1
|
Liu J, Roberts J, Hanby E, Louaddi O, Winickoff JP, Reynolds MJ, Gundersen DA, Gottlieb MA, Emmons KM, Tan ASL. Impacts of the Massachusetts 2019 An Act Modernizing Tobacco Control on tobacco retailer settings: A multi-methods study. Addict Behav 2024; 157:108089. [PMID: 38908050 PMCID: PMC11283354 DOI: 10.1016/j.addbeh.2024.108089] [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: 11/21/2023] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND In November 2019, the Massachusetts legislature passed An Act Modernizing Tobacco Control and became the first state to restrict retail sales of all flavored (including menthol) cigarettes, e-cigarettes, and other tobacco products. Our study aims to provide the retailer experience of the new law from the perspectives of multiple stakeholders, including tobacco retailers themselves, public health officials, and Massachusetts residents. METHODS We conducted in-depth interviews with seven tobacco retailers and ten public health officials from March 2021 to April 2022. Monthly repeated cross-sectional surveys were administered through the online survey panel Prodege from April 2021 to August 2022 (adult sample: N = 765; adolescent sample: N = 900). Themes from interviews were identified by drawing on deductive codes informed by the interview guide, followed by inductive coding of data. Survey data were descriptively analyzed in R. RESULTS Key themes included retailer frustration over loss of sales to neighboring states, factors associated with retailer compliance, and the need for increased education regarding the law. Survey results showed that a minority of adolescents (13.3%) and adults (26.1%) who vaped in the past 30-days were traveling to border states to purchase vape products. Less than one-quarter of adolescent participants and less than half of adult participants could correctly identify which products Massachusetts did not sell. CONCLUSIONS Evidence from the retailer, public health, and end-user perspectives support mutual benefits of adjacent states enacting flavored tobacco sales restrictions, improved policy education for retailers and the public, and improved retailer enforcement.
Collapse
Affiliation(s)
- Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States.
| | - Jane Roberts
- Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA, United States
| | - Elaine Hanby
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, United States
| | - Oulaya Louaddi
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, United States
| | - Jonathan P Winickoff
- MassGeneral Hospital Division of General Academic Pediatrics, Boston, MA, United States; MGH Tobacco Research and Treatment Center, Boston, MA, United States; American Academy of Pediatrics Julius B. Richmond Center, Itasca, IL, United States
| | | | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA, United States; Harvard University, TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, United States
| | - Mark A Gottlieb
- Public Health Advocacy Institute, Northeastern University, Boston, MA, United States
| | - Karen M Emmons
- Harvard University, TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, United States
| | - Andy S L Tan
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, United States; University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, PA, United States
| |
Collapse
|
2
|
Bendotti H, Gartner CE, Marshall HM, Ireland D, Garvey G, Lawler S. Exploring associations of population characteristics and tobacco and vape retailer density and proximity in Australia: a scoping review. Tob Control 2024:tc-2024-058760. [PMID: 38969498 DOI: 10.1136/tc-2024-058760] [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: 04/08/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE This scoping review synthesises Australian evidence on associations between tobacco and vape retailer density/proximity and various population measures and smoking behaviour to identify research gaps and inform future policy and strategies. DATA SOURCES Following Joanna Briggs Institute methodology, relevant studies published in English since 2003 were identified via searches of eight databases in March and August 2023. STUDY SELECTION Two reviewers independently completed screening procedures. Eligible studies were from Australia and described associations between tobacco or vape retailer density/proximity and adult or youth smoking/vaping prevalence or behaviours, neighbourhood socioeconomic status, geographic location, school locations and/or Indigenous status. DATA EXTRACTION Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS Of 794 publications screened, 12 studies from 6 Australian states were included. Six studies from five states reported statistically significant associations between neighbourhood-level socioeconomic disadvantage and tobacco retailer density, yet only two studies from two states found a significant relationship between retailer density and adult smoking prevalence. Increasing retailer density was consistently significantly associated with increasing geographical remoteness in three states. No studies explored associations with tobacco retailer proximity or vape retailer density/proximity. CONCLUSIONS Despite a moderate number of studies overall, state-level evidence is limited, and unknown for Australian territories. Evidence from five Australian states reflects the international evidence that increasing retailer density is significantly associated with increasing socioeconomic disadvantage and remoteness, supporting the need for tobacco supply-based policies. Further research is required to understand the impact of retailer density and adult and youth smoking prevalence in Australia.
Collapse
Affiliation(s)
- Hollie Bendotti
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Chermside, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Henry M Marshall
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Chermside, Queensland, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, Queensland, Australia
| | - David Ireland
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Queensland, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Sheleigh Lawler
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
3
|
Leung J, Sun T, Vu G, Dawson D, Chan GCK. Promotions of vaping products near schools and central business district: A descriptive cross-sectional study. Health Promot J Austr 2024; 35:835-839. [PMID: 37608679 DOI: 10.1002/hpja.791] [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: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
ISSUES ADDRESSED The increase of youth vaping in Australia has raised concerns, especially with increasing promotions of vaping products. We observed the visibility of vaping products near high-adolescent-traffic areas. METHODS We examined stores within walking distance of high schools and the central business district (CBD) in Brisbane, Australia, observing the number and proportion of stores selling or displaying vaping products. Using an observational approach, we analysed advertisements and open displays of vaping products at tobacconists, vape stores, and convenience stores. RESULTS We identified 61 eligible stores located near schools or in the CBD. Overall, 20% of stores displayed vaping products externally, with higher proportions among vape stores (78%) compared to tobacconists (36%). Additionally, 46% of stores had visible interior displays, with vape stores (89%) displaying them more frequently than tobacconists (71%). Among the 28 stores displaying vaping products, 57% included warnings, one store featured only flavoured products, and 25% showcased nicotine-containing products. Youth-appealing features were present in all but one store, with cartoons (61%) as the most common feature. CONCLUSION Vapes were displayed near high schools and in the city, often featuring youth-appealing features, such as colours and flavours. SO WHAT?: The exposure to such promotions could normalise vaping and contribute to increased youth uptake. Continued monitoring of vaping product promotions is essential, particularly considering recent policy changes.
Collapse
Affiliation(s)
- Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Giang Vu
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Danielle Dawson
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Gary Chung Kai Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
4
|
Askwith Z, Grignon J, Ismail M, Martin G, McEachern LW, Seabrook JA, Gilliland JA. Environmental influences on E-cigarette use among young people: A systematic review. Health Place 2024; 87:103212. [PMID: 38493658 DOI: 10.1016/j.healthplace.2024.103212] [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] [Received: 09/11/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 03/19/2024]
Abstract
E-cigarettes are a popular mode of delivery for nicotine, tobacco and cannabis. The prevalence of vaping among youth is increasing and this review aims to identify features of the neighbourhood environment, e.g., retailers, advertisements, and policies, that are associated with youth vaping. We included 48 studies. Of these, approximately 40% and 60% reported that presence of e-cigarette retailers, and advertisements, was associated with statistically higher odds of e-cigarette use in youth, respectively. Approximately 30% of studies reported that policies affecting e-cigarette availability were associated with statistically lower odds of vaping. Identifying these influential features of the neighbourhood environment will help formulate appropriate policies to reduce e-cigarette use among youth.
Collapse
Affiliation(s)
- Zoe Askwith
- Department of Geography and Environment, Western University, Canada
| | - Josh Grignon
- Department of Geography and Environment, Western University, Canada
| | - Mariam Ismail
- Department of Geography and Environment, Western University, Canada
| | - Gina Martin
- Department of Geography and Environment, Western University, Canada; Faculty of Health Disciplines, Athabasca University, Canada
| | - Louise W McEachern
- Department of Geography and Environment, Western University, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Jamie A Seabrook
- Children's Health Research Institute, London, Ontario, Canada; School of Food and Nutritional Sciences, Brescia University College, Canada; Department of Epidemiology and Biostatistics, Western University, Canada; Department of Pediatrics, Western University, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography and Environment, Western University, Canada; Children's Health Research Institute, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, Canada; Department of Pediatrics, Western University, Canada; Lawson Health Research Institute, London, Ontario, Canada.
| |
Collapse
|
5
|
Duan Z, Henriksen L, Vallone D, Rath JM, Evans WD, Romm KF, Wysota C, Berg CJ. Nicotine pouch marketing strategies in the USA: an analysis of Zyn, On! and Velo. Tob Control 2024; 33:154-163. [PMID: 35817549 DOI: 10.1136/tc-2022-057360] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nicotine pouches are gaining popularity, yet their marketing is understudied. METHODS Using Numerator advertising data from January 2019 to September 2021 regarding three popular brands of nicotine pouch in the USA-Zyn (by Swedish Match, introduced in the USA in July 2016), On! (Altria, August 2016) and Velo (RJ Reynolds, July 2019)-we examined (1) general advertising characteristics (eg, media type, year); (2) ad content (ie, headlines and imagery themes); (3) prominent media channels (ie, specific websites, magazines, etc); and (4) ad expenditures. RESULTS There were 286 unique ads (Zyn: 44.4%; On!: 2.8%; Velo: 52.8%), 119 143 occurrences (Zyn: 3.5%; On!: 0.5%; Velo: 96.0%) and $24 774 650 total expenditures (Zyn: 4.7%; On!: 0.6%; Velo: 94.7%). The greatest proportion of ad occurrences and expenditures were accounted for by radio (75.9% and 28.2%, respectively) and television (16.2% and 56.5%), followed by mobile (0.5% and 7.2%) and online display (6.7% and 3.6%). Across ad occurrences and expenditures, prominent headline themes included 'freedom' (26.0% and 17.1%, respectively), 'brand' (9.6% and 18.6%) and 'flavour' (16.4% and 7.6%); images mainly featured the product alone (61.4% and 56.1%), text (16.2% and 24.6%) or men (8.7% and 8.6%); and prominent channel themes were entertainment (34.7% and 37.3%), news/weather (14.3% and 21.7%), business/finance (12.9% and 9.0%) and sports (9.5% and 1.0%). Zyn and On! prioritised online display and print; Velo prioritised radio and television. Zyn's and Velo's headlines focused on 'freedom', with Zyn also emphasising 'brand' and Velo 'innovation'; On!'s headlines emphasised 'flavour'. CONCLUSIONS Regulatory efforts must be informed by surveillance of nicotine pouch marketing and impacts on consumer subgroups (eg, young people).
Collapse
Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donna Vallone
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
- School of Global Public Health, New York University, New York, New York, USA
| | - Jessica M Rath
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - W Douglas Evans
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Christina Wysota
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Carla J Berg
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| |
Collapse
|
6
|
Liu J, Winickoff JP, Hanby E, Rees V, Emmons KM, Tan AS. Prevalence and correlates of past 30-day dual-vaping of nicotine and cannabis among adolescents in five New England states. Drug Alcohol Depend 2024; 254:111055. [PMID: 38071894 PMCID: PMC10872281 DOI: 10.1016/j.drugalcdep.2023.111055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023]
Abstract
SIGNIFICANCE Adolescent vaping behavior includes vaping of multiple substances, including both nicotine and cannabis (dual-vaping). This study describes the prevalence and the sociodemographic correlates of past 30-day dual-vaping. METHODS We recruited adolescents ages 13-17 from five New England states (Massachusetts, Connecticut, Rhode Island, Vermont, New Hampshire) through the Prodege online survey panel from April 2021 to August 2022. Dual-vaping was defined as vaping both nicotine and cannabis (THC and/or CBD) in the past 30-days. We analyzed the prevalence of sole-nicotine, sole-cannabis, and dual-vaping of nicotine and cannabis and used multinomial logistic regression to examine associations between sociodemographic factors and sole- and dual-vaping of nicotine and cannabis. RESULTS The analytic sample included 2013 observations from 1858 participants (mean age 15.1 years, 46.2% female, 74.1% White, 82.2% heterosexual). Among these observations, 5.6% reported past 30-day sole-nicotine vaping, 5.5% reported sole-cannabis vaping, and 7.3% had dual-vaped. Correlates for higher odds of past 30-day dual-vaping included total social media sites used and household tobacco use, in contrast with sole-cannabis vaping, which included older age and self-reported depression (all p's <0.05). DISCUSSION Adolescent past 30-day dual-vaping of nicotine and cannabis was more prevalent than past 30-day sole-vaping of either nicotine or cannabis alone. Future studies should continue to collect detailed data on the type of substances, besides nicotine, that adolescents are vaping.
Collapse
Affiliation(s)
- Jessica Liu
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Kresge Building, Boston, MA, USA; REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
| | - Jonathan P Winickoff
- Massachusetts General for Children, Division of General Academic Pediatrics, Boston, MA, USA; MGH Tobacco Research and Treatment Center, Boston, MA, USA; American Academy of Pediatrics Julius B. Richmond Center, Itasca, IL, USA
| | - Elaine Hanby
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA
| | - Vaughan Rees
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Kresge Building, Boston, MA, USA
| | - Karen M Emmons
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Kresge Building, Boston, MA, USA
| | - Andy Sl Tan
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA; University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA; Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, PA, USA
| |
Collapse
|
7
|
Thoonen KAHJ, Jongenelis MI. Motivators of e-cigarette use among Australian adolescents, young adults, and adults. Soc Sci Med 2024; 340:116411. [PMID: 37989045 DOI: 10.1016/j.socscimed.2023.116411] [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: 03/27/2023] [Revised: 09/22/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE There is limited research examining motivators of e-cigarette use among never smokers, a group for whom vaping has no benefits and many harms. To inform programs and policies that aim to prevent initiation and encourage cessation of e-cigarette use, this study investigated reasons for intended use, initiation, and continued use of e-cigarettes among various age and user groups in Australia. METHODS An online survey was administered to 4617 respondents. Never users of e-cigarettes and never smokers who reported intending to try e-cigarettes (n = 348), current e-cigarette users and never smokers (n = 121), and current e-cigarette users and current smokers (n = 354) were of interest to this study. RESULTS Among never smokers, curiosity was the most commonly reported reason for intended use and use initiation, whereas the taste of e-cigarettes and their appealing flavours were the most frequently reported motivators of current e-cigarette use. Among smokers, taste and flavourings were the most commonly reported motivators of current use, not smoking cessation. Adolescents and young adults in most user groups were more likely than adults to report using e-cigarettes out of curiosity and because they taste good, whereas adults were more likely to use for smoking cessation purposes and because they perceived e-cigarettes to be more acceptable and cheaper than tobacco cigarettes. CONCLUSIONS Results suggest that (i) prohibiting flavourings and (ii) restricting advertising that highlights the pleasurable effects of e-cigarettes could constitute potential means of preventing e-cigarette initiation and encouraging cessation among never smokers, especially adolescents.
Collapse
Affiliation(s)
- Karlijn A H J Thoonen
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia.
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia.
| |
Collapse
|
8
|
Collins-Fairclough A, Rideout K, Joshi P, Philips J, Lanier T, Chow S, Smith D, Hoens A, FitzGerald JM, Rauscher C, Strydom N, Carlsten C. Opportunities to improve asthma and COPD prevention and care: insights from the patient journey obtained through focus groups. BMJ Open Qual 2023; 12:e002403. [PMID: 38092427 PMCID: PMC11148695 DOI: 10.1136/bmjoq-2023-002403] [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: 05/03/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The healthcare experiences of patients hold valuable insights for improving the quality of services related to their well-being. We therefore invited and explored the perspectives of patients living with asthma and chronic obstructive pulmonary disease (COPD) on their interaction with the systems supporting health, in order to identify opportunities to improve services to prevent, treat and manage these conditions. METHODS Two virtual focus groups were held in August 2021, one for adult asthma and one for COPD, to learn of patients' experiences receiving care for these conditions in the Vancouver Coastal Health (VCH) region of British Columbia. Participants were recruited through online postings or their clinician. We discussed the care pathway for each condition and invited participants to share their experiences of the past 5 years, specifically their reflections on the process, including feelings, points of praise and frustration, and opportunities for improvement in this context. Composite patient journey maps were developed for each condition to reflect the experiences shared. Audio recordings of the focus groups were transcribed and used in qualitative data analysis. RESULTS Thematic analysis revealed the following as possible areas for improvement: low public awareness of asthma and COPD and associated risk factors, non-standardised diagnosis pathways that delay diagnosis, and inconsistency in delivering valued aspects of care such as supports for self-management, trust-inspiring acute care, empowering patient communication and timely access to care. CONCLUSION We successfully used focus groups to generate composite journey maps of the experiences of patients living with asthma (n=8) and COPD (n=9) to identify features that these patients consider important for improving the healthcare system for asthma and COPD in VCH. Health professionals, decision makers and patient advocates in VCH and beyond can consider these insights when evaluating, and planning changes to, current practices and policies in service delivery.
Collapse
Affiliation(s)
- Aneisha Collins-Fairclough
- Division of Respiratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Karen Rideout
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Center for Lung Health, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Phalgun Joshi
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Center for Lung Health, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Jeremiah Philips
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tony Lanier
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Santa Chow
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Dan Smith
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alison Hoens
- Department of Physical Therapy, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Center for Lung Health, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Chris Rauscher
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Nardia Strydom
- Department of Family and Community Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Christopher Carlsten
- Division of Respiratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
9
|
Roberson A, Cummings KM, Reid JL, Burkhalter R, Gravely S, East K, Thrasher JF, Hammond D. Trends in E-Cigarette and Tobacco Cigarette Purchasing Behaviors by Youth in the United States, Canada, and England, 2017-2022. Int J Public Health 2023; 68:1606234. [PMID: 38033762 PMCID: PMC10682085 DOI: 10.3389/ijph.2023.1606234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives: This paper describes trends in youth e-cigarette (EC) and tobacco cigarette (TC) purchasing behaviors in Canada, England, and the United States (US) in relationship to changing minimum legal age (MLA) laws. Methods: Data are from eight cross-sectional online surveys among national samples of 16- to 19-year-olds in Canada, England, and the US conducted from 2017 to 2022 (N = 104,467). Average wave percentage change in EC and TC purchasing prevalence and purchase locations were estimated using Joinpoint regressions. Results: EC purchasing increased between 2017 and 2022, although the pattern of change differed by country. EC purchasing plateaued in 2019 for the US and in 2020 for Canada, while increasing through 2022 for England. TC purchasing declined sharply in the US, with purchasing from traditional retail locations declining, while purchasing from social sources increased. Vape shops were the most common location for EC purchasing, although declining in England and the US. Conclusion: Trends in EC and TC purchasing trends in the US are consistent with the expected impact of the federal MLA law increasing the legal age to 21 years in December 2019.
Collapse
Affiliation(s)
- Avery Roberson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Robin Burkhalter
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Katherine East
- National Addiction Centre, Institute of Psychiatry and Neuroscience, King's College London, London, England
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
10
|
Hammond D, Reid JL. Trends in vaping and nicotine product use among youth in Canada, England and the USA between 2017 and 2022: evidence to inform policy. Tob Control 2023:tc-2023-058241. [PMID: 37940402 DOI: 10.1136/tc-2023-058241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Preventing uptake of nicotine products among youth remains a central objective of tobacco control policy. Comparing trends in the use of nicotine across countries provides an opportunity to identify emergent product trends and to evaluate 'natural experiments' in policies. METHODS Repeat cross-sectional data were analysed from eight waves of the International Tobacco Control Youth Tobacco and Vaping Survey, conducted between 2017 and 2022. Non-probability samples of youth aged 16-19 years in Canada, England and the USA (N=104 473) completed online surveys including measures on vaping, smoking and use of other nicotine products. This paper summarises findings across the 5-year period of the study, as part of a comprehensive report on key indicators of youth vaping in the three countries. RESULTS The youth nicotine market has rapidly evolved across the three countries, with different patterns of combustible and non-combustible product use in Canada, the USA and England. These changes are primarily attributable to trends in youth vaping: following declines during the initial COVID-19 pandemic period, by 2022, vaping prevalence neared pre-pandemic levels in the USA and Canada, and reached record highs in England. Notable shifts also occurred in the types of vaping products used by youth, including increased use of disposable, nicotine salt-based products. Additional findings are reported on a range of policy-relevant indicators, including for vaping products, promotions and purchasing. CONCLUSIONS Patterns of nicotine use among youth have rapidly evolved in recent years due to the proliferation of nicotine products, the COVID-19 pandemic and the emerging impact of policy measures.
Collapse
Affiliation(s)
- David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
11
|
Yan D, Wang Z, Laestadius L, Mosalpuria K, Wilson FA, Yan A, Lv X, Zhang X, Bhuyan SS, Wang Y. A systematic review for the impacts of global approaches to regulating electronic nicotine products. J Glob Health 2023; 13:04076. [PMID: 37622721 PMCID: PMC10451104 DOI: 10.7189/jogh.13.04076] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Background The rapid increase in electronic nicotine product (ENP) use among young people has been a global public health challenge, given the potential harm of ENPs and nicotine dependence. Many countries have recently introduced legislations to regulate ENPs, but the impacts of these policies are poorly understood. This systematic review aims to critically synthesise empirical studies on the effects of global regulations regarding ENPs on the prevalence of use, health outcomes and their determinants, using the 4A marketing mix framework (acceptability, affordability, accessibility and awareness). Methods Following the PRISMA guideline, we searched PubMed, Embase, Scopus, Web of Science, Academic Search Complete, Business Source Complete, and APA PsycINFO databases from inception until June 14, 2022 and performed citation searches on the included studies. Reviewed literature was restricted to peer-reviewed, English-language articles. We included all pre-post and quasi-experimental studies that evaluated the impacts of e-cigarette policies on the prevalence of ENP use and other health outcomes. A modified Joanna Briggs Institute (JBI) Critical Appraisal checklist for quasi-experimental studies was used for quality assessment. Due to heterogeneity of the included studies, we conducted a narrative synthesis of evidence. Results Of 3991 unduplicated records screened, 48 (1.2%) met the inclusion criteria, most were from high-income countries in North America and Europe and 26 studies measured self-reported ENPs use. Flavour restrictions significantly decreased youth ENP use and taxation reduced adult use; mixed results were found for the impacts of age restrictions. Indoor vaping restrictions and the European Tobacco Products Directive (TPD) did not seem to reduce ENP use based on existing studies. Changes in determinants such as sales and perceptions corroborated our conclusions. Few studies assessed the impacts of other regulations such as advertising restrictions and retail licensing requirements. Conclusions Flavour restrictions and taxes have the strongest evidence to support effective control of ENPs, while others need powerful enforcement and meaningful penalties to ensure their effectiveness. Future research should focus on under-examined policies and differential impacts across sociodemographic characteristics and countries. Registration PROSPERO CRD42022337361.
Collapse
Affiliation(s)
- Duo Yan
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Zicheng Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Linnea Laestadius
- Joseph J. Zilber College of Public Health, University of Wisconsin – Milwaukee, Milwaukee, Wisconsin USA
| | - Kavita Mosalpuria
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Department of Economics, University of Utah, Salt Lake City, Utah, USA
| | - Alice Yan
- Department of Research Patient Care Service, Stanford Health Care, Palo Alto, California, USA
| | - Xiaoyang Lv
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaotian Zhang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey, USA
- School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
| | - Yang Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
12
|
Smith MJ, Hilton S. Youth's exposure to and engagement with e-cigarette marketing on social media: a UK focus group study. BMJ Open 2023; 13:e071270. [PMID: 37612101 PMCID: PMC10450076 DOI: 10.1136/bmjopen-2022-071270] [Citation(s) in RCA: 2] [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] [Received: 12/20/2022] [Accepted: 06/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Electronic-cigarettes (e-cigarette) are promoted creatively through social media and considering the potential influence of social media marketing on young people, we explored young people's exposure to and engagement with social media marketing of e-cigarettes. DESIGN Semistructured discussion groups. SUBJECTS Twenty focus groups with 82 young people aged 11-16 living in the Central belt of Scotland. METHODS Youths were asked about smoking and vaping behaviours, social media use, vaping advertisement exposure and were shown illustrative examples of social media content (eg, images and videos) about different messages, presentations and contextual features. Transcripts were imported into NVivo V.12, coded thematically and analysed. RESULTS Youths highlighted a variety of tactics e-cigarette companies use, including influencer or celebrity endorsement, attractive youth flavours, bright colours and emotional appeal to advertise and promote their products directly to young people. Social media influencers who advertise e-cigarettes were described as portraying e-cigarettes as 'cool' and 'fashionable' to entice viewers to try the products. Youths considered that there is a need for more restrictions on social media content to protect youths while also still allowing smokers to purchase them as a cessation device. CONCLUSIONS Our study highlights that the e-cigarette industry is using previously employed tactics similar to the tobacco industry to advertise and promote its products on social media. These findings suggest the growing need for governments to work together to develop and implement policies to restrict the advertising and marketing of e-cigarettes on social media.
Collapse
Affiliation(s)
- Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
13
|
Pederson LL, Koval JJ, Vingilis E. E-cigarette use by Ontario public elementary school and secondary school students: Has the use among sociodemographic groups changed from 2017 to 2019? Prev Med Rep 2023; 34:102257. [PMID: 37273527 PMCID: PMC10236451 DOI: 10.1016/j.pmedr.2023.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
This project examined e-cigarette use among Elementary School (ES) (grades 7 and 8) and Secondary School (SS) (grades 9-12) students in Ontario, Canada, for 2017 and 2019 and relationships with sociodemographic variables and traditional cigarette use. The data came from the Ontario Student Drug Use and Health Survey OSDUHS (2017, 2019). Socio-demographics included grade, school performance, sex, race, years in Canada, living arrangements and language spoken at home. E-cigarette use and cigarette smoking were any past year use. For 2017, there are a greater percentage of ES males than females who used e-cigarettes, older students, those living in more than one home and those smoking cigarettes. For SS students a greater percentage for those of older age, higher grades, living in Canada all their lives, using only English language at home, self-identified as white, with lower school performance, those with multiple household living arrangements and who reported smoking traditional cigarettes reported using e-cigarettes. Use was lower among females in 2017 (OR = 0.63, 95% CI = 0.46, 0.86, p = 0.002), but by 2019 use was higher among females, which resulted in a non-significant difference between males and females (OR = 0.91, 95% CI = 0.77, 1.09). Greater use of e-cigarettes was found among students who smoked traditional cigarettes compared to those who did not smoke in both years. Monitoring the trends, patterns and trajectories of use and variables related to use needs to be continued which may help inform the development of further legislative and educational measures.
Collapse
Affiliation(s)
- Linda L. Pederson
- Department of Epidemiology and Biostatistics Department of Family Medicine The Western Centre for Family Medicine and Public, Health University of Western University, 1839 Aldersbrook Road, London, Ontario N6G 3S3, Canada
| | - John J. Koval
- Department of Epidemiology and Biostatistics The Western Centre for Family Medicine and Public, Health University of Western Ontario London Ontario, N6G 2M1, Canada
| | - Evelyn Vingilis
- Department of Family Medicine The Western Centre for Public Health and Family Medicine University of Western Ontario London, ON N6G 2M1, Canada
| |
Collapse
|
14
|
Nottage MK, Taylor EV, Kim Y, Soh N, Hammond D, Simonavicius E, McNeill A, Arnott D, East K. Marketing claims on the websites of leading e-cigarette brands in England. Tob Control 2023:tc-2023-057934. [PMID: 37402577 DOI: 10.1136/tc-2023-057934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Exposure to electronic cigarette (EC) marketing is associated with EC use, particularly among youth. In England, the Tobacco and Related Products Regulations and Committee of Advertising Practice (CAP) regulate EC marketing to reduce appeal to youth; however, there are little published data on EC marketing claims used online. This study therefore provides an overview of marketing claims present on the websites of EC brands popular in England. METHODS From January to February 2022, a content analysis of 10 of England's most popular EC brand websites was conducted, including violation of CAP codes. RESULTS Of the 10 websites, all presented ECs as an alternative to smoking, 8 as a smoking cessation aid and 6 as less harmful than smoking. Four websites presented ECs as risk-free. All mentioned product quality, modernity, convenience, sensory experiences and vendor promotions. Nine featured claims about flavours, colours, customisability and nicotine salts. Seven featured claims concerning social benefits, personal identity, sustainability, secondhand smoke and nicotine strength. Six featured claims about fire safety. Some claimed ECs are cheaper than tobacco (n=5), cited health professionals (n=4) or featured collaborations with brands/icons (n=4). All were assessed by the research team to violate one or more CAP code(s) by featuring medicinal claims (n=8), contents which may appeal to non-smokers (n=7), associations with youth culture (n=6), depictions of youth using ECs (n=6) or media targeting youth (n=5). CONCLUSION Among 10 top EC brand websites in England, marketing elements that might appeal to youth were commonly identified and CAP code compliance was low.
Collapse
Affiliation(s)
| | | | - Yebin Kim
- Addictions Department, King's College London, London, UK
| | - Nicole Soh
- Addictions Department, King's College London, London, UK
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Ann McNeill
- Addictions Department, King's College London, London, UK
- Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM) Consortium, Edinburgh, UK
| | | | - Katherine East
- Addictions Department, King's College London, London, UK
| |
Collapse
|
15
|
Moore G, Hallingberg B, Brown R, McKell J, Van Godwin J, Bauld L, Gray L, Maynard O, Mackintosh AM, Munafò M, Blackwell A, Lowthian E, Page N. Impacts of EU Tobacco Products Directive regulations on use of e-cigarettes in adolescents in Great Britain: a natural experiment evaluation. PUBLIC HEALTH RESEARCH 2023; 11:1-102. [PMID: 37452656 DOI: 10.3310/wtmh3198] [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] [Indexed: 07/18/2023] Open
Abstract
Background E-cigarettes are a popular smoking-cessation tool. Although less harmful than tobacco, use of e-cigarettes by non-smokers should be prevented. There is concern about the use of e-cigarettes by young people and that e-cigarettes may renormalise smoking. In May 2016, Tobacco Products Directive regulations aimed to reduce e-cigarettes' appeal to young people. Aims To examine the effects of the Tobacco Products Directive regulations on young people's use of e-cigarettes, and the role of e-cigarettes in renormalising smoking. Design A mixed-method natural experimental evaluation combining secondary analyses of survey data, with process evaluation, including interviews with young people, policy stakeholders, retailers and trading standards observers, and observations of retail settings. Settings Wales, Scotland and England. Participants Survey participants were aged 13-15 years, living in England, Scotland or Wales and participated in routinely conducted surveys from 1998 to 2019. Process evaluation participants included 14- to 15-year-olds in England, Scotland and Wales, policy stakeholders, trading standards offices and retailers. Intervention Regulation of e-cigarettes, including bans on cross-border advertising, health warnings and restrictions on product strength. Comparison group Interrupted time series design, with baseline trends as the comparator. Main outcome measures The primary outcome was ever e-cigarette use. Secondary outcomes included regular use, ever and regular smoking, smoking attitudes, alcohol and cannabis use. Data capture and analysis Our primary statistical analysis used data from Wales, including 91,687 young people from the 2013-19 Health Behaviour in School-aged Children and School Health Research Network surveys. In Scotland, we used the Scottish Schools Adolescent Lifestyle and Substance Use Survey and in England we used the Smoking Drinking and Drug Use surveys. The process evaluation included interviews with 73 young people in 2017 and 148 young people in 2018, 12 policy stakeholders, 13 trading standards officers and 27 retailers. We observed 30 retail premises before and after implementation. Data were integrated using the Medical Research Council's process evaluation framework. Results Ever smoking continued to decline alongside the emergence of e-cigarettes, with a slight slowing in decline for regular use. Tobacco Products Directive regulations were described by stakeholders as well implemented, and observations indicated good compliance. Young people described e-cigarettes as a fad and indicated limited interaction with the components of the Tobacco Products Directive regulations. In primary statistical analyses in Wales [i.e. short (to 2017) and long term (to 2019)], growth in ever use of e-cigarettes prior to Tobacco Products Directive regulations did not continue after implementation. Change in trend was significant in long-term analysis, although of similar magnitude at both time points (odds ratio 0.96). Data from England and Scotland exhibited a similar pattern. Smoking followed the opposite pattern, declining prior to the Tobacco Products Directive regulations, but plateauing as growth in e-cigarette use stalled. Limitations Alternative causal explanations for changes cannot be ruled out because of the observational design. Conclusions Young people's ever and regular use of e-cigarettes appears to have peaked around the time of the Tobacco Products Directive regulations and may be declining. Although caution is needed in causal attributions, findings are consistent with an effect of regulations. Our analysis provides little evidence that e-cigarettes renormalise smoking. More recent data indicate that declines in smoking are plateauing. Future work International comparative work to understand differences in use of e-cigarettes, and tobacco, within varying regulatory frameworks is a priority. Study registration This study is registered as ResearchRegistry4336. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Britt Hallingberg
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Rachel Brown
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Jordan Van Godwin
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, UK
| | | | - Linsay Gray
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Olivia Maynard
- Medical Research Council Integrative Epidemiology Unit, School of Psychological Sciences, University of Bristol, Bristol, UK
| | | | | | - Anna Blackwell
- Medical Research Council Integrative Epidemiology Unit, School of Psychological Sciences, University of Bristol, Bristol, UK
| | - Emily Lowthian
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Nicholas Page
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
16
|
Kim M, Neilands TB, Gregorich SE, Jordan JW, Ling PM. Young Adult Responses to Peer Crowd-Based Targeting in E-cigarette Advertisements: An Experimental Study. Nicotine Tob Res 2023; 25:1125-1134. [PMID: 37101413 PMCID: PMC10202626 DOI: 10.1093/ntr/ntac292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/16/2022] [Accepted: 12/21/2022] [Indexed: 04/28/2023]
Abstract
AIMS To examine the effects of psychographically targeted e-cigarette advertisements on young adults. METHODS A total of 2100 young adults (18-29 years old) representing five peer crowds (groups with shared values, interests, and lifestyle: Mainstream, Young Professional, Hip Hop, Hipster, and Partier) were recruited from a nationwide opt-in online panel. Participants were randomly assigned to view e-cigarette advertisements featuring characters that either did or did not match their own peer crowd affiliation and evaluated advertising effectiveness using Likert-type and semantic differential scales. Participants also reported their attitudes toward using e-cigarettes. RESULTS No significant overall effect of peer crowd matching was observed. However, significant two-way interaction effects emerged where matching advertisements yielded higher evaluations than mismatching advertisements among those who currently do not use tobacco and nicotine products and among Mainstream participants. Advertisements featuring Mainstream characters were in general rated more highly than other advertisements. Additional analyses found significant effects of peer crowd matching among those who viewed advertisements featuring non-Mainstream characters. CONCLUSIONS Peer crowd-based targeting can increase the effectiveness of e-cigarette advertisements which may impact initiation among current nonusers, requiring stricter marketing regulations. More research is needed to determine if anti-tobacco messaging tailored by peer crowds may effectively counteract targeted e-cigarette marketing. IMPLICATIONS E-cigarette advertisements often use psychographic targeting strategies, using lifestyles, attitudes, and values. Low-risk young adults (eg, those who currently do not use tobacco and nicotine products) are susceptible to psychographically targeted e-cigarette advertisements. This may result in the initiation of e-cigarette use among young adults who would otherwise be less likely to use tobacco and nicotine products. Stricter marketing regulations for emerging tobacco and nicotine products are required to reduce marketing exposure.
Collapse
Affiliation(s)
- Minji Kim
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
17
|
Identifying changes in e-cigarette use among a longitudinal sample of Canadian youth e-cigarette users in the COMPASS cohort study, 2017/18-2018/19. Addict Behav Rep 2022; 16:100458. [PMID: 36164667 PMCID: PMC9508506 DOI: 10.1016/j.abrep.2022.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/11/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022] Open
Abstract
Those who use e-cigarettes may increase, decrease, or keep the same frequency of use. Half of current youth e-cigarette users increased their frequency of use. One third of current youth e-cigarette users decreased their frequency of use. E-cigarette use patterns differed by gender and ethnicity.
Objectives There are few studies describing longitudinal changes in vaping patterns among current youth e-cigarette users. The objective of this study was to identify-one-year changes in e-cigarette use patterns among a longitudinal sample of Canadian youth e-cigarette users between 2017/18 and 2018/19. Methods The longitudinal sample included n = 4,071 current (past 30-day) e-cigarette users in grades 9–11 attending schools in four Canadian provinces. Students reported the number of days they used e-cigarettes in the past 30 days in 2017/18 and 2018/19. Based on responses, students could have escalated, reduced, stopped, or maintained their level of vaping. The prevalence of each e-cigarette use pattern was identified across demographic characteristics and regression models identified significant predictors of each use pattern. Results Over one year, 49.2% of current youth e-cigarette users escalated, 12.8% reduced, 20.2% stopped, and 17.8% maintained their frequency of e-cigarette use. Baseline e-cigarette use frequencies varied according to use pattern. Current youth e-cigarette users with higher baseline vaping frequencies had lower odds of escalating and stopping e-cigarette use and higher odds of reducing e-cigarette use relative to maintaining the same frequency of use. Conclusions While about half of current youth e-cigarette users increased their frequency of e-cigarette use over a 1-year period, a significant number also decreased or stopped vaping at a time when the prevalence of youth e-cigarette use increased rapidly in Canada. There is a need for longitudinal data to monitor and evaluate changes to e-cigarette use patterns that may be in response to changing public health policies.
Collapse
|
18
|
A systematic review of socio-ecological factors influencing current e-cigarette use among adolescents and young adults. Addict Behav 2022; 135:107425. [DOI: 10.1016/j.addbeh.2022.107425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 12/22/2022]
|
19
|
Pipe AL, Mir H. E-Cigarettes Reexamined: Product Toxicity. Can J Cardiol 2022; 38:1395-1405. [PMID: 36089290 DOI: 10.1016/j.cjca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.
Collapse
Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Hassan Mir
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
20
|
Wang Y, Duan Z, Weaver SR, Self-Brown SR, Ashley DL, Emery SL, Huang J. Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use. JAMA Netw Open 2022; 5:e2233938. [PMID: 36173633 PMCID: PMC9523494 DOI: 10.1001/jamanetworkopen.2022.33938] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Little is known about the roles of advertising and parental and peer influence in e-cigarette use among US adolescents in recent years, hindering efforts to address the increasing rate of youth vaping. OBJECTIVE To examine how e-cigarette advertising exposure and parental and peer e-cigarette use were associated with e-cigarette use among US adolescents. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from waves 4 (December 2016 to January 2018), 4.5 (December 2017 to December 2018), and 5 (December 2018 to November 2019) of the Population Assessment of Tobacco and Health study, an on-going cohort study representative of the noninstitutionalized US population. Sample weights were applied to generate nationally representative estimates. Data were analyzed in January 2022. EXPOSURES Past 30-day e-cigarette advertising exposure, past 30-day parental e-cigarette use, and the number of best friends using e-cigarettes (none, a few, some, most, and all). MAIN OUTCOMES AND MEASURES Outcomes were contemporary curiosity about using e-cigarettes and e-cigarette initiation at follow-up. Generalized estimating equations were used to estimate the weighted adjusted associations. RESULTS Wave 4 included 8548 adolescents; wave 4.5, 10 073 adolescents; and wave 5, 11 641 adolescents. Among adolescents in the wave 4 survey, 4425 (51.1%) were boys, 1935 (24.9%) were aged 12 years, 1105 (13.0%) were Black, 2515 (24.4%) were Hispanic, and 3702 (52.3%) were White. More than 60% of adolescents reported past 30-day e-cigarette advertising exposure at each survey. Among adolescents who had never used e-cigarettes, those who reported e-cigarette advertising exposure were more likely to feel curious about using e-cigarettes (adjusted odds ratio [aOR], 1.56 [95% CI, 1.43-1.70]) and were more likely to become ever e-cigarette users (aOR, 1.21 [95% CI, 1.05-1.41]) and current e-cigarette users (aOR, 1.42 [95% CI, 1.16-1.75]) at follow-up. Adolescents who reported having best friends using e-cigarettes were more likely to feel curious about using e-cigarettes (eg, all best friends: aOR, 4.13 [95% CI, 2.35-7.26]) and initiate e-cigarette use at follow-up (eg, among adolescents reporting all best friends use e-cigarettes, risk of ever use: aOR, 4.08 [95% CI, 1.44-11.59]; risk of current use aOR, 5.42 [95% CI, 1.49-19.72]) than adolescents who reported having no best friends using e-cigarettes. CONCLUSIONS AND RELEVANCE This cohort study of US adolescents found that e-cigarette advertising and peer influence were significantly associated with e-cigarette initiation. Efforts to address youth vaping need to consider peer influence and incorporate measures reducing e-cigarette advertising exposure.
Collapse
Affiliation(s)
- Yu Wang
- School of Public Health, Georgia State University, Atlanta
| | - Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Scott R Weaver
- School of Public Health, Georgia State University, Atlanta
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta
| | | | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta
| |
Collapse
|
21
|
Katz SJ, Petersen A, Liu H, Cohen E, Hatsukami D. Vaping Flavors and Flavor Representation: A Test of Youth Risk Perceptions, Novelty Perceptions, and Susceptibility. Nicotine Tob Res 2022; 25:590-595. [PMID: 35931419 PMCID: PMC9910141 DOI: 10.1093/ntr/ntac192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/14/2022] [Accepted: 08/04/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Whether novelty-flavored vaping devices should be available in the marketplace has been a hotly contested debate. From one perspective, the variety of different flavors, such as fruit and mint, may help adult cigarette smokers who are seeking to switch to reduced-harm nicotine products. However, these flavors are also wildly popular among youth, creating concerns about new nicotine product use among minors. AIMS AND METHODS This experiment (n = 176) tests whether vaping flavors (tobacco vs fruit) and flavor representations on packages (flavor color, flavor image) influence how middle school youth perceive vaping products. RESULTS While results show no difference in risk perceptions based on condition, novelty perceptions (eg, how fun, interesting) and susceptibility to vaping are highest among those who view the fruit-flavored vaping product with flavor color and flavor image. Those who viewed this condition reported higher novelty perceptions and susceptibility than those who viewed the fruit-flavored vaping product with no flavor color and no flavor image. Additionally, they reported higher novelty perceptions than those who viewed the tobacco-flavored vaping product with flavor color and flavor image. A post-hoc analysis in supplemental data shows that youth who report lower risk perceptions and higher susceptibility have higher behavioral intentions to vape in the next year. CONCLUSION Findings suggest that restricting flavor representation on packaging might reduce how fun and interesting youth perceive these products to be and how susceptible they are to using them.
Collapse
Affiliation(s)
- Sherri Jean Katz
- Corresponding Author: Sherri Jean Katz, PhD, Hubbard School of Journalism and Mass Communication, University of Minnesota, 206 Church Street, SE, Minneapolis, MN 55455, USA. E-mail:
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Hanjie Liu
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Elisia Cohen
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
22
|
Sreeramareddy CT, Manoharan A. Awareness About and E-Cigarette Use Among Adults in 15 Low- and Middle-Income Countries, 2014-2018 Estimates From Global Adult Tobacco Surveys. Nicotine Tob Res 2022; 24:1095-1103. [PMID: 35596725 DOI: 10.1093/ntr/ntab269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2023]
Abstract
INTRODUCTION E-cigarette (EC) use is seldom reported from low- and middle-income countries (LMICs). We report the prevalence of "awareness" about EC, its use, and distribution of EC use by sociodemographic factors and cigarette smoking (CS) status. AIMS AND METHODS We analyzed Global Adult Tobacco Survey data in Bangladesh, China, Costa Rica, Ethiopia, India, Kazakhstan, Mexico, Philippines, Romania, Russia, Senegal, Ukraine, Turkey, Uruguay, and Viet Nam during 2014-2018. The weighted prevalence of "awareness" (heard about), "ever" (even once), and "current" (daily/nondaily) EC use among never, current, and former cigarette smokers and quit ratios (past smokers/ever smokers) was estimated. Association of EC use with sociodemographic, and CS, was explored by multilevel regression. RESULTS Overall, prevalence of "awareness," "ever," and "current" ECs use was 19.3% (95% confidence interval [CI] 27.4, 31.1), 2.6% (95% CI 2.4, 2.8), and 0.7% (95% CI 0.6, 0.8), respectively. In most countries, "ever use" <10%, and "current use" was about 1% except Romania (4.4%) and Russia (3.5%). "Current use" was 0.1%, 2.9%, and 3.1% among never, current, and former smokers, respectively. "Current" and "ever" EC use was higher among current and former than never smokers (2.8% and 3.1% vs. 0.1%; 9.9% and 10.9% vs. 0.7%), respectively. Current EC use was associated with male sex, urban residence and younger age, higher education, and wealth. "Quit attempts" (aOR 1.3, 95% CI 1.2, 1.5) and cigarettes smoked per day (aOR 1.6, 95% CI 1.4, 1.9) were associated with "ever use." CONCLUSIONS EC use was low in most countries. "Dual use" was common among current smokers and the quit ratio was higher among ECs users. IMPLICATIONS EC use is increasing in high-income countries (HICs) where regulations on ECs are usually permissive. Evidence on the individual- or population-level impact of ECs on CS cessation is inconclusive. Little is known about the prevalence of EC use in LMICs where regulations are nonexistent or less restrictive. Studying the distribution of EC use rates by population subgroups, CS status, and quit ratios for CS among EC users will assist the formulation of EC regulatory policies. We provide comparable nationally representative prevalence estimates of "awareness" about and, use of ECs to serve as a benchmark for future monitoring. EC use was associated with the attempt to quit CS and smoking >10 cigarettes per day. However, "dual use" was common, and the quit ratio for CS was higher among EC users. EC use was very low relative to HICs. Nevertheless, comprehensive EC regulatory policies should be implemented to prevent the escalation of EC use by targeting population subgroups such as young adults, educated and wealthier individuals.
Collapse
Affiliation(s)
| | - Anusha Manoharan
- Primary Care Medicine, Botanic Health Clinic, Ministry of Health, Selangor, Malaysia
| |
Collapse
|
23
|
Hammond D, Vanderlee L, White CM, Acton RB, White M, Roberto CA, Cameron A, Sacks G, Kirkpatrick S, Dubin J, Adams J, Jauregui A, Thrasher JF. The Conceptual Framework for the International Food Policy Study: Evaluating the Population-Level Impact of Food Policy. J Nutr 2022; 152:1S-12S. [PMID: 35274695 PMCID: PMC9188864 DOI: 10.1093/jn/nxac042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/14/2022] Open
Abstract
An unhealthy diet is among the leading global causes of death and disability. Globally, a range of policies are being implemented to support healthy food choices at a population level, including novel polices in the areas of food marketing, nutrition labeling, and taxation of less healthy foods. There is a need to evaluate and inform the implementation of these policies, including their impacts on marginalized population subgroups. The International Food Policy Study (IFPS) consists of repeated cross-sectional surveys conducted in 5 high- and upper-middle-income countries: Australia, Canada, Mexico, the United Kingdom, and the United States. In each country, approximately 4000 adults and 1200 children and youth (aged 10-17) were recruited from a global commercial panel to complete an online survey using consistent measures and methodologies across countries. The first annual IFPS surveys were conducted in 2017 with adults; annual surveys for young people aged 10-17 were launched in 2019 in the same countries, as well as in Chile. The design of the IFPS surveys creates a framework for evaluating "natural experiments" in food policies, including comparisons over time within countries implementing the policy and comparisons with countries in which the policy was not implemented. IFPS surveys have 3 primary areas of focus: 1) knowledge, attitudes, and beliefs associated with specific policies; 2) diet-related behaviors; and 3) dietary intake, including 24-hour dietary recalls for adults in 4 of the 5 countries. Surveys also assess food insecurity, income adequacy, sex and gender, race/ethnicity, and a range of other measures to assess trends among priority subgroups. Overall, the IFPS project has the potential to address important gaps in national monitoring surveys for dietary patterns, and to evaluate the impacts of novel food policies implemented in any of the 5 countries over the study period.
Collapse
Affiliation(s)
- David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrian Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Sharon Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Dubin
- Department Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Jean Adams
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alejandra Jauregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
24
|
Hoek J, Edwards R, Waa A. From social accessory to societal disapproval: smoking, social norms and tobacco endgames. Tob Control 2022; 31:358-364. [PMID: 35241613 DOI: 10.1136/tobaccocontrol-2021-056574] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
25
|
Martinez-Loredo V, González-Roz A, Dawkins L, Singh D, Murphy JG, MacKillop J. Is E-cigarette Use Associated With Persistence or Discontinuation of Combustible Cigarettes? A 24-Month Longitudinal Investigation in Young Adult Binge Drinkers. Nicotine Tob Res 2022; 24:962-969. [PMID: 35176769 PMCID: PMC9199943 DOI: 10.1093/ntr/ntac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION It remains unclear whether electronic cigarette (e-cigarette) use promotes persistent combustible tobacco use or smoking discontinuation over time. Alcohol use is associated with a greater risk of adverse health effects of tobacco, and higher likelihood of e-cigarette use, making drinkers a high-priority subpopulation. AIMS AND METHODS This study examined longitudinal patterns of combustible tobacco and e-cigarette use over 24 months in young adult binge drinkers. A pooled dataset of 1002 (58.5% female; M age = 22.14) binge drinkers from the United States (60%) and Canada (40%) was used. The primary outcomes were past month combustible tobacco and e-cigarette use. Nicotine dependence was measured using the Fagerström Test of Cigarette Dependence. Alcohol severity was measured using the Young Adult Alcohol Consequences Questionnaire. Latent transition analysis (LTA) was used to identify patterns of cigarette smoking and e-cigarette use over 24 months. RESULTS The LTA yielded a four-class solution: (1) e-cigarettes-only users (prevalence over time: 7.75%-10.10%), (2) dual-product users (2.61%-9.89%), (3) combustible-only smokers (8.12%-20.70%), and (4) nonusers (61.66%-80.06%). Dual-product users predominantly transitioned to complete abstinence or exclusively e-cigarette use. In combustible-only smokers, the most common transition was to abstinence, followed by persistence of combustible-only status. At 24 months, 63% of e-cigarettes-only users transitioned to abstinence, with 37% continuing e-cigarettes-only use and 0% transitioning to dual or combustible cigarette use. CONCLUSIONS Dual-product use in young adult binge drinkers was associated with discontinuation of combustible tobacco over time, and e-cigarette-only use was not associated with subsequent combustible tobacco use. IMPLICATIONS These findings suggest that concurrent or exclusive e-cigarette use is not a risk factor for the persistence or development of combustible tobacco use in this subpopulation, with dual-product use reflecting a transitional pattern away from combustible use, toward discontinuation.
Collapse
Affiliation(s)
- Victor Martinez-Loredo
- Corresponding Author: Víctor Martínez Loredo, PhD, Department of Psychology and Sociology, University of Zaragoza, C/ Ciudad escolar s/n, 44003 Teruel, Aragón, Spain. Telephone: +34 978-61-81-54; E-mail:
| | - Alba González-Roz
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
| | - Lynne Dawkins
- Department of Psychology, London South Bank University, London, UK
| | - Desmond Singh
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton/McMaster University, Hamilton, ON, Canada
| | - James G Murphy
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton/McMaster University, Hamilton, ON, Canada
| |
Collapse
|
26
|
Becker TD, Rice TR. 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: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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.
Collapse
Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1230, New York, NY, 10019, USA.
| | - Timothy R Rice
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1230, New York, NY, 10019, USA.
| |
Collapse
|
27
|
Cho YJ, Thrasher JF, Driezen P, Hitchman SC, Reid JL, Hammond D. Trends in exposure to and perceptions of e-cigarette marketing among youth in England, Canada and the United States between 2017 and 2019. HEALTH EDUCATION RESEARCH 2022; 36:657-668. [PMID: 34849859 PMCID: PMC8800160 DOI: 10.1093/her/cyab039] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 10/28/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
E-Cigarette marketing may influence e-cigarette use among youth. This study examined reported exposure to and perceptions of e-cigarette marketing among youth between 2017 and 2019 across countries with varying e-cigarette marketing restrictions. Cross-sectional online surveys were conducted with 35 490 youth aged 16-19 from England, Canada and the United States in 2017, 2018 and 2019. Weighted logistic regression models examined trends in the adjusted prevalence of self-reported exposure to e-cigarette marketing and the perceived appeal of e-cigarette ads between 2017 and 2019, by country and by smoking/vaping status. Reports of frequent exposure to e-cigarette marketing increased between 2017 and 2019 in all countries, but less so in England, where e-cigarette marketing is more restricted. Perceiving e-cigarette marketing as appealing increased from 2017 to 2019 in Canada and the United States, but not in England. In England, exposure to e-cigarette marketing did not increase in prohibited channels between 2017 and 2019. Between 2017 and 2019, never-users' reports increased for exposure to and appeal of e-cigarette marketing. The results suggest some effectiveness of e-cigarette marketing bans in England and receptivity to e-cigarette marketing among youth never users.
Collapse
Affiliation(s)
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Discovery Building I, Room 565. 915 Greene Street, Columbia, SC 29208, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Avenida Universidad #655, Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos CP 62100, México
| | - Pete Driezen
- School of Public Health Sciences, Faculty of Health, University of Waterloo 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada
- Department of Psychology, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada
| | - Sara C Hitchman
- Department of Communication and Media Research, University of Zurich Andreasstrasse 15, Zürich 8050, Switzerland
| | - Jessica L Reid
- School of Public Health Sciences, Faculty of Health, University of Waterloo 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada
| |
Collapse
|
28
|
D'Mello K, Hammond D, Mahamad S, Wiggers D, East K. Nicotine content, labelling and flavours of e-liquids in Canada in 2020: a scan of the online retail market. Health Promot Chronic Dis Prev Can 2022; 42:4-11. [PMID: 35044139 PMCID: PMC9067016 DOI: 10.24095/hpcdp.42.1.02] [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] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The e-cigarette market in Canada has rapidly evolved following the implementation of the Tobacco and Vaping Products Act in May 2018, which liberalized the promotion and sale of vaping products. To date, there is little data on the market profile of key product attributes, including nicotine content, labelling practices and flavours. METHODS An online scan of vaping product retailers (manufacturer, two national, five provincial) was conducted in 2020 to assess the e-liquids available on the Canadian market. Data were extracted from websites and product images regarding the nicotine content, labelling and flavours of e-liquids. RESULTS We identified 1746 e-liquids, with a total of 4790 different nicotine concentrations. Approximately half of the e-liquids were offered with salt-base nicotine (46.6%) and half with freebase nicotine (53.2%); the remainder were hybrids (0.2%). The mean nicotine concentration of salt-base e-liquids (3.4%) was higher than freebase e-liquids (0.5%) (p < 0.001). Labels indicating the presence of nicotine were visible on twothirds of e-liquid packaging displayed online (63.2%) while three-quarters of packaging displayed the nicotine concentration (73.7%), and more than half of packaging displayed health warnings (58.9%). A variety of flavours were also identified, with fruit being the most common (43.6%), followed by candy/desserts (27.6%) and non-alcoholic drinks (12.5%). CONCLUSION Findings demonstrate the diversity of the online e-cigarette market in Canada, including the availability of higher-concentration salt-base nicotine products. Flavour restrictions have the potential to dramatically reduce the number of e-liquid flavours on the market, while restricting nicotine concentrations to < 20 mg/mL will predominantly restrict salt-based e-liquids.
Collapse
Affiliation(s)
- Kimberly D'Mello
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Syed Mahamad
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Danielle Wiggers
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Katherine East
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
29
|
Pokhrel P, Phillips KT, Kawamoto CT, Taketa R, Tabangcura KJ, Yoshioka-Maxwell A, Pagano I. Exposure to e-cigarette content on social media and e-cigarette use: An ecological momentary assessment study. Addict Behav Rep 2021; 14:100368. [PMID: 34938829 PMCID: PMC8664768 DOI: 10.1016/j.abrep.2021.100368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022] Open
Abstract
Exposure to e-cigarette content on social media may affect behavior in the real-time. Exposure to anti-e-cigarette content may have a lagged effect on behavior. Exposure to pro-e-cigarette content may have a more immediate effect on behavior.
This pilot ecological momentary assessment (EMA) study tested the associations between exposure to anti-e-cigarette content on social media and e-cigarette use behavior. For exposure to anti-e-cigarette posts, participants were asked to follow the study account on Instagram, on which anti-e-cigarette content were posted regularly. In addition, we assessed participants’ exposure to pro-e-cigarette content in their daily lives and examined the effects of such exposure on behavior. Participants were 29 diverse young adult current e-cigarette users (18–30 year olds; 54% women), who provided data 3 times daily, for 3 weeks via a mobile phone based EMA application. Relative to no exposure, exposure to anti-e-cigarette content was associated with decreased recent e-cigarette use frequency at the next assessment time-point (p < 0.05; 2-tailed). In addition, a statistically significant concurrent association was found between exposure to pro-e-cigarette content (relative to no exposure) and higher e-cigarette use (p < 0.05; 2-tailed). The current data are some of the first to show that exposure to anti-e-cigarette content on social media may have real time effects on decreased e-cigarette use among young adults as they go about their daily lives. Policies and efforts designed to regulate pro-e-cigarette and promote anti-e-cigarette content on social media may help reduce e-cigarette use among young people.
Collapse
Affiliation(s)
- Pallav Pokhrel
- University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA
| | - Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, 501 Alakawa Street, Suite 201, Honolulu, HI 96817, USA
| | - Crissy T Kawamoto
- University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA
| | - Rachel Taketa
- University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA
| | - Kayzel J Tabangcura
- University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA
| | - Amanda Yoshioka-Maxwell
- Department of Social Work, Thompson School of Social Work and Public Health, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| | - Ian Pagano
- University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA
| |
Collapse
|
30
|
Grilo G, Crespi E, Cohen JE. A scoping review on disparities in exposure to advertising for e-cigarettes and heated tobacco products and implications for advancing a health equity research agenda. Int J Equity Health 2021; 20:238. [PMID: 34717629 PMCID: PMC8557615 DOI: 10.1186/s12939-021-01576-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 01/13/2023] Open
Abstract
Background Disparities in exposure to and density of tobacco advertising are well established; however, it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. Through a scoping review, we sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations. Methods In January 2020, a systematic literature search was conducted in five databases: PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. The search was updated in October 2020. Articles reporting on exposure to e-cigarette and/or HTP advertising and promotion across age, education, sex, gender identity, race/ethnicity, sexual orientation, SES, and/or urban/rural areas were included for full-text review (n = 25). Of those, 15 were deemed relevant for data extraction. Results The majority of the studies were from the U.S. (n = 12) and cross-sectional (n = 14). Studies were published between 2014 and 2020 and focused on determining causal relationships that underlie disparities; only one study assessed HTP advertising and promotion. Exposure to e-cigarette and HTP advertising was assessed at the individual-level (e.g., recall seeing ads on television) and at the neighborhood-level (e.g., ad density at the point-of-sale). Studies addressed differences across age (n = 6), education (n = 2), sex (n = 6), gender identity and sexual orientation (n = 3), race/ethnicity (n = 11), SES (n = 5), and urban/rural (n = 2). The following populations were more likely to be exposed to e-cigarette advertising: youth, those with more than a high school diploma, males, sexual and gender minorities, Whites, and urban residents. At the neighborhood-level, e-cigarette advertisements were more prevalent in non-White neighborhoods. Conclusions Exposure to e-cigarette/HTP advertising varies based on sociodemographic characteristics, although the literature is limited especially regarding HTPs. Higher exposure among youth might increase tobacco-related disparities since it can lead to nicotine/tobacco use. Research should incorporate and apply a health equity lens from its inception to obtain data to inform the elimination of those disparities.
Collapse
Affiliation(s)
- Graziele Grilo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA.
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
| |
Collapse
|
31
|
Stead M, Ford A, Angus K, MacKintosh AM, Purves R, Mitchell D. E-Cigarette Advertising in the UK: A Content Analysis of Traditional and Social Media Advertising to Observe Compliance with Current Regulations. Nicotine Tob Res 2021; 23:1839-1847. [PMID: 33856487 PMCID: PMC8496471 DOI: 10.1093/ntr/ntab075] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/13/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The advertising of e-cigarettes in the UK is regulated through the revised EU Tobacco Products Directive and the Tobacco and Related Products Regulations, with further rules set out in the Advertising Standards Authority (ASA) Committees of Advertising (CAP) Code. Focusing on the ASA CAP Code Rules, we examined e-cigarette advertising regulation compliance in traditional advertising channels and on social media. METHODS We conducted a content analysis of UK e-cigarette and related product advertising using a randomly selected sample (n = 130) of advertising in traditional channels and on Instagram which appeared between January and December 2019. All ads were independently double-coded to assess compliance with each CAP Code Rule. RESULTS In traditional channels, our sample of advertising had largely good compliance. Only very small numbers of these ads appeared to be clearly in breach of any of the ASA rules (5% were in breach of Rule 22.7; 2% of Rule 22.9; and 1% of Rule 22.10). In contrast, we judged that all of the Instagram sample (n = 30) was in breach of Rule 22.12. For some rules, it was not possible to make definitive judgments about compliance, given uncertainty regarding how a rule should be interpreted and applied. CONCLUSIONS We found overall good compliance for advertising in traditional channels, but assessed all of our social media advertising samples was in breach of regulations. Current guidance on e-cigarette advertising could be improved to facilitate e-cigarette advertising assessment and regulation. It would be beneficial to bring consumer perspectives into the assessment of regulation compliance. IMPLICATIONS The regulation of e-cigarette advertising is a global concern. The UK Government has a statutory obligation to review the Tobacco and Related Products Regulations by May 2021. This study assessed compliance with current UK e-cigarette advertising regulations on placement and content. We identified areas where greater clarity is needed and outlined implications for future regulation.
Collapse
Affiliation(s)
- Martine Stead
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Allison Ford
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Kathryn Angus
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Danielle Mitchell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| |
Collapse
|
32
|
Williams GC, Cole AG, de Groh M, Jiang Y, Leatherdale ST. Investigating individual-level correlates of e-cigarette initiation among a large sample of Canadian high school students. Health Promot Chronic Dis Prev Can 2021; 41:292-305. [PMID: 34668684 PMCID: PMC8565859 DOI: 10.24095/hpcdp.41.10.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Having a better understanding of individual factors associated with e-cigarette initiation can help improve prevention efforts. Therefore, this study aimed to (1) identify baseline characteristics associated with e-cigarette initiation, and (2) determine whether changes in these baseline characteristics were associated with e-cigarette initiation. METHODS This study used data from Year 6 (2017/18, baseline) and Year 7 (2018/19, follow-up) of the COMPASS study. The final sample included 12 315 students in Grades 9 to 11 who reported never having tried e-cigarettes at baseline. Students reported demographic information, other substance use, school behaviours, physical activity, sedentary behaviour, sleep, symptoms of anxiety and depression, and emotional regulation and flourishing scores. Hierarchical GEE models, stratified by gender, examined the association between (1) baseline characteristics and e-cigarette initiation at follow-up and (2) changes in baseline characteristics and e-cigarette initiation at follow-up. RESULTS In total, 29% of students who had not yet initiated e-cigarette use reported initiating e-cigarette use at follow-up. Students in Grades 10 and 11 were less likely to initiate e-cigarette use. Other substance use, skipping school and meeting the physical activity guidelines at baseline and one-year changes to these behaviours were associated with e-cigarette initiation among both male and female students. Additionally, some differences were noted between females and males. CONCLUSION Given that other health behaviours were associated with e-cigarette initiation, prevention approaches should target multiple health-risk behaviours to help prevent youth e-cigarette use. Additionally, school-based approaches may benefit by being implemented at the beginning of high school or in junior high school.
Collapse
Affiliation(s)
- Gillain C Williams
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Adam G Cole
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Ying Jiang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
33
|
Szoko N, Ragavan MI, Khetarpal SK, Chu KH, Culyba AJ. Protective Factors Against Vaping and Other Tobacco Use. Pediatrics 2021; 148:e2020048066. [PMID: 34312291 PMCID: PMC8344349 DOI: 10.1542/peds.2020-048066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vaping has gained popularity among adolescents despite negative health consequences. Few studies have focused on factors that may protect against vaping. We sought to determine if future orientation, parental monitoring, school connectedness, and social support are associated with decreased risk of vaping and other forms of tobacco use. METHODS Data were obtained via anonymous school-based health behavior surveys among ninth- through 12th-graders in Pittsburgh, PA (n = 2487). Protective factors were assessed through validated Likert scale instruments. The primary outcome was recent (past 30-day) vaping. Additional outcomes included other forms of tobacco use and intention to quit tobacco products. Poisson regression models examined associations between protective factors and vaping and tobacco use outcomes. RESULTS Mean age was 15.7 years, 1446 (58.1%) respondents were female, and 671 youth (27.0%) reported recent vaping. Positive future orientation and high parental monitoring were associated with significantly lower prevalence of recent vaping (adjusted prevalence ratio: 0.84 [95% confidence interval: 0.73-0.97] and adjusted prevalence ratio: 0.73 [95% confidence interval: 0.62-0.85], respectively). There were no significant relationships between social support or school connectedness and vaping. All 4 protective factors were inversely associated with other forms of tobacco use. No factors were significantly associated with intent to quit tobacco products. CONCLUSIONS Findings reveal significant inverse associations between future orientation, parental monitoring, and vaping but no relationship between protective factors and intent to quit tobacco products. Developing interventions to foster protective factors in youth and their parental supports may inform primary prevention efforts to reduce vaping and other tobacco use.
Collapse
Affiliation(s)
- Nicholas Szoko
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maya I Ragavan
- School of Medicine
- Divisions of General Academic Pediatrics
| | | | - Kar-Hai Chu
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | |
Collapse
|
34
|
The Energy to Smoke: Examining the Longitudinal Association between Beverage Consumption and Smoking and Vaping Behaviours among Youth in the COMPASS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083864. [PMID: 33917040 PMCID: PMC8067730 DOI: 10.3390/ijerph18083864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022]
Abstract
This study examined the longitudinal association between changes in sugar-sweetened and/or caffeinated beverage consumption and smoking/vaping behaviour among Canadian adolescents. Using longitudinal data from the COMPASS study (2015/16 to 2017/18), four models were developed to investigate whether beverage consumption explained variability in smoking and vaping behaviour in adolescence: (1) smoking initiation, (2) vaping initiation, (3) current smoking status, and (4) current vaping status. Models were adjusted for demographic factors. Multinomial logit models were used for model 1, 2, and 3. A binary logistic regression model was used for model 4. An association between change in frequency of beverage consumption and smoking/vaping behaviour was identified in all models. A one-day increase in beverage consumption was associated with smoking initiation (OR = 1.38, 95% CI: 1.25, 1.51), vaping initiation (OR = 1.23, 95% CI: 1.14, 1.32), identifying as a current smoker (OR = 1.17, 95% CI: 1.01, 1.35), and currently vaping (OR = 1.08, 95% CI: 1.04, 1.11). Change in high-energy drink consumption was the best predictor of smoking behaviours and vaping initiation but not current vaping status. Given the health consequences of smoking and vaping and their association with high-energy drink and coffee consumption, policy initiatives to prevent smoking/vaping initiation, and to limit youth access to these beverages, warrant consideration.
Collapse
|
35
|
Cole AG, Laxer RE, Patte KA, Leatherdale ST. Can We Reverse this Trend? Exploring Health and Risk Behaviours of Grade 12 Cohorts of Ontario Students from 2013-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3109. [PMID: 33803500 PMCID: PMC8002993 DOI: 10.3390/ijerph18063109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022]
Abstract
Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.
Collapse
Affiliation(s)
- Adam G. Cole
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | | | - Karen A. Patte
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada;
| | - Scott T. Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW Over the last decade, vaping has emerged into an epidemic of alarming proportions among US teens. This review evaluates the factors leading to the rise of vaping, reasons for its striking popularity among US teens, health consequences of vaping, and measures to mitigate the vaping epidemic. RECENT FINDINGS Contemporary research highlights the continued rise of vaping amongst US teens and explains the reasons for its popularity, such as the variety of devices, a wide range of available flavors, youth-targeted advertisements, and lack of awareness of adverse consequences from vaping. This publication highlights current research findings of health consequences of vaping, including a discussion of EVALI (e-cigarette or vaping product use-associated lung injury) and provides an update on strategies to curtail the vaping epidemic. SUMMARY Vaping has risen to epidemic proportions amongst US teens. This poses a clear and present danger to teens' health with adverse effects ranging from acute lung injury to long-term addiction. This article summarizes key research findings that explain the reasons for the epidemic, health consequences of vaping, and provides an overview of efforts to mitigate the vaping threat to US teens.
Collapse
Affiliation(s)
- Anand N Venkata
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | |
Collapse
|
37
|
Stubbs T, Thomas S, Pitt H, Daube M. Do health halos and conspicuous consumption influence the appeal and risk perceptions of e-cigarettes among young Cambodian men? Tob Control 2021; 31:505-510. [PMID: 33504583 DOI: 10.1136/tobaccocontrol-2020-056110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Reduced risk perceptions influence young people's consumption behaviours of e-cigarettes, suggesting that a health halo effect may be associated with these devices. Product, performative, and social factors contribute to the appeal of e-cigarettes, with young people using e-cigarettes with friends as part of social interactions. This study explored the factors that influence the appeal and risk perceptions associated with e-cigarettes among young Cambodian men. METHODS A mixed-method, interviewer-administered survey with 147 young men in Cambodia, who were aged between 18 and 24 years and identified as cigarette smokers. Participants described their attitudes and consumption behaviours surrounding e-cigarettes, recalled e-cigarette promotions, and described their risk perceptions towards e-cigarettes. Descriptive statistics were calculated for quantitative data, and thematic analysis was conducted for qualitative data. RESULTS Some participants associated e-cigarettes with affluence and exclusivity, describing these devices as products that rich and/or younger people use. Participants also described product attributes that were appealing about e-cigarettes, such as variety of flavours, vapour, and performing smoke 'styles' with friends, which differentiated the product from combustible cigarettes. Participants also had reduced risk perceptions towards e-cigarettes, with some commenting that e-cigarettes were not harmful or might be health-enhancing. CONCLUSION Some young people may perceive e-cigarettes as a form of conspicuous consumption, which they associated with social status and identity. A health halo effect appears to be associated with e-cigarettes among some young people. This may influence young people to underestimate the potential health risks associated with these devices.
Collapse
Affiliation(s)
- Thomas Stubbs
- Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Samantha Thomas
- Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Hannah Pitt
- Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
38
|
Williams GC, Burns KE, Battista K, de Groh M, Jiang Y, Leatherdale ST. High School Intramural Participation and Substance Use: A Longitudinal Analysis of COMPASS Data. Subst Use Misuse 2021; 56:1108-1118. [PMID: 33821756 DOI: 10.1080/10826084.2021.1901932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is an association between sports participation and substance use. However, there is some evidence that intramural sports in high school may not have the same effect. Therefore, the objective of this research was to examine the longitudinal associations between intramural participation in high school and substance use. Methods: This study used a three-year linked sample (2016-2018) of grade 9 and 10 (ages 13-17) Canadian high school students in the COMPASS (Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, Sedentary behavior) study (n = 7,845). Students reported their participation in intramurals over time (consistent, none, initiate, intermittent, and quit) and their substance use behaviors (binge drinking, cannabis use, cigarette use, and e-cigarette use). Mixed effects models were used. Results: 42% of students did not participate in intramurals. For binge drinking, male students who never participated had lower odds (0.66 [0.47-0.93]) compared to consistent intramural participators. Female (3.50 [CI: 1.34-9.16]) and male students (1.97 [1.28-3.02]) who did not participate in any intramurals were more likely to use cannabis than consistent participators. Male students who did not participate were also more likely to use cigarettes (1.81 [1.05-3.12]). No associations were found between intramural participation and e-cigarette use. Conclusion: Intramural participation may be associated with increased binge drinking among male high school students. More promisingly, consistent participation in intramurals may be protective against cannabis use among male and female students and cigarette use among male students.
Collapse
Affiliation(s)
- Gillian C Williams
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Public Health Agency of Canada, Applied Research Division, Ottawa, Ontario, Canada
| | - Kathleen E Burns
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kate Battista
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Margaret de Groh
- Public Health Agency of Canada, Applied Research Division, Ottawa, Ontario, Canada
| | - Ying Jiang
- Public Health Agency of Canada, Applied Research Division, Ottawa, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
39
|
Craig LV, Yoshimi I, Fong GT, Meng G, Yan M, Mochizuki Y, Tabuchi T, Thrasher JF, Xu SS, Quah ACK, Ouimet J, Sansone G, Chung-Hall J. Awareness of Marketing of Heated Tobacco Products and Cigarettes and Support for Tobacco Marketing Restrictions in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228418. [PMID: 33202995 PMCID: PMC7696863 DOI: 10.3390/ijerph17228418] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
Japan is one of the world’s largest cigarette markets and the top heated tobacco product (HTP) market. No forms of tobacco advertising, promotion, and sponsorship (TAPS) are banned under national law, although the industry has some voluntary TAPS restrictions. This study examines Japanese tobacco users’ self-reported exposure to cigarette and HTP marketing through eight channels, as well as their support for TAPS bans. Data are from the 2018 ITC Japan Survey, a cohort survey of adult exclusive cigarette smokers (n = 3288), exclusive HTP users (n = 164), HTP-cigarette dual users (n = 549), and non-users (n = 614). Measures of overall average exposure to the eight channels of cigarette and HTP advertising were constructed to examine differences in exposure across user groups and products. Dual users reported the highest exposure to cigarette and HTP advertising. Tobacco users (those who used cigarettes, HTPs, or both) reported higher average exposure to HTP compared to cigarette advertising, however non-users reported higher average exposure to cigarette compared to HTP advertising. Retail stores where tobacco or HTPs are sold were the most prevalent channel for HTP and cigarette advertising, reported by 30–43% of non-users to 66–71% of dual users. Non-users reported similar exposure to cigarette advertising via television and newspapers/magazines as cigarette smokers and dual users; however, advertising via websites/social media was lower among non-users and HTP users than among cigarette smokers and dual users (p < 0.05). Most respondents supported a ban on cigarette (54%) and HTP (60%) product displays in stores, and cigarette advertising in stores (58%).
Collapse
Affiliation(s)
- Lorraine V. Craig
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
- Correspondence:
| | - Itsuro Yoshimi
- Division of Tobacco Control Policy Research, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
- Ontario Institute for Cancer Research, 61 University Ave., Suite 510, Toronto, ON M5G 0A3, Canada
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Mi Yan
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Yumiko Mochizuki
- Japan Cancer Society, 13th Floor, Yurakucho Center Bldg. 2-5-1, Yurakucho, Chiyoda-ku, Tokyo 100-0006, Japan;
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Chome-1-69 Otemae, Chuo Ward, Osaka 541-8567, Japan;
| | - James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Steve S. Xu
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Genevieve Sansone
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| |
Collapse
|