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ObjectiveTo examine the role of social media in promoting recall and belief of distorted science about nicotine and COVID-19 and whether recall and belief predict tobacco industry beliefs.DesignYoung adults aged 18–34 years (N=1225) were surveyed cross-sectionally via online Qualtrics panel. The survey assessed recall and belief in three claims about nicotine and COVID-19 and three about nicotine in general followed by assessments of industry beliefs and use of social media. Ordinal logistic regression with robust standard errors controlling for gender, race/ethnicity, education, current e-cigarette use and age was used to examine relationships between variables.ResultsTwitter use was associated with higher odds of recall (OR=1.21, 95% CI=1.01 to 1.44) and belief (OR=1.26, 95% CI=1.04 to 1.52) in COVID-19-specific distorted science. YouTube use was associated with higher odds of believing COVID-19-specific distorted science (OR=1.32, 95% CI=1.09 to 1.60). Reddit use was associated with lower odds of believing COVID-19-specific distorted science (OR=0.72, 95% CI=0.59 to 0.88). Recall (OR=1.26, 95% CI=1.07 to 1.47) and belief (OR=1.28, 95% CI=1.09 to 1.50) in distorted science about nicotine in general as well as belief in distorted science specific to COVID-19 (OR=1.61, 95% CI=1.34 to 1.95) were associated with more positive beliefs about the tobacco industry. Belief in distorted science about nicotine in general was also associated with more negative beliefs about the tobacco industry (OR=1.18, 95% CI=1.02 to 1.35).ConclusionsUse of social media platforms may help to both spread and dispel distorted science about nicotine. Addressing distorted science about nicotine is important, as it appears to be associated with more favourable views of the tobacco industry which may erode public support for effective regulation.

ObjectiveGiven the evolving changes in the disposable e-cigarette market, we explore patterns of sales in the USA by e-liquid volume capacity, nicotine strength and real sales-weighted average prices by both e-cigarette unit and volume of e-liquid.MethodologyWe used NielsenIQ retail scanner data from January 2017 to September 2022 to examine changes over time for average product volume capacity in millilitres, nicotine strength (%) and both sales-weighted average price per disposable unit and per millilitre of e-liquid for each 4-week period.ResultsAmong disposable e-cigarettes sold between January 2017 and September 2022, average volume capacity increased 518% from 1.1 mL to 5.7 mL and average nicotine strength increased 294% from 1.7% to 5%. Sales-weighted average price per disposable unit and millilitres of e-liquid both remained relatively constant until January 2020. From January 2020 through September 2022, average unit prices increased 165.7% from US$8.49 to US$14.07, while the average price of 1 mL of e-liquid decreased 69.2% from US$7.96 to US$2.45.ConclusionsThe current regulatory regime around e-cigarettes has resulted in disposable e-cigarette manufacturers providing consumers with bigger, cheaper disposable e-cigarettes that come in increasingly higher nicotine strengths. Tobacco policy recommendations such as restricting e-liquid capacity and minimum price laws as well as regulations on product characteristics that affect nicotine emissions and delivery such as nicotine strength, nicotine output, device power, and puff duration should be considered in regulating the e-cigarette market.

Tobacco content on Twitter (X) generally opposes regulation. Although a near real-time data source of the public’s response to prominent events heightens the allure of extrapolating public sentiment from Twitter content, tobacco policy sentiment on the platform may be more indicative of industry-affiliated top users. We examined 2 years of tobacco policy discussion on Twitter (X) at the user level (N = 3,159,807 posts) from September 2019 to July 2021. We sampled the 100 most followed, amplified (retweets), influential (H index), and connected (betweenness centrality) users at three different time periods: pre-COVID (September 2019 to February 2020), COVID lockdown (March 2020 to March 2021), and post vaccine rollout (April to July 2021) to characterize top users. The Louvain method was used to partition users into communities based on retweet behavior. The 100 most amplified users received between 48% and 71% of all retweets across time periods, with e-cigarette advocates dominating the most amplified (64.7%), influential (38.4%) and connected users (42.1%). The vast majority of interaction took place in communities dominated by e-cigarette advocates, but only reaching 2.5% to 8.2% of users. We identified 58 tobacco policy top users who had 1,000 or more total retweets and were among the top 100 for any of our influence metrics at more than one time period. Among top users, 50 were e-cigarette advocates, and 24 had quantifiable ties to the tobacco industry. Practitioners and researchers should be wary of mischaracterizing industry public relations on social media as public sentiment.

BackgroundSocial media discussion tends to follow news about proposed or enacted government policies. Thus, digital discourse surveillance may be an effective and unobtrusive way of understanding industry and public response to policies and regulations, including in the domain of tobacco control. Recently, the US Food and Drug Administration restricted sales of flavoured cartridge and disposable vape products. Historically, the tobacco industry used modification of product characteristics, labelling or packaging to work around flavour restrictions. We aimed to characterise strategies used by nicotine product manufacturers and vendors to promote flavoured products on Instagram and to identify policy workaround tactics.MethodsKeyword rules were used to collect flavoured electronic cigarette-related Instagram posts from CrowdTangle, from 1 January 2019 to 31 December 2021. Posts were coded for commercial content and promotional strategies using a combination of machine learning methods, keyword algorithms and human coding. Additional exploratory analyses were conducted to identify major discussion themes. Non-English posts were excluded from the analyses.ResultsKeyword filters captured 113 393 relevant posts from 391 unique accounts, with 46 076 posts referencing flavour promotion (40.6%) and 2124 (2%) posts mentioning alternatives to restricted flavoured products or strategies to evade flavour sales restrictions. Promotional messages featured non-characterising flavour references, ‘off-brand’ product substitutes, promotion of new flavoured product technologies, innovation, do-it-yourself appeals, global promotion, international delivery and encouraged flavoured product stockpiling. In addition, promotion of refillable devices, e-juice, tank systems and ‘box mod’ vaporizers was present.ConclusionSocial media surveillance can enhance our understanding of public health needs and policy compliance, as well as inform strategies to prevent policy evasion. Examining evolving industry tactics to promote flavoured products in response to regulatory changes can help authorities and practitioners assess policy effectiveness and inform future design and implementation approaches.

BackgroundThe tobacco industry has spent millions of dollars promoting racialised narratives against the US Food and Drug Administration’s recently announced ban on menthol as a characterising cigarette flavour. This research investigates racialised narratives in online discourse following the ban’s announcement.MethodsTweets and users responding to the April 2022 menthol ban announcement were content analysed to examine the influence of tobacco industry affiliates and potentially organic African-American/Black (AA/B) users. Next we investigated the extent to which the menthol ban was discussed on AA/B subreddits and used Latent Dirichlet Allocation topic modelling to provide an overview of the menthol ban discussion on Reddit.ResultsOnly 28 (13.9%) tweets by 22 users claimed that the menthol ban would lead to police violence and/or racial discrimination. Of users who tweeted about over-policing, eight (36.4%) had financial connections to the tobacco industry. There were only three tweets receiving a combined seven retweets from potentially organic AA/B users. On Reddit, only two posts with one comment discussed the menthol ban on subreddits dedicated to AA/B issues and culture. Topic modelling showed that the most common topic related to the menthol ban involved the social and political implications of the ban followed by illicit markets and protecting youth.ConclusionTweets claiming a menthol ban will lead to police violence are indicative of industry agenda-setting. The menthol ban was not a prominent topic of discussion in AA/B subreddits although users discussing news and politics expressed concern for how AA/B people would respond to a ban politically.

PurposeThis study analyses the Food and Drug Administration (FDA) warning letters sent to e-cigarette companies from 1 January 2020 to 9 September 2021. Study results can inform regulation of e-cigarettes.MethodologyWarning letters retrieved from FDA’s website were coded for company type (retailer, manufacturer or distributor), location (domestic or international), infractions listed (PMTA (premarket tobacco product application), selling to minors, advertising to youth or packaging violation/mislabelling), product type (e-liquid, device or both), flavour (fruit, candy, tobacco, menthol/mint, concept flavour) and consequence (civil money penalties, product seizure and injunction, product detention and refusal of entry to the USA, no-tobacco-sales order, criminal prosecution).ResultsOf 303 coded letters (126 from 2020 and 177 from 2021), 97.4% were sent to small online retailers. Overall, 94.1% of the companies cited were located within the USA, 75.2% of the infractions were identified by reviewing a company’s website and 70.5% were PMTA violations. In 2020, 55.6% of infractions were PMTA violations; in 2021, nearly all infractions were PMTA violations. The letters cited 880 products; 92.2% of which were e-liquid products, with 32.4% fruit and 31.1% concept flavours.DiscussionWarning letters targeted small online retailers rather than large e-cigarette brands or products most used by youth: pod mods and disposables. The focus of these enforcement actions comprises a small share of the market and the impact on use was likely minimal. With PMTA decisions pending for the largest brands of e-cigarettes, the FDA should use its enforcement powers to target manufacturers, distributors and sellers of the tobacco products that have the greatest impact on youth and products that provide no public health benefit.

The person responsible for assigning the review October 30 of Arthur Koestler's new book to an anti-Zionist and pro-Arab like Kermit Roosevelt is in a sense to be congratulated. He evidently had no hope of finding a reviewer who would try to be objective, so he made a choice of one whose background and prejudices should lead to controversial and thought-provoking comments.

\"Concerned\" in his letter of June 15 betrays a noticeable lack of concern for accuracy and truth.

One to two percent of couples suffer recurrent pregnancy loss and over 50% of the cases are unexplained. Whole genome sequencing (WGS) analysis has the potential to identify previously unrecognized causes of pregnancy loss, but few studies have been performed, and none have included DNA from families including parents, losses, and live births. We conducted a pilot WGS study in three families with unexplained recurrent pregnancy loss, including parents, healthy live births, and losses, which included an embryonic loss (<10 weeks’ gestation), fetal deaths (10–20 weeks’ gestation) and stillbirths (≥ 20 weeks’ gestation). We used the Illumina platform for WGS and state-of-the-art protocols to identify single nucleotide variants (SNVs) following various modes of inheritance. We identified 87 SNVs involving 75 genes in embryonic loss (n = 1), 370 SNVs involving 228 genes in fetal death (n = 3), and 122 SNVs involving 122 genes in stillbirth (n = 2). Of these, 22 de novo , 6 inherited autosomal dominant and an X-linked recessive SNVs were pathogenic (probability of being loss-of-function intolerant >0.9), impacting known genes (e.g., DICER1 , FBN2 , FLT4 , HERC1 , and TAOK1 ) involved in embryonic/fetal development and congenital abnormalities. Further, we identified inherited missense compound heterozygous SNVs impacting genes (e.g., VWA5B2 ) in two fetal death samples. The variants were not identified as compound heterozygous SNVs in live births and population controls, providing evidence for haplosufficient genes relevant to pregnancy loss. In this pilot study, we provide evidence for de novo and inherited SNVs relevant to pregnancy loss. Our findings provide justification for conducting WGS using larger numbers of families and warrant validation by targeted sequencing to ascertain causal variants. Elucidating genes causing pregnancy loss may facilitate the development of risk stratification strategies and novel therapeutics.

Despite the prevalence of vaping nicotine, most nicotine cessation research remains focused on smoking cigarettes. However, the lived experience of quitting smoking is different from quitting vaping. As a result, research examining the unique experiences of those quitting vaping can better inform quitting resources and cessation programs specific to e-cigarette use. Examining Reddit forums (ie, subreddits) dedicated to the topics of quitting vaping nicotine can provide insight into the discussion around experiences on quitting vaping. Prior literature examining limited discussions around quitting vaping on Reddit has identified the sharing of barriers and facilitators for quitting, but more research is needed to investigate the content comprehensively across all subreddits. The objective of this study is to examine content across quit vaping subreddits since their inception to better understand quitting vaping within the context of the expanding nicotine market. All posts from January 2015 to October 2021 were scraped from all quit vaping subreddits: r/QuittingJuul, r/QuitVaping, r/quit_vaping, and r/stopvaping (N=7110). Rolling weekly average post volume was calculated. A codebook informed by a latent Dirichlet allocation topic model was developed to characterize themes in a subsample of 695 randomly selected posts. Frequencies and percentages of posts containing each coded theme were assessed along with the number of upvotes and comments. Post volume increased across all subreddits over time, spiking from August - September of 2019 when vaping lung injury emerged. Just over 52% of posts discussed seeking social support and 16.83% discussed providing social support. Posts providing support received the most positive engagements (i.e. upvotes) of all coded categories. Posts also discussed physical and psychological symptoms of withdrawal (30.65% and 18.85%, respectively), strategies for quitting including: quitting cold turkey (38.33%), using alternative nicotine products (17%), and tapering down nicotine content (10.50%). Most posts shared a personal narrative (92.37%) and some discussed quit motivation (28.20%) and relapse (14.99%). This work identifies a desire for peer-to-peer support for quitting vaping, which reinforces existing literature and highlights characteristics of quitting vaping specific to a changing nicotine product environment. Given that posts providing social support were the most upvoted, this suggests that subreddit contributors are seeking support from their peers when discussing quitting vaping. Additionally, this analysis shows the sharing of barriers and facilitators for quitting, supporting findings from prior exploration of quit vaping subreddits. Finally, quitting vaping in an ever-growing nicotine market has led to the evolution of vaping-specific quit methods such as tapering down nicotine content. These findings have direct implications for quit vaping product implementation and development.