Patterns of Premium and Nonpremium Cigar Use in the United States: Findings from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study.

INTRODUCTION: Understanding the characteristics of premium cigar use patterns is essential for minimizing public health harms. Typically, premium cigars are handmade, larger, more expensive, and without the characterizing flavors that are present in other cigar types: Nonpremium traditional cigars, cigarillos, and filtered cigars. AIMS AND METHODS: Self-reported brand and price data were used from Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study to define and estimate premium versus nonpremium cigar use among U.S. adults, as well as to explore cigar smoking patterns, purchasing behavior, and reasons for use by cigar type. RESULTS: In 2021, 0.9% (95% CI = 0.7-1.0) of adults were premium cigar users, compared to 0.4% of nonpremium traditional cigar users (95% CI = 0.3-0.5), 1.1% of cigarillo users (95% CI = 1.0-1.2), and 0.6% filtered cigar users (95% CI = 0.5-0.7). Premium cigar users were overwhelmingly male (97.7%), and 35.8% were aged ≥55 years. The average premium cigar price/stick was $8.67, $5.50-7.00 more than other cigar types. Compared to other cigar types, significantly fewer premium cigar users had a regular brand with a flavor other than tobacco (~15% vs. 38%-53%). Though flavors remained the top reason for premium cigar use, they were less likely to endorse flavors as a reason for use than other cigar users (~40% vs. 68-74%). Premium cigar users had a lower prevalence (aRR: 0.37, 95% CI = 0.25-0.55) of dual use of cigars and cigarettes. CONCLUSIONS: Although <1% of U.S. adults use premium cigars, their use and purchasing characteristics continue to differ from other cigar types, highlighting the importance of capturing data specific to premium cigar use. IMPLICATIONS: This manuscript extends previous research from the National Academies of Science, Engineering, and Medicine report, "Premium cigars: Patterns of use, marketing, and health effects" by utilizing the most recent PATH Study data (Wave 6) to examine patterns of cigar use, including purchasing behavior and reasons for use, by cigar type (eg, premium traditional cigars, nonpremium traditional cigars, cigarillos, and filtered cigars). The findings support continued research on patterns of premium cigar use, which differ from use patterns of other cigar types.

"It's all About the Colors:" How do Mexico City Youth Perceive Cigarette Pack Design.

Objectives: Cigarette packs are relevant to branding strategies, designed to appeal to specific groups. There is little research on how pack features increase product appeal among key constituents such as youth in low- and middle-income countries. Methods: We conducted 10 focus group discussions (FGDs) with adolescents and 5 FGDs with young adult smokers in Mexico City, separated by age, gender, smoking, and socioeconomic status. Participants separated 23 cigarette packs into "appealing" and "unappealing" groups, and were asked to explain their decisions, describing the features that supported their views. FGDs were video-recorded, transcribed in Spanish, translated into English, and subjected to thematic analysis. Results: Pack groupings did not differ greatly across FGDs; bold, contrasting colors and elements communicating flavor and promotion increased cigarette pack appeal and desire to try. Participants perceived packs with these features to be used by and designed for youth, like themselves. Conclusion: Our findings reinforce the importance of packaging design in attracting new consumers and maintaining current ones. Mexico should consider stronger tobacco advertising policies that include packaging color and depiction of flavor to reduce product appeal.

Availability and advertising of electronic cigarettes in two Russian cities following implementation of comprehensive tobacco advertising restrictions.

INTRODUCTION: Electronic cigarettes (e-cigarettes) continue to gain popularity globally. Jurisdictions with comprehensive tobacco control policies, which limit the use and availability of combustible tobacco products but do not regulate e-cigarettes (as in Russia), may be vulnerable to the expansion of the e-cigarette market. METHODS: Using McNemar's test conducted in STATA, this observational study assessed changes between 2014 and 2016 in the availability of e-cigarettes across 239 retail outlets in Moscow and St Petersburg. Also, this study characterized the presence of retail advertising and promotion of e-cigarettes in 2016. RESULTS: Between 2014 and 2016, the availability and display of e-cigarettes increased within traditional tobacco product retail venues (27.6% in 2014 vs 51.9% in 2016; p<0.01). CONCLUSIONS: Observations indicate that there has been an increase in the proportion of retailers selling and displaying e-cigarettes.

Sociodemographic differences in reasons for ENDS use among US youth within Wave 2 of the PATH study.

INTRODUCTION: Adolescents use electronic nicotine delivery systems (ENDS, or e-cigarettes) more than other tobacco products. Among adults, some data indicate that motivations for use vary by sociodemographic group. This study sought to examine how adolescents' motivations for ENDS use vary by sociodemographic characteristics, including age, gender, race/ethnicity and household income. METHODS: The current study used data from Wave 2 of the Population Assessment of Tobacco and Health (PATH) study. Youth who used ENDS in the past 30 days were asked to report their motivations for product use. Rates of reporting each reason for use were compared across sociodemographic groups. RESULTS: Appealing flavors was the most commonly reported motivation for using ENDS, and was mentioned more often among females (89.23%) than males (74.00%). Females were also more likely than males to report using ENDS because the product feels like smoking cigarettes (AOR=1.761) and people who are important to the participant smoke them (AOR=1.895). Older teens were more likely to report using ENDS because the product does not smell bad (56.45%, 15-17 years old; 42.83%, 12-14 years old). CONCLUSIONS: Motivations for ENDS use vary by sociodemographic group. Understanding the motivations for use among sociodemographic subgroups is an initial step towards informing the development of policies and interventions with equally distributed benefits.

"Decide Now, Buy Marlboro": Examining the influence and appeal of Marlboro's new brand architecture among Filipino adolescents.

In recent years, Philip Morris International (PMI) launched a global rebranding strategy to expand the reach of Marlboro. Using a mixed-methods design, this study evaluated the appeal and influence of Marlboro advertising among Filipino youth. Six hundred and twenty-three adolescents aged 13-17 years old in Metro Manila participated in a survey, including three advertising conditions: two for Marlboro and one for Mighty, a local cigarette brand. One-way repeated measures analysis of variance (ANOVA) and paired t-tests evaluated differences between the three conditions on participants' attitudes toward advertisements [measured as identification, likeability, and perceived effectiveness (PE)]. Compared to Mighty, never-smokers rated Marlboro advertisements as more identifiable and likeable. Comparing by smoking status (never vs. ever), multivariable logistic regression assessed the influence of these attitudes on intention to smoke. Increased likeability was associated with greater intention to smoke among never-smokers, and greater PE increased odds of intention to smoke for both never- and ever-smokers. Additionally, six focus group discussions (FGD) explored responses to campaign messaging. Themes were compared within and across groups. Marlboro was also appealing to FGD participants, who described the ads as attractive to youth and promoting "adventure" and "freedom", whereas the Mighty brand was seen as being for adults and current smokers. Our findings illustrate that Marlboro advertisements are distinctly appealing to youth. Marlboro rhetoric - where consumers are urged to "decide" to "Be Marlboro" - was particularly powerful. These findings support the need for addressing gaps in policies regulating the marketing and promotion of tobacco in the Philippines.

E-cigarettes and Weight Loss-Product Design Innovation Insights From Industry Patents.

Objective: There is emerging evidence that e-cigarettes are being used by some to mitigate weight gain after quitting smoking, and being used to help control weight. This study sought to identify and describe patents related to innovations for e-cigarette devices associated and weight loss. Methods: Relevant patents were identified using Google Patents with the core search terms: "electronic cigarette" OR "e-cigarette" OR "vaporizer" OR "vapourizer" AND "nicotine" AND "weight loss" OR "weight control" OR "obesity" OR "hunger". Patents were reviewed to identify and classify the innovation related to weight loss or weight control. Results: Our search identified 23 unique patents that were filed between 2004 and 2015. Patent applications were sponsored by individual inventors (n = 7), tobacco companies (n = 5), e-cigarette companies (n = 8), pharmaceutical companies (n = 2) and a cannabis company (n = 1). More than half the patents (n = 12) were filed in the United States; other countries included China, Germany, South Korea, and South Africa. Strategies included using e-cigarette devices to deliver constituents to users that support weight loss through altered metabolism, reduced nutrient absorption, suppressed appetite, or supported healthy behavior change. In most cases (n = 18), the innovations detailed in the patents were intended to be used with an e-cigarette device that delivered nicotine to the user. Conclusions: Companies from around the world, and from a range of industries are developing and patenting technologies related to e-cigarettes and weight loss. E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain. Implications: This article presents evidence that a range of industries are innovating to design e-cigarettes or constituents to be used with e-cigarettes to deliver a variety of drugs beyond nicotine including weight loss drugs, laxatives, and nutritional supplements. This study may inform surveillance studies to systematically include weight loss as a possible motivation to use e-cigarettes. Further, market surveillance of e-cigarette products needs to monitor ingredients in e-liquids including constituents that have been historically used for weight loss or weight control. Regulations around e-cigarette marketing, promotion, product design including e-liquid constituents need to consider weight loss claims.

Country-of-origin labeling prior to and at the point of purchase: an exploration of the information environment in Baltimore City grocery stores.

The country-of-origin labeling (COOL) law requires United States grocers to indicate the origin and procurement method (farm-raised or wild-caught) for seafood. This study explored the presentation of COOL on fresh, frozen, packaged, and unpackaged seafood in Baltimore City grocery stores. Eight stores were visited bi-monthly to photograph seafood labels, and circulars were collected weekly from fourteen stores over three months. Ninety-six percent of products were labeled correctly. Forty-eight percent of advertisements included COOL. While in-store labels did not highlight COOL, advertising featured references to domestic and wild-caught seafood, signaling to customers that these are high-value product qualities.

Reassuring or risky: the presentation of seafood safety in the aftermath of the British Petroleum Deepwater Horizon Oil Spill.

The BP Deepwater Horizon Oil Spill was enormously newsworthy; coverage interlaced discussions of health, economic, and environmental impacts and risks. We analyzed 315 news articles that considered Gulf seafood safety from the year following the spill. We explored reporting trends, risk presentation, message source, stakeholder perspectives on safety, and framing of safety messages. Approximately one third of articles presented risk associated with seafood consumption as a standalone issue, rather than in conjunction with environmental or economic risks. Government sources were most frequent and their messages were largely framed as reassuring as to seafood safety. Discussions of prevention were limited to short-term, secondary prevention approaches. These data demonstrate a need for risk communication in news coverage of food safety that addresses the larger risk context, primary prevention, and structural causes of risk.

Understanding newsworthiness of an emerging pandemic: international newspaper coverage of the H1N1 outbreak.

BACKGROUND AND OBJECTIVES: During an evolving public health crisis, news organizations disseminate information rapidly, much of which is uncertain, dynamic, and difficult to verify. We examine factors related to international news coverage of H1N1 during the first month after the outbreak in late April 2009 and consider the news media's role as an information source during an emerging pandemic. METHODS: Data on H1N1 news were compiled in real time from newspaper websites across twelve countries between April 29, 2009 and May 28, 2009. A news sample was purposively constructed to capture variation in countries' prior experience with avian influenza outbreaks and pandemic preparation efforts. We analyzed the association between H1N1 news volume and four predictor variables: geographic region, prior experience of a novel flu strain (H5N1), existence of a national pandemic plan, and existence of a localized H1N1 outbreak. RESULTS: H1N1 news was initially extensive but declined rapidly (OR = 0.85, P < .001). Pandemic planning did not predict newsworthiness. However, countries with prior avian flu experience had higher news volume (OR = 1.411, P < .05), suggesting that H1N1 newsworthiness was bolstered by past experiences. The proportion of H1N1 news was significantly lower in Europe than elsewhere (OR = 0.388, P < 0.05). Finally, coverage of H1N1 increased after a first in-country case (OR = 1.415, P < .01), interrupting the pattern of coverage decline. CONCLUSIONS: Findings demonstrate the enhanced newsworthiness of localized threats, even during an emerging pandemic. We discuss implications for news media's role in effective public health communication throughout an epidemic given the demonstrated precipitous decline in news interest.

How accessible was information about H1N1 flu? Literacy assessments of CDC guidance documents for different audiences.

We assessed the literacy level and readability of online communications about H1N1/09 influenza issued by the Centers for Disease Control and Prevention (CDC) during the first month of outbreak. Documents were classified as targeting one of six audiences ranging in technical expertise. Flesch-Kincaid (FK) measure assessed literacy level for each group of documents. ANOVA models tested for differences in FK scores across target audiences and over time. Readability was assessed for documents targeting non-technical audiences using the Suitability Assessment of Materials (SAM). Overall, there was a main-effect by audience, F(5, 82) = 29.72, P<.001, but FK scores did not vary over time, F(2, 82) = .34, P>.05. A time-by-audience interaction was significant, F(10, 82) = 2.11, P<.05. Documents targeting non-technical audiences were found to be text-heavy and densely-formatted. The vocabulary and writing style were found to adequately reflect audience needs. The reading level of CDC guidance documents about H1N1/09 influenza varied appropriately according to the intended audience; sub-optimal formatting and layout may have rendered some text difficult to comprehend.