E-cigarette use among Texas youth: Results from the 2014 Texas Youth Tobacco Survey

The global prevalence of E-cigarettes in youth: A comprehensive systematic review and meta-analysis

Objectives

Smoking, especially cigarettes, is known as one of the most common social and health problems among people. E-cigarettes are another form of tobacco that has been an ordinary daily occurrence.Study Design: systematic review and meta-analysis.

Methods

Systematic searching of databases was performed in Scopus, Web of Science, PubMed, Science Direct, MagIran, IranDoc, SID and Google search engine based on the PRISMA 2020 guideline. This search was conducted by the end of May 2021. Following full-text assessments, the related data were extracted from the papers. Newcastle-Ottawa scale was also used to evaluate the quality of methodology of the articles. Finally, study analysis was performed using Comprehensive Meta-Analysis software (version 2) based on the random effect model.

Results

Global prevalence of E-cigarette in younger individuals was 16.8 (95 % CI: 10.6-25.6) and 4.8 (95 % CI: 3-7.6) in the Ever and Current modes of E-cigarette, respectively. We also found that E-cigarettes were used more common in young boys than young girls in both Ever and Current modes. In young boys, the prevalence of E-cigarette were 18.8 (95 % CI: 8.4-36.8) and 4.9 (95 % CI: 3-8) in both modes of Ever and Current, respectively. In young girls, these factors were 9.9 (95 % CI: 5-18.6) and 1.6 (95 % CI: 1-3.1) in both modes of Ever and Current, respectively.

Conclusions

The global prevalence of e-cigarettes among young people, especially young boys, is increasing. Based on this, the prevention and management of the damage of this social phenomenon requires comprehensive global study, planning and policy.

The prevalence of electronic cigarettes vaping globally: a systematic review and meta-analysis

BACKGROUND

The purpose of this systematic review study was to determine the national, regional, and global prevalence of electronic cigarettes (e-cigarettes) vaping.

METHOD

The articles were searched in July 2020 without a time limit in Web of Science (ISI), Scopus, PubMed, and Ovid-MEDLINE. At first, the titles and abstracts of the articles were reviewed, and if they were appropriate, they entered the second stage of screening. In the second stage, the whole articles were reviewed and articles that met the inclusion criteria were selected. In this study, search, selection of studies, qualitative evaluation, and data extraction were performed by two authors independently, and any disagreement between the two authors was reviewed and corrected by a third author.

RESULTS

In this study, the lifetime and current prevalence of e-cigarettes vaping globally were 23% and 11%, respectively. Lifetime and current prevalence of e-cigarettes vaping in women were 16% and 8%, respectively. Also, lifetime and current prevalence of e-cigarettes vaping in men were 22% and 12%, respectively. In this study, the current prevalence of e-cigarettes vaping in who had lifetime smoked conventional cigarette was 39%, and in current smokers was 43%. The lifetime prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 24%, 26%, 16%, and 25%, respectively. The current prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 10%, 14%, 11%, and 6%, respectively.

CONCLUSIONS

Based on the results of this study, it can be concluded that the popularity of e-cigarettes is increasing globally. Therefore, it is necessary for countries to have more control over the consumption and distribution of e-cigarettes, as well as to formulate the laws prohibiting about the e-cigarettes vaping in public places. There is also a need to design and conduct information campaigns to increase community awareness about e-cigarettes vaping.

Comparing Risk Factors for Past 30-day E-cigarette and Combustible Tobacco Use: A Longitudinal Analysis of the Texas Adolescent Tobacco and Marketing Surveillance Study (2014-2017)

SIGNIFICANCE

Youth use of e-cigarettes is reaching 'epidemic proportions,' even as combustible tobacco use is declining. Comparison of risk factors that are uniquely associated with e-cigarette and combustible tobacco use among adolescents is warranted.

METHODS

Six waves of data from the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) study (n=3907; N=461,069; 2014-2017) were used in this analysis. A random intercept logistic regression model was used to compare intrapersonal, interpersonal, and environmental risk factors for use of both products based on the Social Ecological Model.

RESULTS

Risk factors that were significantly associated with both past 30-day use of e-cigarette and combustible tobacco products over time included past 30-day use of marijuana and alcohol, social acceptability of product use, having friends and family members who used the products, and male gender. Increasing age, worse academic performance, higher sensation seeking score, higher recall of social media promotion in the past 30 days, and lower positive affect score were associated with past 30-day use of combustible tobacco only. White race was associated with past-30 day use of e-cigarettes only.

CONCLUSION

Involving peers and parents in preventive interventions designed to reduce uptake of these products is paramount, as is the need to address other substance use, like alcohol and marijuana. Efforts should also be made to create a social climate that makes tobacco use (e-cigarettes and combustible products) less acceptable and desirable.

Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science

The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA's priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10-18 years) and/or young adults (ages 18-34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior.

IMPLICATIONS

The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science.

Relationship between population characteristics, e-cigarette and tobacco-related perceptions, and likelihood of ever using e-cigarettes

INTRODUCTION

Electronic nicotine delivery systems (ENDS) are a relatively new type of nicotine-containing product that has risen greatly in use within the past decade, displacing conventional tobacco products as the dominant source of nicotine exposure by many groups. Among those impacted are large sections of US youth. Though health outcomes associated with ENDS use are still being assessed, several potential harms have been noted in the extant literature. The purpose of this study is to examine which US youth subpopulations are at greatest risk for ENDS ever use and how perceptions pertaining to nicotine-containing products relate to this risk.

METHODS

A nationwide online survey was administered to US youth ENDS users and non-users aged 13–18 years. A total weighted sample of 2501 participants was obtained. Statistical analyses included binomial logistic regression and a likelihood ratio test.

RESULTS

Of these youth, 1346 (53.8%) reported having ever used an ENDS product. Those most likely to have used ENDS were White males in their late teens. Those who reported ever using a conventional tobacco product were much more likely to have reported ever using ENDS (AOR= 19.96; 95% CI: 15.30–26.05). A number of perceptions related to nicotine-containing products, including product safety and health effects, were significantly associated with an increased likelihood of ENDS use.

CONCLUSIONS

Certain sections of the US youth population have elevated odds of being ENDS ever users. As increasing evidence supports the need to combat ENDS use by youth, effectively targeted education and prevention campaigns will be necessary.

Marketing Exposure Recall is Associated With Past 30-Day Single, Dual, Polytobacco Use Among US Adolescents

Introduction

This study assesses the relationship between tobacco/e-cigarette marketing exposure and single, dual, and polytobacco product use, among adolescents. Given the increased use of noncigarette tobacco products (eg, cigars, e-cigarettes, hookah) among youth, it is imperative to understand if marketing exposure is associated with dual and polytobacco product use.

Methods

Data were obtained from the 2014 National Youth Tobacco Survey and weighted to be representative of US middle and high school students. Multivariable multinomial logistic regression models were used to assess the relationships between product marketing (via internet, print, retail, and TV/movies) and past 30-day single, dual, and poly (three or more) tobacco product use. Three analyses were conducted using different categories as referent groups to allow for comprehensive examination of the relationships between all groups.

Results

Marketing exposure was significantly correlated with a greater risk of single, dual, and polytobacco product use relative to nonusers. Relative to single product users, product marketing exposure was significantly correlated with a greater relative risk of dual and polytobacco use. There was no statistical difference in the association of marketing exposure between dual and polytobacco use, in any model.

Conclusion

A positive relationship between tobacco product marketing exposure and number of tobacco products used was observed. The magnitude of the relationship grew from single product to dual/poly use. Restrictions of marketing of all tobacco products, similar to cigarettes, particularly in the retail setting, should be considered.

Implications

This study has two primary public health implications. First, self-reported exposure to tobacco/e-cigarette marketing is widespread among adolescents of all tobacco product categories. Second, this widespread exposure to tobacco/e-cigarette marketing appears to not only be correlated with use of a single tobacco product (eg, cigarettes, e-cigarettes), but also multiple tobacco products. While longitudinal studies are needed to further investigate the relationships observed in this study, findings justify further study given the known relationship between tobacco marketing exposure and subsequent cigarette use.

Social Profile of Middle School-Aged Adolescents Who Use Electronic Cigarettes: Implications for Primary Prevention

Electronic cigarette (EC) use continues to increase among adolescents. From a primary prevention point of view, an important gap in our knowledge includes determining whether young smokers that use EC maintain a distinct social profile from kids who use combustible cigarettes (CC). Survey data from middle school students in West Virginia, USA were collected between September and November of 2015 (N = 6547, response rate 84.7%) as part of a state wide school-based mental health intervention program. Data was analyzed using multinomial logistic regression for categorical data. The results show that compared to never smokers, EC-only users possessed a weaker social support and parental monitoring profile and performed worse in school. Additionally, EC-only users were more likely to feel alienated from school, to associate with delinquent peers, to spend time outside late at night, and to engage in unsupervised gatherings with their friends. In 11 of 13 statistical models no difference was observed between EC-only users compared with CC-only users. However, dual users (that had used both EC and CC in their lifetime) demonstrated a significantly greater risk profile compared with EC-only users. We conclude that middle school-aged kids that use EC share a similar risk profile as kids of the same age that use CC. Similar to traditional cigarette smoking, EC use in young adolescents is likely to be a social marker of a pathway to further delinquency and should therefore be subject to primary prevention approaches.

Prospective study of dual use of e-cigarettes and other tobacco products among school-going youth in rural Appalachian Tennessee

INTRODUCTION

E-cigarettes have emerged as the most commonly used tobacco or nicotine products among youth in the United States (US), and usage with other products (dual use) is not well understood. This study assessed dual use and identified associated factors of usage in school-going youth in the high tobacco burdened region of rural Appalachian Tennessee.

METHODS

Two waves of data for the same cohort of students were collected in 2014 (Wave 1) and 2016 (Wave 2). Dual use of e-cigarettes with any other tobacco product was the dependent variable. The independent variables consisted of exposure to tobacco use at home, home smoking rules, smoking inside the vehicle, attitudes toward smoking, exposure to tobacco industry marketing/promotion, and peer/family pressure. Descriptive statistics and multivariate logistic regression analyses were conducted to determine the prevalence of dual use and delineate factors associated with usage.

RESULTS

Dual use increased from 13.3% in Wave 1 to 18.6% in Wave 2. Results of logistic regression show that exposure to tobacco industry marketing/promotion was significantly associated with dual use in the two waves, odds ratio (OR) = 4.18 (confidence interval [CI] = 1.69-10.38) and OR = 4.43 (CI = 2.03-9.67), respectively. While allowing smoking inside the vehicles, sometimes, significantly increased dual use in Wave 1 (OR = 3.18 [CI = 1.19-8.48]), exposure to tobacco use at home (OR = 2.94 [1.24-6.97]), and peer/family pressure (OR = 2.92 [1.87-7.19]) increased usage in Wave 2.

CONCLUSION

The increasing trend in dual use of e-cigarettes and other tobacco products among youth in Appalachia Tennessee suggests a critical need for comprehensive tobacco control programs to avert exacerbating disparities in tobacco use and tobacco-related diseases in the US.

Prevalence and Correlates of Electronic Cigarette Use Among a Clinical Sample of Polysubstance Users in Kentucky: Long Live the Cigarette?

BACKGROUND

E-cigarette use has increased in the US, yet, in some regions rates of cigarette use remain high.

PURPOSE

To describe the prevalence and features of lifetime and past-year e-cigarette use among a clinical sample of polysubstance users in Kentucky, and to determine significant associations of past-year e-cigarette use.

RESULTS

Of the final sample (N  =  497), 83.5% reported having ever used e-cigarettes and 97.2% reported having ever used cigarettes. These rates surpass those found among Kentucky's general population. Compared to those who did not report e-cigarette use, e-cigarette users were more likely to be younger ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover><mml:mrow><mml:mi>x</mml:mi></mml:mrow><mml:mo>¯</mml:mo></mml:mover></mml:math> = 33.4 vs. 43.6, p<.001) and White (88.2.1% vs. 62.5%, p = .001). E-cigarette users showed higher rates for lifetime incarceration (91.1% vs. 72.8%, p = .001) and past-year arrest (75.0% vs. 47.5%, p = .001). This group also presented with more severe substance use history and lower mean age for illicit drug use initiation ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover><mml:mrow><mml:mi>x</mml:mi></mml:mrow><mml:mo>¯</mml:mo></mml:mover></mml:math> = 13.8 vs. 16.4, p  =  .001). Approximately 65% of the sample reported past-year e-cigarette use and 96.6% reported past-year cigarette use. Logistic regression indicated that being younger (AOR = .973, p = .030), White (AOR = 1.92, .046), having a past-year arrest (AOR = 1.73, p = .047) and having used cigarettes (AOR = 8.93, p = .001) or kratom (AOR = 3.04, p = .025) within the past year were significantly associated with past-year e-cigarette use.

CONCLUSIONS

E-cigarette use was related to more severe drug-using patterns. Rates of dual tobacco use among this sample are high, particularly among younger individuals. In ecological contexts where cigarette use remains normative, it is likely that dual use will persist for nicotine-dependent, polysubstance-using individuals.

School Policy, Administrator Perceptions, and Student E-cigarette Use

Objective

In this study, we investigated the relationship between school e-cigarette policy and e-cigarette use among students. Secondarily, we examined whether this relationship varied by administrator perceptions about e-cigarette use being "an issue."

Methods

Data were utilized from written school policies, a school tobacco surveillance study of 2755 students (N = 310,412), and administrator interviews in 54 Texas schools.

Results

When administrators perceived e-cigarettes as an issue, the odds of ever e-cigarette use, susceptibility to use e-cigarettes, and perceived peer use of e-cigarettes were 0.20-0.54 times lower for students attending schools that had an e-cigarette policy compared to those without a policy (p < .05).

Conclusion

The impact of school policies on student e-cigarette use behavior is positive if policies are strongly implemented.

E-Cigarette Use Among Adolescents: An Overview of the Literature and Future Perspectives

Background

Electronic cigarettes (e-cigarettes) are rapidly emerging into a new trend among adolescents, signaling a new époque, that of vapers. E-cigarettes are battery-powered nicotine delivery devices that heat a typically flavoring liquid solution into an aerosol mist that users inhale, allowing them to imitate the act of conventional smoking. There are concerns about the impact of e-cigarettes at both individual and public health level.

Aim

To discuss the characteristics of the most vulnerable, to become e-cigarette users, group of adolescents and to further highlight their behaviors and characteristics.

Methods

An electronic search in PubMed, EMBASE, and Google Scholar databases was conducted, using combinations of the following keywords: adolescents, teenagers, e-cigarettes, vaping. The search included all types of articles written in English until August 2017. A total of 100 articles were found, and 25 were finally included in the present review.

Results

Older age, male gender, conventional smokers, peer influence, daily smoking, and heavier smoking are the most common characteristics of adolescent e-cigarette users.

Conclusion

E-cigarette use is common, especially between certain subgroups in the adolescent population. Since e-cigarette use is increasing and considering that the long term health effects are still under investigation, targeted interventions towards more susceptible individuals may be an effective prevention strategy.

Gender Differences in U.S. Adolescent E-Cigarette Use

Purpose of Review

This study aims to review the recent (2012-2017) available gender difference data on e-cigarette use among adolescents.

Recent Findings

E-cigarettes are the most commonly used tobacco product among adolescents, and recent study findings showed that e-cigarette use can lead to cigarette smoking. However, gender differences in e-cigarette use among adolescents are relatively unknown.

Summary

We used the search terms "adolescents" and "e-cigarettes" on PubMed and identified 652 articles. Of these, 16 articles (2.5%) examined gender differences in adolescent e-cigarette use. Boys appear to have greater use of e-cigarettes, but girls may be at increased risk if e-cigarettes are targeted to them, as it has been for cigarettes. Data on gender differences are limited, and future research should continue to examine gender differences in e-cigarette use. Trends in use rates could evolve with new regulations and innovations in e-cigarette marketing and product features.

The relationships between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents

INTRODUCTION

Sensation seeking is strongly associated with cigarette use in adolescents. However, few studies have investigated its relationship with adolescent e-cigarette use. This study examined cross-sectional and longitudinal associations between sensation seeking and a variety of e-cigarette use behaviors among Texas adolescents.

METHODS

This study utilized two waves of data collected 6months apart through the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in 2014-2015 (n=2,488/N=461,069). TATAMS employs a complex probability-sampling design and is representative of students in 6th, 8th and 10th grades from five counties surrounding the four largest cities in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Weighted multivariable logistic regression was used to examine the cross-sectional and longitudinal associations between sensation seeking and susceptibility to e-cigarette use, ever e-cigarette use, and current (past 30day) e-cigarette use.

RESULTS

In the cross-sectional analyses, higher mean sensation seeking scores were associated with higher odds of both susceptibility to e-cigarette use and ever e-cigarette use (AOR=1.25, 95% CI=1.07, 1.47; AOR=1.24, 95% CI=1.08, 1.43, respectively). For the longitudinal analyses, only the association between higher mean sensation seeking scores and transition to ever e-cigarette use remained statistically significant (AOR=1.45, 95% CI=1.01, 2.08). There were no significant associations between sensation seeking and current e-cigarette use in either the cross-sectional or longitudinal analyses.

CONCLUSIONS

Higher sensation seeking scores were consistently and significantly related to experimentation with e-cigarette use among Texas adolescents. Future interventions (e.g., communication campaigns) should target high sensation seeking adolescents to reduce initiation of e-cigarette use among this population.

Current Use of E-Cigarettes and Conventional Cigarettes Among US High School Students in Urban and Rural Locations: 2014 National Youth Tobacco Survey

PURPOSE

Adolescent tobacco use is higher in rural than in urban areas. While e-cigarette use is increasing rapidly among this age group, differences in prevalence between rural versus urban populations for this relatively novel product have not been explored. The purpose is to investigate whether location of school (rural-urban) is associated with e-cigarette use and dual use (defined as the use of both e-cigarettes and conventional cigarettes) among high school students.

DESIGN

Cross-sectional survey obtained using a stratified, 3-stage cluster sample design.

SETTING

United States.

PARTICIPANTS

A nationally representative sample of US high school students (N = 11 053) who completed the 2014 National Youth Tobacco Survey (NYTS); slightly more than half were urban (54%).

MEASURES

The NYTS measures tobacco-related knowledge, attitudes, and use behavior and demographics of students in the United States.

ANALYSIS

Weighted logistic regression assessed the relationships of urban-rural location with current e-cigarette use and dual use, adjusting for demographic factors, perceived risk, and social norms.

RESULTS

There were clear differences in patterns of adolescent e-cigarette and cigarette use in rural versus urban areas. Social norms and perceptions may play a role in understanding these differences.

CONCLUSION

Urban youth current cigarette smokers were nearly twice as likely as rural cigarette smokers to also use e-cigarettes. Reasons for urban-rural differences need to be taken into account when designing prevention programs and policy changes.

Prevalence of substance use among middle school-aged e-cigarette users compared with cigarette smokers, nonusers, and dual users: Implications for primary prevention

BACKGROUND

The objective of this study was to compare the prevalence of substance use in e-cigarette (EC)-only users with combustible cigarette (CC)-only users, dual users, and nonusers in a large sample of middle school-aged adolescents.

METHODS

Population-based cross-sectional school survey conducted in 15 middle schools in 3 counties in West Virginia in the United States between October and December of 2015 (N = 6547, girls = 49.6%; response rate 84.7%).

RESULTS

Approximately 4.3% of participants had used EC only, 4.5% had used CC only, and around 5.5% were dual users. Nonusers had the lowest prevalence of all 9 forms of substance use assessed in the study (i.e., chewing tobacco, any alcohol, drunkenness, marijuana, sniffing, prescription drugs, hallucinogens, synthetic marijuana, and bath salts), followed by EC and CC users. Dual users had the highest prevalence of 8 of 9 forms of substance use. Multinomial logistic regression models showed that EC-only users had significantly greater odds over nonusers of using 8 of 9 types of substances included in the study. Conversely, EC-only users had significantly lower odds of using 7 of 9 types of substances when compared with dual users. However, EC-only users did not differ from CC-only users in odds of use in any of the 9 substances included in this analysis.

CONCLUSIONS

Among middle school-aged adolescents, EC-only users do not differ from CC-only users in odds for other forms of substance use. Primary prevention programs should consider EC use initiation as a pathway to greater risk of other licit and illicit substances among young adolescents.

Recall of E-cigarette Advertisements and Adolescent E-cigarette Use

Objective

We examined the impact of e-cigarette advertising on e-cigarette use behaviors among youth over time.

Methods

At baseline, 3907 students participated in a youth tobacco surveillance study from 2014-2015 and 2488 students completed a 6-month follow-up. Weighted logistic regression models investigated the recall of e-cigarette advertisements (TV/radio/billboards/retail/Internet) as a risk factor for e-cigarette perceived harm, use, and susceptibility.

Results

The odds of ever e-cigarette use was 3 times higher (AOR=2.99; 95% CI, 1.50-5.97) at 6-month follow-up among e-cigarette never-users who recalled e-cigarette advertisements in retail stores at baseline, compared to those who did not. Likewise, the odds of current e-cigarette use and susceptibility to e-cigarette use at 6-month follow-up were 2.03 (95% CI, 1.11-3.72) and 1.77 (95% CI, 1.20-2.61), respectively. Additionally, recall of e-cigarette advertisements on the Internet at baseline was significantly related to current use (AOR=2.17; 95% CI, 1.05-4.48) and susceptibility to use e-cigarettes (AOR=1.72;95% CI, 1.15-2.58) at 6-month follow-up.

Conclusions

Recall of e-cigarette advertisements at point-of-sale and on the Internet was significantly associated with adolescent e-cigarette susceptibility and use, which supports the need to minimize adolescent exposure to these advertisements.

E-cigarette use of young adults motivations and associations with combustible cigarette alcohol, marijuana, and other illicit drugs

BACKGROUND AND OBJECTIVES

Although the prevalence of e-cigarette use among adolescents and young adults has caught up to or eclipsed that of combustible cigarette use, there is relatively little known about (a) the link between e-cigarettes and other substances and (b) the reasons underlying this increase in e-cigarette use. To address this gap in knowledge, the current study examined associations between e-cigarette use and other substances and identified motives for e-cigarette use among young adults.

METHODS

Participants included an ethnically diverse sample of African American, White, and Hispanic young adults (N = 662; 61% female) who were participating in an ongoing survey-based longitudinal study of health and risky behaviors.

RESULTS

Hispanic, White, and male young adults reported significantly greater past year e-cigarette use compared to their African American and female counterparts. Bivariate correlations showed that use of e-cigarettes was positively associated with use of combustible cigarettes, alcohol, marijuana, cocaine, amphetamines, inhalants, hallucinogens, ecstasy, and misuse of over-the-counter and prescription medications. Furthermore, e-cigarette users reported a higher prevalence of substance use relative to those who did not use e-cigarettes. The taste of e-cigarettes was identified as an important motive for use.

CONCLUSIONS AND SIGNIFICANCE

Although the potential harm associated with e-cigarettes remains largely unknown, e-cigarettes appear to be a risk marker for the use of substances that are known to pose substantial health problems. Health care providers should screen for e-cigarette use, and youth substance use prevention programs should target the reduction of e-cigarette use with particular attention to addressing their taste appeal. (Am J Addict 2017;26:343-348).

Electronic Cigarette Use Among Adolescents in the Russian Federation

BACKGROUND

Information on e-cigarettes among youth in the Russian Federation is lacking.

OBJECTIVE

We examined prevalence of and factors associated with youth e-cigarette use in the Russian Federation.

METHODS

A cross-sectional, anonymous survey, conducted among 716 (females 51.5%) high school students in three cities (i.e., Ufa, Sterlitamak, Karagaevo) within the Republic of Bashkortostan, Russian Federation in 2015, assessed e-cigarette use and its correlates (i.e., sex, age, ethnicity, family structure, parents' highest degrees, antisocial behaviors, stress coping strategies, lifetime cigarette, hookah, alcohol, and marijuana use).

RESULTS

Lifetime use of e-cigarettes was 28.6% and past-30-day use was 2.2%. Multilevel modeling showed that belonging to Tatar/Bashkir ethnicity relative to Russian ethnicity (OR = 1.60) and lifetime use of cigarettes (OR = 21.64), hookah (OR = 4.21), and alcohol (OR = 1.90) was associated with greater odds of lifetime use of e-cigarettes. Furthermore, use of social support coping strategies (i.e., utilizing parents for support) were associated with lower odds of lifetime use of e-cigarettes (OR = 0.94).

CONCLUSIONS

Despite high lifetime e-cigarette use, past-30-day use was low. Greater knowledge of the reasons for e-cigarette discontinuation through continued surveillance is needed in the Russian Federation. Social coping strategies involving parents may inform e-cigarette use prevention.

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

CONTEXT

Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS.

EVIDENCE ACQUISITION

The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic.

EVIDENCE SYNTHESIS

There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features.

CONCLUSIONS

Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.

Use of Electronic Nicotine Delivery Systems Among Adolescents: Status of the Evidence and Public Health Recommendations

Although the prevalence of tobacco smoking has been declining in recent years, the use of electronic nicotine delivery systems (ENDS) such as of electronic cigarettes, vaporizers, and hookahs has been steadily rising, especially among adolescents. ENDS are not only advertised to children, but their sale via the Internet has made them easily accessible to youth. In general, children perceive ENDS as safe, or at least safer than smoking traditional combustible tobacco products; however, exposure to nicotine may have deleterious effects on the developing brain. Concern also persists that ENDS may be a "starter" drug that may lead to further tobacco, drug, and/or alcohol use. In contrast to this precautionary stance that is associated with calls for legislative oversight of ENDS marketing and sales, harm reductionists claim that the risks posed by ENDS are minor in comparison with those of combustible tobacco products and that ENDS may be used as a means of nicotine replacement for smoking cessation, despite no concrete evidence to support this assertion. Many medical and health-related organizations have produced position statements concerning ENDS use, including among adolescents. This article summarizes the advantages and disadvantages of using ENDS espoused in these position statements, especially as they relate to use among adolescents. [Pediatr Ann. 2017;46(2):e69-e77.].

Perceptions of E-Cigarettes among Black Youth in California

Research suggests that Black youth are less likely to use e-cigarettes than their white counterparts, yet little is known as to why. We examined perceptions of e-cigarettes among Black young adults (ages 18-25) to explore the meanings these youth ascribe to e-cigarettes and the role that identity plays in how these devices are viewed. Analysis of in-depth interviews with 36 Black smokers and non-smokers in the San Francisco Bay Area suggests that Black youth perceive e-cigarettes as serving distinct, yet overlapping roles: a utilitarian function, in that they are recognized as legitimate smoking cessation tools, and a social function, insofar as they serve to mark social identity, specifically a social identity from which our participants disassociated. Participants described e-cigarette users in highly racialized and classed terms and generally expressed disinterest in using e-cigarettes, due in part perhaps to the fact that use of these devices would signal alignment with a middle class, hipster identity. This analysis is discussed within a highly charged political and public health debate about the benefits and harms associated with e-cigarette use.

Adolescent Awareness and Use of Electronic Cigarettes: A Review of Emerging Trends and Findings

Adult electronic cigarette (e-cigarette) use is increasing globally, and early studies have suggested that similar trends may be observed among the adolescent population, albeit at lower levels. The current literature review presents data collected since 2014 from 21 cross-sectional studies and one cohort study that were all published in English. In particular, it focuses on awareness, ever use, past 30-day use, and regular use of e-cigarettes. The article suggests that adolescents are nearing complete awareness of e-cigarettes. Furthermore, in relation to ever use and past 30-day use, higher prevalence rates continue to be reported across time, especially in the United States. Nonetheless, reported regular use of e-cigarettes remains much lower than past 30-day use, although conclusions are limited due to inconsistencies with measurement and consequent lack of cross-cultural applicability. The majority of studies do not report whether adolescents use non-nicotine e-cigarettes. There is a current absence of longitudinal studies that explore any association between e-cigarettes and tobacco use and little qualitative data that may illuminate how and why adolescents use e-cigarettes. Through addressing these methodological limitations, future research will be able to inform health care and policy more effectively.

Social Norms, Perceptions and Dual/Poly Tobacco Use among Texas Youth

OBJECTIVES

We assessed risk perceptions and social norms about tobacco use across adolescent non-users of tobacco, single- product users, and dual/poly-product users.

METHODS

Use behaviors specific to e-cigarettes, cigarettes, hookah, cigars, and smokeless tobacco were assessed among 6th, 8th and 10th grade students (sample [n] = 3907 from a population of [N] = 461,069 students). Multivariate regression was used to examine differences in these factors across use categories, adjusted for demographic factors.

RESULTS

Results highlight differences between non-users and single- or dual/poly-product users for most tobacco products. Dual/poly-product users differed from single-product users most notably in their higher perceived use of tobacco products by close friends and dating partners, and a higher proportion of single-product users reported most products were not harmful and not addictive compared to non-users. Few differences were seen between dual/poly-product users and single-product users in their perceptions of harm and addictiveness.

CONCLUSIONS

Findings demonstrate the importance of proximal social influences (ie, close friends and dating partners) for adolescent dual/poly-tobacco product users. Understanding similarities and differences in risk factors between these adolescent groups can guide effective public health prevention and treatment programs.

Flavorings and Perceived Harm and Addictiveness of E-cigarettes among Youth

OBJECTIVES

Given the increasing trend in use of electronic cigarettes ("e-cigarettes") among youth, it is crucial to understand how these products are perceived and how these perceptions are associated with their decision whether or not to use them.

METHODS

This is a cross-sectional analysis of data from a rapid response surveillance system of 6th, 8th and 10th grade students' tobacco use behaviors (sample [n] = 3704 from a population of students [N] = 434,601). We used weighted logistic regression models to investigate the relationship between perceptions of harm and addictiveness and e-cigarette use, including the use of flavored and non-flavored e-cigarettes.

RESULTS

Compared to youth who did not use e-cigarettes, ever and current e-cigarette users had higher odds of reporting that e-cigarettes were "not at all harmful" to health and "not at all addictive." Ever and current e-cigarette users had higher odds of reporting that flavored e-cigarettes were "less harmful" than non-flavored e-cigarettes, compared to youth who did not use e-cigarettes.

CONCLUSIONS

These findings warrant attention given that nicotine is an addictive substance whose effects on the adolescent brain are potentially negative. Youth e-cigarette users perceived lower harm from flavored e-cigarettes, which is worrisome given emerging research documenting harmful constituents in certain e-cigarette flavorings.

Heterogeneity in the measurement and reporting of outcomes in studies of electronic cigarette use in adolescents: a systematic analysis of observational studies

OBJECTIVE

To examine consistency between cross-sectional studies of conventional and electronic cigarette use among adolescents in terms of the measurement, analysis and reporting of parameters.

DESIGN

A systematic analysis of cross-sectional studies of conventional and electronic cigarette use in adolescents, to identify measured and reported parameters.

DATA SOURCES

Studies examining use of electronic and conventional cigarette use in adolescents were identified by searching the SCOPUS database in August 2015.

STUDY SELECTION

The selection criteria for studies were: cross-sectional studies, in English, on e-cigarette use in adolescents. Two reviewers independently selected relevant studies from the search. 60 abstracts were identified, from which 31 papers were eligible for review (23 unique studies).

DATA EXTRACTION

Measured and reported parameters were identified and tabulated. These included the prevalence of cigarette and/ or electronic cigarette use, and the definitions of terms. Data were extracted independently by two reviewers.

DATA SYNTHESIS

With regards basic parameters of 'ever' or 'current' use of electronic or conventional cigarettes, there were 31 unique measured parameters across 23 studies. Of 16/23 studies in which authors collected information on dual current use, prevalence was reported in 11/16, with six different definitions of 'dual use'.

CONCLUSIONS

There are substantial differences in measurement and reporting of parameters across observational studies of electronic and conventional cigarette use in adolescents. These studies are at risk of reporting bias, and results are difficult to interpret. A core outcome set that should be measured and reported in all observational studies is required, using structured consensus techniques.

E-cigarette Dual Users, Exclusive Users and Perceptions of Tobacco Products

OBJECTIVES

We examined differences in the characteristics of youth non-users, cigarette-only, e-cigarette-only, and dual e-cigarette and cigarette users.

METHODS

Using weighted, representative data, logistic regression analyses were conducted to examine differences in demographic characteristics and tobacco use behaviors across tobacco usage groups. Multiple linear regression analyses were conducted to examine differences in harm perceptions of various tobacco products and perceived peer use of e-cigarettes by tobacco usage group.

RESULTS

Compared to non-users, dual users were more likely to be white, male, and high school students. Dual users had significantly higher prevalence of current use of all products (except hookah) than e-cigarette-only users, and higher prevalence of current use of snus and hookah than the cigarette-only group. Dual users had significantly lower harm perceptions for all tobacco products except for e-cigarettes and hookah as compared to e-cigarette-only users. Dual users reported higher peer use of cigarettes as compared to both exclusive user groups.

CONCLUSION

Findings highlight dual users' higher prevalence of use of most other tobacco products, their lower harm perceptions of most tobacco products compared to e-cigarette-only users, and their higher perceived peer use of cigarettes compared to exclusive users.