Does the time to nicotine dependence vary by internalizing symptoms for young people who use e-cigarettes? An analysis of the Population Assessment of Tobacco and Health (PATH) study, (Waves 1-5; 2013-2019)

OBJECTIVE

To determine the relationship between past-year internalizing symptoms and the time to first report of signs of nicotine dependence among young people.

METHODS

Secondary analysis using data from the Population Assessment of Tobacco and Health (PATH) (Waves 1-5; 2013-2019). The study included 2,102 (N = 5,031,691) young people (age 12-23 years) who reported past-30-day (P30D) e-cigarette use in one or more waves. Kaplan Meier curves, stratified by past year internalizing symptoms were used to estimate the time to the first report of three nicotine dependence symptoms (i.e., use within 30 min of waking, cravings, and really needing to use) following the first P30D e-cigarette use. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios (AHR), comparing any past year internalizing symptoms to no past year internalizing symptoms.

RESULTS

We found no significant differences between past year internalizing symptoms and the time to the first report of cravings (AHR = 1.30, 95 % CI = 92-1.85), really needing to use (AHR = 1.31; 95 % CI = 0.92-1.89) and use within 30 min of waking for follow-up times 0-156 weeks (AHR = 0.84; 95 % CI = 0.55-1.30) and > 156 weeks (AHR = 0.41; 95 % CI = 0.04-4.67) respectively.

CONCLUSION

Past year internalizing symptoms did not modify the time to the first report of nicotine dependence among youth with P30D e-cigarette use. Further research is needed to understand how changing internalizing symptoms and e-cigarette use frequency influence nicotine dependence over time and, how this relationship impacts cessation behavior.

Psychological distress and e-cigarette use among young Australians: An exploratory, qualitative study

INTRODUCTION

Emerging research suggests an association between psychological distress and e-cigarette use. However, our understanding of young adults' experiences of this relationship is limited. We explored young adults' experiences of psychological distress and e-cigarette use.

METHODS

We conducted semi-structured interviews with 18- to 24-year-old university students (n=13; 77% female; mean age=21.5 years) based in Victoria, Australia. Interviews were conducted May-June 2023. Data were subject to reflexive thematic analysis.

RESULTS

Individuals reported that they or their friends had initiated e-cigarette use to manage their psychological distress (e.g. low mood, social isolation, stress). Immediate stress reduction following use and subsequent nicotine dependence appeared to maintain use.

CONCLUSIONS

A reciprocal relationship likely exists between psychological distress and e-cigarette use whereby psychological distress contributes to use initiation and use maintains distress. Public campaigns and health services should provide: 1) education on adaptive coping/stress management strategies and the signs of nicotine dependence, and 2) support to manage nicotine dependence and the psychological distress that can arise from addiction.

Relationship between electronic cigarette use, dual smoking habits, and psychological distress among youth in Northern Thailand: A cross-sectional study

INTRODUCTION

Amidst the escalating trend of electronic cigarette (e-cigarette) use and dual smoking habits among youth, understanding their potential impact on psychological well-being is imperative. Limited research has explored this relationship, particularly among youth in settings where e-cigarettes are banned. This study investigates the relationship between current e-cigarette and traditional cigarette use patterns and the presence of depression and anxiety symptoms among youth in Thailand.

METHODS

Using a cross-sectional survey encompassing 3424 individuals aged 15-24 years in Northern Thailand from December 2021 to September 2022, we accessed cigarette and e-cigarette usage over the past 30 days alongside depression and anxiety symptoms over the past two weeks. Multivariable logistic regression was employed to analyze the association of these variables, adjusting for sociodemographic factors.

RESULTS

Among the surveyed youths, 10.8% reported cigarette use, 6.2% utilized e-cigarettes, and 3.3% were dual users within the past 30 days. Regarding mental health, 33.96% exhibited moderate-severe to severe depression, while 52.54% experienced anxiety at similar levels. After adjusting for covariates, both current e-cigarette users and dual users exhibited heightened depression symptoms (AOR=1.80; 95% CI: 1.30-2.51, and AOR=2.30; 95% CI: 1.49-3.55, respectively) and only e-cigarette use had increased odds of increased anxiety levels (AOR=1.70; 95% CI: 1.24-2.32) compared to non-users. Notably, current cigarette smokers demonstrated no association with depression but had decreased odds of higher levels of anxiety compared to non-users (AOR=0.73; 95% CI: 0.55-0.96).

CONCLUSIONS

A substantial number of Thai youths are using e-cigarettes and experiencing psychological distress. E-cigarette use is associated with heightened levels of depression and anxiety, whereas cigarette smoking is not associated with depression but is likely to be associated with an increased reporting of anxiety. These contradictory findings highlight the need for comprehensive investigations, especially when e-cigarettes are prohibited.

Health Messaging Strategies for Vaping Prevention and Cessation Among Youth and Young Adults: A Systematic Review

This systematic review evaluates health messaging strategies for the prevention and cessation of e-cigarette use among youth and young adults. Health messaging strategies were defined as the strategic process of developing messages with the intent to shape, reinforce, or change recipients' health attitudes and behaviors. McGuire's Communication/Persuasion Model guided the analysis of the messaging strategies, focusing on the model's five communication inputs (i.e. source, message, channel, audience, destination) and 14 persuasive outcomes. Nine databases were searched from January 2007 to September 2023. The inclusion criteria encompassed studies in English that presented quantitative data on messaging strategies aimed at discouraging vaping among youth and young adults. Each study was also coded for study characteristics and the utilization of theory. Out of 6,045 studies, 25 met the inclusion criteria. The reviewed studies exhibit a diverse array of research methods and a consistent integration of theories. The review emphasizes the nuanced main and interaction effects of various communication inputs, such as message features and audience characteristics, while also pointing out a research gap in message sources. In addition, the utilization of social media for effective messaging to engage the audience requires further research. Only one study specifically evaluated messaging strategies for vaping cessation. More research is imperative to develop targeted and tailored messages that effectively prevent and reduce vaping, especially among populations at higher risk of vaping-related harms, while also leveraging effective channels and innovative communication technologies to engage the audience.

Identifying promising themes and messages for youth vaping prevention: A national study

Use of e-cigarettes and vapes among adolescents continues to be a major public health concern. Health communication efforts can discourage e-cigarette use among adolescents by influencing beliefs and behavior. However, to do so, studies need to identify the most promising themes and messages based on the latest evidence about the harms of e-cigarettes and vaping. Participants were a nationally representative sample of 1,603 US adolescents aged 13-17 years, recruited in the summer of 2022. Adolescents were randomly assigned to view 7 vaping prevention statements (one from each theme: nicotine addiction, chemical harms, health symptoms, mental health, organ effects, cosmetic effects, and monetary cost) and 1 control statement (vape litter theme) from a pool of 46 statements that were developed through a systematic process. Participants rated each statement on perceived message effectiveness (PME), awareness, and believability. Results of linear mixed models indicated that all vaping prevention themes out-performed control messages on PME, with chemical harms and organ effects having the largest effects, followed by nicotine addiction and then other themes. For most message themes, PME effects were stronger for youth susceptible to vaping compared to non-susceptible youth and users. Both awareness and believability predicted higher levels of PME. In secondary analyses, we found that statements specifying the target ("you") and longer statements were also rated higher on PME. Results suggests that the most potent vaping prevention messages for adolescents are those that focus on vape chemicals and the potential of vaping to damage organs and increase disease risk.

Past-Year Mental Illness Diagnosis and E-cigarette Use Status Among a College-Aged Sample: Findings From the National College Health Assessment (2017-2019)

PURPOSE

To examine associations between past-year mental illness (MI) diagnoses and e-cigarette use status.

DESIGN

Data were obtained from the National College Health Assessment, a nationally recognized cross-sectional survey of university students.

SETTING

Participants were recruited from 2-year and 4-year public and private universities across the United States from 2017-2019.

SUBJECTS

The analytic sample included 277 291 university students.

MEASURES

Self-reported past-year MI diagnosis, binarily coded, served as the primary predictor. The outcome was e-cigarette use status (never, noncurrent, and current user).

ANALYSIS

Multinomial logistic regression models were used to estimate relative risk ratios (RRR) of e-cigarette use, as predicted by past-year MI diagnoses, age, race/ethnicity, sex and gender, sexual identity, geographic region, and other combustible tobacco, alcohol, and marijuana use.

RESULTS

Compared to those who had never received any MI diagnosis in the past year, those who did had a 16% higher relative risk (RRR = 1.16, 95% CI: 1.11, 1.20) of being a noncurrent e-cigarette user and a 33% higher relative risk (RRR = 1.33, 95% CI: 1.28, 1.38) of being a current e-cigarette user. Schizophrenia, substance use or addiction, bipolar disorder, and attention deficit and hyperactivity disorder (ADHD) diagnoses demonstrated the strongest associations with noncurrent and current e-cigarette use.

CONCLUSION

Results suggest the need to screen young adults for e-cigarette use and mental health indicators to facilitate early detection and timely intervention for at-risk university students.

Examining the prevalence of nicotine vaping and association of major depressive episodes among adolescents and young adults by disability type in 2021

BACKGROUND

Nicotine vaping is more prevalent among U.S. adults with disabilities compared to those without disabilities. However, less is known about nicotine vaping among adolescents (12-17 years) and young adults (18-25 years) by disability status.

METHODS

Using data from a sample of 24,722 adolescents and young adults (AYAs) from the 2021 National Survey on Drug Use and Health, we conducted descriptive and multivariable analyses to estimate the national prevalence of nicotine vaping by disability type and examined major depressive episodes (MDEs) as a risk factor for nicotine vaping.

RESULTS

A greater proportion of AYAs with disabilities engaged in past-month nicotine vaping compared to those without a disability (13.9 % vs 9.6 %, p = 0.0001). Also, when MDE was excluded from the model, AYAs with any disability had higher odds of nicotine vaping (AOR = 1.41; 95 % CI 1.15, 1.74) than those without a disability. However, disability status was no longer significant when MDE was included (AOR = 1.16; 95 % CI 0.91, 1.46) in the model.

CONCLUSIONS

The higher prevalence of nicotine vaping among AYAs with disabilities suggests that tailored messages may be needed to communicate health risks and adverse outcomes of e-cigarette use. Also, MDE is associated with nicotine vaping among AYA populations. This information can be helpful to school nurses, counselors, and mental health professionals in their screening of major depression as a risk factor for e-cigarette use.

Nicotine use among reservation-area American Indian adolescents compared with a national sample

BACKGROUND

Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021-2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study.

METHODS

Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021-2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade.

RESULTS

Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available.

CONCLUSIONS

Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population.

Electronic cigarette social norms among adolescents in New South Wales, Australia

The use of electronic cigarettes (e-cigarettes) is common and increasing, especially among youth. In 2022/2023, 30% of 12- to 17-year-olds reported ever using e-cigarettes in Australia-a >50% increase from 2017 (14%). Several adverse e-cigarette health effects have been identified and most effects remain unknown. Social norms, rules that govern social behaviours, are associated with current and future adolescent e-cigarette use. Understanding social norms in Australian adolescents is critical to the development of targeted and effective e-cigarette prevention activities. This study aims to explore e-cigarette social norms among adolescents living in New South Wales, Australia. A total of 32 online single or paired semi-structured qualitative interviews were conducted involving 46 participants aged 14-17 years, as part of the Generation Vape project. Reflexive thematic analysis was applied within a constructivist perceptive. Adolescents perceived e-cigarettes use as prolific among their peers, with use considered common, acceptable and normal. Fuelled by social exposure to e-cigarettes, 'everyone' was generally thought to be using them (descriptive norms). E-cigarette use was considered so entrenched that it was part of adolescent identity, with abstinence regarded as atypical. Use was driven by an internalised desire to fit it (injunctive norm), rather than being attributed to overt/external 'peer-pressure'. Positive e-cigarette norms exist among Australian adolescents with norm formation strongly influenced by social exposure, including e-cigarette promotion. Prevention efforts should include limiting adolescent exposure to e-cigarette marketing to help redefine existing pro-e-cigarette social norms and protect health.

Association of ever use of e-cigarettes with health and lifestyle variables among young adults: a Canadian health measure survey study

Research suggests that vaping raises oxidative stress levels and has been implicated in poor mental health. The objective of this study is to assess cross-sectional associations between quality of life (QOL) indicators and e-cigarette (EC) use in young Canadian adults. We used data from the 2016-2017 Canadian Health Measures Survey. We compared physical activity (daily steps), physiological measurements (high-density lipoprotein for cholesterol level), self-perceived life stress, mental health, and QOL between ever-use EC users and non-users. Multivariable binary or ordinal logistic regressions were used to calculate odds ratios (OR) with 95% confidence intervals (CI). Analyses included 905 participants (15-30 years) with 115 (12.7%) reporting EC use and 790 non-users. After adjusting for confounders, compared to non-users, EC users had significantly higher odds of being physically active (OR = 2.19, 95%CI: 1.14-4.20) but also with self-reported extreme life stress (OR = 2.68, 95%CI: 1.45-4.92). Albeit statistically non-significant, EC users also had higher odds of poorer QOL (OR = 1.12, 95%CI: 0.64-1.95). No statistically significant interactions between EC use, cigarette smoking, cannabis consumption and health outcomes were observed.

CONCLUSION

Our study found that EC use was independently and significantly associated with increased odds of life stress and an indication of poorer QOL. Ongoing surveillance on young EC users is important to measure the long-term impact of vaping on their physical, mental health and quality of life to target for interventions.

WHAT IS KNOWN

• E-cigarette use has been associated with high-risk behaviours and adverse mental health outcomes, such as depression and anxiety.

WHAT IS NEW

• E-cigarette users had significantly higher odds of being physically active and higher amounts of life stress.

The Associations of Physical Activity and Health-Risk Behaviors toward Depressive Symptoms among College Students: Gender and Obesity Disparities

Engaging in health-risk behaviors (HRBs) may be correlated with depressive symptoms among college students, but these relationships require more research. The purpose of this study was to examine the associations of physical activity levels (i.e., light [LPA] and moderate-vigorous [MVPA]) and HRBs (i.e., sedentary behavior [screen-based and non-screen-based behavior] and cigarette and e-cigarette tobacco use) with depressive symptoms in a sample of college students. Physical activity levels and HRBs were assessed through validated questionnaires. In total, 366 students participated (Mage = 22.59 ± 3.54; 60.1% female; 52.9% normal weight). E-cigarette use in males (β = 0.23, p < 0.05) and screen-based sedentary behavior in females (β = 0.14, p < 0.05) showed significant predictive utility toward depressive symptoms. In the overweight/obese group, screen-based sedentary behaviors (β = 0.19, p < 0.05) and e-cigarette use (β = 0.23, p < 0.01) showed significant predictive utility toward depressive symptoms. Females reported higher levels of depressive symptoms (Mfemale = 18.23 vs. Mmale = 14.81; η2 = 0.03) and less MVPA (Mmale = 52.83 vs. Mfemale = 41.09; η2 = 0.06) than males. Enhancing mental health by improving physical activity and eliminating HRBs should be tailored toward at-risk demographics.

Fifteen-minute consultation: What paediatricians need to know about vaping

The prevalence of vaping among children and young people (CYP) is on the rise. This is perhaps a result of perceiving vaping as 'harmless', especially after an extensive public acceptance through the UK Government's promotion of vaping in smoking cessation as well as lax regulations on advertisements. More awareness and research of the effects of vaping is necessary and a call for immediate public health strategies to be implemented in the UK. This article highlights essential facts about vaping, signs of addiction and cessation support for CYP as part of health promotion.

Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment

BACKGROUND

e-Cigarette use, especially by young adults, is at unacceptably high levels and represents a public health risk factor. Digital media are increasingly being used to deliver antivaping campaigns, but little is known about their effectiveness or the dose-response effects of content delivery.

OBJECTIVE

The objectives of this study were to evaluate (1) the effectiveness of a 60-day antivaping social media intervention in changing vaping use intentions and beliefs related to the stimulus content and (2) the dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping.

METHODS

Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then randomized to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Follow-up data were collected 30 and 60 days after randomization. We conducted stratified analyses of the full sample and in subsamples defined by the baseline vaping status (never, former, and current). Stimulus was delivered through Facebook and Instagram in four 15-second social media videos focused on anti-industry beliefs about vaping. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions. We estimated a series of multivariate linear regressions in Stata 17 (StataCorp). To capture the dose-response effect, we assigned each study arm a numerical value corresponding to the number of advertisements (exposures) delivered to participants in each arm and used this number as our focal independent variable. In each model, the predictor was the treatment arm to which each participant was assigned.

RESULTS

The baseline sample consisted of 1491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. We compared the retained participants with those lost to follow-up and found no statistically significant differences across demographic variables. We found a significant effect of the social media treatment on vaping intentions (β=-0.138, 95% CI -0.266 to -0.010; P=.04) and anti-industry beliefs (β=-0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. We found no significant effects of self-reported exposure to the stimulus.

CONCLUSIONS

Social media interventions are a promising approach to preventing vaping among young adults. More research is needed on how to optimize the dosage of such interventions and the extent to which long-term exposure may affect vaping use over time.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668.

Psychological Distress and Cannabis Vaping Among U.S. Adolescents

INTRODUCTION

Cannabis vaping has become increasingly popular among adolescents in recent years. However, research examining mental health determinants of cannabis vaping is scant. This study investigated the relationship between psychological distress and cannabis vaping among a nationally representative sample of U.S. adolescents.

METHODS

Data are from the cross-sectional 2022 National Youth Tobacco Survey, restricted to adolescents ages 11-18 (n=22,202). Psychological distress was categorized as normal, mild, moderate, and severe according to the Patient Health Questionnaire for Depression and Anxiety-4. Cannabis vaping was defined as any use in the past 30 days. To estimate the association between psychological distress and cannabis vaping, logistic regression was performed adjusted for age, biological sex, race/ethnicity, sexual orientation, school grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use. Analyses were conducted in 2023.

RESULTS

Nearly 8% of adolescents vaped cannabis in the past 30 days, and 25.6% reported moderate or severe psychological distress. Mild, moderate, and severe psychological distress were associated with cannabis vaping in the unadjusted model. In the adjusted model, the odds of cannabis vaping were higher among adolescents who had severe psychological distress (OR: 1.46, 95% CI: 1.09-1.96), compared to adolescents with no distress. Older age, poor grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use were also associated with cannabis vaping.

CONCLUSIONS

Severe psychological distress was associated with past 30-day cannabis vaping among U.S. adolescents. Adolescents experiencing psychological distress need to be screened for cannabis vaping to help prevent and reduce use and promote mental health.

Substance Use, Suicidal Thoughts, and Psychiatric Comorbidities Among High School Students

This cross-sectional study evaluates the dose-dependent association between alcohol, cannabis, and nicotine use and psychiatric symptoms among participants in the Substance Use and Risk Factor Survey and the Youth Risk Behavior Survey.

Personality Risk Factors for Vape Use amongst Young Adults and Its Consequences for Sleep and Mental Health

(1) Background: The surge in vape (e-cigarette) use among young adults is concerning, as there is limited knowledge about risk factors and health consequences. This study explores the personality traits linked to vape use, and associations between vaping and chronotype, sleep quality, and mental health, among young adults. (2) Methods: 316 participants, aged 18-25, completed measurements of mindfulness, rumination, self-compassion, anxiety/depression, chronotype, and sleep quality. (3) Results: the vape user group scored significantly lower on mindfulness, higher on rumination, and lower on self-compassion. Vape users were more likely to be evening types and had significantly lower sleep quality and higher anxiety symptoms, as well as higher alcohol use and loneliness (at trend) (4) Conclusions: These novel findings enhance our understanding of what might predispose young adults to vaping and the potential impact on their mental health and sleep quality. Findings point to specific cognitive/personality traits as vaping risk factors, which could inform intervention strategies.

The mediating roles of mental health problems and racial differences in the linkage between social media use and E-cigarette use among American youth

OBJECTIVE

Social media use is shown to be linked to youth's e-cigarette use. However, less is known about the underlying mechanisms. This study examined the mediating roles of internalizing and externalizing problems in the association between youth's social media use and e-cigarette use, and the racial differences in the mediation association.

METHODS

The study sample included 4913 U.S. youth from the Population Assessment of Tobacco and Health Study Waves 3-5 (2015-2019). Two weighted generalized structural equation models were conducted to examine the mediation pathways between youth's social media use (Wave 3) and past-30-day e-cigarette use (Wave 5) through internalizing and externalizing problems (Wave 4), respectively. Invariance tests were conducted to examine racial group differences.

RESULTS

Youth with high social media use frequency were more likely to use e-cigarettes (total effect: OR = 1.20, p < 0.001 in both internalizing and externalizing models). Internalizing and externalizing problems mediated the aforementioned associations (mediation proportions: 5.05% and 5.66%, respectively). The invariance tests indicated a significant difference between White and non-White groups (both ps < 0.001), where a larger proportion of mediation was found in the non-White group (12.22% for internalizing and 11.99% for externalizing) compared to their White counterparts (2.46% for internalizing and 3.17% for externalizing).

CONCLUSIONS

Mental health problems following social media use served as a risk factor for e-cigarette use among youth. Interventions aiming to improve youth's mental health could in turn temper e-cigarette use among youth social media users, and implementing tailored interventions in response to racial differences is warranted.

A clinical overview of adolescent e-cigarette use (vaping)

E-cigarette use (also known as "vaping") has become increasingly popular among adolescents over the past decade and grown into a significant public health concern in North America, the United Kingdom, and other countries. Concerns about this new trend have generated numerous new research studies. This aim of this study was to summarize recent scientific findings, with a focus on their relevance to clinicians working with adolescents. The first half covers epidemiology, risk factors for e-cigarette use, characteristics of e-cigarette use, youth perceptions of e-cigarettes, physical health risks of e-cigarettes, evidence for "gateway effects" of e-cigarette exposure on subsequent substance use, and the relationship between e-cigarette use and mental health. The review concludes with a clinical focus on assessment of youth who vape, psychoeducation for youth and families, clinical management of vaping, and regulatory considerations.

Understanding the longitudinal associations between e-cigarette use and general mental health, social dysfunction and anhedonia, depression and anxiety, and loss of confidence in a sample from the UK: A linear mixed effect examination

OBJECTIVE

Our objective was to the longitudinal associations between e-cigarette use and general mental health, social dysfunction & anhedonia, depression & anxiety, and loss of confidence in a sample from the UK.

METHODS

We analyzed data of 19,706 participants from Wave 9 (collected from 2017 to 2018) and Wave 10 (collected from 2018 to 2019) of the Understanding Society: the UK Household Longitudinal Study using a confirmatory factor analysis, linear mixed effect model, and one-sample t-tests.

RESULTS

We found that there is a significant time by e-cigarette use status interaction on mental health issues (b = 0.32, p < 0.001, 95 % C.I. [0.15, 0.49]), social dysfunction & anhedonia (b = 0.36, p < 0.001, 95 % C.I. [0.18, 0.54]), and loss of confidence (b = 0.24, p < 0.01, 95 % C.I. [0.06, 0.41]). Indeed, participants who became e-cigarette smokers at Wave 10 had worse mental health (t(107) = 2.64, p < 0.01, 95 % C.I. [0.07, 0.48], Cohen's d = 0.28), social dysfunction & anhedonia (t(107) = 3.16, p < 0.01, 95 % C.I. [0.12, 0.52], Cohen's d = 0.32), and loss of confidence (t(107) = 2.08, p < 0.05, 95 % C.I. [0.01, 0.37], Cohen's d = 0.19) comparing to one year ago.

LIMITATION

Limitations of this study included its self-report measures, unclassified e-cigarette type, limited generalizability to other populations, and lack of experimental manipulations.

CONCLUSION

We revealed longitudinal associations between e-cigarette initiation and adverse general and dimensions of mental health except for depression and anxiety, which have significant implications for public health, specifically in terms of e-cigarette product regulation and advertising.

Trends in vaping and smoking behavior before and during the COVID-19 pandemic in Canada: Beneficial and potentially detrimental changes

INTRODUCTION

E-cigarette and cigarette use may have changed during the COVID-19 pandemic, however, there is no consensus in existing literature, and current Canadian studies have not used representative samples. Thus, there is a need for robust national estimates.

OBJECTIVE AND METHODS

The primary objective was to describe the 30-day period prevalence of smoking and vaping before and during the COVID-19 pandemic in Canada. This study analyzed three years of the cross-sectional Canadian Tobacco and Nicotine Survey: 2019 (pre-pandemic), 2020 (9 months into the pandemic) and 2021 (21 months into pandemic).

RESULTS

Thirty-day period prevalence of vaping over the 2019, 2020, and 2021 study periods were 4.8 (95%CI: 4.2-5.3), 4.6% (95%CI: 4.1-5.2), and 5.2% (95%CI: 4.7-5.7), respectively. The 30-day period prevalence of smoking over the 2019, 2020, and 2021 study periods were 11.9% (95%CI: 10.9-12.7), 10.3% (95%CI: 9.4-11.2), and 10.3% (95%CI: 9.4-11.1), respectively. Notably, estimates of smoking for females decreased considerably from 2019 (11.0%; 95%CI: 9.9--12.2%) to 2020 (8.6%; 95%CI: 7.5-9.7). Estimates of vaping in those aged 20-24 increased substantially from 2020 (13.0%; 95%CI: 10.9-15.1) to 2021 (17.2%; 95%CI: 15.4-18.9).

CONCLUSIONS

Changes to smoking and vaping were restricted to subsets within the population. In those aged 20-24, there was a modest increase in vaping from 2020 to 2021. In females, there was a decrease in smoking from 2019 to 2020, which persisted in 2021.

A Critical Review of E-Cigarette Regulation in China: Challenges and Prospects for Youth Prevention and Tobacco Control

INTRODUCTION

The increasing popularity of electronic cigarettes (e-cigarettes) has led to the emergence of public health concerns, particularly among the youth. As a major producer and exporter of e-cigarettes, China has faced public health challenges in regulating the unregulated e-cigarette industry.

AIMS AND METHODS

This study aims to evaluate the regulatory development of e-cigarettes in China. We searched and obtained national policy documents related to e-cigarettes and subnational smoke-free laws from LexisNexis on August 2, 2023, which were enacted between January 1, 2023 and July 31, 2023. We used 99 policy documents for the final analysis, specifically 68 national policy documents on e-cigarettes and 31 subnational smoke-free laws. We chronologically reviewed these policy documents in full text and summarized them on the basis of their content and the requirements of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC).

RESULTS

Chinese policymakers established the current regulatory framework for e-cigarettes by amending, enacting, and enforcing laws and regulations. E-cigarettes are categorized as tobacco products, and the State Tobacco Monopoly Administration regulates the e-cigarette industry. The Chinese authorities prioritize youth prevention in strengthening the regulation on e-cigarettes. China adopts various tobacco control measures for e-cigarettes and cigarettes.

CONCLUSIONS

China gained certain degrees of progress on tobacco control by regulating e-cigarettes and adopting measures required by the WHO FCTC. However, tobacco monopoly hinders the full realization of tobacco control goals, which necessitates the National Health Commission to assume its responsibility for the complete implementation of the WHO FCTC.

IMPLICATIONS

This study presents a critical review of the development of e-cigarette regulation in China by reviewing relevant policy documents and analyzing tobacco control measures. It recognizes the degrees of progress of tobacco control measures and highlights tobacco monopoly as a significant hindrance of the full implementation of the WHO FCTC. Furthermore, empirical studies are required on the enforcement of tobacco control measures in China.

Youth Exposure and Response to the FDA Health Warning Label on Electronic Cigarettes Packaging: Policy Implications

INTRODUCTION

Youth represent a high-priority group for e-cigarette health communication. This study examined youth exposure to the Food and Drug Administration (FDA) e-cigarette warning label over 4 years and its association with change in youth harm perception and intention.

AIMS AND METHODS

We pooled data from the 2018-2021 National Youth Tobacco Survey (age 10-17; n = 67 159). Participants were divided into four groups: never users (58.5%), susceptible nonusers (16.3%), former users (12.7%), and current users (12.5%). We examined the prevalence, time-trend, correlates, and association of youth exposure to the warning with addictiveness and harm perception, intention to use e-cigarettes, and intention to quit all tobacco products.

RESULTS

Only 24.5% of youth were exposed to the warning. Exposure increased from 14.9% in 2018 to 30.8% in 2019, then declined to 25.2% in 2021. Hispanic (adjusted odds ratio (aOR) = 0.76 [95% CI = 0.641 to 0.89]) and non-Hispanic black current users (0.53 [0.40 to 0.69]) were less likely to be exposed to the warning than white current users. Youth exposure was positively associated with a higher perception of e-cigarette addictiveness (1.12 [1.04 to 1.19]) and intention to quit all tobacco products (1.28 [1.13 to 1.46]). However, exposure was negatively associated with harm perception (0.91 [0.85 to 0.96]) and the intention to use e-cigarettes among e-cigarette nonusers (2.38 [1.99 to 2.84]).

CONCLUSIONS

The decline in youth exposure to the warning indicates wear-out effects. Strengthening the label by using compelling designs, adding themes on e-cigarette harm to youth, periodically rotating warning content, and using culturally tailored messaging may improve its impact on youth and address racial/ethnic disparities.

IMPLICATIONS

The FDA e-cigarette label reached only 24.5% of youth, and exposure to the warning declined to indicate wear-out effects. Exposure was significantly lower among minorities. Exposure was associated with a higher perception of e-cigarette addictiveness and intention to quit all tobacco products. Still, it did not increase harm perception or reduce intention to use e-cigarettes among nonusers. Strengthening the label by using more compelling designs, including diverse themes focusing on e-cigarette harm relevant to youth, and periodically rotating warning content may improve its impact on youth. Continued surveillance of the implementation of e-cigarette policies is needed to ensure that they equally affect youth across racial/ethnic subpopulations.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Parenting practices, mental health, and electronic cigarette use among U.S. young adolescents: A longitudinal panel analysis, 2013-2018

PURPOSE

This study examined prospective association of parenting practices related to tobacco use with adolescent e-cigarette use and the moderating role of mental health among U.S. young adolescents.

METHODS

We study used multi-wave longitudinal data (2013-2018) drawn from the Population Assessment of Tobacco and Health Study. A total of 5114 young adolescents (12-14 years) who were not lost to follow-ups across four waves (Wave 1-4) comprised the study sample. Weighted logistic regression models along with generalized linear mixed modeling assessed the within-subject associations of parenting practices related to tobacco use (tobacco availability at parent/guardian's home, past-year parent talk about tobacco use, and rules about non-combustible tobacco use at home) with adolescent current e-cigarette use.

RESULTS

Prevalence of having home rules about non-combustible tobacco use increased (74.5%-80.2%) and that of parent talk about tobacco use decreased (52.0%-33.9%) over time while tobacco availability at home did not show a specific trend. Tobacco availability at home was associated with increased odds of adolescent e-cigarette use (adjusted odd ratio[OR] = 2.25, 95% confidence interval[CI] = 1.72-2.95), and having home rules about non-combustible tobacco use was linked to decreased likelihood of e-cigarette use (adjusted OR = 0.72, 95% CI = 0.55-0.92). The magnitude of negative association between having rules about non-combustible tobacco and adolescent e-cigarette use was stronger among adolescents with internalizing problems but weaker among those with externalizing problems.

CONCLUSIONS

Our findings highlight the important role of home-based interventions in discouraging young adolescents from e-cigarette use. Parents/guardians should consider adolescents' mental health to provide more efficient home- and/or clinical-based e-cigarette use prevention.

Prevalence and correlates of past 30-day dual-vaping of nicotine and cannabis among adolescents in five New England states

SIGNIFICANCE

Adolescent vaping behavior includes vaping of multiple substances, including both nicotine and cannabis (dual-vaping). This study describes the prevalence and the sociodemographic correlates of past 30-day dual-vaping.

METHODS

We recruited adolescents ages 13-17 from five New England states (Massachusetts, Connecticut, Rhode Island, Vermont, New Hampshire) through the Prodege online survey panel from April 2021 to August 2022. Dual-vaping was defined as vaping both nicotine and cannabis (THC and/or CBD) in the past 30-days. We analyzed the prevalence of sole-nicotine, sole-cannabis, and dual-vaping of nicotine and cannabis and used multinomial logistic regression to examine associations between sociodemographic factors and sole- and dual-vaping of nicotine and cannabis.

RESULTS

The analytic sample included 2013 observations from 1858 participants (mean age 15.1 years, 46.2% female, 74.1% White, 82.2% heterosexual). Among these observations, 5.6% reported past 30-day sole-nicotine vaping, 5.5% reported sole-cannabis vaping, and 7.3% had dual-vaped. Correlates for higher odds of past 30-day dual-vaping included total social media sites used and household tobacco use, in contrast with sole-cannabis vaping, which included older age and self-reported depression (all p's <0.05).

DISCUSSION

Adolescent past 30-day dual-vaping of nicotine and cannabis was more prevalent than past 30-day sole-vaping of either nicotine or cannabis alone. Future studies should continue to collect detailed data on the type of substances, besides nicotine, that adolescents are vaping.

Motivators of e-cigarette use among Australian adolescents, young adults, and adults

OBJECTIVE

There is limited research examining motivators of e-cigarette use among never smokers, a group for whom vaping has no benefits and many harms. To inform programs and policies that aim to prevent initiation and encourage cessation of e-cigarette use, this study investigated reasons for intended use, initiation, and continued use of e-cigarettes among various age and user groups in Australia.

METHODS

An online survey was administered to 4617 respondents. Never users of e-cigarettes and never smokers who reported intending to try e-cigarettes (n = 348), current e-cigarette users and never smokers (n = 121), and current e-cigarette users and current smokers (n = 354) were of interest to this study.

RESULTS

Among never smokers, curiosity was the most commonly reported reason for intended use and use initiation, whereas the taste of e-cigarettes and their appealing flavours were the most frequently reported motivators of current e-cigarette use. Among smokers, taste and flavourings were the most commonly reported motivators of current use, not smoking cessation. Adolescents and young adults in most user groups were more likely than adults to report using e-cigarettes out of curiosity and because they taste good, whereas adults were more likely to use for smoking cessation purposes and because they perceived e-cigarettes to be more acceptable and cheaper than tobacco cigarettes.

CONCLUSIONS

Results suggest that (i) prohibiting flavourings and (ii) restricting advertising that highlights the pleasurable effects of e-cigarettes could constitute potential means of preventing e-cigarette initiation and encouraging cessation among never smokers, especially adolescents.

The Association Between Nicotine Dependence and Mental Health in the General Population of Saudi Arabia: A Cross-Sectional Analytical Study

Background

High prevalence of mental disorders is associated with psychoactive substances, significantly contributing to morbidity, disability, and premature mortality. Worldwide, individuals who use electronic-cigarettes (EC) and have a mental health diagnosis are more likely to experience stress, depression, and drug use. This study aims to measure the prevalence of both EC use and mental health disorders namely, anxiety and depression additionally to investigate the association between EC use and mental health status among the general population of Saudi Arabia.

Methods

A cross-sectional analytical study was conducted across Saudi Arabia from November 2022 to May 2023. The survey was divided into three sections. The first section focuses on the demographics, while the second part asked about both conventional and EC smoking and their frequency. The third section assessed mental health status using a Patient Health Questionnaire with a 9-item depression scale (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7).

Results

The study revealed 21.1% reporting EC use in the past thirty days. While 19.8% reported smoking tobacco one or more days within the last thirty days. Regarding mental health, 36.6% of individuals had minimal anxiety, while 42.4% experienced mild anxiety. Moreover, most of the participant were considered to have mild followed by minimal depression accounting for 36.7% and 31.9%, respectively. The results indicated a positive and significant correlation between perceived depression scores and nicotine dependence among EC users. Additionally, there was a strong relationship between gender and nicotine dependence, with men being more inclined than women.

Conclusion

There is a correlation between nicotine use and mental health outcomes; people who use nicotine products are more likely to experience anxiety and depression.

Youth mental health and nicotine vape use: The moderating role of rural-urban/suburban school environments

OBJECTIVE

To understand and compare the association between nicotine vape use and mental health among youth in rural and urban/suburban areas.

METHODS

This cross-sectional study included 146,489 high school students from the 2019-2020 California Student Tobacco Survey. Descriptive statistics were estimated with frequencies and percentages. Separate bivariate associations between each covariate/predictor variable and mental health were examined using linear regression. Multivariate linear regression models were used to examine the association between nicotine vape use and mental health for youth attending school in rural versus suburban/urban communities.

RESULTS

Findings showed that vaping nicotine was associated with poorer overall mental health (b = -0.307, SE = 0.019, p < 0.001), and that this association differed based on rural versus urban/suburban school environments (b = -0.135, SE = 0.046, p = 0.004). Specifically, the relationship between vaping and poor mental health was stronger for youth attending school in rural areas (b = -0.443, SE = 0.042, p < 0.001) than in urban/suburban localities (b = -0.307, SE = 0.019, p < 0.001).

CONCLUSIONS

Although differences in mental health were not shown based on rural versus urban/suburban school environments alone, findings showed that the relationship between nicotine vape use and mental health was stronger for youth attending high school in rural areas. Additional research is needed to understand the underlying social and environmental mechanisms that exacerbate this relationship. Future interventions might consider how to support and improve the mental health of rural nicotine vapers to better achieve health equity across different school environments.

The association of current exclusive e-cigarette use and dual use of e-cigarettes and cigarettes with psychological distress among U.S. adults

This observational study examines the association of current e-cigarette use and dual use of e-cigarettes and cigarettes (dual use) with psychological distress among U.S. adults. We differentiate dual use based on the smoking frequency and compare the relationship between dual use and psychological distress to that of exclusive cigarette smoking with the same smoking frequency. Using data from the 2015-2018 National Health Interview Surveys, we analyzed adults aged 18+ (N = 55,780) who currently use e-cigarettes or/and cigarettes and have no history of using other tobacco products, and adults who never used any tobacco. Multinomial logistic regression models estimate the association of current e-cigarette use and dual use with psychological distress severity (no/mild, moderate, and severe).In the sample, 15.3% and 2.9% of adults experienced moderate and severe psychological distress. Compared to never tobacco users, current exclusive e-cigarette users and dual users who smoke daily had higher odds of moderate and severe psychological distress. Dual users who smoke nondaily had higher odds of moderate, but not severe psychological distress than never tobacco users. Compared to exclusive daily smokers, dual users with daily smoking had higher odds of moderate and severe psychological distress. Compared to exclusive nondaily smokers, dual users with nondaily smoking had higher odds of moderate but not severe psychological distress. Our findings suggest that exclusive e-cigarette use is associated with psychological distress severity. Dual use is associated with higher odds of psychological distress severity compared to never tobacco users and exclusive cigarette smoking, and this association differs by smoking frequency.

Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association

Along with the rising burden of peripheral artery disease (PAD), mental health concerns are increasingly being recognized as a comorbidity to address in the chronic disease management of symptomatic PAD. Apart from a high prevalence of comorbid mental health conditions, the role of pain and changing health behaviors and the broader impacts of illness and adaptation to living with PAD require specialized behavioral health expertise. This scientific statement builds a case that this expertise should be integrated within the multidisciplinary PAD team. Furthermore, areas such as cognitive dysfunction and palliative care are highlighted as needing psychological interventions. Although much of the evidence of the efficacy of psychological and psychotropic interventions has been extrapolated from other cardiovascular populations, evidence for the role of psychological interventions for behavior change, for example, uptake of exercise regimens, is increasingly being accrued within PAD. Areas for behavioral health needs and interactions with PAD treatment are discussed, including the use of opioids, depression management, anxiety and stress reduction interventions, the use of benzodiazepines and antidepressants, smoking cessation, rehabilitation trajectories after amputation, and the role of cognitive decline for PAD treatment and outcomes. A case summary highlights the stigma around mental health and vascular disease and the fragmentation of care. This scientific statement provides remarks for building a road map for integrated behavioral PAD care and potential solutions to overcome these barriers. Instrumental to reaching these changes are interprofessional advocacy efforts and initiatives that help break down the stigma around mental health and promote evidence-based collaborative, nonhierarchical, and multidisciplinary PAD care.

Adverse Childhood Experiences and Electronic Cigarette Use among U.S. Young Adults

(1) Background: Adverse childhood experiences (ACEs), which are potentially traumatic childhood events, have been associated with increased tobacco product use. Less is known about electronic cigarette (e-cigarette) use during young adulthood. This study explored the associations between ACEs and current e-cigarette use among U.S. young adults. (2) Methods: This study was a secondary analysis of 2021 Behavioral Risk Factor Surveillance System data including 2537 young adults aged 18-24 years. Unadjusted and adjusted logistic regression analyses were conducted. (3) Results: Of the participants, 19.2% currently used e-cigarettes, and 22.1% reported 1 ACE, 13.0% reported 2 ACEs, 10.7% reported 3 ACEs, and 30.6% reported ≥4 ACEs. Unadjusted results indicated that participants who experienced 1 ACE (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.01-3.07), 2 ACEs (OR = 2.18, 95%CI = 1.24-3.83), 3 ACEs (OR = 2.63, 95%CI = 1.41-4.90), and ≥4 ACEs (OR = 3.69, 95%CI = 2.23-6.09) were at increased odds of reporting current e-cigarette use than participants who experienced 0 ACEs. Adjusted results indicated that participants who experienced 3 ACEs were at 2.20 times higher odds (95%CI = 1.15-4.23) and participants who experienced ≥4 ACEs were at 2.73 times higher odds (95%CI = 1.58-4.71) of reporting current e-cigarette use than participants who experienced 0 ACEs. (4) Conclusions: Young adults exposed to ACEs are at risk of using e-cigarettes.

Correlates of adolescent sole-, dual- and poly-use of cannabis, vaped nicotine, and combusted tobacco

BACKGROUND

Compared to single substance use, adolescents' use of multiple substances is associated with more severe dependence, cessation outcomes, and health risks. This study examined correlates of use and co-use of e-cigarettes, combusted tobacco, and cannabis among high school-aged (9th-12th grade, approximately aged 14-18) adolescents.

METHODS

We analyzed the 2019 Massachusetts Youth Health Survey (MYHS) data to calculate the weighted means of any past 30-day sole-use of e-cigarettes, sole-use of combusted tobacco, sole-use of cannabis, dual-use of two of the above substances, and poly-use of all three substances. We then used weighted multinomial logistic regression to examine the associations between demographic, social and behavioral factors and sole-, dual-, and poly-use (vs. no use) of these substances.

RESULTS

Among N = 1614 respondents, any past 30-day dual-use of e-cigarettes and cannabis was the most prevalent (17.2%, SE: 1.3%). Sole-use of combusted tobacco was less than 1%, whereas 4.5% (SE: 0.7%) of respondents reported poly-use of e-cigarettes, cannabis, and combusted tobacco. Lower academic grades and self-reported depression (1 item on persistent feelings of sadness or hopelessness) were associated with increased odds of dual-use of e-cigarettes and cannabis and poly-use (vs. sole-use of any substance). Adolescents who self-reported having "any long-term emotional problems or learning disabilities" had greater odds of poly-use.

CONCLUSION

Different sets of correlates were associated with sole-, dual-, and poly-use, suggesting that certain adolescents may be more vulnerable than others to multiple substance use. Future research should examine potentially modifiable upstream influences, such as the home environment and socioeconomic factors that may affect the relationship between adolescent mental health, school performance, and multiple addictive substance use.

Online platforms' framing around vaping

In this paper, we provide a descriptive overview of how vaping is framed differently between various online platforms (Wikipedia, Quora, Medium, Reddit, Stack Exchange, wikiHow, Facebook, and online news media). We provide an overview of >1 million posts and news articles about vaping to study the differences in framing between online platforms. Findings indicate an inconsistent framing around vaping across platforms. Stakeholders may utilize our findings to intervene around the framing of vaping and may design communications campaigns that improve the way society sees vaping, possibly aiding smoking cessation and reducing youth vaping.

How do underage youth access e-cigarettes in settings with minimum age sales restriction laws? A scoping review

BACKGROUND

Despite measures to reduce young people's access to electronic cigarettes (ECs), or "vapes", many countries have recorded rising youth vaping prevalence. We summarised studies documenting how underage youth in countries with minimum age sales restrictions (or where sales are banned) report accessing ECs, and outline research and policy implications.

METHODS

We undertook a focused literature search across multiple databases to identify relevant English-language studies reporting on primary research (quantitative and qualitative) and EC access sources among underage youth.

RESULTS

Social sourcing was the most prevalent EC access route, relative to commercial or other avenues; however, social sourcing dynamics (i.e., who is involved in supplying product and why) remain poorly understood, especially with regard to proxy purchasing. While less prevalent, in-person retail purchasing (mainly from vape shops) persists among this age group, and appears far more common than online purchasing.

CONCLUSIONS

Further research examining how social supply routes operate, including interaction and power dynamics, is crucial to reducing youth vaping. Given widespread access via schools and during social activities and events, exploring how supply routes operate and evolve in these settings should be prioritized. Inadequate compliance with existing sales regulations suggest greater national and local policy enforcement, including fines and licence confiscation for selling to minors, is required at the retailer level.

Effectiveness of social video platforms in promoting smoking cessation among youth: A content-specific analysis of smoking cessation topic videos on the social platform Bilibili

INTRODUCTION

Smoking cessation is a significant public health issue for young people. Social media provide the public with health knowledge through various types of videos. Bilibili is a trendy social video platform among the young population in China, and the number of smoking cessation videos on this platform is continuously increasing. Different content creators advocating smoking cessation through videos may influence young people's attitudes and behaviors towards tobacco and smoking. This study aims to measure the message sensation value (MSV) and the information appeals in smoking cessation videos on Bilibili, examining their impact on communication effectiveness.

METHODS

This study collected 337 videos from Bilibili and conducted a content analysis regarding the content creator's information, video presentation, MSV, and message appeals. The communication effectiveness of the videos was defined as a dependent variable and was divided into three dimensions: communication breadth, recognition, and participation.

RESULTS

The average MSV (rated on a scale of 0 to 11) for smoking cessation-themed videos was 4.49 (SD=2.23). Chi-squared analysis revealed significant differences among different types of videos in the use of threat appeal (p<0.001), humor appeal (p<0.001), and psychological benefit (p<0.05). Additionally, different types of creators showed differences in the use of threat appeal (p<0.05), humor appeal (p<0.001), and psychological benefit (p<0.05). ANOVA results indicated significant differences in the level of MSV among different smoking cessation videos (F=39.775, p<0.001). Linear regression analysis showed that MSV, threat appeal, humor appeal, and economic benefit positively impacted dissemination effects (p<0.001).

CONCLUSIONS

The results indicate that young people are likelier to watch smoking cessation videos with higher MSV and information appeal. These elements can enhance persuasion and the effectiveness of communication. Therefore, when video creators aim to promote smoking cessation among young people, they can consider factors such as MSV, threat appeal, humor appeal, and economic benefit to enhance communication effects.

Beyond the label: current evidence and future directions for the interrelationship between electronic cigarettes and mental health

Electronic cigarette use has dramatically increased over the last decade. With this recent technological development and wide range of constituents in various products, putative adverse effects on the brain and body have been largely unexplored. Here, we review current evidence linking electronic nicotine cigarette use with potential health consequences and provide evidence supporting an association between drug use and depression in humans. We also examine the biological effects of individual constituents in electronic cigarette aerosols, which include labeled ingredients, such as propylene glycol, vegetable glycerin, nicotine, and flavorants, as well as unlabeled ingredients found in the aerosols, such as carbonyls and heavy metals. Lastly, we examine the effects of electronic cigarette use on endogenous metabolism via changes in cytochrome P450 enzymes, which can thereby impact therapeutic outcomes. While the current evidence offers insight into the potential effects of electronic cigarette use on biological processes, further studies are necessary to determine the long-term clinical relevance of aerosol inhalation.

Reducing e-cigarette use among youth and young adults: evidence of the truth campaign's impact

BACKGROUND

Mass media campaigns have been shown to be effective in reducing cigarette use. However, evidence is limited for whether campaigns can shift e-cigarette use among youth and young adults (YYA). To assess the impact of the truth anti-e-cigarette campaign, which focused on the effects of vaping on mental health, this study examines the relationship between campaign awareness and e-cigarette behaviour among YYA.

METHODS

Data from weekly cross-sectional surveys of YYA aged 15-24 years from September 2021 to October 2022 were used for multilevel models assessing how weekly campaign awareness is related to intentions to use e-cigarettes and current e-cigarette use (past 30 days). Weekly campaign awareness was calculated by averaging individual-level awareness for each week. Control variables included individual-level campaign awareness, sociodemographics, perceived financial situation, parental smoking, sensation seeking, and mental health.

RESULTS

Weekly campaign awareness ranged from 50% to 78%, with most weeks (77%) being within 65% and 75% of weekly campaign awareness. At weekly awareness levels between 65% and 75%, there was a significant association with lower intentions to use e-cigarettes. A dose-response relationship was observed for current use: compared with weeks with lower (<65%) awareness, weeks with awareness of 65-70% had 14% lower odds of current use, weeks with 70-75% awareness had 16% lower odds and weeks with >75% weekly awareness had 18% lower odds (p=0.018, p=0.009 and p=0.007, respectively).

CONCLUSIONS

Findings from this analysis of weekly campaign awareness demonstrate that exposure to the truth anti-e-cigarette campaign is associated with significantly lower odds of intentions to use and current use of e-cigarette among YYA.

Longitudinal Examination of ENDS Use Among Young Adult College Students: Associations with Depressive Symptoms and Sensation Seeking

The present study examined (1) intraindividual changes in the frequency of electronic nicotine delivery systems (ENDS) use across young adulthood, 18 to 30 years old, and (2) if depressive symptoms and sensation-seeking tendencies, independently and in interaction with one another, were associated with these changes. Data were from a longitudinal study of students recruited from 24 Texas colleges and followed across six waves from fall 2015 to spring 2019. Participants (n = 1298; 36.3% non-Hispanic white, 56.3% women) were 18 to 26 years old in fall 2015 and all reported past 30-day ENDS use on at least one wave. We used growth curve modeling for an accelerated longitudinal design to examine if ENDS use frequency changed with increasing age and if depressive symptoms and sensation seeking, independently and in interaction with one another, were associated with these changes. Results showed that ENDS use frequency increased with increasing age. Depressive symptoms and sensation seeking were not independently associated with more frequent ENDS use or an accelerated increase in ENDS use frequency across increasing age. However, a significant two-way interaction indicated that young adults with elevated depressive symptoms used ENDS more frequently, but only when they had higher levels of sensation seeking. Findings indicate that young adults with depressive symptoms are a heterogeneous population and that those with high levels of sensation-seeking tendencies are at elevated risk for more frequent ENDS use. Interventions for young adults high in both sensation-seeking and depressive symptoms may help prevent and decrease ENDS use.

Underlying patterns of the co-occurrence of tobacco use and mental health among youth

We aimed to examine how bidirectional relationships between mental health problems and tobacco use are formed over time by types of tobacco use in recent samples of U.S. youth. Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (N = 10,082) and analyzed using cross-lagged panel models. A high level of internalizing problems at Wave 1 predicted conventional cigarette smoking (adjusted odds ratio [AOR] = 1.19, 95% CI = 1.06-1.34) and e-cigarette use (AOR = 1.25, 95% CI = 1.09-1.43) at Wave 2, but not vice versa. Both cigarette smoking and e-cigarette use at Wave 2 tended to persist into Wave 3, which, in turn, increased the risk of subsequent internalizing problems in late adolescence or young adulthood (Wave 4). The bidirectional relationship between tobacco use and internalizing problems seems to begin as a procession from internalizing problems to tobacco use, and then from persistent tobacco use to exacerbated internalizing problems over time.

Prevalence of externalising disorder comorbidities in adolescents: a systematic review and meta-analysis protocol

INTRODUCTION

Externalising disorders are some of the most prevalent problems in childhood and particularly during adolescence that can change into more severe psychopathology in adulthood if left unattended. In the research literature, these disorders include attention deficit/hyperactivity disorder, oppositional/defiant disorder, conduct disorder and substance use disorders. The comorbidity prevalence of these disorders is significant and cannot be considered a random factor. The dimensional structure of psychopathology has always been studied by researchers to address disorder comorbidities and aetiology. There has always been controversy over the number of spectra and the lower levels. Currently, the new top-down, Hierarchical Taxonomy of Psychopathology model conceptualising psychopathology is being used, which is a dimensional classification system for the different spectra of psychopathology based on a combination of conceptual modelling and factor analysis of symptoms. This systematic review investigates the comorbidity prevalence of spectra of externalising disorders to provide valuable information and feedback on this model.

METHODS AND ANALYSIS

This systematic review will include all the studies conducted from 1/1/1990 to 1/12/2020 to examine the prevalence and comorbidity of each of the externalising disorders in the general population, schools and outpatients using any instrument (questionnaires or interviews). There will be no language restrictions in selecting the studies. The studies are age restricted and must be conducted on adolescents only, but there are no restrictions on the gender and nationality of the participants.

ETHICS AND DISSEMINATION

This systematic review is based on previously published articles and therefore will not require ethical approval. The results of the systematic review will be disseminated as publication in a peer-reviewed journal and conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42022327629.

A network approach to the symptom-level associations between smoking and posttraumatic stress disorder (PTSD) among young adults exposed to childhood sexual abuse

Background

Previous empirical literature has examined the associations between childhood sexual abuse (CSA) exposure, posttraumatic stress disorder (PTSD), and smoking. However, few studies examined symptom-level associations between smoking and PTSD among CSA victims. Thus, the aims of this study were 1) to explore symptom-level associations between smoking and PTSD among combustible cigarette (CC) and electronic cigarette (EC) users exposed to CSA and 2) to compare the differences manifested in two network structures between EC and CC users with CSA experiences.

Methods

This cross-sectional study covers all 63 universities and colleges in Jilin province, China, from October 26 to November 18, 2021. A total of 117 769 students participated in this study, while 3479 young adults were exposed to CSA (3.62%, 95% CI = 3.50%-3.73%). Childhood sexual abuse, PTSD, and smoking symptoms were measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), 10-item Trauma Screening Questionnaire (TSQ-10), and the 6-item Fagerstrom Test for Nicotine Dependence (FTND-6), respectively. In addition, network analysis was applied to analyse psychopathological symptoms between EC and CC users with CSA experiences. Both the edges and centralities were computed, and the network properties were compared among the two groups.

Results

Four symptoms of PTSD (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were both central and bridge symptoms between PTSD and smoking among EC and CC users with CSA experiences. Moreover, compared with CC users with CSA, there were significantly stronger associations between "nightmares" - "difficulty with restrictions" and "irritability / anger" - "more during wake up" among young EC users with CSA.

Conclusions

The four symptoms (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were keystones for treatments or interventions targeting these CSA victims with PTSD and smoking symptoms. Increasing efforts should be taken to restrict morning smoking among EC users with CSA. In addition, target interventions and strategies founded on these core symptoms and associations should be implemented to relieve the comorbid PTSD and smoking in EC and CC users with CSA experiences.

Cigarette smoking and risk of suicide in bipolar disorder: a systematic review

Objective

Bipolar disorder (BD) is a highly prevalent, chronic and recurrent mental illness. The smoking rates in patients with BD are much higher than those of the general population, and BD is associated with an increased risk of suicide. An association between smoking and suicidal behavior has been found in the general population, this systematic review examines whether there is evidence of an association between smoking and suicide behavior in patients with BD.

Method

A database search was carried out in Medline, Embase, The Cochrane Library, Scopus, and Web of Science, updated until December 31st, 2021, according to the 2020 PRISMA guidelines. We identified prospective and retrospective studies that included patients diagnosed with BD types I, II, and not otherwise specified, and in which smoking and suicidal behavior were correlated. Articles that focused exclusively on other mental disorders were excluded. The Ottawa-Newcastle scale was used to assess the methodological quality of the included articles.

Results

Fifteen articles (n = 7,395) met all the inclusion criteria. In nine of these articles, the authors found an association between smoking and suicidal behavior in BD, while in the remaining six articles, this association was not found. A great deal of variability was observed between articles, particularly in the measurement of suicidal behavior and tobacco consumption. The risk of bias, as assessed by the NOS, was high for most of the included articles, except for two papers, whose risk was low.

Conclusion

It was not possible to establish a clear relationship between tobacco use and the risk of suicide in BD patients due to the heterogeneity of the articles included in this systematic review, which had different sample sizes and methodological issues. However, both conditions are highly prevalent and have a negative impact on the prognosis of BD. Therefore, a systematic approach is needed, based on accurate measurement of a patient's smoking habits and their risk of suicidal behavior, in order to establish an appropriate therapeutic plan.

Additional information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors and was registered on PROSPERO with the CRD42022301570 on January 21th 2022.

Nicotine Vaping and Co-occurring Substance Use Among Adolescents in the United States from 2017-2019

Background: The use of electronic cigarettes (or "vaping") among adolescents remains a public health concern given exposure to harmful substances, plus potential association with cannabis and alcohol. Understanding vaping as it intersects with combustible cigarette use and other substance use can inform nicotine prevention efforts. Methods: Data were drawn from 51,872 US adolescents (grades 8, 10, 12, years: 2017-2019) from Monitoring the Future. Multinomial logistic regression analyses assessed links of past 30-day nicotine use (none, smoking-only, vaping-only, and any smoking plus vaping) with both past 30-day cannabis use and past two-week binge drinking. Results: Nicotine use patterns were strongly associated with greater likelihood of cannabis use and binge drinking, particularly for the highest levels of each. For instance, those who smoked and vaped nicotine had 36.53 [95% CI:16.16, 82.60] times higher odds of having 10+ past 2-week binge drinking instances compared to non-users of nicotine. Discussion: Given the strong associations between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce adolescent nicotine vaping, efforts that acknowledge co-occurring use.

New insights into how popular electronic cigarette aerosols and aerosol constituents affect SARS-CoV-2 infection of human bronchial epithelial cells

The relationship between the use of tobacco products and SARS-CoV-2 infection is poorly understood and controversial. Few studies have examined the effect of electronic cigarettes (ECs) on SARS-CoV-2 infection. We tested the hypothesis that EC fluids and aerosols with nicotine promote SARS-COV-2 infection by increasing viral entry into human respiratory epithelial cells. Responses of BEAS-2B cells to JUUL aerosols or their individual constituents were compared using three exposure platforms: submerged culture, air-liquid-interface (ALI) exposure in a cloud chamber, and ALI exposure in a Cultex system, which produces authentic heated EC aerosols. In general, nicotine and nicotine + propylene glycol/vegetable glycerin aerosols increased ACE2 (angiotensin converting enzyme 2) levels, the SARS-CoV-2 receptor; and increased the activity of TMPRSS2 (transmembrane serine protease 2), an enzyme essential for viral entry. Lentivirus pseudoparticles with spike protein were used to test viral penetration. Exposure to nicotine, EC fluids, or aerosols altered the infection machinery and increased viral entry into cells. While most data were in good agreement across the three exposure platforms, cells were more responsive to treatments when exposed at the ALI in the Cultex system, even though the exposures were brief and intermittent. While both nicotine and JUUL aerosols increased SARS-CoV-2 infection, JUUL significantly decreased the effect of nicotine alone. These data support the idea that vaping can increase the likelihood of contracting COVID-19 and that e-liquid composition may modulate this effect.

Electronic Cigarette Use during Pregnancy: Is It Harmful?

Although combustible cigarette smoking rates have declined in recent years, alternative tobacco product use, particularly electronic cigarette use ("vaping"), has increased among young adults. Recent studies indicate that vaping during pregnancy is on the rise, possibly due to the perception that it is a safer alternative to combustible cigarette smoking. However, e-cigarette aerosols may contain several newer, potentially toxic compounds, including some known developmental toxicants that may adversely impact both the mother and the fetus. However, there is paucity of studies that have examined the effects of vaping during pregnancy. While the adverse perinatal outcomes of cigarette smoking during pregnancy are well established, the specific risks associated with inhaling vaping aerosols during pregnancy requires more research. In this article, we discuss the existing evidence and knowledge gaps on the risks of vaping during pregnancy. Studies that investigate vaping-associated systemic exposure and its effects (i.e., biomarker analyses) and maternal and neonatal clinical health outcomes are needed to reach more robust conclusions. We particularly emphasize the need to go beyond comparative studies with cigarettes, and advocate for research that objectively evaluates the safety of e-cigarettes and other alternative tobacco products.

Mental and Physical Health Disparities Among Sexual and Gender Minority Adolescents Based on Disability Status

Purpose: Sexual and gender minority (SGM) youth and youth with disabilities both experience health disparities. Little data exist on whether SGM youth with disabilities have worse health outcomes compared with SGM youth without disabilities. This study aimed to examine differences in health behaviors and outcomes among a sample of SGM youth by different types of disabilities. Methods: Secondary analyses were conducted with a subset (N = 9418) of the LGBTQ National Teen Survey, a comprehensive survey of risk and protective factors and health outcomes of SGM youth across the United States collected in 2017. Multiple types of disabilities (physical, cognitive, or psychiatric) and mental, behavioral, and physical health outcomes were self-reported. Results: Of the sample, 18.3% reported a disability. Significant findings included higher odds of exercise avoidance, greater depressive symptoms and sleep concerns, and lower self-esteem and overall health ratings among SGM youth who reported any form of disability compared with SGM youth who reported no disability. Youth with cognitive disabilities had lower odds of alcohol use than youth with no disability. Youth with psychiatric disabilities had higher odds of cannabis and cigarette use, and lower physical activity than youth with no disability. Youth with either psychiatric or physical disabilities reported higher body mass index than youth with no disability. Conclusion: SGM youth with disabilities experience greater health disparities than SGM youth with no reported disabilities. Results provide groundwork evidence about the impact of disability status on SGM adolescents. Disability-inclusive or -specific frameworks are needed for future interventions and studies of SGM youth.

Vaping and Sleep as Predictors of Adolescent Suicidality

PURPOSE

To investigate sleep quantity as a moderator of vaping and self-reported suicidality among adolescents.

DESIGN

Cross-sectional. Setting: United States high schools.

SAMPLE

10,520 high-school students with complete data on the primary outcome of suicide attempt in the past year (76.9% response rate).

MEASURES

2019 Youth Risk Behaviors Survey.

ANALYSIS

Logistic regression to examine main effects and potential moderation.

RESULTS

Students with under seven sleep hours on school nights (OR = 2.6; 95% CI = 2.1-3.3) and who vaped in the past month (OR = 3.0; 95% CI = 2.1-3.9) had higher odds of attempting suicide in the last year. Sleep quantity moderated the relationship between vaping and suicidal thoughts in the past year (P = .01) but did not moderate the relationship between vaping and a suicide plan (P = .15) or suicide attempts (P = .06). Specifically, vaping had a smaller effect on suicidal thoughts among students who slept under seven hours on school nights (OR = 1.8) compared to the descriptively larger effect among participants with more sleep (OR = 2.5).

CONCLUSIONS

Students who vape or report low sleep quantity would be ideal participants in suicide prevention interventions as they may be at higher risk for suicidality. Organizations implementing sleep or vaping interventions should incorporate information regarding the higher odds of suicide among students with low sleep quantity or vaping habits.

Nicotine Use and Metabotropic Glutamate Receptor 5 in Individuals With Major Depressive and Posttraumatic Stress Disorders

Metabotropic glutamate receptor 5 (mGluR5) dysregulation has been implicated in the pathophysiology of many psychiatric disorders, as well as nicotine use and dependence. We used positron emission tomography with [18F]FPEB to measure mGluR5 availability in vivo in 6 groups: (1) nicotine users (NUs) without other psychiatric comorbidities (n = 23); (2) comparison controls (CCs) without nicotine use or psychiatric comorbidities (n = 38); (3) major depressive disorder subjects with concurrent nicotine use (MDD-NU; n = 19); (4) MDD subjects without concurrent nicotine use (MDD-CC; n = 20); (5) posttraumatic stress disorder subjects with concurrent nicotine use (PTSD-NU; n = 17); and (6) PTSD subjects without concurrent nicotine use (PTSD-CC; n = 16). The goal of the study was to test the hypothesis that mGluR5 availability in key corticolimbic regions of interest (ROIs) is different in NU with versus without comorbid psychiatric disorders (ROI: dorsolateral prefrontal cortex [dlPFC], orbitofrontal cortex [OFC], ventromedial prefrontal cortex [vmPFC], anterior cingulate cortex [ACC], amygdala, hippocampus). We found that NU had 11%-13% lower mGluR5 availability in OFC, vmPFC, dlPFC, and ACC as compared with CC, while PTSD-NU had 9%-11% higher mGluR5 availability in OFC, dlPFC, and ACC compared with PTSD. Furthermore, relationships between mGluR5 availability and psychiatric symptoms varied as a function of psychiatric diagnosis among NUs. NU showed a negative correlation between mGluR5 and smoking cravings and urges (r's = -0.58 to -0.70, p's = 0.011 - 0.047), while PTSD-NU had the reverse relationship (r's = 0.60-0.71, p's = 0.013-0.035 in ACC, vmPFC, and dlPFC). These findings have substantial implications for our understanding of glutamate homeostasis in psychiatric subgroups and for identifying key neural phenotypes among NU. mGluR5 is a potential treatment target for precision medicine in individuals with nicotine use.

Vaping and Mental Health Conditions in Children: An Umbrella Review

The e-cigarette (EC) epidemic began in the United States (US) in 2007; since 2014 EC is the most commonly used form of tobacco. However, the mental health implications of vaping are grossly unknown. The aim of this umbrella review is to provide astate-of-the-art summary of existing research concerning vaping and mental health conditions in children. Following the PRISMA Statement 2020 guidelines, a systematic search was conducted across PubMed, Cochrane Library, and Google Scholar up to April 15th, 2022 to locate relevant studies. The Joana Briggs Institute (JBI) methodology for umbrella reviews and quality appraisal tool was utilized. Six studies, pooling a total of 846,510 adolescents aged 21 years or below, were included by collating 85 primary clinical studies. Of these, 58.8% of the primary clinical studies originated in the US, with 4.7% from Canada, South Korea, and the United Kingdom each; 3.5% each from England and Taiwan; 2.4% each from Australia, France, Hawaii, Mexico, and Russia; and 1.2% each from Denmark, Greece, Hong Kong, Iceland, New Zealand, Poland, and Switzerland. Overall, significant associations were found between mental health outcomes, including depression and suicidality, among current EC users and those who had ever used EC. Compared to adolescents who had never used EC, both depression and anxiety were reportedly higher among EC users. Impulsive behaviors, reported as impulsivity, were also found to be correlated with the adoption of EC use. However, there is a lack of evidence regarding the impact of EC use on mental health outcomes in children. This umbrella review highlights the urgent need to further explore the effects of current EC use from a psychiatric and public health perspective.