Lilianna Phan

Introduction Nicotine pouch sales have substantially increased in the US. We examined the patterns of dually using nicotine pouches with other tobacco products, and whether nicotine pouch use was associated with tobacco product use cessation. Methods A nationally representative sample of US adults (≥21 years) participated in an online survey in 2024 and provided information about their tobacco use behaviours in 2023 and 2024, along with demographics. This analysis was restricted to those who reported using any tobacco products in 2023 (n=1460). Data were weighted to be nationally representative. Predictive marginal probability differences (PMPDs) were used to examine the association between nicotine pouch use in 2023 and tobacco product use cessation in 2024. Results In 2023, 12.0% of US adults who used tobacco products reported currently using nicotine pouches with another tobacco product. Among those who used nicotine pouches dually with at least one other tobacco product in 2023, none switched to exclusive nicotine pouch use in 2024 and 47.1% continued dual-use, 10.1% stopped using all tobacco products and 42.8% stopped using nicotine pouches in 2024. US adults who dual-used nicotine pouches with other tobacco products in 2023 had lower probabilities than those who did not dual-use to quit tobacco product use in 2024 (10.1% vs 23.7%; PMPD=−15.2%, 95% CI −20.8% to −9.6%). Conclusions Among US adults who dually used nicotine pouches with other tobacco products, none completely switched to exclusive nicotine pouch use. Nicotine pouch use was also not associated with increased probabilities of quitting tobacco product use.

Multilevel interventions in healthcare settings (e.g. Ask, Advise, and Connect; AAC) can reduce tobacco product use among adult patients: their effectiveness in pediatric practice is largely unknown. We implemented an AAC model in pediatric primary care to deter children’s tobacco use, and evaluated its effectiveness in a single-arm trial. At wellness visits, young patients (ages 12–17) completed a tablet-based assessment (Ask) of lifetime and current tobacco use. These data were made available within the electronic health record to pediatric primary care providers for preventive counseling (Advise). Providers then referred patients to an e-health evidence-based tobacco control intervention (Connect). Tobacco control outcomes were examined in the clinic population (N = 2219) and in a sample of patients (N = 388, 62% female, 39% non-White, M age = 15) over time, along with intervention engagement. Population use of tobacco products decreased following introduction of AAC (more than 2-fold). At the patient level, most children (80.9%) engaged with the intervention: those who were Black or African American, who never used tobacco products/were not susceptible to use, and who used fewer non-cigarette tobacco products were more likely to engage, but only after multiple prompts versus a single prompt. Engagement was positively associated with lowering children’s susceptibility to using tobacco at follow-up. A pediatric AAC model holds promise in deterring youth tobacco use, including among historically marginalized populations who may require additional support. By implementing a multilevel Ask, Advise, and Connect intervention, pediatric tobacco use declined in a clinical population, with high intervention engagement and improved outcomes.

Background Public education exposing cigarette industry practices have been effective in changing attitudes and preventing smoking among young people. It is unclear how much young adults are aware of e-cigarette industry practices, and how this awareness relates to anti-e-cigarette attitudes. We examined demographic correlates of awareness of e-cigarette industry practices and anti-e-cigarette attitudes, and the association between awareness of these practices with anti-e-cigarette attitudes. Methods A US sample of young adults aged 18–30 years who do not use commercial tobacco products but are susceptible to e-cigarette use were cross-sectionally surveyed through online panel services from August 2021 to January 2022. Respondents reported their demographics, awareness of cigarette industry practices, awareness of e-cigarette industry practices and their level of agreement with four anti-e-cigarette attitude statements. We used multivariable linear regressions to examine demographic associations and the relationship between awareness of e-cigarette industry practices with each anti-e-cigarette attitude, adjusting for demographics and awareness of cigarette industry practices. Results Generally, Hispanic and Black young adults (vs White) and those with Discussion Public education exposing e-cigarette industry practices may promote anti-e-cigarette attitudes among susceptible young adults who do not use commercial tobacco products. Future research should investigate the utility of anti-e-cigarette industry messaging.

Introduction Many individuals experienced financial hardship during the COVID-19 pandemic; yet commercial tobacco (CT) sales increased in the USA. We examined how experiencing financial hardships relates to increased CT discount coupon reception during the pandemic. Methods A nationally representative sample of 1700 US adults who used CT during the 12 months prior to the survey were surveyed online during January to February 2021. Participants reported if they had received more discount coupons for various CT products during (compared with before) the pandemic. They also reported whether they experienced six different types of financial hardships since the pandemic, and the total number of hardships experienced was counted. Weighted multivariable logistic regressions were used to examine the associations between financial hardships and increased coupon reception, adjusting for demographics and CT product use. Results During the first 10–11 months of the pandemic, 21.3% of US adults who used CT during the 12 months prior to the survey reported receiving more CT discount coupons. Experiencing financial hardship during the pandemic was associated with higher odds of receiving more coupons for all types of CT products: every additional count of financial hardship was associated with higher odds of increased reception of discount coupons for all CT products (adjusted odds ratios ranging from 1.13 to 1.23 across products). Conclusions Over one-fifth of US adults who used CT received more discount coupons during the pandemic. Those facing financial hardships had higher discount coupon reception, suggesting potential targeted marketing to financially vulnerable individuals by the tobacco industry.