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Introduction The use of electronic vaping products (EVPs) containing nicotine, marijuana, and/or other substances remains prominent among youth; with EVPs containing nicotine being the most commonly used tobacco product among youth since 2014. However, a detailed understanding of the chemical composition of these products is limited. Aims and Methods From February 25th to March 15th, 2019, a total of 576 EVPs, including 233 e-cigarette devices (with 43 disposable vape pens) and 343 e-liquid cartridges/pods/bottled e-liquids, were found or confiscated from a convenience sample of 16 public high schools in California. Liquids inside 251 vape pens and cartridges/pods/bottled e-liquids were analyzed using a gas chromatography/mass spectrometry (GC/MS). For comparison, new JUUL pods, the most commonly used e-cigarette among youth during 2018–2019, with different flavorings and nicotine content were purchased and analyzed. Results For e-cigarette cartridges/pods/bottled e-liquids, nicotine was detected in 204 of 208 (98.1%) samples. Propylene glycol and vegetable glycerin were dominant solvents in nicotine-containing EVPs. Among 43 disposable vape pen devices, cannabinoids such as tetrahydrocannabinol (THC) or cannabidiol (CBD) were identified in 39 of 43 (90.1%) samples, of which three contained both nicotine and THC. Differences in chemical compositions were observed between confiscated or collected JUULs and purchased JUULs. Measured nicotine was inconsistent with labels on some confiscated or collected bottled e-liquids. Conclusions EVPs from 16 participating schools were found to widely contain substances with known adverse health effects among youth, including nicotine and cannabinoids. There was inconsistency between labeled and measured nicotine on the products from schools. Implications This study measured the main chemical compositions of EVPs found at 16 California public high schools. Continued efforts are warranted, including at the school-level, to educate, prevent, and reduce youth use of EVPs. [ABSTRACT FROM AUTHOR]

Introduction This manuscript examines prevalence of awareness and use of nicotine pouches among U.S. middle and high school students by sociodemographic characteristics and other tobacco product use and characterizes nicotine pouch and other tobacco product use behaviors among current nicotine pouch users. Aims and Methods Data are from the 2021 National Tobacco Youth Survey, a cross-sectional, school-based survey of middle and high school students (N = 20 413; overall response rate: 44.6%), which included questions on nicotine pouches in 2021 for the first time. Prevalence estimates, 95% confidence intervals, and estimated population counts were assessed for nicotine pouch awareness, ever use, and current (past 30 days) use, and for use behaviors related to nicotine pouches (frequency of use, flavor(s) used) and other tobacco products (ever, current, frequency of use) among current nicotine pouch users. Results Over one-third of students (35.5%) had ever heard of nicotine pouches. An estimated 1.9% (490 000) reported ever using them, while 0.8% (200 000) reported current use. Among current nicotine pouch users, 61.6% reported flavored nicotine pouch use, 64.2% reported current e-cigarette use, and 52.6% used multiple (≥2) tobacco products. Current use of nicotine pouches was common among current smokeless tobacco users (41.3%). Conclusions Overall, in 2021, while relatively few students had ever tried nicotine pouches or currently used them, more than one-third had heard of them. Current nicotine pouch users tended to use other tobacco products, particularly e-cigarettes and smokeless tobacco. Given previous rapid increases in youth uptake of e-cigarettes, it is important to continue monitoring nicotine pouch use among young people. Implications This study's findings provide an important baseline for future monitoring of nicotine pouch awareness and use among middle and high school students. Emerging tobacco products, particularly those that are flavored, widely available, discreet, and inexpensive have the potential to attract youth. Given the potential of these products to appeal to young people, ongoing monitoring of nicotine pouch use behaviors is important to inform public health and regulatory efforts. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco retailers are a key target audience for tobacco product advertising, yet little is known about the messages and channels used to market electronic nicotine delivery systems (ENDS) to retailers. Methods: We assessed expenditures for business‐to‐business print advertising for ENDS in the United States, by year and by advertiser, from 2015 to 2020; and the content of advertisements placed in 2020. Results: The total number of ENDS brands placing business‐to‐business advertisements declined from 45 in 2015 to 6 in 2020; spending declined from $2.6 million in 2015 (for 283 occurrences) to $492,789 in 2020 (69 occurrences). Across years, the top‐spending advertisers were Logic ($1.9 million), blu ($1.0 million), JUUL ($625,050), NJOY ($373,126) and Vuse ($322,075). Common messages of advertisements placed in 2020 included that products are not intended for minors; brand market share; health warnings; profitability or revenue potential for retailers; and flavours. Discussion: This study suggests that ENDS companies anticipate that ENDS retailers are interested in stocking products that maximise profits, appeal to consumers and comply with regulatory requirements. Declines in the number of advertisers mirror the overall consolidation of the ENDS industry that occurred during the study period. Conclusions: Business‐to‐business print advertising represents an important channel in which ENDS brands communicate a variety of messages about their products directly to potential retailers. [ABSTRACT FROM AUTHOR]

Introduction: Effective in August 10, 2018, FDA requires advertisements for electronic nicotine delivery systems (ENDS) that meet the definition of a "covered tobacco product" to feature a standard nicotine warning statement. To date, limited data exist on the presence of warning statements in ENDS advertising.Methods: We acquired ENDS ads (n = 459) that first ran six months before (February 10, 2018-August 9, 2018) and after (August 10, 2018-February 9, 2019) the effective date. The sample included online, print, and outdoor static ads (ie, without video or animated graphics) (n = 166 before, n = 198 after), online and television video ads (n = 16 before, n = 49 after), and radio ads (n = 9 before, n = 21 after). We coded ads for the presence of the verbatim FDA warning. Ads with verbatim warnings were coded for required formatting and additional features.Results: Overall, 28% of static (n = 46/166), 62% of video (n = 10/16), and 67% of radio (n = 6/9) ads that ran before the effective date contained the verbatim warning versus 84% (n = 167/198, p < .001), 96% (n = 47/49, p = .002), and 86% (n = 18/21, p =.329) of ads that ran after, respectively. Following the effective date, nearly all static ads placed the warning as required at the top of the ad (76% [n = 35/46] before, 97% [n = 162/167] after, p < .001), and many video ads featured the warning statement for the entire ad duration (0% [n = 0/10] before, 60% [n = 28/47] after, p < .001). Half (n = 9/18) of radio warnings running after the effective date were read faster than the other promotional content.Conclusions: The presence of the nicotine warning statement on paid promotional static, video, and radio ENDS ads in this sample increased after August 10, 2018, but a notable number still lacked the warning.Implications: Results from this study provide initial insights into the extent to which required nicotine warning statements appear in ENDS ads in the study sample across traditional (eg, magazines, television, radio) and digital (eg, online/mobile ads) advertising mediums. Following the August 10, 2018, effective date, we observed a substantial increase in the presence of the required FDA warning statement on the ENDS ads in this sample. However, a notable number of ads in the study lacked the required warning and warnings did not always include the required formatting displays. [ABSTRACT FROM AUTHOR]

INTRODUCTION TikTok, the video-sharing app popular among youth, is a source of user-generated content about nicotine addiction with the potential to endorse or deter nicotine use among young viewers. We systematically analyzed content and themes of TikTok posts tagged #nicotineaddiction. METHODS We conducted a quantitative content analysis of the visual and textual content of the 149 top-viewed English-language TikTok posts tagged #nicotineaddiction as of 1 March 2021. Posts were double-coded using a shared codebook, noting content creator characteristics, nicotine products featured, references to quitting, and overall themes of #nicotineaddiction expressed. We assessed the prevalence of post characteristics and themes overall and by apparent age of content creators (aged ≥21 years versus <21 years). RESULTS The 149 posts analyzed received a mean and median of 62433 and 15800 likes, respectively. E-cigarettes were referenced or featured in 75% of posts; 58% featured a specific nicotine product brand, most commonly Puff Bar (23% of total) and JUUL (19%). Overall, 22% of posts mentioned quitting nicotine. The top themes of #nicotineaddiction expressed were physical or psychological consequences (e.g. withdrawal symptoms, 46%), physical or psychological benefits (e.g. tasting good, feeling 'buzzed', 28%), and social benefits (e.g. bonding with fellow users, 28%). Compared to those aged ≥21 years, posts by content creators likely <21 years (26%) less commonly mentioned quitting (p<0.01), had fewer followers (p<0.01), were more commonly from Canada (p<0.01) and less commonly from the US (p<0.01), and more commonly featured JUUL (p<0.05). CONCLUSIONS While reaching a large and engaged audience, TikTok content creators suggest a range of benefits and consequences of nicotine addiction. Future research is warranted to examine this content's potential to influence young people's intentions to use or quit nicotine products. [ABSTRACT FROM AUTHOR]

Introduction: Nicotine pouch products, oral smokeless products that contain nicotine but no tobacco leaf material, have recently entered the US marketplace. Available data indicate sales of these products in the United States have increased since 2018; however, the extent of use among US youth and adults is uncertain.Methods: To assay the chemistry of these emerging tobacco products, we analyzed 37 nicotine pouch brands from six total manufacturers. Almost all of the products had flavor descriptors (36 of 37), such as mint, licorice, coffee, cinnamon, and fruit. The amount of free nicotine, the form most easily absorbed, was calculated for each product using total nicotine, product pH, the appropriate pKa, and the Henderson-Hasselbalch equation.Results: Nicotine pouch products varied in pouch content mass, moisture content (1.12%‒47.2%), alkalinity (pH 6.86‒10.1), and % free nicotine (7.7%‒99.2%). Total nicotine content ranged from 1.29 to 6.11 mg/pouch, whereas free nicotine ranged from 0.166 to 6.07 mg/pouch. These findings indicate that nicotine and pH levels found in some of these nicotine pouches are similar to conventional tobacco products, such as moist snuff and snus, and that most of these pouch products are flavored.Conclusions: Although these products likely lack many tobacco-related chemicals, each product analyzed contained nicotine, which is both addictive and can harm human health. Given that nicotine pouches may appeal to a spectrum of users, from novice to experienced users, it is important to include these emerging tobacco products in tobacco control research, policy, and practice.Implications: These "tobacco-free" nicotine pouches have similar pH and nicotine content to conventional tobacco products, such as moist snuff and snus. Although they lack many tobacco-related chemicals, most are highly flavored which could increase experimentation from new users. Given that nicotine pouches may appeal to a spectrum of users, from novice to experienced users, in terms of their flavors and nicotine content, it is important to examine and include these emerging tobacco products as they relate to tobacco control research, policy, and practice. [ABSTRACT FROM AUTHOR]

Aims: To estimate the association of e‐cigarette advertisement exposure with e‐cigarette and cigarette use behavior among US adults. Design Data from the 2013–14 National Adult Tobacco Survey (NATS) were linked to Kantar Media and National Consumer Study data to construct measures of e‐cigarette advertisements on TV and in magazines. The relationship between advertisement measures and outcomes was estimated using logistic and Poisson regressions, controlling for socio‐demographics, state cigarette taxes and state and year fixed‐effects. Setting: United States. Participants/cases: A total of 98 746 adults aged ≥ 18 years who responded to the 2013–14 NATS. Measurements: The independent variables of interest were the number of e‐cigarette advertisements in magazines to which an adult was exposed in the past 6 months and the number of e‐cigarette advertisements on TV to which an adult was exposed in the past 6 months. Outcomes were awareness of e‐cigarettes, ever e‐cigarette use, current e‐cigarette use, current cigarette use and number of cigarettes smoked per month. Findings Exposure to one additional e‐cigarette advertisement on TV was associated with a 0.18, 0.13 and 0.03 percentage point increase, respectively, in awareness, ever use and current use of e‐cigarettes among all adults (P < 0.05). This exposure also was associated with a 0.11 percentage point increase in current cigarette use among all adults and an increase in cigarette consumption of 2.24 cigarettes per month among adults aged ≥ 45 (P < 0.05). Conclusions: Exposure to e‐cigarette advertising appears to be positively associated with the use of e‐cigarettes and cigarettes among adults of all ages, and with increased cigarette consumption among older adults. [ABSTRACT FROM AUTHOR]

Background and Aims: Eleven US states and the District of Columbia have legalized the non‐medical use of marijuana. Public marijuana smoking is generally prohibited, although some states have considered exemptions. This study assessed attitudes about public marijuana smoking, perceptions of harm from marijuana second‐hand smoke (SHS) and self‐reported marijuana SHS exposure. Design Internet panel survey fielded in June–July 2018. Setting: United States. Participants: US adults aged ≥ 18 years (n = 4088). Measurements Current (past‐30 day) tobacco product use, current marijuana use, opinions about public indoor marijuana smoking, perceptions of harm from marijuana SHS and self‐reported past‐7 day exposure to marijuana SHS in public indoor or outdoor areas were assessed. Weighted prevalence estimates were computed and correlates were assessed using logistic and multinomial regression. Findings Overall, 27.4% [95% confidence interval (CI) = 25.7, 29.1] of adults reported past‐week marijuana SHS exposure in indoor and/or outdoor public areas; younger adults, blacks, Hispanics, those in the Northeast or West, and current marijuana and/or tobacco users were more commonly exposed (Ps < 0.0001). More than half of adults (52.4%; 95% CI = 50.7, 54.2) regarded marijuana SHS as harmful, and most (81.0%; 95% CI = 79.5, 82.4) opposed public marijuana smoking. Correlates of favoring public marijuana smoking included being male, younger (Ps < 0.01), black or Hispanic, past‐month tobacco and/or marijuana users and perceiving no/low harm from marijuana SHS (Ps < 0.0001). Conclusion: While one in four US adults report recent marijuana second‐hand smoke exposure, a majority believe marijuana second‐hand smoke is harmful and most oppose public marijuana smoking. [ABSTRACT FROM AUTHOR]

This study uses retail scanner data to assess nicotine pouch sales in the US between 2016 and 2020. [ABSTRACT FROM AUTHOR]

Introduction: The U.S. Surgeon General has concluded that aerosol from electronic vapor products, such as e-cigarettes, can contain harmful and potentially harmful constituents. This study assessed the prevalence and determinants of U.S. adult attitudes toward electronic vapor product use in indoor public places.Methods: Data from 2017 Summer Styles, an Internet survey of U.S. adults aged ≥18 years (n = 4,107) were analyzed in 2017. Respondents were asked, Do you favor or oppose allowing the use of electronic vapor products in indoor public places such as workplaces, restaurants, and bars? Responses were strongly favor, somewhat favor, somewhat oppose, and strongly oppose. Multivariate Poisson regression was used to determine sociodemographic correlates of opposition (somewhat or strongly).Results: In 2017, a total of 82.4% of adults strongly or somewhat opposed the use of electronic vapor products in indoor public places, including 28.0% of current (past 30-day) electronic vapor product users and 52.7% of current cigarette smokers. After adjustment, opposition was significantly lower among current and former electronic vapor product users than never users, current cigarette smokers than never smokers, and people living with tobacco product users. Opposition was significantly higher among adults aged ≥45 years than those aged 18-24 years and among adults who had rules prohibiting electronic vapor product use in their vehicles or homes than those without such rules.Conclusions: Approximately eight in ten U.S. adults, including more than one quarter of electronic vapor product users, opposed electronic vapor product use in indoor public places. Prohibiting electronic vapor product use in indoor public areas can protect bystanders from the health risks of secondhand electronic vapor product aerosol exposure. [ABSTRACT FROM AUTHOR]

Introduction: Heated tobacco products, sometimes marketed as "heat-not-burn" technology, represent a diverse class of products that heat leaf tobacco to produce an inhaled aerosol. Global sales of heated tobacco products are increasing; however, the extent of current heated tobacco product awareness and use in the U.S. is unknown. This study assessed awareness and ever use of heated tobacco products among U.S. adults.Methods: Data were obtained from the 2017 SummerStyles, an Internet survey of U.S. adults aged ≥18 years (N=4,107). Respondents were given a description of heated tobacco products, then asked about awareness and ever use. In 2017, descriptive statistics were calculated overall and by sex, age, race/ethnicity, and cigarette smoking status. Logistic regression was used to calculate AORs.Results: In 2017, a total of 5.2% of U.S. adults were aware of heated tobacco products, including 9.9% of current cigarette smokers. Overall, 0.7% of U.S. adults, including 2.7% of current smokers, reported ever use of heated tobacco products. Odds of ever use were higher among current smokers (AOR=6.18) than never smokers, and higher among adults aged <30 years (AOR=3.35) than those aged ≥30 years.Conclusions: As of July 2017, few U.S. adults had ever used heated tobacco products; however, about one in 20 were aware of the products, including one in ten cigarette smokers. The uncertain impact of heated tobacco products on individual- and population-level health warrants timely and accurate public health surveillance. These first estimates among U.S. adults can serve as a key baseline measure. [ABSTRACT FROM AUTHOR]

The article discusses E-cigarette, or vaping, products have electronic devices that produce an inhalable aerosol by heating an e-liquid typically contains nicotine and additives. Topics include E-cigarette using for U.S. youths increased considerably for 2017–2019; and 1,000 e-cigarette, or vaping, products have collected from 25 high schools in California and North Carolina for the 2018–19 academic year.

Introduction: In recent years, self-reported cigarette smoking has declined among youth and adults, while electronic cigarette (e-cigarette) use has increased. However, sales trends for these products are less certain. This study assessed national and state patterns of U.S. cigarette and e-cigarette unit sales.Methods: Trends in cigarette and e-cigarette unit sales were analyzed using retail scanner data from September 25, 2011 through January 9, 2016 for: (1) convenience stores; and (2) all other outlets combined, including supermarkets, mass merchandisers, drug, dollar, and club stores, and military commissaries (online, tobacco-only, and "vape" shops were not available). Data by store type were available for the total contiguous U.S. and 29 states; combined data were available for the remaining states, except Alaska, Hawaii, and DC.Results: During 2011-2015, cigarette sales exhibited a small, significant decrease; however, positive year-over-year growth occurred in convenience stores throughout most of 2015. E-cigarette unit sales significantly increased during 2011-2015, but year-over-year growth slowed and was occasionally negative. Cigarette unit sales exceeded e-cigarettes by 64:1 during the last 4-week period. During 2014-2015, cigarette sales increases occurred in 15 of 48 assessed states; e-cigarette sales increased in 18 states.Conclusions: Despite overall declines during 2011-2015, cigarette sales in 2015 grew for the first time in a decade. E-cigarette sales growth was positive, but slowed over the study period in assessed stores. Cigarette sales continued to exceed e-cigarette sales, reinforcing the importance of efforts to reduce the appeal and accessibility of cigarettes and other combusted tobacco products. [ABSTRACT FROM AUTHOR]

Objectives. To assess the proportion of electronic cigarette (e-cigarette) products sold in the United States that contain nicotine according to retail scanner data. Methods. We obtained unit sales data from January 11, 2015, to December 12, 2015, from The Nielsen Company for convenience stores; supermarkets; mass merchandisers; drug, club, and dollar stores; and Department of Defense commissaries. The data did not include purchases from tobacco specialty shops, "vape shops," or online sources. Nicotine content was assessed by product type (disposables, rechargeables, and refills), region, andflavor status based on nicotine strength listed in the Universal Product Codes. For the 36.7% of entries lacking nicotine content information, we conducted Internet searches by brand, product, and flavor. Results. In 2015, 99.0% of e-cigarette products sold contained nicotine, including 99.0% of disposables, 99.7% of rechargeables, and 98.8% of refills. Overall, 98.7% of flavored e-cigarette products and 99.4% of nonflavored e-cigarette products contained nicotine. Conclusions. In 2015, almost all e-cigarette products sold in US convenience stores and other assessed channels contained nicotine. Public Health Implications. Findings reinforce the importance of warning labels for nicotine-containing products, ingredient reporting, and restrictions on sales to minors. [ABSTRACT FROM AUTHOR]

This study uses e-cigarette retail sales data to estimate estimate e-cigarette sales and market share of e-cigarette sales by manufacturer in the United States during 2013-2017. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacy stores are positioned to cultivate health and wellness among patrons. This study assessed attitudes toward prohibiting tobacco product sales in pharmacy stores among U.S. adults.Methods: Data from the 2014 Summer Styles, an Internet survey of U.S. adults aged ≥18 years (n=4,269), were analyzed in 2015. Respondents were asked: Do you favor or oppose banning the sale of all tobacco products in retail pharmacy stores? Responses were: strongly favor, somewhat favor, somewhat oppose, and strongly oppose. Prevalence ratios were calculated using multivariate Poisson regression to determine sociodemographic correlates of favorability (strongly or somewhat).Results: Among all adults, 66.1% "strongly" or "somewhat" favored prohibiting tobacco product sales in pharmacy stores. Favorability was 46.5% among current cigarette smokers, 66.3% among former smokers, and 71.8% among never smokers. Favorability was 47.8% among current non-cigarette tobacco users, 63.2% among former users, and 71.4% among never users. Following adjustment, favorability was more likely among women compared with men (p<0.05). Conversely, favorability was less likely among the following: adults aged 25-44 years and 45-64 years compared with those aged ≥65 years, those with annual household income of $15,000-$24,999 compared with ≥$60,000, current cigarette smokers compared with never smokers, and current and former non-cigarette tobacco users compared with never tobacco users (p<0.05).Conclusions: Most U.S. adults favor prohibiting tobacco sales in retail pharmacy stores. Eliminating tobacco product sales in these settings may reinforce pharmacy stores' efforts to promote wellness, and further cultivate social climates that reduce the desirability, acceptability, and accessibility of tobacco. [ABSTRACT FROM AUTHOR]

E-cigarettes are the most commonly used tobacco product among US youth. Most e-cigarettes contain nicotine, which can cause addiction and can harm the developing adolescent brain. In coordination with the release of a Surgeon General's Report on e-cigarette use among young people, the Centers for Disease Control and Prevention collaborated with the Office of the Surgeon General to launch a campaign to educate parents, youth influencers, and young people about the risks of e-cigarettes. This article describes the development of communication products, including innovative media, about this public health risk, and shares lessons learned to inform public health practice. [ABSTRACT FROM AUTHOR]