The Impact of New Jersey's 2020 E-Cigarette Flavor Ban on E-Cigarette, Cigarette, and Cigar Sales in NJ.

INTRODUCTION: On April 20, 2020, New Jersey (NJ) implemented a comprehensive ban on the sale of flavored e-cigarettes. This study compares sales of e-cigarettes, cigarettes, and cigars before and after the law. METHODS: Data were biweekly retailer scanner sales in NJ convenience stores for e-cigarettes, cigarettes, and cigars between August 2019 and December 2020. We used Joinpoint regression to assess sales trends for cigarettes (non-menthol, menthol), cigars (unflavored, flavored), and e-cigarettes (unflavored, fruit/sweet/concept flavor, menthol flavor) in the 36 weeks before and 36 weeks after a statewide ban on flavored e-cigarettes. RESULTS: Flavored e-cigarette sales, not including menthol, significantly decreased over the study period while menthol e-cigarette sales significantly increased until the e-cigarette flavor ban took effect, after which these sales rapidly declined through May 2020, then slowed. Unflavored e-cigarette sales declined through September 2019, then grew modestly until the flavored e-cigarette ban, after which sales significantly increased. Flavored cigar sales increased between March and May 2020, then declined; non-flavored cigar sales increased between mid-February and early July 2020, then declined. Cigarette sales were decreasing before the flavored e-cigarette ban but after, significantly increased until June 2020. Overall, there was no significant trend in the average biweekly percent change for cigarette sales. CONCLUSIONS: Flavored e-cigarette sales were declining prior to the ban but the pace of the decline accelerated following federal and state restrictions on flavored e-cigarette sales, then slowed by the second half of 2020, with a brief period of increased cigarette and cigar sales immediately following the ban. IMPLICATIONS: New Jersey's 2020 statewide e-cigarette flavor ban offered the opportunity to observe how sales of e-cigarette, cigarette, and cigar products shifted after the change. The effect of the state law, at least in the short-term, was decreased sales of flavored e-cigarettes and increased sales of unflavored e-cigarettes. Research on long term policy effects is needed.

Examining Market Trends in Smokeless Tobacco Sales in the United States: 2011-2019.

INTRODUCTION: The smokeless tobacco (SLT) industry in the U.S. continues to transform with novel products amid an evolving regulatory environment. We report SLT sales trends in the U.S. by analyzing retail market scanner data from 2011 through 2019. METHODS: National SLT sales data were obtained from Nielsen's Convenience Track System for January 2011 to December 2019. UPC codes were used to classify products by attributes including type, parent company, brand, form, and flavor. Market share was calculated as percentage of total unit sales. Detailed product analysis was presented for moist snuff, snus, and tobacco-free nicotine products. RESULTS: SLT sales increased by 5.8% between 2011 and 2016 but declined by 3.9% from 2016 to 2019. Moist snuff sales increased by 8.1% between 2011 and 2016 and then declined 7.4% from 2016 to 2019 but still accounted for roughly 90% of the overall market annually. Between 2011 and 2019, snus sales consistently increased while sales of chew, dry snuff, and dissolvables decreased. Tobacco-free nicotine products emerged in 2016 and captured 4.0% of the market by 2019. Portion pouch packaging and flavors showed consistent growth although their popularity varied by the type of smokeless product. CONCLUSION: This study extends our previous work on U.S. SLT market trends through 2019. Overall sales increased between 2011 and 2016 but there were signs of leveling off including declining sales of moist snuff. Newer products continue to gain market share. Continued monitoring of SLT sales is needed, particularly given the new modified risk status of several products. IMPLICATIONS: This study analyzed the last 9 years of smokeless tobacco market data (2011-2019) to describe recent trends in sales. Overall, the smokeless product category is quite resilient although signs suggest downward trends among some product categories and features. New types of smokeless tobacco products (eg, snus and tobacco-free nicotine pouches) account for a growing share of the market.

Cigarette smoking, prescription opioid use and misuse among young adults: An exploratory analysis.

Young adults have the highest prevalence of misuse of prescription opioids. In 2016, 7.1% of 18- to 25-year-olds reported misuse, meaning use other than as prescribed. While smoking is known to be associated with opioid use, to our knowledge no study has examined the relationships between smoking, prescribed use of opioids, and opioid misuse in young adults at the population level. Online survey data were collected in spring 2018 from a nationally representative sample of 18-25-year-olds from the Truth Longitudinal Cohort (N = 10,502). Respondents self-reported cigarette smoking, and both lifetime and recent (past 6-month) prescribed use and misuse of opioids. Generalized ordered logistic regression modeling was used to determine associations between cigarette smoking and recent prescribed use and misuse while controlling for demographic characteristics, other substance use, sensation seeking, and mental health status. Overall, 61.0% of respondents reported lifetime prescribed use of opioids and 16% reported recent prescribed use. Lifetime misuse was reported by 19.4%, with 7.8% reporting recent misuse. Together, the models revealed a graded relationship, with current smokers having higher odds of both prescribed use and misuse, never smokers having lowest odds of use or misuse, and ever smokers, those who had smoked but not in the past 30 days, falling between current and never smokers. Findings indicate a clear association between smoking and use of opioids even after accounting for a strong association between prescribed use and misuse among young adults.

"They're Pretty Much Made for Blunts": Product Features That Facilitate Marijuana Use Among Young Adult Cigarillo Users in the United States.

INTRODUCTION: Cigarillo use is prevalent among young adults in the United States. Many young people use cigarillos as "blunts," a term for a cigar emptied of its tobacco and replaced with marijuana. Because cigars in the United States are not subject to the same regulations as cigarettes, they offer a diverse selection of flavors and packaging styles. It is unclear how these and other product attributes facilitate blunt use. METHODS: Semi-structured telephone interviews were conducted with a sample of 40 young adult cigar or cigarillo users in the United States to assess patterns of use and perceptions about product features. Quotations from interview transcripts were coded for major themes and summarized across participants. RESULTS: Regardless of their preferred brand, participants felt that the brand Black & Mild is primarily smoked for the tobacco. There was a strong perception, however, that other popular cigarillo brands are almost always used to make blunts. Participants believed that cigarillo companies design their products to simplify blunt-making, with features such as perforated lines or wrappings that unroll easily. Resealable foil pouches, a popular packaging style, are often used to hold unused marijuana and mask its smell. CONCLUSIONS: Blunt use is pervasive among young adult cigarillo users in the United States, and certain cigar companies have developed products that facilitate blunt-making. Future surveillance measures should capture the extent to which cigarillo users are using these products as blunts. Continued surveillance of cigarillo sales and popular product attributes are needed. IMPLICATIONS: Cigarillo use is prevalent among young adults in the United States, many of whom are using the products as blunts. This study found that product features such as brand, flavor, packaging, and price influence the selection of cigarillos used for this purpose. There is also a strong perception among young adult cigarillo users that cigarillo companies design their products and packaging to make the blunt-making process simple and enjoyable. Better surveillance measures are needed to capture the extent to which cigarillos are used as blunts and which product features are driving category growth.

Close, but no cigar: certain cigars are pseudo-cigarettes designed to evade regulation.

An abundance of evidence suggests that the tobacco industry's response to increased regulation imposed on cigarettes has been the development of little cigars and filtered cigars which are tobacco products that are merely cigarettes in disguise. Emphasising these products' physical attributes, the tobacco industry has offered cigar products to its consumers as pseudo-cigarettes. For decades, tobacco manufacturers' response to increased cigarette regulation and taxation has been to exploit policy loopholes by offering these little cigars and filtered cigars pseudo-cigarettes that are exempted from this regulatory oversight. As a result, in spite of increased regulations and taxes on cigarettes, smokers can purchase cigars that are almost physically indistinguishable from their cigarettes at a lower cost. This commentary describes the recent evolution of the cigar market in response to federal regulation, and highlights historical cigar industry attempts to evade taxation, capitalise on product features that are off-limits to cigarettes, and capture the shrinking market of cigarette smokers. We present the case that little cigars and filtered cigars, differing very little physically from cigarettes, are products deserving the same regulatory scrutiny.

Electronic Health Record Prompt to Improve Lung Cancer Screening in Primary Care.

INTRODUCTION: Lung cancer is the leading cause of cancer death in the U.S. Combusted tobacco use, the primary risk factor, accounts for 90% of all lung cancers. Early detection of lung cancer improves survival, yet lung cancer screening rates are much lower than those of other cancer screening tests. Electronic health record (EHR) systems are an underutilized tool that could improve screening rates. METHODS: This study was conducted in the Rutgers Robert Wood Johnson Medical Group, a university-affiliated network in New Brunswick, NJ. Two novel EHR workflow prompts were implemented on July 1, 2018. These prompts included fields to determine tobacco use and lung cancer screening eligibility and facilitated low-dose computed tomography ordering for eligible patients. The prompts were designed to improve tobacco use data entry, allowing for better lung cancer screening eligibility identification. Data were analyzed in 2022 retrospectively for the period July 1, 2017 to June 30, 2019. The analyses represented 48,704 total patient visits. RESULTS: The adjusted odds of patient record completeness to determine eligibility for low-dose computed tomography (AOR=1.19, 95% CI=1.15, 1.23), eligibility for low-dose computed tomography (AOR=1.59, 95% CI=1.38, 1.82), and whether low-dose computed tomography was ordered (AOR=1.04, 95% CI=1.01, 1.07) all significantly increased after the electronic medical record prompts were implemented. CONCLUSIONS: These findings show the utility and benefit of EHR prompts in primary care settings to increase identification for lung cancer screening eligibility as well as increased low-dose computed tomography ordering.

Trends in Overall and Menthol Market Shares of Leading Cigarette Brands in the USA: 2014-2019.

Many factors can shift cigarette brand preference, and surveillance is an important tactic to inform regulatory strategy. The objective of this study was to identify shifts in top brands' overall and menthol market share from 2014 to 2019. We used data from the National Survey on Drug Use and Health public use datasets, which are a nationally representative, cross-sectional survey of people aged 12+ in the USA. In our analysis of top brands, we accounted for consumption patterns and computed the percent change in market share for each brand. We observed that overall market share declined for nearly all brands, though top moderately priced brands gained share. Half of the top brands with menthol styles grew in menthol market share. We observed three primary shifts in the cigarette market: brands that gained the most menthol market share were brands with both menthol and non-menthol in their product lineups; menthol contributed substantially to discount brands' market share increases; the two premium brands that employed "natural" descriptors experienced increased market share. Research should continue to focus on trends that influence cigarette market share, as the cigarette market in the USA is likely to look very different in five years than it does today.

The Effect of Cigarillo Packaging Characteristics on Young Adult Perceptions and Intentions: An Experimental Study.

Research demonstrates that characteristics of cigarette packaging influence consumer product perceptions, yet the current literature on the impact of cigar packaging is limited. This study aims to examine how different cigarillo packaging features influence young adult cigar smokers' perceptions. In 2016, we recruited past-year cigar users aged 18-34 from Amazon Mechanical Turk (N = 1260). We utilized a 2 × 2 × 3 × 2 between-subjects factorial design, randomly assigning participants to view one of 24 images of a cigarillo package that varied by brand (Black & Mild vs. Swisher Sweets), brand name (full vs. abbreviated), color (brown vs. green vs. purple), and price promotion (present vs. absent). Participants rated the product on several perceptions and purchase intentions, and they reported on cigar use and demographics. Overall, color and brand name influenced perceptions, but effects varied by brand. For Swisher Sweets, only price promotions influenced perceptions (e.g., taste, use for marijuana); for Black & Mild, all packaging features influenced perceptions (e.g., harshness, tobacco quality), and price promotions increased purchase intentions. Our findings also raise questions that product features may interact with one another, with certain features, such as color, overpowering other attributes. More research is needed to understand the impact of other packaging features, such as warning labels, on product perceptions across a variety of brands.

Effects of Multiple Exposures and Ad-Skipping Behavior on Recall of Health Messages on YouTubeTM.

Although measuring exposure to public health messages is key to understanding campaign effectiveness, little is known about how exposure to and avoidance of digital ad messages may influence self-reported ad recall. A sample of 15-24-year-olds (n = 297) received a varying number of forced-view and skippable test ads across multiple simulated YouTubeTM sessions. Each session was coded for whether the participant viewed the ad or skipped it. While a majority of participants recalled the test ad, the odds of ad recall did not vary by number of sessions (opportunities for exposure). Rather, ad recall was sensitive to the number of completed ad views such that odds of ad recall doubled for each additional time the ad was completely viewed. Findings suggest that public health digital message exposure and recall can be optimized with sufficient attention paid to the proportions of forced-view ads aired when aiming to reach younger audiences.

Young Adults' Opioid Prescription History and Opioid Misuse Perceptions.

Objectives: In this study, we investigated perceptions of prescription opioid misuse among young adults who had or had not been prescribed opioids in the past. Methods: Participants from a national online panel, age 18-34 (N = 1220), completed a survey about their medical use of opioids and their perceptions of the risks and prevalence of opioid misuse and dependence. Associations between prescription history and perceptions of opioids were tested using generalized ordered logistic models. Results:Most respondents reported receiving at least one prescription for opioids in their lifetime (68%), with 57% reporting past-year prescriptions. Re spondents with more lifetime prescriptions perceived higher rates of misuse and dependence. More lifetime prescriptions were associated with lower perceived risk of occasional prescription opioid misuse but higher perceived risk for regular misuse. Conclusions: Prior experience with receiving a prescription for opioid pain relievers is associated with young adults' perceptions of opioid misuse. Taking prescription opioids, even as directed, provides young adults with expo- sure to the drugs that may shape these perceptions both by increasing awareness of the drug and through exposure to misuse of the drug.

Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018.

INTRODUCTION: Considerable declines in cigarette smoking have occurred in the U.S. over the past half century. Yet emerging tobacco products, including e-cigarettes, have increased in popularity among U.S. youth and adults in recent years. Nicotine content is an important factor in weighing the potential benefits and risks of e-cigarettes on individual and population level health. This study examined how nicotine concentrations of e-cigarette products sold have changed from 2013 to 2018. METHODS: E-cigarette sales data aggregated in 4-week periods from March 2, 2013 to September 8, 2018 (66 months total) from convenience store and mass market channels were obtained from Nielsen. Internet and vape shop sales were not available. Internet searches were used to supplement information for nicotine concentration and flavor. Products were categorized by nicotine concentration, flavor, type (disposable or rechargeable), and brand. Dollar sales, unit sales, and average nicotine concentration were assessed. RESULTS: During 2013-2018, the average nicotine concentration in e-cigarettes sold increased overall, for all flavor categories, and for rechargeable e-cigarettes. The proportion of total dollar sales comprised of higher nicotine concentration e-cigarettes (>4% mg/mL) increased from 12.3% to 74.7% during 2013-2018, with a similar increase in unit share. Zero-nicotine products accounted for less than 1% of dollar market share across all years analyzed. CONCLUSIONS: E-cigarettes with higher nicotine concentrations comprise a substantial and increasing portion of U.S. e-cigarette sales. Higher nicotine concentrations may influence patterns of e-cigarette use, including harms from e-cigarette initiation among youth and potential health benefits for adult smokers switching completely to e-cigarettes.

Changes in the Mass-merchandise Cigar Market since the Tobacco Control Act.

OBJECTIVES: This study identifies the specific product characteristics driving mass-merchandise cigar sales in the context of the changing regulatory environment. METHODS: Cigar sales data in US convenience stores during 2008-2015 were purchased from Nielsen's Convenience Track system. Descriptive statistics highlight changes in the cigar market over time. RESULTS: Sales of flavored cigars increased by nearly 50% since 2008 and now make up over half of the cigar market. Fruit remains the most popular flavor group, but the sale of non-descript flavors such as "Jazz" and "Green" has grown substantially. Inexpensive 2- and 3-packs made up less than 1% of cigar sales in 2008, but by 2015 this packaging style held 40% of the market share. Black & Mild and Swisher Sweets dominate the convenience store channel and together are responsible for nearly 60% of total mass-merchandise cigar sales. CONCLUSIONS: Cigar companies take advantage of features recently banned for cigarettes, such as flavorings and small pack sizes to maintain strong sales. Given the appeal of mass-merchandise cigars to youth and young adults, the FDA and other governing bodies should regulate the manufacturing and promotion of cigars in the same way they have regulated cigarettes.

The Cigarette and Smokeless Tobacco Markets in Texas Relative to the United States.

OBJECTIVE: This study compares the cigarette and smokeless tobacco (SLT) markets in Texas and the United States (US) as a whole. METHODS: Nielsen convenience store sales data from 2014 were obtained for Dallas, Houston, San Antonio/Austin, and the total US. Descriptive statistics highlighted market share differences in Texas compared to the US overall. RESULTS: Marlboro and Copenhagen dominated the cigarette (58.9%) and SLT markets (44.8%) in Texas and had substantially higher relative market shares in Texas than nationally (46.7% and 29.8%, respectively). Camel, with sales driven largely by its Camel Crush variety, held second place in Texas (9.8%), outselling Newport (6.6%), despite Newport's status as second best-selling brand in the US (11.5%). Copenhagen led the SLT market in Texas, outselling Grizzly 2 to 1, yet the brands hold roughly equivalent shares nationally. Whereas flavored SLT products made up nearly 60% of the US SLT market, unflavored SLT (58.6%) dominated in Texas markets. Finally, sales of fine-cut SLT in Texas were more than triple their national market share. CONCLUSIONS: Regional tobacco market share differences are likely influenced by multiple factors such as marketing, population demographics, culture, and neighboring communities. Policymakers are encouraged to develop local tobacco control policies and programs within the context of this knowledge.