U.S. Adults' Public Opinion Toward R-Rating Labels for Movies With Cigarette Smoking.

INTRODUCTION: The purpose of this study was to describe the proportion of U.S. adults who support, oppose, or are neutral toward a policy designating R-ratings for movies depicting cigarette smoking and to identify predictors of policy opposition or neutrality among a nationally representative sample. METHODS: Data from the 2020 Health Information National Trends Survey 5 Cycle 4 (fielded in 2020; N=3,865) were used to estimate the prevalence of support, neutrality, and opposition to a policy designating R-ratings for movies containing depictions of cigarette smoking. Weighted, multivariable logistic regression was used to assess the predictors of policy opposition or neutrality. RESULTS: The analysis showed that 47.0% of U.S. adults were supportive, 20.3% opposed, and 30.3% were neutral toward designating R-ratings for movies depicting cigarette smoking. Older adults were significantly less likely to be neutral to or opposed to an R-rating policy than adults aged 18-34 years: age 50-64 years (OR=0.56; 95% CI=0.35, 0.87), age 65-74 years (OR=0.39; 95% CI=0.24, 0.64), and age ≥75 years (OR=0.27; 95% CI=0.16, 0.45). In addition, non-Hispanic Asians were significantly less likely than non-Hispanic Whites to be neutral to or opposed the policy (OR=0.46; 95% CI=0.25, 0.84). CONCLUSIONS: Study findings show that a near majority of U.S. adults support a policy that would designate R-ratings for movies depicting cigarette smoking and that there is greater neutrality than opposition toward the policy. Assessing public opinion toward a policy designating R-ratings for movies depicting cigarette smoking may inform efforts to educate the public about the value of such policies for preventing youth tobacco initiation.

A Longitudinal Analysis of Respiratory Illness and Tobacco Use Transitions.

INTRODUCTION: Among individuals with chronic respiratory conditions, transitions between patterns of tobacco product use are not well understood. This study examines how transitions, including quitting altogether, differ over time between those who do and do not have chronic respiratory conditions. METHODS: Data from youth and adult participants of the longitudinal Population Assessment of Tobacco and Health Study (2013-2018) were analyzed. Youth aged 12-17 years were included if they had aged into the adult sample by Wave 4. Stratified polytomous regression models built under a first-order Markov assumption modeled the probability of transitioning between different states/patterns of tobacco product use (exclusive current E-cigarette use, exclusive current combustible tobacco product use, current dual use of combustible products and E-cigarettes, and no current tobacco product use) at each wave. Marginal transition probabilities were computed as a function of ever or past-year diagnosis of a respiratory condition (separately for asthma and a composite variable representing chronic bronchitis, emphysema, and/or chronic obstructive pulmonary disease). Analyses were conducted in 2020-2021. RESULTS: Most individuals, regardless of respiratory condition, maintained the same pattern of tobacco use between waves. Exclusive combustible tobacco product users, including those with or without a respiratory condition, were not likely to become exclusive E-cigarette users or to quit using tobacco entirely. CONCLUSIONS: Although combustible tobacco use negatively impacts the management and prognosis of respiratory illnesses, combustible tobacco users who were recently diagnosed with a chronic respiratory condition were not likely to quit using tobacco. Efforts to encourage and support cessation in this medically vulnerable population should be increased.

Perceptions of Oral Nicotine Pouches on Reddit: Observational Study.

BACKGROUND: Oral nicotine pouches are a new form of tobacco-free nicotine products launched in recent years with a variety of flavors. OBJECTIVE: This study aims to examine the public perceptions and discussions of oral nicotine pouches on Reddit, a popular social media platform for sharing user experiences. METHODS: Between February 15, 2019, and February 12, 2021, a total of 2410 Reddit posts related to oral nicotine pouches were obtained over a 2-year period. After the removal of unrelated or commercial posts, 653 Reddit posts related to oral nicotine pouches remained. Topics and sentiments related to oral nicotine pouches on Reddit were hand coded. RESULTS: The number of Reddit posts related to oral nicotine pouches increased during the study period. Content analysis showed that the most popular topic was "sharing product information and user experience" (366/653, 56%), in which sharing oral nicotine pouch products and user experiences were dominant. The next popular topic was "asking product-related questions" (product properties and product recommendations; 115/653, 17.6%), followed by "quitting nicotine products" such as vaping or smoking through use of oral nicotine pouches or quitting the oral nicotine pouches themselves (83/653, 12.7%) and "discussing oral nicotine pouch-related health" symptoms or concerns related to oral nicotine pouches (74/653, 11.3%). The least popular topic was "legality and permissions" related to oral nicotine pouches (15/653, 2.3%). In addition, a greater number of Reddit posts described positive attitudes compared to negative attitudes toward oral nicotine pouches (354/653, 54.2% vs 101/653, 15.5%; P<.001). CONCLUSIONS: Reddit posts overall had a positive attitude toward oral nicotine pouches and users were actively sharing product and user experiences. Our study provides the first insight on up-to-date oral nicotine pouch discussions on social media.

U.S. public opinion toward policy restrictions to limit tobacco product placement and advertising at point-of-sale and on social media.

The Family Smoking Prevention and Tobacco Control Act granted the U.S. Food and Drug Administration authority to regulate tobacco advertising and promotion, including at the retail level, and preserved state, tribal, and local tobacco advertising and promotion authorities. Public health experts have proposed prohibiting point-of-sale tobacco advertisements and product displays, among other tobacco advertising restrictions. We examined the prevalence and correlates of public support, opposition, and neutrality toward proposed tobacco product placement and advertising restrictions at point-of-sale and on social media utilizing the National Cancer Institute's 2020 Health Information National Trends Survey (HINTS) (N = 3865), a cross-sectional, probability-based postal survey of U.S. addresses conducted from Feb 24, 2020 to June 15, 2020 (Bethesda, MD). Frequencies and unadjusted, weighted proportions were calculated for support, neutrality, and opposition toward the three policies under study, and weighted, adjusted multivariable logistic regression was employed to examine predictors of neutrality and opposition. Tests of significance were conducted at the p < 0.05 level. Sixty-two percent of U.S. adults supported a policy prohibiting tobacco product advertising on social media; 55% supported a policy restricting the location of tobacco product advertising at point-of-sale; and nearly 50% supported a policy to keep tobacco products out of view at the checkout counter. Neutrality and opposition varied by sociodemographic characteristics including age, sex, education, rurality, and presence of children in the household. Understanding public opinion toward tobacco product placement and advertising restrictions may inform policy planning and implementation.

Assessing Electronic Nicotine Delivery Systems Use at NCI-Designated Cancer Centers in the Cancer Moonshot-funded Cancer Center Cessation Initiative.

Assessing tobacco product use and delivering tobacco dependence treatment is an essential part of cancer care; however, little is known about electronic nicotine delivery systems (ENDS) or e-cigarette use assessment in cancer treatment settings. Given the importance of tailoring tobacco treatment, it is critical to understand how ENDS use is assessed in the electronic health record (EHR) in cancer care settings. Two questionnaires were completed by tobacco treatment program leads at 42 NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative (January 1 to June 30 and July 1 to December 31, 2019). Items assessed how often smoking status and ENDS use were recorded in the EHR. An open-ended item recorded the text and response categories of each center's ENDS assessment question. All 42 centers assessed smoking status at both time periods. Twenty-five centers (59.5%) assessed ENDS use in the first half of 2019, increasing to 30 (71.4%) in the last half of 2019. By the end of 2019, 17 centers assessed smoking status at every patient visit while six assessed ENDS use at every visit. A checkbox/drop-down menu rather than scripted text was used at 30 centers (73.2%) for assessing smoking status and at 18 centers (42.9%) for assessing ENDS use. Our findings underscore the gap in systematic ENDS use screening in cancer treatment settings. Requiring ENDS use measures in the EHR as part of quality measures and providing scripted text scripts to providers may increase rates of ENDS use assessment at more cancer centers. PREVENTION RELEVANCE: This study identifies a gap in the systematic assessment of ENDS use among patients seen at 42 NCI-Designated cancer centers. Requiring the systematic assessment of both ENDS use and use of other tobacco products can inform evidence-based treatment of tobacco dependence and lead to improved cancer treatment outcomes.