The Effect of State and Local Flavored Cigar Sales Restrictions, on Retail Sales of Large Cigars, Cigarillos, and Little Cigars in Massachusetts, California, Illinois, and New York.

INTRODUCTION: In 2009, the Family Smoking Prevention and Tobacco Control Act prohibited flavored cigarettes but allowed for flavored cigars. Since, there has been a 34% increase in youth cigar use and widened racial disparities. State and local jurisdictions have increasingly enacted flavored tobacco product sales restrictions. As more jurisdictions consider implementing flavor restrictions, it is important to understand their effect on tobacco markets that have high flavor proliferation, including the cigar market. AIMS AND METHODS: This study uses data from Truth Initiative's flavor policy database and NielsenIQ retailer scanners for California, Illinois, Massachusetts, and New York. We use a three-way fixed-effect model to assess the impact of the percentage of the population covered by a flavored cigar sales restriction on per capita unit sales of cigars. RESULTS: We find that population coverage by cigar sales restrictions was significantly associated with decreases in per capita cigar sales. More specifically, a 25% increase in the percentage of the population covered by a flavored cigar sales restriction was associated with a decrease in per capita all cigar sales of 15%-19%, 4%-10% for large cigars, 17%-21% for cigarillos, and 2%-41% for little cigars. CONCLUSION: Flavored cigar sales restrictions are an effective policy to reduce per capita cigar sales. The Food and Drug Administration (FDA)'s proposed product standards would increase population covered by a flavored cigar sales restriction to 100%, leading to potential significant reductions in cigar sales, especially little cigar, and cigarillo sales. This may also substantially reduce youth cigar use and racial disparities in cigar use. IMPLICATIONS: In April 2022, the U.S. FDA published a proposed rule to prohibit characterizing flavors in all cigars and menthol cigarettes. Besides this proposed rule, there has been little federal action to date to reduce sales of flavored cigars. However, as of March 31, 2022, Massachusetts and 333 localities across 10 states have enacted policies that restrict the sale of flavored cigars and other tobacco products. We find that population coverage by cigar sales restrictions is significantly associated with decreases in per capita cigar sales.

Quitting smoking with smoke? Unauthorized claims used by herbal cigarette manufacturers.

INTRODUCTION: Herbal cigarettes are made with non-tobacco plant materials (e.g., tea leaves, hemp), are typically sold pre-rolled in packs and with filters, and are combusted and smoked like tobacco cigarettes. Herbal cigarette manufacturers have a history of making misleading health claims and at least one company has previously settled with the US Federal Trade Commission over deceptive advertising. This study examined current claims and product characteristics of herbal cigarettes sold by a popular online retailer. METHODS: We searched Amazon.com for "herbal cigarettes" and "hemp cigarettes" and identified all herbal cigarette products sold on the first page of search results (n=51). Two coders independently content analyzed each product's Amazon page for claims (e.g., smoking cessation, health), product characteristics (e.g., flavors), and presence of disclaimers and warnings. RESULTS: Overall, 78.4% of product pages made smoking cessation claims (e.g., "A more scientific way to quit smoking", "…decreases nicotine craving symptom and helps to quit tobacco smoking"). Further, 45.1% of product pages included claims describing lower risk/exposure compared to tobacco products (e.g., "…without the addictive nicotine and toxic chemicals found in tobacco cigarettes"). Some herbal products were available in multiple flavors, including menthol (21.6%) and fruit (17.7%). Only 35.3% of products included visible health warnings on product packaging. CONCLUSIONS: Many herbal cigarette products sold on Amazon.com make unauthorized cessation and health claims. Regulatory agencies must act decisively to stop the misleading advertising of these products and develop appropriate warnings to educate the public about the potential harms of herbal cigarettes. IMPLICATIONS: This content analysis documents the use of unauthorized and misleading claims made in the marketing of herbal cigarettes.These findings highlight the need for enforcement of existing federal regulations, which prohibit deceptive advertising.Research is needed to inform the development of appropriate warning labels that can be used to inform consumers of the potential harms of smoking herbal cigarettes.

Measuring the impact of state and local Tobacco 21 policies in the United States: A longitudinal study of youth and young adults ages 15-21.

INTRODUCTION: Tobacco 21 (T21) policies, which prohibit tobacco sales to individuals under 21, aim to reduce youth tobacco use by limiting youth access to these products. Little, however, is known about the longitudinal effect of T21 policies on youth tobacco use behaviors at the national level. METHODS: Participants aged 15-21 years from a longitudinal study conducted between May 2014 and May 2019 (n = 13,990) were matched to geocoded T21 policies. Generalized linear mixed models examined the association of direct and bordering T21 policy exposure and cigarette and e-cigarette use and intention to use, accounting for individual characteristics. RESULTS: Controlling for sociodemographic and psychosocial covariates, there were statistically significant positive associations between T21 exposure and e-cigarette use (OR = 1.45 [1.03,2.06], p < .003) and intention to use e-cigarettes (OR = 1.54 [1.05,2.26], p < .027). We found no association between T21 policy exposure and cigarette use or intention to use cigarettes. Furthermore, exposure to T21 policies did not significantly modify the relationship between age and either cigarette outcome. CONCLUSIONS: This is the first longitudinal study to evaluate state and local T21 policies at the national level. Our analyses demonstrate that existing T21 policies are not sufficient to reduce youth tobacco use and intentions to use, and suggest that T21 policies need to be a part of a comprehensive tobacco policy landscape. Our findings suggest further research is warranted on state and local T21 policy enforcement and implementation, including how T21 may differentially impact cigarette and e-cigarette use, and may have implications for the federal T21 policy. IMPLICATIONS: This research evaluates state and local T21 policies in the United States longitudinally, finding that T21 policies are not sufficient to stem e-cigarette use among adolescents and young adults. These findings support further policy action and suggest that local and state T21 policies are not sufficient to reduce tobacco use and rather, need to be part of a broader, more comprehensive set of tobacco control policies. Further research on enforcement and implementation challenges of T21 policies and the impacts of the new federal T21 policy is warranted.

The EVALI outbreak and tobacco sales in the USA, 2014-2020.

BACKGROUND: The E-cigarette, or Vaping Product-Use Associated Lung Injury (EVALI) Outbreak of 2019 hospitalised thousands and killed dozens of people in the USA and raised perceptions of the dangers posed to health by electronic cigarettes (e-cigarettes). These illnesses along with continued increases in youth vaping rates lead to the passage of many state and federal laws intended to curtail the sale of flavoured e-cigarettes. Little is known about the impact of these events on US e-cigarette and cigarette retail sales. METHODS: Using Nielsen Scantrack sales data from January 2014 to January 2020 for 23 US states, we evaluate the effect of the EVALI outbreak. First-differenced state-panel regressions tracking unit sales of total-level and category-level e-cigarettes and cigarette sales controlling for price, Tobacco 21 policy coverage, product distribution, seasonality, EVALI-attributable deaths, and state-level e-cigarette policies affecting the availability of e-cigarettes (non-tobacco flavoured and total) were employed. RESULTS: Dollar sales of e-cigarettes declined 29% from their pre-EVALI peak by January 2020. Total sales of e-cigarettes declined in response to EVALI deaths and the total e-cigarette sales ban put in place in Massachusetts adopted in its wake. Cigarette sales were largely unchanged by either the direct or indirect policy effects of the EVALI outbreak, except for in Massachusetts, where cigarette sales-particularly those smoked by young people-rose temporarily after a total ban on e-cigarette sales. CONCLUSION: Sales of e-cigarettes declined in response to the EVALI outbreak and from the most restrictive regulatory policies that were adopted in response, while sales of cigarettes were affected less.

Effect of e-cigarette taxes on e-cigarette and cigarette retail prices and sales, USA, 2014-2019.

OBJECTIVE: To use a standardised e-cigarette tax measure to examine the impact of e-cigarette taxes on the price and sales of e-cigarettes and cigarettes in the USA. DESIGN: We used State Line versions of NielsenIQ Retail Scanner data from quarter 4 of 2014 through quarter 4 of 2019 to calculate e-cigarette and cigarette prices and sales in 23 US states. We then estimated how these outcomes are associated with standardised state-level e-cigarette taxes, controlling for state fixed effects, quarter-by-year fixed effects, cigarette taxes, other tobacco control policies and other state-level time-varying characteristics. RESULTS: A real $1 increase in the e-cigarette standardised tax increases the price of 1 mL of e-liquid between $0.43 and $0.59 depending on specification. Controlling for fixed effects and cigarette taxes, a 10% increase in e-cigarette taxes is estimated to reduce e-cigarette sales by 0.5% and increase cigarette sales by 0.1%, though both results are attenuated and statistically insignificant in a model with full controls. CONCLUSIONS: Our study finds that e-cigarette taxes increase e-cigarette retail prices by approximately half of the tax. Further, e-cigarette taxes are associated with reduced sales of e-cigarettes and increased sales of cigarettes in some specifications. Our estimates are sizably lower than from other studies using sales and survey data.

E-cigarette Device Type, Source, and Use Behaviors of Youth and Young Adults: Findings from the Truth Longitudinal Cohort (2020-2021).

Background: E-cigarette device types vary in the amount of nicotine delivered to users. Given that youth and young adults are using pod-based and disposable e-cigarettes with high nicotine concentrations, it is important to determine how e-cigarette use behaviors associated with nicotine dependence may differ across e-cigarette device type. Methods: Baseline information was collected from September 2020 to March 2021 and follow-up information was collected from July to October 2021 from the Truth Longitudinal Cohort. The final analytic sample included respondents (aged 15-24) who reported current use of e-cigarettes at either baseline or follow-up and provided information on the 4-item E-cigarette Dependence Scale (EDS). Differences in endorsement of items from the EDS by e-cigarette device type (pod-based, disposable, or tank) were assessed using chi-square tests. Results: Participants (N = 308) were evenly split on age (15-20, 21+) and gender. Most 15-20-year-olds used disposable e-cigarettes, while those 21+ years primarily used tank devices. Although EDS score did not differ by e-cigarette device type, positive endorsement of two items from the EDS significantly differed by e-cigarette device type. More tank users endorsed reaching for a device without thinking about it (tank: 92.6%; pod-based: 79.0%; disposables: 79.9%, p = 0.04) and vaping more before going into a situation where vaping is not allowed (tank: 92.9%; pod-based: 71.0%; disposables: 73.0%, p < 0.01). Conclusions: Findings have the potential to inform policy implementation by providing evidence for specific targets for regulatory action that can help to reduce the burdens of e-cigarette use among youth and young adults, as results suggest that tank device users are more likely to endorse use behaviors associated with nicotine dependence.

Examining the Comprehensiveness of Amended Flavored Tobacco Product Sales Restrictions.

CONTEXT: Flavored tobacco products contribute significantly to youth tobacco initiation and tobacco use disparities. In the last decade, 362 jurisdictions have enacted policies restricting the sale of flavored tobacco products; however, many policies are not fully comprehensive due to menthol and adult-only retailer exemptions. Although several of these restrictions have been amended since their original passage, to date, little is known about how amendments have affected policy comprehensiveness. OBJECTIVE: To describe how amendments to flavored tobacco product sales restrictions affect policy comprehensiveness. DESIGN: We identified flavored tobacco product sales restrictions that had been amended at least once using an internal database of US state and local flavored tobacco product sales restrictions. To characterize policy comprehensiveness, we applied a 6-level flavored tobacco policy classification scheme-level 6 being most comprehensive-to amended restrictions. We conducted a descriptive analysis of each initial policy and its most recent amendment to identify changes in retailer, product, and flavor inclusions, as well as overall comprehensiveness. MAIN OUTCOME MEASURES: Comprehensiveness of amended flavored tobacco product sales restrictions. RESULTS: As of March 31, 2022, no states and 50 localities had amended their flavored tobacco product sales restriction. Amendments largely increased policy comprehensiveness; most laws prior to amendment were categorized as level 1 (n = 28, 56.0%), while after amendment, the plurality were categorized as level 6 (n = 25, 50.0%). Most commonly, amendments removed menthol exemptions (n ≥ 30, 60.0%) and adult-only retailer exemptions (n = 12, 24.0%). CONCLUSIONS: Several local flavored tobacco product sales restrictions have been amended. Nearly all amendments increased policy comprehensiveness, primarily by removing exemptions for menthol products and exemptions for adult-only retailers. While policy advocates remain focused on passing comprehensive policies at initial passage, amendments have served as a tool to strengthen existing sales restrictions. This study along with ongoing flavored tobacco product sales restriction surveillance can inform policy advocacy and evaluation efforts.

Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: A randomized equivalence trial.

STUDY DESIGN: Multi--center randomized controlled trial with two intervention parallel groups. An equivalence trial. INTRODUCTION: Relative motion extension (RME) orthoses are widely used in the postoperative management of finger extensor tendon repairs in zones V-VI. Variability in orthotic additions to the RME only (without a wrist orthosis) approach has not been verified in clinical studies. PURPOSE OF THE STUDY: To examine if two RME only approaches (with or without an additional overnight wrist-hand-finger orthosis) yields clinically similar outcomes. METHODS: Thirty-two adult (>18 years) participants (25 males, 7 females) were randomized to one of two intervention groups receiving either 1) a relative motion extension orthosis for day wear and an overnight wrist-hand-finger orthosis ('RME Day' group), or 2) a relative motion extension orthosis to be worn continuously ('RME 24-Hr' group); both groups for a period of four postoperative weeks. RESULTS: Using a series of linear mixed models we found no differences between the intervention groups for the primary (ROM including TAM, TAM as a percentage of the contralateral side [%TAM], and Millers Criteria) and secondary outcome measures of grip strength, QuickDASH and PRWHE scores. The models did identify several covariates that are correlated with outcome measures. The covariate 'Age' influenced TAM (P = .006) and %TAM (P = .007), with increasing age correlating with less TAM and recovery of TAM compared to the contralateral digit. 'Sex' and 'Contralateral TAM' are also significant covariates for some outcomes. DISCUSSION: With similar outcomes between both intervention groups, the decision to include an additional night orthosis should be individually tailored for patients rather than protocol-based. As the covariates of 'Age' and 'Sex' influenced outcomes, these should be considered in clinical practice. CONCLUSIONS: A relative motion extension only approach with or without an additional overnight wrist-hand-finger orthosis yielded clinically similar results whilst allowing early functional hand use, without tendon rupture.

Exploration of Parkinson's Disease Symptomatology Subtypes From the Caregiver Perspective: Implications for Caregiver Burden, Depression, and Anxiety.

BACKGROUND: While research has demonstrated associations between Parkinson's disease (PD) severity and caregiver burden and emotional functioning, less is known about the associations between specific PD symptom patterns and caregiver functioning. OBJECTIVE: The purpose of the current study was to explore symptomatology subtypes in PD from the caregiver perspective in the U.S. and Mexico and to determine whether caregiver burden, depression, or anxiety differed by PD symptomatology subtype. METHODS: Two hundred fifty-three caregivers (M age = 59.9) completed Parts I and II of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Zarit Burden Interview, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scales. RESULTS: Cluster analysis using domains from the MDS-UPDRS revealed 5 symptomatology subtypes: pain/motor predominant, low symptoms, severe diffuse symptoms, moderate restricted symptoms with speech/oral predominant, and mood predominant. Caregiver burden was greatest for caregivers of individuals in the severe diffuse symptom and moderate restricted symptoms with speech/oral predominant clusters. High caregiver depression and caregiver anxiety were observed in all clusters other than the low symptoms cluster. There were no site by cluster interactions, suggesting that symptom patterns contribute to caregiver functioning in similar ways in the U.S. and Mexico. CONCLUSIONS: This data-driven analysis revealed 5 symptomatology subtypes of PD from caregivers' perspectives and highlighted the need for treatments and interventions based on predominant PD symptom expression. Importance of caregiver support across various symptomatology expressions, and particularly on specialist treatment for predominant speech/oral difficulties was recommended.

The contribution of Lynch syndrome to early onset malignancy in Ireland.

BACKGROUND: Lynch syndrome (LS) is an autosomal dominant hereditary cancer syndrome responsible for 2-4% of hereditary colorectal cancers (CRC). Mismatch repair protein deficiency (dMMR) is a characteristic feature of LS. It has been associated with a poor response to standard chemotherapy in metastatic colorectal cancer (mCRC). There is currently no LS database to monitor trends of disease in Ireland. We aim to centralise LS data in Ireland to assess the burden of LS in Ireland and guide improvements in prevention and treatment of LS-associated cancer. METHODS: A retrospective review was carried out including all medical records for LS patients from two of the three cancer genetics clinics in Ireland between 2000 and 2018 was carried out. Clinicopathological data of probands (n = 57) and affected family members including demographics, mutation status, cancer diagnosis and outcome was recorded. Statistical analysis was carried out using SPSS software. RESULTS: Fifty-seven families including three-hundred and forty-five individuals affected by cancer were identified. The most common cancers recorded were colorectal (53%), breast (12%) and endometrial (10%). One-hundred and thirty-eight confirmed carriers were identified: 65 path_MLH1 (47%), 43 path_MSH2 (31%), 11 path_MSH6 (8%), 17 path_PMS2 (12%) and two path_EPCAM (1%). Cancer type varied significantly by gene. Median age of first diagnosis was 44.5 years (range 23-81). Half of all deceased patients (n = 11) in this group died within 2.5 years of first diagnosis. These deaths were directly related to cancer in 59% of cases. CONCLUSIONS: Under diagnosis of LS misses a powerful preventive and therapeutic opportunity. LS causes early onset dMMR cancer diagnoses with substantial societal impact. Implementation of ICBs into treatment policy for this small cohort of dMMR mCRC is an achievable therapeutic goal that may significantly improve survival. A prospective database for LS in Ireland is necessary to maximise prevention in this population.

Classifying the comprehensiveness of flavoured tobacco sales restrictions: development and application of a tool to examine US state and local tobacco policies.

OBJECTIVES: Comprehensive tobacco control policies with minimal exemptions can reduce tobacco use and sales. Many states and localities have adopted flavoured tobacco product (FTP) sales restrictions. This study describes the development and application of a schema to characterise the comprehensiveness of these FTP sales restrictions. DESIGN: We coded state and local FTP sales restrictions enacted June 2007-March 2021 for retailer, tobacco product, and flavour inclusions and exemptions. Guided by FTP literature, legal resources and meetings with FTP policy experts, we developed a six-level classification scheme to characterise coded FTP policies from least to most comprehensive. We present descriptive statistics of FTP policy features and comprehensiveness. RESULTS: As of 31 March 2021, 7 state-level and 327 local-level FTP sales restrictions were enacted in the USA. Most state-level policies (71.4%) were categorised in the second lowest comprehensiveness category; local policies most commonly fell within the lowest (48.9%) or highest (26.0%) comprehensiveness categories. Across jurisdictions, adult-only retailers were most frequently exempted from the FTP sales restrictions (state: n=1, 14.3%; local: n=184, 56.3%); and most jurisdictions included electronic cigarettes (e-cigarettes) as a banned product (state: n=6, 87.5%; local: n=327, 100%). While just over half of state (n=4, 57.1%) and local (n=169, 51.7%) sales restrictions included menthol e-cigarettes, most excluded menthol cigarettes and/or menthol smokeless tobacco. CONCLUSIONS: Comprehensiveness of FTP sales restrictions in the USA varies widely. Current and future FTP policies would be strengthened by including all flavours and all tobacco products-particularly menthol cigarettes-and by avoiding exemptions for certain retailers, particularly adult-only retailers.

Menthol e-cigarette sales rise following 2020 FDA guidance.

OBJECTIVE: To explore patterns in flavoured e-cigarette sales following Juul Labs' 2019 removal of mint-flavoured products and the Food and Drug Administration's (FDA) 2020 e-cigarette flavour guidance which prohibits flavoured cartridge-based sales, but allows for the sale of tobacco-flavoured and menthol-flavoured cartridges, open-system and disposable e-cigarettes. METHODS: We examined Nielsen Retail Scanner data from September 2013 to March 2020. Inflation-adjusted sales dollars for e-liquid-containing products were classified into five flavour categories (fruit, menthol, mint, tobacco and other). RESULTS: Following the Juul Labs 2019 and FDA 2020 actions, total e-cigarette sales declined; however, menthol-flavoured e-cigarette sales dollars increased, while mint-flavoured e-cigarette sales dollars decreased in both instances. Juul Labs' removal of mint-flavoured products was followed by a 59.4% increase in the market share of menthol-flavoured e-cigarettes over 4 weeks. The FDA's 2020 guidance was followed by a 54.5% increase in the market share of menthol-flavoured e-cigarettes over 4 weeks and a 82.8% increase over 8 weeks. CONCLUSIONS: Juul Labs' self-regulation and the current FDA flavour guidance were followed by a shift towards menthol-flavoured e-cigarettes. Industry self-regulation and current federal guidance appear insufficient in reversing the youth vaping epidemic. E-cigarettes must be fully regulated as a tobacco product including the removal of flavoured e-cigarettes, including menthol, from the market to reduce youth e-cigarette use.

Sleep Health as Measured by RU SATED: A Psychometric Evaluation.

Objective/Background: Sleep health is a multidimensional construct of sleep and wakefulness that operationalizes optimal sleep as more than the absence disease. Despite its importance to public health promotion efforts, empirical research examining sleep health is currently limited, possibly due to the lack of empirically validated measures. Therefore, the purpose of the current study was to evaluate the psychometric properties of a previously proposed six-item sleep health scale (RU- SATED). Participants: A sample of 3,401 adults (Mean Age = 42.77, 47.8% female) completed an online survey of sleep and health. Methods: Participants completed the RU-SATED scale, as well as other sleep-related measures including the Insomnia Severity Index (ISI) and the Sleep Self-Efficacy Scale (SSE). Results: An exploratory factor analysis (EFA) revealed a two-factor structure. A confirmatory factor analysis (CFA) using this two-factor structure demonstrated adequate to good model fit indices (X 2 = 45.96, df = 8, p < .01; RMSEA = .04; CFI = .98; NFI = .98; TLI = .97). Cronbach's α was .64 and the average interitem correlation was .22. RU-SATED was negatively associated with insomnia severity and positively associated with both self-reported sleep and sleep self-efficacy. Conclusions: RU-SATED appears to be a valid instrument for the assessment of sleep health among adults that is related to, but distinct from, other established sleep constructs. Future research may benefit from examining the test-retest reliability of the measure and assessing the predictive validity of sleep health as it relates to health-related outcomes.

Measurement of aggression in older adults.

Aggressive behaviors are prevalent in late-life and are associated with important consequences for older adults, caregivers, and healthcare providers. Age-related changes in the manifestation of aggression are precipitated in part by the rise of cognitive impairment. Such changes necessitate the use of psychometrically sound measures. The present article identifies existing measures of aggression for older adults, highlights the strengths and limitations of these measures, and proposes avenues for future research in this area. Five full-scale measures of aggression, as well as five subscales of aggression embedded within larger non-aggression measures in older adults were identified. Overall, measures of aggression specific to late-life are predominately observational and limited to individuals with dementia or older adults living in long-term care settings. The psychometric properties of aggression scales in late-life generally indicate adequate internal consistency, interrater reliability, and concurrent validity. In contrast, the reliability and validity of subscales of aggression contained within larger neuropsychiatric measures are more difficult to ascertain due to limited research. Future investigations would benefit from examining the psychometric properties of widely-used self-report measures of aggression among older adults, further evaluating the psychometric properties of aggression subscales, and developing additional measures which are predictive of aggressive behaviors.

Examining models of psychologists' telepsychology use during the COVID-19 pandemic: A national cross-sectional study.

OBJECTIVE: The aim of this study is to apply the theory of reasoned action (TRA) and technology acceptance model (TAM) to psychologists' telepsychology use during the COVID-19 pandemic. METHODS: A sample of 2619 US-licensed psychologists completed a survey assessing telepsychology use and aspects of both models in May 2020. RESULTS: Cross-sectional TRA and TAM path models evidenced excellent fit in explaining psychologists' telepsychology use. The TRA indicated that psychologists' attitudes concerning telepsychology and subjective norms were associated with intentions to use telepsychology, which related to percentage of clinical work performed via telepsychology. The TAM showed that perceived usefulness of telepsychology and perceived ease of use were associated with attitudes toward telepsychology. Perceived usefulness was associated with psychologists' intention to use telepsychology, as was perceived ease of use. CONCLUSION: Efforts to facilitate telepsychology provision during the pandemic and broadly may benefit from trainings and campaigns to address attitudes toward telepsychology, subjective norms, and perceived ease of use.

E-cigarette Tobacco Retail Licensing Laws: Variance Across US States as of January 1, 2020.

Objectives. To describe how US states and the District of Columbia regulate e-cigarette sales by examining e-cigarette-specific tobacco retail licensing (TRL) laws.Methods. We coded 25 state-level e-cigarette TRL laws (effective as of January 1, 2020) for provisions we labeled as either "core" (e.g., presence of license terms, fees, and penalties) or "descriptive" (e.g., license fee amount and term length).Results. Overall, 23 laws clearly defined a license term, 23 laws required a license fee, and 19 laws identified penalties for violations that included both license suspension and revocation. Fees widely ranged ($5-$1000 annually), and 8 laws did not explicitly direct fees toward TRL administration or enforcement. No law required that retailers comply with all local, state, and federal tobacco or e-cigarette laws.Conclusions. Most laws contained core TRL provisions. Several laws, however, had minimal license fees and did not direct fees toward administration or enforcement. As youth e-cigarette use increases, more states should consider establishing e-cigarette TRL laws or incorporating provisions into existing TRL laws.

JUUL in School: Teacher and Administrator Awareness and Policies of E-Cigarettes and JUUL in U.S. Middle and High Schools.

Electronic cigarette (e-cigarette) use, including JUUL, has risen to epidemic levels among high school and middle school students in the United States. Schools serve as a key environment for prevention and intervention efforts to address e-cigarette use, yet little is known about the awareness of and response to e-cigarettes in schools. This national survey of middle and high school teachers and administrators (n = 1,420) measured JUUL awareness, e-cigarette policies, and barriers to enforcement in schools. While two thirds of respondents had heard of a product called JUUL (67.6%), less than half accurately identified a photo of a JUUL as a vaping device/e-cigarette (47.3%). Awareness of JUUL (80.9%) was higher among high school teachers (83.3%) than among middle school teachers (78.3%). A large majority of respondents reported that their school had an e-cigarette policy (82.9%), but less than half of the sample worked in a school with a policy that specifically included JUUL (43.4%). Those working in a school with an e-cigarette policy in place noted that e-cigarettes' discreet appearance (65.6%) and difficulties in identifying origin of vapor or scent (46.1%) made the policy difficult to enforce. Efforts to increase middle and high school staff awareness of the ever-evolving e-cigarette market are essential to help prevent youth use. Adoption and enforcement of policies will be critical to ensure that schools remain tobacco-free spaces.

Not-so-disposable e-cigarettes: Methods young people use to discard single-use e-cigarettes.

BACKGROUND AND AIMS: To date, most tobacco product waste research focuses on cigarettes. Less is known about single-use 'disposable' e-cigarette waste, which contains several hazardous and toxic materials. This exploratory study examines self-reported methods for discarding disposables among a national sample of US adolescents and young adults. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Data were obtained from a weekly cross-sectional survey of US residents aged 15-24 years. The analytical sample consisted of data collected from November 2022 to August 2023 from respondents who reported past-30-day use of disposables (n = 1313). Weighted multinomial logistic regressions examined the association between tobacco use behaviors and respondents' primary self-reported method for discarding disposables (reference group: 'throw them in the regular trash'), controlling for socio-demographic variables. FINDINGS: Approximately half of respondents discarded their empty disposables in the regular trash (52.9%). On average, respondents reported throwing away 3.1 disposables monthly [95% confidence interval (CI) = 2.83, 3.29]. Second most commonly, respondents reported keeping or collecting empty disposables (21.4%). Respondents who reported 10-30 days (versus 1-9) of past-month vaping were more likely to primarily keep or collect disposable e-cigarettes (relative risk reduction = 1.64, 95% CI = 1.20, 2.24) compared to discarding in the trash. CONCLUSIONS: Young people in the United States who use disposable e-cigarettes report primarily discarding their disposable e-cigarettes in the regular trash or keeping them. All reported disposal methods raise safety and environmental concerns.

Patient Motivation to Reduce or Discontinue Opioids for Chronic Pain: Self-efficacy, Barriers, and Readiness to Change.

OBJECTIVES: This study aimed to assess levels and predictors of self-efficacy and motivation to change opioid use among a community sample of patients using opioids for chronic pain, as well as patient-reported barriers to pursuing opioid discontinuation. METHODS: Participants with a variety of chronic pain conditions, recruited from ResearchMatch.org , completed a battery of electronic, self-report questionnaires assessing demographic and medical characteristics, pain treatment history, and levels of readiness, self-efficacy, and other attitudes toward reducing or discontinuing opioid use. Multiple regression analyses and analyses of variance were conducted to examine predictors of readiness and self-efficacy to change opioid use. A modified version of rapid qualitative analysis was utilized to analyze themes in participant responses to an open-ended item about "what it would take" to consider opioid discontinuation. RESULTS: The final sample included N=119 participants, the majority of whom were female (78.2%), Caucasian (77.3%), and well-educated. Readiness and self-efficacy to decrease or stop opioid use were fairly low on a 0 to 10 Visual Analog Scale (2.6 to 3.8) and significantly higher to decrease than stop ( P <0.01). Higher readiness to change was predicted by lower pain severity and higher concern about opioids, whereas higher self-efficacy was predicted by shorter pain duration. Results from the qualitative analyses revealed that the availability of an alternative treatment option was the most commonly cited requirement to consider opioid discontinuation. DISCUSSION: Patients with lower pain severity, shorter duration of pain, and higher concerns about opioids may be a prime target from a motivation standpoint for interventions addressing opioid tapering and discontinuation.

Illuminating a Path Forward for Tobacco Nation: Projected Impacts of Recommended Policies on Geographic Disparities.

Introduction: This study quantifies the impacts of strengthening 2 tobacco control policies in "Tobacco Nation," a region of the United States (U.S.) with persistently higher smoking rates and weaker tobacco control policies than the rest of the US, despite high levels of support for tobacco control policies. Methods: We used a microsimulation model, ModelHealthTM:Tobacco, to project smoking-attributable (SA) outcomes in Tobacco Nation states and the U.S. from 2022 to 2041 under 2 scenarios: (1) no policy change and (2) a simultaneous increase in cigarette taxes by $1.50 and in tobacco control expenditures to the CDC-recommended level for each state. The simulation uses state-specific data to simulate changes in cigarette smoking as individuals age and the health and economic consequences of current or former smoking. We simulated 500 000 individuals for each Tobacco Nation state and the U.S. overall, representative of each population. Results: Over the next 20 years, without policy changes, disparities in cigarette smoking will persist between Tobacco Nation and other U.S. states. However, compared to a scenario with no policy change, the simulated policies would lead to a 3.5% greater reduction in adult smoking prevalence, 2361 fewer SA deaths per million persons, and $334M saved in healthcare expenditures per million persons in Tobacco Nation. State-level findings demonstrate similar impacts. Conclusions: The simulations indicate that the simulated policies could substantially reduce cigarette smoking disparities between Tobacco Nation and other U.S. states. These findings can inform tobacco control advocacy and policy efforts to advance policies that align with evidence and Tobacco Nation residents' wishes.