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Vander Woude CA, Buszkiewicz JH, Travis N, James LN, Fleischer NL. Tobacco Control Policies and Sociodemographic Disparities in Cigarette Smoking Behaviors in the U.S.: A Systematic Review Protocol. AJPM FOCUS 2024; 3:100256. [PMID: 39161402 PMCID: PMC11331704 DOI: 10.1016/j.focus.2024.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Since the 1998 Master Settlement Agreement in the U.S., many studies have examined the associations between tobacco control policies and smoking; however, there is a need to comprehensively examine the impact of these policies on sociodemographic disparities in cigarette smoking. This protocol outlines a systematic review that seeks to fill this gap. Quantitative observational, experimental, and quasi-experimental studies are eligible for inclusion. Policies include cigarette taxes, smoke-free air laws, anti-tobacco media campaigns, and Tobacco 21 laws implemented in the U.S. Outcomes include cigarette smoking initiation, prevalence, and cessation among youth and adults. Sources to be searched include Clarivate BIOSIS, EBSCO CINAHL Plus, Cochrane Library, Ovid MEDLINE, PsycINFO, Sociological Abstracts, Clarivate Web of Science Core Collection, and the National Bureau of Economic Research. Included studies must be written in English. Two independent reviewers will screen and analyze relevant articles and then extract data on participants, context, methods, and key findings. Studies will be assessed using the Joanna Briggs Institute critical appraisal checklists and presented in 2 reviews: 1 youth focused (aged <18 years) and 1 adult focused (aged ≥18 years). The findings are intended to inform the creation of new and potentially more targeted tobacco control policies to improve health equity.
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Affiliation(s)
| | - James H. Buszkiewicz
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, District of Columbia
| | - LaTeesa N. James
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Ouellette RR, Morean ME, Lee J, Kong G. Use of ENDS devices and modifications to vape cannabis among adolescents and young adults who also vape nicotine. Addict Behav 2024; 157:108099. [PMID: 39003977 DOI: 10.1016/j.addbeh.2024.108099] [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: 02/01/2024] [Revised: 06/03/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS) are the most used tobacco product among adolescents and young adults (AYAs) and are increasingly used to vape cannabis. It is unclear what vaping devices and ENDS modifications are used most frequently by AYAs who vape both nicotine and cannabis. METHODS AYAs (aged 14-29) reporting ENDS use in the past 30 days were recruited via Qualtrics (N = 1,011). We conducted three multivariable logistic regression models examining differences in likelihood of: 1) vaping cannabis in the past 30 days; 2) mixing cannabis and nicotine liquids; and 3) using nicotine devices to vape cannabis; based on type of vaping device used most often, controlling for age, socio-economic status, gender, race, frequency of ENDS use, and other cannabis use. RESULTS 40 % (n = 405) of AYAs reported vaping both nicotine and cannabis in the past 30 days. AYAs who used vape pens most often were more likely to have vaped cannabis concentrates in the past 30 days compared to individuals using disposable vapes (aOR = 2.72, 95 %CI = 1.75-4.21, p < 0.001). AYAs who used open systems most often (i.e., vape pens, mods, or e-hookah) were more likely than individuals using closed systems (i.e., disposable vapes, rechargeable pods or cigalikes) to combine nicotine and cannabis e-liquids (aOR = 2.03, 95 %CI = 1.43-2.89, p < 0.001) or use a nicotine device to vape cannabis (aOR = 1.66, 95 %CI = 1.17-2.34, p = 0.005). IMPLICATIONS Co-use of cannabis and nicotine via similar devices, particularly vape pens and other open-systems, warrants collaborative regulatory efforts to mitigate co-use of both substances, with a particular need for increased regulation of cannabis vaping products.
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Affiliation(s)
- Rachel R Ouellette
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
| | - Meghan E Morean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Juhan Lee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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Chen N, Dai L, Wang J, Zhang L, Zhu J. Changes of campus tobacco control environment and the impact on tobacco control behaviors among secondary school personnel in Shanghai, China. Tob Induc Dis 2024; 22:TID-22-162. [PMID: 39310712 PMCID: PMC11413989 DOI: 10.18332/tid/191763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Youth smoking is a serious public health problem. Nevertheless, a rigorous tobacco-free environment within schools, combined with exemplary tobacco control behavior among school personnel can effectively contribute to reducing adolescent smoking. This study compared the tobacco control environment in Shanghai secondary schools in 2017 and 2021, and explored how the tobacco control environment influenced the tobacco control behaviors of school personnel. METHODS Two cross-sectional studies were conducted from October to December 2017 and October to December 2021, using stratified cluster random sampling method, and 2403 and 1761 valid questionnaires were collected, respectively. The chi-squared test was used to test the differences between categorical variables. Binary logistic regression was conducted using survey data from 2021 to explore the influencing factors of staff's tobacco control behaviors. RESULTS Compared with 2017, the percentages of staff members who were current smokers, had smoked on campus in the past year and were exposed to secondhand smoke (SHS) on campus in the past 7 days in 2021 decreased by 2.95%, 2.30% and 8.91%, respectively. However, the proportion of personnel who knew the school had organized tobacco control education decreased. Furthermore, school personnel who had received tobacco control education and agreed the school should strictly prohibit students from smoking (AOR=1.64; 95% CI: 1.25-2.15) were more likely to inform about the harm of tobacco to students. Those who had participated in tobacco control education activities or tobacco control trainings (AOR=1.87; 95% CI: 1.30-2.69) and believed that the school did not strictly prohibit either students (AOR=0.30; 95% CI: 0.22-0.41) or personnel (AOR=0.46; 95% CI: 0.36-0.59) from smoking were more inclined to stop students from smoking. CONCLUSIONS Compared with 2017, the rates of smoking and secondhand smoke exposure among school personnel decreased in 2021, but some schools still lacked comprehensive education on tobacco control behaviors for the staff. Enhancing the health literacy and strengthening tobacco control education among staff were effective strategies to encouraging their active adoption of tobacco control behaviors.
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Affiliation(s)
- Nuo Chen
- School of Public Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Luojia Dai
- School of Public Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Juanjuan Wang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Lulu Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jingfen Zhu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Guillory J, Curry L, Homsi G, Saunders M, Henes A, MacMonegle A, Nonnemaker J, Sanders EC, Mekos D, Wall Vigorita M, Budenz A. Predictors of Cigar, Cigarillo, and Little Cigar Initiation Among Hip Hop-Identifying Youth. Subst Use Misuse 2024:1-10. [PMID: 39294924 DOI: 10.1080/10826084.2024.2403127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
BACKGROUND We explored predictors of cigar product initiation among Hip Hop-identifying U.S. youth using data from the U.S. Food and Drug Administration's Fresh Empire evaluation. Participants were Hip Hop-identifying youth living in evaluation markets who had not initiated cigar product use at their first survey. OBJECTIVES We modeled cigar product initiation odds using discrete time survival analysis logistic regression models as a function of factors related to one's large social, physical, social/normative, and intrapersonal environment, and other tobacco use. RESULTS In the unique sample, 26.2% initiated cigar product use. Factors associated with higher cigar product initiation odds included: current/former (vs. non-susceptible never) cigarette smoking (odds ratio [OR]=5.35; p=.008); cigarette experimentation (vs. non-susceptible never smoking) (OR=3.26; p<.001); current (vs. never) e-cigarette use (OR=2.06; p<.001) and hookah use (OR=1.83; p=.011); having at least one friend who uses marijuana (OR=1.43; p=.008); high music use (OR=1.32; p=.035); household tobacco use (OR=1.26; p =.042); increased age (OR=1.18; p< .001); and higher sensation seeking (OR=1.16; p=.018). Youth reporting higher perceived smoking risks had lower cigar product initiation odds (OR=0.86; p=.029) as did Hispanic (OR=0.53; p<.001) and non-Hispanic Other youth (OR= 0.68; p=.023) (vs. non-Hispanic Black youth). CONCLUSIONS The finding that high music use predicted cigar product initiation should be considered in light of cigar brand sponsorship of musical artists and events and indicates a potential opportunity for counter messaging. Peer crowd segmentation in this study identified unique and differing factors that influence tobacco use risk among Hip Hop-identifying youth that are not found in the general population.
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Affiliation(s)
- Jamie Guillory
- Center for Communication & Media Impact, RTI International, Research Triangle Park, North Carolina, USA
| | - Laurel Curry
- Center for Communication & Media Impact, RTI International, Research Triangle Park, North Carolina, USA
| | - Ghada Homsi
- Quality Office, RTI International, Research Triangle Park, North Carolina, USA
| | - McKinley Saunders
- Advanced Methods Development, RTI International, Research Triangle Park, North Carolina, USA
| | - Amy Henes
- Community & Workplace Health, RTI International, Research Triangle Park, North Carolina, USA
| | - Anna MacMonegle
- Center for Communication & Media Impact, RTI International, Research Triangle Park, North Carolina, USA
| | - James Nonnemaker
- Center for Communication & Media Impact, RTI International, Research Triangle Park, North Carolina, USA
| | - Emily C Sanders
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, Maryland, USA
| | - Debra Mekos
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, Maryland, USA
| | - Megan Wall Vigorita
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, Maryland, USA
| | - Alex Budenz
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, Maryland, USA
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Liu J, McCauley D, Gaiha SM, Halpern-Felsher B. Perceptions of Harm and Addictiveness for Nicotine Products, THC e-Cigarettes, and e-Cigarettes with Other Ingredients Among Adolescents, Young Adults, and Adults. Subst Use Misuse 2024:1-11. [PMID: 39289177 DOI: 10.1080/10826084.2024.2403105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND Perceptions of health harms and addictiveness related to nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients are an important predictor of use. This study examined differences in perceived harm and addiction across such products among adolescents, young adults, and adults. METHODS We conducted a cross-sectional survey (N = 6,131, ages 13-40 years old) in which participants reported perceived harm and addictiveness for 11 products (cigarettes, disposable nicotine e-cigarettes, pod-based nicotine e-cigarettes, other nicotine e-cigarettes, THC e-cigarettes, e-cigarettes with other ingredients, nicotine pouches, nicotine lozenges, nicotine gums, nicotine tablets, nicotine toothpicks). We applied adjusted regression models and conducted pairwise comparisons between age groups (13-17, 18-20, 21-25, and 26-40) and product use status (never, ever, and past-30-day use), adjusting for gender, race/ethnicity, sexual orientation, and financial comfort. RESULTS Overall, participants in younger age groups perceived products to be more harmful and addictive than those in older age groups, with the exception of e-cigarettes with other ingredients. For all products, participants who never used perceived each product to be more harmful than those who ever used. For all products, participants who used the products in the past 30-days had lower perceived harm and addictiveness compared to never and ever use. Certain sociodemographic groups, such as people who identify as LGBTQ+, Non-Hispanic Black, or Hispanic, had lower perceived harm and addictiveness for most products. DISCUSSION Efforts should be made to educate all age groups and minoritized groups on harms and addictiveness of all nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients.
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Affiliation(s)
- Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Devin McCauley
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Shivani Mathur Gaiha
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Bonnie Halpern-Felsher
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
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Daisy Dai H. Time since initiation on current vaping among adolescents and associations with adverse health outcomes. Addict Behav 2024; 160:108165. [PMID: 39317011 DOI: 10.1016/j.addbeh.2024.108165] [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: 05/16/2024] [Revised: 08/09/2024] [Accepted: 09/14/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) are the most commonly used tobacco products among U.S. youth. This study examined time since initiation among current adolescent e-cigarette users. METHODS Data were drawn from the 2019-2022 National Youth Tobacco Survey, and the study sample included adolescents who reported ≥ 1 day of e-cigarette use in the past 30 days (n = 9,424). Time since initiation was calculated by subtracting the age of first e-cigarette use from the current age, then classified as < 1 year, 1 year, 2 years, and ≥ 3 years. Logistics regressions were performed to examine the change in time since initiation (≥3 years vs. < 3 years) from 2019 to 2022 and associations of time since initiation with tobacco use and adverse health outcomes. RESULTS The proportion of current e-cigarette users with time since initiation < 1 year decreased from 29.6 % in 2019 to 13.2 % in 2022, while the proportion of those with time since initiation ≥ 3 years increased from 16.5 % to 46.0 % (p < 0.0001). The increases in time since initiation ≥ 3 years were observed across demographic groups. Longer time since initiation (≥3 years vs. < 3 years) was associated with lower odds of vaping quit intention (AOR=0.6[0.4-0.8],p = 0.0003) and higher odds of frequent e-cigarette use (AOR=3.0[2.3-4.0],p < 0.0001), dual use of e-cigarettes and other tobacco products (AOR=1.7[1.3-2.3],p = 0.0005), tobacco craving (AOR=2.2[1.5-3.1],p < 0.0001), tobacco dependence (AOR=1.9[1.2-3.0],p = 0.004) and the presence of cognitive impairment (AOR=1.3[1.04-1.73],p = 0.03) CONCLUSIONS: The findings of this study underscore the need for comprehensive public health initiatives, accessible cessation programs, and effective tobacco control policies to curb prolonged e-cigarette use in early life.
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Affiliation(s)
- Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center. Omaha, NE, United States.
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Kreslake JM, Cordova J, Seidenberg AB, Ali FRM, Schillo B, Marynak K. Youth and young adult flavour expectancies for new 'non-menthol' cigarettes introduced following California's ban on flavoured tobacco products. Tob Control 2024:tc-2024-058589. [PMID: 39256037 DOI: 10.1136/tc-2024-058589] [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: 01/05/2024] [Accepted: 08/06/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Following California's statewide law prohibiting the sale of flavoured tobacco products, some cigarette brands introduced new variants advertised as non-menthol, yet featuring design and text commonly found in menthol cigarette marketing. METHODS Data are from the February-May 2023 wave of the Tobacco Epidemic Evaluation Network (TEEN+) national probability-based survey (aged 13-25 years). Respondents (N=10 217) were shown images of two (of four) 'new non-menthol' brand ads or packaging and two comparators ('classic' non-menthol and menthol cigarette brands). Respondents reported expected taste of each (no or any minty/menthol taste; 'don't know'). Multinomial regression models tested associations between predictors (age, gender identity, race and ethnicity, perceived financial situation, smoking status) and expectation of minty/menthol taste. RESULTS Younger age was associated with expectations of minty/menthol taste, controlling for covariates. Respondents aged 13-17 years had greater odds of expecting minty/menthol taste than no minty/menthol taste for all tested new non-menthol brands (Camel Crush Oasis adjusted OR (aOR): 1.30, p<0.05; Camel Crisp aOR: 1.47, p<0.001; Kool Non-Menthol Blue aOR: 1.27, p<0.05; Kool Non-Menthol Green aOR: 1.43, p<0.01), compared to respondents aged 21 and older. Respondents aged 18-20 years had greater odds of reporting minty/menthol expectancies than no minty/menthol expectancies for Camel Crush Oasis (aOR: 1.35, p<0.05) and Kool Non-Menthol Green (aOR: 1.29, p<0.05) compared to those aged 21-25 years. Compared to non-Hispanic white respondents, non-Hispanic Asian respondents had greater odds of expecting minty/menthol taste than no minty/menthol taste for Camel Crush Oasis (aOR: 1.89, p<0.01), Kool Non-Menthol Blue (aOR: 1.88, p<0.01) and Kool Non-Menthol Green (aOR: 1.72, p<0.05). DISCUSSION Younger age was associated with expectations of new non-menthol cigarettes having a minty/menthol taste. Results raise concerns regarding the potential appeal of these products to youth and young adults.
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Affiliation(s)
| | | | | | | | - Barbara Schillo
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
| | - Kristy Marynak
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Beard J, Sayes CM. An examination of the methods and variables used in experimental design that impact the toxicological outcomes of e-cigarettes. Food Chem Toxicol 2024; 193:114999. [PMID: 39265718 DOI: 10.1016/j.fct.2024.114999] [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: 07/25/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
A clear answer on whether vaping is safe and, if not, to what degree it threatens human health and well-being, still needs to be communicated. Such an answer requires collecting, analyzing, and interpreting sometimes conflicting and indeterminate results. This paper reviews the most recently published research articles that examine vaping toxicities. It highlights the differences in the techniques employed from one paper to another. While e-cigarettes do not appear to cause the same degree of harm as cigarettes, they pose a real biological threat regarding inflammation, oxidative stress, mucociliary interference, and membrane damage. The concentration of nicotine present is directly related to these endpoints and is often higher in fourth-generation devices. However, third-generation devices can do more harm than their successors, possibly due to their high voltage and low resistance capabilities. In addition to nicotine, the flavorants used in e-cigarettes have also been shown to relate to biological stress, and the adverse health effects increase in vape formulations with higher concentrations and numbers of flavor types. Different biological models also yield different health effects, especially when comparing bronchial and alveolar cells or tissues. To universalize the results of vape experiments, researchers should seek greater consistency within the experimental design. Key methodological variables must be recognized and disclosed in future research, including puff duration and number, types of e-cigarettes and e-liquids being tested, device settings during aerosolization, and any details of the employed exposure method that may affect dosimetry.
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Affiliation(s)
- Jon Beard
- Department of Biology, Baylor University, Waco, TX, 76798-7266, USA
| | - Christie M Sayes
- Department of Biology, Baylor University, Waco, TX, 76798-7266, USA; Department of Environmental Science, Baylor University, Waco, TX, 76798-7266, USA.
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Bello MS, Wang CX, Maglalang DD, Rosales R, Tidey JW, Denlinger-Apte RL, Sokolovsky AW, Colby SM, Cassidy RN. Racial/ethnic differences in the acute effects of reduced nicotine content cigarettes among adolescents who smoke. Addict Behav 2024; 160:108147. [PMID: 39243729 DOI: 10.1016/j.addbeh.2024.108147] [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: 02/19/2024] [Revised: 08/12/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Reducing the nicotine content in cigarettes decreases their addictiveness and abuse liability, including among adolescents. Whether these effects differ by race/ethnicity is unknown. This study is a secondary analysis of previously published data collected between 2014-2017. We examined racial/ethnic differences in the effects of smoking cigarettes with varying nicotine content levels on subjective effects and tobacco withdrawal among adolescents who smoke daily. METHODS Across two counterbalanced sessions, 50 adolescents recruited from Rhode Island (ages 15-19; 30 % Underrepresented Minorities [URM], 20 % Asians and Pacific Islanders [API]; 50 % Non-Hispanic Whites) self-administered a very low nicotine content (VLNC; 0.4 mg nicotine/g of tobacco) or normal nicotine content control (NNC; 15.8 mg/g) research cigarette following overnight abstinence. Subjective effects were reported post-administration and tobacco withdrawal outcomes were calculated from pre- to post-administration scores. Multilevel linear models tested main and interactive effects between cigarette nicotine content and race/ethnicity on all study outcomes. RESULTS Participants reported lower positive subjective effects and reductions in smoking urges after smoking a VLNC cigarette relative to smoking an NNC cigarette (ps < 0.01). A main effect of race/ethnicity emerged, such that API (vs. URM and White) adolescents reported lower positive subjective effects, greater craving reduction, and higher cigarette aversion after smoking, regardless of nicotine content (ps < 0.05). Significant interactions were found between race/ethnicity and nicotine content for cigarette aversion, such that API adolescents rated VLNC (vs. NNC) cigarettes as less aversive than White and URM adolescents did (p = 0.03). CONCLUSIONS Findings provide evidence that VLNC cigarettes may reduce abuse liability and tobacco withdrawal symptoms for adolescents across racial/ethnic groups and particularly for API youth.
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Affiliation(s)
- Mariel S Bello
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Crystal X Wang
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | | | - Robert Rosales
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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Morean ME, Davis DR, Kong G, Bold KW, Talley A, Krishnan-Sarin S. Psychometric evaluation of the Self-Report Habit Index for assessing habitual e-cigarette use behavior in high school adolescents. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100251. [PMID: 39050698 PMCID: PMC11267024 DOI: 10.1016/j.dadr.2024.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/02/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024]
Abstract
Background E-cigarettes are the most-used nicotine product among adolescents, but limited psychometrically-sound, e-cigarette-relevant measures exist for adolescents. We examined psychometric properties of the Self-Report Habit Index (SRHI) for assessing adolescents' habitual e-cigarette use. Methods During Fall 2022, 4855 students from eight Connecticut high schools completed an anonymous survey. The analytic sample comprised 491 students who reported past-month e-cigarette use and completed the SRHI (Age M=15.94, SD=1.24 years, 56 % female, 37.1 % Hispanic, 57.6 % White). We examined the SRHI's latent factor structure; internal reliability; measurement invariance and between-groups differences (e.g., nicotine vs. nicotine-free vaping); and associations with total e-cigarette flavors used in the past month, past-30-day vaping frequency, and e-cigarette dependence. Results The SRHI's 6-item, 1-factor structure was confirmed. Internal reliability was excellent. The SRHI was scalar invariant for all subgroups tested. Nicotine (vs. nicotine-free) and daily (vs. non-daily) e-cigarette use were associated with greater habitual e-cigarette use behavior. In adjusted models, habitual e-cigarette use was associated with using more e-cigarette flavors, vaping more frequently, and greater e-cigarette dependence. Habitual e-cigarette use incrementally accounted for variance in past-month flavors used and vaping frequency beyond dependence. Conclusions The SRHI evidenced solid psychometric properties for assessing habitual e-cigarette use behavior among high school students. Relationships between habitual use and frequency of use, e-cigarette flavors, and dependence might be expected as these constructs are associated with the three characterizing features of habitual behaviors: frequent repetition, cue-driven elicitation, and automaticity. Future prospective research can clarify the temporal ordering of habitual e-cigarette use and dependence in adolescents.
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Affiliation(s)
- Meghan E. Morean
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, United States
| | - Danielle R. Davis
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, United States
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, United States
| | - Krysten W. Bold
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, United States
| | - Amelia Talley
- Department of Psychological Sciences, Texas Tech University, 2810 18th St, Lubbock, TX 79410, United States
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, United States
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11
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Zheng X, Li W, Li R, Yang M, Lin HC. Exposure to user-generated e-cigarette content on social media associated with greater vulnerability to e-cigarette use among youth non-users. Addict Behav 2024; 156:108061. [PMID: 38744213 DOI: 10.1016/j.addbeh.2024.108061] [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: 01/30/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Social media are important venues for youth's exposure to e-cigarette content. This study examined how exposure to user-generated e-cigarette content (i.e., content created and shared by individual social media users) is associated with vulnerabilities to e-cigarette use among youth non-users. METHODS We pooled data from the 2021 and 2022 National Youth Tobacco Survey. Youth who have never used e-cigarettes were included. Weighted linear and logistic regressions were conducted to examine how exposure to user-generated e-cigarette content (from real-life friends, online-only friends, and celebrities/influencers) on social media was associated with e-cigarette use vulnerabilities measured by perceived norms, perceived risk, and susceptibility of use, controlling for demographics, advertising exposure, and mental health conditions. Multiple imputations were performed to account for missing data. RESULTS Exposure to e-cigarette content on social media posted by real-life friends, online-only friends, and celebrities/influencers were associated with more positive descriptive norm (βs = 1.56, 0.37, and 0.35, respectively, all ps < .001), more positive injunctive norm (βs = 0.46, 0.19, and 0.10, respectively, all ps < .001), and higher odds of e-cigarette use susceptibility (ORs = 1.48, 1.50. 1.29, respectively, all ps < .001). Exposure to content posted by real-life and online-only friends were associated with reduced risk perception of e-cigarette use (β = -0.04, p < 0.05 and β = -0.07, p < 0.001). CONCLUSIONS Our study highlighted that friends and celebrities/influencers are important sources on social media that can influence youth non-users' vulnerabilities to e-cigarette use. Interventional messages communicated through friends and influencers on social media may in turn help reduce e-cigarette vulnerability among youth non-users.
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Affiliation(s)
- Xia Zheng
- School of Communication and Journalism, Stony Brook University, Stony Brook, NY, USA; The Alan Alda Center for Communicating Science, Stony Brook University, Stony Brook, NY, USA.
| | - Wenbo Li
- School of Communication and Journalism, Stony Brook University, Stony Brook, NY, USA; The Alan Alda Center for Communicating Science, Stony Brook University, Stony Brook, NY, USA
| | - Ruobing Li
- School of Communication and Journalism, Stony Brook University, Stony Brook, NY, USA; The Alan Alda Center for Communicating Science, Stony Brook University, Stony Brook, NY, USA
| | - Meng Yang
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
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12
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Adjei A, Wilkinson AV, Chen B, Mantey DS, Harrell MB. Does the time to nicotine dependence vary by internalizing symptoms for young people who use e-cigarettes? An analysis of the Population Assessment of Tobacco and Health (PATH) study, (Waves 1-5; 2013-2019). Addict Behav 2024; 156:108075. [PMID: 38810488 DOI: 10.1016/j.addbeh.2024.108075] [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: 12/22/2023] [Revised: 05/03/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To determine the relationship between past-year internalizing symptoms and the time to first report of signs of nicotine dependence among young people. METHODS Secondary analysis using data from the Population Assessment of Tobacco and Health (PATH) (Waves 1-5; 2013-2019). The study included 2,102 (N = 5,031,691) young people (age 12-23 years) who reported past-30-day (P30D) e-cigarette use in one or more waves. Kaplan Meier curves, stratified by past year internalizing symptoms were used to estimate the time to the first report of three nicotine dependence symptoms (i.e., use within 30 min of waking, cravings, and really needing to use) following the first P30D e-cigarette use. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios (AHR), comparing any past year internalizing symptoms to no past year internalizing symptoms. RESULTS We found no significant differences between past year internalizing symptoms and the time to the first report of cravings (AHR = 1.30, 95 % CI = 92-1.85), really needing to use (AHR = 1.31; 95 % CI = 0.92-1.89) and use within 30 min of waking for follow-up times 0-156 weeks (AHR = 0.84; 95 % CI = 0.55-1.30) and > 156 weeks (AHR = 0.41; 95 % CI = 0.04-4.67) respectively. CONCLUSION Past year internalizing symptoms did not modify the time to the first report of nicotine dependence among youth with P30D e-cigarette use. Further research is needed to understand how changing internalizing symptoms and e-cigarette use frequency influence nicotine dependence over time and, how this relationship impacts cessation behavior.
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Affiliation(s)
- Abigail Adjei
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Anna V Wilkinson
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Dale S Mantey
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth Houston), School of Public Health, Austin, TX, United States.
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Buettner-Schmidt K, Fraase KS, Barnacle M, Peltier A, Saarinen H, Maack B, Turrubiates N. A review of vaping's health effects, treatment, and policy implications: Nursing's call to action. Nurse Pract 2024; 49:36-47. [PMID: 39186124 PMCID: PMC11343445 DOI: 10.1097/01.npr.0000000000000221] [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: 08/27/2024]
Abstract
ABSTRACT The emergence and subsequent surge in popularity of electronic nicotine delivery systems (ENDS), especially among adolescents and young adults, have reshaped the landscape of tobacco consumption, including use patterns and beliefs as well as therapeutic approaches to the condition. The health implications of ENDS are a cause for concern among NPs, as they include severe nicotine dependence, mental health consequences, and adverse effects on respiratory and cardiac systems, among other issues. This article focuses on the health implications of vaping across the lifespan and emphasizes the need for NPs to evaluate ENDS use consistently across age groups and offer age-appropriate treatment within the clinical setting. Importantly, although vaping is prevalent among various age groups, most tobacco use, including vaping, begins and becomes established during adolescence. This back-to-school season therefore marks an ideal time for NPs to educate their pediatric patients, along with their parents or caregivers, about the widespread effects of vaping on health, and it also serves as a reminder to screen for the condition in adults, regardless of smoking history. To combat this trend on a larger scale, NPs can further advocate for community health by promoting youth prevention programs and supporting policy initiatives aimed at curbing ENDS use.
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14
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Orfin RH, Ramos Santiago JW, Decena Soriano R, Romero Acosta E, Bermudez D, Rodriguez YL, Li D, Rahman I, McIntosh S, Ossip DJ, Cupertino AP, Cartujano-Barrera F. Kick Vaping: Feasibility, acceptability, and preliminary impact of a vaping cessation text messaging intervention for Latino young adults. J Ethn Subst Abuse 2024:1-13. [PMID: 39196764 DOI: 10.1080/15332640.2024.2397422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
OBJECTIVE To assess the feasibility, acceptability, and preliminary impact of Kick Vaping among Latino young adults. METHODS Forty Latino young adults (ages 18 to 25) who were currently vaping received Kick Vaping, a vaping cessation text messaging intervention available in English and Spanish. Feasibility was measured by the eligibility, enrollment, and follow-up rates. Acceptability was measured by overall satisfaction with the intervention. Preliminary impact was measured by self-reported 7-day point prevalence abstinence and changes in self-efficacy. RESULTS Two hundred three individuals were identified, 61 were assessed for eligibility, and 55 were eligible. Forty individuals consented to participate and were enrolled in Kick Vaping. At baseline, most participants used disposable devices (70%), vaped daily (97.5%), had low (37.5%) or medium (35.0%) e-cigarette dependence, and had attempted to quit in the past year (72.5%). At Month 3, the follow-up rate was 90% (36/40). Treating those lost to follow-up as participants who continued vaping, 75% (30/40) of participants self-reported 7-day point prevalence abstinence. Self-efficacy mean scores significantly increased from 30.65 (SD 8.07) at baseline to 50.11 (SD 10.57) at follow-up (p < 0.01). Most participants (88.9%, 32/36) reported being satisfied/extremely satisfied with Kick Vaping. CONCLUSION It is feasible to recruit and retain Latino young adults in a vaping cessation text messaging intervention. Kick Vaping generated high satisfaction among Latino young adults, significantly increased self-efficacy, and resulted in a notable vaping cessation rate at Month 3. Additional testing in a randomized controlled trial is warranted to assess the efficacy of the intervention.
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Affiliation(s)
- Rafael H Orfin
- University of Rochester Medical Center, Rochester, New York
| | | | | | | | | | | | - Dongmei Li
- University of Rochester Medical Center, Rochester, New York
| | - Irfan Rahman
- University of Rochester Medical Center, Rochester, New York
| | - Scott McIntosh
- University of Rochester Medical Center, Rochester, New York
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15
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Silver NA, Kucherlapaty P, Bertrand A, Falk RN, Rath JM. Improving Enforcement Measures and Establishing Clear Criteria: A Content Analysis of Tobacco-Brand-Owned Instagram Accounts. Nicotine Tob Res 2024; 26:1175-1182. [PMID: 38470229 DOI: 10.1093/ntr/ntae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION This study examines limitations of the current regulatory framework for tobacco advertising on Instagram. We first investigate compliance with Food and Drug Administration (FDA) warning label requirements for posts by tobacco-owned accounts. Next, we examine the prevalence of content that has been restricted in broadcast or print for its youth appeal, followed by content meeting more expansive criteria for youth appeal set forth in the FDA's guidance document. AIMS AND METHODS Posts by tobacco-brand-owned accounts between January 1, 2021, and February 14, 2022, were sampled from Mintel's Comperemedia Omni database. Instagram posts from 15 accounts were examined for violations of FDA warning label requirements and content that has been restricted on other mediums, including cartoons, sports branding, unauthorized claims, and young models (N = 1243). Finally, a subsample of n = 453 unambiguously branded posts was coded for themes that met the FDA's criteria of resonating with younger audiences, particularly that "adolescents rely on external information as they seek to shape their own identities." RESULTS Only 12.8% of posts had fully compliant warning labels. Content that has been in some way regulated on other mediums, such as cartoons (1.6%), unauthorized health claims (<1%), sports branding (<1%), and young models (4.4%) were infrequent. However, a conservative analysis focusing only on branded posts found that posts frequently highlighted tech elements (45%), device customizability (24.5%), vaper identity (17.7%), stylized product photography (33.6%), social media engagement (32.2%), and memes (5.7%). CONCLUSIONS Enforcement of existing regulations on Instagram is minimal. Explicit content restrictions applying evidence-based guidance on youth-appealing advertising are needed. IMPLICATIONS This research has important implications for enforcing and expanding advertising regulations on social media. First, Instagram's self-imposed regulations are ineffective, permitting tobacco companies to post ads from brand-owned accounts despite claiming to restrict tobacco promotion on the platform. Second, policymakers should seek to apply FDA guidance on youth-appealing advertising informed by decades of research to create explicit enforceable content restrictions that extend beyond cartoons, sports figures, and young models to include content likely to situate tobacco use within the developing self-concept of vulnerable youth such as presenting e-cigarettes as hi-tech devices, highlighting vaper identity, or infiltrating online social media culture. Finally, greater resources for enforcement are needed given the only applicable regulation, warning labels, remains largely ignored.
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Affiliation(s)
| | | | | | - Robert N Falk
- Truth Initiative Schroeder Institute®, Washington, DC, USA
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16
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Quisenberry AJ, Osborn CC, Pike Moore S, Schneller L, John L, Klein EG, Trapl E. ENDS function as a complement for cigarillos in sexual and gender minority young adult women. Nicotine Tob Res 2024:ntae197. [PMID: 39159047 DOI: 10.1093/ntr/ntae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Cigarillos are the second most used tobacco product among younger populations. The highest prevalence of use of cigars is among sexual and gender minority (SGM) women. Policy interventions like flavor bans and the availability of alternative tobacco products may have a disparate effect. METHODS The current study utilized an online store analog, The Experimental Tobacco Marketplace (ETM), to investigate the effects of cigarillo and ENDS flavor bans on tobacco product purchasing. SGM (n=72) and cisgender heterosexual (Cis-Het; n =46) women viewed conditions in which cigarillo flavors were available or unavailable and ENDS flavors available or unavailable and the interaction between the two. Mixed models were conducted on each dependent variable with condition, price, and SGM identity as predictors and nicotine dependence, annual income, and race/ethnicity as covariates. Simple linear regressions were performed to determine the substitution profile for each tobacco product. Condition showed no effect. RESULTS We found a main effect of price on cigarillo purchasing and a main effect of SGM identity in which SGM women purchased more ENDS than CisHet women. A complementary association between cigarillos and ENDS in which ENDS purchasing decreased as cigarillo purchasing decreased was found. This association was irrespective of flavor ban conditions and among SGM women only. CONCLUSIONS These results suggest that flavor availability of cigarillos and ENDS may not influence women who use cigarillos to move to another tobacco product and that women SGM cigarillo users are not likely to substitute their cigarillo smoking behavior with ENDS. IMPLICATIONS The results of this study suggest that SGM women are not likely to quit using cigarillos if flavors are removed from the market and instead will use unflavored products. Substituting their cigarillo use with ENDS does not appear likely given the complementary relation found between cigarillos and ENDS. The substitution patterns found for cigarettes and ENDS are not found for cigarillos and ENDS among young adult women who use cigarillos, further demonstrating the need for research on the conditions in which people who use cigarillos will decrease consumption or switch to a potentially less harmful product.
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Affiliation(s)
- Amanda J Quisenberry
- Assistant Professor of Oncology, Assistant Member, Department of Health Behavior, Carlton House A-408, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Catherine C Osborn
- Project Manager, CFLASH, Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Avenue, Room 447, Cleveland, OH
| | - Stephanie Pike Moore
- Research Scientist, Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Avenue, Room 452, Cleveland, OH
| | - Liane Schneller
- HRI Scientist, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lovina John
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elizabeth G Klein
- Professor, Heath Behavior and Health Promotion, The Ohio State University, 1841 Neil Avenue, 358 Cunz Hall, Columbus, OH
| | - Erika Trapl
- Professor, Dept. of Population and Quantitative Health Sciences, Director, Prevention Research Center for Healthy Neighborhoods, Associate Director of Community Outreach and Engagement, Case Comprehensive Cancer Center, Case Western Reserve University, 11000 Cedar Ave., BioEnterprise, Room 445, Cleveland, Ohio
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17
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Jeon J, He X, Shinde A, Meister M, Barnett L, Zhang Q, Black M, Shannahan J, Wright C. The role of puff volume in vaping emissions, inhalation risks, and metabolic perturbations: a pilot study. Sci Rep 2024; 14:18949. [PMID: 39147784 PMCID: PMC11327287 DOI: 10.1038/s41598-024-69985-1] [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: 06/06/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024] Open
Abstract
Secondhand vaping exposure is an emerging public health concern that remains understudied. In this study, saliva and exhaled emissions from ENDS users (secondhand) and non-ENDS users (baseline) were collected, firsthand emissions were generated using an automated ENDS aerosol generation system programmed to simulate puffing topography profiles collected from ENDS users. Particulate concentrations and sizes along with volatile organic compounds were characterized. We revealed puffing topography metrics as potential mediators of firsthand and secondhand particle and chemical exposures, as well as metabolic and respiratory health outcomes. Particle deposition modeling revealed that while secondhand emissions displayed smaller deposited mass, total and pulmonary particle deposition fractions were higher than firsthand deposition levels, possibly due to smaller secondhand emission particle diameters. Lastly, untargeted metabolomic profiling of salivary biomarkers of lung injury due to firsthand ENDS exposures revealed potential early indicators of respiratory distress that may also be relevant in bystanders exposed to secondhand vaping scenarios. By leveraging system toxicology, we identified 10 metabolites, including leukotriene D4, that could potentially serve as biomarkers for ENDS use, exposure estimation, and the prediction of vaping-related disease. This study highlights characterization of vaping behavior is an important exposure component in advancing our understanding of potential health effects in ENDS users and bystanders.
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Affiliation(s)
- Jennifer Jeon
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Xiaojia He
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Akshada Shinde
- School of Health Sciences, Purdue University, West Lafayette, IN, 47907, USA
| | - Maureen Meister
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Lillie Barnett
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Qian Zhang
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Marilyn Black
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Jonathan Shannahan
- School of Health Sciences, Purdue University, West Lafayette, IN, 47907, USA.
| | - Christa Wright
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA.
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Jones SK, Benton ML, Wolf BJ, Barth J, Green R, Dolan SL. Neurocognitive Latent Factors Associate With Early Tobacco and Alcohol Use Among Adolescent Brain Cognitive Development Study Youth. J Adolesc Health 2024:S1054-139X(24)00300-8. [PMID: 39140930 DOI: 10.1016/j.jadohealth.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Prospective associations between preadolescent neurocognitive structure and onset of substance use in adolescence have not been examined. This study investigated associations between cognitive structure among youth aged 9 - 10 years and the likelihood of experimentation with tobacco and alcohol by ages 13-14 years. METHODS A principal component (PC) analysis of nine neurocognitive assessments was used to identify the cognitive structure of unrelated adolescent brain cognitive development study participants (n = 9,655). We modeled associations between neurocognitive PCs and odds of tobacco or alcohol use by ages 13-14 years using generalized linear mixed models with a logit link and random intercept for recruitment sites. Demographics, family conflict, neighborhood safety, and externalizing and internalizing behavior were considered covariates. RESULTS Four neurocognitive PCs were identified and labeled general ability, executive function, learning and memory, and mental rotation. Mental rotation [odds ratio [OR] = 0.88, p-value = .013] was associated with lower odds of youth tobacco use; the association was stronger among female youth. General ability [OR = 1.20, p-value < .0001] among both males and females, and learning and memory [OR = 1.11, p-value = .024] among females, were associated with increased odds of youth alcohol use. DISCUSSION Among youth, higher neurocognitive performance was protective for tobacco use but increased the likelihood of alcohol use. Potential sex differences were identified. The role of cognition in processing the social contexts surrounding tobacco and alcohol use in the United States may contribute to the formation of disparate youth expectancies for tobacco and alcohol use.
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Affiliation(s)
| | | | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jackson Barth
- Department of Statistical Science, Baylor University, Waco, Texas
| | - ReJoyce Green
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sara L Dolan
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas
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Morgil GK, Çok İ. Evaluation and comparison of DNA alkylation and oxidative damage in e-cigarette and heated tobacco users. Toxicol Mech Methods 2024:1-11. [PMID: 39138671 DOI: 10.1080/15376516.2024.2390028] [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: 05/02/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES This study, aimed to determine and compare DNA damage in e-cigarette and HTP (IQOS) users by assessing DNA-adducts, which are biomarkers of various DNA alkylation and oxidation. METHODS For the evaluation of DNA alkylation, N3-Ethyladenine (N3-EtA) and N3-Methyladenine (N3-MeA) adducts were used. DNA oxidation was assessed using, 8-hydroxy-2'-deoxyguanosine(8-OHdG). The urinary cotinine, N3-MeA, N3-EtA, and 8-OHdG concentrations of the cigarette smokers (n:39), e-cigarette users (n:28), IQOS users (n:20), passive smokers (n:32), and nonsmokers(n:41) who lived Ankara, Turkiye were determined using, liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS In light of the detected 8-OHdG levels, e-cigarette (3.19 ng/g creatinine) and IQOS (4.38 ng/g creatinine) users had higher oxidative DNA damage than healthy nonsmokers (2.51 ng/g creatinine). Alkylated DNA-adducts were identified in the urine of e-cigarette (N3-MeA: 3.92 ng/g creatinine; N3-EtA: 0.23 ng/g creatinine) and IQOS (N3-MeA: 7.54 ng/g creatinine; N3-EtA: 0.29 ng/g creatinine) users. In the generation of N3-MeA adducts, a significant difference was found between IQOS users and e-cigarette users (p < 0.05). Also, DNA alkylation in flavored e-cigarette users (N3-MeA: 4.51 ng/g creatinine; N3-EtA: 0.27 ng/g creatinine) was higher than in non-flavored e-cigarette users (N3-MeA: 2.27 ng/g creatinine; N3-EtA: 0.06 ng/g creatinine). The highest cotinine levels were found in cigarette smokers (16.1316 ng/g creatinine). No significant difference was found when e-cigarette (1163.02 ng/g creatinine) and IQOS smokers were compared (1088.3 ng/g creatinine). CONCLUSION People who use e-cigarettes and IQOS may be at higher risk of genotoxicity than those who do not use and are not exposed to any tobacco products. Furthermore, the usage of flavoring additives in e-cigarettes contributed to additional genotoxic damage risks.
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Affiliation(s)
- Göksel Koç Morgil
- Minister of Health, General Directorate of Public Health, Department of Consumer Safety and Public Health Laboratories, Toxicology Laboratory, Sıhhıye, Ankara, Türkiye
| | - İsmet Çok
- Faculty of Pharmacy, Department of Toxicology, Gazi University, Ankara, Turkiye
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20
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Williams BS, Kaye JT. Addressing Substance Use in the Adolescent Transplant Population. Pediatr Transplant 2024; 28:e14815. [PMID: 38924242 DOI: 10.1111/petr.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Adolescence is a unique period of physical and psychosocial changes as youth transition, over many years, to adulthood. The psychosocial changes that accompany adolescence include emotional separation from parents, greater influence of peer groups, an interest in self-identification and autonomy, and increased risk-taking behaviors. Substance use is a common form of risk-taking behavior in the adolescent developmental stage. Alcohol, nicotine, and cannabis are the most common types of substances used in the United States. In the adolescent transplant population, rates of substance use appear to be at, or slightly below, their peer counterparts. Substance use can lead to deleterious health outcomes for adolescent transplant patients as a result of impaired decision-making, reduction in medication and clinic visit compliance, increases in mental health disorders, and risk for developing dependence and a substance use disorder. Given the close relationship that many pediatric transplant providers have with their patients and families, transplant care teams are in an excellent position to help their patients by addressing adolescent substance use. This narrative review describes how providers can use proactive standardized approaches to identify and intervene with substance use behavior.
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Affiliation(s)
- Brian S Williams
- Division of Hospital Medicine and Complex Care, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jesse T Kaye
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Mattingly DT, Agbonlahor O, Richardson M, Rayens MK, Rose SW, Hart JL. Factors associated with disposable electronic cigarette use among US youth: A national repeated cross-sectional study, 2021-22. Addiction 2024. [PMID: 39044259 DOI: 10.1111/add.16628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND AIMS Disposable electronic cigarette (e-cigarette) use is becoming more popular among US youth, given the shifting landscape in product marketing, availability and regulation. This study aimed to estimate the prevalence of and test factors associated with the most used e-cigarette product (disposable versus other) among US youth aged 9-18 years who currently use e-cigarettes. DESIGN, SETTING AND PARTICIPANTS This was an observational study using cross-sectional data from the US-based 2021 and 2022 National Youth Tobacco Surveys (n = 48 704). We restricted our analytical sample to youth who currently use e-cigarettes (n = 4137). The sample ranged from 9 to 18 years old and was 53.0% female. MEASUREMENTS We dichotomized e-cigarette device type to disposable versus all other types (e.g. refillable pods/cartridges). We conducted logistic regression to estimate whether age, sex, race/ethnicity, sexual orientation, frequency of e-cigarette use, nicotine vaping, flavored e-cigarette use and current combustible/non-combustible tobacco use were associated with disposable e-cigarette use, compared with other e-cigarette use. FINDINGS Among youth who currently use e-cigarettes, 54.5% used disposable e-cigarettes. Older age (17-18 years), relative to younger age (9-14 years) [odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.07-1.91], non-Hispanic Black (versus non-Hispanic White) race/ethnicity (OR = 1.47, 95% CI = 1.01-2.15), any nicotine (versus non-nicotine) vaping (OR = 2.51, 95% CI = 1.96-3.23) and flavored (versus non-flavored) e-cigarette use (OR = 1.93, 95% CI = 1.46-2.56) were associated with increased odds of mainly using disposable e-cigarettes, compared with using other e-cigarette products, whereas current combustible tobacco use (versus non-current) (OR = 0.65, 95% CI = 0.53-0.80) and current non-combustible tobacco use (versus non-current) (OR = 0.58, 95% CI = 0.43-0.78) were associated with lower odds. CONCLUSION Disposable e-cigarettes appear to be the most used type of e-cigarette product among US youth. Older age, non-Hispanic Black race/ethnicity, nicotine vaping and flavored e-cigarette use are associated with mainly using disposable e-cigarettes, relative to other e-cigarette products.
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Affiliation(s)
- Delvon T Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Osayande Agbonlahor
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Maggie Richardson
- Department of Educational, School, and Counseling Psychology, College of Education, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Shyanika W Rose
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Joy L Hart
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
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22
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Zhao X, Malterud A, Curry L, Malo V, MacMonegle A, Nonnemaker J, Allen J. Promising Themes for Electronic Cigarette Prevention Campaigns for Youth and Young Adults. Nicotine Tob Res 2024; 26:999-1006. [PMID: 38302084 DOI: 10.1093/ntr/ntae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/10/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) are the most widely used tobacco product by youth and young adults in the United States. Effective prevention campaigns require the identification of appropriate content focus for message construction. AIMS AND METHODS A sample of 2622 youth and young adults ages 15-24 were recruited through social media advertisements and completed an online survey. Respondents reported current e-cigarette use or intention to use if not currently using. They also indicated agreement or disagreement with 75 e-cigarette-related beliefs representing 16 themes. The relative promise of each theme/belief for campaign messaging was investigated by examining its association with the behavior/intention outcomes and the opportunity for positive change in its distribution (room to move). RESULTS All themes showed significant associations with the behavior (ORs = 2.49-19.04) and intention (ORs = 2.21-6.11) outcomes. Room to move for themes ranged from 32.9% to 96.3% in behavior analysis and 15.6-93.9% in intention analysis. A normed relative promise index (M = 50, SD = 17) showed flavors (72), comparison to cigarettes (69), and relaxation and mental health (68) as the top ranked themes. Subgroup analyses by demographics revealed few differences. Results on the belief level were largely consistent with those on the theme level. CONCLUSIONS Data from this study provide timely evidence for the relative value of various themes/beliefs as potential targets for message development in e-cigarette prevention campaigns. The final selection of target themes/beliefs requires consideration of openness to persuasion, which may be informed by additional testing. IMPLICATIONS Electronic cigarettes (e-cigarettes) are the most widely used tobacco products among youth and young adults in the United States. This study adds new evidence on the relative promise of a wide range of e-cigarette beliefs and belief clusters (themes) as potential targets for message development in educational campaigns. This evidence is important to consider in future campaign efforts directed at the youth and young adult populations in the United States.
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Affiliation(s)
- Xiaoquan Zhao
- Center for Tobacco Products, Food & Drug Administration, Silver Spring, MD, USA
- Department of Communication, George Mason University, Fairfax, VA, USA
| | - Andie Malterud
- Center for Tobacco Products, Food & Drug Administration, Silver Spring, MD, USA
| | - Laurel Curry
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Jane Allen
- RTI International, Research Triangle Park, NC, USA
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23
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Kelsh S, Young M, Ottney A, Sohn M, Kelly M. Impact of tobacco education on pharmacy students' perceptions of electronic nicotine delivery systems. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:102158. [PMID: 39033561 DOI: 10.1016/j.cptl.2024.102158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/21/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Describe how receiving tobacco education within the PharmD curriculum affects 1) students' perceptions and knowledge of electronic nicotine delivery systems (ENDS) and 2) willingness to counsel on cessation. METHODS Eight institutions used a 29-item questionnaire to assess P1-P4 students' tobacco use, ENDS knowledge, cessation education, and perceptions in the fall of 2020. Students were divided into those who had received tobacco cessation education and those who had not. RESULTS 832 pharmacy students participated in the study with a 28% response rate. 56% of respondents were reported as receiving at least some tobacco education in the pharmacy curriculum. Quitting other forms of tobacco was the only perceived benefit of ENDS that was statistically different between groups. Tobacco education was associated with a greater likelihood of identifying localized harms of ENDS, including explosion/burns and mouth/throat irritation. Those with tobacco education were more likely to agree they received enough education to counsel on smoking cessation and were more likely to agree they are willing to counsel patients on quitting. Tobacco education was associated with an increased willingness to offer smoking cessation (OR 1.56; 95% CI 1.14-2.13) but not more willing to offer ENDS cessation (0.85; 0.58-1.24). Personal history of combustible cigarette use was associated with increased willingness to counsel on both smoking (2.45; 1.27-4.73) and ENDS (2.79; 1.38-5.64) cessation. CONCLUSION Tobacco education in the pharmacy curriculum was associated with an increased likelihood of recognizing localized harms of ENDS and willingness to offer smoking cessation counseling but did not increase willingness to offer ENDS cessation counseling.
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Affiliation(s)
- Shelby Kelsh
- Pharmacy Practice, Ferris State University, College of Pharmacy, 25 Michigan St NE, Ste 7000, Grand Rapids, MI 49503, United States of America.
| | - Mark Young
- Pharmaceutical Sciences, Ferris State University, College of Pharmacy, 220 Ferris Dr, Big Rapids, MI 49307, United States of America.
| | - Anne Ottney
- Pharmacy Practice, Ferris State University, College of Pharmacy, 25 Michigan St NE, Ste 7000, Grand Rapids, MI 49503, United States of America.
| | - Minji Sohn
- Pharmaceutical Sciences, Ferris State University, College of Pharmacy, 220 Ferris Dr, Big Rapids, MI 49307, United States of America.
| | - Michelle Kelly
- Pharmaceutical Sciences, Ferris State University, College of Pharmacy, 220 Ferris Dr, Big Rapids, MI 49307, United States of America.
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24
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Do EK, Tulsiani S, Koris K, Hair EC. Tobacco and Nicotine Product Use Transitions by Race and Ethnicity: Results from a Latent Transition Analysis Using Data from the Truth Longitudinal Cohort (2020-2022). Subst Use Misuse 2024; 59:1770-1777. [PMID: 38963130 DOI: 10.1080/10826084.2024.2374974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigars, and cigarillos (LCCs) over time and determine whether patterns differ by race and ethnicity. METHODS Data was obtained from the Truth Longitudinal Cohort of youth and young adults between September 2020 and June 2022. Latent class and transition analyses were used to classify participants (N = 4448) into subgroups, based on frequency of tobacco product use in the past 30 days, and to estimate the probability of use pattern transitions by race and ethnicity, adjusted for the effects of gender, financial situation, parental education, household tobacco use, and sensation seeking. RESULTS Four latent classes were identified: former/noncurrent users, predominantly frequent to daily (FTD) e-cigarette users, predominantly FTD e-cigarette and LCC users, and predominantly FTD cigarette with polytobacco users. Use trajectories differed by race and ethnicity. A lower proportion of those who identified as non-Hispanic Black (60.0%) remained e-cigarette and LCC users, relative to those who identified as non-Hispanic White (86.0%), Hispanic or Latino (86.0%), and another race and ethnicity (79.0%). A lower proportion of those who identified as Hispanic or Latino (54.0%) and another race and ethnicity (59.9%) remained cigarette with polytobacco users, relative to those who identified as non-Hispanic White (76.0%) and non-Hispanic Black (72.0%). A greater proportion of non-Hispanic Black respondents transitioned from e-cigarette and LCC user to former/noncurrent user (40.0%) and polytobacco user to e-cigarette and LCC user (11.0%), relative to other racial/ethnic groups. CONCLUSION More research is needed to determine why tobacco use trajectories differ by race and ethnicity. Such research will be important in informing comprehensive approaches that promote evidence-based prevention policies and programs.
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Affiliation(s)
- Elizabeth K Do
- Truth Initiative, Schroeder Institute, Washington, DC, USA
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Elizabeth C Hair
- Truth Initiative, Schroeder Institute, Washington, DC, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Global Public Health, New York University, New York, New York, USA
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25
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Selya A, Ruggieri M, Polosa R. Measures of youth e-cigarette use: strengths, weaknesses and recommendations. Front Public Health 2024; 12:1412406. [PMID: 39015391 PMCID: PMC11250581 DOI: 10.3389/fpubh.2024.1412406] [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: 04/04/2024] [Accepted: 05/31/2024] [Indexed: 07/18/2024] Open
Abstract
This perspective discusses how to best define "e-cigarette use" among youth in a way that is relevant to individual and human health. Commonly-used definitions of youth e-cigarette use have been adapted from measures validated for tobacco cigarette smoking among adults, but may not carry the same meaning for a different product (with a much lower risk profile and very different patterns of use) and a different population (whose use is more often transient and experimental, rather than frequent and persistent). We discuss strengths and weaknesses of different definitions, and recommend improvements in defining youth e-cigarette use. We find that current literature employs a range of definitions of e-cigarette use, from lifetime use ("even a puff") to daily use. More lenient measures capture more potentially at-risk youth, but much of this is transient experimentation that has negligible risks in and itself, if not persistent. More stringent measures such as daily use are more relevant to individual and public health. Future research should examine possible improvements to definitions which include intensity of use (e.g., number of puffs per day) and persistence/duration of use, either via self-report or technology-assisted data capture.
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Affiliation(s)
- Arielle Selya
- PinneyAssociates, Inc., Pittsburgh, PA, United States
| | - Martino Ruggieri
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy
- Unit of Pediatric Clinic, AOU “Policlinico”, PO “G. Rodolico”, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
| | - Riccardo Polosa
- Unit of Pediatric Clinic, AOU “Policlinico”, PO “G. Rodolico”, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
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26
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Wilhelm AK, Evans MD, Xiong Z, Ortega L, Vock DM, Maruyama G, Allen ML. School Connectedness and Adolescent E-cigarette Susceptibility in an Urban Sample of Middle and High School Students. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:724-733. [PMID: 38244166 DOI: 10.1007/s11121-024-01643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
Adolescent school connectedness generally protects from risk behaviors such as tobacco use; however, its relationship to e-cigarette use is unclear. This study examines the relationship between adolescent school connectedness and e-cigarette susceptibility in a diverse longitudinal sample. This secondary analysis of a school-based intervention surveyed 608 middle (66%) and high school (34%) students from 10 schools at 3 time points over 1 year. At baseline, respondents had a mean age of 14 years, 54% were female, and 71% were BIPOC (Black, Indigenous, People of Color). Logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and e-cigarette susceptibility over time. E-cigarettes represented the most prevalent form of current nicotine-containing product use in spring 2019 (2.3%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility remained relatively stable during the study. Higher baseline school connectedness levels were associated with lower odds of e-cigarette susceptibility over time. Similarly, higher concurrent school connectedness scores were associated with lower odds of e-cigarette susceptibility over time: spring 2019 (OR, 0.39; 95% CI, 0.32, 0.47), fall 2019 (OR, 0.49; 95% CI, 0.34, 0.72), and spring 2020 (OR, 0.64; 95% CI, 0.47, 0.87). Findings were similar for middle and high school students and did not differ significantly after adjusting for other covariates. Adolescents' school connectedness appears to protect from e-cigarette susceptibility over time, underscoring the importance of promoting positive school experiences to reduce adolescent risk e-cigarette use.
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Affiliation(s)
- April K Wilhelm
- Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota Health, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Michael D Evans
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Health, Minneapolis, USA
| | - Zong Xiong
- Department of Biochemistry, Molecular Biology, and Biophysics, College of Biological Sciences, University of Minnesota Twin Cities, Minneapolis, USA
| | - Luis Ortega
- SoLaHmo Partnership for Health and Wellness, Inc, Community University Health Care Center, Minneapolis, USA
| | - David M Vock
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Health, Minneapolis, USA
- Division of Biostatistics, School of Public Health, University of Minnesota Health, Minneapolis, USA
| | - Geoffrey Maruyama
- Department of Educational Psychology, College of Education and Human Development, University of Minnesota Twin Cities, Minneapolis, USA
| | - Michele L Allen
- Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota Health, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
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27
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Bold KW, Kong G, O'Malley SS. The Scientific Basis for the Regulation of Flavors in Tobacco Products. Annu Rev Clin Psychol 2024; 20:381-406. [PMID: 38346292 PMCID: PMC11446566 DOI: 10.1146/annurev-clinpsy-080921-075624] [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: 02/15/2024]
Abstract
Effective tobacco policies are important for reducing the harm of tobacco use and can have a broad impact at the population level. This review provides an overview of how clinical science can inform tobacco policies with a focus on policies related to flavored tobacco products, using menthol cigarettes as an illustrative example. Specifically, this review summarizes the role of flavors in tobacco use and the history of regulation of flavored tobacco products by the US Food and Drug Administration (FDA), provides an overview of clinical research methods used to contribute to the scientific evidence to inform FDA tobacco policies, discusses key findings related to menthol tobacco products using these methods, and proposes future directions for clinical research. As the tobacco marketplace continues to evolve with new products and flavor chemicals, ongoing clinical science will be essential for establishing evidence-based policies to protect public health and reduce tobacco-related health disparities.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA;
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Grace Kong
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA;
| | - Stephanie S O'Malley
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA;
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28
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Kverno K. Harm Reduction in Psychiatric Settings. J Psychosoc Nurs Ment Health Serv 2024; 62:7-10. [PMID: 38976858 DOI: 10.3928/02793695-20240619-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Public health announcements, the White House, and other government and private agencies have made progress in reducing the stigma associated with substance use disorders, and more Americans are seeking treatment. Yet only a small percentage of persons seeking treatment are receiving care. Many resources are now available to help nurse practitioners use a harm reduction approach to helping people understand their options and make choices. Harm reduction includes offering U.S. Food and Drug Administration-approved medications for treatment of tobacco use disorder, alcohol use disorder, and opioid use disorder. Drug mechanisms for acute and maintenance treatment are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 7-10.].
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29
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Travis N, Warner KE, Goniewicz ML, Oh H, Ranganathan R, Meza R, Hartmann-Boyce J, Levy DT. The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review. Nicotine Tob Res 2024:ntae131. [PMID: 38880491 DOI: 10.1093/ntr/ntae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Oral nicotine pouches (ONPs) are a new class of nicotine products. This scoping review summarizes evidence on ONPs and explores their potential public health impact. AIMS AND METHODS We conducted a structured literature search for empirical studies across three electronic databases through January 10, 2024. Outcomes included ONP product characteristics, use patterns, beliefs and perceptions, toxicity, and marketing and sales. RESULTS Sixty-two studies were included, 17 were industry-funded. Most studies were from the United States. While large variations across studies were observed in ONP youth prevalence estimates, nationally representative U.S. studies find current use at 1.5% and lifetime use below 2.5% through 2023. Between 35% and 42% of U.S. adolescents and young adults have heard of ONPs, and 9-21% of tobacco-naïve youth were susceptible to trying them. U.S. adult-use estimates varied widely (0.8%-3% current; 3%-16% lifetime use) and were limited to populations with a history of tobacco use. The chemical composition of ONPs suggests fewer harmful/potentially harmful compounds at lower levels than cigarettes and smokeless tobacco (SLT), except formaldehyde. Industry-funded studies find substantially less cytotoxicity compared to cigarettes and suggest that higher nicotine-strength ONPs can deliver nicotine at levels comparable to or higher than SLT or cigarettes, although with slower nicotine release than cigarettes. Evidence on the cytotoxicity of ONPs relative to SLT is mixed. CONCLUSIONS ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users, although key data are mainly available from industry-funded studies. Data from independent research is critically needed. Industry marketing of ONPs may encourage initiation in youth and situational and dual use in adults. IMPLICATIONS The review provides an initial assessment of the potential role of ONPs in harm reduction and aims to determine unintended consequences of their use (youth uptake and dual-use) and identify populations that disproportionately use the product. This information is essential for tobacco regulatory bodies in determining the net public health impact of nicotine pouches.
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Affiliation(s)
- Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
| | - Kenneth E Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
| | - Radhika Ranganathan
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC, USA
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30
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Sepulveda Inostroza EA, Bressane A, Schwarzmeier LÂT, Lacerda EB, Anjos KRD, Santos TSPD, Cavalcanti DR, Nascimento FD, Almeida JD, Oliveira Alves MG. Evaluation of micronuclei, cytomorphometric and cytologic changes of the oral mucosa in hookah and cigarette smokers. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:640-650. [PMID: 38692958 DOI: 10.1016/j.oooo.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/05/2023] [Accepted: 03/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To analyze the effect of hookah and cigarettes on the oral mucosa of smokers through the use of exfoliative cytology. STUDY DESIGN Smear samples were collected by exfoliative cytology from the tongue of 33 hookah smokers, 22 cigarette smokers, and 30 non-smokers. The selected analyses include micronuclei (MN), metanuclear anomalies, epithelial maturation, and cytomorphology (nuclear area [NA], cytoplasmic area [CA], and NA/CA ratio). RESULTS The largest differences observed for MN and metanuclear anomalies were between cigarette smokers and the control group (notably 1 MN P = .04; total cells with MN P = .039; total MN P = .042; karyorrhexis and binucleation, P = .0001). The hookah group, compared with the control group, showed the greatest differences for karyolysis (P = .0023), binucleation (P = .0003), and broken egg (P = .008). Significant differences were found between the smokers and the control groups regarding changes in the superficial cell without nucleus, perinuclear halo, vacuolization, color change, mucus, and keratohyalin granules. There was a significant increase in the NA and NA/CA ratio in the smoker groups. CONCLUSION This study showed that a combined analysis of exfoliative cytology associated with other diagnostic methods is a useful tool for studying oral carcinogenesis. Hookah and cigarettes showed similar effects in terms of displaying substantial cytogenetic and cytotoxic damage.
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Affiliation(s)
- Elvira Antonieta Sepulveda Inostroza
- Technology Research Center (NPT), Universidade Mogi das Cruzes, Mogi das Cruzes, Brazil; School of Dentistry, Universidade Mogi das Cruzes, Mogi das Cruzes, Brazil
| | - Adriano Bressane
- Department of Environmental Engineering, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | | | | | - Karine Rodrigues Dos Anjos
- Research Center for Lasers and Applications - Nuclear and Energy Research Institute (IPEN)/University of São Paulo (USP), São Paulo, Brazil
| | | | | | - Fábio Dupart Nascimento
- Department of Biochemistry, Molecular Biology Division, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Janete Dias Almeida
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Mônica Ghislaine Oliveira Alves
- Technology Research Center (NPT), Universidade Mogi das Cruzes, Mogi das Cruzes, Brazil; Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil.
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31
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Dove MS, Gee KA, Tong EK. Flavored Tobacco Sales Restrictions and Youth E-cigarette Behavior: Impact by Tobacco Retailer Density in Diverse Communities in California. Nicotine Tob Res 2024; 26:S65-S72. [PMID: 38817027 PMCID: PMC11140225 DOI: 10.1093/ntr/ntad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Factors that impact flavored tobacco sales restriction (flavor restrictions) effectiveness on youth e-cigarette behavior are unclear. Tobacco retailer density (retailer density) is a health equity issue with greater retailer density in high-minority, low-income areas. We examined the association between flavor restrictions and youth e-cigarette behavior by retailer density across diverse communities in the California Bay Area. AIMS AND METHODS We analyzed data from the California Healthy Kids Survey using a difference-in-differences (DID) strategy. We compared pre- and post-policy changes in e-cigarette access and use one-year post-implementation among high school students in the Bay Area with a flavor restriction (n = 20 832) versus without (n = 66 126). Separate analyses were conducted for students in cities with low and high retailer density, with a median cutoff of 3.3 tobacco retailers/square mile. RESULTS Students with high retailer density were more likely to identify as a minority and have parents with lower education. Among students with low retailer density, flavor restrictions were associated with 24% lower odds in the pre- to post-policy increase in ease of access relative to unexposed students (DID = 0.76, 95% CI: 0.58, 0.99). Among students with high retailer density, flavor restrictions were associated with 26% higher odds in ease of access (DID: 1.26, 95% CI: 1.02, 1.56) and 57% higher odds of current use (DID = 1.57, 95% CI: 1.31, 1.87). CONCLUSIONS Flavor restrictions had positive impacts on youth e-cigarette access in low, but not high retailer density cities. From a health equity perspective, our results underscore how flavor restrictions may have uneven effects among vulnerable groups. IMPLICATIONS In diverse communities in the California Bay Area, our results suggest a protective association between flavored tobacco sales restrictions and youth access to e-cigarettes in low, but not high tobacco retailer density cities one-year post-implementation. These results underscore how flavor restrictions may have uneven effects, and when implemented in high retailer density areas, may disproportionately place already vulnerable groups at heightened exposure to e-cigarette use and access. In high retailer density areas, additional tobacco control efforts may need to be included with flavor restriction implementation, such as increased education, youth prevention and cessation programs, policies to reduce tobacco retailer density, or stronger tobacco retailer enforcement or compliance monitoring.
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Affiliation(s)
- Melanie S Dove
- Department of Public Health Sciences, Division of Health Policy and Management, University of California, Davis, USA
| | - Kevin A Gee
- School of Education, University of California, Davis, USA
| | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, USA
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32
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Marshall LL, Norman L, Rose SW, Tseng TS. Preventing Chronic Disease Collection: From Data to Action: National, State, and Local Efforts to End Menthol and Other Flavored Commercial Tobacco Product Use. Prev Chronic Dis 2024; 21:E39. [PMID: 38815047 PMCID: PMC11155687 DOI: 10.5888/pcd21.240143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Affiliation(s)
- LaTisha L Marshall
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Centers for Disease Control and Prevention, Office on Smoking and Health, 4770 Buford Hwy NE, Mail Stop S107-7, Atlanta, GA 30341
| | - Leslie Norman
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shyanika W Rose
- University of Kentucky, College of Medicine, Behavioral Science and Center for Health Equity Transformation, Lexington, Kentucky
| | - Tung-Sung Tseng
- Louisiana State University Health Sciences Center, Behavioral and Community Health Sciences, School of Public Health, New Orleans, Louisiana
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Cornelius ME, Gentzke AS, Loretan CG, Hawkins NA, Jamal A. Use of Menthol-Flavored Tobacco Products Among US Middle and High School Students: National Youth Tobacco Survey, 2022. Prev Chronic Dis 2024; 21:E37. [PMID: 38815049 PMCID: PMC11155684 DOI: 10.5888/pcd21.230305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Introduction Menthol cigarettes have been associated with increased smoking initiation. Although numerous studies have focused on correlates of menthol cigarette smoking among youths, fewer studies have assessed the prevalence and correlates of overall menthol-flavored tobacco product use among middle and high school students. Methods We analyzed 2022 National Youth Tobacco Survey data to estimate the prevalence of menthol-flavored tobacco product use among US middle and high school students who used tobacco products within the past 30 days. Characteristics associated with menthol-flavored tobacco product use were also examined. Results Use of menthol-flavored tobacco products was reported by 23.8% of students who currently used any tobacco product and by 39.5% of students who currently used any flavored tobacco product. Among students who reported past 30-day use of a flavored tobacco product, characteristics associated with a higher prevalence of menthol-flavored tobacco product use included non-Hispanic White race and ethnicity, frequent tobacco product use, use of multiple tobacco products, wanting to use a tobacco product within the first 30 minutes of awakening, and craving tobacco products within the past 30 days. Conclusion Unlike results of prior research focused on cigarette smoking among young people, prevalence of use of any menthol-flavored tobacco product was highest among non-Hispanic White youths. Any use of menthol-flavored tobacco products of any type (alone or in combination with other flavors) among young people may be associated with continued product use and symptoms of dependence.
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Affiliation(s)
- Monica E Cornelius
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341
| | - Andrea S Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caitlin G Loretan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nikki A Hawkins
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahmed Jamal
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Brose LS, Reid JL, Robson D, McNeill A, Hammond D. Associations between vaping and self-reported respiratory symptoms in young people in Canada, England and the US. BMC Med 2024; 22:213. [PMID: 38807205 PMCID: PMC11134717 DOI: 10.1186/s12916-024-03428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Prevalence of youth nicotine vaping has increased, heightening concerns around negative health effects. This study aimed to compare self-reported respiratory symptoms among youth by vaping behaviours. METHODS Participants (n = 39,214) aged 16-19 from the 2020 and 2021 International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Surveys (Canada, England, US). Weighted multivariable logistic regression assessed associations between reporting any of five respiratory symptoms in the past week (shortness of breath, wheezing, chest pain, phlegm, cough) and: past 30-day smoking and/or vaping; lifetime/current vaping. Among past-30-day vapers (n = 4644), we assessed associations between symptoms and vaping frequency, use of nicotine salts, usual flavour and device type(s). RESULTS Overall, 27.8% reported experiencing any of the five respiratory symptoms. Compared with youth who had only vaped, those who had only smoked had similar odds of symptoms [adjusted odds ratio, OR (95% confidence interval, CI): 0.97 (0.85-1.10)], those who both smoked and vaped had higher odds [1.26 (1.12-1.42)], and those who had done neither, lower odds [0.67 (0.61-0.72)]. Compared with those who had never vaped, past use, experimentation and current regular or occasional use were all associated with higher odds. Reporting usually using nicotine salts was associated with higher odds of symptoms [1.43 (1.22-1.68)] than non-salt but was often uncertain. Compared with tobacco flavour (including with menthol), menthol/mint and sweets flavours were associated with similar odds; fruit [1.44 (1.07-1.93)], multiple [1.76 (1.30-2.39)] and 'other' [2.14 (1.45-3.16)] flavours with higher odds. All device types were associated with similar odds. CONCLUSIONS Among youth, vaping was associated with increased reporting of past-week respiratory symptoms. Among those who vaped, some flavour types and potentially nicotine salts were associated with respiratory symptoms.
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Affiliation(s)
- Leonie S Brose
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8BB, UK.
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Debbie Robson
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8BB, UK
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8BB, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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Kassem NOF, Strongin RM, Stroup AM, Brinkman MC, El-Hellani A, Erythropel HC, Etemadi A, Exil V, Goniewicz ML, Kassem NO, Klupinski TP, Liles S, Muthumalage T, Noël A, Peyton DH, Wang Q, Rahman I, Valerio LG. A review of the toxicity of ingredients in e-cigarettes, including those ingredients having the FDA's "Generally Recognized as Safe (GRAS)" regulatory status for use in food. Nicotine Tob Res 2024:ntae123. [PMID: 38783714 DOI: 10.1093/ntr/ntae123] [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: 12/27/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Some firms and marketers of electronic cigarettes (e-cigarettes; a type of electronic nicotine delivery system (ENDS)) and refill liquids (e-liquids) have made claims about the safety of ingredients used in their products based on the term "GRAS or Generally Recognized As Safe" (GRAS). However, GRAS is a provision within the definition of a food additive under section 201(s) (21 U.S.C. 321(s)) of the U.S. Federal Food Drug and Cosmetic Act (FD&C Act). Food additives and GRAS substances are by the FD&C Act definition intended for use in food, thus safety is based on oral consumption; the term GRAS cannot serve as an indicator of the toxicity of e-cigarette ingredients when aerosolized and inhaled (i.e., vaped). There is no legal or scientific support for labeling e-cigarette product ingredients as "GRAS". This review discusses our concerns with the GRAS provision being applied to e-cigarette products and provides examples of chemical compounds that have been used as food ingredients but have been shown to lead to adverse health effects when inhaled. The review provides scientific insight into the toxicological evaluation of e-liquid ingredients and their aerosols to help determine the potential respiratory risks associated with their use in e-cigarettes. IMPLICATIONS The rise in prevalence of e-cigarette use and emerging evidence of adverse effects, particularly on lung health, warrant assessing all aspects of e-cigarette toxicity. One development is manufacturers' stated or implied claims of the safety of using e-cigarette products containing ingredients determined to be "Generally Recognized As Safe" (GRAS) for use in food. Such claims, typically placed on e-cigarette product labels and used in marketing, are unfounded, as pointed out by the United States Food and Drug Administration (FDA)1 and the Flavor and Extract Manufacturers Association (FEMA)2. Assessment of inhalation health risks of all ingredients used in e-liquids, including those claimed to be GRAS, is warranted.
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Affiliation(s)
- Nada O F Kassem
- Health Promotion and Behavioral Science, San Diego State University, San Diego, CA 92182, U.S
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | - Robert M Strongin
- Department of Chemistry, Portland State University, Portland, OR 97207-0751, U.S
| | - Andrea M Stroup
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD 20850, U.S
| | - Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, OH 43210, U.S
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, U.S
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, U.S
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, U.S
| | - Hanno C Erythropel
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT 06511, U.S
- Yale Center for the Study of Tobacco Products (YCSTP), Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, U.S
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, U.S
| | - Vernat Exil
- School of Medicine, St. Louis University, St. Louis, MO 63104, U.S
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14226, U.S
| | - Noura O Kassem
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | | | - Sandy Liles
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | | | - Alexandra Noël
- Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, U.S
| | - David H Peyton
- Department of Chemistry, Portland State University, Portland, OR 97207-0751, U.S
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 14642, U.S
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 14642, U.S
| | - Luis G Valerio
- Division of Nonclinical Science (DNCS), Office of Science/Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, U.S
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Gutierrez A, Nguyen JD, Creehan KM, Grant Y, Taffe MA. Adult Consequences of Repeated Nicotine Vapor Inhalation in Adolescent Rats. Nicotine Tob Res 2024; 26:715-723. [PMID: 37946372 PMCID: PMC11109496 DOI: 10.1093/ntr/ntad211] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION There has been a resurgence in nicotine inhalation in adolescents due to the popularity and availability of Electronic Nicotine Delivery Systems (ENDS). Almost five times as many US high-school seniors inhale nicotine vapor daily compared with those who smoke tobacco. This study was conducted to determine the impact of repeated adolescent vapor inhalation of nicotine on behavior in adulthood. METHODS Male and female Sprague-Dawley rats were exposed to 30-minute sessions of ENDS vapor inhalation, twice daily, from post-natal day (PND) 31-40. Conditions included vapor from the propylene glycol (PG) vehicle or nicotine (30 mg/mL in the PG). Animals were assessed for effects of nicotine on open field (PND 74-105) and wheel activity (PND 126-180) and for volitional exposure to nicotine vapor (PND 285-395). Plasma nicotine and cotinine were assessed in separate groups of male and female Wistar and Sprague-Dawley rats after a single nicotine inhalation session. RESULTS Group mean plasma nicotine ranged from 39 to 59 ng/mL post-session with minimal strain differences detected. Adolescent nicotine exposure enhanced sensitivity to the locomotor stimulating effects of nicotine (0.1-0.8 mg/kg, s.c.) in an open field in female rats, but didn't change the effects of nicotine on wheel activity. Female rats exposed to nicotine (30 mg/mL) vapor as adolescents responded more vigorously than PG-exposed females to nicotine vapor in a fixed ratio 5 challenge. CONCLUSIONS Repeated adolescent nicotine vapor inhalation leads to enhanced liability for volitional exposure to nicotine vapor in adulthood in female rats, but minimal change in spontaneous locomotor behavior. IMPLICATIONS These results show that adolescent vaping of nicotine can lead to lasting sensitization to the effects of nicotine in adulthood, including volitional responding for nicotine vapor. Demonstration of this in a controlled animal model establishes causality in a manner not possible from longitudinal evidence in human populations. These findings further highlight the importance of decreasing adolescent nicotine exposure to e-cigarettes to reduce consumption in adulthood.
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Affiliation(s)
- Arnold Gutierrez
- Department of Neuroscience; The Scripps Research Institute; La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
| | - Jacques D Nguyen
- Department of Neuroscience; The Scripps Research Institute;La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
- Department of Psychology and Neuroscience, Baylor University;Waco, TX, USA
| | - Kevin M Creehan
- Department of Neuroscience; The Scripps Research Institute;La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
| | - Yanabel Grant
- Department of Neuroscience; The Scripps Research Institute;La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
| | - Michael A Taffe
- Department of Neuroscience; The Scripps Research Institute; La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
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Lee J, Ouellette RR, Morean ME, Kong G. Adolescents and Young Adults Use of Social Media and Following of e-Cigarette Influencers. Subst Use Misuse 2024; 59:1424-1430. [PMID: 38755112 DOI: 10.1080/10826084.2024.2352620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND With high rates of both e-cigarette and social media use among adolescents and young adults (AYAs), social media influencers who promote e-cigarettes are particularly concerning but are understudied. We examined the association between AYAs' use of 11 different social media platforms (e.g. Facebook, Twitter, Instagram, TikTok, and YouTube) and exposure to social media e-cigarette influencers. OBJECTIVES From November 2022 to February 2023, we conducted an online, US national survey of AYAs (14-29 years) who endorsed past-30-day e-cigarette use. We used binomial logistic regression to examine associations between the frequency of use of each social media platform and following e-cigarette influencers, controlling for age, sex, race, ethnicity, e-cigarette use frequency, and other tobacco and substance use (i.e., alcohol and cannabis). The model was stratified by adolescents (14-17 years; n = 293) and young adults (18-29 years; n = 654). RESULTS The most frequently used social media platforms were Snapchat, TikTok and Instagram among adolescents, and YouTube, Instagram and TikTok among young adults. In adjusted models, following e-cigarette influencers was associated with more frequent use of TikTok (adjusted odds ratio [95% CI]; 1.33 [1.05, 1.68]) and Pinterest (1.18 [1.02, 1.38]) among adolescents, and more frequent use of Twitter (1.17 [1.06, 1.29]) among young adults. CONCLUSIONS The use of different platforms was associated with exposure to e-cigarette influencers: TikTok and Pinterest among adolescents and Twitter among young adults. These findings can inform tobacco regulatory policy and social media platform restrictions of e-cigarette influencers on the platforms that are popular among AYAs.
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Affiliation(s)
- Juhan Lee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rachel R Ouellette
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Meghan E Morean
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Fox KR, Rausch JR, Grant VR, Ferketich AK, Groner JA, Garg V, Cua CL, Jackson JL. Associations of Impulsivity and Risky Decision-Making with E-Cigarette-Related Outcomes Among Adolescents with Congenital Heart Disease: Variable- and Person-Oriented Approaches. Behav Med 2024:1-12. [PMID: 38706412 DOI: 10.1080/08964289.2024.2347226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/01/2024] [Indexed: 05/07/2024]
Abstract
Adolescents with congenital heart disease (CHD) have elevated risk for acquired cardiovascular complications, increasing their vulnerability to e-cigarette-related health harms. Impulsivity and risky decision-making have been associated with adolescent substance use, but the relationships between these factors and e-cigarette-related outcomes among cardiovascular at-risk adolescents with CHD are unknown. This cross-sectional study aimed to (a) determine the associations of impulsivity and risky decision-making with e-cigarette-related outcomes (i.e. susceptibility, ever use, perceptions of harm and addictiveness) via variable-oriented analysis (logistic regression), (b) identify groups of adolescents with similar profiles of impulsivity and risky decision-making via exploratory person-oriented analysis (latent profile analysis; LPA), and (c) examine differences on e-cigarette-related outcomes between profile groups. Adolescents aged 12 to 18 years with CHD (N = 98) completed a survey assessing impulsivity facets (Short UPPS-P) and e-cigarette-related outcomes and were administered a risky decision-making task (Iowa Gambling Task, Version 2; IGT2). In variable-oriented analyses, impulsivity facets (negative urgency, positive urgency, lack of premeditation) but not risky decision-making were associated with e-cigarette susceptibility and ever use. The exploratory LPA identified two groups with similar patterns of responding on the Short UPPS-P and IGT2 labeled "Low Impulsivity" and "High Impulsivity," which were primarily characterized by significant differences in negative and positive urgency. Adolescents in the High Impulsivity group had increased odds of e-cigarette susceptibility but not ever use compared to the Low Impulsivity group. This work indicates that strategies to prevent e-cigarette use among adolescents with CHD may be enhanced by addressing impulsivity, particularly negative and positive urgency.
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Affiliation(s)
- Kristen R Fox
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Victoria R Grant
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Judith A Groner
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vidu Garg
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Gimm G, Schulz JA, Rubenstein D, Casseus M. Examining the prevalence of nicotine vaping and association of major depressive episodes among adolescents and young adults by disability type in 2021. Addict Behav 2024; 152:107975. [PMID: 38309240 DOI: 10.1016/j.addbeh.2024.107975] [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: 09/26/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Nicotine vaping is more prevalent among U.S. adults with disabilities compared to those without disabilities. However, less is known about nicotine vaping among adolescents (12-17 years) and young adults (18-25 years) by disability status. METHODS Using data from a sample of 24,722 adolescents and young adults (AYAs) from the 2021 National Survey on Drug Use and Health, we conducted descriptive and multivariable analyses to estimate the national prevalence of nicotine vaping by disability type and examined major depressive episodes (MDEs) as a risk factor for nicotine vaping. RESULTS A greater proportion of AYAs with disabilities engaged in past-month nicotine vaping compared to those without a disability (13.9 % vs 9.6 %, p = 0.0001). Also, when MDE was excluded from the model, AYAs with any disability had higher odds of nicotine vaping (AOR = 1.41; 95 % CI 1.15, 1.74) than those without a disability. However, disability status was no longer significant when MDE was included (AOR = 1.16; 95 % CI 0.91, 1.46) in the model. CONCLUSIONS The higher prevalence of nicotine vaping among AYAs with disabilities suggests that tailored messages may be needed to communicate health risks and adverse outcomes of e-cigarette use. Also, MDE is associated with nicotine vaping among AYA populations. This information can be helpful to school nurses, counselors, and mental health professionals in their screening of major depression as a risk factor for e-cigarette use.
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Affiliation(s)
- Gilbert Gimm
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, MS-1-J3, Fairfax, VA 22030, USA.
| | - Jonathan A Schulz
- Department of Psychiatry, University of Vermont, Vermont Center on Behavior and Health, Burlington, VT, USA
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Myriam Casseus
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Li W, Kalan ME, Kondracki AJ, Gautam P, Jebai R, Osibogun O. Longitudinal impact of perceived harm and addiction on e-cigarette initiation among tobacco-naïve youth: Population Assessment of Tobacco and Health study (Waves 1-5). Public Health 2024; 230:52-58. [PMID: 38507916 PMCID: PMC11025441 DOI: 10.1016/j.puhe.2024.02.021] [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: 09/28/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES This study investigates the effect of e-cigarette-related harm and addiction perceptions on e-cigarette initiation among US tobacco-naïve adolescents. STUDY DESIGN This is a longitudinal study. METHODS Using data from five waves (2013-2019) of the Population Assessment of Tobacco and Health Study, we created a longitudinal data set for 2775 youth aged 12-17 years who had no prior use of tobacco products at Wave 1. E-cigarette initiation was defined as transitioning from non-use at Wave 1 to ever use in subsequent waves. Kaplan-Meier survival and Cox proportional hazard regression models were used to assess the impact of harm and addiction perceptions on e-cigarette initiation. RESULTS Our analytic sample comprised 63.1% of youth who had never used tobacco products at Wave 1 and consequently initiated e-cigarette use in subsequent waves. Over time, fewer individuals perceived e-cigarettes as harmless (14.1%-2.1%), whereas more perceived them as likely to cause addiction (53.7%-76.6%). Compared with perceiving e-cigarettes as a lot of harm, those perceiving some harm (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.12-1.52), little harm (aHR = 1.42, 95% CI: 1.20-1.68), or no harm (aHR = 2.09, 95% CI: 1.64-2.65) were more likely to initiate e-cigarette use. Demographic factors for initiation included being Black or Hispanic ethnicity (vs White), younger age (12-14 vs15-17 years), and receiving over $20 per week (vs $0) in pocket money, with P-values <0.05. However, in adjusted results, addiction perceptions did not significantly impact e-cigarette initiation (P-values >0.05). CONCLUSIONS Among youth without prior tobacco/nicotine use, perceiving e-cigarettes as having low harm significantly predicted initiation over time. Effective prevention strategies, including targeted risk communication interventions, are essential for discouraging e-cigarette use among youth.
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Affiliation(s)
- W Li
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
| | - M E Kalan
- School of Health Professionals, Eastern Virginia Medical School, Norfolk, VA, USA
| | - A J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Savannah, GA, USA
| | - P Gautam
- Texas State Board of Pharmacy, Austin, TX, USA
| | - R Jebai
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, MA, USA
| | - O Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
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Cornacchione Ross J, Kowitt SD, Rubenstein D, Jarman KL, Goldstein AO, Thrasher JF, Ranney LM. Prevalence and correlates of flavored novel oral nicotine product use among a national sample of youth. Addict Behav 2024; 152:107982. [PMID: 38359494 PMCID: PMC10939726 DOI: 10.1016/j.addbeh.2024.107982] [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: 11/20/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Flavored novel oral nicotine products (ONP), such as pouches, gum, lozenges, tablets, and gummies, have recently entered the US market but have not been authorized for smoking cessation. This study assessed the prevalence and correlates of ONPs in a national sample of youth who smoked little filtered cigars or cigarillos (LCCs) or were susceptible to LCCs. METHODS We conducted a national online survey from September-October 2022, as part of a study to develop cigar warnings among youth. Those aged 15-20 years old who reported using (ever or current) or susceptibility to little filtered cigars or cigarillos (LCCs) were eligible. Descriptive statistics and chi-square analyses assessed the prevalence of flavored ONP use and associations with other past 30-day tobacco product use and participant characteristics. RESULTS Approximately one-fifth (17.1 %) of the sample (n = 680) reported past month flavored ONP use. Any past month tobacco use was correlated with past month flavored ONP use (ps < 0.001), increasing from 17.1 % in the overall sample to 26.8 % among those reporting e-cigarette use, 41.4 % (LCCs), 47.8 % (waterpipe tobacco), 61.8 % (large cigars), and 69.1 % (smokeless tobacco). The number of products used in the past month was significantly associated with higher odds of ONPs in the past month in a multivariable logistic regression model (aOR2.26; 95 % CI: 1.92, 2.65). DISCUSSION Almost one-fifth of participants who use or are susceptible to cigar use in our national sample of youth use ONPs. Dual/poly use of other tobacco products and ONPs among youth suggests that many of these youth may be addicted to nicotine. Additional surveillance and regulation of ONPs that exhibit enticing characteristics, such as flavors, kid-friendly formulations, and targeted marketing/branding may be needed.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dana Rubenstein
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Pérez A, Valencia S, Jani PP, Harrell MB. Use of Electronic Nicotine Delivery Systems and Age of Asthma Onset Among US Adults and Youths. JAMA Netw Open 2024; 7:e2410740. [PMID: 38758558 PMCID: PMC11102021 DOI: 10.1001/jamanetworkopen.2024.10740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/11/2024] [Indexed: 05/18/2024] Open
Abstract
Importance The association of use of electronic nicotine delivery systems (ENDS) with the age of asthma onset is unknown. Objective To explore the association of past 30-day ENDS use with the age of asthma onset in adults and youths who did not have asthma or chronic obstructive pulmonary disease and never used cigarettes. Design, Setting, and Participants This cohort study was a secondary analysis of waves 1 to 6 of the US nationally representative Population of Tobacco and Health Study (2013-2021). Eligible participants included adults (≥18 years) and youths (12-17 years) who did not have asthma or chronic obstructive pulmonary disease at the first wave of participation. Data analysis was conducted from September 2022 to April 2024. Exposure Past 30-day ENDS use at the first wave of participation in the study preceding the onset of asthma. Main outcome and measures Lower and upper age limits were estimated using the age reported at the first wave of participation and the number of weeks between follow-up waves until asthma was first reported or censored. The association of past 30-day ENDS use with the age of asthma onset was estimated using weighted interval-censoring Cox regression. The cumulative hazard function for the age of asthma onset was estimated using interval-censoring survival analysis. Results A total of 24 789 participants were included, with 7766 adults (4461 female [weighted percentage, 59.11%] and 3305 male [weighted percentage, 40.89%]), representing 80.0 million adults, and 17 023 youths (8514 female [weighted percentage, 50.60%] and 8496 male [weighted percentage 49.32%]), representing 33.9 million youths. By age 27 years, 6.2 per 1000 adults reported asthma incidence (hazard ratio [HR], 0.62%; 95% CI, 0.46%-0.75%). While controlling for covariates, there was a 252% increased risk of the onset of asthma at earlier ages for adults who used ENDS in the past 30 days vs adults who did not (adjusted HR, 3.52; 95% CI, 1.24-10.02). For youths, there was no association of ENDS use in the past 30 days with age of asthma onset (adjusted HR, 1.79; 95% CI, 0.67-4.77), which could be due to a lack of statistical power. Conclusion and relevance In this cohort study, past 30-day ENDS use among adults was associated with earlier ages of asthma onset. These findings suggest that prevention and cessation programs directed to adults who use ENDS are needed to educate the public, protect public health, prevent adverse health outcomes, and motivate users to stop. Furthermore, modifying symptom-screening asthma guidelines, resulting in earlier asthma detection and treatment, may reduce morbidity and mortality due to asthma.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Austin
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin
| | - Sarah Valencia
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin
| | - Pushan P. Jani
- Division of Pulmonary and Sleep Medicine, The University of Texas Health Science Center at Houston, School of Medicine, Houston
| | - Melissa B. Harrell
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin
- Department of Epidemiology, The University of Texas Health Science Center at Houston, School of Public Health, Austin
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Zhang BY, Bannon OS, Tzu-Hsuan Chen D, Filippidis FT. Dual and poly-nicotine and tobacco use among adolescents in the United States from 2011 to 2022. Addict Behav 2024; 152:107970. [PMID: 38277994 DOI: 10.1016/j.addbeh.2024.107970] [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: 11/13/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Adolescent nicotine and tobacco product use remains common despite declining smoking rates in the United States, likely due to the emergence of novel products. Concurrent use of multiple products may increase the risk of nicotine dependency and subsequent substance use. AIM To identify patterns and trends of dual and poly nicotine and tobacco use among adolescents in the US and explore associations of dual and poly nicotine and tobacco use with sociodemographic factors. METHODS 12 years of annual National Youth Tobacco Survey data (2011-2022) from 242,637 respondents were used to examine prevalence trends of different combinations of nicotine or tobacco product use among adolescents in the US using weighted point estimates for each year. Poisson regression models examined sociodemographic factors associated with different patterns of dual and poly-product use from 2011 to 2022. RESULTS Overall, the prevalence of dual (i.e. at least two products) and poly (i.e. at least three products) use decreased between 2011 and 2021 (from 9.5 % to 2.8 % and from 5.1 % to 1.1 %, respectively), but showed signs of increase between 2021 and 2022 (3.7 % for dual and 1.7 % for poly use). The most common combinations included a combustible product with either a novel or noncombustible product. The risk for dual and poly-product use was higher among non-Hispanic Whites, males, and high school students. CONCLUSIONS Previously declining trends in the prevalence of tobacco/nicotine dual and poly use may have been reversed. Close monitoring and targeted tobacco control policies are essential to tackle multiple product use among adolescents.
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Affiliation(s)
- Baihui Y Zhang
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom
| | - Olivia S Bannon
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom.
| | - Daniel Tzu-Hsuan Chen
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, United Kingdom
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom
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Bearman DS, Sheeran TJ, Kowitt SD, Clark SA, Klein JD, Goldstein AO. Analysis of Candy Tobacco Imitation Products Available Online in the United States. Nicotine Tob Res 2024:ntae055. [PMID: 38584415 DOI: 10.1093/ntr/ntae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Youth tobacco use remains a critical public health concern, and childhood use of candy tobacco imitation products (CTIP) is associated with cigarette use among youth. However, no research has examined the full extent of CTIP available for purchase in the United States. AIMS AND METHODS We conducted a content analysis of CTIP available on English-language, US-based websites. We identified sites that marketed CTIP utilizing Google and candy retail websites, examining each product for product names, the tobacco product being replicated (eg, cigar and cigarette), manufacturer, candy flavor, images, product rating, pack color, and if the product had packaging that may appeal to youth. RESULTS We found 66 CTIP available. The most popular CTIP were cigars, with 39 separate products (59%), followed by candy cigarettes-14 products (21%), candy pipes-8 products (12%), and chewing tobacco-5 products (8%). In the 52 products where packaging design was available, 39 (75%) had packaging that may appeal to youth. CONCLUSIONS CTIP, many of which contain packaging appealing to youth, are widely available for purchase online across the United States. These findings could stimulate policy actions, such as removal of CTIP from popular retail websites, labeling of CTIP as potentially dangerous to youth, or age verification requirements for purchasing CTIP. IMPLICATIONS CTIP continues to be sold on the internet despite research indicating candy cigarette product use by youth increases their likelihood of smoking. We conducted research to understand the extent to which CTIP are sold on the internet and whether these products are being marketed to youth. The results provide evidence that some of the largest retail companies in the world continue to sell CTIP, and the majority are sold in packaging that likely appeals to youth. The results suggest that further research into the market for these products is needed, and regulatory measures should be considered to prevent CTIP from leading to youth tobacco use.
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Affiliation(s)
- Dov S Bearman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tadhg J Sheeran
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sonia A Clark
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan D Klein
- Division of Adolescent Medicine, Stanford University, Palo Alto, CA, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dai HD, Michaud T, Guenzel N, Morgan M, Cohen SM. Biomarker Assessment of Nicotine Exposure Among Adolescent E-Cigarette Users: 2018-2019. Pediatrics 2024; 153:e2023062424. [PMID: 38463008 PMCID: PMC10979298 DOI: 10.1542/peds.2023-062424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Despite the increasing prevalence of vaping e-cigarettes among adolescents, there remains a lack of population-level assessments regarding the objective measurement of nicotine exposure. METHODS This study analyzed a nationally representative sample of adolescents aged 13 to 17 years from Wave 5 of the Population Assessment of Tobacco and Health Study conducted between 2018 and 2019. Urinary nicotine metabolites, including cotinine and trans-3'-hydroxycotinine (3-HC), were assessed among exclusive nonnicotine e-cigarette users (n = 56), exclusive nicotine e-cigarette users (n = 200), and nonusers (n = 1059). We further examined nicotine exposure by past 30-day vaping frequency (ie, occasional [1-5 days], intermittent [6-19 days], and frequent [20+ days]) and flavor types among nicotine e-cigarette users. Multivariable linear regressions tested pairwise group effects, and biomarkers were normalized by the log transformation. RESULTS Compared with nonusers, both nonnicotine and nicotine e-cigarette users exhibited higher levels of cotinine and 3-HC. Nicotine e-cigarette users had mean cotinine concentrations (61.3; 95% confidence interval, 23.8-158.0, ng/mg creatinine) approximately 146 times higher (P < .0001) than nonusers (0.4; 0.3-0.5), whereas nonnicotine users (4.9; 1.0-23.2) exhibited cotinine concentrations ∼12 times higher (P = .02). Among nicotine e-cigarette users, the levels of cotinine and 3-HC increased by vaping frequency, with cotinine increasing from 10.1 (2.5-40.1) among occasional users to 73.6 (31.8-170.6) among intermittent users and 949.1 (482.5-1866.9) among frequent users. Nicotine exposure was not significantly different by flavor type. CONCLUSIONS E-cigarette use poses health-related risks resulting from nicotine exposure among adolescents. Comprehensive regulations of e-cigarette products and marketing, vaping prevention, cessation, and public policies are needed to prevent youth from developing nicotine addiction.
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Affiliation(s)
| | | | | | - Mathuri Morgan
- College of Public Health
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri
| | - Samuel M Cohen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Crabtree MA, Stanley LR, Miech RA, Swaim RC. Nicotine use among reservation-area American Indian adolescents compared with a national sample. Drug Alcohol Depend 2024; 257:111124. [PMID: 38387255 PMCID: PMC11031341 DOI: 10.1016/j.drugalcdep.2024.111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021-2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study. METHODS Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021-2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade. RESULTS Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available. CONCLUSIONS Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population.
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Affiliation(s)
- Meghan A Crabtree
- Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523-1879, USA.
| | - Linda R Stanley
- Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523-1879, USA
| | - Richard A Miech
- Institute for Social Research, University of Michigan, 412 Maynard St, Ann Arbor, MI 48109-1399, USA
| | - Randall C Swaim
- Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523-1879, USA
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Adjei A, Mantey DS, Chen B, Wilkinson AV, Harrell MB. Time to first report of signs of nicotine dependence among youth who use e-cigarettes and cigarettes in the United States: A nationally representative cohort study, findings from the Population Assessment of Tobacco and Health, 2013-2019. Prev Med 2024; 181:107924. [PMID: 38432307 DOI: 10.1016/j.ypmed.2024.107924] [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: 11/24/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To determine the time to first report of signs of nicotine dependence among youth exclusive e-cigarette users and compare this time to that for exclusive cigarette users. METHODS Secondary analysis of data (Waves 1-5; 2013-2019) from the Population Assessment of Tobacco and Health was conducted. Youth never tobacco users in the United States who reported exclusive past-30-day (P30D) e-cigarette or cigarette use (n = 2940, N = 5,391,642) in at least one wave were included in the current analysis. Survival analysis was used to estimate the time to the first report of three nicotine dependence indicators (i.e., "use within 30 minutes of waking"; "cravings" and "really needing to use") following the first report of P30D use. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). RESULTS There were no significant differences in the time to first report of "use within 30 minutes of waking" (aHR = 1.1, 95% CI = 0.87-1.40) and "cravings" (aHR = 1.09, 95% CI = 0.81-1.47) between exclusive P30D e-cigarette use and exclusive P30D cigarette use. However, compared to exclusive P30D e-cigarette use, the hazard of first reporting "really needing to use" tobacco was 39% (aHR 1.39; 95% CI: 1.05-1.84) times higher for those who reported exclusive P30D cigarette use after controlling for covariates. CONCLUSION Compared to exclusive P30D cigarette use, no differences in the time to first report of signs of nicotine dependence ("use within 30 minutes" and "cravings") were observed among exclusive P30D e-cigarette users. Policymakers and regulatory agencies should consider this evidence when assessing the abuse liability of e-cigarette products.
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Affiliation(s)
- Abigail Adjei
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, United States of America.
| | - Dale S Mantey
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, United States of America
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, United States of America
| | - Anna V Wilkinson
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, United States of America
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, United States of America
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Kong G, Morean ME, Davis DR, Bold KW, Krishnan-Sarin S. Tobacco-free blunt wraps: a regulatory conundrum. Tob Control 2024; 33:e136-e137. [PMID: 37604696 PMCID: PMC10879446 DOI: 10.1136/tc-2023-058100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Grace Kong
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Danielle R Davis
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Krysten W Bold
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Snyder K, Liu ST, Donaldson EA, Wang T, Gentzke A. Exposure Among Middle and High School Students to Warning Labels on E-Cigarette Packages Before and After an FDA Requirement, 2018-2019. Prev Chronic Dis 2024; 21:E16. [PMID: 38483809 PMCID: PMC10944637 DOI: 10.5888/pcd21.220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Introduction Beginning August 10, 2018, a US Food and Drug Administration (FDA) rule required all e-cigarette packages to have a health warning. We examined exposure among middle and high school students to e-cigarette warnings before and after the compliance date of the FDA's deeming rule, a rule allowing the FDA to regulate e-cigarettes, cigars, and other products. Methods We analyzed data from middle and high school students participating in the 2018 and 2019 National Youth Tobacco Survey. We generated weighted prevalence estimates for any exposure ("rarely," "sometimes," "most of the time," or "always") and high exposure ("most of the time" or "always") to warnings. We used independent 2-sided t tests to examine differences in exposure between 2018 and 2019 and χ2 tests to examine differences in any exposure and high exposure by demographic characteristics and tobacco use behaviors in 2019. Analyses excluded respondents who reported they had not seen an e-cigarette package. Results In 2019, 68.0% (vs 67.7% in 2018) of students reported any past 30-day exposure to e-cigarette warning labels and 35.0% (vs 28.7% in 2018) reported high exposure; we observed differences in the proportion of students reporting any and high exposure to warning labels across demographic characteristics and tobacco use behaviors. From 2018 to 2019, report of any and high exposure to e-cigarette warning labels increased among students who currently used any tobacco product and e-cigarettes. We observed increases in high exposure to e-cigarette warning labels overall, and among male students, female students, non-Hispanic White students, and middle and high school students. Conclusion After implementation of the health warnings per the FDA's deeming rule, the percentage of current tobacco users and e-cigarette users among middle and high school students who reported any and high exposure to e-cigarette warning labels increased. Continued monitoring of reactions can inform if warnings are achieving their regulatory goal.
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Affiliation(s)
- Kimberly Snyder
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993
| | - Sherry T Liu
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Elisabeth A Donaldson
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Teresa Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Chen Y, Chaudhary S, Li G, Fucito LM, Bi J, Li CSR. Deficient sleep, altered hypothalamic functional connectivity, depression and anxiety in cigarette smokers. NEUROIMAGE. REPORTS 2024; 4:100200. [PMID: 38605733 PMCID: PMC11008573 DOI: 10.1016/j.ynirp.2024.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Background Deficient sleep is implicated in nicotine dependence as well as depressive and anxiety disorders. The hypothalamus regulates the sleep-wake cycle and supports motivated behavior, and hypothalamic dysfunction may underpin comorbid nicotine dependence, depression and anxiety. We aimed to investigate whether and how the resting state functional connectivities (rsFCs) of the hypothalamus relate to cigarette smoking, deficient sleep, depression and anxiety. Methods We used the data of 64 smokers and 198 age- and sex-matched adults who never smoked, curated from the Human Connectome Project. Deficient sleep and psychiatric problems were each assessed with Pittsburgh Sleep Quality Index (PSQI) and Achenbach Adult Self-Report. We processed the imaging data with published routines and evaluated the results at a corrected threshold, all with age, sex, and the severity of alcohol use as covariates. Results Smokers vs. never smokers showed poorer sleep quality and greater severity of depression and anxiety. In smokers only, the total PSQI score, indicating more sleep deficits, was positively associated with hypothalamic rsFCs with the right inferior frontal/insula/superior temporal and postcentral (rPoCG) gyri. Stronger hypothalamus-rPoCG rsFCs were also associated with greater severity of depression and anxiety in smokers but not never smokers. Additionally, in smokers, the PSQI score completely mediated the relationships of hypothalamus-rPoCG rsFCs with depression and anxiety severity. Conclusions These findings associate hypothalamic circuit dysfunction to sleep deficiency and severity of depression and anxiety symptoms in adults who smoke. Future studies may investigate the roles of the hypothalamic circuit in motivated behaviors to better characterize the inter-related neural markers of smoking, deficient sleep, depression and anxiety.
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Affiliation(s)
- Yu Chen
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Shefali Chaudhary
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Guangfei Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing, China
| | - Lisa M. Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Jinbo Bi
- Department of Computer Science and Engineering, School of Engineering, University of Connecticut, Storrs, CT, USA
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06520, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06520, USA
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