Young adults' attention to reduced exposure claims in IQOS advertising and associations with product perceptions and use intentions.

INTRODUCTION: Non-combusted tobacco products, particularly those authorized as modified risk tobacco products (MRTPs), may appeal to young adults. This cross-sectional study explored young adults' attention to reduced exposure claims in IQOS advertising and its associations with product perceptions and use intentions. METHODS: Fifty-one young adults aged 21-29 (mean age = 24.5 years old, 54.9% who smoked cigarettes, 47.1% male, 66.7% White) viewed an IQOS advertisement containing two reduced exposure claims (one large, one detailed) for 20 seconds during eye-tracking, then completed post-exposure questionnaires (risk beliefs, harm perceptions, attitudes, use intentions). We compared attention and questionnaire measures by smoking status and examined associations between attention to reduced exposure claims and questionnaire measures. RESULTS: Overall, the large (vs. detailed) reduced exposure claim attracted young adults' attention more quickly, but the detailed claim held attention longer than all other advertisement features (p's < .001). There were no differences by smoking status in how quickly either claim attracted or held initial attention, but young adults who smoked (vs. did not smoke) spent more cumulative time looking at the large claim and less time looking at the detailed claim (p's < .05). Among those who smoked, greater dwell time on the detailed reduced exposure claim was associated with more beliefs about reduced harm, lower perceived risk of addiction, and greater intentions to try IQOS (p's <.05). CONCLUSIONS: Detailed information on reduced exposure in IQOS advertising may convey reduced risk and potentially promote uptake of IQOS among young adults who smoke and attend to this content. IMPLICATIONS: Findings from this exploratory, single-exposure study demonstrate differences in young adults' attention to reduced exposure claims in an IQOS advertisement based on their smoking status. Among those who smoke, greater attention to detailed reduced exposure information was associated with reduced perceptions of harm compared to cigarettes, and greater intentions to try IQOS. Findings suggest that among young adults who smoke cigarettes and visually engage with this content, detailed text containing IQOS' authorized reduced exposure claims is interpreted as reduced risk information and may promote uptake of this product.

Perceptions of FDA-authorized e-cigarettes and use interest among young adults who do not use tobacco.

INTRODUCTION: It is unclear how young adults who do not use tobacco perceive FDA-authorized e-cigarettes for market entry. This study explored the perceptions and use interests of FDA-authorized e-cigarettes among this population to inform policy decision-making. METHODS: We conducted in-depth interviews with young adults in the US, aged 18-29 years, who do not use tobacco (n=25). Participants viewed images of FDA-authorized e-cigarettes and discussed their perceptions and interest in using these products. We used reflexive thematic analysis to analyze interview data. RESULTS: Many participants stated that they were not interested in using FDA-authorized e-cigarettes because they had little interest in using e-cigarettes in general. Additionally, almost all participants found the tobacco flavor and product design of these products unappealing, which further added to their disinterest. Most reported high trust in the FDA and its authorization process for e-cigarette market entry and considered FDA-authorized e-cigarettes safe to use. Most considered FDA-authorized products less harmful than other (unauthorized) e-cigarettes they saw in daily life but were not more interested in using the authorized products. When given the hypothetical scenario where FDA-authorized products come with a variety of fruit and candy flavors, most participants still expressed little interest in using them, mainly due to the high perceived harm from using any e-cigarette products. CONCLUSIONS: Although non-tobacco-using young adults in our study reported low interest in using FDA-authorized e-cigarettes for market entry and e-cigarettes in general, the FDA is recommended to continue to evaluate the impact of flavorings and packages on e-cigarette product appeal to reduce e-cigarette use among young people. The FDA should also examine strategies to effectively communicate the purpose of FDA authorization to the public and emphasize that it does not mean these products are 'approved' or safer than unauthorized products.

Associations Between Noticing E-Cigarette Advertising Features and E-Cigarette Appeal and Switching Interest Among Young Adult Dual Users.

BACKGROUND: E-cigarette advertising, which often includes various features, may prompt e-cigarette use and product switching. This study examined the associations between noticing e-cigarette ad features and perceived product appeal and interest in completely switching from cigarettes to advertised e-cigarettes among young adult dual users of both products. METHODS: We analyzed data from an online heatmap experiment among young adult dual users defined as established cigarette smokers who currently used e-cigarettes (ages 18-34 years; n = 1,821). Participants viewed 12 e-cigarette ads, clicked on ad features (e.g., fruit flavors, nicotine warnings, price promotions, smoker-targeted claims) that attracted their attention (defined as "noticing"), and answered questions about e-cigarette product appeal and interest in completely switching from cigarettes to the e-cigarettes shown. We examined within-person associations between noticing specific ad features and outcomes, controlling for demographic and tobacco use-related characteristics. RESULTS: Noticing fruit flavors (AOR = 1.67 and 1.28) and fruit images (AOR = 1.53 and 1.21) was positively associated with having any e-cigarette product appeal and switching interest. Noticing price promotions (AOR = 1.23) was positively associated with product appeal. In contrast, noticing nicotine warnings (AOR = 0.74 and 0.86), smoker-targeted claims (AOR = 0.78 and 0.89), and tobacco flavors (AOR = 0.92 and 0.90) was negatively associated with product appeal and switching interest. CONCLUSIONS: Noticing certain e-cigarette ad features (e.g., fruit flavors and nicotine warnings) may be associated with product appeal and/or switching interest among young adult dual users. More research is needed to assess the influence of e-cigarette ad features that promote product switching interests among cigarette smokers while discourage interests among tobacco-naïve individuals.

Recognition of online e-cigarette marketing and e-cigarette-related attitudes and behaviors among young adults.

INTRODUCTION: Past research examining the relationship between exposure to online e-cigarette marketing and e-cigarette-related attitudes and behaviors has relied on unaided recall measures that may suffer from self-report bias. To date, few studies have presented participants with e-cigarette marketing stimuli and assessed recognition. This study examined the associations between recognition of online e-cigarette marketing stimuli and e-cigarette-related attitudes and behaviors among young adults in California. METHODS: A non-probability representative sample of young adults (ages 18-24; N=1500) living in California completed an online survey assessing their recognition of online e-cigarette marketing stimuli, including image-based (i.e., Instagram, email) and audiovisual (i.e., YouTube, TikTok) promotions, and positive e-cigarette-related attitudes (e.g., appeal of e-cigarettes) and behaviors (e.g., e-cigarette use). Adjusted and weighted logistic regression analyses were used. RESULTS: 79.0% (n=1185) of young adults, including 78.1% (n=310/397) of participants under 21 years old, recognized online e-cigarette marketing. Participants who reported recognition of stimuli, compared with those who did not, had greater odds of reporting appeal of e-cigarettes (AOR=2.26, 95% CI=1.65-3.09) and e-cigarette purchase intentions (AOR=1.66, 95% CI=1.13-2.43) among all participants, and susceptibility to use e-cigarettes among never users (AOR=2.29, 95% CI=1.59-3.29). CONCLUSIONS: Young adults in California recognized audiovisual and image-based online e-cigarette marketing. Such recognition may lead to positive e-cigarette-related attitudes and behavioral intentions, especially among never users. Future research should examine the causal relationship between the associations found in this study. Findings may inform the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures. IMPLICATIONS: Recognition of online e-cigarette marketing stimuli was associated with greater odds of reporting appeal and benefits of e-cigarettes, purchase intentions, and lifetime e-cigarette use among all participants, and susceptibility to use e-cigarettes among never users. These findings may motivate the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures.

Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021.

INTRODUCTION: Little is known about the influence of e-cigarette marketing on cannabis vaping behaviors. This study examined the associations between e-cigarette marketing exposure and nicotine and cannabis vaping among adults. METHODS: This cross-sectional study included a U.S. nationally representative sample of adults from the Wave 6 survey of the Population Assessment of Tobacco and Health Study. We used multinomial logistic regressions to examine the associations between past 30-day e-cigarette marketing exposure and past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age. RESULTS: Overall, 52.0 % of respondents reported e-cigarette marketing exposure, and 89.8 %, 5.6 %, 3.2 %, and 1.4 % reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. E-cigarette marketing exposure was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95 % confidence interval [CI], 1.09-1.57) and dual-vaping versus no vaping (aRR, 1.26; 95 % CI, 1.01-1.57). This association was found among those aged 18-24 and 25-34 years. It was also associated with increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95 % CI, 1.04-1.58). This association was found among those aged 18-24 years. DISCUSSION: E-cigarette marketing exposure was associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18-24 and 25-34 years. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in marketing restrictions for cannabis may contribute to e-cigarette marketing influence on cannabis vaping.

Young adults' visual attention to features of social media marketing for disposable e-cigarettes and associated perceptions.

BACKGROUND AND AIMS: E-cigarette marketing exposure on social media influences perceptions; however, limited knowledge exists regarding marketing features attracting the most visual attention. This study examined visual attention to features of social media marketing for disposable e-cigarettes and related product perceptions. DESIGN, SETTING AND PARTICIPANTS: Participants viewed 32 disposable marketing post images from social media (Instagram) using computer-based eye-tracking technology to assess standardized attention metrics of marketing features. They then completed a survey assessing positive product perceptions. The study took place in New Jersey, USA, June-September 2022, comprising young adults (aged 18-29) who do not use tobacco (n = 72) or who smoke cigarettes (n = 42). MEASUREMENTS: We examined associations between 14 marketing features (e.g. product package, personal item, fruit/candy descriptor, social media account) and standardized attention metrics of dwell time (fixation duration) and entry time (time to first fixation). Then, we assessed attention metrics for each feature in relation to positive product perceptions (appeal and positive use expectancy). FINDINGS: Among all participants, dwell time was the longest for the product descriptor [marginal means (MM) = 1.77; 95% confidence interval (CI) = 1.69, 1.86], social media account (MM = 1.76; 95% CI = 1.67, 1.85) and fruit/candy descriptor features (MM = 1.56; 95% CI = 1.41, 1.70); entry time was the shortest for the social media account (MM = 0.35; 95% CI = 0.26, 0.46), personal item (MM = 0.36; 95% CI = 0.17, 0.56) and human model features (MM = 0.40; 95% CI = 0.08, 0.72). Two use status groups had comparable dwell and entry times, except for the product descriptor feature. Longer dwell time for the product package feature increased positive product perceptions among both use status groups [regression coefficient (ß) = 0.44 and 2.61]. Longer dwell time for fruit/candy descriptor (ß = 1.80) and price promotion features (ß = 4.04) increased positive product perceptions among those who smoke. CONCLUSIONS: US young adults appear to be particularly visually engaged by disposable e-cigarette marketing that uses social media account features (account profile pictures, information about the products marketed and relevant hashtags) and features enhancing the products' personal relatability. Disposable product packages, fruit/candy descriptors and price promotions may increase the influence of social media marketing among various use status groups.

Longitudinal association between harm perceptions and tobacco behaviors among adults who smoke cigarettes: Differential associations across age groups using the PATH study.

INTRODUCTION: The relationship between e-cigarette and cigarette harm perceptions and tobacco behaviors may vary by age. We examined longitudinal associations of harm perceptions with tobacco use behaviors among adults who smoke cigarettes. METHODS: Data were from Waves 4 (2016-2018) and 5 (2018-2019) of the Population Assessment of Tobacco and Health survey. Weighted multivariable logistic regressions identified independent associations between relative and absolute e-cigarette and cigarette harm perceptions at baseline and continued smoking, dual use, complete switching, and quit intention at follow-up, stratified by age (young adults [YAs] 18-24, middle-aged adults [MAs] 25-44, and older adults [OAs] ≥45) among U.S. adults who smoke (n=8,231). RESULTS: Perceiving e-cigarettes as less harmful than cigarettes was associated with higher odds of complete switching from cigarettes to e-cigarettes (aORs overall: 1.52; MAs: 1.68). Perceiving e-cigarettes as very/extremely harmful was associated with lower odds of dual use (overall aOR: 0.75; MAs: 0.72) and higher odds of quit intention (aOR among OAs: 1.34). Perceiving cigarettes as very/extremely harmful was associated with lower odds of continued smoking (overall aOR: 0.69; MAs: 0.76; OAs: 0.53), and higher odds of complete switching (overall aOR: 1.65; MAs: 1.86) and quit intention (overall aOR: 1.58; MAs: 1.42; OAs: 1.80). No findings reached significance for YAs. DISCUSSION: E-cigarette relative and absolute harm perceptions were associated with different tobacco behaviors by age. Low cigarette harm perceptions were similarly associated with continued smoking and lower quit intentions in MAs and OAs. Future research should explore what beliefs inform these perceptions and age-related differences. IMPLICATIONS: The associations between harm perceptions and subsequent tobacco behaviors differed by age among adults who smoke. This study adds that low relative harm perceptions of e-cigarettes can promote complete switching among MAs who smoke. High absolute harm perceptions of e-cigarettes may deter dual use among MAs. Additionally, high absolute harm perceptions of cigarettes may reduce smoking and increase cigarette smoking quit intentions among MAs and OAs. Future research is needed to understand the beliefs that support harm perceptions among different age groups and why their effects differ by age, and what factors influence YAs' tobacco use behaviors.

The impact of exposure to FDA e-cigarette authorization messages on product perceptions and interest - an experiment with adults who smoke and youth.

INTRODUCTION: In the United States, e-cigarettes have entered a new regulatory era, needing authorizations from FDA to remain on or enter the marketplace. This study explored the impact of e-cigarette authorization messages on product perceptions and interest. METHODS: We conducted an online experiment in June 2022 with nationally-representative samples of adults (21+) who smoke cigarettes (n=866) and youth ages 15-20 (n=859). They were randomized to one of five conditions: viewing an ad for a fictional e-cigarette brand with no reference to FDA (control), an ad with an "authorized for sale by FDA" claim in varying presentation styles (plain text, FDA "approved" stamp, FDA logo), or reading a fictional news excerpt about the product's authorization plus control ad. We compared group differences on product interest, susceptibility, harm perceptions and message perceptions. RESULTS: Among adults who smoke, there were no effects on product interest nor susceptibility, but ratings of the product's harmfulness compared to cigarettes were lower among those in the news versus control condition (ß=-0.25, p=.04). Among youth, odds of susceptibility were higher among ever e-cigarette users who viewed the ad with the FDA logo authorization message relative to the control ad (OR=6.3, 95% CI:1.67-23.9, p<0.01). About 40% of all participants agreed the authorization claim makes them think the product is safe to use, but fewer (14-19%) agreed it makes them more interested in trying it. CONCLUSIONS: FDA e-cigarette authorization messages may impact some beliefs about product harm. More research is needed to track potential impacts on product use. IMPLICATIONS: This study provides new data about the potential impact of messages about FDA authorization of e-cigarette products (presented as ad claims or a news story) on authorized product perceptions, interest and susceptibility among adults who smoke cigarettes and youth. Our results suggest that FDA e-cigarette authorization messages may impact harm-related beliefs among adults who smoke and product susceptibility among youth who have ever used e-cigarettes before, though real-world effects are likely to be impacted by message type and format, and perceived message source and credibility. Authorization messages are likely to be misinterpreted as "FDA approval" by some; therefore, providing clarifications about authorization meaning and standards are relevant where possible.

Using Eye tracking to Examine Young Adults' Visual Attention to E-cigarette Advertising Features and Associated Positive E-cigarette Perceptions.

BACKGROUND: Little is known about the influence of e-cigarette marketing features on the antecedents of e-cigarette use. PURPOSE: Using an eye-tracking experiment, we examined visual attention to common features in e-cigarette ads and its associations with positive e-cigarette perceptions among young adults. METHODS: Young adults (ages 18-29) who smoke cigarettes (n = 40) or do not use tobacco (n = 71) viewed 30 e-cigarette ads on a computer screen. Eye-tracking technology measured dwell time (fixation duration) and entry time (time to first fixation) for 14 pre-defined ad features. Participants then completed a survey about perceptions of e-cigarettes shown in the ads. We used regression models to examine the associations between ad features and standardized attention metrics among all participants and by tobacco-use status and person-aggregated standardized attention for each ad feature and positive e-cigarette perceptions. RESULTS: Dwell time was the longest for smoker-targeted claims, positive experience claims, and price promotions. Entry time was the shortest for multiple flavor descriptions, nicotine warnings, and people. Those who do not use tobacco had a longer dwell time for minor sales restrictions and longer entry time for purchasing information than those who smoke. Longer dwell time for multiple flavor descriptions was associated with e-cigarette appeal. A shorter entry time for fruit flavor description was associated with positive e-cigarette-use expectancies. CONCLUSIONS: Young adults allocated attention differently to various e-cigarette ad features, and such viewing patterns were largely similar by tobacco-use statuses. Multiple or fruit flavors may be the features that contribute to the positive influence of e-cigarette marketing among young adults.

E-cigarette marketing exposure is associated with e-cigarette use among young adults. However, little is known about the influence of e-cigarette marketing features among this population. This study used eye-tracking technology to objectively measure dwell time and entry time for 14 pre-defined e-cigarette ad features. Young adults (ages 18­29) who smoke cigarettes (n = 40) or do not use tobacco (n = 71) viewed 30 e-cigarette ads on a computer screen and completed an online survey about positive e-cigarette perceptions. The study found that dwell time was the longest for smoker-targeted claims, positive experience claims, and price promotions. Entry time was the shortest for multiple flavor descriptions, nicotine warnings, and people. Those who do not use tobacco had a longer dwell time for minor sales restrictions and longer entry time for purchasing information than those who smoke. Longer dwell time for multiple flavor descriptions was associated with e-cigarette appeal. A shorter entry time for fruit flavor description was associated with positive e-cigarette-use expectancies. The results suggest that young adults allocated attention differently to various e-cigarette ad features, and such viewing patterns were largely similar by tobacco-use statuses. Multiple or fruit flavors may be the features that contribute to the positive influence of e-cigarette marketing among young adults.

Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021.

Importance: Vaping has become an increasingly common method for consuming nicotine and cannabis, a trend potentially influenced by e-cigarette marketing. However, little is known about the influence of e-cigarette marketing on cannabis vaping behaviors. Objective: To examine the associations between e-cigarette marketing exposure and nicotine and cannabis vaping behaviors among adults. Design Setting and Participants: This cross-sectional study included a U.S. nationally representative sample of adults (≥18 years) from the Wave 6 survey of the Population Assessment of Tobacco and Health (PATH) Study, conducted from March to November 2021. Exposure: Past 30-day e-cigarette marketing exposure (overall and by ten marketing channels). Main Outcomes and Measures: Past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age. Results: The study included 30,516 respondents (48.0% male and 63.9% non-Hispanic White). Overall, 52.0% of respondents reported past 30-day e-cigarette marketing exposure, and 89.8%, 5.6%, 3.2%, and 1.4% reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. Multinominal logistic regression results show exposure to e-cigarette marketing was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95% confidence interval [CI], 1.09-1.57) and dual-vaping versus no vaping (aRR, 1.26; 95% CI, 1.01-1.57). Stratification analysis found these associations among those aged 18-24 and 25-34 years but not older adults (≥35 years). Those exposed to e-cigarette marketing also had increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95% CI, 1.04-1.58). Stratification analysis found this association only among those aged 18-24 years. E-cigarette marketing exposure via several channels (retail stores, billboards, events, newspapers/magazines) was associated with increased odds of reporting sole-cannabis vaping. Conclusions and Relevance: E-cigarette marketing exposure was only associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18-24 and 25-35 years and were found for multiple marketing channels. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in such marketing restrictions for cannabis may contribute to continued influence of e-cigarette marketing on cannabis vaping.

Does noticing cigar warnings associate with cigar harm perceptions and smoking behaviors? Analysis from Wave 5 of the population assessment of tobacco and health study.

BACKGROUND: In the US, cigar warning label standards are less stringent than cigarette warning requirements and are not uniformly required; research is needed about warning efficacy in promoting cigar risk beliefs, discouraging use and supporting public health. METHODS: Using data from the PATH Study (Wave 5), we analyzed associations between noticing cigar warnings and perceived harm from cigar use, frequency of thinking about harms, and effects of warnings labels. RESULTS: Among adults who smoke cigars, respondents noticing warnings at least sometimes (vs. never/rarely) had higher odds of thinking about harms of their tobacco use often/very often (cigarillos 30% vs. 19%, p <.001, aOR 1.80 [1.27, 2.56]); filtered cigars: 43% vs. 16%, p <.001, aOR 3.81 [2.50, 5.82]) and of reporting that smoking cigars is very/extremely harmful (cigarillos: 59% vs. 46%, p =.001, aOR 1.45 [1.05, 1.99]). A substantial majority found cigar warnings to be very/extremely believable (cigarillos: 63%, filtered cigars: 59%, traditional cigars: 65%), with 16%, 24% and 12% respectively reporting past-30-day warning avoidance. Those noticing warnings at least sometimes (vs. rarely) had higher rates of reporting that warnings sometimes/often/very often stopped them from having a cigar in the past 30 days (cigarillos: 36% vs. 10%; filtered cigars: 50% versus 6%; traditional cigars: 30% versus 9%; p's < 0.001) and that warnings made them somewhat/a lot more likely to quit smoking (cigarillos: 55% versus 37%, p <.01; filtered cigars: 55% versus 26%, p <.001; traditional cigars: 39% vs. 24%, p <.05). CONCLUSIONS: Results support potential public health benefits of mandating the presence and increasing salience of cigar warning labels.

Exploring the Influence of E-cigarette Ad Features on Perceived Product Appeal and Use Interest Among Young Adults of Varying Tobacco-Use Behaviors.

INTRODUCTION: Exposure to certain features in commercial e-cigarette ads may influence e-cigarette use perceptions. This study explored the reactions toward common features in e-cigarette ads among young adults of various tobacco-use behaviors. AIMS AND METHODS: We used data from in-depth interviews with U.S. young adults (ages 18-29) who do not use tobacco (n = 26) and who currently smoke cigarettes (n = 26). Participants viewed 30 print e-cigarette ads that included multiple features (eg, fruit flavors, price promotions, smoker-targeted messages) before discussing their perceived influence of memorable ad features. We used reflective thematic analysis to analyze interview data. RESULTS: Participants from both groups generally noticed fruit and multiple flavors displayed in the ads, which were seen as appealing and were reported to generate product-use interest because of bright colors, sensory appeal, and a variety of flavor options. Participants who smoke perceived price promotions and positive experience testimonials to be appealing, and some reported this generated use interest. Participants from both groups perceived smoker-targeted messages to be unconvincing, and reported this dampened ad and product appeal and use interest. Participants who do not use tobacco perceived nicotine warnings to be unappealing, resulting in reduced perceived appeal of other attractive features (eg, fruit flavors) appearing in the same ads. CONCLUSIONS: Marketing features appearing in e-cigarette ads may be perceived by young adults of various tobacco-use behaviors in both similar and different ways. Communication and policy strategies that account for these differential perceptions towards various marketing features are needed to reduce the negative impact of e-cigarette marketing. IMPLICATIONS: This study revealed evidence related to young adults' reactions to and perceived influence of commonly used marketing features (eg, fruit flavors, nicotine warnings, price promotions, smoker-targeted messages) in commercial e-cigarette ads. The results highlight the similar and differential perceived appeal and use interest of e-cigarette products promoted with various marketing features among young adults of different tobacco-use behaviors. The results have implications for informing the design of communication strategies and policies related to e-cigarette marketing aimed at promoting complete product switching among young adults who smoke while simultaneously deterring e-cigarette use interest among those who do not use tobacco.

Does Brand Choice Matter: Associations Between Usual E-Cigarette Brands and E-Cigarette Use Patterns Among U.S. Youth, 2021.

BACKGROUND.: To inform youth about e-cigarette use prevention, it is important to understand whether using e-cigarette products from certain brands is associated with youth's differential e-cigarette use patterns and willingness to quit e-cigarettes. METHODS.: Data for this study come from the 2021 U.S. National Youth Tobacco Survey (NYTS). The sample was current (past-30-day) e-cigarette users (unweighted n = 1,436). We examined the associations between users' usual e-cigarette brands (Puff, Vuse, Smoke, JUUL, and others) and e-cigarette use patterns (use frequency, use with nicotine, use with flavors) and willingness to quit, controlling for covariates. RESULTS.: In 2021, 25.6%, 9.7%, 8.1%, and 6.5% of users reported Puff, Vuse, Smok, and JUUL as their usual brands, respectively. Having Smok as a usual brand increased the odds of frequent e-cigarette use compared with other brands. Using Puff, Vuse, and Smok increased the odds of using e-cigarettes with nicotine. Using Puff and Smok increased the odds of using e-cigarettes with any flavors and fruit flavors, and using Smok and JUUL increased the odds of using mint flavors. Finally, using Vuse reduced the odds of having a willingness to quit e-cigarettes. CONCLUSION.: Puff products, which are likely to be used infrequently and with fruit flavors, were the most endorsed usual brand by youth users. Vuse and Smok brand users demonstrated problematic use patterns, including high-frequency use of nicotine and reduced willingness to quit. The high prevalence of using flavors, especially banned flavors (e.g., mint for JUUL products), suggests the need for tightened restrictions on youth's access to flavored e-cigarettes.

Concern for Police Brutality, Societal Discrimination, and School Shootings and Subsequent Cigarette and Cannabis Use in Los Angeles County Hispanic and Non-Hispanic White Youth: a Longitudinal Study.

OBJECTIVE: Examine if concerns for police brutality, societal discrimination, and school shootings relate to subsequent cigarette and cannabis use among Hispanic and non-Hispanic White (NHW) youth. Hispanic youth may be particularly vulnerable to such concern. METHODS: Data are from the University of Southern California's Happiness and Health Survey, a prospective cohort study, which followed Hispanic (N = 1007) and NHW (N = 251) students from ten inner-city and suburban high schools in Los Angeles County, starting from 2013 until 2019. Participants reported concern, worry, and stress levels regarding police brutality, societal discrimination, and school shootings. Four categories were created to indicate levels of each concern variable over time (consistently low, decreased, increased, and consistently high). Associations with past-30-day cannabis, blunt, THC-oil, and cigarette use in 2019 were assessed. Separate models for each racial/ethnic category were used. RESULTS: Among Hispanic participants, reporting consistently high concern about police brutality (vs. consistently low concern) was associated with higher odds to subsequently smoke cannabis (aOR = 1.69, 95% CI = 1.18-2.40), smoke blunts (aOR = 1.63, 95% CI = 1.11-2.39), and vape THC-oil (aOR = 1.67, 95% CI = 1.14-2.44). Hispanic participants who reported consistently high concern for societal discrimination also had higher odds (vs. consistently low concern) to subsequently smoke blunts (aOR = 1.54, 95% CI = 1.04-2.29) and vape THC-oil (aOR = 1.65, 95% CI = 1.12-2.43). Among NHW participants, increasing concern over school shootings (vs. consistently low concern) was associated with higher odds to subsequently smoke cannabis (aOR = 2.98, 95% CI = 1.08-7.70). CONCLUSIONS: Concerns for police brutality, societal discrimination, and school shootings were associated with cannabis use especially among Hispanic participants. Providing Hispanic youth with healthy coping strategies may reduce cannabis use.

Evaluating Correlations Between Premium Cigar Smoking and Mental Health and Substance Use Dependence Conditions Among U.S. Adults, 2010-2019.

INTRODUCTION: Improved understanding of health conditions associated with premium cigar smoking can inform efforts to reduce cigar use. This paper extends findings commissioned for the National Academies of Science, Engineering, and Medicine report on premium cigars. AIMS AND METHODS: We pooled 2010-2019 National Survey on Drug Use and Health data to evaluate cross-sectional associations between premium cigar smoking and mental health and substance use conditions among U.S. adults. A series of logistic regression models adjusted for age, sex, race and ethnicity, cigarette smoking, and alcohol consumption compared odds of each condition associated with past-month premium cigar smoking relative to past-month nonpremium cigar smoking, never tobacco use, and current established cigarette smoking. RESULTS: Premium cigar smoking was associated with lower adjusted odds of past month serious psychological distress, past year major depressive episode, and cannabis and illicit drug dependence relative to nonpremium cigar and cigarette smoking; however, higher odds of alcohol and cannabis dependence were observed relative to never tobacco use, and lower odds of alcohol dependence were observed relative to current cigarette smoking but not current nonpremium cigar smoking. CONCLUSIONS: We observed considerable variation in both magnitude and direction of associations between premium cigar smoking and mental health and substance use indicators depending on the condition and reference group to which premium cigar smoking was compared. IMPLICATIONS: Premium cigar smoking frequently cooccurs with cigarette smoking and alcohol consumption, thus potential health correlates must be considered in appropriate context. We observed considerable variation in direction and magnitude of association depending on the health condition and reference population, as well as potential for reverse causality and residual confounding in this cross-sectional analysis. As the tobacco landscape continues to evolve, rigorous scientific studies that incorporate clear differentiation of cigar type, measures of cumulative use, and temporal data collection are necessary to fully evaluate the health effects of premium cigar smoking and effectively inform Food and Drug Administration regulation.

Cross-sectional Use Patterns and Characteristics of Premium Versus Non-Premium Cigar Smokers in the United States, 2010-2019.

INTRODUCTION: Few studies have addressed the use patterns and characteristics of the past 30 days of premium versus non-premium cigar smokers. AIMS AND METHODS: We pooled 10 years of data from the National Survey on Drug Use and Health (NSDUH; 2010-2019) to evaluate use patterns and demographic and tobacco use characteristics of premium and non-premium cigar smokers ages 12 years and older in the U.S. cigar-type was manually coded as premium or non-premium according to the brand used most often. RESULTS: Between 2010 and 2019, 4.7% (95% CI = 4.6-4.8) of individuals aged 12 and older currently smoked cigars (past-30-day use). Smoking premium cigars (0.9% [95% CI = 0.8-0.9]) was less prevalent than smoking non-premium cigars (3.0% [95% CI = 2.9-3.1]). Although current non-premium cigar smoking prevalence steadily declined over the years, current premium cigar smoking prevalence remained stable. Premium cigar smokers were more likely to be older (≥25 years), male, non-Hispanic white, heterosexual, college educated, living in a large metro area, and to have income above 200% of the poverty threshold compared to non-premium users (p < .05). Additionally, past-30-day premium cigar smokers were less likely than non-premium users to initiate cigar smoking before the age of 18 years, smoke cigars frequently or daily, smoke cigarettes, or use marijuana (p < .05). CONCLUSIONS: Overall, premium cigar smoking is less prevalent than non-premium cigar smoking, especially among populations such as youth, racial/ethnic and sexual minorities, and low socioeconomic individuals. Premium cigar smokers tend to smoke infrequently and initiate cigars later in life compared with non-premium smokers. Study results can inform recommendations for regulating premium cigars. IMPLICATIONS: This study found that between 2010 and 2019, there are meaningful differences in the use patterns and characteristics of past-30-day premium versus non-premium cigar smokers in the United States. Premium cigars comprise a small share of the market compared to other cigar types and are less likely to be used by youth and other tobacco control priority groups (eg, racial/ethnic minorities and individuals with low socioeconomic statuses) that bear a disproportionate burden of risk and harm from using tobacco products. Additionally, most premium cigar users smoke them only occasionally. However, it is important to continue to monitor premium cigar use, as these patterns could shift because of factors like changes in marketing practices, consumer awareness, and product prices. Tobacco policy changes may also alter the patterns and trends of premium cigar use over time. A greater, more comprehensive understanding of premium cigars' physical characteristics, patterns of use, user perceptions, tobacco industry marketing strategies, and health effects will together help to inform cigar-related regulations.

Exploring Young Adults' Beliefs About Cigar Smoking by Susceptibility: A Belief Elicitation Study.

INTRODUCTION: Young adults are at risk for cigar smoking, which is associated with cancers and pulmonary and cardiovascular diseases. Little is known about young adults' beliefs about smoking cigarillos, little filtered cigars, and large cigars, and how these beliefs may vary across cigar types and by cigar susceptibility. AIMS AND METHODS: The larger study surveyed a U.S. sample of young adults (18-30 years old) who never used tobacco products (n = 948) through Qualtrics online panel services in August 2021-January 2022. We assessed participants' susceptibility to using different cigar types. Participants were randomly assigned to open-ended questions about one of the three cigar types to elicit behavioral, normative, and control beliefs. We conducted thematic analysis to code emergent themes within each belief and examined the frequency of reported themes at the intersection of cigar type and cigar susceptibility. RESULTS: Cigar susceptible participants reported positive behavioral beliefs (eg, anticipated relaxation, mood regulation, being cool), friends as supportive referents, and easy-to-smoke control beliefs (eg, high accessibility, low cost) more frequently than non-susceptible participants. Varied frequency by cigar type also emerged. For example, cigarillo and little filtered cigar features were mentioned more frequently as easy-to-smoke control beliefs, while low accessibility was reported more frequently as a hard-to-smoke control belief for large cigars. CONCLUSIONS: Findings identify salient beliefs about cigarillo, little filtered cigar, and large cigar smoking among young adult tobacco never-users. Future research should investigate the potential importance of these beliefs in cigar smoking susceptibility and initiation among young adults, and their potential utility in prevention research. IMPLICATIONS: This thematic analysis identified salient beliefs about cigarillos, little filtered cigars, and large cigars among a U.S. young adult sample, and differentiated emergent beliefs by cigar susceptibility status and by cigar type. Given the lack of cigar smoking prevention media campaigns, identifying these beliefs is the one of the first steps in developing effective cigar smoking prevention strategies. Future quantitative studies are needed to confirm the relationships between these beliefs and smoking initiation of each cigar type to further inform the types of beliefs to be targeted in strategic communication and help prevent cigar smoking initiation among susceptible young adults.

Financial hardship during the COVID-19 pandemic and increased receipt of commercial tobacco discount coupons among US adults who use commercial tobacco.

INTRODUCTION: Many individuals experienced financial hardship during the COVID-19 pandemic; yet commercial tobacco (CT) sales increased in the USA. We examined how experiencing financial hardships relates to increased CT discount coupon reception during the pandemic. METHODS: A nationally representative sample of 1700 US adults who used CT during the 12 months prior to the survey were surveyed online during January to February 2021. Participants reported if they had received more discount coupons for various CT products during (compared with before) the pandemic. They also reported whether they experienced six different types of financial hardships since the pandemic, and the total number of hardships experienced was counted. Weighted multivariable logistic regressions were used to examine the associations between financial hardships and increased coupon reception, adjusting for demographics and CT product use. RESULTS: During the first 10-11 months of the pandemic, 21.3% of US adults who used CT during the 12 months prior to the survey reported receiving more CT discount coupons. Experiencing financial hardship during the pandemic was associated with higher odds of receiving more coupons for all types of CT products: every additional count of financial hardship was associated with higher odds of increased reception of discount coupons for all CT products (adjusted odds ratios ranging from 1.13 to 1.23 across products). CONCLUSIONS: Over one-fifth of US adults who used CT received more discount coupons during the pandemic. Those facing financial hardships had higher discount coupon reception, suggesting potential targeted marketing to financially vulnerable individuals by the tobacco industry.

Awareness and beliefs about FDA e-cigarette regulation in the premarket application review era.

INTRODUCTION: In March 2022, FDA granted its first marketing orders for e-cigarettes. Few studies have assessed awareness of FDA e-cigarette regulation and authorization in the era of premarket review. This study describes prevalence of awareness as well as beliefs about regulation among adults who smoke and youth. METHODS: We conducted a cross-sectional, nationally representative online survey of 866 adults who currently smoke cigarettes and 859 youth (ages 15-20) in June 2022 using Ipsos KnowledgePanel. Population prevalence of regulatory awareness and beliefs are reported. Pearson χ2 and multivariable logistic regressions were conducted to assess dependent and independent associations with demographic and tobacco use characteristics. RESULTS: Awareness that FDA regulates e-cigarettes was low among adults who smoke (25.4 %) and youth (18.5 %). Awareness that FDA authorizes e-cigarettes was also low among adults who smoke (10.8 %) and youth (12.7 %). Agreement with both positive and negative beliefs regarding FDA e-cigarette regulation was below 50 %. Current e-cigarette use was significantly associated with agreeing that regulation: makes e-cigarettes safer (adult aOR: 2.90, youth aOR: 2.51), helps prevent youth initiation (adult aOR 1.92), takes away freedom to choose to use e-cigarettes (adult aOR: 3.02, youth aOR: 2.58), and limits types of e-cigarettes available (adult aOR: 2.22, youth aOR: 2.49). DISCUSSION: There is low awareness of FDA e-cigarette regulation and authorization and relatively low agreement with positive beliefs about e-cigarette regulation. Further study is needed to assess how the changing regulatory environment impacts product perceptions, intentions, and behaviors.