Current Nicotine Research Articles

Electronic nicotine delivery system flavors, devices, and brands used by adults in the United States who smoke and formerly smoked in 2022: Findings from the United States International Tobacco Control Four Country Smoking and Vaping Survey

ObjectiveThis study estimated prevalence of current electronic nicotine delivery systems (ENDS) used by US adults who smoked cigarettes or formerly smoked in 2022 and assessed ENDS flavors, devices, and brands used most often. MethodsData are from the 2022 US ITC Smoking and Vaping Survey. Respondents were recruited from a web panel of a nationally representative sample of US adults ages 18+ who smoked, formerly smoked, and/or vaped ENDS. Using weighted data, we estimated prevalence of current vaping among adults who smoke or formerly smoked (N = 2,016). Among the subset who vaped (n = 554), we assessed flavors and devices used most often. Using unweighted data, we assessed the frequency (count) of reported brands used most often. ResultsIn 2022, 22.0 % of US adults who smoked or formerly smoked were vaping at least monthly. A significantly higher proportion of adults who formerly smoked and/or were younger (18–39) were vaping than adults who were smoking and/or were older (40+) (both p < 0.001). Tank devices were used most often (34.7 %), followed by disposables (27.4 %), pre-filled pods/cartridges (23.0 %), and refillable pods/cartridges (14.9 %). The five most commonly used flavors were fruit (33.9 %), tobacco (20.1 %), menthol (12.2 %), candy/sweets (10.8 %), and mixed ice flavors (10.0 %). The top 5 brands were JUUL, Smok, Vuse, Geekvape, and Blu. ConclusionsIn 2022, a majority of adults who smoked cigarettes or who had quit smoking used a variety of flavors and devices that go beyond the choices that FDA currently has authorized for sale.

Recall of Flavor at First E-cigarette Use and Its Association with E-cigarette Progression: The Mediating Effects of First Sensory Experience

To test whether the association between flavor at first vape and continued use is mediated through subjective experience at first vape. In a 2020 cross-sectional survey, 955 young adult ever-vapers recalled their first flavor vaped, subjective experiences at first use, current vaping behavior, nicotine dependence, and quit attempts. A latent class model grouped first-use subjective experiences into classes. Two-part negative binomial hurdle models for each vaping behavior evaluated whether the association of first flavor used with vaping outcomes was mediated by positive experience. Four latent classes (positive, positive and negative, negative, and minimal experience) were further reduced to "any positive experience" (only positive, positive and negative) vs "no positive experience" (negative or minimal). Class membership mediated the association of first flavor used (mint/menthol/ice [ie, "cooling"] or sweet vs other) with each vaping outcome. For example, cooling flavor (vs. other) was associated with positive class membership (OR=3.5; 95% CI: 1.5, 8.1), which was then associated with any past 30-day vaping (OR=3.9; 95% CI: 2.7, 5.8) and greater number of vaping days among current vapers (RR=1.9; 95% CI: 1.3, 2.7) in the two-part hurdle model. Similar results were observed for nicotine dependence and quit attempts, and for sweet (vs other) flavor for any dependence or quit attempts, but not number of dependence symptoms or quit attempts. Use of a cooling or sweet flavor at first use was associated with having a positive first vaping sensory experience, and then greater likelihood as a young adult of reporting past 30-day vaping, more vaping days, and greater risk for nicotine dependence, suggesting a key mediating role of first use experience.

Association between adolescent alcohol use and cognitive function in young adulthood: A co-twin comparison study.

Studies on adolescent alcohol use and cognition are often unable to separate the potential causal effects of alcohol use on cognition from shared etiological influences, including genetic influences or other substance use comorbidities also known to be associated with cognition, such as nicotine use. The present study aimed to fill this gap and clarify the relationship between adolescent alcohol use and young adult cognition by accounting for both measured and unmeasured confounders. A random effects model accounting for nesting in families was used to control for measured confounders. Next, co-twin comparisons were conducted within the full sample and in monozygotic twin pairs (MZ) to control for unmeasured genetic and environmental confounders shared by co-twins. Participants were 812 individuals (58.6% female, 361 complete pairs, 146 MZ pairs) from the longitudinal FinnTwin12 study in Finland. Adolescent alcohol use was indexed with measures of frequency of use and intoxication averaged across ages 14 and 17. Cognitive outcomes were measured at average age 22 and included Trail Making Test, California Stroop test, Wechsler Adult Intelligence subtests (Vocabulary, Block Design, Digit Symbol), Digit Span subtest of Wechsler Memory Scale, Mental Rotation Test and Object Location Memory test. Covariates included sex, parental education, general cognitive ability, current alcohol use and nicotine use. Greater frequency of alcohol use and frequency of intoxication across adolescence was associated with decreased vocabulary scores in the co-twin control [freq: stnd beta = -0.12, 95% confidence interval (CI) = -0.234, -0.013] and MZ only co-twin control models (freq: stnd beta = -0.305, 95% CI = -0.523, -0.087; intox: stnd beta = -0.301, 95% CI = -0.528, -0.074). In Finland, there appears to be little evidence that adolescent alcohol use causes cognitive deficits in young adulthood, except modest evidence for association of higher adolescent alcohol use with lower young adult vocabulary scores.

Effect of scaling on levels of interleukin 1-beta and clinical periodontal parameters among e-cigarette users and non-smokers: A prospective study.

This cohort study aimed to compare the effect of ultrasonic scaling on the expression of IL-1β in the gingival crevicular fluid (GCF) among ENDS users and non-smokers (NS) with gingivitis. Self-reported current electronic nicotine delivery system (ENDS) users and NS with generalized gingivitis were included in this study. All the patients underwent scaling at the baseline visit (T0). Clinical measures, periodontal parameters [probing depth (PD), plaque index (PI), and bleeding on probing (BOP)], and GCF IL-1β were measured at T0, after 1 week (T1) and after 3 weeks (T2). Wilcoxon signed rank test was used to assess the changes in the periodontal measurements and IL-1β levels at different time points and Mann-Whitney U Test was used to compare the two groups. A total of 38 individuals (18 NS and 20 ENDS users) participated in the study. The PD was significantly higher in ENDS users than in NS at baseline. However, the PI and BOP were similar in all groups at baseline. At T1, the PI was significantly lower for NS than for ENDS users (p=0.045). At T2, there were no significant differences in any of the parameters assessed between the two groups. For ENDS users, BOP was significantly lower at T1 than at baseline. For NS, the BOP at T1 and T2 and the PI at T1 were significantly lower than at baseline. There was no difference in the GCF IL-1β levels in NS and ENDS users at baseline, T1, and T2. At T2, there was a significant reduction in IL-1β (p<0.05) than at baseline in both groups. Both ENDS users and NS with gingivitis responded similarly to scaling. GCF IL-1β levels were significantly higher at baseline (p<0.05) compared with their levels at T1 and T2 for both the groups. The study was registered on the official website of ClinicalTrials.gov. ID NCT05745324.

Secondhand Nicotine Absorption From E-Cigarette Vapor vs Tobacco Smoke in Children

ImportanceWith the prevalence of e-cigarette use (vaping) increasing worldwide, there are concerns about children’s exposure to secondhand vapor.ObjectiveTo compare nicotine absorption among children who are (1) exposed to secondhand tobacco smoke only or (2) exposed to secondhand vapor only with (3) those exposed to neither.Design, Setting, and ParticipantsThe US Continuous National Health and Nutrition Examination Survey (NHANES) is a repeat cross-sectional survey. Participants are interviewed in their homes and, several days after, visit a mobile examination center to provide biological specimens. This study uses data from a nationally representative sample of US households from 2017 to 2020. Participants were children aged 3 to 11 years with serum cotinine levels incompatible with current firsthand nicotine use (ie, <15 μg/L). The final analysis was conducted on January 9, 2024.ExposuresReported exposure to secondhand smoke or vapor indoors in the past 7 days (only secondhand smoke, only secondhand vapor, or neither). Covariates included age, sex, ethnicity, family income, body weight, and height.Main Outcomes and MeasuresThe primary outcome was serum cotinine concentration, an objective biomarker of nicotine absorption. Geometric mean cotinine levels and 95% CIs were calculated using log-normal tobit regression, accounting for the complex survey design and weights.ResultsThe mean (SD) age of the 1777 children surveyed was 7.4 (2.6) years, 882 (49.6%) were female, and 531 (29.9%) had family incomes below the poverty level. Nicotine absorption, as indexed by serum cotinine level, was highest among children only exposed to secondhand smoke (0.494 μg/L μg/L; 95% CI, 0.386-0.633 μg/L), followed by those exposed only to secondhand vapor (0.081 μg/L; 95% CI, 0.048-0.137 μg/L), equating to 83.6% (95% CI, 71.5%-90.5%; P < .001) lower nicotine absorption. Among children with no reported secondhand exposure, the geometric mean cotinine level was 0.016 μg/L (95% CI, 0.013-0.021 μg/L), or 96.7% (95% CI, 95.6%-97.6%; P < .001) lower than for those with exposure to secondhand smoke. Results were similar after covariate adjustment.Conclusions and RelevanceIn this cross-sectional study of US children, nicotine absorption was much lower in children who were exposed to secondhand vapor vs secondhand smoke, but higher than in those exposed to neither. These findings suggest that switching from smoking to vaping indoors may substantially reduce, but not eliminate, children’s secondhand exposure to nicotine and other noxious substances.

Nicotine pouch use by sex, school type and tobacco product use among Finnish adolescents during the 2023 change in regulatory scheme with deregulated sales.

In Finland, nicotine pouches entered the national market abruptly in 2023, following a change in April 2023 from medicinal product classification into less regulated tobacco surrogate status. This study aimed to measure adolescent nicotine pouch use and associated characteristics. A cross-sectional, nationwide school-based survey among students in comprehensive schools (COMP), general upper secondary schools (GEN) and vocational institutes (VOC) in 2023 in Finland. A total of 151 224 respondents aged 14-20 years (mean age 16.18 years, standard deviation 1.20 years). Nicotine pouch use was used as the outcome variable. Demographics included age, sex, school type and tobacco product use (smoking, snus use and e-cigarette use). Covariates included parental education and parental smoking. All measures were self-reported. Unadjusted results showed that current nicotine pouch use was more common among boys (11.3%) than among girls (3.3%), adolescents in VOC (15.4%) compared with COMP (6.8%) and GEN (4.3%), whereas daily use of other tobacco and nicotine products was associated with current nicotine pouch use compared with never using such products and the association was especially strong for snus use. The fully adjusted estimates of current nicotine pouch use remained strong for daily use of other tobacco and nicotine products (snus use: adjusted prevalence ratio [aPR] = 74.95, 95% confidence interval [CI] = 65.65-84.25; smoking: aPR = 1.43, 95% CI = 1.36-1.50; e-cigarette use: aPR = 2.15, 95% CI = 2.04-2.27) and for sex (boys aPR = 1.53, 95% CI = 1.48-1.57). There was no clear evidence of differences in current nicotine pouch use by school type, age or parental factors in the fully adjusted model. In Finland in 2023, during which the availability of nicotine pouches became less regulated, nicotine pouch use appeared to be more common among boys and adolescents who used other nicotine products.

The Role of e-Cigarette Packaging as a Health Communications Tool: A Focus Group Study With Adolescents and Adults in England and Scotland.

In the United Kingdom, e-cigarette and refill packaging must display a nicotine addiction warning. This study explored how this message is perceived, responses to alternative on-pack messages, and other options for using e-cigarette packaging to discourage youth and people who neither smoke nor use e-cigarettes while encouraging smokers to switch. Between August and September 2022, 16 focus groups (n = 70) were conducted to explore these topics with adolescents (n = 31, aged 11-17 years) and adults (n = 39, nonsmokers, smokers that use e-cigarettes, smokers that do not use e-cigarettes) in England and Scotland. While several participants thought the current nicotine addiction warning could help increase awareness of nicotine addiction, most reported that it failed to capture attention and was not a deterrent. Alternative messages shown on packs (about harm, toxicity, wellness, litter, or relative risk) received mixed responses. Relative risk messages were perceived as most beneficial for smokers switching but also thought to potentially encourage uptake among nonsmokers. Some participants considered certain harm and toxicity messages to potentially dissuade uptake. Participants proposed several ideas to reduce the appeal of e-cigarette packaging and devices to deter youth uptake, including more prominent warnings, standardized packaging, and devices that are plain or include health messages. Packaging can play a crucial role in communicating product and health messages to different consumer groups. Further consideration of how packaging and labeling can meet the needs of non-nicotine users while simultaneously reaching those who may benefit from using e-cigarettes to stop smoking is warranted. While some viewed the nicotine addiction warning required on e-cigarettes and refill packaging in the United Kingdom as helpful in raising awareness of nicotine addiction, it did not resonate with most of our sample of adolescents and adults. The findings suggest that e-cigarette packaging could be better used to encourage smokers to switch to a less harmful alternative, with relative risk messages showing promise. Furthermore, strengthening on-pack messaging (eg increasing salience and rotating messages) and reducing the appeal of packaging (eg drab colors) and devices (eg including warnings) may help increase awareness of e-cigarette harms while deterring use among adolescents and nonsmokers.

Recent Stressful Experiences and Electronic Nicotine Product Use Among Young Adults

Background and Objective: The goal of the current study was to examine how specific recent stressors are related to electronic nicotine product use among young adults. Despite increases in electronic nicotine product use among adults, stressors shaping the use of these products remain largely unknown. The current study examined the types and average severity of stressors endorsed between young adults with past 30-day electronic nicotine product use and young adults with no lifetime use, as well as the association between frequency of recent electronic nicotine product use and average severity of stressors. Methods: 175 current electronic nicotine product users and 333 lifetime abstainers of electronic nicotine products and cigarettes reported recent stressful experiences that occurred in the past six months, as well as lifetime and past 30-day substance use. Chi-square, independent samples t-test, and regression analyses were performed. Results: There were no significant group differences in the primary type of stressor experienced (p = 0.320) or average stress of the three recent stressful experiences reported (p = 0.246). There was no significant relationship between electronic nicotine product use and average stress of the three recent stressful experiences, controlling for demographic and substance use covariates (p = 0.150). Both current electronic nicotine product users and lifetime abstainers endorsed school, family, and romantic relationship stressors most frequently as their top stressors. Conclusion: To our knowledge, this is the first study to examine group differences in specific stressor categories and perceived stress between current electronic nicotine product users and lifetime abstainers of these products. Given the novel assessment of stressor types, the current study provides a critical starting point for research on this timely topic. In addition, due to the high overlap between stress and nicotine use, future studies should investigate different populations of electronic nicotine product users and other methods to assess stressful experiences.

The prevalence and sociodemographic determinants of tobacco and nicotine use among students in healthcare disciplines in Saudi Arabian universities: a cross-sectional survey.

Tobacco smoking is one of the most significant health-related problems worldwide. However, the prevalence and sociodemographic determinants of tobacco and nicotine use among students on healthcare courses in Saudi Arabia are limited. This cross-sectional study used a questionnaire that was distributed via SurveyMonkey between November 2022 and June 2023 to all student universities offering healthcare courses. Data are presented as frequency and percentages. The associated sociodemographic factors with current tobacco and nicotine use were subjected to logistic regression. Overall, 5,012, of whom 3,872 (77.25%) were males, responded to the online survey. The prevalence of current tobacco and nicotine use was 3,553 (71%). The majority of users used electronic nicotine delivery systems (1,622: 32.36%). The current use of cigarettes (AOR: 1.75 (1.42 to 2.15)), e-cigarettes (AOR: 1.17 (1.01 to 1.37)), and smokeless tobacco substances (AOR: 1.35 (1.02 to 1.90)) were more pronounced among males compared to female students. However, the current use of a hookah was less among males (AOR: 0.74 (95% CI: 61 to 0.91)). Smoking cigarettes was practiced less among students living in other regions compared to the Central Region. However, smokeless tobacco substances seem to be more prevalent in the Western, Southern, and Northern Regions, (AOR: 1.57 (95% CI: 1.09 to 2.26)), (AOR: 1.43 (95% CI: 1.04 to 1.95)), and (AOR: 1.57 (95% CI: 1.09 to 2.26)), respectively. Smoking is prevalent among students in the healthcare disciplines, with electronic nicotine delivery systems being the most used product. Several sociodemographic factors were associated with higher tobacco or nicotine use.

Reasons for refusal of or ineligibility for radical cystectomy (RC) in patients (Pts) with bacillus Calmette-Guérin (BCG)–unresponsive high-risk non–muscle-invasive bladder cancer (HR NMIBC) from the SunRISe-1 study.

701 Background: RC is the recommended treatment (tx) option for pts with BCG-unresponsive HR NMIBC. However, RC is associated with significant risk of morbidity, mortality, and impact on quality of life (QoL); some patients may refuse/be ineligible for RC. In a systemic review of 160 real-world studies, &lt;20% of pts with HR NMIBC recurrent after BCG underwent RC (PMID 35046678). For RC-ineligible pts, bladder-sparing tx is recommended. TAR-200, a novel intravesical drug delivery system that provides sustained release of gemcitabine within the bladder, is under investigation in pts with BCG-unresponsive HR NMIBC who are ineligible for/refuse RC in the ongoing ph 2b SunRISe-1 (SR-1) study (NCT04640623). Preliminary results showed a promising complete response (CR) rate of 73% and durable responses in pts with BCG-unresponsive HR NMIBC treated with TAR-200 (Daneshmand et al. AUA 2023). We report reasons for refusal/ineligibility for RC in pts enrolled in the TAR-200 monotherapy cohort of SR-1. Methods: SR-1 is evaluating the efficacy and safety of TAR-200 + cetrelimab (CET; anti–PD-1) (Cohort 1 [C1]), TAR-200 alone (C2), or CET alone (C3). Pts ≥18 y with histologically confirmed carcinoma in situ (CIS) ± papillary disease (T1, high-grade Ta) who completed adequate BCG and recurred ≤12 mo since last BCG dose with ECOG performance status (PS) of 0-2 are randomized to C1, C2, or C3. As of Amendment 4, pts with papillary disease only will be enrolled in C4 with TAR-200 alone. The primary end point is overall CR rate at any time. Refusal/ineligibility for RC was documented in the electronic case report form. Results: As of Aug 24, 2023, 54 pts were treated in C2. Median age was 71 y (range 40-85). Pts had a median of 12 (range 7-42) prior BCG doses with a median of 3.0 mo (range 0.2-22.0) from last BCG dose to recurrence. Most pts (96%) had ECOG PS 0; 33% had CIS with papillary disease. 50%, 48%, and 19% of pts had a medical history of Gr ≥2 metabolic, vascular, and cardiac conditions, respectively, and 9% were current nicotine users. Overall, 51 (94%) pts refused RC; 3 (6%) were ineligible (Table). The most common reason for refusal was a preference for bladder preservation (52%), followed by concern about QoL (37%). Pts were ineligible for RC due to medical/surgical comorbidities (4%) and age (2%). Conclusions: Most pts enrolled in C2 of SR-1 refused RC, with preference for bladder preservation and QoL concerns being the most common reason for refusal. This highlights the need for bladder-sparing tx options for pts with HR NMIBC recurrent after BCG. Clinical trial information: NCT04640623 . [Table: see text]

Clinical considerations for adolescents with eating disorders who use nicotine.

Adolescence is a developmental period in which individuals demonstrate increased likelihood of engaging in disordered eating and risk‐taking behaviors, such as substance use. Nicotine use, in particular, (e.g., via vaping, combustible cigarettes, smokeless tobacco) is pervasive among middle and high school students. In 2022, 17.4% of middle school and high school students reported current nicotine vaping. Daily use of nicotine was reported among 27.6% of current users (Cooper et al., 2022). Research posits that eating disorders and nicotine use are highly comorbid. A recent study by Ganson and Nagata (2021) found that nearly 20% of participating adolescents with an eating disorder also used nicotine within the past 30 days. This is problematic, as nicotine use increases the mortality rate for eating disorders, which already has the second highest rate of all mental health disorders. Nicotine use may also exacerbate many of the medical complications associated with eating disorders (e.g., neuroendocrinal, dental, nutritional) and negatively impact eating disorder recovery (Ganson &amp; Nagata, 2021).

Cigarette smoking behaviors and nicotine dependence at the intersection of sexual identity and sex in the United States: Findings from the National Survey on Drug Use and Health

Introduction: Cigarette smoking is disproportionately high among lesbian, gay, and bisexual (LGB) adults. Yet, collapsing these identities into a monolith can disguise important within group disparities (e.g., lesbian/gay versus bisexual female). The purpose of this study is to report recent national prevalence estimates and trends of cigarette smoking behaviors and nicotine dependence by sexual identity and sex. Methods: Data were from the 2015–2019 National Survey on Drug Use and Health (n = 210,392; adults 18+), a nationally representative, repeated cross-sectional study of substance use and mental health in the U.S. We examined bivariate and multivariable associations between sexual identity and cigarette smoking measures (i.e., former smoking, lifetime smoking, current smoking, current daily smoking, nicotine dependence) by sex. We also examined linear time trends in current and former smoking. Covariates included age, race/ethnicity, education, annual household income, and survey year. Results: Bisexual women had the highest unadjusted prevalence of current smoking (31 %) and lowest of former smoking (25 %). LGB females and males had higher adjusted prevalence of current smoking, daily smoking, and nicotine dependence than heterosexual adults. Bisexual females and gay and bisexual males had lower adjusted prevalence of former smoking (adjusted prevalence ratio range: 0.78–0.85) than heterosexual counterparts. Discussion: This is the first study to identify disproportionately low prevalence of former smoking among bisexual females. Paired with findings of high prevalence of current cigarette smoking and nicotine dependence, these data suggest that tobacco control interventions targeted toward bisexual females are urgently needed to reduce the burden of cigarette smoking among these individuals.

Efficacy and safety of non-invasive brain stimulation techniques for the treatment of nicotine addiction: A systematic review of randomized controlled trials.

Non-Invasive Brain Stimulation (NIBS) techniques seem to be effective in treating tobacco use disorder. We aimed to analyze what kinds of protocols are used to treat nicotine addiction in term of cessation and/or reduction and to evaluate the long-term effects of NIBS techniques. We searched PubMed, Scopus, and Web of Science for papers published, with combinations of the following search terms: "Non-invasive brain stimulation OR TMS OR transcranial magnetic stimulation OR tDCS OR transcranial direct current stimulation OR transcranial electrical stimulation OR TES AND Nicotine addiction". We conducted a preliminary search, which revealed papers on the topic. Articles were included in the review according to the following inclusion criteria: English language, publication in peer reviewed journals, articles about studies performed on non-invasive brain stimulations techniques, and RCT studies. Studies involving clinical populations with organic or psychiatric diseases were excluded. We found 280 articles. Of these, at the first screening and conducted by title and abstract, 63 studies were excluded after duplicates were removed (118). After the second screening conducted by full-text examination, 45 articles were excluded. Ten studies met the inclusion criteria and were included in the review. The clinical benefits of NIBS, including the fast onset and minor side effects, showed that this kind of treatment could be helpful in patients with a long history of smoking in terms of cessation and abstinence rates.

Alcohol and Nicotine Dependence and Time to Death in a General Adult Population: A Mortality Cohort Study

Introduction: Findings from general population studies are lacking in regard to the co-occurrence of alcohol and nicotine dependence in relation to later mortality. The aim of this study was to analyze potential interactions of risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and time until the first cigarette is smoked in the morning after awakening in the prediction of mortality. Methods: This study analyzed a random sample of the general population in Northern Germany, which comprised adults aged 18–64 years. Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning after awakening were assessed for the period of 1996–1997 by applying the Munich-Composite International Diagnostic Interview. Data about all-cause mortality were gathered for the period of 2017–2018 and analyzed using Cox proportional hazards models. Results: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning were associated with each other and predicted the time to death. Among participants with a former alcohol dependence, 29.59% had a current nicotine dependence. Participants who had ever been dependent on alcohol at some point in their life before and currently smoked their first cigarette in the morning within 30 min or less after awakening had a hazard ratio of 5.28 (95% confidence interval: 3.33–8.38) for early death compared to low-risk alcohol consumers who had never smoked. Conclusion: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning may have a cumulative impact on time to death. The findings suggest that it could be beneficial to provide support for quitting both risky alcohol drinking and tobacco smoking among nondependent individuals in addition to supporting remission from dependence.

Quick nic: novel smokeless nicotine products and pediatric trends.

The development and marketing of smokeless nicotine products in recent years have become increasingly popular among adolescents. In addition to well known conventional inhaled nicotine products, noninhaled products, such as nicotine toothpicks, orbs, lozenges, strips, and more, have dangerously captivated a new youth audience. Although smokeless nicotine products may seem to be less threatening than conventional inhaled nicotine products, there are significant risks associated with the use of these products, including addiction and severe health issues. The purpose of this review is to provide up-to-date information about alternative nicotine products currently on the market that may appeal to youth, and the dangers of nicotine use for pediatric populations. Smokeless nicotine products appeal to minors with their varying flavors and discrete packaging. These products may lead to nicotine toxicity as well as severe health problems, such as cancer, issues with reproduction, and heart attacks. Nicotine is extremely dangerous for young children; in fact, using nicotine products before the age of 18 years can lead to addiction and is linked to an increased likelihood of experimenting with stronger nicotine products or illicit drugs. The development of inconspicuous nicotine packaging has led to increasing concerns for accidental nicotine exposure and overdose in youth. Greater knowledge regarding current nicotine products on the market, specifically smokeless nicotine products, will help clinicians be more aware of the dangers associated with these products. Clinicians will be better able to provide their patients and families with proper guidance to avoid nicotine addiction, further drug use, and detrimental health issues. Caregivers and medical professionals must recognize novel and inconspicuous nicotine products commonly used among youth, understand the signs of nicotine abuse and dependence, and take measures to address possible nicotine-related health risks.

Nicotine Pouch Awareness and Use Among Youth, National Youth Tobacco Survey, 2021.

This manuscript examines prevalence of awareness and use of nicotine pouches among U.S. middle and high school students by sociodemographic characteristics and other tobacco product use and characterizes nicotine pouch and other tobacco product use behaviors among current nicotine pouch users. Data are from the 2021 National Tobacco Youth Survey, a cross-sectional, school-based survey of middle and high school students (N = 20 413; overall response rate: 44.6%), which included questions on nicotine pouches in 2021 for the first time. Prevalence estimates, 95% confidence intervals, and estimated population counts were assessed for nicotine pouch awareness, ever use, and current (past 30 days) use, and for use behaviors related to nicotine pouches (frequency of use, flavor(s) used) and other tobacco products (ever, current, frequency of use) among current nicotine pouch users. Over one-third of students (35.5%) had ever heard of nicotine pouches. An estimated 1.9% (490 000) reported ever using them, while 0.8% (200 000) reported current use. Among current nicotine pouch users, 61.6% reported flavored nicotine pouch use, 64.2% reported current e-cigarette use, and 52.6% used multiple (≥2) tobacco products. Current use of nicotine pouches was common among current smokeless tobacco users (41.3%). Overall, in 2021, while relatively few students had ever tried nicotine pouches or currently used them, more than one-third had heard of them. Current nicotine pouch users tended to use other tobacco products, particularly e-cigarettes and smokeless tobacco. Given previous rapid increases in youth uptake of e-cigarettes, it is important to continue monitoring nicotine pouch use among young people. This study's findings provide an important baseline for future monitoring of nicotine pouch awareness and use among middle and high school students. Emerging tobacco products, particularly those that are flavored, widely available, discreet, and inexpensive have the potential to attract youth. Given the potential of these products to appeal to young people, ongoing monitoring of nicotine pouch use behaviors is important to inform public health and regulatory efforts.

Factors Associated with Antiretroviral Therapy Adherence Among a Community-Based Sample of Sexual Minority Older Adults with HIV.

Older sexual minorities (e.g., gay, bisexual) living with HIV are at risk for poor HIV outcomes due to their frequent experience with both psychosocial challenges and structural barriers to care. This study utilized a stochastic search variable selection (SVSS) approach to explore potential psychosocial and structural factors associated with HIV-related health outcomes among a community-based sample of older sexual minorities (N = 150) in South Florida, an U.S. HIV-epidemic epicenter. After SVSS, a forward entry regression approach suggested unstable housing, illicit substance use, current nicotine use, and depression were all associated with poorer ART adherence among older sexual minority adults living with HIV. No associations between potential correlates and biological measures of HIV disease severity were observed. Findings highlight a need to focus on multiple levels of intervention that target a combination of psychosocial and structural factors to improve HIV-care outcomes among older sexual minorities and achieve Ending the HIV Epidemic goals.

Abstract P124: Mental Health Differences by Vaping Behavior Observed Among Youth and Young Adults

Introduction: Previous studies have identified associations between nicotine and marijuana vaping among youth. Studies also have identified associations between vaping and both anxiety and depression among young adults. Hypothesis: We hypothesized that mental health differences would be evident across current nicotine-only vapers, current vapers of both nicotine and THC, and never vapers. Methods: A national online survey was conducted among 2,505 youth and young adults aged 13-24 during June and July 2022. The participants were recruited via an online panel and received an incentive to complete the survey. Parent consent was obtained for minors and informed consent was obtained from participants. Quotas were established for vaping and THC use. This analysis focuses on current vapers and never vapers (n=1,762). Current use was defined as having vaped in the past 30 days. Of the participants, 1,200 were current nicotine vapers (370 nicotine-only vapers and 830 dual vapers of nicotine and THC); 562 have never vaped nicotine or THC. Results: Dual vapers were significantly more likely than nicotine-only vapers to indicate addiction to nicotine, as defined as waking up at night to vape (55% vs. 45%, p&lt;0.05). Both vaping groups were significantly more likely than never vapers to report mental health concerns. Anxiety was more prevalent among dual vapers (60%) and nicotine-only vapers (58%) than never vapers (43%) (p&lt;0.05). Depression was more prevalent among dual vapers (52%) and nicotine-only vapers (53%) than never vapers (25%) (p&lt;0.05). And having suicidal thoughts was more prevalent among dual vapers (51%) and nicotine-only vapers (53%) than never vapers (33%) (p&lt;0.05). About one in four dual vapers (24%) and nicotine-only vapers (28%) started vaping nicotine to calm down/feel less stressed or anxious; one in three dual vapers (30%) and nicotine-only vapers (35%) currently vaped nicotine for this reason. One in five vapers (19% of dual vapers and nicotine-only vapers) started vaping to help feel less depressed, and currently vaped for this reason (20% of dual vapers and 21% of nicotine-only vapers). Dual vapers were significantly more likely than nicotine-only vapers to say they were less depressed after starting vaping (46% vs. 31%, p&lt;0.05); nicotine-only vapers were more likely to say vaping had no impact on their depression (38% vs. 27%, p&lt;0.05). Conclusions: In conclusion, our analysis shows an association between mental health symptoms with vaping nicotine and THC. Dual use may either compound the addictive nature of vaping or attract those more prone to addiction, as well as have an impact on depression. Anxiety and depression symptoms were notable among both groups, compared with never vapers, and were cited as reasons for nicotine vaping. These findings suggest the importance of addressing the use of THC and the need for building resilience skills in vaping prevention efforts.

Emerging Oral Nicotine Products and Periodontal Diseases.

Oral nicotine pouches are emerging as a new "modern oral" nicotine product. These prefilled pouches contain nicotine, flavorings, and filling agents that dissolve in the mouth. Nicotine can be derived from tobacco leaf or chemical synthesis. Traces of TSNAs and toxic chromium were detected in the pouch products. This raises the concern about general and periodontal health. This review aims to update the current oral nicotine products research relating to periodontal disease and its relevance in periodontal inflammation. Nicotine interacts with host cells and affects inflammatory responses to microbial challenges. It may directly or indirectly deteriorate periodontal tissues by activating nicotinic acetylcholine receptors, repressing PDL fibroblasts cells, increasing cellular ROS and cytokines/chemokines, growth factors, breaking microbiota balance, and dysregulating miRNAs expression. Studies show that appealing flavorings contained in nicotine pouches pose harm to periodontal innate immune responses and increase penetration of nitrosamines. In addition, flavored ONPs increase the risk of dual or poly-tobacco products among young adults, stacking up detrimental effects on the periodontium. Given the recent growth of users, further studies are needed to elucidate the impact of ONPs, even poly-tobacco use, on systemic and periodontal health. Moreover, policymakers should ensure to avoid generating a new wave of nicotine addiction among youths in the U.S.

The first nicotine product tried is associated with current multiple nicotine product use and nicotine dependence among a nationally representative sample of U.S. youths

This study examines the demographic factors associated with youths' first product tried (i.e., cigarettes, e-cigarettes, cigars, hookah, or smokeless tobacco). This study also evaluates whether the first product tried is associated with future nicotine product use (i.e., no use, single product use, and multiple product use) and nicotine dependence. Participants were 1999 youths (ages 12–17 years) who had ever tried a nicotine product and completed the Population Assessment of Tobacco Health study's Wave 1 (2013–2014) and Wave 4 (2016–2018) assessments. Two separate multinomial logistic regression models examined the association between 1) demographic factors and the first product tried at Wave 1 and 2) the first product tried at Wave 1 and past-30-day product use status at Wave 4. A two-part multivariable model examined the association between the first product tried and nicotine dependence, with part 1 modeling the presence (or absence) of any symptom of dependence and part 2 modeling the degree of dependence among those with any symptom of dependence. The first product tried was associated with sex, race, urbanicity, and parent education. First trying smokeless tobacco (vs. e-cigarettes) was associated with a greater likelihood of multiple product use (vs. no use and vs. single product use). Regarding the degree of nicotine dependence (n = 713), first trying smokeless tobacco (vs. e-cigarettes) was associated with higher nicotine dependence scores among those with any symptom of dependence. Youths who first try smokeless tobacco (vs. e-cigarettes) may be at higher risk for future multiple product use and more symptoms nicotine dependence. Research should explore tailored interventions for smokeless tobacco users.