by Herschel Baker – Director Queensland Director, Drug Free Australia – 03 August 2025 

Story by Kat Lay, Global health correspondent

Avatars smoke in an image shared on social media of a gathering in the metaverse. A packet of Djarum LA cigarettes, an Indonesian brand, sit on the table. Photograph: iceperience.id Instagram via Canary© Photograph: iceperience.id Instagram via Canary

In the image, a group of friends is standing in a bar, smoke winding upwards from the cigarettes in their hands. More lie in an open packet on the table between them. This is not a photograph taken before smoking bans, but a picture shared on social media of a gathering in the metaverse.

Virtual online spaces are becoming a new marketing battleground as tobacco and alcohol promoters target young people without any legislative consequences.

A report shared at the World Conference on Tobacco Control last month in Dublin set out multiple examples of new technologies being adopted to promote smoking and vaping, including tobacco companies launching digital tokens and vape companies sponsoring online games.

It comes from a monitoring project known as Canary – because it seeks to act as the canary in a coalmine – run by the global public health organisation Vital Strategies.

“Tobacco companies are no longer waiting for regulations to catch them up. They are way ahead of us. We are still trying to understand what we’re seeing in social media, but they’re already operating in unregulated spaces like the metaverse,” says Dr Melina Magsumbol, of Vital Strategies India. “They’re using NFTs [non-fungible tokens]. They’re using immersive events to get our kids to come and see what they’re offering.”

In India, one tobacco company made and promoted an NFT, which represents ownership of digital assets, to celebrate its 93rd anniversary.

Canary scans for and analyses tobacco marketing on social media platforms and news sites in India, Indonesia and Mexico. It is expanding to more countries, including Brazil and China, and to cover alcohol and ultra-processed food marketing.

Digital platforms are being used to bypass traditional advertising restrictions and target young audiences

Melina Magsumbol, Vital Strategies India

It is not set up to scan the metaverse – a three-dimensional, immersive version of the internet that uses technology such as virtual reality headsets to enable people to interact in a digital space. But it has picked up references to what is going on there via links and information shared on older social media sites.

Researchers say that children are likely to be exposed to any tobacco marketing in the new digital spaces given the age profile of users – more than half of the metaverse’s active users are aged 13 and below.

Social media companies have deep knowledge of how to drive engagement and keep people coming back for more views, says Dr Mary-Ann Etiebet, chief executive of Vital Strategies.

“When you combine that with the experience and the knowledge of the tobacco industry on how to hook and keep people hooked … those two things together in a space that is unknown and opaque – that scares me.”

Mark Zuckerberg, metaverse’s prominent backer, says in future “you’ll be able to do almost anything you can imagine” there. Already, that includes shopping and attending virtual concerts.

But Magsumbol describes it as “a new battleground for all of us” that is “being taken over by corporate entities that actually push health-harming products”.

“My daughter is very quiet, she’s an introvert. But online, on [gaming platform] Roblox, when she is killing zombies and ghosts, she morphs into a different avatar – she’s like Alexander the Great mixed with Bruce Lee and John Wick. She is so bloodthirsty,” she says.

“Online we behave differently. Social norms change … the tobacco industry knows that very well. And it’s so easy to subtly sell the idea that you can be anything, anyone you want.”

The metaverse art the team saw in Indonesia was shared on an Instagram account for electronic music lovers linked to Djarum, one of Indonesia’s largest cigarette companies. Another example showed a group having coffee, and looking for a lighter.

It all amounts to efforts to “normalise” smoking and vaping, says Magsumbol. “This kind of behaviour is happening and being done by your avatars, but is it seeping into your real life?

“Digital platforms are being used to bypass traditional advertising restrictions and target young audiences,” she says. “What we’re seeing here is not just a shift in marketing, it’s a shift in how influence works.”

Other researchers have set out examples of alcohol being promoted and even sold in virtual stores.

Online marketing is a global issue. At the same conference, Irish researchers shared findings that 53% of teenagers saw e-cigarette posts daily on social media.

A World Health Organization official (WHO) says a rise in youth smoking in Ukraine is due, in part, to Covid and the war pushing children “too much online” and exposing them to marketing.

Related: Vapes threaten to undo gains in tackling dangers of tobacco, health leaders warn

In India, Agamroop Kaur, a youth ambassador at the Campaign for Tobacco-Free Kids, includes social media marketing when speaking to schoolchildren about the dangers of tobacco and vaping. She has seen vapes suggested as a “wellness” item.

“I think educating youth on what an advertisement looks like, why it’s false, how you might not even see that it’s from the tobacco industry and it’s [content posted by an] influencer is really powerful because then that builds a skill – so that when they’re on social media, because they are digital natives, they’re able to see all of that and know that it’s fake and it’s not something they should be attracted by. I think building those skills early from high school to middle school, and even younger, is really important.”

The WHO Framework Convention on Tobacco Control requires countries to implement bans on tobacco advertising, promotion and sponsorship. Last year, signatories agreed that action was needed to tackle the increasing focus on “digital marketing channels such as social media, which increases adolescent and young people’s exposure to tobacco marketing”.

But there is no easy answer, says Andrew Black at the framework’s secretariat.

“The challenge of regulating the internet is not a problem that’s unique to tobacco. It’s a real challenge for governments to think about how they can provide the protections that society is used to in a world where borders are broken down because of these technologies.”

Nandita Murukutla, who oversees Canary, says regulators should take note: “What starts out small and you ignore, rises up to a certain point when you’ve got critical mass, and after that, it just explodes, and dialing something back is virtually impossible.”

Herschel Baker

International Liaison, Director Queensland Director, Drug Free Australia – Web https://drugfree.org.au/

Source:  https://www.msn.com/en-au/news/other/smoking-avatars-and-online-games-how-big-tobacco-targets-young-people-in-the-metaverse/ar-AA1J2WHU?

Statement by the Queensland Cabinet and Ministerial Directory

Abstract

The prevalence of substance use disorders in adults is higher if substance use is initiated during adolescence, underscoring the importance of youth substance use prevention. We examined whether the use of one substance by adolescents is associated with increased risk for using any other substance, regardless of use sequences. In 2017 we examined data from 17,000 youth aged 12–17 who participated in the 2014 National Survey on Drug Use and Health, a sample of nationally representative data on substance use among the U.S. civilian, noninstitutionalized population aged 12 or older. Descriptive analyses and multivariable logistic regression models were applied. After controlling for age, sex, and race/ethnicity, compared with youth without past-month marijuana use, youth with past-month marijuana use were 8.9 times more likely to report past-month cigarette use, 5.6, 7.9 and 15.8 times more likely to report past-month alcohol use, binge use, or heavy use (respectively), and 9.9 times more likely to report past-month use of other illicit drugs. The prevalence of past-month use of cigarettes, marijuana, and other illicit drugs was significantly higher among past-month alcohol users compared with youth without past-month alcohol use, and increased as intensity of alcohol use rose. Among past-month cigarette smokers, the prevalence of marijuana, other illicit drugs, and alcohol use were each significantly higher than youth without past-month cigarette use. Youth marijuana use, cigarette smoking, or alcohol consumption is associated with other substance use. This finding has importance for youth prevention, supporting a message no use by youth of any substance.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0091743518301658?via%3Dihub

Author(s):  Hannah Elmore, PharmD,John Handshaw, PharmD, BCACP  –  December 23, 2024

Pharmacists can help address nicotine addiction by recommending FDA-approved smoking cessation methods and educating on the risks associated with electronic cigarette use.

Electronic cigarettes (E-cigarettes) have emerged as a popular alternative to traditional smoking. This method, known as vaping, involves inhaling an aerosol that contains nicotine, flavorings, and harmful chemicals including carcinogens, toxic substances, and metals. Nicotine is a highly addictive compound that activates the brain’s reward center by increasing dopamine levels, which creates sensations of pleasure and satisfaction. These euphoric feelings are often what leads to nicotine addiction.¹

Although vaping is often perceived as a safer option, it actually carries significant health risks similar to those of traditional cigarettes. Pharmacists can play a vital role in educating patients on the dangers of vaping and providing guidance on safe and effective smoking cessation methods.

E-cigarettes trace back to the 1960s when British American Tobacco created a smoking device under the codename Ariel. At that time, researchers were already aware of nicotine’s addictive properties, but new evidence linking smoking to lung cancer prompted cigarette companies to try and explore alternative products with less risks. They aimed to create an inhalation device with filters to reduce carcinogens and tar. However, it was discovered that filtered cigarettes were not a healthier alternative because all components of cigarette smoke have proven to be harmful. Additionally, if the device only contained pure nicotine, it would warrant classification as a drug-delivery system, subjecting it to stricter regulations. The company wanted to avoid this in order to bypass the stringent safety evaluations and extensive clinical trials required by drug delivery systems, which would allow the company to reduce their manufacturing costs, speed up production, and take this device to the market quicker. They were able to produce a product with 24% nicotine, which is 6 times the concentration found in traditional cigarettes. Despite this innovation, Ariel was discontinued to protect the company’s profitable traditional cigarette market. This marked the first instance of companies exploring the manipulative potential of nicotine.²

E-cigarettes were officially authorized for sale by the FDA in 2007 with over 460 brands. The most popular brand is Juul, accounting for nearly 75% of the e-cigarettes on the market.^3,4 In 2022, the FDA banned the sale of Juul products due to conflicting evidence regarding its associated risks, including the potential to cause strokes, respiratory failure, seizures, and cases of e-cigarette or vaping-use-associated lung injury (EVALI).⁴ EVALI is a condition in which the lungs become severely damaged and often results in admission to the intensive care unit (ICU) on mechanical ventilation.^3,4

Additionally, there is also a lack of long-term safety data for these products.⁵ Although originally marketed as a healthier alternative to cigarettes, e-cigarettes have not demonstrated efficacy as a smoking cessation aid and rather, have led to a rise in the youth vaping epidemic.¹

There has been a lack of data correlating successful smoking cessation rates among those who use e-cigarettes. There have been a few studies that suggest that vaping may aid in quitting tobacco but is not effective for quitting nicotine use altogether.⁶ One study found that those who utilized e-cigarettes in combination with nicotine replacement therapy (NRT) and counseling were 24.3% less likely to quit smoking compared to those who used only NRT and counseling. Additionally, those who used e-cigarettes were 15.1% more likely to become dual users utilizing both tobacco and vaping products. Those who are considered dual users are at an even higher risk for health complications including myocardial infarction and a 4-fold increase in developing lung cancer.⁶

In another survey of 800 people who utilized vaping as a smoking cessation agent, it was reported that only 9% successfully quit when asked 1 year later, compared to 19.8% who utilized NRT.^1,7 These findings help highlight that vaping is not a reliable method for eliminating nicotine use entirely and can even lead to utilizing both traditional and electronic cigarette products.⁸

Vaping is now the most commonly used form of nicotine among adolescents. A study was conducted that showed high schoolers who had used e-cigarettes were 16.7% more likely to start smoking cigarettes within the next year.⁹ Nicotine’s impact on the developing brain can cause mood disorders, affect attention and learning, and amplify the desire for other mood-enhancing drugs such as cocaine or methamphetamine.¹ In 2018, e-cigarette use among high school students increased by 78%, which led the FDA to enforce stricter regulations on the sale of nicotine products. Despite their efforts, vaping remains a leading challenge that teens face today as they have already fallen victim to nicotine addiction.⁴

The FDA currently lists 7 approved quit aids that are safe and effective for smoking cessation. These include several forms of NRT as well as pharmacologic therapy with bupropion and varenicline. Some of the agents, including the NRT gum, patch, and lozenge, are even available OTC. Pharmacists can play a vital role in smoking cessation, especially in patients who lack access to a primary care provider to obtain prescription medications. Therefore, it is crucial for pharmacists to stay up to date on the current smoking cessation guidelines, dosing recommendations, and counseling points for these agents.

The primary goal of pharmacist-driven smoking cessation should always be to support the patient’s desire to quit smoking. Pharmacists should guide patients toward the FDA-approved agents, either prescription medications through a provider, or OTC therapies in the pharmacy, rather than electronic cigarettes due to lack of supportive data and increased risk for adverse health events. The appropriate selection of FDA-approved agent should be individualized based on the patient’s specific factors, contraindications, and goals of therapy. Pharmacists should educate the patient extensively on the appropriate options for smoking cessation and should not recommend the use of e-cigarettes. However, if a patient decides to use e-cigarettes, pharmacists should still serve as a support system for the patient by being the primary educator and providing extensive counseling on the associated risks of vaping. Patients should be made aware of both the known and unknown adverse reactions associated with electronic cigarettes as well as highlighting that the goal of vaping should be to achieve complete smoking cessation.¹⁰

Vaping e-cigarettes has become a popular alternative to traditional cigarettes, with unknown efficacy and safety surrounding these products.¹⁰ Pharmacists should continue to stay up to date on new literature published on e-cigarettes and should follow the FDA’s suggestions on smoking cessation methods. Pharmacists are the most widely accessible health care professionals available to patients. Therefore, pharmacists have the power and knowledge to be the most influential providers available to advise patients on the correct paths to smoking cessation. By offering education and support, pharmacists can help patients live healthier lives and take steps towards reversing the youth smoking epidemic one education at a time.

Source: https://www.pharmacytimes.com/view/clearing-the-air-the-influence-of-vaping-on-smoking-cessation

SAM Drug Report’s Friday Fact report – 11:31 Friday 10th Jan 2025

A study that was published last week in Addictive Behaviors found that alcohol and tobacco are more likely to be used on days when marijuana is used.

The study found that individuals consumed an average of 0.45 more alcoholic drinks on days when marijuana was used, compared to days when marijuana was not used. Similarly, the study found that individuals smoked an average of 0.63 more cigarettes on days when marijuana was used. Both of these findings were statistically significant (p=0.01).

Seeking to explain these findings, the researchers posited that “the impact of cannabis use on the endocannabinoid system may reinforce the use of alcohol and tobacco through mechanisms related to psychological reward.” They added that “bidirectionality must be considered,” given that the use of one substance may influence the effect of an additional substance––it may enhance a high, for example.

The researchers noted that “the observed within-person positive associations between cannabis use and same-day alcohol consumption and cigarettes smoked are consistent with previous research that has shown a tendency for substance use behaviors to co-occur.”

Indeed, cross-tabs from the 2023 National Survey on Drug Use and Health found that those who used marijuana in the past 30 days were three times as likely to have smoked cigarettes in the past 30 days (30.8% vs. 10.4%) and 63% more likely to have used alcohol in the past 30 days (70.7% vs. 43.4%), compared to those who did not use marijuana in the past 30 days.

Source: SAM Drug Report’s Friday Fact report – 11:31 Friday 10th Jan 2025 – The Drug Report’s

Smart Approaches to Marijuana (SAM) is an alliance of organizations and individuals dedicated to a health-first approach to marijuana policy. We are professionals working in mental health and public health. We are bipartisan. We are medical doctors, lawmakers, treatment providers, preventionists, teachers, law enforcement officers and others who seek a middle road between incarceration and legalization. Our commonsense, third-way approach to marijuana policy is based on reputable science and sound principles of public health and safety.

Teen alcohol use has steadily decreased from 2000 to 2024 — falling from 73% to 42% in 12th grade, 65% to 26% in 10th grade and 43% to 13% in 8th grade — according to data from Monitoring the Future (MTF), an annual federally funded study.

Every year, the University of Michigan’s Institute for Social Research uses grant money from the National Institute on Drug Abuse to conduct the MTF main study, which surveys more than 25,000 8th, 10th and 12th graders to monitor behaviors, attitudes and values of adolescents.

Meanwhile, the MTF’s panel study does follow-up surveys with roughly 20,000 adults ages 19 to 65 to continue to track trends over time.

Binge drinking, which researchers defined as “consuming five or more drinks in a row at least once during the past two weeks,” among teens also declined in 2024 for all three grades compared to 2023 and the past two-and-half decades.

Since 2000, binge drinking has fallen from 30% to 9% in 12th grade, from 24% to 5% in 10th grade and from 12% to 2% in 8th grade.

Teen cigarette use in 2024 was the lowest ever recorded since the survey started tracking 12th graders in 1975 and 10th and 8th graders in 1991.

“The intense public debate in the late 1990s over cigarette policies likely played an important role in bringing about the very substantial downturn in adolescent smoking that followed,” researchers said, adding that “an important milestone occurred in 2009 with passage of the Family Smoking Prevention and Tobacco Control Act, which gave the U.S. Food and Drug Administration the authority to regulate the manufacturing, marketing, and sale of tobacco products.”

Researchers emphasized that “over time this dramatic decline in regular smoking should produce substantial improvements in the health and longevity of the population.”

Teen marijuana use (non-medical) in 2024 also declined for all three grades, with the percentage of students using marijuana in the last 12 months at 26% in 12th grade, 16% in 10th grade and 7% in 8th grade.

“Levels of annual marijuana use today are considerably lower than the historic highs observed in the late 1970s, when more than half of 12th graders had used marijuana in the past 12 months,” researchers reported.