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Watkins SL, Page S, Kim Y, Kostygina G, Emery S. Flavored combustible tobacco product initiation in two longitudinal youth cohorts in the US Population Assessment of Tobacco and Health Study: 2013-2016 and 2016-2019. Addict Behav 2024; 160:108176. [PMID: 39348776 DOI: 10.1016/j.addbeh.2024.108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/15/2024] [Accepted: 09/21/2024] [Indexed: 10/02/2024]
Abstract
INTRODUCTION Flavored tobacco products increase appeal and lower barriers to nicotine addiction for young people. We compared environmental, psychosocial, behavioral, and demographic characteristics between youth who started with flavored and non-flavored (i.e., tobacco-flavored) combustible tobacco products (CTPs). METHODS We analyzed two representative US youth cohorts (baseline age 12-15) from the Population Assessment of Tobacco and Health (PATH) Study (Wave 1 Cohort (W1) 2013-2016; Wave 4 Cohort (W4) 2016-2019). We first assessed baseline characteristics associated with any subsequent CTP initiation among youth with baseline never CTP use (W1 n=5,946; W4 n=8,240). Then, for baseline CTP-naïve youth with subsequent CTP initiation (new experimentation; W1 n=519; W4 n=538), we assessed baseline characteristics associated with subsequent initiation with flavored CTPs versus non-flavored. RESULTS Most youth reporting new CTP experimentation initiated with flavored CTPs (W1:67.8%; W4:74.2%). Household norms, susceptibility, baseline experimentation with vaping, alcohol, and/or cannabis; and White race were associated with CTP experimentation. For both cohorts, frequent social media use was associated with flavored CTP initiation (W4 AOR:2.50, 95%CI:1.22,5.12) and Black youth (W4 AOR:0.12, 95%CI:0.06,0.25) were less likely to initiate with flavored CTPs than White youth. Among W1 Cohort youth, perceiving flavored product use as easier was positively associated with flavored CTP initiation (AOR:1.48, 95%CI:1.01,2.17). Among W4 Cohort youth, baseline vaping was negatively associated with flavored CTP initiation (AOR:0.10, 95%CI:0.05,0.20). CONCLUSION Frequent social media use was associated with flavored CTP initiation among youth who used CTPs. Youth who had ever vaped and Black youth were less likely to initiate with flavored CTPs.
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Affiliation(s)
| | - Simon Page
- NORC at the University of Chicago, 55 E Monroe St 30th Floor, Chicago, IL 60603, USA.
| | - Yoonsang Kim
- NORC at the University of Chicago, 55 E Monroe St 30th Floor, Chicago, IL 60603, USA.
| | - Ganna Kostygina
- NORC at the University of Chicago, 55 E Monroe St 30th Floor, Chicago, IL 60603, USA.
| | - Sherry Emery
- NORC at the University of Chicago, 55 E Monroe St 30th Floor, Chicago, IL 60603, USA.
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2
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Buta E, Gueorguieva R, Simon P, Garrison KA. Behavioral Precursors of Nicotine Product Use Trajectories Among Youth. Am J Prev Med 2024; 67:360-369. [PMID: 38782105 DOI: 10.1016/j.amepre.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Preventing nicotine use among youth is a public health priority. Nicotine use emerges from complex relationships between numerous factors. This project used network analysis to model behavioral precursors of nicotine use (knowledge, attitudes, perceptions, intentions) among youth who had never used nicotine and determine which predicted future trajectories of use across multiple nicotine products. METHODS Data were from the Population Assessment of Tobacco and Health study (2013-2018; analyzed 2023-2024), youth ages 12-17, who reported never using nicotine at Wave 1. Network structure was determined for behavioral precursors at Wave 1 and central network nodes were identified (N=5,087). Central nodes were then tested as predictors of trajectories of use across multiple nicotine products during Waves 1-4 (N=3,851). RESULTS Central nodes of the Wave 1 network were harm perception, expectancy that tobacco would calm anger/reduce stress, and intention to try. Those with lower intent to try at Wave 1 had lower odds of being in an Experimentation or Use class versus a Nonuse class during Waves 1-4 (p<0.0001). Those with more accurate harm perception had lower odds of being in an Experimentation versus Nonuse class (p=0.004). Those with positive expectancies had higher odds of being in an Experimentation versus Nonuse or Use class (p=0.04, 0.02). CONCLUSIONS Findings suggest a network model of behavioral precursors of nicotine use that can be tested, including central nodes that predicted trajectories of use across multiple nicotine products, and therefore may be priority intervention targets.
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Affiliation(s)
- Eugenia Buta
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Patricia Simon
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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Blank MD, Turiano NA, Bray BC, Milstred AR, Childers M, Dino G, Romm KF. Factors associated with transitions in tobacco product use states among young adults aged 18-29 years. Am J Addict 2024; 33:409-422. [PMID: 38402462 DOI: 10.1111/ajad.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/19/2023] [Accepted: 02/10/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined young adults' tobacco use transitions based on their past 30-day use states, and identified factors associated with their transitions. METHODS Participants (N = 12377) were young adults aged 18-29 years at Wave 1 of the Population Assessment of Tobacco and Health (PATH) study. Self-reported tobacco use states were categorized by the number of past-month use days (0, 1-4, 5-8, 9-12, 13-30 days) for cigarettes, electronic cigarettes [e-cigarettes], traditional cigars, filtered cigars, cigarillos, smokeless tobacco (SLT), and hookah. Multistate Markov models examined transitions between use states across Waves 1-5 of unweighted PATH data and multinomial logistic regressions examined predictors of transitions. RESULTS Most young adults remained nonusers across adjacent waves for all products (88%-99%). Collapsed across waves, transitioning from use at any level to nonuse (average 46%-67%) was more common than transitioning from nonuse to use at any level (average 4%-10%). Several factors that predicted riskier patterns of use (i.e., transitioning to use and/or remaining a user across adjacent waves) were similar across most products: male, Black, Hispanic, lower education levels, and lower harm perceptions. In contrast, other factors predicted riskier patterns for only select products (e.g., e-cigarette and SLT use among Whites). DISCUSSION AND CONCLUSIONS Few sampled young adults escalated their tobacco use over time, and escalations for many products were predicted by similar factors. SCIENTIFIC SIGNIFICANCE Prevention and regulatory efforts targeted towards adolescents should continue, but also be expanded into young adulthood. These same efforts should consider both shared and unique factors that influence use transitions.
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Affiliation(s)
- Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Nicholas A Turiano
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Bethany C Bray
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea R Milstred
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Margaret Childers
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Geri Dino
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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4
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Ranker LR, Wu J, Hong T, Wijaya D, Benjamin EJ, Bhatnagar A, Robertson RM, Fetterman JL, Xuan Z. Social media use, brand engagement, and tobacco product initiation among youth: Evidence from a prospective cohort study. Addict Behav 2024; 154:108000. [PMID: 38461745 PMCID: PMC11135121 DOI: 10.1016/j.addbeh.2024.108000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/19/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To evaluate whether frequent social media use and liking/following tobacco brand accounts was associated with increased risk of tobacco and polytobacco initiation over approximately 1-year follow-up among youth with no prior tobacco use. METHODS Associations between measures of social media engagement (daily social media use and liking/following tobacco brands) and tobacco initiation risk were examined using data from Waves 2 and 3 (2014-2015) of the US Population Assessment for Tobacco and Health study. Separate log-binomial models, accounting for missing data via multiple imputation and using propensity score adjustment to address confounding, estimated the adjusted relative risk (aRR) of any tobacco initiation and poly-use (2 + products) initiation at 1-year follow-up. RESULTS Among the 8,672 youth with no prior tobacco use (49.3% female, mean [SD] age 14.1 [1.7]), 63.5% used social media at least daily, and 3.3% reported liking/following ≥ 1 tobacco brands on social media. Those reporting daily or more frequent social media use (compared to less) were at increased risk for tobacco (aRR 1.67; 95% CI 1.38-2.02) and polytobacco initiation (aRR 1.32; 95% CI 0.98-1.78). Although results were imprecise, liking/following ≥ 1 tobacco brands on social media (versus none) was associated with tobacco (aRR 1.34; 95% CI 0.95-1.89) or polytobacco initiation (aRR 1.60; 95% CI 0.99-2.60). In sensitivity analyses, liking/following cigarette or cigarillo brands was associated with polytobacco initiation. CONCLUSIONS This study adds to a growing evidence-base describing the exposure of youth to tobacco-related social media content. Such content-often generated by tobacco companies-may contribute to youth tobacco initiation.
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Affiliation(s)
- Lynsie R Ranker
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th floor, Boston, MA 02118, USA.
| | - Jiaxi Wu
- College of Communication, Boston University, 640 Commonwealth Avenue, Boston, MA 02215, USA; Annenberg School for Communication, University of Pennsylvania, 3620 Walnut St, PA 19104, Philadelphia
| | - Traci Hong
- College of Communication, Boston University, 640 Commonwealth Avenue, Boston, MA 02215, USA
| | - Derry Wijaya
- Department of Computer Science, Boston University, 111 Cummington Mall, Boston, MA 02215, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 725 Albany Street, Boston, MA 02118, USA; Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 4th floor, Boston, MA 02118, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, 302 E Muhammad Ali Boulevard, KY 40202, Louisville; American Heart Association Tobacco Regulation and Addiction Center, 7272 Greenville Ave., Dallas, TX 75231, USA
| | - Rose M Robertson
- American Heart Association Tobacco Regulation and Addiction Center, 7272 Greenville Ave., Dallas, TX 75231, USA; Department of Medicine, School of Medicine, Vanderbilt University, 1161 21st Ave. S., Nashville 37232, TN, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, Boston, MA 02118, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th floor, Boston, MA 02118, USA
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Li W, Kong G, Davis DR, Bold KW, Krishnan-Sarin S, Camenga DR, Morean ME. Sources of exposure to non-tobacco nicotine electronic nicotine delivery systems and associations with susceptibility to use and use behaviors among young adults in the United States. PLoS One 2024; 19:e0299533. [PMID: 38718067 PMCID: PMC11078344 DOI: 10.1371/journal.pone.0299533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/12/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The Electronic Nicotine Delivery Systems (ENDS) industry recently introduced non-tobacco nicotine (NTN), which is not tobacco-derived and is often marketed as "tobacco-free nicotine." Given its novelty, it is important to understand where young adults learn about NTN ENDS. This study examined sources of exposure to NTN ENDS and relationships with NTN ENDS use and susceptibility. METHODS We analyzed online survey data collected in Fall 2021 from 642 young adults (18-25 years) who had heard of NTN ENDS. We assessed 9 sources of NTN ENDS exposure (e.g., retail stores, social media) and examined associations between sources of exposure and NTN current (past-month) use, lifetime (non-current) use, and susceptibility to use, adjusting for demographics and other tobacco product use. RESULTS Participants reported current NTN ENDS use (37.4%), lifetime use (12.0%), susceptibility (18.5%), or no susceptibility to use (32.1%). The most common sources of NTN ENDS exposure were retail stores (87.7%) and social media (81.0%). Exposure to NTN ENDS via social media was associated with greater odds of current NTN ENDS use (vs. no susceptibility) (aOR = 1.83, 95%CI: 1.02-3.28). Exposure via online streaming platforms was associated with greater odds of current (aOR = 1.75, 95%CI: 1.08-2.82) and lifetime NTN ENDS use (aOR = 2.42, 95%CI: 1.25-4.68). CONCLUSIONS Young adults were exposed to and learned about NTN ENDS from diverse sources, primarily retail shops and social media. Further, exposure via social media and streaming platforms were associated with NTN ENDS use. Future studies should explore the content of NTN information from various sources to inform prevention efforts.
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Affiliation(s)
- Wei Li
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Meghan E Morean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
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Barker HE, Czaplicki L, Cui Y, Shen R, Nian Q, Xie M, Cohen JE. Exposure to and Appeal of Tobacco Ads and Displays in China: A Qualitative Exploration of Chinese Youth Perceptions. Nicotine Tob Res 2024; 26:427-434. [PMID: 37788378 PMCID: PMC10959156 DOI: 10.1093/ntr/ntad192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Adolescents are uniquely vulnerable to nicotine addiction, and smoking is common among male adolescents in China. Although China implemented a ban on cigarette and e-cigarette advertising in public places, Chinese youth remain exposed to this marketing, which may contribute to future use. AIMS AND METHODS From December 2021 to January 2022, we conducted 20 online focus group discussions with 119 adolescents in 10 Chinese cities to explore sources of tobacco marketing exposure, defined as exposure to cigarette and e-cigarette ads and product displays, and what features made marketing attractive. RESULTS All groups discussed exposure to tobacco ads/displays in public places, including locations near their home or school. Nearly all groups discussed that exposure to online tobacco ads was common, particularly exposure to e-cigarette commercial ads and posts made by classmates or friends selling e-cigarettes. Most groups identified how eye-catching colors, imagery, product packaging, and price promotions featured in e-cigarette ads/displays attracted their attention. CONCLUSIONS Results suggest Chinese adolescents are exposed to cigarette and e-cigarette ads and displays, many of which are placed in youth-friendly locations and contain youth-appealing features. IMPLICATIONS Only a handful of studies have examined the influence of cigarette and e-cigarette advertising on youth in the context of China. Prior research has established the relationship between youth exposure to tobacco marketing and increased susceptibility to future use. Our findings emphasize the importance of effectively enforcing and expanding restrictions on cigarette and e-cigarette marketing in order to protect youth from exposure and future smoking/vaping initiation.
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Affiliation(s)
- Hannah E Barker
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Yuxian Cui
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Rachel Shen
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Marn Xie
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
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Khayat A, Levine H, Berg CJ, Shauly-Aharonov M, Manor O, Abroms L, Romm KF, Wysota CN, Bar-Zeev Y. IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis. Tob Control 2024; 33:e3-e10. [PMID: 36368887 PMCID: PMC10172385 DOI: 10.1136/tc-2022-057585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International's (PMI) IQOS and cigarette advertisements. METHODS Weekly number of ads and weekly adspend of PMI's IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported. RESULTS The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend. CONCLUSIONS IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products' advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michal Shauly-Aharonov
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Setodji CM, Martino SC, Dunbar M, Kim KJ, Jenson D, Wong JCS, Shadel WG. Measuring susceptibility to use tobacco in an increasingly complex consumer marketplace: How many questions do we really need? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024:2024-59384-001. [PMID: 38421778 PMCID: PMC11358647 DOI: 10.1037/adb0000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Predicting which young people are likely to use tobacco in the future is critical for prevention and intervention. Although measures for assessing susceptibility to using tobacco have fulfilled this goal for decades, there is almost no standard for the number of items that should be administered, or which items should be administered for which products. This study explored whether brief but psychometrically sound versions of commonly used susceptibility measures can adequately capture the construct relative to longer measures. METHOD A sample of young people (N = 451; Mage = 16.5 years; 64% females; 65% White) completed 33 susceptibility items, which are designed to assess susceptibility to use different types of tobacco products (cigarette, smokeless tobacco, vaping products, and little cigars/cigarillos) of various flavors (tobacco, menthol, and sweet). RESULTS Analysis of these 33 items indicated that asking about the likelihood of using each tobacco product class when a best friend offers it (four items in all) captures 98.5% of information that is captured using the longer set of items; asking the best friend question for each product by each flavor category (11 items in all) captures 99.7% of the information. CONCLUSIONS Depending on research needs, tobacco use susceptibility can be measured with little loss of information by administering a limited set of items assessing the likelihood that a young person will use a tobacco product if a friend offers it for any product-flavor combination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law,
Saint Paul, MN 55105
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9
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Sharma A, Fix B, Hyland A, Bansal-Travers M, Quisenberry A, O’Connor R. Exposure to IQOS ads and reduced exposure claims, and association with perceived risk from COVID-19 on IQOS purchase and use intentions: results from a web-based survey. Front Public Health 2024; 11:1307484. [PMID: 38269390 PMCID: PMC10805831 DOI: 10.3389/fpubh.2023.1307484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction IQOS was authorized to be marketed as a reduced exposure product by the Food and Drug Administration in October 2020 during the global COVID-19 pandemic. Those who smoke may be more sensitive to reduced exposure marketing claims and may have an increased inclination toward IQOS use. We evaluated the likelihood of trying and purchasing IQOS as a function of exposure to ads, product appeal, and COVID-19 risk perceptions using the original IQOS ads with reduced exposure marketing. Method An online cross-sectional survey recruited 604 US adults (18-45 years), both who smoke and do not smoke. Participants saw one of the six randomly assigned IQOS ads with or without reduced exposure claims, and they answered questions about product appeal and likelihood to try and purchase IQOS. Generalized linear models were used to examine associations. Results A per unit increase in product appeal was associated with a greater likelihood of purchasing (B = 0.17, 95% CI: 0.15-0.18) and trying IQOS (B = 0.16, 95% CI = 0.14-0.18). Current smokers and former e-cigarette users reported greater intentions to try IQOS than never-smokers and never e-cigarette users, respectively. Likelihood to purchase IQOS was associated with greater confidence in not contracting COVID-19 (B = 0.11, 95% CI: 0.01-0.21). No significant differences were observed between different ad conditions. Current (B = -0.34, 95% CI = -0.50-(-0.19)) and former (B = -0.92, 95% CI = -0.15-(-0.68)) cigarette smokers who were someday e-cigarette users reported less intentions to purchase IQOS than never e-cigarette users. However, never smokers who were someday (B = 0.58, 95% CI = 0.27-0.89; B = 0.68, 95% CI = 0.39-0.98) and former e-cigarette (B = 0.38, 95% CI = 0.15-0.61) users reported greater intentions to purchase and try IQOS, respectively. Discussion IQOS may have a higher product appeal, especially for those who currently smoke and those who have lower risk perceptions from COVID-19. Among never smokers, those who currently use or have used e-cigarettes in the past may be more receptive to IQOS marketing. The data are informative for potential trends in the use of IQOS in the future and may have implications for marketing regulations of heated tobacco products (HTPs).
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Affiliation(s)
- Akshika Sharma
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Brian Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Amanda Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Richard O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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10
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Kelly BC, Vuolo M, Orsini MM, Maggs JL, Staff J. Tobacco Policy and ENDS Policy Influences on Adolescent Vaping Across the U.S. States. Am J Prev Med 2023; 65:1026-1033. [PMID: 37482258 PMCID: PMC10799971 DOI: 10.1016/j.amepre.2023.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Although the use of tobacco has declined among youth, ENDS has the potential to disrupt or reverse these trends. Policies for tobacco and ENDS may have an impact on adolescent ENDS use. The impacts of state-level policies were examined for both tobacco and ENDS indoor use bans, excise taxes, and age-of-purchase laws on past-month adolescent ENDS use from 2013 to 2019. METHODS This study used cohort data from the Population Assessment of Tobacco and Health study and policy data from the Americans for Nonsmokers' Rights Foundation repository-3 policies for ENDS and 2 policies for tobacco products. Policies included comprehensive indoor vaping/smoking bans, purchase-age restrictions, and excise taxes. Hybrid panel models were estimated in 2022 using data merged from the 2 longitudinal sources on past-month vaping. The analytic sample (observations=26,008) included adolescents aged 12-17 years, yielding a total of 72,684 observations. RESULTS The odds of adolescent ENDS use were 21.4% lower when the state had an ENDS purchase-age restriction and 55.0% lower when the state had a comprehensive tobacco smoking ban than in the years when the state did not have the ban. CONCLUSIONS During a period of significant growth in ENDS use among U.S. youth, ENDS purchase-age restrictions and smoking bans reduced the odds of past-month vaping among adolescents. Wider implementation of policies may help intervene in youth vaping.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, College of Liberal Arts, Purdue University, West Lafayette, Indiana.
| | - Mike Vuolo
- Department of Sociology, College of Arts and Sciences, The Ohio State University, Columbus, Ohio
| | - Maria M Orsini
- Department of Sociology, College of Arts and Sciences, The Ohio State University, Columbus, Ohio
| | - Jennifer L Maggs
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, State College, Pennsylvania
| | - Jeremy Staff
- Department of Sociology and Criminology, College of Liberal Arts, The Pennsylvania State University, State College, Pennsylvania
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Pierce JP, Luo M, McMenamin SB, Stone MD, Leas EC, Strong D, Shi Y, Kealey S, Benmarhnia T, Messer K. Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge. Tob Control 2023:tc-2022-057907. [PMID: 37940404 DOI: 10.1136/tc-2022-057907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To compare trends in cigarette smoking and nicotine vaping among US population aged 17-18 years and 18-24 years. METHODS Regression analyses identified trends in ever and current use of cigarettes and e-cigarettes, using three US representative surveys from 1992 to 2022. RESULTS From 1997 to 2020, cigarette smoking prevalence among those aged 18-24 years decreased from 29.1% (95% CI 27.4% to 30.7%) to 5.4% (95% CI 3.9% to 6.9%). The decline was highly correlated with a decline in past 30-day smoking among those aged 17-18 years (1997: 36.8% (95% CI 35.6% to 37.9%; 2022: 3.0% (95% CI 1.8% to 4.1%). From 2017 to 2019, both ever-vaping and past 30-day nicotine vaping (11.0% to 25.5%) surged among those 17-18 years, however there was no increase among those aged 18-24 years. Regression models demonstrated that the surge in vaping was independent of the decline in cigarette smoking. In the 24 most populous US states, exclusive vaping did increase among those aged 18-24 years, from 1.7% to 4.0% to equivalent to 40% of the decline in cigarette smoking between 2014-15 and 2018-19. Across these US states, the correlation between the changes in vaping and smoking prevalence was low (r=0.11). In the two US states with >US$1/fluid mL tax on e-cigarettes in 2017, cigarette smoking declined faster than the US average. CONCLUSIONS Since 1997, a large decline in cigarette smoking occurred in the US population under age 24 years, that was independent of the 2017-19 adolescent surge in past 30-day e-cigarette vaping. Further research is needed to assess whether the 2014-15 to 2018-19 increase in exclusive vaping in those aged 18-24 years is a cohort effect from earlier dependence on e-cigarette vaping as adolescents.
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Affiliation(s)
- John P Pierce
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Man Luo
- Division of Biostatistics, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Sara B McMenamin
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Matthew D Stone
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Eric C Leas
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - David Strong
- Division of Health Behavior, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Yuyan Shi
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
| | - Karen Messer
- Division of Biostatistics, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- Biostatistics Shared Resource, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
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12
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Shadel WG, Setodji CM, Martino SC, Dunbar M, Jenson D, Bialas A, Li R. Does removing menthol cigarettes in convenience stores reduce susceptibility to cigarette smoking? An experimental investigation in young people. Drug Alcohol Depend 2023; 251:110938. [PMID: 37651811 PMCID: PMC10544723 DOI: 10.1016/j.drugalcdep.2023.110938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Evidence for the effectiveness of menthol cigarette bans comes mostly from studies of adults that smoke. This experiment evaluated whether the absence of menthol products from a convenience store influenced young people's susceptibility to cigarette smoking after they shopped in the store. METHODS This experiment took place in the RAND StoreLab (RSL), a life-sized research convenience store. A three-group, between-subjects design was used. Study conditions differed in the mix of flavored tobacco products the RSL displayed: 1) All tobacco-, sweet-, and menthol-flavors displayed; 2) only tobacco- and menthol-flavors displayed; and 3) only tobacco-flavors displayed. Participants were randomly assigned to shop in the RSL under one of these conditions and after shopping, completed measures of their susceptibility to cigarette smoking, one measure for menthol cigarettes and one for unflavored cigarettes (scores on each susceptibility measure was dichotomized: 0 = not susceptible; 1 = susceptible). RESULTS Multivariable logistic regression assessed the main effects of condition on susceptibility to smoking menthol and unflavored cigarettes. There was no condition effect on susceptibility to smoking unflavored cigarettes. However, removing menthol-flavored products significantly increased participants' susceptibility to smoking menthol cigarettes compared to when all flavored products were available (OR = 3.66, 95% CI [1.33, 10.03]). This significant effect was only found among young people with some pre-existing risk of cigarette smoking (OR = 5.92, 95% CI [1.81, 19.39]). CONCLUSION Results suggest the need to consider that menthol bans could unintentionally increase the appeal of menthol cigarettes among youth already at risk of smoking.
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Affiliation(s)
| | | | | | | | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, MN 55105, USA
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13
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Dutra LM, Farrelly MC, Bradfield B, Mekos D, Jones C, Alexander T. Awareness of and receptivity to FDA's point-of-sale tobacco public education campaign. PLoS One 2023; 18:e0288462. [PMID: 37440511 DOI: 10.1371/journal.pone.0288462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
The purpose of the study was to assess awareness of and receptivity to FDA's point-of-sale (POS) tobacco public education campaign for adult cigarette smokers called Every Try Counts; it was the first multi-county POS campaign in the U.S. The design was a county-level treatment-control three-wave longitudinal design. The setting was 15 treatment and 15 control counties. Subjects were smokers ages 25 to 54 (N = 3,628). 4,145 individuals screened in as eligible; 3,628 (87.5% response rate) completed the Wave 1 questionnaire (Wave 2: n = 2,812; Wave 3: n = 2,571; retention 70.9%). Measures were self-reported brand and ad awareness (saw any ad a few times or more) and receptivity (5-item perceived effectiveness scale). The analysis included descriptive analyses of receptivity; bivariate analyses of awareness by treatment group; and covariate- and time-adjusted logistic regression models to determine changes in awareness attributable to the campaign. Receptivity was moderate and differed significantly by race/ethnicity. As was the case for all waves, at wave 3, ad awareness was significantly higher in treatment (53.3%) than control counties (36.1%, p < .05). In regression models, brand (OR = 1.53, 95% CI: 1.26-1.86) and ad (OR = 1.74, 95% CI: 1.39-2.16) awareness were significantly higher in treatment than control counties. Every Try Counts generated a moderate level of receptivity and attention from cigarette smokers. Limitations include self-reports of campaign awareness and generalizability to a small number of U.S. counties.
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Affiliation(s)
- Lauren M Dutra
- Center for Health Analytics, Media, and Policy, RTI International, Raleigh, North Carolina, United States of America
| | - Matthew C Farrelly
- Center for Health Analytics, Media, and Policy, RTI International, Raleigh, North Carolina, United States of America
| | - Brian Bradfield
- Center for Health Analytics, Media, and Policy, RTI International, Raleigh, North Carolina, United States of America
| | - Debra Mekos
- Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Chaunetta Jones
- Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Tesfa Alexander
- Public Health Systems Innovation and Transformation, MITRE Corporation, Rockville, Maryland, United States of America
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14
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Hébert ET, Vandewater EA, Businelle MS, Harrell MB, Kelder SH, Perry CL. Tobacco advertising exposure and product use among young adults: An ecological momentary assessment approach. Addict Behav 2023; 139:107601. [PMID: 36592525 PMCID: PMC9872832 DOI: 10.1016/j.addbeh.2022.107601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Tobacco-related content is prevalent on social media, yet many methods of measuring exposure are inadequate due to the personalized nature of online marketing. The purpose of this paper is to examine the association between exposure to pro-tobacco messages (both industry-sponsored and user-generated) and the use of tobacco products, as reported via ecological momentary assessment (EMA). METHODS Young adults (n = 175) were instructed to record all sightings of marketing (both in-person and online) related to tobacco for 28 days. Tobacco product use and recall of message encounters were assessed daily using app-initiated EMA. RESULTS Participants who reported exposure to tobacco messages were significantly more likely to report using tobacco, adjusting for gender, age, race/ethnicity, baseline use of any tobacco product, and having friends who use tobacco and e-cigarettes (p <.001). For each industry-sponsored message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.77 (95 % CI = 1.41, 2.23). For each user-generated message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.52 (95 % CI = 1.27, 1.83). DISCUSSION To our knowledge, this is the first study to specifically examine the association between exposure to user-generated messages and daily tobacco use. The findings suggests that there is a unique element to user-generated messages that distinguishes them from both traditional marketing and from simple peer influence.
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Affiliation(s)
- Emily T Hébert
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States.
| | | | - Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
| | - Steven H Kelder
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
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Atuegwu NC, Mortensen EM, Krishnan-Sarin S, Laubenbacher RC, Litt MD. Prospective predictors of electronic nicotine delivery system initiation in tobacco naive young adults: A machine learning approach. Prev Med Rep 2023; 32:102148. [PMID: 36865398 PMCID: PMC9971268 DOI: 10.1016/j.pmedr.2023.102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/11/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
The use of electronic nicotine delivery systems (ENDS) is increasing among young adults. However, there are few studies regarding predictors of ENDS initiation in tobacco-naive young adults. Identifying the risk and protective factors of ENDS initiation that are specific to tobacco-naive young adults will enable the creation of targeted policies and prevention programs. This study used machine learning (ML) to create predictive models, identify risk and protective factors for ENDS initiation for tobacco-naive young adults, and the relationship between these predictors and the prediction of ENDS initiation. We used nationally representative data of tobacco-naive young adults in the U.S drawn from the Population Assessment of Tobacco and Health (PATH) longitudinal cohort survey. Respondents were young adults (18-24 years) who had never used any tobacco products in Wave 4 and who completed Waves 4 and 5 interviews. ML techniques were used to create models and determine predictors at 1-year follow-up from Wave 4 data. Among the 2,746 tobacco-naive young adults at baseline, 309 initiated ENDS use at 1-year follow-up. The top five prospective predictors of ENDS initiation were susceptibility to ENDS, increased days of physical exercise specifically designed to strengthen muscles, frequency of social media use, marijuana use and susceptibility to cigarettes. This study identified previously unreported and emerging predictors of ENDS initiation that warrant further investigation and provided comprehensive information on the predictors of ENDS initiation. Furthermore, this study showed that ML is a promising technique that can aid ENDS monitoring and prevention programs.
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Affiliation(s)
- Nkiruka C. Atuegwu
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA
- Corresponding author at: University of Connecticut, Department of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - Eric M. Mortensen
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, USA
| | - Reinhard C. Laubenbacher
- Laboratory for Systems Medicine, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mark D. Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT 06030, USA
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16
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Dai HD, Pierce J, Beseler C, Abadi A, Zoucha K, Johnson R, Buckley J, Ramos AK. Hierarchical Modeling of Psychosocial, Parental, and Environmental Factors for Susceptibility to Tobacco Product Use in 9-10-Year-Old Children. J Adolesc Health 2023; 72:267-276. [PMID: 36424333 PMCID: PMC10917612 DOI: 10.1016/j.jadohealth.2022.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Tobacco use during early adolescence can harm brain development and cause adverse health outcomes. Identifying susceptibility in early adolescence before initiation presents an opportunity for tobacco use prevention. METHODS Data were drawn from the Adolescent Brain and Cognitive Development study that enrolled 9-10-year-old children in 21 US cities between 2016 and 2018 at baseline. Separate nested hierarchical models were performed to incrementally examine the associations of sociodemographic factors, psychosocial influences, parental substance use, immediate social contacts, and perceived neighborhood safety with tobacco use susceptibility among never tobacco users (n = 10,449), overall and stratified by gender. RESULTS A total of 16.6% of youths who have never used tobacco reported susceptibility to tobacco. Females (vs. males, adjusted odds ratio [AOR] [95% confidence interval {CI}] = 0.80 [0.70-0.91]), positive parental monitoring (AOR [95% CI] = 0.76 [0.66-0.87]) and positive school environment (AOR [95% CI] = 0.95 [0.93-0.98]) were associated with reduced susceptibility to tobacco use. Parental education level (high school, AOR [95% CI] = 1.52 [1.02-2.28]; bachelor's degree, AOR [95% CI] = 1.53 [1.03-2.28]; or postgraduate degree, AOR [95% CI] = 1.54 [1.03-2.3] vs. less than high school), youth substance ever use (AOR [95% CI] = 2.24 [1.95-2.58]), internalizing problems (AOR [95% CI] = 1.03 [1-1.06]), and high scores on negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and positive urgency-impulsive behavior scale were associated with increased susceptibility to tobacco use. Stratified analysis showed that parent-perceived neighborhood safety was associated with reduced susceptibility to tobacco use among males but not among females (AOR [95% CI] = 0.89 [0.81-0.99]) vs. (AOR [95% CI] = 1.01 [0.9-1.13]). A positive school environment was associated with lower susceptibility to tobacco use among females but not among males. DISCUSSION Parental, environmental, and psychosocial factors influence early childhood tobacco susceptibility. Family and school-based tobacco prevention programs should consider integrating these factors into primary school curricula to reduce youth tobacco susceptibility and later initiation.
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Affiliation(s)
- Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
| | - John Pierce
- Department of Family Medicine & Public Health, University of California-San Diego, San Diego, California
| | - Cheryl Beseler
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Azar Abadi
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kenneth Zoucha
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rachel Johnson
- Division of Internal Medicine/Pediatrics, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - James Buckley
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Athena K Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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The effect of exposure to tobacco smoking-related media messages on youths' smoking behavior in Jordan: A longitudinal, school-based study. Prev Med 2023; 166:107386. [PMID: 36503015 DOI: 10.1016/j.ypmed.2022.107386] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Only a few studies investigated the link between tobacco smoking-related media and youth smoking in the Eastern Mediterranean Region (EMR). This study aimed to assess the influence of both promotional and control messages on cigarette smoking behavior among young Jordanian students. Generalized Linear Mixed Models were analyzed using data from the Irbid Longitudinal Smoking Study that followed a random sample of 2174 students (2008-2011). We examined the associations of media messaging with smoking behavior, as well as intention-to-quit smoking, and intention-to-start smoking, among young adolescents. At baseline, 12.2% and 43.7% of students were exposed to only pro-smoking or only anti-smoking messages, while 41.8% were equally exposed to both. Exposure to anti-smoking messages was associated with lower odds of ever smoking at baseline among girls (AOR = 0.4; 95% CI: 0.2, 0.8). Boys who were exposed to anti-smoking messages were more likely to report an intention to quit, with borderline significance (AOR = 2.0; 95% CI: 0.9, 4.1). The cumulative exposure to anti-smoking messages over time was associated with lower odds of intention to smoke among girls (AOR = 0.5; 95% CI: 0.3, 0.9) but with higher odds among boys (AOR = 1.8; 95% CI: 1.0, 3.1). In both sexes, media messaging was not associated with progression of the smoking habit. In conclusion, this comprehensive analysis of both pro- and anti-smoking messages advances our understanding of their role in influencing youths' smoking behaviors, and could guide the development of evidence-based interventions to address adolescent tobacco smoking in Jordan and the EMR.
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Liu J, Keller-Hamilton B, Patterson JG, Lee DN, Wedel AV, Vázquez-Otero C, Stevens EM. How Age and E-cigarette Use Status Interact to Influence E-cigarette Ad Perceptions. Subst Use Misuse 2022; 58:257-265. [PMID: 36510786 PMCID: PMC9877189 DOI: 10.1080/10826084.2022.2155479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The prevalence of e-cigarette use among young people remains high. Young people are susceptible to e-cigarette advertising, although potential heterogeneity in perceptions of e-cigarette ads with respect to age and e-cigarette use history remains unexplored. We aimed to assess differences in perceptions of e-cigarette ads and product use intention, by age and e-cigarette use status. Methods: Participants from an online convenience sample (N = 497, Mage=31.9) viewed two randomly selected e-cigarette ads and reported their perceptions of the ads and product use intention. We used mixed effects linear regression models to estimate associations between age group (18-20 years, 21-25 years, 26+ years), e-cigarette use status (never, former, and current use), and their interaction effects, on outcomes related to perceptions of ads and use intention. Models controlled for demographics and other tobacco use. Results: Current e-cigarette users (vs. never users) and participants who were 26+ years old (vs. 18-20 years old) had greater liking of the ads, perceived ad relevance, and perceived ad effectiveness. Among current e-cigarette users, participants who were 26+ years old (vs. 18-20 years old) had lower use intention. Conclusion: The effect of e-cigarette ad exposures on perceptions of the ad and use intention is heterogeneous with respect to age group and e-cigarette use history. While ads appealed more to adults who were 26+ years old across e-cigarette use groups, current e-cigarette users who were 18-20 years old demonstrated high use intention following ad exposure, suggesting a need for marketing interventions to mitigate continued e-cigarette use among young people.
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Affiliation(s)
- Jessica Liu
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health
| | - Brittney Keller-Hamilton
- Department of Internal Medicine, The Ohio State University College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Joanne G Patterson
- Division of Epidemiology, The Ohio State University College of Public Health, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Donghee N Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School
| | - Amelia V. Wedel
- Department of Clinical Psychology, Syracuse University, Syracuse, NY
| | - Coralia Vázquez-Otero
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX
| | - Elise M. Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School
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Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement From the American Association for Cancer Research and the American Society of Clinical Oncology. J Clin Oncol 2022; 40:4144-4155. [PMID: 36287017 DOI: 10.1200/jco.22.01749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15%-42% of adults who use ENDS have never used another tobacco product, and another 36%-54% dual use both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
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Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT
| | | | - Dana Acton
- American Association for Cancer Research, Washington, DC
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | | | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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Hassanein ZM, Barker AB, Murray RL, Britton J, Agrawal S, Leonardi-Bee J. Impact of Smoking and Vaping in Films on Smoking and Vaping Uptake in Adolescents: Systematic Review and Meta-Analysis. HEALTH EDUCATION & BEHAVIOR 2022; 49:1004-1013. [PMID: 35502561 PMCID: PMC9578073 DOI: 10.1177/10901981221086944] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prevention of smoking uptake in young people is an essential public health target. We have previously reported a systematic review and meta-analysis of the effect of exposure to smoking imagery in films on the risk of smoking uptake in young people. This study updates that review, and includes studies of the effects of exposure to media vaping imagery on vaping uptake. Four electronic databases (MEDLINE, EMBASE, PsycINFO, and IBSS) were searched to August 2020 for studies reporting the association between exposure to smoking/vaping in films and smoking/vaping uptake in adolescents. Two authors independently screened papers, extracted data, and assessed quality. This review included 26 studies. Exposure to high levels of smoking imagery in films was associated with an increased likelihood of having ever smoked in nine cross-sectional studies and of smoking uptake in 11 longitudinal studies. Vaping imagery in films was associated with increased likelihood of ever vaping in two cross-sectional studies and vaping uptake in five longitudinal studies. This review concluded that exposure to smoking imagery in films increases the risk of smoking among young people. It is likely that a similar association exists between exposure to vaping imagery and vaping uptake. Therefore, this review recommends introduction of new policies to minimize the impact of this in films which contain smoking or vaping and are likely to be viewed by children and adolescents.
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Affiliation(s)
- Zeinab M. Hassanein
- University of Nottingham, Nottingham, UK,Assiut University, Egypt,Zeinab M. Hassanein, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | | | | | - John Britton
- University of Nottingham, Nottingham, UK,SPECTRUM Consortium, UK
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Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Clin Cancer Res 2022; 28:4861-4870. [PMID: 36287033 DOI: 10.1158/1078-0432.ccr-22-2429] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/01/2022] [Indexed: 01/24/2023]
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15% to 42% of adults who use ENDS have never used another tobacco product, and another 36% to 54% "dual use" both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
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Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | | | - Dana Acton
- American Association for Cancer Research, Washington, D.C
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, Virginia
| | | | | | - Benjamin A Toll
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Graham W Warren
- Medical University of South Carolina, Charleston, South Carolina
| | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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22
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Dai HD, Ratnapradipa K, Michaud TL, King KM, Guenzel N, Tamrakar N, Puga T, Sussman S. Vaping Media Literacy, Harm Perception, and Susceptibility of E-Cigarette Use Among Youth. Am J Prev Med 2022; 63:852-860. [PMID: 35931617 DOI: 10.1016/j.amepre.2022.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Exposure to E-cigarette marketing and media advertisements is prevalent among adolescents. A validated vaping media literacy scale is needed to inform effective vaping prevention programs. METHODS A 6-item vaping media literacy scale was adapted from validated smoking and general media literacy scales with an emphasis on marketing influences. A school-based survey (N=856) was conducted to assess the reliability of vaping media literacy and 3 subscales (i.e., authors and audiences [vaping Authors and Audiences], messages and meanings [vaping Messages and Meanings], and representation and reality [vaping Representation and Reality]). Multivariable logistic regression models were performed to examine the associations of vaping media literacy with perceived harmfulness of E-cigarette use and susceptibility to use E-cigarettes. Analyses were conducted in 2021. RESULTS The mean vaping media literacy among students was 2.6 (range=0-6). There were significant disparities with lower vaping media literacy among middle-school (versus high-school, p=0.03) students, males (versus females, p=0.003), and racial/ethnic minority students (Blacks, Hispanics, others versus Whites, p=0.0009). A higher vaping media literacy was significantly associated with increased perceived harmfulness of E-cigarette use (AOR=1.2; 95% CI=1.1, 1.2; p<0.0001). All subscales were also associated with E-cigarette harm perception. Among never E-cigarette users, students with a higher (versus those with a lower) vaping media literacy had lower susceptibility to initiating E-cigarettes (AOR=0.90; 95% CI=0.83, 0.97; p=0.005). Both vaping Messages and Meanings and vaping Representation and Reality subscales were adversely associated with susceptibility to vaping. CONCLUSIONS The vaping media literacy scale may gauge the influence of E-cigarette marketing on adolescents with high reliability and validity. Racial minorities, younger adolescents, and males appear relatively vulnerable to vaping marketing influence. Efforts to increase vaping media literacy are needed to curb youth E-cigarette use.
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Affiliation(s)
- Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Kendra Ratnapradipa
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tzeyu L Michaud
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Keyonna M King
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nicholas Guenzel
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Niran Tamrakar
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Troy Puga
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
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Cooper M, Day HR, Ren C, Oniyide O, Corey CG, Ambrose BK, Michael Cummings K, Sargent J, Niaura R, Pierce JP, Kaufman A, Choi K, Goniewicz ML, Stanton CA, Villanti A, Kasza K, Bansal-Travers M, Silveira ML, Kimmel HL, Hull LC, Koblitz A, Poonai K, Paredes A, Taylor K, Borek N, Hyland AJ. Correlates of tobacco product initiation among youth and young adults between waves 1-4 of the population assessment of tobacco and Health (PATH) study (2013-2018). Addict Behav 2022; 134:107396. [PMID: 35749867 PMCID: PMC9726988 DOI: 10.1016/j.addbeh.2022.107396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION While risk factors for cigarette smoking among youth and young adults are well-documented, less is known about the correlates of initiation of other tobacco products. This study aims to provide estimates and correlates of initiation among U.S. youth and young adults. METHODS Data on youth aged 12-17 (n = 10,072) and young adults aged 18-24 (N = 5,727) who provided information on cigarettes, electronic nicotine delivery systems (ENDS), cigars, pipe, hookah and smokeless tobacco use in Wave 1 (W1: 2013-2014)-Wave 4 (W4: 2016-2018) of the nationally-representative PATH Study were used to calculate ever use initiation and correlates of initiation by W4. RESULTS Nearly 6 million youth and 2.5 million young adults used tobacco for the first time between W1-W4. Approximately one quarter of youth and young adult ENDS never users initiated ENDS between W1-W4 of the PATH Study. Among youth, use of other tobacco products, ever substance use, and high externalizing problems were associated with initiation of most products. Among young adults, use of other tobacco products and ever substance use were associated with initiation of most products. In both youth and young adults, Hispanics were more likely to initiate hookah use than their non-Hispanic White counterparts. While male sex was a risk factor for most tobacco product initiation across both age groups, it was not associated with hookah initiation. CONCLUSIONS Cigarette and non-cigarette products shared many correlates of initiation, although there are noteworthy demographic differences. Findings can help tailor product specific interventions to reach populations at risk during preliminary stages of use.
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Affiliation(s)
- Maria Cooper
- US Food and Drug Administration, Center for Tobacco Products, United States.
| | - Hannah R Day
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Chunfeng Ren
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Olusola Oniyide
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Catherine G Corey
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Bridget K Ambrose
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - K Michael Cummings
- Medical University of South Carolina, Department of Psychiatry & Behavioral Sciences, United States
| | - James Sargent
- Dartmouth Medical School, Data Sciences Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, United States
| | - Ray Niaura
- New York University, College of Global Public Health, United States
| | - John P Pierce
- University of California, San Diego, Herbert Wertheim School of Public Health, United States
| | - Annette Kaufman
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, United States
| | | | | | | | - Karin Kasza
- Roswell Park Comprehensive Cancer Center, United States
| | | | - Marushka L Silveira
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States; Kelly Government Solutions, United States
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Lynn C Hull
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Amber Koblitz
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Karl Poonai
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Antonio Paredes
- US Food and Drug Administration, Center for Tobacco Products, United States
| | - Kristie Taylor
- Westat, Behavioral Health and Health Policy, United States
| | - Nicolette Borek
- US Food and Drug Administration, Center for Tobacco Products, United States
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24
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Stanton CA, Pasch KE, Pericot-Valverde I, Cruz-Cano R, Moran MB, Abadi MH, Mays D, Mercincavage M, Tang Z, Chen-Sankey J. Longitudinal associations between U.S. youth exposure to E-cigarette marketing and E-cigarette use harm perception and behavior change. Prev Med 2022; 164:107266. [PMID: 36152822 PMCID: PMC9691545 DOI: 10.1016/j.ypmed.2022.107266] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/28/2022] [Accepted: 09/17/2022] [Indexed: 10/31/2022]
Abstract
E-cigarette marketing tactics to reach and appeal to youth are rapidly changing. This study examined to what extent youth e-cigarette marketing exposure was associated with e-cigarette use behavior change one year later, during a time when youth e-cigarette use was starting to surge in the U.S. Using nationally representative longitudinal public-use data from the Population Assessment of Tobacco and Health (PATH) Study, we examined associations between recalled e-cigarette marketing exposure (2016-2018) at Wave (W) 4 and e-cigarette use harm perception and behavior change (ever, current, and regular use) one year later (W4.5; 2017-2018) among W4 never tobacco users (n = 9405). Recall of exposure to e-cigarette marketing through different channels was also examined in multivariable models controlling for socio-demographic factors and established e-cigarette use risk factors. Results show that the most frequently recalled channels of e-cigarette marketing exposure were retail stores (50.3%), television (22.2%), and websites/social media (20.2%). Over one year, 21.2%, 7.8%, 3.4%, and 1.2% of respondents reported reduced harm perceptions, and ever, current, and regular use of e-cigarettes, respectively, at follow-up. Recalled exposure to e-cigarette marketing was associated with reduced e-cigarette harm perception (AOR = 1.20; 95% CI = 1.05-1.37) and ever (AOR = 1.26; 95% CI = 1.01-1.56) and current use (AOR = 1.40; 95% CI = 1.02-1.92) at follow-up. E-cigarette marketing exposure through websites/social media was associated with reduced harm perceptions and all stages of e-cigarette use change, including regular use. Identifying marketing techniques and channels that change youth e-cigarette harm perceptions and influence e-cigarette use progression is essential to inform e-cigarette regulatory policies and prevention campaigns.
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Affiliation(s)
- Cassandra A Stanton
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Keryn E Pasch
- Department of Kinesiology and Health Education at the University of Texas, Austin, TX, United States of America
| | - Irene Pericot-Valverde
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics Indiana University School of Public Health-Bloomington, University of Maryland, College Park, MD, United States of America
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa H Abadi
- Pacific Institute for Research & Evaluation, Louisville, KY, United States of America
| | - Darren Mays
- Department of Internal Medicine, College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Zhiqun Tang
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States of America; School of Public Health, Rutgers University, Piscataway, NJ, United States of America.
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Addo Ntim S, Martin B, Termeh-Zonoozi Y. Review of Use Prevalence, Susceptibility, Advertisement Exposure, and Access to Electronic Nicotine Delivery Systems among Minorities and Low-Income Populations in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13585. [PMID: 36294164 PMCID: PMC9603140 DOI: 10.3390/ijerph192013585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Increased use of electronic nicotine delivery systems (ENDS) and improper disposal after use pose a public health and an environmental justice (EJ) concern if use prevalence is disproportionately high among minorities and people of low socioeconomic status (SES) (broadly termed "EJ populations" for the purposes of this review). This review synthesizes literature on demographic patterns of use prevalence, susceptibility, advertisement exposure, and access to ENDS, and extrapolates environmental tobacco exposure (ETE) from ENDS among EJ populations. Seven electronic databases were searched using ENDS-related terms. We included studies published between 2017 and May 2020 that described ENDS use prevalence, susceptibility to ENDS use, advertisement exposure, and access to ENDS by race, ethnicity, or SES. Data synthesis was based on the assumptions that ETE increases with high use prevalence, susceptibility may influence future use, and advertisement exposure and access may impact demographic differences in use. We identified 32 studies describing use prevalence, susceptibility, advertisement exposure, or access to vape shops and other tobacco retail outlets by race/ethnicity or SES. We found higher prevalence of ENDS use among non-Hispanic Whites and inconclusive use patterns by SES. Patterns of susceptibility to use, advertisement exposure, and access were also mixed, with slightly higher outcomes observed among low SES youth. However, the evidence base on advertisement exposure was limited, with limited generalizability. Our findings indicate low prevalence of ENDS use among EJ populations. While this suggests low potential ETE among these groups, mixed outcomes on susceptibility, advertisement exposure, and access to ENDS among low SES groups may affect future ENDS use and ETE. Educational campaigns that discourage ENDS uptake should target EJ youth. Initiatives aimed at managing vape shop presence in EJ communities and monitoring targeted advertisement are also needed.
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Moran MB, Weiger C, Czaplicki L, Heley K. Evidence of Youth-Appealing Cigarette Advertising Tactics from a Randomized, Controlled Experiment. Nicotine Tob Res 2022; 24:1619-1626. [PMID: 35325239 PMCID: PMC9575973 DOI: 10.1093/ntr/ntac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Receptivity to tobacco advertising is an important component in the progression from exposure to advertising to use behavior, yet little is known about current tobacco advertising tactics that increase receptivity. This study tests the effect of three advertising features identified in earlier work as potentially appealing to adolescents and young adults: flora imagery, eco-friendly language, and sweepstakes. AIMS AND METHODS We conducted an online survey in which 1,000 US adolescents (age 15-17) and 1,000 US young adults (age 18-24), equally stratified by smoking status, were exposed to three experimental modules manipulating presence/absence of each feature of interest on cigarette ads. After viewing each ad, participants reported their receptivity to the advertisement. Bivariable analysis and multivariable logistic regression analyses were used to assess the effect of each appeal's presence on receptivity. RESULTS Adolescents (aOR = 1.55, 95%CI: 1.12-2.14) and young adults (aOR = 1.43, 95%CI: 1.06-1.93) were more likely to be receptive to ads with flora imagery. The effect of sweepstakes on receptivity was modified by the specific ad for young adults. Ecofriendly language did not significantly impact receptivity among either group. Exploratory subgroup analysis found a significant ad by sweepstakes interaction among young adult noncurrent smokers. CONCLUSION These findings provide evidence that use of flora imagery increases cigarette advertising receptivity among adolescents and young adults, while the effect of sweepstakes on young adults might additionally depend on the ad shown. Restrictions on youth appealing advertising tactics, such as those identified in this study, as well as broader content-neutral advertising restriction policies, should be considered. IMPLICATIONS This study provides evidence for the appeal of flora imagery in cigarette advertising for both adolescents and young adults, as well as the complexity of how use of sweepstakes interacts with branding in specific ads to predict receptivity among young adults. Because receptivity to cigarette advertising is a documented step in the pathway between advertising exposure and product use, restrictions on use of these tactics should be implemented, and broader content-neutral advertising restriction policies should be considered.
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Affiliation(s)
- Meghan Bridgid Moran
- Corresponding Author: Meghan Bridgid Moran, PhD, Department of Health, Behavior & Society Johns Hopkins University Bloomberg School of Public Health 624 North Broadway, Baltimore, MD 21205, USA. Telephone: 410-614-6872;
| | - Caitlin Weiger
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Lauren Czaplicki
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, 2213 McElderry St., 4 Floor, Baltimore, MD, USA
| | - Kathryn Heley
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 624 North Broadway, Baltimore, MD 21205, USA
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Persoskie A, O'Brien EK. Predicting tobacco product initiation from intentions to use: Comparing the validity of item analysis methods. Prev Med Rep 2022; 28:101855. [PMID: 35789624 PMCID: PMC9249798 DOI: 10.1016/j.pmedr.2022.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
Items measuring tobacco use intentions are used to predict future use. Researchers combine items using different methods; however, no research has compared these methods’ predictive validity. Here, we compare how well six methods of analyzing four intention items predict initiation of cigarettes, e-cigarettes, snus pouches, and other smokeless tobacco one year later. We analyzed youth and young adult never users from the US Population Assessment of Tobacco and Health Study. We compared six methods of analyzing Wave 3 intention items in predicting Wave 4 use: susceptibility scoring (susceptible is not answering “definitely no” to all items); dichotomizing the four-item average using two cut-points on the 1–4 response scale; and dichotomizing one item (next year use intention) with three cut-points. Analyses (1) tested whether each single-item predicted initiation; and (2) compared each method’s (a) true positive rate (rate of correctly identifying future initiators), (b) true negative rate (rate of correctly identifying future non-initiators), and (c) model fit. Results were similar across products and age groups. Averaging items best predicted initiation in regression. Susceptibility scoring had the highest true positive rate but lowest true negative rate. False positives (incorrectly identifying someone as a future initiator) were best minimized by averaging items with a cutoff of 3, or using the single item with a 3 or 4 cutoff. Findings suggest researchers predicting tobacco use initiation using regression should average the four items; and researchers seeking to identify likely initiators should use different analytic methods depending on if they seek to maximize true positives or minimize false positives.
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Affiliation(s)
- Alexander Persoskie
- Corresponding author at: Building 71, Room G335, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
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Vigorita MW, Smith A, Farrelly M, Taylor N, Spinks JG. Predictive validity of the original and expanded susceptibility scales for smokeless tobacco. Addict Behav 2022; 130:107286. [PMID: 35231844 DOI: 10.1016/j.addbeh.2022.107286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study seeks to validate the original and expanded susceptibility scales for smokeless tobacco (SLT) use among a longitudinal sample of rural male youth. We also compare the predictive validity of both scales for SLT. METHODS Data are from a five-wave longitudinal sample of rural males in the Unites States aged 11-16 at baseline. Data were collected from January 2016 to December 2018. We used a series of logistic regressions to identify whether individual demographic variables, the original (use SLT soon, in next year, if friend offers), or the expanded (original plus curiosity) susceptibility scales predicted experimentation with SLT by 2018. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both scales were also calculated to determine reliability. All analyses were limited to 2016 never SLT users. RESULTS Both susceptibility scales were significant predictors of SLT initiation by follow-up. Susceptible youth had three times the odds of SLT initiation by follow-up compared to youth who were non-susceptible. Both scales have high specificity, identifying a large proportion of never users as non-susceptible. Sensitivity for the original scale was 37.0% and increased to 44.2% for the expanded scale. The PPV was approximately 20% for both the original and expanded scales. CONCLUSIONS The SLT susceptibility scales are valid for predicting future SLT initiation; however, there remains room for improvement as the sensitivity of both scales is relatively low compared to the smoking scale. Future research should examine additional methods to identify youth at risk of SLT initiation.
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Pokhrel P, Kawamoto CT, Pagano I, Herzog TA. Trajectories of e-cigarette advertising exposure, e-cigarette use and cigarette smoking in a sample of young adults from Hawaii. Addiction 2022; 117:2015-2026. [PMID: 35072304 PMCID: PMC9236703 DOI: 10.1111/add.15815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
AIM To test whether intrapersonal growth in e-cigarette advertising exposure over time is associated with growth in e-cigarette use and/or cigarette smoking. DESIGN Longitudinal study using four waves of data were collected in 6-month intervals between 2018 and 2020. SETTING AND PARTICIPANTS Participants were 2327 young adults recruited from colleges in Hawaii, USA. MEASUREMENTS Data were collected on demographics, e-cigarette advertising exposure measured using the cued- recall method and recent (past 30-day) cigarette and e-cigarette use. FINDINGS The average trajectory for e-cigarette advertising exposure over time was significant and upward [M slope = 0.18 (0.14-0.22), P < 0.0001]. However, average trajectories for e-cigarette [M slope = -0.08 (-0.18 to 0.02), P = 0.09] and cigarette [M slope = -0.14 (-0.30 to 0.02), P = 0.07] use were not. There were significant differences in individual level trajectories across participants for advertising exposure [σ2 = 0.12 (0.10-0.14), P < 0.0001], e-cigarette use [σ2 = 0.22 (0.14-0.30), and cigarette smoking (σ2 = 0.17 [0.09-0.25], P < 0.0001). Individuals with an increasing rate of advertising exposure showed an increasing rate of e-cigarette use [B = 0.63 (0.36-0.90), P < 0.0001). Neither initial level of, nor rate of change in, advertising exposure was significantly associated with cigarette smoking growth factors (P > 0.05). Higher initial level of e-cigarette use was associated with higher initial level of cigarette smoking [B = 0.89 (0.69-1.09), P < 0.0001] but decreased rate of cigarette smoking over time [B = -0.12 (-0.20 to -0.04) P = 0.003]. Rate of change in e-cigarette use was not associated with the rate of change in cigarette smoking (P > 0.05). CONCLUSIONS Increased exposure to e-cigarette advertising appears to be associated with increased e-cigarette use but not with increased cigarette smoking. Higher initial level of e-cigarette use appears to be associated with higher initial level of cigarette smoking but may be associated with a decreasing rate of cigarette smoking over time.
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Affiliation(s)
- Pallav Pokhrel
- Cancer Prevention in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Crissy T Kawamoto
- Cancer Prevention in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Ian Pagano
- Cancer Prevention in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Thaddeus A Herzog
- Cancer Prevention in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii, USA
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Pérez A, Spells CE, Bluestein MA, Harrell MB, Hébert ET. The Longitudinal Impact of Seeing and Posting Tobacco-related Social Media on Tobacco Use Behaviors Among Youth (Aged 12-17): Findings From the 2014-2016 Population Assessment of Tobacco and Health (PATH) Study. Tob Use Insights 2022; 15:1179173X221087554. [PMID: 35634272 PMCID: PMC9133874 DOI: 10.1177/1179173x221087554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction This study examined the impact of seeing and posting tobacco-related content on social media on tobacco use outcomes in youth. Methods Longitudinal secondary analyses of youth in the nationally representative 2014-2015 Population Assessment of Tobacco and Health (PATH) study were conducted to examine the association between the interaction of (i) seeing and (ii) posting tobacco-related social media content with previous ever use of each tobacco product, and 3 outcomes in 2015-2016: past 30-day e-cigarette use, past 30-day combustible product use, and past 30-day dual use of e-cigarettes and at least one combustible product. Six weighted multiple logistic regression models (2 interaction exposures*3 outcomes) were used to assess these associations, while adjusting for covariates. Results Among youth never users in 2014-2015, seeing tobacco-related social media content was significantly associated with past 30-day e-cigarette use (AOR 1.92; 95% CI= 1.36-2.71), and past 30-day dual use of e-cigarettes and at least one combustible product (AOR= 2.11; 95% CI= 1.08- 4.13) in 2015-2016. Among youth ever users in 2014-2015, posting tobacco-related content on social media was significantly associated with all 3 outcomes: past 30-day day e-cigarette use (AOR= 2.09;95%CI=1.23-3.55), past 30-day combustible product use (AOR=2.86; 95%CI=1.67-4.88), and past 30-day dual use of these products (AOR=3.02;95%CI=1.45-6.31), after adjusting for covariates. Conclusions Seeing and posting tobacco-related content on social media predicts tobacco use among youth, nationwide. Results suggest that interventions and policies prohibiting tobacco-related content on social media are needed to curb the impact of social media on youth tobacco-use.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
| | - Charles E. Spells
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
| | - Emily T. Hébert
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health at the Austin Campus, Austin, TX, USA
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Yang Q, Yang F, Zhang K. Influence of Psychological Factors on College Students' Smoking Behavior: Moderating Role of Tobacco Advertising Receptivity and Health Behavior. Am J Health Behav 2022; 46:12-28. [PMID: 35227366 DOI: 10.5993/ajhb.46.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The main objective of this study was to examine the role of psychological factors affecting college students' smoking behavior. We considered 3 psychological factors in this study - depressive symptoms, novelty seeking personality, and stress, which are common among learners in institutions of higher learning. Furthermore, we also considered the moderating effect of tobacco advertising receptivity and health behavior. Methods: In this study, we used a cross-sectional research design, wherein data were collected through a survey questionnaire, designed on a Likert scale. We received 160 responses for data analysis. Our primary analysis used partial least squares (PLS). Results: Depressive symptoms, novelty seeking personality, stress, and tobacco advertising receptivity had significant positive relationships with college students' smoking behavior; however, pro-health behavior had a negative effect on smoking behavior. Conclusion: Our results reveal a major role of depressive symptoms, novelty seeking personality and stress in shaping the smoking behavior of college students in China. Additionally, the moderating variables of tobacco advertising receptivity and health behavior showed considerable impact, as both showed a positive influence on psychological factors and smoking behavior of college students. Finally, our results provide insights for practitioners to devise strategies to address smoking behavior in college students.
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Affiliation(s)
- Qianqian Yang
- Qianqian Yang, College of Education, Hebei Normal University of Science & Technology, Hebei, China;,
| | - Fei Yang
- Fei Yang, College of Education, Hebei Normal University of Science &Technology, Hebei, China
| | - Kuo Zhang
- Kuo Zhang, College of Education, Hebei Normal University of Science & Technology, Hebei, China
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Do EK, Tulsiani S, Vallone DM, Hair EC. Transitions in Frequent to Daily Tobacco and Nicotine Use among Youth and Young Adults. Subst Use Misuse 2022; 57:1681-1687. [PMID: 35938747 DOI: 10.1080/10826084.2022.2107674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Objective: To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigarillos, and cigars (LCCs) over time. Methods: Data were obtained from the Truth Longitudinal Cohort (TLC), a nationally representative longitudinal cohort of youth and young adults. Latent class analysis was conducted to classify participants (n = 5274) into subgroups based upon frequency of use of cigarettes, e-cigarettes, and little cigars, cigarillos, and cigars (LCCs) in the past 30 days. Latent transition analysis was used to estimate the probability of use pattern transitions across 23 months (February 2018 to December 2019), adjusted for the effects of gender, race/ethnicity, financial situation, sensation seeking, parent education, and household smoking. Findings: Findings reveal four groups of tobacco product users: (1) frequent to daily cigarette users (9%), (2) frequent to daily cigarette and LCC users (3%), (3) frequent to daily e-cigarette users (10%), and (4) former or noncurrent tobacco users (78%). Although most respondents (69-94%) retained their initial user patterns during the observation period, results also indicate shifts between user groups. Notably, 14% of frequent to daily cigarette and LCC users transitioned to frequent to daily cigarette use, while 6% of frequent to daily cigarette and LCC users, 9% of frequent to daily cigarette users, and 4% of former or noncurrent tobacco users transitioned to frequent to daily e-cigarette use. Conclusion: Although most frequent to daily tobacco users stay with their primary product, there are transitions between frequent to daily cigarette, e-cigarette, and LCC use. Transition patterns may influence risk for nicotine addiction among youth and young adults. Thus, policies focused on preventing and reducing all tobacco use are needed to curb the risk of nicotine addiction among youth and young adults.
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Affiliation(s)
- Elizabeth K Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA.,Department of Epidemiology, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | | | - Donna M Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,College of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth C Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,College of Global Public Health, New York University, New York, NY, USA
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Heng PP, Daud F, Yusoff MFM, Lim KH. Susceptibility to e-cigarette initiation among tobacco product naïve adolescents in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian adolescents (TECMA). Tob Induc Dis 2021; 19:89. [PMID: 34887718 PMCID: PMC8611510 DOI: 10.18332/tid/142900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Predicting susceptibility to e-cigarette (EC) initiation among adolescents is crucial to optimize preventive measures before the health risk behavior persists through adulthood. The identification of susceptible groups is needed in response to the surge of EC use. This study aimed to determine the prevalence and determinants associated with EC susceptibility among tobacco product naïve (never users of any single tobacco product) school-going adolescents in Malaysia. METHODS Data were derived from the Tobacco and EC Survey among Malaysians (TECMA), which recruited a total of 13162 school-going adolescents aged 10– 19 years from 138 randomly selected schools via a two-stage stratified cluster sampling design. A validated self-administered questionnaire adapted from the Global Youth Tobacco Survey was utilized as the study instrument. The data were analyzed using SPSS version 22.0 descriptively and with multivariable logistic regression to determine the associated factors of EC susceptibility. RESULTS About 15.7% of the tobacco naïve adolescents were susceptible to EC initiation, with the proportion of susceptibility significantly higher among males, mid-adolescents, rural adolescents, those reporting exposure to tobacco advertisement and those not taught in school about the danger of tobacco use. Multivariable logistic regression revealed that the male students (AOR=2.20; 95% CI: 1.86–2.59) from a rural locality (AOR=1.45; 95% CI: 1.23–1.71), those reporting no lessons on the danger of tobacco use at school (AOR=1.66; 95% CI: 1.39–1.99) and those exposed to tobacco advertisement (AOR=1.67; 95% CI: 1.07–2.61), were more susceptible to EC initiation, while no significant association was found between secondhand smoke exposure and EC susceptibility. CONCLUSIONS Comprehensive EC preventive strategies are critically needed together with the implementation of targeted, gender, and culturally impressionable interventions. In addition, future studies should focus on the evaluation of the impacts of the preventive and control efforts to ensure their effectiveness in preventing EC initiation among Malaysian adolescents.
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Affiliation(s)
- Pei Pei Heng
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.,Institute for Public Health, National Institutes of Health, Setia Alam, Malaysia
| | - Faiz Daud
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Kuang Hock Lim
- Institute for Public Health, National Institutes of Health, Setia Alam, Malaysia
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Prokhorov AV, Calabro KS, Arya A, Russell S, Czerniak KW, Botello GC, Chen M, Yuan Y, Perez A, Vidrine DJ, Perry CL, Khalil GE. Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk. JMIR Mhealth Uhealth 2021; 9:e25618. [PMID: 34822339 PMCID: PMC8663493 DOI: 10.2196/25618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/19/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. OBJECTIVE Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. METHODS With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). RESULTS A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). CONCLUSIONS In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. TRIAL REGISTRATION ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10977.
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ashish Arya
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Health Disparities, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ying Yuan
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Austin, TX, United States
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Cheryl L Perry
- School of Public Health, Health Science Center, University of Texas, Austin, TX, United States
| | - Georges Elias Khalil
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
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Keller-Hamilton B, Curran H, Stevens EM, Slater MD, Lu B, Roberts ME, Ferketich AK. Associations between Cognitive and Affective Responses to Tobacco Advertisements and Tobacco Use Incidence: A Four-Year Prospective Study among Adolescent Boys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11666. [PMID: 34770180 PMCID: PMC8582641 DOI: 10.3390/ijerph182111666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Exposure to tobacco advertisements is associated with initiation of tobacco use among youth. The mechanisms underlying this association are less clear. We estimated longitudinal associations between youths' cognitive and affective responses to advertisements for cigarettes, e-cigarettes, and smokeless tobacco (SLT) and initiation of these products. N = 1220 Ohio-residing boys of ages 11-16 were recruited into a cohort in 2015 and 2016. Participants completed surveys every six months for four years. Surveys assessed cognitive and affective responses to tobacco advertisements (which included health warnings) and tobacco use after an advertisement viewing activity. We used mixed-effects Poisson regression models with robust standard errors to estimate risk of initiating use of each tobacco product according to participants' cognitive (i.e., memorability of health risks) and affective (i.e., likability of advertisement) responses to advertisements for that product. No associations between affective responses to advertisements and tobacco use outcomes were detected in adjusted models. However, finding health risks memorable was associated with reduced risk of ever smoking initiation (aRR = 0.57; 95% CI: 0.34, 0.95) and a reduced risk of ever SLT initiation that approached statistical significance (aRR = 0.61; 95% CI: 0.36, 1.05). Measures to increase saliency of health risks on cigarette and SLT advertisements might reduce use among youth.
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Affiliation(s)
- Brittney Keller-Hamilton
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH 43214, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
| | - Hayley Curran
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH 43210, USA; (H.C.); (A.K.F.)
| | - Elise M. Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01605, USA;
| | - Michael D. Slater
- School of Communication, The Ohio State University College of Arts and Sciences, Columbus, OH 43210, USA;
| | - Bo Lu
- Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH 43210, USA;
| | - Megan E. Roberts
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, OH 43210, USA;
| | - Amy K. Ferketich
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH 43210, USA; (H.C.); (A.K.F.)
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36
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Agaku IT, Egbe CO, Ayo-Yusuf OA. E-cigarette advertising exposure among South African adults in 2017: findings from a nationally representative cross-sectional survey. BMJ Open 2021; 11:e048462. [PMID: 34400455 PMCID: PMC8370548 DOI: 10.1136/bmjopen-2020-048462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In South Africa, the Control of Tobacco and Electronic Delivery Systems Bill seeks to regulate e-cigarettes as tobacco products, including their advertising, promotion and sponsorship. Population data on e-cigarette advertising in South Africa are needed to inform public health programs, practice and policy. We examined self-reported e-cigarette advertising exposure during 2017. DESIGN: Cross-sectional. SETTING Household-based survey. PARTICIPANTS 3063 individuals who participated in the 2017 South African Social Attitudes survey, a nationally representative, in-person survey of the non-institutionalised civilian adult population aged ≥16 years EXPOSURE: 'In the past 12 months, have you seen advertisements or promotions for e-cigarettes (including e-shisha, e-pipe) on any of the following media: newspapers/magazines, billboards, in the malls or any other source?' MAIN OUTCOMES Beliefs and attitudes regarding e-cigarettes. FINDINGS Participants' mean age was 37.7 years. Overall, 20.1% reported exposure to e-cigarette advertisements. By age, exposure was most prevalent among those aged 16-19 years (24.6%). Top sources of exposure among those exposed were stores, 40.7%; malls, 30.9%; and television, 32.5%. Of those aware of e-cigarettes, 61.2% believed 'e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes'; 62.7% believed that 'e-cigarette advertisements and promotions may make ex-smokers think of starting smoking cigarettes again'; and 59.5% supported the statement that 'e-cigarette smoking should be banned indoors just as traditional cigarette smoking'. Notably, teens aged 16-19 reported the lowest prevalence (49.0%) of those believing that 'e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes', whereas this percentage was highest among those aged 55-64 years (73.2%). CONCLUSION Comprehensive regulatory efforts are needed to address e-cigarette advertising, marketing and sponsorship in order to protect public health. The urgent enactment of the new tobacco control legislation, The Control of Tobacco Products and Electronic Delivery Systems Bill, can help reduce youth exposure to e-cigarette advertising in South Africa.
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Affiliation(s)
- Israel Terungwa Agaku
- School of Health System & Public Health, University of Pretoria, Pretoria, South Africa
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Olalekan A Ayo-Yusuf
- School of Health System & Public Health, University of Pretoria, Pretoria, South Africa
- Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Moran MB, Heley K, Czaplicki L, Weiger C, Strong D, Pierce J. Tobacco Advertising Features That May Contribute to Product Appeal Among US Adolescents and Young Adults. Nicotine Tob Res 2021; 23:1373-1381. [PMID: 33377146 PMCID: PMC8360628 DOI: 10.1093/ntr/ntaa275] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Cigarette advertising is a causal agent of smoking uptake among young people. Although prior research links ad receptivity to tobacco product interest and use, little is known regarding the specific advertising tactics associated with increased product appeal among young people. METHODS A national sample of 13-20 year-olds (N = 3688, youth) and 21-24 year-olds (N = 1556, young adults) in the US participated in an online survey in 2017 (mean age 18.1 years). The majority (72.0%) of youth and nearly half (44.8%) of young adults were never smokers. Participants were shown a cigarette ad, randomly assigned from a pool of 50 advertisements, and reported how much they liked the ad, and were curious about and interested in using the advertised product. All 50 advertisements were content analyzed for a variety of features. Data from the survey and content analysis were merged and mixed effects analyses used to identify the features associated with increased liking, curiosity, and interest in using, referred to collectively as product appeal. RESULTS Presence of a sweepstakes offer was associated with increased liking, curiosity and interest among youth and curiosity and interest among young adults. Outdoors settings, flora imagery, natural descriptors, and environmental themes were associated with increased appeal. Price reductions (eg, coupons) were associated with decreased appeal among youth. CONCLUSIONS This study identified several advertising tactics associated with increased appeal among youth and young adults. If additional research confirms these findings, the U.S. Food and Drug Association should consider restricting use of these tactics in tobacco advertising. IMPLICATIONS This study's findings provide insight into features of cigarette ads that appeal to youth and young adults. Overall, the presence of sweepstakes appealed to youth and young adults and outdoors and environmental themes were particularly appealing to young adults. Such tactics could serve to further brand engagement, improve brand image and lead to initiation or escalation of use. If confirmatory studies further demonstrate the effects of the tactics identified in this study on youth product appeal, U.S. Food and Drug Administration should consider using its authority to restrict the use of youth-appealing tactics.
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Affiliation(s)
- Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Heley
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Weiger
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
- Division of Population, Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
| | - John Pierce
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
- Division of Population, Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
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Zheng X, Li W, Wong SW, Lin HC. Social media and E-cigarette use among US youth: Longitudinal evidence on the role of online advertisement exposure and risk perception. Addict Behav 2021; 119:106916. [PMID: 33798917 DOI: 10.1016/j.addbeh.2021.106916] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Previous studies revealed a link between social media use and e-cigarette use among U.S. youth, but less is known about the mechanisms through which they interconnect. This study examined how social media and e-cigarette use are connected through online advertisement exposure and risk perception of e-cigarettes among U.S. youth. METHODS Youth aged 12-17 from the Public Assessment of Tobacco and Health (PATH) Study Waves 2-4 (2014-2018) were included (N = 6,208). This study integrated the incidental exposure framework and the risk perception framework to guide study conceptualization and variable selection. Generalized structural equation modeling was performed to investigate the sequential mediation relationship between social media and e-cigarette use through online e-cigarette advertisement exposure and risk perception of e-cigarette use. RESULTS Youth respondents with more social media use were more likely to be exposed to e-cigarette advertisement at Wave 2 (OR = 1.13, p < 0.001), which led to lower e-cigarette risk perception at Wave 3 (β = -0.07, p < 0.001). Higher e-cigarette risk perception at Wave 3 resulted in lower likelihood of e-cigarette use at Wave 4 (OR = 0.57, p < 0.001). High social media use at Wave 2 was directly associated with high likelihood of e-cigarette use at Wave 4 (OR = 1.11, p < 0.001). CONCLUSIONS The results indicate that social media use is associated with increased e-cigarette use through online e-cigarette advertisement exposure and subsequently decreased e-cigarette risk perception among U.S. youth. Our findings underscore the importance of regulating online e-cigarette advertisement, with the emphasis of avoiding information that could twist youth's risk perception of e-cigarettes, which may in turn curtail youth e-cigarette use.
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Affiliation(s)
- Xia Zheng
- Communication Science and Cognitive Science Program, The Media School, Indiana University, Bloomington, IN, United States
| | - Wenbo Li
- School of Communication, The Ohio State University, Columbus, OH, United States
| | - Su-Wei Wong
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States.
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Clendennen SL, Mantey DS, Wilkinson AV, Perry CL, Harrell MB, Loukas A. Digital marketing of smokeless tobacco: A longitudinal analysis of exposure and initiation among young adults. Addict Behav 2021; 117:106850. [PMID: 33582623 DOI: 10.1016/j.addbeh.2021.106850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examines the relationships between recall of exposure to digital marketing of smokeless tobacco, via the internet and social media, and subsequent initiation of smokeless tobacco use at one-year follow-up, among young adult never users of smokeless tobacco in Texas. METHODS Data were from waves 6 (Spring 2017) and 7 (Spring 2018) of the Marketing and Promotions Across Colleges in Texas Study (Project M-PACT); a longitudinal study of two- and four-year Texas college students. Participants were 2731 young adult never smokeless tobacco users (ages 20-32) with complete data at both assessment periods. A multi-level, multiple logistic regression model was applied, accounting for school clustering, to examine the relationship between recall of exposure to digital marketing of smokeless tobacco at baseline (wave 6) and smokeless tobacco use initiation at one-year follow-up (wave 7). Analyses controlled for important baseline covariates (socio-demographic factors, other marketing exposure, other tobacco product use). RESULTS Overall, 14.6% of never smokeless tobacco users reported exposure to smokeless tobacco marketing via digital media. Exposure to digital marketing of smokeless tobacco at baseline was associated with greater odds of smokeless tobacco use initiation among young adult never users (AOR: 2.14; 95%CI: 1.12 - 4.06) at one-year follow-up. CONCLUSIONS Findings reveal exposure to smokeless tobacco marketing via digital media was common. Further, there appears to be a strong relationship between this exposure and subsequent smokeless tobacco use among young adult never smokeless tobacco users.
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Affiliation(s)
- Stephanie L Clendennen
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA.
| | - Dale S Mantey
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Anna V Wilkinson
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Cheryl L Perry
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Melissa B Harrell
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, the University of Texas at Austin, 2109 San Jacinto Blvd., Austin, TX 78712, USA
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Coreas SI, Rodriquez EJ, Rahman SG, El-Toukhy S, Compton WM, Blanco C, Kimmel HL, Pérez-Stable EJ. Smoking Susceptibility and Tobacco Media Engagement Among Youth Never Smokers. Pediatrics 2021; 147:e2020017921. [PMID: 33941582 PMCID: PMC8331193 DOI: 10.1542/peds.2020-017921] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Susceptibility to future smoking among youth never smokers has not changed in the past 20 years, although experimental cigarette smoking has decreased. We assessed how smoking susceptibility and tobacco industry-related marketing influenced smoking initiation. METHODS Four waves (2013-2018) of the Population Assessment of Tobacco and Health Study data were analyzed among youth aged 12 to 17 years at wave 1 who completed wave 4. Susceptibility was assessed by 4 items (openness to curiosity, try soon, try in the next year, and if your best friend offered) and categorized into 4 levels (0 = definitely no to all; 1 = yes to 1; 2 = yes to 2; and 3 + 4 = yes to 3 or 4 susceptibility items). Multivariable logistic regression evaluated how susceptibility levels, electronic cigarette use, and tobacco-related media activity predicted future experimental (≥1 puff), current (past 30 days), or established (≥100 cigarettes) smoking. RESULTS Among 8899 never smokers at wave 1, 16.4% became experimental smokers, 7.6% current smokers, and 1.8% established smokers at wave 4. Black and Latino/a youth were less likely to experiment. Youth who endorsed 3 or 4 susceptibility items at wave 1 were more likely to be experimental (adjusted odds ratio [aOR] = 6.0; confidence interval [CI] = 4.8-7.4), current (aOR = 4.2; CI = 3.2-5.4), or established (aOR = 4.4; CI = 2.4-7.9) smokers at wave 4. Exposure to tobacco marketing, using tobacco-related apps, seeing social media content posted about tobacco, and ever use of electronic cigarettes also predicted experimental smoking. CONCLUSIONS Smoking susceptibility and exposure to tobacco industry-related marketing were predictive of cigarette smoking. Clinicians should consider screening adolescents for smoking susceptibility and tobacco-related media exposure.
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Affiliation(s)
- Saida I Coreas
- Division of Intramural Research, National Heart, Lung, and Blood Institute
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute
| | - Sana G Rahman
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, and
| | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, and
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Mishu MP, Siddiqui F, Shukla R, Kanaan M, Dogar O, Siddiqi K. Predictors of Cigarette Smoking, Smokeless Tobacco Consumption, and Use of both forms in Adolescents in South Asia: A Secondary Analysis of the Global Youth Tobacco Surveys. Nicotine Tob Res 2021; 23:956-965. [PMID: 33022045 DOI: 10.1093/ntr/ntaa202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/29/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco uptake in adolescents is associated with a range of predictors. We examined the predictors of cigarette smoking, smokeless tobacco (ST) consumption, and use of both ST and cigarettes among adolescents in four South Asian countries. METHODS We analyzed the Global Youth Tobacco Surveys (GYTS) data for Bangladesh (2013), India (2009), Pakistan (2013), and Sri Lanka (2015), using multinomial regression to examine associations between several predictors and tobacco use. RESULTS Data from 23 681 adolescents were analyzed. Overall, 82.8% of the study population were between 13 and 15 years and 52.7% were girls, 2% were cigarette smokers, 6.5% were ST users, and 1.1% used both ST and cigarettes, in the past 30 days. Exposure to smoking in public places was associated with past 30-day smoking (relative risk ratio [RRR] 5.59, 95% confidence intervals [CI] 4.28-7.28), ST use (RRR 2.07, 95% CI 1.84-2.32), and use of both ST and cigarettes (RRR 11.42, 95% CI 7.44-17.54). Exposure to tobacco use in electronic media and being offered free tobacco products were associated with all forms of tobacco use. Shopkeepers' refusal to sell cigarettes protected adolescents from smoking (RRR 0.47, 95% CI 0.36-0.63) and ST use (RRR 0.65, 95% CI 0.45-0.95). However, exposure to antitobacco mass media messages was not protective for any form of tobacco use. Adolescents taught at school about harmful effects of tobacco were less likely to use ST; no evidence of this association was observed for smoking. CONCLUSION The associations between tobacco use and protobacco factors were strong, but the associations with antitobacco factors lacked strength and consistency in this study population. IMPLICATIONS The predictors of adolescents using different tobacco products, crucial to inform and evaluate tobacco control efforts, are poorly understood. We investigated the associations between several environmental-level factors and cigarette smoking, ST consumption, and use of both forms among adolescents, whereas most of the previous studies focused on individual-level factors. Our study found strong associations between tobacco use and protobacco factors and lack of strength and consistency in associations between antitobacco factors and tobacco use in the study population. Our results indicate that the current tobacco control policies need strengthening to curb the tobacco epidemic in these countries.
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Affiliation(s)
| | - Faraz Siddiqui
- Department of Health Science, University of York, York, UK
| | - Radha Shukla
- Department of Health Science, University of York, York, UK
| | - Mona Kanaan
- Department of Health Science, University of York, York, UK
| | - Omara Dogar
- Department of Health Science, University of York, York, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Science, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, University of York, York, UK
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Lazard AJ, Nicolla S, Darida A, Hall MG. Negative Perceptions of Young People Using E-cigarettes on Instagram: An Experiment with Adolescents. Nicotine Tob Res 2021; 23:1962-1966. [PMID: 33990843 DOI: 10.1093/ntr/ntab099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/10/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although e-cigarette marketing on social media increases positive attitudes and experimentation, little is known about non-influencer e-cigarette portrayals of young people. METHODS High school adolescents (n=928, 15-18) were recruited by Lightspeed Health for an online experiment and randomized to view an Instagram post with or without e-cigarette use. Outcomes were positive and negative perceptions (prototypes), social distance, and willingness to use. RESULTS Half (50%) of participants were susceptible to e-cigarette use. E-cigarettes shown (vs. not) led to less positive prototypes, p=.017, more negative prototypes, p=.004, and more social distance, p<.001. Negative prototypes and social distance were moderated by susceptibility (both p<.05); effects among non-susceptible adolescents only. Showing e-cigarettes did not impact willingness to use if offered. DISCUSSION Negative perceptions of e-cigarettes use challenge assumptions that vaping online is universally admirable. Highlighting unfavorable opinions of vaping or negative impacts for adolescents' social image are potential strategies for tobacco counter-marketing. IMPLICATIONS Despite daily use of visual-based social media by most adolescents, little is known about the influence of e-cigarette use among young people online. Adolescent negative perceptions and desired distance from non-influencers using e-cigarettes on Instagram indicate digital e-cigarette portrayals are not universally accepted. Negative impacts for adolescents' social image present a counter-marketing strategy.
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Affiliation(s)
- Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Sydney Nicolla
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill
| | - Avery Darida
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill
| | - Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill.,Carolina Population Center, University of North Carolina at Chapel Hill
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D'Angelo H, Patel M, Rose SW. Convenience Store Access and E-cigarette Advertising Exposure Is Associated With Future E-cigarette Initiation Among Tobacco-Naïve Youth in the PATH Study (2013-2016). J Adolesc Health 2021; 68:794-800. [PMID: 33039271 PMCID: PMC8317228 DOI: 10.1016/j.jadohealth.2020.08.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/04/2020] [Accepted: 08/28/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The association between e-cigarette marketing exposure and youth e-cigarette initiation is not well understood. This study examines whether convenience store access, exposure to retail e-cigarette marketing, and having a favorite e-cigarette ad before e-cigarette use is associated with susceptibility to use and future e-cigarette initiation in a national longitudinal study of youth. METHODS A nationally representative longitudinal cohort of youth in the Population Assessment of Tobacco and Health study (12-17 years) was followed up over three waves of annual data collection (2013-2016). Tobacco-naïve (wave 1) and e-cigarette-naïve (wave 2) youth (n = 6,470) were included. Marketing exposure at wave 2 was examined in association with e-cigarette susceptibility (wave 2) and e-cigarette initiation (wave 3) using adjusted logistic regression models. Analysis occurred in 2019. RESULTS Youth visiting convenience stores at least weekly (vs. never) had 1.51 times the odds of e-cigarette susceptibility (95% confidence interval [CI]: 1.25, 1.81) and 1.79 times the odds of e-cigarette initiation (95% CI: 1.29, 2.48). Noticing a retail e-cigarette ad (vs. not noticing) was associated with e-cigarette susceptibility (adjusted odds ratio [AOR] 1.36, 95% CI: 1.18, 1.57), but not initiation. Youth reporting a favorite branded e-cigarette ad had greater odds of both susceptibility (AOR 1.31, 95% CI, 1.10, 1.56) and e-cigarette initiation (AOR 1.60, 95% CI: 1.18, 2.17) compared to youth without a favorite ad. CONCLUSIONS Tobacco-naïve youth with frequent convenience store access and exposure to e-cigarette marketing were at greater risk of e-cigarette susceptibility and progression to e-cigarette initiation over a 2-year period. Policies to restrict retailer locations and e-cigarette marketing could enhance youth e-cigarette use prevention efforts.
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Affiliation(s)
- Heather D'Angelo
- School of Medicine and Public Health, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin. heather.d'
| | - Minal Patel
- Truth Initiative Schroeder Institute, Washington, District of Columbia
| | - Shyanika W Rose
- College of Medicine, Department of Behavioral Science, and Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky; Markey Cancer Center, Lexington, Kentucky
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Handayani S, Rachmani E, Saptorini KK, Manglapy YM, Nurjanah, Ahsan A, Kusuma D. Is Youth Smoking Related to the Density and Proximity of Outdoor Tobacco Advertising Near Schools? Evidence from Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2556. [PMID: 33806511 PMCID: PMC7967388 DOI: 10.3390/ijerph18052556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smoking was among the top contributors to deaths and disability as the prevalence among male adults remains high, and that among male youth increases in Indonesia. While local studies have shown high visibility of outdoor tobacco advertising around schools, the country still has no outdoor tobacco advertising ban. OBJECTIVE To examine the association between youth smoking behavior and measures of outdoor tobacco advertising density and proximity in Indonesia. METHODS We combined two primary data sources, including outdoor tobacco advertising and smoking behavior among male youth in Semarang city. We randomly selected and interviewed 400 male students at 20 high schools in the city. In addition, we interviewed 492 male adults who lived near the schools for comparison. RESULTS We found significant associations between smoking use among youth (but not among adults) and measures of outdoor tobacco advertising density and proximity in Semarang city. Youth at schools with medium and high density of outdoor tobacco advertising were up to 2.16 times more likely to smoke, compared to those with low density. Similarly, youth at senior high schools with proximity to outdoor tobacco advertising were 2.8 times more likely to smoke. Also, young people at poorer-neighborhood schools with a higher density of and proximity to outdoor tobacco advertising were up to 5.16 times more likely to smoke. CONCLUSIONS There were significant associations between smoking use among male youth (but not among male adults) and measures of outdoor tobacco advertising density and proximity in Indonesia. This highlights the need to introduce an outdoor tobacco advertising ban effectively, at least near schools.
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Affiliation(s)
- Sri Handayani
- Public Health Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (S.H.); (Y.M.M.); (N.)
| | - Enny Rachmani
- Health Information Management Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (E.R.); (K.K.S.)
| | - Kriswiharsi Kun Saptorini
- Health Information Management Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (E.R.); (K.K.S.)
| | - Yusthin Merianti Manglapy
- Public Health Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (S.H.); (Y.M.M.); (N.)
| | - Nurjanah
- Public Health Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (S.H.); (Y.M.M.); (N.)
| | - Abdillah Ahsan
- Faculty of Economics and Business, University of Indonesia, Depok 16424, Indonesia;
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London SW7 2AZ, UK
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45
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Cavazos-Rehg P, Li X, Kasson E, Kaiser N, Borodovsky JT, Grucza R, Chen LS, Bierut LJ. Exploring How Social Media Exposure and Interactions Are Associated With ENDS and Tobacco Use in Adolescents From the PATH Study. Nicotine Tob Res 2021; 23:487-494. [PMID: 32598479 PMCID: PMC7885778 DOI: 10.1093/ntr/ntaa113] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/23/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Tobacco use is a current public health epidemic that puts individuals at risk for many health conditions and diseases, and adolescents are at high risk for the initiation and persistence of tobacco use behaviors partly due to engagement with social media content. The objective of this study is to examine the association between engaging in social media behaviors and patterns of electronic nicotine delivery systems (ENDS) and tobacco use at a 1-year follow-up among 11 279 adolescents from the PATH study. METHODS Five social media variables were questioned at Wave 2 and then compared to ENDS and tobacco status transitions (i.e., initiation, persistence, and escalation) at a 1-year follow-up, respectively. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios and 95% confidence interval. RESULTS Passive behaviors on social media were related to higher likelihoods of starting to use ENDS and other tobacco products. Additionally, active behaviors on social media were related to higher likelihoods for the initiation and persistence of tobacco use. In particular, sending tobacco content to other users was further associated with a higher likelihood of escalation of tobacco product use. DISCUSSION Both exposure to and interactions with social media tobacco content had a significant impact on the patterns of ENDS and tobacco use in adolescents. Due to the amount of time adolescents spend engaging with online content, social media may be a critical place in which to intervene, possibly with the use of antitobacco or tobacco prevention messages. IMPLICATIONS The results of this study have implications for public health and the policies surrounding adolescents and their exposure to social media. Reducing the ENDS and tobacco content to which adolescents are exposed has the potential to decrease the instances of initiation and persistence of ENDS and tobacco use. Intervening on social media may prevent or slow the progression of ENDS and tobacco use, and increase motivation and actions toward the cessation of tobacco use in adolescents.
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Affiliation(s)
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Jacob T Borodovsky
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Richard Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Investigating the role of familial and peer-related factors on electronic nicotine delivery systems (ENDS) use among U.S. adolescents. J Adolesc 2021; 87:98-105. [PMID: 33548695 DOI: 10.1016/j.adolescence.2021.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Tobacco use is a public health concern, and adolescents are at an increased risk of starting and continuing to use tobacco relative to other age groups. Parent involvement and other social environmental factors may influence the development and persistence of tobacco use behaviors in adolescence. This study used the nationally representative Population Assessment of Tobacco and Health (PATH) study data set, and responses from 7025 adolescent participants were analyzed to illustrate the longitudinal relationship between social environment influences and use of adolescent electronic nicotine delivery systems (i.e., ENDS). METHODS Social environmental factors were assessed at Wave 3 and then compared to electronic nicotine delivery systems (ENDS) status transitions (i.e., initiation, expansion, persistence) at follow-up. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS Initiation and persistence of ENDS use were associated with tobacco availability in the house, perception of having no adverse parent reaction to discovering ENDS use and having a best friend who uses ENDS. Initiation of ENDS use was further associated with having biological relatives who have ever been diagnosed with a substance use disorder (SUD) and persistence of ENDS use was also positively associated with lack of in-house rules. Parents talking about ENDS use with adolescents had no association across all three outcomes. CONCLUSIONS Findings suggest that parental and environmental factors alter the risk of initiation and persistence of ENDS and tobacco use in adolescents, and these should be considered when working with this at-risk population.
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Pierce JP, Chen R, Leas EC, White MM, Kealey S, Stone MD, Benmarhnia T, Trinidad DR, Strong DR, Messer K. Use of E-cigarettes and Other Tobacco Products and Progression to Daily Cigarette Smoking. Pediatrics 2021; 147:peds.2020-025122. [PMID: 33431589 PMCID: PMC7849197 DOI: 10.1542/peds.2020-025122] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To identify predictors of becoming a daily cigarette smoker over the course of 4 years. METHODS We identified 12- to 24-year-olds at wave 1 of the US Population Assessment of Tobacco and Health Study and determined ever use, age at first use, and daily use through wave 4 for 12 tobacco products. RESULTS Sixty-two percent of 12- to 24-year-olds (95% confidence interval [CI]: 60.1% to 63.2%) tried tobacco, and 30.2% (95% CI: 28.7% to 31.6%) tried ≥5 tobacco products by wave 4. At wave 4, 12% were daily tobacco users, of whom 70% were daily cigarette smokers (95% CI: 67.4% to 73.0%); daily cigarette smoking was 20.8% in 25- to 28-year-olds (95% CI: 18.9% to 22.9%), whereas daily electronic cigarette (e-cigarette) vaping was 3.3% (95% CI: 2.4% to 4.4%). Compared with single product triers, the risk of progressing to daily cigarette smoking was 15 percentage points higher (adjusted risk difference [aRD] 15%; 95% CI: 12% to 18%) among those who tried ≥5 products. In particular, e-cigarette use increased the risk of later daily cigarette smoking by threefold (3% vs 10%; aRD 7%; 95% CI: 6% to 9%). Daily smoking was 6 percentage points lower (aRD -6%; 95% CI: -8% to -4%) for those who experimented after age 18 years. CONCLUSIONS Trying e-cigarettes and multiple other tobacco products before age 18 years is strongly associated with later daily cigarette smoking. The recent large increase in e-cigarette use will likely reverse the decline in cigarette smoking among US young adults.
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Affiliation(s)
- John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | - Ruifeng Chen
- Herbert Wertheim School of Public Health and Human Longevity Science
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | | | | | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and,Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California
| | - Dennis R. Trinidad
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
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Margolis KA, Thakur SK, Nguyen Zarndt A, Kemp CB, Glover-Kudon R. E-cigarette susceptibility among U.S. middle and high school students: National Youth Tobacco Survey Data Trend Analysis, 2014-2018. Prev Med 2021; 143:106347. [PMID: 33271235 PMCID: PMC10515727 DOI: 10.1016/j.ypmed.2020.106347] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022]
Abstract
Youth e-cigarette use has rapidly increased in the last few years. Susceptibility is a validated measure associated with future tobacco use. We examined trends in e-cigarette susceptibility across five years (2014-2018) of the National Youth Tobacco Survey among youth e-cigarette never users. We observed increases in overall e-cigarette susceptibility from 2014 to 2016 and decreases from 2016 to 2018. Generally, sociodemographic variables were not associated with trend effects; however, there was an interaction between linear trends with both race/ethnicity and other tobacco product (OTP) use. The percentage of youth who were susceptible to using e-cigarettes ranged from 32.9% in 2014 to 33.2% in 2018 with a high of 36.7% in 2016. We also examined the prevalence of e-cigarette susceptibility by race/ethnicity, sex, school level, OTP use, and e-cigarette harm perception. E-cigarette susceptibility was associated with race, school level, OTP ever use, and e-cigarette harm perceptions. Hispanic youth, those in high school, and OTP ever users were more likely to be susceptible to e-cigarette use compared to their counterparts across all years. E-cigarette susceptibility was most prevalent among those who perceived e-cigarettes to pose "no harm" in 2014 and "little harm" in 2018 when compared to other item response options in 2014 and 2018, respectively. This study is the first to document trends in e-cigarette susceptibility among youth. Understanding antecedents of e-cigarette use and identifying youth subgroups vulnerable to e-cigarette use is valuable to developing effective prevention efforts. Disclaimer: The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the Food and Drug Administration or the Centers for Disease Control and Prevention.
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Affiliation(s)
- Katherine A Margolis
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America.
| | - Sapna K Thakur
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America
| | - Anh Nguyen Zarndt
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America
| | - Catherine B Kemp
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States of America
| | - Rebecca Glover-Kudon
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA, United States of America
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49
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Lazard AJ. Social Media Message Designs to Educate Adolescents About E-Cigarettes. J Adolesc Health 2021; 68:130-137. [PMID: 32654836 DOI: 10.1016/j.jadohealth.2020.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/05/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE E-cigarette use is increasing among adolescents, despite potential harms. Social media messages are a promising way to educate youth about e-cigarettes, yet little is known about what message topics and formats will have beneficial impacts for message reception, reach, e-cigarette knowledge, and beliefs about harms. METHODS A national convenience sample of adolescents (n = 928, aged 15-18 years) in high school was recruited for an online experiment. In October 2019, participants were randomized to view one of three social media formats (visual based, quiz, and text only) or a no-message control. Participants in format conditions viewed six unique topics in a random order. Outcomes were e-cigarette knowledge and beliefs. Message reactions and sharing preferences were also assessed among youth who saw social media messages. RESULTS Social media messages led to greater knowledge (Cohen's f = .19; p < .001) and beliefs (f = .16; p < .001) about harms of e-cigarettes compared with the control, regardless of format. Almost four in five adolescents (79%) reported they would share the social media messages, most likely in person (49%) and with friends (52%). Message topics for missing out because of lung damage, having uncontrolled moods, and ingesting specific harmful chemicals elicited higher intended message reactions. CONCLUSIONS Social media messages can educate about e-cigarette harms. Social media campaigns are a promising e-cigarette education strategy to reach youth, directly and potentially through peer-to-peer sharing.
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Affiliation(s)
- Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Chen B, Sterling KL, Bluestein MA, Kuk AE, Harrell MB, Perry CL, Pérez A. Age of initiation of cigarillos, filtered cigars and/or traditional cigars among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017. PLoS One 2020; 15:e0243372. [PMID: 33296394 PMCID: PMC7725294 DOI: 10.1371/journal.pone.0243372] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
SIGNIFICANCE Early age of initiation of tobacco use is associated with sustained tobacco use and lower rates of smoking cessation. Although much is known about age of initiation of cigarette use, much less is known about the age of initiation of cigar product use among youth. METHODS Survival analyses of the Population Assessment of Tobacco and Health youth annual datasets (ages 12-17) from 2013 to 2017 were conducted for any cigar product use, cigarillos or filtered cigars, and traditional cigars across four cigar use outcomes, age of initiation of: susceptibility to use, ever use, past 30-day use and "fairly regular" use. An interval censoring survival method was implemented to estimate the probability of each outcome for age of initiation of each cigar product overall. Differences in age of initiation by sex and race/ethnicity were assessed using weighted Cox proportional hazards models for interval-censored data. RESULTS For each outcome across the three cigar products, striking increases in the probability of initiation begin before 17 years old. For cigarillo or filtered cigars, males had a higher risk of onset of susceptibility to use, initiating ever use, and initiating past 30-day use at earlier ages than females. Compared to Non-Hispanic Whites, Hispanic and Non-Hispanic Other had lower risk of initiating ever use and past 30-day use at earlier ages. Non-Hispanic Black youth had higher risk of initiating past 30-day use and "fairly regular" use than Non-Hispanic White youth at earlier ages. Similar findings are reported for any cigar use and traditional cigar use. CONCLUSION Developmentally and culturally appropriate cigar use interventions and communication campaigns should be provided to youth before 17 years of age to prevent the onset and progression of cigar products. Regulatory policies that reduce appeal of all cigar products should be implemented to curb cigar initiation among youth.
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Affiliation(s)
- Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
| | - Kymberle L. Sterling
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
| | - Cheryl L. Perry
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
| | - Adriana Pérez
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America
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