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Abstract
Electronic cigarettes (ECs) have been growing rapidly in popularity among youth and adults in the United States over the last decade. This increasing prevalence is driven partially by the ability to customize devices, flavors, and nicotine content and the general notion that ECs are harmless, particularly in comparison with conventional cigarettes. In vitro and in vivo murine models have demonstrated a number of harmful biological effects of e-liquids and their aerosols. However, limited clinical data exist on whether these effects translate into detrimental long-term outcomes in human subjects. The short-term harmful respiratory effects of EC use demonstrated in nonsmokers argue against their use. However, slightly more favorable data exist for the respiratory benefits of substituting conventional cigarettes with ECs and the short-term efficacy of ECs as smoking cessation tools. Nonetheless, available research is severely limited in regard to long-term outcomes and by study designs fraught with bias, pointing to the need for additional research efforts with well-designed longitudinal studies to guide US Food and Drug Administration regulatory efforts. The hurdle presented by diverse device designs and e-liquid permutations, which contribute to the inconsistency of available data, also highlights the need for legislative standardization of ECs.
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Affiliation(s)
- Amika K Sood
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Matthew J Kesic
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michelle L Hernandez
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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202
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Auf R, Trepka MJ, Selim M, Ben Taleb Z, De La Rosa M, Cano MÁ. E-cigarette marketing exposure and combustible tobacco use among adolescents in the United States. Addict Behav 2018; 78:74-79. [PMID: 29127787 DOI: 10.1016/j.addbeh.2017.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/27/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022]
Abstract
E-cigarette advertising has been shown to be associated with use of e-cigarettes, but its association with tobacco use has not been studied. Therefore, we examined the association between e-cigarettes advertisement and tobacco use. Data from nationally representative 22,007 middle and high school students (grades 6-12) were used to conduct the analysis. Logistic regression models estimated the adjusted odds ratios (AOR) of ever and current use of cigarette, hookah, cigar, and polytobacco use. Odds ratios were weighted and adjusted for study design, non-response rates, school level, gender, race/ethnicity, e-cigarette use, and smoking at home. E-cigarette marketing exposure was significantly associated with ever use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.5), hookah (AOR: 1.4, 95% CI: 1.2-1.7), cigars (AOR: 1.5, 95% CI: 1.4-1.6), and polytobacco (AOR: 1.7, 95% CI: 1.5-1.8). Likewise, E-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco use (AOR: 1.8, 95% CI: 1.5-2.1). The results suggest that e-cigarette advertisement is associated with use of cigarettes, hookah, cigars, and polytobacco products. These results add to the evidence about the risks of e-cigarette marketing and highlight the need for stricter regulation of e-cigarette advertisements.
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Affiliation(s)
- Rehab Auf
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA.
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; Center for Research on U.S. Latino HIV/AIDS and Drug Abuse [CRUSADA], Florida International University, Miami, FL 33199, USA
| | - Moaz Selim
- Jackson South Community Hospital, Miami, FL 33176, USA
| | - Ziyad Ben Taleb
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse [CRUSADA], Florida International University, Miami, FL 33199, USA; School of Social Work, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; Center for Research on U.S. Latino HIV/AIDS and Drug Abuse [CRUSADA], Florida International University, Miami, FL 33199, USA
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203
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A Longitudinal Study of Predictors for Adolescent Electronic Cigarette Experimentation and Comparison with Conventional Smoking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020305. [PMID: 29425188 PMCID: PMC5858374 DOI: 10.3390/ijerph15020305] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 01/05/2023]
Abstract
Little is known of the predictors of electronic cigarette (e-cigarette) use among adolescents, even though the use is increasing. We studied here the predictors for e-cigarette experimentation (tried and tried more than twice) and compared them with predictors for conventional smoking. A baseline school survey was conducted in the Helsinki metropolitan area, Finland, in 2011 for seventh graders (12 to 13-year-olds). Response rate was 73%. The same students were followed up in 2014 (9th grade, 15 to 16-year-olds), N = 5742. Generalized linear mixed models controlling for school clustering were used. In the follow-up, 43.3% of boys and 25.6% of girls had tried e-cigarettes and 21.9% and 8.1% correspondingly more than twice. The strongest predictors for both genders were conventional smoking, drunkenness and energy drink use. Furthermore, poor academic achievement predicted e-cigarette experimentation for both genders, and for boys, participation in team sports was a predictor. The predictors for experimenting and for experimenting more than twice were very similar, except for boys’ participation in team sports. They were also similar compared to the predictors of conventional smoking but the associations were weaker. To conclude, smoking and other addictive behaviors predict adolescents’ experimentation with e-cigarettes. Family’s socioeconomic background had little significance.
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204
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Fite PJ, Cushing CC, Poquiz J, Frazer AL. Family influences on the use of e-cigarettes. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1436601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula J. Fite
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | | | - Jonathan Poquiz
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Andrew L. Frazer
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
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205
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Robertson L, Hoek J, Blank ML, Richards R, Ling P, Popova L. Dual use of electronic nicotine delivery systems (ENDS) and smoked tobacco: a qualitative analysis. Tob Control 2018; 28:13-19. [PMID: 29419488 PMCID: PMC6317506 DOI: 10.1136/tobaccocontrol-2017-054070] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Electronic nicotine delivery systems (ENDS) arguably pose fewer health risks than smoking, yet many smokers adopt ENDS without fully relinquishing smoking. Known as 'dual use', this practice is widespread and compromises the health benefits that ENDS may offer. To date, few studies have explored how dual use practices arise and manifest. METHODS We conducted in-depth, semi-structured interviews with 20 current ENDS users from New Zealand who reported smoking tobacco at least once a month. We explored participants' smoking history, their recent and current smoking, trial, uptake and patterns of ENDS use, and future smoking and vaping intentions. We managed the data using NVivo V.11 and used a thematic analysis approach to interpret the transcripts. RESULTS Dual use practices among participants evolved in four ways. First, as an attempt to manage the 'inauthenticity' of vaping relative to smoking and to retain meaningful rituals. Second, as complex rationalisations that framed decreased tobacco use, rather than smoking cessation, as 'success'. Third, as a means of alleviating the financial burden smoking imposed and to circumvent smoke-free policies. Lastly, dual use reflected attempts to comply with social group norms and manage stigma. CONCLUSIONS Dual use reflects both social and physical cues. It assisted participants to navigate smoking restrictions and allowed them to manage divergent norms. Policies that discourage smoking, particularly excise tax increases on smoked tobacco and smoke-free space restrictions, appear important in prompting ENDS use. Future research could explore whether these policies also help foster complete transition from smoking to exclusive ENDS use.
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Affiliation(s)
- Lindsay Robertson
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Janet Hoek
- Departments of Public Health and Marketing, University of Otago, Dunedin, New Zealand
| | - Mei-Ling Blank
- Departments of Public Health and Marketing, University of Otago, Dunedin, New Zealand
| | - Rosalina Richards
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Pamela Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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206
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Villanti AC, Pearson JL, Glasser AM, Johnson AL, Collins LK, Niaura RS, Abrams DB. Frequency of Youth E-Cigarette and Tobacco Use Patterns in the United States: Measurement Precision Is Critical to Inform Public Health. Nicotine Tob Res 2018; 19:1345-1350. [PMID: 28013271 DOI: 10.1093/ntr/ntw388] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/15/2016] [Indexed: 12/27/2022]
Abstract
Introduction E-cigarette use occurs with tobacco product use in youth. Methods Using the 2014 National Youth Tobacco Survey (NYTS), we examined past 30-day frequency of cigarette, cigar, smokeless, and e-cigarette use in the context of past 30-day and ever tobacco product use in US middle and high school students (N = 22 007). Frequency of product-specific use was examined by exclusive versus concurrent use with another product in the past 30 days (poly-use). Results In 2014, the majority (83%) of US middle and high school students had not used tobacco or e-cigarettes in the past 30 days. In the 9.3% of youth reporting any past 30-day e-cigarette use, 63% also reported using a tobacco product; among the 3.3% past 30-day exclusive e-cigarette users, about two-thirds (2.1%) had ever used combustible or non-combustible tobacco products and one-third (1.2%) had not. Few never tobacco users had used e-cigarettes on 10 or more days in the past month (absolute percent < 0.1%). Among past 30-day cigarette and smokeless users, the two highest frequency categories were 1-2 days and daily use; among past 30-day e-cigarette and cigar users, prevalence decreased with increasing frequency of use. The majority of past 30-day cigarette, cigar, smokeless, and e-cigarette users reported poly-use. Conclusions Prevalence estimates for a single product mask the complex patterns of frequency, temporality, and poly-use in youth. Two-thirds of past 30-day exclusive e-cigarette users have ever used tobacco. Poly-use is the dominant pattern of tobacco and e-cigarette use among US middle and high school students. Implications Our study highlights the complexity of tobacco use patterns in US middle and high school students. Future studies addressing the full public health impact of movement into or out of combustible tobacco use will require longitudinal data with appropriate measures of tobacco and e-cigarette product-specific use (eg, frequency and intensity), as well as adequate sample size and a sufficient number of waves to determine how use of individual products, like e-cigarettes, impact progression into or out of more stable patterns of tobacco and e-cigarette use.
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Affiliation(s)
- Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Amanda L Johnson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Lauren K Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
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207
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Lanza HI, Teeter H. Electronic Nicotine Delivery Systems (E-cigarette/Vape) use and Co-Occurring Health-Risk Behaviors Among an Ethnically Diverse Sample of Young Adults. Subst Use Misuse 2018; 53:154-161. [PMID: 28777675 PMCID: PMC5825211 DOI: 10.1080/10826084.2017.1327975] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prevalence rates of electronic nicotine delivery systems (ENDS; i.e., e-cigarette/vape) use has grown exponentially in the past few years. College students present a particularly vulnerable group for ENDS use. The current study sought to expand the literature by examining the context in which college students use ENDS, co-occurring health risks beyond traditional tobacco use, and the role of ethnicity in ENDS use. METHODS Health-risk behavior survey data was collected from 452 undergraduates attending a large, public urban university during the 2015-2016 academic year. Ever ENDS users vs. non-ENDS users were compared across potential demographic, health-risk, and other health-related correlates. RESULTS Almost 40% of participants reported lifetime use of ENDS. No ethnic or sex differences were found. The primary source for obtaining ENDS was friends and ENDS were most often used with friends vs. alone or with others not considered friends. Participants engaging in risky alcohol use and cigarette smoking had a higher likelihood of endorsing ENDS use. Conclusions/Importance: The current study indicated that a large proportion of college students have tried ENDS irrespective of ethnicity or sex. An increasingly normative social context may inform the popularity of ENDS use across ethnicity and sex, but additional research using ethnically diverse samples is warranted. Risky alcohol use appears to be a significant correlate of ENDS use, even after accounting for the robust relationship between ENDS use and cigarette smoking. The robust relationship between alcohol and tobacco use likely extends to ENDS use.
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Affiliation(s)
- H Isabella Lanza
- a Department of Human Development , California State University , Long Beach , California , USA
| | - Heather Teeter
- a Department of Human Development , California State University , Long Beach , California , USA
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208
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Owotomo O, Maslowsky J, Loukas A. Perceptions of the Harm and Addictiveness of Conventional Cigarette Smoking Among Adolescent E-Cigarette Users. J Adolesc Health 2018; 62:87-93. [PMID: 29056433 PMCID: PMC5742072 DOI: 10.1016/j.jadohealth.2017.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Although existing evidence indicates that e-cigarette use is a risk factor for cigarette smoking initiation, mechanisms of this association are not yet known. E-cigarette users perceive e-cigarette use to be less harmful relative to conventional cigarettes, but their absolute perceptions of addictiveness of conventional cigarette smoking are unknown. This study examines how e-cigarette users compare with nonusers (non-e-cigarette users/nonconventional cigarette smokers), conventional cigarette smokers, and dual users on perceptions of harm and the addictiveness of conventional cigarette smoking and on other known predictors of cigarette smoking such as peer smoking, influence of antismoking ads, and risk-taking propensity. METHODS National samples of 8th- and 10th-grade students from 2014 and 2015 (N = 14,151) were obtained from the Monitoring the Future Study. Multivariate logistic regression models were used to examine relationships between adolescent smoking status and perceptions of harm and the addictiveness of conventional cigarette smoking while controlling for potential confounders. RESULTS E-cigarette users had lower perceptions of the addictiveness of conventional cigarette smoking compared with nonusers but higher than cigarette smokers and dual users. E-cigarette users reported lower influence by antismoking ads, more conventional cigarette-smoking peers, and greater risk-taking propensity than nonusers. E-cigarette users and cigarette smokers did not differ in their perceived harm of conventional cigarette smoking or in their risk-taking propensity. CONCLUSIONS E-cigarette users' attitudes and perceptions regarding conventional cigarette smoking may leave them vulnerable to becoming conventional cigarette smokers. Future studies should explore the prospective relationship between smoking-related perceptions of conventional cigarette smoking among e-cigarette users and the onset of cigarette smoking.
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Affiliation(s)
- Olusegun Owotomo
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas
| | - Julie Maslowsky
- Department of Kinesiology & Health Education, Population Research Center, University of Texas at Austin, Austin, Texas.
| | - Alexandra Loukas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, Texas
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209
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Bold KW, Kong G, Camenga DR, Simon P, Cavallo DA, Morean ME, Krishnan-Sarin S. Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth. Pediatrics 2018; 141:peds.2017-1832. [PMID: 29203523 PMCID: PMC5744268 DOI: 10.1542/peds.2017-1832] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use is common among youth, and there are concerns that e-cigarette use leads to future conventional cigarette use. We examined longitudinal associations between past-month cigarette and e-cigarette use to characterize the stability and directionality of these tobacco use trajectories over time. METHODS High school students (N = 808, 53% female) completed surveys across 3 waves (2013, 2014, and 2015) in 3 public schools in Connecticut. Using autoregressive cross-lagged models, we examined bidirectional relationships between past-month cigarette and e-cigarette use over time. Models were adjusted for covariates related to tobacco use (ie, sex, race/ethnicity, socioeconomic status, and use of other tobacco products). RESULTS Past-month e-cigarette use predicted future cigarette use (wave 1-2: odds ratio [OR] = 7.08, 95% confidence interval [CI] = 2.34-21.42; wave 2-3: OR = 3.87, 95% CI = 1.86-8.06). However, past-month cigarette use did not predict future e-cigarette use (wave 1-2: OR = 2.02, 95% CI = 0.67-6.08; wave 2-3: OR = 1.90, 95% CI = 0.77-4.71). Additionally, frequency of cigarette and e-cigarette use increased over time. By wave 3, 26% of cigarette users and 20.5% of e-cigarette users reported using 21-30 days out of the past month. CONCLUSIONS E-cigarette use was associated with future cigarette use across 3 longitudinal waves, yet cigarette use was not associated with future e-cigarette use. Future research needs to examine mechanisms through which e-cigarette use leads to cigarette use. E-cigarette regulation and prevention programs may help prevent future use of cigarettes among youth.
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Affiliation(s)
| | | | - Deepa R. Camenga
- Emergency Medicine, School of Medicine, Yale University, New Haven, Connecticut; and
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210
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Bold KW, Morean ME, Kong G, Simon P, Camenga DR, Cavallo DA, Krishnan-Sarin S. Early age of e-cigarette use onset mediates the association between impulsivity and e-cigarette use frequency in youth. Drug Alcohol Depend 2017; 181:146-151. [PMID: 29055268 PMCID: PMC5683935 DOI: 10.1016/j.drugalcdep.2017.09.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Identifying risk factors for youth e-cigarette use is critical, given high rates of e-cigarette use and unknown health effects of long-term use. The current study examined whether an early age of onset of e-cigarette use mediates the association between impulsivity and e-cigarette frequency. METHODS Cross-sectional survey data of e-cigarette users (n=927) were collected from 8 high schools in southeastern Connecticut. The sample was 44.7% female (mean age 16.2 [SD=1.2], mean age of e-cigarette onset 14.7 [SD=1.6]). Two domains of self-reported, trait impulsivity were assessed using the abbreviated Barratt Impulsiveness Scale: impaired self-regulation (e.g., problems with concentration or self-control) and behavioral impulsivity (e.g., doing things without thinking). Mediation was tested with Mplus, and the model included school as a cluster variable and controlled for covariates related to e-cigarette use (i.e., sex, age, race, peer use, and other tobacco products ever tried). RESULTS The hypothesized mediation was supported for both domains of impulsivity (impaired self-regulation a1b=0.09, SE=0.02, 95%CI [0.03-0.14], p=.002; behavioral impulsivity a2b=0.07, SE=0.03, 95%CI [.01-.14], p=0.03). Specifically, impaired self-regulation (B=-0.33, SE=0.06, p<0.001) and behavioral impulsivity (B=-0.26, SE=0.11, p=0.02) predicted trying e-cigarettes at an earlier age, and earlier initiation was associated with more days of e-cigarette use in the past month (B=-0.28, SE=0.08, p<0.001). CONCLUSIONS Adolescents who endorse aspects of impulsivity, such as acting without thinking, are at greater risk for more frequent e-cigarette use through an early age of e-cigarette initiation. Further research is needed to evaluate these relationships longitudinally and to develop targeted e-cigarette interventions for impulsive youth.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
| | - Meghan E Morean
- Department of Psychology, Oberlin College, Oberlin, OH, United States
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Patricia Simon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Deepa R Camenga
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Dana A Cavallo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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211
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Schweitzer RJ, Wills TA, Tam E, Pagano I, Choi K. E-cigarette use and asthma in a multiethnic sample of adolescents. Prev Med 2017; 105:226-231. [PMID: 28964850 PMCID: PMC5653431 DOI: 10.1016/j.ypmed.2017.09.023] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
There is minimal evidence from epidemiological studies on how e-cigarette use is related to health indices in adolescence. We hypothesized that e-cigarette use would be associated with asthma, controlling for demographics and cigarette smoking. The hypothesis was tested with cross-sectional data from a statewide sample of school students. Surveys were administered in classrooms in 2015 to adolescents in 33 high schools throughout the State of Hawaii. The sample (N=6089) was 50% female and mean age was 15.8years. Data were obtained on demographics; ever use and current (past 30days) use of e-cigarettes, combustible cigarettes, and marijuana; ever being diagnosed with asthma; and currently having asthma. Multinomial regression examined the association between e-cigarette use and asthma controlling for cigarette smoking, marijuana use, and six demographic covariates. Current e-cigarette use was associated with currently having (vs. never having) asthma (adjusted odds ratio [aOR]=1.48, CI 1.26-1.74) and with previously having (vs. never having) asthma (aOR=1.22, CI 1.07-1.40). This was independent of cigarette smoking, marijuana use, and other covariates. Smoking and marijuana were nonsignificant in the multivariate analysis. Blacks, Native Hawaiians, other Pacific Islanders, and Filipinos had higher rates of asthma compared with Asian Americans and Caucasians. We conclude that e-cigarette use by adolescents is independently associated with asthma. This finding is consistent with recent laboratory research on pulmonary effects from e-cigarette vapor. Implications for public health should be considered.
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Affiliation(s)
- Rebecca J Schweitzer
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA.
| | - Thomas A Wills
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Elizabeth Tam
- Department of Medicine, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Ian Pagano
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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212
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Kong G, Kuguru KE, Krishnan-Sarin S. Gender Differences in U.S. Adolescent E-Cigarette Use. CURRENT ADDICTION REPORTS 2017; 4:422-430. [PMID: 29545987 DOI: 10.1007/s40429-017-0176-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose of Review This study aims to review the recent (2012-2017) available gender difference data on e-cigarette use among adolescents. Recent Findings E-cigarettes are the most commonly used tobacco product among adolescents, and recent study findings showed that e-cigarette use can lead to cigarette smoking. However, gender differences in e-cigarette use among adolescents are relatively unknown. Summary We used the search terms "adolescents" and "e-cigarettes" on PubMed and identified 652 articles. Of these, 16 articles (2.5%) examined gender differences in adolescent e-cigarette use. Boys appear to have greater use of e-cigarettes, but girls may be at increased risk if e-cigarettes are targeted to them, as it has been for cigarettes. Data on gender differences are limited, and future research should continue to examine gender differences in e-cigarette use. Trends in use rates could evolve with new regulations and innovations in e-cigarette marketing and product features.
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Affiliation(s)
- Grace Kong
- Yale School of Medicine, 34 Park Street, Room S-211, New Haven, CT 06519, USA
| | - Karissa E Kuguru
- Yale School of Medicine, 34 Park Street, Room S-211, New Haven, CT 06519, USA
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213
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Lozano P, Barrientos-Gutierrez I, Arillo-Santillan E, Morello P, Mejia R, Sargent JD, Thrasher JF. A longitudinal study of electronic cigarette use and onset of conventional cigarette smoking and marijuana use among Mexican adolescents. Drug Alcohol Depend 2017; 180:427-430. [PMID: 28988005 PMCID: PMC5771440 DOI: 10.1016/j.drugalcdep.2017.09.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/24/2017] [Accepted: 09/03/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE This study evaluated whether e-cigarette trial among Mexican adolescents increased the likelihood of trial and use of conventional cigarettes or marijuana use at follow-up. METHOD A school-based longitudinal survey was conducted in 60 public middle schools from the three largest cities in Mexico. Students (12-13years old) were surveyed in 2015 and followed up 20 months later (n=6574). Generalized estimating equations models were used to evaluate the association between e-cigarette trial at baseline and conventional cigarettes smoking and marijuana use at follow-up. RESULT Adolescents who had tried e-cigarettes (but not cigarettes) at baseline were more likely to have tried conventional cigarettes at followup compared to adolescents who had tried neither e-cigarettes nor cigarettes (43% vs. 24%, respectively; RR 1.41, 95% CI 1.18-1.70). We also found that adolescents who had tried both conventional cigarettes and e-cigarettes at baseline were more likely to have tried marijuana at follow-up compared to adolescents who had tried neither tobacco product (20% vs. 4%, respectively; RR 2.67, 95% CI 1.78-4.02). Trial of only e-cigarettes was not independently associated with marijuana use at followup. CONCLUSIONS Adolescents who had tried e-cigarettes were more likely to have tried conventional cigarettes and marijuana 20 months later. Although e-cigarettes have been banned in Mexico, it is likely that additional policies and public health campaigns are needed to reduce adolescent use of e-cigarettes and its consequences.
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Affiliation(s)
- Paula Lozano
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
| | - Inti Barrientos-Gutierrez
- Department of Tobacco Research, Center for Population Health Research National Institute of Public Health, Cuernavaca, Mexico.
| | - Edna Arillo-Santillan
- Department of Tobacco Research, Center for Population Health Research National Institute of Public Health, Cuernavaca, Mexico.
| | - Paola Morello
- Department of Health Economy and Society, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.
| | - Raul Mejia
- Department of Health Economy and Society, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.
| | - James D Sargent
- Cancer Control Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
| | - James F Thrasher
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA; Department of Tobacco Research, Center for Population Health Research National Institute of Public Health, Cuernavaca, Mexico.
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Drope J, Cahn Z, Kennedy R, Liber AC, Stoklosa M, Henson R, Douglas CE, Drope J. Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine. CA Cancer J Clin 2017; 67:449-471. [PMID: 28961314 DOI: 10.3322/caac.21413] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 12/20/2022] Open
Abstract
Answer questions and earn CME/CNE Over the last decade, the use of electronic nicotine delivery systems (ENDS), including the electronic cigarette or e-cigarette, has grown rapidly. More youth now use ENDS than any tobacco product. This extensive research review shows that there are scientifically sound, sometimes competing arguments about ENDS that are not immediately and/or completely resolvable. However, the preponderance of the scientific evidence to date suggests that current-generation ENDS products are demonstrably less harmful than combustible tobacco products such as conventional cigarettes in several key ways, including by generating far lower levels of carcinogens and other toxic compounds than combustible products or those that contain tobacco. To place ENDS in context, the authors begin by reviewing the trends in use of major nicotine-containing products. Because nicotine is the common core-and highly addictive-constituent across all tobacco products, its toxicology is examined. With its long history as the only nicotine product widely accepted as being relatively safe, nicotine-replacement therapy (NRT) is also examined. A section is also included that examines snus, the most debated potential harm-reduction product before ENDS. Between discussions of NRT and snus, ENDS are extensively examined: what they are, knowledge about their level of "harm," their relationship to smoking cessation, the so-called gateway effect, and dual use/poly-use. CA Cancer J Clin 2017;67:449-471. © 2017 American Cancer Society.
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Affiliation(s)
- Jeffrey Drope
- Vice President, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Zachary Cahn
- Director, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Rosemary Kennedy
- Program Consultant, Global Cancer Prevention and Early Detection, American Cancer Society, Atlanta, GA
| | - Alex C Liber
- Data Analyst, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Michal Stoklosa
- Senior Economist, Taxation and Health, American Cancer Society, Atlanta, GA
| | - Rosemarie Henson
- Senior Vice President for Prevention and Early Detection, American Cancer Society, Atlanta, GA
| | - Clifford E Douglas
- Vice President, Tobacco Control and Director, Center for Tobacco Control, American Cancer Society, Atlanta, GA
| | - Jacqui Drope
- Managing Director, Global Cancer Prevention and Early Detection, American Cancer Society, Atlanta, GA
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Leventhal AM, Urman R, Barrington-Trimis JL, Goldenson NI, Gallegos K, Chou CP, Wang K, Berhane K, Cruz TB, Pentz MA, Unger J, McConnell RS. Perceived stress and poly-tobacco product use across adolescence: Patterns of association and gender differences. J Psychiatr Res 2017; 94:172-179. [PMID: 28738287 PMCID: PMC5634516 DOI: 10.1016/j.jpsychires.2017.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/09/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
Perceived stress-an endophenotype indicative of the tendency to appraise stress as frequent, unpredictable and unmanageable-is associated with adolescent cigarette smoking. It is unclear whether this association: (1) extends to alternative tobacco products, like electronic cigarettes and hookah (tobacco water pipe), which are increasingly popular among youth, and (2) differs by gender. In this report, data were drawn from a population-based longitudinal cohort of youth in Southern California. Perceived stress was assessed at baseline (7th or 8th grade; 2010). Electronic cigarette, hookah, combustible cigarette, and cigar use were assessed at a 4-year follow-up (11th or 12th grade; 2014). After adjusting for confounders, polytomous logistic regressions showed that a standardized baseline perceived stress score (M = 0, SD = 1) predicted electronic cigarette, hookah, combustible cigarette, and cigar use and a poly-tobacco use index at the 4-year follow-up in the overall sample. Interactions between perceived stress and gender were also observed (Interaction Ps < 0.05), which demonstrated that the association of perceived stress with tobacco product use and poly-use were stronger in females (ORs for current use range: 1.47 to 1.72) than males (ORs range: 0.93 to 1.31). Adjusting for baseline perceived stress, the change in perceived stress from baseline to follow-up was also positively associated with use and poly-use of most tobacco products in females and in males to some extent. In the current era in which teen use of alternative tobacco products is increasingly common, adolescent tobacco use and poly-use research and prevention strategies should address gender-specific origins of tobacco product use risk and consider perceived stress and other emotional endophenotypes in such risk pathways.
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Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States; Department of Psychology, University of Southern California, Los Angeles, CA, United States.
| | - Robert Urman
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Katia Gallegos
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Chih Ping Chou
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Kejia Wang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Kiros Berhane
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Mary Ann Pentz
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Jennifer Unger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Rob S McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
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Frequency of E-cigarette Use, Health Status, and Risk and Protective Health Behaviors in Adolescents. J Addict Med 2017; 11:55-62. [PMID: 27898495 DOI: 10.1097/adm.0000000000000272] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES E-cigarettes (ECs) are increasingly popular among adolescents, who perceive them as "safer" than cigarettes. Although research has examined risk factors for adolescent EC use, little is known about how EC use correlates with health status and protective health behaviors. METHODS In all, 2488 adolescents (mean age = 17.31 years, SD = 0.67; 46% male) completed a survey on EC and cigarette use, physical and mental health, physical activity, diet, sleep, and alcohol and other drug (AOD) use. Logistic regression compared EC-only users to dual EC/cigarette users, cigarette-only users, and nonusers on these health factors. Among EC-only users, separate ordinary least-squares regression models assessed the effects of health status/behavior variables on frequency of past-year EC use, controlling for demographics and smokeless tobacco use. RESULTS User groups were similar on physical health and engagement in protective health behaviors (physical activity, sleep duration/quality, healthy diet), but EC-only users reported fewer mental health symptoms and less AOD use than dual or cigarette-only users. Among EC-only users, AOD use (all P < 0.0001) predicted more frequent EC use; healthy diet predicted less frequent use (P < 0.01). CONCLUSIONS EC-only use is associated with lower engagement in risky behaviors, but not better health status or higher engagement in protective health behaviors, compared with cigarette smoking. Dual EC/cigarette users may represent a particularly high-risk group due to their greater AOD use and cigarette consumption. Among "intermediate-risk" EC-only users, AOD use and unhealthy diet correlated with heavier use, and may be important targets for preventing escalation to more harmful tobacco use.
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Case KR, Harrell MB, Pérez A, Loukas A, Wilkinson AV, Springer AE, Creamer MR, Perry CL. The relationships between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents. Addict Behav 2017; 73:151-157. [PMID: 28521240 DOI: 10.1016/j.addbeh.2017.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Sensation seeking is strongly associated with cigarette use in adolescents. However, few studies have investigated its relationship with adolescent e-cigarette use. This study examined cross-sectional and longitudinal associations between sensation seeking and a variety of e-cigarette use behaviors among Texas adolescents. METHODS This study utilized two waves of data collected 6months apart through the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in 2014-2015 (n=2,488/N=461,069). TATAMS employs a complex probability-sampling design and is representative of students in 6th, 8th and 10th grades from five counties surrounding the four largest cities in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Weighted multivariable logistic regression was used to examine the cross-sectional and longitudinal associations between sensation seeking and susceptibility to e-cigarette use, ever e-cigarette use, and current (past 30day) e-cigarette use. RESULTS In the cross-sectional analyses, higher mean sensation seeking scores were associated with higher odds of both susceptibility to e-cigarette use and ever e-cigarette use (AOR=1.25, 95% CI=1.07, 1.47; AOR=1.24, 95% CI=1.08, 1.43, respectively). For the longitudinal analyses, only the association between higher mean sensation seeking scores and transition to ever e-cigarette use remained statistically significant (AOR=1.45, 95% CI=1.01, 2.08). There were no significant associations between sensation seeking and current e-cigarette use in either the cross-sectional or longitudinal analyses. CONCLUSIONS Higher sensation seeking scores were consistently and significantly related to experimentation with e-cigarette use among Texas adolescents. Future interventions (e.g., communication campaigns) should target high sensation seeking adolescents to reduce initiation of e-cigarette use among this population.
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Affiliation(s)
- Kathleen R Case
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, United States.
| | - Melissa B Harrell
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, United States.
| | - Adriana Pérez
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, United States.
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, University of Texas at Austin, United States.
| | - Anna V Wilkinson
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, United States.
| | - Andrew E Springer
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, United States.
| | - MeLisa R Creamer
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, United States.
| | - Cheryl L Perry
- The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, United States.
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Trinidad DR, Pierce JP, Sargent JD, White MM, Strong DR, Portnoy DB, Green VR, Stanton CA, Choi K, Bansal-Travers M, Shi Y, Pearson JL, Kaufman AR, Borek N, Coleman BN, Hyland A, Carusi C, Kealey S, Leas E, Noble ML, Messer K. Susceptibility to tobacco product use among youth in wave 1 of the population Assessment of tobacco and health (PATH) study. Prev Med 2017; 101:8-14. [PMID: 28526392 PMCID: PMC5537073 DOI: 10.1016/j.ypmed.2017.05.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate susceptibility and ever use of tobacco products among adolescents and young adults in the US. Cross-sectional analysis of Wave 1(2013-2014) adolescent (12-17year-olds; n=13,651) and young adult (18-24year-olds; n=9112) data from the nationally-representative Population Assessment of Tobacco and Health (PATH) Study was conducted. At 12years, 5% were ever tobacco users and 36% were susceptible to use. Seventy percent were susceptible at age 17years, and the same proportion were ever users at age 22years. Susceptibility levels were comparable for cigarettes and e-cigarette (28.6% and 27.4%, respectively), followed by hookah (22.0%), pipes (17.5%), cigars (15.2%), and smokeless tobacco (9.7%). Non-Hispanic (NH) Black (Adjusted Odds Ratio [ORadj]=1.36; 95% Confidence Limit [CL], 1.18-1.56) and Hispanic (ORadj=1.34: 95% CL,1.19-1.49) adolescent never- users were more likely to be susceptible to future use of a tobacco product than NH Whites. Susceptibility was higher with age (15-17yrs. vs 12-14yrs.: ORadj=1.69; 95% CL, 1.55-1.85) and parental education (college graduates vs less than HS education: ORadj=1.22, 95% CL, 1.08-1.39). Compared to exclusive users of hookah, cigars, or smokeless products, larger proportions of exclusive e-cigarette ever users were also susceptible to cigarette use. Among adolescents, lower levels of ever use of tobacco products are often counterbalanced by higher levels of susceptibility for future use, which may suggest delayed initiation in some groups. Ever users of a given tobacco product were more susceptible to use other tobacco products, putting them at risk for future multiple tobacco product use.
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Affiliation(s)
- Dennis R Trinidad
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States.
| | - John P Pierce
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - James D Sargent
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, United States
| | - Martha M White
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States
| | - David R Strong
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - David B Portnoy
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, United States
| | - Victoria R Green
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States; Kelly Government Solutions, Rockville, MD, United States
| | - Cassandra A Stanton
- Westat, Rockville, MD, United States; Department of Oncology, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Maansi Bansal-Travers
- Roswell Park Cancer Institute, Department of Health Behavior, Buffalo, NY, United States
| | - Yuyan Shi
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - Jennifer L Pearson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, United States; Johns Hopkins University Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, MD, United States
| | - Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, United States
| | - Blair N Coleman
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, United States
| | - Andrew Hyland
- Roswell Park Cancer Institute, Department of Health Behavior, Buffalo, NY, United States
| | | | - Sheila Kealey
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States
| | - Eric Leas
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - Madison L Noble
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - Karen Messer
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
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Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, Yang J, Primack BA, Andrews JA, Miech RA, Spindle TR, Dick DM, Eissenberg T, Hornik RC, Dang R, Sargent JD. Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA Pediatr 2017; 171:788-797. [PMID: 28654986 PMCID: PMC5656237 DOI: 10.1001/jamapediatrics.2017.1488] [Citation(s) in RCA: 817] [Impact Index Per Article: 116.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/30/2017] [Indexed: 12/11/2022]
Abstract
Importance The public health implications of e-cigarettes depend, in part, on whether e-cigarette use affects the risk of cigarette smoking. Objective To perform a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking. Data Sources PubMed, EMBASE, Cochrane Library, Web of Science, the 2016 Society for Research on Nicotine and Tobacco 22nd Annual Meeting abstracts, the 2016 Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions abstracts, and the 2016 National Institutes of Health Tobacco Regulatory Science Program Conference were searched between February 7 and February 17, 2017. The search included indexed terms and text words to capture concepts associated with e-cigarettes and traditional cigarettes in articles published from database inception to the date of the search. Study Selection Longitudinal studies reporting odds ratios for cigarette smoking initiation associated with ever use of e-cigarettes or past 30-day cigarette smoking associated with past 30-day e-cigarette use. Searches yielded 6959 unique studies, of which 9 met inclusion criteria (comprising 17 389 adolescents and young adults). Data Extraction and Synthesis Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale and the Risk of Bias in Non-randomized Studies of Interventions tool, respectively. Data and estimates were pooled using random-effects meta-analysis. Main Outcomes and Measures Among baseline never cigarette smokers, cigarette smoking initiation between baseline and follow-up. Among baseline non-past 30-day cigarette smokers who were past 30-day e-cigarette users, past 30-day cigarette smoking at follow-up. Results Among 17 389 adolescents and young adults, the ages ranged between 14 and 30 years at baseline, and 56.0% were female. The pooled probabilities of cigarette smoking initiation were 30.4% for baseline ever e-cigarette users and 7.9% for baseline never e-cigarette users. The pooled probabilities of past 30-day cigarette smoking at follow-up were 21.5% for baseline past 30-day e-cigarette users and 4.6% for baseline non-past 30-day e-cigarette users. Adjusting for known demographic, psychosocial, and behavioral risk factors for cigarette smoking, the pooled odds ratio for subsequent cigarette smoking initiation was 3.62 (95% CI, 2.42-5.41) for ever vs never e-cigarette users, and the pooled odds ratio for past 30-day cigarette smoking at follow-up was 4.28 (95% CI, 2.52-7.27) for past 30-day e-cigarette vs non-past 30-day e-cigarette users at baseline. A moderate level of heterogeneity was observed among studies (I2 = 60.1%). Conclusions and Relevance e-Cigarette use was associated with greater risk for subsequent cigarette smoking initiation and past 30-day cigarette smoking. Strong e-cigarette regulation could potentially curb use among youth and possibly limit the future population-level burden of cigarette smoking.
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Affiliation(s)
- Samir Soneji
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
| | - Jessica L. Barrington-Trimis
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | | | - Adam M. Leventhal
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Jennifer B. Unger
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Laura A. Gibson
- Annenberg School for Communication, University of Pennsylvania, Philadelphia
| | - JaeWon Yang
- currently a medical student at Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brian A. Primack
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Richard A. Miech
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Tory R. Spindle
- Department of Psychology, Virginia Commonwealth University, Richmond
| | - Danielle M. Dick
- Department of Psychology, Virginia Commonwealth University, Richmond
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond
| | - Robert C. Hornik
- Annenberg School for Communication, University of Pennsylvania, Philadelphia
| | - Rui Dang
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
| | - James D. Sargent
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
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Llamas J, Holmes LM, Lisha NE, Ling PM. Psychometric evaluation of an abbreviated version of the intragroup marginalization inventory. J Ethn Subst Abuse 2017; 18:237-256. [PMID: 28708013 DOI: 10.1080/15332640.2017.1336956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tobacco and marijuana use among U.S. young adults is a top public health concern, and racial/ethnic minorities may be at particular risk. Past research examining cultural variables has focused on the individual in relation to the mainstream U.S. culture; however, an individual can also experience within-group stress, or intragroup marginalization. We used the 2014 San Francisco Bay Area Young Adult Health Survey to validate an abbreviated measure of intragroup marginalization and identify associations between intragroup marginalization and tobacco and marijuana use among ethnic minority young adults (N = 1,058). Exploratory factor analysis was conducted to identify factors within the abbreviated scale, and logistic regressions were conducted to examine relationships between intragroup marginalization and tobacco and marijuana use. Two factors emerged from the abbreviated scale. The first factor encompassed items related to belonging and membership, capturing whether individuals experienced marginalization due to not fitting in because of physical appearance or behavior. The second factor encompassed whether individuals shared similar hopes and dreams to their friends and family members. Factor 1 (membership) was associated with increased odds of marijuana use (OR = 1.34, p < .05) and lower odds of using cigars (OR = 0.79, p < .05), controlling for sociodemographic factors. Results suggest that young adults may use marijuana as a means to build connection and belonging to cope with feeling marginalized. Health education programs focused on ethnic minority young adults are needed to help them effectively cope with intragroup marginalization without resorting to marijuana use.
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Affiliation(s)
| | | | - Nadra E Lisha
- c University of California San Francisco , San Francisco , California
| | - Pamela M Ling
- c University of California San Francisco , San Francisco , California
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Affiliation(s)
- Thomas A Wills
- Cancer Prevention Program, University of Hawaii Cancer Center, 701 Ilalo Street, Room 528, Honolulu, HI 96816, USA.
| | - James D Sargent
- Cancer Control Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756.
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Kistler CE, Crutchfield TM, Sutfin EL, Ranney LM, Berman ML, Zarkin GA, Goldstein AO. Consumers' Preferences for Electronic Nicotine Delivery System Product Features: A Structured Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E613. [PMID: 28590444 PMCID: PMC5486299 DOI: 10.3390/ijerph14060613] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 11/21/2022]
Abstract
To inform potential governmental regulations, we aimed to develop a list of electronic nicotine delivery system (ENDS) product features important to U.S. consumers by age and gender. We employed qualitative data methods. Participants were eligible if they had used an ENDS at least once. Groups were selected by age and gender (young adult group aged 18-25, n = 11; middle-age group aged 26-64, n = 9; and women's group aged 26-64, n = 9). We conducted five individual older adult interviews (aged 68-80). Participants discussed important ENDS features. We conducted a structured content analysis of the group and interview responses. Of 34 participants, 68% were white and 56% were female. Participants mentioned 12 important ENDS features, including: (1) user experience; (2) social acceptability; (3) cost; (4) health risks/benefits; (5) ease of use; (6) flavors; (7) smoking cessation aid; (8) nicotine content; (9) modifiability; (10) ENDS regulation; (11) bridge between tobacco cigarettes; (12) collectability. The most frequently mentioned ENDS feature was modifiability for young adults, user experience for middle-age and older adults, and flavor for the women's group. This study identified multiple features important to ENDS consumers. Groups differed in how they viewed various features by age and gender. These results can inform ongoing regulatory efforts.
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Affiliation(s)
- Christine E Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Trisha M Crutchfield
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Erin L Sutfin
- Department of Social Science and Health Policy, Wake Forest University, Winston-Salem, NC 27599, USA.
| | - Leah M Ranney
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Micah L Berman
- College of Public Health & Moritz College of Law, Ohio State University, Columbus, OH 43210, USA.
| | - Gary A Zarkin
- Behavioral Health and Criminal Justice Research Division, RTI International, Research Triangle Park, NC 27599, USA.
| | - Adam O Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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224
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Pierce JP, Sargent JD, White MM, Borek N, Portnoy DB, Green VR, Kaufman AR, Stanton CA, Bansal-Travers M, Strong DR, Pearson JL, Coleman BN, Leas E, Noble ML, Trinidad DR, Moran MB, Carusi C, Hyland A, Messer K. Receptivity to Tobacco Advertising and Susceptibility to Tobacco Products. Pediatrics 2017; 139:e20163353. [PMID: 28562266 PMCID: PMC5470502 DOI: 10.1542/peds.2016-3353] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Non-cigarette tobacco marketing is less regulated and may promote cigarette smoking among adolescents. We quantified receptivity to advertising for multiple tobacco products and hypothesized associations with susceptibility to cigarette smoking. METHODS Wave 1 of the nationally representative PATH (Population Assessment of Tobacco and Health) study interviewed 10 751 adolescents who had never used tobacco. A stratified random selection of 5 advertisements for each of cigarettes, e-cigarettes, smokeless products, and cigars were shown from 959 recent tobacco advertisements. Aided recall was classified as low receptivity, and image-liking or favorite ad as higher receptivity. The main dependent variable was susceptibility to cigarette smoking. RESULTS Among US youth, 41% of 12 to 13 year olds and half of older adolescents were receptive to at least 1 tobacco advertisement. Across each age group, receptivity to advertising was highest for e-cigarettes (28%-33%) followed by cigarettes (22%-25%), smokeless tobacco (15%-21%), and cigars (8%-13%). E-cigarette ads shown on television had the highest recall. Among cigarette-susceptible adolescents, receptivity to e-cigarette advertising (39.7%; 95% confidence interval [CI]: 37.9%-41.6%) was higher than for cigarette advertising (31.7%; 95% CI: 29.9%-33.6%). Receptivity to advertising for each tobacco product was associated with increased susceptibility to cigarette smoking, with no significant difference across products (similar odds for both cigarette and e-cigarette advertising; adjusted odds ratio = 1.22; 95% CI: 1.09-1.37). CONCLUSIONS A large proportion of US adolescent never tobacco users are receptive to tobacco advertising, with television advertising for e-cigarettes having the highest recall. Receptivity to advertising for each non-cigarette tobacco product was associated with susceptibility to smoke cigarettes.
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Affiliation(s)
- John P Pierce
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - James D Sargent
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - David B Portnoy
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Victoria R Green
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
- Kelly Government Solutions, Rockville, Maryland
| | - Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Cassandra A Stanton
- Westat, Rockville, Maryland
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | | | - David R Strong
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Jennifer L Pearson
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Blair N Coleman
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Eric Leas
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Madison L Noble
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Dennis R Trinidad
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Karen Messer
- Cancer Prevention Program, Moores Cancer Center, and
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
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225
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Westling E, Rusby JC, Crowley R, Light JM. Electronic Cigarette Use by Youth: Prevalence, Correlates, and Use Trajectories From Middle to High School. J Adolesc Health 2017; 60:660-666. [PMID: 28242187 PMCID: PMC5441946 DOI: 10.1016/j.jadohealth.2016.12.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to examine the use of electronic cigarettes (e-cigarettes) among adolescents over time, including correlates of lifetime use by eighth grade and trajectories of current use across ninth grade. METHODS Participants (N = 1,091) from seven school districts in Oregon, United States, completed four self-report surveys on substance use, from the spring of eighth grade (M age = 14.4 years old; standard deviation = .50) through the spring of ninth grade. RESULTS Overall, 27.7% of eighth graders had used e-cigarettes, and 16.8% were current e-cigarette users (used in the past 30 days); use did not significantly differ by gender or ethnicity. Correlates of e-cigarette lifetime use by eighth grade included lifetime and current use of marijuana, alcohol, cigarettes, and chewing tobacco. Five percent of students were "accelerators," on average using e-cigarettes 14 of the last 30 days in eighth grade, increasing to daily use (30/30 days) by the end of ninth grade. Across all substances, those in the accelerator group were more likely to have reported lifetime substance use by eighth grade and current substance use in ninth grade, compared to the "infrequent/no use" group. CONCLUSIONS A sizeable proportion of young adolescents are using e-cigarettes, and e-cigarette use is highly correlated with use of other substances, including marijuana. Adolescents who progress to daily e-cigarette use in high school are more likely to use other substances compared to low or nonusers. E-cigarettes may be a relatively new addition to a constellation of substances being actively used by a segment of the youth population.
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226
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Park S, Lee H, Min S. Factors associated with electronic cigarette use among current cigarette-smoking adolescents in the Republic of Korea. Addict Behav 2017; 69:22-26. [PMID: 28110154 DOI: 10.1016/j.addbeh.2017.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/25/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Despite a rapid increase in electronic cigarette (e-cigarette) use and substantial dual use of cigarettes and e-cigarettes among adolescents, little is currently known about adolescent e-cigarette use. Thus, this study aimed to investigate (a) rates of e-cigarette use and (b) significant factors associated with e-cigarette use among current cigarette users in adolescence. METHODS We analyzed secondary data collected from a nationally representative sample of Korean adolescents. Our study sample included 6307 current smokers. Our dependent variable was e-cigarette use and consisted of three categories (nonuse, former use, and current use); independent variables included demographics, perceived stress, parental and friends' smoking, three characteristics of cigarette smoking, and other health risk behaviors. Descriptive statistics was used for the first aim; multinomial logistic regression analysis was performed for the second aim. RESULTS Of current cigarette users, 20% smoked e-cigarettes in their lifetime but not within the past 30days (former users), and 42% smoked e-cigarettes in their lifetime and within the past 30days (current users). Both former and current e-cigarette use were significantly associated with male gender, higher grades, higher weekly allowance, residence in urban areas, friends' smoking, daily smoking, a higher number of cigarettes smoked, and quit attempts. In addition, current e-cigarette use was significantly associated with at-risk drinking, lifetime drug use, and lifetime sexual intercourse. CONCLUSIONS E-cigarette use should be included in intervention strategies for smoking prevention and cessation. Strict regulations should be implemented in order to prohibit easy access to e-cigarettes and forbid advertising of e-cigarettes as well.
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227
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Yu E, Lippert AM. Race/ethnicity modifies the association between school prevalence of e-cigarette use and student-level use: Results from the 2014 US National Youth Tobacco Survey. Health Place 2017; 46:114-120. [PMID: 28527326 DOI: 10.1016/j.healthplace.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
Abstract
This study assessed racial/ethnic moderation of the association between school prevalence of lifetime e-cigarette use and students' use. Using multilevel regression methods and data from the 2014 US National Youth Tobacco Survey, we found attending schools with high rates of e-cigarette use was positively associated with students' lifetime use of e-cigarettes, especially for white students. A cross-level interaction term indicated a weaker association between non-Hispanic black race and attending high-use schools (odds ratio [OR] =0.61, 95% confidence interval [CI] =0.39, 0.95). Results implicate race/ethnicity as an important effect modifier in the link between school contexts and teenage e-cigarette use.
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Affiliation(s)
- Edward Yu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02130, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02130, United States
| | - Adam M Lippert
- Department of Sociology, University of Colorado Denver, Campus Box 105, PO Box 173364 Denver, CO 80217, United States.
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228
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Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015. PLoS One 2017; 12:e0177073. [PMID: 28475634 PMCID: PMC5419603 DOI: 10.1371/journal.pone.0177073] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 04/21/2017] [Indexed: 11/26/2022] Open
Abstract
Objectives Evaluate trends from 2011–2015 in electronic cigarette (e-cigarette) use among U.S. adolescents, grades 6–12, including prevalence and associations with past month use of cigarettes and other tobacco products, cigarette smoking intensity, quit attempts, and quit contemplation. Methods Five consecutive waves from the National Youth Tobacco Survey (N = 101,011) were used to estimate the grade- and race/ethnicity-standardized prevalence of past month use of e-cigarettes and nine non e-cigarette tobacco products. We assessed linear trends by year and compared outcomes (e.g., tobacco use, smoking intensity) by e-cigarette past month use. Results Past month e-cigarette use rose sharply from 2011–2015. In all years and both sexes, e-cigarette past month use and ever use were positively associated with use of cigarettes and other tobacco products, with past month e-cigarette use reaching 52% in 2015 among individuals who used ≥1 non e-cigarette tobacco product in the past month. Meanwhile, from 2011–2015, the population of adolescent past month e-cigarette users increasingly encompassed adolescents who were not past month users of other products (females: 19.0% to 41.7%; males: 11.1% to 36.7%) or had never used other products (females: 7.1% to 13.5%; males: 6.7% to 15.0%). Among male (but not female) past month cigarette users, there was a statistically significant positive association between past month e-cigarette use and daily cigarette smoking but not in all individual years. Past month e-cigarette use among past month cigarette smokers was not associated with cigarette quit attempts or quit contemplation, with no temporal trend. Conclusion Adolescent past month e-cigarette use is associated with past month use of other tobacco but not with cigarette quit attempts or quit contemplation among cigarette users. Over five years, the average characteristics of U.S. adolescents who use e-cigarettes have shifted, increasingly including more adolescents who do not use non e-cigarette tobacco products.
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229
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Geletko KW, Myers K, Brownstein N, Jameson B, Lopez D, Sharpe A, Bellamy GR. Medical Residents' and Practicing Physicians' e-Cigarette Knowledge and Patient Screening Activities: Do They Differ? Health Serv Res Manag Epidemiol 2017; 3:2333392816678493. [PMID: 28462285 PMCID: PMC5266463 DOI: 10.1177/2333392816678493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose of this study was to compare medical residents and practicing physicians in primary care specialties regarding their knowledge and beliefs about electronic cigarettes (e-cigarettes). We wanted to ascertain whether years removed from medical school had an effect on screening practices, recommendations given to patients, and the types of informational sources utilized. Methods: A statewide sample of Florida primary care medical residents (n = 61) and practicing physicians (n = 53) completed either an online or paper survey, measuring patient screening and physician recommendations, beliefs, and knowledge related to e-cigarettes. χ2 tests of association and linear and logistic regression models were used to assess the differences within- and between-participant groups. Results: Practicing physicians were more likely than medical residents to believe e-cigarettes lower cancer risk in patients who use them as an alternative to cigarettes (P = .0003). Medical residents were more likely to receive information about e-cigarettes from colleagues (P = .0001). No statistically significant differences were observed related to e-cigarette knowledge or patient recommendations. Conclusions: Practicing primary care physicians are accepting both the benefits and costs associated with e-cigarettes, while medical residents in primary care are more reticent. Targeted education concerning the potential health risks and benefits associated with the use of e-cigarettes needs to be included in the current medical education curriculum and medical provider training to improve provider confidence in discussing issues surrounding the use of this product.
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Affiliation(s)
- Karen W Geletko
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA
| | - Karen Myers
- Department of Family Medicine and Rural Health, Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA
| | - Naomi Brownstein
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA
| | - Breanna Jameson
- Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA
| | - Daniel Lopez
- Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA
| | - Alaine Sharpe
- Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA
| | - Gail R Bellamy
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA
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230
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Affiliation(s)
- Grace Kong
- Yale School of Medicine, New Haven CT, USA.
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231
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Lanza HI, Pittman P, Batshoun J. Obesity and Cigarette Smoking: Extending the Link to E-cigarette/Vaping Use. Am J Health Behav 2017; 41:338-347. [PMID: 28376978 DOI: 10.5993/ajhb.41.3.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES In recent years, electronic tobacco (e-cigarette/vaping) use among young adults has grown exponentially. Given past research linking obesity and cigarette smoking, assessing whether this relationship extends to electronic tobacco use is warranted. The current study examined weight status as a correlate of substance use patterns reflecting electronic tobacco use. METHODS Survey data were collected from a convenience sample of 452 (59% female) undergraduates attending a large, public university during the 2015-2016 academic year. Latent class analysis (LCA) was conducted to identify substance use classes and examine weight status as a covariate of class membership. RESULTS LCA analyses identified 4 classes: High Substance Use (19%), Risky Alcohol Use (14%), Cigarette/Electronic Tobacco Use (17%), and Low Substance Use (50%). Both obesity status and greater deviation from one's group body mass index (BMI) norm were associated with a higher likelihood of belonging to the Cigarette/Electronic Tobacco Use class. CONCLUSIONS Findings suggest that electronic tobacco use may fit well into previously established relationships between higher weight status and tobacco use. Future research should examine the longitudinal processes and pathways underlying the relationship between weight status and electronic tobacco use.
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Affiliation(s)
- H. Isabella Lanza
- Assistant Professor, Undergraduate Research Assistant, Department of Human Development, California State University, Long Beach, CA;,
| | - Patricia Pittman
- Undergraduate Research Assistant, Department of Human Development, California State University, Long Beach, CA
| | - Jennifer Batshoun
- Undergraduate Research Assistant, Department of Human Development, California State University, Long Beach, CA
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232
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Barraza LF, Weidenaar KE, Cook LT, Logue AR, Halpern MT. Regulations and policies regarding e-cigarettes. Cancer 2017; 123:3007-3014. [DOI: 10.1002/cncr.30725] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/24/2017] [Accepted: 03/16/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Leila F. Barraza
- Mel and Enid Zuckerman College of Public Health; University of Arizona; Tucson Arizona
| | - Kim E. Weidenaar
- Sandra Day O'Connor College of Law; Arizona State University; Phoenix Arizona
| | - Livia T. Cook
- James E. Rogers College of Law; University of Arizona; Tucson Arizona
| | - Andrea R. Logue
- James E. Rogers College of Law; Mel and Enid Zuckerman College of Public Health, University of Arizona; Tucson Arizona
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233
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Jenssen BP, Wilson KM. Tobacco Control and Treatment for the Pediatric Clinician: Practice, Policy, and Research Updates. Acad Pediatr 2017; 17:233-242. [PMID: 28069410 DOI: 10.1016/j.acap.2016.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 12/15/2022]
Abstract
Tobacco use is the leading cause of preventable death in the United States, and exposure to tobacco smoke harms children from conception forward. There is no safe level of tobacco exposure. Although overall smoking rates have declined, the advent of new products, such as electronic cigarettes, threatens to perpetuate nicotine addiction without clear health benefits. In addition to reviewing traditional and new tobacco products, we discuss the unique role that pediatricians should play in tobacco treatment and control efforts. New policies and technologies can empower pediatric clinicians and pediatric health care systems to help parent smokers quit, and new policies outside of the health care setting might help prevent smoking initiation as well as improve cessation treatments. Future research is needed to continue to study the consequences of tobacco use exposure as well as the best ways to help patients and parents stop tobacco use.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania School of Medicine and PolicyLab, The Children's Hospital of Philadelphia.
| | - Karen M Wilson
- Division of General Pediatrics, Kravis Children's Hospital at Mount Sinai, New York, NY
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234
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Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci 2017; 1394:5-30. [PMID: 26774031 PMCID: PMC4947026 DOI: 10.1111/nyas.12977] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
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Affiliation(s)
| | - Eric Soule
- Virginia Commonwealth University, Richmond, Virgina
| | - Alexa Lopez
- Virginia Commonwealth University, Richmond, Virgina
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235
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Dai H. Tobacco Product Use Among Lesbian, Gay, and Bisexual Adolescents. Pediatrics 2017; 139:peds.2016-3276. [PMID: 28348201 DOI: 10.1542/peds.2016-3276] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Sexual minority youth face health disparities and a high risk of substance abuse. This study sought to fully characterize the disparity of tobacco use and risk factors in this high-risk subpopulation. METHODS Using data from the 2015 Youth Risk Behavior Survey, the current use of various tobacco products (cigarettes, smokeless tobacco, cigars, and e-cigarettes) was compared according to sex and distinct sexual identities (lesbian, gay, bisexual, and unsure). Heterosexual/straight adolescents served as the control group. RESULTS Of 14 703 respondents, 88.8% were heterosexual/straight, 2.0% were lesbian or gay, 6.0% were bisexual, and 3.2% were unsure about their sexual identity. Sexual minorities had a higher prevalence of tobacco product use than their heterosexual/straight counterparts. Sex had a significant effect on the disparities of tobacco use. Lesbian and bisexual girls had higher odds of reporting current use of any tobacco product, cigarettes, cigars, and e-cigarettes than did straight girls, whereas sexual minority boys had similar smoking behaviors compared with straight boys. Substance use, including marijuana use, drinking, and binge drinking, was significantly associated with any tobacco use. CONCLUSIONS Tobacco use differs among subgroups of sexual minority youth, with lesbians and bisexual girls having a higher prevalence of tobacco use than their straight peers. Heterogeneity of tobacco use across distinct sexual identity groups underscores the need to develop evidence-based tobacco control strategies for sexual minority youth.
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Affiliation(s)
- Hongying Dai
- Health Services & Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri; and Departments of Biomedical & Health Informatics, and Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
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236
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Wilson FA, Wang Y. Recent Findings on the Prevalence of E-Cigarette Use Among Adults in the U.S. Am J Prev Med 2017; 52:385-390. [PMID: 27988090 DOI: 10.1016/j.amepre.2016.10.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study uses a recent source of nationally representative data from in-person surveys to examine national estimates of e-cigarette use among adults and their relationship with demographic, socioeconomic, and health behavior measures. METHODS Data were provided by the National Health Interview Survey, conducted by the Centers for Disease Control and Prevention. A total of 34,356 respondents aged ≥18 years were examined for 2014, the most recent and only year in which the National Health Interview Survey included questions on e-cigarette use. E-cigarette information included ever and current use. Univariate and multivariable logistic regression analyses were performed, adjusting for age, sex, race/ethnicity, education level, marital status, poverty, and smoking status. Analyses were conducted in 2016. RESULTS Compared with those who had never tried e-cigarettes, e-cigarette users were more likely to be younger, male, non-Hispanic white, non-married, poorer, and current smokers. Multivariable logistic regression suggested that respondents with high school or some college education had significantly higher adjusted odds of ever using e-cigarettes relative to those with less than high school education. However, the adjusted odds were not significantly different for college or graduate school education. CONCLUSIONS The results suggest that, unlike tobacco use, ever using e-cigarettes is positively related to income. Interestingly, e-cigarette use exhibits a non-linear relationship with education. Reasons for the relationship of e-cigarettes with education are unclear and warrant further research.
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Affiliation(s)
- Fernando A Wilson
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Yang Wang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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237
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Electronic cigarette and marijuana use among youth in the United States. Addict Behav 2017; 66:48-54. [PMID: 27871045 DOI: 10.1016/j.addbeh.2016.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/28/2016] [Accepted: 11/04/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are growing concerns over the high rate of electronic cigarette (e-cigarette) use and decreases in perceived harm of marijuana use among youth. We seek to identify risk factors associated with e-cigarette and marijuana use among U.S. middle and high school students. METHODS Estimates of e-cigarette use only, marijuana use only, dual use of both substances as well as frequency of substance use were calculated for 8th, 10th and 12th grades with the typical age of 13, 15, 17 years old respectively by using the 2014 Monitoring the Future survey (n=16,184). RESULTS Overall, 7.9% of students only used e-cigarettes, 9.3% of students only used marijuana, and 6.6% of students used both e-cigarettes and marijuana in the last 30days. E-cigarette use only was most prevalent among 8th and 10th graders while marijuana use only was most prevalent among 12th graders. The dual use of e-cigarettes and marijuana rapidly increased from 8th graders (2.6%) to 10th graders (7.3%) and maintained a high level for 12th graders (8.5%). Students' sociodemographic factors, school performance and work intensity were associated with e-cigarette and marijuana use in the multivariate analysis. Being a dual user of e-cigarettes and marijuana was associated with increased risk of a medium level or a high level of e-cigarette use and a medium level of marijuana use CONCLUSIONS: This study raised the possibility that youth start to use e-cigarettes at an earlier age and then progress to other substances. Education campaigns with tailored messages to prevent youth from vaping and drug use are critically needed.
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238
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Biyani S, Derkay CS. E-cigarettes: An update on considerations for the otolaryngologist. Int J Pediatr Otorhinolaryngol 2017; 94:14-16. [PMID: 28167004 DOI: 10.1016/j.ijporl.2016.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We provide an update in the literature and national regulations regarding electronic cigarettes with special attention to the pediatric population. BACKGROUND Electronic nicotine delivery systems (ENDS) are handheld battery operated devices that vaporize nicotine-containing liquids for inhalation. Use of these products has dramatically increased over the last several years, particularly among the youth. ENDS are being marketed with advertising techniques and flavors which appeal to the adolescent and young adult population. More reports of accidental pediatric exposures are being documented, as are suicides from abuse of liquid nicotine. Federal regulation has only now become required of these devices. CONCLUSION Use of e cigarettes among adolescents increases each year. Government oversight is needed to protect our children from the re-normalization of tobacco. Otolaryngologists should be prepared to counsel their patients and families regarding the latest in ENDS use.
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Affiliation(s)
- Sneh Biyani
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA
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239
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Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med 2017; 96:73-78. [PMID: 28024859 PMCID: PMC5510594 DOI: 10.1016/j.ypmed.2016.12.034] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022]
Abstract
Whether well-documented patterns of mental health comorbidity with adolescent combustible cigarette use extend to e-cigarette use is unclear. Demonstrating associations between e-cigarette and combustible cigarette use with mental health symptomatology across adolescence may be important for promoting accurate perceptions of populations at risk for and potential consequences of tobacco product use. Adolescents (N=2460; mean age at baseline=14.1; 53.4% female; 44.1% Hispanic) who had never previously used combustible or e-cigarettes were assessed at baseline, and 6- and 12-month follow-ups in Los Angeles, CA (2013-2014). Logistic regression was used to examine associations between baseline depressive symptoms and onset of e-cigarette and cigarette single product and dual use at follow-ups. Latent growth modeling was used to examine associations between sustained use of either product (vs. non-use) and changes in depressive symptoms over 12-months. Higher baseline depressive symptoms predicted subsequent onset of cigarette (OR=1.024, 95% C.I.=1.009-1.055), e-cigarette (OR=1.015, C.I.=1.003-1.023), and dual use of both products (OR=1.021, C.I.=1.003-1.043). Sustained use of e-cigarettes over the 12-month observation (vs. non-use) was associated with a greater rate of increase in depressive symptoms over time (b=1.272, SE=0.513, p=0.01). Among those who sustained use of e-cigarettes, higher frequency of use was associated with higher depressive symptoms at the final follow-up (B=1.611, p=0.04). A bi-directional association of depressive symptoms with e-cigarette use onset across mid adolescence was observed. Further research on the causal nature, etiological underpinnings, and intervention implications of mental health and tobacco product use comorbidity is warranted.
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Affiliation(s)
- William V Lechner
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI, USA.
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, PA, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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240
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Krishnan-Sarin S, Morean M, Kong G, Bold KW, Camenga DR, Cavallo DA, Simon P, Wu R. E-Cigarettes and "Dripping" Among High-School Youth. Pediatrics 2017; 139:peds.2016-3224. [PMID: 28167512 PMCID: PMC5330405 DOI: 10.1542/peds.2016-3224] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) electrically heat and vaporize e-liquids to produce inhalable vapors. These devices are being used to inhale vapors produced by dripping e-liquids directly onto heated atomizers. The current study conducts the first evaluation of the prevalence rates and reasons for using e-cigarettes for dripping among high school students. METHODS In the spring of 2015, students from 8 Connecticut high schools (n = 7045) completed anonymous surveys that examined tobacco use behaviors and perceptions. We assessed prevalence rates of ever using e-cigarettes for dripping, reasons for dripping, and predictors of dripping behaviors among those who reported ever use of e-cigarettes. RESULTS Among 1080 ever e-cigarette users, 26.1% of students reported ever using e-cigarettes for dripping. Reasons for dripping included produced thicker clouds of vapor (63.5%), made flavors taste better (38.7%), produced a stronger throat hit (27.7%), curiosity (21.6%), and other (7.5%). Logistic regression analyses indicated that male adolescents (odds ratio [OR] = 1.64), whites (OR = 1.46), and those who had tried multiple tobacco products (OR = 1.34) and had greater past-month e-cigarette use frequency (OR = 1.07) were more likely to use dripping (Ps < .05). CONCLUSIONS These findings indicate that a substantial portion (∼1 in 4) of high school adolescents who had ever used e-cigarettes also report using the device for dripping. Future efforts must examine the progression and toxicity of the use of e-cigarettes for dripping among youth and educate them about the potential dangers of these behaviors.
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Affiliation(s)
| | - Meghan Morean
- Department of Psychology, Oberlin College, Oberlin, Ohio
| | | | | | - Deepa R. Camenga
- Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | | | | | - Ran Wu
- Departments of Psychiatry and
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Abstract
BACKGROUND Information on e-cigarettes among youth in the Russian Federation is lacking. OBJECTIVE We examined prevalence of and factors associated with youth e-cigarette use in the Russian Federation. METHODS A cross-sectional, anonymous survey, conducted among 716 (females 51.5%) high school students in three cities (i.e., Ufa, Sterlitamak, Karagaevo) within the Republic of Bashkortostan, Russian Federation in 2015, assessed e-cigarette use and its correlates (i.e., sex, age, ethnicity, family structure, parents' highest degrees, antisocial behaviors, stress coping strategies, lifetime cigarette, hookah, alcohol, and marijuana use). RESULTS Lifetime use of e-cigarettes was 28.6% and past-30-day use was 2.2%. Multilevel modeling showed that belonging to Tatar/Bashkir ethnicity relative to Russian ethnicity (OR = 1.60) and lifetime use of cigarettes (OR = 21.64), hookah (OR = 4.21), and alcohol (OR = 1.90) was associated with greater odds of lifetime use of e-cigarettes. Furthermore, use of social support coping strategies (i.e., utilizing parents for support) were associated with lower odds of lifetime use of e-cigarettes (OR = 0.94). CONCLUSIONS Despite high lifetime e-cigarette use, past-30-day use was low. Greater knowledge of the reasons for e-cigarette discontinuation through continued surveillance is needed in the Russian Federation. Social coping strategies involving parents may inform e-cigarette use prevention.
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Affiliation(s)
- Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bulat Idrisov
- Section of General Internal Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, USA
- Department of Preventive Medicine, Bashkir State Medical University, Ufa, Russian Federation
| | - Artur Galimov
- Department of Preventive Medicine, Bashkir State Medical University, Ufa, Russian Federation
| | - Radik Masagutov
- Department of Psychiatry and Narcology, Bashkir State Medical University, Ufa, Russian Federation
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- School of Social Work, University of Southern California, Los Angeles, California, USA
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242
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Hefner K, Valentine G, Sofuoglu M. Electronic cigarettes and mental illness: Reviewing the evidence for help and harm among those with psychiatric and substance use disorders. Am J Addict 2017; 26:306-315. [DOI: 10.1111/ajad.12504] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/22/2016] [Accepted: 01/14/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kathryn Hefner
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Gerald Valentine
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Mehmet Sofuoglu
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
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243
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Demissie Z, Everett Jones S, Clayton HB, King BA. Adolescent Risk Behaviors and Use of Electronic Vapor Products and Cigarettes. Pediatrics 2017; 139:e20162921. [PMID: 28115539 PMCID: PMC10962496 DOI: 10.1542/peds.2016-2921] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescent use of tobacco in any form is unsafe; yet the use of electronic cigarettes and other electronic vapor products (EVPs) has increased in recent years among this age group. We assessed the prevalence and frequency of cigarette smoking and EVP use among high school students, and associations between health-risk behaviors and both cigarette smoking and EVP use. METHODS We used 2015 national Youth Risk Behavior Survey data (N = 15 624) to classify students into 4 mutually exclusive categories of smoking and EVP use based on 30-day use: nonuse, cigarette smoking only, EVP use only, and dual use. Prevalence of cigarette smoking and EVP use were assessed overall and by student demographics and frequency of use. Prevalence ratios were calculated to identify associations with health risk-behaviors. RESULTS In 2015, 73.5% of high school students did not smoke cigarettes or use EVPs, 3.2% smoked cigarettes only, 15.8% used EVPs only, and 7.5% were dual users. Frequency of cigarette smoking and EVP use was greater among dual users than cigarette-only smokers and EVP-only users. Cigarette-only smokers, EVP-only users, and dual users were more likely than nonusers to engage in several injury, violence, and substance use behaviors; have ≥4 lifetime sexual partners; be currently sexually active; and drink soda ≥3 times/day. Only dual users were more likely than nonusers not to use a condom at last sexual intercourse. CONCLUSIONS EVP use, alone and concurrent with cigarette smoking, is associated with health-risk behaviors among high school students.
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Affiliation(s)
- Zewditu Demissie
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and
| | - Heather B Clayton
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and
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244
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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245
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Levy DT, Borland R, Villanti AC, Niaura R, Yuan Z, Zhang Y, Meza R, Holford TR, Fong GT, Cummings KM, Abrams DB. The Application of a Decision-Theoretic Model to Estimate the Public Health Impact of Vaporized Nicotine Product Initiation in the United States. Nicotine Tob Res 2017; 19:149-159. [PMID: 27613952 PMCID: PMC5234365 DOI: 10.1093/ntr/ntw158] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/09/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The public health impact of vaporized nicotine products (VNPs) such as e-cigarettes is unknown at this time. VNP uptake may encourage or deflect progression to cigarette smoking in those who would not have otherwise smoked, thereby undermining or accelerating reductions in smoking prevalence seen in recent years. METHODS The public health impact of VNP use are modeled in terms of how it alters smoking patterns among those who would have otherwise smoked cigarettes and among those who would not have otherwise smoked cigarettes in the absence of VNPs. The model incorporates transitions from trial to established VNP use, transitions to exclusive VNP and dual use, and the effects of cessation at later ages. Public health impact on deaths and life years lost is estimated for a recent birth cohort incorporating evidence-informed parameter estimates. RESULTS Based on current use patterns and conservative assumptions, we project a reduction of 21% in smoking-attributable deaths and of 20% in life years lost as a result of VNP use by the 1997 US birth cohort compared to a scenario without VNPs. In sensitivity analysis, health gains from VNP use are especially sensitive to VNP risks and VNP use rates among those likely to smoke cigarettes. CONCLUSIONS Under most plausible scenarios, VNP use generally has a positive public health impact. However, very high VNP use rates could result in net harms. More accurate projections of VNP impacts will require better longitudinal measures of transitions into and out of VNP, cigarette and dual use. IMPLICATIONS Previous models of VNP use do not incorporate whether youth and young adults initiating VNP would have been likely to have been a smoker in the absence of VNPs. This study provides a decision-theoretic model of VNP use in a young cohort that incorporates tendencies toward smoking and shows that, under most plausible scenarios, VNP use yields public health gains. The model makes explicit the type of surveillance information needed to better estimate the effect of new products and thereby inform public policy.
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Affiliation(s)
- David T. Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Ron Borland
- VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Andrea C. Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC
| | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC
| | - Zhe Yuan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Yian Zhang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | | | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - David B. Abrams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Hammett E, Veldheer S, Yingst J, Hrabovsky S, Foulds J. Characteristics, use patterns and perceptions of electronic cigarette users who were never traditional cigarette smokers. Addict Behav 2017; 65:92-97. [PMID: 27816045 DOI: 10.1016/j.addbeh.2016.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 12/23/2022]
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247
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Levy DT, Borland R, Fong GT, Villanti AC, Niaura R, Meza R, Holford TR, Cummings KM, Abrams DB. Developing Consistent and Transparent Models of E-cigarette Use: Reply to Glantz and Soneji et al. Nicotine Tob Res 2017; 19:268-270. [PMID: 28082477 PMCID: PMC6296399 DOI: 10.1093/ntr/ntw236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/01/2016] [Indexed: 12/29/2022]
Affiliation(s)
- David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC;
| | - Ron Borland
- Nigel Gray Distinguished Fellow in Cancer Prevention, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Melbourne, Australia
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | | | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - David B Abrams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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248
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Dutra LM, Glantz SA. E-cigarettes and National Adolescent Cigarette Use: 2004-2014. Pediatrics 2017; 139:peds.2016-2450. [PMID: 28115540 PMCID: PMC5260150 DOI: 10.1542/peds.2016-2450] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND E-cigarette use is rapidly increasing among adolescents in the United States, with some suggesting that e-cigarettes are the cause of declining youth cigarette smoking. We hypothesized that the decline in youth smoking changed after e-cigarettes arrived on the US market in 2007. METHODS Data were collected by using cross-sectional, nationally representative school-based samples of sixth- through 12th-graders from 2004-2014 National Youth Tobacco Surveys (samples ranged from 16 614 in 2013 to 25 324 in 2004). Analyses were conducted by using interrupted time series of ever (≥1 puff) and current (last 30 days) cigarette smoking. Logistic regression was used to identify psychosocial risk factors associated with cigarette smoking in the 2004-2009 samples; this model was then applied to estimate the probability of cigarette smoking among cigarette smokers and e-cigarette users in the 2011-2014 samples. RESULTS Youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking and P = .05 for current smoking), with no significant change in this trend after 2009 (P = .57 and .23). Based on the psychosocial model of smoking, including demographic characteristics, willingness to wear clothing with a tobacco logo, living with a smoker, likelihood of smoking in the next year, likelihood of smoking cigarettes from a friend, and use of tobacco products other than cigarettes or e-cigarettes, the model categorized <25% of current e-cigarette-only users (between 11.0% in 2012 and 23.1% in 2013) as current smokers. CONCLUSIONS The introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette-only users would be unlikely to have initiated tobacco product use with cigarettes.
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Affiliation(s)
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, and,Department of Medicine, University of California San Francisco, San Francisco, California
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249
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Elmore KC, Scull TM, Kupersmidt JB. Media as a "Super Peer": How Adolescents Interpret Media Messages Predicts Their Perception of Alcohol and Tobacco Use Norms. J Youth Adolesc 2017; 46:376-387. [PMID: 27837371 PMCID: PMC5243166 DOI: 10.1007/s10964-016-0609-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Adolescents' media environment offers information about who uses substances and what happens as a result-how youth interpret these messages likely determines their impact on normative beliefs about alcohol and tobacco use. The Message Interpretation Processing (MIP) theory predicts that substance use norms are influenced by cognitions associated with the interpretation of media messages. This cross-sectional study examined whether high school adolescents' (n = 817, 48 % female, 64 % white) media-related cognitions (i.e., similarity, realism, desirability, identification) were related to their perceptions of substance use norms. Results revealed that adolescents' media-related cognitions explained a significant amount of variance in perceived social approval for and estimated prevalence of peer alcohol and tobacco use, above and beyond previous use and demographic covariates. Compared to prevalence norms, social approval norms were more closely related to adolescents' media-related cognitions. Results suggest that critical thinking about media messages can inhibit normative perceptions that are likely to increase adolescents' interest in alcohol and tobacco use.
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Affiliation(s)
- Kristen C Elmore
- Bronfenbrenner Center for Translational Research, Cornell University, Beebe Hall, 110 Plantations Rd., Ithaca, NY, 14853, USA.
| | - Tracy M Scull
- Innovation Research & Training, Durham, NC, 27713, USA
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250
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Affiliation(s)
- Thomas A Wills
- Cancer Prevention and Control Program, University of Hawaii Cancer Center and Department of Native Hawaiian Health, John A. Burns School of Medicine, Honolulu, Hawaii
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