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Blank MD, Turiano NA, Bray BC, Milstred AR, Childers M, Dino G, Romm KF. Factors associated with transitions in tobacco product use states among young adults aged 18-29 years. Am J Addict 2024; 33:409-422. [PMID: 38402462 DOI: 10.1111/ajad.13524] [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: 05/01/2023] [Revised: 12/19/2023] [Accepted: 02/10/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined young adults' tobacco use transitions based on their past 30-day use states, and identified factors associated with their transitions. METHODS Participants (N = 12377) were young adults aged 18-29 years at Wave 1 of the Population Assessment of Tobacco and Health (PATH) study. Self-reported tobacco use states were categorized by the number of past-month use days (0, 1-4, 5-8, 9-12, 13-30 days) for cigarettes, electronic cigarettes [e-cigarettes], traditional cigars, filtered cigars, cigarillos, smokeless tobacco (SLT), and hookah. Multistate Markov models examined transitions between use states across Waves 1-5 of unweighted PATH data and multinomial logistic regressions examined predictors of transitions. RESULTS Most young adults remained nonusers across adjacent waves for all products (88%-99%). Collapsed across waves, transitioning from use at any level to nonuse (average 46%-67%) was more common than transitioning from nonuse to use at any level (average 4%-10%). Several factors that predicted riskier patterns of use (i.e., transitioning to use and/or remaining a user across adjacent waves) were similar across most products: male, Black, Hispanic, lower education levels, and lower harm perceptions. In contrast, other factors predicted riskier patterns for only select products (e.g., e-cigarette and SLT use among Whites). DISCUSSION AND CONCLUSIONS Few sampled young adults escalated their tobacco use over time, and escalations for many products were predicted by similar factors. SCIENTIFIC SIGNIFICANCE Prevention and regulatory efforts targeted towards adolescents should continue, but also be expanded into young adulthood. These same efforts should consider both shared and unique factors that influence use transitions.
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Affiliation(s)
- Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Nicholas A Turiano
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Bethany C Bray
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea R Milstred
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Margaret Childers
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Geri Dino
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Walters KJ, Emery NN, Thrul J, Tomko RL, Gray KM, McClure EA. Temporal associations linking alcohol and cannabis use to cigarette smoking in young adults engaged in a tobacco cessation and relapse monitoring study. Addict Behav 2024; 149:107902. [PMID: 37924584 PMCID: PMC10842007 DOI: 10.1016/j.addbeh.2023.107902] [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: 04/10/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
Young adulthood remains a developmental period in which cigarette smoking initiation and progression to dependence and regular use is common. Moreover, co-use of alcohol and/or cannabis with tobacco is common in this age group and may have detrimental effects on tobacco use rates and cessation outcomes. Although young adults are interested in quitting smoking, achieving abstinence remains difficult, even with evidence-based treatment strategies. Understanding proximal associations between other substance use (e.g., alcohol and cannabis) and smoking may have important treatment implications. This exploratory analysis investigated the role of alcohol and/or cannabis use in contributing to smoking events on the same day or next day among young adults engaged in a smoking cessation and relapse monitoring study. We used ecological momentary assessment (EMA) data from 43 young adults (ages 18-25; 932 observations) who smoked cigarettes daily and agreed to participate in a 5-week study that included a 2-day smoking quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence (incentives were provided only during the 2-day quit attempt). We tested multilevel time-series models of daily associations between alcohol use, cannabis use, and smoking. Consistent with hypotheses, days on which participants were more likely to drink alcohol predicted increased likelihood of smoking the next day (OR = 2.27, p =.003). This effect was significant after controlling for both the one-day lagged effect of smoking (i.e., autoregression) and the concurrent (i.e., same day) effects of drinking and cannabis use. Although there was a positive concurrent effect of cannabis use on smoking (OR = 12.86, p =.003), the one-day lagged effect of cannabis use and the concurrent effect of drinking was not significant, contrary to hypotheses. Results indicate that alcohol use presents a potential threat to successful smoking cessation that extends to the following day. This suggests a risk-window in which treatment could be supplemented with just-in-time interventions and extending the focus on co-use to include this lagged impact on cessation outcomes.
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Affiliation(s)
- Kyle J Walters
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Noah N Emery
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Alam F, Silveyra P. Sex Differences in E-Cigarette Use and Related Health Effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7079. [PMID: 37998310 PMCID: PMC10671806 DOI: 10.3390/ijerph20227079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) comprise a variety of products designed to deliver nicotine, flavorings, and other substances. To date, multiple epidemiological and experimental studies have reported a variety of health issues associated with their use, including respiratory toxicity, exacerbation of respiratory conditions, and behavioral and physiological effects. While some of these effects appear to be sex- and/or gender-related, only a portion of the research has been conducted considering these variables. In this review, we sought to summarize the available literature on sex-specific effects and sex and gender differences, including predictors and risk factors, effects on organ systems, and behavioral effects. METHODS We searched and selected articles from 2018-2023 that included sex as a variable or reported sex differences on e-cigarette-associated effects. RESULTS We found 115 relevant studies published since 2018 that reported sex differences in a variety of outcomes. The main differences reported were related to reasons for initiation, including smoking history, types of devices and flavoring, polysubstance use, physiological responses to nicotine and toxicants in e-liquids, exacerbation of lung disease, and behavioral factors such as anxiety, depression, sexuality, and bullying. CONCLUSIONS The available literature supports the notion that both sex and gender influence the susceptibility to the negative effects of e-cigarette use. Future research needs to consider sex and gender variables when addressing e-cigarette toxicity and other health-related consequences.
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Affiliation(s)
- Fatima Alam
- Department of Environmental and Occupational Health, Indiana University School of Public Health Bloomington, Bloomington, IN 47405, USA;
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, Indiana University School of Public Health Bloomington, Bloomington, IN 47405, USA;
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 47405, USA
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Bluestein MA, Kuk AE, Harrell MB, Chen B, Hébert ET, Pérez A. Longitudinal Transition Patterns of Tobacco Use Among Youth and Young Adults Never Tobacco Product Users: Findings From the Population Assessment of Tobacco and Health Study, 2014-2019. Tob Use Insights 2023; 16:1179173X231161314. [PMID: 36923154 PMCID: PMC10009036 DOI: 10.1177/1179173x231161314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Aims To identify, visualize, and describe the prevalence of within-product patterns of tobacco use behaviors for e-cigarettes, cigarettes, and hookah (TP) by 3 age groups (ie, 12-14-year-old, 15-17-year-old, and 18-20-year-old) with U.S. nationally representative data. Methods In 2014-2015, never users of each (TP) and age group were followed-up longitudinally between 2015-2019 using five transition states: non-susceptible to (TP) use, susceptible to (TP) use, ever (TP) use, past 30-day (TP) use, and discontinued past 30-day (TP) use. Sankey diagrams were used to graphically visualize patterns in tobacco use behaviors across time. Results Among 12-14-year-old who were never users and susceptible to each TP from 2014-2017, 7% initiated ever e-cigarette use and 9.4% first reported past 30-day use by 2018-2019; 5.8% initiated ever cigarette use and 3% first reported past 30-day cigarette use by 2018-2019; and, 4.5% initiated ever hookah use and 1.0% first reported past 30-day hookah use by 2018-2019. Among 15-17-year-old who were never users and susceptible to each TP from 2014-2017, 4.2% initiated ever e-cigarette use and 9.0% first reported past 30-day use by 2018-2019; 4.5% initiated ever cigarette use and 3% first reported past 30-day cigarette use by 2018-2019; and, 4.5% initiated ever hookah use and 2.4% first reported past 30-day hookah use by 2018-2019. Among 18-20-year-old who were never users and susceptible to each TP from 2014-2017, 3.2% initiated ever e-cigarette use and 3.6% first reported past 30-day e-cigarette use by 2018-2019; 3.0% initiated ever cigarette use and 2.3% first reported past 30-day cigarette use; and, 2.8% initiated ever hookah use and 1.0% first reported past 30-day hookah use by 2018-2019. Conclusions From 2014 to 2019, onset and progression of e-cigarette, cigarette, and hookah use occurred more frequently in 12-14 and 15-17-year-old than in young adults 18-20-year-old.
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Affiliation(s)
- Meagan A Bluestein
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Arnold E Kuk
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Melissa B Harrell
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA.,Department of Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin Campus, Austin, TX, USA
| | - Baojiang Chen
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Emily T Hébert
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA.,Department of Health Promotion and Behavioral Sciences, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, USA
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Kuk AE, Bluestein MA, Chen B, Harrell M, Spells CE, Atem F, Pérez A. The Effect of Perceptions of Hookah Harmfulness and Addictiveness on the Age of Initiation of Hookah Use among Population Assessment of Tobacco and Health (PATH) Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5034. [PMID: 35564430 PMCID: PMC9105245 DOI: 10.3390/ijerph19095034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
Despite the negative health consequence of hookah, hookah risk perceptions are misguided among youth. Secondary data analysis of 12-17-year-old never hookah users at their first wave of PATH participation (2013-2019) was performed. The effect of perceptions of hookah harmfulness and addictiveness on the age of initiation ever, past 30-day, and fairly regular hookah use were estimated using interval-censored Cox proportional hazards models. The distribution of the age of initiation of hookah outcomes by perception levels of harmfulness and addictiveness are reported as cumulative incidence and 95% CI. Youth who perceived hookah to be neither harmful nor addictive were 173% more likely to initiate ever, 166% more likely to first report past 30-day use, and 142% more likely to first report fairly regular hookah use at earlier ages compared to youth who considered hookah to be both harmful and addictive. By age 18, 25.5% of youth who perceived hookah as neither harmful nor addictive were estimated to initiate ever hookah use while 9.3% of youth who perceived hookah as harmful and addictive were estimated to initiate ever hookah use. These findings indicate the need to provide prevention and education campaigns to change perceptions of the harmfulness and addictiveness of hookah to delay the age of initiation of hookah use.
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Affiliation(s)
- Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
| | - Baojiang Chen
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA
| | - Melissa Harrell
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA
| | - Charles E. Spells
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
| | - Folefac Atem
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX 75207, USA;
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (A.E.K.); (M.A.B.); (B.C.); (M.H.); (C.E.S.)
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA
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Pérez A, Bluestein MA, Kuk AE, Chen B, Sterling KL, Harrell MB. Age of Onset of Susceptibility to Different Tobacco Products Among Non-Susceptible US Young Adults: Findings from the Population Assessment of Tobacco and Health Study Waves 2-4 (2014-2017). Tob Use Insights 2021; 14:1179173X211065643. [PMID: 34924777 PMCID: PMC8671673 DOI: 10.1177/1179173x211065643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Initiation of tobacco products is increasing in young adulthood. This study prospectively estimated the age of onset of susceptibility to cigarettes, e-cigarettes, hookah, smokeless tobacco, and cigarillos among young adults, which is a cognitive precursor to initiation. METHODS Secondary data analyses of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative longitudinal cohort study of US adults. Young adults (18-24 years) who were non-susceptible to each tobacco product (cigarettes, e-cigarettes, hookah, smokeless tobacco, and cigarillos) at waves 2 or 3 were followed-up into waves 3-4 to prospectively estimate the age of onset of susceptibility to each tobacco product. Weighted interval-censored survival methods and interval-censored Cox regression models were implemented to estimate the age of onset of susceptibility, and to estimate differences in the hazard function by sex and by race/ethnicity, while controlling for the total number of other tobacco products ever used at their first wave of participation in PATH. RESULTS By age 21, 16.5%, 16.0%, 12.6%, 12.4%, and 5.9% of young adults reported onset of susceptibility to hookah, e-cigarettes, cigarillos, cigarettes, and smokeless tobacco, respectively. Among young adults who were non-susceptible to each tobacco product at waves 2 or 3, the highest increase in onset of susceptibility occurred between ages 18 and 19 for cigarettes, e-cigarettes, and hookah, while the highest increase in onset of susceptibility occurs between ages 22 and 23 for cigarillos. Young adult males had increased risk of onset of susceptibility to cigarillos and smokeless tobacco at earlier ages than young adult females. Differences in onset of susceptibility to each tobacco product were also observed by race/ethnicity among young adults. CONCLUSIONS With the changing landscape of tobacco products, monitoring the age of onset of susceptibility of tobacco product use among non-susceptible young adults longitudinally is critical to prevent initiation. Communication and education campaigns tailored to address differences in susceptibility among young adults by tobacco product and sociodemographic factors will be useful.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Adriana Pérez, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin Campus, Austin, TX 78701, USA.
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Kymberle L. Sterling
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
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