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Emerging tobacco products such as electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) have a dynamic landscape and are becoming widely popular as they claim to offer a low-risk alternative to conventional smoking. Most pre-clinical laboratories currently exploit in vitro, ex vivo, and in vivo experimental models to assess toxicological outcomes as well as to develop risk-estimation models. While most laboratories have produced a wide range of cell culture and mouse model data utilizing current smoke/aerosol generators and standardized puffing profiles, much variation still exists between research studies, hindering the generation of usable data appropriate for the standardization of these tobacco products. In this review, we discuss current state-of-the-art in vitro and in vivo models and their challenges, as well as insights into risk estimation of novel products and recommendations for toxicological parameters for reporting, allowing comparability of the research studies between laboratories, resulting in usable data for regulation of these products before approval by regulatory authorities. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about media exposures to heated tobacco products (HTPs). In this study, we examined sources of HTP exposure, including from paid and unpaid media and social connections, in relation to HTP use and use intentions. Methods: In the fall of 2021, we conducted a cross-sectional survey among adult online panelists (aged 18–45 years) in the US and Israel, oversampling tobacco users. The current study analyzed data from participants who responded to the question about HTP awareness or use (n=2061). Multivariable linear and logistic regression analyses examined the relationship between sources of HTP exposure, HTP use, and use intentions. Results: Among those aware of HTPs, both Israelis and Americans reported past-month HTP media exposure via advertisements (58.2% vs 48.0%), nonadvertisement sources (49.7% vs 30.7%), and social connections (51.5% vs 33.6%), respectively. Factors associated with HTP awareness (n=677/2061; 32.9%) included media use frequency (AOR=1.13; 95% CI: 1.01–1.28) and social connections using HTPs (AOR=2.45; 95% CI: 1.92–3.15). Among those aware of HTPs, past-month HTP exposure via digital media advertisements (AOR=2.06; 95% CI: 1.09–3.91) and non-advertising promotion via radio, podcast, movie, television or theatre (AOR=2.30; 95% CI: 1.19–4.44) and websites (AOR=2.36; 95% CI: 1.32–4.21) were associated with current HTP use. Exposure to digital media advertisements (β=0.35; 95% CI: 0.07–0.62) and non-advertising promotion via social media (β=0.62; 95% CI: 0.34–0.91) were correlated with higher use intentions. Having social connections using HTPs was correlated with higher use (AOR=2.21; 95% CI: 1.19–4.11) and intentions (β=0.66; 95% CI: 0.42–0.91). No significant differences were found across countries. Conclusions: Digital media (e.g. online, social media) were particularly salient correlates of HTP intentions and use. Future studies are needed that further examine media exposures to these products, as well as that examine possible regulations to limit HTP promotion via these channels. [ABSTRACT FROM AUTHOR]

Introduction: Heated tobacco products (HTPs) have emerged as a prominent category in the tobacco market, particularly within European countries such as Poland. The introduction of HTPs has been met with increasing public interest, reflected in online search behavior. However, the public health implications of this new form of tobacco consumption remain a concern due to the lack of comprehensive research on its long-term effects. This study aimed to track the trends in online searches related to HTPs in Poland between 2016 and 2022, and to assess the impact of significant events on these trends in order to provide insights into public awareness of HTPs. Methods: Utilizing Google Trends, a free source tool, this study analyzed relative search volume (RSV) for HTP-related keywords in Poland. Key events were identified and mapped against the fluctuations in RSV to understand their impact on search behavior. The analysis was confined to specific HTP-related keywords, excluding broader tobacco-related terms. Results: A notable increase in HTP-related search queries was observed, particularly around the time of product launches and legislative changes. The largest increases occurred during the introduction of HTPs to the Polish market and during major events such as the COVID-19 pandemic. Conclusions: The study demonstrates a market interest in HTPs among Polish internet users, with search trends influenced by product launches and policy changes. The findings highlight the importance of monitoring online behaviors to inform public health efforts, despite limitations such as the lack of demographic data. Further research is needed to deepen the understanding of how these online trends correlate with actual consumer behavior and product sales. [ABSTRACT FROM AUTHOR]

INTRODUCTION Non-combustible nicotine products (NCNPs), such as heated tobacco products (HTPs) and nicotine vaping products (NVPs) have gained a significant nicotine market share in South Korea. This descriptive study examined patterns of regular cigarette and NCNP use among South Korean adults. METHODS Data were from the 2020 International Tobacco Control Korea Survey and included 4016 adults (aged ≥19 years) in the Republic of Korea who were regularly (at least weekly) using at least one NCNP (NVP/HTP, n=2117) and/or smoked cigarettes (n=3763) at the time of the survey. Weighted descriptive estimates were computed to assess respondents' nicotine product use among all respondents (exclusive, dual, or triple use). Thereafter, we identified sociodemographic characteristics associated with NCNP use (n=2117). RESULTS Among Korean adults who were smoking cigarettes, 83.1% (95% CI: 81.6- 84.6) did so exclusively, and 16.9% (95% CI: 15.4-18.4) smoked cigarettes and used NCNPs. Among those who used HTPs (n=1877), 14.9% (95% CI: 11.5-18.4) did so exclusively, 59.6% used HTPs and smoked cigarettes (95% CI: 55.4-63.1), 4.2% used HTPs and vaped (95% CI: 11.5-18.4), and 21.6 % (95% CI: 18.9-24.2) used all three products. Of adults who used HTPs and smoked cigarettes, 86.6% smoked daily. Among those who vaped (n=865), 13.3% did so exclusively (95% CI: 9.4-17.1), 55.6% (95% CI: 49.6-61.5) vaped and smoked cigarettes, 5.1% (95% CI: 1.7-8.6) used HTPs and vaped, and 26.1% (95% CI: 22.1-30.1) used all three products. Of adults who vaped and smoked cigarettes, 82.4% (95% CI: 77.1-87.7) smoked daily. CONCLUSIONS Cigarettes remain the most commonly used nicotine product in South Korea, and among adults using heated tobacco and/or vaping products, the majority were also smoking. Research is urgently needed to assess whether adults who are using an NCNP are doing so to quit, or rather to complement their cigarette smoking. [ABSTRACT FROM AUTHOR]

INTRODUCTION Heated tobacco products (HTPs) and e-cigarettes (ECs) have gained traction as alternatives for harm reduction, especially in Japan. In particular, the use of HTPs is rapidly gaining popularity among young adults in Japan, with a prevalence of 10.9% in 2020. Despite uncertainties regarding the health effects of HTPs and ECs, concerns regarding nicotine and carcinogens persist. Although physicians play a vital role in smoking cessation, they lack awareness and concerns regarding HTPs. This study aimed to assess the prevalence, knowledge, and concerns regarding HTPs and ECs among young Japanese physicians. METHODS A cross-sectional online survey was conducted in 2021 with 529 young Japanese physicians aged 24-39 years. Parameters assessed included awareness, smoking status, knowledge of HTPs and ECs, and concerns related to HTPs. Statistical analyses were conducted to assess prevalence, knowledge, and concerns by smoking status using the chi-squared test and logistic regression. RESULTS Most participants were aware of HTPs (89.0%) and ECs (71.3%). Young male physicians preferred HTPs, while females favored ECs. Primary sources of information included newspapers and stories (56.8%), and TV (37.4%). Nonsmokers (89.0%) demonstrated limited knowledge of these products. Concerns were highest and lowest among non-smokers and HTP users, respectively, with safety concerns being the most prevalent. CONCLUSIONS Young physicians exhibited lower smoking rates than the general population, but HTP use was prominent among young male physicians. Concerns varied based on smoking status, indicating the need to address these issues among healthcare professionals. Despite high awareness, knowledge gaps, particularly among non-smokers, highlight the importance of public health and educational campaigns to disseminate knowledge among physicians, regardless of medical specialty. [ABSTRACT FROM AUTHOR]

INTRODUCTION The surge in popularity of e-cigarettes and heated tobacco products (HTPs) in South Korea, driven by perceived health benefits and COVID-19-related concerns, has led to increased advertising claims about their safety despite ongoing debates about their health effects. This study explores the marketing strategies of online e-cigarette and HTP retailers in South Korea pre- and post-COVID-19, examining potential misleading claims and providing a foundation for future regulatory measures. METHODS We conducted a comprehensive study of eight major e-commerce platforms and three dominant search engines in South Korea to analyze the marketing and advertising strategies of e-cigarettes and heated tobacco products (HTPs) (n=774). Using specific keywords, promotional strategies were identified and categorized, after which statistical analysis was conducted to understand the frequency and proportion of these strategies, highlighting differences between HTP and e-cigarette sellers. RESULTS Our analysis reveals a significant rise in the number of online retailers selling e-cigarettes and HTPs following the COVID-19 pandemic, with the promotional strategies 'Stay home and vape' and 'Trendy' being the most prevalent. Trends also indicate a shift in promotional strategies over the years, with a marked increase in health reassurance themes and appeals to trendiness, particularly targeting female consumers, which were used significantly more at HTPs stores. CONCLUSIONS The study highlights the need for stricter regulation due to the potential health risks posed by the aggressive marketing strategies of e-cigarette and HTP online retailers in South Korea, amplified by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

INTRODUCTION Although advertising and promotion of tobacco products in Poland are prohibited, tobacco companies exploit legal loopholes and insufficient enforcement of the laws to conduct their marketing. To reach young adults, advertisements are placed in entertainment and social venues. This aspect of tobacco product marketing in Poland remains under-researched. The main aim of this study was to investigate the occurrence and characteristics of advertising and promotion of tobacco products in nightclubs in Gdansk, a large city in northern Poland. METHODS We conducted a single-center observational study of nightclubs in Gdansk, between July and October 2022. Two independent observers visited 30 nightclubs and collected information using pre-prepared research form. The occurrences of tobacco branded bar accessories, logo signs, package displays and other forms of advertising and promotion were recorded. Where possible, photographs of visible marketing displays were taken. RESULTS Advertising of tobacco products was present in 2/3 of the nightclubs observed. The most commonly advertised product category were heated tobacco products. Tobacco brand representatives promoted and offered consumers free tobacco product samples. Multi-level marketing activities were observed, including tobacco branded bar accessories, prominent sale points and tobacco brand logo signs. CONCLUSIONS The majority of nightclubs observed in Gdansk advertise and promote tobacco products. The ban on tobacco advertising and promotion is being violated in nightclubs, where the most commonly advertised products are heated tobacco products. The authorities should take steps to extend the bans to cover private promotion and enforce the law to protect high-risk individuals from smoking initiation and relapse. [ABSTRACT FROM AUTHOR]

INTRODUCTION Combustible cigarette (CC) smoking is a risk factor for chronic obstructive pulmonary disease (COPD) and asthma, and some studies reported that tobacco smoking might affect the development or symptom control of allergic rhinitis, sinusitis, and atopic dermatitis. However, evidence on the health risks of heated tobacco products (HTPs) is lacking. We investigated the prevalence of respiratory and allergic diseases according to tobacco use types in Korean adults. METHODS We used data from 18230 adults in the Korea National Health and Nutrition Examination Survey. Multiple logistic regression analyses were performed to assess the prevalence of respiratory and allergic diseases according to tobacco use types (current exclusive CC use, current exclusive HTPs use, and dual use of CC and HTPs). RESULTS The prevalence of exclusive CC users, exclusive HTPs users, dual users of CC and HTPs was 15% (n=2740), 1% (n=182), and 2.4% (n=435), respectively. The prevalence of COPD was higher among past tobacco users (AOR=2.37; 95% CI: 1.02-5.51) versus no tobacco use group. The prevalence of asthma was higher among past tobacco users or exclusive CC users (AOR=1.73; 95% CI: 1.26-2.38, and AOR=1.57; 95% CI: 1.08-2.26) versus non-users of tobacco. The prevalence of allergic rhinitis was higher among past tobacco users versus non-users of tobacco (AOR=1.33; 95% CI: 1.13-1.57), and the prevalence of allergic rhinitis was higher among exclusive HTPs users versus non-users of tobacco or exclusive CC users (AOR=1.60; 95% CI: 1.06-2.4; and AOR=1.74; 95% CI: 1.14-2.66). The adjusted odds of sinusitis and atopic dermatitis were not significantly different between tobacco use types. CONCLUSIONS Exclusive use of HTPs was associated with allergic rhinitis in Korean adults. Further longitudinal studies are needed to clarify the health risk of HTPs. [ABSTRACT FROM AUTHOR]

INTRODUCTION Tobacco users are categorized as single, dual, and triple users based on the number of tobacco products (cigarettes, e-cigarettes, and heated tobacco products) used. This study addressed a literature gap by examining how adult Korean tobacco users' quit attempts/plans differed based on the user type, and the associated psychosocial and subjective health-related factors. METHODS We used a questionnaire to examine participants' self-reported health, stress, health concerns, health behavior, tobacco addiction, intentions/plans to quit, and demographic characteristics. Data were analyzed using chi-squared tests, one-way analysis of variance, and multiple linear regression. RESULTS Of the 1288 tobacco users, 55.4%, 28.3%, and 16.4% were single, dual, and triple users, respectively. Self-rated health and stress were lowest among single users and highest among triple users. Most user types had intentions/plans to quit, especially triple users. Quit attempts and plans increased with increasing health behaviors and time elapsed before first tobacco use in the morning, but decreased with higher stress and self-rated addiction. CONCLUSIONS Intentions/plans to quit tobacco use varied based on the type of tobacco user. Multiple users had higher self-rated health, plans to quit, and self-reported addiction; they considered themselves healthy or engaged in healthy behaviors to offset problems from tobacco use and used multiple tobacco products to quit smoking. Highly stressed users had fewer plans to quit and used tobacco for stress relief. Thus, the provision of accurate information about tobacco products and stress management is important to promote successful quitting. [ABSTRACT FROM AUTHOR]

INTRODUCTION Heated tobacco products (HTPs) and nicotine vaping products (NVPs) both are legal consumer products in the Republic of Korea. Little is known about perceptions of harmfulness of HTPs and NVPs relative to cigarettes in South Korea among adults who smoke, and how exposure to marketing may be associated with harmfulness perceptions. METHODS This study used data from the 2020 International Tobacco Control (ITC) Korea Survey, and included 3713 adult (aged 19 years) cigarette smokers who were: 1) exclusive smokers (n=1845); 2) dual HTP + cigarette consumers (n=1130); 3) dual NVP + cigarette consumers (n=224); and 4) triple consumers (all three products, n=514). Weighted multinomial regression models were conducted to estimate smokers' perceptions of harmfulness of HTPs and NVPs compared to cigarettes, NVPs to HTPs, and self-reported exposure to HTP/NVP advertising. Analyses compared the perceptions of harmfulness between the four different consumer groups, and tested whether exposure to HTP/NVP advertising was associated with perceptions of lower relative harm. RESULTS Among all respondents, 27.5% believe that HTPs are less harmful than cigarettes and 23.4% believe that NVPs are less harmful than cigarettes. Exclusive cigarettes smokers were significantly less likely to perceive that HTPs and NVPs are less harmful than cigarettes compared to dual HTP + cigarette consumers, dual NVP + cigarette consumers, and triple consumers (all p<0.001). Half of respondents perceive NVPs as equally harmful as HTPs (14.1% perceive NVPs as more harmful than HTPs). Exposure to HTP/NVP advertising was associated with perceiving these products as less harmful than cigarettes. CONCLUSIONS About one-quarter of Korean cigarette smokers perceive HTPs and NVPs as less harmful than cigarettes. Further investigation is required to understand how harm perceptions and HTP/NVP advertising are related to changes in product use, such as switching between products, using multiple products, or discontinuing all product use. [ABSTRACT FROM AUTHOR]

INTRODUCTION Few studies have examined the effect of feedback based on oral-malodor measurements on the motivation to quit smoking. Therefore, this study examined whether oral-malodor measurements were associated with the intention to quit smoking. METHODS This retrospective, uncontrolled before-after study invited smokers to a workplace health event in 2019 and 2020 to motivate them to quit smoking. They attended seminars on oral health and smoking cessation aids, and then underwent respiratory function and oral-malodor measurements using exhaled and oral cavity air, respectively. Intention to quit smoking was evaluated by answers to questions regarding the intention to quit in the next 1 or 6 months in questionnaires collected before and after the event. This study analyzed 241 men aged 20-54 years (mean: 33.2 ± 10.5) to examine factors associated with the intention to quit in multivariable logistic regression analyses for age, tobacco type (cigarettes and heated-tobacco products), and category of tobacco consumption. RESULTS Before the event, 8.7%, 17.0%, and 74.3% of smokers had intended to quit in the next month, the next six months, or had no intention to quit, respectively. After the event, the respective percentages were 17.8%, 26.6%, and 55.6%. A higher methyl mercaptan concentration, a volatile sulfide component of oral malodor, was significantly associated with the intention to quit in the next month (adjusted odds ratio, AOR=4.24; 95% CI: 1.52-11.8, p=0.006). The participants with higher daily tobacco consumption were less likely to acquire the intention to quit in the next six months (A0R=0.37; 95% CI: 0.15-0.92, p=0.032). Other variables, such as lung age deficit, exhaled CO concentration, and hydrogen sulfide concentration (another component of oral malodor), were not significantly associated. CONCLUSIONS Oral-malodor measurement feedback may help motivate men to quit smoking in the next 1 month rather than in the next six months. [ABSTRACT FROM AUTHOR]

INTRODUCTION The relationship between nicotine dependence and the use of multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), is not well investigated. We evaluated nicotine dependence symptoms among South Korean adults among single and multiple tobacco product users. METHODS We conducted an online survey involving 7000 adults aged 20--69 years in November 2018 and compared the nicotine dependence among single, dual, and triple use of tobacco products. Nicotine dependence was measured for 'time to the first use of tobacco products within 5 min', 'awaking at night', 'strong craving', 'uncontrollable urge to smoke', and 'irritability or restlessness'. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for nicotine dependence symptoms based on the number of tobacco products were estimated using multivariable logistic regression analysis. RESULTS The current prevalence of use of tobacco products was 27.5%. Proportion of dual and triple uses were: 28.3%, 13.7% for CCs; 36.5%, 50.2% for ECs; and 54.0%, 33.1% for HTPs. Nicotine dependence tended to be higher as the number of tobacco products used increased for most measures, except for ECs with the measure 'time to first use of tobacco products within 5 min'. The ORs of 'awaking at night' increased approximately three times for dual users (OR=2.87; 95% CI: 1.29--6.39, for current EC users) and seven times for triple users (OR=7.24; 95% CI: 3.66--14.31, for current HTP users) compared to that for single users. CONCLUSIONS Multiple tobacco product users reported higher nicotine dependence symptoms than single users. High nicotine dependence of multiple tobacco product users may hamper the future cessation of tobacco products, which can be challenging for future tobacco control policies in South Korea. [ABSTRACT FROM AUTHOR]

IQOS is sold globally in over 60 countries and entered the US market in 2019 and by 17 May 2021, it was sold in four states: Georgia (Atlanta, Buford), Virginia (Richmond, Tysons), North Carolina (Charlotte, Raleigh), and South Carolina (Charleston, Myrtle Beach), and had 52 specialty stores and 400 retail outlets. While US sales stopped on 29 November 2021 due to a patent lawsuit, they may resume in the near future. As IQOS distribution will likely expand in the future throughout the US, surveillance systems are needed to inform local and national regulatory efforts. Key decision-driving factors for IQOS expansion likely include: 1) general market factors such as larger population/market size and higher median household income; 2) specific IQOS target market factors such as higher consumer spending and smoker prevalence; and 3) more lenient tobacco control context (e.g. cigarette excise taxes, smoke-free policies, state cessation/prevention funding). Likely targets for expansion are markets in Nashville, Tennessee; St. Louis, Missouri; and Louisville, Kentucky. Public health surveillance efforts should monitor IQOS market expansion (e.g. new markets, online direct-to-consumer sales) and IQOS marketing activities (e.g. advertisements, direct marketing, social media, point-of-sale promotions, product trials). [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking is the leading cause of chronic obstructive pulmonary disease (COPD), and smoking cessation is the most effective treatment for patients with COPD. However, few studies have investigated the continuation/cessation of smoking and heated tobacco products (HTP) in patients with COPD. The objective of this study was to examine the characteristics of patients with COPD, those who are current smokers and those who switched from cigarettes to HTP, and to examine the reason for the continuation or cessation of smoking. METHODS This multicenter, cross-sectional study included 411 outpatients with COPD. Data for this study were part of a study conducted for a comprehensive evaluation of the smoking status and clinical factors in patients with COPD and their families. RESULTS Logistic regression analysis revealed that a younger age, longer duration of smoking, fewer daily cigarettes, and lower modified Medical Research Council (mMRC) dyspnea score, and a lower Simplified Nutritional Appetite Questionnaire (SNAQ) score for appetite, were characteristics of current smokers (age OR=0.94; duration of smoking OR=1.07; number of cigarettes per day OR=0.94; mMRC OR=0.68; SNAQ OR=0.83; p<0.05). The logistic regression analysis model showed that a younger age and higher education level were associated with the use of HTP (age OR=0.83; higher education level OR=4.63; p<0.05). Many of the current smokers displayed smoking behaviors that are not guaranteed to be safe, such as reducing smoking or switching to lighter cigarettes or HTP. CONCLUSIONS Patients with COPD who continue smoking tended to have low appetite as well as smoking behaviors that are not guaranteed to be safe. Physicians should provide appropriate guidance to these patients on smoking cessation. [ABSTRACT FROM AUTHOR]

INTRODUCTION Since 2016, multi-family housing developments in South Korea can designate public areas such as staircases, elevator, corridors, and underground parking lots as non-smoking areas if at least half of the households residing in the development agree. This study investigated whether there were changes in the use of heat-not-burn tobacco products (HnB) based on whether non-smoking areas were introduced in multi-family housing developments. METHODS An online survey of 1200 apartment residents (599 men and 601 women) in seven metropolitan cities in South Korea was conducted from 10 to 18 October 2018. RESULTS Among the 1200 people who completed the survey, 493 were smokers (351 men and 142 women), of whom 287 (195 men and 92 women) were currently using HnB. In total, 51.5% (n=148) of the HnB users reported that their smoking frequency inside (n=75) or outside (n=73) the apartment building increased after using HnB, whereas the smoking frequency of 27.5% (n=79) decreased and that of 20.9% (n=6) remained unchanged. Of the HnB users, 25.4% (n=73) were currently living in non-smoking apartments, of whom 39.7% reported that the smoking frequency outside the apartment building increased. On the other hand, of 214 people who did not currently reside in non-smoking apartments, 30.4% reported that the smoking frequency in the apartment increased. CONCLUSIONS For smokers to quit smoking, the expansion of non-smoking areas should be accompanied by the facilitation of a smoke-free atmosphere and a smoking-cessation service for smokers. [ABSTRACT FROM AUTHOR]