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Ruleman AM, Clendennen SL, Chen B, Harrell MB. Reasons for multiple tobacco product and cannabis co-use among Texas young adults. Addict Behav 2024; 156:108063. [PMID: 38824720 DOI: 10.1016/j.addbeh.2024.108063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users. METHODS Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use. RESULTS 26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users. CONCLUSIONS Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.
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Affiliation(s)
- Ashlynn M Ruleman
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA.
| | - Stephanie L Clendennen
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
| | - Baojiang Chen
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
| | - Melissa B Harrell
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
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McQuoid J, Regan T, Devkota J, Cheney MK, Kumar V, Oehlers J, Lopez-Paguyo K, Nguyen N, Meacham MC, Ling PM, Thrul J. Situations and roles of cannabis versus cigarette use: Integrating ecological momentary assessment with qualitative mapping interviews. Health Place 2024; 89:103314. [PMID: 39032204 DOI: 10.1016/j.healthplace.2024.103314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/24/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
Use of both cannabis and tobacco has surpassed use of tobacco alone among young adults in California. To better understand why, we collected data with 32 young adults ages 18-30 in Northern California who regularly used cigarettes and cannabis and had diverse sexual, gender, racial, and ethnic identities. Geographically-explicit ecological momentary assessment (EMA; 30 days) was integrated with qualitative mapping interviews. We found contrasting situations of use for cannabis (e.g., around other people) versus cigarettes (e.g., recent discrimination) and different reasons for why participants chose one substance over the other (e.g., enhancing experiences vs. stepping away). Understanding when and why diverse young adults choose cannabis versus cigarettes as they navigate everyday environments helps explain how cannabis and tobacco retail markets shape substance use disparities over time.
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Affiliation(s)
- Julia McQuoid
- TSET Health Promotion Research Center, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Timothy Regan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janardan Devkota
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Vaishnavi Kumar
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Julia Oehlers
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA; John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Kekoa Lopez-Paguyo
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Meredith C Meacham
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.
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Warner E, Azizoddin D, Frank-Pearce SG, Ford L, Bradley D, Cohn A, Businelle M, Spicer P, Appleseth H, McQuoid J. "It frees your body from that pain thought": A mixed methods exploration of patterns, contexts, and experiences of cannabis use for pain in rural communities. THE JOURNAL OF PAIN 2024:104636. [PMID: 39025284 DOI: 10.1016/j.jpain.2024.104636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/02/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
U.S. adults increasingly report using cannabis to manage chronic pain and rural areas have inadequate comprehensive pain management. Using mixed methods, we aimed to understand how and why some rural adults use cannabis for pain, including within the context of co-use with opioids. Participants (N=14; Oklahoma) were rural-dwelling adults who used tobacco and ≥ 1 other substance, including cannabis and opioids, ≥ 3 days per week. Participants completed 14-days of ecological momentary assessment (EMA) regarding substance use and subsequent in-depth interviews discussing maps of their substance use reports. Half (7/14) described cannabis use for chronic pain, and most of these (85%) reported use on ≥75% of EMA days. The most frequently reported cannabis use motive was therapeutic/medicinal (90% of use reports). Most reports were of combusted cannabis (88% of use reports) at home (99% of use reports). Same-day use of cannabis and opioids was relatively common (45% of daily surveys), but seemingly not within close temporal proximity. Interview narratives characterized cannabis as modifying pain-adjacent factors (e.g., thoughts); not eliminating pain itself. They recounted using a repertoire of substances to manage different pain dimensions (e.g., intensity, quality) and balance perceived trade-offs of different substances. Participants described high medical cannabis access, low pain specialist access, and most physicians as unwilling to discuss cannabis for pain. Findings suggest that rural-dwelling patients could benefit from increased access to comprehensive pain management, having cannabis addressed within pain management provider discussions, and that risks and benefits of cannabis use for pain must be better established. PERSPECTIVE: This study used a geographically-explicit ecological momentary assessment mixed method to gather rich, intensive pilot data on cannabis use and co-use for chronic pain in rural Oklahoma. It provides unique insights to inform future research on cannabis use among a vulnerable and understudied sub-group of adults with pain - rural residents.
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Affiliation(s)
- Emily Warner
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA; TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Desiree Azizoddin
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Summer G Frank-Pearce
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lance Ford
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David Bradley
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amy Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, USA
| | - Hannah Appleseth
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA; TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Betts JM, Dowd AN, Motschman CA, Tiffany ST. An Evaluation of the Contextual Factors Associated With the Use of Either Tobacco or Electronic Cigarettes in Individuals Who Dual Use. Nicotine Tob Res 2024; 26:561-570. [PMID: 37831904 DOI: 10.1093/ntr/ntad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/14/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Little is known about patterns of dual use of tobacco and electronic cigarettes (e-cigarettes), especially regarding the factors that lead people to choose either product in particular situations. Identifying contextual factors that are associated with product use would enhance understanding of the maintenance of dual product use. METHODS Individuals who dual use (N = 102) completed ecological momentary assessment surveys via text message regarding the recent use of tobacco and e-cigarettes for 2 weeks. Product legality, availability, craving, the presence of other people who smoke/vape, and social disapproval were assessed. Data were analyzed using hierarchical logistic regression to identify factors associated with the likelihood of tobacco versus e-cigarette use. RESULTS Contexts associated with increased likelihood of using tobacco rather than e-cigarettes included being in the presence of other people who smoke (odds ratio [OR] = 3.50, p < .0001) and experiencing elevated tobacco cigarette craving (OR = 3.51, p < .0001). Decreased likelihood of tobacco over e-cigarette use was associated with smoking restrictions (OR = 0.26, p = .003), the presence of other people who vape (OR = 0.38, p < .001), and experiencing elevated e-cigarette craving (OR = 0.23, p < .0001). The legality of e-cigarettes, social disapproval, and the availability of the alternative product were not significantly associated with the use of one product over the other. An individual difference score of relative tobacco (vs. e-cigarette) use pattern did not significantly moderate these effects. CONCLUSIONS This study provided essential information regarding behavioral patterns of dual use, which informs our understanding of people who dual use. Contexts such as smoking restrictions, craving, and social context significantly differentiated between the use of tobacco and e-cigarettes. This suggests product-specific motivations for dual use of tobacco and e-cigarettes in people who use both. IMPLICATIONS This study assessed the relationship between momentary contextual factors and dual use in a nationally recruited sample of people who dual use. Assessments of dual use in daily life provided novel information regarding patterns of dual use as well as differential use-motivations for each product. This information will be essential to build a theoretical framework of dual use of tobacco and e-cigarettes.
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Affiliation(s)
- Jennifer M Betts
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
- William S. Middleton Memorial Veterans' Hospital, Madison, WI, USA
| | - Ashley N Dowd
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Courtney A Motschman
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
| | - Stephen T Tiffany
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
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5
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Blank ML, Hoek J. Smoking, vaping and drinking: A qualitative analysis of Aotearoa New Zealand young adults who tried e-cigarettes to stop smoking tobacco. Addiction 2024; 119:686-695. [PMID: 38114132 DOI: 10.1111/add.16413] [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: 04/11/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND AIM Social practices such as smoking-drinking co-use often go 'hand-in-hand', linked by the coordination of materials, skills and meanings. However, the experience of using e-cigarettes while drinking among people who smoke (and drink) remains underexplored. We used social practice theory to show how smoking, vaping and drinking intersect and to explain how vaping created two new social practices among people who tried e-cigarettes to stop smoking: 'vaping-drinking' co-use and 'smoking-vaping-drinking' poly-use. METHODS We conducted five in-depth interviews over 18-24 weeks during 2018-19, with each of nine Aotearoa New Zealand young adults aged 20-29 years. Participants smoked daily, did not regularly use e-cigarettes at entry and wished to try vaping to stop smoking. We analysed participants' reports of smoking or vaping while drinking using thematic analysis. RESULTS Individual participants reported both co-use and poly-use occasions throughout the study. Vaping-drinking co-use arose from practice 'replacement' processes, where vaping fully substituted smoking. Smoking-vaping-drinking poly-use arose from 'adjacency' processes where vaping complemented smoking. Participants used both processes flexibly over time, which required new skills in material, temporal, pleasure and social coordination to try to recreate valued meanings of comfort, security and communality associated with well-established smoking-drinking practices. Unsuccessful coordination attempts maintained smoking-drinking co-use. CONCLUSION Among Aotearoa New Zealand young adult smokers who want to use vaping to stop smoking, drinking occasions may help to maintain existing smoking-drinking practices and facilitate the development of vaping-drinking co-use and smoking-vaping-drinking poly-use practices, potentially prolonging individuals' exposure to smoking.
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Affiliation(s)
- Mei-Ling Blank
- Department of Preventive and Social Medicine, University of Otago, Ōtepoti Dunedin, Aotearoa, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Te Whanganui-a-Tara Pōneke, Wellington, Aotearoa, New Zealand
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Hashemi R, Vogel EA. Adolescents' perceptions of substance use messaging in the age of social media: resolving cognitive dissonance. HEALTH EDUCATION RESEARCH 2024; 39:1-11. [PMID: 38183674 PMCID: PMC10805388 DOI: 10.1093/her/cyad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
This study interviewed adolescents about their exposure to and perceptions of substance-related social media content and substance use prevention messages. Participants (analytic sample N = 30, age 14-18 years, in CA, USA, 40% male) were recruited from Instagram and Facebook for online semi-structured interviews. An interview transcript coding guide was developed based on the interview questions and emerging themes. Most (27/30) participants reported exposure to peers using substances on social media through posts made on personal accounts. All peer posts portrayed substance use in a positive light. Most participants reported exposure to formal prevention messages on social media (i.e. public service announcements) (19/30) and in schools (i.e. drug education) (21/30; 70.0%) teaching the negative consequences of substance use. Responses to the differences between peer posts and prevention messages included dismissing prevention messages (7/30), believing that their peers were more credible (4/30), desiring comprehensive substance information (3/30) and believing that the no-use message was ineffective for at-risk youth (4/30). Messages shared by peers online significantly contrasted with prevention messages (i.e. public service announcements and drug education). This difference appeared to undermine prevention message credibility. Balanced prevention messages acknowledging the spectrum of risk and reward when using different substances may reduce dissonance and increase engagement.
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Affiliation(s)
- Rhana Hashemi
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA 94305, USA
| | - Erin A Vogel
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA 94305, USA
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7
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Mugavin J, Room R, Callinan S, MacLean S. How do people drink alcohol at a low-risk level? HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:311-326. [PMID: 37162256 DOI: 10.1080/14461242.2023.2209090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
Reducing the risks associated with drinking is an ongoing public health goal. Approximately two-fifths of Australian adults consume alcohol within low-risk guidelines, yet little is known about their drinking patterns or practices. In this paper, we use social practice theory to consider low-risk drinking at home as a routinised social practice with material, meaning and competence dimensions. We analysed open-text survey responses from 252 Australian adults (30-65, 89% female) who were considered low-risk drinkers. A low-risk drinking occasion was typically closely linked to other practices such as eating dinner or connecting with family or friends. Drinking alcohol, even in small amounts, was associated with enjoyment. Being attuned to bodily sensations and applying some self-imposed rules were competencies that allowed low-risk drinkers to avoid intoxication. Low-risk drinking practices entail some elements that can inform health promotion, including encouraging efforts to limit drinking to times of the day (e.g. during meals) and to attend to bodily feelings of sufficiency. The study also shows how low-risk drinking is entangled with gendered and age-related norms about drinking, and facilitated by rarely being in 'intoxigenic' environments. These factors are imbricated with individual decisions in our respondents' capacity to consume alcohol moderately.
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Affiliation(s)
- Janette Mugavin
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - Sarah MacLean
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Harvanko A, Koester KA, Helen GS, Olson S, Kim HC, Ling PM. A Mixed-Methods Study on Use of Different Tobacco Products among Younger and Older Adults with Lower and Higher Levels of Nicotine Exposure in California in 2019-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5563. [PMID: 35564958 PMCID: PMC9106024 DOI: 10.3390/ijerph19095563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 12/04/2022]
Abstract
An increasing number of tobacco products are entering the market, offering a variety of options to attain desired nicotine intake. However, little is known about the effect of this diverse marketplace on the experiences and nicotine exposure among tobacco users. A mixed-methods study examined experiences with tobacco products among individuals with relatively lower or higher levels of biomarkers of nicotine exposure. Semi-structured interviews were conducted with younger and older adults to examine tobacco use behaviors, addiction to tobacco products, and nicotine effects. Younger and older adults provided similar narratives about addiction and nicotine effects, which were similar across age groups, product types (i.e., ENDS, combustible cigarettes, or oral tobacco products), and having lower or higher nicotine exposure. Some individuals with higher nicotine exposure who switched from combustible cigarettes to another product (e.g., ENDS) found similar or greater access and perceived addiction to nicotine. Adults with higher and lower levels of nicotine exposure provided narratives consistent with features of nicotine addiction, regardless of age and products used. Availability of multiple tobacco products may be associated with greater access and exposure to nicotine. Addiction may occur at low levels of use and with non-cigarette products.
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Affiliation(s)
- Arit Harvanko
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Kimberly A. Koester
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Gideon St. Helen
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Sarah Olson
- Divison of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94143-1390, USA;
| | - Hyunjin Cindy Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
- Divison of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94143-1390, USA;
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Male D, Kansabe S, Lukwata H, Rubanga A, Siddiqi K, Bauld L, McNeill A, Dobbie F. Smokeless Tobacco in Uganda: Perceptions among Tobacco Control Stakeholders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3398. [PMID: 35329084 PMCID: PMC8950400 DOI: 10.3390/ijerph19063398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/27/2022] [Accepted: 03/11/2022] [Indexed: 12/10/2022]
Abstract
The use and sale of smokeless tobacco (SLT) is prohibited in Uganda under the Tobacco Control Act (TCA), 2015. Nonetheless, SLT products remain available, and there are limited and inconsistent data on SLT users. Additionally, the perceptions of tobacco control stakeholders on SLT are unknown, making it difficult to determine barriers to enforcing the ban. This study examined perceptions of tobacco control stakeholders regarding SLT in Uganda. Qualitative semi-structured interviews were conducted with stakeholders who were purposively selected from ministries, semi-autonomous government agencies and Civil Society Organizations. Interviews explored knowledge, attitudes, perceptions of SLT appeal, and user demographics. Data were analysed using Nvivo V.12 software. Participants demonstrated a general lack of awareness of SLT product types and the extent of their use. They believed SLT use was increasing among females and minors and was as harmful to health and the economy as smoking. SLT products were thought to be cheaper than cigarettes and to appeal to minors. Discreet use was thought to help users overcome the cultural aversion towards tobacco use among women and youth in Uganda. There is an urgent need to strengthen the implementation of the SLT ban whilst also increasing efforts to reduce tobacco smoking.
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Affiliation(s)
- Denis Male
- Department of Food Technology and Nutrition, School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | - Shirley Kansabe
- Department of Food Technology and Nutrition, School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | - Hafsa Lukwata
- Mental Health Division, Ministry of Health, Kampala P.O. Box 7272, Uganda;
| | - Alexander Rubanga
- International Affairs Unit, Uganda Revenue Authority, Kampala P.O. Box 7279, Uganda;
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK;
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8BB, UK;
| | - Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK;
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10
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Rubenstein D, Pacek LR, McClernon FJ. Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence. Nicotine Tob Res 2022; 24:1208-1217. [PMID: 35137194 PMCID: PMC9278823 DOI: 10.1093/ntr/ntac032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/04/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION One-third of adults in the United States who use tobacco regularly use two or more types of tobacco products. As the use of e-cigarettes and other noncombusted tobacco products increases-making multiple tobacco product (MTP) use increasingly common-it is essential to evaluate the complex factors that affect product use. AIMS AND METHODS In this update to our 2019 conceptual framework, we review and evaluate recent literature and expand the model to include ways in which MTP use may be affected by market factors such as the introduction of new products and socioenvironmental factors like marketing and advertising. RESULTS AND CONCLUSIONS MTP use patterns are complex, dynamic, and multiply determined by factors at the level of individuals, products, situations or contexts, and marketplace. Substitution, or using one product with the intent of decreasing use of another, and complementarity, or using multiple products for different reasons or purposes, explain patterns in MTP use. Moreover, substitution and complementarity may inform our understanding of how market changes targeted at one product, for instance, new product standards, bans, product pricing, and taxation, affect consumption of other tobacco products. New data from natural experiments and novel laboratory-based techniques add additional data and expand the framework. IMPLICATIONS A substantial proportion of people who use tobacco use more than one product. This review synthesizes and evaluates recent evidence on the diverse factors that affect MTP use in addition to expanding our framework. Our review is accompanied by suggested research questions that can guide future study.
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Affiliation(s)
- Dana Rubenstein
- Corresponding Author: Dana Rubenstein, BA, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA. Telephone: 919-668-3987; Fax: 919-681-1600; E-mail:
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Holmes LM, McQuoid J, Shah A, Cruz T, Akom A, Ling PM. Piloting a spatial mixed method for understanding neighborhood tobacco use disparities. Soc Sci Med 2021; 291:114460. [PMID: 34655940 PMCID: PMC8671214 DOI: 10.1016/j.socscimed.2021.114460] [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: 05/26/2021] [Revised: 08/21/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.
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Affiliation(s)
- Louisa M Holmes
- Departments of Geography and Demography, And the Social Science Research Institute, Pennsylvania State University, 302 Walker Building, University Park, PA, 16802, USA.
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, OK, 73104, USA
| | - Aekta Shah
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Tessa Cruz
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Antwi Akom
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, 94143-1390, USA
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Strickett E, Robertson L, Waa A, Blank ML, Erick S, Hoek J. A Qualitative Analysis of Maori and Pacific people's Experiences of Using Electronic Nicotine Delivery Systems (ENDS). Nicotine Tob Res 2021; 23:550-556. [PMID: 32421174 DOI: 10.1093/ntr/ntaa087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/12/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION If electronic nicotine delivery systems (ENDS) are to bring public health benefits, members of population groups most affected by smoking must find them an easily adopted and satisfying replacement for smoking. We explored experiences of ENDS uptake and use among Māori and Pacific peoples living in New Zealand and probed factors that assisted transitions from smoking to vaping. METHODS We recruited 16 participants using whānaungatanga and community advertising. All were aged 18 or over, identified as Māori or Pacific (or both), had smoked at least 100 cigarettes, and were current ENDS users. We undertook in-depth interviews and analyzed the data using a thematic analysis approach. RESULTS We identified two key challenges that participants reported facing: their search for a satisfying ENDS experience and resisting social cues that could trigger relapse. Two supportive factors facilitated and reinforced smoking to vaping transitions: improved financial and physical well-being, and feeling connected to vaping communities. CONCLUSION Learning about ENDS devices from those who had successfully switched from smoking to vaping provided much-needed information, reinforced the financial benefits of switching, and could inspire those making this transition to persist until they too become smoke free. IMPLICATIONS Measures to support transitions from smoking to ENDS use could reduce inequities in smoking prevalence that indigenous people experience. Collective cessation interventions that draw on communities' knowledge and connections may enable smokers to access support that helps them navigate the potentially complex pathway from smoking to vaping.
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Affiliation(s)
| | - Lindsay Robertson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Department for Health, University of Bath, Claverton Down, Bath, UK
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mei-Ling Blank
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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Lee J, Thompson LA, Salloum RG. Heated tobacco product use among US adolescents in 2019: The new tobacco risk. Tob Prev Cessat 2021; 7:01. [PMID: 33437895 PMCID: PMC7796675 DOI: 10.18332/tpc/130502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is growing public health concern about adolescent use of heated tobacco products (HTPs) after the US Food and Drug Administration approved the leading HTPs, IQOS, as a modified risk tobacco product. Extending the previous studies examining the correlates of HTP use among adolescents, this study aims to investigate potential risk factors for HTP use among US adolescents, including the use of multiple tobacco and flavored tobacco products. METHODS We analyzed the 2019 National Youth Tobacco Survey (n=19018) and conducted a series of logistic regression models on awareness and use of HTPs as a function of tobacco use status (none, single, dual/poly) and past 30 days flavored tobacco use (e.g. menthol cigarette use, flavored e-cigarettes), controlling for sociodemographics. RESULTS In multivariable analyses, awareness of HTPs was associated with usual menthol cigarette use (AOR=1.77; 95% CI: 1.23-2.53) and past 30 days flavored tobacco use (AOR=1.44; 95% CI: 1.16-1.80). Risk factors for ever HTP use included single (AOR=2.52; 95% CI: 1.19-5.33) and dual/poly tobacco use (AOR=4.94; 95% CI: 2.56-9.54), usual menthol cigarette use (AOR=2.50; 95% CI: 1.66-3.76), and past 30 days flavored tobacco use (AOR=1.61; 95% CI: 1.07-2.44). Risk factors for current HTP use included single (AOR=10.84; 95% CI: 6.72-17.49) and dual/poly tobacco use (AOR=31.96; 95% CI: 17.79-57.43), and usual menthol cigarette use (AOR=2.50; 95% CI: 1.63-3.85). CONCLUSIONS This study documents HTP use in adolescents and contributes insight and urgency into prioritizing at-risk adolescents for interventions, including current users of other tobacco products and flavored tobacco users.
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Affiliation(s)
- Juhan Lee
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, United States
| | - Lindsay A Thompson
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, United States
| | - Ramzi G Salloum
- Department Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, United States
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Kim M, Watkins SL, Koester KA, Mock J, Kim HC, Olson S, Harvanko AM, Ling PM. Unboxed: US Young Adult Tobacco Users' Responses to a New Heated Tobacco Product. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8108. [PMID: 33153143 PMCID: PMC7662359 DOI: 10.3390/ijerph17218108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022]
Abstract
The heated tobacco product (HTP) IQOS was authorized for sale in the US in 2019. We investigated how young adults with experience using multiple tobacco products reacted to, perceived, and developed interest in IQOS, informing policies that might prevent HTPs from becoming ubiquitous. We used a novel qualitative method in which 33 young adult tobacco users in California (fall 2019) "unboxed" an IQOS device, tobacco sticks, and marketing materials and narrated their impressions and opinions. We conducted content and thematic analyses of participants' reactions, sensory experiences, and interest. Multiple attributes influenced appeal for participants, including sleek electronic design, novel technology, perceived harmfulness, complexity, and high cost. The "no smoke" claim and heating technology suggested that smoking IQOS was safer than smoking cigarettes. Public health programs should closely monitor HTP marketing and uptake, particularly as "reduced exposure" claims were authorized in July 2020. Evidence-based regulations (e.g., requiring plain packaging for tobacco sticks), actions addressing IQOS' unique attributes (e.g., regulating device packaging to reduce high-tech appeal), and public education might help to counter the appeal generated by potentially misleading IQOS marketing tactics.
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Affiliation(s)
- Minji Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
| | - Shannon Lea Watkins
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Kimberly A. Koester
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Jeremiah Mock
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA 94143, USA;
| | - Hyunjin Cindy Kim
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Sarah Olson
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Arit Michael Harvanko
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
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Hennell K, Piacentini M, Limmer M. ‘Go hard or go home’: a social practice theory approach to young people’s ‘risky’ alcohol consumption practices. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1686460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kath Hennell
- School of Social Science, Liverpool Hope University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Maria Piacentini
- Lancaster University Management School, Lancaster University, Lancaster, United Kingdom of Great Britain and Northern Ireland
| | - Mark Limmer
- Health Research, Lancaster University, Lancaster, United Kingdom of Great Britain and Northern Ireland
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Keamy-Minor E, McQuoid J, Ling PM. Young adult perceptions of JUUL and other pod electronic cigarette devices in California: a qualitative study. BMJ Open 2019; 9:e026306. [PMID: 30948599 PMCID: PMC6500190 DOI: 10.1136/bmjopen-2018-026306] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/24/2018] [Accepted: 02/15/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Electronic cigarettes (e-cigarettes) which utilise prefilled 'pods' (pod devices) entered the US market in 2015. One brand, JUUL, captured more than half the e-cigarette market in early 2018, and the US Food and Drug Administration recently warned its manufacturer about adolescent uptake. This is the first qualitative study to describe distinct features of pod devices that appear to contribute to their popularity among young people. DESIGN Qualitative interview study of young adults who had used pod devices. Participants were recruited from Facebook, other social media, street recruitment and via snowball sampling. SETTING Participants were from California, with most from the San Francisco Bay Area. PARTICIPANTS Young adults (aged 18-29 years) using multiple tobacco products (cigarettes, e-cigarettes and/or smokeless tobacco) were recruited. Of the sample of 60 participants, 24 were included in this analysis: 10 who reported experience with pod devices and 14 who used other non-pod e-cigarette devices. RESULTS Ten participants had used a pod device in the past year. Of the pod device users, seven still used a pod device at the time of the interview and five did so daily. Nearly all (n=9) pod device users smoked cigarettes in the past month; none were daily smokers. The 14 participants who used non-pod devices provided a point of comparison. Participants highlighted some distinct aspects of pod devices that facilitated use, including their aesthetic similarity to personal electronics, high levels of nicotine delivery with distinct psychoactive effects, more discreet and shorter duration use sessions, and greater social acceptability than more ostentatious non-pod e-cigarettes. CONCLUSIONS Pod devices' unique characteristics likely encourage pod device uptake among young people. Limitations on advertising in youth channels, flavours and distribution, and education about nicotine addiction may decrease initiation among young people and non-smokers.
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Affiliation(s)
- Emily Keamy-Minor
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Julia McQuoid
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Pamela M Ling
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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