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Wang P, Williams RJ, Chen W, Wang F, Shamout M, Tanz LJ, Herzig CT, Oakley LP, Peak CM, Heinzerling A, Al-Shawaf M, Melstrom P, Marynak K, Tynan MA, Agaku IT, Kumagai K. Chemical Composition of Electronic Vaping Products From School Grounds in California. Nicotine Tob Res 2024; 26:991-998. [PMID: 38407960 PMCID: PMC11262994 DOI: 10.1093/ntr/ntae042] [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: 05/26/2023] [Revised: 12/27/2023] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION The use of electronic vaping products (EVPs) containing nicotine, marijuana, and/or other substances remains prominent among youth; with EVPs containing nicotine being the most commonly used tobacco product among youth since 2014. However, a detailed understanding of the chemical composition of these products is limited. AIMS AND METHODS From February 25th to March 15th, 2019, a total of 576 EVPs, including 233 e-cigarette devices (with 43 disposable vape pens) and 343 e-liquid cartridges/pods/bottled e-liquids, were found or confiscated from a convenience sample of 16 public high schools in California. Liquids inside 251 vape pens and cartridges/pods/bottled e-liquids were analyzed using a gas chromatography/mass spectrometry (GC/MS). For comparison, new JUUL pods, the most commonly used e-cigarette among youth during 2018-2019, with different flavorings and nicotine content were purchased and analyzed. RESULTS For e-cigarette cartridges/pods/bottled e-liquids, nicotine was detected in 204 of 208 (98.1%) samples. Propylene glycol and vegetable glycerin were dominant solvents in nicotine-containing EVPs. Among 43 disposable vape pen devices, cannabinoids such as tetrahydrocannabinol (THC) or cannabidiol (CBD) were identified in 39 of 43 (90.1%) samples, of which three contained both nicotine and THC. Differences in chemical compositions were observed between confiscated or collected JUULs and purchased JUULs. Measured nicotine was inconsistent with labels on some confiscated or collected bottled e-liquids. CONCLUSIONS EVPs from 16 participating schools were found to widely contain substances with known adverse health effects among youth, including nicotine and cannabinoids. There was inconsistency between labeled and measured nicotine on the products from schools. IMPLICATIONS This study measured the main chemical compositions of EVPs found at 16 California public high schools. Continued efforts are warranted, including at the school-level, to educate, prevent, and reduce youth use of EVPs.
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Affiliation(s)
- Ping Wang
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
| | - Rebecca J. Williams
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, CA, USA
| | - Wenhao Chen
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
| | - Flavia Wang
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
| | - Mays Shamout
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren J. Tanz
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn T.A. Herzig
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa P. Oakley
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Corey M. Peak
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Heinzerling
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
| | - Maeh Al-Shawaf
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Melstrom
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristy Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael A. Tynan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Israel T. Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kazukiyo Kumagai
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
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Farrelly MC, Levine B, Cavazos ML. Advancing youth tobacco surveillance with novel methods. HEALTH EDUCATION RESEARCH 2024; 39:323-330. [PMID: 38367021 DOI: 10.1093/her/cyae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
Tobacco surveillance in the United States is robust but cannot be quickly modified to capture newly identified tobacco products or behaviors. We present an example of a rapidly deployed nonprobability survey using social media recruitment that collected data on rapidly changing tobacco use behaviors. We recruited 15- to 17-year old current vapers from NY, USA, using targeted social media advertisements to complete the New York Adolescent Vaping Survey (NY AVS), which asked about vaping behaviors not addressed in existing probability surveillance surveys. We used the New York Youth Risk Behavior Survey (NY YRBS) to apply calibration weights to ensure that the distribution of the demographic characteristics accurately reflected the population distribution. We found systematic differences in demographic variable distributions between the probability-based NY YRBS and the convenience sample of the NY AVS that were reconciled in the weighting calibration. We found no statistically significant differences between the NY YRBS and NY AVS estimates after calibration for two outcome variables of interest. Recruiting a sample of adolescents using social media advertising to conduct a rapid survey on vaping provided valuable data that complemented traditional surveillance surveys; this approach could be used to fill future knowledge gaps in youth tobacco surveillance.
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Affiliation(s)
- M C Farrelly
- RTI International, 3040 E. Cornwallis Road P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | - B Levine
- RTI International, 3040 E. Cornwallis Road P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | - M L Cavazos
- RTI International, 3040 E. Cornwallis Road P.O. Box 12194, Research Triangle Park, NC 27709, USA
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Rykaczewski C, Tackett AP, Klein EG, Singer JM, Lu B, Wold LE, Wagner DD, Roberts ME. Nicotine information disclosed online by e-cigarette brands popular with young people. Tob Prev Cessat 2024; 10:TPC-10-19. [PMID: 38666216 PMCID: PMC11044183 DOI: 10.18332/tpc/186953] [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: 01/27/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION E-cigarette use is most prevalent among adolescents and young adults - and there are often misperceptions about product risk. The purpose of this study was to determine what nicotine information is provided on e-cigarette brand websites. METHODS Based on national and local surveys, we identified 44 e-cigarette brands commonly used in the US by adolescents and young adults. For each of these brands, their associated websites were analyzed for disclosed nicotine information. Specifically, for each brand's website, we coded whether there was information on nicotine concentration (recorded if a numerical value was provided such as '5% nicotine'), nicotine form (free-base, nicotine salts, or not stated), and nicotine type (tobacco-derived, synthetically derived, or not stated). Coding allowed for both lay (e.g. 'nic salts') as well as scientific (e.g. 'isomers') terms. RESULTS Of the 44 brands examined, all provided basic information on nicotine concentration (e.g. '5% nicotine'). However, 23% of brands did not disclose information on nicotine form (i.e. nicotine salt vs free-base), and 66% of brands did not disclose information on nicotine type (i.e. synthetic vs tobacco-derived). CONCLUSIONS Overall, these results suggest that the e-cigarette industry is not fully informing its consumers about the nicotine in their products. Given that nicotine form and type have implications for e-cigarette addiction potential, these findings highlight a public health concern. There is a need for more comprehensive national regulations for mandating product constituents and emissions disclosures.
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Affiliation(s)
- Clara Rykaczewski
- College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Alayna P. Tackett
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Elizabeth G. Klein
- College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Jill M. Singer
- College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Bo Lu
- College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Loren E. Wold
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Dylan D. Wagner
- Department of Psychology, The Ohio State University, Columbus, Ohio, United States
| | - Megan E. Roberts
- College of Public Health, The Ohio State University, Columbus, Ohio, United States
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Becker TD. A clinical overview of adolescent e-cigarette use (vaping). Minerva Pediatr (Torino) 2024; 76:108-118. [PMID: 37427959 DOI: 10.23736/s2724-5276.23.07131-8] [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: 07/11/2023]
Abstract
E-cigarette use (also known as "vaping") has become increasingly popular among adolescents over the past decade and grown into a significant public health concern in North America, the United Kingdom, and other countries. Concerns about this new trend have generated numerous new research studies. This aim of this study was to summarize recent scientific findings, with a focus on their relevance to clinicians working with adolescents. The first half covers epidemiology, risk factors for e-cigarette use, characteristics of e-cigarette use, youth perceptions of e-cigarettes, physical health risks of e-cigarettes, evidence for "gateway effects" of e-cigarette exposure on subsequent substance use, and the relationship between e-cigarette use and mental health. The review concludes with a clinical focus on assessment of youth who vape, psychoeducation for youth and families, clinical management of vaping, and regulatory considerations.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, New York-Presbyterian Hospital, New York, NY, USA -
- Division of Child and Adolescent Psychiatry, Weill Cornell Medicine, New York, NY, USA -
- Division of Child and Adolescent Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA -
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Balzer G, Landrus A, Ovestrud I, Singer JM, Lu B, Wagner DD, Klein EG, Wold LE, Wilson C, Tackett AP, Roberts ME. What do young people know about the nicotine in their e-cigarettes? Tob Control 2023:tc-2023-058234. [PMID: 37973361 PMCID: PMC11096260 DOI: 10.1136/tc-2023-058234] [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] [Received: 06/23/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION In recent years, the nicotine in e-cigarettes has been available in either a 'free-base' (unprotonated) or 'nicotine salt' (protonated) form. Additionally, e-cigarette nicotine can be either 'synthetic' or 'tobacco-derived'. These dimensions of nicotine have implications for nicotine absorption, bioavailability and sensory experiences. However, it is unclear if the young people using e-cigarettes are aware of these nicotine dimensions. METHODS Data came from a cohort of Ohio youth (aged 15-24) who reported using an e-cigarette in the past 4 months (N=271). Participants were enrolled and provided background information in 2021; their 12-month follow-up survey asked about the presence, form and type of nicotine in their usual e-cigarette. Individuals who reported that they could distinguish between tobacco-derived and synthetic nicotine were additionally asked to describe the difference. RESULTS Of the 247 youth who reported that there was nicotine in their usual e-cigarette, 71.7% did not know whether it was free-base or nicotine salt and 75.7% did not know whether it was synthetic or tobacco-derived. Awareness was higher among youth who were using e-cigarettes at a greater frequency and quantity. The majority reported that they could not detect a difference between the experience of using synthetic vs tobacco-derived nicotine. CONCLUSIONS These findings indicate the generally limited awareness about nicotine among youth who used e-cigarettes. Improvements in health communications and requirements for e-cigarette industry disclosures are necessary to ensure that consumers are better informed about the dimensions-and the risks-of the nicotine they are consuming.
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Affiliation(s)
- Grace Balzer
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Anthony Landrus
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ilona Ovestrud
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Jill M Singer
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Bo Lu
- College of Public Health Division of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Dylan D Wagner
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Elizabeth G Klein
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Loren E Wold
- Division of Cardiac Surgery, Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Clark Wilson
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Alayna P Tackett
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Megan E Roberts
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Peterson ML, Clark CT, Lynch CJ, Cooper JT, Gelfman N, Blumenstein J, Hansen R, Porter JH, Hillhouse TM. Preliminary assessment of the subjective effects of electronic-cigarettes in young-adult low-dose electronic-cigarette users: Effects of nicotine dose and e-liquid flavor. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1887-1896. [PMID: 34283707 DOI: 10.1080/07448481.2021.1950162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The present study evaluated the effects of nicotine concentration (0-10 mg/ml) and flavor (gummy bear vs unflavored) on the subjective experiences of vaporized nicotine in young adult low-dose nicotine (3 mg/ml) ECIG users. PARTICIPANTS Eight young adult ECIG users were recruited. METHODS A single blinded crossover study was used. Participants were instructed to take ten 1.5 second puffs, each separated by 20 seconds. After self-administration, heart rate was recorded, and participants completed the Drug Effects, Direct Effects of Nicotine, and Direct Effects of ECIG questionnaires. RESULTS ECIG user's standard daily nicotine dose influenced the rewarding and aversive effects of nicotine as the 10 mg/ml dose was found to be aversive in this user group. The combination of flavor and nicotine increased the subjective effects of ECIGs. CONCLUSIONS Flavored e-liquids contribute to the reinforcing properties of nicotine by enhancing the subjective effects, which may lead to continued ECIG use.
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Affiliation(s)
- Makenzie L Peterson
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Carson T Clark
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Cayla J Lynch
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - James T Cooper
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Noah Gelfman
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Julia Blumenstein
- Department of Exercise and Nutrition Sciences, Weber State University, Ogden, Utah, USA
| | - Rodney Hansen
- Department of Exercise and Nutrition Sciences, Weber State University, Ogden, Utah, USA
| | - Joseph H Porter
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Todd M Hillhouse
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
- Department of Psychology, University of Wisconsin Green Bay, Green Bay, Wisconsin, USA
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Katz SJ, Petersen A, Cohen E, Hatsukami D. Tobacco Free Nicotine Vaping Products: A Study of Health Halo Effects Among Middle School Youth. JOURNAL OF HEALTH COMMUNICATION 2023; 28:391-400. [PMID: 37340942 PMCID: PMC10287042 DOI: 10.1080/10810730.2023.2217431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Health halo effects are a form of biased processing, wherein a particular product claim bleeds over to other categories of analysis or to an overall healthier impression. This study tests whether the term tobacco-free nicotine triggers a health halo effect. Through an experiment with middle school youth (n = 599), we vary the flavor (tobacco vs. fruit) and nicotine source information (nicotine/tobacco-free nicotine/nicotine from tobacco) on the warning label of the vaping product participants viewed. We evaluate product measures (nicotine content beliefs, nicotine source beliefs, and risk perceptions) and comparative nicotine source misperceptions (addictiveness, safety, and risk). Findings show that the term tobacco-free nicotine triggers inaccurate nicotine content beliefs, nicotine source beliefs, and misperceptions associated with addictiveness, safety, and risk. We conclude with theoretical and regulatory implications.
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Affiliation(s)
- Sherri Jean Katz
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, Minnesota, United States
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Elisia Cohen
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, Minnesota, United States
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Health, University of Minnesota, Minneapolis, Minnesota, United States
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Kowitt SD, Seidenberg AB, Gottfredson O'Shea NC, Ritchie C, Galper EF, Sutfin EL, Sheeran P, Noar SM. Synthetic nicotine descriptors: awareness and impact on perceptions of e-cigarettes among US youth. Tob Control 2023:tc-2023-057928. [PMID: 37173133 PMCID: PMC10640660 DOI: 10.1136/tc-2023-057928] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) are being advertised and sold with synthetic nicotine. Little research has examined youth awareness of synthetic nicotine or the impact of synthetic nicotine descriptors on perceptions of e-cigarettes. METHODS Participants were a sample of 1603 US adolescents (aged 13-17 years) from a probability-based panel. The survey assessed knowledge of nicotine source in e-cigarettes (from 'tobacco plants' or 'other sources besides tobacco plants') and awareness of e-cigarettes containing synthetic nicotine. Then, in a between-subjects experiment with a 2×3 factorial design, we manipulated descriptors on e-cigarette products: (1) nicotine label (inclusion of the word 'nicotine': present or absent) and (2) source label (inclusion of a source: 'tobacco-free', 'synthetic' or absent). RESULTS Most youth were either unsure (48.1%) or did not think (20.2%) that nicotine in e-cigarettes comes from tobacco plants; similarly, most were unsure (48.2%) or did not think (8.1%) that nicotine in e-cigarettes comes from other sources. There was low-to-moderate awareness of e-cigarettes containing synthetic nicotine (28.7%), with higher awareness among youth who use e-cigarettes (48.0%). While no main effects were observed, there was a significant three-way interaction between e-cigarette status and the experimental manipulations. The 'tobacco-free nicotine' descriptor increased purchase intentions relative to 'synthetic nicotine' (simple slope: 1.20, 95% CI 0.65 to 1.75) and 'nicotine' (simple slope: 1.20, 95% CI 0.67 to 1.73) for youth who use e-cigarettes. CONCLUSIONS Most US youth do not know or have incorrect beliefs about the sources of nicotine in e-cigarettes and describing synthetic nicotine as 'tobacco-free nicotine' increases purchase intentions among youth who use e-cigarettes.
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Affiliation(s)
- Sarah D Kowitt
- Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Caroline Ritchie
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily F Galper
- Hussman School of Journalism and Media, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Hussman School of Journalism and Media, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Chaffee BW, Couch ET, Wilkinson ML, Donaldson CD, Cheng NF, Ameli N, Zhang X, Gansky SA. Flavors increase adolescents' willingness to try nicotine and cannabis vape products. Drug Alcohol Depend 2023; 246:109834. [PMID: 36963159 PMCID: PMC10121941 DOI: 10.1016/j.drugalcdep.2023.109834] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 03/05/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Certain product characteristics, such as flavor, may increase adolescents' willingness to try vaped nicotine and cannabis (marijuana) products. METHODS A discrete choice experiment embedded within the 2021-2022 California Teens Nicotine and Tobacco Project Online Survey was administered to a non-probability sample of N = 2342 adolescents ages 12-17. Participants were sequentially presented four randomly-generated pairs of hypothetical vape products that varied in device type (disposable, refillable), content (nicotine, marijuana, "just vapor"), and flavor (seven options) and asked which of these (or neither) they would be more willing to try if a best friend offered. Conditional logistic regression quantified associations between product characteristics and participants' selections, including interactions by past 30-day use of e-cigarettes, marijuana, or both. RESULTS Candy/dessert, fruit, and fruit-ice combination flavors were all associated with greater willingness to try a vape product (versus tobacco flavor) among participants not using e-cigarettes or marijuana, those using only e-cigarettes, and those co-using e-cigarettes and marijuana. Among participants only using marijuana, the most preferred flavors were no flavor, candy/dessert, and icy/frost/menthol. Among participants not using e-cigarettes or marijuana, model-predicted willingness to try a displayed vape product was greater when products were sweet or fruit flavored than tobacco or unflavored, regardless of whether displayed options contained nicotine (fruit/sweet: 21 %, tobacco/unflavored: 4 %), marijuana (fruit/sweet: 18 %, tobacco/unflavored: 6 %), or "just vapor" (fruit/sweet: 29 %, tobacco/unflavored: 16 %). CONCLUSIONS In this online non-probability sample, flavors in nicotine and cannabis vape products increased adolescents' willingness to try them. Comprehensive bans on flavored vapes would likely reduce adolescent use.
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Affiliation(s)
- Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA.
| | - Elizabeth T Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Monica L Wilkinson
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Candice D Donaldson
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Nancy F Cheng
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Niloufar Ameli
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Xueying Zhang
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Stuart A Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
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Nicotine and Nicotine-Free Vaping Behavior among a Sample of Canadian High School Students: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020368. [PMID: 36832497 PMCID: PMC9955355 DOI: 10.3390/children10020368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/28/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023]
Abstract
Youth vaping is a public health concern in Canada. Researchers have explored factors associated with vape use, but rarely differentiated between types of use. This study estimates the prevalence and correlations among past-month nicotine vaping, nicotine-free vaping, and dual-use vaping (nicotine and nicotine-free) in grades 9-12 high school students. Data came from the 2019 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). The total sample consisted of 38,229 students. We used multinomial regression to assess for the correlations among different categories of vape use. Approximately 12% of the students reported past-month vape use exclusively with nicotine, 2.8% reported exclusively nicotine-free vape use, and 14% reported both nicotine vaping and nicotine-free vaping. Substance use (smoking, alcohol, cannabis) and being male were associated with membership in every category of vape use. Age was associated with vape use, but in different directions. Grade 10 and 11 students were more likely than grade 9 students to vape exclusively with nicotine (aOR 1.36; 95% CI: 1.05, 1.77 and aOR 1.46; 95% CI: 1.09, 1.97), while grade 9 students were more likely than grade 11 and 12 students to vape with both nicotine and nicotine-free vapes (aOR 0.82; 95% CI: 0.67, 0.99 and aOR 0.49; 95% CI: 0.37, 0.64). The prevalence of nicotine and nicotine-free vaping is high, with many students reporting the use of both.
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Panagiotakos DB, Georgoulis M, Kapetanstrataki M, Behrakis P. Prevalence, patterns, and determinants of electronic cigarette and heated tobacco product use in Greece: A cross-sectional survey. Hellenic J Cardiol 2023; 70:10-18. [PMID: 36681120 DOI: 10.1016/j.hjc.2023.01.002] [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: 09/01/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Electronic cigarettes (EC) and heated tobacco products (HTP) have been introduced in the global market as safer nicotine delivery systems; however, there is skepticism about their link to smoking and long-term risks. The aim of this study was to evaluate the prevalence, patterns, and determinants of EC/HTP use in Greece. METHODS This was a cross-sectional survey of 1,044 individuals aged ≥15 years old, who were randomly selected from the general Greek population. The study was conducted in May 2022, and participants were assessed through face-to-face interviews using a questionnaire designed to collect information on smoking and EC/HTP use, as well as their sociodemographic, lifestyle, and medical data. RESULTS The use of EC/HTP was reported by 16.2% of the participants, slightly more prevalent in males (17.2%) than in females (15.2%), and significantly more prevalent in <40-year-olds (21.3%) than ≥40-year-olds (11.3%). Most EC/HTP users (72.8%) were current smokers, 13.0% were former smokers, and 14.2% were never smokers. Among users, 60.6% used nicotine-containing products, 30.2% used EC/HTP in parallel with conventional tobacco, and 56.9% used EC/HTP for the first time while being <25 years old. In multiple logistic regression analysis, younger age, being employed, being a former/current smoker, adopting a Western-type diet, and believing that EC/HTP are less harmful than conventional tobacco products and can help toward smoking cessation emerged as significant determinants of EC/HTP use. CONCLUSIONS EC/HTP are commonly used in combination with conventional tobacco, are quite popular among the youth, and also appeal to a small fraction of nonsmokers.
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Affiliation(s)
- Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 176 76 Athens, Greece.
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 176 76 Athens, Greece
| | | | - Panagiotis Behrakis
- "George D. Behrakis" Research Lab, Hellenic Cancer Society, 105 57 Athens, Greece
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12
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Hammond D, Reid JL, Burkhalter R, O'Connor RJ, Goniewicz ML, Wackowski OA, Thrasher JF, Hitchman SC. Trends in e-cigarette brands, devices and the nicotine profile of products used by youth in England, Canada and the USA: 2017-2019. Tob Control 2023; 32:19-29. [PMID: 34099572 PMCID: PMC9359003 DOI: 10.1136/tobaccocontrol-2020-056371] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The e-cigarette market has rapidly evolved, with a shift towards higher nicotine concentration and salt-based products, such as JUUL; however, the implications for youth vaping remain unclear. METHODS Repeat cross-sectional online surveys were conducted in 2017, 2018 and 2019, with national samples of youth aged 16-19 years recruited from commercial panels in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Regression models examined differences between countries and over time in the types of e-cigarette products used (design and nicotine content), reasons for using brands and differences in patterns of use, sociodemographics and dependence symptoms by brand/nicotine content. RESULTS In 2019, the use of pod- or cartridge-style e-cigarettes was greater in Canada and the USA than England, with Smok and JUUL the leading brands in all countries. In 2019, youth vapers in England were less likely to report using e-cigarettes with ≥2% nicotine (12.8%) compared with Canada (40.5%; adjusted OR (AOR)=4.96; 95% CI 3.51 to 7.01) and the USA (37.0%; AOR=3.99, 95% CI 2.79 to 5.71) and less likely to report using nicotine salt-based products (12.3%) compared with Canada (27.1%; AOR=2.77, 95% CI 1.93 to 3.99) and the USA (21.9%; AOR=2.00, 95% CI 1.36 to 2.95). In 2019, self-reported use of products with higher nicotine concentration was associated with significantly greater frequency of vaping, urges to vape and perceived vaping addiction (p<0.05 for all). CONCLUSIONS The use of high-nicotine salt-based products is associated with greater symptoms of dependence, including JUUL and other higher-nicotine brands. Greater use of high-nicotine salt-based products may account for recent increases in the frequency of vaping among youth in Canada and the USA.
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Affiliation(s)
- David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Robin Burkhalter
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Olivia A Wackowski
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway Township, NJ, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara C Hitchman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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13
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Vaping. JAAPA 2022; 35:25-30. [DOI: 10.1097/01.jaa.0000854544.26702.2e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Coats EM, Farrelly MC, Henes AL, Pikowski JM, Brown EM, Nonnemaker JM. Youth vaping beliefs and behaviors: evidence from New York. HEALTH EDUCATION RESEARCH 2022; 37:254-265. [PMID: 35727195 DOI: 10.1093/her/cyac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Current use of vaping products has increased in recent years among youth in the United States. We conducted cross-sectional surveys of vaping product users aged 15-17 in New York in 2017 and 2019 to assess vaping freqency, reported nicotine content of vaping products used, risk perceptions of vaping and openness to vaping cannabis (2019 survey only). Between 2017 and 2019, the proportion of youth vapers who were frequent vaping product users increased from 16.8% to 26.2% (P < 0.05). The proportion of youth vapers who usually used high-nicotine vaping products also increased, from 12.6% to 40.0% (P < 0.05). In both years, the use of high-nicotine vaping products was positively associated with frequent use (P < 0.05). The perceived likelihood of harm from vaping increased (P < 0.05), but respondents' perception of harm from using tobacco-flavored vaping products remained higher than that from using menthol/mint or sweet flavors. In 2019, 60.6% of respondents reported having tried vaping cannabis. Results suggest shifts in youth vaping behavior toward more frequent use and use of higher nicotine vaping products, support previous findings about youth misperceptions about health risks of flavored vaping products and highlight openness to vaping cannabis among youth vaping product users.
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Affiliation(s)
- Ellen M Coats
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Matthew C Farrelly
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Amy L Henes
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Jessica M Pikowski
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - Elizabeth M Brown
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | - James M Nonnemaker
- Center for Health Analytics, Media, and Policy, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
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15
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Livingston JA, Chen CH, Kwon M, Park E. Physical and mental health outcomes associated with adolescent E-cigarette use. J Pediatr Nurs 2022; 64:1-17. [PMID: 35121206 DOI: 10.1016/j.pedn.2022.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Use of electronic cigarettes (e-cigarette) and other electronic nicotine delivery systems (ENDS) among adolescents has increased dramatically, creating a need for research to examine the consequences of e-cigarette use on adolescent health. Given the emergent state of the research literature, this integrative review sought to summarize what is currently known about the physical and mental health outcomes associated with e-cigarette use in an adolescent population, and to identify directions for future research. METHOD The methodology for this integrative review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A methodical search was conducted in February 2020 in PubMed, CINAHL, and Web of Science databases. To be eligible for inclusion, studies had to address e-cigarette use, have samples that were between 13 and 24 years of age, be published in a peer-reviewed journal, and examine health outcomes associated with e-cigarette use. After the screening process, 18 studies were included. RESULTS Physical health outcomes associated with e-cigarette use included oral health and respiratory problems as well as nicotine dependence. Mental health outcomes included depression and suicidal ideation. In studies that compared e-cigarette use to conventional cigarette use and non-use, e-cigarettes tended to be associated with more problems than non-use, but fewer problems than conventional cigarette use. Dual use, that is, use of both conventional cigarettes and e-cigarettes, was associated with the greatest harm. CONCLUSION Although somewhat less harmful than conventional cigarettes, e-cigarette use is related to a variety of negative physical and mental health outcomes among adolescent users.
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Affiliation(s)
- Jennifer A Livingston
- School of Nursing, University at Buffalo, State University of New York, United States of America.
| | - Chia-Hui Chen
- School of Nursing, University at Buffalo, State University of New York, United States of America
| | - Misol Kwon
- School of Nursing, University at Buffalo, State University of New York, United States of America
| | - Eunhee Park
- School of Nursing, University at Buffalo, State University of New York, United States of America
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16
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Zutrauen S, Do MT, Ghandour L, Moore-Hepburn C, Beno S, Richmond SA, Chadi N. Acute injury or illness related to the inhalation of vaping aerosols among children and adolescents across Canada: A cross-sectional survey of Canadian paediatricians. Paediatr Child Health 2022; 27:43-49. [DOI: 10.1093/pch/pxab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/11/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vaping prevalence rates have increased among Canadian youth. Evidence suggests that vaping poses significant health risks to children and adolescents.
Objectives
The objectives of the study were to investigate epidemiological characteristics of acute injury/illness cases due to the inhalation of vaping aerosols among children and adolescents across Canada and to explore factors contributing to severe cases.
Methods
Data from the 2019 Canadian Paediatric Surveillance Program cross-sectional survey on vaping-related injury/illness were used. Analyses focused on injury/illness cases (n=71) among children and adolescents aged 0 to 17 years who presented to participating paediatricians for a harm related to the inhalation of vaping aerosols. We conducted descriptive analyses and performed logistic regression to explore associations between severe presentations requiring hospitalization or intensive care unit (ICU) admission and selected case characteristics.
Results
Of the 71 reported injury/illness cases related to inhalation of vaping aerosols, 56% of patients were male, and 68% were aged 15 to 17 years. Nicotine vaping was reported in 42% of cases, and cannabis vaping in 24%. Fifty-four per cent presented with respiratory distress, 18% with symptoms of nicotine toxicity, and 41% required hospitalization and/or admission to the ICU. Cases presenting with respiratory distress were more likely to be hospitalized/admitted to the ICU (odds ratio [OR]=5.37, 95% confidence interval [CI]:1.76 to 16.39).
Conclusions
The inhalation of vaping aerosols among children and adolescents may contribute to acute injury/illness. Clear associations between study variables and severe cases could not be established due to a small sample size. Additional research is needed to determine predictors and preventable risk factors of severe vaping-related injuries.
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Affiliation(s)
- Sarah Zutrauen
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Minh T Do
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Consumer and Hazardous Products Safety Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Lina Ghandour
- Consumer and Hazardous Products Safety Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Charlotte Moore-Hepburn
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suzanne Beno
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah A Richmond
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Paediatrics, Sainte-Justine University Hospital Centre, Montréal, Québec, Canada
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17
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Tokle R, Brunborg GS, Vedøy TF. Adolescents' Use of Nicotine-Free and Nicotine E-Cigarettes: A Longitudinal Study of Vaping Transitions and Vaper Characteristics. Nicotine Tob Res 2022; 24:400-407. [PMID: 34546348 PMCID: PMC8842395 DOI: 10.1093/ntr/ntab192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although adolescents' nicotine addiction from e-cigarettes is a concern, few studies differentiate between vaping with and without nicotine. This study examines the prevalence of nicotine and nicotine-free vaping, maps transitions between vaping behaviors, and assesses differences in the personal characteristics of vapers in a sample of Norwegian adolescents. AIMS AND METHODS Data came from a nationwide longitudinal study of adolescents (n = 2018) conducted in 2017 (T1), 2018 (T2), and 2019 (T3) (mean age: 14.2, 15.0, and 16.2). Using an online questionnaire, we measured vaping with and without nicotine, snus use, smoking, sensation-seeking, conduct problems, and levels of depression. RESULTS Past 12-month vaping prevalence was stable (12%, 13%, and 15%). Among adolescents reporting vaping at T1, 66% had used e-cigarettes without nicotine, 22% with nicotine, and 12% were unsure of nicotine content. Individual vaping trajectories were unstable: of nicotine-free vapers, 54% became non-users, while 14% became nicotine vapers from T1 to T2. From T2 to T3, 50% became non-users, while 17% became nicotine vapers. Of nicotine vapers, 39% became non-users from T1 to T2, while 46% became non-users from T2 to T3. Compared to nicotine-free vapers, nicotine vapers had more conduct problems (mean = 3.67 vs 2.17), had more symptoms of depression (mean = 11.38 vs 6.95), and comprised more past 30-day snus users (33% vs 14%) and cigarette users (33% vs 9%). CONCLUSIONS Adolescent vapers most commonly used e-cigarettes without nicotine, few of these transitioned into nicotine vaping, and a majority became non-users. Nicotine vapers were more likely to use other tobacco products and have more conduct problems and symptoms of depression compared to nicotine-free vapers. IMPLICATIONS Reporting the prevalence of nicotine-free vaping is critical for assessing nicotine exposure and subsequent risks of nicotine addiction. This multi-cohort longitudinal study showed that use of nicotine-free e-cigarettes is common among young vapers in Norway. Adolescents' vaping patterns-both with and without nicotine-are generally temporal and experimental. Despite the majority of nicotine vapers becoming non-users, they are characterized by having more conduct problems and poorer mental health, and they more often used other tobacco products.
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Affiliation(s)
- Rikke Tokle
- Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Geir Scott Brunborg
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Tord Finne Vedøy
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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18
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Becker TD, Rice TR. Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations. Eur J Pediatr 2022; 181:453-462. [PMID: 34396473 PMCID: PMC8364775 DOI: 10.1007/s00431-021-04220-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/24/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
Worldwide, youth electronic cigarette use (vaping) has risen significantly over the past decade. This public health concern has spurred many high-quality studies characterizing country-specific prevalence, risk factors, physical and behavioral health complications, and optimal methods of assessment and counseling for youth vaping. Clinicians remain underexposed to this recent work, limiting translation of evidence into higher quality patient care. This review aims to provide pediatricians and other clinicians working with youth a clinically focused survey of key research findings and considerations based on recent evidence. This narrative review surveys emerging trends in EC use across different countries, reasons for youth vaping, characteristics of vaping materials that promote youth use, associations with combustible cigarette use, relation with cannabis and other illicit substances, physical and behavioral health risks associated with vaping, and methods of assessment, counseling, and intervention for problematic vaping in youth. Since vaping remains a relatively new phenomenon, long-term health consequences remain unknown.Conclusion: Youth vaping is an increasingly well-studied phenomenon with both physical and behavioral health risks. Pediatricians and other youth-focused clinicians can apply the lessons of recent research in work with youth and their families. What is Known: • Youth vaping is an increasingly prevalent public health concern. • Recent research demonstrates physical and behavioral health risks associated with vaping as well as methods for assessment, counseling, and intervention. What is New: • The current review summarizes the latest evidence in a clinically focused framework to facilitate translation of emerging knowledge to practice.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1230, New York, NY, 10019, USA.
| | - Timothy R Rice
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1230, New York, NY, 10019, USA.
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19
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Cohen N, Jeter J, Schissler K, Lozano J, Maniaci V, Peña B. Poor Perception and Knowledge of Electronic Cigarettes Among Adolescents and Their Parents. Pediatr Emerg Care 2022; 38:e709-e713. [PMID: 35100768 DOI: 10.1097/pec.0000000000002339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Electronic cigarettes (e-cigs) and vaping are a popular form of substance abuse among adolescents. Studies have shown that adolescents have a poor understanding of e-cigs but little is known about parental understanding. The primary objective was to assess if a discrepancy in perception and knowledge regarding the content and safety profile of e-cigs between adolescents and their parents exists. METHODS Single-site prospective questionnaire analysis of adolescents (12-21 years) and their parents between November 2018 and March 2019 was performed. Each participant pair received an anonymous, confidential, electronic questionnaire. Data were collected via Research Electronic Data Capture. χ2 and independent t tests were used for comparative analysis. RESULTS A total of 300 adolescent/parent pairs were included for analysis. The mean age of adolescents was 15.1 years (SD, 2.1), and that of parents was 43.9 years (SD, 8.7). Overall knowledge of e-cigs was inadequate in both adolescents and parents: 93.7% and 88.3%, respectively (P < 0.0001). Less adolescents (49.0%) compared with parents (71.0%) perceived any health risks to smoking e-cigs (P < 0.0001). Among adolescents, 17% admitted to smoking e-cigs compared with 5.4% smoking conventional tobacco cigarettes (P < 0.0001), and they reported using e-cigs (17.0%) more often than any other substance except alcohol (27.3%). Only 49.7% of adolescents reported receiving formal education at school regarding e-cigs. Parents reported discussing e-cigs risks/benefits with adolescents less often than other topics (71.3% vs 79.0% to 84.3%; P < 0.0007). CONCLUSIONS This analysis suggests that perception and knowledge regarding the content and safety profile of e-cigs are poor among both adolescents and parents. These findings support the need for tighter federal regulation and an increase in public health awareness programs.
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Affiliation(s)
- Naiomi Cohen
- From the Department of Pediatric Emergency Medicine
| | - Justin Jeter
- Department of Medical Education, Nicklaus Children's Hospital
| | | | - Juan Lozano
- Division of Medical and Population Health Sciences Education and Research, College of Medicine, Florida International University, Miami, FL
| | | | - Barbara Peña
- From the Department of Pediatric Emergency Medicine
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20
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Fuentes AL, Crotty Alexander LE. Beware, vaping e-cigarettes around children is adversely impacting their lung health. Thorax 2022; 77:638-639. [PMID: 35012999 DOI: 10.1136/thoraxjnl-2021-218168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Ana Lucia Fuentes
- Medicine, University of California San Diego, La Jolla, California, USA.,Medicine, VA San Diego Healthcare System, San Diego, California, USA
| | - Laura E Crotty Alexander
- Medicine, University of California San Diego, La Jolla, California, USA .,Medicine, VA San Diego Healthcare System, San Diego, California, USA
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21
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Sidani JE, Hoffman BL, Colditz JB, Melcher E, Taneja SB, Shensa A, Primack B, Davis E, Chu KH. E-Cigarette-Related Nicotine Misinformation on Social Media. Subst Use Misuse 2022; 57:588-594. [PMID: 35068338 PMCID: PMC9257904 DOI: 10.1080/10826084.2022.2026963] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background. Twitter provides an opportunity to examine misperceptions about nicotine and addiction as they pertain to electronic nicotine delivery systems (ENDS). The purpose of this study was to systematically examine a sample of ENDS-related tweets that presented information about nicotine or addiction for the presence of potential misinformation.Methods. A total of 10.1 million ENDS-related tweets were obtained from April 2018 through March 2019 and were filtered for unique tweets containing keywords for nicotine and addiction. A subsample (n = 3,116) were human coded for type of account (individual, group, commercial, or news) and presence of potential misinformation.Results. Of tweets that presented ENDS-related nicotine or addiction information (n = 904), 41.7% (n = 377) contained potential misinformation coded as anti-vaping exaggeration, pro-vaping exaggeration, nicotine is not addictive or is never harmful, or unproven health benefits.Conclusions. Anti-vaping exaggeration tweets distorted or embellished claims about ENDS nicotine and addiction; pro-vaping exaggeration tweets misinterpreted results from scientific studies. Misinformation that nicotine is not addictive or is never harmful or has unproven health benefits appeared less but are potentially problematic. ENDS-related messaging should be designed to be easily understood by the public and monitored to detect the spread of misinterpretation or misinformation on social media.
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Affiliation(s)
- Jaime E Sidani
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Beth L Hoffman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason B Colditz
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Eleanna Melcher
- Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sanya Bathla Taneja
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ariel Shensa
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Primack
- College of Education and Health Professions, University of Arkansas, Fayetteville, Arkansas, USA
| | - Esa Davis
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kar-Hai Chu
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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ElShahawi HH, Amin GR, Khalil SA, Morsy MH, Farwiez MG, Nawara MM. Prevalence of tobacco smoking in a sample of general secondary school students in Cairo and its correlation to other psychiatric disorders. MIDDLE EAST CURRENT PSYCHIATRY, AIN SHAMS UNIVERSITY 2022; 29:87. [PMCID: PMC9558021 DOI: 10.1186/s43045-022-00252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Tobacco smoking is considered currently a global public health concern among youth especially school students. There is a scarcity of data about the impact of this global phenomenon in Middle Eastern countries. This study assesses the prevalence of tobacco smoking, including conventional cigarettes, E-cigarettes, and water pipe and its sociodemographic and psychiatric correlates among a sample of general secondary school students in Cairo, Egypt. Results A convenient sample of 391 Egyptian general secondary students from different areas of Greater Cairo were assessed using the Socioeconomic scale, Fagerstrom Test For Nicotine Dependence, The Lebanon Water pipe Dependence Scale, questionnaire for electronic cigarette use, Barratt impulsivity scale 11, and The MINI International Neuropsychiatric Interview for Children and Adolescents. 12.8% (n = 50) were smokers. There is a significant relation between family history of smoking and substance use and smoking and significant relation between smoking, impulsivity, and mood symptoms. Conclusions Prevalence of tobacco smoking in Egyptian adolescents was 12.8% with significant relation between smoking and impulsivity and mood symptoms.
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Affiliation(s)
- Heba Hamed ElShahawi
- grid.7269.a0000 0004 0621 1570Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ghada Refaat Amin
- grid.7269.a0000 0004 0621 1570Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sherien Ahmed Khalil
- grid.7269.a0000 0004 0621 1570Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Hassan Morsy
- grid.7269.a0000 0004 0621 1570Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Gamal Farwiez
- grid.7269.a0000 0004 0621 1570Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt ,grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, 22, Dair Al-Malak, Abbassia, Cairo, 11657 Egypt
| | - Mayar Medhat Nawara
- grid.7269.a0000 0004 0621 1570Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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23
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Intravia J, Vito AG, Rocheleau GC. Low Self-Control and Vaping: The Mediating Role of Health and Risk Perceptions. Subst Use Misuse 2022; 57:956-966. [PMID: 35341458 DOI: 10.1080/10826084.2022.2052102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research has shown independent attention in the role of self-control and health/risk perceptions toward vaping in predicting vaping use among youth and young adults. Yet, there are good theoretical notions to believe that low self-control, perceptions toward vaping, and self-reported vaping are intertwined. OBJECTIVES To examine whether three different health/risk perceptions toward vaping mediate the effect of low self-control on vaping use among young adults. METHODS A survey was administered to 325 undergraduate students attending a large university in the Midwest (Mean age = 19.5; 60.4% female; 73.1% White). Single and multiple mediation modeling strategies were used to assess the mediation hypothesis. RESULTS Logistic regression results indicate that individuals with low self-control are more likely to vape (O.R. = 1.041, p < .05). Further, when health/risk perceptions are included in the models individually and simultaneously, it reduces the effect of low self-control on vaping between 15% and 37.5%, and renders low self-control to become non-significant. CONCLUSIONS Findings suggest the impact that harm/risk perceptions toward vaping have in engaging in this behavior. Thus, preventative efforts should target potential sources, such as media and advertisements, that may shape young adults' perceptions toward vaping.
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Affiliation(s)
- Jonathan Intravia
- Department of Criminal Justice and Criminology, Ball State University, Muncie, IN, USA
| | - Anthony G Vito
- Department of Criminal Justice and Criminology, Ball State University, Muncie, IN, USA
| | - Gregory C Rocheleau
- Department of Criminal Justice and Criminology, Ball State University, Muncie, IN, USA
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Wagner LM, Clifton SM. Modeling the public health impact of e-cigarettes on adolescents and adults. CHAOS (WOODBURY, N.Y.) 2021; 31:113137. [PMID: 34881588 DOI: 10.1063/5.0063593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
Since the introduction of electronic cigarettes to the U.S. market in 2007, vaping prevalence has surged in both adult and adolescent populations. E-cigarettes are advertised as a safer alternative to traditional cigarettes and as a method of smoking cessation, but the U.S. government and health professionals are concerned that e-cigarettes attract young non-smokers. Here, we develop and analyze a dynamical systems model of competition between traditional and electronic cigarettes for users. With this model, we predict the change in smoking prevalence due to the introduction of vaping, and we determine the conditions under which e-cigarettes present a net public health benefit or harm to society.
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Affiliation(s)
- Lucia M Wagner
- Department of Mathematics, Statistics, and Computer Science, St. Olaf College, Northfield, Minnesota 55057, USA
| | - Sara M Clifton
- Department of Mathematics, Statistics, and Computer Science, St. Olaf College, Northfield, Minnesota 55057, USA
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Mantey DS, Case KR, Omega-Njemnobi O, Springer AE, Kelder SH. Use frequency and symptoms of nicotine dependence among adolescent E-cigarette users: Comparison of JUUL and Non-JUUL users. Drug Alcohol Depend 2021; 228:109078. [PMID: 34614433 PMCID: PMC8595823 DOI: 10.1016/j.drugalcdep.2021.109078] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Nicotine exposure among adolescent e-cigarette users remains a public health concern. JUUL, a popular e-cigarette brand among youth, is particularly alarming given the high nicotine delivery (59 mg/mL). This study compares e-cigarette use frequency and symptoms of nicotine dependence among adolescent JUUL and non-JUUL users. METHODS We analyzed data from the 2020 National Youth Tobacco Survey. Participants were n = 1713 U.S. middle and high school students who reported past 30-day e-cigarette use. We compared adolescent e-cigarette users who reported JUUL use to those who did not. Outcomes were: (1) symptoms of nicotine dependence (i.e. nicotine cravings; use within 30 min of waking); (2) past 30-day e-cigarette use frequency, categorized as 1-5 days, 6-19 days, and 20-30 days. Covariates were sex, race/ethnicity, other tobacco product use, primary e-cigarette device type (i.e., disposable; pod; mod/tank). RESULTS Overall, 49.5% of adolescent e-cigarette users reported using JUUL in the past 30 days, 40.1% reported symptoms of nicotine dependence, and 36.2% reported using an e-cigarette on 20-30 days. JUUL users were 1.77 (95% CI: 1.36-2.31) times as likely to report symptoms of nicotine dependence and 1.43 (95% CI: 1.02-2.01) time as likely to report using e-cigarettes on 20-30 days, compared to 1-5 days, relative to non-JUUL users, controlling for covariates. CONCLUSION JUUL use was associated with greater odds of nicotine dependence and more frequent e-cigarette use among adolescents. Greater prevention and regulatory efforts should be made to prevent adolescent use of high dose nicotine devices such as JUUL.
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Affiliation(s)
- Dale S Mantey
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States.
| | - Kathleen R Case
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229, United States.
| | - Onyinye Omega-Njemnobi
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin, TX, United States.
| | - Andrew E Springer
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States.
| | - Steven H Kelder
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States.
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Preoperative Considerations for Teenagers Undergoing Orthopaedic Surgery: VTE Prevention, Mental Health Assessment, Vaping, and Drug Addiction. J Pediatr Orthop 2021; 41:S64-S69. [PMID: 34096540 DOI: 10.1097/bpo.0000000000001764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Adolescents undergoing pediatric orthopaedic surgery typically experience an uncomplicated postoperative course. However, adolescence represents a unique transition period from pediatric to adult physiology. As a result, the astute pediatric orthopaedic surgeon will be aware of unique medical and social scenarios which are relevant to adolescents during the perioperative course including the risk of venous thromboembolism (VTE), prevalence of mental health conditions, and rising use of electronic cigarettes or "vaping" to consume nicotine and cannibas. DISCUSSION Adolescents are at a greater risk of VTE after pediatric orthopaedic surgery. In particular, adolescent females with a family history of blood clotting disorders and those with a change in mobility after surgery should be considered for prophylaxis. The prevalence of adolescent mental health conditions including anxiety, depression, and behavioral issues is increasing in the United States. Higher levels of preoperative anxiety and the presence of mental health pathology are associated with slower recovery, higher levels of postoperative pain, and the increased likelihood for chronic pain. Several quick screening instruments are available to assess adolescents for preoperative anxiety risk, including the Visual Analogue Scale for Anxiety or the Amsterdam Perioperative Anxiety Information Scale. Unfortunately, electronic cigarettes have become increasingly popular for the consumption of nicotine and cannabis among adolescents. Preoperative use of combustive cigarettes (nicotine/cannabis) represents perioperative risks for induction/anesthesia, postoperative pain, and analgesia requirements and issues with delayed wound and fracture healing. CONCLUSIONS VTE, underlying mental health conditions, and usage of nicotine and cannabis are clear detriments to the recovery and healing of adolescent patients following orthopaedic surgery. Therefore, standardized screening for adolescents before orthopaedic surgery is indicated to identify perioperative risk factors which have negative impacts on functional outcomes.
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Kowitt SD, Cornacchione Ross J, Goldstein AO, Jarman KL, Thrasher JF, Ranney LM. Youth Exposure to Warnings on Cigar, E-Cigarette, and Waterpipe Tobacco Packages. Am J Prev Med 2021; 61:80-87. [PMID: 33849776 DOI: 10.1016/j.amepre.2021.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Studies of tobacco product warnings have focused primarily on the reach and effectiveness of cigarette warnings for adult smokers, whereas few observational studies have examined noncigarette tobacco product warnings among youth. METHODS High school students from the 2019 National Youth Tobacco Survey (n=10,094) reported the frequency of exposure to warnings on cigar, e-cigarette, and waterpipe tobacco packages and the perceived harm of occasionally using e-cigarettes and waterpipe tobacco. In 2020, results were analyzed for the entire sample and among subgroups, including never users, ever users, youth susceptible to using tobacco, and current users. RESULTS Reported high exposure to warnings was highest for cigars (22.3%), followed by that for e-cigarettes (20.8%) and that for waterpipe tobacco (7.0%). Youth who were susceptible to using cigars (AOR=1.53, 95% CI=1.29, 1.82), who ever used cigars (AOR=4.32, 95% CI=3.57, 5.22), or who currently used cigars (AOR=8.90, 95% CI=6.95, 11.39) were more likely to report high exposure to cigar warnings than youth who never used cigars. Similar findings were observed for e-cigarette and waterpipe tobacco warnings. For youth who ever used e-cigarettes, high exposure to warnings was associated with higher odds of perceiving e-cigarettes as harmful for occasional product use (AOR=1.50, 95% CI=1.05, 2.15), and high exposure to waterpipe tobacco warnings was associated with higher odds of perceiving waterpipe tobacco as harmful (AOR=1.21, 95% CI=1.00, 1.45). CONCLUSIONS Warnings on noncigarette tobacco products reach some youth at risk for using these products, but these warnings may need to be strengthened to further reduce their use.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Jennifer Cornacchione Ross
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Adam O Goldstein
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristen L Jarman
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Leah M Ranney
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kinnunen JM, Rimpelä AH, Lindfors PL, Clancy L, Alves J, Hoffmann L, Richter M, Kunst AE, Lorant V. Electronic cigarette use among 14- to 17-year-olds in Europe. Eur J Public Health 2021; 31:402-408. [PMID: 33079986 PMCID: PMC8071596 DOI: 10.1093/eurpub/ckaa145] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Studies comparing adolescent e-cigarette use in different countries are scarce. We study students' e-cigarette and conventional cigarette ever-use, their social correlates and e-liquid use in seven EU countries. METHODS SILNE-R data (N=12 167, response rate 79.4%) of 14-17-year-olds from Amersfoort (NL), Coimbra (PT), Dublin (IR), Hanover (GE), Latina (IT), Namur (BE) and Tampere (FI) were used. E-cigarette and conventional cigarette ever-use, dual-use, type of e-liquid and social correlates were measured with a school survey and analyzed with cross-tabulations and multinomial logistic regression. RESULTS About 34% had tried e-cigarettes, but the variation was large between the cities (Latina 50%; Hanover 23%). Of e-cigarette ever-users, 37% had used nicotine e-liquid, 43% exclusively non-nicotine liquid and 20% did not know the content. Nicotine e-liquid was more prevalent among monthly e-cigarette users and weekly smoking e-cigarette users. The social correlates were mainly the same for exclusive e-cigarette ever-use, exclusive conventional cigarette ever-use and dual-use. Boys had greater odds for exclusive e-cigarette and dual-use compared to girls. Of social correlates, low academic achievement and parental smoking were positively associated with all categories of use, but parental education and immigrant background were not. The strongest association was found between peer smoking (most/all best friends smoke) and dual-use (OR 34.29). CONCLUSIONS Students' e-cigarette ever-use varies greatly between EU countries. E-cigarettes seem not to be a substitute for conventional cigarettes but more a complementary product. Tobacco control policies might also prevent e-cigarette use but specific regulations on e-cigarettes are needed to prevent nicotine addiction originating from them.
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Affiliation(s)
- Jaana M Kinnunen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Arja H Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Pitkäniemi Hospital, Nokia, Tampere University Hospital, Finland.,PERLA - Tampere Centre for Childhood, Youth and Family Research, Tampere University, Tampere, Finland
| | - Pirjo L Lindfors
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,PERLA - Tampere Centre for Childhood, Youth and Family Research, Tampere University, Tampere, Finland
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Laura Hoffmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Lee YS, Yang K, Kameg B, Palmer J, Lee H. Characteristics of electronic cigarette user and traditional smokers: 2017 Youth risk behavior surveillance system. Public Health Nurs 2021; 38:1030-1038. [PMID: 34101886 DOI: 10.1111/phn.12936] [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: 12/30/2020] [Revised: 05/04/2021] [Accepted: 05/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although electronic cigarette (e-cigarette) use among adolescents rapidly has increased over the past decade, which has raised concerns over the corresponding behavioral health risks, the current literature presents limited data for understanding the characteristics of adolescent e-cigarette users. OBJECTIVE The purpose of this study was to (1) identify general characteristics that may be shared between e-cigarette users and traditional cigarette smokers and (2) examine the unique characteristics of e-cigarette users vis-à-vis traditional cigarette smokers. DESIGN Cross-sectional descriptive study. SAMPLE AND DATA SOURCE A total of 14,765 9th- to 12-grade students drawn from the CDC 2017 Youth Risk Behavior Surveillance System. RESULTS We observed that the prevalence of marijuana, alcohol, and other illicit drug use was higher among e-cigarette users and traditional tobacco users than non-users. Moreover, physically active adolescents were more likely to use e-cigarettes than those who were physically inactive, although the level of the activity did not predict smoking status. CONCLUSION We recommend that primary prevention strategies for e-cigarette use should be incorporated in physical education programs and target adolescents who engage in not only health risk behaviors, but also health promoting behaviors, such as physical activity.
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Affiliation(s)
- Young-Shin Lee
- School of Nursing, San Diego State University, San Diego, California, USA
| | - Kyeongra Yang
- School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Brayden Kameg
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Josh Palmer
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Heeyoung Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Garrett PI, Honeycutt SC, Marston C, Allen N, Barraza AG, Dewey M, Turner B, Peterson AM, Hillhouse TM. Nicotine-free vapor inhalation produces behavioral disruptions and anxiety-like behaviors in mice: Effects of puff duration, session length, sex, and flavor. Pharmacol Biochem Behav 2021; 206:173207. [PMID: 34019915 DOI: 10.1016/j.pbb.2021.173207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Electronic-cigarette's (ECIGs) popularity has grown over the last decade and changed the way individuals administer nicotine. Preclinical research is imperative for understanding the addictive properties and health-risks associated with ECIG use; however, there is not a standard dosing regimen used across research laboratories. The main objective was to determine how vapor puff durations, administration session length, and flavored e-liquid alter general and mood-disorder related behaviors while providing a foundation of vapor administration parameters. Adult male and female C57BL/6 mice were exposed to several nicotine-free unflavored vapor puff durations (1, 3, 6, or 10 s) and vapor administration session lengths (10 and 30 min) then measured on the following assays: locomotor activity (LMA), tail suspension test (TST), and light-dark test. The effects of mecamylamine and the time-course of vapor-induced depression of LMA also were assessed. Additionally, mice were exposed to flavored (strawberry and adventurers tobacco blend) vapor inhalation and measured on locomotor activity, tail suspension test, and light-dark test. Following both 10 and 30 min vapor administration session, there was a puff duration-dependent decrease in distance traveled, time in center, and rearing. The vapor-induced depression of LMA was not mediated by nicotine or nicotinic acetylcholine receptor (nAChR) activation and lasted 60-90 min. The 10 s puff duration produced an anxiogenic-like effect in the light-dark test by decreasing the time spent in the light side. Vapor inhalation did not significantly alter TST behavior. No significant effects of sex or flavor were found. The anxiogenic-like effects of nicotine-free vapor inhalation are concerning as many adolescents vape nicotine-free flavored e-liquid, and there is an association between ECIGs and mood disorders. Additionally, these studies demonstrate that vapor puff duration, but not vapor administration session length, is an important variable to consider during research design as it can become a confounding variable and alter baseline behaviors.
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Affiliation(s)
- Patrick I Garrett
- Neuroscience Graduate Program, University of Wyoming, Laramie, WY, USA; Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Sarah C Honeycutt
- Department of Psychology, University at Buffalo, Buffalo, NY, USA; Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Clarissa Marston
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Nicole Allen
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Allyson G Barraza
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Megan Dewey
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Breeann Turner
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Ashley M Peterson
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Todd M Hillhouse
- Department of Psychological Science, Weber State University, Ogden, UT, USA; Department of Psychology, University of Wisconsin Green Bay, Green Bay, WI, USA.
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Sharma A, McCausland K, Jancey J. Adolescent's Health Perceptions of E-Cigarettes: A Systematic Review. Am J Prev Med 2021; 60:716-725. [PMID: 33775514 DOI: 10.1016/j.amepre.2020.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
CONTEXT E-cigarette use is increasing among adolescents, particularly in high-income countries. This review examines the health perceptions of E-cigarettes among adolescents (aged 12-17 years) residing in the U.S., United Kingdom, Canada, Australia, and New Zealand and their sources of E-cigarette information. EVIDENCE ACQUISITION Peer-reviewed literature published in January 2009-April 2019 in MEDLINE, Embase, and ProQuest were systematically reviewed using identified keywords. The search identified 654 references. Studies (n=99) that met the inclusion criteria were subjected to full-text screening. A total of 27 articles were subjected to quality appraisal using the Joanna Briggs Institute's critical appraisal checklists. EVIDENCE SYNTHESIS A total of 7 qualitative and 18 quantitative studies were included in the review, and the study characteristics, results, and limitations were extracted. A total of 4 main themes emerged from the study findings: (1) perceived relative harm of E-cigarettes versus that of cigarettes, (2) perceived health effects of E-cigarettes, (3) perceived benefits and safety of E-cigarettes, and (4) sources of E-cigarette information and exposure. Most adolescents perceived E-cigarettes to be less harmful than cigarettes; however, often, their health perceptions of E-cigarettes were conflicting. Sources of exposure to E-cigarette information included friends, family, retail point of sale, TV and online advertising, national agencies, healthcare providers, and from direct experience. CONCLUSIONS Findings indicate that adolescents, particularly E-cigarette users, have more favorable perceptions of E-cigarettes than of cigarettes; however, these perceptions are conflicting. Advertising, marketing, and peer and family networks appear to influence adolescents' perceptions. More research is required, particularly in Australia and New Zealand, to better understand adolescents' health perceptions of E-cigarettes and where they source information from so that misperceptions can be addressed through appropriate channels with suitable messaging.
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Affiliation(s)
- Anupriya Sharma
- School of Population Health, Curtin University, Bentley, Australia.
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, Australia
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Abstract
Electronic cigarettes are the most common form of nicotine delivery used by youth and young adults, and in 2018, the US Surgeon General declared this to be an epidemic. The developing adolescent brain is vulnerable to nicotine exposure, which can lead to long-lasting cognitive and mood disorders. Screening rates for vaping are low and lack of knowledge by adolescents, clinicians, parents, and caregivers is high. This article reviews the components of vaping, prevalence, adverse reactions, regulation, treatment, and prevention strategies related to vaping in youth and young adults.
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O’Leary R, Polosa R, Li Volti G. Critical appraisal of the European Union Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) Preliminary Opinion on electronic cigarettes. Harm Reduct J 2021; 18:31. [PMID: 33691708 PMCID: PMC7945356 DOI: 10.1186/s12954-021-00476-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In preparation for the 2021 revision of the European Union Tobacco Products Directive, the Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) has posted its Preliminary Opinion on Electronic Cigarettes. They concluded that e-cigarettes only achieve a sub-optimal level of protection of human health. In this paper, we provide evidence that the Opinion's conclusions are not adequately backed up by scientific evidence and did not discuss the potential health benefits of using alternative combustion-free nicotine-containing products as substitute for tobacco cigarettes. METHODS Searches for articles were conducted in PubMed and by citation chasing in Google Scholar. Articles were also retrieved with a review of references in major publications. Primary data from World Health Organization surveys, the conclusions of reviews, and peer-reviewed non-industry studies were cited to address errors and omissions identified in the Opinion. RESULTS The Opinion omitted reporting on the individual and population health benefits of the substitution of e-cigarettes (ENDS) for cigarette smoking. Alternative hypotheses to the gateway theory were not evaluated. Its assessment of cardiovascular risk is contradicted by numerous reviews. It cites ever-use data that do not represent current patterns of use. It did not report non-nicotine use. It presented erroneous statements on trends in ENDS prevalence. It over-emphasized the role of flavours in youth ENDS initiation. It did not discuss cessation in sufficient length. CONCLUSIONS For the delivery of a robust and comprehensive final report, the members of the Working Group of the Scientific Committee on Health, Environmental and Emerging Risks will need to consider (1) the potential health benefits of ENDS substitution for cigarette smoking, (2) alternative hypotheses and contradictory studies on the gateway effect, (3) its assessment of cardiovascular risk, (4) the measurements of frequency of use, (5) non-nicotine use, (6) the role of flavours, and (7) a fulsome discussion of cessation.
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Affiliation(s)
- Renée O’Leary
- Center of Excellence for the Acceleration of Harm Reduction, Via S. Sofia, 89, 95123 Catania, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, Via S. Sofia, 89, 95123 Catania, Italy
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Sanchez S, Kaufman P, Pelletier H, Baskerville B, Feng P, O'Connor S, Schwartz R, Chaiton M. Is vaping cessation like smoking cessation? A qualitative study exploring the responses of youth and young adults who vape e-cigarettes. Addict Behav 2021; 113:106687. [PMID: 33045643 DOI: 10.1016/j.addbeh.2020.106687] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/08/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Young people are now seeking help to quit vaping. However, little is known about vaping cessation. To bridge the gap between the current state of research and the urgent need for interventions, practitioners have drawn upon smoking cessation models under the assumption that vaping and smoking are fairly similar. In this study, we sought to understand the nature and extent to which vaping is similar to smoking in order to inform the development of vaping cessation interventions for young people. METHODS Seven focus groups were conducted between November 2019 and February 2020 among youth (ages 16-18) and young adults (ages 19-29) living in the Greater Toronto Area who self-identified as e-cigarette vapers and expressed interest in vaping cessation (n = 41). Focus groups were audio recorded, transcribed verbatim, and analyzed using thematic analysis methods. RESULTS Perceived similarities between vaping and smoking emerged from participant narratives: three themes relating to barriers to quitting (social benefits, stress reduction, sensory and behavioural gratification), and three relating to reasons for quitting (financial loss, industry influence, dependence). However, there were also perceived differences that emerged: three themes relating to barriers to quitting vaping (enjoyment of flavours, convenience and discreetness, lack of self-awareness of vaping behaviours), and two relating to reasons for quitting vaping (lack of trusted information, perceived social acceptability). CONCLUSIONS Although there is significant overlap between vaping and smoking, understanding perceived differences in barriers to quitting and reasons for quitting is critical to advancing vaping cessation research and practice among young people.
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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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Yang B, Popova L. Communicating risk differences between electronic and combusted cigarettes: the role of the FDA-mandated addiction warning and a nicotine fact sheet. Tob Control 2020; 29:663-671. [PMID: 31641058 PMCID: PMC7174095 DOI: 10.1136/tobaccocontrol-2019-055204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The US Food and Drug Administration requires e-cigarettes to carry a nicotine addiction warning. This research compared the effects of messages communicating comparative risk of electronic and combusted cigarettes (CR messages) with and without the mandated warning and tested the effects of showing a nicotine fact sheet (NFS) before exposure to CR messages with warning. METHOD In an online experiment, 1528 US adult smokers were randomised to one of four conditions: (1) three CR messages, (2) three CR messages in condition one with an addiction warning, (3) an NFS followed by the three messages in condition 2 and (4) control messages. Outcomes included message reactions and perceived effectiveness, e-cigarette-related and cigarette-related beliefs and behavioural intentions and nicotine-related beliefs. RESULTS CR messages with and without an addiction warning did not differ. The NFS condition produced higher odds of correctly understanding the risk of nicotine and stronger beliefs that switching to e-cigarettes could reduce health risks (response efficacy) than other treatments. Compared with control, all messages made it more likely for people to report e-cigarettes are less harmful than cigarettes and increased response efficacy and switch intentions to e-cigarettes. Only NFS condition increased correct beliefs about the risk of nicotine and self-efficacy about switching to e-cigarettes. CONCLUSION Including an addiction warning on CR messages did not reduce intentions to switch to e-cigarettes. Communicating accurate risk of nicotine together with CR messages and addiction warning increased smokers' self-efficacy beliefs about switching completely to e-cigarettes, making it a potentially promising antitobacco communication strategy.
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Affiliation(s)
- Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Hendricks KJ, Temples HS, Wright ME. JUULing Epidemic Among Youth: A Guide to Devices, Terminology, and Interventions. J Pediatr Health Care 2020; 34:395-403. [PMID: 32564873 DOI: 10.1016/j.pedhc.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
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Al-Saleh I, Elkhatib R, Al-Rajoudi T, Al-Qudaihi G, Manogarannogaran P, Eltabache C, Alotaibi A, Mummer AB, Almugbel S. Cytotoxic and genotoxic effects of e-liquids and their potential associations with nicotine, menthol and phthalate esters. CHEMOSPHERE 2020; 249:126153. [PMID: 32058129 DOI: 10.1016/j.chemosphere.2020.126153] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/15/2020] [Accepted: 02/06/2020] [Indexed: 05/06/2023]
Abstract
In this study, we determined DNA damage and chromosome breakage (indicators of genotoxicity) and cell viability (an indicator of cytotoxicity) in human lymphoblastoid TK6 and Chinese hamster ovary (CHO) cells treated with 33 e-liquids using in vitro single cell gel (comet), micronucleus (MN), and trypan blue assays, respectively. We also measured the contents of nicotine, five phthalate esters, and DL-menthol in the e-liquids to examine their effects on DNA damage, chromosome breakage, and cell viability. Our chemical analyses showed that: (1) six e-liquids had nicotine ≥2-fold higher than the manufacture's label claim (2-3.5 mg); (2) both dimethyl- and dibutyl-phthalate levels were >0.1 μg/g, i.e., their threshold limits as additives in cosmetics; and (3) the DL-menthol contents ranged from 0.0003 to 85757.2 μg/g, with those of two e-liquids being >1 mg/g, the threshold limit for trigging sensory irritation. Though all the e-liquids induced DNA damage in TK6 cells, 20 resulted in cell viabilities ≤75%, indicating cytotoxicity, yet the inverse relationship between cell viability and DNA damage (r = -0.628, p = 0.003) might reflect their role as pro-apoptotic and DNA damage inducers. Fifteen e-liquids induced MN% in TK6 cells ≥3-fold that of untreated cells. Some of the increase in %MN might be false due to high cytotoxicity, yet six brands showed acceptable cell viabilities (59-71%), indicating chromosome damage. DNA damage and %MN increased when the TK6 cells were exposed to metabolic activation. The CHO cells were less sensitive to the genotoxic effects of the e-liquids than the TK6 cells. DL-menthol was found to be associated with decreased cell viability and increased DNA damage, even at low levels. We cannot dismiss the presence of other ingredients in e-liquids with cytotoxic/genotoxic properties since out of the 63 different flavors, 47 induced DNA damage (≥3-folds), and 26 reduced cell viability (≤75%) in TK6 cells.
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Affiliation(s)
| | | | | | | | | | | | - Aminah Alotaibi
- National Center for Biotechnology and Genomic Research, King Abdulaziz City for Science and Technology, Saudi Arabia
| | - Abdulrahman Bin Mummer
- Biostatistics, Epidemiology & Scientific Computing Department, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
| | - Saad Almugbel
- College of Medicine, Al-Imam Muhammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Fataar F, Hammond D. The Prevalence of Vaping and Smoking as Modes of Delivery for Nicotine and Cannabis among Youth in Canada, England and the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4111. [PMID: 31731420 PMCID: PMC6862259 DOI: 10.3390/ijerph16214111] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 01/09/2023]
Abstract
Background: Vaping has become an increasingly common mode of administration for both nicotine and cannabis, with overlap among users, devices, as well as nicotine and cannabis companies. There is a need to understand patterns of use among youth, including the way nicotine and cannabis are administered. Methods: Data are from Wave 2 of the ITC Youth Tobacco and Vaping survey, an online survey conducted in 2018 among 16-19 year-olds recruited from commercial panels in Canada (n = 3757), England (n = 3819), and the U.S. (n = 3961). The prevalence of past 30-day vaping nicotine, non-nicotine and cannabis substances, as well as cannabis modes of use was examined. Logistic regression models examined between country differences in prevalence. Results: Past 30-day cannabis use was highest among Canadian youth (16.6%), followed by youth in the U.S. (13.8%) and England (9.0%). Vaping e-cigarettes was substantially more prevalent than vaping cannabis in all three countries. All forms of cannabis use were higher among Canadian and U.S. youth compared to England (p < 0.001 for all). Past 30-day cannabis users in the U.S. were more likely to report vaping cannabis oil (30.1%), and consuming solid concentrates such as wax and shatter (30.2%), compared to cannabis users in Canada (18.6% and 22.9%) and England (14.3% and 11.0%; p < 0.001 for all). Conclusions: Youth are administering cannabis and nicotine using a wide diversity of modes. Cannabis users in the U.S.-where an increasing number of states have legalized medical and non-medical cannabis-reported notably higher use of more potent cannabis products, including cannabis oils and extracts.
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Affiliation(s)
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
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Ford KL, Albritton T, Dunn TA, Crawford K, Neuwirth J, Bull S. Youth Study Recruitment Using Paid Advertising on Instagram, Snapchat, and Facebook: Cross-Sectional Survey Study. JMIR Public Health Surveill 2019; 5:e14080. [PMID: 31599739 PMCID: PMC6811770 DOI: 10.2196/14080] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/21/2019] [Accepted: 08/09/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The use of paid social media advertising for targeted study recruitment is an effective strategy in health research and evaluation, specifically to reach diverse youth participants. Although the literature adequately describes the utility of Facebook in recruitment, limited information exists for social media platforms that are more popular with youth, specifically Instagram and Snapchat. OBJECTIVE This paper outlines a paid advertising approach using Instagram, Snapchat, and Facebook to evaluate a statewide youth marijuana prevention campaign. The objective of this study was to compare recruitment metrics across Instagram, Snapchat, and Facebook for two surveys documenting youth knowledge, attitudes, and behaviors related to retail marijuana in Colorado post legalization. In addition, the study assessed the feasibility of using Instagram and Snapchat as effective additions to Facebook for youth study recruitment. METHODS A social media recruitment strategy was used to conduct two cross-sectional surveys of youth, aged 13 to 20 years, in Colorado. Geographically targeted ads across 3 social media platforms encouraged the completion of a Web-based self-administered survey. Ad Words and Snap Ads were used to deploy and manage advertising campaigns, including ad design, placement, and analysis. Ad costs and recruitment metrics (ie, impressions, link clicks, and conversion rates) were calculated across the three social media platforms. RESULTS Over two 1-month periods, 763,613 youth were reached (ie, impressions), 6089 of them clicked survey links (ie, clicks), and 828 eligible youth completed surveys about knowledge, attitudes, and behaviors related to retail marijuana. Instagram converted 36.13% (803/2222) of impressions to clicks (ie, conversion rate) in the first survey and 0.87% (864/98982) in the second survey. Snapchat generated the most impressions and link clicks, but it did so with the lowest conversion rate for both surveys, with a 1.40% (1600/114,200) conversion rate in the first survey and a 0.36% (1818/504700) conversion rate in the second survey. Facebook maintained a consistent conversion rate of roughly 2% across both surveys, despite reductions in budget for the second survey. The cost-per-click ranged between US $0.25 and $0.37 across the three platforms, with Snapchat as both the most cost-effective platform in the first survey and the most expensive platform in the second survey. CONCLUSIONS Recruitment and enrollment outcomes indicate the use of Instagram and Snapchat, in addition to Facebook, may be a modern, useful, and cost-effective approach to reach youth with surveys on sensitive health topics. As the use of Facebook declines among youth, the use of more popular social media platforms can augment study recruitment for health research and evaluation efforts.
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Affiliation(s)
- Kelsey Lynett Ford
- The mHealth Impact Lab, Colorado School of Public Health, Aurora, CO, United States.,Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Tashuna Albritton
- School of Medicine, The City College of New York, New York, NY, United States
| | - Tara A Dunn
- Colorado Department of Public Health & Environment, Denver, CO, United States
| | - Kacy Crawford
- Colorado Department of Public Health & Environment, Denver, CO, United States
| | - Jessica Neuwirth
- Colorado Department of Public Health & Environment, Denver, CO, United States
| | - Sheana Bull
- The mHealth Impact Lab, Colorado School of Public Health, Aurora, CO, United States.,Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
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Patiño-Masó J, Font-Mayolas S, Salamó A, Arboix M, Sullman MJ, Gras ME. Predictors of intentions to use cigarettes and electronic-cigarettes among high school students. J Multidiscip Healthc 2019; 12:591-599. [PMID: 31534341 PMCID: PMC6681556 DOI: 10.2147/jmdh.s208031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose Tobacco is the second most commonly used drug by Spanish high school students and e-cigarette use has increased over the last three years among this population. Students who reported smoking tobacco and/or e-cigarette use often have friends and family that also consume these substances. The aims of the present study were to: determine the prevalence of tobacco and electronic cigarette consumption among young adolescents, the age of initiation and the intention to consume both of these substances in the future; study the relationships between their current tobacco and e-cigarette consumption status, intentions to consume these substances in the future and the consumption of these substances by family members living in their home and friend’s consumption status; investigate the relationship between their current tobacco and e-cigarette consumption status, friends’ consumption status and their intention to consume each substance in the future; analyse the relationship between current consumption status, intentions to consume in the future and perceived risk; identify the main predictors of intentions to use these substances in the future. Methods A cross-sectional survey was conducted in 2017. The sample consisted of 468 school students in the first cycle of secondary education in Catalonia, Spain. The participants who were aged between 11 and 15 years old, with 49.4% being female. Results A stepwise binary logistic regression showed that the best predictors of the intention to smoke tobacco in the future were: having tried tobacco, being a current consumer, having a family member smoking at home and having a low perceived risk of smoking. The best predictors of the intention to use electronic cigarettes in the future were: having tried tobacco, being a current consumer and having friends who smoke or use electronic cigarettes. Conclusion Smoking prevention programs must consider the social network surrounding teenagers, particularly close friends and family. Intervention strategies for delaying the onset of tobacco or e-cigarette consumption are greatly needed.
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Affiliation(s)
- Josefina Patiño-Masó
- Department of Nursing, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
| | - Sílvia Font-Mayolas
- Department of Psychology, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
| | - Anna Salamó
- Department of Psychology, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
| | - Montserrat Arboix
- Department of Health, Escola Municipal del Treball, Granollers, Catalunya, Spain
| | - Mark Jm Sullman
- Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Maria-Eugenia Gras
- Department of Psychology, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
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Fadus MC, Smith TT, Squeglia LM. The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug Alcohol Depend 2019; 201:85-93. [PMID: 31200279 PMCID: PMC7183384 DOI: 10.1016/j.drugalcdep.2019.04.011] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/15/2019] [Accepted: 04/05/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) were first introduced in the U.S. market in 2006, with the more recent evolution of "pod-mod" e-cigarettes such as JUUL introduced in 2015. Although marketed as a smoking cessation tool, e-cigarettes are rarely used for this purpose in youth. This review aims to synthesize the literature regarding e-cigarette use among youth, and provides a resource for clinicians, educators, and families that helps answer commonly asked questions about e-cigarettes. METHODS PubMed, Scopus, and PsycINFO search was performed using search terms "Electronic Nicotine Delivery Systems," "e cigarettes," "e-cigarettes," "electronic cigarettes," "vaping," "JUUL," "e-cigs," and "vape pens." Search results were filtered to only include those related to adolescents and young adults. RESULTS E-cigarette use among youth is common, with rates of use increasing from 1.5% in 2011 to 20.8% in 2018. Pod mod devices such as JUUL have gained favor among youth for their sleek design, user-friendly function, desirable flavors, and ability to be used discreetly in places where smoking is forbidden. Adolescents are often uninformed about the constituents of e-cigarettes, and little is known about the long-term effects of e-cigarettes. Studies have suggested a "gateway" effect for combustible cigarettes and cannabis use. CONCLUSIONS E-cigarette use is becoming increasingly common among youth, leading to a myriad of questions and concerns from providers, educators, and family members. More research is needed to determine the ultimate public health impact of e-cigarette use. The authors provide a summary table of frequently asked questions in order to help clarify these common concerns.
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Affiliation(s)
- Matthew C Fadus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA.
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
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Riehm KE, Young AS, Feder KA, Krawczyk N, Tormohlen KN, Pacek LR, Mojtabai R, Crum RM. Mental Health Problems and Initiation of E-cigarette and Combustible Cigarette Use. Pediatrics 2019; 144:peds.2018-2935. [PMID: 31160343 PMCID: PMC6615573 DOI: 10.1542/peds.2018-2935] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES During adolescence, mental health problems may increase the risk of initiating combustible cigarette use. However, it is unknown if this association extends to electronic cigarettes (e-cigarettes). We examined whether internalizing and externalizing problems were associated with initiation of e-cigarette, combustible cigarette, and dual-product use among adolescents. METHODS Participants were drawn from the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adolescents followed from 2013 to 2015. The study sample included 7702 adolescents aged 12 to 17 years who at baseline reported no lifetime use of tobacco products. We examined the respective associations between baseline internalizing and externalizing problems and initiating use of e-cigarettes, combustible cigarettes, or both at 1-year follow-up. RESULTS Compared with adolescents with low externalizing problems, adolescents with high externalizing problems were significantly more likely to initiate use of e-cigarettes (adjusted relative risk ratio [aRRR] = 2.78; 95% confidence interval [CI]: 1.76-4.40), combustible cigarettes (aRRR = 5.59; 95% CI: 2.63-11.90), and both products (aRRR = 2.23; 95% CI: 1.15-4.31). Adolescents with high internalizing problems were at increased risk of initiating use of e-cigarettes (aRRR = 1.61; 95% CI: 1.12-2.33) but not combustible cigarettes or both products. CONCLUSIONS Mental health problems are associated with increased risk for initiating e-cigarette, combustible cigarette, and dual-product use in adolescence. This association is more consistent for externalizing problems than internalizing problems. Addressing mental health problems could be a promising target for preventing initiation of nicotine- and/or tobacco-product use by adolescents.
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Affiliation(s)
| | - Andrea S. Young
- Division of Child and Adolescent Psychiatry, School
of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | | | | | | | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences,
School of Medicine, Duke University, Durham, North Carolina
| | | | - Rosa M. Crum
- Welch Center for Prevention, Epidemiology, and
Clinical Research and,Departments of Mental Health and,Epidemiology, Bloomberg School of Public Health
and
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McGee PL, Goldschmidt K. E-cigarettes and Vaping: What Do Pediatric Nurses Need to Know? J Pediatr Nurs 2019; 46:121-123. [PMID: 30819563 DOI: 10.1016/j.pedn.2019.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Pamela L McGee
- Drexel University, Philadelphia, PA, United States of America.
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Barrientos-Gutierrez I, Lozano P, Arillo-Santillan E, Morello P, Mejia R, Thrasher JF. "Technophilia": A new risk factor for electronic cigarette use among early adolescents? Addict Behav 2019; 91:193-200. [PMID: 30224154 PMCID: PMC6358480 DOI: 10.1016/j.addbeh.2018.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/11/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Develop and validate a scale that measures Technophilia (positive orientation toward new technology) and use it to address orientation toward new technologies to explain e-cigarette trial and adoption, especially in relatively low risk adolescents. METHODS Survey data were obtained from students of the three largest cities in Mexico (n = 8123). We developed eight questions involving access, use and pleasure from different electronic media to measure technophilia. Exploratory factor analysis (EFA) was conducted. Linear GEE models were used when regressing technophilia on covariates. When regressing e-cigarette and conventional cigarette trial and use, logistic GEE models were used. Finally, we used multinomial logistic regression to evaluate the associations between technophilia and e-cigarettes as the first tobacco product. RESULTS Technophilia were correlated with theoretically-related variables. Unadjusted and adjusted models regressing e-cigarette trial and use indicated that students in the highest quartile for technophilia were more likely to have tried e-cigarettes compared with the lowest quartile (AORQ4 vs Q1 = 1.36, 95% CI 1.14-1.62). Technophilia was not independently associated with current e-cigarette use in adjusted models. Students with higher technophilia were more likely to have first tried e-cigarettes in both crude and adjusted models (AORQ4vQ1 = 1.66, 95% CI 1.20-2.31; AORQ3vQ1 = 1.43, 95% CI 1.02-2.01). Technophilia did not have a statistically significant, independent association with first use of other tobacco products. CONCLUSION This study suggests that technophilia is associated with trial of e-cigarettes among youth. The measure we developed appears useful for understanding why some youth are open to trying novel, technologically oriented ways to consume nicotine.
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Affiliation(s)
- Inti Barrientos-Gutierrez
- National Institute of Public Health, Mexico Universidad, No. 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico, CP.62100.
| | - Paula Lozano
- University of South Carolina, Arnold School of Public Health. Discovery I,915 Greene Street, Columbia, SC 29208, United States
| | - Edna Arillo-Santillan
- National Institute of Public Health, Mexico Universidad, No. 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico, CP.62100
| | - Paola Morello
- Centro de Estudios de Estado y Sociedad (CEDES), Sánchez de Bustamante 27, C1173AAA CABA, Argentina
| | - Raul Mejia
- Centro de Estudios de Estado y Sociedad (CEDES), Sánchez de Bustamante 27, C1173AAA CABA, Argentina
| | - James F Thrasher
- National Institute of Public Health, Mexico Universidad, No. 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico, CP.62100; University of South Carolina, Arnold School of Public Health. Discovery I,915 Greene Street, Columbia, SC 29208, United States
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The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults' E-Cigarette Perceptions and Use Intentions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020184. [PMID: 30634618 PMCID: PMC6352031 DOI: 10.3390/ijerph16020184] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 11/17/2022]
Abstract
Although e-cigarettes in the United States are required to carry one nicotine addiction warning, little is known about the impact of other potential e-cigarette warning themes, nor about pairing warnings with messages that communicate e-cigarettes' reduced-harm potential relative to cigarettes. We randomly assigned 876 young adults (ages 18⁻29) to view e-cigarette ads in a 3 × 2 plus control online experiment that varied by warning theme (i.e., nicotine addiction; nicotine's impact on adolescent brain development; presence of harmful chemicals) and warning type-i.e., the presence ("relative harm warning") or absence ("standard warning") of a relative harm (RH) statement in the warning label ("e-cigarettes may cause harm to health but are less harmful than cigarettes"). Warning believability, informativeness, understandability and support were high across conditions and there were no significant differences by warning theme on e-cigarette harm perceptions or use intentions nor on nicotine (mis)perceptions. Perceived warning effectiveness for discouraging youth initiation was higher for the "brain" and "chemicals" warnings compared to the addiction warning. Warnings with the included RH statement were perceived as less believable and credible and were less frequently correctly recalled. Research should continue to investigate the impact of different e-cigarette warning themes and formats with priority audiences.
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Miech R, Johnston LD, O'Malley PM, Terry-McElrath YM. The national prevalence of adolescent nicotine use in 2017: Estimates taking into account student reports of substances vaped. Addict Behav Rep 2019; 9:100159. [PMID: 31193782 PMCID: PMC6542751 DOI: 10.1016/j.abrep.2019.100159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction This study presents the first nationally-representative estimates of adolescent nicotine prevalence that take into account adolescent reports of substances vaped. These reports allow nicotine estimates that consider the impact of the newly-emerged group of adolescents who report vaping only non-nicotine substances such as flavoring and/or marijuana and do not use nicotine in any form - a group typically treated as nicotine users. Methods Data come from Monitoring the Future and are a randomly-selected subsample of 2231 U.S. 12th grade students who answered surveys with detailed questions on tobacco use and vaping in 2017. Results Among 12th grade students 24.7% used nicotine in the last 30 days. This estimate does not include the 3.8% of students who vaped only non-nicotine substances and did not use nicotine in any other form. These students more closely resemble their peers who do not use nicotine than those who do, in terms of perceived risk and disapproval of cigarettes, as well as percentage of friends who use cigarettes. Conclusions A decline in nicotine prevalence was statistically significant, but not strikingly large, after taking into account students who vape non-nicotine substances and do not use nicotine in any form. These students are largely similar to their peers who do not use nicotine, which underscores the importance of efforts to alert youth that they may be vaping nicotine unknowingly, and prevent them from doing so.
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Affiliation(s)
- Richard Miech
- Institute for Social Research, University of Michigan, 426 Thompson Street, PO Box 1248, Ann Arbor, MI 48106-1248, USA
| | - Lloyd D Johnston
- Institute for Social Research, University of Michigan, 426 Thompson Street, PO Box 1248, Ann Arbor, MI 48106-1248, USA
| | - Patrick M O'Malley
- Institute for Social Research, University of Michigan, 426 Thompson Street, PO Box 1248, Ann Arbor, MI 48106-1248, USA
| | - Yvonne M Terry-McElrath
- Institute for Social Research, University of Michigan, 426 Thompson Street, PO Box 1248, Ann Arbor, MI 48106-1248, USA
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Adolescents have unfavorable opinions of adolescents who use e-cigarettes. PLoS One 2018; 13:e0206352. [PMID: 30403731 PMCID: PMC6221340 DOI: 10.1371/journal.pone.0206352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/11/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction While evidence suggests positive opinions of smokers are associated with tobacco use, research exploring adolescents’ opinions of e-cigarette users is nascent. We hypothesized that adolescents harbor positive opinions of e-cigarette users, and that these opinions will be more positive among adolescents willing to try or who have used e-cigarettes. Methods Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015–2016. Analyses examined whether these variables were associated with willingness to try and use (ever vs. never) of e-cigarettes. Results The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users. Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users. Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users (all p < .01). Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users. Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users (all p < .01). Conclusions Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents’ negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.
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Pepper JK, Coats EM, Nonnemaker JM, Loomis BR. How Do Adolescents Get Their E-Cigarettes and Other Electronic Vaping Devices? Am J Health Promot 2018; 33:420-429. [PMID: 30068216 DOI: 10.1177/0890117118790366] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE More adolescents "vape" (use e-cigarettes and similar devices) than smoke, but little is known about how underage users obtain vaping devices. This knowledge could inform efforts to prevent youth access. DESIGN Original cross-sectional survey with social media recruitment. SETTINGS Online. PARTICIPANTS A total of 1729 adolescents (2809 qualified on screener; completion rate 61.6%) aged 15 to 17 years who vaped in the past 30 days. MEASURES Adolescents' vaping attitudes, ownership of vaping devices, how they obtain devices, and frequency of borrowing others' devices. ANALYSIS Logistic regression. RESULTS Most adolescents (78.2%) owned a vaping device. The most common sources were purchasing from a store or online (31.1%), buying from another person (16.3%), or giving someone money to purchase for them (15.0%). The majority (72.8%) had used someone else's vaping device in the past 30 days. Adolescents who vaped more often, did not own a vaping device, vaped in social situations, and had previously been refused purchase were more likely to frequently borrow others' devices. CONCLUSIONS Despite high rates of ownership, many adolescents borrowed devices, suggesting that borrowing is part of users' social experience, not just a means of acquisition. Although better enforcement of age restrictions could lessen purchasing, future research is needed to understand why adolescents borrow and how their acquisition sources shift over time. That information could be harnessed for targeted, borrowing-related antivaping campaigns.
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Affiliation(s)
- Jessica K Pepper
- 1 Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Ellen M Coats
- 1 Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - James M Nonnemaker
- 1 Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Brett R Loomis
- 1 Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC, USA
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