is zyn safer than tobacco Are pouches safe? Johns Hopkins expert weighs in on popular nicotine product The Health Effects of FDA-Authorized

Circa 1950 Please be careful! Hospital bedside promotional card Philip Morris Circa 1945 How to make the Doctor say Ah!' KOOL cigarettes promotional card, two sides Brown and Williamson Tobacco Company 1940s Correspondence Smoking in the hospital setting E-Mail from Alan Blum to Tim Pennycuff, University of Alabama Birmingham September 25, 2010 Smoking in the hospital setting E-Mail from Alan Blum to Tim Pennycuff, University of Alabama Birmingham October 10, 2010 Cleveland Clinic Foundation Letter from Karen Kokinda, Cleveland Clinic Foundation, to Alan Blum May 29, 1985 A column about smoking in hospitals Letter from Katie Baer to Alan Blum June 11, 1980 Why didnt you tackle the problem in the hospital setting? Letter from Alan Blum to Judy Shaw, American Hospital Association November 21, 1984 Smokeless tobacco sales in hospital Letter from Alan Blum to Bill Cassels, DCH Hospital March 20, 2001 Articles and Letters Smoking Guidelines for Hospitals Article by Alan Blum, MD JAMA July 11, 1980 DCH Health System Smoking Policy Druid City Hospital, Tuscaloosa, Alabama 2002 Policies on sale of cigarettes differ Newspaper article 1990s Hospitals challenged to restrict smoking Article in HOSPITALS March 16, 1982 Heat on hospital over fund-raisersponsors hit: Brewery, tobacco firm back event Article by DJ Wilson Houston Post March 14, 1989 Enacting a smoke free hospital policy Letter to health professionals Susan B

Methods Design This study primarily adapted the research design and protocol of the Tobacco Pack Surveillance System (TPackSS) and its 2015 Field Collection Protocol developed by the Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health [36]

People living with HIV often face multiple health challenges, and alcohol use can further compound the risks of smokingparticularly when it comes to cancers and cardiovascular disease

Population-specific interventions, including raising taxes, increasing price, formulating laws and regulations, and raising public awareness on the risks of substance use, should be implemented to prevent and reduce the substance use burden

Dissemination At the completion of the study, the PI will share the results through academic presentations and publication in peer-reviewed journals