College Students' Polytobacco Use, Cigarette Cessation, and Dependence

Whose Post Is It? Predicting E-cigarette Brand from Social Media Posts

OBJECTIVES

E-cigarette advertisers know that 76% of youth use social media, yet little is known about the nature of e-cigarette advertising on social media most favored by youth. We utilized text-mining to characterize e-cigarette advertising and marketing messages from image-focused social media brand sites, and to construct and test an algorithm for predicting brand from brand-generated social media posts.

METHODS

Data comprised 5022 unique posts accompanied by an image from Facebook, Instagram or Pinterest e-cigarette brand pages for Blu, Logic, Metro, and NJOY from February 2012 to April 2015. Text-tokenization was used to quantify text for use as predictors in analyses.

RESULTS

Blu had the largest social media presence (65%), followed by Logic (16%), NJOY (12%) and Metro (7%). Blu's average post length was significantly shorter than all other brands. Words most commonly used in posts differed by brand. Regression analyses successfully differentiated Blu and NJOY brands from other brands.

CONCLUSIONS

Analyses revealed e-cigarette brands used different types of messages to appeal to social media users. Whereas words used by Blu and NJOY sold a "lifestyle," words used by Logic and Metro relied on device and product identification.

Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative study

INTRODUCTION

Diverse non-cigarette alternative tobacco products are increasingly popular in the United States. This study investigates the reasons why young adults initiate and continue the use of these products, as well as potential motivations and approaches for quitting. Products assessed include cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, e-cigarettes, and hookahs.

METHODS

We conducted 60 telephone interviews, of 30-minute duration, with tobacco users enrolled in colleges in Georgia. Qualitative analysis was used to identify themes emerging from the data.

RESULTS

Reasons for initiation, continued use, and (potential) cessation showed similarities and differences across products. Most commonly cited reasons for initiation included: peer influence (all products), flavors/tastes (all products except cigarettes), and easy environmental access and/or low costs (LCCs, smokeless tobacco, and e-cigarettes). Participants discussed several influences on continued use, such as peer influence (cigarettes, LCCs, and hookahs), stress management (all products except hookahs), and use with other substances (cigarettes, LCCs, and hookahs). Primary motivations for cessation mentioned by participants were family responsibilities (cigarettes, e-cigarettes, and hookahs) and health concerns (all products except e-cigarettes). Frequently used cessation strategies included avoidance of other tobacco users (cigarettes, LCCs, and hookahs) and a reduction of nicotine intake (cigarettes and e-cigarettes).

CONCLUSIONS

Our findings suggest that researchers should consider the differences in reasons for use and discontinued use of tobacco products in order to develop targeted messaging strategies, particularly noting the differential impact of interpersonal influences and health concerns. We also point to a need for regulatory action that limits diversification and accessibility of different products.

Exclusive e-cigarette use predicts cigarette initiation among college students

INTRODUCTION

An increasing body of research indicates that use of electronic nicotine delivery systems (ENDS) predicts cigarette initiation. However, no studies examine if risk for cigarette initiation varies for exclusive ENDS users versus users of ENDS and other tobacco products. This study examined if: a) cigarette-naïve young adults (i.e., never cigarette users) who ever used ENDS had a greater odds of initiating cigarettes than non-ENDS users over a 1.5year period and b) the odds of cigarette initiation was consistent across exclusive ENDS users and users of ENDS and at least one tobacco product.

METHODS

Participants were 2558 cigarette-naïve 18-25year old (M=19.71; SD=1.61) students from 24 Texas colleges who participated in a four-wave study, with six months between each wave.

RESULTS

Overall, 11% of students reported cigarette initiation by wave 4. Of those, 20.1% were wave 1 ENDS users and 8.4% were non-ENDS users. Multivariable, multilevel discrete-time hazard models indicated that wave 1 ENDS use predicted subsequent cigarette initiation, over and above the significant effects of cigarette use susceptibility, family-of-origin tobacco use, friend cigarette use, and other tobacco use. Additional findings indicated that exclusive ENDS users had a greater odds than non-users of subsequent cigarette initiation. Among users of alternative tobacco products, ENDS users did not have a greater odds of initiation than non-ENDS users.

CONCLUSION

Findings extend existing research by showing that ENDS use by young adults is a specific risk factor for later cigarette initiation and not an extension of a constellation of existing tobacco use behaviors.

Examining College Students' Social Environment, Normative Beliefs, and Attitudes in Subsequent Initiation of Electronic Nicotine Delivery Systems

BACKGROUND

Although use of Electronic Nicotine Delivery Systems (ENDS) is increasingly prevalent among young adults, little is known about predictors of ENDS initiation among this population.

AIMS

We examined the roles of the social environment (i.e., peer ENDS use and household ENDS use), normative beliefs (i.e., social acceptability of ENDS use), and attitudes (i.e., inclination to date someone who uses ENDS) in prospectively predicting initiation of ENDS over a 1-year period among 18- to 29-year-old college students.

METHOD

Participants were 2,110 (18- to 29-year-old) students ( M = 20.27, SD = 2.17) from 24 colleges in Texas who participated in a three-wave online survey, with 6 months between each wave. All participants reported never using ENDS at baseline. A multivariable, multilevel logistic regression model, accounting for clustering of students within colleges, was used to assess if students' social environment, normative beliefs, and attitudes predicted subsequent initiation of ENDS up to 1 year later, adjusting for various sociodemographic factors and number of other tobacco products used.

RESULTS

In all, 329 college students (16%) initiated ENDS within 1 year. Results from the logistic regression indicated that college students who were younger (18-24 years old), ever used other tobacco products, indicated a more dense peer network of ENDS users, and had a higher inclination to date someone who uses ENDS had higher odds of initiating ENDS than their peers.

CONCLUSION

Preventing ENDS initiation should be included in college health promotion programs, which should highlight the roles of students' social environment and attitudes regarding ENDS use.

E-cigarette Use and Cigarette Smoking Cessation among Texas College Students

OBJECTIVES

We examined the relationships between e-cigarette use and subsequent cigarette smoking behaviors at 6- and 12-month follow-ups among young adults.

METHODS

Participants were 18-29 year-old current and former cigarette smokers (N = 627) at 24 Texas colleges, participating in a 3-wave study. Multi-level, multivariable logistic regression models, accounting for school clustering, examined the impact of self-reported use of e-cigarettes on cigarette smoking status at 6- and 12-month follow-ups. Two mutually-exclusive groups of e-cigarette users were examined: those that used for cigarette smoking cessation and those that used for reasons other than cessation. Baseline covariates included socio-demographics, past quit attempts, nicotine dependence, cigarettes per day, and other tobacco use.

RESULTS

Use of e-cigarettes for cigarette smoking cessation was associated with increased odds of cigarette smoking cessation at 6- and 12-month follow-ups, while using e-cigarettes for other reasons was not, when adjusting for covariates.

CONCLUSIONS

Use of e-cigarettes for cigarette smoking cessation may reduce cigarette smoking rates in young adult college students. Additional research is needed examining e-cigarettes as a complement to evidence-based cessation resources that are associated with cigarette smoking cessation among young adults.

Depressive Symptoms Predict Current E-Cigarette Use Among College Students in Texas

INTRODUCTION

No studies have examined the longitudinal relationship between e-cigarette use and elevated depressive symptoms among young adults. The main objective of the current study was to establish a potential bi-directional relationship between e-cigarette use and elevated depressive symptoms among college students in Texas, across a 1 year period of time.

METHODS

A survey of 5445 college students in Texas was conducted with 6-month and 1-year follow-ups. A longitudinal cross-lagged model was used to simultaneously examine the bi-directional relationships between current, or past 30-day, e-cigarette use and elevated depressive symptoms across the three study waves. Depressive symptoms were measured using a 10-item Center for Epidemiologic Studies Depression Scale (CES-D) with a cutpoint of ≥ 10 to measure elevated depressive symptoms. Covariates included baseline age, gender, college type (2- or 4-year), and other alternative tobacco products used.

RESULTS

E-cigarette use did not predict elevated depressive symptoms at 6-month and 1-year follow-ups. However, depressive symptoms predicted e-cigarette use at both 6-month and 1-year follow-ups.

CONCLUSIONS

The current study indicates that depressive symptoms predict subsequent e-cigarette use and not vice versa. Future studies are needed to replicate current findings and also further establish the mechanisms for causality, which could inform Food and Drug Administration regulatory planning.

IMPLICATIONS

There has been recent evidence for cross-sectional associations between e-cigarette use and elevated depressive symptoms and mental health problems. There have been no studies examining these associations using longitudinal designs. This study established a temporal relationship, such that elevated depressive symptoms predicted e-cigarette use 6 months later among college students. Future research is needed to establish the mechanisms of association as well as causality.

The association between sensation seeking and e-cigarette use in Texas young adults: A cross-sectional study

OBJECTIVE

To examine the associations between sensation seeking and ever and current e-cigarette use in Texas young adults (18-29 years old). Current cigarette use was examined as a potential effect modifier of the associations.

PARTICIPANTS

Participants included college students enrolled in four-year and two-year colleges in four metropolitan areas in Texas (n  =  5,418) who completed the survey between November 2014 and February 2015.

METHODS

This cross-sectional study utilized mixed effects logistic regression to determine the associations between mean sensation seeking scores and ever and current e-cigarette use after controlling for covariates.

RESULTS

After controlling for covariates, significant associations between sensation seeking and both ever and current e-cigarette use were observed; however, these associations were significant for noncurrent smokers only (adjusted odds rations [AOR]  =  1.55, 95% confidence interval (CI)  =  1.39, 1.73; AOR  =  1.82, 95% CI  =  1.54, 2.15, respectively).

CONCLUSIONS

Sensation seeking is an important factor in identifying college students who may be at increased risk for e-cigarette use behaviors.

Flavored Tobacco Product Use among Youth and Young Adults: What if Flavors Didn't Exist?

OBJECTIVE

We aimed to determine the potential for reductions in the prevalence of young people's e-cigarette and tobacco use if characterizing flavors were not present.

METHODS

Two parallel cross-sectional surveys of 2483 youth (TATAMS: Texas Adolescent Tobacco and Marketing Surveillance System) and 4326 young adults (M-PACT: Marketing and Promotions across Colleges in Texas) in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Current use of e-cigarettes and other tobacco (cigarettes, cigar products, hookah, smokeless tobacco). Users were asked: "When you use [product], do you usually use any of the following flavors?" Flavored product users were asked: "Would you continue using [product] if it were not flavored?"

RESULTS

Over 80% of youth and young adult tobacco users reported using flavored tobacco. Three-fourths of flavored product users said they would no longer use the product if it was not flavored. This was highest for e-cigarettes and hookah and lowest for cigarettes. Few demographic differences in findings were observed.

CONCLUSIONS

Restricting flavors in tobacco products would not eradicate e-cigarette or other tobacco use among young people, but the potential for substantial reductions in the prevalence of young people's e-cigarette and other tobacco use seems high if flavors were removed.

Associations between tobacco and nicotine product use and depressive symptoms among college students in Texas

BACKGROUND

There is a well-established link between cigarette smoking and depression; less is known about the potential association between alternative tobacco products, such as hookah, cigars, smokeless tobacco, and electronic cigarette (e-cigarette use) with depression. The Food and Drug Administration (FDA) is now regulating tobacco products and is interested in tobacco product use among those with mental health problems and other special populations such as college students.

METHODS

Cross-sectional statewide convenience sample study of 5438 college students in 24 colleges and universities in Texas. Past 30-day use of hookah, cigar, smokeless tobacco, cigarette, and e-cigarette use were measured by self-report. Depressive symptoms were measured by the 10-item short form of the Center for Epidemiologic Studies scale.

RESULTS

Only e-cigarette use was positively associated with depressive symptoms, even after accounting for all other tobacco products and socio-demographics. There were no significant interactions between race/ethnicity or gender with each of the tobacco products on depressive symptoms.

CONCLUSIONS

E-cigarette use was positively associated with depressive symptoms among college students in Texas. Further research is needed to determine causality, which may inform FDA regulatory planning.

College students' perceptions and knowledge of hookah use

PURPOSE

Hookah is an increasingly popular tobacco product among college students. The purpose of this study was to determine if college students are aware of tobacco and nicotine content in hookah, and examine associations between college students' knowledge and perceptions of hookah and their past 30-day hookah use.

METHODS

Participants were 5451 young adults attending one of 24 2- and 4-year colleges. Analyses examined if hookah knowledge was uniquely associated with current hookah use, over and above perceptions of harm and addictiveness, number of other tobacco products currently used, and socio-demographic factors. Analyses were first conducted for the entire sample and then only for current hookah users.

RESULTS

26.9% of all students believed hookah did not contain tobacco and 38% believed that hookah did not contain nicotine. Students who believed that hookah contained tobacco were at increased odds of hookah use, and those with increased perceptions of harm were at decreased odds of hookah use. However, hookah knowledge was not associated with hookah users' intensity of use. Moreover, although increased perceptions of harm were associated with lower intensity of use among current users, increased perceptions of addictiveness were associated with higher intensity of use.

CONCLUSIONS

This study shows gaps in knowledge of hookah contents, and adds to the body of literature, which provides evidence for mandating warning labels as well as tobacco interventions for college students.