Co-use of Electronic Nicotine Delivery Systems and Combustible Cigarettes, and Their Association with Internalizing Pathology and Vulnerabilities

Emotion Dysregulation and E-Cigarette Expectancies among College Student E-Cigarette Users

Background: E-cigarette outcome expectancies (i.e., beliefs about the expected consequences of e-cigarette use) are a key factor in motivating use. Emotion regulation difficulties have demonstrated significant associations with outcome expectancies; however, there has yet to be an examination of associations between specific emotion regulation difficulties and specific e-cigarette outcome expectancies, which could serve as targets for intervention efforts. Therefore, the current study sought to examine the unique predictive ability of specific emotion regulation difficulties in terms of e-cigarette outcome expectancies. Methods: Participants were 116 college student e-cigarette users (Mage = 19.72, SD = 1.88; 71.6% female) who completed self-report questionnaires for course credit. Results: Greater difficulties engaging in goal-directed behavior when experiencing negative emotions and fewer difficulties accessing effective emotion regulation strategies were associated with positive reinforcement outcome expectancies. Greater emotion regulation difficulties in general were also associated with negative reinforcement outcome expectancies, though there were no significant individual predictors. Conclusion: These results suggest that greater emotion regulation difficulties are associated with mood-related e-cigarette outcome expectancies, and targeting emotion regulation difficulties, particularly difficulty engaging in goal-directed behavior when upset, may be useful to incorporate into intervention efforts.

Factors associated with Korean adolescent's e-cigarette use by the severity level of generalized anxiety disorder (GAD-7)

BACKGROUND

The use of e-cigarette among Korean adolescents is spreading with alarming rapidity, but it has not been studied along with the severity level of GAD-7. This study aims to identify adolescents' e-cigarette use and its associated factors among four different anxiety groups using the problem behavioral theory (PBT).

METHODS

A cross-sectional secondary dataset was retrieved from the 2020 Korea Youth Risk Behavior Survey. Of the total sample of 54,948, four anxiety groups were formed: minimal (score 0-4; n = 36,711), mild (score 5-9; n = 12,138), moderate (score 10-14; n = 4143), and severe (score above 15; n = 1965). A total of 11 variables were selected based on the PBT domains. Descriptive analysis, Chi-square, ANOVA, univariate analysis, and multiple linear regression analysis were performed.

RESULTS

E-cigarette use was the highest in the order of severe, mild, moderate, and minimal. While cigarette use was associated with vaping in all anxiety groups, adolescents with minimal or mild anxiety levels were more likely to be influenced by tobacco accessibility and other behavior system factors such as sexual intercourse, alcohol use, and smartphone addiction. Meanwhile, secondhand smoke exposure in public areas was only associated with those with severe anxiety levels, and secondhand smoke exposure at school was a significant factor in all anxiety groups except for those with moderate anxiety levels.

LIMITATION

Due to the nature of cross-sectional dataset, the study could not draw causal links between vaping and other identified factors, include all the necessary PBT components.

CONCLUSION

These findings underscore the need to consider different levels of anxiety when addressing the problems related to vaping among Korean adolescents.

E-Cigarette Use: The Effects of Psychological Vulnerabilities, Perceptions, and Intentions to Use E-Cigarettes

Little research has examined the effects that psychological vulnerabilities (i.e., difficulty with emotion regulation, depressed mood, distress tolerance) have on the perceptions of e-cigarettes, intent to use e-cigarettes, and actual e-cigarette use. Data were collected via an online survey from 837 adults (55.6% male, Mage = 29.2, 71.7% Caucasian). The two path analytic models predicting lifetime and current use fit the data well. Difficulty with emotion regulation was positively associated with depressed mood and negatively associated with distress tolerance, while distress tolerance was negatively associated with depressed mood. Depressed mood was positively associated with perceived benefits of e-cigarette use, and perceived benefits was positively associated with intent to use. Perceived benefits and intent to use were significantly associated with both lifetime and current use. Findings enhance our understanding of the effects that mood and emotion-related factors have on perceptions of, intent to use, and actual use of e-cigarettes, which may have important implications for prevention and cessation.

Readability of online e-cigarette cessation information

INTRODUCTION

Given the growing awareness of the health risks associated with e-cigarettes, many users will access information about how to effectively quit using e-cigarettes, and the internet likely will be a popular source of information. However, little is known about the readability of online e-cigarette cessation information. Therefore, the goal of the current study was to assess the readability of webpage information about e-cigarette cessation.

METHODS

A search of webpages was conducted using the following search terms: vaping addiction, quit vaping, quit Juul, stop vaping, stop Juul, and vaping cessation. The 464 webpages identified were coded for target audience, message valence, and source, and then assessed for reading level with the Flesch-Kincaid Grade Level assessment.

RESULTS

On average, webpage content was written at a 7th grade reading level (Flesch-Kincaid Grade Level Mean=7.34, SD=2.22) and less than 25% of webpages met readability guidelines (i.e. ≤6th grade reading level). There were no differences in readability by target audience, message valence, or webpage source.

CONCLUSIONS

The results suggest that most online content related to e-cigarette cessation is not written at a level that is easily understood by general audiences. Thus, tobacco control advocates should assess the reading level of their messaging to ensure wide accessibility of information.

Passive exposure to e-cigarette emissions is associated with worsened mental health

BACKGROUND

Cigarette smoking, secondhand cigarette smoke (SHS) exposure, and e-cigarette use ("vaping") are each associated with increased rates of depressive symptoms and other internalizing mental health disorders. The prevalence of vaping has increased greatly, yet the mental health correlates of secondhand exposure to e-cigarette emissions are as yet to be investigated. This study examined the potential adverse mental health outcomes associated with different tobacco exposures (direct and passive), with a particular focus on the mental health correlates of secondhand exposure to e-cigarette emissions.

METHODS

The Population Assessment of Tobacco and Health Study data collected from a sample of 16,173 Wave 4 adults were used to test the hypothesis that secondhand e-cigarette emissions exposure is associated with increased odds of internalizing mental health disorders. Individuals were categorized as exclusive cigarette smokers, exclusive e-cigarette users, cigarette and e-cigarette dual users, exclusive noncombustible tobacco users, secondhand smoke exposed non-users, secondhand e-cigarette emissions exposed non-users, and non-users with no current SHS/secondhand e-cigarette aerosol exposure. Adjusted weighted logistic regression analysis was used to investigate the association between exposure type and internalizing problems as assessed by scores on the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), a widely used instrument for assessing mental health problems.

RESULTS

Cigarette smokers (AOR = 2.53, 95% CI: 2.19-2.92), e-cigarette users (AOR = 3.14, 2.41-4.09), dual users (AOR = 3.37, 2.85-4.00), noncombustible tobacco users (AOR = 1.48, 1.01-2.17), SHS exposed non-users (AOR = 1.63, 1.37-1.94), and secondhand e-cigarette emissions exposed non-users (AOR = 1.43, 1.03-1.99) were each associated with increased odds of moderate to severe internalizing mental health problems as compared to unexposed non-users. Odds of internalizing problems among SHS and secondhand e-cigarette emissions exposed non-users did not differ (p = 0.46).

CONCLUSIONS

This is the first study, to our knowledge, to identify an association between recent secondhand exposure to e-cigarette emissions and mental health problems, and the risk is comparable to that of SHS. Corroboration of this relationship needs further research to explicate directionality and mechanisms underlying this association.

Emotion dysregulation, transdiagnostic vulnerabilities, and e-cigarette expectancies in a young adult sample

OBJECTIVE

Use of e-cigarettes is more common among youth with psychological distress. Negative affect reduction outcome expectancies (beliefs about ability of a product to reduce unpleasant emotional states) and emotional transdiagnostic vulnerabilities (maladaptive responses to emotional states common to multiple forms of emotional psychopathology) are both positively related to tobacco susceptibility and use. However, it is unclear if expectancies mediate the effects between emotional issues and use.

METHOD

College students aged 18 to 24 (N = 216; 79.6% female; 36.6% African American) completed an online survey with measures on e-cigarette negative affect reduction outcome expectancies (ENAROE), e-cigarette use, and the following emotional transdiagnostic vulnerabilities (ETV): difficulties in emotion regulation, distress tolerance (DT), positive/negative urgency, and positive/negative affect.

RESULTS

In individual predictor path analysis models, ENAROE mediated the relationship between ETVs and e-cigarette use. Expectancies (ENAROE) mediated 47.3% of the total relationship between positive urgency and use. Significant effects were found for a comprehensive model, in which negative urgency was related to higher ENAROE (b = 0.47, 95% BCCI [0.04, 0.96]), controlling for all other transdiagnostic vulnerabilities. Higher positive urgency was related to an increased likelihood of current use.

CONCLUSIONS

This study provides a novel examination of expectancies as a potential mediator for current e-cigarette use via emotional vulnerabilities. Negative Affect Reduction outcome expectancies mediated the relationship between vulnerabilities and e-cigarette use, indicating that the association between positive urgency and e-cigarette use may be explained partially though emotional expectancies. Thus, expectancies are important targets for prevention and further ETV research.

Worry and e-cigarette cognition: The moderating role of sex

As electronic cigarette (e-cigarette) use continues to rise, it is important to identify individual characteristics that may influence e-cigarette use behavior and potential group-level moderators of effects, such as sex. Initial evidence has suggested that worry, defined as excessive, unrealistic thoughts focused on the possibility of future negative events, may contribute to e-cigarette use behavior. Yet, how these established relations differ across groups, such as male and female e-cigarette users, has not been explored. The present study evaluated the effect of worry on perceived barriers for quitting e-cigarettes, perceptions of benefits for e-cigarette use, and perceived negative consequences of e-cigarette use across sex. The sample included 584 current e-cigarette users (52.2% female, M_age = 35.15 years, SD = 10.27). Analyses indicated a significant interaction between sex and worry on each criterion variable (perceived benefits: b = 0.02, SE = 0.01, t = -2.73, p = .01; perceived barriers for quitting e-cigarettes: b = -0.45, SE = 0.08, t = -5.70, p ≤ 0.001; negative consequences to use: b = -0.033, SE = 0.01, t = -4.50, p < .001), such that worry was more strongly related to each outcome among males than females. These findings suggest that sex plays a role in e-cigarette use behaviors and that males may constitute a group that is especially vulnerable to the effects of worry on both positive and negative e-cigarette use perceptions and perceived barriers for quitting e-cigarettes.

Anxiety Sensitivity and Emotion Dysregulation in Dual and Exclusive E-Cigarette Users

Background: E-cigarette use has increased exponentially over the past decade, particularly among current combustible cigarette users. Preliminary evidence has demonstrated differences across exclusive and dual e-cigarette/combustible cigarette users, such that dual users represent a more clinically severe group. Yet, the extent to which these groups differ on critical transdiagnostic risk factors that may promote and maintain nicotine dependence, such as anxiety sensitivity and emotional dysregulation has yet to be systematically studied. The purpose of the current study was to examine differences between exclusive e-cigarette users and dual e-cigarette and combustible cigarette users in anxiety sensitivity and both global emotion regulation difficulties as well as within specific emotion regulation difficulty domains. Methods: Participants were 192 exclusive e-cigarette users and 315 dual e-cigarette and combustible cigarette users (52.1% female, Mage = 34.8 years, SD = 11.42). Results: Compared to exclusive e-cigarette users, dual users reported higher anxiety sensitivity, overall emotion regulation difficulties, and specific emotion regulation difficulties related to impulse control and lack of access to effective emotion regulation strategies. There were no group differences in emotion regulation difficulties related to emotional clarity, ability to engage in goal-directed behavior when upset, and emotional non-acceptance. Conclusion: The current data suggest that dual users are an at-risk group in terms of emotional processes. Dual users would likely benefit from targeted intervention efforts focused on reducing anxiety sensitivity and improving emotion regulation in order to reduce nicotine consumption and/or promote cessation.

The Role of Anxiety in Smoking Onset, Severity, and Cessation-Related Outcomes: a Review of Recent Literature

PURPOSE OF REVIEW

Anxiety is one of the most common mental health conditions globally and co-occurs with smoking at a markedly high rate. The present review offers a narrative overview of the most recent research on the role of anxiety in smoking onset, maintenance, and cessation-related outcomes. Additionally, given the rise in electronic cigarette use, we review the emerging literature on the influence of anxiety on e-cigarette use.

RECENT FINDINGS

Evidence across studies varied as to the role of anxiety or anxiety symptoms in smoking behavior. The most consistent findings suggested that those with anxiety are more likely to be a smoker, supporting a high rate of co-occurrence across these conditions. Less consistent evidence was observed for the association between anxiety and onset, indicators of severity, and cessation outcomes. Although there is robust evidence for an association between smoking and anxiety, there were considerable discrepancies for the precise role of anxiety in smoking onset, severity, and cessation outcomes. Future work utilizing more sophisticated methodologies is needed to identify causal relations as well as putative moderators and mediators of the anxiety-smoking relation.