Knowledge and Beliefs About E-Cigarettes in Straight-to-Work Young Adults

Interpersonal communication and perceived norms as social influence mechanisms of e-cigarette use among adults: a systematic review

Background: Given the increasing popularity of e-cigarette use among adults and the ongoing debate about the benefits and the potential adverse health risks associated with e-cigarette use, it is critical to identify the correlates of e-cigarette use. Prior research has found associations between interpersonal communication, perceived norms, and adults' e-cigarette use, but the evidence has yet to be summarized and synthesized.Objectives: This paper reviewed empirical studies examining the relationship between interpersonal communication, perceived norms, and e-cigarette use among adults.Methods: Following PRISMA guidelines, articles were searched on DOAJ, EMBASE, Europe PubMed Central, Google Scholar, PsychINFO, PubMed, Web of Science, and the reference list of the retrieved studies for studies that examined social influence on e-cigarette use. Three reviewers independently screened 1,713 non-duplicate papers and further screened the full text of 195 articles for inclusion.Results: Thirty studies (30), consisting of quantitative (n = 25) and qualitative (n = 5) data, were included in this review. The twenty-five (25) quantitative studies consisted of both cross-sectional (n = 20) and longitudinal (n = 5) studies. Interpersonal communication portraying e-cigarettes as beneficial or harmful was found to increase e-cigarette use and quit attempts, respectively. Across study designs, greater perceptions of others' e-cigarette use or approval were related to more frequent e-cigarette use.Conclusions: The findings highlight that e-cigarette-related interpersonal communication and perceived norms are associated with e-cigarette use. These factors may be useful targets in brief interventions. However, most of the included studies were cross-sectional, limiting the ability to establish clear cause-and-effect relationships; therefore, more longitudinal studies are needed.

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

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

Examination of Tobacco-Related Messaging and Tobacco Use over Time among U.S. Military Young Adults

Background: People from minoritized populations have historically been targeted by tobacco companies. Little is known about exposure to tobacco-related messages among military personnel from disadvantaged backgrounds. Objectives: The current study aimed to examine exposure to tobacco-related messaging across many nicotine products and through a variety of mediums (i.e., family, friends, advertisements, event promotions, social media) among diverse military populations and use one year later in a sample of young adults who recently enlisted in the U.S. Air Force. Methods: In this study, 8,901 U.S. Air Force trainees reported on demographics, tobacco use, and exposure to positive tobacco messages from social sources (i.e., friends, family, social media) and environmental sources (i.e., advertisements and promotions). Tobacco use was reported one-year later. Results: Compared to others of the same reported racial/ethnic background, Latino/a/x (Relative Risk Ratio [RRR] = 1.354, 95% CI: [1.145, 1.563]) and multiracial (RRR = 1.594, 95% CI: [1.173, 2.016]) participants who were exposed to positive tobacco messages from social sources were significantly more likely to report tobacco product use at one-year follow-up than those who were not exposed to social messages. Exposure to positive tobacco messages from environmental sources were not significantly associated with tobacco use one year later. Conclusions: Social messages may play an important role in increasing risk of tobacco use among some minoritized populations. Cultural as well as systemic factors could be addressed in future tobacco prevention programs to decrease the potency of positive tobacco-related social messages among Latino/a/x and multiracial communities.

College Student E-Cigarette Users' Knowledge about E-Cigarettes: Ingredients, Health Risks, Device Modifications, and Information Sources

Although college students represent a growing demographic of e-cigarette users, it is unclear how knowledgeable they are about the product they use. The lack of such knowledge could result in unsafe practices and greater health risks. Therefore, the purpose of the current study was to examine college student e-cigarette users’ knowledge about e-cigarette ingredients and health risks, how often they modify their devices, and whether they utilize reputable sources when searching for information regarding e-cigarettes. The participants were 183 undergraduate e-cigarette users (M_age = 19.98, SD = 1.98; 71.6% female; 85.8% White). Most participants correctly recognized that e-cigarettes increase the risk of cardiovascular disease and lung disease, but fewer than half recognized the increased risk of seizures and depression. Only one-third to one-half of participants correctly identified the toxic compounds commonly found in e-cigarettes, and most indicated that they would consult Google or a friend with questions about e-cigarettes. College student e-cigarette users are well-informed about many health risks associated with e-cigarettes. However, they are relatively unaware of the harmful substances in e-cigarettes and are seeking information from less reliable sources. Targeted public health campaigns educating college students about e-cigarettes, including where to seek reliable information, are needed.

Social connections influencing e-cigarette use and intentions in Australia: a survey

Social factors play a role in e-cigarette uptake, but Australian evidence is limited. This study evaluated associations between social factors and e-cigarette intention and use.

Australian participants surveyed between March 2019 and July 2019 using a cross-sectional survey design, measuring e-cigarette intentions and use, and factors including smoking status and social acceptability.

Of 243 respondents, 185 were included in the final analysis, measuring e-cigarette intention and use, and factors including smoking status and social acceptability. Of 185 participants, daily, occasional, and ex-smokers (123 participants) were more likely to have used e-cigarettes (OR = 9.33; 95% CI 4.63-18.80) or intend to use e-cigarettes (OR = 4.86; 95% CI 2.32-10.21), relative to nonsmokers (62 participants). Participants reporting acceptability among people they study or work with (70 participants) were more likely to have used e-cigarettes relative to the reference group (OR = 16.76; 95% CI 3.70-75.83; p = 0.001) and were more likely report intending to use e-cigarettes relative to the reference group (OR = 3.40; 95%CI 1.58-7.30; p = 0.002).

With caveats related to the survey participant composition, the results suggest that places of work or study may be an appropriate place to consider interventions aimed at reducing e-cigarette uptake among nonsmokers.

Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk

BACKGROUND

The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication.

OBJECTIVE

Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges.

METHODS

With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7).

RESULTS

A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003).

CONCLUSIONS

In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/10977.

"That's the whole thing about vaping, it's custom tasty goodness": a meta-ethnography of young adults' perceptions and experiences of e-cigarette use

Background

E-cigarettes are increasing in popularity, particularly among young adults. With public health organisations contesting the possible benefits of e-cigarettes, research is required to explore young adults’ use of e-cigarettes as a smoking cessation and recreational tool. This study examined existing qualitative data to understand how transition into adulthood and issues of identity affect young adults’ perceptions and experiences of e-cigarette use.

Methods

A meta-ethnography was conducted to examine how young adults perceive and use e-cigarettes. Data were synthesised using Noblit and Hare’s (1988) meta-ethnographic approach. Bronfenbrenner’s socio-ecological model (1979) was used to conceptualise themes and map findings.

Results

A total of 34 studies were included in the review. Young adults viewed e-cigarettes as a safer alternative to traditional cigarette smoking and perceived e-cigarettes as an effective cessation tool. Users were able to personalise their e-cigarette use due to the variety of flavours and devices available. E-cigarettes were found to be a sociable tool as they allowed users to align themselves with their peers who used e-cigarettes and facilitated use within smoke-free environments. Young adults demonstrated high levels of self-efficacy with regards to obtaining e-cigarettes from various retailers and were active consumers of e-cigarette marketing.

Conclusion

This meta-ethnography provides an in-depth insight into social norms around e-cigarette use and beliefs that e-cigarettes could be a safer alternative to traditional cigarettes. As young adults increasingly engage with e-cigarettes, there is a need for informed policy decisions regarding appropriate use. Engagement with e-cigarettes is often reflected within social media, so this medium could be a key platform for creating tailored interventions which inform young adults about the appropriate use of these products.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-021-00416-4.

Smoking Behaviors of General Educational Development (GED) Recipients

OBJECTIVE

Cigarette smoking is inversely associated with education, and despite this gradient effect, individuals with a General Educational Development (GED) diploma, obtained through a high school equivalency test, have the highest smoking prevalence. Considered the high school equivalency credential, it is unclear why individuals with a GED have a substantially higher smoking prevalence compared to high school graduates and dropouts. We conducted a qualitative study to understand life experiences, tobacco use patterns, and perceptions of tobacco among GED smokers and attitudes and behaviors around smoking cessation.

METHODS

We recruited 40 GED smokers aged 18 to 35 years and conducted surveys and semi-structured individual interviews. Transcripts were independently coded, then coding differences were resolved and reviewed by a third team member. We independently determined themes within and between codes and met to determine final themes.

RESULTS

GED recipients had many early life experiences and characteristics that made them highly vulnerable to tobacco dependence. With perceived high cognitive abilities, GED smokers were knowledgeable of many evidence-based smoking cessation strategies and were aware of health risks. Health risks and the financial burden of smoking were motivation to quit. The majority were uninterested or lacked confidence that nicotine replacement therapy, medications, counseling, or the quitline could help them quit. Nearly all were enthusiastic and confident that financial incentives had the potential to help them quit.

CONCLUSIONS

Research is needed to determine whether financial incentives could improve smoking cessation outcomes in this unique population with an unequal burden of smoking.

Electronic cigarette survey characteristics

Introduction

Electronic cigarettes (EC) remain a controversial topic with uncertainty about harm reduction in current smokers, their efficacy in smoking cessation, their potential for addiction, the need for regulation, and the type of information needed to educate the public about the benefits and hazards of EC. Multiple medical institutions and organizations have conducted surveys to investigate the demographics and perceptions of EC consumers in adult and youth populations. However, it is unknown whether these surveys use consistent, reliable, or accurate measures for EC use.

Methods

We analyzed 13 survey articles identified during a review of the use of EC during smoking cessation programs to determine the characteristic features of the surveys and to determine how frequently they satisfied the measurement of important core items suggested by recent articles.

Results

Our analysis focused on 13 studies. These studies represented the work of 13 separate research groups and were published in 10 different biomedical journals with a median impact factor score of 4.1. The median number of participants in the studies was 2,624 (Q1-Q3: 662-6,356); the number of participants ranged from 179 to 19,414. The median number of e-cigarette users in the surveys was 840 (Q1-Q3: 256-3,849). All studies provided clear study goals in their introduction. Five surveys used on-line methods to collect information; four studies provided limited information about the reliability of their data. All studies reported study outcomes and considered limitations. Five studies had limited external validity. None of the surveys collected a complete set of core information recommended by recent authorities on survey methodology for EC.

Conclusions

The surveys reviewed in this project had significant variability in study design, survey population, and study goals. Consequently, comparisons across studies become difficult and limit the external validity of survey studies on EC.

Social Influence in the Uptake and Use of Electronic Cigarettes: A Systematic Review

CONTEXT

E-cigarettes were introduced to support smoking cessation, but their popularity has increased among nonsmokers, challenging current perspectives on their safety and effectiveness as a public health intervention. The objective of this systematic review was to identify and synthesize current evidence on the influence of social factors on e-cigarette intentions and use.

EVIDENCE ACQUISITION

MEDLINE, CINAHL, PsycINFO, and Embase were searched for studies of the effects of social factors on e-cigarette intention or use in February 2019. Studies were included if they used experimental, longitudinal, qualitative, or mixed methods designs. Advertising, social interactions, and social norms were considered as social factors; social media was considered a conduit for other social factors. Two reviewers screened all studies; bias risk was evaluated for all RCTs using the Cochrane risk of bias tool.

EVIDENCE SYNTHESIS

This review included 43 studies: 9 experimental, 11 longitudinal, 22 qualitative, and 1 mixed method. All experimental studies examined advertising and consistently showed that exposure increased intentions to use e-cigarettes. Evidence of the influence of social interactions and social norms came from longitudinal and qualitative studies, suggesting that these factors could increase e-cigarette use. Most participants were nonsmokers (81%; 22,233 of 27,303). Studies rarely considered differences in the effects of social factors on smokers and nonsmokers.

CONCLUSIONS

Given the increased popularity among nonsmokers and the potential for advertising to increase e-cigarette use, closer public health monitoring of e-cigarette uptake by nonsmokers is warranted. Future primary research should be designed to measure how social factors affect smokers and nonsmokers differently.

Pilot study to inform young adults about the risks of electronic cigarettes through text messaging

INTRODUCTION

Young adults are rapidly adopting electronic cigarette (e-cigarette) use. The popularity of e-cigarettes among young people can be attributed to heavy industry advertising and misleading health claims. Data indicate that young e-cigarette users who have never used conventional cigarettes may transition toward smoking combustible cigarettes. Communicating e-cigarette risks via text messaging is limited. This pilot study assessed the impact of exposure to 16 text messages on e-cigarette knowledge and risk perception. The short text messages delivered to participants conveyed e-cigarette use may lead to addiction to nicotine and explained the latest health-related findings.

METHODS

A two-group randomized pretest and posttest study was conducted among 95 racially, ethnically diverse young adults recruited from vocational training programs. Fifty percent of participants were randomized to receive either gain- or loss-framed messages. Knowledge and risk perceptions about e-cigarettes and tobacco use were assessed pre- and post-message exposure.

RESULTS

Participants had a mean age of 20.8 years, SD = 1.7. Current use of e-cigarettes was reported by 10.5% (10/95) and 27.4% (26/95) used a variety of other tobacco products. Findings revealed significant increases in knowledge about e-cigarettes after exposure to the messages (range for ps: p < 04 to p < 0.0001). A statistically significant increase in perceived e-cigarette risk was found post-exposure (p = 0.002). Participants randomized to gain-framed messages reported a significantly higher perceived risk of using e-cigarettes post-exposure than did those who received loss-framed messages (p = 0.02).

CONCLUSIONS

This was a small-scale pilot requiring additional evidence to support the effectiveness of text messaging for increasing e-cigarette knowledge and risk perception. Future research may apply text messages to test new ways to educate young populations about tobacco use and consider addressing these messages to specific subgroups at high risk of use such as non-college bound young adults.

Perceptions and Reasons Regarding E-Cigarette Use among Users and Non-Users: A Narrative Literature Review

This paper aims to provide an in-depth understanding of the attractiveness of e-cigarettes for several different groups. For this purpose, perceptions of and reasons for e-cigarette use were systematically reviewed as reported by e-cigarette users, cigarette smokers, dual users, and non-users, among both adults and youth. MEDLINE^&reg; and Scopus were used to search for relevant articles, and references of included studies were also investigated. Two reviewers screened all titles and abstracts independently, blinded to authors and journal titles (Cohen&rsquo;s Kappa = 0.83), resulting in 72 eligible articles. Risk perceptions, perceived benefits, and reasons for e-cigarette use were categorized in themes and sub-themes. Risk perceptions included harmfulness in general, and specific health risks. Perceived benefits included improved taste and smell, and safety for bystanders. Reasons for use included (health) benefits, curiosity, smoking cessation, and friends using e-cigarettes. The findings highlight that there is a variety of perceptions and reasons mentioned by adult and youth e-cigarette users, cigarette smokers, dual users, and non-users. As such, this overview provides valuable information for scientists, public health professionals, behavior change experts, and regulators to improve future research, risk communication, and possibilities to effectively regulate e-cigarettes.

Validation of mobile phone text messages for nicotine and tobacco risk communication among college students: A content analysis

INTRODUCTION

In the United States, young adults have the highest prevalence of tobacco use. The dissemination of mobile phone text messages is a growing strategy for tobacco risk communication among young adults. However, little has been done concerning the design and validation of such text messages. The Texas Tobacco Center of Regulatory Science (Texas-TCORS) has developed a library of messages based on framing (gain- or loss-framed), depth (simple or complex) and appeal (emotional or rational). This study validated the library based on depth and appeal, identified text messages that may need improvement, and explored new themes.

METHODS

The library formed the study sample (N=976 messages). The Linguistic Inquiry and Word Count (LIWC) software of 2015 was used to code for word count, word length and frequency of emotional and cognitive words. Analyses of variance, logistic regression and scatter plots were conducted for validation.

RESULTS

In all, 874 messages agreed with LIWC-coding. Several messages did not agree with LIWC. Ten messages designed to be complex indicated simplicity, while 51 messages designed to be rational exhibited no cognitive words. New relevant themes were identified, such as health (e.g. ‘diagnosis’, ‘cancer’), death (e.g. ‘dead’, ‘lethal’) and social connotations (e.g. ‘parents’, ‘friends’).

CONCLUSIONS

Nicotine and tobacco researchers can safely use, for young adults, messages from the Texas-TCORS library to convey information in the intended style. Future work may expand upon the new themes. Findings will be utilized to develop new campaigns, so that risks of nicotine and tobacco products can be widely disseminated.

To vape or not to vape? Effects of exposure to conflicting news headlines on beliefs about harms and benefits of electronic cigarette use: Results from a randomized controlled experiment

News coverage of novel tobacco products including e-cigarettes has framed the use of these products with both positive and negative slants. Conflicting information may shape public knowledge, perceptions of e-cigarettes, and their harms. The objective of this study is to assess effects of exposure to conflicting news coverage on US adults' beliefs about harms and benefits of e-cigarette use. We conducted a one-way between-subjects randomized controlled experiment in 2016 to compare the effects of viewing either 1) positive, 2) negative, 3) both positive and negative (conflicting) news headlines about the safety of using e-cigarettes, or 4) no-message. Participants were 2056 adults aged 18 and older from an online survey panel. Outcomes were beliefs about harms (3-item scale, α=0.76) and benefits (3-item scale, α=0.82) of using e-cigarettes. Participants who viewed negative headlines reported increased beliefs about harms (B=0.164, p=0.039) and lower beliefs about benefits of e-cigarette use (B=-0.216, p=0.009), compared with those in the positive headlines condition. These differences were replicated in subgroup analyses among never e-cigarette users. In addition, never e-cigarette users who viewed conflicting headlines reported lower beliefs about benefits of e-cigarette use (B=-0.221, p=0.030) than the positive headlines condition. Valence of news coverage about e-cigarettes (positive, negative, or conflicting) could influence people's beliefs about harms and benefits of e-cigarette use.