• FY2022 Annual Survey.

• Deadline of October 31: Comment Opportunity - Medicaid and CHIP Core Set.
• SelfMade Health Network Webinar Series on Lung Cancer Disparities - Part 3. 
• Webinar on November 3 at 2:30 pm ET: Future Priorities for Federal Commercial Tobacco Regulation: A Conversation with Dr. Brian King.
• November 8 and 9: Continuing Education Credits & Certification in Nicotine Dependence Treatment.
• Webinar on November 10 at 1 pm ET: Illuminating a path forward for Tobacco Nation: Projected Impacts of Recommended Policies on Geographic Disparities.
• Deadline of November 25: FDA Seeks Nominations for Tobacco Products Scientific Advisory Committee.

• Upcoming Virtual Tobacco Treatment Training and Education Offerings.
• 2021 BRFSS Public Data Set Now Available.
• NACCHO Tobacco Report: View from the Field.
• FDA’s New, Adult Smoking Cessation Social Media Animations and New Online Vaping Prevention and Education Resource Center.
• Tobacco Control Network Adopts New Strategic Plan.
• Next Round of Drug-Free Communities Program Funding Available in January 2023.
• FDA Enforcement Likely Resulting in Minimal Impact on E-cigarette Accessibility.
• OSH Public Service Announcements Now Available in North Dakota.
• Now Available: Mitch Zeller's September 29 Talk on "Nicotine and Tobacco Regulatory Policy - A Look Back and a Look Forward".

Lachter RB, Rhodes KL, Roland KM, et al.
Turning Community Feedback into a Culturally Responsive Program for American Indian/Alaska Native Commercial Tobacco Users.
Prog Community Health Partnersh. 2022;16(3):321-329. doi:10.1353/cpr.2022.0049

Background. American Indian/Alaska Native (AI/AN) cigarette smoking prevalence is disproportionately high, especially in the northern United States. Tailored quitlines are needed to support AI/AN commercial tobacco users with quitting.
Objectives. Obtain community feedback by working with trusted AI/AN partners; genuinely incorporate feedback into program design; collaboratively develop and implement culturally relevant quitline services for Minnesota's AI/AN community.
Methods. Working in partnership, AI/AN community input was gathered, and community partners were engaged to inform the development, training, implementation and monitoring of a tailored program within the existing state quitline.
Results. Findings suggest focusing on the commercial tobacco user/coach relationship, increased cultural understanding and program content adaptations could make quitlines more acceptable for AI/AN commercial tobacco users.
Conclusions. The development and launch of the AI Quitline demonstrated the feasibility of collaboration among AI/AN organizations and community members, funders and providers to create a culturally relevant cessation service for AI/AN commercial tobacco users.

Choi K, Jones JT, Ruybal AL, McNeel T, Duarte DA, Webb Hooper M.
Trends in Education-related Smoking Disparities among U.S. Black/African American and White Adults: Intersections of Race, Sex, and Region.
[published online ahead of print, 2022 Oct 14]. Nicotine Tob Res. 2022;ntac238. doi:10.1093/ntr/ntac238

Introduction. Despite its overall decline in the U.S., trends in cigarette smoking could vary by intersection with demographic characteristics. We explored trends in education-related disparities in current smoking among U.S. adults by race (Black/African American and White), sex, and U.S. census region.
Methods. Data were from U.S. civilian non-institutionalized adults (aged 18+ years) who self-identified as Black and White and participated in the 1995-2019 Tobacco Use Supplement to the Current Population Survey. We estimated average annual percent changes in current cigarette smoking by the intersections of race, sex, census region, and educational attainment. We calculated educated-related prevalence differences (PDs) in current cigarette smoking by subtracting the prevalence of bachelor's degrees from that of <high school in 1995-1996 and 2018-2019, then examined their variations by the intersection of sex, race, and region. Weighted multivariable logistic regression models were used to test education*survey year interactions across sexes, races, and regions.
Results. Education-related disparities in current cigarette smoking increased over time, especially among Black/African American male (PD1995-1996=22.8%; PD2018-2019=27.2%) and female adults (PD1995-1996=12.1%; PD2018-2019=16.5%). By region, Black/African American male adults in the Midwest showed the largest increase in education-related current cigarette smoking disparities, followed by Black/African American male and female adults in the South, and White male and female adults in the Midwest. These findings were because of small to no declines in the prevalence of current cigarette smoking among those with <high school education.
Conclusion and relevance. The gap in prevalence of current cigarette smoking by education widened over time, especially among Black/African American adults in certain regions.
Implications. Despite the decline in the prevalence of current cigarette smoking in the U.S. population overall, such public health gain may not benefit all individuals equally. Using the data from a U.S. representative serial cross-sectional survey study during 1995-2019, we found that disparities in current cigarette smoking prevalence between those with <high school versus bachelor's degree education widened especially among Black/African American adults. Future research to investigate the barriers for progress among Black/African American adults with <high school education could inform interventions to reduce racial and education-related cigarette smoking disparities.

Powers JM, Zale EL, Deyo AG, et al.
Pain and Menthol Use are Related to Greater Nicotine Dependence among Black Adults who Smoke Cigarettes at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study.
[published online ahead of print, 2022 Sep 28]. J Racial Ethn Health Disparities. 2022;10.1007/s40615-022-01419-y. doi:10.1007/s40615-022-01419-y

Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.

Patten CA, Koller KR, Sinicrope PS, et al.
Facebook Intervention to Connect Alaska Native People with Resources and Support to Quit Smoking: CAN Quit Pilot Randomized Controlled Trial.
[published online ahead of print, 2022 Sep 20]. Nicotine Tob Res. 2022;ntac221. doi:10.1093/ntr/ntac221

Introduction. There is some evidence that social media interventions can promote smoking cessation. This randomized controlled pilot study is the first to evaluate the feasibility and potential efficacy of a Facebook smoking cessation intervention among Alaska Native adults.
Methods. Recruitment and data collection occurred December 2019-March 2021. Participants were recruited statewide in Alaska using Facebook advertisements with a targeted sample of 60 enrolled. Participants were stratified by gender, age, and rural/urban residence and randomly assigned to receive referral resources on evidence-based cessation treatments (EBCTs) (control, n=30) or these resources plus a three-month, closed/private, culturally tailored, Facebook group (intervention, n=31) that connected participants to EBCT resources and was moderated by two Alaska Native Trained Tobacco Specialists. Assessments were conducted online post-randomization at one, three, and six months. Outcomes were feasibility (recruitment, retention, intervention engagement), self-reported use of EBCTs, and biochemically confirmed seven-day point-prevalence smoking abstinence.
Results. Of intervention participants, 90% engaged (e.g., posted, commented) more than once. Study retention was 57% at six months (no group differences). The proportion utilizing EBCTs was about double for intervention compared with the control group participants at three and six months. Smoking abstinence was higher for intervention than control participants at three months (6.5% vs. 0%, p=0.16) but comparable at six months (6.4% vs. 6.7%, p=0.97).
Conclusions. While additional research is needed to promote long-term cessation, this pilot trial supports recruitment feasibility during the COVID-19 pandemic, consumer uptake, and a signal for intervention efficacy on the uptake of cessation treatment and short-term smoking abstinence.
Implications. This study is the first evaluation of a social media intervention for smoking cessation among Indigenous people. We learned that statewide Facebook recruitment of Alaska Native adults who smoke was feasible and there was a signal for the efficacy of a Facebook intervention on the uptake of evidence-based cessation treatment and short-term (three months) biochemically verified smoking abstinence. Clinically, social media platforms may complement current care models by connecting Alaska Native individuals and others living in hard-to-reach communities to cessation treatment resources.

Goodwin RD, Ganz O, Weinberger AH, Smith PH, Wyka K, Delnevo CD.
Menthol Cigarette Use among Adults who Smoke Cigarettes, 2008 to 2020: Rapid Growth and Widening Inequities in the United States.
[published online ahead of print, 2022 Oct 13]. Nicotine Tob Res. 2022;ntac214. doi:10.1093/ntr/ntac214

Introduction. In April 2021, the United States (US) Food and Drug Administration announced its intention to issue a product standard banning menthol as a characterizing flavor in cigarettes. Given the potential relevance of national estimates of menthol use to pending legislation, this study estimated the prevalence of menthol use among US adults who smoke cigarettes in 2020 and investigated changes in menthol use from 2008-2019 by sociodemographics, mental health, and substance use.
Methods. Nationally representative annual, cross-sectional data from individuals ages 18 and older residing in the US from the 2008-2019 and 2020 National Survey on Drug Use and Health (NSDUH) were analyzed using logistic and linear regression models to estimate trends in menthol use among adults who smoke cigarettes by sociodemographic, mental health and substance use variables (total analytic sample 2008-2019 n=128,327).
Results. In 2020, 43.4% of adults who smoked cigarettes in the past-month used menthol. Menthol use was most common among Black adults (80%) and over 50% of those Hispanic, female, young (ages 18-34), lesbian/gay, with serious psychological distress, and with cigar use used menthol. Menthol use increased among adults who used cigarettes from 2008 to 2019, overall, and grew more rapidly among adults ages 26-34, Hispanic, light cigarette use (1-5 per day) and those who smoked cigars.
Conclusions. Menthol use has increased among US adults who smoke cigarettes over the past decade. Enacting menthol bans could have a widespread public health impact, especially among younger and minoritized groups.
Implications. Menthol cigarette use increased among individuals who smoke cigarettes across from 2008 to 2019 in the US. In 2020, over 40% of smokers used menthol, and menthol use was considerably higher among adult smokers from racial/ethnic minoritized groups, who were younger and who reported mental health problems. The US Food and Drug Administration seeks to ban menthol as a characterizing flavor in cigarettes; our results suggest that such ban is likely to have a wide-ranging impact on public health.

Lee SH, Han DH, Seo DC.
Toward a Better Understanding of Adult Dual Use of Cigarettes and E-cigarettes Based on Use Intensity and Reasons for Dual Use.
[published online ahead of print, 2022 Oct 7]. Addict Behav. 2022;137:107517. doi:10.1016/j.addbeh.2022.107517

Background. Dual use of combustible cigarettes and e-cigarettes is an emerging phenomenon among U.S. adults. Literature suggests two primary reasons for this emerging use (i.e., to help quit smoking and to stealth vape). This study investigated user profiles based on use intensity and the reasons for dual use.
Methods. A total of 1,151 U.S. adult dual users were drawn from the 2018-2019 Tobacco Use Supplement to the Current Population Survey. We divided them into four groups: daily dual users (n = 189), predominant smokers (n = 608), predominant vapers (n = 143), and non-daily dual users (n = 211). We performed weighted multivariable logistic regressions to identify factors associated with the two primary reasons for dual use.
Results. 3 in 10 of U.S. adult dual users used e-cigarettes to help quit smoking while 2 in 10 of U.S. adult dual users used e-cigarettes to stealth vape. Compared to daily dual users, predominant smokers [adjusted odds ratio (AOR) = 0.61, 95% CI = 0.23, 0.62] were less likely to use e-cigarettes to help quit smoking whereas predominant vapers (AOR = 1.80, 95% CI = 1.04, 3.13) were more likely to use e-cigarettes to help quit smoking and less likely to use e-cigarettes to stealth vape (AOR = 0.30, 95% CI = 0.10, 0.89).
Conclusions. There was notable heterogeneity among the four groups of dual users. As the landscape of tobacco use is rapidly changing with an increasing popularity of e-cigarettes, reasons as well as behaviors of dual users need to be regularly monitored for effective tobacco control.

Noar SM, Gottfredson NC, Kieu T, et al.
Impact of Vaping Prevention Advertisements on US Adolescents: A Randomized Clinical Trial.
JAMA Netw Open. 2022;5(10):e2236370. Published 2022 Oct 3. doi:10.1001/jamanetworkopen.2022.36370

Importance. Understanding whether prevention advertisements reduce susceptibility to vaping is important owing to concerning levels of adolescent vaping.
Objective. To examine whether vaping prevention advertisements from the US Food and Drug Administration (FDA) national Real Cost campaign lead to lower susceptibility to vaping among adolescents.
Design, setting, and participants. For this 3-group randomized clinical trial with parallel assignment, participants were US adolescents aged 13 to 17 years who were susceptible to vaping or current e-cigarette users, recruited from online panels. Adolescents were randomized to 1 of 2 Real Cost vaping prevention trial groups (health harms- or addiction-themed advertisements) or to a control group (investigator-created neutral videos about vaping). Adolescents completed 4 weekly online surveys at visits 1 to 4 over a 3-week period. Data were analyzed from December 1, 2021, to August 25, 2022.
Interventions. Adolescents saw 3 randomly ordered 30-second video advertisements online at each of 3 weekly study visits (visits 1, 2, and 3).
Main outcomes and measures. The primary trial outcome was susceptibility to vaping. Surveys also assessed susceptibility to smoking cigarettes to examine any spillover effects of vaping prevention advertisements on smoking outcomes. Both susceptibility measures had 3 items and ranged from 1 (indicating not susceptible) to 4 (indicating highly susceptible). The primary analyses compared Real Cost groups (combined) with the control group, while exploratory analyses compared the Real Cost groups with each other.
Results. Participants were 1514 adolescents (1140 [75.3%] boys; mean [SD] age, 15.22 [1.18] years), including 504 randomized to the Real Cost health harms group, 506 randomized to the Real Cost addiction group, and 504 randomized to the control group. Adolescents in the Real Cost groups (combined) had lower susceptibility to vaping at visit 4 than those in the control group (b = -0.21; 95% CI, -0.32 to -0.10). The Real Cost groups did not differ from one another on susceptibility to vaping (visit 4: b = -0.05; 95% CI, -0.17 to 0.07). Adolescents in the Real Cost groups (combined) also had lower susceptibility to smoking cigarettes than those in the control group (b = -0.21; 95% CI, -0.32 to -0.10). For both vaping and smoking, Real Cost groups had less positive attitudes (vaping: b = -0.27; 95% CI, -0.40 to -0.14; smoking: b = -0.23; 95% CI, -0.39 to -0.08) compared with the control group.
Conclusions and relevance. These findings suggest that vaping prevention advertisements from the FDA Real Cost campaign led to lower adolescent susceptibility to vaping and had beneficial spillover effects on cigarette smoking outcomes. Tobacco prevention campaigns can help reduce youth tobacco use.

Cooper M, Park-Lee E, Ren C, Cornelius M, Jamal A, Cullen KA.
Notes from the Field: E-cigarette Use among Middle and High School Students — United States, 2022.
MMWR Morb Mortal Wkly Rep 2022;71:1283–1285. DOI: http://dx.doi.org/10.15585/mmwr.mm7140a3

Since 2014, e-cigarettes have been the most commonly used tobacco product among U.S. middle and high school students (1). Most e-cigarettes contain nicotine, which is highly addictive, can harm the developing adolescent brain, and can increase risk for future addiction to other drugs (2). Among middle and high school current e-cigarette users (i.e., use on ≥1 day during the past 30 days), use of disposable e-cigarette devices* increased significantly between 2019 and 2020 (3) and was the most commonly used device type reported in 2021 (4). In 2020 and 2021, approximately eight in 10 middle and high school students who used e-cigarettes reported using flavored e-cigarettes (4,5). CDC and the Food and Drug Administration (FDA) analyzed nationally representative data from the 2022 National Youth Tobacco Survey (NYTS), a school-based, cross-sectional, self-administered survey conducted during January 18–May 31, 2022,^† using a web-based survey instrument and administered to U.S. middle school (grades 6–8) and high school (grades 9–12) students.^§ Participating students could complete the survey whether they were physically in school or at home engaging in remote learning; 99.3% of students reported completing the survey in school. Current e-cigarette use was assessed overall and by frequency of use, device type, flavors, and brands used (any brand used and usual brand used).^¶ Weighted prevalence estimates and population totals were calculated.** The NYTS study protocol was reviewed and approved by CDC’s institutional review board.^††
In 2022, 14.1% of high school students and 3.3% of middle school students reported current e-cigarette use (Table). Among current e-cigarette users, 42.3% reported using e-cigarettes frequently,^§§ including 46.0% of high school students and 20.8% of middle school students; daily use was reported among 27.6% of current e-cigarette users, including 30.1% of high school students and 11.7% of middle school students. Among current e-cigarette users, the types of devices most often used were disposables (high school = 57.2%; middle school = 45.8%), followed by prefilled or refillable pods or cartridges (high school = 25.7%; middle school = 21.6%), and tanks or mod systems (high school = 5.9%; middle school = 9.8%), with 11.2% of high school students and nearly 23% of middle school students reporting not knowing the type of e-cigarette device used.
Among current e-cigarette users, Puff Bar was the most commonly reported brand used in the past 30 days by both middle and high school students (29.7%), followed by Vuse (23.6%), JUUL (22.0%), SMOK (13.5%), NJOY (8.3%), Hyde (7.3%), and blu (6.5%). Among current e-cigarette users, 14.5% reported that the brand they usually used was Puff Bar, followed by Vuse (12.5%), Hyde (5.5%), and SMOK (4.0%). Approximately one fifth (21.8%) of current e-cigarette users reported “some other brand” as their usual brand.
Among current e-cigarette users overall, 84.9% used flavored e-cigarettes; of these, the reported flavor types, in descending order of use, were fruit (69.1%); candy, desserts, or other sweets (38.3%); mint (29.4%); and menthol (26.6%). A similar pattern was observed among current users of flavored disposable e-cigarettes: fruit (75.2%); candy, desserts, or other sweets (40.4%); mint (29.6%); and menthol (16.7%) (Supplementary Table, https://stacks.cdc.gov/view/cdc/121630). Among current users of flavored pods or cartridges, the reported flavor types used were fruit (58.4%); menthol (53.9%); candy, desserts, or other sweets (30.3%); and mint (27.6%). Among current users of flavored tanks or mod systems, the reported flavor types used were fruit (69.6%); candy, desserts, or other sweets (47.7%); mint (40.1%); and menthol (35.2%).
In 2022, 2.55 million U.S. middle and high school students currently used e-cigarettes. Most reported using flavored products, and, among those students, approximately seven of 10 used fruit flavors. Disposable products were the most commonly reported device type. Further, among middle and high school students who used e-cigarettes, approximately four in 10 reported frequent use, and approximately one in four reported daily use. The use of tobacco products in any form, including e-cigarettes, by middle and high school students is unsafe. Sustained implementation of comprehensive tobacco prevention and control strategies at the national, state, and local levels,^¶¶ coupled with FDA regulation and enforcement, is critical to addressing e-cigarette use among middle and high school students (2).

Technology

Whittaker R, Dobson R, Garner K.
Chatbots for Smoking Cessation: Scoping Review.
J Med Internet Res. 2022;24(9):e35556. Published 2022 Sep 26. doi:10.2196/35556

Background. Despite significant progress in reducing tobacco use over the past 2 decades, tobacco still kills over 8 million people every year. Digital interventions, such as text messaging, have been found to help people quit smoking. Chatbots, or conversational agents, are new digital tools that mimic instantaneous human conversation and therefore could extend the effectiveness of text messaging.
Objective. This scoping review aims to assess the extent of research in the chatbot literature for smoking cessation and provide recommendations for future research in this area.
Methods. Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, Google Scholar, and Scopus, as well as additional searches on JMIR, Cochrane Library, Lancet Digital Health, and Digital Medicine. Studies were considered if they were conducted with tobacco smokers, were conducted between 2000 and 2021, were available in English, and included a chatbot intervention.
Results. Of 323 studies identified, 10 studies were included in the review (3 framework articles, 1 study protocol, 2 pilot studies, 2 trials, and 2 randomized controlled trials). Most studies noted some benefits related to smoking cessation and participant engagement; however, outcome measures varied considerably. The quality of the studies overall was low, with methodological issues and low follow-up rates.
Conclusions. More research is needed to make a firm conclusion about the efficacy of chatbots for smoking cessation. Researchers need to provide more in-depth descriptions of chatbot functionality, mode of delivery, and theoretical underpinnings. Consistency in language and terminology would also assist in reviews of what approaches work across the field.

Tobacco Use

Loretan CG, Cornelius ME, Jamal A, Cheng YJ, Homa DM.
Cigarette Smoking among US Adults with Selected Chronic Diseases Associated with Smoking, 2010-2019.
Prev Chronic Dis. 2022;19:E62. Published 2022 Sep 29. doi:10.5888/pcd19.220086

Introduction. People who smoke cigarettes are at greater risk of developing chronic diseases and related complications. Our study provides recent estimates and trends in cigarette smoking among people with respiratory and cardiovascular diseases, cancers, and diabetes.
Methods. Using data from the 2019 National Health Interview Survey, we calculated the prevalence of current and former cigarette smoking among adults aged 18 to 44 years, 45 to 64 years, and 65 years or older with chronic diseases. Those diseases were cancers associated with smoking, chronic obstructive pulmonary disease, diabetes, coronary heart disease, and/or stroke (N = 3,741). Using data from the 2010-2019 National Health Interview Surveys, we assessed trends in current cigarette smoking by chronic disease by using the National Cancer Institute's Joinpoint Regression Program.
Results. In 2019, current cigarette smoking prevalence among adults with chronic diseases associated with smoking ranged from 6.0% among adults aged 65 or older with diabetes to 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases. During 2010 through 2019, a significant decrease occurred in current cigarette smoking among adults aged 45 to 64 years with diabetes.
Conclusion. Overall, smoking prevalence remains high and relatively unchanged among people with chronic diseases associated with smoking, even as the overall prevalence of cigarette smoking in the US continues to decrease. The lack of progress in smoking cessation among adults with chronic diseases associated with smoking suggests that access, promotion, and integration of cessation treatment across the continuum of health care (ie, oncology, pulmonology, and cardiology settings) may be important in the success of smoking cessation in this population.