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Aims Design Setting Participants Measurements Findings Conclusions To measure changes over time (between 2017 and 2023) in disposable e‐cigarette use and popular brands among youth in Canada, England and the United States (US) who vaped.Nine waves of repeat cross‐sectional data from the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey.Online surveys conducted in Canada, England and the US between 2017 and 2023.Youth aged 16 to 19 years who had vaped in the past 30 days (n = 19 710).Usual type (disposable, cartridge/pod, tank) and brand of e‐cigarette used; covariates sex at birth, age, race/ethnicity, cigarette smoking status, vaping on ≥20 of the past 30 days.In 2017, the majority of youth who vaped in the past 30 days reported using refillable tank e‐cigarettes, whereas disposable e‐cigarettes were the least commonly used product type in Canada (10.0%), England (8.6%) and the US (14.4%). Cartridge/pods overtook tank devices in Canada and the US by 2020; however, by 2023, disposables were the leading type of e‐cigarette used by youth who vaped in all three countries (Canada = 58.5%; England = 83.2%; US = 67.3%). The shift to disposables occurred among all socio‐demographic groups, with few differences by vaping and smoking status. The percentage of youth who vaped that reported ‘no usual’ brand also decreased substantially from 2017 (29% to 42%) to 2023 (11% to 17%). The rise of disposable e‐cigarettes appeared to be driven primarily by individual brands in the US (Puff Bar in 2020/2021, Elf Bar in 2022/2023) and England (Elf Bar in 2022/2023).The e‐cigarette market has evolved rapidly with notable shifts in the types of e‐cigarettes used by youth who vape in Canada, England and the United States. Although the timing differed across countries, major shifts in device types appear to be driven by individual brands and were often accompanied by increases in vaping prevalence among youth. [ABSTRACT FROM AUTHOR]

Purpose: Accumulated axial growth observed during a 6‐year clinical trial of a dual focus myopia control contact lens was used to explore different approaches to assess treatment efficacy. Methods: Axial length measurements from 170 eyes in a 6‐year clinical trial of a dual focus myopia control lens (MiSight 1 day, CooperVision) were analysed. Treatment groups comprised one having undergone 6 years of treatment and the other (the initial control group) having 3 years of treatment after 3 years of wearing a single vision control lens. Efficacy was assessed by comparing accumulated ocular growth during treatment to that expected of untreated myopic and emmetropic eyes. The impact of treatment on delaying axial growth was quantified by comparing the increased time required to reach criterion growths for treated eyes and survivor analysis approaches. Results: When compared to the predicted accumulated growth of untreated eyes, 6 years of treatment reduced growth by 0.52 mm, while 3 years of treatment initiated 3 years later reduced growth by 0.19 mm. Accumulated differences between the growth of treated and untreated myopic eyes ranged between 67% and 52% of the untreated myopic growth, and between 112% and 86% of the predicted difference in growth between untreated myopic and age‐matched emmetropic eyes. Treated eyes took almost 4 years longer to reach their final accumulated growth than untreated eyes. Treatment increased the time to reach criterion growths by 2.3–2.7 times. Conclusion: Estimated growth of age‐matched emmetropic and untreated myopic eyes provided evidence of an accumulated slowing in axial elongation of 0.52 mm over 6 years, and the treated growth remained close to that expected of emmetropic eyes. Six years of dual focus myopia control delayed the time to reach the final growth level by almost 4 years. [ABSTRACT FROM AUTHOR]

Introduction: The legalisation of cannabis in Canada in 2018, and subsequent increase in prevalence of use, has generated interest in understanding potential changes in problematic patterns of use, including by socio‐demographic factors such as race/ethnicity and neighbourhood deprivation level. Methods: This study used repeat cross‐sectional data from three waves of the International Cannabis Policy Study web‐based survey. Data were collected from respondents aged 16–65 prior to cannabis legalisation in 2018 (n = 8704), and post‐legalisation in 2019 (n = 12,236) and 2020 (n = 12,815). Respondents' postal codes were linked to the INSPQ neighbourhood deprivation index. Multinomial regression models examined differences in problematic use by socio‐demographic and socio‐economic factors and over time. Results: No evidence of a change in the proportion of those aged 16–65 in Canada whose cannabis use would be classified as 'high risk' was noted from before cannabis legalisation (2018 = 1.5%) to 12 or 24 months after legalisation (2019 = 1.5%, 2020 = 1.6%; F = 0.17, p = 0.96). Problematic use differed by socio‐demographic factors. For example, consumers from the most materially deprived neighbourhoods were more likely to experience 'moderate' vs 'low risk' compared to those living outside deprived neighbourhoods (p < 0.01 for all). Results were mixed for race/ethnicity and comparisons for high risk were limited by small sample sizes for some groups. Differences across subgroups were consistent from 2018 to 2020. Discussion and Conclusions: The risk of problematic cannabis use does not appear to have increased in the 2 years following cannabis legalisation in Canada. Disparities in problematic use persisted, with some racial minority and marginalised groups experiencing higher risk. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined consumer knowledge and communication of tetrahydrocannabinol (THC) content among cannabis consumers, including potential differences by cannabis legislation. The study sought to: (i) examine self‐reported knowledge of THC content across 10 cannabis products; (ii) examine self‐reported intoxication levels; and (iii) examine association between self‐reported THC levels and intoxication levels. Methods: Repeat cross‐sectional surveys were conducted in Canada and the United States in September–November 2020 as part of the International Cannabis Policy Study. Respondents were past 12‐month cannabis consumers, aged 16–65 (n = 13,689). A weighted logistic regression model examined the association between expected intoxication of dried flower, jurisdiction and frequency of cannabis use. Results: Across all 10 cannabis products, approximately two‐thirds of consumers did not know the quantitative THC level of the cannabis product they last used. Qualitative levels of THC (e.g., 'low' or 'high' THC) showed moderate correspondence with quantitative self‐reported THC levels for most products. Approximately half of consumers across all products reported achieving their desired intoxication level at last use, with higher levels among more frequent consumers and Canadian consumers of dried flower (F = 2.54, p = 0.019). Discussion and Conclusions: Overall, comprehension of THC levels in cannabis products is low among consumers in both illegal and legal markets. [ABSTRACT FROM AUTHOR]

Summary: Background: Many countries, including Canada, are considering regulations to restrict food and beverage marketing to children. However, little evidence is available outside of the US on how marketing exposure differs across sociodemographic subgroups. Objective: To investigate potential associations between child and adolescent sociodemographic characteristics and exposure to food and beverage marketing in Canada. Methods: Participants (n = 3780) aged 10–17 self‐reported exposure to food and beverage marketing across food categories, locations and marketing techniques. Logistic regression models tested relationships between sociodemographics (age, sex, ethnicity and income adequacy) and marketing exposure. Results: Among other differences identified, 13–17 years old were more likely than 10–12 years old to report seeing unhealthy food marketing online. Girls were more likely than boys to see such marketing online and in retail settings, while boys were more likely to see it in video games. Minority ethnicities (including Indigenous youth) and respondents with lower income adequacy generally reported more exposure than White and higher income respondents, respectively. Conclusions: This study highlights important differences in marketing exposure among youth of different sociodemographic groups in Canada, including greater exposure to marketing among those most disadvantaged and emphasizes the essential need to consider food marketing across equity groups when developing restrictions on marketing to kids. [ABSTRACT FROM AUTHOR]

Introduction: Initiating cannabis use at an early age elevates risk of harm. Cannabis vaping is an emerging issue, and it is unknown whether the patterning and correlates of early‐onset cannabis vaping differ from those of cannabis smoking. Methods: We used repeat cross‐sectional data from a nationally representative biennial survey (2012–2018) of students aged 14–15 years in New Zealand (N = 11,405), response rate 65% (2012), 64% (2014–2016) and 59% (2018). Results: Between 2012 and 2018 lifetime cannabis use decreased, but regular use (past month, weekly, daily) was stable. Prevalence of past month, weekly and daily use in 2016–2018 (pooled) was 8.6%, 3.4% and 1.5%, respectively. Cannabis vaping was reported by 24% of past month cannabis users. The demographic profile of early‐onset cannabis smokers and vapers was similar, with elevated use of both modes among Māori (Indigenous), same‐ or both‐sex attracted students and those in low decile (high‐deprivation) schools. Correlates were similar for both modes. Cannabis use was strongly associated with tobacco and alcohol use. The next strongest associations (after adjustment) were exposure to second‐hand smoke at home, student income >$50/week and low parental monitoring of whereabouts. Past week social media use, psychological distress and low parental monitoring of spending were also associated with both modes. Discussion and conclusions: Early‐onset cannabis use is much higher in structurally disadvantaged groups, and among those who use tobacco and alcohol. Comprehensive multisubstance approaches to prevention are indicated in this age group. Efforts to reduce socio‐economic inequity and exposure to other risk factors may reduce cannabis‐related harm. [ABSTRACT FROM AUTHOR]

Background and Aims: Smoking fewer cigarettes per day may increase the chances of stopping smoking. Capping the number of cigarettes per pack is a promising policy option, but the causal impact of such a change is unknown. This study aimed to test the hypothesis that lowering cigarette pack sizes from 25 to 20 reduces the number of cigarettes smoked. Design: This randomized controlled cross‐over trial had two 14‐day intervention periods with an intervening 7‐day period of usual behaviour. Participants purchased their own cigarettes. They were instructed to smoke their usual brand from either one of two sizes of pack in each of two 14‐day intervention periods: (a) 25 cigarettes and (b) 20 cigarettes. Participants were randomized to the order in which they smoked from the two pack sizes (a–b; b–a). Setting: Canada. Participants: Participants were adult smokers who smoked from pack sizes of 25, recruited between July 2020 and June 2021. Of 252 randomized, 240 (95%) completed the study and 236 (94%) provided sufficient data for the primary analysis. Measurements Cigarettes smoked per participant per day. Findings Participants smoked fewer cigarettes per day from packs of 20 cigarettes [n = 234, mean = 15.7 standard deviation (SD) = 7.1] than from packs of 25 (n = 235, mean = 16.9, SD = 7.1). After adjusting for pre‐specified covariates (baseline consumption and heaviness of smoking), modelling estimated that participants smoked 1.3 fewer cigarettes per day [95% confidence interval (CI) = −1.7 to −0.9], equivalent to 7.6% fewer (95% CI = −10.1 to −5.2%) from packs of 20 cigarettes. Conclusions: Smoking from packs of 20 compared with 25 cigarettes reduced the number of cigarettes smoked per day. [ABSTRACT FROM AUTHOR]

The author comments on the article "The implementation and public health impacts of cannabis legalization in Canada: a systematic review" by W. Hall and colleagues. Topics discussed include origin of legal access to medical cannabis in Canada, perspectives of stakeholders on the effectiveness of legal market, and significance of a mandatory legislative review of the federal Cannabis Act.

Background and Aims: Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit. Design: Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020. Setting: This study was conducted in the United States, Canada, England and Australia. Participants: Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815). Measurements Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow‐up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow‐up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter‐wave vaping uptake was assesed between baseline and follow‐up (none, only non‐daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter‐wave vaping uptake was associated with smoking cessation at follow‐up and with planning to quit at follow‐up, each stratified by plans to quit smoking at baseline. Findings Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06–14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91–4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow‐up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17–9.59). Conclusions: Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers. [ABSTRACT FROM AUTHOR]

Background: The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. Methods: A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. Results: The expert‐based consensus agreed upon a three‐layered hierarchical framework. Each layer—universal measures, detailed self‐report and biological measures—reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. Conclusions: Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation. [ABSTRACT FROM AUTHOR]

We explored socioeconomic gradients in self‐rated overall health (SROH) using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial perspectives (subjective social status (SSS)) among adults living in countries with varying levels of income inequality, and the importance of psychosocial stress in mediating these associations. If psychosocial processes at the individual and societal levels correspond, associations between SSS and SROH should be higher among adults in countries with higher income inequality, and psychosocial stress should be a more important mediator of these associations. We used multigroup structural equation models to analyse cross‐sectional data from the International Food Policy Study of adults (n = 22,824) in Australia, Canada, Mexico, the UK and the United States. Associations between SSS and SROH were not higher in more unequal countries, nor was psychosocial stress a more important mediator of these associations. Inequities in SROH in more unequal countries may not predominantly reflect stress‐related pathways of social status differentiation. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and correlates of weight gain attempts in a pooled sample of adults aged 18 and older from Canada, Australia, the United Kingdom, the United States, and Mexico. Method: Data collected during 2 years (2018 and 2019) of the International Food Policy Study (N = 42,108) were analyzed. Unadjusted 12‐month prevalence of weight gain attempts was estimated based on body mass index (BMI; kg/m2), weight perception, country, survey year, and sex. Logistic regression analyses were estimated to determine the sociodemographic correlates (age, race/ethnicity, education, BMI, weight perception, weight perception accuracy, and self‐rated mental health) of weight gain attempts among the pooled sample stratified by sex. Results: Men (10.4%) were significantly more likely than women (5.4%) to report weight gain attempts (p <.001). Nearly one in five (17.1%) men with a BMI in the "normal" range (≥18.5 to <25.0) reported weight gain attempts. Among both men and women, minority group identity was associated with higher odds, while older age and higher BMI category were associated with lower odds, of reporting weight gain attempts. Country differences over the two survey years showed the prevalence of weight gain attempts in 2019 (vs. 2018) was higher among women in Australia (p <.05) and men in the United States (p <.01). Discussion: Weight gain attempts are more common among men, compared to women, across five countries, potentially reflecting the global salience of the pursuit of a muscular body. [ABSTRACT FROM AUTHOR]

The iCannToolkit is a first important step to systematically gather evidence regarding the health effects of contemporary medical and non-medical cannabis use—over time, among licit and illicit settings, cultures and age groups—in order to inform policy development and to raise awareness concerning cannabis use-related risks and benefits. [ABSTRACT FROM AUTHOR]

Introduction: Little empirical evidence exists about the efficacy of labelling and marketing restrictions in a regulated cannabis market. This study examined perceptions of cannabis product packaging designs, health warning labels (HWL) and perceptions of packs displaying brand imagery and leading descriptors on measures of appeal, and perceived consumer attributes. Methods: An online experimental survey of Canadian cannabis users and non‐users (n = 870) aged 16–30 years containing eight between‐group experiments was conducted in October 2017. Primary outcomes were appeal and perceived consumer attributes of cannabis product packaging, including the likelihood of being younger, female, fashionable, health conscious and likely to go out and party. Results: When cannabis product branding was present, respondents were more likely (P = 0.027) to report greater appeal than when branding was absent. When an HWL was present, respondents were less likely (P = 0.010) to report greater appeal than when absent. The presence of a celebrity sponsor (P < 0.001), music references (P < 0.001) or party references (P < 0.001) increased the likelihood that respondents perceived the product as targeted at someone younger, and a party lifestyle. Differences by cannabis use status were observed across experiments; those who had used were more likely to find branding elements appealing. Discussion and Conclusions: The findings demonstrate that brand imagery on cannabis packaging can promote lifestyle associations and increase the appeal of cannabis products among young people. Plain/standardised packs displaying HWLs were perceived as less appealing than packs with branding or without HWLs. Lifestyle associations can be communicated through brand imagery on cannabis packaging. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This paper examines the impact of an alcohol labelling intervention on recall of and support for standard drink (SD) labels, estimating the number of SDs in alcohol containers, and intended and unintended use of SD labels. Design and Methods: A quasi‐experimental study was conducted in Canada where labels with a cancer warning, national drinking guidelines and SD information were applied to alcohol containers in the single liquor store in the intervention site, while usual labelling continued in the two liquor stores in the comparison site. Three waves of surveys were conducted in both sites before and at two time‐points after the intervention with 2049 cohort participants. Generalised estimating equations were applied to estimate changes in all outcomes. Results: Participants in the intervention relative to the comparison site had greater odds of recalling [adjusted odds ratio (AOR) 5.69, 95% confidence interval (CI) 3.02, 10.71] and supporting SD labels (AOR 1.49, 95% CI 1.04, 2.12) and lower odds of reporting using SD labels to purchase high strength, low‐cost alcohol (AOR 0.65, 95% CI 0.45, 0.93). Exposure to the labels had negligible effects on accurately estimating the number of SDs (AOR 1.06, 95% CI 0.59, 1.93) and using SD labels to drink within guidelines (AOR 1.04, 95% CI 0.75, 1.46). Discussion and Conclusions: Evidence‐informed labels increased support for and decreased unintended use of SD labels. Such labels can improve accuracy in estimating the number of SDs in alcohol containers and adherence to drinking guidelines. [ABSTRACT FROM AUTHOR]

Objective: Sugar-sweetened beverage taxes are increasingly used to discourage sugar intake; however, the impact on consumer preferences for particular products is largely unknown. This study explored the impact of two tax structures (tiered vs. nontiered and inclusive vs. exclusive of 100% fruit juice) on participants' probability of purchasing moderately sugary beverages and 100% fruit juice.Methods: A sample of 3,584 Canadians aged 13 years and older completed a series of beverage purchasing tasks, each corresponding to a different tax condition, within an experimental marketplace. Tax conditions included a no-tax control, plus four taxes varying by structure (tiered vs. nontiered) and whether or not 100% fruit juice was included.Results: The odds of purchasing a moderately sugary beverage were higher under tiered versus nontiered taxes. Purchases of higher sugar beverages differed little across tiered versus nontiered structures. Odds of purchasing 100% fruit juice were lower when these products were taxed versus not taxed.Conclusions: Results suggest that two key tax structures are likely to function as expected; taxes including 100% fruit juice products may lead to lower probability of purchasing fruit juice, and taxes incorporating multiple tiers may be more likely to encourage purchases of moderately sugary products than nontiered formats. [ABSTRACT FROM AUTHOR]

Introduction and Aims: There is little objective market data on the price or potency of legal and illegal cannabis products following recreational cannabis legalisation.Design and Methods: In the 2 months post-legalisation in Canada (November-December 2018), legal and illegal cannabis retailers were identified from government lists and online directories. The store location, price and Δ9-tetrahydrocannabinol (THC) and cannabidiol levels of dried herb and cannabis cookies were collected from retailer websites or Weedmaps.Results: We identified 185 legal retailers (22 online stores, 163 storefronts; 65 government-run stores, 120 private stores) and 944 illegal retailers (791 delivery-only services, 157 storefronts). Relative to legal dried herb, illegal dried herb was lower in price (1 g: $10.23 vs. $11.08, ⅛ oz: $9.37/g vs. $10.88/g, ½ oz: $8.18/g vs. $8.85/g; P < 0.05 for all) and higher in potency (THC: 20.5% vs. 16.1%, cannabidiol: 2.4% vs. 1.7%; P < 0.05 for both). Legal private stores had higher prices for dried herb than government-run stores (1 g: $13.08 vs. $10.89, ⅛ oz: $12.75/g vs. $10.45/g, ½ oz: $10.85/g vs. $8.71/g, 1 oz: $8.54/g vs. $7.22/g; P < 0.05 for all). On average, one cannabis cookie in the illegal market contained 96 mg of THC and cost $1.57 per 10 mg of THC.Discussion and Conclusions: In the 2 months post-legalisation, illegal cannabis was less expensive, with higher labelled THC content than legal cannabis, although the scope of these differences was more modest than estimates from other crowdsourced and self-reported data. Direct monitoring of cannabis price and potency from legal and illegal retailers is needed to examine the impact of legalisation over time. [ABSTRACT FROM AUTHOR]

Introduction and Aims: To investigate relationships between smoking-related behaviours and knowledge of the disease risks of smoking and the causes of smoking harms, using a four-way division of 'component causes': nicotine, other substances found in unburned tobacco, combustion products of tobacco and additives.Design and Methods: The data were collected using an on-line survey in Australia with 1047 participants in three groups; young non-smokers (18 to 25), young smokers (18 to 25) and older smokers (26 and above).Results: Most participants agreed that cancer and heart disease are major risks of smoking but only a quarter accurately quantified the mortality risk of lifetime daily smoking. Very few (two of 1047) correctly estimated the relative contributions of all four component causes. Post-hoc analyses reinterpreting responses as expressions of relative concern about combustion products and nicotine showed that 29% of participants rated combustion products above nicotine. We delineated six relative concern segments, most of which had distinctive patterns of beliefs and actions. However, higher levels of concern about combustion products were only weakly positively associated with harm reducing beliefs and actions.Discussion and Conclusions: Most smokers do not appear to understand the risks of smoking and their causes well enough to be able to think systematically about the courses of action open to them to reduce their health risk. To facilitate informed decision-making, tobacco control communicators may need to better balance the dual aims of creating fear/negative affect about smoking and imparting knowledge about the health harms and their mechanisms. [ABSTRACT FROM AUTHOR]

Background and Aims: The regulatory environment for nicotine vaping products (NVPs) varies widely across countries and this will probably affect the devices used, nicotine content and usage, and hence the ability of NVPs to substitute for cigarettes. We aimed to describe the types of NVPs used by current vapers in four countries with varying regulatory and enforcement approaches toward the marketing and sale of NVPs. Methods: Data are from wave 1 (July–November 2016) of the ITC Four Country Smoking and Vaping Survey (4CV1), conducted among a cohort of current and former smokers, and current NVP users (n = 5147 adults; ≥ 18 years) in Australia (AU), Canada (CA), England (EN) and the United States (US) reporting either current daily, weekly or occasional NVP use. Devices were described by type, brand, voltage variability and refill capacity. Refill solutions were described by flavour and nicotine content. Descriptive statistics and bivariate analyses were conducted on the overall sample and stratified by country. A multinomial logistic regression examined factors associated with device preference across the whole sample. Results: The types of NVPs used differed by pattern of use and country. Exclusive, daily vapers were more likely to use refillable pen‐shaped devices [odds ratio (OR) = 10.0] or refillable box‐shaped devices (OR = 5.4) than disposable cigalike devices, when compared with other (non‐daily/dual) users. Nearly all respondents reported using flavoured NVPs, fruit (28.3%) being the most common flavour. Refillable devices were the most popular: refillable box‐shaped devices were more commonly reported by vapers in AU (36.8%) and US (31.4%), whereas in EN (47.4%) and CA (29.7%), vapers more often reported using refillable pen‐style devices. Most users also reported that their products contained nicotine, even in CA (87.8%) and AU (91.2%), where vaping products containing nicotine were technically illegal. Conclusions: In Australia, Canada, England and the United States in 2016, refillable nicotine vaping products were the most common type of nicotine vaping products used by daily vapers. Most daily vapers reported using flavoured e‐liquids/refills (with variance across countries) and most reported using products that contain nicotine, even where vaping products with nicotine were banned. [ABSTRACT FROM AUTHOR]

Background and Aims: The presence and content of health warning labels (HWLs) on nicotine vaping products (NVPs), such as electronic cigarettes, varies by country and manufacturer. We compared proportions of people who report (i) noticing HWLs on NVPs and (ii) feeling concerned having noticed HWLs, by country and by smoking or vaping status. We also examined recall of HWL content and whether this varies by country. Design Cross‐sectional survey. Setting: Australia (AU), Canada (CA), England (EN) and the United States (US). At the time of data collection, HWLs on NVPs were only mandatory in EN. Participants: A total of 11 561 respondents from the following samples in the 2016 International Tobacco Control Four Country Project: (1) re‐contacted smokers and quitters who had participated in the previous wave of the project; (2) newly recruited current smokers and recent quitters; and (3) newly recruited current vapers from CA, EN and US. Measurements Outcomes included: (1) having noticed HWLs on NVPs, (2) feeling concerned having noticed HWLs, and (3) recall of HWL message content. Findings Compared with respondents in EN, respondents in CA were more likely to report having noticed HWLs [odds ratio (OR) = 1.58, P = 0.02], whereas respondents in AU (OR = 0.76, P = 1.00) and the US (OR = 1.54, P = 0.09) were not significantly more or less likely to report having noticed HWLs. Compared with concurrent smokers and vapers, daily smokers, non‐daily smokers and quitters were less likely to report having noticed HWLs (ORs = 0.21, 0.33 and 0.19, respectively, all P < 0.001). There were no significant differences in reports of noticing HWLs when comparing concurrent smokers and vapers with daily (OR = 1.62, P = 0.91) or non‐daily (OR = 1.15, P = 1.00) vapers. There were no significant differences by country in reporting that HWLs made them concerned about using NVPs. Daily vapers were less likely to report feeling concerned than concurrent users (OR = 0.11, P = 0.017). Among those who reported reading HWLs (n = 688), there was little evidence of differences in recall of the HWL content. Conclusions: Respondents in England, where health warning labels on nicotine vaping products are mandatory, were not significantly more likely to report having noticed such warnings than those in Australia, Canada and the United States where warnings are not mandatory. [ABSTRACT FROM AUTHOR]

Background and Aims: Debate exists about whether health professionals (HPs) should advise smokers to use nicotine vaping products (NVPs) to quit smoking. The objectives were to examine in four countries: (1) the prevalence of HP discussions and recommendations to use an NVP; (2) who initiated NVP discussions; (3) the type of HP advice received about NVPs; and (4) smoker's characteristics related to receiving advice about NVPs. Design Cross‐sectional study using multivariable logistic regression analyses on weighted data from the 2016 ITC Four Country Smoking and Vaping Survey (ITC 4CV1). Setting: Four countries with varying regulations governing the sale and marketing of NVPs: 'most restrictive' (Australia), 'restrictive' (Canada) or 'less restrictive' (England and United States). Participants: A total of 6615 adult smokers who reported having visited an HP in the last year (drawn from the total sample of 12 294 4CV1 respondents, of whom 9398 reported smoking cigarettes daily or weekly). Respondents were from the United States (n = 1518), England (n = 2116), Australia (n = 1046), and Canada (n = 1935). Measurements Participants' survey responses indicated if they were current daily or weekly smokers and had visited an HP in the past year. Among those participants, further questions asked participants to report (1) whether NVPs were discussed, (2) who raised the topic, (3) advice received on use of NVPs and (4) advice received on quitting smoking. Findings Among the 6615 smokers who visited an HP in the last year, 6.8% reported discussing NVPs with an HP and 2.1% of smokers were encouraged to use an NVP (36.1% of those who had a discussion). Compared with Australia (4.3%), discussing NVPs with an HP was more likely in the United States [8.8%, odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.41–3.29] and Canada (7.8%, OR = 1.87, 95% CI = 1.26–2.78). Smokers in Australia were less likely to discuss NVPs than smokers in England (6.2%), although this was not statistically significant (OR = 1.47, 95% CI = 0.98–2.20). Overall, the prevalence of HPs recommending NVPs was three times more likely in the United States than in Australia (OR = 3.07, 95% CI = 1.45–6.47), and twice as likely in Canada (OR = 2.28, 95% CI = 1.06–4.87) than in Australia. Australia and England did not differ (OR = 1.76, 95% CI = 0.83–3.74). Just over half (54%) of respondents brought up NVPs themselves; there were no significant differences among countries. Conclusions: Discussions in Australia, Canada, England, and the United States between smokers and health professionals about nicotine vaping products appear to be infrequent, regardless of the regulatory environment. A low percentage of health professionals recommended vaping products. This was particularly evident in Australia, which has the most restrictive regulatory environment of the four countries studied. [ABSTRACT FROM AUTHOR]

BACKGROUND: We explored priority areas of food safety education needed by high‐school students within Ontario, Canada. METHODS: We analyzed transcripts from semistructured interviews with 20 experts in food safety, food safety education in youth, and high‐school education in Ontario. Inductive thematic analysis was used to identify priority food safety education needs. RESULTS: We identified 4 priority action areas for food safety education targeting students: how to safely do the things they typically do with food; how to keep themselves and their kitchens clean and safe; how microorganisms grow and how they can result in foodborne disease; and how to keep food out of the "danger zone" 4°C to 60°C (40° F to 140° F). The results indicate that students need specific education around the use of microwaves, consumption of convenience meals, preparing and handling foods at school events, and safe transportation of food for lunches, school trips, and sporting events. CONCLUSIONS: High‐school students need food safety education specific to their usual interactions with food, including the foods, tools, and settings students regularly encounter. Delivery of food safety education should emphasize sequences of safe food‐handling behaviors for specific food interactions, such as reheating a meal in the microwave, rather than traditional food safety concepts, such as temperature abuse. [ABSTRACT FROM AUTHOR]

Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Design, Setting, Participants and Measurements: A cross‐sectional analysis of adult (≥ 18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013–17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non‐daily). Findings NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries (ever‐use = 7.1–48.9%; current use = 0.3–3.5%) relative to LRP countries (ever‐use = 38.9–66.6%; current use = 5.5–17.2%) and RP countries (ever‐use = 10.0–62.4%; current use = 1.4–15.5%). NVP use was highest among high‐income countries, followed by upper–middle‐income countries, and then by lower–middle‐income countries. Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Cannabis use is the most widely used illicit substance in the USA. Currently, over half of US jurisdictions have legalised medical cannabis and nine US jurisdictions (and Washington DC) have legalised non-medical cannabis. Comparisons across jurisdictions can help to evaluate the impact of these policies. The current study examined patterns of cannabis use among youth in three categories: (i) states that have legalised non-medical cannabis with established markets; (ii) jurisdictions that recently legalised non-medical cannabis without established markets; and (iii) all other jurisdictions where non-medical cannabis is prohibited.Design and Methods: Data come from an online survey conducted among 4097 US youth aged 16-19 recruited through a commercial panel in July/August 2017. Regression models were fitted to examine differences between regulatory categories for cannabis consumption, perceived access to cannabis, modes of use, perceptions of harm and cannabis-impaired driving. All estimates represent weighted data.Results: States that had legalised non-medical cannabis had higher prevalence, easier access and lower driving rates than non-legal states. There were few differences between states with established non-medical cannabis markets and those that had recently legalised.Discussion and Conclusions: Cannabis use among youth was higher in states that have legalised non-medical cannabis, regardless of how long the policy had been implemented or whether markets had been established. This suggests that differences between states with and without legal non-medical cannabis may partly be due to longer-term patterns established prior and highlights the importance of longitudinal evidence to evaluate the impact of cannabis policies. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to test the industry claim that "high in" front-of-package (FOP) labeling systems are perceived as harsh and reduce consumers' control over food choices.Methods: Respondents aged 16 to 32 years completed a between-group experimental task in an online survey (n = 1,000). Participants viewed a beverage with one of four FOP labels (text-only, octagon, triangle, or health star rating) and rated the label on its "harshness" and whether it made them feel more or less "in control" of their healthy eating decisions.Results: Across all label conditions, at least 88% of respondents indicated the symbols were "about right" or "not harsh enough." At least 93% felt the symbols made them feel "more in control" or "neither less nor more in control." Participants viewing the health star rating were more likely to rate the symbol as "not harsh enough" and less likely to state that the symbol made them feel "more in control."Conclusions: There was no evidence to support industry claims that consumers perceive "high in" FOP symbols as harsh or as restricting their control. Indeed, most participants reported that the symbols were about the right harshness, and that they increased their control, including "stop sign" FOP symbols similar to those implemented in Chile. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the prevalence of various weight-loss behaviors among young adults in Canada and differences in the use of these methods by demographic characteristics, health literacy, and perceived body size.Methods: Data from the 2016 wave of the Canada Food Study were used, which collected self-reported information from 3,000 young adults in five cities. Linear regression models were conducted to investigate correlates of the number and type of weight-loss methods used across the following four categories: dietary changes, physical activity, assisted weight-loss methods, and unhealthy behaviors.Results: In the past 12 months, more than half of respondents reported a weight-loss attempt, and nearly one-fifth engaged in an unhealthy weight-loss method. The risk of engaging in a greater number of weight-loss behaviors across categories was higher for women, nonbinary-gendered individuals, and individuals who perceived themselves as having overweight or obesity. Respondents with lower health literacy engaged in a significantly greater number of unhealthy methods.Conclusions: Many young adults use healthier weight-loss strategies, but a concerning number use multiple and/or unhealthy weight-loss methods as well. Furthermore, there are subgroup differences in weight-loss method engagement, which holds significance for public health efforts aiming to improve weight-related behaviors. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Very little is known about the social experience of medical cannabis use, including the experience of stigma among approved users. The current study examined perceptions of support from physicians, family and friends as well as the prevalence of 'hiding' medicinal cannabis use.Design and Methods: An online cross-sectional survey (N = 276) was conducted from 29 April to 8 June 2015. No public sampling frame was available from which to sample approved medical cannabis users (MCU). Eligible respondents were approved MCUs, aged 18 years or older, and reported cannabis use in the past 30 days for health reasons. Logistic regression analyses were used to assess aspects of stigma, including perceived support from their immediate social environment as well as behaviours reflecting a perceived social disapproval.Results: Approximately one-third of respondents (32.6%) reported that their physician had refused to provide a medical document, and the vast majority of respondents (79.3%) reported hiding their medical cannabis use, most commonly to avoid judgement. Fewer than half of approved users perceived that their doctor was 'supportive' (38%), whereas two-thirds perceived support from family (66.3%) and friends (66.3%). Perceptions of support were similar across most socio-demographic sub-groups.Discussion and Conclusions: Substantial proportions of approved MCUs in Canada report a lack of support and most have made some effort to conceal their medical cannabis use. Overall, the findings suggest that social norms around medical cannabis use remain unfavourable for many users, despite that fact that medical cannabis has been legal in Canada for more than a decade. [ABSTRACT FROM AUTHOR]

Context Providing a nutrition rating system on the front of food packages or on retail shelf tags has been proposed as a policy strategy for supporting healthier food choices. Guiding Stars is an on-shelf nutrition labelling system that scores foods in a supermarket based on nutritional quality; scores are then translated into ratings of 0 to 3 stars. It is consistent with evidence-informed recommendations for well-designed labels, except for not labelling 0-star products. The largest supermarket retailer in Canada rolled out the Guiding Stars system in supermarkets across Ontario, Canada. The aim of our study was to examine the extent to which consumers respond to an on-shelf nutrition labelling system in supermarkets to inform current and future nutrition labelling policies and practices. Methods Capitalizing on a natural experiment, we conducted a quasi-experimental study across 3 supermarket banners (or 'chains') in Ontario, one of which implemented the Guiding Stars system in 2012. We used aggregated supermarket transaction data to test the effect of Guiding Stars on the nutritional quality of food purchases in intervention supermarkets relative to control supermarkets. We also conducted exit surveys among 783 randomly selected shoppers from intervention and control supermarkets to assess consumer awareness, understanding, trust, and self-reported use of the labelling system. Findings Relative to control supermarkets, shoppers in intervention supermarkets made small but significant shifts toward purchasing foods with higher nutritional ratings; however, shifts varied in direction and magnitude across food categories. These shifts translated into foods being purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. We also found increases in the number of products per transaction, price per product purchased, and total revenues. Results of the exit surveys indicate a modest proportion of consumers were aware of, understood, and trusted Guiding Stars in intervention supermarkets, and a small proportion of consumers reported using this system when making purchasing decisions. However, 47% of shoppers exposed to Guiding Stars were confused when asked to interpret the meaning of a 0-star product that does not display a rating on the shelf tag. Conclusions This study demonstrates support for policies promoting on-shelf nutrition labels designed according to evidence-informed principles, but policymakers should move forward with caution when investing in such systems until research has confirmed optimal label design, clarified the mechanisms through which dietary intake is improved, and assessed associations with nutrition-related health outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Frequent fruit and vegetable ( FV) consumption is protective against some cancers, cardiovascular disease, and other chronic diseases. This study explores self-reported frequency of FV consumption in a nationally generalizable sample of Canadian youth in grades 6-12. METHODS Data from grades 6-12 students who participated in the 2012-2013 Youth Smoking Survey (N = 47,203) were used to examine frequency of FV consumption. Logistic regression models were fitted to examine differences in meeting national FV intake recommendations by sociodemographic, student, and regional characteristics. RESULTS Approximately 10% of Canadian grade 6-12 students met FV recommendations. Students in grades 6 and 7 had significantly higher odds of meeting recommendations relative to students in grades 8-12. Students who reported achieving 'mostly As' on their report cards had significantly higher odds of meeting FV recommendations relative to those receiving As and Bs, Bs and Cs, or Cs ( OR = 0.71, OR = 0.53, and OR = 0.46, respectively, p < .0001 for each). Students in British Columbia and Ontario had higher odds of meeting recommendations relative to students in Newfoundland, Prince Edward Island, and Nova Scotia. CONCLUSIONS Only 1 in 10 Canadian youth are meeting FV recommendations. Programs and policies to encourage FV consumption are required to help mitigate future health issues associated with inadequate FV consumption. [ABSTRACT FROM AUTHOR]

Objective: To examine knowledge of sugar recommendations and test the efficacy of formats for labeling total and added sugar on pre-packaged foods.Methods: Online surveys were conducted among 2008 Canadians aged 16-24. Participants were asked to identify recommended limits for total and added sugar consumption. In Experiment 1, participants were randomized to one of six labeling conditions with varying information for total sugar for a high- or low-sugar product and were asked to identify the relative amount of total sugar in the product. In Experiment 2, participants were randomized to one of three labels with different added sugar formats and were asked if the product contained added sugar and the relative amount of added sugar.Results: Few young people correctly identified recommendations for total sugar (5%) or added sugar (7%). In Experiment 1, those who were shown percent daily value information were more likely to correctly identify the relative amount of total sugar (P < 0.05). In Experiment 2, those shown added sugar information were more likely to correctly identify that the product contained added sugar and the relative amount of added sugar in the product (P < 0.05).Conclusions: Improved labeling may improve consumer understanding of the amount of sugars in food products. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Sugar-sweetened beverages ( SSBs) may play a role in increased rates of obesity. This study examined patterns and frequencies of beverage consumption among youth in 3 distinct regions in Canada, and examined associations between beverage consumption and age, sex, body mass index ( BMI), physical activity and dieting behavior, as well as beverage displacement. METHODS The study included data from 10,188 youth (ages 13-18) from Hamilton and Thunder Bay, Ontario, and Prince Edward Island ( PEI) in 2009 to 2010. The study used in-school self-reported surveys with 12 questions regarding beverage consumption during the previous day, along with self-reported height, weight, physical activity levels, and demographic information. Logistic regression analyses were conducted to examine variables associated with SSB intake. RESULTS Overall, 80% of youth consumed at least 1 SSB in the previous day, with 44% consuming 3 or more SSBs. Youth in Thunder Bay consumed significantly more SSBs than Hamilton and PEI, and youth in Hamilton consumed more SSBs than PEI. Boys consumed significantly more SSBs than girls. Older and more physically active youth consumed significantly fewer SSBs. No significant association between BMI and SSB consumption was observed in any model. A modest positive correlation was identified between SSB consumption and milk (r = .06, p < .001) and 100% fruit juice (r = .10, p < .001). CONCLUSIONS A large proportion of youth consumed SSBs, many at high levels. Research evaluating SSB policy and interventions should be considered a priority. [ABSTRACT FROM AUTHOR]

Aims To use tobacco industry documents on cigarette pack shape, size and openings to identify industry findings on associations with brand imagery, product attributes, consumer perceptions and behaviour. Methods Internal tobacco industry research and marketing documents obtained through court disclosure contained in the Legacy Tobacco Documents Library were searched using keywords related to pack shapes, sizes and opening methods. The search identified 66 documents related to consumer research and marketing plans on pack shape, size and openings, drawn from 1973 to 2002. Results Industry research consistently found that packs that deviated from the traditional flip-top box projected impressions of 'modern', 'elegant' and 'unique' brand imagery. Alternative pack shape and openings were identified as an effective means to communicate product attributes, particularly with regard to premium quality and smooth taste. Consumer studies consistently found that pack shape, size and opening style influenced perceptions of reduced product harm, and were often used to communicate a 'lighter' product. Slim, rounded, oval and booklet packs were found to be particularly appealing among young adults, and several studies demonstrated increased purchase interest for tobacco products presented in novel packaging shape or opening. Evidence from consumer tracking reports and company presentations indicate that pack innovations in shape or opening method increased market share of brands. Conclusions Consumer research by the tobacco industry between 1973 and 2002 found that variations in packaging shape, size and opening method could influence brand appeal and risk perceptions and increase cigarette sales. [ABSTRACT FROM AUTHOR]

Purpose Young eyes compensate for the defocus imposed by spectacle lenses by changing their rate of elongation and their choroidal thickness, bringing their refractive status back to the pre-lens condition. We asked whether the initial rate of change either in the ocular components or in refraction is a function of the power of the lenses worn, a result that would be consistent with the existence of a proportional controller mechanism. Methods Two separate studies were conducted; both tracked changes in refractive errors and ocular dimensions. Study A: To study the effects of lens power and sign, young chicks were tracked for 4 days after they were fitted with positive (+5, +10 or +15 D) or negative (−5, −10, −15 D) lenses over one eye. In another experiment, biometric changes to plano, +1, +2 and +3 D lenses were tracked over a 24 h treatment period. Study B: Normal emmetropisation was tracked from hatching to 6 days of age and then a defocusing lens, either +6 D or −7 D, was fitted over one eye and additional biometric data collected after 48 h. Results In study A, animals treated with positive lenses (+5, +10 or +15 D) showed statistical similar initial choroid responses, with a mean thickening 24 μm h−1 over the first 5 h. Likewise, with the low power positive lenses, a statistically similar magnitude of choroidal thickening was observed across groups (+1 D: 46.0 ± 7.8 μm h−1; +2 D: 53.5 ± 9.9 μm h−1; +3 D 53.3 ± 24.1 μm h−1) in the first hour of lens wear compared to that of a plano control group. These similar rates of change in choroidal thickness indicate that the signalling response is binary in nature and not influenced by the magnitude of the myopic defocus. Treatments with −5, −10 and −15 D lenses induced statistically similar amounts of choroidal thinning, averaging −70 ± 15 μm after 5 h and −96 ± 45 μm after 24 h. Similar rates in inner axial length changes were also seen with these lens treatments until compensation was reached, once again indicating that the signalling response is not influenced by the magnitude of hyperopic defocus. In study B, after 48 h of +6 D lens treatment, the average refractive error and choroidal changes were found to be larger in magnitude than expected if perfect compensation had taken place, with a + 2.4 D overshoot in refractive compensation. Conclusion Taken together, our results with both weak and higher power positive lenses suggest that eye growth is guided more by the sign than by the magnitude of the defocus, and our results for higher power negative lenses support a similar conclusion. These behaviour patterns and the overshoot seen in Study B are more consistent with the behaviour of a bang-bang controller than a proportional controller. [ABSTRACT FROM AUTHOR]

Aim To evaluate the population effectiveness of stop-smoking medications while accounting for potential recall bias by controlling for quit attempt recency. Design Prospective cohort survey. Setting United Kingdom, Canada, Australia and the United States. Participants A total of 7436 adult smokers (18+ years) selected via random digit dialling and interviewed as part of the International Tobacco Control Four Country Survey ( ITC-4) between 2002 and 2009. Primary analyses utilized the subset of respondents who participated in 2006 or later ( n = 2550). Measurements Continuous abstinence from smoking for 1 month/6 months. Findings Among participants who recalled making a quit attempt within 1 month of interview, those who reported using varenicline, bupropion or nicotine patch were more likely to maintain 6-month continuous abstinence from smoking compared to those who attempted to quit without medication [adjusted odds ratio ( OR) 5.84, 95% confidence interval ( CI) (2.12-16.12), 3.94 (0.87-17.80), 4.09 (1.72-9.74), respectively]; there were no clear effects for oral NRT use. Those who did not use any medication when attempting to quit tended to be younger, to be racial/ethnic minorities, to have lower incomes and to believe that medications do not make quitting easier. Conclusions Consistent with evidence from randomized controlled trials, smokers in the United Kingdom, Canada, Australia and the United States are more likely to succeed in quit attempts if they use varenicline, bupropion or nicotine patch. Previous population studies that failed to find an effect failed to control adequately for important sources of bias. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To assess the effects on brand appeal of plain packaging and size of pictorial health warnings (PHWs). Design Three (30%, 70% and 100% size front-of-pack PHWs) by two (branded versus plain) between-subjects online experiment. Setting Australia. Participants A total of 1203 adult smokers. Measurements Rating of cigarette brands, smoking attitudes and intentions, purchase intent. Findings Compared to branded packs, plain packs reduced smokers' ratings of 'positive pack characteristics' ( P < 0.001), 'positive smoker characteristics' ( P < 0.001) and 'positive taste characteristics' ( P = 0.039). Plain packs were rated as being smoked by people who were more 'boring' than those who smoked branded packs ( P = 0.001). By contrast, increasing size of PHW above 30% only reduced ratings of 'positive pack characteristics' ( P = 0.001), but also decreased ratings of smokers as being 'boring' ( P = 0.027). Plainness and size of PHW interacted in predicting ratings of 'positive pack characteristics' ( P = 0.008), so that when packs were plain, increasing the size of PHW above 30% did not further reduce ratings. Presentation of only plain packs increased the likelihood that smokers would not choose to purchase any pack (20.3%) compared to presentation of only branded packs (15.3%) (odds ratio = 1.4; P = 0.026), while size of PHWs had no influence upon purchase choice. Conclusions Plain packaging probably plays a superior role in undermining brand appeal and purchase intent to increasing health warning size. Policymakers should not rely solely upon large health warnings, which are designed primarily to inform consumers about smoking harms, to also reduce brand appeal: both strategies are likely to be required. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support. Design Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary). Settings Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States. Participants Samples of smokers from 15 countries. Measurements Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits. Findings Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (<20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available. Conclusions There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim This paper examines how smokers' beliefs about 'light/mild' cigarettes in Australia, Canada and the United Kingdom were affected by the removal of misleading 'light/mild' terms from packs. Design, setting and participants The data come from the first seven waves (2002-09) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, the United States, the United Kingdom and Australia (21 613 individual cases). 'Light' and 'mild' descriptors were removed in 2003 in the United Kingdom, in 2006 in Australia and in 2007 in Canada. We compare beliefs about 'light' cigarettes both before and after the bans, with those of smokers in the United States serving as the control condition. Measures Smokers' beliefs about 'light' cigarettes were assessed using a set of statements rated on a five-point 'agree'-'disagree' scale. Findings The proportions of respondents reporting misperceptions about light cigarettes declined between 2002 and 2009 in all four countries. There were marked temporary reductions in reported misperceptions in the United Kingdom and Australia, but not in Canada, following the removal of 'light/mild' descriptors. Conclusions Removal of 'light/mild' descriptors and tar, nicotine and carbon monoxide yield information from cigarette packs is insufficient to effectively eliminate false beliefs. The combination of alternative descriptors and design features that produce differences in taste strength and harshness, independent of actual intakes, are sufficient to produce or sustain the same misbeliefs. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To examine the use and role of planned quit attempts by smokers and their impact on abstinence. Design Retrospective, using longitudinal data from the Ontario Tobacco Survey. Setting Ontario, Canada. Participants A total of 551 adult smokers who reported having made a quit attempt during 2007-08. Measurements Reported planning of the most recent quit attempt (i.e. unplanned or planned some time in advance), engaging in preparatory behaviours believed to be related to planning (i.e. use of quit aids such as pharmacotherapy, formal support or health professionals) and abstinence at 1 week and 1 month following the attempt. Findings Of the smokers, 73.6% planned their quit attempt in advance. Reported planning was more likely among those who thought they were very addicted, compared with those who were less addicted [odds ratio (OR) = 2.22, 95% confidence interval (CI): 1.15-4.28]. Smokers who planned a quit attempt were much more likely to use a quit aid (OR = 3.50, 95% CI: 1.80-6.79), particularly pharmacotherapy (OR = 6.13, 95% CI: 3.05-12.34). The odds of abstaining for 1 week were lower among those who planned (OR = 0.45, 95% CI: 0.22-0.89), independent of perceived addiction. No significant difference was observed for abstinence lasting 1 month. Other factors associated with abstinence were smoking fewer cigarettes per day and having personal support. Conclusions Although most quit attempts were planned and planners had higher odds of using quit aids, planning did not increase the likelihood of success. [ABSTRACT FROM AUTHOR]

To examine perceptions of risk related to type of cigarette brand. Cross-sectional findings from wave 5 of the ITC Four Country Survey, conducted with nationally representative samples of smokers in 2006. A total of 8243 current and former adult (≥18 years) smokers from Canada ( n = 2022), the United States ( n = 2034), the United Kingdom ( n = 2019) and Australia ( n = 2168). Outcomes included beliefs about the relative risks of cigarettes, including perceptions of 'own' brand. Correlates included socio-demographic, smoking-related covariates and brand characteristics. One-fifth of smokers believed incorrectly that 'some cigarette brands could be less harmful' than others. False beliefs were higher in both the United States and United Kingdom compared to Canada and Australia. Smokers of 'light/mild', 'slim' and 100 mm/120 mm cigarettes were more likely to believe that some cigarettes could be less harmful [odds ratio (OR) = 1.29, 95% confidence interval (CI) = 1.12-1.48 and that their own brand might be a little less harmful (OR = 2.61, 95% CI = 2.01-3.41). Smokers of 'gold', 'silver', 'blue' or 'purple' brands were more likely to believe that their 'own brand might be a little less harmful' compared to smokers of 'red' or 'black' brands (OR = 12.48, 95% CI = 1.45-107.31). Despite current prohibitions on the words 'light' and 'mild', smokers in western countries continue to falsely believe that some cigarette brands may be less harmful than others. These beliefs are associated with descriptive words and elements of package design that have yet to be prohibited, including the names of colours and long, slim cigarettes. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Formerly GISTs were commonly classified histologically as leiomyosarcomas; however, they are now known to arise from the interstitial cells of Cajal. Majority of GISTs overexpress KIT and have characteristic mutations within the gene, which are the targets of drug treatment with tyrosine kinase inhibitors. Leiomyosarcoma is a malignant tumour of smooth muscle differentiation and falls into a group of sarcomas that show complex karyotypic changes with no consistent recurrent genetic abnormality. We have used comparative genomic hybridization in combination with fluorescence in situ hybridization to determine genetic differences between the tumour types. We found leiomyosarcomas and GISTs share common regions of chromosomal 13q and 11q imbalance, in addition to more specific 1p and 8p losses in leiomyosarcoma and 15q and 22q losses in GISTs. More importantly, we have shown for the first time a deletion in the ataxia telangiectasia mutated (ATM) gene locus with decreased/absent expression of ATM protein, and amplification in the region 13q21–q32 in both tumour types, suggesting both regions may play a role in leiomyosarcoma and GIST biology. [ABSTRACT FROM AUTHOR]

Objective To examine the association of financial stress with interest in quitting smoking, making a quit attempt and quit success. Design and participants The analysis used data from 4984 smokers who participated in waves 4 and 5 (2005–07) of the International Tobacco Control (ITC) Four Country Survey, a prospective study of a cohort of smokers in the United States, Canada, the United Kingdom and Australia. Measurement The outcomes were interest in quitting at wave 4, making a quit attempt and quit success at wave 5. The main predictor was financial stress at wave 4: ‘. . . because of a shortage of money, were you unable to pay any important bills on time, such as electricity, telephone or rent bills?’. Additional socio-demographic and smoking-related covariates were also examined. Findings Smokers with financial stress were more likely than others to have an interest in quitting at baseline [odds ratio (OR): 1.63; 95% confidence interval (CI): 1.22–2.19], but were less likely to have made a quit attempt at follow-up (OR: 0.74; 95% CI: 0.57–0.96). Among those who made a quit attempt, financial stress was associated with a lower probability of abstinence at follow-up (OR: 0.53; 95% CI: 0.33–0.87). Conclusions Cessation treatment efforts should consider assessing routinely the financial stress of their clients and providing additional counseling and resources for smokers who experience financial stress. Social policies that provide a safety net for people who might otherwise face severe financial problems, such as not being able to pay for rent or food, may have a favorable impact on cessation rates. [ABSTRACT FROM AUTHOR]

Aim To evaluate the impact of a new licence for some nicotine replacement therapy products (NRT) for cutting down to stop (CDTS) on changes in the pattern of NRT use. Design Quasi-experimental design comparing changes in NRT use across two waves of a population-based, replenished-panel, telephone survey conducted before and after the introduction of new licensing laws in the United Kingdom with changes in NRT use in three comparison countries (Australia, Canada and United States) without a licensing change. Participants A total of 7386 and 7013 smokers and recent ex-smokers participating in the 2004 and/or 2006/7 survey. Measurements Data were collected on demographic and smoking characteristics as well as NRT use and access. In order to account for interdependence resulting from some participants being present in both waves, generalized estimation equations with an exchangeable correlation matrix were used to assess within-country changes and linear and logistic regressions to assess between-country differences in adjusted analyses. Findings NRT use was more prevalent in the United Kingdom and increased across waves in all countries but no wave × country interaction was observed. There was no evidence that the licensing change increased the prevalence of CDTS or the use of NRT (irrespective of how it was accessed) for CDTS in the United Kingdom relative to comparison countries. There was also no evidence for a change in concurrent smoking and NRT use among smokers not attempting to stop in the United Kingdom relative to comparison countries. Conclusion The addition of the CDTS licence for some NRT products in the United Kingdom appears to have had very limited, if any, impact on NRT use in the first year after the licence change. [ABSTRACT FROM AUTHOR]

Objectives To examine prospectively the impact of health warnings on quitting activity. Design Five waves (2002–06) of a cohort survey where reactions to health warnings at one survey wave are used to predict cessation activity at the next wave, controlling for country (proxy for warning differences) and other factors. These analyses were replicated on four wave-to-wave transitions. Setting and participants Smokers from Australia, Canada, the United Kingdom and the United States. Samples were waves 1–2: n = 6525; waves 2–3: n = 5257; waves 3–4: n = 4439; and waves 4–5: n = 3993. Measures Warning salience, cognitive responses (thoughts of harm and of quitting), forgoing of cigarettes and avoidance of warnings were examined as predictors of quit attempts, and of quitting success among those who tried (1 month sustained abstinence), replicated across four wave-to-wave transitions. Results All four responses to warnings were independently predictive of quitting activity in bivariate analyses. In multivariate analyses, both forgoing cigarettes and cognitive responses to the warnings predicted prospectively making quit attempts in all replications. However, avoiding warnings did not add predictive value consistently, and there was no consistent pattern for warning salience. There were no interactions by country. Some, but not all, the effects were mediated by quitting intentions. There were no consistent effects on quit success. Conclusions This study adds to the evidence that forgoing cigarettes as a result of noticing warnings and quit-related cognitive reactions to warnings are consistent prospective predictors of making quit attempts. This work strengthens the evidence base for governments to go beyond the Framework Convention on Tobacco Control to mandate health warnings on tobacco products that stimulate the highest possible levels of these reactions. [ABSTRACT FROM AUTHOR]

Aims To measure the prevalence and correlates of nicotine replacement therapy (NRT) use for reasons other than quitting smoking among smokers in four countries. Design and setting Population-based, cross-sectional telephone survey with nationally representative samples of adult smokers in Canada, the United States, the United Kingdom and Australia, conducted in 2005. Participants A total of 6532 adult daily smokers in Canada ( n = 1660), the United States ( n = 1664), the United Kingdom ( n = 1617) and Australia ( n = 1591). Measurements Survey questions included demographics, smoking behaviour, use of NRT and reasons for NRT use, as well as access and availability of NRT. Findings Approximately 17% of smokers surveyed had used NRT in the past year. Among NRT users, approximately one-third used NRT for a reason other than quitting smoking, including temporary abstinence or reducing the number of cigarettes smoked. The prevalence of non-standard NRT use was remarkably consistent across countries. Using NRT for reasons other than quitting was associated with higher education level, heavier smoking, having no quit intentions, having no past-year quit attempts, the type of NRT product used and accessing NRT without a prescription. Conclusions The use of NRT for purposes other than quitting smoking is fairly common and may help to explain the difficulty in detecting significant quitting benefits associated with NRT use in population studies. Tobacco control policies, including the accessibility of NRT, may have important implications for patterns of NRT use. [ABSTRACT FROM AUTHOR]

Ventilated cigarettes were designed to reduce the levels of smoke under machine testing conditions; however, smokers alter their smoking pattern to compensate for the reduction in yields. A relative shift in incidence of lung cancer from the more central lung airways to the alveolar region has also been associated with ventilated cigarette use. Validated mathematical models indicate that particle deposition patterns in the lung depend on particle size and inhalation behavior, including inhalation volume, flow rate, and breath-hold time. This article finds that most mathematical models underpredict total cigarette smoke particulate (CSP) deposition in the lung, likely because they do not account for coagulation, hygroscopicity, and cloud dynamics, which may increase the effective particle diameter of CSP reaching the lung tissue. The models that include these processes indicate that puff volume would be unlikely to affect particle deposition in the lung, but puff time, inhalation depth, breath-hold time, and exhalation time may affect total deposition. Most compensation appears to occur through a combination of increased puff volume and puff flow, with possible increases in inhalation depth and breath-hold time. The complex interaction between the extent of cigarette ventilation, which can affect puffing/inhalation behavior, CSP concentration, and CSP size with CSP dose to the alveolar versus more central lung airways is described. Deposition efficiency in the alveoli could plausibly be increased through compensation, but it is still unclear whether compensation could sufficiently alter patterns of CSP deposition in the lung to elicit a shift in lung cancer sites. [ABSTRACT FROM AUTHOR]

A soil charcoal survey was undertaken across 60,000 ha of closed-canopy tropical forest in central Guyana to determine the occurrence, ubiquity, and age of past forest fires across a range of terra firme soil types. Samples were clustered around six centers consisting of spatially nested sample stations. Most charcoal was found between 40 and 60 cm depth with fewest samples yielding material at 0–20 cm depth. The first core yielded charcoal at most stations. Charcoal ages of a random subsample ranged from less than 200 YBP to 9500 YBP with a noticeable peak between 1000 and 1250 YBP. Results reinforce a view that most closed-canopy tropical forests in eastern Amazonia have been subject to palaeo-fire events of unknown severity with a peak in charcoal age consistently appearing between 1000 and 2000 YBP. The two samples dated to the early Holocene represent some of the oldest indicators of paleo-fire known from upland Neotropical forest soils. Ubiquitous soil charcoal in central Guyana further indicate both forest resilience to fire and the widespread propensity for regional forests to burn, particularly during anomalous periods of drought. [ABSTRACT FROM AUTHOR]

The increasing diversity of cannabis products represents a challenge for measuring and reporting potency. Freeman & Lorenzetti’s proposal for a standard tetrahydrocannabinol(THC) unit has considerable potential as a tool for reporting potency with respect to market surveillance and sales data, as well as in research studies. Although no standard unit can fully capture the qualitative differences across modes of administration, a 5-mg THC unit represents an appropriate threshold for communicating the potency of cannabis products. [ABSTRACT FROM AUTHOR]