Nicotine pouches: a summary of regulatory approaches across 67 countries.

INTRODUCTION: Nicotine pouches are small, permeable pouches containing nicotine. The nicotine may either be derived from tobacco plants or synthetically produced. Nicotine pouches are available worldwide, but little is known as to how various countries regulate these products. This study summarises nicotine pouch regulatory policies across 67 countries. METHODS: This research summarises insights obtained through active policy surveillance work in which we requested information on the availability of nicotine pouches and applicable policies and analysed responses from representatives of 67 countries (representatives included subject matter experts in government or civil society organisations). These countries span all WHO regions. RESULTS: We found significant variation in how countries classify nicotine pouches, with many countries' current regulatory approach failing to regulate nicotine pouches that used synthetic nicotine. We found 34 countries regulate nicotine pouches with 23 of these countries' policies encompassing synthetic nicotine. Countries regulating both synthetic and tobacco-derived nicotine pouches generally (1) rely on existing policies for tobacco products and/or medicines or (2) have developed new policies or regulatory classifications that specify nicotine as the substance at issue rather than linking policies solely to tobacco. CONCLUSION: Our work offers novel insight into nicotine pouch markets and national regulatory approaches. Policy approaches vary from not regulating nicotine pouches at all to banning both forms of nicotine pouches. Policies used by countries regulating both tobacco-derived and synthetic nicotine pouches offer a roadmap for how other jurisdictions can add effective guardrails to the use of these and other non-medicinal nicotine products.

State of the literature discussing smoke-free policies globally: A narrative review.

Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.

Individual and environmental bicycling determinants during a pandemic.

Introduction: Research has identified many factors associated with bicycling, but little is known on their relative influence for an individual's decision to bicycle or what led to the surge in bicycling during the COVID-19 pandemic in the U.S. Methods: Our research leverages a sample of 6735 U.S. adults to identify key predictors and their relative influence on both increased bicycling during the pandemic and on whether an individual commutes by bicycle. LASSO regression models identified a reduced set of predictors for the outcomes of interest from 55 determinants included in the modeling. Results: We find individual and environmental factors have a role in explaining the shift towards bicycling-with key differences in predictors for increased overall cycling during the pandemic compared to bicycle commuting. Conclusions: Our findings add to the evidence base that policies can impact bicycling behavior. Specifically, increasing e-bike accessibility and limiting residential streets to local traffic are two policies that show promise for encouraging bicycling.

Flavored electronic nicotine delivery systems ads (2019-2020) on traditional U.S. Media by audience demographics.

The tobacco industry has historically targeted flavored products to specific U.S. consumer segments, including young people, women, and systemically marginalized groups based on race, ethnicity, or sexual/gender identity. Existing research on target marketing is focused on cigarettes and smokeless tobacco. In contrast, studies of target marketing of electronic nicotine delivery systems (ENDS)-a growing segment of the U.S. tobacco product market - are much more limited. We analyzed data on 496 ENDS ads and audience demographics to explore the extent to which flavored ENDS ads on cable television (n = 25 ads), terrestrial radio (n = 412 ads), and in print consumer magazines (n = 59 ads) are targeted to different demographic groups based on age, sex, and race/ethnicity. We observed flavor-related content in one-quarter to one-third of ENDS ad occurrences during 2019-2020. Across all media outlets examined, audience age was an important factor in explaining the likelihood of ENDS ads containing flavor-related content. For example, within a television channel, there were 3.82 [95% confidence interval (CI): 1.39-10.49] times greater odds that an ENDS ad contained flavor-related content versus not for every 1% increase in the proportion of U.S. youth ages 6-17 watching a television show. In addition, there were 2.13 [95 %CI: 1.30-3.51] and 1.61 [95 %CI:1.60-1.63] times greater odds that an ENDS ad contained flavor-related content versus not in cable television and radio stations, respectively, for every 1% increase in the proportion of male audience members. Race/ethnicity was an important explanatory factor for the presence of flavor-related content on radio but not television ENDS ads. Our findings suggest differences in target marketing of flavored ENDS by media outlet and audience demographics.

Association between perceived risk of COVID-19 and support for transportation policies.

The association between perceived risk of COVID-19 at the individual level and support for transportation policies designed to mitigate coronavirus transmission has received little attention. We surveyed a nationally representative sample of U.S. adults (N = 2,011) in June 2020 to examine how support for public policy varied according to perceived risk. We used logistic regression models to control for demographic factors and identify the effect of perceived risk, defined as a combination of self-reported perceptions of personal risk of acquiring the disease and the severity of the illness if infected, on support for a range of policies related to transportation. We found that perceived risk did not vary significantly by sex, race, urbanicity, income, or age. Support for policies aimed at mitigating COVID-19 transmission was consistently higher among those with higher perceived risk of the disease.

Modeling state preferences for Covid-19 policies: Insights from the first pandemic summer.

INTRODUCTION: During the COVID-19 pandemic, governments have experimented with a wide array of policies to further public health goals. This research offers an application of multilevel regression with post-stratification (MRP) analysis to assess state-level support for commonly implemented policies during the pandemic. METHODS: We conducted a national survey of U.S. adults using The Harris Poll panel from June 17-29, 2020. Respondents reported their support for a set of measures that were being considered in jurisdictions in the U.S. at the time the survey was fielded. MRP analysis was then used to generate estimates of state-level support. RESULTS: The research presented here suggests generally high levels of support for mask mandates and social distancing measures in June 2020-support that was consistent throughout the United States. In comparison, support for other policies, such as changes to the road environment to create safer spaces for walking and bicycling, had generally low levels of support throughout the country. This research also provides some evidence that higher support for coronavirus-related policies could be found in more populous states with large urban centers, recognizing that there was low variability across states. CONCLUSION: This paper provides a unique application of MRP analysis in the public health field, uncovering noteworthy state-level patterns, and offering several avenues for future research. Future research could examine policy support at a small geographic level, such as by counties, to understand the distribution of support for public policies within states.

Mobility Patterns Before, During, and Anticipated After the COVID-19 Pandemic: An Opportunity to Nurture Bicycling.

INTRODUCTION: The purpose of this study is to quantify the immediate and anticipated effect of the COVID-19 pandemic on local travel in the U.S. METHODS: A national survey of a representative sample of U.S. adults was conducted using The Harris Poll panel. The online survey was conducted from June 17 to 29, 2020. Respondents reported the frequency of travel before the pandemic, during the pandemic, and anticipated travel when normal activities resume for walking, bicycling, personal vehicle use, and public transit. Analyses were conducted in July and August 2020. RESULTS: During the pandemic, local travel significantly decreased (-10.36%, 95% CI= -16.26, -4.02) relative to prepandemic levels. Within travel modes, significant decreases were reported for public transit, personal vehicle use, and walking. There was no change in reported bicycle use during the pandemic period relative to prepandemic levels. When normal activities resume, respondents anticipated a significant increase in bicycling (24.54%, 95% CI=3.24, 50.24). Anticipated travel using personal vehicles, public transit, and walking were not significantly different from the prepandemic levels. CONCLUSIONS: Unlike the other local travel modes, bicycling did not decrease during the pandemic and is anticipated to significantly increase. Investment in bicycle-safe infrastructure could sustain the anticipated increase in bicycling.

Drug presence in driving deaths in Maryland: Comparing trends and prevalence in medical examiner and FARS data.

Accurate and reliable information on drug use by road users is essential to inform safety policy development but the reliability of national data has been questioned. There are two primary repositories of drug test information from fatal motor vehicle crashes in Maryland: (1) the Fatality Analysis Reporting System (FARS), which is a national crash database managed by the US Department of Transportation, and (2) the Maryland Medical Examiner (ME). In this study, we compared drug test information for people killed in crashes in Maryland between the FARS system and ME from 2006 - 2018. As ME records are the primary source for the FARS data from Maryland, these two data sets should be closely correlated. We used probabilistic linkage to match FARS and ME cases and compared matched cases by individual drug group. Matching was achieved on 83 % of cases (N = 4803 matched pairs). ME data consistently indicated higher overall incidence and trends in the presence of depressants, narcotics, and stimulants in crash deaths. Sensitivity analysis using both strict and relaxed matching criteria did not change this result. Road safety policy and prevention efforts for crashes involving drugs and alcohol require an accurate understanding of both long-term trends and year-to-year changes in drug prevalence. These findings demonstrate the potential value of using ME data as source of drug test information for crash deaths in the United States.

Geographic variation and trends in opioid-involved crash deaths in Maryland: 2006-2017.

The objective of this study was to describe trends in the prevalence of opioids in driver fatalities and examine geographic variation in opioid-involved crashes at a county level. Using comprehensive toxicological data from the Office of the Chief Medical Examiner in Maryland, we examined the prevalence of opioids in all motor vehicle crash fatalities in Maryland between 2006-2017 and tested for trends to assess the statistical significance of changes in the prevalence of prescription opioids detected in these drivers over time. Opioid-involved crash deaths accounted for 10.0% of all driver deaths during the study period. The prevalence of opioids detected in fatally injured drivers increased from 8.3% in 2006 to 14.1% in 2017, (Z = -1.9, p < .05). The trends in opioid deaths do not follow broader trends in motor vehicle crash deaths; opioid-involved crashes appear to be increasing while overall motor vehicle crashes appear to be decreasing over the same period. To determine if the increase in opioid-involved crash deaths was the result of changes in pain management related to injuries sustained from the crash, we analyzed a subgroup of cases where death occurred at the scene of the crash. Within this group, there was no statistically significant increase in opioid-involved crashes during the study period. Opioid prevalence was higher in middle aged, and white drivers, and in crashes occurring in rural counties. Geographic distribution of opioid-involved crash deaths reflect broader patterns of opioid deaths overdose across the state. Irrespective of the timing of the deaths, of the drivers testing positive for opioids, 28% had elevated blood alcohol concentrations (‡ 0.01 g/dL), and 45% tested positive for other drugs.