Adolescents and Young Adults Use of Social Media and Following of e-Cigarette Influencers.

BACKGROUND: With high rates of both e-cigarette and social media use among adolescents and young adults (AYAs), social media influencers who promote e-cigarettes are particularly concerning but are understudied. We examined the association between AYAs' use of 11 different social media platforms (e.g. Facebook, Twitter, Instagram, TikTok, and YouTube) and exposure to social media e-cigarette influencers. OBJECTIVES: From November 2022 to February 2023, we conducted an online, US national survey of AYAs (14-29 years) who endorsed past-30-day e-cigarette use. We used binomial logistic regression to examine associations between the frequency of use of each social media platform and following e-cigarette influencers, controlling for age, sex, race, ethnicity, e-cigarette use frequency, and other tobacco and substance use (i.e., alcohol and cannabis). The model was stratified by adolescents (14-17 years; n = 293) and young adults (18-29 years; n = 654). RESULTS: The most frequently used social media platforms were Snapchat, TikTok and Instagram among adolescents, and YouTube, Instagram and TikTok among young adults. In adjusted models, following e-cigarette influencers was associated with more frequent use of TikTok (adjusted odds ratio [95% CI]; 1.33 [1.05, 1.68]) and Pinterest (1.18 [1.02, 1.38]) among adolescents, and more frequent use of Twitter (1.17 [1.06, 1.29]) among young adults. CONCLUSIONS: The use of different platforms was associated with exposure to e-cigarette influencers: TikTok and Pinterest among adolescents and Twitter among young adults. These findings can inform tobacco regulatory policy and social media platform restrictions of e-cigarette influencers on the platforms that are popular among AYAs.

Machine Learning Quantification of Pulmonary Regurgitation Fraction from Echocardiography.

Assessment of pulmonary regurgitation (PR) guides treatment for patients with congenital heart disease. Quantitative assessment of PR fraction (PRF) by echocardiography is limited. Cardiac MRI (cMRI) is the reference-standard for PRF quantification. We created an algorithm to predict cMRI-quantified PRF from echocardiography using machine learning (ML). We retrospectively performed echocardiographic measurements paired to cMRI within 3 months in patients with ≥ mild PR from 2009 to 2022. Model inputs were vena contracta ratio, PR index, PR pressure half-time, main and branch pulmonary artery diastolic flow reversal (BPAFR), and transannular patch repair. A gradient boosted trees ML algorithm was trained using k-fold cross-validation to predict cMRI PRF by phase contrast imaging as a continuous number and at > mild (PRF ≥ 20%) and severe (PRF ≥ 40%) thresholds. Regression performance was evaluated with mean absolute error (MAE), and at clinical thresholds with area-under-the-receiver-operating-characteristic curve (AUROC). Prediction accuracy was compared to historical clinician accuracy. We externally validated prior reported studies for comparison. We included 243 subjects (median age 21 years, 58% repaired tetralogy of Fallot). The regression MAE = 7.0%. For prediction of > mild PR, AUROC = 0.96, but BPAFR alone outperformed the ML model (sensitivity 94%, specificity 97%). The ML model detection of severe PR had AUROC = 0.86, but in the subgroup with BPAFR, performance dropped (AUROC = 0.73). Accuracy between clinicians and the ML model was similar (70% vs. 69%). There was decrement in performance of prior reported algorithms on external validation in our dataset. A novel ML model for echocardiographic quantification of PRF outperforms prior studies and has comparable overall accuracy to clinicians. BPAFR is an excellent marker for > mild PRF, and has moderate capacity to detect severe PR, but more work is required to distinguish moderate from severe PR. Poor external validation of prior works highlights reproducibility challenges.

Sources of exposure to non-tobacco nicotine electronic nicotine delivery systems and associations with susceptibility to use and use behaviors among young adults in the United States.

INTRODUCTION: The Electronic Nicotine Delivery Systems (ENDS) industry recently introduced non-tobacco nicotine (NTN), which is not tobacco-derived and is often marketed as "tobacco-free nicotine." Given its novelty, it is important to understand where young adults learn about NTN ENDS. This study examined sources of exposure to NTN ENDS and relationships with NTN ENDS use and susceptibility. METHODS: We analyzed online survey data collected in Fall 2021 from 642 young adults (18-25 years) who had heard of NTN ENDS. We assessed 9 sources of NTN ENDS exposure (e.g., retail stores, social media) and examined associations between sources of exposure and NTN current (past-month) use, lifetime (non-current) use, and susceptibility to use, adjusting for demographics and other tobacco product use. RESULTS: Participants reported current NTN ENDS use (37.4%), lifetime use (12.0%), susceptibility (18.5%), or no susceptibility to use (32.1%). The most common sources of NTN ENDS exposure were retail stores (87.7%) and social media (81.0%). Exposure to NTN ENDS via social media was associated with greater odds of current NTN ENDS use (vs. no susceptibility) (aOR = 1.83, 95%CI: 1.02-3.28). Exposure via online streaming platforms was associated with greater odds of current (aOR = 1.75, 95%CI: 1.08-2.82) and lifetime NTN ENDS use (aOR = 2.42, 95%CI: 1.25-4.68). CONCLUSIONS: Young adults were exposed to and learned about NTN ENDS from diverse sources, primarily retail shops and social media. Further, exposure via social media and streaming platforms were associated with NTN ENDS use. Future studies should explore the content of NTN information from various sources to inform prevention efforts.

Characteristics of Adolescents' and Young Adults' Exposure to and Engagement with Nicotine and Tobacco Product Content on Social Media.

To inform policy and messaging, this study examined characteristics of adolescents' and young adults' (AYAs') exposure to and engagement with nicotine and tobacco product (NTP) social media (SM) content. In this cross-sectional survey study, AYAs aged 13-26 (N=1,163) reported current NTP use, SM use frequency, and exposure to and engagement with SM content promoting and opposing NTP use (i.e. frequency, source[s], format[s], platform[s]). Participants who used NTPs (vs. did not use) were more likely to report having seen NTP content (p-values<.001). Prevalent sources were companies/brands (46.6%) and influencers (44.4%); prevalent formats were video (65.4%) and image (50.7%). Exposure to content promoting NTP use was prevalent on several popular platforms (e.g. TikTok, Instagram, Snapchat); exposure to content opposing NTP use was most prevalent on YouTube (75.8%). Among those reporting content engagement (i.e. liking, commenting on, or sharing NTP content; 34.6%), 57.2% engaged with influencer content. Participants reported engaging with content promoting and opposing NTP use on popular platforms (e.g. TikTok, Instagram, YouTube). Participants with (versus without) current NTP use were significantly more likely to use most SM platforms and to report NTP content exposure and engagement (p-values<.05). Results suggest that NTP education messaging and enforcement of platforms' content restrictions are needed.

Non-tobacco nicotine E-cigarette use and flavored E-cigarette use among young adults in the United States.

BACKGROUND: E-cigarette flavors can create sensations of sweetness and coolness while masking the aversiveness of nicotine. Recently, non-tobacco nicotine (NTN) products were introduced to the market, but little is known about flavors in NTN e-cigarette use. We examined associations between flavors (i.e., sweet, mint/menthol) and susceptibility to and use of NTN e-cigarettes. METHODS: 1239 US young adults (18-25 years) completed an anonymous, online survey in Fall 2021. The analytic sample included 520 participants who had used e-cigarettes and heard of NTN. Multinomial logistic regression models analyzed associations of flavored e-cigarette use (sweet and mint/menthol) with NTN e-cigarette use status (i.e., current [past-month] use, past [ever but not current] use, susceptible to use, and non-susceptible to use [reference]). RESULTS: Overall, 46.2% of participants reported current NTN use, 14.8% reported past use, 16.7% were susceptible to use, and 22.3% reported no susceptibility. Participants reported dual-use of sweet and mint/menthol NTN e-cigarette flavors (56.5%), sweet flavors use (24.8%), and mint/menthol flavor use (1.7%). Ever dual use of sweet and mint/menthol flavors was associated with current (OR = 9.64, 95%CI: 3.21-28.98) and past NTN e-cigarette use (8.30, [2.10-32.80]). Ever sweet flavor use was associated with current NTN use (3.80, 95%CI: 1.44-10.03) and susceptibility to future use (4.25, [1.53-11.81]). Similar findings were observed for mint/menthol flavors (current: 5.03, [1.41-17.99]; susceptible: 5.65, [1.64-19.51]). CONCLUSION: The use of sweet and mint/menthol flavors was significantly associated with NTN e-cigarette use among US young adults, highlighting the need for ongoing surveillance of flavored NTN e-cigarettes and appropriate regulations to discourage use.

E-cigarette dependence and cooling flavor use are linked among youth.

BACKGROUND: E-cigarette flavors that produce cooling sensations may reduce nicotine harshness and enhance appeal among youth. While previous research has shown that use of cooling flavors is associated with more frequent vaping among youth, it is unknown whether the same holds true for e-cigarette dependence. This study examines the relationship between cooling flavor use and e-cigarette dependence among youth accounting for vaping frequency. METHODS: In Fall 2022, a survey was conducted among Connecticut high school students to assess past-month nicotine e-cigarette use, ever use of cooling flavors, cooling flavor types (e.g., fruit-cooling), and e-cigarette dependence. Analyses were restricted to those with past-month nicotine and nicotine-free e-cigarette use and complete data (n=204). Multivariable linear regressions were run to examine the association between cooling flavor use and e-cigarette dependence, adjusting for demographics, e-cigarette use characteristics, and other tobacco product use. RESULTS: 78.4% of the sample used cooling e-cigarette flavors, with 55.0% using mint-cooling flavors and 52.5% using fruit-cooling flavors. Regression results observed that cooling flavor use was associated with higher e-cigarette dependence (ꞵ=1.53, SE=0.63, p=0.017), with those who used cooling flavors having higher e-cigarette dependence than those who did not (M=5.78 [SD=5.33] vs. 2.84 [3.19]). CONCLUSIONS: Our results suggest that cooling flavor use is significantly associated with e-cigarette dependence among youth. While regulations often target menthol flavor, tobacco control agencies should consider restricting any flavor that can produce cooling sensations, even if they are not traditional menthol products, as cooling flavors is associated with youth e-cigarette dependence.

Quantitative calibration of Tb-161 SPECT/CT in view of personalised dosimetry assessment studies.

BACKGROUND: Terbium-161 (161Tb)-based radionuclide therapy poses an alternative to current Lutetium-177 (177Lu) approaches with the additional benefit of secondary Auger and conversion electron emissions capable of delivering high doses of localised damage to micro-metastases including single cells. Quantitative single-photon emission computed tomography, paired with computed tomography (SPECT/CT), enables quantitative measurement from post-therapy imaging. In view of dosimetry extrapolations, a Tb-161 sensitivity SPECT/CT camera calibration was performed using a method previously validated for 177Lu. METHODS: Serial imaging of a NEMA/IEC body phantom with Tb-161 was performed on SPECT/CT with low-energy high-resolution collimators employing a photopeak of 75 keV with a 20% width. Quantitative stability and recovery coefficients were investigated over a sequence of 19 scans with buffered 161Tb solution at total phantom activity ranging from 70 to 4990 MBq. RESULTS: Sphere recovery coefficients were 0.60 ± 0.05, 0.52 ± 0.07, 0.45 ± 0.07, 0.39 ± 0.07, 0.28 ± 0.08, and 0.20 ± 0.08 for spheres 37, 28, 22, 17, 13, and 10mm, respectively, when considered across all activity and scan durations with dual-energy window scatter correction. Whole-field reconstructed sensitivity was calculated as 1.42E-5 counts per decay. Qualitatively, images exhibited no visual artefacts and were comparable to 177Lu SPECT/CT. CONCLUSIONS: Quantitative SPECT/CT of 161Tb is feasible over a range of activities enabling dosimetry analogous to 177Lu whilst also producing suitable imaging for clinical review. This has been incorporated into a prospective trial of 161Tb-PSMA for men with metastatic prostate cancer.

The Scientific Basis for the Regulation of Flavors in Tobacco Products.

Effective tobacco policies are important for reducing the harm of tobacco use and can have a broad impact at the population level. This review provides an overview of how clinical science can inform tobacco policies with a focus on policies related to flavored tobacco products, using menthol cigarettes as an illustrative example. Specifically, this review summarizes the role of flavors in tobacco use and the history of regulation of flavored tobacco products by the US Food and Drug Administration (FDA), provides an overview of clinical research methods used to contribute to the scientific evidence to inform FDA tobacco policies, discusses key findings related to menthol tobacco products using these methods, and proposes future directions for clinical research. As the tobacco marketplace continues to evolve with new products and flavor chemicals, ongoing clinical science will be essential for establishing evidence-based policies to protect public health and reduce tobacco-related health disparities. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Using Computer Vision to Detect E-cigarette Content in TikTok Videos.

INTRODUCTION: Previous research has identified abundant e-cigarette content on social media using primarily text-based approaches. However, frequently used social media platforms among youth, such as TikTok, contain primarily visual content, requiring the ability to detect e-cigarette-related content across large sets of videos and images. This study aims to use a computer vision technique to detect e-cigarette-related objects in TikTok videos. AIMS AND METHODS: We searched 13 hashtags related to vaping on TikTok (eg, #vape) in November 2022 and obtained 826 still images extracted from a random selection of 254 posts. We annotated images for the presence of vaping devices, hands, and/or vapor clouds. We developed a YOLOv7-based computer vision model to detect these objects using 85% of extracted images (N = 705) for training and 15% (N = 121) for testing. RESULTS: Our model's recall value was 0.77 for all three classes: vape devices, hands, and vapor. Our model correctly classified vape devices 92.9% of the time, with an average F1 score of 0.81. CONCLUSIONS: The findings highlight the importance of having accurate and efficient methods to identify e-cigarette content on popular video-based social media platforms like TikTok. Our findings indicate that automated computer vision methods can successfully detect a range of e-cigarette-related content, including devices and vapor clouds, across images from TikTok posts. These approaches can be used to guide research and regulatory efforts. IMPLICATIONS: Object detection, a computer vision machine learning model, can accurately and efficiently identify e-cigarette content on a primarily visual-based social media platform by identifying the presence of vaping devices and evidence of e-cigarette use (eg, hands and vapor clouds). The methods used in this study can inform computational surveillance systems for detecting e-cigarette content on video- and image-based social media platforms to inform and enforce regulations of e-cigarette content on social media.

Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data.

BACKGROUND: Tobacco-free nicotine (TFN) is often marketed as being better tasting and healthier than tobacco-derived nicotine (TDN). Studies have yet to systematically characterize subjective experiences using TFN e-cigarettes. This qualitative study explored young adults' reasons for using TFN e-cigarettes and perceptions of differences between using TFN and TDN e-cigarettes. METHOD: We conducted a national online Qualtrics survey of U.S. young adults aged 18-25 years in October 2021. Respondents who reported lifetime TFN e-cigarette use (n = 317, mean age: 20.8 (SD:2.2), 53.9 % female) provided write-in responses to open-ended questions assessing reasons for using TFN e-cigarettes and perceptions of differences between TFN and TDN e-cigarettes. Responses from participants were thematically analyzed by independent raters. RESULTS: Reasons for using TFN e-cigarettes included product taste/flavor, health reasons (e.g. believing TFN was healthy), and product accessibility. Perceptions of differences between TFN and TDN e-cigarettes included differences in taste/ flavor and acute psychoactive and physical effects (e.g., nicotine buzz, throat hit), with TFN e-cigarettes being described as generally stronger and superior relative to TDN e-cigarettes. CONCLUSION: These qualitative data suggest that taste and perceived health benefits are primary reasons that young adults try TFN e-cigarettes. Compared to TDN, young adults perceive TFN as better tasting with different psychoactive and less aversive effects. Determining if these perceived reasons for use and differences occur in blinded human experimental studies is a necessary next step to understanding TFN e-cigarette use. Additionally, understanding why young adults use TFN e-cigarettes is important in the development of prevention communication about these products.

Psychometric evaluation of the sensory e-cigarette expectancies scale for use with adolescents.

BACKGROUND: The Sensory E-cigarette Expectancies Scale (SEES) has demonstrated solid psychometric properties for use with adults. It assesses expectancies for enjoying the taste and smell of vaping, experiencing pleasurable physical sensations, and enjoying creating vapor clouds. We evaluated psychometric properties of the SEES for use with adolescents. METHODS: In Fall 2022, 4,855 students from eight Connecticut high schools completed an anonymous, cross-sectional, online survey. Our analytic sample (n = 724) endorsed lifetime e-cigarette use and completed the SEES. Psychometric analyses included factor analyses, internal reliability, measurement invariance, between-groups differences, and relationships with vaping outcomes. RESULTS: The three-factor SEES structure was confirmed. Internal reliability of each subscale was excellent (range: 0.88-0.95). The SEES was invariant by sex (male/female), race (Black/White/Other), Hispanic ethnicity (no/yes), nicotine e-cigarette use (no/yes), any past-month vaping (no/yes), daily vaping (no/yes), and vaping status (a variable created based on the distribution of past-month vaping frequency [0; 1-4; 5-20; 21+ days]). Those who reported using nicotine e-cigarettes, past-month vaping, daily vaping, and vaping on 21+ days in the past month reported stronger scores on each subscale compared to their respective counterparts. In adjusted models, expecting Pleasurable Physical Sensations was associated with total flavors used, past-month vaping frequency, and e-cigarette dependence. Enjoyment of Taste and Smell was positively associated with total flavors used and e-cigarette dependence. Enjoyment of Vapor Clouds was positively associated with total flavors used and past-month vaping frequency. CONCLUSIONS: Given its strong psychometric properties, the SEES can be used in future research to assess sensory-related vaping expectancies in youth.

Content Analysis of YouTube Videos Related to E-Cigarettes and COVID-19.

BACKGROUND: E-cigarettes are frequently promoted on social media and portrayed in ways that are attractive to youth. While the COVID-19 pandemic significantly affected people's lives, less is known about how the pandemic influenced e-cigarette-related marketing and information on social media. This study examined how e-cigarettes were portrayed on youtube, one of the most popular social media platforms during the COVID-19 pandemic. METHODS: We searched for combinations of search terms related to e-cigarettes (e.g., "electronic cigarette" and "vape") and COVID-19 (e.g., "corona" and "COVID") in July of 2021. To be included in analyses, videos must be: uploaded after February 1, 2020, in English, related to e-cigarettes and COVID-19, and less than 30 min in length. We conducted a content analysis of included videos, coding for uploader characteristics, what e-cigarette products were showcased, and specific themes that intersected between e-cigarettes and COVID-19. RESULTS: We examined N = 307 videos and found that N = 220 (73.6%) discussed the health effects of e-cigarette use on COVID-19, followed by videos on how COVID-19 affects e-cigarette sales (N = 40, 12.9%), face mask-related videos (N = 16, 5.1%; e.g., vape tricks including masks) and instructional videos (N = 10, 3.2%; e.g., sanitizing vape devices during COVID-19). Instructional videos had the highest number of likes (Median = 23; IQR = 32) and comments (Median = 10; IQR = 7). CONCLUSIONS: Our findings support the need for continuous surveillance and research on novel vaping-related content in reaction to policies and events, such as the global pandemic. More research is needed to understand the impact of this content on young people's perceptions and use of e-cigarettes.

Electronic Nicotine Delivery Systems and E-Liquid Modifications to Vape Cannabis Depicted in Online Videos.

Importance: Electronic nicotine delivery systems (ENDS) were created to vape nicotine e-liquids; however, social media demonstrates increased ENDS modifications to vape cannabis. Analysis of social media content helps with understanding ENDS modifications for cannabis use, overlapping markets for ENDS and cannabis, and the need for additional regulation. Objective: To analyze online videos for use, modification, and marketing of ENDS to vape cannabis. Design, Setting, and Participants: In this qualitative study, 10 searches were performed on YouTube on July 14, 2022, using different combinations of relevant search terms to identify videos depicting modifications to ENDS and e-liquids to vape cannabis. The first 40 videos from each search (400 videos total, 152 without duplicates) were extracted, of which 59 included depiction or discussion of cannabis vaping content. Content analysis of videos included iterative development of codes, consensus building across team members, and reliability checks. Main Outcomes and Measures: Metadata (ie, video length, number of likes, comments, and views) were extracted for included videos. Coding was performed for uploader type, modifications to ENDS and e-liquids, devices used, cannabis products vaped, age restriction, purchasing links, health claims, and discussion of warning messages and cannabis regulations. Results: Of the 59 videos analyzed, 34 (58%) included tetrahydrocannabinol; 33 (56%), cannabidiol; and 8 (14%), both. A total of 21 videos (36%) were age-restricted, while 25 (42%) included purchasing links for cannabis products, 20 (34%) for ENDS, and 7 (12%) for nicotine e-liquids. Twenty-six videos (44%) made claims about health benefits of vaping cannabis. Forty-one videos (69%) demonstrated vaping manufacturer-made cannabis products (eg, cannabis concentrates) with no modifications needed. Eighteen videos (31%) depicted modifications to e-liquids or ENDS for cannabis use. The most frequent modification was mixing e-liquids with cannabis products to be compatible with ENDS. The most frequently reported reason for modifications was to vape cannabis in public by using the same devices used for nicotine. Conclusions and Relevance: This qualitative study of online videos found high frequencies of statements about health benefits from vaping cannabis, frequent purchasing links, and inadequate age restrictions. Exposure to such content on social media platforms may increase risk of cannabis vaping among youth. Use of the same devices for multiple substances may also enable dual use and complicate the US Food and Drug Administration's regulation of ENDS.

A non-randomized pilot study protocol of a novel social support intervention for individuals in early recovery from hazardous alcohol use.

INTRODUCTION: Connecting individuals to recovery support services such as recovery community centers and mutual help organizations can be crucial for sustaining recovery from addiction. However, there may be barriers to engagement with recovery support services on individual (e.g., limited motivation) and structural (e.g., limited information on recovery resources) levels. This pilot study will determine the feasibility and acceptability of a novel online social support intervention (Let's Do Addiction Recovery Together!, abbreviated as LDART) that uses pre-recorded videos created by members from several recovery support services to help individuals in early recovery from hazardous alcohol use sustain motivation during recovery and introduce them to freely available recovery support services in the community. METHODS AND ANALYSIS: This will be a non-randomized mixed-method pilot study. We will recruit 30 adults who engaged in past-year hazardous alcohol use and have some desire to cut down or quit to use LDART every night for a month. A subset of these participants will be invited to participate in a semi-structured qualitative interview after completing the study. Primary outcomes will be feasibility parameters such as recruitment and retention rates, and acceptability measures such as frequency of intervention use. Secondary outcomes will include self-reported changes in alcohol use, engagement in recovery support services, and quality of life at one-month post-intervention relative to baseline. DISCUSSION: Results of this pilot study will inform a randomized controlled trial to examine efficacy of this intervention, with the goal of creating an accessible and scalable intervention that has direct benefits on individuals who want to cut down or quit problematic alcohol use. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06022107.

Social Media Use and Subsequent E-Cigarette Susceptibility, Initiation, and Continued Use Among US Adolescents.

INTRODUCTION: Social media has a large amount of e-cigarette content. Little is known about the associations between social media use and a wide range of e-cigarette use behaviors, including susceptibility, initiation, and continued use. We analyzed national data on US adolescents to assess these associations. METHODS: We used data on adolescents participating in the Population Assessment of Tobacco and Health (PATH) Study Wave 4 (2016-2018) and Wave 5 (2018-2019). We conducted 2 models: 1) a multinomial logistic regression on e-cigarette use susceptibility and use behaviors at Wave 5 by social media use at Wave 4 among adolescents who never used e-cigarettes at Wave 4 and 2) a binomial logistic regression on current e-cigarette use at Wave 5 by social media use at Wave 4 among adolescents who ever used e-cigarettes at Wave 4. RESULTS: Among adolescents who never used e-cigarettes at Wave 4 (n = 7,872), daily social media use (vs never) was associated with a higher likelihood of being susceptible to e-cigarette use (adjusted odds ratio [aOR] =1.46; 95% CI, 1.20-1.78), past e-cigarette use (aOR = 3.55; 95% CI, 2.49-5.06), and current e-cigarette use (aOR = 3.45; 95% CI, 2.38-5.02) at Wave 5. Among adolescents who ever used e-cigarettes at Wave 4 (n = 794), we found no significant association between social media use at Wave 4 and continued e-cigarette use at Wave 5. CONCLUSION: Our study found that social media use is associated with subsequent susceptibility to e-cigarette use and initiation but not with continued use of e-cigarettes among US adolescents. These findings suggest that understanding and addressing the association between social media and e-cigarette use is critical.

The Portrayal of Premium Cigar Selling Propositions in Lifestyle Magazines: A Content Analysis.

INTRODUCTION: Although lifestyle magazines are an important marketing tool for premium cigars, little is known about their recent portrayal of the products. We expand on research conducted for the National Academies of Sciences, Engineering, and Medicine's Committee on Patterns of Use and Health Effects of "Premium Cigars" and Priority Research. AIMS AND METHODS: A content analysis of magazine covers, articles, and advertisements published in 2021 from Cigar Aficionado and Cigar Snob (five issues each) and Cigar Journal (three issues) assessed magazine themes and mentions of lower harm. Magazine covers (n = 14), advertisements (n = 105), and every fifth article (n = 45) were coded. RESULTS: In total, 92% of the magazine covers, 72.4% of advertisements, and 62.2% of articles had premium cigar content. Celebrities (e.g. musicians and actors) appeared on 92.9% of covers. The most common themes in the advertisements and articles were "high quality." Regarding article content, 80% portrayed the premium cigars' quality (e.g. superior materials), and the taste of featured products (e.g. "tones," "aromas," and "notes") was portrayed in 42.4%. While no articles described their health risks, 6.7% described the positive health effects of premium cigar use (e.g. stress relief and clear cognition). Additionally, a digital search of Cigar Snob and Cigar Aficionado for terms related to lower harm (e.g. "organic," "healthy," "clean," "pure," and "natural") found 7.7 mentions of lower-harm words per issue. CONCLUSIONS: Our findings indicate that lifestyle magazines are an important marketing strategy that promotes and normalizes premium cigar use as a high-quality product that can have positive health effects for users. IMPLICATIONS: Our manuscript characterized the premium cigar companies' use of selling propositions, including promoting the products' features, safety, taste, and flavors, as a part of their advertising promotion practices. Premium cigar companies used digital and print lifestyle magazines as marketing tools to promote and normalize the use of their products by emphasizing their high quality and positive health benefits (e.g. reducing stress). Premium cigars were promoted as a symbol of power and success, featured in advertisements of upscale social events (e.g. exclusive trade shows, social clubs, and lounges), and often juxtaposed with expensive alcohol, food, and other luxurious goods. Future research should assess if exposure to premium cigar content increases consumer appeal and detracts from the products' potential adverse health outcomes.