1. Between 1965 and 2022, cigarette use has decreased by 73%

The recognition of tobacco use as a health hazard, and subsequent decrease in use, is often credited as one of the 10 greatest public health achievements of the 20th century. Efforts such as anti-smoking campaigns, smoking bans, tobacco taxes, and cessation support have all contributed to this decrease.

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2. As of 2021, tobacco use in the U.S. remains the third leading risk factor for early death and disability

People with lower household income, lower education levels, and those who are male, Black, African American and/or multiracial experience the most disparities from tobacco use. These trends exist across the U.S. as well as in Washington and have been similar over time.

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3. It is not just about cigarettes

E-cigarettes and smokeless tobacco are gaining popularity. In Washington, about 8% of individuals vape e-cigarettes and about 3% of individuals use smokeless tobacco. E-cigarettes have been shown to help with smoking cessation and may be less harmful than cigarettes; however, e-cigarettes are still linked to various health issues such as addiction and respiratory problems.

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4. It is critical to prevent young people from using any type of nicotine products

Nicotine/tobacco use in adolescence has been linked to numerous harmful outcomes, such as inattention, impulsivity, psychosis, and increased risk of substance use and other mental health disorders.

Importantly, the use of cigarettes, smokeless tobacco, and e-cigarettes dropped substantially among adolescents during the COVID-19 pandemic.

However, as of 2023, about 2% of 10th graders in Washington smoke cigarettes, 3% use smokeless tobacco, and about 8% vape nicotine. That means four times as many adolescents vape nicotine compared to smoking cigarettes (8% vs. 2%).

Among adolescents, demographic groups at higher risk of tobacco use include those who identify as sexually or gender diverse, have one or more disabilities, or are part of a migratory working family.

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*Trend lines are not continued after 2018 due to methodology changes related to the COVID-19 pandemic. The definition of “smokeless tobacco” was expanded in 2023 to include other smokeless nicotine products such as pouches, lozenges, gum, or toothpicks.

5. Continued focus on tobacco/nicotine prevention and reduction remain essential to public health efforts

Check out the Department of Health Commercial Tobacco Prevention Program for more information and resources.

For more information provided by the LCB Research Program, visit our website.

What are “crossover” products?

The term “crossover alcohol product” or “co-branded alcohol product” refers to an alcoholic product that is marketed with a similar brand name, logo, or packaging of an existing non-alcoholic brand. Examples include well-known brands of juice, soda, iced tea, iced coffee, and other beverages, which often have the word “hard” or “spiked” in the name. These crossover products have recently been increasing in availability across the United States, which has caused concerns related to public health and safety.

What are the concerns?

A main concern about these products is the similarity to their non-alcoholic counterparts. In many cases, the packaging and labeling designs are nearly identical which could cause confusion among consumers, or perhaps even accidental product selection and purchasing. A related concern is the placement of crossover alcohol products in retail stores. If crossover products are placed near their non-alcoholic counterparts or other non-alcoholic products, this may also cause confusion among consumers about which product they are selecting and purchasing. However, since these products are so new, there has not yet been research conducted on the impact on consumer choice and preference.

A major concern is crossover product appeal to youth. Youth are large consumers of the non-alcoholic counterparts. The 2023 Healthy Youth Survey found that 86% of Washington 10th graders reported drinking a sugar-sweetened beverage in the past week. It is possible that exposure of these crossover beverages, particularly those that use the same brand or logo as what they currently drink, may play a role in youth appeal. Research has shown a link between alcohol advertising exposure and substance use among young people.

Beyond familiarity with product brands, crossover alcohol products also tend to use many of the same non-alcoholic packaging and labeling elements that have been shown to be especially appealing to youth including cartoons, bright colors, images of fruit and other flavors, and other elements used to market juice, soda, lemonade, iced tea, and other non-alcoholic beverages. However, more research is needed to better understand how crossover alcohol products specifically may impact youth perceptions and risk for use as these products become more available.

What is being done?

In the absence of current research, some states have taken the lead in a proactive approach to regulate crossover alcohol products. Illinois and Virginia have both issued rules related to crossover alcohol product placement in retail stores, labeling, and signage with the goals of preventing confusion among consumers and limiting appeal to youth. In addition, a recent industry coalition commitment in June 2024 also focused on strategies to limit consumer confusion and avoid advertising and marketing to people under the age of 21.

In summary, crossover alcohol products have quickly expanded which has caused concerns related to consumer confusion and youth appeal. While a few rules and commitments have been issued, comprehensive regulation and guidance is currently lacking. Additional research is needed on how crossover alcohol products impact public health and safety.

A “crossover” product is the alcoholic version of a traditionally non-alcoholic product. Soft drink and juice producers along with alcohol suppliers have introduced many of these products within the last year.

While these products are gaining in popularity, there is concern that the crossover products may potentially be confused with their non-alcohol beverage counterparts. Crossover brand products often retain many of the same branding elements and consumer recognition as their non-alcoholic beverage counterparts.

Keep Customers Informed

In order to avoid any consumer confusion, retailers are encouraged to take measures to ensure that crossover products are merchandised in a manner that makes it clear that they contain alcohol.

Retailers can do this by:

• Separating products containing alcohol from those without alcohol.
• Do not display or promote crossover brand products in a manner that could create confusion with their non-alcohol beverage counterparts.
• Use signage easily visible to the consumer to identify products that contain alcohol.
• Keep all alcohol products in a separate section that is away from child-friendly items (such as candy and toys). Do not use endcaps located at the end of aisles with kid-friendly items.
• If using endcaps, do not include non-alcohol products in this area, and use signage easily visible to the consumer to indicate the products contain alcohol.
• Keep mini-bottles (airplane size) either behind a counter or in locked cabinets to prevent theft. Do not place them loosely in bins or baskets near check-out stands and exits.
• Keep alcohol products away from areas with easy-to-access exits — especially products that can be concealed and stolen.
• If feasible, apply security monitors to alcohol products that alert when products leave the store without being purchased.
• If possible, program crossover brand product barcodes to indicate that they contain alcohol when they are scanned at checkout so that the retail outlet employee confirms that the customer is of legal drinking age.

Retail employees are encouraged to get training to differentiate crossover brand products and packaging from their nonalcoholic counterparts.

Preventing Youth Access

Social media has shown us that when at a self-checkout aisle, a person under 21 has two canned products: one crossover product, and one non-alcohol beverage counterpart. The underage person scans the non-alcohol version twice, pays for their products, and leaves the store. It appears to be a compliant sale however, the person under 21 has now left the store with an alcoholic product.

Preventing underage use and adult misuse of alcohol is a primary objective of our mission. There are known dangers of underage drinking, including the impact on the developing brain and the increased risk of poor decision-making, injury, and even death. Product confusion can also create increased risk when consumers are not aware a product contains alcohol.