Adolescent Tobacco Use and Misperceptions of Social Norms Across Schools in the United States

Water Treatment Practices and Misperceived Social Norms among Women Living with Young Children in Rural Uganda

Access to water safe for consumption is critical for health and well-being, yet substantial structural barriers often necessitate household action to make water safer. Social norms about water treatment practices are understudied as a driver of personal water treatment practice. This study assesses reported and perceived water treatment practices among women in a rural, water insecure setting. We used cross-sectional data from a population-based study of women living with children under 5 years old across eight villages in southwest Uganda. Participants reported their typical household water treatment practices and what they perceived to be the common practices among most other women with young children in their own village. Modified multivariable Poisson regression models estimated the association between individual behavior and perceptions. Of 274 participants (78% response rate), 221 (81%) reported boiling water and 228 (83%) reported taking at least one action to make water safer. However, 135 (49%) misperceived most women with young children in their village not to boil their water, and 119 (43%) misperceived most to take no action. Participants who misperceived these norms were less likely to practice safe water treatment (e.g., for boiling water, adjusted relative risk = 0.80; 95% CI 0.69-0.92, P = 0.002), adjusting for other factors. Future research should assess whether making actual descriptive norms about local water treatment practices visible and salient (e.g., with messages such as "most women in this village boil their drinking water") corrects misperceived norms and increases safe water treatment practices by some and supports consistent safe practices by others.

Association of monoaminergic gene polymorphisms in chronic inflammatory pulmonary disease patients with successful smoking cessation

BACKGROUND

Albeit smoking cessation has unequivocal health benefits, attempts to quit are not unanimous, even in patient populations at high risk for smoking-related diseases cessation. Allelic variations of enzymes involved in dopamine metabolism are being considered as candidates for nicotine addiction. We set out to assess whether rs4680 G/A and rs2235186 G/A polymorphisms of COMT and MAO-A, respectively are associated with the ability to quit smoking in chronic inflammatory pulmonary disease patients.

METHODS

Patients managed for chronic inflammatory pulmonary disease by the Department of Pulmonology (University of Debrecen, Hungary), with a current or past smoking habit were included in the current analysis. The study was designed in line with the STROBE statement for cross-sectional studies and was approved by the National Center for Public Health, Hungary. Genomic DNA was extracted from peripheral blood specimens. SNPs were genotyped using TaqMan SNP genotyping assays.

RESULTS

rs4680 COMT polymorphism showed significant effect for successful smoking cessation in patients with pulmonary disease. Accordingly, A/A subjects had lower odds for successful smoking cessation (odds ratio 0.37; 95% confidence interval 0.20-0.69, p = 0.002 (additive model). On the other hand, patients homozygous for the minor allele (A) at rs2235186 of MAO-A showed a non-significant trend toward increased odds for successful smoking cessation.

CONCLUSIONS

The presence of the minor allele for rs4680 COMT was shown to decrease the odds for successful smoking cessation, a finding that may be interpreted in view of the altered balance between tonic and phasic dopamine release.

Neural Tracking of Perceived Parent, but Not Peer, Norms Is Associated with Longitudinal Changes in Adolescent Attitudes about Externalizing Behaviors

Adolescents' perceptions of parent and peer norms about externalizing behaviors influence the extent to which they adopt similar attitudes, yet little is known about how the trajectories of perceived parent and peer norms are related to trajectories of personal attitudes across adolescence. Neural development of midline regions implicated in self-other processing may underlie developmental changes in parent and peer influence. Here, we examined whether neural processing of perceived parent and peer norms in midline regions during self-evaluations would be associated with trajectories of personal attitudes about externalizing behaviors. Trajectories of adolescents' perceived parent and peer norms were examined longitudinally with functional neuroimaging (n = 165; ages 11-16 years across three waves; 86 girls, 79 boys; 29.7% White, 21.8% Black, 35.8% Latinx, 12.7% other/multiracial). Behavioral results showed perceived parent norms were less permissive than adolescents' own attitudes about externalizing behaviors, whereas perceived peer norms were more permissive than adolescents' own attitudes, effects that increased from early to middle adolescence. Although younger adolescents reported less permissive attitudes when they spontaneously tracked perceived parent norms in the ventromedial and medial pFCs during self-evaluations, this effect weakened as they aged. No brain-behavior effects were found when tracking perceived peer norms. These findings elucidate how perceived parent and peer norms change in parallel with personal attitudes about externalizing behaviors from early to middle adolescence and underscore the importance of spontaneous neural tracking of perceived parent norms during self-evaluations for buffering permissive personal attitudes, particularly in early adolescence.

Impact of social networks and norms on e-cigarette use among adolescents in Southern California: a prospective cohort study

Objective

Using social network analysis, we assessed the mechanisms of social influence that promote e-cigarette use in adolescent networks.

Methods

Data on health behaviours and friendship networks from a cohort of 10 high schools in Southern California (N=1599) were collected in grade 9 Spring 2021 (W1), grade 10 Fall 2021 (W2) and Spring 2022 (W3). Two mixed effects logistic regression models were estimated (full sample and subsample of non-vapers only) to evaluate the associations of W1 and W2 pro-vaping norms, peer e-cigarette use exposure and prior e-cigarette use (full sample) on past 6-month vaping at W3, adjusting for demographic covariates and school clustering.

Results

Previous vaping was the strongest predictor of past 6-month vaping at W3 among the full sample. Greater exposure to friend e-cigarette use at W2 (adjusted OR (AOR)=12.2, 95% CI 4.04 to 36.5) and greater pro-vaping norms at W2 (AOR=2.63, 95% CI 1.24 to 5.55) were significantly and positively associated with increased odds of initiating e-cigarette use at W3 among students with no lifetime e-cigarette use.

Conclusion

Peer network exposure and pro-vaping norms are significant predictors of vaping initiation even when network vaping prevalence is low.

Cigarette smoking and misperceived norms among adults in rural Uganda: a population-based study

BACKGROUND

Little is known about perceived norms about cigarette smoking in Uganda or the extent to which perceptions drive personal cigarette smoking behaviour.

METHODS

We conducted a cross-sectional study in 2016-2018 that targeted all adults who resided within eight villages in Rwampara District, southwestern Uganda. Personal cigarette smoking frequency was elicited by self-report. We also asked participants what they believed to be the cigarette smoking frequency of most other adult men and women in their villages (i.e., perceived norms). Frequent cigarette smoking was defined as 4+ times/week. We compared perceived norms to cigarette smoking frequency reports aggregated at the village level. We used multivariable Poisson regression to estimate the association between perceived norms and personal cigarette smoking behaviour.

RESULTS

Among 1626 participants (91% response rate), 92 of 719 men (13%) and 6 of 907 women (0.7%) reported frequent smoking. However, 1030 (63%) incorrectly believed most men in their villages smoked cigarettes frequently. Additionally, 116 (7%) incorrectly believed that most women in their villages smoked cigarettes frequently. These misperceptions were pervasive across social strata. Men who misperceived frequent cigarette smoking as the norm among other men in their villages were more likely to smoke frequently themselves (adjusted relative risk=1.49; 95% CI, 1.13 to 1.97).

CONCLUSIONS

Most adults overestimated cigarette smoking frequency among village peers. Men who incorrectly believed that frequent smoking was the norm were more likely to engage in frequent smoking themselves. Applying a 'social norms approach' intervention by promoting existing healthy norms may prevent smoking initiation or motivate reductions in smoking among men in rural Uganda.

The prototype willingness model: An application to adolescent driver speeding

INTRODUCTION

Many young drivers are involved in crashes due to speeding. Some studies have used the Prototype Willingness Model (PWM) to explain the risky driving behavior of young people. However, many have measured PWM constructs in a manner inconsistent with its formulation. The PWM asserts that the social reaction pathway is underpinned by a heuristic comparison of oneself with a cognitive prototype of someone who engages in a risky behavior. This proposition has not been comprehensively examined and few PWM studies specifically examine social comparison. The current study investigates intentions, expectations, and willingness to speed by teen drivers using operationalizations of PWM constructs more aligned with their original conceptualizations. Additionally, the influence of dispositional social comparison tendency on the social reaction pathway is examined to further test the original propositions underpinning the PWM.

METHOD

Two hundred and eleven independently driving adolescents completed an online survey including items measuring PWM constructs and social comparison tendency. Hierarchical multiple regression was used to investigate the influence of perceived vulnerability, descriptive and injunctive norms, and prototypes on speeding intentions, expectations, and willingness. A moderation analysis examined the effect of social comparison tendency on the association between prototype perceptions and willingness.

RESULTS

The regression models explained substantial amounts of variance in intentions (39%), expectations (49%), and willingness (30%) to speed. There was no evidence that social comparison tendency influences the relationship between prototypes and willingness.

CONCLUSIONS

The PWM is useful for predicting teenage risky driving. More studies should confirm that social comparison tendency does not moderate the social reaction pathway. However, there may be need for further theoretical development of the PWM.

PRACTICAL APPLICATIONS

The study suggests that it may be possible to develop interventions to reduce adolescent driver speeding based on manipulation of PWM constructs such as speeding driver prototypes.

Race and Ethnic Differences in the Protective Effect of Parental Educational Attainment on Subsequent Perceived Tobacco Norms among US Youth

BACKGROUND

Although parental educational attainment is known to be associated with a lower prevalence of behaviors such as tobacco use, these effects are shown to be weaker for Black than White youth. It is important to study whether this difference is due to higher perceived tobacco use norms for Black youth.

AIM

To study the association between parental educational attainment and perceived tobacco use norms overall and by race/ethnicity among youth in the US.

METHODS

The current study used four years of follow-up data from the Population Assessment of Tobacco and Health (PATH-Youth) study conducted between 2013 and 2017. All participants were 12- to 17-year-old non-smokers at baseline and were successfully followed for four years (n = 4329). The outcome of interest was perceived tobacco use norms risk at year four. The predictor of interest was baseline parental educational attainment, the moderator was race/ethnicity, and the covariates were age, sex, and parental marital status at baseline.

RESULTS

Our linear regressions in the pooled sample showed that higher parental educational attainment at baseline was predictive of perceived disapproval of tobacco use at year four; however, this association was weaker for Latino than non-Latino youth. Our stratified models also showed that higher parental educational attainment was associated with perceived tobacco use norms for non-Latino but not for Latino youth.

CONCLUSION

The effect of high parental educational attainment on anti-tobacco norms differs between Latino and non-Latino youth. Latino youth with highly educated parents remain at risk of tobacco use, while non-Latino youth with highly educated parents show low susceptibility to tobacco use.

Stealth vaping and associated attitudes, perceptions, and control beliefs among US college students across four tobacco-free campuses

OBJECTIVES

Stealth vaping gained popularity among college students in recent years. It may undermine the benefits introduced by tobacco-free policies. Yet, no studies have investigated attitude and belief factors associated with stealth vaping. The objective of the study was to explore the relationship between attitudes toward on-campus tobacco regulations, normative perceptions of stealth vaping behaviors, and control beliefs with on-campus stealth vaping among U.S. college students.

METHODS

Participants from four large, public universities with policies prohibiting use of all forms of tobacco (including e-cigarettes) on campus (N = 863) completed an online survey in Fall 2020. On-campus stealth vaping behavior was captured by past 30-day stealth vaping status and frequency. Hurdle models with logistic and negative binomial regressions were conducted, where stealth vaping status was treated as a binary variable based on the non-zero and zero frequency, and stealth vaping frequency was treated as a count variable. Multiple imputation by chained equations was employed to handle the missing data.

RESULTS

Participants with more positive attitudes toward regulating on-campus tobacco use were less likely to practice stealth vaping on campus (OR = 1.16, p < 0.01 [predicting zero]). Those with higher perceptions of stealth vaping among other students were more likely to stealth vape more frequently (IRR = 1.03, p < 0.01).

CONCLUSION

Our results highlight the need for interventions to address students' attitudes and normative beliefs about stealth vaping. Efforts are needed to educate college students about the risk of e-cigarettes and to enhance enforcement of campus tobacco-free policies.

Assessing Adolescent Vaping Norms and Perceptions in a Statewide Multi-Community Project

Background: Adolescent e-cigarette use has increased dramatically in recent years and is quickly becoming a serious public health issue. While studies have identified the influence of social norms on the use of traditional cigarettes, few have examined these factors in the context of e-cigarettes and other vaping devices. Objective: The goal of this study was to examine social norms predictors of past 30-day e-cigarette use among high school students in 10 communities located in Minnesota. Results: In our sample (N = 3,285), students who believe most students in their school vape daily are more likely to have vaped in the past 30 days than those who believe most students vape weekly or less frequently. Further, students were likely to have used e-cigarettes in the past 30 days if they perceived that most students approved of vaping (i.e., they disagreed with the statement that, "vaping is not a good thing for anyone their age to do"). Findings from this study highlight social norms related to perceptions that increase the likelihood of past 30-day e-cigarette use. Conclusions: Results from this study lend themselves to norms-based prevention science strategies that are critical to reducing e-cigarette use among high school students.

Psychosocial Indicators of Adolescent Alcohol, Cigarette, and Marijuana Use: An Analysis of Normalized, Harmonized, and Pooled Data

We normalized, harmonized, and pooled 344,429 surveys collected from 106,470 research participants from 25 research studies that assessed past 30-day alcohol use, drunkenness, smoking cigarettes, using marijuana, and a host of psychosocial variables. After normalizing and harmonizing psychosocial measures, we completed analyses to examine the ability of psychosocial variables to serve as proxy indicators of use. Intentionality, peer descriptive normative beliefs, and age emerged as being of primary importance in indicating use. Additional variables - peer injunctive norms, beliefs about the positive and negative consequences of use, and attitudes - were also demonstrated to have the potential to serve as proxies in the assessment of substance use risk. There were developmental patterns in how intentionality and descriptive normative beliefs changed with age. Young adolescents had scores that are protective; they have positive intentionality and do not see the prevalence of alcohol and other drug use as widespread. These and other psychosocial variable's mean scores generally erode with age while the distribution of scores widens as youth grow older. The goal of analyses was to define age-related psychosocial profiles that can be used prospectively to estimate substance use risk. These profiles are useful in creating virtual control cases for evaluating disseminated prevention programs.

Tobacco Dependence Among French University Students: A Cluster Analytic Approach to Identifying Distinct Psychological Profiles of Smokers

This study investigates the combination of several psychological factors related to tobacco smoking to identify smokers’ psychological profiles among French university students. A cluster analysis was performed on smoking motives, psychosocial variables, and the smoker identity ( N = 909). Five profiles were identified and then compared regarding tobacco dependence and motivations to quit. “Normative” and “sociohedonist smokers” are characterized by two distinct social factors (normative influences and social motives) and moderate dependence. “Dependent identified smokers” have higher levels of dependence motives, smoker identity and tobacco dependence associated with low motivations to quit. “Inconsistent smokers” have weak smoker identity and weak smoking motives, a strong perceived control over resisting smoking, low dependence and motivations to quit. “Coping smokers” have strong sedative and addictive motives and exhibit moderate dependence and motivations to quit. This research encourages prevention programs to consider the diversity of student smokers with strategies adapted to their psychological profiles.

Perceptions About Local ART Adherence Norms and Personal Adherence Behavior Among Adults Living with HIV in Rural Uganda

Although misperceived norms often drive personal health behaviors, we do not know about this phenomenon in the context of antiretroviral therapy (ART) adherence. We conducted a cross-sectional study including all persons living with HIV (PLWH) on ART across eight villages in one parish in a rural region of southwestern Uganda. We used surveys to measure personal reports of ART adherence (not missing any doses of ART in the past 7 days was considered optimal adherence whereas missing doses was considered suboptimal adherence) and perceived norms about the local ART adherence norm (whether or not each individual thought 'most other PLWH on ART in this parish' missed any doses in the past 7 days). Multivariable Poisson regression models were used to estimate the association between perceived norms and personal adherence. Among 159 PLWH on ART (95% response rate), 142 (89%) reported no missed doses. However, 119 (75%) thought most individuals in this population of PLWH on ART were sub-optimally adherent. This misperception about the local ART adherence norm was prevalent in every subgroup of PLWH. Misperceiving the local ART adherence norm to be sub-optimal adherence was associated with a reduced likelihood of optimal adherence among married PLWH (adjusted relative risk [aRR] = 0.83; 95% confidence interval [CI] 0.71-0.97). The association was similar but imprecisely estimated for all PLWH (aRR = 0.91; 95% CI 0.82-1.01). Interventions to correct misperceived ART adherence norms as a stand-alone intervention or as a complement to other adherence promotion programs may influence ART adherence behavior and perhaps reduce HIV-related stigma.

Parent-child Communication, Social Norms, and the Development of Cyber Aggression in Early Adolescence

To understand the development of cyber aggression during adolescence, it is important to consider the temporal variability of its potential predictors. This study uses a four-wave survey to investigate how changes in peer norms, parental norms, and parental communication are associated with two-year trajectories of online peer aggression. The sample includes 1521 Swiss middle school students (M_age T1 = 11.54, SD = 0.40; 48% female). The results showed that over time a better parental communication quality and anti-aggression norms predicted lower rates and slower development of cyber aggression. Moreover, parental variables emerged as a quite stable deterrent of aggressive conduct. Although entrance into adolescence is characterized by the rise of peer influence, results from this study suggest that parents maintain an important protective role.

Perceived and misperceived norms about khat and/or cannabis use among adults in southwest Uganda

BACKGROUND

Studies from high-income contexts have found evidence that norms about substance use are misperceived. The accuracy of perceived norms about khat and cannabis use in Uganda have not previously been described.

METHODS

We conducted a population-based study targeting all resident adults across eight villages in southwestern Uganda. Personal khat and/or cannabis use frequency was based on self-report. We measured perceived norms about substance use by eliciting individuals' perceptions about how often most other adult men and most other adult women in their villages used these substances. We compared perceived norms to aggregated village rates of use to assess the extent to which norms were misperceived. We used multivariable Poisson regression to estimate correlates of misperceived norms.

RESULTS

Among 1626 participants (91% response rate), only 29 men (4%) and 9 women (1%) reported any lifetime use of khat and/or cannabis. However, 695 participants (43%) did not think lifetime abstinence was the norm among men in their villages, and 256 participants (16%) did not think lifetime abstinence was the norm among women. Moreover, 219 participants (13%) incorrectly believed most men in their village regularly used khat and/or cannabis (≥4 times per week). Misperceived norms were present across subgroups and were correlated with larger social networks, symptoms of depression, loneliness, and younger age.

CONCLUSION

In this study of all adults across 8 villages in rural Uganda, many participants misperceived norms about khat and/or cannabis use. Providing accurate information about prevailing norms in the local population may help prevent initiation of khat and/or cannabis use among adults in this context.

Stealth Vaping Among College Students on Four Geographically Distinct Tobacco-Free College Campuses: Prevalence and Practices

INTRODUCTION

To offset tobacco use among college students, many universities have implemented tobacco-free campus policies. Given how easily e-cigarette users can discreetly vape in places where it is prohibited without being detected (ie, stealth vape), it is important to assess whether students are subverting these policies. This study examined the prevalence of stealth vaping on-campus among students at multiple universities, including frequency and methods for stealth vaping.

AIMS AND METHODS

A convenience sample of college students was obtained from four geographically distinct, large, public universities with established policies prohibiting all forms of tobacco use on campus. Participants (N = 863 current e-cigarette users) reported on demographics and e-cigarette use. Those who previously stealth vaped on-campus (n = 422) completed additional questions, including common locations, techniques, and devices/e-liquids used for stealth vaping.

RESULTS

Nearly half (48.9%) of past 30-day e-cigarette users reported previously stealth vaping on-campus. Among stealth vapers, 48.1% owned a smaller device for stealth vaping and 38.9% used e-liquids with low visibility vapors. Common on-campus stealth vaping locations included bathrooms, libraries, parking garages, and classrooms. Techniques used for stealth vaping included deep inhale, blowing a hit into one's clothes, and swallowing a hit.

CONCLUSIONS

A large percentage of respondents commonly violated campus tobacco-free policies by stealth vaping. For such policies to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications.

IMPLICATIONS

This sample of college student e-cigarette users commonly violated campus smoke- and tobacco-free policies by stealth vaping on campus. Respondents used a range of methods (eg, smaller device and low visibility e-liquids) and locations (eg, bathrooms, libraries, and parking garages) for stealth vaping. If campus policies are to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. E-cigarette devices specifically designed and marketed to facilitate stealth vaping (eg, resembling USB flash drives and pens) may require regulatory action. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications.

An in-school social norms approach intervention for reducing unhealthy snacking behaviours amongst 11-12-year-olds

OBJECTIVES

Adolescents tend to overestimate the extent of peers' unhealthy snacking consumption and such misperceptions have been associated with increased personal unhealthy snacking. This study aims to test whether a Social Norms Approach (SNA) intervention which challenges these misperceptions of peers' unhealthy snacking will have a positive effect on students' personal unhealthy snacking behaviours, related attitudes, and behavioural intentions.

DESIGN

A quasi-experimental study tested the effectiveness of an in-school SNA intervention (n = 163) compared to a control condition (n = 95) among 11-12-year-old students.

METHOD

Both conditions received healthy eating information, while students in the SNA intervention received additional normative feedback (outlining the discrepancies between perceived and actual unhealthy snacking of the majority based on baseline data) delivered through an interactive poster-making session. Students completed self-reported measures of personal unhealthy snacking, related-attitudes, behavioural intentions, and normative perceptions (descriptive and injunctive) at baseline, post-intervention, and at a 3-month follow-up.

RESULTS

Students who received SNA feedback were significantly less likely to overestimate peers' unhealthy snacking attitudes post-intervention (F(1,232) = 16.405, p < .001), and at 3-month follow-up consumed fewer unhealthy snacks (F(1,232) = 6.133, p = .014) and had less positive attitudes towards unhealthy snacking (F(1,198) = 8.779, p = .003). The changes in personal snacking attitudes at 3-month follow-up were mediated by changes in normative misperceptions about peers' unhealthy snacking attitudes post-intervention, which indicated that the reductions in normative misperceptions following SNA messages mediated the effect of the intervention.

CONCLUSION

The results indicate that in-school SNA interventions which challenge normative misperceptions constitute a promising strategy for reducing unhealthy snacking in young adolescents.

Normative vs personal attitudes toward persons with HIV, and the mediating role of perceived HIV stigma in rural Uganda

Background

HIV stigma has well-documented negative impacts on HIV testing, transmission risk behavior, initiation of and adherence to antiretroviral therapy, and retention in care. We sought to assess the extent to which anticipated HIV stigma is based on misperceptions of normative attitudes toward persons with HIV, and to determine whether persons with HIV have stronger misperceptions compared with HIV-negative persons or persons of unknown serostatus. We also sought to estimate the association between normative attitudes about persons with HIV and personal attitudes about persons with HIV, and to determine the extent to which anticipated stigma mediates this association.

Methods

We conducted a whole-population survey of 1776 persons living in 8 rural villages in southwestern Uganda. Negative attitudes toward persons with HIV, and anticipated stigma, were measured using a newly validated 15-item scale measuring multiple dimensions of HIV stigma, including social distance, blaming attitudes, and concerns about reciprocity. We used multivariable regression to estimate the association between normative attitudes about persons with HIV and personal attitudes toward persons with HIV, and to determine the extent to which perceptions of normative attitudes (anticipated stigma) mediated this association.

Results

Study participants believed that negative attitudes toward persons with HIV were more pervasive than they actually are. Perceptions of the extent to which these negative attitudes are normative mediated more than one-third of the association between normative attitudes and their personal attitudes. In contrast to what we originally hypothesized, persons with HIV were less likely to misperceive these norms and perceived normative attitudes to be less stigmatizing than did others in the general population.

Conclusions

Interventions designed to accurately describe normative attitudes toward persons with HIV may reduce HIV stigma without directly focusing on the educational components that are typically embedded in anti-stigma interventions.

Do emerging adults know what their friends are doing and does it really matter? Methodologic challenges and associations of perceived and actual friend behaviors with emerging adults' disordered eating and muscle building behaviors

Disordered eating and muscle building behaviors are common among emerging adults, and friends may be a particularly salient social influence. Epidemiologic research often includes questions about participants' perceptions of their friends. A less common approach, with greater logistical challenges, is to ask for friend nominations and then survey friends about their actual behaviors. The comparability of these different approaches is unknown. This study addresses the following research questions: 1) What is the feasibility of collecting data from emerging adults' friends in epidemiologic research? 2) Do perceptions of friends' weight- and shape-related behaviors align with friends' actual behaviors? and 3) Are perceptions or friends' actual behaviors more strongly and consistently associated with emerging adults' behaviors? Participants (N = 2383) in the EAT (Eating and Activity over Time)-2018 study in Minnesota, USA, were asked to nominate up to three friends and provide data about those friends' weight- and shape-related behaviors (i.e. perceptions); nominated friends were invited to complete an abbreviated survey and report on their own same behaviors (i.e. actual). Among the invited friends, 191 responded and were linked to the 152 EAT 2018 participants who nominated them. Descriptive statistics, Spearman's correlations, and logistic regression were used to address the research questions. The response rate for nominated friends was very low (9.9%), suggesting this approach may have low feasibility for epidemiologic studies of emerging adults. Emerging adults' perceptions of their nominated friends' weight and shape-related behaviors generally did not align well with the behaviors reported by those friends. Furthermore, analytic models found different associations between friends' behavior and EAT 2018 participant behaviors, depending on the measure of friends' behavior used (perceived or actual). Careful consideration of the pros and cons of each study design is essential to build an evidence base and support interventions regarding emerging adults' weight- and shape-related health.

Tobacco Use Status and Temptation to Try E-Cigarettes among a Sample of Appalachian Youth

E-cigarettes are commonly used tobacco products among youth populations, including Appalachian youth. However, knowledge of the extent to which tobacco use status relates to temptation to try e-cigarettes is limited. Data from the Youth Appalachian Tobacco Study (n = 1047) were used. Temptation to try e-cigarettes was derived from a 12-item situational inventory. Tobacco use status was defined as never, ever non-e-cigarette, and ever e-cigarette use. A factorial ANOVA was used to estimate the adjusted association between tobacco use status and the e-cigarette use temptation scale. Two-way interaction terms between tobacco use status and gender, and tobacco use status and race/ethnicity, were plotted to depict effect modification. Approximately 10% of youth were ever non-e-cigarette users and 24% were ever e-cigarette users. Never and ever non-e-cigarette user middle schoolers had higher temptation to try e-cigarettes than their high school counterparts. The same relationship was found among never and ever e-cigarette users living in households with tobacco users. The ANOVA results suggest a positive, monotonic relationship between tobacco use status and temptation to try e-cigarettes, and that the adjusted group means differ by gender and race/ethnicity. The findings can inform tobacco prevention interventions for youth at higher risk for e-cigarette use, especially youth who have not yet tried e-cigarettes.

Normative misperceptions of unhealthy snacking amongst 11- to 12-year-old secondary school students

Younger adolescents are at an age where they have increasing control of their diet, and where peers become an important social reference for acceptable and normative dietary behaviours. These normative perceptions are often inaccurate and can lead to the development of unhealthy eating practices; although, the role of normative misperceptions of peers' unhealthy snacking behaviours in younger adolescents' personal snacking behaviours is not clear. The current study was a cross-sectional analysis of baseline data from a social norms-based healthy eating intervention sampling two secondary schools in deprived areas of England. Students aged 11-12 years (n = 252) completed self-report measures of their demographic characteristics and personal behaviours, attitudes, intentions, and normative perceptions (descriptive and injunctive norms), relating to unhealthy snacking. Results indicated students overestimated peers' daily unhealthy snacks consumption by approximately 3.2 portions, misperceived peers to have more positive attitudes towards unhealthy snacking and more negative attitudes towards reducing snacking. The greater these misperceptions of peers' behaviours and attitudes, the more likely students were to consume unhealthy snacks and have positive attitudes about unhealthy snacking. Girls had a stronger intention to reduce their snacking behaviours if they had more positive attitudes to reducing snacking behaviours and misperceived peers to also have a positive attitude. In summary, 11- to 12-year-olds misperceive the snacking behaviour and attitudes of their peers, and such normative misperceptions are associated with students' own snacking behaviours and attitudes. Interventions which challenge these misperceptions may assist in reducing the social acceptability of unhealthy snacking and in reducing unhealthy snacking amongst young adolescents.

Associations between electronic cigarette use and quitting behaviours among South African adult smokers

BACKGROUND

The South African Medicines Control Council classifies e-cigarettes as Schedule 3 substances and requires them to be dispensed only within pharmacies. e-Cigarettes are however ubiquitous and are marketed as cessation aids. We investigated the relationship between e-cigarette use and smoking cessation among South African adult smokers.

METHODS

Data came from a 2018 web survey of South African adults aged ≥18 years (n=18 208). Cessation-related attitudes and behaviours were assessed. Using multivariable logistic regression, we measured the association between e-cigarette use and cessation behaviours among ever-established combustible tobacco smokers who tried to quit.

FINDINGS

Among current combustible smokers, more e-cigarette ever versus never users believed e-cigarettes could assist smokers to completely quit (35.5% vs 20.4%) or cut down (51.7% vs 26.5%) (all p<0.05). Among ever-established smokers, the odds of sustained quitting at the 12-month mark were lower among those who used e-cigarettes once off/rarely (adjusted OR (AOR)=0.20, 95% CI=0.16-0.24), former e-cigarette users (AOR=0.30, 95% CI=0.24-0.38) and current e-cigarette users (AOR=0.23, 95% CI=0.18-0.29), compared with never e-cigarette users. Among ever-established smokers who had ever tried to quit, 53.6% relapsed into smoking after quitting for any length of time. The odds of relapsing among ever-established smokers who had made a quit attempt and had a quit intention were higher among those who used e-cigarettes once off/rarely (AOR=2.66; 95% CI=2.31-3.08), former e-cigarette users (AOR=1.41; 95% CI=1.18-1.69) and current e-cigarette users (AOR=1.85; 95% CI=1.55-2.22) than never e-cigarette users.

CONCLUSION

e-Cigarette use depressed long-term cessation. These findings can inform restrictions on unsubstantiated claims of e-cigarettes as cessation aids within South Africa.

Age of initiation of cigarillos, filtered cigars and/or traditional cigars among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017

SIGNIFICANCE

Early age of initiation of tobacco use is associated with sustained tobacco use and lower rates of smoking cessation. Although much is known about age of initiation of cigarette use, much less is known about the age of initiation of cigar product use among youth.

METHODS

Survival analyses of the Population Assessment of Tobacco and Health youth annual datasets (ages 12-17) from 2013 to 2017 were conducted for any cigar product use, cigarillos or filtered cigars, and traditional cigars across four cigar use outcomes, age of initiation of: susceptibility to use, ever use, past 30-day use and "fairly regular" use. An interval censoring survival method was implemented to estimate the probability of each outcome for age of initiation of each cigar product overall. Differences in age of initiation by sex and race/ethnicity were assessed using weighted Cox proportional hazards models for interval-censored data.

RESULTS

For each outcome across the three cigar products, striking increases in the probability of initiation begin before 17 years old. For cigarillo or filtered cigars, males had a higher risk of onset of susceptibility to use, initiating ever use, and initiating past 30-day use at earlier ages than females. Compared to Non-Hispanic Whites, Hispanic and Non-Hispanic Other had lower risk of initiating ever use and past 30-day use at earlier ages. Non-Hispanic Black youth had higher risk of initiating past 30-day use and "fairly regular" use than Non-Hispanic White youth at earlier ages. Similar findings are reported for any cigar use and traditional cigar use.

CONCLUSION

Developmentally and culturally appropriate cigar use interventions and communication campaigns should be provided to youth before 17 years of age to prevent the onset and progression of cigar products. Regulatory policies that reduce appeal of all cigar products should be implemented to curb cigar initiation among youth.