Expectancies for cigarettes, e-cigarettes, and nicotine replacement therapies among e-cigarette users (aka vapers)

Cytotoxic impact of nicotine products on periodontal ligament cells

OBJECTIVES

The primary objective of this in vitro experiment was an assessment of proliferative capacity, metabolic activity, and potential cellular detriment of human periodontal ligament cells (hPDL) exposed to cigarette smoke (CS), electronic cigarette vapor (eCV), and heated tobacco product aerosol (HTP), or air (control).

MATERIALS AND METHODS

Using a CAD/CAM-designed exposition chamber, hPDL were exposed to CS, eCV, HTP, or air (control) based on the Health Canada Intense Smoking Regime. Cell proliferation, metabolic activity, and cellular detriment were assessed at various time points.

RESULTS

Compared to the control, hPDL exposed to CS exhibited significantly decreased cell numbers at all time points. HTP exposure led to reduced cell numbers 48 h and 72 h post-exposure, while eCV-exposed cells showed no significant decrease. The metabolic activity of eCV-treated hPDL was slightly reduced at 7 h but recovered at 24 h and 48 h. In contrast, CS-treated cells exhibited significantly decreased metabolic activity at 24 h and 48 h, and HTP-exposed cells showed a significant decrease after 48 h. Flow cytometry indicated both apoptotic and necrotic cell death following CS exposure, with necrotic cell death being more pronounced.

CONCLUSIONS

eCV and HTP demonstrated comparatively reduced detrimental effects on hPDL compared to CS.

CLINICAL RELEVANCE

The findings suggest that conventional cigarette smoke poses a substantial risk to periodontal health by significantly impairing cell proliferation and metabolic activity. However, alternatives such as eCV and HTP may offer a comparatively reduced risk.

Emotion Dysregulation and E-Cigarette Expectancies among College Student E-Cigarette Users

Background: E-cigarette outcome expectancies (i.e., beliefs about the expected consequences of e-cigarette use) are a key factor in motivating use. Emotion regulation difficulties have demonstrated significant associations with outcome expectancies; however, there has yet to be an examination of associations between specific emotion regulation difficulties and specific e-cigarette outcome expectancies, which could serve as targets for intervention efforts. Therefore, the current study sought to examine the unique predictive ability of specific emotion regulation difficulties in terms of e-cigarette outcome expectancies. Methods: Participants were 116 college student e-cigarette users (Mage = 19.72, SD = 1.88; 71.6% female) who completed self-report questionnaires for course credit. Results: Greater difficulties engaging in goal-directed behavior when experiencing negative emotions and fewer difficulties accessing effective emotion regulation strategies were associated with positive reinforcement outcome expectancies. Greater emotion regulation difficulties in general were also associated with negative reinforcement outcome expectancies, though there were no significant individual predictors. Conclusion: These results suggest that greater emotion regulation difficulties are associated with mood-related e-cigarette outcome expectancies, and targeting emotion regulation difficulties, particularly difficulty engaging in goal-directed behavior when upset, may be useful to incorporate into intervention efforts.

Examining smoking and vaping behaviors, expectancies, and cessation outcomes between bisexual and heterosexual individuals

Prior research indicates bisexual individuals have higher smoking and vaping rates and heightened vulnerability to negative health outcomes. Thus, we compared adult bisexual (n = 294) and heterosexual (n = 2412) participants enrolled in a smoking cessation trial on baseline smoking and vaping use behaviors, motivations, and expectancies/beliefs as well as follow-up smoking and vaping status. This is a secondary analysis of a large randomized controlled trial testing a smoking cessation intervention for dual users of combustible and electronic cigarettes (e-cigarettes) in the United States. Self-reported 7-day point prevalence smoking and vaping abstinence were collected at 3-, 12-, and 24-month assessments. Bisexual and heterosexual participants did not differ in sociodemographic variables or baseline smoking and vaping history and behavior. We found significant differences among bisexual and heterosexual individuals in smoking and vaping beliefs/expectancies. Specifically, bisexual participants expressed overall greater positive expectancies regarding smoking and vaping, such as smoking and vaping to reduce negative affect and stress. There were no differences in smoking at any follow-up assessment. Only at 3 months were bisexual individuals more likely to be abstinent from vaping and less likely to be dual users than heterosexual individuals. Despite similar smoking and vaping status over time, bisexual individuals reported greater positive expectancies regarding smoking and vaping. Our findings revealed few targets for tailoring cessation interventions to bisexual individuals; thus, it is possible that there may be greater utility in targeting the disparities in prevalence (i.e., via prevention efforts).

The relationship between chronic lung disease diagnosis and the susceptibility to e-cigarette use in adults: The mediation effects of psychosocial, cognitive influences, and the moderation effect of physiological factors

INTRODUCTION

There is a paucity of studies on e-cigarette use among adults with chronic lung disease. In the present study, we aimed to assess whether psychosocial or cognitive factors elucidate the relationship between chronic lung disease (CLD) and susceptibility to e-cigarette use and whether the relationship between CLD and e-cigarette use is conditional on the presence of respiratory symptoms.

METHODS

We recruited adults aged ≥18 years in Alabama with CLD from university medical clinics (n=140) and individuals without CLD (n=123 as a reference group). Information on sociodemographics, susceptibility to e-cigarette use, psychosocial factors, and cognitive factors were collected. Mediation analysis was used to assess whether the psychosocial factors or cognitive factors explained the association between CLD and susceptibility to using e-cigarettes, and moderation analysis was conducted to determine if respiratory factors would change the association between CLD and susceptibility to e-cigarette use.

RESULTS

Psychosocial factors (stress, depression, anxiety) and e-cigarette positive expectancy were notably high among individuals with CLD. Having CLD was associated with a lower likelihood of susceptibility to e-cigarette use. Higher levels of stress, being a smoker, boredom, taste/sensorimotor manipulation, and social facilitation were associated with higher odds of susceptibility to using e-cigarettes among individuals with CLD. Mediation analysis indicated a statistically significant indirect effect of CLD on the susceptibility to using e-cigarettes through stress and boredom reduction. We did not find a statistically significant interaction between CLD and respiratory symptoms affecting susceptibility to using e-cigarettes.

CONCLUSIONS

Individuals with CLD often exhibit stress, depression, and a positive view of e-cigarettes but are generally less inclined to use them. Stress, smoking habits, boredom, taste, and social influence can increase their susceptibility to e-cigarette use. Our findings call for further exploration to evaluate the temporal relationship between CLD status, psychosocial factors, cognitive factors, and susceptibility to using e-cigarettes.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov, on 5 November 2019. Identifier: NCT04151784.

E-cigarette weight and appetite control beliefs and e-cigarette initiation in young adults

E-cigarette use has increased among young adults, and emerging research suggests a subset of young adults report using e-cigarettes for appetite control/weight loss. The current article examined the association of e-cigarette weight control beliefs with subsequent e-cigarette initiation. Data were collected via online surveys from a prospective cohort study of young adults in Southern California (N = 1,368) at baseline (May-October 2020; M [SD]age = 21.2 [0.4]) and 6 months later (January-May 2021). Binary logistic regression models were used to evaluate the association of e-cigarette weight control beliefs (i.e., perceptions that e-cigarettes help people lose weight and satisfy hunger and desire to eat unhealthy foods) with new onset e-cigarette use at follow-up. All models were adjusted for sociodemographic characteristics. Among individuals who had never used e-cigarettes at baseline, those who agreed (vs. disagreed) that e-cigarettes help people lose weight had more than three times the odds of initiating e-cigarette use by follow-up (OR [95% CI]: 3.24 [1.52, 6.62]). Similarly, those who agreed (vs. disagreed) that vaping certain e-cigarette flavors help satisfy hunger and desire to eat unhealthy foods had more than twice the odds of initiating e-cigarette use by follow-up (OR [95% CI]: 2.40 [1.15, 4.82]). Findings highlight that e-cigarette weight control beliefs are an important risk factor for vaping initiation. Future interventions and policies aiming to prevent vaping among young adults should address e-cigarette weight control beliefs and long-term health consequences from related use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effectiveness of smoking cessation on the high-risk population of lung cancer with early screening: a systematic review and meta-analysis of randomized controlled trials until January 2022

BACKGROUND

Lung cancer has always been the malignant tumor with the highest incidence rate. Smoking is the most important risk factor for lung cancer. Although potential positive effects of smoking cessation interventions on the high-risk population of lung cancer have been observed, evidence of its definitive effect remains uncertain. This study aimed to summarize the evidence related to the effects and safety of smoking cessation interventions for the high-risk population of lung cancer.

METHODS

A systematic literature search was conducted through the following seven databases: PubMed, Embase, Web of Science, CENTRAL, CINAHL, PsycINFO, and Science Direct. Screening and assessment for risk of bias were conducted by two independent reviewers. Meta-analysis was performed for the 7-day-point prevalence of smoking abstinence and continuous smoking abstinence using RevMan 5.3 software.

RESULTS

Meta-analysis results show that in the 7-day-point prevalence of smoking abstinence (by patient-reported outcome): individualized intervention was significantly higher than that of the standard care [RR = 1.46, 95%CI = (1.04,2.06), P < 0.05]. Moreover, the smoking cessation interventions were significantly elevated than that of standard care [RR = 1.58, 95%CI = (1.12, 2.23), P < 0.05] within 1-6 month follow-up time. In line with the findings in cigarette smoking, the continuous smoking abstinence of E-cigarettes (biochemical verified): E-cigarettes were significantly higher than that of the standard care [RR = 1.51, 95%CI = (1.03, 2.21), P < 0.05], and within 1-6 month follow-up time, the smoking cessation interventions were significantly greater than that of standard care [RR = 1.51, 95%CI = (1.03, 2.21), P < 0.05]. Publication bias was detected possibly.

CONCLUSIONS

The results of this systematic review show that smoking cessation intervention is effective for long-term lung cancer high-risk smokers who participate in early screening, of which E-cigarettes are the best, followed by individual smoking cessation.

TRIAL REGISTRATION

A review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO).

TRIAL REGISTRATION

CRD42019147151. Registered 23 June 2022.

Psychoactive Comfort Products or Snacks: How Chinese Young Adults Perceive the Potentially Addictive Nature of E-Cigarettes

The potential health value and pitfalls of e-cigarettes are currently under dispute in the scientific community. Exploring young adult e-cigarette users' perceptions would assist in adding a public dimension of understanding to the literature and in scientific public health decision making. Therefore, in this study, we collected and analyzed data from interviews with young adult (n = 14) e-cigarette users and found that many referred to e-cigarettes as "snacks," indicating that they considered that both their frequency of use and addiction were manageable and that they could stop using e-cigarettes at any time. To further understand the behavior of Chinese young adults in relation to their perception of e-cigarettes as a "snack", the study developed a social context framework (crossroads model) and psychological judgment model to explain how youth e-cigarette users' perception of "controlled addiction and ready cessation" arises. These models can be used to assess the effectiveness of e-cigarette policy.

Measuring vaping-related expectancies in young adults: Psychometric evaluation of the Electronic Nicotine Vaping Outcomes (ENVO) scale

OBJECTIVE

Electronic cigarettes are the most commonly used tobacco products by young adults. Measures of beliefs about outcomes of use (i.e., expectancies) can be helpful in predicting use, as well as informing and evaluating interventions to impact use.

METHODS

We surveyed young adult students (N = 2296, Mean age=20.0, SD=1.8, 64 % female, 34 % White) from a community college, a historically black university, and a state university. Students answered ENDS expectancy items derived from focus groups and expert panel refinement using Delphi methods. Factor Analysis and Item Response Theory (IRT) methods were used to understand relevant factors and identify useful items.

RESULTS

A 5-factor solution [Positive Reinforcement (consists of Stimulation, Sensorimotor, and Taste subthemes, α = .92), Negative Consequences (Health Risks and Stigma, α = .94), Negative Affect Reduction (α = .95), Weight Control (α = .92), and Addiction (α = .87)] fit the data well (CFI=0.95; TLI=0.94; RMSEA=0.05) and was invariant across subgroups. Factors were significantly correlated with relevant vaping measures, including vaping susceptibility and lifetime vaping. Hierarchical linear regression demonstrated factors were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. IRT analyses indicated that individual items tended to be related to their underlying constructs (a parameters ranged from 1.26 to 3.18) and covered a relatively wide range of the expectancies continuum (b parameters ranged from -0.72 to 2.47).

CONCLUSIONS

A novel ENDS expectancy measure appears to be a reliable measure for young adults with promising results in the domains of concurrent validity, incremental validity, and IRT characteristics. This tool may be helpful in predicting use and informing future interventions.

IMPLICATIONS

Findings provide support for the future development of computerized adaptive testing of vaping beliefs. Expectancies appear to play a role in vaping similar to smoking and other substance use. Public health messaging should target expectancies to modify young adult vaping behavior.

Dual users' perceptions of the addictive properties of cigarettes versus E-cigarettes

INTRODUCTION

Electronic cigarettes ("e-cigarettes") are commonly promoted as a less-harmful alternative to combustible cigarettes, yet many individuals concurrently use both products ("dual users"). Little is known about the extent to which dual users' perceptions of the addictive properties of these products differ, or to what extent there are differences in the factors that elicit craving for each product.

METHODS

An online survey evaluated beliefs about the addictive properties of cigarettes vs e-cigarettes and the situational and affective precipitants of product craving, on a scale from 1 to 10, in a sample of Canadian adults that reported past-month use of combustible and e-cigarettes (N = 175; 79 female).

RESULTS

Participants rated cigarettes as more addictive than e-cigarettes, and on average reported higher levels of dependence on combustible cigarettes. While the addictive properties of both combustible and e-cigarettes were largely attributed to nicotine, non-nicotine factors (e.g. flavouring, other non-nicotine ingredients) were believed to make a relatively stronger contribution to the addictive properties of e-cigarettes, particularly among women. Participants reported greater increases in craving for combustible cigarettes in response to negative affective states and situational factors, and these effects were strongest among participants that displayed greater dependence on combustible tobacco relative to e-cigarettes.

CONCLUSIONS

Dual users perceived cigarettes to be more addictive than e-cigarettes and attributed the addictive properties of each product to different factors. Further, cravings for combustible cigarettes were more strongly linked to certain negative affective states and situational factors relative to e-cigarettes. Findings suggest that there may be limited substitutability between combustible and e-cigarettes.

Outcome Expectancies and Resistance Self-Efficacy Mediate the Relationship Between Asthma Diagnosis and E-cigarette Use among Youth and Young Adults

Introduction: The use of electronic cigarettes (e-cigarettes) may exacerbate pulmonary complications in youth and young adults with asthma. We sought to identify the cognitive mechanisms that might explain e-cigarette use in this population. We hypothesized that e-cigarette outcome expectancies and e-cigarette resistance self-efficacy would mediate the relationship between asthma diagnosis and e-cigarette use in youth and young adults. Methods: We enrolled youth and young adults (15-25 years old) in Alabama with a clinical diagnosis of asthma (n = 130) or without a diagnosis of any chronic pulmonary disease (n = 115; reference group). Author-constructed and validated questionnaires (young adult e-cigarette use outcome expectancies and modified Self-efficacy Scale for Adolescent Smoking) were administered to collect demographic data and assess susceptibility to e-cigarette use as well as current use of e-cigarettes, e-cigarette outcome expectancies, and e-cigarette resistance self-efficacy. We then conducted structural equation modeling to test whether e-cigarette expectancies and e-cigarette resistance self-efficacy mediate the relationship between asthma and susceptibility to e-cigarette use as well as current e-cigarette use. Results: The frequency of the susceptibility to e-cigarette use and current e-cigarette use was lower among those with clinically diagnosed asthma than among those without asthma (35.8% vs 59.8% for susceptibility and 6.0% vs 18.2% for current use). Individuals with asthma reported weaker expectancies that e-cigarettes would make them feel relaxed which, in turn, was a significant predictor of lower susceptibility to e-cigarette use and current e-cigarette use, suggesting mediation. Finally, individuals with asthma demonstrated greater e-cigarette resistance self-efficacy in the context of social opportunities and friends' influence to use e-cigarettes. This self-efficacy was associated with lower susceptibility to e-cigarette use as well as current e-cigarette use. Conclusion: Although longitudinal studies are needed to determine relationships prospectively, targeted interventions that reduce outcome expectancies and increase resistance self-efficacy to e-cigarette use may further reduce e-cigarette use among youth and young adults with asthma.

Dual Use of Nicotine and Cannabis Through Vaping Among Adolescents

INTRODUCTION

This study seeks to identify adolescent nicotine and cannabis vaping patterns and the characteristics of those adolescents who comprised each pattern.

METHODS

This prospective longitudinal survey study measured the relationship between nicotine and cannabis vaping among 1,835 adolescents from 4 public high schools outside of Philadelphia, Pennsylvania. Adolescents completed in-classroom surveys, including questions of lifetime and past 30-day nicotine and cannabis vaping, at Wave 1 (fall 2016, ninth grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). Data were analyzed in 2021.

RESULTS

A sequential processes growth mixture model revealed 4 latent conjoint classes of nicotine and cannabis vaping: early, declining dual use (Class 1: n=259); rapidly increasing dual use (Class 2: n=128); later, slower dual use (Class 3: n=313); and no use (Class 4: n=1,136). Increased odds of belonging to Class 1 and Class 2 versus belonging to Class 4 were significantly associated with cigarette smoking (OR=3.71, OR=2.21), alcohol use (OR=2.55, OR=4.39), peer vaping (OR=1.24, OR=1.20), sensation seeking (OR=1.03, OR=1.11), positive E-cigarette expectations (OR=1.21, OR=1.17), and cigar smoking (OR=2.39 Class 2 only). Increased odds of belonging to Class 3 versus Class 4 were significantly associated with alcohol use (OR=1.66), perceived benefits of E-cigarette use (OR=1.03), positive E-cigarette expectations (OR=1.08), depressive symptoms (OR=1.02), and sensation seeking (OR=1.03).

CONCLUSIONS

From middle to late adolescence, vaping of nicotine and cannabis develop in close parallel. Regulatory policy and prevention interventions should consider the interplay between these 2 substances during this period of adolescence.

Participant Experiences of a Quit Smoking Attempt Through Either Nicotine Replacement Therapy (NRT) Methods or the Use of an E-cigarette

OBJECTIVES

There is a lack of evidence exploring experiences of using e-cigarettes for smoking cessation. The study's main aim was to explore participant experiences of e-cigarettes compared to nicotine replacement therapy (NRT) delivered through stop smoking services.

METHODS

Semi-structured, face-to-face, and telephone interviews at 3-month post-quit follow-up in a randomized controlled trial comparing nicotine-containing e-cigarettes, nicotine-free e-cigarettes, and NRT for smoking cessation. N = 17 participants, 9 were male, mean age 44 years, 5 using nicotine-containing e-cigarettes, 7 nicotine-free e-cigarettes, and 5 NRT. Interviews were transcribed and analyzed using thematic analysis.

RESULTS

Two global themes and 5 organizing themes were identified. Global themes included: (1) experiences of e-cigarette and NRT quit aids (e-cigarette positive impact and dilemmas, NRT perceptions and experiences), and (2) key mechanisms to support quit attempt (physical aids, advice and support, feedback and structure). E-cigarettes were viewed with caution, however, generally evaluated positively alongside NRT methods, finding e-cigarettes useful during a quit attempt due to their versatility in application. Nicotinecontaining e-cigarettes were favored due to their support with nicotine cravings. Participants were, however, wary of replacing smoking addiction with vaping habit.

CONCLUSIONS

Participant e-cigarette experience were generally positive; however, concerns over long-term application were noted. There was a noticeable preference for nicotine-containing e-cigarettes, but further research is required to better understand how nicotine is used in conjunction with e-cigarettes long-term as a quit aid alongside other NRT.

Perceptions of E-cigarettes among adults in treatment for opioid use disorder

Background

Individuals with opioid use disorder (OUD) have a high prevalence of smoking and limited success quitting smoking with existing tools. There is ongoing debate about whether electronic cigarettes (e-cigarettes) may be a viable harm reduction strategy. We sought to determine the potential acceptability of e-cigarettes for cigarette harm reduction among individuals receiving medication treatment for opioid use disorder (MOUD) with buprenorphine. Among individuals receiving MOUD we investigated health harm perceptions of cigarettes, nicotine e-cigarettes, and nicotine replacement therapy (NRT), and perceptions of the helpfulness of e-cigarettes and NRT for quitting cigarettes.

Methods

Cross-sectional telephone survey conducted among adults in buprenorphine treatment at five community health centers in the Boston, MA metropolitan area from February to July 2020.

Results

93% and 63% of participants rated cigarettes and e-cigarettes, respectively, as very or extremely harmful to health, and 62% rated NRT as not to slightly harmful to health. Over half (58%) rated cigarettes as more harmful than e-cigarettes; 65% and 83% perceived e-cigarettes and NRT, respectively, to be helpful for reducing/quitting cigarette use. In bivariate analyses, nicotine e-cigarette users, compared to nonusers, perceived e-cigarettes to be less harmful to health and more often rated e-cigarettes as helpful for reducing/quitting cigarette use (both p<0.05).

Conclusions

This study suggests that Massachusetts patients receiving MOUD with buprenorphine have concerns about the health harms of e-cigarettes yet rate them as helpful tools for reducing or quitting cigarette smoking. Future research is needed to test the efficacy of e-cigarettes for cigarette harm reduction.

Expectancies for and Pleasure from Simultaneous Alcohol and E-Cigarette Use among Young Adults

Background: Young adults' use of alcohol and e-cigarettes are of public health concern, as they report among the highest prevalence for use of both substances. Many young adults use alcohol and e-cigarettes simultaneously (i.e., at the same time with overlapping effects) despite heightened risk for adverse effects. Objectives: This study assessed simultaneous use expectancies and changes in pleasure from e-cigarettes as a function of alcohol consumption and simultaneous use frequency. Participants (N = 408; Mage = 23.64 years; 52.7% female) recruited through Amazon MTurk completed measures of alcohol and e-cigarette use, and expectancies, pleasure and frequency of simultaneous use. Results: Separate linear regression models revealed that alcohol consumption was positively associated with expectancies for simultaneous use of e-cigarettes/alcohol and pleasure from simultaneous use (ps ≤ .015). As individuals engaged in simultaneous use more frequently, they also reported greater expectancies for, and increased pleasure from, simultaneous use (ps < .001). Conclusions/Importance: Expectancies for simultaneous use may be greatest among young adults who consume more alcohol and engage in simultaneous use more frequently. Increased pleasure from e-cigarettes while drinking suggests that positive reinforcement may be implicated in simultaneous use patterns. Future research should examine the role of pleasure in simultaneous use trajectories.

The Dilemma of Correcting Nicotine Misperceptions: Nicotine Replacement Therapy versus Electronic Cigarettes

Many people overestimate the health risks associated with nicotine, mistakenly perceiving nicotine as the main carcinogen in cigarettes and a leading cause of smoking-related diseases. Health professionals have been calling for public education programs to correct nicotine misperceptions in the hope that a lower risk perception of nicotine could encourage the use of nicotine replacement therapy (NRT). However, a lower risk perception of nicotine could also lower perceived risk of electronic cigarettes (e-cigarettes). This paper evaluated the necessity of correcting nicotine misperceptions and explored possible intervention strategies to increase use of NRT and decrease use of e-cigarettes. In Study 1, smokers were surveyed about their perceptions of nicotine harm, and attitudes and intention toward using NRT and e-cigarettes. Results showed that overestimation of nicotine harm was associated with e-cigarette attitude and intention, but not with NRT. Informed by the survey results, three correction messages (a nicotine message, an NRT message, and an e-cigarette message) were developed and experimentally tested in Study 2 on both tobacco users and non-tobacco users. The nicotine message lowered people's perception of nicotine harm but it did not change attitude and intention toward tobacco product use. The NRT message also failed to influence NRT attitudes and intentions. The e-cigarette message significantly lowered attitudes and intentions to use e-cigarette.

The moderating role of anxiety sensitivity in terms of fatigue severity and e-cigarette use expectancies

Little is understood about individual difference factors related to e-cigarette expectancies about use. This study examined the interactive effects of fatigue severity and anxiety sensitivity in relation to e-cigarette expectancies among 525 e-cigarette users (51.0% female, Mage = 35.25 years, standard deviation = 10.10). Results indicated a significant interaction between fatigue severity and anxiety sensitivity in terms of positive expectancies (β = 0.57, p < 0.001, 95% confidence interval = (0.002, 0.01)), but not for negative expectancies (β = 0.25, p = 0.08, 95% confidence interval = (0, 0.005)) for e-cigarette use. These results support anxiety sensitivity as a moderator in the relation between fatigue severity and positive outcome expectancies for e-cigarette use.

Conjoint Developmental Trajectories of Adolescent E-cigarette and Combustible Cigarette Use

OBJECTIVES

In this study, we sought to identify which adolescents progress to regular electronic cigarette (e-cigarette) use (without cigarette smoking), which adolescents become dual users of both types of cigarettes, and how dual use develops across time.

METHODS

Adolescents (N = 1808) from public high schools outside Philadelphia, Pennsylvania, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade).

RESULTS

A sequential processes growth mixture model identified 4 conjoint latent classes: later, rapid e-cigarette uptake (class 1: n = 230); no use of e-cigarettes or combustible cigarettes (class 2: n = 1141); earlier, steady e-cigarette uptake (class 3: n = 265); and dual use of e-cigarettes and combustible cigarettes (class 4: n = 204). Using a rich set of potential risk factors, multinomial logistic regression assessed the likelihood of belonging to each conjoint class compared with the comparison class (dual use). Adolescents in the dual use class were characterized by a greater number and severity of e-cigarette and combustible cigarette risk factors. Adolescents in the 2 e-cigarettes-only classes were characterized by either e-cigarette-specific risk factors (earlier onset) or no risk factors (later onset). The no use class had an absence of risk factors for e-cigarette and cigarette use.

CONCLUSIONS

This study provides new prospective evidence for distinct patterns and profiles of adolescents who progress to current e-cigarette use, including adolescents who were initially cigarette smokers. The findings have implications for prevention intervention timing, tobacco product focus, content, and the adolescent subgroups to target.

Adolescent depression symptoms and e-cigarette progression

BACKGROUND

Depression symptoms are associated with the initiation of cigarette smoking and progression to regular use. Whether similar relationships exist between depression symptoms and adolescent e-cigarette progression has not been firmly established.

METHODS

This prospective longitudinal survey study measured the relationship between depression symptoms and e-cigarette use among 1822 adolescents from four public high schools outside of Philadelphia, PA. Adolescents completed in-classroom surveys at wave 1 (fall 2016, 9th grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). E-cigarette use, depression symptoms, and potential covariates were measured at each wave. A latent growth curve model was used to assess the longitudinal relationship between e-cigarette use and depression symptoms.

RESULTS

Baseline depressive symptoms had a significant effect on e-cigarette use trend (b = 0.01, z = 4.29, p < 0.0001) while holding other variables constant. A standard deviation increase in depressive symptoms at baseline was associated with a 0.25 standard deviation increase in the rate of e-cigarette progression across the following 36 months. By contrast, the path from baseline e-cigarette use to depressive symptoms trend was not significant (p = 0.74).

CONCLUSIONS

The present study provides new evidence for the effects of depression symptoms on adolescent e-cigarette progression. Greater depressive symptoms at age 14 years old were associated with a faster rate of e-cigarette escalation. However, e-cigarette use was not related to the development of depression symptoms over time. It will be important to examine whether adolescents with elevated depression symptoms respond similarly to e-cigarette prevention campaigns as adolescents in general.

Regulatory approaches and implementation of minimally addictive combusted products

INTRODUCTION

A joint meeting was held by the World Health Organization (WHO) and the Convention Secretariat of the WHO Framework Convention on Tobacco Control to examine the potential effects of a regulatory policy to reduce nicotine in cigarettes to minimally addictive levels. This paper reviews the feasibility of and approaches to implementing a nicotine product standard.

METHODS

Prior WHO reports on this topic were consulted and a systematic review of the scientific literature was conducted. The paper was reviewed by the participants at the aforementioned meeting and their feedback was incorporated.

RESULTS

The nicotine dose most likely to consistently reduce smoking behavior and dependence is < 0.4 mg nicotine/g tobacco. An immediate rather than a gradual nicotine reduction approach appears to be more beneficial. Smokers are likely to seek nicotine from alternate sources (e.g., nicotine replacement therapies, e-cigarettes) or potentially, the illegal market. As such, the availability of alternative products, as well as strong policies against illegal markets, can potentially mitigate unintended consequences. An effective reduced nicotine regulation must be imbedded in a comprehensive and strong tobacco control program that includes public education and surveillance. Barriers and challenges to implementing a nicotine product standard exist, particularly in low-capacity countries.

CONCLUSION

Not all countries will have the capacity to implement a regulation to reduce nicotine in cigarettes (and preferably other combusted tobacco products) to minimally addictive levels. However, for the countries that choose to implement it, such a policy could potentially dramatically reduce the burden of tobacco use.

E-cigarettes use prior to smoking combustible cigarettes among dual users: The roles of social anxiety and E-cigarette outcome expectancies

E-cigarette use is prevalent, and rates of use continue to increase. Although e-cigarettes are often used to help combustible users quit or reduce smoking, some use e-cigarettes in the absence of combustible cigarettes, increasing risk for smoking combustible cigarettes. Yet, little research has examined individual vulnerability factors implicated in transitioning from exclusive e-cigarettes use to dual use of combustible cigarettes. Social anxiety may be one such factor given it is related to a variety of negative smoking-related outcomes. Thus, the current study tested whether social anxiety was related to using e-cigarettes before smoking combustibles among 226 current undergraduate dual users (use both e-cigarettes and combustible cigarettes). Most dual users reported initiating with e-cigarettes (67%). Those who initiated with e-cigarettes reported statistically significantly greater negative reinforcement (d = 0.59) and weight control expectancies (d = 0.37) and greater social anxiety (d = 0.37) than those who initiated with combustibles. Social anxiety was indirectly related to e-cigarette initiation via negative and weight control expectancies. Findings add to a growing literature that dual users initiated with e-cigarettes and extend understanding of this phenomenon by identifying that socially anxious persons may be especially vulnerable to doing so, at least partially due to expectations regarding e-cigarette's ability to manage negative affect and/or weight.

Patterns of E-cigarette Use and Subsequent Cigarette Smoking Cessation Over 2 Years (2013/2014-2015/2016) in the Population Assessment of Tobacco and Health Study

INTRODUCTION

Understanding the population impact of e-cigarettes requires determining their effect on cigarette smoking cessation.

METHODS

Using the US Population Assessment of Tobacco and Health cohort, we examined smoking cessation among adult current cigarette smokers at Wave 1 with follow-up data at Waves 2 and 3 (n = 9724).

RESULTS

By Wave 3 (2015/2016), 17.3% of smokers had quit smoking. Smokers using e-cigarettes daily or who increased to daily use over the three waves were two to four times more likely to have quit in the short term (<1 year) and long term (1+ years) compared with never e-cigarette users (p < .001). E-cigarette use in the last quit attempt was associated with a higher likelihood of short-term (<1 year) quitting at Wave 3 (adjusted relative risk ratio: 1.33; 95% confidence interval: 1.04, 1.71) compared with smokers who did not use an e-cigarette in their last quit attempt. Noncurrent (no use in any wave) e-cigarette users and users who were unstable in use frequency were 33% and 47% less likely to quit in the short-term, respectively (p < .001). Flavored (vs nonflavored) and using a rechargeable (vs disposable) e-cigarette device was associated with an increased likelihood of both short- and long-term quitting.

CONCLUSION

Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices. Less frequent, unstable, past, or never e-cigarette users were less likely to quit smoking. Monitoring the relationship between patterns of e-cigarette and cigarette use is complex but critical for gauging the potential of e-cigarettes as a harm reduction tool.

IMPLICATIONS

This study suggests that consistent and frequent e-cigarette use over time is associated with cigarette smoking cessation among adults in the United States. In addition, findings suggest that flavored e-cigarette use and use of rechargeable e-cigarette devices can facilitate smoking cessation. These results underscore the importance of carefully defining and characterizing e-cigarette exposure patterns, potential confounders, and use of e-cigarettes to quit smoking, as well as variations in length of the smoking cessation.

Intentions to Seek Information about E-Cigarettes: Perceived Risk, Efficacy, and Smoking Identity

While e-cigarette use increases in the US., people's knowledge about e-cigarettes is limited. Information seeking may influence people's knowledge about e-cigarettes. Using the risk perception attitude framework and the identity theory, this study examined if U.S. adult current smokers (n = 1,841) differing in perceived efficacy of switching completely to e-cigarettes, perceived risk of cigarette smoking, and smoking identity report different levels of intentions to seek information about e-cigarettes. Results revealed that smokers with high perceived risk of smoking and perceived efficacy about switching completely to e-cigarettes (responsive group) reported strongest intentions to seek information about e-cigarettes (M = 5.41 on a 1-7 scale), followed by the group having low smoking risk perceptions and high e-cigarette efficacy beliefs (proactive group; M = 4.58), the group having high smoking risk perceptions and low e-cigarette efficacy beliefs (avoidance group; M = 3.18), and the group low on both factors (indifference group; M = 2.76). The differences between responsive group and proactive, avoidance, and indifference groups were greater among smokers with high (M_diff = 6.14) vs. low (M_diff = 5.27) smoking identity. Theoretical and practical implications of the findings are discussed.

Evaluating the psychometric properties of the e-cigarette barriers to cessation scale

Evidence suggests that electronic cigarette (e-cigarette) users have difficulty quitting e-cigarettes. The Electronic Cigarette Barriers to Cessation Scale (E-BCS) was developed to assess barriers to cessation among e-cigarette users. Yet, no work has evaluated the psychometric properties of the E-BCS. The current study utilized data from two independent samples of adult e-cigarette users to evaluate the psychometric properties and structure of the E-BCS. In Study 1, competing models of the E-BCS were evaluated, and initial construct validity and reliability were explored using data from 599 adult e-cigarettes users (52.3% female, M_age = 35.16 years, SD = 10.30). Results supported a unidimensional structure for the E-BCS comprised of 18 items. In Study 2, the unidimensional structure of the 18-item E-BCS and construct validity were evaluated among a sample of 516 current e-cigarette using adults (52.3% female; M_age = 34.74, SD = 11.37). Results confirmed the unidimensional structure, measurement invariance across sex, and construct validity across related e-cigarette behavior constructs and psychopathology for the E-BCS. These findings suggest that the E-BCS is a potentially useful clinical instrument for measuring barriers that may interfere with e-cigarette cessation.

Adolescent perceptions of E-cigarette use and vaping behavior before and after the EVALI outbreak

This study sought to determine whether adolescents' e-cigarette risk perceptions, perceived benefits, and positive expectations, and vaping behavior changed after the electronic-cigarette or vaping product use-associated lung injury (EVALI) outbreak. This longitudinal survey studied 1539 high school students in suburban Philadelphia, PA in 11th and 12th grade, before and after the outbreak of EVALI cases in 2019. Adolescents who reported current nicotine vaping at baseline (versus those who did not) had a greater increase in risk perceptions (B = -0.31, p = 0.04) and a greater decrease in positive expectations (B = -1.30, p = 0.003) at follow-up. Adolescents who reported current marijuana vaping at baseline (versus those who did not) had greater perceived benefits (B = 2.19, p < 0.001), lower risk perceptions (B = 0.39, p < 0.001), and greater positive expectations of e-cigarette use (B = 1.43, p < 0.001) across time. Odds of current nicotine vaping at follow-up increased (OR = 1.61, 95% CI = 1.08, 2.41) for adolescents who maintained lower risk perceptions. Odds of current nicotine vaping at follow-up decreased (OR = 0.33, 95% CI = 0.21, 0.50) for adolescents whose positive expectations of e-cigarette use decreased. The odds of current marijuana vaping at follow-up decreased (OR = 0.64, 95% CI = 0.42, 0.98) for adolescents whose positive expectations of e-cigarette use decreased. Perceptions of the risks of e-cigarette use increased and positive expectations of e-cigarette use decreased after the EVALI outbreak. Adolescent risk perceptions and positive expectations of e-cigarette use are two potential targets to impact vaping behavior. Emphasizing the risks of e-cigarette use while decreasing positive expectations of use have the potential to reduce vaping behavior, and perhaps subsequent EVALI cases.

Emotion dysregulation, fatigue, and electronic cigarette expectancies

Emotion dysregulation and the experience of fatigue have both been linked to the maintenance of substance use. However, limited empirical data has evaluated individual differences in these constructs in terms of e-cigarette use expectancies. The present study examined a theoretically relevant model focused on whether the experience of more severe fatigue explains, in part, the relation between individual differences in emotion dysregulation and positive and negative e-cigarette expectancies among 525 adult e-cigarette users (50.9% female, Mage = 35.25 years, SD = 10.10). It was hypothesized that emotion dysregulation, via fatigue severity, would significantly predict greater positive and negative e-cigarette expectancies, which was examined in two separate mediation models. Fatigue severity significantly explained, in part, the relation between emotion dysregulation and positive (b = 0.02, CI [0.01, 0.02]) and negative expectancies of e-cigarette use (b = 0.02, 95% CI [0.02, 0.03]). The current findings suggest that the experience of fatigue helps explain the relation between emotion dysregulation and positive and negative e-cigarette expectancies among adult e-cigarette users. Future work is needed to explicate how reducing fatigue severity in the context of emotion dysregulation may change expectancies about e-cigarette expectancies.

Development of a Self-Help Smoking Cessation Intervention for Dual Users of Tobacco Cigarettes and E-Cigarettes

Most users of electronic cigarettes (e-cigarettes) report initiating use to quit combustible cigarettes. Nevertheless, high levels of dual use (i.e., using both combustible cigarettes and e-cigarettes) occur among adults. Using formative data from in-depth interviews and employing learner verification, we adapted an existing, validated self-help smoking-cessation intervention (Stop Smoking for Good; SSFG) to create a targeted intervention for dual users, If You Vape: A Guide to Quitting Smoking (IYV). In Phase I, in-depth interviews (n = 28) were conducted to assess relevance of the existing SSFG materials (10 booklets, nine pamphlets) and identify new content for the booklets. Next, for Phase II, learner verification interviews (n = 20 dual users) were conducted to assess their appeal and acceptability. Several key themes emerged from the Phase I in-depth interviews. Findings led to the inclusion of e-cigarette-specific strategies used by successful quitters such as gradually reducing nicotine levels, switching from tobacco flavor to alternative flavors, and limiting e-cigarette use to places one would normally smoke (i.e., not expanding use). Suggestions from Phase II learner verification included broadening the visual appeal for a younger, more diverse demographic, expanding tips for quitting smoking via e-cigarettes, and expanding terminology for e-cigarette devices. Beginning with an efficacious self-help intervention, we used a systematic process to develop a version specifically for dual users.

Associations Between Peer Use, Costs and Benefits, Self-Efficacy, and Adolescent E-cigarette Use

OBJECTIVE

Prior research identified peer use as a salient risk factor of adolescent electronic cigarette (e-cigarette) use, but has not expanded on the mechanisms of this association.

METHODS

Participants were 562 adolescents recruited from rural and suburban public high schools and an adolescent medicine clinic in the mid-Atlantic United States. Participants completed a packet of questionnaires that assessed demographics, substance use, expectations about the consequences of e-cigarette use, and perceptions of their own self-efficacy to resist using e-cigarettes. We estimated a series of mediation models using the MODEL INDIRECT command in MPLUS statistical software. In all models, significance of indirect effects from peer e-cigarette use to self-reported e-cigarette use were tested via two variables: (a) expected costs, (b) benefits of e-cigarette use, and (c) the perceived self-efficacy of the individual to refrain from e-cigarette use.

RESULTS

Adolescents with more peers using e-cigarettes were more likely to have ever used an e-cigarette and perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 1). Those with more peers using e-cigarettes were more likely to be currently using e-cigarettes themselves because they perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 2).

CONCLUSION

Peer use, self-efficacy to resist use, and expectations of cost and benefits of e-cigarette use should be considered as possible targets when devising tailored interventions and policies to prevent or reduce negative health consequences of long-term e-cigarette use.

Social media's influence on e-cigarette use onset and escalation among young adults: What beliefs mediate the effects?

As an extension of a previous cross-sectional study, this study employed prospective data to test positive outcome expectancy beliefs as mediators of social media's influence on e-cigarette use progression among young adults. Self-report data were collected from 2327 young adult college students (Mean age = 21.2; SD = 2.1; 54% women) between 2017 and 2019, every 6-month, at 3 time-points. Structural equation modeling was used to test the mediational models. Among baseline never e-cigarette users, higher affect regulation expectancies-e.g., beliefs that e-cigarette use results in feeling good, reduced boredom and stress-mediated the effects of higher baseline social media e-cigarette exposure on e-cigarette use onset one year later. Among baseline lifetime e-cigarette users, higher positive sensory, positive "smoking" experience, and affect regulation expectancy beliefs mediated the effects of higher social media e-cigarette exposure at baseline on increased current e-cigarette use one year later. E-cigarette content on social media may persuade young adults to try e-cigarettes by imparting the sense that e-cigarettes make one feel good and help reduce stress. E-cigarette content on social media that promote e-cigarette flavors and e-cigarettes as cleaner and a socially more acceptable alternative to cigarettes may work to escalate e-cigarette use among experimenters. Efforts to prevent e-cigarette use onset and escalation may need to target the outcome expectancy beliefs influenced by social media.

Exploring positive expectancies and quit status among adult electronic cigarette users

Initial research on electronic cigarette (e-cigarette) use suggests differences exist in levels of use, beliefs, and cessation difficulties among users. However, little research has explored how these factors interact to confer worse e-cigarette outcomes. The current study examined the association between positive expectancies of e-cigarette use and e-cigarette processes among 544 (51.1% female; M_age = 35.4 years, SD = 10.12) adult e-cigarette users who had and had not attempted to quit e-cigarettes, a defining characteristic believed to distinguish those with and without greater e-cigarette quit difficulty. Results indicated that greater positive outcome expectancies of e-cigarette use were significantly related to increased perceived risks, benefits, and barriers to quitting. The strength of the associations was stronger for those who reported past quit attempts compared to those who never attempted quitting. Overall, the current study highlights the potentially important role that positive expectancies for e-cigarette use and quit attempt status play in e-cigarette processes. Findings suggest a possible need to contextualize positive expectancies for e-cigarette use within future e-cigarette cessation tactics and tailoring treatments based on quit attempt status.

Perceptions of Smoking and Vaping on Weight Control Among Adult American Indians Who Smoke

Interest in electronic cigarette (EC) use, or vaping, to help control weight is increasing. Many American Indian (AI) populations have a high prevalence of smoking, obesity, and EC use, but their perceptions of EC use for weight control are unknown. In Oklahoma in 2016, 375 AI adults who smoke completed a survey including perceptions about smoking and EC effects on weight control. Only 24% believed that smoking helps control weight, and 8% believed that vaping helps control weight. Perceptions differed by EC use, with ever users more often than never users perceiving that smoking (30% vs 12%, respectively; p < .01) and vaping (10% vs 5%; p = .04) help to control weight. Sex, age group (18-44 years vs 45 + years), education (high school graduate/equivalent vs less than high school), smoking cessation attempt in past year, and likelihood to quit in 6 months were not associated with weight control perceptions for either smoking or vaping. Uncertainty regarding EC effects on weight control was less common among EC ever users compared to never users (41% vs 53%, respectively; p = .04). Most people who did not believe or were uncertain that smoking controls weight also did not believe or were uncertain that vaping controls weight. However, only a minority (29%) of people who believed smoking controls weight also believed that vaping controls weight. Among adult AI who smoke, both smoking and vaping were infrequently perceived as helping to control weight, but such perceptions were reported more frequently among those who ever used ECs.

A preliminary validation of the adolescent e-cigarette consequences questionnaire

INTRODUCTION

Given the recent dramatic increase among adolescents in the use of electronic nicotine delivery systems (ENDS) or electronic cigarettes (e-cigarettes), there is a growing need to identify outcome expectancies that influence the initiation or continued use of e-cigarettes. While a self-report measure exists for assessing adolescent outcome expectancies for cigarette use, there is currently not one available for e-cigarette use. Validation and use of such a measure would provide insight into the growing popularity of e-cigarettes.

METHODS

The sample consisted of 264 (50.76 % female, 86.36 % White, 84.47 % Hispanic/Latinx) freshmen and sophomores from South Florida high schools who were identified as at-risk for e-cigarette use. The current study adapted the Adolescent Smoking Consequences Questionnaire (ASCQ) to derive the Adolescent E-Cigarette Consequences Questionnaire (AECQ) to characterize e-cigarette outcome expectancies. A confirmatory factor analysis was estimated to test the underlying factor structure.

RESULTS

The confirmatory factor analysis provided support for a seven-factor structure (negative affect reduction, taste/sensorimotor manipulation, social facilitation, weight control, negative physical feelings, boredom reduction, and negative social impression) after removing two items with low factor loadings from the social facilitation subscale. After removing these items, factor loadings ranged from 0.46 to 0.86.

CONCLUSION

The current study provides preliminary evidence to suggest that the Adolescent E-Cigarette Consequences Questionnaire is a psychometrically sound measure. Future work should continue to test this measure among diverse samples of adolescents (e.g., non-Latinx samples) with varying levels of use.

Positive Expectancies for E-Cigarette Use and Anxiety Sensitivity Among Adults

INTRODUCTION

Although e-cigarette use is on the rise among youth and adults, there is little understanding of the individual difference factors at a cognitive level of analysis for e-cigarette beliefs and quit behavior.

METHOD

The present investigation sought to test a theoretically driven interactive model of positive expectancies for e-cigarettes and anxiety sensitivity (fear of the consequences of anxiety) among 551 adult e-cigarette users (50.6% female, Mage = 35.2 years, SD = 10.1).

RESULTS

Results indicated a significant interaction between positive expectancies for e-cigarette use and AS was significantly related to greater perceived benefits of e-cigarette use, greater perceived risk of e-cigarette use, and more serious attempts for trying to quit e-cigarettes. The significant interaction effect for each dependent variable was evident over and above the main effects as well as the covariates of sex, income, education, and concurrent combustible cigarette use. The form of this interaction indicated that e-cigarette users higher in AS who also maintained more positive outcome expectancies for e-cigarette use reported more perceived benefits as well as more perceived risk of e-cigarette use and engaged in more (failed) attempts to quit e-cigarettes.

CONCLUSIONS

Overall, the current data suggest that individual differences in AS and positive expectancies may represent two important factors to consider in e-cigarette beliefs and quit attempts.

IMPLICATIONS

This study provides the first empirical evidence of a transdiagnostic construct (anxiety sensitivity) in relation to e-cigarette use and how it interplays with positive expectancies for e-cigarette use beliefs and behavior. These novel data suggest that future clinical research may benefit by understanding the potential therapeutic role of anxiety sensitivity and expectancies for e-cigarette use behavior.

How Does Smoking and Nicotine Dependence Change After Onset of Vaping? A Retrospective Analysis of Dual Users

INTRODUCTION

Although some smokers switch to exclusive use of electronic cigarettes (e-cigarettes), others become dual users of combustible cigarettes and e-cigarettes. Little is known about how the onset of vaping affects the use of and dependence on combustible cigarettes or total nicotine use and dependence, which may influence health-related and cessation outcomes. Using self-report data of current combustible and e-cigarette use and retrospective recall of pre-vaping smoking in a sample of dual users, the aims of this study were (1) to compare pre- and post-vaping number of cigarettes per day and combustible cigarette dependence; (2) to compare pre- and post-vaping total nicotine use frequency (number of vaping sessions and cigarettes smoked per day), and total nicotine dependence; and (3) to examine predictors of nicotine dependence.

METHODS

We used baseline data from a smoking cessation trial with 2896 dual users. Nicotine use frequency and the Heaviness of Smoking Index were used as measures of nicotine use and dependence, respectively.

RESULTS

Participants decreased cigarettes/day from pre- (M = 19.24, SD = 9.01) to post-vaping (M = 11.15, SD = 8.02, p < .0001) and combustible cigarette dependence declined from pre- (M = 3.55, SD = 1.51) to post-vaping (M = 2.11, SD = 1.60, p < .0001). Total daily nicotine use frequency increased after initiating vaping (M = 19.25, SD = 9.01 vs. M = 29.46, SD = 8.61; p < .0001), as did total nicotine dependence (M = 3.55, SD = 1.51 vs. M = 4.68, SD = 1.38; p < .0001). Hierarchical regression analyses indicated that variables associated with greater overall nicotine dependence included: younger age, lower education, more years smoking, higher pre-vaping nicotine dependence, using e-cigarettes more days per month, more puffs per vaping session, higher e-liquid nicotine concentration, and longer vaping history.

CONCLUSIONS

Dual use leads to a reduction in the number of combustible cigarettes, but total nicotine use and dependence increases.

IMPLICATIONS

In dual users, a reduction in smoking following onset of vaping may offer some harm reduction via reduction in cigarette intake. However, the increase in total nicotine use and dependence could affect the ability to quit either or both products.

Measurement of Electronic Cigarette Frequency of Use Among Smokers Participating in a Randomized Controlled Trial

BACKGROUND

The United States Food and Drug Administration has prioritized understanding the dependence potential of electronic cigarettes (e-cigs). Dependence is often estimated in part by examining frequency of use; however measures of e-cig use are not well developed because of varying product types. This study used an e-cig automatic puff counter to evaluate the value of self-reported e-cig use measures in predicting actual use (puffs).

METHODS

Data were collected from a two-site randomized placebo-controlled trial evaluating the effects of e-cigs on toxicant exposure in smokers attempting to reduce their cigarette consumption. Participants randomized to an e-cig condition self-reported their e-cig frequency of use (times per day-one "time" consists of around 15 puffs or lasts around 10 minutes) on the Penn State Electronic Cigarette Dependence Index (PSECDI) and kept daily diary records of the number of puffs per day from the e-cig automatic puff counter. A linear mixed-effects model was used to determine the predictive value of the times per day measure. Correlations were used to further investigate the relationship.

RESULTS

A total of 259 participants with 1165 observations of e-cig use were analyzed. Self-reported e-cig use in times per day was a significant predictor of e-cig puffs per day (p < .01). The Spearman correlation between measures was r equal to .58. Examination of individual participant responses revealed some potential difficulties reporting and interpreting times per day because of the difference in use patterns between cigarettes and e-cigs.

CONCLUSION

This study provides evidence that the self-reported PSECDI measure of times per day is a significant predictor of actual frequency of e-cig puffs taken.

IMPLICATIONS

Self-reported measures of e-cig frequency of use are predictive of actual use, but quantifying e-cig use in patterns similar to cigarettes is problematic.

Perception of E-cigarette Use among Adult Users in China: A Mixed-method Study

The use of electronic cigarettes (ECs) is increasing rapidly in China, but the perception of these products and their health impact among Chinese users have received little research attention. This study collected semi-structured in-depth interview data from experienced adult EC (including heated tobacco products also named ECs on the Chinese market) users in the Shanghai area. The subjects were recruited from those who participated in a previous online survey on EC use. A thematic narrative approach was used to analyze the data. Thirty current EC users were interviewed for evaluation of their perception of EC use in a variety of categories, including reasons for using, concerns, social acceptance, satisfaction, and health impacts. Participants' common reasons for using ECs were the ease of use and carrying, hygiene, no fire hazard, reduced smoke exposure, aiding quitting smoking, reduced health hazard, palatable flavor, being fashionable, and substituting cigarettes in non-smoking areas. Most (90%; 27/30) participants reduced (77%) or quit smoking (13%) after using ECs, and 80% were willing to recommend these products to others. Most (90%) of the participants reportedly noticed positive health changes after using ECs. Regulatory concerns were expressed by 33% participants. Participants predominately viewed ECs as a viable substitute for smoking, with substantial effects on tobacco harm reduction. These findings lend support to EC use as a promising opportunity for public health promotion in China through engaging smokers in smoking cessation attempts. However, overall public health benefits/risks of EC use, and its regulatory affairs need to be considered.

Young adult e-cigarette users: perceptions of stress, body image, and weight control

OBJECTIVE

With the rise in electronic cigarette (ENDS) use among US young adults, more research is needed on expectations for use and perceptions related to body image, weight control, and stress relief.

METHODS

College students (N = 230; modal age 21 years; 68% female) completed an online survey assessing cigarette smoking and ENDS, dieting and body image, perceptions about flavors, stress, weight gain prevention, and appetite regulation.

SAMPLE CHARACTERISTICS

Dual use (cigarette and ENDS) was reported by n = 69 (30.0%). Exclusive cigarette smoking was endorsed by n = 53 (23%) with exclusive ENDS use reported by n = 15 (6.5%). Ninety-three participants (40.5%) reported not using either product.

RESULTS

Among those using ENDS, < 33% reported using as a stress management tool, < 15% reported using ENDS to control appetite, and > 70% reported using cartridges that tasked like sweets. There was a positive correlation between dieting behaviors and body concern, suggesting those who reported higher use of ENDS for weight and appetite regulation also had higher pathological eating scores and concern over body shape and size.

CONCLUSION

Prevention and education related to weight, body image, and tobacco are needed to address misperceptions of tobacco products.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Nicotine or expectancies? Using the balanced-placebo design to test immediate outcomes of vaping

INTRODUCTION

Electronic (e-)cigarette use has increased in popularity, especially among those attempting to quit smoking. Previous studies evaluating the therapeutic efficacy of e-cigarettes have suggested that non-pharmacologic factors, such as expectancies about nicotine effects, may influence the experienced effects of e-cigarettes.

METHOD

The independent and synergistic influences of drug and expectancies were parsed using a balanced-placebo design, whereby 128 participants (52 dual users) were provided an e-cigarette that either contained nicotine or non-nicotine solution, while told that it did or did not contain nicotine. We hypothesized main effects of nicotine content on physiological, objective outcomes (attention, appetite, aversion, respiratory tract sensations), and main effects of the instructions on more subjective, psychosocial outcomes (affect, reward, satisfaction). Sex was included as a moderator.

RESULTS

Results showed that nicotine increased sustained attention, and more so among females. Nicotine delivery was associated with aversion among females, but not males. Among those who were both told and did not receive nicotine, higher enjoyment of respiratory tract sensations was reported. Nicotine with complementary instructions produced the highest reward ratings; additionally, nicotine was rewarding to males but not females.

DISCUSSION

Findings demonstrated that both nicotine content and non-pharmacologic factors impact acute outcome effects of e-cigarettes, with moderation by sex in some cases. Results are relevant to the interpretation of clinical trials of e-cigarettes and suggest a more nuanced view of reinforcement pathways.

Vaping Expectancies: A Qualitative Study among Young Adult Nonusers, Smokers, Vapers, and Dual Users

BACKGROUND

"Expectancies," or beliefs about outcomes, robustly correlate with and predict several behaviors including electronic nicotine delivery system ("e-cigarette") use. However, there is limited qualitative research available regarding relevant e-cigarette vaping expectancies.

OBJECTIVES

The present study used a qualitative approach to derive and refine e-cigarette expectancy themes among young adults.

METHODS

We conducted 12 focus groups and two individual interviews with young adult nonusers, e-cigarette vapers, cigarette smokers, and dual users to assess beliefs about the effects of e-cigarettes. After a series of open-ended questions, follow-up questions assessed reactions to domains previously examined in expectancy measures for cigarette smoking and e-cigarette vaping. The constant comparative method was used to derive themes from transcripts.

RESULTS

Four main themes (Positive Reinforcement, Social Benefits, Negative Affect Reduction, Negative Consequences) emerged from the results. Each theme contained three associated subthemes (Positive Reinforcement: Sensorimotor Experiences, Taste, Stimulation; Social Benefits: Social Facilitation, Influence on Others, Convenience; Negative Affect Reduction: Stress Reduction, Appetite Reduction, Boredom Reduction; and Negative Consequences: Health Risks, Addiction, Secondhand Effects).

CONCLUSIONS/IMPORTANCE

Previously identified smoking expectancies appear relevant for young adult vaping, with some notable refinements. Positive reinforcement aspects encompassed aerosol clouds, vaping tricks, and unique flavors. Social benefits included influencing others via social media and competitive activity, as well as the convenience of use in a variety of places. Negative affect reduction was controversial among user groups, but vaping was seen as more interesting than smoking and thus more effective at boredom reduction. Young adults were uncertain regarding negative consequences, but appreciated a potential for secondhand effects. Measure refinement via qualitative research and future field testing can enhance our understanding of this relatively new behavior, supporting tobacco control surveillance, marketing/labeling regulations, and counter-advertising development/evaluation.

How do electronic cigarettes affect cravings to smoke or vape? Parsing the influences of nicotine and expectancies using the balanced-placebo design

OBJECTIVE

Although electronic cigarettes (e-cigarettes) are frequently initiated for smoking cessation, results from the first two clinical trials testing this suggest that the perceived benefits of vaping may be influenced by non-nicotine factors, including cognitive outcome expectancies. The current study investigated the separate and combined effects of nicotine delivery and outcome expectancies on cravings for cigarettes and e-cigarettes using a balanced-placebo experiment.

METHOD

Drug dosage (contains nicotine or not) was crossed with instructional set (told nicotine or non-nicotine) during ad lib e-cigarette use sessions by 128 current e-cigarette users (52 identifying as current cigarette smokers or "dual users"). It was hypothesized that reduction in craving for both cigarettes and e-cigarettes following e-cigarette administration would be driven primarily by the instructional set manipulation, reflecting the influence of outcome expectancies.

RESULTS

As hypothesized, among dual users, a main effect of instructional set emerged on reductions in craving to smoke cigarettes, with participants who were told that their e-cigarette contained nicotine reporting greater craving reduction (p = .046). With respect to reduced cravings for e-cigarettes, we found an interaction between drug dose and instructional set (p = .02) such that nicotine e-cigarettes reduced cravings more than non-nicotine e-cigarettes only among participants told to expect nicotine.

CONCLUSIONS

Findings suggest that cognitive expectancies contribute to the acute effects of e-cigarettes on craving, which may provide guidance for their potential as smoking cessation aids. (PsycINFO Database Record

Vaping characteristics and expectancies are associated with smoking cessation propensity among dual users of combustible and electronic cigarettes

BACKGROUND AND AIMS

Most e-cigarette users who also smoke combustible cigarettes (dual users) begin vaping to quit smoking, yet only a subset succeeds. We hypothesized that reinforcing characteristics of e-cigarettes (vaping reinforcement) would positively predict smoking cessation propensity (SCP) among dual users.

DESIGN

Secondary analysis of cross-sectional baseline data from dual users in an ongoing smoking cessation trial. Exploratory and confirmatory factor analysis (EFA and CFA) created latent variables for vaping reinforcement and SCP. A structural equation modeling (SEM) approach was used to test the hypothesis.

SETTING

United States.

PARTICIPANTS

A national sample of dual users of combustible and electronic cigarettes who smoke and vape at least once per week (n = 2896) were enrolled (63% male; mean age = 29.9 years) into a randomized controlled trial in which they would receive either smoking cessation materials or no smoking cessation materials.

MEASUREMENTS

Vaping reinforcement was indexed by vaping frequency (days/week vaping, times/day vaping, puffs/e-cigarette use), e-cigarette characteristics [numbers of modifications and tobacco or non-tobacco flavors, nicotine content (mg) and positive e-cigarette expectancies]. SCP was measured by items of confidence, commitment to being smoke-free, cessation motivation (contemplation ladder), change in cigarettes per day since beginning e-cigarette use and negative smoking expectancies.

FINDINGS

Four factors emerged from the EFA: vaping propensity (vaping frequency, positive expectancies), vaping enthusiasm (e-cigarette modifications, using non-tobacco flavors, puffs per use), nicotine/tobacco flavor (nicotine strength, tobacco flavors) and SCP (negative expectancies about smoking, motivation to quit smoking, reduction in smoking). A CFA upheld the exploratory factor structure [root mean square error of approximation (RMSEA) = 0.046, CFI = 0.91]. An SEM with the three vaping latent variables directly predicting SCP had good model fit (RMSEA = 0.030, CFI = 0.97) with a positive relationship of vaping propensity (0.509, P < 0.001), and small negative relationships of vaping enthusiasm (-0.158, P = 0.014) and nicotine/tobacco flavor (-0.230, P < 0.001).

CONCLUSIONS

Among e-cigarette users who also smoke combustible cigarettes, frequent vaping combined with positive e-cigarette expectancies appears to predict greater smoking cessation propensity. However, vaping enthusiasm (measured by e-cigarette modifications, using non-tobacco flavors and puffs per use), higher nicotine content and use of tobacco flavored solution may reduce cessation propensity.

Development and psychometric validation of a novel measure of sensory expectancies associated with E-cigarette use

INTRODUCTION

E-cigarette dependence measures largely focus on e-cigarette use ("vaping") that is linked to nicotine use, and measures assessing sensory aspects of vaping that may influence use (e.g., taste) are limited in scope. Thus, we developed the novel Sensory E-cigarette Expectancies Scale (SEES).

METHODS

In Summer 2017, 610 adult e-cigarette users (48.7% male, 84.9% White, 37.41[±12.15] years old) completed an online survey that included 23 SEES items. Psychometric analyses included evaluating latent structure, internal consistency, measurement invariance, mean differences, and test-criterion relationships.

RESULTS

Factor analyses supported a 9-item, 3-subscale structure (taste/smell, pleasure/satisfaction, vapor cloud production). Subscales evidenced internal consistency and scalar invariance by sex, race, smoking status (current/not), vaping status (daily/not), e-liquid nicotine content (yes/no), and device type (cig-a-likes/vape-pens/Advanced Personal Vaporizers [APVs]/Mods). Women and daily e-cigarette users reported stronger SEEs for taste/smell and pleasure than their counterparts. Non-white participants reported stronger SEEs for cloud production than White participants. Cig-a-like users reported the weakest SEEs for taste/smell and weaker SEEs linked to cloud production than APV/mod users. SEES scores evidenced convergence with nicotine dependence (mean r = .36). Finally, SEES scores predicted vaping frequency and habitual vaping concurrently and incrementally beyond nicotine dependence.

CONCLUSIONS

The SEES evidenced good psychometric properties, suggesting that the measure can be used to assess sensory vaping expectancies in adults. Importantly, SEES scores indicated that sensory expectancies are related, yet distinct, from nicotine dependence. Future research should evaluate how SEEs relate to product characteristic preferences and patterns of vaping including the development and maintenance of addiction.

An introduction to the electronic waterpipe

Despite the associated negative health outcomes, waterpipe smoking remains a popular method of tobacco consumption, specifically in young adults. While there have been expanding efforts to decrease waterpipe use, there is a new, non-combustible waterpipe device on the market, the electronic waterpipe (e-waterpipe), that could serve as an alternative to traditional, combustible waterpipe smoking. There is currently no known literature evaluating the e-waterpipe including prevalence of use or its health risks. This mini review defines the e-waterpipe, explains how an e-head is used to construct an e-waterpipe, and describes the various e-head models available for use. The review also discusses implications of e-head use and provides recommendations for future research and regulation.

Electronic cigarettes: a task force report from the European Respiratory Society

There is a marked increase in the development and use of electronic nicotine delivery systems or electronic cigarettes (ECIGs). This statement covers electronic cigarettes (ECIGs), defined as "electrical devices that generate an aerosol from a liquid" and thus excludes devices that contain tobacco. Database searches identified published articles that were used to summarise the current knowledge on the epidemiology of ECIG use; their ingredients and accompanied health effects; second-hand exposure; use of ECIGs for smoking cessation; behavioural aspects of ECIGs and social impact; in vitro and animal studies; and user perspectives.ECIG aerosol contains potentially toxic chemicals. As compared to conventional cigarettes, these are fewer and generally in lower concentrations. Second-hand exposures to ECIG chemicals may represent a potential risk, especially to vulnerable populations. There is not enough scientific evidence to support ECIGs as an aid to smoking cessation due to a lack of controlled trials, including those that compare ECIGs with licenced stop-smoking treatments. So far, there are conflicting data that use of ECIGs results in a renormalisation of smoking behaviour or for the gateway hypothesis. Experiments in cell cultures and animal studies show that ECIGs can have multiple negative effects. The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Based on current knowledge, negative health effects cannot be ruled out.

E-Cigarette Outcome Expectancies among Nationally Representative Samples of Adolescents and Young Adults

Objectives: We conducted nationally representative surveys of adolescents and young adults to examine associations between e-cigarette outcome expectancies and e-cigarette use. Background: E-cigarette use among adolescents and young adults has grown rapidly in recent years, yet little research has examined the beliefs that may underlie this behavior among nationally representative samples. Methods:N = 1,298 adolescents (13-17) and 2,219 young adults (18-25) were surveyed using a probability-based web panel. Participants completed a survey that included a new outcome expectancy measure examining 3 positive (enjoyment, social influences, advantage over cigarettes) and 2 negative (health concerns, smoker association) expectancy domains and ever having used e-cigarettes [ever use]. Results: Confirmatory factor analyses demonstrated a good fit of the outcome expectancies' factor structure to the data. All outcome expectancies were associated with e-cigarette use in both populations in univariate analyses. In multiple logistic regression models controlling for several covariates, higher expected enjoyment was positively associated with a greater likelihood of e-cigarette use (aOR = 2.10, p < .05) among adolescents. Among young adults, enjoyment (aOR = 3.08, p < .001) was positively associated with a greater likelihood of use while both health concerns (aOR = 0.70, p < .01) and smoker association (aOR = 0.73, p < .05) were negatively associated with e-cigarette use. Conclusions: This study suggests that expected enjoyment is robustly associated with e-cigarette use among both adolescents and young adults. Health concerns may also play a role in e-cigarette use. Implications for e-cigarette prevention efforts and future research directions are discussed.

To "vape" or smoke? Experimental evidence on adult smokers

A growing share of the United States population uses e-cigarettes but the optimal regulation of these controversial products remains an open question. We conduct a discrete choice experiment to investigate how adult tobacco cigarette smokers' demand for e-cigarettes and tobacco cigarettes varies by four attributes: (i) whether e-cigarettes are considered healthier than tobacco cigarettes, (ii) the effectiveness of e-cigarettes as a cessation device, (iii) bans on use in public places, and (iv) price. We find that adult smokers' demand for e-cigarettes is motivated more by health concerns than by the desire to avoid smoking bans or higher prices.

Whether to push or pull? Nicotine reduction and non-combusted alternatives - Two strategies for reducing smoking and improving public health

Combustible cigarettes remain the most harmful and addictive tobacco product, and reducing the prevalence of smoking continues to be a critical public health goal. While nicotine is the constituent primarily responsible for addiction to cigarettes, most of the harm associated with smoking comes from byproducts of tobacco combustion. Recently, two different approaches for reducing the harms of smoking have emerged, both of which focus on breaking the link between the addiction to nicotine and the harms caused by smoking. First, the addictive potential of cigarettes could be minimized by requiring a large reduction in the nicotine content of cigarettes. Evidence for a nicotine reduction policy thus far shows that the use of very low nicotine content cigarettes results in a reduction in the number of cigarettes people smoke per day and a reduction in cigarette dependence. Second, emerging alternative nicotine delivery systems (ANDS) like electronic cigarettes may provide sufficient nicotine to act as substitutes for cigarettes while delivering much lower levels of toxicants. Evidence suggests that the emergence of ANDS has increased the percentage of smokers who are able to quit. The present paper will briefly review the evidence for each of these approaches, and consider what contemporary reinforcement and addiction theories can tell us about their likely success. We argue that the most effective endgame approach is one that pursues both nicotine reduction and alternative nicotine delivery systems as complementary.

The influence of three e-cigarette models on indoor fine and ultrafine particulate matter concentrations under real-world conditions

Electronic cigarette (e-cigarette) use has steadily increased since 2010. Indoor e-cigarette use exposes bystanders to a new source of particulate matter (PM) air pollution. Elevated short-term exposures to PM with a lower measuremented aerodynamic diameter (≤2.5 μm), PM_2.5 and ultrafine particles (UFPs) have been linked to increased risk of adverse respiratory and cardiac events. This exposure study estimated concentrations of PM_2.5 and UFPs from indoor e-cigarette use at 0.5 meters (m) and 1 m away from an e-cigarette user and investigated whether these indoor concentrations varied across three common e-cigarette models. One e-cigarette user tested three different e-cigarettes containing the same nicotine solution on three separate occasions and measured concentrations on PM_2.5 and UFPs at 0.5 and 1 m in a ∼38 m³ office. Continuous measures of PM_2.5 and UFPs were taken for 5.5 min before e-cigarette use, then the user puffed seven times for 6.5 min (exposure), and for 10 min after ceasing e-cigarette use. Following the initiation of e-cigarette use, levels of PM_2.5 increased 160-fold at a distance of 0.5 m, and 103-fold at 1 m. The corresponding increases in UFP counts were 5.2, and 3.0-fold higher, respectively. The PM_2.5 concentrations and UFP counts between e-cigarette models were statistically significantly different at 1 m, but not at 0.5 m. There was substantial variability between distances, e-cigarettes, and replicates. This study indicates that e-cigarette vapors influence PM_2.5 and UFPs concentrations/counts at close proximity distances indoors; additional research is needed to characterize the composition of those particles and evaluate the impacts of other e-cigarette solutions on indoor air quality.

Alcohol, tobacco, and marijuana expectancies as predictors of substance use initiation in adolescence: A longitudinal examination

Outcome expectancies have been found to be predictive of substance use. While development of expectancies may be dynamic during adolescence, it is unknown whether the rate of change (slope) in substance use expectancies is a risk factor for use onset across multiple substance use domains. The present study tested the hypothesis that the slope of positive and negative alcohol, tobacco, and marijuana use expectancies during mid-adolescence (9th-10th grade) would predict use onset of each respective substance during late adolescence (11th-12th grade). Data from 3,396 ethnically diverse high school students were collected across eight waves of assessment and analyzed within a latent growth modeling framework. Results revealed that the slopes of positive substance use expectancies among never-users of each respective substance predicted increased odds of onset (Alcohol: ORB = 7.73, p < .001; Tobacco: ORB = 5.58, p < .001; Marijuana: ORB = 2.49, p = .001). Only the slope of negative marijuana expectancies predicted increased odds of onset (Marijuana: ORB = .44, p = .04). Baseline level of positive and negative substance use outcome expectancies were also generally found to be associated with onset. For three common drugs used by adolescents, change in substance use expectancies during the first two years of high school may be a marker of risk propensity for substance use onset. Change in expectancies may be an important target in substance use prevention, with research indicating that expectancy challenge and life skills interventions being potentially efficacious. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Worry, anxiety sensitivity, and electronic cigarettes among adults

Although electronic cigarette (e-cigarette) use is now a common substance use behavior, there is little understanding of the individual difference factors related to e-cigarette use beliefs and dependence. The present investigation sought to test a theoretically-driven model of anxiety sensitivity as an explanatory element in a worry-e-cigarette beliefs and dependence model. Participants included 558 adult e-cigarette users (51.4% female; 35.2 years, SD = 10.1) who were nationally recruited via an online survey system. Participants completed a single survey that assessed their mood and e-cigarette behavior and beliefs. Results supported a statistically significant indirect pathway for worry in relation to perceived benefits of e-cigarettes, e-cigarette positive outcome expectancies, and e-cigarette dependence via anxiety sensitivity; effect sizes were small. The indirect effects were evident when accounting for several theoretically relevant covariates (sex, income, education, concurrent cigarette use, and neuroticism). This study provides the first empirical evidence of the role of anxiety sensitivity in the relation between worry and e-cigarette use beliefs and behavior, which may represent a novel intervention target.