Organic, Earth-Friendly Tobacco With a Charcoal Filter and Smooth Taste: A Randomized Experiment Testing Effects of Natural American Spirit's "Sky" Cigarette Advertising on Consumer Perceptions.

INTRODUCTION: The Natural American Spirit (NAS) brand has a history of marketing tactics that may convey reduced harm. While no longer allowed to use "additive-free" or natural descriptors (except in the brand name), it continues promoting potentially misleading attributes. This study examined perceptions of NAS's newer "Sky" style, promoted as organic tobacco with a charcoal filter. AIMS AND METHODS: In an online experiment, we randomized 1927 adult past 30-day tobacco or nicotine product users to one of six conditions showing Sky ads with different descriptors: (1) charcoal filter, (2) charcoal + organic, (3) charcoal + earth-friendly, (4) charcoal + smooth taste, (5) charcoal + all other descriptors, and (6) no-descriptor control (Sky ads without target descriptors). Product perceptions were compared by condition. Participants also reported perceived benefits of charcoal filters. RESULTS: Overall, 28% of participants indicated Sky is less harmful and 38% believed it exposes users to fewer chemicals. Participants in the "charcoal + organic," "charcoal + earth-friendly," and the all-descriptor conditions had higher odds of believing Sky reduces chemical exposure (respectively, 43%, 40%, and 42%), relative to the no-descriptor control. Fewer control participants endorsed beliefs that Sky has a "better filter" and is "more environmentally friendly". Many believed cigarettes with charcoal filters could confer benefits relative to other cigarettes, such as reducing chemical exposure, or being cleaner, purer or safer (though research on relative safety of charcoal filters in cigarettes is inconclusive). CONCLUSIONS: Sky marketing may promote misperceptions about product safety and composition, and ads using both charcoal and organic text may particularly reinforce them. IMPLICATIONS: This study examined the impact of new cigarette advertising promoting the use of charcoal filters and organic tobacco along with other suggestive claims ("environmentally friendly," "smooth taste") on tobacco users' perceptions of the advertised product-NAS Sky cigarettes. Our study provides new data about positive consumer perceptions of charcoal-filtered cigarettes, and results suggest that combinations of these marketing terms evoke perceptions about reduced harm and reduced exposure to harmful chemicals that may be misleading to the public. Our findings underscore a need for additional regulatory action regarding tobacco marketing that makes use of natural-themed marketing.

Varenicline OTC Trial on Efficacy and Safety.

INTRODUCTION: Varenicline helps people who smoke quit at rates 2-3 times greater than placebo. Currently in the U.S., varenicline is not available over the counter (OTC). In this study, we assessed the safety and efficacy of 1mg and 0.5mg varenicline as an OTC medication for smoking cessation in comparison to placebo. METHODS: This randomized, double-blind, placebo-controlled study was performed at two clinical sites in the United States of n=313 people. The treatment period was 12 weeks. During the COVID pandemic, the protocol was modified to allow remote participation; verification of smoking status was via breath carbon monoxide levels for in-person visits and mailed urine cotinine kits for the remote participants. RESULTS: There was no difference in biologically confirmed continuous abstinence by condition between Weeks 8-12; however, the odds of biologically confirmed point prevalence abstinence were higher for those in the 1mg b.i.d. condition than for those in the placebo condition at Week 12 (OR 3.39; 95% CI 1.49, 7.71), and were higher for those assigned to the 1.0mg b.i.d. condition than the 0.5mg b.i.d. condition at Week 12 (OR 2.37; 95% CI 1.11, 5.05). Adverse events were modest, and as expected (vivid dreams and nausea in the medication conditions). CONCLUSIONS: The results are suggestive that varenicline is safe and effective as an OTC medication.

Greenwashed Cigarette Ad Text and Imagery Produce Inaccurate Harm, Addictiveness, and Nicotine Content Perceptions: Results from a Randomized Online Experiment.

INTRODUCTION: The tobacco industry has a long history of circumventing regulations to present their products, inaccurately, as less harmful. Greenwashing (portraying a product as natural/eco-friendly) is increasingly used by tobacco companies and may mislead consumers to believe that certain cigarettes are less harmful than others. This study assesses the effect of some common greenwashing tactics on consumer product perceptions. METHODS: We conducted an online experiment with 1,504 participants ages 18-29, randomized to view a cigarette ad manipulated for presence/absence of a combination of 4 different greenwashing techniques: greenwashed ad text, greenwashed ad imagery, recycled paper ad background, and image of greenwashed cigarette pack. Participants rated perceived absolute harm, relative harm to other cigarettes, absolute addictiveness, relative addictiveness, and relative nicotine content. RESULTS: Participants who viewed ads containing greenwashed text were more likely to have inaccurate perceptions about absolute harm (AOR=1.72), relative harm (AOR=3.92), relative addictiveness (AOR=2.93) and nicotine content (AOR=2.08). Participants who viewed ads containing greenwashed imagery were more likely to have inaccurate perceptions of relative harm (AOR=1.55), absolute addictiveness (AOR=1.72), relative addictiveness (AOR=1.60) and nicotine content (AOR=1.48). Forty-two percent of those who saw an ad with all greenwashed features believed the product was less harmful than other cigarettes vs. 2% of those who saw an ad without greenwashed features. CONCLUSIONS: We found greenwashed text and imagery produced inaccurate risk perceptions. More active U.S. Food & Drug Administration (FDA) enforcement against such greenwashing and new FDA rulemaking to prohibit unnecessary imagery in tobacco advertising and establish plain packaging requirements would help protect consumers and public health. IMPLICATIONS: These findings provide evidence that greenwashing tactics used by the tobacco industry increase inaccurate product risk perceptions. These tactics could be a way for the industry to make implicit modified risk claims, despite applicable U.S. Family Smoking Prevention and Tobacco Control Act prohibitions. Findings from this study support the need for prohibitions on these tactics, and the potential for such prohibitions to help protect public health.

Cigarette unit sales volume for brands using 'natural', 'organic' and 'tobacco and water' pack terms in the USA, 2018-2022.

BACKGROUND: Terms such as 'natural', 'organic' and 'tobacco and water' on cigarette packs may communicate misleading reduced harm messages to consumers. This study describes sales volume and price for brands that used these misleading descriptors in the USA by year, brand and state. METHODS: The data come from Information Resources Incorporated sales data collected in 44 US states from January 2018 to January 2023. Trained coders used Universal Product Codes, purchased packs and internet searches to identify cigarettes sold with 'natural', 'organic' and 'tobacco and water' on packs. We report cigarette pack unit sales counts (sales volume) and average price per pack by year, as well as per cent year-over-year change in sales volume and price and annual market share by descriptor terms. RESULTS: Overall, pack sales volume decreased year-over-year from 2019 to 2022. Sales volume for packs with 'natural', 'tobacco and water' and 'organic' decreased less than overall; in some cases, they increased. In 2022, packs with 'natural' accounted for the greatest share of cigarette unit sales (5.42% or 33 605 036 packs), followed by 'tobacco and water' (2.25% or 12 959 905 packs) and 'organic' (0.53% or 4 614 592 packs). Natural American Spirit (NAS) and Winston accounted for most sales with 'natural' and 'tobacco and water'; NAS accounted for nearly all sales with 'organic'. Packs with 'natural', 'tobacco and water' or 'organic' made up the largest portion of sales in western (Oregon, Idaho, California, Colorado and Washington) and northeastern (Vermont, Massachusetts and New Hampshire) US states. CONCLUSION: Brands using 'natural', 'tobacco and water' and 'organic' on packs increased their market share between 2019 and 2022; in some states, market share was over 10% in 2022. Our findings emphasise the importance of regulating these terms and continually monitoring their population impact.

Timing of Trial of Void After Radical Hysterectomy: Long-Term Urinary Outcomes at Two Academic Tertiary Care Institutions.

INTRODUCTION AND HYPOTHESIS: Many patients develop bladder symptoms after radical hysterectomy. This study compared urinary outcomes following radical hysterectomy based on trial of void (TOV) timing (pre-discharge TOV versus post-discharge TOV). METHODS: A retrospective non-inferiority study of patients at two academic tertiary referral centers who underwent radical hysterectomy between January 2010 and January 2020 was carried out. Patients were stratified according to timing of postoperative TOV: either pre-discharge or post-discharge from the hospital. Short-term urinary outcomes (including passing TOV, representation with retention) and long-term de novo urinary dysfunction (defined as irritative voiding symptoms, urgency, frequency, nocturia, stress or urgency incontinence, neurogenic bladder, and/or urinary retention) were extracted from the medical record. We hypothesized that the proportion of patients who failed pre-discharge TOV would be within a 15% non-inferiority margin of post-discharge TOV. RESULTS: A total of 198 patients underwent radical hysterectomy for cervical (118 out of 198; 59.6%), uterine (36 out of 198; 18.2%), and ovarian (29 out of 198; 14.6%) cancer. One hundred and nineteen patients (119 out of 198, 60.1%) underwent pre-discharge TOV, of whom 14 out of 119 (11.8%) failed. Of the post-discharge TOV patients (79 out of 198, 39.9%), 5 out of 79 (6.3%) failed. The proportion of patients who failed a pre-discharge TOV was within the non-inferiority margin (5.4% difference, p = 0.23). A greater proportion of patients in the post-discharge TOV group developed long-term de novo urinary dysfunction (27.2% difference, p = 0.005). Median time to diagnosis of de novo urinary dysfunction was 0.5 years (range 0-9) in the pre-discharge TOV group versus 1.0 year (range 0-6) in the post-discharge TOV group (p > 0.05). CONCLUSIONS: In this study, pre-discharge TOV had non-inferior short-term outcomes and improved long-term outcomes.

"I Like the Vibes it Gives": Adolescent Perspectives on Cannabis Billboards and Print Advertising in Nevada.

An influx of laws permitting recreational cannabis sales in the US has allowed for increased advertising. The purpose of this study was to describe how adolescents perceive outdoor and print cannabis advertising and to identify aspects of advertising that are appealing or eye-catching, focusing on five themes: price promotion, sex appeal, wellness, party, and text-only. We recruited adolescents ages 11-17 to participate in seven focus groups (44 participants) from 2019 to 2020. Participants viewed cannabis advertisements and responses were summarized using deductive thematic analysis. The party-themed advertisements were the most salient to participants, who desired to emulate the behaviors shown. Participants favored ads featuring young people and containing multiple colors. Participants disliked advertisements perceived to portray misleading or contradictory messages, such as the promotion of physical activity or use of sex appeal, and ads perceived to lack authenticity. Identification of youth appealing features can help inform cannabis advertising regulations.

Predictors of E-cigarette and Cigarette Use Trajectory Classes from Early Adolescence to Emerging Adulthood Across Four Years (2013-2017) of the PATH Study.

INTRODUCTION: This study examines predictors of trajectories of cigarette and e-cigarette use among a cohort of US adolescents transitioning into young adulthood. Comparing trajectories of each tobacco product is important to determine if different intervention targets are needed to prevent progression to daily use. METHODS: Latent trajectory class analyses identified cigarette and e-cigarette use (never, ever excluding past 12-month, past 12-month (excluding past 30-day (P30D)), P30D 1-5 days, P30D 6+ days) trajectory classes, separately, among US youth (12-17; N = 10,086) using the first 4 waves (2013-2017) of data from the nationally representative PATH Study. Weighted descriptive analyses described the class characteristics. Weighted multinomial logistic regression analyses examined demographic, psychosocial, and behavioral predictors of class membership. RESULTS: Younger adolescents 12-15 years had lower tobacco use compared to 16-17 year olds and less stable classes. In the 16-17 year group, there were five unique trajectories of cigarette smoking, including a Persistent High Frequency class. Four e-cigarette use trajectories were identified; but not a persistent use class. Shared predictors of class membership for cigarettes and e-cigarettes included mental health problems, other tobacco use, marijuana use, and poorer academic achievement. Male sex and household tobacco use were unique e-cigarette trajectory class predictors. CONCLUSIONS: There was no evidence that initiation with e-cigarettes as the first product tried was associated with cigarette progression (nor cigarettes as first product and e-cigarette progression). Interventions should focus on well-established risk factors such as mental health and other substance use to prevent progression of use for both tobacco products. IMPLICATIONS: Using nationally representative data and definitions of use that take into account frequency and recency of use, longitudinal 4-year trajectories of e-cigarette and cigarette use among US adolescents transitioning into young adulthood were identified. Results among 16-17-year olds revealed a class of persistent high frequency cigarette smoking that was not identified for e-cigarette use. Cigarette use progression was not associated with e-cigarettes as the first product tried. Risk factors for progression of use of both products included mental health and other substance use, which are important prevention targets for both tobacco products.

Shifts in preference for Natural American Spirit and associated belief that one's own cigarette brand might be less harmful than other brands: results from Waves 1-4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2018).

INTRODUCTION: People believe that cigarettes using 'organic,' 'additive-free' or similar descriptors are less harmful than other cigarettes. Natural American Spirit (NAS) is the most popular US cigarette brand using these descriptors. This cohort study describes changes in US smokers' odds of preferring NAS and changes in NAS smokers' odds of believing their brand might be less harmful than other brands. METHODS: Data come from four waves (2013-2018) of the Population Assessment of Tobacco and Health (PATH) Study. Generalised estimating equations produced population-averaged estimates of relationships between (1) NAS brand preference and wave and (2) belief that one's own brand might be less harmful than other brands, wave and NAS brand preference. Models tested interactions by age group and sexual minority status. RESULTS: The odds that smokers preferred NAS increased by 60% in W4 relative to W1. Disproportionate preference by younger adult and sexual minority smokers was observed. The odds that NAS smokers believed their own brand might be less harmful decreased by 50% between W1 and W4, but this perception was still 16 times higher for NAS compared with non-NAS smokers. Given the increasing preference for NAS, there was no significant change in the absolute number of NAS smokers who believed their own brand might be less harmful (W1: 562 122 (95% CI 435 190 to 689 055) vs W4: 580 378 (95% CI 441 069 to 719 689)). CONCLUSIONS: Both brand popularity and concentration of brand-related harm perceptions are important for understanding population impact of changes in cigarette marketing.

Longitudinal relationship between relative harm perceptions, beliefs about organic and additive-free tobacco, and cigarette brand switching among Natural American Spirit, Camel and Marlboro cigarette smokers.

INTRODUCTION: While previous research has examined misperceptions related to Natural American Spirit (NAS), a premium cigarette brand using 'natural'-themed marketing, the longitudinal relationship between NAS-related harm beliefs and switching to NAS has not been established. METHODS: Using data from the PATH study, we modelled the longitudinal relationship between (1) brand switching and subsequent belief that one's own brand might be less harmful than other brands (Waves 1-5); (2) belief that organic and/or additive-free tobacco products are less harmful and subsequent brand switching (Waves 3-5); and (3) belief that some types of cigarettes are less harmful and subsequent brand switching (Waves 3-5) for NAS and two leading comparator brands (Camel and Marlboro). RESULTS: Among people who did not think their prior brand might be less harmful, switching to NAS or maintaining NAS preference increased the odds of believing one's own brand might be less harmful (aOR 19.4; 95% CI: 15.19, 24.8; aOR 6.1; 95% CI: 4.23, 8.67, respectively). Prior belief that organic and additive-free tobacco products were less harmful increased the odds of switching to (aOR 2.5; 95% CI: 1.68, 3.74) and decreased the odds of switching away (0.57; 955 CI: 0.36, 0.92) from NAS in the subsequent wave. Parallel analyses for Marlboro/Camel were largely null or in the opposite direction. CONCLUSIONS: NAS use may maintain or shape new beliefs that the brand may be less harmful than other brands; holding pre-existing beliefs about the relative harm of some tobacco products may increase risk for NAS use.

The "Organic" Descriptor and Its Association With Commercial Cigarette Health Risk Expectancies, Subjective Effects, and Smoking Topography: A Pilot Human Laboratory Study.

INTRODUCTION: The purpose of this mixed-method pilot study was to: (1) examine whether the "organic" descriptor affects smokers' health risk expectancies, subjective ratings of smoking, and topography, and (2) describe how smokers interpret the "organic" descriptor and relate it to their subjective smoking experience. METHODS: Twenty-two daily smokers (45.5% men, 81.8% non-Hispanic White, M (SD) age = 47.3 [12.7], M (SD) cigarettes/day = 14.5 [5.1]) completed a within-person laboratory study. Following a baseline session, smokers attended 2 experimental sessions where they smoked a study-provided cigarette (identical across conditions) paired with either an "organic" or conventional (e.g., no "organic") descriptor condition and completed subjective and behavioral measures. Participants completed a semi-structured interview at the last visit. RESULTS: Relative to the conventional cigarette, more participants rated the "organic" cigarette as healthier, having fewer chemicals, and having a more favorable burn rate (P's < 0.05). There were no differences in total puff volume by condition (P = 0.42). Stratifying by gender, men inhaled 225 ml (SE = 82.7) more in the conventional condition (P = 0.02); women inhaled 408 ml (SE = 233.3) more in the organic condition (P = 0.11). A common understanding of "organic" was that the product was "…less processed... like less chemicals and it's more natural." Some believed that "organic" cigarettes contained fewer chemicals, which in turn produced a "much cleaner and healthier smoking cigarette" and that they could "taste the difference." CONCLUSIONS: Findings support that smokers associate the "organic" descriptor with health and reduced harm. This descriptor may differentially impact puffing behavior by gender. IMPLICATIONS: This study provides qualitative and quantitative data regarding how the "organic" descriptor influences adult daily smokers' perceptions and use of cigarettes. After smoking two identical cigarettes described as "organic" and conventional (e.g., no "organic"), smokers expressed more problematic health expectancies about the "organic" cigarette condition, providing further empirical support that the "organic" descriptor is associated with expectancies of reduced harm. The source of reduced harm was understood to be fewer chemicals in the organic cigarette. Though preliminary, findings suggest that "organic" may differentially affect puffing behavior by gender.

A feasibility randomised controlled trial of a Fibromyalgia Self-management Programme for adults in a community setting with a nested qualitative study (FALCON).

BACKGROUND: Fibromyalgia is a condition associated with widespread musculoskeletal pain, fatigue and sleep problems. Fibromyalgia treatment guidelines recommend non-pharmacological interventions and the development of self-management skills. An example of a programme that fits these guidelines is the Fibromyalgia Self-management Programme (FSMP) which consists of one 2.5-hour weekly session over six successive weeks and includes education about fibromyalgia, goal setting, pacing, sleep hygiene and nutritional advice. The FSMP is currently provided in a secondary care hospital setting and co-delivered by a multidisciplinary team. Delivery in a primary care setting has the potential to improve the accessibility of the programme to people with fibromyalgia. Therefore, this feasibility study aimed to determine the practicality and acceptability of conducting a future definitive randomised controlled trial of the FSMP in a community setting. METHOD: An exploratory, parallel-arm, one-to-one, randomised controlled trial. Participants were recruited from general practices across South West England, and the FSMP was co-delivered by physiotherapists and occupational therapists across two community sites. To determine the outcome measures for a future definitive trial several were tested. The Revised Fibromyalgia Impact Questionnaire, Arthritis Self-Efficacy Scale-8, Chalder Fatigue Scale, Short form 36, 5-Level EQ-5D version and Jenkins Sleep Scale were collected at baseline, 6 weeks and 6 months. Semi-structured interviews were conducted with patient participants, occupational therapists and physiotherapists to explore the acceptability and feasibility of delivering the FSMP in a community setting. RESULTS: A total of 74 participants were randomised to the FSMP intervention (n = 38) or control arm (n = 36). Attrition from the trial was 42% (31/74) at 6 months. A large proportion of those randomised to the intervention arm (34%, 13/38) failed to attend any sessions with six of the 13 withdrawing before the intervention commenced. The proportion of missing values was small for each of the outcome measures. Three overarching themes were derived from the interview data; (1) barriers and facilitators to attending the FSMP; (2) FSMP content, delivery and supporting documentation; and (3) trial processes. CONCLUSION: It is feasible to recruit people with fibromyalgia from Primary Care to participate in a randomised controlled trial testing the FSMP in a community setting. However, improvement in trial attrition and engagement with the intervention is needed. TRIAL REGISTRATION: The trial is registered with ISRCTN registry and was assigned on 29/04/2019. The registration number is ISRCTN10824225.

Health and social outcomes of HIV-vulnerable and HIV-positive pregnant and post-partum adolescents and infants enrolled in a home visiting team programme in Kenya.

OBJECTIVES: HIV-positive and HIV-vulnerable pregnant adolescent girls and adolescent mothers face significant barriers and vulnerabilities. Infants born to adolescent mothers are also more likely to die and be exposed to life-threatening conditions. This paper presents findings from an evaluation of a programme that used a home visitation model and offered a case-management, team-focused approach to increase family and community supportiveness to enhance health and social service uptake among pregnant adolescent girls and adolescent mothers in Kenya. METHODS: The study used a quasi-experimental design with before and after comparisons among a non-randomised population to examine the effectiveness of bi-monthly household visits to 384 enrolled pregnant adolescent girls, adolescent mothers (ages 10-19) and their infants (0-24 months) between March 2018 and February 2019 in three counties in Kenya. RESULTS: During the programme, household support increased from 57% to 85%, while 100% of eligible participants were on ART and virally suppressed (total of 20 adolescents). Nearly all pregnant adolescent girls (94%) delivered under skilled care vs. 78% of those who were post-partum at the time of enrolment (P < 0.001); 100% of infants (total of 17 infants) had an up-to-date PCR test with no seroconversions. Uptake of modern family planning increased from 39% at baseline to 64% at end line (P < 0.001). The referral rate declined from 84% to 78% from baseline to end line with low uptake of referrals for mental health services (17.3%). CONCLUSIONS: A team-focused approach of home visits to HIV-vulnerable and HIV-positive pregnant and post-partum adolescent girls and their infants combined with efforts to reduce stigma and increase supportiveness of households and the community can help address critical socio-cultural and behavioural barriers to accessing and using health and social services.

Smokers' Exposure to Perceived Modified Risk Claims for E-Cigarettes, Snus, and Smokeless Tobacco in the United States.

INTRODUCTION: Based on arguments for harm reduction and health benefits, tobacco companies in the United States can apply for regulatory authorization to make "modified risk tobacco product" (MRTP) marketing claims. The impact of future MRTP claims may depend on whether they are noticed, believed, and lead to smokers switching products. This study provides baseline data about smokers' exposure to perceived MRTP claims ahead of any MRTP authorizations. AIMS AND METHODS: We analyzed measures from Wave 3 of the US-based Population Assessment of Tobacco and Health (PATH) study which asked smokers to indicate if they had seen any e-cigarettes, snus, or other smokeless tobacco (SLT) products that claim to be "less harmful" in the past 12 months, and their likelihood of using products with these claims in the next 30 days. RESULTS: Significantly fewer smokers noted having seen snus (5.1%) or other SLT (5.6%) with "less harmful" claims compared with e-cigarettes (29.1%). For each product, the prevalence of MRTP claim exposure was higher among smokers who perceived the product to be less harmful than smoking, who currently used the product, and who had higher rates of tobacco advertising exposure at the point of sale. Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%). CONCLUSIONS: Ahead of any Food & Drug Administration (FDA) authorization for MRTP claims, some smokers already perceive exposure to "less harmful" claims for e-cigarettes, but few do for SLT. MRTP claims may motivate some smokers to use these products. IMPLICATIONS: This study provides new baseline data about smokers' perceived exposure to MRTP claims in the United States ahead of any regulatory claim authorization. Using data from Wave 3 of the US PATH study, we found that some smokers already perceive exposure to "less harmful" claims for e-cigarettes (29%), but few do for SLT (5%-6%). Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%), suggesting MRTP claims may motivate some smokers to use products described as "less harmful."

Youth Vaping and Tobacco Use in Context in the United States: Results From the 2018 National Youth Tobacco Survey.

INTRODUCTION: According to the National Youth Tobacco Survey (NYTS), youth e-cigarette use (vaping) rose between 2017 and 2018. Frequency of vaping and concurrent past 30-day (p30d) use of e-cigarettes and tobacco products have not been reported. METHODS: We analyzed the 2018 NYTS (N = 20 189) for vaping among all students (middle and high school; 6-12th grades; 9-19 years old) by frequency of vaping, exclusive vaping, p30d poly-product use (vaping and use of one or more tobacco product), and any past tobacco product use. RESULTS: In 2018, 81.4% of students had not used any tobacco or vapor product in the p30d, and 86.2% had not vaped in the p30d. Among all students, of the 13.8% vaped in the p30d, just over half vaped on ≤5 days (7.0%), and roughly a quarter each vaped on 6-19 days (3.2%) and on 20+ days (3.6%). Almost three quarters of p30d vapers (9.9%) reported past or concurrent tobacco use and the remainder (3.9%) were tobacco naïve. 2.8% of students were tobacco naïve and vaped on ≤5 days; 0.7% were tobacco-naïve and vaped on 6-19 days, and 0.4% were tobacco-naïve and vaped on 20+ days. CONCLUSIONS: Vaping increased among US youth in 2018 over 2017. The increases are characterized by patterns of low p30d vaping frequency and high poly-product use, and a low prevalence of vaping among more frequent but tobacco naïve vapers. IMPLICATIONS: Results underscore the importance of including the full context of use patterns. The majority of vapers (60.0%-88.9% by use frequency) were concurrent p30d or ever tobacco users. About 4% of students were tobacco naïve and vaped in the p30d, but few (0.4%) vaped regularly on 20 or more days. Reporting youth vaping data with frequency and tobacco product co-use will give public health decision-makers the best possible information to protect public health.

Intensive Longitudinal Study of the Relationship Between Cigalike E-cigarette Use and Cigarette Smoking Among Adult Cigarette Smokers Without Immediate Plans to Quit Smoking.

INTRODUCTION: This study examined the association between the introduction of an e-cigarette and subsequent change in cigarette smoking among smokers who were not immediately interested in quitting. AIMS AND METHODS: The Moment Study was a 21-day intensive longitudinal study with an online follow-up survey at 30 days. After observing baseline cigarette smoking for 1 week, participants received 10 cigalike e-cigarettes on study days 6 and 13. Participants reported cigarettes per day, e-cigarette puffs per day, and e-cigarette satisfaction using text-message-based surveys. RESULTS: The sample of 96 daily smokers was majority female (53.1%), African American (67.7%), and non-Hispanic (95.8%). When e-cigarettes were provided (day 6), average cigarettes per day dropped by 1.82 cigarettes (p < .0001). The within-person e-cigarette puff effect on daily cigarette smoking was significantly negative (ß = -0.023; p = .005); a participant who consumed 100 more e-cigarette puffs in a day than usual for that person was expected to smoke 2.3 fewer cigarettes that day, but this was only true for non-menthol smokers (p = .006). Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps < .05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up. CONCLUSIONS: Giving e-cigarettes to smokers who did not intend to quit reduced their cigarette smoking on days when they used e-cigarette more frequently, but this relationship did not hold for menthol smokers. Satisfaction with e-cigarette use was predictive of continued use 30 days later. IMPLICATIONS: A greater amount of cigalike e-cigarette use resulted in less smoking among adult daily smokers without immediate plans to quit, but a lack of nicotine delivery and satisfaction for these devices may have limited their utility as a replacement for cigarette smoking, especially among menthol smokers. The global concept of "satisfaction" may be an important driver of e-cigarette use among adult smokers.

Menthol and Mint Cigarettes and Cigars: Initiation and Progression in Youth, Young Adults and Adults in Waves 1-4 of the PATH Study, 2013-2017.

INTRODUCTION: This study examined in youth (12-17 years), young adults (18-24 years), and adults (25+ years): (1) the prevalence of the first menthol cigarette and menthol/mint cigar use among new tobacco users; (2) association between the first menthol/mint use, subsequent tobacco use, and nicotine dependence ~1 year later compared with the first non-menthol/mint use. AIMS AND METHODS: Longitudinal analysis of data from Waves 1 to 4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2017; 10 086 youth and 21 281 adults). Main outcome measures were past 12-month and past 30-day cigarette and cigar use, and nicotine dependence. RESULTS: Youth and young adult new cigarette users are more likely to smoke a menthol cigarette or indicate that they do not know the flavor compared with adults aged 25+. A greater proportion of adults aged 25+ first used menthol/mint-flavored cigars (13.4%) compared with youth (8.5%) and young adults (7.4%). Among young adults, first use of a menthol cigarette is associated with past 12-month use of cigarettes at the subsequent wave and first use of any menthol/mint-flavored cigars is associated with past 30-day use of these products at the subsequent wave in both youth and young adults. In youth and adults, there were no significant relationships between first use of a menthol/mint cigarette or cigar and nicotine dependence scores at a subsequent wave in multivariable analyses. CONCLUSIONS: The first use of menthol/mint cigarettes and cigars is associated with subsequent cigarette and cigar use in young people aged 12-24. IMPLICATIONS: This study examined the relationship between initiation with menthol cigarettes and menthol/mint cigars, subsequent tobacco use, and nicotine dependence in US youth, young adults, and adults who participated in Waves 1-4 of the Population Assessment of Tobacco and Health study. New use of menthol cigarettes was associated with greater past 12-month cigarette use in young adults and new use of menthol/mint-flavored cigars was associated with greater past 30-day cigar use in youth and young adults compared with non-menthol use. Initiation with menthol/mint cigarette and cigar products may lead to subsequent use of those products.

"Tobacco and Water": Testing the Health Halo Effect of Natural American Spirit Cigarette Ads and Its Relationship with Perceived Absolute Harm and Use Intentions.

In 2015, the FDA formally warned Santa Fe Natural Tobacco Company that their "natural" and "additive-free" claims for its Natural American Spirit cigarettes conveyed reduced harm to consumers. In a settlement, Santa Fe was allowed to continue using the word "natural" in the brand name and the phrase "tobacco and water". The company also uses eco-friendly language and plant imagery and these tactics have also been shown to communicate reduced product harm. In this study, we propose the health halo effect as an overarching framework for explaining how these ad tactics mislead consumers in an effort to provide more comprehensive guidance for regulatory action. In a between-subjects experiment, 1,577 US young adults, ages 18-24, were randomly assigned to view one of five Natural American Spirit cigarette ads featuring either: 1) eco-friendly language; 2) plant imagery; 3) the phrase "tobacco and water"; 4) all of these tactics; or 5) a control condition featuring none of these tactics. In line with past research, ads with the phrase "tobacco and water" or with all the tactics together (vs. control) created a health halo effect, increasing perceptions that Natural American Spirit cigarettes were healthier and had less potential to cause disease; these tactics also had an indirect positive effect on smoking intentions through reduced perceptions of the brand's potential to cause disease and perceived absolute harm. Inconsistent with prior work, the eco-friendly language and plant imagery (vs. control) reduced healthfulness perceptions, increased perceptions of absolute harm, and had an indirect negative effect on smoking intentions. We contribute to past research showing that Natural American Spirit cigarette ad tactics mislead consumers. Inconsistent findings are explained in terms of stimuli design and processing of message features, indices of relative message persuasiveness, and multiple versus single-message designs.

EDUCATIONAL OUTCOMES OF GENDER-DIVERSE YOUTH: A National Population-Based Study.

Despite the growing population of youth identifying with a transgender or nonbinary gender identity, research on gender-diverse individuals' educational outcomes is limited. This study takes advantage of the first nationally representative, population-based data set that includes measures of gender identity and educational outcomes: the High School Longitudinal study of 2009. Using minority stress and structural symbolic interactionist frameworks, we examine the association between gender identity and high school and college educational outcomes. We compare the educational outcomes of gender-diverse youth-binary transgender, nonbinary, and gender unsure-with those of cisgender youth, and also examine differences within the gender-diverse population. Given the strong link between minority stress and educational experiences among gender-diverse youth, we examine differences in outcomes before and after accounting for school belonging and emotional distress. We also account for individuals' social-structural location, arguing that social positionality shapes both gender identity and educational outcomes. Results indicate important differences in educational outcomes within the gender-diverse population: Whereas binary transgender and gender-unsure youth exhibit educational disadvantage, relative to cisgender youth, nonbinary youth do not. The gender-unsure disadvantage remains even after accounting for differences in social-structural location and social-psychological factors associated with minority stress.

The influence of cultural food security on cultural identity and well-being: a qualitative comparison between second-generation American and international students in the United States.

The purpose of this study was to explore the impact of cultural food insecurity on identity and well-being in second-generation American and international university students. Thirty-one semi-structured interviews were conducted from January-April 2020. Audio transcripts were analyzed using continuous and abductive thematic analysis. Students indicated that cultural foodways enhanced their well-being by facilitating their cultural/ethnic identity maintenance, connection, and expression. Conversely, cultural food insecurity diminished student well-being due to reduced cultural anchors, highlighting the importance of cultural food in this population. Universities that reduce cultural foodways barriers may mitigate cultural food insecurity for second-generation American and international university students. (100/100).

Sphingosine kinase-2 is overexpressed in large granular lymphocyte leukaemia and promotes survival through Mcl-1.

Sphingolipid metabolism is increasingly recognised as a therapeutic target in cancer due to its regulation of cell proliferation and apoptosis. The sphingolipid rheostat is proposed to control cell fate through maintaining balance between pro-apoptotic and pro-survival sphingolipids. This balance is regulated by metabolising enzymes involved in sphingolipid production. One such enzyme, sphingosine kinase-2 (SPHK2), produces pro-survival sphingosine 1-phosphate (S1P) by phosphorylation of pro-apoptotic sphingosine. Elevated SPHK2 has been found in multiple cancer types and contributes to cell survival, chemotherapeutic resistance and apoptosis resistance. We have previously shown elevation of S1P in large granular lymphocyte (LGL) leukaemia serum and cells isolated from patients. Here, we examined SPHK2 expression in LGL leukaemia and found SPHK2 mRNA and protein upregulation in a majority of LGL leukaemia patient samples. Knockdown of SPHK2 with siRNA in LGL leukaemia cell lines decreased proliferation. Additionally, the use of ABC294640 or K145, both SPHK2-specific inhibitors, decreased viability of LGL leukaemia cell lines. ABC294640 selectively induced apoptosis in LGL cell lines and freshly isolated LGL leukaemia patient cells compared to normal controls. Mechanistically, SPHK2 inhibition downregulated pro-survival myeloid cell leukaemia-1 (Mcl-1) protein through proteasomal degradation. Targeting of SPHK2 therefore provides a novel therapeutic approach for the treatment of LGL leukaemia.