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How is European Education Governed? Data is now the lifeblood of education governance. At the international level, organisations like the OECD steer education systems through their programmes of assessment and the European Commission's project of creating the most successful knowledge economy in the world is driven by data collection, analysis and comparison. At the national level, policy-makers increasingly depend on data to show them where they are positioned, in relation to their competitors, and draw on data to justify policy directions. Within systems, schools and teachers have become proficient in data use, and interpret their priorities with reference to data. This book draws on a three-year comparative study of the influence of data on education systems in Europe, looking at the contrasting policy contexts of Denmark, England, Finland, Scotland and Sweden, and examining the use of data in these systems, in relation to steering by Europe, as well as policy mediation and 'translation' of data within systems. The authors draw on interviews with key policy actors in the European Commission and with national policy makers in all five systems, as well as on local case studies and a major comparative survey of the effects of data production and use on the work of teachers and headteachers. The research brought together international researchers from a variety of disciplinary backgrounds, including educationalists, political scientists and specialists in research and evaluation. The book offers new arguments relating to the use of Quality Assurance and Evaluation as a means of standardising and harmonising education policy and practice, while also drawing attention to significant variation in policy and practice across these systems. It should be of interest to researchers, post-graduate students and advanced undergraduate students in policy studies in education and more generally.

BackgroundOral nicotine products (ONPs) are increasing in sales, availability and flavours. In April 2022, the US Food and Drug Administration (FDA) obtained regulatory authority over non-tobacco nicotine products, which include many ONPs. Advertising practices for ONPs need monitoring to understand marketing strategies and inform FDA marketing authorisation decisions.MethodsONP advertisement (ad) expenditure data (January 2016–June 2023) were purchased (print, TV, radio, online video, online display and mobile; N=125 236) and adjusted to 2023 dollars. Descriptive statistics examined expenditures by ONP brand and media outlet over time.ResultsVelo spent the most on ONP advertising (89.8%), followed by Zyn (5.7%) and Black Buffalo (1.2%). Velo encompassed the majority of TV (98.1%), radio (99.9%) and mobile ad spend (87.3%); Zyn was the leader for online display (46.2%) and online video (71.1%); and Black Buffalo accounted for 100% of print ads. In 2023, (January–June), Zyn accounted for 88.0% of ad expenditures and Velo spent $0, though the total amount spent by Zyn was far less than Velo in prior years. TV ads (98.1% Velo) aired primarily on prime time/late night or 09:00–17:00 on weekends. Radio ads (99.9% Velo) aired primarily from 06:00 to 10:00, 12:00 to 14:00 and 15:00 to 19:00 on weekdays. Overall, expenditures focused on reaching a national audience, though print ads indicated potential male-targeted marketing.ConclusionsFollowing FDA’s regulatory authority over non-tobacco nicotine products, ad expenditures for Velo dropped to $0. Ongoing surveillance of ONP ad trends can inform FDA marketing authorisation decisions by revealing brand-specific marketing strategies that may be targeted toward populations at increased risk of tobacco use.

Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a \"better alternative\" to combustible cigarettes. Philip Morris International's IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration's (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International's promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy. This study aims to examine HTP-related social media discourse around important policy events. We analyzed HTP-related posts on Twitter during the time period that included IQOS's MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes. Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7%), followed by news/information (862/2796, 30.8%) and direct marketing/retail (321/2796, 11%). Among personal testimonials, more tweets were positive (495/1613, 30.7%) than negative (372/1613, 23.1%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9%) or vaping products (252/1613, 15.6%). Approximately 10% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9%) discussed US and global policy, including misinterpretation about IQOS being a \"safer\" tobacco product after the US FDA's MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3%) and discussing policy (378/1613, 23.4%) showed the largest pairwise co-occurrence. Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas.

Background Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention. Methods Eligible bystanders were Massachusetts residents ≥ 18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews ( N  = 22) were conducted April-July 2018, to inform the development of a subsequent quantitative survey ( N  = 260), conducted February-July 2020. Results Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone. Conclusions Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma, and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

Background Prior research has linked e-cigarette use with chronic obstructive pulmonary disease (COPD). We examined the relationship between e-cigarette use and COPD prevalence in older adults with varying cigarette use status. Methods Data from the 2020 National Health Interview Survey were used to estimate the association between each of 9 exposure categories based on cigarette use (never, former, current) and e-cigarette use (never, former, current), with respondent-reported physician-diagnosed COPD prevalence in individuals 40 years and older ( N  = 22,997). Weighted multivariable analysis accounted for cigarette pack years, age of cigarette smoking onset, race, income-to-poverty ratio, rurality, gender, age, and medical comorbidities. Sensitivity of results was tested in 3 separate models with addition of years since quit cigarettes, smoking intensity and duration. Results 39.7% of individuals reported ever smoking cigarettes and 10.2% reported ever using e-cigarettes. Among individuals with ever e-cigarette use, 88.5% also reported current or former cigarette smoking. The weighted prevalence of COPD was 7.2%; Among those who reported former cigarette smoking, the highest risk of COPD prevalence compared to never cigarette/never e-cigarette use was in those currently using e-cigarettes (adjusted risk ratio (ARR) 2.82, 95% confidence interval (CI) [1.5, 5.3]). The ARR for former cigarette/current e-cigarette use was significantly larger than the ARR for former cigarette/never e-cigarette use ( p  < 0.002) in 3 out of 4 models; however, one model had the ARR attenuated to 1.35 (0.67, 2.76) when years since quitting smoking was added to the model. Other cigarette/e-cigarette combinations were also sensitive to how cigarette smoking history was modeled. For example, ARR for former cigarette/former e-cigarette (1.68 [1.00, 2.80] and current cigarette/former e-cigarette (2.50 [1.56,4.02]) were reduced to 1.05 (0.62, 1.77) and 1.04 (0.62, 1.75) respectively, when cigarette smoking duration was substituted for pack-years. Conclusions Current e-cigarette use among former cigarette smokers was associated with significantly higher COPD prevalence compared to never e-cigarette use. However, COPD risk for most cigarette/e-cigarette combinations could be greatly attenuated by how cigarette smoking history was modeled, raising questions about the robustness of these associations in prior research and the possibility of reverse causality in prior cross-sectional research.

BackgroundZYN is the leading nicotine pouch brand and a predominant driver of nicotine pouch advertising. In November 2022, Philip Morris International (PMI) acquired Swedish Match, the manufacturer of ZYN.MethodsWe conducted a content analysis of 207 US-based consumer-facing ZYN advertisements (ads) from January 2019 to June 2023 to delineate the characteristics of ZYN ads and compare them before and after Swedish Match was acquired by PMI.ResultsMost ZYN ads were on digital media, and nearly all included information on nicotine strength and flavour. Peppermint was the most advertised flavour across time. After the acquisition, ZYN ads included significantly fewer ‘tobacco-free’ claims, whereas ‘spit-free’ claims significantly increased. The most common marketing claims were that multiple choices of products were available, followed by easy to buy, change, sales success, ability to use anywhere and improved social interaction before and after the acquisition. The percentages of ads with easy to buy, change and sales success claims, reward programmes and those linked to websites significantly increased after the acquisition.ConclusionsAfter PMI acquired Swedish Match, ZYN ads used ‘tobacco-free’ claims less frequently. The most advertised marketing claims remained unchanged but were made more frequently in post-acquisition ads. Such claims, together with the promotion of reward programmes and links to websites for easy purchase, may attract young people or those who do not use tobacco to ZYN, indicating a need for increased monitoring and potential restrictions.

IntroductionAlthough 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.MethodsWe 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.ResultsMost 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’).ConclusionThis 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.

Correspondence to Dr Jenny E Ozga; JennyOzga@westat.com Background Menthol tobacco products are associated with cooling sensations in the mouth or throat and the availability of fruit-flavoured or candy-flavoured nicotine products that have cooling properties (with menthone, peppermint or the synthetic coolant WS-23, eg) has grown internationally, particularly in electronic nicotine delivery systems (ENDS)1 2 and commercial oral nicotine products.3 In addition, non-menthol cigarettes with synthetic coolants4 5 and flavour capsule cigarettes6 7 are being sold in markets where flavoured cigarette sales are prohibited.8 Due to policies that include definitions of menthol that do not comprehensively capture additives that have similar properties or evoke similar sensory effects (eg, synthetic coolants and menthol analogues),9 introduction of these novel products and additives may allow tobacco companies to circumvent restrictions on menthol tobacco manufacturing and sales. [...]the group compiled existing self-report measures related to menthol, mint and cooling-flavoured nicotine and tobacco products from the PhenX Toolkit, population-level surveys, projects led by the US Tobacco Centers of Regulatory Science (TCORS) and published literature. Population-level surveys included the Population Assessment of Tobacco and Health (PATH) Study, the International Tobacco Control Survey (both adult and youth versions), the Behavioural Risk Factor Surveillance System, the National Youth Tobacco Survey, the National Health Interview Survey, the National Survey on Drug use and Health, the National Health and Nutrition Examination Survey and the Tobacco Use Supplement to the Current Population Survey. Q1: Tobacco-flavoured Menthol Mint, wintergreen, or spearmint Ice Fruit Fruit-mint or ice-fruit combinations (such as strawberry freeze or blueberry ice)† Clove or spice Chocolate An alcoholic drink (such as wine, cognac, margarita, or other cocktails) A non-alcoholic drink (such as coffee, soda, energy drinks or other beverages) Candy, desserts or other sweets Some other flavour (specify) Q2: Yes No Q1 left ‘as is’, though ‘fruit-mint or ice-fruit combinations’ is recommended as an additional response option given that it is unclear whether someone who uses fruit-cooling flavours would indicate that

Affiliates receive a financial reward for each consumer action (eg, product purchase) tied directly to their marketing efforts.1 Because affiliate marketing is a performance-based strategy that only requires advertisers to pay when a sale occurs, these programmes are common across a variety of business sectors that have turned to digital creators and social media platforms to promote their products.2 A concerning recent trend has been the use of affiliate programmes by tobacco companies, including popular electronic cigarette (e-cigarette) companies like VaporFi and Relx.3–7 These programmes may incentivise social media influencers or businesses to attract new people to tobacco use and potentially hinder prevention efforts, particularly among young people. [...]tobacco product influencers have become pervasive globally.8 Exposure to influencer-generated content has been associated with increased odds of e-cigarette use among nicotine-naïve adolescents/young adults.9 10 Moreover, JUUL—the e-cigarette brand that drove the US youth vaping epidemic—recruited influencers and small businesses to promote JUUL products with enticements to earn up to 25% of affiliated sales.11 12 JUUL voluntarily discontinued their affiliate programme after increased scrutiny of the company’s tactics.12 The American tobacco company Juice Head also promotes an affiliate marketing programme. Juice Head has grown over the years expanding product offerings from e-liquids to include disposable e-cigarettes13 and nicotine pouches14—a fast-growing tobacco product category.15 The company offers products in a variety of flavours (eg, Pineapple Mint, Cake Batter) and colourful packaging; both features could appeal to youth.16 Juice Head’s affiliate programme is operated by ShareASale, a membership network that connects affiliates like ‘a traditional affiliate, blogger, vlogger, podcaster, influencer, or website owner’ with brands.17 18 Information about Juice Head’s affiliate programme on their website (as of 21 May 2024) highlights how affiliates can earn a 10% sales commission (figure 1). The intensified presence of Juice Head in retail stores may increase brand recognition among consumers and facilitate receptivity to future affiliate marketing.22 This is particularly relevant for youth who may be attracted to Juice Head’s appealing flavours and branding.16 Surveillance is needed to monitor tobacco brand affiliate programmes like Juice Head’s, including on social media where sponsored pro-tobacco marketing from registered influencers is prevalent and may promote youth use, despite being prohibited by platforms like Instagram and TikTok.23 24 Comprehensive surveillance efforts may include forensic analysis to uncover financial relationships between brands and influencers and research on the impact of affiliate marketing on consumers’ perceptions of harm, appeal and product initiation.

Rationale Nicotine acts as an agonist for nicotinic acetylcholine receptors (nAChRs), and mecamylamine, a nonselective nAChR antagonist, attenuates effects of nicotine on delay discounting in some rat strains; whether nicotine’s attenuation is specific to nAChR antagonism is unknown. Objective During experiment 1, we evaluated dose-dependent effects of nicotine on delay discounting of pair-housed Lewis (LEW) and Fischer 344 (F344) rats. During experiment 2, we examined the sensitivity of nicotine’s effects on delay discounting to pharmacological antagonism of nAChRs or muscarinic AChRs (mAChRs). Materials and methods Male LEW and F344 were trained to choose between one food pellet delivered immediately and three food pellets delivered after an increasing delay. During experiment 1, saline and nicotine (0.1–1.0 mg/kg) were tested acutely. During experiment 2, mecamylamine (0.25–1.0 mg/kg) or a nonselective mAChR antagonist, scopolamine (0.01–0.056 mg/kg), was administered prior to nicotine administration. Results Nicotine dose dependently reduced delay discounting for both rat strains, and no strain differences were observed (ΔAUC = + 107% for 1.0 mg/kg and + 69.6% for 0.3 mg/kg relative to saline). At some doses, pretreatment with mecamylamine (range ΔAUC = − 27.6 to − 7.3%) or scopolamine (range ΔAUC = − 0.74 to − 51.6%) significantly attenuated the nicotine-induced reduction in some measures of delay discounting for both strains. Conclusions Results from experiment 1 suggest that when LEW and F344 are pair housed, there are no strain differences in delay discounting in response to nicotine. Results from experiment 2 suggest that attenuation of nicotine’s effects on delay discounting may not be specific to nAChR antagonism.