Sexy, trashy, cool: Perceptions of electronic cigarette users across sociodemographic groups and E-cigarette use among United States Air Force Airmen

E-cigarette use has increased in recent years. Military personnel have higher rates of e-cigarette use than civilian populations, with 15.3% of Air Force recruits using e-cigarettes. The current study assessed associations between perceptions of e-cigarette users and current use of e-cigarettes, and differences in sociodemographic characteristics to determine if there were different beliefs among different groups to inform intervention development among these straight-to-work young adults. Participants (N = 17,314) were United States Air Force Airmen (60.7% White, 29.7% women) who completed a survey during their first week of Technical Training. Regression results indicated that identifying as a man (B = 0.22, SE = 0.02), identifying as Black (B = 0.06, SE = 0.02), reporting younger age (B = -0.15, SE = 0.02), having less education (B = -0.04, SE = 0.02), and current e-cigarette use (B = 0.62, SE = 0.02) were associated with endorsing more positive e-cigarette user perceptions. Identifying as a woman (B = -0.04, SE = 0.02) and being younger (B = -0.06, SE = 0.02) were associated with endorsing more negative perceptions of e-cigarette users. Current e-cigarette use was inversely associated with negative e-cigarette user perceptions (B = -0.59, SE = 0.02). Differences across groups were found for individual e-cigarette user characteristics. Future intervention strategies among Airmen may benefit from addressing e-cigarette user perceptions to change use behaviors, as these perceptions may result in stigmatized beliefs related to e-cigarette users.

Use of Electronic Cigarettes and Other Tobacco Products Among Active Component Services Members

INTRODUCTION

e-cigarettes have been touted as a safer alternative to classic cigarettes and other combustible tobacco products. However, a growing body of evidence finds that any risk reduction associated with e-cigarette use is eliminated when individuals use "both" e-cigarettes and other tobacco products. Recent analyses from the Health Related Behaviors Survey suggest that rates of e-cigarette use are higher among active component service members than in the general population. However, little is known about the frequency and health behaviors associated with the dual use of e-cigarettes and other tobacco products among service members.

DATA AND METHOD

Using data from the 2018 Health Related Behaviors Survey, this paper investigates whether active component service members who use both e-cigarettes and other tobacco products are more likely to engage in other types of substance use or negative health behaviors.

RESULTS

We find that the dual use of e-cigarettes and other tobacco products is associated with poorer physical and mental health, higher rates of alcohol misuse, and higher rates of insufficient sleep.

CONCLUSION

The association between the dual use of e-cigarettes and tobacco products suggests that these individuals represent an important target group for health-related resources and attention in DoD.

Policy and Behavior: Comparisons between Twitter Discussions about the US Tobacco 21 Law and Other Age-Related Behaviors

To combat the e-cigarette epidemic among young audiences, a federal law was passed in the US that raised the minimum legal sales age of tobacco to 21 years (commonly known as Tobacco 21). Little is known about sentiment toward this law. Thus, the purpose of our study was to systematically explore trends about Tobacco 21 discussions and comparisons to other age-restriction behaviors on Twitter. Twitter data (n = 4628) were collected from September to December of 2019 that were related to Tobacco 21. A random subsample of identified tweets was used to develop a codebook. Two trained coders independently coded all data, with strong inter-rater reliability (κ = 0.71 to 0.93) found for all content categories. Associations between sentiment and content categories were calculated using χ2 analyses. Among relevant tweets (n = 955), the most common theme—the disjunction between ages for military enlistment and tobacco use—was found in 17.8% of all tweets. Anti-policy sentiment was strongly associated with the age of military enlistment, alcohol, voting, and adulthood (p < 0.001 for all). Opposition to Tobacco 21 propagates on social media because the US federal law does not exempt military members. However, the e-cigarette epidemic may have fueled some support for this law.

E-cigarette and dual product use as an emerging health threat to the US military

INTRODUCTION

Cigarette and e-cigarette use are threats to the health and readiness of the US military. The study objective was to determine the prevalence and factors associated with e-cigarette, cigarette, and dual use among active duty service members (SMs).

METHODS

We used data from the 2015 Health Related Behaviors Survey—a crosssectional survey weighted to represent the US military (n=16699). Weighted prevalence and odds ratios assessed associations between risk factors and e-cigarette/cigarette use via weighted multinomial logistic models.

RESULTS

The prevalence of cigarette use in the US military declined from 24% in 2011 to 13.8% in 2015. However, e-cigarette use (12.4%) and dual product use (4.7%) increased during this period. Additionally, prevalence of e-cigarette use was higher in the military compared to the general population (12.4% vs 3.5%), particularly among those aged 17–24 years (22.8% vs 5.2%); cigarette use was also higher in the military in this age group (19.3% vs 13.0%). After adjustment, SMs who were enlisted, lacked a Bachelor’s degree, and/or had probable alcohol use disorder had significantly greater odds of cigarette, e-cigarette, and dual use. While SMs aged 17–24 years had the highest prevalence of all types of product use, only being aged ≥45 years was significantly associated with decreased odds of product use in adjusted models.

CONCLUSIONS

Military efforts to control cigarette use among SMs seem to have been successful, as demonstrated by the dramatic declines in its use and the lower prevalence seen in the military compared to the general population. However, the concurrent increases in e-cigarette use are concerning, particularly among the youngest members of the military. The US military must continue to monitor emerging trends in e-cigarette, cigarette, and dual use and rapidly take steps to address them as threats to health and readiness.

Correlates of e-cigarette use among active duty US military personnel: implications for cessation policy

BACKGROUND

Electronic cigarette (or e-cigarette) use has grown substantially since its US market introduction in 2007. Although marketed as a safer alternative to traditional cigarettes, studies have shown they can also be a gateway to their use. The purpose of this investigation is to identify factors associated with different patterns of tobacco use among active duty military personnel.

METHODS

A secondary analysis was conducted using the 2014 Defense Health Agency Health Related Behaviors survey data. Results are based on 45 986 US military respondents, weighted to 1 251 606. Both univariate and regression analyses were conducted to identify correlates.

RESULTS

In 2014, approximately 7.8% of respondents reported using e-cigarettes at least once in the past year. Among e-cigarette users, 49% reported exclusive e-cigarette use. Prevalence of exclusive use is highest among white people (58%), Navy (33%), men (83%) and persons with income ≤$45 000 (65%). Regression comparing exclusive cigarette with exclusive e-cigarette users revealed higher odds of being Air Force (OR=2.19; CI 1.18 to 4.06) or Navy (OR=2.25; CI 1.14 to 4.41) personnel and being male (OR=1.72; CI 1.12 to 2.64), and more likely to not receive smoking cessation messaging from healthcare providers in the last 12 months (OR=2.88; CI 1.80 to 4.62). When comparing exclusive e-cigarette users with poly-tobacco users, e-cigarette users had higher odds of being Hispanic (OR=2.20; CI 1.02 to 4.78), college educated (OR=4.25; CI 1.22 to 14.84) and not receiving tobacco prevention/cessation messaging (OR=4.80; CI 2.79 to 8.27).

CONCLUSION

The results demonstrate that exclusive e-cigarette users in the military have unique characteristics when compared with groups of other/mixed tobacco users. Findings can inform cessation and prevention efforts to improve both the overall health and combat readiness of active duty military personnel.

E-Cigarette Use and Perceptions Among Veterans Receiving Outpatient Treatment in Veterans Affairs Substance Use and Mental Health Clinics

Introduction

Individuals with substance use disorders and/or mental health (MH) conditions have higher rates of cigarette smoking than the general population. Electronic nicotine delivery systems (ENDS) while gaining popularity pose health risks. Herein we investigate risk perceptions and attitudes toward e-cigarettes in military Veterans with MH conditions.

Materials and Methods

Participants included U.S. Veterans receiving services from Veterans Administration MH/substance use disorder clinics in the San Francisco Bay Area (N = 98; 95% male, 44% White, 34% Black/African American), who completed a survey on smoking and health. Results compare attitudes and perceptions regarding e-cigarette use between ever and never e-cigarette users. The study was reviewed by the Institutional Review Board at both the Veterans Administration and University.

Results

Most respondents reported being current/past cigarette smokers (91%) and over a third reported having ever used an e-cigarette (38%). Most believed that e-cigarettes are not safe, are potentially dangerous, are potentially addictive if they use every day and are tempting and appealing to youth. Fifty-one percent of ever-users agreed with a statement that e-cigarettes can help people quit smoking regular cigarettes completely, and there was a significant difference in this belief when comparing them with never-users (23% agreed); χ2 = 9.259, P = 0.010.

Conclusions

Proportion of e-cigarette use in this Veteran sample is greater than the general population. We observed high risk perception about e-cigarettes among all respondents and differences in perceived helpfulness of e-cigarettes for quitting in ever-users versus never-users in this sample. More consistent assessment of tobacco use among Veterans, with inclusion of ENDS use, would help inform prevention and treatment priorities, especially as information on health impacts of ENDS surfaces.

E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) in an Active Duty Service Member

E-cigarette or vaping product use-associated lung injury (EVALI) is a developing serious pulmonary disease associated with the increasing use of vaping products in both civilian and active duty populations. This case study describes an active duty trainee using unbranded vaping products who developed acute respiratory distress syndrome necessitating intubation and multiday intensive care unit hospitalization. Diffuse ground glass opacities in imaging, lipid-laden macrophages found on bronchoalveolar lavage, negative infectious disease workup, and recent vaping indicate EVALI. This case demonstrates more work needs to be done within the Armed Forces to reduce use of vaping products given the danger of EVALI.

Negative Alcohol and Tobacco Consumption Behaviors in an Australian Army Combat Brigade

Introduction

Western militaries have consumption rates of alcohol and tobacco which are higher than the associated civilian populations, and are concerned about the negative effects on health, wellbeing, and military performance that such high rates may have.

Materials and Methods

A survey questionnaire which collected nonidentifiable data was distributed to all accessible members of an Australian Army Combat Brigade over the annual induction training and prefield exercise period between January and March 2019. The survey was composed of personal and demographic questions, followed by questions concerning the personal consumption habits of alcohol and tobacco. 1,606 complete and valid surveys were returned, representing 55.3% of the Brigade’s posted strength. Ethical clearance for this project was provided by the Australian Defence Force Joint Health Command Low Risk Ethics Panel (18-012).

Results

Almost one quarter of the Combat Brigade exceeded the Australian daily risk guideline for alcohol consumption, and over three quarters exceeded the occasion risk guideline; with 6.1% of soldiers drinking alcohol daily. 24.3% identified as tobacco smokers, with 15.9% smoking daily. Smoking rates and volumes were higher when deployed on field training exercises and on international training and operational deployments; as was the consumption of roll-your-own cigarettes. Overall, the main determinants of the negative consumption behaviors were gender (male) and age (under 25).

Conclusions

This study confirmed that the members of an Australian Army Combat Brigade have higher negative health consumption behaviors concerning alcohol and tobacco than the general civilian population. The results also identified a cohort of Senior Non-Commissioned Officers and Warrant Officers (E5–E9) between the ages of 35 and 44 who had high negative consumption behaviors which could result in poor health outcomes. This could be a suitable cohort for a targeted campaign to reduce tobacco and alcohol consumption and to assist to make healthy life changes.

Electronic Cigarette Use and Related Factors among Active Duty Service Members in the U.S. Military

Introduction

Electronic cigarettes (e-cigarettes) are increasingly used in the U.S.A. by young people. As young adults serve as the primary recruiting pool for military, active duty service members in military may be susceptible to using e-cigarettes. However, factors related to e-cigarette use in military population have rarely been studied. We aimed to identify factors associated with e-cigarette use and factors related to duration of use among active duty service members.

Materials and Methods

Subjects (N = 2,467) from Fort Bragg Army Base, North Carolina and Lackland Air Force Base, Texas completed a self-administered questionnaire during July 2015 to May 2016 time frame. The questionnaire collected data on demographic and military characteristics, tobacco use (including e-cigarette use) and other information. Stepwise logistic regression was performed to identify significant factors associated with e-cigarette use. Stepwise linear regression was performed to identify factors associated with duration of use.

Results

A total of 356 (14.4%) study participants reported ever use of e-cigarettes. There was no significant difference in prevalence of use between the two military installations (15.6% at Fort Bragg vs. 13.2% at Lackland, P = 0.097). Increased use of e-cigarettes was associated with young age (20–24 years old) (OR = 1.98, 95% CI = 1.22–3.22), enlisted military rank (E1–E4: OR = 2.45, 95% CI = 1.36–4.40; E5–E9: OR = 1.88, 95% CI = 1.10–3.21), low perception of harm (OR = 5.18, 95% CI = 3.65–7.34), former (OR = 9.12, 95% CI = 6.29–13.22) and current (OR = 13.24, 95% CI = 9.22–19.02) cigarette smoking, and former smokeless tobacco use (OR = 2.07, 95% CI = 1.33–3.22), former (OR = 2.62, 95% CI = 1.42–4.85) and current (OR = 2.82, 95% CI = 1.82–4.37) cigar or pipe smoking. However, serving mainly in combat unit during deployment was associated with decreased odds of use (OR = 0.57, 95% CI = 0.34–0.97). Among e-cigarette users, the number of years using e-cigarettes was significantly longer among the participants with lower perception of harm than those with higher perception of harm (0.82 vs. 0.22, P &lt; 0.001), and the duration was longer among subjects who used e-cigarette with nicotine than those without nicotine (0.79 vs. 0.49, P = 0.003). Finally, reasons for use differed markedly by cigarette smoking status. Never smokers used e-cigarette for the taste or flavor, while cigarette smokers used e-cigarette to help quit tobacco or reduce tobacco use.

Conclusion

Young age, lower military ranks, other tobacco use, and low perception of harm were associated with increased odds of using e-cigarettes, while serving in combat unit was associated with decreased odds of use in active duty service members. Low harm perception and using nicotine-containing e-cigarettes were associated with long duration of use. The reasons for using e-cigarettes differed by cigarette smoking status. Our study provides clues for future hypothesis-driven studies.