Use Of Nicotine Products Research Articles

The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel

BackgroundEarly in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking.MethodsWe used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May–June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses.ResultsMost respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04–2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%).ConclusionsWhile many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.

Youth and the Use of Nicotine Products

Youth and the Use of Nicotine Products

Electronic cigarette menthol flavoring is associated with increased inhaled micro and sub-micron particles and worse lung function in combustion cigarette smokers

Flavored electronic cigarettes (ECs) present a serious health challenge globally. Currently, it is unknown whether the addition of highly popular menthol flavoring to e-liquid is associated with changes in the number of aerosolized particles generated or altered lung function. Here, we first performed preclinical studies using our novel robotic platform Human Vaping Mimetic Real-Time Particle Analyzer (HUMITIPAA). HUMITIPAA generates fresh aerosols for any desired EC in a very controlled and user-definable manner and utilizes an optical sensing system to quantitate and analyze sub-micron and microparticles from every puff over the course of vaping session in real-time while emulating clinically relevant breathing mechanics and vaping topography. We discovered that addition of menthol flavoring to freshly prepared e-liquid base propylene glycol–vegetable glycerin leads to enhanced particle counts in all tested size fractions, similar to the effect of adding vitamin E acetate to e-liquid we previously reported. Similarly, we found that menthol vs. non-menthol (tobacco) flavored pods from commercially available ECs leads to generation of significantly higher quantities of 1–10 µm particles upon inhalation. We then retrospectively analyzed data from the COPDGene study and identified an association between the use of menthol flavored ECs and reduced FEV1% predicted and FEV1/FVC independent of age, gender, race, pack-years of smoking, and use of nicotine or cannabis-containing vaping products. Our results reveal an association between enhanced inhaled particle due to menthol addition to ECs and worse lung function indices. Detailed causal relation remains to be demonstrated in future large-scale prospective clinical studies. Importantly, here we demonstrate utility of the HUMITIPAA as a predictive enabling technology to identify inhalation toxicological potential of emerging ECs as the chemical formulation of e-liquid gets modified.

Correlates of smoking during COVID-19 in the LGBTQI + cancer survivor population.

Stressors brought on by the pandemic may have further encouraged lesbian, gay, bisexual, transgender, queer, and intersex plus (LGBTQI +) cancer survivors to smoke. The purpose of this study is to examine factors associated with smoking among LGBTQI + cancer survivors during the pandemic. We used a secondary data analysis of OUT: The National Cancer Survey. We conducted logistic regression analysis to examine the associations between psychological distress, binge drinking, and socio-demographic factors with ever use and current use of cigarettes, other tobacco, and nicotine products. Of the 1629 participants in our sample, 53% used in their lifetime and 13% reported current use. Correlates of increased ever use included being of older age (AOR = 1.02; 95% CI: 1.01, 1.03) and binge drinking (AOR = 2.47; 95% CI: 1.17, 5.20) while correlates of decreased ever use were among those with a graduate or professional degree (AOR = 0.40; 95% CI: 0.23, 0.71). Correlates of increased current use included being of Latine descent (AOR = 1.89; 95% CI: 1.07, 3.36), binge drinking (AOR = 3.18; 95% CI: 1.56, 6.48), without health insurance (AOR = 2.37; 95% CI: 1.10, 5.10), and being disabled (AOR = 1.64; 95% CI: 1.19, 2.26) while correlates of decreased current use were among cisgender women (AOR = 0.30; 95% CI: 0.12, 0.77), being of younger age (AOR = 0.98; 95% CI: 0.96, 0.99), and having a graduate or professional degree (AOR = 0.33; 95% CI: 0.15, 0.70). Our findings demonstrate that a proportion of LGBTQI + cancer survivors continue to smoke during the pandemic despite the increased risk involved with smoking. Furthermore, individuals with intersecting marginalized identities experience additional stressors that may have been further exacerbated by the conditions of the pandemic that encourage them to smoke. Quitting smoking after a cancer diagnosis can decrease the chances of recurrence and a new primary malignancy. In addition, practitioners and researchers should advocate towards examining and addressing systemic forms of oppression in institutions that LGBTQI + cancer survivors navigate during the pandemic.

Use of tobacco, nicotine and cannabis products among students in Switzerland.

Most people who smoke cigarettes begin in their teens and teens may also be attracted to new tobacco, nicotine, and cannabis products. We describe use prevalence among upper-secondary school students in Switzerland, including daily use, of tobacco, nicotine, and cannabis products. We invited secondary school students (age 15 to 21) in two Swiss cantons to take an online survey between October 2021 and February 2022. The survey collected demographic information and asked how frequently they used tobacco products (cigarettes in commercial packages, self-rolled cigarettes, hookahs, pipes, cigars and cigarillos, tobacco heating systems, snus, snuff), non-tobacco nicotine products (nicotine pouches, e-cigarettes with and without nicotine), and cannabis products (smoking with and without tobacco, cannabis vaping). Answers were scored on a Likert scale (no use in past month, less than weekly, weekly but not daily, daily use, prefer not to say), then tabulated and reported as descriptive statistics. Of 32,614 students in the schools we contacted, 9,515 (29.2%) completed the survey; 49.5% identified as female and 48.4% as male; 9.5% were under 16, 47% were 16-17, 27.5% were 18-19, and 16% were over 19. Reported daily use was most frequent for tobacco cigarettes in commercial packages (14.2%), snus (4.1%) and cannabis smoking with tobacco (3.6%). Most participants (54.8%) reported they had used at least one product at least once within the last month. Students who used a product were most likely to smoke cigarettes, but many regularly used new tobacco, nicotine and cannabis products, though use frequency varies.

Prevalence of Nicotine and Tobacco Product Use by Sexual Identity, Gender Identity, and Sex Assigned at Birth Among Emerging Adult Tobacco Users in California, United States.

Sexual and gender minority (SGM) nicotine and tobacco use disparities are well-documented among youth and young adults (YYA), and despite decades of prevention efforts, these disparities stubbornly persist. To better understand tobacco use disparities and craft tailored interventions, tobacco use patterns must be assessed in a contemporary sample of YYA across lines of sexual and gender identity, sex assigned at birth, and tobacco product types. Data were from an online survey of a diverse sample of emerging adult tobacco users (ages 18-29; N = 1491) in California, United States (2020-2021). Participants were recruited from various online and in-person locations. Bivariate and adjusted models assessed differences in four nicotine and tobacco use outcomes (past 30-day use of cigarettes, e-cigarettes, other tobacco products, and multiple tobacco product types) across six groups: Cisgender heterosexual males, cisgender heterosexual females, cisgender sexual minority (SM) males, cisgender SM females, transfeminine participants, and transmasculine participants. Compared to cisgender heterosexual males, both transfeminine (OR = 2.25, 95% confidence intervals (CI) = 1.29 to 4.05) and transmasculine (OR = 1.85, 95% CI = 1.32 to 2.80) participants had higher odds of using cigarettes. Few differences were noted between groups in use of e-cigarettes. Cisgender heterosexual males had higher odds of other tobacco product use, compared to most other groups (eg, cisgender SM males: OR = 0.57, 95% CI = 0.37 to 0.87). Transmasculine participants had higher odds of multiple product use, compared to cisgender heterosexual females. Among multiple product users, transfeminine participants had the highest prevalence of using all three individual product types (35.6%). Results highlight the need for different tobacco control approaches across sexual and gender identities, sex assigned at birth, and nicotine and tobacco products. SGM nicotine and tobacco use disparities remain entrenched, despite concerted efforts to reduce them. The SGM population is heterogeneous and different SGM subgroups may have different needs. This study assessed, among young adult nicotine and tobacco users in California, U.S. patterns of tobacco use across sexual and gender identities, sex assigned at birth, as well as specific tobacco products used-a necessity to craft tailored tobacco control measures. We found patterns of nicotine and tobacco product use across several of these characteristics, highlighting how different prevention and cessation interventions may be needed to meaningfully address SGM nicotine and tobacco use disparities.

E-cigarette, cigarette, dual e-cigarette with cigarette use, and disability status among reproductive-aged women

ObjectiveE-cigarettes have increased steadily among reproductive-aged women, despite our limited understanding of their effect on reproductive health. This study examined the associations of e-cigarette, cigarette, and dual use with disability in reproductive-aged women. Study designThis was a cross-sectional study. MethodsData for this study were obtained from reproductive-aged women (18–44 years; n = 24,904) from the 2020 Behavioral Risk Factor Surveillance System. Descriptive statistics and logistic regression analyses were conducted to assess the associations of tobacco use patterns (dependent variable, i.e. non-use, current e-cigarette use, current cigarette use, and current dual use of e-cigarettes and cigarettes) with overall disability and the type of disability (independent variables). ResultsAmong women who reported any disability, 70.6%, 8.7%, 11.4% and 9.3% reported non-use, e-cigarette, cigarette, and dual use, respectively. In adjusted analysis, relative to non-use, women who reported any disability had higher odds of e-cigarette (adjusted odds ratio [aOR]: 1.88; 95% confidence interval [CI]: 1.15–3.07), cigarette (aOR: 1.58; 95% CI: 1.12–2.25), and dual use (aOR: 2.37; 95% CI: 1.55–3.62) compared with women without disabilities. ConclusionsThis cross-sectional study found higher odds of current e-cigarette use, cigarette use, and dual use of e-cigarettes and cigarettes among women of reproductive age with ≥1 disability. Improved screening for the use of nicotine products among women of reproductive age with disabilities may be necessary to lessen the use of nicotine products in this vulnerable population.

Marijuana Use in Middle and High School Students: Insights from the 2020 National Youth Tobacco Survey.

The use of marijuana by middle and high school students could have important consequences, including physical harm, poor decision making, increased use of tobacco products, and involvement in the legal system. Determining the level of use by students provides the initial information needed to understand the extent of the problem and possible approaches to reducing student use. The National Youth Tobacco Surveys provide important information about the frequency of use of nicotine and tobacco products by a representative sample of students in schools in the United States. The 2020 survey included a question about the use of marijuana by survey respondents. The results from the survey were analyzed using descriptive statistics and logistic regression to model the association between the use of marijuana and the use of electronic or conventional cigarettes. The final survey from 2020 included 13,357 students, with 6537 male respondents and 6820 female respondents. Ages ranged from younger than 12 to 18 and older years; 961 students used both cigarettes and marijuana, and 1880 students used both electronic cigarettes (e-cigarettes) and marijuana. The adjusted odds ratio for the use of marijuana increased in female students, in non-Hispanic Black students, Hispanic students, and all ages from 13 through 18 and older. The perception of harm associated with either e-cigarettes or cigarettes did not change the odds ratio for using marijuana. Students who did not smoke cigarettes or did not smoke e-cigarettes had significantly lower odds ratios for using marijuana. The 2020 National Youth Tobacco Survey indicates that approximately 18.4% of middle school and high school students have used marijuana. Parents, educators, public health officials, and policymakers need to understand that there is a relatively high use of marijuana among students and that education programs should focus on its use with or without other tobacco products.

Dual and poly-use of novel and conventional nicotine and tobacco product use in Europe: Challenges for population health, regulatory policies, and the ways ahead.

Dual and poly-use of novel and conventional nicotine and tobacco product use in Europe: Challenges for population health, regulatory policies, and the ways ahead.

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.

Use, marketing, and appeal of oral nicotine products among adolescents, young adults, and adults

ImportanceOral nicotine products such as pouches, lozenges, tablets, gums, and toothpicks are gaining popularity, especially among adolescents and young adults, with increased marketing. ObjectiveTo estimate use patterns of oral nicotine products and likelihood of buying and liking products based on marketing, using a large group of adolescents, young adults, and adults. Design, setting, and participantsA cross-sectional, online survey among U.S. participants (n = 6,131; ages 13–40 years) was conducted in November-December 2021. Main outcomes and measuresEver, past-30-day, and past-7-day use, behaviors, and flavors of oral nicotine products. Liking marketing and likelihood of buying specific oral nicotine products (Zyn pouches and Lucy gum) from marketing. ResultsOur sample included 2,025 (33.0%) ever-users, 1,191 (19.4%) past-30-day users, and 998 (16.3%) past-7-day users of any oral nicotine product. Use patterns by age (in years): ever-users (<21: 816 (22.3%); 21–40: 1,209 (48.9%)); past-30-day users (<21: 458 (12.5%); 21–40: 733 (29.7%)); and past-7-day users (<21: 383 (10.5%); 21–40: 615 (24.9%)). Across products, 10–18% of participants reported using nicotine strength ranging from 6–10 mg. Fruit, sweet/dessert, alcohol, coffee, and mint were the most used flavors. When shown marketing, ever-users liked and were likely to buy Zyn pouches compared to never users, and participants under 21 years felt equally targeted by Lucy and Zyn marketing. Liking Zyn marketing even a little bit compared to not at all increased the likelihood of buying Zyn pouches across age groups. After observing marketing, participants < 21 years were more likely to buy Zyn if they perceived marketing to contain messages about good tasting flavors (AOR 1.43, 1.09–1.87; 0.009) and helping to feel comfortable in social situations (AOR 1.38, 1.02–1.87; 0.033), and were more likely to buy Lucy if they felt it could be used anywhere (AOR 1.57, 1.05–2.33; 0.026). ConclusionsThis study provides a foundation for estimating use, behaviors, flavors, and marketing influence of oral nicotine products in the US and globally. Adolescent and young adult use of oral nicotine products and likelihood of buying products when exposed to marketing highlights the need for expanded tobacco use surveillance, marketing regulations, and counter marketing and educational efforts.

517 - Student use of alternative nicotine products: analysis of the national youth tobacco survey

517 - Student use of alternative nicotine products: analysis of the national youth tobacco survey

Tobacco-Free Oral Nicotine Product Use Among Youth in the U.S., 2019–2021

Novel tobacco-free oral nicotine products are not combusted, easy to conceal, available in flavors, and do not contain tobacco leaf. Since 2016, oral nicotine product sales have increased and may be gaining popularity among youth. This study aims to examine the trends in the prevalence and correlates of oral nicotine product use among U.S. youth. Data from participants aged 16-19 years in the U.S. International Tobacco Control Policy Evaluation Project Youth Tobacco and Vaping Survey were analyzed cross-sectionally from August 2019, February 2020, August 2020, February 2021, and August 2021. Weighted descriptive statistics and logistic regressions were used to describe the use and correlates of oral nicotine products. Oral nicotine product use significantly increased from 3.5% in August 2019 to 4.1% in August 2021. Oral nicotine product use was most prevalent among those aged 18 years, male, and non-Hispanic White. Those who used cigarettes (AOR=2.18, 95% CI=19.37, 40.88), nicotine vaping products (AOR=4.27, 95% CI=3.02, 6.04), and smokeless tobacco (AOR=28.14, 95% CI=19.37, 40.88) in the past 30 days were more likely to report recent use of oral nicotine products. Although oral nicotine products are less popular among U.S. youth than cigarettes, nicotine vaping products, and smokeless tobacco, their prevalence of use significantly increased. Oral nicotine product users are more likely to use other nicotine products, but the availability of flavors and easy-to-conceal design may be appealing to those who may not use nicotine products. Researchers should continue to observe the behaviors associated with oral nicotine product use to inform the need for future regulatory efforts.

Prevalence of and disparities in adolescents' susceptibility to novel oral nicotine products marketed as “tobacco-free”

Non-therapeutic, novel oral nicotine products are convenient, discreet to use, and flavored, with increasing sales in the United States. It is unclear whether these products appeal predominantly to adolescents already susceptible to inhalable nicotine products, or whether they attract adolescents who would not otherwise use nicotine. This study examined prevalence and correlates of susceptibility to inhalable and oral nicotine product use among adolescents. Ninth- and tenth-grade students from Southern California who had never used any nicotine product (N = 3129) completed an online survey in Fall 2021 assessing susceptibility to inhalable (i.e., cigarettes, e-cigarettes) and oral (e.g., pouches, gum, gummies) nicotine products. Multinomial logistic regression analyses estimated associations of demographic characteristics with odds of susceptibility to oral, inhalable, or both products. Susceptibility was highest for e-cigarettes (19.7%), followed by cigarettes (15.0%) and nicotine gum, lozenges, tablets and/or gummies (15.0%), and nicotine pouches (8.7%). Dual susceptibility to oral and inhalable products (vs. neither product type) was higher in cisgender female and non-cisgender (vs. cisgender male) adolescents (odds ratios [ORs] = 1.36–2.02; ps < 0.05). Hispanic adolescents (vs. Asian) were more susceptible to both products (OR = 1.47; p < .05). Lower-socioeconomic status (SES) and sexual minority adolescents were more susceptible to oral (ORs = 1.76–1.87; ps < 0.05) and both products (ORs = 1.32–1.88; ps < 0.05), compared to higher-SES and heterosexual adolescents. Adolescents in Southern California may be more susceptible to e-cigarettes than other nicotine/tobacco products. However, appreciable numbers may be susceptible to oral nicotine products, including some youth who might not otherwise use nicotine and youth from populations historically impacted by tobacco-related health disparities.

Association of psychological distress with smoking cessation, duration of abstinence from smoking, and use of non-combustible nicotine-containing products: A cross-sectional population survey in Great Britain

BackgroundTobacco smoking cessation is associated with improvements in mental health. This study assessed psychological distress, using the K6 non-specific screening tool ((items cover feelings of nervousness, hopelessness, restlessness, depression, ‘everything an effort’ and worthlessness), by smoking status, time since quit, and use of a non-combustible nicotine product. MethodsMonthly repeat cross-sectional household survey of adults (18 + ) from October 2020–February 2022 in Great Britain (N = 32,727). Using unadjusted and adjusted logistic regression (adjusted models included socio-demographic characteristics and ever diagnosis with a mental health condition), we assessed: associations between any/serious past-month psychological distress and smoking status and time since quit, whether these relationships were moderated by ever diagnosis with a mental health condition, and associations between distress and use of a nicotine product by people who formerly smoked. ResultsIn the unadjusted model, those who had not smoked for > 1y and who had never smoked had lower odds of any distress (OR = 0·42, 95 % CI 0·39-0·45; OR = 0·44, 0·41-0·47) compared with those who currently smoked. Moreover, the association of lower distress in those who had not smoked for > 1y and never smoked compared with those who currently smoked was more pronounced among those who had ever been diagnosed with a mental health condition (AOR = 0·58, 0·51-0·66; AOR = 0·60, 0·53-0·67) than among those who had not (AOR = 0·86, 0·76-0·98; AOR = 0·72, 0·65-0·81). In adjusted models of people who formerly smoked, current use of any nicotine product was associated with higher odds of distress compared with not using any nicotine product (AOR 1·23, 1·06-1·42). ConclusionPeople who had never smoked, or had not smoked for > 1y had lower levels of distress than those who currently smoked. The lower odds of distress among people who had not smoked for > 1y was more pronounced among those with an ever (vs never) diagnosis of a mental health condition. Nicotine product use among those who formerly smoked was associated with greater distress. Due to potential residual confounding and selection bias more research is needed to determine causality.

Nicotine Gummies, Tablets Popular Among Adolescents

Back to table of contents Previous article Next article Clinical & ResearchFull AccessNicotine Gummies, Tablets Popular Among AdolescentsNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:24 Nov 2022https://doi.org/10.1176/appi.pn.2022.12.11.14AbstractA recent survey conducted at Southern California high schools found that over 3% of 9th and 10th graders have tried nontherapeutic nicotine gum, gummies, tablets, or lozenges.iStock/brazzoA recent survey of high schoolers in Southern California has found that nontherapeutic oral nicotine products such as tablets or gummies are popular among adolescents, ranking only second in use to e-cigarettes. The survey findings were published in Pediatrics.“Nontherapeutic nicotine gums, lozenges, tablets, and gummies have a number of features that could potentially attract youth,” said Alyssa F. Harlow, Ph.D., a postdoctoral scholar at the Keck School of Medicine at the University of Southern California (USC) who led the survey. “These products resemble candy and are highly discreet, making them easy to hide.” The act of popping a piece of gum or candy in the mouth might also feel less risky to an adolescent than inhaling nicotine, the researchers noted in the Pediatrics paper.The decision to add questions about nicotine products to an ongoing behavioral health survey of adolescents across seven school districts in Southern California arose after the researchers noticed increased marketing of these products on social media and other platforms. The survey included questions about nicotine pouches (which are placed in between the lip and gums like snus, but are filled with cellulose, nicotine salt, and flavorings rather than shredded tobacco), as well as nicotine gums, lozenges, tablets, and gummies.The youth were also asked about their use of combustible cigarettes, e-cigarettes, snus, cigars, little cigars or cigarillos, and hookahs or waterpipes.The researchers analyzed the responses of 3,516 9th and 10th graders who completed the survey between September 30 and December 14, 2021.Overall, e-cigarette use was the most prevalent among the respondents, with 9.6% of students reporting ever vaping and 5.5% vaping in the past six months. The use of oral nicotine products (not including nicotine pouches) was second most prevalent among the youth, with 3.1% of students reporting ever use and 1.4% reporting past six-month use.The reported use of all other products (including nicotine pouches) was lower than 1%. In the paper, Harlow and colleagues suggested pouches might seem less appealing to use or possibly more difficult to access than other nicotine or tobacco products. But as pouches are also heavily marketed and come in fruit flavors, continued monitoring of these products is also warranted, they wrote.“Since there have been no prior estimates of the use of these oral products, we had no exact idea of what to expect,” Harlow said. Still, she said her team was a little surprised to see that adolescents were using oral nicotine products more than other tobacco-based products.The researchers also found that the use of any oral nicotine product (including nicotine pouches) was more likely among Hispanic teens; females; and teens identifying as transgender, nonbinary, or a sexual minority.Shortly after the publication of the study, the Food and Drug Administration (FDA) issued its first warning letter to a company for illegally marketing flavored nicotine gummies without FDA authorization. In a statement, FDA Commissioner Robert M. Califf, M.D., acknowledged that these oral products “are a public health crisis just waiting to happen to our nation’s youth.” The company has since discontinued its line of flavored nicotine gummies.Harlow hopes her group’s findings serve as a call to action for groups involved in health surveillance. “National surveys documenting trends in the use of these oral products are a must,” she said. Such data could help researchers to better understand when youth start using these products, which groups are most vulnerable, and if use of oral products leads to other illicit substance use.Harlow and colleagues noted that in their analysis, over 77% of the adolescents who reported using oral nicotine products also reported a history of using other nicotine products, but the survey did not identify which products were initiated first.Richard Miech, Ph.D., M.P.H., a research professor at the University of Michigan Institute for Social Research, told Psychiatric News that beginning in 2023 many more high school students will be asked about use of nicotine products as part of the Monitoring the Future survey. Miech is the principal investigator for this national survey, which is funded by the National Institute on Drug Abuse.Miech thinks the use of these products has the potential to skyrocket, so his team is planning on watching the usage trends closely.This study was supported by awards from the National Cancer Institute; National Institute on Drug Abuse; National Heart, Lung and Blood Institute; and Food and Drug Administration Center for Tobacco Products. ■Resources“Adolescent Use of Flavored Non-Tobacco Oral Nicotine Products”The warning letter from the FDA ISSUES NewArchived

The actual and anticipated effects of restrictions on flavoured electronic nicotine delivery systems: a scoping review

ObjectiveTo synthesize the outcomes of policy evaluations of flavoured electronic nicotine delivery systems (ENDS) restrictions.Data sourcesPubMed, Scopus, Embase and Web of Science before May 3, 2022.Study selectionStudies that report sales, behaviour, or compliance outcomes related to implemented or hypothetical ENDS flavour restrictions.Data extractionRestriction details, whether implemented or hypothetical, whether additional products were restricted, jurisdictional level, study locations, and outcomes classified by sales, behaviour, and compliance.Data synthesisWe included 30 studies. Of those, 26 were conducted exclusively in the US, two in India, and two surveyed respondents in multiple countries, including the US. Twenty-one evaluated implemented restrictions, while nine considered hypothetical restrictions. Five studies evaluated product sales, 17 evaluated behaviour, and 10 evaluated compliance, with two studies reporting multiple outcomes. Two studies reported an increase and one a reduction in cigarette sales following restrictions, while three reported reductions in ENDS sales. Behavioural studies presented a mixed view of the impacts of regulations on ENDS and cigarette use. However, the use of disparate outcomes limits the comparability of studies. Studies of hypothetical restrictions suggest decreased ENDS use, increased cigarette use, and increased use of illicit markets. Studies of compliance with flavoured product restrictions that included ENDS found that 6–39% of stores sold restricted flavoured products post-restrictions. Online stores remain a potential source of restricted products.ConclusionOur findings highlight the need for additional research on the impacts of ENDS restrictions. Research should further evaluate the impact of restrictions on youth and adult use of nicotine and tobacco products in addition to the effects of restrictions in countries beyond the US to enable a robust consideration of the harm-benefit trade-off of restrictions.

Factors affecting tobacco, nicotine, and cannabis product use among California young adults during the COVID-19 pandemic: A qualitative study

The effects of COVID-19 on tobacco and cannabis use have been variable, and it is unclear the extent to which factors affecting changes in tobacco and cannabis use differ. The purpose of this study was to identify the COVID-19-related factors that affect changes in tobacco and cannabis use during the pandemic. Focus groups with 114 young adults in California in April 2021 were held to discuss tobacco and cannabis use patterns, adverse events, and the effect of COVID-19 on tobacco and cannabis product use. Factors affecting changes in use were largely similar between tobacco products and cannabis products. Increases in product use were a result of changing social environment, coping with emotional and psychological distress, and product related factors. Decreases in product use were a result of social isolation, COVID-19-related health concerns, disruptions in daily patterns of living, and reduced access. Drivers of increased cannabis use distinct from tobacco or nicotine product use included feeling greater freedom to disengage and perceptions of less harm. Improved understanding of how the pandemic has affected tobacco and cannabis use can inform tailored interventions to both support those who have decreased or quit and assist those who have increased use during the pandemic to reduce or cease their consumption.

E-cigarette and tobacco product use among NYS youth before and after a state-wide vaping flavour restriction policy, 2020–2021

SignificanceReducing youth e-cigarette use is a New York State (NYS) public health priority. In May 2020, a state-wide restriction on flavoured e-cigarettes, except tobacco flavour, was passed. This study examines...

Nicotine initiation risk among Polish youth - PolNicoYouth study results

Abstract Smoking and the use of electronic cigarettes pose a risk of cardiovascular disease. The aim of the study was to analyze the initiation of these behaviors among Polish youth. The cross-sectional study was carried out in 2020 on a sample of secondary school students (N = 19241) representative of the Polish population, using the CAWI method. In order to estimate the relationship between the independent variables and the outcome variables, the Bayesian multivariate logistic regression was used in the R program using the brms library. Among Polish youth, age (lnBF = 303.55), smoking of traditional cigarettes by parents (lnBF = 117.29) and the type of school to which youth (lnBF = 36.15) and the province of residence (lnBF = 9.08) attend. Gender, size of the place of residence and parents’ education are not related to the risk of tobacco initiation with traditional cigarettes. When e-cigarettes were tried at least once in their life, a significant correlation was identified with a greater number of factors, such as age (lnBF = 124.87), smoking of traditional cigarettes by parents (lnBF = 56.48), province of residence (lnBF = 23.41), gender (lnBF = 16.53), use of heated tobacco (lnBF = 9.34) and e-cigarettes (lnBF = 9.13) by parents, size of the place of residence (lnBF = 8.61) and school type (lnBF = 7.26). Only the level of parents’ education remains unrelated. Factors related to the initiation and attempted use of nicotine products by adolescents indicate potential targets for the intervention. Parents who smoke and use e-cigarettes and heated tobacco should be made aware that their addiction is a strong risk factor for their children’s health. It can become a motivating factor for quitting the addiction. Key messages • Parental health behaviors are factors related to the initiation and attempted use of nicotine products by adolescents and indicate a potential target for a public health intervention. • Parents who smoke and use tobacco products should be made aware that their addiction is a strong risk factor for their children’s health. It can become a motivating factor for quitting the addiction.