Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science

Use of Machine Learning Tools in Evidence Synthesis of Tobacco Use Among Sexual and Gender Diverse Populations: Algorithm Development and Validation

BACKGROUND

From 2016 to 2021, the volume of peer-reviewed publications related to tobacco has experienced a significant increase. This presents a considerable challenge in efficiently summarizing, synthesizing, and disseminating research findings, especially when it comes to addressing specific target populations, such as the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, Two Spirit, and other persons who identify as part of this community) populations.

OBJECTIVE

In order to expedite evidence synthesis and research gap discoveries, this pilot study has the following three aims: (1) to compile a specialized semantic database for tobacco policy research to extract information from journal article abstracts, (2) to develop natural language processing (NLP) algorithms that comprehend the literature on nicotine and tobacco product use among sexual and gender diverse populations, and (3) to compare the discoveries of the NLP algorithms with an ongoing systematic review of tobacco policy research among LGBTQ+ populations.

METHODS

We built a tobacco research domain-specific semantic database using data from 2993 paper abstracts from 4 leading tobacco-specific journals, with enrichment from other publicly available sources. We then trained an NLP model to extract named entities after learning patterns and relationships between words and their context in text, which further enriched the semantic database. Using this iterative process, we extracted and assessed studies relevant to LGBTQ+ tobacco control issues, further comparing our findings with an ongoing systematic review that also focuses on evidence synthesis for this demographic group.

RESULTS

In total, 33 studies were identified as relevant to sexual and gender diverse individuals' nicotine and tobacco product use. Consistent with the ongoing systematic review, the NLP results showed that there is a scarcity of studies assessing policy impact on this demographic using causal inference methods. In addition, the literature is dominated by US data. We found that the product drawing the most attention in the body of existing research is cigarettes or cigarette smoking and that the number of studies of various age groups is almost evenly distributed between youth or young adults and adults, consistent with the research needs identified by the US health agencies.

CONCLUSIONS

Our pilot study serves as a compelling demonstration of the capabilities of NLP tools in expediting the processes of evidence synthesis and the identification of research gaps. While future research is needed to statistically test the NLP tool's performance, there is potential for NLP tools to fundamentally transform the approach to evidence synthesis.

Non-daily Cigarette Smoking: Stability and Transition to Abstinence in Young Adults

INTRODUCTION

There is increasing recognition that non-daily cigarette smoking is common in early adulthood but less is known about its stability over time, or what influences transitions to heavier or nonsmoking. We examined the stability of non-daily smoking in a sample of young adults, and tested whether social and cognitive factors predicted transitions to other smoking patterns over time.

AIMS AND METHODS

Participants were 579 young adults (18-24 years old at enrollment, 52% male) who were non-daily and never-daily cigarette smokers and California residents. Participants completed 13 waves of assessment over 3 years. We used descriptive statistics to evaluate the frequency of consistent abstinence, defined as no cigarette use at two consecutive waves and no cigarette use at any subsequent waves. Cox and logistic regression were used to test predictors of consistent abstinence.

RESULTS

We found that 55% of participants smoked intermittently throughout the study, while 43% were consistently abstinent by the end of the study; few transitioned to daily smoking. Stopping smoking was associated with having fewer smoking friends, smoking less in social situations, having lower positive reinforcement expectancies for smoking, and having stronger intent to quit. Post hoc analyses indicated those who stopped smoking tended to report reductions in positive reinforcement expectancies and increased intent to quit in the 6 months before stopping.

CONCLUSIONS

Findings suggest a substantial minority of young adult non-daily smokers may stop on their own, but that the majority continue smoking and may require intervention. Interventions for this population should address social motives and reinforcement expectancies.

IMPLICATIONS

The majority of young adults who are non-daily cigarette smokers appear to maintain this habit over an extended period and may require intervention. Interventions that focus on reducing expectancies for positive effects of and social motives for cigarette use and on increasing intent to quit smoking may be most effective.

Adolescent nicotine administration impacts working memory and reversal learning but not cognitive flexibility

There has been increased interest in early exposure to nicotine through tobacco products and vaping specifically as it relates to addiction, yet fewer studies have focused on whether behavioral effects resulting from early nicotine exposure may persist into adulthood. Our experiments tested the hypothesis that exposure to nicotine during adolescence would impair selective aspects of behavioral cognition in rodents in adulthood. Male and female adolescent rats received either nicotine (0.4 mg/kg) or vehicle injections (intraperitoneal) once daily for 10 days (PND 29-38) followed by a washout period before behavioral testing. Animals were followed in a longitudinal design and evaluated on a battery of both behavioral and cognitive tasks during adulthood (PND 90+) that included locomotor activity, working memory (novel object recognition), cognitive flexibility (attentional set-shifting task, ASST), and anxiety-like behaviors. Data suggested that subchronic exposure to nicotine during adolescence produced significant changes in working memory, in two reversal problems in the ASST, and in anxiety-related behaviors. Taken together these data may suggest that limited early exposure to nicotine may produce selective longer term impairments in cognitive and behavioral processes related to working memory and reversal learning.

Expanding the E-Liquid Flavor Wheel: Classification of Emerging E-Liquid Flavors in Online Vape Shops

INTRODUCTION

Electronic cigarettes are the most popular tobacco product among U.S. youth, and over 80% of current youth users of e-cigarettes use flavored e-cigarettes, with fruit, mint/menthol, and candy/sweets being the most popular flavors. A number of new e-liquid flavors are currently emerging in the online e-cigarette market. Menthol and other flavored e-cigarettes could incentivize combustible tobacco smokers to transition to e-cigarette use.

METHODS

From February to May 2021, we scraped data of over 14,000 e-liquid products, including detailed descriptions of their flavors, from five national online vape shops. Building upon the existing e-liquid flavor wheel, we expanded the semantic databases (i.e., key terms) to identify flavors using WordNet-a major database for keyword matching and group discussion. Using the enriched databases, we classified 14,000+ e-liquid products into the following 11 main flavor categories: "fruit", "dessert/candy/sweets", "coffee/tea", "alcohol", "other beverages", "tobacco", "mint/menthol", "nuts", "spices/pepper", "other flavors", and "unspecified flavor".

RESULTS

We find that the most prominent flavor sold in the five online vape shop in 2021 was fruit flavored products, followed by dessert/candy/other sweets. Online vendors often label a product with several flavor profiles, such as fruit and menthol.

CONCLUSIONS

Given that online stores market products with multiple flavor profiles and most of their products contain fruit flavor, the FDA may have issued marketing denial orders to some of these products. It is important to further examine how online stores respond to the FDA flavor restrictions (e.g., compliance or non-compliance).

Individual Health Determinants that Predict Low Risk of Transitioning to Tobacco Use During Young Adulthood: An in-Depth Examination of Race and Ethnicity

Introduction

The present study examines the contributions of individual-level health determinants on young adult tobacco use initiation to improve understanding of racial and ethnic distinctions and to inform effective tobacco prevention strategies.

Methods

Using time-to-event analyses, the 10–wave (2011–2016) Truth Initiative Young Adult Cohort, a probability-based, nationally representative sample of the US young adults aged 18–34 years (N = 7 665), provides data to examine differences in variables that influence tobacco uptake, by race and ethnicity.

Results

Among Non–Hispanic White young adults, having fewer peers who smoke cigarettes is protective against any tobacco initiation, whereas hazard of tobacco initiation increases for males, having low confidence to resist smoking, and having higher proclivity for sensation seeking. Depressive and anxiety symptoms increase uptake hazard most in the Non–Hispanic All Other Races group and least among Non–Hispanic Black individuals. Among Hispanic young adults, being female and perceiving tobacco as harmful are notably protective while being male is a notable uptake hazard. Unlike other groups, higher income levels do not lower hazards among Hispanic individuals. Cannabis use and overestimating the smoking rate among peers increase hazard least among Hispanic individuals. In the Non–Hispanic All Other Races group, aging is least protective; hazard increases notably if individuals engage in regular alcohol or cannabis use.

Conclusions

Tobacco prevention efforts are critical during young adulthood. Specific tobacco uptake hazard and protective factors exist by race and ethnicity and should be considered when developing selective young adult prevention, particularly among groups with the highest risk for tobacco initiation during this life stage.

Implications

Rising rates of tobacco initiation among the US young adults necessitate expanded efforts to prevent tobacco use initiation and progression beyond youth. Results highlight nuanced and differential tobacco uptake hazards by race and ethnicity for late initiation and sustained non–tobacco use among young adults. The study confirms existing evidence on tobacco use patterns and contributes to new knowledge on risk and protective factors. Tobacco prevention and control interventions, including policies, tailored in more meaningful ways could reduce tobacco use disparities among those most disproportionately affected.

E-cigarette use and adverse respiratory symptoms among adolescents and Young adults in the United States

E-cigarette use among adolescents and young adults has been associated with adverse respiratory symptoms, including symptoms of asthma and bronchitis. This investigation examined whether such associations differ by primary type of e-cigarette device used. This cross-sectional study included data from four study populations in California and Connecticut, United States, ages 13-21 years (N = 10,483), who self-reported their tobacco use behaviors and health status from 2018 to 2020. Adverse respiratory symptoms were grouped as bronchitis, asthma exacerbation, and shortness of breath. Associations with e-cigarette use were examined by frequency of e-cigarette use (regardless of device type) and most-frequently use device type in the past 30 days (pod, pen/tank, disposable, or mod). Multivariable modeling accounted for demographic variables and use of other tobacco and cannabis. Results were pooled at the study level via random-effects meta-analysis. Across the four studies, e-cigarette use >5 days/month versus never use was associated with bronchitic symptoms (summary odds ratio, sOR: 1.56; 95% confidence interval, CI: 1.37, 1.77) and shortness of breath (sOR: 1.68; 95% CI: 1.35, 2.08) but not statistically significantly with asthma exacerbations (sOR: 1.36; 95% CI; 0.95, 1.95). Among past 30-day e-cigarette users, associations with respiratory symptoms did not differ by device type. In these populations, e-cigarette use was positively associated with symptoms of bronchitis and shortness of breath, but adjusted odds of symptoms did not differ meaningfully by device type. These findings suggest that risk of these respiratory outcomes is elevated among more frequent e-cigarette users regardless of device type used.

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.

Increasing use of flavoured tobacco products amongst youth

Adolescence and early adulthood are the most susceptible phase of life for tobacco initiation and its use during this period can have profound public health implications. Anti-smoking campaigns have helped in reducing the social acceptability of smoking; however, newer nicotine products are becoming increasingly popular, globally. Evidence suggests that flavours play a key role in youth initiation of tobacco use. Flavoured Tobacco Products (FTP) are disproportionately used by the youth and young adults due to their high palatability and misperceptions regarding reduced ill effects of their constituents. Early use of a flavoured tobacco product puts youth and young adults at risk of continued tobacco use and other substance use. The prevalence of FTP use (72.7%) is much higher in young adults as compared to non-flavoured tobacco products.

Behavioral economic measurement of cigarette demand: A descriptive review of published approaches to the cigarette purchase task

The cigarette purchase task (CPT) is a behavioral economic method for assessing demand for cigarettes. Growing interest in behavioral correlates of tobacco use in clinical and general populations as well as empirical efforts to inform policy has seen an increase in published articles employing the CPT. Accordingly, an examination of the published methods and procedures for obtaining these behavioral economic metrics is timely. The purpose of this investigation was to provide a review of published approaches to using the CPT. We searched specific Boolean operators (["behavioral economic" AND "purchase task"] OR ["demand" AND "cigarette"]) and identified 49 empirical articles published through the year 2018 that reported administering a CPT. Articles were coded for participant characteristics (e.g., sample size, population type, age), CPT task structure (e.g., price framing, number and sequence of prices; vignettes, contextual factors), and data analytic approach (e.g., method of generating indices of cigarette demand). Results of this review indicate no standard approach to administering the CPT and underscore the need for replicability of these behavioral economic measures for the purpose of guiding clinical and policy decisions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Using the Cigarette Purchase Task to examine the relative reinforcing value of cigarettes among mothers with versus without opioid dependence

The Cigarette Purchase Task (CPT), in which participants estimate the number of cigarettes they would smoke across increasing cigarette prices, measures the relative reinforcing value of cigarettes. Although opioid-dependent individuals are particularly vulnerable to tobacco addiction, more research is needed to elucidate whether and to what extent their motivation to smoke differs from not-opioid-dependent smokers controlling for potential sociodemographic differences. Participants were 173 women (65 opioid-dependent) in an ongoing clinical trial for smoking cessation. Baseline CPT responses were compared between opioid-dependent and not-opioid-dependent women using five demand indices: Demand Intensity; O_max; P_max; Breakpoint (BP); and α, and two latent factors: Amplitude and Persistence. Final regression models adjusted for sociodemographic characteristics differing between the two groups. Opioid-dependent women had greater demand Intensity (i.e., number of cigarettes they would smoke if they were free) than not-opioid dependent women in the adjusted model, F(1, 156) = 6.93, p = .016. No other demand indices differed significantly. Regarding latent factors, demand Amplitude (i.e., volumetric consumption), but not Persistence (i.e., price insensitivity), was greater for opioid-dependent women in the adjusted model, F(1, 146) = 4.04, p = .046. These results further demonstrate that the CPT is a highly sensitive task that can illuminate potentially important individual and population differences in the relative reinforcing value of smoking. Greater demand Intensity and Amplitude differentiated smokers with comorbid opioid dependence; thus, decreasing smoking prevalence among opioid-dependent populations may require policies and interventions that can decrease cigarette demand Intensity and Amplitude. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Young adult e-cigarette use: A latent class analysis of device and flavor use, 2018-2019

OBJECTIVE

The myriad of e-cigarette devices and flavors used by young adults (YAs) complicates identification of the particular e-cigarette products that are associated with more frequent tobacco use and merit consideration for regulation. The current study used latent class analysis to identify distinct patterns of e-cigarette device and flavor use and evaluate their association with vaping and smoking frequency.

METHODS

Cross-sectional survey data (2018-2019) from a Southern California cohort were analyzed. YAs reporting past 30-day nicotine vaping (N = 550; M age = 19.2 years) self-reported e-cigarette device type/brand and flavor. Six device (e-cig/vape pen, mech mod, box mod, JUUL, non-JUUL pod, disposable) and three flavor (tobacco, mint/menthol, sweet/fruit) indicators were included in a latent class analysis. Past 30-day nicotine vaping and cigarette smoking frequency were assessed as correlates of device and flavor class membership.

RESULTS

Three classes were identified: Any Pod-Mint/Menthol or Sweet/Fruit Flavor Users (prevalance:47%); Non-JUUL-Sweet/Fruit Flavor Users (28%); and Poly-Device-Poly-Flavor Users (25%). Greater frequency of vaping and smoking were associated with higher odds of belonging to the Poly-Device-Poly-Flavor Users class vs. the Any Pod-Mint/Menthol or Sweet/Fruit Flavor Users (vaping: aOR[95%CI] = 1.36[1.16, 1.59], p < .001; smoking: aOR[95%CI] = 1.25[1.02, 1.54], p = .03) and Non-JUUL-Sweet/Fruit Flavor Users (vaping: aOR[95%CI] = 1.30[1.10, 1.53], p < .01; smoking: aOR[95%CI] = 1.42[1.07, 1.88], p = .02) classes.

CONCLUSIONS

Although YAs that predominately used pod devices alongside non-tobacco flavors were most common, YAs characterized by a proclivity toward using many different devices and flavors were appreciably prevalent and smoked and vaped more frequently. Regulations targeting a wide spectrum of vaping products may be optimal in protecting YA health.

E-cigarette use among young adults: A latent class analysis examining co-use and correlates of nicotine vaping

INTRODUCTION

Although a significant proportion of young adults report e-cigarette use (nicotine vaping), little is known about co-use with other substances, including correlates that predict co-use. The current study aimed to identify co-occurring substance use patterns and evaluate multiple correlates in a college student sample.

METHODS

435 participants (21.4 ± 2.9 years; 57% women; 41% Hispanic/Latina/o, 29% Asian-American/Pacific Islander, 17% Caucasian/White, 6% Multiracial, and 5% African-American/Black) from a large, urban university were recruited in-person and completed an online survey in the fall of 2018 and the spring of 2019.

RESULTS

Using latent class analysis (LCA), four substance use patterns were identified: Binge Drinkers (7%); e-cigarette Users (8%); Cannabis Users (14%); and Low Substance Users (71%). The e-cigarette Users class was characterized by moderate or greater use (>5 days of nicotine vaping in past 30-days) as well as past 30-day binge drinking and cannabis use. Higher levels of deviant peer affiliation (aOR = 1.28[1.11-1.47], p < .01), impulsivity-lack of premeditation (aOR = 1.36[1.05-1.78], p < .05), and lower levels of social anxiety (aOR = 0.94[0.88-0.99], p < .05), predicted membership in the e-cigarette Users class.

CONCLUSIONS

The most pervasive co-occurring substance use was observed among the e-cigarette Users class. Young adults reporting moderate or greater levels of nicotine vaping tended to engage in binge drinking and cannabis use, which may ultimately increase risk of deleterious health outcomes. Deviant peer affiliation and impulsivity-lack of premeditation (but not internalizing symptoms) predicted membership in the e-cigarette Users class; consequently, public health efforts may benefit from increased selectivity in targeting young adults for e-cigarette prevention and intervention services.

Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control

Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Exposure to adverse childhood experiences and early initiation of electronic vapor product use among middle school students in Nevada

•

1 in 5 middle school students had used EVPs and 5.1% initiated before age 11.

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A strong graded relationship between cumulative ACEs and early initiation of EVPs was observed.

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Hispanic, rural, and military family students were also at risk for early initiation of EVPs.

Introduction

The use of electronic vapor products (EVPs) among youth has increased significantly in recent years, yet little is known about factors associated with initiation of EVPs during early adolescence. The purpose of this study was to explore the relationship between chronic exposure to adverse childhood experiences (ACEs) and early initiation of EVPs in a representative sample of middle school students.

Methods

5,464 students from 113 middle schools (grades 6–8) completed the Nevada Youth Risk Behavior Survey (YRBS) in the spring of 2017. Six abuse and household dysfunction measures were used to calculate a cumulative ACE score (range 0–6). Initiation of EVPs (e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens) before age 11 was considered early initiation. Weighted logistic regression was used to assess the relationship between cumulative ACE exposure and early initiation of EVPs after controlling for sex, age, race/ethnicity, rurality, free or reduced lunch status, and military family involvement.

Results

Nearly 1 in 5 middle school students (18.6%) reported using EVPs, 6.7% had used EVPs during the past 30 days, and 5.1% started using EVPs before age 11. After controlling for sociodemographics, a strong graded relationship between cumulative ACE exposure and early initiation of EVPs was observed: 1 ACE (AOR = 1.60; 95% CI = 0.99–2.59), 2 ACEs (AOR = 2.29; 95% CI = 1.33–3.93), and 3–6 ACEs (AOR = 3.43, 95% CI = 2.20–5.36) compared to no ACEs.

Conclusions

Screening for ACEs in school-based settings may be a feasible approach for identifying students who may be at-risk for early initiation of EVPs.

A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of "CATCH My Breath"

OBJECTIVES

From 2017 to 2018, electronic cigarette (e-cigarette) use increased 78% among high school students and 48% among middle school students in the United States. However, few e-cigarette prevention interventions have been evaluated. We determined the feasibility and initial effectiveness of "CATCH My Breath," an e-cigarette prevention program, among a sample of middle schools in central Texas.

METHODS

Twelve middle schools in Texas (6 intervention schools and 6 control schools) participated in the CATCH My Breath pilot program during 2016-2017. CATCH My Breath is rooted in social cognitive theory, consists of 4 interactive in-class modules, and is collaboratively administered via classroom and physical education teachers, student-peer leaders, and social messaging (eg, school posters). We collected 3 waves of data: baseline (January 2017), 4-month follow-up (May 2017), and 16-month follow-up (May 2018). Using school as the unit of analysis, we tested a repeated cross-sectional, condition-by-time interaction on e-cigarette ever use, psychosocial determinants of use, and other tobacco use behaviors. Analyses controlled for school-level sociodemographic characteristics (eg, sex, race/ethnicity, and percentage of students eligible for free or reduced-price lunch).

RESULTS

From baseline to 16-month follow-up, increases in ever e-cigarette use prevalence were significantly lower among intervention schools (2.8%-4.9%) than among control schools (2.7%-8.9%), controlling for covariates (P = .01). Intervention schools also had significantly greater improvements in e-cigarette knowledge (β = 0.71; 95% confidence interval [CI], 0.21-1.21; P = .008) and perceived positive outcomes (β = -0.12; 95% CI, -0.23 to -0.02; P = .02) than control schools, controlling for covariates from baseline to 16-month follow-up.

CONCLUSION

Ever e-cigarette use was lower among middle schools that implemented the CATCH My Breath program than among those that did not. Replication of findings among a larger sample of schools, using a group-randomized, longitudinal study design and a longer follow-up period, is needed.

E-Cigarette Use and Subsequent Cigarette Initiation and Sustained Use Among Youth, U.S., 2015-2017

PURPOSE

Using cross-sectional data, we measured the association between electronic cigarette (e-cigarette) use and subsequent initiation and sustained use of cigarettes among U.S. youth.

METHODS

Data were pooled from the 2015-2017 National Youth Tobacco Survey, a school-based survey of U.S. students in grades 6-12. Questions on current age and age of first use of different tobacco products (cigarettes, e-cigarettes, cigars, and smokeless tobacco) were used to ascertain the temporal sequence of tobacco product use. The pooled study population was 52,579 youth who 5 years before the survey had never smoked cigarettes. E-cigarette users were defined as those who used e-cigarettes before or without ever smoking cigarettes. Cigarette smoking was assessed with the following measures: ever smoking a cigarette at any time within the past 5 years and sustained smoking (smoked ≥1 year ago and within past 30 days). Adjusted odds ratios (AORs) were calculated, controlling for other tobacco product use and sociodemographics.

RESULTS

Among never cigarette smokers as of 5 years before the survey, 17.4% used e-cigarettes, and 15.6% first smoked within the past 5 years. Compared with those who did not use e-cigarettes, those who used e-cigarettes had higher odds of ever smoking cigarettes within the past 5 years (AOR = 2.73) and had higher odds of sustained smoking (AOR = 1.55; all p < .05).

CONCLUSIONS

E-cigarette use is associated with subsequent initiation and sustained use of cigarettes among youth. Efforts are warranted to reduce youth use of all tobacco products, including e-cigarettes.

Examining effects of unit price on preference for reduced nicotine content cigarettes and smoking rate

Cigarette preference increases as a function of greater nicotine content, but manipulating cost can shift preference. The aims of the present study are to model whether (1) the behavioral-economic metric unit price (cost/reinforcer magnitude) accounts for preference shifts and (2) whether preference shifts toward reduced nicotine content are associated with smoking reductions. In a multisite study between 2015 and 2016, 169 daily smokers from vulnerable populations completed two concurrent-choice conditions examining preference for smoking normal (15.8 mg/g) and reduced (0.4 mg/g) nicotine content cigarettes. In Condition 1, both products were available at 10 responses/choice. In Condition 2, availability of the 0.4 mg/g dose remained at 10 responses/choice while the 15.8 mg/g dose was available on a progressive-ratio (PR) schedule wherein response cost increased following each choice. Unit prices were calculated by dividing dose by response requirement. Results were analyzed using ANOVA and binomial tests (p < .05). Participants preferred the 15.8 over 0.4 mg/g dose in Condition 1, but shifted preference to the 0.4 mg/g dose in Condition 2 (p < .001) immediately before the point in the PR progression where unit price for 15.8 dose exceeded unit price for the 0.4 dose (p < .001). This shift was associated with a reduction in smoking (p < .001). The unit price of nicotine appears to underpin cigarette product preference and may provide a metric for predicting preference and potentially impacting it through tobacco regulations. These results also demonstrate that reduced compared to normal nicotine content cigarettes sustain lower smoking rates discernible even under acute laboratory conditions and in vulnerable populations.

A review of tobacco regulatory science research on vulnerable populations

In 2013 the U.S. Food and Drug Administration and National Institutes of Health established fourteen Tobacco Centers of Regulatory Science (TCORS) to advance scientific knowledge relevant to conducting evidence-based tobacco regulation. This report reviews TCORS-funded research with adult vulnerable populations. The literature search included a list of all TCORS-funded publications compiled by the TCORS coordinating center; all TCORS were requested to share publications not in the coordinating-center's list. Only TCORS-funded reports describing an empirical study with an adult vulnerable population published in a peer-reviewed journal between September 2013 and June 2018 were included. 71 reports met inclusion criteria; 39% (28/71) examined tobacco use among those with mental health and medical comorbidities, 34% (24/71) socioeconomic disadvantage, 31% (22/71) women of reproductive age, 30% (21/71) racial/ethnic minorities, 18% (13/71) rural residents, and 3% (2/71) each among active military/veterans and sexual/gender minorities. Regarding scientific domains, 63% (45/71) investigated behavior, 37% (26/71) addiction, 24% (17/71) health effects, 20% (14/71) impact analyses, 18% (13/71) toxicity, 8% (6/71) marketing influences, and 7% (5/71) communications. Totals exceed 100% because some reports addressed multiple populations/domains. TCORS funding has generated a substantial, multidisciplinary body of new scientific knowledge on tobacco use in adult vulnerable populations. However, considerable variability was noted in the amount of research conducted across the various vulnerable populations and scientific domains. Most notably, relatively few studies focused on active military/veterans or sexual/gender minorities, and the scientific domains of marketing influences and communications were conspicuously underrepresented. These are important knowledge gaps to address going forward.

Current advances in research in treatment and recovery: Nicotine addiction

The health harms of combusted tobacco use are undeniable. With market and regulatory pressures to reduce the harms of nicotine delivery by combustion, the tobacco product landscape has diversified to include smokeless, heated, and electronic nicotine vaping products. Products of tobacco combustion are the main cause of smoking-induced disease, and nicotine addiction sustains tobacco use. An understanding of the biology and clinical features of nicotine addiction and the conditioning of behavior that occurs via stimuli paired with frequent nicotine dosing, as with a smoked cigarette, is important for informing pharmacologic and behavioral treatment targets. We review current advances in research on nicotine addiction treatment and recovery, with a focus on conventional combustible cigarette use. Our review covers evidence-based methods to treat smoking in adults and policy approaches to prevent nicotine product initiation in youth. In closing, we discuss emerging areas of evidence and consider new directions for advancing the field.