Nicotine & Tobacco Research最新文献

Introduction: This review summarizes research on the public health impacts of flavored cigar bans, which are policies that restrict the sale of cigars containing characterizing flavors.

Methods: A systematic literature search was conducted using PubMed, Scopus, PsycInfo, CINAHL, and Applied Social Sciences Index and Abstracts. Studies were included if they evaluated the impact of a real-world or hypothesized flavored cigar ban. The primary outcome was tobacco use behavior. Secondary outcomes included retailer compliance, sales, and the tobacco industry response to flavored cigar bans. Two reviewers independently screened articles for inclusion, extracted data, and assessed study quality. We also conducted a meta-analysis using random effects models to pool estimates on tobacco use behavior after a flavored cigar ban. This review was registered with PROSPERO (CRD42023481603).

Results: Of 2399 articles identified in the preliminary search, 55 were included in the review. Many real-world studies found declines in cigar use post-ban, specifically among youth. However, other studies found no significant changes in cigar use. Among studies examining sales, there were declines in flavored cigar sales but increases in sales of non-flavored cigars and other tobacco products. Among studies assessing hypothesized tobacco use behavior, pooled results indicate that 8% (95% CI: 2%, 27%) of flavored cigar users intend to quit tobacco altogether, 45% (95% CI: 39%, 50%) would switch to non-flavored cigars or cigarettes, and 41% (95% CI: 32%, 51%) would switch to other tobacco products.

Conclusion: Flavored cigar bans may reduce cigar use and improve public health when policies are comprehensive and well-enforced.

Introduction: The popularity of e-cigarettes is increasing globally. Validated instruments in local languages are needed to measure e-cigarette dependence for surveillance, diagnosis, and treatment of e-cigarette dependence. We assessed the psychometric properties of the Malay language version of the 8-item E-cigarette Dependence Scale, EDS-8(Malay), among exclusive e-cigarette users.

Methods: The original English version of the eight-item E-cigarette Dependence Scale (EDS-8) was translated into Malay to suit the local context by standard forward and backward translation methods. Two professional native Malay-speaking translators and two professional native English-speaking translators carried out the forward and backward translation process, respectively. The reliability and validity of the EDS-8(Malay) were determined using a group of 251 adult Malaysians who were exclusive e-cigarette users. They were recruited from social media platforms.

Results: Their mean age was 37.9 (SD=10.3) years, and 73.2% were males, Malay race (41.3%), attained secondary education (51.8%), were employed(88.4%), and 61.7% were frequent vapers. Cronbach's alpha of EDS-8(Malay) was 0.894. Corrected item-total correlations were >0.4. The EDS-8(Malay) displayed a good composite reliability of 0.896. A confirmatory factor analysis revealed that the one-factor model exhibited good fit indices, including RMSEA (0.056), GFI (0.967), AGFI (0.935), CFI (0.984), and NNFI (0.975). EDS-8 (Malay) was able to detect the between-group mean differences as shown by higher scores among e-cigarette users who were Indians, had lower income, received secondary education, and vaped regularly.

Conclusions: The instrument EDS-8 (Malay) displayed acceptable reliability, content, and construct validity. The convergent validity of EDS-8 (Malay) should be tested when comparable tools become available in the Malay language.

Implications: To date, there are no validated translated versions of e-cigarette dependence tools originally developed in the English language. Our Malay language version of the eight-item e-cigarette dependence scale provides locally validated e-cigarette dependence for potential use in Malaysian clinical settings and for research on e-cigarette addiction. The other tools available for the assessment of e-cigarettes need to be translated and validated to assess the convergent validity of the eight-item e-cigarette dependence scale in the Malay language.

Introduction: Couple-based smoking cessation interventions can be more effective than individual ones in initiating and maintaining cessation behaviors, but they often require costly in-person visits. More affordable and accessible options are needed. The aim of this study was to develop a couple-based, web-app, WeQuit, for smoking couples and to pilot-test its feasibility, acceptability, and preliminary effects.

Methods: Using Family Systems theory, WeQuit was developed focusing on three relational constructs: communal coping, smoking-system fit, and ironic processes. Feasibility was evaluated by completion rates and time spent on the app. Acceptability was determined by using standardized measures of perceived usability and satisfaction with WeQuit. Preliminary effects were determined by changes in smoking-related and relational couple dynamic variables.

Results: Forty couples were invited and completed WeQuit. Nearly half of the primary smoking participants were female (n = 20, 50.0%) and Black (n = 18, 45.0%). About 77.5% (n = 31/40) and 45.0% (n = 18/ 40) completed more than half and 100% of the program, respectively. WeQuit was perceived as "very useful" (80.0 %) and "very easy to use (87.0 %). Respondents felt 'very confident developing quit plans' (80.0 %) and 'very satisfied" (87.0 %). WeQuit significantly improved positive partner support (p<.001). Participants who quit showed significant improvements in positive partner support (p<.001) and dyadic efficacy (p=.006).

Conclusions: This study reveals that the theory-guided couple-based web-app, WeQuit, holds promise for promoting smoking cessation among smoking couples. Future research will involve a large pilot trial to evaluate the effectiveness of WeQuit on smoking cessation outcomes.

Introduction: Sales of oral nicotine pouches (ONPs), including brands such as Zyn, on!, Velo, and Rogue, have risen precipitously in the United States. One potential driver of ONP use may be exposure to the products and their marketing in local tobacco retailers. This study examines the prevalence and correlates of ONP availability in a large, representative sample of tobacco retailers in three major US cities.

Aims and methods: In 2023, research staff visited a stratified, random sample of 20% of licensed tobacco retailers in San Francisco, New York City, and Philadelphia (n = 1402) and documented the availability of ONPs. Binomial generalized linear mixed models estimated adjusted odds of ONP availability by city, store type, and district sociodemographic characteristics.

Results: ONPs were available in 28.7% of retailers and were most prevalent in chain convenience stores (60.5%), followed by smoke/vape shops (53.3%, p < .0001). After adjusting for city and store type, the odds of a retailer carrying ONPs were higher in districts with a greater proportion of non-Hispanic White residents (adjusted odds ratio [aOR]: 2.33 [1.10, 4.94]), a higher median household income (aOR: 2.04 [1.23, 3.38]), and a lower proportion of youth residents (aOR: 0.25 [0.15, 0.43]).

Conclusions: ONP availability was greater in retailers located in predominantly White and higher-income neighborhoods and those with fewer youth. As researchers continue to evaluate the risks of ONPs as well as their potential as a tobacco harm reduction strategy, attention to variations in retail access and population patterns of use will be critical to determine impacts on health equity.

Implications: Sales of oral ONPs have increased precipitously in the United States, but little is known about patterns of retail access in neighborhoods, which may influence consumer use behaviors. This study found that over one in four tobacco retailers carried ONPs, but availability was greater in largely White and high-income neighborhoods and those with fewer youth. As researchers continue to evaluate ONP risks and potential benefits, this study provides insight into the role that retail access may play in shaping population patterns of use and subsequent impacts on health equity.

Introduction: Oral nicotine pouches (ONPs) are increasingly prevalent among young people and feature widely within social media content. This study systematically analyzes the most viewed videos on TikTok relating to ZYN (the most popular ONP, manufactured by a subsidiary of Philip Morris International) to understand their content sentiment and patterns, as well as the demographics and potential commercial biases of their creators.

Aims and methods: We used an Apify scraper in July 2024 to collect URLs and metadata for the top 100 most viewed videos on TikTok under the #ZYN hashtag. Profiles of content creators, plus their externally linked sites, were examined for commercial connections to ONP entities. We then undertook an inductive manifest content analysis.

Results: The top 100 TikTok videos identified garnered over 400 million views and over 3.8 million shares. A total of 10.3% (n = 9) of content creators had an external link to a website that sold ONPs. Videos predominantly indicated positive sentiment toward ZYN products or other ONPs (79%), and portrayed young men enthusing about the products, often employing humor. ZYN products are featured directly in 71% of videos. Few videos contained disclaimers or warnings about potential risks of ONPs and only 5% portrayed ZYN as a vaping or smoking cessation tool.

Discussion: Our findings suggest the most widely viewed content relating to ZYN on TikTok is overwhelmingly positive in sentiment, commonly featuring young men and often portraying ONP use in a humorous context, minimizing risks. Many content creators actively sell ONP products through TikTok, some overtly and some via external links.

Implications: ZYN oral nicotine pouches are presented positively and primarily for recreational purposes on TikTok. Few videos referenced ZYN for smoking cessation purposes or mentioned the risks of nicotine. 10.3% of the creators linked their profile to an external website selling oral nicotine pouches, which appears inconsistent with TikTok's policies. The use of humor and downplaying or omission of addiction and health risks across most of the sample echoes marketing efforts by the tobacco industry to present oral nicotine pouches as fun and safe.

Background: The public health impact of new nicotine products will depend on their use by different population groups. We assessed the prevalence of nicotine pouch use among youth and adults in Great Britain (GB).

Aims and methods: Cross-sectional annual Action on Smoking and Health Smokefree GB Adult Surveys 2020-2024 (n: 12 247 to 13 266, 18+) and Action on Smoking and Health Smokefree GB Youth Survey 2024 (n = 2872 11-18-year-olds). Weighted proportions and 95% confidence intervals for pouch ever and current use among adults over time, and in 2024 among youth and adults overall, by socio-demographics, mental health, tobacco smoking, vaping, past-12-month gambling, cannabis, and alcohol use; for youth also family members' smoking and vaping. Multivariable logistic regression assessed the association with ever pouch use.

Results: The prevalence of adult ever and current use doubled from 2020 to 2024, reaching 5.4% (95% confidence interval = 5.0 to 5.8) and 1.0% (0.8-1.1). Among youth, 3.3% (2.7-4.0) reported ever use, including 1.2% (0.8-1.6) reporting current use. Ever use was associated with the use of other addictive products. Among adults, ever use was also more common among younger groups (18-24, 25-34, 35-44 vs. 55+), males, and those in rented accommodation or receiving mental health treatment. Among youth, ever use was also more common among those in London than elsewhere in England.

Conclusions: Pouch use in GB is rare with about 1 in 100 youth and adults reporting current use. However, use appears to be increasing and is higher in some groups, including younger adults, males and people with experience of vaping, smoking, and use of other addictive products.

Implications: While currently low, close monitoring of pouch use is indicated. It is currently concentrated among those with experience of nicotine use. However, given the higher levels of use among young adults and teenagers, consideration of regulation may be required to minimize uptake among groups that would otherwise not have used nicotine-containing products.

Introduction: Oral nicotine pouches (ONPs) have steadily gained popularity since first appearing in the US market during 2014, but research on how their features are associated with consumer preference remains limited. We examined how ONP characteristics, including prices, flavors, pouches per can, nicotine concentration, and ingredient claims, are associated with online ratings (1-5 stars), which measured consumer preferences in our analysis.

Aims and methods: Data on 1689 unique ONPs from 19 brands that received reviews were scraped from 4 online stores that shipped to the United States, and we used ordinary least squares regressions to estimate associations between product features and ratings.

Results: On average, products cost $0.20/pouch and contain 19 pouches/can. Nearly half (46%) had 5 to <10 mg nicotine/pouch. The most common flavors were "fruit/sweet" (33%), "mint" (25%), and "wintergreen" (13%), while 21% of products had "ice/freeze" mentions. The brand on! accounted for 15% of products. Nicotine claims included "tobacco-free" (21%), "leaf-free" (26%), "synthetic" (8%), and multiple claims (20%). Product size was associated with lower ratings, while mint flavor was associated with higher ratings (p < .05). Product characteristics were highly correlated with brands, and the negative association between price per pouch and ratings became insignificant after adjusting for brands.

Conclusions: More pouches per can are associated with lower ratings. Sales prices vary across ONP brands, which is related to how consumers rate more expensive products. Future research should investigate how restricting mint flavor, product size, and certain brands may impact consumer preferences for ONPs and their subsequent use.

Implications: We provide novel evidence on how oral nicotine pouch (ONP) features are associated with consumer preferences, measured by online ratings (ranging from 1 to 5 stars). Larger product size (more pouches per can) is associated with lower consumer ratings, while mint flavor is associated with higher ratings. Brands are strongly correlated with ratings, impacting how consumers rate more expensive products. Restricting mint flavor, product size and certain brands may influence consumer preferences for ONPs and their subsequent use, which should be investigated in future research.

Introduction: Nicotine pouches are gaining popularity among young people. Within 5 years of their introduction, Pakistan has become the third-largest market for Velo, a leading brand among nicotine pouches. However, more information is needed to know about the availability and marketing of these products at point-of-sale (POS).

Aims and methods: In August 2023, we surveyed 711 POS across nine districts covering all four provinces of Pakistan. We collected data on the availability of different brands of nicotine pouches and their flavors, nicotine strengths, prices, and pack features. Furthermore, we recorded any POS advertising in a subsample of 382 POS.

Results: In Pakistan, nicotine pouches were available in all four provinces, eight of nine surveyed districts, and 56 of 711 (7.9%) POS. Urban settings had wider availability and more variety than rural settings. Velo, available in six flavors and three different strengths, captured 85% of the market. On average, nicotine pouches cost 133 Pakistani Rupees (standard deviation 18.9, range 100-190 PKR) or 0.44 US dollars. Display stands advertising nicotine pouches were observed in 12.3% (46/382) POS.

Conclusions: Nicotine pouches are widely available across Pakistan. A range of flavors and strengths are being sold at an affordable price, making it attractive, particularly for young people. Continued surveillance of these products is needed. Their perceptions and use, and their impact on the tobacco uptake in youth, also need further research.

Implications: We observed the widespread availability of Velo and the growing nicotine pouch market in Pakistan, underscoring the urgent need for regulation. These products appeal to youth with diverse flavors and affordability, raising concerns about experimentation leading to addiction. Policymakers must prioritize regulating manufacturing, sales, and marketing to limit youth access. Limited research in Asia necessitates longitudinal studies to explore the oral health impact of using these products. Continued monitoring of promotions at POS, along with studies on youth perceptions, usage patterns, and influence on tobacco uptake, is critical for effective policy development.

Introduction: Artificial sweeteners, sucralose and acesulfame-k, are listed as ingredients of oral nicotine pouches (ONPs), a product category with a rapidly growing market share. The exact quantities of these sweeteners in ONPs remain unknown. Artificial sweeteners in ONPs may reduce aversion, facilitate initiation, and encourage consumption behavior.

Aims and methods: Sucralose and acesulfame-k contents in major US-marketed ONP brands (Zyn, on!, and Velo) were determined by liquid chromatography-mass spectrometry. Sweetener effects on aversion and consumption of ONPs were modeled in single- and two-bottle drinking tests, offering mice ONP extracts calibrated to contain nicotine levels similar to the saliva of people who use smokeless tobacco. To examine the contribution of sweet taste perception, consumption behavior was compared between wild-type and sweet taste receptor-deficient mice (Tas1r2-/-).

Results: Acesulfame-k was detected in on!, Zyn, and Velo ONPs (~0.3 to 0.9 mg/pouch), including products marketed as "Unflavored" or "Flavor ban-approved." In Velo ONPs, sweetened with sucralose (~0.6 to 1.2 mg/pouch), higher nicotine strength products contained higher sucralose levels. Tas1r2-/- mice consumed less ONP extracts than wild-type mice in both sexes. ONP extracts with both higher nicotine and sweetener strengths were tolerated by wild-type mice, but produced stronger aversion in Tas1r2-/- mice.

Conclusions: ONPs contain significant amounts of artificial sweeteners acesulfame-k and sucralose, with some brands adding more sweeteners to higher nicotine strength ONPs. In mice, artificial sweeteners, at levels present in ONPs, increase nicotine consumption. Increasing sweetener contents facilitates the consumption of higher nicotine strength ONPs. Sweetness imparted by sweetener addition to ONPs likely reduces the aversive sensory effects of nicotine and other ONP constituents.

Implications: Artificial sweeteners such as acesulfame-k or sucralose reduce aversion and likely facilitate the consumption of ONPs. The marketing of some artificially sweetened ONPs as "Unflavored" or "Flavor ban-approved" suggests that the tobacco industry rejects sweet taste as a determinant for the presence of a characterizing flavor. Sweetness as imparted by artificial sweeteners in tobacco products needs to be addressed by regulators as a component of a characterizing flavor, with the aim to reduce product appeal and initiation by never users, and especially youth attracted to sweet flavors.