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Jongenelis MI, Gill M, Lawrence N, Wakefield CE. Quitting intentions and behaviours among young Australian e-cigarette users. Addiction 2024; 119:1608-1615. [PMID: 38923180 DOI: 10.1111/add.16530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/13/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND AIMS With the prevalence of e-cigarette use among Australian youth increasing significantly in recent years, greater attention is being paid to encouraging and supporting cessation. However, research to inform such efforts is lacking. The present study sought to (i) measure desire to quit e-cigarette use and actual quitting attempts among young Australians and (ii) explore correlates of quitting-related cognitions and behaviours. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional on-line survey conducted in Australia. The participants were 14-25-year-old e-cigarette users (n = 602; 53% women). MEASUREMENTS Desire to quit vaping and attempts to quit vaping were the primary dependent variables. The independent variables included several individual (e.g. harm perceptions, perceived appeal of vapes), social (descriptive norms) and environmental (e.g. ease of e-cigarette access) factors. FINDINGS A majority of respondents (61%) expressed a desire to quit vaping, and just over half (55%) had made a quit attempt. Finding vapes easy to access was associated with both a lack of desire [odds ratio (OR) = 0.71] and attempts to quit (OR = 0.77), while self-reported addiction to vaping (OR = 1.42 and OR = 3.11) and perceiving vaping to be associated with mental health risks (OR = 1.30 and OR = 1.40) were positively correlated with these variables. Perceiving that vaping is common among people of one's age (OR = 0.82) and finding vapes appealing (OR = 0.55) were associated with a lack of desire to quit, while perceiving vaping to have physical health risks was positively associated with quitting desire (OR = 1.58). School-based education on vaping was associated with reporting an attempt/s to quit (OR = 0.47). CONCLUSIONS This survey of young Australian e-cigarette users suggests a high level of desire to quit using e-cigarettes and attempts to quit. Increasing knowledge regarding the physical and mental health risks associated with e-cigarette use may assist with promoting quitting-related intentions. Changing social norms, reducing the accessibility of e-cigarettes and reducing the appeal of the products also constitute potential means of increasing the desire to quit.
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Affiliation(s)
- Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Claire E Wakefield
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales (UNSW), Kensington, New South Wales, Australia
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Gomes MN, Reid JL, Rynard VL, East KA, Goniewicz ML, Piper ME, Hammond D. Comparison of Indicators of Dependence for Vaping and Smoking: Trends Between 2017 and 2022 Among Youth in Canada, England, and the United States. Nicotine Tob Res 2024; 26:1192-1200. [PMID: 38531767 PMCID: PMC11339172 DOI: 10.1093/ntr/ntae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The current study sought to examine trends in indicators of dependence for youth vaping and smoking during a period of rapid evolution in the e-cigarette market. AIMS AND METHODS Data are from repeat cross-sectional online surveys conducted between 2017 and 2022 among youth aged 16-19 in Canada, England, and the United States (US). Participants were 23 145 respondents who vaped and/or smoked in the past 30 days. Four dependence indicators were assessed for smoking and vaping (perceived addiction, frequent strong urges, time to first use after waking, days used in past month) and two for vaping only (use events per day, e-cigarette dependence scale). Regression models examined differences by survey wave and country, adjusting for sex, age, race, and exclusive/dual use. RESULTS All six indicators of dependence increased between 2017 and 2022 among youth who vaped in the past 30 days (p < .001 for all). For example, more youth reported strong urges to vape at least most days in 2022 than in 2017 (Canada: 26.5% to 53.4%; England: 25.5% to 45.4%; US: 31.6% to 50.3%). In 2017, indicators of vaping dependence were substantially lower than for smoking; however, by 2022, youth vaping was associated with a greater number of days used in the past month (Canada, US), shorter time to first use (all countries), and a higher likelihood of frequent strong urges (Canada, US) compared to youth smoking. CONCLUSIONS From 2017 to 2022, indicators of vaping dependence increased substantially. By 2022, vaping dependence indices were comparable to those of smoking. IMPLICATIONS Indicators of vaping dependence among youth have increased substantially since 2017 to levels that are comparable to cigarette dependence among youth who smoke. Future research should examine factors underlying the increase in dependence among youth who vape, including changes to the nicotine profile and design of e-cigarette products.
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Affiliation(s)
- Makenna N Gomes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Vicki L Rynard
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Katherine A East
- Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Nian Q, Hardesty JJ, Crespi E, Cohen JE. Reasons for continued usage of ENDS: Differences by device and liquid characteristics among US adults. Tob Prev Cessat 2024; 10:TPC-10-26. [PMID: 38911068 PMCID: PMC11191354 DOI: 10.18332/tpc/189924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Motivations for using electronic nicotine delivery systems (ENDS) include quitting or reducing cigarette smoking, flavor, and addiction. This study examines whether the primary reason for continued ENDS usage changes over time, and its association with device and liquid characteristics. METHODS Data are from a longitudinal cohort study and include 526 US adults (≥21 years) using ENDS frequently (≥5 days/week) as self-reported, and uploaded photos of their most used ENDS devices and liquids and self-reported primary reason for continued ENDS usage in wave 2 (December 2020-April 2021) and wave 5 (February-April 2023). Device-liquid grouping was defined by device (disposable/disposable pod/refillable pod/tank, adjustable/no adjustable settings) and liquid (salt/freebase) characteristics. A device was classified as having adjustable settings if it allowed users to modify the power, coil, or airflow. Data were analyzed using multivariable logistic regressions and McNemar tests. RESULTS From wave 2 to 5, the primary reason for continued ENDS usage significantly changed, with more participants reporting addiction (29.2% vs 34.6%, p<0.001); and significantly more participants used disposable devices (salt, no adjustable settings) (7.9% vs 25.2%, p<0.001). Compared to those using tanks (freebase, adjustable settings), participants using devices with nicotine salt liquids were more likely to report addiction (AOR>2; 95% CI: 1.12-8.19); and participants using disposable devices (salt, no adjustable settings) were less likely to report quitting/reducing smoking as the primary ENDS use reason after controlling for smoking status and sociodemographic characteristics (AOR<0.6; 95% CI: 0.14-0.995). CONCLUSIONS Over a 2.5-year period, the proportion of participants continuing to use ENDS at least 5 days/week because of addiction grew, and participants' motivations varied by device-liquid grouping. Restrictions on nicotine salts may disproportionately impact those using ENDS because of addiction; and regulations targeting tanks with freebase liquids may disproportionately impact those using ENDS for smoking cessation/reduction.
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Affiliation(s)
- Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Jeffrey J. Hardesty
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Joanna E. Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
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Palmer AM, Rojewski AM, Carpenter MJ, Klemperer EM, Baker NL, Sanford BT, Toll BA. Interest in quitting e-cigarette use by device type and smoking history in US adults. Tob Control 2024; 33:537-540. [PMID: 36650050 PMCID: PMC10350465 DOI: 10.1136/tc-2022-057710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of e-cigarettes has been increasing, especially since the introduction of 'pod' devices to the marketplace since 2018. Most adults who vape report interest in quitting. The present study examined level of interest in e-cigarette cessation between users with varying cigarette smoking histories and device types. METHODS Data obtained from wave 5 (2018-2019) of the Population Assessment of Tobacco and Health study (n=34 309). Analyses were conducted on adult current established e-cigarette users, categorised on cigarette smoking history (current, former or never) and device type (disposable, cartridge/pod, tank or mod). Participants reported if they planned to ever quit e-cigarettes, attempted to quit in the past year and attempted to quit by cutting back in the past year. RESULTS Of the 2922 established e-cigarette users, 68.21% reported plans to quit vaping; 17.27% reported attempting to quit e-cigarettes in the past year; and 29.28% reported attempting to quit by cutting back in the past year. Cartridge users had higher odds of interest in quitting than tank and mod users. Disposable and cartridge users had higher odds of reporting a past year quit attempt than tank and mod users. Individuals with no smoking history had higher odds of reporting a past year quit attempt or cutting back relative to those reporting dual use (of both e-cigarettes and cigarettes) and former smoking. CONCLUSIONS Tobacco control should consider the type of e-cigarette device that is being used, alongside users' cigarette smoking history, when developing interventions and other resources for vaping cessation.
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Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
| | - Matthew J Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elias M Klemperer
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brandon T Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
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East K, Taylor EV, Simonavičius E, Reid JL, Burkhalter R, McNeill A, Hammond D. Use of 'Elf Bar' among youth and young adults who currently vape in England: cross-sectional associations with demographics, dependence indicators and reasons for use. Addiction 2024. [PMID: 38515247 DOI: 10.1111/add.16463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/31/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Elf Bar is currently the leading e-cigarette (vape) brand in Great Britain. This study examined youth and young adults' use of Elf Bar, socio-demographic characteristics and dependence indicators and reasons for use over other brands. DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS Online 2022 International Tobacco Control Project Youth Tobacco and Vaping Survey (N = 1355 16-29-year-olds in England who had vaped in the past 30 days). MEASUREMENTS Currently using Elf Bar most often (versus other brands) and associations with: socio-demographics, owning a vaping device, dependence indicators and reasons for brand choice. Logistic regressions were used. FINDINGS Among 16-29-year-olds who vaped in the past 30 days, 48.4% (n = 732) reported Elf Bar as the brand they used most often. Among 16-17-year-olds, 40.7% used Elf Bar over other brands; this was lower than among 18-19-year-olds (60.1%) and 20-29-year-olds (47.4%) (P ≤ 0.002). Using Elf Bar over other brands was higher among those who were female (55.2 versus 41.5% male), identified as White (53.1 versus 30.9% other/mixed), a student (54.5 versus 44.3% not), did not own a vape (66.7 versus 44.4% who did) and typically vaped 5-8 hours after waking (62.7 versus 36.8% within 5 min) (P ≤ 0.044). Most who vaped but had never smoked used Elf Bar (64.3%), although use did not significantly differ from those who currently (45.4%), formerly (42.3%) or experimentally (48.7%) smoked (all P ≥ 0.060). Popular reasons for choosing Elf Bar over other brands were better flavour/taste (47.5%), less expensive (28.7%), easier to get (26.1%), smoother to inhale (24.0%) and popularity (23.1%). 'Better for quitting smoking' (10.1%) was least frequently selected reason for choosing Elf Bar over other brands. CONCLUSIONS Elf Bar brand e-cigarettes were used by approximately half of 16-29-year-olds who vaped in England in 2022 and was mainly chosen over other brands for subjective responses (e.g. flavour/taste), rather than for quitting smoking.
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Affiliation(s)
- Katherine East
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
| | - Eve V Taylor
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Erikas Simonavičius
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica L Reid
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
| | - Robin Burkhalter
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Canada
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Choi SH, Templin T. College students' preferences for tobacco treatment: a discrete choice experiment. HEALTH EDUCATION RESEARCH 2023; 38:563-574. [PMID: 37639385 DOI: 10.1093/her/cyad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
The purpose of this study was to elicit preferences for the 'format' and 'content' of tobacco treatment among college student smokers, using an online discrete choice experiment (DCE) survey. A DCE survey, supplemented with a think-aloud method, was conducted among 54 college students who smoked combustible cigarettes and/or e-cigarettes. Conditional logistic regression models were constructed to determine optimal profiles of treatment. Cutting down nicotine rather than quitting 'cold turkey' (P < 0.001) and two-way communication (P < 0.001) were viewed as the most critical attributes for the intervention 'format'; changing behaviors rather than social groups/peers (P < 0.001) and autonomy (P < 0.001) were viewed as the most critical attributes for the intervention 'content'. Some preferences varied based on smoking subgroups. Combustible cigarette users preferred interventions with a longer time commitment (P < 0.05) and without nicotine replacement therapies (NRTs) (P < 0.001). Think-aloud data supported the DCE findings and further revealed a strong desire for cutting down nicotine and keeping social groups/peers and misconceptions regarding NRTs. Our study findings can guide tobacco treatment tailored to college students. These treatments should be tailored to specific smoker subgroups.
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Affiliation(s)
- S H Choi
- College of Nursing - Wayne State University, 5557 Cass Ave #350, Detroit, MI 48202, USA
| | - T Templin
- College of Nursing - Wayne State University, 5557 Cass Ave #350, Detroit, MI 48202, USA
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Amin S, Pokhrel P, Elwir T, Mettias H, Kawamoto CT. A systematic review of experimental and longitudinal studies on e-cigarette use cessation. Addict Behav 2023; 146:107787. [PMID: 37393697 PMCID: PMC10527397 DOI: 10.1016/j.addbeh.2023.107787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The present study addresses the need to synthesize the findings in the current literature on e-cigarette use cessation. METHODS PubMed, MEDLINE, and EMBASE databases were searched in November 2022 to systematically review studies focused on intentions, attempts, and successful e-cigarette use cessation. Three authors independently reviewed the full-texts of the initial pool of potentially eligible articles. Narrative data synthesis was conducted, and the risk of bias was evaluated. RESULTS A total of 12 studies were selected for review, 7 of which were experimental and 5longitudinal. The majority of the studies focused on participants' intentions to quit e-cigarette use. The experimental studies varied in sample size, intervention type, and length of participant follow-up. Findings across the experimental studies were mixed, with only one full-fledged trial having examined cessation as an outcome. The experimental studies that assessed cessation outcomes utilized mobile technology as an intervention tool. Results from longitudinal studies indicated sociodemographic characteristics (gender, race/ethnicity), vaping frequency, and cigarette smoking status as predictors of intentions, attempts and e-cigarette use cessation. CONCLUSION This review highlights the current paucity of methodologically rigorous research on e-cigarette use cessation. Our findings suggest that vaping cessation programs that employ mobile health technology to provide personalized cessation services may help promote intentions, attempts, and e-cigarette use cessation. Limitations of the current studies on vaping cessation include small sample sizes, heterogeneous cohorts that limit comparisons, and inconsistent ways of assessing vaping cessation. Future research needs to test long-term intervention effects using experimental and prospective designs among representative samples.
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Affiliation(s)
- Samia Amin
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States.
| | - Pallav Pokhrel
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
| | - Taha Elwir
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
| | - Hannah Mettias
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
| | - Crissy T Kawamoto
- Population Sciences Program, University of Hawai'i at Mānoa, 701 Ilalo St., Honolulu, HI 96813, United States
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Jovell L, González-Marrón A, Lidón-Moyano C, Martínez-Sánchez JM. Novel nicotine products: Averting a harmful revolution. Tob Induc Dis 2023; 21:139. [PMID: 37881172 PMCID: PMC10594407 DOI: 10.18332/tid/172415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Laura Jovell
- Group of Evaluation of Health Determinants and Health Policies, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
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Singh I, Valavil Punnapuzha V, Mitsakakis N, Fu R, Chaiton M. A Machine Learning Approach Reveals Distinct Predictors of Vaping Dependence for Adolescent Daily and Non-Daily Vapers in the COVID-19 Era. Healthcare (Basel) 2023; 11:healthcare11101465. [PMID: 37239751 DOI: 10.3390/healthcare11101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Since 2016, there has been a substantial rise in e-cigarette (vaping) dependence among young people. In this prospective cohort study, we aimed to identify the different predictors of vaping dependence over 3 months among adolescents who were baseline daily and non-daily vapers. We recruited ever-vaping Canadian residents aged 16-25 years on social media platforms and asked them to complete a baseline survey in November 2020. A validated vaping dependence score (0-23) summing up their responses to nine questions was calculated at the 3-month follow-up survey. Separate lasso regression models were developed to identify predictors of higher 3-month vaping dependence score among baseline daily and non-daily vapers. Of the 1172 participants, 643 (54.9%) were daily vapers with a mean age of 19.6 ± 2.6 years and 76.4% (n = 895) of them being female. The two models achieved adequate predictive performance. Place of last vape purchase, number of days a pod lasts, and the frequency of nicotine-containing vaping were the most important predictors for dependence among daily vapers, while race, sexual orientation and reporting treatment for heart disease were the most important predictors in non-daily vapers. These findings have implications for vaping control policies that target adolescents at different stages of vape use.
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Affiliation(s)
- Ishmeet Singh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Varna Valavil Punnapuzha
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Nicholas Mitsakakis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Rui Fu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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10
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Mavragani A, Deck A, Baskerville NB, Chaiton M. Supporting Youth Vaping Cessation With the Crush the Crave Smartphone App: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e42956. [PMID: 36705967 PMCID: PMC9919446 DOI: 10.2196/42956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/09/2022] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The use of e-cigarettes, or vaping, has increased exponentially in the past decade, particularly among youth. Emerging evidence indicates growing nicotine dependence among youth, revealing historically higher rates of dependence among current e-cigarette users compared to rates seen in earlier research. Despite the urgent need for youth vaping cessation interventions, there is limited knowledge about the process of vaping cessation, and few evidence-based interventions are available to young people seeking support. A notable literature review on vaping cessation resources for young people recommended technology-based interventions, such as smartphone apps and SMS text messaging services, as a promising area of vaping cessation research and intervention development. OBJECTIVE The primary aim of our study is to determine the effectiveness of the Crush the Crave app in supporting vaping cessation among youth recruited to the intervention arm via comparison with an assessment-only control group. The primary hypothesis is that participants in the intervention group-those using Crush the Crave-will be more likely to be abstinent at the 6-month follow-up point than participants in the assessment-only control arm. METHODS A 2-arm, single-blind, parallel randomized controlled trial will be conducted over 12 months. Study invitations will be sent to 600 youth (age: 16-18 years) and young adult (age: 19-29 years) e-cigarette users and randomized between an intervention arm, which will be using Crush the Crave (n=300), and an assessment-only control arm (n=300) in a 1:1 ratio. The primary hypothesis is that participants in the intervention group-those using Crush the Crave-will be more likely to be abstinent at the 6-month follow-up point. RESULTS Study recruitment began on March 4, 2022. Recruitment is anticipated to be completed in December 2022. CONCLUSIONS This protocol describes one of the first-ever randomized controlled trial studies to evaluate the effectiveness of an app-based intervention for supporting vaping cessation among youth aged 16 to 18 years and young adults aged 19 to 29 years. The findings from our trial will help increase our understanding of the process of vaping cessation among youth and provide evidence on the effectiveness of an app-based intervention in helping young people quit vaping. The trial results will also have implications in the development of current and future approaches to youth vaping cessation. TRIAL REGISTRATION OSF Registries osf.io/hmd87; https://doi.org/10.17605/OSF.IO/HMD87. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42956.
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Affiliation(s)
| | - Alicia Deck
- Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Michael Chaiton
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
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11
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Hammond D, Reid JL, Burkhalter R, O'Connor RJ, Goniewicz ML, Wackowski OA, Thrasher JF, Hitchman SC. Trends in e-cigarette brands, devices and the nicotine profile of products used by youth in England, Canada and the USA: 2017-2019. Tob Control 2023; 32:19-29. [PMID: 34099572 PMCID: PMC9359003 DOI: 10.1136/tobaccocontrol-2020-056371] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The e-cigarette market has rapidly evolved, with a shift towards higher nicotine concentration and salt-based products, such as JUUL; however, the implications for youth vaping remain unclear. METHODS Repeat cross-sectional online surveys were conducted in 2017, 2018 and 2019, with national samples of youth aged 16-19 years recruited from commercial panels in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Regression models examined differences between countries and over time in the types of e-cigarette products used (design and nicotine content), reasons for using brands and differences in patterns of use, sociodemographics and dependence symptoms by brand/nicotine content. RESULTS In 2019, the use of pod- or cartridge-style e-cigarettes was greater in Canada and the USA than England, with Smok and JUUL the leading brands in all countries. In 2019, youth vapers in England were less likely to report using e-cigarettes with ≥2% nicotine (12.8%) compared with Canada (40.5%; adjusted OR (AOR)=4.96; 95% CI 3.51 to 7.01) and the USA (37.0%; AOR=3.99, 95% CI 2.79 to 5.71) and less likely to report using nicotine salt-based products (12.3%) compared with Canada (27.1%; AOR=2.77, 95% CI 1.93 to 3.99) and the USA (21.9%; AOR=2.00, 95% CI 1.36 to 2.95). In 2019, self-reported use of products with higher nicotine concentration was associated with significantly greater frequency of vaping, urges to vape and perceived vaping addiction (p<0.05 for all). CONCLUSIONS The use of high-nicotine salt-based products is associated with greater symptoms of dependence, including JUUL and other higher-nicotine brands. Greater use of high-nicotine salt-based products may account for recent increases in the frequency of vaping among youth in Canada and the USA.
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Affiliation(s)
- David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Robin Burkhalter
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Olivia A Wackowski
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway Township, NJ, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara C Hitchman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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12
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Elbaz D, Bar Zeev Y, Berg CJ, Abroms LC, Levine H. Proximity of IQOS and JUUL points of sale to schools in Israel: a geospatial analysis. Tob Control 2022; 31:e156-e161. [PMID: 34753792 PMCID: PMC10674050 DOI: 10.1136/tobaccocontrol-2021-056718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/18/2021] [Indexed: 11/03/2022]
Abstract
SIGNIFICANCE Exploring proximity and density of heated tobacco product (HTP) and electronic nicotine delivery system (ENDS) points of sale (POS) to schools is critical for understanding youth marketing exposure and informing policy and enforcement to protect youth. This study examined IQOS and JUUL POS (prominent HTPs and ENDS), specifically their proximity to and density around schools in Israel. METHODS Using geospatial analysis and IQOS/JUUL website data, distance matrices were used to calculate distance from each school in Israel (grades 1-12) to the nearest POS and number of POS within 1 km, accounting for schools' neighbourhood socioeconomic status (SES) ranking. RESULTS An average of 8.7 IQOS POS and 5.2 JUUL POS were within walking distance (1 km) from schools. Average distances from schools to nearest IQOS and JUUL POS were 954 m (median=365 m) and 1535 m (median=579 m), respectively. The percentages of schools with at least one IQOS or JUUL POS within 1 km were 86% and 74%, respectively. The average numbers of POS within 1 km of schools in low-SES, middle-SES, and high-SES neighbourhoods were 7.5, 9.9, and 7.6 for IQOS and 4.1, 5.9, and 5.5 for JUUL, respectively. Median distances from schools in low-SES, middle-SES, and high-SES neighbourhoods to nearest POS were 428 m, 325 m, and 403 m for IQOS and 1044 m, 483 m, and 525 m for JUUL. CONCLUSIONS Youth experience high environmental exposure to IQOS and JUUL POS, particularly IQOS. POS were more densely located near schools in middle-SES neighbourhoods. Thus, regulating HTP and ENDS POS near schools and in certain neighbourhoods is key to reducing youth population impact in Israel and elsewhere.
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Affiliation(s)
- Daniel Elbaz
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - Yael Bar Zeev
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
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13
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Nicotine Dependence from Different E-Cigarette Devices and Combustible Cigarettes among US Adolescent and Young Adult Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105846. [PMID: 35627381 PMCID: PMC9140375 DOI: 10.3390/ijerph19105846] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
E-cigarettes, the most popular tobacco product among adolescents, vary widely in design and nicotine composition; thus, different devices may have different addictive potential. However, few studies examine levels of nicotine dependence across devices among adolescent and young adult (AYA) e-cigarette users. To assess the extent of nicotine dependence among US AYA (ages 13-24) by e-cigarette device type, we conducted a large, national, cross-sectional survey (n = 4351) and used the Hooked on Nicotine Checklist (HONC) to assess levels of nicotine dependence among those who had used disposable, pod-based, and/or mods/other e-cigarette devices in the past 30 days. We also examined HONC scores among those who had used combustible cigarettes in the past 30 days, whether with or without using e-cigarettes. Patterns of nicotine dependence were comparable across those who had used a combustible cigarette and/or e-cigarette in the past 30 days, with 91.4% of combustible cigarette users, 80.7% of disposable e-cigarette users, 83.1% of pod-based e-cigarette users, and 82.5% of mods/other e-cigarette users showing signs of nicotine dependence, as measured by endorsing at least one HONC symptom. This pattern persisted when analyses were restricted to e-cigarette only users, with more than 70% of all e-cigarette only past-30-day users endorsing at least one HONC symptom, across all types of devices. A thorough understanding of the extent and presentation of nicotine dependence among AYA will help researchers, public health officials, and clinicians recognize and manage AYA nicotine dependence.
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14
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Huma ZE, Struik L, Bottorff JL, Hasan MK. Preferences for Mobile-Supported e-Cigarette Cessation Interventions Among Young Adults: Qualitative Descriptive Study. JMIR Form Res 2022; 6:e33640. [PMID: 35363140 PMCID: PMC9015737 DOI: 10.2196/33640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/04/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Despite the steady rise in electronic cigarette (e-cigarette) uptake among young adults, increasingly more young people want to quit. Given the popularity of smartphones among young adults, mobile-based e-cigarette cessation interventions hold significant promise. Smartphone apps are particularly promising due to their varied and complex capabilities to engage end users. However, evidence around young adults’ preferences and expectations from an e-cigarette cessation smartphone app remains unexplored.
Objective
The purpose of this study was to take an initial step toward understanding young adults’ preferences and perceptions on app-based e-cigarette cessation interventions.
Methods
Using a qualitative descriptive approach, we interviewed 12 young adults who used e-cigarettes and wanted to quit. We inductively derived themes using the framework analysis approach and NVivo 12 qualitative data analysis software.
Results
All participants agreed that a smartphone app for supporting cessation was desirable. In addition, we found 4 key themes related to their preferences for app components: (1) flexible personalization (being able to enter and modify goals); (2) e-cigarette behavior tracking (progress and benefits of quitting); (3) safely managed social support (moderated and anonymous); and (4) positively framed notifications (encouraging and motivational messages). Some gender-based differences indicate that women were more likely to use e-cigarettes to cope with stress, preferred more aesthetic tailoring in the app, and were less likely to quit cold turkey compared with men.
Conclusions
The findings provide direction for the development and testing of app-based e-cigarette cessation interventions for young adults.
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Affiliation(s)
- Zil E Huma
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Laura Struik
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Joan L Bottorff
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
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15
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Sanchez S, Kundu A, Limanto E, Selby P, Baskerville NB, Chaiton M. Smartphone Apps for Vaping Cessation: Quality Assessment and Content Analysis. JMIR Mhealth Uhealth 2022; 10:e31309. [PMID: 35343904 PMCID: PMC9002586 DOI: 10.2196/31309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/08/2021] [Accepted: 01/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background As the prevalence of electronic cigarette (e-cigarette) use, or vaping, continues to grow, particularly among young people, so does the need for research and interventions to address vaping. Objective This study examines the quality of free vaping cessation apps, their contents and features, popularity among users, and adherence to evidence-based principles. Methods A systematic search of existing apps for vaping cessation was conducted in December 2020. Eligible apps were free, in English, and included features specifically targeting vaping cessation. Each app included in the analysis was used daily for at least seven consecutive days, assessed using the Mobile App Rating Scale, and rated by at least two authors (AK, EL, or SS) based on adherence to evidence-based practices. Intraclass correlation coefficient (ICC) estimates were computed to assess interrater reliability (excellent agreement; ICC 0.92; 95% CI 0.78-0.98). Results A total of 8 apps were included in the quality assessment and content analysis: 3 were developed specifically for vaping cessation and 5 focused on smoking cessation while also claiming to address vaping cessation. The mean of app quality total scores was 3.66 out of 5. Existing vaping cessation apps employ similar approaches to smoking cessation apps. However, they are very low in number and have limited features developed specifically for vaping cessation. Conclusions Given the lack of vaping cessation interventions at a time when they are urgently needed, smartphone apps are potentially valuable tools. Therefore, it is recommended that these apps apply evidence-based practices and undergo rigorous evaluations that can assess their quality, contents and features, and popularity among users. Through this process, we can improve our understanding of how apps can be effective in helping users quit vaping.
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Affiliation(s)
- Sherald Sanchez
- Institute of Medical Science, Termerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anasua Kundu
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Limanto
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Michael Chaiton
- Institute of Medical Science, Termerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
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16
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Bold K, Kong G, Cavallo D, Davis D, Jackson A, Krishnan-Sarin S. School-based E-cigarette cessation programs: What do youth want? Addict Behav 2022; 125:107167. [PMID: 34753093 PMCID: PMC8629945 DOI: 10.1016/j.addbeh.2021.107167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE E-cigarette use is a problem among youth, yet few vaping cessation programs exist. This study aimed to understand what youth want in a school-based vaping cessation program to inform intervention development. METHODS We conducted 8 focus groups in Fall 2019 with Connecticut high school youth (N = 4-10 adolescents per group, total N = 62, 50% female). 6 groups were with youth who were current (i.e., past-month) e-cigarette users and 2 groups were with past users (i.e., lifetime users with no past-month use). Discussions focused on desired features and concerns about a vaping cessation program and analyses used an iterative inductive and deductive approach to identify qualitative themes. We also collected brief survey data assessing skills youth wanted to learn from a vaping cessation program. RESULTS Qualitative themes emerged indicating that youth want a vaping cessation program to include education about health effects of vaping, relatable personal anecdotes from others, and rewards for quitting. Potential concerns include confidentiality (e.g., ensuring teachers/coaches would not know about e-cigarette use), perceptions that youth may not want to participate due to lack of interest/apathy or embarrassment, and needing methods to verify abstinence to limit inaccurate reporting. The most frequently endorsed skills from the survey indicated youth want to learn ways to deal with stress (92%), relax (60%), and deal with poor concentration/attention (55%). CONCLUSIONS Findings identified key features to include and issues to address when developing school-based vaping cessation programs. Developing effective vaping cessation programs that appeal to youth is important for addressing youth e-cigarette use.
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Affiliation(s)
- Krysten Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Dana Cavallo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Danielle Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Asti Jackson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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