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McCauley DM, Liu J, Gaiha SM, Halpern-Felsher B. Products and patterns through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Addict Behav 2024; 158:108105. [PMID: 39047653 PMCID: PMC11365758 DOI: 10.1016/j.addbeh.2024.108105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Co-use of tobacco and cannabis is common. However, few studies have examined the temporal sequencing through which individuals initiate co-use, and how these patterns vary across age. This study addresses this gap by examining the specific products and temporal sequencing through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Among adolescents, young adults, and adults who co-used tobacco and cannabis in the past 30 days, we examined (a) whether tobacco or cannabis was used first in their lifetime and (b) which specific tobacco or cannabis product (e.g., nicotine e-cigarettes, cannabis edibles) was the first used. METHODS Data were from a cross-sectional national survey (N = 6,131, 13-40 years old) in which participants reported ever use, past-30-day-use, and order of use for 17 different tobacco and cannabis products. Results were analyzed overall and by age group (13-20; 21-24; 25-40). RESULTS 38.4% of participants reported use of both tobacco and cannabis in the past 30 days. Among these participants, 70.9% used tobacco first in their lifetime (66.6% < 21; 71.7% 21-24; 76.6% > 24). Approximately 60% of participants who initiated co-use with tobacco reported nicotine e-cigarettes as their first tobacco product (63.3% < 21; 66.7% 21-24; 49.6% > 24). CONCLUSIONS The majority of participants who used both tobacco and cannabis used tobacco first in their lifetime, and nicotine e-cigarettes were the most common form of tobacco initiation, particularly among adolescents and young adults. Findings emphasize the need for co-use prevention programs to target common products of initiation.
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Affiliation(s)
- Devin M McCauley
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, USA
| | - Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, USA
| | - Shivani Mathur Gaiha
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, USA; Faculty of Pediatrics, Harvard Medical School, USA
| | - Bonnie Halpern-Felsher
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, USA.
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Zavala-Arciniega L, Cook S, Hirschtick JL, Xie Y, Mukerjee R, Arenberg D, Barnes GD, Levy DT, Meza R, Fleischer NL. Longitudinal associations between exclusive, dual and polytobacco use and respiratory illness among youth. BMC Public Health 2024; 24:2159. [PMID: 39118071 PMCID: PMC11312221 DOI: 10.1186/s12889-024-19582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The health consequences of polytobacco use are not well understood. We evaluated prospective associations between exclusive, dual, and polytobacco use and diagnosed bronchitis, pneumonia, or chronic cough among US youth. METHODS Data came from Waves 1-5 of the Population Assessment of Tobacco and Health Study. We categorized time-varying past 30-day tobacco use into seven categories: (1) non-current use; exclusive use of 2) cigarettes, 3) e-cigarettes, and 4) other combustible products (OC; pipes, hookah, and cigars); dual use of 5) e-cigarettes + cigarettes or e-cigarettes + OC, and 6) cigarettes + OC; and 7) polyuse of all three products. The outcome was parent-reported diagnosis of bronchitis, pneumonia, or chronic cough among youth. We conducted weighted multilevel Poisson models (person n = 17,517, 43,290 observations) to examine the longitudinal exposure-outcome relationship, adjusting for covariates: sex, age, race and ethnicity, parental education, body mass index, secondhand smoke exposure, and household use of combustible products. RESULTS Compared to nonuse, exclusive cigarette use (Risk Ratio (RR) = 1.83, 95% CI 1.25-2.68), exclusive e-cigarette use (RR = 1.53, 95% CI 1.08-2.15), combustible product + e-cigarette dual use (RR = 1.90, 95% CI 1.18-3.04), cigarettes + OC dual use (RR = 1.96, 95% CI 1.11-3.48), and polytobacco use (RR = 3.06 95% CI 1.67-5.63) were associated with a higher risk of bronchitis, pneumonia, or chronic cough. In additional analyses, we found that the risk ratio for polytobacco use was higher compared to exclusive e-cigarette use (RR 2.01 CI 95% 1.02-3.95), but not higher compared to exclusive cigarette use (RR 1.67 CI 95% 0.85-3.28). CONCLUSION We found that exclusive, dual, and poly tobacco use were all associated with higher risk of bronchitis, pneumonia, or chronic cough compared to non-current use.
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Affiliation(s)
- Luis Zavala-Arciniega
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Steven Cook
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Jana L Hirschtick
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Yanmei Xie
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Richa Mukerjee
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Douglas Arenberg
- Division of Pulmonary & Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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Lund L, Andersen S, Ritz C, Bast LS. Predicting longitudinal changes in patterns of tobacco and nicotine product use among adolescents: A Latent Transition Analysis based on the X:IT study. Soc Sci Med 2024; 352:117029. [PMID: 38843676 DOI: 10.1016/j.socscimed.2024.117029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Understanding factors influencing the transition from non-use to tobacco and nicotine product initiation among adolescents is crucial for designing and implementing effective preventive strategies. This study explores transition patterns among 13-15-year-old adolescents in lower secondary school, focusing on the transition from non-use to tobacco and nicotine product initiation and the influence of individual, social, risk behavioral, and mental health factors on this transition. METHODS Based on data from a Danish smoking prevention trial between 2017 and 2019, this study employed questionnaire surveys at three time points: baseline (start of seventh grade, n = 1,990, response rate = 86.3%), eight-month follow-up (end of seventh grade, n = 1,666, response rate = 74,8%), and 20-month follow-up (end of eighth grade, n = 1,149, response rate = 70,6%). Tobacco and nicotine use indicators included current and lifetime use of cigarettes and lifetime use of e-cigarettes, smokeless tobacco, and hookah. A latent transition analysis was applied to identify longitudinal transition patterns across waves and to explore predictors of these patterns. RESULTS Three user classes emerged across all waves: none-use, lifetime e-cigarette and cigarette use, and poly-tobacco use. While the most prevalent class was the non-user class (71%-86%), the proportion of the lifetime e-cigarette and cigarette class increased over time (from 12% to 17%). Similarly, the poly-tobacco user class increased from 2% to 12%. The probability of transitioning from non-use to lifetime e-cigarette and cigarette use increased from 0.5% at baseline to 12% by the second follow-up, while the probability of transitioning from lifetime e-cigarette and cigarette use remained stable over time (12%-15%). Across all waves, elevated risk behavior predicted this transition. For instance, binge-drinking (OR = 3.76, 95% CI: 1.51-9.34), susceptibility to smoking (OR = 7.63, 95% CI: 3.68-16.83), and truancy (OR = 7.00, 95% CI: 1.98-24.59) influenced the transition from non-use at baseline to lifetime e-cigarette and cigarette use at first follow-up. Additionally, boys, adolescents with low socioeconomic status, low life satisfaction, and those with smoking friends or parents were more likely to transition from non-use to lifetime e-cigarette and cigarette use. CONCLUSION This study demonstrates that sociodemographic, social risk, behavioral, and mental health factors impact the transition from non-use to lifetime e-cigarette and cigarette use. The findings provide valuable insights for developing targeted preventive strategies focusing on these influencing factors.
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Affiliation(s)
- Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestræde, 61455, Copenhagen, Denmark.
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Egbe CO, Khan A, Scheibe A, Ayo-Yusuf OA. E-cigarettes and harm reduction: a view from sub-Saharan Africa. Tob Control 2024; 33:419-421. [PMID: 38901968 DOI: 10.1136/tc-2024-058840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Catherine O Egbe
- Mental health, Alcohol, Substance use & Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Arshima Khan
- Mental health, Alcohol, Substance use & Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Scheibe
- Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Olalekan A Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Travis N, Warner KE, Goniewicz ML, Oh H, Ranganathan R, Meza R, Hartmann-Boyce J, Levy DT. The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review. Nicotine Tob Res 2024:ntae131. [PMID: 38880491 DOI: 10.1093/ntr/ntae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Oral nicotine pouches (ONPs) are a new class of nicotine products. This scoping review summarizes evidence on ONPs and explores their potential public health impact. AIMS AND METHODS We conducted a structured literature search for empirical studies across three electronic databases through January 10, 2024. Outcomes included ONP product characteristics, use patterns, beliefs and perceptions, toxicity, and marketing and sales. RESULTS Sixty-two studies were included, 17 were industry-funded. Most studies were from the United States. While large variations across studies were observed in ONP youth prevalence estimates, nationally representative U.S. studies find current use at 1.5% and lifetime use below 2.5% through 2023. Between 35% and 42% of U.S. adolescents and young adults have heard of ONPs, and 9-21% of tobacco-naïve youth were susceptible to trying them. U.S. adult-use estimates varied widely (0.8%-3% current; 3%-16% lifetime use) and were limited to populations with a history of tobacco use. The chemical composition of ONPs suggests fewer harmful/potentially harmful compounds at lower levels than cigarettes and smokeless tobacco (SLT), except formaldehyde. Industry-funded studies find substantially less cytotoxicity compared to cigarettes and suggest that higher nicotine-strength ONPs can deliver nicotine at levels comparable to or higher than SLT or cigarettes, although with slower nicotine release than cigarettes. Evidence on the cytotoxicity of ONPs relative to SLT is mixed. CONCLUSIONS ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users, although key data are mainly available from industry-funded studies. Data from independent research is critically needed. Industry marketing of ONPs may encourage initiation in youth and situational and dual use in adults. IMPLICATIONS The review provides an initial assessment of the potential role of ONPs in harm reduction and aims to determine unintended consequences of their use (youth uptake and dual-use) and identify populations that disproportionately use the product. This information is essential for tobacco regulatory bodies in determining the net public health impact of nicotine pouches.
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Affiliation(s)
- Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
| | - Kenneth E Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
| | - Radhika Ranganathan
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
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Poliakova N, Shrier LA, Harris SK, Bélanger RE. Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products. Tob Use Insights 2024; 17:1179173X241259603. [PMID: 38846268 PMCID: PMC11155328 DOI: 10.1177/1179173x241259603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.
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Affiliation(s)
- Natalia Poliakova
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Lydia A. Shrier
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sion Kim Harris
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard E. Bélanger
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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Cruz-Jiménez L, Barrientos-Gutiérrez I, Vidaña-Pérez D, Gallegos-Carrillo K, Arillo-Santillán E, Rodríguez-Bolaños R, Hardin JW, Kim M, Thrasher JF. Heated tobacco product use frequency, smoking quit attempts, and smoking reduction among Mexican adult smokers. Tob Induc Dis 2024; 22:TID-22-90. [PMID: 38813582 PMCID: PMC11135162 DOI: 10.18332/tid/187576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Heated tobacco products (HTPs) are promoted as less harmful than cigarettes; nonetheless, whether HTPs help smokers quit is uncertain. METHODS Data from 4067 Mexican adult smokers surveyed longitudinally every four months (November 2019-March 2021) were analyzed. Mixed-effects multinomial models regressed HTP use frequency (no use=reference; monthly; weekly; and daily use) on sociodemographics and tobacco/nicotine-related variables. Among participants who completed at least two surveys (n=2900) over four months, the duration of their longest smoking quit attempt (SQA) between surveys (SQAs: <30 days; ≥30 days; no SQA=reference) was regressed on HTP use frequency, and changes in the number of cigarettes smoked per day were regressed on HTP initiation between surveys, adjusting for covariates. RESULTS Consistent predictors of all HTP use frequencies (monthly, weekly, or daily vs no use) were daily smoking >5 cigarettes (ARRR=1.69 [95% CI: 1.12-2.55], 1.88 [95% CI: 1.26-2.81] and 6.46 [95% CI: 3.33-12.52], respectively); e-cigarette use (ARRR =5.68 [95% CI: 3.38-9.53], 6.54 [95% CI: 4.06-10.55] and 2.59 [95% CI: 1.26-5.30]); lower HTP risk perceptions (ARRR=2.12 [95% CI: 1.50-30.00], 2.25 [95% CI: 1.63-3.10] and 2.00 [95% CI: 1.25-3.22]); exposure to HTP information inside (ARRR=2.13 [95% CI: 1.44-3.15], 2.13 [95% CI: 1.49-3.05] and 3.72 [95% CI: 2.28-6.09]) and outside stores (ARRR=2.36 [95% CI: 1.56-3.57], 2.32 [95% CI: 1.65-3.25] and 2.44 [95% CI: 1.41-4.24]) where tobacco is sold; having family (ARRR=2.46 [95% CI: 1.54-3.91], 2.90 [95% CI: 1.93-4.37] and 2.96 [95% CI: 1.52-5.77]) and friends (ARRR=5.78 [95% CI: 3.60-9.30], 4.98 [95% CI: 3.22-7.72] and 6.61 [95% CI: 2.91-15.01]) who use HTPs. HTP use frequency was not associated with quit attempts, except for monthly HTP use predicting SQAs lasting ≥30 days (ARRR=2.12 [95% CI: 1.17-3.85]). Initiation of HTP use was not associated with changes in smoking frequency. Limiting analysis to those who intend to quit smoking also yielded null results. CONCLUSIONS Among Mexican adult smokers, frequency of HTP use was mostly not associated with either cessation behaviors or changes in cigarette consumption, suggesting that HTPs have limited to no effectiveness for smoking cessation.
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Affiliation(s)
- Lizeth Cruz-Jiménez
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | | | - Dèsirée Vidaña-Pérez
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Katia Gallegos-Carrillo
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Mexico
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - James W. Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Minji Kim
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - James F. Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
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Popova L, Massey ZB, Giordano NA. Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications. Annu Rev Public Health 2024; 45:425-442. [PMID: 38166502 DOI: 10.1146/annurev-publhealth-060922-042254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA;
| | - Zachary B Massey
- School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Cornacchione Ross J, Kowitt SD, Rubenstein D, Jarman KL, Goldstein AO, Thrasher JF, Ranney LM. Prevalence and correlates of flavored novel oral nicotine product use among a national sample of youth. Addict Behav 2024; 152:107982. [PMID: 38359494 PMCID: PMC10939726 DOI: 10.1016/j.addbeh.2024.107982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Flavored novel oral nicotine products (ONP), such as pouches, gum, lozenges, tablets, and gummies, have recently entered the US market but have not been authorized for smoking cessation. This study assessed the prevalence and correlates of ONPs in a national sample of youth who smoked little filtered cigars or cigarillos (LCCs) or were susceptible to LCCs. METHODS We conducted a national online survey from September-October 2022, as part of a study to develop cigar warnings among youth. Those aged 15-20 years old who reported using (ever or current) or susceptibility to little filtered cigars or cigarillos (LCCs) were eligible. Descriptive statistics and chi-square analyses assessed the prevalence of flavored ONP use and associations with other past 30-day tobacco product use and participant characteristics. RESULTS Approximately one-fifth (17.1 %) of the sample (n = 680) reported past month flavored ONP use. Any past month tobacco use was correlated with past month flavored ONP use (ps < 0.001), increasing from 17.1 % in the overall sample to 26.8 % among those reporting e-cigarette use, 41.4 % (LCCs), 47.8 % (waterpipe tobacco), 61.8 % (large cigars), and 69.1 % (smokeless tobacco). The number of products used in the past month was significantly associated with higher odds of ONPs in the past month in a multivariable logistic regression model (aOR2.26; 95 % CI: 1.92, 2.65). DISCUSSION Almost one-fifth of participants who use or are susceptible to cigar use in our national sample of youth use ONPs. Dual/poly use of other tobacco products and ONPs among youth suggests that many of these youth may be addicted to nicotine. Additional surveillance and regulation of ONPs that exhibit enticing characteristics, such as flavors, kid-friendly formulations, and targeted marketing/branding may be needed.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dana Rubenstein
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Bigwanto M, Ramadhan FA, Wijayanto XA. Online e-cigarette promotion in Indonesia. Tob Control 2024; 33:406-409. [PMID: 36344256 DOI: 10.1136/tc-2022-057568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The decline in the global prevalence of cigarette smoking has prompted tobacco companies to expand their business by producing and marketing new nicotine-based products in various countries, including Indonesia. The study aims to assess e-cigarette promotional frequency and content on social media in Indonesia. METHODS Monitoring was conducted on Instagram in October 2021. A total of 45 Instagram influencer accounts were monitored to assess the frequency of posting and interactions from 4 to 20 October for InstaStories and from 4 to 31 October for Instagram Feeds. Content analysis was carried out on 310 posts collected from 10 randomly selected accounts from 1 to 31 October (one post per account per day) to evaluate the form, type and characteristics of the promotions. RESULTS There were a total of 2 897 327 followers across the 45 Instagram accounts. On average, the 45 accounts posted about 185 stories and 43 feed posts per day. Of the 310 feed posts analysed from 10 randomly selected accounts, 64% featured images of women; 50% highlighted or displayed the product; and 32% showed enjoyment of the product flavours. CONCLUSIONS The tobacco industry has successfully taken advantage of the e-cigarette promotion regulatory void. The Indonesian government needs to ban the promotion of these products, including those on online platforms.
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Affiliation(s)
- Mouhamad Bigwanto
- Doctoral School of Psychology. Faculty of Education and Psychology, Eotvos Lorand University, Budapest, Hungary
- Faculty of Health Sciences, University of Muhammadiyah Prof Dr Hamka, Jakarta Selatan, Indonesia
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
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Borowiecki M, Emery SL, Kostygina G. New recreational nicotine lozenges, tablets, gummies and gum proliferate on the US market. Tob Control 2024; 33:414-416. [PMID: 36319083 PMCID: PMC10149575 DOI: 10.1136/tc-2022-057673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Mateusz Borowiecki
- Public Health, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Sherry L Emery
- Public Health, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Ganna Kostygina
- Public Health, NORC at the University of Chicago, Chicago, Illinois, USA
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12
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Silver N, Kucherlapaty P, Kierstead E, Schillo B. Objective Characteristics and Subjective Responses of 18-24-Year-Olds to U.S. nationally Televised Tobacco Advertisements. Subst Use Misuse 2024; 59:1115-1125. [PMID: 38409656 DOI: 10.1080/10826084.2024.2320394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background: Restrictions on televised tobacco ads do not apply to vaping and oral nicotine products. Several campaigns are currently active on U.S. national television. This research examines the extent to which objective ad features are associated with ad, brand, and product appeal and use intentions among 18-24-year-olds. Methods: We identified seven unique campaigns for Vuse, Velo, and JUUL from the Mintel Comperemedia database, coded for youth-appealing content, and then randomly assigned among N = 1450 18-24-year-olds. Following exposure to one 15-second ad, participants completed a survey assessing their subjective responses. Results: Youth-appealing content was prevalent across these ads to varying degrees. Mixed effects regression analyses showed a positive association between features from the Content Appealing to Youth (CAY) index and pro-social brand perceptions, positive attitudes, reactions, and perceived effectiveness of the ad, and positive use perceptions. Moreover, themes related to customization of the device and environmental sustainability were associated with similar positive perceptions, including that using the product would be cool, as well as behavioral intentions to try, use occasionally, and use daily. Conclusions: Regulators need to update tobacco advertising restrictions to accurately reflect the current tobacco product landscape. This study contributes to the research on tobacco promotion strategies by examining the current marketing landscape for newer tobacco products and their appeal to youth. Findings from this study inform comprehensive tobacco marketing regulations, recommending the FDA update its guidelines and apply current marketing restrictions to e-cigarettes and oral nicotine products.
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Affiliation(s)
- Nathan Silver
- Truth Initiative Schroeder Institute, Washington, DC, USA
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13
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Aienobe-Asekharen C, Norris E, Martin W. A Scoping Review of Tobacco Control Health Communication in Africa: Moving towards Involving Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:259. [PMID: 38541261 PMCID: PMC10970500 DOI: 10.3390/ijerph21030259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 07/23/2024]
Abstract
Health communication has been highlighted as a cost-effective preventive intervention in Africa, where the prevalence of tobacco use is still relatively low compared to other World Health Organization (WHO) regions. This scoping review aimed to examine tobacco control health communication interventions in Africa. The review was guided by the PRISMA-ScR checklist. Data was extracted from 20 peer-reviewed papers, WHO Global Health Observatory on anti-tobacco mass-media campaigns for 54 African countries, and 6 WHO Framework Convention on Tobacco Control reports on Article 12. Data extraction informed by the Joanna Briggs Institute (JBI) data-extraction questions was used for peer-reviewed studies while a pre-determined template was used for the other sources. Narrative data synthesis informed by the JBI manual for evidence synthesis was employed. A lack of research that comprehensively addresses all areas of health communication and inconsistent use of health communication campaigns were identified. Only an average of 6 countries had ever implemented high-quality national mass-media campaigns in a decade, while an average of 33 countries consistently failed to conduct campaigns that lasted more than 3 weeks. Although the involvement of key populations was clearly vital to ensure content relevance and message clarity, a lack of health communication informed by young people was observed, as they rarely participated in key decision-making despite reportedly being the targets of interventions. Clear health communication for tobacco-use prevention informed by young people is lacking in African countries. Active participation of young people in developing targeted campaigns is needed to facilitate content relevance and comprehension to ultimately contribute to tobacco-use prevention.
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Affiliation(s)
| | | | - Wendy Martin
- Department of Health Sciences, Brunel University London, London UB8 3PH, UK; (C.A.-A.); (E.N.)
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14
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Hendlin YH, Han EL, Ling PM. Pharmaceuticalisation as the tobacco industry's endgame. BMJ Glob Health 2024; 9:e013866. [PMID: 38316465 PMCID: PMC10859997 DOI: 10.1136/bmjgh-2023-013866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
CONTEXT Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal. METHODS We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs' investor and other professional reports, websites and public statements. FINDINGS Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate. CONCLUSIONS Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of 'clean' reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.
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Affiliation(s)
- Yogi Hale Hendlin
- Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elieen Le Han
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
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15
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Liu Y, Filippidis FT. Tobacco market trends in 97 countries between 2007 and 2021. Tob Induc Dis 2024; 22:TID-22-31. [PMID: 38314375 PMCID: PMC10835573 DOI: 10.18332/tid/177441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Analysis of the tobacco market can provide valuable insights for developing tobacco control strategies. This study examines the market trends of cigarettes, cigars/cigarillos, smoking tobacco, smokeless tobacco, e-cigarettes, heated tobacco products (HTPs), and tobacco-free oral nicotine, across 97 countries between 2007 and 2021. METHODS We obtained annual tobacco retail value data from Euromonitor Passport and calculated the market share for each type of tobacco product. The research examined trends in retail value and market share globally, stratified by national income level, as well as in individual countries. RESULTS From 2007 to 2015, the growth of the global tobacco market was primarily driven by cigarette sales. However, starting in 2016, emerging products, including e-cigarettes, HTPs, and tobacco-free oral nicotine, as well as non-cigarette combustible products, including cigars/cigarillos and smoking tobacco, have been mostly responsible for the increases in the global tobacco retail value. High-income countries experienced the greatest increase in the retail value of emerging products, while middle- and low-income countries still observed rises in cigarette sales. CONCLUSIONS Trends in the retail value of different tobacco products varied widely during the study period, with distinct trends observed in different income levels and within individual countries. These trends can supplement prevalence data and be used to inform local tobacco control policies.
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Affiliation(s)
- Yifei Liu
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
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16
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Mišković I, Kuiš D, Špalj S, Pupovac A, Prpić J. Periodontal Health Status in Adults Exposed to Tobacco Heating System Aerosol and Cigarette Smoke vs. Non-Smokers: A Cross-Sectional Study. Dent J (Basel) 2024; 12:26. [PMID: 38392230 PMCID: PMC10887685 DOI: 10.3390/dj12020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Tobacco heating systems (THS) are new products on the market, advertised as a less harmful alternative for smokers, in which tobacco is heated and not burned like in conventional cigarettes. This research explored the effect on periodontal tissues in contact with heating and burning tobacco residual products (smoke and tobacco). METHODS The sample included 66 subjects, patients of the Clinic of Dentistry in Rijeka, Croatia, aged 26-56 (median 38), 64% females. Three age- and gender-matched groups were formed (each N = 22): non-smokers, classic cigarettes smokers and THS smokers. Probing depth (PD) and clinical attachment loss (CAL) were primary research parameters. RESULTS Three groups differed in average PD and CAL (p ≤ 0.002), with cigarette smokers having the highest and non-smokers the lowest values (p ≤ 0.002). THS consumers generally had lower values of periodontal indices than smokers, but only CAL differed significantly (p = 0.011). Periodontal indices CAL and PD were worse in THS consumers than non-smokers, but they did not reach a level of statistical significance. Cigarette smoking was the only predictor of periodontitis (average CAL ≥ 4 mm) in logistic regression models, with an odds ratio of 4.7 (95% confidence interval 1.2-18.3; p = 0.027). CONCLUSIONS Exposure to nicotine-containing aerosol of THS in adults has a less harmful effect on periodontal tissues, measurable through periodontal indices (PD and CAL), compared to burning tobacco of conventional cigarettes. THS, presented as an alternative product to classic cigarettes, also has a detrimental effect on the periodontium.
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Affiliation(s)
- Ivana Mišković
- Clinical Hospital Centre Rijeka, Krešimirova 40, 51000 Rijeka, Croatia
| | - Davor Kuiš
- Clinical Hospital Centre Rijeka, Krešimirova 40, 51000 Rijeka, Croatia
- Department of Periodontology, Faculty of Dental Medicine, University of Rijeka, Krešimirova 40-42, 51000 Rijeka, Croatia
- Department of Dental Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
| | - Stjepan Špalj
- Clinical Hospital Centre Rijeka, Krešimirova 40, 51000 Rijeka, Croatia
- Department of Dental Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, Krešimirova 40-42, 51000 Rijeka, Croatia
| | - Aleksandar Pupovac
- Department of Periodontology, Faculty of Dental Medicine, University of Rijeka, Krešimirova 40-42, 51000 Rijeka, Croatia
| | - Jelena Prpić
- Clinical Hospital Centre Rijeka, Krešimirova 40, 51000 Rijeka, Croatia
- Department of Periodontology, Faculty of Dental Medicine, University of Rijeka, Krešimirova 40-42, 51000 Rijeka, Croatia
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17
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Shroff SM, Sreeramareddy CT. Marketing claims, promotional strategies, and product information on Malaysian e-cigarette retailer websites-a content analysis. Subst Abuse Treat Prev Policy 2024; 19:11. [PMID: 38273314 PMCID: PMC10809498 DOI: 10.1186/s13011-024-00592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Marketing and sales of e-cigarettes are unregulated in Malaysia. We analyzed content displayed on e-cigarette retailer websites to identify marketing claims, promotional strategies, and product details in the year 2022. METHODS We analyzed 30 Malaysia-based retailer websites using a mixed methods approach. Data were extracted as the frequency of occurrences of marketing claims, presence of regulatory information, product types, and flavors of e-juice as per a predefined codebook based on published literature. We also extracted textual details published on the websites about marketing claims, and slogans. RESULTS Most retailer websites provided contact information and physical store addresses (83%) but only half had 'click through' age verification (57%) that seldom needed any identification proof for age (3%). Marketing claims were related to health (47%), smoking cessation (37%), and modernity/trend (37%) and none had health warnings. Promotional strategies were discounts (80%). starter kits (57%) and email subscriptions (53%). Product types displayed were rechargeable (97%) and disposable (87%) devices and e-liquids (90%) of an array of flavors (> 100). Nicotine presence, its concentration, and "nicotine is an addictive chemical" were displayed in 93%, 53%, and 23% of websites respectively. CONCLUSION Surveillance of content displayed online on e-cigarette retailer websites and regulation of online marketing and sales should be implemented by the Ministry of Health, Malaysia. Such measures are needed to prevent access to, and initiation of e-cigarette use among the youth and adults who do not smoke.
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Affiliation(s)
- Sameeha Misriya Shroff
- School of Postgraduate Studies, International Medical University, Jalan Jalil Perkasa 19, Kuala Lumpur, 57000, Malaysia
| | - Chandrashekhar T Sreeramareddy
- Division of Community Medicine and Public Health, International Medical University, Jalan Jalil Perkasa 19, Kuala Lumpur 57000, Malaysia.
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18
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Duan Z, Romm KF, Wang Y, Huang J, Berg CJ. Exposure to E-Cigarette Advertisements or Reviews and E-Cigarette Use Progression: A Longitudinal Examination of Short-Term and Long-Term Associations among US Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:123. [PMID: 38397614 PMCID: PMC10887947 DOI: 10.3390/ijerph21020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Limited research has investigated the impact of e-cigarette advertising and reviews on the progression of e-cigarette use among young adults in the US. This study utilized five-wave longitudinal data (2018-2020) with 3006 young adults aged 18-34, reporting exposure to e-cigarette advertisements or reviews at Wave 1 (W1) and W3. Generalized estimating equations (GEE) were used to examine the prospective associations between frequent exposure to e-cigarette advertisements or reviews and e-cigarette use progression in four groups: never users (n = 1271 at W1), former users (previously used but quit ≥ 6 months ago, n = 422 at W1), recent former users (used in the past 6 months but not in the past month, n = 186 at W1), and current users (used in the past month, n = 1127 at W1). Among baseline former users, frequent exposure to e-cigarette reviews was associated with current use at 6-month follow-up (aOR = 4.40, 95%CI = 1.46-13.29). Among baseline current users, frequent exposure to e-cigarette reviews was associated with increased days of use at 6-month follow-up (IRR = 1.20, 95%CI = 1.07-1.34) and 12-month follow-up (IRR = 1.18, 95%CI = 1.03-1.35). E-cigarette reviews may contribute to relapse among recent former users and increased usage frequency among current users, highlighting the need for enhanced e-cigarette promotional activity regulation.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Katelyn F. Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA;
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (Y.W.); (C.J.B.)
| | - Jidong Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA;
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (Y.W.); (C.J.B.)
- George Washington Cancer Center, George Washington University, Washington, DC 20052, USA
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19
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Zavala-Arciniega L, Cook S, Hirschtick J, Xie Y, Mukerjee R, Arenberg D, Barnes GD, Levy DT, Meza R, Fleischer N. Longitudinal associations between exclusive, dual and polytobacco use and respiratory illness among youth. RESEARCH SQUARE 2024:rs.3.rs-3793149. [PMID: 38343856 PMCID: PMC10854317 DOI: 10.21203/rs.3.rs-3793149/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background The health consequences of polytobacco use are still well not understand. We evaluated prospective associations between exclusive, dual, and polytobacco use and diagnosed bronchitis, pneumonia, or chronic cough among US youth. Methods Data came from Waves 1-5 of the Population Assessment of Tobacco and Health Study. We categorized time-varying past 30-day tobacco use into seven categories: (1) non-current use; exclusive use of 2) cigarettes, 3) electronic nicotine delivery systems (ENDS), or 4) other combustible products (OC; pipes, hookah, and cigars); dual use of 5) ENDS + cigarettes or ENDS + OC 6) cigarettes + OC; or 7) polyuse of all three products. The outcome was incident diagnosis of bronchitis, pneumonia, or chronic cough. We conducted weighted multilevel Poisson models (person n = 17,517, 43,290 observations) to examine the longitudinal exposure-outcome relationship, adjusting for covariates: sex, age, race and ethnicity, parental education, body mass index, secondhand smoke exposure, and household use of combustible products. Results Compared to nonuse, exclusive cigarette use (Incidence Rate Ratio (IRR) = 1.83, 95% CI 1.25-2.68), exclusive ENDS use (IRR = 1.53, 95% CI 1.08-2.15), combustible product + ENDS dual use (IRR = 1.90, 95% CI 1.18-3.04), cigarettes + OC dual use (IRR = 1.96, 95% CI 1.11-3.48), and polytobacco use (IRR = 3.06 95% CI 1.67-5.63) were associated with a higher incidence of bronchitis, pneumonia, or chronic cough. Conclusion We found that exclusive, dual, and poly tobacco use was associated with higher incidence of bronchitis, pneumonia, or chronic cough; Moreover, the incidence rate ratio for polytobacco use was higher than the incidence rate ratio for exclusive use compared to non-current use.
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Affiliation(s)
| | - Steven Cook
- University of Michigan School of Public Health
| | | | - Yanmei Xie
- University of Michigan School of Public Health
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20
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Agaku IT, Sulentic R, Dragicevic A, Njie G, Jones CK, Odani S, Tsafa T, Gwar J, Vardavas CI, Ayo-Yusuf O. Gender differences in use of cigarette and non-cigarette tobacco products among adolescents aged 13-15 years in 20 African countries. Tob Induc Dis 2024; 22:TID-22-20. [PMID: 38259662 PMCID: PMC10801700 DOI: 10.18332/tid/169753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/10/2023] [Accepted: 07/18/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa. METHODS This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13-15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls. RESULTS Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20-4.30). CONCLUSIONS The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.
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Affiliation(s)
- Israel T. Agaku
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Rose Sulentic
- Centers for Disease Control and Prevention Foundation, Atlanta, United States
| | - Adriana Dragicevic
- Centers for Disease Control and Prevention Foundation, Atlanta, United States
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Gibril Njie
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Candace K. Jones
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Satomi Odani
- Osaka International Cancer Institute, Cancer Control Center, Osaka, Japan
| | - Tina Tsafa
- Department of Mass Communication, Benue State University, Makurdi, Nigeria
| | - Joy Gwar
- Department of Clinical Psychology, Federal Medical Centre Makurdi, Makurdi, Nigeria
| | - Constantine I. Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States
| | - Olalekan Ayo-Yusuf
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Nargis N, Asare S. Legalization of access to cannabis: a growing agenda for tobacco control research in the USA. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100630. [PMID: 38026445 PMCID: PMC10663687 DOI: 10.1016/j.lana.2023.100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Nigar Nargis
- Tobacco Control Research, Surveillance & Health Equity Science, American Cancer Society, 270 Peachtree Street, Atlanta, GA 30303, USA
| | - Samuel Asare
- Tobacco Control Research, Surveillance & Health Equity Science, American Cancer Society, 270 Peachtree Street, Atlanta, GA 30303, USA
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22
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Graham-DeMello A, Hoek J, Drew J. How do underage youth access e-cigarettes in settings with minimum age sales restriction laws? A scoping review. BMC Public Health 2023; 23:1809. [PMID: 37723457 PMCID: PMC10506222 DOI: 10.1186/s12889-023-16755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Despite measures to reduce young people's access to electronic cigarettes (ECs), or "vapes", many countries have recorded rising youth vaping prevalence. We summarised studies documenting how underage youth in countries with minimum age sales restrictions (or where sales are banned) report accessing ECs, and outline research and policy implications. METHODS We undertook a focused literature search across multiple databases to identify relevant English-language studies reporting on primary research (quantitative and qualitative) and EC access sources among underage youth. RESULTS Social sourcing was the most prevalent EC access route, relative to commercial or other avenues; however, social sourcing dynamics (i.e., who is involved in supplying product and why) remain poorly understood, especially with regard to proxy purchasing. While less prevalent, in-person retail purchasing (mainly from vape shops) persists among this age group, and appears far more common than online purchasing. CONCLUSIONS Further research examining how social supply routes operate, including interaction and power dynamics, is crucial to reducing youth vaping. Given widespread access via schools and during social activities and events, exploring how supply routes operate and evolve in these settings should be prioritized. Inadequate compliance with existing sales regulations suggest greater national and local policy enforcement, including fines and licence confiscation for selling to minors, is required at the retailer level.
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Affiliation(s)
- Anna Graham-DeMello
- Department of Public Health, University of Otago, 23 Mein Street, Newtown, Wellington, 6021, New Zealand.
| | - Janet Hoek
- Department of Public Health, University of Otago, 23 Mein Street, Newtown, Wellington, 6021, New Zealand
| | - Jonathan Drew
- Te Whatu Ora Southern, Health New Zealand, Dunedin Hospital, Dunedin, New Zealand
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Pike Moore S, Masyn KE, Fryer C, Lee E, Gunzler D, Trapl E, Shang C, Sterling KL. Recency measures matter: Variability in reported last use of tobacco and marijuana products among a nationally representative study of U.S. young adults. Addict Behav 2023; 144:107746. [PMID: 37163886 PMCID: PMC10330519 DOI: 10.1016/j.addbeh.2023.107746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Current use of tobacco and marijuana products is largely defined as use within the past 30-days or more recently. These products are not used in the same manner, frequency, or context especially among young adults who are increasingly at risk for poly-product use. The purpose of this study was to examine patterns of most recent product use across select tobacco and marijuana products. MATERIALS AND METHODS Data used in this study come from a cross-sectional survey conducted among a nationally representative sample of young adults ages 18-34 (n = 1,189) in the U.S. from October-November 2020. Respondents were asked about past product and most recent use of select tobacco/nicotine products (cigarettes, little filtered cigars and cigarillos, large cigars, e-cigarettes, hookah/water pipes) and marijuana products (blunts, e-cigarettes with marijuana, and other products with marijuana). RESULTS A high proportion of young adults reported having used at least one tobacco (79.6%) or marijuana (68.6%) products. There is variability in the distribution of most recent use across different tobacco and marijuana users even within the past 3 to past 6 months where nearly one in five users of any product report last use. The average number of tobacco/nicotine products used as well as concurrent marijuana use were lowest when looking at those whose most recent use was within the past 30-days. As the measures of most recent use became more broad, the number of tobacco/nicotine products used increased as did the prevalence of concurrent marijuana use which extended through the past 6-months. CONCLUSION Measures of current use may need to be expanded beyond the past 30-days to include through the past 6-months to better encapsulate usage patterns when considering poly-tobacco and marijuana co-use.
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Affiliation(s)
- Stephanie Pike Moore
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA.
| | - Katherine E Masyn
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Craig Fryer
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Eugenia Lee
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, USA
| | - Douglas Gunzler
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA
| | - Ce Shang
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Kymberle L Sterling
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, USA
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Njie GJ, Kirksey Jones C, Jacques N, Adetokun A, Ross J, Owens A, Anton L, Johns M, Pan L. Changes in Tobacco Product Use Among Students Aged 13 to 15 Years in 34 Countries, Global Youth Tobacco Survey, 2012-2020. Prev Chronic Dis 2023; 20:E68. [PMID: 37535901 PMCID: PMC10763619 DOI: 10.5888/pcd20.220410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Most adults who currently use tobacco start before age 21. Comprehensive, cost-effective strategies and interventions to prevent initiation and encourage tobacco use cessation among youth are critical aspects of protecting youth from the harms of commercial tobacco. We describe changes in current tobacco product use among youth in 34 sites using data from the Global Youth Tobacco Survey (GYTS). METHODS GYTS is a nationally representative school-based survey of students aged 13 to 15 years. The analysis included 34 sites that completed 2 survey waves during 2012-2020. Prevalence of current tobacco use was assessed for each country. Marginal effects in multivariable logistic regression models were used to estimate adjusted prevalence difference (aPD) between waves. RESULTS The adjusted prevalence of current tobacco product use remained unchanged in more than 60% of the included sites. For any tobacco use, significant decreases were reported for Bhutan (aPD = -8.1; 95% CI, -12.9 to -3.4), Micronesia (aPD = -7.2; 95% CI, -9.7 to -4.7), San Marino (aPD = -7.0; 95% CI, -11.2 to -2.7), Togo (aPD = -2.7; 95% CI, -4.6 to -0.7), and Panama (aPD = -2.2; 95% CI, -4.1 to -0.4); significant increases were reported for Moldova, Albania, and Paraguay. Current e-cigarette use increased significantly in 7 of 10 sites. CONCLUSION Data show that progress toward reducing tobacco use among youth stalled during 2012-2020, while e-cigarette use increased in a few sites with available data.
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Affiliation(s)
- Gibril J Njie
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S107-7, Atlanta, GA 30341-3717
| | - Candace Kirksey Jones
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- RTI International, Research Triangle Park, North Carolina
| | - Nerline Jacques
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- CyberData Technologies, Herndon, Virginia
| | - Adewole Adetokun
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- CyberData Technologies, Herndon, Virginia
| | - James Ross
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashlyn Owens
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Linda Anton
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Chenega Enterprise Systems and Solutions, LLC, Chesapeake, Virginia
| | - Michelle Johns
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Liping Pan
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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McKerchar C, Bidwell S, Curl A, Pocock T, Cowie M, Miles H, Crossin R. Promoting health in the digital environment: health policy experts' responses to on-demand delivery in Aotearoa New Zealand. Health Promot Int 2023; 38:daad091. [PMID: 37611159 PMCID: PMC10446141 DOI: 10.1093/heapro/daad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Services offering on-demand delivery of unhealthy commodities, such as fast food, alcohol and smoking/vaping products have proliferated in recent years. It is well known that the built environment can be health promoting or harmful to health, but there has been less consideration of the digital environment. Increased availability and accessibility of these commodities may be associated with increased consumption, with harmful public health implications. Policy regulating the supply of these commodities was developed before the introduction of on-demand services and has not kept pace with the digital environment. This paper reports on semi-structured interviews with health policy experts on the health harms of the uptake in on-demand delivery of food, alcohol and smoking/vaping products, along with their views on policies that might mitigate these harms. We interviewed 14 policy experts from central and local government agencies and ministries, health authorities, non-Government Organisations (NGOs) and university research positions in Aotearoa New Zealand using a purposive sampling strategy. Participants concerns over the health harms from on-demand services encompassed three broad themes-the expansion of access to and availability of unhealthy commodities, the inadequacy of existing restrictions and regulations in the digital environment and the expansion of personalized marketing and promotional platforms for unhealthy commodities. Health policy experts' proposals to mitigate harms included: limiting access and availability, updating regulations and boosting enforcement and limiting promotion and marketing. Collectively, these findings and proposals can inform future research and public health policy decisions to address harms posed by on-demand delivery of unhealthy commodities.
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Affiliation(s)
- Christina McKerchar
- Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
| | - Susan Bidwell
- Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
| | - Angela Curl
- Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
| | - Tessa Pocock
- Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Matt Cowie
- University of Otago Medical School, Dunedin, New Zealand
| | - Hannah Miles
- University of Otago Medical School, Dunedin, New Zealand
| | - Rose Crossin
- Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
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Sharapova SR, Whitney C, Sulentic R, Pan L, Ahluwalia IB. Reasons to decrease or stop nicotine and tobacco use among adults and association with MPOWER scores in twenty-one middle- and high-income countries, 2019-2020. Tob Prev Cessat 2023; 9:25. [PMID: 37485279 PMCID: PMC10360442 DOI: 10.18332/tpc/167957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION This study examined reasons why people planned to reduce or stop tobacco consumption and their relationship with MPOWER scores, adjusting for sociodemographic, cultural, and economic factors. METHODS Data used were Euromonitor International's Voice of the Consumer: Nicotine Survey 2019-2020, World Bank's country income and WHO's MPOWER policy scores. Analytical sample included 21913 adults of legal smoking age in 21 middle- and high-income countries who used nicotine and tobacco products and planned to reduce or stop their consumption in the next 12 months. Poisson regression models with robust error variance, adjusted for sociodemographic and tobacco use covariables, generated adjusted risk ratios (ARRs) of selecting a certain reason to reduce tobacco consumption dependent on continuous MPOWER scores. RESULTS Main reasons to reduce or stop tobacco consumption were improving health (85%), saving money (65%), pressure from family (19%), and using another substance instead (4%). Country variation was observed by MPOWER scores. Positive associations were found between some MPOWER scores and reasons to reduce or stop tobacco consumption: enforcing bans on tobacco advertising and using another substance (ARR=1.28; 95% CI: 1.11-1.47); warning about dangers of tobacco and saving money (ARR=1.25; 95% CI: 1.19-1.32); offering help to quit tobacco and using another substance (ARR=1.26; 95% CI: 1.10-1.45) or family pressure (ARR=1.11; 95% CI: 1.04-1.17); anti-tobacco campaigns and using another substance (ARR=1.15; 95% CI: 1.08-1.23); and raising taxes and saving money (ARR=1.11; 95% CI: 1.09-1.13). CONCLUSIONS MPOWER scores are associated with reported reasons to quit tobacco including to improve health, save money, respond to family pressure or use another substance instead.
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Affiliation(s)
| | | | | | - Liping Pan
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Indu B. Ahluwalia
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
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Han DH, Cho J, Harlow AF, Tackett AP, Vogel EA, Wong M, Barrington-Trimis JL, Lerman C, Unger JB, Leventhal AM. Young adults' beliefs about modern oral nicotine products: Implications for uptake in nonvapers, dual use with e-cigarettes, and use to reduce/quit vaping. Exp Clin Psychopharmacol 2023; 31:455-463. [PMID: 36048111 PMCID: PMC10026537 DOI: 10.1037/pha0000595] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Modern oral nicotine products (ONPs; nontherapeutic nicotine pouches, gums, lozenges, and gummies) may be perceived in ways that could promote uptake in nonvapers, dual use with e-cigarettes, or use to quit vaping. In this cross-sectional digital remote survey of 1,460 respondents aged 21-24 from Southern California, we examined beliefs about ONPs among past-30-day e-cigarette nonusers, users unmotivated to quit vaping, and users motivated to quit vaping. Positive beliefs about ONPs were reported by 31.8% of the overall sample and higher in past-30-day e-cigarette users (with or without quit motivation) than nonusers. Perceiving ONPs to be easy to conceal, convenient, and able to be used where vaping/smoking is not allowed were the most common types of beliefs reported. Among e-cigarette users with quit motivation (n = 142), interest in using ONPs to quit/reduce vaping (44.4%) was higher than interest in using medicinal nicotine gum/lozenges (23.4%), nicotine patch (17.6%), or prescription medications (16.6%). Interest in using ONPs to reduce/quit vaping (vs. no interest) was greater among participants who reported vaping ≥ 20 (vs. < 10) days in the past month, vaping ≥ 10 (vs. < 10) times per day, low/moderate (vs. high) quit vaping self-efficacy, and low/moderate (vs. high) desire to quit vaping. These findings suggest that: (a) appreciable subsets of the young adult population may hold positive beliefs about ONPs that could promote ONP uptake, particularly e-cigarette users and (b) some young adult e-cigarette users may be interested in using ONPs to reduce/quit vaping, particularly frequent vapers with relatively lower self-efficacy and desire to quit vaping. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Dae-Hee Han
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Junhan Cho
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Alyssa F. Harlow
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Alayna P. Tackett
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Erin A. Vogel
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Melissa Wong
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Jessica L. Barrington-Trimis
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Caryn Lerman
- Institute for Addiction Science, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Jennifer B. Unger
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Adam M. Leventhal
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
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Pitt H, McCarthy S, Thomas SL, Randle M, Marko S, Cowlishaw S, Kairouz S, Daube M. Older adults' perceptions of the risks associated with contemporary gambling environments: Implications for public health policy and practice. FRONTIERS IN SOCIOLOGY 2023; 8:1061872. [PMID: 37006633 PMCID: PMC10060892 DOI: 10.3389/fsoc.2023.1061872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/20/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Rapid changes in the Australian gambling environment have amplified the risks for gamblers and pose significant threats to public health. Technological advances, saturation of marketing, and the embedding of gambling in sport have all contributed to significant changes in the gambling risk environment. Older adults have witnessed the changes to the way gambling is provided and promoted in public spaces, but little is known about how these changes have shaped the way they conceptualize the risks associated with gambling. METHOD Guided by critical qualitative inquiry, semi structured interviews were conducted with 40 Australian adults aged 55 years and older, who had gambled at least once in the last 12 months. Reflexive thematic analysis was used to interpret the data. RESULTS Participants discussed gambling environments in Australia and how they had changed through the proliferation of gambling products, environments, and opportunities; the risks posed through the embedding of gambling in community and media environments; the role of technology in gambling environments; and the role of marketing and promotions in the changing gambling environments. Participants recognized that these factors had contributed to gambling environments becoming increasingly risky over time. However, despite the perception of increased risk, many participants had engaged with new gambling technologies, products, and environments. DISCUSSION This research supports the adoption of public health responses that include consideration of the environmental, commercial, and political factors that may contribute to risky gambling environments.
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Affiliation(s)
- Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Simone McCarthy
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Samantha L. Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Melanie Randle
- Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Sarah Marko
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Sylvia Kairouz
- Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Mavragani A, Hrywna M, Talbot EM, Lewis MJ. Tobacco-Derived Nicotine Pouch Brands and Marketing Messages on Internet and Traditional Media: Content Analysis. JMIR Form Res 2023; 7:e39146. [PMID: 36790840 PMCID: PMC9978966 DOI: 10.2196/39146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nicotine pouches and lozenges are increasingly available in the United States, and sales are growing. The brands of nicotine pouch products with the largest market share are produced by tobacco companies. OBJECTIVE The aim of this study is to examine the marketing of 5 oral nicotine products sold by tobacco companies. METHODS Internet, radio, television, print, and web-based display advertisements between January 2019 and March 2020 for 6 brands of nicotine pouches and lozenges were identified through commercially available marketing surveillance systems supplemented by a manual search of trade press and a review of brand websites. A total of 711 advertisements (122 unique) were analyzed to identify characteristics, themes, marketing strategies, and target audiences, and qualitatively compared by brand. All 5 brand websites were also analyzed. Coders examined the entirety of each advertisement or website for products, marketing claims, and features and recorded the presence or absence of 27 marketing claims and lifestyle elements. RESULTS All 6 brands of nicotine pouch products spent a total of US $11.2 million on advertising in 2019, with the most (US $10.7 million) spent by the brand Velo, and 86.1% (n=105) of the unique advertisements were web-based. Of the 711 total nicotine pouch advertisements run in 2019, the 2 brands Velo (n=407, 57%) and ZYN (n=303, 42%) dominated. These brands also made the greatest number of advertising claims in general. These claims focused on novelty, modernity, and use in a variety of contexts, including urban contexts, workplaces, transportation, and leisure activities. Of the 122 unique advertisements, ZYN's most common claims were to be "tobacco-free," featuring many flavors or varieties, and modern. Velo was the only brand to include urban contexts (n=14, 38.9% of advertisements) or freedom (n=8, 22.2%); Velo advertisements portrayed use in the workplace (n=15, 41.7%), bars or clubs (n=5, 13.9%), leisure activities (n=4, 11.1%), transportation (n=4, 11.1%), sports (n=3, 8.3%), cooking (n=2, 5.6%), and with alcohol (n=1, 2.8%). Velo and ZYN also included most of the images of people, including women and people of color. The 36 Velo ads included people in advertising in 77.8% (n=28) of advertisements, and of those advertisements with identifiable people, 40% (n=4) were young adults and 50% (n=5) were middle-aged. About one-third (n=11, 35.5%) of the 31 unique ZYN advertisements included people, and most identifiable models appeared to be young adults. Brands such as Rogue, Revel, Dryft, and on! focused mainly on product features. All nicotine pouch products made either tobacco-free, smoke-free, spit-free, or vape-free claims. The most common claim overall was "tobacco-free," found in advertisements from Rogue (1/1, 100%), ZYN (30/31, 96.8%), Velo (19/36, 52.8%), and Dryft (1/3, 33.3%), but not Revel. CONCLUSIONS Nicotine pouches and lozenges may expand the nicotine market as tobacco-free claims alleviate concerns about health harms and advertising features a greater diversity of people and contexts than typical smokeless tobacco advertising. The market leaders and highest-spending brands, ZYN and Velo, included more lifestyle claims. Surveillance of nicotine pouch marketing and uptake, including influence on tobacco use behaviors, is necessary.
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Affiliation(s)
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States.,Department Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Eugene M Talbot
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - M Jane Lewis
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States.,Department Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ, United States
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Duren M, Atella L, Welding K, Kennedy RD. Nicotine pouches: a summary of regulatory approaches across 67 countries. Tob Control 2023:tc-2022-057734. [PMID: 36750358 DOI: 10.1136/tc-2022-057734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Nicotine pouches are small, permeable pouches containing nicotine. The nicotine may either be derived from tobacco plants or synthetically produced. Nicotine pouches are available worldwide, but little is known as to how various countries regulate these products. This study summarises nicotine pouch regulatory policies across 67 countries. METHODS This research summarises insights obtained through active policy surveillance work in which we requested information on the availability of nicotine pouches and applicable policies and analysed responses from representatives of 67 countries (representatives included subject matter experts in government or civil society organisations). These countries span all WHO regions. RESULTS We found significant variation in how countries classify nicotine pouches, with many countries' current regulatory approach failing to regulate nicotine pouches that used synthetic nicotine. We found 34 countries regulate nicotine pouches with 23 of these countries' policies encompassing synthetic nicotine. Countries regulating both synthetic and tobacco-derived nicotine pouches generally (1) rely on existing policies for tobacco products and/or medicines or (2) have developed new policies or regulatory classifications that specify nicotine as the substance at issue rather than linking policies solely to tobacco. CONCLUSION Our work offers novel insight into nicotine pouch markets and national regulatory approaches. Policy approaches vary from not regulating nicotine pouches at all to banning both forms of nicotine pouches. Policies used by countries regulating both tobacco-derived and synthetic nicotine pouches offer a roadmap for how other jurisdictions can add effective guardrails to the use of these and other non-medicinal nicotine products.
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Affiliation(s)
- Michelle Duren
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lara Atella
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bigwanto M, Arumsari I, Fauzi R. The portrayal of electronic cigarettes in Indonesia: a content analysis of news media. BMC Public Health 2023; 23:52. [PMID: 36611150 PMCID: PMC9824992 DOI: 10.1186/s12889-022-14886-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The news media play an essential role in shaping public opinion. Analyzing a specific issue reported in the news media provides insight and considerations for a government to form a policy. This study aimed to assess the portrayal of electronic cigarettes (e-cigarettes) in Indonesian news media, including the variety of arguments being presented and the actors behind them. METHODS We used a paid service database from eBdesk to collect Indonesian news articles from 2020 to 2021 using the keywords 'rokok elektronik' (electronic cigarette), 'rokok elektrik' (electric cigarette), 'e-rokok' (e-cigarette), 'vape', and 'vaping'. Content analysis of 551 full-text news articles was conducted to identify the concepts, topics, and frames of quoted arguments and to examine whether any frames were presented by different types of organizations and the origin of actors. RESULTS News articles related to e-cigarettes were mostly published in the national newspaper and in the non-health section of the newspaper desk. A total of 891 arguments from 393 persons representing 212 institutions were identified. Twenty-eight concepts were further categorized into 12 topics. Health impact was the most frequently reported topic, followed by regulation, tax/price, and e-cigarettes as smoking cessation tools. Overall, the articles and arguments with positive tones toward e-cigarettes outnumbered negative articles and arguments. The industry, university, and research-based institutions were the most involved types of organizations in the news articles. There were more neutral frames toward e-cigarettes among government, even though the frame within the non-health government sector was reported to be more positive toward e-cigarettes. CONCLUSIONS Although health impact is the most reported topic, the actors involved in delivering arguments were mainly from the non-health sector, including when the news articles were published by the newspaper desk. The e-cigarette issue in Indonesia was mainly played by the non-health sector, which is more inclined toward economic interest than health.
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Affiliation(s)
- Mouhamad Bigwanto
- grid.5591.80000 0001 2294 6276Doctoral School of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064 Hungary ,grid.5591.80000 0001 2294 6276Institute of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064 Hungary ,grid.443454.60000 0001 0177 9026Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jl. Limau II, Jakarta, 12210 Indonesia
| | - Imas Arumsari
- grid.443454.60000 0001 0177 9026Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jl. Limau II, Jakarta, 12210 Indonesia
| | - Ridhwan Fauzi
- grid.443452.00000 0004 0380 9286Faculty of Public Health, Universitas Muhammadiyah Jakarta, Jl. KH Ahmad Dahlan, Jakarta, 15419 Indonesia
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Sy D. Tobacco industry's 'wellness' tactic: Ethical dilemma and solutions. Tob Prev Cessat 2023; 9:11. [PMID: 37101784 PMCID: PMC10123402 DOI: 10.18332/tpc/159119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/03/2023] [Accepted: 02/28/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Deborah Sy
- Global Center for Good Governance in Tobacco Control, School of Global Studies, Thammasat University, Rangsit, Thailand
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Bigwanto M, Muhammad F, Widad SM, Yudha L. Product variety and regulation avoidance in the sale of new tobacco products: findings from a point-of-sale survey in Indonesia. Subst Abuse Treat Prev Policy 2022; 17:78. [PMID: 36494852 PMCID: PMC9733199 DOI: 10.1186/s13011-022-00507-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Since the imposition of the 2018 excise tax, new tobacco products (electronic nicotine delivery system, heated tobacco products, and nicotine pouches) have been considered legal, and their sale has grown rapidly in Indonesia. This study aims to assess the variety of new tobacco products available on the market and evaluate the point-of-sale (POS) environment. METHODS Data collection was carried out by 12 trained surveyors between March 7 and 13, 2022, in three provinces that had the most e-cigarette users: Yogyakarta, East Kalimantan, and Jakarta. All the vape stores with a Google rating of 4.5 stars or higher and a minimum of 100 reviews were included. In addition to vape stores, the nearest retail stores were included. The data collected included information about available products, product displays, and whether the POS followed tobacco-control measures, such as health warnings and smoke-free regulations. RESULTS A total of 27 vape stores and 35 retail stores were observed. The available liquid volumes ranged from 15 to 100 ml, with nicotine levels from 3 to 50 mg. No stores sold flavorless products, and all the products were sold without pictorial health warnings (PHWs). Most of the vape stores (92.6%) reported selling products that used cartoon images or public figures, and most (96.3%) allowed customers to use the products inside the store. Five vape stores and four retail stores reported that they did not require customers to undergo an identity-verification process to buy products. More than half (55.6%) of the vape stores and 46.6% of the retail stores reported that they were located less than 500 m from a school. CONCLUSION The available products were widely varied, and they were easy to access through online and offline stores. The new tobacco products had successfully avoided several tobacco-control measures, including smoke-free regulations and the appearance of PHWs on the products. The government needs to impose regulations sufficient to prevent youth from consuming new tobacco products.
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Affiliation(s)
- Mouhamad Bigwanto
- grid.5591.80000 0001 2294 6276Doctoral School of Psychology, Eötvös Loránd University, Izabella u. 46, 1064 Budapest, Hungary ,grid.5591.80000 0001 2294 6276Institute of Psychology, Eötvös Loránd University, Izabella u. 46, 1064 Budapest, Hungary ,grid.443454.60000 0001 0177 9026Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jl. Limau II, Jakarta, 12210 Indonesia
| | - Fathi Muhammad
- National Committee on Tobacco Control, Jl. Teuku Umar No.8, Jakarta, 10350 Indonesia
| | - Sarah Muthia Widad
- National Committee on Tobacco Control, Jl. Teuku Umar No.8, Jakarta, 10350 Indonesia
| | - Laksmana Yudha
- National Committee on Tobacco Control, Jl. Teuku Umar No.8, Jakarta, 10350 Indonesia
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Murukutla N, Magsumbol MS, Raskin H, Kuganesan S, Dini S, Martinez-Mejia C, Rachfiansyah, Aguilar BGR. A content analysis of e-cigarette marketing on social media: Findings from the Tobacco Enforcement and Reporting Movement (TERM) in India, Indonesia and Mexico. Front Public Health 2022; 10:1012727. [PMID: 36424977 PMCID: PMC9679495 DOI: 10.3389/fpubh.2022.1012727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background The use of e-cigarettes is proliferating globally, especially among youth and even children. Marketing is a known risk factor for e-cigarette initiation, yet little is known of e-cigarette marketing on social media in low- and middle-income countries. This study compares e-cigarette social media marketing in India, Indonesia, and Mexico, three such countries with different regulatory environments. Methods Instances of e-cigarette marketing on social media platforms were identified via the Tobacco Enforcement and Reporting Movement (TERM), a digital tobacco marketing monitoring system. Through systematic keyword-based searches, all tobacco marketing posts observed between 15 December 2021 and 16 March 2022 were included in the analysis. The final sample included 1,437 e-cigarette-related posts on Instagram, Facebook, Twitter, YouTube, and TikTok, which were systematically content analyzed by independent coders after inter-reliability (Cohen's Kappa K > 0.79) was established using a theory-derived codebook. The final data is represented in percentages and frequencies for ease of presentation. Results We observed e-cigarette marketing online in all countries studied, yet there was variation in the volume of marketing and types of accounts identified. In India, where e-cigarettes were comprehensively banned, we identified 90 (6%) posts; in Mexico, where e-cigarettes were partially restricted, 318 (22%) posts were observed; and in Indonesia, where there were no restrictions, 1,029 (72%) posts were observed. In both India and Mexico, marketing originated from retailer accounts (100%), whereas in Indonesia, it was primarily product brand accounts (86%). Across countries, e-cigarettes were mostly marketed directly to sell products (India: 99%, Indonesia: 69% and Mexico: 93%), though the sales channels varied. Product features, including e-liquid flavors, device colors and technical specifications, was the most prominent message framing (India: 86%; Mexico: 73%; Indonesia: 58%). Harm reduction messaging was most popular in Mexico (8%) and was not common in Indonesia (0.3%) or India (0%). Conclusion Our study provides important insights for tobacco control stakeholders on the evolving nature of e-cigarette marketing in low- and middle-income countries. It underscores the presence of e-cigarette marketing, including in countries where comprehensive regulations exist, and suggests the importance of continuous monitoring to keep up with industry practices and strengthen tobacco control stakeholder efforts to counter them.
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Affiliation(s)
- Nandita Murukutla
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Melina S Magsumbol
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Hana Raskin
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Sharan Kuganesan
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Silvia Dini
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Carlos Martinez-Mejia
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Rachfiansyah
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
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Fitzpatrick I, Dance S, Silver K, Violini M, Hird TR. Tobacco industry messaging around harm: Narrative framing in PMI and BAT press releases and annual reports 2011 to 2021. Front Public Health 2022; 10:958354. [PMID: 36330126 PMCID: PMC9623273 DOI: 10.3389/fpubh.2022.958354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/31/2022] [Indexed: 01/24/2023] Open
Abstract
Influencing public perception is a key way in which all transnational corporations (TNCs) maintain market dominance and political power. Transnational tobacco companies (TTCs) have a long history of leveraging narratives to serve commercial ambitions. The global reach of these companies' narratives has been highlighted as a challenge in combatting public health problems caused by tobacco. The corporate power of TTCs is carefully curated, and their narratives play an important role in the setting of governance dynamics at local, national and transnational levels. This qualitative work explores and compares the language used by British American Tobacco (BAT) and Philip Morris International (PMI) around harm, harm reduction and terms used to refer to newer nicotine and tobacco products, including electronic cigarettes and heated tobacco products. We systematically examine framings used by these two TTCs through company reports published between 2011 and 2021. Qualitative coding was carried out by four coders, according to a protocol developed specifically for this work. We firstly identified the presence of pre-selected keywords and then assigned chunks of text containing those key words to one or more associated frames drawn from Boydstun's policy frames codebook (2013). Qualitative coding identified the most common frames from Boydstun's codebook and thematic analysis highlighted three overarching themes. The most common frames assigned were "capacity and resources", "health and safety" and "economic" frames. The overarching themes were individualization, normalization, and regulation. These themes capture how both BAT and PMI use particular framings to downplay the role of TTCs in the perpetuation of population- and individual-level harms related to tobacco use. They seek to normalize their role in public discussions of health policy, to cast themselves as instrumental in the redress of tobacco-related inequalities and shift responsibility for the continuation of tobacco-product use onto individual consumers. These tactics are problematic for the effective and impartial development and implementation of local, national and international tobacco control agendas.
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Morar T, Robertson L. Smoking cessation among people with mental illness: A South African perspective. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 36073100 PMCID: PMC9453116 DOI: 10.4102/safp.v64i1.5489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Tobacco use is recognised as a serious, worldwide public health concern. Smoking cessation is of great interest across a wide range of medical specialities, including family medicine. However, smoking cessation among people with mental illness (PWMI) has attracted scant attention in South African literature. This is despite PWMI suffering disproportionately from the damages of tobacco. The harms of smoking are not limited to physical health but extend to mental health. This article discusses the need for multifaceted smoking cessation treatments for PWMI in the public health sector, taking into consideration the prevalence and unique drivers of smoking in this population. A brief overview of patterns of tobacco use, associated harms and smoking cessation interventions in South Africa is given; all within the context of mental illness.
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Affiliation(s)
- Tejil Morar
- Department of Psychiatry, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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Freeman B, Watts C, Astuti PAS. Global tobacco advertising, promotion and sponsorship regulation: what's old, what's new and where to next? Tob Control 2022; 31:216-221. [PMID: 35241591 DOI: 10.1136/tobaccocontrol-2021-056551] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/23/2021] [Indexed: 11/04/2022]
Abstract
Tobacco advertising, promotion and sponsorship (TAPS) bans are a cornerstone of comprehensive tobacco control laws. Global progress in implementing TAPS bans has been enabled by the adoption of the WHO Framework Convention on Tobacco Control. Innovative TAPS policies are in place internationally and include: point-of-sale display bans, plain packaging of products, industry spending on TAPS disclosure reporting, bans on retailer incentive programmes, and regulation of TAPS in entertainment and online media. However, there is an over-reliance on entertainment and digital content producers and platforms to self-regulate TAPS. Ensuring TAPS laws are regularly examined to limit loopholes and remove exemptions is crucial to continued success. The definition of what constitutes TAPS can allow the tobacco industry to deploy corporate communication and political campaigns that skirt TAPS bans. TAPS laws must also maintain pace with the changing media landscape, which includes monitoring and reporting TAPS that cross international borders, primarily through digital media platforms. Limiting tobacco retail supply will also serve to prevent the continued undermining of TAPS bans. Leveraging global corporation to ensure enforcement of TAPS bans across borders is urgently needed.
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Affiliation(s)
- Becky Freeman
- School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Christina Watts
- Daffodil Centre, Faulty of Medicine and Health, The Univeristy of Sydney, Sydney, New South Wales, Australia
| | - Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Udayana University Faculty of Medicine, Denpasar, Bali, Indonesia
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