Background:Arab Americans are one of the fastest-growing immigrant populations in the United States, yet they remain largely invisible in tobacco surveillance and prevention efforts due to their classification as "White" in national data. Despite evidence of elevated tobacco use and chronic disease burden, limited research has examined how cultural, psychological, and social factors shape tobacco-related health risks in this community. Objectives:This study examined associations between ethnic identity, tobacco use, and health outcomes (self-rated health, chronic disease diagnosis) among Arab American adults, and tested whether ethnic identity moderated the association between tobacco use and health outcomes. Methods:In a cross-sectional study, a convenience sample of 112 Arab American adults residing in Central California completed a survey assessing ethnic identity, tobacco use, and health. Ethnic identity was measured using an abbreviated, Arabic-translated adaptation of Phinney's Multigroup Ethnic Identity Measure. Tobacco use was categorized as non-use, single-product use, or multi-product use. Multivariable regression models assessed associations and potential moderating effects of ethnic identity on health outcomes. Results:Over 48% of study participants reported current use, defined as at least some use or more, of at least one tobacco or nicotine product, including cigarettes, e-cigarettes (which may contain synthetic rather than tobacco-derived nicotine), and hookah. Higher ethnic identity scores were associated with significantly lower odds of tobacco use (adjusted OR = 0.35, 95% CI: 0.15-0.83). Single-product users had 75% lower odds of reporting better self-rated health compared to non-users (OR = 0.25, 95% CI: 0.07-0.96). No significant associations were found for multi-product use or chronic disease in adjusted models, and ethnic identity did not significantly moderate associations with health outcomes. Conclusion:Ethnic identity is associated with lower tobacco use among Arab Americans, though its protective effects on health outcomes remain less clear. These findings underscore the need to move beyond acculturation-based frameworks and incorporate identity-informed, culturally responsive approaches to tobacco control in marginalized immigrant communities.

Background Existent research examining perceptions of nicotine addiction use largely surface level items that fail to address the complexity of nicotine addiction. Additional investigation is needed to better understand people’s perceptions of nicotine addiction and whether these align with measures of nicotine dependence. Understanding these perceptions about nicotine addiction may help provide insight into vaping intentions and behavior. This study examines the validity of the Nicotine Addiction Perceptions (NAP) scale, a novel measure designed to assess perceptions of addictive vaping behavior that aligns with the clinical dimensions of tobacco use disorder. Methods Data were collected from U.S. adults via Prolific (n = 549). As part of scale development and validation a confirmatory factor analysis and psychometric evaluation was conducted. The NAP’s reliability, convergent, discriminant, and criterion validity were established. Results A five-factor solution returned acceptable fit on all model indices (RMSEA = 0.050; CFI = 0.994; TLI = 0.993). The NAP was significantly related to assessments of perceived risk, 6 month quit intentions, the number of quit intentions over the past year, and past 30-day e-cigarette use ( P’s < .05). Findings also indicate support for discriminant validity. Conclusions Findings suggest that for most, perceptions of nicotine addiction may not fully align with the clinical criteria of addiction, which may be due to the lack of education surrounding the clinical definition. Future research examining perceptions of nicotine addiction can utilize the NAP scale to better understand people’s understanding of addiction and its relationship to vaping-related behavior.

OBJECTIVE:The present study explored perspectives on COVID-19 vaccine acceptability, access, and strategies for pandemic recovery among rural and urban/suburban American Indian (AI) community leaders and members in California. METHOD:The qualitative study was initiated by a community-academic partnership with a large AI health organization and two universities and included virtual focus groups focused on COVID-19 vaccine acceptability (concerns, risks, benefits), initial vaccine rollout accessibility (vaccination site preferences, accessibility, strategies for improving vaccination), and recommendations for pandemic recovery. Reflexive thematic analysis was used to generate themes. RESULTS:In Fall 2021, three urban/suburban (n = 9) and three rural (n = 9) AI focus groups in California were held virtually. A majority of participants were Tribal or community leaders (n = 12). Participants in both urban/suburban and rural settings reported preferences for Tribal or Indian Health Service clinics for vaccination and recommended culturally tailored COVID-19 educational materials, health services, and community events to promote pandemic recovery. Participants in rural groups provided examples of tailored community-led pandemic care but illustrated how health care access limited vaccination, how basic needs affected vaccine prioritization, and how gaps in data on AI communities limited local informed decision-making. CONCLUSION:Findings demonstrate differences in the COVID-19 experience among AI adults living in urban/suburban and rural regions, including vaccine access and basic needs concerns. Findings also highlight local preferences in the pandemic community response and recommendations for culturally tailored health information, health services, and gatherings. Public health campaigns may require additional resources for AI communities to improve equitable distribution and uptake. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The present study examined tobacco health perceptions, regulation attitudes, and cessation intentions among California adults before and after the COVID-19 lockdown, given the pandemic’s mixed impact on tobacco use. An online survey of California adults was conducted in two phases: pre-lockdown (March 2020, n = 1349) and post-lockdown (May 2020, n = 1201). Participants ( M age 30.29 years; SD = 5.91) from both samples were predominately former or current smokers, male, and non-Hispanic White (>60% for all). This method allowed for a comparison of attitudes and behaviors across two distinct periods with two samples. There were significant differences between pre- and post-lockdown risk perceptions, regulatory attitudes, and cessation intentions. Examining shifts in perceptions and attitudes amidst the pandemic aids in understanding the complex and dynamic nature of tobacco behavior change through the lens of a major socioenvironmental event to guide future tobacco control efforts.

The COVID-19 pandemic provides both reasons to quit smoking as well as stress that may promote increased cigarette consumption. Perceptions of COVID-19 risk related to smoking may motivate cessation among smokers. At the same time, other evidence shows that affective perceptions (i.e., worry) could lead to increased smoking as a coping mechanism. Using a sample drawn from a rural region of California (N = 295), we examined the relationship between perceptions about health risks for smokers during the pandemic and both reported increases in smoking frequency and intentions to quit smoking. We also examined whether worry about health risks mediated these relationships. High perceived risk was associated both with reported increases in smoking frequency as well as greater intentions to quit smoking. Worry partially mediated both these relationships, with worry accounting for 29.11% of the variance in the relationship between high risk perceptions and increased smoking as well as 20.17% of the relationship between risk perceptions and intentions to quit smoking. These findings suggest that while smokers' awareness about their increased risk of COVID-19 can motivate intent to quit smoking in the future, smokers may require greater support to act on these intentions.

IntroductionOwned by a major US tobacco company with no American Indian/Alaska Native (AI/AN) tribal affiliation, Natural American Spirit (NAS) cigarette packs feature an American Indian warrior, thunderbird and peace pipe. The current study examined AI/AN adults’ perceptions of NAS cigarette packs in the US, which have not been reported on prior.MethodsAI/AN adults were recruited via Qualtrics national panels (n=500; 64% female, age M=39.9 years, 47% current smokers) in 2020. After viewing NAS pack images online (front, back and sides), participants were asked about NAS tribal affiliation, health perceptions and purchase intentions. Participants also wrote-in what the NAS pack logos meant to them.ResultsMost participants (65%) believed NAS is AI/AN-owned and/or grown on tribal lands. Among current smokers, beliefs of an AI/AN affiliation were associated with misperceptions of NAS being a healthier cigarette and with greater intention to purchase NAS cigarettes (p’s<0.01). Participants who did not believe NAS was grown or owned by AI/AN tribes were more likely to describe the NAS warrior logo as cultural misappropriation (17%) than participants who believed NAS was AI/AN tribally affiliated (4%, p<0.001).ConclusionsThe findings indicate a dichotomy in beliefs among surveyed AI/AN adults regarding NAS brand cigarettes. A majority held the misconception that NAS is tribally affiliated, while an informed and concerned minority characterised the branding as cultural misappropriation. The current packaging is reasonably expected to result in beliefs that NAS cigarettes are AI/AN tribally affiliated, and these beliefs may be associated with misperceptions of lesser harm.

Background:Significant disparities in COVID-19 morbidity and mortality exist for Native American (NA) people, the majority of whom live in urban areas. COVID-19 vaccination is a key strategy for mitigating these disparities; however, vaccination disparities affect NA communities. The current study investigated COVID-19 vaccine decision-making before widespread vaccine rollout occurred, among urban NA communities. We aimed to understand vaccine decision-making factors to develop recommendations about COVID-19 vaccine outreach. Methods:We conducted three in-depth virtual focus groups with 17 NA adults living in an urban community (Los Angeles County) between December 2020 and January 2021. Participants were recruited through NA community-based organizations and community stakeholders. Reflexive thematic analysis was conducted using Atlas.ti. Findings:Participants in this study identified two overarching themes with implications for health vaccination campaigns. First, participants described a need for tailored information and outreach, including NA vaccine outreach that addresses misconceptions about vaccine development to calm fears of experimentation and support communication of vaccine evidence specific to NA people. Second, participants suggested strategies to improve public health resources in the urban NA community, such as the need for unified, proactive communication across trusted NA entities, navigation support to improve vaccine accessibility, and adequately resourcing health partnerships with and among trusted NA community agencies for improved reach. Conclusion:In this qualitative study, we found that urban NA participants reported several factors that affected their vaccine decision-making, including a lack of tailored information for their communities. Our findings also underscore the need to work with tribes, tribal leadership, and urban NA serving organizations to coordinate vaccine communication and distribution to urban communities where the majority of NAs now reside. Further, these findings have implications for COVID-19 vaccine outreach among urban NA communities and demonstrate the need for clear and tailored engagement about the COVID-19 vaccine.

Objective: There is minimal research that has measured motivations behind e-cigarette use and the relationship to cigarette and e-cigarette use. The aim of this study was to (1) examine extent to which motivations to use e-cigarettes varies among dual users and (2) examine whether e-cigarette motivations are related to e-cigarette and cigarette consumption among dual users. Methods: Adults residing in California were recruited through social media (n = 1762, 68.9 % males, 62.9 % White) to complete an online survey. Participants self-identified as using combustible cigarettes and e-cigarettes (dual users) and reported their motivations for using an e-cigarette device, nicotine consumption, and nicotine dependence with both combustible cigarettes and e-cigarettes. Results: A greater proportion of people reported using e-cigarettes for enjoyment purposes than other motivations (34.2 %). Motivations to use e-cigarettes to quit were positively related to monthly cigarette consumption (IRR = 1.17, 95 % CI [1.08, 1.26]). Motivations to use e-cigarettes to quit smoking were also related to smoking the first cigarette within 30 min (IRR = 1.46, 95 % CI [1.05, 2.02]) and first e-cigarette within 30 min (b = 0.28, 95 % CI [0.19, 0.37]). Conclusions: Compared to those who use e-cigarettes for enjoyment, smokers who are motivated to use e-cigarettes for cessation purposes are more likely to have greater nicotine dependence, cigarette consumption, and e-cigarette consumption. Future research needs to acknowledge that not all e-cigarette users are the same; motivations and use differ and are related to both consumption and dependence.

Background Most adults report beliefs that cannabis has at least one benefit (e.g., stress relief, chronic pain management); however, the benefits are not well established. Beliefs about cannabis benefits are associated with the initiation of use, whereas beliefs about the risks of cannabis are protective factors against its use. Little is known about how health-related beliefs impact cannabis use among American Indians/Alaska Natives (AIAN). Purpose This exploratory study examined beliefs about perceived benefits (i.e., stress relief, pain management) of cannabis, how beliefs vary as a function of use, and associations between health worry and benefits of cannabis among AIAN adults. Methods Participants ( n = 182) were on average 41.4 (SD = 16.3) years old, 63.9% female, and identified as AIAN. Participants were asked questions about general demographics, health-related worry and perceptions, and cannabis use. Linear regressions were conducted to examine associations. Results Those who used cannabis in the past year were more likely to agree that cannabis relieves stress and less likely to believe that those who use cannabis should be very worried about their health. Participants who agreed that those who use cannabis should be worried about their health were less likely to report beliefs that cannabis relieves stress or helps with chronic pain. Conclusions Our study confirms the role of health-related perceptions and worry about cannabis products with cannabis use among this population that may be at risk for higher cannabis use. Findings may have implications for cannabis policy at the tribal, state, and federal levels and the need for the development of targeted communications about the true health risks of cannabis.

BACKGROUND:Previous research indicates that differences in cigarette smoking exist among those of different race/ethnicity and varying levels of socioeconomic status. However, most research has examined the influence of these factors separately on cigarette smoking despite their observed covariation. To examine the interaction of race/ethnicity and socioeconomic status on adolescent tobacco use and behaviors, this study tests whether or not the social gradient holds for smoking patterns and perceptions of smoking among African American, American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents.METHODS:Using data from the 2018 National Survey on Drug Use and Health, the sample included African American/Black (Black), American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents (N = 12,474), ages 12-17 years old. Measures included race/ethnicity, annual household income, age, gender, cigarette smoking, perceptions of peer use, parental attitudes, and health risks of smoking; logistic regression analyses were conducted.RESULTS:Findings indicated significant interactions between high income and Black and Hispanic race/ethnicity for having ever smoked a cigarette indicating a difference in comparison to high-income White adolescents (p's < 0.05). We also found that the interaction between high income and AIAN race/ethnicity for disapproval of peers smoking was significant compared to White adolescents at the same income levels (p < 0.05). No differences were found for smoking health risk perceptions.CONCLUSIONS:The relationship between race/ethnicity, income, and smoking may be more complex than previously thought with these results having important preventative implications for identification of adolescents who may be most at risk for tobacco use.

OBJECTIVE:E-cigarette use is associated with increased risk of negative health outcomes, including respiratory problems such as Coronavirus Disease 2019 (COVID-19). Nevertheless, adolescents and young adults (AYAs) continue to use e-cigarettes at alarming rates. We examined AYA's perceptions of the health harms of e-cigarettes in relation to respiratory problems and the associations between these perceptions and e-cigarette use. METHOD:In May 2020, we conducted an online, national cross-sectional survey of AYAs aged 13 to 24 years old (N = 4,315; 65% female; 50% ever-users, 50% never-users) to assess e-cigarette use and perceptions of the risk of respiratory problems, COVID-19, and severe lung disease for AYAs with different levels of e-cigarette use. RESULTS:In comparisons between AYAs with different levels of e-cigarette use, e-cigarette-related health risk perceptions were lower among ever-users compared to never-users and among ever-users who used e-cigarettes in the past 30 days compared to ever-users who did not use in the past 30 days. After controlling for demographics, AYAs were less likely to have used in the past 30 days if they agreed that young people are at risk of respiratory problems due to e-cigarette use (adjusted Odds Ratio [aOR] = .68, 95% confidence interval [CI; .59, .78]) and e-cigarettes are harmful for their health (aOR = .52, 95% CI [.30, .90]). AYAs were more likely to have used in the past 30 days if they believed that there is no hard evidence that e-cigarette use with nicotine increases risk of severe lung disease (aOR = 1.61, 95% CI [1.42, 1.82]) and that e-cigarette use is safer than smoking cigarettes (aOR = 1.26, 95% CI [1.11, 1.42]). CONCLUSIONS:Among AYAs who had ever used e-cigarettes, those who did not believe that e-cigarette use increases the risks of respiratory problems were more likely to have used e-cigarettes in the past month. To bridge the gap between youth perceptions and emerging scientific evidence on e-cigarette-related health risks, prevention messaging should seek to explain how e-cigarette use is linked to respiratory problems and could affect COVID-19 outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

To determine if cigarette smoking, electronic cigarette use, and rate of consumption of these products differed before and after a pandemic lockdown order, two convenience samples of adults in Central California were recruited and surveyed before (March 2020) and after (May 2020) COVID-19 lockdown orders were implemented in California (n = 2571). Multivariable logistic and negative binomial regression models tested the association between adults recruited pre- or post-California lockdown and past month cigarette use, past month electronic cigarette use, past month cigarette consumption, and past month e-cigarette consumption among current users, controlling for demographic differences. Adults pre- and post-lockdown had equal odds of using cigarettes during the past month. Cigarette users who responded post-lockdown had higher cigarette consumption rates compared to cigarette users who responded pre-lockdown (IRR = 1.13, 95% CI = 1.15, 1.23). Adults who responded post-lockdown had lower odds of using electronic cigarettes during the past month compared to participants surveyed before the order (OR = 0.66, 95% CI: 0.55, 0.78). Cigarette users may be using more cigarettes during the state mandated lockdown. Possible causes for this increase in cigarette use may include increased stress, the change in workplace smokefree protections coverage, and increased opportunities for smoking or vaping.

Dual-process theories may be effective at predicting adolescent smoking; however, little is known about the effectiveness of these models across race/ethnicity and gender. Adolescents (N = 4035) completed biopsychosocial and tobacco-related perception measures in Grade 7 and reported on smoking initiation in Grade 10. Using structural equation modeling and comparing models by gender and race/ethnicity showed differences, where both intentions and willingness predicted smoking initiation for only Black and male adolescents, compared to their Latino and White and female counterparts. Intentions and willingness appear to play a role in whether an adolescent will initiate smoking in the future, but this does not apply universally across gender and race/ethnicity.

Dairy-free milk, vegan eggs, meatless burgers and…plant-based cigarettes? While the proliferation of plant-based products is most commonly associated with food and beverages,1 2 Winston’s new packaging and advertising—highlighting ‘100% plant-based menthol’ (figure 1) and ‘farm to pack’ (figure 2) cigarettes—suggest that the tobacco industry is tapped into some of today’s most popular food trends. These marketing strategies are well aligned with the tobacco industry’s history of using language and imagery that communicate reduced health risks and environmental sustainability,3–5 as well as its long-standing connections to the food industry.6 7 Figure 1 Advertisement for Winston’s menthol cigarettes as seen in the October 2020 issue of Rolling Stone . The term ‘plant-based’ appears three times: in the headline, copy and image of the cigarette pack. The pack is placed next to an image of mint leaves growing in dirt. Unlike a warning written with black font on white background, small letters in white font overlaid on a textured background indicate that the product does not present a reduced risk of harm (lower right corner) (adapted from Trinkets & Trash (https://www.trinketsandtrash.org/detail.php?artifactid=15469)). Figure 2 Screenshot from Winston’s website advertising their ‘100% plant-based menthol’ cigarettes next to the phrase ‘consider …

Youth e-cigarette use is associated with increased risk of COVID-19-related health outcomes. However, in the absence of public information campaigns about such health risk as well as e-cigarettes still on the market, youth will likely continue using e-cigarettes. We examined youth perceptions of the health harms of e-cigarettes in relation to COVID-19 and the impact on e-cigarette use. We conducted a national cross-sectional survey of adolescents and young adults (AYAs) aged 13-24 years old in May 2020 (n=4,351; 65% female; 50:50 e-cigarette ever-users/never-users) to assess e-cigarette use. Participants were asked about perceptions of COVID-19 risk, respiratory problems, and severe lung disease given e-cigarette use. Over one-third (37.1%) of ever-users and 22.4% of never-users believed that e-cigarette use did not increase the risk of COVID-19 because it affects the lungs. Among past month users, 42.8% believed that e-cigarette use did not increase the risk of COVID-19 because it affects the lungs compared to 29.4% of ever-users who did not use in the past 30 days. After controlling for demographics, AYAs who agreed that vaping increases the risk of COVID-19 were less likely to have used e-cigarettes in the past month (OR = 0.80 [95% CI: 0.66, 0.98]). Ever e-cigarette users who did not believe that e-cigarette use increases the risks of COVID-19 were more likely to have used e-cigarettes in the past month. Since youth perceptions about the risk of COVID-19 are inconsistent with emerging scientific evidence, prevention messaging should seek to explain how e-cigarette use is linked to respiratory problems and could affect COVID-19 outcomes.

INTRODUCTION The decline in tobacco smoking among US adolescents has been exceeded by the exponential rise in nicotine vaping with an overall net gain in youth tobacco product use. While cigarette companies are restricted from advertising on television/radio, vaping promotions have been largely unrestricted. This study examined exposure to tobacco product promotions in a US sample of 1003 adolescents and its associations with product use and susceptibility to use. METHODS Adolescents (13-17) were recruited online and anonymously surveyed in 2019 about their ever and current (past 30-day) tobacco smoking (cigarette and cigar) and nicotine vaping behaviors, and among never-users, susceptibility to vaping. Multivariate models tested associations with past-month exposure to tobacco product promotions controlling for demographic features, harm perceptions, and family and peer influences. RESULTS Tobacco product use was 34% ever-use and 20% current-use. Most had seen cigarette (91%) and nicotine vaping (80%) product promotions in the past 30 days. A majority reported exposure at point-of-sale and on major (television, cinema) and social media. In adjusted multivariate models, greater exposure to tobacco product promotions was significantly associated with ever and current smoking and vaping; and among never-users, susceptibility to vaping (all p<.01, effect sizes 1.03 to 1.05). Family/peer use and attitudes also were significant correlates. CONCLUSIONS Tobacco product promotions remain ubiquitous and are significantly associated with adolescents' tobacco product use and susceptibility to vape. Peers and family are important social influences and may reflect indirect channels of tobacco marketing. Stricter regulatory restrictions on tobacco marketing to young people is warranted. IMPLICATIONS This study adds to mounting evidence showing that tobacco marketing remains pervasive and is associated with tobacco use and susceptibility to use. Most youth report seeing cigarette and nicotine vaping product promotions, with notable differences by channel: traditional media predominating for cigarettes and social media/email for e-cigarettes. Greater exposure to tobacco promotions is significantly associated with ever and current smoking and vaping, and among never-users, susceptibility to vaping. The accumulating findings support stricter regulatory restrictions on marketing of tobacco products in media channels accessed by youth.

PURPOSE:Natural American Spirit (NAS) cigarettes, which have recently grown in popularity, are marketed as eco-friendly and natural. The present study examined whether NAS's on-the-pack messaging influences adolescents' health perceptions of the brand. METHODS:In a mixed-factor design, adolescent participants (N = 1,003, ages 13-17, 75% female) were randomized to one of the six exposure conditions. All viewed images of an NAS and a Pall Mall (comparison brand) cigarette pack, but differed in pack color (blue, green, or gold/orange) and brand viewed first. Perceptions of pack logos, addictiveness, harms to the smoker, others, and the environment were assessed directly after viewing pack images for each brand. RESULTS:Adolescents who perceived NAS as more pro-environment tended to perceive NAS cigarettes to be less addictive, r = -.19, p < .01. NAS cigarettes also were perceived as less addictive and better for the environment than Pall Mall. Most (90%) participants provided nature-friendly words (e.g., environment, recycle) when asked to describe logos on the NAS packs. In adjusted models, relative to Pall Mall, NAS was perceived as healthier for smokers, healthier for smokers' family and friends, and safer for the environment. Findings did not differ by pack color and ever tobacco use. CONCLUSIONS:Adolescents perceived a health advantage for NAS cigarettes with its on-the-pack, eco-friendly and pro-health marketing. The findings are consistent with prior research with adults. Given the accumulating evidence of consumer misperceptions, eco-friendly messaging on cigarettes is a public health concern that warrants further consideration for regulatory intervention.

Legalization of marijuana in US states has produced a rapidly evolving policy and retail landscape. To date, 11 states and Washington DC have legalized marijuana for recreational use for adults 21 years and older; 33 states have legalized medical marijuana.1