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Shadel WG, Martino SC, Setodji CM, Dunbar M, Jenson D, Wong JC, Falgoust G. Doing more with less: A proposal to advance cigarette packaging regulations in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104308. [PMID: 38184903 PMCID: PMC10939880 DOI: 10.1016/j.drugpo.2023.104308] [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: 07/06/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
Cigarette packages are potent marketing tools. Following guidance from the WHO Framework Convention on Tobacco Control, many countries have sought to diminish this marketing power by mandating that (1) large graphic health warnings be affixed to the packages (i.e., text warnings combined with graphic images of the health consequences of smoking) and (2) all packages be fully "plain" in their design (i.e., all packages use the same drab/bland color and font type; no brand logos, other colors, or designs are permitted). Yet, the United States lags other countries in implementing regulations designed to blunt the marketing power of cigarette packages. This is not because of a lack of effort on the part of the Food and Drug Administration, the main governmental body charged with regulating tobacco products in the United States. Rather, it is because the regulatory options that that have been advanced in the country (e.g., graphic health warnings) have not been found - yet - to be legally feasible by its courts. This commentary works through some of the conceptual, practical, and legal issues regarding packaging regulations in the United States. It considers the political and bureaucratic risks involved with issuing new regulations. The overall intent is to prompt our field to think creatively about what is realistic in this regulatory space and to offer a novel perspective that may help move the United States tobacco control community forward in its efforts to reduce the promotional power of cigarette packages.
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Affiliation(s)
- William G Shadel
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States.
| | - Steven C Martino
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Claude M Setodji
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Michael Dunbar
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, MN 55105, United States
| | - Jody Cs Wong
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Grace Falgoust
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
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Vargees C, Stroup AM, Niznik T, Dunn D, Wyatt R, Hoetger C, Taleb ZB, Cohn AM, Cobb CO, Fetterman JL. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review. BMC Public Health 2023; 23:2357. [PMID: 38017396 PMCID: PMC10685631 DOI: 10.1186/s12889-023-17216-z] [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: 08/16/2022] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.
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Affiliation(s)
- Comreen Vargees
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA
| | | | - Taylor Niznik
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
- Institute for Integrative Health Care and Health Promotion (IGVF), Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA.
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Blackwell AKM, Pilling MA, De-Loyde K, Morris RW, Brocklebank LA, Marteau TM, Munafò MR. Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study. Tob Control 2023; 32:e220-e227. [PMID: 35418506 PMCID: PMC10423515 DOI: 10.1136/tobaccocontrol-2021-056980] [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: 08/12/2021] [Accepted: 03/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate the impact of electronic cigarette (e-cigarette) retail display exposure on attitudes to smoking and vaping (susceptibility to tobacco smoking and using e-cigarettes, and perceptions of the harms of smoking and e-cigarette use). DESIGN Between-subjects randomised experiment using a 2 (e-cigarette retail display visibility: high vs low)×2 (proportion of e-cigarette images: 75% vs 25%) factorial design. SETTING Online via the Qualtrics survey platform. PARTICIPANTS UK children aged 13-17 years (n=1034), recruited through a research agency. INTERVENTION Participants viewed 12 images of retail displays that contained e-cigarette display images or unrelated product images. E-cigarette display images were either high or low visibility, based on a conspicuousness score. Participants were randomised to one of four groups, with e-cigarette display visibility and proportion of e-cigarette images, compared with images of unrelated products, manipulated: (1) 75% e-cigarettes, high visibility; (2) 25% e-cigarettes, high visibility; (3) 75% e-cigarettes, low visibility; (4) 25% e-cigarettes, low visibility. MAIN OUTCOME MEASURES The primary outcome was susceptibility to smoking (among never smokers only). Secondary outcomes were susceptibility to using e-cigarettes (among never vapers only), and perceptions of smoking and e-cigarette harm (all participants). RESULTS Neither e-cigarette retail display visibility, nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to smoking (visibility: OR=0.84, 95% CI 0.62 to 1.13, p=0.24; proportion: OR=1.34, 95% CI 1.00 to 1.82, p=0.054 (reference: low visibility, not susceptible)).Planned subgroup analyses indicated that exposure to a higher proportion of e-cigarette images increased susceptibility to smoking among children who visited retail stores more regularly (n=524, OR=1.59, 95% CI 1.04 to 2.43, p=0.034), and those who passed the attention check (n=880, OR=1.43, 95% CI 1.03 to 1.98, p=0.031).In addition, neither e-cigarette retail display visibility nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to using e-cigarettes (visibility: OR=1.07, 95% CI 0.80 to 1.43, p=0.65; proportion: OR=1.22, 95% CI 0.91 to 1.64, p=0.18).Greater visibility of e-cigarette retail displays reduced perceived harm of smoking (mean difference (MD)=-0.19, 95% CI -0.34 to -0.04, p=0.016). There was no evidence that the proportion of e-cigarette images displayed had an effect (MD=-0.07, 95% CI -0.22 to 0.09, p=0.40).Perceived harm of e-cigarette use did not appear to be affected by e-cigarette retail display visibility (MD=-0.12, 95% CI -0.28 to 0.05, p=0.16) or by the proportion of e-cigarette images displayed (MD=-0.10, 95% CI -0.26 to 0.07, p=0.24). CONCLUSIONS There is no evidence in the full sample to suggest that children's susceptibility to smoking is increased by exposure to higher visibility e-cigarette retail displays, or to a higher proportion of e-cigarette images. However, for regular store visitors or those paying more attention, viewing a higher proportion of e-cigarette images increased susceptibility to smoking. In addition, viewing higher visibility e-cigarette images reduced perceived harm of smoking. A review of the current regulatory discrepancy between tobacco and e-cigarette point-of-sale marketing is warranted. TRIAL REGISTRATION NUMBER ISRCTN18215632.
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Affiliation(s)
| | - Mark A Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Katie De-Loyde
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Richard W Morris
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Laura A Brocklebank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
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Phan L, Mays D, Tercyak KP, Johnson AC, Rehberg K, Lipkus IM. Initial development of the Hookah Smoker Scale: Assessing young adults' mental schemas about hookah "smokers". Transl Behav Med 2021; 11:206-215. [PMID: 31722424 DOI: 10.1093/tbm/ibz155] [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: 11/12/2022] Open
Abstract
Many young adult hookah tobacco users do not consider themselves hookah "smokers," but data on this topic are limited. There are no existing measures of young adults' mental schemas of hookah "smokers." We examined the factor structure and reliability of the Hookah Smoker Scale and examined associations with perceived harm and addictiveness and attitudes toward hookah. Two hundred and forty-six young adult (ages 18-30) hookah smokers participated in a cross-sectional online study. Participants completed items assessing schemas characterizing hookah smokers and valid measures of perceived harm and addictiveness of hookah smoking, risk appraisals, and attitudes toward hookah. Exploratory factor analysis using principal axis factoring with oblique rotation extracted a 12-item scale with three dimensions (Regular Use, Social-Enabled Use, and Self-Enabled Use). The scale explained 69.7% of the variance (eigenvalue = 9.2). Cronbach's α for the scale was .89, with Cronbach's α ≥ .80 for four-item subscales. Higher subscale scores indicate stronger beliefs that the dimension characterizes a hookah smoker. Higher Regular Use scores (score variance = 46.9%; eigenvalue = 5.6) were associated with greater perceived harm and addictiveness (β = 0.21, p = .01), greater risk appraisals (β = 0.20, p = .02), and more negative attitudes toward hookah (β = -0.18, p = .03). The Hookah Smoker Scale is a promising measure that can be used to identify targets for preventing and reducing young adults' hookah tobacco use. Findings also suggest young adults associate health risks of hookah with daily smoking, but not with intermittent social smoking patterns.
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Affiliation(s)
- Lilianna Phan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Darren Mays
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth P Tercyak
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Johnson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
| | - Kathryn Rehberg
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Berg CJ, Haardörfer R, Lanier A, Childs D, Foster B, Getachew B, Windle M. Tobacco Use Trajectories in Young Adults: Analyses of Predictors Across Systems Levels. Nicotine Tob Res 2021; 22:2075-2084. [PMID: 32170324 DOI: 10.1093/ntr/ntaa048] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/11/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Research is needed to examine trajectories of tobacco use beyond cigarette smoking, particularly during emerging middle young adulthood, and to identify distinct multilevel influences of use trajectories. AIMS AND METHODS We examined (1) tobacco use trajectories over a 2-year period among 2592 young adult college students in a longitudinal cohort study and (2) predictors of these trajectories using variables from a socioecological framework, including intrapersonal-level factors (eg, sociodemographics, psychosocial factors [eg, adverse childhood experiences, depressive symptoms, and attention-deficit hyperactivity disorder symptoms], early-onset substance use), interpersonal factors (eg, social support, parental substance use), and community-level factors (eg, college type, rural vs. urban). RESULTS About 64.5% were female and 65.0% were white. From age 18 to 26, 27%-31% of participants reported past 30-day use of any tobacco product. We identified four trajectory classes: Abstainers/Dabblers who never or infrequently used (89.2%); Adult users who began using frequently around age 20 and continued thereafter (5.9%); College Smokers who began using before 19 but ceased use around 25 (2.5%); and Teenage users who used during their teenage years but ceased use by 22 (1.9%). Multinomial regression showed that, compared to Abstainers/Dabblers, significant predictors (p < .05) of being (1) Adult users included being male, earlier onset marijuana use, attending public universities or technical colleges (vs. private universities), and living in urban areas; (2) College users included being male, earlier onset marijuana use, and parental alcohol or marijuana use; and (3) Teenage users included only earlier onset marijuana use. CONCLUSION Distinct prevention and intervention efforts may be needed to address the trajectories identified. IMPLICATIONS Among young adult college students, the largest proportion of tobacco users demonstrate the risk of continued and/or progression of tobacco use beyond college. In addition, specific factors, particularly sex, earlier onset marijuana use, parental use of alcohol and marijuana, and contextual factors such as college setting (type of school, rural vs. urban) may influence tobacco use outcomes. As such, prevention and cessation intervention strategies are needed to address multilevel influences.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Donyale Childs
- Department of Nursing, Albany State University, Albany, GA
| | - Bruce Foster
- Student Support Services, Central Georgia Technical College, Macon, GA
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
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Leavens ELS, Lechner WV, Stevens EM, Miller MB, Meier E, Brett EI, Moisiuc A, Hale JJ, Wagener TL. Electronic cigarette and combustible cigarette use following a campus-wide ban: Prevalence of use and harm perceptions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:332-335. [PMID: 30681933 PMCID: PMC8689442 DOI: 10.1080/07448481.2018.1551803] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/29/2018] [Accepted: 11/12/2018] [Indexed: 05/29/2023]
Abstract
The current study examined changes in prevalence of e-cigarette use and perceptions of the harmfulness of e-cigarette and combustible cigarettes following a campus-wide tobacco ban. Undergraduate students completed surveys of tobacco use and perceived product harmfulness. Four samples were collected: in 2013 prior to the ban (n = 792) and in fall 2014 (n = 310), 2015 (n = 208), and 2016 (n = 417). E-cigarette use increased in the years following the ban (p = .01) while combustible cigarette use decreased from 2013 to 2016 (p = .02). Men were more likely than women to use both products (ps < .05). Students' perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban (p > .05). This study is the first to examine the impact of including e-cigarettes in tobacco free policies. Combustible cigarette use declined, but e-cigarette use increased in the years following the e-cigarette ban. Prospective research is needed to understand the long-term impacts of e-cigarette bans.
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Affiliation(s)
- Eleanor L. S. Leavens
- Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA
- Oklahoma State University, Stillwater, Stillwater, Oklahoma, USA
| | | | | | - Mary Beth Miller
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ellen Meier
- University of Wisconsin - Stevens Point, Stevens Point, Wisconsin, USA
| | - Emma I. Brett
- Oklahoma State University, Stillwater, Stillwater, Oklahoma, USA
| | - Alexis Moisiuc
- Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA
| | - Jessica J. Hale
- Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA
| | - Theodore L. Wagener
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Vasiljevic M, St John Wallis A, Codling S, Couturier DL, Sutton S, Marteau TM. E-cigarette adverts and children's perceptions of tobacco smoking harms: an experimental study and meta-analysis. BMJ Open 2018; 8:e020247. [PMID: 30012646 PMCID: PMC6082488 DOI: 10.1136/bmjopen-2017-020247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Children exposed to electronic cigarette (e-cigarette) adverts may perceive occasional tobacco smoking as less harmful than children not exposed to e-cigarette adverts. Given the potential cross-cueing effects of e-cigarette adverts on tobacco smoking, there is an urgent need to establish whether the effect found in prior research is robust and replicable using a larger sample and a stronger control condition. DESIGN A between-subjects experiment with one independent factor of two levels corresponding to the advertisements to which participants were exposed: glamorous adverts for e-cigarettes, or adverts for objects unrelated to smoking or vaping. PARTICIPANTS English school children aged 11-16 (n=1449). OUTCOMES Perceived harm of occasional smoking of one or two tobacco cigarettes was the primary outcome. Secondary outcomes included: perceived harm of regular tobacco smoking, susceptibility to tobacco smoking and perceived prevalence of tobacco smoking in young people. Perceptions of using e-cigarettes were gauged by adapting all the outcome measures used to assess perceptions of tobacco smoking. RESULTS Tobacco smokers and e-cigarette users were excluded from analyses (final sample n=1057). Children exposed to glamorous e-cigarette adverts perceived the harms of occasional smoking of one or two tobacco cigarettes to be lower than those in the control group (Z=-2.13, p=0.033). An updated meta-analysis comprising three studies with 1935 children confirmed that exposure to different types of e-cigarette adverts (glamorous, healthful, flavoured, non-flavoured) lowers the perceived harm of occasional smoking of one or two tobacco cigarettes (Z=3.21, p=0.001). CONCLUSIONS This study adds to existing evidence that exposure to e-cigarette adverts reduces children's perceptions of the harm of occasional tobacco smoking.
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Affiliation(s)
- Milica Vasiljevic
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Amelia St John Wallis
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Saphsa Codling
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Stephen Sutton
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Lechner WV, Murphy CM, Colby SM, Janssen T, Rogers ML, Jackson KM. Cognitive risk factors of electronic and combustible cigarette use in adolescents. Addict Behav 2018; 82:182-188. [PMID: 29549801 DOI: 10.1016/j.addbeh.2018.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/03/2018] [Accepted: 03/04/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cognitive susceptibility to cigarette smoking has been demonstrated to predict future cigarette initiation in adolescents. Examining this construct prior to tobacco product initiation may provide useful information on the differential risk of individuals initiating cigarette vs. e-cigarette products. Additionally, examining how susceptibility and tobacco product use relate to perceived harm cognitions will increase understanding of risk predisposition among adolescents. METHOD Data were taken from a longitudinal study of middle school students (n = 1023; age = 12.1, 52.2% female, 72.1% white) in the Northeastern U.S. Likelihood of e-cigarette and cigarette ever-use in high school was examined as a function of a validated index of cigarette smoking susceptibility among tobacco naïve students in middle school. Prospective associations between cognitive susceptibility to smoking and subsequent perceived harm of e-cigarettes (assessed in high school), and cross-sectional associations between concurrent tobacco product ever-use status and perceived harm of e-cigarettes were examined. RESULTS Adolescents classified as susceptible to cigarette smoking in middle school were more likely to initiate use of cigarettes (OR = 2.53) and e-cigarettes (OR = 1.95) as compared to adolescents classified as non-susceptible; cigarette smoking susceptibility did not differentially predict use of one product over the other. Adolescents endorsing e-cigarette use, reported significantly less perceived harm associated with e-cigarettes vs. cigarettes, while those who endorsed cigarette only or dual use did not. CONCLUSION Our data indicate that cognitive susceptibility to cigarette smoking may index a broad risk factor for using either cigarettes or e-cigarettes in the future, and is prospectively associated with perceived harm of e-cigarette use. Overall, those who used any tobacco product perceived e-cigarettes as less harmful when compared to abstainers. Individual facets of perceived harm (addiction potential and harm vs. cigarettes) differ between cigarette only users and e-cigarette users and may help to explain the choice to use one product vs. the other. IMPLICATIONS This is the first study to examine prospective associations between cognitive susceptibility to cigarette smoking, predating tobacco use, and subsequent likelihood of cigarette vs. e-cigarette initiation. This study demonstrates that initiation of either product is elevated among youth who are susceptible to smoking; thus susceptibility to smoking may serve as a useful marker of vulnerability to tobacco product use. Furthermore, this study provides novel information on the relationship between tobacco product onset and specific harm perceptions associated with e-cigarettes versus cigarettes among adolescents.
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Cooper M, Loukas A, Case KR, Marti CN, Perry CL. A longitudinal study of risk perceptions and e-cigarette initiation among college students: Interactions with smoking status. Drug Alcohol Depend 2018; 186:257-263. [PMID: 29626778 PMCID: PMC5911205 DOI: 10.1016/j.drugalcdep.2017.11.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/10/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent data suggest that lower perceived risks of e-cigarettes are associated with e-cigarette use in young adults; however, the temporality of this relationship is not well-understood. We explore how perceptions of harmfulness and addictiveness of e-cigarettes influence e-cigarette initiation, and specifically whether this association varies by cigarette smoking status, in a longitudinal study of tobacco use on college campuses. METHODS Data are from a 5-wave 24-college study in Texas. Only students who reported never using e-cigarettes at wave 1 were included (n = 2565). Multilevel discrete-time hazard models, accounting for school clustering, were used. The dependent variable, ever e-cigarette use, was assessed at each wave. Both time-varying (e-cigarette perceptions of harmfulness and addictiveness, age, use of cigarettes, use of other tobacco products, and use of other substances) and time-invariant demographic covariates were included. Two-way interactions between each e-cigarette perception variable and current conventional cigarette use were tested to determine if the hypothesized relationship differed among smokers and non-smokers. RESULTS 21% of all never e-cigarette users at baseline had initiated e-cigarette ever use by wave 5. Significant two-way interactions qualified the relationship between risk perceptions and e-cigarette initiation. Specifically, perceptions of a lower degree of harmfulness (OR = 1.13, p = .047) and addictiveness (OR = 1.34, p < .001) of e-cigarettes predicted initiation among non-smokers, but not among current smokers. CONCLUSION Perceiving a lower degree of risk of e-cigarettes contributes to subsequent e-cigarette initiation among non-smokers, but not among current smokers. FINDINGS have implications for prevention campaigns focusing on the potential harm of e-cigarettes for non-smoking college students.
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Affiliation(s)
- Maria Cooper
- Michael and Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA.
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd, Austin, TX 78712, USA.
| | - Kathleen R Case
- Michael and Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA.
| | - C Nathan Marti
- Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd, Austin, TX 78712, USA.
| | - Cheryl L Perry
- Michael and Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA.
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Ioverno S, Baiocco R, Laghi F, Verrastro V, Odorifero C, Dittrich M. Interpersonal and Intrapersonal Differences among Adolescent Nonsmokers, Ex-Smokers, and Smokers. Subst Use Misuse 2018; 53:606-609. [PMID: 28910178 DOI: 10.1080/10826084.2017.1349801] [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: 10/18/2022]
Abstract
BACKGROUND A large body of research has traced tobacco dependence among adolescents to a series of intrapersonal and interpersonal factors. However, there are remaining questions regarding the differences on these factors related to tobacco use. OBJECTIVES We sought to investigate intrapersonal and interpersonal differences among adolescent nonsmokers, ex-smokers, and smokers. METHODS We used data from a 3-year project designed to investigate and address tobacco dependence among 1071 students (Mage = 15.76, SD = 1.52; girls = 51.54%) who were recruited from 11 high schools. Participants, filling out a survey, provided information on tobacco use (nonsmoker, ex-smoker, and smoker), tobacco-related experiences (smoking-related risk perception, parental smoking, number of friends who smoke, resisting peer pressure to smoke), cognitive variables (metacognitive skills), and personality traits (disinhibition and impulsivity). RESULTS Results from a discriminant function analysis showed that smokers and ex-smokers reported more disinhibition, impulsivity, number of friends who smoke and less self-control under peer pressure to smoke compared to nonsmokers. Ex-smokers reported less metacognitive processes, more smoking-related risk perception and were less likely to have parents who smoke. Conclusions/Importance: Interventions and campaigns aimed to persuade adolescents to stop smoking should work to develop adaptive metacognitive skills and an accurate risk perception of tobacco use.
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Affiliation(s)
- Salvatore Ioverno
- a Department of Social and Developmental Psychology , Sapienza University of Rome , Rome , Italy
| | - Roberto Baiocco
- a Department of Social and Developmental Psychology , Sapienza University of Rome , Rome , Italy
| | - Fiorenzo Laghi
- a Department of Social and Developmental Psychology , Sapienza University of Rome , Rome , Italy
| | - Valeria Verrastro
- b Department of Humanities and Social Sciences , University of Cassino , Cassino , Frosinone , Italy
| | - Carmen Odorifero
- c Primary Prevention Department , Italian League against Cancer, Milan Division , Milan , Italy
| | - Marcella Dittrich
- c Primary Prevention Department , Italian League against Cancer, Milan Division , Milan , Italy
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Peña-Purcell NC, Rahn RN, Atkinson TD. Assessing College Students’ Perceptions About Cigarette Smoking: Implications for Prevention. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1428701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Vu M, Getachew B, Payne JB, Kirchner TR, Berg CJ. Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative study. Tob Prev Cessat 2018; 4. [PMID: 30272039 PMCID: PMC6159942 DOI: 10.18332/tpc/84869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diverse non-cigarette alternative tobacco products are increasingly popular in the United States. This study investigates the reasons why young adults initiate and continue the use of these products, as well as potential motivations and approaches for quitting. Products assessed include cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, e-cigarettes, and hookahs. METHODS We conducted 60 telephone interviews, of 30-minute duration, with tobacco users enrolled in colleges in Georgia. Qualitative analysis was used to identify themes emerging from the data. RESULTS Reasons for initiation, continued use, and (potential) cessation showed similarities and differences across products. Most commonly cited reasons for initiation included: peer influence (all products), flavors/tastes (all products except cigarettes), and easy environmental access and/or low costs (LCCs, smokeless tobacco, and e-cigarettes). Participants discussed several influences on continued use, such as peer influence (cigarettes, LCCs, and hookahs), stress management (all products except hookahs), and use with other substances (cigarettes, LCCs, and hookahs). Primary motivations for cessation mentioned by participants were family responsibilities (cigarettes, e-cigarettes, and hookahs) and health concerns (all products except e-cigarettes). Frequently used cessation strategies included avoidance of other tobacco users (cigarettes, LCCs, and hookahs) and a reduction of nicotine intake (cigarettes and e-cigarettes). CONCLUSIONS Our findings suggest that researchers should consider the differences in reasons for use and discontinued use of tobacco products in order to develop targeted messaging strategies, particularly noting the differential impact of interpersonal influences and health concerns. We also point to a need for regulatory action that limits diversification and accessibility of different products.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, United States
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, United States
| | - Jackelyn B Payne
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, United States
| | - Thomas R Kirchner
- College of Global Public Health, New York University, New York City, United States
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, United States
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Berg CJ, Payne J, Henriksen L, Cavazos-Rehg P, Getachew B, Schauer GL, Haardörfer R. Reasons for Marijuana and Tobacco Co-use Among Young Adults: A Mixed Methods Scale Development Study. Subst Use Misuse 2018; 53:357-369. [PMID: 28792283 PMCID: PMC5890801 DOI: 10.1080/10826084.2017.1327978] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Marijuana-tobacco co-use has increased recently, particularly in young adults. OBJECTIVES We conducted a mixed-methods study to: (1) examine reasons for co-use; and (2) develop a scale assessing reasons for co-use among participants in a longitudinal cohort study of 3,418 students aged 18-25 from 7 Georgia colleges and universities. METHODS Phone-based semi-structured interviews were conducted in Summer 2015 among 46 current (past 30-day, n = 26) or lifetime (n = 20) marijuana users. Subsequently, scale items were developed and included at Wave 3. Participants reporting past 4-month tobacco and marijuana use (n = 328) completed the Reasons for Marijuana-Tobacco Co-use section. RESULTS Per qualitative data, reasons for marijuana-tobacco co-use included synergistic effects, one triggering or preceding the other's use, using one to reduce the other's use, co-administration, social context, and experimentation. The survey subsample included 37.1% who used cigarettes, 30.4% LCCs, 9.4% smokeless, 23.7% e-cigarettes, and 30.4% hookah. Four subscale factors emerged: (1) Instrumentality, indicating synergistic effects; (2) Displacement, indicating using one product to reduce/quit the other; (3) Social context, indicating use in different settings/social situations; and (4) Experimentation, indicating experimentation with both but no specific reasons for co-use. These subscales demonstrated distinct associations with tobacco type used; nicotine dependence; marijuana and alcohol use frequency; tobacco and marijuana use motives, respectively; perceptions of tobacco and marijuana; and parental and friend use. Including these subscales in regressions predicting nicotine dependence and days of marijuana use significantly contributed to each model. CONCLUSIONS These findings might inform theoretical frameworks upon which marijuana-tobacco co-use occurs and direct future intervention studies.
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Affiliation(s)
- Carla J Berg
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
| | - Jackelyn Payne
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
| | - Lisa Henriksen
- b Stanford Prevention Research Center, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
| | - Patricia Cavazos-Rehg
- c Department of Psychiatry , Washington University School of Medicine in St. Louis , St. Louis , Missouri , USA
| | - Betelihem Getachew
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
| | - Gillian L Schauer
- d Department of Health Services, School of Public Health , University of Washington , Seattle , Washington , USA
| | - Regine Haardörfer
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
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14
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Measuring youth beliefs about the harms of e-cigarettes and smokeless tobacco compared to cigarettes. Addict Behav 2017; 70:7-13. [PMID: 28160661 DOI: 10.1016/j.addbeh.2017.01.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/11/2017] [Accepted: 01/24/2017] [Indexed: 11/23/2022]
Abstract
This study examined validity of direct and indirect measures of perceived harm of e-cigarettes and smokeless tobacco (SLT) compared to cigarettes. On direct measures, people compare one product to another, whereas on indirect measures, people rate each product separately and the researcher compares these ratings. Data from youth in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2014) were analyzed (N=13,651 youth aged 12-17years). The study included direct measures of perceived harm of e-cigarettes and SLT compared to cigarettes, and indirect measures were created by comparing ratings of the products. Weighted multinomial logistic regressions tested criterion validity by assessing whether direct and indirect measures were associated with criterion variables, including use of e-cigarettes and SLT. Youth were more likely to rate e-cigarettes as less harmful than cigarettes on the indirect measure (67.3%) than the direct measure (50.2%). The same pattern held for ratings of SLT as less harmful than cigarettes (indirect: 29.7%; direct: 11.7%). Direct measures explained unique variance in product use criterion variables even after adjusting for indirect measures, as did indirect measures after adjusting for direct measures. However, the criterion variables were more often associated with the direct measures than the indirect measures. Results offer preliminary support for using both direct and indirect measures when assessing youth's perceived relative harm of various types of products. However, if researchers cannot include both direct and indirect measures in a study, associations with product use criterion variables support prioritizing direct measures.
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Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med 2017; 96:73-78. [PMID: 28024859 PMCID: PMC5510594 DOI: 10.1016/j.ypmed.2016.12.034] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022]
Abstract
Whether well-documented patterns of mental health comorbidity with adolescent combustible cigarette use extend to e-cigarette use is unclear. Demonstrating associations between e-cigarette and combustible cigarette use with mental health symptomatology across adolescence may be important for promoting accurate perceptions of populations at risk for and potential consequences of tobacco product use. Adolescents (N=2460; mean age at baseline=14.1; 53.4% female; 44.1% Hispanic) who had never previously used combustible or e-cigarettes were assessed at baseline, and 6- and 12-month follow-ups in Los Angeles, CA (2013-2014). Logistic regression was used to examine associations between baseline depressive symptoms and onset of e-cigarette and cigarette single product and dual use at follow-ups. Latent growth modeling was used to examine associations between sustained use of either product (vs. non-use) and changes in depressive symptoms over 12-months. Higher baseline depressive symptoms predicted subsequent onset of cigarette (OR=1.024, 95% C.I.=1.009-1.055), e-cigarette (OR=1.015, C.I.=1.003-1.023), and dual use of both products (OR=1.021, C.I.=1.003-1.043). Sustained use of e-cigarettes over the 12-month observation (vs. non-use) was associated with a greater rate of increase in depressive symptoms over time (b=1.272, SE=0.513, p=0.01). Among those who sustained use of e-cigarettes, higher frequency of use was associated with higher depressive symptoms at the final follow-up (B=1.611, p=0.04). A bi-directional association of depressive symptoms with e-cigarette use onset across mid adolescence was observed. Further research on the causal nature, etiological underpinnings, and intervention implications of mental health and tobacco product use comorbidity is warranted.
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Affiliation(s)
- William V Lechner
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI, USA.
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, PA, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Petrescu DC, Vasiljevic M, Pepper JK, Ribisl KM, Marteau TM. What is the impact of e-cigarette adverts on children's perceptions of tobacco smoking? An experimental study. Tob Control 2016; 26:421-427. [PMID: 27601455 PMCID: PMC5520264 DOI: 10.1136/tobaccocontrol-2016-052940] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/19/2016] [Accepted: 07/08/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Exposure to e-cigarette adverts increases children's positive attitudes towards using them. Given the similarity in appearance between e-cigarettes and tobacco cigarettes, we examined whether exposure to e-cigarette adverts has a cross-product impact on perceptions and attitudes towards smoking tobacco cigarettes. METHODS Children aged 11-16 (n=564) were interviewed in their homes and randomised to one of three groups: two groups saw different sets of 10 images of e-cigarette adverts and one group saw no adverts. Of the 20 e-cigarette adverts, 10 depicted the product as glamorous and 10 depicted it as healthy. The children then self-completed a questionnaire assessing perceived appeal, harms and benefits of smoking tobacco cigarettes. RESULTS The analyses were conducted on 411 children who reported never having smoked tobacco cigarettes or used e-cigarettes. Exposure to the adverts had no impact on the appeal or perceived benefits of smoking tobacco cigarettes. While the perceived harm of smoking more than 10 cigarettes per day was similar across groups, those exposed to either set of adverts perceived the harms of smoking one or two tobacco cigarettes occasionally to be lower than those in the control group. CONCLUSIONS This study provides the first evidence that exposure to e-cigarette adverts might influence children's perceptions of smoking tobacco cigarettes, reducing their perceived harm of occasional smoking. These results suggest the potential for e-cigarette adverts to undermine tobacco control efforts by reducing a potential barrier (ie, beliefs about harm) to occasional smoking.
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Affiliation(s)
- D C Petrescu
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - M Vasiljevic
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - J K Pepper
- Department of Health Behaviour, UNC Gillings School of Global Public Health, Cambridge, UK.,RTI International, Research Triangle Park, North Carolina, USA
| | - K M Ribisl
- Department of Health Behaviour, UNC Gillings School of Global Public Health, Cambridge, UK.,Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina, USA
| | - T M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Berg CJ, Haardörfer R, Lewis M, Getachew B, Lloyd SA, Thomas SF, Lanier A, Trepanier K, Johnston T, Grimsley L, Foster B, Benson S, Smith A, Barr DB, Windle M. DECOY: Documenting Experiences with Cigarettes and Other Tobacco in Young Adults. Am J Health Behav 2016; 40:310-21. [PMID: 27103410 PMCID: PMC4903022 DOI: 10.5993/ajhb.40.3.3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We examined psychographic characteristics associated with tobacco use among Project DECOY participants. METHODS Project DECOY is a 2-year longitudinal mixed-methods study examining risk for tobacco use among 3418 young adults across 7 Georgia colleges/universities. Baseline measures included sociodemographics, tobacco use, and psychographics using the Values, Attitudes, and Lifestyle Scale. Bivariate and multivariable analyses were conducted to identify correlates of tobacco use. RESULTS Past 30-day use prevalence was: 13.3% cigarettes; 11.3% little cigars/cigarillos (LCCs); 3.6% smokeless tobacco; 10.9% e-cigarettes; and 12.2% hookah. Controlling for sociodemographics, correlates of cigarette use included greater novelty seeking (p < .001) and intellectual curiosity (p = .010) and less interest in tangible creation (p = .002) and social conservatism (p < .001). Correlates of LCC use included greater novelty seeking (p < .001) and greater fashion orientation (p = .007). Correlates of smokeless tobacco use included greater novelty seeking (p = .006) and less intellectual curiosity (p < .001). Correlates of e-cigarette use included greater novelty seeking (p < .001) and less social conservatism (p = .002). Correlates of hookah use included greater novelty seeking (p < .001), fashion orientation (p = .044), and self-focused thinking (p = .002), and less social conservatism (p < .001). CONCLUSIONS Psychographic characteristics distinguish users of different tobacco products.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael Lewis
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven A Lloyd
- Department of Psychological Science, University of North Georgia, Dahlonega, GA, USA
| | - Sarah Fretti Thomas
- Department of Exercise Physiology, Valdosta State University, Valdosta, GA, USA
| | - Angela Lanier
- Department of Kinesiology, Berry College, Mount Berry, GA, USA
| | | | - Teresa Johnston
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, USA
| | - Linda Grimsley
- Department of Nursing, Albany State University, Albany, GA, USA
| | - Bruce Foster
- Campus Life, Central Georgia Technical College, Warner Robins, GA, USA
| | | | - Alicia Smith
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Atlanta, GA, USA
| | - Dana Boyd Barr
- Department of Environmental Health, Emory University School of Public Health, Atlanta, GA, USA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Little MA, Talcott GW, Bursac Z, Linde BD, Pagano LA, Messler EC, Ebbert JO, Klesges RC. Efficacy of a Brief Tobacco Intervention for Tobacco and Nicotine Containing Product Use in the US Air Force. Nicotine Tob Res 2015; 18:1142-9. [DOI: 10.1093/ntr/ntv242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/18/2015] [Indexed: 11/12/2022]
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