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Ollila H, Konttinen H, Ruokolainen O, Karvonen S. Are educational aspirations associated with susceptibility to smoking, e-cigarette use, and smokeless tobacco use in adolescence? Eur J Public Health 2024; 34:962-969. [PMID: 39111777 PMCID: PMC11430905 DOI: 10.1093/eurpub/ckae107] [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: 09/29/2024] Open
Abstract
The early socio-economic differences in smoking build on the interplay between individual-, family-, peer-, and school-related factors. The present study aimed to add knowledge to this by examining susceptibility to smoking (S-SM), electronic cigarette (e-cigarette) use (S-EC), and smokeless tobacco (snus) use (S-SN) by educational aspirations in a country with advanced tobacco control policies. National cross-sectional School Health Promotion study survey was conducted among 8.-9. grade students (av. 15-year-olds) in 2017 with no prior smoking (n = 47 589), e-cigarette use (n = 49 382), or snus use (n = 53 335). Gender-stratified, age-adjusted multilevel logistic regression analyses with S-SM, S-EC, and S-SN were considered as outcomes and student- and school-level (aggregated) factors were considered as independent variables. The highest prevalence was observed for S-EC (girls 29%, boys 35%), followed by S-SM (16%, 15%) and S-SN (10%, 16%). Compared to those planning for general upper secondary education, S-SM was the highest for those without educational aspirations (OR = 1.20, 95% CI = 1.04-1.40), S-EC for those planning for vocational education [1.15 (1.05-1.25)], and S-SN for those planning for extra year/discontinuation [1.65 (1.04-2.60)] among girls. Among boys, both S-SM [1.37 (1.23-1.52)] and S-EC [1.19 (1.09-1.29)] were the highest among those planning for vocational education, with no clear associations with S-SN. Current other tobacco/e-cigarette use [OR range 1.27-8.87], positive attitude towards product use in one's age group [3.55-6.63], and liking school [0.58-0.68] consistently associated with susceptibility. Students not planning for academically oriented education had higher susceptibility to different nicotine products. High S-EC warrants monitoring to strengthen policy evaluation and prevention.
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Affiliation(s)
- Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Hanna Konttinen
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sakari Karvonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Vittaporn S, Kanthajaem K, Coothongkul A, Pooseesod K. Effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang Province, Thailand. Tob Prev Cessat 2024; 10:TPC-10-40. [PMID: 39296972 PMCID: PMC11409427 DOI: 10.18332/tpc/192694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/05/2024] [Accepted: 08/28/2024] [Indexed: 09/21/2024]
Abstract
INTRODUCTION The use of e-cigarettes is increasing worldwide, especially among young adults. Due to the health risks, this study aimed to assess undergraduate students' e-cigarette use and attitudes toward them, and evaluate the effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang province, Thailand. METHODS Participatory action research (PAR) was conducted among 46 undergraduate students. To assess the situations of undergraduate students' e-cigarette use and attitudes toward them, in-depth interviews were conducted with 18 of those students - nine users and nine non-users. The remaining 28 were student leaders who were given questionnaires and took part in focus groups to evaluate the effectiveness of the intervention program in developing e-cigarette control leaders. Descriptive statistics and the Wilcoxon signed rank test were used to analyze quantitative data. The qualitative data were analyzed using a thematic analysis of the content. This study took place at the University in Lampang province, Thailand, in 2023. RESULTS Regarding the use of e-cigarettes on the part of undergraduate students and their attitudes about their use, the majority of users stated that e-cigarettes were accessible, appealing, and more socially acceptable than conventional cigarettes. However, most non-users cited vapor smell and health impacts as their main reason for not using e-cigarettes. The intervention program to develop leaders in e-cigarette control could significantly enhance the leaders' knowledge (p<0.001) and attitude regarding e-cigarettes (p=0.001). After their anti-e-cigarette campaign, the soft skills and managerial abilities of the leaders in e-cigarette control improved, and the knowledge and attitude regarding e-cigarettes of undergraduate students who attended the campaign also increased. CONCLUSIONS The intervention program to develop leaders in e-cigarette control resulted in positive outcomes. This program could enhance the leaders' knowledge and attitude regarding e-cigarettes. Their soft skills and managerial abilities in e-cigarette control also improved.
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Affiliation(s)
- Supa Vittaporn
- Faculty of Public Health, Thammasat University, Lampang, Thailand
- Thammasat University Research Unit in Environment, Health and Epidemiology, Thammasat University, Pathum Thani, Thailand
| | | | - Arpapon Coothongkul
- Health Promotion Unit, Thammasat University Hospital, Pathum Thani, Thailand
| | - Kasama Pooseesod
- Faculty of Public Health, Thammasat University, Lampang, Thailand
- Thammasat University Research Unit in One Health and Ecohealth, Thammasat University, Pathum Thani, Thailand
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Nyman J, Salanterä S, Pasanen M, Parisod H. Effectiveness of a Digital Health Game Intervention on Early Adolescent Smoking Refusal Self-Efficacy. HEALTH EDUCATION & BEHAVIOR 2024; 51:562-572. [PMID: 38497462 PMCID: PMC11193316 DOI: 10.1177/10901981241237788] [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] [Indexed: 03/19/2024]
Abstract
Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.
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Affiliation(s)
| | - Sanna Salanterä
- University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | | | - Heidi Parisod
- University of Turku, Turku, Finland
- Nursing Research Foundation sr, Helsinki, Finland
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Jones D, Morgan A, Moodie C, Alexandrou G, Ford A, Mitchell D. The Role of e-Cigarette Packaging as a Health Communications Tool: A Focus Group Study With Adolescents and Adults in England and Scotland. Nicotine Tob Res 2024:ntae107. [PMID: 38839060 DOI: 10.1093/ntr/ntae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION In the United Kingdom, e-cigarette and refill packaging must display a nicotine addiction warning. This study explored how this message is perceived, responses to alternative on-pack messages, and other options for using e-cigarette packaging to discourage youth and people who neither smoke nor use e-cigarettes while encouraging smokers to switch. AIMS AND METHODS Between August and September 2022, 16 focus groups (n = 70) were conducted to explore these topics with adolescents (n = 31, aged 11-17 years) and adults (n = 39, nonsmokers, smokers that use e-cigarettes, smokers that do not use e-cigarettes) in England and Scotland. RESULTS While several participants thought the current nicotine addiction warning could help increase awareness of nicotine addiction, most reported that it failed to capture attention and was not a deterrent. Alternative messages shown on packs (about harm, toxicity, wellness, litter, or relative risk) received mixed responses. Relative risk messages were perceived as most beneficial for smokers switching but also thought to potentially encourage uptake among nonsmokers. Some participants considered certain harm and toxicity messages to potentially dissuade uptake. Participants proposed several ideas to reduce the appeal of e-cigarette packaging and devices to deter youth uptake, including more prominent warnings, standardized packaging, and devices that are plain or include health messages. CONCLUSIONS Packaging can play a crucial role in communicating product and health messages to different consumer groups. Further consideration of how packaging and labeling can meet the needs of non-nicotine users while simultaneously reaching those who may benefit from using e-cigarettes to stop smoking is warranted. IMPLICATIONS While some viewed the nicotine addiction warning required on e-cigarettes and refill packaging in the United Kingdom as helpful in raising awareness of nicotine addiction, it did not resonate with most of our sample of adolescents and adults. The findings suggest that e-cigarette packaging could be better used to encourage smokers to switch to a less harmful alternative, with relative risk messages showing promise. Furthermore, strengthening on-pack messaging (eg increasing salience and rotating messages) and reducing the appeal of packaging (eg drab colors) and devices (eg including warnings) may help increase awareness of e-cigarette harms while deterring use among adolescents and nonsmokers.
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Affiliation(s)
- Daniel Jones
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Amber Morgan
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Georgia Alexandrou
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Allison Ford
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Ylitörmänen T, Tarasenko Y, Hiilamo H, Ruokolainen O, Puska P, Ollila H. Cross-sectional study of the associations between the implementation of the WHO FCTC tobacco advertising, promotion and sponsorship bans and current e-cigarette use among youth from countries with different income levels. Tob Control 2024:tc-2023-058160. [PMID: 38286590 DOI: 10.1136/tc-2023-058160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The WHO Framework Convention on Tobacco Control (WHO FCTC) Article 13 requires countries to ban tobacco advertising, promotion and sponsorship (TAPS), and bans are recommended to cover electronic cigarettes (e-cigarettes). We examined youth e-cigarette prevalence by TAPS regulations in countries with different income levels. METHODS We analysed data on 165 299 respondents from 48 countries with 2016/2018 WHO FCTC implementation reports and 2016-2019 Global Youth Tobacco Survey. We used multilevel logistic regressions to examine associations between TAPS regulations and current e-cigarette use, stratified by country income. RESULTS About 1 in 10 respondents was currently using e-cigarettes. Respondents in countries with TAPS bans on the internet were less likely to use e-cigarettes (adjOR=0.58; 95% CI 0.39 to 0.86) than youth in countries without such bans. In lower middle-income and low-income countries, bans on displaying tobacco products at the point of sale (adjOR=0.55; 95% CI 0.34 to 0.90), bans on product placement (adjOR=0.44; 95% CI 0.28 to 0.69) and strength of additional TAPS measures were associated with lower prevalence of e-cigarette use among students. Being taught about the dangers of the use of tobacco in school was associated with lower odds of e-cigarette use. No differences in the use of e-cigarettes were observed by types of TAPS among respondents in high-income countries. CONCLUSIONS Strengthening implementation of TAPS policies and assuring they cover new and emerging products, online channels and points of sales are essential, especially in lower income countries. Maintaining tobacco health education is also important to protect youth from e-cigarette use.
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Affiliation(s)
- Tuija Ylitörmänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Yelena Tarasenko
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Heikki Hiilamo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Puska
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Azagba S, Ebling T, Korkmaz A. Social media and e-cigarette use: The mediating role of mental health conditions. J Affect Disord 2024; 344:528-534. [PMID: 37852589 DOI: 10.1016/j.jad.2023.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In recent years, youth social media use, youth e-cigarette use, and youth mental health conditions have become major public health concerns. We examined the role of mental health condition indicators in the link between youth social media use and e-cigarette use. METHODS We used data from the 2022 National Youth Tobacco Survey (N = 23,445) to measure social media use by time spent, anxiety and depression symptoms by the Patient Health Questionnaire-4, and past-30-day e-cigarette use. We applied the potential outcomes framework to examine the relationship between social media use and e-cigarette use mediated by mental health condition indicators. RESULTS Mental health condition indicators mediated the relationship between social media use and e-cigarette use in a dose-response manner, with higher levels of social media use associated with higher odds of e-cigarette use. With mental health condition indicators as a mediator, those who used social media for 4+ hours/day or 3-4 h/day had significantly higher odds of e-cigarette use than those who used social media sometimes or never. In the sex-stratified analysis, we found that very often social media use was associated with higher odds of e-cigarette use for both males and females, compared to sometimes users (OR = 1.53, 95 % CI [1.18,1.96] for males; OR = 2.27, 95 % CI [1.76,2.92] for females). LIMITATIONS Anxiety and depression symptoms were self-reported. CONCLUSIONS This study shows that anxiety and depression symptoms mediate the relationship between social media and e-cigarette use among youth and support the growing concern that frequent social media use may negatively affect youth health.
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Affiliation(s)
- Sunday Azagba
- College of Nursing, The Pennsylvania State University, University Park, PA, United States of America.
| | - Todd Ebling
- College of Nursing, The Pennsylvania State University, University Park, PA, United States of America
| | - Alperen Korkmaz
- College of Nursing, The Pennsylvania State University, University Park, PA, United States of America
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Thoonen KAHJ, Jongenelis MI. Motivators of e-cigarette use among Australian adolescents, young adults, and adults. Soc Sci Med 2024; 340:116411. [PMID: 37989045 DOI: 10.1016/j.socscimed.2023.116411] [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: 03/27/2023] [Revised: 09/22/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE There is limited research examining motivators of e-cigarette use among never smokers, a group for whom vaping has no benefits and many harms. To inform programs and policies that aim to prevent initiation and encourage cessation of e-cigarette use, this study investigated reasons for intended use, initiation, and continued use of e-cigarettes among various age and user groups in Australia. METHODS An online survey was administered to 4617 respondents. Never users of e-cigarettes and never smokers who reported intending to try e-cigarettes (n = 348), current e-cigarette users and never smokers (n = 121), and current e-cigarette users and current smokers (n = 354) were of interest to this study. RESULTS Among never smokers, curiosity was the most commonly reported reason for intended use and use initiation, whereas the taste of e-cigarettes and their appealing flavours were the most frequently reported motivators of current e-cigarette use. Among smokers, taste and flavourings were the most commonly reported motivators of current use, not smoking cessation. Adolescents and young adults in most user groups were more likely than adults to report using e-cigarettes out of curiosity and because they taste good, whereas adults were more likely to use for smoking cessation purposes and because they perceived e-cigarettes to be more acceptable and cheaper than tobacco cigarettes. CONCLUSIONS Results suggest that (i) prohibiting flavourings and (ii) restricting advertising that highlights the pleasurable effects of e-cigarettes could constitute potential means of preventing e-cigarette initiation and encouraging cessation among never smokers, especially adolescents.
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Affiliation(s)
- Karlijn A H J Thoonen
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia.
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia.
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Pelters P, Galanti MR. "It's nice to just be": A qualitative study on the meaning-imbued reality of waterpipe smoking among young adults in Sweden. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:482-501. [PMID: 37969904 PMCID: PMC10634388 DOI: 10.1177/14550725231195183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/01/2023] [Indexed: 11/17/2023] Open
Abstract
Background and aims: Waterpipe smoking is regarded as a burgeoning public health problem due to its popularity among young adults. This study aims to understand the meaning-imbued reality of waterpipe smoking for young adults in Sweden. Method: Data from 18 individual interviews with ethnically diverse Swedish young adults were analysed using inductive latent-level qualitative content analysis. Results: The youth's experience of waterpipe smoking shows different dimensions (time, space, fun, community) that construct the practice of waterpipe smoking as a closed bubble characterised by harmlessness, cosiness and freedom to develop an adult self in the waterpipe group. The bubble provides a breathing space and timeout in everyday life, fuelled by an understanding of the hookah as hazard-free and liberating. A variety of control mechanisms are used to defend the bubble's constructed harmlessness, proving responsibility by applying practice-, communication- and Othering-oriented means. Conclusion: The study enhances the understanding of waterpipe smoking by highlighting its community- and self-forming meaning in a combined focus on ritualistic and symbolic qualities. For young adults, waterpipe smoking combines potentially beneficial and detrimental impacts on health. This complex situation requires a dialogical - rather than a traditional - approach to prevention that negotiates the risk landscape faced by young adults.
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Affiliation(s)
- Pelle Pelters
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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Smith MJ, Hilton S. Youth's exposure to and engagement with e-cigarette marketing on social media: a UK focus group study. BMJ Open 2023; 13:e071270. [PMID: 37612101 PMCID: PMC10450076 DOI: 10.1136/bmjopen-2022-071270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Electronic-cigarettes (e-cigarette) are promoted creatively through social media and considering the potential influence of social media marketing on young people, we explored young people's exposure to and engagement with social media marketing of e-cigarettes. DESIGN Semistructured discussion groups. SUBJECTS Twenty focus groups with 82 young people aged 11-16 living in the Central belt of Scotland. METHODS Youths were asked about smoking and vaping behaviours, social media use, vaping advertisement exposure and were shown illustrative examples of social media content (eg, images and videos) about different messages, presentations and contextual features. Transcripts were imported into NVivo V.12, coded thematically and analysed. RESULTS Youths highlighted a variety of tactics e-cigarette companies use, including influencer or celebrity endorsement, attractive youth flavours, bright colours and emotional appeal to advertise and promote their products directly to young people. Social media influencers who advertise e-cigarettes were described as portraying e-cigarettes as 'cool' and 'fashionable' to entice viewers to try the products. Youths considered that there is a need for more restrictions on social media content to protect youths while also still allowing smokers to purchase them as a cessation device. CONCLUSIONS Our study highlights that the e-cigarette industry is using previously employed tactics similar to the tobacco industry to advertise and promote its products on social media. These findings suggest the growing need for governments to work together to develop and implement policies to restrict the advertising and marketing of e-cigarettes on social media.
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Affiliation(s)
- Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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