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Zhang L, Ao SH, Zhao X. A four-year longitudinal analysis examining the effects of e-cigarette advertisements and disparities among youth with internalizing problems. Addict Behav 2024; 153:108002. [PMID: 38430643 DOI: 10.1016/j.addbeh.2024.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Prior research indicates a direct, short-term effect of e-cigarette advertising on e-cigarette use among youth. This study seeks to investigate the long-term effects of e-cigarette advertisements and disparities in exposure among adolescents with different levels of internalizing problems. METHODS Panel data of the Population Assessment of Tobacco and Health (PATH) Study Waves 3-5 (2015-2019) were analyzed. Youth aged 12-17 who were non-e-cigarette users at the time of Wave 3 were included (n = 4,678). A moderated mediation model was employed to examine the mediating role of perceived harm of e-cigarettes and the moderating effect of internalizing problems. RESULTS Exposure to e-cigarette advertisements in Wave 3 predicted lower harm perception of e-cigarette in Wave 4 (bp = -0.055, p <.01), leading to more e-cigarette use in Wave 5 (bp = -0.042, p <.001). While e-cigarette advertisements exhibited a lasting indirect effect (bp = 0.002, p <.05), there was no long-term direct effect (bp = 0.017, p >.05) on youth e-cigarette use. Furthermore, a moderating effect of internalizing problems was observed (bp = 0.107, p <.05). CONCLUSIONS E-cigarette advertisements can exert a lasting influence indirectly by diminishing harm perception, particularly among those with lower internalizing problems. Adolescents with higher internalizing problems exhibit lower susceptibility to advertisement influence, yet their perceived harm of e-cigarettes is notably lower than their peers with fewer internalizing problems. These disparities underscore the need for tailored prevention strategies: implementing anti-e-cigarette education programs for adolescents with low internalizing problems and providing mental health care for those facing internalizing challenges. Regulatory measures targeting e-cigarette advertising are also crucial.
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Affiliation(s)
- Luxi Zhang
- Department of Communication / Institute of Collaborative Innovation, University of Macau, Macau
| | - Song Harris Ao
- Department of Communication / Institute of Collaborative Innovation / Center for Research in Greater Bay Area, University of Macau, Macau
| | - Xinshu Zhao
- Department of Communication / Institute of Collaborative Innovation / Center for Research in Greater Bay Area, University of Macau, Macau.
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Li W, Kalan ME, Kondracki AJ, Gautam P, Jebai R, Osibogun O. Longitudinal impact of perceived harm and addiction on e-cigarette initiation among tobacco-naïve youth: Population Assessment of Tobacco and Health study (Waves 1-5). Public Health 2024; 230:52-58. [PMID: 38507916 PMCID: PMC11025441 DOI: 10.1016/j.puhe.2024.02.021] [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: 09/28/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES This study investigates the effect of e-cigarette-related harm and addiction perceptions on e-cigarette initiation among US tobacco-naïve adolescents. STUDY DESIGN This is a longitudinal study. METHODS Using data from five waves (2013-2019) of the Population Assessment of Tobacco and Health Study, we created a longitudinal data set for 2775 youth aged 12-17 years who had no prior use of tobacco products at Wave 1. E-cigarette initiation was defined as transitioning from non-use at Wave 1 to ever use in subsequent waves. Kaplan-Meier survival and Cox proportional hazard regression models were used to assess the impact of harm and addiction perceptions on e-cigarette initiation. RESULTS Our analytic sample comprised 63.1% of youth who had never used tobacco products at Wave 1 and consequently initiated e-cigarette use in subsequent waves. Over time, fewer individuals perceived e-cigarettes as harmless (14.1%-2.1%), whereas more perceived them as likely to cause addiction (53.7%-76.6%). Compared with perceiving e-cigarettes as a lot of harm, those perceiving some harm (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.12-1.52), little harm (aHR = 1.42, 95% CI: 1.20-1.68), or no harm (aHR = 2.09, 95% CI: 1.64-2.65) were more likely to initiate e-cigarette use. Demographic factors for initiation included being Black or Hispanic ethnicity (vs White), younger age (12-14 vs15-17 years), and receiving over $20 per week (vs $0) in pocket money, with P-values <0.05. However, in adjusted results, addiction perceptions did not significantly impact e-cigarette initiation (P-values >0.05). CONCLUSIONS Among youth without prior tobacco/nicotine use, perceiving e-cigarettes as having low harm significantly predicted initiation over time. Effective prevention strategies, including targeted risk communication interventions, are essential for discouraging e-cigarette use among youth.
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Affiliation(s)
- W Li
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
| | - M E Kalan
- School of Health Professionals, Eastern Virginia Medical School, Norfolk, VA, USA
| | - A J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Savannah, GA, USA
| | - P Gautam
- Texas State Board of Pharmacy, Austin, TX, USA
| | - R Jebai
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, MA, USA
| | - O Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
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Li W, Osibogun O. Time-Varying Determinants of Changes in E-Cigarette Relative Harm Perception Among US Young Adults. Int J Behav Med 2024; 31:276-283. [PMID: 37184820 DOI: 10.1007/s12529-023-10181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Current e-cigarette use has increased among young adults in the USA despite a consistent decrease in perceiving e-cigarettes as less harmful than cigarettes over time. This study examined time-varying predictors associated with the changes in e-cigarette relative harm perception over time among US young adults. METHODS Data were from the 2013-2018 Population Assessment of Tobacco and Health (PATH) Study for young adults (18-24 years). A time-varying effect model (TVEM) was applied to examine the association between the relative harm perception change and the associated time-varying predictors. RESULTS Of the 8427 young adults, the prevalence of those who perceived e-cigarettes as less harmful than cigarettes decreased from 50.3% in Wave 1 (2013-2014) to 27.7% in Wave 4 (2016-2018). Young adults who were male were more likely to perceive e-cigarettes as less harmful than cigarettes over time (OR = 1.58; 95%CI, 1.53-1.64). In addition, the changes in e-cigarette relative harm perception were less noticeable among those with advanced degrees, who had non-combustible smoke-free home rules, who held negative tobacco-related attitudes, and those who were current e-cigarette users or ever used alcohol (all p values < 0.05). CONCLUSIONS A decline was observed in US young adults who perceived e-cigarettes as less harmful than cigarettes from the PATH Study across four waves (2013-2018). The study findings underscore the importance of risk communication that focuses on harm perception profiles and the need for appropriate interventions to balance the considerations of e-cigarette use among young adults.
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Affiliation(s)
- Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University, S-206, 34 Park St, New Haven, CT, 06519, USA.
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
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Patterson JG, Keller-Hamilton B, Wedel A, Vázquez-Otero C, Liu J, Lee D, Stevens EM, Wagener TL. Absolute and relative e-cigarette harm perceptions among young adult lesbian and bisexual women and nonbinary people assigned female at birth. Addict Behav 2023; 146:107788. [PMID: 37429104 PMCID: PMC10529580 DOI: 10.1016/j.addbeh.2023.107788] [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: 02/18/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Young adult lesbian and bisexual women report considerable e-cigarette disparities, which may be attributed to low harm perceptions. No studies have assessed differences in e-cigarette harm perceptions in this group, nor which factors might be intervention targets to influence harm perceptions. MATERIALS AND METHODS We investigated differences in and modifiable correlates of e-cigarette harm perceptions among young adult lesbian and bisexual women and non-binary people assigned female at birth. Young adult women and non-binary people assigned female at birth, aged 18-30 years old, and who self-identified as lesbian or bisexual (N = 471) reported absolute and relative harm perceptions of e-cigarettes to health in an online survey. We modeled associations between harm perceptions and individual, interpersonal, and contextual factors. RESULTS Bisexual (vs. lesbian) participants perceived higher absolute harm of e-cigarettes (Mean (M) = 7.61 vs M = 7.09, p = .03). Participants rated e-cigarettes as slightly less harmful than cigarettes, and there was no statistically significant difference by sexual orientation (Bisexual: M = 4.84 vs Lesbian: M = 4.36). In multivariable models, bisexual (vs. lesbian) participants and Hispanic/Latinx and Other race (vs. non-Hispanic White) participants reported higher absolute and relative e-cigarette harm perceptions. Greater sexual identify affirmation and greater perceived stress were associated with higher absolute and relative e-cigarette harm perceptions. CONCLUSIONS E-cigarette harm perceptions vary vis-à-vis individual-level factors. Self-identification as bisexual or minoritized race/ethnicity, greater sexual identity affirmation, and greater perceived stress was associated with increased harm perceptions. Understanding variations may inform targeted health communications to reduce e-cigarette use disparities.
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Affiliation(s)
- Joanne G Patterson
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, 1841 Neil Avenue, Columbus, OH 43120, USA; The Ohio State University Comprehensive Cancer Center, Cancer Control Program, 460 W. 10th Ave, Columbus, OH 43120, USA; Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Rd, Columbus, OH 43214, USA.
| | - Brittney Keller-Hamilton
- The Ohio State University Comprehensive Cancer Center, Cancer Control Program, 460 W. 10th Ave, Columbus, OH 43120, USA; Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Rd, Columbus, OH 43214, USA; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Rd, Columbus, OH 43221, USA
| | - Amelia Wedel
- Department of Psychology, Syracuse University, 430 Hunting Hall, Syracuse, NY 13244, USA
| | - Coralia Vázquez-Otero
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, One UTSA Circle, Main Building 2.306, San Antonio, TX 78249, USA
| | - Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, 3145 Porter Drive, Palo Alto, CA 94304, USA
| | - Donghee Lee
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01655, USA
| | - Elise M Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01655, USA
| | - Theodore L Wagener
- The Ohio State University Comprehensive Cancer Center, Cancer Control Program, 460 W. 10th Ave, Columbus, OH 43120, USA; Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Rd, Columbus, OH 43214, USA; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Rd, Columbus, OH 43221, USA
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Li W, Osibogun O, Gautam P, Li T, Cano MÁ, Maziak W. Effect of harm perception on ENDS initiation among US adolescents and young adults: Longitudinal findings from the population assessment of tobacco and health (PATH) study, 2013-2018. Drug Alcohol Depend 2023; 244:109784. [PMID: 36706674 DOI: 10.1016/j.drugalcdep.2023.109784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study investigates how ENDS harm perception influences ENDS initiation over time among US young people. METHODS Data were from the sample of the Population Assessment of Tobacco and Health (PATH) Study conducted from 2013 to 2018. The Cox proportional hazards regression models were used to assess the relationship between absolute (the perception of harm from ENDS only) and relative harm perception (ENDS' harm relative to cigarettes) and ENDS initiation among adolescents (12-17 years) and young adults (18-24 years) separately. Harm perception was assessed at the wave before ENDS initiation in a subsequent wave. Weighted results were reported. RESULTS Of the 11,633 adolescents and 5089 young adults from baseline, 17.1% and 25.5% initiated ENDS use across four waves, respectively. Among adolescents (HR=2.31; 95%CI: 1.95-2.73) and young adults (HR=1.97; 95%CI: 1.69-2.30), perceiving lower relative harm of ENDS significantly predicted ENDS initiation in subsequent waves. Among adolescents, perceiving lower absolute harm of ENDS (HR=2.18; 95%CI: 1.83-2.60) predicted ENDS initiation in subsequent waves. Additionally, adolescents and young adults who ever used any other tobacco products or alcohol and lived with anyone who used tobacco were more likely to initiate ENDS use. CONCLUSIONS Among a representative longitudinal cohort of adolescents and young adults who had never used ENDS at baseline, perceiving ENDS as reduced or low-harm products significantly predicted ENDS initiation in subsequent waves. These findings underscore the importance of ENDS harm perception and the central role of risk communication strategies that need to target those young people at particular risk of unwarranted ENDS use.
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Affiliation(s)
- Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Prem Gautam
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA; Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
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Wade NE, Courtney KE, Doran N, Baca R, Aguinaldo LD, Thompson C, Finegan J, Jacobus J. Young Adult E-Cigarette and Combustible Tobacco Users Attitudes, Substance Use Behaviors, Mental Health, and Neurocognitive Performance. Brain Sci 2022; 12:brainsci12070889. [PMID: 35884696 PMCID: PMC9312928 DOI: 10.3390/brainsci12070889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 02/05/2023] Open
Abstract
Nicotine and tobacco product (NTP) use has escalated, largely due to the advent of e-cigarettes. The NTP administration method (i.e., combustible cigarette, e-cigarette) may be an important differentiator. We assessed young adult substance use history, nicotine attitudes, mental health, and neurocognition by the NTP use method. Emerging adults (16–22 year olds) were divided into combustible NTP users (Combustible+ = 79, had used any combustible NTP in the last 6 months), non-combustible users (E-Cig = 43, had used non-combustible NTP, in the past 6 months), and NTP Naïve (n = 79; had not used NTP in the past 6 months) based on past 6-month NTP use patterns. Participants completed self-report and objective neurocognition measures. Analysis of covariance assessed mental health and neurocognition by group, controlling for confounds and correcting for multiple comparisons. Nicotine groups reported more favorable attitudes toward combustible cigarette and e-cigarette use, with taste as the primary reason for e-cigarette use. Combustible+ reported more nicotine dependence and craving. Substance use differed by group, with Combustible+ using the most NTP, alcohol, and cannabis. Nicotine groups reported higher depression and stress symptoms; male Combustible+ reported higher depression symptoms than other same-gender groups. Groups did not differ on neurocognition, though cannabis use was associated with inaccurate emotional Stroop responses. Overall, research suggests that young adult combustible users are likely qualitatively different from non-combustible users. Understanding the unique characteristics related to NTP product use will help guide intervention and prevention development.
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