The United States (U.S.) Food and Drug Administration has expressed concern about flavored e-cigarettes (e.g., JUUL brand) because they are appealing to youth who may be unaware that the product is addictive. The Population Assessment of Tobacco and Health Study Wave 3 provided data on flavor categories, type of e-cigarette product, and smoking status among past 30-day youth and adult e-cigarette users in the US. Most past 30-day youth and adult users reported using only one flavor category, with fruit (53% youth, 31% adult) being the most commonly reported category. Adults were far more likely to report using tobacco flavor alone, compared to any other individual flavor category or flavor category combinations (OR: 21.08, 95%CI: 5.92, 75.12). Whereas, youth were more likely to report using multiple flavor categories (OR: 2.03, 95%CI: 1.55, 2.65), with the most reported pairing being fruit and candy (36%). The variety of flavors on the market appeals to consumers of all ages. Although most past 30-day e-cigarette users reported only one flavor category, non-tobacco flavors were far more common among youth. Differences in flavor preferences among adult versus youth vapers may have implications for the role of flavors in both the initiation of youth vaping and adult vaping for smoking cessation.

Introduction: Oral Nicotine Pouches (ONPs) are the new form of nicotine pouches that have become a type of emerging smokeless tobacco product sold by various tobacco companies. These smokeless tobacco products are marketed for usage all over as snus containing tobacco-derived nicotine (natural) or as tobacco-free nicotine (synthetic) as substitutes for other tobacco products. Based on perception and socio-behavioral aspects, ONPs have become popular tobacco products among adolescents/young adults, and over 50% of young adult users of ONP use flavored ONPs, such as menthol/mint, tobacco, dessert/candy, and fruity, which are the most popular flavors. Various new ONP flavors are currently popular locally as well as in the online market. Tobacco, menthol, and fruit-flavored ONPs could motivate cigarette smokers to change to ONPs. Methods: We expanded our knowledge on natural/synthetic ONP flavor wheels to available data on ONPs, describing, in detail, their flavors and brands (US and Europe) in both natural and synthetic ONP categories. We classified over 152 snus and 228 synthetic ONPs into the following flavor categories: “Tobacco”, “Menthol/Mint”, “Fruity”, “Candy/Deserts”, “Drink”, “Aroma”, “Spices”, and “Mixed Flavors”. Results: Based on total numbers, we found the most popular ONP flavors, sold as tobacco and menthol, to be among natural ONPs; among synthetic ONPs, fruity and menthol are the most prominent flavors, with varying concentrations of nicotine and other flavoring chemicals, including coolant WS-23. We also showed possible molecular targets and toxicities, due to exposure to ONPs, activating several signaling cascades such as AKT and NF-kappaB, which might possibly lead to apoptosis and epithelial mesenchymal transition (EMT). Conclusions: Considering the marketing of ONP products with various flavor profiles and with most of these products containing tobacco/menthol/fruit flavor, it is likely to have regulation and a marketing disclaimer on some of these products. Further, it would be logical to determine how the market reacts in terms of compliance and non-compliance with flavor restrictions by the regulatory agencies.

Background: Oral nicotine pouches are a new form of tobacco-free nicotine products launched in recent years with a variety of flavors. Objective: This study aims to examine the public perceptions and discussions of oral nicotine pouches on Reddit, a popular social media platform for sharing user experiences. Methods: Between February 15, 2019, and February 12, 2021, a total of 2410 Reddit posts related to oral nicotine pouches were obtained over a 2-year period. After the removal of unrelated or commercial posts, 653 Reddit posts related to oral nicotine pouches remained. Topics and sentiments related to oral nicotine pouches on Reddit were hand coded. Results: The number of Reddit posts related to oral nicotine pouches increased during the study period. Content analysis showed that the most popular topic was “sharing product information and user experience” (366/653, 56%), in which sharing oral nicotine pouch products and user experiences were dominant. The next popular topic was “asking product-related questions” (product properties and product recommendations; 115/653, 17.6%), followed by “quitting nicotine products” such as vaping or smoking through use of oral nicotine pouches or quitting the oral nicotine pouches themselves (83/653, 12.7%) and “discussing oral nicotine pouch–related health” symptoms or concerns related to oral nicotine pouches (74/653, 11.3%). The least popular topic was “legality and permissions” related to oral nicotine pouches (15/653, 2.3%). In addition, a greater number of Reddit posts described positive attitudes compared to negative attitudes toward oral nicotine pouches (354/653, 54.2% vs 101/653, 15.5%; P<.001). Conclusions: Reddit posts overall had a positive attitude toward oral nicotine pouches and users were actively sharing product and user experiences. Our study provides the first insight on up-to-date oral nicotine pouch discussions on social media.

• Statewide vaping prevalence was significantly associated with COVID-19 cases on a state level. • Statewide vaping prevalence was significantly associated with COVID-19 death on a state level. • This study emphasizes the importance of studying the susceptibility of current vapers to COVID-19 cases and death.

Background: Scanning with low-dose computed tomography reduces lung cancer mortality by 20% among high-risk individuals. Despite its efficacy, the uptake of lung cancer screening (LCS) remains low. Our study aimed to estimate state-level and nationwide LCS rates among eligible individuals and to assess disparities in LCS uptake. Methods: Data for this study were obtained from the 2022 Behavioral Risk Factor Surveillance System. Multivariable logistic regression models were used to model the associations between predictors and outcome variables and to examine LCS variability across states. Results: Of the 28,071 participants eligible for LCS, 17.24% underwent LCS. Participants ages 65 to 79 years were [OR, 1.75; 95% confidence interval (CI), 1.54–1.99] more likely to undergo LCS than their younger counterparts. Those who were female (OR, 0.83; 95% CI, 0.73–0.94); divorced, separated, or widowed (OR, 0.85; 95% CI, 0.74–0.98); without health insurance (OR, 0.34; 95% CI, 0.22–0.53); without a primary care provider (OR, 0.29; 95% CI, 0.19–0.44); and without chronic obstructive pulmonary disease or those who did not disclose their chronic obstructive pulmonary disease status (OR, 0.35; 95% CI, 0.31–0.40 and OR, 0.37; 95% CI, 0.19–0.73, respectively) were less likely to undergo LCS than their respective counterparts. LCS uptake also varied significantly across U.S. states. Conclusions: We observed a low uptake of LCS overall and significant variability in LCS uptake by sociodemographic and health-related factors, as well as by state of residence. Impact: The findings from this study have important implications for community health workers and healthcare clinicians and indicate the need to design effective interventions to increase LCS uptake, targeting specific subgroups of populations and particular U.S. states. See related In the Spotlight, p. 9

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