Introduction: Smoking tobacco causes poor mental health, while quitting smoking improves mental health. However, the biological mechanisms underlying this relationship remain unclear. Although smoking has been linked to both systemic inflammation and depression, few studies have investigated whether inflammatory biomarkers mediate the association between smoking and mental health outcomes. Methods: Using 2021-2023 National Health and Nutrition Examination Survey (NHANES) data, we investigated whether white blood cell (WBC) count, platelet count (PLT), high-sensitivity c-reactive protein (hs-CRP), mean platelet volume (MPV), and red cell distribution width (RDW) mediate associations between smoking status and depressive symptoms as measured using the Patient Health Questionnaire (PHQ-9). Data from 6029 adults (14.3% current smokers, 25.5% former smokers, 60.2% never smokers) were analysed with survey-weighted structural equation models and multiple imputation, adjusting for age, sex, and race/ethnicity. Results: Current smokers had higher depressive symptoms (M = 5.81, SD = 5.79) than former smokers (M = 4.08, SD = 4.71) and never smokers (M = 3.91, SD = 4.70). WBC, PLT, hs-CRP, and RDW were elevated in smokers and significantly predicted higher PHQ-9 scores. Mediation analyses showed that WBC explained 10.9% of the smoking-depression association in current smokers (beta = 0.01, SE = 0.004, P < .001) and 7.6% in former smokers (beta = 0.005, SE = 0.002, P = .008). PLT mediated 3.7% (current smokers: beta = 0.005, SE = 0.002, P = .006) and 4.1% (former smokers: beta = 0.003, SE = 0.001, P = .003). hs-CRP mediated 3.7% (current smokers: beta = 0.005, SE = 0.002, P = .03) and 5.0% (former smokers: beta = 0.003, SE = 0.002, P = .05). RDW mediated 3.0% of the effect for current smokers (beta = 0.004, SE = 0.002, P = .02). MPV showed no mediation. Conclusions: These findings indicate that systemic inflammation partly explains the link between smoking and depression, highlighting biological pathways that may inform integrated cessation and mental health strategies.
INTRODUCTION:Although robust evidence shows a link between depression and tobacco use among adolescents, little information exists concerning pregnant adolescents. As such, we examined: 1) the association between pre-pregnancy depression and e-cigarette/cigarette use during late pregnancy, and 2) whether prenatal care visit frequency moderates this association. METHODS:We analyzed data from 10 363 adolescents (ages 19 or younger) in the U.S. Pregnancy Risk Assessment Monitoring System (2016-2021), a national cross-sectional survey supplemented with birth certificates. Participants reported pre-pregnancy depression and e-cigarette and cigarette use in the last 3 months of pregnancy. Multivariable logistic regression models estimated 1) associations of depression with e-cigarette/cigarette use and 2) the interaction between depression and prenatal care visit frequency, adjusting for sociodemographic and pregnancy-related confounders. RESULTS:Adolescents with pre-pregnancy depression were as likely to use e-cigarettes exclusively during late pregnancy as those without pre-pregnancy depression (3.21% vs. 1.66%; confounder-adjusted odds ratio [aOR], 1.33 [95% CI, 0.78-2.27]). However, those with pre-pregnancy depression were more likely to use cigarettes exclusively (12.72% vs. 4.81%; 1.94 [1.44-2.61]) or use both e-cigarettes and cigarettes (3.50% vs. 0.59%; 4.62 [2.18-9.81]) during late pregnancy. The association between pre-pregnancy depression and exclusive cigarette use was weaker (interaction p < 0.05) among adolescents with 9-11 prenatal care visits (1.38 [0.82-2.32]) and ≥ 12 prenatal care visits (1.77 [1.10-2.84]) compared to those with ≤8 prenatal care visits (3.86 [2.23-6.67]). CONCLUSIONS:Pre-pregnancy depression was associated with cigarette smoking and dual use of e-cigarettes and cigarettes, but not exclusive e-cigarette use, in pregnant adolescents. Frequent prenatal care seemed to partially buffer the elevated risk of cigarette use associated with pre-pregnancy depression in this observational research.
INTRODUCTION:Much of the evidence on using health communications campaigns to promote tobacco quitlines focuses on traditional media channels. This study examines the effect of both broadcast and digital media on tobacco quitline enrollments. METHODS:We utilized data from the Oklahoma Tobacco Helpline (OTH) and media exposure data from 2019 to 2023. Linear mixed effects models were used to examine the effect of media intensity, measured in weekly gross rating points (GRPs) and impressions, on total enrollments per week. Models were also fitted separately by mode of enrollment (phone or web). RESULTS:Both broadcast GRPs and digital impressions were consistently associated with expected increases in total weekly enrollment, especially when media intensity was 151+ GRPs or 1 000 000 or more impressions, controlling for other factors. When looking separately by mode of enrollment, both broadcast GRPs and digital impressions were associated with increased enrollments via phone and web. Post hoc comparisons suggested that GRPs and impressions may have diminishing returns at the highest level of intensity observed in this study. Weeks with messaging about a limited-time NRT offer also had higher expected enrollment. CONCLUSIONS:Both broadcast and digital advertisements were associated with higher phone and web enrollments when run at sufficient intensity levels. Our findings suggest there is a place for both traditional and digital media in driving quitline enrollments.
INTRODUCTION:Lung cancer screening (LCS) is an optimal time to offer tobacco treatment to adults who smoke, but many cannot quit even with treatment. Replacing combustible cigarettes (CC) with e-cigarettes (EC) could be a harm reduction approach, but few older adults use EC. No study has examined EC harm reduction potential among individuals undergoing LCS. METHODS:In a pilot mixed-methods single-arm clinical trial, we assessed the feasibility and short-term effects of providing EC to older adults not planning to quit after completing a smoking cessation trial at LCS. Participants were asked to use tobacco-flavored NJOY Ace EC (5% nicotine) for 4 weeks. Assessments occurred at weeks 1, 2, 3, 4, and 8, with qualitative interviews at week 4. Primary outcomes were study feasibility and change in cigarettes/day (CPD) during EC provision. Secondary outcomes included breath carbon monoxide (CO) and EC use. RESULTS:From 9/2024-2/2025, we enrolled 15 participants (54% of eligibles; mean age = 66.1 years, 40% female); 14 (93%) completed the study. Over the 4-week EC provision, mean CPD and breath CO declined significantly (CPD = 16.9 [SD:7.2] to 10.4[SD: 7.0], P<.001; CO: 19.4[SD:11.0] to 12.3[SD: 8.5], P=.04). Mean CPD remained stable post-EC provision. At week 4, participants used EC on 5.5 (SD:2.4) days/week; 2 participants (13%) used only EC, 12 (80%) were dual users, and 1 (7%) used only CC. CONCLUSIONS:This pilot trial showed the feasibility of recruiting older adults unable to quit smoking after LCS to use EC and suggested the short-term efficacy of EC to reduce CC consumption and CO exposure. IMPLICATIONS:This pilot study demonstrates the feasibility and promising short-term effects of switching older adults who smoke and did not quit at LCS to use EC. Participants' cigarette consumption and CO exposure declined over 4 weeks of EC provision, but most participants became dual users (EC and CC). Qualitative interviews illustrated benefits and challenges of switching. The findings deserve confirmation in a larger sample, but suggest that longer EC provision and behavioral support might help this group to completely replace CC use and gain the full harm reduction benefits associated with switching to EC.
INTRODUCTION:People who smoke often develop a smoking identity, making it challenging to quit. The current study aimed to test whether reflecting on one's most feared and aspirational future selves impacted peoples' smoking identity, smoking intentions, and willingness to make a quitting plan. METHODS:Adults who smoke (N = 300) completed an online experiment where they were randomized to a future possible self or control condition. The future-self intervention involved envisioning an aspirational future self as a nonsmoker and future feared self as a smoker. Participants wrote descriptions about and uploaded images representing these possible selves. Those in the control condition wrote about and uploaded images of activities unrelated to smoking. Post-intervention, smoker and nonsmoker identity, intention to quit, and willingness to create a quitting plan were measured as primary outcomes. RESULTS:In comparison to the control condition (M = 5.53), those in the future self intervention (M = 6.20) had stronger nonsmoker identity (p = 0.004), but no differences in smoker identity. Intervention effects were stronger for precontemplators compared to contemplators/preparers. For precontemplators, those who reflected on their future self had greater intentions to quit compared to control participants (b = 0.87, p = 0.002), and these quit intentions were associated with a greater willingness to draft a quitting plan (OR = 1.03, 95% CI [1.00, 1.07]). CONCLUSION:Results suggest that future identity conflict tasks can help people shift from unhealthy to healthy identities, particularly for precontemplators who may not have considered the benefits of quitting. IMPLICATIONS:Our findings suggest that identity-based interventions may be most effective for people who smoke who do not yet intend to quit compared to those already contemplating change.
INTRODUCTION:We examined how the association between five measures of socio-economic position (SEP) - social grade, housing tenure, income, education, and employment - and smoking status changed between 2013 and 2019. We also identified whether the strongest independent SEP predictor of smoking in England varied over time. To provide additional context for interpreting pre-pandemic trends, we conducted exploratory extended analyses including data to May 2025 for education and social grade. METHODS:Data from the Smoking Toolkit Study (n=139,314 adults aged ≥16 years) were analysed using weighted Generalised Additive Models (GAMs). Each SEP measure was regressed onto smoking status with an interaction term for time (modelled linearly). Unplanned analyses extended the timeframe (2013-2025) for education and social grade. Year-stratified ridge logistic regression models including all SEP indicators simultaneously were used to assess their relative independent predictive contribution. RESULTS:For all SEP measures, individuals in the more disadvantaged categories started the study period with significantly higher odds of smoking than the reference groups. No time interactions were found for employment, social grade, or housing tenure, indicating that the significant baseline differences persisted across the series. Education and income showed significant time interactions, with widening differences primarily between higher and middle socioeconomic groups. Smoking declined by 0.3% monthly among university graduates, but only 0.0-0.1% among less-educated groups. A similar decline was seen in higher-income groups (£40,000+), with no change in the £25,000-£39,999 group. Unplanned analyses extending the series to 2025 suggested a possible narrowing of inequalities for education and social grade, with faster declines among some more disadvantaged SEP groups. While the strength of the association between housing tenure and smoking declined slightly over time, it remained the strongest independent predictor each year, followed by social grade. CONCLUSIONS:From 2013-2019, income- and education-related smoking inequalities widened, while inequalities based on social grade, housing tenure, and employment status remained stable. Housing tenure remained the strongest independent predictor of smoking across all years, highlighting the importance of targeting cessation support in social housing. More recent data (for social grade and education) hint at a possible narrowing of these gaps.
INTRODUCTION:Cigarette smoking poses a pervasive health risk increasingly recognized for its impact on the nervous system, yet its effects on brain structure and organization remain incompletely understood. This study examined how smoking addiction influences white matter (WM) microstructure and the architecture of structural brain networks in adults. METHODS:We used diffusion tensor imaging to compare fractional anisotropy between participants who smoke (n = 122) and non-smoking control participants (n = 55) to detect WM abnormalities. Whole-brain structural connectomes were constructed, with connections categorized by fiber length. Network features quantified included degree centrality and hemispheric asymmetry. Adaptive Best-Subset Selection method was applied to identify WM connections that may serve as biomarkers for distinguishing individuals who smoke from those who do not. RESULTS:Participants who smoke showed widespread WM alterations in pathways related to reward valuation, habit formation, and craving, along with abnormalities in both short- and medium-range connections. Reduced rightward asymmetry in the cuneus indicated lateralized structural changes possibly linked to cue processing in nicotine dependence. Discriminative connections involved orbitofrontal, sensorimotor, and visual regions, underscoring how smoking reshapes brain networks supporting reward valuation, motor control, and cue reactivity. CONCLUSIONS:Nicotine dependence is associated with extensive alterations in WM microstructure and network organization, including reduced hemispheric asymmetry. These findings suggest that smoking affects structural connectivity in circuits involved in emotional regulation and reward-related memory. IMPLICATIONS:This study enhances our understanding of how nicotine dependence reshapes WM networks, potentially impairing communication within circuits sustaining addictive behaviors, and provide insights into how smoking alters brain structure and connectivity.
INTRODUCTION:Nicotine pouches (NPs) are disposable pouches containing pure nicotine, flavorings, sweeteners, and other fillers. Although their health effects are understudied, they are marketed as a safer alternative to other nicotine products. Videos on social media platforms (SMPs) inform health behaviors, especially among youth and young adults. This study aims to investigate imagery, marketing, and health-communication surrounding NPs in YouTube Short videos. METHODS:We used the YouTube Data API to retrieve YouTube Shorts videos posted from September 2020-January 2025 containing topic-relevant keywords. After screening videos for eligibility criteria (n=239), content analysis was conducted. Associations between themes and engagement metrics were investigated. RESULTS:Imagery used to increase interest in, or awareness of NPs was the most frequent theme present in 81% of videos, with 80% depicting products, 33% depicting use, 30% depicting youth/young adults. Marketing and promoting NPs was, present in 73% of the videos reviewed. Health warnings (38%) and positive health claims (30%) were prevalent in videos. The most prevalent health warning mentioned was addiction/dependence (26%), while the most prevalent health claim mentioned was harm reduction (25%). Quantitative analyses revealed diverse codes predictive of higher view, like, and comment metrics. DISCUSSION:While NPs are recognized as addictive, they are marketed as products with high social appeal and are promoted using potential health benefits and product use imagery. Research should further investigate discussions of NPs on SMPs, as exposure to this content may impact attitudes about or uptake of these products, especially among youth and young adults.
INTRODUCTION:Despite reductions in tobacco smoking among Aboriginal and Torres Strait Islander peoples since 2004, particularly among youth, smoking remains elevated in Indigenous communities - highlighting the importance of understanding why some Aboriginal and Torres Strait Islander people never take up smoking. METHODS:Taking a strength-based approach and using data from 474 Aboriginal and Torres Strait Islander youth aged 16-24-years joining the Next Generation Youth Wellbeing Study (Western and Central Australia, New South Wales), 2018-2020, age-, sex- and family-adjusted prevalence ratios (PR) for never-smoking relative to sociodemographic, health, social and other factors across socioecological levels were estimated through Poisson regression. RESULTS:Overall, 45% of participants had never smoked tobacco; 31% reported current daily/weekly/monthly smoking, indicating a normative shift. Among those who ever smoked, mean initiation age was 15. Never-smoking was greater with: younger age [16-17-years (PR=1.9; 95% Confidence Interval=1.5-2.5), 18-20 (1.3;1.0-1.8)]; completing ≥Year 10 (1.8;1.1-3.0); no interaction with (1.9;1.5-2.5) or being charged by police (2.3;1.5-3.3); never being imprisoned (2.5;1.2-4.8); not having friends imprisoned (1.7;1.3-2.2); having non-smoker friends (1.8;1.4-2.2); never vaping (5.7;3.2-10.1) or smoking marijuana (7.9;4.9-12.8), never having tried alcohol (2.4;2.0-3.0); higher physical activity (1.4;1.1-1.7); lower psychological distress (1.3;1.1-1.6), never being diagnosed with depression (1.5;1.1-2.1) or anxiety (1.7;1.2-2.4) and having 'good-to-excellent' perceived health (1.5;1.1-2.1), compared with not having these attributes. CONCLUSION:These findings highlight the importance of strengthening family, community, and social environments that protect against smoking initiation and support smoking cessation and call for sustained structural and policy reforms to address systemic drivers of tobacco use.
INTRODUCTION:Accessible, culturally-tailored interventions are needed to address the high prevalence of cigarette smoking and the challenges to cessation experienced by sexual and gender minority (SGM) young adults. This study evaluated, in a randomized, controlled pilot trial, the acceptability, preliminary cessation-related outcomes, and impact on theory-based change processes of the SGM-tailored, Acceptance and Commitment Therapy (ACT)-based Empowered, Queer, Quitting, and Living (EQQUAL) digital program relative to the National Cancer Institute's Smokefree.gov program. METHODS:Participants were SGM young adults, aged 18-30, who smoked at least weekly. Participants were randomized 1:1 to either EQQUAL or Smokefree.gov, both of which included a web app and text messaging. Outcomes were assessed at 3 months post-randomization, and smoking abstinence was biochemically-verified. RESULTS:The sample included 124 participants (n=63 in EQQUAL, n=61 in Smokefree.gov). On the primary acceptability outcomes, overall satisfaction was descriptively higher in the EQQUAL arm (68.8% vs. 60.0%; OR=1.17, 95% CI=0.50-2.78), and EQQUAL usability ratings exceeded the acceptable benchmark score of 68. The average number of EQQUAL digital sessions completed was 1.4 (of 6). On the primary cessation outcomes, biochemically-verified 7-day point prevalence abstinence was higher in EQQUAL than Smokefree.gov (11.1% vs. 4.9%; OR=1.89, 95% CI=0.45-9.66). Change in readiness to quit and cigarettes per day were similar between arms, as were outcomes of theory-based change processes. CONCLUSIONS:EQQUAL demonstrated potential benefits over Smokefree.gov on acceptability and cessation, albeit with a lack of robust effect on theory-based change processes. Increased engagement with the web-based portion of the program may be needed to improve outcomes.
INTRODUCTION:Although tobacco use disorder (TUD) and long COVID (LC) have been associated to neuropsychiatric disturbances, it remains unclear how tobacco dependence affects the recovery of clinical, cognitive, and biological processes over time. METHODS:This study compared individuals with tobacco use disorder and healthy controls using longitudinal assessments from pre-infection baseline through two post-COVID follow-ups over 12 months. Comprehensive assessments covered clinical, neuropsychiatric, and cognitive functioning, tobacco dependence and exposure, and peripheral biomarkers reflecting neuroendocrine regulation, inflammation, neuroplasticity-related processes, and nicotine metabolism relevant to post-COVID recovery. RESULTS:Both groups exhibited marked clinical, cognitive, and biological alterations following LC; however, recovery trajectories diverged over time. Healthy controls showed clear improvement by 12 months, whereas individuals with TUD showed persistent impairment across clinical and cognitive functioning. Cognitive performance recovered in controls but remained reduced in the TUD group. Biological trajectories paralleled clinical recovery patterns. Dimensional analyses identified two latent components reflecting neuropsychiatric and inflammatory-neurobiological processes. Within the TUD group, two recovery-related phenotypes emerged: a persistently impaired subgroup and an adaptive subgroup showing partial recovery. CONCLUSIONS:Tobacco use disorder is associated with impaired and incomplete clinical and biological recovery following long COVID, beyond smoking exposure alone. These findings emphasize the need for post-COVID care models that integrate tobacco dependence with recovery-related clinical and biological processes, supporting sustained recovery and cessation outcomes.
INTRODUCTION:Vaping nicotine is the most prevalent mode of nicotine use among US youth. Research is needed to understand youth use over time, including transitions to or away from dual use. How these transitions are related to frequency of use, nicotine dependence, and biomarkers of nicotine and tobacco toxicant exposure provides key information on the public health impact of ENDS use among US youth. METHODS:Longitudinal data from Waves 4 and 5 (2016/18 - 2018/19) of the Wave 4 Biomarker Core sample (ages 12-17 at Wave 4) of the Population Assessment of Tobacco and Health (PATH) Study were used. Eight Wave 4 to 5 transitions in ENDS and combustible tobacco use were examined among youth reporting current ENDS use at Wave 4 (n=419). Past 30-day ENDS use frequency, nicotine dependence, and biomarkers of nicotine and tobacco toxicant exposure at Wave 4 and Wave 5 were compared across transition groups. RESULTS:Youth who maintained dual use and youth who transitioned from dual use to ENDS-only use reported the highest estimated days of ENDS use (M=22.12 days and 23.86 days, respectively) and the highest mean nicotine dependence (M=2.75 and 2.74, respectively). Those who maintained dual use had significantly greater increases in nicotine exposure (GMR=3.87; 95% CI=1.67, 8.98) and tobacco-specific nitrosamine exposure (GMR=3.53; 95% CI=2.19, 5.70) compared to youth who maintained ENDS-only use. CONCLUSIONS:We found significant heterogeneity by transition group among US youth using ENDS. Dual use, particularly persistent dual use, represents a significant concern for the health of youth.
INTRODUCTION:Electronic Nicotine Delivery Systems (ENDS) present persistent public health challenges. Marketed for cessation, they may initiate the nicotine-naïve into addiction, and regulation has not curbed the appeal of flavors. Recent policies targeting menthol cigarettes and flavored cartridge-based ENDS are being challenged as the industry pivots to "copy-cat" coolants that users perceive similarly to menthol. Building on our prior work showing deleterious effects of vape components on craniofacial-derived cells, we examined acute in vitro exposures to coolant formulations. METHODS:We assessed cell viability, apoptosis, autophagy, and senescence in murine craniofacial derived cells with and without ENDS constituents, nicotine, propylene glycol (PG), and glycerin (G). RESULTS:Consistent with previous findings that nicotine increases and nicotine+PG/G decreases cell viability, we observed that menthol and synthetic coolants WS3 and WS23 produced similar toxicological profiles by MTS assay. When combined with nicotine and PG/G, these coolants further decreased viability. Senescence occurred only for menthol when combined with PG/G and/or nicotine. Apoptosis and autophagy showed no changes. These results demonstrate that WS3 and WS23 act like menthol in craniofacial-derived cells under acute exposure conditions when assessed for cell viability. CONCLUSIONS:As the tobacco and ENDS industries adopt synthetic alternatives to navigate flavor regulations, safety evaluations must explicitly include menthol like ingredients. Our data provide a biologically relevant basis for including coolant analogs in regulatory toxicology based in mesenchymal and skeletal precursor cell health. These findings support inclusion of coolant flavorants in hazard screening frameworks, especially given youth driven exposure and evolving products and device chemistries.
INTRODUCTION:Adults with serious mental illness (SMI) have elevated morbidity and mortality, largely attributable to increased cigarette smoking. Effective smoking cessation interventions remain a critical need for this population. This study tested the Parks and Recreation Quit Smoking Program (PARQuit), a multi-component treatment program for adults with SMI. The aims were to compare the effectiveness of the PARQuit physical activity and PARQuit sedentary groups on smoking cessation, smoking reduction, and psychiatric symptom reduction. METHODS:Ninety-nine participants with SMI were randomized to a physical activity intervention or a sedentary control group, each receiving pharmacotherapy (nicotine replacement therapy (NRT) or bupropion SR) and cessation counseling for 12 weeks in the United States of America, from 2019 through 2025. The PARQuit physical activity group engaged in game-based group exercise (50 minutes, 3 times/week), whereas the PARQuit sedentary group participated in sedentary group activities. Outcomes included smoking cessation (measured at baseline, 6, and 12 weeks) and psychiatric symptoms assessed via the Brief Psychiatric Rating Scale. RESULTS:At baseline, participants smoked a mean of 76 cigarettes per week, declining to 35 cigarettes at 12 weeks. Both groups showed a significant linear decline in cigarette consumption over time (mean change: -3.7 cigarettes/week; 95% CI: -5.2, -2.4), with no significant between-group difference. Smoking abstinence increased significantly (McNemar χ2=5.33, p<.05). Psychiatric symptoms decreased continually, with scores dropping by 0.29 units per week (95% CI: -0.50, -0.09) in both groups. CONCLUSIONS:Although there were no significant differences between study groups, both study groups showed a significant reduction in cigarettes smoked each week and in psychiatric symptoms. Group-based counseling and pharmacotherapy likely contributed to these improvements. Future research should assess longer-term outcomes in sustaining smoking cessation. Clinical Trials Registration Number: NCT03950427.
INTRODUCTION:To examine the relationship between early product substitution and harm reduction (HR) in an ENDS switching trial for adults who smoke. METHODS:We conducted a longitudinal structural equation analysis of 120 treatment participants who received disposable ENDS for 8 weeks and were assessed every 2weeks. The predictor was w2 ENDS sessions/day. The HR latent construct included 4 binary indicators: cigarettes/day (CPD) ≤5 and carbon monoxide (CO) <10ppm at weeks 6 & 8. We tested an indirect path from w2 ENDS use through w2 CPD reduction to HR, and a direct path from w2 ENDS use to HR, both moderated by w0 CPD. RESULTS:Mean age was 45.9 years, and 42.7% smoked ≥20 CPD. ENDS use at w2 significantly increased the odds of HR for all participants (p<0.001), mediated through reductions in w2 CPD. The ENDS direct pathway was moderated by w0 CPD (p<0.001). For the total (direct + indirect) association, greater w2 ENDS use increased chances of HR for individuals with w0 CPD>16, decreased the chances of HR for individuals with w0 CPD<7 and had no impact on those in the w0 CPD 7-15. All predictors combined explained 66% of the variance in HR. CONCLUSIONS:In this study, early ENDS use predicted short-term HR, but only for individuals who smoked more heavily. For those with low smoking intensity, early ENDS use predicted decreased short-term chances of HR and increased dual product use. This is a novel finding limited to a small sample of persons with severe mental illness. IMPLICATIONS:If replicated and extended to later HR outcomes, the finding supports a focus on early ENDS use as an intermediate outcome for phase 2 trials of ENDS products, and adaptive treatment designs aimed at early non responders, with a particular focus on persons who smoke heavily.
INTRODUCTION:Ultrasonic vaping devices like SURGE are marketed as safer alternatives to conventional coil-based electronic cigarettes like JUUL due to their lower operating temperatures. However, their impact on cardiovascular health has not been fully characterized. METHODS:Sprague-Dawley rats were exposed daily for 9 weeks to aerosol generated from SURGE, JUUL, or clean air. Heart rate variability (HRV) was continuously monitored via implanted telemetry. Cardiac fibrosis was quantified using histological analysis. Temperature profiles of SURGE, JUUL, and Nautilus (a coil-based tank device) were recorded. Aerosol samples were analyzed for carbonyl compounds using high-performance liquid chromatography. RESULTS:Both SURGE and JUUL exposures significantly reduced HRV (high frequency and total power) compared to air. JUUL exposure significantly increased cardiac fibrosis; SURGE showed a similar mean fibrosis level but greater variability, resulting in a nonsignificant difference. SURGE devices operated at lower peak temperatures (~131°C) than JUUL (~239°C) and Nautilus (~160-170°C). Despite it having the lowest temperature, SURGE emitted higher levels of carbonyl compounds than JUUL, although still substantially lower than Nautilus. CONCLUSIONS:Although SURGE operates without coils and at lower temperatures than coiled vaping devices, it generates higher levels of carbonyls than some coiled devices and impairs cardiac autonomic regulation, and it can cause cardiac fibrosis comparable to JUUL although with high variability; that is, SURGE does not reliably avoid the increase in fibrosis caused by conventional e-cigarettes. These findings suggest that non-thermal mechanisms predominate in mediating cardiovascular toxicity associated with ultrasonic vaping, challenging the assumption that coil-free designs are inherently safer. IMPLICATIONS:Despite its lower operating temperature and coil-free design, the SURGE ultrasonic vaping device impaired cardiac autonomic function and promoted fibrosis at a mean level comparable to that of JUUL. These findings challenge claims of reduced harm from coil-less vaping technologies and suggest that non-thermal mechanisms may drive toxicity. Regulatory evaluations should consider device emissions and physiological outcomes-not just hardware features. Physicians and policymakers should be aware that coil-less systems may still pose cardiovascular risks, and marketing these devices as inherently safer may mislead users and undermine tobacco harm reduction efforts.
Introduction Monitoring changes in disposable e-cigarette attributes is crucial for youth health and market regulations. Online stores are a major purchasing channel for US youth. This study compares trends in product attributes of disposables between 2022 and 2024 using our unique data scraped from online stores.Methods We obtained product-level information by scraping websites of online vape stores from our 2022 study that remained in business in 2024, and we examined changes in product attributes including sales prices and standardized prices, product size (mL volume and puff counts), consumer ratings and reviews, nicotine dimensions (concentration, free-base/nicotine salt, tobacco-derived/synthetic), battery capacity, and flavor mentions in description texts.Results Unique product listings significantly increased from 1638 in 2022 to 8339 in 2024. Sales price per unit and standardized price (per mL or per puff) declined, while product size in terms of mL volume and puff counts increased dramatically. The proportion of products with nicotine salt or synthetic nicotine claims decreased, and 5% nicotine level remained dominant. Fruits, sweets, and menthol were the most prevalent flavor mentions in both years, though the percentage of products declined from 97% to 79%, 69% to 19%, and 59% to 15%, respectively.Conclusions Disposable e-cigarettes available in the online market have become more diverse, more affordable, and larger in size, especially in puff counts. High nicotine concentration (5%) persists, and fruity flavors remain prevalent. These trends raise public health concerns and require effective market regulations.Implications From 2022 to 2024, US online retailers of disposable e-cigarettes expanded product offerings, including more unique brands, greater product variety, and more flavor options. Fruits, sweets, and menthol were the most prevalent flavor mentions in both 2022 and 2024, and 5% nicotine concentration remained dominant. The online availability of less expensive disposables with appealing flavors and larger sizes is concerning and suggests rapid market expansion and intensified competition.
Introduction Cigarette smoking and other forms of commercial tobacco use remain disproportionately high among American Indian communities compared with the general US population. Mainstream tobacco control strategies often have limited success in Tribal contexts, underscoring the need for culturally grounded interventions.Methods We conducted 30 key informant interviews with program staff and Tribal community members from 11 California Tribes participating in the California American Indian Tobacco Initiative. Interviews were conducted at two time points, transcribed, and analyzed using descriptive and evaluation coding to assess the implementation, perceived impact, and challenges of core tobacco control objectives.Results All 11 programs successfully engaged youth through coalitions and education activities. Nine programs implemented smoke-free household efforts with mixed but generally positive uptake of voluntary pledges. Five programs implemented tobacco product waste initiatives that increased awareness of environmental harms and mobilized community clean-up events, and four pursued excise tax strategies, with questions about revenue allocation emerging as a key challenge. Across objectives, culturally relevant, community-driven approaches were seen as critical to success.Conclusions Tribal-led interventions including youth coalitions, smoke-free household pledges, and tobacco waste campaigns show promise for reducing commercial tobacco harms in California American Indian communities, though policy and implementation barriers remain and warrant ongoing attention.Implications This study adds to the limited body of research evaluating culturally grounded tobacco control interventions in American Indian communities. By highlighting the relative success of youth engagement, smoke-free household pledges, and community-based environmental initiatives, the findings underscore the importance of culturally relevant, community-driven approaches. These results can inform future Tribal, state, and federal tobacco prevention strategies, reinforcing the need to integrate Indigenous values, leadership, and local context into public health programming to improve intervention reach and sustainability.
INTRODUCTION:Anxiety during acute smoking abstinence is strongly implicated in the maintenance of as well as lapse and relapse to smoking. Central to anxiety is heightened sensitivity to unpredictable threat-a tendency for anxious apprehension of future, uncertain threat-with work from animal models robustly indicating its contributory role in nicotine seeking behavior during deprivation. However, the handful of studies on this question in humans have yielded mixed findings, possibly due to their suboptimal usage of between-subject designs. Consequently, the present study used a within-subject laboratory design to examine whether sensitivity to unpredictable threat mediates the effect of manipulated acute smoking abstinence on smoking lapse behavior. METHODS:Non-treatment-seeking adults who smoked daily (N = 63) attended 2 counterbalanced experimental sessions under overnight smoking deprivation or smoking as usual. For both sessions, participants completed the No-Predictable-Unpredictable threat task assessing the eyeblink reflex to acoustic startle probes while anticipating electric shocks. Next, participants completed the McKee Experimental Relapse Analogue Task, assessing lapse behavior, including the ability to delay smoking for monetary reward and number of cigarettes smoked once initiated. RESULTS:As expected, smoking deprivation (vs smoking as usual) led to shorter time delay to smoking and more cigarettes smoked once initiated. Importantly, sensitivity to unpredictable threat partially mediated abstinence-induced lapse behavior. Deprivation was associated with an enhanced startle potentiation to unpredictable (vs no) shock-although this effect emerged only in follow-up analyses-which, in turn, predicted increased smoking. CONCLUSIONS:Sensitivity to unpredictable threat may be an important, but underrecognized, biobehavioral mechanism underlying the smoking-anxiety link. IMPLICATIONS:Using a within-subject laboratory design, this study provided preliminary evidence that sensitivity to unpredictable threat may contribute to smoking relapse during acute abstinence. Although these findings await replication in larger samples, they indicate sensitivity to unpredictable threat as a potential biobehavioral target for evaluating anxiety-related processes in smoking cessation interventions.
INTRODUCTION:Waterpipe tobacco smoking remains a popular social activity among young adults in the United States. This study aims to understand sentiment toward waterpipe on social media in the United States by analyzing Twitter/X data. METHODS:Using keywords ("hookah," "waterpipe," "shisha"), we collected US tweets posted between March 2021 and March 2023. Commercial content (eg, containing "sale," "discount," "$") was filtered out, yielding 299 544 non-commercial tweets. A random sample of 2300 tweets was manually coded for sentiment (positive/negative/neutral) and for whether the author might use waterpipe, which were used to fine-tune a deep-learning model (Llama-2). We applied BERTopic modeling to identify main themes. RESULTS:Overall, tweets with a positive sentiment (57.0%, 170 597/299 544) were higher than those with a negative sentiment (16.7%, 50 196/299 544). Among those Twitter users who might use waterpipe, 82.0% of their tweets showed a positive sentiment toward waterpipe while only 7.5% of the tweets had a negative sentiment. In contrast, among those who might not use waterpipe, 29.6% of their posts showed a positive sentiment and 27.0% of the posts with a negative sentiment. Main themes identified from positive tweets included excitement about waterpipe lounges, enjoyment of specific flavors, and social desires for waterpipe use. Negative tweets focused on health concerns of waterpipe, discomfort from waterpipe smoking, criticism of promotional content, and negative social sentiments. CONCLUSION:Our results provide preliminary insights into how waterpipe smoking was perceived and discussed among Twitter users in the United States, which could help with future targeted social media-based public health intervention campaigns. IMPLICATIONS:By applying fine-tuned Llama-2 language models and BERTopic modeling, this study showed how the public perceived waterpipe on Twitter, which varied depending on the user status (whether they used waterpipe or not), time of day or day of week, and geolocation. These findings offer some insights into the waterpipe discourse on Twitter. More importantly, our understanding of different sentiments toward waterpipe will provide useful guidance for designing effective health communication to reduce or prevent waterpipe use.
