Combustible Products Research Articles

Effects of freebase/protonated nicotine concentration, liquid composition and electrical power on throat hit in direct-to-lung vaping: theory and clinical measurements

BackgroundFor decades, the tobacco industry has engineered the sensory characteristics of combustible tobacco products including the degree of harshness experienced at the back of the throat. Commonly referred to as...

Switching from Cigarettes to Heated Tobacco Products in Japan-Potential Impact on Health Outcomes and Associated Health Care Costs.

Japan's rising health expenditure, driven by an aging population, coincides with growing demands for increased spending. Reducing smoking-related costs could alleviate the burden on the health care system. Despite efforts to promote smoking cessation, success has been limited, indicating a need for strategies beyond cessation. Using a status quo simulation based on hospital resource data from the Japanese Ministry of Health, Labor, and Welfare, we examine the impact of heated tobacco products (HTPs) on the prevalence of four smoking-attributable diseases (chronic obstructive pulmonary disease, ischemic heart disease, stroke, and lung cancer) and the related direct health care costs. The baseline scenario assumes a 50% switch from combustible cigarettes to HTPs, with a 70% risk reduction. A sensitivity analysis was conducted to assess the effects of parameter variations. If 50% of smokers replaced combustible tobacco products with HTPs, 12 million patients could be averted equivalent to JPY 454 billion in health care savings. Prefectures located in the north and south of Japan would benefit the most. Considering the heterogeneous prevalence rates, a one-size-fits-all tobacco control approach is ineffective. Japan should prioritize cost-efficient measures that promote public health and economic benefits. Encouraging smokers to switch to reduced-risk products, raising awareness of health risks, and adopting a harm-based taxation model can drive positive change. Public-private partnerships can further enhance harm reduction efforts. With a combination of tax reforms, revised regulations, collaborations, and ongoing research, Japan can create a more effective and comprehensive approach to tobacco control.

Flavored combustible tobacco product initiation in two longitudinal youth cohorts in the US Population Assessment of Tobacco and Health Study: 2013–2016 and 2016–2019

IntroductionFlavored tobacco products increase appeal and lower barriers to nicotine addiction for young people. We compared environmental, psychosocial, behavioral, and demographic characteristics between youth who started with flavored and non-flavored (i.e., tobacco-flavored) combustible tobacco products (CTPs). MethodsWe analyzed two representative US youth cohorts (baseline age 12–15) from the Population Assessment of Tobacco and Health (PATH) Study (Wave 1 Cohort (W1) 2013–2016; Wave 4 Cohort (W4) 2016–2019). We first assessed baseline characteristics associated with any subsequent CTP initiation among youth with baseline never CTP use (W1 n=5,946; W4 n=8,240). Then, for baseline CTP-naïve youth with subsequent CTP initiation (new experimentation; W1 n=519; W4 n=538), we assessed baseline characteristics associated with subsequent initiation with flavored CTPs versus non-flavored. ResultsMost youth reporting new CTP experimentation initiated with flavored CTPs (W1:67.8%; W4:74.2%). Household norms, susceptibility, baseline experimentation with vaping, alcohol, and/or cannabis; and White race were associated with CTP experimentation. For both cohorts, frequent social media use was associated with flavored CTP initiation (W4 AOR:2.50, 95%CI:1.22,5.12) and Black youth (W4 AOR:0.12, 95%CI:0.06,0.25) were less likely to initiate with flavored CTPs than White youth. Among W1 Cohort youth, perceiving flavored product use as easier was positively associated with flavored CTP initiation (AOR:1.48, 95%CI:1.01,2.17). Among W4 Cohort youth, baseline vaping was negatively associated with flavored CTP initiation (AOR:0.10, 95%CI:0.05,0.20). ConclusionFrequent social media use was associated with flavored CTP initiation among youth who used CTPs. Youth who had ever vaped and Black youth were less likely to initiate with flavored CTPs.

Changes in the harm perceptions of different types of tobacco products for youth and adults: Waves 1–5 of the population assessment of tobacco and health (PATH) study, 2013–2019

IntroductionTobacco harm perceptions are associated with tobacco use for both youth and adults, but it is unknown how these harm perceptions have changed over time in a changing tobacco product landscape. MethodsData from Waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study were analyzed to examine perceptions of harm of eight non-cigarette tobacco products compared to cigarettes. Perceptions of harm were assessed with the questions, “Is smoking/using [product] less harmful, about the same, or more harmful than smoking cigarettes?”. ResultsThe share of participants who perceived non-cigarette combustible products as posing similar harm to cigarettes increased over time, while the share of participants who perceived non-combustible products as less harmful than cigarettes decreased over time. ConclusionsTobacco harm perceptions are changing over time, along with the tobacco product marketplace and regulatory environment.

Patterns of poly tobacco use among adults in the Population Assessment of Tobacco and Health (PATH) study, 2013–2017: a multistate Markov transition analysis

BackgroundA better understanding of sociodemographic transition patterns between single, dual and poly tobacco product use may help improve tobacco control policy interventions.MethodsHRs of transition between never, non-current (no past 30-day...

Cannabis Use and Subsequent CIGARETTE Discontinuation among U.S. Adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1-5.

This study examined the association between current co-use of cannabis and cigarettes in the past 30 days, and subsequent cigarette discontinuation (past 30-day point prevalence abstinence) among U.S. adults with established cigarette use in the Population Assessment of Tobacco and Health (PATH) Study. Additionally, we investigated the impact of co-use on the subsequent discontinuation of all combustible tobacco products. A total of 26,381 observations contributed by 8,218 adults with established cigarette use (i.e., smoked ≥ 100 cigarettes in their lifetime, and currently smoking cigarettes every day or some days) from Waves 1-5 of the PATH Study were included in the analysis. Weighted Generalized Estimating Equations (GEE) models were used to evaluate the association between current co-use at baseline (Waves 1-4) with the outcomes assessed at the subsequent wave (cigarette and combustible tobacco discontinuation at Waves 2-5). Final models included: demographic characteristics (age, sex, race and ethnicity, educational attainment), behavior characteristics (intention to quit, internalizing symptoms, externalizing symptoms, substance use problems), and wave-pair. Over one-third (35.91%) of cigarette users self-reported co-use during the study period. Cannabis use among adults with established cigarette use increased over time. Co-use was associated with a decreased odds of cigarette smoking discontinuation at follow-up, after adjusting for covariates (aOR: 0.81; 95% CI: 0.72, 0.93; p=0.0018). Similar effect sizes were observed for discontinuation of all combustible tobacco products (aOR: 0.75; 95% CI: 0.65, 0.86; p<.0001). Cannabis use among adults who smoke cigarettes was inversely related to subsequent cigarette discontinuation, suggesting that co-use may reduce likelihood of successful tobacco cessation. Findings demonstrate that cannabis use may lead to lower odds of discontinuation among adults with established cigarette use; therefore, individuals that co-use cigarettes and cannabis may need additional tobacco cessation support. Notably, this study observed an increase in co-use of cigarettes and cannabis, emphasizing the need for researchers and public health programs to shift their focus towards understanding and addressing concurrent substance use among adults who smoke cigarettes.

A Vaping Cessation Text Message Program for Adolescent E-Cigarette Users

E-cigarettes are the most commonly used tobacco product among adolescents. Despite known harms of nicotine exposure among teens, there are no empirically tested vaping cessation interventions. To compare the effectiveness of a text message program for nicotine vaping cessation among adolescents with assessment-only control. A parallel, 2-group, double-blind, individually randomized clinical trial with follow-ups at 1 and 7 months after randomization was conducted from October 1, 2021, to October 18, 2023. Participants were recruited via social media ads; the intervention was delivered via text message; and assessments were completed online or by telephone. Eligible individuals were US residents aged 13 to 17 years who reported past 30-day e-cigarette use, were interested in quitting within 30 days, and owned a mobile phone with an active text message plan. To optimize study retention, all participants received monthly assessments via text message about e-cigarette use. Assessment-only controls (n = 744) received only study retention text messages. Intervention participants (n = 759) also received an automated, interactive text message program for vaping cessation that delivers cognitive and behavioral coping skills training and social support. The primary outcome was self-reported 30-day point-prevalence abstinence from vaping at 7 months analyzed as intention-to-treat, with missingness coded as vaping. Among n = 1503 adolescents randomized, average age was 16.4 (SD, 0.8) years. The sample was 50.6% female, 42.1% male, and 7.4% nonbinary/other; 10.2% Black/African American, 62.6% White, 18.5% multiracial, and 8.7% another race; 16.2% Hispanic; 42.5% sexual minority; and 76.2% vaped within 30 minutes of waking. The 7-month follow-up rate was 70.8%. Point-prevalence abstinence rates were 37.8% (95% CI, 34.4%-41.3%) among intervention participants and 28.0% (95% CI, 24.9%-31.3%) among control participants (relative risk, 1.35 [95% CI, 1.17-1.57]; P < .001). No baseline variables moderated the treatment-outcome relationship. There was no evidence that adolescents who quit vaping transitioned to combustible tobacco products. A tailored, interactive text message intervention increased self-reported vaping cessation rates among adolescents recruited via social media channels. ClinicalTrials.gov Identifier: NCT04919590.

Exploring the Utility of Long Non-Coding RNAs for Assessing the Health Consequences of Vaping.

Electronic cigarette (e-cig) use, otherwise known as "vaping", is widespread among adolescent never-smokers and adult smokers seeking a less-harmful alternative to combustible tobacco products. To date, however, the long-term health consequences of vaping are largely unknown. Many toxicants and carcinogens present in e-cig vapor and tobacco smoke exert their biological effects through epigenetic changes that can cause dysregulation of disease-related genes. Long non-coding RNAs (lncRNAs) have emerged as prime regulators of gene expression in health and disease states. A large body of research has shown that lncRNAs regulate genes involved in the pathogenesis of smoking-associated diseases; however, the utility of lncRNAs for assessing the disease-causing potential of vaping remains to be fully determined. A limited but growing number of studies has shown that lncRNAs mediate dysregulation of disease-related genes in cells and tissues of vapers as well as cells treated in vitro with e-cig aerosol extract. This review article provides an overview of the evolution of e-cig technology, trends in use, and controversies on the safety, efficacy, and health risks or potential benefits of vaping relative to smoking. While highlighting the importance of lncRNAs in cell biology and disease, it summarizes the current and ongoing research on the modulatory effects of lncRNAs on gene regulation and disease pathogenesis in e-cig users and in vitro experimental settings. The gaps in knowledge are identified, priorities for future research are highlighted, and the importance of empirical data for tobacco products regulation and public health is underscored.

Screening evaluation of the quality of commercially available cigars, cigarillos, and bidis based on emission levels of selected terpenes and terpenoids

The aim of the research was to verify the use of the solvent-free, non-destructive and easy to operate analytical method to study and compare the emissions of 16 representatives of terpenes and terpenoids from commercially available cigars, cigarillos and bidis − a potential screening analysis for the quality of combustible tobacco products. To assess the amount of organic compounds emitted to the gaseous phase from investigated tobacco samples, the stationary emission chambers system (at the sample conditioning stage) and gas chromatography with flame ionization detector (at the final analyte determination stage) were used. Studied samples represented five origins: the Dominican Republic, Nicaragua, Mexico, Cuba, and India and two manufacture approaches: machine-made and handmade. The assessed values of total volatile organic compounds (TVOCs) was from 0.58 to 28 µg·g−1 (at 60 °C) and from 26 to 430 µg·g−1 (at 120 °C). For Dominican products, Camphene and α-Cedrene were characterized by the highest emission level (233 ± 34 ng·g−1 and (3.7 ± 1.4) × 102 ng·g−1, respectively). In a case of Mexican and Cuban products it was noticed that the emission level of determined terpenes and terpenoids is higher in the case of hand-rolled tobacco products than mechanically manufactured ones. In a case of Nicaraguan hand-rolled products, Camphene, L-(−)-Fenchone, and α-Cedrene were characterized by the highest emission rate at 120 °C (213 ± 81 ng·g−1, 191 ± 45 ng·g−1 and 213 ± 84 ng·g−1, respectively). The highest emission level for Indian products in 120 °C was observed for α-Cedrene and Geranyl Acetate – respectively 181.6 ± 4.4 ng·g−1 and 101 ± 13 ng·g−1. The results of this study may indicate that sometimes cheaper products such as cigarillo have an emission profile that classifies them between expensive products such as “large cigars.”

Global policy scan of commercial combustible tobacco product retailing regulations by WHO region

Background/aimsRegulatory schemes for tobacco retailing help restrict the supply and availability of smoked tobacco products. Tobacco retailer density and the proximity of tobacco outlets to youth spaces, such as schools,...

Association between cannabis use and nicotine use persistence among adolescents

IntroductionProspective associations of adolescent cannabis use with nicotine use persistence are not well characterized but are important for informing prevention and policy. This study examined the association of 4 types of cannabis product use with subsequent persistent nicotine product use among adolescents. MethodsWe used prospective data from an adolescent cohort (14–17 years) from Southern California surveyed at baseline and at approximately 6-month follow-up (2022–2023). We incorporated three mutually non-exclusive analytic samples comprised of individuals with baseline past 6-month use of: (1) any nicotine product (N=308 [mean[SD] age = 16.3[0.6] years]), (2) e-cigarettes (n = 276), and (3) any combustible tobacco product (n = 137). Baseline past 6-month cannabis smoking, vaping, edible use, cannabidiol [CBD] or hemp product use, and any cannabis product use (yes/no) were separately modeled as predictors of past 6-month persistent use of any nicotine products, e-cigarettes, and combustible tobacco at follow-up. ResultsBaseline use of any cannabis product was associated with increased odds of persistent use of e-cigarettes or any nicotine product (adjusted odds ratio[OR] range: 1.96–2.66). Cannabis smoking was positively associated with persistent any nicotine product use (adjusted OR=2.19, 95 % CI=1.20–4.02). Cannabis smoking, vaping, and edible use predicted persistent use of e-cigarettes (adjusted OR range: 2.22–2.79). Cannabis product use did not predict combustible tobacco use persistence. Associations of CBD/hemp product use with nicotine use persistence outcomes were all non-significant. ConclusionsAdolescents who use cannabis may be at elevated risk for persistent nicotine use.

Messages About Tobacco and Alcohol Co-users.

People who use both alcohol and combustible tobacco have an increased risk of developing cancer. Few interventions have been developed to inform people about the risks of co-use. This study developed and tested messages about the risks of alcohol and combustible tobacco co-use among adults. In June-July 2021, we surveyed 1,300 U.S. adults who used both alcohol and combustible tobacco products within the past 30 days. After reporting their awareness of diseases caused by tobacco and alcohol co-use, participants were randomly assigned to four between-subjects experiments that manipulated specific cancer health effects vs. the word "cancer"; cancer health effects vs. noncancer health effects; different descriptions of co-use (e.g., Using alcohol and tobacco…, Drinking alcohol and smoking tobacco…); and co-use vs. single-use messages. Participants saw one message for each experiment and rated each message using a validated perceived message effectiveness (PME) scale. Awareness of health effects caused by alcohol and tobacco co-use ranged from moderately high for throat cancer (65.4%) to moderately low for colorectal cancer (23.1%). Messages about cancer health effects increased PME more than messages about non-cancer health effects (B=0.18, p=0.01). Messages about some specific cancers-including oral cancer (B=-0.20, p=0.04) and colorectal cancer (B=-0.22, p=0.02) decreased PME more than messages with only the word "cancer." No significant differences were identified for descriptions of co-use or co-use vs. single-use messages. Messages about some cancer health effects of co-using alcohol and tobacco may be effective when communicating the harms of both drinking alcohol and using tobacco.

Benchmarking a universal smoking machine adaptor for tobacco product testing

SignificanceCharacterisation of tobacco product emissions is an important step in assessing their impact on public health. Accurate and repeatable emissions data require that a leak-tight seal be made between the...

Free Radicals in Little Cigar Mainstream Smoke and the Potential Influence of Flavoring Chemicals on Free Radical Production.

Implementation of the Tobacco Control Act in 2009 banned characterizing flavors in cigarettes (except menthol and tobacco), but substitution has occurred by the continued availability of alternative flavored products (i.e., flavored little cigars). Little is known about how flavorants in noncigarette tobacco products impact human health. Thus, we investigated the impact of flavorants on free radical production in the mainstream smoke of little cigars. Gas- and particulate-phase free radical yields in mainstream smoke generated from 12 commercial little cigar brands and research little cigars and cigarettes were measured via electron paramagnetic resonance spectroscopy using the International Organization of Standardization (ISO) smoking protocol. Flavorants were extracted from unsmoked little cigars and analyzed by gas chromatography-mass spectroscopy. Gas- and particulate-phase radical yields from little cigars ranged from 13.5 to 97.6 and 0.453-1.175 nmol/unit, respectively. Comparatively, research cigarettes yielded an average of 4.9 nmol gas-phase radicals/unit and 0.292 nmol particulate-phase radicals/unit. From the products, 66 flavorants were identified, with each brand containing 4-24 individual flavorants. The free radical content was strongly correlated with the number of flavorants present in each cigar (r = 0.74, p = 0.01), indicating that highly flavored little cigars may produce higher levels of toxic free radicals. The presence of the flavorant ethyl methylphenylglycidate (strawberry) was associated with >2-fold higher levels of GP radicals (p = 0.001). Our results show that free radical delivery from little cigars is greater than that from research cigarettes and provide empirical evidence for the harmfulness of flavored tobacco products. Additionally, it demonstrates that flavorants present in combustible tobacco products can influence the levels of free radicals produced. Therefore, future tobacco product standards should consider little cigars.

Development of a pyrolysis reaction model for epoxy based flame retardant composites: Relationship between pyrolysis behavior and material composition

This paper presents a methodology to develop a pyrolysis reaction model that captures the flammability behavior of epoxy-based intumescent flame retardant coatings (EP/IFR) as a function of material composition. This approach adopted Thermogravimetric Analysis (TGA), Differential Scanning Calorimetry (DSC), and Microscale Combustion Calorimetry (MCC) experiments as well as the inverse modeling of the experimental results using ThermaKin2Ds and COMSOL Multiphysics modeling framework. The interactive reactions between EP and IFR were identified and quantified in the resulting lumped model, which is based on fitting of experimental data. It was found that the developed model was able to reproduce the TGA/DSC/MCC data within the prescribed criteria for EP/IFR blends with different material compositions. The model’s extrapolating capability was further validated through accurately predicting the experimental TGA data under different thermal conditions and for blends with different IFR ratios which were not used for model development. Additional TG-FTIR and XPS experiments were conducted to quantify the effect of IFR additive on the evolution of gaseous products and char formation. With a higher ratio of IFR, the amount of fuel dilution gases (i.e., CO2, NH3) was increased and the amount of combustible organic gaseous products was reduced. This work provides the core subset parameters for comprehensive pyrolysis modeling and enables the intelligent design of EP/IFR coatings with enhanced flame resistance.

Associations of educational and marketing messages with beliefs about nicotine and reduced nicotine cigarettes

IntroductionWidespread misperceptions about nicotine may have unintended effects on public health. We examined associations between existing messages about nicotine or tobacco and beliefs about nicotine and reduced nicotine cigarettes (RNC). Methods2962 U.S. 18–45-year-olds were randomized in a May 2022 web-based survey to view one of 26 text-based messages about tobacco or nicotine from three sources: ongoing research (n = 8), messages authorized by FDA for VLN cigarettes (n = 6), and FDA's “From Plant to Product to Puff” campaign (n = 12); six messages from FDA's campaign did not reference nicotine and were treated as the reference source. Analyses examined associations between messages, grouped by source and individually, with beliefs about nicotine and RNC addictiveness and harms. ResultsRelative to FDA messages that did not reference nicotine, all message sources were associated with greater odds of a correct belief about nicotine (Odds Ratios [ORs] = 1.40–1.87, p's < 0.01); VLN messages were associated with greater correct beliefs about RNC addictiveness (b = 0.23, p < .05). No campaign produced greater correct beliefs about RNC harms. At the individual level, only five messages were associated with a correct belief about nicotine (ORs = 2.12–2.56, p-values < .01), and one with correct beliefs about RNC harms (b = 1.09, p < .05), vs. the reference message. ConclusionsFew existing messages improved understanding of the risks of nicotine separately from the risks of combustible products. Communication research is needed to promote greater public understanding of nicotine while minimizing unintended effects on nicotine and tobacco use.

Low temperature carbonization, smoke suppression and durable flame retardancy of cotton fabric spray-assisted coated by phosphorus nitrogen silicon composite system

To solve the problems of flammability, smoldering, smoking and flame retardant durability of cotton fabric, flame retardant fininshing was executed using spray assisted self-assembly method, and P/N/Si synergistic flame retardant system was constructed by polyethylene imine (PEI), phytic acid (PA) and 3-aminopropyltriethoxysilane (APTES). Cotton cellulose carbonized at low temperature prompting by PA catalytic effect, and this cooperated with PEI thermal decomposition to endow cotton fabric with flame retardancy and smoking suppression by reducing its pyrolysis rate at high temperature and lessening combustible products. Meanwhile APTES as silane coupling agent further improved its flame retardant durability and smoke suppression effect. The synchronous thermal analysis results indicate that cotton fabrics treated by PA/PEI/APTES composite system present significant low-temperature carbonization trend, and their initial decomposition temperatures advance by 46.5℃-75.9℃. Moreover, they form 4.6 %-44.9 % aromatic structure char through dehydration and carbonization reactions during the low-temperature carbonization process, improving their thermal stability at high temperature, and their after-flame and smoldering phenomena disappear. The damaged length of treated fabric with five layers reduces to 5.0 cm, its limiting oxygen index reaches 33.7 %, and it presents excellent flame retardant durability and smoke suppression effect. This low-temperature carbonization mechanism possesses importantly innovative significance for the flame retardant finishing of cotton fabric, and it not only more actively guides the selection of flame retardants to make them match with the material required, but provides a new thinking method for flame retardant material research in the future.

The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review.

Oral nicotine pouches (ONPs) are a new class of nicotine products. This scoping review summarizes evidence on ONPs and explores their potential public health impact. We conducted a structured literature search for empirical studies across three electronic databases through January 10, 2024. Outcomes included ONP product characteristics, use patterns, beliefs and perceptions, toxicity, and marketing and sales. Sixty-two studies were included, 17 were industry-funded. Most studies were from the United States. While large variations across studies were observed in ONP youth prevalence estimates, nationally representative U.S. studies find current use at 1.5% and lifetime use below 2.5% through 2023. Between 35% and 42% of U.S. adolescents and young adults have heard of ONPs, and 9-21% of tobacco-naïve youth were susceptible to trying them. U.S. adult-use estimates varied widely (0.8%-3% current; 3%-16% lifetime use) and were limited to populations with a history of tobacco use. The chemical composition of ONPs suggests fewer harmful/potentially harmful compounds at lower levels than cigarettes and smokeless tobacco (SLT), except formaldehyde. Industry-funded studies find substantially less cytotoxicity compared to cigarettes and suggest that higher nicotine-strength ONPs can deliver nicotine at levels comparable to or higher than SLT or cigarettes, although with slower nicotine release than cigarettes. Evidence on the cytotoxicity of ONPs relative to SLT is mixed. ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users, although key data are mainly available from industry-funded studies. Data from independent research is critically needed. Industry marketing of ONPs may encourage initiation in youth and situational and dual use in adults. The review provides an initial assessment of the potential role of ONPs in harm reduction and aims to determine unintended consequences of their use (youth uptake and dual-use) and identify populations that disproportionately use the product. This information is essential for tobacco regulatory bodies in determining the net public health impact of nicotine pouches.

Importance of Various E-Cigarette Device and E-Liquid Characteristics by Smoking Status among Young Adults Who Vape

Background E-cigarette product characteristics are known to influence appeal among young adults. Understanding which characteristics appeal to individuals with (vs. without) a history of combusted tobacco use is essential for developing effective tobacco control policies. Methods Anonymous, self-report data were collected from young adults (18-30 years) who had used e-cigarettes in the past 30 days (n = 295) online via Prolific from September-October 2019. Using a visual analogue scale (range: 0-100), participants rated the importance of ten e-cigarette device and nine e-liquid characteristics. Adjusted linear regression models were used to evaluate the association of combusted tobacco use status (never, former, current) with mean rating scores for each of the nineteen characteristics. Results The most important e-cigarette device characteristics were price (Mean = 81.1; [SD = 17.9]), size (Mean = 75.5 [SD = 20.9]), and hit strength (Mean = 73.8 [SD = 20.4]) while the most important e-liquid characteristics were flavor (M = 85.1 [SD = 16.3]), price (M = 80.9 [SD = 18.4]), and nicotine level (M = 77.8 [18.9]). Differences by combusted tobacco use status were observed for device brand, temperature/voltage, customizability, color, and popularity, with the highest ratings generally observed among those concurrently using combustible tobacco products. For e-liquids, differences by use status were observed for flavor, price, and bottle type. Notably, those concurrently using combusted products rated flavor as less important than those with no history of combustible tobacco use (B=-5.01[95%CI=-9.97, −0.05]). Conclusions The self-rated importance of e-cigarette device and e-liquid attributes varies by combustible tobacco use status among young adults which may be used to inform regulatory decisions regarding e-cigarette product characteristics.

Waterpipe Tobacco Brands and Flavors Sold Online in the USA

Introduction Flavor additives are commonly used in combustible tobacco products to mask harshness and increase appeal. However, research on the availability of flavored waterpipe tobacco (WT) is lacking, yet is important to support implementation of policies. Methods We completed a comprehensive online search in 2020 to identify WT brands and flavors sold online in the USA. We conducted a descriptive content analysis categorizing flavors as explicit (i.e., clear taste/flavor) or concept (i.e., no clear taste/flavor); and coded for 23 flavor descriptors (e.g., fruit, mint/menthol, tobacco). Flavor names were double-coded and discrepancies were resolved by a third coder. Results We identified 66 WT brands with 118 product lines (i.e., sub-brands). We found 2953 flavors, including 1871 unique flavors. Brands averaged 45 flavors (range: 1–183). Almost three quarters (73.5%, n = 2171) used explicit flavor names and 26.5% (n = 782) used concept flavor names. Concept flavors varied widely, and included names such as 1001 Nights and California Dream. The most common flavor descriptors were fruit (54.1%) and mint/menthol (12.5%). Tobacco was rarely (0.2%) used as a flavor descriptor. Flavor descriptors also included location (10.7%), color (11.1%), candy (6.3%), cool/ice (5.3%), and alcohol (5.5%). Conclusions WT is available in 1871 unique flavors, likely contributing to product appeal and use. Like other tobacco products, fruit and mint/menthol are common flavors. Given the significant health consequences associated with WT smoking and the role of flavors in product use, regulatory action specifically targeting WT flavors is urgently needed.