What does it take to be a smoker? Adolescents' characterization of different smoker types

Perceptions of Harm and Addictiveness for Nicotine Products, THC e-Cigarettes, and e-Cigarettes with Other Ingredients Among Adolescents, Young Adults, and Adults

BACKGROUND

Perceptions of health harms and addictiveness related to nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients are an important predictor of use. This study examined differences in perceived harm and addiction across such products among adolescents, young adults, and adults.

METHODS

We conducted a cross-sectional survey (N = 6,131, ages 13-40 years old) in which participants reported perceived harm and addictiveness for 11 products (cigarettes, disposable nicotine e-cigarettes, pod-based nicotine e-cigarettes, other nicotine e-cigarettes, THC e-cigarettes, e-cigarettes with other ingredients, nicotine pouches, nicotine lozenges, nicotine gums, nicotine tablets, nicotine toothpicks). We applied adjusted regression models and conducted pairwise comparisons between age groups (13-17, 18-20, 21-25, and 26-40) and product use status (never, ever, and past-30-day use), adjusting for gender, race/ethnicity, sexual orientation, and financial comfort.

RESULTS

Overall, participants in younger age groups perceived products to be more harmful and addictive than those in older age groups, with the exception of e-cigarettes with other ingredients. For all products, participants who never used perceived each product to be more harmful than those who ever used. For all products, participants who used the products in the past 30-days had lower perceived harm and addictiveness compared to never and ever use. Certain sociodemographic groups, such as people who identify as LGBTQ+, Non-Hispanic Black, or Hispanic, had lower perceived harm and addictiveness for most products.

DISCUSSION

Efforts should be made to educate all age groups and minoritized groups on harms and addictiveness of all nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients.

Tobacco use, smoking identities and pathways into and out of smoking among young adults: a meta-ethnography

BACKGROUND

This meta-ethnography investigates how young adults describe their tobacco use, smoking identities and pathways into and out of regular smoking, to inform future smoking prevention and harm reduction interventions.

METHODS

Eight databases were systematically searched using keywords and indexed terms. Studies were included if they presented qualitative data from young adults aged 16-25 reporting smoking histories and/or smoking identities from countries culturally similar to the UK. A systematic and rigorous meta-ethnographic approach was employed, consistent with Noblit and Hare's methodology.

RESULTS

Thirty papers were included. Reasons stated for taking up smoking and becoming a smoker included alleviating stress, transforming one's identity, and coping with the transition to further education, employment or leaving home. Many used smoking to aid acceptance within new peer groups, particularly when alcohol was present. Smoking was also perceived as an act of resistance and a coping mechanism for those with marginalised identities. Barriers to quitting smoking included young adults' minimisation or denial of the health risks of smoking and not identifying with "being a smoker".

CONCLUSIONS

This meta-ethnography may provide a blueprint to inform the development of health and wellbeing interventions designed specifically for young adults. Smoking cessation interventions should be co-designed with young adults based on their perceived needs, resonant with their desire to quit in the future at key milestones. Harm reduction interventions should address the social aspect of addiction, without reinforcing stigma, particularly for those with marginalised identities.

Identidad como fumador y riesgo percibido en adolescentes fumadores de tabaco: un modelo predictivo

Este estudio descriptivo correlacional con análisis de corte multivariante tuvo como objetivo determinar si la identidad del fumador y el riesgo percibido predecían el nivel de consumo de tabaco en una muestra de 935 de los cuales 554 hombres (59.3%) y 381 mujeres (40.7%). Se utilizó el Cuestionario de Consumo de Cigarrillo (C4), el Cuestionario de Identificación con el Consumo de Cigarrillo (CICC) y el Cuestionario de Expectativas sobre el Consumo de Cigarrillo (CECC). Se realizaron análisis correlacionales bivariados y multivariados para la identidad del modelo de ecuaciones estructurales y se evaluó en el modelo las bondades de los criterios de ajuste. Los resultados indicaron que el 33.2% fumaba y que tanto el riesgo percibido como la no identificación del fumador en conjunto con otros factores predecían el 40.1% de la varianza en el modelo propuesto.

Perceptions of the Harm and Addictiveness of Conventional Cigarette Smoking Among Adolescent E-Cigarette Users

PURPOSE

Although existing evidence indicates that e-cigarette use is a risk factor for cigarette smoking initiation, mechanisms of this association are not yet known. E-cigarette users perceive e-cigarette use to be less harmful relative to conventional cigarettes, but their absolute perceptions of addictiveness of conventional cigarette smoking are unknown. This study examines how e-cigarette users compare with nonusers (non-e-cigarette users/nonconventional cigarette smokers), conventional cigarette smokers, and dual users on perceptions of harm and the addictiveness of conventional cigarette smoking and on other known predictors of cigarette smoking such as peer smoking, influence of antismoking ads, and risk-taking propensity.

METHODS

National samples of 8th- and 10th-grade students from 2014 and 2015 (N = 14,151) were obtained from the Monitoring the Future Study. Multivariate logistic regression models were used to examine relationships between adolescent smoking status and perceptions of harm and the addictiveness of conventional cigarette smoking while controlling for potential confounders.

RESULTS

E-cigarette users had lower perceptions of the addictiveness of conventional cigarette smoking compared with nonusers but higher than cigarette smokers and dual users. E-cigarette users reported lower influence by antismoking ads, more conventional cigarette-smoking peers, and greater risk-taking propensity than nonusers. E-cigarette users and cigarette smokers did not differ in their perceived harm of conventional cigarette smoking or in their risk-taking propensity.

CONCLUSIONS

E-cigarette users' attitudes and perceptions regarding conventional cigarette smoking may leave them vulnerable to becoming conventional cigarette smokers. Future studies should explore the prospective relationship between smoking-related perceptions of conventional cigarette smoking among e-cigarette users and the onset of cigarette smoking.

Mixed methods research in tobacco control with youth and young adults: A methodological review of current strategies

INTRODUCTION

Tobacco use among young people is a complex and serious global dilemma that demands innovative and diverse research approaches. The purpose of this methodological review was to examine the current use of mixed methods research in tobacco control with youth and young adult populations and to develop practical recommendations for tobacco control researchers interested in this methodology.

METHODS

Using PubMed, we searched five peer-reviewed journals that publish tobacco control empirical literature for the use of mixed methods research to study young populations, age 12-25 years. Our team analyzed the features of each article in terms of tobacco control topic, population, youth engagement strategies, and several essential elements of mixed methods research.

RESULTS

We identified 23 mixed methods studies published by authors from five different countries reported between 2004 and 2015. These 23 articles examined various topics that included tobacco use behavior, tobacco marketing and branding, and cessation among youth and young adults. The most common mixed methods approach was variations of the concurrent design in which the qualitative and quantitative strands were administered at the same time and given equal priority. This review documented several innovative applications of mixed methods research as well as challenges in the reporting of the complex research designs.

CONCLUSIONS

The use of mixed methods research in tobacco control has great potential for advancing the understanding of complex behavioral and sociocultural issues for all groups, especially youth and young adults.

A qualitative study on Canadian youth's perspectives of peers who smoke: an opportunity for health promotion

Background

Peer influence, peer selection, and health risk awareness are factors in smoking among youth. Despite the numerous studies on the social context, social network, and how youth define themselves and their smoking status in relation to tobacco use, qualitative knowledge about the role of smoking within peer relationships from youth themselves is only emerging. In this paper, qualitative findings describing Canadian youth’s perspectives and experiences of smoking within the context of peer relationships are presented.

Methods

To examine youth’s perceptions, a qualitative research study design was used. Seventy-five Canadian youth aged 11–19 years participated in open-ended interviews, focus groups, and photovoice methods. Data analysis involved several levels of analysis consistent with qualitative research.

Results

Youth who smoked were perceived by non-smoking peers as less popular and less socially accepted as represented by the theme: The coolness (not so cool) factor. Non-smoking youth felt that peers who smoked strained relationships and forced them to set boundaries and negotiate friendships as denoted by the theme: Negotiating friendships: Being influenced, but also influencing. Finally, in the theme of Making sense of peers who smoke, youth struggled to understand peers who continued to smoke and why they would start in the first place.

Conclusions

As reinforced in this study, Canadian youth increasingly view smoking as unhealthy and uncool. Moreover, youth report resisting peer influence to smoke and in fact, are now influencing their friends who smoke to quit. The self-empowerment stories of non-smoker youth reinforces the idea that the social meaning of smoking with peers is continuing to change from one where youth accepted and participated in the smoking behaviors of their peers, to an environment where youth’s perceptions of personal health is paramount. Findings from this study could be used to guide health promotion and smoking prevention programs and campaigns for youth.

Longitudinal examination of predictors of smoking cessation in a national sample of U.S. adolescent and young adult smokers

INTRODUCTION

To better inform the development of smoking cessation programs for adolescents and young adults, a prospective study was employed to systematically examine behavioral, demographic, health, and psychosocial determinants of smoking cessation.

METHODS

Data from the 2003-2005 National Youth Smoking Cessation Survey were used. Of 2,582 smokers aged 16-24 years sampled, 1,354 provided complete baseline telephone interview data on the study variables, and their self-reported smoking status at 2-year follow-up was known (currently smoking vs. not smoking). Multivariable logistic regression analysis was employed to examine independent predictors of smoking status (outcome variable) at the 2-year follow-up period.

RESULTS

Four of 5 participants remained smokers after 2 years. Of the high nicotine dependence smokers, 90% remained smokers at follow-up; of the low nicotine dependence smokers, 77% remained smokers at follow-up. Higher nicotine dependence smokers started smoking earlier in life (13.2 vs. 14.3 years; p < .05). Similarly, those not smoking at the 2-year follow-up period started smoking later in life than those still smoking (14.5 vs. 13.7 years). Along with nicotine dependence, various psychosocial and demographic variables at baseline predicted smoking status at the 2-year follow-up period.

CONCLUSIONS

Identifiable demographic and psychosocial factors influence smoking behavior among U.S. adolescents and young adults. Even low nicotine dependence is a strong predictor of follow-up smoking behavior. This, coupled with the early smoking age of high nicotine dependence smokers, underscores the importance of early nicotine avoidance among youth.

[Occasional smoking in Norway]

BACKGROUND

In recent decades, daily smoking has become less common, while occasional smoking has stayed at the same level. The purpose of the study is to describe occasional smokers on the basis of their smoking behaviour and socio-demographic characteristics.

MATERIAL AND METHOD

Data from Statistics Norway's quarterly surveys of tobacco use in 2010 and 2011 were used. Information on smoking habits, smoking-related behaviour and the respondents' attitudes to their own smoking was collected in telephone interviews.

RESULTS

Of the 8,700 men and women aged 16-74 (response rate 57%) who were included, altogether 1,583 were daily smokers and 907 occasional smokers. The occasional smokers were younger, more frequently lived in large cities and had a higher level of education and income than the daily smokers. Twenty-nine of 174 (17%) occasional smokers used snus on a daily basis, compared to 10 of 394 (3%) of the daily smokers. The occasional smokers had great confidence in their ability to quit: 95% responded that they would be smoke-free in five years, compared to 55% of the daily smokers (n = 2,158). Fifty-five (35%) of the occasional smokers lit up several times weekly (16 cigarettes per week on average), while the remaining (65%) smoked only once per week as a maximum (five cigarettes per week on average). Those who smoked several times each week had attitudes to their own smoking and usage pattern for tobacco that were similar to those of the daily smokers. Nearly half of the occasional smokers defined themselves as non-smokers.

INTERPRETATION

Norwegian occasional smokers are a heterogeneous group in terms of their smoking pattern and frequency, and many define themselves as non-smokers.

A history of ashes: an 80 year comparative portrait of smoking initiation in American Indians and Non-Hispanic whites--the Strong Heart Study

The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a well-defined population of American Indians (AI) resembles a group of Non-Hispanic white (NHW) populations born over an 80 year period. We obtained data on age of smoking initiation among 7,073 AIs who were members of 13 tribes in Arizona, Oklahoma and North and South Dakota from the 1988 Strong Heart Study (SHS) and the 2001 Strong Heart Family Study (SHFS) and 19,747 NHW participants in the 2003 National Health Interview Survey. The participants were born as early as 1904 and as late as 1985. We classified participants according to birth cohort by decade, sex, and for AIs, according to location. We estimated the cumulative incidence of smoking initiation by age 18 in each sex and birth cohort group in both AIs and NHWs and used Cox regression to estimate hazard ratios for the association of birth cohort, sex and region with the age at smoking initiation. We found that the cumulative incidence of smoking initiation by age 18 was higher in males than females in all SHS regions and in NHWs (p < 0.001). Our results show regional variation of age of initiation significant in the SHS (p < 0.001). Our data showed that not all AIs (in this sample) showed similar trends toward increased earlier smoking. For instance, Oklahoma SHS male participants born in the 1980s initiated smoking before age 18 less often than those born before 1920 by a ratio of 0.7. The results showed significant variation in age of initiation across sex, birth cohort, and location. Our preliminary analyses suggest that AI smoking trends are not uniform across region or gender but are likely shaped by local context. If tobacco prevention and control programs depend in part on addressing the origin of AI smoking it may be helpful to increase the awareness in regional differences.