101
|
Kienhuis AS, Talhout R. Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use. Tob Induc Dis 2020; 18:69. [PMID: 32934615 PMCID: PMC7485441 DOI: 10.18332/tid/125079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 07/08/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Despite its known adverse effects on human health, waterpipe smoking is increasing in popularity worldwide. However, compared to cigarettes, regulation of waterpipe product smoking lags behind and presents unique challenges. In search for regulatory options, this systematic review analyzes 36 studies on the differential effects on human health of the waterpipe characteristics including smoking products, heating sources, device components, and packages. METHODS A systematic review was performed according to PRISMA guidelines, revealing 443 unique citations. After screening, 36 studies were included in the results. Research articles were selected to inform on differential effects caused by product characteristics on adverse health effects, attractiveness, addictiveness and prevalence of waterpipe use. RESULTS Flavors are the key aspect that defines attractiveness of waterpipe product smoking. All waterpipe products, with or without nicotine, produce toxicants in similar quantities as cigarettes. Heating sources for waterpipe tobacco include charcoals and electrical heating. Both heating sources increase toxicant emissions in different ways. Hoses and mouth tips are device components that are often shared in waterpipe smoking. Sharing influences attractiveness by enriching the social experience. At the same time, it influences the transfer of infectious diseases by bacteria and viruses from one smoker to another. Studies showed that more generic and less attractive packages with health warnings are effective in reducing the attractiveness of waterpipe smoking. CONCLUSIONS Based on our findings, we advise to include all waterpipe products, tobacco and non-tobacco, with or without nicotine, in tobacco product regulations and smoking bans in order to: ban waterpipe molasses with characterizing flavors or ban the use of flavorings at any level; mandate dissemination of information on all waterpipe tobacco elements to the national regulator; prescribe testing to regulate contents of waterpipe smoking products and heating sources. Moreover, we advise to stimulate research on emissions of waterpipes.
Collapse
Affiliation(s)
- Anne S. Kienhuis
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
102
|
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.
Collapse
|
103
|
Affiliation(s)
- Brian A King
- Brian A. King is with the Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
104
|
Hung PH, Savidge M, De M, Kang JC, Healy SM, Valerio LG. In vitro and in silico genetic toxicity screening of flavor compounds and other ingredients in tobacco products with emphasis on ENDS. J Appl Toxicol 2020; 40:1566-1587. [PMID: 32662109 DOI: 10.1002/jat.4020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 12/16/2022]
Abstract
Electronic nicotine delivery systems (ENDS) are regulated tobacco products and often contain flavor compounds. Given the concern of increased use and the appeal of ENDS by young people, evaluating the potential of flavors to induce DNA damage is important for health hazard identification. In this study, alternative methods were used as prioritization tools to study the genotoxic mode of action (MoA) of 150 flavor compounds. In particular, clastogen-sensitive (γH2AX and p53) and aneugen-sensitive (p-H3 and polyploidy) biomarkers of DNA damage in human TK6 cells were aggregated through a supervised three-pronged ensemble machine learning prediction model to prioritize chemicals based on genotoxicity. In addition, in silico quantitative structure-activity relationship (QSAR) models were used to predict genotoxicity and carcinogenic potential. The in vitro assay identified 25 flavors as positive for genotoxicity: 15 clastogenic, eight aneugenic and two with a mixed MoA (clastogenic and aneugenic). Twenty-three of these 25 flavors predicted to induce DNA damage in vitro are documented in public literature to be in e-liquid or in the aerosols produced by ENDS products with youth-appealing flavors and names. QSAR models predicted 46 (31%) of 150 compounds having at least one positive call for mutagenicity, clastogenicity or rodent carcinogenicity, 49 (33%) compounds were predicted negative for all three endpoints, and remaining compounds had no prediction call. The parallel use of these predictive technologies to elucidate MoAs for potential genetic damage, hold utility as a screening strategy. This study is the first high-content and high-throughput genotoxicity screening study with an emphasis on flavors in ENDS products.
Collapse
Affiliation(s)
- Pei-Hsuan Hung
- Division of Nonclinical Science, Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Matthew Savidge
- Division of Nonclinical Science, Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mamata De
- Division of Nonclinical Science, Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jueichuan Connie Kang
- Division of Nonclinical Science, Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, USA.,US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Sheila M Healy
- Division of Nonclinical Science, Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Luis G Valerio
- Division of Nonclinical Science, Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, USA
| |
Collapse
|
105
|
Abstract
Objectives Health warning messages could be an effective means of communicating the health risks associated with waterpipe (WP) smoking. The objective of this study was to select a message that conveyed the risks associated with WP smoking. Methods A mixed-methods approach was used to explore the effectiveness of the Food and Drug Administration's (FDA's) mandated message, and others, among young adults using focus groups and surveys. Two focus group studies and one convenience survey were conducted to examine the FDA's mandated message and 11 other WP warning messages. The final study, conducted with a random sample of first-year university students, examined the effectiveness and reactance of the chosen message using previously validated items (scored on a 1-5 scale). Results The FDA's mandated message did not resonate well with focus group participants. In the random sample of students, the top message (WARNING: Hookah smoke contains poisons that cause lung and oral cancers) had high effectiveness (M = 4.49) and a low reactance (M = 2.12). Conclusions Our studies suggest that other messages are more effective for communicating the risks associated with WP smoking than the FDA's message for WP tobacco.
Collapse
|
106
|
Chung S, Bengtson CD, Kim MD, Salathe M. CrossTalk opposing view: E-cigarettes expose users to adverse effects of vapours and the potential for nicotine addiction. J Physiol 2020; 598:3053-3056. [PMID: 32495948 DOI: 10.1113/jp279271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Samuel Chung
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Charles D Bengtson
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Michael D Kim
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Matthias Salathe
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| |
Collapse
|
107
|
Orlan EN, Queen TL, Ribisl KM, Sutfin EL. One-item susceptibility measure predicts waterpipe and little cigar/cigarillo uptake in a national sample of adolescents and young adults in the United States. Tob Prev Cessat 2020; 5:17. [PMID: 32411881 PMCID: PMC7205113 DOI: 10.18332/tpc/108554] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Adolescents and young adults in the United States (US) are increasingly using non-cigarette tobacco products such as waterpipe (WP) and little cigars/cigarillos (LCC). One way to predict which non-user adolescents and young adults are most likely to use these products is through measuring their susceptibility or openness to using the products. METHODS We conducted a national phone survey (baseline) and an internet survey (follow-up) of adolescents and young adults (ages 13–25 years), who, at baseline, had never used WP (N=1002) or LCC (N=990). At baseline, we measured susceptibility using a single item, asking participants whether they would try WP or LCC if their best friend offered it to them, and subsequently measured uptake at follow-up. We conducted multivariate regression analyses to determine whether product-specific susceptibility was a significant predictor of uptake at follow-up. RESULTS Participants who were susceptible and participants who had ever used another tobacco product had higher odds of using WP (AOR=3.5, AOR=4.2) and LCC (AOR=3.2, AOR=5.3) at follow-up than those who were not susceptible to those products, and had not ever used tobacco products respectively, controlling for sociodemographic factors. The one-item measure had adequate sensitivity (WP=51.4%, LCC=40.2%) and specificity (WP=84.9%, LCC=87.9%). CONCLUSIONS Our national study of US adolescents and young adults shows that a one-item susceptibility measure at baseline was a significant predictor of WP and LCC uptake at follow-up, even after controlling for other predictors. Future research should assess the predictive validity of the one-item compared to the multi-item scale.
Collapse
Affiliation(s)
- Elizabeth N Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States
| | - Tara L Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, United States
| |
Collapse
|
108
|
Sharma E, Edwards KC, Halenar MJ, Taylor KA, Kasza KA, Day H, Gardner LD, Anic G, Bansal-Travers M, Limpert J, Hammad HT, Borek N, Kimmel HL, Compton WM, Hyland A, Stanton CA. Longitudinal pathways of exclusive and polytobacco smokeless use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016). Tob Control 2020; 29:s170-s177. [PMID: 32321851 PMCID: PMC7534605 DOI: 10.1136/tobaccocontrol-2020-055628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Use of smokeless tobacco (SLT) with other tobacco products is growing, yet gaps in understanding transitions among SLT and other product use remain. The aim of this study is to examine cross-sectional prevalence and longitudinal pathways of SLT use among US youth (12-17 years), young adults (18-24 years) and adults 25+ (25 years and older). DESIGN Data were drawn from the first three waves (2013-2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses. RESULTS Young adults had the highest current SLT use compared with other age groups. Among Wave 1 (W1) past 30-day youth and young adult SLT users, most were SLT and cigarette polytobacco users compared with adults 25+, who more often used SLT exclusively. Among W1 exclusive SLT users, persistent exclusive use across all three waves was more common among adults 25+, while transitioning from exclusive SLT use to SLT polytobacco use at Wave 2 or Wave 3 was more common among youth and young adults. Among W1 SLT and cigarette polytobacco users, a common pathway was discontinuing SLT use but continuing other tobacco use. CONCLUSIONS Our results showed distinct longitudinal transitions among exclusive and SLT polytobacco users. Deeper understanding of these critical product transitions will allow for further assessment of population health impact of these products.
Collapse
Affiliation(s)
- Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Kathryn C Edwards
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Michael J Halenar
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Kristie A Taylor
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Hannah Day
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Lisa D Gardner
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Gabriella Anic
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Hoda T Hammad
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
- Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
| |
Collapse
|
109
|
Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e917-e936. [PMID: 30845826 DOI: 10.1161/cir.0000000000000671] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
Collapse
|
110
|
Watle SV, Caugant DA, Tunheim G, Bekkevold T, Laake I, Brynildsrud OB, Næss LM. Meningococcal carriage in Norwegian teenagers: strain characterisation and assessment of risk factors. Epidemiol Infect 2020; 148:e80. [PMID: 32228726 PMCID: PMC7189347 DOI: 10.1017/s0950268820000734] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022] Open
Abstract
Teenagers have a higher risk of invasive meningococcal disease (IMD) than the general population. This cross-sectional study aimed to characterise strains of Neisseria meningitidis circulating among Norwegian teenagers and to assess risk factors for meningococcal carriage. Oropharyngeal swabs were collected from secondary-school students in southeastern Norway in 2018-2019. Meningococcal isolates were characterised using whole genome sequencing. Risk factors for meningococcal carriage were assessed from questionnaire data. Samples were obtained from 2296 12-24-year-olds (majority 13-19-year-olds). N. meningitidis was identified in 167 (7.3%) individuals. The highest carriage rate was found among 18-year-olds (16.4%). Most carriage isolates were capsule null (40.1%) or genogroup Y (33.5%). Clonal complexes cc23 (35.9%) and cc198 (32.3%) dominated and 38.9% of carriage strains were similar to invasive strains currently causing IMD in Norway. Use of Swedish snus (smokeless tobacco) (OR 1.56, 95% CI 1.07-2.27), kissing >two persons/month (OR 2.76, 95% CI 1.49-5.10) and partying >10 times/3months (OR 3.50, 95% CI 1.45-8.48) were associated with carriage, while age, cigarette smoking, sharing of drinking bottles and meningococcal vaccination were not. The high meningococcal carriage rate among 18-year-olds is probably due to risk-related behaviour. Use of Swedish snus is possibly a new risk factor for meningococcal carriage. Almost 40% of circulating carriage strains have invasive potential.
Collapse
Affiliation(s)
- S. V. Watle
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
| | - D. A. Caugant
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
| | - G. Tunheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - T. Bekkevold
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - I. Laake
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - O. B. Brynildsrud
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - L. M. Næss
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| |
Collapse
|
111
|
Khanagar SB, Siddeeqh S, Khinda V, Khinda P, Divakar DD, Jhugroo C. Impact of electronic cigarette smoking on the Saudi population through the analysis of literature: A systematic review. J Oral Maxillofac Pathol 2020; 23:473. [PMID: 31942135 PMCID: PMC6948040 DOI: 10.4103/jomfp.jomfp_141_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tobacco usage is harming the health, the treasury and the spirit of Saudi Arabia. Every year, more than 7000 of its people are killed by tobacco-caused diseases. Still, more than 20,000 children and 3,352,000 adults continue to use tobacco each day. Likewise, the usage of electronic (e)-cigarette is also increasing; this could be because of the publicity and marketing strategies adopted by the manufacturers of these products which are attracting the younger population. This review was taken up to determine the usage and attitude toward e-cigarette smoking among the Saudi population through the analysis of literature. This review identified peer-reviewed articles using several search terms and databases from 2010 to 2018. PubMed, ISI-Web of Science, Medline and Google Scholar were searched using the following alternate terms for e-cigarettes: electronic cigarettes, electronic nicotine delivery systems following which hand search was conducted through the reference list of articles. The search results only found descriptive data on these e-cigarettes among the Saudi population. This literature review reported that the usage of these e-cigarettes was high among this population and recorded a wide variety of reasons for using e-cigarettes. Reducing tobacco use, considering e-cigarette as less harmful, less addictive, for pleasure and peer influence, lower cost and curiosity were the most commonly reported reasons. Recognizing the dangerous impact of smoking and usage of other type of tobacco, the aggressive marketing of these e-cigarettes needs to be controlled.
Collapse
Affiliation(s)
- Sanjeev Balappa Khanagar
- Preventive Dental Science Department, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Salman Siddeeqh
- Maxillofacial Surgery and Diagnostic Science Department, College of Dentistry, King Saud Bin Abdulaziz University for Health Science, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Vineet Khinda
- Preventive Dental Science Department, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Paramjit Khinda
- Preventive Dental Science Department, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Darshan Devang Divakar
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Chitra Jhugroo
- Public Health Department, Texila American University, Guyana, South America, Guyana
| |
Collapse
|
112
|
Darawad MW, Rezk-Hanna M, Alhussami M, Lee J, Mostafa A, Abu-Rmeileh N, Kheirallah K, Salama M, Nakkash R, Saleh Z, Salloum R. Poly-Tobacco Use among Young Adult Waterpipe Smokers: Insights from University Students in Three Eastern Mediterranean Countries. Subst Use Misuse 2020; 55:2099-2108. [PMID: 32666880 DOI: 10.1080/10826084.2020.1790010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is a tendency of waterpipe smokers to advance their practice toward concurrent use (poly-tobacco use) of other tobacco products and nicotine delivery systems. This study investigated poly-tobacco use among waterpipe smokers, and its effect on their quit intention. METHODS Descriptive cross-sectional design was utilized to recruit a convenience sample of university students who used waterpipe in three East Mediterranean countries. Using an internet-based survey, data were collected regarding participants' demographics, use of alternative tobacco products and nicotine delivery systems, and waterpipe quitting profile. Results: A total of 2290 students agreed to participate, among which 1116 (45.3%) reported using at least one tobacco product beside waterpipe. Poly-tobacco use was highest (61.1%) in Egypt, followed by Jordan (45.1%) and Palestine (33.1%). Across countries, cigarettes were the most common product (45.2%, n = 924) followed by cigar (18.6%, n = 374) and e-shisha (17.5%, n = 353). Conversely, the least reported product was smokeless tobacco (7.5%, n = 151) preceded by regular pipe (9.5%, n = 193). Participants who were males (OR = 2.83, 95% CI: 2.18-3.65), older (22-29 years) (OR = 1.15, 95% CI: 1.09-1.22), unemployed (OR = 1.58, 95% CI: 1.22-2.04), and those who initiated waterpipe at a younger age (OR = 0.87, 95% CI: 0.87-0.91) had higher odds of being poly-smokers. Poly-tobacco users were significantly more resistant to quit waterpipe. Conclusion: This study demonstrates poly-tobacco use as a rising phenomenon among waterpipe smokers and highlights the necessity for initiating advanced interventions to help waterpipe poly-tobacco users quit this dangerous type of addiction. Various country-specific programs are needed considering the various products used by the users.
Collapse
Affiliation(s)
| | - Mary Rezk-Hanna
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | | | - Juhan Lee
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aya Mostafa
- Department of Community Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Khalid Kheirallah
- Department of Public Health-Medical School, Jordan University of Science & Technology, Irbid, Jordan
| | - Mohammed Salama
- Clinical Nursing Department, Mansoura University, Mansoura, Egypt
| | - Rima Nakkash
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeyad Saleh
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Ramzi Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
113
|
Vasquez D, Jones MC, Brown LD. Attitudes toward tobacco among low-income Hispanic adolescents: Implications for prevention. J Ethn Subst Abuse 2020; 19:86-100. [PMID: 30064307 PMCID: PMC6355387 DOI: 10.1080/15332640.2018.1484309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Although US cigarette smoking rates have steadily declined, the changing nature of nicotine consumption and the popularity of non-combustible nicotine products urges us to revise tobacco prevention strategies. Research on smoking perspectives among Hispanic youth is limited yet crucial for prevention efforts with Hispanics being the largest minority in the U.S.Objective: This study sought to understand the experience and perceptions of low-income Hispanic youth regarding tobacco use.Methods: Forty-nine adolescents (ages 9 to 19) from El Paso, Texas, participated in five extended focus group discussions about tobacco/nicotine use.Results: Adolescents were predominantly exposed to tobacco through relatives, although school and party contexts became more relevant as youth aged. Youth had negative perceptions of tobacco and smokers, but believed their peers often viewed tobacco positively. Youth also saw tobacco use as a functional stress-management strategy, especially within their extended family. Health and family were strong motivators not to smoke.Conclusions: Youth maintain several tensions in their views on tobacco. Tobacco use is considered unpleasant and harmful, yet youth perceive their peers to view it as cool. Peer to peer discussion of tobacco experiences and perceptions may help correct these incongruent viewpoints. Adding to this tension is the perception that tobacco is used to manage stress. Given the importance of the home environment for Hispanic youth, tobacco prevention efforts may benefit from engaging family to identify the ways in which tobacco use causes stress.
Collapse
Affiliation(s)
- Denise Vasquez
- University of Texas Health Science Center at Houston, School of Public Health, 1851 Wiggins Way, HSN 424, El Paso, TX 79968
| | | | - Louis D. Brown
- University of Texas Health Science Center at Houston, School of Public Health, 1851 Wiggins Way, HSN 424, El Paso, TX 79968
| |
Collapse
|
114
|
Rostron BL, Cheng YC, Gardner LD, Ambrose BK. Prevalence and Reasons for Use of Flavored Cigars and ENDS among US Youth and Adults: Estimates from Wave 4 of the PATH Study, 2016-2017. Am J Health Behav 2020; 44:76-81. [PMID: 31783934 DOI: 10.5993/ajhb.44.1.8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we present updated estimates of use prevalence, flavor use, and flavors as a reason for use among US cigar and electronic nicotine delivery system (ENDS) users. Methods: Data come from Wave 4 of the Population Assessment of Tobacco and Health (PATH) Study and were collected between December 2016 and early January 2018. Results are presented for youth (12-17 years), young adults (18-24 years), and adults (25+ years). Results: Approximately half (50.7%) of young adults reported having ever used an ENDS product with 83.7% reporting that their first ENDS product was flavored. Flavor use was particularly high among current (past 30-day) ENDS users at 97.0% among youth, 96.8% among young adults, and 81.2% among adults. For cigars, cigarillos were the most commonly used type among youth and young adults. Flavor use was highest among current cigarillo and filtered cigar users, with close to half of current users reporting flavor use across age groups. Conclusions: Flavored product use is common among ENDS and cigar users.
Collapse
Affiliation(s)
- Brian L. Rostron
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD;,
| | - Yu-Ching Cheng
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Lisa D. Gardner
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Bridget K. Ambrose
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| |
Collapse
|
115
|
Brinkman MC, Kim H, Buehler SS, Adetona AM, Gordon SM, Clark PI. Evidence of compensation among waterpipe smokers using harm reduction components. Tob Control 2020; 29:15-23. [PMID: 30377243 PMCID: PMC7350613 DOI: 10.1136/tobaccocontrol-2018-054502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We examined two waterpipe tobacco smoking components advertised to reduce harm to determine if they result in lower levels of biomarkers of acute exposure. METHODS We conducted a crossover study of 34 experienced waterpipe smokers smoking a research-grade waterpipe in three configurations ad libitum in a controlled chamber: control (quick-light charcoal), electric (electric heating) and bubble diffuser (quick-light charcoal and bubble diffuser). We collected data on smoking topography, environmental carbon monoxide (CO), subjective effects, heart rate, plasma nicotine and exhaled CO and benzene. RESULTS Smokers' mean plasma nicotine, heart rate, and exhaled benzene and CO boost were all significantly lower for electric compared with control. However, smokers puffed more intensely and took significantly more and larger volume puffs for a larger total puffing volume (2.0 times larger, p<0.0001) when smoking electric; machine yields indicate this was likely due to lower mainstream nicotine. Smokers rated electric smoking experience less satisfying and less pleasant. For charcoal heating, the mean mass of CO emitted into the chamber was ~1 g when participants smoked for a mean of 32 minutes at a typical residential ventilation rate (2.3 hr-1). CONCLUSION Waterpipe smokers engaged in compensation (i.e., increased and more intense puffing) to make up for decreased mainstream nicotine delivery from the same tobacco heated two ways. Waterpipe components can affect human puffing behaviours, exposures and subjective effects. Evidence reported here supports regulation of waterpipe components, smoking bans in multifamily housing and the use of human studies to evaluate modified or reduced risk claims.
Collapse
Affiliation(s)
- Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
| | - Hyoshin Kim
- Battelle Public Health Center for Tobacco Research, Battelle, Seattle, Washington, USA
| | - Stephanie S Buehler
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Anna M Adetona
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Sydney M Gordon
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Pamela I Clark
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
| |
Collapse
|
116
|
Salloum RG, Nakkash R, Abu-Rmeileh NME, Hamadeh RR, Darawad MW, Kheirallah KA, Al-Farsi Y, Yusufali A, Thomas J, Mostafa A, Salama M, El Kadi L, Alzyoud S, Al-Sheyab N, Thrasher JF. Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries. Health Promot Int 2019; 34:1157-1166. [PMID: 30412234 DOI: 10.1093/heapro/day084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment methodology. Participants were young adult university students (18-29 years) who were ever waterpipe smokers, recruited from universities across four Eastern Mediterranean countries: Jordan, Oman, Palestine and the United Arab Emirates. The Internet-based discrete choice experiment, with 6 × 3 × 2 block design, evaluated preferences for choices of waterpipe smoking sessions, presented on hypothetical waterpipe café menus. Participants evaluated nine choice sets, each with five fruit-flavored options, a tobacco flavored option (non-flavored), and an opt-out option. Choices also varied based on nicotine content (0.0% vs. 0.05% vs. 0.5%) and price (low vs. high). Participants were randomized to receive menus with either a pictorial + text health-warning message or no message (between-subjects attribute). Multinomial logit regression models evaluated the influence of these attributes on waterpipe smoking choices. Across all four samples (n = 1859), participants preferred fruit-flavored varieties to tobacco flavor, lower nicotine content and lower prices. Exposure to the health warning did not significantly predict likelihood to opt-out. Flavor accounted for 81.4% of waterpipe smoking decisions. Limiting the use of fruit flavors in waterpipe tobacco, in addition to accurate nicotine content labeling and higher pricing may be effective at curbing the demand for waterpipe smoking among young adults.
Collapse
Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, PO Box 14, Birzeit, Palestine
| | - Randah R Hamadeh
- College of Medicine and Medical Sciences, Arabian Gulf University, Road 2904, 293 Manama, Bahrain
| | - Muhammad W Darawad
- School of Nursing, The University of Jordan, Queen Rania Street, 11942 Amman, Jordan
| | - Khalid A Kheirallah
- Department of Public Health, Community Medicine, Jordan University of Science and Technology, PO Box 3030, 22110 Irbid, Jordan
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, 123, Al Khod, Muscat, Oman
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority and Dubai Medical College, 35th Street, PO Box 2017, Dubai, United Arab Emirates
| | - Justin Thomas
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassiya, 11566 Cairo, Egypt
| | - Mohamed Salama
- Medical Experimental Research Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Lama El Kadi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Sukaina Alzyoud
- Department of Community and Mental Health Nursing, Faculty of Nursing, Hashemite University, PO Box 330127, 13133 Zarqa, Jordan
| | - Nihaya Al-Sheyab
- Department of Maternal and Child Nursing, Jordan University of Science and Technology, PO Box 3030, 22110 Irbid, Jordan
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, 29208 Columbia, SC, USA
| |
Collapse
|
117
|
Abstract
Waterpipe (hookah, shisha, narghileh) smoking is emerging as an epidemic, particularly among young people in the USA and globally. Unlike cigarettes, waterpipe smoking involves several components (eg, tobacco, charcoal, device and venues) and is characterised by unique smoking patterns that expose smokers to significant amounts of nicotine and other toxic substances. With the rising prevalence of use among young people and continuing misperceptions about waterpipe's harmful nature, a better understanding of health risks associated with waterpipe smoking is warranted. In response to waterpipe's rising trends, a Deeming Rule that extended the US Food and Drug Administration's (FDA) regulatory authority to all tobacco products was issued in 2016. This rule includes waterpipe tobacco, components and parts. This development created the need for evidence to guide the FDA into best evidence-based strategies to limit waterpipe's spread among young people and harm to public health. This special issue presents some of the studies that were funded under the 'Chemistry, Toxicology, and Addiction Research on Waterpipe Tobacco' programme to inform promising regulatory action on waterpipe products. In this preamble, we briefly summarise findings from these studies and discusses their policy and regulatory implications for different waterpipe products and components.
Collapse
Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | | |
Collapse
|
118
|
Verhaegen A, Van Gaal L. Vaping and Cardiovascular Health: the Case for Health Policy Action. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
119
|
Bold KW, Krishnan-Sarin S, Stoney CM. E-cigarette use as a potential cardiovascular disease risk behavior. ACTA ACUST UNITED AC 2019; 73:955-967. [PMID: 30394775 DOI: 10.1037/amp0000231] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Electronic cigarette (e-cigarette) use is rapidly increasing among youth and adults despite limited information regarding the long-term risks or benefits. The potential impact of e-cigarette use on public health is complex. E-cigarettes are sometimes considered as smoking cessation aids and, to the extent that they are successful in this regard, could have a net population benefit for adult smokers. However, limited knowledge exists about the long-term health effects of e-cigarette use, and research has suggested these novel tobacco products may lead to initiation and continued use among vulnerable populations, including youth. The current review aimed to summarize trends and available scientific information about e-cigarette use, focusing on the potential cardiovascular health risks and benefits, characteristics associated with e-cigarette use, and critical areas for future investigation to inform the research and clinical work of psychologists. Psychologists have a leadership role in mitigating health risks from smoking behavior, and there is a need for rigorous research assessing the impact of e-cigarette use on population health. In addition, psychologists are uniquely qualified to understand the underlying processes regarding decision-making and behaviors around e-cigarette use. Collectively, the research of psychologists in this area can have a substantial impact on patient education, policies, and the development of prevention and intervention programs to promote public health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine
| | | | - Catherine M Stoney
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health
| |
Collapse
|
120
|
Maziak W, Osibogun O, Asfar T. Waterpipe smoking: the pressing need for risk communication. Expert Rev Respir Med 2019; 13:1109-1119. [PMID: 31519113 PMCID: PMC7004232 DOI: 10.1080/17476348.2019.1668271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023]
Abstract
Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking. Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking. Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them.
Collapse
Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
121
|
Leventhal AM, Goldenson NI, Cho J, Kirkpatrick MG, McConnell RS, Stone MD, Pang RD, Audrain-McGovern J, Barrington-Trimis JL. Flavored E-cigarette Use and Progression of Vaping in Adolescents. Pediatrics 2019; 144:e20190789. [PMID: 31659004 PMCID: PMC6856781 DOI: 10.1542/peds.2019-0789] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Electronic cigarettes (e-cigarettes) are available in nontraditional flavors (eg, fruit and candy) that are banned in combustible cigarettes in the United States. Whether adolescent use of e-cigarettes in nontraditional flavors prospectively predicts continuation of vaping and progression to more frequent vaping is unknown. METHODS High school students in Los Angeles, California, completed 5 semiannual surveys (2014-2017 [10th grade to 12th grade]). Among past-6-month e-cigarette users at survey waves 1 to 4 (N = 478), e-cigarette flavor (or flavors) used was coded into 2 mutually exclusive categories at each wave (use of ≥1 nontraditional flavors [fruit, candy, sweet or dessert, buttery, blends or combinations, and other] versus exclusive use of tobacco, menthol or mint, or flavorless). Flavor used during waves 1 to 4 was modeled as a time-varying, time-lagged regressor of vaping status and frequency outcomes 6 months later at waves 2 to 5. RESULTS Across waves 1 to 4, there were 739 (93.8%) observations of nontraditional-flavor use and 49 (6.2%) observations of exclusive use of tobacco, mint or menthol, or flavorless e-cigarettes. Use of e-cigarettes in nontraditional flavors (versus only tobacco, mint or menthol, or flavorless) was positively associated with vaping continuation (64.3% vs 42.9%; adjusted odds ratio = 3.76 [95% confidence interval 1.20 to 10.31]) and past-30-day number of puffs per nicotine vaping episode (mean: 3.1 [SD 5.5] vs 1.5 [SD 3.8]; adjusted rate ratio = 2.41 [95% confidence interval 1.08 to 5.92]) 6 months later. Flavor used was not associated with the subsequent number of past-30-day vaping days or episodes per day. CONCLUSIONS Adolescents who vaped e-cigarettes in nontraditional flavors, compared with those who exclusively vaped tobacco-flavored, mint- or menthol-flavored, or flavorless e-cigarettes, were more likely to continue vaping and take more puffs per vaping occasion 6 months later.
Collapse
Affiliation(s)
- Adam M Leventhal
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California;
- Departments of Psychology and
| | - Nicholas I Goldenson
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Junhan Cho
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew G Kirkpatrick
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rob S McConnell
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew D Stone
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California; and
| | - Raina D Pang
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|
122
|
Trivers KF, Gentzke AS, Phillips E, Tynan M, Marynak KL, Schauer GL. Substances used in electronic vapor products among adults in the United States, 2017. Addict Behav Rep 2019; 10:100222. [PMID: 31828201 PMCID: PMC6888746 DOI: 10.1016/j.abrep.2019.100222] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/31/2022] Open
Abstract
Electronic vapor products are used by adults for a variety of substances. Nicotine was the most commonly reported substance used in electronic vapor products. Many adults also use these devices for flavors and marijuana. Adults younger than 30 years and females were more likely to report flavor use.
Introduction Electronic vapor products (EVPs), including e-cigarettes, can be used to aerosolize many substances. Examination of substances used in EVPs by US adults has been limited; we assessed past-year use of EVPs to deliver various substances. Methods Data came from the 2017 SummerStyles Survey, a web-based survey of US adults (N = 4107). Ever EVP users were asked if they had used nicotine, marijuana, flavors or “something else” in an EVP during the past year. Weighted estimates for any, exclusive, and combined EVP substance use were calculated among ever (n = 586) and current (past 30-day; n = 121) EVP users. Results Past-year use of nicotine, flavors, and marijuana in EVPs was 30.7%, 23.6%, and 12.5% among ever EVP users, respectively; and 72.3%, 54.6%, and 17.8% among current EVP users. Among ever EVP users, the most commonly used substances were nicotine only (29.6%), nicotine plus flavors (27.2%), flavors only (16.4%), and marijuana only (14.9%). Among current EVP users, the most common substances used were nicotine plus flavors (39.1%), nicotine only (29.6%), and flavors only (11.2%). Among ever users, males and 18–29 year olds were more likely to report use of flavors than females and respondents ≥30 years. Conclusions Approximately 7 in 10 current EVP users reported nicotine use, about 1 in 2 used flavors, and nearly 1 in 6 used marijuana. These findings suggest that EVPs are used to consume a variety of substances and could guide efforts to address tobacco and non-tobacco substance use.
Collapse
Affiliation(s)
- Katrina F Trivers
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Andrea S Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Elyse Phillips
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Michael Tynan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Kristy L Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Gillian L Schauer
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,McKing Consulting, Atlanta, GA, United States
| |
Collapse
|
123
|
Modeling drug exposure in rodents using e-cigarettes and other electronic nicotine delivery systems. J Neurosci Methods 2019; 330:108458. [PMID: 31614162 DOI: 10.1016/j.jneumeth.2019.108458] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 12/25/2022]
Abstract
Smoking tobacco products is the leading cause of preventable death worldwide. Coordinated efforts have successfully reduced tobacco cigarette smoking in the United States; however, electronic cigarettes (e-cigarette) and other electronic nicotine delivery systems (ENDS) recently have replaced traditional cigarettes for many users. While the clinical risks associated with long-term ENDS use remain unclear, advancements in preclinical rodent models will enhance our understanding of their overall health effects. This review examines the peripheral and central effects of ENDS-mediated exposure to nicotine and other drugs of abuse in rodents and evaluates current techniques for implementing ENDS in preclinical research.
Collapse
|
124
|
Villanti AC, Johnson AL, Glasser AM, Rose SW, Ambrose BK, Conway KP, Cummings KM, Stanton CA, Edwards KC, Delnevo CD, Wackowski OA, Feirman SP, Bansal-Travers M, Bernat JK, Holder-Hayes E, Green VR, Silveira ML, Hyland A. Association of Flavored Tobacco Use With Tobacco Initiation and Subsequent Use Among US Youth and Adults, 2013-2015. JAMA Netw Open 2019; 2:e1913804. [PMID: 31642927 PMCID: PMC6820032 DOI: 10.1001/jamanetworkopen.2019.13804] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Flavors in tobacco products may appeal to young and inexperienced users. OBJECTIVE To examine among youth (aged 12-17 years), young adults (aged 18-24 years), and adults (aged ≥25 years) the prevalence of first use of flavored tobacco products among new tobacco users and the association between first flavored use of a given tobacco product and tobacco use 1 year later, including progression of tobacco use. DESIGN, SETTING, AND PARTICIPANTS This cohort study represents a longitudinal analysis of data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative study with data collected in 2013 to 2014 (wave 1) and 2014 to 2015 (wave 2). Participants were noninstitutionalized individuals, including 11 996 youth and 26 447 adults, in selected households who participated in both waves of the PATH Study. Data analysis was conducted from July 2016 to June 2019. MAIN OUTCOMES AND MEASURES Prevalence of tobacco product use at wave 2. RESULTS The mean (SE) age of the participants was 14.5 (0.0) years for youth, 21.1 (0.0) years for young adults, and 50.3 (0.0) for adults. Most youth (71.9%; 95% CI, 69.7%-74.0%) and young adults (57.6%; 95% CI, 54.9%-60.3%) who were new users of tobacco products over the 10- to 13-month follow-up period used flavored products. First use of a menthol or mint or other flavored cigarette documented at wave 1 was positively associated with past 12-month and past 30-day cigarette use in all age groups at wave 2 compared with first use of a nonflavored cigarette (youth, flavored cigarette, past 12-month use adjusted prevalence ratio [aPR], 1.14 [95% CI, 1.05-1.25] and past 30-day use aPR, 1.15 [95% CI, 1.00-1.31]; youth, menthol or mint cigarette, past 12-month use aPR, 1.18 [95% CI, 1.08-1.29] and past 30-day use aPR, 1.19 [95% CI, 1.04-1.37]; young adult, flavored cigarette, past 12-month use aPR, 1.09 [95% CI, 1.04-1.15] and past 30-day use aPR, 1.13 [95% CI, 1.06-1.21]; young adult menthol or mint cigarette, past 12-month use aPR, 1.10 [95% CI, 1.05-1.16] and past 30-day use aPR, 1.15 [95% CI, 1.07-1.23]; adult flavored cigarette, past 12-month use aPR, 1.10 [95% CI, 1.05-1.15] and past 30-day use aPR, 1.09 [95% CI, 1.04-1.14]; adult menthol or mint cigarette, past 12-month use aPR, 1.13 [95% CI, 1.08-1.18] and past 30-day use aPR, 1.12 [95% CI, 1.07-1.17]). Among young adults, first use of flavored e-cigarettes (aPR, 2.05; 95% CI, 1.61-2.61), any cigars (aPR, 1.60; 95% CI, 1.26-2.02), cigarillos (aPR, 1.49; 95% CI, 1.08-2.05), filtered cigars (aPR, 3.69; 95% CI, 2.08-6.57), hookah (aPR, 1.91; 95% CI, 1.23-2.98), and any smokeless tobacco (aPR, 1.54; 95% CI, 1.08-2.20) was prospectively associated with current regular use of those products at wave 2 compared with first nonflavored use. Among adults aged 25 years and older, first use of flavored e-cigarettes (aPR, 1.60; 95% CI, 1.41-1.82), any cigars (aPR, 1.56; 95% CI, 1.29-1.87), cigarillos (aPR, 1.29; 95% CI, 1.01-1.64), filtered cigars (aPR, 1.79; 95% CI, 1.25-2.54), hookah (aPR, 5.66; 95% CI, 2.04-15.71), and any smokeless tobacco (aPR, 1.55; 95% CI, 1.32-1.82) was prospectively associated with current regular use of those products at wave 2 compared with first nonflavored use. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study, flavors in tobacco products were associated with youth and young adult tobacco experimentation. First use of a flavored tobacco product may place youth, young adults, and adults at risk of subsequent tobacco use.
Collapse
Affiliation(s)
- Andrea C. Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont, Burlington
| | - Amanda L. Johnson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Allison M. Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Shyanika W. Rose
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Kevin P. Conway
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Cassandra A. Stanton
- Westat, Rockville, Maryland
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | - Cristine D. Delnevo
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey
| | - Olivia A. Wackowski
- Department of Health Education and Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey
| | - Shari P. Feirman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Maansi Bansal-Travers
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York
| | - Jennifer K. Bernat
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Enver Holder-Hayes
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Victoria R. Green
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
- Kelly Government Solutions, Rockville, Maryland
| | - Marushka L. Silveira
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
- Kelly Government Solutions, Rockville, Maryland
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York
| |
Collapse
|
125
|
Stanton CA, Bansal-Travers M, Johnson AL, Sharma E, Katz L, Ambrose BK, Silveira ML, Day H, Sargent J, Borek N, Compton WM, Johnson SE, Kimmel HL, Kaufman AR, Limpert J, Abrams D, Cummings KM, Goniewicz ML, Tanski S, Travers MJ, Hyland AJ, Pearson JL. Longitudinal e-Cigarette and Cigarette Use Among US Youth in the PATH Study (2013-2015). J Natl Cancer Inst 2019; 111:1088-1096. [PMID: 30689915 PMCID: PMC6792095 DOI: 10.1093/jnci/djz006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/01/2018] [Accepted: 01/10/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence is accumulating that youth who try Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) may go on to try cigarettes. This analysis examines the bidirectional patterns of ENDS and cigarette use among US youth over one year and uses propensity score matching (PSM) to examine frequency of ENDS use on changes in cigarette smoking. METHODS Our analysis included 11 996 participants who had two waves of available data (Wave 1 [W1] 2013-2014; Wave 2 [W2] 2014-2015) drawn from the longitudinal Population Assessment of Tobacco and Health Study. Cross-sectional weighted prevalence estimates are reported for cigarettes and ENDS. We used PSM to estimate the likelihood of ENDS use at W1 and to draw matched analytic samples, then used regression (logistic or linear) models to examine the effect of W1 ENDS use on W2 cigarette smoking. All statistical tests were two-sided. RESULTS In weighted analyses, 69.3% of W1 past-30-day cigarette smokers exhibited past-30-day smoking at W2; 42.2% of W1 past-30-day ENDS users were using ENDS at W2. W1 ever use of either product was similarly associated with W2 new use of the other product. Unweighted PSM models indicated W1 cigarette-naïve ENDS use was associated with W2 ever-cigarette smoking (n = 676; adjusted odds ratio = 3.21, 95% confidence interval [CI] = 1.95 to 5.45, P < .001); W1 ever-ENDS use did not affect change in cigarette frequency at W2 (n = 1020, beta = 0.31, 95% CI = -0.76 to 1.39, P = .57); 1-5 days ENDS use compared with ever, no past-30-day ENDS use was associated with a statistically significant decrease of W2 smoking days (n = 256, beta = -2.64, 95% CI = -4.96 to -0.32; P = .03); and W1 6+ day ENDS users did not show a decrease in frequency of cigarette smoking. CONCLUSIONS Ever-ENDS use predicts future cigarette smoking, and frequency of ENDS use has a differential impact on subsequent cigarette smoking uptake or reduction. These results suggest that both cigarettes and ENDS should be targeted in early tobacco prevention efforts with youth.
Collapse
Affiliation(s)
- Cassandra A Stanton
- Correspondence to: Cassandra A. Stanton, PhD, Westat, 1600 Research Boulevard, Rockville, MD 20850 (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
126
|
Reilly SM, Goel R, Bitzer Z, Elias RJ, Foulds J, Muscat J, Richie JP. Little Cigars, Filtered Cigars, and their Carbonyl Delivery Relative to Cigarettes. Nicotine Tob Res 2019; 20:S99-S106. [PMID: 30125018 PMCID: PMC6093475 DOI: 10.1093/ntr/ntx274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/12/2018] [Indexed: 11/14/2022]
Abstract
Introduction Little cigars and filtered cigars are currently growing in popularity due to their low cost and wide variety of flavors while retaining an appearance similar to cigarettes. Given the health consequences associated with cigarette use, it is important to understand the potential harm associated with these similar products. This includes the potential harm associated with carbonyls (eg, acetaldehyde, acrolein, formaldehyde, etc.), an important class of toxicants and carcinogens in tobacco smoke. Our objective was to determine the carbonyl levels in mainstream smoke from little and filtered cigars compared to cigarettes. Methods We examined two brands each of little cigars and filtered cigars, as well as two research cigarettes for carbonyl delivery using the International Organization of Standards (ISO) and the Health Canada Intense (HCI) machine-smoking protocols. Results On a per puff basis, the levels of five of the seven carbonyls were higher from little cigars than filtered cigars and cigarettes (ISO: 56-116%; HCI: 39-85%; p < .05). On a per unit basis, most carbonyl levels were higher from both cigar types than cigarettes using the ISO method (ISO: 51-313%; p < .05) whereas only filtered cigars were higher using the HCI method (HCI: 53-99%; p < .05). Conclusion These findings suggest that cigar smokers can be exposed to higher levels of carbonyls per cigar than cigarette smokers per cigarette. Implications These data will increase our understanding of the relative harm from carbonyl exposure from little and filtered cigars both for cigar-only smokers and the cumulative harm among the growing population of cigarette-cigar multi-product smokers.
Collapse
Affiliation(s)
- Samantha M Reilly
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - Reema Goel
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - Zachary Bitzer
- Department of Food Science, Pennsylvania State University, College of Agricultural Sciences, University Park, PA
| | - Ryan J Elias
- Department of Food Science, Pennsylvania State University, College of Agricultural Sciences, University Park, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - Joshua Muscat
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Pennsylvania State University Tobacco Center of Regulatory Science (TCORS), Pennsylvania State University College of Medicine, Hershey, PA
| |
Collapse
|
127
|
Rose SW, Johnson AL, Glasser AM, Villanti AC, Ambrose BK, Conway K, Cummings KM, Stanton CA, Delnevo C, Wackowski OA, Edwards KC, Feirman SP, Bansal-Travers M, Bernat J, Holder-Hayes E, Green V, Silveira ML, Zhou Y, Abudayyeh H, Hyland A. Flavour types used by youth and adult tobacco users in wave 2 of the Population Assessment of Tobacco and Health (PATH) Study 2014-2015. Tob Control 2019; 29:432-446. [PMID: 31542778 DOI: 10.1136/tobaccocontrol-2018-054852] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/18/2019] [Accepted: 05/28/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most youth and young adult (YA) tobacco users use flavoured products; however, little is known about specific flavours used. METHODS We report flavour types among US tobacco users from the Population Assessment of Tobacco and Health Study, wave 2, 2014-2015. At wave 2, we examined (1) flavour use and type at past 30-day use; (2) new flavoured tobacco product use and type; (3) product-specific flavour patterns across youth (ages 12-17) (n=920), YA (18-24) (n=3726) and adult (25+) (n=10 346) past 30-day and new tobacco users and (4) concordance between self-coded and expert-coded brand flavour type among all adults (18+). RESULTS Prevalence of flavoured tobacco product use was highest among youth, followed by YA and adult 25+ any tobacco users. Within each age group, flavoured use was greatest among hookah, e-cigarette and snus users. Overall, menthol/mint, fruit and candy/sweet were the most prevalent flavour types at first and past 30-day use across age groups. For past 30-day use, all flavour types except menthol/mint exhibited an inverse age gradient, with more prevalent use among youth and YAs, followed by adults 25+. Prevalence of menthol/mint use was high (over 50% youth, YAs; 76% adults 25+) and exhibited a positive age gradient overall, though the reverse for cigarettes. Brand-categorised and self-reported flavour use measures among adults 18+ were moderately to substantially concordant across most products. CONCLUSIONS Common flavours like menthol/mint, fruit and candy/sweet enhance appeal to young tobacco users. Information on flavour types used by product and age can inform tobacco flavour regulations to addess flavour appeal especially among youth.
Collapse
Affiliation(s)
| | - Amanda L Johnson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Andrea C Villanti
- Truth Initiative Schroeder Institute, Washington, DC, USA.,Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kevin Conway
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - K Michael Cummings
- Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cassandra A Stanton
- Westat Inc, Rockville, Maryland, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | | | - Shari P Feirman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Jennifer Bernat
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Enver Holder-Hayes
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Victoria Green
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Marushka L Silveira
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Yitong Zhou
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | | | - Andrew Hyland
- Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| |
Collapse
|
128
|
Roditis ML, Dineva A, Smith A, Walker M, Delahanty J, D'lorio E, Holtz KD. Reactions to electronic nicotine delivery system (ENDS) prevention messages: results from qualitative research used to inform FDA's first youth ENDS prevention campaign. Tob Control 2019; 29:510-515. [PMID: 31506379 PMCID: PMC7476260 DOI: 10.1136/tobaccocontrol-2019-055104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 02/02/2023]
Abstract
Background Youth e-cigarette use is a major public health concern. Large-scale tobacco prevention campaigns are a proven strategy to prevent tobacco use. There is a gap in understanding what types of e-cigarette prevention messages might be most effective. This study addresses this gap by reporting youth reactions to health messages aimed at preventing e-cigarette use. Methods In 2018, twenty-four focus groups, with 159 teens (12–17) at risk for or experimenting with e-cigarettes were conducted in four cities across the USA. During focus groups, youth responded to creative concepts dealing with (1) the addictive nature of e-cigarettes, (2) the fact that e-cigarettes come in flavours, which may encourage youth initiation, and nicotine which may lead to addiction, or (3) that youth who use e-cigarettes are more likely to use cigarettes. Youth also gave feedback to specific facts about harmful and potentially harmful chemicals in e-cigarettes. Transcripts were analysed using thematic analysis. Results Messages focusing on addiction alone did not resonate with participants. While youth found the idea that e-cigarettes may contain nicotine and can be addictive believable, with many describing personal experiences of addiction, they questioned how bad this really was, comparing addiction to e-cigarettes to things like being addicted to food. Participants wanted more information about negative consequences of vaping. Concepts paired with strong health effects messages resonated with participants. Conclusion These focus groups clarified which e-cigarette prevention messages might be most persuasive to teens. Youth in this study responded favourably to messages stating specific health consequences of e-cigarette use.
Collapse
Affiliation(s)
- Maria L Roditis
- Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Atanaska Dineva
- Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Alexandria Smith
- Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Matthew Walker
- Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Janine Delahanty
- Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Emily D'lorio
- Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | |
Collapse
|
129
|
L Rostron B, G Corey C, Holder-Hayes E, K Ambrose B. Estimating the Potential Public Health Impact of Prohibiting Characterizing Flavors in Cigars throughout the US. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3234. [PMID: 31487796 PMCID: PMC6765886 DOI: 10.3390/ijerph16183234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022]
Abstract
Flavored cigar use is common among cigar smokers, particularly those at younger ages. Several US localities have implemented policies restricting the sale of flavored tobacco products, including cigars. We estimated the population health benefits of removal of flavored cigars throughout the US in terms of reductions in cigar smoking-attributable mortality due to increased cessation and reductions in cigar smoking prevalence due to decreased initiation and continuing use. Monte Carlo simulation was used to estimate possible ranges for these values. We used published estimates of cigar use and attributable mortality in the US, as well as prior study conclusions on the effect of local and national flavor restriction policies. We estimated that removal of flavored cigars would result in approximately 800 (90% prediction interval = 400-1200) fewer cigar smoking-attributable deaths in the US each year and 112,000 fewer cigar smokers (90% prediction interval = 76,000-139,000) in each cohort of 18 year olds. The removal of characterizing flavors in cigars sold in the US is thus projected to have substantial public health benefits over time.
Collapse
Affiliation(s)
- Brian L Rostron
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Catherine G Corey
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Enver Holder-Hayes
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Bridget K Ambrose
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20993, USA
| |
Collapse
|
130
|
Mehra VM, Keethakumar A, Bohr YM, Abdullah P, Tamim H. The association between alcohol, marijuana, illegal drug use and current use of E-cigarette among youth and young adults in Canada: results from Canadian Tobacco, Alcohol and Drugs Survey 2017. BMC Public Health 2019; 19:1208. [PMID: 31477067 PMCID: PMC6721192 DOI: 10.1186/s12889-019-7546-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background E-cigarettes have grown in popularity around the world since 2003. Although marketed as a smoking cessation tool, e-cigarettes can lead to tobacco cigarette smoking in youth. In Canada, among all age groups, youth and young adults have the highest prevalence of e-cigarette use. The objective of this study was to assess the factors associated with e-cigarette use among youth and young adults in Canada, and to specifically examine the association between alcohol, marijuana and illicit drug use. Methods Data from the 2017 Canadian Tobacco, Alcohol and Drugs Survey were used. The sample was restricted to those aged 15–24 years (n = 10,322), and main outcome defined as ‘E-cigarette use in the past 30-days’. Multivariable logistic regression was performed to assess the association between the main outcome and substance use variables (illicit drug, marijuana and alcohol use), tobacco exposure variables, and demographic and health-related factors. Results 6.2% Canadians aged 15–24 reported using e-cigarettes in the past 30-days, while 23.9% reported having ever tried e-cigarettes. Twenty-three percent of the past 30-day users reported using e-cigarettes every day and 72.5% of the past 30-day users reported having nicotine in their last e-cigarette. Additionally, youth aged 15–17 were 4.95 times more likely to be e-cigarette users as compared to those aged 22–24 (OR: 4.95, 95% CI: 3.1–7.9). Moreover, e-cigarette use was significantly associated with marijuana use (OR:4.17, 95% CI: 2.6–6.7) and alcohol use (OR: 5.08, 95% CI: 2.9–9.0), and approached significance with illicit drug use (OR: 1.68, 95% CI: 1.0–2.9). Furthermore, being a current smoker (OR: 2.93, 95% CI: 1.8–4.7) and male (OR: 2.28, 95% CI: 1.5–3.4) was significantly associated with the outcome. Conclusion This study is nationally representative and provides insight into e-cigarette use among youth and young adults aged 15–24 years. Given that e-cigarettes can be used as illicit drug delivery systems, more studies are needed to understand how Canadian youth and young adults are using e-cigarettes. Stricter restrictions on public e-cigarette smoking, and awareness campaigns informing youth of risks of e-cigarette smoking should be implemented.
Collapse
Affiliation(s)
- Vrati M Mehra
- School of Kinesiology and Health Sciences, Faculty of Health, York University, Toronto, Canada.
| | - Asvini Keethakumar
- School of Kinesiology and Health Sciences, Faculty of Health, York University, Toronto, Canada
| | - Yvonne M Bohr
- Department of Psychology, York University, 4700 Keele Street, Toronto, Canada
| | - Peri Abdullah
- School of Kinesiology and Health Sciences, Faculty of Health, York University, Toronto, Canada
| | - Hala Tamim
- School of Kinesiology and Health Sciences, Faculty of Health, York University, Toronto, Canada
| |
Collapse
|
131
|
Audrain-McGovern J, Rodriguez D, Pianin S, Alexander E. Initial e-cigarette flavoring and nicotine exposure and e-cigarette uptake among adolescents. Drug Alcohol Depend 2019; 202:149-155. [PMID: 31351341 PMCID: PMC7168773 DOI: 10.1016/j.drugalcdep.2019.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE E-cigarettes are the most prevalent tobacco product used by adolescents. We sought to determine whether the presence of flavoring and/or the presence of nicotine at the first e-cigarette exposure predicted progression to current e-cigarette use (use in past 30 days) as well as escalation in use (number of days in the past 30 days) among adolescents. METHODS Adolescents from public high schools outside of Philadelphia, PA completed in-classroom surveys at baseline (9th grade) and at 6-month intervals for the following 18 months (fall 2018, beginning of 11th grade). Adolescents who reported ever having used e-cigarettes at baseline (N = 354) comprised the analytical sample. RESULTS We employed a two-part Latent Growth Curve Model including flavor, nicotine, and other covariates. Initial use of a flavored (vs unflavored) e-cigarette was associated with progression to current e-cigarette use (β = 0.54, z = 2.09, p = 0.04) and escalation in the number of days of e-cigarette use (β = 0.35, z = 2.58, p = 0.01) across the following 18 months. Initial use of an e-cigarette with nicotine (vs without nicotine) was associated with a greater number of days of e-cigarette use at baseline (β = 0.49, z = 2.16, p = 0.03). CONCLUSIONS The findings underscore the risk that flavoring and nicotine pose for progression beyond initial e-cigarette use. Regulations addressing flavoring and nicotine in e-cigarettes have the potential to reduce the number of adolescents who become current as well as frequent e-cigarette users.
Collapse
Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA.
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, LaSalle University, 1900 West Olney Avenue Philadelphia, PA 19141, USA
| | - Stephen Pianin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA
| | - Emily Alexander
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA
| |
Collapse
|
132
|
Ren M, Lotfipour S. Nicotine Gateway Effects on Adolescent Substance Use. West J Emerg Med 2019; 20:696-709. [PMID: 31539325 PMCID: PMC6754186 DOI: 10.5811/westjem.2019.7.41661] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/15/2019] [Accepted: 07/01/2019] [Indexed: 11/11/2022] Open
Abstract
Given the rise in teenage use of electronic nicotine delivery systems ("vaping") in congruence with the increasing numbers of drug-related emergencies, it is critical to expand the knowledge of the physical and behavioral risks associated with developmental nicotine exposure. A further understanding of the molecular and neurochemical underpinnings of nicotine's gateway effects allows emergency clinicians to advise patients and families and adjust treatment accordingly, which may minimize the use of tobacco, nicotine, and future substances. Currently, the growing use of tobacco products and electronic cigarettes among teenagers represents a major public health concern. Adolescent exposure to tobacco or nicotine can lead to subsequent abuse of nicotine and other substances, which is known as the gateway hypothesis. Adolescence is a developmentally sensitive time period when risk-taking behaviors, such as sensation seeking and drug experimentation, often begin. These hallmark behaviors of adolescence are largely due to maturational changes in the brain. The developing brain is particularly vulnerable to the harmful effects of drugs of abuse, including tobacco and nicotine products, which activate nicotinic acetylcholine receptors (nAChRs). Disruption of nAChR development with early nicotine use may influence the function and pharmacology of the receptor subunits and alter the release of reward-related neurotransmitters, including acetylcholine, dopamine, GABA, serotonin, and glutamate. In this review, we emphasize that the effects of nicotine are highly dependent on timing of exposure, with a dynamic interaction of nAChRs with dopaminergic, endocannabinoid, and opioidergic systems to enhance general drug reward and reinforcement. We analyzed available literature regarding adolescent substance use and nicotine's impact on the developing brain and behavior using the electronic databases of PubMed and Google Scholar for articles published in English between January 1968 and November 2018. We present a large collection of clinical and preclinical evidence that adolescent nicotine exposure influences long-term molecular, biochemical, and functional changes in the brain that encourage subsequent drug abuse.
Collapse
Affiliation(s)
- Michelle Ren
- University of California, Irvine, Department of Pharmaceutical Sciences, Irvine, California
| | - Shahrdad Lotfipour
- University of California, Irvine, Department of Emergency Medicine and Pharmaceutical Sciences, Irvine, California
| |
Collapse
|
133
|
McMillen R, Klein JD, Wilson K, Winickoff JP, Tanski S. E-Cigarette Use and Future Cigarette Initiation Among Never Smokers and Relapse Among Former Smokers in the PATH Study. Public Health Rep 2019; 134:528-536. [PMID: 31419184 DOI: 10.1177/0033354919864369] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Any potential harm-reduction benefit of electronic cigarettes (e-cigarettes) could be offset by nonsmokers who initiate e-cigarette use and then smoke combustible cigarettes. We examined correlates of e-cigarette use at baseline with combustible cigarette smoking at 1-year follow-up among adult distant former combustible cigarette smokers (ie, quit smoking ≥5 years ago) and never smokers. METHODS The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal study, surveyed 26 446 US adults during 2 waves: 2013-2014 (baseline) and 2014-2015 (1-year follow-up). Participants completed an audio computer-assisted interview in English or Spanish. We compared combustible cigarette smoking at 1-year follow-up by e-cigarette use at baseline among distant former combustible cigarette smokers and never smokers. RESULTS Distant former combustible cigarette smokers who reported e-cigarette past 30-day use (9.3%) and ever use (6.7%) were significantly more likely than those who had never used e-cigarettes (1.3%) to have relapsed to current combustible cigarette smoking at follow-up (P < .001). Never smokers who reported e-cigarette past 30-day use (25.6%) and ever use (13.9%) were significantly more likely than those who had never used e-cigarettes (2.1%) to have initiated combustible cigarette smoking (P < .001). Adults who reported past 30-day e-cigarette use (7.0%) and ever e-cigarette use (1.7%) were more likely than those who had never used e-cigarettes (0.3%) to have transitioned from never smokers to current combustible cigarette smokers (P < .001). E-cigarette use predicted combustible cigarette smoking in multivariable analyses controlling for covariates. CONCLUSIONS Policies and counseling should consider the increased risk for nonsmokers of future combustible cigarette smoking use as a result of using e-cigarettes and any potential harm-reduction benefits e-cigarettes might bring to current combustible cigarette smokers.
Collapse
Affiliation(s)
- Robert McMillen
- 1 Julius B Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA.,2 Social Science Research Center, Mississippi State University, Starkville, MS, USA
| | - Jonathan D Klein
- 1 Julius B Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA.,3 Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - Karen Wilson
- 1 Julius B Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA.,4 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan P Winickoff
- 1 Julius B Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA.,5 Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Susanne Tanski
- 1 Julius B Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA.,6 Cancer Risk Behaviors Group, Norris Cotton Cancer Center, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| |
Collapse
|
134
|
Gammon DG, Rogers T, Coats EM, Nonnemaker JM, Marynak KL, Kuiper NM, King BA. National and state patterns of concept-flavoured cigar sales, USA, 2012-2016. Tob Control 2019; 28:394-400. [PMID: 30068564 PMCID: PMC10938265 DOI: 10.1136/tobaccocontrol-2018-054348] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cigar sales have increased in the USA in recent years. A growing proportion of cigar sales are of flavoured varieties, many bearing ambiguous or 'concept' flavour descriptions (eg, Jazz). This study assessed US cigar sales by flavour category (ie, concept flavoured, characterising flavoured and tobacco), at national, regional and state levels. METHODS Sales of cigarillos, large cigars and little cigars from chain, franchise and convenience stores, mass merchandisers, supermarkets, drug, dollar and club stores, and military commissaries during 2012-2016 were acquired from the Nielsen Company. US national-level and state-level sales, including District of Columbia, were analysed by flavour category. Flavour descriptors were classified as 'tobacco', 'characterising' or 'concept', based on Universal Product Code (UPC)-linked characteristics and brand website and consumer review descriptions. RESULTS Cigar sales increased by 29% during 2012-2016, driven by a 78% increase in cigarillo sales. The proportion of concept-flavoured sales increased from 9% to 15%, while the proportion of sales decreased for tobacco (50% to 49%) and characterising flavours (eg, cherry) (41% to 36%). Cigarillos had the greatest increase in unique concept flavour descriptions (17 to 46 unique UPCs), with most sales occurring among Sweet, Jazz and Green Sweets concept flavours. By US region, total and concept-flavoured cigarillo sales were highest in the South. CONCLUSIONS Flavoured cigars are increasingly labelled with concept flavours, including in areas with flavoured tobacco sales restrictions. Cigarillos are driving recent increases in US cigar and concept-flavoured cigar sales. It is important to consider concept flavours when addressing flavoured tobacco product sales and use.
Collapse
Affiliation(s)
- Doris G Gammon
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Todd Rogers
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Ellen M Coats
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - James M Nonnemaker
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Kristy L Marynak
- Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Nicole M Kuiper
- Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| |
Collapse
|
135
|
McKelvey K, Baiocchi M, Lazaro A, Ramamurthi D, Halpern-Felsher B. A cigarette pack by any other color: Youth perceptions mostly align with tobacco industry-ascribed meanings. Prev Med Rep 2019; 14:100830. [PMID: 30815339 PMCID: PMC6378849 DOI: 10.1016/j.pmedr.2019.100830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/08/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022] Open
Abstract
•Youth interpret cigarette pack-colors in line with industry-intended associations.•Product-packaging restrictions may be circumvented by use of colors that misrepresent product harms.•43.2% of participants attributed extra strong to the black cigarette pack.•35.6% of participants ascribed rich to gold.•31.1% of participants ascribed menthol to green.
Collapse
Affiliation(s)
- Karma McKelvey
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, United States of America
| | - Mike Baiocchi
- Stanford Prevention Research Center, Stanford University, United States of America
| | - Adrienne Lazaro
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, United States of America
| | - Divya Ramamurthi
- Stanford Research into the Impact of Tobacco Advertising, Stanford University, United States of America
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, United States of America
| |
Collapse
|
136
|
Abstract
PURPOSE OF THE REVIEW The purpose of this review is to describe current trends in e-cigarette use, provide an overview of the potential health risks and benefits, and discuss tobacco policy and regulatory considerations. RECENT FINDINGS E-cigarette use is popular among youth and adults, despite limited evidence about the long-term risks or benefits. Internationally there is wide variability in how e-cigarettes are classified, which has also led to large differences in regulations on these products. Regulatory policies that strike a balance between the potential benefit of these devices for adult smokers who are trying to quit smoking with reducing the appeal and addictive potential for youth are critically needed. SUMMARY Continued research on the health effects and consequences of e-cigarette use will be essential to inform e-cigarette product standards and tobacco regulatory policies as scientific research strives to keep pace with the ever-changing landscape of e-cigarette technology.
Collapse
Affiliation(s)
- Krysten W. Bold
- Yale University School of Medicine, 34 Park Street CMHC, New Haven, CT 06519
| | | |
Collapse
|
137
|
Abstract
OBJECTIVES This study examines the relationships between flavored tobacco use and single, dual, and poly tobacco product use, among adolescents. Given the increased use of flavored tobacco products, it is vital to understand if flavored products are associated with dual and poly tobacco product use. METHODS Data were obtained from the 2017 National Youth Tobacco Survey. Participants were 2042 adolescent past 30-day tobacco users. Multivariable multinomial logistic regression models were used to assess the relationship between flavored tobacco use and past 30-day single, dual, and poly (three or more) tobacco product use. Two analyses were conducted using different categories as referent groups to allow for a comprehensive examination of the relationship between all groups. Covariates included sex, grade level, race/ethnicity and exposure to tobacco marketing. RESULTS Approximately half of all adolescent tobacco users (45.7%) reported use of more than one product. The majority of adolescent tobacco users reported using flavors (69.4%). Flavored tobacco use was significantly correlated with a greater risk of dual (RRR: 2.09) and poly (RRR: 5.54) tobacco use, relative to single product use, controlling for covariates. Similarly, flavored tobacco use was significantly correlated with a greater risk of poly (RRR: 2.66) tobacco use, relative to dual tobacco use, controlling for covariates. CONCLUSIONS A positive relationship was observed for flavored tobacco use and multiple tobacco product use. Findings suggest the need to consider stronger regulations of flavored tobacco products. Similarly, as most adolescent tobacco users reported using flavors, findings suggest the need to emphasize flavored tobacco use in prevention and education programs.
Collapse
|
138
|
Goldenson NI, Leventhal AM, Simpson KA, Barrington-Trimis JL. A Review of the Use and Appeal of Flavored Electronic Cigarettes. CURRENT ADDICTION REPORTS 2019; 6:98-113. [PMID: 31453046 PMCID: PMC6709993 DOI: 10.1007/s40429-019-00244-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW E-cigarettes are available in a variety of flavors not found in traditional tobacco products (i.e., "nontraditional flavors"), which is a commonly-cited reason for e-cigarette use. This review examines the prevalence of nontraditional-flavored e-cigarette use, mechanisms through which flavorings enhance product appeal, use of nontraditional-flavored e-cigarettes for smoking cessation, and differences in these findings between youth and adults. RECENT FINDINGS Nontraditional-flavored e-cigarettes are used at e-cigarette initiation by the majority of youth. These flavors enhance the appeal of e-cigarettes by creating sensory perceptions of sweetness and coolness and masking the aversive taste of nicotine. Use of nontraditional-flavored e-cigarettes is higher among youth and young adults (vs. older adults) and among nonsmokers (vs. combustible cigarette smokers). SUMMARY Nontraditional-flavored e-cigarettes are popular among youth, but may be less common among older adults and combustible cigarette smokers. Further research is needed to determine whether use of e-cigarettes in nontraditional flavors affects smoking cessation.
Collapse
Affiliation(s)
- Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Kelsey A. Simpson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | | |
Collapse
|
139
|
Mantey DS, Omega-Njemnobi O, Montgomery L. WITHDRAWN: Flavored Tobacco Use is Associated with Dual and Poly Tobacco Use among Adolescents. Addict Behav 2019; 92:84-88. [PMID: 30597335 DOI: 10.1016/j.addbeh.2018.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
|
140
|
Soule EK, Sakuma KLK, Palafox S, Pokhrel P, Herzog TA, Thompson N, Fagan P. Content analysis of internet marketing strategies used to promote flavored electronic cigarettes. Addict Behav 2019; 91:128-135. [PMID: 30606627 DOI: 10.1016/j.addbeh.2018.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/23/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Flavored e-cigarette (ECIG) use and Internet marketing have increased in the U.S. This study examined the content used to promote flavored ECIG liquids on retailer websites. METHODS Four ECIG liquid retailers from four U.S. geographic regions (n = 16) were randomly selected. Menthol, apple, and tobacco flavored liquids were purchased in April of 2016 (n = 144, 48 unique flavors). Staff analyzed the text and image descriptors displayed on liquid bottles and retailer websites and coded content for presence of specific flavor, taste/smell, chemesthesis (i.e., touch), America/patriotic, and product quality/potentially modified risk content. A follow-up of retailer websites was conducted in March 2018. RESULTS Nearly all (97.9%) ECIG liquids included a description that promoted flavor. Most descriptions including images of something other than an ECIG liquid bottle (e.g., 62% of tobacco ECIG liquid images included dried tobacco leaves, 43% of menthol ECIG liquid images included mint leaves or ice, 62% of apple ECIG liquid images included an apple). Images often promoted product sensations (e.g., cool, ice), sweet tastes of other products (e.g., chocolate, apple pie), or other appeals (e.g., America). Menthol and apple descriptions/images were more likely than tobacco descriptions/images to promote appeals related to chemesthesis (e.g., cool, warm, moist; p < .05). Most flavors were still available in 2018 and included the same flavor descriptions from 2016. CONCLUSIONS Flavored ECIG liquid marketing often includes text descriptions and images that appeal to consumer sensations. Studies are needed to examine how access to point-of-sale Internet advertisements influences attitudes, perceptions, and purchasing of ECIG products, especially among at-risk populations such as youth.
Collapse
Affiliation(s)
- Eric K Soule
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA.
| | - Kari-Lyn K Sakuma
- College of Public Health and Human Sciences, School of Social and Behavioral Sciences, Oregon State University, Corvallis, OR, USA
| | - Sherilyn Palafox
- Cancer Prevention and Control Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Pallav Pokhrel
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Thaddeus A Herzog
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Noel Thompson
- Department of Biostatistics, Fay W. Boozman College of Public Health, Center for the Study of Tobacco, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pebbles Fagan
- Department Health Behavior and Health Education, Fay W. Boozman College of Public Health, Center for the Study of Tobacco, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
141
|
McKelvey K, Baiocchi M, Ramamurthi D, McLaughlin S, Halpern-Felsher B. Youth say ads for flavored e-liquids are for them. Addict Behav 2019; 91:164-170. [PMID: 30314868 DOI: 10.1016/j.addbeh.2018.08.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/10/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION E-cigarettes are the most popular tobacco product among adolescents and young adults ("AYA") and are available in many flavors. The e-cigarette industry argues that flavors are not meant to appeal to youth, yet no study has asked youth what age group they think ads for flavored e-liquids are targeting. We asked AYA which age group they thought ads for flavored e-liquids targeted. METHODS In 2016 as part of a larger survey, a random sample of 255 youth from across California (62.4% female, mean age = 17.5, SD = 1.7) viewed eight ads, presented in randomized order, for fruit-, dessert-, alcohol-, and coffee-flavored e-liquids and indicated the age group they thought the ads targeted: younger, same age, a little older, or much older than them. Population means and 95% confidence intervals were estimated using bootstrapping (100,000 replicate samples). RESULTS Most participants (93.7%) indicated the cupcake man flavor ad targeted an audience of people younger than they. Over half felt ads for smoothy (68.2%), cherry (63.9%), vanilla cupcake (58%), and caramel cappuccino (50.4%) targeted their age and for no flavor ad did most feel the primary target age group was much older. CONCLUSIONS Youth believe ads for flavored e-liquids target individuals about their age, not older adults. Findings support the need to regulate flavored e-liquids and associated ads to reduce youth appeal, which ultimately could reduce youth use of e-cigarettes.
Collapse
Affiliation(s)
- Karma McKelvey
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mike Baiocchi
- Stanford Prevention Research Center, Stanford University, Palo Alto, CA, USA
| | - Divya Ramamurthi
- Stanford Research into the Impact of Tobacco Advertising, Stanford University, Palo Alto, CA, USA
| | - Sheila McLaughlin
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| |
Collapse
|
142
|
From Apple to Werewolf: A content analysis of marketing for e-liquids on Instagram. Addict Behav 2019; 91:119-127. [PMID: 30253933 DOI: 10.1016/j.addbeh.2018.09.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/05/2018] [Accepted: 09/07/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION With the growing popularity of refillable e-cigarettes and recent FDA regulatory action on e-liquid warning labels, e-liquids are an increasingly important area of study. At present, however, little is known about how e-liquids are marketed. This study examined e-liquid marketing on the visual social media platform Instagram, on which users have created significant amounts of e-cigarette related content. METHODS A systematic, random sample of Instagram posts with either #eliquid or #ejuice was collected from the Instagram API during one week in May 2017 and in October 2017 using the Netlytic application. A final sample of 1000 posts was analyzed using qualitative content analysis to discern e-liquid themes, claims, promotions, and products promoted. RESULTS Of the 1000 posts, 61.1% promoted e-liquid. These posts were most frequently made by vape shops and ambassadors/representatives. Almost 80% of promotional posts featured a flavored e-liquid. Posts focused largely on e-liquids tasting good (35.4%) or being cool/edgy (19.0%). Many posts made use of Instagram's visual nature to share creative label designs. Just over a third of posts made some claim about e-liquid benefits or quality, with smokeless tobacco claims being most common. Although posts most commonly originated from the United States, posts made from Indonesia and the United Kingdom were also common. CONCLUSIONS E-liquid marketing on Instagram emphasizes positive experiences, personalization, and aspirational identities rather than explicit health and cessation claims. Appeal to youth is a significant concern based both on marketing strategies and the demographics of Instagram users.
Collapse
|
143
|
McKelvey K, Halpern-Felsher B. From tobacco-endgame strategizing to Red Queen's race: The case of non-combustible tobacco products. Addict Behav 2019; 91:1-4. [PMID: 30642577 PMCID: PMC6541479 DOI: 10.1016/j.addbeh.2019.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Karma McKelvey
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, 770 Welch Rd., Suite 100, Palo Alto, CA 94304, United States.
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, 770 Welch Rd., Suite 100, Palo Alto, CA 94304, United States.
| |
Collapse
|
144
|
Prochaska JJ. The public health consequences of e-cigarettes: a review by the National Academies of Sciences. A call for more research, a need for regulatory action. Addiction 2019; 114:587-589. [PMID: 30347473 DOI: 10.1111/add.14478] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 11/30/2022]
|
145
|
Owens VL, Ha T, Soulakova JN. Widespread use of flavored e-cigarettes and hookah tobacco in the United States. Prev Med Rep 2019; 14:100854. [PMID: 30976489 PMCID: PMC6441788 DOI: 10.1016/j.pmedr.2019.100854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022] Open
Abstract
In 2009, the U.S. Food and Drug Administration banned the sale of flavored cigarettes (excluding menthol) in the U.S. However, the sale of flavored e-cigarettes (FE) and flavored hookah tobacco (FHT) is still legal. In this study (conducted in the US in the period from October 2018 to February 2019), we estimated the prevalence of use of FE and FHT across users' sociodemographic characteristics (e.g., age, sex, race/ethnicity) and identified the key characteristics of tobacco users associated with use of FE and FHT. We analyzed the 2014–2015 Tobacco Use Supplement to the Current Population Survey data for current e-cigarette (n = 3691) and hookah tobacco (n = 658) users. Among e-cigarette users, 65.5% used FE; and among hookah tobacco users, 87.3% used FHT. Among e-cigarette users, the prevalence of use of FE was significantly higher for 18–24 year-old than 45+ year-old adults; women than men; Southern than Northeastern residents; and never smokers of regular cigarettes than current smokers of regular cigarettes (all adjusted p's < 0.05). Among hookah tobacco users, the rates of FHT use were significantly higher for women than men, and never smokers of regular cigarettes than current smokers (all adjusted p's < 0.05). Because availability and accessibility of flavored tobacco products may promote tobacco use, revising regulatory guidelines concerning manufacturing and distribution of FE and FHT may help reduce the popularity of emerging tobacco products. Implications Among users of emerging tobacco products such as e-cigarettes and hookah tobacco, use of flavored products is very common. Among e-cigarette users, 66% consumed flavored e-cigarettes; and among users of hookah tobacco, 87% consumed flavored hookah tobacco. Use of flavored products was especially common among users who were young adults, women, or never and former smokers of regular cigarettes. Availability of emerging tobacco products in many different flavors could be a reason for tobacco use initiation and continued use of tobacco after cessation of regular-cigarette smoking.
Collapse
Affiliation(s)
- Victoria L Owens
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
| | - Trung Ha
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
| | - Julia N Soulakova
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
| |
Collapse
|
146
|
Soneji SS, Knutzen KE, Villanti AC. Use of Flavored E-Cigarettes Among Adolescents, Young Adults, and Older Adults: Findings From the Population Assessment for Tobacco and Health Study. Public Health Rep 2019; 134:282-292. [PMID: 30857471 DOI: 10.1177/0033354919830967] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The use of flavored electronic cigarettes (e-cigarettes) is common among e-cigarette users, but little is known about the potential harms of flavorings, the extent to which the concurrent use of multiple flavor types occurs, and the correlates of flavor type use. The objective of this study was to assess the types of e-cigarette flavors used by adolescent (aged 12-17), young adult (aged 18-24), and older adult (aged ≥25) e-cigarette users. METHODS We assessed the prevalence of flavored e-cigarette use within the past month by flavor types and concurrent use of multiple flavor types among past-month e-cigarette users sampled during Wave 2 (2014-2015) of the Population Assessment for Tobacco and Health Study among 414 adolescents, 961 young adults, and 1711 older adults. We used weighted logistic regression models for the use of fruit-, candy-, mint/menthol-, tobacco-, or other-flavored e-cigarettes and concurrent use of multiple flavor types. Covariates included demographic characteristics, e-cigarette use frequency, cigarette smoking status, current use of other tobacco products, and reasons for e-cigarette use. RESULTS The leading e-cigarette flavor types among adolescents were fruit, candy, and other flavors; among young adults were fruit, candy, and mint/menthol; and among older adults were tobacco or other flavors, fruit, and mint/menthol. Compared with older adults, adolescents and young adults were more likely to use fruit-flavored e-cigarettes (adjusted odds ratio [aOR] = 3.35; 95% confidence interval [CI], 2.56-4.38; and aOR = 2.31; 95% CI, 1.77-3.01, respectively) and candy-flavored e-cigarettes (aOR = 3.81; 95% CI, 2.74-5.28; and aOR = 2.95; 95% CI, 2.29-3.80, respectively) and concurrently use multiple flavor types (aOR = 4.58; 95% CI, 3.39-6.17; and aOR = 2.28; 95% CI, 1.78-2.91, respectively). CONCLUSIONS Regulation of sweet e-cigarette flavors (eg, fruit and candy) may help reduce the use of e-cigarettes among young persons without substantially burdening adult e-cigarette users.
Collapse
Affiliation(s)
- Samir S Soneji
- 1 Dartmouth Geisel School of Medicine, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,2 Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Kristin E Knutzen
- 2 Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Andrea C Villanti
- 3 Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| |
Collapse
|
147
|
Jawad M, Cheeseman H, Brose LS. Waterpipe tobacco smoking prevalence among young people in Great Britain, 2013-2016. Eur J Public Health 2019; 28:548-552. [PMID: 29272388 DOI: 10.1093/eurpub/ckx223] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background One percent of adults in Great Britain use waterpipe tobacco at least monthly, however national epidemiological evidence among young people is absent. This study aims to assess waterpipe tobacco prevalence and correlates among young people in Great Britain. Methods Data were analyzed from online surveys conducted annually from 2013 to 2016 with weighted national samples of 11 to 18-year olds in Great Britain (annual n = 1936-2059). Primary outcome measures were at least monthly waterpipe tobacco use and lifetime waterpipe tobacco use. Binary logistic regression models tested the association between these outcomes and age, sex, country of residence and other tobacco consumption. Results Between 2013 and 2016, 1.7% (95% CI 1.5-2.1%) used waterpipe tobacco at least monthly and 9.9% (95% CI 9.2-10.7%) used waterpipe in their lifetime. There were no changes in prevalence over time. At least monthly use was associated with older age groups [16-18 years vs. 11-15 years, adjusted odds ratio (AOR) 2.63, 95% CI 1.55-4.46], male sex (AOR 1.82, 95% CI 1.23-2.71) and other tobacco consumption (e.g. lifetime cigarette use AOR 10.30, 95% CI 5.22-20.29). Lifetime use had similar correlates, but was not associated with male sex (AOR 0.97, 95% CI 0.80-1.17). Conclusions One in 10 young people in Great Britain have tried waterpipe tobacco, though more frequent use appears low. We found no evidence of increasing or decreasing prevalence of waterpipe use between 2013 and 2016. Being male, older and a concurrent user of other tobacco products were correlated with waterpipe tobacco use.
Collapse
Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, Hammersmith, London, UK
| | | | - Leonie S Brose
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| |
Collapse
|
148
|
Rice VH, Templin TN, Harden JK, Jenuwine ES, Abdulhamid I, Hammad A. Health Effects Reported by Adolescent Water Pipe and/or Cigarette Smokers Compared to Nonsmokers. J Adolesc Health 2019; 64:333-339. [PMID: 30409754 DOI: 10.1016/j.jadohealth.2018.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the prevalence of respiratory and/or physical fitness health problems in adolescent (ages 18-21) water pipe (WP) smokers (with or without cigarette smoking), cigarette-only smokers, and nonsmokers. METHODS A comparative four-group study design was used to recruit a non-probability sample of 153 WP smokers only, 103 cigarette smokers only, and 102 cigarette+WP smokers along with 296 nonsmokers. Our hypothesis was that youth who smoked WPs and/or cigarettes would report more respiratory problems and/or poorer physical fitness than those who did not smoke. RESULTS The results showed that coughs were significantly associated with smoking in all three of the smoking groups (p < .05). Cigarette-only smokers reported the most adverse outcomes with more wheezing, difficulty breathing, and less ability to exercise without shortness of breath. A dose-response analysis showed similar patterns of adverse health effects for both WP and cigarette smokers. The combined use of both products was not appreciably worse than smoking one product alone. This could be due to cigarette+WP smokers' reporting using less of the respective products when only one product was smoked. CONCLUSIONS Even during the adolescent years, WP and/or cigarette smoking youth experienced reportable negative health effects.
Collapse
Affiliation(s)
| | | | - Janet K Harden
- Wayne State University College of Nursing, Detroit, Michigan
| | | | - Ibrahim Abdulhamid
- Wayne State University College of Nursing, Detroit, Michigan; Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
| | - Adnan Hammad
- Arab Community Center for Economic & Social Services, Dearborn, Michigan
| |
Collapse
|
149
|
Dai H. Changes in Flavored Tobacco Product Use Among Current Youth Tobacco Users in the United States, 2014-2017. JAMA Pediatr 2019; 173:282-284. [PMID: 30615022 PMCID: PMC6396867 DOI: 10.1001/jamapediatrics.2018.4595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines the recent changes in self-reported flavored tobacco product use among youth tobacco users between 2014 and 2017.
Collapse
Affiliation(s)
- Hongying Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha
| |
Collapse
|
150
|
Chen-Sankey JC, Kong G, Choi K. Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users. PLoS One 2019; 14:e0212353. [PMID: 30811486 PMCID: PMC6392261 DOI: 10.1371/journal.pone.0212353] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is an increased need to understand how e-cigarette flavors may contribute to e-cigarette uptake and use among youth. We examined the relationship between perceived ease of flavored e-cigarette use and e-cigarette use susceptibility and progression among a nationally representative sample of U.S. youth never tobacco users. METHODS The wave 1 (2013-2014) and wave 2 (2014-2015) surveys of PATH Study were used. Youth never tobacco users (ages 12-17) who reported whether flavored e-cigarettes were easier to use than unflavored e-cigarettes at wave 1 (n = 6,983) were included in the study. Multivariable logistic regressions were used to examine the associations between perceived ease of using flavored e-cigarettes (wave 1) and e-cigarette use outcomes including e-cigarette use susceptibility (wave 1) and e-cigarette initiation and past-30-day use (wave 2). RESULTS Overall, 21.2% of the sample perceived flavored e-cigarettes easier to use than unflavored e-cigarettes; and 28.9% of the sample were susceptible to using e-cigarettes at wave 1, and 7.5% and 2.0% initiated e-cigarettes and used e-cigarettes in the past 30 days at wave 2, respectively. Among those who perceived flavored e-cigarettes easier to use, 41.0% were susceptible to using e-cigarettes at wave 1, and 10.6% and 3.4% initiated and used e-cigarettes in the past 30 days at wave 2, respectively. Perceiving flavored e-cigarettes as easier to use than unflavored e-cigarettes at wave 1 was positively associated with e-cigarette use susceptibility at wave 1 (AOR = 1.43, CI = 1.21, 1.69), and e-cigarette initiation (AOR = 1.32, CI = 1.12, 1.67) and past-30-day use (AOR = 1.25, CI = 1.10, 2.47) at wave 2. CONCLUSIONS Perceiving flavored e-cigarettes as easier to use than unflavored e-cigarettes may lead to e-cigarette use progression among youth never tobacco users. Determining the factors (including e-cigarette marketing and specific e-cigarette flavors) that lead to perceived ease of using flavored e-cigarettes would inform efforts to prevent and curb youth e-cigarette use.
Collapse
Affiliation(s)
- Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States of America
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States of America
| |
Collapse
|