Psychosocial Factors Associated With Adolescent Electronic Cigarette and Cigarette Use

Does the time to nicotine dependence vary by internalizing symptoms for young people who use e-cigarettes? An analysis of the Population Assessment of Tobacco and Health (PATH) study, (Waves 1-5; 2013-2019)

OBJECTIVE

To determine the relationship between past-year internalizing symptoms and the time to first report of signs of nicotine dependence among young people.

METHODS

Secondary analysis using data from the Population Assessment of Tobacco and Health (PATH) (Waves 1-5; 2013-2019). The study included 2,102 (N = 5,031,691) young people (age 12-23 years) who reported past-30-day (P30D) e-cigarette use in one or more waves. Kaplan Meier curves, stratified by past year internalizing symptoms were used to estimate the time to the first report of three nicotine dependence symptoms (i.e., use within 30 min of waking, cravings, and really needing to use) following the first P30D e-cigarette use. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios (AHR), comparing any past year internalizing symptoms to no past year internalizing symptoms.

RESULTS

We found no significant differences between past year internalizing symptoms and the time to the first report of cravings (AHR = 1.30, 95 % CI = 92-1.85), really needing to use (AHR = 1.31; 95 % CI = 0.92-1.89) and use within 30 min of waking for follow-up times 0-156 weeks (AHR = 0.84; 95 % CI = 0.55-1.30) and > 156 weeks (AHR = 0.41; 95 % CI = 0.04-4.67) respectively.

CONCLUSION

Past year internalizing symptoms did not modify the time to the first report of nicotine dependence among youth with P30D e-cigarette use. Further research is needed to understand how changing internalizing symptoms and e-cigarette use frequency influence nicotine dependence over time and, how this relationship impacts cessation behavior.

Youth attention, perceptions, and appeal in response to e-cigarette advertising features: A focus group study

Background

E-cigarette marketing exposure may influence vaping-related outcomes among youth, but less is known on which specific advertising features impact youth attention, perceptions, and appeal. This study qualitatively examines responses to different e-cigarette advertising features among e-cigarette-naïve youth.

Methods

We conducted four online focus groups in 2021 with a national U.S. sample of 13-17 year olds (n = 25) who had never used e-cigarettes. Participants viewed and discussed their reactions to different e-cigarette advertisements varying in the inclusion of ad features, including color, models in imagery, text claims targeting smokers, and the nicotine warning label.

Results

Participants were attracted to ads with bright colors, particularly when contrasted against a dark background. Ads featuring models attracted attention and reduced perceptions that the product is harmful. Comments indicated mixed reactions to smoker-targeted text claims. On one hand, participants perceived ads with text that specified "for smokers" as targeting older adults. On the other hand, text referring to "switching" from cigarettes to e-cigarettes led to some perceptions that the product is healthy, and certain text that implicitly referred to smoking (e.g., "no odor") had the potential to appeal to youth who wanted to use e-cigarettes discreetly. The level of attention paid to warnings depended on warning size and the color contrast between the warning and the rest of the ad.

Conclusions

Findings suggest specific e-cigarette ad features play an important role in attracting youth attention and influencing perceptions. More research is needed on the potential public health benefits versus unintended consequences of smoker-targeted text claims.

Comparison of the Predictors of Smoking Cessation Plans between Adolescent Conventional Cigarette Smokers and E-Cigarette Smokers Using the Transtheoretical Model

Recently, there has been a shift in smoking patterns among adolescents, with a decrease in the prevalence of conventional cigarette smoking and an increase in the use of electronic cigarettes (e-cigarettes). The harmful effects of e-cigarettes are remarkable, highlighting the need for proactive interventions for adolescent users and smoking cessation that consider the characteristics of both conventional cigarette smokers and e-cigarette users. This study aims to investigate the smoking status of adolescent conventional cigarette and e-cigarette smokers and to analyze the predictors of their smoking cessation plans (SCPs) based on the transtheoretical model. Self-rated health, prior smoking cessation education, consciousness-raising, and dramatic relief as types of experiential processes of change, and formation of helping relationships as a type of behavioral process of change significantly differed according to the type of cigarette behavior among adolescents. The predictors of SCP among adolescents were perceived pros of smoking and academic performance among conventional cigarette smokers and behavioral process of change, perceived pros of smoking, and economic status among e-cigarette users. This study identified differences in the characteristics and predictors of SCP. Strategies tailored to each specific adolescent smoking population are further required to promote smoking cessation.

Demographic and Behavioral Differences Between Adolescents and Young Adults Who Use E-Cigarettes at Low and High Frequency

BACKGROUND

Among adolescents and young adults (AYAs), "current use" of electronic cigarettes (e-cigarettes) is commonly defined as any use in the past 30 days. However, few studies have examined differences among those within this broad category. This study examined characteristics of AYAs who used e-cigarettes at a low frequency (within the last 3 months but <6 days out of the past 30 days) and those who used e-cigarettes at a high frequency (6+ days out of the past 30 days).

METHODS

We conducted cross-sectional analyses among 551 Ohio AYAs (15- to 24-year-olds) who reported using an e-cigarette to vape nicotine in the past 3 months. We used descriptive statistics and logistic regression to characterize those using e-cigarettes at a low frequency and a high frequency.

RESULTS

Among our sample of AYAs who reported past 3-month e-cigarette use, about half (50.8%) reported using an e-cigarette 6 or more days out of the past 30 days (ie, high frequency). In the multivariable analysis, reported nicotine dependence (Odds Ratio [OR]: 7.0, 95% CI: 4.8, 10.3) and current other tobacco product use (OR: 1.8, 95% CI: 1.1, 2.9) were associated with high-frequency e-cigarette use.

CONCLUSION

Our results suggest that frequency of use is an important characteristic in understanding AYA e-cigarette use. Any use in the past 30 days may not be sensitive enough to understand dependence and tobacco-use behaviors. Further characterizing "current" e-cigarette use by frequency of use may provide meaningful information for public health professionals to better target intervention and cessation efforts to AYAs.

Vuse Solo e-cigarettes do not provide net benefits to public health: a scientific analysis of FDA's marketing authorisation

In October 2021, the US Food and Drug Administration (FDA) authorised marketing of RJ Reynolds Vapor Company's (RJR) Vuse Solo e-cigarette through FDA's Premarket Tobacco Product Application (PMTA) pathway. FDA concluded that RJR demonstrated Vuse products met the statutory standard of providing a net benefit to public health. A review of FDA's scientific justification reveals deficiencies: (1) not adequately considering Vuse's popularity with youth and evidence that e-cigarettes expanded the nicotine market and stimulate cigarette smoking; (2) trading youth addiction for unproven adult benefit without quantifying these risks and benefits; (3) not considering design factors that appeal to youth; (4) not addressing evidence that e-cigarettes used as consumer products do not help smokers quit and promote relapse in former smokers; (5) not discussing evidence that dual use is more dangerous than smoking; (6) narrowly focusing on the fact that e-cigarettes deliver lower levels of some toxicants without addressing direct evidence on adverse health effects; (7) downplaying significant evidence of other substantial harms; (8) not acting on FDA's own study showing no all-cause mortality benefit of reducing (but not stopping) cigarette use; and (9) improperly considering e-cigarettes' high abuse liability and potential for high youth addiction and undermining tobacco cessation. Because marketing these products is not appropriate for the protection of the public health, FDA should reconsider its Vuse marketing order as statutorily required and not use it as a template for other e-cigarette PMTAs. Policymakers outside the USA should anticipate that tobacco companies will use FDA's decision to try to weaken tobacco control regulation of e-cigarettes and promote their products.

Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults

RATIONALE

Electronic cigarette (e-cigarette) aerosol contains volatile aldehydes, including flavourings and oxidant metals with known pulmonary toxicity.

OBJECTIVES

To evaluate the associations of e-cigarette use with symptoms of wheeze, bronchitic symptoms and shortness of breath (SOB) across 4 years of prospective data.

METHODS

Participants completed questionnaires on respiratory symptoms and past 30-day e-cigarette, cigarette and cannabis use in 2014 (wave 1; N=2094; mean age 17.3 years, SD=0.6 years). Follow-up information was collected in 2015 (wave 2; n=1609), 2017 (wave 3; n=1502) and 2018 (wave 4; n=1637) using online surveys. Mixed-effects logistic regression models evaluated associations of e-cigarette use with respiratory symptoms.

MEASUREMENTS AND MAIN RESULTS

Participants were mostly Hispanic white (51.8%) and evenly representative by sex (49.6% female; 50.4% male). Compared with never e-cigarette users, past 30-day e-cigarette users reported increased odds of wheeze (OR 1.81; 95% CI 1.28, 2.56), bronchitic symptoms (OR 2.06; 95% CI 1.58, 2.69) and SOB (OR 1.78; 95% CI 1.23, 2.57), adjusting for study wave, age, sex, race, lifetime asthma diagnosis and parental education. Effect estimates were attenuated (wheeze (OR 1.41; 95% CI 0.99, 2.01), bronchitic symptoms (OR 1.55; 95% CI 1.18, 2.05), SOB (OR 1.48; 95% CI 1.01, 2.18)), after adjusting additionally for current cigarette use, cannabis use and secondhand exposure to e-cigarettes/cigarettes/cannabis.

CONCLUSIONS

E-cigarette use in young adults was associated with respiratory symptoms, independent of combustible cannabis and cigarette exposures.

Household vaping bans and youth e-cigarette use

AIMS

The aims of this study were to measure whether household bans on vaping were associated with lower odds of youth past-month vaping when compared with (1) otherwise similar youth whose households did not have a vaping ban (using coarsened exact matching); and (2) themselves in waves when their household did not have a ban (using hybrid panel models). We used the same analytical strategies to examine cross-sectional associations between household smoking bans and adolescents' past-month cigarette smoking.

DESIGN

This was a longitudinal study using data from a nationally representative sample of youth (age 12-17 years) in the Population Assessment of Tobacco and Health Study.

SETTING

United States of America.

PARTICIPANTS

A total of 16 214 adolescents followed over 48 103 total observations (approximately three waves).

MEASUREMENTS

Measurements comprised youth past-month e-cigarette and cigarette use and parent-reported household bans on vaping and smoking. Potential confounders were prior adolescent smoking, vaping, and other nicotine product use; parent current smoking, vaping, and other nicotine use; adolescent peer e-cigarette/cigarette use; parental monitoring; and demographic characteristics.

FINDINGS

Before matching, smoking bans were associated with 46% lower odds of youth smoking [odds ratio (OR) = 0.54; 95% confidence interval (CI) = 0.41-0.70] and vaping bans with 37% lower odds of youth e-cigarette use (OR = 0.63; 95% CI = 0.50-0.80). However, households with and without bans differed significantly on all confounders before matching. After matching, household vaping bans were associated with 56% lower odds of youth vaping (OR = 0.44; 95% CI = 0.33-0.58). Results from hybrid panel models also revealed 37% lower odds of vaping in waves when youth lived in a vape-free household compared to waves when they did not (OR = 0.63; 95% CI = 0.50-0.78). Associations between smoking bans and youth smoking were not statistically significant after matching or when using hybrid panel models.

CONCLUSIONS

Household vaping bans appear to be associated with lower odds of past-month vaping among US adolescents, compared with similar youth whose households did not have a ban and to themselves in waves when their households did not have a ban.

Pubertal development at age 14 is associated with male adolescents' combustible cigarette smoking and dual use, but not with e-cigarette use - Findings from the UK Millennium Cohort Study

BACKGROUND

Adolescent nicotine exposure via electronic cigarettes (e-cigarettes) is a global health concern. Pubertal development earlier than peers increases the risk of tobacco smoking compared to peers experiencing on-time or late maturation, yet relationships of pubertal timing with e-cigarettes are unknown. We examine whether early pubertal timing is associated with risk for e-cigarette use, tobacco cigarettes, or both by age 14.

METHODS

The Millennium Cohort Study follows a representative cohort of 18,552 9-month-old children born 2000-2002 in the United Kingdom. Our sample includes 11,445 adolescents (5697 boys, 5748 girls) classified at age 14 as early, on-time, or late in pubertal development timing (PDT) relative to same-age, same-sex peers using the Pubertal Development Scale. Outcomes were use of e-cigarettes, tobacco cigarettes, or both by age 14. We included childhood liability confounders and demographics measured from age 7-11.

RESULTS

For girls, no PDT differences in age 14 e-cigarette or tobacco cigarette use were observed. All relative to on-time PDT boys, early maturing boys' odds of tobacco cigarette use were 59% higher (OR=1.59, 95% confidence interval (CI)=1.08,2.35), and odds of dual-use were 49% higher (OR=1.49, CI=1.11,1.99), both compared to odds of never use. Among late PDT boys, dual-use odds were lower than never use by 35% (OR=0.65, CI=0.47,0.91) and lower than e-cigarette use only by 36% (OR=0.64, CI=0.42,0.97).

CONCLUSIONS

At age 14, PDT was not associated with e-cigarette use for either sex, yet it was linked with tobacco use and dual use among boys.

Associations for subgroups of E-cigarette, cigarette, and cannabis use with asthma in a population sample of California adolescents

Knowledge about the respiratory health consequences of adolescents' use of tobacco products with cannabis remains limited. We studied whether e-cigarettes, combustible cigarettes, and cannabis were independently associated with asthma in a population-based sample of 150,634 public high school students (10th and 12th graders), drawn in a two-stage design to be representative of the state of California in 2019-2020. Measures were obtained for use of e-cigarettes, combustible cigarettes, and cannabis; motives for use (three substances); method of use (for cannabis); ever being diagnosed with asthma; and having an asthma attack in past 12 months. Cross-classification indicated Nonuse for 64% of the sample; 15% Dual E-cigarette/Cannabis Use; 10% Exclusive Cannabis Use; 5% Exclusive E-cigarette Use; and 5% Triple Use. Multinomial logistic regression with a three-level criterion variable, controlling for age, sex, parental education, race/ethnicity, and three types of household use showed that compared with Nonuse, odds of Lifetime Asthma (vs. Never Had) was elevated for Triple Use (AOR = 1.14, CI 1.06-1.24), Dual E-cigarette/Cannabis Use (1.17, 1.12-1.23), Exclusive Cannabis Use (1.17, 1.11-1.23), and Exclusive E-cigarette Use (1.10, 1.02-1.18). Similar results were noted for Recent Asthma. Among persons who had used cannabis, 88% of the Triple group and 74% of the Dual E-cigarette/Cannabis group reported both smoking and vaping cannabis. Thus, co-occurrence of e-cigarette and cannabis use was a common pattern among adolescents in this study, and subgroups of cannabis and e-cigarette use showed similar associations with asthma. Preventive approaches should highlight the health implications of exclusive or combined e-cigarette and cannabis use.

Mutual pathways between peer and own e-cigarette use among youth in the United States: a cross-lagged model

BACKGROUND

Electronic cigarettes (e-cigarettes) have become the most common tobacco product used among adolescents in the United States (US). Prior research has shown that peer e-cigarette use was associated with increased risk of own e-cigarette use. Nonetheless, there is little empirical evidence on the directionality of these associations-if peer use predicts own use (peer influence) or if own use predicts peer use (peer selection).

METHODS

We estimated the association between peer and own e-cigarette use among US adolescents 12-17 years of age. We used the cross-lagged model to investigate the mutual relationship between peer and own e-cigarette use over time using data from a population-based longitudinal study, Population Assessment of Tobacco and Health. Stratified analyses were conducted by sex and age subgroups.

RESULTS

Results from a cross-lagged model showed a statistically significant predicting path leading from peer use at the prior time point to own use at the following time point, but not vice versa.

CONCLUSIONS

We found strong relationships between peer e-cigarette use and own e-cigarette use at within-individual levels. Peer influence paths were more robust than peer selection paths for e-cigarette use. Incorporating peers into prevention and intervention programs may help enhance these strategies.

Prediction and potential risk factors for electronic cigarette use behaviors among adolescents: a pilot study in Chiayi, Taiwan

Introduction

Electronic cigarette (e-cigarette) use among adolescents has become increasingly common; therefore, effectively reducing adolescent e-cigarette use is an urgent issue. We aimed to predict and identify potential factors related to adolescent e-cigarette use behaviors.

Methods

This cross-sectional study was conducted using anonymous questionnaires given to Taiwanese high school students in 2020. Approximately 1,289 adolescent students completed questions on e-cigarette use, personal characteristics, family environment, and substances used. We performed multivariate logistic regression analyses to assess the model's predictive performance in terms of the area under the receiver operating characteristic curve.

Results

We found that 9.3% of adolescent students used e-cigarettes. Tobacco smoking, close friends' reactions to e-cigarette use, and the use of other substances were independent risk factors for adolescent e-cigarette use. Furthermore, relative to tobacco nonuse, tobacco use and tobacco smoking dependence had odds ratios of 76.49 and 113.81, respectively. The predictive accuracy of adolescent e-cigarette use from personal characteristics, family environment, and substance use status was 73.13, 75.91, and 93.80%, respectively.

Conclusion

The present study highlights the need for early prevention of e-cigarette use among adolescents, particularly those with a history of using tobacco and other substances and those who have close friends with positive attitudes towards e-cigarette use.

Asian American adolescent e-cigarette use and associated protective factors: Heterogeneity in a statewide sample

OBJECTIVES

This study characterized variation in e-cigarette use patterns and related protective factors by ethnicity among Asian American adolescents.

METHODS

Multivariable logistic regressions modelled associations between ethnic group, 6 protective factors (college aspirations, internal developmental assets, positive teacher engagement, family caring, and peer and parent anti-smoking norms), and past 30-day e-cigarette use, adjusting for covariates among 10,482 8th, 9th, and 11th grade Asian American respondents to the 2019 Minnesota Student Survey. Interaction terms (protective factor × ethnic group) were used in 6 subsequent regression models to examine whether the association between each protective factor and e-cigarette use differed as a function of ethnic group.

RESULTS

Respondents included 9.0% Indian, 0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean, 2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multi-ethnic, and 21.6% multi-racial adolescents. E-cigarettes were the predominant form of tobacco use. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indians reported the lowest (4.7% and 5.0%). Strong peer anti-smoking norms, higher internal developmental assets scores, and positive teacher engagement were associated with lower odds of e-cigarette use across groups, with significant interactions for internal developmental assets by ethnicity.

CONCLUSIONS

E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota, with notable heterogeneity by ethnicity. While most established protective factors appeared to function similarly for Asian adolescents, others differed, underscoring the importance of disaggregating data by ethnicity to inform the tailoring of prevention and control strategies for these ethnic groups.

Sexual Identity Differences in Tobacco (Re)Uptake: Testing Mediation by Internalizing and Externalizing Symptoms

INTRODUCTION

Tobacco use among gay, lesbian, and bisexual individuals is disproportionately higher than among heterosexual individuals. Identifying the mechanisms behind these differences can inform prevention and cessation efforts aimed at advancing health equity. Internalizing and externalizing symptoms as mediators of tobacco (re)uptake among sexual minority individuals was examined.

METHODS

Waves 4 and 5 of the Population Assessment of Tobacco and Health (2016-2019) study were analyzed in 2022. Adolescents aged ≥14 and adults years not using tobacco at Wave 4 (n=21,676) were included. Wave 4 sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or something else. Associations of sexual identity with (re)uptake of cigarette use, E-cigarette use, and polytobacco use at Wave 5 were assessed, along with possible mediation of these associations by Wave 4‒internalizing and ‒externalizing symptoms.

RESULTS

Internalizing and externalizing symptoms predicted tobacco (re)uptake regardless of sexual identity, particularly for female individuals. Gay/lesbian females (AOR=2.26; 95% CI=1.14, 4.48) and bisexual females (AOR=1.36; 95% CI=1.06, 1.74) had greater odds of E-cigarette (re)uptake than heterosexual females. High internalizing and externalizing symptoms accounted for over one third of the difference in E-cigarette (re)uptake among bisexual compared with that among heterosexual females. Males who reported sexual identity as something-else had lower odds of cigarette (re)uptake than heterosexual males (AOR=0.19; 95% CI=0.06, 0.66); this association was not mediated by internalizing and externalizing symptoms.

CONCLUSIONS

Internalizing and externalizing symptoms uniquely contribute to E-cigarette (re)uptake among bisexual females. Strategies that reduce sexual minority stressors and resulting psychological distress may help to reduce tobacco use disparities.

Is socioeconomic status related to youth e-cigarette use? Examining family affluence and sexual identity

There is limited evidence about the relationship between socioeconomic status (SES) and youth electronic cigarette use, particularly among sexual minorities. This study investigates whether family affluence is significantly associated with e-cigarette use among youth, including sexual minority youth. Data came from the 2021 National Youth Tobacco Survey (N = 10,515). The prevalence of e-cigarette use for all participants and sexual minority youth (N = 1376) by SES was calculated and ranked according to the Family Affluence Scale. A propensity score weighting method was used to address the imbalance in characteristics among SES groups. The associations of SES with current e-cigarette use and current flavored e-cigarette use were estimated using univariate survey logistic regression for all participants and self-identified sexual minority students. The prevalence of e-cigarette use was similar among socioeconomic groups for all participants and sexual minorities. The propensity score weighting analysis showed no significant association between SES and current e-cigarette use for all participants and sexual minority students. Equally, there was no significant association between SES and current flavored e-cigarette use. Findings suggest that other protective and risk factors might explain youth e-cigarette use more than SES (family affluence scale).

Electronic cigarette use by and perceptions of middle and high school students in the United States

Electronic cigarettes (e-cigarettes) provide a novel source of nicotine and may lead to experimentation by adolescents and eventually to their use of conventional cigarettes. The National Youth Tobacco Survey collected information from a nationally representative sample of students in 2016 to determine their experiences with conventional cigarettes and e-cigarettes, their intentions to use these products in the future, and their perceptions of harm and addiction associated with these products. We analyzed these data with ordered probit regression models to determine possible associations with the intention to try e-cigarettes and conventional cigarettes. This survey included 20,520 respondents, 50.6% were male, 5.9% had used conventional cigarettes, and 9.0% had used e-cigarettes. Approximately 10% thought e-cigarettes caused no harm, 3.7% thought that conventional cigarettes caused no harm, and 52.5% thought that e-cigarettes were less harmful than conventional cigarettes. Less than 1% of the students responded "Definitely yes" to the question, "Do you think you will try an e-cig?" The odds ratios for an intention to try e-cigarettes increased as the perception of harm decreased; these ratios increased from 1.0 for "A lot of harm" to 5.85 (95% CI: 3.51, 9.75) for "No harm." In 2016, the majority of students thought that e-cigarettes could cause some harm. This survey indicates that most students have not tried e-cigarettes or conventional cigarettes. The minority of students who think that e-cigarettes pose no harm and students in the ages 14 and 16 are more likely to try them.

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.

Factors Associated With E-Cigarette Quitting Behavior Among Adolescents in the United States: A Prospective Observational Study

PURPOSE

This prospective observational study examined the association of socioecological factors with quitting behavior among US adolescents who exclusively use electronic cigarettes (e-cigarettes).

METHODS

We used data from past 30-day adolescent exclusive e-cigarette users (n = 243) participating in Wave 3 of the Population Assessment of Tobacco and Health study, who were then followed-up with approximately 12 months later for Wave 4. Weighted unadjusted and adjusted multivariate logistic regression models and structural equation modeling were performed to analyze the data.

RESULTS

Adolescents were significantly less likely to quit e-cigarettes if they perceived that nicotine in e-cigarettes was "slightly/somewhat harmful" to health (adjusted odds ratio [aOR] = 0.38; 95% confidence interval [CI]: 0.16-0.90, p = .02). Similarly, adolescents who reported that someone else in their home owned an e-cigarette (aOR = 0.43 [95% CI: 0.19-0.94], p = .03) or important people in their life used e-cigarettes (aOR = 0.45 [95% CI: 0.21-0.95], p = .03) were significantly less likely to quit e-cigarettes. The structural equation modeling showed a direct significant relationship of individual-level (b = 0.206, p = .02) and interpersonal-level factors (b = 0.170, p = .04) with e-cigarette quitting behavior.

DISCUSSION

Our findings suggest that individual-level (harm perception) and interpersonal-level (e-cigarette use at home and by important people) factors may play a significant role in e-cigarette quitting behavior among US adolescents.

Correlates of tobacco product initiation among youth and young adults between waves 1-4 of the population assessment of tobacco and Health (PATH) study (2013-2018)

INTRODUCTION

While risk factors for cigarette smoking among youth and young adults are well-documented, less is known about the correlates of initiation of other tobacco products. This study aims to provide estimates and correlates of initiation among U.S. youth and young adults.

METHODS

Data on youth aged 12-17 (n = 10,072) and young adults aged 18-24 (N = 5,727) who provided information on cigarettes, electronic nicotine delivery systems (ENDS), cigars, pipe, hookah and smokeless tobacco use in Wave 1 (W1: 2013-2014)-Wave 4 (W4: 2016-2018) of the nationally-representative PATH Study were used to calculate ever use initiation and correlates of initiation by W4.

RESULTS

Nearly 6 million youth and 2.5 million young adults used tobacco for the first time between W1-W4. Approximately one quarter of youth and young adult ENDS never users initiated ENDS between W1-W4 of the PATH Study. Among youth, use of other tobacco products, ever substance use, and high externalizing problems were associated with initiation of most products. Among young adults, use of other tobacco products and ever substance use were associated with initiation of most products. In both youth and young adults, Hispanics were more likely to initiate hookah use than their non-Hispanic White counterparts. While male sex was a risk factor for most tobacco product initiation across both age groups, it was not associated with hookah initiation.

CONCLUSIONS

Cigarette and non-cigarette products shared many correlates of initiation, although there are noteworthy demographic differences. Findings can help tailor product specific interventions to reach populations at risk during preliminary stages of use.

Impact of Smoking on Visual Field Progression in a Long-term Clinical Follow-up

PURPOSE

To investigate the effect of smoking on rates of progressive visual field (VF) damage over time in glaucoma.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Five hundred eleven eyes of 354 patients with glaucoma followed up from multicenter glaucoma registries.

METHODS

In this longitudinal study, 354 patients with primary open-angle glaucoma with a minimum of 3 years of follow-up and 5 VF tests were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Univariate and multivariate linear mixed models were used to investigate the effects of smoking on rates of 24-2 VF mean deviation loss. Visual field progression was defined using pointwise linear and significant negative VF mean deviation loss. Logistic regression was used to identify baseline factors and whether different levels of smoking intensity were associated with VF progression. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between smoker and never smoker groups.

MAIN OUTCOME MEASURES

Visual field progression.

RESULTS

Five hundred eleven eyes of 354 patients were included over the median follow-up of 12.5 years. Median baseline age was 64.8 years. Of the 354 patients, 124 (35%) were Black, and 149 (42.1%) and 168 (59.8%) had reported a history of smoking or alcohol consumption, respectively. In a multivariate model, higher smoking intensity was associated with faster VF loss (coefficient, -0.05 decibels (dB)/year per 10 pack-years; 95% confidence interval [CI], -0.08 to -0.01 dB/year per 10 pack-years; P = 0.010). Developing VF progression in eyes of heavy smokers (≥ 20 pack-years) was 2.2 times more than in eyes of patients without smoking history (odds ratio, 2.21; 95% CI, 1.02-4.76; P = 0.044). Statistically significant differences were found between heavy smokers (≥ 20 pack-years) and never smokers by Kaplan-Meier analysis (P = 0.011, log-rank test).

CONCLUSIONS

Heavy smokers are more likely to sustain VF loss in eyes with glaucoma. The prospective longitudinal design of this study supports the hypothesis that levels of smoking may be a significant predictor for glaucoma progression. Additionally, this information can be used for clinically relevant tobacco prevention and intervention messages.

Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis

BACKGROUND

Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed.

METHODS

Fourteen databases were searched for eligible studies from the Inception of database until March 2022 to examine the effect estimates of the association between perceptions of harmfulness and addictiveness and overall e-cigarette usage among adolescents and youth.

RESULTS

The meta-analysis showed that in comparison to non-users, young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful (OR: 2.20, 95% CI: 1.41-3.43) and perceived e-cigarettes as less harmful than tobacco cigarettes (OR: 2.01, 95% CI 1.47-2.75). Youths who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive (OR: 2.28, 95% CI: 1.81-2.88) or perceive e-cigarettes as more addictive (OR: 1.82, 95% CI: 1.22-2.73) than tobacco cigarettes, as compared with non-users. The subgroup analysis reported that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise.

CONCLUSION

the risk perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth and could be the focus of health promotion to prevent and curb the uptake of e-cigarettes among young people.

Associations Between Perceptions of e-Cigarette Harmfulness and Addictiveness and the Age of E-Cigarette Initiation Among the Population Assessment of Tobacco and Health (PATH) Youth

Introduction

Youth perceptions of harmfulness and addictiveness of e-cigarettes may impact the age that they initiate e-cigarette use, but this has not been investigated previously.

Methods

Youth (12-17 years old) never e-cigarette users at their first wave of PATH participation (waves 1-3, 2013-2016) were included. PATH questions on absolute perceptions of e-cigarette harmfulness and addictiveness were used as exposures. Interval-censored Cox proportional hazards models were used to estimate the impact of perceptions of harmfulness, and perceptions of addictiveness on (i) the age of initiation of e-cigarette use and (ii) age of first reporting past 30-day e-cigarette use, while controlling for covariates.

Results

Youth who perceive e-cigarettes as having no/little harm had increased risk of initiating both ever e-cigarette use (AHR = 2.04; 95%CI = 1.74-2.40) and past 30-day e-cigarette use (AHR = 2.64; 95%CI = 2.07-3.37) at earlier ages compared to youth who perceive e-cigarettes as having a lot of harm. Youth who perceive the likelihood of becoming addicted to e-cigarettes to be very/somewhat unlikely had increased risk of an earlier age of both ever (AHR = 1.28; 95%CI = 1.07-1.52) and past 30-day (AHR = 1.36; 95%CI = 1.04-1.79) e-cigarette initiation compared to youth who perceived the likelihood of becoming addicted to e-cigarettes to be somewhat/very likely.

Conclusion

These results highlight the importance of communicating to youth the potential for health harms and addiction from e-cigarette use in prevention and intervention campaigns, as those with the lowest perceptions of harmfulness and addictiveness had the earliest ages of e-cigarette initiation.

Association of Residence Type on Smoking in South Korean Adolescents during the COVID-19 Pandemic: Findings from a National Survey

The closure of schools due to the COVID-19 pandemic has forced adolescents to stay home. These disruptions, as well as a significant decrease in social access, have impacted smoking behavior. This study identified the association between the adolescents' type of residence and tobacco product use. A cross-sectional study (using data from the Korea Youth Risk Behavior Web-based Survey) examined 3774 students in 2019 (pre-pandemic) and 2575 students in 2020 (during the pandemic). The participants were South Korean middle and high school students aged 13-19 years. Using multinomial logistic regression, it was shown that adolescents who lived alone or in a boarding house had a higher risk of being an e-cigarette smoker compared with those who lived with family or relatives (OR = 6.49, CI = 2.06-20.45). Living in a dormitory or orphanage also increased the risk of dual tobacco use compared with living with family (OR = 2.09, 95% CI = 1.13-3.84). With the advent and continuation of the COVID-19 pandemic, this effect became more significant in 2020 than in 2019. Our findings support the theory that residential differences affect adolescent smoking behavior and highlight the importance of integrated smoking bans and educational programs to control adolescent smoking.

An International Systematic Review of Prevalence, Risk, and Protective Factors Associated with Young People's E-Cigarette Use

While the prevalence of young people's conventional cigarette use has decreased in many countries, the use of e-cigarettes has risen. To effectively counteract the growing popularity of e-cigarettes among young people internationally, researchers should know the exact prevalence as well as the protective and risk factors associated with vaping. Based on five eligibility criteria, 53 articles were chosen and analyzed by general characteristics, prevalence, sample characteristics, gender difference, protective factors, and risk factors. In this study, the international pooled prevalence of young people's lifetime e-cigarette use was 15.3%, the current use was 7.7%, and dual use was 4.0%. While the highest lifetime, current, and dual prevalence were found in Sweden, Canada, and the United Kingdom, respectively, the lowest prevalence was found in Germany, followed by South Korea and Sweden. Some protective and risk factors include perceived cost and danger of vaping, parental monitoring, internal developmental assets, cigarette use, family and peer smoking, exposure to online advertisements, and the presence of nearby retail stores. Based on this review, researchers and practitioners can develop different intervention programs and strategies for young smokers.

Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use

IMPORTANCE

Little is known about the roles of advertising and parental and peer influence in e-cigarette use among US adolescents in recent years, hindering efforts to address the increasing rate of youth vaping.

OBJECTIVE

To examine how e-cigarette advertising exposure and parental and peer e-cigarette use were associated with e-cigarette use among US adolescents.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from waves 4 (December 2016 to January 2018), 4.5 (December 2017 to December 2018), and 5 (December 2018 to November 2019) of the Population Assessment of Tobacco and Health study, an on-going cohort study representative of the noninstitutionalized US population. Sample weights were applied to generate nationally representative estimates. Data were analyzed in January 2022.

EXPOSURES

Past 30-day e-cigarette advertising exposure, past 30-day parental e-cigarette use, and the number of best friends using e-cigarettes (none, a few, some, most, and all).

MAIN OUTCOMES AND MEASURES

Outcomes were contemporary curiosity about using e-cigarettes and e-cigarette initiation at follow-up. Generalized estimating equations were used to estimate the weighted adjusted associations.

RESULTS

Wave 4 included 8548 adolescents; wave 4.5, 10 073 adolescents; and wave 5, 11 641 adolescents. Among adolescents in the wave 4 survey, 4425 (51.1%) were boys, 1935 (24.9%) were aged 12 years, 1105 (13.0%) were Black, 2515 (24.4%) were Hispanic, and 3702 (52.3%) were White. More than 60% of adolescents reported past 30-day e-cigarette advertising exposure at each survey. Among adolescents who had never used e-cigarettes, those who reported e-cigarette advertising exposure were more likely to feel curious about using e-cigarettes (adjusted odds ratio [aOR], 1.56 [95% CI, 1.43-1.70]) and were more likely to become ever e-cigarette users (aOR, 1.21 [95% CI, 1.05-1.41]) and current e-cigarette users (aOR, 1.42 [95% CI, 1.16-1.75]) at follow-up. Adolescents who reported having best friends using e-cigarettes were more likely to feel curious about using e-cigarettes (eg, all best friends: aOR, 4.13 [95% CI, 2.35-7.26]) and initiate e-cigarette use at follow-up (eg, among adolescents reporting all best friends use e-cigarettes, risk of ever use: aOR, 4.08 [95% CI, 1.44-11.59]; risk of current use aOR, 5.42 [95% CI, 1.49-19.72]) than adolescents who reported having no best friends using e-cigarettes.

CONCLUSIONS AND RELEVANCE

This cohort study of US adolescents found that e-cigarette advertising and peer influence were significantly associated with e-cigarette initiation. Efforts to address youth vaping need to consider peer influence and incorporate measures reducing e-cigarette advertising exposure.

Recognition of cartoon-based e-cigarette-related marketing is associated with e-cigarette use among adolescents

INTRODUCTION

Recent research has shown that e-cigarette companies use cartoon-based marketing. Recognition of this cartoon-based marketing has been associated with increased risk for e-cigarette use in young adults, however it is unclear if this generalizes to adolescents. This study examined the associations between recognition of e-liquid packaging with cartoons and e-cigarette use, susceptibility to use, and expectations of benefits and risks of use in adolescents.

METHODS

A cross-sectional sample of adolescents drawn from three Southern California high schools (n = 1,734; 55% female; Mean [SD] age = 15.2[0.9]) completed online surveys assessing e-cigarette use, susceptibility to use, expectations about benefits and risks of use, and tobacco marketing exposure. To assess recognition of cartoon images, participants were presented with 40 images of e-liquid packages (20 with and 20 without cartoons) and asked to endorse whether they recognized the products. The primary predictor was relative cartoon recognition (i.e., percentage of cartoons recognized out of the total images recognized).

RESULTS

Relative recognition of cartoon images was positively associated with e-cigarette use, susceptibility to use, and a perceived social benefit of use.

CONCLUSIONS

Adolescents recognize e-cigarette-related cartoon marketing, and these adolescents are using e-cigarettes. The restriction of cartoon-based marketing of e-cigarettes may affect e-cigarette uptake among adolescents.

Changes in the Patterns and Characteristics of Youth ENDS Use over Time

Research on youth use of electronic nicotine delivery systems (ENDS) has explored the correlates of initiation and use; however, little is known about the factors that predict continued youth use of ENDS. We used an ecological momentary assessment (EMA) burst design to explore both daily variability within adolescents over a two-week observation period and variability over time two years later (2018 and 2020). The contribution of device characteristics, motivations for use, contextual factors, and community factors to daily use occasions were explored. Youth participants (n = 35) at the start of the study were past two-week nicotine vapers, 14 to 17 years old, who resided within 100 miles of Louisville, KY, and reported past two-week ENDS use. Close to a quarter of participants ceased all tobacco use two years later, suggesting that some youth, despite prior regular vaping habits, may have only been experimenting with ENDS. The regular continued use of ENDS was predicted by trying to quit using cigarettes, appealing flavors, and being in locations where cigarette use was prohibited. Except for flavors, these factors did not affect ENDS use in year one. These findings suggest that tobacco policy might target ENDS use by prohibiting all tobacco use, including ENDS, in locations where smoking is already banned.

Trajectories of Nicotine Use Leading to Dual and Cyclical Tobacco Product Use in Young Adults

INTRODUCTION

Young adult never-smokers who vape are at elevated risk of initiating cigarettes, while young adults who smoke often begin vaping to substitute or reduce cigarette use. Reasons underlying different use patterns of tobacco products are not well-understood.

AIMS AND METHODS

We conducted 1-on-1 qualitative interviews with young adults (N = 62) who vape in Los Angeles, California from June 2018 to June 2019. Participants were 18-25 years old (79% male; racially/ethnically diverse) and self-reported vaping ≥1x/week. We used a semi-structured interview guide and applied thematic analysis method to analyze data.

RESULTS

Young adults initiated vaping due to peer socialization and e-liquid flavor novelty. They often reported vaping (after first smoking) due to a belief that e-cigarettes are healthier, social pressure to quit smoking, and convenience of use. Participants reported smoking (after first vaping) when traveling outside of the United States where vaping products were less accessible, and cigarettes were normative. Many of the personal narratives described patterns of dual and cyclical use, which was often attributed to nicotine dependence and cost, or described as dependent upon the current environment (eg, at a party).

CONCLUSIONS

The current study characterizes nicotine use trajectories and reasons why young adults vape, and smoke cigarettes. Dual and cyclical use of both e-cigarettes and cigarettes was common; this pattern of use should be considered in policy and prevention work to address nicotine dependence among young people.

IMPLICATIONS

We display findings from the current study in a model depicting common trajectories of nicotine use, along with reasons for initiation, transitions between products, and dual/cyclical e-cigarette and combustible cigarette use.

E-cigarette Transitions Among US Youth and Adults: Results from the Population Assessment of Tobacco and Health Study (2013-2018)

Currently, the debate surrounding the regulation of e-cigarettes focuses mainly on the size of e-cigarettes' potentially beneficial effects (i.e., adult cessation) versus their unwarranted effects (i.e., initiation among tobacco-naïve adolescents). Therefore, we investigated the relative scale of e-cigarette use transitions in the United States. We reported cross-sectional weighted prevalence estimates of past-month e-cigarette use by ever cigarette use from Waves 1-4 of the Population Assessment of Tobacco and Health study (2013-2018) among youth (12-17 years) and adults (≥ 18 years). We also examined past-month e-cigarette mono and dual transitions related to cigarette smoking and reported the longitudinal weighted prevalence across waves. Among youth new e-cigarette users, the proportion of never-cigarette smokers increased from 24.1 in Wave 1 (n = 418) to 51.4% in Wave 4 (n = 310) (p < 0.0001 for trend). Of youth past-month e-cigarette mono-users in Wave 1 (n = 151), 15.2% transitioned to cigarette mono-use and 8.2% dual-use at Wave 2 or 3 or 4, compared to 60.2% no tobacco use and 16.4% e-cigarette mono-use. Among young adult past-month dual-users (18-24 years; n = 684), 22.6% transitioned to no tobacco use, 60.1% continued cigarette use, 11.4% dual use, and 5.9% e-cigarette mono-use. Among adult dual-users ≥ 25 years old (n = 1560), 13.6% transitioned to no tobacco use, 71.3% cigarette mono-use, 9.0% dual-use, and 6.1% e-cigarette mono-use. Transition to cigarette mono-use and continued dual-use were common among adult past-month e-cigarette users, while e-cigarette initiation was common among youth never-cigarette smokers. These findings contrast with data from other countries showing limited evidence of e-cigarette initiation among youth never cigarette smokers. Both e-cigarette and cigarette use should be addressed in youth and adults, given the potential for dual use in both populations.

Emotion dysregulation, transdiagnostic vulnerabilities, and e-cigarette expectancies in a young adult sample

OBJECTIVE

Use of e-cigarettes is more common among youth with psychological distress. Negative affect reduction outcome expectancies (beliefs about ability of a product to reduce unpleasant emotional states) and emotional transdiagnostic vulnerabilities (maladaptive responses to emotional states common to multiple forms of emotional psychopathology) are both positively related to tobacco susceptibility and use. However, it is unclear if expectancies mediate the effects between emotional issues and use.

METHOD

College students aged 18 to 24 (N = 216; 79.6% female; 36.6% African American) completed an online survey with measures on e-cigarette negative affect reduction outcome expectancies (ENAROE), e-cigarette use, and the following emotional transdiagnostic vulnerabilities (ETV): difficulties in emotion regulation, distress tolerance (DT), positive/negative urgency, and positive/negative affect.

RESULTS

In individual predictor path analysis models, ENAROE mediated the relationship between ETVs and e-cigarette use. Expectancies (ENAROE) mediated 47.3% of the total relationship between positive urgency and use. Significant effects were found for a comprehensive model, in which negative urgency was related to higher ENAROE (b = 0.47, 95% BCCI [0.04, 0.96]), controlling for all other transdiagnostic vulnerabilities. Higher positive urgency was related to an increased likelihood of current use.

CONCLUSIONS

This study provides a novel examination of expectancies as a potential mediator for current e-cigarette use via emotional vulnerabilities. Negative Affect Reduction outcome expectancies mediated the relationship between vulnerabilities and e-cigarette use, indicating that the association between positive urgency and e-cigarette use may be explained partially though emotional expectancies. Thus, expectancies are important targets for prevention and further ETV research.

Smoking Susceptibility in Canadian Adolescent Electronic-Cigarette Users

Background: E-cigarette use is increasing among Canadian youth, with experimentation especially prevalent among never-smoking youth. Among this group, there is concern e-cigarette use contributes to future initiation of smoking through a gateway effect. However, e-cigarette use and smoking share many common risk factors; a postulated mechanism to explain the apparent causal pathway from e-cigarette use to smoking initiation in previously smoking-naïve youth. A better understanding of the relationships between smoking susceptibility and e-cigarette use among never-smoking youth is needed. Purpose/objectives: The primary aim of this study was to gain a deeper understanding of the risk factors associated with smoking susceptibility in youth who have recently used e-cigarettes. Methods: This study used data (n = 40,363) from the 2018/2019 Canadian Student Tobacco Alcohol and Drug Use Survey (CSTADS) to compare the risk factor profiles of susceptible and non-susceptible never-smoking e-cigarette users, as well as susceptible and non-susceptible never-smoking youth who have never used an e-cigarette. Results: E-cigarette use, independent of susceptibility status, was associated with a sociodemographic and behavioral risk factor profile likely to confer a higher risk of initiating smoking. Among e-cigarette users, smoking susceptibility was associated with more smoking risk factors. Conclusions/importance: Study findings support a common risk-factor model, rather than e-cigarette use itself, to explain differences in the likelihood of smoking initiation among e-cigarette users. E-cigarette use and smoking initiation may be interchangeable outcomes amongst those with smoking risk factors. The risks of e-cigarette use, and their regulatory status, need to be balanced with their potential as harm reduction tools.

The association of adolescent e-cigarette harm perception to advertising exposure and marketing type

BACKGROUND

Despite controversy over their possible health consequences, manufacturers of e-cigarettes employ a variety of marketing media to increase their popularity among adolescents. This study analyzed the relationship between adolescent e-cigarette harm perception and five types of e-cigarette advertising exposures: social media, radio, billboard, newspaper, and television.

METHODS

This study used data from Wave 4.5 of the Population Assessment of Tobacco and Health Study (PATH). PATH collects demographic data and interview individuals about issues pertaining to tobacco use, health outcomes, attitudes, and behaviors. This study applied factor analysis to three individual PATH harm perception items to develop a composite harm perception score. Using linear regression, the study explored the relationship of harm perception and participant responses to their recalled viewing of five different types (i.e., newspaper, radio, billboard, television and social media) of advertisements within the past 30 days. A second analysis explored if adjusting for exposure to anti-tobacco messaging and environmental factors such as family approval mitigated the association of harm perception and advertisement types.

RESULTS

The study sample consisted of 12,570 (weighted N = 23,993,149) individuals aged 12 to 17 years old. Unadjusted past 30-day exposure to newspaper, radio, billboard, and social media advertising all correlated with a reduced harm perception, but only the associations for newspaper and social media were statistically significant (p<0.05). After adjusting for environmental support factors, exposure to warning labels, and anti-tobacco advertisements, the analysis yielded statistically significant associations between increased e-cigarette harm perception and exposure to radio, billboard, and television advertisements (p<0.05). Adjusting for covariates also reduced the association of marketing and harm perception for all forms of media.

CONCLUSION

E-cigarette advertising influences adolescent perceptions of harm in e-cigarette use, particularly for social media and newspaper advertisements. This association weakens when adjusted for covariates such as environmental support and exposure to anti-tobacco marketing. These findings provide evidence for policy makers to continue anti-tobacco marketing and incorporate environmentally supportive strategies such as holistic, family-centered educational approaches to reduce e-cigarette use among adolescents.

Vaping Prevention in a Middle School Population Using CATCH My Breath

INTRODUCTION

The number of teens using electronic cigarettes in the United States has reached epidemic proportions. One in 20 middle school youth currently vapes regularly (Wang et al., 2020), supporting the need for e-cigarette education and prevention programs in this vulnerable population.

METHOD

The evidence-based youth vaping prevention program, CATCH My Breath, was implemented and evaluated in a small, private, parochial middle school using a quasi-experimental, within-subjects, longitudinal design.

RESULTS

Students' e-cigarette knowledge significantly improved postintervention (p < .001) and was sustained at 3 months follow-up. Attitudes about vaping remained stable after postintervention and at 3 months follow-up (p > .05). Susceptibility toward vaping increased or remained consistent despite increased knowledge (p = .096).

DISCUSSION

CATCH My Breath is an effective school-based resource to educate middle school youth about the dangers of vaping. Additional research is needed to evaluate the intervention's impact on e-cigarette attitudes and the measurement of susceptibility in teens.

A Snapshot of Parenting Practices Useful for Preventing Adolescent Vaping

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Youth with more parental knowledge perceive higher vaping prevalence.

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Youth with more parental knowledge perceive greater vaping harm.

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Youth with more parental knowledge perceive less accepting of vaping.

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Youth with greater parental media mediation report less lifetime vaping.

Introduction

Smoking research demonstrates that parents can influence their adolescent’s tobacco smoking perceptions and behaviors, but little is known about the protective effects of different parenting practices on adolescent vaping. In this study we investigate how adolescent perceptions of parents’ knowledge of their activities and parental media mediation are associated with adolescents’ perceptions of vaping and adolescent vaping behaviors.

Method

Six hundred thirty-nine youth (65.7% female, average age: 14.71 years old) recruited through 4-H clubs in nine states participated in a study evaluating a substance use intervention program. Because the evaluation design could influence participants, we used only baseline data. An online self-reported survey was administrated. Most youth self-identified as White (87.3%) and only handful youth indicated Asian (3.4%), African American (3.4%), American Indian (1.1%), and other or unreported (4.8%). Approximately 60% of youth lived in small town or rural areas in US.

Results

Analyses revealed that parental knowledge was positively related with adolescent perceived harm of vaping and perceived prevalence of vaping, but was negatively related with perceived acceptability of vaping and social expectancy of vaping. In addition, youth who reported greater parental media mediation were more likely to perceive the harm of vaping and less likely to vape compared with youth with lower parental media mediation.

Conclusion

These findings suggest that parental education about vaping, including those promoting conversations regarding vaping and vaping ads, may be important to the prevention of adolescent vaping.

E-cigarette device type and combustible tobacco use: Results from a pooled analysis of 10,482 youth

INTRODUCTION

To understand whether using a certain e-cigarette device is more strongly associated with risk of combustible tobacco use among youth.

METHODS

We conducted multivariable logistic regression analyses using cross-sectional data from 4 samples of youth in Connecticut and California (N = 10,482; ages 13-24), separately for each study using the total sample and the sample of past-month e-cigarette users, to understand the association between e-cigarette device type and past-month combustible tobacco use, while controlling for age, sex, race/ethnicity, socioeconomic status, school, and past-month marijuana use. Then, we conducted meta-analyses to calculate pooled associations for adolescents, young adults, and all individuals combined.

RESULTS

Among the total sample, combustible tobacco use was associated with any e-cigarette device use (vs. no e-cigarette use) in the pooled analysis across all studies. Among past-month e-cigarette users, combustible tobacco use across all studies was 15.8%- 61.5%. Pooled associations among past-month e-cigarette users showed that using disposable devices (vs. pods; AOR=2.83, 95% CI: 1.73-4.61) and multiple devices most frequently (vs. pods; AOR=2.13, 95% CI: 1.16-3.90) was associated with greater odds of combustible tobacco use. Pooled associations also found that using multiple devices (vs. a single device) in the past month was associated with greater odds of combustible tobacco use (AOR 2.33, 95% CI: 1.74, 3.14).

DISCUSSION

Using disposable e-cigarettes and multiple devices is associated with greater likelihood of combustible tobacco use among e-cigarette using youth. Future research should elucidate the trajectory of e-cigarette device used and combustible tobacco use among youth to inform prevention and product regulation.

Adolescent electronic cigarette use and tobacco smoking in the Millennium Cohort Study

AIMS

To evaluate the catalyst, diversion and common liability hypotheses by examining associations between e-cigarette use and tobacco cigarette smoking at modal ages 14 and 17 years, controlling for adolescent and infancy risk factors.

DESIGN

Intergenerational, prospective cohort data from the Millennium Cohort Study (MCS). Nationally representative sample of infants born September 2000 to January, 2002.

SETTING

United Kingdom.

PARTICIPANTS

Parent and child data from 10 625 youth assessed in infancy and modal ages 11, 14 and 17 years.

MEASUREMENTS

Age 14 and 17 e-cigarette and combustible cigarette use (recency, frequency). Potential confounders were age 11 risk factors (e.g. alcohol use, externalizing behaviors, parental tobacco use, permissiveness), infancy risk factors (e.g. maternal smoking during pregnancy, smoke exposure in infancy) and demographic characteristics.

FINDINGS

Among youth who had not smoked tobacco by age 14 (n = 9046), logistic regressions estimated that teenagers who used e-cigarettes by age 14 compared with non-e-cigarette users, had more than five times higher odds of initiating tobacco smoking by age 17 [odds ratio (OR) = 5.25, 95% confidence interval (CI) = 3.28-8.38] and nearly triple the odds of being a frequent tobacco smoker at age 17 (OR = 2.91, 95% CI = 1.56-5.41), net of risk factors and demographics. Among youth who had not used e-cigarettes by age 14 (n = 9078), teenagers who had smoked tobacco cigarettes by age 14 had three times higher odds of initiating e-cigarettes by age 17 (OR = 2.98, 95% CI = 1.74-5.09) compared with non-tobacco smokers and nearly three times higher odds of frequently using e-cigarettes at age 17 (OR = 2.90, 95% CI = 1.21-6.95), net of confounders. Similar links between e-cigarette and tobacco cigarette use were observed in regressions following coarsened exact matching.

CONCLUSIONS

E-cigarette use by age 14 is associated with increased odds of tobacco cigarette initiation and frequent smoking at age 17 among British youth. Similarly, tobacco smoking at age 14 is associated with increased odds of both e-cigarette initiation and frequent use at age 17.

E-cigarette Use Among Middle and High School Students in New York City Before and After Passage of Tobacco 21

Introduction

Despite declines in cigarette smoking in the US, electronic cigarette (e-cigarette) use has increased among middle and high school students. In 2014, New York City (NYC) implemented Tobacco 21 (T21) to prohibit sales to anyone under age 21. Our study goal was to measure the effectiveness of T21 on e-cigarette use.

Methods

We used the New York State (NYS) Youth Tobacco Survey—a biennial, school-based, self-administered survey. We explored middle (N = 5249) and high (N = 7296) school NYC students’ (male and female) current (past 30 days’) e-cigarette use from 2014 (pre-T21) to 2018 (post-T21). Results were compared with students in the rest of NYS (ROS). Bivariate and multivariable logistic regression analyses assessed correlates of e-cigarette use, beliefs about harmfulness, addictiveness, and susceptibility.

Results

NYC high school students’ current e-cigarette use increased from 2014 to 2018 (8.1% vs 23.5%, P < .001). Middle school students’ use increased between 2014 (4.8%) and 2016 (9.0%) yet reversed by 2018 (5.7%) (2014 vs 2018, P = .576). ROS middle school (2.2% vs 7.4%, P < .001) and high school (12.0% vs 29.3%, (P < .001) use increased from 2014 to 2018. Willingness to try e-cigarettes among those who had never tried an e-cigarette was twice as high (AOR = 2.19, 95% CI = 1.15-3.17) among NYC high school students in 2018 compared with 2014.

Conclusions

E-cigarette use increased among NYC high school students despite T21. T21 may have reduced use among middle school students over time. Programs that denormalize e-cigarettes and policies that further restrict access are needed to decrease youth e-cigarette use.

Adverse childhood experiences and other risk factors associated with adolescent and young adult vaping over time: a longitudinal study

BACKGROUND

Vaping among adolescents and young adults is a significant public health concern worldwide. Understanding which risk factors are associated with vaping is important to help inform evidence-based prevention and intervention strategies. There are several gaps in the current literature examining these associations such as limited longitudinal research. We examined the association between parental smoking/vaping, adolescent sex, mental disorders in adolescence, 13 adverse childhood experiences (ACEs) and a) any vaping and b) course of vaping across two time points among adolescents and young adults.

METHODS

Data were from Waves 1 and 2 of the longitudinal Well-Being and Experiences Study (The WE Study) in Manitoba, Canada which collected data from a community sample of adolescents (14 to 17 years) and their parent/caregiver in Wave 1 in 2017-18 and the adolescents/young adults only in Wave 2 in 2019. A total of 752 adolescents/young adults (72.4% of the original cohort) completed both waves of the study. Binary and multinomial logistic regressions were conducted to understand the relationship between the 16 risk factors and the two vaping outcomes.

RESULTS

Vaping prevalence was 45.5% for any vaping, 2.7% for Wave 1 vaping only, 19.7% for new onset Wave 2 vaping, and 21.2% for vaping at both waves. After adjusting for covariates, the majority of risk factors examined were associated with any adolescent or young adult vaping, including: parental smoking or vaping, emotional abuse, emotional neglect, exposure to verbal intimate partner violence, household substance use, household mental illness, parental separation/divorce, parental problems with police, foster care or contact with a child protective organization, an unsafe neighbourhood, and peer victimization. The majority of these risk factors, as well as adolescent mental health and parental gambling, were associated with different courses of vaping across the two time points.

CONCLUSIONS

The findings emphasize the need for early vaping prevention and identified several ACEs and other factors that were associated with adolescent and young adult vaping and course of vaping. These identified ACEs and risk factors can help inform programs, strategies, and potential groups to target for vaping interventions.

Factors Associated with E-Cigarette Quit Intention Among Adolescents in the United States

Background: Given increasing use of e-cigarettes among adolescents in the United States and its potential for nicotine addiction, encouraging adolescents to quit using these products has become a public health priority. This study examined factors at various socio-ecological levels associated with e-cigarette quit intention (pre-contemplation, contemplation, or preparation) using the Stages of Change of the Trans-theoretical Model among the U.S. adolescents. Methods: We used cross-sectional data from the past 30-day adolescent exclusive e-cigarette users participating in Wave 4 of the Population Assessment of Tobacco and Health study (n = 349). Weighted adjusted multinomial logistic regression models were used to analyze the data. Results: Compared to pre-contemplators and contemplators, preparators were more likely to believe that nicotine in e-cigarettes was "very/extremely harmful" (vs. "not at all harmful") to health (p < 0.001) and people cause a "lot of harm" (vs. "no harm") to themselves when they use e-cigarettes (p < 0.001). In comparison to pre-contemplators, contemplators and preparators were more likely to report that their parents/guardians talked with them about not using e-cigarettes than those whose parents/guardians did not talk with them (p < 0.001). Additionally, contemplators and preparators were also more likely to report that they "often/very often" (vs. never) noticed health warnings on e-cigarette packages (p < 0.001). Conclusion: Our findings suggest that harm perception, influence of family, and e-cigarette health warnings are some of the important factors associated with the stages of change for intention to quit among adolescent e-cigarette users. This study will help public health practitioners and researchers design multi-level e-cigarette cessation interventions for adolescents.

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

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

Young people's e-cigarette risk perceptions, policy attitudes, and past-month nicotine vaping in 30 U.S. cities

BACKGROUND

This study examined young people's e-cigarette risk perceptions, policy attitudes, and past-month nicotine vaping in 30 US cities in relation to city e-cigarette retail policy.

METHODS

Participants ages 13-20 were recruited online September-November 2020 (N = 900, approximately 30 per city). Cities (median population = 688,531) were in 23 states. Ever e-cigarette users were oversampled. A multilevel generalized estimating equations (GEE) model compared past-month nicotine vaping as a function of local e-cigarette retail policy. Among ever-users, multilevel bivariate GEE models examined associations of participant characteristics with past-month vaping (yes/no) and, among past-month nicotine vapers, purchase of vaping products at a retail location (yes/no).

RESULTS

The sample (age M = 17.7 [SD = 1.8]) was 60.2% female and 29.3% Black. Minimal city-level variation was observed in e-cigarette risk perceptions or policy attitudes (ICCs < 0.001). Nearly half the sample (44.6%) reported ever e-cigarette use; 11.8% reported past-month nicotine vaping. Past-month nicotine vaping was associated with older age, being non-Hispanic white, living with someone who vapes, having friends who vape, greater exposure to retail e-cigarette ads, lower e-cigarette risk perceptions, and lower perceived efficacy of flavored tobacco policy. Among ever-users, past-month nicotine vaping was not significantly associated with city e-cigarette flavor policy (p = .784). Most participants reporting past-month nicotine vaping purchased products in-store (58.5%).

CONCLUSIONS

Among young people surveyed in US cities, e-cigarette risk perceptions and policy attitudes showed minimal between-city variation. Past-month vaping among ever-users did not differ significantly by local flavor policies. A majority of past-month users, regardless of city policies, reported underage access to flavored products in retail locations.

Has increased youth e-cigarette use in the USA, between 2014 and 2020, changed conventional smoking behaviors, future intentions to smoke and perceived smoking harms?

INTRODUCTION

An increase in electronic cigarette (EC) use among US youth has raised concerns that their use may increase conventional cigarette smoking.

METHODS

Repeated cross-sectional data from two large nationally representative samples of US youth were drawn from the National Youth Tobacco Survey (NYTS) and Monitoring the Future (MTF). Students from grade 6-12 of the NYTS (N = 98,454-132,003) and students from grade 12 of the MTF (N = 17,870-30,981) were included in the analyses. Trends in smoking behavior, intention to smoke in the future and perceived smoking harms among youth who do and do not use ECs were estimated from 2014 to 2020 using weighted multinomial logistic regression and predicted marginal probabilities.

RESULTS

The prevalence for regular smoking decreased among youth who regularly use ECs. For example, among regular EC users, smoking prevalence decreased from 27.8% to 6.7% (-21%; 99.67% CI:[-32.3%, -9.9%]) in the NYTS between 2014 and 2020 and from 31.8% to 10.6% (-21.2%, 99.67% CI:[-35.0%, -7.3%]) in the MTF between 2014 and 2018. Intent to smoke in the future and perceiving smoking as harmless decreased or remained unchanged during the same period. For example, among regular EC users, there was no significant change in intention to smoke next year in the NYTS between 2014 and 2018; intention to smoke in the next 5 years decreased significantly from 30.7% to 11.2% (-19.5%, 99.67% CI:[-37.7%, -1.3%]) in the MTF.

CONCLUSIONS

In two national samples of US youth, smoking prevalence declined by a sizeable relative percentage. Intent to smoke in the future and harm perceptions of smoking declined or remained unchanged while EC use increased. Results provide little evidence that EC use has increased conventional cigarette smoking among youth.

Validation of the Electronic Cigarette Expectancy Scale for Adolescents

INTRODUCTION

Expectancies of costs and benefits can be predictive of tobacco use, as well as cessation attempts and success. Measuring electronic cigarette (ECIG) expectancies is in its infancy, particularly among adolescents. However, the popularity of adolescent ECIG use demonstrates the need to understand better these contributing factors. Our aim was to evaluate the factor structure and initial psychometric properties of an ECIG expectancies questionnaire adapted from an existing validated scale for conventional cigarette smoking (Smoking Expectancy Scale for Adolescents; SESA).

METHODS

Five-hundred sixty-nine adolescents (14-18 years; 60.1% female; 84.1% White) were recruited from high schools and an adolescent medicine clinic. Participants completed a battery of self-report measures, including the ECIG Expectancies Scale for Adolescents (EESA). Exploratory factor analyses were used to examine the underlying factor structure, and convergent validity was evaluated using variables conceptually related to ECIG expectancies.

RESULTS

A three-factor solution was chosen based on statistical evidence and conceptual relevance. All three factors - Costs, Social Benefits, and Affective/Weight Benefits - had strong internal consistencies and demonstrated convergent validity via significant associations with peer ECIG use and Conscientiousness. The Costs and Affective/Weight Benefits factors also demonstrated convergent validity with sensation-seeking, intention to use ECIGs, and ECIG use status (current, lifetime, nonuser).

CONCLUSION

Results support the initial reliability and validity of the EESA scores. This factor structure is related to, yet different from, that observed not only for the SESA but also for other ECIG-expectancy measures among adult populations.

Waterpipe smoking and subsequent cigarette and e-cigarette use: a cohort study

Aim

We tested the hypothesis that waterpipe smoking increases the likelihood to try conventional and electronic cigarettes.

Methods

In 2017 and 2018, 2752 German adolescents (mean age: 14.9 years), who had never tried conventional cigarettes or e-cigarettes, took part in a longitudinal survey with a 6-month observational period. Multiple regression analyses tested the association between waterpipe use at baseline and first experimentation with e-cigarettes at follow-up. The models adjusted for risk-taking propensity (sensation seeking and experimentation with alcohol and marijuana), age, sex, migration background, type of school and peer substance use.

Results

Some 381 adolescents (12.5% of the survey population) reported waterpipe smoking at baseline. The overall initiation rate during the 6 months was 4.9% (n=134) for conventional cigarettes and 10.5% (n=288) for e-cigarettes. Prior waterpipe smoking significantly predicted cigarette use (adjusted relative risk (ARR)=1.81, 95% CI 1.19-2.76), as well as e-cigarette use (ARR=3.29, 95% CI 2.53-4.28). In addition, a significant interaction between waterpipe use and sensation seeking was found (ARR=0.56, 95% CI 0.33-0.95), with waterpipe use being more predictive of later e-cigarette initiation for lower sensation-seeking individuals.

Discussion

Waterpipe use predicted both later cigarette and e-cigarette use independent of all other assessed risk factors, indicating that waterpipe use might be a risk factor on its own. The results suggest that the association was stronger for adolescents with a lower risk-taking propensity, which brings this group into focus for prevention efforts. However, further research is needed to understand whether these associations are causal.

Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged < 20 years. A systematic review and meta-analysis

BACKGROUND

This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged <20 years with subsequent tobacco use.

METHODS

We searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged < 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use.

FINDINGS

A total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p<0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p<0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p<0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035).

CONCLUSION

There is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group.

Community- and individual-level risk factors of past month e-cigarette use among adolescents in France

PURPOSE

Studies of adolescent e-cigarette use infrequently consider how environmental effects impact use. Adolescent e-cigarette use in France is also understudied, yet an important contrast since e-cigarette use rarely precedes conventional tobacco use and daily tobacco use is common. We examine whether there is significant variation in e-cigarette use across the geographic unit of départements (n = 95), and whether community factors explain these differences and individual-level probabilities of e-cigarette use.

METHODS

The ESCAPAD survey is a cross-sectional, nationally representative survey collected at a day of civic and military information mandatory for French 17-year-olds. We use the 2014 (n = 22,023) and 2017 (n = 39,115) surveys and geographic information from Eurostat and INSEE. Multilevel, multiple logistic regression models examine any and daily past month e-cigarette use.

RESULTS

We find significant département-level variation in both outcomes, with a considerable proportion of this variation explained by département-level factors. Net of numerous significant individual-level covariates, département-level unemployment (OR = 1.049, p < .05), poverty (OR=0.975, p < .05), age structure (OR=0.720, p < .01), and population growth (OR=0.987 p < .01) were associated with any past month use. The département-level percentage of adolescents using conventional tobacco daily was associated with individual-level any (OR=1.029, p < .001) and daily (OR=1.033, p < .01) e-cigarette use. Predicted probabilities demonstrate that département-level and individual-level tobacco use together were associated with e-cigarette use.

CONCLUSIONS

Researchers should incorporate community effects into studies of e-cigarette use. Particularly, the tobacco use environment contributes to risk of e-cigarette use. For policymakers, resources may be mobilized to address local socioeconomic, demographic, and tobacco use patterns to potentially affect adolescent e-cigarette use.

Use patterns of cigarettes and alternative tobacco products and socioeconomic correlates in Hong Kong secondary school students

Smoking is a major cause of health inequities. However, sociodemographic differences in adolescent tobacco use are unclear. In a territory-wide school-based anonymous survey in 2018/19, we investigated tobacco use and sociodemographic correlates in 33,991 students (mean age 14.8 ± 1.9 years) in Hong Kong. Tobacco use prevalence and current-ever use ratios by sociodemographic factors were calculated. Generalised linear mixed models were used in association analyses. Current use was highest for cigarettes (3.2%), closely followed by alternative tobacco products (3.0%). Current-ever use ratios were highest for heated tobacco products (HTPs, 0.60), followed by nicotine e-cigarettes (0.52), waterpipe (0.51), and cigarettes (0.35). Use prevalence and current-ever use ratios of all products showed curvilinear relations with perceived family affluence (P values < 0.01), being highest in the richest families. Tobacco use was also associated with more senior grades, the lowest parental education, and boys, but current-ever use ratios of HTPs and waterpipe were higher in girls (P values < 0.05). The results suggested that adolescent ever users of nicotine-containing alternative tobacco products were more likely to keep using them than cigarettes, and the richest adolescents were at the highest risks of tobacco use. Diverse tobacco control measures are needed to improve health equity, especially on alternative tobacco products.

Protective Factors Against Vaping and Other Tobacco Use

BACKGROUND AND OBJECTIVES

Vaping has gained popularity among adolescents despite negative health consequences. Few studies have focused on factors that may protect against vaping. We sought to determine if future orientation, parental monitoring, school connectedness, and social support are associated with decreased risk of vaping and other forms of tobacco use.

METHODS

Data were obtained via anonymous school-based health behavior surveys among ninth- through 12th-graders in Pittsburgh, PA (n = 2487). Protective factors were assessed through validated Likert scale instruments. The primary outcome was recent (past 30-day) vaping. Additional outcomes included other forms of tobacco use and intention to quit tobacco products. Poisson regression models examined associations between protective factors and vaping and tobacco use outcomes.

RESULTS

Mean age was 15.7 years, 1446 (58.1%) respondents were female, and 671 youth (27.0%) reported recent vaping. Positive future orientation and high parental monitoring were associated with significantly lower prevalence of recent vaping (adjusted prevalence ratio: 0.84 [95% confidence interval: 0.73-0.97] and adjusted prevalence ratio: 0.73 [95% confidence interval: 0.62-0.85], respectively). There were no significant relationships between social support or school connectedness and vaping. All 4 protective factors were inversely associated with other forms of tobacco use. No factors were significantly associated with intent to quit tobacco products.

CONCLUSIONS

Findings reveal significant inverse associations between future orientation, parental monitoring, and vaping but no relationship between protective factors and intent to quit tobacco products. Developing interventions to foster protective factors in youth and their parental supports may inform primary prevention efforts to reduce vaping and other tobacco use.

Use of E-Cigarettes and Associated Factors among Youth in Thailand

OBJECTIVE

The study explored e-cigarette use among youth and associated factors in Thailand.

METHODS

This was a cross sectional study of 6,045 seventh grade students selected using a multistage design. Self-administered questionnaires relating to the socio-demographic characteristics, history of cigarette and e-cigarette uses, friends' and family's use of e-cigarettes, knowledge and perception of e-cigarette use, history of alcohol uses, and life assets were gathered. Multivariate logistic regression models were used to examine the variables and their association with e-cigarette use.

RESULTS

Prevalence of ever e-cigarette use was 7.2% and current e-cigarette use was 3.7%. We found that current cigarette smoking (AOR 4.28, 95% CI: 2.05-8.94), parental e-cigarette use (AOR 6.08, 95% CI: 2.81-13.17), peer e-cigarette use (AOR 3.82, 95% CI: 2.19-6.65), peer approval of smoking (AOR 1.95, 95% CI: 1.11-3.41), and unaware of e-cigarettes' risk (AOR 5.25, 95% CI: 2.67-10.34). were significantly associated with current use of e-cigarettes. Male sex, poor academic achievement, and poor life assets (power of wisdom) were only significantly associated with ever e-cigarette use.

CONCLUSION

Prevalence of current e-cigarette use among Thai middle school students did not change significantly since the government banned importation and sales of e-cigarettes in 2015, suggesting that the Thai ban has been a success. Factors associated with e-cigarette use among Thai youth were consistent with other countries. Ever e-cigarette use, increased, but less than in countries without a ban. To strengthen efforts to prevent youth from e-cigarette use and addiction, the government should improve law enforcement, especially against online marketing and strengthen school-based anti-smoking programs to include e-cigarette lessons, educating parents and the public about the harm of e-cigarettes, including secondhand effects on non-users.
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Effects of tobacco product type and characteristics on appeal and perceived harm: Results from a discrete choice experiment among Guatemalan adolescents

Guatemala is one of the few countries where both heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) remain unregulated. We used a discrete choice experiment (DCE) administered to 2038 high school students to assess how tobacco product attributes influence their appeal among Guatemalan adolescents. Participants were randomly assigned to evaluate 4 of 32 contrasting sets, each containing 3 packs (1 of each product type). Experimental manipulations included: product type, brand, nicotine content and flavor. Participants then indicated which product they were most and least interested in trying and would be most and least harmful to their health. Conditional logistic regression models were used to assess the impact of product characteristics on choice. Product type accounted for almost 90% of variation in choices. Respondents were less interested in trying HTPs (B = -0.93; p < 0.001) and viewed them as more harmful (B = 2.77; p < 0.001) compared to cigarettes. They were more interested in trying e-cigarettes (B = 1.22; p < 0.001), which were also perceived as less harmful (B = -1.47; p < 0.001) compared to cigarettes. Products without nicotine were of more interest for trying (B = 0.14; p < 0.001) and perceived as more harmful (B = 0.20; p < 0.001) than those with. Students were more interested in trying a flavor compared to regular tobacco and among the flavors, berry was the highest rated one (B = 0.28; p < 0.001). Finally, in this country with weak tobacco control, e-cigarettes appear to be more appealing and perceived as less harmful than HTPs and cigarettes. Packaging and flavoring regulations are urgently needed on these products as they are a marketing strategy targeting adolescents.