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Ahuja NA, Kedia SK, Regmi S, Dillon PJ. Disparities in E-Cigarette Harm and Addiction Perceptions Among Adolescents in the United States: a Systematic Review of the Literature. J Racial Ethn Health Disparities 2024; 11:696-709. [PMID: 36877379 DOI: 10.1007/s40615-023-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Health disparities associated with e-cigarette use are increasingly apparent among US adolescents. Perceptions of e-cigarette harm and addiction play an important role in understanding adolescents' e-cigarette use behavior. The objective of this systematic review is to examine racial/ethnic and socio-economic disparities in e-cigarette harm and addiction perceptions among US adolescents. METHODS We searched five databases to identify cross-sectional or longitudinal studies that focused on adolescents (≤ 18 years of age) who were ever, current, or never e-cigarettes users; we then examined how race/ethnicity and/or socio-economic status (SES) impacted e-cigarette harm and/or addiction perceptions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. RESULTS Adhering to PRISMA guidelines, eight of 226 identified studies met the inclusion criteria. These eight studies examined either perceptions regarding absolute e-cigarette harm and/or addiction (i.e., assessing perception of only e-cigarette) or relative e-cigarette harm and/or addiction (i.e., comparative perceptions to traditional cigarettes) by race and ethnicity. Two of the eight studies assessed absolute harm and/or addiction perceptions of e-cigarettes by SES. Our results indicate that, compared to all other racial/ethnic groups, relative e-cigarette harm and addiction perceptions were lower among Non-Hispanic White adolescents; however, absolute e-cigarette harm perception was higher among these groups. No clear patterns of racial/ethnic differences in absolute e-cigarette addiction perceptions and SES differences in absolute e-cigarette harm perceptions were reported. CONCLUSION More research is needed to explicitly assess perceptions of e-cigarette harm and addiction among US adolescents by race/ethnicity and SES to develop subgroup appropriate public health messaging.
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Affiliation(s)
- Nikhil A Ahuja
- Department of Public Health, College of Health Professions, Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Sanjaya Regmi
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Albers L, Rogers CJ, Steinberg J, Vos RO, Soto D, Lee R, Wu JS, Unger JB. Proximity to Cannabis Retailers and Recent Cannabis Use among a Diverse Sample of California Adolescents. Subst Use Misuse 2023; 59:643-650. [PMID: 38115623 DOI: 10.1080/10826084.2023.2294965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors (N = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018-2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935-0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926-0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820-0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers.
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Affiliation(s)
- Larisa Albers
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Christopher J Rogers
- Department of Health Sciences, California State University, Northridge, Los Angeles, CA, USA
| | - Jane Steinberg
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Robert O Vos
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jasmine Siyu Wu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Vargees C, Stroup AM, Niznik T, Dunn D, Wyatt R, Hoetger C, Taleb ZB, Cohn AM, Cobb CO, Fetterman JL. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review. BMC Public Health 2023; 23:2357. [PMID: 38017396 PMCID: PMC10685631 DOI: 10.1186/s12889-023-17216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.
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Affiliation(s)
- Comreen Vargees
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA
| | | | - Taylor Niznik
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
- Institute for Integrative Health Care and Health Promotion (IGVF), Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA.
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Llanes KD, Ling PM, Guillory J, Vogel EA. Young Adults' Perceptions of and Intentions to Use Nicotine and Cannabis Vaporizers in Response to e-Cigarette or Vaping-Associated Lung Injury Instagram Posts: Experimental Study. J Med Internet Res 2023; 25:e46153. [PMID: 37552552 PMCID: PMC10540020 DOI: 10.2196/46153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Inhaling aerosolized nicotine and cannabis (colloquially called "vaping") is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging the use of both products received national media attention during the 2019 outbreak of e-cigarette or vaping-associated lung injury (EVALI). OBJECTIVE This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults' perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. METHODS Participants (N=1229) aged 18-25 (mean 21.40, SD 2.22) years were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (618/1229, 50.3%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) × 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive and aesthetically pleasing selfies. The positive text was supportive and uplifting regarding quitting the use of vaporized products. Negative images and text were graphic and fear inducing. After viewing 3 posts, participants reported the perceived harmfulness of nicotine and cannabis products, the perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on intentions to use nicotine and cannabis vaporizers. Analyses were adjusted for product use history. RESULTS Compared to viewing positive images, viewing negative images resulted in significantly greater perceived harm of nicotine (P=.02 for disposable pod-based vaporizers and P=.04 for other e-cigarette "mods" devices) and cannabis vaporized products (P=.01), greater perceived risk of nicotine vaporizers (P<.01), and lower odds of intentions to use nicotine (P=.02) but not cannabis (P=.43) vaporizers in the future. There were no significant main effects of text valence on perceived harm, perceived risk, and intentions to use nicotine and cannabis vaporized products. No significant interaction effects of image and text valence were found. CONCLUSIONS Negative imagery in Instagram posts about EVALI may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post's text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI.
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Affiliation(s)
- Karla D Llanes
- Center for Tobacco Control Research & Education, University of California San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research & Education, University of California San Francisco, San Francisco, CA, United States
| | | | - Erin A Vogel
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Hamberger ES, Halpern-Felsher B. Concern over tobacco and marijuana perceptions and use among adolescents and young adults with cystic fibrosis. Addict Behav 2023; 142:107669. [PMID: 36921439 PMCID: PMC10896606 DOI: 10.1016/j.addbeh.2023.107669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND This study assesses use and perceptions of short- and long-term harms associated with cigarettes, e-cigarettes, and smoked marijuana among adolescents and young adults (AYAs) with cystic fibrosis (CF). METHODS A total of 205 AYAs with CF completed an online survey querying about use, safety perceptions, and education related to traditional cigarettes, electronic cigarettes (e-cigarettes), and smoked marijuana. In addition, parents of AYAs with CF and CF healthcare providers were asked questions about experiences in avoidance education. RESULTS AYA participants with CF reported using tobacco and marijuana at rates lower than that of the general AYA population, with heavy use considerably lower in this population. AYAs with CF perceived lower risk of negative outcomes associated with using e-cigarettes and smoked marijuana compared to combustible cigarettes. Ever-use was correlated with a lower perception of risk across all products. CF providers estimated lower rates of product use in their own patients compared to both the general AYA CF population and the general AYA population, and estimated lower use among the general CF AYA population compared to the general AYA population. Receipt of avoidance education varied greatly when comparing AYAs with CF, parents of individuals with CF, and CF healthcare providers. Reasons for undereducation include but are not limited to lack of familiarity with products, assumption of avoidance, assumption of education, and time constraints. CONCLUSIONS Findings concerning safety perceptions and use of combustible tobacco, e-cigarettes, and marijuana in individuals with cystic fibrosis underscore the importance of providing avoidance education to vulnerable patient populations. Insight derived from this study may also inform pediatric to adult clinic transition education, when chronic disease populations are at greatest risk for engaging in risky behaviors. IMPLICATIONS AND CONTRIBUTION We report data on use, risk perception, and education of cigarettes, electronic cigarettes, and cannabis in individuals with cystic fibrosis, with a focus on adolescents and young adults. Such Findings will inform prevention education, especially during the critical transition period from pediatric to adult care when these behaviors are prevalent.
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Affiliation(s)
- Eric S Hamberger
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, UCLA, Los Angeles, CA, United States.
| | - Bonnie Halpern-Felsher
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
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Kim M, Neilands TB, Gregorich SE, Jordan JW, Ling PM. Young Adult Responses to Peer Crowd-Based Targeting in E-cigarette Advertisements: An Experimental Study. Nicotine Tob Res 2023; 25:1125-1134. [PMID: 37101413 PMCID: PMC10202626 DOI: 10.1093/ntr/ntac292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/16/2022] [Accepted: 12/21/2022] [Indexed: 04/28/2023]
Abstract
AIMS To examine the effects of psychographically targeted e-cigarette advertisements on young adults. METHODS A total of 2100 young adults (18-29 years old) representing five peer crowds (groups with shared values, interests, and lifestyle: Mainstream, Young Professional, Hip Hop, Hipster, and Partier) were recruited from a nationwide opt-in online panel. Participants were randomly assigned to view e-cigarette advertisements featuring characters that either did or did not match their own peer crowd affiliation and evaluated advertising effectiveness using Likert-type and semantic differential scales. Participants also reported their attitudes toward using e-cigarettes. RESULTS No significant overall effect of peer crowd matching was observed. However, significant two-way interaction effects emerged where matching advertisements yielded higher evaluations than mismatching advertisements among those who currently do not use tobacco and nicotine products and among Mainstream participants. Advertisements featuring Mainstream characters were in general rated more highly than other advertisements. Additional analyses found significant effects of peer crowd matching among those who viewed advertisements featuring non-Mainstream characters. CONCLUSIONS Peer crowd-based targeting can increase the effectiveness of e-cigarette advertisements which may impact initiation among current nonusers, requiring stricter marketing regulations. More research is needed to determine if anti-tobacco messaging tailored by peer crowds may effectively counteract targeted e-cigarette marketing. IMPLICATIONS E-cigarette advertisements often use psychographic targeting strategies, using lifestyles, attitudes, and values. Low-risk young adults (eg, those who currently do not use tobacco and nicotine products) are susceptible to psychographically targeted e-cigarette advertisements. This may result in the initiation of e-cigarette use among young adults who would otherwise be less likely to use tobacco and nicotine products. Stricter marketing regulations for emerging tobacco and nicotine products are required to reduce marketing exposure.
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Affiliation(s)
- Minji Kim
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
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Rapoport E, Zhu M, Pham D, Keim SA, Adesman A. Sports Team Participation and Vaping Among High School Students: 2015-2019. Pediatrics 2023; 151:190261. [PMID: 36504398 DOI: 10.1542/peds.2021-055565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Electronic vapor products (EVPs) have gained popularity among adolescents despite the health risks. This study aimed to evaluate whether sports team participation, a well-established protective factor against cigarette use, is similarly associated with decreased EVP use. METHODS This cross-sectional study analyzed the 2015-2019 Youth Risk Behavior Survey cohorts. Survey-weighted logistic regressions investigated associations between sports team participation and past 30-day exclusive cigarette use, exclusive EVP use, and dual cigarette/EVP use among US high school students, adjusting for sex, grade, and survey year. RESULTS The analytic cohort included 16 790 sports team participants (1.7% exclusive cigarette users, 18.3% exclusive EVP users, 5.5% dual users) and 13 972 nonparticipants (3.1% exclusive cigarette users, 13.4% exclusive EVP users, 7.6% dual users). Sports team participation was associated with lower odds of cigarette use (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.48-0.71) and dual use (aOR, 0.74; 95% CI, 0.63-0.88) and higher odds of EVP use (aOR, 1.39; 95% CI, 1.25-1.54). Among exclusive cigarette users and exclusive EVP users, sports team participation was associated with lower odds of frequent (≥20 days in the past month) than intermittent (1-19 days in the past month) cigarette use (aOR, 0.30; 95% CI, 0.19-0.49) and EVP use (aOR, 0.74; 95% CI, 0.61-0.91), respectively. CONCLUSIONS Our findings suggest that risk profiles for cigarette and EVP use differ with respect to sports team participation. Given the health risks associated with EVP use, aggressive efforts must be taken to educate student athletes about the health risks of EVP use.
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Affiliation(s)
- Eli Rapoport
- New York University Grossman School of Medicine, New York, New York
| | - Meng'ou Zhu
- Washington University School of Medicine, Saint Louis, Missouri
| | - Duy Pham
- Cohen Children's Medical Center of New York, Lake Success, New York
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Andrew Adesman
- Cohen Children's Medical Center of New York, Lake Success, New York.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Nguyen N, Wong M, Delucchi K, Halpern-Felsher B. Adolescents' and young adults' perceptions of risks and benefits differ by type of cannabis products. Addict Behav 2022; 131:107336. [PMID: 35436697 DOI: 10.1016/j.addbeh.2022.107336] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Cannabis use patterns among adolescents and young adults (AYAs) have changed recently, with increasing use of non-combustible cannabis products. Little is known about perceived risks or benefits related to non-combustible products (e.g., vaporized and edible cannabis). We examined whether AYAs' perceived risks and benefits differ across four cannabis products, and by use status. METHODS We conducted a survey of 433 California AYAs (Mage = 18.9 years old, 66.5% females) during 2017-2018. We compared a variety of perceived risks and benefits corresponding to short-term and long-term use of each product (combustible, blunt, vaporized, and edible cannabis), and between ever and never users. RESULTS Participants perceived combustible cannabis and blunts conferred the greatest risk for short-term (bad cough, trouble catching breath) and long-term (lung disease, oral and lung cancer, and heart attack) health outcomes and short-term social risks (friends upset, getting into trouble). These products were also perceived to have greater short-term and long-term benefits (i.e., reducing mental health problems) than vaporized and edible cannabis. The most common perceived risks were "get into trouble" and "become addicted." The most common benefits were "feel high or buzzed" and "feel less anxious." Ever cannabis users perceived less risks and greater benefits related to cannabis use than never users. CONCLUSIONS AYAs differentially perceived risks and benefits related to use of four cannabis products. Public health and education efforts should address both perceived and real risks and benefits of specific cannabis products to prevent cannabis use among AYAs.
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Adolescents, Young Adults, and Adults Continue to Use E-Cigarette Devices and Flavors Two Years after FDA Discretionary Enforcement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148747. [PMID: 35886599 PMCID: PMC9322506 DOI: 10.3390/ijerph19148747] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
This study assesses the use of e-cigarette devices and flavors using a large, cross-sectional survey of adolescents, young adults, and adults (N = 6131; ages 13−40 years old; Mage = 21.9) conducted from November to December 2021, 22 months after the FDA announced its prioritized enforcement policy against some flavored pod/cartridge-based e-cigarettes. We analyzed the patterns of use by age group: adolescents and young adults (AYAs) under 21 (minimum age of e-cigarette sales), young adults (21−24 years old), and adults (25−40 years old). The participants reported using e-cigarettes ever (44.2% < 21; 67.1% 21−24; 58.0% > 24), in the past 30 days (29.8% < 21; 52.6% 21−24; 43.3% > 24), and in the past 7 days (24.5% < 21; 43.9% 21−24; 36.5% > 24). Disposables were the most used e-cigarette device type across age groups (39.1% < 21; 36.9% 21−24; 34.5% > 24). Fruit, sweet, mint, and menthol flavors were popular across age groups; however, chi-squared tests for trends in proportions revealed age-related trends in past 30-day flavor use by device type. Findings suggest current AYA e-cigarette use may be higher than recorded by the NYTS 2021. The FDA, states, and localities should adopt more comprehensive restrictions on flavored e-cigarette products in order to reduce adolescent and young adult e-cigarette use.
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Virgili F, Nenna R, Ben David S, Mancino E, Di Mattia G, Matera L, Petrarca L, Midulla F. E-cigarettes and youth: an unresolved Public Health concern. Ital J Pediatr 2022; 48:97. [PMID: 35701844 PMCID: PMC9194784 DOI: 10.1186/s13052-022-01286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/25/2022] [Indexed: 11/11/2022] Open
Abstract
The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use. Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices. In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns.
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Affiliation(s)
- Fabrizio Virgili
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Raffaella Nenna
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Shira Ben David
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Enrica Mancino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Greta Di Mattia
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luigi Matera
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Liu J, Gaiha SM, Halpern-Felsher B. School-based programs to prevent adolescent e-cigarette use: A report card. Curr Probl Pediatr Adolesc Health Care 2022; 52:101204. [PMID: 35534403 PMCID: PMC9296568 DOI: 10.1016/j.cppeds.2022.101204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Given high rates and known health consequences of adolescent e-cigarette use as well as adolescents' susceptibility to nicotine addiction, school-based efforts to prevent and reduce adolescent e-cigarette use should continue to be developed, implemented, disseminated, and evaluated. This paper elaborates on best practices for developing and implementing prevention programs, including the importance of grounding programs in theories and frameworks that empower adolescents, including normative and interactive education, and having programs that are easily accessible and free of cost. Programs should also address key factors driving adolescent e-cigarette use, including discussing misperceptions, flavors, nicotine content, addiction, and the role that marketing plays in appealing to adolescents. The paper also discusses the gap areas of currently available prevention programs and highlights the need for evidence-based approaches and the importance of rigorous evaluation of programs.
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Affiliation(s)
- Jessica Liu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, United States
| | - Shivani Mathur Gaiha
- Stanford Reach Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford Research Park, 3145 Porter Drive, Wing A, Room A104, MC 5395, Palo Alto, CA 94304, United States
| | - Bonnie Halpern-Felsher
- Stanford Reach Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford Research Park, 3145 Porter Drive, Wing A, Room A104, MC 5395, Palo Alto, CA 94304, United States.
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12
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Emotion Regulation Difficulties and Health-Risk Behaviours in Adolescents. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Health-Risk Behaviours (HRBs) are significantly associated with avoidable mortality in adolescents, and preventing HRBs requires an adequate understanding of related factors. Among associated factors, emotion regulation difficulties may impact youths’ engagement in HRBs. Researchers explored the relation of emotion regulation with HRBs; however, specific emotion regulation difficulties for less severe and more prevalent HRBs, such as self-harming behaviour, risky-driving, violence, unhealthy dietary behaviour, and poor adherence to prescribed medication, has not been much explored. The current study aimed to explore the predictability of adolescents’ specific difficulties in emotion regulation in relation to their engagement in HRBs. For this purpose, six different HRBs, that is, self-harm, violence, risky-driving, unhealthy dietary behaviour, inadequate physical activity, and lack of medication adherence, were studied. A total of 617 (Males = 356) adolescents (Mage = 15.77) from five districts of Punjab state (India) provided required information on standardised self-report measures. The data were subjected to regression analysis, and the findings show that the participants who scored high on emotion regulation difficulties reported engagement in HRBs more than their counterparts. Some specific difficulties are more important than others for different forms of HRBs. It implies that the intervention programmes targeting specific HRBs should address specific facets of emotional dysregulation.
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13
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Association between electronic cigarette and combustible cigarette use with cardiometabolic risk biomarkers among U.S. adults. Ann Epidemiol 2022; 71:44-50. [DOI: 10.1016/j.annepidem.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/11/2022] [Accepted: 02/13/2022] [Indexed: 01/09/2023]
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14
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El-Amin S, Kinnunen JM, Rimpelä A. Adolescents' Perceptions of Harmfulness of Tobacco and Tobacco-like Products in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1485. [PMID: 35162508 PMCID: PMC8834861 DOI: 10.3390/ijerph19031485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/05/2022]
Abstract
During the recent years, new tobacco and tobacco-like products, e.g., e-cigarettes, have emerged on the market. Adolescents often underestimate health risks in general, including those concerning tobacco. Little is known of adolescents' perceptions of health risks of the newer products. Our paper compares adolescents' perceptions of harmfulness of cigarettes, e-cigarettes, snus, water pipes, and nicotine in Finland, a country with a long history of strict tobacco control policy. Online surveys to nationally representative samples of 12-18-year-olds were conducted in 2017 and 2019, with 7578 answering the surveys. Only 3% of boys and 2% of girls did not agree that cigarettes are harmful to health. The percentages were slightly higher for snus (6% and 3%, respectively) and nicotine (12%, 8%) but much higher for e-cigarettes (30%, 22%) and water pipes (36%, 38%). Those who used the product, whose parents were smokers or had lower education, and whose school performance was lower, less often agreed with the harmful health effects of the products. Our results showed that adolescents understood the harmfulness of older tobacco products better than the harmfulness of the newer ones. Our results also showed the need to strengthen health education and fix adolescents' misperceptions of the health effects of the newer products.
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Affiliation(s)
- Salma El-Amin
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (S.E.-A.); (A.R.)
| | - Jaana M. Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (S.E.-A.); (A.R.)
| | - Arja Rimpelä
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (S.E.-A.); (A.R.)
- Department of Adolescent Psychiatry, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
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15
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Singh P. Conscientiousness moderates the relationship between neuroticism and health-risk behaviors among adolescents. Scand J Psychol 2022; 63:256-264. [PMID: 35060640 DOI: 10.1111/sjop.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Health-Risk-Behaviors (HRBs) are considered significant antecedent conditions of adolescents' poor health and mortality. Prevention of any adverse health outcome requires an in-depth understanding of the risk and protective factors associated with its development and maintenance. Among other potential causal pathways, the "neuroticism- HRBs-adverse health" link has been supported in previous studies. Trait neuroticism has been associated with poor health and HRBs, but several moderators were also observed, which might transform neuroticism into a desirable phenomenon, that is, healthy neuroticism, that leads to better health. Conscientiousness is one such potential moderator; however, the moderating effect of conscientiousness in the neuroticism-HRBs link has not been explored extensively among adolescents, especially in India; therefore, no conclusive evidence is available. Thus, the present study was planned to explore the moderating effect of conscientiousness in the relationship between neuroticism and HRBs among adolescents. The study was conducted in India and its cross-sectional sample, procured through a multi-stage stratified random sampling, consists of 648 (364 males) adolescents (Mage = 16.08). Participants provided relevant information on standardized questionnaires. Moderated regression analysis was applied to test the stated hypotheses. Individuals high on neuroticism and low on conscientiousness reported more indulgence in health-risk behaviors than individuals high on both neuroticism and conscientiousness. It indicates that a higher level of conscientiousness may reduce the negative impact that neuroticism has on HRBs. The findings imply that the assessment of conscientiousness and strategies to increase the same should be part of interventional programs to achieve adolescents' wellbeing.
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Affiliation(s)
- Parwinder Singh
- Department of Humanities and Social Sciences, Indian Institute of Technology Ropar, Ropar, India
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16
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Ahuja NA, Kedia SK, Jiang Y, Ward KD, Pichon LC, Dillon PJ, Yu X, Xie L. Factors Associated with E-Cigarette Quit Intention Among Adolescents in the United States. Subst Use Misuse 2022; 57:2074-2084. [PMID: 36205511 DOI: 10.1080/10826084.2022.2130000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Background: Given increasing use of e-cigarettes among adolescents in the United States and its potential for nicotine addiction, encouraging adolescents to quit using these products has become a public health priority. This study examined factors at various socio-ecological levels associated with e-cigarette quit intention (pre-contemplation, contemplation, or preparation) using the Stages of Change of the Trans-theoretical Model among the U.S. adolescents. Methods: We used cross-sectional data from the past 30-day adolescent exclusive e-cigarette users participating in Wave 4 of the Population Assessment of Tobacco and Health study (n = 349). Weighted adjusted multinomial logistic regression models were used to analyze the data. Results: Compared to pre-contemplators and contemplators, preparators were more likely to believe that nicotine in e-cigarettes was "very/extremely harmful" (vs. "not at all harmful") to health (p < 0.001) and people cause a "lot of harm" (vs. "no harm") to themselves when they use e-cigarettes (p < 0.001). In comparison to pre-contemplators, contemplators and preparators were more likely to report that their parents/guardians talked with them about not using e-cigarettes than those whose parents/guardians did not talk with them (p < 0.001). Additionally, contemplators and preparators were also more likely to report that they "often/very often" (vs. never) noticed health warnings on e-cigarette packages (p < 0.001). Conclusion: Our findings suggest that harm perception, influence of family, and e-cigarette health warnings are some of the important factors associated with the stages of change for intention to quit among adolescent e-cigarette users. This study will help public health practitioners and researchers design multi-level e-cigarette cessation interventions for adolescents.
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Affiliation(s)
- Nikhil A Ahuja
- Department of Public Health and Social Work, Slippery Rock University of Pennsylvania, Slippery Rock, Pennsylvania, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Yu Jiang
- Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, Ohio, USA
| | - Xinhua Yu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Lu Xie
- Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA
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17
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Cummins K, Lu Y. Adolescents’ Perceptions of Substance Use Harms are Contingent on Mode of Administration and Type of Substance. Subst Abuse 2022; 16:11782218221119584. [PMID: 36032327 PMCID: PMC9411736 DOI: 10.1177/11782218221119584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022]
Abstract
Early vaping research often did not differentiate between substances vaped. The present study investigates risk perceptions for vaped nicotine and vaped cannabis. A school-based census of 9th and 11th graders yielded 431 responses to the California Healthy Kids Survey. Differences in harm perceptions were evaluated using multilevel mixed-effects models. Students were more likely to report nicotine vaping as great-moderate risk in comparison to cannabis vaping. Additionally, vaped cannabis was viewed as riskier than traditional administration. These results indicate that differences in harm perceptions may need to be addressed when targeting specific classes of substance use in investigations and interventions.
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Affiliation(s)
- Kevin Cummins
- Public Health, California State University Fullerton, Fullerton, CA, USA
| | - Yang Lu
- Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
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18
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Okpalauwaekwe U, Nwoke CN, Messier J. Youth Demographic Characteristics and Risk Perception of Using Alternative Tobacco Products: An Analysis of the 2014-2015 Canadian Student Tobacco, Alcohol, and Drugs Survey (CSTADS). Tob Use Insights 2021; 14:1179173X211058150. [PMID: 34866954 PMCID: PMC8637779 DOI: 10.1177/1179173x211058150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is a growing attraction by youth to alternative tobacco products (ATPs) such as e-cigarettes and hookahs. This study investigated risk perceptions and demographic characteristics associated with ATP use in grade 8-10 students. Methods Data were drawn from the 2014/15 cycle of the CSTADS. The analytic sample included 1819 students from a total pool of 42 094 students who completed the survey. Logistic regression models were used to examine factors (demographic characteristics and risk perception) associated with ATP use in the past 30 days. Results 12% of students in grade 8-10 self-identified as having used ATPs in the past 30-days, with a majority of students in grade 10 (56%). Male students had higher odds of reporting ATP use when compared to females. Although a lesser proportion of Indigenous students reported ATP use in comparison to White students (31% vs 61%), Indigenous students were 2.42 (1.49, 3.93) times as likely to use ATPs as White students. Students who perceived smoking hookah once in a while as "no to slight risk" were 1.58 (1.09, 2.28) times more likely to report ATP use than students who perceived "moderate to great risk." Also, students who perceived using e-cigarettes on a regular basis as "no to slight risk" were 2.21 (1.53, 3.21) times more likely to report ATP use as students who perceived "moderate-great risk." Conclusion A significant number of grade 8-10 students use ATPs, especially e-cigarettes, with the misconception of minimal health risks. There remains the need to do more to counteract the rise in social and epidemiological alternative tobacco use trends among the youth.
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Affiliation(s)
- Udoka Okpalauwaekwe
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Jacinthe Messier
- Independent Researcher in Indigenous Studies, Project Coordinator, Siksika First Nation Project, Calgary, AB, Canada
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Agbonlahor O, Rai J, Mattingly D, Hart J, Walker K. Cardiovascular disease risk perceptions and tobacco use among Appalachian youth. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/143749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Buu A, Hu YH, Wong SW, Lin HC. Internalizing and Externalizing Problems as Risk Factors for Initiation and Progression of E-cigarette and Combustible Cigarette Use in the US Youth Population. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00261-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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Mathur Gaiha S, Halpern-Felsher B, Feld AL, Gaber J, Rogers T, Henriksen L. JUUL and other e-cigarettes: Socio-demographic factors associated with use and susceptibility in California. Prev Med Rep 2021; 23:101457. [PMID: 34194963 PMCID: PMC8227835 DOI: 10.1016/j.pmedr.2021.101457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
This study examined which socio-demographic factors are associated with susceptibility (lack of commitment to avoid future use), past-12-month and past-30-day use of JUUL and other e-cigarettes, and reasons for and against using JUUL. An online survey of 3,075 Californians ages 15-29, including 24.3% who identified as LGBTQ, were recruited via social media in January-March 2019. Multi-level weighted logistic regression models suggest that LGBTQ participants were more likely to be susceptible to JUUL [AOR = 2.11 (1.60, 2.79) (parentheses include 95% Confidence Intervals)] and other e-cigarettes [AOR = 2.31 (1.75, 3.05)], and more likely to use JUUL [AOR = 1.27 (1.02, 1.58)] and other e-cigarettes [AOR = 1.66 (1.35, 2.05)] in the past 12 months. Susceptibility to using JUUL was more likely among adolescents (ages 15-17) [AOR = 1.72 (1.30, 2.28)] and young adults (ages 18-20) [AOR = 1.26 (1.00,1.58)] than adults (ages 21-29). At the community level, living in jurisdictions with higher median household income was associated with a higher likelihood of being susceptible to using JUUL and other e-cigarettes. Compared to non-Hispanic Whites, Asian/Pacific Islanders were less likely to use JUUL [AOR = 0.68 (0.54, 0.86)] and other e-cigarettes [AOR = 0.60 (0.48, 0.76)] in the past 12 months. Past-30-day JUUL use was more likely among males than females [AOR = 1.44 (1.11, 1.88)]. Common reasons for using JUUL were: friends' use, flavors, "safer" than cigarettes, no one will notice, and nicotine rush is greater than other devices. Common reasons against using JUUL were: harmful to self/others, contains nicotine and is addictive. E-cigarette prevention and cessation efforts should include tailored messaging for people who identify as LGBTQ and reinforce reasons for not vaping nicotine.
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Affiliation(s)
| | | | - Ashley L. Feld
- RTI International, Research Triangle Park, NC, United States
| | - Jennifer Gaber
- RTI International, Research Triangle Park, NC, United States
| | - Todd Rogers
- RTI International, Research Triangle Park, NC, United States
| | - Lisa Henriksen
- Stanford University School of Medicine, Palo Alto, CA, United States
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22
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Kjeld SG, Andersen S, Andersen A, Glenstrup S, Lund L, Danielsen D, Bast LS. Who are the young users of tobacco products? Prevalence and characteristics of Danish adolescents who have either smoked cigarettes, used alternative tobacco products, or used both. NORDIC STUDIES ON ALCOHOL AND DRUGS 2021; 38:555-572. [PMID: 35309851 PMCID: PMC8900172 DOI: 10.1177/14550725211027687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/08/2021] [Indexed: 01/16/2023] Open
Abstract
Aims: We examined characteristics (smoking in social relations, binge drinking, and well-being measures) of Danish 13-year-olds in relation to their tobacco use patterns. Ever use of cigarettes exclusively, ever use of alternative tobacco products (ATPs; e-cigarettes, snus, or waterpipe) exclusively, and use of both cigarettes and ATPs were studied. Methods: We used self-reported data from students at 46 Danish schools in 2017 comprising 2,307 students (response rate = 86%). Multi-level logistic regression analyses were used to examine the associations between student characteristics and the odds for having ever used any tobacco products, smoked cigarettes exclusively, used ATPs exclusively, or used both cigarettes and ATPs compared with never use of any tobacco products. Unadjusted estimates and estimates adjusted for gender were reported. Results: A significant minority of youth (13.2%) had used one or more tobacco products. Of these, 2.0% had exclusively smoked cigarettes, 7.2% had exclusively used ATPs, and 4.0% had used both. Findings showed that all included characteristics (families’ and friends’ smoking, binge drinking, and well-being characteristics) were associated with using any tobacco product; however, students with friends who smoked, had been binge drinking, and had low well-being at home had notably higher odds for having both smoked cigarettes and used ATPs compared to the other tobacco use patterns. Conclusion: ATPs were popular among Danish adolescents compared with conventional cigarettes. Thus, prevention efforts among adolescents should not merely focus on the health risks of conventional cigarette smoking but also on ATPs. Students with diverse tobacco use patterns were similar on various characteristics. However, findings indicate that adolescents who had used both conventional cigarettes and ATPs constitute a more risk-averse group in special need of prevention efforts. Gender did not markedly influence the results. These findings may help future strategies aiming at the youngest adolescents at risk of using tobacco products.
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Affiliation(s)
- Simone Gad Kjeld
- Simone Gad Kjeld, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
| | | | | | | | - Lisbeth Lund
- University of Southern Denmark, Copenhagen, Denmark
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23
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Seidel AK, Morgenstern M, Galimov A, Pedersen A, Isensee B, Goecke M, Hanewinkel R. Use of electronic cigarettes as a predictor of cannabis experimentation: A longitudinal study among German youth. Nicotine Tob Res 2021; 24:366-371. [PMID: 34383071 DOI: 10.1093/ntr/ntab166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/10/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Experimentation with e-cigarettes is rising among youth, and there are concerns that e-cigarettes could be a new risk factor for initiating substance use. This study aimed to investigate whether e-cigarette use longitudinally predicts experimentation with cannabis. METHODS During 2017-2019, a prospective cohort study with an observation period of 18 months was conducted with 3,040 students from Germany who had never used cannabis (mean age = 14.8, range: 13-18 years). A multiple poisson regression was used to investigate whether e-cigarette use was an independent predictor of future cannabis use. RESULTS Lifetime e-cigarette use was reported by 29.4 % of the survey population (n = 894) at baseline, and 17.4 % (n = 529) initiated cannabis use during the observation period. Among e-cigarette ever users, the initiation rate was 34.5 % compared to 10.4 % of never users. Results were robust to adjustment for age, sex, migrant status, type of school, sensation seeking, peer cannabis use, the use of alcohol and conventional cigarettes (ARR = 1.83; 95 % CI: 1.48-2.25). Further analyses revealed that the association between e-cigarette use and cannabis experimentation was stronger among youth with low sensation seeking scores (ARR = .77, CI: .61-.97) and no conventional cigarette use (ARR = .48, CI: .37-.64) at baseline. CONCLUSION E-cigarette use is associated with a subsequent initiation of cannabis use. This association seems to be stronger for youth who have a lower risk for substance use in general. Future studies need to investigate whether this is only true for experimental or also more frequent cannabis use. IMPLICATIONS The study indicates a prospective association between e-cigarette use and initiation of cannabis experimentation independent of other risk factors. It suggests that e-cigarette use is more strongly associated with cannabis initiation for youth with a lower propensity to use substances (low sensation-seekers and non-smokers).
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Affiliation(s)
- Ann-Kathrin Seidel
- Institute for Therapy and Health Research, IFT-Nord gGmbH, Harmsstr, Kiel, Germany
| | - Matthis Morgenstern
- Institute for Therapy and Health Research, IFT-Nord gGmbH, Harmsstr, Kiel, Germany
| | - Artur Galimov
- Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anya Pedersen
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Olshausenstr, Kiel, Germany
| | - Barbara Isensee
- Institute for Therapy and Health Research, IFT-Nord gGmbH, Harmsstr, Kiel, Germany
| | | | - Reiner Hanewinkel
- Institute for Therapy and Health Research, IFT-Nord gGmbH, Harmsstr, Kiel, Germany
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Lazaro A, Ceballos R, Fischer M, Smuin S, Halpern-Felsher B. A novel approach to training educators to conduct school-based adolescent e-cigarette education and prevention: Using the Tobacco Prevention Toolkit. Addict Behav 2021; 118:106858. [PMID: 33640832 DOI: 10.1016/j.addbeh.2021.106858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Emerging tobacco products, especially e-cigarettes, present a challenge for educators tasked with providing adolescent tobacco prevention education, as they typically have insufficient time to stay uptodate with the latest information on all tobacco products. To equip educators to implement e-cigarette and other prevention materials, we developed a novel, experiential training of the Tobacco Prevention Toolkit, comprising three components: (1) information session, (2) website navigation demonstration, and (3) hands-on curriculum demonstration allowing educators to present and practice Toolkit lessons. METHODS We evaluated this experiential training using a post-training survey, conducted with 486 participants (75% female) from 21 separate trainings. Surveys included demographic questions, training evaluation questions, and 4 open-ended questions administered via Qualtrics. Quantitative data were analyzed for frequencies via R statistical software. Qualitative data were analyzed using grounded theory. RESULTS Training participants overwhelmingly agreed or strongly agreed that their knowledge of e-cigarettes increased as a result of the training; they were satisfied with the overall training; and they indicated intention to use the Toolkit in the future. Participants favored the enthusiastic presenters, the information about e-cigarettes, the website navigation, and the curriculum demonstration features of the training. Participants requested more time for various components of the training, more in-depth information about e-cigarettes, and more direction for Toolkit implementation. CONCLUSIONS This novel, experiential training increased educator-reported knowledge of tobacco products and was overwhelmingly well-received, suggesting that such training can be important for effective dissemination of other e-cigarette prevention and intervention curricula.
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Affiliation(s)
- Adrienne Lazaro
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Richard Ceballos
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Molly Fischer
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | | | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
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Gu J, Guo X, Veenstra G, Zhu Y, Fu Q. Adolescent Marijuana Use in the United States and Structural Breaks: An Age-Period-Cohort Analysis, 1991-2018. Am J Epidemiol 2021; 190:1056-1063. [PMID: 33324982 DOI: 10.1093/aje/kwaa269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/26/2022] Open
Abstract
To investigate temporal patterns, sociodemographic gradients, and structural breaks in adolescent marijuana use in the United States from 1991 to 2018, we used hierarchical age-period-cohort logistic regression models to distinguish temporal effects of marijuana use among 8th, 10th, and 12th graders from 28 waves of the Monitoring the Future survey (1991-2018). Structural breaks in period effects were further detected via a dynamic-programing-based method. Net of other effects, we found a clear age-related increase in the probability of marijuana use (10.46%, 23.17%, and 31.19% for 8th, 10th, and 12th graders, respectively). Period effects showed a substantial increase over time (from 16.23% in 2006 to 26.38% in 2018), while cohort effects remained stable throughout the study period. Risk of adolescent marijuana use varied by sex, racial group, family status, and parental education. Significant structural breaks during 1995-1996, 2006-2008, and 2011-2013 were identified in different subpopulations. A steady increase in marijuana use among adolescents during the latter years of this time period was identified. Adolescents who were male, were non-Black, lived in nonintact families, and had less educated parents were especially at risk of marijuana usage. Trends in adolescent marijuana use changed significantly during times of economic crisis.
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Sharma A, McCausland K, Jancey J. Adolescent's Health Perceptions of E-Cigarettes: A Systematic Review. Am J Prev Med 2021; 60:716-725. [PMID: 33775514 DOI: 10.1016/j.amepre.2020.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
CONTEXT E-cigarette use is increasing among adolescents, particularly in high-income countries. This review examines the health perceptions of E-cigarettes among adolescents (aged 12-17 years) residing in the U.S., United Kingdom, Canada, Australia, and New Zealand and their sources of E-cigarette information. EVIDENCE ACQUISITION Peer-reviewed literature published in January 2009-April 2019 in MEDLINE, Embase, and ProQuest were systematically reviewed using identified keywords. The search identified 654 references. Studies (n=99) that met the inclusion criteria were subjected to full-text screening. A total of 27 articles were subjected to quality appraisal using the Joanna Briggs Institute's critical appraisal checklists. EVIDENCE SYNTHESIS A total of 7 qualitative and 18 quantitative studies were included in the review, and the study characteristics, results, and limitations were extracted. A total of 4 main themes emerged from the study findings: (1) perceived relative harm of E-cigarettes versus that of cigarettes, (2) perceived health effects of E-cigarettes, (3) perceived benefits and safety of E-cigarettes, and (4) sources of E-cigarette information and exposure. Most adolescents perceived E-cigarettes to be less harmful than cigarettes; however, often, their health perceptions of E-cigarettes were conflicting. Sources of exposure to E-cigarette information included friends, family, retail point of sale, TV and online advertising, national agencies, healthcare providers, and from direct experience. CONCLUSIONS Findings indicate that adolescents, particularly E-cigarette users, have more favorable perceptions of E-cigarettes than of cigarettes; however, these perceptions are conflicting. Advertising, marketing, and peer and family networks appear to influence adolescents' perceptions. More research is required, particularly in Australia and New Zealand, to better understand adolescents' health perceptions of E-cigarettes and where they source information from so that misperceptions can be addressed through appropriate channels with suitable messaging.
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Affiliation(s)
- Anupriya Sharma
- School of Population Health, Curtin University, Bentley, Australia.
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, Australia
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Soneji S, Knutzen KE, Gravely S, Elton-Marshall T, Sargent J, Lambert E, Hilmi N, Sharma E, Jackson KJ, Wang B, Robinson J, Driezen P, Bover Manderski M, Bansal-Travers M, Hyland A, Travers M, Yang DH, Dang R, Fong GT. Transitions in frequency of hookah smoking among youth and adults: findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study, 2013-15. Addiction 2021; 116:936-948. [PMID: 32896050 DOI: 10.1111/add.15250] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/01/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The prevalence of hookah smoking has increased in the United States since at least 2010, especially among youth and young adults. This study assessed self-reported reasons for hookah smoking cessation and transition to or maintenance of high-frequency hookah smoking among current hookah smokers. DESIGN Separately analyzed data from the Population Assessment of Tobacco and Health (PATH) study, a longitudinal cohort study. Frequency of and reasons for hookah smoking were ascertained at wave 1 (2013-14); frequency of hookah smoking and past-year cessation were ascertained at wave 2 (2014-15). Weighted multivariable logistic and ordinal logistic regression models were fitted to predict hookah smoking cessation and frequency of hookah smoking at wave 2, respectively, accounting for demographic and behavioral risk factors, reasons for hookah smoking and frequency of hookah smoking at wave 1. SETTING United States. PARTICIPANTS A total of 693 youth and 4400 adult past-year hookah smokers. MEASUREMENTS Self-reported tobacco-use patterns and associated health behaviors were measured via audio computer-assisted self-interviews (ACASI). FINDINGS At wave 1, 5.9% of youth and 7.5% of adults were past-year hookah smokers. Among all age groups, the leading reasons for hookah smoking were enjoyment of socializing while smoking, the availability of appealing flavors and believing that it was less harmful than cigarette smoking. The odds of cessation were lower for adults who liked hookah flavors [adjusted odds ratio (aOR) = 0.40; 95% confidence interval (CI) = 0.26-0.62] compared with adults who did not like hookah flavors. The odds of transitioning to, or maintaining, monthly or more frequent hookah smoking at wave 2, compared with cessation or less than monthly smoking, were higher for adults who liked hookah flavors [adjusted proportional odds ratio (aPOR) = 2.10; 95% CI = 1.48-2.99 and enjoyed socializing while smoking hookah (aPOR = 1.82; 95% CI =1.13-2.94) compared with adults who did not like hookah flavors or socializing. CONCLUSION The availability of appealing flavors, affordability and socialization while smoking hookah in the United States are associated with reduced likelihood of cessation and increased likelihood of high-frequency hookah smoking.
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Affiliation(s)
- Samir Soneji
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Kristin E Knutzen
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Tara Elton-Marshall
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - James Sargent
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Elizabeth Lambert
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Nahla Hilmi
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
- Kelly Government Solutions, Rockville, MD, USA
| | | | - Kia J Jackson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Baoguang Wang
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Joelle Robinson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Michelle Bover Manderski
- Center for Tobacco Studies, School of Public Health, Rutgers, State University of New Jersey, Piscataway, NJ, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | - Mark Travers
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | | | - Rui Dang
- University of Information Science and Technology, Ohrid, North Macedonia
| | - Geoffrey T Fong
- Center for Tobacco Studies, School of Public Health, Rutgers, State University of New Jersey, Piscataway, NJ, USA
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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McKelvey K, Gaiha SM, Delucchi KL, Halpern-Felsher B. Measures of both perceived general and specific risks and benefits differentially predict adolescent and young adult tobacco and marijuana use: findings from a Prospective Cohort Study. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2021; 8:91. [PMID: 34435190 PMCID: PMC8382238 DOI: 10.1057/s41599-021-00765-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/23/2021] [Indexed: 05/25/2023]
Abstract
Health behavior theorists and prevention researchers use a variety of measures of adolescent and young adult (AYA) risk and benefit perceptions to predict tobacco-use and marijuana-use behaviors. However, studies have not examined whether and how perception measures that ask about likelihood of more general outcomes such as "harm" versus ask about specific risk or benefit outcomes compare or whether they differentially predict AYA willingness to use if one of your best friends were to offer it and intentions to use in the next year; and if these measures have differential ability to predict actual use of tobacco and marijuana. We used data from a prospective cohort of California AYAs to create and test new scales to measure perceptions of specific health and social outcomes related to risks (e.g., smell bad) and benefits (e.g., look cool) related to tobacco and marijuana, and then addressed three questions: (1) Whether and how measures of perceptions of specific social and health risks and benefits (for our purposes "specific measures") and measures of perceived general harm are differentially associated with measures of willingness, social norms, and intentions to use? (2) Are specific versus general measures differentially associated with and predictive of tobacco and cannabis use behavior? (3) Are specific perceptions measures differentially predictive of behavior compared to measures of willingness, social norms, and behavioral intentions? Our results demonstrate that to better predict AYA tobacco and marijuana use, measures that address general outcomes, such as harmfulness, as well as willingness and behavioral intention should be used. We also found that measures of specific perceived risks (short-term, long-term, social) and benefits were unrelated and correlated differently with different products. For example, adolescents perceived both risks and benefits from using products like e-cigarettes, and perceived greater risk from smokeless tobacco compared to combustible cigarettes. These findings indicate that measures of specific perceived social and health outcomes can be useful to discern nuanced differences in motivation for using different substances. Study implications are important for survey dimension-reduction and assessing relationships among perceptions, motivations, and use of tobacco and marijuana products.
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Affiliation(s)
- Karma McKelvey
- Department of Pediatrics, School of Medicine, Stanford University, 770 Welch Road, Suite 100, Palo Alto, CA 94304, USA
- These authors contributed equally: Karma McKelvey, Shivani Mathur Gaiha
| | - Shivani Mathur Gaiha
- Department of Pediatrics, School of Medicine, Stanford University, 770 Welch Road, Suite 100, Palo Alto, CA 94304, USA
- These authors contributed equally: Karma McKelvey, Shivani Mathur Gaiha
| | - Kevin L. Delucchi
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, School of Medicine, Stanford University, 770 Welch Road, Suite 100, Palo Alto, CA 94304, USA
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Burnley A, Bold KW, Kong G, Wu R, Krishnan-Sarin S. E-cigarette use perceptions that differentiate e-cigarette susceptibility and use among high school students. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:238-246. [PMID: 33058696 DOI: 10.1080/00952990.2020.1826501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND E-cigarette use among adolescents is increasingly popular and a growing public health concern. OBJECTIVES To examine how individual e-cigarette use perceptions differ between adolescents based on e-cigarette use status and susceptibility to future use of e-cigarettes. METHODS Data were collected using surveys administered across eight Connecticut high schools (grades 9-12), Spring 2015. N = 2592 students (Mage = 16.01, SD = 1.28, Female = 51.7%) reported e-cigarette use and susceptibility and were categorized into non-susceptible never-users (57.8%), susceptible never-users (16.9%) and ever-users (25.4%). Youth also responded to 12 e-cigarette use perceptions describing perceived benefits and risks of e-cigarette use. RESULTS A multinomial logistic regression model was used. Eight use perceptions were related to susceptibility or use of e-cigarettes. The benefit-related use perception "feel relaxed" was the only item associated with greater odds of being both susceptible (vs. non-susceptible, p <.001) and an ever-user (vs. susceptible; p <.05). Two other benefit-related use perceptions were related to higher odds of being susceptible to e-cigarette use ("control your weight"; AOR = 1.82, p <.05; "look cool"; AOR = 3.13, p <.05). Results also identified key risk-related use perceptions that related to lower odds of either being susceptible to e-cigarette use ("have a heart attack"; AOR =.43, p <.001) or of ever-use ("have bad breath"; AOR =.28, p <.001; "get lung cancer"; AOR =.58, p <.05). CONCLUSION E-cigarette use perceptions among youth differ by e-cigarette use and susceptibility status. Findings could help identify youth who are vulnerable to e-cigarette use and inform prevention, for example by developing counter-messaging for benefit perceptions associated with susceptibility and ever-use.
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Affiliation(s)
- Annabel Burnley
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Ran Wu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Liu J, Ramamurthi D, Halpern-Felsher B. Inside the adolescent voice: A qualitative analysis of the appeal of different tobacco products. Tob Induc Dis 2021; 19:15. [PMID: 33654482 PMCID: PMC7908110 DOI: 10.18332/tid/132856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION While cigarette use has decreased, adolescents’ overall use of tobacco (e.g. e-cigarettes, cigars, and hookah) has increased. The purpose of this qualitative study is to highlight the decision-making process of adolescents to use certain products over others and why certain tobacco products appeal to them. METHODS Twenty-five participants were recruited from a larger study surveying adolescents’ perceptions and tobacco use (772 high school students). The participants were involved in one-on-one semi-structured phone interviews on the appeal of different tobacco products. Interviews were recorded, transcribed verbatim, and analyzed by identifying relevant codes and themes. RESULTS Participants for this study had a mean age of 16.4 (SD=1.2) years; over half (14/25) were female. Three major themes emerged from the interviews: 1) social context and circumstances to use, including using and sharing with peers, and reducing boredom; 2) importance of flavors, smell, taste, smoke tricks, and accessibility of products; and 3) misperceptions and misinformation of product risks. CONCLUSIONS The findings that emerged showed why participants favored certain tobacco products, especially e-cigarettes, over others. The results support areas for future research and practice, and inform how interventions can better address the appeal of different tobacco products to ultimately prevent adolescent use.
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Affiliation(s)
- Jessica Liu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Divya Ramamurthi
- Stanford Research into the Impact of Tobacco Advertising, Stanford University, Palo Alto, United States
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, United States
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31
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Chau SL, Wang MP, Wu Y, Cheung DYT, Kong A, Lai V, Lam TH, Ho SY. Polytobacco product use among current cigarette smokers in Hong Kong, China: results from population surveys (2015-17). BMC Public Health 2021; 21:307. [PMID: 33549071 PMCID: PMC7866759 DOI: 10.1186/s12889-021-10341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polytobacco product use is increasingly popular, but little is known about the prevalence, trend, and factors of such use particularly in non-western countries. METHOD A representative sample of 1139 current cigarette smokers aged 15+ (84.1% male) were telephone interviewed in Tobacco Control Policy-related Surveys in 2015-2017. Information collected included poly-tobacco use (PTU), smoking and socio-demographic characteristics. Associations of current PTU with related factors were analyzed using logistic regression with adjustment for confounders. Prevalence was weighted by age and sex of current cigarette users in the general population. RESULTS Eighty-four point one percent (95% CI 81.4-86.6%) were exclusive cigarette smokers. Fifteen point nine percent (13.4-18.6%) were current polytobacco product users, 12.3% (10.2-14.8%) used one tobacco product and 2.52% (1.59-3.97%) used two tobacco products in addition to cigarette. Cigarette use with cigar was more common (6.28%, 4.75-8.27%), and the least used product with cigarette was e-cigarette (1.05%, 0.44-2.50%). The changes in overall prevalence of PTU by number of products use varied in 3 years. Current PTU was associated with being male (AOR 2.01, 95% CI 1.12-3.61), younger age (AORs range from 1.34-4.65, P for trend < .001) and less ready to quit (2.08, 1.09-3.97). CONCLUSIONS Prevalence of PTU increased slowly by year, one tobacco product use with cigarette was more common. The most used tobacco product with cigarette was cigar. Being male, younger and less ready to quit were associated with current PTU.
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Affiliation(s)
- S L Chau
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - M P Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Y Wu
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - D Y T Cheung
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - A Kong
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - V Lai
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - T H Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
| | - S Y Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
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Gaiha SM, Duemler A, Silverwood L, Razo A, Halpern-Felsher B, Walley SC. School-based e-cigarette education in Alabama: Impact on knowledge of e-cigarettes, perceptions and intent to try. Addict Behav 2021; 112:106519. [PMID: 32890911 DOI: 10.1016/j.addbeh.2020.106519] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/21/2020] [Accepted: 06/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Educational programs are needed to combat the sharp rise in adolescent e-cigarette use. We assessed adolescent knowledge about e-cigarettes, perceptions of harmfulness and addictiveness and intent to try e-cigarettes before and after an e-cigarette educational session. METHODS We conducted a one-group pre- and post-test study among middle and high school students in Alabama in 2019. The intervention included a 30-minute educational session based on the Stanford Tobacco Prevention Toolkit on e-cigarette types, contents, marketing and advertising, health effects and nicotine addiction. McNemar tests of paired proportions and multi-level, mixed-effects logistic regression models were used to analyze intervention effects. RESULTS Surveys were completed by 2,889 middle and high school students. The intervention was associated with significantly increased knowledge about e-cigarettes and perceptions that e-cigarettes are harmful and addictive, and with significantly lower intent to try e-cigarettes. At pre-test, middle school students had lower knowledge, believed that e-cigarettes were not as addictive and showed higher intent to try both e-cigarettes and cigarettes compared to high school students. Groups that were associated with lower perceived harmfulness and addictiveness were: ever-users of e-cigarettes, ever-users of both e-cigarettes and cigarettes and prior users of mint/menthol flavored e-cigarettes. CONCLUSIONS A school-based educational session was significantly associated with improved adolescent knowledge about e-cigarettes, increased the perceived harmfulness and addictiveness of e-cigarettes, and reduced intent to try e-cigarettes. E-cigarette education should be prioritized for middle school students due to lower levels of knowledge and higher intent to try tobacco compared to high school students.
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McKelvey K, Baiocchi M, Halpern-Felsher B. PMI's heated tobacco products marketing claims of reduced risk and reduced exposure may entice youth to try and continue using these products. Tob Control 2020; 29:e18-e24. [PMID: 32029537 PMCID: PMC7416542 DOI: 10.1136/tobaccocontrol-2019-055318] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/16/2019] [Accepted: 10/31/2019] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Philip Morris International (PMI) is seeking Food and Drug Administration's (FDA) authorisation to market IQOS as a modified risk tobacco product and to make marketing claims of reduced risk and reduced exposure. Such claims may be misunderstood by youth, thereby increasing their risk for tobacco initiation. OBJECTIVE To assess youth (mean age 19.3, SD=1.7) understanding and perceptions of PMI's proposed consumer marketing claims of reduced risk and reduced exposure, we embedded a randomised controlled experiment into a survey of 450 California youth (April to August 2018). Participants were randomised to see 'reduced exposure', 'reduced risk' or neither claim. Perceptions of IQOS-related health risks and general harm and understanding of the term 'switching completely' as used in PMI's proposed claims were compared. RESULTS Mean expectancies to experience specific health risks did not differ by claim exposure. The reduced exposure group's perceptions of general harm did not differ from those of controls nor from the reduced risk group. The reduced risk group had the largest proportion who perceived IQOS as moderately/less harmful (n=78, 52%); controls the largest proportion perceiving IQOS as quite/extremely harmful (n=91, 63%). While 71% of the sample understood the term 'switch completely' correctly as used in the reduced risk (n=194, 71%) and reduced exposure (n=206, 72%) claims, more than 1 in 4 did not. CONCLUSIONS FDA and other regulators must use caution when considering allowing claims of reduced risk or reduced exposure to appear on retail tobacco packaging. Youth misunderstand such claims, and misperceptions of harm are known to lead to tobacco-use initiation.
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Affiliation(s)
- Karma McKelvey
- Pediatrics/Adolescent Medicie, Stanford University School of Medicine, Stanford, California, USA
| | - Michael Baiocchi
- Statistics, Stanford University Stanford Prevention Research Center, Stanford, California, USA
| | - Bonnie Halpern-Felsher
- Pediatrics/Adolescent Medicie, Stanford University School of Medicine, Stanford, California, USA
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Ho LLK, Li WHC, Cheung AT, Xia W, Lam TH. Awareness and Use of Heated Tobacco Products among Youth Smokers in Hong Kong: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8575. [PMID: 33227929 PMCID: PMC7699292 DOI: 10.3390/ijerph17228575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
The growing popularity of heated tobacco products (HTPs) among youth may act as a gateway for smoking and jeopardize youth health. We aimed to describe the use of HTPs among youth smokers in Hong Kong and examine their risk awareness of HTPs as well as awareness of the proposed legislation. We conducted retrospective data analyses on the Youth Quitline Cohort (n = 731). We extracted participants' sociodemographic data, smoking profiles, and HTP use from 1 January 2017. Participants' HTP use increased from 5.7% in 2017 to 37.9% in 2020. Among the 731 participants, 175 were HTP users and 556 were HTP nonusers. Compared with nonusers, a significantly higher proportion of HTP users had tried using other tobacco products at least once. The most common reason for using HTPs was curiosity. HTP users were more likely than nonusers to misclassify HTPs as e-cigarettes; agree that HTPs were healthier and contained fewer harmful substances than conventional cigarettes; consider HTPs as a smoking cessation aid; and believe that HTPs could reduce conventional cigarette consumption. Overall, 61.2% of youth smokers disagreed with banning HTPs. Risk awareness of HTPs among youth might affect their likelihood of using these products. Stricter regulations on advertising and intensive health education are imperative to avoid misleading information and limit youth exposure to such harmful products.
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Affiliation(s)
- Laurie Long Kwan Ho
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - William Ho Cheung Li
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Ankie Tan Cheung
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Wei Xia
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China;
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Liu J, Gaiha SM, Halpern-Felsher B. A Breath of Knowledge: Overview of Current Adolescent E-cigarette Prevention and Cessation Programs. CURRENT ADDICTION REPORTS 2020; 7:520-532. [PMID: 33204602 PMCID: PMC7661014 DOI: 10.1007/s40429-020-00345-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Adolescent use of electronic cigarettes (e-cigarettes) has risen rapidly, which is concerning given the health effects of e-cigarettes and youth susceptibility to nicotine addiction. It is critical that efforts to educate, prevent, and reduce adolescent use of e-cigarettes are developed and evaluated. The purpose of this paper is to review available current prevention and cessation programs. FINDINGS A web-based search of currently available e-cigarette prevention and cessation/treatment programs was conducted using Google in May of 2020. Programs were then reviewed on whether they included theory- and evidence-based practices of effective adolescent prevention and cessation programs. Eight prevention programs, seven cessation programs, and one program that addressed both prevention and cessation were identified and included in this review. Most prevention programs included the importance of understanding flavored e-cigarette products, addressed industry-targeted marketing, included social learning activities to develop refusal skills, delivered free-of-cost, available online, and explicitly stated their incorporation of theory. Five prevention programs and two cessation programs had empirically evaluated their e-cigarette-related components. CONCLUSIONS Although the programs reviewed largely incorporated theory and included key components known to be effective, there are some gaps in the programs' overall ability to prevent and stop adolescents from using e-cigarettes, such as lack of dedicated e-cigarette materials. More evidence-based tools, resources, and evaluations are needed to best inform adolescent e-cigarette cessation. Addressing the gaps that existing prevention and cessation programs present requires intervening at multiple systematic levels, conducting more rigorous program evaluations, and bolstering the availability of cessation programs.
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Affiliation(s)
- Jessica Liu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA USA
| | - Shivani Mathur Gaiha
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, 770 Welch Road, Suite 100, Palo Alto, CA 94304 USA
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, 770 Welch Road, Suite 100, Palo Alto, CA 94304 USA
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Klosterhalfen S, Kotz D, Kuntz B, Zeiher J, Starker A. Waterpipe Use among Adolescents in Germany: Prevalence, Associated Consumer Characteristics, and Trends (German Health Interview and Examination Survey for Children and Adolescents, KiGGS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7740. [PMID: 33105905 PMCID: PMC7660200 DOI: 10.3390/ijerph17217740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Waterpipe (WP) use is popular among youth worldwide, but epidemiological data from Germany are scarce. We aimed to describe prevalence rates of WP use (current, last 12 months, ever) and analysed correlates and trends among 11- to 17-year-olds in Germany. Analyses were based on data from the "German Health Interview and Examination Survey for Children and Adolescents" study during 2014-2017 (n = 6599). Changes in WP use prevalence compared with 2009-2012 were used to describe trends. Associations with sociodemographic characteristics and cigarette smoking were assessed with multivariable logistic regression models. Prevalence of current WP use among adolescents was 8.5% (95% confidence interval (CI) = 7.5-9.6), use in the last 12 months was 19.7% (95% CI = 18.3-21.2), and ever use was 25.8% (95% CI = 24.2-27.5). High prevalence rates were particularly found among 16-17-year-olds. During 2009-2012, these prevalence rates were 9.0%, 18.5%, and 26.1%, respectively. WP use was associated with older age, male sex, migration background, lower educational level, and current smoking status. Among current WP users, 66.2% (95% CI = 60.0-71.9) identified themselves as non-smokers, and 38.1% (95% CI = 32.5-44.0) had used WP ≥ three times in the last month. WP consumption is popular among German youth, and prevalence rates have not changed over time. Specific prevention strategies to reduce harmful WP consumption among youth should be implemented.
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Affiliation(s)
- Stephanie Klosterhalfen
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany; (S.K.); (D.K.)
| | - Daniel Kotz
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany; (S.K.); (D.K.)
| | - Benjamin Kuntz
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany; (B.K.); (J.Z.)
| | - Johannes Zeiher
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany; (B.K.); (J.Z.)
| | - Anne Starker
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany; (B.K.); (J.Z.)
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Russell C, Katsampouris E, Mckeganey N. Harm and Addiction Perceptions of the JUUL E-Cigarette Among Adolescents. Nicotine Tob Res 2020; 22:713-721. [PMID: 31556452 PMCID: PMC7171269 DOI: 10.1093/ntr/ntz183] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022]
Abstract
Introduction This study assessed adolescents’ harm and addiction perceptions of the highest-selling brand—JUUL—of the most commonly used tobacco product—electronic cigarettes (e-cigarettes)—among adolescents in the United States. Methods A cross-sectional online survey assessed use and perceptions of the harmfulness and addictiveness of the JUUL e-cigarette and conventional tobacco cigarettes in a nationally representative sample of 9865 adolescents aged 13–17 years in the United States. Associations between adolescents’ harm and addiction perceptions and their use of a JUUL e-cigarette were examined through multinomial logistic regression models. Results Overall, 6.1% and 9.3% of adolescents believed daily use and occasional use of a JUUL e-cigarette, respectively, would cause them no harm. Around 11.3% believed they would either never experience harm from using a JUUL e-cigarette or they could use a JUUL e-cigarette for at least 20 years before experiencing any harm, and 7.3% believed they would be “very unlikely” to become addicted to using a JUUL e-cigarette. Overall, 39.3% and 29.3% of adolescents perceived the JUUL e-cigarette as “less harmful” and “less addictive” than conventional cigarettes, respectively. Compared to never users of the JUUL e-cigarette, current and former users held significantly lower harm and addiction perceptions of the JUUL e-cigarette on all measures. Conclusions The majority of adolescents believed using a JUUL e-cigarette would put them at, at least, some risk for experiencing health problems and addiction. A smaller but significant proportion believed they could use a JUUL e-cigarette without ever being harmed by or becoming addicted to the JUUL e-cigarette. Implications The study reports adolescents’ perceptions of the harmfulness and addictiveness of the highest-selling brand of the most commonly used tobacco product among youth in the United States. Though the majority of adolescents correctly believed that using a JUUL e-cigarette would put them at, at least, some risk for experiencing health problems and addiction, a small proportion believed that using a JUUL e-cigarette would be risk free. Correcting such risk-free perceptions may reduce adolescents’ interest in trying and continuing to use JUUL e-cigarettes.
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Affiliation(s)
| | | | - Neil Mckeganey
- Centre for Substance Use Research, Glasgow, United Kingdom
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Hwang JH, Ryu DH, Park I, Park SW. Cigarette or E-Cigarette Use as Strong Risk Factors for Heated Tobacco Product Use among Korean Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197005. [PMID: 32987944 PMCID: PMC7579640 DOI: 10.3390/ijerph17197005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
Heated tobacco products (HTPs) were first introduced in Korea in June 2017. This study examined the prevalence of current HTP use among Korean adolescents and its association with conventional cigarette (CC) or electronic cigarette (EC) use. The study analyzed nationally representative data (the 2019 Korea Youth Risk Behavior Web-based Survey) from a sample of 57,303 Korean students from grades 7–12. Multinomial logistic regression models were designed to evaluate the association between EC or CC use and HTP use. A total of 2.6% of respondents were current HTP users and 95.9% of them were dual or triple users of CC or EC. The likelihood of HTP use was higher among current CC or EC users and highest among dual users. When the association between each tobacco product and current HTP use was analyzed, the dual use tendency of HTPs and other products steadily increased with the increase of CC or EC smoking frequency. Adolescents who use ECs and/or CCs are likely to use HTPs. Thus, HTPs could be a new public health concern for adolescents in terms of dual or triple use patterns of CC or EC.
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Affiliation(s)
- Jun Hyun Hwang
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea; (J.H.H.); (D.H.R.)
| | - Dong Hee Ryu
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea; (J.H.H.); (D.H.R.)
| | - Inho Park
- Department of Statistics, College of Natural Sciences, Pukyong National University, Busan 48513, Korea;
| | - Soon-Woo Park
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea; (J.H.H.); (D.H.R.)
- Correspondence: ; Tel.: +82-53-650-4493; Fax: +82-53-654-3881
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Lin C, Baiocchi M, Halpern-Felsher B. Longitudinal trends in e-cigarette devices used by Californian youth, 2014-2018. Addict Behav 2020; 108:106459. [PMID: 32388394 DOI: 10.1016/j.addbeh.2020.106459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
The rate of adolescent and young adult (AYA) e-cigarette usage has increased in recent years, possibly due to the introduction of sleek new e-cigarette devices such as JUUL. This study analyzed data from 400 California AYA to examine trends in e-cigarette usage by device type (disposables, large-size rechargeables, vape/hookah pens, JUUL/pod-based). Participants were asked about their ever, past 30-day, and past 7-day use of e-cigarettes; their usual e-cigarette device used; and co-use of devices in seven surveys administered approximately biannually from 2014 to 2018. During this time period, total e-cigarette ever-usage in our cohort increased linearly from 14.1% to 46.2% (ptrend < 0.001). JUUL/pod-based e-cigarette ever-usage increased from 14.9% to 22.5% in just six months in 2018. Furthermore, a majority of new e-cigarette users at the time of the survey endorsed using JUUL/pod-based devices (58.3% in Wave 6, 73.0% in Wave 7). With newer device options, AYA were also increasingly less likely to endorse older models such as disposables (19.1% to 6.9% from 2014 to 2018, ptrend < 0.01) and rechargeables (69.1% to 26.2% from 2014 to 2018, ptrend < 0.001) as their usual e-cigarette device. Participants who used JUUL/pod-based only as their usual device were more likely to endorse using only JUUL/pod-based devices during follow-up survey (70%), and none switched to a new device completely. Overall, this study provides a snapshot of how AYA's e-cigarette preferences appear to respond to new devices entering the market.
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Chaffee BW, Couch ET, Urata J, Cash D, Werts M, Halpern-Felsher B. Electronic cigarette and moist snuff product characteristics independently associated with youth tobacco product perceptions. Tob Induc Dis 2020; 18:71. [PMID: 32934617 PMCID: PMC7485438 DOI: 10.18332/tid/125513] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Tobacco product characteristics convey product attributes to potential users. This study aimed to assess independent contributions of specific e-cigarette and smokeless tobacco product characteristics to adolescents' perceptions about these products. METHODS In 2019-2020, students (N=1003) attending a convenience sample of 7 high schools in California (USA) were individually randomized to one of two discrete choice experiments, featuring either electronic cigarettes (e-cigarettes) or moist snuff. Participants were presented like-product pairs of randomlygenerated hypothetical tobacco products differing in device type, flavor, vapor cloud, and nicotine amount (for e-cigarettes) or differing in brand, flavor, cut, and price (for moist snuff). Within pairs, participants were asked about which product they were more curious, was more dangerous, would give a greater 'buzz,' and would be easier to use. Conditional logistic regression was used to quantify independent associations of product characteristics to participants' choices. RESULTS Each e-cigarette and moist snuff characteristic was independently associated with multiple product perceptions. All non-tobacco flavors were associated with more curiosity and perceived ease-of-use but lower perceived danger. Tank and pod-type e-cigarettes were viewed as easier to use and garnered more curiosity than 'cigalike' or 'drip-mod' devices. Smaller vapor cloud e-cigarettes and lower-price moist snuff were viewed as less dangerous, less buzz-inducing, and easier to use. Product ever users held stronger perceptions than never users about device type (e-cigarettes) and brands (moist snuff), while product naïve participants more strongly associated flavor with danger and buzz. CONCLUSIONS Tobacco product characteristics convey product attributes to adolescents that may increase appeal. Restricting specific characteristics, including flavors, could reduce positive perceptions of these products among youth.
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Affiliation(s)
- Benjamin W Chaffee
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, United States
| | - Elizabeth T Couch
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, United States
| | - Janelle Urata
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, United States
| | - David Cash
- Division of Adolescent Medicine, Stanford University, Stanford, United States
| | - Miranda Werts
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, United States
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Abstract
Objectives In our cross-sectional study, we aimed to determine age verification and sales of little cigars and cigarillos (LCCs) online to underage teens. Methods We selected 100 popular Internet Little Cigar and Cigarillo Vendors (ILVs) for order attempts. From August to December 2015, we supervised 14 teens 14-17 years old making order attempts for LCCs. Results Of the 91 valid orders attempted, we received 89. For the valid orders attempted, 9.9% of ILVs used no age verification strategies at all, 84.6% used less effective forms of age verification, and 50.5% used more effective ones. Only one order was blocked during the order attempt and only one attempt was made to verify age at delivery. Most (79.8%) deliveries were left at the door and only 2 order attempts were rejected because of age verification strategies, resulting in a successful or valid buy rate of 97.8%. Conclusions Our study demonstrated that ILVs selling LCCs were not making adequate efforts to verify the age of their customers, at the point-of-sale or point-of-delivery, facilitating easy access by minors. Few ILVs utilized age verification strategies that prevented online sales of LCCs to underage teens.
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Liu J, McLaughlin S, Lazaro A, Halpern-Felsher B. What Does It Meme? A Qualitative Analysis of Adolescents' Perceptions of Tobacco and Marijuana Messaging. Public Health Rep 2020; 135:578-586. [PMID: 32791026 DOI: 10.1177/0033354920947399] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES With the increasing popularity of electronic cigarettes and legalization of recreational marijuana, messaging from websites and social media is shaping product perceptions and use. Quantitative research on the aesthetic appeal of these advertisements from the adolescent and young adult perspective is lacking. We evaluated (1) how adolescents and young adults perceived tobacco and marijuana messaging online and through social media platforms and (2) interactive behaviors related to these messages. METHODS We interviewed 24 participants from the Tobacco Perceptions Study, a longitudinal study of adolescents' and young adults' (aged 17-21) tobacco-related perceptions and tobacco use. We collected qualitative data from October 2017 through February 2018, through individual semi-structured interviews, on participants' experiences and interactions with online tobacco and marijuana advertisements and the advertisements' appeal. Two analysts recorded, transcribed, and coded interviews. RESULTS Themes that emerged from the interviews focused on the direct appeal of online messaging to adolescents and young adults; the value of trusting the source; the role of general attitudes and personal decision-making related to using tobacco and/or marijuana; the appeal of messaging that includes colors, interesting packaging, and appealing flavors; and the preference of messages communicated by young people and influencers rather than by industry. CONCLUSION These findings suggest the need for increased regulation of social media messaging and marketing of tobacco and marijuana, with a particular focus on regulating social media, paid influencers, and marketing that appeals to adolescents and young adults. The findings also suggest the importance of prevention programs addressing the role of social media in influencing the use of tobacco and marijuana.
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Affiliation(s)
- Jessica Liu
- 1857 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sheila McLaughlin
- 6429 Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Adrienne Lazaro
- 6429 Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Bonnie Halpern-Felsher
- 6429 Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
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McKelvey K, Halpern-Felsher B. How and Why California Young Adults Are Using Different Brands of Pod-Type Electronic Cigarettes in 2019: Implications for Researchers and Regulators. J Adolesc Health 2020; 67:46-52. [PMID: 32192827 PMCID: PMC7311231 DOI: 10.1016/j.jadohealth.2020.01.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/22/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of the study was to describe young adult use and perceptions of different brands of pod-based electronic cigarettes (e-cigarettes) and compare with earlier types of non-pod-based e-cigarettes (e.g., mods and tanks). METHODS Data were collected from January to March 2019 and derive from the final wave of a cohort study recruited in 2013-2014 using a convenience sample from 10 large California high schools with racially/ethnically and socioeconomically diverse populations. A total of 445 participants completed an online survey (mean age = 20.1 years [SD = 1.66], 64.8% female [n = 278], 38.8% white [n = 161], 23.9% each for Asian and "more than one race" [n = 99], 13.5% other [n = 56], and 36.9% Hispanic [n = 160]). The main outcomes were description of and reasons to use pods, perceived nicotine content, and use patterns. RESULTS Although <25% of participants reported smoking cigarettes and using non-pod-based e-cigarettes, >25% reported ever use of JUUL. Similarly, <33% of cigarette smokers and non-pod-based e-cigarette users reported use in the past 30 days, and >50% of JUUL ever users did. The most agreed upon reason (58%) for using pods was because they are "easy to hide." About half of pod users "do not know" if they mix brands of e-juice and pods, the nicotine concentration in their e-juice cartridges, nor time to finish a cartridge. Of the 50% of participants who shared their pod, 23 (15%) did "sometimes," 20 (13%) "always," and 16 (11% each) "about half the time" or "often." There was no consensus about how to refer to different brands of pods. CONCLUSIONS Our findings indicate young adults harbor confusion about pod-based e-cigarettes, including nicotine content, usage patterns, and labeling, and that pod use is largely because of the ease with which they can "stealth" vape. The findings suggest needed regulation and education about these products.
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Affiliation(s)
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
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Perry CL, Creamer MR, Chaffee BW, Unger JB, Sutfin EL, Kong G, Shang C, Clendennen SL, Krishnan-Sarin S, Pentz MA. Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science. Nicotine Tob Res 2020; 22:1063-1076. [PMID: 31127298 PMCID: PMC7457341 DOI: 10.1093/ntr/ntz059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/16/2019] [Indexed: 12/21/2022]
Abstract
The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA's priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10-18 years) and/or young adults (ages 18-34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior. IMPLICATIONS The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science.
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Affiliation(s)
- Cheryl L Perry
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | - MeLisa R Creamer
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Jennifer B Unger
- Keck School of Medicine,University of Southern California, Los Angeles, CA
| | | | | | - Ce Shang
- Oklahoma Tobacco Research Center, Stephenson Cancer Center
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephanie L Clendennen
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Mary Ann Pentz
- Keck School of Medicine,University of Southern California, Los Angeles, CA
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Alternative flavored and unflavored tobacco product use and cigarette quit attempts among current smokers experiencing homelessness. Addict Behav Rep 2020; 12:100280. [PMID: 32637560 PMCID: PMC7330871 DOI: 10.1016/j.abrep.2020.100280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 01/27/2023] Open
Abstract
Almost two-thirds of participants used alternative tobacco products. Cigars, blunts, and e-cigarettes most commonly used alternative tobacco products. Most cigar and e-cigarette users used fruit-flavored tobacco products. Discordance found between perceptions of addiction/harm and alternative tobacco use. Alternative tobacco product use was not associated with a past-year quit attempt.
Introduction Alternative tobacco product (ATP) use is common in the general population; however, few studies have explored ATP among individuals experiencing homelessness. We recruited individuals experiencing homelessness who were current cigarette smokers to explore flavored and unflavored ATP use and its association with past-year cigarette quit attempts. Methods Using time-location sampling, we recruited participants from eight service sites in San Francisco, CA between December 2017 and July 2018. We explored type of ATP use and perceptions of product addiction, harm and risk between cigarette-only smokers and those who used cigarettes and ATPs (‘ATP users’). We used logistic regression to examine the association between ATP and past-year quit attempts, adjusting for demographics, substance use disorders, depressive symptoms, and cigarette use characteristics. Results Among the 470 participants, 34.5% were cigarette-only users and 65.5% were ATP users. Among ATP users, 74.0% used cigars and 29.8% used e-cigarettes in the past month, with fruit-flavored products being the most common. ATP users were more likely to perceive cigars, blunts, and smokeless tobacco to be quite to extremely harmful or addictive compared to cigarette-only users. ATP use was not associated with past-year quit attempts, whereas hazardous alcohol use (OR = 2.07; CI 1.07–4.02) was associated with higher odds and and amphetamine use (OR = 0.50; CI 0.26–0.98) was associated with lower odds of past-year attempts. Conclusions High rates of ATP use highlight a need for studies that explore motivations for use, beyond use as a smoking cessation aid, among people experiencing homelessness.
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Gaiha SM, Halpern-Felsher B. Public Health Considerations for Adolescent Initiation of Electronic Cigarettes. Pediatrics 2020; 145:S175-S180. [PMID: 32358208 PMCID: PMC7301615 DOI: 10.1542/peds.2019-2056e] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 12/22/2022] Open
Abstract
Adolescent use of electronic cigarettes (e-cigarettes) has increased dramatically, with younger and nicotine-naive adolescents starting to use these devices and use them more frequently than combustible cigarettes. In emerging evidence, it is shown that e-cigarettes are not effective in helping adult smokers quit and that youth using e-cigarettes are at risk for becoming nicotine dependent and continuing to use as adults. Important gaps in our knowledge remain regarding the long-term health impact of e-cigarettes, effective strategies to prevent and reduce adolescent e-cigarette use, and the impact of provider screening and counseling to address this new method of nicotine use.
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Affiliation(s)
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
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47
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Lin VY, Fain MD, Jackson PL, Berryhill TF, Wilson LS, Mazur M, Barnes SJ, Blalock JE, Raju SV, Rowe SM. Vaporized E-Cigarette Liquids Induce Ion Transport Dysfunction in Airway Epithelia. Am J Respir Cell Mol Biol 2020; 61:162-173. [PMID: 30576219 DOI: 10.1165/rcmb.2017-0432oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cigarette smoking is associated with chronic obstructive pulmonary disease and chronic bronchitis. Acquired ion transport abnormalities, including cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, caused by cigarette smoking have been proposed as potential mechanisms for mucus obstruction in chronic bronchitis. Although e-cigarette use is popular and perceived to be safe, whether it harms the airways via mechanisms altering ion transport remains unclear. In the present study, we sought to determine if e-cigarette vapor, like cigarette smoke, has the potential to induce acquired CFTR dysfunction, and to what degree. Electrophysiological methods demonstrated reduced chloride transport caused by vaporized e-cigarette liquid or vegetable glycerin at various exposures (30 min, 57.2% and 14.4% respectively, vs. control; P < 0.0001), but not by unvaporized liquid (60 min, 17.6% vs. untreated), indicating that thermal degradation of these products is required to induce the observed defects. We also observed reduced ATP-dependent responses (-10.8 ± 3.0 vs. -18.8 ± 5.1 μA/cm2 control) and epithelial sodium channel activity (95.8% reduction) in primary human bronchial epithelial cells after 5 minutes, suggesting that exposures dramatically inhibit epithelial ion transport beyond CFTR, even without diminished transepithelial resistance or cytotoxicity. Vaporizing e-cigarette liquid produced reactive aldehydes, including acrolein (shown to induce acquired CFTR dysfunction), as quantified by mass spectrometry, demonstrating that respiratory toxicants in cigarette smoke can also be found in e-cigarette vapor (30 min air, 224.5 ± 15.99; unvaporized liquid, 284.8 ± 35.03; vapor, 54,468 ± 3,908 ng/ml; P < 0.0001). E-cigarettes can induce ion channel dysfunction in airway epithelial cells, partly through acrolein production. These findings indicate a heretofore unknown toxicity of e-cigarette use known to be associated with chronic bronchitis onset and progression, as well as with chronic obstructive pulmonary disease severity.
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Affiliation(s)
| | | | | | - Taylor F Berryhill
- 2Pharmacology/Toxicology and Targeted Metabolomics and Proteomics Laboratory
| | - Landon S Wilson
- 2Pharmacology/Toxicology and Targeted Metabolomics and Proteomics Laboratory
| | | | - Stephen J Barnes
- 2Pharmacology/Toxicology and Targeted Metabolomics and Proteomics Laboratory
| | | | | | - Steven M Rowe
- 1Department of Medicine.,3Gregory J. Fleming Cystic Fibrosis Center.,4Department of Pediatrics, and.,5Department of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
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Abdel Magid HS, Halpern-Felsher B, Ling PM, Bradshaw PT, Mujahid MS, Henriksen L. Tobacco Retail Density and Initiation of Alternative Tobacco Product Use Among Teens. J Adolesc Health 2020; 66:423-430. [PMID: 31784411 PMCID: PMC7089810 DOI: 10.1016/j.jadohealth.2019.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The rise of noncigarette, alternative tobacco product (ATP) use among adolescents may be due in part to an increase in retail availability of ATPs. We examined whether proximity and density of tobacco retailers near students' homes are associated with a higher likelihood of initiating ATP use over time. METHODS Using data from 728 adolescents (aged 13-19 years at baseline) residing in 191 different neighborhoods and attending 10 different California high schools, longitudinal multilevel and cross-classified random effect models evaluated individual-level, neighborhood-level, and school-level risk factors for ATP initiation after 1 year. Covariates were obtained from the American Community Survey and the California Department of Education. RESULTS The sample was predominantly female (63.5%) and was racially and ethnically diverse. Approximately one third of participants (32.5%) reported ever ATP use at baseline, with 106 (14.5%) initiating ATP use within 1 year. The mean number of tobacco retailers per square mile within a tract was 5.66 (standard deviation = 6.3), and the average distance from each participant's residence to the nearest tobacco retailer was .61 miles (standard deviation = .4). Living in neighborhoods with greater tobacco retailer density at baseline was associated with higher odds of ATP initiation (odds ratio = 1.22, 95% confidence interval = 1.07-2.12), controlling for individual and school factors. CONCLUSIONS Tobacco retailers clustered in students' home neighborhood may be an environmental influence on adolescents' ATP use. Policy efforts to reduce adolescent ATP use should aim to reduce the density of tobacco retailers and limit the proximity of tobacco retailers near adolescents' homes and schools.
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Affiliation(s)
- Hoda S Abdel Magid
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California
| | - Patrick T Bradshaw
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Palo Alto, California
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Kelder SH, Mantey DS, Van Dusen D, Case K, Haas A, Springer AE. A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of "CATCH My Breath". Public Health Rep 2020; 135:220-229. [PMID: 31968177 DOI: 10.1177/0033354919900887] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES From 2017 to 2018, electronic cigarette (e-cigarette) use increased 78% among high school students and 48% among middle school students in the United States. However, few e-cigarette prevention interventions have been evaluated. We determined the feasibility and initial effectiveness of "CATCH My Breath," an e-cigarette prevention program, among a sample of middle schools in central Texas. METHODS Twelve middle schools in Texas (6 intervention schools and 6 control schools) participated in the CATCH My Breath pilot program during 2016-2017. CATCH My Breath is rooted in social cognitive theory, consists of 4 interactive in-class modules, and is collaboratively administered via classroom and physical education teachers, student-peer leaders, and social messaging (eg, school posters). We collected 3 waves of data: baseline (January 2017), 4-month follow-up (May 2017), and 16-month follow-up (May 2018). Using school as the unit of analysis, we tested a repeated cross-sectional, condition-by-time interaction on e-cigarette ever use, psychosocial determinants of use, and other tobacco use behaviors. Analyses controlled for school-level sociodemographic characteristics (eg, sex, race/ethnicity, and percentage of students eligible for free or reduced-price lunch). RESULTS From baseline to 16-month follow-up, increases in ever e-cigarette use prevalence were significantly lower among intervention schools (2.8%-4.9%) than among control schools (2.7%-8.9%), controlling for covariates (P = .01). Intervention schools also had significantly greater improvements in e-cigarette knowledge (β = 0.71; 95% confidence interval [CI], 0.21-1.21; P = .008) and perceived positive outcomes (β = -0.12; 95% CI, -0.23 to -0.02; P = .02) than control schools, controlling for covariates from baseline to 16-month follow-up. CONCLUSION Ever e-cigarette use was lower among middle schools that implemented the CATCH My Breath program than among those that did not. Replication of findings among a larger sample of schools, using a group-randomized, longitudinal study design and a longer follow-up period, is needed.
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Affiliation(s)
- Steven H Kelder
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health-Austin, Austin, TX, USA
| | - Dale S Mantey
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health-Austin, Austin, TX, USA
| | | | - Kathleen Case
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health-Austin, Austin, TX, USA
| | - Alexandra Haas
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health-Austin, Austin, TX, USA
| | - Andrew E Springer
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health-Austin, Austin, TX, USA
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Abstract
The rapid increase in e-cigarette use among adolescents and young adults has led to drastic changes in patterns of nicotine consumption worldwide. The use of e-cigarettes, many of which contain high levels of nicotine, is especially harmful in this age group and is associated with increased use of cigarettes and other substances among youth. While the risks of short- and long-term e-cigarette use and secondhand aerosol exposure remain only partially understood, e-cigarettes should not be recommended for smoking cessation for youth in any circumstances given the lack of evidence for effectiveness and potential harmful physical and mental health effects. The perceptions of low e-cigarette risk of adolescents and young adults combined with few market regulations and the appeal of youth-friendly flavors, have created ideal conditions for the e-cigarette industry to thrive and place millions of youth at risk of developing an addiction to nicotine. Policies and regulations aiming to prevent youth-directed marketing and sales of e-cigarette and all nicotine delivery products are needed to protect young people. Public health-led education campaigns and educational curricula are also needed to help inform youth and families about the risks of e-cigarette use. While more research is required to determine the best ways to help youth quit e-cigarette use, adolescent health providers can play a key role in screening and counseling youth about e-cigarette use and should be adequately trained and supported to care for youth with e-cigarette addiction.
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