INTRODUCTIONAdolescents often overestimate peer smoking and vaping, increasing the likelihood of initiation. School environments play a central role in shaping these perceptions. This study therefore aimed to examine whether a school-based environmental intervention modifying the school environment can shift adolescents’ perceived norms and reduce (e-)cigarette use.METHODSA quasi-experimental pre-post study was conducted in three Swiss secondary schools (March–June 2024; baseline n=664; follow-up n=884). The intervention comprised a multi-component environmental approach, including the relocation of designated smoking areas to less visible locations, accompanying signage, improvements to non-smoking areas, and informational posters. Perceived peer (e-)cigarette use, and self-reported (e-)cigarette use were reported through online surveys at baseline and at one month post-intervention.RESULTSEffects varied across schools. In School 1, perceived prevalence of (e-) cigarette use decreased (cigarettes: β= -0.44; 95% CI: -0.68 – -0.21; e-cigarettes: β= -0.53; 95% CI: -0.80 – -0.25). In School 2, reductions differed by (e-)cigarette use: never and former users reported lower perceived cigarette prevalence at follow-up, whereas occasional and regular users showed no change. Perceived e-cigarette prevalence decreased (β= -0.42; 95% CI: -0.69 – -0.15). In School 3, changes varied by (e-)cigarette use, with regular users reporting lower perceived cigarette prevalence (interaction: β= -1.60; 95% CI: -2.75 – -0.45). Perceived e-cigarette prevalence did not change. Across schools, the intervention did not affect (e-)cigarette use.CONCLUSIONSA school-based environmental intervention modifying the school environment may influence adolescents’ descriptive norms, although effects appear to depend on baseline policies and implementation context.

INTRODUCTIONTobacco use among Caribbean adolescents surpasses global averages. Given the adverse effects, regional efforts have prioritized reduction and eventual elimination and have adopted the World Health Organization's Framework Convention on Tobacco Control (WHO-FCTC). Guided by the Health Belief Model, we examine changes in tobacco abstinence and abstinence-related perceptions before and after the WHO-FCTC.METHODSWe conducted a cross-sectional secondary analysis of Global Youth Tobacco Survey data. We specifically examined adolescents aged 13–15 years from three Caribbean countries, including participants surveyed in 2000 (n=3431) and 2017–2018 (n=3767). We first conducted chi-squared tests and t-tests to examine changes in tobacco abstinence and abstinence-related perceptions across survey years. We then used the latest survey data (2017–2018) and logistic regression to assess associations between perceptions and intentions to abstain in the next year, among adolescents who did not report tobacco use (n=3050). All analyses incorporated survey weights and clusters.RESULTSCompared with 2000, adolescents surveyed in 2017–2018 had improved 30-day tobacco abstinence, including cigarette abstinence (89.67% to 95.39%, p<0.01). However, intentions to abstain in the next year declined over the study years (93.65% to 90.53%, p<0.01). Key tobacco abstinence-related perceptions, including perceived severity (88.51% to 83.87%, p<0.01) and refusal self-efficacy (91.08% to 88.67%, p<0.01), also declined. In regression analysis, perceived benefits of anti-tobacco campaigns (AOR=2.25; 95% CI: 1.40–3.60) and refusal self-efficacy (AOR=11.35; 95% CI: 7.55–17.04) were associated with higher intentions to abstain. Exposure to anti-tobacco messaging (AOR=0.52; 95% CI: 0.30–0.90) was negatively associated with abstinence intentions.CONCLUSIONSGiven that abstinence-related perceptions declined across survey years and were associated with tobacco use intentions, these findings underscore the importance of continued attention to WHO-FCTC anti-tobacco initiatives that address tobacco-related perceptions. Incorporating culturally sensitive messaging may enhance the relevance and effectiveness of such efforts.

Since late 2022, the sale of most flavored tobacco products has been prohibited in California, including menthol cigarettes. Tobacco companies responded by introducing ‘non-menthol’ cigarettes in which menthol was replaced with WS-3, an odorless synthetic cooling agent to elicit cooling sensations similar to menthol. Legislation enacted in 2024 banned the addition of cooling characterizing flavors in tobacco products in California. However, the industry continues to market ‘non-menthol’ cigarettes in the state, with very similar package designs. The aim of this study was to verify whether cooling agents were removed from these cigarettes. Available Newport-branded ‘non-menthol’ cigarettes were purchased in California in 2025, extracted and tested for sensory cooling activity by Ca2+ microfluorimetry of HEK293T cells expressing the human TRPM8 cold/menthol receptor. Chemical analysis was performed by gas chromatography - mass spectrometry (GCMS). ‘Non-menthol’ and menthol cigarettes marketed in 2023–2024 served as controls. While extracts from Newport ‘non-menthol’ and menthol cigarettes marketed in California in 2023 produced a TRPM8-mediated Ca2+ increase of 60 ± 8% and 39 ± 3%, (p<0.0001, n=3) respectively, responses elicited by extracts of Newport ‘non-menthol’ cigarettes marketed in 2025 were indistinguishable from baseline (p=0.48, n=3). Chemical analysis confirmed no menthol or WS-3 above the level of detection (10 μg/cigarette), and no other major commercial synthetic cooling agents. The tobacco industry removed sensory cooling agents from ‘non-menthol’ cigarettes marketed in California. However, this did not result in the market withdrawal of ‘non-menthol’ cigarettes in the state. ‘Non-menthol’ cigarettes in California continue to be marketed with package designs resembling those of former menthol cigarettes, signaling the potential presence of a characterizing flavor.

INTRODUCTIONFollowing the increased use of e-cigarettes and smokeless nicotine products among Danish youth, the proportion of youth wishing to quit or already had attempted to quit has increased too. To adapt cessation services, knowledge is needed about youth self-reported reasons to quit and whether reasons differ across nicotine products.METHODSIn a cross-sectional study carried out from September to November 2023, using age and gender-weighted questionnaire data, 2228 Danish youth aged 15–29 years, that had attempted to quit one or more nicotine product (cigarettes, e-cigarettes or smokeless nicotine) were included. Differences in self-reported reasons across products used were assessed using unadjusted logistic regression. A supplementary interaction analysis, using quit success as the interacting variable, and unadjusted logistic regressions stratified by quit success, were performed to assess the role of quit success on the most reported reasons.RESULTS‘Thoughts about health’ and ‘Don’t want to be addicted’ were the most frequently reported reasons to quit cigarettes (51.5% and 39.1%, respectively), e-cigarettes (38.8% and 33.6%, respectively) and smokeless nicotine (61.3% and 60.3%, respectively). However, prevalences varied between products. ‘Due to economics’ was the third most prevalent reason among youth who had attempted to quit cigarettes (29.0%) and smokeless nicotine (40.7%), whereas this was ‘Switching to another product’ among those who had attempted to quit e-cigarettes (21.5%). Quit success significantly modified the reporting of ‘People I know privately’ as reason for quit attempt, across the products.CONCLUSIONSCounselors, parents, and those developing new interventions should consider health and addiction concerns as reasons for wanting to quit among youth, and must be aware of different reasons for quitting different products. Further studies are needed to verify the present findings and their interpretation related to intrapersonal, interpersonal and structural issues.

INTRODUCTIONE-cigarettes are increasingly popular among university students, raising significant public health concerns. This study aimed to assess the prevalence of e-cigarette use, as well as knowledge, and attitudes toward e-cigarettes among health and non-health science undergraduate students in Thailand.METHODSA cross-sectional survey among health and non-health science students in Thailand was conducted between March and September 2023 using a self-administered online questionnaire. Data were analyzed using descriptive statistics, chi-squared tests, and multivariate logistic regression.RESULTSAmong 440 participants, 37.05% were from health science programs and 62.95% from non-health science. E-cigarette use was reported by 15.7% of health science and 27.7% of non-health science students (p=0.001). Significant differences were also found in income (p<0.001), family smoking history (p=0.006), and alcohol consumption (p<0.001). Health science students had greater awareness of health risks, including lung inflammation (91.4% vs 85.9%, p=0.04, AOR=0.69; 95% CI: 0.47–0.98) and lung cancer (90.8% vs. 81.6%, p=0.006, AOR=1.62; 95% CI: 1.14–2.28). In contrast, non-health science students were more likely to believe e-cigarettes aid smoking cessation (39.4% vs 21.5%, p=0.02, AOR=1.36; 95% CI: 1.05–1.77). Despite these differences, misconceptions about nicotine addiction and safety remained common across both groups.CONCLUSIONSThe findings highlight the need for targeted educational programs and public health interventions to address misconceptions and discourage e-cigarette use among university students. Improved health education is essential to equip students with accurate information for making informed decisions about e-cigarettes.

Smoking after discharge from the hospital increases the risk of adverse health outcomes such as unplanned hospital readmissions. This prospective study explores predictors of self-reported continuous smoking abstinence in adult patients 6 weeks after hospital discharge. The study population includes 985 adult currently smoking patients, admitted to the hospital between March and December 2021, who were discharged home following their hospital stay and followed up 6 weeks later to reassess smoking status. Electronic health records (EHRs) were used to measure potential predictors of smoking abstinence and included patient demographic factors (age, gender, race, insurance status), clinical characteristics (i.e. length of hospital stay, Charlson Comorbidity score, and other comorbidities such as alcohol or other substance use disorders), and exposure to the hospital's tobacco treatment program (TTP). Among the 985 patients reached for follow-up, 21.1% reported continuous abstinence from cigarette use 6 weeks after hospital discharge. In adjusted analyses, significant predictors of smoking abstinence included being male (adjusted odds ratio, AOR=1.5; 95% CI: 1.0-2.1), older age (AOR=1.02; 95% CI: 1.0-1.04), fewer years smoking (AOR=0.97; 95% CI: 0.95-0.99), and longer hospital stay length (AOR=1.42; 95% CI: 1.1-1.8). A diagnosis of substance use disorder was also associated with lower odds of abstinence (AOR=0.37; 95% CI: 0.2-0.7) while exposure to the TTP was not associated with smoking abstinence at follow-up. Patients requiring longer hospitalizations were more likely to report smoking abstinence after discharge.

Although much is already known about the strategies that tobacco companies use to generate profits (and consequently compromise health), and options for retail regulation, industry tactics within the retail environment have not been comprehensively collated. Tobacco companies' billions of dollars of investments in retail play a vital role in normalizing tobacco products in everyday life because they are an everyday sight. These investments include for example retailer incentives, instore advertising and display stands. Companies continue to promote their tobacco products indirectly through retailer-related activities in many countries because they are often not included in governments' tobacco marketing restrictions. In light of this, in this monitoring letter, we highlight some of the industry's tactics to control the retail environment and discuss potential solutions to counter its strategic presence in retail.

Jordan has one of the highest global smoking and secondhand smoke (SHS) exposure rates. Nicotine metabolite ratio (NMR), the ratio of nicotine metabolites trans-3'-hydroxycotinine to cotinine, serves as a marker for tailored smoking cessation strategies to improve abstinence rates. This study examined smokers' NMR status, attitudes toward NMR-informed smoking cessation care, and SHS exposure markers in non-smokers exposed and not exposed to SHS. This cross-sectional study recruited participants using convenience sampling from Amman and Madaba, Jordan. Participants were categorized into current smokers, non-smokers not exposed to SHS, and non-smokers exposed to SHS. Smokers were classified as slow (NMR <0.31) or fast (NMR ≥0.31) metabolizers. A baseline questionnaire gathered demographics, smoking data, and attitudes toward NMR-informed smoking cessation care. Statistical analyses, including descriptive statistics, chi-squared tests, and non-parametric tests were performed. A total of 251 participants were recruited: 125 smokers (49.8%), 63 non-smokers exposed to SHS (25.1%), and 63 non-smokers not exposed to SHS (25.1%). Median cotinine levels were high in non-smokers exposed to SHS (36.1 ng/mL) and non-smokers not exposed to SHS (32 ng/mL). Among smokers, 105 (84%) were fast nicotine metabolizers (NMR ≥0.31) and 20 (16%) were slow metabolizers (NMR <0.31), with a median NMR of 0.52 (range: 0.14-6.6). Most smokers showed a positive attitude towards NMR-informed smoking cessation care. The predominance of fast nicotine metabolizers in this study underscores the need for NMR-tailored cessation approaches. High SHS exposure observed underscores the need to enforce strict public smoking restrictions in Jordan.

IQOS is a heated tobacco product from Philip Morris International (PMI) with modified risk tobacco product (MRTP) designation from the U.S. Food and Drug Administration (FDA). The commercial relaunch of IQOS featured experiential marketing centered in Austin, Texas, and began in October 2024. Invitation-only events were offered to adults aged ≥21 years who resided near Austin/Travis County and confirmed they were tobacco users when they joined the 'IQOS Circle'. Events were free-of-charge and included live music concerts, movie premieres, and seasonally and locally themed parties. Events offered free food, drinks, and giveaways, and usually included PMI representatives who invited discussion and questions about IQOS, where customers could hold devices with the promise that opportunities to try IQOS were coming soon. A two-day downtown block party marked IQOS’ commercial release in March 2025, offering 'guided experiences' to customers who could then initiate a 14-day trial. The IQOS device and charging case with ten packs of HEETS sticks cost $1.00, plus a non-refundable $40 'trial fee'. Within the trial window, customers could return the product free of charge or pay an additional $60.00 to keep the device. In April 2025, IQOS products were made available for purchase online to Austin-area zip codes, and on 2 September 2025, shipping expanded to 'selected major cities' in Texas, including Dallas, Houston, and San Antonio. Events in Austin, TX and subsequent pilots in Ft. Lauderdale, FL, and Jackson, MS will inform PMI’s launch of ILUMA, their most advanced IQOS model currently awaiting FDA authorization. It remains to be seen whether IQOS will provide health benefits to individuals who switch completely to IQOS from cigarettes, or whether those initiating IQOS are cigarette-naïve and/or otherwise not using nicotine products. Continued monitoring of the use and appeal of IQOS will be essential to tobacco control and public health efforts.

INTRODUCTIONTobacco consumption is a significant public health problem in Nepal, accounting for 39200 deaths each year, accounting for 23.7% of all deaths. While Nepal has taken several policy measures to strengthen tobacco control, the persistent burden of tobacco and the associated health risks highlight the need for continuous monitoring and evaluation. Therefore, this study assessed the trend in age-specific and sex-specific mortality and disability attributable to different forms of tobacco use (smoking, chewing tobacco) in Nepal from 1990 to 2021.METHODSThis observational study used publicly available data from Nepal's Global Burden of Disease (GBD) 2021 estimations. The age-standardized and age-specific summary exposure value (SEV), mortality, and disability-adjusted life years (DALYs) were extracted to measure the burden and trend of tobacco use. The data are presented as percentages or rates per 100000 population.RESULTSFrom 1991 to 2021, the age-standardized SEV of tobacco consumption for both sexes at all ages decreased from 44.1% to 28.2%. The age-standardized deaths attributable to tobacco use, including all forms of tobacco products, decreased by (46.7%) from 262.9 (95% UI: 193.5–344.3) per 100000 in 1990 to 140.2 (95% UI: 101.1–181.9) per 100000 in 2021.CONCLUSIONSDespite declines in SEV, and DALYs from 1990 to 2021, tobacco use remains a major public health concern. Strengthening smoking cessation programs, enforcing stricter tobacco control policies, raising taxes on tobacco products, and expanding public awareness campaigns are essential to reducing its burden.