Background Public policy can limit alcohol consumption and its associated harms, but no direct comparison of the relative efficacy of alcohol control policies exists for the U.S. Purpose To identify alcohol control policies and develop quantitative ratings of their efficacy and strength of evidence. Methods In 2010, a Delphi panel of ten U.S. alcohol policy experts identified and rated the efficacy of alcohol control policies for reducing binge drinking and alcohol-impaired driving among both the general population and youth, and the strength of evidence informing the efficacy of each policy. The policies were nominated based on scientific evidence and potential for public health impact. Analysis was conducted in 2010–2012. Results Panelists identified and rated 47 policies. Policies limiting price received the highest ratings, with alcohol taxes receiving the highest ratings for all four outcomes. Highly rated policies for reducing binge drinking and alcohol-impaired driving in the general population were also highly rated among youth, although several policies were rated more highly for youth compared with the general population. Policy efficacy ratings for the general population and youth were positively correlated for reducing both binge drinking (r = 0.50) and alcohol-impaired driving (r = 0.45). The correlation between efficacy ratings for reducing binge drinking and alcohol-impaired driving was strong for the general population (r = 0.88) and for youth (r = 0.85). Efficacy ratings were positively correlated with strength-of-evidence ratings. Conclusions Comparative policy ratings can help characterize the alcohol policy environment, inform policy discussions, and identify future research needs.

Background As user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking. Objective This study aimed to analyze the content of YouTube videos depicting modifications of ENDS. Methods YouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos. Results Videos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative). Conclusions This study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications.

Competing interests None declared. patient consent for publication Not required. provenance and peer review Not commissioned; externally peer reviewed. data availability statement There are no data in this work.

Users’ modifications to electronic nicotine delivery systems (ENDS) products could increase initiation, inhibit cessation, or change the toxicity of the product. This study aims to begin to identify consumers’ common ENDS modification behaviors. We conducted audio-recorded, in-depth one-on-one interviews with 13 adult ENDS users in the metropolitan Atlanta area, who self-reported extensive modification experience. Modifications to coils, batteries, and e-liquids were commonly mentioned. Participants indicated that users modified devices to produce large clouds, change levels of nicotine delivery, alter tastes of e-liquids, and experience different throat hits. Because manufacturers have changed product characteristics to be in line with consumer preferences, interviewees indicated that fewer users currently engage in modifications to coils and batteries compared to the more widespread practice a few years ago. Hobbyists continue to perform modifications and many users continue to misuse or abuse e-liquids, despite the view that fewer users currently alter their ENDS than in the past. The Food and Drug Administration (FDA) regulatory actions that limit certain product characteristics may unintentionally increase the likelihood that users will once again make more extensive modifications to their products, and this should be considered as part of the FDA’s regulatory decision-making process.

Research suggests that smoking may compound the risk of serious health problems to smokers who contract COVID-19. This study examines whether and how exposure to news stories reporting the severe COVID-19 risk to smokers may influence smokers’ emotional responses (fear, anxiety, and sadness) and intentions to take measures to quit smoking. Current smokers in the US participated in an online experiment (N = 495) and were randomized to read smoking risk news stories or news stories reporting the combined risk of smoking and COVID-19. We found that combined risk news stories lead to participants feeling more fearful and sadder than when they viewed smoking risk news stories (M = 5.74; SD = 2.57 vs. M = 5.20; SD = 2.74; p < .05). Fear fully mediated the effect of news exposure on intentions to take measures to quit smoking (ß = .09; SE = 05; 95% CI [.010, .200]). Moreover, moderated-mediation analyses revealed that the mediating effect of fear was conditioned on the levels of comparative optimism, such that the association between fear and intentions to take measures to quit smoking was only significant among smokers whose comparative optimism was at the mean score (ß = .16; SE = 05; 95% CI [.071, .250]), and for those whose comparative optimism was high (ß = .27; SE = .06; 95% CI [.146, .395]). These results suggest that fear of the pandemic and optimism might play important roles in predicting and explaining the association between exposure to news stories and intentions to take measures to quit smoking. Messages about heightened risk of COVID-19 complications for smokers that increase fear might be an effective strategy to motivate smokers to quit. Such messages should be used to turn the adversity of COVID-19 pandemic into an intervention opportunity to reduce tobacco-related disease.