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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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Assari S, Najand B, Sheikhattari P. Household Income and Subsequent Youth Tobacco Initiation: Minorities' Diminished Returns. JOURNAL OF MEDICINE, SURGERY, AND PUBLIC HEALTH 2024; 2:100063. [PMID: 38425566 PMCID: PMC10900246 DOI: 10.1016/j.glmedi.2024.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Introduction Household income, a prominent socioeconomic status (SES) indicator, is known to mitigate youth engagement in various health risk behaviors, including tobacco use. Nevertheless, the Minorities' Diminished Returns theory suggests that this protective effect may be less pronounced for racial and ethnic minorities compared to majority groups. This study aimed to investigate the protective role of high household income against tobacco use among youth and explore potential variations across different racial and ethnic groups. Methods Conducted as a longitudinal analysis, this study utilized data from the initial three years of the Adolescent Brain Cognitive Development (ABCD) Study spanning 2016-2022. The cohort consisted of 11,875 American youth aged 9-10 years, tracked over a three-year period. The dependent variable was tobacco initiation, irrespective of the product, while household income served as the independent variable. Covariates included youth age, gender, family education, structure, and employment, with race/ethnicity acting as the moderating variable. Results Out of the 8,754 American youth who were non-smokers at baseline, 3.1% (n = 269) initiated tobacco use during the 30-month follow-up, while 96.9% (n = 8,485) remained non-smokers. A family income exceeding $100,000 per year was associated with a lower hazard ratio for tobacco initiation (transitioning to ever-use) over the follow-up period (HR = 0.620, p = 0.022). However, household income of $50-100k exhibited significant interactions with race/ethnicity on tobacco initiation, indicating weaker protective effects for Black (HR for interaction = 7.860, p < 0.001) and Latino (HR for interaction = 3.461, p = 0.001) youth compared to non-Latino White youth. Conclusions Within the United States, the racialization and minoritization of youth diminish the protective effects of economic resources, such as high household income, against the transition to tobacco use. Non-Latino White youth, the most socially privileged group, experience greater protection from their elevated household income regarding tobacco initiation compared to Black and Latino youth, who face minoritization and racialization. Policymakers should address not only the SES gap but also the mechanisms contributing to the heightened risk of tobacco use among racialized and minoritized youth from affluent backgrounds.
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Affiliation(s)
- Shervin Assari
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Marginalization-related Diminished Returns (MDRs) Center, Los Angeles, CA, United States
| | - Babak Najand
- Marginalization-related Diminished Returns (MDRs) Center, Los Angeles, CA, United States
| | - Payam Sheikhattari
- Department of Behavioral Health Science, School of Community Health and Policy, Morgan State University, Baltimore, MD, United States
- Prevention Sciences Research Center, Morgan State University, Baltimore, MD, United States
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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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Le TTH, Le TH, Le MD, Nguyen TT. Exposure to E-Cigarette Advertising and Its Association With E-Cigarette Use Among Youth and Adolescents in Two Largest Cities in Vietnam 2020. Tob Use Insights 2023; 16:1179173X231179676. [PMID: 37255579 PMCID: PMC10226302 DOI: 10.1177/1179173x231179676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/14/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND E-cigarette products have become more popular due to the marketing campaigns on various sources but caused adverse health impacts to users, especially adolescents and youths. This paper aims to describe the situation of exposure to e-cigarette advertisements of youth and adolescents living in two cities of Hanoi and Ho Chi Minh in 2020 and identify the associated factors of e-cigarette marketing with e-cigarettes use in these groups. METHODOLOGY This was a cross-sectional study. The study participants were 1211 youth and adolescents aged 15-24 living in Hanoi and Ho Chi Minh City during the time of data collection (from January 2020 to September 2020). Two primary outcome variables included the ever e-cigarettes use and the intention to use e-cigarettes. Multivariate logistic regression models were used to assess the association between the outcome variables and e-cigarette marketing exposure. RESULTS The proportion of participants who ever use e-cigarettes was 7.4% and a proportion of 4.8% have intention to use e-cigarettes. The most popular source of exposure to e-cigarettes advertisements was social network (Facebook, Twitter, Instagram, Youtube, etc.) and this source had positive association with the odds of e-cigarette smoking among youth and adolescents (OR = 3.38, 95% CI: 1.59-7.14). In addition, referral marketers also contributed to making the participants more likely to smoke e-cigarettes (OR = 2.68, 95% CI: 1.03-6.95). Attractive color and free sample of e-cigarettes were also found to be the motivated factors associated with smoking behaviour among youth and adolescents. CONCLUSIONS New policies should be considered to oppose the impact of youth-oriented e-cigarette advertisements which include regulating and restricting e-cigarette advertisements on social media, as well as through referral marketers.
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Affiliation(s)
| | - Tu Hoang Le
- Hanoi University of Public
Health, Hanoi, Vietnam
| | - Minh Dat Le
- Vietnam Public Health
Association, Hanoi, Vietnam
| | - Tien Thang Nguyen
- Vietnam Public Health
Association, Hanoi, Vietnam
- International Livestock Research
Institute, Hanoi, Vietnam
- Mahidol-Oxford Tropical Medicine
Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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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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Russell Pike J, Miller S, Cappelli C, Tan N, Xie B, Stacy AW. Using Marketing Frameworks to Predict the Effects of E-Cigarette Commercials on Youth. YOUNG CONSUMERS 2023; 24:149-164. [PMID: 37377451 PMCID: PMC10296781 DOI: 10.1108/yc-07-2022-1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Purpose This investigation applied the Product Life Cycle (PLC) and Product Evolutionary Cycle (PEC) frameworks to the nicotine and tobacco market to predict the impact of television commercials for electronic cigarettes (e-cigarettes) on youth. Design/methodology/approach Surveys were administered over a three-year period to 417 alternative high school students from southern California who had never used e-cigarettes, cigarettes, or cigars at the baseline. Covariate-adjusted logistic regression causal mediation models were employed to test competing hypotheses from the PLC and PEC frameworks. Findings Results support a refined version of the PEC framework where e-cigarette commercials increase the odds of e-cigarette use, which leads to subsequent use of competing products including cigarettes and cigars. Originality Regulations in the United States that permit television commercials for e-cigarettes but restrict the promotion of cigarettes and cigars have created an opportunity to study product adoption among youth consumers when one product has a strategic marketing advantage. Practical implications This investigation demonstrates the utility of frameworks that conceptualize youth-oriented marketing as a two-part process in which potential customers are first convinced to adopt a behavior and then enticed to use a specific product to enact the behavior. Social implications Rising rates of nicotine and tobacco product use among youth may be partially attributable to e-cigarette commercials.
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Affiliation(s)
- James Russell Pike
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Stephen Miller
- Department of Research and Evaluation, Didi Hirsch Mental Health Services, Culver City, California, United States
| | - Christopher Cappelli
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, California, United States
| | - Nasya Tan
- School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, Claremont, California, United States
| | - Alan W Stacy
- School of Community and Global Health, Claremont Graduate University, Claremont, California, United States
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Dai L, Lu W, Wang J, Zhang L, Zhu J. Social environment exposure to electronic cigarettes and its association with e-cigarette use among adolescents in Shanghai, China. Front Public Health 2022; 10:1005323. [PMID: 36407975 PMCID: PMC9669338 DOI: 10.3389/fpubh.2022.1005323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Objective This study investigated adolescents' social-environmental exposure to e-cigarettes in association with e-cigarette use in Shanghai, China. We also explored these differences by gender and school type. Methods Sixteen thousand one hundred twenty-three students were included by a stratified random cluster sampling, and the number was weighted according to selection probability. Association between social environment exposure and e-cigarette use was examined by multivariate logistic regressions. Results There were 35.07, 63.49, 75.19, 9.44, and 18.99% students exposed to secondhand e-cigarette aerosol (SHA), e-cigarette sales, e-cigarette information, parents' and friends' e-cigarette use. Students exposed to SHA (aOR = 1.73, 95% CI 1.40-2.14), e-cigarette sales from ≥2 sources (aOR = 1.55, 95% CI 1.18-2.03), e-cigarette information exposure from ≥2 sources (aOR = 1.39, 95% CI 1.05-1.83), and having a social e-smoking environment (friends' e-cigarette use: aOR = 2.56, 95% CI 2.07-3.16; parents' e-cigarette use: aOR = 1.54, 95% CI 1.17-2.02) were significantly associated with their intention to use e-cigarettes. More girls were exposed to e-cigarette sales in the malls, e-cigarette information at points of sale and on social media (P < 0.01), and exposure to sales from ≥2 sources were associated with girls' intention to use e-cigarettes (aOR = 1.84, 95% CI 1.22-2.78). However, boys were more likely to be exposed to friends' e-cigarette use (P < 0.001), and having friends using e-cigarettes was associated with greater intention to use them in boys (aOR = 2.64, 95% CI 1.97-3.55). Less vocational high school students were exposed to parents' e-cigarette use (P < 0.001), but they were more likely to use e-cigarettes in the future after being exposed (aOR = 2.27, 95% CI 1.50-3.43). A similar phenomenon was observed between junior high students and their exposure to SHA. Conclusions This study reported adolescents' high exposure rates to the social environment of e-cigarettes. Exposure to SHA, e-cigarette sales from ≥2 sources, e-cigarette information from ≥2 sources and having a social e-smoking environment were related to adolescents' intention to use e-cigarettes. Differences in gender and school type were observed. More attention should be paid to girls, and different interventions should be designed for different types of school students. Additionally, comprehensive tobacco control policies are needed.
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Martins BNFL, Normando AGC, Rodrigues-Fernandes CI, Wagner VP, Kowalski LP, Marques SS, Marta GN, Júnior GDC, Ruiz BII, Vargas PA, Lopes MA, Santos-Silva AR. Global frequency and epidemiological profile of electronic cigarette users: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:548-561. [PMID: 36182650 DOI: 10.1016/j.oooo.2022.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Electronic cigarette (e-cigarette) use is growing significantly worldwide, especially among young people. This product has been associated with renormalizing smoking and hindering quit attempts in smokers. Moreover, among nonsmokers, it can lead to subsequent cigarette smoking and nicotine dependence. The present study aimed to assess the epidemiological profile of e-cigarette users worldwide. STUDY DESIGN A systematic review was performed using 3 main electronic databases (Medline/PubMed, SCOPUS, and EMBASE). Studies were independently assessed by 2 reviewers based on established eligibility criteria. The risk of bias was assessed using the MAStARI critical appraisal instrument. RESULTS From 4,496 records, 43 were included. Among the 1,238,392 participants, 132,786 (10.72%) were e-cigarette users. The age range with the highest percentage of e-cigarette users was 18-24 years old, with 40,989 (30.86%) males, 34,875 (26.26%) females, and 33.6% being current cigarette smokers. The highest prevalence of users was 52.88% in Croatia and 49.62% in New Zealand. Other possible correlations were observed with e-cigarette use, such as a high level of education. CONCLUSION Overall, e-cigarette users tended to be male young adults with a higher level of education. The highest prevalence of use was found in Croatia. This systematic review provides valuable information to improve the development of appropriate intervention strategies targeting e-cigarette users for more accurate anti-smoking actions.
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Affiliation(s)
| | | | | | - Vivian Petersen Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Sandra Silva Marques
- São Paulo State Reference Centre on Alcohol, Tobacco and Other Drugs, Secretary of Health, São Paulo, Brazil; State Coordination of the Tobacco Program, São Paulo, Brazil
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês São Paulo, São Paulo, Brazil
| | - Gilberto de Castro Júnior
- Clinical Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, São Paulo, Brazil
| | | | - Pablo Agustin Vargas
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, São Paulo, Brazil
| | - Marcio Ajudarte Lopes
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, São Paulo, Brazil.
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Aly AS, Mamikutty R, Marhazlinda J. Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1678. [PMID: 36360406 PMCID: PMC9689130 DOI: 10.3390/children9111678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 08/16/2023]
Abstract
BACKGROUND Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed. METHODS Fourteen databases were searched for eligible studies from the Inception of database until March 2022 to examine the effect estimates of the association between perceptions of harmfulness and addictiveness and overall e-cigarette usage among adolescents and youth. RESULTS The meta-analysis showed that in comparison to non-users, young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful (OR: 2.20, 95% CI: 1.41-3.43) and perceived e-cigarettes as less harmful than tobacco cigarettes (OR: 2.01, 95% CI 1.47-2.75). Youths who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive (OR: 2.28, 95% CI: 1.81-2.88) or perceive e-cigarettes as more addictive (OR: 1.82, 95% CI: 1.22-2.73) than tobacco cigarettes, as compared with non-users. The subgroup analysis reported that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise. CONCLUSION the risk perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth and could be the focus of health promotion to prevent and curb the uptake of e-cigarettes among young people.
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Affiliation(s)
- Ameera Syafiqah Aly
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Oral Health Program, Ministry of Health, Putrajaya 62590, Malaysia
| | - Rokiah Mamikutty
- Oral Health Program, Ministry of Health, Putrajaya 62590, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Pan L, Morton J, Mbulo L, Dean A, Ahluwalia IB. Electronic cigarette use among adults in 14 countries: A cross-sectional study. EClinicalMedicine 2022; 47:101401. [PMID: 35497060 PMCID: PMC9046112 DOI: 10.1016/j.eclinm.2022.101401] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The tobacco product landscape continues to change. No recent data for electronic cigarette (e-cigarette) use have been reported for multiple countries based on nationally representative surveys. We examined prevalence of e-cigarette use and variations by sociodemographic characteristics in 14 countries using Global Adult Tobacco Survey (GATS) data between Jan 1, 2015, and Dec 31, 2018. METHODS GATS is a nationally representative household survey of tobacco use among adults aged ≥15 years. The analytic sample size ranged from 4347 in Senegal to 74,037 in India. Prevalence of current e-cigarette use was stratified by sociodemographic subgroups. Age-standardized prevalence was estimated according to world 2000-2025 standard population. Significant differences in adjusted prevalence across sociodemographic subgroup was determined by p value for marginal effect contrast in multivariable logistic regression models. FINDINGS More than 50% of adults in Russia, Romania, and Ukraine and additionally more than 30% of adults in China, Costa Rica, Uruguay, Mexico, and Philippines were aware of e-cigarettes. Crude prevalence of current e-cigarette use ranged from 0.02% (95% CI 0.01%-0.04%) in India to 3.5% (2.9%-4.2%) in Russia. Prevalence was <1% in nine countries. Approximately 18.3 million adults currently used e-cigarettes across the 14 countries. Men had a significantly higher prevalence of current e-cigarette use than women in eight countries. Additionally, higher adjusted prevalence was observed in some countries among young adults aged 15‒24 years, urban residents, and adults with higher education levels and higher wealth index. INTERPRETATION The study provides needed baseline data on e-cigarette awareness and use. Continued surveillance is essential to inform interventions and policies to prevent initiation and enhance cessation support. FUNDING None.
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Affiliation(s)
- Liping Pan
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Corresponding Author: Liping Pan, Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop S107-7, Atlanta, GA 30341.
| | - Jeremy Morton
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC Foundation, Atlanta, Georgia, USA
| | - Lazarous Mbulo
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anna Dean
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC Foundation, Atlanta, Georgia, USA
| | - Indu B. Ahluwalia
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Brockenberry LO, Braitman AL, Harrell PT. Emotion dysregulation, transdiagnostic vulnerabilities, and e-cigarette expectancies in a young adult sample. Addict Behav 2022; 128:107253. [PMID: 35085950 PMCID: PMC8820465 DOI: 10.1016/j.addbeh.2022.107253] [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: 08/10/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Use of e-cigarettes is more common among youth with psychological distress. Negative affect reduction outcome expectancies (beliefs about ability of a product to reduce unpleasant emotional states) and emotional transdiagnostic vulnerabilities (maladaptive responses to emotional states common to multiple forms of emotional psychopathology) are both positively related to tobacco susceptibility and use. However, it is unclear if expectancies mediate the effects between emotional issues and use. METHOD College students aged 18 to 24 (N = 216; 79.6% female; 36.6% African American) completed an online survey with measures on e-cigarette negative affect reduction outcome expectancies (ENAROE), e-cigarette use, and the following emotional transdiagnostic vulnerabilities (ETV): difficulties in emotion regulation, distress tolerance (DT), positive/negative urgency, and positive/negative affect. RESULTS In individual predictor path analysis models, ENAROE mediated the relationship between ETVs and e-cigarette use. Expectancies (ENAROE) mediated 47.3% of the total relationship between positive urgency and use. Significant effects were found for a comprehensive model, in which negative urgency was related to higher ENAROE (b = 0.47, 95% BCCI [0.04, 0.96]), controlling for all other transdiagnostic vulnerabilities. Higher positive urgency was related to an increased likelihood of current use. CONCLUSIONS This study provides a novel examination of expectancies as a potential mediator for current e-cigarette use via emotional vulnerabilities. Negative Affect Reduction outcome expectancies mediated the relationship between vulnerabilities and e-cigarette use, indicating that the association between positive urgency and e-cigarette use may be explained partially though emotional expectancies. Thus, expectancies are important targets for prevention and further ETV research.
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13
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Li W, Osibogun O, Li T, Sutherland MT, Maziak W. Changes in harm perception of ENDS and their predictors among US adolescents: findings from the population assessment of tobacco and health (PATH) study, 2013-2018. Prev Med 2022; 155:106957. [PMID: 35065977 PMCID: PMC10165612 DOI: 10.1016/j.ypmed.2022.106957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/03/2022] [Accepted: 01/15/2022] [Indexed: 12/24/2022]
Abstract
Electronic nicotine delivery systems (ENDS) use has dramatically increased in the US. This study aimed to characterize changes in ENDS harm perception over time and associated predictors among US adolescents. Data from the 2013-2018 Population Assessment of Tobacco and Health Study (PATH) for adolescents (12-17 years) were utilized. Trend analyses were employed to delineate changes in comparative and absolute ENDS harm perception over a four-year interval. We applied a time-varying effect model (TVEM) to examine the associations between the changes in harm perception and associated predictors. The results suggest that perception of ENDS as less harmful than cigarettes significantly decreased from 54.3% at Wave 1 (2013) to 30.4% at Wave 4 (2018) (P < 0.001). Perception of ENDS as no or little harm decreased from 35.9% at Wave 1 to 16.9% at Wave 4 (P < 0.001). These changes in harm perception were less robust among males, adolescents who did not have positive tobacco-related attitudes, and those with smoke-free home rules (P's < 0.05). Additionally, having ever used ENDS or alcohol were more likely to be associated with reduced ENDS-related harm perception over time (P's < 0.05). Our results show that while ENDS-related harm perception have generally increased, this does not appear to be equally experienced across all adolescents, potentially highlighting the importance of at-risk groups and targets for intervention. This study can help identify individuals at risk of ENDS initiation because of their favorable ENDS harm perception profile, as well as guide the development of ENDS risk communication interventions for adolescents.
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Affiliation(s)
- Wei Li
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
| | - Olatokunbo Osibogun
- 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
| | - Matthew T Sutherland
- Department of Psychology, College of Arts, Sciences & Education, 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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14
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Heng PP, Daud F, Yusoff MFM, Lim KH. Susceptibility to e-cigarette initiation among tobacco product naïve adolescents in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian adolescents (TECMA). Tob Induc Dis 2021; 19:89. [PMID: 34887718 PMCID: PMC8611510 DOI: 10.18332/tid/142900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Predicting susceptibility to e-cigarette (EC) initiation among adolescents is crucial to optimize preventive measures before the health risk behavior persists through adulthood. The identification of susceptible groups is needed in response to the surge of EC use. This study aimed to determine the prevalence and determinants associated with EC susceptibility among tobacco product naïve (never users of any single tobacco product) school-going adolescents in Malaysia. METHODS Data were derived from the Tobacco and EC Survey among Malaysians (TECMA), which recruited a total of 13162 school-going adolescents aged 10– 19 years from 138 randomly selected schools via a two-stage stratified cluster sampling design. A validated self-administered questionnaire adapted from the Global Youth Tobacco Survey was utilized as the study instrument. The data were analyzed using SPSS version 22.0 descriptively and with multivariable logistic regression to determine the associated factors of EC susceptibility. RESULTS About 15.7% of the tobacco naïve adolescents were susceptible to EC initiation, with the proportion of susceptibility significantly higher among males, mid-adolescents, rural adolescents, those reporting exposure to tobacco advertisement and those not taught in school about the danger of tobacco use. Multivariable logistic regression revealed that the male students (AOR=2.20; 95% CI: 1.86–2.59) from a rural locality (AOR=1.45; 95% CI: 1.23–1.71), those reporting no lessons on the danger of tobacco use at school (AOR=1.66; 95% CI: 1.39–1.99) and those exposed to tobacco advertisement (AOR=1.67; 95% CI: 1.07–2.61), were more susceptible to EC initiation, while no significant association was found between secondhand smoke exposure and EC susceptibility. CONCLUSIONS Comprehensive EC preventive strategies are critically needed together with the implementation of targeted, gender, and culturally impressionable interventions. In addition, future studies should focus on the evaluation of the impacts of the preventive and control efforts to ensure their effectiveness in preventing EC initiation among Malaysian adolescents.
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Affiliation(s)
- Pei Pei Heng
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.,Institute for Public Health, National Institutes of Health, Setia Alam, Malaysia
| | - Faiz Daud
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Kuang Hock Lim
- Institute for Public Health, National Institutes of Health, Setia Alam, Malaysia
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15
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Fairman RT, Weaver SR, Akani BC, Dixon K, Popova L. "You have to vape to make it through": E-cigarette Outcome Expectancies among Youth and Parents. Am J Health Behav 2021; 45:933-946. [PMID: 34702440 DOI: 10.5993/ajhb.45.5.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objectives: Outcome expectancies are central to explaining health behavior and have been shown to predict tobacco use. Research on outcome expectancies for e-cigarette use among youth is scarce but increasingly important given the growing rates of use, particularly of high-nicotine pod devices and the recent outbreak of e-cigarette related lung disease. Methods: In 2019, we conducted 3 focus groups with middle school youth (N=25), 5 with high school youth (N=38), and 4 with parents (N=27). Youth and parents were not related and groups included both users and non-users. Participants discussed reasons for e-cigarette use and bad and good things that might happen to a person who vapes. Results: Participants described positive and negative psychoactive/sensory, social, and health-related outcome expectancies. Both youth and parents mentioned stress relief and appearing older as positive outcome expectancies, and e-cigarette flavors, acting rebellious, and structural opportunities as other reasons for initiating e-cigarette use. Social consequences and health outcomes were negative outcome expectancies deterring use. Conclusions: Regulations and public communication campaigns can counteract the positive outcome expectancies (flavor regulation, providing stress reduction tips) and capitalize on negative ones (communicating negative health outcomes) to decrease youth e-cigarette use.
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Affiliation(s)
- Robert T. Fairman
- Robert T. Fairman, Second Century Initiative Fellow, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Scott R. Weaver
- Scott R. Weaver, Associate Professor, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Bangaman C. Akani
- Bangaman C. Akani, Graduate Research Assistant, School of Public Health, Georgia State University, Atlanta, GA, United States. Also Assistant Lecturer, Department of Public Health, Felix Houphouet Boigny University, Abidjan,
Cote d'Ivoire
| | - Kristin Dixon
- Kristin Dixon, Health Promotion Director, Fulton County Board of Health, Atlanta, GA, United States
| | - Lucy Popova
- Lucy Popova, Associate Professor, School of Public Health, Georgia State University, Atlanta, GA, United States;,
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16
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Ali FRM, Dave D, Colman G, Wang X, Saffer H, Marynak K, Dench D, Grossman M. Association of e-cigarette advertising with e-cigarette and cigarette use among US adults. Addiction 2021; 116:1212-1223. [PMID: 33271632 PMCID: PMC8434873 DOI: 10.1111/add.15281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/15/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the association of e-cigarette advertisement exposure with e-cigarette and cigarette use behavior among US adults. DESIGN Data from the 2013-14 National Adult Tobacco Survey (NATS) were linked to Kantar Media and National Consumer Study data to construct measures of e-cigarette advertisements on TV and in magazines. The relationship between advertisement measures and outcomes was estimated using logistic and Poisson regressions, controlling for socio-demographics, state cigarette taxes and state and year fixed-effects. SETTING United States. PARTICIPANTS/CASES A total of 98 746 adults aged ≥ 18 years who responded to the 2013-14 NATS. MEASUREMENTS The independent variables of interest were the number of e-cigarette advertisements in magazines to which an adult was exposed in the past 6 months and the number of e-cigarette advertisements on TV to which an adult was exposed in the past 6 months. Outcomes were awareness of e-cigarettes, ever e-cigarette use, current e-cigarette use, current cigarette use and number of cigarettes smoked per month. FINDINGS Exposure to one additional e-cigarette advertisement on TV was associated with a 0.18, 0.13 and 0.03 percentage point increase, respectively, in awareness, ever use and current use of e-cigarettes among all adults (P < 0.05). This exposure also was associated with a 0.11 percentage point increase in current cigarette use among all adults and an increase in cigarette consumption of 2.24 cigarettes per month among adults aged ≥ 45 (P < 0.05). CONCLUSIONS Exposure to e-cigarette advertising appears to be positively associated with the use of e-cigarettes and cigarettes among adults of all ages, and with increased cigarette consumption among older adults.
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Affiliation(s)
- Fatma Romeh M. Ali
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- Department of Economics, Faculty of Economics and Political Science, Cairo University, Giza, Egypt
| | - Dhaval Dave
- Bentley University, National Bureau of Economic Research, and Institute of Labor Economics (IZA). Waltham, MA
| | - Gregory Colman
- Pace University and National Bureau of Economic Research. New York, NY
| | - Xu Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Henry Saffer
- National Bureau of Economic Research. New York, NY
| | - Kristy Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Daniel Dench
- Ph.D. Program in Economics, City University of New York Graduate Center, New York, NY
| | - Michael Grossman
- City University of New York Graduate Center, National Bureau of Economic Research, and Institute of Labor Economics (IZA). New York, NY
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17
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Peiper N, Aramburú C, Thompson K, Abadi M. Differential patterns of e-cigarette and tobacco marketing exposures among youth: Associations with substance use and tobacco prevention strategies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102925. [PMID: 33217687 PMCID: PMC8715723 DOI: 10.1016/j.drugpo.2020.102925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study identified patterns of tobacco marketing exposures among youth and examined their associations with substance use and tobacco prevention strategies. METHODS In Fall 2018, 2,058 middle and high school students (ages 11-18) in an Appalachian county completed a substance use and behavioral health surveillance survey. We conducted latent class analysis (LCA) to identify exposure classes based on responses to 14 tobacco marketing exposures. Multinomial logistic regression was then performed to determine associations between the latent classes with past 30-day substance use and tobacco prevention strategies (e.g., school policies, parental rules, prevention messages). RESULTS Four latent classes of marketing exposure were identified among middle school students: low exposure, television, social media, and high exposure. Multinomial logistic regression found significant associations between e-cigarette use with the social media and high exposure classes, while prescription drug use was associated with the social media class and alcohol use with the high exposure class. For high school students, five classes were identified: low exposure, social media, environmental, cigarettes, and high exposure. E-cigarette and prescription drug use were associated with the social media and high exposure classes. Cigarette use was associated with the social media class. School rules prohibiting e-cigarettes were associated with the television class for middle school students. Self-reported exposure to prevention messages about the harms of tobacco were associated with multiple exposure classes for both middle (television and social media) and high school (social media and cigarettes) students, suggesting that both pro- and anti-tobacco communications have become ubiquitous and may be saturating youth. CONCLUSION This study demonstrates the need for stricter tobacco marketing regulations and multi-level interventions beginning in early adolescence that focus on increasing media-based literacy for youth to better discern tobacco prevention messages from pro-tobacco communications.
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Affiliation(s)
- Nicholas Peiper
- Louisville Center, Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville 40202, KY, USA; Department of Epidemiology and Population Health, University of Louisville, 485 East Gray Street, Louisville 40202, KY, USA.
| | - Camila Aramburú
- Louisville Center, Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville 40202, KY, USA.
| | - Kirsten Thompson
- Louisville Center, Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville 40202, KY, USA.
| | - Melissa Abadi
- Louisville Center, Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville 40202, KY, USA.
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18
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Trucco EM, Fallah-Sohy N, Hartmann SA, Cristello JV. Electronic Cigarette Use Among Youth: Understanding Unique Risks in a Vulnerable Population. CURRENT ADDICTION REPORTS 2020; 7:497-508. [PMID: 33409119 PMCID: PMC7781233 DOI: 10.1007/s40429-020-00340-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review discusses prevalence rates of electronic (e-)cigarette use among youth and factors that likely contribute to their growing popularity among this population. Trends shaping the e-cigarette landscape, the appeal of e-cigarettes among youth, perceptions contributing to the initiation of e-cigarettes, available assessments capturing the usage of and attitudes towards e-cigarettes, and e-cigarette policies and regulations are reviewed. RECENT FINDINGS E-cigarette use among this vulnerable group may relate to factors associated with the promotion of social status, individuality, and enjoyment, along with low perceptions of risk and harm. Measures assessing factors unique to e-cigarette use among youth (e.g., individuality) still need to be developed and validated. Effects of existing regulations to limit youth access to e-cigarettes may be limited, and shortcomings of current policy measures are discussed with recommendations. SUMMARY The rise of e-cigarette use among youth culminated through a perfect storm of clever marketing targeting youth appeal, innovations in more effective nicotine delivery systems, capitalizing on increased susceptibility of the adolescent brain, and regulatory gaps. Understanding risk and protective factors specific to this vulnerable group, which can be gleaned in part by psychometrically valid assessments, could inform regulatory strategies and prevention programming efforts. Yet, few validated measures exist that assess attitudes, behaviors, and patterns of e-cigarette use that are specific to youth. Ultimately, it is incumbent upon policymakers to create comprehensive regulations that prioritize harm reduction and can evolve in lockstep with the constantly changing e-cigarette product landscape.
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Affiliation(s)
- Elisa M. Trucco
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
- University of Michigan, Psychiatry Department, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Nilofar Fallah-Sohy
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
| | - Sarah A. Hartmann
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
| | - Julie V. Cristello
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
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19
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Shilco P, Golshan T, Lande S, Nickfardjam K, Roitblat Y, Morgan A, Nehuliaieva L, Shterenshis M. Knowledge and attitudes of adolescents to e-cigarettes: an international prospective study. Int J Adolesc Med Health 2020; 34:/j/ijamh.ahead-of-print/ijamh-2019-0210/ijamh-2019-0210.xml. [PMID: 32474455 DOI: 10.1515/ijamh-2019-0210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/21/2019] [Indexed: 11/15/2022]
Abstract
Purpose The aim of the study was to assess the familiarity of adolescents with e-cigarettes. We performed a survey to investigate the frequency of their contact with e-cigarettes, beliefs about this sort of smoking (vaping), and their real knowledge of its effects. Methods The survey was carried out among 1600 high school students in the USA, Israel, Ukraine and Australia. The questionnaire comprised three parts, each with five questions. The first part was designed to assess the frequency of contact with the phenomenon. The second part assessed misconceptions and opinions concerning vaping. The third part questioned the participants' real knowledge of the subject. Results Out of a maximum score of 5, the average score of 4.25 for Part 1 indicated that the participants had frequent contact with e-cigarettes. The score of 3.65 for Part 2 showed that adolescents have both right and wrong beliefs on the subject. Part 3 was completed by 1224 participants (76.5%) while 376 (23.5%) reported a lack of any specific knowledge about vaping. The average score of 3.33 demonstrated that adolescents who completed Part 3 of the survey have incomplete knowledge about e-cigarettes. For the whole cohort of 1600 participants, the average score was 2.80. No significant sex differences were detected. The Ukranian participants had poor knowledge about the dangers of vaping in comparison with the participants in the USA and Australia (p = 0.03). Conclusion While the contact of adolescents with e-cigarettes users is extensive, their actual knowledge remains inadequate. Various school-based smoking risk campaigns face a necessity for further adjustments and improvements.
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Affiliation(s)
- Phillip Shilco
- Science Research Department, Alexander Muss High School in Israel (AMHSI) affiliated with Alexander Muss Institute for Israel Education (AMIIE), Aliyat HaNoar 9, Hod HaSharon45102,Israel, Phone: +97254-337-9865
| | - Taylor Golshan
- Science Research Department, Milken Community High School, Los Angeles, CA, USA
| | - Sarah Lande
- Science Research Department, Milken Community High School, Los Angeles, CA, USA
| | - Kaitlyn Nickfardjam
- Science Research Department, Milken Community High School, Los Angeles, CA, USA
| | - Yulia Roitblat
- Department of Sciences, Belkind School for Special Education, Rishon-LeZion, Israel
| | - Antony Morgan
- Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Liliia Nehuliaieva
- Department of Pediatrics, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Michael Shterenshis
- Science Research Department, Alexander Muss High School in Israel (AMHSI) affiliated with Alexander Muss Institute for Israel Education (AMIIE), Aliyat HaNoar 9, Hod HaSharon45102,Israel, Phone: +97254-337-9865
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20
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Collins L, Glasser AM, Abudayyeh H, Pearson JL, Villanti AC. E-Cigarette Marketing and Communication: How E-Cigarette Companies Market E-Cigarettes and the Public Engages with E-cigarette Information. Nicotine Tob Res 2020; 21:14-24. [PMID: 29315420 DOI: 10.1093/ntr/ntx284] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 12/28/2017] [Indexed: 12/26/2022]
Abstract
Introduction Given the lack of regulation on marketing of electronic cigarettes (e-cigarettes) in the United States and the increasing exchange of e-cigarette-related information online, it is critical to understand how e-cigarette companies market e-cigarettes and how the public engages with e-cigarette information. Methods Results are from a systematic review of peer-reviewed literature on e-cigarettes via a PubMed search through June 1, 2017. Search terms included: "e-cigarette*" or "electronic cigarette" or "electronic cigarettes" or "electronic nicotine delivery" or "vape" or "vaping." Experimental studies, quasi-experimental studies, observational studies, qualitative studies, and mixed methods studies providing empirical findings on e-cigarette marketing and communication (ie, nonmarketing communication in the public) were included. Results One hundred twenty-four publications on e-cigarette marketing and communication were identified. They covered topics including e-cigarette advertisement claims/promotions and exposure/receptivity, the effect of e-cigarette advertisements on e-cigarette and cigarette use, public engagement with e-cigarette information, and the public's portrayal of e-cigarettes. Studies show increases in e-cigarette marketing expenditures and online engagement through social media over time, that e-cigarettes are often framed as an alternative to combustible cigarettes, and that e-cigarette advertisement exposure may be associated with e-cigarette trial in adolescents and young adults. Discussion Few studies examine the effects of e-cigarette marketing on perceptions and e-cigarette and cigarette use. Evidence suggests that exposure to e-cigarette advertisements affects perceptions and trial of e-cigarettes, but there is no evidence that exposure affects cigarette use. No studies examined how exposure to e-cigarette communication, particularly misleading or inaccurate information, impacts e-cigarette, and tobacco use behaviors. Implications The present article provides a comprehensive review of e-cigarette marketing and how the public engages with e-cigarette information. Studies suggest an association between exposure to e-cigarette marketing and lower harm perceptions of e-cigarettes, intention to use e-cigarettes, and e-cigarette trial, highlighting the need to for advertising regulations that support public health goals. Findings from this review also present the methodological limitations of the existing research (primarily due to cross-sectional and correlational analyses) and underscore the need for timely, rigorous research to provide an accurate understanding of e-cigarette marketing and communication and its impact on e-cigarette and tobacco product use.
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Affiliation(s)
- Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Jennifer L Pearson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,School of Community Health Sciences, University of Nevada, Reno, NV
| | - Andrea C Villanti
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
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21
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Assari S, Boyce S, Caldwell CH, Bazargan M. Parent Education and Future Transition to Cigarette Smoking: Latinos' Diminished Returns. Front Pediatr 2020; 8:457. [PMID: 32974240 PMCID: PMC7466764 DOI: 10.3389/fped.2020.00457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background: High parent education is protective against youth health risk behaviors such as tobacco use. According to the Minorities' Diminished Returns theory, however, higher parent education seems to exert less protection for the ethnic minority relative to the majority groups. Objectives: To explore ethnic differences in the effects of parent education on the transition to cigarette smoking in a national sample of American never-smoker adolescents. Methods: This longitudinal study used data of waves 1 and 4 of the Population Assessment of Tobacco and Health (PATH 2013-2018). This analysis included 5,021 American youth who were never smokers at baseline (2013) and were followed for 4 years. Transition to cigarette smoking was the dependent variable. Parent education was the independent variable. Youth age, youth gender, and family structure were the covariates. Ethnicity was the moderating variable. Results: From the 5,021 American youth who were never smokers at baseline (2013), 89.4% continued as never smokers, and 10.6% became ever-smokers. Overall, 4.0% were current smokers at wave 4. Overall, a higher parent education was associated with lower odds of transitioning to ever and current cigarette smoker at the end of the 4th year. Parent education, however, showed significant interaction with Latino ethnicity on both outcomes suggesting smaller protective effects of high parent education against transitioning to tobacco use for Latino than for non-Latino youth. Conclusions: In the U.S., ethnicity alters the magnitude of the protective effect of parent education against youth transition to tobacco use. While high parent education is protective against transitioning to become a cigarette smoking overall, non-Latinos (a socially privileged group) gain more and Latino youth (a socially marginalized group) gain least from such a resource. In addition to addressing the SES gap, policymakers should identify and address mechanisms by which ethnic minority youth remain at risk of tobacco use, even when they are from highly educated families.
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Affiliation(s)
- Shervin Assari
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Shanika Boyce
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Mohsen Bazargan
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States.,Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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22
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Barrington-Trimis JL, Bello MS, Liu F, Leventhal AM, Kong G, Mayer M, Cruz TB, Krishnan-Sarin S, McConnell R. Ethnic Differences in Patterns of Cigarette and E-Cigarette Use Over Time Among Adolescents. J Adolesc Health 2019; 65:359-365. [PMID: 31248804 PMCID: PMC6708763 DOI: 10.1016/j.jadohealth.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Little is known about whether adolescent cigarette and e-cigarette use patterns over time differ by ethnicity. METHODS Data were pooled from three prospective cohort studies of adolescents in California and Connecticut (baseline: 2013-2014; 12-month follow-up: 2014-2015; N = 6,258). Adjusted polytomous regression models evaluated the association of baseline exclusive ever e-cigarette use, exclusive ever cigarette use, ever use of both e-cigarettes and cigarettes (dual use) with past 30-day use at follow-up (exclusively e-cigarettes, exclusively cigarettes, dual use; no use at baseline/follow-up were the referent groups). Interaction analyses evaluated differences by race/ethnicity (Hispanic white [HW], non-Hispanic white [NHW], Other). RESULTS A significant global interaction was observed for the association of baseline with follow-up tobacco use by ethnicity (p = .009). Among NHW participants, ever e-cigarette or cigarette users at baseline (vs. never users) had significantly higher odds of every past 30-day use tobacco use pattern at follow-up. Among HW participants, compared with never users, exclusive e-cigarette users at baseline had increased odds of continued e-cigarette use (ORexclusive e-cigarettes = 5.22; 95% confidence interval [CI]: 3.50, 7.79; ORdual use = 3.64; 95% CI: 1.62, 8.18) but not of transition to exclusive cigarette use at follow-up (ORexclusive cigarettes = 1.27; 95% CI: .47, 3.46), and HW exclusive cigarette users at baseline had greater odds of continued cigarette use (ORexclusive e-cigarettes = 12.3; 95% CI: 5.87, 25.8; ORdual use = 3.82; 95% CI: 1.06, 13.7) but not of transition to exclusive e-cigarette use at follow-up (ORexclusive cigarettes = 1.61; 95% CI: .62, 4.18). CONCLUSIONS Findings that NHW youth report more transitional use patterns and HW youth report more stable use patterns suggest a potential for differential impacts of e-cigarettes, by ethnicity, in increasing subsequent transition to or cessation from cigarette smoking.
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Affiliation(s)
| | - Mariel S Bello
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Fei Liu
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, California; Department of Psychology, University of Southern California, Los Angeles, California
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Margaret Mayer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
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23
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Lippert AM, Corsi DJ, Venechuk GE. Schools Influence Adolescent E-Cigarette use, but when? Examining the Interdependent Association between School Context and Teen Vaping over time. J Youth Adolesc 2019; 48:1899-1911. [DOI: 10.1007/s10964-019-01106-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
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24
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Wagoner KG, Reboussin DM, King JL, Orlan E, Cornacchione Ross J, Sutfin EL. Who Is Exposed to E-Cigarette Advertising and Where? Differences between Adolescents, Young Adults and Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2533. [PMID: 31315189 PMCID: PMC6679184 DOI: 10.3390/ijerph16142533] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 12/28/2022]
Abstract
Little is known about differences between adolescents' and adults' exposure to e-cigarette advertising in various media channels, such as retail establishments, print, television, radio, and digital marketing. We examined the exposure to e-cigarette advertising in these channels amongst adolescents (13-17), young adults (18-25), and older adults (26+). Adolescents (N = 1124), young adults (N = 809), and adults (N = 4186) were recruited through two nationally representative phone surveys from 2014-2015. Lifetime e-cigarette advertising exposure was prevalent (84.5%). Overall, older adult males and older adult cigarette smokers reported the highest exposure to e-cigarette advertising (p < 0.001). Television was the largest source of exposure for all age groups. Adolescents and young adults had higher odds than older adults of exposure through television and digital marketing. However, adolescents had lower odds than young adults and older adults of exposure through retailers and print media. Although e-cigarette advertising appears to be reaching the intended audience of adult smokers, vulnerable populations are being exposed at high rates via television and digital marketing. Regulations aimed at curbing exposure through these media channels are needed, as are counter advertising and prevention campaigns.
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Affiliation(s)
- Kimberly G Wagoner
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - David M Reboussin
- Wake Forest School of Medicine, Department of Biostatistics and Data Science, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jessica L King
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Erin L Sutfin
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
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25
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Walley SC, Wilson KM, Winickoff JP, Groner J. A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL. Pediatrics 2019; 143:peds.2018-2741. [PMID: 31122947 DOI: 10.1542/peds.2018-2741] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 12/15/2022] Open
Abstract
Electronic cigarettes (e-cigarettes) and vape devices have rapidly become the most common tobacco products used by youth, driven in large part by marketing and advertising by e-cigarette companies. There is substantial evidence that adolescent e-cigarette use leads to use of combustible tobacco products. E-cigarette companies commonly advertise that e-cigarettes contain nicotine, flavoring chemicals, and humectants (propylene glycol and/or vegetable glycerin), but toxicants, ultrafine particles, and carcinogens have also been found in e-cigarette solutions and emissions, many of which are known to cause adverse health effects. Most major e-cigarette brands are owned by big tobacco companies that use similar marketing and advertising strategies to attract youth users as they did with traditional tobacco products. In this review, we provide an overview of e-cigarettes and vape devices with an emphasis on the impact for the pediatric population. We describe the vast array of e-cigarette devices and solutions, concern for nicotine addiction, and the scientific background on the known health harms. There are accompanying visual depictions to assist in identifying these products, including newer e-cigarette products and JUUL. Because current federal regulations are insufficient to protect youth from e-cigarette use, exposure, and nicotine addiction, there are recommendations for pediatricians and pediatric health care providers to counsel and advocate for a tobacco-free lifestyle for patients and families.
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Affiliation(s)
- Susan C Walley
- Division of Pediatric Hospital Medicine, The University of Alabama at Birmingham and Children's of Alabama, Birmingham, Alabama;
| | - Karen M Wilson
- Division of General Pediatrics, Icahn School of Medicine at Mount Sinai and Mount Sinai Kravis Children's Hospital, New York, New York
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts; and
| | - Judith Groner
- Division of Primary Care, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
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26
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Diez SL, Cristello JV, Dillon FR, De La Rosa M, Trucco EM. Validation of the electronic cigarette attitudes survey (ECAS) for youth. Addict Behav 2019; 91:216-221. [PMID: 30473247 PMCID: PMC6358488 DOI: 10.1016/j.addbeh.2018.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/07/2023]
Abstract
Electronic cigarette (e-cigarette) use among adolescents has rapidly increased in recent years, especially among Latinx and non-Latinx Black adolescents. Yet, limited research exists on adolescent attitudes that may contribute to the popularity of these products. This is in part due to the lack of measures focused on assessing adolescent attitudes towards e-cigarette use. The aim of this study was to develop a measure of adolescent e-cigarette use attitudes. The sample consisted mainly of Latinx and non-Latinx Black adolescents. Data were collected from 247 youth (M age = 16.0, SD = 1.2), 63.6% were girls, a majority (69.2%) were non-Latinx Black, and 27.1% were Latinx. The Electronic Cigarette Attitudes Survey (ECAS) is comprised of 12 items reflecting attitudes associated with e-cigarettes, which were derived from prior theoretical, quantitative, and qualitative work with e-cigarette users. To determine the factor structure, a parallel analysis scree plot and an exploratory factor analysis (EFA) of the ECAS was conducted using half of the sample chosen at random (n = 113). Results supported a one-factor solution. A confirmatory factory analysis (CFA) was conducted on the other randomly chosen half of participants (n = 121). Results confirm a one-factor solution. No significant differences were found on ECAS scores based on race/ethnicity or e-cigarette use status (lifetime e-cigarette use vs. no use). The ECAS represents a viable measure for assessing e-cigarette attitudes among youth.
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Affiliation(s)
- Stephanie L Diez
- Dissertation Year Fellow, Florida International University, 11200 SW 8(th) Street, AHC-5, Miami, FL 33199, USA.
| | - Julie V Cristello
- Florida International University, Center for Children and Families, Department of Psychology, 11,200 SW 8th Street, AHC-5, Miami, FL 33199, United States.
| | - Frank R Dillon
- Counseling & Counseling Psychology, Arizona State University, College of Integrative Sciences and Arts, 446 Payne Hall, MC-0811, Tempe, AZ 85287-0811, United States.
| | - Mario De La Rosa
- Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8(th) Street, AHC-5 Room 425, Miami, FL 33199, USA.
| | - Elisa M Trucco
- Florida International University, University of Michigan, Center for Children and Families, Department of Psychiatry, Department of Psychology, Ann Arbor, MI 48109, 11200 SW 8(th) Street, AHC-1 Room 237, Miami, FL 33199, United States.
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27
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Jenssen BP, Boykan R. Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels). CHILDREN-BASEL 2019; 6:children6020030. [PMID: 30791645 PMCID: PMC6406299 DOI: 10.3390/children6020030] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Abstract
E-cigarettes have emerged and soared in popularity in the past ten years, making them the most common tobacco product used among youth in the United States (US). In this review, we discuss what the Surgeon General has called a public health “epidemic”—the precipitous increase in youth use of e-cigarettes and the health consequences of this behavior. Further, we review tobacco control policy efforts (e.g., Tobacco 21, banning flavors, advertising restrictions, and clean indoor air laws)—efforts proven to be critical in reducing cigarette smoking and smoking-related disease and death among US children and adults—including their potential and challenges regarding managing and mitigating the emergence of e-cigarettes. Finally, we close with a discussion of the efforts of transnational tobacco companies to rebrand themselves using e-cigarettes and other new products.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania School of Medicine and PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Rachel Boykan
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
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28
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Abstract
Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among youth. The 2016 US Surgeon General's Report on e-cigarette use among youth and young adults concluded that e-cigarettes are unsafe for children and adolescents. Furthermore, strong and consistent evidence finds that children and adolescents who use e-cigarettes are significantly more likely to go on to use traditional cigarettes-a product that kills half its long-term users. E-cigarette manufacturers target children with enticing candy and fruit flavors and use marketing strategies that have been previously successful with traditional cigarettes to attract youth to these products. Numerous toxicants and carcinogens have been found in e-cigarette solutions. Nonusers are involuntarily exposed to the emissions of these devices with secondhand and thirdhand aerosol. To prevent children, adolescents, and young adults from transitioning from e-cigarettes to traditional cigarettes and minimize the potential public health harm from e-cigarette use, there is a critical need for e-cigarette regulation, legislative action, and counterpromotion to protect youth.
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Affiliation(s)
- Brian P. Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and PolicyLab, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan C. Walley
- Department of Pediatrics, The University of Alabama at Birmingham and Children’s of Alabama, Birmingham, Alabama
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29
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Electronic Cigarette Harm and Benefit Perceptions and Use Among Youth. Am J Prev Med 2018; 55:361-367. [PMID: 30031636 PMCID: PMC6168072 DOI: 10.1016/j.amepre.2018.04.043] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/21/2018] [Accepted: 04/25/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The purpose of this study is to examine adolescent perceptions of harms and benefits associated with electronic cigarettes (e-cigarettes) and their associations with use. METHODS Data from the 2016 Florida Youth Tobacco Survey were analyzed in 2017. Participants who were in high school aged 14-17 years were included (n=22,884). Logistic regression analyses were used to compare e-cigarette use groups on perceived harms and benefits of e-cigarettes. RESULTS Less than one half of the sample reported that e-cigarettes are harmful to their health and less than two thirds reported that individuals can get addicted to e-cigarettes. Compared with committed never users, susceptible never users and all e-cigarette use groups were less likely to report that e-cigarettes were harmful to their health, people can get addicted to e-cigarettes, and that smoke from others' e-cigarettes were harmful. Furthermore, susceptible never users and all use groups were more likely to report that it would be easy to quit using e-cigarettes than committed never users. Susceptible never users and all use groups were also more likely to perceive benefits of e-cigarette use including having more friends, looking cool or fitting in, feeling more comfortable in social situations, and stress relief compared with committed never users. CONCLUSIONS Youth who are susceptible to use, currently use, or have used e-cigarettes are less likely to report harms and more likely to perceive benefits associated with e-cigarette use compared with committed never users. Addressing harm and benefit perceptions may be important for interventions designed to reduce e-cigarette use among adolescents.
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30
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Marynak K, Gentzke A, Wang TW, Neff L, King BA. Exposure to Electronic Cigarette Advertising Among Middle and High School Students - United States, 2014-2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:294-299. [PMID: 29543786 PMCID: PMC5857199 DOI: 10.15585/mmwr.mm6710a3] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among U.S. middle and high school students (1). Exposure to e-cigarette advertisements is associated with higher odds of current e-cigarette use among middle and high school students (2-4). To assess patterns of self-reported exposure to four e-cigarette advertising sources (retail stores, the Internet, television, and newspapers and magazines), CDC analyzed data from the 2014, 2015, and 2016 National Youth Tobacco Surveys (NYTSs). Overall, exposure to e-cigarette advertising from at least one source increased each year during 2014-2016 (2014: 68.9%, 18.3 million; 2015: 73.0%, 19.2 million; 2016: 78.2%, 20.5 million). In 2016, exposure was highest for retail stores (68.0%), followed by the Internet (40.6%), television (37.7%), and newspapers and magazines (23.9%). During 2014-2016, youth exposure to e-cigarette advertising increased for retail stores (54.8% to 68.0%), decreased for newspapers and magazines (30.4% to 23.9%), and did not significantly change for the Internet or television. A comprehensive strategy to prevent and reduce youth use of e-cigarettes and other tobacco products includes efforts to reduce youth exposure to e-cigarette advertising from a range of sources, including retail stores, television, the Internet, and print media such as newspapers and magazines (5).
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Affiliation(s)
- Kristy Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Andrea Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Linda Neff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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31
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Yu B. Racial group categorization in minority drug use studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:621. [PMID: 28075175 DOI: 10.1080/00952990.2016.1258707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Bin Yu
- a Department of Epidemiology , University of Florida , Gainesville , FL , USA
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32
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Abstract
Electronic cigarettes, or e-cigarettes as they are commonly called, have gained wide acceptance among adolescents, especially those with sweet flavors such as bubble gum and cheesecake. Although health effects of e-cigarettes have not been well characterized, their use increases a teen's exposure to nicotine and may serve as a gateway to traditional cigarettes. This article outlines the basics of e-cigarettes and potential health hazards, followed by selected literature on teens' perceptions of e-cigarettes, as well as motivational interviewing strategies that can be used in talking to teens about using electronic cigarettes.
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Affiliation(s)
- Vania Modesto-Lowe
- 1 Connecticut Valley Hospital, Middletown, CT, USA.,2 University of Connecticut School of Medicine, Farmington, CT, USA.,3 Quinnipiac University, Hamden, CT, USA
| | - Camille Alvarado
- 2 University of Connecticut School of Medicine, Farmington, CT, USA
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33
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Daniluk A, Gawlikowska-Sroka A, Stępien-Słodkowska M, Dzięciołowska-Baran E, Michnik K. Electronic Cigarettes and Awareness of Their Health Effects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1039:1-8. [PMID: 28801792 DOI: 10.1007/5584_2017_83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The use of electronic cigarettes or e-cigarettes is strongly on the rise. The literature confirms that in the process of quitting smoking using an electronic device dispensing nicotine should be a transitional stage before the complete cessation of smoking. The aim of the present study was to assess the popularity of e-cigarettes, the underlying reasons for use of such nicotine products, and the level of awareness of health hazards associated with e-cigarettes. The study is of a survey type. The material consisted of data collected from an anonymous survey distributed among 46 female and 23 male users of e-cigarettes in 2015. We used a questionnaire of our own design. The findings demonstrate that the main reason for a recourse to e-cigarettes is a desire to use fashionable technological innovations, and the conviction that such cigarettes are less harmful than the traditional tobacco products. Some respondents used e-cigarettes to quit smoking; others to minimize the harmful effects of smoking. Most respondents acquired information about e-cigarettes from friends or from the Internet. There was a high awareness of the chemical composition of substances contained in e-cigarettes. An interest in e-cigarettes is caused by an increased knowledge on the negative effects of traditional smoking. Currently, the e-cigarettes remains a technological novelty, so that the exact health effects of their long-term use are open to conjecture.
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Affiliation(s)
- A Daniluk
- Faculty of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
| | - A Gawlikowska-Sroka
- Department of Anatomy, Pomeranian Medical University, 72 Powstańców Wielkopolskich Street, 70-111, Szczecin, Poland.
| | - M Stępien-Słodkowska
- Faculty of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
| | - E Dzięciołowska-Baran
- Department of Anatomy, Pomeranian Medical University, 72 Powstańców Wielkopolskich Street, 70-111, Szczecin, Poland
| | - K Michnik
- School of European Integration, Szczecin, Poland
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