IntroductionThis study aims to provide prevalence data on dual-use (one additional product) and poly-use (two or more products) of inhaled nicotine and tobacco products (cigarettes, e-cigarettes and/or heated tobacco products (HTP)) among current waterpipe (WP) users in Germany over recent years, and explores specific person characteristics associated with such co-use.MethodsA series of cross-sectional, nationwide, representative, face-to-face household surveys in Germany between 2019 and 2023. Samples were selected using multistratified random sampling (50%) combined with quota sampling (50%). The current analysis included 61 713 respondents (aged ≥14 years) of which 1303 reported current WP use.ResultsWP use in Germany fluctuated between 1.5% and 2.8% from 2019 and 2023. The prevalence rate for 2023 was 1.5% (95%CI = 1.2,1.7). Among users, exclusive WP use declined from 41.8% (95%CI = 35.3,48.5) in 2019 to 26.3% (95%CI = 20.2,33.3) in 2023. Over this period, dual-use increased from 49.3% (95%CI = 42.6,56.1) to 62.3% (95%CI = 55.0,69.3), and poly-use rose from 8.9% (95%CI = 5.5,13.4) to 11.2% (95%CI = 7.1,16.7). Multivariable analyses confirmed a significant decline in exclusive WP use over time (OR per year = 0.90, 95%CI = 0.81–0.99), while the increases in dual-use was not statistically robust after adjustment. Among dual users, the majority (94.2%) reported also smoking cigarettes. The likelihood of using at least one additional product alongside WP was positively associated with increasing age, and with low and middle compared with high educational attainment.ConclusionAmong current WP users in Germany, exclusive WP use has decreased in recent years, with potential commensurate increase in dual- and poly-use.ImplicationThese novel data help inform on the consumption behavior of current WP users and highlights the need for targeted public health interventions that address not only exclusive product use but also the rising combination of different products.

IntroductionGlobally, tobacco use rates in Muslim communities, particularly among men, are significantly higher than in non-Muslim communities. In the United Kingdom, there are also low rates of help-seeking among British Muslims who use tobacco. Ramadan could be a “window of opportunity” to support tobacco use behavior change but we lack the voice of British Muslim communities on culturally tailored cessation support. We undertook a public and patient involvement and engagement (PPIE) project to gain views from representatives of these communities.Aims and MethodsDiscussions with 15 PPIE representatives from, or who worked with, a variety of British Muslim communities identified through gatekeepers, social media, and snowballing approaches. Key points and views from PPIE discussions were summarized into broad themes.ResultsOpportunities and challenges with culturally adapting tobacco cessation support to Ramadan were raised. “Light touch” positive religious messaging connected to tobacco cessation was recommended, and overemphasizing religion in messaging content to be avoided. Quitting during Ramadan was felt challenging due to fasting, precluding the use of nicotine replacement products or medication, and reinforcing tobacco use as part of fast-breaking routines. Instead, PPIE representatives suggested quitting in advance of Ramadan or promoting cessation afterward by capitalizing on tobacco reduction achieved during Ramadan. There was support for digital cessation approaches, but it was felt many in their communities would prefer traditional approaches, including interpersonal support and messaging through influential community members.Conclusions“Light touch” culturally tailored tobacco cessation support before or after Ramadan was felt more promising than supporting cessation initiation during Ramadan.ImplicationsMembers of British Muslim communities identified challenges with using Ramadan as a “window of opportunity” for tobacco behavior change and favored quitting ahead of time for Ramadan or capitalizing on tobacco behavior change achieved during Ramadan to promote a quit attempt afterward. Taking a “light touch” approach with religiously tailored messaging could help engage Muslim people who smoke in cessation support. However, avoiding any strong or negatively framed tobacco-related messages linked to religious phrases or imagery is important. This work reinforces the importance of engaging with communities when considering culturally adapting interventions to prevent misdirected adaptions.

IntroductionVape use is increasing, particularly among young people who have never been cigarette smokers. Stealth vaping, that is, discrete use in places where it is prohibited, is also reported to be increasing. Regular vape use is high among those who identify as Māori, with the Tobacco Industry reported to be targeting Indigenous communities, thus continuing long-running harmful, colonial practices.Aims and MethodsThis qualitative study, using group interviews within a kaupapa Māori framework, explored stealth vaping with 19 young adults, of whom 18 identified as Māori in the Indigenous context in New Zealand.ResultsThe results showed that hiding vape use is enhanced by the features of devices, while the nicotine content drives the need to vape nearly anywhere.ConclusionsThe tobacco and nicotine endgame approach is favored by Māori leaders, meaning stricter regulation on vaping devices alone does not adequately protect young people. Instead, stronger measures must be implemented to reduce the appeal of vaping. Vaping does not align with Māori worldviews. Addiction and their easy concealment sustain their use, highlighting the tension between alternative nicotine products that benefit the Tobacco Industry, with the goals of Māori and other Indigenous peoples to eradicate nicotine entirely.ImplicationsThe study results reinforce that priority must be given to culturally led and culturally safe regulatory and policy changes and advocacy for both smoke- and vape-free environments. Regulating the features of devices to negate their stealth use, as their invisibility was facilitated by their manipulability, should enable the existing smoke-free environment spaces to again deter vape use. Advocates must understand Māori history and context to extend the spaces where the strength that comes from being Māori will overcome the need to vape.

IntroductionEmerging tobacco and nicotine products, such as e-cigarettes and heated tobacco products (HTPs), are gaining popularity, particularly among young people. This study examines the perceptions of e-cigarettes and HTPs among nicotine-naive individuals and their variations across sociodemographic subgroups.MethodsWe conducted a cross-sectional analysis of the Special Eurobarometer 99.3 (May–June 2023) among never users of tobacco or nicotine products in the European Union (EU) (n = 13 436). We estimated the weighted prevalence of perceptions of e-cigarettes and HTPs: appeal, perceived effectiveness for smoking cessation, support for them being regulated like cigarettes, and support for keeping them out of sight in points of sale. Multi-level Poisson regression models examined associations of sociodemographic factors with these perceptions.ResultsAmong never users in the EU, 2.6% found e-cigarettes appealing, while 2.0% found HTPs appealing. Fifty-point eight percent and 58.8% of participants supported strict regulations and point-of-sale restrictions for these products, respectively. Younger age groups were more likely to find e-cigarettes (prevalence ratio [PR] = 1.70, for ages 15–39 vs. ≥55) and HTPs (PR = 1.88, PR = 1.54 for ages 15–24 and 25–39) appealing and view them as effective for smoking cessation. Support for regulations similar to cigarettes was higher among women, individuals with higher education, those living with children, and those without financial difficulties.ConclusionWhile the appeal of these products to never users remained low overall, the study found that young people were more likely to find them appealing, posing a risk for experimentation. Meanwhile, over 50% of respondents supported stricter regulations, which could influence policy changes in this area.ImplicationsAlthough appeal of e-cigarettes and Heated Tobacco Products (HTPs) was relatively low among people who have never used e-cigarettes, HTPs, or smoking tobacco in the EU, appeal was higher among younger age groups, which are often targeted by the industry. We also found substantial support for stricter regulatory policies for e-cigarettes and HTPs across the EU. These findings might encourage governments to increase restrictions around these emerging nicotine and tobacco products.

IntroductionE-cigarettes are an increasingly popular method of smoking cessation assistance; however, there is little research on whether this has affected the number of smokers who quit using “any” evidence-based cessation aid. This study examined trends in the use of cessation aids, including e-cigarettes and other evidence-based methods.Aims and MethodsData were cross-sectional surveys in 2016, 2018, and 2020 from the International Tobacco Control Four Country Smoking and Vaping Survey conducted in Canada, United States (US), England, and Australia. Respondents were adults (≥18) recruited by commercial panel firms who currently smoked, and/or quit smoking in the past 12 months. Respondents were asked about use of e-cigarettes, nicotine replacement therapies, prescription medications, quitlines, and counseling services during their last quit attempt (LQA). Generalized estimating equation regression models that were analyzed separately by country examined use of cessation assistance among 14 536 observations (Canada = 4880; US = 2917; England = 4846; and Australia = 1898).ResultsE-cigarettes (29.9%) and nicotine replacement therapy (29.8%) were popular methods of cessation assistance at LQA. Using e-cigarettes at LQA increased in Australia (2016 = 11.1%; 2020 = 25.1%; p=.002) and England (2016 = 37.1%; 2018 = 46.7%; p=.002), with no significant change in Canada or the US. Across all countries, there was little change over time in the overall use of evidence-based cessation assistance. Nearly half of respondents used some form of cessation assistance excluding e-cigarettes. Approximately two-thirds used “any” form of evidence-based cessation including e-cigarettes at LQA, which decreased in Canada (2016 = 64.0%, 2020 = 58.9%; p=.010).ConclusionsWhile e-cigarettes are a popular cessation aid, use of other evidence-based cessation assistance has remained comparatively stable among adults that tried to quit smoking.ImplicationsThe findings indicated that e-cigarettes are a popular cessation method among adults trying to quit smoking. Despite differences in e-cigarette use and regulatory environments in the four countries, rates of evidence-based cessation assistance were similar across countries and over time. E-cigarettes can be an effective method for stopping smoking; however, the current study suggests few, if any, changes in the proportion of adults who smoke using any evidence-based form of cessation assistance, despite changes in the use of e-cigarettes as a quit aid.

IntroductionThe harms of cigarette smoking are greater for those who smoke more heavily. This study aimed to provide up-to-date estimates of cigarette consumption across Great Britain and explore differences by socioeconomic position, the presence of children in the household, nation, and region.MethodsCross-sectional analysis of data from a nationally representative household survey of adults in Great Britain, 2022–2024 (n = 77 796). Main outcome measures were mean daily cigarette consumption and the proportion consuming more than 20 cigarettes per day (among those who smoked cigarettes) and average per-capita cigarette consumption (among adults).ResultsOverall, adults who smoked cigarettes consumed on average 10.4 [95%CI = 10.2%–10.6%] cigarettes per day, with 5.5% [5.0%–6.0%] smoking more than 20 per day. Average per-capita consumption was 528 [512–543] cigarettes per year, equating to a total consumption of 28.6 [27.8–29.5] billion cigarettes in Great Britain per year. Consumption was lower among those from more vs. less advantaged socioeconomic positions (mean consumption: 9.4 [9.1–9.7] vs. 11.0 [10.7–11.3] cigarettes per day; proportion smoking more than 20 per day: 4.6% [3.9%–5.2%] vs. 6.1% [5.4%–6.9%]). It was also lower among those with children in the household than those without (9.7 [9.3–10.0] vs. 10.7 [10.4–10.9]; 4.0% [3.2%–4.9%] vs. 6.1% [5.4%–6.7%]), although these differences appeared to be largely explained by the younger age of those with children in the household. Cigarette consumption also varied geographically, with the highest consumption in the North East of England (11.7 [10.6–12.8] cigarettes per day) and Scotland (11.7 [10.8–12.5]) and the lowest in London (8.4 [7.9–9.0]) and the South West (9.5 [8.9–10.1]).ConclusionsAn estimated 28.6 billion cigarettes are smoked in Great Britain each year. There are persistent disparities in cigarette consumption across socioeconomic groups, regions, and nations, reflecting broader patterns of health inequality.ImplicationsWhile smoking prevalence has declined and regional differences have narrowed over recent decades, strong socioeconomic and geographic disparities in consumption remain, with particularly high levels among less advantaged groups and in regions with historically poorer health outcomes, such as the North East and Scotland. Addressing these disparities through targeted public health efforts and cessation support could contribute meaningfully to reducing health inequalities across Great Britain.

IntroductionThis study examines trends in social norms toward cigarette smoking and e-cigarette use among US youth during 2015-2021, focusing on descriptive interpersonal norms (friends’ behavior) and injunctive norms at interpersonal (perceived important others’ negative view) and societal level (perceived public disapproval).MethodsRespondents were youth aged 12 to 17 from the Population Assessment of Tobacco and Health Study of the United States, Wave 3 (2015-2016) to Wave 6 (2021). Logistic regression models that adjusted for demographics and participation effects assessed norm changes over time and their association with use status in Wave 6.ResultsBetween 2015 and 2021, the probability of having friends who smoked cigarettes decreased (26.1% vs. 7.9%, adjusted odds ratio [aOR] = 0.81 [95% confidence interval = 0.72 to 0.91]), while having friends who use e-cigarettes generally decreased (31.6% vs. 22.3%, aOR = 0.46, [0.37-0.58]) despite an increase in 2018-2019. Perceived negative views from important others remained stable for both products during 2015-2019, peaked in 2020 (85.2% and 86.2%) before declining slightly in 2021. Perceived public disapproval increased to a peak in 2020 for both products (73.3% to 84.2% for cigarettes and 55.4% to 77.5% for e-cigarettes). In 2021, having friends who used e-cigarettes was associated with current e-cigarette use (relative risk ratio [RRR] = 15.07 [9.94-22.85]) and current dual use (RRR = 3.38 [1.41-8.13]), while important others’ negative view toward e-cigarette use reduced the likelihood of current e-cigarette use (RRR = 0.3 [0.2-0.44]).ConclusionsAmong US youth during 2015-2021, norms consistently indicated denormalization of cigarette smoking. e-cigarette norms showed greater variability, particularly during the coronavirus disease 2019 (COVID-19) pandemic.

IntroductionHigh rates of smoking among people with HIV (PWH) persist and may be due to HIV-associated neurocognitive disorders exacerbating abstinence-induced cognitive deficits, leading to higher risk of relapse. This study assessed differences in smoking abstinence rates and abstinence-induced cognitive deficits among PWH and people without (PWOH).MethodsIn this prospective observational design (NCT03169101), treatment-seeking adults completed two laboratory sessions during a pre-quit phase to assess cognition: once following 24h abstinence and once smoking-as-usual. Cognition was measured through response inhibition, working memory, and verbal memory tasks. All received standard smoking cessation treatment over 8 weeks (i.e., counseling, nicotine patch). Point-prevalence abstinence was assessed at end-of-treatment.ResultsOur sample included 210 participants (38.1% PWH; 61.9% PWOH), who were mostly male (59.5%) and Black/African-American (76.7%). No significant HIV status by abstinence condition interactions emerged for any cognitive outcome (all ps > .4). There were significant abstinence-induced deficits in response inhibition (p = .02), working memory response time (p = .005), and verbal memory (p=<.001). No significant differences emerged in abstinence rates between PWH and PWOH (31.2%, 32.3%, respectively; OR = 1.26, 95% CI: 0.67, 2.39, p = .48).ConclusionDespite prior research suggesting differences in abstinence rates and cognition between PWH and PWOH who smoke, hypotheses were not supported. However, this is one of a few studies to directly compare people with and without HIV in a rigorously designed mechanistic smoking cessation study. Given that cognition does not appear to play a primary role in smoking among PWH, more work is needed to understand the mechanisms driving disproportionate smoking rates among PWH.