Amid increasing rates of electronic cigarette (e-cigarette) use in the United States, there is an urgent need to monitor patterns of use at the population level in order to inform practice, policy and regulation. This article examines how patterns of e-cigarette use among adults differ between users and nonusers of cigarettes using the most current national data. We analyzed data from the 2014 National Health Interview Survey. We estimated prevalence of ever, current, and daily e-cigarette use and examined how use patterns differed by demographic subgroups and measures of cigarette smoking status that accounted for the recent availability of e-cigarettes in the US marketplace. Current e-cigarette use is extremely low among never cigarette smokers (0.4%) and former smokers who quit cigarettes 4 or more years ago (0.8%). Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes ( AOR : 4.33 [95% CI: 3.08–6.09]). Extremely low e-cigarette use among never-smokers and longer term former smokers suggest that e-cigarettes neither promote widespread initiation nor relapse among adults. Recognition of the heterogeneity of smokers, including the time since quitting, is critical to draw accurate conclusions about patterns of e-cigarette use at the population level and its potential for public health benefit or harm. Data from 2014 National Health Interview Survey indicate that e-cigarettes have not been attracting adult non-smokers or promoting relapse in longer term former smokers. Moreover, the data are suggestive that some recent quitters may have done so with the assistance of e-cigarettes. Creating measures of smoking status that treat former smokers as a homogenous group is insufficient to assess the epidemiology of e-cigarette use and the potential impact on public health.

Background. Young adulthood provides an enormous opportunity to alter trajectories of smoking behaviour for a large public health impact. Objective. The purpose of this study was to examine correlates of perceived barriers to quitting smoking and reasons to quit in a sample of young adult current and former smokers. Methods. This study used data from the 2011 National Young Adult Health Survey, a random-digit-dial cellphone survey. Participants were US young adult current smokers aged 18–34 (n = 699) and young adults who were either current smokers who had made a quit attempt in the past-year (n = 402) or former smokers (n = 289). Correlates of barriers to quitting smoking and reasons for quitting smoking were assessed using bivariate and multivariable analyses. Results. More than half of current smokers identified ‘loss of a way to handle stress’ (59%) and ‘cravings or withdrawal’ (52%) as barriers to quitting. Female gender, daily smoking and intention to quit remained significantly associated with endorsing ‘loss of a way to handle stress’ as a barrier to quitting in multivariable analyses. The two most popular reasons for quitting smoking were physical fitness (64%) and the cost of tobacco (64%). Conclusion. These findings highlight barriers to cessation and the reasons that young smokers give for quitting. This information may be helpful to physicians as they counsel their young adult patients to quit smoking.

Introduction: The smokeless tobacco (SLT) industry in the U.S. continues to transform with novel products amid an evolving regulatory environment. We report SLT sales trends in the U.S. by analyzing retail market scanner data from 2011 through 2019. Methods: National SLT sales data were obtained from Nielsen's Convenience Track System for January 2011 to December 2019. UPC codes were used to classify products by attributes including type, parent company, brand, form, and flavor. Market share was calculated as percentage of total unit sales. Detailed product analysis was presented for moist snuff, snus, and tobacco-free nicotine products. Results: SLT sales increased by 5.8% between 2011 and 2016 but declined by 3.9% from 2016 to 2019. Moist snuff sales increased by 8.1% between 2011 and 2016 and then declined 7.4% from 2016 to 2019 but still accounted for roughly 90% of the overall market annually. Between 2011 and 2019, snus sales consistently increased while sales of chew, dry snuff, and dissolvables decreased. Tobacco-free nicotine products emerged in 2016 and captured 4.0% of the market by 2019. Portion pouch packaging and flavors showed consistent growth although their popularity varied by the type of smokeless product. Conclusion: This study extends our previous work on U.S. SLT market trends through 2019. Overall sales increased between 2011 and 2016 but there were signs of leveling off including declining sales of moist snuff. Newer products continue to gain market share. Continued monitoring of SLT sales is needed, particularly given the new modified risk status of several products. Implications: This study analyzed the last 9 years of smokeless tobacco market data (2011–2019) to describe recent trends in sales. Overall, the smokeless product category is quite resilient although signs suggest downward trends among some product categories and features. New types of smokeless tobacco products (eg, snus and tobacco-free nicotine pouches) account for a growing share of the market.

An abundance of evidence suggests that the tobacco industry's response to increased regulation imposed on cigarettes has been the development of little cigars and filtered cigars which are tobacco products that are merely cigarettes in disguise. Emphasising these products' physical attributes, the tobacco industry has offered cigar products to its consumers as pseudo-cigarettes. For decades, tobacco manufacturers' response to increased cigarette regulation and taxation has been to exploit policy loopholes by offering these little cigars and filtered cigars pseudo-cigarettes that are exempted from this regulatory oversight. As a result, in spite of increased regulations and taxes on cigarettes, smokers can purchase cigars that are almost physically indistinguishable from their cigarettes at a lower cost. This commentary describes the recent evolution of the cigar market in response to federal regulation, and highlights historical cigar industry attempts to evade taxation, capitalise on product features that are off-limits to cigarettes, and capture the shrinking market of cigarette smokers. We present the case that little cigars and filtered cigars, differing very little physically from cigarettes, are products deserving the same regulatory scrutiny.