Children prefer sweet flavors more than adults do,¹ and tobacco industry documents^2-5 confirm that flavors in tobacco products can increase their appeal to young and inexperienced tobacco users. Consistent with studies^6-8 on menthol cigarettes and flavored cigars, data from the first wave of the Population Assessment of Tobacco and Health (PATH) Study^9-11 revealed a strong inverse age gradient in the prevalence of flavored tobacco product use, with the highest use among youth aged 12 to 17 years, followed by young adults aged 18 to 24 years, and the lowest use among adults aged 25 years and older. These data^9,10 also show a strong association between first use of a flavored tobacco product and current tobacco use among youth and adults.

Background While cigarette consumption in the USA continues to decline, promotion for and consumption of smokeless tobacco (SLT) is growing. However, little research has explored what product features are driving SLT growth, despite awareness that product-level factors may be important in SLT use. This study analyses national sales data to better understand the impact of product features on SLT sales. Methods Data on sales of SLT in US convenience stores from 2005 to 2011 were obtained from Nielsen Research Company. Each listed product was coded for attributes such as type, brand, flavouring and form to calculate their respective total sales, market share and contribution to overall SLT growth. Results Sales of moist snuff products (including snus) increased by 65.6% between 2005 and 2011. Sales of pouched and flavoured forms of moist snuff increased by 333.8% and 72.1%, respectively, and contributed to 28% and 59.4% of the total growth in the moist snuff category, respectively. Value/discount brands accounted for 42% of moist snuff sales in 2011 among the top 10 selling brands, largely driven by Grizzly. After 2 years on the national market, Camel Snus was also one of the top 10 selling moist snuff brands. Conclusions Sales of moist snuff, both overall and for particular styles, are increasing. Growing pouch use may be attributed to new SLT users, which may include cigarette smokers using them as starter SLT products. Increased sales of flavoured and discounted snuff raise concerns about use and appeal to youth. Continued surveillance of SLT sales trends is warranted.

Objectives. Tobacco product risk perceptions may influence whether individuals use those products instead of or in addition to regular cigarettes. This study aimed to explore risk perceptions of various tobacco products relative to traditional cigarettes with young adults, a group with higher rates of tobacco use. Method. We examined risk perception responses among a nationally representative sample of young adults (age 18-34 years; n = 2,871, including tobacco and non–tobacco users) from the 2011 National Young Adult Health Survey. Results. Most (57.8%) respondents believed that e-cigarettes were less risky than cigarettes. Respondents were more likely to rate combustible products hookah (24.5%) and cigars (13.9%) as being less risky compared to noncombustible snus (10%) and other smokeless tobacco (SLT) products (7.1%) relative to cigarettes. Few (2.5%) rated menthol cigarettes as less risky. For e-cigarettes, hookah, and SLT, less risky beliefs were significantly higher among ever or current versus never product users. Between 22% and 33% of all respondents believed that SLT, snus, menthol cigarettes, and cigars were more risky than cigarettes, but differences in this belief between current and nonusers of these products were small and insignificant. Younger young adults were more likely to rate e-cigarettes and hookah as being “less risky” and rate cigars and SLT as being “more risky” than older young adults. Conclusion. The public’s views of comparative tobacco risk perceptions vary widely by tobacco product type and age-group. While “less risky” perceptions may be associated with product use, perceptions that products are “more risky” than cigarettes may not necessarily dissuade people from their use.

JUUL has emerged as the leading brand in a rapidly evolving electronic cigarette (e-cigarette) market. JUUL is distinctive for its novel nicotine delivery method that results in high nicotine concentrations, as well as its sleek, discreet design. This study examined national estimates of JUUL among youth in the United States, including whether JUUL users report different patterns of use compared to users of other e-cigarettes. Data were analyzed from the US arm of the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and E-cigarette Survey, an online survey conducted in July–August 2017 with youth aged 16–19 years recruited from consumer panels (n = 4086). Overall, 14.2% of respondents had used an e-cigarette in the past 30 days. JUUL was the second-most popular brand reported by past-30-day e-cigarette users (9.7%). Compared to e-cigarette users of other brands, JUUL users were significantly older (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI] = 1.56 to 4.01) and reported a greater number of computers in the household (a socioeconomic status proxy; aOR = 1.55, 95% CI = 1.22 to 1.96), with no differences by sex, race/ethnicity, or student status. Controlling for sociodemographic variables, JUUL users were more likely than other e-cigarette users to have ever tried to quit e-cigarettes (aOR = 2.65, 95% CI = 1.12 to 6.30), with no differences observed by smoking status, frequency of e-cigarette use, urges to use e-cigarettes, or perceived addiction to e-cigarettes. JUUL was among the most popular e-cigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between users of JUUL and other e-cigarette brands. This study examined national estimates of JUUL e-cigarette use among youth in the United States, during the early phase of JUUL’s popularity. JUUL was among the most popular e-cigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between JUUL and other e-cigarette brands. The findings help to characterize the rapid rise of this new product category within the rapidly evolving e-cigarette market at a time when the US Food and Drug Administration and public health community are seeking to understand JUUL and its appeal among young people.

Product and marketing innovation is key to the tobacco industry’s success. One recent innovation was the development and marketing of flavored cigarettes as line extensions of 3 popular brands (Camel, Salem, and Kool). These products have distinctive blends and marketing as well as innovative packaging and have raised concerns in the public health community that they are targeted at youths. Several policy initiatives have aimed at banning or limiting these types of products on that basis. We describe examples of the products and their marketing and discuss their potential implications (including increased smoking experimentation, consumption, and “someday smoking”), as well as their potential impact on young adults.