To benefit public health, electronic nicotine delivery systems (ENDS) must be sufficiently satisfying to adults who smoke to promote switching away from cigarettes while presenting limited risk of persistent use and dependence among nonusers of tobacco products. This behavioral pharmacology study evaluated the abuse liability and switching potential of four pod-based ENDS (tobacco and menthol flavors) relative to cigarettes. U.S. adults who smoked cigarettes daily (N = 78; 51.3% female; Mage[SD] = 42.91 [9.84]; 53.8% non-Hispanic White; mean cigarettes/day [SD] = 14.42 [11.96]) completed a randomized five-arm crossover behavioral pharmacology study. On 5 separate days, participants used one of four pod-based ENDS, all with 5.0% nicotine concentrations (JUUL2 Virginia Tobacco, NJOY Ace Classic Tobacco, JUUL2 Fresh Menthol, JUUL Menthol 5.0%), or smoked their usual brand cigarette for 20 min ad libitum. After using each product, questionnaires assessed subjective reinforcing and sensory effects relevant to abuse liability and potential for switching away from cigarettes. All ENDS products were rated statistically significantly and meaningfully lower than usual brand cigarette on subjective reinforcing effects (ps < .001; Cohen's ds = 0.58-1.73). The tobacco- and menthol-flavored ENDS were generally rated similarly on measures of subjective reinforcing and sensory effects, but JUUL2 Fresh Menthol 5% was rated significantly higher than the other ENDS on the modified Product Evaluation Scale satisfaction subscale (ps ≤ .01; Cohen's ds = 0.38-0.59). The abuse liability of all tobacco- and menthol-flavored pod-based ENDS in this study is likely substantially lower than cigarettes. The results regarding subjective satisfaction suggest that the switching potential of JUUL2 Fresh Menthol 5% may be higher than tobacco-flavored ENDS. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objectives:Since 2025, administrative changes have resulted in the dismissal of federal workers responsible for implementing US national health surveys. While national data are crucial to understanding trends at the national level, it may be possible to complement such data sources using state-level observational data by using the latter to predict the former in statistical models. This study presents a proof-of-concept approach for estimating the national prevalence of health behaviors in the United States based on partial state-level prevalence estimates. Methods:Focusing on US adolescent e-cigarette use, the prevalence of which informs regulatory efforts by the US Food and Drug Administration's Center for Tobacco Products, we implemented temporal generalized linear mixed models (GLMMs; with binomial or beta response distributions, a logit link function, and a spatial power covariance structure to account for autocorrelation). Models were fitted to national e-cigarette use prevalence from the National Youth Tobacco Survey and state-level e-cigarette use prevalence from 38 state-specific surveys administered by state health and education departments and other organizations from 2011 to 2025. Results:Beta models performed similarly to binomial models in year-level predictive performance, with modest mean absolute error (MAE) for in-sample predictions (beta: 1.5-1.8 percentage points [pp]; binomial: 1.4-2.6 pp) and out-of-sample predictions (beta: 2.3 pp; binomial: 2.2 pp). MAEs were generally higher for simpler comparator models: time-trend extrapolation models, 4.7-5.5 pp; 1-year-lag persistence models, 4.1-4.7 pp; and naïve mean models, 1.8-2.0 pp. Conclusion:Temporal GLMMs may be useful tools for monitoring national trends in substance use behaviors when subnational data, but not national data, are available.

BACKGROUND:Adults who switch completely from smoking cigarettes to using electronic nicotine delivery systems (ENDS) substantially reduce their exposure to toxicants and carcinogens that are associated with smoking-related diseases. OBJECTIVE:This 6-week actual use study-a prospective uncontrolled real-world study designed to evaluate quasi-naturalistic product use-aimed to assess switching behavior among US adults who smoked cigarettes and were provided with JUUL2 ENDS products. METHODS:US adults who smoked cigarettes every day but were predominantly not ready to quit (N=1160; mean age 39.42, SD 11.03 years; 641/1160, 55.26% female participants; 667/1160, 57.5% non-Hispanic White; mean cigarettes per day 14.11, SD 8.96; only 1% [11/1160] planning to stop smoking within 30 days; and 481/1160, 41.47% dual users) were recruited to use JUUL2 ENDS products (18 mg/mL nicotine) in 1 of 5 flavors in real-world environments for 6 weeks. Participants who expressed sufficient interest in using JUUL2 products were enrolled at 24 different consumer research sites across the United States into one of the two following study arms: (1) traditional flavors (Virginia Tobacco and Polar Menthol, 10 sites); or (2) complex flavors (Autumn Tobacco, Summer Menthol, and Ruby Menthol, 14 sites). No instructions regarding JUUL2 product use or cigarette smoking were provided. After a 1-week trial period, participants were provided with their preferred flavor for 6 weeks of ad libitum use (10 pods per week). In total, 6 weekly web-based surveys were used to assess switching (smoking abstinence) and smoking reduction; dependence and respiratory symptoms were assessed at baseline and week 6. RESULTS:Across the 5 flavor groups at week 6, the rates of complete past-7-day switching away from cigarettes ranged from 38.2% (79/207) to 47.3% (95/201), and 24.3% (55/226) to 33.9% (74/218) of participants reported complete past-30-day switching. Participants who used the 3 menthol-flavored (vs 2 tobacco-flavored) JUUL2 products had significantly higher rates of past-30-day switching at week 6 (odds ratio 1.36, 95% CI 1.04-1.78). Compared to their baseline values when they were smoking, the past-30-day switchers at week 6 had significantly reduced their dependence (mean differences in dependence, cigarettes - JUUL2: 0.57-0.99; P<.001) and self-reported frequency of respiratory symptoms (P<.05). Among participants who continued to smoke at week 6, 50.9% (59/116) to 62.9% (73/116) reduced their daily cigarette consumption by at least 50% from baseline. CONCLUSIONS:Adoption of JUUL2 ENDS products can likely help substantial proportions of US adults who smoke to switch completely away from cigarettes or meaningfully reduce their cigarette consumption, thereby reducing their dependence on tobacco products and improving their respiratory symptoms.

Background: Adults who smoke cigarettes (AWS) who switch to electronic nicotine delivery systems (ENDS) are likely to reduce their health risks.Objectives: To explore ENDS-users' readiness to stop smoking (RTSS) when adopting ENDS, the prospective association of RTSS and switching away from smoking (past-30-day abstinence), and the role of frequency of JUUL use in switching.Methods: Analyses used data from a naturalistic 2-year longitudinal study of 17,393 AWS (55.4% male) who had purchased a JUUL Starter Kit.Results: Only 20% were planning to stop smoking within 7 days at baseline but had the highest likelihood of switching, 70% at Month-24 (vs. in a year or more: OR = 2.33; 95%CI = 2.13-2.55). Those planning to stop smoking within 30 days (24%), 6 months (24%) or a year or more (27%) had switch rates of 53 ~ 59% at Month-24; those who planned never to quit (6%) had 51% switch rates. Daily ENDS use was prospectively associated with the highest likelihood of subsequent switching (vs. infrequent: OR = 1.68; 95%CI = 1.60-1.77); frequent users (≥20 days/month) also had higher switch rates (OR = 1.22; 95%CI = 1.15-1.28). Descriptively, participants higher on RTSS were more likely to be daily or frequent users, but frequency of use neither interacted with RTSS, nor mediated its association with switching.Conclusions: Most ENDS adopters were not ready to stop smoking, and would not be candidates for cessation treatment. However, a majority - even of those never planning to quit - were abstinent from cigarettes two years later. ENDS may facilitate smoking abstinence in populations not reached by traditional cessation interventions.

Completely switching from cigarette smoking to electronic nicotine delivery systems (ENDS) reduces exposure to toxic substances. Yet, many smokers believe that ENDS are at least as harmful as smoking, making them less likely to switch from cigarettes to ENDS. Effectively communicating reduced-exposure information is critical, but such messages must be properly understood. This online study evaluated comprehension of a factual message, indicating that smokers who switch completely away from smoking to JUUL-brand ENDS can reduce their exposure to harmful chemicals in cigarette smoke. Participants were 12 557 adults 18+ years (smokers, dual users and former and never users of tobacco) randomized to see the reduced-exposure message or to a Control condition. After exposure to the message, the majority of smokers (89%) understood the need to switch completely from cigarettes to JUUL to achieve reduced exposure. Most smokers and nonusers (>75%) did not misperceive JUUL as completely eliminating exposure to harmful chemicals, and >85% understood that using JUUL has risk. Exposure to the message improved understanding of the intended audience for JUUL. Individuals with limited health literacy showed modestly lower comprehension, regardless of condition. Ensuring adequate comprehension of messages about reduced exposure from ENDS is important to ensuring that such messaging can benefit public health.

BACKGROUND Menthol-flavored electronic nicotine delivery systems (ENDS) are a focus of public health and regulatory policy considerations. The abuse liability of five menthol-flavored pod-based ENDS was compared to combustible cigarettes, and switching potential of ENDS was also evaluated. METHODS 215 US adults who smoke cigarettes (34.4% female; mean age[SD]=29.60[8.75]; 40.9% non-Hispanic White; mean cigarettes/day[SD]=12.04[8.52]) completed a randomized 6-arm within-person cross-over product-use study. Participants used five pod-based menthol-flavored ENDS (JUUL2 Polar Menthol 1.5%, JUUL2 Prototype Fresh Menthol 3.0%, JUUL Menthol 5.0%, Vuse Alto Menthol 5.0%, NJOY Ace Menthol 5.0%) and their usual brand (UB) cigarette for 20minutes ad libitum. After each product use, subjective reinforcing effects relevant to abuse liability and associated with switching away from cigarettes (e.g., satisfaction, product liking) were assessed. RESULTS All ENDS products were rated substantially and statistically significantly lower than UB cigarette on measures of subjective reinforcing effects (ps<0.001). Satisfying effects of JUUL2 1.5% were rated significantly higher than other ENDS products. JUUL2 Prototype 3.0% and Vuse Alto 5.0% did not significantly differ (ps>0.05), and both were rated significantly higher than JUUL 5.0% and NJOY Ace 5.0% (ps<0.05). Differences in subjective responses to study products did not significantly differ by preference for menthol cigarettes or by current ENDS use. CONCLUSIONS Abuse liability of all menthol-flavored ENDS in this study was substantially lower than combustible cigarettes. Abuse liability of JUUL2 1.5% was within the range of currently marketed pod-based menthol-flavored ENDS products. JUUL2 1.5% likely has high potential for facilitating switching among US adults who smoke.

The harm caused by cigarette smoking is overwhelmingly due to byproducts of tobacco combustion. Electronic Nicotine Delivery Systems (ENDS) provide nicotine to users without combustion, and may support tobacco harm reduction among cigarette smokers who would not otherwise quit in the near term. Analyses of Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study compared biomarkers of exposure (BOE) levels for nicotine, 3 metals, 2 tobacco-specific nitrosamines and 14 smoking-related volatile organic compounds in 151 exclusive ENDS users, 1341 exclusive cigarette smokers, 115 dual users (cigarettes and ENDS), and 1846 past 30-day nonusers of tobacco, adjusting for demographics. Nicotine exposure in ENDS users and dual users did not significantly differ from smokers. Among ENDS users, 16 of 18 other BOEs were significantly lower than smokers’; 9 BOEs were not significantly different from nonusers. Among dual users smoking < 10 cigarettes/day, 15 of 18 non-nicotine BOEs were significantly lower than smokers’, whereas in dual users smoking ≥ 10 cigarettes per day none of the BOEs significantly differed from smokers’. In this representative sample of US adults, exclusive use of ENDS (vs. cigarette smoking) was associated with much lower exposures to many harmful chemicals associated with smoking-related disease. BOE levels in dual users were directly related to their cigarette consumption. These BOE data provide further evidence that ENDS expose users to substantially lower levels of toxicants than combustible cigarettes, confirming their potential for harm reduction.

Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product which could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS’ potential benefits. This study examines whether increased US ENDS sales have been associated with reduced cigarette sales. Retail data on weekly per-capita cigarette and ENDS purchases in the USA during 2014–2019 were obtained from a national sample of brick-and-mortar retail outlets. Trends in cigarette sales were modeled before (2014–2016) ENDS had a substantial market share, and, after adjusting for macroeconomic factors, projected into the post-period (2017–2019). Actual cigarette sales were lower than projected sales (by up to 16% across the post-period), indicating a substantial “cigarette shortfall” in the post-period. To explore whether general (i.e., inclusive of potentially many mechanisms) substitution by ENDS can explain the cigarette shortfall, its association with per-capita ENDS volume sales was examined. Higher ENDS sales were significantly associated with a greater cigarette shortfall: for every additional per-capita ENDS unit, cigarette sales were 1.4 packs-per-capita lower than expected ( B = 1.4, p < .0001). Error correction models which account for spurious correlation yielded similar results. These findings support ENDS serving as a substitute for cigarettes (through potentially many mechanisms including cigarette price), causing cigarette consumption to decline. Since ENDS potentially pose lower risk than cigarettes, this general substitution effect suggests that risk-proportionate tobacco regulation could mitigate the tobacco-related health burden.

Background Perceived risk reduction motivates smokers to switch to electronic nicotine delivery systems (ENDS). This research examines US smokers' relative risk perceptions and their prospective association with various behavioral stages of switching to ENDS. Methods Data from the nationally representative, longitudinal Population Assessment of Tobacco and Health (PATH) Adult survey, Waves 1 (2014) through 5 (2019), were analyzed. We assessed the association between the perceived risk of ENDS relative to cigarettes ("less harmful" vs. "equally harmful" or "more harmful") and 1) adoption of ENDS (among never-ENDS-using smokers), 2) complete switching to ENDS (i.e., stopping smoking, among ever-ENDS-using smokers), and 3) avoiding reversion to smoking (among smokers who had switched to ENDS), at the next wave. Results The proportion of US smokers perceiving ENDS as less harmful than cigarettes continually decreased, reaching 17.4% in Wave 5 (2019). Current smokers with such belief were more likely to adopt ENDS (aOR 1.31; 95% CI 1.15-1.50) and switch completely to ENDS (aOR 2.24; 95% CI 1.89-2.65) in the subsequent wave. Among smokers who had switched within the past year, such beliefs predicted avoidance of resumption of smoking in the next wave (aOR 0.55; 95% CI 0.33-0.93). Conclusions Smokers' beliefs about the relative risk of ENDS compared to cigarettes had a strong and consistent association with transitions between smoking and ENDS use. Addressing the growing misperception about ENDS has the potential to contribute to public health by encouraging smokers' switching to ENDS.

Objectives: The Adult JUUL System User Switching and Smoking Trajectories (ADJUSST) study assessed the smoking and JUUL use trajectories of adults who purchased JUUL. In this paper, we describe study methods, characterize the sample, and assesses potential for bias due to loss to follow-up. Methods: We entered 55,414 US adults (≥ age 21) who purchased a JUUL Starter Kit for the first time (online or at retail) in 2018 into a naturalistic, longitudinal observational study, irrespective of baseline smoking status. Participants were invited for follow-ups 1, 2, 3, 6, 9, and 12 months later, focused on assessing past-30-day smoking and JUUL use. Analyses assessed potential bias due to non-response. Results: Over 90% of participants had a history of smoking; 62.8% were past-30-day smokers; 23.3% were former smokers. Participants' average age was 30; 75% were white. Most participants (77.6%) completed some follow-ups; 25% completed all follow-ups. Baseline differences among complete responders (N = 13,729), partial responders (N = 29,252), and complete non-responders (N = 12,433) were small. When recontacted, few 12-month non-responders said their non-response was due to smoking; many reported no past-30-day smoking. Conclusions: The study may elucidate smoking trajectories of adult JUUL users. The potential for bias due to loss to follow-up in ADJUSST was limited.

INTRODUCTION:Snus, a low nitrosamine smokeless tobacco product, presents less risks to health than cigarettes. Effectively communicating such risk information could facilitate smokers switching completely to snus, thereby benefiting public health. METHODS:This study assessed comprehension and perceptions of modified-risk information regarding snus. Adult cigarette smokers, former tobacco users, and never tobacco users (N = 3,922) from a US internet panel viewed an advertisement stating that smokers who switched completely to snus could greatly reduce risk of lung cancer, respiratory disease, heart disease, and oral cancer. Respondents answered questions regarding the modified-risk information and rated perceived risks of snus relative to cigarettes and other smokeless tobacco products. RESULTS:Across the four diseases mentioned in the advertisement, most respondents (49.7%-68.6%, across tobacco user groups) understood that snus presents less risk than cigarettes but is not completely safe. Some indicated snus presents the same risk as cigarettes; this was highest for oral cancer (33.7%-42.02%) and lowest for lung cancer (15.4%-23.1%) and respiratory disease (15.6%-23.4%). Majorities understood snus is addictive (77.7%-87.9%), quitting all tobacco is the best option for smokers (83.6%-93.1%), and non-users of tobacco should not use snus (80.4%-87.8%). Only 2.1%-5.8% indicated smokers would receive a health benefit if they continued to smoke while using snus. CONCLUSIONS:The modified-risk information, conveying that snus presents less risk than cigarettes but is not completely safe, was understood by majorities of respondents. Differential risk beliefs across diseases suggest responses were shaped not only by the modified-risk information, but also by intuitions and pre-existing beliefs about tobacco products.

ABSTRACTBackground and aimsCigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e‐cigarette use. This study assesses dependence among current and former adult e‐cigarette users on cigarettes and e‐cigarettes, compared with dependence on cigarettes.DesignCross‐sectional data from the Population Assessment of Tobacco and Health (PATH) study from 2013–2016. Psychometrically assessed dependence was compared for cigarettes and e‐cigarettes among current and former exclusive and dual users of the products and among e‐cigarette users who had and had not recently stopped smoking.SettingA population‐based representative sample of US adults.ParticipantsParticipants were 13 311 US adults (18+) in Waves 1–3 of PATH reporting current established smoking, current use of e‐cigarettes, or stopping use of either product in the past year who were administered dependence assessments for cigarettes and/or e‐cigarettes.MeasurementsA 16‐item scale assessing tobacco dependence (on a 1–5 scale), previously validated for assessment and comparison of dependence on varied tobacco products, including cigarettes and e‐cigarettes, with a variation assessing residual dependence among users who stopped in the past year.FindingsAmong current users, dependence on e‐cigarettes was significantly lower than dependence on cigarettes, in within‐subjects comparisons among dual users of both e‐cigarettes and cigarettes (1.58 [SE = 0.05] vs. 2.76 [0.04]), P < 0.0001), and in separate groups of e‐cigarette users and cigarette smokers (1.95 [0.05] vs. 2.52 [0.02], P < 0.0001), and among both daily and non‐daily users of each product. Among former users, residual symptoms were significantly lower for e‐cigarettes than cigarettes, both among former dual users (1.23 [0.07] vs. 1.41 [0.06], P < 0.001) and among users of one product (1.28 [0.03] vs. 1.53 [0.03], P < 0.0001). The highest level of e‐cigarette dependence was among e‐cigarette users who had stopped smoking (2.17 [0.08]). ConclusionUse of e‐cigarettes appears to be consistently associated with lower nicotine dependence than cigarette smoking.

Background: Kratom is a South Eastern Asian tree whose leaves are used to make tea-like brews or swallowed in powdered form for various health and well-being reasons including to relieve pain and opioid withdrawal. It is important to learn more about the potential public health impact of kratom in the context of the opioid epidemic. Methods: An anonymous online survey of kratom users (2867 current users and 157 former users) was conducted in September 2017 through the American Kratom Association and associated social media sites. Results: Kratom was used primarily to relieve pain (endorsed by 48% of respondents), for anxiety, PTSD, or depression (22%), to increase energy or focus (10%) and to help cut down on opioid use and/or relieve withdrawal (10%). Over 90% of respondents who used it in place of opioids indicated that it was helpful to relieve pain, reduce opioid use, and relieve withdrawal. The reported incidence of bad adverse reactions was 13%, and reactions were overwhelmingly mild and self-managed. Conclusions: Respondents reported using kratom for conditions which often require use of opioids, including pain and reduction of opioid use. The high self-reported efficacy and low incidence of adverse reactions associated with kratom use suggest that it may provide a potential alternative to opioids for some persons even though it has not been evaluated in multi-center clinical trials or approved for any therapeutic purpose. Further study of kratom, including systematic characterization of its safety and efficacy for various conditions is warranted.

BACKGROUND AND AIMS:Quitting smoking is the most potent way to reduce the health risks associated with smoking cigarettes, and public health objectives in the United States include dramatic increases in the proportion of smokers making a serious quit attempt each year. The US Centers for Disease Control and Prevention (CDC) has, since 2000, set as its Healthy People 2020 objective to encourage 80% of smokers to make a serious quit attempt per year. This study assessed the trend in quit attempts from 2009 to 2014.DESIGN:We examined the percentage of US smokers making a serious quit attempt each year from 2009 to 2014 from the repeating cross-sectional National Health Interview Survey (NHIS).SETTING:United States.PARTICIPANTS:The number of qualifying respondents per year ranged from 5748 in 2010 to 7219 in 2012, with a total of 40 362 respondents included in the analysis.MEASUREMENTS:Respondents were deemed to have made a serious quit attempt if they were either current smokers who reported that they stopped smoking for more than 1 day in the past 12 months because they were trying to quit smoking, or reported being former smokers (smoked 100+ cigarettes life-time, but now not smoking) who quit in the past year.FINDINGS:Analyses of trends from 2009 to 2014 showed an overall linear increase in quit attempts [odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.01-1.04, P = 0.0075], but also a quadratic trend (OR = 1.01, 95% CI = 1.00-1.02, P = 0.0189).CONCLUSIONS:The proportion of US smokers making a serious quit attempt has increased since 2009, due to an upward trend since 2011. The 2014 serious quit attempt rate was 55.0%. These rates are still below the Healthy People 2020 objective of 80% of smokers making a serious quit attempt per year.

Adding icons on labels of acetaminophen-containing medicines could help users identify the active ingredient and avoid concomitant use of multiple medicines containing acetaminophen. We evaluated five icons for communication effectiveness. Adults (n = 300) were randomized to view a prescription container label or over-the-counter labels with either one or two icons. Participants saw two icon candidates, and reported their interpretation; experts judged whether these reflected critical confusions that might cause harm. Participants rated how effectively each icon communicated key messages. Icons based on abbreviations of acetaminophen (Ac, Ace, Acm) were rated less confusing and more effective in communicating the active ingredient than icons based on APAP or an abstract symbol. Icons did not result in critical confusion when seen on a readable medicine label. Icon implementation on prescription labels was more effective at communicating the warning against concomitant use than implementation on over-the-counter (OTC) labels. Adding an icon to a second location on OTC labels did not consistently enhance this communication, but reduced rated effectiveness of acetaminophen ingredient communication among participants with limited health literacy. The abbreviation-based icons seem most suitable for labeling acetaminophen-containing medications to enable users to identify acetaminophen-containing products.

OBJECTIVES:To assess the effect of adding an acetaminophen ingredient icon to acetaminophen medication labels on consumer decision making about concomitant use of acetaminophen medications to avoid overdose, which is associated with liver injury.DESIGN:Parallel-group randomized study.SETTING:Consumer research facilities in Indianapolis, Baltimore, and Los Angeles.PARTICIPANTS:A total of 517 adults (30% with limited health literacy) recruited at 3 consumer research sites.INTERVENTION:Participants were randomized to a non-icon condition in which medications carried current labeling or an icon condition in which all acetaminophen medications were additionally marked with an icon.MAIN OUTCOME MEASURES:Participants were presented with a medicine cabinet containing 12 diverse prescription and non-prescription medications, one-half containing acetaminophen, and made decisions about which medications were appropriate to take after an acetaminophen medication had already been taken. Outcome measures were errors in medication decisions and response time.RESULTS:The icon reduced the odds of participants making medication-decision errors by 53% (CI 31%-68%), with effects evident across medication categories. The icon eliminated a trend for those with lower health literacy or less education to have a greater likelihood of making errors. The icon also reduced response times, indicating reduced cognitive load for decisions.CONCLUSION:An icon can improve decision making regarding acetaminophen-containing medications, particularly among individuals with limited health literacy or education.

INTRODUCTION:Smokers switching completely from combustible cigarettes to electronic cigarettes (e-cigarettes) are likely to reduce health risk, suggesting that e-cigarettes should be made appealing to adult smokers. However, uptake of e-cigarettes by nonsmoking teens would add risk without benefit and should be avoided. Although e-cigarette flavors may appeal to adult smokers, the concern is that flavors might attract nonsmoking teens.METHODS:Nonsmoking teens (n = 216, ages 13-17, no tobacco in past 6 months) and adult smokers (n = 432, ages 19-80, smoking 3+ years; could have used e-cigarettes) were recruited from an Internet research panel. In assessments completed online (May 22, 2014 to June 13, 2014), participants indicated their interest (0-10 scale) in e-cigarettes paired with various flavor descriptors. These were mixed (order balanced) with similar flavor offerings for ice cream and bottled water to mask the focus on e-cigarettes and validate the assessment. Mixed models contrasted interest between teens and adults and among adults by e-cigarette history.RESULTS:Nonsmoking teens' interest in e-cigarettes was very low (mean = 0.41 ± 0.14 [SE] on 0-10 scale). Adult smokers' interest (1.73 ± 0.10), while modest, was significantly higher overall (p < .0001) and for each flavor (most p values < .0001). Teen interest did not vary by flavor (p = .75), but adult interest did (p < .0001). Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor. Adults who never tried e-cigarettes had the lowest interest, yet still higher than nonsmoking teens' interest (p < .0001).CONCLUSION:The e-cigarette flavors tested appealed more to adult smokers than to nonsmoking teens, but interest in flavors was low for both groups.

Concomitant use of multiple acetaminophen medications is associated with overdose. To help patients identify acetaminophen medications and thus avoid concomitant use, an icon with an abbreviation for "acetaminophen" has been proposed for all acetaminophen medications. This study assessed pharmacists' and physicians' use and interpretation of abbreviations for "acetaminophen", to identify abbreviations with other meanings that might cause confusion. Physicians (n = 150) reported use and interpretation of candidate abbreviations Ac and Acm. Pharmacists (n = 150) interpretations of prescription orders using the candidate abbreviations APAP, Ac, Ace and Acm in typed, handwritten or spoken form, were judged for critical confusions likely to cause patient harm. Critical confusion was rare, except for omission by pharmacists of the acetaminophen dose for Hydrocodone/APAP prescriptions (10%). Ac was in common use to indicate "before meals", and was interpreted as such, but some physicians (8%) said they use Ac to indicate anticoagulant drugs. Most pharmacists (54%) interpreted Ace as acetaminophen, and none interpreted it as referring to ACE-inhibitors. Acm was rarely used in prescriptions, had no common interfering meanings, and was often (63%) interpreted as acetaminophen, especially when prescribed in combination with an opiate (85%). The data validated concerns about abbreviations in prescribing: all abbreviations resulted in some misinterpretations. However, Acm was rarely misinterpreted, was readily associated with "acetaminophen", and seemed appropriate for use in a graphic icon to help consumers/patients identify acetaminophen medications.

INTRODUCTION:Nicotine gum, a proven effective aid to cessation, comes in two doses: 2-mg and 4-mg. Assignment to the higher dose has traditionally been based on daily cigarette consumption. This paper evaluates efficacy of the gum when the 4-mg dose is assigned based on time to first cigarette (TTFC) being ≤ 30 min.METHODS:In a secondary analysis of a randomized, double-blind, placebo-controlled trial that allocated smokers randomly to placebo, 2-mg, or 4-mg gum (Garvey, A. J., Kinnunen, T., Nordstrom, B. L., Utman, C. H., Doherty, K., Rosner, B., et al. (2000). Effects of nicotine gum dose by level of nicotine dependence. Nicotine & Tobacco Research, 2, 53-63. doi:10.1080/14622200050011303), we evaluated outcomes when 4-mg gum was given to subjects with TTFC ≤ 30 (n = 158, placebo n = 159).RESULTS:Active treatment doubled or tripled abstinence rates versus placebo. This also held among smokers with a history of treatment failure. The effect of 4-mg gum was significant among light smokers (<25 CPD) with TTFC ≤ 30; 2-mg gum was not.CONCLUSION:This analysis suggests that assigning dose of nicotine gum based on TTFC is an effective and appropriate means of dose allocation.