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Alabdulqader M, Almulhim MA, Alquraini M, Ali I, Alhajri MS, Alsaleh NA, Al Naim A, Al Noaim KI, Majzoub RA, Alalawi ZH. Exploring the Rise of E-cigarette Use Among Male Adolescents in Al-Ahsa, Saudi Arabia: Prevalence, Patterns, and Influencing Factors. Cureus 2024; 16:e51644. [PMID: 38313903 PMCID: PMC10837823 DOI: 10.7759/cureus.51644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND The rising prevalence of electronic cigarette (E-cigarette) use among adolescents is a major public health concern. This study investigates the prevalence of E-cigarette use among male adolescents in Al-Ahsa, Saudi Arabia, and explores associated factors. METHODOLOGY A cross-sectional study was conducted from December 2022 to April 2023, involving 476 male students aged 12 to 19. Data were collected through structured questionnaires, covering sociodemographic information, E-cigarette usage patterns, reasons for use, sources of acquisition, awareness of nicotine content, and perceptions of harm. Statistical analysis was performed using SPSS 25 (IBM Corp., Armonk, NY), with significance set at p < 0.05. RESULTS The study revealed a prevalence of 17.4% E-cigarette use among participants, with 12.6% using E-cigarettes exclusively and 4.8% concurrently with traditional tobacco cigarettes. Key findings included initiation as early as age eight, sustained and frequent use, and motivations including peer influence (61.4%), curiosity (31.3%), and flavored options (26.5%). Online platforms (34.9%) and shopping malls (28.9%) were the primary sources of E-cigarette acquisition. Most participants were aware of the nicotine content (84.3%) and believed E-cigarettes were harmful (86.7%). Importantly, 69.9% expressed intentions to quit, with 44.6% planning to do so within 30 days. Significant associations were found between E-cigarette use, education level, and having friends who smoke. CONCLUSION This study highlights the prevalence of E-cigarette use among male adolescents in Al-Ahsa, Saudi Arabia, and identifies peer influence, curiosity, and appealing flavors as driving factors. Targeted prevention and intervention programs, along with regulatory efforts to restrict access, are urgently needed to address this growing public health issue. Increasing awareness of E-cigarette risks and providing cessation support are vital steps towards mitigating E-cigarette use among Saudi male adolescents.
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Affiliation(s)
| | | | | | - Insaf Ali
- College of Medicine, King Faisal University, Al-Ahsa, SDN
| | | | - Noor A Alsaleh
- Collage of Medicine, King Faisal University, Al-Ahsa, SAU
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Amin S, Pokhrel P, Elwir T, Mettias H, Kawamoto CT. A systematic review of experimental and longitudinal studies on e-cigarette use cessation. Addict Behav 2023; 146:107787. [PMID: 37393697 PMCID: PMC10527397 DOI: 10.1016/j.addbeh.2023.107787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The present study addresses the need to synthesize the findings in the current literature on e-cigarette use cessation. METHODS PubMed, MEDLINE, and EMBASE databases were searched in November 2022 to systematically review studies focused on intentions, attempts, and successful e-cigarette use cessation. Three authors independently reviewed the full-texts of the initial pool of potentially eligible articles. Narrative data synthesis was conducted, and the risk of bias was evaluated. RESULTS A total of 12 studies were selected for review, 7 of which were experimental and 5longitudinal. The majority of the studies focused on participants' intentions to quit e-cigarette use. The experimental studies varied in sample size, intervention type, and length of participant follow-up. Findings across the experimental studies were mixed, with only one full-fledged trial having examined cessation as an outcome. The experimental studies that assessed cessation outcomes utilized mobile technology as an intervention tool. Results from longitudinal studies indicated sociodemographic characteristics (gender, race/ethnicity), vaping frequency, and cigarette smoking status as predictors of intentions, attempts and e-cigarette use cessation. CONCLUSION This review highlights the current paucity of methodologically rigorous research on e-cigarette use cessation. Our findings suggest that vaping cessation programs that employ mobile health technology to provide personalized cessation services may help promote intentions, attempts, and e-cigarette use cessation. Limitations of the current studies on vaping cessation include small sample sizes, heterogeneous cohorts that limit comparisons, and inconsistent ways of assessing vaping cessation. Future research needs to test long-term intervention effects using experimental and prospective designs among representative samples.
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Affiliation(s)
- Samia Amin
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States.
| | - Pallav Pokhrel
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
| | - Taha Elwir
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
| | - Hannah Mettias
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
| | - Crissy T Kawamoto
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
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Ma H, Gaudiello E, Sheeran P, Sanzo N, Sutfin EL, Noar SM. National Youth tobacco surveys (2014-2019) show increasing beliefs in the harm and relative addiction of e-cigarettes but decreasing associations between those beliefs and e-cigarette use. Addict Behav 2023; 144:107713. [PMID: 37086609 PMCID: PMC10330167 DOI: 10.1016/j.addbeh.2023.107713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND To evaluate the potential efficacy of increasing harm and relative addiction beliefs in discouraging e-cigarette use, we examined how adolescents' beliefs about e-cigarettes have changed over 6 years and how the predictive validity of these beliefs has changed over time. METHODS Using data from the 2014-2019 National Youth Tobacco Survey (NYTS) (grades 6-12; N = 117,472), we evaluated the association between adolescents' beliefs about the harm and relative addiction of e-cigarettes and current e-cigarette use, as well as susceptibility to use. Logistic regressions and pairwise contrasts were used to analyze changes in these beliefs and determine how well these beliefs predict ever use, current use, and susceptibility to use over time. RESULTS E-cigarette harm and relative addiction beliefs tended to increase over time. In most years, these beliefs were negatively associated with e-cigarette use, including ever use, current use, and susceptibility to use. Interactions between these beliefs were also observed in some years such that harm belief better predicted use when e-cigarettes were also perceived as more addictive. Survey year also interacted with health harm and relative addiction beliefs such that the predictive validity of these beliefs for e-cigarette use decreased over time. CONCLUSIONS Beliefs about e-cigarette harm and relative addiction have increased over time and predict use of, and susceptibility to, e-cigarettes among US adolescents. However, the predictive validity of these beliefs has decreased over time. Future research should explore the reasons for the decreased predictive validity of health beliefs in e-cigarette use and identify constructs that predict adolescent e-cigarette use over and above general harm and relative addiction beliefs.
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Affiliation(s)
- Haijing Ma
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Eric Gaudiello
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Nora Sanzo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC 27514, USA.
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Pane J, Murray J, Nugent R, Yang S, Nugent K. Electronic cigarette use by and perceptions of middle and high school students in the United States. J Investig Med 2023; 71:212-222. [PMID: 36772925 DOI: 10.1177/10815589221140588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Electronic cigarettes (e-cigarettes) provide a novel source of nicotine and may lead to experimentation by adolescents and eventually to their use of conventional cigarettes. The National Youth Tobacco Survey collected information from a nationally representative sample of students in 2016 to determine their experiences with conventional cigarettes and e-cigarettes, their intentions to use these products in the future, and their perceptions of harm and addiction associated with these products. We analyzed these data with ordered probit regression models to determine possible associations with the intention to try e-cigarettes and conventional cigarettes. This survey included 20,520 respondents, 50.6% were male, 5.9% had used conventional cigarettes, and 9.0% had used e-cigarettes. Approximately 10% thought e-cigarettes caused no harm, 3.7% thought that conventional cigarettes caused no harm, and 52.5% thought that e-cigarettes were less harmful than conventional cigarettes. Less than 1% of the students responded "Definitely yes" to the question, "Do you think you will try an e-cig?" The odds ratios for an intention to try e-cigarettes increased as the perception of harm decreased; these ratios increased from 1.0 for "A lot of harm" to 5.85 (95% CI: 3.51, 9.75) for "No harm." In 2016, the majority of students thought that e-cigarettes could cause some harm. This survey indicates that most students have not tried e-cigarettes or conventional cigarettes. The minority of students who think that e-cigarettes pose no harm and students in the ages 14 and 16 are more likely to try them.
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Affiliation(s)
- Joseph Pane
- Data Science, Thermo Fisher Scientific, Pittsburg, PA, USA
| | - Jared Murray
- McCombs School of Business University of Texas, Austin, TX, USA
| | - Rebecca Nugent
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Shengping Yang
- Department of Biostatistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Watson CV, Puvanesarajah S, Hawkins NA, Trivers KF. Racial Disparities in Flavored Tobacco Product Use, Curiosity, Susceptibility, and Harm Perception, National Youth Tobacco Survey 2019-2020. Health Equity 2023; 7:137-147. [PMID: 36876232 PMCID: PMC9982141 DOI: 10.1089/heq.2022.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Studies characterizing differences in youth flavored tobacco product use prevalence, curiosity/susceptibility, and harm perceptions by race and ethnicity are limited. This study comprehensively examines flavored tobacco product use and harm perceptions among U.S. middle and high school students, by race and ethnicity. Methods Data came from the 2019 (N=19,018) and 2020 (N=14,531) National Youth Tobacco Surveys (NYTS). Weighted prevalence estimates of flavored tobacco product use and curiosity, susceptibility, and harm perception are reported by race and ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, or NH Other). t-Tests assessed differences in prevalence by years and racial/ethnic groups. Results Among youth with past 30-day tobacco use, use of most flavored tobacco products increased across all racial/ethnic groups; the largest increase was observed among Hispanic youth using other flavored tobacco products (30.3%). The group with the highest susceptibility to future electronic cigarette (e-cigarette) use was Hispanic students (42.3%). Hispanic students had the highest curiosity about and susceptibility to future use of cigarettes and cigars as well. Conclusions Increases in the use of and higher susceptibility to other flavored tobacco products, particularly among Hispanic youth, suggest a need for additional changes in environmental conditions and possibly targeted or tailored tobacco control interventions for Hispanic youth. Implications Given that flavored tobacco use is prevalent among youth and aggressively marketed more to racial/ethnic minority populations, it is important to understand how susceptibility and perceptions relate to tobacco use. Our results suggest a need for a better understanding of social and environmental factors that drive tobacco use behaviors and perceptions, particularly among Hispanic youth, to address the root causes of these differences and create more equitable tobacco control interventions.
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Affiliation(s)
- Christina Vaughan Watson
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
| | - Samantha Puvanesarajah
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
| | - Nikki A Hawkins
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
| | - Katrina F Trivers
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
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Mai J, Lin L, Zhou L, Guan Q, Zhu W, Zhou W. Will personality traits affect the use of e-cigar among college students? A cross-sectional study in Guangdong Province, China. Front Public Health 2022; 10:1032606. [PMID: 36589985 PMCID: PMC9800422 DOI: 10.3389/fpubh.2022.1032606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Background The prevalence of e-cigar among adolescents and young adults around the world is increasing rapidly, which has a serious impact on the health of young people. This study assessed the prevalence of e-cigar among college students and to explore the relationship between e-cigar use and personality traits. Methods This study conducted an electronic questionnaire survey on college students who were from three undergraduate universities and three junior colleges in Guangdong Province from January 2022 to March 2022. The survey was conducted by stratified cluster sampling, and the respondents were 1362. Statistical descriptions are used to describe the demographic characteristics and personality traits of participants. Mann-Whitney U tests, and Chi-square tests were used to compare the differences between current e-cigar users and non e-cigar users. Two-step hierarchical Logistic regression was used to predict the associated factors with e-cigar use. Results The prevalence of current e-cigar users was 5.1%. Agreeableness showed statistically significant higher in non-users (Z = 2.585, P < 0.01). Moreover, gender (AOR = 0.312, 95%CI: 0.174-0.562), the relationship with mother (AOR = 5.887, 95%CI: 1.460-23.748), friends who use e-cigar (AOR = 3.808, 95%CI: 2.159-6.719), allowance per month (AOR = 2.482, 95%CI: 1.371-4.490), and agreeableness (AOR = 0.957, 95%CI: 0.918-0.997) were related to the use of e-cigar. Conclusion The level of agreeableness is associated with the use of e-cigar among college students. All these provided an important theoretical basis for future intervention.
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Gaddy MY, Vasquez D, Brown LD. Predictors of e-cigarette initiation and use among middle school youth in a low-income predominantly Hispanic community. Front Public Health 2022; 10:883362. [PMID: 36238238 PMCID: PMC9551350 DOI: 10.3389/fpubh.2022.883362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/12/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction E-cigarette use among middle and high school youth increased from 2. 5 million in 2014 to 9.2 million in 2019, becoming the most common tobacco product used among youth. Hispanic youth, the largest ethnic minority in the United States, have higher rates of tobacco use, including e-cigarettes, than non-Hispanics. Identifying factors that put youth at risk for future e-cigarette use is vital to focusing prevention efforts. Informed by social cognitive theory, this study identifies predictors of e-cigarette uptake among e-cigarette naïve youth in a predominantly low-income Hispanic community. Methods 1,249 students (6-8th grades) from two middle schools in El Paso, Texas consented to participate in this longitudinal survey during the 2016-2017 school year. The study sample for analysis was restricted to e-cigarette naïve students (n = 862). Outcome measures were e-cigarette initiation and current use at follow-up. Logistic regression models tested six hypotheses about predictors of e-cigarette initiation and current use: (1) intention, (2) outcome expectations, (3) knowledge, (4) friendship network exposure, (5) normative beliefs, and (6) social acceptability. Results Among e-cigarette naïve students at baseline, 8% (n = 71) reported initiation at follow-up; of these, 3% (n = 23) reported current use. Significant predictors of initiation were intention (AOR = 2.46; 95% CI 1.69-3.59; p < 0.001), outcome expectations (AOR = 1.73; 95% CI 1.14-2.61; p = 0.009), friendship network exposure (AOR = 1.53; 95% CI 1.11-2.11; p =0.01), normative beliefs (AOR = 2.12; 95% CI 1.47-3.08; p < 0.001), and social acceptability (AOR = 1.91; 95% CI 1.28-2.85; p = 0.002). Significant predictors of current use were intention (AOR = 1.98; 95% CI 1.07-3.69; p = 0.03) and friendship network exposure (AOR = 1.69; 95% CI 1.06-2.70; p = 0.03). Conclusions With the increasing popularity of e-cigarettes, age appropriate and culturally sensitive prevention strategies tailored at altering these predictive factors are essential in preventing future e-cigarette use.
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Affiliation(s)
- M. Yvonne Gaddy
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health, El Paso, TX, United States
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Li X, Kaiser N, Borodovsky JT, Riordan R, Kasson E, Cao C, Cavazos-Rehg PA. National Trends of Adolescent Exposure to Tobacco Advertisements: 2012-2020. Pediatrics 2021; 148:e2021050495. [PMID: 34851424 DOI: 10.1542/peds.2021-050495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of the current study is to evaluate the temporal trends in the prevalence of cigarette and electronic cigarette (e-cigarette) advertisement exposure by venue and sociodemographic correlates among US adolescents from 2012 to 2020. METHODS We conducted a serial cross-sectional analysis of nationally representative samples of middle and high school youth from the 2012-2020 National Youth Tobacco Survey. Advertisement exposure was defined as self-report of seeing advertisements "sometimes," "most of the time," and "always." The prevalence of cigarette (and other tobacco products) and e-cigarette advertisement exposure, including overall and at specific venues (Internet, press, screen, and retail stores), was estimated by survey year. RESULTS A total of 139 795 adolescents aged 11 to 19 years old were included in the analysis. The prevalence of exposure to combustible cigarette marketing remained high across all years (any venue ranging from 77.0% [2018] to 91.1% [2014]). An increasing trend for cigarette advertisement exposure was observed from 2017 to 2020 after a drop in 2015 (β2012-2015 = 2.8, P for trend < .001; β2017-2020 = .7, P for trend = .03), driven by retail store-based and Internet-based exposure. A similar increasing pattern in the estimated prevalence of e-cigarette marketing was observed (β2014-2016 = 4.6, P for trend < .001; β2017-2020 = 5.1, P for trend < .001). CONCLUSIONS Given the high estimated prevalence of cigarette and e-cigarette marketing exposure among US adolescents, further regulation efforts for both off-line and online tobacco marketing are needed to mitigate adolescent exposure to content regarding these products, reducing susceptibility to uptake.
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Affiliation(s)
| | | | | | | | | | - Chao Cao
- Program in Physical Therapy
- Center for Human Nutrition, School of Medicine, Washington University, St Louis, Missouri
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Durkin K, Williford DN, Turiano NA, Blank MD, Enlow PT, Murray PJ, Banvard-Fox C, Duncan CL. Associations Between Peer Use, Costs and Benefits, Self-Efficacy, and Adolescent E-cigarette Use. J Pediatr Psychol 2021; 46:112-122. [PMID: 33120416 PMCID: PMC8456300 DOI: 10.1093/jpepsy/jsaa097] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Prior research identified peer use as a salient risk factor of adolescent electronic cigarette (e-cigarette) use, but has not expanded on the mechanisms of this association. METHODS Participants were 562 adolescents recruited from rural and suburban public high schools and an adolescent medicine clinic in the mid-Atlantic United States. Participants completed a packet of questionnaires that assessed demographics, substance use, expectations about the consequences of e-cigarette use, and perceptions of their own self-efficacy to resist using e-cigarettes. We estimated a series of mediation models using the MODEL INDIRECT command in MPLUS statistical software. In all models, significance of indirect effects from peer e-cigarette use to self-reported e-cigarette use were tested via two variables: (a) expected costs, (b) benefits of e-cigarette use, and (c) the perceived self-efficacy of the individual to refrain from e-cigarette use. RESULTS Adolescents with more peers using e-cigarettes were more likely to have ever used an e-cigarette and perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 1). Those with more peers using e-cigarettes were more likely to be currently using e-cigarettes themselves because they perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 2). CONCLUSION Peer use, self-efficacy to resist use, and expectations of cost and benefits of e-cigarette use should be considered as possible targets when devising tailored interventions and policies to prevent or reduce negative health consequences of long-term e-cigarette use.
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Affiliation(s)
| | | | - Nicholas A Turiano
- Department of Psychology, West Virginia University
- WV Prevention Research Center, West Virginia University
| | - Melissa D Blank
- Department of Psychology, West Virginia University
- WV Prevention Research Center, West Virginia University
| | - Paul T Enlow
- Center for Healthcare Delivery Science, Nemours/A.I. DuPont Hospital for Children
| | | | | | - Christina L Duncan
- Department of Psychology, West Virginia University
- Department of Pediatrics, West Virginia University
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Hedman L, Backman H, Stridsman C, Lundbäck M, Andersson M, Rönmark E. Predictors of electronic cigarette use among Swedish teenagers: a population-based cohort study. BMJ Open 2020; 10:e040683. [PMID: 33376167 PMCID: PMC7778771 DOI: 10.1136/bmjopen-2020-040683] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim was to identify predictors of electronic cigarette (e-cigarette) use among teenagers. DESIGN AND SETTING A prospective population-based cohort study of schoolchildren in northern Sweden. PARTICIPANTS In 2006, a cohort study about asthma and allergic diseases among schoolchildren started within the Obstructive Lung Disease in Northern Sweden studies. The study sample (n=2185) was recruited at age 7-8 years, and participated in questionnaire surveys at age 14-15 and 19 years. The questionnaire included questions about respiratory symptoms, living conditions, upper secondary education, physical activity, diet, health-related quality of life, parental smoking and parental occupation. Questions about tobacco use were included at age 14-15 and 19 years. PRIMARY OUTCOME E-cigarette use at age 19 years. RESULTS At age 19 years, 21.4% had ever tried e-cigarettes and 4.2% were current users. Among those who were daily tobacco smokers at age 14-15 years, 60.9% had tried e-cigarettes at age 19 years compared with 19.1% of never-smokers and 34.0% of occasional smokers (p<0.001). Among those who had tried e-cigarettes, 28.1% were never smokers both at age 14-15 and 19 years, and 14.4% were never smokers among the current e-cigarette users. In unadjusted analyses, e-cigarette use was associated with daily smoking, use of snus and having a smoking father at age 14-15 years, as well as with attending vocational education, physical inactivity and unhealthy diet. In adjusted analyses, current e-cigarette use was associated with daily tobacco smoking at age 14-15 years (OR 6.27; 95% CI 3.12 to 12.58), attending a vocational art programme (OR 2.22; 95% CI 1.04 to 4.77) and inversely associated with eating a healthy diet (OR 0.74; 95% CI 0.59 to 0.92). CONCLUSIONS E-cigarette use was associated with personal and parental tobacco use, as well as with physical inactivity, unhealthy diet and attending vocational upper secondary education. Importantly, almost one-third of those who had tried e-cigarettes at age 19 years had never been tobacco smokers.
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Affiliation(s)
- Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
- Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
- Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University Faculty of Medicine, Umeå, Sweden
| | - Magnus Lundbäck
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
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Ben Taleb Z, Kalan ME, Bahelah R, Boateng GO, Rahman M, Alshbool FZ. Vaping while high: Factors associated with vaping marijuana among youth in the United States. Drug Alcohol Depend 2020; 217:108290. [PMID: 32956975 DOI: 10.1016/j.drugalcdep.2020.108290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of e-cigarette and other vaping devices have become popular among youth in US. In addition to nicotine, vaping devices can be used to vaporize marijuana. However, factors associated with vaping marijuana among youth remain unexplored. This study examined the rates of vaping marijuana and its correlates among youth in the US. METHODS We conducted a cross-sectional analysis of survey data from the 2018 National Youth Tobacco Survey of middle-and high-schoolers who provided information regarding ever use of vaping devices to vape marijuana (n = 10,680). Multivariable regression model was conducted to assess factors associated with vaping marijuana. RESULTS Overall, 26.2 % of participants reported ever vaping marijuana. High-schoolers [vs middle-schoolers; aOR = 2.16,95 %CI:1.76-2.67], Hispanics [vs Whites; aOR = 2.30,95 %CI:1.90-2.80], and Blacks [vs Whites; aOR = 1.42,95 %CI:1.04-1.92] were more likely to ever vape marijuana. Those who perceived e-cigarette as equally addictive to cigarettes, were less likely to ever vape marijuana [aOR = 0.79, 95 %CI:0.65-0.97]. In addition, those who reported ever trying cigarettes [aOR = 1.63,95 %CI:1.29-2.06], cigars [aOR = 2.62, 95 %CI:2.08-3.30], or hookah [aOR = 2.88,95 %CI:2.14-3.89] were more likely to ever vape marijuana. Lifetime frequency of e-cigarette use was associated with greater odds of ever vaping marijuana (p-values <0.001). CONCLUSION Large numbers of youth in the US have ever vaped marijuana. Our findings indicate that sociodemographic characteristics, tobacco product use, frequency of e-cigarette use are important factors associated with vaping marijuana. Tobacco control campaigns targeted at curbing the use of e-cigarette and other vaping devices among youth in the US should be extended to address vaping substances other than nicotine such as marijuana.
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Affiliation(s)
- Ziyad Ben Taleb
- Department of Kinesiology, University of Texas at Arlington, 411 S. Nedderman Drive Box 19407, Arlington, TX, 76019-0407, USA.
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Florida International University, 11200 SW 8thSt, Miami, FL, 33199, USA
| | - Raed Bahelah
- Department of Public Health & Prevention Science, Baldwin Wallace University, 275 Eastland Rd. Berea, OH, 44017, USA
| | - Godfred O Boateng
- Department of Kinesiology, University of Texas at Arlington, 411 S. Nedderman Drive Box 19407, Arlington, TX, 76019-0407, USA
| | - Mashikur Rahman
- Department of Mathematics, University of Texas at Arlington, 411 S. Nedderman Drive Box 19407, Arlington, TX, 76019-0407, USA
| | - Fatima Z Alshbool
- Department of Pharmacy Practice, Texas A&M University, 1010 West Avenue B, Kingsville, TX 78363, USA
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Navas-Acien A, Martinez-Morata I, Hilpert M, Rule A, Shimbo D, LoIacono NJ. Early Cardiovascular Risk in E-cigarette Users: the Potential Role of Metals. Curr Environ Health Rep 2020; 7:353-361. [PMID: 33242201 DOI: 10.1007/s40572-020-00297-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Electronic cigarettes (e-cigs) are a source of metals. Epidemiologic and experimental evidence support that metals are toxic to the cardiovascular system. Little is known, however, about the role that e-cig metals may play as toxicants for the possible cardiovascular effects of e-cig use. The goal of this narrative review is to summarize the evidence on e-cig use and metal exposure and on e-cig use and cardiovascular toxicity and discuss the research needs. RECENT FINDINGS In vitro studies show cytotoxicity and increased oxidative stress in myocardial cells and vascular endothelial cells exposed to e-liquids and e-cig aerosols, with effects partially reversed with antioxidant treatment. There is some evidence that the heating coil plays a role in cell toxicity. Mice exposed to e-cigs for several weeks showed higher levels of oxidative stress, inflammation, platelet activation, and thrombogenesis. Cross-over clinical experiments show e-cig use alters nitric oxide-mediated flow-mediated dilation, endothelial progenitor cells, and arterial stiffness. Cross-sectional evidence from large nationally representative samples in the USA support that e-cig use is associated with self-reported myocardial infarction. Smaller studies found associations of e-cig use with higher oxidized low-density protein and heart variability compared to healthy controls. Numerous studies have measured elevated levels of toxic metals in e-cig aerosols including lead, nickel, chromium, and manganese. Arsenic has been measured in some e-liquids. Several of these metals are well known to be cardiotoxic. Numerous studies show that e-cigs are a source of cardiotoxic metals. Experimental studies (in vitro, in vivo, and clinical studies) show acute toxicity of e-cigs to the vascular system. Studies of long-term toxicity in animals and humans are missing. Longitudinal studies with repeated measures of metal exposure and subclinical cardiovascular outcomes (e.g., coronary artery calcification) could contribute to determine the long-term cardiovascular effects of e-cigs and the potential role of metals in those effects.
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Affiliation(s)
- Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Irene Martinez-Morata
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Markus Hilpert
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nancy J LoIacono
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA.
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Ferrell A, Hadddad L, Harrison Elder J, Garvan C, Cook CL, Salloum R. Perceptions and Use of Electronic Nicotine Delivery Systems Among Floridian Middle and High School Students: Secondary Analysis of Cross-sectional Survey Results. Tob Use Insights 2020; 13:1179173X20953402. [PMID: 33994818 PMCID: PMC8079930 DOI: 10.1177/1179173x20953402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Rapid increase in youth use of Electronic Nicotine Delivery Systems (ENDS)
led the state and the federal governments to implement minimum-age policies
to restrict minors’ access to vaping products. Limited success of the age
restrictions fueled efforts to increase the distribution age of all tobacco
products to 21 (ie, Tobacco 21 or T21 policies). With limited data on the
T21 policies, the current study examines the prevalence of ENDS use and the
perceptions about ENDS among youth in the pre- and
post-policy-implementation periods for one of these bans in the state of
Florida. Methods: This study conducted secondary analysis on the responses from the 2014 and
2015 Florida Youth Tobacco Survey, which collected cross-sectional data. Results: Compared to the data from spring of 2014, the minimum-age policy enacted on
July 1, 2014 did not lead to a significant decrease in Florida’s high school
and middle school students’ ever ENDS use (14.9% in 2014 vs
25.8% in 2015) and current ENDS use (7.5% in 2014 vs 12.4%
in 2015). There was some ambiguity among students regarding the ENDS
harm—more students in 2015 thought of ENDS as both equally (11.0% vs 7.7%)
and less (32.4% vs 28%) harmful than cigarettes. There was a decrease in the
proportion of students who were unsure about their answer to this question
(51.5% vs 59.2%). Conclusions: Policy change alone may not be effective in shifting the trend of ENDS use
among middle and high school students. Although students may know about some
of the ENDS effects, many of them are still not aware about the harms.
Interventions in school and in the community should be aiming to raise this
awareness.
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Affiliation(s)
- Anastasiya Ferrell
- School of Nursing, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Linda Hadddad
- School of Nursing, University of North Carolina Wilmington, Wilmington, NC, USA
| | | | - Cyndi Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Christa L Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Ramzi Salloum
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
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14
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Struik LL, Dow-Fleisner S, Belliveau M, Thompson D, Janke R. Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements. J Med Internet Res 2020; 22:e18943. [PMID: 32663163 PMCID: PMC7455879 DOI: 10.2196/18943] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences. Objective The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television. Methods In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC). Results In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively. Conclusions The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages.
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Affiliation(s)
- Laura L Struik
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Sarah Dow-Fleisner
- School of Social Work, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Michelle Belliveau
- School of Social Work, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Desiree Thompson
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Robert Janke
- Library, University of British Columbia Okanagan, Kelowna, BC, Canada
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Milicic S, Piérard E, DeCicca P, Leatherdale ST. Examining the Association Between Physical Activity, Sedentary Behavior and Sport Participation With E-Cigarette Use and Smoking Status in a Large Sample of Canadian Youth. Nicotine Tob Res 2019; 21:285-292. [PMID: 29099946 DOI: 10.1093/ntr/ntx238] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/27/2017] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Youth e-cigarette use is common worldwide, but the profile of e-cigarette users compared with tobacco users is unclear. This study examines how sport participation and activity levels among youth differ between e-cigarette users and smokers. METHODS Using Canadian data from 38977 grade 9 to 12 students who participated in Year 3 (2014-15) of the COMPASS study, logistic regression models were used to examine the likelihood of sport participation and activity level based on e-cigarette use and smoking status. Pearson's chi-square tests were used to examine subgroup differences by gender. RESULTS E-cigarette users are more likely to participate in intramural, competitive, and team sports compared to non-users. Current and former smokers are less likely to participate in those sports than non-smokers. Youth e-cigarette users are more likely than non-users to meet the physical activity guidelines. Current smokers are more likely than non-smokers to undertake physical activity at least 60 min daily but less likely than non-smokers to tone at least 3 times per week. Youth e-cigarette users are less likely than non-users to be sedentary less than 2 h daily. Gender differences among males and females show that male e-cigarettes users drive the general relationship. CONCLUSION Results suggest that e-cigarette users are more likely to engage in physical activity compared to non e-cigarette users. Youth e-cigarette users are more likely to be physically active while the opposite is true for smokers. Although e-cigarettes may be less harmful to health compared to cigarette smoking, the increased uptake among youth of differing profiles should be considered in prevention efforts. IMPLICATIONS These results highlight the importance of addressing e-cigarette use in youth who undertake health promoting behaviors. Prevention efforts should not focus only on youth who may undertake riskier health habits; e-cigarette prevention programs should go beyond the domain of tobacco control.
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Affiliation(s)
- Sandra Milicic
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Emma Piérard
- Department of Economics, University of Waterloo, Waterloo, ON
| | - Philip DeCicca
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON.,Department of Economics, McMaster University, Department of Economics, Hamilton, ON
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
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Bigwanto M, Nurmansyah MI, Orlan E, Farradika Y, Purnama TB. Determinants of e-cigarette use among a sample of high school students in Jakarta, Indonesia. Int J Adolesc Med Health 2019; 34:/j/ijamh.ahead-of-print/ijamh-2019-0172/ijamh-2019-0172.xml. [PMID: 31800392 DOI: 10.1515/ijamh-2019-0172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to determine the predisposing, enabling and reinforcing factors associated with electronic cigarette (e-cigarette) use among high school students in Jakarta, Indonesia. METHODS This cross-sectional study took place in eight high schools in Jakarta, Indonesia. A total of 767 students were recruited by multistage cluster random sampling. Bivariate and multivariate statistical analyses were employed to determine the associations between socio-demographic, predisposing, reinforcing and enabling factors and e-cigarette use. RESULTS Respondents were 54.1% male and the mean age was 16 years old [standard deviation (SD): 1.02]. In this sample, 32.2% of students (n = 247) had ever used e-cigarettes and 11.8% of students were e-cigarette users (n = 90). Several measured factors were positively associated with e-cigarette use, including: current smoking of conventional cigarettes [odds ratio (OR): 2.06]; perception that e-cigarettes are less addictive than conventional cigarettes (OR: 1.98); perception that e-cigarettes do not cause cancer (OR: 2.38); parental acceptance of e-cigarette use (OR: 3.80); and having enough money to buy e-cigarettes (OR: 3.24). The only variable found that was negatively associated with e-cigarette use was teacher's use of e-cigarettes (OR: 0.34). CONCLUSIONS This study found that student social influences, perceptions about and accessibility to e-cigarettes were significantly positively associated with e-cigarette use among high school students in Jakarta, Indonesia. This study highlights the importance of educating students, their parents and teachers regarding safety and potential health hazards of using e-cigarettes. Efforts to implement and enforce youth access restrictions on e-cigarettes in Indonesia are crucial to preventing further uptake of these products.
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Affiliation(s)
- Mouhamad Bigwanto
- University of Muhammadiyah Prof. Dr. Hamka, Faculty of Health Sciences, South Jakarta, Indonesia
| | - Mochamad Iqbal Nurmansyah
- Universitas Islam Negeri Syarif Hidayatullah Jakarta, Faculty of Health Science, Kertamukti No. 5 South Tangerang, Banten, 15412, Indonesia
| | - Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yoli Farradika
- University of Muhammadiyah Prof. Dr. Hamka, Faculty of Health Sciences, South Jakarta, Indonesia
| | - Tri Bayu Purnama
- Faculty of Public Health, Universitas Islam Negeri Sumatera Utara, Medan, Indonesia
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Jongenelis MI, Brennan E, Slevin T, Kameron C, Jardine E, Rudaizky D, Pettigrew S. Factors associated with intentions to use e-cigarettes among Australian young adult non-smokers. Drug Alcohol Rev 2019; 38:579-587. [PMID: 31317596 DOI: 10.1111/dar.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS A growing body of evidence suggests e-cigarette use increases the risk of conventional cigarette use. Assessing the factors associated with intentions to use e-cigarettes can inform programs designed to minimise uptake, potentially assisting in preventing a new population of smokers. This study developed and tested a model assessing the importance of various factors that may be associated with intentions to use e-cigarettes among young adults who have never used e-cigarettes or tobacco cigarettes. DESIGN AND METHODS A web-panel provider recruited 429 Australian 18- to 25-year-olds who had never used e-cigarettes or smoked tobacco cigarettes (56% female, mean age = 21.17 years). Various individual and social factors were assessed as potential direct and indirect predictors of e-cigarette use intentions. RESULTS The developed model provided an excellent fit to the data and accounted for 49% of the variance in use intentions. Males had greater intentions to use e-cigarettes compared to females (β = -0.13). Having a greater number of friends who smoke tobacco cigarettes (β = 0.11) and curiosity about e-cigarette use (β = 0.58) were also directly associated with greater use intentions. Positive expectancies about e-cigarettes (β = 0.14), having family members who use e-cigarettes (β = 0.11), and having friends who smoke tobacco cigarettes (β = 0.07) were indirectly associated with intentions via curiosity. DISCUSSION AND CONCLUSIONS Curiosity about e-cigarette use was strongly associated with use intentions. Aspects of the social environment were also important. Further research is needed to identify effective means of challenging positive e-cigarette expectancies given these were found to be strongly associated with intentions via curiosity.
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Affiliation(s)
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Terry Slevin
- School of Psychology, Curtin University, Perth, Australia.,Public Health Association of Australia, Canberra, Australia
| | - Caitlin Kameron
- School of Psychology, Curtin University, Perth, Australia.,Cancer Council WA, Perth, Australia
| | | | - Daniel Rudaizky
- School of Psychological Sciences, The University of Western Australia, Perth, Western Australia, Australia
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18
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Cavallo DA, Kong G, Ells DM, Camenga DR, Morean ME, Krishnan-Sarin S. Youth generated prevention messages about electronic cigarettes. HEALTH EDUCATION RESEARCH 2019; 34:247-256. [PMID: 30753438 PMCID: PMC6424147 DOI: 10.1093/her/cyz001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/01/2019] [Indexed: 05/16/2023]
Abstract
Rates of e-cigarette use are high among youth, and there is little known about the long-term health effects of e-cigarettes. Since peer influence is a powerful determinant of tobacco use, we aimed to identify message themes about e-cigarettes that youth would use to encourage or discourage peers from using e-cigarettes. We conducted 10 focus groups (N = 69) with non-smokers and smokers from one middle school, high school and college in Connecticut. Participants engaged in a discussion about e-cigarettes, and each participant created one written message to encourage e-cigarette use and one to discourage use among peers. We content-analyzed the messages and identified three main themes and 12 encouraging and discouraging sub-themes. Encouraging themes included health benefits of e-cigarettes relative to cigarettes, attractive product characteristics (e.g. flavors) and social advantages (e.g. positive social image) of using e-cigarettes. Discouraging messages included health risks of e-cigarettes relative to cigarettes, unattractive product characteristics (e.g. cost) and social disadvantages (e.g. negative social image of using an e-cigarette). Overall, there were no differences by sex, age group or smoking status in generation of encouraging and discouraging message themes. This study identified youth-generated themes that may aid in e-cigarette prevention among youth.
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Affiliation(s)
- Dana A Cavallo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel M Ells
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Deepa R Camenga
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Meghan E Morean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Oberlin College, Oberlin, OH, USA
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19
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Lozano P, Arillo-Santillán E, Barrientos-Gutíerrez I, Shigematsu LMR, Thrasher JF. E-Cigarette Social Norms and Risk Perceptions Among Susceptible Adolescents in a Country That Bans E-Cigarettes. HEALTH EDUCATION & BEHAVIOR 2019; 46:275-285. [PMID: 30606077 PMCID: PMC6438717 DOI: 10.1177/1090198118818239] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study examined how risk perceptions and social norms around e-cigarettes are associated with susceptibility (i.e., openness to using the product in the next 12 months) of e-cigarettes and smoking among adolescents. METHODS We analyzed data from a 2016 representative survey of 8,718 middle school students in Mexico. The study sample was restricted to students who had tried neither e-cigarettes nor cigarettes, ( N = 4471). Students reported on the risks of e-cigarettes compared with those of cigarettes, and product-specific norms were measured by assessing current use by family members, at least one close friend, and, for e-cigarettes, by perceived societal acceptability of use (i.e., acceptability among people in general). Adjusted prevalence ratios (APR) were estimated using generalized estimating equation models that regressed e-cigarette societal acceptability on study variables. Adjusted generalized estimating equation models also regressed susceptibility for each product on study variables. RESULTS Susceptibility to both e-cigarettes and smoking was higher among students who reported that their family and friends used only cigarettes or both products when compared with students whose family and friends did not use either of these products. Friend use of e-cigarettes was associated with e-cigarette susceptibility (APR = 1.33) but not smoking susceptibility. Students who perceived that e-cigarettes were less risky than smoking were more susceptible to e-cigarette use (APR = 1.45). The association between e-cigarette susceptibility and friend or family use was not mediated by societal acceptability. CONCLUSIONS E-cigarette use among family and peers appears associated with susceptibility to use e-cigarettes in a way that is similar to the patterns found for cigarettes. However, the influences appear somewhat specific to the type of product that network members use.
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Affiliation(s)
- Paula Lozano
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Edna Arillo-Santillán
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
| | - Inti Barrientos-Gutíerrez
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
| | - Luz Myriam Reynales Shigematsu
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
| | - James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
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20
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Chaffee BW, Cheng J. Tobacco product initiation is correlated with cross-product changes in tobacco harm perception and susceptibility: Longitudinal analysis of the Population Assessment of Tobacco and Health youth cohort. Prev Med 2018; 114:72-78. [PMID: 29913179 PMCID: PMC6082707 DOI: 10.1016/j.ypmed.2018.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/04/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
Youth initiation with one tobacco product is associated with risk of using additional tobacco types. How use of one product potentially encourages use of others could result from changing tobacco-related perceptions. This study aimed to evaluate how tobacco product initiation correlates with changes in susceptibility (curiosity and willingness) and perceived harm of other tobacco products. For each of cigarettes, e-cigarettes, hookah, and smokeless tobacco, youth (ages 12-16; N = 8005) rated perceived harm, curiosity, and willingness to try in Waves 1 and 2 of the Population Assessment of Tobacco and Health (United States, 2013-2015). For each product, we estimated associations between decreased harm rating, increased curiosity, or increased willingness with initiation (from never- to ever-use) of cigarettes, e-cigarettes, hookah, smokeless tobacco, or other combustible products using multivariate (multiple outcomes) regression, adjusting for other tobacco risk factors. Tobacco product initiation was associated with decreased perceived harm for that product and with decreased perceived harm, increased curiosity, and increased willingness in some, but not all, cross-product combinations. Most cross-product combinations of initiation and susceptibility yielded positive associations. For example, trying e-cigarettes was associated with concomitant increases in curiosity about cigarettes (OR: 5.69; 95% CI: 3.68, 8.79) and hookah (OR: 4.19; 95% CI: 2.55, 6.88) and with increased willingness to try cigarettes (OR: 9.61; 95% CI: 5.67, 16.3), hookah (OR: 8.46; 95% CI: 4.76, 15.0), and smokeless tobacco (OR: 3.48; 95% CI: 1.75, 6.94). New use of one tobacco product may catalyze subsequent use of others through cross-product changes in perceptions and susceptibility.
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Affiliation(s)
- Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA; Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.
| | - Jing Cheng
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA; Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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21
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Carey FR, Wilkinson AV, Harrell MB, Cohn EA, Perry CL. Measurement and predictive value of susceptibility to cigarettes, e-cigarettes, cigars, and hookah among Texas adolescents. Addict Behav Rep 2018; 8:95-101. [PMID: 30140729 PMCID: PMC6104349 DOI: 10.1016/j.abrep.2018.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
Susceptibility to cigarette smoking, defined as the lack of a firm commitment not to smoke in the future, begins in childhood and is a phase in the transition from never to ever use of cigarettes. While a consistent and validated predictor of cigarette use, little research has assessed whether the susceptibility construct applies equally well across other tobacco products. Baseline data were collected in 2014–2015 from a representative sample of (n = 2844) middle and high school students in five counties surrounding the four largest cities in Texas, (49% female and mean age 13.13 years, with subsequent waves at 6, 12, and 18 months. Confirmatory factor analysis examined the appropriateness of a three-item susceptibility measure (product-specific curiosity, intention to use, and peer influence) across product types and ethnic groups (Hispanic versus non-Hispanic). Logistic regression examined whether product specific susceptibility at baseline predicted future product initiation. At baseline, 11.5%, 17.0%, 17.4% and 29.4%, of adolescent never users were susceptible to cigars, cigarettes, hookah and e-cigarettes, respectively; significantly more Hispanic than non-Hispanic adolescents were susceptible to e-cigarettes (32.4% versus 26%, p < 0.01) and cigarettes (19.9% versus 13.9%, p < 0.05). Product-specific items were significantly and consistently associated with the respective underlying susceptibility product construct and across ethnic groups (p < 0.001 for all). Susceptibility to e-cigarettes (AOR = 2.28–6.64) or any combustible product (cigarettes, hookah, cigars; AOR = 3.38–5.20) significantly predicted subsequent ever use. This study confirms the appropriateness of the susceptibility construct across four tobacco product types and ethnic groups, and the utility of susceptibility in predicting future product use among adolescents. Susceptibility to e-cigarettes and combustible tobacco products is robustly measured by the same three product-specific items Product-specific susceptibility constructs predicted use of respective tobacco products at 6, 12, and 18 months post-baseline Susceptibility to e-cigarettes and combustible tobacco products can be measured reliably in Hispanic and non-Hispanic youth
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Affiliation(s)
- Felicia R Carey
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Anna V Wilkinson
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Melissa B Harrell
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Elisabeth A Cohn
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
| | - Cheryl L Perry
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, United States of America
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Margolis KA, Donaldson EA, Portnoy DB, Robinson J, Neff LJ, Jamal A. E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Prev Med 2018; 112:119-125. [PMID: 29673886 PMCID: PMC5971002 DOI: 10.1016/j.ypmed.2018.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 12/15/2022]
Abstract
Understanding factors associated with youth e-cigarette openness and curiosity are important for assessing probability of future use. We examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey (NYTS) were analyzed. The 2015 NYTS is a nationally representative survey of 17,711 U.S. middle and high school students. We calculated weighted prevalence estimates of never users of tobacco products (cigarettes, cigars/cigarillos/little cigars, waterpipe/hookah, smokeless tobacco, bidis, pipes, dissolvables, e-cigarettes) who were open to or curious about e-cigarette use, by demographics. Weighted regression models examined how e-cigarette harm perceptions and advertising exposure were associated with openness using e-cigarettes and curiosity about trying e-cigarettes. Among respondents who never used tobacco products, 23.8% were open to using e-cigarettes and 25.4% were curious. Respondents that perceived e-cigarettes cause a lot of harm had lower odds of both openness (OR = 0.10, 95% CI = 0.07, 0.15) and curiosity about e-cigarettes (OR = 0.10, 95% CI = 0.07, 0.13) compared to those with lower harm perception. Respondents who reported high exposure to e-cigarette advertising in stores had greater odds of being open to e-cigarette use (OR = 1.22, 95% CI = 1.03, 1.44) and highly curious (OR = 1.25, 95% CI = 1.01, 1.53) compared to those not highly exposed. These findings demonstrate that youth exposed to e-cigarette advertising are open and curious to e-cigarette use. These findings could help public health practitioners better understand the interplay of advertising exposure and harm perceptions with curiosity and openness to e-cigarette use in a rapidly changing marketplace.
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Affiliation(s)
- Katherine A Margolis
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States.
| | - Elisabeth A Donaldson
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - David B Portnoy
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Joelle Robinson
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Linda J Neff
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA, United States
| | - Ahmed Jamal
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA, United States
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Lisdahl KM, Sher KJ, Conway KP, Gonzalez R, Feldstein Ewing SW, Nixon SJ, Tapert S, Bartsch H, Goldstein RZ, Heitzeg M. Adolescent brain cognitive development (ABCD) study: Overview of substance use assessment methods. Dev Cogn Neurosci 2018; 32:80-96. [PMID: 29559216 PMCID: PMC6375310 DOI: 10.1016/j.dcn.2018.02.007] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 02/01/2018] [Accepted: 02/16/2018] [Indexed: 12/21/2022] Open
Abstract
One of the objectives of the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org/) is to establish a national longitudinal cohort of 9 and 10 year olds that will be followed for 10 years in order to prospectively study the risk and protective factors influencing substance use and its consequences, examine the impact of substance use on neurocognitive, health and psychosocial outcomes, and to understand the relationship between substance use and psychopathology. This article provides an overview of the ABCD Study Substance Use Workgroup, provides the goals for the workgroup, rationale for the substance use battery, and includes details on the substance use module methods and measurement tools used during baseline, 6-month and 1-year follow-up assessment time-points. Prospective, longitudinal assessment of these substance use domains over a period of ten years in a nationwide sample of youth presents an unprecedented opportunity to further understand the timing and interactive relationships between substance use and neurocognitive, health, and psychopathology outcomes in youth living in the United States.
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Affiliation(s)
- Krista M Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 East Hartford Ave, 224 Garland Hall, Milwaukee, WI, 53211, United States.
| | - Kenneth J Sher
- Curators' Professor of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, United States
| | - Kevin P Conway
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse,6001 Executive Boulevard, Bethesda, MD 20892, United States
| | - Raul Gonzalez
- Department of Psychology, Florida International University,11200 SW 8th Street AHC-4, 461, Miami, FL 33199, United States
| | - Sarah W Feldstein Ewing
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Mail code: DC7P, 3181 SW Sam Jackson Park Rd, Portland OR 97239, United States
| | - Sara Jo Nixon
- Department of Psychiatry, P.O. Box 100256, University of Florida, Gainesville, FL 32610, United States
| | - Susan Tapert
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, United States
| | - Hauke Bartsch
- Center for Multimodal Imaging and Genetics, Department of Radiology, University of California, San Diego,9452 Medical Center Drive, La Jolla, CA, 92037, United States
| | - Rita Z Goldstein
- Department of Psychiatry (primary) and Department of Neuroscience, Friedman Brain Institute (secondary), Chief, Brain Imaging Center (BIC), Icahn School of Medicine at Mount Sinai, The Leon and Norma Hess Center for Science and Medicine, 1470 Madison Ave, New York, NY 10029, United States
| | - Mary Heitzeg
- Department of Psychiatry, University of Michigan,4250 Plymouth Road, Ann Arbor, MI 48109, United States
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24
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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