Nicotine and Tobacco Research

Electronic cigarettes are the most commonly used tobacco product among U.S. adolescents. Schools most often respond to student e-cigarette use with exclusionary discipline such as suspension, which removes students from school and does not address potential underlying nicotine dependence. Web-based alternatives to suspension offer a way to keep students in school while providing cessation-focused support, but evidence on their effects is limited. This study examined changes in e-cigarette-related attitudes and motivation among adolescents who completed ReFresh, a self-paced, web-based alternative-to-suspension program completed in approximately 3 hours. Using a single-group pre-post design, we analyzed data from 173 middle and high school students (grades 6 to 12; mean age 15.0) referred after being caught using e-cigarettes on school grounds across 24 delivery sites (e.g., schools, afterschool programs, and health centers). The program comprises five interactive online lessons grounded in the 5 A's clinical framework (Ask, Advise, Assess, Assist, Arrange), motivational interviewing, and cognitive and behavioral skills training. Changes were analyzed with non-parametric tests. After completing ReFresh, participants reported greater motivation to quit ({chi}2 (6) = 22.79,OR = 3.80, 95% CI [2.2,8.8], p < .001) and rated quitting as more important (V = 3037.50,95% CI [1.00, 2.00], p < .001, r = 0.2). They also viewed e-cigarette use as more harmful and more risky (V = 8137.00, 95% CI [0.50, 0.63, p < .001, r = 0.62; V = 7734.50, 95% CI [0.50,0.80), p < .001, r = 0.65)), with the largest shifts in perceived harm relative to cigarettes and perceived risk of mental health problems. Most students reported comfort and confidence seeking help for e-cigarette use or mental health concerns, ranging from 71.10% of students agreeing they felt "More confident asking a trusted adult for help at school" to 80.50% of students agreeing they felt "More confident encouraging a peer to seek help". This study suggests that a brief, web-based alternative to suspension may shift the attitudes and motivation that precede quitting while keeping students in school, offering schools a non-exclusionary way to respond to e-cigarette use. Controlled studies measuring actual e-cigarette behavior are needed to confirm whether these programs reduce use.

Introduction: Nicotine Pouches are increasingly used as a smokeless alternative to cigarettes and other nicotine products, yet their acute cardiovascular effects remain poorly documented. While nicotine's impact on heart rate and electrocardiogram (ECG) parameters is well-documented in smoking, no trials have evaluated these effects specifically for nicotine pouches. Methods: This study is a single-center, double-blind, placebo-controlled, crossover trial which will include 20 healthy adult nicotine users. Participants will undergo three sessions, receiving either a placebo, 6 mg, or 14 mg nicotine pouch in random order. Heart rate obtained by an ECG and various other ECG parameters, vital signs, and subjective symptoms will be measured at baseline, and multiple time points over 30 minutes. Conclusions: This study aims to determine whether nicotine pouches cause acute changes in heart rate, ECG parameters, vital signs, and self-reported symptoms. We hypothesize that higher nicotine pouch does will lead to measurable increases in heart rate and other autonomic effects compared to placebo.

Background: In the United States, several states have restricted sales of flavoured tobacco products, including popular menthol- and mint-flavoured Oral Nicotine Pouches (ONP). In response, tobacco companies introduced "unflavoured" ONP containing odorless synthetic cooling agents. Since these, in turn, have become targets of legislative bans, the tobacco industry may seek out flavourants with other sensory effects to increase the appeal of "unflavoured" ONP. Methods: Online merchants were searched for "unflavored" ONP marketed to consumers in jurisdictions with flavour bans. Sensory effects of aqueous extracts from identified "heat", "spicy" and "unflavoured" ONP were analyzed by Ca2+ microfluorimetry in HEK293 cells expressing the human heat/chili pepper flavourant (capsaicinoid) receptor, hTRPV1. ONP were analyzed for capsaicinoids and sweeteners by Liquid Chromatography/Mass Spectrometry (LC/MS). Results: A new category of "heat" or "spicy" ONP was identified, including products marketed as "unflavoured". Extracts from all these ONP robustly activated TRPV1, with "unflavoured" Lucy Heat the most potent. Chemical analysis demonstrated that Lucy Heat contained the synthetic capsaicinoid nonivamide at high levels (~675 microgram/pouch), while others contained mixtures of capsaicinoids (5-25 microgram/pouch) combined with other characterizing flavours (tropical, fruit). All tested ONP contained sweeteners. Conclusions: The tobacco industry continues to probe regulatory loopholes by claiming that newly introduced capsaicinoid flavourants and sweeteners in ONP do not represent characterizing flavours. This is contradicted by industry and regulatory determinations assigning characterizing flavour properties to these additives. The toxicological health risks of repeated capsaicinoid exposures due to ONP use, in combination with nicotine and other constituents, need to be assessed.

BackgroundObservational comparisons of former smokers who use non-combusted nicotine products with former smokers who quit without them require that two quantities be measured precisely: which product is being used, and how long ago cigarette smoking stopped. Neither quantity is recorded by the National Health Insurance Service (NHIS) screening instrument used in a recent Korean cohort study of post-cessation e-cigarette use and lung cancer risk. We characterized both quantities in a contemporaneous, nationally representative survey of the same population. MethodsWe analyzed the public-release microdata of the Korea National Health and Nutrition Examination Survey (KNHANES), 2018 to 2023, restricted to adults aged 19 years and older. Former smokers were identified by smoking status, and cessation duration was taken from the item recording months since the last cigarette. Former smokers currently using a heated tobacco product (HTP) or an e-cigarette (EC) were compared with former smokers using neither. KNHANES 2018 asked a generic e-cigarette question and, separately, a checklist naming HTP brands, allowing the two product classes to be separated. Distributions were compared with rank-based methods, the age-duration relationship with Theil-Sen regression, and residual imbalance by restricting the comparison group to respondents age-matched to within two years. ResultsThe 2018 analytic sample comprised 1,348 former smokers, of whom 43 currently used HTP or EC and 1,305 used neither. Among the product-using former smokers, 58% reported HTP use without e-cigarette use, 21% reported both, and 21% reported e-cigarette use without HTP use; 79% reported any HTP use. Median cessation duration was 0.7 years (IQR 0.25 to 1.5) among product users and 12.0 years (IQR 5.0 to 20.0) among those using neither (Kolmogorov- Smirnov D = 0.76, P < 0.001), with the product user having quit more recently in 92% of cross-group pairs. The separation persisted within the short-term (<5 year) stratum (D = 0.34, P < 0.001; 73% of pairs) and after age matching, where the residual gap was 9.3 years. Cessation duration rose with age among those using no product (Theil-Sen slope +0.30 years per year) but was flat among product users (-0.01). Restricting to the screening-eligible stratum used in the cohorts high-risk analysis did not attenuate the imbalance: among those aged 50 to 80, median cessation among no-product quitters rose to 15.5 years (n = 858), and adding a 20 pack-year criterion left 421 no-product quitters with a median of 11.0 years against three HTP/EC users who had quit 0.25, 1.0 and 2.0 years earlier, despite closely matched cumulative exposure (mean 37.6 vs 37.7 pack-years). The overall contrast reproduced in every wave from 2018 to 2023, with an age-matched residual of 9 to 11 years. ConclusionsIn a nationally representative survey of the same population and the same calendar year as the NHIS screening cohort analyzed by Kim et al., Korean former smokers using non-combusted nicotine products differed from other former smokers in two respects that bear directly on how such comparisons should be read. First, they were predominantly HTP users: 79% reported any HTP use, and only 21% reported e-cigarette use without HTP use. Second, they had stopped smoking approximately a decade more recently, a difference that survived stratification at five years and exact age matching. Neither quantity is recorded in the NHIS screening instrument. Cohort estimates comparing post-cessation product users with other quitters should therefore be interpreted with caution if they do not precisely characterize product composition and to time since cessation, and future studies should measure both directly.

Introduction Smoking prevalence remains higher in rural than in urban populations in the United States. To examine recent trends, we assessed state-level differences in cigarette smoking between urban and rural areas from 2018 to 2024. Methods Using repeated cross-sectional data from the Behavioral Risk Factor Surveillance System, we estimated state-specific logistic regression models to examine the relationship between urban-rural county residence and cigarette smoking. Unadjusted models (model 1) included urban-rural county status and year. Subsequent models (model 2) added age, sex, and race/ethnicity. A final model (model 3) included education and an interaction term between urban-rural county status and year to examine whether gaps in urban-rural smoking changed over time. In states with significant interactions, simple effects tests compared trends for urban-rural groups separately. Results Compared to urban adults, rural adults had higher unadjusted odds of cigarette smoking (odds ratio [OR] range:1.07-1.88) in 88.4% (38/43) of states. Adjusting for demographic covariates (model 2) increased the proportion of states with significant marginal effects of rurality to 90.7% (ORs:1.09-1.87). A final model that also controlled for education (model 3) decreased the proportion of states with significant marginal effects of rurality to 60.5% (ORs:1.10-1.54). Among the 14 states with significant interaction terms, the odds of smoking declined faster among urban than rural residents. Conclusion Urban-rural differences in smoking persist across most states. No state showed a reduction in urban-rural disparities over time, and the urban-rural gap widened in 14 states. Demographic variation accounted for some, but not the majority, of observed urban-rural differences.

Aims To estimate the prevalence of past-year smoking quit attempts in Great Britain and examine variation by sociodemographic and socioeconomic characteristics, mental health, alcohol use, smoking-related characteristics, and geographic area. Design Cross-sectional analysis of data from a nationally representative household survey (the Smoking Toolkit Study) conducted October 2020 to May 2026. Setting Great Britain. Participants 24,786 adults ([&ge;]18y) who reported past-year tobacco smoking. Measurements The outcome was self-reporting having made at least one serious attempt to stop smoking in the previous 12 months. Associations with age, gender, ethnicity, social grade, health-related economic inactivity, mental health conditions, psychological distress, alcohol consumption, use of non-combustible nicotine, cigarette type and consumption, strength of urges to smoke, and motivation to stop smoking were assessed. We calculated weighted prevalence estimates and odds ratios (ORs) adjusted for survey year. Findings Overall, 36.7% [95%CI=36.0-37.4] of adults who had smoked in the past year self-reported making at least one quit attempt. Annual prevalence was relatively stable over the study period (range: 35.5% [33.9-37.1] to 37.6% [35.9-39.3]). Making a past-year quit attempt was more common among younger adults (48.0% among 18-24-year-olds) and declined progressively with age (24.6% among [&ge;]65-year-olds; OR=0.35, 95%CI=0.31-0.39). Compared with White adults, making a past-year quit attempt was more common among Black (OR=1.31, 1.11-1.55) and Asian (OR=1.40, 1.21-1.62) adults. Adults with a history of diagnosed mental health conditions (OR=1.27, 1.17-1.38) and moderate (OR=1.31, 1.20-1.43) or severe psychological distress in the past month (OR=1.39, 1.25-1.56) had greater odds of reporting a past-year quit attempt than those without. Those reporting increasing/higher risk alcohol consumption had lower odds than non-drinkers (OR=0.88, 0.82-0.95). Current use of nicotine replacement therapy (OR=2.59, 2.36-2.83) and vapes (OR=2.15, 2.02-2.30) were positively associated with reporting a past-year quit attempt. Odds were lower among those with greater cigarette consumption (OR range 0.79-0.86 among those smoking >10 vs. [&le;]5 cigarettes per day). Motivation to stop smoking showed the strongest gradient (OR range 2.95-29.09). Geographic differences were modest, with prevalence ranging from 32.1% [29.9-34.3] in Wales to 39.4% [35.9-43.1] in North East England. Conclusions Between 2020 and 2026, around one in three adults in Great Britain who smoked in the past year reported making a serious attempt to quit, corresponding to approximately 3.5 million people annually. Making a past-year quit attempt was more strongly associated with smoking-related factors than sociodemographic characteristics.

Introduction In July 2025, WHO launched the 3 by 35 Initiative calling on countries to increase real prices of tobacco, alcohol, and sugary drinks by at least 50% by 2035 to secure an additional $ 1 trillion in public revenue. While the effectiveness of excise taxes and prices in reducing tobacco use is well-documented, the feasibility of this call to action has not been evaluated empirically across the world. Methods Trend changes in countries nominal and inflation-adjusted retail prices were investigated using the most-sold brand of cigarettes over windows ranging from 2 to 16 years over the period 2008-2024, derived from nine editions of the World Health Organization Report on the Global Tobacco Epidemic. Statistical models of the association of cigarette excise taxes and prices from the panel of 195 countries were estimated. The frequencies of cigarette prices rising by at least 20% and 50% over preceding periods was estimated, and the length of time countries would need to reach these targets based on past trends were predicted. Results Over one- fifth of nominal cigarettes prices (and up to 40% in WHOs African region) were sticky across successive periods, even in countries with high overall consumer price inflation. Between 2008 and 2024, inflation-adjusted international dollar cigarette prices rose at a least squares annual trend growth rate of 2.9% (95% UI 2.8-3.0%) Excise tax increases strongly predict price increases. One-third of countries saw real prices at least 50% higher than 10 years prior. Conclusion Many of the instances of real price increases of 50% or more over 10-year periods occurred without countries implementing a conscious strategy to raise taxes. It is feasible to achieve and even surpass WHOs 3 by 35 call to action for tobacco if countries strategize and accelerate tobacco tax increases.

Background: The nicotine analog 6-methyl nicotine (6-MN) has appeared in commercial e-cigarette liquids, and other products, spurring interest in determining the extent to which it conveys similar effects to those of nicotine. Objective: To determine if 6-MN acts like nicotine to decrease body temperature, decrease nociception, suppress wheel activity and reinforce operant behavior when delivered by vapor inhalation using an Electronic Nicotine Delivery System (ENDS; "e-cigarette") approach in a rat model. Methods: Male and female (N=8 per sex) young adult Sprague-Dawley rats were evaluated for rectal temperature and nociceptive responses (warm water tail-withdrawal) to the inhalation of vapor from (-)-6-MN or (-)-nicotine in concentrations ranging from 5-30 mg/mL in the propylene glycol vehicle. Rats were then assessed for the reinforcing effects of nicotine and 6-MN using a vapor self-administration procedure and the rate suppressing effects of nicotine and 6-MN on wheel activity following injection. Results: Inhalation of nicotine or 6-MN for 30 minutes decreased the rectal temperature and increased tail-withdrawal latency of female and male rats in a concentration-dependent manner. The magnitude of the effects of 6-MN and nicotine were similar at similar vapor concentrations. Operant responding for 6-MN vapor was increased by pre-treatment with the antagonist mecamylamine. 6-MN was more potent than nicotine at suppressing wheel activity after injection. Conclusions: 6-MN induces effects very similar to those of nicotine, at a similar potency when inhaled and at a slightly increased potency when injected.

Tobacco use is the leading preventable cause of death worldwide. Anxiety increases the risk for smoking, and smoking in turn increases the risk for anxiety disorders. There is therefore a need to identify interventions that reduce anxiety, in general and in the context of smoking, without producing sedation. Kava (Piper methysticum), a natural product with a long history of indigenous use, has been shown to have anxiolytic and calming effects and reduce nicotine withdrawal. The current study examined whether kava without the hepatotoxic flavokavains A and B (AB-free) could reduce anxiety-like behavior in mice repeatedly treated with nicotine. Male and female C57BL/6NCrl mice received either a control diet or an AB-free kava-supplemented diet and underwent two blocks of nicotine treatments. Mice underwent a first block of five every-other-day injections of nicotine (0.5 mg/kg) or saline, with open field testing after each injection, followed one week later by a nicotine challenge. A second block of injections was given using the same injection schedule, followed by a second challenge one week later, and two weeks afterward mice received a final challenge in a novel open field. During the first treatment block, AB-free kava significantly increased center time overall, an effect most pronounced in saline-treated animals, and increased locomotor activity, while nicotine decreased both measures. During the second challenge, nicotine reduced center time but not locomotor activity, and AB-free kava increased center time in saline-treated animals only. During the final challenge, nicotine reduced both measures, whereas AB-free kava increased center time regardless of nicotine treatment, and kava-treated animals also showed a near-significant increase in center entries. These results suggest that AB-free kava reduces anxiety-like behavior without inducing sedation but does not prevent nicotine-induced suppression of exploratory behavior.

Introduction: Tobacco use during pregnancy increases risks for adverse birth outcomes. In the US, tobacco use during pregnancy is associated with several poverty-related social determinants of health (fewer years of education, housing and food insecurity, substance abuse) that also contribute to adverse birth outcomes. In the Smoke-free Household and Parent (Smoke-free HOPE) pilot feasibility study, we designed and tested a theory-based intervention (socio-ecological framework) that leverages our group's ten years of experience enrolling and evaluating the largest maternal smoking cessation program in San Bernardino County. The Smoke-free HOPE intervention is delivered by community health workers (CHW) and integrates tobacco cessation support into the other support services that are typically offered during perinatal CHW visits. To our knowledge, this is the first US-based study to test a CHW-delivered prenatal tobacco cessation intervention. Methods: The Smoke-free HOPE intervention is a two-arm RCT that randomizes pregnant adults (n=32) who use tobacco products (combustible, e-cigarettes/vapes) to one of two CHW-delivered interventions: brief behavioral advice or patient navigation to community-based tobacco cessation services (i.e., state quitline). Both intervention arms were delivered during up to eight CHW visits (home, telehealth). Primary feasibility and acceptability outcomes are reported. Results: At baseline, we found that the predominant form of habitual tobacco use was e-cigarettes (53%) and that co-use of cannabis occurred in 69%. Two participants switched from cigarettes/cigars (blunts) to e-cigarettes during the trial. For feasibility, we met our recruitment and retention progression criteria by achieving the following: a county-based enrollment of four consenting participants per month, 87% initiating CHW support (i.e., dropout rate of <13%), and 66% completing all eight CHW visits. For post-intervention acceptability, 91% were very satisfied with the program, and 100% would recommend it to their peers. Post-intervention key informant interviews revealed that participants valued the trust, flexibility, and nonjudgmental support of CHW visits. Seventy-five percent [95% CI = 60% to 90%] set a quit date, and 50% [95% CI = 33% to 67%] achieved 30-day point-prevalence abstinence from nicotine. Conclusions: We have documented the feasibility and acceptability of a CHW-delivered intervention to provide cessation support for all major tobacco products used by pregnant adults in our community. Scaling the intervention to multiple sites will help us measure its efficacy.

Background. Cannabidiol (CBD) products are sold in many forms for many purposes, but it is largely unknown which characteristics of real-world use relate to how users evaluate their experience. Methods. We analyzed an anonymous web-based survey of 377 CBD product users in Japan. We evaluated perceived-effect (0-5) and satisfaction (0-6) scores using main regression models of use frequency adjusted for age, sex, and body mass index. Separate supplementary models examined estimated daily CBD amount and other-cannabinoid co-use, purposes of use, or specific CBD amount-reporting status. Results. Use frequency was positively associated with perceived effects (B = 0.148, 95% CI 0.091 to 0.205) and satisfaction (B = 0.113, 95% CI 0.049 to 0.177; both p < 0.001). Estimated daily amount showed no clear association with either outcome after adjustment, whereas participants who reported specific milligram information had higher scores on both (B = 0.543, p < 0.001 and B = 0.559, p = 0.002). Amount-reporting status was associated with product form (tincture 48.5% vs 30.8%; smoking or inhalation 58.5% vs 75.7%; both FDR-adjusted p = 0.009), whereas no statistically significant group differences were found for age, sex, body mass index, use frequency, or sleep timing. Purposes of use and sleep-timing indicators showed no clear associations with the outcomes. Conclusions. Subjective evaluation of CBD use was more consistently related to how often CBD was used and whether a specific milligram amount was reported than to how much was reportedly taken, and amount-reporting status was related to product form. Specific CBD amount-reporting status may be a useful complementary dimension for characterizing real-world CBD use.

Background and aims Over the past decade, there has been increased lifetime use of illicit and medical cannabis, underscoring the need to examine public health impacts. This included reports of increased cannabis-related psychosis. In this context, this study aimed to determine all cannabis-related hospital admissions over a ten-year period to characterise poisonings and mental health harms. Design This is a retrospective observational study of the Victorian Admitted Episodes Dataset (VAED) records, which include all hospital admissions in the state of Victoria and are supplied by the Victorian Department of Health. Setting Victoria, Australia. Cases Hospital records for poisoning (T40.7) and mental health and behavioural disorders (F12.0-F12.9) related to use of cannabis for the period July 2013 to June 2023 were selected for this study. Measurements Crude and age-standardised rates per 100,000 population are reported. Net percentage change over the ten-year study window was estimated using generalised linear models with a log-population offset, contrasting the final year (2022/23) against the baseline (2013/14). Findings There were 39,565 cannabis-related admissions in the ten-year period, including 7263 admissions where cannabis-related harm was the principal diagnosis. The age-standardised rate per 100,000 population was 63.6 for all cannabis-related harm admissions and 11.7 for principal diagnosis cases. The peak annual rate for all cannabis-related harm was observed in 2020/2021 (77.3 per 100,000). There was a 49.0% (p<0.0001) increase in the rate of hospital admissions with a cannabis-related principal diagnosis, when comparing 2022/23 with baseline (2013/14). Overall, harmful use (F12.1) was the most common cannabis-related mental and behavioural disorder. Psychotic disorder (F12.5) was the most common diagnosis (45.3%; n=2,909/6,421). When considering principal diagnosis only, the rates were highest in males aged 15-24 years (36.9/100,000), followed by females in the same age group (20.5/100,000). While most principal diagnosis cases involved males, a greater percentage change between the first and last years of the study period was observed for females (+75.1%, p<0.0001) compared with males (+34.6%, p=0.003). Conclusions A 49% increase in the rate of cannabis-related hospital admissions, particularly mental and behavioural disorders due to use of cannabinoids, has occurred over the past decade. These trends are non-linear, rates in the last two years were lower than the peak in 2020/2021.

Introduction The role of population-wide smoking cessation campaigns is uncertain as smoking prevalence reaches historically low levels. We examined whether the Power to Quit campaign in England, which aimed to increase uptake of evidence-based cessation support, particularly digital aids, was associated with changes in quitting behaviour. Methods We analysed nationally-representative cross-sectional surveys of adults in England who smoked in the past year, conducted immediately before (n=803) and after (n=1,713) the campaign (February-April 2026). Logistic regression estimated associations with quit attempts, digital cessation support, local Stop Smoking Services (SSS), and quit success, overall and by social grade. Exploratory analyses examined participants recognising campaign materials (n=799). Smoking Toolkit Study (STS) data (January 2023-June 2026; n=11,442) were used to contextualise findings against longer-term trends. Results In the primary pre/post analysis, there were increases in quit attempts (48.4% to 52.3%, aOR=1.16 [95%CI=0.97-1.38]), attempts involving digital support (16.0% to 18.4%, aOR=1.18 [0.92-1.50], and attempts involving SSS (2.4% to 3.6%, aOR=1.53 [0.89-2.65]), although estimates were uncertain. Associations were larger among participants recognising campaign materials (quit attempts: 64.9%, aOR=1.82 [1.47-2.26]; digital support: 28.7%, aOR=1.88 [1.44-2.45]; SSS: 5.4%, aOR=2.14 [1.19-3.88]). Increases in support uptake were particularly evident among less advantaged adults. There was no clear evidence of a change in quit success. STS data showed increases in support uptake continued from before the campaign. Conclusions Power to Quit coincided with increased engagement with cessation support, particularly among less advantaged adults and those recognising campaign materials. Increases in support continued pre-campaign trends, indicating that the contribution of the campaign occurred within a broader period of changing cessation behaviour.

Introduction: E-cigarettes are the second most commonly used nicotine product in the United States after cigarettes. Their role in smoking cessation remains debated. Further research is needed to clarify their potential impact on quitting combustible cigarette use. Methods: We analyzed data from adults aged 18 and older who participated in Wave 4 (12/2016-01/2018), Wave 5 (12/2018-11/2019), and Wave 7 (01/2022-04/2023) of the Population Assessment of Tobacco and Health Study. We employed a causal forest to estimate the associations between Wave 5 e-cigarette use and past 12-month cigarette smoking abstinence at Wave 7. Eligible participants had smoked at least 100 cigarettes in their lifetime at Wave 4, currently smoked cigarettes some days or every day at both Waves 4 and 5, completed follow-up at Wave 7, and had a substantial estimated probability of either vaping or not vaping at Wave 5. Analyses adjusted for 26 Wave 4 covariates, including demographic characteristics, tobacco use history, and other relevant factors. Results: Compared with no vaping, vaping on 1-5 days was associated with a 2.4 percentage-point lower probability of cessation (95% CI: -7.7 to 2.9), whereas vaping on 6-29 days and daily vaping were associated with increases of 7.5 percentage points (95% CI: -0.4 to 15.5) and 12.5 percentage points (95% CI: 6.2 to 18.7), respectively. Conclusions: The association between vaping and smoking cessation varied by vaping frequency. Compared with non-vaping, infrequent vaping was not significantly associated with subsequent cigarette abstinence, whereas more frequent vaping was associated with a greater likelihood of abstinence. Daily vaping showed the strongest positive association.

Introduction There is evidence that regular and high-risk-consumption is more prevalent among adolescents with a lower socioeconomic family status (SES). Yet, the causes for the SES gap remain unclear. We postulate that SES inequalities in regular and high-risk cannabis use among adolescents are mediated by differences in risk perception and access. Methods This cross-sectional study used data from a survey to students aged 15-17 years from 35 European countries in 2019 (European School Survey Project on Alcohol and Drugs). We modelled current regular use ([&ge;]10 times in the past month) and past-year high-risk/problematic use as a function of maternal and paternal education, adjusting for age, sex, and country, then further adjusting for moderating variables: perceived cannabis availability and perceived risk of harm. Results Lower paternal education was related to both higher regular and high-risk use (OR: 1.55 (1.20-2.0) and OR: 1.77 (1.49-2.11), respectively. A similar pattern was observed with maternal educational level. Including mediating factors, perceived availability increased the likelihood of higher use among adolescents with lower SES, related to their lower perceived availability. In contrast, adjusting for risk perception, SES factors lost significance for regular use and reduced OR by 40 to 50% for high-risk use. Conclusion Results indicate that SES inequalities in perceived risk explain the SES gap in regular and high-risk cannabis use among the worse-off. Attention should be paid to policies that may foster the perception that cannabis is risky, which may aggravate dangerous consumption among the worse-off, contributing to larger SES inequalities.

Objective: Effective strategies to prevent Alzheimer's disease and related dementias (ADRD) are limited. Implementing our Medication-Wide Association Study (MWAS+), we highlighted varenicline as a candidate. This study evaluated the association between varenicline use and risk of ADRD relative to nicotine replacement therapy (NRT). Methods: Using the All of Us Research Database, we identified adults aged 50 years or older with available lifestyle survey responses regarding tobacco use history who initiated smoking cessation therapy with either varenicline or NRT between 2006 and 2023. We limited our cohort to incident monotherapy users and designated the index date as the first prescription. Individuals with baseline ADRD or no follow-up were excluded. Baseline characteristics included demographics, comorbidities, BMI, and prior medication exposures. Outcomes were incident ADRD and a composite outcome of ADRD or death. Findings: The cohort consisted of 9,584 individuals (1,801 varenicline users and 7,783 NRT users). After propensity score matching, there were 1,758 individuals in each group with balanced baseline characteristics. Varenicline use was associated with a reduced risk of ADRD (HR 0.516, 95% CI: 0.353-0.754) and the composite outcome ADRD or death (HR 0.657, 95% CI: 0.501-0.861). Kaplan-Meier curves also demonstrated varenicline's sustained benefits through the study period. Implications: Varenicline use is associated with a lower risk of ADRD among older adults receiving smoking cessation therapy. Further investigation of varenicline as a potential strategy for ADRD prevention is warranted. These findings underscored the value of explainable AI-guided approaches to drug repurposing.

Background: Nicotine pouches (NPs) are increasingly popular tobacco-free nicotine products, particularly among young people. Despite growing use, evidence regarding their oral health effects remains limited. Methods: We employed a mixed-methods approach comprising: (1) a national cross-sectional survey of NP users, (2) a survey of UK dental professionals, and (3) in-person clinical assessments of NP users. Survey data explored patterns of NP use, oral and dental side effects, and perceptions of risk. Clinical assessments included comprehensive oral examinations, periodontal assessments, and histopathological investigation of lesions where indicated. Results: A total of 3,659 NP users completed the public survey. Participants were predominantly male (89%) and aged 16-22 years (78%). Overall, 45% reported at least one oral or dental side effect. The most commonly reported effects were gingival recession (60%), burning sensations (41%), white patches (30%), and dry mouth (29%). Higher nicotine exposure was associated with increasing numbers of reported side effects. Among 126 dental professionals, oral lesions associated with NP use were commonly observed clinically, while only 17% reported seeing no oral or dental effects. Thirty-three NP users underwent in-person assessment. Ten lesions were biopsied; six demonstrated hyperkeratosis and four showed oral epithelial dysplasia (three mild, one moderate). All dysplastic lesions occurred at pouch placement sites. In two cases, clinical follow-up demonstrated partial or complete resolution of lesions following cessation of NP use. Periodontal assessments demonstrated generally low levels of periodontal disease and gingival recession across the cohort. Conclusions: Oral and dental side effects associated with NP use were commonly reported by users and observed by dental professionals. Histopathological assessment identified biopsy-confirmed oral epithelial dysplasia in lesions occurring at pouch placement sites, representing, to our knowledge, the first such report associated with NP use. Evidence of lesion improvement following discontinuation of use suggests that at least some NP-associated oral changes may be reversible. Although causality cannot be established, these findings highlight the need for vigilance among dental professionals and urgent longitudinal research to determine the incidence, progression, and reversibility of NP-associated oral lesions.

Introduction Within the Tobacco and Vapes Act 2026, the UK Government is considering restricting retail displays of vaping and other nicotine products to discourage youth uptake. We explored how adult nicotine users and adolescents responded to conventional and restricted displays. Methods Two UK-wide cross-sectional online surveys were conducted April-June 2026, with current and former adult nicotine users (n=2,851), and adolescents (11-17 years; n=2,123). Participants rated images of vape and nicotine pouch point-of-sale (POS) displays (two conventional, two restricted) across 10 items. Other measures included demographics, smoking/vaping/nicotine pouch use, vaping susceptibility, and product choice. Results Ratings of two conventional POS images were consistently favourable. Two restricted POS images were almost exclusively rated unfavourably. GEE analyses, controlling for demographics and behaviour, indicated that a display with standardised white packs (versus a conventional display) consistently had lower odds of favourable ratings (adults range:0.13-0.31; adolescents range:0.11-0.32). A fully covered display had even lower odds of favourable ratings on all items (adults range:0.06-0.19; adolescents range:0.05-0.10). Presented with hypothetical restricted displays, most adults using nicotine remained consistent with their product choice. Favourable ratings of conventional displays were positively associated with adolescents' vaping susceptibility. Those favourably rating a large, branded display were more likely to be susceptible than those giving unfavourable/neutral ratings (AOR=2.73, 95%CI [2.16-3.45] p<0.001). No association was found between favourable ratings of restricted displays and susceptibility. Conclusion Restricting POS displays could reduce positive messaging around vaping and adolescent susceptibility. The potential impact of restrictions on adult users' perceptions of harm and accessibility should be considered.

Introduction: Childrens exposure to second hand tobacco smoke is a preventable global public health issue, yet there is no consensus on how best to support families to create a smoke free home. This pilot randomised controlled trial tested the feasibility of use of free nicotine replacement therapy combined with telephone delivered support to reduce childrens exposure to second hand smoke in the home, and inform a future full scale trial. Methods: Parents and carers aged 18 and over, who smoke in the home and care for one or more children aged 0 to 16 years were recruited through existing initiatives and social media. Participants were randomised to either the intervention or control arm. Group A received free posted to home nicotine replacement therapy, alongside fortnightly telephone calls to support smoking abstinence in the home. Group B were signposted to the Scottish Government Take it Right Outside website which provides interactive advice on creating a smoke free home. To measure second-hand smoke levels, participants installed an air quality monitor in their living room for 7 days to measure fine particulate matter at baseline and 12 week follow-up. Results: Approximately one-quarter (27 of 100) of the intended sample size was recruited. Median fine particulate matter concentrations reduced in both the intervention (by 36mg per cubic metre) and control (by 16mg per cubic metre) groups. Retention rates and adherence rates to nicotine replacement therapy were 70 percent and above, with no risks and or safety concerns reported, suggesting this approach is feasible and acceptable to participants. The estimated cost of delivering this 12 week intervention was two hundred and forty four pounds per individual. Conclusions: Although recruitment rates were insufficient to recommend progression to a larger trial to test effectiveness of this approach in Scotland, this study could inform trial development in other countries where smoking in the home is commonplace. Insights regarding the alignment of smoke free home interventions with broader smoking cessation initiatives could inform future policy and public health approaches.

Background and Aims: Anxiety remains prevalent among adolescents while tobacco and nicotine product use, especially the recent increases of novel product use such as e-cigarettes and nicotine pouches, raises further public health concerns. The associations between novel tobacco and nicotine product use and anxiety remains understudied. This study aims to determine whether tobacco and nicotine product use is associated with generalised anxiety and whether this association differs by used product. Design: Cross-sectional survey, School Health Promotion study in 2025. Setting: A school-based nationwide survey conducted in all Finnish lower and upper secondary schools. Participants: Students aged 13-20 years in three school levels: 8.-9. grade students in lower secondary schools (N= 94 743, 73% of the students), 1st and 2nd-year students in general upper secondary schools (n=47 248, 70% of the students) and of vocational institutions (n=24 998, 38% of the students). Measurements: Exclusive (single product) and non-exclusive ([&ge;]1 products) daily or weekly use of tobacco and nicotine products, including nicotine pouches, e-cigarettes, cigarettes, and smokeless tobacco (snus). Generalised anxiety was measured using the Generalised Anxiety Disorder Scale (GAD-7). The cut-off of >10 points indicated participants with moderate to severe self-reported generalised anxiety symptoms. Background variables included sociodemographic variables and heavy drinking. Results: Of the 166,989 participants 51.4% were females, mean age was 15.7 (SD 1.27), 21.2% reported generalised anxiety. Prevalence of generalised anxiety increased gradient-wise in accordance with both non-exclusive and exclusive use frequency of different tobacco and nicotine products, as well as with number of products used. Daily use of nicotine pouches was associated with higher odds of anxiety compared with never use (boys: adjusted odds ratios (aOR) 1.19, 95% CI, 1.05 to 1.34; girls: aOR 1.74, 95% CI, 1.58 to 1.91), yet the association between daily e-cigarette use seemed to be stronger (boys aOR 1.96, 95% CI, 1.54 to 2.49; girls: aOR 2.29, 95% CI, 2.09 to 2.51). Summary: Any use of tobacco and nicotine products, including new products, is associated with generalised anxiety among adolescents, with some differences between products. Measures to prevent the initiation of tobacco and nicotine product use and to promote mental health among adolescents should be enacted.