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).

Purpose This study examined police officer wellness using data from a large national survey of public safety personnel. It described mental health symptoms, stressors, coping strategies, resource use and barriers to care among law enforcement officers (LEOs) and examined how wellness outcomes varied across officer and organizational characteristics. Design/methodology/approach Using a quantitative cross-sectional design, responses from 6,522 individuals who had served in sworn law enforcement roles were analyzed. Validated self-report screening measures assessed anxiety, depression, posttraumatic stress symptoms, alcohol-related risk and suicidal ideation. Descriptive analyses were supplemented with multivariable logistic regression models examining associations between wellness outcomes and officer experience, agency size, weekly work hours, supervisory status and demographic characteristics. Findings LEOs reported substantial occupational and personal stressors, along with barriers to help-seeking related to stigma, confidentiality concerns, career impact and preferences for self-reliance. Based on established screening thresholds, 16.9% screened positive for clinically elevated anxiety, 16.2% for depression, 19.9% for alcohol-related risk and 21.1% of those completing the PCL-5 screened positive for clinically significant posttraumatic stress symptoms. Longer weekly work hours were consistently associated with elevated anxiety, depression and PTSD-related outcomes, whereas alcohol-related risk was more strongly associated with years of service and relationship status. Originality/value This study provides a large national description of police wellness and highlights workload as a consistent correlate of mental health burden, underscoring the need for accessible and confidential wellness supports for LEOs.

Electronic nicotine delivery system (ENDS) regulation includes the assessment of consumer response to advertising and promotional materials (APM) and behavioral intentions to try and to use the product among adults who smoke and adults who do not use tobacco. This study evaluated the impact of APM for a new ENDS product on intentions to try and to use the product among current Adults-who-smoke and Adults-who-do-not-use-tobacco. Participants (US adults aged 18 and over, n = 3045 Adults-who-smoke, n = 3527 Adults-who-do-not-use-tobacco, including Former Established Users, Former Experimenters, and Never Triers) were randomized to just view an image of the ENDS product (in tobacco and menthol flavors) and health information (Control group) or to additionally view APM (three promotional fliers and information about an available product App; Test group). Outcome measures were openness to try (OTT) and openness to use (OTU), assessed separately for tobacco and menthol flavors. Compared to Adults-who-smoke, very few Adults-who-do-not-use-tobacco were open to trying or using the ENDS product. Exposure to APM significantly increased OTT and OTU among Adults-who-smoke but largely did not affect OTT or OTU among Adults-who-do-not-use-tobacco. The APM did not significantly impact OTT or OTU among young adults-who-do-not-use-tobacco or young adults-who-smoke. OTT was largely flavor-specific; few participants were open to trying both tobacco and menthol flavors. These results support that the ENDS APM tested were generally not appealing to Adults-who-do-not-use-tobacco, including young adults, but did significantly increase OTT and OTU among Adults-who-smoke. The study illustrates the use of consumer data in tobacco regulatory science.

Correctional Officers’ (COs) occupational functions are to maintain security and internal discipline in jails and prisons, and facilitate the social reintegration of inmates. This position involves high trauma exposure (e.g., violence between inmates, attempted/completed suicides, potential assaults on personnel) due to direct contact with inmates. Such exposure, and other job-related stressors, increase COs’ risk for psychological problems, such as depression, anxiety, substance use, and posttraumatic stress disorder (PTSD). This paper presents the results from the National Wellness Survey for Public Safety Personnel specific to COs (N = 190). Descriptive statistics were used to analyze the data. Findings indicated high levels of both occupational and individual stressors. Approximately one-third of COs reported symptoms of anxiety (39.3

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.

INTRODUCTION:Adults who switch from smoking cigarettes to use of electronic nicotine delivery systems (ENDS) may reduce their exposure to harmful and potentially harmful constituents (HPHCs). This study assessed changes in exposure to HPHCs, assessed via biomarkers of exposure (BOEs), among adults who switched to a new ENDS product. METHODS:Adults who smoke cigarettes (N = 89) were randomized to: (1) switch completely to using JUUL2 Virginia Tobacco (N = 24) or Polar Menthol (N = 24); (2) continue smoking usual brand (UB) cigarettes (N = 21); or (3) abstain from all tobacco/nicotine products (N = 20) for 6 d. Changes in exposure to nicotine and 11 other HPHCs from Baseline to Day 6 were compared among study groups. RESULTS:Changes in nicotine exposure did not significantly differ between JUUL2 and UB Cigarette groups (ps > 0.37). Among participants who switched completely to JUUL2 products, median percent reductions (Day 6-Baseline) in non-nicotine BOEs ranged from 65% to 94%, significantly greater than changes in the UB Cigarette group (ps < 0.001). None of the non-nicotine BOEs significantly differed between the JUUL2 groups and the Abstinence group (ps > 0.025). CONCLUSIONS:This randomized study demonstrates that adults who switch completely from smoking cigarettes to use of JUUL2 ENDS products substantially reduce their exposure to HPHCs associated with smoking-related diseases. INTERNATIONAL STANDARD REGISTERED CLINICAL TRIAL NUMBER:ISRCTN27662176.

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.

Objective: Numeric rating scales (NRSs) could be inappropriate for assessing constructs such as risk perception if individuals with limited health numeracy (LHN) have difficulty expressing their perceptions on such scales. This paper compares the psychometric functioning of numerical risk perception ratings for an e-cigarette obtained from LHN individuals, comparing them to those from individuals with adequate health numeracy (AHN). Methods: In a randomized trial of a risk-related message (not evaluated here), participants (N = 12,557) used NRSs to rate their perception of (1) overall risk of harm (from 0 %-100 % harmful to health), and (2) likelihood (0-100 %) of suffering four tobacco-related diseases from using e-cigarettes; and used a 4-point adjectival scale ('not at all harmful' to 'very harmful') to rate the harm of using e-cigarettes. Based on the Newest Vital Sign (NVS), 29 % of participants were classified as LHN. Results: Numeric ratings of e-cigarette harm in LHN and AHN groups showed a nearly identical and equally strong relationship to verbal perceived risk ratings. Analyses of disease-specific ratings as a unidimensional scale demonstrated configural, metric, and scalar invariance between ratings from LHN and AHN individuals. Conclusion: LHN individuals are able to make meaningful ratings using numeric scales, comparable to those from AHN individuals.

Professional firefighters are routinely exposed to occupational stressors that place them at a higher risk of developing mental health symptoms, including anxiety, depression, and posttraumatic stress. This article discusses findings of the National Wellness Survey for Public Safety Personnel, specifically the stressors that professional firefighters are exposed to on the job and their impact. Results indicated high levels of both occupational and individual stressors in this group. Common occupational and personal stressors and mental health symptomology endorsed by professional firefighters are discussed. Findings also revealed that about 40% of professional firefighters are facing clinically substantial levels of anxiety and depression, and more than 10% are experiencing clinically significant levels of posttraumatic stress disorder in numbers surpassing the general population. Most professional firefighters indicated being adversely impacted by their duties but did not want to utilize services, which is in line with prior research. Suggestions for assisting professional firefighters in mitigating occupational and personal stress are presented, and proposals for future research are provided. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

OBJECTIVES:Real-world evidence on exposure to harmful and potentially harmful constituents (HPHCs) and on biological effects in cigarette smokers who switch to electronic nicotine delivery systems (ENDS) can inform the health effects of switching. AIMS AND METHODS:This cross-sectional, observational study assessed adults who had smoked ≥10 cigarettes/day for ≥10 years, comparing 124 continuing cigarette smokers (Smokers) to 140 former smokers who switched to JUUL-brand ENDS exclusively for ≥6 months (Switchers). Assessments included biomarkers of exposure (BOEs) to select HPHCs, biomarkers of potential harm (BOPHs) related to smoking-related diseases, psychometric assessments of dependence on cigarettes and ENDS, respectively, and respiratory symptoms. Planned analyses compared geometric means, adjusted for demographic covariates; further analyses adjusted for additional lifestyle and smoking history covariates. RESULTS:Nicotine levels were significantly higher in Switchers (median time switched = 3 years), who were unusually heavy users of JUUL. All other BOEs, including NNAL and HPMA3 (primary endpoints), were significantly lower in Switchers than Smokers. Most BOPHs (sICAM-1 [primary], and eg, white blood cell count, MCP1, HbA1c) were significantly lower in Switchers than Smokers; HDL was significantly higher. Switchers reported significantly lower dependence on JUUL than Smokers did on cigarettes, and respiratory symptom scores were significantly lower among Switchers than Smokers. CONCLUSIONS:Compared to continuing smokers, smokers who switched to JUUL had substantially lower exposures to multiple HPHCs, favorable differences in markers of inflammation, endothelial function, oxidative stress, and cardiovascular risk, and fewer respiratory symptoms. These findings suggest that switching from cigarettes to JUUL likely reduces smokers' health risks. IMPLICATIONS:Short-term confinement studies and randomized clinical trials demonstrate that adult smokers who switch completely to ENDS experience substantial reductions in exposure to many smoking-related toxicants. This study extends those findings to longer periods of switching to JUUL-brand ENDS (almost 3 years on average) under naturalistic use conditions in real-world settings and also found that switching to JUUL resulted in favorable differences in BOPHs more proximally related to smoking-induced disease, as well as in respiratory symptoms. Smokers who switch to ENDS reduce their exposure to toxicants, likely reducing their disease risk.

The past decade has witnessed increased clinical and investigative attention directed to the mental health of active-duty firefighters. Yet, to our knowledge, no investigations have focused on the well-being of retired firefighters, despite awareness of retirement posing significant challenges for many older adults in general, and, in particular, first responders. The purpose of this study was to (a) conduct an initial assessment of psychological functioning in 315 retired firefighters, (b) examine the relationship between overall psychological functioning and self-concept clarity (i.e., the extent to which an individual's self-concept is clearly defined, internally consistent, and temporally stable), and (c) determine whether self-concept clarity moderates and/or mediates relationships between psychological functioning and relevant demographic and personal variables. Results indicated firefighters suffer from mental health symptoms associated with psychological disorders, such as depression and posttraumatic stress disorder, at higher rates than their same-aged counterparts in the general population. Furthermore, results showed that factors like age, length of time on active duty, and length of time retired, each significantly correlated with overall psychological functioning. Finally, results suggested that self-concept clarity both mediates and moderates the association between overall psychological functioning and personal factors such as daily levels of pain, feelings of financial stability, and access to affordable health care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Smokers often experience respiratory symptoms (eg, morning cough), and those who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in symptoms. Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are intended for patient populations, such as those with chronic obstructive pulmonary disease (COPD). This study aimed to develop a respiratory symptom questionnaire appropriate for current smokers and for assessing changes when smokers stop smoking. The Respiratory Symptom Experience Scale (RSES) was derived from existing instruments and subject matter expert input and refined through cognitive debriefing interviews (n=49). Next, for purposes of the quantitative psychometric evaluation, the RSES was administered to smokers (n=202), former smokers (no tobacco use in >6 months; n=200), and switchers (n=208, smokers who switched to ENDS for >6 months), all of whom had smoked for at least 10 years (mean age 33 years). Participants, who averaged 62 (SD 12) years of age, included 28% (173/610) with respiratory allergy symptoms and 17% (104/610) with COPD. Test-retest reliability was assessed by repeat assessment after 1 week in 128 participants. A generalized partial credit model confirmed that the response options were ordered, and a parallel analysis using principal components confirmed that the scale was unidimensional. With allowance for 2 sets of correlated errors between pairs of items, a 1-factor graded response model fit the data. Discrimination parameters were approximately 1 or greater for all items. Scale reliability was 0.80 or higher across a broad range of severity (standardized scores −0.40 to 3.00). Test-retest reliability (absolute intraclass correlation) was good, at 0.89. RSES convergent validity was supported by substantial differences (Cohen d=0.74) between those with and without a diagnosis of respiratory disease (averaging 0.57 points, indicating that differences of this size or smaller represent meaningful differences). RSES scores also strongly differentiated those with and without COPD (d=1.52). Smokers’ RSES scores were significantly higher than former smokers’ scores (P<.001). Switchers’ RSES scores were significantly lower than smokers’ scores (P<.001) and no different from former smokers’ scores (P=.34). The RSES fills an important gap in the existing toolkit of respiratory symptom questionnaires; it is a reliable and valid tool to assess respiratory symptoms in adult current and former smokers, including those who have switched to noncombusted nicotine products. This suggests that the scale is sensitive to respiratory symptoms that develop in smokers and to their remission when smokers quit or switch to noncombusted nicotine products intended to reduce the harm of smoking. The findings also suggest that switching from cigarettes to ENDS may improve respiratory health.

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.

Emergency communication operators (ECOs) are routinely exposed to duty-related trauma and tasked with obtaining pertinent information to identify the nature of the emergency, allocate necessary resources and provide critical details to those responding to the crisis. Stress associated with responding to a difficult call places ECOs at an increased risk for mental health problems. This paper presents results of the National Wellness Survey for Public Safety Personnel, concerning the impact of occupational stressors ECOs experience. Findings indicate high prevalence rates of occupational and personal stressors, as well as diagnostic impressions of ECOs. The findings revealed that more than one-third of ECOs are experiencing clinically significant levels of anxiety, depression, and PTSD. Consistent with research, ECOs endorsed being negatively affected by their job, yet were reluctant to seek help. Implications of the findings for assisting ECOs in alleviating stress are considered. Suggestions for future directions in this area are offered.