Nicotine and Tobacco Research

Graphic warning labels (GWLs) have been implemented on cigarette packaging worldwide. In the U.S., GWLs have encountered legal obstacles based on the tobacco industry arguments that their aversive imagery unnecessarily triggers strong emotional arousal. This longitudinal study evaluated the effect of the high-arousal GWLs on cigarette craving and the neural substrates of emotional processing. 158 adult smokers were exposed to either high-arousal (n=79) or low-arousal (n=79) GWLs that were attached to their own cigarette packs for 4 weeks. Craving and brain activity in response to GWLs and control stimuli were measured using functional magnetic resonance imaging before and after the 4-week exposure. The amygdala, which plays a key role in emotional processing, served as the a priori region of interest. Results indicate that, at baseline, high-arousal GWLs elicited a larger reduction in craving and stronger amygdala neural response compared to low-arousal GWLs; however, at week 4, GWL-induced craving reduction and amygdala response became comparable between the high-arousal and low-arousal groups. Amygdala response mediated GWLs effects on craving reduction, which was moderated by arousal and time in such a way that the amygdalas mediating role was more pronounced for high-arousal than low-arousal GWLs at baseline but did not differ between groups at week 4. Together, the results suggest that the impact of emotional arousal on cigarette cravings decreases over time, potentially due to the amygdalas diminishing responsivity to repeated presentations of high-arousal imagery. Low-arousal GWLs may represent a more feasible approach for tobacco control efforts in the U.S.

BackgroundThe relationship between the use of tobacco products and SARS-CoV-2 infection is poorly understood and controversial. Most studies have been done with tobacco cigarettes, while few have examined the effect of electronic cigarettes (ECs) on SARS-CoV-2 infection. We tested the hypothesis that EC fluids and aerosols with high concentrations of nicotine promote SARS-COV-2 infection by increasing viral entry into human respiratory epithelial cells. MethodsResponses of BEAS-2B cells to authentic JUUL aerosols or their individual constituents (propylene glycol (PG)/vegetable glycerin (VG) and nicotine) were compared using three exposure platforms: submerged culture, air-liquid-interface (ALI) exposure in a cloud chamber, and ALI exposure in a Cultex(R) system, which produces authentic heated EC aerosols. SARS-CoV-2 infection machinery was assessed using immunohistochemistry and Western blotting. Specifically, the levels of the SARS-CoV-2 receptor ACE2 (angiotensin converting enzyme 2) and a spike modifying enzyme, TMPRSS2 (transmembrane serine protease 2), were evaluated. Following each exposure, lentivirus pseudoparticles with spike protein and a green-fluorescent reporter were used to test viral penetration and the susceptibility of BEAS-2B cells to infection. ResultsNicotine, EC fluids, and authentic JUUL aerosols increased both ACE2 levels and TMPRSS2 activity, which in turn increased viral particle entry into cells. While most data were in good agreement across the three exposure platforms, cells were more responsive to treatments when exposed at the ALI in the Cultex system, even though the exposures were brief and intermittent. In the Cultex system, PG/VG, PG/VG/nicotine, and JUUL aerosols significantly increased infection above clean air controls. However, both the PG/VG and JUUL treatments were significantly lower than nicotine/PG/VG. PG/VG increased infection only in the Cultex(R) system, which produces heated aerosol. ConclusionOur data are consistent with the conclusion that authentic JUUL aerosols or their individual constituents (nicotine or PG/VG) increase SARS-CoV-2 infection. The strong effect produced by nicotine was modulated in authentic JUUL aerosols, demonstrating the importance of studying mixtures and aerosols from actual EC products. These data support the idea that vaping increases the likelihood of contracting COVID-19.

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.

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.

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.

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.

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.

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.

BackgroundDespite their potential to serve as a reduced-harm alternative to combustible tobacco, e-cigarette take-up remains low among older (45+) adult smokers, especially in the U.S. While social media is a known driver of vaping attitudes and behaviors in younger populations, its influence on older smokers is poorly understood. This paper provides the first focused analysis of e-cigarette-related social media exposure in this population, documenting its prevalence, characteristics, and attitudinal correlates. MethodsData come from an opt-in survey of U.S. adults (N = 974) recruited via Prolific, comprising three groups: (i) non-vaping smokers aged 45+ (N = 484), (ii) former-smoking vapers aged 45+ (N = 149), and (iii) any-vaping-status smokers aged 18-35 (N = 341). Descriptive statistics, weighted to U.S. population benchmarks, characterize self-reported exposure to e-cigarette-related content on social media. Logistic regressions estimate associations between exposure and intentions for future e-cigarette use, e-cigarette harm perceptions, and related attitudes. ResultsOlder smokers (35.3%) reported exposure to e-cigarette-related content on social media less frequently than both older vapers (44.0%) and younger smokers (72.0%). For older smokers, e-cigarette health risks were the most frequently reported topic of content viewed, followed by youth vaping and e-cigarette addiction. Among this group, exposure was positively associated with stated intentions for future e-cigarette use. Exposure was not significantly associated with perceived e-cigarette harms for any group. ConclusionsFindings provide suggestive evidence that social media exposure may promote e-cigarette adoption among older smokers. However, the cross-sectional design limits causal inference, and the observed associations may reflect selection bias or reverse causality. If a causal relationship exists, the patterns observed suggest that exposure influences e-cigarette adoption through mechanisms other than updating beliefs about e-cigarette risks. While these results tentatively support the potential of social media as a channel for older-smoker harm reduction, any policy applications must carefully weigh privacy concerns and risks to youth. Rigorous experimental studies are needed to confirm these findings and clarify how social media might be leveraged to improve public health outcomes among older smokers.

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.

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.

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.

Nicotine intake by cigarettes is linked to the maintenance and development of anxiety disorders and impairs adaptive discrimination of threat and safety in humans. Yet, it is unclear if nicotine exerts a causal pharmacological effect on the affective and neural mechanisms that underlie aversive learning. We conducted a pre-registered, pseudo-randomly and double-blinded pharmacological fMRI study to investigate the effect of acute nicotine on Fear Acquisition and Extinction in non-smokers (n=88). Our results show that nicotine administration led to decreased discrimination between threat and safety in subjective fear. Nicotine furthermore decreased differential (threat vs. safety) activation in the hippocampus, which was functionally coupled with Nucleus Accumbens and amygdala, compared to placebo controls. Additionally, nicotine led to overactivation of the ventral tegmental area. This study provides mechanistic evidence that single doses of nicotine impair neural substrates of adaptive aversive learning in line with the risk for the development of pathological anxiety.

BackgroundUS sales of oral nicotine pouches (ONPs) have rapidly increased, with cool/mint-flavored ONPs the most popular. Restrictions on sales of flavored tobacco products have either been implemented or proposed by several US states and localities. Zyn, the most popular ONP brand, is marketing Zyn-"Chill" and Zyn-"Smooth" as "Flavor-Ban Approved", probably to evade flavor bans. At present it is unclear whether these ONPs are indeed free of flavor additives that can impart pleasant sensations such as cooling. MethodsSensory cooling and irritant activities of "Flavor-Ban Approved" ONPs, Zyn-"Chill" and "Smooth", along with "minty" varieties (Cool Mint, Peppermint, Spearmint, Menthol), were analyzed by Ca2+ microfluorimetry in HEK293 cells expressing the cold/menthol (TRPM8) or menthol/irritant receptor (TRPA1). Flavor chemical content of these ONPs was analyzed by GC/MS. ResultsZyn-"Chill" ONP extracts robustly activated TRPM8, with much higher efficacy (39-53%) than the mint-flavored ONPs. In contrast, mint-flavored ONP extracts elicited stronger TRPA1 irritant receptor responses than Zyn-"Chill" extracts. Chemical analysis demonstrated the presence of WS-3, an odorless synthetic cooling agent, in Zyn-"Chill" and several other mint-flavored Zyn-ONPs ConclusionsSynthetic cooling agents such as WS-3 found in Flavor-Ban Approved Zyn-"Chill" can provide a robust cooling sensation with reduced sensory irritancy, thereby increasing product appeal and use. The label "Flavor-Ban Approved" is misleading and may implicate health benefits. Regulators need to develop effective strategies for the control of odorless sensory additives used by the industry to bypass flavor bans.

The debate about electronic cigarettes has divided healthcare professionals, policymakers, and communities. Central points of disagreement are whether vaping electronic cigarettes are addictive and whether they produce major pulmonary complications. We developed a novel model of nicotine vapor self-administration in rats and found that rats voluntarily exposed themselves to nicotine vapor to the point of reaching blood nicotine levels that are similar to humans, exhibiting both addiction-like behaviors and cardiopulmonary abnormalities. The smoking cessation drug varenicline decreased electronic cigarette self-administration. These findings confirm the addictive properties and harmful effects of nicotine vapor and identify a potential medication for the treatment of electronic cigarette addiction.\n\nOne Sentence SummaryVaping nicotine-containing electronic cigarettes produces cardiopulmonary abnormalities, nicotine dependence and addiction-like behaviors, which are reduced by the smoking cessation drug varenicline.

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.

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.

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.

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.

Background The clinical safety profile of e-cigarette use for smoking reduction remains poorly characterized. This study compared the relative safety and tolerability of nicotine e-cigarette use with non-nicotine e-cigarettes or a non-aerosol cigarette substitute (CS) among adults interested in reducing their smoking. Methods We conducted a secondary analysis of adverse events (AEs) reported in a 6-month, double-blind RCT involving 520 participants assigned to either e-cigarettes with 0, 8, or 36 mg/mL nicotine or a CS. AEs were coded using CTCAE V4.0 and assessed for frequency, severity, seriousness and relatedness across groups. Cumulative incidence was calculated over 24 weeks. We estimated risk differences (RDs) and 95% confidence intervals (CIs) for frequently reported AEs (>=1% of participants overall) comparing e-cigarette vs. CS and nicotine versus non-nicotine e-cigarette groups. Fisher's exact test, with adjustment for multiple comparisons, was used to assess statistical significance. Results Most study-related AEs (those rated as possibly, probably, or definitely related by medical monitor) were mild in severity and none were classified as serious. At 24 weeks, cumulative incidence of first study-related AE was highest in the 36 mg/mL (37.0%) and 8 mg/mL (35.2%) e-cigarette groups, followed by 0 mg/mL (23.4%), and lowest in CS group (2.5%). E-cigarette users experienced significantly greater risks of cough (RD [95%CI]: 8.5% [5.6-11.3]), headache (RD [95%CI]: 5.4% [3.3-7.6]) and sore throat (RD [95%CI]: 5.4% [3.2-7.6]) as compared with the CS group. Cough was also more common in those randomized to nicotine versus non-nicotine e-cigarettes (RD [95%CI]: 8.1% [3.4-12.8]). Conclusion All study products were generally well-tolerated; however, AEs were more common in e-cigarette groups, especially with nicotine. Findings highlight the need to monitor common symptoms such as cough, headache, and sore throat in clinical and regulatory evaluations of e-cigarette safety.