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Cornacchione Ross J, Kowitt SD, Rubenstein D, Jarman KL, Goldstein AO, Thrasher JF, Ranney LM. Prevalence and correlates of flavored novel oral nicotine product use among a national sample of youth. Addict Behav 2024; 152:107982. [PMID: 38359494 PMCID: PMC10939726 DOI: 10.1016/j.addbeh.2024.107982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Flavored novel oral nicotine products (ONP), such as pouches, gum, lozenges, tablets, and gummies, have recently entered the US market but have not been authorized for smoking cessation. This study assessed the prevalence and correlates of ONPs in a national sample of youth who smoked little filtered cigars or cigarillos (LCCs) or were susceptible to LCCs. METHODS We conducted a national online survey from September-October 2022, as part of a study to develop cigar warnings among youth. Those aged 15-20 years old who reported using (ever or current) or susceptibility to little filtered cigars or cigarillos (LCCs) were eligible. Descriptive statistics and chi-square analyses assessed the prevalence of flavored ONP use and associations with other past 30-day tobacco product use and participant characteristics. RESULTS Approximately one-fifth (17.1 %) of the sample (n = 680) reported past month flavored ONP use. Any past month tobacco use was correlated with past month flavored ONP use (ps < 0.001), increasing from 17.1 % in the overall sample to 26.8 % among those reporting e-cigarette use, 41.4 % (LCCs), 47.8 % (waterpipe tobacco), 61.8 % (large cigars), and 69.1 % (smokeless tobacco). The number of products used in the past month was significantly associated with higher odds of ONPs in the past month in a multivariable logistic regression model (aOR2.26; 95 % CI: 1.92, 2.65). DISCUSSION Almost one-fifth of participants who use or are susceptible to cigar use in our national sample of youth use ONPs. Dual/poly use of other tobacco products and ONPs among youth suggests that many of these youth may be addicted to nicotine. Additional surveillance and regulation of ONPs that exhibit enticing characteristics, such as flavors, kid-friendly formulations, and targeted marketing/branding may be needed.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dana Rubenstein
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kowitt SD, Goldstein AO, Cornacchione Ross J, Clark SA, Jarman KL, Sheeran P, Thrasher JF, Ranney LM. Perceived Effectiveness of Cigar Warnings in Discouraging Blunt Use. Nicotine Tob Res 2024; 26:512-516. [PMID: 37819722 PMCID: PMC10959065 DOI: 10.1093/ntr/ntad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Many people remove the tobacco leaf from cigars and replace it with cannabis (ie, blunts), but few studies have examined whether messages about the risks of cigars, like warnings on cigar packages, can affect blunt use. METHODS Participants were 438 U.S. adults who reported past 30-day cigar use and ever blunt use, recruited from a probability-based national panel to take an online survey. In a 2 × 2 experiment with a between-subjects design, we manipulated two cigar warning characteristics: (1) warning type: text-only versus pictorial (ie, text + image) and (2) warning size: 30% (smaller) versus 50% (larger) of the product package. Participants then viewed six different warnings on a fictious cigarillo package, within their randomly assigned condition. After evaluating all stimuli, participants were asked the extent to which the warnings discouraged them from wanting to use cigars to smoke cannabis (ie, blunt perceived warning effectiveness). Response options ranged from "not at all" (1) to "a great deal" (5). RESULTS We observed no main effects of warning type or size on blunt perceived warning effectiveness. However, a significant interaction existed between the two experimental manipulations (p = .009). Whereas adding images made no difference to blunt perceived warning effectiveness when warnings were smaller (simple effect: -0.22, p = .28), images mattered for larger warnings. Specifically, adding images increased blunt perceived warning effectiveness when warnings were 50% of the product package (simple effect: 0.52, p = .008). CONCLUSIONS This experiment provides preliminary evidence that larger pictorial cigar warnings may discourage blunt use relative to larger but text-only warnings. IMPLICATIONS Blunts, which are hollowed out cigars with tobacco leaf wrappers that are filled with cannabis leaf, are one of the most common ways in which tobacco and cannabis are used simultaneously, yet few studies have examined whether messages about the risks of cigars can affect blunt use. We conducted an online experiment concerning the perceived effectiveness of cigar warnings among people who use blunts recruited from a probability-based panel. Results provide novel, preliminary evidence that larger pictorial cigar warnings may discourage blunt use, relative to larger but text-only warnings. More research evaluating cigar warnings on blunt use is needed.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sonia A Clark
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cornacchione Ross J, Zizzi AR, Suerken CK, Kimes C, Soule E, Sutfin EL. Compliance With US Federal Regulations on Waterpipe Tobacco Warnings on Packaging. JAMA Netw Open 2024; 7:e2354467. [PMID: 38306102 PMCID: PMC10837745 DOI: 10.1001/jamanetworkopen.2023.54467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
This cohort study reports the rate and degree of compliance with the Food and Drug Administration–mandated warning labels among waterpipe tobacco brands and products.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina
- Now with Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Alexandra R Zizzi
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Caroline Kimes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Eric Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina
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Rubenstein D, Carroll DM, Denlinger-Apte RL, Cornacchione Ross J, McClernon FJ. Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample. Subst Use Addctn J 2024; 45:54-64. [PMID: 38258860 DOI: 10.1177/29767342231210554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The prevalence of combusted cigarette (CC) smoking among older adults is stagnant, with 0 declines attributable to e-cigarette (EC) use. Given that normative beliefs are associated with quitting and switching to ECs, we assessed cross-sectional associations between age, CC, and EC descriptive and injunctive norms and potential interactions with tobacco use behavior. METHODS Data are from people with current, established (≥100 lifetime CCs) CC use (n = 8072) at Wave 5 (2018-2019) of the adult Population Assessment of Tobacco and Health Study. We used adjusted multivariable logistic regressions to model social norms as a function of age (18-24, 25-34, 35-44, 45-54, 55-64, ≥65 years). We also dichotomized age (≥55 vs 18-54) to investigate interactions between age and social norms on past 12-month CC quit attempts and past-month EC use. RESULTS Older age was positively associated with pro- and anti-CC norms and anti-EC norms. Significant interactive effects revealed that being advised to quit smoking by a healthcare provider was more strongly associated with CC quit attempts among adults ≥55 years (adjusted odds ratio [aOR] [95% CI]: 2.12 [1.66, 2.71]) than adults <55 years (aOR: 1.63 [1.34, 2.00]). Reporting people close to you use ECs was also more strongly associated with EC use among adults ≥55 years (aOR: 4.37 [3.35, 5.69]) than among adults <55 years (aOR: 3.43 [2.89, 4.08]). CONCLUSIONS This study identified modifiable risk factors for tobacco use that may be particularly beneficial for older adults. Behavioral and communication interventions that target normative beliefs may maximize smoking cessation, or harm reduction when cessation is not possible.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
| | - Dana M Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
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Sutfin EL, Lazard AJ, Wagoner KG, King JL, Cornacchione Ross J, Wiseman KD, Orlan EN, Suerken CK, Reboussin DM, Wolfson M, Noar SM, Reboussin BA. The Development and Testing of a Point-of-Sale E-Cigarette Health Communication Campaign. Health Commun 2023:1-12. [PMID: 37937858 DOI: 10.1080/10410236.2023.2265648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Adolescents and young adults continue to use e-cigarettes, and communication campaigns are needed to decrease use among these populations. We developed and tested a point-of-sale communication campaign focused on e-cigarette chemical exposure. We developed messages based on formative research and tested them (versus text-only messages) in a nationally-representative online survey among adolescents and young adults (16-25) (Phase 1). Based on survey findings, we selected a message focused on nicotine and brain development for the point-of-sale trial (Phase 2). We then conducted a cluster-randomized trial at six gas stations with convenience stores, randomly assigned to the intervention (messages displayed) or no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 participants (ages 16-25) per store, at baseline and a four-week follow-up. Phase 1 included 1,636 participants in the online study. Intervention messages were rated as more attention grabbing than plain text messages (p < .05), though were rated similarly on other outcomes. Exposure to intervention messages resulted in larger changes from pre- to posttest for beliefs about addiction and relative harms versus cigarettes (p < .05). Phase 2 included 586 participants in the point-of-sale study. Real-world campaign exposure was low (31.8%), and no differences were found between conditions. E-cigarette prevention messages focused on nicotine's impact on brain development show promise. However, garnering attention for communication campaigns in saturated point-of-sale environments, often dominated by tobacco advertising, is challenging. Future efforts should utilize additional communication channels to directly target adolescents and young adults.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | - Allison J Lazard
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | - Jessica L King
- Department of Health and Kinesiology, University of Utah
| | | | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | - Elizabeth N Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, University of California at Riverside
| | - Seth M Noar
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
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Cornacchione Ross J, Kowitt SD, Jarman KL, Ranney LM, Lazard AJ, Thrasher JF, Sheeran P, Goldstein AO. Perceived message effectiveness of cigar warning themes among adults in the United States. Prev Med Rep 2023; 34:102236. [PMID: 37234566 PMCID: PMC10206194 DOI: 10.1016/j.pmedr.2023.102236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Most tobacco warnings focus on health harms to the consumer, but other message themes may be promising. We assessed perceived message effectiveness (PME) among adults who smoke cigars for 12 cigar warning statements to discourage smoking, and measured PME across four message themes: explicit health effects to the consumer, secondhand smoke effects, chemicals/constituents, and toxicity. Between April 23 and May 7, 2020, we conducted an online study with U.S. adults who used any cigar type in the past 30 days (n = 777). Participants were randomly assigned to view two out of 12 warnings and rate each one on PME. We analyzed PME mean ratings (range 1 [low] to 5 [high]). The warning statements for lung cancer (M = 3.91) and heart disease (M = 3.77) had the highest PME ratings; secondhand smoke (M = 3.50) and formaldehyde (M = 3.48) had the lowest PME ratings. Multilevel analyses showed that the explicit health effects theme was associated with higher PME ratings compared to other warning themes (ps < 0.05 for chemicals/constituents and secondhand smoke effects) except toxicity (p =.16). Higher awareness of consequences was associated with higher PME ratings (p <.001). Higher nicotine dependence was also associated with higher PME ratings (p = .004). Warning statements with information addressing the themes of health harms and toxicity could potentially inform those who smoke cigars about the broader harms of cigar use and should be considered in FDA labeling regulations for cigars.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Sarah D. Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen L. Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Leah M. Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Allison J. Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adam O. Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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King Jensen JL, Cornacchione Ross J, Rebentisch K, Delnevo CD, Azagba S. Examining Cigar Pack Quantity Purchases by Cigar Type in the United States Between 2014 and 2017. Nicotine Tob Res 2023; 25:S50-S58. [PMID: 37506242 PMCID: PMC10380179 DOI: 10.1093/ntr/ntac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION We examined whether the proportion of cigar pack quantity usually purchased differed between 2014 and 2017 in the United States. METHODS Data are from waves 1 and 4 of the Population Assessment of Tobacco and Health Study. The proportions of pack quantity purchases between waves for premium cigars, large cigars, cigarillos, and filtered cigars for 10-pack quantities (singles, 2-packs, 3-packs, 4-packs, 5-packs, 6-9-packs, 10-packs, 11--19-packs, 20-packs, ≥21 packs) were compared using Z-tests. We used multivariable linear regressions to examine factors associated with pack quantity. RESULTS For premium cigars, most adults purchased singles, with 84.4% in 2014 and 88.7% in 2017. For large cigars, single purchases increased from 46.2% to 62.7% (p < .00001). Two-packs also increased, 3.1% to 10.2% (p < .00001), while 5-packs, 6-9 packs, 10-19-packs, and 20-packs decreased. For cigarillos, singles purchases increased from 51.9% to 57.5% (p = .0002). Two-packs also increased, 8.8% to 19.6% (p < .00001), while 3-packs, 4-packs, 5-packs, and 20-packs decreased. For filtered cigars, the most prevalent pack quantity shifted from 20-packs in 2014 (62.6%) to singles in 2017 (36.7%). Singles, 2-packs, 3-4-packs, and 5-packs increased while 11-19-packs, 20-packs, and ≥21 packs decreased. Days used were positively associated with pack quantity purchase for all cigar types in 2017, while the price was positively associated with premium cigar purchase. CONCLUSIONS Between 2014 and 2017, the proportion of consumers who purchased singles remained at over 80% for premium cigars and increased for other cigars. Continued monitoring of use behaviors, including pack quantities by cigar type, is needed as the market and policy landscapes continue shifting. IMPLICATIONS Single cigar purchases are prominent across cigar types. Five-packs and 20-packs were the second most common pack quantities across cigar types, with relatively low proportions for other pack quantities. These findings suggest adults consuming premium cigars consistently prefer singles, a pattern that was found across cigar types. However, when considering purchases made online, premium cigars are widely purchased in larger pack quantities. Age and race were associated with purchase for some cigar types at some years, days used were associated with the purchase quantity in 2017 for all cigar types, and price was positively associated across time periods for only premium cigar purchases. Thus, the factors associated with cigar pack quantity purchase remain unclear. As the cigar policy landscape shifts, continued monitoring of the purchase behaviors by cigar type will be important to better inform future cigar policies.
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Affiliation(s)
- Jessica L King Jensen
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118
| | - Kayla Rebentisch
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
| | - Sunday Azagba
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
- Consortium for Substance Use and Addiction, Pennsylvania State University, University Park, PA, USA
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
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Kowitt SD, Clark SA, Jarman KL, Cornacchione Ross J, Ranney LM, Sheeran P, Thrasher JF, Enyioha C, Goldstein AO. Improving Point-of-Sale Warnings for Single Cigars: Implications for Premium Cigars. Nicotine Tob Res 2023; 25:S76-S80. [PMID: 37506244 PMCID: PMC10380183 DOI: 10.1093/ntr/ntad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/16/2022] [Accepted: 02/10/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION For cigars sold individually without packaging, including many premium cigars, the US Food and Drug Administration (FDA) proposed that retailers display six warning statements on a sign at the point-of-sale (POS). AIMS AND METHODS To examine the potential effectiveness of cigar warning signs, we conducted a between-subjects online experiment. Participants were 809 U.S. adults who reported using cigars (78% ever large cigar use, 49% past 30-day large cigar use) recruited from a probability-based panel. Participants viewed an image of a cigar store countertop with randomization to one of four conditions: (1) no warning sign, (2) a sign with six FDA proposed text-only warnings, (3) a sign with six novel text-only warnings, or (4) a sign with six novel text + image warnings. We used analysis of variance (ANOVA) models and post hoc Tukey tests to examine the results. RESULTS The FDA-proposed text-only warning sign was perceived as less effective in discouraging participants from smoking cigars (M: 3.26, SD: 1.39; scale range: 1-5, where five indicates higher discouragement) compared with the novel text-only warning sign (M = 3.38, SD = 1.40) and the novel text + image warning sign (M = 3.65, SD = 1.34). The novel text + image warning sign increased discouragement from smoking cigars versus the FDA-proposed text-only warning sign (p = .02) and decreased the perceived satisfaction of smoking cigars versus no warning sign (p = .04). In a sensitivity analysis, the novel text + image warning sign decreased the perceived satisfaction of smoking cigars (p = .01), decreased cigar purchase intentions (p = .03), decreased the urge to smoke (p = .03), and increased discouragement from smoking cigars (p = .006) compared with all other study conditions. CONCLUSIONS Results provide new evidence that policymakers, such as the FDA, could use when proposing POS warning signs for cigars. IMPLICATIONS The US FDA proposed that retailers display a warning sign at the POS for cigars sold individually without packaging. We conducted an online experiment concerning the potential effectiveness of this regulatory policy with people who use cigars recruited from a probability-based panel. Results provide the first evidence that the FDA-proposed text-only warning sign was perceived as less effective than other types of warning signs and that adding images could potentially increase the effectiveness of warning signs. These findings are particularly relevant for premium cigars, which are often sold individually in brick-and-mortar retail settings.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sonia A Clark
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Rubenstein D, Denlinger-Apte RL, Cornacchione Ross J, McClernon FJ. Adoption of E-Cigarettes Among Older Adults Who Smoke to Reduce Harm and Narrow Age-Related Disparities: An Application of the Health Belief Model. Nicotine Tob Res 2023; 25:1212-1214. [PMID: 36702774 PMCID: PMC10202631 DOI: 10.1093/ntr/ntad016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA
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Rubenstein D, Denlinger-Apte RL, Cornacchione Ross J, Carroll DM, McClernon FJ. Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke. Tob Control 2023:tc-2023-057943. [PMID: 37137702 PMCID: PMC10622327 DOI: 10.1136/tc-2023-057943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The prevalence of cigarette smoking among adults aged ≥55 has remained stagnant over the past decade. National data modelling suggests no reduction in cigarette smoking prevalence attributable to e-cigarette use in the USA among people aged ≥45. Misperceptions about the absolute risks (ie, cigarettes are not harmful) and relative risks (ie, e-cigarettes are more harmful than cigarettes) of tobacco products may contribute to sustained smoking prevalence and hesitancy to switch from cigarettes to e-cigarettes among older adults. METHODS Participants reported cigarette use (n=8072) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regressions included six age categories (independent variable) and cigarette and e-cigarette risk perceptions (outcomes). Additional models assessed the associations between dichotomous age (≥55 vs 18-54), risk perceptions and an interaction term (independent variables) with past 12-month quit attempts and past-month e-cigarette use (outcomes). RESULTS Adults aged ≥65 were less likely than adults aged 18-24 to rate cigarettes as very/extremely harmful (p<0.05). Odds of rating e-cigarettes as more harmful than cigarettes among adults aged 55-64 and ≥65 were 1.71 (p<0.001) and 1.43 (p=0.024) greater than for adults aged 18-24. This misperception was negatively associated with past-month e-cigarette use and was stronger among adults aged ≥55 (p<0.001) than adults aged <55 (p<0.001). DISCUSSION Adults aged ≥55 are more likely to have misperceptions about the absolute and relative risks of tobacco products, which may contribute to continued smoking. Health communications targeting this age group could modify beliefs about the perceived harms of tobacco products.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel L Denlinger-Apte
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Sutfin EL, Lazard AJ, Wagoner KG, King JL, Ross JC, Wiseman KD, Orlan EN, Suerken CK, Reboussin DM, Wolfson M, Noar SM, Reboussin BA. Point-of-Sale Health Communication Campaigns for Cigarillos and Waterpipe Tobacco: Effects and Lessons Learned from Two Cluster Randomized Trials. Health Commun 2023; 38:1201-1212. [PMID: 34781799 PMCID: PMC9107525 DOI: 10.1080/10410236.2021.1996910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many adolescents and young adults hold erroneous beliefs that cigarillos and waterpipe tobacco (WT) are safer than cigarettes, contributing to use. Communication campaigns can correct misperceptions and increase risk beliefs. We tested point-of-sale (POS) communication campaigns focused on chemical exposure for cigarillos and WT. We conducted two cluster randomized trials at 20 gas stations with convenience stores (10 stores for cigarillos, 10 for WT) in North Carolina between June and November 2017. Within each trial, stores were randomly assigned to either the intervention (campaign messages displayed) or a no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 adolescents and young adults (ages 16-25) per store, at baseline and follow-up. There were 978 participants (mean age = 20.9 years) in the cigarillo trial, and 998 participants (mean age = 21.0 years) in the WT trial. Rates of campaign exposure were low (26% for cigarillos; 24.3% for WT). The cigarillo campaign increased knowledge that ammonia is in cigarillo smoke (p < .01). There were also significant increases in knowledge about ammonia and cyanide in cigarillo smoke and arsenic in WT smoke (p < .05) in the sub-sample who reported exposure to the campaign. No differences were found in outcome expectancies, product attitudes, worry about chemical exposure, or behavioral intentions in either campaign. Garnering attention for communication campaigns in saturated POS environments, often dominated by tobacco advertising, is challenging. Our study demonstrates the feasibility of anti-tobacco campaigns at the POS and points to several lessons learned for future POS campaigns.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Allison J. Lazard
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Kimberly G. Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Jessica L. King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, U.T., United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Elizabeth N. Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, University of California at Riverside, Riverside, C.A., United States
| | - Seth M. Noar
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
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Cornacchione Ross J, Lazard AJ, Hedrick McKenzie A, Reffner Collins MK, Sutfin EL. What Cigarillo Companies are Putting on Instagram: A Content Analysis of Swisher Sweets' Marketing from 2013 to 2020. Nicotine Tob Res 2023; 25:755-762. [PMID: 36326790 DOI: 10.1093/ntr/ntac255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Tobacco marketing includes text and visual content, which conveys important meaning to consumers and influences use. Little is known about the marketing tactics used by a popular brand of cigarillos on social media to promote their products, including their visual design. METHODS A content analysis was conducted to analyze text and visuals for all posts on Swisher Sweets' official Instagram account from Jan 23, 2013 to Feb 28, 2020. We assessed product depictions (e.g. warnings, smoking cues), presence of FDA-prohibited or potentially misleading claims (e.g. lower risk, organic), marketing tactics (e.g. celebrities, selling propositions), flavors, and demographic representation. RESULTS We coded 1402 posts. Smoking cues (e.g. images of people smoking, product imagery) were in 764 posts (54.5%), and a warning appeared in 690 (49.2%) posts, but obscured in 29.4% of those instances (n = 203). No posts included FDA-prohibited claims, but some potentially misleading language was identified, including the use of words or visual depictions of smooth (n = 254, 18.1%) and quality/well-made (n = 239, 17%). Marketing tactics such as scarcity (n = 159, 11.3%), event promotion (n = 586, 41.8%), and alcohol depictions (n = 171, 12.2%) were common, and flavor names appeared in 598 posts (42.7%). People depicted were often young adults (n = 709, 50.6%), Black/African American (n = 549, 39.2%), and in groups (n = 473, 33.7%). CONCLUSIONS Both text and visuals are used to market Swisher Sweets on their Instagram account. Using social images of young adults, especially Black individuals, signals the intended use of the product. These images of visual-based social media may influence appeal, glamorization, and normalization of cigarillo smoking among vulnerable populations. IMPLICATIONS Tobacco marketing, including from popular cigarillo brands like Swisher Sweets, is widely used to influence consumer perceptions and behavior. Social media marketing includes text and visual, both of which increase product appeal and encourage use. Visual-based social media from the industry itself have been understudied, particularly for cigarillos. This study characterizes the ways in which Swisher Sweets uses text and visuals to market their products through their Instagram account, including smoking cues, potentially misleading language, use of celebrity endorsers, and promotion and sponsorship of events.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Ranney LM, Clark SA, Jarman KL, Lazard AJ, Kowitt SD, Cornacchione Ross J, Baler G, Thrasher JF, Goldstein AO. How do current tobacco warnings compare to the WHO FCTC guidelines: a content analysis of combustible tobacco warnings worldwide. BMJ Open 2023; 13:e062033. [PMID: 36940946 PMCID: PMC10030571 DOI: 10.1136/bmjopen-2022-062033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
OBJECTIVE Many countries have adopted warning labels for combustible tobacco products, yet little research exists describing tobacco warning characteristics globally and to what extent they meet the WHO Framework Convention for Tobacco Control (FCTC) Guidelines. This study evaluates characteristics of combustible tobacco warnings. DESIGN We conducted a content analysis to describe the overall landscape of warnings using descriptive statistics and compared to the WHO FCTC Guidelines. SETTING We searched existing warning databases for combustible tobacco warnings from English-speaking countries. We compiled warnings meeting inclusion criteria and coded for message and image characteristics using a pre-defined codebook. PRIMARY AND SECONDARY OUTCOMES MEASURES Characteristics of combustible tobacco warning text statements and warning images were the primary study outcomes. There were no secondary study outcomes. RESULTS We identified a total of 316 warnings from 26 countries or jurisdictions worldwide. Of these warnings, 94% included warning text and an image. Warning text statements most often described health effects to the respiratory (26%), circulatory (19%) and reproductive systems (19%). Cancer was the most frequently mentioned health topic (28%). Fewer than half of warnings included a Quitline resource (41%). Few warnings included messages about secondhand smoke (11%), addiction (6%) or cost (1%). Of warnings with images, most were in colour and showed people (88%), mostly adults (40%). More than 1 in 5 warnings with images included a smoking cue (ie, cigarette). CONCLUSIONS While most tobacco warnings followed WHO FCTC guidance on effective tobacco warnings, such as communicating health risks and inclusion of images, many did not include local Quitline or cessation resources. A sizeable minority include smoking cues that could inhibit effectiveness. Full alignment with WHO FCTC guidelines will improve warnings and better achieve the WHO FCTC objectives.
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Affiliation(s)
- Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sonia A Clark
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University, School of Public Health, Boston, MA, USA
| | - Guido Baler
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Cornacchione Ross J, Lazard AJ, King JL, Noar SM, Reboussin BA, Jenson D, Sutfin EL. Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults. Tob Control 2023; 32:211-217. [PMID: 34330882 PMCID: PMC8985738 DOI: 10.1136/tobaccocontrol-2020-056288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The US Food and Drug Administration requires six text-only warnings for cigar products, including cigarillos. Research has demonstrated the superiority of pictorial over text-only cigarette warnings, yet the relative effectiveness of pictorial warnings for cigarillos has not been examined. We examined the impact of pictorial cigarillo warnings compared with text-only warnings. METHODS Data were collected from a nationally representative sample of US young adult (18-29) cigarillo users and susceptible non-users. Participants were randomised to one of three experimental conditions: text-only or one of two pictorial conditions (combined for analyses). For each warning, we assessed negative emotional reactions, cognitive elaboration (ie, thinking about cigarillo risks) and perceived message effectiveness (PME). RESULTS Participants (N=661) were 46.5% female, 64.7% white and 21.9% Hispanic; 34.1% reported past 30-day cigarillo use; 41.4% were lifetime users (excluding past 30-day use); and 24.4% were susceptible non-users. Pictorial warnings elicited more negative emotional reactions and higher PME than text-only warnings (p values<0.01), with interactions showing the largest effects for past 30-day users (emotional reactions: d=0.99, PME: d=0.63). For cognitive elaboration, there was no main effect of warning type, but an interaction revealed effects for past 30-day users (p<0.05, d=0.46). CONCLUSIONS Pictorial cigarillo warnings elicited greater negative emotional reactions and PME compared with text-only warnings. These effects and the effects on cognitive elaboration were strongest for past 30-day users. Our findings extend research on cigarette warnings to cigarillos, demonstrating that pictorial warnings are superior to text-only warnings for cigarillos in eliciting beneficial responses.
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Affiliation(s)
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L King
- Department of Health & Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Beth A Reboussin
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, Minnesota, USA
| | - Erin L Sutfin
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Breland AB, Carroll D, Denlinger-Apte R, Ross JC, Soto C, White C, Donny EC, Fagan P, Gardiner P, Eissenberg T, Guy MC. Centering racial justice for Black/African American and Indigenous American people in commercial tobacco product regulation. Prev Med 2022; 165:107117. [PMID: 35716811 PMCID: PMC9722549 DOI: 10.1016/j.ypmed.2022.107117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/29/2022] [Accepted: 06/12/2022] [Indexed: 01/13/2023]
Abstract
Although overall health in the United States (US) has improved dramatically during the past century, long-standing health inequities, particularly the unequal and unjust burden of tobacco-related disease and death among racialized populations, persist. A considerable gap exists in our understanding of how commercial tobacco product regulations and policies cause and/or exacerbate race-based health inequities among Black/African American (B/AA) and Indigenous American people. The purpose of this paper is to 1) describe how existing US commercial tobacco regulatory policies may contribute to structural racism and undermine the full benefits of tobacco prevention and control efforts among B/AA and Indigenous American groups; and 2) initiate a call to action for researchers and regulators of tobacco products to examine policies using an equity lens. These actions are imperative if empirically-informed regulation of commercial tobacco products is to address health equity.
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Affiliation(s)
- Alison B Breland
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA.
| | - Dana Carroll
- University of Minnesota, School of Public Health, Division of Environmental Health Sciences, 717 Delaware St SE, Minneapolis, MN 55414, USA.
| | - Rachel Denlinger-Apte
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Claradina Soto
- University of Southern California, Keck School of Medicine, Institute for Health Promotion and Disease Prevention Research, SSB 300 2001 N. Soto Street, Health Sciences Campus, Los Angeles, CA 90033, USA.
| | - Cassidy White
- Wake Forest School of Medicine, Department of Physiology and Pharmacology, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Eric C Donny
- Wake Forest School of Medicine, Department of Physiology and Pharmacology, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Pebbles Fagan
- University of Arkansas for Health Sciences, Fay W. Boozman College of Public Health, 4301 West Markham, # 820, Little Rock, AK 72205, USA.
| | - Phillip Gardiner
- African American Tobacco Control Leadership Council, 390 Fourth Street, San Francisco, CA 94107, USA
| | - Thomas Eissenberg
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA.
| | - Mignonne C Guy
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA; Virginia Commonwealth University, Department of African American Studies, 816 W. Franklin St., Box 842509, Richmond, VA 23284, USA.
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Kowitt SD, Cox MJ, Jarman KL, Kong AY, Sivashanmugam A, Cornacchione Ross J, Goldstein AO, Ranney LM. Communicating the risks of tobacco and alcohol co-use. Addict Behav 2022; 134:107383. [PMID: 35700653 PMCID: PMC9708929 DOI: 10.1016/j.addbeh.2022.107383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/18/2022] [Accepted: 05/29/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND While tobacco and alcohol co-use is highly prevalent across the United States, little experimental research has examined ways to counter such dual use. We developed and tested messages about the risks of co-using tobacco and alcohol among adults who used a combustible tobacco product and drank alcohol within the 30 days. METHODS In an online experiment, 1,300 participants were randomly assigned to read different messages about tobacco and alcohol co-use (e.g., Alcohol and tobacco cause throat cancer). Three between-subjects experiments manipulated the presence of: 1) a marker word (e.g., Warning), 2) text describing the symptoms of health effects and a quitting self-efficacy cue, and 3) an image depicting the health effect. Participants rated each message using a validated Perceived Message Effectiveness (PME) scale. We used independent samples t-tests to examine differences between experimental conditions. Results include effect sizes (Cohen's d) to compare standardized mean differences. RESULTS Our sample was 64% male, 70% white, 23% Black, and 17% Hispanic/Latino with a mean age of 42.4 (SD = 16.4) years. Messages that described the symptoms of the health effect (d = 0.17, p = 0.002) and included an image (d = 0.11, p = 0.04) were rated significantly higher in PME compared with messages that did not describe symptoms and were text-only. We found no significant effects of a marker word or self-efficacy cue on PME. CONCLUSIONS Messages that describe the symptoms of health effects and include text and images may be particularly effective for communicating the risks of tobacco and alcohol co-use and decreasing adverse health effects from co-use.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Melissa J Cox
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Amanda Y Kong
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, United States; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
| | - Arvind Sivashanmugam
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC 27157, United States
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
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Sutfin EL, Denlinger-Apte RL, Ross JC, Wagoner KG, Suerken CK, Spangler J, Wolfson M, Reboussin BA. Corrigendum to "Longitudinal latent class analysis of tobacco use and correlates among young adults over a 10-year period" [Drug Alcohol Depend. 236 (2022) 109474]. Drug Alcohol Depend 2022; 239:109593. [PMID: 35987084 DOI: 10.1016/j.drugalcdep.2022.109593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, USA.
| | | | | | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, USA
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, USA
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, USA
| | - Mark Wolfson
- Department of Social Medicine, Population, & Public Health, School of Medicine, University of California, Riverside, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, USA
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Wagoner KG, Reboussin BA, Ross JC, Denlinger-Apte R, Spangler J, Sutfin EL. Exposure to e-cigarette health claims and association with e-cigarette use and risk perceptions: A cohort study of young adults. Addict Behav 2022; 132:107359. [PMID: 35576816 PMCID: PMC9434727 DOI: 10.1016/j.addbeh.2022.107359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION E-cigarettes have been marketed illicitly as smoking cessation aids and reduced risk tobacco products in the United States. Our study assessed consumers' exposure to such claims and evaluated their impact on relative risk perceptions and e-cigarette use. METHODS Data are from the Assessment of the post-College Experience study, which followed a cohort of young adults since 2010 when they were college freshmen. We used data from survey waves 10 (fall 2017) through 14 (fall 2019) to assess past 6 month exposure to e-cigarette marketing that made smoking cessation or modified risk tobacco product (MRTP) claims. Logistic regression models examined if exposure to claims at waves 11 through 14 were predictors of e-cigarette use and relative risk perceptions at wave 14. RESULTS Exposure to MRTP (28.4% to 40.1%) and cessation claims (29.1% to 46.6%) increased, with participants reporting more exposure to cessation than MRTP claims at each wave. Multiple exposures were associated with perceptions that e-cigarettes are less harmful compared to cigarettes (Cessation: AOR = 1.12, CI: 1.01-1.23; p = 0.025; MRTP: AOR = 1.16; CI: 1.05-1.29; p = 0.003). Neither claim type was associated with past 30-day e-cigarette use. Claim exposure did not increase e-cigarette initiation among never e-cigarette users. However, current cigarette smokers who had never used e-cigarettes at wave 10 had 2.5 higher odds of initiating e-cigarette use by wave 14 for each exposure to a cessation claim (AOR = 2.53; CI: 1.43-4.45; p = 0.001). CONCLUSIONS Young adults reported increasing exposure to unauthorized e-cigarette health claims. Exposure was associated with reduced relative risk perceptions, but was not associated with past 30-day e-cigarette use. Cessation claims may motivate current cigarette smokers to try e-cigarettes.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Beth A Reboussin
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Cornacchione Ross J, K Suerken C, Reboussin BA, Denlinger-Apte RL, Spangler JG, Sutfin EL. Cigar Harm Beliefs and Associations with Cigar Use among Young Adults. Subst Use Misuse 2022; 57:1478-1485. [PMID: 35786154 PMCID: PMC9680833 DOI: 10.1080/10826084.2022.2092149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cigar use, including little cigars and cigarillos (LCCs) and large traditional cigars, continues to harm young adults. Research on harm beliefs about cigars, particularly large cigars, is sparse. The current study examined cigar harm beliefs and associations with cigar use. Methods: Data are from a 2019 survey of a young adult cohort study recruited in fall 2010. Participants were asked questions about their beliefs about the harm of LCC and large cigar use. Those reporting ever use of cigars were asked how frequently they inhale the smoke into their lungs. Results: Participants (N = 1910) were 51.9% female with a mean age of 26.7 (SD = 0.6). Ever cigar use was 44.2% for large cigars and 43% for LCCs. Compared to those who have never used large cigars or LCCs, those reporting ever use of large cigars or LCCs reported lower harm beliefs about inhaling harmful chemicals and becoming addicted (ps <.0001). Those who reported higher harm beliefs also reported inhaling the smoke into their lungs more frequently for large cigars and LCCs (ps<.05). Conclusions: Cigar use harm beliefs were lower among participants reporting ever use of cigars compared to those reporting never use. Contrary to predictions, those reporting greater harm beliefs were more likely to report inhaling smoke more frequently than those with lower harm beliefs.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin L Sutfin
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Denlinger-Apte R, Suerken CK, Ross JC, Reboussin BA, Spangler J, Wagoner KG, Sutfin EL. Decreases in smoking and vaping during COVID-19 stay-at-home orders among a cohort of young adults in the United States. Prev Med 2022; 156:106992. [PMID: 35149114 PMCID: PMC8824729 DOI: 10.1016/j.ypmed.2022.106992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/12/2021] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
Abstract
In Spring 2020, most US states and territories implemented stay-at-home orders to slow transmission of the novel coronavirus SARS-CoV2, the cause of COVID-19. Little is known about the impact of stay-at-home orders on tobacco and nicotine use including among young adults. The current study examined participants (N = 1727) completing three recent survey waves from a longitudinal cohort of young adults recruited in 2010 from North Carolina and Virginia, USA: Wave 13 (Spring 2019), Wave 14 (Fall 2019), and Wave 15 (Spring 2020) to assess changes in cigarette and e-cigarette use. We conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 14 relative to Wave 13 to establish if there was a trend of use pre-pandemic. Then, we conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 15 relative to Wave 14 to determine the impact of COVID-19 stay-at-home orders. When comparing the odds of reporting tobacco use at Wave 14 to Wave 13, no differences emerged (p > 0.05). However, when comparing tobacco use at Wave 15 to Wave 14, participants had 40% lower odds of reporting past 30-day cigarette use (p = 0.02) and 50% lower odds of reporting past 30-day e-cigarette use (p < 0.01). The current study provides initial evidence that young adults may have reduced their tobacco and nicotine use during the stay-at-home orders. However, more work is needed to determine the long-term impact of the COVID-19 pandemic on tobacco use and cessation in this population.
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Affiliation(s)
- Rachel Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Abstract
This study uses Nielsen Company data for cigar sales to describe trends and patterns in sales of flavored cigars and cigars sold in small pack sizes in US convenience stores from 2009 to 2020.
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Affiliation(s)
| | - Erin Miller Lo
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey
| | - Daniel P. Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey
| | - Andrew A. Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
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22
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Razzouk J, Bilić A, Wackowski OA, Cornacchione Ross J, King Jensen JL. Does warning language impact perceptions? Results from an exploratory experiment comparing English, Spanish, and Dual language E-Cigarette warnings among Spanish speakers in the US. Prev Med Rep 2021; 24:101656. [PMID: 34976703 PMCID: PMC8684015 DOI: 10.1016/j.pmedr.2021.101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
We explored the impact of English only, Spanish only, or dual language warnings. Dual language exposure increased affect, reactance, and message effectiveness. Warning language may impact warning effectiveness among Spanish speakers.
Tobacco warnings written in English may not be as effective among Spanish speakers. We explored whether warning perceptions differ based on exposure to English, Spanish, or dual language warnings. From November 2, 2020 – December 29, 2020, we conducted an online experiment with a convenience sample of 776 Spanish-speaking adults in the US, randomizing each to one of three warning conditions: English only, Spanish only, or dual (both English and Spanish). Multivariable linear and logistic regressions examined associations between warning exposure and perceptions. Of 776 participants, 291 preferred to read in Spanish, 55.5% were male, 62.5% were Hispanic, and 48.1% reported past 30-day e-cigarette use. Negative affect (β = 1.79, p = 0.007), perceived message effectiveness (β = 0.84, p = 0.007), and psychological reactance (β = 1.55, p < 0.001) were greater among participants exposed to the dual language warnings compared to those exposed to the English warnings. Results of this exploratory study suggest that e-cigarette warning statements presented in both English and Spanish may result in stronger reactions among Spanish speakers. With increasing prevalence of Spanish speakers in the US, future work should continue to examine this topic.
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Affiliation(s)
- Jacob Razzouk
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, Utah 84112, USA
| | - Anna Bilić
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Drive, Salt Lake City, Utah 84112, USA
| | | | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jessica L. King Jensen
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, Utah 84112, USA
- Corresponding author.
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Wagoner KG, King JL, Suerken CK, Reboussin BA, Cornacchione Ross J, Sutfin EL. Changes in knowledge, perceptions and use of JUUL among a cohort of young adults. Tob Control 2021; 30:638-643. [PMID: 32848079 PMCID: PMC8142342 DOI: 10.1136/tobaccocontrol-2020-055651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE E-cigarettes have gained popularity, most recently with pod-style devices, such as JUUL. We examined changes in JUUL awareness, use, perceptions, nicotine content knowledge, number of days a pod lasts and exposure to JUUL retail advertising over a 6-month period in a cohort of young adults. METHODS In spring and fall 2018, 1836 young adults completed online surveys on tobacco use, including JUUL perceptions and use behaviours. Demographics, tobacco use and JUUL advertising exposure in spring 2018 were examined as predictors of current JUUL use in fall 2018. RESULTS Ever and current JUUL use doubled in 6 months (5.9% vs 12.7%, p<0.001; 1.6% vs 3.4%, p<0.001). The number of days a JUUL pod lasts significantly changed (p=0.049). Although there was an increase in those reporting JUUL has as much or more nicotine than a pack of cigarettes, 58% are 'not sure' of JUUL's nicotine content. Exposure to JUUL's advertising significantly increased (31.8% to 46.4%; p<0.001). In multivariable models, those perceiving JUUL as or more harmful than cigarettes, and former and never cigarette smokers had significantly lower odds of current JUUL use at 6 months compared with their respective counterparts (p<0.0001). Those reporting exposure to JUUL's advertising had significantly increased odds of current JUUL use 6 months later (p<0.03). CONCLUSIONS Findings demonstrate changes in knowledge of JUUL's nicotine content, perceptions and use over a short period of time, suggesting frequent measurement is necessary. Additionally, efforts are needed to regulate retail advertising and ensure consumer education about product risks as they are associated with current use.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jessica L King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Kowitt SD, Jarman KL, Cornacchione Ross J, Ranney LM, Smith CA, Kistler CE, Lazard A, Sheeran P, Thrasher JF, Goldstein AO. Designing more effective cigar warnings: an experiment among adult cigar smokers. Nicotine Tob Res 2021; 24:617-622. [PMID: 34628506 DOI: 10.1093/ntr/ntab207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Little systematic evidence exists about the effectiveness of cigar warnings. This study examined the perceived message effectiveness (PME) of warning statements about different health consequences caused by cigars. PME is a validated self-report scale of how effectively a health message discourages smoking. METHODS We conducted an online study from April-May 2020 with adults in the United States who used cigars in the past 30 days (n=777). Participants were randomly assigned to view and rate PME (3 items, range 1 to 5) for 7 out of 37 text warning statements about different health consequences from cigar use. Linear mixed effects models evaluated the most effective warning characteristics (e.g., type of health consequence), controlling for repeated measures and participant demographics. RESULTS Analyses showed that health consequences about the cardiovascular system (B=0.38), mouth (B=0.40), other digestive (B=0.45), respiratory system (B=0.36), and early death (B=0.36) were associated with higher PME scores than reproductive health consequences (all p-values <0.001). Similar results were found for these health consequences compared to addiction (all p-values p<0.001). We also observed that awareness of the health consequence was associated with higher PME scores (B=0.19, p<0.001) and length of the warning message (number of characters) was associated with lower PME scores (B=-0.007, p=0.03). No differences were observed between cancer and non-cancer health consequences (p=0.27) or health consequences that used plain language vs. medical jargon (p=0.94). CONCLUSIONS Our study provides new evidence about the perceived effectiveness of different cigar health warning statements and identifies features that may strengthen statements. IMPLICATIONS Our study with cigar smokers from across the United States provides much-needed evidence concerning the perceived effectiveness of different cigar health warning statements and features that may strengthen such statements. Mandated cigar warnings in the United States could be strengthened by including health consequences that were perceived as more effective in our study (e.g., early death), using health consequences that participants were aware of, and using short warning statements.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caleb A Smith
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christine E Kistler
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Allison Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James F Thrasher
- . Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Reboussin BA, Wagoner KG, Ross JC, Suerken CK, Sutfin EL. Tobacco and marijuana co-use in a cohort of young adults: Patterns, correlates and reasons for co-use. Drug Alcohol Depend 2021; 227:109000. [PMID: 34507062 PMCID: PMC8516030 DOI: 10.1016/j.drugalcdep.2021.109000] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND As marijuana is legalized in more states, modes of administration that facilitate co-use with tobacco are growing in popularity among young adults. This study examines the prevalence, patterns, correlates, and reasons for co-use so that targeted interventions can be developed to prevent negative consequences associated with tobacco use and co-use. METHODS In Fall 2019, 1887 young adults, originally recruited in 2010 from 11 colleges in North Carolina and Virginia to participate in a cohort study, completed an online survey. Co-use was defined as self-reported use of marijuana and tobacco in the past month. Tobacco-only, marijuana-only and co-users were compared using regression modeling. RESULTS Overall, 9.3% of the sample were co-users, 7.1% tobacco-only, and 15.8% marijuana-only users. Tobacco use was associated with an increased likelihood of marijuana use and vice-versa. Co-users were more likely to use e-cigarettes and blunts to administer marijuana and less likely to use smokeless tobacco products. They were more likely to use cocaine, have less anxiety, and be heavier marijuana users than marijuana-only users. Co-users of e-cigarettes and marijuana were less likely to be daily e-cigarette users and make quit attempts than e-cigarette users that did not use marijuana. Experimentation was the primary reason for co-use of tobacco and marijuana. CONCLUSIONS Co-users were more likely to use modes of administration that facilitate use of both substances and have patterns of use that may impact cessation efforts. These findings highlight the importance of surveillance of co-use and the development of interventions targeting experimentation with these substances by young adults.
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Affiliation(s)
- Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States.
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Kowitt SD, Cornacchione Ross J, Goldstein AO, Jarman KL, Thrasher JF, Ranney LM. Youth Exposure to Warnings on Cigar, E-Cigarette, and Waterpipe Tobacco Packages. Am J Prev Med 2021; 61:80-87. [PMID: 33849776 DOI: 10.1016/j.amepre.2021.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Studies of tobacco product warnings have focused primarily on the reach and effectiveness of cigarette warnings for adult smokers, whereas few observational studies have examined noncigarette tobacco product warnings among youth. METHODS High school students from the 2019 National Youth Tobacco Survey (n=10,094) reported the frequency of exposure to warnings on cigar, e-cigarette, and waterpipe tobacco packages and the perceived harm of occasionally using e-cigarettes and waterpipe tobacco. In 2020, results were analyzed for the entire sample and among subgroups, including never users, ever users, youth susceptible to using tobacco, and current users. RESULTS Reported high exposure to warnings was highest for cigars (22.3%), followed by that for e-cigarettes (20.8%) and that for waterpipe tobacco (7.0%). Youth who were susceptible to using cigars (AOR=1.53, 95% CI=1.29, 1.82), who ever used cigars (AOR=4.32, 95% CI=3.57, 5.22), or who currently used cigars (AOR=8.90, 95% CI=6.95, 11.39) were more likely to report high exposure to cigar warnings than youth who never used cigars. Similar findings were observed for e-cigarette and waterpipe tobacco warnings. For youth who ever used e-cigarettes, high exposure to warnings was associated with higher odds of perceiving e-cigarettes as harmful for occasional product use (AOR=1.50, 95% CI=1.05, 2.15), and high exposure to waterpipe tobacco warnings was associated with higher odds of perceiving waterpipe tobacco as harmful (AOR=1.21, 95% CI=1.00, 1.45). CONCLUSIONS Warnings on noncigarette tobacco products reach some youth at risk for using these products, but these warnings may need to be strengthened to further reduce their use.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Jennifer Cornacchione Ross
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Adam O Goldstein
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristen L Jarman
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Leah M Ranney
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sutfin EL, Lazard AJ, Soule EK, Kimes CM, King J, Jenson D, Ross JC. Health Claims, Marketing Appeals, and Warnings on Popular Brands of Waterpipe Tobacco Packaging Sold in the United States. Nicotine Tob Res 2021; 23:1183-1190. [PMID: 33406241 DOI: 10.1093/ntr/ntab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Waterpipe tobacco (WT) smoking is associated with misperceptions of harm, especially among users. WT packaging contains imagery, flavor descriptors, and text claims that may contribute to misperceptions. The study goal was to characterize visual and text elements of WT packaging. AIMS AND METHODS Using data from the U.S. Population Assessment on Tobacco and Health Study Wave 2 (October 2014-October 2015), we identified the 10 most popular WT brands. For each brand, we identified available flavors, including flavor collections with unique packaging elements. We randomly selected 10 flavors per brand for purchase (March-April 2018). We conducted descriptive content analysis to code all textual and visual design elements of each package. RESULTS Over half (54%) of WT packages had modified risk tobacco product (MRTP) claims prohibited by federal law, including substance-free MRTP claims (43%) and the descriptor "natural" (11%). No MRTP reduced exposure or reduced risk claims were found. Over a quarter (26%) of packaging including one or more of terms that may imply reduced harm including "fresh," "premium," "quality," and "pure." All packages included a text-only warning, yet none appeared on the primary display panel. Almost all packaging (99%) included imagery, with 72% including flavor imagery. The majority of packages (72%) included a smoking cue. The most popular marketing appeals were "well-made" (57%), "enjoyable" (55%), and "patriotic" (47%). CONCLUSIONS Prohibited MRTP claims, other descriptors, and flavor imagery are common on WT packaging, despite federal law. Future research is needed to evaluate if this marketing contributes to misperceptions of reduced harm. IMPLICATIONS Tobacco packaging is used to convey health-related messages, both explicitly and implicitly; however, information about WT packaging is virtually nonexistent. We conducted a content analysis of WT packaging from the 10 most popular US brands. Over half (54%) of packages had prohibited MRTP claims and over a quarter (26%) included one or more descriptors that may be perceived as implying reduced harm. Use of imagery, including smoking cues, was common. The widespread use of prohibited MRTP claims, other descriptors, and imagery on WT packaging may contribute to misperceptions of reduced harm.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Caroline M Kimes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jessica King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Desmond Jenson
- Mitchell Hamline School of Law, Public Health Law Center, Saint Paul, MN, USA
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Sutfin EL, Lazard AJ, Cornacchione Ross J, Noar SM, Reboussin BA. Waterpipe Tobacco Warnings: An Experimental Study among a Nationally Representative Sample of U.S. Young Adults. Nicotine Tob Res 2021; 23:1855-1860. [PMID: 34077539 DOI: 10.1093/ntr/ntab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/01/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Waterpipe tobacco (WT) smoking by young adults remains high and misperceptions are common. Product warnings can increase knowledge of harms and reduce use. The goal of this study was to test warning statements, including the FDA-required nicotine warning (prior to implementation), on young adults' thinking about harms of and discouragement from WT smoking. METHODS We conducted a between-subjects experiment in a nationally representative telephone survey of 1,152 young adults ages 18-29. Participants were randomly assigned to hear one of five warning statements and reported how much, on a 4-point scale, the warning made them think about the harms and discouraged them from WT smoking. RESULTS The sample was 36.8% female, 57.8% white, 20.2% Black, 24.1% Hispanic, with a mean age of 23.2 (SE=0.25). Under half (43.5%) had ever smoked WT. There were significant differences among the statements on both thinking about harms (p<.0001) and discouragement (p<.0001). The FDA-required 'nicotine' warning led to the lowest thinking about harms (M=2.85, SE=0.08) and was the least discouraging (M=2.86, SE=0.08), while the '100 cigarettes' warning resulted in the greatest thinking about harms (M=3.62, SE=0.05) and was the most discouraging (M=3.56, SE=0.06). CONCLUSION The nicotine warning resulted in the lowest levels of thinking about harms and discouragement from WT smoking, suggesting limited impact. However, a warning focused on comparing smoke inhalation from WT smoking to cigarettes seems promising. Warnings should cover a broad range of WT health effects, and possibly comparisons to cigarettes. Findings also have implications for the content of international waterpipe warnings. IMPLICATIONS This study indicates that the nicotine warning is the least effective at making young adults think about the harms of and discouraging waterpipe tobacco smoking. The FDA and other countries should consider requiring warnings to cover a broader range of health harms, misperceptions, and possibly comparisons to cigarettes.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Allison J Lazard
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Seth M Noar
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Denlinger-Apte RL, Pacek LR, Ross JC, Bansal-Travers M, Donny EC, Hatsukami DK, Carroll DM. Risk Perceptions of Low Nicotine Cigarettes and Alternative Nicotine Products across Priority Smoking Populations. Int J Environ Res Public Health 2021; 18:5311. [PMID: 34067652 PMCID: PMC8156883 DOI: 10.3390/ijerph18105311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the U.S. Food and Drug Administration considers a low nicotine product standard for cigarettes, it is important to examine how people who smoke, especially individuals from priority populations disproportionately affected by smoking, perceive low nicotine content (LNC) cigarettes and their relative risk perceptions of alternative nicotine delivery system (ANDS) products, including e-cigarettes and snus, and medicinal nicotine. METHODS Data are from Wave 4 (2016-2017) of the adult Population Assessment of Tobacco Use and Health (PATH) Study. We examined respondents' absolute risk perceptions about nicotine, LNC cigarettes, ANDS products and medicinal nicotine; their relative risk perceptions of LNC cigarettes and ANDS products compared to conventional cigarettes; and their relative risk perceptions of medicinal nicotine compared to ANDS products. RESULTS The majority of respondents across priority smoking populations indicated snus, e-cigarettes, and LNC cigarettes were 'about the same' level of harmfulness or addictiveness as conventional cigarettes. The majority of respondents indicated e-cigarettes to be 'about the same' harmfulness as medicinal nicotine. CONCLUSIONS Our study indicates that adults who smoke cigarettes generally have misperceptions about the harms of nicotine and the relative risks of ANDS products and such misperceptions exist regardless of their racial/ethnic identity, sexual orientation, and gender identity.
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Affiliation(s)
- Rachel L. Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (R.L.D.-A.); (J.C.R.)
| | - Lauren R. Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA;
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (R.L.D.-A.); (J.C.R.)
| | - Maansi Bansal-Travers
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Buffalo, NY 14263, USA;
| | - Eric C. Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Dorothy K. Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55414, USA;
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA
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Cornacchione Ross J, King JL, Lazard AJ, Noar SM, Reboussin BA, Jenson D, Sutfin EL. Developing Pictorial Cigarillo Warnings: Insights From Focus Groups. Nicotine Tob Res 2021; 23:383-389. [PMID: 32766683 DOI: 10.1093/ntr/ntaa130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/06/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The Food and Drug Administration (FDA) selected six text-only warnings for cigarillos to be implemented on packaging and advertising. Pictorial warnings are more effective at discouraging cigarette use than text-only warnings, yet no research exists for cigarillos. We sought to understand what types of images might be most effectively paired with the cigarillo text warnings to inform broad principles for developing pictorial warnings, with a focus on young adults, who have the highest rate of cigarillo use. METHODS We conducted five focus groups with a total of N = 30 young adult cigarillo users and susceptible nonusers (53% female, 50% White, and 33% Black). Participants were shown four to eight unique images for each of the six text statements and were asked about visual-verbal congruency, emotional and cognitive reactions, and perceived effectiveness of each image. Sessions were recorded and transcribed; two investigators independently coded transcripts for emergent themes. RESULTS Participants reported images that were graphic or "gross" would best grab attention and discourage use of cigarillos. Participants preferred images that were a direct illustration of the information in the warning text, rather than abstract images that required more cognitive effort to understand. Participants also highlighted that including people in the images, especially youth and young adults making eye contact, helped them relate to the warnings, garner their attention, and positively influence their reactions. CONCLUSIONS We identified several principles to inform the selection of images to pair with the FDA-required cigarillo text statements. These insights may also apply to pictorial warnings for other tobacco products. IMPLICATIONS This focus group study identified principles for selecting images to develop pictorial warnings for the six FDA text-only cigarillo warnings. We found that young adult cigarillo users and susceptible nonusers preferred images that were graphic and gross, believable, congruent to the warning text, and included people. Images that match young adults' visual expectations of a disease and are emotion-provoking may be most effective in pictorial warnings and highlight challenges for developing pictorial warnings for health effects that do not have a visible health consequence.
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Affiliation(s)
| | - Jessica L King
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT
| | - Allison J Lazard
- Hussman School of Media and Journalism, University of North Carolina, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Seth M Noar
- Hussman School of Media and Journalism, University of North Carolina, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, St. Paul, MN
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Cornacchione Ross J, Reboussin DM, Noar SM, Wiseman KD, Sutfin EL. What Do Adolescents and Young Adults Think a Cigarillo Is? Implications for Health Communication. Int J Environ Res Public Health 2021; 18:3311. [PMID: 33806872 PMCID: PMC8004959 DOI: 10.3390/ijerph18063311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term "cigarillo" in such efforts. The study goal was to assess adolescent and young adult perceptions of the term "cigarillo". We conducted a nationally representative online survey of 3517 adolescents and young adults (ages 13-25). We asked participants "what is a cigarillo?" with several response options. Participants were 49.6% female, 69.8% white, 5.2% reported past 30-day cigarillo use, and 11.6% reported lifetime cigarillo use. The most common response to the question "what is a cigarillo" was "I don't know" (51% of participants), followed by "a thinner and smaller version of a traditional cigar" (30.1% of participants), which was chosen by 19.4% of adolescents and 36.8% of young adults. Among past 30-day cigarillo users, the most common response was "I don't know" (54.9%) followed by "a thinner and smaller version of a traditional cigar" (45.1%). Cigarillo users were more likely to select the "a thinner and smaller version of a traditional cigar" response than nonusers. Findings suggest that many adolescents and young adults have varied understandings of the term "cigarillo". Researchers and practitioners need to ensure that terminology used in health communication campaigns is clearly understood by the target audience to maximize effectiveness.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC 27157, USA;
| | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
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Ballard PJ, Pankratz M, Wagoner KG, Cornacchione Ross J, Rhodes SD, Azagba S, Song EY, Wolfson M. Changing course: supporting a shift to environmental strategies in a state prevention system. Subst Abuse Treat Prev Policy 2021; 16:7. [PMID: 33430898 PMCID: PMC7802283 DOI: 10.1186/s13011-020-00341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/28/2022] Open
Abstract
Background This study examines how the North Carolina state prevention system responded to a policy shift from individual-level prevention strategies to environmental strategies from the perspective of the organizations implementing the policy shift. Methods We use two data sources. First, we conducted interviews to collect qualitative data from key informants. Second, we used prevention provider agency expenditure data from the year the shift was announced and the following year. Results The interviews allowed us to identify effective features of policy change implementation in complex systems, such as the need for clear communication and guidance about the policy changes. Our interview and expenditure analyses also underscore variation in the level of guidance and oversight provided by implementing agencies to prevention providers. Conclusions Our analyses suggest that more active monitoring and oversight may have facilitated more consistent implementation of the policy shift toward greater use of environmental prevention strategies.
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Affiliation(s)
- Parissa J Ballard
- Wake Forest School of Medicine, Family & Community Medicine, Piedmont Plaza Building 1, 1920 W 1st St., Winston-Salem, NC, 27104, USA.
| | - Melinda Pankratz
- Wake Forest School of Medicine, Social Sciences and Health Policy, Piedmont Plaza Building 1, 1920 W 1st St., Winston-Salem, NC, 27104, USA
| | - Kimberly G Wagoner
- Wake Forest School of Medicine, Social Sciences and Health Policy, Piedmont Plaza Building 1, 1920 W 1st St., Winston-Salem, NC, 27104, USA
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Social Sciences and Health Policy, Piedmont Plaza Building 1, 1920 W 1st St., Winston-Salem, NC, 27104, USA
| | - Scott D Rhodes
- Wake Forest School of Medicine, Social Sciences and Health Policy, Piedmont Plaza Building 1, 1920 W 1st St., Winston-Salem, NC, 27104, USA
| | - Sunday Azagba
- University of Utah School of Medicine, Salt Lake City, USA
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King JL, Wagoner KG, Suerken CK, Song EY, Reboussin BA, Spangler J, Walker S, Ross JC, Wolfson M, Sutfin EL. Are Waterpipe Café, Vape Shop, and Traditional Tobacco Retailer Locations Associated with Community Composition and Young Adult Tobacco Use in North Carolina and Virginia? Subst Use Misuse 2020; 55:2395-2402. [PMID: 32969275 PMCID: PMC8073526 DOI: 10.1080/10826084.2020.1823417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We examined whether waterpipe café, vape shop, and traditional tobacco retailer (e.g. stores selling cigarettes, cigars, smokeless tobacco) locations were associated with census tract composition and tobacco use among young adults in North Carolina and Virginia. Methods: We identified waterpipe cafés, vape shops, and traditional tobacco retailers in North Carolina and Virginia and conducted multivariable analyses between community characteristics (gender, race, ethnicity, education, college enrollment, and poverty) and density per 1000 population. Using fall 2017 data from 1099 young adults residing in North Carolina and Virginia, we conducted logistic regression analyses to determine whether tobacco retailer density and proximity were associated with tobacco use. Results: Waterpipe café, vape shop, and traditional retailer density were higher in communities with more people who were Hispanic, college-educated, and college-enrolled (each p < .05). Waterpipe café and traditional retailer density were higher in communities with more people living below the poverty level (each p < .05). Waterpipe café density was higher in communities with more people who were male (p < .05), while traditional retailer density was lower (p < .05). Waterpipe café and vape shop proximity were associated with increased likelihood of waterpipe tobacco use in the past 6 months (each p < .05; unadjusted). Traditional retailer proximity and waterpipe café, vape shop, and traditional retailer density were not associated with tobacco use. Conclusions: Waterpipe cafés and vape shops are located in both impoverished and college-educated communities in North Carolina and Virginia, similar to where traditional tobacco retailers are located. Further research is needed to examine associations with tobacco use.
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Affiliation(s)
- Jessica L. King
- Department of Health & Kinesiology, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Kimberly G. Wagoner
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Eunyoung Y. Song
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John Spangler
- Department of Family Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephannie Walker
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, California, USA
| | - Erin L. Sutfin
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Kowitt SD, Cornacchione Ross J, Jarman KL, Kistler CE, Lazard AJ, Ranney LM, Sheeran P, Thrasher JF, Goldstein AO. Tobacco Quit Intentions and Behaviors among Cigar Smokers in the United States in Response to COVID-19. Int J Environ Res Public Health 2020; 17:E5368. [PMID: 32722469 PMCID: PMC7432467 DOI: 10.3390/ijerph17155368] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022]
Abstract
Combustible tobacco users appear to be at greater risk for serious complications from COVID-19. This study examined cigar smokers' perceived risk of COVID-19, quit intentions, and behaviors during the current pandemic. We conducted an online study between 23 April 2020 to 7 May 2020, as part of an ongoing study examining perceptions of different health effects of cigars. All participants used cigars in the past 30 days (n = 777). Three-quarters of the sample (76.0%) perceived they had a higher risk of complications from COVID-19 compared to non-smokers. The majority of participants (70.8%) intended to quit in the next six months due to COVID-19, and almost half of the sample (46.5%) reported making a quit attempt since the start of the COVID-19 pandemic. Far more participants reported increasing their tobacco use since COVID-19 started (40.9%) vs. decreasing their tobacco use (17.8%). Black or African American participants, participants who reported using a quitline, and participants with higher COVID-19 risk perceptions had higher intentions to quit using tobacco due to COVID-19, and higher odds of making a quit attempt since COVID-19 started. More research is needed to understand how tobacco users are perceiving COVID-19 risks and changing their tobacco use behaviors.
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Affiliation(s)
- Sarah D. Kowitt
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.L.J.); (C.E.K.); (L.M.R.); (A.O.G.)
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC 27157, USA;
| | - Kristen L. Jarman
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.L.J.); (C.E.K.); (L.M.R.); (A.O.G.)
| | - Christine E. Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.L.J.); (C.E.K.); (L.M.R.); (A.O.G.)
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.J.L.); (P.S.)
| | - Allison J. Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.J.L.); (P.S.)
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Leah M. Ranney
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.L.J.); (C.E.K.); (L.M.R.); (A.O.G.)
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.J.L.); (P.S.)
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Adam O. Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.L.J.); (C.E.K.); (L.M.R.); (A.O.G.)
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.J.L.); (P.S.)
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Jeong M, Zhang D, Morgan JC, Ross JC, Osman A, Boynton MH, Mendel JR, Brewer NT. Similarities and Differences in Tobacco Control Research Findings From Convenience and Probability Samples. Ann Behav Med 2020; 53:476-485. [PMID: 30052702 DOI: 10.1093/abm/kay059] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Online convenience samples are a quick and low-cost way to study health behavior, but the comparability to findings from probability samples is not yet well understood. PURPOSE We sought to compare convenience and probability samples' findings for experiments, correlates, and prevalence in the context of tobacco control research. METHODS Participants were a probability sample of 5,014 U.S. adults recruited by phone from September 2014 through May 2015 (cost ~U.S.$620,000) and an online convenience sample of 4,137 U.S. adults recruited through Amazon Mechanical Turk (MTurk) in December 2014 (cost ~U.S.$17,000). Participants completed a survey with experiments, measures of tobacco product use and demographic characteristics. RESULTS MTurk convenience and probability samples showed the same pattern of statistical significance and direction in almost all experiments (21 of 24 analyses did not differ) and observational studies (19 of 25 associations did not differ). Demographic characteristics of the samples differed substantially (1 of 17 estimates did not differ), with the convenience sample being younger, having more years of education, and including more Whites and Asians. Tobacco product use also differed substantially (1 of 22 prevalence estimates did not differ), with the convenience sample reporting more cigarette and e-cigarette use (median error 19%). CONCLUSIONS Using MTurk convenience samples can yield generalizable findings for experiments and observational studies. Prevalence estimates from MTurk convenience samples are likely to be over- or underestimates.
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Affiliation(s)
- Michelle Jeong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Dongyu Zhang
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
| | - Jennifer C Morgan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Amira Osman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marcella H Boynton
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer R Mendel
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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King JL, Lazard A, Reboussin BA, Ranney L, Cornacchione Ross J, Wagoner KG, Sutfin EL. Optimizing Warnings on E-Cigarette Advertisements. Nicotine Tob Res 2020; 22:630-637. [PMID: 31132095 DOI: 10.1093/ntr/ntz091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/25/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We examined the effect of visual optimizations on warning text recall. METHODS We used Amazon's Mechanical Turk to recruit 1854 young adult (18-34 years) electronic cigarette (e-cigarette) users or susceptible nonusers. We conducted a between-subjects 3 × 2 × 2 experiment to examine the influence of color (black text on white background [BW] vs. black on yellow [BY] vs. yellow on black [YB]), shape (rectangle vs. novel), and signal word (presence vs. absence of the word "warning"). We randomized participants to view one of 12 warnings on a fictional e-cigarette advertisement. We coded open-ended recall responses into three categories: (1) recalled nothing, (2) recalled something, (3) recalled the concept. We examined main effects on warning text recall using multinomial regression. We examined differences in attention, perceived message effectiveness, and appeal. RESULTS Those exposed to BW or BY warnings were more likely than those exposed to YB to recall something (AOR = 1.6, AOR = 1.5, respectively) or the concept (OR = 1.4, BW). Those exposed to novel shape (44.7% novel vs. 37.9% rectangle; p = .003) or color (44.5% BY vs. 41.9% YB vs. 37.5% BW; p = .04) warnings were more likely to report attention to the warning. In aided recall, those exposed to the signal word were more likely than those not exposed to select the correct response (64.0% vs. 31.3%; p < .0001). We did not find differences for message effectiveness or appeal. CONCLUSIONS Visual optimizations such as color may influence warning text recall and should be considered for new warnings. Research should continue exploring variations for advertisement warnings to maximize attention to warning text. IMPLICATIONS This study examines the impact of visual optimizations on recall of the US Food and Drug Administration-mandated e-cigarette advertisement warning text. We found that color might influence warning text recall, but we did not find effects for shape or signal word. It is possible the newly mandated e-cigarette advertisement warnings, which are required to occupy at least 20% of the advertisement, are currently novel enough to attract attention. Future research should examine optimizations following implementation of the new advertisement warnings.
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Affiliation(s)
- Jessica L King
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Allison Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Leah Ranney
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Lazard AJ, Pikowski J, Horrell L, Ross JC, Noar SM, Sutfin EL. Adolescents' and Young Adults' Aesthetics and Functionality Preferences for Online Tobacco Education. J Cancer Educ 2020; 35:373-379. [PMID: 30734263 PMCID: PMC6687578 DOI: 10.1007/s13187-019-1475-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As cigarette use rates decline among adolescents and young adults, public health officials face new challenges with high use of non-cigarette tobacco products (NCTPs). Online tobacco education is a potential solution to discourage use, yet limited information is available for how online media should look and function. This study aims to fill this gap by conducting focus group interviews to identify adolescents and young adults' aesthetic and functionality preferences for online tobacco education (phase 1) followed by interviews to assess a NCTP education website developed (phase 2). We found preferences for use of font and colors to highlight tobacco information in organized designs. Interactive features (quizzes) motivated engagement, and participants desired responsive designs that function similarly across devices. Public health researchers and educators should apply aesthetic and functionality preferences to reduce NCTP use and help create a tobacco-free future for youth.
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Affiliation(s)
- Allison J Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, 384 Carroll Hall (CB 3365), Chapel Hill, NC, 27599-3365, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Jessica Pikowski
- School of Media and Journalism, University of North Carolina at Chapel Hill, 384 Carroll Hall (CB 3365), Chapel Hill, NC, 27599-3365, USA
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC, 27709, USA
| | - Lindsey Horrell
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, 384 Carroll Hall (CB 3365), Chapel Hill, NC, 27599-3365, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Erin L Sutfin
- Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
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Cornacchione Ross J, Sutfin EL, Suerken C, Walker S, Wolfson M, Reboussin BA. Longitudinal associations between marijuana and cigar use in young adults. Drug Alcohol Depend 2020; 211:107964. [PMID: 32251920 PMCID: PMC7508868 DOI: 10.1016/j.drugalcdep.2020.107964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND We assess the longitudinal associations between marijuana and cigar (little cigars and cigarillos [LCCs] and large cigars) use on subsequent initiation of marijuana and cigar use. METHODS Data are from a cohort study of 2189 young adults recruited in fall 2010 from 11 colleges in the Southeast. We used discrete-time survival analysis to examine whether ever use of marijuana at baseline (spring 2011, freshman year) predicted initiation of LCCs and large cigars and whether ever use of these cigar products predicted initiation of marijuana use across 10 waves of data collection (2011-2018). RESULTS The sample was 65.3 % female, 83.6 % White, 5.9 % Hispanic, and 61.8 % had college-educated mothers. At baseline, 70 % reported never using LCCs, 71 % reported never using large cigars, and 74 % reported never using marijuana. Ever use of marijuana at baseline was associated with an increased risk of LCC initiation (Incident rate ratio [IRR] = 1.6, 95 %CI = 1.0, 2.5) but not large cigar initiation. Ever use of LCCs (IRR = 1.4, 95 %CI = 1.1, 1.8) and ever use of large cigars (IRR = 1.3, 95 %CI = 1.1, 1.8) at baseline both predicted initiation of marijuana use. CONCLUSIONS Our findings support growing evidence that marijuana and LCCs are strongly associated and use of one substance predicts use of the other. In contrast to studies of adults, we also found that young adults who have tried large cigars may be at increased risk for subsequent marijuana use. These findings highlight the need to consider each product as a potential gateway of the other when developing interventions for young adults.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA.
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Cynthia Suerken
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Stephannie Walker
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Mark Wolfson
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, Riverside, 3333 14(th)Street, Riverside, CA, 92501, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
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Reboussin BA, Wagoner KG, Sutfin EL, Suerken C, Ross JC, Egan KL, Walker S, Johnson RM. Trends in marijuana edible consumption and perceptions of harm in a cohort of young adults. Drug Alcohol Depend 2019; 205:107660. [PMID: 31704375 PMCID: PMC7008857 DOI: 10.1016/j.drugalcdep.2019.107660] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/07/2019] [Accepted: 09/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rates of marijuana legalization have increased rapidly in recent years resulting in the marketing of alternative products like edibles that do not involve inhaling smoke. Edibles however pose unique public health challenges due to their greater risk for over-intoxication. METHODS 1858 young adults were surveyed every six months from 2016 to 2018. Logistic regression models examined trends in use and perceptions of harm. Chi-squared tests compared demographic and behavioral characteristics of edible users and non-users by frequency of marijuana use. RESULTS Perceptions of no harm from edibles increased (25.4%, 27.3%, 26.7%, 28.4%, 29.6%; p = 0.006) while it declined for smoking marijuana (12.2%, 13.5%, 11.7%, 10.6%, 9.1%; p < 0.001). Among non-daily marijuana users, edible use increased (20.3%, 24.8%, 30.5%, 36.2%, 36.6%; p < 0.001) while smoking marijuana declined for both daily and non-daily users. Among daily users, edible users were more likely to use all modes of consumption than non-edible users. Among non-daily users, edible users were less likely to smoke marijuana and perceive harm from edibles and were more likely to perceive harm from smoking marijuana and have visited a dispensary than non-edible users. CONCLUSIONS Edibles are increasingly consumed and perceived to not be harmful, despite the greater danger of over-intoxication. However, daily use of edibles alone is uncommon. The finding that edible users were more likely to have visited a dispensary provides a potential intervention point for consumer education. Strong scientific evidence is needed to guide policymakers in best practices for communicating knowledge and potential harms of these products.
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Affiliation(s)
- Beth A Reboussin
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Kimberly G Wagoner
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Erin L Sutfin
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Cynthia Suerken
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Kathleen L Egan
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Stephannie Walker
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Renee M Johnson
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
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Wagoner KG, Berman M, Rose SW, Song E, Cornacchione Ross J, Klein EG, Kelley DE, King JL, Wolfson M, Sutfin EL. Health claims made in vape shops: an observational study and content analysis. Tob Control 2019; 28:e119-e125. [PMID: 31123104 PMCID: PMC8142343 DOI: 10.1136/tobaccocontrol-2018-054537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prior to the final deeming rule, federal law in the USA prohibited electronic cigarettes (e-cigarettes) from being marketed as smoking cessation products; for other therapeutic purposes and in ways that conveyed Food and Drug Administration (FDA) approval/endorsement. After August 2016, additional federal prohibitions were added including false/misleading and unauthorised modified risk tobacco product (MRTP) claims. No systematic investigation of e-cigarette health claims has been conducted in the retail environment. We sought to document and characterise claims made in vape shops. METHODS Between November 2015 and February 2016, before final deeming rule implementation, two trained data collectors conducted unannounced observational assessments of 46 vape shops in North Carolina. Data collectors used wearable imaging technology to document health claims about e-cigarettes. Photos were coded for five claim types: (1) cessation device; (2) drug effect/device; (3) FDA-approved/endorsed; (4) false/misleading and (5) MRTP. Photos were double coded; differences between coders were adjudicated and reviewed by an expert panel. RESULTS At least one health claim was displayed in 41.3% (n=19) of retailers, ranging from 0 to 27 claims per retailer. All claim types were found. Cessation device claims were the most prevalent (62.2%, n=84), followed by MRTP (27.4%, n=37), drug effect/device (8.1%, n=11), false/misleading (1.5%, n=2), and FDA approved/endorsed (0.7%, n=1). Retail chains made the majority of claims compared with independent shops (88.9% vs 11.1%). CONCLUSIONS Many vape shops displayed e-cigarette health claims, which are all now FDA prohibited. These claims could mislead consumers and influence behaviour. Findings highlight the need for retailer education, continued surveillance, enforcement specific to advertising and research on consumer perceptions of claims.
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Affiliation(s)
- Kimberly G Wagoner
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Micah Berman
- Health Services Management and Policy, The Ohio State University College of Public Health and Moritz College of Law, Columbus, Ohio, USA
| | - Shyanika W Rose
- Truth Initiative, Schroeder Institute for Tobacco Research and Policy Studies, Washington, DC, USA
| | - Eunyoung Song
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Elizabeth G Klein
- Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Dannielle E Kelley
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L King
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark Wolfson
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin L Sutfin
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Kong G, Creamer MR, Simon P, Cavallo DA, Ross JC, Hinds JT, Fishbein H, Gutierrez K. Systematic review of cigars, cigarillos, and little cigars among adolescents: Setting research agenda to inform tobacco control policy. Addict Behav 2019; 96:192-197. [PMID: 31125939 PMCID: PMC6645397 DOI: 10.1016/j.addbeh.2019.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/01/2019] [Accepted: 04/28/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We conducted a systematic review of the literature on cigar research on youth to identify potential future research agenda to generate evidence to inform cigar regulations to prevent cigar use among youth. METHODS We searched articles on Medline, EMBASE, and PsycINFO in April 2017 to identify articles relevant to cigars and adolescents. Two independent coders examined 48 articles to determine eligibility: (1) published between 2000-April 2017; (2) published in English; (3) conducted in the United States; (4) published in a peer-review journal; (5) examined cigars, cigarillos, or little cigars; (6) included youth (12-18 years old); and (7) included empirical data. Three independent coders reviewed the included articles (n = 48) to identify whether the studies addressed FDA's Research Priorities. RESULTS The studies addressed FDA's Research Priorities of "behavior" (n = 48), "communications" (n = 4), "marketing influences" (n = 1), and "impact analysis" (n = 1). Studies on "behavior" underscored the need for improvements in measurement, such as using brand names and distinguishing cigar products. The review revealed the need for restrictions on cigar flavors, development of media campaigns and interventions, increasing the cost (via taxation), and evaluating the impact of cigar policies. CONCLUSIONS The studies mostly focused on surveillance of behaviors and use patterns, which revealed cigar specific issues to address in policies to decrease cigar use among youth. The lack of studies addressing other FDA's research priorities highlighted the critical need for future studies that inform prevention of youth cigar use.
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Affiliation(s)
- Grace Kong
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America.
| | - MeLisa R Creamer
- UTHealth The University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, TX 78701, United States of America
| | - Patricia Simon
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America
| | - Dana A Cavallo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Winston Salem, NC 27101, United States of America
| | - Josephine T Hinds
- The University of Texas at Austin, Department of Kinesiology & Health Education, Austin, TX 78712, United States of America
| | | | - Kevin Gutierrez
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America
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King JL, Reboussin BA, Ross JC, Sutfin EL. Waterpipe tobacco package warning exposure's impact on risk perceptions and use among young adults in the USA: a longitudinal analysis of the population assessment of tobacco and health study. Tob Control 2019; 28:e16-e23. [PMID: 30158209 PMCID: PMC6395506 DOI: 10.1136/tobaccocontrol-2018-054562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/23/2018] [Accepted: 08/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although Food and Drug Administration (FDA)-mandated waterpipe tobacco warnings were not required until August 2018, some waterpipe tobacco packaging (WTP) sold in the USA, contained warnings prior to this date. We examined the prevalence of WTP warning exposure and whether exposure influenced risk perceptions or use among young adult (aged 18-24 years) current waterpipe users. METHODS We used data from waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adults and youth. We conducted logistic regression analyses to identify factors associated with wave 1 warning exposure, and whether wave 1 WTP warning exposure predicted wave 2 relative risk perceptions and waterpipe use. RESULTS More than one-third of our sample (35.9%, 95% CI 33.5 to 38.4) reported past-month WTP warning exposure. Exposure was higher among males (adjusted OR (AOR)=1.34, 95% CI 1.04 to 1.72), those who usually do not share the waterpipe (AOR=3.10, 95% CI 1.45 to 6.60), those who purchased waterpipe tobacco (AOR=1.73, 95% CI 1.28 to 2.34), and those with a regular brand (AOR=1.84, 95% CI 1.26 to 2.68). Those exposed to WTP warnings at wave 1 were more likely than those not exposed to perceive waterpipe tobacco to be as or more harmful than cigarettes at wave 2 (AOR=1.35, 95% CI 1.02 to 1.78). There was no association between wave 1 WTP exposure and wave 2 waterpipe use. CONCLUSIONS More than one-third of US young adult current waterpipe users reported WTP warning exposure prior to FDA-mandated warning implementation. Findings suggest the mandated warning may result in high exposure among users; it will be critical to assess exposure's impact on risk perceptions and behaviour after FDA-mandated warnings are implemented.
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Affiliation(s)
- Jessica L King
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Wagoner KG, Reboussin DM, King JL, Orlan E, Cornacchione Ross J, Sutfin EL. Who Is Exposed to E-Cigarette Advertising and Where? Differences between Adolescents, Young Adults and Older Adults. Int J Environ Res Public Health 2019; 16:E2533. [PMID: 31315189 PMCID: PMC6679184 DOI: 10.3390/ijerph16142533] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 12/28/2022]
Abstract
Little is known about differences between adolescents' and adults' exposure to e-cigarette advertising in various media channels, such as retail establishments, print, television, radio, and digital marketing. We examined the exposure to e-cigarette advertising in these channels amongst adolescents (13-17), young adults (18-25), and older adults (26+). Adolescents (N = 1124), young adults (N = 809), and adults (N = 4186) were recruited through two nationally representative phone surveys from 2014-2015. Lifetime e-cigarette advertising exposure was prevalent (84.5%). Overall, older adult males and older adult cigarette smokers reported the highest exposure to e-cigarette advertising (p < 0.001). Television was the largest source of exposure for all age groups. Adolescents and young adults had higher odds than older adults of exposure through television and digital marketing. However, adolescents had lower odds than young adults and older adults of exposure through retailers and print media. Although e-cigarette advertising appears to be reaching the intended audience of adult smokers, vulnerable populations are being exposed at high rates via television and digital marketing. Regulations aimed at curbing exposure through these media channels are needed, as are counter advertising and prevention campaigns.
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Affiliation(s)
- Kimberly G Wagoner
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - David M Reboussin
- Wake Forest School of Medicine, Department of Biostatistics and Data Science, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jessica L King
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Erin L Sutfin
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
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Francis DB, Mason N, Ross JC, Noar SM. Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies. Tob Induc Dis 2019; 17:41. [PMID: 31516484 PMCID: PMC6662785 DOI: 10.18332/tid/108614] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults. METHODS We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes. RESULTS Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs. CONCLUSIONS The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.
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Affiliation(s)
- Diane B Francis
- Department of Communication, University of Kentucky, Lexington, United States
| | - Nia Mason
- Manship School of Mass Communication, Louisiana State University, Baton Rouge, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, United States
| | - Seth M Noar
- School of Media & Journalism, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, United States
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Noar SM, Rohde JA, Horvitz C, Lazard AJ, Cornacchione Ross J, Sutfin EL. Adolescents' receptivity to E-cigarette harms messages delivered using text messaging. Addict Behav 2019; 91:201-207. [PMID: 29960716 DOI: 10.1016/j.addbeh.2018.05.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/24/2018] [Accepted: 05/27/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION E-cigarette use among adolescents has dramatically risen since 2011, yet little research has tested e-cigarette harms messages among adolescents. We conducted a pretest-posttest pilot study to examine adolescents' receptivity to e-cigarette health harms messages delivered using text messaging. METHODS N = 69 adolescents were enrolled in an 8-day pretest-posttest text messaging study. Participants completed a pretest survey on day one, were texted one of three e-cigarette health harms messages per day on days two through seven, and completed a posttest survey on day eight (88% retention). We assessed message ratings at posttest and knowledge, thoughts, and beliefs about e-cigarette harms at pretest and posttest. RESULTS Adolescents rated the three messages favorably, with both the chemical and brain messages scoring higher than the nicotine message on fear arousal and perceived message effectiveness. More than one-third of adolescents showed the messages to others and talked to others about the messages. At posttest, knowledge about the harms of e-cigarettes, thinking about the risks of e-cigarettes, and perceived risks of e-cigarettes were all significantly higher compared to pretest (p < .05). Participants largely adhered to the text messaging protocol and found the study highly acceptable. CONCLUSIONS This pilot study suggests that adolescents are receptive to e-cigarette health harms messages and that delivering such messages using text messaging is feasible and acceptable. Future research should systematically develop and test a broad set of e-cigarette health harms messages and examine their impact in a randomized controlled trial.
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Affiliation(s)
- Seth M Noar
- University of North Carolina at Chapel Hill, United States; Lineberger Comprehensive Cancer Center, United States.
| | - Jacob A Rohde
- University of North Carolina at Chapel Hill, United States
| | - Casey Horvitz
- Lineberger Comprehensive Cancer Center, United States
| | - Allison J Lazard
- University of North Carolina at Chapel Hill, United States; Lineberger Comprehensive Cancer Center, United States
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Sutfin EL, Ross JC, Lazard AJ, Orlan E, Suerken CK, Wiseman KD, Reboussin BA, Wolfson M, Noar SM. Developing a Point-of-Sale Health Communication Campaign for Cigarillos and Waterpipe Tobacco. Health Commun 2019; 34:343-351. [PMID: 29236565 PMCID: PMC6481293 DOI: 10.1080/10410236.2017.1407277] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Adolescents and young adults smoke waterpipe tobacco (WT) and cigarillos, at least in part, based on erroneous beliefs that these products are safer than cigarettes. To address this challenge, we used a systematic, three-phase process to develop a health communication campaign to discourage WT and cigarillo smoking among at-risk (tobacco users and susceptible non-users) 16- to 25-year-olds. In Phase 1, we used a national phone survey (N = 896) to determine salient message beliefs. Participants reported constituents (i.e., harmful chemicals) emitted by the products were worrisome. In Phase 2, we developed and evaluated four message executions, with varying imagery, tone, and unappealing products with the same constituents, using focus groups (N = 38). Participants rated one execution highly, resulting in our development of a campaign where each message: (1) identified a tobacco product and constituent in the smoke; (2) included an image of an unappealing product containing the constituent (e.g., pesticides, gasoline) to grab attention; and (3) used a humorous sarcastic tone. In Phase 3, we tested the campaign messages (17 intervention and six control) with a nationally representative online survey (N = 1,636). Participants rated intervention and control messages highly with few differences between them. Exposure to messages resulted in significant increases in all risk beliefs from pre to post (p < 0.05). For WT, intervention messages increased beliefs about addiction more than control messages (p < 0.05). This systematic, iterative approach resulted in messages that show promise for discouraging WT and cigarillo use.
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Affiliation(s)
- Erin L. Sutfin
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | | | - Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
| | - Cynthia K. Suerken
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Kimberly D. Wiseman
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Mark Wolfson
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
- Center for Research on Substance Use and Addiction, Wake Forest School of Medicine
| | - Seth M. Noar
- School of Media and Journalism, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
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Abstract
The Food and Drug Administration, which now has regulatory authority over all tobacco products meeting the statutory definition, is tasked with communicating the risks of these products to the public through health warnings and public education. However, there have been no attempts to summarize what is known about non-cigarette tobacco product (NCTP) health messaging. We conducted a systematic review to examine the existing literature on health communication for NCTPs and identify key research gaps. A total of 45 unique studies were retrieved and coded, with the majority focused on messaging for smokeless tobacco (SLT, k = 32, 71.1%), followed by waterpipe tobacco (WT, k = 9, 20%), electronic nicotine delivery systems (ENDS, k = 2, 4.4%), cigars (k = 2, 4.4%), and a potentially reduced exposure product (k = 1, 2.2%). Studies most commonly examined tobacco product warnings (k = 26, 57.8%) and public education (k = 19, 42.2%), which included mass media campaigns. Most studies examined knowledge, attitudes, and beliefs as outcomes (k = 27, 60%), while behavior was an outcome in the minority of studies (k = 8, 17.8%). Pictorial warnings and public education about NCTPs demonstrated positive impact in some studies, although the literature is nascent. Given the increasing use of NCTPs such as ENDS, WT, and cigars, particularly among adolescents and young adults, more research is needed on effective ways to communicate product risk to those audiences most at risk.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Seth M. Noar
- School of Media and Journalism, University of North Carolina, Chapel Hill
| | - Erin L. Sutfin
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
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Barker JO, Kelley DE, Noar SM, Reboussin BA, Cornacchione Ross J, Sutfin EL. E-Cigarette Outcome Expectancies among Nationally Representative Samples of Adolescents and Young Adults. Subst Use Misuse 2019; 54:1970-1979. [PMID: 31188055 PMCID: PMC6764885 DOI: 10.1080/10826084.2019.1624773] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: We conducted nationally representative surveys of adolescents and young adults to examine associations between e-cigarette outcome expectancies and e-cigarette use. Background: E-cigarette use among adolescents and young adults has grown rapidly in recent years, yet little research has examined the beliefs that may underlie this behavior among nationally representative samples. Methods:N = 1,298 adolescents (13-17) and 2,219 young adults (18-25) were surveyed using a probability-based web panel. Participants completed a survey that included a new outcome expectancy measure examining 3 positive (enjoyment, social influences, advantage over cigarettes) and 2 negative (health concerns, smoker association) expectancy domains and ever having used e-cigarettes [ever use]. Results: Confirmatory factor analyses demonstrated a good fit of the outcome expectancies' factor structure to the data. All outcome expectancies were associated with e-cigarette use in both populations in univariate analyses. In multiple logistic regression models controlling for several covariates, higher expected enjoyment was positively associated with a greater likelihood of e-cigarette use (aOR = 2.10, p < .05) among adolescents. Among young adults, enjoyment (aOR = 3.08, p < .001) was positively associated with a greater likelihood of use while both health concerns (aOR = 0.70, p < .01) and smoker association (aOR = 0.73, p < .05) were negatively associated with e-cigarette use. Conclusions: This study suggests that expected enjoyment is robustly associated with e-cigarette use among both adolescents and young adults. Health concerns may also play a role in e-cigarette use. Implications for e-cigarette prevention efforts and future research directions are discussed.
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Affiliation(s)
- Joshua O Barker
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Dannielle E Kelley
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine , Winston-Salem , North Carolina , USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine , Winston-Salem , North Carolina , USA
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Lazard AJ, Horrell L, Pikowski J, Cornacchione Ross J, Noar SM, Sutfin EL. Message and Delivery Preferences for Online Tobacco Education among Adolescents and Young Adults. J Health Commun 2018; 23:735-742. [PMID: 30280989 PMCID: PMC6421838 DOI: 10.1080/10810730.2018.1523259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Use of cigarettes and noncigarette tobacco products (NCTPs) among adolescents and young adults remains high. Strategies to communicate the risks of cigarettes and NCTPs are needed. Online tobacco education is one such strategy; however, there is little guidance for message development. We conducted four focus groups (n = 39) with adolescent and young adult to identify message and delivery preferences for online tobacco education. Participants evaluated three existing tobacco education websites. Transcripts were coded for preferred tobacco education message content, delivery, and willingness to use online tobacco education. Participants preferred novel, concise facts, embedded links to credible sources, and an anti-industry tone for website messages. Participants expressed an aversion to message strategies that relied on scare tactics or attempted to simulate youth media trends (e.g., overuse of hashtags). To increase exposure, participants recommended using social media to drive engagement. Results serve as guidelines for what information adolescents and young adults desire, as well as how they want this information communicated with online tobacco education. Our findings - youth prefer new, fact-based information that is conveyed concisely, with sources, without authoritative tones, and delivered via social media - provides guidance for how to develop online tobacco education for this at-risk population.
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Affiliation(s)
- Allison J Lazard
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , USA
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Lindsey Horrell
- c School of Nursing , University of North Carolina at Chapel Hill , Chapel Hill , USA
- d Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Jessica Pikowski
- e Center for Health Policy and Tobacco Research , RTI International - Research Triangle Park , Durham , USA
| | - Jennifer Cornacchione Ross
- f Department of Social Sciences and Health Policy , Wake Forest School of Medicine , Winston-Salem , USA
| | - Seth M Noar
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , USA
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Erin L Sutfin
- f Department of Social Sciences and Health Policy , Wake Forest School of Medicine , Winston-Salem , USA
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King JL, Reboussin D, Cornacchione Ross J, Wiseman KD, Wagoner KG, Sutfin EL. Polytobacco Use Among a Nationally Representative Sample of Adolescent and Young Adult E-Cigarette Users. J Adolesc Health 2018; 63:407-412. [PMID: 30115508 PMCID: PMC6388402 DOI: 10.1016/j.jadohealth.2018.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/02/2018] [Accepted: 04/18/2018] [Indexed: 01/11/2023]
Abstract
PURPOSE Electronic nicotine delivery systems (ENDS) are adolescents' most commonly used tobacco product and young adults' second most used. Little is known about ENDS use alongside other tobacco products (polytobacco use) and whether exclusive ENDS users differ from polytobacco ENDS users. METHODS In spring 2016, we surveyed a nationally representative sample of 3,517 13-25-year olds (36.9% 13-17-year olds), and examined sociodemographic and relative risk perceptions between two groups of past 30-day ENDS users: exclusive (only ENDS) and polytobacco (ENDS and at least one other tobacco product). RESULTS 4.5% of adolescents and 10% of young adults reported past 30-day ENDS use (n = 281; analytic sample). ENDS users were 38.8% female and 70.6% white. Over half (55.9%) were polytobacco ENDS users. The most common patterns of polytobacco ENDS use were ENDS and cigarettes (11.5%), ENDS and cigars (7.7%), and ENDS, cigars, and waterpipe (5.2%). Those who perceived ENDS to be less harmful than cigarettes were more likely to be exclusive ENDS users than those who perceived ENDS to be as or more harmful than cigarettes (adjusted odds ratio = 2.6, confidence interval = 1.2, 5.7). There were no differences between ENDS groups on age, race, sex, parental education, sexual orientation, or ENDS use frequency. CONCLUSIONS Just over half of ENDS users also used other tobacco products, increasing their risk for nicotine addiction and other health harms. The Food and Drug Administration is responsible for communicating product risk to consumers and should consider common patterns of use and relative risk perceptions in its ENDS public education efforts.
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Affiliation(s)
- Jessica L King
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - David Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
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