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Gullahorn B, Kuo I, Robinson AM, Bailey J, Loken J, Taggart T. Identifying facilitators and barriers to the uptake of medication for opioid use disorder in Washington, DC: A community-engaged concept mapping approach. PLoS One 2024; 19:e0306931. [PMID: 39028730 PMCID: PMC11259286 DOI: 10.1371/journal.pone.0306931] [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: 12/15/2023] [Accepted: 06/25/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Opioid overdose is a major public health challenge. We aimed to understand facilitators and barriers to engagement in medication for opioid use disorder (MOUD) among persons with OUD in Washington, DC. METHODS We used a cross-sectional mixed-methods concept mapping approach to explore MOUD engagement between 2021-2022. Community members at-large generated 70 unique statements in response to the focus prompt: "What makes medication for opioid use disorder like buprenorphine (also known as Suboxone or Subutex) difficult to start or keep using?" Persons with OUD (n = 23) and service providers (n = 34) sorted and rated these statements by theme and importance. Data were analyzed with multidimensional scaling and hierarchical cluster analysis, producing thematic cluster maps. Results were validated by our community advisory board. RESULTS Seven themes emerged in response to the focus prompt: availability and accessibility; hopelessness and fear; unmet basic needs; characteristics of treatment programs; understanding and awareness of treatment; personal motivations, attitudes, and beliefs; and easier to use drugs. "Availability and accessibility," "hopelessness and fear," and "basic needs not being met" were the top three identified barriers to MOUD among consumers and providers; however, the order of these priorities differed between consumers and providers. There was a notable lack of communication and programming to address misconceptions about MOUD's efficacy, side effects, and cost. Stigma underscored many of the statements, showcasing its continued presence in clinical and social spaces. CONCLUSIONS This study distinguishes itself from other research on MOUD delivery and barriers by centering on community members and their lived experiences. Findings emphasize the need to expand access to treatment, dismantle stigma associated with substance use and MOUD, and address underlying circumstances that contribute to the profound sense of hopelessness and fear among persons with OUD-all of which will require collective action from consumers, providers, and the public.
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Affiliation(s)
- Britta Gullahorn
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
| | - Irene Kuo
- Department of Epidemiology, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
| | - Artius M. Robinson
- Family and Medical Counseling Services, Inc., Washington, DC, United States of America
| | | | - Jennifer Loken
- Whitman-Walker Health, Washington, DC, United States of America
| | - Tamara Taggart
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
- Whitman-Walker Health, Washington, DC, United States of America
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
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Herman RJ, Schmidt HD. Targeting GLP-1 receptors to reduce nicotine use disorder: Preclinical and clinical evidence. Physiol Behav 2024; 281:114565. [PMID: 38663460 PMCID: PMC11128349 DOI: 10.1016/j.physbeh.2024.114565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 04/30/2024]
Abstract
Nicotine use disorder (NUD) remains a leading cause of preventable death in the U.S. Unfortunately, current FDA-approved pharmacotherapies for smoking cessation have limited efficacy and are associated with high rates of relapse. One major barrier to long-term smoking abstinence is body weight gain during withdrawal. Nicotine withdrawal-induced body weight gain can also lead to development of chronic disease states like obesity and type II diabetes mellitus. Therefore, it is critical to identify novel pharmacotherapies for NUD that decrease relapse and nicotine withdrawal symptoms including body weight gain. Recent studies demonstrate that glucagon-like peptide-1 receptor (GLP-1R) agonists attenuate voluntary nicotine taking and seeking and prevent withdrawal-induced hyperphagia and body weight gain. Emerging evidence also suggests that GLP-1R agonists improve cognitive deficits, as well as depressive- and anxiety-like behaviors, which contribute to smoking relapse during withdrawal. While further studies are necessary to fully characterize the effects of GLP-1R agonists on NUD and understand the mechanisms by which GLP-1R agonists decrease nicotine withdrawal-mediated behaviors, the current literature supports GLP-1R-based approaches to treating NUD.
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Affiliation(s)
- Rae J Herman
- Neuroscience Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Heath D Schmidt
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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3
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Palmer AM, Rojewski AM, Carpenter MJ, Klemperer EM, Baker NL, Sanford BT, Toll BA. Interest in quitting e-cigarette use by device type and smoking history in US adults. Tob Control 2024; 33:537-540. [PMID: 36650050 PMCID: PMC10350465 DOI: 10.1136/tc-2022-057710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of e-cigarettes has been increasing, especially since the introduction of 'pod' devices to the marketplace since 2018. Most adults who vape report interest in quitting. The present study examined level of interest in e-cigarette cessation between users with varying cigarette smoking histories and device types. METHODS Data obtained from wave 5 (2018-2019) of the Population Assessment of Tobacco and Health study (n=34 309). Analyses were conducted on adult current established e-cigarette users, categorised on cigarette smoking history (current, former or never) and device type (disposable, cartridge/pod, tank or mod). Participants reported if they planned to ever quit e-cigarettes, attempted to quit in the past year and attempted to quit by cutting back in the past year. RESULTS Of the 2922 established e-cigarette users, 68.21% reported plans to quit vaping; 17.27% reported attempting to quit e-cigarettes in the past year; and 29.28% reported attempting to quit by cutting back in the past year. Cartridge users had higher odds of interest in quitting than tank and mod users. Disposable and cartridge users had higher odds of reporting a past year quit attempt than tank and mod users. Individuals with no smoking history had higher odds of reporting a past year quit attempt or cutting back relative to those reporting dual use (of both e-cigarettes and cigarettes) and former smoking. CONCLUSIONS Tobacco control should consider the type of e-cigarette device that is being used, alongside users' cigarette smoking history, when developing interventions and other resources for vaping cessation.
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Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
| | - Matthew J Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elias M Klemperer
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brandon T Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
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Whitesell C, Blount TH, Alton Dailey S, Hall MG, Ribisl KM, Sheeran P, Kalan ME, Brewer NT. Uncontrolled vaping and restraint strategies: A qualitative study. Soc Sci Med 2024; 349:116900. [PMID: 38669894 PMCID: PMC11348397 DOI: 10.1016/j.socscimed.2024.116900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Little is known about uncontrolled vaping, defined as vaping more than the user prefers. We sought to understand e-cigarette users' experiences with uncontrolled vaping and how they restrain their vaping. METHODS Participants were 24 US adult e-cigarette users recruited in 2021. We conducted semi-structured qualitative interviews about uncontrolled vaping and restraint strategies and analyzed findings based on behavioral categories described in the Process Model of Self-Control. RESULTS While most participants (21 of 24) described experiences of uncontrolled vaping, some expressed ambivalence about how much they vaped. To restrain vaping, willpower was rarely used and was not perceived as effective. Distraction, deployment of attention away from the urge to vape, and reappraisal, thinking differently about vaping such as reminding oneself of health consequences, were common and helped some participants limit use in the moment of wanting to vape. Participants described using both situation selection, choosing to be in situations where e-cigarette use was less possible, and situation modification, modifying their circumstances to restrict opportunities to vape. DISCUSSION Uncontrolled vaping is not yet a well-defined concept for many e-cigarette users. E-cigarette users employed proactive situational strategies that required planning ahead to restrain use and found these strategies more effective compared to reactive strategies. Tobacco control programs and interventions should consider leveraging restraint strategies that people who vape are naturally using and perceive to be effective.
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Affiliation(s)
- Callie Whitesell
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC, USA, 27599
| | - Thomas H Blount
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC, USA, 27599
| | - Susan Alton Dailey
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC, USA, 27599
| | - Marissa G Hall
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC, USA, 27599; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr, Chapel Hill, NC, USA, 27599; Carolina Population Center, University of North Carolina at Chapel Hill 123 West Franklin St, Chapel Hill, NC, USA, 27516
| | - Kurt M Ribisl
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC, USA, 27599; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr, Chapel Hill, NC, USA, 27599
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr, Chapel Hill, NC, USA, 27599; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, USA, 27599
| | - Mohammad Ebrahimi Kalan
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC, USA, 27599; Eastern Virginia Medical School, Norfolk, VA, USA, 23501
| | - Noel T Brewer
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC, USA, 27599; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr, Chapel Hill, NC, USA, 27599.
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Milstred AR, Douglas AE, Felicione NJ, Blank MD. Psychometric properties of measures for electronic cigarette dependence among former-smoking electronic cigarette users. Addict Behav 2024; 152:107974. [PMID: 38301587 DOI: 10.1016/j.addbeh.2024.107974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Measures designed to assess electronic cigarette (ECIG) dependence are largely adapted from those developed for cigarette smoking, and have been evaluated mainly among dual ECIG-cigarette users. The present study evaluated the psychometric properties of four dependence measures among former-smoking ECIG users. METHODS Respondents (N = 187) were daily ECIG users who had formerly smoked cigarettes regularly. As part of an online survey, they completed four dependence measures: Penn State Electronic Cigarette Dependence Index (PSECDI); E-Cigarette Dependence Scale (EDS-4); Glover Nilsson Behavioral Questionnaire (GNBQ); and Diagnostic and Statistical Manual 5th Edition (DSM-5). RESULTS Confirmatory factor analysis revealed a single factor structure for all four measures, and fit indices were adequate for all models. Most inter-item correlations (mean r's = 0.21 to 0.45) and all item-total correlations (mean r's = 0.53 to 0.80) were significant for all four measures. Internal consistency was highest for the GNBQ (α = 0.86) followed by the EDS-4 (α = 0.81), PSECDI (α = 0.76), and DSM-5 (α = 0.75). Age of ECIG initiation was correlated negatively with scores on the EDS-4 and DSM-5, while number of ECIG quit attempts was correlated positively with scores on all measures except the GNBQ. Convergent validity was highest for comparisons between the EDS-4 and PSECDI (r = 0.75) though all comparisons were significant (p's < 0.001). CONCLUSIONS All four measures demonstrated acceptable reliability and validity in this sample of former-smoking ECIG users.
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Affiliation(s)
- Andrea R Milstred
- Department of Psychology, Eberly College of Arts & Sciences, West Virginia University, Morgantown, WV 26508, USA.
| | - Ashley E Douglas
- Department of Psychology, Eberly College of Arts & Sciences, West Virginia University, Morgantown, WV 26508, USA
| | - Nicholas J Felicione
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14261, USA
| | - Melissa D Blank
- Department of Psychology, Eberly College of Arts & Sciences, West Virginia University, Morgantown, WV 26508, USA; WV Prevention Research Center, School of Public Health, Morgantown, WV
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Soule EK, Mayne S, Snipes W, Guy MC, Breland A, Fagan P. Reactions to a Hypothetical Ban of Open-System Electronic Cigarettes Among People Who Currently Use Electronic Cigarettes. Nicotine Tob Res 2024:ntae020. [PMID: 38408200 DOI: 10.1093/ntr/ntae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Policies limiting electronic cigarette (ECIG) device and liquid characteristics have been considered to prevent dependence potential and youth product appeal. "Open-system" ECIGs allow people to adjust device and liquid characteristics, which may undermine these policies. This study examined anticipated reactions to a policy prohibiting the sale of open-system ECIG devices in the United States using concept mapping. METHODS In 2020, adults who reported ECIG use in the past 30 days (n = 70; 45.1% women; mean age = 33.0, SD = 10.6) recruited from a research registry of individuals from across the United States provided statements into a shared list that completed a prompt: "If open-system vaping devices were no longer sold in the US and only closed-system vaping devices were available, what is a specific reaction or response you would have?" at a study website. Participants rated statements (1-7) on how true the statements were for them. Multidimensional scaling and hierarchical cluster analyses were used to identify thematic clusters. Mean ratings of statements were calculated and compared based on the type of ECIG used and current cigarette smoking status. RESULTS Participants generated 85 unique statements. The analysis identified eight themes that were organized into two broad groups. The first group of five clusters described behavioral responses to the hypothetical policy (Loopholes, Switch to Closed-System ECIGs, Legal Approaches to Use Open-System ECIGs, ECIG Use Cessation, Switch to non-ECIG Products). The second group of three clusters described psychological responses to the hypothetical policy (Closed-System ECIG Cons, Psychological Responses, Policy Outcome Concerns). CONCLUSIONS While a ban on open-system ECIG devices may have positive impacts on public health, policy loopholes, and consumer behaviors may undermine the policy. Efforts to support policy enforcement could increase policy effectiveness. IMPLICATIONS Open-system electronic cigarettes (ECIGs) that allow people who use ECIGs to modify ECIG device and liquid characteristics may limit the effectiveness of policies that establish product standards which attempt to limit nicotine delivery and flavor content in ECIG liquids. This study identified predicted reactions to a hypothetical policy prohibiting the sale of open-system ECIGs in the United States. Results suggest that people who use ECIGs may view a policy prohibiting open-system ECIGs unfavorably, but would be willing to use closed-system ECIGs. However, many ECIG users may attempt to find loopholes in the policy or alternative sources to purchase open-system ECIGs if open-systems were banned. Future research should identify strategies for tobacco regulatory policy enforcement to increase effectiveness.
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Affiliation(s)
- Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Shannon Mayne
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - William Snipes
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Mignonne C Guy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Department of African American Studies, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Alison Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Pebbles Fagan
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, Center for the Study of Tobacco, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Cui Y, Dai Z, Cohen JE, Rosas S, Clegg Smith K, Welding K, Czaplicki L. Culturally specific health-related features on cigarette packs sold in China. Tob Control 2024; 33:232-239. [PMID: 36008126 DOI: 10.1136/tc-2022-057527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND China is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy. METHODS We used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is 'healthy' or 'good for you'. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time. RESULTS Overall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one 'healthy' or 'good for you' feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint). CONCLUSION Health-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.
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Affiliation(s)
- Yuxian Cui
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zheng Dai
- Department of Applied Economics, Johns Hopkins University Zanvyl Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Rosas
- Concept Systems Incorporated, Ithaca, New York, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Soule EK, Mayne S, Snipes W, Heym M, Coffey A, Guy M, Breland A, Fagan P. Electronic Cigarette Users' Reactions and Responses to a Hypothetical Nicotine Concentration Reduction in Electronic Cigarette Liquids. Subst Use Misuse 2023; 58:1202-1211. [PMID: 37222484 PMCID: PMC10339361 DOI: 10.1080/10826084.2023.2212280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background: Regulations limiting nicotine in electronic cigarettes (e-cigarettes) have been proposed or implemented. Little is known about e-cigarette users' reactions to reducing e-cigarette liquid nicotine concentration. Methods: We used concept mapping to describe e-cigarette users' reactions to a 50% reduction in the nicotine concentration of their e-cigarette liquids. In 2019, current e-cigarette users who used e-cigarette liquid with greater than 0 mg/ml nicotine concentration completed an online study. Participants (n = 71, mean age = 34.9 (SD = 11.0), 50.7% women), brainstormed statements completing a prompt: "If the e-liquid that I use now in my e-cigarette/vaping device was only available in half the nicotine concentration or amount that I use now, a specific action I would take or a specific reaction I would have is…", Participants then sorted a final list of 67 statements into piles of similar content and rated statements on how true the statements would be for them. Multidimensional scaling and hierarchical cluster analyses identified thematic clusters. Results: Eight clusters were identified: (1) Replacement Product Seeking, (2) Mental Preparations and Expectations, (3) Use the New Liquid, (4) Information Seeking, (5) Compensation Behaviors, (6) Opportunity for E-Cigarette Reduction, (7) Physical and Psychological Effects, and (8) Replacement with non-E-Cigarette Products and Behaviors. Cluster ratings suggested many participants would search for other e-cigarette products/liquids to replace their current liquids, but using other tobacco products (e.g., cigarettes) may be less likely. Conclusions: If nicotine concentrations were decreased in e-cigarette liquids, e-cigarette users may attempt to purchase different e-cigarette products or modify their products to achieve desired effects.
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Affiliation(s)
- Eric K. Soule
- Department of Health Education and Promotion, Mail Stop 529, East Carolina University, 1000 East 5 Street, Greenville, NC 27858 USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
| | - Shannon Mayne
- Department of Health Education and Promotion, Mail Stop 529, East Carolina University, 1000 East 5 Street, Greenville, NC 27858 USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
| | - William Snipes
- Department of Health Education and Promotion, Mail Stop 529, East Carolina University, 1000 East 5 Street, Greenville, NC 27858 USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
| | - Molly Heym
- Department of Health Education and Promotion, Mail Stop 529, East Carolina University, 1000 East 5 Street, Greenville, NC 27858 USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
| | - AnneMarie Coffey
- Department of Health Education and Promotion, Mail Stop 529, East Carolina University, 1000 East 5 Street, Greenville, NC 27858 USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
| | - Mignonne Guy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
- Department of African American Studies, College of Humanities and Sciences, Virginia Commonwealth University, 816 W Franklin Street, Richmond, VA 23284 USA
| | - Alison Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284 USA
| | - Pebbles Fagan
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St., Suite 200, Richmond, VA 23220 USA
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, Center for the Study of Tobacco, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205 USA
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Singh I, Valavil Punnapuzha V, Mitsakakis N, Fu R, Chaiton M. A Machine Learning Approach Reveals Distinct Predictors of Vaping Dependence for Adolescent Daily and Non-Daily Vapers in the COVID-19 Era. Healthcare (Basel) 2023; 11:healthcare11101465. [PMID: 37239751 DOI: 10.3390/healthcare11101465] [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: 03/01/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Since 2016, there has been a substantial rise in e-cigarette (vaping) dependence among young people. In this prospective cohort study, we aimed to identify the different predictors of vaping dependence over 3 months among adolescents who were baseline daily and non-daily vapers. We recruited ever-vaping Canadian residents aged 16-25 years on social media platforms and asked them to complete a baseline survey in November 2020. A validated vaping dependence score (0-23) summing up their responses to nine questions was calculated at the 3-month follow-up survey. Separate lasso regression models were developed to identify predictors of higher 3-month vaping dependence score among baseline daily and non-daily vapers. Of the 1172 participants, 643 (54.9%) were daily vapers with a mean age of 19.6 ± 2.6 years and 76.4% (n = 895) of them being female. The two models achieved adequate predictive performance. Place of last vape purchase, number of days a pod lasts, and the frequency of nicotine-containing vaping were the most important predictors for dependence among daily vapers, while race, sexual orientation and reporting treatment for heart disease were the most important predictors in non-daily vapers. These findings have implications for vaping control policies that target adolescents at different stages of vape use.
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Affiliation(s)
- Ishmeet Singh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Varna Valavil Punnapuzha
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Nicholas Mitsakakis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Rui Fu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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10
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Milstred AR, Douglas AE, Romm KF, Blank MD. Evaluation of the Psychometric Properties of Dependence Measures for Exclusive Electronic Cigarette Users. Nicotine Tob Res 2023; 25:563-570. [PMID: 36377569 PMCID: PMC9910153 DOI: 10.1093/ntr/ntac260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Extant electronic cigarette (ECIG) dependence measures are largely adapted from those designed for cigarette smoking, though few have been evaluated for their psychometric properties. AIMS AND METHODS Never-smoking ECIG users (N = 134) participating in an online survey completed four dependence measures: Penn state electronic cigarette dependence index (PSECDI), e-cigarette dependence scale (EDS-4), diagnostic and statistical manual for tobacco use disorder (DSM-5), and Glover Nilsson behavioral questionnaire (GNBQ). They also reported on their ECIG use characteristics (eg, behaviors and reasons). RESULTS Internal consistency was highest for the EDS-4 (Cronbach's α = 0.88) followed by the GNBQ (α = 0.75), PSECDI (α = 0.72), and DSM (α = 0.71). Confirmatory factor analyses revealed a single-factor structure for the PSECDI, EDS-4, and GNBQ. For the DSM-5, however, two items did not load significantly (ECIG use interferes with responsibilities; reduce/give up activities because of ECIG use). Significant correlations were observed between all measures and the number of ECIG use days/week and/or years using ECIGs, as well as between DSM-5 scores and the number of ECIG quit attempts and initiation age. Endorsement of using ECIGs because "I like flavors" was correlated positively with DSM-5 and GNBQ scores. CONCLUSIONS All dependence measures evaluated herein demonstrated adequate reliability and construct validity. Future work should focus on determining which aspects of dependence are those that are unique to ECIG use, and subsequently developing a more comprehensive measure of ECIG dependence. IMPLICATIONS The measures assessed herein-PSECDI, EDS-4, DSM-5, and GNBQ-demonstrated adequate to good reliability and construct validity among a sample of never-smoking ECIG users. The dependence domains covered across measures were related yet distinct. Findings demonstrate the need for future evaluation of these different domains to determine which are the most salient characteristics of ECIG dependence.
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Affiliation(s)
- Andrea R Milstred
- Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV 26508, USA
| | - Ashley E Douglas
- Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV 26508, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Melissa D Blank
- Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV 26508, USA
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11
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Douglas AE, Felicione NJ, Childers MG, Soule EK, Blank MD. Predictors of electronic cigarette dependence among non-smoking electronic cigarette users: User behavior and device characteristics. Addict Behav 2023; 137:107500. [PMID: 36194979 PMCID: PMC10873757 DOI: 10.1016/j.addbeh.2022.107500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/25/2022] [Accepted: 09/19/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION ECIGs differ in their ability to deliver nicotine to the user and, consequently, they may differ in their ability to produce dependence. This study examined individual device characteristics, device type, and user behaviors as predictors of ECIG dependence in a sample of never-smoking ECIG users. METHODS Participants (N = 134) completed an online survey that assessed demographics, ECIG use behavior, and ECIG dependence as measured via the Penn State Electronic Nicotine Dependence Index (PSECDI) and E-cigarette Dependence Scale (EDS-4). Participants uploaded a picture of their personal ECIG device/liquid, which was coded by raters to identify product features. Multivariable linear regressions examined device characteristics (e.g., adjustable power, nicotine concentration) and device type (e.g., vape pen, mod, pod, modern disposable) as predictors of dependence controlling for demographics and user behaviors (e.g., ECIG use duration and frequency, other tobacco use). RESULTS Longer durations of ECIG use and more use days/week were associated significantly with higher PSECDI (β's = 0.91 and 1.90, respectively; p's < 0.01) and EDS-4 scores (β's = 0.16 and 0.28, respectively; p's < 0.01). Higher nicotine concentrations were associated with higher PSECDI scores only (β = 0.07, p =.011). Dependence scores did not differ as a function of ECIG device types after controlling for covariates. CONCLUSIONS ECIG dependence was observed among the never-smoking ECIG users in this sample, regardless of their ECIG device/liquid features. Findings suggest that regulatory efforts aimed at reducing the dependence potential of ECIGs in never smokers should focus on overall nicotine emissions rather than product features.
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Affiliation(s)
- Ashley E Douglas
- Department of Psychology, West Virginia University, Morgantown, WV, United States.
| | - Nicholas J Felicione
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
| | - Margaret G Childers
- Department of Psychology, West Virginia University, Morgantown, WV, United States.
| | - Eric K Soule
- Health Education and Promotion, East Carolina University, Greenville, NC, United States.
| | - Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, WV, United States.
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12
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Loukas A, Marti CN, Harrell MB, Pasch KE, Wilkinson AV. Electronic nicotine delivery systems (ENDS) dependence among Texas Young Adults, 2014-2019: Increasing trajectory after the 2017 surge in vape pod popularity. Drug Alcohol Depend 2022; 241:109700. [PMID: 36434881 PMCID: PMC9806720 DOI: 10.1016/j.drugalcdep.2022.109700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/21/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Use of electronic nicotine delivery systems (ENDS) increased significantly after 2017. The increase is attributed to a surge in popularity of vape pods containing nicotine salts, which are high nicotine concentration ENDS that may heighten risk for dependence. However, little is known about changes in ENDS dependence before and after the 2017 surge. We examined the trajectory of ENDS dependence among young adults from 2014 to 2019. METHODS Participants were 1700 18-25-year-olds (57.6 % female) from 24 Texas colleges who reported past 30-day ENDS use in at least one of eight study waves. ENDS dependence was assessed at all waves with one item, use of ENDS within 30 min of waking. A discontinuous growth curve model was fit to test the hypothesis that the ENDS dependence trajectory would increase only after 2017, from 2018 to 2019. The model included socio-demographic and cigarette dependence covariates RESULTS: The proportion of young adults reporting ENDS dependence ranged from 2.3 % in 2014 to 8.2 % in 2019. Results from the discontinuous growth curve model indicated that the ENDS dependence trajectory was flat from fall 2014 to spring 2017. However, the post-2017 trajectory, from spring 2018 to spring 2019, was positive and significant indicating that the proportion of young adults reporting ENDS dependence increased after 2017. CONCLUSIONS The increase in ENDS dependence after 2017 likely resulted from the surge in popularity of vape pods containing nicotine salts. These vape pods are a disruptive technology that may result in more young adults developing nicotine dependence symptoms than do earlier generation devices.
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Affiliation(s)
- Alexandra Loukas
- Kinesiology & Health Education, University of Texas at Austin, 2109 San Jacinto Blvd. D3700, Austin, TX 78712, United States.
| | - C Nathan Marti
- Kinesiology & Health Education, University of Texas at Austin, 2209 San Jacinto Blvd. D3700, Austin, TX 78712, United States
| | - Melissa B Harrell
- Epidemiology, Human Genetics, and Environmental Sciences, UTHealth, School of Public Health-Houston, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, United States
| | - Keryn E Pasch
- Kinesiology & Health Education, University of Texas at Austin, 2109 San Jacinto Blvd. D3700, Austin, TX 78712, United States
| | - Anna V Wilkinson
- Epidemiology, Human Genetics, and Environmental Sciences, UTHealth, School of Public Health-Houston, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, United States
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13
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Soule EK, Mayne S, Snipes W, Thomas L, Guy MC, Breland A, Fagan P. Electronic cigarette users' reactions and responses to a hypothetical ban of flavoured electronic cigarette liquids. Tob Control 2022; 31:s197-s205. [PMID: 36328459 PMCID: PMC9661374 DOI: 10.1136/tc-2022-057454] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022]
Abstract
Regulations have been proposed to limit e-cigarette flavours, but limited research has examined potential impacts of such policies. This study examined adult e-cigarette users’ reactions to a hypothetical e-cigarette flavour ban.
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Affiliation(s)
- Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Shannon Mayne
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - William Snipes
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Luke Thomas
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mignonne C Guy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA,Department of African American Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alison Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pebbles Fagan
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA,Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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14
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Soule EK, Sousan S, Streuber D, Fresquez SE, Mooring R, Salman R, Talih S, Pender J. Increased JUUL Emissions from Initial Puffs after Removing and Reinserting Pod. Chem Res Toxicol 2022; 35:383-386. [PMID: 35258926 PMCID: PMC9125989 DOI: 10.1021/acs.chemrestox.2c00017] [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] [Indexed: 11/30/2022]
Abstract
Standard laboratory electronic cigarette (ECIG) puffing protocols that do not consider user behaviors, such as removing and resinserting a pod, may underestimate emissions. This study compared JUUL emissions from four 10-puff bout procedures. We generated ECIG aerosol in a chamber using a JUUL device and measured concentrations of particulate matter ≤2.5 μm in diameter (PM2.5). The JUUL pod was removed and reinserted 0 times, 1 time, 4 times, and 9 times in experiments 1-4, respectively. Mean real-time PM2.5 concentration was 65.06 μg/m3 (SD = 99.53) for experiment 1, 375.50 μg/m3 (SD = 346.45) for experiment 2, 501.94 μg/m3 (SD = 450.00) for experiment 3, and 834.69 μg/m3 (SD = 578.34) for experiment 4. In this study, removing and reinserting a JUUL pod resulted in greater PM2.5 concentrations compared to puffing protocols in which the JUUL pod was not removed and reinserted. ECIGs should be examined and evaluated based on ECIG users' real-world behaviors.
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Affiliation(s)
- Eric K Soule
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina 27858, United States
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
| | - Sinan Sousan
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, United States
- North Carolina Agromedicine Institute, Greenville, North Carolina 27858, United States
| | - Dillon Streuber
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina 27858, United States
| | - Sarah E Fresquez
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina 27858, United States
| | - Ronald Mooring
- Department of Chemistry, Thomas Harriot College of Arts & Sciences, East Carolina University, Greenville, North Carolina 27858, United States
| | - Rola Salman
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
- Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Soha Talih
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23220, United States
- Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Jack Pender
- Department of Chemistry, Thomas Harriot College of Arts & Sciences, East Carolina University, Greenville, North Carolina 27858, United States
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15
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Do EK, O’Connor K, Perks SN, Soule EK, Eissenberg T, Amato MS, Graham AL, Martin CK, Höchsmann C, Fuemmeler BF. E-cigarette device and liquid characteristics and E-cigarette dependence: A pilot study of pod-based and disposable E-cigarette users. Addict Behav 2022; 124:107117. [PMID: 34555560 PMCID: PMC8511126 DOI: 10.1016/j.addbeh.2021.107117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND E-cigarette device and liquid characteristics, such as electrical power output and liquid nicotine concentration, determine the rate at which nicotine is emitted from the e-cigarette (i.e., nicotine flux), and thus are likely to influence user nicotine dependence. We hypothesize that nicotine flux would be associated with the E-cigarette Dependence Scale (EDS) among pod-based and disposable e-cigarette products. METHODS Data were obtained from online panel participants between 18 and 65 years of age, who had indicated that they were either former or current e-cigarette users and resided within the United States (N = 1036). To be included in these analyses, participants had to provide information regarding device type (pod-based or disposable), power (watts), and nicotine concentration (mg/mL), from which we could determine nicotine flux (µg/s) (N = 666). To assess the relationship between nicotine flux and EDS, a series of multivariable linear regressions were conducted. Each model was separated by device type and adjusted for by age and past 30-day e-cigarette use. RESULTS Greater nicotine flux was associated with higher EDS scores among pod-based e-cigarette users (beta = 0.19, SE = 0.09, p-value = 0.043), but not users of disposable e-cigarettes. Neither power nor nicotine concentration were associated with EDS scores among users of either e-cigarette device type. CONCLUSION Results support the hypothesis that nicotine flux is positively associated with nicotine dependence in a sample of current users of pod-based and disposable e-cigarettes.
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Affiliation(s)
- Elizabeth K. Do
- Schroeder Institute at Truth Initiative, Washington, DC, USA,Department of Health Behavior and Policy, Virginia Commonwealth University,Department of Epidemiology, Milken Institute of Public Health, The George Washington University, Washington, DC, USA
| | - Katie O’Connor
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | | | - Eric K. Soule
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Grenville, NC, USA,Center for the Study of Tobacco Products, Psychology Department (Health Program), Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Psychology Department (Health Program), Virginia Commonwealth University, Richmond, VA, USA
| | - Michael S. Amato
- Truth Initiative Innovations Department, Washington, DC, USA,Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Amanda L. Graham
- Truth Initiative Innovations Department, Washington, DC, USA,Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Bernard F. Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University,Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
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16
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Simpson KA, Kechter A, Schiff SJ, Braymiller JL, Yamaguchi N, Ceasar RC, Bluthenthal RN, Barrington-Trimis JL. Characterizing symptoms of e-cigarette dependence: a qualitative study of young adults. BMC Public Health 2021; 21:959. [PMID: 34016066 PMCID: PMC8138971 DOI: 10.1186/s12889-021-10945-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background While rates of e-cigarette use (‘vaping’) continue to potentiate concern, there is limited data on common symptoms of e-cigarette dependence among young adults who vape. This study sought to critically explore how young adults experience, manifest, and conceptualize vaping dependence symptoms in their everyday lives. Methods Between June 2018 and 2019, in-depth qualitative interviews were conducted with 62 young adults who use e-cigarettes (aged 18–25) and live in Southern California. We explored participants’ product preferences, daily e-cigarette use patterns, vaping history, withdrawal experiences, and quit attempts or periods of cessation. We used a thematic analysis approach to interpret the transcripts. Results Young adults discussed nine dimensions of vaping dependence that were organized into two categories: 1) general nicotine dependence symptoms, and 2) unique dependence symptoms related to vaping. Nicotine dependence symptoms included cravings and urgency to use, increased use to achieve desired effects, and unsuccessful quit attempts and withdrawal. Symptoms unique to vaping dependence included greater nicotine consumption due to accessibility and lack of restrictions, habitual vaping, inability to track vaping frequency, immediate gratification and comfort, social acceptability and norms, and awareness of vaping dependency. Conclusions In addition to nicotine dependence symptoms that have been characterized for other tobacco products, young adult e-cigarette users described unique symptoms of vaping dependence that necessitate the need for more refined measures. All dimensions of vaping dependence should be considered in discussions of policies as well as treatment and education efforts intended to protect young people from e-cigarette dependence. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10945-z.
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Affiliation(s)
- Kelsey A Simpson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA.
| | - Afton Kechter
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Sara J Schiff
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Jessica L Braymiller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA.,Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Naosuke Yamaguchi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Rachel Carmen Ceasar
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA.,Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA.,Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
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17
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Hammond D, Reid JL, Rynard VL, O'Connor RJ, Goniewicz ML, Piper ME, Bansal-Travers M. Indicators of dependence and efforts to quit vaping and smoking among youth in Canada, England and the USA. Tob Control 2021; 31:tobaccocontrol-2020-056269. [PMID: 33526441 PMCID: PMC8325708 DOI: 10.1136/tobaccocontrol-2020-056269] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The current study examined indicators of dependence among youth cigarette smokers and e-cigarette users in Canada, England and the USA, including changes between 2017 and 2019. METHODS Data are from repeated cross-sectional online surveys conducted in 2017, 2018 and 2019 with national samples of youth aged 16-19 years, in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Measures included perceived addiction to cigarettes/e-cigarettes, frequency of experiencing strong urges to smoke/use an e-cigarette, plans to quit smoking/using e-cigarettes and past attempts to quit. Logistic regression models were fitted to examine differences between countries and changes over time. RESULTS The proportion of ever-users who vaped frequently was significantly higher in 2019 compared with 2017 for all outcomes in each country. Between 2017 and 2019, the proportion of past 30-day vapers reporting strong urges to vape on most days or more often increased in each country (Canada: 35.3%, adjusted OR (AOR) 1.69, 95% CI 1.20 to 2.38; England: 32.8%, AOR 1.55, 1.08 to 2.23; USA: 46.1%, AOR 1.88, 1.41 to 2.50), along with perceptions of being 'a little' or 'very addicted' to e-cigarettes (Canada: 48.3%, AOR 1.99, 1.44 to 2.75; England: 40.1%, AOR 1.44, 1.03 to 2.01; USA: 53.1%, AOR 1.99, 1.50 to 2.63). Indicators of dependence among smokers were consistently greater than e-cigarette users, although differences had narrowed by 2019, particularly in Canada and the USA. CONCLUSIONS Prevalence of dependence symptoms among young e-cigarette users increased between 2017 and 2019, more so in Canada and the USA compared with England. Dependence symptom prevalence was lower for e-cigarettes than smoking; however, the gap has narrowed over time.
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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
| | - Vicki L Rynard
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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18
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Kittaneh AA, Sidhu NK, Tackett AP, Lechner WV. Effects of Negative Emotion on Abstinence Induced Change in Urge to Vape and Measures of Vaping Dependence. Subst Use Misuse 2021; 56:768-776. [PMID: 33706646 DOI: 10.1080/10826084.2021.1892143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Negative emotion and craving to smoke are established factors driving the maintenance of combustible cigarette use and dependence. The current study aimed to examine whether these findings extend to e-cigarette use. Toward that aim, change in vaping urge following abstinence was examined as a function of negative emotion. Additionally, a mediation model which previously demonstrated relationships between negative emotion, craving, and combustible cigarette dependence was tested in e-cigarette users. METHOD Daily e-cigarette users (N = 32, Mage = 21 years, SDage = 7 years; 78% white) completed a battery of psychological, behavioral, and smoking-related measures in a human laboratory setting. Using their personal devices, participants completed a 5-minute ad-libitum vaping session, a baseline measure of vaping urge, followed by a 2-hour observed abstinence period and a final assessment of vaping urge. RESULTS Multivariate regression and two mediation models were utilized to examine factors associated with vaping dependence. The results of these models indicated that negative affect predicted vaping urge following observed abstinence. The relationship between negative affect and measures of vaping dependence and habit, respectively, were significantly mediated by changes in urge during the abstinence period. CONCLUSIONS These preliminary results indicate that psychological constructs underlying vaping dependence are similar to those previously found to be associated with combustible cigarette dependence. Further research examining whether these constructs, namely negative affect and change in urge following abstinence, will be important variables to target for vaping cessation treatments is needed.
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Affiliation(s)
- Ahmad A Kittaneh
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Natasha K Sidhu
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Alayna P Tackett
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - William V Lechner
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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19
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Impacts of COVID-19 on Electronic Cigarette Purchasing, Use and Related Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186762. [PMID: 32948084 PMCID: PMC7558653 DOI: 10.3390/ijerph17186762] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
Background: COVID-19 has caused health impacts and disruptions globally. Electronic cigarette (ECIG) users may face additional impacts. This study examined impacts of COVID-19 on ECIG users. Methods: Concept mapping, a mixed-methods approach, was used to identify COVID-19 impacts on adult ECIG users. ECIG users (n = 93) provided statements completing a prompt: "A specific way Coronavirus/COVID-19 has affected my vaping/e-cigarette use, my vaping/e-cigarette related purchasing, or other vaping/e-cigarette related behaviors or issues is…". Participants generated 85 unique statements, sorted statements into groups of similar content and rated each statement on how true they were. Multidimensional scaling and hierarchical cluster analysis identified thematic clusters. Mean cluster ratings were compared between sample subgroups. Results: Ten clusters were identified: Stocking up and Bulk Purchasing, Challenges in Obtaining ECIG Supplies, Alternative Purchasing Procedures, Increased ECIG use, Disruption of Routine and ECIG Use, Efforts to Decrease ECIG Use, Improving ECIG Skills, COVID-19 Health Concerns, Perceptions of ECIG Use and COVID-19, and COVID-19 Protection. More dependent ECIG users and dual users of ECIGs and cigarettes rated clusters higher than less dependent ECIG users and non-dual users. Conclusions: ECIG users may experience or perceive they face additional COVID-19 impacts, such as increased exposure, financial burdens, stress, and health risks.
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20
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Leslie FM. Unique, long-term effects of nicotine on adolescent brain. Pharmacol Biochem Behav 2020; 197:173010. [PMID: 32738256 DOI: 10.1016/j.pbb.2020.173010] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/23/2020] [Accepted: 07/28/2020] [Indexed: 01/20/2023]
Abstract
Adolescence is a time of major plasticity of brain systems that regulate motivated behavior and cognition, and is also the age of peak onset of nicotine use. Although there has been a decline in teen use of cigarettes in recent years, there has been a huge increase in nicotine vaping. It is therefore critically important to understand the impact of nicotine on this critical phase of brain development. Animal studies have shown that nicotine has unique effects on adolescent brain. The goal of this review is therefore to systematically evaluate age- and sex-differences in the effects of nicotine on brain and behavior. Both acute and chronic effects of nicotine on brain biochemistry and behavior, particularly drug reward, aversion, cognition and emotion, are evaluated. Gaps in our current knowledge that need to be addressed are also highlighted. This review compares and integrates human and animals findings. Although there can be no experimental studies in humans to confirm similar behavioral effects of teen nicotine exposure, an emerging observational literature suggests similarities across species. Given the substantial evidence for long-term negative impact of adolescent nicotine exposure on brain and behavior, further longitudinal assessment of health outcomes in teen and young adult e-cigarette users is warranted.
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Affiliation(s)
- Frances M Leslie
- University of California, Irvine, Department of Pharmaceutical Sciences, 367 Med Surge II, Irvine, CA 92697, United States of America.
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