Estimating the Impact of COVID-19 on Changes in Volume Sales of Cigars, Smokeless Tobacco Products, Pipe, and Roll-your-own Tobacco in the United States.

INTRODUCTION: We examined the potential impact of COVID-19 on trends in volume sales of non-cigarette combustible and smokeless tobacco products in the United States. AIMS AND METHODS: We analyzed monthly national sales for cigars, smokeless tobacco, pipe, and roll-your-own tobacco during June 2019-June 2021. Data were from the U.S Department of the Treasury. Interrupted time-series were used to measure associations of the COVID-19 "shock" (taken as June 2020 or 6 months after the first diagnosis of COVID-19 in the United States) and volume sales. Negative binomial regression was used to evaluate associations between volume sales and changes in community mobility. RESULTS: Within interrupted time-series analysis, the shock of the COVID-19 pandemic was associated with an initial increase in the number of little cigars sold by 11.43 million sticks (p < .01), with no significant sustained change in trend. The COVID-19 shock was also associated with an initial increase in large cigar volume sales by 59.02 million sticks, followed by a subsequent decrease by 32.57 million sticks per month (p = .005). Every 10% reduction in mobility to retail stores was significantly associated with reduced volume sales of little cigars (IRR = 0.84, 95% CI, 0.71 to 0.98) and large cigars (IRR = 0.92, 95% CI, 0.88 to 0.96). Other findings were statistically nonsignificant. CONCLUSIONS: COVID-19 was associated with increased volume sales for cigars and there was a significant association between reduced mobility to points of sale and reduced cigar volume sales. Intensified efforts are needed to prioritize evidence-based tobacco prevention and control efforts amidst the pandemic.

Prevalence and correlates of roll-your-own cigarette smoking among South African adults during 2010-2011 and 2017-2018.

INTRODUCTION: The increasing use of roll-your own (RYO) cigarettes has been documented globally, but there are no recent data from South Africa, particularly among youths and low-income groups. We assessed changes in prevalence and correlates of RYO smoking among South African adults during 2010-2011 and 2017-2018, and explored expenditure differences between daily smokers of RYO and manufactured cigarettes. METHODS: Nationally representative data of South Africans aged ≥16 years used in this study were from the South African Social Attitudes Survey (SASAS) for 2010-2011 (n=6116), and 2017-2018 (n=5799). Current RYO cigarette use included daily and non-daily use. Annual expenditures were estimated based on typical usage patterns for daily users. Descriptive and multivariable analyses were performed using Stata Version 15 with the level of statistical significance set at p<0.05. RESULTS: The prevalence of ever RYO cigarette use increased from 6.5% (95% CI: 5.6-7.5) during 2010-2011, to 8.5% (95% CI: 7.0-10.0) during 2017-2018 (p=0.026). Current RYO cigarette use prevalence however remained largely unchanged when we compared 2010-2011 to 2017-2018 (5.2% vs 6.3%, p=0.544). During 2017-2018, current RYO cigarette use prevalence was highest among men (11.6%), those who self-identified as Coloreds (11.1%), people aged 25-34 years (7.8%), those with no schooling (7.5%), and those unemployed (9.8%). Annual expenditures associated with typical patterns of daily RYO cigarette smoking were substantially less than for smoking of manufactured cigarettes. CONCLUSIONS: The prevalence of ever RYO cigarette use increased between 2010-2011 and 2017-2018. Current RYO cigarette use during 2017-2018 was more prevalent among Coloreds, Black Africans, youths, those with lower education, and the unemployed. This study's findings highlight the need to harmonize taxation of cigarettes and RYO cigarettes, and to intensify implementation of evidence-based tobacco control and prevention interventions in South Africa.

20-Year Trends in Tobacco Sales and Self-Reported Tobacco Use in the United States, 2000-2020.

INTRODUCTION: In the past 2 decades, many tobacco control policies were enacted, and several new or modified products were introduced into the US marketplace. Continued tobacco surveillance is critical in this evolving landscape. We examined 20-year trends in tobacco use from sales and self-reported data. METHODS: We obtained data on taxable removals (sales) of cigarettes, cigars, roll-your-own (RYO) tobacco, and pipe tobacco from the US Department of the Treasury. We assessed self-reported past 30-day tobacco use from the National Survey on Drug Use and Health among people aged 18 years or older. Volume sales were standardized to cigarette packs and cigarette pack equivalents (CPEs) and trends measured by using joinpoint and logistic regression. RESULTS: From 2000 to 2019-2020, declines occurred in per capita sales of cigarettes (101.01 to 42.29 packs/capita), little cigars (0.54 to 0.03 CPEs/capita), and RYO tobacco (1.34 to 0.21 CPEs/capita). Volume sales also decreased for chewing tobacco and scotch/dry snuff (all P < .05). Conversely, volume sales increased for pipe tobacco, moist snuff, and snus for the respective assessed periods. Large cigar volume sales did not change significantly. We found consistent trends in self-reported use, except for RYO tobacco (decreased volume sales but increased self-reported use) and pipe smoking (increased volume sales, but trivial self-reported use <1% throughout the study period). Current use of any tobacco product decreased from 32.2% to 22.9% during the assessed period. CONCLUSION: Harmonizing the tax and regulatory structure within and across the diversity of tobacco products may help reduce aggregate tobacco consumption in the US.

A Rapid Evaluation of the US Federal Tobacco 21 (T21) Law and Lessons From Statewide T21 Policies: Findings From Population-Level Surveys.

BACKGROUND: On December 20, 2019, the minimum age for purchasing tobacco in the US was raised nationally to 21 years. We evaluated this law (Tobacco 21 [T21]) 1 year after implementation. We also compared states with versus without T21 policies during 2019 to explore potential equity impacts of T21 policies. METHODS: We examined shifts in tobacco access among 6th through 12th graders using the National Youth Tobacco Survey. To explore equity of state T21 policies among youths and young adults, the associations with tobacco use were explored separately for race and ethnicity by using data from the 2019 Behavioral Risk Factor Surveillance System (for persons aged 18 to 20 years) and the 2019 Youth Risk Behavior Survey (for high school students). RESULTS: The overall percentage of 6th to 12th graders perceiving that it was easy to buy tobacco products from a store decreased from 2019 (67.2%) to 2020 (58.9%). However, only 17.0% of students who attempted buying cigarettes in 2020 were unsuccessful because of their age. In the 2019 BRFSS, those aged 18 to 20 years living in a state with T21 policies had a lower likelihood of being a current cigarette smoker (adjusted prevalence ratio [APR], 0.58) or smoking cigarettes daily (APR, 0.41). Similar significant associations were seen when analyses were restricted to only non-Hispanic White participants but not for participants who were non-Hispanic Black, non-Hispanic Asian, Hispanic, or of other races or ethnicities. Consistent findings were seen among high school students. CONCLUSION: Greater compliance with the federal T21 law is needed as most youth who attempted buying cigarettes in 2020 were successful. Comparative analysis of states with versus states without statewide T21 policies in 2019 suggest the policies were differentially more protective of non-Hispanic White participants than other participants. Equitable and intensified enforcement of T21 policies can benefit public health.

A cross-sectional analysis of U=U as a potential educative Intervention to mitigate HIV stigma among youth living with HIV in South Africa.

Introduction: the HIV educative campaign Undetectable Equals Untransmissible (U=U) is a potential gamechanger to address HIV stigma. We investigated what percentage of South African adolescents were aware of U=U, and the associations with perceived HIV stigma and past-year HIV testing. Methods: we used a cross-sectional design. Data were from the 2017/2018 South African National HIV prevalence, incidence, behaviour and communication survey. HIV status was measured using both laboratory confirmation and self-reports. Among adolescents aged 15-18 years, we calculated the percentage who believed that "the risk of HIV transmission through sex can be reduced by an HIV-positive partner consistently taking drugs that treat HIV." Data were weighted to yield nationally representative estimates. Results: overall, 49.8% of all adolescents aged 15-18 years (and 49.2% of this HIV seropositive) believed that the risk of HIV transmission through sex can be reduced by an HIV-positive partner consistently taking drugs that treat HIV. After adjusting for HIV status, geographic location, race, sex, and orphanhood status, those with belief in U=U were less likely to endorse stigmatizing statements that teachers with HIV should not teach (IRR=0.63, 95%CI, 0.47-0.84), pupils with HIV should not attend class (IRR=0.62, 95%CI, 0.45-0.84), or that children with HIV in general should be in segregated schools (IRR=0.55, 95%CI, 0.41-0.74). Among those reporting not living with HIV, U=U belief was associated with increased likelihood of past-year HIV testing (IRR=1.19, 95%CI, 1.01-1.41). Conclusion: U=U belief was associated with reduced stigma perceptions and increased HIV testing. Adoption of U=U into clinical practice guidelines in South Africa may benefit public health.

Gender norms, HIV risk, and attitudes towards pre-exposure prophylaxis and other HIV preventive interventions among South African adolescents.

Introduction: we examined HIV-related social norms and perceptions among South African adolescents aged 15-18 years and evaluated their openness to using pre-exposure prophylaxis (PrEP) to reduce HIV risk. Methods: we analyzed cross-sectional data of 4,567 adolescents aged 15-18 years from the "fifth South African National HIV prevalence, HIV incidence, behaviour and communication survey (2017/2018)". Outcomes of interest in our study were HIV-related social norms and awareness of HIV prevention methods, including pre-exposure prophylaxis (PrEP). Results: our results showed that compared to their female counterparts, a significantly higher percentage of male adolescents endorsed the statement "Men can have two or more sexual partners at the same time" (14.2% vs 10.1%, p=0.021). Condoms were the most popular method of HIV prevention, with 83.5% of all participants reporting awareness. Yet, 35.4% of those sexually active in the past year reported not using condoms all the time. Perceived parental sex education and exposure to community campaigns for HIV prevention were both associated with increased awareness of HIV prevention measures and openness to PrEP. Unaided recall of PrEP was very low (3.7%), but most of those who were HIV seronegative (69.3%) were open to using it after learning about it. Openness towards PrEP was significantly higher among those reporting vs not reporting past-year sexual activity (adjusted prevalence ratio (APR=1.16, 95%CI, 1.06-1.28), and binge-drinking (APR=1.24, 95%CI, 1.08-1.41). Conclusion: this study showed that while many South African adolescents were interested in trying PrEP, initial awareness was low. Ensuring barrier-free access to evidence-based preventive strategies may benefit public health.