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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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Subasinghe SKJ, Hettiarachchi PVKS, Jayasinghe RD. Prevalence, Habit Pattern, and Awareness on Harmful Effects of Tobacco/Areca Nut Use among Patients Visiting a Tertiary Care Center in Sri Lanka. South Asian J Cancer 2023. [DOI: 10.1055/s-0043-1761442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Background The carcinogenicity of tobacco and areca nut is well established worldwide. Areca nut is the fourth most common psychoactive substance identified recently. The effects of areca nut on the autonomic nervous system make the users dependent on the habit which has been an emerging health issue among Sri Lankan adults and adolescents. This study aimed to evaluate the prevalence and patterns of these risk habits among the patients attending a tertiary care center in Sri Lanka, and their awareness of the harmful effects of the habit.
Method A hospital-based cross-sectional study was conducted among 512 patients using an interviewer-administered questionnaire.
Results The sample consisted of 167 (33%) tobacco consumers. The average age of the initiation of tobacco consumption was 23.66 years (standard deviation ± 8.04). Age (p = 0.001), gender (p = 0.001), income (p = 0.005), and educational level (p = 0.001) are significantly associated with tobacco consumption. There is a strong likelihood for tobacco consumers to consume areca nut (odds ratio [OR] 30.58, 95% confidence interval [CI] 17.05–54.88) and alcohol (OR 11.16, 95% CI 6.91–17.98) at any stage in their lives. The majority of the tobacco consumers (61%) were smokeless tobacco users. Areca nut consumers are 0.44 times more likely to know its carcinogenic effects than nonconsumers (95% CI 0.28–0.69). Tobacco consumers are more likely to be aware of the harmful effects of tobacco consumption than nonconsumers (OR 1.11, 95% CI 0.45–2.74). Sixty percent have made at least one attempt to quit the habit. Sixty-two percent of the unsuccessful quitters reported the reason as “addiction.”
Conclusion Prevalence of smokeless tobacco consumption prevails at a high level among Sri Lankans. Tobacco and areca nut users are more likely to be aware of its harmful effects than the nonconsumers but unable to quit the habit due to the psychoactive properties of tobacco and areca nut.
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Affiliation(s)
| | | | - Ruwan Duminda Jayasinghe
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Center for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Shafie-Khorassani F, Piper ME, Jorenby DE, Baker TB, Benowitz NL, Hayes-Birchler T, Meza R, Brouwer AF. Associations of Demographics, Dependence, and Biomarkers With Transitions in Tobacco Product Use in a Cohort of Cigarette Users and Dual Users of Cigarettes and E-cigarettes. Nicotine Tob Res 2023; 25:462-469. [PMID: 36037523 PMCID: PMC9910158 DOI: 10.1093/ntr/ntac207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/09/2022] [Accepted: 08/24/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION It is uncertain whether e-cigarettes facilitate smoking cessation in the real world. We aimed to understand whether and how transitions among cigarette, e-cigarette, and dual use are associated with sociodemographics, dependence measures, and biomarkers. AIMS AND METHODS We followed 380 adult daily cigarette users and dual users every 2 months for up to 2 years. We estimated transition rates between noncurrent, cigarette-only, e-cigarette-only, and dual use states using a multistate transition model. We estimated univariable hazard ratios (HR) for demographics, dependence measures for cigarettes and e-cigarettes, biomarkers, spousal or partner behaviors, and other measures. RESULTS We estimated that participants transitioned from cigarette-only to e-cigarette-only through a period of dual use. Dual users ceased smoking (transitioning to e-cigarette-only use) at a greater rate than cigarette-only users did (HR 2.44, 95% CI: 1.49, 4.02). However, of the 60% of dual users estimated to transition to single product use in 1 year, 83% would transition to cigarette-only use and only 17% to e-cigarette-only use. E-cigarette dependence measures were generally associated with reduced e-cigarette cessation rather than enhanced cigarette cessation. E-cigarette users motivated by harm or toxicity reduction or because of restrictions on where or when they could smoke had reduced rates of smoking relapse. Cigarette dependence and spousal smoking were barriers to cigarette cessation for dual users, while using e-cigarettes first in the morning, motivation to quit smoking, and sensory, social, and emotional enjoyment of e-cigarettes (secondary dependence motives) were facilitators of smoking cessation among dual users. CONCLUSIONS Tobacco control policy and interventions may be informed by the barriers and facilitators of product transitions. IMPLICATIONS Although e-cigarettes have the potential to promote smoking cessation, their real-world impact is uncertain. In this cohort, dual users were more likely to quit smoking than cigarette-only users, but the overall impact was small because most dual users returned to cigarette-only use. Moreover, e-cigarette dependence promoted continued dual use rather than smoking cessation. Yet, high motivation to quit smoking and the sensory, social, and emotional enjoyment of e-cigarettes facilitated smoking cessation in dual users. Better understanding the barriers and facilitators of transitions can help to develop regulations and interventions that lead to more effective use of e-cigarettes for smoking cessation.
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Affiliation(s)
| | - Megan E Piper
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Timothy B Baker
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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The Impact of Menthol Cigarette Flavor in the U.S.: Cigarette and ENDS Transitions by Sociodemographic Group. Am J Prev Med 2022; 62:243-251. [PMID: 34740512 PMCID: PMC8748271 DOI: 10.1016/j.amepre.2021.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A better understanding of how menthol cigarette flavoring and ENDS impact smoking initiation, cessation, and transitions between tobacco products could help elucidate the potential impact of a U.S. menthol ban on combustible tobacco products. METHODS A multistate transition model was applied to data on 23,232 adults from Waves 1-4 (2013-2017) of the Population Assessment of Tobacco and Health Study (analysis was conducted in 2020-2021). Transition rates among never, noncurrent, nonmenthol versus menthol cigarette, ENDS, and dual everyday/someday use were estimated, as were transition-specific hazard ratios for age, sex, race/ethnicity, education, and income. RESULTS Non-Hispanic Blacks who smoked menthol discontinued smoking at a much lower rate than those who smoked nonmenthol (hazard ratio=0.43, 95% CI=0.29, 0.64), but there was no statistically significant difference in the discontinuation rates among non-Hispanic Whites (hazard ratio=0.97, 95% CI=0.80, 1.16) or Hispanics (hazard ratio=0.81, 95% CI=0.56, 1.16). Non-Hispanic Whites who smoked menthol were more likely to become dual users than those who smoked nonmenthol (hazard ratio=1.43, 95% CI=1.14, 1.80). Young adults initiated menthol smoking at a higher rate than older adults (age 18-24 years versus ≥55 years: hazard ratio=2.45, 95% CI=1.44, 4.15) but not nonmenthol smoking (hazard ratio=1.02, 95% CI=0.62, 1.69). There were differences by sex in the impact of menthol flavor on smoking initiation and discontinuation but little difference by education or income. CONCLUSIONS Sociodemographic differences in product transitions should be accounted for when estimating the potential impact of a menthol ban.
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Little MA, Wang XQ, Fahey MC, Wiseman KP, Pebley K, Klesges RC, Talcott GW. Efficacy of a group-based brief tobacco intervention among young adults aged 18-20 years in the US Air Force. Tob Induc Dis 2021; 19:95. [PMID: 34963775 PMCID: PMC8653010 DOI: 10.18332/tid/143282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Most smokers begin using tobacco before the age of 25 years, making it important to reduce tobacco use during adolescence and early adulthood. Rates of use are historically higher among military personnel. While 'Tobacco 21' made it illegal for US retailers to sell tobacco to those aged <21 years, the policy did not address cessation for current youth and young adult tobacco users. Additionally, there is limited research on cessation interventions among young adults under 21 years. The current study evaluated the efficacy of a group-based Brief Tobacco Intervention (BTI) among US Air Force trainees, who are predominantly aged 18-20 years and directly impacted by Tobacco 21 legislation. METHODS Participants were 2969 US Air Force Trainees from April 2017 through January 2018 cluster randomized to three conditions: 1) BTI + Airman's Guide to Remaining Tobacco Free (AG), 2) AG alone, and 3) the National Cancer Institute's Clearing the Air (CTA) pamphlet. To assess the efficacy of the interventions among people aged 18-20 years, a domain analysis (<21 years, n=2117; and ≥21 years, n=852) of a multinomial logistic regression model was run. RESULTS Mono tobacco users aged <21 years at baseline who received the BTI+AG had higher odds of quitting tobacco at 3 months (OR=2.13; 95% CI: 1.02-4.46). Dual and poly users aged <21 years at baseline who received the BTI+AG intervention had higher odds of reducing the number of tobacco products used at 3 months (OR=2.94; 95% CI: 1.03-8.37). CONCLUSIONS The BTI was effective for people aged 18-20 years. The current study offers insight into components of interventions that might be successful in helping this age group decrease tobacco use.
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Affiliation(s)
- Melissa A. Little
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Xin-Qun Wang
- School of Medicine, University of Virginia, Charlottesville, United States
| | - Margaret C. Fahey
- Department of Psychology, University of Memphis, Memphis, United States
| | - Kara P. Wiseman
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Kinsey Pebley
- Department of Psychology, University of Memphis, Memphis, United States
| | - Robert C. Klesges
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Gerald W. Talcott
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Lackland, United States
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Brouwer AF, Jeon J, Hirschtick JL, Jimenez-Mendoza E, Mistry R, Bondarenko IV, Land SR, Holford TR, Levy DT, Taylor JM, Fleischer NL, Meza R. Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1-4): multistate transition modelling accounting for complex survey design. Tob Control 2020; 31:tobaccocontrol-2020-055967. [PMID: 33199541 PMCID: PMC8124082 DOI: 10.1136/tobaccocontrol-2020-055967] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Even prior to 2018, electronic nicotine delivery systems (ENDS) began to dramatically change the landscape of tobacco products and product use patterns in the USA. METHODS Using a Markov multistate transition model accounting for complex survey design, transition rates between never, non-current, cigarette, ENDS and dual use states were estimated for 23 253 adult participants in waves 1-4 (approximately 2013-2017) of the Population Assessment of Tobacco and Health study. We made short-term transition projections and estimated HRs for age, sex, race/ethnicity, education and income. RESULTS Cigarette use was persistent among adults, with 89.7% (95% CI 89.1% to 90.3%) of exclusive cigarette users and 86.1% (95% CI 84.4% to 87.9%) of dual users remaining cigarette users (either exclusive or dual) after one wave. In contrast, ENDS use was less persistent, with 72.1% (95% CI 69.6% to 74.6%) of exclusive ENDS users and 50.5% (95% CI 47.8% to 53.3%) of dual users remaining ENDS users (with or without cigarettes) after one wave. Exclusive ENDS users were more likely to start cigarette use after one wave than either never users (HR 25.2; 95% CI 20.9 to 30.5) or non-current users (HR 5.0; 95% CI 4.3 to 5.8). Dual users of ENDS and cigarettes were more likely to stop using cigarettes than exclusive cigarette users (HR 1.9; 95% CI 1.6 to 2.3). Transition rates varied among sociodemographic groups. CONCLUSIONS Multistate transition models are an effective tool for uncovering and characterising longitudinal patterns and determinants of tobacco use from complex survey data. ENDS use among US adults was less persistent than cigarette use prior to 2018.
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Affiliation(s)
- Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Jana L. Hirschtick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Irina V. Bondarenko
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Stephanie R. Land
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
| | | | - David T. Levy
- Department of Oncology, Georgetown University, Washington, DC, United States
| | - Jeremy M.G. Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Nancy L. Fleischer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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Niaura R, Rich I, Johnson AL, Villanti AC, Romberg AR, Hair EC, Vallone DM, Abrams DB. Young Adult Tobacco and E-cigarette Use Transitions: Examining Stability Using Multistate Modeling. Nicotine Tob Res 2020; 22:647-654. [PMID: 30820566 DOI: 10.1093/ntr/ntz030] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/22/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The objective of this study was to describe tobacco and nicotine product use state transition probabilities among youth and young adults over time. METHODS A national sample of young adult tobacco product users and nonusers between the ages of 18 and 34 years at baseline was surveyed at 6-month intervals for 3 years. Use and nonuse states were defined as mutually exclusive categories based on self-reported, past 30-day use of the various products. Never use, noncurrent use, and current use of combustible, noncombustible tobacco, and electronic cigarette (e-cigarette) products was assessed at each interval. A multistate model was fit to estimate transition probabilities between states and length of stay within each state. RESULTS After 6 months, same-state transition probabilities were high for all use states (0.76-0.96), except for dual product use (0.48). After 3 years, transition probabilities were smaller and tended to converge toward combustible product use for baseline e-cigarette (0.42), combustible (0.51), and dual product users (0.52). Age was inversely associated with transition risk from never or noncurrent use to use of combustible or e-cigarette products. CONCLUSIONS Never and noncurrent users, followed by combustible product users, were most likely to remain in those states throughout the 3-year observation interval. Users of any tobacco or e-cigarette product at baseline were most likely to transition to combustible product use or noncurrent use by the final follow-up. IMPLICATIONS This study describes the probability of transitioning between various states of tobacco product use, including never and no current use, over a span of 3 years in a sample of young adults. This type of longitudinal description, which includes all tobacco product use states, is lacking in most studies that tend to focus on one or only a few products. The results suggest that it is important to assess outcomes over a sufficiently long period to capture true variability in patterns of product use.
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Affiliation(s)
- Raymond Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York, NY
| | - Ilan Rich
- Schroeder Institute at Truth Initiative, Washington, DC
| | | | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont College of Medicine, Burlington, VT
| | | | | | | | - David B Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York, NY
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Dugas EN, Sylvestre MP, Wellman RJ, O'Loughlin J. Does use of other tobacco products change when cigarette smoking status changes: A descriptive study of young adults. Addict Behav 2020; 107:106404. [PMID: 32222562 DOI: 10.1016/j.addbeh.2020.106404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whether polytobacco use or nicotine dependence (ND) change when cigarette smoking status changes in young adults is an understudied issue. Our objective was to describe use of other tobacco products (OTPs) and ND according to change in cigarette smoking status over four years in young adults. METHODS We drew data from a longitudinal study of 1294 adolescents age 12-13 at inception in 1999-2000 and followed into young adulthood. Among 790 participants with data at age 20 and 24, 22% had never smoked cigarettes; 37% were "sustained smokers"; 9% were "relapsers"; 10% had quit 1-3 years ago; and 22% had quit ≥4 years ago. We described past-year OTP (i.e., cigars/cigarillos, waterpipe, sundry tobacco products (i.e., pipe, bidis, chewing tobacco, snuff)) use and ND over 4 years in these groups. RESULTS At age 20, sustained smokers reported using a mean(SD) of 1.1(0.9) OTP in the past-year; relapsers reported 0.5(0.6); shorter-term quitters reported 0.9(0.7); longer-term quitters reported 0.3(0.6); and never smokers reported 0.2(0.4). There was no change in OTP use or ND in never smokers and longer-term quitters. Shorter-term quitters reduced the number of OTPs by -0.5(95% confidence interval: -0.7,-0.3) on average over 4 years; sustained smokers decreased by -0.2(-0.3,-0.1). Relapsers increased by 0.6(0.4,0.7) on average. CONCLUSIONS OTP use and ND were stable in early adulthood among never smokers, sustained smokers and longer-term quitters, but fluctuated in parallel with stopping and starting to smoke. Research is needed to ascertain the underpinnings of these fluctuations and whether they help or hinder cessation.
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Affiliation(s)
- Erika N Dugas
- Centre de recherche du centre hospitalier de l Université de Montréal (CRCHUM), Montreal, QC, Canada.
| | - Marie-Pierre Sylvestre
- Centre de recherche du centre hospitalier de l Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Robert J Wellman
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Jennifer O'Loughlin
- Centre de recherche du centre hospitalier de l Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.
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Sharma E, Edwards KC, Halenar MJ, Taylor KA, Kasza KA, Day H, Gardner LD, Anic G, Bansal-Travers M, Limpert J, Hammad HT, Borek N, Kimmel HL, Compton WM, Hyland A, Stanton CA. Longitudinal pathways of exclusive and polytobacco smokeless use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016). Tob Control 2020; 29:s170-s177. [PMID: 32321851 PMCID: PMC7534605 DOI: 10.1136/tobaccocontrol-2020-055628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Use of smokeless tobacco (SLT) with other tobacco products is growing, yet gaps in understanding transitions among SLT and other product use remain. The aim of this study is to examine cross-sectional prevalence and longitudinal pathways of SLT use among US youth (12-17 years), young adults (18-24 years) and adults 25+ (25 years and older). DESIGN Data were drawn from the first three waves (2013-2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses. RESULTS Young adults had the highest current SLT use compared with other age groups. Among Wave 1 (W1) past 30-day youth and young adult SLT users, most were SLT and cigarette polytobacco users compared with adults 25+, who more often used SLT exclusively. Among W1 exclusive SLT users, persistent exclusive use across all three waves was more common among adults 25+, while transitioning from exclusive SLT use to SLT polytobacco use at Wave 2 or Wave 3 was more common among youth and young adults. Among W1 SLT and cigarette polytobacco users, a common pathway was discontinuing SLT use but continuing other tobacco use. CONCLUSIONS Our results showed distinct longitudinal transitions among exclusive and SLT polytobacco users. Deeper understanding of these critical product transitions will allow for further assessment of population health impact of these products.
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Affiliation(s)
- Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Kathryn C Edwards
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Michael J Halenar
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Kristie A Taylor
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Hannah Day
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Lisa D Gardner
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Gabriella Anic
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Hoda T Hammad
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
- Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
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10
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Hair EC, Romberg AR, Niaura R, Abrams DB, Bennett MA, Xiao H, Rath JM, Pitzer L, Vallone D. Longitudinal Tobacco Use Transitions Among Adolescents and Young Adults: 2014-2016. Nicotine Tob Res 2020; 21:458-468. [PMID: 29452385 DOI: 10.1093/ntr/ntx285] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/19/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Among youth, the frequency and prevalence of using more than one tobacco (small cigar, cigarette, and hookah) or nicotine-containing product (e-cigarettes-ENDS) are changing. These shifts pose challenges for regulation, intervention, and prevention campaigns because of scant longitudinal data on the stability of use patterns in this changing product landscape. METHODS A nationally representative longitudinal survey of 15- to 21-year olds (n = 15,275) was used to describe transitions between never use, noncurrent use, and past 30-day use of combustible tobacco, e-cigarettes (ENDS), and dual use of both kinds of products. A multistate model was fit to observations collected every 6 months across 2.5 years to estimate the probability of transitions between states (TPs), the average time in state (sojourn time), and the effect of age on transitions. RESULTS Current state strongly predicted future state over time intervals of 1 year or less, but only weakly predicted future state at longer intervals: TP to noncurrent use was higher for ENDS-only than combustible-only users over a 6-month interval but was similar for both groups over a 2-year interval. Sojourn time was significantly longer for combustible-only (0.52 years) and dual use (0.55 years) than ENDS-only use (0.27 years); older youth were more likely than younger youth to stay combustible tobacco users or noncurrent users. CONCLUSIONS The dynamics of transitions between combustible tobacco products and ENDS in a population of youth and young adults suggest that policy and prevention efforts must consider the frequent changes and instability over a 1-year or less time period in use patterns among young people. IMPLICATIONS The study addresses an urgent need in public health for timely information on how youth and young adults use tobacco and nicotine products. We found that youth, particularly adolescents, moved frequently between using ENDS and combustible tobacco products either alone or together. Importantly, the utility of current-use states for predicting future use states declined for time horizons longer than 1 year. Our results demonstrate a need for caution in interpreting product transitions. Longitudinal data with frequent observations and coverage of a wide range of possible product types is required to fully characterize usage patterns in youth.
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Affiliation(s)
- Elizabeth C Hair
- Schroeder Institute at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Raymond Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY
| | - David B Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY
| | - Morgane A Bennett
- Schroeder Institute at Truth Initiative, Washington, DC.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Haijun Xiao
- Schroeder Institute at Truth Initiative, Washington, DC
| | - Jessica M Rath
- Schroeder Institute at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Donna Vallone
- Schroeder Institute at Truth Initiative, Washington, DC.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY
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11
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Danielsson M, Lammi A, Siitonen S, Ollgren J, Pylkkänen L, Vasankari T. Alarming development of dual snus and cigarette usage among young Finnish males. BMC Public Health 2019; 19:1249. [PMID: 31510968 PMCID: PMC6737716 DOI: 10.1186/s12889-019-7519-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background The consumption of tobacco products has evolved to include more complex combinations of different products. We investigated the tobacco habits of a representative population of young Finnish male conscripts in order to evaluate the prevalence of dual use of cigarettes and snus as well as the transition from one tobacco product to another. In addition, we evaluated the correlation between the level of education and the use of cigarettes and snus. Methods A questionnaire-based survey was carried out in three out of 17 garrisons among conscripts during their first week of service in 2014. A total of 1971 male conscripts were selected by simple random sampling of the 9013 males in the selected garrisons. Of them 1916 participated and filled in the questionnaire. The response rate was 97.2%. The questionnaire consisted of 25 questions including age, gender, basic education, use of tobacco products as well as questions assessing nicotine dependency. Results The amount of dual users of cigarettes and snus was 21%. There was a higher probability of dual use of cigarettes and snus among smokers compared to snus users (p < 0.001). One third (35%) of former smokers reported daily snus use and over 40% of the former snus users smoked daily. One third (34%) of the participants reported snus usage and 14% of the study subjects used snus daily. 40% of the study population were smokers and over 25% smoked daily. Of the participants with basic educational background 57% smoked daily (p < 0.001), however, no association between snus and level of education was found (p = 0.69). Conclusions This study provides better understanding of the complex tobacco habits of young adult males. The simultaneous usage of multiple tobacco products as well as the high tendency to transition from one tobacco product to another should be taken into consideration when planning cessation interventions in health care settings and tobacco control policies at societal levels. Electronic supplementary material The online version of this article (10.1186/s12889-019-7519-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Danielsson
- The Finnish Defence Forces, Fabianinkatu 2, 00130, Helsinki, Finland. .,Doctoral School in Health Sciences, University of Helsinki, P.O. BOX 3, 00014, Helsinki, Finland.
| | - Anelma Lammi
- Finnish Lung Health Association (FILHA), Filha Ry, Sibeliuksen katu 11 A 1, 00250, Helsinki, Finland
| | - Simo Siitonen
- The Finnish Defence Forces, Fabianinkatu 2, 00130, Helsinki, Finland
| | - Jukka Ollgren
- National Institute for Health and Welfare, P.O. BOX 30, 00271, Helsinki, Finland
| | - Liisa Pylkkänen
- Finnish Medicine Agency Fimea, Helsinki, Finland.,Division of Medicine, Department of Oncology, Turku University Hospital, and University of Turku, P.O. Box 52, 20521, Turku, Finland
| | - Tuula Vasankari
- Finnish Lung Health Association (FILHA), Filha Ry, Sibeliuksen katu 11 A 1, 00250, Helsinki, Finland.,Division of Medicine, Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital, and University of Turku, P.O. Box 52, 20521, Turku, Finland
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12
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Loukas A, Marti CN, Perry CL. Trajectories of Tobacco and Nicotine Use Across Young Adulthood, Texas, 2014-2017. Am J Public Health 2019; 109:465-471. [PMID: 30676800 DOI: 10.2105/ajph.2018.304850] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine intraindividual change in polytobacco and individual tobacco and nicotine product use across young adulthood. METHOD Participants were 2711 students from 24 Texas colleges participating in a 6-wave online study, with 6 months between each wave. Participants were aged 18 to 25 years at baseline in fall 2014 or spring 2015 and aged 20 to 28 years at wave 6. We used growth curve modeling for an accelerated longitudinal design to examine change from ages 18 to 28 years in polytobacco use (use of 2 or more products) and in use of 5 individual products (cigarettes, smokeless tobacco or snus, large cigars, cigarillos, or little cigars, hookah, and electronic nicotine delivery systems [ENDS]). RESULTS There was a statistically significant decline in polytobacco use from ages 18 to 28 years. There were also statistically significant declines in ENDS, hookah, and cigar use but not in smokeless tobacco use, for which use was negligible, or in cigarette use. Importantly, cigarettes were the most used product at virtually all ages. CONCLUSIONS Young adults may mature out of polytobacco use with increasing age, but they may continue to use some products, most notably cigarettes, potentially the most toxic and addictive tobacco and nicotine product.
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Affiliation(s)
- Alexandra Loukas
- Alexandra Loukas and C. Nathan Marti are with the Department of Kinesiology & Health Education, University of Texas at Austin. Cheryl L. Perry is with the University of Texas Health Science Center at Houston, School of Public Health in Austin
| | - C Nathan Marti
- Alexandra Loukas and C. Nathan Marti are with the Department of Kinesiology & Health Education, University of Texas at Austin. Cheryl L. Perry is with the University of Texas Health Science Center at Houston, School of Public Health in Austin
| | - Cheryl L Perry
- Alexandra Loukas and C. Nathan Marti are with the Department of Kinesiology & Health Education, University of Texas at Austin. Cheryl L. Perry is with the University of Texas Health Science Center at Houston, School of Public Health in Austin
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13
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Lee PN, Coombs KJ, Afolalu EF. Considerations related to vaping as a possible gateway into cigarette smoking: an analytical review. F1000Res 2018; 7:1915. [PMID: 31354936 PMCID: PMC6652100 DOI: 10.12688/f1000research.16928.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2019] [Indexed: 10/14/2023] Open
Abstract
Background: Toxicant levels are much lower in e-cigarettes than cigarettes. Therefore, introducing e-cigarettes into the market seems likely to reduce smoking-related diseases (SRD). However, vaping might provide a gateway into cigarette smoking for those who otherwise would never have smoked, a concern fuelled by cohort studies showing vaping predicts subsequent smoking initiation in young people. Methods: In this discussion paper, we consider various aspects of the gateway issue in youths. We provide a descriptive critical review of results from prospective studies relating to the gateway effect and the extent to which the studies considered other potential confounding variables associated with smoking initiation. We then estimate the effects of omitting a confounding variable, or misclassifying it, on the association between vaping and subsequent smoking initiation, and determine how the prevalence of smoking might be affected by any true gateway effects of vaping. Finally, we examine trends in e-cigarette and smoking prevalence in youths based on national surveys. Results: First, we demonstrate that although studies report that vaping significantly predicts smoking initiation following adjustment for various other predictors, the sets of predictors considered are quite incomplete. Furthermore, no study considered residual confounding arising from inaccurate measurement of predictors. More precise adjustment may substantially reduce the association. Second, we show any true gateway effect would likely affect smoking prevalence only modestly. Third, we show smoking prevalence in U.S. and U.K. youths in 2014-2016 declined somewhat faster than predicted by the preceding trend; a substantial gateway effect suggests the opposite. Finally, we argue that even if some gateway effect exists, introducing e-cigarettes still likely reduces SRDs. Conclusions: Given that the existence of any true gateway effect in youth is not yet clearly demonstrated the population health impact of introducing e-cigarettes is still likely to be beneficial.
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Affiliation(s)
- Peter N. Lee
- P.N.Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | | | - Esther F. Afolalu
- PMI R&D, Philip Morris Products S.A., Quai JeanRenaud 5, Neuchâtel, CH-2000, Switzerland
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14
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Lee PN, Coombs KJ, Afolalu EF. Considerations related to vaping as a possible gateway into cigarette smoking: an analytical review. F1000Res 2018; 7:1915. [PMID: 31354936 PMCID: PMC6652100 DOI: 10.12688/f1000research.16928.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 10/14/2023] Open
Abstract
Background: Toxicant levels are much lower in e-cigarettes than cigarettes. Therefore, introducing e-cigarettes into the market seems likely to reduce smoking-related diseases (SRD). However, vaping might provide a gateway into cigarette smoking for those who otherwise would never have smoked, a concern fueled by cohort studies showing vaping predicts subsequent smoking initiation in young people. Methods: In this discussion paper, we consider various aspects of the gateway issue in youths. We provide a descriptive critical review of results from prospective studies relating to the gateway effect and the extent to which the studies considered other potential confounding variables associated with smoking initiation. We then estimate the effects of omitting a confounding variable, or misclassifying it, on the association between vaping and subsequent smoking initiation, and determine how the prevalence of smoking might be affected by any true gateway-in effects of vaping. Finally, we examine trends in e-cigarette and smoking prevalence in youths based on national surveys. Results: First, we demonstrate that although studies report that vaping significantly predicts smoking initiation following adjustment for various other predictors, the sets of predictors considered are quite incomplete. Furthermore, no study considered residual confounding arising from inaccurate measurement of predictors. More precise adjustment may substantially reduce the association. Second, we show any true gateway effect would likely affect smoking prevalence only modestly. Third, we show smoking prevalence in U.S. and U.K. youths in 2014-2016 declined somewhat faster than predicted by the preceding trend; a substantial gateway effect suggests the opposite. Finally, we argue that even if some gateway effect exists, introducing e-cigarettes still likely reduces SRDs. Conclusions: We have shown that the existence of any true gateway-in effect in youth is not yet clearly demonstrated and that the population health impact of introducing e-cigarettes is still likely to be beneficial.
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Affiliation(s)
- Peter N. Lee
- P.N.Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | | | - Esther F. Afolalu
- PMI R&D, Philip Morris Products S.A., Quai JeanRenaud 5, Neuchâtel, CH-2000, Switzerland
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15
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Lee PN, Coombs KJ, Afolalu EF. Considerations related to vaping as a possible gateway into cigarette smoking: an analytical review. F1000Res 2018; 7:1915. [PMID: 31354936 PMCID: PMC6652100 DOI: 10.12688/f1000research.16928.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Compared to cigarette smoking, e-cigarette use is likely to present a reduced risk of smoking-related disease (SRD). However, several studies have shown that vaping predicts smoking initiation and might provide a gateway into smoking for those who otherwise would never have smoked. This paper considers various aspects of the gateway issue in youths. Methods: Here, we reviewed studies (N=15) of the gateway effect examining how extensively they accounted for confounders associated with smoking initiation in youths. We estimated how omitting a confounder, or misclassifying it, might bias the association between vaping and smoking initiation. We assessed how smoking prevalence might be affected by any true gateway effect, and examined trends in youth smoking and e-cigarette use from national surveys. Results: The list of smoking predictors adjusted for in studies reporting a significant gateway effect is not comprehensive, rarely considering internalising/externalising disorders, outcome expectancies, school performance, anxiety, parental smoking and peer attitudes. Furthermore, no study adjusted for residual confounding from inaccurately measured predictors. Better adjustment may substantially reduce the estimated gateway effect. Calculations showed that as any true gateway effects increase, there are much smaller increases in smoking prevalence, and that gateway effects increase only if initiating vaping is more frequent than initiating smoking. These effects on prevalence also depend on the relative odds of quitting vs. initiation. Data from five surveys in US/UK youths all show that, regardless of sex and age, smoking prevalence in 2014-2016 declined faster than predicted by the preceding trend, suggesting the absence of a substantial gateway effect. We also present arguments suggesting that even with some true gateway effect, introducing e-cigarettes likely reduces SRD risk. Conclusions: A true gateway effect in youths has not yet been demonstrated. Even if it were, e-cigarette introduction may well have had a beneficial population health impact.
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Affiliation(s)
- Peter N. Lee
- P.N.Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | | | - Esther F. Afolalu
- PMI R&D, Philip Morris Products S.A., Quai JeanRenaud 5, Neuchâtel, CH-2000, Switzerland
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16
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King JL, Reboussin D, Cornacchione Ross J, Wiseman KD, Wagoner KG, Sutfin EL. Polytobacco Use Among a Nationally Representative Sample of Adolescent and Young Adult E-Cigarette Users. J Adolesc Health 2018; 63:407-412. [PMID: 30115508 PMCID: PMC6388402 DOI: 10.1016/j.jadohealth.2018.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/02/2018] [Accepted: 04/18/2018] [Indexed: 01/11/2023]
Abstract
PURPOSE Electronic nicotine delivery systems (ENDS) are adolescents' most commonly used tobacco product and young adults' second most used. Little is known about ENDS use alongside other tobacco products (polytobacco use) and whether exclusive ENDS users differ from polytobacco ENDS users. METHODS In spring 2016, we surveyed a nationally representative sample of 3,517 13-25-year olds (36.9% 13-17-year olds), and examined sociodemographic and relative risk perceptions between two groups of past 30-day ENDS users: exclusive (only ENDS) and polytobacco (ENDS and at least one other tobacco product). RESULTS 4.5% of adolescents and 10% of young adults reported past 30-day ENDS use (n = 281; analytic sample). ENDS users were 38.8% female and 70.6% white. Over half (55.9%) were polytobacco ENDS users. The most common patterns of polytobacco ENDS use were ENDS and cigarettes (11.5%), ENDS and cigars (7.7%), and ENDS, cigars, and waterpipe (5.2%). Those who perceived ENDS to be less harmful than cigarettes were more likely to be exclusive ENDS users than those who perceived ENDS to be as or more harmful than cigarettes (adjusted odds ratio = 2.6, confidence interval = 1.2, 5.7). There were no differences between ENDS groups on age, race, sex, parental education, sexual orientation, or ENDS use frequency. CONCLUSIONS Just over half of ENDS users also used other tobacco products, increasing their risk for nicotine addiction and other health harms. The Food and Drug Administration is responsible for communicating product risk to consumers and should consider common patterns of use and relative risk perceptions in its ENDS public education efforts.
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Affiliation(s)
- Jessica L King
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - David Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
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17
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Kurti AN, Bunn JY, Villanti AC, Stanton CA, Redner R, Lopez AA, Gaalema DE, Doogan NJ, Cepeda-Benito A, Roberts ME, Phillips JK, Quisenberry AJ, Keith DR, Higgins ST. Patterns of Single and Multiple Tobacco Product Use Among US Women of Reproductive Age. Nicotine Tob Res 2018; 20:S71-S80. [PMID: 30125011 PMCID: PMC6093396 DOI: 10.1093/ntr/nty024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 01/31/2018] [Indexed: 12/21/2022]
Abstract
Introduction Understanding patterns of single and multiple tobacco product use among reproductive-aged women is critical given the potential for adverse health effects on mother and infant should a woman become pregnant. Methods Patterns of tobacco use over a 2-year period were examined among all women (18-44 years) who completed wave 1 (W1) and wave 2 (W2) of the US Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) Study. We examined the most common patterns of single and multiple tobacco product use in W1, and longitudinal trajectories of women engaged in each of these patterns of use from W1 to W2, among women not pregnant in either wave (n = 7480), not pregnant in W1 and pregnant in W2 (n = 332), and pregnant in W1 and not pregnant in W2 (n = 325). Results The most prevalent patterns of tobacco use in W1 among all three subgroups were using cigarettes alone followed by using cigarettes plus e-cigarettes. In all three subgroups, women using multiple products in W1 were more likely to adopt new use patterns in W2 relative to single-product users, with the new patterns generally involving dropping rather than adding products. The majority of multiple product use included cigarettes, and transitions to single product use typically involved dropping the noncigarette product. The most common trajectory among tobacco users transitioning to or from pregnancy was to use cigarettes alone in W2. Discussion This study contributes new knowledge characterizing tobacco use patterns across time and reproductive events among reproductive-aged women.
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Affiliation(s)
- Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Department of Biostatistics, University of Vermont, Burlington, VT
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Cassandra A Stanton
- Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Westat, Rockville, MD
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Rehabilitation Institute, Southern Illinois University, Carbondale, IL
| | - Alexa A Lopez
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Nathan J Doogan
- Center for Excellence in Regulatory Tobacco Science, The Ohio State University, Colombus, OH
- College of Public Health, The Ohio State University, Colombus, OH
| | - Antonio Cepeda-Benito
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Megan E Roberts
- College of Public Health, The Ohio State University, Colombus, OH
| | - Julie K Phillips
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, VT
| | - Amanda J Quisenberry
- Center for Excellence in Regulatory Tobacco Science, The Ohio State University, Colombus, OH
| | - Diana R Keith
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
- Department of Psychological Science, University of Vermont, Burlington, VT
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18
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Jones DM, Popova L, Weaver SR, Pechacek TF, Eriksen MP. A National Comparison of Dual Users of Smokeless Tobacco and Cigarettes and Exclusive Cigarette Smokers, 2015-2016. Nicotine Tob Res 2018; 20:S62-S70. [PMID: 30125015 PMCID: PMC6093383 DOI: 10.1093/ntr/nty010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022]
Abstract
Introduction While smoking rates have declined, use of smokeless tobacco (ST) has remained constant. ST is heavily marketed to cigarette smokers, and many ST users smoke cigarettes. This study provides updated comparisons of the characteristics, smoking behaviors, and perceptions of US adult dual ST and cigarette users and exclusive cigarette smokers in 2015-2016. Methods Data were from nationally representative, cross-sectional surveys from 2015 and 2016. Adult smokers reported past 30-day use of ST, current cigarette smoking, risk perceptions, smoking, and quitting behaviors. We estimated Rao-Scott χ2 and adjusted odds ratios (AORs) to compare dual users and exclusive smokers. Results Dual users were more likely to be younger, reside in nonmetropolitan statistical areas (MSA) and outside the Northeast United States. Adjusting for covariates, dual users did not differ significantly from exclusive smokers on most smoker characteristics, including number of past year quit attempts. Dual users were more likely to report past 30-day use of novel tobacco products (AORs 2.90 [little cigars and cigarillos] to 11.02 [hookah]). Dual users who reported at least 1 past year cigarette quit attempt were more likely than exclusive smokers to report using ST, traditional cigars, hookah, or heat-not-burn as a past year quit method (AOR: 9.54 [95% CI: 3.22 to 28.23]). Conclusions Smokers who use ST are more likely than exclusive smokers to attempt to quit smoking cigarettes using other tobacco products. These findings may be attributed to increasing use prevalence of novel products. We recommend further monitoring to assess polytobacco use and differences among these populations. Implications Many current ST users smoke cigarettes and ST promotions often target cigarette smokers. As the FDA considers ST regulations and implements a nicotine centered regulatory framework, it is imperative to evaluate how these policies and promotion of ST as potentially reduced risk products impact dual and polytobacco use. Our study found that many dual users engage in novel tobacco use in general and as a cessation method. Consideration of ST and polytobacco use among smokers may be helpful in the development of forthcoming FDA regulations, messaging, and interventions.
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Affiliation(s)
- Dina M Jones
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Lucy Popova
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA
| | - Scott R Weaver
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA
| | - Terry F Pechacek
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA
| | - Michael P Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA
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19
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Osibogun O, Ben Taleb Z, Bahelah R, Salloum RG, Maziak W. Correlates of poly-tobacco use among youth and young adults: Findings from the Population Assessment of Tobacco and Health study, 2013-2014. Drug Alcohol Depend 2018; 187:160-164. [PMID: 29674249 PMCID: PMC5959787 DOI: 10.1016/j.drugalcdep.2018.02.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Poly-tobacco use is common among youth and young adults. This study examined sociodemographic, tobacco-related, and substance use characteristics of poly-tobacco use compared to mono-tobacco use among youth and young adults (12-34 years) in the United States. METHODS We conducted a descriptive analysis by age-group of 12898 youth (12-17 years), 8843 younger young adults (18-24 years), and 6081 older young adults (24-34 years) from the 2013-2014 Population Assessment of Tobacco and Health study. Multiple logistic regression modeling was conducted to assess the sociodemographic, tobacco-related, and substance use associations with current (past 30 days) tobacco use on a binary scale (poly- versus mono-tobacco use) among tobacco users. RESULTS Between 2013 and 2014, 3.6% of youth, 21.7% of younger young adults, and 15.8% of older young adults were current poly-tobacco users in the general population. In the regression analyses, among youth tobacco users, heavy drinking was the only factor associated with higher odds of poly-tobacco use. Factors associated with higher odds of poly-tobacco use among younger young adults included being male, having less than high school diploma or GED, residing in the South, having 2 and ≥3 quit attempts, heavy drinking, and marijuana use. Residing in the South, older ages of exposure to tobacco use, and marijuana use were associated with higher odds of poly-tobacco use among older young adults. CONCLUSIONS Regardless of tobacco product type, poly-tobacco use was common among youth and young adults. Interventions designed to address factors associated with poly-tobacco use among youth and young adults are warranted.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA.
| | - Ziyad Ben Taleb
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA
| | - Raed Bahelah
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA
| | - Ramzi G. Salloum
- Department of Health Outcomes and Policy, University of Florida, PO Box 100177, Gainesville, FL 32610-0177, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199, USA
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Lee YO, Pepper JK, MacMonegle AJ, Nonnemaker JM, Duke JC, Porter L. Examining Youth Dual and Polytobacco Use with E-Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040699. [PMID: 29642480 PMCID: PMC5923741 DOI: 10.3390/ijerph15040699] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
Abstract
E-cigarettes and other non-cigarette tobacco products are increasingly popular among youth. Little is known to inform public health efforts to reduce youth use. We examined psychosocial correlates of single and multiple tobacco product use among youth e-cigarette users. Data were from the 2014 Florida Youth Tobacco Survey (N = 69,923), a representative sample of Florida middle and high school students. Associations between combinations of e-cigarette, cigarette and other tobacco product (OTP) use and psychosocial variables were examined using multinomial logistic regression with an analytic sample of N = 2756. Most e-cigarette-using youth used at least one other product (81%). Perceiving cigarettes as easy to quit was significantly associated with greater likelihood of combined e-cigarette/OTP use (relative risk ratio (RRR) = 2.51, p < 0.001) and combined e-cigarette/cigarette/OTP use (RRR = 3.20, p < 0.0001). Thinking you will be smoking cigarettes in 5 years was associated with product combinations that include cigarettes. Tobacco company marketing receptivity was associated with multiple product user types. Given that specific psychosocial factors put youth at risk for concurrent use of e-cigarettes with tobacco products, public health efforts should address polytobacco use specifically, instead of individual product use. Youth perceptions about the ease of quitting cigarettes, intentions to continue smoking cigarettes and receptivity to tobacco company marketing are promising areas for messaging aimed at reducing e-cigarette polytobacco product use.
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Affiliation(s)
- Youn Ok Lee
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Jessica K Pepper
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Anna J MacMonegle
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - James M Nonnemaker
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Jennifer C Duke
- RTI International, Public Health Research Division, Research Triangle Park, NC 27709, USA.
| | - Lauren Porter
- Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL 32399, USA.
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Yu M, Sacco P, Choi HJ, Wintemberg J. Identifying patterns of tobacco use among US middle and high school students: A latent class analysis. Addict Behav 2018; 79:1-7. [PMID: 29227789 DOI: 10.1016/j.addbeh.2017.11.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/17/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study sought to (a) understand patterns of tobacco use among US middle and high school students based on their lifetime or current use of tobacco products: cigarettes, cigars, chewing tobacco, pipes, e-cigarettes, and hookah tobacco, and (b) examine differences in the underlying patterns by sociodemographic and tobacco-related characteristics (e.g., exposure to tobacco products, tobacco advertising, parental disapproval of tobacco use and feedback from healthcare providers). METHODS We analyzed self-report data from the 2013 National Youth Tobacco Survey (n=18,046). Latent Class Analysis was conducted to identify patterns of tobacco use and tested how sociodemographic and tobacco-related characteristics are associated with such patterns. RESULTS Four subtypes of tobacco use were identified: "Very Low Risk (VLR)," "Lifetime Smoking (LS)," "Lifetime Multiple Tobacco Use (LMT)," and "Past Month Multiple Tobacco Use (PMT)." Latino and Asian American youth were more likely to be in PMT. Compared with students in LS, students in VLR were less likely to receive advice not to use tobacco from their healthcare providers, but more likely to have parental disapproval of smoking. Students in LMT (vs. LS) were more likely to use tobacco coupons and promotional materials, report greater access to tobacco, and receive advice from a healthcare professional. Students in PMT (vs. LS) were more likely to use coupons, take part in tobacco promotions, and be exposed to smoking in a vehicle. CONCLUSIONS Our study suggests that it may be important to consider the underlying patterns and correlates of tobacco use in designing tobacco control programs for youth.
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Kozlowski LT, Sweanor DT. Young or adult users of multiple tobacco/nicotine products urgently need to be informed of meaningful differences in product risks. Addict Behav 2018; 76:376-381. [PMID: 28148394 DOI: 10.1016/j.addbeh.2017.01.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/23/2017] [Indexed: 01/17/2023]
Abstract
Previously, it has been argued that health information efforts need to inform the public about meaningful differential risks from tobacco/nicotine products. The fact of multiple product use by the same individual further supports this need. When the majority of youth, for example, who use smokeless tobacco are also current tobacco smokers, it makes little sense to mount a smokeless prevention campaign that fails to include clear messages about the much greater risks from smoking. In April 2016, The Food & Drug Administration (FDA) announced a $36 million campaign for youth that "smokeless doesn't mean harmless." Research shows the public (a) already knows that smokeless tobacco is not harmless, but are (b) also largely unaware that cigarettes are much more harmful than smokeless. Though not harmless, smokeless tobacco has been estimated to be over 90% less harmful than cigarettes. 'Gateway' fears are made moot by current use of multiple tobacco/nicotine products. When multi-tobacco product use is commonplace among users, usable information on significant differences in risk is crucial for both adult and younger users. The FDA and like campaigns and health information websites should follow established ethical principles and accepted communication methods to inform the public of less-harmful tobacco/nicotine products as well as the greater harms of smoking, in keeping with the Surgeon-General's advice that reductions in smoking in particular will bring about the greatest public health advances.
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Niaura R. Communicating differences in tobacco product risks: Timing is of the essence. Addict Behav 2018; 76:388-389. [PMID: 28153392 DOI: 10.1016/j.addbeh.2017.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/23/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Ray Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, United States.
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Loukas A, Marti CN, Cooper M, Pasch KE, Perry CL. Exclusive e-cigarette use predicts cigarette initiation among college students. Addict Behav 2018; 76:343-347. [PMID: 28892771 PMCID: PMC5614895 DOI: 10.1016/j.addbeh.2017.08.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION An increasing body of research indicates that use of electronic nicotine delivery systems (ENDS) predicts cigarette initiation. However, no studies examine if risk for cigarette initiation varies for exclusive ENDS users versus users of ENDS and other tobacco products. This study examined if: a) cigarette-naïve young adults (i.e., never cigarette users) who ever used ENDS had a greater odds of initiating cigarettes than non-ENDS users over a 1.5year period and b) the odds of cigarette initiation was consistent across exclusive ENDS users and users of ENDS and at least one tobacco product. METHODS Participants were 2558 cigarette-naïve 18-25year old (M=19.71; SD=1.61) students from 24 Texas colleges who participated in a four-wave study, with six months between each wave. RESULTS Overall, 11% of students reported cigarette initiation by wave 4. Of those, 20.1% were wave 1 ENDS users and 8.4% were non-ENDS users. Multivariable, multilevel discrete-time hazard models indicated that wave 1 ENDS use predicted subsequent cigarette initiation, over and above the significant effects of cigarette use susceptibility, family-of-origin tobacco use, friend cigarette use, and other tobacco use. Additional findings indicated that exclusive ENDS users had a greater odds than non-users of subsequent cigarette initiation. Among users of alternative tobacco products, ENDS users did not have a greater odds of initiation than non-ENDS users. CONCLUSION Findings extend existing research by showing that ENDS use by young adults is a specific risk factor for later cigarette initiation and not an extension of a constellation of existing tobacco use behaviors.
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Affiliation(s)
- Alexandra Loukas
- University of Texas at Austin, 2109 San Jacinto Blvd, Austin, TX 78712-1415, USA.
| | - C Nathan Marti
- University of Texas at Austin, 2109 San Jacinto Blvd, Austin, TX 78712-1415, USA.
| | - Maria Cooper
- UTHealth School of Public Health in Austin, 1616 Guadalupe Street Suite 6.300, Austin, TX 78701, USA.
| | - Keryn E Pasch
- University of Texas at Austin, 2109 San Jacinto Blvd, Austin, TX 78712-1415, USA.
| | - Cheryl L Perry
- UTHealth School of Public Health in Austin, 1616 Guadalupe Street Suite 6.300, Austin, TX 78701, USA.
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Couch ET, Darius EF, Walsh MM, Chaffee BW. ST product characteristics and relationships with perceptions and behaviors among rural adolescent males: a qualitative study. HEALTH EDUCATION RESEARCH 2017; 32:537-545. [PMID: 29112713 PMCID: PMC5914412 DOI: 10.1093/her/cyx067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/13/2017] [Accepted: 10/28/2017] [Indexed: 06/07/2023]
Abstract
Although smoking declines in the United States, the prevalence of male adolescent smokeless tobacco (ST; moist snuff and chewing tobacco) use remains unchanged. ST product characteristics, such as flavoring, packaging, and branding, could influence adolescents' ST initiation and continued use. This qualitative study examines the potential role of product characteristics in shaping ST-related perceptions and behaviors among rural adolescent males. Semi-structured individual interviews were conducted at three California rural high schools. ST users were asked about their experiences and perceptions related to product characteristics. Interviews were transcribed, coded, and analyzed using a general inductive approach. Participants associated flavored ST with appealing non-tobacco products, such as chewing gum and alcohol. Availability of different varieties and flavors stimulated interest and curiosity in sampling or switching between ST products. Time-limited promotional flavors and packaging also enhanced product appeal. Adolescent ST users preferred certain brands based on perceived brand features and perceived nicotine content, associating higher-strength brands as better suited for experienced ST users. Brand preferences frequently reflected perceived ST brand popularity within peer groups. Based on these observations, potential ST regulation and health education campaigns to address misconceptions about ST characteristics could influence adolescents' ST-related perceptions and reduce ST use among this vulnerable population.
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Affiliation(s)
- Elizabeth T Couch
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California St. Suite 495, San Francisco, CA 94143-1361, USA
| | - Ellen F Darius
- Alameda County Public Health Department, Office of Dental Health, 1000 Broadway, Oakland, CA 94607, USA
| | - Margaret M Walsh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California St. Suite 495, San Francisco, CA 94143-1361, USA
| | - Benjamin W Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California St. Suite 495, San Francisco, CA 94143-1361, USA
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Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015. PLoS One 2017; 12:e0177073. [PMID: 28475634 PMCID: PMC5419603 DOI: 10.1371/journal.pone.0177073] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 04/21/2017] [Indexed: 11/26/2022] Open
Abstract
Objectives Evaluate trends from 2011–2015 in electronic cigarette (e-cigarette) use among U.S. adolescents, grades 6–12, including prevalence and associations with past month use of cigarettes and other tobacco products, cigarette smoking intensity, quit attempts, and quit contemplation. Methods Five consecutive waves from the National Youth Tobacco Survey (N = 101,011) were used to estimate the grade- and race/ethnicity-standardized prevalence of past month use of e-cigarettes and nine non e-cigarette tobacco products. We assessed linear trends by year and compared outcomes (e.g., tobacco use, smoking intensity) by e-cigarette past month use. Results Past month e-cigarette use rose sharply from 2011–2015. In all years and both sexes, e-cigarette past month use and ever use were positively associated with use of cigarettes and other tobacco products, with past month e-cigarette use reaching 52% in 2015 among individuals who used ≥1 non e-cigarette tobacco product in the past month. Meanwhile, from 2011–2015, the population of adolescent past month e-cigarette users increasingly encompassed adolescents who were not past month users of other products (females: 19.0% to 41.7%; males: 11.1% to 36.7%) or had never used other products (females: 7.1% to 13.5%; males: 6.7% to 15.0%). Among male (but not female) past month cigarette users, there was a statistically significant positive association between past month e-cigarette use and daily cigarette smoking but not in all individual years. Past month e-cigarette use among past month cigarette smokers was not associated with cigarette quit attempts or quit contemplation, with no temporal trend. Conclusion Adolescent past month e-cigarette use is associated with past month use of other tobacco but not with cigarette quit attempts or quit contemplation among cigarette users. Over five years, the average characteristics of U.S. adolescents who use e-cigarettes have shifted, increasingly including more adolescents who do not use non e-cigarette tobacco products.
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Morello P, Pérez A, Peña L, Lozano P, Thrasher JF, Sargent JD, Mejía R. PREVALENCE AND PREDICTORS OF E-CIGARETTE TRIAL AMONG ADOLESCENTS IN ARGENTINA. Tob Prev Cessat 2016; 2. [PMID: 31355353 DOI: 10.18332/tpc/66950] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction Over the last few years, the increasing use of electronic cigarettes has become a new public health problem. Since 2011, Argentina has had a complete ban on marketing and sale of e-cigarettes. However, e-cigarettes are marketed online and can be easily bought in stores. We conducted a longitudinal study to evaluate the determinants of e-cigarette trial among Argentinean early adolescents. Methods A school-based longitudinal study was conducted in 2014-15, in 3 large cities in Argentina. Among students who reported never smoking an e-cigarette at baseline, we assessed demographics, media use, sensation seeking, smoking behavior, network member smoking, use of other substances, and perception of e-cigarette risk as potential risk factors for e-cigarette trial at follow up (mean between-wave interval 17.1 months) using multilevel logistic regression models with random intercepts for schools. Results E-cigarette trial prevalence increased from baseline (1.8%; n=57) to follow up (7.1%; n=139). Independent predictors of e-cigarette use at follow up included: higher sensation seeking (OR: 1.49 95% CI 1.21-1.84); being a current smoker (OR: 2.58 95% CI 1.38-4.83); having close friends that smoke cigarettes (OR: 1.93 95% CI 1.25-2.99) and being highly exposed to tobacco product ads online (OR: 1.87 95% CI 1.04-3.36). Attending a public school was the only protective factor (OR: 0.40 95% CI 0.22-0.73). Conclusion In Argentina, illicit trial of e-cigarettes among early adolescents is low but appears to be rapidly increasing. Identifying students at risk could help identify policies and programs to prevent increasing use in this population.
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Affiliation(s)
- Paola Morello
- Centro de Estudios de Estado y Sociedad (CEDES), Argentina
| | - Adriana Pérez
- Centro de Estudios de Estado y Sociedad (CEDES), Argentina.,Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | - Lorena Peña
- Centro de Estudios de Estado y Sociedad (CEDES), Argentina
| | - Paula Lozano
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - James D Sargent
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, USA
| | - Raúl Mejía
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, USA
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Ting WJ, Yang JJ, Kuo CH, Xiao ZJ, Lu XZ, Yeh YL, Day CH, Wen SY, Viswanadha VP, Jiang CH, Kuo WW, Huang CY. Environmental tobacco smoke increases autophagic effects but decreases longevity associated with Sirt-1 protein expression in young C57BL mice hearts. Oncotarget 2016; 7:39017-39025. [PMID: 27167200 PMCID: PMC5129910 DOI: 10.18632/oncotarget.9176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/16/2016] [Indexed: 11/25/2022] Open
Abstract
Recently, a survey by the Centers for Disease Control and Prevention (CDC) reported that nearly 90% of U.S. adult smokers began smoking at the age of 18. This demonstrates that the exposure to environmental tobacco smoke (ETS) of youngsters today is changing from passive smoking to active smoking (direct inhalation of tobacco). In the current study, an investigation of ETS exposure in young C57BL mice was conducted. After 6 weeks of ETS exposure, the Sirt-1 protein level was decreased and cardiac autophagy was increased in C57BL mice. Furthermore, the IGF2R cardiac hypertrophy signaling pathway was also triggered, although cardiac apoptosis and hypertrophy were not induced. Youngsters' desire to look more mature is one of the psychological factors that impacts smoking amongst young people. Our results suggest that though ETS exposure might cause cardiac autophagy amongst youngsters, the loss of the longevity Sirt-1 protein and the increase in IGF2R cardiac hypertrophy signaling could still promote heart diseases that are age-specific.
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Affiliation(s)
- Wei-Jen Ting
- The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Jaw-Ji Yang
- Institute of Medicine, School of Dentistry, Chung-Shan Medical University, Taichung, Taiwan
| | - Chia-Hua Kuo
- Department of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Zi-Jun Xiao
- National Taichung First Senior High School, Taichung, Taiwan
| | - Xin-Ze Lu
- National Taichung First Senior High School, Taichung, Taiwan
| | - Yu-Lan Yeh
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | | | - Su-Ying Wen
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | | | - Chong-He Jiang
- The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Wei-Wen Kuo
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Chih-Yang Huang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
- Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
- Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
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Filippidis FT, Laverty AA, Gerovasili V, Vardavas CI. Two-year trends and predictors of e-cigarette use in 27 European Union member states. Tob Control 2016; 26:98-104. [PMID: 27220621 PMCID: PMC5256312 DOI: 10.1136/tobaccocontrol-2015-052771] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study assessed changes in levels of ever use, perceptions of harm from e-cigarettes and sociodemographic correlates of use among European Union (EU) adults during 2012-2014, as well as determinants of current use in 2014. METHODS We analysed data from the 2012 (n=26 751) and 2014 (n=26 792) waves of the adult Special Eurobarometer for Tobacco survey. Point prevalence of current and ever use was calculated and logistic regression assessed correlates of current use and changes in ever use, and perception of harm. Correlates examined included age, gender, tobacco smoking, education, area of residence, difficulties in paying bills and reasons for trying an e-cigarette. RESULTS The prevalence of ever use of e-cigarettes increased from 7.2% in 2012 to 11.6% in 2014 (adjusted OR (aOR)=1.91). EU-wide coefficient of variation in ever e-cigarette use was 42.1% in 2012 and 33.4% in 2014. The perception that e-cigarettes are harmful increased from 27.1% in 2012 to 51.6% in 2014 (aOR=2.99), but there were major differences in prevalence and trends between member states. Among those who reported that they had ever tried an e-cigarette in the 2014 survey, 15.3% defined themselves as current users. Those who tried an e-cigarette to quit smoking were more likely to be current users (aOR=2.82). CONCLUSIONS Ever use of e-cigarettes increased during 2012-2014. People who started using e-cigarettes to quit smoking tobacco were more likely to be current users, but the trends vary by country. These findings underscore the need for more research into factors influencing e-cigarette use and its potential benefits and harms.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Vasiliki Gerovasili
- Department of Ergospirometry and Rehabilitation, Medical School, University of Athens, Athens, Greece
| | - Constantine I Vardavas
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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