BACKGROUND:Internationally, there has been growing interest in expanding smoke-free environments to include residential settings. Historically, smoke-free policies have been framed as a controversial social issue in the media and this framing can deter policy action in advancing smoke-free homes. Previous studies have examined the media discourse on smoke-free policies in public or semiprivate settings but none in residential settings. We explored how the Australian media has framed smoking and secondhand smoke drift issues in residential settings over a 10-year period. METHODS:We searched the Factiva database and used Google News search engine to identify relevant Australian news articles that reported on smoking or smoke-drift-related issues in housing contexts, published between 2015 and 2024. We conducted a content analysis of all included articles to determine temporal trends in article characteristics and used thematic analysis on a subset of articles to explore the news frames used. RESULTS:We identified 220 relevant news articles and the majority were published between 2015 and 2017 (57%). Most articles contained supportive views about policy change to address smoke-drift in homes (61%) and discussed smoke-drift in multiunit housing contexts (72%). The articles predominantly cited spokespersons from non-governmental health organisations (44%). In a subsample of articles (n=89), we identified three dominant news frames: moral contention between individual rights, power imbalances and the realities of smoke-drift and government responsibility to protect public health. CONCLUSIONS:Our findings suggest that the media portrayed smoke-drift in homes as fundamentally conflictual and primarily a 'rights-based' conflict between individuals. This framing may deter policy action to provide comprehensive protection from residential smoke-drift.
BACKGROUND:Smoking-related respiratory cancers, including lung, laryngeal and nasopharyngeal cancers, remain a major global public health challenge. The WHO MPOWER framework has guided international tobacco control, but most evaluations have focused on smoking prevalence and cessation rather than disease-specific burden. The present study introduces an ecological, lag-aligned inequality regression framework, linking MPOWER policy scores with age-standardised disability-adjusted life-years (DALYs) of smoking-related respiratory diseases derived from the Global Burden of Disease (GBD) study. MATERIALS AND METHODS:We quantified the global burden of smoking-attributable respiratory cancers from 1990 to 2021 using GBD 2021 estimates, the WHO MPOWER policy database and World Bank ageing statistics. We analysed age-standardised mortality rates (ASMRs) and age-standardised DALY rates (ASDRs) by sex and region and projected trends to 2050 with a BAPC model. For the policy analysis, we ran associational, ecological, lag-aligned global inequality regressions, regressing the annual cross-country 90-10 ASDR gap (Δq_t) on the global-mean MPOWER score and global-mean ageing aligned by lags. RESULTS:Smoking-attributable ASDRs and ASMRs declined from 2008 to 2021, although disparities by sex and region persisted. BAPC projections suggest continued decline through 2050, particularly among women. Countries with higher MPOWER scores, especially for Monitor, Protect and Enforce measures, were associated with narrower ASDR gaps with slower progress among men. CONCLUSION:Our findings suggest that robust MPOWER implementation is associated with reduced inequality in smoking-related cancer burden. Prioritising monitoring, protective measures and enforcement, while tailoring strategies by sex and age, may further accelerate the reductions. Future studies with unit-level data are needed to strengthen causal inference.
INTRODUCTION:Oral nicotine pouch (ONP) use is increasing among young populations. Many ONP brands are using continuity programmes (also called 'rewards' or 'loyalty' programmes), a marketing strategy that offers points for purchase that can be redeemed for prizes. No research has examined whether awareness of ONP continuity programmes is associated with US young adult intention to use or use of these products. METHODS:Undergraduate and graduate students (N=764) from a southern US university completed an online survey. Items asked about intention to use and ever use of ONPs. Participants were also asked about their awareness of and participation with ONP continuity programmes. Relationships between awareness of continuity programmes, controlling for covariates, were examined with ever use and intention to use ONPs in the future. RESULTS:Zyn Rewards (27.7%) was the most recognised ONP continuity programme. Participants most often first learnt about continuity programmes through word of mouth (31.9%) and social media influencers (27.5%). Only 1.2% ever participated in an ONP continuity programme. Gender, fraternity/sorority membership and socioeconomic status were all associated with intention to use ONPs. Awareness of an ONP continuity programme was associated with higher odds of intention (adjusted OR (aOR)=4.79 (2.73 to 8.39)) and ever use (aOR=3.99 (2.62 to 6.08)) of ONPs. DISCUSSION:US college students are aware of ONP continuity programmes, and awareness is associated with intention to use and ever use of ONPs. State and federal agencies are authorised to regulate tobacco marketing, and consumer protections should monitor social media influencers' promotion of ONP continuity programmes.
Background Since 1 January 2024, the Netherlands has banned all e-liquid flavours other than tobacco in order to discourage e-cigarette use among young people. This ban is based on a restrictive list of 16 permitted flavour-determining ingredients that only enable the production of a tobacco flavour. To evaluate the impact of the flavour ban on the Dutch e-cigarette flavour landscape, we determined how the number of newly notified e-cigarette products and their composition have changed since the ban came into effect. Methods We analysed product data for e-cigarette products notified to the Dutch part of the European Common Entry Gate system’s tobacco and e-cigarette product database from 1 January 2020 to 31 December 2025. Based on their ingredients, products were assigned to four groups, namely those containing (1) any non-allowed flavourings; (2) any ingredients with insufficient flavour information; (3) allowed flavourings only and (4) no flavourings. Results In 2025, there was a 61% decrease in the total number of newly notified e-cigarette products compared with 2020. Furthermore, there was a 38% increase in the percentage of products containing only allowed flavourings and a 56% decrease in those containing non-allowed flavourings. Conclusions These findings support the overall goals of the flavour ban, namely to discourage the attractiveness and use of e-cigarettes while keeping them available for people who smoke tobacco as an alternative. Additional studies on attractiveness, consumer behaviour and sales will be needed to fully evaluate the effect of the flavour ban.
OBJECTIVE:This scoping review aims to identify public education or mass media campaigns aimed at discouraging purchasing or selling illicitly traded tobacco and/or vaping products and to summarise the characteristics of the campaigns. METHOD:We searched six databases (PubMed, EMBASE, Web of Science, Scopus, PsycINFO and CINAHL) for peer-reviewed articles and conducted targeted Google searches to identify relevant campaigns implemented in English-speaking countries. Eligible campaigns aimed to lower demand for, raise public awareness of and/or deter purchasing or selling of illicit tobacco/vaping products. RESULTS:We identified 28 campaigns; of these, 15 were funded and distributed by government/health charity organisations, nine by tobacco companies, three by Crime Stoppers chapters and one by a consumer lobby group. 24 focused on illicit tobacco products (12 government/health charity), three on tobacco and vaping products (all government/health charity) and one on vaping products only (lobby group funded). Most government/health charity (n=10) and industry-funded (n=6) campaigns highlighted the association of illicit products with organised crime. Industry-funded campaigns featured messaging on lost tax revenue (n=5) and damages to legitimate businesses (n=5). The Keep IT Out campaign from England was the only campaign evaluated for effectiveness and resulted in increased public awareness and hotline reports. DISCUSSION:Our findings highlight the critical need for future research to identify effective campaign messages, especially those that avoid unintentionally reinforcing the use of illicit tobacco/vape products, increasing awareness of where or how to access these products, implying that taxed products are safer or legitimising the tobacco industry and its retail channels.
BACKGROUND:Specialty tobacco retailers, including vape shops, smoke shops and cigar shops, are important sources of tobacco access, yet there is no reproducible national database documenting their locations and consumer engagement. METHODS:We develop a national database of specialty tobacco retailers in the USA by combining Google Maps business listings as of June 2024 with Advan unique visitor count data, updated to May 2024. We match approximately 20 000 businesses across both databases and observe roughly 50 million monthly visits to these locations. We then perform two cross-sectional analyses examining specialty retailer density and visits at the census tract and county levels. RESULTS:We find strong clustering of all types of specialty retailers in low-income areas and fewer shops per capita in rural areas. We find that smoke and vape shop density is negatively correlated with both educational attainment and population share of racial and ethnic minorities. Cigar and smoke shops were less common in areas with high shares of young people aged 15-24. Additional businesses are positively associated with total consumer visits, with evidence of spillover effects across shop types. CONCLUSIONS:This study provides the first reproducible national assessment of specialty tobacco retailer locations linked to consumer visit data, offering a new foundation for monitoring retail access and informing tobacco control policy.
INTRODUCTION:We sought to evaluate preliminary efficacy and implementation outcomes of an e-cigarette and tobacco cessation intervention for hospitalised youth in the USA. METHODS:We conducted a pilot randomised controlled trial at a paediatric hospital with 3-month follow-up from August 2023 to December 2024. Hospitalised youth (14-21 years) with self-reported past 30-day e-cigarette use were eligible. Exclusions included severe medical/psychiatric illness, cognitive impairment and inability to communicate in English. Intervention entailed health education, motivational interviewing counselling, quit planning, nicotine replacement therapy (NRT) and phone booster sessions. Control entailed brief advice and quit programme referral. The primary outcome was self-reported past 30-day e-cigarette abstinence at 3 months with biochemical confirmation with intention-to-treat (ITT) sensitivity analysis. Implementation outcomes included acceptability, feasibility and fidelity. RESULTS:In 144 hospitalised youth enrolled, the mean age was 16.2 years (SD: 1.3) and 62% were female. At 3 months there was no difference in past 30-day e-cigarette abstinence between arms (intervention 43% vs control 42%; p=0.91). In ITT analysis we found the OR of abstinence was OR 0.77 (95% CI 0.27 to 2.19, p=0.62) in the intervention versus control. Mean fidelity score was 43 (SD: 3; out of 50). All intervention participants (n=96) completed the initial in-person intervention, 49% made a quit plan, of those 23% were prescribed NRT. Most (89%) were somewhat/very satisfied with the intervention. CONCLUSIONS:Our study is among the first to demonstrate promising implementation but not efficacy of an e-cigarette cessation intervention in hospitalised youth. Future work is needed to enhance intervention efficacy in this population. TRIAL REGISTRATION NUMBER:NCT05936099.
BACKGROUND:The increasing popularity of flavoured cigarettes in South Korea poses a challenge to recent declines in smoking prevalence, particularly among younger populations. This study aimed to estimate the potential impact of implementing a flavoured cigarette ban on smoking and vaping prevalence in South Korea using the Smoking and Vaping Model (SAVM). METHODS:We adapted the SAVM to the Korean context using national demographic data, smoking and vaping prevalence from the Korea National Health and Nutrition Examination Survey (KNHANES) and flavoured cigarette use data from the International Tobacco Control (ITC) survey. To validate the model, we compared the projected smoking prevalence under the status quo scenario from 2016 to 2022 with the smoking prevalence reported in KNHANES. The model assumes implementation of the flavoured cigarette ban beginning in 2025 and projects smoking and vaping prevalence from 2025 to 2034 under both the status quo and flavour ban scenarios. Sensitivity analyses were conducted by varying key parameters by ±10%. RESULTS:Under the flavour ban scenario, male smoking prevalence is projected to further decline by 2.0% point and female prevalence by 0.5% point within 1 year of policy implementation, compared with the status quo. Flavoured cigarette use is expected to drop substantially, with partial substitution to unflavoured cigarettes and flavoured nicotine vaping products. Vaping prevalence is projected to increase by approximately 1.0% point in both sexes, compared with the status quo. Sensitivity analysis indicated the robustness of these projections. CONCLUSIONS:A comprehensive flavour ban could significantly reduce smoking prevalence in South Korea, but may lead to increased use of alternative tobacco products. To maximise public health benefits, policies should address flavoured products across all tobacco products and anticipate potential substitution behaviours.
OBJECTIVE:Despite the recommendation that heated tobacco products (HTPs) and conventional cigarettes (CCs) be regulated equivalently, Japan has adopted a national policy allowing some types of employers to institute workplace policies designating indoor HTP-only smoking rooms, in addition to the long-standing partial smoking ban system that allows smoking CCs and HTPs only inside smoking rooms. This study assessed whether employers' workplace policies regarding smoking were associated with employees' self-reported CC or HTP smoking. METHODS:In 2024, we conducted a nationwide internet-based survey of 12 625 workers. Relative risks (RRs) for current (past 30 days) CC and HTP smoking based on workplace policies were estimated using modified Poisson regression analysis, adjusted for demographic and behavioural characteristics. Workplace smoking policies were classified into three categories: complete bans on smoking CCs and HTPs, partial smoking bans with HTP-only smoking rooms and partial smoking bans without HTP-only smoking rooms. Additionally, we conducted stratified analyses to identify possible associations between workplace smoking policies and smoking CCs and HTPs within each stratum of characteristics. RESULTS:Compared with complete smoking bans, partial smoking bans with HTP-only smoking rooms were associated with a higher likelihood of HTP smoking (RR=1.55, 95% CI 1.35 to 1.77). This association was observed both among people who formerly (RR=1.88, 95% CI 1.51 to 2.33) and currently (RR=1.28, 95% CI 1.09 to 1.51) smoke CCs. CONCLUSIONS:The presence of HTP-only smoking rooms in workplaces likely resulted in more workers smoking HTPs. HTP-only smoking rooms should therefore be eliminated, and employers should completely prohibit CC and HTP smoking in their workplaces.
BACKGROUND:As oral nicotine pouches (ONPs) have gained popularity in the US, little is known from nationally representative data about who uses them and how they are being used. OBJECTIVES:To examine tobacco use and sociodemographic correlates of ONP use, use frequency and flavour use among US adults. METHODS:Data were drawn from the 2022-2023 Tobacco Use Supplement to the Current Population Survey (n=1 57 485). Weighted logistic regression models were used to identify predictors of (1) current ONP use, (2) daily versus non-daily ONP use and (3) flavoured versus unflavoured ONP use. RESULTS:The odds of current ONP use were higher among younger adults, males, non-Hispanic Whites, individuals with higher income and those who had ever used cigarettes, e-cigarettes or smokeless tobacco (SLT). People who currently use cigarettes, e-cigarettes or SLT had lower odds of daily (vs non-daily) ONP use, whereas people with a history of cigarette use who do not currently smoke had higher odds. Males, younger adults and people with a history of SLT use who do not currently use SLT were more likely to use flavoured ONPs. CONCLUSIONS:ONP use was common among individuals with current and prior tobacco use which may be consistent with alternative nicotine use. However, a small proportion of ONP users reported no prior use of other tobacco products, highlighting the need for continued research on nicotine uptake through ONPs among tobacco-naïve populations, particularly among young adults. In addition, the prevalence of co-use with other tobacco products may limit potential public health benefits.
BACKGROUND:Philip Morris International's (PMI) heated tobacco brand IQOS has long been advertised as a fashionable lifestyle product and as a supposedly safer alternative to cigarettes. PMI's new campaign for IQOS, focused on 'Curiosity', was launched in 2024 and is ongoing in 2026. METHODS:The IQOS Curiosity advertising campaign sources included 20 company-controlled, country-specific Instagram accounts, 2 Facebook accounts and 10 'X' (formerly Twitter) accounts and videos from YouTube (14), Vimeo (7), and TikTok (4). RESULTS:The principal brand descriptors were all variations on the central theme of curiosity: Stay Curious, Forever Curious, Curious? and Curious X. Key advertising words included: Discover, innovation, explorations, creativity, inspires and trailblazing. Key campaign slogans included: New experience, new possibilities, open your mind, next adventure, unexpected adventures, your passion, drives confidence and let life surprise you. Social media advertising was supplemented by sponsored events, partnerships with popular media such as Rolling Stone and Vogue, and use of influencers. The campaign consistently portrays IQOS as a highly desirable, novel experience that stimulates adventure seeking, enhances self-confidence, promotes romantic success and helps users unwind. These messages are disseminated primarily through social media platforms that are heavily frequented by youth. CONCLUSIONS:Marketers know that curiosity is at its peak during youth. The IQOS Curiosity campaign appears designed to appeal to impulsive and sensation-seeking youth who are drawn to novel experiences. In its new 'Curiosity' campaign PMI has transitioned its IQOS advertising strategy from one focused on recruiting adults who smoke to differentially targeting youth and young adults.
INTRODUCTION:The US Food and Drug Administration has proposed a product standard that would reduce the nicotine content and addictiveness of cigarettes. It is unclear what impact this would have on economic outcomes or priority populations who are disproportionately harmed by tobacco use, such as people with major depression (MD). We evaluated the long-term health and economic impacts of a nicotine product standard for the US population by MD status. METHODS:We developed and calibrated a microsimulation model using the National Survey on Drug Use and Health 2005-2023 data on smoking, e-cigarette use and MD episodes. We used this model to simulate a nicotine product standard from 2027 to 2100 based on the FDA's expert elicitation estimates of the policy's anticipated effects on smoking and vaping. RESULTS:Under the proposed product standard, smoking is projected to decline to <1% for people with and without MD by 2040, resulting in 1.6 million premature deaths averted by 2100 and 8.0 million fewer cases of MD. Longer life expectancies under the policy are projected to increase medical costs by US$336 billion, while also increasing worker productivity by US$298 billion and consumer spending by US$1.3 trillion. CONCLUSIONS:Timely implementation of a nicotine reduction strategy, either through a federal product standard or state-level sales restrictions, is cost-effective and could prevent millions of premature deaths while reducing smoking disparities by MD status.
OBJECTIVE:E-cigarette nicotine concentration level is critical to tobacco regulation. This study seeks to examine whether nicotine level is associated with transitions in tobacco use status such as exclusive cigarette, exclusive electronic (e-)cigarette, dual and no use. METHODS:Using a large, nationally representative cohort from the Population Assessment of Tobacco and Health (PATH) study in the USA, we compared changes in the prevalence of tobacco use status at 1-year follow-up (Wave 7) based on level of e-cigarette nicotine exposure at baseline (Wave 6). Self-reported nicotine concentration was categorised into high (5.0% or more), moderate (1.8-4.9%), low (0.1-1.7%), 0% and 'I don't know'. RESULTS:Among those using e-cigarettes at baseline, those using products containing nicotine (≥0.1%) were more likely to continue exclusive e-cigarette use at follow-up than those using 0% or unknown nicotine content. Among those reporting dual use at baseline, nearly half continued dual use at follow-up regardless of nicotine concentration. However, those using higher nicotine concentrations (≥1.8%) were more likely to either switch to exclusive e-cigarettes or quit entirely indicating greater harm reduction than those using low-nicotine or no-nicotine products. In contrast, nearly half with baseline dual use and 0% nicotine transitioned to exclusive cigarette smoking. CONCLUSION:These findings highlight the complex relationship between e-cigarette nicotine concentration and tobacco use transitions. Regulatory and public health approaches may benefit from balancing the potential harm reduction role of nicotine-containing e-cigarettes for adults who smoke with concerns regarding sustained nicotine dependence and long-term e-cigarette use.
Background Tobacco-khat co-use is common in Ethiopia, where khat is cultivated. However, information is limited regarding tobacco-khat co-use among adults in the study setting. Aims (1) Explore behavioural patterns of tobacco-khat co-use and (2) investigate the factors associated with tobacco-khat co-use in Haramaya district, and Maya City, eastern Ethiopia. Methods We conducted eight focus groups (FGs) with adult males (n=36, four FGs) and females who use tobacco (n=18, two FGs), and community leaders (n=17, two FGs). Participants were purposively recruited. The interview guide addressed tobacco-khat co-use behaviours and related factors. The data were analysed using thematic analysis. Results The male participants had a mean age of 37.7 (SD±12.4), while the females had a mean age of 44.9 (SD±15.5) years. Males initiated tobacco and khat use at a younger average age compared with females. All participants acknowledged the widespread co-use of tobacco-khat in the region. Two key themes emerged: (1) Tobacco use is tied to khat consumption, reflecting distinct behavioural patterns of co-use. (2) Multiple drivers of co-use included deeply rooted social and cultural practices, progression from habitual use to dependence and accessibility and affordability. Conclusion Findings suggest that male participants begin tobacco and khat use at an earlier age, driven by sociocultural norms and gendered expectations. This co-use is sustained by multiple reinforcing drivers: perceived synergistic stimulation between khat and tobacco, deeply rooted social and cultural practices, progression from habitual use to dependence and accessibility and affordability, which perpetuate the behaviour. Thus, effective cessation programmes must address co-use and be adapted to sociocultural realities.
OBJECTIVES:This study investigates smoking depictions in the globally popular manga ONE PIECE over its 27-year publication period and its associations with tobacco control measures implemented in Japan. DESIGN:Time-series study. SETTING:Volumes 1-110 (1121 episodes) of ONE PIECE published between August 1997 and December 2024. INTERVENTIONS:Smoking scenes were identified and quantified by panel-based content analysis. MAIN OUTCOME MEASURES:Prevalence of smoking panels relative to the total number of panels per volume. RESULTS:The overall prevalence of smoking panels was 4.7%, with a significant downward trend (p<0.001). Smoking depictions of Sanji, the only smoker among the 10 core characters in the series, accounted for 54% of the total of 5076, and his smoking portrayal significantly declined over the 27-year publication period (p=0.007). Interrupted time series analyses demonstrated statistically significant slope changes indicating decreasing trends in Sanji's smoking depictions following the implementation of the revised Health Promotion Act (p<0.001). CONCLUSIONS:Despite this decline, smoking behaviour and tobacco product depictions continued to appear in the series. Policies with adolescent-focused, legally binding implications for smoking environments were associated with reductions in the smoking depictions of a core character. Given the global reach of Japanese manga among young audiences, strengthening regulations on smoking depictions and enhancing media literacy education for adolescents may be necessary to reduce the risk of smoking initiation.
Background Bidis are the most commonly used smoked tobacco product in India. Despite their significant health burden, bidi taxation remains low and there are tax exemptions for small producers. Methods We used a multistate life table model to project the 50-year impact of bidi tax reform under two scenarios: 10% and 30% tax-induced price increases combined with removal of small-producer exemptions. Outcomes included years of life gained (YLG), changes in direct health expenditures, indirect morbidity costs, economic output from averted premature mortality, consumer spending and tax revenues. Total economic effects were defined as reductions in direct health expenditures and indirect morbidity costs plus gains in economic output. Long-run monetary outcomes were discounted at 3%. Results A 10% price increase yields 21.78 million YLG (95% uncertainty interval (UI) 13.25 to 32.42 million) and Indian rupees (INR) 560.1 billion (0.25% of total health expenditure (THE)) in discounted health savings over 50 years; a 30% increase yields 47.95 million YLG (95% UI 29.17 to 71.37 million) and INR 1232.3 billion (0.54% of THE). Total economic effects reach INR 2530.8 billion (1.12% of THE) and INR 5557.7 billion (2.45% of THE) under the 10% and 30% scenarios, respectively. Discounted tax revenues increase by INR 519.9 billion and INR 1390.0 billion. Absolute gains are largest in Uttar Pradesh and West Bengal, while Uttarakhand, Haryana and Tripura show the highest per capita and proportional benefits. Conclusion Strengthening bidi taxation and removing exemptions would substantially reduce smoking, improve health and generate significant long-term economic and fiscal gains.
