two nicotine-deprived people who smoke (black [n = 12] and white [n = 10]) completed three visits that included a standardized 10-puff bout followed by a 50-minute ad libitum use assessment with their usual brand cigarette (UBC), an e-cigarette, and HTP. Visits were completed in a randomized crossover design and were separated by a minimum 48-hour washout period. Assessments included plasma nicotine, Cmax, and reductions in craving and withdrawal.ResultsUBC delivered significantly greater levels of nicotine compared to the e-cigarette (p

We examined whether a community engagement approach and jurisdictional attributes were associated with local action to restrict the sale of flavored tobacco products in Los Angeles County during 2019-2022. We estimated crude and adjusted risk ratios to examine these associations. Jurisdictions that used an active community engagement approach to adopt a flavored tobacco ban ordinance, those with previous experience adopting other tobacco-related ordinances, and those located next to communities that have an existing tobacco retail license ordinance were more likely than jurisdictions without these attributes to adopt a new ordinance to restrict the sale of flavored tobacco products. Efforts to adopt such an ordinance were generally more successful in jurisdictions where community members were engaged and policy makers were familiar with the adoption of public health ordinances.

In 2020, California passed a flavored tobacco sales restriction (FTSR), but the tobacco companies filed a referendum, and the ban will not be implemented unless approved by voters in November 2022. This study examined the percentage of the California population covered by a city FTSR and identified groups more likely to be covered. Mean demographics as well as tobacco use and control measures were compared for California cities with (n = 93) and without (n = 389) a FTSR, and t tests were used to examine the differences. We calculated adjusted odds ratios using logistic regression models. City FTSR policies covered 20.7% of the California population. Adjusted predictors of having a FTSR included the American Lung Association tobacco control score (odds ratio [OR] = 1.27, 95% confidence interval [CI]: [1.17, 1.38]), voting democratic (OR = 1.06, 95% CI: [1.02, 1.10]). and having a lower adult smoking prevalence (OR = 0.84, 95% CI: [0.72, 0.99]). A state-level policy would cover all populations in California.

ObjectiveTo examine the association between co-use of commercial tobacco product (hereafter referred to as tobacco) and cannabis with educational outcomes among high school students.Study designWe analyzed high school student data from the 2021-2022 California Healthy Kids Survey (n = 287 653). Current (past-month) or ever tobacco and cannabis use was categorized as co-use, only tobacco or cannabis, or neither. Two self-reported educational outcomes were examined: absenteeism and grades. Adjusted logistic and linear regression models were used to examine the association between tobacco/cannabis use and absenteeism or grades, respectively. Estimates were adjusted for individual, peer, and school covariates, and clustering within schools.ResultsCurrent co-use of tobacco and cannabis was more than double the use of only tobacco (3.7% vs 1.7%) and similar to only cannabis (3.7%). Almost 18% of students reported absenteeism. Compared with students who used neither substance, students with current co-use had greater odds of absenteeism (aOR 1.41, 95% CI 1.33-1.49) and lower grades (β = -0.87, 95% CI -0.92 to -0.82). Compared with students using tobacco alone, students with co-use also had a significant elevated odds of absenteeism (aOR 1.19, 95% CI 1.10-1.29) and lower grades (β = -0.39, 95% CI -0.46 to -0.32). Similar results were found for students who ever used tobacco and cannabis.ConclusionsCalifornia youth who co-use tobacco and cannabis were most likely to have absenteeism and lower grades. Comprehensive efforts to prevent or reduce youth substance use may improve educational outcomes.

AimsTo examine the relationship between changes in electronic cigarette (e-cigarette) use and subsequent cigarette smoking cessation.MethodsUsing data from the Population Assessment of Tobacco and Health Study (wave 1-wave 4), we analysed a study cohort of 3014 current adult cigarette smokers at wave 1 who tried to quit during the past 12 months. We categorised changes in e-cigarette use from wave 1 to wave 2 as: daily initiation, non-daily initiation, increase to daily use, increase to non-daily use, stable daily use, stable non-daily use, decrease from daily use, quit non-daily use and non-use. We estimated multivariable logistic regressions on short-term (≥1 month and

PurposeCo-use of tobacco and cannabis is a common and complex behavior. The lack of harmonized measures of co-use yields confusion and inconsistencies in synthesizing evidence about the health effects of co-use. We aimed to classify co-use patterns based on temporal proximity and describe preferred products and motives for each pattern in order to improve co-use surveillance.MethodsWe conducted semi-structured interviews in a sample of 34 young adults (Mage = 22.8 years, 32.4 % female) during 2017-2019 in California, USA. We employed a qualitative thematic analysis to identify timing, reasons, and contexts for tobacco and cannabis co-use and classify co-use patterns.ResultsFour emergent patterns of co-use with increasing temporal proximity between tobacco use and cannabis use were: Same-month different-day co-use (Pattern 1); Same-day different-occasion co-use (Pattern 2); Same-occasion sequential co-use (Pattern 3); and Same-occasion simultaneous co-use (Pattern 4). Participants used various product combinations within each pattern. Similar motives for all patterns were socialization, product availability, and coping with stress/anxiety. Unique motive for temporally distant patterns (Patterns 1 and 2) was seeking substance-specific effects (e.g., stimulant effect from nicotine, relaxation effects from cannabis), while unique motives for temporally close patterns (Patterns 3 and 4) were seeking combined effects from both substances (e.g., more intense psychoactive effects, mitigating cannabis adverse effects) and behavioral trigger (e.g., cannabis use triggers tobacco use).ConclusionsOur classification of co-use patterns can facilitate consistency for measuring co-use and assessing its health impacts. Future research should also measure product types and motives for different patterns to inform intervention efforts.

INTRODUCTION: There has been a rapid proliferation of synthetic nicotine products in recent years, despite newly established regulatory authority and limited research into its health risks. Previous research has implicated social media platforms as an avenue for nicotine product unregulated sales. Yet, little is known about synthetic nicotine product content on social media. We utilized natural language processing to characterize the sales of synthetic nicotine products on Instagram. METHODS: We collected Instagram posts by querying Instagram hashtags (eg, #tobaccofreenicotine) related to synthetic nicotine. Using Bidirectional Encoder Representations from Transformers, collected posts were categorized into thematically related topic clusters. Posts within topic clusters relevant to study aims were then manually annotated for variables related to promotion and selling (eg, cost discussion, contact information for offline sales). RESULTS: A total of 7425 unique posts were collected with 2219 posts identified as related to promotion and selling of synthetic nicotine products. Nicotine pouches (52.9%, n = 1174), electronic nicotine delivery systems (30.6%, n = 679), and flavored e-liquids (14.1%, n = 313) were most commonly promoted. About 16.1% (n = 345) of posts contained embedded hyperlinks and 5.8% (n = 129) provided contact information for purported offline transactions. Only 17.6% (n = 391) of posts contained synthetic nicotine-specific health warnings. CONCLUSIONS: In the United States, synthetic nicotine products can only be legally marketed if they have received premarket authorization from the Food and Drug Administration (FDA). Despite these prohibitions, Instagram appears to be a hub for potentially unregulated sales of synthetic and tobacco-free products. Efforts are needed by platforms and regulators to enhance content moderation and prevent unregulated online sales of existing and emerging synthetic nicotine products. IMPLICATIONS: There is limited clinical understanding of synthetic nicotines unique health risks and how these novel products are changing over time due to regulatory oversight. Despite synthetic nicotine-specific regulatory measures, such as the requirement for premarket authorization and FDA warning letters issued to unauthorized sellers, access to and promotion of synthetic nicotine is widely occurring on Instagram, a platform with over 2 billion users and one that is popular among youth and young adults. Activities include direct-to-consumer sales from questionable sources, inadequate health warning disclosure, and exposure with limited age restrictions, all conditions necessary for the sale of various tobacco products. Notably, the number of these Instagram posts increased in response to the announcement of new FDA regulations. In response, more robust online monitoring, content moderation, and proactive enforcement are needed from platforms who should work collaboratively with regulators to identify, report, and remove content in clear violation of platform policies and federal laws. Regulatory implementation and enforcement should prioritize digital platforms as conduits for unregulated access to synthetic nicotine products and other future novel and emerging tobacco products.

ObjectivesThe effects of electronic cigarettes (e-cigarettes) on the larynx are relatively unknown. This study examined the short-term effects of e-cigarette inhalation on cellular and inflammatory responses within the mouse laryngeal glottic and subglottic regions after exposure to pod-based devices (JUUL).MethodsMale C57BL6/J mice (8-9 weeks) were assigned to control (n = 9), JUUL flavors Mint (JMi; n = 10) or Mango (JMa; n = 10). JUUL mice were exposed to 2 h/day for 1, 5, and 10 days using the inExpose inhalation system. Control mice were in room air. Vocal fold (VF) epithelial thickness, cell proliferation, subglandular area and composition, inflammatory cell infiltration, and surface topography were evaluated in the harvested larynges. Mouse body weight and urinary nicotine biomarkers were also measured. Chemical analysis of JUUL aerosols was conducted using selective ion flow tube mass spectrometry.ResultsJUUL-exposed mice had reduced body weight after day 5. Urinary nicotine biomarker levels indicated successful JUUL exposure and metabolism. Quantitative analysis of JUUL aerosol indicated that chemical constituents differ between JMi and JMa flavors. VF epithelial thickness, cellular proliferation, glandular area, and surface topography remained unchanged after JUUL exposures. Acidic mucus content increased after 1 day of JMi exposure. VF macrophage and T-cell levels slightly increased after 10 days of JMi exposures.ConclusionsShort-term e-cigarette exposures cause minimal flavor- and region-specific cellular and inflammatory changes in the mouse larynx. This work provides a foundation for long-term studies to determine if these responses are altered with multiple e-cigarette components and concentrations.Level of evidenceN/A Laryngoscope, 134:1316-1326, 2024.

PurposeE-cigarettes are the most commonly used tobacco product among youth in the United States. Yet evidence-based prevention programming is limited due to the rapid onset of this threat. Community-based efforts to address vaping largely target youth in school settings. Although parents can play an important role in youth tobacco control efforts, messages about the dangers of vaping, use among adolescents, and strategies for intervening have not reached many Spanish-speaking parents in low-income Latinx communities. Our community-academic team developed e-cigarette prevention programming for use by promotor/as de salud to address this unmet need.MethodsDuring the 1-year project, the team worked closely with a Project Advisory Committee to: review existing evidence-informed materials; conduct focus groups with parents, youth and promotor/as to guide program development; develop a curriculum to prepare promotor/as to educate low-literacy, Spanish-speaking parents about vaping; craft Spanish language resources for promotor/as to use in community education sessions; train 61 promotor/as to deliver the program; and support program delivery to 657 community members.ResultsFocus groups with promotor/as and community members, key-informant interviews, and brief surveys informed program development and assessment. Community member feedback was essential to development of appropriate materials. Promotor/as demonstrated significant pre- to post- training increases in e-cigarette knowledge and confidence in delivering vaping prevention education. Community members demonstrated a mastery of basic e-cigarette concepts and expressed intention to discuss vaping with their children.ConclusionsPromotor/a-led programming for parents represents a promising approach to vaping prevention and control in the Latinx community.

BACKGROUND: E-cigarettes are promoted as less harmful than cigarettes. There has not been a direct comparison of health effects of e-cigarettes or dual use (concurrently using e-cigarettes and cigarettes) with those of cigarettes in the general population. METHODS: Studies in PubMed, EMBASE, Web of Science, and PsychINFO published through October 1, 2023, were pooled in a random-effects meta-analysis if five or more studies were identified with a disease outcome. We assessed risk of bias with Risk Of Bias In Non-randomized Studies of Exposure and certainty with Grading of Recommendations, Assessment, Development, and Evaluations. Outcomes with fewer studies were summarized but not pooled. RESULTS: We identified 124 odds ratios (94 cross-sectional and 30 longitudinal) from 107 studies. Pooled odds ratios for current e-cigarette versus cigarette use were not different for cardiovascular disease (odds ratio, 0.81; 95% confidence interval, 0.58 to 1.14), stroke (0.73; 0.47 to 1.13), or metabolic dysfunction (0.99; 0.91 to 1.09) but were lower for asthma (0.84; 0.74 to 0.95), chronic obstructive pulmonary disease (0.53; 0.38 to 0.74), and oral disease (0.87; 0.76 to 1.00). Pooled odds ratios for dual use versus cigarettes were increased for all outcomes (range, 1.20 to 1.41). Pooled odds ratios for e-cigarettes and dual use compared with nonuse of either product were increased (e-cigarette range, 1.24 to 1.47; dual use, 1.49 to 3.29). All included studies were assessed as having a low risk of bias. Results were generally not sensitive to study characteristics. Limited studies of other outcomes suggest that e-cigarette use is associated with additional diseases. CONCLUSIONS: There is a need to reassess the assumption that e-cigarette use provides substantial harm reduction across all cigarette-caused diseases, particularly accounting for dual use.

The precise determination of tobacco leaf maturity is pivotal for safeguarding the taste and quality of tobacco products, augmenting the financial gains of tobacco growers, and propelling the industry's sustainable progression. This research addresses the inherent subjectivity and variability in conventional maturity evaluation techniques reliant on human expertise by introducing an innovative YOLOv10-based method for tobacco leaf maturity detection. This technique facilitates a rapid and non-invasive assessment of leaf maturity, significantly elevating the accuracy and efficiency of tobacco leaf quality evaluation. In our study, we have advanced the YOLOv10 framework by integrating DCNv3 with C2f to construct an enhanced neck network, designated as C2f-DCNv3. This integration is designed to augment the model's capability for feature integration, particularly concerning the morphological and edge characteristics of tobacco leaves. Furthermore, the incorporation of the Efficient Local Attention (ELA) mechanism at multiple stages of the model has substantially enhanced the efficiency and fidelity of feature extraction. The empirical results underscore the model's pronounced enhancement in performance across all maturity classifications. Notably, the overall precision (P) has been elevated from 0.939 to 0.973, the recall rate (R) has improved from 0.968 to 0.984, the mean average precision at 50% intersection over union (mAP50) has advanced from 0.984 to 0.994, and the mean average precision across the 50% to 95% intersection over union range (mAP50-95) has risen from 0.962 to 0.973. This research presents the tobacco industry with a novel rapid detection instrument for tobacco leaf maturity, endowed with substantial practical utility and broad prospects for application. Future research endeavors will be directed towards further optimization of the model's architecture to bolster its generalizability and to explore its implementation within the realm of actual tobacco cultivation and processing. [ABSTRACT FROM AUTHOR]

Smokeless oral nicotine products are addictive, and their use has potential adverse effects on some but not all biomarkers of cardiovascular risk. The use of some types of these products, for instance, is associated with an increased mortality risk in those with ischemic heart or cerebrovascular disease. Similarly, smokeless tobacco has the potential to increase the risk of oral cancer, but the risks depend on the chemical composition of the product. The market of smokeless oral nicotine products has transformed since the last American Heart Association smokeless tobacco policy statement. Several varieties of tobacco-free oral nicotine products—including oral nicotine pouches; nontherapeutic nicotine gums, lozenges, and tablets; and nicotine gummies—have rapidly proliferated. The sales of oral nicotine pouches, in particular, have increased substantially; however, no data are available on their cardiovascular or health risks. In addition, synthetic (compared with tobacco-derived) nicotine has been used in some brands of oral nicotine products, but its cardiovascular and health effects have been inadequately studied. Robust public policy levers are identified to support ending addiction to all commercial tobacco products. Critical components and policy initiatives include clinicians emphasizing the prevention of tobacco product initiation and supporting cessation with established pharmacological and behavioral tobacco dependence treatment therapies as primary goals for achieving an end to commercial tobacco and nicotine addiction. [ABSTRACT FROM AUTHOR]

Objective: We conducted a systematic review and meta-analysis of randomised studies in humans comparing the outcomes of switching to heated tobacco products (HTPs) versus continuing conventional tobacco smoking by burning. Methods: We searched the electronic databases which included PubMed, Web of Science, Cochrane Controlled Trials Register, and Google Scholar from inception to May 2023. Randomised Controlled Trials (RCTs) in humans comparing HTPs with conventional burnt tobacco products were selected. Our search yielded 4817 search results, of which six RCTs (number of participants 1362, all from high-income countries) were selected. Five of the six included RCTs had low risk in four of five domains of bias; only one study had a high risk of bias in one domain. PRISMA guidelines were followed. Results: There were 40 biomarkers of harm reduction reported categorised into six categories. One cancer biomarker (nitrosamine) and two cardiovascular biomarkers (eosinophils and total bilirubin) showed statistically significant harm reduction (total NNAL SMD=0·82, 95% CI 0·67-0·98, eosinophils SMD=0·38, 95% CI 0·12-0·65, total bilirubin SMD=0·71, 95% CI 0·28-1·31). The remaining biomarkers of harm in cardiovascular, inflammatory, metabolic, pulmonary, and renal categories showed imprecise findings. Conclusions: In RCTs of moderate quality, some biomarkers show harm reduction associated with switching from burnt tobacco smoking to HTPs. The majority of the findings are imprecise due to the small sample sizes of the included studies. Sufficiently powered, robust RCTs targeting key harm reduction biomarkers within both upper and low-middle income country settings are required in the future. [ABSTRACT FROM AUTHOR]

Objective. Evaluate how conversations about health warning labels (HWLs) influence attempts to quit smoking (QAs) and sustained attempts to quit (SQAs) among in Mexican adult who smoke. Materials and methods. Data were analyzed from a cohort of 2 164 participants surveyed every four months between November 2018 and March 2021. Multinomial models regressed the frequency of talking about HWLs on sociodemographics and smokingrelated variables. Generalized Estimating Equations assessed whether the effect of HWL talking frequency on QAs and, separately, SQAs at follow-up was mediated by the topic of conversation. Results. The majority reported having talked about HWLs (63.7%), regarding the harms of tobacco (73.3%), cessation benefits (58.5%), and lack of credibility/utility of HWLs (9.8%). At follow-up, 42.0% reported an QAs and 20.7% an SQAs. Conversations about HWLs were more frequent among younger participants, those with a university education, those who had recently attempted to quit smoking, and those intending to quit. Talking about HWLs was associated with a higher frequency of QAs and SQAs, mediated equally by discussions about cessation benefits and tobacco harms. Conclusion. Conversation topics around HWL are mesassociated with more smoking cessation attempts. Mexican HWLs focus primarily on harms, more research is needed to evaluate the optimal mix of content. [ABSTRACT FROM AUTHOR]

ABSTRACT: Context: In 2003, the government of India formulated "the cigarettes and other tobacco products Act (prohibition of advertisement and regulation of trade and commerce, production, supply, and distribution) (COTPA)". The aim of the study is to evaluate hospital staff's knowledge of the COTPA Act and their enablers and hurdles using qualitative analysis. Settings and Design: This study was conducted in GSVM Medical College, and this was a convergent parallel mixed-methods study, with a quantitative component (cross-sectional survey) complemented by a qualitative component (descriptive study). Methods and Material: A pre-tested, semi-structured, face-validated questionnaire was incorporated into the Epicollect5 application for data collection. The qualitative study was conducted among 11 hospital staff. Statistical Analysis Used: The collected data were imported into a Microsoft Excel spreadsheet and analysed with Jamovi version 2.0. To determine associations between variables, appropriate tests of significance were applied. For qualitative analysis, an interview guide was prepared. Results: On quantitative analysis, hospital personnel's overall awareness of any tobacco control law was 59.4%, with 56.6% being tobacco abusers and 69.5% being non-abusers. On qualitative analysis by in-depth interview framework analysis, decalogues were taken from the responses provided by the participants. After that, the decalogues were divided into three keynotes which were openers, hurdles, and recommendations. Conclusions: Study demonstrates that more than half of the employees are already aware of COTPA Act but still need more coordinated effort from all responsible authorities of medical institute to increase COTPA Act awareness. [ABSTRACT FROM AUTHOR]

Electronic cigarettes (e-cigarettes) have been attracting users around the world due in part to appealing flavors. Many countries and regions have now taken action to limit the sales of flavored e-cigarettes. In 2022, China implemented a flavor ban on e-cigarettes, prohibiting all but tobacco-flavor. It is important for international tobacco control efforts to understand responses to the ban by analyzing news media content. Articles identified through keyword searches in the HuiKe newspaper database were qualitatively examined by thematic analysis, focusing on stakeholder reactions and regulatory impacts. Using HuiKe news database and searching between May 1, 2022, and March 1, 2023, 125 news articles were identified and coded using thematic analysis to explore the main stakeholders mentioned in relation to the e-cigarette flavor ban, actions undertaken, and perceptions expressed. Four stakeholders were identified: administrative departments, businesses, users and the public. Eight themes were developed through analysis: the purpose of the prohibition, supervision and penalties for illegal products, approaches adopted for legal sales, approaches adopted for illegal sales, shifting use habits, speculation about the impact of the prohibition, health concerns, and suggestions for reducing illegal sales. The study revealed that enforcement of the policy is portrayed as a significant concern and that controlling the spread of illegal online sales remains a significant challenge. A comprehensive regulatory strategy to address youth e-cigarette use more effectively is urgently needed. Adaptive e-cigarettes control policy should co-evolve with ever-changing industries and markets. [ABSTRACT FROM AUTHOR]

The prevalence of tobacco use is high in Bangladesh, with a cigarette being the most consumed tobacco product. Taxing tobacco is highly effective for tobacco control, raising costs and encouraging smokers to quit or reduce cigarette consumption. Garment workers are the major group of low-wage earners in Bangladesh. This study aims to determine the perceived effects of raising cigarette prices on smoking behaviors and their influences on quitting the decision of male garment workers in Bangladesh. Cross-sectional study. The Study adopted a cross-sectional method among 739 male garment workers from Gazipur and Savar, Dhaka, for six months, using a semi-structured questionnaire. Factors such as the prevalence of lifetime tobacco use and rising cigarette prices on smoking behaviors were analyzed. The study found that most participants began smoking before age 16, and increased tobacco prices influenced quitting decisions for both smoking and smokeless tobacco users, with reductions of 79% and 68%, respectively. Higher prices notably impacted smoking cessation among lower-income individuals, decreasing smoking frequency by 12-fold. Significantly changing their smoking behavior, on average, daily cigarette or biri consumption decreased from 7 to 5, with some participants switching to less expensive tobacco products. Findings from the study depict that imposing a high tax on tobacco products such as cigarette or biri has a desirable impact on the smoking behavior of low earning community. The price of all tobacco products should be increased to auspicate a considerable positive change in the community. [ABSTRACT FROM AUTHOR]

Purpose: Examine tobacco use on college campuses by assessing: (1) types of tobacco products used, (2) where they are most commonly used, and (3) the sociodemographic characteristics of students most likely to use on campus. Method: Participants were a convenience sample of 3,575 18- to 25-year-old enrolled in 14 Texas colleges during Spring 2021 who used at least one tobacco product in the past 30-days. Results: Over 60% of participants used tobacco on their campus, and among these, nearly 93% used electronic nicotine delivery systems (ENDS) on campus. Common campus locations for tobacco use included outdoors (85.0%), dormitories (53.9%), and bathrooms (44.5%). Older young adults, males, those from a college with a partial tobacco policy, and current ENDS users were more likely than their peers to have ever used tobacco on campus. Conclusion: Tobacco use on college campuses is common, underscoring the need for enhanced monitoring and enforcement of tobacco-free policies. [ABSTRACT FROM AUTHOR]

Purpose: Despite the advent of heated tobacco products (HTPs), their relationship to mental health remains unclear. This study aimed to determine associations between the use of combustible cigarettes (CCs) and HTPs with depressive symptoms. Methods: This descriptive-analytical cross-sectional study was conducted in March 2023. Using the 8th Korea National Health and Nutrition Examination Survey, 5,349 adults aged 19 years or older were classified into four groups: non-users, CC-only users, HTP-only users, and dual users. Relationships between exclusive or dual use of CCs and HTPs and depressive symptoms were analyzed using item scores and total scores of the Patient Health Questionnaire-9 (PHQ-9). To examine associations between exclusive or dual use of CCs and HTPs and depressive symptoms, a multinomial regression analysis was performed using the PHQ-9 total score. Results: HTP-only users had the highest proportion of those with anhedonia and depressed mood. CC-only users had the highest proportion of individuals with trouble sleeping, while dual users had a higher proportion of those with fatigue and appetite problems. After adjusting for general characteristics, compared to non-users, CC-only users were more likely to have mild and moderate to severe depressive symptoms. HTP-only users and dual users were also more likely to have moderate to severe depressive symptoms. Conclusions: All smokers have a higher risk of depression than non-smokers. Health care providers should closely monitor depressive symptoms, especially in HTP users and dual users of tobacco products. [ABSTRACT FROM AUTHOR]

The article discusses the harmful impact of the commercial Tobacco and Nicotine Industry on Indigenous peoples, including predatory advertising, misleading health claims, and the normalization of tobacco use. It highlights historical injustices, such as early settlers using tobacco to exploit Indigenous peoples, and the disproportionate impact of smoking-related deaths on Indigenous communities. The text emphasizes the need for structural changes, evidence-based regulations, and culturally safe cessation support to combat addiction and improve health outcomes among Indigenous populations. [Extracted from the article]

Introduction Previous research suggests that e-cigarettes can alter immune function, including in the nasal mucosa, in unique ways. The respiratory microbiome plays a key role in respiratory host defense, but the effects of e-cigarettes on the respiratory or nasal microbiome, are not well understood. Aims and Methods Using 16S rRNA gene sequencing on nasal samples from adult e-cigarette users, smokers, and nonsmokers, we determined that e-cigarette use and cigarette smoking are associated with differential respiratory microbiome dysbiosis and substantial sex-dependent differences in the nasal microbiome, particularly in e-cigarette users. Results Staphylococcus aureus, a common respiratory pathogen, was more abundant in both e-cigarette users and smokers in comparison with nonsmokers, while Lactobacillus iners , often considered a protective species, was more abundant in smokers but less abundant in e-cigarette users in comparison with nonsmokers. In addition, we identified significant dysbiosis of the nasal microbiome between e-cigarette users and smokers with high versus low serum cotinine levels, an indicator of tobacco product use and toxicant exposure. We also analyzed nasal lavage fluid for immune mediators associated with host × microbiota interactions. Conclusions Our analysis identified disruption of immune mediators in the nose of e-cigarette users and smokers, which is indicative of disrupted respiratory mucosal immune responses. Taken together, our data identified unique, sex-dependent host immune dysfunction associated with e-cigarette use in the nasal mucosa. More broadly, our data highlight the need for continued inclusion and careful consideration of sex as an important variable in the context of toxicant exposures. Implications This is the first study investigating the effects of e-cigarette use and sex on the nasal microbiome, which is considered an important gatekeeper for protecting the lower respiratory tract from pathogens. We found significant sex, exposure group, and serum cotinine level-associated differences in the composition of the nasal microbiome, demonstrating the importance of considering sex in future nasal microbiome studies and warranting further investigation of the mechanisms by which e-cigarette use dysregulates nasal immune homeostasis. [ABSTRACT FROM AUTHOR]

Introduction The use of hashtags is a common way to promote e-cigarette content on social media. Analysis of hashtags may provide insight into e-cigarette promotion on social media. However, the examination of text data is complicated by the voluminous amount of social media data. This study used machine learning approaches (ie, Bidirectional Encoder Representations from Transformers [BERT] topic modeling) to identify e-cigarette content on TikTok. Aims and Methods We used 13 unique hashtags related to e-cigarettes (eg, #vape) for data collection. The final analytic sample included 12 573 TikTok posts. To identify the best fitting number of topic clusters, we used both quantitative (ie, coherence test) and qualitative approaches (ie, researchers checked the relevance of text from each topic). We, then, grouped and characterized clustered text for each theme. Results We evaluated that N  = 18 was the ideal number of topic clusters. The 9 overarching themes were identified: Social media and TikTok-related features (N  = 4; "duet," "viral"), Vape shops and brands (N  = 3; "store"), Vape tricks (N  = 3; "ripsaw"), Modified use of e-cigarettes (N  = 1; "coil," "wire"), Vaping and girls (N  = 1; "girl"), Vape flavors (N  = 1; "flavors"), Vape and cigarettes (N  = 1; "smoke"), Vape identities and communities (N  = 1; "community"), and Non-English language (N  = 3; Romanian and Spanish). Conclusions This study used a machine learning method, BERTopic modeling, to successfully identify relevant themes on TikTok. This method can inform future social media research examining other tobacco products, and tobacco regulatory policies such as monitoring of e-cigarette marketing on social media. Implications This study can inform future social media research examining other tobacco products, and tobacco regulatory policies such as monitoring of e-cigarette marketing on social media. [ABSTRACT FROM AUTHOR]

Introduction The Tobacco and Related Products Regulations (TRPR) 2016 require consumers in the United Kingdom to be informed about the presence of nicotine in vaping products. However, there is misunderstanding among some young people and adults around the strength of products. We examined how nicotine content is displayed on the front of vape packaging in the United Kingdom. Aims and Methods Between August and December 2022, we systematically analyzed a representative, stratified selection of vapes and refill packs (n  = 156) on the UK market to assess TRPR compliance. This paper presents an analysis of free-text responses collected to indicate the presence of nicotine information on the front-of-pack including metric, percentage, graphic, and text indicators. Data were analyzed using descriptive statistics produced for the sample as a whole and for five product categories. Results Most packs (n  = 126, 81%) displayed at least one front-of-pack nicotine descriptor, including the majority of disposables (n  = 43, 90%), e-liquid (n  = 42, 88%) and refill pods (n  = 36, 100%). Many packs (n  = 107, 69%) contained a nicotine-related metric (eg mg/ml), a quarter (n  = 37, 24%) included a percentage indicator and most (n  = 126, 81%) displayed at least one of these. Almost two-fifths (n  = 57, 37%) mentioned nicotine beyond the warning. Less observed indicators included graphic and textual depictions of strength, dosage information, and an equivalent number of cigarettes. Conclusions The front of vape packaging communicates important product information to consumers. There is inconsistency in how nicotine content is currently displayed. Future research should examine how best to display nicotine content to promote consumer understanding and informed decision making. Implications This pack analysis of a representative sample of UK vape packaging highlights the varied ways in which nicotine content and strength are currently communicated to consumers on the front of vape packaging. The inconsistent presentation of nicotine content on the front of packs may contribute to misperceptions around product strength. A consistent and easily understood way of communicating nicotine content on the front of vape packaging may help consumers make more informed choices about vape products. [ABSTRACT FROM AUTHOR]

Introduction In recent years tobacco taxation in Spain has regressed, with its Tobacconomics tax scorecard falling from 3.9 points (out of 5) in 2014, to only 2.625 in 2020. The objective of this research is to provide a detailed analysis of the causes behind this deterioration and identify possible ways forward for reversing this trend. Aims and Methods A retrospective 2014–2022 analysis of manufactured cigarettes (FM) and roll-your-own tobacco (RYO) markets including tax structure/rates, affordability, retail price gaps across products, and price differentials with bordering countries. A market-level simulation model for 2028 studied the impact of various tax policy scenarios on smoking prevalence, premature deaths averted, smoking intensity, product substitution, government revenue, sales, and industry profit. Results A lack of tax increases in a context of inflation and income growth during the past 8 years means FM and RYO have become 13% more affordable, with a constant differential of €2 between 20 FM and RYO sticks, and the price gap between Spain and neighboring France increased. Modeling of two realistic reform scenarios that reduce/eliminate the price gap between FM and RYO suggest substantial increases in government revenues and up to 700 000 fewer smokers and 210 000 fewer premature deaths. Conclusions Current European Union (EU) legislation on tobacco taxes leaves ample room for much-needed tobacco tax reform. For the sake of both public health and the economy, Spain should increase its Minimum Excise Tax. This would not only save lives, but also bring much-needed revenue for the government. Implications The stance of Spain on tobacco taxes has deteriorated recently. This study argues that the failure of successive governments to raise minimum taxes in an inflationary context has made tobacco products more affordable, and quantifies the improvements in smoking prevalence and excise revenue that would accrue if the authorities act urgently increasing rates within realistic limits. Spain is representative of European countries where government inaction has rendered minimum tobacco taxes obsolete. Given the postponement of the revision of the EU Tobacco Tax Directive, this study highlights the need to act unilaterally within the existing legal framework. [ABSTRACT FROM AUTHOR]

Introduction To examine legislative efforts to regulate new and emerging tobacco and nicotine products (NETNPs) in Latin America and the Caribbean (LAC) between 2017 and 2022. Aims and Methods Analysis of online national legislation databases to track NETNP bills using standard snowball search methods. Results Bills were identified in 15 out of the 33 LAC countries, accounting for a total of 91 bills targeting NETNPs. Mexico had the highest number (n  = 38) of bills, followed by Brazil (n  = 16), Argentina (n  = 10), Colombia (n  = 8), and Chile (n  = 5). The remaining countries introduced two or fewer NETNP bills. Among the identified 91 bills, the majority (n  = 60) addressed both electronic cigarettes and heated tobacco products (HTPs), almost one-third of bills (n  = 29) applied only to electronic cigarettes, and only two focused solely on HTPs. Six of the fifteen countries with identified bills, enacted one NETNP law including Barbados, Bolivia, Costa Rica, Guyana, Mexico, and Panama. Since 2019, there has been a steady increase in the amount of NETNP bills introduced in LAC. In 2017 and 2018, 10 NETNP bills were introduced each year followed by 23 NETNP bills introduced in each 2019 and 2020, 19 in 2021, and 16 by August 2022. Conclusions The substantial increase in the number of NETNP bills introduced since 2019 indicates the growing importance of regulating NETNPs in LAC. As NETNPs continue to evolve and grow it is important to continue monitoring and evaluating tobacco and nicotine regulatory initiatives while also staying ahead of the evolving market of NETNPs. Implications Previous studies have analyzed the regulatory environment of NETNPs but it is less known about legislative and regulatory efforts and attempts. This is the first known study to analyze legislative bills to regulate NETNPs in Latin America and the Caribbean (LAC). The substantial increase in the number of NETNP bills introduced in LAC since 2019 indicates the growing importance of regulating NETNPs in LAC. As NETNPs continue to evolve and grow it is important to continue monitoring and evaluating tobacco and nicotine regulatory initiatives while also staying ahead of the evolving market of NETNPs. [ABSTRACT FROM AUTHOR]

Developmental scientists routinely examine how a focal predictor relates to some aspect of children's development. Although covariate adjustment is typically used to test hypotheses, propensity score-based methods, including inverse probability of treatment weighting (IPTW) and marginal structural models (MSM), can strengthen inference and answer more nuanced, developmentally relevant questions. This article provides a didactic introduction to IPTW and MSM methods and demonstrates their use for testing the impact of environmental smoke exposure (continuous treatment) from 6 to 90 months on parent-reported attention deficit hyperactivity disorder behaviors in first grade for 1,053 children (51% male, 44% Black) in the Family Life Project. We highlight differences that result both in conclusions and in the evaluation of assumptions for IPTW and MSM relative to more traditional covariate adjustment methods. Sample Stata syntax is provided. Public Significance Statement: Covariate adjustment approaches are widely used by developmental psychologists to infer associations between focal predictors and child outcomes. Inverse probability of treatment weighting and marginal structural models are two alternative approaches, which are more widely used in public health and medicine, that provide a more sophisticated approach for addressing developmental questions. We provide a didactic orientation to these approaches through an applied example. [ABSTRACT FROM AUTHOR]

Introduction: Flavorings are one of the major appealing factors of current tobacco products, especially for young adults. They constantly evolve, and new flavorings are introduced to the market every year, but little is known about user profiles of flavored tobacco products (FTPs). Methods: We analyzed young adult (ages 18–24) tobacco product users (N = 4,707) from Wave 5 of the Population Assessment of Tobacco and Health Study. We applied bivariate analyses to compare individuals who use FTP and non-FTPs by different flavor types (i.e., menthol/mint, fruit, candy/sweets, and tobacco). Parameter estimates were weighted by applying the sample and replicate weights for the complex study design to produce population-representative estimates. Results: Sixty percent of the current combustible tobacco users and 90% of electronic nicotine delivery systems (ENDS) users were FTP users. FTP users were more likely to be multiple product users than non-FTP users. Being non-Hispanic White, drinking alcohol in the past year, experiencing internalizing problems in the past month, and having tobacco dependence were associated with FTP use. Flavored ENDS users had different sociodemographic characteristics by flavor types but did not differ significantly in vaping-related behaviors (e.g., frequency). Also, preferred flavors differed among tobacco user groups (i.e., ENDS, hookah, and cigars). Conclusions: FTPs appear to be gaining popularity among young adults and tend to show co-use with multiple tobacco products and other substances. Future studies are warranted to monitor the risk factors of young adult FTP use, especially in the context of flavor ban on ENDS products. [ABSTRACT FROM AUTHOR]

Background: We explored predictors of cigar product initiation among Hip Hop-identifying U.S. youth using data from the U.S. Food and Drug Administration's Fresh Empire evaluation. Participants were Hip Hop-identifying youth living in evaluation markets who had not initiated cigar product use at their first survey. Objectives: We modeled cigar product initiation odds using discrete time survival analysis logistic regression models as a function of factors related to one's large social, physical, social/normative, and intrapersonal environment, and other tobacco use. Results: In the unique sample, 26.2% initiated cigar product use. Factors associated with higher cigar product initiation odds included: current/former (vs. non-susceptible never) cigarette smoking (odds ratio [OR]=5.35; p=.008); cigarette experimentation (vs. non-susceptible never smoking) (OR=3.26; p<.001); current (vs. never) e-cigarette use (OR=2.06; p<.001) and hookah use (OR=1.83; p=.011); having at least one friend who uses marijuana (OR=1.43; p=.008); high music use (OR=1.32; p=.035); household tobacco use (OR=1.26; p =.042); increased age (OR=1.18; p<.001); and higher sensation seeking (OR=1.16; p=.018). Youth reporting higher perceived smoking risks had lower cigar product initiation odds (OR=0.86; p=.029) as did Hispanic (OR=0.53; p<.001) and non-Hispanic Other youth (OR= 0.68; p=.023) (vs. non-Hispanic Black youth). Conclusions: The finding that high music use predicted cigar product initiation should be considered in light of cigar brand sponsorship of musical artists and events and indicates a potential opportunity for counter messaging. Peer crowd segmentation in this study identified unique and differing factors that influence tobacco use risk among Hip Hop-identifying youth that are not found in the general population. [ABSTRACT FROM AUTHOR]

Introduction: Netflix pledged to avoid depictions of e-cigarette use in scripted series and movies rated TV-14 or below. However, this policy did not extend to young adults, many of whom are below the legal tobacco purchasing age. This study examined the association between recall of Netflix scripted series and movies previously identified to contain e-cigarette imagery and susceptibility to use e-cigarettes among never users. Materials and Methods: A non-probability representative sample of young adults (ages 18-24; N = 1500) living in California were recruited to complete an online survey assessing their recall of Netflix scripted series and movies previously identified to contain e-cigarette imagery and e-cigarette-related behaviors. Adjusted and weighted logistic regression analyses were used among participants who had never used e-cigarettes (n = 967). Results: Among participants who had never used e-cigarettes, 68.1% (n = 659/967) recalled viewing at least one Netflix scripted series or movie previously identified to contain e-cigarette imagery, including 66.4% (n = 192/289) of participants under the legal tobacco purchasing age. Participants who recalled viewing at least one Netflix scripted series or movie previously identified to contain e-cigarette imagery, compared with those who did not, had greater odds of reporting susceptibility to use e-cigarettes among never users (AOR = 1.65, 95% CI = 1.20-2.25). Conclusions: Young adults living in California recalled Netflix scripted series or movies previously identified to contain e-cigarette imagery. Such recall was associated with susceptibility to use e-cigarettes among never users. These findings should motivate prevention programmers to design tobacco-related digital media literacy interventions for young adults. [ABSTRACT FROM AUTHOR]

U.S.- and foreign-born Black young adults often have different cultural backgrounds and experiences that can an affect the types of, extent of, and response to the psychosocial stressors encountered. This study examined whether psychosocial and structural stressors are similarly related to any and polytobacco (i.e., 2 or more tobacco products) use among subgroups of Black young adults in the U.S. Cross sectional data were collected in 2023 from 445 Black young adults (aged 18–25 years) in the U.S. Stratified regression models were used to examine the association of psychosocial (mental health adversity, race-related adversity, concerns about societal issues) and structural (food insecurity and housing insecurity) stressors with past 6-month any and polytobacco use among U.S.- and foreign-born Black young adults. Race-related adversity was associated with higher odds of polytobacco use (than odds of nonuse) among both U.S.- (AOR=1.36, 95% CI=1.06, 1.74) and foreign- (AOR=2.18, 95% CI=1.18, 4.03) born Black young adults. Food insecurity was associated with higher odds of polytobacco use among foreign-born Black young adults (AOR=1.92, 95% CI=1.13, 3.27) and any tobacco use among both U.S.- (AOR=1.36, 95% CI=1.04, 1.79) and foreign- (AOR=1.47, 95% CI=1.01, 2.17) born Black young adults. However, concern about societal issues was associated with reduced odds of polytobacco use in both groups. In all models, experiences of racism and discrimination (race-related adversity) were linked to higher odds of polytobacco use, whereas concern about societal issues was protective. However, there were nativity differences in the association of food insecurity with any and polytobacco use. Findings support the need for culturally/ethnically conscious tobacco prevention strategies that address the underlying psychosocial and structural drivers of tobacco use among Black young adult subgroups. [ABSTRACT FROM AUTHOR]

Substance use among youth aged 12 to 17 presents a major public health concern in the United States with statistics revealing that one in eight youths have engaged in illicit substance misuse within the past year (National Center for Drug Abuse Statistics, 2023). The long‐term consequences of youth substance use include complicated medical issues, mental health disorders, impaired brain development, social and behavioral issues, addiction and dependence problems, and financial and legal consequences. By comprehending, preventing, and addressing factors of youth substance use, parents, educators, and healthcare providers can protect the well‐being of young individuals, their families, and the community. [ABSTRACT FROM AUTHOR]

The advent of heated tobacco products (HTPs) has introduced new variables in the study of nicotine delivery systems and their health implications. Amidst concerns over cardiovascular effects, this study aims to elucidate the acute impact of HTP inhalation on extracellular vesicles (EV) levels in young, healthy individuals. In this controlled, acute exposure study, 23 young, healthy volunteers were subjected to HTP inhalation. EV levels of endothelial and platelet origin were quantified through flow cytometry before and after exposure. Data analysis was performed using multiple measures ANOVA to assess changes in EV concentrations. Our findings reveal a significant increase in EVs of endothelial and platelet origin following short-term HTP inhalation with nicotine. Notably, no significant change was observed in leukocyte- and neutrophil-derived EVs. This increase in EVs suggests acute vascular stress, with peak levels observed 4 h post-exposure. The rise in endothelial and platelet-derived EVs aligns with documented responses to acute vascular injury, paralleling the effects seen with traditional cigarette and e-cigarette use. Despite HTPs being marketed as safer alternatives, our results indicate that nicotine-containing HTPs may still pose significant vascular risks. These findings contribute to the growing body of evidence cautioning against the perceived safety of HTPs and reinforce the importance of regulatory oversight and public health initiatives targeting nicotine delivery technologies. Trial Registrations: ClinicalTrials.gov ID: NCT04824495, registered 2021–01-07. [ABSTRACT FROM AUTHOR]

Tobacco smoking is becoming one of the major worldwide concerns regarding environmental pollution as well as health threats. In 2005, the World Health Organization (WHO) released the Framework Convention On Tobacco Control (FCTC), which outlined protocols for controlling tobacco products. Oman was one of the leading countries to follow these protocols; however, Egypt has only followed these protocols recently in 2020. One of the main challenges in tobacco product control is the variation in their trace element's types and amounts from country to country owing to differences in agriculture techniques and used chemical additives. Smoking releases different toxic metal ions found in them into the air, and hence, analyzing trace amounts of metals in tobacco smoking products is becoming more critical. The proposed research aims to evaluate the current levels of 11 heavy metals (namely, As, Pb, Cd, Co, Cr, Be, Ba, Mn, Ni, Fe, and Hg) in 22 tobacco products available in Egypt and Oman using inductively coupled plasma optical emission spectroscopy and a direct mercury analyzer. Although some elements such as Be, Co, and Cd were absent, the positive detection of As and Pb and the levels of Ba, Cr, and Ni are still alarming, especially for heavy smokers. The obtained results were then statistically related to previously published data in 2017 to explore the effectiveness of implementing the FCTC protocols within the Egyptian market. The outcomes suggested a positive impact of FCTC protocol implementation in Egypt, besides the lower levels of elemental content for Omani products compared to the Egyptian market. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is recognized as a leading global cause of mortality, with tobacco use being one of the established risk factors responsible for 29% of related deaths. Although tobacco smoking, particularly through hookah, is increasing globally, limited data are available to evaluate its impact on CVD. This study aimed to investigate the relationship between cigarette and hookah smoking and coronary artery disease (CAD). Objectives: This study evaluated the relationship between cigarette and hookah smoking and coronary artery involvement based on coronary angiography findings. Methods: In this hospital-based cross-sectional study, 256 patients were included, with 128 patients in the CAD group (showing at least 50% stenosis in the left main artery or over 70% stenosis in other coronary arteries) and 128 patients in the normal angiography group. We assessed their smoking status, categorizing participants as current smokers, ex-smokers, or neversmokers. To ensure the collection of accurate and reliable data, we conducted face-to-face interviews, observations, and administered a questionnaire and medical checklist. Results: Based on multivariable logistic regression models, after adjusting for additional risk factors, individuals who smoked exhibited an approximately eight-fold higher likelihood of developing CAD compared to non-smokers. Additionally, hookah users showed a five-fold increase in CAD risk compared to non-hookah users (P = 0.001). Conclusions: Cigarette and hookah smoking are significantly associated with CAD, with cigarette smoking showing a comparatively stronger association with CAD than hookah use when considering other risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco is the leading modifiable risk factor for cancer and other chronic diseases. The workplace provides an opportunity to advance tobacco cessation efforts. Combining tobacco cessation with complementary components addressing mental health, physical activity, and healthy eating has demonstrated effectiveness in non-workplace settings. This scoping review examines the literature on multicomponent workplace tobacco cessation interventions to identify core components and implementation facilitators and barriers to support uptake in the workplace setting. Methods: A scoping review was conducted following PRISMA guidelines for Scoping Reviews and Arksey and O'Malley's five-step process. Peer-reviewed literature published in the past 20 years was searched across 9 databases. A search for relevant gray literature (i.e., conference papers/proceedings) was also completed. Articles were screened by two independent researchers for inclusion. Included studies evaluated workplace interventions recruiting individuals to participate in a tobacco cessation program alongside a complementary component (i.e., physical activity, mental health, healthy eating). Results: Most of the 12 included studies paired tobacco cessation with mental health or stress reduction interventions. Most complementary components targeted the individual versus organizational or policy levels. The synthesized facilitators indicated that multicomponent interventions should be incentivized and tailored to adequately meet the needs of different workplaces and employees. Discussion: This scoping review synthesizes studies integrating multiple complementary program components into workplace tobacco cessation efforts. Future interventions should implement tobacco cessation interventions at multiple levels, combining complementary components to maximize effectiveness and overcome barriers (e.g., weight gain and stress) to successful outcomes. [ABSTRACT FROM AUTHOR]

Background: Statistics from the Centers for Disease Control indicate that the use of e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS) are increasing although data on their safety is limited. While most employers ban smoking in the workplace, tobacco-free policies do not always extend specifically to e-cigarette products. Methods: An IRB approved exploratory, cross-sectional study was conducted to investigate occupational health professionals' (OHPs) knowledge of e-cigarettes, vaping and ENDS and the ability to create change in tobacco-free workplace policies. A 91-item electronic survey was sent via email to 3248 OHPs who were members of the American Association of Occupational Health Nurses. Findings: A total of 299 surveys were returned, but only 230 completed the entire survey. Of those who completed the entire survey, those with advanced education had higher attitude toward change summary scores (p =.043) and those with lower years of practicing had low scores for transformational leadership (p =.039). Approximately 40% of individuals did not have or were unsure that a tobacco-free program was in place that included e-cigarettes, but the majority (90%) perceived their organizational leaders as interested in safety changes. Conclusions: The majority of respondents understood the health issues inherent in e-cigarettes, were open to implementing policies that included e-cigarettes but needed education and both managerial and employee support to implement policy changes. Application to Practice: OHPs are well positioned to be advocates for workplace education, policy development, and worker health promotion for smoking and vaping cessation by leading organizational change. [ABSTRACT FROM AUTHOR]

Background: Use of combustible cigarettes (CCs) and smokeless oral tobacco products are well documented risk factors for a variety of oral diseases. However, the potential oral health risks of using recently introduced (since about 2000) non-combustible tobacco/nicotine products (NCPs: electronic cigarettes (ECs), heated tobacco products (HTPs) and oral nicotine pouches (ONPs), remain poorly established. Methods: This review evaluates published human studies on detrimental oral health effects in people who use NCPs compared to those smoking cigarettes and those not using any tobacco/nicotine product (NU). We identified 52 studies, predominantly focusing on adults who used electronic cigarettes as an NCP. The studies exhibited significant heterogeneity regarding design, populations, endpoints and quality. Reported outcomes, based on both single and grouped endpoints were qualitatively evaluated by comparing people who use NCPs with NU and with people smoking CCs. Significant increases (indicating a worsening in oral health), significant decreases (indicating a lower level of detrimental effects) and no significant difference between groups were assigned scores of + 1, -1 and 0, respectively. Scores from studies belonging to the same single or grouped endpoints were averaged to a summary score ranging from − 1 to + 1. Results: The qualitative meta-analysis revealed that comparisons of EC versus NU groups yielded mean scores of 0.29 for pre-cancerous lesions (N = 14 observations), 0.27 for inflammatory processes (N = 83), 0.43 for oral clinical parameters (N = 93) and 0.70 for shifts in the oral microbiome (N = 10). The corresponding values for the EC versus CC group comparisons amounted to -0.33 (N = 15), -0.14 (N = 76), -0.27 (N = 78) and 0.57 (N = 7). Most studies had significant limitations regarding group sizes, duration of NCP use (mostly only a few years) and validity of self-reported exclusive NCP use. Notably, the implications of dual use (EC + CC) and prior CC use were often not adequately considered. Conclusions: The evaluated studies suggest that use of ECs is associated with relatively fewer detrimental oral health effects compared to smoking, yet oral health status remains poorer compared to not using any tobacco/nicotine products. These results have to be interpreted with caution due to a number of limitations and uncertainties in the underlying studies, particularly the potential biases and confounding factors inherent in cross-sectional study designs. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionSubstance usage is a growing concern among tribal communities in the southern region of Kerala, as it is associated with various social, health, and economic problems. alcohol being the most commonly abused substance. This is particularly true in Southern Kerala, where the prevalence of alcohol abuse among tribal communities is estimated to be between 20% and 30%. The prevalence of alcohol use was higher among male tribal members compared to female tribal members who initiated alcohol misuse at a younger age due to parental influence, home environment, and peer pressure.A mixed methods approach was done to identify substance usage in the tribal community. 101 residents of the tribal community were chosen random and handed the survey, demographic details, substance they were used and using, views regarding substance use were all covered in the survey. Following that, 20 respondents who acknowledged to using at least one substance underwent semi-structured interview.In total, 101 respondents, 91 men and 10 women were included in the quantitative study. The majority of respondents responded to using substances, including alcohol, cigarettes, and marijuana. 74% responded to using tobacco products. This result implies that tobacco usage was very common in the research’s population. In addition, 67% of the respondents said that, they consumed alcohol, showing that a significant proportion of the participants used alcohol. 13% responded to using marijuana. Fortunately, the percentage is slightly lower than that of alcohol and tobacco consumption, it nevertheless shows that marijuana use is prevalent in the sample. These findings show that alcohol and cigarette use, in particular, are significantly more common among the respondents. Through qualitative analysis, we were able to find the primary trends in tribal men’s consumption of alcohol and substances. They began the usage of substances like alcohol, cigarettes and marijuana at an earlier age as a result of peer pressure, parental influence, and the home environment.The study explored that, substance usage and its prevalence is high among the tribal communities of southern Kerala. [ABSTRACT FROM AUTHOR]

Puff Bar, a disposable electronic nicotine delivery system (ENDS), was the ENDS brand most commonly used by U.S. youth in 2021. We explored whether Puff Bar's rise in marketplace prominence was detectable through advertising, retail sales, social media, and web traffic data sources. We retrospectively documented potential signals of interest in and uptake of Puff Bar in the United States using metrics based on advertising (Numerator and Comperemedia), retail sales (NielsenIQ), social media (Twitter, via Sprinklr), and web traffic (Similarweb) data from January 2019 to June 2022. We selected metrics based on (1) data availability, (2) potential to graph metric longitudinally, and (3) variability in metric. We graphed metrics and assessed data patterns compared to data for Vuse, a comparator product, and in the context of regulatory events significant to Puff Bar. The number of Twitter posts that contained a Puff Bar term (social media), Puff Bar product sales measured in dollars (sales), and the number of visits to the Puff Bar website (web traffic) exhibited potential for surveilling Puff Bar due to ease of calculation, comprehensibility, and responsiveness to events. Advertising tracked through Numerator and Comperemedia did not appear to capture marketing from Puff Bar's manufacturer or drive change in marketplace prominence. This study demonstrates how quantitative changes in metrics developed using advertising, retail sales, social media, and web traffic data sources detected changes in Puff Bar's marketplace prominence. We conclude that low-effort, scalable, rapid signal detection capabilities can be an important part of a multi-component tobacco surveillance program. [ABSTRACT FROM AUTHOR]

Originally native to South America, tobacco and is now distributed worldwide as a major cash crop. Nicotine is the main harmful component of tobacco leaves, cigarette smoke and tobacco waste, which severely affects not only the flavor of the tobacco leaf, but also causes great damage to human health. As the anti-smoking movement continued to grow since the 1950s, and consumers become more aware of their health and environmental protection, the world tobacco industry has been committed to research, develop and produce low nicotine cigarette products with relatively low risk to human health. Among various approaches, the use of microorganisms to reduce nicotine content and improve tobacco quality has become one of the most promising methods. Due to increasing interest in nicotine-degrading microorganisms (NDMs), this article reviews recent reports on NDMs, nicotine-degrading enzymes, regulation of nicotine-degrading bacterial consortia and optimization of fermentation conditions, aiming to provide updated references for the in-depth research and application of microorganisms for the degradation of nicotine. [ABSTRACT FROM AUTHOR]

Background: How common it is with the presence of human papillomavirus (HPV) in the healthy and diseased oral cavity is largely unknown for Africans. In this cross-sectional study we assessed the prevalence of oral HPV and the risk factors associated with HPV contraction including sexual practice in the urban and rural Zambian population. Methods: Urban (N = 188) and rural (N = 211) Zambian adults aged 21 years and older living in Ndola and Mansa, respectively, were interviewed about demographical data, oral and coital sexual history and tobacco and alcohol use. Participants were orally examined and underwent a buccal swab test for 12 high-risk HPVs (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) and two low-risk HPVs (HPV6 and 11) with real-time PCR. Results: Alcohol consumption was higher in urban participants than rural participants, i.e., 34.1% and 16.6%, respectively, consumed alcohol once a week or more (p = 0.001). Ever-smokers constituted 38.8% of urban and 32.2% of rural participants (p = 0.363). Engaging in orogenital sex was uncommon, however, more common in urban than rural participants (13.3% and 4.3%, respectively, p = 0.003). Only three participants were positive for HPV (HPV16, 35, and 45, respectively). Conclusions: Urban participants displayed higher sexual risk behaviour than rural participants. However, the prevalence of oral HPV infection in Zambia was low, which contrasts to the high incidence of cervical cancer reported for the country. [ABSTRACT FROM AUTHOR]

Background: As the primary cause of various preventable illnesses, smoking results in approximately five million premature deaths each year in the US and a multitude of adults living with serious illness. The majority of smokers know the health risks associated with smoking and intend to quit. However, quitting is very difficult partly because of insomnia and stress associated with it. Current tobacco cessation medications are not designed to address these problems, which may have contributed to their limited success in enabling cessation. Novel interventions are thus urgently needed to enhance success rates in tobacco cessation. Based on its historical usage and our preliminary data, kava is such a candidate. Kava, customarily enjoyed by South Pacific Islanders, is known for its relaxing effects, stress-relieving properties, and ability to enhance sleep. In the US, it is marketed and distributed as a dietary supplement due to its recognized calming properties. A pilot trial was performed among active smokers with a one-week ingestion of a kava supplement. The results for the first-time revealed kava's potential in enabling tobacco cessation with effects on a panel of biological signatures. The primary goal of this trial is to replicate kava's effects on the biological signatures of tobacco use, stress, and sleep in addition to its compliance and safety among those who smoke. Methods: A double-blind randomized placebo controlled two-arm trial will enroll 76 smokers with intention to quit, who will consume AB-free kava at a dietary supplement dose or placebo, 3 times per day for 4 weeks with two follow-ups. Discussion: The study will (1) monitor the adherence to and safety of AB-free kava consumption among smokers and evaluate changes in smoking habits, and (2) quantify a panel of non-invasive translatable biomarkers to objectively evaluate AB-free kava's holistic effects on biological signatures associated with tobacco use, stress, and sleep. We hypothesize that AB-free kava is a novel and promising intervention to facilitate tobacco cessation via its holistic effects associated with managing stress and insomnia during abstinence. If the results from this study support our hypothesis, kava could emerge as an affordable and accessible dietary supplement candidate for tobacco cessation. Trial Registration: registered on 04/14/2023 in ClinicalTrials.gov with the identifier NCT05814055. [ABSTRACT FROM AUTHOR]

Background: Sociodemographic factors have been implicated in cardiovascular health with differential morbidity and mortality. It is essential to comprehend how sociodemographic factors contribute to the improvement of Metabolic Syndrome (MetS), the primary cardiovascular diseases indicator. Objective: Determine the role of sociodemographic factors in improving MetS among adults residing in the Slums of Nairobi, Kenya. Methods: Adults with MetS participated in this randomized controlled trial study for a period of 12-months. A random assignment was used to place eligible participants in the intervention or control groups. The intervention group received lifestyle intervention that entails not using tobacco products or alcohol, exercising, and adhering to recommended dietary guidelines, while the control group had standard medical care. Clinical, biochemistry, and lifestyle habits were measured before and a year after the intervention. The association between the sociodemographic factors and the improvement in MetS was examined using a multiple logistic regression model with backward conditional. Results: In the intervention group, lack of improvement in metabolic syndrome was significantly higher among aged (≥50 years) respondents [AOR = 9.097; P <.001]; Protestants [AOR = 7.292; P =.017] and Catholics [AOR = 5.270; P =.050]. Compared to unemployed, formally employed respondents had an 84.6% lower chance of having MetS [AOR = 0.154; P =.005]. Within the control group, lack of improvement in metabolic syndrome was significantly higher among aged (≥50 years) respondents [AOR = 5.013; P =.047]. Compared to respondents who had less than $100, individuals with monthly incomes between $100 and $500 had a roughly 10-fold [AOR = 10.499; P =.024] higher chance of having MetS. Conclusion: In the current study, the findings show that sociodemographic factors namely: advanced age, unemployment, being Protestants and Catholics as well as higher income were negatively associated with improvement in MetS. The findings indicate that social factors have impact in the management and intervention outcomes of CVDs. Programmers and policy makers should plan interventions for CVD prevention and response with these factors in mind. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the potential role of endophytic bacteria in tobacco leaves during the fermentation process to enhance the quality of tobacco. Methods: We isolated 11 endophytic bacteria from fresh tobacco leaves and selected Bacillus halotolerans NS36 and Bacillus mycoides NS75 based on sensory evaluation, both of which significantly improved the sensory quality of tobacco leaves. Results: Specifically, NS36 decreased offensive taste in tobacco leaves, while NS75 improved the quality by increasing the aroma. Chemical analysis revealed that fermentation with B. halotolerans NS36 significantly decreased the content of irritant compounds such as lignin, cellulose, starch, and pectin. In contrast, fermentation with B. mycoides NS75 reduced the content of cellulose, starch, and protein, while significantly increasing the content of Amadori compounds and glycosides. Through whole-genome sequencing, we predicted enzyme systems related to these chemical changes. B. halotolerans NS36 mainly secreted enzyme systems associated with the degradation of lignin, cellulose, starch, and pectin, thereby reducing irritants in tobacco leaves, diminishing unpleasant tastes, and achieving a more balanced sensory quality. B. mycoides NS75, on the other hand, secreted enzyme systems related to protein and glycoside hydrolysis, increasing Maillard reaction products and glycosylated compounds in tobacco leaves, thus enhancing the aroma quality and quantity. Discussion: The findings of this study offer a new perspective for the tobacco industry, namely, the use of endophytic bacilli to improve the off-flavors and aroma of tobacco leaves, which could not only enhance the industrial applicability of tobacco leaves but also potentially strengthen the market competitiveness of products. These discoveries lay the foundation for further research and application, especially in the development of new biotechnologies to improve the quality of tobacco products. [ABSTRACT FROM AUTHOR]