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Yimer TM, McClure-Thomas C, Stjepanovic D, Wilson J, Chan GCK, Hall WD, Leung J. The relationship between cannabis and nicotine use: A systematic review and meta-analysis. Addiction 2024. [PMID: 39129583 DOI: 10.1111/add.16642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND AND AIMS Cannabis and nicotine (tobacco or e-cigarettes) use commonly co-occurs and understanding their relationship can help to inform public health strategies to prevent their harms. We conducted a systematic review and meta-analysis to estimate the association of cannabis use given prior nicotine use and vice versa. METHODS PubMed, Embase, PsycINFO, Google Scholar and a hand-search were conducted in 2023 for longitudinal studies of the general population with no restrictions in settings (locations). Random-effects meta-analysis was conducted to estimate odds ratios between cannabis and nicotine use in both directions. The impact of unmeasured confounding was assessed using E-values. RESULTS From 5387 identified records, we included 20 studies. Among cannabis-naïve youths, baseline use of any nicotine products was positively associated with initiation of any cannabis use at follow-up [odds ratio (OR) = 5.39, 95% confidence interval (CI) = 3.19, 9.11; adjusted OR (aOR) = 2.59, 95% CI = 2.01, 3.32]. In nicotine-naïve participants (youths + adults), baseline cannabis use was positively associated with the initiation of any nicotine use at follow-up (OR = 4.08, 95% CI = 2.05, 8.11; aOR = 2.94, 95% CI =1.54, 5.61). There were no significant associations between baseline cannabis use and subsequent initiation of any nicotine (aOR = 3.29, 95% CI = 0.85, 12.76) or daily nicotine use (aOR = 2.63, 95% CI = 0.41, 16.95) among youths. The median E-values were 5.5 for nicotine exposure and cannabis use initiation and 4.1 for cannabis exposure and nicotine use initiation, indicating that substantial unmeasured confounding would need to have a strong association with both outcomes to fully explain away the cannabis and nicotine relationship. CONCLUSION Although the evidence for associations between cannabis use and tobacco use is mixed, a majority of studies to date have found that cannabis use is associated with prior nicotine use and vice versa.
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Affiliation(s)
- Tesfa Mekonen Yimer
- National Center for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Caitlin McClure-Thomas
- National Center for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Daniel Stjepanovic
- National Center for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Jack Wilson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Gary Chung Kai Chan
- National Center for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Wayne Denis Hall
- National Center for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- National Center for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
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Evans-Polce RJ, Chen B, McCabe SE, West BT. Longitudinal associations of e-cigarette use with cigarette, marijuana, and other drug use initiation among US adolescents and young adults: Findings from the population assessment of tobacco and health study (Waves 1-6). Drug Alcohol Depend 2024; 263:111402. [PMID: 39137612 DOI: 10.1016/j.drugalcdep.2024.111402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 07/05/2024] [Accepted: 07/14/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Research examining prospective links of e-cigarette use with cigarette, marijuana, and other substance use has been limited largely to 1-2-year follow-up periods and focused on younger adolescents. This study examined longitudinal associations of e-cigarette use with cigarette, marijuana, and other substance use initiation among U.S. adolescents and young adults (AYAs) across an eight-year period. METHODS Adolescent (ages 12-17) and young adult (ages 18-25) data from waves 1-6 of the nationally representative Population Assessment of Tobacco and Health study (2013-2021) were used. Discrete time survival models with time-varying weights were employed to examine the risk of cigarette, marijuana, and other drug use initiation over an eight-year follow-up period among AYAs with no lifetime use of e-cigarettes/other tobacco, lifetime but no past 30-day use of e-cigarettes/other tobacco, past 30-day e-cigarettes only, other tobacco use only, or past 30-day e-cigarette/other tobacco use. We compare our time-varying weighting approach to a traditional time-invariant/complete case weighting approach. RESULTS Across six follow-up waves, all three past 30-day nicotine/tobacco use groups, including e-cigarettes only, had greater risk for cigarette, marijuana, and other drug use initiation relative to those not using nicotine/tobacco. The three past 30-day nicotine/tobacco use groups did not differ from each other in risk for marijuana use initiation. Associations were smaller in magnitude for young adults compared to adolescents, but significant for both age groups. CONCLUSIONS Substance use initiation risks persist beyond 1-2 years for U.S. AYAs using e-cigarettes. Prevention strategies to reduce AYA e-cigarette use are needed to reduce cancer-related risk.
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Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking, and Health, School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States.
| | - Bingxin Chen
- Applied Biostatistics Laboratory, School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking, and Health, School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, United States; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Brady T West
- Center for the Study of Drugs, Alcohol, Smoking, and Health, School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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Elsherif I, Jammah AA, Ibrahim AR, Alawadi F, Sadek IS, Rahman AM, Sharify GE, AlFeky A, Aldossari K, Roushdy E, ELBarbary NS, BenRajab F, Elghweiry A, Farah SIS, Hajjaji I, AlShammary A, Abdulkareem F, AbdelRahim A, Orabi A. Clinical practice recommendations for management of Diabetes Mellitus in Arab region: An expert consensus statement from Arab Diabetes Forum (ADF). Prim Care Diabetes 2024:S1751-9918(24)00120-7. [PMID: 38955658 DOI: 10.1016/j.pcd.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024]
Abstract
Prevalence of diabetes in Arab region has significantly increased, resulting in a significant economic burden on healthcare systems. This surge can be attributed to obesity, rapid urbanization, changing dietary habits, and sedentary lifestyles. The Arab Diabetes Forum (ADF) has established localized recommendations to tackle the region's rising diabetes prevalence. The recommendations, which incorporate worldwide best practices, seek to enhance the quality of treatment for people with diabetes by raising knowledge and adherence among healthcare providers. The guidelines include comprehensive recommendations for screening, diagnosing, and treating type 1 and type 2 diabetes in children and adults for better overall health results.
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Affiliation(s)
| | - Anwar Ali Jammah
- Endocrinology and Diabetes Division, Medicine Department, King Saud University, Saudi Arabia
| | | | - Fatheya Alawadi
- Dubai Medical College - President of EDS emirates diabetes society, the United Arab Emirates
| | | | | | | | | | - Khaled Aldossari
- Department of family and community medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Eman Roushdy
- Internal medicine and Diabetes, Cairo University, Egypt
| | - Nancy Samir ELBarbary
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt
| | | | - Awad Elghweiry
- National Center for Diagnosis and Treatment of Diabetes, Benghazi, Libya
| | | | - Issam Hajjaji
- Endocrine & Diabetes Hospital, University of Tripoli, Libya
| | - Afaf AlShammary
- Department of Internal Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Saudi Arabia
| | - Faris Abdulkareem
- Internal medicine, diabetes and endocrinology, Alkindy College of Medicine, Iraq
| | - Aly AbdelRahim
- Internal medicine and Diabetes Department, Alex University, Egypt
| | - Abbass Orabi
- Internal medicine and Diabetes, Zagazig University, Egypt.
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Campbell JE, Chen S, Bailey A, Blair A, Comiford AL. Investigating Cannabis-Use Among Students Attending High Schools Within the Cherokee Nation Reservation 2017 and 2019. J Community Health 2024; 49:402-414. [PMID: 38066219 PMCID: PMC10981585 DOI: 10.1007/s10900-023-01304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 02/18/2024]
Abstract
Oklahoma's medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9-12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis.
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Affiliation(s)
- Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Anna Bailey
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Andrea Blair
- Cherokee Nation Public Health, 1325 East Boone Street, Tahlequah, OK, 74464, USA
| | - Ashley L Comiford
- Cherokee Nation Health Services, 19600 East Ross Road, Tahlequah, OK, 74464, USA
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Fingesi TS, Kimaru LJ, Okusanya BO, Ehiri JE, Rosales C. Nicotine and Alcohol Use as Predictors of Recreational Cannabis Use in Adolescence: A Systematic Review and Narrative Synthesis. Subst Use Misuse 2024; 59:1367-1382. [PMID: 38658323 DOI: 10.1080/10826084.2024.2342008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: The prevalence of recreational cannabis use among adolescents is a growing public health concern due to its link to short- and long-term adverse effects on adolescents' wellbeing, physical health, mental health, and interpersonal behaviors. Method: Five databases were searched from inception to March 17, 2023, for exposure (nicotine product, alcohol) and outcome (recreational cannabis) in adolescents (persons aged 10-19 years). The studies were screened independently by two reviewers, and the quality of the studies was assessed with Newcastle Ottawa and AXIS tool. PRISMA guidelines were employed in this review. Result: Twenty-one (21) studies involving 2,778,406 adolescents were included in the appraisal and heterogeneity was found among these studies. Ascertainment bias was commonly detected in thirteen (13) of the included studies. Among the substances examined as potential exposures, nicotine-product use emerged as a significant factor associated with future cannabis use among adolescents, particularly in mid-adolescence and in places where recreational cannabis use has been legalized. Conclusion: Current evidence suggests an association between nicotine-product use and subsequent recreational cannabis use among adolescents. However, further research is needed to establish causality between exposure to nicotine substances and the use of recreational cannabis within this age demographic. Additionally, there is a need for the development of prevention programs and targeted policies that continuously inform and update this vulnerable sub-population about the risks associated with cannabis use for leisure.
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Affiliation(s)
- T S Fingesi
- Community Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, Arizona, USA
| | - L J Kimaru
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - B O Okusanya
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - J E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - C Rosales
- Division of Public Health Practice and Translational Research, Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, Arizona, USA
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Han DH, Cho J, Vogel EA, Harlow AF, Tackett AP, Eckel SP, McConnell R, Barrington-Trimis JL, Leventhal AM. Longitudinal Transitions Between Use of Combustible, Noncombustible, and Multiple Cannabis Products From Adolescence to Young Adulthood and Intersections With Nicotine Use. Am J Epidemiol 2024; 193:617-625. [PMID: 37981712 DOI: 10.1093/aje/kwad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/14/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023] Open
Abstract
Understanding transitions across use of different types of cannabis products and multiple cannabis products and how they intersect with nicotine use in young people can inform etiology and prevention. In this study, we examined transitions across use of combustible and noncombustible forms of cannabis and multiple types of cannabis from adolescence to young adulthood and the role of nicotine use in transitions. In a Southern California longitudinal cohort study (n = 3,298; baseline mean age = 16.1 (standard deviation, 0.4) years) with 9 semiannual survey waves (2015-2021), we used Markov multistate transition modeling to estimate short-term (2-wave) and long-term (9-wave) probabilities of transition across 5 cannabis use states: never use of any product, prior use with no past-6-month (P6M) use of any product, and P6M use of exclusively noncombustible products, exclusively combustible products, and multiple (noncombustible + combustible) products. Sizable transition probabilities from prior and exclusive P6M noncombustible or combustible cannabis use to P6M poly-cannabis-product use were observed in short-term (10.7%-38.9%) and long-term (43.4%-43.8%) analyses. P6M nicotine use increased risk of transitioning from never and prior use to exclusive P6M noncombustible and combustible cannabis use. Cannabis use in any form, even temporary use, during midadolescence may often be followed by poly-cannabis-product use. Nicotine use may amplify the probability of future cannabis use onset or recurrence.
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7
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Temourian AA, Halliday DM, Yan Y, Chan-Golston AM, Song AV. Marijuana and E-cigarette Initiation Among Adolescents: A Survival Analysis. J Adolesc Health 2024; 74:747-754. [PMID: 38085208 DOI: 10.1016/j.jadohealth.2023.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE Prior literature suggests marijuana and e-cigarette initiation among adolescents is surpassing combustible cigarette uptake. Marijuana and nicotine co-use is also a concern as these products grow in popularity. Initiation trajectories for marijuana and e-cigarette products are not well understood, let alone how the use of one product may impact initiation susceptibility for the other. METHODS We used national longitudinal data from the Population Assessment of Tobacco and Health study from 2013 to 2018. Eighth graders in Wave 1 made up the analytic sample (N = 2,270). We employed discrete time survival analyses to determine the likelihood of initiating marijuana and e-cigarettes between Waves 2 and 5. We used survival analyses to estimate the relationships between prior cigarette and marijuana use and subsequent e-cigarette initiation, as well as prior cigarette and e-cigarette use and subsequent marijuana initiation. RESULTS Previous marijuana initiation was associated with later e-cigarette initiation (odds ratio = 6.88, 95% confidence interval [4.89, 9.67]). Previous e-cigarette initiation was associated with later marijuana initiation (odds ratio = 9.28, 95% confidence interval [6.86, 12.56]). By wave 5, adolescents were more than 42% likely to initiate marijuana and e-cigarettes. DISCUSSION Susceptibility to marijuana and e-cigarette products starts as early as eighth grade and increases over time. The use of one product is significantly related to later initiation for the other. Rather than addressing marijuana and nicotine as separate concerns, interventions may benefit by recognizing the closely related nature of these products.
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Affiliation(s)
- Allison A Temourian
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, California; Nicotine and Cannabis Policy Center, Health Sciences Research Institute, University of California, Merced, California
| | - Deanna M Halliday
- Center for Tobacco Control Research and Education, University of California, San Francisco, California
| | - Yueqi Yan
- Biostatistics and Data Support Center, Health Sciences Research Institute, University of California, Merced, California
| | - Alec M Chan-Golston
- Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced, California; Biostatistics and Data Support Center, Health Sciences Research Institute, University of California, Merced, California
| | - Anna V Song
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, California; Nicotine and Cannabis Policy Center, Health Sciences Research Institute, University of California, Merced, California.
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8
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Becker TD. A clinical overview of adolescent e-cigarette use (vaping). Minerva Pediatr (Torino) 2024; 76:108-118. [PMID: 37427959 DOI: 10.23736/s2724-5276.23.07131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
E-cigarette use (also known as "vaping") has become increasingly popular among adolescents over the past decade and grown into a significant public health concern in North America, the United Kingdom, and other countries. Concerns about this new trend have generated numerous new research studies. This aim of this study was to summarize recent scientific findings, with a focus on their relevance to clinicians working with adolescents. The first half covers epidemiology, risk factors for e-cigarette use, characteristics of e-cigarette use, youth perceptions of e-cigarettes, physical health risks of e-cigarettes, evidence for "gateway effects" of e-cigarette exposure on subsequent substance use, and the relationship between e-cigarette use and mental health. The review concludes with a clinical focus on assessment of youth who vape, psychoeducation for youth and families, clinical management of vaping, and regulatory considerations.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, New York-Presbyterian Hospital, New York, NY, USA -
- Division of Child and Adolescent Psychiatry, Weill Cornell Medicine, New York, NY, USA -
- Division of Child and Adolescent Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA -
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Lau L, Conti AA, Hemmati Z, Baldacchino A. The prospective association between the use of E-cigarettes and other psychoactive substances in young people: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 153:105392. [PMID: 37714228 DOI: 10.1016/j.neubiorev.2023.105392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
The use of electronic cigarettes by young people has increased exponentially in the past decade due to various health and social influences. E-cigarettes, particularly those containing nicotine, can cause health complications and addiction, which may result in a subsequent initiation of psychoactive substance use. This systematic review and meta- analysis evaluated the prospective association between e-cigarette use and subsequent use of psychoactive substances in young people aged 10-24 years. Pooling of data from the identified longitudinal studies showed that ever e-cigarette users have an increased likelihood for subsequent cannabis, alcohol, and unprescribed Ritalin/Adderall use compared to never e-cigarette users. The findings indicate a need for interventions to reduce e-cigarette use in adolescents and young adults.
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Affiliation(s)
- Lucinda Lau
- University of Edinburgh Medical School, Edinburgh EH16 4TJ, UK.
| | - Aldo Alberto Conti
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AB, UK.
| | - Zeynab Hemmati
- School of Medicine, The University of Manchester, Manchester M13 9PL, UK.
| | - Alex Baldacchino
- University of St Andrews School of Medicine, Division of Population and Behavioural Science, North Haugh, St Andrews, Fife, Scotland KY16 9TF, UK.
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Bessenyei K, Yakovenko I. Predictors of polysubstance vaping in emerging adults. Addict Behav 2023; 142:107675. [PMID: 36857931 DOI: 10.1016/j.addbeh.2023.107675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Polysubstance use, which increases the risk for negative consequences of substance use, is common among emerging adults who regularly consume substances by vaping. Examining predictors of polysubstance vaping is crucial for understanding whether this novel form of substance consumption lends itself equally efficaciously to established forms of intervention for smoked substances. OBJECTIVE The current study aimed to examine whether modifiable cognitive risk factors for increased vaping in the form of attitudes, expectancies and norms can predict co-use of nicotine and cannabis among vapers over and above the effect of demographics, personality risk factors and anxiety, depression symptoms. METHODS Regular nicotine and cannabis vapers between 18 and 30 years were recruited online in Canada via a Qualtrics panel. Hierarchical binary logistic regression was used to predict membership in a polysubstance or a single substance vaping group. Demographics, personality risk factors, depression and anxiety symptoms were included as predictors in block 1; attitudes, expectancies and perceived norms of vaping were added in block 2. RESULTS Attitudes, expectancies and norms predicted polysubstance use over and above the effect of demographics, personality risk factors and anxiety, depression symptoms. Positive expectancies played a uniquely significant role in the prediction of polysubstance vaping. CONCLUSIONS Cognitive interventions targeting attitudes, expectancies and norms may be effective in prevention of polysubstance vaping, although positive expectancies appear to be the main unique factor that has an influence above and beyond all other cognitive factors related to vaping. Treatment and prevention programs should put special focus on lowering positive expectancies.
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Affiliation(s)
- Kitti Bessenyei
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Igor Yakovenko
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Chen G, Rahman S, Lutfy K. E-cigarettes may serve as a gateway to conventional cigarettes and other addictive drugs. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:11345. [PMID: 38389821 PMCID: PMC10880776 DOI: 10.3389/adar.2023.11345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/14/2023] [Indexed: 02/24/2024]
Abstract
Electronic cigarettes (e-cigarettes) are devices that allow the user to inhale nicotine in a vapor, and are primarily marketed as a means of quitting smoking and a less harmful replacement for traditional cigarette smoking. However, further research is needed to determine if vaping nicotine via e-cigarettes can be effective. Conversely, nicotine has been considered a gateway drug to alcohol and other addictive drugs and e-cigarettes containing nicotine may have the same effects. Previous reports have shown that e-cigarette use may open the gate for the use of other drugs including conventional cigarettes, cannabis, opioids, etc. The increasing prevalence of e-cigarettes, particularly among youth and adolescents in the last decade have led to an increase in the dual use of e-cigarettes with alcohol, cannabis, and other illicit drug use like heroin and 3-4-methylenedioxymethamphetamine (MDMA). The advent of e-cigarettes as a device to self-administer addictive agents such as cocaine and synthetic cathinones may bring about additional adverse health effects associated with their concurrent use. This review aims to briefly describe e-cigarettes and their different generations, and their co-use with other addictive drugs as well as the use of the device as a tool to self-administer addictive drugs, such as cocaine, etc.
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Affiliation(s)
- Grace Chen
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, United States
| | - Shafiqur Rahman
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, SD, United States
| | - Kabirullah Lutfy
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, United States
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13
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Williams RJ, Wills TA, Choi K, Pagano I. Associations for subgroups of E-cigarette, cigarette, and cannabis use with asthma in a population sample of California adolescents. Addict Behav 2023; 145:107777. [PMID: 37336095 DOI: 10.1016/j.addbeh.2023.107777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/12/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
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.
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Affiliation(s)
- Rebecca J Williams
- California Department of Public Health, California Tobacco Control Program, Sacramento, CA, United States.
| | - Thomas A Wills
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Ian Pagano
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, United States
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14
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Nicotine and Nicotine-Free Vaping Behavior among a Sample of Canadian High School Students: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020368. [PMID: 36832497 PMCID: PMC9955355 DOI: 10.3390/children10020368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/28/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023]
Abstract
Youth vaping is a public health concern in Canada. Researchers have explored factors associated with vape use, but rarely differentiated between types of use. This study estimates the prevalence and correlations among past-month nicotine vaping, nicotine-free vaping, and dual-use vaping (nicotine and nicotine-free) in grades 9-12 high school students. Data came from the 2019 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). The total sample consisted of 38,229 students. We used multinomial regression to assess for the correlations among different categories of vape use. Approximately 12% of the students reported past-month vape use exclusively with nicotine, 2.8% reported exclusively nicotine-free vape use, and 14% reported both nicotine vaping and nicotine-free vaping. Substance use (smoking, alcohol, cannabis) and being male were associated with membership in every category of vape use. Age was associated with vape use, but in different directions. Grade 10 and 11 students were more likely than grade 9 students to vape exclusively with nicotine (aOR 1.36; 95% CI: 1.05, 1.77 and aOR 1.46; 95% CI: 1.09, 1.97), while grade 9 students were more likely than grade 11 and 12 students to vape with both nicotine and nicotine-free vapes (aOR 0.82; 95% CI: 0.67, 0.99 and aOR 0.49; 95% CI: 0.37, 0.64). The prevalence of nicotine and nicotine-free vaping is high, with many students reporting the use of both.
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15
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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16
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Abstract
Depression commonly onsets in adolescence, affecting approximately 1 in 4 female adolescents and 1 in 10 males in the United States. Adolescent depression is a significant risk factor for suicide, the cause of over a third of all American adolescent deaths. Adolescent depression is introduced alongside its developmental and gendered considerations with a focus on important risk factors of adolescent depression, including nonsuicidal self-injury, adverse childhood experiences, and substance abuse. Protective factors and contemporary special topics of the COVID-19 pandemic and social media use are reviewed. Therapeutic options and clinical barriers are highlighted before a summary of findings and conclusion.
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Affiliation(s)
- Aliza Grossberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, Babcock Building 5 West, New York, NY, USA
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, Babcock Building 5 West, New York, NY, USA.
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17
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Olszewski NA, Tetteh-Quarshie S, Henderson BJ. Understanding the Impact of Flavors on Vaping and Nicotine Addiction-Related Behaviors. Curr Behav Neurosci Rep 2022. [DOI: 10.1007/s40473-022-00253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Asfar T, Jebai R, Li W, Oluwole OJ, Ferdous T, Gautam P, Schmidt M, Noar SM, Lindblom EN, Eissenberg T, Bursac Z, Vallone D, Maziak W. Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies. Tob Control 2022:tobaccocontrol-2022-057495. [PMID: 36252567 PMCID: PMC10043882 DOI: 10.1136/tc-2022-057495] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This umbrella review aims to summarise the evidence about electronic nicotine delivery systems' (ENDS) risk and safety health profile to inform ENDS health communication strategies. DATA SOURCES AND STUDY SELECTION Six databases were searched for systematic reviews presenting evidence on ENDS-related health effects. Ninety reviews divided into five categories were included: toxicity=20, health effects=40, role in smoking cessation=24, role in transition to combustible cigarettes (CCs)=13 and industry marketing claims=4. DATA EXTRACTION Findings were synthesised in narrative summaries. Meta-analyses were conducted by study type when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine's Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive and limited-not-conclusive. DATA SYNTHESIS We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of respiratory disease; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CC initiation; and exposure to ENDS marketing increases its use/intention to use. Evidence was moderate for ENDS association with mental health and substance use, limited-suggestive for cardiovascular, and limited-not-conclusive for cancer, ear, ocular and oral diseases, and pregnancy outcomes. CONCLUSIONS As evidence is accumulating, ENDS communication can focus on high-level evidence on ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning) and anti-ENDS industry sentiment. Direct comparison between the harm of CCs and ENDS should be avoided. PROSPERO REGISTRATION NUMBER CRD42021241630.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rime Jebai
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Olusanya Joshua Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tarana Ferdous
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Prem Gautam
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, TN, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina System, Chapel Hill, NC, USA
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Thomas Eissenberg
- Psychology and Institute for Drug/Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Zoran Bursac
- Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA
| | - Donna Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Truth Initiative Schroeder Institute, New York University College of Global Public Health, New York, NY, USA
| | - Wasim Maziak
- Epidemiology, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA
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19
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Vaping. JAAPA 2022; 35:25-30. [DOI: 10.1097/01.jaa.0000854544.26702.2e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Harlow AF, Vogel EA, Tackett AP, Cho J, Han DH, Wong M, Cockburn MG, Sussman SY, Unger JB, Leventhal AM, Barrington-Trimis JL. Adolescent Use of Flavored Non-Tobacco Oral Nicotine Products. Pediatrics 2022; 150:188734. [PMID: 35934731 PMCID: PMC9994602 DOI: 10.1542/peds.2022-056586] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Flavored non-tobacco oral nicotine products (eg, nicotine pouches and nontherapeutic nicotine gum, lozenges, tablets, gummies), are increasingly marketed in the United States. Prevalence of non-tobacco oral nicotine product use among adolescents is unknown. METHODS We calculated prevalence of ever and past 6-month use of nicotine pouches, other non-tobacco oral nicotine products (ie, gum, lozenges, tablets, and/or gummies), e-cigarettes, cigarettes, hookah or waterpipe, cigars, cigarillos, and snus among high school students in Southern California between September and December 2021. Generalized linear mixed models tested associations of sociodemographic factors and tobacco-product use with use of any non-tobacco oral nicotine product. RESULTS Among the sample (n = 3516), prevalence was highest for e-cigarettes (ever: 9.6%, past 6-month: 5.5%), followed by non-tobacco oral nicotine products (ever: 3.4%, past 6-month: 1.7%), and <1% for other products. Ever users of combustible tobacco (adjusted odds ratio [aOR] = 77.6; 95% confidence interval [CI] = 39.7-152) and ever users of noncombustible tobacco (aOR = 40.4; 95% CI= 24.3-67.0) had higher odds of ever using non-tobacco oral nicotine products, compared to never users of combustible and noncombustible tobacco. Use of any non-tobacco oral nicotine product was greater for Hispanic (versus all other races/ethnicities except Asian, aOR = 2.58; 95% CI = 1.36-4.87), sexual minority (versus heterosexual, aOR=1.63; 95% CI = 1.03-2.57), gender minority (versus male, aOR = 2.83; 95% CI = 1.29-6.19), and female (versus male, aOR=1.92, 95% CI = 1.20-3.06) participants. CONCLUSIONS Non-tobacco oral nicotine products were the second most prevalent nicotine product used by adolescents. They were disproportionately used by certain racial or ethnic, sexual, or gender minority groups, and those with a history of nicotine use. Adolescent non-tobacco oral nicotine product use surveillance should be a public health priority.
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Affiliation(s)
- Alyssa F Harlow
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine
| | - Erin A Vogel
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine
| | - Alayna P Tackett
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine.,USC Norris Comprehensive Cancer Center, Keck School of Medicine
| | - Junhan Cho
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine.,USC Norris Comprehensive Cancer Center, Keck School of Medicine
| | - Dae-Hee Han
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine
| | - Melissa Wong
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine
| | - Myles G Cockburn
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine.,USC Norris Comprehensive Cancer Center, Keck School of Medicine.,Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steve Y Sussman
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine.,USC Norris Comprehensive Cancer Center, Keck School of Medicine
| | - Jennifer B Unger
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine.,USC Norris Comprehensive Cancer Center, Keck School of Medicine
| | - Adam M Leventhal
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine.,USC Norris Comprehensive Cancer Center, Keck School of Medicine
| | - Jessica L Barrington-Trimis
- USC Institute for Addiction Science.,Department of Population and Public Health Sciences, Keck School of Medicine.,USC Norris Comprehensive Cancer Center, Keck School of Medicine
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21
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Lewis NM, Friedrichs M, Wagstaff SS, Nakashima AK, Dunn AC. Characteristics of Adults Who Use Both Marijuana and E-Cigarette, or Vaping, Products: A Cross-Sectional Study, Utah, 2018. Public Health Rep 2022; 137:695-701. [PMID: 34039118 PMCID: PMC9257507 DOI: 10.1177/00333549211018679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Among young people, dual use of marijuana and e-cigarette, or vaping, products (EVPs) is linked with using more inhalant substances and other substances, and poorer mental health. To understand antecedents and potential risks of dual use in adults, we analyzed a representative adult population in Utah. METHODS We used data from the 2018 Utah Behavioral Risk Factor Surveillance System (n = 10 380) and multivariable logistic regression to evaluate differences in sociodemographic characteristics, comorbidities, and risk factors among adults aged ≥18 who reported currently using both EVPs (any substance) and marijuana (any intake mode), compared with a referent group of adults who used either or neither. RESULTS Compared with the referent group, adults using EVPs and marijuana had greater odds of being aged 18-29 (adjusted odds ratio [aOR] = 12.44; 95% CI, 6.15-25.14) or 30-39 (aOR = 3.75; 95% CI, 1.73-8.12) versus ≥40, being male (aOR = 3.29; 95% CI, 1.82-5.96) versus female, reporting ≥14 days of poor mental health in previous 30 days (aOR = 2.30; 95% CI, 1.23-4.32) versus <14 days, and reporting asthma (aOR = 2.09; 95% CI, 1.02-4.31), chronic obstructive pulmonary disorder (aOR = 2.94; 95% CI, 1.19-7.93), currently smoking cigarettes (aOR = 4.56; 95% CI, 2.63-7.93), or past-year use of prescribed chronic pain medications (aOR = 2.13; 95% CI, 1.06-4.30), all versus not. CONCLUSIONS Clinicians and health promotion specialists working with adults using both EVPs and marijuana should assess risk factors and comorbidities that could contribute to dual use or associated outcomes and tailor prevention messaging accordingly.
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Affiliation(s)
- Nathaniel M. Lewis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Utah Department of Health, Salt Lake City, UT, USA
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22
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Moustafa AF, Rodriguez D, Pianin SH, Testa SM, Audrain-McGovern JE. Dual Use of Nicotine and Cannabis Through Vaping Among Adolescents. Am J Prev Med 2022; 63:60-67. [PMID: 35365396 PMCID: PMC9232951 DOI: 10.1016/j.amepre.2021.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study seeks to identify adolescent nicotine and cannabis vaping patterns and the characteristics of those adolescents who comprised each pattern. METHODS This prospective longitudinal survey study measured the relationship between nicotine and cannabis vaping among 1,835 adolescents from 4 public high schools outside of Philadelphia, Pennsylvania. Adolescents completed in-classroom surveys, including questions of lifetime and past 30-day nicotine and cannabis vaping, at Wave 1 (fall 2016, ninth grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). Data were analyzed in 2021. RESULTS A sequential processes growth mixture model revealed 4 latent conjoint classes of nicotine and cannabis vaping: early, declining dual use (Class 1: n=259); rapidly increasing dual use (Class 2: n=128); later, slower dual use (Class 3: n=313); and no use (Class 4: n=1,136). Increased odds of belonging to Class 1 and Class 2 versus belonging to Class 4 were significantly associated with cigarette smoking (OR=3.71, OR=2.21), alcohol use (OR=2.55, OR=4.39), peer vaping (OR=1.24, OR=1.20), sensation seeking (OR=1.03, OR=1.11), positive E-cigarette expectations (OR=1.21, OR=1.17), and cigar smoking (OR=2.39 Class 2 only). Increased odds of belonging to Class 3 versus Class 4 were significantly associated with alcohol use (OR=1.66), perceived benefits of E-cigarette use (OR=1.03), positive E-cigarette expectations (OR=1.08), depressive symptoms (OR=1.02), and sensation seeking (OR=1.03). CONCLUSIONS From middle to late adolescence, vaping of nicotine and cannabis develop in close parallel. Regulatory policy and prevention interventions should consider the interplay between these 2 substances during this period of adolescence.
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Affiliation(s)
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania
| | - Stephen H Pianin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shannon M Testa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janet E Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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23
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Sun R, Mendez D, Warner KE. Use of Electronic Cigarettes Among Cannabis-Naive Adolescents and Its Association With Future Cannabis Use. JAMA Netw Open 2022; 5:e2223277. [PMID: 35867059 PMCID: PMC9308048 DOI: 10.1001/jamanetworkopen.2022.23277] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Electronic cigarette (e-cigarette) use has been reported to increase the likelihood of future cigarette smoking among adolescents. The prospective association between e-cigarette use and cannabis use has been less clear, especially in recent years. OBJECTIVE To examine the association between e-cigarette use among cannabis-naive adolescents and cannabis use 1 year later. DESIGN, SETTING, AND PARTICIPANTS The Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study, uses a 4-stage, stratified probability sample design to select participants aged 12 years or older from the US civilian, noninstitutionalized population. This study sample included 9828 cannabis-naive adolescents at the baseline survey who participated in both wave 4.5 (2017-2018) and wave 5 (2018-2019) of PATH. EXPOSURES e-Cigarette use, assessed by ever use, past 12-month use, and past 30-day use. MAIN OUTCOMES AND MEASURES Cannabis use in wave 5, assessed by past 12-month and past 30-day use. Multivariable logistic regressions assessed the association between e-cigarette use and cannabis use 1 year later. Results were weighted to produce nationally representative findings. RESULTS Of the 9828 adolescents included in the analysis, 5361 (57.3%) were aged 12 to 14 years, 5056 (50.7%) were male, and 4481 (53.0%) were non-Hispanic White. After adjustment for sociodemographic characteristics, environmental factors, other substance use, and sensation seeking, e-cigarette use among cannabis-naive adolescents was associated with increased likelihoods of both self-reported past 12-month and past 30-day cannabis use 1 year later. The adjusted relative risks (aRRs) of subsequent past 12-month cannabis use with ever use of e-cigarettes was 2.57 (95% CI, 2.04-3.09), with past 12-month use of e-cigarettes was 2.62 (95% CI, 2.10-3.15), and with past 30-day use of e-cigarettes was 2.18 (95% CI, 1.50-2.85). The aRRs of subsequent past 30-day cannabis use with ever use of e-cigarettes was 3.20 (95% CI, 2.10-4.31), with past 12-month use of e-cigarettes was 3.40 (95% CI, 2.17-4.63), and with past 30-day use of e-cigarettes was 2.96 (95% CI, 1.52-4.40). CONCLUSIONS AND RELEVANCE This cohort study's findings suggest a strong association between adolescent e-cigarette use and subsequent cannabis use. However, despite the strong association at the individual level, e-cigarette use seems to have had a minimal association with the prevalence of youth cannabis use at the population level.
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Affiliation(s)
- Ruoyan Sun
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham
| | - David Mendez
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Kenneth E. Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
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24
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Duan Z, Wang Y, Weaver SR, Spears CA, Zheng P, Self-Brown SR, Eriksen MP, Huang J. Effect modification of legalizing recreational cannabis use on the association between e-cigarette use and future cannabis use among US adolescents. Drug Alcohol Depend 2022; 233:109260. [PMID: 35152099 PMCID: PMC8957562 DOI: 10.1016/j.drugalcdep.2021.109260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many states have legalized recreational cannabis use for adults. However, no study has examined how this policy may interact with youth vaping to influence cannabis use among US adolescents. This study investigates whether the association between baseline e-cigarette use and subsequent cannabis use differs by state recreational cannabis legalization status. METHODS This study analyzed data from the first four waves (2013-2018) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal survey. The study sample included adolescents (aged 12-17) who reported never used cannabis at baseline. Generalized estimating equations were used to analyze the effect modification of state recreational cannabis law on the association between baseline e-cigarette use and cannabis use at 12-month follow-up, controlling for individual characteristics. RESULTS Among adolescents who have never used cannabis at baseline, baseline past-30-day e-cigarette use was significantly associated with past-30-day cannabis use at 12-month follow-up (aOR=5.92, 95% CI: 3.52-9.95). This association was different by state recreational cannabis legalization status, as indicated by the significant interaction term. Subgroup analysis showed that the aOR was 18.39 (95% CI: 4.25-79.68) for adolescents living in states that legalized adult recreational cannabis use and 5.09 (95% CI: 2.86-9.07) for adolescents living in states without such laws. CONCLUSIONS E-cigarette use is associated with cannabis initiation among youth. This association is stronger among those living in states that legalized adult recreational cannabis use. Further examination of the impact of e-cigarette use on cannabis initiation in relation to state cannabis laws is warranted.
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Affiliation(s)
- Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Yu Wang
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Scott R. Weaver
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Claire A. Spears
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Pinpin Zheng
- School of Public Health, Fudan University, Shanghai 200433, China
| | | | - Michael P. Eriksen
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA.
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25
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Staff J, Vuolo M, Kelly BC, Maggs JL, Silva CP. Electronic cigarette use in adolescence is associated with later cannabis use. Drug Alcohol Depend 2022; 232:109302. [PMID: 35038607 DOI: 10.1016/j.drugalcdep.2022.109302] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/29/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Research is needed to determine whether e-cigarette use during adolescence is associated with higher odds of subsequent cannabis use, net of tobacco cigarette use and childhood confounders. METHODS Multivariable logistic regressions predicting using cannabis by age 17 based upon prospective, intergenerational data from 10,251 youth in a nationally representative UK birth cohort followed from infancy who had not used cannabis by age 14. The focal predictor is e-cigarette use by age 14 in the context of the potential confounder tobacco cigarette use. Regressions include sociodemographic background and risk factors assessed at age 11 (e.g., alcohol initiation, problem behaviors, parental and peer smoking) and during early childhood (e.g., maternal smoking during pregnancy, parental substance use). RESULTS Youth use of e-cigarettes by age 14 was associated with 2.8 times higher odds of subsequent cannabis use by age 17 [OR 2.75; 95% CI 1.82,4.15], net of tobacco cigarette smoking and childhood confounders. Similarly, use of e-cigarettes by age 14 was associated with 2.5 times higher odds [OR 2.46; 95% CI 1.48,4.08] of frequent cannabis use at age 17 (>10 times in prior year). If youth used both e-cigarettes and tobacco cigarettes by age 14, the probabilities of cannabis initiation were 75% and of frequent use was 25% by age 17, compared to probabilities of 23% and 6%, respectively, among youth who had used neither product. CONCLUSIONS Findings add to accumulating evidence that adolescent e-cigarette use is associated with higher odds of later cannabis initiation and frequent use, independent of tobacco cigarette use.
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Affiliation(s)
- Jeremy Staff
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA, USA.
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, USA.
| | - Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA.
| | - Jennifer L Maggs
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA.
| | - Constanza P Silva
- Criminal Justice Research Center, Pennsylvania State University, University Park, PA, USA.
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Duan Z, Wang Y, Spears CA, Self-Brown SR, Weaver SR, Zheng P, Eriksen MP, Huang J. Role of Mental Health in the Association Between E-Cigarettes and Cannabis Use. Am J Prev Med 2022; 62:307-316. [PMID: 34949509 PMCID: PMC8863617 DOI: 10.1016/j.amepre.2021.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/31/2021] [Accepted: 09/17/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION E-cigarette use may be associated prospectively with subsequent cannabis use among U.S. adolescents. However, it remains unclear whether this association differs by individual mental health status. This longitudinal study examines effect modifications by mental health status. METHODS The first 4 waves (2013-2017) of the Population Assessment of Tobacco and Health study were analyzed in 2020. Adolescents (aged 12-17 years) who reported never using cannabis at baseline waves were included. Waves 1-3 were each considered as baseline for their 12-month follow-up waves. Generalized estimating equations were used to evaluate the effect modification of internalizing mental health and externalizing mental health problems on the associations between baseline past 30-day e-cigarette use and past 30-day cannabis use at follow-up, controlling for individual characteristics and state recreational cannabis laws. RESULTS Baseline e-cigarette use was significantly associated with cannabis use at follow-up (AOR=4.81, 95% CI=2.93, 7.90). Adolescents with high severity of internalizing mental health/externalizing mental health problems were significantly more likely to initiate cannabis use. However, current e-cigarette users who reported high severity of internalizing mental health symptoms were less likely to initiate cannabis use (AOR=2.51, 95% CI=0.92, 6.83) than those who reported low severity of internalizing mental health problems (AOR=8.84, 95% CI=4.19, 18.65). There were no differences by the severity of externalizing mental health problems. CONCLUSIONS Baseline e-cigarette use and endorsement of severe internalizing mental health/externalizing mental health problems were significantly associated with subsequent cannabis use among U.S. adolescents. Efforts to reduce youth vaping and improve youth mental health could help curb cannabis initiation. Tailored interventions may be warranted for e-cigarette‒using adolescents with internalizing mental health problems.
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Yu Wang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Claire A Spears
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Shannon R Self-Brown
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Scott R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Pinpin Zheng
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai, China
| | - Michael P Eriksen
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Jidong Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia.
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Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations. Eur J Pediatr 2022; 181:453-462. [PMID: 34396473 PMCID: PMC8364775 DOI: 10.1007/s00431-021-04220-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/24/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
Worldwide, youth electronic cigarette use (vaping) has risen significantly over the past decade. This public health concern has spurred many high-quality studies characterizing country-specific prevalence, risk factors, physical and behavioral health complications, and optimal methods of assessment and counseling for youth vaping. Clinicians remain underexposed to this recent work, limiting translation of evidence into higher quality patient care. This review aims to provide pediatricians and other clinicians working with youth a clinically focused survey of key research findings and considerations based on recent evidence. This narrative review surveys emerging trends in EC use across different countries, reasons for youth vaping, characteristics of vaping materials that promote youth use, associations with combustible cigarette use, relation with cannabis and other illicit substances, physical and behavioral health risks associated with vaping, and methods of assessment, counseling, and intervention for problematic vaping in youth. Since vaping remains a relatively new phenomenon, long-term health consequences remain unknown.Conclusion: Youth vaping is an increasingly well-studied phenomenon with both physical and behavioral health risks. Pediatricians and other youth-focused clinicians can apply the lessons of recent research in work with youth and their families. What is Known: • Youth vaping is an increasingly prevalent public health concern. • Recent research demonstrates physical and behavioral health risks associated with vaping as well as methods for assessment, counseling, and intervention. What is New: • The current review summarizes the latest evidence in a clinically focused framework to facilitate translation of emerging knowledge to practice.
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Mamudu HM, Shahani D, Jones A, Ahuja M, Adeniran E, Weierbach F, Swindle J, Liu Y, Keener J, Blair CJ, McNabb M, Asare M, Wood DL, Ferketich A. Exploring Patterns of the Use of Electronic Nicotine Delivery Systems among Adolescents in High-Risk Appalachian (U.S.A) Communities. Subst Use Misuse 2022; 57:167-174. [PMID: 34927538 DOI: 10.1080/10826084.2021.1990333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Electronic nicotine delivery systems (ENDS) use among adolescents in the United States (U.S.) has surpassed conventional tobacco products (CTPs), including cigarettes. Increasingly, ENDS are used concurrently with CTPs and substances such as cannabis. However, few studies involve Central Appalachia, a region with historically high rates of tobacco and other substance use. Objective: To examine prevalence of concurrent use of ENDS and cannabis among school-going adolescents in Appalachian Tennessee and delineate associations between ENDS use and substance-related risk behavior (cannabis use), social relations (peer use), and school-related risk behavior (academic performance). Methods: Data were obtained from a survey conducted with youth aged 13-17 years in 2018 in a county in Appalachian Tennessee (n = 280). A multivariable logistic regression model was fit to evaluate associations between ENDS and cannabis use, and other factors. Results: Overall, lifetime ENDS and cannabis prevalence estimates were 31.1% and 18.6%, respectively. Lifetime ENDS users had increased odds of also being lifetime cannabis users [OR = 9.22, 95% confidence interval (CI): 3.44-24.75]. Lifetime ENDS users had increased odds of reporting ENDS use among peers [OR = 12.11; 95% CI: 5.40-27.12] and lower academic performance (OR associated with mostly C or D vs. A grades was 4.28, 95% CI: 1.68-10.90). Conclusion: This study found an association between ENDS and cannabis use among adolescents in Appalachian Tennessee exists. Additionally, peer use and academic performance were associated with ENDS use. The findings have implications for public health intervention planning to address not only ENDS but also substance use among Appalachian youth.
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Affiliation(s)
- Hadii M Mamudu
- East Tennessee States University, Johnson City, Tennessee, USA
| | - Disha Shahani
- George Washington University, Washington, District of Columbia, USA
| | - Antwan Jones
- George Washington University, Washington, District of Columbia, USA
| | - Manik Ahuja
- East Tennessee States University, Johnson City, Tennessee, USA
| | - Esther Adeniran
- East Tennessee States University, Johnson City, Tennessee, USA
| | | | - Jean Swindle
- East Tennessee States University, Johnson City, Tennessee, USA
| | - Ying Liu
- East Tennessee States University, Johnson City, Tennessee, USA
| | - Janet Keener
- East Tennessee States University, Johnson City, Tennessee, USA
| | - Cynthia J Blair
- East Tennessee States University, Johnson City, Tennessee, USA
| | | | | | - David L Wood
- East Tennessee States University, Johnson City, Tennessee, USA
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Audrain-McGovern J, Rodriguez D, Testa S, Pianin S. The Indirect Effect of Cigarette Smoking on e-Cigarette Progression via Substitution Beliefs. J Adolesc Health 2022; 70:140-146. [PMID: 34420821 PMCID: PMC8692338 DOI: 10.1016/j.jadohealth.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE This study sought to evaluate whether associations between adolescent combustible cigarette smoking and e-cigarette progression were explained by beliefs that e-cigarettes substitute for cigarettes in nonsmoking situations. METHODS Adolescents (N = 1,799) from public high schools outside of Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade). RESULTS A parallel process latent growth curve model revealed that the pathway from baseline smoking to e-cigarette use trend through baseline e-cigarette substitution beliefs was significant (B = .02, z = 2.16, p = .03), indicating that the positive effect of greater baseline cigarette smoking on the rate of e-cigarette progression was channeled through e-cigarette substitution beliefs. The indirect effect from baseline smoking to e-cigarette use trend via e-cigarette substitution beliefs trend was also significant, albeit negative (B = -.05, z = -2.61, p = .009). The negative indirect effect suggested that the strong positive effect of baseline cigarette smoking on baseline substitution beliefs was followed by a slowing of the overall rate of change from baseline. Given that the total effect from baseline smoking to e-cigarette trend was not significant (p = .91), the results suggested complete mediation. CONCLUSIONS Among adolescents with greater use of combustible cigarettes, beliefs regarding the substitutability of e-cigarettes in nonsmoking situations appear to foster progression in e-cigarette use. Addressing these beliefs in the school setting and through media campaign messaging early in adolescence may help to prevent the use of e-cigarettes and combustible cigarettes.
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Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, LaSalle University, 1900 West Olney Avenue, Philadelphia, PA 19141, United States of America
| | - Shannon Testa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States of America
| | - Stephen Pianin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States of America
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Pokhrel P, Elwir T, Mettias H, Kawamoto CT, Oli N, Okamoto SK. The Effects of E-Cigarette Use on Alcohol and Marijuana Abuse Symptoms in an Ethnically Diverse Sample of Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413159. [PMID: 34948769 PMCID: PMC8701290 DOI: 10.3390/ijerph182413159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We examined e-cigarette use as a prospective predictor of alcohol and marijuana abuse symptoms in a sample consisting of Native Hawaiian and Other Pacific Islander (NHPI), Filipino, Asian (i.e., Japanese, Chinese, Korean), and White young adults. NHPI represent a highly vulnerable group with regard to substance use and are severely understudied. METHODS Data were collected from 1463 young adults (M age = 22.2, SD = 3.2; 59.5% women) enrolled across community colleges in Hawai'i at two time-points six months apart. RESULTS Higher frequency of e-cigarette use at baseline was predictive of higher alcohol (B = 0.06, SE = 0.02, p < 0.01) and marijuana (B = 0.06, SE = 0.02, p < 0.01) use problems at six-month follow up, adjusting for baseline cigarette smoking, problem alcohol/marijuana use, sensation seeking, and demographic variables. Ethnicity was found to significantly moderate the relationship between baseline e-cigarette use and problem marijuana use later, such that White and NHPI ethnicities were particularly vulnerable to the effects of e-cigarette use on problem marijuana use. CONCLUSION NHPI are often combined with Asians in national surveys, which obfuscates the higher risks faced by NHPI compared with groups that are routinely classified as Asians (e.g., Chinese, Japanese, Filipinos). The current research highlights the NHPI's vulnerability in terms of the effects of e-cigarette use on marijuana and alcohol abuse symptoms.
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Affiliation(s)
- Pallav Pokhrel
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA; (T.E.); (C.T.K.); (S.K.O.)
- Correspondence: ; Tel.: +1-808-441-7711
| | - Taha Elwir
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA; (T.E.); (C.T.K.); (S.K.O.)
| | - Hannah Mettias
- John A. Burns School of Medicine, University of Hawai‘i at Manoa, 651 Ilalo St., Honolulu, HI 96813, USA;
| | - Crissy T. Kawamoto
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA; (T.E.); (C.T.K.); (S.K.O.)
| | - Nabin Oli
- Kokua Kalihi Valley Comprehensive Family Services, 2239 N School St., Honolulu, HI 96819, USA;
| | - Scott K. Okamoto
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA; (T.E.); (C.T.K.); (S.K.O.)
- School of Social Work, College of Health & Society, Hawai‘i Pacific University, 1 Aloha Tower Drive, Honolulu, HI 96813, USA
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Audrain-McGovern J, Rodriguez D, Pianin S, Testa S. Conjoint Developmental Trajectories of Adolescent E-cigarette and Combustible Cigarette Use. Pediatrics 2021; 148:peds.2021-051828. [PMID: 34635583 DOI: 10.1542/peds.2021-051828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this study, we sought to identify which adolescents progress to regular electronic cigarette (e-cigarette) use (without cigarette smoking), which adolescents become dual users of both types of cigarettes, and how dual use develops across time. METHODS Adolescents (N = 1808) from public high schools outside Philadelphia, Pennsylvania, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade). RESULTS A sequential processes growth mixture model identified 4 conjoint latent classes: later, rapid e-cigarette uptake (class 1: n = 230); no use of e-cigarettes or combustible cigarettes (class 2: n = 1141); earlier, steady e-cigarette uptake (class 3: n = 265); and dual use of e-cigarettes and combustible cigarettes (class 4: n = 204). Using a rich set of potential risk factors, multinomial logistic regression assessed the likelihood of belonging to each conjoint class compared with the comparison class (dual use). Adolescents in the dual use class were characterized by a greater number and severity of e-cigarette and combustible cigarette risk factors. Adolescents in the 2 e-cigarettes-only classes were characterized by either e-cigarette-specific risk factors (earlier onset) or no risk factors (later onset). The no use class had an absence of risk factors for e-cigarette and cigarette use. CONCLUSIONS This study provides new prospective evidence for distinct patterns and profiles of adolescents who progress to current e-cigarette use, including adolescents who were initially cigarette smokers. The findings have implications for prevention intervention timing, tobacco product focus, content, and the adolescent subgroups to target.
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Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Rodriguez
- Department of Public Health, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania
| | - Stephen Pianin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shannon Testa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Adolescent depression symptoms and e-cigarette progression. Drug Alcohol Depend 2021; 228:109072. [PMID: 34571288 PMCID: PMC8595844 DOI: 10.1016/j.drugalcdep.2021.109072] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Depression symptoms are associated with the initiation of cigarette smoking and progression to regular use. Whether similar relationships exist between depression symptoms and adolescent e-cigarette progression has not been firmly established. METHODS This prospective longitudinal survey study measured the relationship between depression symptoms and e-cigarette use among 1822 adolescents from four public high schools outside of Philadelphia, PA. Adolescents completed in-classroom surveys at wave 1 (fall 2016, 9th grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). E-cigarette use, depression symptoms, and potential covariates were measured at each wave. A latent growth curve model was used to assess the longitudinal relationship between e-cigarette use and depression symptoms. RESULTS Baseline depressive symptoms had a significant effect on e-cigarette use trend (b = 0.01, z = 4.29, p < 0.0001) while holding other variables constant. A standard deviation increase in depressive symptoms at baseline was associated with a 0.25 standard deviation increase in the rate of e-cigarette progression across the following 36 months. By contrast, the path from baseline e-cigarette use to depressive symptoms trend was not significant (p = 0.74). CONCLUSIONS The present study provides new evidence for the effects of depression symptoms on adolescent e-cigarette progression. Greater depressive symptoms at age 14 years old were associated with a faster rate of e-cigarette escalation. However, e-cigarette use was not related to the development of depression symptoms over time. It will be important to examine whether adolescents with elevated depression symptoms respond similarly to e-cigarette prevention campaigns as adolescents in general.
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Wills TA, Leventhal AM, Sargent JD, Pagano I. Concurrent Use of E-cigarettes, Combustible Cigarettes, and Marijuana. Pediatrics 2021; 148:peds.2021-050749. [PMID: 34584003 PMCID: PMC8906369 DOI: 10.1542/peds.2021-050749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Subgroups of adolescent single and dual e-cigarette and cigarette users have been identified, but usage patterns have changed in recent years, and there has been an increase in marijuana use. Research is needed with current data to identify subgroups of use including marijuana and determine their behavioral correlates. METHODS We cross classified ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among US high school students in the 2019 Youth Risk Behavior Survey (YRBS), providing 8 different groups. Levels of 14 risk and protective factors were compared across groups in general linear models with demographic covariates using omnibus tests, pairwise comparisons, and planned contrasts. Replicability was tested through identical analyses for 2017 YRBS data. RESULTS The nonuser group was 43.9% of the sample. The most frequent user groups were triple users (ever-use proportion: 16.9%), dual (e-cigarette and marijuana) users (15.8%), and exclusive e-cigarette users (13.2%). For risk profiles on levels of psychosocial variables, the triple-user group was typically elevated above all other groups. Exclusive e-cigarette users were above nonusers in risk profile but below dual users (both cigarettes and marijuana). Results were similar for ever use and recent use. The patterning of results in 2019 YRBS data were closely replicated in 2017 YRBS data. CONCLUSIONS Co-occurrence of e-cigarette, cigarette, and marijuana use is currently substantial among adolescents and is associated with an elevated psychosocial risk profile. This has implications for both epidemiology and prevention studies. Further research is needed to study prevalence and identify pathways to triple use.
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Affiliation(s)
| | | | - James D. Sargent
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, Hawaii
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Luken A, Thrul J, Johnson RM. Electronic cigarette and cannabis use: results from the 2018 Maryland Youth Risk Behavior Survey. J Cannabis Res 2021; 3:21. [PMID: 34172100 PMCID: PMC8234632 DOI: 10.1186/s42238-021-00080-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/08/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine the relationship between lifetime e-cigarette use and current cannabis use among youth. Our analyses accounted for county variability, in addition to student-level covariates. METHODS This study examined responses from high school students on a state-level population survey, the 2018 Maryland Youth Risk Behavior Survey/Youth Tobacco Survey, a cross-sectional, complex survey sample. Of participating students, final analyses included an unweighted sample of 41,091 9th to 12th grade students who provided complete reports for measured variables. Analyses with survey weights were conducted between August 2019 and May 2020. A multivariable logistic regression was conducted to investigate the association between lifetime e-cigarette use and current (past 30-day) cannabis use, after controlling for county, lifetime cigarette use, current (past 30-day) alcohol use, emotional distress, and demographics. RESULTS Lifetime e-cigarette use significantly increased the odds of current cannabis use among Maryland high school students (aOR = 6.04; 95% CI 5.27, 6.93). Other significant risk factors for current cannabis use included lifetime cigarette use (aOR 2.23, 95% CI 1.86, 2.68) and current alcohol use (aOR 5.21, 95% CI 4.42, 6.14). Significantly higher odds of current cannabis use were also found among older high school students, males, non-Hispanic Blacks and students identifying as other race, and those reporting emotional distress. CONCLUSIONS Lifetime e-cigarette use among Maryland high school students is strongly associated with current cannabis use when including counties as a covariate. Non-significant county differences, however, suggest smaller geographical units may be required to control for variability. Efforts should focus on reducing youth e-cigarette use to decrease cannabis use. Maryland's recent implementation of Tobacco 21 and a ban on flavored e-cigarettes will be of interest for future evaluations.
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Affiliation(s)
- Amanda Luken
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, Maryland, 21205, USA.
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, Maryland, 21205, USA.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, Maryland, 21205, USA
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Malik A, Khan MI, Karbasian H, Nieminen M, Ammad-Ud-Din M, Khan S. Modelling Public Sentiments about Juul Flavors on Twitter through Machine Learning. Nicotine Tob Res 2021; 23:1869-1879. [PMID: 33991191 DOI: 10.1093/ntr/ntab098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/10/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The availability of a variety of e-cigarettes flavors is one of the frequently cited reasons for their adoption. An active stream of discussion about flavoring can be observed online. Analyzing these real-time conversations offers nuanced insights into key factors related to the adoption of flavors, subsequently supporting public health interventions. METHODS Google's BERT, a state-of-the-art deep learning method was employed to model the first sentiment corpus on JUUL flavors. BERT, which is pre-trained with the complete English Wikipedia was fine-tuned by integrating a classification model, with human labeled Tweets, as training data. A collection of 30,075 Tweets about JUUL flavors was classified into positive and negative sentiments. Finally, using topic models, we identify and grouped thematic areas into positive and negative Tweets. RESULTS With an average of 89% cross-validation precision for classifying tweets, the finetuned BERT model classified 24,114 Tweets as positive and 5,961 Tweets as negative. Through the topic modeling approach 10 thematic topics were identified from the predicted positive and negative sentiments expressed in the Tweets. CONCLUSIONS JUUL flavors, notably mango, mint, and cucumber, provoke overwhelmingly positive sentiments indicating a strong likeness due to favoarble taste and odor. Negative discourse about JUUL flavors revolve around addictiveness, high nicotine content, and youth targeted marketing. IMPLICATIONS Limiting the content related to flavors and positive perceptions on social media is necessary to minimize exposure to youth. The novel methodology used in this study may be adopted to monitor e-cigarette discourse periodically, as well as other critical public health phenomena online.
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Affiliation(s)
- Aqdas Malik
- Department of Computer Science, Aalto University, Konemiehintie, Espoo, Finland Sultan Qaboos University, Muscat, Oman
| | - Muhammad Irfan Khan
- Department of Computer Science, Arcada University of Applied Sciences, Helsinki, Finland
| | - Habib Karbasian
- Department of Information Sciences & Technology, George Mason University, Fairfax, VA, United States
| | - Marko Nieminen
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Muhammad Ammad-Ud-Din
- Helsinki Research Center, Europe Cloud Service Competence Center Huawei Technologies Oy (Finland) Co. Ltd., Helsinki, Finland
| | - Suleiman Khan
- FIMM Institute of Molecular Medicine, Helsinki University, Helsinki, Finland
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Gupta PS, Kalagher KM. Where There Is (No) Smoke, There Is Still Fire: a Review of Trends, Reasons for Use, Preferences and Harm Perceptions of Adolescent and Young Adult Electronic Cigarette Use. CURRENT PEDIATRICS REPORTS 2021; 9:47-51. [PMID: 33996271 PMCID: PMC8107807 DOI: 10.1007/s40124-021-00240-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/05/2022]
Abstract
Purpose of the review To review the current prevalence, trends, perceptions, and effects of e-cigarette or vaping product use associated lung injury (EVALI) on e-cigarette use among US adolescents and young adults. Recent findings COVID-19 diagnosis was more likely among the current/ever dual cigarette and e-cigarettes users, as well as ever e-cigarette only users. Additionally, the EVALI outbreak may have influenced harm perceptions, as daily nicotine vaping declined significantly from 2019 to 2020, and more youth and young adults perceived vaping as harmful. Summary The prevalence of e-cigarette use, specifically flavored use, remains high among adolescents and young adults, which is concerning due to the short-term and unknown long-term effects of e-cigarettes and their association with future cigarette and other substance use.
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Affiliation(s)
- Priya Sarin Gupta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Kelly M. Kalagher
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA
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Coleman M, Donaldson CD, Crano WD, Pike JR, Stacy AW. Associations Between Family and Peer E-Cigarette Use With Adolescent Tobacco and Marijuana Usage: A Longitudinal Path Analytic Approach. Nicotine Tob Res 2021; 23:849-855. [PMID: 33038257 PMCID: PMC8628870 DOI: 10.1093/ntr/ntaa204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/01/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Research indicates a link between adolescent e-cigarette use and combustible tobacco cigarette (CTC) initiation, and recent studies suggest their connection with marijuana uptake. Our 3-year longitudinal cohort study investigated the implications of adolescent, peer, and family e-cigarette use with adolescents' expectations and willingness to initiate CTC use, and subsequent CTC and marijuana use. AIMS AND METHODS Relationships were examined in a secondary analysis of a 3-year longitudinal cohort subsample involving adolescents enrolled in alternative California high schools (N = 1025). Analyses examined responses over three yearly observations. Family, peer, and respondents' e-cigarette use, respondents' positive cigarette expectancies and willingness to use CTCs were assessed in the study's first year (T1). CTC use in the survey's second year (T2) and marijuana use in the third year (T3) were assessed via path analysis. RESULTS Respondents reporting at least one family member or peer using e-cigarettes were more likely to use e-cigarettes at T1 than those whose peers/family members did not. They reported more positive expectancies about CTCs and greater willingness to initiate use. These variables predicted CTC use at T2, which directly anticipated marijuana use in the survey's third year (T3), as did adolescents' use of e-cigarettes at T1. All model relations were statistically significant. CONCLUSIONS Analysis demonstrated the strong association of family members' and peers' behaviors with adolescent e-cigarette use, and the temporal precedence of e-cigarette use with subsequent CTC and marijuana uptake. The predictive implications of e-cigarettes for other dangerous substance use should be examined in future prevention campaigns. IMPLICATIONS The presented study expands upon existing literature connecting adolescent e-cigarette use and later CTC and marijuana use. The findings indicate the significant implications of exposure to e-cigarette use by parents and peers and demonstrate in a longitudinal 4-year panel survey the direct and indirect predictive implications of e-cigarette use for CTC and marijuana uptake. The research illustrates the utility of programs and campaigns that target peer and family groups to maximize impacts on adolescent willingness to try CTCs, positive expectancies, and possible onset of CTC and marijuana use.
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Affiliation(s)
- Michael Coleman
- Department of Psychology, School of Social Science, Policy, and
Evaluation, Claremont Graduate University, Claremont, CA
| | - Candice D Donaldson
- Department of Psychology, School of Social Science, Policy, and
Evaluation, Claremont Graduate University, Claremont, CA
| | - William D Crano
- Department of Psychology, School of Social Science, Policy, and
Evaluation, Claremont Graduate University, Claremont, CA
| | - James R Pike
- Department of Biostatistics, Gillings School of Global Public
Health, Chapel Hill, NC
| | - Alan W Stacy
- School of Community and Global Health, Claremont Graduate
University, Claremont, CA
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Ross CP, Lin J, Hefner K, Waters AJ. Use of electronic cigarettes in the United States service member and Veteran populations: A narrative review (2019). MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1897493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Charles P. Ross
- Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
| | - Jie Lin
- Murtha Cancer Center Research Program, USU Walter Reed Surgery, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
| | - Kathryn Hefner
- National Institute on Drug Abuse (NIDA) Data and Statistics Center, The Emmes Company, Rockville, Maryland
| | - Andrew J. Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
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Sadeghi R, Masoudi MR, Khanjani N. Health Communication Efforts to Reduce Hookah Use among Adolescents. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1902884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Laviolette SR. Exploring the impact of adolescent exposure to cannabinoids and nicotine on psychiatric risk: insights from translational animal models. Psychol Med 2021; 51:940-947. [PMID: 31801641 DOI: 10.1017/s0033291719003325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adolescence represents a highly sensitive period of mammalian neurodevelopment wherein critical synaptic and structural changes are taking place in brain regions involved in cognition, self-regulation and emotional processing. Importantly, neural circuits such as the mesocorticolimbic pathway, comprising the prefrontal cortex, sub-cortical mesolimbic dopamine system and their associated input/output centres, are particularly vulnerable to drug-related insults. Human adolescence represents a life-period wherein many individuals first begin to experiment with recreational drugs such as nicotine and cannabis, both of which are known to profoundly modulate neurochemical signalling within the mesocorticolimbic pathway and to influence both long-term and acute neuropsychiatric symptoms. While a vast body of epidemiological clinical research has highlighted the effects of adolescent exposure to drugs such as nicotine and cannabis on the developing adolescent brain, many of these studies are limited to correlative analyses and rely on retrospective self-reports from subjects, making causal interpretations difficult to discern. The use of pre-clinical animal studies can avoid these issues by allowing for precise temporal and dose-related experimental control over drug exposure during adolescence. In addition, such animal-based research has the added advantage of allowing for in-depth molecular, pharmacological, genetic and neuronal analyses of how recreational drug exposure may set up the brain for neuropsychiatric risk. This review will explore some of the advantages and disadvantages of these models, with a focus on the common, divergent and synergistic effects of adolescent nicotine and cannabis exposure on neuropsychiatric risk.
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Affiliation(s)
- Steven R Laviolette
- Addiction Research Group, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, CanadaN6A3K7
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, CanadaN6A3K7
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, CanadaN6A3K7
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Moustafa AF, Rodriguez D, Mazur A, Audrain-McGovern J. Adolescent perceptions of E-cigarette use and vaping behavior before and after the EVALI outbreak. Prev Med 2021; 145:106419. [PMID: 33422576 PMCID: PMC8474118 DOI: 10.1016/j.ypmed.2021.106419] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023]
Abstract
This study sought to determine whether adolescents' e-cigarette risk perceptions, perceived benefits, and positive expectations, and vaping behavior changed after the electronic-cigarette or vaping product use-associated lung injury (EVALI) outbreak. This longitudinal survey studied 1539 high school students in suburban Philadelphia, PA in 11th and 12th grade, before and after the outbreak of EVALI cases in 2019. Adolescents who reported current nicotine vaping at baseline (versus those who did not) had a greater increase in risk perceptions (B = -0.31, p = 0.04) and a greater decrease in positive expectations (B = -1.30, p = 0.003) at follow-up. Adolescents who reported current marijuana vaping at baseline (versus those who did not) had greater perceived benefits (B = 2.19, p < 0.001), lower risk perceptions (B = 0.39, p < 0.001), and greater positive expectations of e-cigarette use (B = 1.43, p < 0.001) across time. Odds of current nicotine vaping at follow-up increased (OR = 1.61, 95% CI = 1.08, 2.41) for adolescents who maintained lower risk perceptions. Odds of current nicotine vaping at follow-up decreased (OR = 0.33, 95% CI = 0.21, 0.50) for adolescents whose positive expectations of e-cigarette use decreased. The odds of current marijuana vaping at follow-up decreased (OR = 0.64, 95% CI = 0.42, 0.98) for adolescents whose positive expectations of e-cigarette use decreased. Perceptions of the risks of e-cigarette use increased and positive expectations of e-cigarette use decreased after the EVALI outbreak. Adolescent risk perceptions and positive expectations of e-cigarette use are two potential targets to impact vaping behavior. Emphasizing the risks of e-cigarette use while decreasing positive expectations of use have the potential to reduce vaping behavior, and perhaps subsequent EVALI cases.
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Affiliation(s)
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, LaSalle University, Philadelphia, PA, USA
| | - Alexa Mazur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Rogers SM, Harrell MB, Chen B, Springer A, Loukas A, Perry CL. Multi-directional pathways of tobacco and marijuana use, including comorbid use, among a population-based cohort of adolescents in Texas: A six-wave cross-lagged model. Addict Behav 2021; 115:106771. [PMID: 33387975 PMCID: PMC8686621 DOI: 10.1016/j.addbeh.2020.106771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Past 30-day tobacco and marijuana use commonly occur among adolescents. It is unclear whether use of one product precedes the other, especially given the new climate surrounding marijuana legalization and the increasing popularity of e-cigarettes. METHODS Six-panel cross-lagged regression models, with six months between each panel/Wave (2014-17), were used to model stability paths, bi-directional paths, and comorbid paths (i.e., correlations) between past 30-day use of marijuana and tobacco products. Data were derived from three cohorts of adolescents (n = 3907; weighted N = 461,069) in 6th, 8th, and 10th grades at baseline. RESULTS Few bidirectional relationships between past 30-day tobacco and marijuana use were observed in early adolescence (6th grade). During the middle adolescence developmental period (8th grade), past 30-day marijuana use was prospectively associated with greater risk of past 30-day tobacco use. In late adolescence (10th grade), increased odds of past 30-day marijuana use given prior past 30-day e-cigarette use, and vice versa, were observed. For all cohorts, stability paths were common, especially for past 30-day marijuana use. Comorbid use was common in middle adolescence (8th grade) but small in magnitude. CONCLUSIONS This is the first study to longitudinally situate comorbid, past 30-day use of tobacco and marijuana and simultaneously examine bi-directional past 30-day use of these products for adolescents. Marijuana use more often and more strongly predicted subsequent tobacco use than the reverse, especially during middle adolescence (13-15 years old). Marijuana use should be considered when creating interventions that address adolescent e-cigarette use in the U.S.
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Affiliation(s)
- Shannon M Rogers
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA.
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
| | - Andrew Springer
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
| | - Alexandra Loukas
- Health Behavior and Health Education in the Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
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Audrain-McGovern J, Rodriguez D, Testa S, Alexander E, Pianin S. Adolescent E-Cigarette Onset and Escalation: Associations With Internalizing and Externalizing Symptoms. J Adolesc Health 2021; 68:801-807. [PMID: 33158686 PMCID: PMC8012221 DOI: 10.1016/j.jadohealth.2020.09.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE We sought to evaluate if internalizing symptoms (i.e., anxiety and depression) and/or externalizing symptoms (i.e., impulsivity, sensation seeking, and substance use) were risk factors for the onset of 30-day e-cigarette use and escalation in the number of days used across the following 30 months among adolescents. METHODS Adolescents (N = 1,808) from public high schools outside Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 30 months (spring 2019, end of 11th grade). RESULTS A two-part latent growth curve model of e-cigarette use revealed significant positive associations between externalizing factors, past 30-day e-cigarette use, and the number of days of e-cigarette use only at wave 1 (p values <.05). Cigarette smoking was associated with a slowing in the rate of onset of 30-day e-cigarette use across the 30-month follow-up (β = -.24, z = -2.41, p = .02). Depression was associated with an increased rate of escalation in the number of days of e-cigarette use across the following 30 months (β = .01, z = 2.52, p = .01), whereas anxiety was associated with a decreased rate (β = -.72, z = -2.36, p = .02). CONCLUSIONS The findings highlight two groups of adolescents at risk for e-cigarette use: adolescents whose e-cigarette use reflects a higher-risk profile with early e-cigarette onset, and adolescents who have a lower-risk profile, at least initially, with later e-cigarette use onset. The timing and content of prevention efforts should be tailored to each group.
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Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, LaSalle University, 1900 West Olney Avenue, Philadelphia, PA 19141, United States of America
| | - Shannon Testa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States of America
| | - Emily Alexander
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States of America
| | - Stephen Pianin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States of America
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Jacobs W, Idoko E, Montgomery L, Smith ML, Merianos AL. Concurrent E-cigarette and marijuana use and health-risk behaviors among U.S. high school students. Prev Med 2021; 145:106429. [PMID: 33476680 PMCID: PMC8194044 DOI: 10.1016/j.ypmed.2021.106429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/28/2022]
Abstract
The use of electronic cigarettes (e-cigarettes) and marijuana remain prevalent problems among adolescents nationwide. We assessed current (past 30-day) exclusive e-cigarette use, exclusive marijuana use, and concurrent use with unintentional injury and violent behaviors, alcohol and other drug use behaviors, and sexual behaviors among U.S. high school students. We analyzed 2017 Youth Risk Behavior Survey data including 12,578 high school students nationwide. Multivariable logistic regression models were performed to compare these health-risk behaviors among exclusive e-cigarette users, exclusive marijuana users, and concurrent users with non-users among the overall sample, and then to compare exclusive e-cigarette users and exclusive marijuana users with concurrent users among current users only. All models adjusted for adolescent sex, grade, and race/ethnicity, and other tobacco product use. Approximately 77% of students were non-users, 5.2% were exclusive e-cigarette users, 9.9% were exclusive marijuana users, and 7.8% were concurrent users. Compared to non-users, exclusive e-cigarette users and exclusive marijuana users were more likely to engage in most negative health-risk behaviors associated with unintentional injuries and violence, alcohol and other drug use, and sexual behaviors. Among current users only, exclusive e-cigarette users and exclusive marijuana users were at reduced odds of engaging in most of these health-risk behaviors when compared to concurrent users of both substances. The relationship between exclusive and concurrent e-cigarette and marijuana use and health-risk behaviors highlights the importance of comprehensive educational efforts during high school. Findings suggest need for more studies on influence of e-cigarette and marijuana use on injury and violence risk among youth.
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Affiliation(s)
- Wura Jacobs
- Department of Kinesiology, California State University, Stanislaus, One University Circle, Turlock, CA 95382, USA.
| | - Ehikowoicho Idoko
- Department of Health and Kinesiology, Texas A&M University, 2929 Research Parkway, College Station, TX 77843, USA.
| | - LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, P.O. Box 670559, Cincinnati, OH 45267, USA.
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab, College Station, TX 77843, USA; School of Public Health, Texas A&M University, 212 Adriance Lab, College Station, TX 77843, USA.
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA.
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Cho J, Goldenson NI, Kirkpatrick MG, Barrington-Trimis JL, Pang RD, Leventhal AM. Developmental patterns of tobacco product and cannabis use initiation in high school. Addiction 2021; 116:382-393. [PMID: 32533801 PMCID: PMC7736052 DOI: 10.1111/add.15161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/23/2019] [Accepted: 06/10/2020] [Indexed: 12/25/2022]
Abstract
AIMS To identify prototypical developmental patterns of tobacco product and cannabis use and co-use initiation during adolescence, and determine risk factors for and consequences of these initiation patterns. DESIGN Prospective repeated-measures cohort with eight semi-annual assessments during high school. Multiple-event process survival mixture modeling identified latent initiation classes with distinct patterns of variation in timing of use initiation of tobacco products and cannabis. We then estimated: (1) associations of baseline risk factors with membership in initiation classes and (2) differences between initiation classes in frequency of cannabis and tobacco product use at the final assessment. SETTING Ten high schools in the Los Angeles, CA, USA metropolitan area, 2013-17. PARTICIPANTS Students [1031 (45.4%) males; mean (standard deviation) age at baseline = 14.6 (0.39) years] who had never used any tobacco products or cannabis at baseline 9th grade assessment (n = 2272). MEASUREMENTS Self-report measures of electronic cigarette (e-cigarette), combustible cigarette, hookah, cigar/cigarillos and cannabis use were collected at each assessment. FINDINGS Four distinct tobacco and cannabis use initiation classes were identified: (1) early and high-risk cannabis and polytobacco initiators (n = 116; 5.1%); (2) early cannabis and polytobacco initiators (n = 172; 7.6%); (3) late cannabis and e-cigarette initiators (n = 431; 19.0%); and (4) abstainers (n = 1553; 68.4%). At baseline, older age for the early and high-risk cannabis and polytobacco initiators [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.10, 1.35, P < 0.001], peer cannabis use (OR = 1.60, 95% CI = 1.23, 2.08, P < 0.001) and delinquent behavior (OR = 1.30, 95% CI = 1.08, 1.55, P = 0.004) were associated with membership in the three initiation classes (versus abstainers). Membership in the early and high-risk cannabis and polytobacco initiators class (versus three other classes) was significantly associated with increased past 30-day frequency and daily intensity of use at the final assessment (P-values < 0.001). CONCLUSIONS Older age, peer cannabis use and delinquent behavior appear to be risk factors for the initiation of tobacco/cannabis product use among high school students in the Los Angeles metropolitan region. Early and higher-risk polyproduct use initiation appears to be associated with greater escalation of past 30-day and daily tobacco and cannabis use at the end of the high school.
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Affiliation(s)
- Junhan Cho
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA,Corresponding author: Junhan Cho, Ph.D., University of Southern California, Keck School of Medicine, 2001 N Soto Street, SSB302X), Los Angeles, CA 90032-9239, USA; , Phone: 323-442-8239, Fax: 323-442-2359
| | - Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Matthew G. Kirkpatrick
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Raina D. Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA,Department of Psychology, University of Southern California, Los Angeles, CA
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Rogers SM, Loukas A, Harrell MB, Chen B, Springer A, Perry CL. Multidirectional Pathways of Tobacco and Marijuana Use, Including Comorbid Use, Among Young Adults (Aged 18-25 Years) in Texas: A Six-Wave Cross-Lagged Model. J Adolesc Health 2021; 68:116-122. [PMID: 32631731 PMCID: PMC7755747 DOI: 10.1016/j.jadohealth.2020.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/01/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Prevalence of past 30-day tobacco and marijuana use are highest among young adults in the U.S., and comorbid use of these products is common. However, it is unclear whether the use of one product precedes the other-an important consideration, given the new climate surrounding marijuana legalization and the popularity of e-cigarette products. METHODS Six-panel cross-lagged regression models, with 6 months between each panel/wave, were used to model bidirectional paths between past 30-day use and comorbid use of marijuana and tobacco products from 2014 to 2017 among young adults (N = 5,221 college students, aged 18-25 years). RESULTS Combustible tobacco use and e-cigarette use were prospectively associated with greater risk of future marijuana use while controlling for the stability of use over time, age, race/ethnicity, and sex. Marijuana use was prospectively associated with greater risk of future combustible tobacco and e-cigarette use. Comorbid use was common, but while the odds of comorbid use decreased with increasing age, odds of tobacco use increased. CONCLUSIONS More young adults may be consolidating their use than are successfully ceasing their tobacco or marijuana use as they mature through young adulthood. Although we observed decreases in comorbid use of combustible tobacco with marijuana and e-cigarettes with marijuana, we simultaneously observed strong stability in single use of these products over time. Taken together, these results should help structure interventions specific to young adults that target use and comorbid use in early young adulthood to discourage initiation, encourage cessation, and curb subsequent escalation in later young adulthood.
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Affiliation(s)
- Shannon M Rogers
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Alexandra Loukas
- Health Behavior and Health Education, Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, Texas.
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Andrew Springer
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
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49
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Braymiller JL, Barrington-Trimis JL, Leventhal AM, Islam T, Kechter A, Krueger EA, Cho J, Lanza I, Unger JB, McConnell R. Assessment of Nicotine and Cannabis Vaping and Respiratory Symptoms in Young Adults. JAMA Netw Open 2020; 3:e2030189. [PMID: 33351085 PMCID: PMC7756238 DOI: 10.1001/jamanetworkopen.2020.30189] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Rates of e-cigarette use (ie, nicotine vaping) and cannabis vaping continue to increase among youth and young adults. However, the association of nicotine and cannabis vaping with independent respiratory health outcomes has not been well studied. OBJECTIVE To investigate associations of nicotine and cannabis vaping with bronchitic symptoms, wheeze, and shortness of breath. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey data on self-reported lifetime, 6-month, and 30-day vaping from 2553 young adults recruited from high schools in Southern California were collected from June 2018 to October 2019. Of these participants, 94% provided data for shortness of breath and wheeze, and 86% provided data for chronic bronchitis. MAIN OUTCOMES AND MEASURES Self-reported nicotine and cannabis vaping were measured on a Likert-type scale using the following responses: (1) never used, (2) lifetime but no past 6-month use, (3) past 6-month use but no use in the past 30 days, (4) use on 1 or 2 of the past 30 days, and (5) use on 3 or more of the past 30 days. Three respiratory health outcomes were assessed separately on the basis of self-reported symptoms: bronchitic symptoms in the previous 12 months (ie, daily cough for 3 months in a row, congestion or phlegm other than with a cold, and/or bronchitis), wheeze in the previous 12 months, and shortness of breath when hurrying on level ground or walking up a slight hill. RESULTS Of 2553 participants in the analytic sample (mean [SD] age, 19.3 [0.79] years; 1477 [57.9%] female individuals), 1095 of 2553 young adults (42.9%) reported vaping nicotine and 939 of 2553 (38.4%) reported vaping cannabis. Compared with those who never vaped cannabis, individuals who vaped cannabis in their lifetime but not in the past 60 months (204 of 2553 [8.4%]; adjusted odds ratio [aOR], 1.83 [95% CI, 1.08-3.10]), in the past 6 months but not in the last 30 days (490 of 2443 [20.1%]; aOR, 1.58 [95% CI, 1.02-2.46]), 1-2 days in the past 30 days (90 of 2443 [3.7%]; aOR, 2.83 [95% CI, 1.46-5.50]), and 3 or more days in the past 30 days (155 of 2443 [6.3%]; aOR, 2.14 [95% CI, 1.16-3.92]) had significantly higher odds of chronic bronchitic symptoms after adjusting for nicotine vaping, cigarette smoking, cannabis smoking, and sociodemographic characteristics. Cannabis vaping 3 or more times in the last 30 days was also associated with increased odds of wheeze (aOR, 2.27 [95% CI, 1.17-4.37]). Associations of cannabis vaping with shortness of breath and nicotine vaping with any respiratory health outcome were not statistically significant in fully adjusted models. CONCLUSIONS AND RELEVANCE Findings of this cross-sectional study suggest that cannabis vaping is associated with increased risk of bronchitic symptoms and wheeze in young adults. Further research is needed to understand the temporality of the association and the mechanisms underlying the difference between nicotine and cannabis vaping in the risk of bronchitic symptoms and wheeze.
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Affiliation(s)
- Jessica L. Braymiller
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
| | - Jessica L. Barrington-Trimis
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
- USC Norris Comprehensive Cancer Center, Keck Medicine of USC, Los Angeles
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
- USC Norris Comprehensive Cancer Center, Keck Medicine of USC, Los Angeles
- Department of Psychology USC, Los Angeles
| | - Talat Islam
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
| | - Afton Kechter
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
| | - Evan A. Krueger
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
| | - Junhan Cho
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
| | - Isabella Lanza
- Department of Human Development, California State University Long Beach, Long Beach
| | - Jennifer B. Unger
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
- USC Norris Comprehensive Cancer Center, Keck Medicine of USC, Los Angeles
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California (USC), Los Angeles
- USC Norris Comprehensive Cancer Center, Keck Medicine of USC, Los Angeles
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Alnajem A, Redha A, Alroumi D, Alshammasi A, Ali M, Alhussaini M, Almutairi W, Esmaeil A, Ziyab AH. Use of electronic cigarettes and secondhand exposure to their aerosols are associated with asthma symptoms among adolescents: a cross-sectional study. Respir Res 2020; 21:300. [PMID: 33198741 PMCID: PMC7670675 DOI: 10.1186/s12931-020-01569-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Globally, a surge in electronic cigarette (e-cigarette) use has been observed in recent years, with youth being the most susceptible group. Given their recent emergence, studies assessing the health consequences of using e-cigarettes and exposure to their secondhand aerosols (SHA) are limited. Hence, this study sought to assess associations between e-cigarette use and household exposure to SHA from e-cigarettes with asthma symptoms among adolescents. Methods A school-based cross-sectional study was conducted by enrolling high school students (n = 1565; aged 16–19 years) in Kuwait. Participants self-completed a questionnaire on tobacco products use (e-cigarettes and cigarettes) and asthma symptoms. Current e-cigarette use and cigarette smoking were defined as any use in the past 30 days. Household exposure to SHA from e-cigarettes in the past 7 days was reported as none (0 days), infrequent (1–2 days), and frequent (≥ 3 days). Asthma symptoms included current (past 12 months) wheeze, current asthma (history of clinical diagnosis and current wheeze and/or medication use), and current symptoms of uncontrolled asthma (≥ 4 attacks of wheeze, ≥ 1 night per week sleep disturbance from wheeze, and/or wheeze affecting speech). Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. Results Among the analytical study sample (n = 1345), current e-cigarette use and cigarette smoking was reported by 369 (27.4%) and 358 (26.6%) participants, respectively. Compared to never e-cigarette users and never cigarette smokers, current e-cigarette users with no history of cigarette smoking had increased prevalence of current wheeze (aPR = 1.54, 95% CI 1.01–2.45) and current asthma (aPR = 1.85, 95% CI 1.03–3.41). Moreover, the frequency of exposure to household SHA from e-cigarettes was associated with asthma symptoms. For example, compared to those with no exposure to household SHA, frequent exposure to household SHA was associated with current wheeze (aPR = 1.30, 95% CI 1.04–1.59), current asthma (aPR = 1.56, 95% CI 1.13–2.16), and current uncontrolled asthma symptoms (aPR = 1.88, 95% CI 1.35–2.62). Conclusions E-cigarette use and their household SHA exposure were independently associated with asthma symptoms among adolescents. Hence, such observations indicate that e-cigarette use and passive exposure to their aerosols negatively impact respiratory health among adolescents.
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Affiliation(s)
| | - Abdullah Redha
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Dalal Alroumi
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Mohamad Ali
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Waad Almutairi
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali Esmaeil
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
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