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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.

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.

BackgroundTobacco smoke adversely affects the prognosis of adult cancers including myeloid leukemia, but less is known in children.MethodsWe evaluated whether pre- and postnatal exposures to tobacco smoke decrease 5-year survival of 1,235 childhood acute lymphoblastic leukemia (ALL) and 188 childhood acute myeloid leukemia (AML) cases derived from a population-based case-control study in California. Cases were diagnosed between 1995 and 2015 (median follow-up time of 13.2 years overall). We obtained data on tobacco smoking (before conception, during pregnancy, after birth), parental education and income, clinical features, and vital status through 2020. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for mortality associated with smoking, adjusting for sociodemographic characteristics and risk group (ALL only).ResultsAbout 23% of mothers and 39% of fathers reported smoking and 130 children with ALL and 52 with AML died within 5 years. For AML, increased risks of death were observed among children whose fathers smoked before conception compared with nonsmoking fathers [HR = 1.41; 95% confidence interval (CI), 0.95-3.44 and 3.47; 95% CI, 1.37-8.81, respectively for

BACKGROUND: Approximately 70-80% of people experiencing homelessness in the United States use tobacco. Smoking cessation programs specifically for this population have been found to be less effective for African American participants. The purpose of this study was to explore discrimination experiences and their impact on smoking habits and readiness to quit cigarette smoking while experiencing homelessness. METHODS: In the qualitative phase of this mixed methods study, five focus groups were conducted for African Americans residing in a homeless shelter in Skid Row, Los Angeles, CA. Using a semi-structured interview guide, we asked participants about discrimination experiences, how smoking habits were impacted by these experiences, and tools needed to successfully abstain from cigarette smoking. Qualitative descriptive content analysis was used to explore discrimination experiences and its association with readiness to quit cigarette smoking. RESULTS: Of the 17 participants, 14 (82.4%) were male, and the average age was 46.8 years. Using a qualitative In Vivo coding method, three themes were revealed: Experiencing Discrimination while Black, The Psychosocial Fabric-Why Quitting Cigarette Smoking is a Challenge, and The Lesser of Two Evils-Choosing to Smoke over More Harmful Options. Participants discussed working in the blue-collar workforce while Black, identifying as a double minority, smoking to cope with stress, early exposure to cigarettes, smoking being a central part of ones belonging to a group, and the legality of cigarette smoking. DISCUSSION: Our findings show that African Americans experiencing homelessness (1) may experience discrimination in multiple settings, regardless of housing status, (2) could have grown up around cigarette smoking and remain surrounded by it while experiencing homelessness, and (3) may experience a calming effect with smoking, which slows some from reacting negatively to adverse situations. CONCLUSION: Barriers to successfully abstaining from smoking are multifactorial among African Americans experiencing homelessness and should be addressed individually. Future research should explore the cultural tailoring of interventions that support cessation efforts unique to minoritized populations to improve smoking cessation programs offered to this population.

IntroductionMenthol tobacco products have been marketed disproportionately to communities of color for decades.MethodsIn Los Angeles County, California, a health marketing campaign, which used glossy visuals and attractive people in appealing poses, reminiscent of tobacco marketing tactics, was created and implemented to educate smokers on the health risks of using menthol cigarettes. The campaign encouraged smokers to make a quit attempt by offering access to free or low-cost resources through the Kick It California quitline and the LAQuits website (laquits.com). A survey tailored for public health professionals and community members from the approximately 382,000 people in the county who smoked menthol cigarettes and were exposed to their smoke (our primary audience) was administered to generate insights about this problem. Survey data were used to finesse the campaign creative materials prior to launch. Advertisement exposures, website visits, and quitline call volume were monitored and tabulated to assess the performance of the campaign.ResultsAt the conclusion of its initial run (February-April 2021), the "Done with Menthol" campaign had garnered more than 66 million impressions, received approximately 56,000 clicks on its various digital media platforms, and had click-through rates that surpassed industry benchmarks. The quitline call volume for African American and Latino subgroups were 1.9 and 1.8 times higher than the average inbound call volume for corresponding months during 2018 and 2019, respectively. In its second run (May-June 2023), the campaign garnered approximately 11 million additional impressions.ConclusionsDespite having a lower budget and fewer resources than the tobacco industry, the "Done with Menthol" campaign attained excellent reach and offered free, low-cost, and accessible resources to county residents interested in tobacco use cessation.

Electronic nicotine delivery systems (ENDS) continue to rapidly evolve. Current products pose unique challenges and opportunities for researchers and regulators. This commentary aims to highlight research gaps, particularly in toxicity research, and provide guidance on priority research questions for the tobacco regulatory community. Disposable flavoured ENDS have become the most popular device class among youth and may contain higher nicotine levels than JUUL devices. They also exhibit enhanced harmful and potentially harmful constituents production, contain elevated levels of synthetic coolants and pose environmental concerns. Synthetic nicotine and flavour capsules are innovations that have recently enabled the circumvention of Food and Drug Administration oversight. Coil-less ENDS offer the promise of delivering fewer toxicants due to the absence of heating coils, but initial studies show that these products exhibit similar toxicological profiles compared with JUULs. Each of these topic areas requires further research to understand and mitigate their impact on human health, especially their risks to young users.

IntroductionLesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals use tobacco at disproportionately high rates but are as likely as straight tobacco users to want to quit and to use quitlines. Little is known about the demographics and geographic distribution of LGBTQ quitline participants, their engagement with services, or their long-term outcomes.Aims and methodsCalifornians (N = 333 429) who enrolled in a statewide quitline 2010-2022 were asked about their sexual and gender minority (SGM) status and other baseline characteristics. All were offered telephone counseling. A subset (n = 19 431) was followed up at seven months. Data were analyzed in 2023 by SGM status (LGBTQ vs. straight) and county type (rural vs. urban).ResultsOverall, 7.0% of participants were LGBTQ, including 7.4% and 5.4% of urban and rural participants, respectively. LGBTQ participants were younger than straight participants but had similar cigarette consumption. Fewer LGBTQ participants reported a physical health condition (42.1% vs. 48.4%) but more reported a behavioral health condition (71.1% vs. 54.5%; both p's < .001). Among both LGBTQ and straight participants, nearly 9 in 10 chose counseling and both groups completed nearly three sessions on average. The groups had equivalent 30-day abstinence rates (24.5% vs. 23.2%; p = .263). Similar patterns were seen in urban and rural subgroups.ConclusionsLGBTQ tobacco users engaged with and appeared to benefit from a statewide quitline even though it was not LGBTQ community-based. A quitline with staff trained in LGBTQ cultural competence can help address the high prevalence of tobacco use in the LGBTQ community and reach members wherever they live.ImplicationsThis study describes how participants of a statewide tobacco quitline broke down by sexual orientation and gender. It compares participants both by SGM status and by type of county to provide a more complete picture of quitline participation both in urban areas where LGBTQ community-based cessation programs may exist and in rural areas where they generally do not. To our knowledge, it is the first study to compare LGBTQ and straight participants on their use of quitline services and quitting aids, satisfaction with services received, and rates of attempting quitting and achieving prolonged abstinence from smoking.

The article examines the problematic aspects of the practical implementation of Articles 16, 16¹ of the Law of Ukraine «On measures to prevent and reduce the use of tobacco products and their harmful effects on the health of the population» in the context of distinguishing between the concepts of advertising and promotion of the sale of tobacco products, as well as advertising and promotion of sales devices for consuming tobacco products without burning them. On the basis of the analysis of current legislation, answers to the following questions were formulated: firstly, whether the promotion of the sale of tobacco products is the placement of a QR code on the tables of a restaurant, which contains a link to the Internet, which contains the menu of the restaurant and information about the available sale of tobacco products, hookah devices, hookah preparation services, devices for consumption of tobacco products without burning them, electronic cigarettes (Article 16 of Law No. 2899-VI); secondly, whether advertising and promoting the sale of tobacco products, placement of tobacco products and/or information about them on visible elements of equipment or on shop windows of business entities in illuminated boxes or on elements that contain images, drawings, background inserts, color which differs from the color of commercial equipment (Article 16 of Law No. 2899-VI); thirdly, whether advertising and promoting the sale of devices for consumption of tobacco products without burning them, placing devices for consumption of tobacco products without burning them and/or information about them (description, prices, etc.) in retail trade places on external elements of the equipment of illuminated advertising structures, background inserts, the color of which is different from the color of retail equipment, and which contain devices for consuming tobacco products without burning them and/or information about them (description, prices, etc.) (Article 16¹ of Law No. 2899-VI); fourth, whether it is advertising and promoting the sale of devices for consuming tobacco products without burning them, placing information about the manufacturer of devices for consuming tobacco products without burning them, as well as placing devices for consuming tobacco products without burning them outside the places of sale of these products (Article 16¹ of Law No. 2899-VI). Key words: advertising of tobacco products, promoting the sale of tobacco products, devices for consuming tobacco products without burning them, places where tobacco products are sold, QR-codes on the tables of restaurants with information about tobacco products available for sale, hookahs, devices for consuming tobacco products without their combustion, electr onic cigarettes. [ABSTRACT FROM AUTHOR]

Background: The γ‐aminobutyric acid‐B (GABAB) receptor is a promising target for the development of new medications to treat alcohol use disorder (AUD). The GABAB agonist baclofen has been reported to reduce alcohol consumption but is associated with some undesirable side effects, including sedation. ASP8062 is a novel compound that acts as a positive allosteric modulator at the GABAB receptor and may be more tolerable than baclofen. This proof‐of‐concept human laboratory clinical trial evaluated the safety profile of ASP8062 and tested its effects on cue‐elicited alcohol craving and alcohol use among treatment‐seeking individuals with AUD. Methods: This double‐blind, randomized, multisite trial tested the effect of ASP8062 (25 mg once daily), relative to placebo, on alcohol cue‐elicited craving in a laboratory setting and alcohol consumption, craving, mood, sleep, cigarette smoking, and alcohol‐related consequences in the natural environment over a 6‐week treatment period. Participants were 60 individuals (26 females and 34 males) with moderate or severe AUD. Results: ASP8062, relative to placebo, was well tolerated, and there were no adverse events (AEs) that significantly differed between treatment groups. Most AEs were mild/moderate, and there were no serious AEs among individuals treated with ASP8062. However, ASP8062 did not attenuate alcohol cue‐elicited craving compared with placebo. Moreover, exploratory analyses indicated that ASP8062, relative to placebo, did not significantly affect alcohol consumption, naturalistic alcohol craving, mood, sleep, cigarette smoking, or alcohol‐related negative consequences during the 6‐week treatment period. Conclusions: Although ASP8062 was well tolerated with no serious AEs, the novel compound did not significantly dampen alcohol cue‐elicited craving or improve other AUD‐related outcome measures. These data indicate positive allosteric modulation of the GABAB receptor at the dose evaluated here may not blunt alcohol cue‐elicited craving, and preliminary drinking outcome data suggest it may not be an efficacious treatment strategy for AUD. [ABSTRACT FROM AUTHOR]

Objective: To describe the rate, timing, and primary diagnosis codes for emergency care visits up to 8 weeks (56 days) after live birth among Medicaid beneficiaries in North Carolina (NC). Materials and Methods: Using a linked dataset of Medicaid hospital claims and certificates of live birth, which included Medicaid beneficiaries who had a live-born infant in NC between January 1, 2013, and November 4, 2019, and met inclusion criteria (n = 321,879), we estimated week-specific visit rates for emergency care visits that did not result in hospital admission (outpatient) and those that did (inpatient). We assessed the 10 leading diagnosis code categories for emergency care visits and described the characteristics of people with 0, 1, or ≥2 outpatient emergency care visits. Results: One in eight (12.4%) Medicaid beneficiaries had an emergency care visit that did not result in inpatient hospital admission during the first 8 weeks postpartum. Visit rates peaked in postpartum week 2. Diagnosis codes for nonspecific symptoms and substance use were the two leading diagnosis code categories for outpatient emergency care visits. Respiratory concerns and gastrointestinal concerns were the two leading diagnosis code categories for inpatient emergency care visits. Compared with those with zero outpatient emergency care visits, a greater proportion of people with ≥2 visits had less than a high school education, used tobacco during pregnancy, had Medicaid insurance outside of pregnancy, had mental health as a medical comorbidity, and/or had ≥2 medical comorbidities. Conclusions: These findings support scheduling health care visits early in the postpartum period, when emergency care visits are most frequent, and point to unmet needs for substance use support. [ABSTRACT FROM AUTHOR]

Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets. [ABSTRACT FROM AUTHOR]

Nicotine is an alkaloid found in tobacco. Human exposure to nicotine primarily occurs through the use of tobacco products. To date, limited nicotine pharmacokinetic data in animals have been reported. This study exposed male Sprague-Dawley rats to vehicle (and/or air) or 4 doses of nicotine via nose-only inhalation (INH), oral gavage (PO), and intravenous (IV) infusion. Plasma, 6 tissues (brain, heart, lung, liver, kidney, and muscle), and urine were collected at multiple timepoints from 5 min to 48 h post-dose. The concentrations of nicotine, cotinine, and trans -3′-hydroxycotinine (3-OH-cotinine) were determined, and the pharmacokinetic profiles were compared among the 4 doses for each route. The results indicated that after single nicotine dose, nicotine bioavailability was 53% via PO. Across all the administration routes and doses, nicotine was quickly distributed to all 6 tissues; kidney had the highest nicotine and cotinine levels, and the lung had the highest 3-OH-cotinine levels; nicotine was metabolized extensively to cotinine and cotinine was metabolized to a lesser extent to 3-OH-cotinine; the elimination of plasma nicotine, cotinine, and 3-OH-cotinine followed first-order kinetics; plasma nicotine had a shorter half-life than cotinine or 3-OH-cotinine; the half-lives of plasma nicotine, cotinine, and 3-OH-cotinine were dose- and route-independent; and nicotine and cotinine were major urinary excretions followed by 3-OH-cotinine. Nicotine, cotinine, and 3-OH-cotinine levels in plasma, tissues, and urine exhibited dose-dependent increases. These study findings improve our understanding of the pharmacokinetics of nicotine, cotinine, and 3-OH-cotinine across different routes of exposure. [ABSTRACT FROM AUTHOR]

Health communication research applies communication science to develop generalizable knowledge capable of improving the health and well-being of individuals and communities. But to what extent does the knowledge generated by the health communication field actually achieve public health impact? To answer this question, we discuss the application of health communication science and research within a tobacco regulatory science framework. We describe three areas in which health communication research funded by the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) contributed to 1) youth tobacco prevention campaigns, 2) cigarette health warnings, and 3) regulation of labeling, advertising, and marketing claims. These examples demonstrate how communication regulatory science achieves public health impact in the real world by informing national policies, regulatory actions, and public health practice. [ABSTRACT FROM AUTHOR]

The article presents a 2001 report from the U.S. National Academy of Science on the science base of tobacco harm reduction (THR). The report discusses the use of potential reduced-exposure products to reduce exposure to harmful substances in tobacco, feasibility of THR, potential of e-cigarettes and oral nicotine products to reduce cigarette smoking prevalence and tobacco-related harm, public health impact of e-cigarettes, safety and effectiveness of snus, a low-nitrosamine smokeless tobacco.

Background and aims: Cannabis and nicotine (tobacco or e‐cigarettes) use commonly co‐occurs and understanding their relationship can help to inform public health strategies to prevent their harms. We conducted a systematic review and meta‐analysis to estimate the association of cannabis use given prior nicotine use and vice versa. Methods: PubMed, Embase, PsycINFO, Google Scholar and a hand‐search were conducted in 2023 for longitudinal studies of the general population with no restrictions in settings (locations). Random‐effects meta‐analysis was conducted to estimate odds ratios between cannabis and nicotine use in both directions. The impact of unmeasured confounding was assessed using E‐values. Results: From 5387 identified records, we included 20 studies. Among cannabis‐naïve youths, baseline use of any nicotine products was positively associated with initiation of any cannabis use at follow‐up [odds ratio (OR) = 5.39, 95% confidence interval (CI) = 3.19, 9.11; adjusted OR (aOR) = 2.59, 95% CI = 2.01, 3.32]. In nicotine‐naïve participants (youths + adults), baseline cannabis use was positively associated with the initiation of any nicotine use at follow‐up (OR = 4.08, 95% CI = 2.05, 8.11; aOR = 2.94, 95% CI =1.54, 5.61). There were no significant associations between baseline cannabis use and subsequent initiation of any nicotine (aOR = 3.29, 95% CI = 0.85, 12.76) or daily nicotine use (aOR = 2.63, 95% CI = 0.41, 16.95) among youths. The median E‐values were 5.5 for nicotine exposure and cannabis use initiation and 4.1 for cannabis exposure and nicotine use initiation, indicating that substantial unmeasured confounding would need to have a strong association with both outcomes to fully explain away the cannabis and nicotine relationship. Conclusion: Although the evidence for associations between cannabis use and tobacco use is mixed, a majority of studies to date have found that cannabis use is associated with prior nicotine use and vice versa. [ABSTRACT FROM AUTHOR]

Smoking is the g'reatest preventable cause of mortality all over the world as it causes lung cancer, vascular disease, peptic ulcers, coronary heart disease, stroke and harm to the developing fetal brain, and numerous respiratory issues, such as chronic bronchitis, emphysema, pulmonary hypertension, obstruction of tiny airways, and chronic obstructive pulmonary diseases. These diseases are mainly caused by smoking of tobacco products, including pipe tobacco, snuff, cigars, and cigarettes. To overcome the dangerous and adverse effects of tobacco alkaloids, the utilization of novel class of quantum dots, the graphene quantum dot (GQD) has not yet been thoroughly investigated. To fill this gap, the mechanistic sensing capability of the tetragonal graphene quantum dot towards tobacco alkaloids including anabasine (Anab), anatabine (Anat), myosmine (Myos), nitrosoanabasine (NAB), nitrosoanatabine (NAT), and nornicotine (NOR) has been investigated by employing first-principles DFT and TD-DFT computations. The computational tools have been utilized to investigate the interaction energies, the energy gap (FMO analysis), non-covalent interactions (NCI analysis), transfer of charges (QNBO), and the nature and strength of intermolecular interactions (QTAIM analysis). The NOR@T-GQD complex has the greatest interaction energy (− 20.1051 kcal/mol) among all the studied complexes. Also, the complex NOR@T-GQD has the lowest energy gap (1.072 eV) and chemical hardness (0.536 eV) which indicates the highest conductivity (2.486 × 109), shortest recovery time (3.005 × 10−16), and highest sensing response (2.326). UV–Vis analysis explored the maximum absorbance wavelength, excitation energy, and oscillator strength for the studied system and the thermodynamic analysis explored the spontaneity of the interaction process of the studied complexes. So, all the investigation parameters have proved that the tetragonal graphene quantum dot-based sensor is an influential sensing material towards all studied tobacco alkaloids especially for the tobacco alkaloid nornicotine. [ABSTRACT FROM AUTHOR]

Background: Perceptions of health harms and addictiveness related to nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients are an important predictor of use. This study examined differences in perceived harm and addiction across such products among adolescents, young adults, and adults. Methods: We conducted a cross-sectional survey (N = 6,131, ages 13–40 years old) in which participants reported perceived harm and addictiveness for 11 products (cigarettes, disposable nicotine e-cigarettes, pod-based nicotine e-cigarettes, other nicotine e-cigarettes, THC e-cigarettes, e-cigarettes with other ingredients, nicotine pouches, nicotine lozenges, nicotine gums, nicotine tablets, nicotine toothpicks). We applied adjusted regression models and conducted pairwise comparisons between age groups (13–17, 18–20, 21–25, and 26–40) and product use status (never, ever, and past-30-day use), adjusting for gender, race/ethnicity, sexual orientation, and financial comfort. Results: Overall, participants in younger age groups perceived products to be more harmful and addictive than those in older age groups, with the exception of e-cigarettes with other ingredients. For all products, participants who never used perceived each product to be more harmful than those who ever used. For all products, participants who used the products in the past 30-days had lower perceived harm and addictiveness compared to never and ever use. Certain sociodemographic groups, such as people who identify as LGBTQ+, Non-Hispanic Black, or Hispanic, had lower perceived harm and addictiveness for most products. Discussion: Efforts should be made to educate all age groups and minoritized groups on harms and addictiveness of all nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients. [ABSTRACT FROM AUTHOR]

Introduction: Many people who smoke cigarettes report believing that nicotine causes cancer, a misperception that may reduce interest in switching to noncombustible nicotine products. Quantitative survey questions do not capture how this population thinks about nicotine and switching to noncombustible products. Methods: This study used an online convenience sample of 193 US adults who smoke cigarettes and reported that nicotine causes cancer. Respondents were asked if they thought nicotine was harmful (and why or why not) and if they would consider switching to a noncombustible product (and why or why not). Inductive and deductive coding were used, and descriptive statistics are reported. Results: Descriptions of nicotine directly causing disease (61%) were more common than descriptions of nicotine causing addiction to a harmful product (8%). One-third expressly stated that nicotine causes cancer, and 21% that nicotine causes lung disease. Interest in switching was moderate (mean 47.4 out of 100). When asked about switching, 34% described enjoying their current smoking experience, 23% described a perceived health benefit, 16% described a health concern, and 11% worried that switching would not address nicotine addiction. Discussion: Adults who smoke commonly perceived nicotine as a direct cause of cigarette-related disease, and harm and addictiveness perceptions were often mentioned as reasons for interest or disinterest in switching to a noncombustible. Future studies could explore strategies for correcting nicotine misperception, stigma related to addiction, and common concerns related to health as well as user experience. [ABSTRACT FROM AUTHOR]

The text discusses the research on EVALI (electronic cigarettes or vaping product use-associated lung injury) and its impact on public health. It highlights the outbreak of EVALI in the United States, the toxicological aspects of vaping fluids, and the response of official bodies in Europe. The text also delves into toxicological research avenues, clinical manifestations of EVALI, and the urgent need for further experimental and clinical research on this issue. The complexity of EVALI necessitates ongoing research and contributions to the field of toxicology. [Extracted from the article]

The text discusses the global efforts to regulate tobacco harm reduction products, particularly e-cigarettes, to address smoking-related health issues. Various countries have adopted different approaches to regulating e-cigarettes, leading to diverse outcomes in smoking trends. The text highlights four studies published in the Journal of Consumer Policy that analyze the impact of e-cigarette regulations on smoking behaviors in the USA, Russia, Canada, and Korea. The editors emphasize the importance of transparent research practices and intellectual debate in advancing scientific understanding of tobacco harm reduction. [Extracted from the article]

Aim: In this study, it was aimed to evaluate the attachment styles and life satisfaction of adolescents (12–18 years old) with and without smoking, alcohol, and substance use. Method: With the questionnaire applied on the digital platform and 225 adolescents between the ages of 12–18 were reached. The data were collected using a questionnaire, attachment style scale, and life satisfaction scale. The analyzes of the research were performed using the SPSS 25 program. Findings: The rate of young people who stated that they have smoked, or used alcohol and drugs was 40%. Of the adolescents, 35.6% used cigarettes, 0.4% used substances, and 6% used alcohol. Attachment styles and life satisfaction scale mean scores were lower in smoking, alcohol, and substance-using youth than in those who did not use these. It was observed that the average avoidant and anxious context styles scores of adolescents with smoking, alcohol and substance use were higher. Conclusions: It is important to take initiatives to support adolescents with problematic attachment styles and to protect their health [ABSTRACT FROM AUTHOR]

Background: Electronic cigarettes, hookahs, or water pipes are new forms of tobacco consumption, these alternatives are becoming popular in the adolescent and young adult population. Objective: To determine the prevalence and factors associated with the usage of electronic cigarettes and hookahs in Colombian adolescents. Materials and Methods: Secondary analysis of data from one study aimed to determine the prevalence of traditional cigarette use (Emtamplona Study). The adolescents were considered consumers if he/she claimed to have consumed at least one cigarette or used a hookah and/or electronic cigarette during the last 30 days. A self-administered and anonymous questionnaire was answered by 812 adolescents aged 14 ± 2 years (438 women). Results: The prevalence of electronic cigarette and hookah use was 1.8% (95%CI 0.9%–2.7%) and 2.8% (95%CI 1.8%–4.1%), respectively. A logistic regression analysis showed that traditional cigarette consumption was associated (OR 10.46, 95%CI 3.64–30.97) with electronic cigarette use. On the other hand, being in sixth-seventh grade (OR 5.19 95%CI 1.08–25.01) and belonging to a private school (OR 10.54 95%CI 3.95–28.13), smoking (OR 15.38 95%CI 3.45–68.62) was associated with hookah use. Conclusions: Electronic cigarette and hookah use among these adolescents is low; however, public health strategies are important to control tobacco consumption. [ABSTRACT FROM AUTHOR]

Youth vaping is a concern and schools may use many approaches to discipline students caught vaping at school. This study identified the prevalence of school staff seeing vaping in schools and the measures used to discipline students. A state-wide sample of 7,938 staff from 255 middle and high schools reported whether they saw any students vaping at school in the last 30 days, whether they have caught any students vaping during class in the last semester, and what happened after catching a student vaping in class. Open-text responses were coded and themes were identified related to disciplinary approaches. 31.9% of staff reported seeing students vaping at school, and 11.9% of teachers reported catching a student vaping during class. Teachers described four categories of disciplinary approaches after catching students vaping in class: no consequences, punitive approaches, restorative approaches, and mixed approaches. Additional support is necessary to help schools address student vaping. [ABSTRACT FROM AUTHOR]

AbstractThe absorption of nicotine from smokeless tobacco products (STPs) in humans is affected by various factors, including nicotine content, flavoring compounds, cutting format, tobacco cut sizes, and pH. In this study, participants were asked to use STP 1 for a specific period, after which the nicotine content was measured before and after use to determine the release rate using the Weibull model. Blood samples were collected from participants after 30 min of using STP 1 to assess nicotine pharmacokinetics. Additionally, guinea pigs were administered four types of STPs with varying pH levels, and tobacco cut sizes, but with identical nicotine content on the oral mucosa to evaluate nicotine pharmacokinetics. The human results showed that nicotine in STP was quickly released in the mouth, reaching 73.66% within 30 min. Plasma nicotine concentration in guinea pigs and human participants were comparable following STP use. Guinea pigs exposed to STPs with smaller tobacco cut sizes or higher pH absorbed more nicotine and metabolized it more slowly. The findings suggest that pH and cut size of STPs are key factors affecting nicotine absorption, while the impact of flavoring agents and other components on nicotine absorption remains to be determined. [ABSTRACT FROM AUTHOR]

Background: Quitting cigarette smoking can substantially reduce or eliminate the risk of developing numerous chronic diseases. Use of flavored tobacco or nicotine products is commonly cited by adults who smoke cigarettes to be important in helping them reduce or quit smoking. The purpose of this analysis was to understand the association between the levels of use of flavored oral nicotine products and smoking reduction and quitting and how reduction or quitting may differ between predominant users of fruit/other versus mint flavored oral nicotine products after six months of use. Methods: Participants were provided with their choice of a variety of forms and flavors of Rogue® nicotine products (Study Products) over a 6-month actual use period and completed online surveys assessing tobacco, nicotine and Study Product use at Baseline and Months 1, 2, 4, and 6 thereafter. Results: Among the 1393 participants at Month 6, 41.4% and 52.5% used predominantly fruit/other or mint Study Product flavors, respectively. Compared to predominant mint users, predominant fruit/other users had greater cigarette reduction (mean reduction: 50.0% vs. 48.4%) and a higher proportion had quit smoking (proportion quit: 15.4% vs. 11.6%) at Month 6. Additionally, 38.8% of predominant fruit/other users and 39.3% of predominant mint users reduced their cigarette consumption by ≥ 50% from Baseline. Increased use of fruit/other flavors was independently associated with smoking reduction (8.6% greater reduction per 10 pieces/day; p < 0.001) and odds of quitting smoking (OR = 1.29 [95% CI: 1.04–1.59] per 10 pieces/day; p = 0.017). Increased use of mint flavors was independently associated with smoking reduction (7.5% greater reduction per 10 mint pieces/day; p < 0.001) but not with odds of quitting smoking. Conclusions: Increased use of either fruit/other or mint flavored Study Products at Month 6 was associated with significantly increased smoking reduction, whereas only increased use of fruit/other flavors was associated with greater odds of quitting smoking among participants in the study. Trial Registration: This study was observational. Participants were not prospectively assigned to one or more health-related interventions and could choose to use or not use the commercially available study products provided during the study. Thus, the study was not registered in a trial database by the Sponsor. [ABSTRACT FROM AUTHOR]

Development of low temperature catalytic pyrolysis technology for heated tobacco sheets is expected to increase the aroma of heated tobacco products and improve their overall smoking quality. In this study, the low temperature pyrolysis performances of heated tobacco sheets catalyzed by various anionic sodium salts were investigated using TG-DTG, Py-GC-MS technology and smoke routine chemical composition analysis. The results showed that the total weight loss between 100°C and 300°C increased by 7.8%–13.15% after adding various anionic sodium salts, among which, sodium acetate and sodium tartrate showed a relatively higher weight loss. The relative content of free hydroxyacetone, furfuryl alcohol, butyrolactone and megastigmatrienone in the pyrolysis gas increased, while the relative content of free nicotine decreased. With the change of anionic species, the catalytic decomposition ability of cellulose, lignin, and other substances may change, resulting in the distribution alteration of compounds in the pyrolysis gas. After adding sodium acetate and sodium citrate, the release of total particulate matter (TPM), glycerol, and nicotine in flue gas increased. Overall, the addition of sodium acetate and sodium citrate showed a higher low temperature pyrolysis performance of heated tobacco sheets. The research results in this paper provide data support for changing the low temperature catalytic pyrolysis performance of heated tobacco sheets by adjusting the type of anions in sodium salts. [ABSTRACT FROM AUTHOR]

Purpose: To understand changes in purchasing behaviors and use of tobacco products such as e-cigarettes and cigarettes among different tobacco user groups during the COVID-19 pandemic using a mixed methods approach. Methods: A quantitative online survey was conducted in October-November 2020 using a national probability sample of US adults (N = 1,460) comprising exclusive cigarette smokers (n = 1,080), dual users of both cigarettes and e-cigarettes (n = 143), and exclusive e-cigarette users (n = 237). Simultaneously, ten online focus groups were conducted with 61 adults in the Atlanta, GA area including exclusive smokers (n = 16), current E-cigarette users (n = 22), and transitioning (recently quit or currently quitting) smokers and/or E-cigarette users (n = 23). Results: From the survey, dual users vs. exclusive smokers had higher odds of buying cheaper cigarette brands (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) = 1.49, 4.20), buying cigarettes online (aOR = 2.79; 95% CI = 1.02, 7.69), buying from Indian Reservations (aOR = 3.99; 95% CI = 2.07, 7.69), buying fewer cigarettes than normal (aOR = 4.01; 95% CI = 2.42, 6.65) and buying other tobacco products (aOR = 4.44; 95% CI = 2.24, 8.79). From the focus groups, participants perceived reduced accessibility, fear of contracting COVID-19, rising prices, and convenience to influence their purchasing behaviors and tobacco use. Conclusions: Exclusive and dual users differed in their tobacco purchasing behaviors during the COVID-19 pandemic, such that dual users were more likely to change their purchasing behaviors (e.g., buying other tobacco products) than exclusive users. Educational campaigns and public health workers may promote interventions targeting dual users either to switch to reduced-risk products or quit smoking, particularly during stressful societal situations such as the COVID-19 pandemic. Implications: The findings inform public health educators and policymakers to develop policies and interventions carefully tailored for tobacco user groups targeting the perceived factors influencing purchasing behaviors during challenging situations affecting tobacco product availability. [ABSTRACT FROM AUTHOR]

Background: Oral cavity cancer (OCC) represents a significant public health burden in South Asia, ranking as the most prevalent cancer affecting males in Pakistan and contributing considerably to morbidity and mortality. The objective of this study was to evaluate the survival rates in patients diagnosed with OCC in the Pakistani population and identify the factors influencing survival. Methods: This was a retrospective cohort study conducted at the Aga Khan University Hospital Karachi, Pakistan. A total of 2238 cases diagnosed with OCC from May 2011 through December 2020, who met the inclusion criteria, were included. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Adjusted hazard ratios (HR) and their 95% confidence intervals (CIs) were estimated using a Cox regression model to identify the factors significantly influencing survival. Results: Among all cases, 54.0% were diagnosed in individuals 50 years of age and below and 73.0% were tobacco users. Overall survival, 1-year, 3-year, and 5-year survival rates were 54.9%, 88.9%, 81.6%, and 75.9% respectively. After adjustment for all the significant confounding and prognostic factors, age was an important factor showing that adults > 50 years had poorer survival compared to ≤ 50 years (HR = 1.43, 95% CI = 1.11–1.83). Poorly differentiated grade of OCC compared to well-differentiated grade (HR = 2.49, 95% CI = 1.61–3.84) and stage IV compared to earlier stages (HR = 3.56, 95% CI = 2.13–5.94) were also associated with poor survival. Conclusion: Notably, there was a high occurrence of late stage (III and IV) OCC in individuals aged ≤ 50 years, with the buccal mucosa being the most common site involved. Moreover, a large proportion of our patients had a history of tobacco use. Patients with advanced-stage disease and poorly differentiated grade showed poor survival. Therefore, public awareness about tobacco control for OCC prevention and earlier diagnosis of OCC is urgently needed in our Pakistani population. [ABSTRACT FROM AUTHOR]

The insufficient understanding of the impact of hydrothermal products on the growth characteristics of compost microorganisms presents a significant challenge to the broader implementation of hydrothermal coupled composting for tobacco waste. Traditional biochemical detection methods are labor-intensive and time-consuming, highlighting the need for faster and more accurate alternatives. This study investigated the effects of hydrothermal treatment on tobacco straw products and their influence on compost microorganism growth, using hyperspectral imaging (HSI) technology and machine learning algorithms. Sixty-one tobacco straw samples were analyzed with a hyperspectral camera, and image processing was used to extract average spectra from regions of interest (ROI). Hierarchical cluster analysis (HCA) and principal component analysis (PCA) were applied to assess four key variables: nicotine content, total humic acid content, Penicillium chrysogenum H/C ratio, and Bacillus subtilis OD600 ratio. The effects of hydrothermal treatment on compost were classified as promoting, inhibiting, or neutral regarding microbial growth. The Competitive Adaptive Reweighted Sampling (CARS) method identified the most influential wavelengths in the 900-1700 nm spectral range. The Random Forest (RF) model outperformed SVM, KNN, and XGBoost models in predicting microbial growth responses, achieving R c = 0.957, RMSE = 3.584. Key wavelengths were identified at 1096 nm, 1101 nm, 1163 nm, 1335 nm, and 1421 nm. The results indicate that hyperspectral imaging combined with machine learning can accurately predict changes in the chemical composition of tobacco straws and their effects on microbial activity. This method provides an innovative and effective means of improving the resource usage of tobacco straws in composting, enhancing sustainable waste management procedures. [ABSTRACT FROM AUTHOR]

To estimate the prevalence of lifetime e-cigarette use and explore the association between lifetime conventional and electronic cigarette use with suicidality among Chinese adolescents, focusing on sex and school-type differences. A total of 22,509 students from 432 classes in 80 schools were recruited in Guangdong Province using a multistage, stratified cluster, random sampling method in 2021. Self-report questionnaires were used to collect information. Multivariable logistic regression models were performed and stratification analysis was conducted. All analyses were weighted and adjusted for the complex survey design. The weighted prevalence of lifetime e-cigarette use among adolescents in Guangdong Province was 8.7 % (4.3 % were dual users and 4.4 % were e-cigarette-only users) and 2.6 % were conventional-cigarette-only users. Lifetime e-cigarette-only users (AOR [Adjusted OR] =1.46, 95 % CI = 1.21–1.76), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.58–2.46) and dual users (AOR = 1.67, 95 % CI = 1.38–2.02) were at a higher risk of suicidal ideation than non-users. Lifetime e-cigarette-only users (AOR = 2.03, 95 % CI = 1.53–2.70), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.42–2.73), and dual users (AOR = 2.76, 95 % CI = 2.10–3.61) had a significantly higher risk of suicide attempts than non-users. After further analysis stratified by sex and school type, the associations of lifetime cigarette use patterns with suicidality slightly varied. The cross-sectional study design and self-report information. The prevalence of e-cigarettes among Chinese adolescents is concerning. Lifetime conventional and e-cigarette use were associated with suicidality among Chinese adolescents, with sex and school type moderating these associations. Targeted measures to restrict cigarette use, including new tobacco product (e-cigarette) use, among adolescents are warranted. • A large cross-sectional study of cigarette patterns and suicidality in China • E-cigarettes were associated with suicidality in Chinese adolescents. • Dual users had the highest risk of suicide attempts among cigarette users. • The association of cigarette use with suicidality varied by sex and school type. [ABSTRACT FROM AUTHOR]

To examine associations between depression, anxiety, and stress, as measured by the Depression, Anxiety and Stress Scale (DASS-21) scale, with current e-cigarette use. Data from the Truth Longitudinal Cohort – a nationally representative sample of youth and young adults – was collected between October 2022 to February 2023. The analytic sample was comprised of participants who provided information on e-cigarette use and the DASS-21 scale (N = 4198). Chi-square statistics were used to determine differences by current e-cigarette use across covariates and DASS-21 items. Logistic regression analyses were applied to the cross-sectional data to determine which scales predicted current e-cigarette use, adjusted for the effects of age, gender identity, race and ethnicity, parental educational attainment, perceived financial situation, and current use of alcohol, marijuana, and other tobacco use. Those who had severe/extremely severe levels of depression, anxiety, and stress had greater odds of current e-cigarette use, relative to those who had normal levels of depression, anxiety, and stress, even after adjusting for covariates. Results also demonstrated associations between age, race/ethnicity, parental education, and current use of alcohol, marijuana, and other tobacco products with current e-cigarette use. Cross-sectional analyses of self-reported data limit the ability to determine directionality of effects between depression, anxiety, stress, and current e-cigarette use. More severe levels of depression, anxiety, and stress were associated with a greater likelihood of current e-cigarette use. Future research is needed to evaluate changes in e-cigarette use, in response to depression, anxiety, and stress symptomatology. • Results demonstrate associations between depression, anxiety, and stress with current electronic nicotine delivery systems (ENDS) use. • More severe levels of depression, anxiety, and stress were associated with greater odds of current ENDS use. • Older age and current use of alcohol, marijuana, or other tobacco products were also associated with greater odds of current ENDS use. • Identifying as Non-Hispanic Black, Hispanic, and non-Hispanic Asian and having parents with higher education were associated with lower odds of current ENDS use. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionNicotine gum products from brands like Lucy and Rogue are relatively new arrivals to the tobacco marketplace. While studies of correlates of nicotine gum use are in their nascent stage, data from social media can be used to stay abreast of user experiences with novel tobacco products. This study leveraged machine learning to identify topics of Twitter posts about nicotine gum from the year 2022.Twitter data was collected using the Twitter Application Programming Interface (API), with search terms “nicotine” AND “gum” OR “nic” AND “gum”. 16,940 tweets from 10,353 unique users were included in the analysis. Topic modeling with Top2Vec was used to identify topics and a string search of popular brands and flavors was also conducted.Eight distinct topics were identified. Smoking and vaping cessation was the most common topic, followed by promotion, pricing, and marketing; appeal; product comparisons; perceived benefits; distrust in institutions; health concerns; and COVID-19 misinformation. The most mentioned brand was Nicorette. A tenth of the tweets contained a reference to a flavor.The goal of identifying topics in nicotine gum-related conversations is to better understand the public’s perceptions and experiences with nicotine gum. These findings may be used to inform survey-based research, policy targets, and health communication campaigns. [ABSTRACT FROM AUTHOR]

Introduction: Smoking increases the risk of lung cancer due to a number of components of smoke. The use of novel heated tobacco products (HTPs), alternative to conventional combustion cigarettes, has increased in recent years. However, the in vivo biological effects of HTPs are poorly understood. This study aimed to clarify the acute effects of injecting aerosol extract prepared from an HTP on regional cerebral blood flow (rCBF) in rat cortex by comparing them to the effects of injecting smoke extract prepared from conventional combustible cigarettes. Methods: In urethane anesthetized rats, rCBF was measured using laser speckle contrast imaging simultaneously with arterial pressure. Results: Both cigarette smoke extract and HTP aerosol extract, at a dose equivalent to 30 μg nicotine/kg, injected intravenously, increased cortical rCBF without changing arterial pressure. The magnitude and time course of the increased rCBF response to both extracts were similar throughout the cortical area, and the rCBF increases were all abolished by dihydro-β-erythroidine, an α4β2-preferring nicotinic acetylcholine receptor (nAChR) antagonist. Conclusion: In conclusion, our study demonstrated that the effect of injecting aerosol extract prepared from an HTP, an acute increase in cortical rCBF, is mediated via activation of α4β2-like neuronal nAChRs in the brain. [ABSTRACT FROM AUTHOR]

The present study uses latent class analysis to explore patterns of family communication about health-related topics during early adolescence. Directed parent–child communication is important for early adolescents to make informed health risk decisions, yet not all families discuss all health issues, especially surrounding sensitive topics such as sex and substance use. Participants were 182 seventh-grade students from a rural, low-income county in the Southeastern U.S. (M age = 12; 49% girls, 48% boys, 2% transgender or another gender; 49% lower socioeconomic status; 34% Latine, 33% White, 23% Black/African American, 2% Asian, 8% another race/ethnicity). Participants self-reported if they had ever discussed 10 health risk topics with their parents: alcohol, cigarettes, e-cigarettes/vaping, marijuana, sex, sexting, condoms/birth control, bullying, sleep, and time spent online. Four latent classes emerged: those who were unlikely to have discussed any topics ("Low—All Topics", 38.7%); those who were likely to have discussed all topics ("High—All Topics", 25.2%); those whose communication selectively excluded discussions of sex ("Everything but Sex", 18.1%); and those who selectively excluded discussions of substance use ("Moderate—Low Substance", 18.1%). Adolescents' gender and sexual experience were related to class membership; their socioeconomic status and substance use experience were not. Results highlight that health risk family communication patterns are not one-size-fits-all. Understanding pluralistic patterns of parent-child health risk communication can inform interventions to promote effective parent communication. Highlights: Latent class analysis determined four profiles of parent–child communication about 10 health risk topics during early adolescence. Most families discussed (1) no or (2) all topics, some selectively excluded (3) sex and (4) substance use topics. Early adolescents' gender and sexual experience (but not SES or prior substance use) were related to class membership. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Tobacco use is major serious threats to health and well-being killing approximately 1 million people each year. One of the better ways for tobacco cessation is by promoting the cultural-religious belief that may influence a person's tobacco-related habits. Methods: A Descriptive cross-sectional study was conducted among 174 adult subjects of smoking and smokeless tobacco users. The questionnaire consisted of demographic information and the Duke University Religion Index was used to assess the influence of religious belief and the use of tobacco products. The appropriate statistical tests were done using the Chi square test and ANOVA. Result: The study involved 174 participants of smoking and smokeless tobacco users. The participants were predominantly males (96%) with a mean age of 36 years, and more than half were Hindus (71.85). Among the study participants, 37.4% were graduates and 17.8% were illiterates. With regard to Occupation, the majority of the respondents were Professionals (24.7%). Majority of tobacco users had religious beliefs and strongly accepted that using tobacco during the fasting period was against their religious beliefs. Conclusion: The study concluded that there is a strong influence of religious belief on tobacco usage. Hence, there is a need to conduct community awareness programs for the adult population about the consequences of tobacco use. [ABSTRACT FROM AUTHOR]

ABSTRACT: Tobacco use among women in India is becoming a critical public health issue. Once viewed predominantly as a male habit, tobacco consumption among Indian women has seen a rising trend. This shift is driven by factors such as evolving societal norms, aggressive marketing by the tobacco industry, and increasing urbanization. Women are now using a variety of tobacco products, including smokeless tobacco and electronic nicotine delivery systems (ENDS). The health effects are particularly alarming, with elevated risks for cancers, cardiovascular diseases, respiratory conditions, and reproductive health problems. Despite these concerns, public health initiatives and policies often fail to address the specific needs of women. editorial examines the social and cultural drivers of tobacco use among Indian women, outlines the severe health risks, and calls for immediate action through gender-sensitive tobacco control policies. It provides recommendations, including robust regulation, community involvement, and specialized cessation programs to reduce the growing tobacco use among women. [ABSTRACT FROM AUTHOR]

The detection and quantification of additives in tobacco products are critical for ensuring consumer safety and compliance with regulatory standards. Traditional analytical techniques, like gas chromatography–mass spectrometry (GC–MS), liquid chromatography–mass spectrometry (LC–MS), and others, although effective, suffer from drawbacks, including complex sample preparation, high costs, lengthy analysis times, and the requirement for skilled operators. This study addresses these challenges by evaluating the efficacy of mid-infrared (MIR) spectroscopy and near-IR (NIR) spectroscopy, coupled with multivariate analysis, as potential solutions for the detection and quantification of additives in tobacco products. So, a representative set of tobacco products was selected and spiked with the targeted additives, namely caffeine, menthol, glycerol, and cocoa. Multivariate analysis of MIR and NIR spectra consisted of principal component analysis (PCA), hierarchical clustering analysis (HCA), partial least squares-discriminant analysis (PLS-DA) and soft independent modeling of class analogy (SIMCA) to classify samples based on targeted additives. Based on the unsupervised techniques (PCA and HCA), a distinction could be made between spiked and non-spiked samples for all four targeted additives based on both MIR and NIR spectral data. During supervised analysis, SIMCA achieved 87–100% classification accuracy for the different additives and for both spectroscopic techniques. PLS-DA models showed classification rates of 80% to 100%, also demonstrating robust performance. Regression studies, using PLS, showed that it is possible to effectively estimate the concentration levels of the targeted molecules. The results also highlight the necessity of optimizing data pretreatment for accurate quantification of the target additives. Overall, NIR spectroscopy combined with SIMCA provided the most accurate and robust classification models for all target molecules, indicating that it is the most effective single technique for this type of analysis. MIR, on the other hand, showed the overall best performance for quantitative estimation. [ABSTRACT FROM AUTHOR]

Objective: Describe the epidemiology of cluster headache (CH) using Veterans Health Administration (VHA) Electronic Health Record (EHR) data. Background: Epidemiologic studies of CH at the population level are difficult because it has a prevalence of ~0.1%. Hospital system‐wide studies are an attractive alternative as they have large numbers of patients and broader populations than headache or neurology clinic‐based studies. The VHA is an ideal hospital‐based system in which to study CH because it is nationwide, predominantly male, has a strong focus on mood disorders and suicidality, and has accessible individual medical records. Here, we report the first headache study based on an ongoing longitudinal cohort of patients with CH using VHA EHR data. Methods: The VHA EHR data were accessed from Fiscal Year 2008 to 2019. Patients with CH consisted of all patients with at least one outpatient visit containing a CH diagnosis code from the International Classification of Diseases (ICD)‐9 or ‐10. We extracted data on demographic features, incidence, and prevalence, as well as pain and psychiatric comorbidities. Results: Of the 1,524,960 distinct patients who presented for headache treatment in the VHA between Fiscal Year 2008–2019, 24,131 had at least one visit with a CH diagnosis. The 1‐year period prevalence of a CH diagnosis in the VHA ranges from 0.08% to 0.10% for women and 0.10% to 0.18% for men. A larger proportion of women versus men received a diagnosis of unspecified CH (59.6% [1412/2368] vs. 53.6% [11,663/21,763], p < 0.001). Most patients with CH had both comorbid headache and non‐headache pain diagnoses. Headache not‐otherwise‐specified was the most common comorbid headache disorder at 70.0% (16,885/24,131) and was more common in women (76.1%, 1801/2368) compared to men (69.3%, 15,084/21,763). Other common comorbidities included migraine, depression, tobacco use, and obstructive sleep apnea. Rates of suicidal ideation or attempt were almost 50% higher in women (5‐year proportion 9.4%, 222/2368) with CH compared to men (6.6%, 1433/21,763). Conclusions: To our knowledge this is the largest hospital system study of CH to date and reinforces several previous studies. Pain, mental health, and sleep disorders comorbidities are particularly prevalent in this group and were often more common in women compared to men with CH. Future work should examine gender and race stratified prevalence estimates within the VHA and other healthcare systems. Plain Language Summary: This study describes the epidemiology of cluster headache among all Veterans Health Administration (VHA) enrollees using electronic medical record data from the VHA. We found that during any given 1‐year period, between 0.08–0.10% of women and 0.10–0.18% of men in the VHA were treated for cluster headache. Many of these patients also had co‐occurring disorders including other headache disorders and depression, so more research is needed to find the best ways to treat these patients. [ABSTRACT FROM AUTHOR]