Introduction:It is estimated that almost one quarter of young adults use electronic nicotine delivery systems (ENDS) despite health risks. Perceptions of addiction to nicotine has been linked with motivation to quit, highlighting the importance of understanding contributors to addiction perceptions among young adults. Methods:The current study used cross-sectional survey data to examine how perceptions of addiction were impacted by physical dependence, risk perception, intention to quit, number of quit attempts, and initiation regret among a sample of undergraduate students (n=99) who had used ENDS within the past 30 days. Participants were aged 18-23 years with a mean age of 19.64 years (SD=1.156). The majority (64.6%) identified as women, and 61.6% identified as White. Results:Only symptoms of nicotine dependence were significantly related to perception of addiction (β=-0.636; 95% CI: -0.829--0.474, t=-7.415, p<0.001) indicating that experiencing more symptoms of nicotine dependence predicted stronger perceptions of nicotine addiction. The number of lifetime quit attempts moderated the relationship between symptoms of addiction and perception of addiction (β=0.129; 95% CI: 0.069-0.190, p<0.000) such that symptoms of nicotine dependence have a stronger relationship with perceptions of addiction when an individual has engaged in fewer quit attempts. The number of quit attempts did not moderate the relationship between initiation regret and perceptions of addiction or the relationship between perceptions of the risk of becoming addicted to vaping and perceptions of addiction. Conclusions:The results highlight the role of symptoms of physical dependence on perceptions of addiction among young adults attending college. Surprisingly, this relationship was stronger for individuals with fewer quit attempts. Perhaps more failed quit attempts lead young adults to adopt self-exemption beliefs and disconnect their symptoms of nicotine dependence from their perception that they are addicted to ENDS.
Introduction:Despite overall declines in the rate of tobacco use in the United States over the past 30 years, nearly 38 million Americans still smoke, posing extremely high risk for long-term health problems and death. Recent reviews note that there has been significant progress in the application of both clinical and public health interventions to help smokers quit; however, they have also concluded that the overall success rate has not significantly improved. There remains a need for novel, theory-driven approaches to enhance quit rates and innovative interventions that increase reach and engagement. In the current pilot study, we evaluated the use of a cognitive dissonance intervention for smoking cessation that was delivered via a mobile app. Methods:The Support2Quit app was evaluated in a single arm pilot study with 72 adult daily smokers who were assessed at baseline, 1 month and 3 months. Feasibility, usability, participant satisfaction, and intervention outcomes were evaluated. Results:The evaluation demonstrated promise that the Support2Quit app could effectively invoke significant increases in cognitive dissonance (average effect r=0.55; a large effect) and significant increases in readiness to quit smoking (average effect r=0.36; a medium effect). Outcomes showed a decrease in the number of cigarettes smoked each day for 41 (72%) of this sample; the non-parametric Wilcoxen signed-rank test showed an overall decrease in the number of cigarettes smoked per day from pretest to posttest (Z-score= -5.64, asymptotic p<0.001). User satisfaction ratings using a 5-point Likert scale indicated that the majority of 87.5% of participants reported liking the app (mean=3.7; SD=1.0) and that 82.5% reported that the app was helpful in reducing or stopping using cigarettes (mean=3.3; SD=1.0). Conclusions:Outcomes suggest that the Support2Quit mobile app was effective at inducing cognitive dissonance and might be a useful tool for reducing or quitting the use of cigarettes.
Introduction:Tobacco exposure is a preventable breast cancer risk factor. High smoking rates among Vietnamese American (VA) men place VA women at elevated secondhand smoke exposure (SHSe) risk; yet research on the extent to which VA women are aware of SHSe and breast cancer risk is limited. Methods:This community-partnered, mixed-methods, cross-sectional study examined SHSe prevalences, knowledge, attitudes, and beliefs about SHSe as a breast cancer risk factor among VA women (aged 18-65 years) and explored multilevel factors contributing to SHSe within VA families in Southern California, December 2024 - January 2026. We recruited self-identifying VA women (n=179) via a community-based, snowball strategy for a 30 min survey, and then conducted 60 min one-on-one interviews with 22 VA individuals (11 family dyads). Results:Current SHSe prevalence was 43% (vs 25.2% nationally); 52.0% reported indoor SHSe during childhood. Only 63.7% had explicit home smoking rules, despite 99.4% believing SHSe affects children's health and 85.2% linking SHSe to increased breast cancer risk. A Rapid Group Analysis Process of the interview data revealed 3 themes, corroborating survey findings: 1) Religious/spiritual influences led participants to attribute health outcomes to fate or divine will, undermining preventive behaviors and beliefs, 2) A lack of available health information contributed to uncertain/diverging views on breast cancer causes; and 3) Non-smoker women expressing challenges navigating familial smoking-related tension while maintaining relational harmony. Conclusions:Our findings highlight the importance of family-centered communication while accounting for gender-related tension and family roles to promote cessation, breast cancer prevention and smoke-free spaces.
Introduction:Adolescence is a critical period for experimentation with psychoactive substances, including electronic cigarettes (e-cigarettes). This study aimed to assess the prevalence of e-cigarette use among high school students in Paris and to explore adolescents' motivations for use and their perceptions of its effects. Methods:This cross-sectional study, based on self-reported data collected through an online questionnaire, was conducted between January and April 2021 among students from six educational institutions in the Paris region. The anonymized survey collected demographic and health data, information on tobacco and e-cigarette use behaviors, and perceptions and motivations related to e-cigarette use. Associations between the social environment and tobacco and e-cigarette experimentation were evaluated using prevalence ratios, crude odds ratios (ORs), and adjusted ORs (AORs), with 95% confidence intervals (CIs). Results:A total of 1187 students participated (median age: 17 years; 55.5% male). E-cigarette experimentation was reported by 46.8%, current use by 18.9%, and daily use by 8.6%. The mean age at e-cigarette initiation was 14.9±1.9 years. Dual experimentation with tobacco and e-cigarettes was observed in 39.2% of participants, while 5.2% reported exclusive e-cigarette use. Curiosity was the most frequently reported motivation for e-cigarette ever users (91.4%), followed by flavor variety (75.0%), and the ability to use e-cigarettes at home without tobacco odor (63.6%). Exposure to e-cigarette use among friends was strongly associated with e-cigarette experimentation (AOR=3.68; 95% CI: 2.88-4.73). Notably, 23.4% of all respondents and 12.3% of e-cigarette ever users were unaware whether e-liquids contained nicotine. Most e-cigarette users expressed concerns about lung health (85.2%) and addiction risk (75.5%). Conclusions:E-cigarette use is prevalent among adolescents in the Paris region and is driven by curiosity, sensory appeal, and social influences. Additional studies, particularly longitudinal cohort studies, are needed to provide evidence-based information on tobacco and e-cigarette use trajectories among adolescents.
Introduction:Tobacco use and the screening of nicotine dependence using the Fagerström test among adults with intellectual disabilities (ID) is an understudied public health issue. Despite lower reported prevalence relative to the general population, methodological challenges - particularly the suitability of self-reported tools - limit reliable measurement. This study assesses the convergent validity of the Fagerström test for nicotine dependence (FTND) by comparing it with exhaled carbon monoxide (CO), an objective biomarker of recent smoking, in a sample of adults with ID. Methods:Data were collected from an observational cross-sectional validation study during 2024, which investigates addictive behaviors, health indicators, and physical activity among adults with ID in northern France. Nurses administered a standardized questionnaire, including the FTND, and measured exhaled CO using a portable analyzer. Associations were examined using correlation analyses and univariable and multivariable linear regressions controlling for sociodemographic and health variables. Results:Among 35 people who smoke, FTND scores were positively and strongly correlated with exhaled CO (r=0.540, p<0.001). In adjusted regression models, FTND remained a significantly associated factor of CO levels (0.60; 95% CI: 0.17-1.02), alongside age (0.065; 95% CI: 0.00-0.13), employment in sheltered workshops (1.86; 95% CI: -0.07-3.78), and cognitive support needs (-1.62; 95% CI: -3.51-0.26). Analyses conducted on the full sample, including 68 people who do not smoke, yielded consistent results, with FTND remaining the strongest predictor of exhaled CO. Conclusions:The results suggest evidence of validity of the FTND in adults with ID, suggesting that self-report instruments can reliably estimate nicotine dependence when administered with appropriate support. Nevertheless, the interpretation of CO levels in adults with ID should account for age, cognitive support needs, and contextual factors.
Introduction: Residents of counties with higher poverty levels experience elevated smoking rates and disproportionate tobacco-related cancer mortality. This study examined differences in sociodemographic characteristics, tobacco use, and service utilization among Oklahoma Tobacco Helpline (OTH) registrants across county poverty designations. Methods: In this cross-sectional study, data were analyzed from 33847 adults registered with the OTH between 1 July 2023 and 30 June 2024. Counties were classified as persistent poverty (PPC: ≥20% of residents in poverty for ≥30 years), current poverty (CPC: ≥20% of residents in poverty currently for <30 years), or non-poverty (NPC: <20% of residents in poverty). Group differences were examined using the chi-squared test and analysis of variance. Adjusted multinomial logistic regression analyses evaluated associations between poverty status, tobacco use, and service utilization, controlling for age, sex/gender, race, education level, household income, health insurance, and chronic conditions. Results: Registrants residing in PPCs and CPCs differed from those in NPCs in terms of age and race, and they had lower education, income, and greater Medicaid coverage (all P<0.05). In adjusted models, PPC registrants had higher odds of smoking >1 pack/day (heavy smoking) (AOR=1.49; 95% CI: 1.30-1.70; p<0.001) and learning about OTH through personal networks (AOR=1.42; 95% CI: 1.16-1.73; p<0.001) compared with NPCs. Compared with registrants residing in non-poverty counties (NPCs), CPC registrants had higher odds of smoking >1 pack/day (AOR=1.39; 95% CI: 1.16-1.65; p<0.001) and learning about OTH through community/social organizations (AOR=1.77; 95% CI: 1.33-2.35; p<0.001). Service type and nicotine replacement therapy receipt/duration were similar across poverty designations. Conclusions: PPC and CPC registrants showed greater socioeconomic disadvantage and nicotine dependence than NPC registrants but had distinct information pathways. These findings highlight geographically concentrated poverty as a potential contributor to tobacco-related disparities and suggest that interventions addressing social and environmental conditions in PPCs may help enhance cessation engagement and reduce tobacco-related inequities.
Introduction:There is a potential risk of increased dual use of e-cigarettes and cigarettes among people who currently smoke and use e-cigarettes. Limited data are available on why people who smoke in the Philippines use e-cigarettes, including reasons that relate to smoking cessation. The current study addresses this gap to inform e-cigarette regulatory strategy. Methods:Data were collected via an online self-administered cross-sectional survey in November 2023 from 611 Filipino adults who smoke and reported current e-cigarette use (i.e. dual users). Participants selected their primary reason for e-cigarette use from a pre-populated list of 15 reasons. We conducted separate logistic regression models of each top reason for e-cigarette use, controlling for demographic and tobacco-use variables. Results:The top primary reasons for e-cigarette use were to cut down smoking (26%), to help quit smoking (24%), to use when not allowed to smoke cigarettes (11.6%), vaping is less harmful than smoking to others around me (11.6%), and 'I enjoy the flavor' (8.5%). Men were more likely than women to select to help quit (adjusted odds ratio, AOR=1.84; p=0.003, 95% CI: 1.22-2.77). Those intending to quit smoking within the year were more likely to select to help quit (AOR=5.22; p<0.001, 95% CI: 2.30-11.9) and to cut down (AOR=2.84, p<0.001, 95% CI: 1.36-5.95), and less likely to select to use when not allowed to smoke (AOR=0.25, p<0.001, 95% CI: 0.13-0.50) and because 'I enjoy the flavor' (AOR=0.24, p<0.001, 95% CI: 0.12-0.49). Conclusions:Some people who smoke in the Philippines use e-cigarettes in order to support smoking cessation; however, there is a risk of prolonged dual use if strong regulations are not implemented to promote complete cessation. Further research should investigate causal factors for e-cigarette use to identify policy pathways for reducing dual use and supporting cessation efforts.
Introduction:Tobacco taxation is widely recognized as one of the most effective policy measures for reducing tobacco use and saving lives. The aim of this study is to estimate the fiscal and public health effects of increasing cigarette excise taxes in Serbia, an upper middle-income country with historically high smoking prevalence and increasing affordability in recent years. Methods:A simulation-based analysis was conducted to estimate the effects of an annual increase in the specific excise tax per cigarette pack in Serbia. The baseline year was 2023, with projections for two years. Changes in cigarette consumption were estimated using price elasticity, income elasticity, and cross-price elasticity derived from previous research. The model assessed impacts on cigarette consumption, government revenues, smoking prevalence, smoking-attributable premature mortality, and youth smoking initiation, under assumptions of full price pass-through, a constant illicit market share, and no inflation. Results:An increase in cigarette excise taxes is associated with higher retail prices (10-11%) and reductions in cigarette consumption (-4.7% in the first year and -5.3% in the second year) and smoking prevalence (from 37.9% at baseline to 35.8%). Youth smoking initiation declined across all age groups, with >17000 individuals deterred from initiating smoking. Government revenues from tobacco increased over the observed period, as higher tax revenues per pack outweighed reductions in sales volumes, with excise tax revenues rising by about 7% annually. Declines in smoking prevalence resulted, among other effects, in reductions in premature smoking-attributable mortality, with 320 premature deaths avoided in the first year and 678 in the second year. Conclusions:The findings indicate that increasing cigarette excise taxes in Serbia can yield substantial public health benefits while strengthening government revenues. Further research accounting for substitution toward other tobacco or nicotine products would strengthen the evidence base and provide a more comprehensive assessment of the health and fiscal impacts of tobacco tax policies.
Introduction:Cigarette smoking remains disproportionately prevalent among people with HIV (PWH) and contributes substantially to preventable morbidity and mortality. Although exercise confers many health benefits, little is known about how PWH who smoke perceive exercise as a strategy to support smoking cessation. The purpose of this qualitative study was to explore barriers and facilitators to smoking cessation and exercise engagement, with particular attention to exercise as a potential cessation-support strategy. Methods:Within this qualitative study, PWH were recruited from HIV clinics in Colorado and New England between September 2025 and February 2026, and were eligible if they were aged ≥21 years and current smokers. Guided by the Health Belief Model (HBM) and the Social Ecological Model (SEM), semi-structured interviews were transcribed verbatim and analyzed using a hybrid deductive-inductive framework. Results:Ten PWH (50.6 ± 8.8 years) participated. Participants demonstrated high awareness of smoking-related harms yet described persistent individual and structural barriers to quitting. Exercise was frequently perceived as a supportive strategy that reduced cravings, improved mood, and provided behavioral structure, particularly when embedded in socially supportive contexts. Multilevel barriers included addiction, stress, physical limitations, limited organizational attention to exercise, and resource constraints. Facilitators included peer accountability, structured group exercise, supportive counseling, and environmental incentives. Emergent themes highlighted behavioral substitution and autonomy as important. Conclusions:PWH who smoke perceive exercise not only as a health behavior but as a potential cessation-support strategy when delivered within socially connected and autonomy-respecting environments. Additional work is needed to develop multidisciplinary interventions that may enhance smoking cessation efforts.
Introduction:Certain Asian American subgroups have higher smoking rates than the general population, contributing to preventable mortality. This study evaluated the implementation and outcomes of a proactive tobacco treatment outreach strategy at Paul Hom Asian Clinic (PHAC), a student-run free clinic serving Asian Americans in Sacramento, California. Methods:We conducted a retrospective observational study of all active PHAC patients from August 2020 to June 2021. Volunteers used the Ask, Advise, Connect framework, which involves assessing tobacco use, advising smokers to quit, and referring them to cessation resources via the Asian Smokers' Quitline (ASQ). Outreach calls were made in patients' preferred languages to collect demographics, smoking status, and referral acceptance. The ASQ provided outcomes for referred patients, including counseling completion, unreachable status, or refusal. Descriptive statistics and exploratory logistic regression identified factors associated with successful contact. Results:Among 1733 patients, 194 (11.2%) had a history of tobacco use or exposure, including 162 current smokers, 27 former smokers, and 5 passive smokers, most being non-English speakers. Proactive outreach reached 23.2% of patients, with a 24.4% referral acceptance rate. Of those referred, 8 out of 11 completed counseling, 2 were unreachable, and 1 declined. Logistic regression indicated that increasing age was associated with lower odds of contact, particularly for patients aged ≥50 years. Sex and language were not significant predictors. Conclusions:Proactive outreach by student volunteers shows promise for promoting tobacco cessation among Asian American patients. Despite barriers, nearly one-quarter accepted referral, with most engaging in counseling. These findings highlight the potential for student-run clinics to deliver culturally and linguistically tailored interventions to underserved populations.
The EU Tobacco Products Directive specifies the types of information required on e-cigarette package leaflets, but leaves further details and design to the Member States. In practice, however, both aspects are largely determined by the industry. This policy case study presents a comprehensive leaflet proposal developed by the Belgian Superior Health Council in collaboration with national tobacco control stakeholders. This multidisciplinary engagement enhances both the content quality and its acceptance among health professionals. The proposal defines formatting requirements for maximum legibility and comprehension across the general population, and structures evidence-based warning and informative messages into five thematic chapters. It aims to prevent vaping initiation among non-smokers and specific vulnerable groups by highlighting both short- and long-term health risks, while providing adult smokers with balanced information on the potential role of e-cigarettes in smoking cessation, preferably under professional supervision. The content should be updated periodically to reflect new scientific evidence, and complemented with evaluation metrics to assess real-world impact (leaflet reach, reader comprehension, behavioral influence). Given that leaflets are poorly to moderately noticed and rarely read, integration with pictorial warnings is recommended, following the relatively successful Canadian model for cigarette package inserts.
Introduction:BRICS and associated economies have a considerable share of the world's population and cancer burden; however, long-term trends, heterogeneity and inflection points of smoking-attributable gastrointestinal (GI) cancers are still unclear. This retrospective population-based secondary analysis utilized Global Burden of Disease (GBD) 2023 data to investigate the mortality, disability-adjusted life years (DALYs) and age-standardized rates (ASRs) of smoking-attributable GI cancers among 11 BRICS and associated economies in 1990-2023, and to provide data-driven evidence for epidemiological and clinical prevention research on smoking-related GI cancers. Methods:This secondary analysis used 2023 GBD data, which included five main types of GI cancers caused by smoking: esophageal, stomach, colon and rectum, liver and pancreas cancers. Mortality, DALYs and ASRs were analyzed at the global, region and country levels. Joinpoint regression was used to compute annual percentage change (APC) and average annual percentage change (AAPC). Results:The total number of smoking-attributable GI cancer deaths in the study regions rose from 236305.08 in 1990 to 328324.75 in 2023 and total DALYs increased from 6.53 million to 8.08 million; the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) decreased with an AAPC of -1.44% and -1.48%, respectively. Brazil and China experienced the greatest declines in ASMR. India, Egypt and Ethiopia showed an increasing trend. Esophageal cancer was still the main cause of death and pancreatic cancer had the highest increase in mortality rate. Age-stratified analysis showed that the 20-29 years age group had a growing disease burden and the 40-64 years group had the largest decrease in DALYs. For people aged >75 years, the decline of disease burden decelerated. Conclusions:The burden of smoking-attributable GI cancers in BRICS and associated economies has increased with rising absolute mortality and DALYs and falling ASRs. Regional disparities, age trends and rising youth risks reveal marked epidemiological differences in GI cancer burden.
Introduction:Heated tobacco products (HTPs) and nicotine pouches (NPs) are emerging nicotine containing products. This study aims to examine the prevalence and patterns of use of HTPs and NPs, and factors associated with starting to use HTPs among European Union (EU) Member State (MS) citizens. Methods:We conducted a secondary analysis of data from the Special Eurobarometer 539 survey on attitudes towards tobacco and related products, carried out between May and June 2023, which included 26359 individuals aged ≥ 15 years across the 27 EU MS. We performed two-level logistic regression models, including sociodemographic factors as independent variables, to identify factors associated with HTP and NP current and ever use and reasons to start using HTPs. Results:In 2023, 1.7% (95% CI: 1.4-1.9) of EU MS citizens were current users of HTPs and 1.0% (95% CI: 0.9-1.3) were current users of NPs; 81.2% (95% CI: 75.6-85.8) of all current HTP users were concurrently smoking tobacco, while 43.5% (95% CI: 34.4-53.1) of current NP users were also current smokers, whereas 4.3% (95% CI: 2.16-83.6) of HTP users and 18.3% (95% CI: 12.1-26.8) of NP users had never smoked tobacco. Individuals aged 15-24 years were more likely to be current users of HTPs (AOR=4.21; 95% CI: 2.67-6.64), ever users of HTPs (AOR=9.70; 95% CI: 7.66-12.29), current users of NPs (AOR=7.36; 95% CI: 4.11-13.18) and ever users of NPs (AOR=6.48; 95% CI: 4.95-8.47). Finally, individuals aged 15-24 years (AOR=5.31; 95% CI: 1.72-16.38) and 25-39 years (AOR=2.68; 95% CI: 1.19-6.42) were more likely to have reported to have commenced HTP use because they liked HTP flavors. Conclusions:Although the overall prevalence of HTP and NP use in 2023 within the EU remained low, usage was concentrated among younger individuals, with dual use with conventional tobacco products being common. The emergence of NP use among individuals who have never smoked, along with the role of HTP flavors on HTP initiation among young people, are particularly concerning.
INTRODUCTION:Adolescents often overestimate peer smoking and vaping, increasing the likelihood of initiation. School environments play a central role in shaping these perceptions. This study therefore aimed to examine whether a school-based environmental intervention modifying the school environment can shift adolescents' perceived norms and reduce (e-)cigarette use. METHODS:A quasi-experimental pre-post study was conducted in three Swiss secondary schools (March-June 2024; baseline n=664; follow-up n=884). The intervention comprised a multi-component environmental approach, including the relocation of designated smoking areas to less visible locations, accompanying signage, improvements to non-smoking areas, and informational posters. Perceived peer (e-)cigarette use, and self-reported (e-)cigarette use were reported through online surveys at baseline and at one month post-intervention. RESULTS:Effects varied across schools. In School 1, perceived prevalence of (e-) cigarette use decreased (cigarettes: β= -0.44; 95% CI: -0.68 - -0.21; e-cigarettes: β= -0.53; 95% CI: -0.80 - -0.25). In School 2, reductions differed by (e-)cigarette use: never and former users reported lower perceived cigarette prevalence at follow-up, whereas occasional and regular users showed no change. Perceived e-cigarette prevalence decreased (β= -0.42; 95% CI: -0.69 - -0.15). In School 3, changes varied by (e-)cigarette use, with regular users reporting lower perceived cigarette prevalence (interaction: β= -1.60; 95% CI: -2.75 - -0.45). Perceived e-cigarette prevalence did not change. Across schools, the intervention did not affect (e-)cigarette use. CONCLUSIONS:A school-based environmental intervention modifying the school environment may influence adolescents' descriptive norms, although effects appear to depend on baseline policies and implementation context.
INTRODUCTION:Tobacco use among Caribbean adolescents surpasses global averages. Given the adverse effects, regional efforts have prioritized reduction and eventual elimination and have adopted the World Health Organization's Framework Convention on Tobacco Control (WHO-FCTC). Guided by the Health Belief Model, we examine changes in tobacco abstinence and abstinence-related perceptions before and after the WHO-FCTC. METHODS:We conducted a cross-sectional secondary analysis of Global Youth Tobacco Survey data. We specifically examined adolescents aged 13-15 years from three Caribbean countries, including participants surveyed in 2000 (n=3431) and 2017-2018 (n=3767). We first conducted chi-squared tests and t-tests to examine changes in tobacco abstinence and abstinence-related perceptions across survey years. We then used the latest survey data (2017-2018) and logistic regression to assess associations between perceptions and intentions to abstain in the next year, among adolescents who did not report tobacco use (n=3050). All analyses incorporated survey weights and clusters. RESULTS:Compared with 2000, adolescents surveyed in 2017-2018 had improved 30-day tobacco abstinence, including cigarette abstinence (89.67% to 95.39%, p<0.01). However, intentions to abstain in the next year declined over the study years (93.65% to 90.53%, p<0.01). Key tobacco abstinence-related perceptions, including perceived severity (88.51% to 83.87%, p<0.01) and refusal self-efficacy (91.08% to 88.67%, p<0.01), also declined. In regression analysis, perceived benefits of anti-tobacco campaigns (AOR=2.25; 95% CI: 1.40-3.60) and refusal self-efficacy (AOR=11.35; 95% CI: 7.55-17.04) were associated with higher intentions to abstain. Exposure to anti-tobacco messaging (AOR=0.52; 95% CI: 0.30-0.90) was negatively associated with abstinence intentions. CONCLUSIONS:Given that abstinence-related perceptions declined across survey years and were associated with tobacco use intentions, these findings underscore the importance of continued attention to WHO-FCTC anti-tobacco initiatives that address tobacco-related perceptions. Incorporating culturally sensitive messaging may enhance the relevance and effectiveness of such efforts.
Since late 2022, the sale of most flavored tobacco products has been prohibited in California, including menthol cigarettes. Tobacco companies responded by introducing 'non-menthol' cigarettes in which menthol was replaced with WS-3, an odorless synthetic cooling agent to elicit cooling sensations similar to menthol. Legislation enacted in 2024 banned the addition of cooling characterizing flavors in tobacco products in California. However, the industry continues to market 'non-menthol' cigarettes in the state, with very similar package designs. The aim of this study was to verify whether cooling agents were removed from these cigarettes. Available Newport-branded 'non-menthol' cigarettes were purchased in California in 2025, extracted and tested for sensory cooling activity by Ca2+ microfluorimetry of HEK293T cells expressing the human TRPM8 cold/menthol receptor. Chemical analysis was performed by gas chromatography - mass spectrometry (GCMS). 'Non-menthol' and menthol cigarettes marketed in 2023-2024 served as controls. While extracts from Newport 'non-menthol' and menthol cigarettes marketed in California in 2023 produced a TRPM8-mediated Ca2+ increase of 60 ± 8% and 39 ± 3%, (p<0.0001, n=3) respectively, responses elicited by extracts of Newport 'non-menthol' cigarettes marketed in 2025 were indistinguishable from baseline (p=0.48, n=3). Chemical analysis confirmed no menthol or WS-3 above the level of detection (10 μg/cigarette), and no other major commercial synthetic cooling agents. The tobacco industry removed sensory cooling agents from 'non-menthol' cigarettes marketed in California. However, this did not result in the market withdrawal of 'non-menthol' cigarettes in the state. 'Non-menthol' cigarettes in California continue to be marketed with package designs resembling those of former menthol cigarettes, signaling the potential presence of a characterizing flavor.
Introduction E-cigarettes are increasingly popular among university students, raising significant public health concerns. This study aimed to assess the prevalence of e-cigarette use, as well as knowledge, and attitudes toward e-cigarettes among health and non-health science undergraduate students in Thailand. Methods A cross-sectional survey among health and non-health science students in Thailand was conducted between March and September 2023 using a self-administered online questionnaire. Data were analyzed using descriptive statistics, chi-squared tests, and multivariate logistic regression. Results Among 440 participants, 37.05% were from health science programs and 62.95% from non-health science. E-cigarette use was reported by 15.7% of health science and 27.7% of non-health science students (p=0.001). Significant differences were also found in income (p<0.001), family smoking history (p=0.006), and alcohol consumption (p<0.001). Health science students had greater awareness of health risks, including lung inflammation (91.4% vs 85.9%, p=0.04, AOR=0.69; 95% CI: 0.47-0.98) and lung cancer (90.8% vs. 81.6%, p=0.006, AOR=1.62; 95% CI: 1.14-2.28). In contrast, non-health science students were more likely to believe e-cigarettes aid smoking cessation (39.4% vs 21.5%, p=0.02, AOR=1.36; 95% CI: 1.05-1.77). Despite these differences, misconceptions about nicotine addiction and safety remained common across both groups. Conclusions The findings highlight the need for targeted educational programs and public health interventions to address misconceptions and discourage e-cigarette use among university students. Improved health education is essential to equip students with accurate information for making informed decisions about e-cigarettes.
Sesh+ oral nicotine pouches (ONPs) are marketed as premium nicotine products and promoted regularly on social media platforms such as TikTok, Instagram, and X (formerly Twitter). In July 2025, Sesh+ ran 2623 ads on X; 561 (21.4%) explicitly promoted their 'clear' ONPs as being available for purchase in California using taglines like 'Clear in California', 'California Clear', and 'Shop Sesh Clear in California'. California Senate Bill 793 (SB 793) prohibits retail sales of tobacco products, including ONPs that impart a 'characterizing flavor'. Sesh+ markets its 'clear' ONPs on its website as 'flavorless', and the 'clear' pouches were present on California's Unflavored Tobacco List in January 2026. The 'Clear in California' advertising raises concerns about geographically targeted marketing that turns regulatory compliance into a promotional message. By explicitly incorporating a state name and the term 'clear', the ads may imply special approval or regulatory endorsement, confusing consumers. Combined with youth-oriented social media content, this strategy may increase appeal to young audiences. Sesh+ advertising illustrates how ONP companies may transform legal compliance into a marketing asset, underscoring the need for continued surveillance of geographically targeted nicotine advertising and its implications for perceptions of harm, product appeal, and tobacco initiation.
