Sleep Difficulties and Their Associations With Smoking Abstinence Among Adults Seeking Tobacco Cessation Treatment

American Journal of Preventive Medicine · 2026-03-18

INTRODUCTION: In prior studies, sleep difficulties have been associated with lower likelihood of smoking cessation, although little is known about this relationship among people trying to quit smoking. This study aimed to examine the associations between pre-existing sleep difficulties and smoking cessation outcomes in adults seeking tobacco cessation treatment. METHODS: Participants in a New Jersey statewide cessation program between November 2019 and July 2022 provided self-reported smoking abstinence at 1-month (n=2,919) and/or 7-month (n=1,471) follow-ups. Participants completed 3 items on sleep difficulties at baseline: difficulty sleeping (past and present) and insomnia as a withdrawal symptom. Multivariable logistic regression models estimated the associations between sleep difficulties and smoking cessation at each follow-up, controlling for sex, age, household income, ethnicity, and baseline heaviness of smoking index in 2024. RESULTS: At baseline, 3.6% of participants reported difficulty sleeping in the past, 20.1% reported difficulty sleeping in the present, and 14.6% experienced insomnia as a withdrawal symptom. Lower income, depression, anxiety, excessive alcohol and caffeine use, dual use, and identifying as male or Hispanic were associated with higher odds of pre-existing sleep difficulties (e.g., OR=4.30, 95% CI=3.66, 5.04). Sleep difficulty in the past was positively associated with nonabstinence at 1-month follow-up (AOR=2.95, 95% CI=1.28, 6.79) and 7 months (AOR=4.64, 95% CI=1.06, 20.23). There were no associations between the other 2 measures of sleep difficulties and cessation outcomes. CONCLUSIONS: Pre-existing sleep difficulties may be associated with lower short-term smoking abstinence among adults seeking tobacco cessation treatment. Addressing pre-existing sleep difficulties in smoking cessation interventions may enhance the chances of successful smoking cessation.

Assessing the impact of a reduced chemical exposure claim in advertisements for US Food and Drug Administration-authorized e-cigarette products among youth and young adults

Nicotine & Tobacco Research · 2026-02-20 · 1 citations

Abstract Introduction We tested whether e-cigarette advertisements (ads) with a claim of reduced chemical exposure (RCE) and various brands impact e-cigarette-related perceptions among young people. Methods A randomized, 2 × 3 between-subjects experiment was embedded in a web-based survey of youth (ages 13-17) and young adults (ages 18-29) who smoke cigarettes (n = 1667) or who do not use tobacco (n = 833). Participants viewed 1 of 6 e-cigarette ad conditions that varied according to 2 manipulated factors: RCE claim (present or absent) and e-cigarette brand (Logic Power, Vuse Vibe, or Njoy Ace). After viewing the ad, perceptions about the ad and the promoted e-cigarette product in the ad were assessed. Results We did not observe an e-cigarette brand effect or interactive effects between the two main factors on any outcomes. Among those who smoke, the RCE claim generated increased perceptions that the ad made them want to use (P = .039) or completely switch to the e-cigarette (P = .048). Among those who do not use tobacco, it led to elevated perceptions that the e-cigarette is less addictive than cigarettes (P = .034) and intentions of using the e-cigarette compared to cigarettes (P = .009). Conclusion E-cigarette ads containing a RCE claim may be perceived as more effective in influencing product use and complete switching intentions among young people who smoke. While we did not observe such an effect among those who do not use tobacco, future efforts to promote e-cigarette MRTP claims should aim to limit exposure to such claims among this audience to mitigate the potential for unintended effects. Implications This study demonstrates the potential influence of reduced chemical exposure (RCE) claims in advertisements (ads) for US Food and Drug Administration-authorized e-cigarette products among young adults who smoke, suggesting that such claims may enhance the perceived effectiveness of advertising. Although we found few significant effects among tobacco-naïve youth and young adults, any efforts to promote e-cigarette RCE claims should aim to limit exposure to such claims among these young audiences to mitigate the potential for unintended effects. These results will be critical to understanding how RCE claims in e-cigarette ads may differentially shape e-cigarette-related perceptions and behaviors across young people of diverse tobacco-use groups.

Pushing the US nicotine pouch market: insights from Zyn’s free can campaign in September 2025

Tobacco Control · 2026-02-23

Examining the implementation of court-ordered cigarette ‘corrective statements’ displayed in a regional sample of US tobacco retailers

Tobacco Control · 2026-01-29 · 1 citations

INTRODUCTION: In 2022, a US Federal District Court ordered cigarette companies to display 'corrective statements' in over 200 000 tobacco retailers to remediate years of consumer fraud. This study conducted store assessments in a sample of affected retailers in New York City and New Jersey to document implementation features and differences by store type and community characteristics. METHODS: Addresses of retailers required to display statements were geocoded and spatially joined with US Census Zip Code Tabulation Areas. Within nine counties, 627 retailers were randomly sampled and visited for inperson assessments between October 2024 and May 2025 to document sign presence, number and characteristics (eg, size, location, obstruction). Multilevel logistic regressions measured differences by store type and zip code demographics (in quartiles). RESULTS: Signage display was generally high (92.2%), but lower in non-chain convenience stores (91.4%; OR: 0.33 (0.13, 0.84)) and smoke/vape shops (84%; OR: 0.14 (0.05, 0.43)) versus chain convenience stores (97.2%), which also displayed a higher volume of signs. Stores in zip codes with the highest percentage of non-Hispanic Black residents (Q4) had significantly lower display rates (88.6%; OR: 0.22 (0.06, 0.77)) versus Q1 (96.4%). Among 906 coded signs, 63.5% were the larger format, 40.3% were located above the tobacco display, 36.6% were near the exterior entrance and 6.1% were obstructed, indicating high visibility. CONCLUSIONS: Differences in corrective statement display and volume may shape exposure opportunities, influencing population impacts. Future research should examine whether consumers notice and process these messages in real-world conditions, critical precursors to knowledge or behavioural change.

Leveraging inoculation theory to combat the spread of health misinformation

Behavioral Science & Policy · 2025-10-01

Health misinformation is a growing problem in today’s world, reflecting an increasingly polarizing discourse in social and news media as well as declining trust in institutions. It is a particularly concerning issue in public health, where its effects can range from individually damaging to disastrous on a population level. In this article, we present and investigate one approach for addressing health misinformation—inoculation strategies—focusing specifically on tobacco marketing, which frequently uses suggestive descriptors that imply reduced harm. We theorized that inoculation strategies, that is, exposing people to weakened versions of opposing arguments to make them more resistant to persuasion or influence, can prevent misperceptions about a topic while preserving accurate favorable beliefs. We found that inoculation messages generally prevented lower-harm misperceptions without affecting lower-addictiveness beliefs for reduced nicotine content cigarettes or opinions about other modified risk tobacco products. We also found that information about prior industry deception promoted industry skepticism. These findings expand the evidentiary base for inoculating against misinformation, exploring strategies for nuanced communication of potentially competing messages. They also can inform policy and messaging strategies for health campaign designers and tobacco regulators.

Targeting three United States priority populations of people who smoke with educational nicotine messages using curiosity-eliciting strategies

Scientific Reports · 2025-07-02 · 1 citations

Misperceptions about nicotine are associated with reduced smoking cessation success and a lower likelihood of using less harmful nicotine products. Three priority populations – Black/African American adults, rural adults, and young adults who smoke in the United States – tend to hold more nicotine false beliefs relative to other groups and are at risk for poor smoking cessation outcomes. The present study used an optimization phase in the form of a 23 factorial design to identify the curiosity-eliciting message components (social signals, questions, ratings) with the greatest likelihood of reducing nicotine false beliefs in each priority population (n = 200 for each population). Following message optimization, we compared exposure to targeted messages (from the optimization phase) with no message exposure and exposure to standard nicotine messages in new samples (n = 200 for each priority population). Targeted messages significantly reduced nicotine false beliefs (and other relevant outcomes) in Black/African American adults who smoke and rural adults who smoke. In young adults who smoke, targeted messages significantly reduced nicotine false beliefs compared to the no message exposure condition, but did not show additional benefits beyond standard nicotine messages. Findings highlight the benefit of an optimization phase and curiosity-eliciting strategies in messages designed to reduce nicotine false beliefs.

The Impact of Cigarillo Text Warning Presence and Size on Young Adults’ Cigarillo Risk Beliefs, Knowledge, Appeal, and Use Intentions

Nicotine & Tobacco Research · 2025-04-03

INTRODUCTION: Cigar warning labels can serve as health communication tools; yet current cigar warnings in the United States can be small or absent, and efforts to standardize them have met industry resistance, partly because of limited research. AIMS AND METHODS: In 2021, we conducted an online 3 × 2 × 2 factorial experiment with 1352 young adults (aged 18-34) past 12-month cigar users. Participants viewed a cigarillo pack image that varied by: text-only warning size (none; small 15%-of-pack label; larger 30%-of-pack label); warning color (White; Black); and brand (Swisher Sweets; White Owl). We compared group means on risk perceptions, knowledge, and intentions. RESULTS: Packs with any warning label (vs. none) elicited higher endorsement that the packs made participants think about the health risks of smoking cigarillos (p < .001), as did packs with larger 30%-of-pack versus 15%-of-pack warnings (p < .001). Packs with a warning label (vs. without) elicited greater absolute perceptions of cigarillo harm (p < .001), as did 30%-of-pack versus 15%-of-pack warnings (p < .001). Risks referenced in the stimuli warning (mouth and throat cancer) were more frequently mentioned in an open-ended knowledge item by participants in conditions with a warning label versus the no-warning condition (p < .05). Packs with 30%-of-pack warnings were also rated as less attractive and elicited lower use intentions than packs without a warning or with the 15%-of-pack warning (p < .05). CONCLUSIONS: Results provide evidence that cigar text-only warning labels, particularly larger ones, can facilitate some cigar risk knowledge and beliefs, reduce pack appeal, and discourage product interest, supporting policy efforts to strengthen cigar warning requirements. IMPLICATIONS: Our results suggest that the use of the small text warnings on cigarillo packs (~15% of pack size), as currently still found in the United States based on existing Federal Trade Commission agreement guidelines, is better than having no warnings at all, but that larger warnings sized at 30% of the pack (as proposed by the U.S. Food and Drug Administration (FDA) and voluntarily used by some brands/manufacturers) could have significant benefits across a range of outcomes. Study findings lend support for the cigar warning requirements proposed by the U.S. FDA through the Deeming Rule.

Marketing for Sensa: a ‘zero nicotine vapor product’ from a major tobacco company

Tobacco Control · 2025-02-16 · 2 citations

Trends in patient tobacco use behaviors as reported by tobacco treatment providers: Findings from a repeated cross-sectional survey

Tobacco Prevention & Cessation · 2025-10-20

The tobacco marketplace is more varied than ever, giving consumers a breadth of products to choose from, including cigarettes, cigars, smokeless tobacco, electronic cigarettes, and nicotine pouches 1 .Product diversity has resulted in increasingly complex patterns of tobacco use, including experimentation with new products and multiple tobacco product use 2,3 , and a more complicated policy landscape where regulations differ by product 4,5 .Tobacco treatment providers (i.e.individuals providing tobacco treatment services) may be among the first to notice changes in patients' quitting or shifts in tobacco product use behaviors resulting from the availability of new products or policy changes 6 .Accordingly, the Rutgers Center for Rapid Surveillance of Tobacco (CRST) conducts bi-annual cross-sectional surveys of the Association for the Treatment of Tobacco Use and Dependence (ATTUD), a large professional organization of primarily US-based tobacco treatment providers, for signal generation of such changes among their clients.Here, we report observations about provider-reported patient tobacco use behaviors collected during the first two survey waves.We solicited participation from ATTUD members via email requests through the organization's listserv to complete a short, online survey hosted on the Qualtrics platform during January-March 2024 (Wave 1) and November-December 2024 (Wave 2) (Supplementary file).Eligible participants indicated currently providing tobacco and/or nicotine product treatment to patients in the US and consented to participate in the survey.Wave 1 participants received no compensation; to increase participation in Wave 2, all those who completed the survey were offered a $25 Amazon gift card.Fifty-one and ninety-two tobacco treatment providers completed Wave 1 and Wave 2, respectively.They were geographically diverse, 60% had graduate degrees, and 77% were Certified Tobacco Treatment Specialists.Table 1 illustrates, across both waves, the percentage of tobacco treatment providers reporting in the past 6 months if patients: 1) mentioned a particular tobacco product, 2) reported seeking cessation from a particular tobacco product, and 3) reported using a particular tobacco product to support quitting another product.Of note, across both waves, combustible and electronic cigarettes were the most common products that providers reported their patients sought to quit using (>90%), followed by smokeless tobacco (>70%), and cigars (>50%).E-cigarettes were also the most commonly reported product that providers observed patients using to quit another tobacco product (>90%), followed by nicotine pouches (>50%).In response to open-ended questions asking providers to share about their clinical encounters, several providers expressed concerns about the nicotine concentrations and lack of regulation of vaping products, as well as the increased

Self-reported exposure and reactions to cigarette corrective statements at the point-of-sale among US adults who smoke and youth

Tobacco Control · 2025-12-25 · 1 citations

INTRODUCTION: Following a historic 2006 US Federal Court ruling, major cigarette manufacturers were mandated to display corrective statements about smoking harms at the point-of-sale (POS) in about 200 000 tobacco retailers nationwide from October 2023 to June 2025. This study assessed sign exposure and reactions among US adults who smoke (AWS) cigarettes and youth. METHODS: An online survey was conducted in late 2024 with nationally representative samples of (≥21 years) AWS (n=1575) and youth aged 15-20 (n=1039). Respondents viewed image examples and reported sign exposure over the past 12 months. Measures included exposure frequency, sign reactions and sociodemographic and behavioural correlates. Weighted prevalence estimates and multivariable logistic regression were used. RESULTS: Self-reported exposure was 26.2% among AWS and 18.4% among youth. Exposure was higher among more frequent visitors to chain convenience stores and gas stations, younger adults, AWS interested in quitting and youth who had tried cigarettes. Most exposed participants saw the signs multiple times and reported signage trust (80.2% AWS; 88.7% youth), support (85.3% AWS; 88.7% youth) and thoughts about smoking risks (71.4% AWS; 81.9% youth). Sign exposure was considerably lower than for tobacco ads at POS (84.0% AWS; 74.3% youth). CONCLUSIONS: About 18% of youth and 26% of smoking adults reported corrective statement exposure at POS. While exposure was positively associated with store visitation frequency, exposure was lower than for other tobacco POS messaging, suggesting that visual competition and limited retailer coverage may have constrained reach. Findings can inform future health messaging strategies in retail environments.