American Legacy Foundation

Although numerous US jurisdictions restrict the sale of flavored tobacco products, the comprehensiveness of policies varies greatly. This study assesses differences in tobacco product use and flavored tobacco use among youth and young adults residing in areas with and without flavored tobacco restriction policies other than federal-level restrictions, by strength of policy. Cross-sectional data come from Wave 1 (October 2022) of the nationally representative Tobacco Epidemic Evaluation Network (TEEN+) Study of US youth and young adults (N = 10255). Respondents' latitude and longitude were used to assign flavor policy coverage as no policy (80.9%), partial policy (major exemptions, 11.1%), or strong policy (minor/no exemptions, 8.0%). Policy coverage varied by several demographic characteristics, including race and ethnicity (P < .001), household smoking (P < .01), and household e-cigarette exposure (P < .01). Compared with living in an area with no flavor policy, a lower prevalence of any tobacco product use (aPR = 0.76, P < .001) and a lower prevalence of any flavored tobacco product use (aPR = 0.70, P < .001) were observed for those covered by strong flavor policies in multivariable Poisson regressions, adjusting for other individual- and state-level covariates. Living in an area with a partial flavor restriction was not significantly associated with different prevalence of either outcome in adjusted models compared with living in an area with no flavor policy. However, currently only 1 in 12 young people are protected by strong flavored tobacco sales restrictions, with notable gaps by race and ethnicity. Strong flavored tobacco sales restrictions that protect everyone, everywhere might help accelerate declines in youth and young adult tobacco use.

Clientelism—the exchange of goods and services for political support—is widely understood as a phenomenon targeted at and demanded by poorer constituents. In this short article, we question that assumption by exploring class differences in preferences for clientelism conditional on the type of goods and services provided. We explore these intuitions through a conjoint experiment in Lebanon, where candidates in national elections make different clientelist pledges of varying value. We find that the poor and rich both disfavor lower-value clientelism, that the rich and poor react similarly toward different types of clientelism overall, and that the rich prefer higher-value clientelist pledges from copartisan candidates, whereas this distinction does not hold among poorer voters. Our findings suggest a need to reconsider previously assumed linear ties between class and clientelism and raise questions for further research about how the rich and poor engage differently with patronage-based parties in some developing country contexts.

Abstract Carbon dioxide removal (CDR) is a crucial component of climate mitigation required to reach international climate targets. However, gaps exist in our understanding of the responses and feedbacks of the Earth system to the deployment of CDR. In this study, we compare two complementary approaches that enhance the terrestrial and marine carbon sinks with afforestation and reforestation (A/R) and ocean alkalinity enhancement (OAE), respectively, under the high emission scenario SSP5-8.5. Eight CMIP6 Earth system models are utilized, enabling a quantification of both inter-model and internal variability. By mid-century, simulated large-scale deployment of A/R and OAE individually reduces atmospheric CO2 concentrations by up to 20 ppm. For both methods, while carbon removal from the atmosphere is robust, it is difficult to detect the effects on global mean temperature, posing challenges for monitoring, reporting and verification of mitigation efforts. To quantify the carbon cycle feedbacks, we define the carbon cycle feedback ratio of A/R (OAE) as the ratio of changes in the marine (terrestrial) sink to changes in the terrestrial (marine) sink. We show that the carbon cycle feedback ratios of A/R and OAE have similar magnitudes, which are −16% and −13%, respectively. Moreover, although inter-model differences of the simulated amounts of carbon removal due to A/R are large, the corresponding carbon cycle feedback ratios of A/R are similar.

BackgroundE-cigarette products are the most popular tobacco/nicotine product used among youth and young adults in the USA. While emerging research has shown that e-cigarette taxes increase their price, no study to date has examined e-cigarette tax burdens nor their affordability for youth and young adults.MethodsUsing real (2021 US dollars) prices per mL of e-liquid data from NielsenIQ and annual real (2021 US dollars) personal income data from Integrated Public Use Microdata Series, we calculate relative income prices and examine average annual percentage changes in affordability using Joinpoint trend analysis from 2015 to 2021. In addition, we use tax data to calculate e-cigarette tax burdens as a percentage of price per 1 mL of e-liquid.ResultsIn all states analysed, tax burdens increased from 2015 to 2021. E-cigarette prices decreased considerably from 2019 to 2021; in 2021 the real (2021 US dollars) average price of 1 mL of e-liquid was US$4.45. E-cigarettes on average became more affordable for all age groups and states; however, e-cigarettes tended to be less affordable in states with ad-valorem tax structures. On average, 16–17-year-olds needed 31% of their annual income to purchase 100 mL of e-liquid, whereas 18–19-year-olds, 20–24-year-olds and 25–34-year-olds needed 9%, 3% and 1%, respectively.ConclusionsE-cigarettes have become more affordable for young people, but less so in states with ad-valorem tax structures. Policy efforts should focus on reducing e-cigarette affordability, especially for youth, through tax-induced increases in e-cigarette prices to levels high enough to outpace income growth.

BackgroundDespite 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.ObjectiveThe 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.MethodsAll 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.ResultsPost 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%).ConclusionsThis 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.

BackgroundElectronic cigarettes (e-cigarettes) are being advertised and sold with synthetic nicotine. Little research has examined youth awareness of synthetic nicotine or the impact of synthetic nicotine descriptors on perceptions of e-cigarettes.MethodsParticipants were a sample of 1603 US adolescents (aged 13–17 years) from a probability-based panel. The survey assessed knowledge of nicotine source in e-cigarettes (from ‘tobacco plants’ or ‘other sources besides tobacco plants’) and awareness of e-cigarettes containing synthetic nicotine. Then, in a between-subjects experiment with a 2×3 factorial design, we manipulated descriptors on e-cigarette products: (1) nicotine label (inclusion of the word ‘nicotine’: present or absent) and (2) source label (inclusion of a source: ‘tobacco-free’, ‘synthetic’ or absent).ResultsMost youth were either unsure (48.1%) or did not think (20.2%) that nicotine in e-cigarettes comes from tobacco plants; similarly, most were unsure (48.2%) or did not think (8.1%) that nicotine in e-cigarettes comes from other sources. There was low-to-moderate awareness of e-cigarettes containing synthetic nicotine (28.7%), with higher awareness among youth who use e-cigarettes (48.0%). While no main effects were observed, there was a significant three-way interaction between e-cigarette status and the experimental manipulations. The ‘tobacco-free nicotine’ descriptor increased purchase intentions relative to ‘synthetic nicotine’ (simple slope: 1.20, 95% CI 0.65 to 1.75) and ‘nicotine’ (simple slope: 1.20, 95% CI 0.67 to 1.73) for youth who use e-cigarettes.ConclusionsMost US youth do not know or have incorrect beliefs about the sources of nicotine in e-cigarettes and describing synthetic nicotine as ‘tobacco-free nicotine’ increases purchase intentions among youth who use e-cigarettes.