The Marketing and Perceptions of Non-Tobacco Blunt Wraps on Twitter.

OBJECTIVE: Non-tobacco blunt wraps (N-TBWs), which entered the marketplace in 2017, are being promoted as an alternative to traditional TBWs (e.g., cigarillos) for blunt smoking. The lack of studies on these novel products warrants an investigation. This study was the first to explore blunt smokers' perceptions about N-TBWs and the extent of product marketing on Twitter. METHODS: A corpus of tweets from Twitter, posted between January 2017 and November 2021, were identified by a Boolean search string (N = 149,343), where 48,695 tweets were classified as relevant by a machine learning algorithm. These relevant tweets were further screened and labeled as promotional or organic based on product URLs, usernames, keywords, or hashtags. Topic modeling using Dirichlet Allocation was then employed for identifying latent patterns of words among relevant tweets. The Social Networking Potential (SNP) score was employed for identifying influential accounts. RESULTS: Most relevant tweets (89%) were organic, non-promotional expressions about N-TBWs. Account users who only posted non-promotional tweets had a significantly higher SNP than those who only posted promotional tweets. Yet, neither of the two groups of account users consisted of known celebrities. Topic modeling revealed three broad groups of topics (7 in total) denoting the attributes of hemp N-TBWs, interest in non-hemp N-TBWs, and product marketing. CONCLUSIONS: The large proportion of organic tweets is indicative of the nascency of N-TBWs, which will need to be marketed more extensively if they are to replace cigar products used by blunt smokers.

Strategies and barriers to achieving the goal of Finland's tobacco endgame.

OBJECTIVES: Finland boldly legislated the end of tobacco use in its 2010 Tobacco Act, and subsequently expanded the goal in 2016 to eradicate other nicotine-containing products. This study explored stakeholders' perceptions about the strengths, barriers, solutions and rationale for Finland's comprehensive but conventional strategy to achieve its nicotine-free goal. DESIGN: Study participants were selected based on expertise in policy or practice of tobacco control (n=32). Semi-structured interviews, conducted in 2017 and 2018, covered topics ranging from consensus among stakeholders to Finland's ranking on the 2016 Tobacco Control Scale. The framework method was chosen for analysing interview transcripts. RESULTS: A perceived strength of Tobacco-Free Finland 2030 was the consensus and cooperation among members of the tobacco control community. The objective of becoming a nicotine- versus smoke-free society had almost unanimous support, challenged by a small minority who argued for greater discussion of harm reduction approaches. The need for maintaining legitimacy and historical successes in tobacco control were reasons for using a conventional strategy. Barriers to achieving the endgame goal included insufficient funding and over-reliance on non-governmental organisations, political/legal constraints, impact of institutional practices on tobacco disparities, ambivalence about the role of mass media and lack of prioritising smoking cessation. CONCLUSIONS: Stakeholders' broad confidence in reaching the goal of Finland's tobacco endgame suggests that future policy initiatives will reflect the current, conventional strategy. If the Finnish government chooses to continue this approach, then it should designate separate funds for Tobacco-Free Finland 2030 and implement structural changes that will facilitate tobacco control initiatives.

Smokers' Receipt of Cessation Advice from Healthcare Professionals in National Samples of People Diagnosed with HIV and the General Population.

Background: The high prevalence of smoking in persons living with HIV (PLWH) warrants an accurate estimation of smokers' receipt of advice on smoking cessation. Prior studies on the topic have been limited by convenience samples. Objective: This study aims to be the first to estimate PLWH smokers' receipt of cessation advice from a healthcare professional in a nationally representative sample. Methods: PLWH smokers were selected from the 2015-2016 Medical Monitoring Project (MMP; n = 1179), and smokers from the general population were selected from the 2014-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS; n = 15,635) and 2015 National Health Interview Survey (NHIS; n = 4,219). Prevalence ratios in MMP were estimated for testing the hypothesis that PLWH smokers, who are treated by other provider types, have a greater likelihood of receiving advice to quit smoking. Results: The weighted estimate of PLWH smokers from the MMP who received cessation advice (82.2%) was higher than weighted estimates from the TUS-CPS (70.9%) and NHIS (68.7%). While the higher estimate can be partially attributed to a higher percentage of daily smokers, the finding was still observed in stratified samples of daily and non-daily smokers. Statistically significant differences in cessation advice, however, were not observed by other provider types. Conclusions: The study's primary finding indicates that most PLWH smokers in care are receiving advice to quit smoking. The next steps are to train HIV care providers in all 5 A's of smoking cessation through the Ryan White HIV/AIDS Program's AIDS Education and Training Centers.

Linking the content to demographic reach of online advertising of electronic nicotine delivery systems.

INTRODUCTION: Recent studies have separately examined the content and demographic reach of the advertising of electronic nicotine delivery systems (ENDS). No study to our knowledge has linked the two in investigating whether racial/ethnic groups are differentially exposed to the comparative messages conveyed in online ENDS advertisements. METHODS: 932 unique ENDS advertisements (6311 total), which were posted on 3435 websites between December, 2009 and October, 2015, were categorized as either comparative or non-comparative with respect to the traditional cigarette. The race/ethnicity of website visitors was obtained from a proprietary source and used in constructing variables for racial/ethnic viewership. The variables for advertising content and website racial/ethnic viewership were then linked yielding a final sample of 551 unique ENDS advertisements (2498 total) on 1206 websites. A two-level hierarchical generalized linear model, used in estimating website racial/ethnic viewership as a predictor of comparative advertising, accounted for the nesting of advertisements (level 1) within 152 ENDS brands (level 2). RESULTS: In contrast to racial/ethnic minorities, a greater proportion of non-Hispanic whites visited websites with ENDS advertisements than the overall proportion of nonHispanic white U.S. Internet users. Yet, it was the advertisements on websites that appealed to Hispanics that had greater odds of comparing ENDS to traditional cigarettes. CONCLUSIONS: The lower exposure to ENDS advertising among racial/ethnic minorities versus non-Hispanic whites is consistent with survey data. Yet, the greater odds of comparative advertising of ENDS on websites that appeal to racial/ethnic minorities (ie, Hispanics) could impact the longterm health of minority smokers. IMPLICATIONS: This study's findings have important implications for the uptake of ENDS among minority smokers. If the comparative advertising yields greater interest and eventual use of ENDS, then minority smokers could either benefit from smoking cessation because they switch to ENDS, or adopt dual tobacco use. The fate of comparative advertising of ENDS versus the traditional cigarette will depend on the Food and Drug Administration enforcement of its deeming rules and the ensuing changes in the ENDS marketplace.

Characterizing Blunt Smokers by Their Acquisition of Cannabis.

BACKGROUND: Ethnographers have reported that young, urban males embraced blunt smoking in response to the crack cocaine epidemic that ravaged their neighborhoods in the 1980s. But, recent survey data has indicated high rates of other illicit drug use among blunt smokers. OBJECTIVES: The objective of this study was to examine the association between blunt smoking and cannabis acquisition as a potential explanation for the correlation with other illicit drug use. METHODS: The sample consisted of participants from the 2014 National Survey on Drug Use and Health (NSDUH) who reported use of cannabis or blunts in the prior month (n = 6,040). Logistic regression was used in estimating measures of demographics, access to illicit drugs, access to medical cannabis, frequency of cannabis/blunt use, and type of blunt smoker as correlates of a cannabis purchase versus other means of acquisition (e.g. sharing it). RESULTS: Accounting for other variables, current blunt smokers had 1.4 times the odds of purchasing cannabis relative to the cannabis users who had never smoked a blunt. Furthermore, the current blunt smokers had greater odds of purchasing cannabis frequently and making the purchases in outdoor settings. Conclusions/Importance: The findings suggest that current blunt smokers compared to other cannabis users are at greater risk of the dangers associated with illegal drug transactions. The legalization of recreational cannabis in some U.S. states is coinciding with the growth of a cannabis black market, highlighting the need for the continued assessment of cannabis acquisition in NSDUH questionnaires.

A longitudinal study of smokeless tobacco use and mortality in the United States.

Few studies in the United States have examined longitudinally the mortality risks associated with use of smokeless tobacco (SLT). The sample of our study was composed of participants from the National Longitudinal Mortality Study who completed a single Tobacco Use Supplement to the Current Population Survey between the years 1985 and 2011. Using survival methods, SLT use at the baseline survey was examined as a predictor of all-cause mortality and cause-specific mortalities in models that excluded individuals who had ever smoked cigarettes, cigars or used pipes (final n = 349,282). The participants had median and maximum follow-up times of 8.8 and 26.3 years, respectively. Regression analyses indicated that compared to the never tobacco users, the current SLT users did not have elevated mortality risks from all cancers combined, the digestive system cancers and cerebrovascular disease. However, current SLT users had a higher mortality risk for coronary heart disease (CHD) [hazard ratio (HR) (95% CI) = 1.24 (1.05, 1.46)] relative to never tobacco users. In a separate model, the elevated risk for CHD mortality corresponded to the use of moist snuff [HR (95% CI) = 1.30 (1.03, 1.63)]. The associations with CHD mortality could be attributed to long-term nicotine exposure, other SLT constituents (e.g., metals) or the confounding effects of CHD risk factors not accounted for in our study. The study's findings contribute to the ongoing dialogue on tobacco harm reduction and the US FDA's evaluation of Modified Risk Tobacco Product applications submitted by American SLT manufacturers.

The Case to Include Brand of Moist Snuff in Health Surveys.

INTRODUCTION: Brand of smokeless tobacco was added to the most recent Tobacco Use Supplement to the Current Population Survey (TUS-CPS), but deleted from the Centers for Disease Control's National Adult Tobacco Survey. The objective of this study was to assess the utility of brand in distinguishing users of moist snuff. METHODS: The sample consisted of participants from the 2010-2011 TUS-CPS who reported having used one of 14 brands of moist snuff in the past month (n = 2334). The brands were categorized into one of three types: snus, discount snuff, premium snuff. Multinomial logistic regression was employed for testing for associations between brand type and a series of demographic and tobacco use measures. RESULTS: Females, metropolitan residents, current smokers, and moderate users of snuff had significantly greater odds of using snus relative to premium snuff in the adjusted model (P < .001). Frequent users of snuff (eg, daily users), current smokers, young adults, participants with low household income, and those exhibiting dependence on nicotine had greater odds of using discount versus premium snuff. Separate analyses among current smokers (n = 470) and former smokers (n = 70) revealed positive associations between smoking cessation attempts and smokers' switch to discount snuff. CONCLUSIONS: Differences among the three categories of snuff users are likely attributed to variations in marketing campaigns. The differences are sufficient to warrant inclusion of snuff brand in health surveys because brand type could serve as a proxy measure for snuff use and dependence. IMPLICATIONS: Inclusion of brand of moist snuff in health surveys will enable researchers to categorize snuff users by brand type. Findings from this study indicate that brand type, defined according to cost (ie, discount vs. premium brands) and type of preferred snuff (ie, snus vs. other moist snuff), can distinguish snuff users by various demographic and tobacco use measures. Consequently, categorization by brand type could be used as a proxy measure for studies whose surveys do not include detailed information on snuff use and behavior.

Is the E-Liquid Industry Regulating Itself? A Look at E-Liquid Internet Vendors in the United States.

INTRODUCTION: The objective of this study was to assess whether the nascent, but rapidly growing e-liquid industry prohibits Internet sales to minors and employs safety measures to prevent accidental poisonings. METHODS: A stratified simple random sample (n = 120) was selected from the target population (N = 1107) of US online vendors of e-liquid in July 2015. The vendors were stratified and subsequently oversampled by trade association membership and vendor popularity. Three minors aged 16 to 17, who were supervised by adult research staff, attempted to purchase e-liquid from the 120 online vendors using debit cards issued in their names. Measures included vendors' use of age verification, warning labels on e-liquid bottles, and child-resistant packaging. RESULTS: Statistically significant differences were observed by vendor popularity, but not by membership in a trade association. The differences by vendor popularity, however, occurred for measures that were limited to an age warning and list of ingredients. The most striking finding was the scant vendors (n = 4) who successfully prevented the sale of e-liquid to the minors. In contrast, 87.5% and 53.9% of the bottles contained child-resistant packaging and a health warning label, respectively. CONCLUSIONS: Irrespective of trade association membership or vendor popularity, online vendors of e-liquids are not taking the proper precautions in preventing sales to minors. The FDA's upcoming deeming rules on e-cigarette products should include explicit requirements for offline and online e-liquid vendors, particularly the use of effective age verification, warning labels, and child-resistant packaging. IMPLICATIONS: This study demonstrates that, in the absence of any current FDA regulation of e-liquid products, self-regulation among vendors is not effective in preventing product acquisition by minors. Lax oversight of the e-liquid industry may draw consumers to bypass current tobacco control restrictions implemented in face-to-face sales settings. As a consequence, there may be an increase in online sales to minors. Further regulation of the industry may increase the already prevalent use of child-resistant packaging, leading to fewer cases of accidental nicotine poisoning.

Advertising Receptivity and Youth Initiation of Smokeless Tobacco.

BACKGROUND: Cross-sectional data suggests that adolescents' receptivity to the advertising of smokeless tobacco is correlated with use of chewing tobacco or snuff. Lack of longitudinal data has precluded determination of whether advertising receptivity precedes or follows initiation of smokeless tobacco. OBJECTIVES: The objective of this study was to test for the association between advertising receptivity and subsequent initiation of smokeless tobacco among adolescent males. METHODS: Adolescent males from the 1993-1999 Teen Longitudinal California Tobacco Survey were selected at the baseline survey for never having used smokeless tobacco. Separate longitudinal analyses corresponded to two dependent variables, ever use of smokeless tobacco (1993-1996; N = 1,388) and use on 20 or more occasions (1993-1999; N = 1,014). Models were adjusted for demographic variables, risk factors for smokeless tobacco use, and exposure to users of smokeless tobacco. RESULTS: Advertising receptivity at baseline was predictive of ever use by late adolescence (RR(95% CI) = 2.0 (1.5, 2.8)) and regular use by young adulthood (RR(95% CI) = 3.7 (2.1, 6.7)) in models that were adjusted for covariates. Conclusions/ Importance: The findings challenge the tobacco industry's assertion that tobacco marketing does not impact youth initiation. This is particularly relevant to tobacco control in the United States because the 2009 Tobacco Control Act places fewer restrictions on smokeless tobacco products compared to cigarettes.

A Dynamic Model of Adolescent Friendship Networks, Parental Influences, and Smoking.

Peer and parental influences are critical socializing forces shaping adolescent development, including the co-evolving processes of friendship tie choice and adolescent smoking. This study examines aspects of adolescent friendship networks and dimensions of parental influences shaping friendship tie choice and smoking, including parental support, parental monitoring, and the parental home smoking environment using a Stochastic Actor-Based model. With data from three waves of the National Longitudinal Study of Adolescent Health of youth in grades 7 through 12, including the In-School Survey, the first wave of the In-Home survey occurring 6 months later, and the second wave of the In-Home survey, occurring one year later, this study utilizes two samples based on the social network data collected in the longitudinal saturated sample of sixteen schools. One consists of twelve small schools (n = 1,284, 50.93 % female), and the other of one large school (n = 976, 48.46 % female). The findings indicated that reciprocity, choosing a friend of a friend as a friend, and smoking similarity increased friendship tie choice behavior, as did parental support. Parental monitoring interacted with choosing friends who smoke in affecting friendship tie choice, as at higher levels of parental monitoring, youth chose fewer friends that smoked. A parental home smoking context conducive to smoking decreased the number of friends adolescents chose. Peer influence and a parental home smoking environment conducive to smoking increased smoking, while parental monitoring decreased it in the large school. Overall, peer and parental factors affected the coevolution of friendship tie choice and smoking, directly and multiplicatively.

Establishing a standard measure of blunt and cigar use for U.S. national surveys.

BACKGROUND: Researchers have drawn attention to the need for modifying survey questions on cigars for distinguishing use intended for tobacco versus cannabis (i.e. blunt) consumption. Yet, most surveys do not distinguish persons who only smoke blunts (POSB) from persons who smoke blunts and unmodified cigars/cigarillos (PSBC). This study was intended to evaluate existing measures in U.S. national surveys for establishing a standard for the field. METHODS: Two of six leading U.S national surveys, the NSDUH and PATH, measured dual use of blunts and cigars. The analytical sample of this study included adult participants of the 2017 NSDUH (n = 2493) and Wave 4 PATH (n = 3175) who smoked a cigar or blunt in the past month and reported cigar brand usually or last smoked; the latter was used as a validation measure. RESULTS: Odds of using Swisher Sweets and other brands (vs. Black & Mild) increased with more frequent blunt use relative to persons who only smoked unmodified cigars/cigarillos (POSC). Further, regression coefficients for the three subgroups of PSBC differed significantly, highlighting the utility of an ordinal versus aggregated measure. Estimates of the former were diminished in magnitude upon expanding the sample to persons who smoked any cigar product. CONCLUSIONS: Validation of the ordinal measure of blunt-cigarillo use in PATH supports the measure's implementation as a standard for U.S. national surveys. Implementation of the measure in other surveys (e.g., NSDUH) would provide a more consistent and accurate assessment of blunt and cigar use for monitoring health risks.

A qualitative assessment of blunt smokers' perceptions and receptivity to non-tobacco blunt wraps.

OBJECTIVE: The recent debut of the non-tobacco blunt wrap (N-TBW) for smoking cannabis has received little attention from the tobacco control community. The present study is intended to assess blunt smokers' perceptions and receptivity to N-TBWs, which are being marketed as an alternative to cigarillos and other tobacco products used for making blunts. METHODS: Current blunt smokers (n=41) were recruited from social media platforms to participate in one of nine two-hour focus groups held between October 2022 and May 2023. Six topics ranging from social aspects of blunt smoking to impediments to switching to N-TBWs were discussed. A domain analysis was utilized in uncovering semantic relationships between a given variable (e.g., uneven burn rate) and outcome (e.g., not using N-TBWs). RESULTS: Blunt smokers conveyed interest in the N-TBWs because of health concerns about tobacco. Yet, the following three main barriers impede blunt smokers use of N-TBWs: lack of awareness and accessibility of the N-TBW, familiarity with preparing and smoking a traditional blunt, and incomparability of the tobacco blunt wrap (e.g., cigarillo). The latter was the most formidable challenge as participants expressed several negative product features of N-TBWs (e.g., flimsy material) relative to cigarillos. CONCLUSIONS: The N-TBW is unlikely to displace the cigarillo in the near-term future. A more likely scenario is that blunt smokers will continue to use cigarillos with intermittent use of N-TBWs in situational settings. If this occurs, then blunt smokers will continue to be exposed to harmful tobacco products.

Trends in the use and advertising of discount versus premium snuff.

INTRODUCTION: The Conwood Company, a major producer of discount moist snuff, was awarded a $1 billion antitrust settlement in the year 2000 against its leading competitor, the U.S. Smokeless Tobacco Company. The objective of this study was to examine the trends in use and advertising of discount versus premium snuff since the Conwood settlement, a topic seldom addressed in the tobacco control literature. METHODS: 2 sources of data were analyzed in 2011: (a) male snuff users from the 2002-2009 National Surveys on Drug Use and Health (N = 13,172) and (b) total advertisements of moist snuff identified from over 350 consumer magazines dated 2005-2009 (N = 861). For the survey data, demographic and tobacco-related measures were assessed as predictors of use of discount versus premium snuff in logistic regression models. For the advertising data, associations were examined between the snuff category and nicotine content, magazine youth readership, and year of magazine publication. RESULTS: The prevalence of discount and premium snuff use among males increased and decreased, respectively, from 2002 to 2009. Significant predictors of using discount versus premium snuff were being an adolescent, being an African-American, being a current or former smoker, living in a less populated region of the country, and using snuff frequently. Discount snuff advertising was associated with publication in magazines with a high youth readership. CONCLUSIONS: Discount snuff has grown in popularity among male adolescents who have been a target of advertising. The tobacco's cheap price and high nicotine content pose a public health problem because of the potential for long-term tobacco use and dependence.

Variation in adults' use of flavored tobacco products by sales restrictions in California jurisdictions.

BACKGROUND: State and local policies prohibiting the sales of flavored tobacco have been effective in curtailing retail availability and sales of products across the United States. Less is known about the use of flavored tobacco which could vary as a function of type of ordinance, product category, policy implementation, and other factors. METHODS: The 2019-2020 California Health Interview Surveys were used to estimate flavored and non-flavored tobacco use among adults (n = 43,681) residing in a California jurisdiction with a comprehensive (n = 48), partial (n = 35), or no flavored tobacco sales restriction (FTSR) (n = 427). Multinomial logistic regression models, which accounted for clustering within jurisdictions (n = 510), were separately developed for outcomes corresponding to use of any tobacco, non-cigarette tobacco products (NCTPs), electronic nicotine delivery systems, and conventional cigarettes. Individual-level effects of policy on tobacco use were estimated due to the overlap between the survey periods and effective policy dates. RESULTS: Approximately 22% of Californians were subject to a partial or comprehensive FTSR by December 31, 2020. Accounting for potential confounders, residents of jurisdictions with a comprehensive FTSR (vs. no ban) had 30% lower odds of using any flavored tobacco. The strongest and only statistically significant association by product category was exposure to a comprehensive FTSR and use of a flavored NCTP (aOR=0.4 (0.2, 0.8); p=0.008). Null or positive associations were primarily observed between a partial FTSR and flavored tobacco use, as well as associations between any FTSR and non-flavored tobacco use. CONCLUSION: Recent passage of a statewide ban in California will close gaps from the patchwork of local policies and eliminate most partial FTSR exemptions. However, state law still exempts the sales of some flavored tobacco products (e.g., hookah), leaving jurisdictions the option of enacting comprehensive FTSRs that may be more effective than partial FTSRs in reducing use of flavored tobacco.

Cannabis Vape Product Sales in California Following CDC's Initial Advisory About Lung Injuries.

Introduction: The 2019 outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) is believed to have been caused by vitamin E acetate, an additive used in some cannabis vaporizer products. Previous studies have primarily focused on changes in sales of electronic nicotine delivery systems following the initial advisory issued by the Centers for Disease Control (CDC) on August 17, 2019. The present study is intended to examine variation by age groups in sales of regulated cannabis vape products in the state of California before, during, and after the outbreak. Methods: Weekly sales revenue of cannabis vape products (from January 1, 2018, to December 31, 2020) was obtained from a sample of recreational cannabis retailers licensed in California. An interrupted time series analysis, using AutoRegressive, Integrated, Moving Average methods, was employed to estimate changes in the sales and market share of cannabis vape products in the weeks following the CDC advisory. Results: The total volume of regulated cannabis vape product sales increased substantially over the 3-year study period (2018-2020). Sales and market share of cannabis vape products, however, declined in both young and older adults immediately following the advisory, rebounding to pre-EVALI levels only for the young adults. For sales, the potential EVALI effect following the CDC's advisory equates to an 8.0% and 2.2% decline below expected levels in the older and young adults, respectively. Conclusions: The differential age effect on sales may reflect concerns regarding health effects of cannabis vaping products and greater awareness of the outbreak among older adults. Findings highlight the importance of informing consumers about health risks associated with using cannabis vape products acquired from regulated versus illicit sources.

Tribal casinos in California: the last vestige of indoor smoking.

BACKGROUND: High levels of airborne particles from secondhand smoke have been reported in California Indian casinos. Yet, little is known regarding the smoking status of casino patrons, their avoidance of secondhand smoke while visiting, and their views on a hypothetical smoking ban. METHODS: Predictors of visiting an Indian casino were assessed among participants of the 2008 California Tobacco Survey (n = 10,397). Exposure to and avoidance of secondhand smoke were subsequently analyzed among a subset of participants who had visited a casino in the year prior to the survey (n = 3,361). RESULTS: Ethnic minorities, older individuals, current smokers and residents of sparsely populated regions of California were more likely than other demographic groups to visit a tribal casino. Avoidance of secondhand smoke was more frequent among the never smokers than former and current smokers, particularly those who last visited a casino lacking physical separation between non-smoking and smoking sections. The never smokers versus current smokers disproportionately expressed a willingness to extend their stay and visit again if smoking were prohibited. CONCLUSIONS: If casinos became smoke free, then it is anticipated that they would be visited by a significantly larger number of Californians, including both patrons and those who otherwise would not have visited a casino.

Do smokers' harm perceptions of cigarillos differ by modified use of the tobacco product? Findings from waves 3 and 4 of the PATH study.

OBJECTIVE: The harm perceptions of individuals who smoke either blunts or the Black & Mild (B&M) brand, which is often "freaked," have seldom been investigated. Since these practices could affect users' perceived health risks of the cigarillo, this study was intended to compare such risks among cigarillo users by modified use of the tobacco product. METHOD: Adult cigarillo and blunt smokers were selected from the Population Assessment of Tobacco and Health Study for cross-sectional (Wave 4; n = 3,331) and longitudinal (Waves 3-4; n = 1,898) analyses of predictors of general and relative harm perceptions of cigarillos. Ordinal and multinomial logistic regression methods were employed for testing whether adjusted odds of perceiving cigarillo harms were greater in blunt versus cigarillo smokers. In a separate model (n = 1,258), preference for B&M cigarillos was examined as a correlate of harm perception due to the perceived health benefits of removing the inner tobacco liner. RESULTS: Cross-sectional estimates indicated that blunt smokers, mixed cigarillo/blunt smokers, and those who preferred B&M brand perceived significantly more risk than conventional cigarillo smokers. Longitudinal estimates indicated that among those who underwent a transition in use, former blunt and former cigarillo smokers had significantly greater odds of reporting an increase in perceived harm compared to new users. CONCLUSIONS: The change in blunt smokers' harm perceptions upon transitioning in blunt use suggests acknowledgment of the harm of using cigarillos in some form. Given their high perceived risk of cigarillos, blunt smokers might be receptive to replacing the tobacco product with a nontobacco wrap. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reframing the banning of flavored tobacco in unprecedented times- an example from California's Senate bill 793.

Several cities, but only two U.S states, have passed a law banning the sales of flavored tobacco products. It has been suggested that framing tobacco control policy solely in terms of the youth could send the erroneous message that tobacco use is an acceptable behavior for adults. This study was intended to compare the framing of policy between California's Senate Bill (SB) 38 and 793. Seven audio files of hearings on SB-38 (N = 2) and SB-793 (N = 5), held between March 2019 and August 2020, were transcribed and coded for youth issues and the unprecedented events of 2020 that shaped society's views of health and racial/social justice. The Framework Method was used for organizing and analyzing content of the legislative hearings. Many of the same arguments pertaining to youth were presented in hearings on the two bills. The one notable difference was legislators' sense of obligation to younger constituents, which was expressed in hearings on SB-793, but not SB-38. The hearings on SB-793 also differed with respect to greater discussion about the relevance of a tobacco flavor ban to society as a whole. These discussions revolved around the COVID-19 pandemic and potential impact of a ban on communities of color. Discussions on SB-793 about the larger societal impact of flavored tobacco may be a more effective strategy than focusing exclusively on the youth. Thus, legislators from other U.S. states who are contemplating a statewide ban should consider reframing the issue according to California's SB-793.

Concentration of Cannabis and Tobacco Retailers in Los Angeles County, California: A Spatial Analysis of Potential Effects on Youth and Ethnic Minorities.

OBJECTIVE: Cannabis and tobacco retailers are believed to cluster in areas with more racial/ethnic minorities, which could account for the disproportionate use of blunts in Black and Hispanic communities. The current study examined the spatial relationship between cannabis and licensed tobacco retailers in Los Angeles County, California, and assessed whether various neighborhood and business factors influenced the spatial patterning. METHOD: Generalized additive models were used to test the association between the location of cannabis retailers (N = 429) and their accessibility potential (AP) to tobacco retailers (N = 8,033). The covariates included cannabis licensure status, median household income, population density, percentages of racial/ ethnic minorities and young adults (18-34), unemployment status, families living in poverty, minimum completion of high school/General Educational Development (GED) credential, and industrial businesses by census tract. RESULTS: The location of cannabis retailers was significantly associated with AP in all adjusted models (p < .005). The percentage of racial/ethnic minorities, age (18-34 years), and nonlicensure of cannabis retailers, which were positively correlated with AP (p < .05), confounded the association between AP and cannabis retailer location. CONCLUSIONS: The concentration of unlicensed cannabis retailers and tobacco retailers in young and racially/ethnically diverse neighborhoods may increase access to and use of cigarillos for blunt smoking. Jurisdictions within Los Angeles County should consider passing ordinances requiring minimum distances between cannabis and tobacco retailers.

A content analysis of Camel Snus advertisements in print media.

INTRODUCTION: Researchers have questioned whether the R.J. Reynolds Tobacco Company is marketing Camel Snus as a product for nontobacco users, smokeless-tobacco users, or cigarette smokers. The objective of this study was to examine advertisements of Camel Snus in print media to determine the most likely audience of intent. METHODS: A content analysis was conducted among Camel Snus advertisements printed in newspaper and consumer magazines between July 2007 and August 2010. The advertisements (n = 83 distinct; N = 458 total) were identified from a comprehensive search of a proprietary database maintained by TNS Media Intelligence. RESULTS: Results indicated that all advertisements, published between July 2007 and September 2009, were intended to promote a tobacco product for cigarette smokers. A shift in marketing strategy occurred from October 2009 to the present time with publication of the "Break Free" magazine advertisements, characterized by an ambiguous message that could conceivably appeal to any group, including nontobacco users (e.g., adolescents), smokeless-tobacco users, and/or cigarette smokers. However, an examination of the consumer magazines advertising Camel Snus indicated a demographically diverse readership in terms of gender, age, and education, suggesting that the advertisements are less likely to be intended for smokeless-tobacco users. CONCLUSIONS: These findings validate other reports and editorials, suggesting that Camel Snus was being marketed as a product for smokers at the time of the product's national debut. The recent shift to the "Break Free" marketing campaign may reflect an attempt to enhance the image of the Camel brand in order to attract a broader spectrum of consumers.