Trajectories of Tobacco and Nicotine Use Across Young Adulthood, Texas, 2014-2017

Depressive symptoms prospectively increase risk for new onset cigarette and ENDS dependence symptoms

Little research has examined the new onset of cigarette and Electronic Nicotine Delivery System (ENDS) dependence symptoms among young adults. This study aims to 1) examine new onset cigarette and ENDS dependence symptoms over a 4.5-year period and 2) examine how depressive symptoms impact new onset dependence symptoms among young adults. Participants were drawn from 24 colleges in Texas who were participating in a multi-wave cohort study (2014-2019). The present study included 4536 participants aged 18-25 who did not report cigarette or ENDS dependence symptoms at wave 1 (64.1% female; 65.2% non-white; m age = 20.62 [SD = 1.80] at wave 1). Cox's regression models were employed to determine the hazard of new onset cigarette and ENDS dependence symptoms overall and the impact of depressive symptoms. Models controlled for sociodemographic factors and other tobacco product use. 14.4% of participants reported new onset cigarette dependence symptoms and 14.6% reported new onset ENDS dependence symptoms over the 4.5 years of the study. Depressive symptoms significantly predicted increased risk for new onset cigarette (HR = 1.30, CI = [1.21, 1.39]) and ENDS (HR = 1.20, CI = [1.12, 1.29]) dependence symptoms. Young adults exhibited dependence symptoms for cigarettes and ENDS products at similar rates across the 4.5 years of the study. Elevated depressive symptoms increased risk of new onset cigarette and ENDS dependence symptoms, advancing evidence for the self-medication hypothesis. Tobacco and nicotine prevention and cessation programs and messaging are needed particularly among young adults who experience depressive symptoms.

Depressive symptoms predict trajectories of electronic delivery nicotine systems, cigarette, and cannabis use across 4.5 years among college students

BACKGROUND

This study examined the role of depressive symptoms on trajectories of electronic nicotine delivery systems (ENDS), cigarette, and cannabis use across 4.5 years in a sample of college students aged 18-19 at the initial study wave.

METHODS

Participants were 2,264 students enrolled in one of 24 Texas colleges that participated in a multi-wave study between 2014 and 2019. Latent growth mixture models were fit to identify longitudinal trajectories for past 30-day ENDS, cigarette, and cannabis use over a 4.5-year period. Class membership was regressed on baseline depressive symptoms in multinomial regression models.

RESULTS

Four trajectory classes were identified for each product: abstainer/minimal, decreasing, increasing, and high. Depressive symptoms were associated with a greater likelihood of belonging to the decreasing, increasing, and high trajectory classes relative to the abstainer/minimal class for all products, with the exception of the increasing ENDS class and the decreasing cannabis class.

DISCUSSION

The findings demonstrate that there is considerable similarity across trajectories of ENDS, cigarette, and cannabis use during traditional collegiate years. Furthermore, depressive symptoms increased the likelihood of belonging to substance using trajectory classes for all products.

Psychosocial predictors of trajectories of dual cigarette and e-cigarette use among young adults in the US

INTRODUCTION

Young adults have the highest prevalence of cigarette and e-cigarette use, warranting research to identify psychosocial correlates of their use trajectories.

METHODS

Repeated measures latent profile analyses (RMLPAs) examined past 6-month cigarette and e-cigarette trajectories across 5 waves of data (2018-2020) among 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 60.2% racial/ethnic minority). Multinomial logistic regression models examined associations among psychosocial factors (i.e., depressive symptoms, adverse childhood experiences [ACEs], personality traits) and trajectories of cigarette and e-cigarette use, controlling for sociodemographics and past 6-month alcohol and cannabis use.

RESULTS

RMLPAs yielded a 6-profile solution, which were uniquely associated with predictors: stable low-level or nonusers of cigarettes and e-cigarettes (66.3%; referent group), stable low-level cigarette and high-level e-cigarette use (12.3%; greater depressive symptoms, ACEs, openness; male, White, cannabis use), stable mid-level cigarette and low-level e-cigarette use (6.2%; greater depressive symptoms, ACEs, extraversion; less openness, conscientiousness; older age, male, Black or Hispanic, cannabis use), stable low-level cigarette and decreasing e-cigarette use (6.0%; greater depressive symptoms, ACEs, openness; younger age, cannabis use), stable high-level cigarette and low-level e-cigarette use (4.7%; greater depressive symptoms, ACEs, extraversion; older age, cannabis use), and decreasing high-level cigarette and stable high-level e-cigarette use (4.5%; greater depressive symptoms, ACEs, extraversion, less conscientiousness; older age, cannabis use).

CONCLUSIONS

Cigarette and e-cigarette prevention and cessation efforts should be targeted both toward specific trajectories of use and their unique psychosocial correlates.

Longitudinal transitions in adolescent polytobacco use across waves 1-4 of the Population Assessment of Tobacco and Health study

AIMS

This study aims to identify adolescent patterns of polytobacco use and measure transitions between patterns over time.

DESIGN

Longitudinal analysis using data derived from waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study. Transitions in tobacco use patterns were examined via latent transition analysis, and then, socio-demographic characteristics were used to predict transitions via logistic regression.

SETTING

United States.

PARTICIPANTS

Participants included 975 adolescents who used at least one tobacco product at any wave (W1 mean age = 13.29, standard deviation = 0.86; W4 54.2% male; 54.5% white, 25.9% Hispanic).

MEASUREMENTS

Measurements included past 30-day use of cigarettes, electronic cigarettes (e-cigs), traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco (SLT) or hookah.

FINDINGS

Six latent classes were identified. Cigarette users (43.5-58.8%) and SLT users (50.8-79.6%) tended to persist in their use over time. E-cig users began to probably transition to non-users (80.0%), but became more likely to persist in this use over time (31.1%). Non-users at a given wave were most likely to transition to e-cig users (8.5-43.7%) or cigarette users (6.7-28.6%). Cigarillo/poly-users and hookah/poly-users displayed more variable transition patterns. Adolescents were more likely to transition to non-use (versus become/remain e-cig users) if they were older (cigarette users, SLT users), younger (e-cig users), other race (SLT users), male (SLT users) or had less-educated parents (SLT users) compared with their counterparts. Hispanic (versus white) cigarette users were more likely to transition to non-users than to persist in this use.

CONCLUSIONS

Among adolescents in the United States, patterns of tobacco use characterized by the use, mainly, of single, specific products appear to be stable, particularly by late adolescence. In contrast, patterns characterized by polytobacco use appear to be more variable and may represent experimentation without specialization.

Socioecological Predictors of Change in Adolescent Tobacco Use Across Waves 1-4 of the Population Assessment of Tobacco and Health Study

BACKGROUND

Despite decreases in adolescents' cigarette use over the past decade, overall rates of adolescent tobacco use have increased. Research examining adolescents' changes across a range of tobacco products reflective of the current market, as well as multilevel predictors of use trajectories is needed.

METHODS

Data derive from Waves 1-4 (W1-4; 2013-2018) of the Population Assessment of Tobacco and Health (PATH) study. Participants included 975 adolescents who used ≥1 tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco [SLT], hookah) at any wave (W1 Mage = 13.29 [0.86], 54.2% male; 54.5% White, 25.9% Hispanic).

RESULTS

Utilizing latent growth curve modeling (separate models per product), adolescents displayed increases in their past 30-day use of all tobacco products from W1-4. Greater W1 use was predicted by identifying as non-Hispanic (cigarettes); lower parent education (SLT); greater externalizing problems (cigarillos); greater motives (all products except cigarillos); greater youth-reported household smoking rules (cigarillos); and greater isolation (ECIGs). More use across time (i.e., higher slope) was predicted by older age (cigarettes); identifying as male (ECIGs, SLT), Black (vs. White; cigarillos), White (vs. Black, Hispanic; ECIGs, SLT); fewer externalizing problems (SLT); fewer motives (ECIGs); fewer youth-reported rules (cigarillos, SLT); and greater geographic isolation (cigarettes, SLT).

DISCUSSION

Although some individual-level factors (i.e., motives, externalizing problems) predicted greater W1 use (i.e., intercept) only, interpersonal- (parent rules) and community-level (geographic isolation) factors were associated with changes in use over time (i.e., slope). Intervention efforts may address such factors to reduce adolescents' escalations in use.

Ethnicity and the mechanisms of point-of-sale e-cigarette marketing's influence on behavior: A longitudinal study

Objective: To test the mechanisms by which exposure to point-of-sale (POS) e-cigarette marketing mediate the relationship between an ethnic minority group highly vulnerable for tobacco product use, namely Native Hawaiian/Other Pacific Islander (NHPI), and increased future e-cigarette use through explicit (positive outcome expectancies) and implicit (spontaneous positive reactions) pathways. Method: Four waves of data were collected in 6-month intervals from 2,327 multiethnic young adults (Mage = 21.2, SD = 2.2; 54% women) enrolled across two 4-year and four 2-year colleges belonging to a University system in Hawaii. POS e-cigarette marketing exposure was assessed with an objective measure involving store visit patterns and store audits, as well as a measure of self-reported exposure. Spontaneous reactions were assessed with an implicit measure, namely Affect Misattribution Procedure (AMP). Path analyses were used to test the hypotheses. Results: In a model employing the objective measure of POS exposure, a statistically significant pathway was found from NHPI ethnicity to increased current e-cigarette use at Wave 4 mediated through increased POS exposure at Wave 2, and increased affect regulation expectancies at Wave 3. Similar indirect effects on prospective e-cigarette use were found for Asian ethnicity. The dual process model of the effects of POS exposure on e-cigarette use was not fully supported, although the implicit measure was found to independently predict e-cigarette use. Conclusions: Differential exposure to POS marketing may explain some of the ethnic disparities in tobacco product use behavior such as e-cigarette use. POS marketing may affect e-cigarette use behavior mainly through the explicit pathway, notably affect regulation expectancies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal latent class analysis of tobacco use and correlates among young adults over a 10-year period

INTRODUCTION

We assessed patterns and correlates, including demographic characteristics, psychological factors, and social role transitions, of young adults' tobacco use over time.

METHODS

In the fall of 2010, we recruited a cohort of 3146 students from 11 colleges in North Carolina and Virginia. Participants completed baseline and at least two survey waves between 2010 and 2019.

RESULTS

The sample was 49.8% female, 15.7% non-white, and 6.6% Hispanic. Longitudinal latent class analysis revealed a five-class model with distinct patterns and correlates of tobacco use. Limited Use (52.6% of sample) had minimal use. College-Limited Combustible Tobacco Users (18.6%) had moderate probability of cigarette, cigar, and waterpipe smoking, which decreased to no use post-college. Intermittent Sustained Polytobacco Users (10.9%) had low probability of use that continued post-college. College Polytobacco with Continued Cigarette and E-Cigarette Users (14.5%) had high probability of use of cigarette smoking and increasing probability of e-cigarette, both of which continued post-college. Sustained Polytobacco Users (5.7%) had moderate probability of use of tobacco products across all waves.

CONCLUSIONS

Patterns of tobacco use varied considerably. In most classes, tobacco use was highest during freshman year and in three classes, use continued post-college. Prevention activities should focus on first-year students and target those at risk for post-college tobacco use.

Psychosocial predictors of longitudinal changes in tobacco and cannabis use among young adults

INTRODUCTION

In recent years, cigarette use has decreased, but alternative tobacco product and cannabis use has increased in young adults. Thus, research regarding intraindividual changes in tobacco product and cannabis use in this population, and related psychosocial predictors, is warranted.

METHODS

We analyzed data from 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 60.2% racial/ethnic minority) in a 2-year, 5-wave longitudinal study (2018-2020). Latent growth modeling analyzed the outcomes of past 6-month use of cigarettes, e-cigarettes, traditional cigars, little cigars/cigarillos, smokeless tobacco (SLT), hookah, and cannabis across Waves 1-5 among all participants; psychosocial predictors included depressive symptoms, adverse childhood experiences (ACEs), and personality traits.

RESULTS

Results indicated decreases in likelihood of using each tobacco product over time, but no significant change in likelihood of cannabis use. Psychosocial predictors of baseline use across products included depressive symptoms and extraversion, as well as ACEs and openness for nearly all products (e.g., except traditional cigars). Psychosocial predictors of less decreases in use likelihood over time included: for cigarettes and traditional cigars, ACEs; for e-cigarettes, extraversion; for little cigars/cigarillos, depressive symptoms and extraversion; for SLT, openness; and for hookah, neuroticism (controlling for sociodemographics). Predictors of greater decreases in likelihood of use over time included: for e-cigarettes and hookah, conscientiousness; and for cannabis, agreeableness.

CONCLUSIONS

Interventions to reduce young adults' use might target distinct risk/protective factors for using different products (and combinations). Moreover, results regarding decreasing likelihood of using tobacco products but not cannabis over time warrant replication and explanation in other samples.

Trajectories of depressive symptoms among young adults in Texas 2014-2018: a multilevel growth curve analysis using an intersectional lens

INTRODUCTION

Research has demonstrated disparities in depressive symptoms among people who are marginalized. However, more work should examine depressive symptoms through an intersectional lens, recognizing that multiple systems of privilege and oppression interlock to create unique struggles where multiple marginalized identities meet. Recent methodological developments have advanced quantitative intersectionality research using multilevel modeling to partition variance in depressive symptoms to person-level sociodemographic variables and intersectional-level social strata. The purpose of this study is to leverage these methods to examine trajectories of depressive symptoms among young adults in Texas through an intersectional lens.

METHODS

Multilevel modeling was used to examine the longitudinal trajectories of depressive symptoms among 3575 young adults from 24 colleges in Texas assessed seven times between Fall 2014 and Spring 2018. Intersectional identities included sex, race/ethnicity, and sexual and gender minority identities. The model examined time nested within individuals and individuals nested within intersectional social strata.

RESULTS

Young adults in Texas experienced an increase in depressive symptoms from 2014-2018. Those with female, Hispanic, AAPI, other race/ethnicity, or LGBTQ + identities experienced more depressive symptoms. After controlling for the main effects of the sociodemographic variables, 0.08% of variance in depressive symptoms remained attributed to the effects of intersectional identities.

CONCLUSION

Evaluating disparities in depressive symptoms through an intersectional lens offers a more complete description of the epidemiology of depressive symptoms. Communities and institutions that serve marginalized people should consider the elevated burden of depressive symptoms that marginalized people may carry, and integrate culturally competent psychoeducation, assessments, and therapies where possible.

Effects of mental simulation of future waterpipe tobacco smoking on attitudes, perceived harms and intended use among young adults

The desire to engage in waterpipe tobacco smoking (WTS) may occur when smokers and nonsmokers conjure positive mental simulations of WTS. However, effects of these simulations on desire to smoke waterpipe tobacco and potential mediators are unexplored. This research addressed these effects among young adult waterpipe tobacco smokers and nonsmokers. Two online studies were conducted with adults ages 18-30. In Study 1, 200 smokers, 190 susceptible nonsmokers, and 182 nonsusceptible nonsmokers were randomized to mentally simulate or not WTS in the future. In Study 2, 234 smokers and 241 susceptible nonsmokers were randomized to four arms: no simulation or simulations that varied valence of experience (positive, negative or no valence provided). Main outcomes were immediate desire to smoke waterpipe tobacco, cognitive and affective attitudes, and perceived harms. In Study 1, mental simulations increased the desire to smoke waterpipe tobacco among smokers. In Study 2, asking participants to simulate WTS positively or with no valence instruction increased desire to smoke relative to negative valence instruction or no simulation. Negative simulations reduced perceived probability of smoking within a month compared to positive simulations. Effects on desire to engage in WTS were mediated by cognitive and affective attitudes among susceptible nonsmokers and by cognitive attitudes among smokers. These findings suggest that exploring when and how often mental simulations about WTS are evoked and their potency for promoting prevention and cessation of WTS merit further attention.

Rising vape pod popularity disrupted declining use of electronic nicotine delivery systems among young adults in Texas, USA from 2014 to 2019

AIMS

To examine the longitudinal trajectory of young Texan (US) adults' electronic nicotine delivery systems (ENDS) use from 2014 to 2019, and to determine if there are changes in the trajectory among younger and older young adults post-2017, when vape pods surged in popularity in the United States.

DESIGN

Nine-wave longitudinal study, with 6 months between each of the first eight waves and 1 year between the last two waves. Discontinuous, or piecewise, growth curve models were used to test the hypotheses that (a) the overall current/past 30-day ENDS use trajectory would decline from 2014 to spring 2017 but then increase from fall 2017 to 2019, and (b) the increasing trajectory from 2017 to 2019 would occur only for younger participants, but not older participants. All models included socio-demographic covariates of sex, race/ethnicity, type of college attended at baseline (2- or 4-year) and time-varying age.

SETTING AND PARTICIPANTS

A total of 5218 students (aged 18-25 years at baseline; 63.7% female) from 24 colleges in the five counties surrounding Austin, Dallas/Fort Worth, Houston and San Antonio, Texas, USA.

MEASUREMENTS

Participants completed on-line surveys regarding past 30-day ENDS use at all nine waves.

FINDINGS

Current ENDS use significantly declined from 2014 to spring 2017 [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.59-0.68], and then significantly increased from autumn 2017 to 2019 (OR = 1.14, 95% CI = 1.01-1.29). Further examination indicated the increase in current ENDS use from autumn 2017 to 2019 occurred only for younger [-1 standard deviation (SD) below the mean age, 22.6 years old], but not older (+1 SD above the mean age, 26.2 years old), participants.

CONCLUSION

The surge in the popularity of vape pods in the United States in late 2017 may have contributed to increasing use of electronic nicotine delivery systems among younger young adults (below 22.6 years) from late 2017 to 2019.

A Cross-Sectional Evaluation of Cigarette Smoking in the Brazilian Youth Population

Introduction: The transition from adolescence to adulthood involves a variety of physical, behavioral, and social transformations, often including tobacco use. Because understanding smoking at this stage is important for tobacco control, we aimed to analyze the prevalence of cigarette smoking in the Brazilian youth population. Methods: This study included participants aged 16-25 years from all Brazilian capitals. A standardized questionnaire was administered by trained healthcare professionals to collect information about sociodemographic status, sexual behavior, and tobacco use. The samples from each capital were weighted by age range and sex. Results: Of the 8,581 participants, 15.1% were current smokers, and 20.0% were former smokers; the average age at first tobacco use was 15.5 years. The prevalence of smoking in men was higher than that in women (20.1 vs. 10.3%, p < 0.01). Education level was associated with current smoking and former smoking. Participants with an elementary education level had a higher smoking prevalence (PR: 5.84, 95%, CI: 4.29-7.95) than those with a secondary education (PR: 2.19, 95% CI: 1.63-2.93) and those with higher education. Those without current partners (PR: 1.27, 95% CI: 1.03-1.56) also had a higher prevalence of smoking than those with partners, and participants who had a previous same-sex sexual experience smoked more (PR: 2.29, 95% CI: 1.78-2.96) than those who did not. In addition, regular use of alcohol was associated with higher prevalence of cigarette smoking (PR: 5.65, 95% CI: 4.03-7.90) than a lack of alcohol consumption. Skin color and socioeconomic class did not exhibit significant relationships with tobacco use patterns. Conclusions: Smoking was associated with education level regardless of social class, and some specific behaviors associated with a same-sex sexual experience were associated with a higher prevalence of smoking. These findings are important for formulating policies and directing actions to combat and prevent smoking among young populations.

Longitudinal Impact of Depressive Symptoms and Peer Tobacco Use on the Number of Tobacco Products Used by Young Adults

We examined the role of depressive symptoms in the longitudinal trajectory of the number of tobacco products used across young adulthood, ages 18-30 years, and whether peer tobacco use exacerbated the effects of the depressive symptoms. Participants were 4534 initially 18-25-year-old young adults in the Marketing and Promotions Across Colleges in Texas project (Project M-PACT), which collected data across a 4.5-year period from 2014 to 2019. Growth curve modeling within an accelerated design was used to test study hypotheses. Elevated depressive symptoms were associated with a greater number of tobacco products used concurrently and at least six months later. The number of tobacco-using peers moderated the association between depressive symptoms and the number of tobacco products trajectory. Young adults with elevated depressive symptoms used a greater number of tobacco products but only when they had a greater number of tobacco-using peers. Findings indicate that not all young adults with depressive symptoms use tobacco. Having a greater number of tobacco-using peers may facilitate a context that both models and encourages tobacco use. Therefore, tobacco prevention programs should aim to include peer components, especially for young adults.

Cigarette smoking frequency, quantity, dependence, and quit intentions during adolescence: Comparison of menthol and non-menthol smokers (National Youth Tobacco Survey 2017-2020)

BACKGROUND

Use of menthol cigarettes is linked to sustained cigarette smoking adults. However, the relationship between menthol and smoking profile has not been thoroughly explored in adolescent cigarette smokers. This study examines the relationship between use of menthol cigarette and smoking frequency (i.e., days per month), quantity (i.e., cigarettes per day), quit intentions, and nicotine dependence (i.e., craving tobacco; use within 30 min of waking).

METHODS

We pooled four years (2017-2020) of cross-sectional data from the National Youth Tobacco Survey. Participants were 2699 adolescent, past 30-day cigarette smokers. Multinomial logistic regression models examined the relationship between menthol and cigarette smoking frequency and quantity. Logistic regressions examined the relationship between menthol and intentions to quit smoking and nicotine dependence. Models controlled for socio-demographics and other tobacco use.

RESULTS

Menthol cigarette smokers had greater risk of smoking 20-30 days per month relative to 1-5 days per month (RRR: 1.90; 95% CI: 1.41 - 2.54) and greater risk of smoking 11+ cigarettes per day relative to 1 or less cigarettes per day (RRR: 1.35; 95% CI: 1.01 - 1.80), adjusting for covariates. Menthol cigarette smokers had lower odds of intentions to quit smoking (Adj OR: 0.70; 95% CI: 0.58 - 0.84) but great odds of craving tobacco (OR: 1.47; 95% CI: 1.20 - 1.81) and using tobacco within 30 minutes of waking (OR: 1.63; 95% CI: 1.29 - 2.05), adjusting for covariates CONCLUSION: Findings suggest the relationship between menthol and cigarette smoking profile (i.e., frequency, quantity, quit intentions) is different for youth than that of adults. This study adds adolescent-specific evidence to existing research that suggests menthol reinforces sustained cigarette smoking among youth.

Trends and Patterns of Tobacco and Nicotine Product Use Among Youth in Canada, England, and the United States From 2017 to 2019

PURPOSE

The tobacco and nicotine market is diversifying. Implications for public health will depend on trends in use, including overall use, and who is using these products. This study examined differences over time (2017-2019), across countries (Canada, England, the United States (US)), and by smoking and vaping, in use of other tobacco/nicotine products and overall use.

METHODS

The study includes online repeat cross-sectional surveys of youth aged 16-19 years in Canada (N = 11,714), England (N = 11,170), US (N = 11,838) in 2017, 2018, and 2019. Past 30-day use of tobacco/nicotine products (any, cigarette, e-cigarette, other combusted [cigars/cigarillos/waterpipe], other non-combusted [smokeless tobacco/nicotine replacement therapies) were examined by country, year, and, for other combusted and non-combusted products, past 30-day cigarette smoking and vaping. Use of emerging products (IQOS, nicotine pouches) was explored in 2018-2019.

RESULTS

From 2017 to 2019, use of any product increased in Canada (17.1%-23.2%, AOR = 1.07 [95% CI = 1.04-1.09]) and the US (18.0%-24.0%, AOR = 1.06 [1.04-1.09]) but not England (20.8%-21.7%, AOR = 1.01 [.99-1.03]). Use of other combusted products (cigars/cigarillos/waterpipe) showed little change (Canada: 8.1%-7.8%; England: 6.3%-7.3%; US: 8.6%-8.5%; p ≥ .151). Use of other non-combusted products (smokeless/nicotine replacement therapies) increased in all countries (Canada: 1.5%-3.2%, AOR = 1.02 [1.01-1.02]; England: 1.4%-2.6%, AOR = 1.02 [1.01-1.03]; US: 3.3%-4.9%, AOR = 1.02 [1.01-1.02]). Vaping increased in all countries (Canada: 8.4%-17.8%; England: 8.7%-12.6%; United States: 11.1%-18.5%; all p < .001). Smokers and vapers reported greater use of other combusted and non-combusted products than those who neither smoked/vaped (p < .001). Emerging product use was rare (≤1.5%).

CONCLUSIONS

Youth past 30-day tobacco and nicotine product use increased from 2017 to 2019 in Canada and the United States, largely due to increases in vaping and other non-combusted products. "Other" tobacco/nicotine products were used predominantly by youth who smoked cigarettes and/or vaped.

Exposure to cigar Point-of-Sale marketing and use of cigars and cigarettes among young adults

INTRODUCTION

Few studies examine the impact of objective exposure to point-of-sale (POS) marketing for cigars including little cigars and cigarillos (LCCs) on tobacco use. The present study aimed to examine the relationship between exposure to LCC marketing at the POS and current and future use of LCCs and cigarettes among young adult college students.

METHOD

Data on LCC and cigarette use from 4201 young adult students (mean age = 22.8 [SD = 2.3]; 35.9% non-Hispanic whites) attending 24 Texas colleges was linked to objective assessments of POS marketing at 220 tobacco retail outlets within one mile of the colleges. Multilevel logistic regression analyses examined the impact of LCC marketing at the POS on use of LCCs and cigarettes currently and 6-months later.

RESULTS

Participants were, on average, exposed to 43 LCC marketing materials per week. Results from cross-sectional analyses indicated that exposure to LCC POS marketing was associated with higher odds of current use of LCCs (AOR = 1.003, 95% CI = 1.0002, 1.0053) and cigarettes (AOR = 1.006, 95% CI = 1.0050, 1.0075). The relationship between LCC POS marketing exposure and LCC use was not significant in longitudinal models; however, exposure to LCC POS marketing at baseline did predict current cigarette use at 6-month follow-up (AOR = 1.004, 95% CI = 1.0021, 1.0052).

CONCLUSION

Findings suggest a substantial influence of LCC marketing exposure at the POS. Regulations on LCC marketing at the POS, especially around college campuses, should be considered.

Youth Vaping and Tobacco Use in Context in the United States: Results From the 2018 National Youth Tobacco Survey

INTRODUCTION

According to the National Youth Tobacco Survey (NYTS), youth e-cigarette use (vaping) rose between 2017 and 2018. Frequency of vaping and concurrent past 30-day (p30d) use of e-cigarettes and tobacco products have not been reported.

METHODS

We analyzed the 2018 NYTS (N = 20 189) for vaping among all students (middle and high school; 6-12th grades; 9-19 years old) by frequency of vaping, exclusive vaping, p30d poly-product use (vaping and use of one or more tobacco product), and any past tobacco product use.

RESULTS

In 2018, 81.4% of students had not used any tobacco or vapor product in the p30d, and 86.2% had not vaped in the p30d. Among all students, of the 13.8% vaped in the p30d, just over half vaped on ≤5 days (7.0%), and roughly a quarter each vaped on 6-19 days (3.2%) and on 20+ days (3.6%). Almost three quarters of p30d vapers (9.9%) reported past or concurrent tobacco use and the remainder (3.9%) were tobacco naïve. 2.8% of students were tobacco naïve and vaped on ≤5 days; 0.7% were tobacco-naïve and vaped on 6-19 days, and 0.4% were tobacco-naïve and vaped on 20+ days.

CONCLUSIONS

Vaping increased among US youth in 2018 over 2017. The increases are characterized by patterns of low p30d vaping frequency and high poly-product use, and a low prevalence of vaping among more frequent but tobacco naïve vapers.

IMPLICATIONS

Results underscore the importance of including the full context of use patterns. The majority of vapers (60.0%-88.9% by use frequency) were concurrent p30d or ever tobacco users. About 4% of students were tobacco naïve and vaped in the p30d, but few (0.4%) vaped regularly on 20 or more days. Reporting youth vaping data with frequency and tobacco product co-use will give public health decision-makers the best possible information to protect public health.

Body esteem, weight-control outcome expectancies, and e-cigarette use among young adults

INTRODUCTION

Evidence is still scarce regarding the use of e-cigarettes by young people for weight-control reasons. This study aimed to test a model in which the prospective association between negative body esteem and e-cigarette use is mediated by weight-control outcome expectancies for e-cigarette use. The model was tested across genders.

METHODS

Data were collected at three time points, 6 months apart, from 2327 young adults (mean age = 21.2; SD = 2.2; 54% women). Self-reported data were collected on demographics, body mass index, body esteem, weight-control outcome expectancies for e-cigarette use, and current e-cigarette use and cigarette smoking.

RESULTS

Among women, we found a significant indirect effect of lower body esteem on higher likelihood of current e-cigarette use 1 year later, mediated by higher weight-control outcome expectancies at 6-month follow-up, adjusting for demographics, body mass index, and baseline e-cigarette use and cigarette smoking. Among men, body esteem was not found to have significant effect on either weight-control expectancies or e-cigarette use.

CONCLUSIONS

Based on the current findings, young adult women who have higher negative body esteem are at increased risk for using e-cigarettes for weight-control motives.

IMPLICATIONS

The current findings are some of the first to show prospective associations among weight-control motives and e-cigarette use among young adults. These findings suggest that a group of vulnerable young women may be using e-cigarettes to lose or control weight. More research is needed to understand their choice of flavors, nicotine concentration, and device type. In addition, research is needed to understand whether e-cigarettes are being marketed, directly or indirectly, as being useful for weight loss or control. There may be a need for health promotion strategies that provide healthier alternatives to young women struggling with low body esteem who use e-cigarettes for weight loss or control.

Tobacco Magazine Advertising Impacts Longitudinal Changes in the Number of Tobacco Products Used by Young Adults

PURPOSE

The present study examined the longitudinal associations between exposure to tobacco advertisements in magazines popular among young adults and changes in the number of tobacco products used by young adults.

METHODS

Participants were 4,824 students from 24 Texas colleges participating in a longitudinal study. Tobacco advertisements in 11 magazines, collected from 2015 to 2017, were objectively assessed and young adults self-reported the frequency of reading each magazine on five biannual surveys from 2015 to 2017. The objective and self-reported measures were multiplied to create a tobacco advertisement exposure score. Growth curve models were used to determine if exposure to tobacco advertisements in magazines predicted changes in the number of tobacco products used across the 2-year period, controlling for sociodemographic factors, ever tobacco use, recall of tobacco advertisements on the internet, and personality characteristics.

RESULTS

Young adults with more exposure to tobacco advertisements reported a slower decline in the number of tobacco products they used across time.

CONCLUSIONS

Tobacco advertising in magazines contributes to the continuation of single-product and polyproduct use among young adults. Findings highlight the need for additional federal regulations limiting advertisements for all types of tobacco products in magazines, particularly those popular among young adults, the youngest legal targets of the tobacco industry.

Trends in E-Cigarette Use by Age Group and Combustible Cigarette Smoking Histories, U.S. Adults, 2014-2018

INTRODUCTION

The trends in e-cigarette prevalence and population count of users according to cigarette smoking histories are unknown. These data are needed to inform public health actions against a rapidly changing U.S. e-cigarette market.

METHODS

Data collected between 2014 and 2018 (analyzed in 2020) from cross-sectional, nationally representative National Health Interview Surveys were used to estimate current e-cigarette prevalence, adjusted prevalence differences (percentage points), and population counts of users. Analyses were stratified by age group (younger, 18-29 years, n=25,445; middle age, 30-49 years, n=47,745; older, ≥50 years, n=79,517) and cigarette smoking histories (current smokers, recent quitters [quit <1 year ago], near-term quitters [quit 1-8 years ago], long-term quitters [quit >8 years ago], never smokers).

RESULTS

Among younger adults, e-cigarette use increased in all groups of smokers, with notable increases between 2014 and 2018 among never smokers (1.3%-3.3%, adjusted prevalence difference=2%, p<0.001) and near-term quitters (9.1%-19.2%, adjusted prevalence difference=8.8%, p=0.024). Conversely, the only substantial increase in e-cigarette use between 2014 and 2018 among middle-aged (5.8%-14.4%, adjusted prevalence difference=8.2%, p<0.001) and older (6.3%-9.5%, adjusted prevalence difference=3.3%, p=0.045) adults was among near-term quitters. The largest absolute population increase in e-cigarette users between 2014 and 2018 was among younger-adult never smokers (0.49-1.35 million), followed by near-term quitters among middle-aged (0.36-0.95 million), younger (0.23-0.57 million), and older (0.35-0.50 million) adults.

CONCLUSIONS

The continuous increase among younger-adult never smokers suggests a rise in primary nicotine initiation with e-cigarettes. The concomitant increase among near-term quitters of all age groups suggests continuing e-cigarette use among smokers who may have switched from cigarettes previously.

Social media's influence on e-cigarette use onset and escalation among young adults: What beliefs mediate the effects?

As an extension of a previous cross-sectional study, this study employed prospective data to test positive outcome expectancy beliefs as mediators of social media's influence on e-cigarette use progression among young adults. Self-report data were collected from 2327 young adult college students (Mean age = 21.2; SD = 2.1; 54% women) between 2017 and 2019, every 6-month, at 3 time-points. Structural equation modeling was used to test the mediational models. Among baseline never e-cigarette users, higher affect regulation expectancies-e.g., beliefs that e-cigarette use results in feeling good, reduced boredom and stress-mediated the effects of higher baseline social media e-cigarette exposure on e-cigarette use onset one year later. Among baseline lifetime e-cigarette users, higher positive sensory, positive "smoking" experience, and affect regulation expectancy beliefs mediated the effects of higher social media e-cigarette exposure at baseline on increased current e-cigarette use one year later. E-cigarette content on social media may persuade young adults to try e-cigarettes by imparting the sense that e-cigarettes make one feel good and help reduce stress. E-cigarette content on social media that promote e-cigarette flavors and e-cigarettes as cleaner and a socially more acceptable alternative to cigarettes may work to escalate e-cigarette use among experimenters. Efforts to prevent e-cigarette use onset and escalation may need to target the outcome expectancy beliefs influenced by social media.

Predictors of marijuana vaping onset and escalation among young adults

BACKGROUND

Little is known about factors that influence marijuana vaping among young people. We examined cigarette, e-cigarette and marijuana use experiences, social network characteristics and exposure to direct e-cigarette marketing as predictors of marijuana vaping initiation and escalation.

METHODS

One-year prospective data were collected between 2017 and 2019 from 2327 young adults (Mean age = 21.2; SD = 2.1; 54 % women) attending 2-year and 4-year colleges in Hawaii.

RESULTS

Among participants who were never marijuana users at baseline, being a dual user of cigarette and e-cigarette at baseline was the strongest predictor of marijuana vaping initiation, followed by baseline cigarette-only and e-cigarette-only use. Higher prevalence of regular marijuana users in one's social networks, but not e-cigarette users or cigarette smokers, significantly predicted marijuana vaping initiation a year later. Among baseline current e-cigarette users and lifetime marijuana users, higher presence in social networks of individuals who frequented vape shops at baseline was a significant predictor of increased current marijuana vaping at one-year follow-up.

CONCLUSIONS

Dual use of cigarette and e-cigarette and greater presence in social networks of marijuana users and people who frequent vape shops appear to be robust predictors of marijuana vaping onset and escalation among young adults. In addition to promoting e-cigarette use prevention/cessation, efforts to control marijuana vaping may need to consider promoting smoking prevention/cessation and the effects of increasing prevalence of marijuana use.

Young Adult Tobacco and E-cigarette Use Transitions: Examining Stability Using Multistate Modeling

INTRODUCTION

The objective of this study was to describe tobacco and nicotine product use state transition probabilities among youth and young adults over time.

METHODS

A national sample of young adult tobacco product users and nonusers between the ages of 18 and 34 years at baseline was surveyed at 6-month intervals for 3 years. Use and nonuse states were defined as mutually exclusive categories based on self-reported, past 30-day use of the various products. Never use, noncurrent use, and current use of combustible, noncombustible tobacco, and electronic cigarette (e-cigarette) products was assessed at each interval. A multistate model was fit to estimate transition probabilities between states and length of stay within each state.

RESULTS

After 6 months, same-state transition probabilities were high for all use states (0.76-0.96), except for dual product use (0.48). After 3 years, transition probabilities were smaller and tended to converge toward combustible product use for baseline e-cigarette (0.42), combustible (0.51), and dual product users (0.52). Age was inversely associated with transition risk from never or noncurrent use to use of combustible or e-cigarette products.

CONCLUSIONS

Never and noncurrent users, followed by combustible product users, were most likely to remain in those states throughout the 3-year observation interval. Users of any tobacco or e-cigarette product at baseline were most likely to transition to combustible product use or noncurrent use by the final follow-up.

IMPLICATIONS

This study describes the probability of transitioning between various states of tobacco product use, including never and no current use, over a span of 3 years in a sample of young adults. This type of longitudinal description, which includes all tobacco product use states, is lacking in most studies that tend to focus on one or only a few products. The results suggest that it is important to assess outcomes over a sufficiently long period to capture true variability in patterns of product use.

Addiction vs. dependence: A mixed methods analysis of young adult JUUL users

OBJECTIVE

JUUL-brand electronic cigarettes (e-cigarettes) contain higher levels of nicotine than other e-cigarettes. The current study examined the relationship between young adults' self-reported addiction and measured JUUL dependence.

METHODS

This study used a sequential, explanatory mixed methods design. Data were collected from a large, southwestern college in the US. College students who were weekly JUUL users and owned a JUUL device (n = 595) completed a cross-sectional online survey, then a subsample (n = 51) participated in in-person interviews. All data were collected between March-April 2019. T-tests were used to examine differences between JUUL dependence and self-reported addiction, and logistic regressions were employed to examine factors that may influence self-reported addiction to JUUL, nicotine, and other e-cigarettes. Interviews were independently coded by 2 coders (kappa ranged from 0.46 to 0.99) then analyzed for corresponding themes.

RESULTS

Participants who had a higher JUUL dependence were more likely to report addiction to several substances/products, including nicotine, JUULs, cigarettes, other e-cigarettes, alcohol, and marijuana. Interview participants minimized JUUL addiction by comparing JUUL to other socially acceptable addictions and describing JUUL addiction as a habit. Interview participants suggested addiction to nicotine was more stigmatizing than JUUL. The number of days participants used JUUL per week, use of traditional tobacco products, and measured JUUL dependence were each associated with self-reported JUUL addiction.

CONCLUSIONS

Social construction of self-reported addictions may be changing young audiences' views of addiction to JUUL. Research is needed to see if using the phrase 'nicotine dependence' rather than 'JUUL addiction' influences young adults' JUUL use.

Differential Trends in Hookah Use Among New Jersey Youth

Introduction

Use of 2 or more types of tobacco products is common among youth and young adults, highlighting the need for monitoring and intervention activities to encompass products beyond combustible cigarettes. This study documented patterns and trends of ever, current, and frequent hookah use among high school students in New Jersey by other tobacco product use status.

Methods

We analyzed data from the 2008, 2010, 2012, 2014, 2016 waves of the New Jersey Youth Tobacco Survey. Point estimates and 95% confidence intervals described hookah use stratified by use of other tobacco products. Multivariable logistic regression models assessed trends and correlates of hookah use, controlling for the use of other tobacco products and users’ sociodemographic characteristics. Negative binomial regression models examined the association between total number of tobacco products used and hookah use while controlling for sociodemographic variables and survey year.

Results

The adjusted odds of current and frequent hookah use among New Jersey high school students were significantly higher in 2014, but not in 2016, compared to 2008. In recent years, hookah use among students who had ever smoked hookah, currently smoked hookah, or frequently smoked hookah was more common among students who had ever or currently smoked cigarettes or e-cigarettes. Hookah users consumed a wider variety of other tobacco products than those who did not use hookah.

Conclusion

Hookah use remains a public health concern for adolescents; it is more common among users of other tobacco products, especially cigarette and e-cigarette smokers. Questions remain as to whether users of multiple tobacco products are being adequately reached by existing policies and regulations.