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To examine the chemical composition of JUUL pods collected from a convenience sample of 16 high schools in California to identify possible consumer modification or counterfeit use. Using Gas Chromatography–Mass Spectrometry, we quantitatively analyzed the nicotine, propylene glycol (PG), and vegetable glycerin (VG) in JUUL pods (n = 26) collected from California high schools and compared results to commercial 3% (n = 15) and 5% (n = 24) JUUL pods purchased online. Most of the collected JUUL pods (24/26 pods) had a nicotine concentration (43.3 mg/ml, 95% PI: 21.5–65.1) outside the prediction intervals (PI) of the 3% (33.5 mg/ml, 95% PI: 31.8–35.2) and 5% (55.0 mg/ml, 95% PI: 51.5–58.3) commercial JUUL pods. Most (73%) collected JUUL pods had VG concentrations (583.5 mg/ml, PI: 428.9–738.1) lower than the 3% (722.2 mg/ml, PI: 643.0–801.4) and 5% (710.5 mg/ml, PI: 653.1–767.8) commercial JUUL pods. Used JUUL products collected from high school students or found on school grounds were not chemically consistent with the manufacturer's stated formulations. [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]

Purpose We aimed to describe U.S. youth harm perceptions of intermittent tobacco use. Methods Using data from the 2016 National Youth Tobacco Survey of U.S. students (grades 6–12; N = 20,675), we examined prevalence and correlates of all respondents' perceived harm of using four different tobacco products on “some days but not every day.” Associations between current (past 30-day) use and harm perceptions were assessed using multivariable regression. Results Perceiving that intermittent use causes “no” or “little” harm was 9.7% for cigarettes, 12.0% for smokeless tobacco, 18.7% for hookah, and 37.5% for e-cigarettes. Compared with those who reported “a lot” of harm, youth with lower harm perceptions were more likely to report current use. Conclusions One in ten youth perceived intermittent cigarette smoking as causing “little” or “no” harm; this perception was higher among current users. Efforts to educate youth about the risks of even intermittent tobacco product use could reduce misperceptions of harm. [ABSTRACT FROM AUTHOR]

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]

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]

Introduction: Efforts to disrupt tobacco sales to minors through age of sale restrictions can contribute to reductions in youth tobacco use. The objective of this study was to assess attitudes toward raising the minimum tobacco age of sale to 21 years among U.S. adults.Methods: Data from the 2014 Summer Styles, an Internet survey of U.S. adults aged ≥18 years (N=4,219), were analyzed in 2014. Respondents were asked: Do you favor or oppose raising the legal minimum age to purchase all tobacco products from 18 to 21? Responses included: strongly favor, somewhat favor, somewhat oppose, and strongly oppose. ORs and 95% CIs were calculated using logistic regression; covariates included sex, age, race/ethnicity, education, income, region, and cigarette smoking status.Results: Among all adults, 50.4% strongly and 24.6% somewhat favored raising the age to 21 years; 77.5% of never smokers, 74.6% of former smokers, and 69.9% of current smokers strongly or somewhat favored it. Adjusted odds of strongly or somewhat favoring raising the age were higher among adults aged 25-44 (OR=1.8, 95% CI=1.3, 2.5), 45-64 (OR=2.3, 95% CI=1.7, 3.2), and ≥65 (OR=3.1, 95% CI=2.2, 4.5) years, and lower among former (OR=0.7, 95% CI=0.6, 0.9) and current (OR=0.7, 95% CI=0.5, 0.8) smokers.Conclusions: Three quarters of adults favor raising the minimum tobacco age of sale to 21 years, including seven in ten smokers. Raising the minimum age of sale, along with proven tobacco control strategies, could prevent youth tobacco use. [ABSTRACT FROM AUTHOR]