Tobacco Control最新文献

Background: The landscape of tobacco and nicotine delivery products has rapidly evolved with the introduction of electronic nicotine delivery systems (ENDSs) and oral nicotine pouches (ONPs). Understanding sales trends and flavour preferences is critical for assessing these products' public health impact and informing regulatory strategies.

Objective: To characterise recent trends in US sales of ENDS and ONPs from 2018 to 2023, overall and by flavour.

Methods: Information Resources retail sales data covering 40 states from 7 January 2018 to 16 July 2023, were used to document trends in ENDS and ONP sales from brick-and-mortar retailers, by product flavour (non-menthol, mint/menthol and tobacco/unflavoured) in 4 week periods.

Results: ENDS and ONP sales have shown significant growth, with notable fluctuations coinciding with public health concerns and regulatory announcements. Specifically, non-menthol flavoured ENDS initially experienced a decline in sales following regulatory actions in early 2020 but strongly rebounded thereafter. Meanwhile, ONP sales have increased steadily, dominated by mint/menthol flavours. These trends may reflect consumer flavour preferences as well as manufacturers' strategic responses to policy changes. Sensitivity analyses using more recent sales data from 24 states confirm that these patterns persist.

Conclusions: Differences in ENDS and ONP sales trends by flavour type underscore the importance of ongoing, detailed monitoring of nicotine product sales and use, to clarify public health implications and guide regulation. Given the growing variety of nicotine and tobacco products available today, tobacco regulatory frameworks must consider trends across this rapidly evolving market to understand and mitigate associated public health risks.

Background: Tobacco taxation is a proven strategy to reduce cigarette consumption, but its impact may be reduced by industry pricing tactics. Relatively few studies have examined the extent to which tobacco industry pricing strategies attenuate the impact of taxes on cigarette demand. This study compared the impacts of the 2018 and 2023 tobacco taxes in Singapore, focusing on changes in cigarette demand and industry pricing responses.

Methods: We analysed brand-level recommended retail pricing (RRP) and monthly sales volume data from 2016 to 2023. We grouped brands into five price tiers, using weighted averages to assess changes in RRP and interrupted time series analyses to assess changes in cigarette demand and calculated price elasticity of demand (PED) before and after each tax increase.

Results: The 10% tax increase in 2018 raised average RRP by 4.6% and reduced cigarette demand by 4.0% (PED=-0.22). The 15% tax increase in 2023 raised average RRP by 13.8% and reduced demand by 7.5% (PED=-0.86). In 2018, tobacco companies used price smoothing and undershifting to protect cheaper brands, whereas in 2023, price increases were more uniform across all price tiers.

Conclusion: Singapore's 2023 tobacco tax increase was predictably more impactful than the 2018 increase, both in terms of price change and demand reduction. Industry pricing tactics blunted the effect of the 2018 tax but were less protective in 2023. Repeated, substantial tax increases, coupled with regulatory oversight of pricing practices, are important to maximise public health impacts.

Objectives: This systematic review examines eye-tracking experiments evaluating the effects of tobacco health warning labels (HWLs) on visual attention. We focus on eye-tracking metrics (dwell time, fixation counts and time to first fixation) to inform tobacco control strategies.

Data sources: Controlled keyword searches were conducted in APA PsycINFO, ASSIA, CMMC, CINAHL, Embase, Psychology & Behavioral Sciences Collection, PubMed and Web of Science from January 2018 to December 2023.

Study selection: Eligible articles (n=25) were peer-reviewed, written in English, involved human participants and included eye-tracking technology to assess attention to HWLs.

Data extraction: Extracted data included article information, HWL characteristics (product type, context, format, source), study design, sample demographics and eye-tracking outcomes. Two trained reviewers collaboratively screened and extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data synthesis: Across 31 experiments, dwell time was consistently longer for pictorial than textual HWLs, fixation counts increased when packs contained fewer visual distractions, and time to first fixation was shorter for more visually salient HWLs. Greater visual attention was also associated with lower liking of tobacco products and stronger negative emotional responses. Independent t-tests on summary data showed that participants (mostly adult males) spent more time viewing and less time locating pictorial HWLs than text-only HWLs, while fixation counts did not differ significantly.

Conclusions: This review provides eye-tracking evidence aligned with WHO recommendations for pictorial HWLs and highlights key research gaps that future studies should address to strengthen global tobacco control efforts.

Introduction: Following a historic 2006 US Federal Court ruling, major cigarette manufacturers were mandated to display corrective statements about smoking harms at the point-of-sale (POS) in about 200 000 tobacco retailers nationwide from October 2023 to June 2025. This study assessed sign exposure and reactions among US adults who smoke (AWS) cigarettes and youth.

Methods: An online survey was conducted in late 2024 with nationally representative samples of (≥21 years) AWS (n=1575) and youth aged 15-20 (n=1039). Respondents viewed image examples and reported sign exposure over the past 12 months. Measures included exposure frequency, sign reactions and sociodemographic and behavioural correlates. Weighted prevalence estimates and multivariable logistic regression were used.

Results: Self-reported exposure was 26.2% among AWS and 18.4% among youth. Exposure was higher among more frequent visitors to chain convenience stores and gas stations, younger adults, AWS interested in quitting and youth who had tried cigarettes. Most exposed participants saw the signs multiple times and reported signage trust (80.2% AWS; 88.7% youth), support (85.3% AWS; 88.7% youth) and thoughts about smoking risks (71.4% AWS; 81.9% youth). Sign exposure was considerably lower than for tobacco ads at POS (84.0% AWS; 74.3% youth).

Conclusions: About 18% of youth and 26% of smoking adults reported corrective statement exposure at POS. While exposure was positively associated with store visitation frequency, exposure was lower than for other tobacco POS messaging, suggesting that visual competition and limited retailer coverage may have constrained reach. Findings can inform future health messaging strategies in retail environments.

Objective: To systematically review the instrumental and discursive barriers and facilitators that have influenced standardised packaging (SP) policies for tobacco, emphasising contextual, institutional, legal, political and rhetorical dynamics.

Data sources: We searched PubMed, Embase and Web of Science for peer-reviewed studies published in English between January 2005 (post-Framework Convention on Tobacco Control enforcement) and October 2025. Search terms combined tobacco and packaging concepts (eg, 'tobacco', 'standardised packaging') with policy process terms (eg, 'barrier', 'facilitator'). Reference lists of included studies were also screened.

Study selection: Of 967 records identified, 41 met the inclusion criteria. Eligible studies examined barriers or facilitators to any phase of the SP policy process (preadoption, implementation or postimplementation). Screening was conducted by one reviewer and verified by two others; discrepancies were resolved by consensus.

Data extraction and quality appraisal: Data were extracted into a framework integrating the Policy Dystopia Model, Multiple Streams Theory and Strategic Action Typologies. Extracted elements included instrumental (action-based) and discursive (argument-based) strategies, policy stage, actor type, design/data collection methods. Quality was assessed using an adapted Critical Appraisal of Research Evidence tool.

Data synthesis: Industry-led legal, economic and framing strategies were consistent barriers, while governmental legal preparedness, coordination and strategic framing enabled progress, mainly in high-income countries. Evidence on low and middle-income countries and postimplementation processes remains scarce. Research relies heavily on secondary or descriptive designs, underscoring the need for longitudinal, process-oriented analyses.

Conclusions: SP success depends on navigating political, institutional and discursive arenas as much as technical design. Strengthening legal capacity, coordination and framing is vital to sustain implementation globally.

Significance: Compared with adults who smoke cigarettes, adults who vape nicotine are exposed to similar levels of nicotine and significantly lower levels of tobacco-specific nitrosamines (TSNAs). Little research outside the USA has included youth who vape, particularly those using newer disposable vapes. We investigated exposure to nicotine and the TSNA NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) among youth in England who vape, smoke, do both (dual) or do neither.

Methods: In 2023, youth aged 16-19 years from England completed a survey and provided a urine sample (n=201). Linear regressions examined associations of creatinine-normalised urinary concentrations of total nicotine equivalents (TNE-2) and NNAL (a metabolite of NNK) with past 7-day smoking/vaping status and self-reported recency of vaping. All analyses were adjusted for age, sex at birth, ethnicity and any past 7-day cannabis use.

Findings: Over three-quarters (77%) of those vaping were using the newer disposable vapes. Urinary TNE-2 concentrations among those who exclusively vaped in the past 7 days (n=83, geometric mean (GM)=5.09 nmol/mg creatinine (95% CI 3.19 to 8.12)) did not differ significantly from those who smoked (n=9, GM=1.74 nmol/mg creatinine (95% CI 0.64 to 4.72), p=0.426) or those who dual used (n=55, GM=5.60 nmol/mg creatinine (95% CI 3.32 to 9.43), p=0.953). Levels of NNAL among those who exclusively vaped (GM=1.87 pg/mg creatinine (95% CI 1.62 to 2.17)) were significantly lower than those who smoked (GM=4.87 pg/mg creatinine (95% CI 2.45 to 9.68), p=0.001) or those who dual used (GM=3.67 pg/mg creatinine (95% CI 2.76 to 4.86), p<0.001) and not significantly different from youth who neither vaped nor smoked (GM=1.84 pg/mg creatinine (95% CI 1.52 to 2.24), p=0.887).

Interpretation: Youth who vape are exposed to similar levels of nicotine as those who smoke or who dual use. NNAL exposure among youth who vape is much lower than among those who smoke and indistinguishable from youth who do not vape or smoke.

Background: Some tobacco companies have announced support for transitioning people who smoke to non-combustible tobacco products. However, tobacco manufacturers continue to spend billions of US$ annually promoting combustible products. This study examined the prevalence and characteristics of three types of promotions offered by leading US combustible brands.

Methods: We identified leading US cigarette and cigar brands by market share and conducted online searches to determine which of these brands had brand-specific websites. A total of 11 cigarette and 8 cigar brand websites were included, representing 85.6% and 90.3% of cigarette and cigar sales, respectively. Each brand website was dual-coded for content related to coupons, rewards programmes and sweepstakes.

Results: All cigarette brand websites offered coupons, while 27.3% promoted rewards programmes. Examples of prizes offered through rewards programmes included Apple AirPods, Ray-Ban sunglasses, GoPro cameras, cigarette coupons and a variety of gift cards (eg, Uber Eats). Moreover, 45.5% of cigarette brand websites promoted sweepstakes, offering prizes, including instant cash, a motorcycle and a vacation. Among leading cigar brands, 12.5% offered coupons and 37.5% promoted rewards programmes, with prizes including cigar coupons, cigar branded clothing and ashtrays. None of the cigar brands offered sweepstakes.

Conclusions: Many leading US combustible tobacco product brands incentivise continued combustible product use through offerings of free prizes and reduced prices, including some brands made by manufacturers that claim to be committed to tobacco harm reduction. Marketing restrictions may be needed to address combustible tobacco product use.