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Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings. Tob Control 2016. [PMID: 27633766 DOI: 10.1136/tobaccocontrol‐2016‐053223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The present study examined the influence of flavouring on the smoking and vaping behaviour of cigarette smokers asked to adopt e-cigarettes for a period of 6 weeks. METHODS Participants were 88 current male and female smokers with no intention to stop smoking, but who agreed to substitute e-cigarettes for their current cigarettes. On intake, participants were administered tests of taste and smell for e-cigarettes flavoured with tobacco, menthol, cherry and chocolate, and were given a refillable e-cigarette of their preferred flavour or a control flavour. Participants completed daily logs of cigarette and e-cigarette use and were followed each week. RESULTS Analyses over days indicated that, during the 6-week e-cigarette period, cigarette smoking rates dropped from an average of about 16 to about 7 cigarettes/day. e-Cigarette flavour had a significant effect such that the largest drop in cigarette smoking occurred among those assigned menthol e-cigarettes, and the smallest drop in smoking occurred among those assigned chocolate and cherry flavours. e-Cigarette vaping rates also differed significantly by flavour assigned, with the highest vaping rates for tobacco- and cherry-flavoured e-cigarettes, and the lowest rates for those assigned to chocolate. CONCLUSIONS The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates and that e-cigarette flavourings can moderate this effect. e-Cigarette vaping rates are also influenced by flavourings. These findings may have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of flavourings in e-cigarettes for harm reduction.
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Affiliation(s)
- Mark D Litt
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | - Cheryl Oncken
- University of Connecticut Health Center, Farmington, Connecticut, USA
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Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings. Tob Control 2016; 25:ii67-ii72. [PMID: 27633766 DOI: 10.1136/tobaccocontrol-2016-053223] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/04/2016] [Accepted: 08/12/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The present study examined the influence of flavouring on the smoking and vaping behaviour of cigarette smokers asked to adopt e-cigarettes for a period of 6 weeks. METHODS Participants were 88 current male and female smokers with no intention to stop smoking, but who agreed to substitute e-cigarettes for their current cigarettes. On intake, participants were administered tests of taste and smell for e-cigarettes flavoured with tobacco, menthol, cherry and chocolate, and were given a refillable e-cigarette of their preferred flavour or a control flavour. Participants completed daily logs of cigarette and e-cigarette use and were followed each week. RESULTS Analyses over days indicated that, during the 6-week e-cigarette period, cigarette smoking rates dropped from an average of about 16 to about 7 cigarettes/day. e-Cigarette flavour had a significant effect such that the largest drop in cigarette smoking occurred among those assigned menthol e-cigarettes, and the smallest drop in smoking occurred among those assigned chocolate and cherry flavours. e-Cigarette vaping rates also differed significantly by flavour assigned, with the highest vaping rates for tobacco- and cherry-flavoured e-cigarettes, and the lowest rates for those assigned to chocolate. CONCLUSIONS The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates and that e-cigarette flavourings can moderate this effect. e-Cigarette vaping rates are also influenced by flavourings. These findings may have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of flavourings in e-cigarettes for harm reduction.
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Affiliation(s)
- Mark D Litt
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | - Cheryl Oncken
- University of Connecticut Health Center, Farmington, Connecticut, USA
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Vanderkam P, Boussageon R, Underner M, Langbourg N, Brabant Y, Binder P, Freche B, Jaafari N. [Efficacy and security of electronic cigarette for tobacco harm reduction: Systematic review and meta-analysis]. Presse Med 2016; 45:971-985. [PMID: 27597300 DOI: 10.1016/j.lpm.2016.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/23/2016] [Accepted: 05/23/2016] [Indexed: 12/23/2022] Open
Abstract
CONTEXT Smoking is the first cause of preventable death in France and in the world. Without help, it was shown that 80 % of smokers who try to quit smoking relapse after one month with a low long-term success rate. Smoking reduction can concern smokers who did not want to quit or failed in their attempt to weaning. The final aim is to increase attractiveness of drug therapies by developing new products, such as electronic cigarettes, that can compete cigarette without reproducing its harmful effects. OBJECTIVE Assess the capacity of electronic cigarettes to reduce or stop tobacco use among regular smokers. DATA SOURCES Consultations MEDLINE and COCHRANE databases. KEYWORDS e-cigarette; electronic cigarettes; ENDD (electronic nicotine delivery system); ENDS (electronic nicotine delivery device); vaping were used. TRIAL SELECTION Randomized controlled trials (RCTs) comparing the electronic cigarette with nicotine versus placebo device. RESULTS Two randomized controlled trials were included in the quantitative analysis. The nicotine electronic cigarette users have tobacco consumption significantly decreased compared to the placebo group (RR: 1.30, 95 % CI [1.02 to 1.66]) at 6 months. Smoking cessation rate at 3 months was greater with the electronic cigarette contains nicotine (RR: 2.55, 95 % CI [1.31 to 4.98]). LIMITS The small number of RCTs included does not allow definitive conclusions about the effectiveness of electronic cigarettes, especially in the medium to long term. CONCLUSION The use of electronic cigarette with nicotine decreases tobacco consumption among regular smokers. Further studies are needed to specify electronic cigarettes safety profile and its ability to cause a reduction in consumption and a long-term cessation in smokers.
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Affiliation(s)
- Paul Vanderkam
- CHU la Milétrie, université de médecine et de pharmacie de Poitiers, unité de recherche clinique intersectorielle en psychiatrie, département de médecine générale, 86021 Poitiers, France.
| | - Rémy Boussageon
- Université de médecine et de pharmacie de Poitiers, département de médecine générale, conseil scientifique, collège national des enseignants généralistes, 86021 Poitiers, France
| | - Michel Underner
- CHU de Poitiers, unité de tabacologie, service de pneumologie, pavillon René-Beauchant, 86021 Poitiers, France
| | - Nicolas Langbourg
- Centre hospitalier Henri-Laborit, université de médecine et de pharmacie de Poitiers, unité de recherche clinique intersectorielle en psychiatrie, Poitiers, France
| | - Yann Brabant
- Université de médecine et de pharmacie de Poitiers, département de médecine générale, 86021 Poitiers, France
| | - Philippe Binder
- Université de médecine et de pharmacie de Poitiers, département de médecine générale, 86021 Poitiers, France
| | - Bernard Freche
- Université de médecine et de pharmacie de Poitiers, département de médecine générale, 86021 Poitiers, France
| | - Nematollah Jaafari
- CHU de Poitiers, centre hospitalier Henri-Laborit, université de médecine et de pharmacie de Poitiers, laboratoire de neurosciences expérimentale et clinique, groupement de recherche CNRS 3557, unité de recherche clinique intersectorielle en psychiatrie, Inserm U 1084, Inserm CIC-P 1402, Poitiers, France
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de Andrade M, Angus K, Hastings G. Teenage perceptions of electronic cigarettes in Scottish tobacco-education school interventions: co-production and innovative engagement through a pop-up radio project. Perspect Public Health 2016; 136:288-93. [PMID: 26543156 DOI: 10.1177/1757913915612109] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This article thematically analyses spontaneous responses of teenagers and explores their perceptions of electronic cigarettes (e-cigarettes) with a focus on smoking cessation from data collected for research exploring Scottish secondary school students' recall of key messages from tobacco-education interventions and any influence on perceptions and behaviours. METHODS E-cigarettes were not included in the research design as they did not feature in interventions. However, in discussions in all participating schools, e-cigarettes were raised by students unprompted by researchers. Seven of 19 publicly funded schools in the region opted to participate. Groups of 13- to 16-year-olds were purposely selected to include a range of aptitudes, non-smokers, smokers, males and females. A total of 182 pupils took part. Data were generated through three co-produced classroom radio tasks with pupils (radio quiz, sitcom, factual interviewing), delivered by a researcher and professional broadcast team. All pupils were briefly interviewed by a researcher. Activities were recorded and transcribed verbatim and the researcher discussed emerging findings with the broadcast team. Data were analysed using NVivo and transcripts making reference to e-cigarettes examined further using inductive thematic analysis. RESULTS Key themes of their impressions of e-cigarettes were easy availability and price; advertising; the products being safer or healthier, addiction and nicotine; acceptability and experiences of use; and variety of flavours. CONCLUSIONS This was a qualitative study in one region, and perception of e-cigarettes was not an a priori topic. However, it provides insights into youth perceptions of e-cigarettes. How they discerned e-cigarettes reflects their marketing environment. The relative harmlessness of nicotine, affordability of e-cigarettes, coolness of vaping, absence of second-hand harms and availability of innovative products are all key marketing features. Conflicting messages on safety, efficacy, potential 'gateway' to smoking and nicotine may be contributing to teenagers' confusion. The allure of 'youthful cool' to vaping offers no public health gain, so children should be protected from misleading promotion. Consistent tobacco-education initiatives need to account for this popular trend.
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Affiliation(s)
| | - Kathryn Angus
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Gerard Hastings
- Institute for Social Marketing, University of Stirling and the Open University, Stirling, UK; L'École des Hautes Etudes en Santé Publique, Rennes, France
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Soule EK, Lopez AA, Guy MC, Cobb CO. Reasons for using flavored liquids among electronic cigarette users: A concept mapping study. Drug Alcohol Depend 2016; 166:168-76. [PMID: 27460860 PMCID: PMC4983519 DOI: 10.1016/j.drugalcdep.2016.07.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Electronic cigarettes (ECIGs) aerosolize liquids often containing flavorants for inhalation. Few studies have examined the role of flavors in ECIG use. This study's purpose was to examine reasons for flavored ECIG use using a mixed-method approach, concept mapping (CM). METHODS Forty-six past 30-day adult ECIG users recruited from vape forums/conferences completed three online CM tasks. Participants brainstormed responses to a prompt: "A specific reason I use flavored e-liquid in my electronic cigarette product is…". The final 107 brainstormed statements were sorted by participants into groups of similar content. Participants rated each statement on a 7-point scale (1-Definitely NOT a reason to 7-Definitely a reason) based on a prompt: "This is a specific reason why I used flavored e-liquid in my electronic cigarette product in the past month." A cluster map was generated from participants' sorting and ratings using CM statistical software. Cluster mean ratings were compared. RESULTS Analysis revealed five clusters of reasons for flavored ECIG use including Increased Satisfaction/Enjoyment, Better Feel/Taste than Cigarettes, Variety/Customization, Food Craving Suppression, and Social Impacts. Statements in the Increased Satisfaction/Enjoyment and Better Feel/Taste than Cigarettes clusters were rated significantly higher than statements from other clusters (ps<0.05). Some statements indicated flavors were perceived as masking agents for nicotine or other bad tastes associated with cigarette smoking making ECIG use more palatable. CONCLUSIONS Flavored ECIGs are used for many reasons. Some statements suggested flavors may increase the rewarding and possible addictive effects of ECIGs. These results support continued examination of the role of flavors and ECIG use behaviors.
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Affiliation(s)
- Eric K. Soule
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298
| | - Alexa A. Lopez
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298
| | - Mignonne C. Guy
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298,Virginia Commonwealth University, Department of African American Studies, PO Box 842509, Richmond, VA 23284
| | - Caroline O. Cobb
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298
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Use of electronic cigarettes among secondary and high school students from a socially disadvantaged rural area in Poland. BMC Public Health 2016; 15:703. [PMID: 27488357 PMCID: PMC4973054 DOI: 10.1186/s12889-016-3417-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The use of e-cigarettes has been growing and has become a significant public health concern. Prevention of the youth access to, initiation and continuous use of e-cigarettes with special attention to vulnerable groups is a subject of a health debate. However, still little is known about characteristics of the underage e-cigarette users from different geographic and socio-economic backgrounds as well as other potential factors associated with the use of e-cigarettes, including simultaneous use with tobacco products or alcohol. The aim of the study was to investigate the prevalence and factors associated with ever and continued e-cigarette use among the secondary and high school students from a socially disadvantaged rural area in Poland. Methods The study sample consisted of 3552 students aged 13–19 years from Piotrkowski district. The anonymous, self-administered questionnaire adapted from the Global Youth Tobacco Survey was implemented to collect relevant information. The uni- and multivariate logistic regression analyses were applied to identify factors associated with ever, current (in the previous 30 days) and continued e-cigarette use. Results Almost 22 % of the sample reported ever e-cigarettes use and 27 % of the respondents indicated e-cigarettes use in the past month. Boys, in comparison with girls, were more likely to report current e-cigarette use (OR = 1.7; p < 0.001). Current e-cigarette use was strongly associated with alcohol consumption (OR = 4.3; p < 0.001), current (OR = 32.5; p < 0.001) and ever tobacco smoking (OR = 7.5; p < 0.001) as well as smoking parents (OR = 1.4; p < 0.05) and friends (OR = 4.5; p < 0.05). The use of e-cigarettes was also significantly associated with harm perception (p < 0.001). A similar pattern was observed among ever e-cigarette users. Male gender (OR = 1.4; p < 0.05), current tobacco smoking (OR = 3.0; p < 0.01) and lack of knowledge about a ban on smoking in the school (OR = 1.4; p < 0.05) were predictors of the continued e-cigarette use. Higher paternal education (OR = 0.5; p < 0.001) and perception of e-cigarettes as more harmful comparing to tobacco (OR = 0.2; p < 0.001) protected from the continued e-cigarette use. Conclusions E-cigarette use is widespread in the investigated population, especially among boys, those with other risky behaviors and with smoking parents or friends. There is a need for further research and preventive policies to protect the youth from that exposure. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3417-y) contains supplementary material, which is available to authorized users.
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107
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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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Gowin M, Cheney MK, Wann TF. Knowledge and Beliefs About E-Cigarettes in Straight-to-Work Young Adults. Nicotine Tob Res 2016; 19:208-214. [PMID: 27613919 DOI: 10.1093/ntr/ntw195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Young adults are a growing segment of electronic cigarette (e-cigarette) users. Young adults who go straight to work (STW) from high school make up a large portion of the young adult population, yet research to date has focused on college-educated young adults. This study explored STW young adult beliefs and knowledge about e-cigarettes. METHODS Semistructured individual interviews were used to elicit in-depth information from STW young adults ages 19-31 from a state in the southwest United States. Thirty interviews were conducted focusing on beliefs about e-cigarettes, current knowledge, and information-seeking practices. Interviews were recorded, transcribed, and analyzed using NVivo. RESULTS Nine themes were identified falling into three categories: (1) beliefs about e-cigarettes, (2) knowledge about e-cigarettes, and (3) personal rules about e-cigarettes. STW young adults held positive beliefs about the health and safety of e-cigarettes for themselves, others, and the environment. They reported their social networks and the Internet as reliable sources of information about e-cigarettes, but they reported parents as the best source for advice. Participants had rules about e-cigarettes that contradicted some of their beliefs such as using e-cigarettes around children indicating that their beliefs were not as strongly held as they initially reported. CONCLUSIONS Industry marketing and contradictory information may contribute to STW young adult knowledge and beliefs about e-cigarettes. Lack of credible public health information may also contribute to this issue. Ensuring that what is known about the benefits and harms of e-cigarettes is conveyed through multichannel communication and continued monitoring of marketing practices of the e-cigarette industry in light of the soon to be implemented regulations should be top priorities for public health. IMPLICATIONS Beliefs and knowledge of STW young adults have not been explored even though they are heavily targeted by the e-cigarette industry. This group holds strong positive beliefs about the health and safety of e-cigarettes, despite having little credible knowledge about them. This study indicates a need for efforts focused on educating STW young adults on the potential risks and benefits of e-cigarettes and the communication of credible information or at minimum the acknowledgment of the uncertainty regarding the long-term health effects of e-cigarettes. It also indicates a need for continued monitoring and advocacy related to marketing practices of the e-cigarette industry.
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Affiliation(s)
- Mary Gowin
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
| | - Taylor F Wann
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
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Case K, Crook B, Lazard A, Mackert M. Formative research to identify perceptions of e-cigarettes in college students: Implications for future health communication campaigns. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:380-389. [PMID: 26979833 PMCID: PMC4929619 DOI: 10.1080/07448481.2016.1158180] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This formative study examined perceptions of e-cigarettes in college students with the goal of informing future health communication campaigns. Differences between e-cigarette users and nonusers were also examined. PARTICIPANTS Thirty undergraduate students were recruited from a large southwestern public university (15 users, 15 nonusers). METHODS Structured interviews were conducted and transcripts were coded for themes. RESULTS Although users had more favorable attitudes toward e-cigarettes, both users and nonusers believed that e-cigarettes produce water vapor and reported that e-cigarettes were less harmful than conventional cigarettes. Potential health consequences and addiction concerns were the most common perceived threats for both users and nonusers. Both nonusers and users cited social stigma as a perceived disadvantage of e-cigarette use. CONCLUSIONS Ultimately, themes with particular relevance to future health communication campaigns included negative perceptions of e-cigarette users and social stigma, as well as harm perceptions and potential health consequences associated with e-cigarette use.
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Affiliation(s)
- Kathleen Case
- University of Texas School of Public Health Austin Regional Campus, Austin, Texas, USA
| | - Brittani Crook
- University of Texas School of Public Health Austin Regional Campus, Austin, Texas, USA
| | - Allison Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Mackert
- Stan Richards School of Advertising and Public Relations, University of Texas at Austin, Austin, Texas, USA
- University of Texas at Austin Center for Health Communication, University of Texas at Austin, Austin, Texas, USA
- School of Public Health, The University of Texas Health Science Center, Austin, Texas, USA
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Smoke and Vapor: Exploring the Terminology Landscape among Electronic Cigarette Users. TOB REGUL SCI 2016; 2:204-213. [PMID: 27430008 DOI: 10.18001/trs.2.3.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We explored the terminology of adult e-cigarette users in describing e-cigarette products and their use. We report how users discuss and differentiate these products and the language and culture surrounding them. METHODS Focus groups (N = 12) were held in 5 locations in the United States between March and May, 2014. Participants (N = 99) included young adults or adults who were either exclusive or nonexclusive e-cigarette users. We gathered data on how users identify various types of e-cigarettes and how users understand and describe specific terms. RESULTS Participants were familiar with the attributes of e-cigarettes in general but confused by the variety of products and unable to describe differences between product types. They were familiar with the term "vaping" even when they used "smoking" more frequently, and were clear that e-cigarettes do not produce traditional cigarette smoke. They had varied opinions about what to call regular users of e-cigarettes. CONCLUSIONS Findings highlight that conceptual clarity, including using specific and familiar terminology and product descriptions for users and nonusers alike, is challenging and crucial. It is important that surveillance efforts, policy development, messaging, and future research reflect the language understood and used by consumers to enable widespread comprehension.
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Wadsworth E, Neale J, McNeill A, Hitchman SC. How and Why Do Smokers Start Using E-Cigarettes? Qualitative Study of Vapers in London, UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070661. [PMID: 27376312 PMCID: PMC4962202 DOI: 10.3390/ijerph13070661] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023]
Abstract
The aims of the study were to (1) describe how and why smokers start to vape and what products they use; (2) relate findings to the COM-B theory of behaviour change (three conditions are necessary for behaviour change (B): capability (C), opportunity (O), and motivation (M)); and (3) to consider implications for e-cigarette policy research. Semi-structured interviews (n = 30) were conducted in London, UK, with smokers or ex-smokers who were currently using or had used e-cigarettes. E-cigarette initiation (behaviour) was facilitated by: capability (physical capability to use an e-cigarette and psychological capability to understand that using e-cigarettes was less harmful than smoking); opportunity (physical opportunity to access e-cigarettes in shops, at a lower cost than cigarettes, and to vape in "smoke-free" environments, as well as social opportunity to vape with friends and family); and motivation (automatic motivation including curiosity, and reflective motivation, including self-conscious decision-making processes related to perceived health benefits). The application of the COM-B model identified multiple factors that may lead to e-cigarette initiation, including those that could be influenced by policy, such as price relative to cigarettes and use in smoke-free environments. The effects of these policies on initiation should be further investigated along with the possible moderating/mediating effects of social support.
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Affiliation(s)
- Elle Wadsworth
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK.
| | - Joanne Neale
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK.
| | - Ann McNeill
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK.
- UK Centre for Tobacco and Alcohol Studies, Nottingham NG5 1PB, UK.
| | - Sara C Hitchman
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK.
- UK Centre for Tobacco and Alcohol Studies, Nottingham NG5 1PB, UK.
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Wackowski OA, Delnevo CD. Young Adults' Risk Perceptions of Various Tobacco Products Relative to Cigarettes: Results From the National Young Adult Health Survey. HEALTH EDUCATION & BEHAVIOR 2016; 43:328-36. [PMID: 26304709 PMCID: PMC4766060 DOI: 10.1177/1090198115599988] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objectives Tobacco product risk perceptions may influence whether individuals use those products instead of or in addition to regular cigarettes. This study aimed to explore risk perceptions of various tobacco products relative to traditional cigarettes with young adults, a group with higher rates of tobacco use. Method We examined risk perception responses among a nationally representative sample of young adults (age 18-34 years; n = 2,871, including tobacco and non-tobacco users) from the 2011 National Young Adult Health Survey. Results Most (57.8%) respondents believed that e-cigarettes were less risky than cigarettes. Respondents were more likely to rate combustible products hookah (24.5%) and cigars (13.9%) as being less risky compared to noncombustible snus (10%) and other smokeless tobacco (SLT) products (7.1%) relative to cigarettes. Few (2.5%) rated menthol cigarettes as less risky. For e-cigarettes, hookah, and SLT, less risky beliefs were significantly higher among ever or current versus never product users. Between 22% and 33% of all respondents believed that SLT, snus, menthol cigarettes, and cigars were more risky than cigarettes, but differences in this belief between current and nonusers of these products were small and insignificant. Younger young adults were more likely to rate e-cigarettes and hookah as being "less risky" and rate cigars and SLT as being "more risky" than older young adults. Conclusion The public's views of comparative tobacco risk perceptions vary widely by tobacco product type and age-group. While "less risky" perceptions may be associated with product use, perceptions that products are "more risky" than cigarettes may not necessarily dissuade people from their use.
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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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Peace MR, Baird TR, Smith N, Wolf CE, Poklis JL, Poklis A. Concentration of Nicotine and Glycols in 27 Electronic Cigarette Formulations. J Anal Toxicol 2016; 40:403-7. [PMID: 27165804 DOI: 10.1093/jat/bkw037] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Personal battery-powered vaporizers or electronic cigarettes were developed to deliver a nicotine vapor such that smokers could simulate smoking tobacco without the inherent pathology of inhaled tobacco smoke. Electronic cigarettes and their e-cigarette liquid formulations are virtually unregulated. These formulations are typically composed of propylene glycol and/or glycerin, flavoring components and an active drug, such as nicotine. Twenty-seven e-cigarette liquid formulations that contain nicotine between 6 and 22 mg/L were acquired within the USA and analyzed by various methods to determine their contents. They were screened by Direct Analysis in Real Time™ Mass Spectrometry (DART-MS). Nicotine was confirmed and quantitated by high-performance liquid chromatography-tandem mass spectrometry, and the glycol composition was confirmed and quantitated by gas chromatography-mass spectrometry. The DART-MS screening method was able to consistently identify the exact mass peaks resulting from the protonated molecular ion of nicotine, glycol and a number of flavor additives within 5 mmu. Nicotine concentrations were determined to range from 45 to 131% of the stated label concentration, with 18 of the 27 have >10% variance. Glycol composition was generally accurate to the product description, with only one exception where the propylene glycol to glycerin percentage ratio was stated as 50:50 and the determined concentration of propylene glycol to glycerin was 81:19 (% v/v). No unlabeled glycols were detected in these formulations.
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Affiliation(s)
- Michelle R Peace
- Department of Forensic Science, Virginia Commonwealth University, 1015 Floyd Avenue, Room 2015, PO Box 843079, Richmond, VA 23284, USA
| | - Tyson R Baird
- Department of Forensic Science, Virginia Commonwealth University, 1015 Floyd Avenue, Room 2015, PO Box 843079, Richmond, VA 23284, USA
| | - Nathaniel Smith
- Department of Chemistry, Virginia Commonwealth University, PO Box 842006, Richmond, VA 23284, USA
| | - Carl E Wolf
- Department of Forensic Science, Virginia Commonwealth University, 1015 Floyd Avenue, Room 2015, PO Box 843079, Richmond, VA 23284, USA Department of Pathology, Virginia Commonwealth University, PO Box 980165, Richmond, VA 23298-0165, USA
| | - Justin L Poklis
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA
| | - Alphonse Poklis
- Department of Forensic Science, Virginia Commonwealth University, 1015 Floyd Avenue, Room 2015, PO Box 843079, Richmond, VA 23284, USA Department of Pathology, Virginia Commonwealth University, PO Box 980165, Richmond, VA 23298-0165, USA Department of Pharmacology and Toxicology, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA
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115
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Reasons for electronic cigarette use beyond cigarette smoking cessation: A concept mapping approach. Addict Behav 2016; 56:41-50. [PMID: 26803400 DOI: 10.1016/j.addbeh.2016.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 01/08/2016] [Accepted: 01/14/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Electronic cigarettes (ECIGs) continue to grow in popularity, however, limited research has examined reasons for ECIG use. METHODS This study used an integrated, mixed-method participatory research approach called concept mapping (CM) to characterize and describe adults' reasons for using ECIGs. A total of 108 adults completed a multi-module online CM study that consisted of brainstorming statements about their reasons for ECIG use, sorting each statement into conceptually similar categories, and then rating each statement based on whether it represented a reason why they have used an ECIG in the past month. RESULTS Participants brainstormed a total of 125 unique statements related to their reasons for ECIG use. Multivariate analyses generated a map revealing 11, interrelated components or domains that characterized their reasons for use. Importantly, reasons related to Cessation Methods, Perceived Health Benefits, Private Regard, Convenience and Conscientiousness were rated significantly higher than other categories/types of reasons related to ECIG use (p<.05). There also were significant model differences in participants' endorsement of reasons based on their demography and ECIG behaviors. CONCLUSIONS This study shows that ECIG users are motivated to use ECIGs for many reasons. ECIG regulations should address these reasons for ECIG use in addition to smoking cessation.
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116
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Mays D, Arrazola RA, Tworek C, Rolle IV, Neff LJ, Portnoy DB. Openness to Using Non-cigarette Tobacco Products Among U.S. Young Adults. Am J Prev Med 2016; 50:528-534. [PMID: 26549502 PMCID: PMC5253657 DOI: 10.1016/j.amepre.2015.08.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION National data indicate that the prevalence of non-cigarette tobacco product use is highest among young adults; however, little is known about their openness to use these products in the future and associated risk factors. This study sought to characterize openness to using non-cigarette tobacco products and associated factors among U.S. young adults. METHODS In 2014, National Adult Tobacco Survey data (2012-2013) were analyzed to characterize openness to using the following tobacco products among all young adults aged 18-29 years (N=5,985): cigars; electronic cigarettes ("e-cigarettes"); hookah; pipe tobacco; chew, snuff, or dip; snus; and dissolvables. Among those who were not current users of each product, multivariable logistic regression was used to examine associations between demographics, cigarette smoking status, lifetime use of other non-cigarette products, perceived harm and addictiveness of smoking, and receipt of tobacco industry promotions and openness to using each product. RESULTS Among all young adults, openness to using non-cigarette tobacco products was greatest for hookah (28.2%); e-cigarettes (25.5%); and cigars (19.1%). In multivariable analyses, which included non-current users of each product, non-current ever, current, and former smokers were more likely than never smokers to be open to using most examined products, as were men and adults aged 18-24 years. Receipt of tobacco industry promotions was associated with openness to using e-cigarettes; chew, snuff, or dip; and snus. CONCLUSIONS There is substantial openness to trying non-cigarette tobacco products among U.S. young adults. Young adults are an important population to consider for interventions targeting non-cigarette tobacco product use.
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Affiliation(s)
- Darren Mays
- Food and Drug Administration Tobacco Regulatory Science Fellowship Program, Silver Spring, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - René A Arrazola
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Cindy Tworek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Italia V Rolle
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Linda J Neff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - David B Portnoy
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
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Hinds JT, Loukas A, Chow S, Pasch KE, Harrell MB, Perry CL, Delnevo C, Wackowski OA. Using Cognitive Interviewing to Better Assess Young Adult E-cigarette Use. Nicotine Tob Res 2016; 18:1998-2005. [PMID: 27029822 DOI: 10.1093/ntr/ntw096] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/22/2016] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Characteristics of electronic nicotine delivery systems (ENDS) make assessment of their use a challenge for researchers. Cognitive interviews are a way of gaining insight into participants' interpretations of survey questions and the methods they use in answering them, to improve survey tools. METHODS We used cognitive interviews to modify a young adult survey and improve assessment of quantity and frequency of ENDS use, as well as reasons for initiation and use of ENDS products. Twenty-five college students between the ages of 18 and 32 participated in individual cognitive interviews, which assessed question comprehension, answer estimation, retrieval processes, and answer response processes. RESULTS Comprehension issues arose discerning between ENDS device types (eg, cigalikes vs. vape pens), and answer estimation issues arose regarding ENDS use as drug delivery systems. These issues appeared to improve when pictures were added specifying the device in question, as well as when specific language naming nicotine as the ENDS product content was added to survey questions. Regarding answer retrieval, this sample of users had problems reporting their frequency of ENDS use, as well as quantifying the amount of ENDS products consumed (eg, volume of e-juice, number of cartridges, nicotine concentration). CONCLUSIONS Accurate assessment of ENDS products proved challenging, but cognitive interviews provided valuable insight into survey interpretation that was otherwise inaccessible to researchers. Future research that explores how to assess the wide array of ENDS devices, as well as possible population differences among specific device-type users would be valuable to public health researchers and professionals. IMPLICATIONS This study extends the current literature by using cognitive interviews to test ENDS assessment questions in a sample of young adults, a population at elevated risk for ENDS use. Problems encountered when answering ENDS use questions underscore the need to develop easily understood ENDS questions that allow for quantification of ENDS use. Future research examining the nature of ENDS product types and different levels of user experience will yield valuable assessment tools for researchers and tobacco control professionals.
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Affiliation(s)
- Josephine T Hinds
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
| | - Sherman Chow
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
| | - Keryn E Pasch
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston, School of Public Health-Austin Regional Campus, Austin, TX
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston, School of Public Health-Austin Regional Campus, Austin, TX
| | - Cristine Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
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Wagoner KG, Cornacchione J, Wiseman KD, Teal R, Moracco KE, Sutfin EL. E-cigarettes, Hookah Pens and Vapes: Adolescent and Young Adult Perceptions of Electronic Nicotine Delivery Systems. Nicotine Tob Res 2016; 18:2006-12. [PMID: 27029821 DOI: 10.1093/ntr/ntw095] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/22/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Most studies have assessed use of "e-cigarettes" or "electronic cigarettes," potentially excluding new electronic nicotine delivery systems (ENDS), such as e-hookahs and vape pens. Little is known about how adolescents and young adults perceive ENDS and if their perceptions vary by sub-type. We explored ENDS perceptions among these populations. METHODS Ten focus groups with 77 adolescents and young adults, ages 13-25, were conducted in spring 2014. Participants were users or susceptible nonusers of novel tobacco products. Focus group transcripts were coded for emergent themes. RESULTS Participants reported positive ENDS attributes, including flavor variety; user control of nicotine content; and smoke trick facilitation. Negative attributes included different feel compared to combustible cigarettes, nicotine addiction potential, and no cue to stop use. Participants perceived less harm from ENDS compared to combustible cigarettes, perhaps due to marketing and lack of product regulation, but noted the uncertainty of ingredients in ENDS. Numerous terms were used to describe ENDS, including "e-cigarette," "e-hookah," "hookah pens," "tanks," and "vapes." Although no clear classification system emerged, participants used product characteristics like nicotine content and chargeability to attempt classification. Perceptions differed by product used. E-hookah users were perceived as young and trendy while e-cigarette users were perceived as old and addicted to nicotine. CONCLUSIONS Young adults and adolescents report distinct ENDS sub-types with varying characteristics and social perceptions of users. Although they had more positive than negative perceptions of ENDS, prevention efforts should consider highlighting negative attributes as they may discourage use and product trial among young nonusers. IMPLICATIONS Our study underscores the need for a standardized measurement system for ENDS sub-types and additional research on how ENDS sub-types are perceived among adolescents and young adults. In addition, our findings highlight negative product attributes reported by participants that may be useful in prevention and regulatory efforts to offset favorable marketing messages.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC;
| | - Jennifer Cornacchione
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kathryn E Moracco
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Saddleson M, Kozlowski L, Giovino G, Goniewicz M, Mahoney M, Homish G, Arora A. Enjoyment and other reasons for electronic cigarette use: Results from college students in New York. Addict Behav 2016; 54:33-9. [PMID: 26704429 DOI: 10.1016/j.addbeh.2015.11.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Young people are more likely to have experimented with e-cigarettes (e-cigs) compared with older adults. Few studies identify reasons for experimentation/use of e-cigs among young people; we sought to discover what drives college students to use e-cigs. METHODS Undergraduate students (ages 18-23) at four universities in New York State were surveyed. Among e-cig ever users (n=429), reasons for use were examined. A multinomial logistic regression model analyzed the relative risk of reasons for using e-cigs among discontinued, current non-daily and current daily e-cig users. RESULTS Using e-cigs for enjoyment was associated with current non-daily (RR=2.11, 95% CI=1.18-3.75) and current daily use (RR=19.1, 95% CI=3.71-98.54). Non-daily use was related to use because e-cigs are less toxic than cigarettes (RR=2.80, 95% CI=1.75-4.50). More daily users reported use to quit smoking compared with either non-daily or discontinued users (53.3% vs. 12.2% and 13.3%, respectively; p<0.05). Among current users, 72.3% used for enjoyment, compared with 42.9% of discontinued users (p<0.05). DISCUSSION In contrast to adults, who often report e-cig use to quit smoking, young people are less likely to use for this reason. The exception was daily e-cig users, who often reported use for quitting/reduction of smoking. Rather, college students report usage reasons related to affect (e.g. enjoyment). Overall, enjoyment was reported more often than was use for quitting smoking; affective reasons likely play a role in the popularity of e-cigs and should be considered in future assessments of e-cig users.
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120
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Simmons VN, Quinn GP, Harrell PT, Meltzer LR, Correa JB, Unrod M, Brandon TH. E-cigarette use in adults: a qualitative study of users' perceptions and future use intentions. ADDICTION RESEARCH & THEORY 2016; 24:313-321. [PMID: 27725794 PMCID: PMC5055066 DOI: 10.3109/16066359.2016.1139700] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND There has been an exponential increase in the prevalence of e-cigarette use, particularly among youth. However, adult use is also rising, and there have been relatively few qualitative studies with adult users to understand their reasons for use and future use intentions. Such information is needed to inform both prevention and cessation approaches. METHOD Thirty-one e-cigarette users participated in one of several focus groups assessing the appeal of e-cigarettes as well as comparisons to combustible cigarettes and approved smoking cessation aids. We also obtained perspectives on future use intentions and interest in e-cigarette cessation interventions. Verbatim transcripts were analyzed using the constant comparative method. RESULTS Participants reported several aspects of e-cigarette appeal as compared to approved cessation treatment options. These included similarities to combustible cigarettes, fewer side effects, and control of e-cigarettes to suit personal preferences. Participants were split on whether they preferred flavors that mimicked or contrasted with their combustible cigarettes (i.e., tobacco vs. alternative flavors, such as candy). Some participants who were unmotivated to quit smoking reported an unanticipated disinterest in continuing use of combustible cigarettes shortly after initiating e-cigarettes. Despite strong interest in reducing nicotine dosage, the majority did not intend to fully discontinue e-cigarettes. CONCLUSIONS Understanding e-cigarette users' perspectives can inform policy and treatment development. Regulatory and policy initiatives will need to balance the appealing characteristics of e-cigarettes with the potential for negative public health outcomes.
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Affiliation(s)
- Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Gwendolyn P. Quinn
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Community and Family Health, University of South Florida, Tampa, FL, USA
| | - Paul T. Harrell
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Lauren R. Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - John B. Correa
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Marina Unrod
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Thomas H. Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Cooper M, Harrell MB, Perry CL. A Qualitative Approach to Understanding Real-World Electronic Cigarette Use: Implications for Measurement and Regulation. Prev Chronic Dis 2016; 13:E07. [PMID: 26766848 PMCID: PMC4714939 DOI: 10.5888/pcd13.150502] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction An understanding of the real-world use of electronic cigarettes (e-cigarettes) is needed to inform surveillance efforts and future state and federal regulation. This study investigates the behavioral aspects of e-cigarette use. Methods We used qualitative methods to examine salient characteristics of e-cigarette use. The lead investigator (M.C.) conducted in-depth, semistructured individual interviews to explore patterns and behaviors associated with e-cigarette use among a purposive sample of 50 current adult users. Thematic content analysis was used to analyze qualitative data and document themes. Results Several important themes emerged. Although most users started with “closed system” products, the majority switched from that type of e-cigarette to “open system” devices. Responses were diverse on preferred flavors, although mixing flavors was a common practice. Many users had difficulty estimating the total amount of e-liquid they used within a given period and described an iterative process in which they experimented with different nicotine levels to determine their preferred concentration. Reported frequency of use and puffing behaviors varied greatly between users and also differed from the way traditional cigarettes are smoked. Conclusion Results from this study have implications for developing appropriate survey metrics for e-cigarette surveillance, the regulation of flavorings, and reporting of e-cigarette product constituents.
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Affiliation(s)
- Maria Cooper
- University of Texas School of Public Health, Austin Regional Campus, 400 W. 15th Street, Suite 1050, Austin, TX 78701. E-mail:
| | - Melissa B Harrell
- University of Texas School of Public Health, Austin Regional Campus, Austin, Texas
| | - Cheryl L Perry
- University of Texas School of Public Health, Austin Regional Campus, Austin, Texas
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Meng Q, Schwander S, Son Y, Rivas C, Delveno C, Graber J, Giovenco D, Bruen U, Mathew R, Robson M. Has the mist been peered through? Revisiting the building blocks of human health risk assessment for electronic cigarette use. HUMAN AND ECOLOGICAL RISK ASSESSMENT : HERA 2016; 22:558-579. [PMID: 38162291 PMCID: PMC10756495 DOI: 10.1080/10807039.2015.1100064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background Electronic cigarettes, battery-powered nicotine delivery devices, have been increasingly used in the past decade. However, human health risks associated with E-vapor inhalation have not been fully characterized. Aims This critical review aims at revisiting the building blocks of human health risk assessment, summarizing the state of the science, and identifying major knowledge gaps in exposure assessment and toxicity assessment. Approach A qualitative research synthesis was conducted based on scientific findings reported to date in peer-reviewed publications and our own preliminary experimental results. Results There are a limited number of studies across all lines of evidence on E-vapor exposure and the health impacts of E-vapor inhalation. E-cigarette may be as efficient as traditional cigarettes in nicotine delivery, especially for experienced users, and studies suggest lower emissions of air toxics from E-cigarette vapor and lower second- and third-hand vapor exposures. But some toxic emissions may surpass those of traditional cigarettes, especially under high voltage vaping conditions. Experimentally, E-vapor/E-liquid exposures reduce cell viability and promote pro-inflammatory cytokine release. User vulnerability to concomitant environmental agent exposures, such as viruses and bacteria, may potentially be increased. Conclusion While evidence to date suggests that e-cigarettes release fewer toxins and carcinogens and compared to cigarettes, E-vapor is not safe and might adversely affect human immune functions. Major knowledge gaps hinder risk quantification and effective regulation of E-cigarette products including: 1) lack of long-term exposure studies; 2) lack of understanding of biological mechanisms associated with exposure; and 3) lack of integration of exposure and toxicity assessments.,. Better data are needed to inform human health risk assessments and to better understand the public health impact of E-vapor exposures.
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Affiliation(s)
- Qingyu Meng
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Stephan Schwander
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Yeongkwon Son
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Cesar Rivas
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Cristine Delveno
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Judith Graber
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Daniel Giovenco
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Uma Bruen
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Rose Mathew
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Mark Robson
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
- School of Environmental and Biological Sciences Rutgers University, New Brunswick, NJ, USA
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Comparison of beliefs about e-cigarettes' harms and benefits among never users and ever users of e-cigarettes. Drug Alcohol Depend 2016; 158:67-75. [PMID: 26621550 DOI: 10.1016/j.drugalcdep.2015.11.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/15/2015] [Accepted: 11/03/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION E-cigarette use is rapidly increasing, especially among youth and young adults. We need to learn what factors are associated with uptake in e-cigarettes. One important set of predictors is beliefs about e-cigarettes' potential harms and benefits. METHODS Online survey data were collected in July, 2014 from 527 U.S. adults from a nationally representative online panel (KnowledgePanel) who reported being aware of e-cigarettes. Participants were asked to rate 7 statements related to e-cigarettes harms or benefits (e.g., breathing vapors from other people's e-cigarettes is harmful to my health; vaping or using e-cigarettes can help people quit smoking regular cigarettes completely). Responses were categorized into agree, disagree, or no opinion. We compared the proportions of agreement between respondents who ever used e-cigarettes and those who had never used. Multinomial logistic regression was used to predict agree or no opinion versus disagree (base outcome) for each belief. Relative risk ratios (RRRs) are reported. The analyses were completed in December, 2014 and were weighted to match the general U.S. adult population. RESULTS Agreement across the 7 beliefs ranged from 33% (vaping can help people quit smoking) to 56% (e-cigarettes make smoking look more acceptable to youth). Ever use of e-cigarettes was associated with lower relative risk of agreeing with statements about potential harms and higher relative risk of agreeing with statements about benefits (versus disagreeing) compared with never users. DISCUSSION These findings provide timely data on beliefs about e-cigarettes between e-cigarette users and non-users to inform potential message topics for health campaign interventions.
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Ramo DE, Thrul J, Chavez K, Delucchi KL, Prochaska JJ. Feasibility and Quit Rates of the Tobacco Status Project: A Facebook Smoking Cessation Intervention for Young Adults. J Med Internet Res 2015; 17:e291. [PMID: 26721211 PMCID: PMC4736286 DOI: 10.2196/jmir.5209] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background Young adult smokers are a challenging group to engage in smoking cessation interventions. With wide reach and engagement among users, Facebook offers opportunity to engage young people in socially supportive communities for quitting smoking and sustaining abstinence. Objective We developed and tested initial efficacy, engagement, and acceptability of the Tobacco Status Project, a smoking cessation intervention for young adults delivered within Facebook. Methods The intervention was based on the US Public Health Service Clinical Practice Guidelines and the Transtheoretical Model and enrolled participants into study-run 3-month secret Facebook groups matched on readiness to quit smoking. Cigarette smokers (N=79) aged 18-25, who used Facebook on most days, were recruited via Facebook. All participants received the intervention and were randomized to one of three monetary incentive groups tied to engagement (commenting in groups). Assessments were completed at baseline, 3-, 6-, and 12-months follow-up. Analyses examined retention, smoking outcomes over 12 months (7-day point prevalence abstinence, ≥50% reduction in cigarettes smoked, quit attempts and strategies used, readiness to quit), engagement, and satisfaction with the intervention. Results Retention was 82% (65/79) at 6 months and 72% (57/79) at 12 months. From baseline to 12-months follow-up, there was a significant increase in the proportion prepared to quit (10/79, 13%; 36/79, 46%, P<.001). Over a third (28/79, 35%) reduced their cigarette consumption by 50% or greater, and 66% (52/79) made at least one 24-hour quit attempt during the study. In an intent-to-treat analysis, 13% (10/79) self-reported 7-day abstinence (6/79, 8% verified biochemically) at 12-months follow-up. In their quit attempts, 11% (9/79) used a nicotine replacement therapy approved by the Food and Drug Administration, while 18% (14/79) used an electronic nicotine delivery system to quit (eg, electronic cigarette). A majority (48/79, 61%) commented on at least one Facebook post, with more commenting among those with biochemically verified abstinence at 3 months (P=.036) and those randomized to receive a personal monetary incentive (P=.015). Over a third of participants (28/79, 35%) reported reading most or all of the Facebook posts. Highest acceptability ratings of the intervention were for post ease (57/79, 72%) and thinking about what they read (52/79, 66%); 71% (56/79) recommended the program to others. Only 5 participants attended the optional cognitive-behavioral counseling sessions, though their attendance was high (6/7 sessions overall) and the sessions were rated as easy to understand, useful, and helpful (all 90-100% agreed). Conclusions A Facebook quit smoking intervention is attractive and feasible to deliver, and early efficacy data are encouraging. However, the 1.5-fold greater use of electronic cigarettes over nicotine replacement products for quitting is concerning.
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Affiliation(s)
- Danielle E Ramo
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.
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Meernik C, Baker HM, Paci K, Fischer-Brown I, Dunlap D, Goldstein AO. Electronic Cigarettes on Hospital Campuses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:E87. [PMID: 26729142 PMCID: PMC4730478 DOI: 10.3390/ijerph13010087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 11/16/2022]
Abstract
Smoke and tobacco-free policies on hospital campuses have become more prevalent across the U.S. and Europe, de-normalizing smoking and reducing secondhand smoke exposure on hospital grounds. Concerns about the increasing use of electronic cigarettes (e-cigarettes) and the impact of such use on smoke and tobacco-free policies have arisen, but to date, no systematic data describes e-cigarette policies on hospital campuses. The study surveyed all hospitals in North Carolina (n = 121) to assess what proportion of hospitals have developed e-cigarette policies, how policies have been implemented and communicated, and what motivators and barriers have influenced the development of e-cigarette regulations. Seventy-five hospitals (62%) completed the survey. Over 80% of hospitals reported the existence of a policy regulating the use of e-cigarettes on campus and roughly half of the hospitals without a current e-cigarette policy are likely to develop one within the next year. Most e-cigarette policies have been incorporated into existing tobacco-free policies with few reported barriers, though effective communication of e-cigarette policies is lacking. The majority of hospitals strongly agree that e-cigarette use on campus should be prohibited for staff, patients, and visitors. Widespread incorporation of e-cigarette policies into existing hospital smoke and tobacco-free campus policies is feasible but needs communication to staff, patients, and visitors.
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Affiliation(s)
- Clare Meernik
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Hannah M Baker
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Karina Paci
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Isaiah Fischer-Brown
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Daniel Dunlap
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
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An Examination of Electronic Cigarette Content on Social Media: Analysis of E-Cigarette Flavor Content on Reddit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:14916-35. [PMID: 26610541 PMCID: PMC4661688 DOI: 10.3390/ijerph121114916] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/17/2022]
Abstract
In recent years, the emerging electronic cigarette (e-cigarette) marketplace has shown great development prospects all over the world. Reddit, one of the most popular forums in the world, has a very large user group and thus great influence. This study aims to gain a systematic understanding of e-cigarette flavors based on data collected from Reddit. Flavor popularity, mixing, characteristics, trends, and brands are analyzed. Fruit flavors were mentioned the most (n = 15,720) among all the posts and were among the most popular flavors (n = 2902) used in mixed blends. Strawberry and vanilla flavors were the most popular for e-juice mixing. The number of posts discussing e-cigarette flavors has increased sharply since 2014. Mt. Baker Vapor and Hangen were the most popular brands discussed among users. Information posted on Reddit about e-cigarette flavors reflected consumers' interest in a variety of flavors. Our findings suggest that Reddit could be used for data mining and analysis of e-cigarette-related content. Understanding how e-cigarette consumers' view and utilize flavors within their vaping experience and how producers and marketers use social media to promote flavors and sell products could provide valuable information for regulatory decision-makers.
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Wackowski OA, Lewis MJ, Delnevo CD. Interviews with smokers about smokeless tobacco products, risk messages and news articles. Tob Control 2015; 25:671-678. [PMID: 26576840 DOI: 10.1136/tobaccocontrol-2015-052412] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/28/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Smokeless tobacco (SLT) products and their communication have been topics of discussion in harm reduction debates, but little is known about smokers' perceptions of existing SLT risk messages. This study aimed to explore smokers' perceptions of SLT and snus products and news stories with different risk messages about them. METHODS We conducted interviews with 30 smokers assigned to read 1 of 3 constructed news stories about SLT and snus with different messages about their risks relative to cigarettes: (1) a 'favourable' version (describing SLT/snus as a 'safer' smoking alternative); (2) a 'cautious' version (describing SLT/snus as having various risks); and (3) a 'mixed' version (both stating SLT risks and potential reduced-risk benefits). RESULTS Smokers felt somewhat more informed about snus after article reading and largely found quoted sources to be credible. Though some exposed to favourable SLT/snus messages appeared to modify their beliefs about the products' acceptability and risks, many were left unchanged given pre-existing SLT risk perceptions influenced by prior SLT warnings, observed effects in known users, and concerns about SLT's mode of use. Willingness to use/not use snus in the future was also influenced by non-risk-related factors (eg, preference for smoking rituals). Many referenced e-cigarettes as being safer and more attractive smoking alternatives. CONCLUSIONS Exposure to reduced-risk SLT information may have some impact on smokers' SLT perceptions and interest, but this might be limited by a variety of negative SLT beliefs and growth of other smoking alternatives. Future research should explore SLT risk message effects with larger samples and different study designs.
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Affiliation(s)
- Olivia A Wackowski
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - M Jane Lewis
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Cristine D Delnevo
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
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Allem JP, Forster M, Neiberger A, Unger JB. Characteristics of emerging adulthood and e-cigarette use: Findings from a pilot study. Addict Behav 2015; 50:40-4. [PMID: 26093505 DOI: 10.1016/j.addbeh.2015.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/02/2015] [Accepted: 06/05/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Emerging adults (ages 18 to 25) are more likely to use e-cigarettes compared to other age groups, but little is known about their risk and protective factors. A next step to understanding e-cigarette use among emerging adults may involve examining how transition-to-adulthood themes are associated with e-cigarette use. It may also be important to know which specific transitions, and how the accumulated number of role transitions experienced in emerging adulthood, are associated with e-cigarette use. METHODS Emerging adults completed surveys indicating their identification with transition-to-adulthood themes, role transitions in the past year, and e-cigarette use. Logistic regression models examined the associations between transition-to-adulthood themes and e-cigarette use. Separate logistic regression models explored the association between individual role transitions, as well as the accumulated number of role transitions experienced, and e-cigarette use, controlling for age, gender, and ethnicity. RESULTS Among the participants (n = 555), 21% were male, the average age was 22, 45% reported lifetime, and 12% reported past-month, e-cigarette use. Participants who felt emerging adulthood was a time of experimentation/possibility were more likely to report e-cigarette use. Several role transitions were found to be associated with e-cigarette use such as loss of a job, dating someone new, and experiencing a breakup. The relationship between the accumulated number of role transitions and e-cigarette use was curvilinear. CONCLUSION Findings from this pilot study can be a point of departure for future studies looking to understand the risk and protective factors of e-cigarettes among emerging adults.
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Affiliation(s)
- Jon-Patrick Allem
- Keck School of Medicine of USC, 2001 N. Soto Street, 3rd Floor Mail, Los Angeles, CA 90032, United States.
| | - Myriam Forster
- Keck School of Medicine of USC, 2001 N. Soto Street, 3rd Floor Mail, Los Angeles, CA 90032, United States
| | - Adam Neiberger
- Keck School of Medicine of USC, 2001 N. Soto Street, 3rd Floor Mail, Los Angeles, CA 90032, United States
| | - Jennifer B Unger
- Keck School of Medicine of USC, 2001 N. Soto Street, 3rd Floor Mail, Los Angeles, CA 90032, United States
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Ooms GI, Bosdriesz JR, Portrait FRM, Kunst AE. Sociodemographic Differences in the Use of Electronic Nicotine Delivery Systems in the European Union. Nicotine Tob Res 2015; 18:724-9. [DOI: 10.1093/ntr/ntv215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/12/2015] [Indexed: 11/14/2022]
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Baeza-Loya S, Viswanath H, Carter A, Molfese DL, Velasquez KM, Baldwin PR, Thompson-Lake DGY, Sharp C, Fowler JC, De La Garza R, Salas R. Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bull Menninger Clin 2015; 78:243-52. [PMID: 25247743 DOI: 10.1521/bumc.2014.78.3.243] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Electronic cigarettes (e-cigarettes) are nicotine-delivery devices that are increasingly used, especially by young people. Because e-cigarettes lack many of the substances found in regular tobacco, they are often perceived as a safer smoking alternative, especially in high-risk situations such as pregnancy. However, studies suggest that it is exposure to nicotine that is most detrimental to prenatal development. The authors studied perceptions of tobacco and e-cigarette health risks using a multiple-choice survey. To study the perceived safety of e-cigarettes versus tobacco cigarettes, 184 modified Global Health Youth Surveys (WHO, http://www.who.int/tobacco/surveillance/gyts/en/ ) were completed electronically or on paper. Age range, smoking status, and perceptions about tobacco cigarettes and e-cigarettes were studied. The results verified that younger people use e-cigarettes more than older people. Tobacco cigarettes were perceived as more harmful than e-cigarettes to health in general, including lung cancer and pregnancy. Although more research is necessary, the authors postulate that the perception that e-cigarettes are safer during pregnancy may induce pregnant women to use these devices more freely. Given that nicotine is known to cause fetal harm, pregnant mothers who smoke e-cigarettes could cause even greater harm to the fetus because e-cigarettes are perceived as being safer than tobacco cigarettes. Until more data about the effects of nicotine during pregnancy are available, the authors advocate for labeling of e-cigarettes as potentially harmful, at least during pregnancy.
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Cabrera-Nguyen EP, Cavazos-Rehg P, Krauss M, Kim Y, Emery S. Awareness and Use of Dissolvable Tobacco Products in the United States. Nicotine Tob Res 2015; 18:857-63. [PMID: 26391580 DOI: 10.1093/ntr/ntv212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/10/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Little is known about dissolvable tobacco products (DTPs) compared with other alternative tobacco products (ATPs) like e-cigarettes and snus. We sought to understand US adults' awareness and use of DTPs. METHODS A nationally representative sample of US adults (age ≥ 18 years, N = 17 522) completed an online survey in March 2013 assessing their awareness and use of DTPs. RESULTS Approximately 16% of all respondents were aware of DTPs. Few reported ever using DTPs (1.6%). DTP awareness among all respondents was greatest among males, younger adults, current and former smokers, never married respondents, blacks and Latinos, and those who used other ATPs. Among current smokers, DTP awareness was greatest for males, younger adults, blacks and Latinos, those who used other ATPs, and Southerners. DTP use among all respondents was greatest among males, younger adults, Lesbian, Gay, Bisexual, and Transgender (LGBT) respondents, former and current smokers, and those who used other ATPs. Among current smokers, DTP use was greatest among males, younger adults, LGBT respondents, those who used other ATPs, those who intended to quit, and those who received medical advice to quit. CONCLUSIONS DTP awareness and use have increased since 2009. DTPs are being used as smoking cessation aids thereby increasing risk of polytobacco use. Medical professionals should emphasize use of empirically-supported smoking cessation aids when advising patients to quit. Regulations are needed to prevent tobacco company promotion of DTPs as smoking cessation aids and to inform consumers of the risks associated with DTPs and polytobacco use. Increased national surveillance of DTP use is recommended.
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Affiliation(s)
| | | | - Melissa Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Yoonsang Kim
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Sherry Emery
- School of Public Health, University of Illinois College of Medicine at Chicago, Chicago, IL
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132
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Schneider S, Diehl K. Vaping as a Catalyst for Smoking? An Initial Model on the Initiation of Electronic Cigarette Use and the Transition to Tobacco Smoking Among Adolescents. Nicotine Tob Res 2015; 18:647-53. [PMID: 26386472 DOI: 10.1093/ntr/ntv193] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/29/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The popularity of electronic cigarettes (e-cigarettes) among adolescents is growing worldwide. A more accurate model than the much discussed but inadequate Gateway Hypothesis is needed to explain some adolescents' initial preference for e-cigarettes over tobacco cigarettes, as well as any transition from e-cigarettes to tobacco smoking. Our aim was to summarize the diffuse fear that adolescents will be indirectly encouraged to begin smoking tobacco via the use of e-cigarettes and to systematize the disparate causal hypotheses used thus far in relevant literature. METHODS We summarized the vague and fragmented hypotheses formulated thus far in literature on both trajectories from abstinence to e-cigarette use and from there to tobacco smoking into a set of empirically testable hypotheses and organized them into a comprehensive model. RESULTS Our results indicate that the perceived health risks, specific product characteristics (such as taste, price and inconspicuous use), and higher levels of acceptance among peers and others potentially make e-cigarettes initially more attractive to adolescents than tobacco cigarettes. Later, increasing familiarity with nicotine could lead to the reevaluation of both electronic and tobacco cigarettes and subsequently to a potential transition to tobacco smoking. The suggested "catalyst model" takes variations in the nicotine content of e-cigarettes as well as the dual use of different substances into account. CONCLUSION Our model provides causal hypotheses for the initiation of e-cigarette use and for the potential transition to tobacco smoking which, after being tested in empirical studies, could lead to the formulation of concrete recommendations for healthcare intervention and prevention measures. IMPLICATIONS We developed a model that provides causal hypotheses for the initiation of e-cigarette use and for the potential transition to tobacco smoking.
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Affiliation(s)
- Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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King AC, Smith LJ, McNamara PJ, Matthews AK, Fridberg DJ. Passive exposure to electronic cigarette (e-cigarette) use increases desire for combustible and e-cigarettes in young adult smokers. Tob Control 2015; 24:501-4. [PMID: 24848637 PMCID: PMC4992990 DOI: 10.1136/tobaccocontrol-2014-051563] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/30/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Passive exposure to combustible cigarette use has been shown to act as a cue to increase smoking urge. Given the resemblance of e-cigarettes and other electronic nicotine delivery systems (ENDS) to combustible cigarettes, we examined whether these devices could also act as a cue to increase smoking desire and urges in those passively exposed. METHODS Young adult daily smokers (age 18-35 years; N=60) completed subjective ratings before and after exposure to a study confederate drinking bottled water (control cue) and then smoking either a combustible or e-cigarette (active cue). Smoking desire and urge ratings were measured with visual analogue scale items for desire for a regular and an e-cigarette and the Brief Questionnaire of Smoking Urges. RESULTS Passive exposure to both the e-cigarette and combustible cigarette cue significantly increased observers' ratings of desire and urge to smoke a regular cigarette (all ps<0.05). Exposure to the e-cigarette cue but not the regular cigarette cue also increased desire to smoke an e-cigarette (p<0.01). CONCLUSIONS The results provide the first evidence in a controlled setting that electronic cigarette exposure may evoke smoking urges in young adult daily smokers. With replication, these findings may have relevance for ENDS regulation and policy.
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Affiliation(s)
- Andrea C King
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Lia J Smith
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Patrick J McNamara
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Alicia K Matthews
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois, USA
| | - Daniel J Fridberg
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
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134
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Feirman SP, Lock D, Cohen JE, Holtgrave DR, Li T. Flavored Tobacco Products in the United States: A Systematic Review Assessing Use and Attitudes. Nicotine Tob Res 2015; 18:739-49. [PMID: 26315475 DOI: 10.1093/ntr/ntv176] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/07/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We systematically reviewed research examining use of and attitudes toward nonmenthol-flavored tobacco products to provide information relevant to a decision to regulate these products in the future. METHODS To identify eligible studies, we searched PubMed, CINHAL, Embase, LILACS, and PsycINFO on September 19, 2013, without date restrictions. We obtained additional studies via gray literature searches, expert contacts, and hand-searching citations of included articles. We included participants of all ages. We conducted a qualitative synthesis for included studies. RESULTS The 32 studies included in this review exhibited substantial heterogeneity and were of varied methodological quality. Findings from observational, experimental, and quasiexperimental studies suggest that flavored tobacco use is associated with young age and that consumers may perceive flavored products more favorably than nonflavored products. Evidence from qualitative studies indicates that flavoring in tobacco is viewed favorably by users and nonusers of these products. CONCLUSIONS The Food and Drug Administration has expressed interest in regulating flavored tobacco products. This systematic review strengthens the evidence base relating to this issue by synthesizing the literature from the United States on the use of and attitudes toward flavored tobacco. To address gaps in the literature, more research is needed to understand how flavoring impacts tobacco use over time. The evidence base would further be strengthened with the collection of brand-, flavor-, and product-specific data.
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Affiliation(s)
- Shari P Feirman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC;
| | - Diana Lock
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David R Holtgrave
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tianjing Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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135
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Pokhrel P, Herzog TA, Muranaka N, Fagan P. Young adult e-cigarette users' reasons for liking and not liking e-cigarettes: A qualitative study. Psychol Health 2015; 30:1450-69. [PMID: 26074148 DOI: 10.1080/08870446.2015.1061129] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To gain an in-depth understanding of what young adult electronic- or e-cigarette users like or dislike about e-cigarettes. We aimed to determine the reasons that may encourage young adults to use e-cigarettes or discourage them from using e-cigarettes. DESIGN Twelve focus group discussions were conducted with 62 current daily e-cigarette users (63% men) of mean age = 25.1 years (standard deviation = 5.5). Data were analysed following principles of inductive content analysis. RESULTS Results indicated 12 categories of reasons for liking e-cigarettes (e.g., recreation, smoking cessation) and 6 categories of reasons for not liking e-cigarettes (e.g. poor product quality, poor smoking experience). CONCLUSIONS Young adults' motives for using or not using e-cigarettes appear to be varied and their relative importance in terms of predicting e-cigarette use initiation, dependence, and cigarette/e-cigarette dual use needs to be carefully studied in population-based, empirical studies. The current findings suggest that e-cigarettes may serve social, recreational, and sensory expectancies that are unique relative to cigarettes and not dependent on nicotine. Further, successful use of e-cigarettes in smoking cessation will likely need higher standards of product quality control, better nicotine delivery efficiency and a counselling component that would teach smokers how to manage e-cigarette devices while trying to quit smoking cigarettes.
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Affiliation(s)
- Pallav Pokhrel
- a Cancer Prevention & Control Program , University of Hawaii Cancer Center , Honolulu , HI , USA
| | - Thaddeus A Herzog
- a Cancer Prevention & Control Program , University of Hawaii Cancer Center , Honolulu , HI , USA
| | - Nicholas Muranaka
- a Cancer Prevention & Control Program , University of Hawaii Cancer Center , Honolulu , HI , USA
| | - Pebbles Fagan
- a Cancer Prevention & Control Program , University of Hawaii Cancer Center , Honolulu , HI , USA
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Johnson M, Pennington N. Adolescent Use of Electronic Cigarettes: An Emergent Health Concern for Pediatric Nurses. J Pediatr Nurs 2015; 30:611-5. [PMID: 25482982 DOI: 10.1016/j.pedn.2014.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/12/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022]
Abstract
Recent statistics show an increasing trend of electronic cigarette usage among adolescents. Despite common misconceptions, electronic cigarette use does not reduce cigarette use among adolescents and can potentially increase cigarette dependence via nicotine addiction and modeling of smoking behaviors. Pediatric nurses and health care providers should be aware of the popularity and safety concerns of electronic cigarettes so that they can properly provide education regarding the possible negative health effects of adolescent electronic cigarette use, raise awareness of this public health concern, and impact policies in their communities.
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Affiliation(s)
- Molly Johnson
- Ohio University Southern, Department of Nursing, Ironton, OH.
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137
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Cheney MK, Gowin M, Wann TF. Vapor Store Owner Beliefs and Messages to Customers. Nicotine Tob Res 2015; 18:694-9. [DOI: 10.1093/ntr/ntv129] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/03/2015] [Indexed: 12/25/2022]
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138
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Liu ST, Nemeth JM, Klein EG, Ferketich AK, Kwan MP, Wewers ME. Risk perceptions of smokeless tobacco among adolescent and adult users and nonusers. JOURNAL OF HEALTH COMMUNICATION 2015; 20:599-606. [PMID: 25832126 PMCID: PMC4491912 DOI: 10.1080/10810730.2015.1012237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The recent growth in smokeless tobacco (ST) consumption has raised questions about consumer risk perceptions of ST products, especially in high-risk vulnerable populations. This qualitative study examined risk perceptions of ST among adolescent and adult users and nonusers in Ohio Appalachia. Focus groups and interviews were held with adolescents (n = 53; M age = 17 years) and adults (n = 63; M age = 34 years) from four Ohio Appalachian counties. Participants were asked about their perceptions of ST-related health risks, ST safety, and the relative safety of ST compared with cigarettes. Transcriptions were coded independently by two individuals. Overall, participants were knowledgeable about health problems from ST use (e.g., oral cancers, periodontal disease). Nearly all participants stated that ST use is not safe; however, there was disagreement about its relative safety. Some perceived all tobacco products as equally harmful; others believed that ST is safer than cigarettes for either the user or those around the user. Disagreements about ST relative safety may reflect mixed public health messages concerning the safety of ST. Comprehensive consumer messages about the relative safety of ST compared with cigarettes are needed. Messages should address the effect of ST on the health of the user as well as those exposed to the user.
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Affiliation(s)
- Sherry T Liu
- a Division of Health Behavior and Health Promotion , The Ohio State University College of Public Health , Columbus , Ohio , USA
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139
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Saddleson ML, Kozlowski LT, Giovino GA, Hawk LW, Murphy JM, MacLean MG, Goniewicz ML, Homish GG, Wrotniak BH, Mahoney MC. Risky behaviors, e-cigarette use and susceptibility of use among college students. Drug Alcohol Depend 2015; 149:25-30. [PMID: 25666362 DOI: 10.1016/j.drugalcdep.2015.01.001] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/11/2014] [Accepted: 01/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since 2007, there has been a rise in the use of electronic cigarettes (e-cigarettes). The present study uses cross-sectional data (2013) to examine prevalence, correlates and susceptibility to e-cigarettes among young adults. METHODS Data were collected using an Internet survey from a convenience sample of 1437, 18-23 year olds attending four colleges/universities in Upstate New York. Results were summarized using descriptive statistics; logistic regression models were analyzed to identify correlates of e-cigarette use and susceptibility to using e-cigarettes. RESULTS Nearly all respondents (95.5%) reported awareness of e-cigarettes; 29.9% were ever users and 14.9% were current users. Younger students, males, non-Hispanic Whites, respondents reporting average/below average school ability, ever smokers and experimenters of tobacco cigarettes, and those with lower perceptions of harm regarding e-cigarettes demonstrated higher odds of ever use or current use. Risky behaviors (i.e., tobacco, marijuana or alcohol use) were associated with using e-cigarettes. Among never e-cigarette users, individuals involved in risky behaviors or, with lower harm perceptions for e-cigarettes, were more susceptible to future e-cigarette use. CONCLUSIONS More e-cigarette users report use of another nicotine product besides e-cigarettes as the first nicotine product used; this should be considered when examining whether e-cigarette use is related to cigarette susceptibility. Involvement in risky behaviors is related to e-cigarette use and susceptibility to e-cigarette use. Among college students, e-cigarette use is more likely to occur in those who have also used other tobacco products, marijuana, and/or alcohol.
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Affiliation(s)
- M L Saddleson
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA.
| | - L T Kozlowski
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - G A Giovino
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - L W Hawk
- University at Buffalo, State University of New York; Department of Psychology, Buffalo, NY, USA
| | - J M Murphy
- State University of New York, at Cortland, Health Department, Cortland, NY, USA
| | - M G MacLean
- State University of New York, Buffalo State, Department of Psychology, Buffalo, NY, USA
| | - M L Goniewicz
- Roswell Park Cancer Institute, Division of Cancer Prevention and Population Sciences, Buffalo, NY, USA
| | - G G Homish
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - B H Wrotniak
- D'Youville College, Center for Health Behavior Research, Buffalo, NY, USA
| | - M C Mahoney
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA; Roswell Park Cancer Institute, Department of Medicine and Department of Health Behavior, Buffalo, NY, USA
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140
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Tan ASL, Bigman CA, Mello S, Sanders-Jackson A. Is exposure to e-cigarette communication associated with perceived harms of e-cigarette secondhand vapour? Results from a national survey of US adults. BMJ Open 2015; 5:e007134. [PMID: 25814497 PMCID: PMC4386241 DOI: 10.1136/bmjopen-2014-007134] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES E-cigarettes are frequently advertised and portrayed in the media as less harmful compared with regular cigarettes. Earlier surveys reported public perceptions of harms to people using e-cigarettes; however, public perceptions of harms from exposure to secondhand vapour (SHV) have not been studied. We examined associations between self-reported exposure to e-cigarette advertising, media coverage, and interpersonal discussion and perceived harms of SHV. DESIGN Observational study. SETTING National online sample of US adults aged ≥18 years. PARTICIPANTS 1449 US adults (mean age 49.5 years), 51.3% female, 76.6% non-Hispanic Caucasian, 7.5% African-American, 10.0% Hispanic and 5.9% other races. OUTCOMES Perceived harm measures included (1) harmfulness of SHV to one's health, (2) concern about health impact of breathing SHV and (3) comparative harm of SHV versus secondhand smoke (SHS). Predictors were (1) self-reported frequency of exposure to e-cigarette advertising, media coverage and interpersonal discussion (close friends or family) and (2) perceived valence of exposure from each source. Covariates were demographic characteristics, cigarette smoking status and e-cigarette use, and were weighted to the general US adult population. RESULTS More frequent interpersonal discussion was associated with lower perceived harmfulness of SHV to one's health and lower perceived comparative harm of SHV versus SHS. Frequency of e-cigarette ad and other media exposure were not significant predictors. Perceived negative valence of ad exposure and interpersonal discussion (vs no exposure) was associated with higher perceived harm across all three outcomes, while negative valence of media coverage was associated with higher concern about health impact of breathing SHV. Perceived positive valence (vs no exposure) of interpersonal discussion was associated with lower perceived harm across all three outcomes about health impact of breathing SHV. CONCLUSIONS Exposure to information about e-cigarettes through advertising, media coverage and interpersonal discussion could play a role in shaping public perceptions of the harmfulness of SHV.
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Affiliation(s)
- Andy S L Tan
- Population Sciences Division, Dana-Farber Cancer Institute, Center for Community Based Research, Boston, USA Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, USA
| | - Cabral A Bigman
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, USA
| | - Susan Mello
- Department of Communication Studies, Northeastern University, Boston, USA
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141
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Perceived Characteristics of E-cigarettes as an Innovation by Young Adults. HEALTH BEHAVIOR AND POLICY REVIEW 2015; 2:154-162. [PMID: 25729752 DOI: 10.14485/hbpr.2.2.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We examined channels through which information about e-cigarettes has flowed, public perception of e-cigarettes as an innovation, and how these may influence use. METHODS An online survey of US adults aged 18-24 years (N = 874) was used. Measures included information channels, perception of e-cigarettes as an innovation, and intention to use. RESULTS Television ranked first for exposure to e-cigarette information. The most positive innovation attributes were observability and relative advantage. A structural model showed that information exposure and favorable perception as an innovation predicted use. CONCLUSIONS The high degree of e-cigarette awareness combined with depiction of the devices as a favorable innovation may contribute to their wider adoption and may argue for regulation of e-cigarette advertising.
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142
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Abstract
OBJECTIVES Social media platforms are used by tobacco companies to promote products. This study examines message content on Twitter from e-cigarette brands and determines if messages about flavors are more likely than non-flavor messages to be passed along to other viewers. METHODS We examined Twitter data from 2 e-cigarette brands and identified messages that contained terms related to e-cigarette flavors. RESULTS Flavor-related posts were retweeted at a significantly higher rate by e-cigarette brands (p = .04) and other Twitter users (p < .01) than non-flavor posts. CONCLUSIONS E-cigarette brands and other Twitter users pay attention to flavor-related posts and retweet them often. These findings suggest flavors continue to be an attractive characteristic and their marketing should be monitored closely.
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143
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Camenga DR, Cavallo DA, Kong G, Morean ME, Connell CM, Simon P, Bulmer SM, Krishnan-Sarin S. Adolescents' and Young Adults' Perceptions of Electronic Cigarettes for Smoking Cessation: A Focus Group Study. Nicotine Tob Res 2015; 17:1235-41. [PMID: 25646346 DOI: 10.1093/ntr/ntv020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/17/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Research has shown that adults perceive that electronic cigarettes (e-cigarettes) are effective for smoking cessation, yet little is known about adolescents and young adults' perceptions of e-cigarettes for quitting cigarette smoking. This study describes middle, high school, and college students' beliefs about, and experiences with, e-cigarettes for cigarette smoking cessation. METHODS We conducted 18 focus groups (n = 127) with male and female cigarette smokers and nonsmokers in 2 public colleges, 2 high schools, and 1 middle school in Connecticut between November 2012 and April 2013. Participants discussed cigarette smoking cessation in relation to e-cigarettes. Verbatim transcripts were analyzed using thematic analysis. RESULTS All participants, regardless of age and smoking status, were aware that e-cigarettes could be used for smoking cessation. College and high school participants described different methods of how e-cigarettes could be used for smoking cessation: (a) nicotine reduction followed by cessation; (b) cigarette reduction/dual use; and (c) long-term exclusive e-cigarette use. However, overall, participants did not perceive that e-cigarette use led to successful quitting experiences. Participants described positive attributes (maintenance of smoking actions, "healthier" alternative to cigarettes, and parental approval) and negative attributes (persistence of craving, maintenance of addiction) of e-cigarettes for cessation. Some college students expressed distrust of marketing of e-cigarettes for smoking cessation. CONCLUSIONS Adolescent and young adult smokers and nonsmokers perceive that there are several methods of using e-cigarettes for quitting and are aware of both positive and negative aspects of the product. Future research is needed to determine the role of e-cigarettes for smoking cessation in this population.
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Affiliation(s)
- Deepa R Camenga
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Dana A Cavallo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Meghan E Morean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Psychology, Oberlin College, Oberlin, OH
| | | | - Patricia Simon
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Sandra M Bulmer
- Department of Public Health, Southern Connecticut State University, New Haven, CT
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144
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Zhu SH, Sun JY, Bonnevie E, Cummins SE, Gamst A, Yin L, Lee M. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control 2015; 23 Suppl 3:iii3-9. [PMID: 24935895 PMCID: PMC4078673 DOI: 10.1136/tobaccocontrol-2014-051670] [Citation(s) in RCA: 687] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION E-cigarettes are largely unregulated and internet sales are substantial. This study examines how the online market for e-cigarettes has changed over time: in product design and in marketing messages appearing on websites. METHODS Comprehensive internet searches of English-language websites from May-August 2012 and December 2013-January 2014 identified brands, models, flavours, nicotine strengths, ingredients and product claims. Brands were divided into older and newer groups (by the two searches) for comparison. RESULTS By January 2014 there were 466 brands (each with its own website) and 7764 unique flavours. In the 17 months between the searches, there was a net increase of 10.5 brands and 242 new flavours per month. Older brands were more likely than newer brands to offer cigalikes (86.9% vs. 52.1%, p<0.01), and newer brands more likely to offer the more versatile eGos and mods (75.3% vs. 57.8%, p<0.01). Older brands were significantly more likely to claim that they were healthier and cheaper than cigarettes, were good substitutes where smoking was banned and were effective smoking cessation aids. Newer brands offered more flavours per brand (49 vs. 32, p<0.01) and were less likely to compare themselves with conventional cigarettes. CONCLUSIONS The number of e-cigarette brands is large and has been increasing. Older brands tend to highlight their advantages over conventional cigarettes while newer brands emphasise consumer choice in multiple flavours and product versatility. These results can serve as a benchmark for future research on the impact of upcoming regulations on product design and advertising messages of e-cigarettes.
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Affiliation(s)
- Shu-Hong Zhu
- 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
| | - Erika Bonnevie
- 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
| | - Anthony Gamst
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Lu Yin
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Madeleine Lee
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
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145
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Medicaid managed care: Issues for beneficiaries with disabilities. Disabil Health J 2015; 8:130-5. [DOI: 10.1016/j.dhjo.2014.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/16/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022]
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146
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Pokhrel P, Fagan P, Kehl L, Herzog TA. Receptivity to e-cigarette marketing, harm perceptions, and e-cigarette use. Am J Health Behav 2015; 39:121-31. [PMID: 25290604 PMCID: PMC4877176 DOI: 10.5993/ajhb.39.1.13] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To test whether exposure and receptivity to e-cigarette marketing are associated with recent e-cigarette use among young adults through increased beliefs that e-cigarettes are less harmful than cigarettes. METHODS Data were collected from 307 multiethnic 4- and 2-year college students; approximately equal proportions of current, never, and former cigarette smokers [mean age = 23.5 (SD = 5.5); 65% female]. RESULTS Higher receptivity to e-cigarette marketing was associated with perceptions that e-cigarettes are less harmful than cigarettes, which in turn, were associated with higher recent e-cigarette use. CONCLUSIONS The findings provide preliminary support to the proposition that marketing of e-cigarettes as safer alternatives to cigarettes or cessation aids is associated with increased e-cigarette use among young adults. The findings have implications for development of e-cigarette regulations.
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Affiliation(s)
| | - Pebbles Fagan
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Lisa Kehl
- University of Hawaii Cancer Center, Honolulu, HI, USA
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147
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Rupprecht LE, Smith TT, Schassburger RL, Buffalari DM, Sved AF, Donny EC. Behavioral mechanisms underlying nicotine reinforcement. Curr Top Behav Neurosci 2015; 24:19-53. [PMID: 25638333 PMCID: PMC4536896 DOI: 10.1007/978-3-319-13482-6_2] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cigarette smoking is the leading cause of preventable deaths worldwide, and nicotine, the primary psychoactive constituent in tobacco, drives sustained use. The behavioral actions of nicotine are complex and extend well beyond the actions of the drug as a primary reinforcer. Stimuli that are consistently paired with nicotine can, through associative learning, take on reinforcing properties as conditioned stimuli. These conditioned stimuli can then impact the rate and probability of behavior and even function as conditioning reinforcers that maintain behavior in the absence of nicotine. Nicotine can also act as a conditioned stimulus (CS), predicting the delivery of other reinforcers, which may allow nicotine to acquire value as a conditioned reinforcer. These associative effects, establishing non-nicotine stimuli as conditioned stimuli with discriminative stimulus and conditioned reinforcing properties as well as establishing nicotine as a CS, are predicted by basic conditioning principles. However, nicotine can also act non-associatively. Nicotine directly enhances the reinforcing efficacy of other reinforcing stimuli in the environment, an effect that does not require a temporal or predictive relationship between nicotine and either the stimulus or the behavior. Hence, the reinforcing actions of nicotine stem both from the primary reinforcing actions of the drug (and the subsequent associative learning effects) as well as the reinforcement enhancement action of nicotine which is non-associative in nature. Gaining a better understanding of how nicotine impacts behavior will allow for maximally effective tobacco control efforts aimed at reducing the harm associated with tobacco use by reducing and/or treating its addictiveness.
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Affiliation(s)
| | | | | | | | - Alan F. Sved
- Department of Neuroscience, University of Pittsburgh
- Department of Psychology, University of Pittsburgh
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148
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Pisinger C. Why public health people are more worried than excited over e-cigarettes. BMC Med 2014; 12:226. [PMID: 25488431 PMCID: PMC4260246 DOI: 10.1186/s12916-014-0226-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 11/10/2022] Open
Abstract
The research field on e-cigarettes is characterized by severe methodological problems, severe conflicts of interest, relatively few and often small studies, inconsistencies and contradictions in results, and a lack of long-term follow-up. Therefore, no firm conclusions can be drawn on the harm of e-cigarettes, but they can hardly be called safe. Experimental studies indicate negative health effects and, amongst others, the major ingredient propylene glycol warrants concern. Growing evidence raises doubt about the efficacy of e-cigarettes as a smoking cessation aid. Unfortunately, it seems that many smokers use e-cigarettes with the intention to quit but switch to long-term use of e-cigarettes or dual use. Use is spreading rapidly to minors, ex-smokers, and never-smokers. It is questionable whether the potential health benefits obtained by some smokers outweigh the potential harm by use of non-smokers, of undermining of complete cessation, smokers' dual use, and of eventual re-normalization of smoking. Even if e-cigarettes are significantly less harmful than conventional cigarettes, the product may have a very negative impact on public health if its use is spread to a large part of the population.
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Affiliation(s)
- Charlotta Pisinger
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Nordre Ringvej 57, Glostrup, DK 2600, Denmark.
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149
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Pisinger C, Døssing M. A systematic review of health effects of electronic cigarettes. Prev Med 2014; 69:248-60. [PMID: 25456810 DOI: 10.1016/j.ypmed.2014.10.009] [Citation(s) in RCA: 317] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/19/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To provide a systematic review of the existing literature on health consequences of vaporing of electronic cigarettes (ECs). METHODS Search in: PubMed, EMBASE and CINAHL. INCLUSION CRITERIA Original publications describing a health-related topic, published before 14 August 2014. PRISMA recommendations were followed. We identified 1101 studies; 271 relevant after screening; 94 eligible. RESULTS We included 76 studies investigating content of fluid/vapor of ECs, reports on adverse events and human and animal experimental studies. Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest. Studies found fine/ultrafine particles, harmful metals, carcinogenic tobacco-specific nitrosamines, volatile organic compounds, carcinogenic carbonyls (some in high but most in low/trace concentrations), cytotoxicity and changed gene expression. Of special concern are compounds not found in conventional cigarettes, e.g. propylene glycol. Experimental studies found increased airway resistance after short-term exposure. Reports on short-term adverse events were often flawed by selection bias. CONCLUSIONS Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless.
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Affiliation(s)
- Charlotta Pisinger
- Research Centre for Prevention and Health, Glostrup Hospital, DK-2600 Glostrup, Denmark.
| | - Martin Døssing
- Medicinsk Afdeling, Frederikssund Hospital, DK-3600 Frederikssund, Denmark
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150
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Nodora J, Hartman SJ, Strong DR, Messer K, Vera LE, White MM, Portnoy DB, Choiniere CJ, Vullo GC, Pierce JP. Curiosity predicts smoking experimentation independent of susceptibility in a US national sample. Addict Behav 2014; 39:1695-700. [PMID: 25117844 PMCID: PMC4183504 DOI: 10.1016/j.addbeh.2014.06.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 05/30/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To improve smoking prevention efforts, better methods for identifying at-risk youth are needed. The widely used measure of susceptibility to smoking identifies at-risk adolescents; however, it correctly identifies only about one third of future smokers. Adding curiosity about smoking to this susceptibility index may allow us to identify a greater proportion of future smokers while they are still pre-teens. METHODS We use longitudinal data from a recent national study on parenting to prevent problem behaviors. Only oldest children between 10 and 13years of age were eligible. Participants were identified by RDD survey and followed for 6years. All baseline never smokers with at least one follow-up assessment were included (n=878). The association of curiosity about smoking with future smoking behavior was assessed. Then, curiosity was added to form an enhanced susceptibility index and sensitivity, specificity and positive predictive value were calculated. RESULTS Among committed never smokers at baseline, those who were 'definitely not curious' were less likely to progress toward smoking than both those who were 'probably not curious' (ORadj=1.89; 95% CI=1.03-3.47) or 'probably/definitely curious' (ORadj=2.88; 95% CI=1.11-7.45). Incorporating curiosity into the susceptibility index increased the proportion identified as at-risk to smoke from 25.1% to 46.9%. The sensitivity (true positives) for this enhanced susceptibility index for both experimentation and established smoking increased from 37-40% to over 50%, although the positive predictive value did not improve. CONCLUSION The addition of curiosity significantly improves the identification and classification of which adolescents will experiment with smoking or become established smokers.
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Affiliation(s)
- Jesse Nodora
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, United States; Department of Family and Preventive Medicine, University of California, San Diego, United States
| | - Sheri J Hartman
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, United States; Department of Family and Preventive Medicine, University of California, San Diego, United States
| | - David R Strong
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, United States; Department of Family and Preventive Medicine, University of California, San Diego, United States
| | - Karen Messer
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, United States; Department of Family and Preventive Medicine, University of California, San Diego, United States
| | - Lisa E Vera
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, United States; Department of Family and Preventive Medicine, University of California, San Diego, United States
| | - Martha M White
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, United States; Department of Family and Preventive Medicine, University of California, San Diego, United States
| | - David B Portnoy
- Center for Tobacco Products, US Food and Drug Administration, Rockville, MD, United States
| | - Conrad J Choiniere
- Center for Tobacco Products, US Food and Drug Administration, Rockville, MD, United States
| | | | - John P Pierce
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, United States; Department of Family and Preventive Medicine, University of California, San Diego, United States.
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