Pamela M Ling’s research while affiliated with UCSF University of California, San Francisco and other places

Introduction Although the popularity of oral nicotine products (ONPs) such as ZYN and On! is growing globally, there is limited research on their marketing and advertising. This report describes recent ONP marketing communication to retailers. Promotion to retailers can provide insight into new product flavours and styles, as well as future marketing strategies targeting consumers. Methods We obtained all unique ONP print and online advertisements (ads) (N=50) targeted towards US businesses between January 2016 and August 2022 from Vivvix (formerly Numerator Ad Intel). Two independent reviewers coded for type of ONP, brand, nicotine strength(s), flavour(s), slogan(s), claim(s) and frequency of each component. Results Most ads featured nicotine pouches alone (52%), while 22% featured a mix of ONPs including pouches, tablets and lozenges. By brand, Rogue constituted 36% of ads, followed by Zyn and On! (16% each). Most (82%) ads featured at least one cooling flavour and 48% displayed at least one fruit flavour. Wintergreen flavour appeared most frequently (48%). Most (72%) ads contained a slogan, which frequently highlighted convenience of use (eg, ‘Chew on this Anywhere… Anytime’), bypassing current restrictions on other tobacco and nicotine products use (eg, ‘Laughs at no smoking signs’) and highlighting big profit margins from sales of ONPs for retailers (eg, ‘small pouches big margins’). Conclusion This analysis provides insight into tobacco companies’ strategies for increasing ONP endorsement among retailers. Strategies include appealing to profitability, emphasising convenience of product use and primarily promoting non-tobacco flavours. These findings highlight new trends in ONP products and marketing tactics and identify important areas to monitor to inform tobacco marketing regulations.

Background Dual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation). Objective This formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming. Methods Semistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs. Results Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly “cold turkey.” The priority product for quitting first varied by the individual’s perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement. Conclusions This study provides important insights into young adults’ experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes.

Background Little is known about the role of exposure to e-cigarette–related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling. Objective The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette–related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants’ e-cigarette use. Methods A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46% identified as female and 37/85, 44% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother’s education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration. Results Almost all respondents (83/85, 98%) reported using social media more since shelter-in-place, and 74% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83%) compared to those who did not increase e-cigarette use (25/39, 64%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95% CI 0.71‐8.46). Respondents who felt lonely (AOR 3.33, 95% CI 1.27‐9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95% CI 1.39‐13.41), or had ≥2 family members aware of participants’ e-cigarette use (AOR 6.42, 95% CI 1.29‐39.49) were more likely to report increased e-cigarette use. Conclusions Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic.

Background Tobacco-related cancers are the leading causes of morbidity and mortality among people experiencing homelessness who are 50 years and older. We examined tobacco use, tobacco-related cancer risk, and cancer-related worry among people experiencing homelessness who smoke cigarettes. Methods Between October and November 2020, we recruited a convenience sample of 25 adults experiencing homelessness who reported current smoking and were staying in two shelters in San Francisco, CA. We used the common sense model (CSM) of self-regulation, a framework that connects illness-related beliefs and worry to behaviors that reduce the threat of disease. We focused on the cognitive and affective representations of tobacco-related cancer risk as outlined in the CSM of self-regulation. We conducted in-depth interviews to understand tobacco use, tobacco-related cancer beliefs, and cancer-related worry in the context of homelessness experiences. We obtained information on demographics, tobacco use, and cancer worry from each participant. We analyzed qualitative data using directed content analysis. Results Of the participants, 64% identified as belonging to underrepresented racial/ethnic groups, 80% reported smoking daily, and 80% intended to quit smoking. Participants reported cancer-related worry and attributed their cancer risk to internal (e.g., tobacco use) and external (e.g., secondhand smoke exposure) factors. While participants generally understood cancer and its health consequences, some held the misperception that nicotine, rather than tobacco use, caused cancer. Despite perceptions about the health risks associated with smoking, struggles related to securing basic needs, often preceded health concerns. Specifically, the experience of homelessness and its associated competing priorities posed significant challenges to taking actions, such as quitting smoking to reduce cancer risk. Conclusions Multi-level tobacco cessation interventions that combine structural interventions that reduce barriers to quitting with health messaging to address misperceptions around tobacco-related cancer risk are needed for people experiencing homelessness.

This Viewpoint explores tobacco industry–funded continuing medical education and concerns regarding the precedents this funding sets in relation to commercial bias and influence and conflicts of interest.