Nicotine and Tobacco Research

IntroductionElectronic cigarette (e-cig) use in previously tobacco-naive individuals may increase the risk of nicotine addiction and adverse health outcomes, including lung injury and cardiovascular disease. This study identifies a subgroup of heavy exclusive e-cig vapers, characterizes their demographics, and establishes an optimal serum cotinine threshold to differentiate them from tobacco-naive individuals. MethodsWe analyzed data from the National Health and Nutrition Examination Survey (2013- 2020) to characterize serum cotinine levels by e-cig use frequency. The optimal cotinine cutoff for identifying heavy exclusive vapers was 2.2 ng/mL (sensitivity 98%, specificity 96%). We used receiver operating characteristic curve analysis to identify the cotinine threshold for discriminating heavy exclusive e-cig vapers from tobacco-naive individuals and logistic regression to explore sociodemographic factors. ResultsExclusive heavy e-cig vapers--defined as those who vaped on four or more of the past five days--had mean cotinine levels (220 {+/-} 38 ng/mL) comparable to cigarette smokers (212 {+/-} 6 ng/mL). These vapers were more likely to be 12-18 (AOR 7.96; 95% CI: [3.38 - 18.7]) or 19-25 [AOR 7.36 [2.84 - 19]) years old and less likely to be female (AOR 0.3 [0.16-0.57]). ConclusionHeavy exclusive e-cig vapers had serum cotinine levels similar to cigarette smokers and were predominantly young males. Public health interventions should target this high-risk subgroup to reduce potential long-term health consequences.

BackgroundConcerns have been raised that e-cigarettes have created a new generation of people addicted to nicotine. This study aimed to examine changes in the proportion of US high-school students reporting symptoms of nicotine dependence over the past decade, in the context of changing patterns of nicotine product use. MethodsRepeat cross-sectional analyses of a nationally-representative sample of 107,968 US high-school students (14-18y) participating in the 2014-2023 National Youth Tobacco Surveys. Nicotine product use was categorised based on self-reported past-30-day use of cigarettes, other combustible tobacco, smokeless/non-combustible products, and e-cigarettes. Nicotine dependence was operationalised as (i) strong past-30-day cravings to use tobacco and (ii) wanting to use nicotine products within 30 minutes of waking. ResultsPast-30-day use of any nicotine product decreased from 24.5% [22.5-26.6%] to 19.6% [16.8-22.4%] between 2014 and 2017, increased sharply reaching 31.4% [29.0-33.7%] in 2019, then fell to the lowest level at 12.5% [10.9-14.1%] by 2023. The proportion who reported symptoms of nicotine dependence was substantially lower, but followed a similar pattern of changes over time. For example, the proportion reporting strong cravings decreased from 7.8% [6.6-9.0%] to 5.5% [4.3-6.7%] between 2014 and 2017, increased to 7.9% [6.8-9.0%] between 2017 and 2018 and remained stable up to 2020, then fell to the lowest level at 2.5% [1.9-3.1%] by 2023. Use of cigarettes fell considerably across the period (from 9.0% [7.9-10.3%] to 1.8% [1.4-2.4%]); this was the product category consistently associated with the highest levels of dependence. The proportion using only e-cigarettes increased rapidly between 2017 and 2019 (from 5.4% [4.2-6.8%] to 17.0% [15.3-18.7%]) then fell to 6.7% [5.6-7.9%] by 2023; symptoms of nicotine dependence within this group increased non-linearly over time with increases through to 2022 before possible declines in 2023. ConclusionsThe sharp rise in the prevalence of nicotine product use (in particular, e-cigarettes) among US high-school students in the late 2010s was short-lived and was not accompanied by a sustained increase in the overall population burden of nicotine dependence. By 2023, both nicotine product use and nicotine dependence had reached historic lows.

Cigarette smoke exposure is a major risk factor for various diseases, and in vitro studies using smoke medium (SM) are crucial for elucidating underlying mechanisms. However, the lack of standardized protocols for SM preparation has led to inconsistencies in experimental results. This paper presents an optimized protocol for reproducible generation of SM from conventional cigarette smoke extract (CSE), electronic cigarette smoke (ECS), and waterpipe vapour (WPV). The protocol involves: O_LIA custom-built apparatus for smoke capture in a cell culture medium C_LIO_LISpecific parameters mimicking human smoking topography C_LIO_LIRigorous aseptic techniques and safety measures C_LI Extensive details are provided for material preparation, apparatus setup, smoke generation procedures, and post-processing steps. This standardized method enables reliable in vitro exposure models, easing comparative studies across different tobacco products. To prove protocol consistency, we present optical. Additionally, we highlight the protocols utility by figuring out the SM quality through analysing O.D. data and morphological changes, cell viability assays, ELISA and gene expression analyses i.e., RNA sequencing through several in-vitro models, i.e., Human Umbilical Vein Endothelial Cells, (HUVECs, Merck), human leukaemia monocytic cell line (THP-1, Sigma) and induced pluripotent stem cells differentiated to cardiomyocytes (iPSC-CMs, Axol) respectively. This optimized protocol addresses variability in SM preparation, enabling consistent investigations into smoke-induced pathologies and potential therapeutic interventions. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=124 SRC="FIGDIR/small/606957v1_ufig1.gif" ALT="Figure 1"> View larger version (26K): org.highwire.dtl.DTLVardef@142ca65org.highwire.dtl.DTLVardef@1f5d797org.highwire.dtl.DTLVardef@11d1e63org.highwire.dtl.DTLVardef@b5fd55_HPS_FORMAT_FIGEXP M_FIG C_FIG Specifications table O_TBL View this table: org.highwire.dtl.DTLVardef@af8a3org.highwire.dtl.DTLVardef@49ccbforg.highwire.dtl.DTLVardef@121329forg.highwire.dtl.DTLVardef@828a3borg.highwire.dtl.DTLVardef@413930_HPS_FORMAT_FIGEXP M_TBL C_TBL

The prevalence of e-cigarette use in adolescents is concerning, particularly because of high rates of vapers transitioning to combustible tobacco. It is unclear why young, never smoker, e-cigarette vapers decide to start smoking cigarettes, but the transition may be influenced by perceptions of health risks and accessibility. We designed a social media questionnaire to assess factors driving switches from vaping to smoking, smoking to vaping, and multi-inhalant use. Among respondents (n=864) who switched from vaping to smoking (n=104), primary reasons included: 1. perception that smoking was healthier (44%); and 2. greater accessibility of cigarettes (40%). For switchers from smoking to vaping (n=178), predominant motivations included: 1. having friends or family who vape (40%); and 2. perception that vaping was healthier (36%). Among multi-inhalant users (n=223), key factors driving this behavior included: 1. increased enjoyment (47%); and 2. greater variety (42%). Our findings imply that there is no single, dominant reason driving switching from vaping to smoking. Further, tobacco users are receiving mixed messaging, leading many to believe that combustible tobacco is the healthier option. Public health interventions are needed to prevent initiation of e-cigarette vaping by youth and education of the public about health effects across tobacco products.

BackgroundOral nicotine pouches (ONPs) have become the second most commonly used nicotine product among U.S. youth. However, little is known about how ONP use is distributed across population subgroups and how strongly it is patterned by use of other tobacco or nicotine products. MethodData were drawn from the 2021-2023 waves of the National Youth Tobacco Survey (NYTS), a nationally representative survey of U.S. middle and high school students (N = 66,349). We estimated the annual survey-weighted prevalence of current ONP use ([≥]1 day in the past 30). Using 2023 data (N = 20,174), we estimated prevalence by demographics and other tobacco/nicotine product use, and fitted survey-weighted Poisson regression models to estimate associations of current ONP use with demographics and other nicotine/tobacco product use. ResultsIn 2023, 1.6% reported current ONP use (95% confidence interval [CI] 1.0-2.1), up from 0.8% in 2021 (95% CI 0.5-1.0). Prevalence in 2023 was higher among males (2.3%, 95% CI 1.5-3.1) than females (0.8%, 95% CI 0.4-1.3), and among students who used any other tobacco or nicotine product (13.4%, 95% CI 10.3-16.5) than those who did not (0.4%, 95% CI 0.1-0.8). In fully adjusted models, use of nicotine products other than cigarettes or e-cigarettes showed the strongest association with ONP use (APR 21.1, 95% CI 13.0-34.0), followed by cigarette smoking (APR 2.0, 95% CI 1.1-3.7) and e-cigarette use (APR 1.9, 95% CI 0.8-4.5). Most current ONP users also used other tobacco/nicotine products (75.0%), though 16.6% reported no lifetime use of other products. ConclusionsOverall ONP prevalence among U.S. youth remains low but is increasing. While ONP use is largely concentrated in youth who use other nicotine/tobacco products, it is also increasing among adolescents who are otherwise nicotine-naive. These findings highlight the need for continued monitoring and targeted regulations that balance harm reduction for people who smoke against the risk of expanding nicotine dependence among youth. Key Points QuestionWhat are the prevalence, demographic patterns, and tobacco/nicotine co-use profiles of oral nicotine pouch users among US middle and high school students? FindingsIn this cross-sectional study of 66,349 students from the 2021-2023 National Youth Tobacco Survey, current oral nicotine pouch use doubled from 0.8% in 2021 to 1.6% in 2023. Most users also used other tobacco or nicotine products, but the proportion of current users with no lifetime use of other products increased from 7.4% to 16.6%. MeaningAlthough oral nicotine pouch use among US youth remains low, increasing uptake among adolescents without prior tobacco or nicotine exposure suggests a need for targeted prevention efforts alongside continued surveillance.

Sales of deep-discount cigarettes are growing; yet little is known about who is using these products and their potential impact on tobacco use behavior. Using multinomial logistic regression, this cross-sectional analysis of 2021 National Survey on Drug Use and Health data examines associations between sociodemographic characteristics and smoking behaviors and odds of using value and deep-discount cigarettes (versus premium). Use of value and deep-discount cigarettes was significantly more prevalent for older adults and people with lower incomes and significantly less prevalent among non-Hispanic Black individuals. People who received government assistance, smoked daily, smoked more than a pack of cigarettes per day, and who met the criteria for nicotine dependence were significantly more likely to use deep-discount--but not value--brands than premium cigarettes. More research is needed to better understand how deep-discount cigarettes may impact tobacco use behavior (including smoking cessation), particularly among people with low socioeconomic status.

Abstract Importance: The overall prevalence of youth nicotine and tobacco product use has declined over recent years, but the product landscape continues to evolve rapidly, particularly with new disposable e-cigarettes and oral nicotine pouches. Objective: To examine changes between 2024 and 2025 in the prevalence of nicotine and tobacco product use among US middle and high school students and describe shifts in product characteristics among current e-cigarette and nicotine pouch users. Design, Setting, and Participants: Repeated cross-sectional study using nationally representative data from the 2024 and 2025 National Youth Tobacco Survey (NYTS), a school-based survey of US students in grades 6-12 (approximately ages 11-18). The analytic sample included 29,678 students in 2024 and 23,557 students in 2025. Exposures: Survey year (2025 vs 2024). Main Outcomes and Measures: Past 30-day use of nicotine/tobacco products, including e-cigarettes, nicotine pouches, cigarettes, and other combustible and non-combustible products. Among current e-cigarette and nicotine pouch users, frequency of use, device type, brands, and flavors were assessed. Results: In 2025, 7.2% (95% CI, 6.4-8.2%) of US middle and high school students reported past 30-day use of any nicotine/tobacco product, compared with 8.1% (7.4-8.9%) in 2024. E-cigarettes remained the most commonly used product (5.2%, 4.5-5.9%); 1.7% (1.4-2.1%) used nicotine pouches, 1.7% (1.4-1.9%) smoked cigarettes, and 2.7% (2.4-3.1%) smoked any combustible tobacco product. Among current e-cigarette users, 40.7% (36.7-44.9%) reported frequent use and 27.0% (24.0-30.2%) reported daily use in 2025. Disposable e-cigarette use increased from 55.8% (52.6-59.0%) in 2024 to 66.7% (62.5-70.7%) in 2025, while pod/cartridge device use declined. Flavored product use was reported by 90.0% of e-cigarette users and 88.0% of nicotine pouch users. The most commonly reported brands were Geek Bar among e-cigarette users (61.1%) and ZYN among nicotine pouch users (69.4%). Conclusions and Relevance: Overall youth nicotine and tobacco use remains relatively low, but the product landscape is evolving rapidly, with increasing disposable device use and shifting brand preferences. These findings highlight the importance of ongoing, product-specific surveillance to inform public health strategies and regulatory policies.

Structured AbstractO_ST_ABSImportanceC_ST_ABSWhile sales and use of cigarettes have declined, it is important to understand how these trends differ across brands and product characteristics, and how the demographic makeup of cigarette smokers has shifted. ObjectiveExamine trends in U.S. market share for leading cigarette brands by brand tier and menthol status and describe the sociodemographic profile of people who use top cigarette brands. DesignCohort study: The Population Assessment of Tobacco and Heath (PATH) Study collects data from a nationally representative sample of U.S. youth (age 12-17) and adults (age 18+) in 1-2-year intervals from 2013-2023 (Waves 1-7). SettingRespondents complete the questionnaire via in-person audio-computer-assisted interviews. Telephone interviews were available in 2020-2023 due to the COVID-19 pandemic. ParticipantsThis study utilized data from 19,722 individuals (youth: N=1,201; adults: N=18,521) who smoked cigarettes in the past 30-days (P30D) ExposuresTime (survey wave). Main Outcome and MeasuresRespondents were asked the cigarette brand that they usually smoke or last smoked, the number of cigarettes smoked per day, and how many days they smoked in the P30D to estimate monthly intake and market share. Cigarette brands were coded into premium and non-premium brand tiers. Demographic characteristics, other tobacco use, alcohol use, marijuana use, and mental health status were also assessed. ResultsPremium brands (overall and menthol) experienced significant market declines. Non-premium brands saw a market share increase. Characteristics of those smoking cigarettes changed: reduced number of cigarettes smoked per day, increased marijuana use, decreased alcohol use, and decreased moderate-to-high-severity mental health symptoms. Conclusions and RelevanceWhile brand loyalty remains strong for the top three cigarette brands, the expanding non-premium market continues to encroach on the premium brand market. Similar patterns were observed in the menthol sector. As the marketplace changes so do the profiles of the people who use them or market potentially reflects the people who are still smoking. Continued timely surveillance of cigarette brand preferences and profiles of the people who use them will inform tobacco control policies that minimize tobacco-related mortality. Key PointsO_ST_ABSObjectiveC_ST_ABSExamine market share trends (2013-2023) for cigarette brands by brand tier and menthol status; describe the sociodemographic profile of people who use top cigarette brands. FindingsPremium brands experienced significant market declines overall and among the menthol category. Non-premium brands saw a market share increase. Characteristics of those smoking cigarettes changed: reduced cigarettes smoked per day, increased marijuana use, decreased alcohol use, and decreased moderate-to-high-severity mental health symptoms. MeaningWhile brand loyalty remains strong for top cigarette brands, the expanding non-premium market is encroaching on the premium brand market. These changes reflect shifts in sociodemographic profiles of people smoking in 2023.

ObjectivesMenthol flavoring is a critical public health issue, but prior work has largely represented the voices of White adults who smoke (AWS) menthol cigarettes who comprise a small subset of AWS menthol cigarettes in the US. This study compared perceptions of a hypothetical MC/FC ban among Black and White AWS menthol cigarettes. MethodsParticipants were a convenience sample of 2,113 Black and 1,087 White AWS menthol cigarettes collected through Amazon Mechanical Turk between July 2023 and January 2024. Participants reported opinions about a MC/FC ban, likely public health outcomes, and hypothetical impact of the ban on their smoking behavior. Stepwise logistic regression modeled factors associated with ban opposition/ambivalence. ResultsOver one-third of menthol cigarette users supported a MC/FC ban (Black, 37.2% vs White, 34.5%, p=.13], but Black AWS were more likely to endorse public health benefits of a ban assessed via agreement with 5 statements of FDA rationale [3.0 (SD=1.7) versus 2.4 (SD=1.8), p<.001]. Smoking more cigarettes per day, belief that menthol cigarettes are more addictive/harder to quit, and intent to continue using nicotine under a ban increased odd of opposition/ambivalence. ConclusionsCompared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. Targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users. Summary Box1) What is the current understanding of this subject?Knowledge of the publics perception of a MC/FC ban is largely informed by White menthol cigarette users. Given that Blacks represent the majority of AWS menthol cigarettes in the US, the paucity of data from Black voices engenders a critical gap in research used to inform health policy. 2) What does this report add to the literature?Compared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. To our knowledge, this study comprises the largest convenience sample of perceptions and perceived impact of a federal MC/FC product standard among Black AWS menthol cigarettes in the US and provides valuable evidence to inform policy action in these areas. 3) What are the implications for public health practice?Findings support ongoing efforts to advance a MC/FC product standard and suggest that targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users.

BackgroundPictorial health warnings on tobacco packs can stimulate short-term cognitive and emotional responses that lead to quit attempts. We tested novel product attribute health warnings (PAHWs) that corrected misperceptions about harm created by the use of filter-venting, menthol and roll-your-own tobacco. PAHWs uniquely influenced outcomes assessing knowledge of industry manipulation of cigarettes, industry-centric negative emotional responses, and product-specific smoking dissonance. In this study, we examined if these unique short-term responses predicted subsequent quitting-related behaviours. MethodWe analysed follow-up data from a between-subjects online experiment that assessed effects of new PAHWs. Participants were randomised to view PAHWs alone (PAHW condition) or with a complementary video (PAHW+Video), and exposure occurred during a baseline session and then repeatedly each day for 7 days. Short-term PAHW responses were measured at 8-day follow-up (N=712). Quitting-related behaviours were measured at 4-week follow-up (N=301). Covariate-adjusted logistic regression models examined associations between short-term PAHW responses and subsequent quitting-related behaviours. ResultsTwo of the short-term responses - knowledge of industry manipulation of cigarettes, and product-specific smoking dissonance - significantly and positively predicted all three quitting-related outcomes: smoke-limiting micro-behaviours (e.g., foregoing cigarettes), quit attempts, and 7-day sustained abstinence. Additionally, industry-centric negative emotional responses significantly and positively predicted smoke-limiting micro-behaviours and 7-day sustained abstinence, but not quit attempts. ConclusionPAHWs featuring corrective information about the tobacco industrys manipulation of tobacco products elicited short-term responses that predicted subsequent engagement in smoke-limiting micro-behaviours, quit attempts, and sustained quit attempts. PAHWs can complement other health warnings featuring the health risks of smoking and may help motivate people who smoke to quit and stay quit.

BackgroundRegulating features of tobacco products can reduce the appeal and addictiveness of smoking. We examined predicted behavioural responses to bans on i) filter ventilation (FV), ii) regular nicotine content (RNC), and iii) menthol and flavour crushballs (MFC), as well as perceived rationales for these bans. MethodsAustralian adults who smoked at least weekly were recruited from an online research panel to participate in a cross-sectional survey and were allocated to either the FV (n=301), RNC (n=335), or MFC (n=298) study arm, depending on current product use. Respondents viewed a basic description of each ban before completing measures of predicted behavioural responses and perceived rationale. ResultsThe proportion of respondents who reported being likely to try to quit smoking in response to the product regulations was 25.9% in the FV arm, 18.5% in the RNC arm, and 13.4% in the MFC arm. However, in each study arm, respondents more commonly predicted that they would switch to tobacco products that would remain available after the ban (FV: 33.6%; RNC: 37.0%; MFC: 51.3%), and some reported being likely to switch to e-cigarettes (FV: 14.6%; RNC: 11.6%; MFC: 23.2%). The majority of respondents reported either misperceptions or uncertainty about the rationale for the bans (FV: 69.8%; RNC: 81.5%; MFC: 62.4%). ConclusionA higher proportion of people who smoke anticipate that they would respond to tobacco product bans by switching to a different product, rather than using the ban as an opportunity to quit. Future studies should experimentally investigate whether public health messaging about these product regulation measures can be used to encourage greater rates of quitting by minimising switching to available products, including e-cigarettes, and to minimise misperceptions by increasing awareness of the rationale for each product regulation measure.

IntroductionBeginning in 2019, several U.S. states implemented temporary or permanent bans on the sale of flavored e-cigarettes. This study examined the impact of flavor bans on adult e-cigarette use in Washington, New Jersey, and New York. MethodsAdults who used e-cigarettes at least once a week before the flavor bans were recruited online. Respondents reported their e-cigarette use, primarily used flavor, and ways of obtaining ecigarettes before and after the bans. Descriptive statistics and multinomial logistic regression models were applied. ResultsAfter the ban, 8.1% of respondents (N=1624) quit using e-cigarettes, those primarily used banned menthol or other flavors declined from 74.4% to 50.8, those using tobacco-flavored declined from 20.1% to 15.6%, and those using non-flavored increased from 5.4% to 25.4%. More frequent e-cigarette use and smoking cigarettes were associated with being less likely to quit e-cigarettes and more likely to use banned flavors. Of those primarily using banned flavors, 45.1% obtained e-cigarettes from in-state stores, 31.2% from out-of-state stores, 32% from friends, family, or others, 25.5% from Internet/mail sellers, 5.2% from illegal sellers, 4.2% mixed flavored e-liquids themselves, and 6.9% stocked up on e-cigarettes before the ban. ConclusionsMost respondents continued to use e-cigarettes with banned flavors post-ban. Compliance of local retailers with the ban was not high, and many respondents obtained banned-flavor e-cigarettes through legal channels. However, the significant increase in the use of non-flavored e-cigarettes post-ban suggests that these may serve as a viable alternative among those who used previously used banned or tobacco flavors. ImplicationsThis study examined the impact on adult e-cigarette users from the recent e-cigarette-only flavor bans in Washington State, New Jersey, and New York. We found that most respondents continued to use e-cigarettes with banned flavors post-ban and obtain banned-flavor e-cigarettes through legal channels. Our findings indicate that non-flavored e-cigarettes may serve as an acceptable alternative to both non-tobacco and tobacco-flavored e-cigarettes and state e-cigarette flavor bans are unlikely to prompt a significant number of adult e-cigarette users to replace their e-cigarette use with new or increased smoking. Enforcing compliance of retailers to the policy is crucial to control e-cigarette use.

IntroductionNon-cigarette tobacco smoking increased in England between 2013 and 2023, but little is known about the prevalence of use of specific types of non-cigarette tobacco, including smokeless products, or whether the increasing trend has continued. This study examined recent trends in exclusive non-cigarette tobacco smoking and estimated the prevalence of different smoked and smokeless product use by sociodemographic characteristics, vaping and cigarette smoking status. MethodsData came from the Smoking Toolkit Study, a nationally representative monthly cross-sectional survey of adults ([&ge;]18y) in England (n=94,918; April-2020 to February-2025). We used logistic regression to estimate trends in exclusive non-cigarette tobacco smoking. We further examined the prevalence and correlates of (non-exclusive) use of eight specific smoked and smokeless non-cigarette tobacco products among 8,129 participants surveyed October-2024 to February-2025. ResultsThe prevalence of exclusive non-cigarette tobacco smoking increased from 1.3% [1.1-1.6%] in April-2020 to 2.0% [1.8-2.1%] in August-2022, before declining to 1.2% [1.1-1.5%] by February-2025. Between October-2024 and February-2025, 3.7% [3.2-4.1%] of adults reported any non-cigarette tobacco use ([~]1.7 million people). Cigars (1.2%) and waterpipes (0.9%) were the most used products. Use patterns varied: cigars, cigarillos, and pipes were more common among men and those who smoked cigarettes, while waterpipes were more common among younger adults, minority ethnic groups, and people who vaped. Smokeless tobacco use was more common among those who smoked (any form of) tobacco. ConclusionsIn England, exclusive non-cigarette tobacco smoking has fluctuated in recent years. Patterns of smoked and smokeless tobacco use vary across products and sociodemographic groups.

IntroductionIt is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among adolescent users over time. MethodsData from representative repeated online cross-sectional surveys of youth in Great Britain (11-18 years) were used (2018-2022; n=12,445). Outcome measures included noticing product displays and sources of e-cigarettes and tobacco cigarettes. Logistic regressions examined the associations of these outcome variables over time and with sociodemographic variables. ResultsOf 12,040 participants with complete data, 10.1% used some form of nicotine product (4.2% cigarettes, 2.9% e-cigarettes, 3.0% both) at least occasionally. The likelihood of noticing tobacco cigarettes on display fell over time for both supermarkets (2018: 67.1% to 2022: 58.5%) and small shops (2018: 81.3% to 2022: 66.3%), but the likelihood of noticing e-cigarettes in supermarkets rose (2018: 57.4% to 2022: 66.5%). Sources of tobacco cigarettes did not differ over time, but e-cigarette users were more likely to get their e-cigarettes from small shops in 2022 (51.2%) vs. 2019 (34.2%) (Odds ratio 2.02; 95%CI 1.24, 3.29). ConclusionThis study provides evidence that current policies to limit awareness of and access to both tobacco and e-cigarettes among adolescents in the UK may not be effective. UK policy on the advertising, promotion and sale of both tobacco and e-cigarettes need to be reinforced to deter use among children.

BackgroundAdolescent tobacco and nicotine product (TNP) use remains a public health concern, with emerging gender convergence and rising e-cigarette use among females. We examined gender-specific trends in Georgian adolescents alongside national tobacco control policies and social context. MethodsWe analyzed nationally representative Global Youth Tobacco Survey data from Georgia (2014, 2017, and 2023) for youth aged 11-17 to estimate prevalence and patterns of current TNP use in the context of tobacco-related advertising and promotion, secondhand smoke, and national policy, via a policy review. Adjusted prevalence estimates were derived using post- estimation predictive margins after fitting multinomial logistic regression models. ResultsFrom 2014 to 2023, current TNP use declined among boys but increased among girls, particularly in exclusive e-cigarette use. The percentages reporting no current TNP use increased among boys from 77.4% to 85.6% (p < 0.01), but declined among girls from 92.1% to 88.1% (p = 0.04). By 2023, exclusive e-cigarette use was more prevalent among girls than boys. Across sexes, exposure to pro-tobacco advertising and promotion and secondhand smoke declined. Exposure to anti-tobacco promotion peaked in 2017 and receded by 2023. The policy review documented strengthened measures, alongside gaps in oversight of digital marketing and newer products, including e-cigarettes. ConclusionsGeorgias tobacco control policies have contributed to reduced TNP use among boys and a less permissive social environment. Rising e-cigarette use among girls is concerning. Policies should close regulatory gaps, enhance enforcement, and address evolving product and marketing developments to prevent TNP uptake and protect adolescents from tobacco-related harms. SUMMARY BOXO_ST_ABSWhat is already known on this topicC_ST_ABSAdolescent tobacco use patterns are shifting globally, with narrowing gender gaps and rising use of new products like e-cigarettes, especially among girls. In Georgia, the impact of recent tobacco control reforms targeting youth tobacco and nicotine product use by gender had not been fully assessed. What this study addsBetween 2014 and 2023, TNP use significantly declined among boys in Georgia but rose in exclusive e-cigarette use among girls. Exposure to tobacco advertising and promotion and secondhand smoke decreased, yet gaps in anti-tobacco promotion and regulation of novel products persist. How this study might affect research, practice or policyFindings from this study reinforce WHOs call for gender-responsive tobacco control policies. Regulatory measures must address how product design and marketing tactics exploit gendered social norms and youth vulnerabilities. Comprehensive, gender-responsive strategies that strengthen anti-tobacco promotion and close regulatory gaps are essential to counter these influences and protect all adolescents from targeted industry tactics.

IntroductionIn England, non-cigarette tobacco products (e.g., cigarillos, cigars, waterpipes, bidis, smokeless tobacco, heated tobacco) are subject to fewer regulatory restrictions than cigarettes/rolling tobacco. This study assessed trends in youth use of these products in England, Canada, and the US, focussing on evaluating the impact of Englands May 2020 ban on menthol in cigarettes but not non-cigarette tobacco. MethodsData were from the ITC Youth Tobacco and Vaping Survey (16-19-year-olds; N=129,575) across ten waves (2017-2024). Segmented regressions assessed changes in trends of non-cigarette tobacco products before vs. after May 2020, adjusting for race/ethnicity/sex/age. ResultsIn England, non-cigarette tobacco use increased similarly before (aOR=1.16,1.02-1.31) and after (1.13,1.07-1.20) the ban (change in trend: 0.98,0.91-1.06), from 7.4% in 2017 and reaching in 11.6% in 2024. In contrast, non-cigarette tobacco use decreased similarly before and after the ban in both the US (pre-ban: 0.82, 0.73-0.93; post-ban: 0.84,0.80-0.89; change in trend: 1.02,0.94-1.11; from 10.2% reaching 7.1%), and Canada (pre-ban: 0.84,0.76-0.93; post-ban: 0.90,0.86-0.94; from 9.2% reaching 7.9%), although the decline in Canada after the ban was slightly slower (1.07,1.001-1.15). Cigarillo, cigar, and smokeless tobacco use specifically increased to a greater extent in England than Canada and the US. ConclusionsBetween 2017 and 2024, youth non-cigarette tobacco product use increased in England and surpassed declining use in Canada and the US. There was little evidence that Englands menthol cigarette ban accelerated increases, although increases highlight the need for comprehensive regulations encompassing all tobacco products in England. IMPLICATIONSYouth use of non-cigarette tobacco products has been increasing in England but declining in Canada and the US. Englands menthol cigarette ban did not appear to alter trends in use of non-cigarette tobacco, but findings highlight a need for more comprehensive regulation encompassing all tobacco products to mitigate youth uptake.

IntroductionGiven the rapidly changing media landscape and tobacco marketplace, timely data on media consumption and exposure to pro-tobacco content across media channels among lesbian, gay, and bisexual (LGB) young adults is imperative for developing counter-messaging and public education campaigns for these individuals. MethodsUsing 2023 data from young adults in California, this study examined how social media use differed across media channels for heterosexual and LGB young adults, by gender identity. Exposure to pro-tobacco content across media channels between heterosexual and LGB young adults, by gender identity was also compared. ResultsFindings from a representative sample of young adults in California showed that more LGB young adults reported using Tumblr and fewer reported using Facebook and Snapchat, compared with heterosexual young adults, among both males and females. Additionally, social media use differed by gender identity. For example, use of Reddit was more common among LGB versus heterosexual females, but there were no differences by sexual identity among males. Exposure to tobacco marketing was more common among LGB females compared with heterosexual females, but this was not the case for males. Exposure to user-generated e-cigarette content, and self-reported visits to e-cigarette websites, were more common among LGB females compared to heterosexual females. ConclusionsThese findings highlight the importance of treating LGB individuals as a heterogeneous group. As such, anti-tobacco campaigns designed for LGB individuals that leverage social media will want to consider which social media platforms are most used among their target audience, ensuring maximum campaign reach.

RATIONALEThe ban of menthol cigarettes is one of the key strategies to promote smoking cessation in the United States. Menthol cigarettes are preferred by young beginning smokers for smoking initiation. Almost 90% of African American smokers use menthol cigarettes, a result of decades-long targeted industry marketing. Several states and municipalities already banned menthol cigarettes, most recently California, effective on December 21, 2022. In the weeks before Californias ban took effect, the tobacco industry introduced several "non-menthol" cigarette products in California, replacing previously mentholated brands. Here, we hypothesize that tobacco companies replaced menthol with synthetic cooling agents to create a cooling effect without using menthol. Similar to menthol, these agents activate the TRPM8 cold-menthol receptor in sensory neurons innervating the upper and lower airways. METHODSCalcium microfluorimetry in HEK293t cells expressing the TRPM8 cold/menthol receptors was used to determine sensory cooling activity of extracts prepared from these "non-menthol" cigarette brands, and compared to standard menthol cigarette extracts of the same brands. Specificity of receptor activity was validated using TRPM8-selective inhibitor, AMTB. Gas chromatography mass spectrometry (GCMS) was used to determine presence and amounts of any flavoring chemicals, including synthetic cooling agents, in the tobacco rods, wrapping paper, filters and crushable capsule (if present) of these "non-menthol" cigarettes. RESULTSCompared to equivalent menthol cigarette extracts, several California-marketed "non-menthol" cigarette extracts activated cold/menthol receptor TRPM8 at higher dilutions and with stronger efficacies, indicating substantial pharmacological activity to elicit robust cooling sensations. Synthetic cooling agent, WS-3, was detected in tobacco rods of several of these "non-menthol" cigarette brands. Crushable capsules added to certain "non-menthol" crush varieties contained neither WS-3 nor menthol but included several "sweet" flavorant chemicals, including vanillin, ethyl vanillin and anethole. CONCLUSIONTobacco companies have replaced menthol with the synthetic cooling agent, WS-3, in California-marketed "non-menthol" cigarettes. WS-3 creates a cooling sensation similar to menthol, but lacks menthols characteristic "minty" odor. The measured WS-3 content is sufficient to elicit cooling sensations in smokers, similar to menthol, that facilitate smoking initiation and act as a reinforcing cue. Regulators need to act quickly to prevent the tobacco industry from bypassing menthol bans by substituting menthol with synthetic cooling agents, and thereby thwarting smoking cessation efforts.

IntroductionGraphic warning labels (GWLs) are widely employed to communicate smoking-related health risks; however, their implementation in the US has been held back by concerns about their efficacy. Most GWLs elicit a high level of emotional reaction (ER). The extent to which ER contributes to GWLs efficacy in improving smoking outcomes is a subject of debate. Our recent study showed poorer efficacy of the high-ER GWLs versus the low-ER ones during a month-long naturalistic exposure. Whether GWL effects persist after discontinuing the exposure remains unclear. MethodsWe conducted a secondary analysis to investigate the delayed effects of GWLs on smoking severity in adult smokers. The number of cigarettes smoked per day (CPD) was measured immediately as well as 4 weeks after the end of a month-long exposure to high-ER versus low-ER GWLs. Participants indicated their subjective feeling of being relieved from having to see the GWLs. ResultsWe found a significant reduction in CPD from the immediate to the 4-week post-exposure timepoint. There was no difference in CPD reduction between the high-ER and low-ER groups. Subjective sense of relief from GWL exposure was associated with greater CPD reduction in the high-ER group, but not the low-ER group. ConclusionsOur study suggests lasting impact of GWLs on smoking behavior. The findings may be particularly important to high-arousal GWLs, which appear less effective in reducing smoking during active exposure. ImplicationsWhether GWLs that evoke higher ER are more effective remains inconclusive. We recently showed that high-ER GWLs are less effective than low-ER ones in reducing smoking during continuous exposure. Here, we found evidence of delayed GWL effects such that smoking decreased from immediately to four weeks after the end of GWL exposure. Feeling of relief from GWL exposure was associated greater smoking reduction in the high-ER group. We suggest that continuously exposing smokers to high-ER GWLs that have been well remembered may be unnecessary and counterproductive.

IntroductionWhile premium cigars have similar addictive, toxic, and carcinogenic constituents as other cigars and cigarettes, about 1% of the US adults reported premium cigar use from 2010 to 2019. This study aimed to understand public perceptions and discussions of premium cigars on Reddit, one of the most popular social media platforms. MethodsUsing keywords such as "premium cigar", we extracted 2,238 Reddit posts from Reddit Archive between July 2019 and June 2021. Among them, 1,626 posts were related to premium cigars. By employing the inductive approach, we manually coded each Reddit post on premium cigars to understand public perceptions and discussions of premium cigars by summarizing them into different topics and subtopics. ResultsLongitudinal analysis showed that the number of Reddit posts on premium cigars increased since June 2020. Content analysis showed that among Reddit posts related to premium cigars, the most popular topic is "Information sharing" (75.72%), in which Reddit users shared their perceptions about premium cigars, asked for advice, and provided some recommendations about premium cigars. Over one-quarter of posts (27.17%) are sharing user experiences of premium cigars (such as taste). Nearly one-fifth (18.99%) of posts are discussing the affordability of premium cigars. In addition, 7.87% of posts are discussing legal/policy issues related to premium cigars, and 6.82% of posts are related to the health risks of premium cigars compared to cigarettes. ConclusionsPublic perceptions including misperceptions, user experiences, and affordability related to premium cigars have been actively discussed on Reddit. ImplicationsWith the increasing trend of premium cigar use, it is necessary to understand how premium cigars are perceived by the public and why they are becoming more popular. This study provides the first evidence on public perceptions and discussions of premium cigars on social media, which could provide useful information on future regulatory policies that aim to prevent the prevalence of premium cigars to protect public health.