Examining the Association Between Physical Activity, Sedentary Behavior and Sport Participation With E-Cigarette Use and Smoking Status in a Large Sample of Canadian Youth

The association between vaping and health behaviors among undergraduate college students in the United States

Objective: To examine the association between vaping and health behaviors (physical activity, fruit and vegetable consumption, sleep, cigarette use, alcohol consumption) and mental health among college students. Methods: Socio-demographic characteristics, vaping, health behaviors, perceived stress, and depressive symptoms of undergraduates enrolled at a large university located in the Northeast of the United States were assessed via an online survey. Results: Of all participants (n = 1775), less than a fifth (n = 314, 17.7%) reported any vaping in the past month. More men reported vaping than women (23.2% vs. 14.5%). Those who vaped reported fewer nights of restful sleep and greater alcohol consumption. Those who smoked and binge drank were more likely to report vaping. Perceived stress was greater among women who vaped, and depressive symptoms were greater among those who vaped regardless of gender. Conclusions: Vaping was associated with smoking, alcohol consumption, and poorer mental health among young adults.

Examining the Relationship Between E-Cigarette Status and Wearable Device Use on Physical Activity Levels in U.S. Adults

PURPOSE

The aim of this analysis is to investigate physical activity levels amongst e-cigarette users based on their wearable device use.

DESIGN

Cross-sectional secondary data analysis using 2017 Behavioral Risk Factor Surveillance Survey (BRFSS).

SETTING

Data from the 2017 BRFSS were used.

SAMPLE

5,562 U.S. adults (age 18+).

MEASURES

Self-reported physical activity related variables from U.S. adults (age 18+).

ANALYSIS

Separate unadjusted and adjusted linear regression models were performed for each of the dependent variables using survey analysis.

RESULTS

Non-users of wearable devices and e-cigarettes account for 96.6% (95%CI [95.7, 97.6]) of the sample, whereas users of wearable devices and e-cigarettes account for 3.3% (95%CI [1.2, 5.4]) of the sample. Those who use e-cigarettes participate in almost 50% less vigorous physical activity minutes per week than nonusers, 46 (95%CI [0.43, 91.57]) and 93 (95%CI [80.59, 106.34]) minutes respectively. Individuals who use e-cigarettes and use wearable devices were found to spend significantly more time in total physical activity per week in both the unadjusted and adjusted linear regressions, P = =0.01 and P = =0.04 respectively.

CONCLUSION

The use of e-cigarettes, wearable devices, or both technologies may influence the physical activity levels of its users. Additional research is needed to better understand the association between physical activity levels and the usage of these technologies.

E-cigarette use, psychological distress, and daily activity participation among adults in Riyadh

Objectives

The prevalence of e-cigarettes is significantly increasing among adults as an alternative method to tobacco smoking. However, the chemical products of e-cigarettes have an influence on human general health. Therefore, this study aims to investigate the association between e-cigarette use and psychological distress as well as participation in daily activities among adults in Riyadh, Saudi Arabia. It also evaluates the demographic profile and usage patterns of e-cigarette users.

Methods

This cross-sectional study involved 396 e-cigarette smokers in Riyadh city. An online survey was administered, including questions about smoking patterns and the perceived effects of e-cigarettes on activities of daily living. Additionally, mental health were assessed using the Kessler 6 scale.

Results

Most of the participants were educated young males (61.4%). About 29.5% of the participants reported using e-cigarettes primarily to quit tobacco cigarettes. In addition, e-cigarette usage was significantly associated with lower participation in activities of daily living and higher psychological distress.

Conclusion

This study found that many e-cigarette users are well-educated young individuals who use e-cigarettes as a substitute for traditional cigarettes. However, the study also revealed that using e-cigarettes is associated with negative effects on smokers' daily activities and mental health.

The association between marijuana and e-cigarette use and exercise behavior among adults

Background

As the prevalence of marijuana and e-cigarette use among American adults rises and the perceived risk decreases, more information is needed on the potential costs and benefits of marijuana and e-cigarette use, including patterns of exercise. Prior studies have found mixed results, lacked data on types of exercise, and involved only adolescents and young adults. Thus, the current study explored whether marijuana and e-cigarette use are associated with strength training, walking for exercise, or general physical activity among adults in the United States.

Method

2,591 adults from Wave V of the National Longitudinal Study of Adolescent to Adult Health (2016-2018) comprised the sample. Separate one-way analyses of variance (ANOVAs) and post hoc tests examined whether participants' marijuana and e-cigarette use predicted their exercise, while follow-up analyses of covariance (ANCOVAs) probed significant effects.

Results

Results indicated that participants' marijuana and e-cigarette use predicted their walking for exercise, with marijuana users walking the highest number of times per week, followed by non-users, e-cigarette users, and dual users. However, this effect only approached significance after controlling for covariates. There were no significant differences in strength training or general exercise between groups.

Conclusion

These findings challenge the stereotype that marijuana and e-cigarette users are less active than non-users, and future research should examine the potential mechanisms of these findings.

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

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

CONCLUSION

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

WHAT IS KNOWN

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

WHAT IS NEW

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

Exploring the prevalence, knowledge, attitudes and influencing factors of e-cigarette use among university students in Palestine: a cross-sectional study

OBJECTIVES

E-cigarettes have gained popularity, especially among young adults. This study aims to determine the prevalence of e-cigarette smoking, assess knowledge and attitudes and identify associated factors among Palestinian university students.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

The study was conducted among Palestinian university students in early 2023.A self-administered questionnaire was used to survey 1792 students from six Palestine universities in the West Bank. The questionnaire covered various aspects, including sociodemographic information, daily habits, exposure to smoking, attitudes and knowledge about e-cigarettes. Data were analysed using descriptive statistics, χ2 tests and multivariate regression analysis.

RESULTS

The study revealed a high prevalence of tobacco use (41.2%), with e-cigarette use prevalent among 19.7% of participants. Knowledge about e-cigarettes was suboptimal, with misconceptions regarding their safety and health effects. Negative attitudes towards e-cigarettes were common, and students with negative attitudes were more likely to use e-cigarettes (aOR=2.6, 95% CI: 1.9 to 3.6). Gender (aOR=2.1, 95% CI: 1.4 to 3.0), waterpipe smoking (aOR=4.5, 95% CI: 3.2 to 6.3), physical inactivity (aOR=1.4, 95% CI: 1.1 to 1.9), high coffee consumption (aOR=1.6, 95% CI: 1.1 to 2.3), spending time with friends (aOR=2.4, 95% CI: 1.5 to 3.7), having a mother who is a smoker (aOR=1.5, 95% CI: 1.1 to 2.2) and having a friend who uses e-cigarettes (aOR=1.5, 95% CI: 1.1 to 2.1) were significantly associated with e-cigarettes use.

CONCLUSIONS

E-cigarette use is a growing concern among Palestinian university students. Combating this trend should include educational initiatives, social interventions and policy measures to promote informed decision-making and discourage e-cigarette use. Comprehensive tobacco control programs considering various tobacco and nicotine products and involving multiple stakeholders are warranted.

Sex Differences in E-Cigarette Use and Related Health Effects

BACKGROUND

Electronic cigarettes (e-cigarettes) comprise a variety of products designed to deliver nicotine, flavorings, and other substances. To date, multiple epidemiological and experimental studies have reported a variety of health issues associated with their use, including respiratory toxicity, exacerbation of respiratory conditions, and behavioral and physiological effects. While some of these effects appear to be sex- and/or gender-related, only a portion of the research has been conducted considering these variables. In this review, we sought to summarize the available literature on sex-specific effects and sex and gender differences, including predictors and risk factors, effects on organ systems, and behavioral effects.

METHODS

We searched and selected articles from 2018-2023 that included sex as a variable or reported sex differences on e-cigarette-associated effects.

RESULTS

We found 115 relevant studies published since 2018 that reported sex differences in a variety of outcomes. The main differences reported were related to reasons for initiation, including smoking history, types of devices and flavoring, polysubstance use, physiological responses to nicotine and toxicants in e-liquids, exacerbation of lung disease, and behavioral factors such as anxiety, depression, sexuality, and bullying.

CONCLUSIONS

The available literature supports the notion that both sex and gender influence the susceptibility to the negative effects of e-cigarette use. Future research needs to consider sex and gender variables when addressing e-cigarette toxicity and other health-related consequences.

The impact of JUUL market entry on cigarette sales: evidence from a major chain retailer in Canada

BACKGROUND

Electronic nicotine delivery systems (ENDS), such as the JUUL system, are nicotine products for adults who currently smoke cigarettes but are looking for an alternative to combustible cigarettes. Sales of ENDS products were legislatively acknowledged and authorized federally in Canada with the Royal Assent of the Tobacco and Vaping Products Act in 2018.

METHODS

With the unique dataset from a major chain retailer in Canada, we evaluated the impacts of JUUL market entry on cigarette sales across Canada from January 2017 to August 2019 using two-way fixed effects panel regression models by leveraging on the entry time variation at the city level. We conducted various robustness checks and a permutation test to validate our results.

RESULTS

Our estimates suggested that JUUL market entry was, on average, significantly correlated with a 1.65% per-month decrease in cigarette sales during the initial months, and with a potentially larger impact on urban areas. Our results were robust across various specifications and tests. These findings implied that JUUL and combustible cigarettes act as economic substitutes during the study time period in Canada.

CONCLUSIONS

These results suggested that local availability of ENDS products, such as JUUL, has the potential to reduce local cigarette consumption.

Correlates of physical activity habits in adolescents: A systematic review

Physical activity habits are crucial for the physical and mental wellbeing of adolescents (individuals aged 10-19 years). However, few studies over the last two decades have systematically aggregated the influential factors of physical activity habits for adolescents. Five online databases (EBSCOhost (Eric), Psychology and Behavioral Sciences Collection, PubMed, Scopus, Web of Science) were searched for relevant studies published before 14 August 2022. Our systematic review indicated the following: 1) boys performed more physical activity habits than girls, whereas girls preferred to engage in moderate-to-vigorous physical activity; 2) physical activity in adolescents decreased with age; 3) African American adolescents performed significantly more habitual physical activities than white adolescents; 4) adolescents with higher literacy had better physical activity habits; 5) support from parents, teachers, friends, and others helped adolescents in developing physical activity habits; 6) adolescents who spent less time participating in habitual physical activity had a higher body mass index; 7) adolescents who reported higher levels of self-efficacy and satisfaction with school sports tended to have stronger physical activity habits; 8) sedentary behavior, smoking, drinking, prolonged screen time, negative emotions, and excessive use of media technology were correlated with reduced habitual physical activity in adolescents. These findings could help develop interventions to motivate adolescents and promote physical activity habits among them.

Sports Team Participation and Vaping Among High School Students: 2015-2019

BACKGROUND AND OBJECTIVES

Electronic vapor products (EVPs) have gained popularity among adolescents despite the health risks. This study aimed to evaluate whether sports team participation, a well-established protective factor against cigarette use, is similarly associated with decreased EVP use.

METHODS

This cross-sectional study analyzed the 2015-2019 Youth Risk Behavior Survey cohorts. Survey-weighted logistic regressions investigated associations between sports team participation and past 30-day exclusive cigarette use, exclusive EVP use, and dual cigarette/EVP use among US high school students, adjusting for sex, grade, and survey year.

RESULTS

The analytic cohort included 16 790 sports team participants (1.7% exclusive cigarette users, 18.3% exclusive EVP users, 5.5% dual users) and 13 972 nonparticipants (3.1% exclusive cigarette users, 13.4% exclusive EVP users, 7.6% dual users). Sports team participation was associated with lower odds of cigarette use (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.48-0.71) and dual use (aOR, 0.74; 95% CI, 0.63-0.88) and higher odds of EVP use (aOR, 1.39; 95% CI, 1.25-1.54). Among exclusive cigarette users and exclusive EVP users, sports team participation was associated with lower odds of frequent (≥20 days in the past month) than intermittent (1-19 days in the past month) cigarette use (aOR, 0.30; 95% CI, 0.19-0.49) and EVP use (aOR, 0.74; 95% CI, 0.61-0.91), respectively.

CONCLUSIONS

Our findings suggest that risk profiles for cigarette and EVP use differ with respect to sports team participation. Given the health risks associated with EVP use, aggressive efforts must be taken to educate student athletes about the health risks of EVP use.

Associations between muscle-building exercise and concurrent e-cigarette, cigarette, and cannabis use among U.S. adolescents

Physical activity and team sports may be protective of substance use among adolescents, although there is mixed evidence on whether muscle-building exercise is associated with patterns of e-cigarette use (i.e., vaping), cigarette use, and cannabis use. Therefore, this study aimed to determine the association between muscle-building exercise and patterns of concurrent substance use among U.S. adolescents. Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 8,474) were analyzed in 2022. Muscle-building exercise was assessed by number of days of the behavior in the past week and categorized based on level of engagement (none, low, medium, and high). Concurrent vaping, cigarette use, and cannabis use within the past 30 days were assessed using a combined, four-category variable (no use, any single use, any dual use, and triple use). Multinomial logistic regressions, with coefficients transformed to relative risk ratios (RRR), were conducted to estimate the associations between muscle-building exercise and concurrent substance use among the overall sample, and by sex, while adjusting for relevant sociodemographic variables. Among the overall sample, high engagement (6-7 days) in muscle-building exercise was associated with greater relative risk of any single use (RRR 1.36, 95% confidence interval [CI] 1.06-1.72), any dual use (RRR 1.46, 95% CI 1.10-2.94), and triple use (RRR 1.81, 95% CI 1.05-3.12). While muscle-building exercise was associated with greater relative risk of concurrent patterns of vaping, cigarette use, and cannabis use among adolescent males, there were no significant relationships found among adolescent females. Healthcare professionals should consider this association when treating adolescent males, particularly given the high prevalence of muscle-building exercise and substance use among this group. More research is needed to understand the experiences of adolescent males who report high engagement in muscle-building exercise and substance use to uncover mechanisms of association.

Gendered associations between e-cigarette use, cigarette smoking, physical activity, and sedentary behaviour in a sample of Canadian adolescents

Objectives

To examine associations between e-cigarette use, cigarette smoking, physical activity, and sedentary behaviour among a large sample of Canadian adolescents (Grades 9-12) by sex.

Methods

Cross-sectional data from 55,629 students who participated in COMPASS Year 6 (2017-2018) were used. Exposures included e-cigarette use and cigarette smoking. Outcomes included meeting recommendations for moderate- to vigorous- physical activity (MVPA;≥60 min/d), muscular strengthening exercises (MSE;≥3 time/wk), and recreational screen time (ST;≤2 h/day) and participating in intramurals or competitive team sports. Logistic regressions were performed after adjusting for relevant covariates.

Results

Male adolescents showed higher prevalence of e-cigarette use (40.0% vs 31.3%) and cigarette smoking (4.4% vs 2.9%) than females. Both males and females who used e-cigarettes were more likely to meet MVPA and MSE recommendations, but less likely to meet the ST recommendation than those who did not use e-cigarettes. E-cigarette use was also consistently associated with more sport participation in males, however, among females the results were mixed. Current cigarette use was associated with meeting the MVPA recommendation and less participation in intramurals in males; however, in females, current cigarette smoking was consistently associated with less participation in any sports. Former cigarette use was associated with participation in competitive team sport within school and meeting the MSE recommendation in females only.

Conclusions

This study found that associations between e-cigarette use and cigarette smoking with physical activity, sedentary behaviour, and sport participation are largely gendered. Identifying differential co-occurrence of risk behaviours by gender is important for future health promotion efforts targeting physical activity among adolescents.

Physical activity and substance use among Canadian adolescents: Examining the moderating role of school connectedness

Physical activity may play a role in promoting or preventing substance use among youth. The purpose of this study was to examine the association between different types of physical activity [i.e., non-competitive school sport, competitive school sport, outside of school sport and minutes of moderate to vigorous physical activity (MVPA) per day] and substance use (i.e., current smoking, e-cigarette, cannabis, binge drinking) among Canadian youth. Interaction effects between physical activity and school connectedness were also examined. Using data from the COMPASS study (2018-19; n = 73,672), four multi-level logistic regression models were developed to investigate whether physical activity lessened or worsened the odds of (1) smoking; (2) e-cigarette use; (3) cannabis use; and (4) binge drinking. Models were stratified by gender to reflect the inherent differences between genders. Models were adjusted for demographic factors and other covariates. Sport participation was consistently associated with substance use, whereas less evidence was found for meeting MVPA guidelines. Non-competitive school sport lessened the odds of cannabis use for males and females. However, non-competitive school sport only lessened the odds of e-cigarette use for females but increased the odds of binge drinking for males. Participation in competitive school sport lessened the odds of cigarette smoking but increased the odds of e-cigarette use and binge drinking for males and females. Outside of school sport lessened the odds of cigarette smoking and cannabis use but increased the odds of e-cigarette use and binge drinking for males and females. A significant moderation effect was found for males participating in sport outside of school and meeting MVPA guidelines who were at a lower risk of e-cigarette use in the presence of high levels of school connectedness. Our study provides evidence for further consideration and provision of extracurricular activities, specifically non-competitive sport, in protecting against substance use. Caution is required in claiming that sport participation or physical activity, in general, is negatively associated with substance use among youth.

Electronic Vapor Product Use and Levels of Physical Activity Among High School Students in Georgia

Introduction

Using a cross-sectional population-based survey, electronic vapor product (EVP) use was evaluated in relation to physical activity levels among high school students in Georgia.

Methods

We used self-reported EVP and cigarette use from the Georgia Student Health Survey 2.0 data from 2018 (N =362 933) and used multi-level multinomial logistic regression models to estimate relative risks of the type of product use relative to no-use by levels of physical activity.

Results

Nearly 7% of the students were EVP-only users. The relative risks of being an EVP-only user were 11% and 23% higher for those who were physically active 2-3 days/week and 4-5 days/week, respectively, compared to those who were physically active <=1 day/week.

Conclusions

Being physically active was positively associated with EVP use among adolescents. Health promotion education and health policies should be developed as a means of reducing EVP use among adolescents.

A national survey of physical activity after spinal cord injury

Physical activity is a powerful modifiable risk factor for disease and mortality. Physical activity levels in people with spinal cord injury (SCI) have not been quantified relative to uninjured individuals in a large population-based sample. We aimed to quantify and compare physical activity in people with and without SCI, and to examine the associations between physical activity, lifestyle, and socioeconomic factors. The 2010 Canadian Community Health Survey (n > 57,000) was used, which includes three measures that assess physical activity levels (i.e., leisure time activity frequency, leisure time activity intensity, and transportation time activity intensity). Bivariable and multivariable logistic regressions were performed and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were estimated. The odds of physical activity in people with SCI were 0.43 (95% CI 0.3–0.61), 0.53 (95% CI 0.36–0.75), and 0.42 (95% CI 0.28–0.61), across the three measures of physical activity, respectively. These differences persisted after adjustment for lifestyle, comorbidities, and socioeconomic factors. Physical activity is reduced in the SCI population compared with the general population. This knowledge is important to direct future research and guide the allocation of health care resources.

Longitudinal associations between e-cigarette use, cigarette smoking, physical activity and recreational screen time in Canadian adolescents

INTRODUCTION

This study examined longitudinal associations between e-cigarette use, cigarette smoking, physical activity, and recreational screen time (ST) in a cohort of Canadian adolescents (ages 14-17 years; grades 9-12).

METHODS

Data from 5,951 adolescents who participated in COMPASS Year 4 (2015-16; baseline) and Year 6 (2017-18; follow-up) were used. Exposures included e-cigarette use and cigarette smoking. Outcomes included cut-points for moderate- to vigorous- physical activity (MVPA; ≥ 60 min/d), muscular strengthening exercises (MSE; ≥ 3 time/wk), participation in sport (SP; intramural or competitive), and recreational screen time (ST; ≤ 430 min/day). Generalized linear mixed models were performed.

RESULTS

E-cigarette use (16.6% vs 39.2%), cigarette smoking (0.9% vs 4.7%) and dual use (0.8% vs 4.1%) increased from baseline to follow-up. SP (70.8% vs 61.3%) and the prevalence of meeting MVPA (49.8% vs 42.1%) and MSE cut-points (54.0% vs 45.3%) decreased from baseline to follow-up. Recreational ST remained similar from baseline to follow-up. New e-cigarette use at follow-up was associated with maintenance of SP and meeting MVPA and MSE cut-points, but also with increased ST. New cigarette smoking at follow-up was associated with maintaining high ST and low SP. Cigarette smoking at baseline and follow-up was associated with maintaining high ST, low MSE, and low SP. Cigarette smoking cessation at follow-up was associated with increasing MVPA and MSE, decreasing ST, and maintaining low SP.

CONCLUSION

Given the clustering and co-occurring unhealthy behavioral patterns, intervention strategies to promote healthy lifestyles should take a holistic approach, by targeting multiple behavioral changes simultaneously.

IMPLICATIONS

This investigation highlighted that, unhealthy behaviors, particularly e-cigarette use, cigarette smoking, and excessive use of screens, tend to co-occur among Canadian adolescents. Therefore, intervention strategies to promote healthy lifestyles should take a holistic approach, by targeting multiple behavioral changes simultaneously particularly in school and community settings. As an exception, new and stable e-cigarette use appears to co-occur with achieving sufficient levels of physical activity. Increasing awareness about the risk of e-cigarette use may target population groups that are physically and socially active (e.g., athletes, sport teams).

Investigating individual-level correlates of e-cigarette initiation among a large sample of Canadian high school students

INTRODUCTION

Having a better understanding of individual factors associated with e-cigarette initiation can help improve prevention efforts. Therefore, this study aimed to (1) identify baseline characteristics associated with e-cigarette initiation, and (2) determine whether changes in these baseline characteristics were associated with e-cigarette initiation.

METHODS

This study used data from Year 6 (2017/18, baseline) and Year 7 (2018/19, follow-up) of the COMPASS study. The final sample included 12 315 students in Grades 9 to 11 who reported never having tried e-cigarettes at baseline. Students reported demographic information, other substance use, school behaviours, physical activity, sedentary behaviour, sleep, symptoms of anxiety and depression, and emotional regulation and flourishing scores. Hierarchical GEE models, stratified by gender, examined the association between (1) baseline characteristics and e-cigarette initiation at follow-up and (2) changes in baseline characteristics and e-cigarette initiation at follow-up.

RESULTS

In total, 29% of students who had not yet initiated e-cigarette use reported initiating e-cigarette use at follow-up. Students in Grades 10 and 11 were less likely to initiate e-cigarette use. Other substance use, skipping school and meeting the physical activity guidelines at baseline and one-year changes to these behaviours were associated with e-cigarette initiation among both male and female students. Additionally, some differences were noted between females and males.

CONCLUSION

Given that other health behaviours were associated with e-cigarette initiation, prevention approaches should target multiple health-risk behaviours to help prevent youth e-cigarette use. Additionally, school-based approaches may benefit by being implemented at the beginning of high school or in junior high school.

Oral Health Implications of Risky Behaviors in Adolescence

Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.

Assessing the impact of sports and recreation facility density within school neighbourhoods on Canadian adolescents' substance use behaviours: quasi-experimental evidence from the COMPASS study, 2015-2018

OBJECTIVES

There has been relatively little exploration to date of potential protective effects within school neighbourhoods, such as those conferred by facilities that seek to promote health with respect to substance use and related harms. This study examined how the density of sports and recreation facilities in the school neighbourhood is associated with the likelihood of binge drinking, e-cigarette use, cigarette smoking and cannabis use among Canadian secondary school students.

DESIGN

Longitudinal data from the COMPASS study on Canadian youth health behaviours from 2015/2016 to 2017/2018 was linked with school neighbourhood data capturing the number of sports and recreation facilities within a 1500 m radius of schools.

SETTING

Secondary schools and school neighbourhoods in Alberta, British Columbia, Ontario and Quebec who participated in the COMPASS study.

PARTICIPANTS

16 471 youth who participated in the COMPASS study over three school years (2015/2016-2017/2018).

PRIMARY AND SECONDARY OUTCOME MEASURES

Binge drinking, e-cigarette use, cigarette use, cannabis use.

RESULTS

Logistic regression models using generalised estimating equations identified that greater density of sports and recreation facilities within the school neighbourhood was significantly associated with lower likelihood of binge drinking and e-cigarette use but was not associated with cigarette smoking or cannabis use.

CONCLUSIONS

This research can help to support evidence-informed school community-based efforts to prevent substance-related harms among youth.

E-cigarette and marijuana use and the attainment of obesity prevention guidelines among U.S. adolescents

•

Majority of U.S. youth still not meeting 5-2-1-0 obesity prevention guidelines.

•

Current marijuana users did not meet screen time and physical activity guidelines.

•

E-cigarette users met physical activity and screen time guidelines.

•

Dual users are more likely to meet fruits and vegetables guidelines.

The study objectives were to examine the associations of exclusive and dual use of e-cigarettes and marijuana and the attainment of the “Let’s Go! 5–2-1–0” obesity prevention guidelines and perceptions of weight status among U.S. adolescents. Data from the 2017 Youth Risk Behavior Survey, a school-based nationally representative cross-sectional study, were analyzed (N = 12,578). Participants were categorized based on their past 30-day e-cigarette and marijuana use as: non-users, exclusive e-cigarette users, exclusive marijuana users, and dual users. Adjusted logistic regression models were conducted. Of adolescents, 5.2% were exclusive e-cigarette users, 10.3% were exclusive marijuana users, and 7.4% were dual users. Compared to non-users, exclusive e-cigarette users were more likely (aOR = 1.55, 95%CI = 1.16–2.07) to meet the physical activity recommendation. Compared to dual-users, exclusive e-cigarette users were more likely (aOR = 1.47, 95%CI = 1.10–1.97) to meet the screen time recommendation. Compared to non-users, exclusive marijuana users were at increased odds to meet the fruit/vegetable recommendation (aOR = 1.33, 95%CI = 1.03–1.71), but were at decreased odds to meet the sugar-sweetened beverages recommendation (aOR = 0.81, 95%CI = 0.65–0.99). Compared to exclusive e-cigarette users, exclusive marijuana users were less likely to meet the screen time (aOR = 0.71, 95%CI = 0.54–0.93) and physical activity recommendations (aOR = 0.60, 95%CI = 0.43–0.84). Compared with dual users, exclusive marijuana users were more likely (aOR = 1.38, 95%CI = 1.01–1.88) to perceive themselves as slightly/very overweight. Compared to non-users, dual users were less likely to meet the sugar-sweetened beverages recommendation (aOR = 0.63, 95%CI = 0.46–0.87). Adolescent current marijuana users and dual users were less likely to meet obesity prevention guidelines. Prevention efforts are needed to reduce e-cigarette and marijuana use and increase adherence to these guidelines.

Characteristics of electronic cigarette user and traditional smokers: 2017 Youth risk behavior surveillance system

BACKGROUND

Although electronic cigarette (e-cigarette) use among adolescents rapidly has increased over the past decade, which has raised concerns over the corresponding behavioral health risks, the current literature presents limited data for understanding the characteristics of adolescent e-cigarette users.

OBJECTIVE

The purpose of this study was to (1) identify general characteristics that may be shared between e-cigarette users and traditional cigarette smokers and (2) examine the unique characteristics of e-cigarette users vis-à-vis traditional cigarette smokers.

DESIGN

Cross-sectional descriptive study.

SAMPLE AND DATA SOURCE

A total of 14,765 9th- to 12-grade students drawn from the CDC 2017 Youth Risk Behavior Surveillance System.

RESULTS

We observed that the prevalence of marijuana, alcohol, and other illicit drug use was higher among e-cigarette users and traditional tobacco users than non-users. Moreover, physically active adolescents were more likely to use e-cigarettes than those who were physically inactive, although the level of the activity did not predict smoking status.

CONCLUSION

We recommend that primary prevention strategies for e-cigarette use should be incorporated in physical education programs and target adolescents who engage in not only health risk behaviors, but also health promoting behaviors, such as physical activity.

Association between Tobacco Consumption and Problematic Internet Use and the Practice of Physical Activity in Spanish Adolescents

The practice of physical activity (PA) is a healthy habit that offers health benefits. In contrast, the lack thereof may be associated with an increase in diseases, even at an early age. The objective of this study was to analyze the association between unhealthy behaviors, such as tobacco consumption and problematic internet use, and the practice of PA in adolescents. Protective factors (physical activity and sport) and risk factors (leading a sedentary life, tobacco use, and problematic internet use) were evaluated. Other variables such as sex, the intensity of physical activity, and being a member of a sports federation were also evaluated. The sample consisted of a total of 1222 Spanish adolescents. Univariate descriptive analysis and multiple linear regression were used, and confirmatory factor analyses and structural models were also estimated. The results confirm a significant positive association between physical activity, intensity, and being a member of a sports federation, as well as between cigarette consumption and internet use. It is advisable to implement public policies that promote the practice of sports as a direct investment in health, preventing the consumption of tobacco and other habits that are harmful to the health of adolescents.

High School Intramural Participation and Substance Use: A Longitudinal Analysis of COMPASS Data

There is an association between sports participation and substance use. However, there is some evidence that intramural sports in high school may not have the same effect. Therefore, the objective of this research was to examine the longitudinal associations between intramural participation in high school and substance use. Methods: This study used a three-year linked sample (2016-2018) of grade 9 and 10 (ages 13-17) Canadian high school students in the COMPASS (Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, Sedentary behavior) study (n = 7,845). Students reported their participation in intramurals over time (consistent, none, initiate, intermittent, and quit) and their substance use behaviors (binge drinking, cannabis use, cigarette use, and e-cigarette use). Mixed effects models were used. Results: 42% of students did not participate in intramurals. For binge drinking, male students who never participated had lower odds (0.66 [0.47-0.93]) compared to consistent intramural participators. Female (3.50 [CI: 1.34-9.16]) and male students (1.97 [1.28-3.02]) who did not participate in any intramurals were more likely to use cannabis than consistent participators. Male students who did not participate were also more likely to use cigarettes (1.81 [1.05-3.12]). No associations were found between intramural participation and e-cigarette use. Conclusion: Intramural participation may be associated with increased binge drinking among male high school students. More promisingly, consistent participation in intramurals may be protective against cannabis use among male and female students and cigarette use among male students.

What is the face of new nicotine users? 2012-2018 e-cigarettes and tobacco use among young students in Italy

BACKGROUND

With increased use of electronic-nicotine delivery devices (e-cigarettes) and non-cigarettes tobacco products (heated tobacco products, shisha, moist snuff/snus) among adolescents, the percentage of Italian students who use nicotine products is at its highest level of the past ten years, even though prevention and anti-smoking policies have produced tangible results in decreasing tobacco smoking prevalence. This cross-sectional study examined trends in exclusive and dual smoking, identified new poly-consumption patterns and profiled old and new nicotine users.

METHODS

We used the annual cross-sectional ESPAD® Italia survey which sampled students (aged 15-19), currently used for surveillance and monitoring of at risk population, between 2012 and 2018 (N = 170,974) to describe Italian trends in exclusive cigarette, exclusive vaping, and dual cigarette and vaping use. . For the 2018 sample, patterns of poly-consumption were described, and a multinomial logistic regression (N = 15,732) estimated characteristics associated with exclusive and dual cigarette and vaping use.

RESULTS

The lifetime prevalence of cigarette smokers slightly decreased from 60.9% in 2012 to 56.9% in 2018, whereas the proportion of vaping users substantially increased from 32.9% in 2013 to 52.0% in 2018. Combining cigarette and vaping use, these trends result in an increase in the lifetime prevalence of any use from 60.8% in 2013 to 66.2% in 2018. Three out of every 10 minors have experienced smoking and/or vaping, and younger students were more prone to be dual users. Overall, current vapers were generally less prone to risky behaviours.

CONCLUSION

In contrast to a slight decrease in cigarette smoking, the prevalence of Italian students approaching old and/or new smoking habits in their lifetime is substantially increasing. The popularity of alternative nicotine-based products, particularly e-cigarettes, has increased among teenagers, resulting in a summation of usage patterns rather than a compensation, and attracting a novel slice of young users. The lack of regulation within current drug policy to limit the access to such licit psychoactive substance use, is urgently needed to avoid a future nicotine addicted population.

High school sport participation and substance use: A cross-sectional analysis of students from the COMPASS study

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Over half the sample did not participate in any school sports.

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32% of youth reported use of one or more substances.

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Intramurals were negatively associated with cannabis and cigarette use.

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Varsity sports were associated with lower odds of cigarette use.

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Varsity sports were associated with increased odds of binge drinking and e-cigarette use.

Introduction

The objective of this study was to examine the association between participation in school sports and substance use behaviors in both male and female high school students.

Methods

The current study used cross-sectional data from 60,601 students from Year 6 (2017–2018) of the COMPASS study. Students reported their school physical activity participation (none, intramurals only, varsity only, both) and past 30-day substance use (binge drinking, cannabis use, cigarette use, e-cigarette use). Hierarchical logistic regression models predicted the odds of substance use, by sex.

Results

55% of students did not participate in any school sports and 32% reported substance use. Intramurals were negatively associated with cannabis use and cigarette use among all students and e-cigarette use among females. Varsity sports were associated with lower odds of cigarette use among all students and cannabis use among males. In contrast, participating in varsity sports was associated with increased odds of binge drinking and e-cigarette use among all students. Participating in both intramurals and varsity sports was associated with increased odds of binge drinking and e-cigarette use but with decreased odds of cannabis use and cigarette use.

Conclusions

Intramurals were found to be protective against cannabis use and cigarette use among all students and e-cigarette use among females. Although varsity sports were protective against cannabis and cigarette use, they were found to be a risk factor for binge drinking and e-cigarette use. Substance use prevention efforts should be a focus among school varsity sports teams, especially for binge drinking and e-cigarette use.

The effect of tobacco policies on youth physical activity

Our research examines the effects of tobacco policies on teenagers' physical activity. Smoking and physical activity are both strategies for weight management, and exercise may be a way to reduce some of the ill effects of smoking. These different links suggest that cigarette taxes could either increase or decrease physical activity. We explore this relationship using repeated cross-sectional 1991-2017 data from the national and state Youth Risk Behavior Surveillance System (YRBSS), combined with state-level policies and controls. Our smoking participation results confirm past work; cigarette taxes have a negative effect on smoking that has waned in recent years. The estimated effects of cigarette taxes on physical activity echo those of smoking; cigarette taxes decrease physical activity and, like smoking, these effects have waned recently. However, one likely avenue - sports participation - is unaffected. These results suggest that increased cigarette taxes lead to modest declines in teen physical activity, a finding consistent with youth using exercise to compensate for the health effects of smoking.

Adolescents' Perceived Risk of Harm Due to Smoking: The role of extracurricular activities

Purpose: Tobacco use initiated during adolescence often leads to continued use in adulthood. There are multiple factors influencing initiation, including low perceived risk of harm. Adolescents involved in school-based extracurricular activities have opportunities to interact with coaches, leaders, and group supervisors who may influence their perception of risk. The purpose of this study was to examine the role of extracurricular activities and adolescents' perceived risks of harm of tobacco use, utilizing an existing dataset.Methods: The 2016 National Survey on Drug Use and Health (NSDUH) dataset was used for a cross-sectional study of youth, ages 12 to <18 years. Adolescents involved in one or more school-based, extracurricular activities were compared with adolescents involved in no activities. The key variable was the response to the NSDUH question regarding perceived risk of harm from daily smoking (≥1 packs of cigarettes). Chi-square tests and multinomial logistic regression were used to analyze the data.Results: At the time of the 2016 NSDUH study period, among the adolescents aged 12 to <18 years (n=4,308), 17.5% indicated that they did not participate in any extracurricular activities and 10.6% reported no/slight perceived risk of harm associated with tobacco use. Adolescents who did not participate in extracurricular activities were more likely to report no/slight risk of harm from smoking (Adjusted Odds Ratio, AOR= 2.21 [95%CI: 1.62, 3.02]) as opposed to the perception of great risk of harm.Conclusion: Adolescents who are not involved in extracurricular activities are more likely to endorse the perception that cigarettes have no/slight risk of harm. School-based extracurricular activities may provide unintended benefits to adolescents; health care professionals, including dental hygienists, should be aware of this associated health benefit.

Physical Activity and Use of Cigarettes and E-Cigarettes Among Young Adults

INTRODUCTION

Physical activity is known to be inversely associated with cigarette smoking among young people. However, evidence is not clear about the association between physical activity and e-cigarette use. Young people who otherwise lead a healthy lifestyle are attracted to e-cigarettes for nicotine or flavor consumption given the low harm perceptions associated with e-cigarette use. This is of concern given the potentially serious adverse health consequences of some forms of e-cigarette use. This study tested the hypotheses that increased physical activity is associated with lower levels of cigarette and e-cigarette use, both cross-sectionally and prospectively.

METHODS

Self-reported physical activity data and past-30-day cigarette smoking and e-cigarette use data were collected in 2018-2019 from 2,401 young adults (mean age=21.2 years, SD=2.2 years, 55% women) at 2 timepoints, 6 months apart. Data were analyzed between May and August 2019, using ordered logistic regression.

RESULTS

Higher moderate or vigorous physical activity was inversely associated with cigarette and e-cigarette use cross-sectionally. Only higher moderate physical activity was statistically significantly associated with reduced cigarette smoking 6 months later, after adjusting for baseline cigarette smoking, sensation seeking, BMI, and demographic variables. Higher physical activity at baseline was associated with increased e-cigarette use at follow-up, adjusting for baseline e-cigarette use, sensation seeking, BMI, and demographic variables.

CONCLUSIONS

The prospective association between increased physical activity at baseline and higher e-cigarette use 6 months later is of concern. More research is needed to determine if this finding is replicable. Some plausible reasons for the observed associations are discussed.

Using Mobile Health Tools to Assess Physical Activity Guideline Adherence and Smoking Urges: Secondary Analysis of mActive-Smoke

Background

Rates of cigarette smoking are decreasing because of public health initiatives, pharmacological aids, and clinician focus on smoking cessation. However, a sedentary lifestyle increases cardiovascular risk, and therefore, inactive smokers have a particularly enhanced risk of cardiovascular disease.

Objective

In this secondary analysis of mActive-Smoke, a 12-week observational study, we investigated adherence to guideline-recommended moderate-to-vigorous physical activity (MVPA) in smokers and its association with the urge to smoke.

Methods

We enrolled 60 active smokers (≥3 cigarettes per day) and recorded continuous step counts with the Fitbit Charge HR. MVPA was defined as a cadence of greater than or equal to 100 steps per minute. Participants were prompted to report instantaneous smoking urges via text message 3 times a day on a Likert scale from 1 to 9. We used a mixed effects linear model for repeated measures, controlling for demographics and baseline activity level, to investigate the association between MVPA and urge.

Results

A total of 53 participants (mean age 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite, and 38% [20/53] obese) recorded 6 to 12 weeks of data. Data from 3633 person-days were analyzed, with a mean of 69 days per participant. Among all participants, median daily MVPA was 6 min (IQR 2-13), which differed by sex (12 min [IQR 3-20] for men vs 3.5 min [IQR 1-9] for women; P=.004) and BMI (2.5 min [IQR 1-8.3] for obese vs 10 min [IQR 3-15] for nonobese; P=.04). The median total MVPA minutes per week was 80 (IQR 31-162). Only 10% (5/51; 95% CI 4% to 22%) of participants met national guidelines of 150 min per week of MVPA on at least 50% of weeks. Adjusted models showed no association between the number of MVPA minutes per day and mean daily smoking urge (P=.72).

Conclusions

The prevalence of MVPA was low in adult smokers who rarely met national guidelines for MVPA. Given the poor physical activity attainment in smokers, more work is required to enhance physical activity in this population.

Physical activity among adolescent tobacco and electronic cigarette users: Cross-sectional findings from the Population Assessment of Tobacco and Health study

Research examining relationships between protective health behaviors and tobacco use offers valuable insight regarding the behavior profiles of product users. In particular, protective health behavior trends among adolescent e-cigarette users have not been examined thoroughly to date. This study investigates physical activity patterns among adolescent e-cigarette users, smokers, and dual users of both products, as compared with never users of tobacco products.

Data were collected from 8383 youth participants (12–17 years of age) enrolled in Wave 2 (2014–2015) of the nationally-representative Population Assessment of Tobacco and Health Study. Relationships between use of tobacco products and physical activity were examined via weighted multivariable logistic regression procedures. Compared with never users, each product use group demonstrated an increased likelihood to abstain from moderate-vigorous physical activity. While dual users (aOR = 0.52; 95% CI: 0.30–0.85) and smokers (aOR = 0.53; 95% CI: 0.35–0.71) were less likely than never users to participate in vigorous physical activity, no differences were observed between e-cigarette and never users (aOR = 1.04; 95% CI: 0.74–1.47). Dual users consistently demonstrated the lowest likelihood of physical activity participation.

In conclusion, e-cigarette users were more likely to abstain from moderate-vigorous physical activity participation than never users. However, results did not indicate differences in vigorous or muscle-strengthening physical activity participation between e-cigarette users and never users. Though findings specific to moderate-vigorous physical activity demonstrate a behavioral similarity between e-cigarette users and smokers, key differences in vigorous physical activity were observed. Comparatively low physical activity among dual users suggests existence of a behavior profile gradient according to product use.

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Adolescent e-cigarette users were more likely to be physically active than smokers.

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Adolescent nonusers were more likely to be physically active than e-cigarette users.

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A product use-related physical activity behavior profile gradient was observed.

Association of the Use of a Heated Tobacco Product with Perceived Stress, Physical Activity, and Internet Use in Korean Adolescents: A 2018 National Survey

The awareness and use of the recently introduced heated product in the global tobacco market is rapidly increasing. Few studies have investigated the association of this product’s use with health-related factors. To examine the association of the heated tobacco product (HTP)’s use with perceived stress, physical activity, and internet use, we analyzed data from the Korea Youth Risk Behavior Survey using multinomial logistic regression models. The participants included 60,040 students from middle school and high school. There were significant associations between high perceived stress and cigarette use only, dual use of cigarette and e-cigarette, triple use of cigarette, e-cigarette, and HTP; a negative association between HTP’s use and perceived stress; positive association between physical activity and tobacco use; and not using the internet significantly increased the odds of use of all types of tobacco products. A smoking prevention program, tailored to meet the needs of different types of tobacco product users, is recommended. A program aimed at not only increasing awareness of perceived risk but also decreasing perceived benefits of risky behaviors, should also be considered. Further research using a longitudinal design to test the causal relationship of tobacco product use with perceived stress, physical activity, and internet use is warranted.