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Carlsson S, Andersson T, Araghi M, Galanti R, Lager A, Lundberg M, Nilsson P, Norberg M, Pedersen NL, Trolle-Lagerros Y, Magnusson C. Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts. J Intern Med 2017; 281:398-406. [PMID: 28164394 DOI: 10.1111/joim.12592] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Smoking and nicotine exposure increase insulin resistance and the risk of type 2 diabetes. Swedish smokeless tobacco (snus) is high in nicotine, and its use is prevalent in Scandinavian countries, but few studies have investigated snus use in relation to diabetes risk. OBJECTIVE To explore the association between snus use and risk of type 2 diabetes using pooled data from five cohorts. METHODS Analyses were based on prospective studies conducted between 1990 and 2013 including 54 531 never-smoking men and 2441 incident cases of type 2 diabetes identified through screening, self-reporting and hospital and prescription registries. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed and adjusted for age, body mass index, educational level, alcohol consumption and physical activity. RESULTS Compared to never users, the HR of type 2 diabetes was 1.15 (95% CI: 1.00-1.32) in current users of snus. In individuals consuming 5-6 boxes per week, the HR was 1.42 (95% CI: 1.07-1.87); in those consuming ≥7 boxes per week, the HR was 1.68 (95% CI: 1.17-2.41). Each additional box of snus consumed per week yielded an HR of 1.08 (95% CI: 1.01-1.16). CONCLUSION Our findings indicate that high consumption of snus is a risk factor for type 2 diabetes. The risk was similar to that in smokers, implying that smokers will not reduce their risk of type 2 diabetes by changing to snus use. The results also support the notion that nicotine increases the risk of type 2 diabetes.
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Affiliation(s)
- S Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - M Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - R Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - A Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - M Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - P Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Norberg
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - N L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - C Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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102
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Schoren C, Hummel K, de Vries H. Electronic cigarette use: comparing smokers, vapers, and dual users on characteristics and motivational factors. Tob Prev Cessat 2017; 3:8. [PMID: 32432183 PMCID: PMC7232819 DOI: 10.18332/tpc/69392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 02/13/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study examined vaping behaviour, precursors of vaping, and motivational differences between smokers, dual users and vapers. The objectives were to assess a) vaping characteristics and reasons for use, b) differences in motivational factors and behavioural precursors associated with e-cigarette use, and c) socio-demographic and motivational factors associated with electronic cigarette use. METHODS A cross-sectional survey among 259 vapers, 135 smokers, and 83 dual users was conducted in the Netherlands. The questionnaire, based on the I-Change Model, assessed demographics, smoking and vaping behaviour, quit attempt, attitudes towards e-cigarettes, social influences, self-efficacy about not to vape and intention to quit. RESULTS Vaping e-cigarettes was mostly started for health reasons. Less than 2% of the vapers had never used conventional cigarettes. Vapers reported most advantages of e-cigarettes whereas smokers were least convinced of them, encountered more modelling of vaping in their social environment and reported higher self-efficacy to control vaping. Older respondents and respondents with low levels of education and low income were more likely to use e-cigarettes instead of conventional cigarettes. CONCLUSIONS Although vaping was mostly started for health reasons, the use of the product was not strictly limited to (former) smokers. Health communication for non-smokers is needed to stress potential dangers. Both vapers and non-vapers encounter barriers for using e-cigarettes in difficult situations. If e-cigarettes are used as a smoking cessation tool, more information is needed to help users cope with these situations. For future interventions we recommend to take potential motivational differences among low and high income and educated groups into account.
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103
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Mohammed KA, Geneus CJ, Yadgir S, Subramaniam DS, Burroughs TE. Correlates of Hookah Pipe Awareness and Perceived Harmfulness Among U.S. Adults. Am J Prev Med 2017; 52:513-518. [PMID: 27989450 DOI: 10.1016/j.amepre.2016.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/10/2016] [Accepted: 10/25/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Hookah smoking has recently become a common form of smoking, and its prevalence has increased worldwide. This study determined the prevalence and correlates of hookah awareness and perceived harmfulness among U.S. adults. METHODS Weighted multivariable logistic regression analyses were performed on 6,711 adults aged ≥18 years collected from the 2013-2014 Health Information National Trends Survey (Cycles 3 and 4). Analysis was conducted in 2016. RESULTS Overall, 74.3% were aware of hookah. Of these, 73.4% believed hookah pipes were equally harmful as cigarettes whereas 15.7% believed otherwise. Older (OR=0.13, 95% CI=0.09, 0.18), black (OR=0.51, 95% CI=0.38, 0.71), Hispanic (OR=0.52, 95% CI=0.37, 0.71), and less-educated (OR=0.42, 95% CI=0.27, 0.65) respondents had lower odds of being aware of hookah. Compared with non-smokers, former smokers had 83% (95% CI=1.44, 2.33) higher odds of hookah awareness. Among those aware of hookah, older (OR=0.44, 95% CI=0.31, 0.62), black (OR=0.64, 95% CI=0.43, 0.96), and less-educated (OR=0.55, 95% CI=0.33, 0.92) respondents had lower odds of perceiving hookah as less harmful than cigarettes. CONCLUSIONS Most adults in U.S. are aware of hookah, but only 15.7% believe it is less harmful than cigarettes. This small proportion are mostly young, white, and college graduates. Targeted behavioral interventions will be necessary to increase individuals' perceived risk, knowledge, and perceived harmfulness of hookah smoking.
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Affiliation(s)
- Kahee A Mohammed
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, Missouri.
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Simon Yadgir
- Saint Louis University College of Public Health and Social Justice, St. Louis, Missouri
| | - Divya S Subramaniam
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, Missouri
| | - Thomas E Burroughs
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, Missouri
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104
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Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci 2017; 1394:5-30. [PMID: 26774031 PMCID: PMC4947026 DOI: 10.1111/nyas.12977] [Citation(s) in RCA: 230] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
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Affiliation(s)
| | - Eric Soule
- Virginia Commonwealth University, Richmond, Virgina
| | - Alexa Lopez
- Virginia Commonwealth University, Richmond, Virgina
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105
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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106
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Levy DT, Borland R, Villanti AC, Niaura R, Yuan Z, Zhang Y, Meza R, Holford TR, Fong GT, Cummings KM, Abrams DB. The Application of a Decision-Theoretic Model to Estimate the Public Health Impact of Vaporized Nicotine Product Initiation in the United States. Nicotine Tob Res 2017; 19:149-159. [PMID: 27613952 PMCID: PMC5234365 DOI: 10.1093/ntr/ntw158] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/09/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The public health impact of vaporized nicotine products (VNPs) such as e-cigarettes is unknown at this time. VNP uptake may encourage or deflect progression to cigarette smoking in those who would not have otherwise smoked, thereby undermining or accelerating reductions in smoking prevalence seen in recent years. METHODS The public health impact of VNP use are modeled in terms of how it alters smoking patterns among those who would have otherwise smoked cigarettes and among those who would not have otherwise smoked cigarettes in the absence of VNPs. The model incorporates transitions from trial to established VNP use, transitions to exclusive VNP and dual use, and the effects of cessation at later ages. Public health impact on deaths and life years lost is estimated for a recent birth cohort incorporating evidence-informed parameter estimates. RESULTS Based on current use patterns and conservative assumptions, we project a reduction of 21% in smoking-attributable deaths and of 20% in life years lost as a result of VNP use by the 1997 US birth cohort compared to a scenario without VNPs. In sensitivity analysis, health gains from VNP use are especially sensitive to VNP risks and VNP use rates among those likely to smoke cigarettes. CONCLUSIONS Under most plausible scenarios, VNP use generally has a positive public health impact. However, very high VNP use rates could result in net harms. More accurate projections of VNP impacts will require better longitudinal measures of transitions into and out of VNP, cigarette and dual use. IMPLICATIONS Previous models of VNP use do not incorporate whether youth and young adults initiating VNP would have been likely to have been a smoker in the absence of VNPs. This study provides a decision-theoretic model of VNP use in a young cohort that incorporates tendencies toward smoking and shows that, under most plausible scenarios, VNP use yields public health gains. The model makes explicit the type of surveillance information needed to better estimate the effect of new products and thereby inform public policy.
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Affiliation(s)
- David T. Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Ron Borland
- VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Andrea C. Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC
| | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC
| | - Zhe Yuan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Yian Zhang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | | | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - David B. Abrams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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107
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Levy DT, Cummings KM, Villanti AC, Niaura R, Abrams DB, Fong GT, Borland R. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction 2017; 112:8-17. [PMID: 27109256 PMCID: PMC5079857 DOI: 10.1111/add.13394] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/19/2015] [Accepted: 03/03/2016] [Indexed: 12/18/2022]
Abstract
The use of vaporized nicotine products (VNPs), especially e-cigarettes and, to a lesser extent, pressurized aerosol nicotine products and heat-not-burn tobacco products, are being adopted increasingly as an alternative to smoking combusted products, primarily cigarettes. Considerable controversy has accompanied their marketing and use. We propose a framework that describes and incorporates patterns of VNP and combustible cigarette use in determining the total amount of toxic exposure effects on population health. We begin by considering toxicity and the outcomes relevant to population health. We then present the framework and define different measures of VNP use; namely, trial and long-term use for exclusive cigarette smokers, exclusive VNP and dual (cigarette and VNP) use. Using a systems thinking framework and decision theory we considered potential pathways for current, former and never users of VNPs. We then consider the evidence to date and the probable impacts of VNP use on public health, the potential effects of different policy approaches and the possible influence of the tobacco industry on VNP and cigarette use.
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Affiliation(s)
- David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ray Niaura
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David B Abrams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ron Borland
- Nigel Gray Distinguished Fellow in Cancer Prevention, The Cancer Council Victoria, Melbourne, Victoria, Australia
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108
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Johnson AC, Mays D, Hawkins KB, Denzel M, Tercyak KP. A Qualitative Study of Adolescent Perceptions of Electronic Cigarettes and Their Marketing: Implications for Prevention and Policy. CHILDRENS HEALTH CARE 2016; 46:379-392. [PMID: 30899129 DOI: 10.1080/02739615.2016.1227937] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study examined youths' perceptions of electronic cigarettes ("e-cigarettes"), sources of e-cigarettes exposure, and preferred sources of e-cigarette health information. Participants (n = 25, M age 15.0 years) recruited during primary care visits completed an in-depth qualitative interview assessing these topics. Most participants (72%) perceived e-cigarettes as "healthier" than cigarettes and reported e-cigarette advertising exposure (80%) and interpersonal exposure (60%). Participants reported advertisements portray e-cigarettes as less harmful than cigarettes and novel products. Most (72%) indicated their doctor was their preferred source of e-cigarette health information, suggesting pediatric health care providers are well-positioned to counsel patients to prevent e-cigarette use.
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Affiliation(s)
- Andrea C Johnson
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, USA 20007
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, USA 20007
| | - Kirsten B Hawkins
- Department of Pediatrics, Georgetown University Medical Center, 4200 Wisconsin Avenue, NW, Washington, DC, USA, 20016
| | - Molly Denzel
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, USA 20007
| | - Kenneth P Tercyak
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, USA 20007.,Department of Pediatrics, Georgetown University Medical Center, 4200 Wisconsin Avenue, NW, Washington, DC, USA, 20016
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109
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Patel D, Davis KC, Cox S, Bradfield B, King BA, Shafer P, Caraballo R, Bunnell R. Reasons for current E-cigarette use among U.S. adults. Prev Med 2016; 93:14-20. [PMID: 27612572 PMCID: PMC5316292 DOI: 10.1016/j.ypmed.2016.09.011] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/05/2016] [Accepted: 09/05/2016] [Indexed: 12/23/2022]
Abstract
E-cigarette use has increased rapidly among U.S. adults. However, reasons for use among adults are unclear. We assessed reasons for e-cigarette use among a national sample of U.S. adults. Data were collected via online surveys among U.S. adults aged 18 or older from April through June 2014. Descriptive and multivariate regression analyses were conducted to assess reasons for e-cigarette use among 2448 current e-cigarette users, by sociodemographic characteristics and product type. Assessed reasons included cessation/health, consideration of others, convenience, cost, curiosity, flavoring, and simulation of conventional cigarettes. Among current e-cigarette users, 93% were also current cigarette smokers. The most common reasons for e-cigarette use were cessation/health (84.5%), consideration of others (71.5%), and convenience (56.7%). The prevalence of citing convenience (adjusted prevalence ratio [aPR]=1.49) and curiosity (aPR=1.54) as reasons for e-cigarette use were greater among current cigarette smokers than nonsmokers (P<0.05). The prevalence of citing flavoring as a reason for use was greater among adults aged 18 to 24 (aPR=2.02) than 55 or older (P<0.05). Tank use was associated with greater prevalence of citing every assessed reason except convenience and curiosity. Cessation- and health-related factors are primary reasons cited for e-cigarette use among adults, and flavorings are more commonly cited by younger adults. Efforts are warranted to provide consumers with accurate information on the health effects of e-cigarettes and to ensure that flavoring and other unregulated features do not promote nicotine addiction, particularly among young adults.
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Affiliation(s)
- Deesha Patel
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Kevin C Davis
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC, United States
| | - Shanna Cox
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brian Bradfield
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC, United States
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul Shafer
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC, United States; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ralph Caraballo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Rebecca Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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110
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Burris JL, Wahlquist AE, Alberg AJ, Cummings KM, Gray KM, Garrett-Mayer E, Carpenter MJ. A longitudinal, naturalistic study of U.S. smokers' trial and adoption of snus. Addict Behav 2016; 63:82-8. [PMID: 27450153 DOI: 10.1016/j.addbeh.2016.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 01/07/2023]
Abstract
To refine public health policy amidst a changing landscape of tobacco products in the United States, it is first necessary to describe fully the nature of smokers' alternative product use. Little research addresses smokers' snus use, and most studies are limited by small samples, cross-sectional designs, and crude outcome measurement. This study sample includes 626 adult US smokers who denied intention to quit in the next month and were randomized to receive free snus during a 6-week sampling period, after which no snus was provided. Participants were then followed for one year. Outcome data were collected via phone. Participants (mean age: 48.7years) were predominately female, White non-Hispanic. Eighty-four percent reported trial of snus. Eleven percent reported purchase (i.e., adoption). Current use declined from 47.1% at the end of the sampling period to 6.5% at the end of follow-up. Frequency and quantity of snus use among current users was low. Among snus users, 79.3% said it functioned as an alternative to smoking and 58.4% said it provided a means of coping with smoking restrictions; options not mutually exclusive. In logistic regressions, men were more likely to report trial (odds ratio [OR]=2.33, p<0.01) and adoption (OR=1.84, p<0.05) than women. Baseline expectations about the nature of snus use also predicted snus outcomes (OR=1.28-1.78, p<0.05). Smokers showed willingness to try snus, but product interest waned over time. Snus as currently marketed is unlikely to play a prominent role in US tobacco control efforts.
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Affiliation(s)
- Jessica L Burris
- University of Kentucky, Department of Psychology and Markey Cancer Center, 206 Combs Cancer Research Building, Lexington, KY 40536, USA.
| | - Amy E Wahlquist
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 135 Cannon St., Room 302E, Charleston, SC 29425, USA.
| | - Anthony J Alberg
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
| | - K Michael Cummings
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA; Medical University of South Carolina, Department of Psychiatry and Behavioral Science and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
| | - Kevin M Gray
- Medical University of South Carolina, Department of Psychiatry and Behavioral Science, 125 Doughty St., Charleston, SC 29425, USA.
| | - Elizabeth Garrett-Mayer
- Medical University of South Carolina, Department of Public Health Sciences and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
| | - Matthew J Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Science and Hollings Cancer Center, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
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111
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Lam CN, Goldenson NI, Burner E, Unger JB. Cultural buffering as a protective factor against electronic cigarette use among Hispanic emergency department patients. Addict Behav 2016; 63:155-60. [PMID: 27513593 DOI: 10.1016/j.addbeh.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/21/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hispanics in the U.S. historically use tobacco at lower rates than other racial and ethnic groups. Cultural buffering, the process by which aspects of traditional Hispanic culture delay the adoption of unhealthy behaviors, is believed to be a protective factor against tobacco use. Electronic cigarettes (e-cigarettes) are a new tobacco product that have not been extensively studied, and it is unknown if cultural factors that protect against tobacco use will buffer against e-cigarette use among the Hispanic population. METHODS This cross-sectional study was conducted at the emergency department (ED) in a safety-net hospital in 2014. Patients visiting the ED participated in a survey assessing demographics and substance use. Cultural buffering was operationalized as participants' primary language spoken at home. Multivariate logistic regression and generalized estimating equations examined the association between Hispanic cultural buffering and e-cigarette ever-use. RESULTS Of the 1476 Hispanic ED patients (age: 46.6M±14.5SD, 49.3% male), 7.6% reported e-cigarette ever-use and 11.1% reported current combustible cigarette use. In adjusted models, Spanish speakers were half as likely to report e-cigarette ever-use (O.R.: 0.54, 95% C.I.: 0.34-0.84, p=0.007), compared with English speakers. Combustible cigarette use remained the most significant factor associated with e-cigarette ever-use (O.R.: 9.28, 95% C.I.:7.44-11.56, p<0.001). In higher-income neighborhoods, English speakers reported e-cigarette ever-use at higher rates than Spanish speakers (28.2% vs. 5.9%, p<0.001). CONCLUSIONS Cultural buffering was protective against e-cigarette ever-use, especially in higher-income neighborhoods. These results support research on culturally-sensitive prevention programs for new and emerging tobacco products in Hispanic communities.
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Affiliation(s)
- Chun Nok Lam
- Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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112
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Xu Y, Guo Y, Liu K, Liu Z, Wang X. E-Cigarette Awareness, Use, and Harm Perception among Adults: A Meta-Analysis of Observational Studies. PLoS One 2016; 11:e0165938. [PMID: 27861501 PMCID: PMC5115669 DOI: 10.1371/journal.pone.0165938] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study is to systematically review the published literature on the awareness, previous and current use, and harm perceptions of electronic cigarettes (e-cigarettes) among adults. METHODS A search of the most current literature using the PubMed and Scopus database to identify articles published since 2003 yielded a total of 28 relevant articles. RESULTS The pooled prevalence of awareness, previous use, current use of e-cigarettes and perceived healthier of e-cigarettes than regular cigarettes (healthier perception) among adults were 61.2% (95% confidence interval (CI): 51.5-70.8%), 16.8% (95% CI: 14.0-19.6%), 11.1% (95% CI: 9.2-13.1%), and 52.6% (95% CI: 42.5-62.6%), respectively, using a random effects model. The subgroup analysis showed that pooled estimates were highest in the group of current smokers of regular cigarettes, except that the highest pooled rate of current use was seen in the group of former smokers of regular cigarettes (the corresponding rates were 71.9% (95% CI: 57.5-86.3%), 27.2% (95% CI: 18.8-35.6%), 16.8% (95% CI: 7.2-26.3%), and 63.1% (95% CI: 52.1-74.1%)), and the lowest pooled rates were in the group of non-smokers, except for the rate of healthier perception in the users of e-cigarettes (and the corresponding rates were 46.8% (95% CI: 26.8-66.8%), 2.5% (95% CI: 1.1-5.6%), 1.2% (95% CI: 0.4-2.1%), and 37.9% (95% CI: -0.5-76.3%)). The cumulative meta-analysis found that awareness increased over time, while the prevalence of previous use, current use, and healthier perception first experienced an increase followed by a decrease and remained stable thereafter. CONCLUSIONS E-cigarette awareness has been increasing, and e-cigarette use and perceived health risks are nearly invariable between 2009 and 2014. Given the substantial heterogeneity in the prevalence rate estimates, there is a need for more accurate and comparable prevalence estimates for e-cigarettes across the world.
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Affiliation(s)
- Ying Xu
- Department of Chronic non-communicable disease prevention and control, Baoan Chronic Diseases Prevent and Cure Hospital, Shenzhen, China
| | - Yanfang Guo
- Department of Chronic non-communicable disease prevention and control, Baoan Chronic Diseases Prevent and Cure Hospital, Shenzhen, China
| | - Kaiqian Liu
- Department of Chronic non-communicable disease prevention and control, Baoan Chronic Diseases Prevent and Cure Hospital, Shenzhen, China
| | - Zheng Liu
- Department of Chronic non-communicable disease prevention and control, Baoan Chronic Diseases Prevent and Cure Hospital, Shenzhen, China
| | - Xiaobo Wang
- Department of Nutrition, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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113
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Amato MS, Boyle RG, Levy D. E-cigarette use 1 year later in a population-based prospective cohort. Tob Control 2016; 26:e92-e96. [PMID: 27807298 DOI: 10.1136/tobaccocontrol-2016-053177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/11/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Population prevalence estimates of electronic nicotine delivery system (ENDS) use range considerably based on the operational definition of 'use'. Recently, we investigated the utility of 'use frequency' for restricting prevalence estimates to non-experimenters in adult populations. Results suggested that individuals reporting use on ≤5 days in the past 30 were likely to discontinue use, and should be excluded from estimates of population prevalence. OBJECTIVE This study investigated the predictive validity of ENDS use frequency as a measure for likelihood of continued use, and cigarette smoking abstinence. METHODS We recontacted smokers and recent quitters who participated in the random digit dial 2014 Minnesota Adult Tobacco Survey. At ∼1 year follow-up, we reassessed ENDS use and cigarette smoking among N=601 respondents. RESULTS Fewer than half of respondents who reported using ENDSs on 1-5 days in the past 30 at baseline reported any ENDS use 1 year later (27%, 95% CI (18% to 40%)). Conversely, more than half of respondents who reported daily use at baseline also reported subsequent use at follow-up (89%, 95% CI (78% to 100%)). The likelihood of subsequent ENDS use by respondents using ENDSs on more than 5 days but less than daily did not significantly differ from chance (37%, 95% CI (22% to 61%)). CONCLUSIONS For adult population surveillance surveys, defining current use prevalence as 'any use in the past 30 days' includes many individuals who can be expected to discontinue use within 1 year. Until measures of ENDS use become standardised, researchers should choose definitions carefully because different definitions are likely to yield different results.
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Affiliation(s)
- Michael S Amato
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC, USA.,ClearWay Minnesota, Minneapolis, Minnesota, USA
| | | | - David Levy
- Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
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Cherng ST, Tam J, Christine P, Meza R. Modeling the Effects of E-cigarettes on Smoking Behavior: Implications for Future Adult Smoking Prevalence. Epidemiology 2016; 27:819-26. [PMID: 27093020 PMCID: PMC5039081 DOI: 10.1097/ede.0000000000000497] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use has increased rapidly in recent years. Given the unknown effects of e-cigarette use on cigarette smoking behaviors, e-cigarette regulation has become the subject of considerable controversy. In the absence of longitudinal data documenting the long-term effects of e-cigarette use on smoking behavior and population smoking outcomes, computational models can guide future empirical research and provide insights into the possible effects of e-cigarette use on smoking prevalence over time. METHODS Agent-based model examining hypothetical scenarios of e-cigarette use by smoking status and e-cigarette effects on smoking initiation and smoking cessation. RESULTS If e-cigarettes increase individual-level smoking cessation probabilities by 20%, the model estimates a 6% reduction in smoking prevalence by 2060 compared with baseline model (no effects) outcomes. In contrast, e-cigarette use prevalence among never smokers would have to rise dramatically from current estimates, with e-cigarettes increasing smoking initiation by more than 200% relative to baseline model estimates to achieve a corresponding 6% increase in smoking prevalence by 2060. CONCLUSIONS Based on current knowledge of the patterns of e-cigarette use by smoking status and the heavy concentration of e-cigarette use among current smokers, the simulated effects of e-cigarettes on smoking cessation generate substantially larger changes to smoking prevalence compared with their effects on smoking initiation.
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Affiliation(s)
- Sarah T. Cherng
- Department of Epidemiology, University of Michigan School of Public Health
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health
| | - Jamie Tam
- Department of Health Management and Policy, University of Michigan School of Public Health
| | - Paul Christine
- Department of Epidemiology, University of Michigan School of Public Health
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health
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115
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Cooper M, Creamer MR, Ly C, Crook B, Harrell MB, Perry CL. Social Norms, Perceptions and Dual/Poly Tobacco Use among Texas Youth. Am J Health Behav 2016; 40:761-770. [PMID: 27779944 DOI: 10.5993/ajhb.40.6.8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We assessed risk perceptions and social norms about tobacco use across adolescent non-users of tobacco, single- product users, and dual/poly-product users. METHODS Use behaviors specific to e-cigarettes, cigarettes, hookah, cigars, and smokeless tobacco were assessed among 6th, 8th and 10th grade students (sample [n] = 3907 from a population of [N] = 461,069 students). Multivariate regression was used to examine differences in these factors across use categories, adjusted for demographic factors. RESULTS Results highlight differences between non-users and single- or dual/poly-product users for most tobacco products. Dual/poly-product users differed from single-product users most notably in their higher perceived use of tobacco products by close friends and dating partners, and a higher proportion of single-product users reported most products were not harmful and not addictive compared to non-users. Few differences were seen between dual/poly-product users and single-product users in their perceptions of harm and addictiveness. CONCLUSIONS Findings demonstrate the importance of proximal social influences (ie, close friends and dating partners) for adolescent dual/poly-tobacco product users. Understanding similarities and differences in risk factors between these adolescent groups can guide effective public health prevention and treatment programs.
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Affiliation(s)
- Maria Cooper
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX;,
| | - MeLisa R. Creamer
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Christina Ly
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Brittani Crook
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
| | - Cheryl L. Perry
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX
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Webb Hooper M, Kolar SK. Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13101009. [PMID: 27754449 PMCID: PMC5086748 DOI: 10.3390/ijerph13101009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/17/2016] [Accepted: 09/29/2016] [Indexed: 01/20/2023]
Abstract
The prevalence of e-cigarette use is increasing, yet few studies have focused on its use in racial/ethnic minority populations. We examined associations between race/ethnicity and e-cigarette use, plans to continue using e-cigarettes, and reasons for use among current/former smokers. Participants (285 in total; 29% non-Hispanic White, 42% African American/Black, and 29% Hispanic) were recruited between June and November 2014. Telephone-administered surveys assessed demographics, cigarette smoking, e-cigarette use, plans to continue using, and reasons for use. Analyses of covariance (ANCOVAs) and multivariable logistic regressions were conducted. African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001). However, African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01). African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48). White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02). In conclusion, racial/ethnic differences in e-cigarette use, intentions, and reasons for use emerged in our study. African American ever users may be particularly vulnerable to maintaining their use, particularly to try to quit smoking. These findings have implications for cigarette smoking and e-cigarette dual use, continued e-cigarette use, and potentially for smoking-related disparities.
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Affiliation(s)
- Monica Webb Hooper
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33146, USA.
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA.
| | - Stephanie K Kolar
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33146, USA.
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Abstract
With passage of the 2009 Family Smoking Prevention and Tobacco Control Act, the FDA has authority to regulate tobacco advertising. As bans on traditional advertising venues and promotion of tobacco products have grown, a greater emphasis has been placed on brand exposure and price promotion in displays of products at the point-of-sale (POS). POS marketing seeks to influence attitudes and behavior towards tobacco products using a variety of explicit and implicit messaging approaches. Behavioral laboratory methods have the potential to provide the FDA with a strong scientific base for regulatory actions and a model for testing future manipulations of POS advertisements. We review aspects of POS marketing that potentially influence smoking behavior, including branding, price promotions, health claims, the marketing of emerging tobacco products, and tobacco counter-advertising. We conceptualize how POS marketing potentially influence individual attention, memory, implicit attitudes, and smoking behavior. Finally, we describe specific behavioral laboratory methods that can be adapted to measure the impact of POS marketing on these domains.
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118
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Zhuang YL, Cummins SE, Sun JY, Zhu SH. Long-term e-cigarette use and smoking cessation: a longitudinal study with US population. Tob Control 2016; 25:i90-i95. [PMID: 27697953 PMCID: PMC5099206 DOI: 10.1136/tobaccocontrol-2016-053096] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/03/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND E-cigarettes have grown popular. The most common pattern is dual use with conventional cigarettes. Dual use has raised concerns that it might delay quitting of cigarette smoking. This study examined the relationship between long-term use of e-cigarettes and smoking cessation in a 2-year period. METHODS A nationally representative sample of 2028 US smokers were surveyed in 2012 and 2014. Long-term e-cigarette use was defined as using e-cigarettes at baseline and follow-up. Use of e-cigarettes only at baseline or at follow-up was defined as short-term use. Non-users did not use e-cigarettes at either survey. Quit attempt rates and cessation rates (abstinent for 3 months or longer) were compared across the three groups. RESULTS At 2-year follow-up, 43.7% of baseline dual users were still using e-cigarettes. Long-term e-cigarette users had a higher quit attempt rate than short-term or non-users (72.6% vs 53.8% and 45.5%, respectively), and a higher cessation rate (42.4% vs 14.2% and 15.6%, respectively). The difference in cessation rate between long-term users and non-users remained significant after adjusting for baseline variables, OR=4.1 (95% CI 1.5 to 11.4) as did the difference between long-term users and short-term users, OR=4.8 (95% CI 1.6 to 13.9). The difference in cessation rate between short-term users and non-users was not significant, OR=0.9 (95% CI 0.5 to 1.4). Among those making a quit attempt, use of e-cigarettes as a cessation aid surpassed that of FDA-approved pharmacotherapy. CONCLUSIONS Short-term e-cigarette use was not associated with a lower rate of smoking cessation. Long-term use of e-cigarettes was associated with a higher rate of quitting smoking.
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Affiliation(s)
- Yue-Lin Zhuang
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Sharon E Cummins
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Jessica Y Sun
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Shu-Hong Zhu
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
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119
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Shi Y, Cummins SE, Zhu SH. Use of electronic cigarettes in smoke-free environments. Tob Control 2016; 26:e19-e22. [PMID: 27609779 DOI: 10.1136/tobaccocontrol-2016-053118] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/17/2016] [Accepted: 08/23/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although most US states prohibit cigarette smoking in public places and worksites, fewer jurisdictions regulate indoor use of electronic cigarettes (e-cigarettes). Given the dramatic increase in e-cigarette use and concern about its impact on non-users, there is a need to examine the use of e-cigarettes in smoke-free environments and related attitudes and perceptions. METHODS Recruited from a nationally representative adult panel (GfK's KnowledgePanel), 952 current users of e-cigarettes completed a cross-sectional online survey in 2014. Multivariate logistic regressions were conducted to examine the factors associated with ever using e-cigarettes in smoke-free environments. RESULTS Overall, 59.5% of e-cigarette users had vaped where cigarette smoking was not allowed. Young adults (18-29 years) were most likely to do so, 74.2%. The places of first-time use most often mentioned were service venues (bar, restaurant, lounge and club), 30.7%, followed by worksites, 23.5%. Daily e-cigarette users were more likely to have vaped in smoke-free environments than non-daily users (OR=2.08, p=0.012). Only 2.5% of those who used e-cigarettes in smoke-free environments reported negative reactions from other people. Most e-cigarette users did not think e-cigarettes are harmful to themselves or to by-standers, and thus should not be banned where smoking is; those who had used e-cigarettes where smoking is banned were even more likely to hold these views. CONCLUSIONS E-cigarette use in smoke-free environments was common, suggesting that most e-cigarette users do not consider smoke-free laws to apply to e-cigarettes. Explicit laws should be considered if jurisdictions want to prohibit e-cigarette use in public places.
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Affiliation(s)
- Yuyan Shi
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Sharon E Cummins
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA.,Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA.,Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California, USA
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120
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Knowledge and beliefs about electronic cigarettes among quitline cessation staff. Addict Behav 2016; 60:78-83. [PMID: 27100472 DOI: 10.1016/j.addbeh.2016.03.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Smokers are asking health practitioners for guidance about using e-cigarettes as an aid to quitting. Several studies have surveyed physicians. However, in North America many smokers seek help from telephone quitlines rather than physicians. The objective of the current study was to assess quitline counselors' perceptions of e-cigarettes and what they tell callers about these products. METHODS An online cross-sectional survey, conducted in 2014 with 418 quitline counselors in the U.S. and Canada, measured perceptions of e-cigarettes: (1) use as a quitting aid; (2) safety; (3) professional guidance given and organizational guidance received; (4) regulation. The response rate was 90.1%. Analyses included calculating standard errors and 95% confidence intervals around summary statistics. RESULTS Nearly 70% of counselors believed that e-cigarettes are not effective quitting aids. Most believed e-cigarettes are addictive (87%) and that secondhand exposure to vapor is harmful (71%). Counselors reported that callers ask for advice about e-cigarettes, but few counselors recommended e-cigarettes (4%). Counselors (97%) reported being instructed by quitline employers to explain to clients that e-cigarettes are not FDA-approved; 74% were told to recommend approved quitting aids instead. Most counselors (>87%) believed e-cigarettes should be regulated like cigarettes in terms of advertising, taxation, access by minors, and use in public places. CONCLUSIONS Quitline counselors view e-cigarettes as ineffective quitting aids, potentially dangerous, and in need of greater regulations. Counselors can influence how treatment seekers view e-cigarettes, therefore it is imperative that quitlines stay abreast of emerging data and communicate about these products in ways that best serve clients.
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121
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Bauhoff S, Montero A, Scharf D. Perceptions of e-cigarettes: a comparison of adult smokers and non-smokers in a Mechanical Turk sample. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:311-323. [PMID: 27712126 DOI: 10.1080/00952990.2016.1207654] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Given plans to extend its regulatory authority to e-cigarettes, the Food and Drug Administration (FDA) urgently needs to understand how e-cigarettes are perceived by the public. OBJECTIVES To examine how smoking status impacts adult perceptions and expectations of e-cigarettes. METHODS We used Mechanical Turk (MTurk), a "crowdsourcing" platform, to rapidly survey a large (n = 796; female = 381; male = 415), diverse sample of adult ever (44%) and never smokers (56%), including ever (28%) and never (72%) users of e-cigarettes. RESULTS Smokers and non-smokers learned about e-cigarettes primarily through the internet and conversations with others. Ever smokers were more likely than never smokers, and female current smokers were more likely than female former smokers, to have learned about e-cigarettes from point of sale advertising (p's < 0.05) and to believe that e-cigarettes help smokers quit (ps < 0.05). Among never users of e-cigarettes, current smokers were more likely than never smokers and former smokers to report that they would try e-cigarettes in the future (ps < 0.01). Current smokers' top reason for wanting to try e-cigarettes was to quit or reduce smoking (56%), while never and former smokers listed curiosity. In contrast, female current smokers' top reason for not trying e-cigarettes was health and safety concerns (44%) while males were deterred by expense (44%). CONCLUSIONS Adult smokers and non-smokers have different perceptions and expectations of e-cigarettes. Public health messages regarding e-cigarettes may need to be tailored separately for persons with and without a history of using conventional cigarettes. Tailoring messages by gender within smoker groups may also improve their impact.
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Affiliation(s)
| | - Adrian Montero
- b Center for Economic and Social Research , University of Southern California , Los Angeles , CA , USA
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122
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Social Interactions as a Source of Information about E-Cigarettes: A Study of U.S. Adult Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080788. [PMID: 27527199 PMCID: PMC4997474 DOI: 10.3390/ijerph13080788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/14/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022]
Abstract
The novelty of e-cigarettes and ambiguity about their effects may foster informal sharing of information, such as through social interactions. We aimed to describe smokers' social interactions about e-cigarettes and their recommendations that others use e-cigarettes. Data were collected from 2149 adult smokers in North Carolina and California who participated in a study of the impact of pictorial cigarette pack warnings. In the previous month, almost half of participants (45%) reported talking to at least one person about e-cigarettes and nearly a third of participants (27%) recommended e-cigarettes to someone else. Smokers recommended e-cigarettes to cut back on smoking (57%), to quit smoking (48%), for health reasons (36%), and for fun (27%). In adjusted analyses, more frequent e-cigarette use, positive views about typical e-cigarette users, and attempting to quit smoking in the past month were associated with recommending e-cigarettes for health reasons (all p < 0.05). Social interactions appear to be a popular method of information-sharing about e-cigarettes among smokers. Health communication campaigns may help to fill in the gaps of smokers' understanding of e-cigarettes and their long-term effects.
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123
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Pratt SI, Sargent J, Daniels L, Santos MM, Brunette M. Appeal of electronic cigarettes in smokers with serious mental illness. Addict Behav 2016; 59:30-4. [PMID: 27043170 DOI: 10.1016/j.addbeh.2016.03.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Up to 75% of people with serious mental illness (SMI) smoke, and most are highly dependent on nicotine, consuming more cigarettes per day than smokers without mental illness. Even with evidence-based treatment, relapses are common, resulting in high morbidity and early mortality from tobacco-related diseases. Electronic cigarettes (e-cigarettes) are theoretically safer because they deliver no tar or carbon monoxide; however, their appeal is largely untested in people with SMI. METHODS We enrolled 21 chronic smokers with SMI who had failed a quit attempt and were not engaged in cessation treatment. Research staff provided e-cigarettes and instructions on how to use them, and assessed participants weekly for 4weeks. RESULTS Of the enrolled participants, 19 completed weekly assessments. From baseline to the final study visit, mean self-reported use of combustible tobacco declined from 192 to 67cigarettes/week (t=3.62, df=17, p=0.005), confirmed by reduction in breath carbon monoxide from 27ppm to 15ppm (t=3.246, df=18, p=0.004). Use of e-cigarettes did not escalate over the 4weeks. Temporary and mild side effects, including dry/sore throat, nausea, dizziness, and cough, were reported by 58% of participants. End of trial ratings of enjoyment, satisfaction compared to regular cigarettes, and willingness to buy e-cigarettes were high (ranging from 3.82-4.51 on a 5-point scale). CONCLUSIONS Results of this study suggest that people with SMI may find e-cigarettes an appealing substitute for combustible cigarettes. We found no evidence of increasing nicotine dependence. Further randomized studies are needed to better assess e-cigarette appeal and toxicity.
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
| | - James Sargent
- Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Luke Daniels
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Meghan M Santos
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Mary Brunette
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Pénzes M, Foley KL, Balázs P, Urbán R. Intention to Experiment With E-Cigarettes in a Cross-Sectional Survey of Undergraduate University Students in Hungary. Subst Use Misuse 2016; 51:1083-92. [PMID: 27159776 PMCID: PMC5024343 DOI: 10.3109/10826084.2016.1160116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Electronic cigarettes are often used to promote cessation. Only a few studies have explored the motivations for e-cigarette experimentation among young adults. OBJECTIVES The goals of this study were to assess the intention to try e-cigarettes among Hungarian university students and to develop a motivational scale to measure vulnerability to e-cigarette experimentation. METHODS 826 Hungarian university students completed an internet-based survey in 2013 to measure motives for trying e-cigarettes. We conducted exploratory factor analyses and identified factors that promote and deter experimentation. Logistic regression analysis was performed to test the concurrent predictive validity of the identified motivational factors and we used these factors to predict e-cigarette experimentation, controlling for other known correlates of e-cigarette use. RESULTS 24.9% of the participants have ever tried an e-cigarette and 17.2% of current nonsmokers experimented with the product. Almost 11% of respondents intended to try an e-cigarette in the future, yet only 0.6% were current e-cigarette users. Six factors were identified in the motivational scale for experimentation, four that promote usage (health benefits/smoking cessation; curiosity/taste variety; perceived social norms; convenience when smoking is prohibited) and two that deter usage (chemical hazard; danger of dependence). In a logistic regression analysis, the curiosity/taste factor was the only motivational factor significantly associated with the intention to try e-cigarettes in the future. CONCLUSIONS This is the first study to test a motivational scale about what motivates e-cigarettes usage among university students. Additional research is needed to better understand these factors and their influence on e-cigarette uptake.
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Affiliation(s)
- Melinda Pénzes
- a Institute of Public Health, Semmelweis University , Budapest , Hungary
| | - Kristie L Foley
- b Department of Social Sciences & Health Policy , Wake Forest University School of Medicine , Winston-Salem , North Carolina , USA
| | - Péter Balázs
- a Institute of Public Health, Semmelweis University , Budapest , Hungary
| | - Róbert Urbán
- c Department of Personality and Health Psychology , Eötvös Loránd University , Budapest , Hungary
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Clark EM, Jones CA, Williams JR, Kurti AN, Norotsky MC, Danforth CM, Dodds PS. Vaporous Marketing: Uncovering Pervasive Electronic Cigarette Advertisements on Twitter. PLoS One 2016; 11:e0157304. [PMID: 27410031 PMCID: PMC4943591 DOI: 10.1371/journal.pone.0157304] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/30/2016] [Indexed: 12/15/2022] Open
Abstract
Background Twitter has become the “wild-west” of marketing and promotional strategies for advertisement agencies. Electronic cigarettes have been heavily marketed across Twitter feeds, offering discounts, “kid-friendly” flavors, algorithmically generated false testimonials, and free samples. Methods All electronic cigarette keyword related tweets from a 10% sample of Twitter spanning January 2012 through December 2014 (approximately 850,000 total tweets) were identified and categorized as Automated or Organic by combining a keyword classification and a machine trained Human Detection algorithm. A sentiment analysis using Hedonometrics was performed on Organic tweets to quantify the change in consumer sentiments over time. Commercialized tweets were topically categorized with key phrasal pattern matching. Results The overwhelming majority (80%) of tweets were classified as automated or promotional in nature. The majority of these tweets were coded as commercialized (83.65% in 2013), up to 33% of which offered discounts or free samples and appeared on over a billion twitter feeds as impressions. The positivity of Organic (human) classified tweets has decreased over time (5.84 in 2013 to 5.77 in 2014) due to a relative increase in the negative words ‘ban’, ‘tobacco’, ‘doesn’t’, ‘drug’, ‘against’, ‘poison’, ‘tax’ and a relative decrease in the positive words like ‘haha’, ‘good’, ‘cool’. Automated tweets are more positive than organic (6.17 versus 5.84) due to a relative increase in the marketing words like ‘best’, ‘win’, ‘buy’, ‘sale’, ‘health’, ‘discount’ and a relative decrease in negative words like ‘bad’, ‘hate’, ‘stupid’, ‘don’t’. Conclusions Due to the youth presence on Twitter and the clinical uncertainty of the long term health complications of electronic cigarette consumption, the protection of public health warrants scrutiny and potential regulation of social media marketing.
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Affiliation(s)
- Eric M. Clark
- Department of Mathematics & Statistics, University of Vermont, Burlington, VT, United States of America
- Computational Story Lab, Burlington, VT, United States of America
- Complex Systems Center, University of Vermont, Burlington, VT, United States of America
- Department of Surgery, University of Vermont, Burlington, VT, United States of America
- * E-mail:
| | - Chris A. Jones
- Department of Surgery, University of Vermont, Burlington, VT, United States of America
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, United States of America
- Global Health Economics Unit of the Vermont Center for Clinical and Translational Science, University of Vermont, Burlington, VT, United States of America
| | - Jake Ryland Williams
- Computational Story Lab, Burlington, VT, United States of America
- Complex Systems Center, University of Vermont, Burlington, VT, United States of America
- University of California Berkeley, School of Information, Berkeley CA, United States of America
| | - Allison N. Kurti
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | | | - Christopher M. Danforth
- Department of Mathematics & Statistics, University of Vermont, Burlington, VT, United States of America
- Computational Story Lab, Burlington, VT, United States of America
- Complex Systems Center, University of Vermont, Burlington, VT, United States of America
| | - Peter Sheridan Dodds
- Department of Mathematics & Statistics, University of Vermont, Burlington, VT, United States of America
- Computational Story Lab, Burlington, VT, United States of America
- Complex Systems Center, University of Vermont, Burlington, VT, United States of America
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The Effect of Comparatively-Framed versus Similarity-Framed E-Cigarette and Snus Print Ads on Young Adults' Ad and Product Perceptions. TOB REGUL SCI 2016; 2:214-229. [PMID: 28042597 DOI: 10.18001/trs.2.3.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study examined the effects of comparative-framing [C-F; ads highlighting differences between the advertised product and conventional cigarettes and/or smokeless tobacco products] versus similarity-framing (S-F; ads highlighting congruence with conventional cigarettes and/or smokeless tobacco products) in e-cigarette and snus ads on young adult smokers' and non-smokers' ad- and product-related perceptions. METHODS One thousand fifty one (1,051) young adults (18-24 years; 76% women; 50% smokers) from existing consumer panels were recruited in a within-subjects quasi-experiment. Each participant viewed 4 online advertisements, varied by tobacco product type (e-cigarette or snus) and ad framing (C-F or S-F). The dependent measures for this study were ad-related (ad perceptions, ad credibility) and product-related perceptions (absolute and comparative risk perceptions, product appeal, and product use intentions). RESULTS Former and current smokers rated C-F ads as more persuasive than S-F ads, as evidenced by favorable ad perceptions and high product use intentions. Former and current smokers also rated e-cigarette ads with more favorable ad perceptions, low absolute and comparative risk perceptions, high product appeal, and high product use intentions as compared to snus ads. However, the effect sizes of the significant differences are less than.2, indicating small magnitude of difference between the study variables. CONCLUSIONS Unless FDA regulates e-cig and snus advertising, there is a potential of decreasing risk perceptions and increasing use of e-cigs among young adults. Further research on implicit/explicit comparative claims in e-cigarettes and snus advertisements that encourage risk misperceptions is recommended.
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Lund I, Scheffels J. Adolescent tobacco use practices and user profiles in a mature Swedish moist snuff (snus) market: Results from a school-based cross-sectional study. Scand J Public Health 2016; 44:646-653. [PMID: 27340188 DOI: 10.1177/1403494816656093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this work was to study the diversity of tobacco use among Norwegian adolescent tobacco users and to investigate how different user groups compared with each other in terms of lifestyle and risk correlates. Swedish moist snuff (snus) use has increased dramatically in Norway over the last few years and is now more prevalent than smoking in younger age groups. METHODS The participants were 736 15-year-old tobacco users obtained from a large school-based cross-sectional survey (response rate 73%). Leisure time activity and risk behaviour factors were extracted by principal components analysis. Associations between tobacco use, leisure activities, risk behaviours, alcohol use and sex were studied bivariately and by logistic regression. RESULTS In total, 41.5% of the tobacco users were dual users (smokers and snus users). Problem behaviour and risk-taking lifestyles were associated with tobacco use frequency and high-frequency dual use, with a low risk profile for all types of occasional users (snus, cigarettes or dual users), a medium risk profile for all types of daily single-product users, including those who occasionally used the other product (i.e. dual users) and a high-risk profile for those who used both products daily (daily dual users). CONCLUSIONS Fragmented use patterns in adolescence undermine the dichotomy often applied between smokers and snus users. For associations with lifestyle and risk correlates, use frequency and high-frequency dual use seem to be more important than the choice of product.
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Affiliation(s)
- Ingeborg Lund
- Department of Drug Policy, Norwegian Institute of Public Health, Norway
| | - Janne Scheffels
- Department of Drug Policy, Norwegian Institute of Public Health, Norway
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Franceschini N, Deng Y, Flessner MF, Eckfeldt JH, Kramer HJ, Lash JP, Lee DJ, Melamed ML, Moncrieft AE, Ricardo AC, Rosas SE, Kaplan RC, Raij L, Cai J. Smoking patterns and chronic kidney disease in US Hispanics: Hispanic Community Health Study/Study of Latinos. Nephrol Dial Transplant 2016; 31:1670-6. [PMID: 27257272 DOI: 10.1093/ndt/gfw210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/17/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Intermittent smoking is prevalent among Hispanics, but little is known about whether this smoking pattern associates with increased chronic kidney disease (CKD) risk in this population. The objective of the present study is to identify patterns of exposure associated with CKD in US Hispanics. METHODS We used cross-sectional data on 15 410 participants of the Hispanics Community Health Study/the Study of Latinos, a population-based study of individuals aged 18-74 years, recruited in 2008 to 2011 from four US field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA). Smoking exposure was obtained through a questionnaire. CKD was defined by an estimated glomerular filtration rate of <60 mL/min/1.73 m(2) or a urine albumin-to-creatinine ratio of ≥30 mg/g. RESULTS Approximately 14% of individuals were daily and 7% were intermittent smokers, and 16% were past smokers. There was a significant interaction between smoking status and pack-years of exposure (P = 0.0003). In adjusted models, there was an increased odds of CKD among daily, intermittent and past smokers by pack-years compared with never smokers. The association of intermittent smokers was significant at 10 pack-years [odds ratio (OR) = 1.38, 95% confidence intervals (CI) 1.06, 1.81], whereas for daily smokers this association was observed at 40 pack-years (OR = 1.43, 95% CI 1.09, 1.89). CONCLUSIONS Our findings of increased risk of CKD among Hispanics who are intermittent smokers support screening and smoking cessation interventions targeted to this population for the prevention of CKD. It also suggests novel mechanistic pathways for kidney toxicity that should be further explored in future studies.
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Affiliation(s)
- Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yu Deng
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael F Flessner
- National Institute of Diabetes, Digestive, and Kidney Disease, Bethesda, MD, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Holly J Kramer
- Division of Nephrology, Loyola University, Maywood, IL, USA
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sylvia E Rosas
- Joslin Diabetes Center, Harvard University, Boston, MA, USA
| | | | | | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mays D, Smith C, Johnson AC, Tercyak KP, Niaura RS. An experimental study of the effects of electronic cigarette warnings on young adult nonsmokers' perceptions and behavioral intentions. Tob Induc Dis 2016; 14:17. [PMID: 27231479 PMCID: PMC4880975 DOI: 10.1186/s12971-016-0083-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/18/2016] [Indexed: 01/24/2023] Open
Abstract
Background Electronic cigarette (“e-cigarette”) manufacturers use warning labels on their advertising that vary widely in content and the U.S. Food and Drug Administration has issued a warning label requirement for e-cigarettes. There is limited data on the effects of these warnings on e-cigarette perceptions and other potential predictors of future tobacco use behavior in populations of interest to inform future regulatory requirements. This study examined the effects of e-cigarette warnings on perceptions of e-cigarettes and cigarettes and other cognitive precursors to tobacco use among young adult non-smokers. Methods Non-smoking young adults ages 18 to 30 years (n = 436) were recruited through an internet-based crowdsourcing platform for an online experiment. Participants completed pre-exposure measures of demographics, tobacco use, and other relevant constructs and were randomized to view 1 of 9 e-cigarette stimuli in a 3 (Ad/Warning condition: Ad Only, Ad with Warning, Warning Only) x 3 (E-cigarette brand: Blu, MarkTen, Vuse) design. After viewing e-cigarette stimuli, participants reported perceptions of e-cigarettes and behavioral intentions to use e-cigarettes. Participants in the Ad Only and Ad with Warning conditions also completed a heat-mapping task assessing aspects of the ads that captured their attention. Then, participants were randomized to view cigarette ads from 1 of 3 major cigarette brands and reported perceptions of cigarettes and intentions to smoke cigarettes. Results Participants in the Warning Only condition reported significantly greater perceived harm and addictiveness of e-cigarettes and thoughts about not using e-cigarettes than the Ad Only and Ad with Warning conditions (p’s < .05). The Ad Only and Ad with Warning conditions did not differ on these outcomes. Participants in the Warning Only condition also reported the harms of e-cigarettes were closer to those of cigarettes than the Ad Only condition (p < .05), but neither differed from the Ad with Warning condition. Visual inspection of heat-mapping task data indicate warnings drew few participants’ attention. There were no significant differences across study conditions on perceptions of cigarettes or intentions to smoke. Conclusions Text-based warning messages influenced young non-smokers’ perceptions in a way that may dissuade e-cigarette use, but warnings appearing on advertisements had little impact. Electronic supplementary material The online version of this article (doi:10.1186/s12971-016-0083-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Darren Mays
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St NW Suite 4100, Washington DC, 20007 USA
| | - Clayton Smith
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St NW Suite 4100, Washington DC, 20007 USA
| | - Andrea C Johnson
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St NW Suite 4100, Washington DC, 20007 USA
| | - Kenneth P Tercyak
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St NW Suite 4100, Washington DC, 20007 USA
| | - Raymond S Niaura
- Schroeder Institute for Tobacco Research & Policy Studies, Truth Initiative, 900 G Street NW, Washington DC, 20001 USA
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Awan KH. Experimentation and correlates of electronic nicotine delivery system (electronic cigarettes) among university students - A cross sectional study. Saudi Dent J 2016; 28:91-5. [PMID: 27486295 PMCID: PMC4957264 DOI: 10.1016/j.sdentj.2015.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/23/2015] [Accepted: 12/19/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE E-cigarettes are becoming popular among youth as safe nicotine delivery systems. Many have expressed concern, however, that e-cigarettes may serve as a gateway to future smoking, given their low perceived risk, or that their use may prevent regular smokers from quitting by maintaining their nicotine addiction. The aim of this study was to assess experimentation with and correlates of e-cigarette use among university students. MATERIAL AND METHODS A cross-sectional study was carried out among 480 university students from four faculties at a university in Riyadh in August-October 2014. A modified version of the World Health Organization's Global Adult Tobacco Survey was used, and multinomial logistic regression was carried out to assess correlations with e-cigarette variables in the whole study sample and among smokers. RESULTS Almost all students, including the majority of ex-smokers (96.3%) and smokers (94.4%), reported having heard about e-cigarettes. In addition, about one-quarter of the sample (54.2% of smokers, 24.7% of ex-smokers, 6% of never smokers) had experimented with e-cigarettes at least once during their lifetime. Curiosity and peer influence were reported as the main reasons for the use of e-cigarettes. Factors found to be correlated significantly with e-cigarette use were male gender, being a traditional cigarette smoker, having friends who have tried e-cigarettes, and having a strong belief that e-cigarettes could aid smoking cessation. CONCLUSION E-cigarettes are popular among Saudi youth, especially among smokers and ex-smokers. Well-designed health education programs and regulatory interventions are required to address this issue.
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Affiliation(s)
- K H Awan
- Department of Oral Medicine & Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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131
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Knowledge about electronic cigarettes and its perception: a community survey, Egypt. Respir Res 2016; 17:58. [PMID: 27183972 PMCID: PMC4869382 DOI: 10.1186/s12931-016-0365-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 03/14/2016] [Indexed: 11/12/2022] Open
Abstract
Background Electronic cigarettes are promoted as safer products than traditional cigarettes and as smoking cessation devices. Awareness and perception are key elements for the adoption of new habits. Little is known about electronic cigarettes and public opinions towards it. This study aims to identify the prevalence of knowledge about electronic cigarettes, its perception, and use among Egyptian population. Methods An observational cross-sectional study using self-administered questionnaire in Arabic language was conducted between March and April 2015 among a sample of Egyptian population aged 15–75 years (N = 1239). We compared between respondent’s who know e-cigarettes and those who do not know it. Results More than half (57.5 %) of the respondents had heard about e-cigarettes, 51.8 % were non-smokers and nobody of them reported use of e-cigarettes. There were statistically significant differences between those who know and those who do not know e-cigarettes regarding age, educational levels and history of smoking. Among those who know e-cigarettes, 41.6 % believed that e-cigarettes help smoking cessation and 31.9 % believed it is less harmful than traditional cigarettes. Conclusions A considerable level of knowledge about e-cigarettes is found among young people aged 15–39 years. E-cigarettes were perceived as less harmful than traditional cigarettes or a smoking cessation aid. None of the respondents reported use of e-cigarettes.
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Berg CJ, Haardörfer R, Lewis M, Getachew B, Lloyd SA, Thomas SF, Lanier A, Trepanier K, Johnston T, Grimsley L, Foster B, Benson S, Smith A, Barr DB, Windle M. DECOY: Documenting Experiences with Cigarettes and Other Tobacco in Young Adults. Am J Health Behav 2016; 40:310-21. [PMID: 27103410 PMCID: PMC4903022 DOI: 10.5993/ajhb.40.3.3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We examined psychographic characteristics associated with tobacco use among Project DECOY participants. METHODS Project DECOY is a 2-year longitudinal mixed-methods study examining risk for tobacco use among 3418 young adults across 7 Georgia colleges/universities. Baseline measures included sociodemographics, tobacco use, and psychographics using the Values, Attitudes, and Lifestyle Scale. Bivariate and multivariable analyses were conducted to identify correlates of tobacco use. RESULTS Past 30-day use prevalence was: 13.3% cigarettes; 11.3% little cigars/cigarillos (LCCs); 3.6% smokeless tobacco; 10.9% e-cigarettes; and 12.2% hookah. Controlling for sociodemographics, correlates of cigarette use included greater novelty seeking (p < .001) and intellectual curiosity (p = .010) and less interest in tangible creation (p = .002) and social conservatism (p < .001). Correlates of LCC use included greater novelty seeking (p < .001) and greater fashion orientation (p = .007). Correlates of smokeless tobacco use included greater novelty seeking (p = .006) and less intellectual curiosity (p < .001). Correlates of e-cigarette use included greater novelty seeking (p < .001) and less social conservatism (p = .002). Correlates of hookah use included greater novelty seeking (p < .001), fashion orientation (p = .044), and self-focused thinking (p = .002), and less social conservatism (p < .001). CONCLUSIONS Psychographic characteristics distinguish users of different tobacco products.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael Lewis
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven A Lloyd
- Department of Psychological Science, University of North Georgia, Dahlonega, GA, USA
| | - Sarah Fretti Thomas
- Department of Exercise Physiology, Valdosta State University, Valdosta, GA, USA
| | - Angela Lanier
- Department of Kinesiology, Berry College, Mount Berry, GA, USA
| | | | - Teresa Johnston
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, USA
| | - Linda Grimsley
- Department of Nursing, Albany State University, Albany, GA, USA
| | - Bruce Foster
- Campus Life, Central Georgia Technical College, Warner Robins, GA, USA
| | | | - Alicia Smith
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Atlanta, GA, USA
| | - Dana Boyd Barr
- Department of Environmental Health, Emory University School of Public Health, Atlanta, GA, USA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Mays D, Moran MB, Levy DT, Niaura RS. The Impact of Health Warning Labels for Swedish Snus Advertisements on Young Adults' Snus Perceptions and Behavioral Intentions. Nicotine Tob Res 2016; 18:1371-5. [PMID: 26116085 PMCID: PMC5942605 DOI: 10.1093/ntr/ntv140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/16/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study examined the impact of warning labels conveying the potential harms and addictiveness of Swedish snus and the potential-reduced harms of Swedish snus among young adult nonsmokers and smokers. METHODS A convenience sample of young adults aged 18-30 residing in the United States (n = 517, 56% male, 33% smokers) participated in an online experiment. Participants completed baseline measures and were randomized to 1 of 5 experimental conditions where they viewed a Swedish snus ad with warning labels that varied by condition: (1) Control-no warning; (2) Addiction-warning conveying the addictiveness of snus; (3) Harm-warning communicating the potential harms of snus; (4) Harm Reduction-warning conveying the potential-reduced harms of snus compared with cigarettes; (5) Harm Reduction Switch-warning communicating the potential-reduced harms of snus when switching completely from cigarettes to snus. Outcomes measured included perceived harms and addictiveness of snus, thoughts about not using snus, and intentions to use snus. RESULTS Participants in the Harm Reduction and Harm Reduction Switch conditions perceived snus to be less harmful than cigarettes compared with the Control, Addiction, and Harm conditions. Nonsmokers in the Harm Reduction condition reported fewer thoughts about not using snus than nonsmokers in the Harm condition. CONCLUSIONS Warnings conveying the potential-reduced harms of Swedish snus compared with cigarettes generate perceptions that snus is less harmful than cigarettes and produce fewer thoughts about not using snus among nonsmokers. Such perceptions have been associated with snus use in prior studies.
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Affiliation(s)
- Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC;
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Raymond S Niaura
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
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Vickerman KA, Schauer GL, Malarcher AM, Zhang L, Mowery P, Nash CM. Reasons for Electronic Nicotine Delivery System use and smoking abstinence at 6 months: a descriptive study of callers to employer and health plan-sponsored quitlines. Tob Control 2016; 26:126-134. [DOI: 10.1136/tobaccocontrol-2015-052734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/15/2016] [Indexed: 11/03/2022]
Abstract
ObjectiveDescribe cigarette smoking abstinence among employer and health plan-sponsored quitline registrants who were not using Electronic Nicotine Delivery Systems (ENDS), were using ENDS to quit smoking or were using ENDS for other reasons at the time of quitline registration.MethodsWe examined 6029 quitline callers aged ≥18 years who smoked cigarettes at registration, and completed ≥1 counselling calls, baseline ENDS use questions and a 6-month follow-up survey (response rate: 52.4%). 30-day point prevalence smoking quit rates (PPQRs) were assessed at 6-month follow-up (ENDS-only users were considered quit). Data were weighted for non-response bias. Logistic regression analyses controlled for participant characteristics and programme engagement.ResultsAt registration, 13.8% of respondents used ENDS (7.9% to quit smoking, 5.9% for other reasons). 30-day PPQRs were: 55.1% for callers using ENDS to quit, 43.1% for callers using ENDS for other reasons, and 50.8% for callers not using ENDS at registration. Callers using ENDS for other reasons were less likely to quit than other groups (adjusted ORs=0.65–0.77); quit rates did not significantly differ between non-ENDS users and those using ENDS to quit. Among callers using ENDS to quit at baseline, 40% used ENDS regularly at follow-up.ConclusionsENDS users not using ENDS to quit smoking were less successful at quitting at 6-month follow-up compared with callers using ENDS to quit smoking and callers who did not use ENDS at programme registration. Incorporating reasons for ENDS use may be important for future studies examining the role of ENDS in tobacco cessation.
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135
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Wackowski OA, Bover Manderski MT, Delnevo CD, Giovenco DP, Lewis MJ. Smokers' Early E-cigarette Experiences, Reasons for Use, and Use Intentions. TOB REGUL SCI 2016; 2:133-145. [PMID: 27042688 PMCID: PMC4810443 DOI: 10.18001/trs.2.2.4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study examined the context of smokers' first e-cigarette experiences, reasons for trying e-cigarettes, not continuing their use, and future use intentions. METHODS We surveyed a nationally representative sample of 519 current cigarette smokers in the United States (classified as never, current, or former e-cigarette users/triers) in April 2014 about their e-cigarette experiences and use intentions. RESULTS Among ever e-cigarette users/triers, 43% purchased an e-cigarette on their own as their first method of trial. These respondents were more likely to have used e-cigarettes more times than those who first tried e-cigarettes from a friend. Positive perceptions about first experiences were significantly higher among current (34.5%) compared to former e-cigarette users/triers (17.9%). Few (8.7%) current e-cigarette users/triers had a negative first experience. Susceptibility to future e-cigarette use was significantly associated with e-cigarette use status, intention to quit smoking and satisfaction with first e-cigarette experience. Among those interested in e-cigarettes, 26.3% were more interested in trying an e-cigarette made by a major tobacco company and 31.8% in trying an e-cigarette that looked "similar" versus different (13.8%) than a real cigarette. CONCLUSIONS The context and perceptions of e-cigarette trial experiences, product quality, style and manufacturer may influence e-cigarette trial and use.
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Affiliation(s)
- Olivia A Wackowski
- Rutgers School of Public Health, Center for Tobacco Studies, New Brunswick, NJ
| | | | - Cristine D Delnevo
- Rutgers School of Public Health, Center for Tobacco Studies, New Brunswick, NJ
| | - Daniel P Giovenco
- Rutgers School of Public Health, Center for Tobacco Studies, New Brunswick, NJ
| | - M Jane Lewis
- Rutgers School of Public Health, Center for Tobacco Studies, New Brunswick, NJ
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136
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Berg CJ. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health 2016; 61:225-36. [PMID: 26582009 PMCID: PMC4808473 DOI: 10.1007/s00038-015-0764-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 10/29/2015] [Accepted: 11/04/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare e-cigarette flavors preferred and reasons for use and discontinued use across never, current, and former e-cigarette users and cigarette smokers. METHODS We recruited 1567 participants aged 18-34 years through Facebook ads targeting tobacco users and nonusers in August 2014 to complete an online survey. We assessed tobacco use, preferred flavors, and reasons for e-cigarette use and discontinued use. RESULTS Our sample was 49 % male, 87 % White; 56 % current cigarette smokers; and 53 % e-cigarette users. Current e-cigarette users used an average of 20.9 days in the past 30 (SD = 11.7) and 55.2 puffs/day (SD = 37.3). Compared to never and current smokers, former smokers used e-cigarettes more frequently (p's <0.001). Among users and nonusers, the most preferred was fruit flavors, and the most commonly reported reason for e-cigarette use was "they might be less harmful than cigarettes". The most endorsed reason for discontinued e-cigarette use was "using other tobacco products instead". Never, current, and former smokers had distinct reasons for e-cigarette use and discontinued use and differed in flavor preferences. CONCLUSIONS Regulating marketing and flavors may impact e-cigarette uptake by young adults.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Room 524, Atlanta, GA, 30322, USA.
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137
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Weaver SR, Majeed BA, Pechacek TF, Nyman AL, Gregory KR, Eriksen MP. Use of electronic nicotine delivery systems and other tobacco products among USA adults, 2014: results from a national survey. Int J Public Health 2016; 61:177-88. [PMID: 26560309 PMCID: PMC4819498 DOI: 10.1007/s00038-015-0761-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study assessed the awareness and use of traditional and novel tobacco products and dual use of cigarettes with electronic nicotine delivery systems (ENDS) among USA adults. METHODS Data were obtained from the 2014 Tobacco Products and Risk Perceptions Survey of a probability sample of 5717 USA adults conducted June-November, 2014. RESULTS Use of ENDS varied by demography and by cigarette and other tobacco use. Adults aged 25-34, non-heterosexual adults, and those reporting poorer health reported higher rates of current ENDS use. Current cigarette smokers had much greater odds of ENDS ever use than never smokers, with one-half of all cigarette smokers having used ENDS and 20.7 % currently using them. However, 22.0 % of current ENDS users were former cigarette smokers, and 10.0 % were never cigarette smokers. CONCLUSIONS Patterns of ENDS use are evolving rapidly and merit continued surveillance. Nearly 10 % of adult ENDS usage is among never smokers. The public health challenge is how to enhance the potential that ENDS can replace combusted tobacco products without expanding nicotine use among youth, long-term ex-smokers, and other vulnerable populations.
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Affiliation(s)
- Scott R Weaver
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA.
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Ban A Majeed
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Terry F Pechacek
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Amy L Nyman
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Kyle R Gregory
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Michael P Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA
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138
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Nelluri B, Murphy K, Mookadam F, Mookadam M. The current literature regarding the cardiovascular effects of electronic cigarettes. Future Cardiol 2016; 12:167-79. [PMID: 26916427 DOI: 10.2217/fca.15.83] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Smoking is the leading cause of preventable morbidity and mortality globally. Electronic cigarettes are marketed both as nicotine substitutes and recreational devices. The popularity of electronic cigarettes has superseded other forms of nicotine replacement therapy. They are also popular in 'never smokers'. This review summarizes the available data regarding the cardiovascular effects of electronic cigarettes. The existing literature is limited and short term with a lack of high-quality studies and adequate follow-up. The available literature suggests that electronic cigarettes have sympathomimetic effects related to nicotine exposure, however, electronic cigarettes also contain other chemicals that require further investigation. Sparse data suggest vascular injury may be another concern. Further research is needed before broad recommendations can be made.
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Affiliation(s)
- Bhargava Nelluri
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Katie Murphy
- Department of Family Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Martina Mookadam
- Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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139
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Lee DC, Crosier BS, Borodovsky JT, Sargent JD, Budney AJ. Online survey characterizing vaporizer use among cannabis users. Drug Alcohol Depend 2016; 159:227-33. [PMID: 26774946 PMCID: PMC4745650 DOI: 10.1016/j.drugalcdep.2015.12.020] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/14/2015] [Accepted: 12/20/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Along with changes in cannabis laws in the United States and other countries, new products for consuming cannabis are emerging, with unclear public health implications. Vaporizing or "vaping" cannabis is gaining popularity, but little is known about its prevalence or consequences. METHODS This study characterized the prevalence and current patterns of vaping cannabis among a large national sample of cannabis users. An online survey was distributed through Facebook ads targeting individuals with interests related to cannabis use. The sample comprised 2910 cannabis users (age: 18-90, 84% male, 74% Caucasian). RESULTS A majority (61%) endorsed lifetime prevalence of ever vaping, 37% reported vaping in the past 30 days, 20% reported vaping more than 100 lifetime days, and 12% endorsed vaping as their preferred method. Compared to those that had never vaped, vaporizer users were younger, more likely to be male, initiated cannabis at an earlier age, and were less likely to be African American. Those that preferred vaping reported it to be healthier, better tasting, produced better effects, and more satisfying. Only 14% reported a reduction in smoking cannabis since initiating vaping, and only 5% mixed cannabis with nicotine in a vaporizer. Many cannabis users report vaping cannabis, but currently only a small subset prefers vaping to smoking and reports frequent vaping. CONCLUSION Increases in availability and marketing of vaping devices, and the changing legal status of cannabis in the United States and other countries may influence patterns of use. Frequent monitoring is needed to assess the impact of changing cannabis laws and regulations.
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Affiliation(s)
- Dustin C Lee
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Benjamin S Crosier
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jacob T Borodovsky
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - James D Sargent
- C. Everett Koop Institute, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Alan J Budney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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140
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Kilibarda B, Mravcik V, Martens MS. E-cigarette use among Serbian adults: prevalence and user characteristics. Int J Public Health 2016; 61:167-75. [DOI: 10.1007/s00038-016-0787-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 12/01/2022] Open
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Abstract
OBJECTIVES Risk perception measures of tobacco products relative to cigarettes are commonly used and important to tobacco research given that they may be associated with and predict tobacco use. However, results may differ based on measures used. This study compares direct and indirect approaches to measuring e-cigarette/cigarette risk perceptions. METHODS We compared the responses of 519 current smokers on a nationally representative 2014 survey that gauged perceptions of e-cigarettes' harm relative to cigarettes in two ways: 1) a single-item direct measure of comparative harm and a two-item indirect measure (which measured perceived levels of harm from e-cigarettes and cigarettes independently in two parallel questions). RESULTS We found that 60% of smokers rated e-cigarettes "less harmful" than cigarettes when using a direct comparative risk measure versus 73% when using an indirect measure. Agreement between measure types was fair (Cohen's Kappa=0.45) and was lower for males, Blacks, older and less educated smokers. CONCLUSIONS E-cigarettes were more likely to be rated by smokers as less harmful than cigarettes when using indirect versus direct measures. Additional methodology research into this area is warranted given the importance of risk perceptions to tobacco control interventions, communications, policy-making and regulation.
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142
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Aleknaitė A, Andrijauskaitė M, Latauskienė J, Andrejevaitė V. Elektroninės cigaretės: naujas būdas mesti rūkyti ar nauja grėsmė? Acta Med Litu 2016; 23:43-53. [PMID: 28356791 PMCID: PMC4924632 DOI: 10.6001/actamedica.v23i1.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/21/2016] [Indexed: 11/27/2022] Open
Abstract
ELECTRONIC CIGARETTES A NEW WAY TO QUIT SMOKING OR A NEW THREAT? The use of e-cigarettes in adults and adolescents has increased since 2010. Most e-cigarette users are cigarette smokers. A majority of e-cigarette users perceive them to be a tool to quit or reduce smoking. E-cigarette devices consist of a cartridge containing a liquid, an atomizer (vaporization chamber with a heating element), and a battery. The user activates the atomizer, which heats the liquid and produces a vapour to inhale. Across all brands, the main components in e-cigarette liquids are propylene glycol or glycerol, in addition, nicotine and/or flavourings can be added. A variety of other compounds have also been identified. Long-term health consequences of e-cigarette use are unknown but are likely to be less than continuing to smoke conventional cigarettes. The toxicity of chronic exposure to these and other components of e-cigarettes is uncertain. The safety and efficacy of e-cigarette use for smoking cessation is unknown. Clinicians should encourage smokers seeking to quit smoking to use US Food and Drug Administration (FDA)-approved smoking cessation aids as a first choice and make sure that newer approved strategies for smoking cessation pharmacotherapy are offered. If a smoker is not willing to use these evidence-based approaches and asks about using e-cigarettes, the clinician should not discourage e-cigarette use as long as the smoker is informed about the uncertainties of the device safety and efficacy. Public health concerns regarding e-cigarettes include their potential to increase youth initiation of tobacco products and to re-normalize tobacco use in places where cigarette smoking is not acceptable. The health effects of second-hand vapour exposure are unknown. Regulation for e-cigarettes varies worldwide and is changing. Keywords: electronic cigarettes, smoking, vapour.
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Affiliation(s)
| | | | - Justė Latauskienė
- Vilniaus universiteto Medicinos fakultetas
- Vilniaus universiteto Medicinos fakulteto Vidaus ligų, šeimos medicinos ir onkologijos klinika
| | - Viktorija Andrejevaitė
- Vilniaus universiteto Medicinos fakultetas
- Vilniaus universiteto Medicinos fakulteto Vidaus ligų, šeimos medicinos ir onkologijos klinika
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143
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Piñeiro B, Correa JB, Simmons VN, Harrell PT, Menzie NS, Unrod M, Meltzer LR, Brandon TH. Gender differences in use and expectancies of e-cigarettes: Online survey results. Addict Behav 2016; 52:91-7. [PMID: 26406973 DOI: 10.1016/j.addbeh.2015.09.006] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/17/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Given the rapid increase in e-cigarette use, it is important to understand factors that may contribute to their initiation and maintenance. Because gender differences in tobacco use, product preferences, and expectancies are well established, similar gender differences may exist with e-cigarettes. The aim of this study was to identify gender differences among e-cigarette users in patterns of use, reasons for initiation and maintenance, and outcome expectancies regarding e-cigarettes. METHODS Participants (N=1815) completed an online survey from August through November, 2013. We assessed sociodemographics, smoking and e-cigarette history and use, and expectancies about e-cigarettes. RESULTS We found gender differences in type of e-cigarette used, flavors used, nicotine dosage, source of information about e-cigarettes, place of purchase, and use of e-cigarettes where smoking is prohibited. In addition, males were more likely to report initiating e-cigarette use to quit smoking due to health concerns, whereas females were more likely to report initiation based on recommendations from family and friends. Males reported higher attributions for maintenance of e-cigarette use related to positive reinforcement (enjoyment), whereas females reported higher negative reinforcement attributions (stress reduction or mood management). Males reported more positive expectancies about e-cigarettes, including taste, social facilitation, and energy, whereas women rated e-cigarettes higher for weight control. Males also reported greater addiction-related e-cigarette expectancy than females. CONCLUSIONS Many of the gender differences with e-cigarettes parallel those previously found with traditional cigarette smoking. Although effect sizes associated with these differences were small, the results may help advance research and intervention development with respect to e-cigarette initiation, maintenance and cessation.
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144
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Rass O, Pacek LR, Johnson PS, Johnson MW. Characterizing use patterns and perceptions of relative harm in dual users of electronic and tobacco cigarettes. Exp Clin Psychopharmacol 2015; 23:494-503. [PMID: 26389638 PMCID: PMC4658305 DOI: 10.1037/pha0000050] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Awareness and use of electronic cigarettes (e-cigarettes) is increasing. Questions regarding positive (e.g., smoking reduction/cessation) and negative (e.g., delay of cessation) potential public health consequences of e-cigarettes may be informed by studying dual users of e-cigarettes and tobacco cigarettes. A cross-sectional online survey assessed demographics, product use patterns, and beliefs about relative product benefits and harms among dual users (n = 350) in the United States using the website Amazon Mechanical Turk. Compared to tobacco cigarettes, e-cigarettes were used less often and were associated with lower dependence. Participants reported a 30% reduction in self-reported tobacco cigarette smoking since beginning to use e-cigarettes. Reported primary reasons for e-cigarette use were harm reduction and smoking cessation. E-cigarette use was reported as more likely in settings with smoking restrictions and when others' health could be adversely affected. Conversely, participants reported having used tobacco cigarettes more often than e-cigarettes in hedonic situations (e.g., after eating, drinking coffee or alcohol, or having sex), outdoors, or when stressed. Participants were twice as likely to report wanting to quit tobacco cigarettes compared to e-cigarettes in the next year and intended to quit tobacco cigarettes sooner. Tobacco cigarettes were described as more harmful and addictive, but also as more enjoyable than e-cigarettes. Participants provided evidence consistent with both positive and negative public health consequences of e-cigarettes, highlighting the need for experimental research, including laboratory studies and clinical trials. Policies should consider potential public health benefits of e-cigarettes, in addition to potential harms.
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Affiliation(s)
- Olga Rass
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Lauren R Pacek
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Patrick S Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Matthew W Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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145
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Huh J, Leventhal AM. Intraindividual covariation between e-cigarette and combustible cigarette use in Korean American emerging adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 30:246-51. [PMID: 26618795 DOI: 10.1037/adb0000141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Critical gaps exist in understanding the patterns and correlates of dual use of electronic cigarettes (ECs) and combustible cigarettes (CCs), particularly in ethnic minority populations. In this study, we assessed CC and EC use in the naturalistic environment using ecological momentary assessment (EMA). We hypothesized that within-subject variation in EC use (yes/no each day) would be inversely associated with within-subject variation in number of CCs consumed and craving during that same day. We also examined gender and nicotine dependence as moderators of the EC-CC and EC-craving covariations. Korean American emerging adult (KAEA; 18-25 years old) smokers (N = 78) completed 7 days of EMA. Participants completed EMA surveys throughout the day, which assessed CC craving, and end-of-day surveys, which assessed EC use and the number of CCs smoked that day. Generalized linear mixed models were used to predict day-level EC use, with number of CCs smoked and craving during that same day, gender, and nicotine dependence as predictors (n = 501). We found that within-subject variation in CC use was not associated with same-day EC use; neither was within-subject variation in craving (ps > .27). Gender moderated the relationship between craving and EC use on a given day (p = .03); only for females, on the days with higher craving, the likelihood of their EC use that day was significantly heightened. This study does not suggest that EC use is linked with lower CC smoking quantity, at least at the day level and among KAEA smokers. CC craving may play a role in dual EC-CC use for KAEA female smokers.
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Affiliation(s)
- Jimi Huh
- Department of Preventive Medicine, University of Southern California
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California
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146
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King AC, Smith LJ, Fridberg DJ, Matthews AK, McNamara PJ, Cao D. Exposure to electronic nicotine delivery systems (ENDS) visual imagery increases smoking urge and desire. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 30:106-12. [PMID: 26618797 DOI: 10.1037/adb0000123] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Use and awareness of electronic nicotine delivery systems (ENDS; also known as electronic cigarettes or e-cigarettes) has increased rapidly in recent years, particularly among young adults. As use of ENDS resembles traditional smoking in both hand-to-mouth movements and inhalation and exhalation behaviors, we determined whether exposure to e-cigarette use via video exposure would act as a cue to elicit urge and desire for a combustible cigarette. Young adult smokers (mean age of 26.3 ± 4.1 years) were randomized to view a brief video montage of advertisements depicting either e-cigarette vaping (n = 38) or bottled water drinking (n = 40). Pre- and postcue exposure assessments were conducted in a controlled laboratory setting without other smoking or vaping cues present or behaviors allowed. Primary outcomes included change from pre-exposure baseline in smoking urge (Brief Questionnaire of Smoking Urges) and desire for a combustible and e-cigarette (visual analogue scales). Results showed that relative to exposure to the bottled water video, exposure to the ENDS video significantly increased smoking urge (p < .001) as well as desire for a regular cigarette (p < .05) and an e-cigarette (p < .001). These findings provide preliminary evidence that passive exposure to video imagery of ENDS use may generalize as a condition cue and evoke urges for a combustible cigarette in young adult smokers. It remains to be determined whether such increases in urge and desire correspond to increases in actual smoking behavior.
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Affiliation(s)
- Andrea C King
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago
| | - Lia J Smith
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago
| | - Daniel J Fridberg
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago
| | | | - Patrick J McNamara
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
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147
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Villanti AC, Rath JM, Williams VF, Pearson JL, Richardson A, Abrams DB, Niaura RS, Vallone DM. Impact of Exposure to Electronic Cigarette Advertising on Susceptibility and Trial of Electronic Cigarettes and Cigarettes in US Young Adults: A Randomized Controlled Trial. Nicotine Tob Res 2015; 18:1331-9. [PMID: 26574551 DOI: 10.1093/ntr/ntv235] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/05/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This study assessed the impact of brief exposure to four electronic cigarette (e-cigarette) print advertisements (ads) on perceptions, intention, and subsequent use of e-cigarettes and cigarettes in US young adults. METHODS A randomized controlled trial was conducted in a national sample of young adults from an online panel survey in 2013. Participants were randomized to ad exposure or control. Curiosity, intentions, and perceptions regarding e-cigarettes were assessed post-exposure and e-cigarette and cigarette use at 6-month follow-up. Analyses were conducted in 2014. RESULTS Approximately 6% of young adults who had never used an e-cigarette at baseline tried an e-cigarette at 6-month follow-up, half of whom were current cigarette smokers at baseline. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette (18.3% exposed vs. 11.3% unexposed, AOR = 1.63, 95% CI = 1.18, 2.26) among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up (3.6% exposed vs. 1.2% unexposed, AOR = 2.85; 95% CI = 1.07, 7.61) among never users of cigarettes and e-cigarettes. Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users, nor cigarette use among smokers over time. Curiosity mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users. CONCLUSIONS Exposure to e-cigarette ads may enhance curiosity and limited trial of e-cigarettes in never users. Future studies are needed to examine the net effect of curiosity and trial of e-cigarettes on longer-term patterns of tobacco use. IMPLICATIONS This randomized trial provides the first evidence of the effect of e-cigarette advertising on a behavioral outcome in young adults. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up in a small number of never e-cigarette users and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes.
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Affiliation(s)
- Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
| | - Jessica M Rath
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Evaluation Science and Research, Truth Initiative, Washington, DC
| | | | - Jennifer L Pearson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda Richardson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - David B Abrams
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Raymond S Niaura
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Donna M Vallone
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Evaluation Science and Research, Truth Initiative, Washington, DC
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148
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Nonnemaker J, Kim AE, Lee YO, MacMonegle A. Quantifying how smokers value attributes of electronic cigarettes. Tob Control 2015; 25:e37-43. [PMID: 26546152 DOI: 10.1136/tobaccocontrol-2015-052511] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/20/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Rates of electronic cigarette (e-cigarette) use have increased quickly among US adults (3.3% in 2010 to 8.5% in 2013) and youth (4.5% in 2013 to 13.4% in 2014). As state and local governments consider regulatory policies, understanding what smokers believe about e-cigarettes and how they value e-cigarettes is important. METHODS Using data from a convenience sample of Florida adult smokers (N=765), we investigated the value smokers place on specific attributes of e-cigarettes (availability of flavours, effectiveness of e-cigarettes as a cessation aid, healthier alternative to regular cigarettes, ability to use e-cigarettes in public places) by asking smokers how much they would be willing to pay for e-cigarettes with and without each of these attributes. RESULTS For cigarette-only and dual users, losing the ability to use an e-cigarette as a quit aid and losing the harm reduction of an e-cigarette significantly reduced the price respondents were willing to pay for an e-cigarette. For cigarette-only users, not being able to use an e-cigarette indoors and losing flavours also significantly reduced the price respondents were willing to pay for an e-cigarette. CONCLUSION Our results suggest that smokers value multiple attributes of e-cigarettes. Our valuation measures also appear to align with smokers' beliefs about e-cigarettes.
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149
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Delnevo CD, Giovenco DP, Steinberg MB, Villanti AC, Pearson JL, Niaura RS, Abrams DB. Patterns of Electronic Cigarette Use Among Adults in the United States. Nicotine Tob Res 2015; 18:715-9. [PMID: 26525063 DOI: 10.1093/ntr/ntv237] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/05/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Amid increasing rates of electronic cigarette (e-cigarette) use in the United States, there is an urgent need to monitor patterns of use at the population level in order to inform practice, policy and regulation. This article examines how patterns of e-cigarette use among adults differ between users and nonusers of cigarettes using the most current national data. METHODS We analyzed data from the 2014 National Health Interview Survey. We estimated prevalence of ever, current, and daily e-cigarette use and examined how use patterns differed by demographic subgroups and measures of cigarette smoking status that accounted for the recent availability of e-cigarettes in the US marketplace. RESULTS Current e-cigarette use is extremely low among never cigarette smokers (0.4%) and former smokers who quit cigarettes 4 or more years ago (0.8%). Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes (AOR: 4.33 [95% CI: 3.08-6.09]). CONCLUSIONS Extremely low e-cigarette use among never-smokers and longer term former smokers suggest that e-cigarettes neither promote widespread initiation nor relapse among adults. Recognition of the heterogeneity of smokers, including the time since quitting, is critical to draw accurate conclusions about patterns of e-cigarette use at the population level and its potential for public health benefit or harm. IMPLICATIONS Data from 2014 National Health Interview Survey indicate that e-cigarettes have not been attracting adult non-smokers or promoting relapse in longer term former smokers. Moreover, the data are suggestive that some recent quitters may have done so with the assistance of e-cigarettes. Creating measures of smoking status that treat former smokers as a homogenous group is insufficient to assess the epidemiology of e-cigarette use and the potential impact on public health.
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Affiliation(s)
- Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ;
| | - Daniel P Giovenco
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - Michael B Steinberg
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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150
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A Randomized Trial of the Effect of E-cigarette TV Advertisements on Intentions to Use E-cigarettes. Am J Prev Med 2015; 49:686-693. [PMID: 26163170 DOI: 10.1016/j.amepre.2015.05.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/08/2015] [Accepted: 05/08/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Adolescents' use of electronic cigarettes (e-cigarettes) and exposure to e-cigarette TV advertising have increased in recent years, despite questions about their safety. The current study tests whether exposure to e-cigarette TV advertisements influences intentions to use e-cigarettes in the future and related attitudes. METHODS A parallel-group randomized controlled experiment was conducted and analyzed in 2014 using an online survey with a convenience sample of 3,655 U.S. adolescents aged 13-17 years who had never tried e-cigarettes. Adolescents in the treatment group viewed four e-cigarette TV advertisements. RESULTS Adolescents in the treatment group reported a greater likelihood of future e-cigarette use compared with the control group. ORs for the treatment group were 1.54 (p=0.001) for trying an e-cigarette soon; 1.43 (p=0.003) for trying an e-cigarette within the next year; and 1.29 (p=0.02) for trying an e-cigarette if a best friend offered one. Adolescents in the treatment group had higher odds of agreeing that e-cigarettes can be used in places where cigarettes are not allowed (OR=1.71, p<0.001); can be used without affecting those around you (OR=1.83, p<0.001); are a safer alternative to cigarettes (OR=1.19, p=0.01); and are less toxic (OR=1.16, p=0.03). CONCLUSIONS Exposure to e-cigarette advertising had relatively large and consistent effects across experimental outcomes. Together with the simultaneous increase in e-cigarette advertising exposure and e-cigarette use among adolescents, findings suggest that e-cigarette advertising is persuading adolescents to try this novel product. This raises concerns that continued unregulated e-cigarette advertising will contribute to potential individual- and population-level harm.
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