INTRODUCTION:Individuals with psychiatric disorders experience substantial tobacco-related morbidity and mortality. Concerns persist that smoking cessation may exacerbate depression and anxiety, potentially limiting treatment efforts in psychiatric settings. This study examined whether sustained smoking abstinence following psychiatric hospitalization is associated with changes in depressive and anxiety symptoms. METHODS:This secondary analysis used data from the Helping HAND 3 RCT of a smoking cessation intervention among psychiatric inpatients. Participants (N=224) with elevated baseline depression and/or anxiety symptoms on the PROMIS Depression and Anxiety Short Forms 8a were assessed at 1-, 3-, and 6-months post-discharge. Self-reported continuous abstinence (vs. continuous smoking) was examined as a predictor of depressive and anxiety symptoms using linear mixed models. RESULTS:Continuous abstinence was associated with significant reductions in depressive (β = -3.88, 95% CI: -7.29, -0.47, p = .026) and anxiety symptoms (β = -5.06, 95% CI: -8.11, -2.02, p = .001) across follow-up. Significant abstinence-by-time interactions indicated that longer durations of abstinence were associated with greater symptom improvements. At 6 months, abstinence, compared to continued smoking, was associated with large reductions in depression (Cohen's d = 1.10) and anxiety (Cohen's d = 1.21). Participants who remained abstinent improved from markedly elevated baseline symptom levels to near population norms. CONCLUSIONS:Sustained smoking abstinence following psychiatric hospitalization is associated with substantial improvements in depression and anxiety. These findings challenge concerns that tobacco cessation worsens psychiatric symptoms and suggest that integrating evidence-based cessation interventions into routine psychiatric care could improve overall treatment outcomes without compromising symptom stability.
INTRODUCTION:The goal of this study was to identify knowledge and beliefs held by Black adults that are associated with strongly favoring proposed menthol cigarette and flavored cigar bans in the United States. METHODS:Eight hundred twenty-three US non-Hispanic Black adults (aged 18+) were surveyed in June 2024 through a nationally representative panel, oversampling people who currently smoke cigarettes. Participants completed items related to beliefs about and support for menthol cigarette and flavored cigar bans. Weighted bivariate analyses followed Hornik's approach to message planning strategies, assessing the proportion of participants holding each belief, the relationship between each belief and policy support, and "percentage to gain" (ie, intention to support the bans if a perfectly effective campaign moved everyone to strongly agree with a belief). RESULTS:Approximately 40% of respondents strongly favored menthol cigarette and flavored cigar bans. Seven beliefs had the largest potential percentage to gain (>30%) for building policy support, pertaining to: focus of the proposed policies on tobacco companies and retailers versus individuals, positive impacts of the proposed bans, addressing concerns that bans would do more harm than good in Black communities, and adult choice. CONCLUSION:Findings support the opportunity to develop messages for Black adults on potential positive impacts of menthol cigarette and flavored cigar bans, which in turn may impact policy support. Findings also highlight the need to address disinformation regarding the impact of these policies on Black individuals rather than on the manufacture, distribution, and sales of menthol cigarettes and flavored cigars. IMPLICATIONS:This study identified several beliefs that have the potential to influence policy support for bans on menthol cigarettes and flavored cigars. Findings from this study support the opportunity to message to Black adults on potential positive impacts of menthol cigarette and flavored cigar bans and to correct misperceptions about the bans, and that changing these beliefs may impact support for these policies.
INTRODUCTION:Continuity programs are a marketing strategy that use proof-of-purchase to redeem points that can be exchanged for prizes. Tobacco companies that sell nicotine pouches use continuity programs to promote their products, including the brand leader, ZYN (Philip Morris International). The purpose of this study was to characterize social media advertisements about ZYN's continuity program. METHODS:Social media advertisements about 'ZYN Rewards' (n=55) posted between 2020-2025 were accessed via Stanford's Research into the Impact of Tobacco Advertising (SRITA) website and ZYN's Facebook and Instagram accounts. Following codebook development and establishing coder reliability, three independent coders annotated advertisements for features, including continuity programs, product features (flavor, nicotine strength), warnings, and other visual cues (e.g., presence of alcohol). RESULTS:Among advertisements in our sample, 87.3% displayed prizes, which were categorized into technology (36.4%; e.g., Apple products, camera) and adventurer items (32.7%; e.g., coolers, tents, grills). A quarter of the prizes included the ZYN branded logo, including clothing (14.5%). Advertisements often (92.7%) included a nicotine addiction warning label, and 89.1% mentioned the minimum legal sales age for sale and participation in the continuity program. Nicotine strengths were displayed in 21.8% of the advertisements. Flavors were displayed (36.4%), with cool mint (10.9%) and wintergreen (9.1%) portrayed most often. CONCLUSIONS:Nicotine pouch continuity programs promote prizes that resemble those once used for cigarettes and smokeless tobacco products. As the tobacco industry recycles past marketing strategies to promote emerging nicotine products, researchers and policymakers should monitor appeal among young populations.
INTRODUCTION:Nicotine pouches are relatively new on the UK market. Although prevalence remains relatively low overall in the UK, nicotine pouch use is growing rapidly, especially in young men. This study analysed the content of retailer websites selling nicotine pouches in the UK. METHODS:Sixteen UK-based nicotine pouch retailer websites were identified through a structured Google search plus manual search of the most popular brands in the UK in November 2024. A content analysis was performed by reviewing each site for pricing, product features, flavours, age verification, social media, and six predefined themes (i.e., 'Health benefits', 'Cessation claims', 'Environmental advantages', 'Cost savings', 'Other product benefits', and 'Health/Addiction warnings'). RESULTS:Nicotine pouches were widely described as 'affordable' and 'ready to use', with entry-level pricing as low as £1 per can. Most flavour descriptors were classified as 'sweet', particularly fruit flavours. Many retailers offered promotions, such as student discounts. The websites often linked to social media platforms. Most websites emphasised convenience and ease of use and included content about health benefits compared to other nicotine products, particularly cigarettes, and around half linked to smoking cessation. Only half displayed age verification prompts. Most had addiction warnings, but these varied in prominence and clarity. CONCLUSIONS:Retailer websites market nicotine pouches by highlighting affordability, convenience, and sweet flavours. These may appeal both to people who want to quit smoking and younger nicotine-naïve audiences. While these products are likely less harmful for adults who smoke, promotional messaging risks normalising nicotine use among youth.
INTRODUCTION:The popularity of oral nicotine pouches (ONPs) is rising in the US and worldwide. This review provides an update on their potential public health impact. METHODS:We searched six electronic databases for ONP-related empirical studies through September 30, 2025, updating an earlier review. Outcomes included ONP product characteristics, use patterns, beliefs, perceptions, toxicity, sales, and marketing. RESULTS:We identified 73 new studies published since our previous review (majority conducted in the US; 12 industry-funded). Data from heterogeneous national surveillance sources indicate a slow but steady increase in current ONP use prevalence among youth in 2024, with the National Youth Tobacco Survey (NYTS) reporting 1.8% prevalence among middle and high school students and the Monitoring the Future (MTF) study reporting 2.6% prevalence among 10th and 12th graders. Current use among adults was relatively low in 2022-2023 (0.4%-0.8%), with higher use among ages 18-44 and current tobacco users. US sales have more than tripled between 2021 and 2024. Marketing strategies increasingly emphasize potentially youth-appealing claims, with online and social media as key promotional channels. ONPs generally contain a higher proportion of freebase nicotine than other oral nicotine products and tobacco-containing pouches, with nicotine delivery increasing proportionally with nicotine strength. Nicotine uptake from higher strength ONPs (≥6mg) typically exceeds that from cigarettes in adult smokers, while ONPs consistently score lower in positive subjective ratings than cigarettes. Preliminary evidence from short-term, heterogeneous studies suggests that ONP use can reduce smoking in daily smokers, generally resulting in dual use rather than complete cigarette cessation. ONPs are considerably less toxic than cigarettes, but their long-term health impacts remain understudied. CONCLUSIONS:The review underscores the need for further research on ONP health effects, their efficacy in long-term smoking cessation, and broader public health impact in tobacco-naïve populations.
INTRODUCTION:E-cigarette use and dual cigarette-e-cigarette use are increasingly prevalent in the United Kingdom, yet few longitudinal UK studies have examined whether people with functional disabilities are at elevated risk of subsequent use of these products. We examined whether baseline functional disability was associated with the subsequent risk of exclusive e-cigarette use, dual use, and, for comparison, exclusive cigarette smoking among UK adults. METHODS:We conducted a prospective cohort analysis of 19,609 adults from the UK Household Longitudinal Study who were non-current users of both cigarettes and e-cigarettes at Wave 10 (2018-2019) and were followed to Wave 14 (2022-2023). The outcome was a four-category nicotine-use pattern at follow-up: neither current cigarette smoking nor current e-cigarette use (reference), exclusive cigarette smoking, exclusive e-cigarette use, and dual use, with current use defined as any ongoing use including less-than-monthly use. Functional disability was measured at baseline using twelve self-reported functional limitation domains and operationalised as any reported domain versus none; disability extent was also categorised as 0, 1, or ≥2 affected domains. Survey-weighted multinomial logistic regression estimated adjusted relative risk ratios (RRRs) controlling for age, sex, education, ethnicity, urban/rural residence and country of residence. RESULTS:At baseline, 4,910 participants (25.0%) reported at least one functional disability. By follow-up, 338 participants reported exclusive current e-cigarette use, 61 reported current dual use, and 216 reported exclusive current cigarette smoking. In fully adjusted multinomial models, with neither current cigarette smoking nor current e-cigarette use as the reference outcome, participants with functional disability were compared with those without functional disability. Functional disability was not associated with exclusive e-cigarette use (RRR = 0.98, 95% CI: 0.72-1.33, p = 0.915) or dual use (RRR = 0.57, 95% CI: 0.25-1.32, p = 0.191). In contrast, functional disability was associated with exclusive cigarette smoking (RRR = 1.41, 95% CI: 1.02-1.95, p = 0.038). Compared with participants reporting no disability domains, those reporting two or more domains had a higher relative risk ratio for exclusive cigarette smoking versus neither current cigarette smoking nor current e-cigarette use (RRR = 1.67, 95% CI: 1.08-2.55, p = 0.020). CONCLUSIONS:Among UK adults who were non-users of both products at baseline, functional disability was not associated with subsequent exclusive e-cigarette use or dual use but was associated with exclusive cigarette smoking. This product-specific pattern suggests that disability-related differences in nicotine uptake may be concentrated in combustible tobacco smoking rather than e-cigarette uptake.
INTRODUCTION:Tobacco smoking is a major public health risk, and treatment efficacy differs by sex. Previous imaging studies reported sex differences in smoking-induced striatal dopamine release, but no PET study has independently replicated these findings. We applied a novel, more sensitive modeling pipeline to examine sex differences in dopamine responses to smoking and modulation by nicotine replacement therapy in archival PET data. METHODS:Thirty-one smokers (13 women) underwent 90-min PET scans with [11C]raclopride. Participants smoked a cigarette mid-scan (35 min) after tracer injection both following one week of placebo patch and one week of nicotine patch in a crossover design. Voxel-wise striatal time-activity curves were analyzed using our pipeline that combined the linear parametric neurotransmitter PET (lp-ntPET) model with Bayesian parameter estimation. Endpoints included spatial extent of dopamine activation and a dopamine activation metric that integrates probability of activation and peak dopamine magnitude at every voxel. RESULTS:Under placebo, men showed greater dopamine activation in the ventral striatum (p=0.047), consistent with reward-driven smoking. Women exhibited higher spatial extent in the right dorsal caudate (p=0.028) and whole caudate (q=0.033), consistent with habit- and stress-related mechanisms. The dopamine activation difference between placebo and nicotine patch conditions was larger in men than women across the whole striatum (p=0.011), indicating sex-specific modulation by constant nicotine administration. CONCLUSIONS:These findings support previously observed sex differences in striatal smoking-induced dopamine responses. Sex-specific effects of the nicotine patch may be relevant to widespread findings in the literature reporting lower efficacy of nicotine replacement therapy efficacy in women.
INTRODUCTION:Most adults with opioid use disorder (OUD) smoke cigarettes, and cessation rates with FDA-approved medications are low. Switching to e-cigarettes (EC) is an effective cigarette reduction method in adults without OUD but has not been rigorously evaluated in adults with OUD. METHODS:Adults (N=41) in OUD treatment who smoked >5 cigarettes/day (CPD), used EC <3 of prior 30days, and did not want to quit smoking, were randomized to receive an 8 week supply of NIDA's standardized research EC immediately (SREC, n=22) or after an 8-week delay (waitlist control; WLC, n=19). Participants reported past 24-hr CPD and EC use in daily texts for 8 weeks and research assessments and biochemical monitoring (e.g., carbon monoxide [CO]) every 2 weeks for 8 weeks. RESULTS:Participants had a mean age of 50, were 76% male, 88% white. From Baseline (BL) to Week 8, the change in CPD differed significantly between groups (p=0.001) with a larger decrease in CPD in SREC vs. WLC (SREC 15.3 at BL to 7.2 CPD at W8, WLC 14.2 to 12.8). There was a significant reduction in breath CO levels within SREC across the 8-weeks (from 22.9 at BL to 12.5 at W8, p<0.001), that was larger than WLC (23.7 vs. 20.3, p=0.042) (group x time p=0.071). No group differences were observed on nicotine dependence, withdrawal, or OUD stability (p's>0.05). CONCLUSIONS:Provision of ECs to people with OUD who smoke, not planning to quit, resulted in reduced combusted tobacco use, exposure and no worsening withdrawal, dependence, or OUD stability.
INTRODUCTION:Text messaging programs are effective for smoking cessation. Unprompted, participant-initiated text messages that are unrecognized by rules-based programs (UNRs) provide real-time reactions and feedback regarding program experiences. This mixed methods study characterizes UNRs and examines their prospective relationship with treatment outcome. METHODS:This is a secondary analysis of a randomized controlled cessation induction trial with adult smokers in a 4-week text message program. UNRs were defined as participant-initiated text messages not matching pre-defined expected responses or not in answer to pre-programmed queries. UNRs were qualitatively coded (if not related to a study payment issue or question) and analyzed for associations with participant and program characteristics as well as outcomes (use of evidence-based treatments [EBTs] for cessation and 7-day point prevalence abstinence from smoking). RESULTS:Participants (n=440; mean age = 47.5, 47.4% female, 16.9% motivated to quit) sent 2,264 UNRs (1,785 met criteria for coding) and 59.8% sent > 1 UNR. Sending any UNR or any codable UNR predicted greater odds of EBT use during the 7-month study period (self-reported and objectively verified, all ORs > 1.50). Sending any codable UNR (OR = 1.91 [1.09-3.33]) or a UNR acknowledging a program-initiated text (OR = 2.00 [1.18-3.37]) predicted greater odds of self-reported smoking abstinence during the follow-up. Sending a UNR conveying updates on target behaviors predicted greater odds of biochemically verified abstinence during follow-up (OR = 3.05 [1.24-7.46]). CONCLUSIONS:UNRs may serve as markers of meaningful engagement and early indicators of subsequent behavioral outcomes in text messaging programs.
INTRODUCTION:Frequent mental distress (FMD) is closely related to nicotine use, and its prevalence varies across population groups. Understanding patterns of nicotine use by FMD can help identify groups that are candidates for tobacco prevention and cessation interventions. METHODS:Using pooled data from annual tobacco-related surveys of adults between 2021-2024 in New York, we used Pearson's F-tests and pair-wise tests to determine differences in the prevalence of FMD in demographic groups. We assessed associations between FMD and tobacco-related behaviors, including novel product use and quitting behavior, in adjusted regression models. RESULTS:Sexual and gender minority adults, young adults, and adults living with disabilities, among other groups, were at higher risk of experiencing FMD. In adjusted models, adults who experienced FMD had higher odds of any nicotine use excluding blunts (AOR=1.39; 95% CI: 1.16-1.67) and including blunts (AOR=1.48; 95% CI: 1.24-1.77), cigarette use (AOR=1.44; 95% CI: 1.12-1.85), e-cigarette use (AOR=1.28; 95% CI: 1.01-1.64), and blunt use (AOR=1.38; 95% CI: 1.06-1.79) than adults who did not experience FMD. Among adults who currently smoked cigarettes, FMD was associated with higher odds of having made a past-year quit attempt (AOR=1.55; 95% CI: 1.01-2.38). CONCLUSIONS:Adults who experienced FMD had higher adjusted odds of several nicotine use outcomes and a past-year quit attempt. Controlling for demographics, adults with FMD had higher odds of any tobacco use, cigarette use, e-cigarette use, and blunt use, but not cigar, smokeless, hookah, or nicotine pouch use.
INTRODUCTION:Very low nicotine content (VLNC) cigarettes have been proposed to reduce cigarette consumption. However, previous studies were not adequately powered to analyze the effects of VLNC cigarettes on abstinence, especially within subpopulations (e.g., people who smoke (PWS) menthol cigarettes). Here, we developed and applied two statistical approaches to address these power limitations in analyses stratified by menthol status. METHODS:Using data from a recent randomized trial of VLNC cigarettes available within an experimental marketplace with alternative nicotine delivery systems (ANDS), we estimated the treatment effect on abstinence stratified by menthol status. Two novel methods leveraged secondary endpoints (total nicotine equivalents, NNAL) to improve efficiency: the multiple endpoint multisource exchangeability model (ME-MEM) and the super learner structural equation model (SL-SEM). RESULTS:Among 206 PWS menthol cigarettes, VLNC cigarettes were estimated to increase the probability of abstinence by 11.3 percentage points (95% credible interval: 4.7-19.6) using the ME-MEM and 18.4 percentage points using the SL-SEM (95% confidence interval: 7.7-27.0), increasing precision by 46% and 12%, respectively. For 232 PWS non-menthol cigarettes, the ME-MEM estimated an increase of 10.2 percentage points (95% credible interval: 2.3-17.3) and the SL-SEM estimated an increase of 8.1 percentage points (95% confidence interval: -1.0-13.2), increasing precision by 35% and 99%, respectively. CONCLUSIONS:In the presence of ANDS, randomization to VLNC cigarettes increases the probability of abstinence for PWS menthol cigarettes and may increase the probability of abstinence for PWS non-menthol cigarettes. Methods that leverage secondary endpoints may improve precision when conventional methods are underpowered.
INTRODUCTION:Smoking remains one of the leading preventable causes of morbidity and mortality worldwide. Understanding long-term trends in smoking-related diseases is essential for evaluating policy effectiveness and guiding prevention efforts. This study assessed the burden of disease attributable to smoking in China from 1990 to 2021, comparing its trends with global and sociodemographic index (SDI) patterns to identify policy priorities. METHODS:Age-, sex-, and SDI-stratified analyses were conducted using mortality and disability-adjusted life years (DALYs) data from the Global Burden of Disease Study 2021. Temporal trends were evaluated with Joinpoint regression and multiple visualization methods. RESULTS:Globally, age-standardized smoking-attributable death rates declined, but China showed a steeper decline (average annual percent change = -2.00 vs. -1.77). However, China's absolute smoking-related deaths rose by 57.5% to 2.30 million in 2021, accounting for 37.3% of the global total. Males bore a disproportionately higher burden, with an age-standardized death rate nearly 10 times that of females. Burden peaked at ages 65-74 for death counts and at ages 90-94 for rates. Unlike the global pattern where cardiovascular diseases dominate, neoplasms were the leading cause in China. Age-standardized DALYs rates for diabetes and kidney diseases showed a rising trend. CONCLUSION:From 1990 to 2021, China experienced faster declines in standardized smoking burden than the global average, yet its absolute burden and global share increased substantially. Sustained, targeted tobacco control-especially among older males and for cancer prevention-is urgently needed.
INTRODUCTION:Depression is strongly associated with higher tobacco use and lower quit rate; few communication campaigns have been designed with these mental health factors in mind. This scoping review compiles existing research on tobacco prevention and cessation messaging involving people with depression to identify gaps and opportunities for future message development. METHODS:Sources included PubMed, PsycINFO, Scopus, Academic Search Premier, and ProQuest Central (November - December 2024). The 55 studies included examined tobacco prevention or cessation messages and measured depression, depressive symptoms, or mental health as a primary outcome or analytic covariate. Study characteristics, target population, delivery format, message content, theoretical frameworks, outcomes, and gaps were extracted. RESULTS:RCTs made up half (51%) of the included studies, and most (78%) were conducted in the U.S. Nearly half (46%) required participants to have a mental health condition. Interventions most often used interactive (65.5%) or text-based (47.3%) communication and focused on tobacco cessation (89%) rather than vaping (9%). Common outcomes included feasibility or acceptability (37.7%) and point prevalence abstinence (37.7%). Mental health-specific messages showed mixed effectiveness. CONCLUSIONS:Despite progress in integrating mental health into tobacco messaging, targeted interventions for people with depression remain limited. Few studies tested long-term outcomes or used biochemical verification; many relied on untargeted generalized messaging.
INTRODUCTION:Tobacco and cannabis co-use is an increasingly complex public health challenge shaped by rapid expansion of vaping technologies and product diversity. To inform prevention and intervention efforts, behavioral typologies that incorporate use frequency, vaping, dependence/disordered use indicators are needed. METHODS:We analyzed pooled 2022-2023 National Survey on Drug Use and Health data from 14,500 U.S. young adults aged 18-29 who reported tobacco/nicotine or cannabis use. Latent class analysis identified subgroups based on past 30-day tobacco use frequency, nicotine vaping frequency, cannabis use frequency, nicotine dependence (Nicotine Dependence Syndrome Scale), and cannabis use disorder (DSM-5 criteria). RESULTS:A four-class model optimally balanced fit and interpretability. The largest subgroup was the nicotine-dominant use class (38.6%), marked by high tobacco use and minimal cannabis involvement. Three distinct co-use classes were identified: low co-use (17.4%), characterized by the lowest levels of tobacco product use, nicotine vaping, and cannabis use and comparatively low nicotine dependence and cannabis use disorder; cannabis-dominant co-use (32.3%), characterized by near-daily cannabis use with relatively low tobacco product use, nicotine vaping, and nicotine dependence; and high-frequency co-use (11.7%), characterized by frequent use of both nicotine products and cannabis and elevated nicotine dependence and cannabis use disorder. Serious psychological distress was associated with nearly twice the risk of cannabis-dominant co-use relative to nicotine-dominant use. CONCLUSION:Incorporating use frequency, vaping behaviors, and validated dependence and disordered use measures revealed distinct, tobacco-cannabis co-use behavioral phenotypes among young adults. Findings underscore the need for integrated prevention and cessation approaches tailored to heterogeneous co-use patterns.
INTRODUCTION:Positive Psychology Interventions (PPIs) aim to enhance well-being and have shown promise in improving mental health and augmenting behavioral interventions. Although pilot studies have suggested PPIs may support smoking cessation, no full-scale randomized clinical trials (RCTs) have tested their efficacy in this context. METHOD:In this RCT, 271 adults who smoked > 5 cigarettes per day (55.2% female, mean age = 49.2 (SD = 12.0); average cigarettes per day = 16.9 [SD = 7.0]) were randomized to six sessions of Positive Psychotherapy for Smoking Cessation with text messaging (PPT-S+) or a time-matched standard treatment with text messaging (ST+). All participants received eight weeks of nicotine replacement therapy (transdermal nicotine patch). The primary outcome was biochemically-confirmed 7-day point-prevalence smoking abstinence at 12, 26, and 52 post quit date. RESULTS:Seven-day point-prevalence abstinence did not differ significantly by condition: 20.9%, 19.4%, and 19.4% at 12, 26, and 52 weeks in PPT-S+ compared to 19.1%, 20.6%, and 21.4% at 12, 26, and 52 weeks in ST+. Conditions did not differ in self-reported use of positive psychology-consistent strategies for quitting smoking at posttreatment, representing an implementation failure, and these strategies did not significantly predict subsequent smoking outcomes. Those in ST+ rated the text messaging program as significantly more helpful than those in PPT-S+. CONCLUSIONS:PPT-S+ did not improve smoking cessation outcomes compared to a time-matched control. The completion of positive psychology exercises through text messaging may have reduced the helpfulness of the text-messaging support program received in both conditions.
INTRODUCTION:This study aimed to compare cessation and weight gain among US adults in Wave 6 of the PATH Study. METHODS:Participants reporting a past year quit attempt (n = 2454) were grouped by cessation aid used: (1) medication (Rx), (2) nicotine replacement therapy (NRT), (3) e-cigarettes (EC), (4) Rx + NRT, (5) Rx or NRT plus EC, or (6) None/no aid. Past-year smoking cessation and cessation-related eating/weight gain were regressed onto cessation aid, adjusting for relevant covariates. The impact of flavor was also tested among those using e-cigarettes to quit. RESULTS:In adjusted models, those using e-cigarettes were less likely to quit than those using no aid. Among successful quitters, all cessation aids, except exclusive e-cigarette use, were associated with increased eating/weight gain in unadjusted models, but not in adjusted models. Use of novel e-cigarette flavors did not increase cessation likelihood. CONCLUSIONS:Commonly used cessation aids did not improve cessation outcomes or prevent weight gain among US adults in real-world quit attempts. People using e-cigarettes to quit were less successful and had comparable weight gain to those using no aid, with no impact of e-cigarette flavor, suggesting additional support may be needed for people trying to use e-cigarettes to quit.
INTRODUCTION:Cigarette smoking among youth has continued to decline in recent years as vaping product use has become increasingly popular. Lower socioeconomic status (SES), psychological distress, and exposure to more permissive smoking norms are associated with higher rates of cigarette smoking. It remains unclear the extent to which SES, psychological distress, and smoking norms may represent common correlates for youth smoking and vaping. METHODS:The current study estimated pooled, cross-sectional, generalized linear mixed models to examine associations between SES, psychological distress, and smoking norms with lifetime and recent smoking and vaping among statewide samples of Utah youth from 2011 to 2019 (N=231,972). Moderation analyses investigated changes in the strength of association between SES, psychological distress, and smoking norms with outcomes over time. RESULTS:Lower area-level SES was significantly associated with increased odds of smoking and reduced odds of vaping while higher household SES was significantly associated with decreased odds of both smoking and vaping. Greater psychological distress and more permissive smoking norms were associated with increased odds of both smoking and vaping. Moderation analyses indicated that, over time, the association between SES and vaping strengthened, the effects of psychological distress on smoking and vaping strengthened, and the effects of smoking norms on smoking and vaping weakened. CONCLUSIONS:Results of this study suggest that SES, psychological distress, and smoking norms represent common correlates for smoking and vaping. Interventions to improve health literacy, reduce psychological distress, improve health literacy, and influence social norms may reduce long-term tobacco-related health risks.
INTRODUCTION:England provides comprehensive support for cigarette smoking cessation, and some services also assist people who use non-cigarette tobacco products (e.g., cigars/cigarillos, shisha, and chewing tobacco). Little is known about whether users are interested in quitting, their willingness to engage with cessation services, or beliefs shaping these intentions. METHODS:Five semi-structured focus groups and two interviews were conducted with adults who use non-cigarette tobacco in England (N=25). Topic guides covered harm perceptions, interest in quitting, and knowledge of, interest in, and barriers to using services for quitting. Data were prepared and analysed using iterative categorisation and abductive thematic analysis. RESULTS:Participants often recognised health harms and some reported experiencing addiction. Many participants had never considered quitting, whereas others described multiple attempts. Interest in quitting was shaped by perceptions of addiction and socio-cultural roles of non-cigarette tobacco. Participants were rarely asked about non-cigarette tobacco use by healthcare professionals and were unaware of whether cessation services could support non-cigarette tobacco use. Although some expressed interest in using services, many preferred to rely on willpower and online support, or felt insufficiently dependent to use services. Participants suggested improving awareness of support through community outreach and routinely asking about all forms of tobacco use in healthcare settings. CONCLUSIONS:People who use non-cigarette tobacco show varied interest in quitting, which appears to be shaped by perceived addiction and social factors. Limited awareness of cessation support and low engagement by healthcare professionals may represent missed opportunities for intervention.
INTRODUCTION:Higher prevalence of adolescent e-cigarette use among racially marginalized communities remains an issue in the United States. Experiences of racial bullying victimization may contribute to increased vulnerability to e-cigarette use and initiation. Although previous studies have looked at bullying and traditional tobacco products, fewer studies have examined the relationship between bullying and e-cigarette use, especially within racial and ethnic groups. METHODS:We used data from the 2021-2022 California Healthy Kids Survey, a survey of 7th, 9th, and 11th-grade public school adolescents (ages 12-17) in California. Lifetime and current e-cigarette use were self-reported outcomes. Racial bullying victimization was assessed by self-report of harassment or bullying due to race or ethnicity. We used multivariable logistic regressions stratified by race and ethnicity to examine associations between racial bullying victimization and e-cigarette use, controlling for grade, gender identity, parental education, and clustering within schools. RESULTS:Across all races and ethnic groups in the full analytic sample, adolescents had higher odds of lifetime and current e-cigarette use when exposed to racial bullying. Elevated odds were most pronounced among Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and Asian adolescents, though confidence intervals overlapped with non-Hispanic White adolescents. Non-Hispanic White and Hispanic adolescents exhibited lower but still increased odds. CONCLUSION:Racial bullying victimization is consistently associated with increased likelihood of adolescent e-cigarette use across racial and ethnic groups. These findings highlight the potential importance of addressing race-based bullying to reduce disparities in adolescent e-cigarette use.
INTRODUCTION:Tobacco use causes substantial morbidity and mortality, including oral consequences such as periodontitis, impaired healing, and oral cancer. Dentists are well positioned to provide cessation advice, but many students report limited knowledge, confidence, preparedness, and counseling skills. This review assessed students' baseline knowledge, attitudes, confidence, and preparedness and evaluated structured training. METHODS:Following PRISMA guidelines, Ovid MEDLINE, Embase, and Cochrane Central were searched for studies published between January 2016 and July 2025 enrolling dental undergraduates. Baseline status was captured from any quantitative design; interventional studies evaluated structured cessation training. Findings were narratively synthesized. RESULTS:From 995 records, 13 studies met inclusion: seven cross-sectional and six interventional. At baseline (n ≈ 2851), knowledge was modest (37%-52%; median ≈49%), attitudes were positive (83%-99%; median ≈93%), preparedness was low (26%-44%), and confidence was inconsistently reported, but one study found that 62% felt cessation counseling would be difficult. Formal training exposure was limited (~12%), although most wanted more teaching (83%-91%). Structured training (~2-12 hours) was associated with short-term improvements: knowledge increased by +24-57 percentage points, counseling skills by +25-30 percentage points, attitudes by +8-15 percentage points, and confidence increased where reported, including +26.7 percentage points in one study. Certainty of evidence was low to very low. CONCLUSION:Despite positive attitudes, students had limited readiness for cessation support. Low to very low certainty evidence suggests that short, structured, skills-based modules may improve knowledge, attitudes, confidence, and counseling skills in the short term. Undergraduate curricula should consider early, clinically reinforced, and assessed cessation training. IMPLICATIONS:This review focuses exclusively on undergraduate dental students from 2016 to 2025, synthesizing baseline preparedness and structured cessation training outcomes. Students generally held positive attitudes toward tobacco cessation counseling but had modest knowledge, low confidence, and limited preparedness at baseline. Low to very low certainty evidence suggests that structured, skills-based approaches, including role-play, simulation, and objective structured clinical examination (OSCE)-based assessment, may improve knowledge, practical counseling skills, attitudes, and confidence in the short term. Findings support consideration of early brief advice training, standardized outcomes and assessments, and alignment with WHO FCTC Article 14. Stronger evaluations are needed to confirm durability and real-world impact.
