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Ahuja NA, Kedia SK, Regmi S, Dillon PJ. Disparities in E-Cigarette Harm and Addiction Perceptions Among Adolescents in the United States: a Systematic Review of the Literature. J Racial Ethn Health Disparities 2024; 11:696-709. [PMID: 36877379 DOI: 10.1007/s40615-023-01553-1] [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: 11/16/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Health disparities associated with e-cigarette use are increasingly apparent among US adolescents. Perceptions of e-cigarette harm and addiction play an important role in understanding adolescents' e-cigarette use behavior. The objective of this systematic review is to examine racial/ethnic and socio-economic disparities in e-cigarette harm and addiction perceptions among US adolescents. METHODS We searched five databases to identify cross-sectional or longitudinal studies that focused on adolescents (≤ 18 years of age) who were ever, current, or never e-cigarettes users; we then examined how race/ethnicity and/or socio-economic status (SES) impacted e-cigarette harm and/or addiction perceptions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. RESULTS Adhering to PRISMA guidelines, eight of 226 identified studies met the inclusion criteria. These eight studies examined either perceptions regarding absolute e-cigarette harm and/or addiction (i.e., assessing perception of only e-cigarette) or relative e-cigarette harm and/or addiction (i.e., comparative perceptions to traditional cigarettes) by race and ethnicity. Two of the eight studies assessed absolute harm and/or addiction perceptions of e-cigarettes by SES. Our results indicate that, compared to all other racial/ethnic groups, relative e-cigarette harm and addiction perceptions were lower among Non-Hispanic White adolescents; however, absolute e-cigarette harm perception was higher among these groups. No clear patterns of racial/ethnic differences in absolute e-cigarette addiction perceptions and SES differences in absolute e-cigarette harm perceptions were reported. CONCLUSION More research is needed to explicitly assess perceptions of e-cigarette harm and addiction among US adolescents by race/ethnicity and SES to develop subgroup appropriate public health messaging.
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Affiliation(s)
- Nikhil A Ahuja
- Department of Public Health, College of Health Professions, Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Sanjaya Regmi
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Zvolensky MJ, Shepherd JM, Clausen BK, Redmond BY, Correa-Fernández V, Ditre JW. Combustible cigarette smokers versus e-cigarette dual users among Latinx individuals: Differences in alcohol and drug use severity. Exp Clin Psychopharmacol 2024; 32:197-206. [PMID: 37470998 PMCID: PMC10799193 DOI: 10.1037/pha0000673] [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: 07/21/2023]
Abstract
The Latinx population in the United States (U.S.) experiences significant tobacco and other substance use-related health disparities. Yet, little is known about the couse of combustible cigarettes and e-cigarettes (dual use) in relation to substance use behavior among Latinx smokers. The present investigation compared English-speaking Latinx adults living in the United States who exclusively smoke combustible cigarettes versus dual users in terms of alcohol use and other drug use problem severity. Participants were 297 Hispanic/Latinx daily cigarette smokers (36.4% female, Mage = 35.9 years, SD = 8.87) recruited nationally across the United States using Qualtrics Panels to complete self-report measures of behavioral health outcomes. Five analysis of covariance models were conducted to evaluate differences in overall alcohol consumption, dependence, related problems, hazardous drinking, and drug use problem severity between exclusive combustible cigarette smokers (N = 205) and dual users (N = 92). Results indicated that dual users evinced greater levels of alcohol consumption, dependence, alcohol-related problems, and hazardous drinking compared to exclusive combustible cigarette smokers (ps < .001). Dual users also reported greater levels of drug use problems relative to exclusive combustible cigarette smokers (p < .001). The current findings are among the first to document that dual cigarette and e-cigarette use status (compared to exclusive combustible cigarette smoking) may serve as a clinically relevant risk indicator for a range of deleterious substance use problems among Latinx individuals. Future research is needed to corroborate these findings and examine dual-use status as a longitudinal predictor of alcohol and other substance-related problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- HEALTH Institute, University of Houston
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Liu J, Tan ASL, Winickoff JP, Rees VW. Correlates of adolescent sole-, dual- and poly-use of cannabis, vaped nicotine, and combusted tobacco. Addict Behav 2023; 146:107804. [PMID: 37478525 PMCID: PMC10528055 DOI: 10.1016/j.addbeh.2023.107804] [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: 04/07/2023] [Revised: 07/01/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Compared to single substance use, adolescents' use of multiple substances is associated with more severe dependence, cessation outcomes, and health risks. This study examined correlates of use and co-use of e-cigarettes, combusted tobacco, and cannabis among high school-aged (9th-12th grade, approximately aged 14-18) adolescents. METHODS We analyzed the 2019 Massachusetts Youth Health Survey (MYHS) data to calculate the weighted means of any past 30-day sole-use of e-cigarettes, sole-use of combusted tobacco, sole-use of cannabis, dual-use of two of the above substances, and poly-use of all three substances. We then used weighted multinomial logistic regression to examine the associations between demographic, social and behavioral factors and sole-, dual-, and poly-use (vs. no use) of these substances. RESULTS Among N = 1614 respondents, any past 30-day dual-use of e-cigarettes and cannabis was the most prevalent (17.2%, SE: 1.3%). Sole-use of combusted tobacco was less than 1%, whereas 4.5% (SE: 0.7%) of respondents reported poly-use of e-cigarettes, cannabis, and combusted tobacco. Lower academic grades and self-reported depression (1 item on persistent feelings of sadness or hopelessness) were associated with increased odds of dual-use of e-cigarettes and cannabis and poly-use (vs. sole-use of any substance). Adolescents who self-reported having "any long-term emotional problems or learning disabilities" had greater odds of poly-use. CONCLUSION Different sets of correlates were associated with sole-, dual-, and poly-use, suggesting that certain adolescents may be more vulnerable than others to multiple substance use. Future research should examine potentially modifiable upstream influences, such as the home environment and socioeconomic factors that may affect the relationship between adolescent mental health, school performance, and multiple addictive substance use.
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Affiliation(s)
- Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Andy S L Tan
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, United States; University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, PA, United States
| | - Jonathan P Winickoff
- MassGeneral Hospital Division of General Academic Pediatrics, Boston, MA, United States; MGH Tobacco Research and Treatment Center, Boston, MA, United States; American Academy of Pediatrics Julius B. Richmond Center, Itasca, IL, United States
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Shafie Khorassani F, Brouwer AF, Hirschtick JL, Jeon J, Jimenez-Mendoza E, Meza R, Fleischer NL. Patterns of poly tobacco use among adults in the Population Assessment of Tobacco and Health (PATH) study, 2013-2017: a multistate Markov transition analysis. Tob Control 2023:tc-2022-057822. [PMID: 37094934 PMCID: PMC10593910 DOI: 10.1136/tc-2022-057822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND A better understanding of sociodemographic transition patterns between single, dual and poly tobacco product use may help improve tobacco control policy interventions. METHODS HRs of transition between never, non-current (no past 30-day use), cigarette, e-cigarette, other combustible, smokeless tobacco (SLT), dual and poly tobacco use states in adults were estimated for age, sex, race/ethnicity, education and income using a multistate model for waves 1-4 of the Population Assessment of Tobacco and Health study (2013-2017), a US-based cohort study, accounting for complex survey design. RESULTS Sole cigarette and SLT use were persistent, with 77% and 78% of adults continuing use after one wave. Other use states were more transient, with 29%-48% of adults reporting the same pattern after one wave. If single-product users transitioned, it was most likely to non-current use while dual or poly cigarette users were most likely to transition to exclusive cigarette use. Males were more likely than females to initiate combustible product use after a history of no use, and after a period of tobacco use cessation. Hispanic and non-Hispanic black participants initiated cigarette use at higher rates than non-Hispanic white participants, and had higher rates of experimentation with tobacco products between study waves. Lower socioeconomic status was associated with higher rates of transition into combustible tobacco use. CONCLUSIONS Dual and poly tobacco use is largely transient, while single-use patterns are more stable over time. Transitions differ by age, sex, race/ethnicity, education and income, which may influence the impact of current and future tobacco control efforts.
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Affiliation(s)
| | - Andrew F Brouwer
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jana L Hirschtick
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jihyoun Jeon
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Rafael Meza
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nancy L Fleischer
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Addo Ntim S, Martin B, Termeh-Zonoozi Y. Review of Use Prevalence, Susceptibility, Advertisement Exposure, and Access to Electronic Nicotine Delivery Systems among Minorities and Low-Income Populations in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13585. [PMID: 36294164 PMCID: PMC9603140 DOI: 10.3390/ijerph192013585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Increased use of electronic nicotine delivery systems (ENDS) and improper disposal after use pose a public health and an environmental justice (EJ) concern if use prevalence is disproportionately high among minorities and people of low socioeconomic status (SES) (broadly termed "EJ populations" for the purposes of this review). This review synthesizes literature on demographic patterns of use prevalence, susceptibility, advertisement exposure, and access to ENDS, and extrapolates environmental tobacco exposure (ETE) from ENDS among EJ populations. Seven electronic databases were searched using ENDS-related terms. We included studies published between 2017 and May 2020 that described ENDS use prevalence, susceptibility to ENDS use, advertisement exposure, and access to ENDS by race, ethnicity, or SES. Data synthesis was based on the assumptions that ETE increases with high use prevalence, susceptibility may influence future use, and advertisement exposure and access may impact demographic differences in use. We identified 32 studies describing use prevalence, susceptibility, advertisement exposure, or access to vape shops and other tobacco retail outlets by race/ethnicity or SES. We found higher prevalence of ENDS use among non-Hispanic Whites and inconclusive use patterns by SES. Patterns of susceptibility to use, advertisement exposure, and access were also mixed, with slightly higher outcomes observed among low SES youth. However, the evidence base on advertisement exposure was limited, with limited generalizability. Our findings indicate low prevalence of ENDS use among EJ populations. While this suggests low potential ETE among these groups, mixed outcomes on susceptibility, advertisement exposure, and access to ENDS among low SES groups may affect future ENDS use and ETE. Educational campaigns that discourage ENDS uptake should target EJ youth. Initiatives aimed at managing vape shop presence in EJ communities and monitoring targeted advertisement are also needed.
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Sutherland BD, Sutherland MT, Trucco EM. Electronic Cigarette Use Intentions Mediate the Association between Low Self-Control and Future Use by Internalizing Symptoms. Subst Use Misuse 2022; 57:1797-1807. [PMID: 36041007 PMCID: PMC9560985 DOI: 10.1080/10826084.2022.2115848] [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: 10/14/2022]
Abstract
Background: Adolescent electronic (e-)cigarette use intentions are related to initiation. Low self-control is also a risk factor for early stages of substance use. Yet, the impact of low self-control on use through intentions may vary across individuals; depression and anxiety may affect this association. Methods: A sample of 200 adolescents who completed waves 1 and 2 of an ongoing longitudinal study were assessed. We hypothesized that high internalizing symptoms would moderate the indirect effect of low self-control on actual e-cigarette use through e-cigarette use intentions. Results: The mediation pathway was significant at high levels of internalizing symptoms, but not at low or moderate levels. Conclusion: Specifically, those with low self-control and high internalizing symptomatology endorsed the highest e-cigarette use intentions and were more likely to subsequently use e-cigarettes. Youth low in self-control and high in depression and anxiety might be at increased risk to initiate e-cigarette use compared to youth high in self-control and high in internalizing symptomatology.
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Affiliation(s)
- Benjelene D. Sutherland
- Center for Children and Families, Florida International University, 11200 SW 8th Street, AHC-1 Rm. 140, Miami, FL, 33199 USA
| | - Matthew T. Sutherland
- Center for Children and Families, Florida International University, 11200 SW 8th Street, AHC-1 Rm. 140, Miami, FL, 33199 USA
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Elisa M. Trucco
- Center for Children and Families, Florida International University, 11200 SW 8th Street, AHC-1 Rm. 140, Miami, FL, 33199 USA
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
- Addiction Center, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
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Livingston JA, Chen CH, Kwon M, Park E. Physical and mental health outcomes associated with adolescent E-cigarette use. J Pediatr Nurs 2022; 64:1-17. [PMID: 35121206 DOI: 10.1016/j.pedn.2022.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Use of electronic cigarettes (e-cigarette) and other electronic nicotine delivery systems (ENDS) among adolescents has increased dramatically, creating a need for research to examine the consequences of e-cigarette use on adolescent health. Given the emergent state of the research literature, this integrative review sought to summarize what is currently known about the physical and mental health outcomes associated with e-cigarette use in an adolescent population, and to identify directions for future research. METHOD The methodology for this integrative review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A methodical search was conducted in February 2020 in PubMed, CINAHL, and Web of Science databases. To be eligible for inclusion, studies had to address e-cigarette use, have samples that were between 13 and 24 years of age, be published in a peer-reviewed journal, and examine health outcomes associated with e-cigarette use. After the screening process, 18 studies were included. RESULTS Physical health outcomes associated with e-cigarette use included oral health and respiratory problems as well as nicotine dependence. Mental health outcomes included depression and suicidal ideation. In studies that compared e-cigarette use to conventional cigarette use and non-use, e-cigarettes tended to be associated with more problems than non-use, but fewer problems than conventional cigarette use. Dual use, that is, use of both conventional cigarettes and e-cigarettes, was associated with the greatest harm. CONCLUSION Although somewhat less harmful than conventional cigarettes, e-cigarette use is related to a variety of negative physical and mental health outcomes among adolescent users.
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Affiliation(s)
- Jennifer A Livingston
- School of Nursing, University at Buffalo, State University of New York, United States of America.
| | - Chia-Hui Chen
- School of Nursing, University at Buffalo, State University of New York, United States of America
| | - Misol Kwon
- School of Nursing, University at Buffalo, State University of New York, United States of America
| | - Eunhee Park
- School of Nursing, University at Buffalo, State University of New York, United States of America
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Unger JB, Falcon A. E-cigarette use among Hispanics: Reducing risk or recruiting new tobacco users? Addict Behav 2022; 125:107149. [PMID: 34678711 DOI: 10.1016/j.addbeh.2021.107149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/25/2021] [Accepted: 10/09/2021] [Indexed: 12/15/2022]
Abstract
The prevalence of cigarette smoking in the United States has been declining for over 50 years among all racial/ethnic groups. However, this progress could be stalled or even reversed by the increasing popularity of electronic cigarettes (e-cigarettes). Hispanics have experienced tobacco-related health disparities resulting from early age of cigarette smoking initiation and less success in quitting smoking. The effects of e-cigarettes on tobacco-related health disparities among Hispanics have not been well described. The uptake of e-cigarettes among Hispanic youth could lead to a "tipping point" phenomenon, in which Hispanics disproportionately become nicotine-dependent in adolescence and suffer increased tobacco-related disease in adulthood. Hypothetically, if Hispanic adult cigarette smokers switch to e-cigarettes, they could reduce (but not completely eliminate) their health risks. This article summarizes the research on the use of e-cigarettes among Hispanics. We describe the prevalence and patterns of e-cigarette use among Hispanic adolescents and adults compared with non-Hispanic whites. Findings indicate that e-cigarette use is rare among Hispanic adults, but Hispanic adolescents are at risk of experimenting with e-cigarettes at early ages, potentially leading to early nicotine addiction and exacerbating tobacco-related disparities in the future. Health education and policy interventions are needed to prevent e-cigarette use among Hispanic adolescents, while acknowledging that some Hispanic adult cigarette smokers may benefit from switching to e-cigarettes.
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Affiliation(s)
- Jennifer B Unger
- University of Southern California Keck School of Medicine, United States.
| | - Adolph Falcon
- National Alliance for Hispanic Health, United States
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Dai H, Ramos AK, Faseru B, Hill JL, Sussman SY. Racial Disparities of E-Cigarette Use Among US Youths: 2014‒2019. Am J Public Health 2021; 111:2050-2058. [PMID: 34554815 PMCID: PMC8630507 DOI: 10.2105/ajph.2021.306448] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
Objectives To evaluate disparities in youth e-cigarette use patterns and flavor use by race/ethnicity over time. Methods We used data from the US 2014-2019 National Youth Tobacco Survey (NYTS) to examine trends in dual use (co-use of e-cigarettes and cigarettes or other tobacco products), occasional (≤ 5 days) versus frequent use (≥ 20 days) in the past 30 days, and flavor use among current (past-30-day) e-cigarette users (n = 13 178) across racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics/Latinos, and non-Hispanic others). Results Among current e-cigarette users, dual use and occasional use decreased significantly from 2014 to 2019 across racial and ethnic groups except for non-Hispanic Blacks; frequent use and flavored e-cigarette use increased among non-Hispanic Whites, Hispanics/Latinos, and non-Hispanic others but not among non-Hispanic Blacks. In 2019, non-Hispanic Black e-cigarette users were more likely to report dual use (adjusted odds ratio [AOR] = 2.2; 95% confidence interval [CI] = 1.5, 3.2; P < .001) and occasional use of e-cigarettes (AOR = 3.7; 95% CI = 2.3, 5.9; P < .001) but less likely to report frequent use (AOR = 0.2; 95% CI = 0.1, 0.4; P < .001) and flavored e-cigarette use (AOR = 0.4; 95% CI = 0.3, 0.5; P < .001) than their White peers. Conclusions Youth e-cigarette use patterns differed considerably across racial/ethnic groups, and tailored strategies to address disparities in e-cigarette use are needed. (Am J Public Health. 2021;111(11):2050-2058. https://doi.org/10.2105/AJPH.2021.306448).
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Affiliation(s)
- Hongying Dai
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Athena K Ramos
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Babalola Faseru
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Jennie L Hill
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Steven Y Sussman
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
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Hedman L, Galanti MR, Ryk L, Gilljam H, Adermark L. Electronic cigarette use and smoking cessation in cohort studies and randomized trials: A systematic review and meta-analysis. Tob Prev Cessat 2021; 7:62. [PMID: 34712864 PMCID: PMC8508281 DOI: 10.18332/tpc/142320] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The aim of this systematic review and meta-analysis was to assess the association between e-cigarette use and subsequent smoking cessation in cohort studies and randomized controlled trials (RCT). METHODS A systematic literature search was finalized 11 November 2019 using EMBASE, Cochrane Library, Scopus, PubMed Health, NICE evidence search, PROSPERO, CRD, PsycInfo, and PubMed including Medline. Inclusion criteria were: reporting empirical results; longitudinal observational design with a minimum of 3 months of follow-up; including general population samples; and allowing for comparison between users and non-users of e-cigarettes. Studies rated as having high risk of bias were excluded. The procedures described by PRISMA were followed, and the quality of evidence was rated using GRADE. RESULTS Twenty-eight longitudinal, peer-reviewed publications from 26 cohort studies, and eight publications from seven RCTs assessing the association between e-cigarette use and smoking cessation were included in this review. A random-effects meta-analysis based on 39147 participants in cohort studies showed a pooled unadjusted odds ratio (OR) for smoking cessation among baseline e-cigarette users compared with baseline non-users of 0.97 (95% CI: 0.67-1.40), while the adjusted OR was 0.90 (95% CI: 0.63-1.27). The pooled odds ratio for smoking cessation in RCTs was 1.78 (95% CI: 1.41-2.25). The evidence for cohort studies was graded as very low and for RCTs as low. CONCLUSIONS We did not find quality evidence for an association between e-cigarette use and smoking cessation. Although RCTs tended to support a more positive association between e-cigarette use and smoking cessation than the cohort studies, the grading of evidence was consistently low.
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Affiliation(s)
- Linnea Hedman
- Department of Public Health and Clinical Medicine, Division Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
- Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Maria R. Galanti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre of Epidemiology and Community Medicine, Stockholm, Sweden
| | - Lotta Ryk
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Hans Gilljam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Louise Adermark
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Adermark L, Galanti MR, Ryk C, Gilljam H, Hedman L. Prospective association between use of electronic cigarettes and use of conventional cigarettes: a systematic review and meta-analysis. ERJ Open Res 2021; 7:00976-2020. [PMID: 34262971 PMCID: PMC8273394 DOI: 10.1183/23120541.00976-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this systematic review and meta-analysis was to assess the association between e-cigarette use and subsequent initiation or recurrence of cigarette smoking. Data sources A systematic literature search was finalised on 11 November 2019 using PubMed (including MEDLINE), EMBASE, Cochrane Library, Scopus, PubMed Health, NICE Evidence Search, PROSPERO, CRD and PsycInfo. Study selection Studies were included if meeting the following criteria: reporting empirical results; longitudinal observational design with a minimum of 3 months of follow-up; including general population samples; allowing for the comparison between users and nonusers of e-cigarettes. Studies rated as having high risk of bias were excluded. Studies were independently assessed by at least two authors. The procedures described by PRISMA were followed, and the quality of evidence was rated using GRADE. Data synthesis 30 longitudinal studies from 22 different cohorts assessing e-cigarette use among nonsmokers or never-smokers at baseline, and subsequent use of cigarette smoking at follow-up, were included in this review. A random-effects meta-analysis based on 89 076 participants showed a pooled unadjusted odds ratio (OR) of cigarette smoking among baseline nonsmoker e-cigarette users compared with nonusers of 4.68 (CI 3.64–6.02), while the adjusted OR was 3.37 (CI 2.68–4.24). These results were consistent irrespective of whether the outcome was measured as ever-smoking or as past 30-day smoking. The evidence was graded as moderate. Conclusions Use of e-cigarettes may predict the initiation or recurrence of cigarette smoking. This meta-analysis shows that e-cigarette use increases the risk of future initiation or recurrence of cigarette smoking, even after adjusting for potential confounders, suggesting that e-cigarette use could be considered a predictor of subsequent smokinghttps://bit.ly/3buMccm
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Affiliation(s)
- Louise Adermark
- Dept of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Dept of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Rosaria Galanti
- Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre of Epidemiology and Community Medicine, Stockholm, Sweden
| | - Charlotta Ryk
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Hans Gilljam
- Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Hedman
- Dept of Public Health and Clinical Medicine, Division Sustainable health, The OLIN Unit, Umeå University, Umeå, Sweden.,Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
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12
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Seo YS, Chang YP. Racial and Ethnic Differences in E-Cigarette and Cigarette Use Among Adolescents. J Immigr Minor Health 2021; 24:713-720. [PMID: 34106360 DOI: 10.1007/s10903-021-01229-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/01/2022]
Abstract
This study examined whether e-cigarette/cigarette use status would differ by student race/ethnicity. Using the 2017 Youth risk behavior survey (YRBS), weighted Chi-square tests with Rao-Scott adjustments and adjusted weighted multinomial logistic regression analysis were conducted to examine the relationship. Weighted Chi-square tests showed that American Indian/Alaska Native (AI/AN) students had the highest prevalence rates among dual users (16.2%) and e-cigarette only users (11.3%), while White peers had the highest prevalence rates among cigarette only users (3.5%). The results of weighted multinomial logistic regression indicated that AI/AN students had higher odds than White peers of being dual users (Relative risk ratio (RRR), 2.10, 95% CI, 1.01, 4.39), while Black, Hispanic, Asian and multi-racial groups had lower odds than White peers of being dual users. Additionally, Asian students had lower odds than White students of being e-cigarette only users, whereas Black and Asian students had lower odds than their White peers of being cigarette only users. Given that AI/AN students are most vulnerable to e-cigarette/cigarette use, there should be comprehensive tobacco prevention and intervention approaches that could narrow racial/ethnic differences among both youths and adults at population level.
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Affiliation(s)
- Young S Seo
- Health Behavior Department, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Yu-Ping Chang
- School of Nursing, The State University of New York at Buffalo, 3435 Main Street Wende Hall 101C, Buffalo, NY, 14214, USA
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13
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Baenziger ON, Ford L, Yazidjoglou A, Joshy G, Banks E. E-cigarette use and combustible tobacco cigarette smoking uptake among non-smokers, including relapse in former smokers: umbrella review, systematic review and meta-analysis. BMJ Open 2021; 11:e045603. [PMID: 33785493 PMCID: PMC8011717 DOI: 10.1136/bmjopen-2020-045603] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/01/2021] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To review and summarise the current evidence on the uptake of combustible cigarette smoking following e-cigarette use in non-smokers-including never-smokers, people not currently smoking and past smokers-through an umbrella review, systematic review and meta-analysis. DESIGN Umbrella review, systematic review and meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science, PsychINFO (Ovid), Medline (Ovid) and Wiley Cochrane Library up to April 2020. RESULTS Of 6225 results, 25 studies of non-smokers-never, not current and former smokers-with a baseline measure of e-cigarette use and an outcome measure of combustible smoking uptake were included. All 25 studies found increased risk of smoking uptake with e-cigarette exposure, although magnitude varied substantially. Using a random-effects model, comparing e-cigarette users versus non-e-cigarette users, among never-smokers at baseline the OR for smoking initiation was 3.25 (95% CI 2.61 to 4.05, I2 85.7%) and among non-smokers at baseline the OR for current smoking was 2.87 (95% CI 1.97 to 4.19, I2 90.1%). Among former smokers, smoking relapse was higher in e-cigarette users versus non-users (OR=2.40, 95% CI 1.50 to 3.83, I2 12.3%). CONCLUSIONS Across multiple settings, non-smokers who use e-cigarettes are consistently more likely than those avoiding e-cigarettes to initiate combustible cigarette smoking and become current smokers. The magnitude of this risk varied, with an average of around three times the odds. Former smokers using e-cigarettes have over twice the odds of relapse as non-e-cigarettes users. This study is the first to our knowledge to review and pool data on the latter topic. PROSPERO REGISTRATION NUMBER CRD42020168596.
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Affiliation(s)
- Olivia Nina Baenziger
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Laura Ford
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Amelia Yazidjoglou
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Grace Joshy
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Emily Banks
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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14
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Lanza HI, Barrington-Trimis JL, McConnell R, Cho J, Braymiller JL, Krueger EA, Leventhal AM. Trajectories of Nicotine and Cannabis Vaping and Polyuse From Adolescence to Young Adulthood. JAMA Netw Open 2020; 3:e2019181. [PMID: 33021651 PMCID: PMC7539114 DOI: 10.1001/jamanetworkopen.2020.19181] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Little is known about cannabis vaping trajectories across adolescence and young adulthood or the co-occurrence with nicotine vaping. OBJECTIVE To evaluate nicotine vaping and cannabis vaping trajectories from late adolescence to young adulthood (≥18 years of age) and the extent of polysubstance vaping. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study, 5 surveys (including information on substance vaped) were completed at 10 high schools in the Los Angeles, California, metro area. Students were surveyed at 6-month intervals from fall of 11th grade (October to December 2015; wave 5) through spring of 12th grade (March to June 2017; wave 8) and again approximately 1 to 2 years after high school (October 2018 to October 2019; wave 9). EXPOSURES Past 30-day nicotine and cannabis vaping frequency across 5 waves. MAIN OUTCOMES AND MEASURES Self-reported frequency of nicotine vaping and cannabis vaping within the past 30 days across 5 time points from late adolescence to young adulthood. Trajectories were measured with these past 30-day use frequencies at each wave. Parallel growth mixture modeling estimated conditional probabilities of polysubstance vaping. RESULTS The analytic sample included 3322 participants with at least 1 time point of data (mean [SD] age, 16.50 [0.42] years at baseline; 1777 [53.5%] female; 1573 [47.4%] Hispanic or Latino). Growth mixture modeling identified the 5-trajectory model as optimal for both nicotine vaping and cannabis vaping. Trajectories for nicotine and cannabis vaping were similar (nonusers: 2246 [67.6%] nicotine, 2157 [64.9%] cannabis; infrequent users: 566 [17.0%] nicotine, 608 [18.3%] cannabis; moderate users: 167 [5.0%] nicotine, 233 [7.0%] cannabis; young adult-onset frequent users: 213 [6.4%] nicotine, 190 [5.7%] cannabis; adolescent-onset escalating frequent users: 131 [3.9%] nicotine, 134 [4.0%] cannabis). Males had greater odds of belonging to the adolescent-onset escalating frequent users nicotine (adjusted odds ratio, 2.88; 95% CI, 1.58-5.23; P < .01) and cannabis (adjusted odds ratio, 1.95; 95% CI,1.03-3.66; P < .05) vaping trajectories compared with nonusers. Polysubstance vaping was common, with those in trajectories reflecting more frequent nicotine vaping (adolescent-onset escalating frequent users and young adult-onset frequent users) having a high probability of membership (85% and 93%, respectively) in a cannabis-use trajectory. CONCLUSIONS AND RELEVANCE In this cohort study, the prevalence and type of nicotine vaping and cannabis vaping developmental trajectories from late adolescence to young adulthood were similar. Polysubstance vaping was common from late adolescence to young adulthood, particularly among those reporting more frequent vaping use. The findings suggest that public health policy and clinical interventions should address polysubstance vaping in both adolescence and young adulthood.
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Affiliation(s)
- H. Isabella Lanza
- Department of Human Development, California State University, Long Beach
| | | | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Junhan Cho
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | | | - Evan A. Krueger
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles
- Department of Psychology, University of Southern California, Los Angeles
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles
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Stokes AC, Wilson AE, Lundberg DJ, Xie W, Berry KM, Fetterman JL, Harlow AF, Cozier YC, Barrington-Trimis JL, Sterling KL, Benjamin EJ, Blaha MJ, Hamburg NM, Bhatnagar A, Robertson RM. Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use With Subsequent Initiation of Cigarettes in US Youths. Nicotine Tob Res 2020; 23:900-908. [PMID: 32948872 PMCID: PMC8150136 DOI: 10.1093/ntr/ntaa170] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
Introduction Understanding which non-cigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco-related health disparities. Methods We used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1–4. The sample was a dynamic cohort of cigarette-naïve youth aged 12–17 years. Mixed-effects models were used to assess non-cigarette product (e-cigarette, cigar product, or other product) use with cigarette use over 1-year intervals. Results Of the 28 788 observations pooled across waves 1–4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow-up were higher among youth with prior use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.21–3.45), cigars (OR, 2.00; 95% CI, 1.42–2.80), or other products (OR, 1.66; 95% CI, 1.28–2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth. Conclusions Prior use of e-cigarettes, cigars, and other non-cigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use). Implications Our findings suggest that previous studies on effects of non-cigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.
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Affiliation(s)
- Andrew C Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Anna E Wilson
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Dielle J Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Wubin Xie
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Kaitlyn M Berry
- Department of Epidemiology, University of Minnesota, Minneapolis, MN
| | - Jessica L Fetterman
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Alyssa F Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | | | - Kymberle L Sterling
- School of Public Health, University of Texas Health Sciences Center, Dallas, TX
| | - Emelia J Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Michael J Blaha
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Naomi M Hamburg
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Medicine, University of Louisville, Louisville, KY
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Assari S, Boyce S, Caldwell CH, Bazargan M. Parent Education and Future Transition to Cigarette Smoking: Latinos' Diminished Returns. Front Pediatr 2020; 8:457. [PMID: 32974240 PMCID: PMC7466764 DOI: 10.3389/fped.2020.00457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background: High parent education is protective against youth health risk behaviors such as tobacco use. According to the Minorities' Diminished Returns theory, however, higher parent education seems to exert less protection for the ethnic minority relative to the majority groups. Objectives: To explore ethnic differences in the effects of parent education on the transition to cigarette smoking in a national sample of American never-smoker adolescents. Methods: This longitudinal study used data of waves 1 and 4 of the Population Assessment of Tobacco and Health (PATH 2013-2018). This analysis included 5,021 American youth who were never smokers at baseline (2013) and were followed for 4 years. Transition to cigarette smoking was the dependent variable. Parent education was the independent variable. Youth age, youth gender, and family structure were the covariates. Ethnicity was the moderating variable. Results: From the 5,021 American youth who were never smokers at baseline (2013), 89.4% continued as never smokers, and 10.6% became ever-smokers. Overall, 4.0% were current smokers at wave 4. Overall, a higher parent education was associated with lower odds of transitioning to ever and current cigarette smoker at the end of the 4th year. Parent education, however, showed significant interaction with Latino ethnicity on both outcomes suggesting smaller protective effects of high parent education against transitioning to tobacco use for Latino than for non-Latino youth. Conclusions: In the U.S., ethnicity alters the magnitude of the protective effect of parent education against youth transition to tobacco use. While high parent education is protective against transitioning to become a cigarette smoking overall, non-Latinos (a socially privileged group) gain more and Latino youth (a socially marginalized group) gain least from such a resource. In addition to addressing the SES gap, policymakers should identify and address mechanisms by which ethnic minority youth remain at risk of tobacco use, even when they are from highly educated families.
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Affiliation(s)
- Shervin Assari
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Shanika Boyce
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Cleopatra H. Caldwell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Mohsen Bazargan
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Assari S, Mistry R, Bazargan M. Race, Educational Attainment, and E-Cigarette Use. JOURNAL OF MEDICAL RESEARCH AND INNOVATION 2019; 4:10.32892/jmri.185. [PMID: 32090188 PMCID: PMC7034862 DOI: 10.32892/jmri.185] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although higher educational attainment lowers high-risk behaviors such as substance use, according to the Minorities' Diminished Returns theory, the effect of educational attainment may be smaller for Blacks than Whites. AIMS To explore the racial differences in the link between educational attainment and electronic cigarettes (e-cigarettes). METHODS We used the Health Information National Trends Survey (HINTS) data. This national survey was conducted in 2017 and included 2,277 American adults composed of 1,868 White and 409 Black individuals. Educational attainment was the independent variable. E-cigarette use (lifetime) was the dependent variables. Age and gender were the covariates. Race was the effect modifier. RESULTS In the overall sample, a higher level of education attainment was linked to lower odds of e-cigarette use (OR = 0.76, 95% CI =0.61-0.95). Race showed a significant interaction with educational attainment on the outcome (OR = 1.63, 95% CI =1.04-2.56), suggesting a weaker negative association between high educational attainment and e-cigarette use for Blacks than Whites. In race-stratified logistic regression models, high educational attainment was inversely associated with risk of e-cigarette use for Whites but not Blacks. CONCLUSIONS Educational attainment shows a stronger effect on e-cigarette use in White than Black Americans.
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Affiliation(s)
- Shervin Assari
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, 118th St, Los Angeles, CA, 90059, United States
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA
| | - Mohsen Bazargan
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, 118th St, Los Angeles, CA, 90059, United States
- Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
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