Category: Research

Surgeon General Releases Report on Tobacco Use
Vivek Murthy
The Surgeon General of the United States released a new report on health disparities related to tobacco use. The report finds that despite the nation’s substantial progress in reducing cigarette smoking and secondhand smoke exposure in the overall U.S. population, that progress has not been equal for all population groups.
Disparities in tobacco use persist by race and ethnicity, income, education, sexual orientation and gender identity, occupation, geography, behavioral health status, and other factors. Additionally, cigarette smoking and secondhand smoke exposure continue to cause nearly half a million deaths a year in the United States—nearly one in five of all deaths.
“Tobacco use continues to decline. Americans increasingly understand tobacco products are dangerous and addictive and many are taking advantage of available tools to help them quit. That’s great news,” said Xavier Becerra, HHS Secretary for Health. “Smoking is still the leading cause of preventable death in the United States. That’s unacceptable. We will keep working until tobacco is no longer a menace to individuals and families across the nation. We will continue our efforts to improve health equity and support communities that remain the most vulnerable.”
This report expands upon the 1998 Surgeon General’s report on tobacco use among U.S. racial and ethnic groups to include data and trends by additional demographic factors and their intersection. This report also summarizes research on factors that influence tobacco-related disparities, and outlines actions everyone can take to eliminate these disparities and advance health equity in the United States.
“Tobacco use imposes a heavy toll on families across generations. Now is the time to accelerate our efforts to create a world in which zero lives are harmed by or lost to tobacco,” said Surgeon General Dr. Vivek Murthy. “This report offers a vision for a tobacco-free future, focused on those who bear the greatest burden, and serves as a call to action for all people to play a role in realizing that vision.”
Tobacco-Related Disparities Today
Smoking has declined more than 70% in the United States since 1965. However, progress achieved through improvements in tobacco-related policies, regulations, programs, research, clinical care, and other areas, has not resulted in the same outcomes across all U.S. population groups.
Cigarette smoking is higher among American Indian and Alaska Native people than other racial and ethnic groups, and smoking among men and women living in poverty is more than twice as common compared to those not living in poverty. Smoking is also higher among adults with lower levels of education; people who identify as gay, lesbian, or bisexual; adults who work in manual labor and service jobs; people who reside in rural areas; adults who reside in the Midwest or South; and people living with a mental health condition or substance use disorder.
Despite the good news that deaths due to secondhand tobacco smoke exposure have declined by more than 50% since 2006, among people who don’t smoke, secondhand smoke exposure remains disproportionately high among children, Black people, people with lower incomes, and adults with lower levels of education. The magnitude of these disparities has increased since 2000.
“While there is much to celebrate, the progress has not been equal across all populations or communities. Progress, in the form of improvements in tobacco-related policies, regulations, programs, research, clinical care, and other areas, has not resulted in the same outcomes for everyone,” said Adm. Rachel L. Levine, HHS Assistant Secretary for Health. “We have not made progress unless we have all made progress.”
While cigarette smoking remains the leading preventable cause of disease and death in the United States, disparities exist in smoking-related health outcomes. For example, American Indian and Alaska Native adults have the highest prevalence of COPD, and Black men have the highest incidence and death rate due to lung cancer of any racial and ethnic group of men or women.
Factors that Influence Tobacco-Related Disparities
Multiple factors influence tobacco-related health disparities, including:

Poverty, racism, discrimination, and other social determinants of health—such as where people live, how much money they make, access to health care – and exposure to tobacco product advertising and marketing.
The tobacco industry, whose tactics include concentrated marketing of tobacco products in neighborhoods with greater percentages of Black and Hispanic people, and residents with lower incomes; and marketing flavored products, including menthol, to specific groups. Menthol can make it easier to start smoking and harder to quit.
Financial and other obstacles to accessing treatments proven to help people quit using tobacco.
Social and environmental influences, such as whether family and friends smoke, smokefree air policies at home and work, and stress and exposure to dangers in the workplace.
Gaps in tobacco prevention and control protections, such as smokefree air policies.
Preemptive laws that block communities from protecting their members’ health.
What Can be Done to Eliminate Tobacco-Related Disparities
Everyone has a role to play in eliminating tobacco-related disparities, according to a press release.
“To do this, we must:

Address the factors that influence tobacco-related disparities, such as inequitable access to health care; high-quality education; and safe, smokefree housing and workplaces.
Drive down the appeal, addictiveness, and availability of commercial tobacco products, such as by placing restrictions on the sale of flavored tobacco products, establishing a maximum nicotine yield to reduce the addictiveness of cigarettes and other combusted tobacco products, and regulating the number of stores that sell tobacco.
Equitably implement strategies proven to reduce commercial tobacco use and exposure to secondhand smoke. These strategies include tobacco product price increases, comprehensive smokefree air policies, effective counter-marketing and media campaigns, and evidence-based quitting resources.
Encourage friends, family members, and coworkers—including youth—to quit the use of tobacco products and support them in getting help to quit through resources, such as 1-800-QUIT-NOW and smokefree.gov.”
For Surgeon General’s report information and resources, including the full report, a report executive summary, a consumer guide, and fact sheets, visit www.SurgeonGeneral.gov or www.CDC.gov/EndTobaccoDisparities
November 19, 2024
Study: ‘Switchers’ See Improved Respiratory Health

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People who switch from smoking to vaping see improved respiratory health, but people who begin consuming electronic cigarettes while continuing to smoke regular cigarettes do not report improved respiratory symptoms, according to a new paper in Nicotine and Tobacco Research, published by Oxford University Press.
Adults increasingly use electronic cigarettes to try to quit smoking because of the perceived reduced risk. But while vaping reduces exposure to toxic chemicals, it has been unclear whether switching from cigarettes to e-cigarettes results in a reduction of the respiratory problems—like wheezing and coughing—common in regular cigarette smokers.
Researchers used data from the Population Assessment of Tobacco and Health (PATH) study, a national longitudinal measure of tobacco use in the United States performed by the National Institutes of Health. The investigators here observed adult participants between 2013 and 2019 who reported smoking cigarettes exclusively at the beginning of the investigation and reported a baseline cough or wheeze.
The researchers divided the subjects into four groups: those who transitioned from exclusive cigarette smoking to quitting nicotine altogether, those who switched from cigarette smoking to vaping exclusively, those who continued to smoke cigarettes only, and those who kept smoking and also began vaping.
Completely switching from cigarettes to e-cigarettes led to a moderate increase in the resolution of wheeze symptoms compared with persistent smoking. However, there were lower rates of respiratory symptom resolution among those transitioning to vaping while maintaining or increasing their smoking.
Among 5,210 subjects with a baseline cough, 3,362 (65 percent) saw their coughs go away. Of the 5,367 people who reported a baseline wheeze, the researchers observed that 2,862 (53 percent) saw improvements. Switching from cigarettes to e-cigarettes exclusively resulted in significantly reduced wheezing but not cough resolution. Transitioning to both smoking and vaping (versus just continuing to smoke cigarettes) was not associated with respiratory improvement overall or even among participants who reduced their cigarette smoking intensity.
The researchers note that the rates of symptom resolution were 14 percent lower (for cough) and 15 percent lower (for wheeze) among those who switched to dual use and maintained or increased their smoking intensity; those who started using electronic cigarettes while continuing to smoke the same number of regular cigarettes saw their wheeze and coughing get worse.
Switching from smoking cigarettes to quitting nicotine altogether was, perhaps unsurprisingly, associated with the best improvements in both coughs and wheezing.
November 12, 2024
Study: Online Vape Sellers Fail to Comply With Rules

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Online vape product retailers are not consistently adhering to California laws aimed at preventing the sale of the products to minors, including regulations on age verification, shipping methods and flavor restrictions, report researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego.
In a study published online on Nov. 11, 2024, in JAMA, researchers asked 16 people to purchase flavored vape products online and have them delivered to their homes in the County of San Diego, then analyzed the results of these attempted purchases. Of 156 attempted transactions 73% were processed and 67% were delivered.
As of March 21, 2024, sale restrictions on flavored tobacco have been enacted in eight U.S. states and 392 cities or counties, but some of these do not cover e-commerce. For example, the 2022 California Senate Bill (SB) 793 prohibited the sale of flavored tobacco products but left e-commerce restrictions ambiguous.
Due to the ambiguity in California law, the researchers aimed to test differences in compliance with local tobacco e-commerce ordinances. Eight buyers were from the City of San Diego, where an ordinance restricts the sale of flavored tobacco products, including online sales. The other eight were from other County of San Diego communities, which do not have the same restrictions. Delivery did not differ significantly between buyers in these two jurisdictions.
In addition to violations of flavor restrictions, the online purchases violated the Preventing Online Sales of E-Cigarettes to Children Act, a federal law prohibiting the use of the United States Postal Service (USPS) to ship vaping products and requires both age verification and scanning identifications upon delivery.
November 11, 2024
NYTS Survey: U.S. Vaping Rates Hit Record Lows

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The latest tally of federal data finds that vaping rates fell from 10 percent of high school students in 2023 to 7.8 percent this year, “reaching the lowest level ever measured,” reported a team of researchers from the U.S. Centers for Disease Control and Prevention.
According to newly released data from the 2024 National Youth Tobacco Survey (NYTS), current tobacco product use among U.S. middle and high school students has dropped to the lowest recorded level in 25 years,
“Reaching a 25-year low for youth tobacco product use is an extraordinary milestone for public health. However, with more than 2 million youth using tobacco products and certain groups not experiencing declines in use, our mission is far from complete,” Deirdre Lawrence Kittner, director of CDC’s Office on Smoking and Health, said in a news release announcing the new data.
Rates of use of traditional cigarettes are also meager: Only 1.4 percent of middle- and high-school kids now smoke, the report found.
“We’re headed in the right direction when it comes to reducing tobacco product use among our nation’s youth,” said Brian King, director of the US Food and Drug Administration’s Center for Tobacco Products. “But we can’t take our foot off the gas. Continued vigilance is needed to continue to reduce all forms of tobacco product use among youth. Addressing disparities remains an essential part of these efforts to ensure that we don’t leave anyone behind.”
Modern oral nicotine pouches now rank as the second most popular tobacco product, with 2.4 percent of high school students using them regularly, an FDA release states.
“Nicotine pouch sales have substantially increased nationwide since 2016,” noted the team led by CDC investigator Ahmed Jamal, and “nearly one million (890,000) students reported ever using nicotine pouches in 2024.”
Still, the overall trends are positive, and by 2024 only 1 in every 10 middle-and high-school students was using any form of tobacco product.
October 17, 2024
England: Rich Kids More Likely to Vape, Use Drugs

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Vaping, illegal drug use, and drinking alcohol are more common among English children from better-off families compared to poorer households, a new study suggests.
The data showed that a more significant proportion of children aged 11 to 15 from affluent backgrounds in England self-reported their experience of each than those from the least affluent backgrounds.
The Social Mobility Commission said its analysis of National Health Service (NHS) digital data showed that almost a third (32 percent) of young people from wealthier backgrounds had consumed alcohol in the previous month.
This compared to less than a fifth (19 percent) of those from poorer households, suggests media reports.
Some 13 percent of more affluent kids had vaped, compared with 10 percent in the least advantaged group, while almost a quarter (23 percent) had taken drugs compared with 17 percent from poorer groups.
The authors suggested access to alcohol might be easier for children from higher socioeconomic backgrounds.
However, the researchers said they don’t believe this explains the broader findings, and called for further research “to explore these worrying trends.”
October 9, 2024
‘Never Smoker’ Ill-Defined in Recent Study: UKVIA

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A recent study suggesting there are more vapers without a history of smoking in England improperly defines “never smokers,” according to the U.K. Vaping Industry Association (UKVIA).
“This new research talks about ‘never-regular-smokers’ vaping, their definition for this being people who have not smoked for more than a year,” said UKVIA Director General John Dunne in a statement.
“This definition is problematic as it does not exclusively include what most people would define as nonsmokers. As the study authors also point out, it is impossible to say if their cohort, whether experimenting with cigarettes already or not, would not have become smokers were it not for vapes.
“The authors themselves also note that some people have genes and circumstances leading them to like nicotine products; traditionally, they ended up smoking, but some are now discovering vaping without becoming smokers first. If vaping did not exist, they would be smoking.
“Vaping should only be for smokers looking to quit, but we also need to ensure that those smokers continue to have access to what they need in order to quit.”
October 7, 2024
Generational Ban Could Save Millions of Lives: Study

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Creating a generation of people who never smoke could prevent 1.2 million deaths from lung cancer globally, according to a study led by researchers from the University of Santiago de Compostela, the International Agency for Research on Cancer (IARC), and global collaborators published in The Lancet Public Health journal.
The simulation study—the first of its kind—suggests that banning the purchase of cigarettes and other tobacco products among people born between 2006 and 2010 could prevent 1.2 million lung cancer deaths in 185 countries by 2095.
The findings indicate that creating a so-called tobacco-free generation could reduce the impact of smoking on lung cancer deaths in future generations.
“Lung cancer is a major killer worldwide, and a staggering two-thirds of deaths are linked to one preventable risk factor—tobacco smoking, said author Julia Rey Brandariz, University of Santiago de Compostela, in a statement.
“Our modelling highlights how much there is to gain for governments considering the implementation of ambitious plans towards creating a tobacco-free generation. Not only could this save huge numbers of lives; it could massively reduce the strain on health systems of treating, and caring for people in ill health as a result of smoking.”
No countries have laws currently making it illegal to sell tobacco to young people. New Zealand’s groundbreaking legislation to ban the sale of tobacco products to anyone born in or after 2009 was recently repealed.
To date, few studies have analyzed the impact of banning the sale of tobacco products among specific age groups or generation, with most focusing on potential health benefits rather than deaths.
The new study is the first to evaluate the effect that implementing a tobacco-free generation would have on future lung cancer deaths. It focused on people born between 2006 and 2010 because the legal age for buying tobacco products is 18 years in most of the countries included in the analysis.
Future lung cancer death rates were predicted based on historical data on 82 countries recorded in the WHO Mortality Database. These estimated rates were applied to data in the GLOBOCAN 2022 database—an IARC global cancer statistics platform—to predict lung rates among people born between 2006 and 2010 for 185 countries. The number of avoidable smoking-related lung cancer deaths was calculated using data on lung cancer deaths among people who had never smoked from a previous study.
The analysis indicates an estimated 1.2 million lung cancer deaths could be prevented in 185 countries if smoking was eliminated among people born between 2006 and 2010. This could prevent 40.2 percent (1.2 of 2.9 million) of the total lung cancer deaths expected to occur in this birth cohort by 2095.
Almost half of expected lung cancer deaths among men could be prevented (45.8 percent, 844,200 of 1.8 million deaths), and close to one-third of expected deaths in women (30.9 percent, 342,400 of 1.1 million deaths).
Among men, the greatest number of potential lung cancer deaths avoided would be in upper-middle-income countries (64.1 percent or 541,100 of 844,200 deaths). The impact would be greatest in Central and Eastern Europe, where 74.3 percent of potential deaths (48,900 of 65,800 deaths) could be averted. In women, the most potential deaths averted would be in high-income countries (62.0 percent or 212,300 of 342,400 deaths). The greatest impact would be in Western Europe, where 77.7 percent of deaths (56,200 of 72,300 deaths) could be avoided.
Overall, most of the potential prevented deaths would occur in low- and middle-income countries (LMICs), with estimates suggesting almost two-thirds of the potential deaths avoided (65.1 percent or 772,400 of 1.2 million) would be in these countries. The other potential deaths avoided would be in high-income countries, where close to two-thirds of all potential lung cancer deaths (61.1 percent, 414,100 of 677,600) would be prevented.
“While rates of smoking in high-income countries have fallen in recent years, lung cancer remains a leading cause of death and disease. In low- and middle-income countries, which have rapidly growing populations of young people, the impact of banning tobacco sales could be even greater,” said author Isabelle Soerjomataram of the International Agency for Research on Cancer,
“Part of the reason why eliminating smoking could save so many lives in low- and middle-income countries is because they tend to have younger populations than high-income countries. Smoking also remains very common in many of these countries, while rates have fallen in many high-income countries. While we must redouble our efforts to eliminate smoking in all parts of the world, this is especially important in low- and middle-income countries.”
The authors acknowledge some limitations to their study. It was not possible to take into account all the factors affecting implementation, such as the black market or poor compliance, but the authors conducted further analyses to estimate the reduction in health impacts if the ban was not completely effective. Lack of data in some regions meant lung cancer predictions could only be carried out for 82 countries. Predictions for other countries—mostly low-income countries—may be over- or underestimated as these were produced by extrapolating data based on location and lung cancer burden. There was limited data on lung cancer rates among people who have never smoked—some from before the 2000s—which could affect the estimates as rates may have changed due to improvements in healthcare. Predictions did not account for the use of e-cigarettes.
October 6, 2024
More Vapers Without Smoking History in England

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About 1 million vapers in England have no history of regular smoking, reports Bloomberg, citing a new University College London (UCL) study.
From 2016 to 2020, the country’s rate of vaping among adults without a smoking history remained stable and low at 0.5 percent, according to the paper, which was published in The Lancet Public Health this week.
When disposable vapes became popular after 2021, the share of vapers without a smoking history increased rapidly, with the rate reaching one in every 28 as of April this year.
One in seven people aged 18 to 24 who never regularly smoked are now using e-cigarettes, the study found. There has also been a noticeable increase in the proportion using disposable devices.
“These findings are a reminder that action is required to try to minimize vaping among young people,” Jamie Brown, the study’s co-author and professor at the UCL Institute of Epidemiology and Health Care, was quoted as saying by Bloomberg. “Banning disposables, as the U.K. government currently plans, is unlikely to fix the issue as popular brands have already launched reusable products with very similar designs and prices.”
October 3, 2024
Survey: Most Vapers Oppose Retail Display Ban

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A recent survey by the Malaysian Vapers Alliance (MVA), a local advocacy group for vape consumers, showed that many vapers oppose the retail display ban that is expected to be implemented.
Following the survey, MVA has raised concerns over critical elements of the Control of Smoking Products for Public Health Act 2024 (Act 852).
The survey, which garnered close to 500 responses, aimed at understanding consumer perspectives on the impending regulations.
The survey showed that 71.3% of respondents do not agree with the ban, citing dissatisfaction with the inability to browse through products before making a decision (39.7%) and difficulties in the purchasing process (38.3%).
The survey also uncovered that if the retail display ban occurs, consumers will likely seek illegal alternatives (47.4%) or return to smoking cigarettes (44.5%).
Only a tiny percentage (8.1%) indicated they would quit vaping altogether if faced with such restrictions.
In commenting on the findings, MVA president Khairil Azizi Khairuddin emphasized the potential dangers of pushing consumers towards unregulated products.
“The survey findings clearly show that a retail display ban is not the solution,” said Khairuddin. “Restricting consumers’ ability to see and choose legitimate products will only drive them to the black market, where the quality and safety of products are questionable.
“This is not the direction we want to go in, mainly as vaping serves as a harm-reduction tool for many who are trying to move away from smoking.”
September 23, 2024
Study Suggests Vapes Alter Brain Function in Youth

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College students who vape have lower cognitive function scores than those who don’t, researchers reported Sunday at the American Neurological Association’s annual meeting in Orlando, Fla.
Researchers found that the more students vape, the lower their scores on learning, memory, problem-solving, and critical thinking tests.
Researchers found that students who vaped 10 to 20 puffs per day scored 9 percent lower than those who did not vape or smoke, while those who vaped more than 20 puffs a day scored nearly 14 percent lower, media states.
“We believe our research marks a before-and-after in the field of studying cognitive function regarding vaping,” said lead researcher Linker Vinan Paucar, a medical student at the Catholic University of Santiago de Guayaquil in Ecuador.
Previous studies have shown that smoking can affect brain function by shrinking the brain and lowering blood flow to brain cells, researchers said in background notes. Nicotine also causes neurotoxicity that damages brain cells.
The risk might be even more significant in people who vape, Paucar said.
“People in the study who had previously smoked cigarettes typically smoked three or four a week, but with vaping, they now smoke double, triple or more, especially if they smoke and vape,” Paucar said.
September 16, 2024