We tested whether e-cigarette advertisements (ads) with a claim of reduced chemical exposure (RCE) and various brands impact e-cigarette-related perceptions among young people. A randomized, 2 x 3 between-subjects experiment was embedded in a web-based survey of youth (ages 13-17) and young adults (ages 18-29) who smoke cigarettes (n=1,667) or who do not use tobacco (n=833). Participants viewed one of six e-cigarette ad conditions that varied according to two manipulated factors: RCE claim (present or absent) and e-cigarette brand (Logic Power, Vuse Vibe, or Njoy Ace). After viewing the ad, perceptions about the ad and the promoted e-cigarette product in the ad were assessed. We did not observe an e-cigarette brand effect or interactive effects between the two main factors on any outcomes. Among those who smoke, the RCE claim generated increased perceptions that the ad made them want to use (p=0.039) or completely switch to the e-cigarette (p=0.048). Among those who do not use tobacco, it led to elevated perceptions that the e-cigarette is less addictive than cigarettes (p=0.034) and intentions of using the e-cigarette compared to cigarettes (p=0.009). E-cigarette ads containing a RCE claim may be perceived as more effective in influencing product use and complete switching intentions among young people who smoke. While we did not observe such an effect among those who do not use tobacco, future efforts to promote e-cigarette MRTP claims should aim to limit exposure to such claims among this audience to mitigate the potential for unintended effects.

Introduction:Cigars remain among the most affordable tobacco products in the U.S., with package features designed to increase appeal, including pack size, flavor, price, and potentially misleading descriptors, like "natural." Building upon prior work showing frequent changes in the cigar market, we examined trends in US cigar unit sales and prices by package feature from 2021 to 2025. Methods:Nielsen Convenience Track national cigar sales data from 2021 to 2025 were used for analyses. Results:Total cigar unit sales decreased from $2.22 billion in 2021 to $1.79 billion in 2025, while average price per stick increased from $2.86 to $3.91. In 2025, the pack sizes with the greatest market share were two cigars/pack (46.8% of market) and single sticks (30.3%). In 2025, over one-quarter of cigar sales featured a "natural" descriptor; unflavored cigars had the greatest market share (43.3%), followed by flavored cigars (34.0%), and cigars with concept (i.e., ambiguous) descriptors (22.7%). From 2021 to 2025, market share decreased for flavored and unflavored cigars but increased for concept cigars. For average price per cigar, in 2025, two-packs, three-packs, and 20-packs were the cheapest per cigar compared with other pack sizes ($0.76, $0.75, and $0.66, respectively), with price per cigar for two- and three-packs decreasing from 2021 to 2025. Flavored cigars ($1.03) were cheaper than unflavored ($6.84) and concept cigars ($2.23) per cigar. Cigars with a "natural" descriptor were cheaper ($1.42) than those without ($4.60). Conclusions:Findings reflect a diverse cigar market with respect to pack size, flavor, and marketing descriptors.

Anti-vaping campaigns have the potential to reduce youth e-cigarette use in the United States. It is unclear how humor, a common feature in youth anti-tobacco communication, affects intended and unintended message outcomes and interacts with message themes and youth rebelliousness. We conducted a mixed between- and within-subjects experiment using an online convenience sample of 13-17-year-old non-current e-cigarette users (N = 1,366). Participants were randomized to view anti-vaping public service announcement (PSA) ads with humorous text and humorous imagery (HH), humorous text and non-humorous imagery (HN), or non-humorous text and non-humorous imagery (NN). Within each condition, participants viewed five images. The five images represented five themes identified in previous literature as highly effective (i.e., health effects and chemicals) and less effective (i.e., flavors, industry manipulation, mental health). Linear mixed effects models explored main effects of message condition on intended effects (i.e., perceived message effectiveness, message liking, amusement, and worry) and unintended effects (i.e., reactance, anger, perceived message credibility, and susceptibility to e-cigarettes), and additionally tested interactions with theme and youth rebelliousness. Eighty-six percent of the sample were susceptible to e-cigarette use at baseline. Main effects indicated lower perceived message effectiveness (PME) and ad liking for the HN compared to the NN condition (p < .05). Ads in the HH condition elicited higher amusement compared to the NN condition (p < .05). Significant interactions were observed between theme and condition for PME and messaging liking. Interactions between condition and youth rebelliousness were not significant. PSAs with both humorous text and imagery performed similarly to non-humorous messages and did not result in unintended consequences, a finding that can support the use of humor as a variation in message strategy in anti-vaping campaigns. Humor, however, may decrease perceived effectiveness and liking relative to non-humorous messages when paired with lower effectiveness themes. Pilot testing of humorous anti-vaping PSAs may be needed prior to dissemination.

BACKGROUND:Exposure to e-cigarette marketing may influence youths' e-cigarette perceptions and behavior. However, less is known about the effect of specific advertisement (ad) features on youth who have never tried e-cigarettes. METHODS:We conducted an online 2x2x2 factorial experiment with a nationally-representative sample of e-cigarette-naïve youth (ages 13-17) (n = 516). Participants viewed two ads in one of eight randomized e-cigarette ad conditions that varied by three ad features: color (vibrant/muted), images of models (present/absent), and smoking-relevant language (present/absent). We assessed interest in trying e-cigarettes and perceptions. Analyses examined main effects of ad features and interactions with e-cigarette use susceptibility. RESULTS:Youth who saw vibrantly-colored ads (versus ads with muted colors) were more likely to perceive that fewer people their age vaped and peers disapproved of e-cigarette use. They were also more likely to rate the ads as appealing and targeting youth (with an interaction between color and e-cigarette susceptibility, such that susceptible youth were more likely to perceive brightly colored ads as targeting youth). Youth who saw ads with smoking-relevant language were less likely to rate them as appealing, compared to those who saw ads without such language. There was an interaction between presence of models and e-cigarette susceptibility on e-cigarette interest (less interest among susceptible youth) and the perception that ads were targeting youth (less likely among susceptible youth). None of the three ad features impacted noticeability of the nicotine warning. CONCLUSIONS:Findings suggest that specific ad features may play a role in e-cigarette interest and perceptions among e-cigarette-naïve youth.

INTRODUCTION:We tested whether e-cigarette advertisements (ads) with a claim of reduced chemical exposure (RCE) and various brands impact e-cigarette-related perceptions among young people. METHODS:A randomized, 2 × 3 between-subjects experiment was embedded in a web-based survey of youth (ages 13-17) and young adults (ages 18-29) who smoke cigarettes (n = 1667) or who do not use tobacco (n = 833). Participants viewed 1 of 6 e-cigarette ad conditions that varied according to 2 manipulated factors: RCE claim (present or absent) and e-cigarette brand (Logic Power, Vuse Vibe, or Njoy Ace). After viewing the ad, perceptions about the ad and the promoted e-cigarette product in the ad were assessed. RESULTS:We did not observe an e-cigarette brand effect or interactive effects between the two main factors on any outcomes. Among those who smoke, the RCE claim generated increased perceptions that the ad made them want to use (P = .039) or completely switch to the e-cigarette (P = .048). Among those who do not use tobacco, it led to elevated perceptions that the e-cigarette is less addictive than cigarettes (P = .034) and intentions of using the e-cigarette compared to cigarettes (P = .009). CONCLUSION:E-cigarette ads containing a RCE claim may be perceived as more effective in influencing product use and complete switching intentions among young people who smoke. While we did not observe such an effect among those who do not use tobacco, future efforts to promote e-cigarette MRTP claims should aim to limit exposure to such claims among this audience to mitigate the potential for unintended effects. IMPLICATIONS:This study demonstrates the potential influence of reduced chemical exposure (RCE) claims in advertisements (ads) for US Food and Drug Administration-authorized e-cigarette products among young adults who smoke, suggesting that such claims may enhance the perceived effectiveness of advertising. Although we found few significant effects among tobacco-naïve youth and young adults, any efforts to promote e-cigarette RCE claims should aim to limit exposure to such claims among these young audiences to mitigate the potential for unintended effects. These results will be critical to understanding how RCE claims in e-cigarette ads may differentially shape e-cigarette-related perceptions and behaviors across young people of diverse tobacco-use groups.

Introduction: Emerging evidence suggests that E-cigarettes are likely less harmful than combustible cigarettes, presenting an opportunity for adults who smoke to quit or switch. E-cigarettes also risk increasing the number of young people who become addicted to nicotine. Physicians’ perceptions of and attitudes toward this tradeoff remain underexplored. Methods: A random sample of U.S. physicians (N=940) were surveyed on a variety of tobacco-related issues and on their treatment practices and demographics. Questions aimed to elicit tradeoffs between protecting youth from becoming addicted to nicotine and helping adult smokers quit. Results: Most respondents (93%) reported caring about both helping adults quit smoking and protecting the young, with the majority (66.2%) prioritizing the latter. Of the various specialties, pediatricians were most likely to believe that preventing nicotine addiction among young people matters more than helping adults quit. Prioritization of youth over adults who smoke was also associated with being female, being younger, and having negative beliefs about the utility of E-cigarettes for smoking cessation. Conclusions: The findings show that physicians attribute greater ethical priority to protecting young people than to reducing risk to adults. Improved education on the risks versus benefits of E-cigarettes may assist physicians in making appropriate recommendations depending on patients' needs.

Introduction Given the rapidly changing media landscape and popularity of e-cigarettes among young adults who identify as lesbian or gay, bisexual, questioning, or something else (LGB+), timely data on media consumption and exposure to e-cigarette content across media channels is imperative for developing counter-messaging and public education campaigns for these individuals.Aims and Methods Using 2023 data from young adults in California, this study examined how social media use differed for heterosexual and LGB + young adults, by sex. Exposure to e-cigarette content across media channels was also compared between heterosexual and LGB + young adults, by sex.Results Findings from a non-probability representative sample of young adults in California showed that more LGB + young adults reported using Tumblr and fewer reported using Facebook and Snapchat, compared with heterosexual young adults, among both males and females. Use of Reddit was more common among LGB + versus heterosexual females, but there were no differences in sexual identity among males. Exposure to e-cigarette marketing was more common among LGB + females compared with heterosexual females, but this was not the case for males. Exposure to user-generated e-cigarette content, and self-reported visits to e-cigarette websites, were more common among LGB + females compared to heterosexual females.Conclusions These findings highlight the importance of treating LGB + individuals as a heterogeneous group. As such, anti-tobacco campaigns targeting LGB + individuals that leverage social media will want to consider which platforms are most used among their target audience to increase campaign reach.Implications This study builds upon the literature by providing timely data on how LGB + young adults consume social media and are exposed to e-cigarette marketing. Findings have implications for tobacco education campaigns designed for LGB + individuals that leverage social media.

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.

Background: E-cigarette marketing exposure may influence vaping-related outcomes among youth, but less is known on which specific advertising features impact youth attention, perceptions, and appeal. This study qualitatively examines responses to different e-cigarette advertising features among e-cigarette-na & iuml;ve youth. Methods: We conducted four online focus groups in 2021 with a national U.S. sample of 13-17 year olds (n = 25) who had never used e-cigarettes. Participants viewed and discussed their reactions to different e-cigarette advertisements varying in the inclusion of ad features, including color, models in imagery, text claims targeting smokers, and the nicotine warning label. Results: Participants were attracted to ads with bright colors, particularly when contrasted against a dark background. Ads featuring models attracted attention and reduced perceptions that the product is harmful. Comments indicated mixed reactions to smoker-targeted text claims. On one hand, participants perceived ads with text that specified "for smokers" as targeting older adults. On the other hand, text referring to "switching" from cigarettes to e-cigarettes led to some perceptions that the product is healthy, and certain text that implicitly referred to smoking (e.g., "no odor") had the potential to appeal to youth who wanted to use e-cigarettes discreetly. The level of attention paid to warnings depended on warning size and the color contrast between the warning and the rest of the ad. Conclusions: Findings suggest specific e-cigarette ad features play an important role in attracting youth attention and influencing perceptions. More research is needed on the potential public health benefits versus unintended consequences of smoker-targeted text claims.

BACKGROUND:E-cigarette advertising, which often includes various features, may prompt e-cigarette use and product switching. This study examined the associations between noticing e-cigarette ad features and perceived product appeal and interest in completely switching from cigarettes to advertised e-cigarettes among young adult dual users of both products. METHODS:We analyzed data from an online heatmap experiment among young adult dual users defined as established cigarette smokers who currently used e-cigarettes (ages 18-34 years; n = 1,821). Participants viewed 12 e-cigarette ads, clicked on ad features (e.g., fruit flavors, nicotine warnings, price promotions, smoker-targeted claims) that attracted their attention (defined as "noticing"), and answered questions about e-cigarette product appeal and interest in completely switching from cigarettes to the e-cigarettes shown. We examined within-person associations between noticing specific ad features and outcomes, controlling for demographic and tobacco use-related characteristics. RESULTS:Noticing fruit flavors (AOR = 1.67 and 1.28) and fruit images (AOR = 1.53 and 1.21) was positively associated with having any e-cigarette product appeal and switching interest. Noticing price promotions (AOR = 1.23) was positively associated with product appeal. In contrast, noticing nicotine warnings (AOR = 0.74 and 0.86), smoker-targeted claims (AOR = 0.78 and 0.89), and tobacco flavors (AOR = 0.92 and 0.90) was negatively associated with product appeal and switching interest. CONCLUSIONS:Noticing certain e-cigarette ad features (e.g., fruit flavors and nicotine warnings) may be associated with product appeal and/or switching interest among young adult dual users. More research is needed to assess the influence of e-cigarette ad features that promote product switching interests among cigarette smokers while discourage interests among tobacco-naïve individuals.

ObjectiveThe Food and Drug Administration has the authority to set a minimum for cigar pack size, a product feature linked to price. This study examined the effects of cigarillo package size and price on young adults’ smoking and purchase intentions.DesignYoung adults (n=1032) 18–30 years old who smoked cigarillos in the past 12 months completed an online 3×2 within-subjects experiment testing the effects of cigarillo pack size (1, 2, 5) and price (actual price, standardised price per stick) on intentions to purchase and smoke cigarillos. We modelled the main effects and interactions of pack size and price on intentions to buy and smoke cigarillos overall and by cigarillo use frequency.ResultsIntentions to buy and smoke were strongest for lower priced singles and two packs compared with higher priced five packs. Under standardised price conditions, participants preferred larger packs, but under actual pricing conditions smaller packs, especially two packs, were preferred. Participants who smoked cigarillos less than monthly were more likely to buy and smoke the least expensive products (buy: singles actual price adjusted OR (aOR)=4.51, 95% CI 3.76 to 5.42; two packs actual price aOR=9.76, 95% CI 8.11 to 11.75; five packs standardised price aOR=3.17, 95% CI 2.89 to 3.48) with the strongest preference for two packs and singles.ConclusionsYoung adult cigarillo smokers prefer smaller packs in conditions where pricing incentivises smaller packs. Minimum pack size policies may reduce the appeal of cigarillos among young adults, especially less frequent cigarillo smokers. Pack size policy should take into consideration price, and ideally these two factors should be addressed together.

To cite: Ganz O, Wackowski OA, Strasser AA, et al. Tob Control Epub ahead of print: [please include Day Month Year]. doi:10.1136/ tobaccocontrol-2022-057396 Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Introduction: Given the rapidly changing media landscape and tobacco marketplace, timely data on media consumption and exposure to pro-tobacco content across media channels among lesbian, gay, and bisexual (LGB) young adults is imperative for developing counter-messaging and public education campaigns for these individuals. Methods: Using 2023 data from young adults in California, this study examined how social media use differed across media channels for heterosexual and LGB young adults, by sex. Exposure to pro-tobacco content across media channels between heterosexual and LGB young adults, by sex was also compared. Results: Findings from a representative sample of young adults in California showed that more LGB young adults reported using Tumblr and fewer reported using Facebook and Snapchat, compared with heterosexual young adults, among both males and females. Additionally, social media use differed by sex. For example, use of Reddit was more common among LGB versus heterosexual females, but there were no differences by sexual identity among males. Exposure to tobacco marketing was more common among LGB females compared with heterosexual females, but this was not the case for males. Exposure to user-generated e-cigarette content, and self-reported visits to e-cigarette websites, were more common among LGB females compared to heterosexual females. Conclusions: These findings highlight the importance of treating LGB individuals as a heterogeneous group. As such, anti-tobacco campaigns designed for LGB individuals that leverage social media will want to consider which social media platforms are most used among their target audience, ensuring maximum campaign reach. ### Competing Interest Statement Dr. Allem has received fees for consulting services in court cases pertaining to the content on social media platforms. He reports no other conflicts of interest. All other authors declare no competing interests. ### Funding Statement This publication was funded by the California Tobacco Prevention Program of the California Department of Public Health through contract #21-10032 Tobacco Industry Monitoring Evaluation (TIME). The findings and conclusions in this article are those of the authors and do not necessarily represent the views or opinions of the California Department of Public Health or the California Health and Human Services Agency. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the University of Southern California Institutional Review Board. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data and associated study materials will be made available upon request

Introduction Young adults new to tobacco (including e-cigarettes) are at an increased risk of e-cigarette use after e-cigarette exposure. This study examined the association between noticing e-cigarette advertising features and perceived product appeal among non-tobacco-using young adults. Methods A sample of non-tobacco-using young adults (ages 18–29 years; n=1993) completed an online survey in 2021. We content analysed visible features from 12 e-cigarette ads that represented commonly used e-cigarette brands. Participants viewed the ads and clicked on the areas of the ads that drew their attention. Participants reported e-cigarette product appeal for each ad, including ad liking, product curiosity and use interest. We used generalised estimating equations to examine within-person associations between noticing specific ad features and reporting each and any type of product appeal, adjusting for noticing other features and participant characteristics. Results Noticing people, discounts, non-tobacco (menthol and mint/fruit) flavours, positive experience claims or product images was positively associated with having any e-cigarette product appeal. Noticing discounts or mint/fruit flavours was also positively associated with e-cigarette use interest. In contrast, noticing nicotine warnings or smoking cessation claims was negatively associated with ad liking and product curiosity. Conclusions Attention to several e-cigarette ad features (eg, people, discounts, non-tobacco flavours) was associated with increased e-cigarette product appeal, whereas attention to nicotine warnings and smoking cessation claims was associated with reduced appeal among non-tobacco-using young adults. Restricting appeal-promoting features while strengthening the effects of nicotine warnings and smoker-targeted claims in e-cigarette ads may potentially reduce e-cigarettes’ overall appeal among this priority population.

Lost Mary is a popular e-cigarette brand among youth in the United States. This study aimed to analyze Lost Mary's branded social media activity and assess whether marketing efforts may have contributed to its youth appeal. We conducted a content analysis of 53 Lost Mary posts published on social media platforms from 2022 to 2023. More than a third of the posts included flavor descriptors, including fruit or ice, both popular flavors among youth. More than two-thirds of the posts used vibrant colors, and any human models included appeared to be young adults. Findings suggest that Lost Mary may target youth on social media platforms through the use of youth-appealing advertisement strategies (e.g. flavors). These findings highlight the need for increased monitoring of e-cigarette brand marketing on social media.

BACKGROUND AND AIMS:E-cigarette marketing exposure on social media influences perceptions; however, limited knowledge exists regarding marketing features attracting the most visual attention. This study examined visual attention to features of social media marketing for disposable e-cigarettes and related product perceptions. DESIGN, SETTING AND PARTICIPANTS:Participants viewed 32 disposable marketing post images from social media (Instagram) using computer-based eye-tracking technology to assess standardized attention metrics of marketing features. They then completed a survey assessing positive product perceptions. The study took place in New Jersey, USA, June-September 2022, comprising young adults (aged 18-29) who do not use tobacco (n = 72) or who smoke cigarettes (n = 42). MEASUREMENTS:We examined associations between 14 marketing features (e.g. product package, personal item, fruit/candy descriptor, social media account) and standardized attention metrics of dwell time (fixation duration) and entry time (time to first fixation). Then, we assessed attention metrics for each feature in relation to positive product perceptions (appeal and positive use expectancy). FINDINGS:Among all participants, dwell time was the longest for the product descriptor [marginal means (MM) = 1.77; 95% confidence interval (CI) = 1.69, 1.86], social media account (MM = 1.76; 95% CI = 1.67, 1.85) and fruit/candy descriptor features (MM = 1.56; 95% CI = 1.41, 1.70); entry time was the shortest for the social media account (MM = 0.35; 95% CI = 0.26, 0.46), personal item (MM = 0.36; 95% CI = 0.17, 0.56) and human model features (MM = 0.40; 95% CI = 0.08, 0.72). Two use status groups had comparable dwell and entry times, except for the product descriptor feature. Longer dwell time for the product package feature increased positive product perceptions among both use status groups [regression coefficient (β) = 0.44 and 2.61]. Longer dwell time for fruit/candy descriptor (β = 1.80) and price promotion features (β = 4.04) increased positive product perceptions among those who smoke. CONCLUSIONS:US young adults appear to be particularly visually engaged by disposable e-cigarette marketing that uses social media account features (account profile pictures, information about the products marketed and relevant hashtags) and features enhancing the products' personal relatability. Disposable product packages, fruit/candy descriptors and price promotions may increase the influence of social media marketing among various use status groups.

INTRODUCTION:In the United States, e-cigarettes have entered a new regulatory era, needing authorizations from the Food and Drug Administration (FDA) to remain on or enter the marketplace. This study explored the impact of e-cigarette authorization messages on product perceptions and interests. AIMS AND METHODS:We conducted an online experiment in June 2022 with nationally representative samples of adults (≥21) who smoke cigarettes (n = 866) and youth ages 15-20 (n = 859). They were randomized to one of five conditions: Viewing an ad for a fictional e-cigarette brand with no reference to the FDA (control), an ad with an "authorized for sale by FDA" claim in varying presentation styles (plain text, FDA "approved" stamp, FDA logo), or reading a fictional news excerpt about the product's authorization plus control ad. We compared group differences in product interest, susceptibility, harm perceptions, and message perceptions. RESULTS:Among adults who smoke, there were no effects on product interest nor susceptibility, but ratings of the product's harmfulness compared to cigarettes were lower among those in the news versus control condition (β = -0.25, p = .04). Among youth, odds of susceptibility were higher among ever e-cigarette users who viewed the ad with the FDA logo authorization message relative to the control ad (OR = 6.3, 95% CI:1.67 to 23.9, p < .01). About 40% of all participants agreed the authorization claim makes them think the product is safe to use, but fewer (14%-19%) agreed it makes them more interested in trying it. CONCLUSIONS:FDA e-cigarette authorization messages may impact some product harm beliefs. More research is needed to track potential impacts on product use and on ways to promote accurate message understanding. IMPLICATIONS:This study provides new data about the potential impact of messages about FDA authorization of e-cigarette products (presented as ad claims or a news story) on authorized product perceptions, interest, and susceptibility among adults who smoke cigarettes and youth. Our results suggest that FDA e-cigarette authorization messages may impact harm-related beliefs among adults who smoke and product susceptibility among youth who have ever used e-cigarettes before, though real-world effects are likely to be impacted by message type and format, and perceived message source and credibility. Authorization messages are likely to be misinterpreted as "FDA approval" by some; therefore, providing clarifications about authorization meaning and standards are relevant where possible.

ABSTRACTBackgroundAlthough smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population.MethodsWe conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message.ResultsParticipants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one’s mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting.ConclusionsThis study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health.ImplicationsThese data can begin to inform regulatory efforts to address tobacco use in those with comorbid anxiety and/or depression by providing information on how to effectively communicate the benefits of quitting smoking on mental health.

Introduction: In March 2022, FDA granted its first marketing orders for e-cigarettes. Few studies have assessed awareness of FDA e-cigarette regulation and authorization in the era of premarket review. This study describes prevalence of awareness as well as beliefs about regulation among adults who smoke and youth.Methods: We conducted a cross-sectional, nationally representative online survey of 866 adults who currently smoke cigarettes and 859 youth (ages 15-20) in June 2022 using Ipsos KnowledgePanel. Population prevalence of regulatory awareness and beliefs are reported. Pearson chi 2 and multivariable logistic regressions were conducted to assess dependent and independent associations with demographic and tobacco use characteristics.Results: Awareness that FDA regulates e-cigarettes was low among adults who smoke (25.4 %) and youth (18.5 %). Awareness that FDA authorizes e-cigarettes was also low among adults who smoke (10.8 %) and youth (12.7 %). Agreement with both positive and negative beliefs regarding FDA e-cigarette regulation was below 50 %. Current e-cigarette use was significantly associated with agreeing that regulation: makes e-cigarettes safer (adult aOR: 2.90, youth aOR: 2.51), helps prevent youth initiation (adult aOR 1.92), takes away freedom to choose to use e-cigarettes (adult aOR: 3.02, youth aOR: 2.58), and limits types of e-cigarettes available (adult aOR: 2.22, youth aOR: 2.49).Discussion: There is low awareness of FDA e-cigarette regulation and authorization and relatively low agreement with positive beliefs about e-cigarette regulation. Further study is needed to assess how the changing regulatory environment impacts product perceptions, intentions, and behaviors.

Objectives The e-cigarette or vaping product use-associated lung injury (EVALI) outbreak caused serious lung injuries in over 2800 people in the USA in 2019. By February 2020, most cases were determined as linked with vaping tetrahydrocannabinol (THC), including black market products using vitamin E acetate. This study examined smokers’ EVALI awareness, knowledge and perceived impact on their e-cigarette interest approximately 16 months after its peak. Design Between January and February 2021, we surveyed 1018 adult current smokers from a nationally representative US research panel. Participants were asked if they had heard about EVALI prior to COVID-19, knew its main cause, and if EVALI had impacted their interest in future e-cigarette use. Results Approximately 54% of smokers had heard of EVALI. Among those who had heard of EVALI (n=542), 37.3% believed its main cause was e-cigarettes used to vape nicotine, like JUUL. Fewer (16.6%) thought the main cause was products for vaping marijuana/THC, and 20.2% did not know. About 29% had heard vitamin E acetate was associated with EVALI, and 50.9% indicated EVALI made them less interested in using e-cigarettes in the future. EVALI awareness was significantly associated with e-cigarette risk perceptions (ie, that e-cigarettes are as harmful as smoking). Conclusions Despite the passage of time, considerable lack of knowledge and misperceptions about EVALI remain among those who smoke. Our findings suggest the need for continued efforts to promote better understanding of EVALI and appropriate behavioural and policy responses.