A National Study of Social Media, Television, Radio, and Internet Usage of Adults by Sexual Orientation and Smoking Status: Implications for Campaign Design.

Background: Smoking rates among lesbian, gay, and bisexual (LGB) people significantly exceed that of heterosexuals. Media interventions are an important part of tobacco control efforts, but limited information is available on LGB people's media use. Methods: A nationally representative sample of 12,900 U.S. adults completed an online questionnaire assessing media use, smoking status, and demographic information. Multivariable logistic regression was used to assess relationships between media use with sexual orientation and smoking status. Results: A total of 590 (4.6%) respondents identified as LGB, of which 29% were smokers. Regardless of sexual orientation and smoking status, the Internet was the most popular media channel used, followed by television and radio. LGB respondents had significantly greater odds of having accounts on social media websites, accessing Facebook daily, and being a frequent Internet user, compared to heterosexual respondents. Similar media use was found between smokers and non-smokers, but smokers had greater odds of being frequent television viewers and frequent Internet users, compared to non-smokers. Conclusions: Compared to heterosexuals, LGB respondents reported greater use of the Internet, especially social media. Media campaigns targeting LGB populations can maximize reach by utilizing social media alongside traditional media channels.

Child-resistant and tamper-resistant packaging: A systematic review to inform tobacco packaging regulation.

OBJECTIVE: We aimed to investigate the effects of special packaging (child-resistant, adult-friendly) and tamper-resistant packaging on health and behavioral outcomes in order to identify research gaps and implications for packaging standards for tobacco products. METHODS: We searched seven databases for keywords related to special and tamper-resistant packaging, consulted experts, and reviewed citations of potentially relevant studies. 733 unique papers were identified. Two coders independently screened each title and abstract for eligibility. They then reviewed the full text of the remaining papers for a second round of eligibility screening. Included studies investigated a causal relationship between type of packaging or packaging regulation and behavioral or health outcomes and had a study population composed of consumers. Studies were excluded on the basis of publication type, if they were not peer-reviewed, and if they had low external validity. Two reviewers independently coded each paper for study and methodological characteristics and limitations. Discrepancies were discussed and resolved. RESULTS: The review included eight studies: four assessing people's ability to access the contents of different packaging types and four evaluating the impact of packaging requirements on health-related outcomes. Child-resistant packaging was generally more difficult to open than non-child-resistant packaging. Child-resistant packaging requirements have been associated with reductions in child mortality. CONCLUSIONS: Child-resistant packaging holds the expectation to reduce tobacco product poisonings among children under six.

Differences in the design and sale of e-cigarettes by cigarette manufacturers and non-cigarette manufacturers in the USA.

BACKGROUND: Three categories of e-cigarette brands have emerged within the US market: e-cigarette brands developed by cigarette manufacturers, brands acquired by cigarette manufacturers and brands with no cigarette manufacturer affiliation. In the absence of federal regulatory oversight of e-cigarettes, we assessed differences in e-cigarette products and sales practices across these categories. METHODS: Brand websites for top-selling e-cigarette brands from each of these categories were examined in October of 2015 to compare website access restrictions, online sales practices and products sold, including e-cigarette model type (eg, 'cigalike' vs advanced systems) and options available (eg, flavoured, nicotine free). RESULTS: Website access to brands developed by cigarette manufacturers was restricted to users aged 21 years or older, and one website required user registration. In addition, these brands were exclusively reusable/rechargeable 'cigalikes.' Limited flavour options were available for these products, and nicotine-free options were not sold. In contrast, brands acquired by cigarette manufacturers and brands with no cigarette manufacturer affiliation generally required website visitors to be 18, offered a nicotine-free option, and most offered disposable products and an array of flavoured products (eg, fruit/candy flavours). CONCLUSIONS: This exploratory study finds differences in e-cigarette products and sales practices across these three e-cigarette brand categories, with brands developed by cigarette manufacturers adopting a particularly distinctive product and sales strategy. Anticipated regulation of e-cigarettes in the USA may be influencing these product and sales decisions.

Price-related promotions for tobacco products on Twitter.

OBJECTIVES: This cross-sectional study examined price-related promotions for tobacco products on Twitter. METHODS: Through the Twitter Firehose, we obtained access to all public tweets posted between 6 December 2012 and 20 June 2013 that contained a keyword suggesting a tobacco-related product or behaviour (eg, cigarette, vaping) in addition to a keyword suggesting a price promotion (eg, coupon, discount). From this data set of 155 249 tweets, we constructed a stratified sampling frame based on the price-related keywords and randomly sampled 5000 tweets (3.2%). Tweets were coded for product type and promotion type. Non-English tweets and tweets unrelated to a tobacco or cessation price promotion were excluded, leaving an analytic sample of 2847 tweets. RESULTS: The majority of tweets (97.0%) mentioned tobacco products while 3% mentioned tobacco cessation products. E-cigarettes were the most frequently mentioned product (90.1%), followed by cigarettes (5.4%). The most common type of price promotion mentioned across all products was a discount. About a third of all e-cigarette-related tweets included a discount code. Banned or restricted price promotions comprised about 3% of cigarette-related tweets. CONCLUSIONS: This study demonstrates that the vast majority of tweets offering price promotions focus on e-cigarettes. Future studies should examine the extent to which Twitter users, particularly youth, notice or engage with these price promotion tweets.

Tobacco products sold by Internet vendors following restrictions on flavors and light descriptors.

INTRODUCTION: The 2009 Family Smoking Prevention and Tobacco Control Act bans characterizing flavors (e.g., grape, strawberry) in cigarettes, excluding tobacco and menthol, and prohibits companies from using misleading descriptors (e.g., light, low) that imply reduced health risks without submitting scientific data to support the claim and obtaining a marketing authorization from the U.S. Food and Drug Administration. This observational study examines tobacco products offered by Internet cigarette vendors (ICV) pre- and postimplementation of the ban on characterizing flavors in cigarettes and the restriction on misleading descriptors. METHODS: Cross-sectional samples of the 200 most popular ICVs in 2009, 2010, and 2011 were identified. Data were analyzed in 2012 and 2013. RESULTS: In 2011 the odds for selling cigarettes with banned flavors or misleading descriptors were 0.40 times that for selling the products in 2009 (95% confidence interval [CI] = 0.18, 0.88). However, 89% of vendors continued to sell the products, including 95.8% of international vendors. Following the ban on characterizing flavors, ICVs began selling potential alternative products. In 2010, the odds for selling flavored little cigars were 1.71 (95% CI = 1.09, 2.69) times that for selling the product in 2009 and, for clove cigars, were 5.50 (95% CI = 2.36, 12.80) times that for selling the product in 2009. CONCLUSIONS: Noncompliance with the ban on characterizing flavors and restriction on misleading descriptors has been high, especially among international vendors. Many vendors appear to be circumventing the intent of the flavors ban by selling unbanned flavored cigars, in some cases in lieu of flavored cigarettes.

US consumer interest in non-cigarette tobacco products spikes around the 2009 federal tobacco tax increase.

OBJECTIVES: This quasi-experimental longitudinal study monitored aggregate Google search queries as a proxy for consumer interest in non-cigarette tobacco products (NTP) around the time of the 2009 US federal tobacco tax increase. METHODS: Query trends for searches mentioning common NTP were downloaded from Google's public archives. The mean relative increase was estimated by comparing the observed with expected query volume for the 16 weeks around the tax. RESULTS: After the tax was announced, queries spiked for chewing tobacco, cigarillos, electronic cigarettes ('e-cigarettes'), roll-your-own (RYO) tobacco, snuff, and snus. E-cigarette queries were 75% (95% CI 70% to 80%) higher than expected 8 weeks before and after the tax, followed by RYO 59% (95% CI 53% to 65%), snus 34% (95% CI 31% to 37%), chewing tobacco 17% (95% CI 15% to 20%), cigarillos 14% (95% CI 11% to 17%), and snuff 13% (95% CI 10% to 14%). Unique queries increasing the most were 'ryo cigarettes' 427% (95% CI 308% to 534%), 'ryo tobacco' 348% (95% CI 300% to 391%), 'best electronic cigarette' 221% (95% CI 185% to 257%), and 'e-cigarette' 205% (95% CI 163% to 245%). CONCLUSIONS: The 2009 tobacco tax increase triggered large increases in consumer interest for some NTP, particularly e-cigarettes and RYO tobacco.