Tragic Triad of Tobacco Dependence, Cancer, and COVID-19 Pandemic: An Urgent Call for Attention by Health Care Systems and Professionals

Tobacco smoke is a well-known carcinogen associated with multiple malignancies. Patients with cancer, as well as survivors, who continue to smoke are at a greater risk for poor cancer treatment outcomes. With the emergence of the COVID-19 pandemic, there is increased frequency and severity of the infection in patients with cancer. Furthermore, smoking and/or vaping increases incidence or likelihood of progression of COVID-19. Cigarette smoking, cancer, and COVID-19 each impose disproportionate burden of illness and death among racial and ethnic minorities. Geographic and population-specific analyses reveal that neighborhoods with lower income and higher minority populations have more tobacco/vape shops and face increased risk associated with tobacco marketing. Referral to tobacco cessation has been reduced during the pandemic. To reduce the adverse health effects of tobacco dependence among patients with cancer during the pandemic, urgent evidence-based solutions are described for health systems and professionals to prioritize tobacco cessation for patients with cancer in the midst of the COVID-19 pandemic, on the basis of cessation implementation at City of Hope Medical Center.

Machine learning models of tobacco susceptibility and current use among adolescents from 97 countries in the Global Youth Tobacco Survey, 2013-2017

Adolescents are particularly vulnerable to tobacco initiation and escalation. Identifying factors associated with adolescent tobacco susceptibility and use can guide tobacco prevention efforts. Novel machine learning (ML) approaches efficiently identify interactive relations among factors of tobacco risks and identify high-risk subpopulations that may benefit from targeted prevention interventions. Nationally representative cross-sectional 2013–2017 Global Youth Tobacco Survey (GYTS) data from 97 countries (28 high-income and 69 low-and middle-income countries) from 342,481 adolescents aged 13–15 years (weighted N = 52,817,455) were analyzed using ML regression tree models, accounting for sampling weights. Predictors included demographics (sex, age), geography (region, country-income), and self-reported exposure to tobacco marketing, secondhand smoke, and tobacco control policies. 11.9% (95% CI 11.1%-12.6%) of tobacco-naïve adolescents were susceptible to tobacco use and 11.7% (11.0%-12.5%) of adolescents reported using any tobacco product (cigarettes, other smoked tobacco, smokeless tobacco) in the past 30 days. Regression tree models found that exposure or receptivity to tobacco industry promotions and secondhand smoke exposure predicted increased risks of susceptibility and use, while support for smoke-free air policies predicted decreased risks of tobacco susceptibility and use. Anti-tobacco school education and health warning messages on product packs predicted susceptibility or use, but their protective effects were not evident across all adolescent subgroups. Sex, region, and country-income moderated the effects of tobacco promotion and control factors on susceptibility or use, showing higher rates of susceptibility and use in males and high-income countries, Africa and the Americas (susceptibility), and Europe and Southeast Asia (use). Tobacco policy-related factors robustly predicted both tobacco susceptibility and use in global adolescents, and interacted with adolescent characteristics and other environments in complex ways that stratified adolescents based on their tobacco risk. These findings emphasize the importance of efficient ML modeling of interactions in tobacco risk prediction and suggest a role for targeted prevention strategies for high-risk adolescents.

National Trends of Adolescent Exposure to Tobacco Advertisements: 2012–2020

BACKGROUND AND OBJECTIVES The objective of the current study is to evaluate the temporal trends in the prevalence of cigarette and electronic cigarette (e-cigarette) advertisement exposure by venue and sociodemographic correlates among US adolescents from 2012 to 2020. METHODS We conducted a serial cross-sectional analysis of nationally representative samples of middle and high school youth from the 2012–2020 National Youth Tobacco Survey. Advertisement exposure was defined as self-report of seeing advertisements “sometimes,” “most of the time,” and “always.” The prevalence of cigarette (and other tobacco products) and e-cigarette advertisement exposure, including overall and at specific venues (Internet, press, screen, and retail stores), was estimated by survey year. RESULTS A total of 139 795 adolescents aged 11 to 19 years old were included in the analysis. The prevalence of exposure to combustible cigarette marketing remained high across all years (any venue ranging from 77.0% [2018] to 91.1% [2014]). An increasing trend for cigarette advertisement exposure was observed from 2017 to 2020 after a drop in 2015 (β2012–2015 = 2.8, P for trend < .001; β2017–2020 = .7, P for trend = .03), driven by retail store–based and Internet-based exposure. A similar increasing pattern in the estimated prevalence of e-cigarette marketing was observed (β2014–2016 = 4.6, P for trend < .001; β2017–2020 = 5.1, P for trend < .001). CONCLUSIONS Given the high estimated prevalence of cigarette and e-cigarette marketing exposure among US adolescents, further regulation efforts for both off-line and online tobacco marketing are needed to mitigate adolescent exposure to content regarding these products, reducing susceptibility to uptake.

Research on Curriculum Examination Mode of Cultivating Students’ Independent Learning Ability – Taking Hotel Management Major (Specialty Direction on Tobacco) as an Example

Scientific and reasonable examination mode can not only make effective evaluation and feedback, but also play an important role in cultivating students' good learning habits and shaping their social and vocational adaptability. Meanwhile, it is also an important method of cultivating students' innovative spirit and creative ability. Specialty direction on tobacco emphasizes cultivating senior disciplinary talents who will engage in tobacco promotion and rational use, tobacco marketing and tobacco enterprise management. So it is necessary to practice various and effective examination modes to make students master the knowledge they have learned well and truly achieve the aim of professional training. Thus the students may become qualified talents with professional quality of tobacco industry.

Influence of cigarillo packaging characteristics on young adults’ perceptions and intentions: findings from three online experiments

ObjectivesPackaging is an important component of tobacco marketing that influences product perceptions and use intentions. However, little research exists on cigar packaging. We leveraged variability in existing Swisher Sweets cigarillo packaging to extend the evidence base.MethodsBetween 2017 and 2019, we conducted three online experiments with 774 young adult past-year cigar smokers recruited via Amazon Mechanical Turk. After viewing Swisher package images that differed by flavour descriptor and/or colour, participants rated them on perceptions and purchase intentions. In study 1, participants viewed one of four cigarillos (‘Wild Rush Encore’, ‘Wild Rush Limited’, ‘Twisted Berry’ and ‘Strawberry’). In study 2, participants viewed two different watermelon rum-flavoured cigarillos (‘Boozy Watermelon’ and ‘Island Madness’). In study 3, participants viewed two of three ‘Wild Rush’ cigarillo versions (‘Encore’ with or without an explicit flavour descriptor or ‘Limited’).ResultsIn study 1, more participants perceived ‘Twisted Berry’ and ‘Wild Rush Limited’ as tasting good and less harsh tasting compared with ‘Wild Rush Encore’. In study 2, compared with ‘Island Madness’, more participants perceived ‘Boozy Watermelon’ as tasting good, less harsh tasting and used by younger users but less by masculine users; female participants were more likely to purchase ‘Boozy Watermelon’. In study 3, participants perceived ‘Wild Rush Encore’ with the explicit flavour descriptor as tasting better than packages without and being used by younger users but less by masculine users.ConclusionsVariations in cigarillo packaging, even among cigarillos with the same flavour, may have differential consumer appeal, suggesting packaging features should be considered in cigar product regulation.

Exploring the Discursive Function of Hashtags: A Semantic Network Analysis of JUUL-Related Instagram Messages

This study used semantic network analysis to investigate the themes of JUUL electronic cigarette-related messages on Instagram posted by three account types (commercial, vape community, and organic users) and explore the function of hashtags in the JUUL-related discourse across these groups. Posts were collected from 1 March 2018 to 15 May 2018. We conducted network analyses for each user group, with separate analyses to examine texts with and without inclusion of hashtags. Network statistics determined which words occurred most frequently, which words co-occurred or clustered together, and what communication function hashtags perform. Analyses of message content with hashtags included revealed that the largest cluster of terms by account type was brand promotion (commercial), brand engagement (community), and youth social use of JUUL and other substances, such as marijuana (organic users). On removal of hashtags, the largest cluster for each group was online and offline retailer promotion (commercial), JUUL promotion or shares of existing promotional content (community), and youth social use (organic users). Commercial accounts used hashtags to increase brand visibility and engage with vape communities present on Instagram. Community accounts served as discursive intermediaries between commercial accounts and organic users, fostering organic user engagement with brands. Social media serve as an extension of real-life peer groups among youth and young adults. Community accounts, which likely have greater credibility among users compared to commercial accounts, may help enhance the effects of targeted promotion and normalize vaping comprehensive regulation of commercial digital tobacco marketing is necessary to reduce the amount of commercial content youth and other consumers are exposed to through overt commercial and influential community accounts.

Gender Representation in Chinese Tobacco Advertising

The broad development prospects of the Chinese tobacco consumer market have attracted an increasing number of international companies to do business and invest in China. In tobacco marketing campaign, gender representation in advertising is a common and effective means to attract consumers. It has a great significance to marketing practitioners and advertisers, especially in the emerging market of China. A comprehensive understanding of gender representation in Chinese advertising can provide a universal framework for marketing campaign and help establish an academic foundation for market segmentation. This literature review aims to research the portrayal of gender representative images and roles in Chinese advertising, their formation reasons and changing trends. Drawing on huge number of academic journals, research papers and academic books in the online academic literature database, this literature review will critically analyze and summarize the literature related to gender representation in Chinese tobacco advertising. The results show that the characteristics of gender representation in traditional Chinese advertisements are influenced by traditional Chinese culture, socialist political policies and Western value culture, and tend to modern Western advertising models. The gender representation in Chinese online advertising emphasized the concept of self and began to show more Chinese characteristics. In the future, the booming Chinese online advertising will have more variables and more complex trends, and there will be a huge academic gap left for future research.