Cross-sectional examination of tobacco point-of-sale marketing practices by location and type of retail environment in the District of Columbia

The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology.

Alternative Tobacco Products as a Second Front in the War on Tobacco

CVS becomes CVS Health, ends tobacco sales early

January 11, 2014, marks the 50th anniversary of a significant milestone in our nation's public health. It was on this date in 1964 that US Surgeon General, Dr. Luther Terry, courageously released the first Surgeon General's Report on Smoking and Health.[1][1] This landmark report transformed the way

Tobacco Use Patterns

Cancer-Related News from the CDC

Summary Providing data on usage patterns is key to assessing the reduced-risk potential of novel tobacco and nicotine products as compared to conventional cigarettes at a population level. A pilot cross-sectional survey was conducted in 2018 across 3 areas of Japan (Tokyo, Osaka, and Sendai) to assess tobacco and nicotine product use after the introduction of Heated Tobacco Products (HTPs). Following successful completion of the pilot study, two nationwide cross-sectional surveys were conducted using the general population in Japan to assess use patterns after the introduction of HTPs. The first (Wave 1) was conducted in 2019, and the second in 2020. In Wave 2, the concern of this publication, additional population-level data was obtained on use patterns and behaviour relating to tobacco and nicotine products in Japan. Eligible participants were Japanese residents, aged 20 years or older who consented to complete the survey. A 3-stage probability sampling method was applied that was geographically stratified by street blocks proportionate to population density. Respondents self-reported patterns of product use and reasons for HTP use. Complete responses were available from 5307 individuals, of whom 889 (16.7%) were current users, 1012 (19.1%) were former users, and 3407 (64.2%) were never users of tobacco products (weighted respondent totals). Of current tobacco users, 63.5% smoked cigarettes exclusively and 17.9% used HTPs exclusively. HTP dual use in combination with conventional cigarettes was 12.7%. The remaining 5.9% of users were categorised as poly users (i.e., use of 2 or more tobacco products). The most common reasons reported for HTP use were perceived reduction in harm to others and self - compared to cigarettes. These findings are consistent across pilot and Wave 1 conducted in Japan as part of this survey programme. Cigarettes were still the most frequent tobacco product used (13.4% in the pilot to 15.5% in Wave 1) within the general population, the usage prevalence for HTPs (5.3% to 5.4%) being considerable in comparison to other tobacco or nicotine-containing products like cigars, cigarillos, pipe, kiseru, and oral tobacco, where usage prevalence was close to zero. As with the previous Waves, no gateway effect (use of non-traditional combustible tobacco use – such as e-cigarettes and in this case HTP use – leading to subsequent tobacco smoking) was observed in this study. The findings presented here are indicative of the results from the initial study in 2018 and the nationwide Wave 1 study in 2019 but with a larger population, where the market is now more established with new-generation products. In conclusion, the prevalence of cigarette use in Japan is decreasing and HTPs seem to be increasingly used as an alternative to cigarette smoking.

Few topics in public health and medicine are as contentious as electronic cigarettes (e-cigarettes), novel handheld battery-operated nicotine-delivery devices that resemble conventional tobacco cigarettes and simulate the experience of smoking a cigarette.1-3 Unlike cigarettes that burn tobacco to generate smoke, e-cigarettes heat a liquid consisting of nicotine, propylene glycol or glycerin, flavorings, and other chemicals to create a vapor that is inhaled. Both conventional cigarettes and e-cigarettes deliver nicotine, the addictive agent in tobacco, but e-cigarettes do not expose the user to the many other tobacco smoke constituents responsible for causing tobacco-related diseases. e-Cigarettes therefore offer the tantalizing prospect that they could reduce the harms of conventional tobacco use, the leading cause of preventable death and disability in the United States and worldwide.4 e-Cigarettes have substantial consumer appeal, generating an estimated $2.2 billion in revenue in the United States in 2014.5 Their use by adults and adolescents in the United States has increased substantially.6,7 Their novel design and consumerappealmakee-cigarettesa“disruptive technology,”3 andtheirpotentialbenefitsandharmsaresubstantial andhotly debated.1,2 Meanwhile, the characteristics of these products are evolving; newer generationsdelivermorenicotine and resemble cigarettes less.8 Thus, e-cigarettes raise many questions forwhich thereare fewanswers.Theevidencebase is limited because e-cigarettes entered the marketplace without being regulated as either drugs or devices. The primary potential benefit of e-cigarettes is to reduce the prevalence of tobacco use by helping current smokers to quit or to switch completely and permanently from combustible tobacco to e-cigarette use. Dual use involving substituting someconventional cigaretteswith e-cigaretteswouldprovide far lessbenefit.However, anybenefitofe-cigaretteswould be offset to the extent that these products are harmful. The 3 principal public health concerns about e-cigarettes are their potential to renormalize cigarette use if they are permitted in venueswhere cigarettes are banned; their potential appeal to nonsmokers, especially to children and adolescents; and their possible health risks as a result of users’ exposure to e-cigarette constituents, such as flavorings or propylene glycol, or to e-cigarette contaminants.9 e-Cigarettes could increase tobacco use initiation rates if youthswhowouldnothaveotherwise triedconventional cigarettes try e-cigarettes, becomeaddicted tonicotine, and transition tousingcombustible tobaccoproducts.Adolescentsmay be especially susceptible to develop nicotine addiction after e-cigarette exposure because their brains are still developing and are particularly sensitive to nicotine.4 There is universal agreement that this is not a good outcome, and there is concern that it could occur because e-cigarettes are marketed in ways that appeal to youth.8 Whetheradolescents’useofe-cigarettespredisposes them to initiate conventional tobacco use is a critical question for assessing the net public health effect of e-cigarettes. The existing evidence derives from cross-sectional studies. In a nationally representative sample of US middle and high school students from 2011-2013, ever use of e-cigarettes was associated with conventional tobacco product use and with a measure of susceptibility to start smoking in the future,10 consistentwith anearlier analysis.11 In anational surveyofUSyoung adults from 2012-2013, ever use of e-cigarettes was associatedwithanopenness to smokeconventional cigarettes.12 The associations observed in these studies persisted after statistical adjustment for potential confounders, but crosssectional studydesigns cannot establish causality or the temporal direction of observed relationships.13 A longitudinal study can help untangle the temporality of these relationships. In this issue of JAMA, Leventhal and colleagues14 report findings fromsuchastudy.Theauthorsused a repeated-measuresprospectiveobservational studydesign to assess combustible tobacco and e-cigarette use among a diverse cohort of 2530 ninth graders attending 10 public high schools in Los Angeles, California, from 2013-2014.14 At baseline, all students were nonsmokers (defined has never having used a combustible tobacco product, including cigarettes, cigars, blunts, and hookah); 222 (8.8%) of them had ever used an e-cigarette. Nonsmokers with previous exposure to e-cigarettes at initial interview compared with those without exposure toe-cigarettesweremore likely to reportuseofacombustible tobacco product during the next 6 months (30.7% vs 8.1%, respectively) and 12 months (25.2% vs 9.3%, respectively). Significant associations also were found for each individual tobacco product, including cigarettes, cigars, and hookah. The investigators carefully adjusted the analysis for manyknownsociodemographic, family,environmental,andintrapersonal factors associated with e-cigarette and combustible tobacco use. This adjustment substantially lowered the magnitude of the association between e-cigarettes and subsequent tobaccouse (odds ratio [OR]declined from4.27 [95%CI, 3.19-5.71] to 2.73 [95%CI, 2.00-3.73]), suggesting that these facAuthor Audio Interview at jama.com

Position Statement on Tobacco Exposures in Children and Families

Introduction: Objectives of this study were to determine retail and neighborhood characteristics associated with smokeless tobacco (ST) product promotion, price promotion, and storefront advertising among retailers in Oklahoma.Methods: In this statewide point-of-sale study, we collected data from 1,354 ST retailers. Using store characteristics and census tract information, we estimated summary statistics and adjusted prevalence ratios during 2019–2020.Results: Of ST retailers audited, 11.0% demonstrated ST youth promotion, 43.0% ST price promotions, and 19.6% ST storefront advertising. The adjusted prevalence ratio (aPR) for convenience stores was higher for all three ST strategies: youth promotion (aPR = 3.4, 95% CI 1.9, 6.2), price promotion (aPR = 3.8, 95% CI 2.9, 5.0), and storefront advertising (aPR=16.4, 95% CI 6.7, 40.3) compared to other store types. Metropolitan tobacco retailers had higher aPRs for youth promotion (aPR = 1.7, 95% CI 1.12 2.6) and storefront advertising (aPR = 1.5, 95% CI 1.2, 1.9).Conclusions: Findings of this study suggest there are currently ample opportunities for youth and adults at risk for tobacco initiation to be exposed to ST products in the retail environment. Convenience stores, more likely to be found and utilized in rural areas compared to metropolitan areas, are disproportionately more likely to engage in marketing strategies that could lure youth into trying smokeless tobacco.

Tobacco use constitutes the largest preventable cause of death and disability in developed countries and a rapidly growing health problem in developing nations. It is responsible for 30% of all cancer deaths and 80% of lung cancer deaths and is associated with increased risk for at least 17 types of cancer. In addition to the tremendous human toll tobacco has taken in the 20th and 21st centuries, the economic costs of tobacco-related illnesses remain enormous. From 2000 to 2004, the United States spent approximately $193 billion each year on tobacco-related illnesses and lost productivity because of tobaccorelated premature death. Loss in productivity and increased health care costs associated with secondhand smoke (SHS) were reported in 2005 to have cost the United States an additional $10 billion per year. Although the United States has witnessed a decline in cigarette use, the use of other tobacco products is on the rise. Furthermore, the rate of reduction of youth tobacco use is no longer as rapidly decreasing, despite intense public education and policy efforts to reduce youth tobacco use. At the global level, the epidemic of tobacco-related disease and death has just begun, because of the several-year lag between when individuals begin using tobacco and when their health suffers. Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to 1 billion deaths in the 21st century. Unchecked, tobacco-related deaths will increase to more than 8 million per year by 2030. More than 80% of those deaths will be in lowand middle-income countries. As the leading professional organization representing physicians involved in cancer treatment and research, the American Society of Clinical Oncology (ASCO) is dedicated to the prevention and treatment of cancer. The overarching goal of the tobacco cessation and control efforts of ASCO are to promote the rapid, worldwide reduction and ultimate elimination of tobacco-related disease through discouraging the use of tobacco products and exposure to secondhand tobacco smoke. The tobacco control efforts of ASCO are led by a subcommittee of the Cancer Prevention Committee. The primary tobacco control goals of ASCO are multifaceted: 1) to develop an oncology workforce that effectively integrates tobacco cessation and control into its practices; 2) to collaborate with other organizations and professional societies to promote rapid, worldwide reduction in tobacco use and ultimate elimination of tobacco-caused disease, including disease resulting from secondhand smoke; and 3) to urge oncology providers to become proponents of tobacco policy change. In 2003, ASCO released a policy statement on tobacco cessation and control, which set forth specific recommendations and called for personal accountability in eradicating tobacco use domestically and globally. Since that time, there have been significant developments in tobacco cessation and control that have changed the political and scientific landscape. In response, the ASCO Cancer Prevention Committee commissioned this update of the previous ASCO statement to reflect the evolving regulatory and policy environment. This statement reviews advancements that have been made in tobacco cessation and control since 2003 and sets forth a refined set of recommendations for addressing tobacco cessation and control based on current challenges and opportunities. Key principles in the statement are as follows:

In the Russian Federation, after the adoption of Federal Law “On the Protection of Citizens' Health from the Effects of Tobacco Smoke and the Consequences of Tobacco Use”, the prevalence of smoking tobacco has significantly decreased. Reducing the consumption of smoking tobacco products led to the emergence of a new aggressive policy of tobacco companies, which resulted in the emergence of new “innovative” products and the concepts of “less harmful tobacco product” or “less harmful nicotine-containing product”. The undoubtedly aggressive advertising campaigns of tobacco companies and manufacturers of electronic cigarettes have affected the smoking behavior of tobacco consumers, which has begun to change in recent years.The purposeof this study was to study new trends in the structure of consumption of tobacco and nicotine-containing products in various age groups of the Russian Federation, as well as among men and women.Methods. Analysis of the structure of consumption of tobacco and nicotine-containing products was carried out as part of an online public opinion poll to study the level of awareness of measures to reduce the prevalence of tobacco products in the Russian Federation, initiated in 2019 by the Ministry of Health of the Russian Federation. A total of 1 282 respondents from 73 regions of the Russian Federation took part in the survey. Among the respondents there were 447 (34.9%) men and 835 women (65.1%) aged 18 years and younger to 70 years. To conduct a comparative analysis of the structure of use of tobacco and nicotine-containing products, the frequencies of their use in different age groups, among men and women, were calculated. A statistically significant difference between the groups was confirmed by analyzing the dependence in the contingency table using the χ2criterion.Results. A total of 432 respondents reported the use of tobacco and nicotine-containing products, which amounted to 33.7% of all respondents. The most used products were smoking tobacco (57.64%), electronic cigarettes (34.03%) and waterpipe (33.80%). However, in different age groups, the structure of their use was significantly different (p < 0.05). The highest level of electronic cigarette use, including vapors containing nicotine and electronic nicotine delivery product, were found in the age group of 18 years and younger (58.82%). In the older age groups, a significant decrease in the level of consumption was observed. Chewing tobacco and snuff were consumed by consumers significantly less than other tobacco products. Smokeless tobacco was mainly consumed by consumers aged 18 years and younger, its level was 20.58%. The highest level of waterpipe consumption was found among consumers in the age group of 19 – 29 years (53.85%), it was slightly less in the group of 18 years and younger (44.11%). The higher level of waterpipe consumption was detected (40.35%) among women than it was among men (26.47%). Many consumers indicated that they consumed several types of tobacco and nicotine-containing products. The most popular combination of products was found among consumers under the age of 30, and 20.59% of consumers aged 18 and younger consumed at the same time almost all the types of tobacco and nicotine-containing products that were presented on the market.Conclusion. The study revealed new trends in preferences for consumption of tobacco and nicotine-containing products. The new trends have significantly changed the structure of the consumption of these products among the population of Russian Federation.

Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pipe tobacco occurred among high school students, while decreases in current use of any tobacco product, e-cigarettes, and hookah occurred among middle school students. Current use of any combustible tobacco product, ≥2 tobacco products, cigarettes, cigars, smokeless tobacco, and bidis did not change among middle or high school students during 2016-2017. Comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among U.S. youths (1,2).

Smoke alarm from Afghanistan to Morocco

Over the past half century, tobacco control arguably has been America's greatest public health success story. Antismoking campaign–induced decisions to quit smoking or not to start in the first place have translated into the avoidance of more than 5 million premature smoking-related deaths. On