E-cigarette use among young adults: A latent class analysis examining co-use and correlates of nicotine vaping

Products and patterns through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis

BACKGROUND

Co-use of tobacco and cannabis is common. However, few studies have examined the temporal sequencing through which individuals initiate co-use, and how these patterns vary across age. This study addresses this gap by examining the specific products and temporal sequencing through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Among adolescents, young adults, and adults who co-used tobacco and cannabis in the past 30 days, we examined (a) whether tobacco or cannabis was used first in their lifetime and (b) which specific tobacco or cannabis product (e.g., nicotine e-cigarettes, cannabis edibles) was the first used.

METHODS

Data were from a cross-sectional national survey (N = 6,131, 13-40 years old) in which participants reported ever use, past-30-day-use, and order of use for 17 different tobacco and cannabis products. Results were analyzed overall and by age group (13-20; 21-24; 25-40).

RESULTS

38.4% of participants reported use of both tobacco and cannabis in the past 30 days. Among these participants, 70.9% used tobacco first in their lifetime (66.6% < 21; 71.7% 21-24; 76.6% > 24). Approximately 60% of participants who initiated co-use with tobacco reported nicotine e-cigarettes as their first tobacco product (63.3% < 21; 66.7% 21-24; 49.6% > 24).

CONCLUSIONS

The majority of participants who used both tobacco and cannabis used tobacco first in their lifetime, and nicotine e-cigarettes were the most common form of tobacco initiation, particularly among adolescents and young adults. Findings emphasize the need for co-use prevention programs to target common products of initiation.

Identifying predictors of multi-year cannabis vaping in U.S. Young adults using machine learning

INTRODUCTION

Increasing number of current cannabis users report using a vaporized form of cannabis and young adults are most likely to vape cannabis. However, the number of studies on cannabis vaping is limited, and predictors of cannabis vaping among U.S. young adults remain unclear. Previous studies on cannabis vaping have known limitations, as they (1) relied heavily on regression-based approaches that often fail to examine complex and non-linear interactive effects, (2) focused on examining cannabis vaping initiation but not on its use over multiple years, and (3) failed to account for recreational cannabis legalization (RCL) status.

METHODS

This study was a secondary analysis of the restricted use files of the Population Assessment of Tobacco and Health Study, Waves 4-6 (December 2016-November 2021). A two-stage machine learning approach, which included Least Absolute Shrinkage and Selection Operator (LASSO) and Classification and Regression Tree (CART), was used to identify predictors of multi-year cannabis vaping while accounting for state-level RCL status among a representative sample of U.S. young adults.

RESULTS

Stratified CART created a five-terminal-node prediction model for states with RCL (split by cannabis use, cigarette use, bullying behavior, and ethnicity) and a different five-terminal-node prediction model for states without RCL (split by cannabis use, heroin use, nicotine vaping, and hookah use).

CONCLUSIONS

Characteristics predicting multi-year cannabis vaping appear to differ from those of cannabis vaping initiation. Results also highlight the importance of accounting for RCL status because predictors of cannabis vaping may differ for individuals living in states with and without RCL.

Use of cannabis among youth who vape nicotine

BACKGROUND

Youth e-cigarette use remains a public health concern and many youth want to quit. However, cannabis use is common among youth who use e-cigarettes, which may interfere with nicotine cessation efforts. This study aimed to investigate cannabis use among youth who vape nicotine and are motivated to quit nicotine.

METHODS

Connecticut youth (N=223, Mage = 17.3 [SD=1.7] years) who completed an intake for a vaping cessation study reported on their nicotine vaping, cannabis products used, reasons for use, frequency of use, and readiness to quit cannabis. Descriptives characterized population. Regressions were used to examine association of cannabis use and nicotine vaping.

RESULTS

Most reported cannabis use (lifetime: 92.4 %; past-month: 68.6 %). Cannabis smoking and vaping were highly prevalent (smoking: lifetime - 90.8 %, current - 63.6 %; vaping: lifetime - 90.8 %, current - 63.1 %). Most reported preferring smoking cannabis (58.7 %) over other routes of administration. Common reasons for cannabis use, were psychoactive (e.g., getting high), physical (e.g., improving sleep), and social (e.g., partying). Cannabis use frequency and preferring smoking cannabis (vs. other modes) was positively associated with more frequent nicotine vaping (ps < 0.05). Participants averaged 6.3 (of 10) on a readiness to quit cannabis scale, a moderate desire to quit.

CONCLUSIONS

Cannabis use across multiple routes of administration was common among youth seeking help quitting vaping nicotine. Heaviness of cannabis and nicotine use appear to be associated, raising interesting harm-reduction challenges for those seeking to quit nicotine vaping. Understanding cannabis and nicotine co-use is important for targeting treatment for use of both substances.

"I've lost my children to vaping": A frame analysis of the Australian media's construction of the "Youth vaping crisis"

BACKGROUND

Youth vaping has become an issue of extreme concern in the Australian public and political discourse, recently culminating in the announcement of further restrictions on the sale and use of nicotine vaping products (NVPs) by the Federal Government. We examine how youth vaping has been framed in the Australian news media in the six months leading up to the announcement of these new measures in May 2023.

METHODS

Drawing a sample from the Factiva database, we conducted a frame analysis on articles published during this six month period, identifying media framings that included the necessary components of a distinct Problem Definition, Causal Attribution, Moral Evaluation, and Treatment Recommendation.

RESULTS

We identified 123 relevant articles, and four dominant framings being applied. Most common was that of A Failure of Control, followed by A Poisonous Epidemic, A Health Behaviour Needing Regulation, and A Moral Failure.

CONCLUSION

These findings are discussed in the context of moral panic theory and how framings are constructed by the media in collaboration with policy actors to support particular policy measures.

Applying Latent Variable Models to Estimate Cumulative Exposure Burden to Chemical Mixtures and Identify Latent Exposure Subgroups: A Critical Review and Future Directions

Environmental mixtures, which reflect joint exposure to multiple environmental agents, are a major focus of environmental health and risk assessment research. Advancements in latent variable modeling and psychometrics can be used to address contemporary questions in environmental mixtures research. In particular, latent variable models can quantify an individual's cumulative exposure burden to mixtures and identify hidden subpopulations with distinct exposure patterns. Here, we first provide a review of measurement approaches from the psychometrics field, including structural equation modeling and latent class/profile analysis, and discuss their prior environmental epidemiologic applications. Then, we discuss additional, underutilized opportunities to leverage the strengths of psychometric approaches. This includes using item response theory to create a common scale for comparing exposure burden scores across studies; facilitating data harmonization through the use of anchors. We also discuss studying fairness or appropriateness of measurement models to quantify exposure burden across diverse populations, through the use of mixture item response theory and through evaluation of measurement invariance and differential item functioning. Multi-dimensional models to quantify correlated exposure burden sub-scores, and methods to adjust for imprecision of chemical exposure data, are also discussed. We show that there is great potential to address pressing environmental epidemiology and exposure science questions using latent variable methods.

E-cigarettes in college: Associations between mental health and e-cigarette use with other substances

INTRODUCTION

College students are a priority population for substance use prevention, and other studies have reported associations between mental health and e-cigarette use. This study described the association of mental health to e-cigarette and other substance use (ECIG+ use) among US college students.

METHODS

We used Fall 2018 and Spring 2019 National College Health Assessment data among undergraduate students aged 18-24 years (n=55654) at 138 institutions. We characterized substance use patterns and used multinomial regression to model adjusted odds of past 30-day ECIG use type [no substance use (reference); sole e-cigarette use; e-cigarette use and other substance use (ECIG+ use); no e-cigarette use but other substance use] by mental health characteristics, past 12-month diagnosis/treatment and psychological distress, individual characteristics, and college characteristics.

RESULTS

Alcohol was the most prevalent substance (58%) used, followed by cannabis (23%) and e-cigarettes (15%). Nearly all (95%) students who used e-cigarettes reported using another substance. Adjusted odds of ECIG+ use (vs no substance use) were higher among students with past 12-month mental health diagnosis/treatment (AOR=1.5; 95% CI: 1.4-1.6) and higher psychological distress (AOR=1.1; 95% CI: 1.1-1.2). Other characteristics significantly associated with ECIG+ use included gender identity, sexual orientation, race and ethnicity, self-rated health, year in school, cumulative grade average, fraternity/sorority membership, and current residence.

CONCLUSIONS

Most students who used e-cigarettes also reported other substance use, and this pattern of use was associated with poorer mental health outcomes than no substance use. Clarifying the relationship between mental health and ECIG+ use may enhance health interventions for college students.

A Latent Class Analysis of Personal Coping Resources and Depressive Symptoms Among Middle-Aged and Older Latinx Adults

Objectives: To identify coping profiles and evaluate their implications for depressive symptoms among Latinx adults. Methods: Data come from a community-dwelling sample of Latinx adults ages 45+ in Florida (N = 461). Latent class analysis was used to identify profiles of personal coping resources based on patterns across spirituality (spiritual coping, divine fate), ethnic identity (centrality, connectedness), and personal control (mastery, self-esteem). Multivariable linear regression assessed differences in depressive symptoms across coping resource classes. Results: Four coping resource profiles were identified: (1) low resources overall, yet high spiritual coping; (2) high spirituality and personal control; (3) high spirituality and ethnic identity; and (4) high resources overall. Members of Class 4 had significantly fewer depressive symptoms than members of Class 1 and Class 3, controlling for sociodemographic characteristics, p < .001. Discussion: Results elucidate nuances in personal coping resources among aging Latinx adults, identify under-resourced groups, and suggest that resource profiles characterized by few personal coping resources are linked with more depressive symptoms. Findings clarify the underpinnings of the latent coping construct and have implications for mental health promotion interventions among aging Latinx adults.

Stressful Life Events and Patterns of Polysubstance Use Among U.S. Late Middle-Aged and Older Adults: A Latent Class Analysis

The goals of this study were to identify patterns of polysubstance use and their associations with stressful life events among U.S. late middle-aged and older adults and examine whether gender moderates these associations. Adults aged 50 and older (N = 14,738) from the National Epidemiological Survey on Alcohol and Related Conditions-III were included. Latent class analysis was conducted to identify patterns of polysubstance use. Weighted multinomial logistic regression was estimated with a generalized structural equation model. Three different polysubstance use patterns (non-users/low substance users; cannabis and excessive alcohol users; painkiller and sedative/tranquilizer misusers) were identified. Higher levels of stressful life events were associated with patterns of polysubstance use. Gender moderated the association between stressful life events and co-misusing painkillers and sedatives/tranquilizers (p < 0.05). Substance use prevention efforts should consider aging adults' patterns of polysubstance use and associated stressful life events when designing and implementing gender-specific polysubstance use prevention interventions.

Predictors of polysubstance vaping in emerging adults

BACKGROUND

Polysubstance use, which increases the risk for negative consequences of substance use, is common among emerging adults who regularly consume substances by vaping. Examining predictors of polysubstance vaping is crucial for understanding whether this novel form of substance consumption lends itself equally efficaciously to established forms of intervention for smoked substances.

OBJECTIVE

The current study aimed to examine whether modifiable cognitive risk factors for increased vaping in the form of attitudes, expectancies and norms can predict co-use of nicotine and cannabis among vapers over and above the effect of demographics, personality risk factors and anxiety, depression symptoms.

METHODS

Regular nicotine and cannabis vapers between 18 and 30 years were recruited online in Canada via a Qualtrics panel. Hierarchical binary logistic regression was used to predict membership in a polysubstance or a single substance vaping group. Demographics, personality risk factors, depression and anxiety symptoms were included as predictors in block 1; attitudes, expectancies and perceived norms of vaping were added in block 2.

RESULTS

Attitudes, expectancies and norms predicted polysubstance use over and above the effect of demographics, personality risk factors and anxiety, depression symptoms. Positive expectancies played a uniquely significant role in the prediction of polysubstance vaping.

CONCLUSIONS

Cognitive interventions targeting attitudes, expectancies and norms may be effective in prevention of polysubstance vaping, although positive expectancies appear to be the main unique factor that has an influence above and beyond all other cognitive factors related to vaping. Treatment and prevention programs should put special focus on lowering positive expectancies.

Within-person associations of escalated electronic nicotine delivery systems use with cigarette, alcohol, marijuana and drug use behaviors among US young adults

AIMS

Most extant evidence has addressed between-person differences, short-term or cross-sectional associations of electronic nicotine delivery systems (ENDS) use with other substance use, the majority focusing on current rather than escalated use. The present study aimed to examine within-person changes in escalated ENDS use and their associations with individual and combined substance use over a 6-year period.

DESIGN, SETTING AND PARTICIPANTS

This study used a longitudinal cohort design with US young adults. A generalized linear mixed-model approach was employed to fit a series of weighted logistic regression models. Data were drawn from waves 1-5 of the Population Assessment of Tobacco and Health (PATH) study in the United States. Of the 9110 young adults at baseline, aged 18-24 years, a total of 5042 individuals had matched data across all five waves of assessments.

MEASUREMENTS

Escalated ENDS use was computed by subtracting the number of days of ENDS use within the past 30 days at wave w - 1 from that at wave w and coded as 1 = escalated, if the value was greater than zero (otherwise, coded as 0 = not escalated).

FINDINGS

Escalated ENDS use gradually decreased over time, with the lowest prevalence at wave 4 (4.0%) but sharply increasing at wave 5 (8.4%). Escalated ENDS use was associated with increased odds of using each substance (binge drinking, marijuana use, marijuana vaping, prescription and illicit drugs) and different combinations of polysubstance use between cigarette smoking, binge drinking and marijuana use (Ps < 0.05). In addition, sweet/fruit flavor use (versus menthol/mint) was associated with increased likelihood of reporting co-use of cigarettes and marijuana.

CONCLUSIONS

In the United States, the prevalence of young adults using electronic nicotine delivery systems appears to have increased steadily between 2013 and 2019, although the rate of increase may have started to accelerate in recent years. Escalated electronic nicotine delivery systems use and time-lagged established electronic nicotine delivery systems use appear to be prospectively associated with individual and combined substance use, particularly between cigarettes, alcohol and marijuana. Among established electronic nicotine delivery systems users, sweet/fruit flavor appears to be associated with increased risk of co-using cigarettes and marijuana.

Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5

BACKGROUND

Tobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns.

METHODS

Using the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013-2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities.

RESULTS

Three tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use.

CONCLUSIONS

The transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.

The role of trauma and positive youth development in polysubstance use among rural middle school students: a latent class analysis

BACKGROUND

Rural youth often begin developing polysubstance use and other risk behaviors during middle school. However, little polysubstance use research focuses on rural middle school youth. Our research uses Latent Class Analysis to understand existing patterns of rural middle school polysubstance use and risk and protective factors associated with polysubstance use.

METHODS

We used survey data from a rural middle school pregnancy prevention program (N = 2,708). The survey included measures of demographics, lifetime substance use, trauma (adverse childhood experiences and bullying victimization) and aspects of youth development (parent communication on drugs and alcohol, parent connectedness and school connectedness). We used latent class analysis to produce participant polysubstance use profiles and multinomial regression to examine associations between polysubstance use, demographics, trauma and aspects of youth development.

RESULTS

We categorized our participants into four latent classes. Our analysis classified 2.2% of participants as Regular Polysubstance users, 6.9% as Polysubstance experimenters, 19% as Vape + Alcohol experimenters and 71.9% as Non-Users. More adverse childhood experiences were associated with greater risk of polysubstance use and experimentation. Bullying was positively associated with greater risk of vape and alcohol experimentation. Higher reported parental and school connectedness were associated with lower risk of high frequency polysubstance use. Higher reported school connection was also associated with lower risk of polysubstance experimentation.

CONCLUSION

Rural substance use prevention programs should begin during middle school, as polysubstance use development is common among rural middle schoolers. These programs should be trauma informed and focus on connectedness as a modifiable factor to reduce risk of polysubstance use development.

TRIAL REGISTRATION

This article does not report results of a health care intervention on human participants.

Puff bars: a dangerous trend in adolescent disposable e-cigarette use

PURPOSE OF REVIEW

Puff Bars, a brand of disposable e-cigarettes, have skyrocketed in popularity recently, presenting significant health and safety risks to adolescents. Puff Bars and other disposable e-cigarette products are attractive to children and teenagers because of their vibrant colors and flavors, low cost, and ease of access. This review examines the rise in Puff Bar popularity, describes notable health and safety concerns, and provides advice for parents and pediatricians in identifying and preventing adolescent Puff Bar use.

RECENT FINDINGS

Puff Bars have increased in popularity as their product design evaded strict regulations imposed on alternate e-cigarette products, such as Juul. In addition, Puff Bars' sweet and fruit flavors and marketing on social media have made their use pervasive among youth. Puff Bar use can lead to increased risk of e-cigarette product use-associated lung injury (EVALI) and potential exposure to carcinogens. Furthermore, the developmental risks of nicotine use during adolescence include negative effects on cognitive function and detriments to short-term memory.

SUMMARY

Puff Bars present a significant danger to adolescents, and it is imperative that parents and pediatricians are aware of the health risks involved with vaping. Pediatricians should explore e-cigarette use during patient visits, and parents must communicate these dangers to their children and be able to identify these products to regulate their use.

Cannabis use among youth who vape nicotine E-cigarettes: A qualitative analysis

BACKGROUND

Nicotine vaping and cannabis use are common among youth. Among youth who use e-cigarettes, little is known about how and why they use cannabis and patterns of cannabis and nicotine co-use. Given the popularity of both products among youth, the study aim is to utilize qualitative data to better understand cannabis use among youth who use e-cigarettes.

METHOD

Six focus groups of high schoolers who reported past-month e-cigarette use (N = 50; 52% male) were conducted to inform e-cigarette cessation programming. We conducted secondary data analysis examining report of cannabis use during focus groups. Transcripts were examined for report of cannabis use, reasons for use, and nicotine and cannabis co-use.

RESULTS

In focus groups, cannabis was commonly discussed. Youth reported vaping cannabis, however other forms of cannabis delivery were common (e.g. blunts, joints). Themes related to reasons for simultaneous use of nicotine and cannabis were to experience stronger psychoactive effects than using either product alone and needing to use less nicotine product overall. Reasons for liking cannabis were positive psychoactive effects and stress relief. Reasons for disliking were related to health concerns. Notably, when youth reported disliking cannabis due to health concerns, a common discussion was strategies to acquire and continue cannabis use in ways that they perceived mitigated health concerns.

CONCLUSION

Qualitative evidence identified associations between e-cigarette use and cannabis use among youth. Research and interventions targeting youth using e-cigarettes should consider how to address dual use of these products.

Impulsivity-Related Personality Traits as Predictors of E-Cigarette Use among Young Adults over Time

Introduction: There has been rising concern about e-cigarette usage among teenagers and young adults. As knowledge about the adverse health effects of e-cigarettes accumulates, it is critical to identify factors that may increase risk of vaping initiation and frequency of use. One potential risk factor known to increase risk for other substance use is impulsivity. This study tested the hypothesis that impulsivity prospectively predicts vaping over time. Methods: Active e-cigarette users (n = 137; 51.8% male; Mean age 20 years at baseline) completed 8 waves of assessment over 21 months (2017-2020). The S-UPPS-P impulse behavior scale was used at baseline to measure impulsivity, and frequency of e-cigarette, cigarette, marijuana and alcohol use was calculated at each wave thereafter. Results: Vaping frequency declined over time [Incidence Rate Ratio (IRR) = 0.92]. There were significant, stable, positive associations between e-cigarette use and lack of premeditation (IRR = 1.06) and sensation seeking (IRR = 1.09). Vaping frequency was inversely associated with negative urgency (IRR = 0.95). Positive urgency and lack of perseverance were not associated with frequency of vaping. Conclusion: These findings suggest that young adults who have higher impulsivity of certain types may use e-cigarettes more frequently. Thus, vaping interventions for young adults should address these factors to ensure the greatest impact on public health.

Concurrent use of e-cigarettes and cannabis and associated COVID-19 symptoms, testing, and diagnosis among student e-cigarette users at four U.S. Universities

Introduction

This investigation assessed whether current (past 30-day) electronic cigarette (e-cigarette) and cannabis use was associated with coronavirus disease 2019 (COVID-19) symptomatology, testing, and diagnosis among college student e-cigarette users.

Methods

Participants were 18–26-year-old college student e-cigarette users attending four geographically diverse, large U.S. public universities during October-December 2020 (N = 800). Multivariable logistic regression models explored associations between exclusive e-cigarette use and concurrent e-cigarette and cannabis use and COVID-19 symptoms, testing, and diagnosis. Models controlled for demographics, university site, and current use of combustible cigarettes, cigars, and smokeless tobacco.

Results

Over half of student e-cigarette users (52.0%) concurrently used cannabis. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 3.53 times more likely (95%CI = 1.96–6.36) to report COVID-19 symptoms, after adjusting for the covariates. Compared to infrequent exclusive e-cigarette users, infrequent concurrent users (AOR = 4.72, 95%CI = 1.31–17.00), intermediate concurrent users (AOR = 5.10, 95%CI = 1.37–18.97), and frequent concurrent users (AOR = 7.44, 95%CI = 2.06–26.84) were at increased odds of reporting COVID-19 symptoms. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 1.85 times more likely (95%CI = 1.15–2.98) to report a COVID-19 diagnosis. Intermediate concurrent users (AOR = 2.88, 95%CI = 1.13–7.35) and frequent concurrent users (AOR = 3.22, 95%CI = 1.32–7.87) were at increased odds of reporting a COVID-19 diagnosis, compared to infrequent exclusive e-cigarette users.

Conclusions

Concurrent use of e-cigarettes and cannabis may be an underlying risk factor of COVID-19 symptomatology and diagnosis, with more pronounced odds found among intermediate and frequent users. Results highlight the need to educate students about the impacts of e-cigarette and cannabis use on respiratory, immune, and overall health.

Exploring the Association of e-Cigarette and/or Cannabis Use with Heavy Episodic Drinking among Ontario Adults

Background: The use of electronic cigarettes and cannabis has significantly increased in recent years, which raises public health concerns. There are also concerns about the association of these substances with drinking behaviors. The main objective of the present study is to examine the association of e-cigarettes and/or cannabis use with heavy episodic drinking (HED) among Ontario adults. Methods: The sample consisted of 5,564 adults from the Monitor Survey in 2018 and 2019. Cannabis and e-cigarette use reflected any use of the substances in the past 12 months. HED was defined as consumption of four/five or more drinks on a single occasion at least monthly in the past 12 months. Odds ratios (OR) were estimated from logistic regression models accounting for complex survey design and sociodemographic factors. Results: Overall, the prevalence of HED was 17.5% in 2018 and 2019. Among participants who reported both e-cigarette and cannabis use, about one-half (50.4%) reported HED at least monthly. Adjusting for covariates, the odds of HED were 5.71 (95%CI, 3.92-8.30) times higher among those who reported both e-cigarette and cannabis use compared to those who used neither substance. Conclusions: The use of e-cigarettes and cannabis are significantly associated with heavy episodic drinking among adults, indicating that those who engage in the dual use of e-cigarette and cannabis may be an important group to target with intervention programs.

Changes in cannabis use modes among Canadian youth across recreational cannabis legalization: Data from the COMPASS prospective cohort study

INTRODUCTION

Canadian youth consume cannabis in multiple ways, including by smoking, vaping, and eating or drinking. Existing evidence suggests that these behaviours may change after law liberalization, though data regarding youth are scarce. We investigated changes in cannabis modes of use and associated factors across the federal legalization of recreational cannabis use for adults in Canada, among a large sample of underage youth before alternative products were made legally available.

METHODS

Data were available from 2953 longitudinally linked Canadian high school students who reported on their cannabis use during the 2017/2018 and 2018/2019 school years. We explored whether students maintained a single or multiple cannabis use mode(s), contracted, or expanded the number of modes used. We then used generalized estimating equations to analyse associations of baseline characteristics with use mode trajectory.

RESULTS

Expansion of cannabis use modes (42.3%) was more common than maintenance of a single mode (31.3%), maintenance of multiple modes (14.3%), or reduction (12.1%). Students who maintained multiple modes were significantly more likely to have high amounts of weekly spending money (AOR 1.68), to binge drink (AOR 2.25) or vape (AOR 1.99), to use cannabis regularly (AOR 2.67), and to endorse more symptoms of depression (AOR 1.06). School support for quitting tobacco, drug, or alcohol use appeared to have no effect.

CONCLUSIONS

Multi-modal cannabis use increased among Canadian youth in our sample. Its association with other substance use and depressive symptoms may indicate clustering of additional harms. Screening for this use pattern may assist in identifying high-risk substance use and should be considered in the design of harm reduction programming.

Appeal of novel cessation intervention approaches among young-adult users of traditional and alternative tobacco products

Significance

Given limited research on young-adult tobacco cessation interventions, we examined preferred tobacco/e-cigarette cessation approaches among young-adult tobacco/e-cigarette users.

Methods

We analyzed Spring 2020 data from a longitudinal study of young adults (ages 18–34) across 6 metropolitan areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle). We examined tobacco/e-cigarette use and self-reported appeal of various intervention approaches, and regarding technology-based approaches, the appeal of types of technology and intervention functions.

Results

In this sample of past 6-month tobacco/e-cigarette users (M_age = 24.69; 48.4% male; 73.3% White), 59.6% used e-cigarettes, and 48.2% used cigarettes. The most frequently endorsed intervention approach was nicotine replacement therapy (NRT; 72.7%), followed by technology-based programs (70.0%) and oral medications (53.0%). The most frequently endorsed technology-based approach was smartphone apps (85.9%), followed by programs involving text-messaging (62.1%), websites (57.1%), social media (48.4%), and video counseling (41.6%). The most frequently endorsed technology-based program function was behavioral monitoring (68.3%), followed by earning rewards (60.3%). We identified no differences in approach appeal among subcategories of tobacco/e-cigarette users.

Conclusions

Findings underscore the promise of technology-based approaches, particularly apps, and text-messaging for tobacco/e-cigarette cessation, and functions like behavioral monitoring and gamification. Additionally, appropriate and effective NRT use for young-adult tobacco/e-cigarette users warrants further research.

A synthesis of the literature to inform vaping cessation interventions for young adults

There is an urgent need to address young adult (YA) vaping. However, there is limited vaping cessation intervention research, particularly studies tested via experimental designs. This manuscript focuses on YA vaping and critical needs for research to advance vaping cessation interventions for YAs. The smoking cessation literature, especially regarding YA smoking, provides evidence and theory from which to draw. However, the extent to which this literature has utility for vaping cessation warrants investigation. Research to inform the development and optimization of effective vaping cessation interventions for YAs requires attention to both potential targets for behavioral intervention (e.g., conceptual framework) and how to best reach YAs (i.e., delivery modality). Regarding the former, such interventions must consider the complexity of YA vaping (e.g., complex social influences, limited negative outcome expectancies, quit intentions). One particularly challenging aspect of YA cessation is co-use of other tobacco products and marijuana and ensuring that those who quit vaping do not continue or increase other product use. With regard to intervention modality, technology-based interventions (e.g., text messaging, apps) may prove promising, and individualized intervention (e.g., one-on-one counseling) may be needed to carefully intervene on the complexity of substance use, particularly cigarette and marijuana use, within this population.

"Taking Up a New Problem": Context and Determinants of Pod-Mod Electronic Cigarette Use Among College Students

In this article, we explore the context and determinants of pod-mod electronic cigarette (ECIG) use among college students aged 18 to 24 in the United States. We conducted semi-structured interviews with 55 students (M age = 20 years, 56% female, 65% White) on three campuses in the Northwest, Midwest, and Southeast. We performed a thematic analysis. Students described ECIG use by peers, increased ECIG exposure and prevalence in college, and school-related stress as reasons for vaping. Pod-mod features such as convenience, design, easy concealment, and flavors made vaping more appealing. Negative aspects of vaping included addiction, cost, and possible health consequences. Most viewed vaping as a college behavior and intended to quit after graduation. Our results show that the college environment plays a major role in young adult ECIG use. These findings can inform the development of targeted interventions to prevent and control uptake of ECIGs by young adults.

It's Not All Smoke and Mirrors: The Role of Social Norms, Alcohol Use, and Pandemic Partying in e-Cigarette Use During COVID-19

E-cigarette use among college students is increasing. In the era of COVID-19, such usage is especially dangerous given that the virus can be deadly for those with impaired respiratory systems. A small but growing body of research suggests that social norms may predict e-cigarette use. However, one's perception of e-cigarette use behaviors (descriptive norms) and approval by peers (injunctive norms) have yet to be studied in college students. The overarching purpose of this study is to determine whether descriptive and injunctive norms for e-cigarette use contribute unique variance to past 30-day e-cigarette use. Methods: Using a sample of 191 students (138 women) surveyed from introductory-level courses at a university in the northeastern United States, we explored the relationships between student demographic characteristics, alcohol use, binge drinking, COVID-19 non-compliant party attendance on and off campus, and social norms with past 30-day e-cigarette use using sequential regression. Two models were utilized to determine if descriptive and injunctive e-cigarette use norms predicted e-cigarette use after controlling for demographic characteristics in the social norms model, and above and beyond demographics and COVID-19 noncompliant party attendance, alcohol use, and binge drinking in the party behaviors model. Results: The results demonstrated that descriptive and injunctive norms for e-cigarette use significantly predicted e-cigarette use in both models, controlling for all covariates. Conclusions/Importance: Findings highlight the importance of social norms in predicting e-cigarette use during the COVID-19 pandemic, identifying areas for prevention and intervention for public health officials and higher education administrators.

JUUL E-Cigarette Quit Attempts and Cessation Perceptions in College Student JUUL E-Cigarette Users

PURPOSE

This study describes the frequency of JUUL e-cigarette (referred to as JUUL) quit attempts and identifies characteristics associated with confidence in quitting and perceived difficulty quitting JUUL.

DESIGN

Cross-sectional study from a self-administered online survey.

SETTING

Two public southern California universities.

PARTICIPANTS

A total of 1,001 undergraduate students completed the survey from February to May 2019.

MEASURES

Self-report measures about JUUL included use, history of quit attempts, time to first use, perceived difficulty with cessation/reduction, and confidence in quitting.

ANALYSIS

Binary logistic regressions were used to identify demographic and tobacco-related behavioral correlates of JUUL cessation-related perceptions and behaviors.

RESULTS

Nearly half of ever-JUUL users (47.8%) reported a JUUL quit attempt. Adjusting for demographic factors and other tobacco product use, shorter time to first JUUL use after waking was associated with lower confidence in quitting JUUL (aOR = 0.02, 0.00-0.13) and greater perceived difficulty in quitting JUUL (aOR = 8.08, 2.15-30.35). Previous JUUL quit attempt history was also associated with greater odds of perceived difficulty quitting JUUL (aOR = 5.97, 1.74-20.53).

CONCLUSIONS

History of JUUL quit attempts among college students was common. Those who had previously tried quitting were more likely to perceive difficulty with cessation. Time to first JUUL use, a marker of dependence, was linked with greater perceived cessation difficulty and lower confidence in quitting. These findings suggest that there is a need for cessation and relapse prevention support for college student JUUL users.