How effective are tobacco industry bar and club marketing efforts in reaching young adults?

Uncovering the advertising and promotional strategies of tobacco companies in Cambodia: recall of below-the-line marketing among young male smokers

INTRODUCTION

Tobacco companies have used below-the-line marketing in novel ways to promote their brands to youth in low/middle-income countries in Southeast Asia. This study explores how young male smokers in Cambodia experience below-the-line marketing strategies.

METHODS

Convenience sampling was used to recruit 147 young male smokers (18-24 years) in Cambodia in early 2020. Local research assistants conducted mixed-methods interviews with participants in Khmer or English. Participants recalled exposure to below-the-line marketing strategies and provided in-depth descriptions about their experiences with individual sales promotions. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using thematic analysis.

RESULTS

54% of participants recalled exposure to at least one below-the-line marketing strategy, including point-of-sale promotions (32.7%), individual sales promotions (27.9%) and online advertising (14.3%). Participants described individual sales promotions in public settings, and recalled that promoters were mostly female, attractive and targeted young males. Tactics used to encourage young people to accept promotional offers included free cigarettes and sample packets, swapping current cigarettes for new brands and collecting consumer details after interviewing. The brands and product features of cigarettes being promoted were readily described by participants.

CONCLUSION

This study provides evidence that illegal below-the-line marketing is still occurring in Cambodia, and increased monitoring and enforcement of advertising restrictions is needed.

Examination of social smoking classifications using a machine learning approach

INTRODUCTION

Idiosyncratic definitions of social smoking proliferate in the literature, making cross-study comparison challenging. This project investigated and differentiated four distinct classifications of social smoking using traditional modeling techniques as well as a multilayer perceptron artificial network, a novel machine learning approach suited for heterogeneous, multidimensional data.

METHODS

One hundred thirty-three adults recruited from a college in the Pacific Northwest and from Amazon Mechanical Turk, age 18 to 25 (48% men; 37% women; 8% nonbinary; 73% white; 24% Hispanic or Latinx), completed a set of self-report measures assessing common variables associated with cigarette use. Participants also completed a well-validated audio simulation (Smoking-Simulated Intoxication Digital Elicitation) depicting social smoking contexts and reported their willingness to use cigarettes or alcohol in these contexts.

RESULTS

Across three of the four social smoking definitions, social smokers consistently scored lower on measures of dependence, frequency, quantity, willingness to smoke, and all use motives than nonsocial smokers. The area under the curve for all four models ranged from excellent to outstanding discrimination within the training set. Frequency of days smoked in the past month was the most important predictor for three of the classification models with a relative importance of 100%.

CONCLUSION

The social smoking definitions demonstrated great variability across common cigarette use variables between groups, except for one. The machine learning approach successfully differentiated all four classifications. Recommendations are made for which social smoker classifications to use in subsequent research to maximize appropriate endorsement by the target population.

Association between smoke-free legislation in hospitality venues and smoking behavior of young people: a systematic review

INTRODUCTION

While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people.

METHODS

A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (e.g. bar, restaurant) with a smoking behavior outcome (e.g. initiation, current smoking) among young people (aged 10-24 years).

RESULTS

Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decrease progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, while two other studies did not.

CONCLUSION

Most studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions.

IMPLICATIONS

This is the first systematic review to provide insight in the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas).

Join the Commune: A Controlled Study of Social Branding Influencers to Decrease Smoking Among Young Adult Hipsters

PURPOSE

To evaluate the impact of a Social Branding intervention in bars and nightclubs on smoking behavior.

DESIGN

Quasi-experimental controlled study.

SETTING

Bars and nightclubs in San Diego and San Francisco (intervention) and Los Angeles (control).

PARTICIPANTS

"Hipster" young adults (age 18-26) attending bars and nightclubs.

INTERVENTION

Anti-tobacco messages delivered through monthly anti-tobacco music/social events, opinion leaders, original art, direct mail, promotional activities, and online media.

MEASURES

A total of 7240 surveys were collected in 3 cities using randomized time location sampling at baseline (2012-2013) and follow-up (2015-2016); data were analyzed in 2018. The primary outcome was current smoking.

ANALYSIS

Multivariable logistic regression assessed correlates of smoking, adjusting for covariates including electronic cigarette use; differences between cities were evaluated using location-by-time interactions.

RESULTS

Smoking in San Francisco decreased at a significantly faster rate (51.1%-44.1%) than Los Angeles (45.2%-44.5%) (P = .034). Smoking in San Diego (mean: 39.6%) was significantly lower than Los Angeles (44.8%, P < .001) at both time points with no difference in rate of change. Brand recall was not associated with smoking behavior, but recall was associated with anti-tobacco attitudes that were associated with smoking.

CONCLUSION

This is the first controlled study of Social Branding interventions. Intervention implementation was accompanied by decreases in smoking (San Francisco) and sustained lower smoking (San Diego) among young adult bar patrons over 3 years.

Marketing exposure and smokeless tobacco use initiation among young adults: A longitudinal analysis

OBJECTIVES

This study examines the relationships between self-reported exposure to smokeless tobacco marketing and initiation/onset of smokeless tobacco use/susceptibility at 6-month follow-up, among a cohort of young adults in urban Texas.

METHODS

Participants were 3597 18-25 year old never smokeless tobacco users, attending 24 Texas two-year colleges and four-year universities. A multi-level, multivariate logistic regression model, accounting for school clustering, examined the impact of self-reported recall of smokeless tobacco marketing exposure at baseline and subsequent initiation of smokeless tobacco use. A subsample analysis of non-susceptible never users (n = 3097) examined the impact of self-reported exposure to smokeless tobacco marketing at baseline and onset of susceptibility to use smokeless tobacco. Both outcomes were assessed at 6-month follow-up. Baseline covariates included age, race/ethnicity, sex, two-/four-year institution, and other tobacco use. For the full analysis, susceptibility to use smokeless tobacco at baseline was included as a covariate.

RESULTS

From baseline to 6-month follow-up, 6.1% of never users initiated smokeless tobacco use (n = 219) and 7.0% of non-susceptible never users became susceptible to smokeless tobacco use (n = 221). Self-reported recall of smokeless tobacco marketing exposure at baseline was associated with initiation of smokeless tobacco (Adj OR: 1.17; 95% CI: 1.08-1.27) and onset of susceptibility to use smokeless tobacco (Adj OR: 1.11; 95% CI: 1.02-1.21) at 6-month follow-up, controlling for all covariates.

CONCLUSIONS

Findings build on previous research by demonstrating an association between recall of smokeless tobacco marketing and subsequent use. Findings are concerning given the 300% increase in smokeless tobacco marketing expenditures from 2006 to 2016.

Latent Class Analysis to Examine Patterns of Smoking and Other Tobacco Products in Young Adult Bar Patrons

PURPOSE

Use of multiple tobacco products is increasing, particularly among young adults. Latent class analysis of substance-use patterns provides a framework for understanding the heterogeneity of use. We sought to identify different patterns of cigarette, e-cigarette, hookah, cigarillo, and smokeless tobacco use among young adult bar patrons.

METHODS

We conducted repeated cross-sectional surveys of randomized time location samples of young adult California bar patrons in 2013 and 2014. Latent class analysis was used to examine patterns of use among current (past 30-day) tobacco users. Classes were compared on demographic characteristics and tobacco use correlates.

RESULTS

Overall 84.4% of the current tobacco users were cigarette smokers, 38.7% used electronic cigarettes, 35.9% used hookah, 30.1% smoked cigars/cigarillos, and 15.4% used smokeless tobacco in the past 30 days. We extracted six latent classes: "Cigarette only" (n = 1690), "Hookah mostly" (n = 479), "High overall use" (n = 528), "Smokeless mostly" (n = 95), "E-cigarette mostly" (n = 439), "Cigars mostly" (n = 435). These classes differed in their risk profiles on both current use compared to no use, and number of days they used each tobacco product. Differences between classes emerged on demographics (age, sex, race/ethnicity) and tobacco correlates including perceived peer smoking, antitobacco industry attitudes, prioritizing social activities, and advertising receptivity.

CONCLUSIONS

Understanding different patterns of multiple tobacco product use may inform both prevention and cessation programming for young adults. It may be efficient to tailor messages to different latent classes and address the distinct demographic and attitudinal profiles of groups of multiple tobacco product users.

Return of cartoon to market e-cigarette-related products

INTRODUCTION

The tobacco industry's use of cartoons to market products has been shown to be effective at increasing awareness and appeal of combustible cigarettes among youth. While the Master Settlement Agreement placed restrictions on the use of cartoons for major cigarette and smokeless (chew) tobacco brands in the USA, no such restrictions exist for electronic cigarettes (e-cigarettes). Research has shown that e-cigarette manufacturers are using cartoons to market products, but limited data exist on the extent of these practices. This study examined the extent of the use of cartoons to market e-liquids on Instagram.

METHODS

Instagram posts with the hashtag #ejuice or #eliquid were collected from 3 November 2017 to 17 November 2017. Rules were established to identify Cartoon (the post contained a cartoon), Logo (the post was labelled a cartoon due to the logo) and Promo (the image of the post or accompanying text indicated it was a promotion) in the data (n=3481).

RESULTS

Among all posts, 723 (20.77%) contained a Cartoon, and 479 (13.76%) were coded as a cartoon because of the Logo. In other words, 479/723 or (66.25%) of Cartoon were coded as cartoons due to the vendor's or manufacture's logo. Among all posts, 2360 (67.80%) were Promo.

CONCLUSION

Findings indicate that e-cigarette companies are using cartoons to market their products and many of these companies' logos are cartoons. Empirical data are needed to determine whether cartoon marketing strategies impact perceived risk and benefits, product appeal, the intention to use and actual use of e-cigarettes.

Peer crowd affiliation as a segmentation tool for young adult tobacco use

BACKGROUND

In California, young adult tobacco prevention is of prime importance; 63% of smokers start by the age of 18 years, and 97% start by the age of 26 years. We examined social affiliation with 'peer crowd' (eg, Hipsters) as an innovative way to identify high-risk tobacco users.

METHODS

Cross-sectional surveys were conducted in 2014 (N=3368) among young adult bar patrons in 3 California cities. We examined use rates of five products (cigarettes, e-cigarettes, hookah, cigars and smokeless tobacco) by five race/ethnicity categories. Peer crowd affiliation was scored based on respondents' selecting pictures of young adults representing those most and least likely to be in their friend group. Respondents were classified into categories based on the highest score; the peer crowd score was also examined as a continuous predictor. Logistic regression models with each tobacco product as the outcome tested the unique contribution of peer crowd affiliation, controlling for race/ethnicity, age, sex, sexual orientation and city.

RESULTS

Respondents affiliating with Hip Hop and Hipster peer crowds reported significantly higher rates of tobacco use. As a categorical predictor, peer crowd was related to tobacco use, independent of associations with race/ethnicity. As a continuous predictor, Hip Hop peer crowd affiliation was also associated with tobacco use, and Young Professional affiliation was negatively associated, independent of demographic factors.

CONCLUSIONS

Tobacco product use is not the same across racial/ethnic groups or peer crowds, and peer crowd predicts tobacco use independent of race/ethnicity. Antitobacco interventions targeting peer crowds may be an effective way to reach young adult tobacco users.

TRIAL REGISTRATION NUMBER

NCT01686178, Pre-results.

Exposure to Tobacco Advertising, Promotion Among the Adult Population in Vietnam and Its Implications for Public Health

INTRODUCTION

The Law on Tobacco Control and the Law on Advertisement prohibit the advertising of any tobacco product in Vietnam. Tobacco promotion and marketing are alsostrictly prohibited. However, the violation of tobacco adverting and promotion is still common in Vietnam.

OBJECTIVES

This article aims at describing the exposure to tobacco advertising and promotion among the population aged 15+ years in Vietnam based on the data from the Global Adult Tobacco Survey 2015 from the view of the community, identifying any possible associations between the exposure to tobacco advertising and promotion and other individual factors, and discussing its possible public health implications.

METHOD

A cross-sectional study with the nationwide scale. Secondary data from the Global Adult Tobacco Survey 2015 was explored and analyzed. Chi-square test and multivariate logistic regressions were applied in the data analysis.

RESULTS

The most common type of adults' exposure to tobacco advertising and promotion was points of sale (8.6%); 9.8% adults exposure to one source of tobacco advertising and 4.0% of them exposed to one source of tobacco promotion. Around 13.3% of Vietnamese adults were exposed to tobacco advertisement, while 2.0% were exposed to tobacco promotion, 5.3% were exposed to both tobacco advertising and promotion, and 16.6% were exposed to tobacco advertising or promotion. Gender, educational level, age, occupation, marital status, socioeconomic status, location (urban, rural), and current smoking status were associated with the exposure to tobacco advertising, tobacco promotion, tobacco advertising and promotion, and tobacco advertising or promotion.

CONCLUSION AND RECOMMENDATION

Although there are comprehensive bans on tobacco advertising and promotion in Vietnam, adults aged 15+ years still reported their exposure to tobacco advertising and promotion. There should be a strict enforcement of the ban on tobacco advertising and promotion in Vietnam.

Young adult non-smokers' exposure to real-world tobacco marketing: results of an ecological momentary assessment pilot study

Background

The aims of this pilot study were to assess and characterize non-current smoking young adults’ exposure to tobacco marketing through an ecological momentary assessment protocol.

Methods

Ecological momentary assessment (EMA) consists of repeated measurement of momentary phenomena and is well-suited to capture sporadic experiences in the real-world, such as exposure to tobacco marketing. EMA has the potential to capture detailed information about real-world marketing exposures in ways that reduce recall bias and increase ecological validity. In this study, young adults (n = 31; ages 18–25) responded to random prompts regarding their momentary exposure to tobacco marketing via text messages on their smartphones for 14 days (n = 1798 observations). Unadjusted and adjusted analyses were conducted using multilevel logistic regression to assess the odds of exposure accounting for correlation of multiple repeated measures within individuals while controlling for variability between individuals.

Results

Respondents reported, on average, two momentary exposures to tobacco advertising in the 14-day study period. In adjusted analyses, African–American (aOR 3.36; 95% CI 1.07, 10.54) and Hispanic respondents (aOR 5.08; 95% CI 1.28, 20.13) were more likely to report exposure to tobacco advertising. Respondents were also more likely to report exposure when also exposed to others using tobacco products and when they were at stores compared with at home (aOR 14.82; 95% CI 3.61, 60.88).

Conclusion

Non-smoking young adults report exposure to tobacco marketing particularly at the point-of-sale, with the highest likelihood of exposure among African-American and Hispanic young people. EMA protocols can be effective in assessing the potential impact of point-of-sale tobacco marketing on young adults.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2758-7) contains supplementary material, which is available to authorized users.

Tobacco Marketing Receptivity and Other Tobacco Product Use Among Young Adult Bar Patrons

PURPOSE

Use of other tobacco products (smokeless tobacco, hookah, cigarillo, and e-cigarettes) is increasing, particularly among young adults, and there are few regulations on marketing for these products. We examined the associations between tobacco marketing receptivity and other tobacco product (OTP) use among young adult bar patrons (aged 18-26 years).

METHODS

Time-location sampling was used to collect cross-sectional surveys from 7,540 young adult bar patrons from January 2012 through March of 2014. Multivariable logistic regression analyses in 2015 examined if tobacco marketing receptivity was associated (1) with current (past 30 day) OTP use controlling for demographic factors and (2) with dual/poly use among current cigarette smokers (n = 3,045), controlling for demographics and nicotine dependence.

RESULTS

Among the entire sample of young adult bar patrons (Mean_age = 23.7, standard deviation = 1.8; 48.1% female), marketing receptivity was consistently associated with current use of all OTP including smokeless tobacco (adjusted odds ratio [AOR]= 2.56, 95% confidence interval [CI] 2.08-3.16, p < .001), hookah (AOR = 1.97, 95% CI 1.58-2.43, p < .001), cigarillos (AOR = 3.00, 95% CI 2.21-4.08, p < .001), electronic cigarettes (AOR = 2.43, 95% CI 1.93-3.04, p < .001), and multiple tobacco products (AOR = 2.93, 95% CI 2.45-3.51, p < .001). Among current smokers, marketing receptivity was significantly associated with use of smokeless tobacco (AOR = 1.63, 95% CI 1.22-2.18, p < .01), cigarillos (AOR = 1.81, 95% CI 1.22-2.70, p < .01), and multiple tobacco products (AOR = 1.58, 95% CI 1.27-1.97, p < .001).

CONCLUSIONS

OTP use is common among young adult bar patrons, and it is associated with tobacco marketing receptivity. Efforts to limit tobacco marketing should address OTP in addition to cigarettes.

Impact of Total Vending Machine Restrictions on US Young Adult Smoking

INTRODUCTION

In an analysis of smoking using a longitudinal sample of US young adults, we extend research on tobacco vending machine restrictions beyond its prior focus on minors by examining the influence of total vending machine restrictions, which apply to adult-only facilities and represents the only remaining vending machine exemption since the enactment of the Family Smoking Prevention and Tobacco Control Act. We identify whether the passage of a restriction influences an individual's smoking on repeated observations, and if the propensity is lower among those who live in locations with a restriction.

METHODS

Combining a repository of US tobacco policies at all geographic levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel logistic regression to examine the impact of total vending machine restrictions on any past 30-day smoking and past 30-day smoking of one pack per day among young adults (ages 19-31), while accounting for other tobacco control policy, community, and individual covariates.

RESULTS

We find that total vending machine restrictions decrease any recent smoking (OR = 0.451; p < .01), net of other covariates. Though the passage of a restriction does not alter an individual's smoking over time, living longer in an area that has a restriction lowers the propensity that an individual will smoke at all (OR = 0.442; p < .05). We find no effect of total vending machine restrictions on smoking a pack daily.

CONCLUSIONS

Total vending machine restrictions appear to be an effective, yet highly underutilized, means of tobacco control.

IMPLICATIONS

Past scientific inquiries examining vending machine restrictions have focused upon minor access, adolescent perceptions of availability, and subsequent smoking. The potential for total vending machine restrictions, which extend to adult-only facilities, to influence patterns of smoking among those of legal age, remains significant. Those who are subject to total vending machine restrictions for longer periods are less likely to have recently smoked, but individuals do not change their smoking behavior in response to the passage of a restriction. These restrictions do not affect heavy smokers. Such policies are an effective but underutilized policy mechanism to prevent smoking among young adults.

Young Adults' Risk Perceptions of Various Tobacco Products Relative to Cigarettes: Results From the National Young Adult Health Survey

Objectives Tobacco product risk perceptions may influence whether individuals use those products instead of or in addition to regular cigarettes. This study aimed to explore risk perceptions of various tobacco products relative to traditional cigarettes with young adults, a group with higher rates of tobacco use. Method We examined risk perception responses among a nationally representative sample of young adults (age 18-34 years; n = 2,871, including tobacco and non-tobacco users) from the 2011 National Young Adult Health Survey. Results Most (57.8%) respondents believed that e-cigarettes were less risky than cigarettes. Respondents were more likely to rate combustible products hookah (24.5%) and cigars (13.9%) as being less risky compared to noncombustible snus (10%) and other smokeless tobacco (SLT) products (7.1%) relative to cigarettes. Few (2.5%) rated menthol cigarettes as less risky. For e-cigarettes, hookah, and SLT, less risky beliefs were significantly higher among ever or current versus never product users. Between 22% and 33% of all respondents believed that SLT, snus, menthol cigarettes, and cigars were more risky than cigarettes, but differences in this belief between current and nonusers of these products were small and insignificant. Younger young adults were more likely to rate e-cigarettes and hookah as being "less risky" and rate cigars and SLT as being "more risky" than older young adults. Conclusion The public's views of comparative tobacco risk perceptions vary widely by tobacco product type and age-group. While "less risky" perceptions may be associated with product use, perceptions that products are "more risky" than cigarettes may not necessarily dissuade people from their use.

Booze and butts: A content analysis of the presence of alcohol in tobacco industry's lifestyle magazines

Background

Advertising influences people's health behaviors. Tobacco companies have linked tobacco and alcohol in their marketing activities. We examined how depictions of alcohol were placed in lifestyle magazines produced by tobacco companies, and if these references differed depending on the magazine’s orientation, if it was towards men, women, or if it was unisex.

Methods

Content analysis of 6 different tobacco industry lifestyle magazines (73 issues), including 73 magazine covers, 1558 articles, 444 tobacco ads, and 695 non-tobacco ads.

Results

14 of 73 (19%) magazine covers featured alcohol; 581 of 1558 (37%) magazine articles mentioned alcohol; 119 of 444 (27%) tobacco ads showed alcohol images; and 57 of 695 (8%) non-tobacco ads portrayed alcohol. Male-oriented magazines (Unlimited, CML, and Real Edge) contained the most alcohol references, and the references were mainly beer, mixed drinks, and liquor or spirits. Female-oriented magazines (All Woman and Flair) contained the fewest alcohol references, and wine and mixed drinks were the major types of alcoholic beverage portrayed. For the unisex magazine (P.S.), the frequency of alcohol references fell between the male- and female-oriented magazines, and the magazine most frequently mentioned mixed drinks.

Conclusions

Frequent depictions of smoking and drinking in tobacco industry lifestyle magazines might have reinforced norms about paired use of tobacco and alcohol among young adults. The pairing of tobacco and alcohol may particularly target young men. Anti-tobacco interventions need to address the co-use of tobacco and alcohol, change the social acceptability of smoking in social settings, and tailor anti-tobacco messaging by gender.

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Tobacco companies frequently portrayed alcohol in their lifestyle magazines.

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More alcohol references appeared in male-oriented magazines than female-oriented magazines.

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Frequent depictions of smoking and drinking may reinforce co-use norms.

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Interventions should reduce the social acceptability of tobacco and alcohol co-use.

Binge drinking: Burden of liver disease and beyond

The consumption of alcoholic beverages is harmful to human health. In recent years, consumption patterns of alcoholic beverages have changed in our society, and binge drinking has generalized. It is considered to be a socio-sanitary problem with few known consequences in terms of individual and third-party social impacts (in the form of violence or traffic accidents) and its organic impact (affects the liver and other organs and systems, such as the nervous and cardiovascular systems) and represents an important financial burden due to its increasing economic impact. This review provides a global approach to binge drinking and emphasizes its epidemiological character, the effect of this type of consumption and the possible management of a problem with an increasing tendency in our society.

VapeCons: E-cigarette user conventions

INTRODUCTION

E-cigarette 'vaping conventions' provide a venue for user social networking, parties, and 'try before you buy' access to a wide range of e-cigarette products. This study identifies and describes vaping conventions, raising awareness of this potentially problematic practice.

METHODS

Conventions were identified via Google searches in April and May 2014 and August 2015. Details captured included location, sponsors, admission cost, event features, and promotions.

RESULTS

41 distinct organizations have planned 90 vaping conventions in 37 different locations since 2010. Conventions promoted access to a wide range of product vendors, seminars, social interactions with other users, parties, gifts, vaping contests, and other events. E-cigarette use at conventions was encouraged.

CONCLUSIONS

Vaping conventions promote e-cigarette use and social norms without public health having a voice to educate attendees about negative consequences of use. Future research should focus on the effects of attending these conventions on attendees and on indoor air quality in vapor-filled convention rooms.

Social smoking among intermittent smokers

BACKGROUND

"Social smoking" - smoking mostly or even only with others - may be an important pattern that implies smoking motivated extrinsically by social influences. Non-daily smokers (intermittent smokers; ITS) are often assumed to be social smokers, with some authors even assuming that all ITS are social smokers (SS+). We sought to identify and characterize social smokers in a sample of ITS.

METHODS

204 adult ITS (smoking 4-27 days/month) recorded the circumstances of smoking in their natural settings using Ecological Momentary Assessment, while also recording their circumstances in nonsmoking moments. SS+ were defined as ITS who were with others when they smoked most of their cigarettes, and who were ≥50% more likely to be with others when smoking than when not.

RESULTS

Only 13% of ITS were SS+. Although defined solely on the basis of presence of others, SS+ showed a distinct pattern of smoking across multiple dimensions: compared to other ITS (who were significantly less likely to smoke when with others), SS+ smoking was more associated with socializing, being with friends and acquaintances, drinking alcohol, weekends, evening or nighttime, being in other people's homes, but not their own home. SS+ smoking was low in the morning and increased in the evening. SS+ smoked fewer days/week and were less dependent, but did not differ demographically.

CONCLUSIONS

Social smoking does constitute a highly distinct smoking pattern, but is not common among adult ITS.

Racial/ethnic differences in associations between neighborhood socioeconomic status, distress, and smoking among U.S. adults

Neighborhood disadvantage may increase smoking by increasing distress, while neighborhood affluence may reduce smoking by increasing positive affect. We examined whether relationships between neighborhood socioeconomic status (SES) and daily smoking operated through distress and positive affect. Simultaneous multivariate path models used pooled cross-sectional data from the 2000 and 2005 National Alcohol Surveys (15,963 respondents; weighted N = 10,753) and the 2000 Decennial Census. Multiple groups analysis assessed differences by gender and race/ethnicity. Covariates included neighborhood immigrant concentration and individual-level demographics. In the full sample, neighborhood disadvantage significantly increased smoking and neighborhood affluence significantly decreased smoking, with no indirect paths through either distress or positive affect. Unique among Hispanics, affluence resulted in decreased smoking indirectly through reduced distress. Relationships between affect and smoking also varied by race/ethnicity, with no significant differences by gender. Interventions targeting neighborhood socioeconomic status and distress may help reduce smoking, particularly for racial/ethnic minorities.

Tobacco Retail Outlet Density and Young Adult Tobacco Initiation

BACKGROUND

A growing body of evidence indicates that the density of tobacco retail outlets around the home residence may influence tobacco use among youth and adults. The purpose of this study was to examine the impact of neighborhood tobacco retail outlet density on young adult initiation of different tobacco product types.

METHODS

Cross-sectional data from a 2013 nationally representative sample of young adults aged 18-34 was examined in relation to a 2012 geocoded listing of all outlets likely to sell tobacco in the United States. Separate multivariable logistic regression analyses examined associations between neighborhood outlet density and past 6 months first use of cigarettes, non-cigarette combustible products, and noncombustible products among adults aged 18-24 and 25-34.

RESULTS

Outlet density was significantly associated with recent initiation of cigarettes and other combustibles, but this impact varied for younger and older groups. Increased density was significantly associated with a higher likelihood of initiating cigarette use among adults aged 25-34 (OR = 3.75, 95% CI = 1.18, 11.90), and of initiating non-cigarette combustible use among 18-24 year olds (OR = 3.16, 95% CI = 1.03, 9.74). There was no impact of outlet density on recent noncombustible product initiation among either group.

CONCLUSION

This study is the first to examine the impact of tobacco outlet density on young adult initiation of cigarettes and other tobacco products. Findings demonstrate that residential neighborhood outlet density is associated with recent initiation of combustible products and this effect varies by product type and age. The tobacco outlet environment may be a critical factor in promoting young adult tobacco use initiation.

A Qualitative Study of Smoker Identity Among College Student Smokers

BACKGROUND

This research was motivated by findings that college students who smoke cigarettes often self-categorize as nonsmokers, that is, they reject the social identity of "smoker."

OBJECTIVES

The goal of the present study was to shed light on college students' smoker identities beyond the smoker/nonsmoker dichotomy.

METHODS

Focus groups were conducted to investigate how college students categorize their own smoking patterns and to identify what behaviors and attitudes are associated with these different categories of smoker identities. Forty-one students from a western university participated in this study in November 2011.

RESULTS

The focus group results indicated that there were five distinct smoker identities on campus. Light and regular smokers were the daily smoker identities present, while stress, social, and drunk smokers were the occasional smoker identities. Moreover, each of these smoker identities was defined by a unique pattern of smoking behavior, attitudes, and motives.

CONCLUSIONS/IMPORTANCE

These findings support the notion that there are different types of smokers, both daily and occasional, in the college population. We suggest that researchers, healthcare providers, and prevention/intervention programs may all benefit from distinguishing between these different types of smokers.

Wreaking "havoc" on smoking: social branding to reach young adult "partiers" in Oklahoma

BACKGROUND

More than 25% of young adult Oklahomans smoked cigarettes in 2012. Tobacco marketing campaigns target young adults in social environments like bars/nightclubs. Social Branding interventions are designed to compete directly with this marketing.

PURPOSE

To evaluate an intervention to reduce smoking among young adult "Partiers" in Oklahoma. The Partier peer crowd was described as follows: attendance at large nightclubs, fashion consciousness, valuing physical attractiveness, and achieving social status by exuding an image of confidence and financial success.

DESIGN

Repeated cross-sectional study with three time points.

SETTING/PARTICIPANTS

Randomized time location survey samples of young adult Partier bar and club patrons in Oklahoma City (Time 1 [2010], n=1,383; Time 2 [2011], n=1,292; and Time 3 [2012], n=1,198). Data were analyzed in 2013.

INTERVENTION

The "HAVOC" Social Branding intervention was designed to associate a smoke-free lifestyle with Partiers' values, and included events at popular clubs, brand ambassador peer leaders who transmit the anti-tobacco message, social media, and tailored anti-tobacco messaging.

MAIN OUTCOME MEASURES

Daily and nondaily smoking rates, and binge drinking rates (secondary).

RESULTS

Overall, smoking rates did not change (44.1% at Time 1, 45.0% at Time 2, and 47.4% at Time 3; p=0.17), but there was a significant interaction between intervention duration and brand recall. Partiers reporting intervention recall had lower odds of daily smoking (OR=0.30 [0.10, 0.95]) and no difference in nondaily smoking, whereas Partiers who did not recall the intervention had increased odds of smoking (daily AOR=1.74 [1.04, 2.89]; nondaily AOR=1.97 [1.35, 2.87]). Among non-Partiers, those who recalled HAVOC reported no difference in smoking, and those who did not recall HAVOC reported significantly increased odds of smoking (daily AOR=1.53 [1.02, 2.31]; nondaily AOR=1.72 [1.26, 2.36]). Binge drinking rates were significantly lower (AOR=0.73 [0.59, 0.89]) overall.

CONCLUSIONS

HAVOC has the potential to affect smoking behavior among Oklahoma Partiers without increasing binge drinking.

Young adult social smokers: their co-use of tobacco and alcohol, tobacco-related attitudes, and quitting efforts

OBJECTIVE

Young adults frequently report social smoking. This study examined the relationship between different social smoking definitions and the co-use of cigarettes and alcohol, tobacco-related attitudes, and quitting efforts.

METHOD

Cross-sectional data were collected at bars using randomized time location sampling among young adults aged 21-26 in San Diego, California from 2010 to 2011 (73% response rate). Multivariable logistic regression examined if current smoking and quit attempts were associated with tobacco-related attitudes, and whether social smoking self-identification or behavior was associated with cigarette-and-alcohol co-use, tobacco-related attitudes, quit attempts, or quitline use.

RESULTS

Among 537 current smokers, 80% self-identified and 49% behaved as social smokers. Social smoking self-identification was positively associated with cigarette-and-alcohol co-use, and quit attempts. Social smoking behavior was negatively associated with tobacco marketing receptivity, quit attempts, and quitline use. Tobacco-related attitudes were associated with smoking but did not generally differ by social smoking status.

CONCLUSION

Identification and behavior as a social smoker have opposing associations with co-use of cigarettes and alcohol and quit attempts. Tobacco cessation programs for self-identified social smokers should address co-use. Interventions denormalizing the tobacco industry or emphasizing the health effects of temporary smoking and secondhand smoke may address smoking among young adult bar patrons regardless of social smoking status.

Prevalence and Correlates of Social Smoking in Young Adults: Comparisons of Behavioral and Self-Identified Definitions

INTRODUCTION

Social smoking is an increasingly common pattern among emerging adults. Although distinct patterns have emerged between social smokers and non-social smokers, there is discrepancy about how to define the construct, with inconsistencies between self-identified social smoking and behavioral social smoking. We report prevalence and correlates of young adult smokers who self-identify and behave as social smokers (SELF + BEH), self-identified non-behavioral social smokers (SELF-ONLY), and non-social smokers (NON-SOCIAL).

METHODS

Young adults age 18-25 years who have smoked at least 1 cigarette in the past 30 days (N = 1,811) were recruited through Facebook for a national anonymous, online survey of tobacco and other substance use. Three social smoking items were used to categorize respondents into 1 of 3 smoking groups. Groups were examined for prevalence and differences on demographics, substance use, motivation to quit smoking and thoughts about tobacco abstinence.

RESULTS

SELF-ONLY (46%) was the largest group, followed by SELF + BEH (27%) and NON-SOCIAL (27%). SELF + BEH smoke less frequently, smoke fewer cigarettes per day, are less addicted to cigarettes, have a higher desire to quit, and perceive a lower quitting difficulty compared with SELF-ONLY. SELF + BEH and SELF-ONLY were more likely to be male, be marijuana users, and be addicted to marijuana than NON-SOCIAL. SELF + BEH exhibited a lower frequency of smoking, less cigarettes per day, were less addicted, and had more days co-using alcohol and cigarettes than NON-SOCIAL.

CONCLUSION

Identifying social smokers based on self-identification in addition to behavioral components appears to be important for designing smoking cessation interventions for emerging adults.

Multiple streams approach to tobacco control policymaking in a tobacco-growing state

Smokefree policies (SFPs) have diffused throughout the US and worldwide. However, the development of SFPs in the difficult policy environment of tobacco-producing states and economies worldwide has not been well-explored. In 2007, Tennessee, the third largest tobacco producer in the US, enacted the Non-Smoker Protection Act (NSPA). This study utilizes the multiple streams model to provide understanding of why and how this policy was developed by triangulating interviews with key stakeholders and legislative debates with archival documents. In June 2006, the Governor unexpectedly announced support for SFP, which created a window of opportunity for policy change. The Campaign for Healthy and Responsible Tennessee, a health coalition, seized this opportunity and worked with the administration and the Tennessee Restaurant Association to negotiate a comprehensive SFP, however, a weaker bill was used by the legislative leadership to develop the NSPA. Although the Governor and the Tennessee Restaurant Association's support generated an environment for 100% SFP, health groups did not fully capitalize on this environmental change and settled for a weak policy with several exemptions. This study suggests the importance for proponents of policy change to understand changes in their environment and be willing and able to capitalize on these changes.

Association between tobacco and alcohol use among young adult bar patrons: a cross-sectional study in three cities

BACKGROUND

Bars and nightclubs are key public venues where young adults congregate and use both tobacco and alcohol, and young adult bar patrons are at high risk for substance use. This study examined the association between cigarette smoking and alcohol use among a random sample of young adult bar patrons from three different cities in the USA.

METHODS

Cross-sectional data was collected from a random sample of young adult bar patrons aged 18-29 in San Diego, CA (N = 1,150), Portland, ME (N = 1,019), and Tulsa, OK (N = 1,106) from 2007-2010 (response rate 88%) using randomized time location sampling. Respondents reported the number of days they smoked cigarettes, drank alcohol, and binge drank in the past 30 days. Multinomial logistic regression was used to analyze the association between smoking (nonsmoker, occasional smoker, and regular smoker) and drinking and binge drinking for each city controlling for age, gender, race/ethnicity, and education. Predicted probabilities of each smoking category were calculated by drinking and binge drinking status. The association between smoking and drinking and binge drinking among combined samples was also analyzed, controlling for demographic variables and city.

RESULTS

Respondents reported high current smoking rates, ranging from 51% in Portland to 58% in Tulsa. Respondents in Tulsa were more likely to report regular smoking than those in San Diego and Portland, with demographic variables being controlled. Young adult bar patrons also exhibited a strong association between smoking and drinking. In general, as the frequency of drinking and binge drinking increased, the predicted probability of being a smoker, especially a regular smoker, increased in each city.

CONCLUSIONS

Young adult bar patrons consistently reported a high smoking rate and a strong relationship between smoking and drinking, regardless of the different bar cultures and tobacco control contexts in each of the three cities. While smoke-free bar policies were negatively associated with regular smoking, these policies alone may not be enough to influence the association between smoking and drinking, particularly if tobacco marketing continues in these venues, or in the absence of programs specifically addressing the co-use of tobacco and alcohol.

Social branding to decrease smoking among young adults in bars

OBJECTIVES

We evaluated a Social Branding antitobacco intervention for "hipster" young adults that was implemented between 2008 and 2011 in San Diego, California.

METHODS

We conducted repeated cross-sectional surveys of random samples of young adults going to bars at baseline and over a 3-year follow-up. We used multinomial logistic regression to evaluate changes in daily smoking, nondaily smoking, and binge drinking, controlling for demographic characteristics, alcohol use, advertising receptivity, trend sensitivity, and tobacco-related attitudes.

RESULTS

During the intervention, current (past 30 day) smoking decreased from 57% (baseline) to 48% (at follow-up 3; P = .002), and daily smoking decreased from 22% to 15% (P < .001). There were significant interactions between hipster affiliation and alcohol use on smoking. Among hipster binge drinkers, the odds of daily smoking (odds ratio [OR] = 0.44; 95% confidence interval [CI] = 0.30, 0.63) and nondaily smoking (OR = 0.57; 95% CI = 0.42, 0.77) decreased significantly at follow-up 3. Binge drinking also decreased significantly at follow-up 3 (OR = 0.64; 95% CI = 0.53, 0.78).

CONCLUSIONS

Social Branding campaigns are a promising strategy to decrease smoking in young adult bar patrons.

Young adults' behavioral intentions surrounding a potential menthol cigarette ban

INTRODUCTION

Menthol cigarette smoking is more prevalent among young adults, who are a known target of tobacco industry marketing. This study explores young adults' menthol use and behavioral intentions in the event of a ban on menthol cigarettes.

METHODS

Data from 2,871 respondents of the 2011 National Young Adult Health Survey were examined to estimate young adults' current smoking, current menthol smoking, and behavioral intentions in the event of a menthol cigarette ban.

RESULTS

Of all respondents, 23.8% were current smokers, and 40.3% of the current smokers were menthol smokers. Menthol use was significantly higher among 18- to 24-year-olds versus 25- to 34-year-olds (51% vs. 34.3%, p = .02) and was significantly associated with race/ethnicity (p < .0001), with prevalence highest among Black smokers (82.0%). Among menthol smokers, 65.7% indicated they would quit tobacco use altogether if menthol cigarettes were no longer sold, while 18.4% said they would switch to nonmenthol cigarettes, and 16.0% said they would switch to some other tobacco product (OTP). Behavioral intention was significantly associated with race/ethnicity (p = .02), where intention to quit tobacco was most prevalent among Black menthol smokers (79.3%), and concurrent use of OTPs (p = .03), where intention to switch to an OTP was more prevalent among menthol smokers who indicated concurrent OTP use (35.3% vs. 5.5%).

CONCLUSIONS

A majority of young adult menthol smokers stated they would quit smoking if menthol cigarettes were no longer sold, which builds on research finding public support for such a policy and on work modeling the public health impact such a ban could have.

Understanding tobacco-related attitudes among college and noncollege young adult hookah and cigarette users

OBJECTIVE

To examine differences in tobacco-related attitudes and hookah and cigarette use among college and noncollege young adults.

PARTICIPANTS

Time-location samples of young adult bar patrons in San Diego, California (N = 2,243), Tulsa (N = 2,095) and Oklahoma City (N = 2,200), Oklahoma, Albuquerque (N = 1,044) and Las Cruces (N = 894), New Mexico, between September 2009 and July 2011.

METHODS

Multinomial logistic regression examined associations between hookah and cigarette use and tobacco-related attitudes.

RESULTS

Current college students and graduates are less likely to smoke cigarettes, but more likely to use hookah. Among current hookah users, 22.6% were hookah-only users and 77.4% were dual users (cigarettes and hookah). College status is associated with different hookah use patterns, and those with anti-tobacco industry attitudes were more likely to smoke hookah.

CONCLUSIONS

Novel interventions are needed for college students using hookah. Existing strategies targeting smokers with anti-tobacco industry messages may be irrelevant to hookah users.

Social facilitation expectancies for smoking: psychometric properties of a new measure

OBJECTIVE

Expectancies about social outcomes for smoking are relevant to college student smokers, who frequently report "social smoking." A new measure, the Social Facilitation Expectancies (SFE) scale, was developed to assess these beliefs.

PARTICIPANTS

The SFE was administered to undergraduate college student smokers (N = 1,096; study completed in May 2011).

METHODS

Items were scored on a 5-point scale with a summed total score. The sample was randomly split and principle axis factoring and confirmatory factor analysis applied to determine scale structure. The structure was tested across sex and smoking groups and validation analyses were conducted.

RESULTS

A 9-item, 1-factor scale was replicated within each group. Higher SFE scores were observed among those with greater smoking experience and higher scores were associated with greater endorsement of other smoking-related beliefs.

CONCLUSIONS

These preliminary findings provide support for the sound psychometric properties of this measure for use with young adult college students.

Secondhand smoke exposure among young adult sexual minority bar and nightclub patrons

OBJECTIVES

We compared exposure to secondhand smoke (SHS) and attitudes toward smoke-free bar and nightclub policies among patrons of lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT bars and nightclubs.

METHODS

We conducted randomized time-location sampling surveys of young adults (aged 21-30 years) in 7 LGBT (n = 1113 patrons) and 12 non-LGBT (n = 1068 patrons) venues in Las Vegas, Nevada, in 2011, as part of a cross-sectional study of a social branding intervention to promote a tobacco-free lifestyle and environment in bars and nightclubs.

RESULTS

Compared with non-LGBT bars and nightclubs, patrons of LGBT venues had 38% higher adjusted odds of having been exposed to SHS in a bar or nightclub in the past 7 days but were no less likely to support smoke-free policies and intended to go out at least as frequently if a smoke-free bar and nightclub law was passed.

CONCLUSIONS

The policy environment in LGBT bars and nightclubs appears favorable for the enactment of smoke-free policies, which would protect patrons from SHS and promote a smoke-free social norm.

Secondhand smoke exposure and smoking behavior among young adult bar patrons

OBJECTIVES

We described frequency of secondhand smoke (SHS) exposure among young adults patronizing bars and associations between SHS exposure, attitudes, and smoking behavior.

METHODS

We collected cross-sectional surveys from randomized time-location samples of bar patrons aged 18 to 26 years in San Diego, California, and Oklahoma City and Tulsa, Oklahoma, in 2010 to 2011. Multivariate logistic regression evaluated associations between SHS exposure, attitudes about dangers of SHS, susceptibility to smoking initiation among nonsmokers, and quit attempts among current smokers.

RESULTS

More than 80% of respondents reported past 7-day exposure to any SHS, and more than 70% reported exposure at a bar. Current smokers reported more SHS exposure in cars and their own homes than did nonsmokers. Among nonsmokers, SHS exposure was associated with susceptibility to initiation, but those who believed that SHS exposure is harmful were less susceptible. Belief that SHS is dangerous was associated with quit attempts among smokers.

CONCLUSIONS

Smoke-free environments and education about the harms of SHS may decrease tobacco use among young adults who frequent bars, where they are heavily exposed to SHS.

Marketing little cigars and cigarillos: advertising, price, and associations with neighborhood demographics

OBJECTIVES

We have documented little cigar and cigarillo (LCC) availability, advertising, and price in the point-of-sale environment and examined associations with neighborhood demographics.

METHODS

We used a multimodal real-time surveillance system to survey LCCs in 750 licensed tobacco retail outlets that sold tobacco products in Washington, DC. Using multivariate models, we examined the odds of LCC availability, the number of storefront exterior advertisements, and the price per cigarillo for Black & Mild packs in relation to neighborhood demographics.

RESULTS

The odds of LCC availability and price per cigarillo decreased significantly in nearly a dose-response manner with each quartile increase in proportion of African Americans. Prices were also lower in some young adult neighborhoods. Having a higher proportion of African American and young adult residents was associated with more exterior LCC advertising.

CONCLUSIONS

Higher availability of LCCs in African American communities and lower prices and greater outdoor advertising in minority and young adult neighborhoods may establish environmental triggers to smoke among groups susceptible to initiation, addiction, and long-term negative health consequences.

Marijuana and tobacco co-use in young adults: patterns and thoughts about use

OBJECTIVE

We examined the frequency and intensity of tobacco use and thoughts about abstinence among young adults in the United States as a function of their use of marijuana. We hypothesized that heavier marijuana use would be associated with heavier tobacco use and fewer attempts to quit smoking, and we explored relationships between marijuana use and ratings of intentions and thoughts related to quitting tobacco.

METHOD

This was a cross-sectional survey consisting of online recruitment and anonymous self-report. Participants were English literate, were between the ages of 18 and 25 years, and reported past-month tobacco use. More than half (53%) had smoked marijuana in the past 30 days. Tobacco use (quantity/frequency, Heavy Smoking Index, past-year quit attempt), thoughts about tobacco use (outcome expectancies, desire, self-efficacy, difficulty of quitting, abstinence goal, pros and cons, stage of change), alcohol use, and other drug use were assessed.

RESULTS

Compared with those who smoked only tobacco, cousers were younger and had smoked for fewer years; had higher household income; were more likely to be male, multiethnic, and nondaily smokers; and reported greater alcohol and other drug use. The variable of days using marijuana in the past 30 days was associated with multiple measures of tobacco use intensity/frequency. Only one association was significant between marijuana use and tobacco-related cognitions: Cousers had a lower likelihood of planning to quit tobacco for good (odds ratio = 0.75, 95% CI [0.58, 0.98]).

CONCLUSIONS

Findings support the association between tobacco and marijuana use among young people but speak to the importance of addressing tobacco cognitions in young adult smokers regardless of level of marijuana use.

Implementation and research priorities for FCTC Articles 13 and 16: tobacco advertising, promotion, and sponsorship and sales to and by minors

INTRODUCTION

Article 13 of the Framework Convention on Tobacco Control (FCTC) calls for a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS), and Article 16 calls for prohibition of tobacco sales to and by minors. Although these mandates are based on sound science, many countries have found provision implementation to be rife with challenges.

OBJECTIVE

This paper reviews the history of tobacco marketing and minor access restrictions in high-, middle-, and low-income countries, identifying past challenges and successes. We consider current challenges to FCTC implementation, how these barriers can be addressed, and what research is necessary to support such efforts. Specifically, we identify implementation and research priorities for FCTC Articles 13 and 16.

DISCUSSION

Although a solid evidence base underpins the FCTC's call for TAPS bans and minor access restrictions, we know substantially less about how best to implement these restrictions. Drawing on the regulatory experiences of high-, middle-, and low-income countries, we discern several implementation and research priorities, which are organized into 4 categories: policy enactment and enforcement, human capital expertise, the effects of FCTC marketing and youth access policies, and knowledge exchange and transfer among signatories. Future research should provide detailed case studies on implementation successes and failures, as well as insights into how knowledge of successful restrictions can be translated into tobacco control policy and practice and shared among different stakeholders.

CONCLUSION

Tobacco marketing surveillance, sales-to-minors compliance checks, enforcement and evaluation of restriction policies, and capacity building and knowledge transfer are likely to prove central to effective implementation.

Impact of alcohol use and bar attendance on smoking and quit attempts among young adult bar patrons

OBJECTIVES

We examined cigarette smoking and quit attempts in the context of alcohol use and bar attendance among young adult bar patrons with different smoking patterns. Methods. We used randomized time location sampling to collect data among adult bar patrons aged 21 to 26 years in San Diego, California (n = 1235; response rate = 73%). We used multinomial and multivariate logistic regression models to analyze the association between smoking and quit attempts and both drinking and binge drinking among occasional, regular, very light, and heavier smokers, controlling for age, gender, race/ethnicity, and education.

RESULTS

Young adult bar patrons reported high rates of smoking and co-use of cigarettes and alcohol. Binge drinking predicted smoking status, especially occasional and very light smoking. All types of smokers reported alcohol use, and bar attendance made it harder to quit. Alcohol use was negatively associated with quit attempts for very light smokers, but positively associated with quitting among heavier smokers.

CONCLUSIONS

Smoking and co-use of cigarettes and alcohol are common among young adult bar patrons, but there are important differences by smoking patterns. Tobacco interventions for young adults should prioritize bars and address alcohol use.

Young adults' favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: findings from a focus group study

OBJECTIVES

We explored young adults' perceptions of snus (spitless moist snuff packed in porous bags), dissolvable tobacco products, and electronic cigarettes and intention to try these products.

METHODS

We conducted 11 focus group discussions involving a total of 66 young adults (18-26 years old) on these new tobacco products (e.g., harmfulness, potential as quit aids, intention to try) held between July and December 2010. We analyzed discussions using a thematic approach.

RESULTS

Participants generally reported positive perceptions of the new products, particularly because they came in flavors. Few negative perceptions were reported. Although some participants believed these products were less harmful than cigarettes and helpful in quitting smoking, others thought the opposite, particularly regarding electronic cigarettes. Participants also commented that these products could be gateways to cigarette smoking. Half of the participants, including a mix of smokers and nonsmokers, admitted they would try these products if offered by a friend.

CONCLUSIONS

Young adults perceive the new tobacco products positively and are willing to experiment with them. Eliminating flavors in these products may reduce young adults' intentions to try these products.

Tobacco use by college students: a comparison of daily and nondaily smokers

OBJECTIVES

To explore demographics, contextual factors, and health risk behaviors associated with nondaily smoking by college students.

METHODS

In fall 2005, a random sample of 4100 students completed an online survey.

RESULTS

Of those surveyed, 29% reported current smoking; of that 29%, 70% were nondaily smokers. Compared to daily smokers, nondaily smokers were younger, African American (compared to white), had mothers with higher education, belonged to Greek organizations, and attended private (vs public) schools. Nondaily smokers were less likely to have used illicit drugs.

CONCLUSIONS

Nondaily and daily smokers differed on several demographic and contextual factors, but reported mostly similar health risk behaviors.

Momentary effects of exposure to prosmoking media on college students' future smoking risk

OBJECTIVE

This study used ecological momentary assessment to examine acute changes in college students' future smoking risk as a function of their exposure to prosmoking media (e.g., smoking in movies, paid advertising, point-of-sale displays).

METHOD

A sample of 135 college students ("ever" and "never" smokers) carried handheld computers for 21 days, recording their exposures to all forms of prosmoking media during the assessment period. They also responded to three investigator-initiated control prompts during each day of the assessment period (i.e., programmed to occur randomly). After each prosmoking media exposure and after each random control prompt they answered questions that measured their risk of future smoking. Responses between prosmoking media encounters were compared (within subjects) to responses made during random control prompts.

RESULTS

Compliance with the study protocol was high, with participants responding to over 83% of all random prompts. Participants recorded nearly three encounters with prosmoking media each week. Results of linear mixed modeling indicated that all participants had higher future smoking risk following exposure to prosmoking media compared with control prompts (p < .05); this pattern of response did not differ between ever and never smokers (p = .769). Additional modeling of the variances around participants' risk of future smoking revealed that the response of never smokers to prosmoking media was significantly more variable than the response of ever smokers.

CONCLUSION

Exposure to prosmoking media is associated with acute changes in future smoking risk, and never smokers and ever smokers respond differently to these exposures.

Use of price-minimizing strategies by smokers and their effects on subsequent smoking behaviors

INTRODUCTION

Use of cigarette price-minimizing strategies may reduce the effectiveness of cigarette excise taxes on the prevalence of smoking. We examined the use of different price-minimizing strategies by smokers and their associations with subsequent smoking behaviors.

METHODS

Seven hundred eighteen current smokers from the Minnesota Adult Tobacco Survey Cohort Study provided information on the use of six different price-minimizing strategies in 2009; 602 of them were resurveyed in 2010 to assess their smoking behavior. Logistic regression was used to assess the effects of use of each strategy, use of at least one strategy, and the number of strategies used on quit smoking, attempted to quit, or cut back on cigarette consumption.

RESULTS

Overall, 78% of participants used at least one price-minimizing strategy in 2009 to save money on cigarettes. About 53% reported buying from less expensive places, 49% used coupons or promotions, 42% purchased by the carton, and 34% changed to a cheaper brand. Participants' characteristics differed somewhat by strategy. Participants who reported buying by the carton were less likely to attempt to quit smoking and cut back on cigarette consumption subsequently; those who used more strategies were less likely to cut back on their cigarette consumption.

CONCLUSIONS

Use of cigarette price-minimizing strategies is common among smokers and appears to hinder smokers from attempting to quit and reducing cigarette consumption. Prohibiting the use of coupons and promotions may uphold the effect of cigarette taxes to reduce the prevalence of smoking.

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

INTRODUCTION

Studies have demonstrated that clinical- and research-based definitions of who a smoker is and what constitutes smoking often differ from adolescent-derived definitions, which can be problematic for effective intervention and prevention efforts. We investigated how adolescents define different smoker types (nonsmoker, smoker, regular smoker, addicted smoker, heavy smoker, experimental smoker, casual smoker, and social smoker) using multiple indicators of smoking behaviors, including frequency, amount, place, and length of time cigarette smoking, and whether differences exist by smoking experience.

METHODS

Quantitative and qualitative methods were used to analyze data from a cohort of adolescents (N = 372) in northern California.

RESULTS

We found differences in how adolescents characterized smoker types based on their own smoking experience. Ever-smokers tended to have a greater flexibility in determining what constituted nonsmoking and heavy smoking, while never-smokers had much narrower definitions. Results also indicated that adolescents may mistakenly associate nicotine addiction with a high frequency and amount of cigarette use as 74.3% characterized an addicted smoker as having smoked for a few years or more. In addition, there was a considerable amount of overlap in definitions between different smoker types, particularly among the smoker-regular smoker, addicted smoker-heavy smoker, and casual smoker-social smoker pairs.

CONCLUSION

Health communication strategies for youth smoking prevention need to address the wide variability and overlap in how adolescents define different smoker types. Greater attention should be directed to understanding the nuances of how adolescents define smoking in order to maximize the effectiveness of youth-centered smoking prevention and cessation messages.

Reinforcement of smoking and drinking: tobacco marketing strategies linked with alcohol in the United States

OBJECTIVES

We investigated tobacco companies' knowledge about concurrent use of tobacco and alcohol, their marketing strategies linking cigarettes with alcohol, and the benefits tobacco companies sought from these marketing activities.

METHODS

We performed systematic searches on previously secret tobacco industry documents, and we summarized the themes and contexts of relevant search results.

RESULTS

Tobacco company research confirmed the association between tobacco use and alcohol use. Tobacco companies explored promotional strategies linking cigarettes and alcohol, such as jointly sponsoring special events with alcohol companies to lower the cost of sponsorships, increase consumer appeal, reinforce brand identity, and generate increased cigarette sales. They also pursued promotions that tied cigarette sales to alcohol purchases, and cigarette promotional events frequently featured alcohol discounts or encouraged alcohol use.

CONCLUSIONS

Tobacco companies' numerous marketing strategies linking cigarettes with alcohol may have reinforced the use of both substances. Because using tobacco and alcohol together makes it harder to quit smoking, policies prohibiting tobacco sales and promotion in establishments where alcohol is served and sold might mitigate this effect. Smoking cessation programs should address the effect that alcohol consumption has on tobacco use.

High tobacco use among lesbian, gay, and bisexual populations in West Virginian bars and community festivals

With no information on tobacco use for lesbian, gay, or bisexual (LGB) populations in West Virginia (WV), it is unclear if nationally-identified LGB tobacco disparities also exist in this State. To address this data gap, we conducted a community tobacco survey in bars and events associated with the WV Pride Parade and Festival. Trained community surveyors used electronic and paper survey instruments in bars (n = 6) in three WV cities and community events associated with the WV Pride Parade and Festival. We analyzed results from 386 completed surveys from self-identified LGB individuals. Tobacco use among LGB bar patrons and LGB attendees at Pride-affiliated events was elevated (45%), as was current cigarette use (41%). Users of cigars and chewing tobacco were frequently dual users of cigarettes, with 80% and 60% reporting dual use, respectively. A substantial disparity likely exists in tobacco use among LGB West Virginians. Targeted interventions addressing tobacco use among LGB West Virginians are warranted in these venues, and the addition of a demographic question on sexual orientation would improve data collection and monitoring of this disparity.

Social smoking among young adults: investigation of intentions and attempts to quit

OBJECTIVES

We compared the association between 3 different definitions of social smoking-a common pattern of smoking among young adults-and cessation indicators.

METHODS

We used a Web-enabled, cross-sectional national survey of 1528 young adults (aged 18-25 years) from a panel (recruited by random-digit dialing) maintained by the research group Knowledge Networks.

RESULTS

Among 455 smokers, 62% self-identified or behaved as social smokers. Compared with established smokers, self-identified social smokers were less likely to have cessation intentions (odds ratio [OR] = 0.83; 95% confidence interval [CI] = 0.70, 0.98) and cessation attempts lasting 1 month or longer (OR = 0.54; 95% CI = 0.45, 0.66). Behavioral social smokers (mainly or only smoking with others) were more likely than were self-identified social smokers (those who did not report these behavior patterns) to have cessation intentions (mainly OR(mainly) = 1.66; 95% CI = 1.05, 2.63; and OR(only) = 2.02; 95% CI = 1.02, 3.97) and cessation attempts (OR(mainly) = 4.33; 95% CI = 2.68, 7.00; and OR(only) = 6.82; 95% CI = 3.29, 14.15).

CONCLUSIONS

Self-identified social smokers may be considered a high-risk group with particular challenges for cessation. Behavioral social smokers may represent a group primed for cessation. Public health efforts should address these differences when developing smoking cessation strategies.

Smoking identities and behavior: evidence of discrepancies, issues for measurement and intervention

Although researchers and health care practitioners tend to use standard categories to classify smokers and nonsmokers, recent research suggests that individual smokers may use a variety of self-definitions regarding their smoking behavior. The purpose of this study was to examine smoking identity and smoking behavior among college students, specifically, the relationship between self-identifying as a smoker, nonsmoker, occasional smoker, or social smoker and number of days smoked in the past month. Data were obtained during a campuswide health assessment of randomly selected full-time students (N = 741). Results indicate discrepancy between smoking identity and cigarette use. Twenty percent of students who smoked in the past 30 days self-identified as nonsmokers. Such discrepancies have implications for data collection in research as well as on questionnaires and in health care interviews. Failure to understand actual smoking behavior may increase the risk that individuals will not receive effective smoking prevention and cessation interventions.

Daily patterns of conjoint smoking and drinking in college student smokers

Epidemiological data indicate a robust association between smoking and alcohol use. However, a critical question that is less resolved is the extent to which the smoking event takes place during the time of alcohol consumption. The present study used data from an 8-week prospective web-based study of college student smokers to examine daily associations between smoking and alcohol use, using measures of both likelihood and level of use. Findings indicated that consumption of alcohol and smoking covaried on a daily basis per person. In addition, consistent with the idea of smoking as a social activity for college students, light smokers were more likely than heavier smokers to smoke while drinking and to smoke more cigarettes while drinking. Smoking behavior among light smokers may be influenced by external social contextual cues, in contrast to heavier smokers who may be more affected by internal cues. Implications of findings for prevention work suggest the importance of targeting social situations in which smoking and drinking co-occur.