Importance:In May 2022, the US Food and Drug Administration (FDA) requested public comment on proposed rules to ban menthol in cigarettes and characterizing flavors in cigars. In 2024, the US Health and Human Services Secretary noted that a proposed ban on menthol cigarettes (MCs) would take more time given the high volume of public comments submitted. Objective:To characterize the comments submitted to these dockets, including the sources and types of submissions and themes present in unique comments. Design, Setting, and Participants:In this qualitative study, computer-assisted content analysis was conducted for public comments on the FDA's MC and flavored cigar (FC) proposed federal rules submitted from May to August 2022. Iterative data processing identified form letters and unique comments for thematic analysis in the MC comments and was applied to the FC comments. Informed by a validated codebook, deductive automated content analysis identified themes in unique comments. Analyses were conducted from October 2023 to December 2024. Main Outcomes and Measures:The primary outcomes were identification of comments as form letters, duplicates, or unique, and whether they included arguments for and against the FDA's proposed rules. Results:Of 246 808 comments submitted to these dockets (175 285 comments in the MC docket and 71 523 in the FC docket), most were identified as form letters (169 440 MC comments [97%]; 66 640 FC comments [93%]), with only 4774 comments (2%; 3342 MC comments and 1432 FC comments) identified as unique. Content tied to specific tobacco companies was identified in 44% of comments in the MC docket (77 445 comments) and 10% in the FC docket (6883 comments). Most unique comments opposed these bans (3208 MC comments [96%]; 1418 FC comments [99%]), with themes that addressed loss of revenue and sales (1155 MC comments [35%]; 720 FC comments [49%]), illicit market concern (835 MC comments [25%]; 555 FC comments [38%]), and suggesting more effective routes (607 MC comments [18%]; 420 FC comments [28%]) for action than the proposed policies. Conclusions and Relevance:In this study of nearly 250 000 public comments submitted to inform FDA rulemaking, most comments were form letters that reflected tobacco company talking points. These findings raise concerns about corporations co-opting mechanisms for public comment and distorting the prevalence of arguments to influence public health policy.

OBJECTIVES:Limited research has evaluated the impact of cannabis policies on young adult cannabis use, after full implementation (retail outlets opened), nor on cannabis product type. This study examined the relationship between adult-use cannabis retail sales in New Jersey (United States) and young adult cannabis use by type. METHODS:Data on New Jersey young adults (18-23 years) were from the Policy Communication and Evaluation (PACE) New Jersey Study. Generalized estimating equations models estimated differences in prevalence of ever and past 30-day use of cannabis and sub-types before (Waves 1-3 [March-November 2021], n = 1439) and after (Wave 4 [June-July 2022], n = 1127) adult-use retail sales began. RESULTS:Ever cannabis use among New Jersey young adults was higher in the post-retail sales period than pre-sales (58.1 % vs. 48.9 %, p < 0.01). The odds of ever cannabis use were 42 % higher (95 % CI = 32 %-54 %) in the post-retail period. Ever use of dried herb (post vs. pre: 44.4 % vs. 38.5 %, p < 0.01), drinks (7.0 % vs. 4.8 %, p < 0.01), edibles (45.9 % vs. 35.6 %, p < 0.01), and topicals (6.4 % vs. 4.6 %, p < 0.05), and past 30-day edible use (11.8 % vs. 9.0 %, p = 0.01) were higher post-retail; use of other product types did not differ. CONCLUSIONS:Cannabis use overall and among certain subtypes (e.g., edibles) increased among New Jersey young adults in the three months after adult-use cannabis retail sales began, demonstrating that increased access to legal cannabis for sale may encourage use. Continued monitoring is needed over longer follow-up periods in New Jersey and other states legalizing cannabis.

OBJECTIVES:In the USA, every state imposes an excise tax for cigarettes, and virtually all states require tax stamps. Because cigarette taxes vary widely, traffickers smuggle cigarettes from states with low cigarette taxes into high-tax states to sell them illicitly for profits. With high cigarette taxes and roughly 565 000 adults who smoke, New York City (NYC) is an epicentre for the illicit trade of cigarettes. This study of littered packs of cigarettes in NYC provides a timely update to prior studies given three developments. First, New York State increased its cigarette tax in 2023. Second, NYC implemented laws to combat cigarette tax evasion. Third, adult smoking rates have declined, and with the popularity of electronic cigarettes, a more diverse tobacco marketplace has emerged. METHODS:Studies of littered packs of cigarettes examine tax stamps, or their absence, to ascertain the states from which littered packs originated. In this study, data collectors picked up littered cigarette packs in 30 census tracts across NYC's five boroughs. To facilitate comparisons over time, this study replicated the methodology used by several previous studies. CONCLUSIONS:This study found that in 2024, the percentage of littered packs bearing the proper NYC tax stamp declined to 16.6%. Georgia surpassed Virginia as the primary source of littered cigarettes. Packs with no stamp increased, rivalling Virginia as the second most common type of littered packs. Last, Newport's menthol cigarettes were the dominant brand. Declining smoking rates suggest NYC's tobacco control policy has made progress. However, the persistence of illicit trade suggests additional interventions should be considered.

Objective:The Youth Tobacco Product Monitoring Project provides timely data on the characteristics of products obtained from youth in the United States (U.S.). This manuscript documents the methodology and findings from the initial two years of collection. Methods:Launched in November 2023, as part of the Rutgers Center for Rapid Surveillance of Tobacco, U.S. school staff and community partners voluntarily upload images of products obtained from youth to an online survey. Images are coded for brand and product features. Results:Between November 1, 2023, and September 31, 2025, we received 1535 images of 9589 nicotine products. Most (n = 9503, 99.1 %) were electronic nicotine devices (e-cigarettes), with the majority (n = 8642) disposable e-cigarettes. Other products were nicotine pouches (n = 34, 0.4 %), cigarettes and rolling papers (n = 21, 0.2 %), smokeless tobacco (n = 17, 0.2 %), cigars (n = 9, 0.1 %), and nicotine gum (n = 5, 0.1 %). Over 99 % of products with an identifiable flavor were non-tobacco flavored, most often fruit. Of 404 distinct nicotine brands, the most common were Geek Bar (n = 2014, 24.8 %), Hyde (n = 1206, 14.8 %), and Lost Mary (n = 738, 9.1 %). Nicotine brand popularity differed by school year and state. Conclusions:Monitoring nicotine products confiscated in schools can provide timely insights into product types, flavors, and brands U.S. youth are obtaining.

INTRODUCTION:Cigar warning labels can serve as health communication tools; yet current cigar warnings in the United States can be small or absent, and efforts to standardize them have met industry resistance, partly because of limited research. AIMS AND METHODS:In 2021, we conducted an online 3 × 2 × 2 factorial experiment with 1352 young adults (aged 18-34) past 12-month cigar users. Participants viewed a cigarillo pack image that varied by: text-only warning size (none; small 15%-of-pack label; larger 30%-of-pack label); warning color (White; Black); and brand (Swisher Sweets; White Owl). We compared group means on risk perceptions, knowledge, and intentions. RESULTS:Packs with any warning label (vs. none) elicited higher endorsement that the packs made participants think about the health risks of smoking cigarillos (p < .001), as did packs with larger 30%-of-pack versus 15%-of-pack warnings (p < .001). Packs with a warning label (vs. without) elicited greater absolute perceptions of cigarillo harm (p < .001), as did 30%-of-pack versus 15%-of-pack warnings (p < .001). Risks referenced in the stimuli warning (mouth and throat cancer) were more frequently mentioned in an open-ended knowledge item by participants in conditions with a warning label versus the no-warning condition (p < .05). Packs with 30%-of-pack warnings were also rated as less attractive and elicited lower use intentions than packs without a warning or with the 15%-of-pack warning (p < .05). CONCLUSIONS:Results provide evidence that cigar text-only warning labels, particularly larger ones, can facilitate some cigar risk knowledge and beliefs, reduce pack appeal, and discourage product interest, supporting policy efforts to strengthen cigar warning requirements. IMPLICATIONS:Our results suggest that the use of the small text warnings on cigarillo packs (~15% of pack size), as currently still found in the United States based on existing Federal Trade Commission agreement guidelines, is better than having no warnings at all, but that larger warnings sized at 30% of the pack (as proposed by the U.S. Food and Drug Administration (FDA) and voluntarily used by some brands/manufacturers) could have significant benefits across a range of outcomes. Study findings lend support for the cigar warning requirements proposed by the U.S. FDA through the Deeming Rule.

This cross-sectional study investigates coupon redemption in a national sample of US adults who used tobacco and nicotine in the past 30 days.

Objectives. To describe progression, content, and stringency of state legislation regulating indoor tanning and association with state government political party leadership. Methods. Trained research assistants used legal mapping methods to code legislative bills on indoor tanning introduced in US states, the District of Columbia, and Puerto Rico. We calculated composite scores on the stringency of age restrictions and of warnings, operator requirements, and enforcement. We evaluated associations of the political party of the legislative sponsor and legislature majority. Results. Between 1992 and 2023, 184 bills were introduced in 49 of 50 states and DC (56 laws were enacted, and 126 bills failed). An under-18 ban was enacted in 22 states and DC. Party affiliation of the bill sponsor and legislature majority combined to affect bill passage and age restrictions. Conclusions. In many states, it took several years and proposed bills before a law on indoor tanning was enacted. Enacted bills were more stringent than failed bills. Public Health Implications. Increasing support for stringent regulations on indoor tanning is evident and may motivate other states or the federal government to prohibit minors from using indoor tanning facilities. (AmJ Public Health. 2025;115(2):191-200. https://doi.org/10.2105/AJPH.2024.307894)

Background. To inform youth about e-cigarette use prevention, it is important to understand whether using e-cigarette products from certain brands is associated with youth's differential e-cigarette use patterns and willingness to quit e-cigarettes. Methods. Data for this study come from the 2021 U.S. National Youth Tobacco Survey (NYTS). The sample was current (past-30-day) e-cigarette users (unweighted n = 1,436). We examined the associations between users' usual e-cigarette brands (Puff, Vuse, Smoke, JUUL, and others) and e-cigarette use patterns (use frequency, use with nicotine, use with flavors) and willingness to quit, controlling for covariates. Results. In 2021, 25.6%, 9.7%, 8.1%, and 6.5% of users reported Puff, Vuse, Smok, and JUUL as their usual brands, respectively. Having Smok as a usual brand increased the odds of frequent e-cigarette use compared with other brands. Using Puff, Vuse, and Smok increased the odds of using e-cigarettes with nicotine. Using Puff and Smok increased the odds of using e-cigarettes with any flavors and fruit flavors, and using Smok and JUUL increased the odds of using mint flavors. Finally, using Vuse reduced the odds of having a willingness to quit e-cigarettes. Conclusion. Puff products, which are likely to be used infrequently and with fruit flavors, were the most endorsed usual brand by youth users. Vuse and Smok brand users demonstrated problematic use patterns, including high-frequency use of nicotine and reduced willingness to quit. The high prevalence of using flavors, especially banned flavors (e.g., mint for JUUL products), suggests the need for tightened restrictions on youth's access to flavored e-cigarettes.

Abstract The First Amendment of the U.S. Constitution is considered a bedrock of American freedoms. The first part of this chapter explores The First Amendment’s protection against government restrictions and compulsions of speech and expression. In some ways such protection is substantially broader than found in other countries. Controlling the information environment is crucial. Industries that produce products that cause harm may constitutionally market these products to consumers, often conflicting with public health prerogatives. Government attempts to inform the public about certain information through its own speech, or by requiring information disclosures on labels or through other methods. the First Amendment’s application to such requirements varies in interesting ways. The second part of this chapter discusses the First Amendment’s protection against government interference with the practice and establishment of religion and the sometimes-conflicting interests of religion and public health. Constitutional protection for religious practice has led to many lawsuits in the context of public health policies and practices, such as those that require vaccines, protect same-sex marriage, and the issuance of COVID-19 stay-at-home orders, among others. Religious belief also underlies patients’ refusal to accept medical treatment, including life-saving treatments. Congress passed the Religious Freedom Restoration Act in 1993 to provide greater protection for religious practice than the Supreme Court’s interpretation that the First Amendment afforded.

Abstract Most public health activities are carried out by state health departments. This chapter discusses how these departments typically are organized and reviews the laws that authorize their activities. In some states, local health departments and boards of health also play a role in protecting public health. This chapter discusses how state law can delegate police powers to local governments, and particularly local health departments and boards of health, in addition to state preemption of local control.

Abstract Introduction Few studies have addressed the use patterns and characteristics of the past 30 days of premium versus non-premium cigar smokers. Aims and Methods We pooled 10 years of data from the National Survey on Drug Use and Health (NSDUH; 2010–2019) to evaluate use patterns and demographic and tobacco use characteristics of premium and non-premium cigar smokers ages 12 years and older in the U.S. cigar-type was manually coded as premium or non-premium according to the brand used most often. Results Between 2010 and 2019, 4.7% (95% CI = 4.6–4.8) of individuals aged 12 and older currently smoked cigars (past-30-day use). Smoking premium cigars (0.9% [95% CI = 0.8–0.9]) was less prevalent than smoking non-premium cigars (3.0% [95% CI = 2.9–3.1]). Although current non-premium cigar smoking prevalence steadily declined over the years, current premium cigar smoking prevalence remained stable. Premium cigar smokers were more likely to be older (≥25 years), male, non-Hispanic white, heterosexual, college educated, living in a large metro area, and to have income above 200% of the poverty threshold compared to non-premium users (p < .05). Additionally, past-30-day premium cigar smokers were less likely than non-premium users to initiate cigar smoking before the age of 18 years, smoke cigars frequently or daily, smoke cigarettes, or use marijuana (p < .05). Conclusions Overall, premium cigar smoking is less prevalent than non-premium cigar smoking, especially among populations such as youth, racial/ethnic and sexual minorities, and low socioeconomic individuals. Premium cigar smokers tend to smoke infrequently and initiate cigars later in life compared with non-premium smokers. Study results can inform recommendations for regulating premium cigars. Implications This study found that between 2010 and 2019, there are meaningful differences in the use patterns and characteristics of past-30-day premium versus non-premium cigar smokers in the United States. Premium cigars comprise a small share of the market compared to other cigar types and are less likely to be used by youth and other tobacco control priority groups (eg, racial/ethnic minorities and individuals with low socioeconomic statuses) that bear a disproportionate burden of risk and harm from using tobacco products. Additionally, most premium cigar users smoke them only occasionally. However, it is important to continue to monitor premium cigar use, as these patterns could shift because of factors like changes in marketing practices, consumer awareness, and product prices. Tobacco policy changes may also alter the patterns and trends of premium cigar use over time. A greater, more comprehensive understanding of premium cigars’ physical characteristics, patterns of use, user perceptions, tobacco industry marketing strategies, and health effects will together help to inform cigar-related regulations.

Abstract This chapter provides important foundation for the study of public health law. It provides background on the framework of the U.S. government at the federal, state and local levels and an overview of the structure of businesses, most notably corporations. The U.S. Constitution established the framework for the U.S. government. The main body of the Constitution established the federal executive, legislative and executive branches and the relationship between the federal government and the states. Notably, local governments are not mentioned in the Constitution, as they are a creation of each state. Public health concepts and policies often conflict with business interests so an examination of corporate structure provides important context for conflicts discussed throughout the book. In addition, the chapter provides an overview of controversies decided by courts. The outcome of litigation creates case law which fundamentally shapes public health law in the United States. Relatedly, the government has passed laws to protect specific businesses from litigation.

Abstract This chapter provides an overview of various elements involved in public health policy making. It starts with a look at how legislatures develop policymaking priorities. It discusses the tools of policymaking, including laws, rules, executive orders and more, and weighs some of their benefits and shortcomings. It also describes the process of drafting legislation, highlighting a number of factors that should be considered, including strategies regarding coalition building inside government and with external organizations and community groups.

Received: April 17, 2023. Accepted: May 17, 2023. © The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https:// creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@ oup.com Regulatory Research Advances on Premium Cigars

Abstract Health departments are government agencies, at the federal, state and local levels, are regulated in how they conduct business and spend public money. For example, there are laws governing how decisions to hire or select contractors are made. There are also laws that grant the public access to government records and data. Anyone working at a health department will inevitably encounter these special processes. These processes and the reasons for them, are discussed in this chapter.