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Do VV, Spears CA, Ling PM, Eriksen MP, Weaver SR, Pechacek TF, Nyman AL, Emery SL, Berg CJ, Huang J. Racial/ethnic disparities in exposure to e-cigarette advertising among U.S. youth. Public Health 2024; 230:89-95. [PMID: 38521029 DOI: 10.1016/j.puhe.2024.02.011] [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: 08/16/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES This study aims to assess exposure to e-cigarette advertising across multiple marketing channels among U.S. youth and to examine whether racial/ethnic disparities exist in exposure to e-cigarette advertisements. STUDY DESIGN This is a cross-sectional study. METHODS Cross-sectional data were drawn from a longitudinal survey of participants recruited from two nationally representative panels (NORC's AmeriSpeak® and GfK's KnowledgePanel). A total of 2043 youth aged 13-17 completed the initial 2018 survey, and 2013 youth completed the follow-up survey in 2019 (including a replenishment sample of 690 youth). Outcome variables were self-reported e-cigarette advertisement exposure in the past three months through various sources, such as television, point of sale, and online/social media. Generalized estimating equation models were used to estimate the adjusted odds ratios (AOR) of the association between racial/ethnic identity and e-cigarette advertisement exposure. RESULTS The prevalence of reported exposure to e-cigarette advertisements through any channel was 79.8% (95% CI: 77.1-82.2) in 2018 and 74.9% (95% CI: 72.5-77.1) in 2019, respectively. Point of sale was the most common source of e-cigarette advertisement exposure in both years. Non-Hispanic Black and non-Hispanic Asian youth were more likely to report exposure to e-cigarette advertisements through television (AOR = 2.07, 95% CI: 1.44-2.99 and AOR = 2.11, 95% CI: 1.17-3.82, respectively) and online/social media (AOR = 1.61; 95% CI: 1.11-2.33 and AOR = 1.99, 95% CI: 1.10-3.59, respectively) channels compared with non-Hispanic White youth. CONCLUSIONS A substantial proportion of U.S. youth reported exposure to e-cigarette advertising through a variety of marketing channels. Significant racial/ethnic disparities existed, with non-Hispanic Black and Asian youth reporting more marketing exposure than their non-Hispanic White counterparts.
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Affiliation(s)
- V V Do
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - C A Spears
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - P M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M P Eriksen
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - S R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - T F Pechacek
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - A L Nyman
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - S L Emery
- NORC at University of Chicago, Chicago, IL, USA
| | - C J Berg
- Department of Prevention & Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - J Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
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Nguyen N, Islam S, Llanes KD, Koester KA, Ling PM. Classification of patterns of tobacco and cannabis co-use based on temporal proximity: A qualitative study among young adults. Addict Behav 2024; 152:107971. [PMID: 38281461 PMCID: PMC10923078 DOI: 10.1016/j.addbeh.2024.107971] [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: 09/01/2023] [Revised: 12/19/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Co-use of tobacco and cannabis is a common and complex behavior. The lack of harmonized measures of co-use yields confusion and inconsistencies in synthesizing evidence about the health effects of co-use. We aimed to classify co-use patterns based on temporal proximity and describe preferred products and motives for each pattern in order to improve co-use surveillance. METHODS We conducted semi-structured interviews in a sample of 34 young adults (Mage = 22.8 years, 32.4 % female) during 2017-2019 in California, USA. We employed a qualitative thematic analysis to identify timing, reasons, and contexts for tobacco and cannabis co-use and classify co-use patterns. RESULTS Four emergent patterns of co-use with increasing temporal proximity between tobacco use and cannabis use were: Same-month different-day co-use (Pattern 1); Same-day different-occasion co-use (Pattern 2); Same-occasion sequential co-use (Pattern 3); and Same-occasion simultaneous co-use (Pattern 4). Participants used various product combinations within each pattern. Similar motives for all patterns were socialization, product availability, and coping with stress/anxiety. Unique motive for temporally distant patterns (Patterns 1 and 2) was seeking substance-specific effects (e.g., stimulant effect from nicotine, relaxation effects from cannabis), while unique motives for temporally close patterns (Patterns 3 and 4) were seeking combined effects from both substances (e.g., more intense psychoactive effects, mitigating cannabis adverse effects) and behavioral trigger (e.g., cannabis use triggers tobacco use). CONCLUSIONS Our classification of co-use patterns can facilitate consistency for measuring co-use and assessing its health impacts. Future research should also measure product types and motives for different patterns to inform intervention efforts.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - Sabrina Islam
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Karla D Llanes
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
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Waring JJC, Nguyen N, Ling PM, Thrul J. Quantity of cigarettes smoked when co-used with alcohol and cannabis: Consideration of different definitions of co-use based on daily diary data. Drug Alcohol Depend 2024; 258:111264. [PMID: 38547786 DOI: 10.1016/j.drugalcdep.2024.111264] [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] [Received: 09/18/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Cigarettes are frequently co-used with alcohol and cannabis. However, definitions of co-use vary and the extent to which cigarette use changes on days with different patterns of co-use is unclear. We compared the number of cigarettes smoked on different days based on co-use patterns of cigarettes and alcohol or cannabis. METHODS This study analyzed 2408 smoking days collected in a 30-day smartphone-based daily diary study among 146 young adults (aged 18-26) with an oversample from sexual minority groups. Two separate multilevel models were estimated: one for cigarette and alcohol co-use and the other for cigarette and cannabis co-use. Both models examined day-level associations between the number of cigarettes smoked and 3 different types of days (smoking-only days, same-occasion co-use days, different-occasion co-use days), controlling for demographic characteristics. RESULTS More cigarettes were smoked on same-occasion co-use days compared to cigarette-smoking-only days for both alcohol (b=1.474, SE=0.136, t=10.8, p<.001) and cannabis (b=0.822, SE=0.209, t=3.9, p<.001). There were no significant differences in cigarettes smoked on days with co-use on the same day, but on different occasions, compared to days with smoking only. CONCLUSIONS Compared to days with cigarette smoking only, more cigarettes are smoked on days when cigarettes are co-used with alcohol or cannabis on the same occasion, while the same is not true for days with co-use on different occasions. Conflating different definitions of co-use may impact findings on associations between co-use and smoking behavior.
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Affiliation(s)
- Joseph J C Waring
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.
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Lyu JC, Meacham MC, Nguyen N, Ramo D, Ling PM. Factors Associated With Abstinence Among Young Adult Smokers Enrolled in a Real-world Social Media Smoking Cessation Program. Nicotine Tob Res 2024; 26:S27-S35. [PMID: 38366340 PMCID: PMC10873491 DOI: 10.1093/ntr/ntad170] [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: 03/31/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Social media platforms are promising to provide smoking cessation support. This study aimed to identify baseline factors associated with cigarette smoking abstinence among young adult smokers enrolled in a real-world social media-based smoking cessation program. AIMS AND METHODS We analyzed data from young adult smokers (aged 18-30 years) participating in a publicly available Facebook-based smoking cessation program serving the San Francisco Bay Area. The analytic sample consisted of 248 participants who completed both the baseline and follow-up surveys at 3 months. Multivariable logistic regression analysis determined baseline factors significantly associated with self-reported 7-day cigarette smoking abstinence at 3 months. RESULTS Participants were race/ethnically diverse, well-educated, and 47.6% reported LGB + sexual identity. Those who reported dual use of cigarettes and e-cigarettes in the past 30 days (vs. cigarette use only), current alcohol users (vs. non-users), and those aged 25-30 years (vs. 18-24 years) were significantly less likely to report 7-day abstinence at 3 months. Non-daily smokers (vs. daily smokers) and those with high desire to quit smoking (vs. low to moderate desire) were more likely to report abstinence. Results also showed reduction in the percentage of e-cigarette and other tobacco product use among participants. CONCLUSIONS Social media interventions may be more effective for young adult non-daily smokers and those with high desire to quit smoking. Smoking cessation programs may help reduce use of other tobacco products among treatment-seeking smokers. Smoking cessation interventions for young adults need to explicitly address dual use of cigarettes and e-cigarettes and use of alcohol. IMPLICATIONS Findings of this study highlight the need for future interventions to address dual use of cigarettes and e-cigarettes and use of alcohol to improve cigarette smoking abstinence outcomes. The reduction in the use of other tobacco products among program participants indicates that social media smoking cessation programs may exert a broader positive influence on overall tobacco consumption. The large number of LGB+ smokers participating in the program suggests social media is a promising cessation channel for this hard-to-reach group, warranting further study.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Meredith C Meacham
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Danielle Ramo
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
- HopeLab, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
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Hendlin YH, Han EL, Ling PM. Pharmaceuticalisation as the tobacco industry's endgame. BMJ Glob Health 2024; 9:e013866. [PMID: 38316465 PMCID: PMC10859997 DOI: 10.1136/bmjgh-2023-013866] [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: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
CONTEXT Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal. METHODS We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs' investor and other professional reports, websites and public statements. FINDINGS Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate. CONCLUSIONS Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of 'clean' reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.
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Affiliation(s)
- Yogi Hale Hendlin
- Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elieen Le Han
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco School of Medicine, San Francisco, California, USA
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Pravosud V, Holmes LM, Lempert LK, Ling PM. Impacts of Tax and Flavor Tobacco Policies on San Francisco Bay Area Tobacco Prices. Eval Rev 2023; 47:763-785. [PMID: 36943027 PMCID: PMC10542911 DOI: 10.1177/0193841x231164908] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.
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Affiliation(s)
- Vira Pravosud
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Louisa M. Holmes
- The Pennsylvania State University, Departments of Geography and Demography, University Park, PA, USA
| | - Lauren K. Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Watkins SL, Thompson J, Feld AL, Ling PM, Lee YO. Flavored Cannabis Use and Cannabis-Tobacco Co-use: Patterns In U.S. States With Legalized Nonmedical Adult Use. Am J Prev Med 2023; 65:551-559. [PMID: 37169316 PMCID: PMC10527725 DOI: 10.1016/j.amepre.2023.05.006] [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] [Received: 10/07/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Little is known about inhaled flavored cannabis use. This study aimed to investigate the prevalence and patterns of flavored cannabis use and cannabis-tobacco co-use. METHODS This study surveyed adult past 30-day cannabis users in U.S. states and districts that have legalized cannabis for nonmedical/adult use (n=9) (November 2018; n=2,978). By product/behavior (any cannabis, cannabis extract vaporizers, mixed cannabis-nicotine vaporizers, blunts, chasing), the association between flavored (versus non-flavored) use and sociodemographic characteristics, cannabis use disorder symptoms, and tobacco use was estimated using weighted multivariable logistic regression in January 2022. RESULTS Almost half of adult cannabis users reported using at least one flavored cannabis product (46.5%). Flavored cannabis use was more likely among respondents who were female (AOR=1.2, CI=1.0, 1.4), were Black (ref: White; AOR=2.2, CI=1.5, 3.1), were Hispanic/Latino/a/x (ref: White; AOR=1.6, CI=1.2, 1.9), had cannabis use disorder symptoms (AOR=2.0, CI=1.6, 2.4), or were currently using tobacco (AOR=2.4, CI=2.1, 2.9). Use was less likely among middle-aged/older adults (ref: ages 21-34 vs 35-49 years; AOR=0.6, CI=0.5, 0.7). CONCLUSIONS Observed differences in flavored cannabis use are concerning if flavors raise appeal or dependence. Integrating flavored cannabis and tobacco research and practice is warranted.
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Affiliation(s)
- Shannon Lea Watkins
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa.
| | - Jesse Thompson
- RTI International, Research Triangle Park, North Carolina
| | - Ashley L Feld
- RTI International, Research Triangle Park, North Carolina
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Youn Ok Lee
- RTI International, Research Triangle Park, North Carolina
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Llanes KD, Ling PM, Guillory J, Vogel EA. Young Adults' Perceptions of and Intentions to Use Nicotine and Cannabis Vaporizers in Response to e-Cigarette or Vaping-Associated Lung Injury Instagram Posts: Experimental Study. J Med Internet Res 2023; 25:e46153. [PMID: 37552552 PMCID: PMC10540020 DOI: 10.2196/46153] [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: 01/31/2023] [Revised: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Inhaling aerosolized nicotine and cannabis (colloquially called "vaping") is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging the use of both products received national media attention during the 2019 outbreak of e-cigarette or vaping-associated lung injury (EVALI). OBJECTIVE This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults' perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. METHODS Participants (N=1229) aged 18-25 (mean 21.40, SD 2.22) years were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (618/1229, 50.3%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) × 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive and aesthetically pleasing selfies. The positive text was supportive and uplifting regarding quitting the use of vaporized products. Negative images and text were graphic and fear inducing. After viewing 3 posts, participants reported the perceived harmfulness of nicotine and cannabis products, the perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on intentions to use nicotine and cannabis vaporizers. Analyses were adjusted for product use history. RESULTS Compared to viewing positive images, viewing negative images resulted in significantly greater perceived harm of nicotine (P=.02 for disposable pod-based vaporizers and P=.04 for other e-cigarette "mods" devices) and cannabis vaporized products (P=.01), greater perceived risk of nicotine vaporizers (P<.01), and lower odds of intentions to use nicotine (P=.02) but not cannabis (P=.43) vaporizers in the future. There were no significant main effects of text valence on perceived harm, perceived risk, and intentions to use nicotine and cannabis vaporized products. No significant interaction effects of image and text valence were found. CONCLUSIONS Negative imagery in Instagram posts about EVALI may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post's text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI.
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Affiliation(s)
- Karla D Llanes
- Center for Tobacco Control Research & Education, University of California San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research & Education, University of California San Francisco, San Francisco, CA, United States
| | | | - Erin A Vogel
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Nguyen N, Peyser ND, Olgin JE, Pletcher MJ, Beatty AL, Modrow MF, Carton TW, Khatib R, Djibo DA, Ling PM, Marcus GM. Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study. PLoS One 2023; 18:e0289058. [PMID: 37703257 PMCID: PMC10499225 DOI: 10.1371/journal.pone.0289058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/31/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Little is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression. METHODS We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome. RESULTS In the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression. CONCLUSIONS Use of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.
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Affiliation(s)
- Nhung Nguyen
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Noah D. Peyser
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
| | - Jeffrey E. Olgin
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Alexis L. Beatty
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Madelaine F. Modrow
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Thomas W. Carton
- Louisiana Public Health Institute, New Orleans, Louisiana, United States of America
| | - Rasha Khatib
- Advocate Aurora Health, Downers Grove, Illinois, United States of America
| | | | - Pamela M. Ling
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Gregory M. Marcus
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
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Nguyen N, Holmes LM, Pravosud V, Cohen BE, Ling PM. Changes in perceived harms of tobacco and cannabis and their correlations with use: A panel study of young adults 2014-2020. Addict Behav 2023; 144:107758. [PMID: 37263178 PMCID: PMC10330743 DOI: 10.1016/j.addbeh.2023.107758] [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: 02/17/2023] [Revised: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Perceived harm is associated with substance use. Changes in product and policy landscapes may impact perceived harms of tobacco and cannabis. This study aimed to examine changes in young adults' perceived harms of tobacco and cannabis and their associations with use behavior during a period including both before and after legalization of cannabis. METHODS We conducted a panel survey of California Bay Area young adults (mean age = 23.5 years old, 64.4% female) in 2014 and 2019-2020. Participants (N = 306) reported past 30-day use and perceived harms of tobacco and cannabis at both waves. Perceived harms to health of cannabis and tobacco (cigarettes, e-cigarettes, hookah, smokeless tobacco, and secondhand tobacco smoke) were measured from 1-"Not at all harmful" to 7-"Extremely harmful." Mixed-effects logistic regressions examined associations between perceived harms and use of tobacco and cannabis, controlling for demographics. RESULTS Participants perceived lower harm for cannabis than for tobacco products. Perceived harms of e-cigarettes, hookah, and smokeless tobacco significantly increased over time; while perceived harms of cigarettes, secondhand tobacco smoke, and cannabis did not change. Increased perceived harm of e-cigarettes was associated with lower odds of any tobacco use (OR = 0.72, 95%CI = 0.56, 0.92), and increased perceived harm of cannabis was associated with lower odds of any cannabis use (OR = 0.51, 95%CI = 0.42, 0.62). CONCLUSIONS Findings suggest that perceived harms of e-cigarettes and cannabis play important roles in driving young adult use behaviors. Risk communication efforts that increase perceptions of health harms related to e-cigarettes and cannabis may decrease use of tobacco and cannabis among young people.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Louisa M Holmes
- Departments of Geography and Demography and the Consortium on Substance Use and Addiction, The Pennsylvania State University, PA, USA
| | - Vira Pravosud
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Beth E Cohen
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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11
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Chambers J, Keyhani S, Ling PM, Hoggatt KJ, Hasin D, Nguyen N, Woods A, Ryder A, Cohen BE. Perceptions of Safety of Daily Cannabis vs Tobacco Smoking and Secondhand Smoke Exposure, 2017-2021. JAMA Netw Open 2023; 6:e2328691. [PMID: 37566411 PMCID: PMC10422186 DOI: 10.1001/jamanetworkopen.2023.28691] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023] Open
Abstract
Importance While rates of cigarette use are declining, more US adults are using cannabis. Perceptions of safety are important drivers of substance use and public policy; however, little is known about the comparative views of US adults on tobacco and cannabis safety. Objective To compare public perceptions of safety of cannabis vs tobacco smoke and evaluate how perceptions may be changing over time. Design, Setting, and Participants This longitudinal survey study was conducted using a web-based survey administered in 2017, 2020, and 2021. US adults participating in Ipsos KnowledgePanel, a nationally representative, population-based survey panel, were included. Data were analyzed from March 2021 through June 2023. Main Outcomes and Measures Two questions directly compared the perception of safety of cannabis vs tobacco in terms of daily smoking and secondhand smoke exposure. Additional questions assessed perceptions of safety of secondhand tobacco smoke for adults, children, and pregnant women, with an analogous set of questions for secondhand cannabis smoke. Results A total of 5035 participants (mean [SD] age, 53.4 [16.2] years; 2551 males [50.7%]) completed all 3 surveys and provided responses for tobacco and cannabis risk questions. More than one-third of participants felt that daily smoking of cannabis was safer than tobacco, and their views increasingly favored safety of cannabis vs tobacco over time (1742 participants [36.7%] in 2017 vs 2107 participants [44.3%] in 2021; P < .001). The pattern was similar for secondhand cannabis smoke, with 1668 participants (35.1%) responding that cannabis was safer than tobacco in 2017 vs 1908 participants (40.2%) in 2021 (P < .001). Participants who were younger (adjusted odds ratio [aOR] for ages 18-29 years vs ≥60 years, 1.4 [95% CI, 1.1-1.8]; P = .01) or not married (aOR, 1.2 [95% CI, 1.0-1.4]; P = .01) were more likely to move toward safer views of cannabis use over time, while those who were retired (aOR vs working, 0.8 [95% CI, 0.7-0.9]; P = .01) were less likely to move toward a safer view of cannabis. Participants were also more likely to rate secondhand smoke exposure to cannabis vs tobacco as completely or somewhat safe in adults (629 participants [12.6%] vs. 119 participants [2.4%]; P < .001), children (238 participants [4.8%] vs. 90 participants [1.8%]; P < .001), and pregnant women (264 participants [5.3%] vs. 69 participants [1.4%]; P < .001). Conclusions and Relevance This study found that US adults increasingly perceived daily smoking and secondhand exposure to cannabis smoke as safer than tobacco smoke from 2017 to 2021. Given that these views do not reflect the existing science on cannabis and tobacco smoke, the findings may have important implications for public health and policy as the legalization and use of cannabis increase.
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Affiliation(s)
- Julia Chambers
- Department of Medicine, University of California San Francisco
| | - Salomeh Keyhani
- Department of Medicine, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, and Division of General Internal Medicine, University of California San Francisco
| | - Katherine J Hoggatt
- Department of Medicine, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Deborah Hasin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, and Division of General Internal Medicine, University of California San Francisco
| | - Anne Woods
- Northern California Institute for Research and Education - the Veterans Health Research Institute, San Francisco, California
| | - Annie Ryder
- Department of Psychology, University of Kansas, Lawrence
| | - Beth E Cohen
- Department of Medicine, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
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12
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Kim M, Neilands TB, Gregorich SE, Jordan JW, Ling PM. Young Adult Responses to Peer Crowd-Based Targeting in E-cigarette Advertisements: An Experimental Study. Nicotine Tob Res 2023; 25:1125-1134. [PMID: 37101413 PMCID: PMC10202626 DOI: 10.1093/ntr/ntac292] [Citation(s) in RCA: 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: 03/07/2022] [Revised: 11/16/2022] [Accepted: 12/21/2022] [Indexed: 04/28/2023]
Abstract
AIMS To examine the effects of psychographically targeted e-cigarette advertisements on young adults. METHODS A total of 2100 young adults (18-29 years old) representing five peer crowds (groups with shared values, interests, and lifestyle: Mainstream, Young Professional, Hip Hop, Hipster, and Partier) were recruited from a nationwide opt-in online panel. Participants were randomly assigned to view e-cigarette advertisements featuring characters that either did or did not match their own peer crowd affiliation and evaluated advertising effectiveness using Likert-type and semantic differential scales. Participants also reported their attitudes toward using e-cigarettes. RESULTS No significant overall effect of peer crowd matching was observed. However, significant two-way interaction effects emerged where matching advertisements yielded higher evaluations than mismatching advertisements among those who currently do not use tobacco and nicotine products and among Mainstream participants. Advertisements featuring Mainstream characters were in general rated more highly than other advertisements. Additional analyses found significant effects of peer crowd matching among those who viewed advertisements featuring non-Mainstream characters. CONCLUSIONS Peer crowd-based targeting can increase the effectiveness of e-cigarette advertisements which may impact initiation among current nonusers, requiring stricter marketing regulations. More research is needed to determine if anti-tobacco messaging tailored by peer crowds may effectively counteract targeted e-cigarette marketing. IMPLICATIONS E-cigarette advertisements often use psychographic targeting strategies, using lifestyles, attitudes, and values. Low-risk young adults (eg, those who currently do not use tobacco and nicotine products) are susceptible to psychographically targeted e-cigarette advertisements. This may result in the initiation of e-cigarette use among young adults who would otherwise be less likely to use tobacco and nicotine products. Stricter marketing regulations for emerging tobacco and nicotine products are required to reduce marketing exposure.
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Affiliation(s)
- Minji Kim
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
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13
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Hendlin YH, Small S, Ling PM. 'No-Barriers' tobacco product? Selling smokeless tobacco to women, people of colour and the LGBTQ+ community in the USA. Tob Control 2023; 32:330-337. [PMID: 34599083 PMCID: PMC10171187 DOI: 10.1136/tobaccocontrol-2020-056178] [Citation(s) in RCA: 1] [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: 02/25/2021] [Accepted: 08/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In both Sweden and the USA, smokeless tobacco (ST) is legal and used predominantly by men. Starting in the 1970s, US tobacco companies attempted to expand the ST market to women, African Americans, Hispanic Americans and lesbian, gay, bisexual, transgender, queer and other sexual orientation (LGBTQ+) people. DESIGN We analysed industry documents from the Truth Tobacco Industry Documents Library triangulating findings with recent ST advertising and publicly available literature. FINDINGS We found tobacco companies used design innovations such as pouched moist snuff, snus and dissolvable products to expand the market. In addition, diverse advertising campaigns targeted women, people of colour (Hispanic, African American) and LGBTQ+ communities with identity-targeted messages emphasising novelty, convenience, cleanliness and use in smoke-free environments. However, stereotypes of ST users as rural white males endured, perpetuated by continued marketing aimed at this customer base, which created cognitive dissonance and stymied marketer's hopes that pouch products would 'democratize' ST. CONCLUSION These failed campaigns suggest novel products such as nicotine pouch products may provide a 'clean slate' to similarly target women and other low-ST-using groups. Based on this history, the risk of new tobacco and nicotine products to increase health disparities should be closely monitored.
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Affiliation(s)
- Yogi Hale Hendlin
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
- Dynamics of Inclusive Prosperity Initiative, Erasmus University Rotterdam, Rotterdam, South Holland, Netherlands
| | - Sarah Small
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
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14
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Nguyen N, Koester KA, Kim M, Watkins SL, Ling PM. "I'm both smoking and vaping": a longitudinal qualitative study of US young adults who tried to quit smoking cigarettes by using electronic cigarettes. Tob Control 2023:tc-2022-057804. [PMID: 37072166 PMCID: PMC10582197 DOI: 10.1136/tc-2022-057804] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking. METHODS Longitudinal qualitative data were collected annually from 2017 to 2019 for 25 young adult tobacco users (aged 18-29 years) in California (USA) who used ENDS to quit/reduce smoking. Thematic and trajectory analyses were used to identify key within-person and between-person changes in tobacco/nicotine use over time. RESULTS Five types of tobacco use transition were identified among baseline dual users of cigarettes and ENDS: sustained dual use without reduced smoking (n=8), transition to exclusive daily ENDS use (n=6), sustained dual use with reduced smoking (n=5), transition back to exclusive smoking (n=4) and transition to neither smoking nor vaping (n=2). Participants' ENDS use behaviour varied over time in terms of vaping quantity and device characteristics (eg, changing nicotine concentrations/flavours, switching between multiple devices). Three themes that related to successfully replacing cigarettes with ENDS were perceived positive physical effects, perceived satisfaction and enjoyment and context changes. Four themes for unsuccessful replacement were perceived negative physical discomforts, perceived addictiveness and harm, unsatisfactory substitution for cigarettes and device malfunction. CONCLUSIONS Young adults' experiences with using ENDS as a smoking cessation aid were highly variable. Adequate nicotine delivery and perceived safety and benefits contributed to successfully reducing or quitting cigarettes. Providing behavioural counselling and standardising ENDS products may enhance cessation for young adults.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Shannon Lea Watkins
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
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15
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Nguyen N, Thrul J, Neilands TB, Ling PM. Associations Between Product Type and Intensity of Tobacco and Cannabis Co-use on the Same Day Among Young Adult Smokers: Smartphone-Based Daily-Diary Study. JMIR Mhealth Uhealth 2023; 11:e40736. [PMID: 36806440 PMCID: PMC9989918 DOI: 10.2196/40736] [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: 07/04/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Co-use of tobacco and cannabis is highly prevalent among young US adults. Same-day co-use of tobacco and cannabis (ie, use of both substances on the same day) may increase the extent of use and negative health consequences among young adults. However, much remains unknown about same-day co-use of tobacco and cannabis, in part due to challenges in measuring this complex behavior. Nuanced understanding of tobacco and cannabis co-use in terms of specific products and intensity (ie, quantity of tobacco and cannabis use within a day) is critical to inform prevention and intervention efforts. OBJECTIVE We used a daily-diary data collection method via smartphone to capture occurrence of tobacco and cannabis co-use within a day. We examined (1) whether the same route of administration would facilitate co-use of 2 substances on the same day and (2) whether participants would use more tobacco on a day when they use more cannabis. METHODS This smartphone-based study collected 2891 daily assessments from 147 cigarette smokers (aged 18-26 years, n=76, 51.7% female) during 30 consecutive days. Daily assessments measured type (ie, cigarette, cigarillo, or e-cigarette) and intensity (ie, number of cigarettes or cigarillos smoked or number of times vaping e-cigarettes per day) of tobacco use and type (ie, combustible, vaporized, or edible) and intensity (ie, number of times used per day) of cannabis use. We estimated multilevel models to examine day-level associations between types of cannabis use and each type of tobacco use, as well as day-level associations between intensities of using cannabis and tobacco. All models controlled for demographic covariates, day-level alcohol use, and time effects (ie, study day and weekend vs weekday). RESULTS Same-day co-use was reported in 989 of the total 2891 daily assessments (34.2%). Co-use of cigarettes and combustible cannabis (885 of the 2891 daily assessments; 30.6%) was most commonly reported. Participants had higher odds of using cigarettes (adjusted odds ratio [AOR] 1.92, 95% CI 1.31-2.81) and cigarillos (AOR 244.29, 95% CI 35.51-1680.62) on days when they used combustible cannabis. Notably, participants had higher odds of using e-cigarettes on days when they used vaporized cannabis (AOR 23.21, 95% CI 8.66-62.24). Participants reported a greater intensity of using cigarettes (AOR 1.35, 95% CI 1.23-1.48), cigarillos (AOR 2.04, 95% CI 1.70-2.46), and e-cigarettes (AOR 1.48, 95% CI 1.16-1.88) on days when they used more cannabis. CONCLUSIONS Types and intensities of tobacco and cannabis use within a day among young adult smokers were positively correlated, including co-use of vaporized products. Prevention and intervention efforts should address co-use and pay attention to all forms of use and timeframes of co-use (eg, within a day or at the same time), including co-use of e-cigarettes and vaporized cannabis, to reduce negative health outcomes.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
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16
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Lyu JC, Olson SS, Ramo DE, Ling PM. Delivering vaping cessation interventions to adolescents and young adults on Instagram: protocol for a randomized controlled trial. BMC Public Health 2022; 22:2311. [PMID: 36496358 PMCID: PMC9735274 DOI: 10.1186/s12889-022-14606-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adolescent and young adult use of electronic nicotine delivery systems ("vaping") has increased rapidly since 2018. There is a dearth of evidence-based vaping cessation interventions for this vulnerable population. Social media use is common among young people, and smoking cessation groups on social media have shown efficacy in the past. The objective of this study is to describe the protocol for a randomized controlled trial (RCT) testing the efficacy of an Instagram-based vaping cessation intervention for adolescents and young adults. METHODS Adolescents and young adults aged 13-21 residing in California who have vaped at least once per week in the past 30 days will be recruited through social media ads, community partners, and youth serving organizations. Participants will be randomly assigned to intervention or control conditions: the intervention group takes place on Instagram, where participants receive up to 3 posts per weekday for 25 days over 5 weeks; the control group will be directed to kickitca.org, a website offering links to chatline and texting cessation services operated by the California Smokers' Helpline. The primary outcome is biochemically verified 7-day point prevalence abstinence for nicotine vaping; secondary outcomes are vaping reduction by 50% or more, vaping quit attempts, readiness to quit vaping, confidence in ability to quit, desire to quit, commitment to abstinence, and use of evidence-based cessation strategies. Both the primary outcome and secondary outcomes will be assessed immediately, 3 months, and 6 months after the treatment. DISCUSSION This is the first RCT to test a vaping cessation intervention delivered through Instagram. If effective, it will be one of the first evidence-based interventions to address vaping among adolescents and young adults and add to the evidence base for social media interventions for this population. TRIAL REGISTRATION ClinicalTrials.gov: NCT04707911, registered on January 13, 2021.
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Affiliation(s)
- Joanne Chen Lyu
- grid.266102.10000 0001 2297 6811Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA USA
| | - Sarah S. Olson
- grid.266102.10000 0001 2297 6811Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Danielle E. Ramo
- grid.428737.dHopeLab, 100 California St #1150, San Francisco, CA 94111 USA
| | - Pamela M. Ling
- grid.266102.10000 0001 2297 6811Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA USA
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17
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Lyu JC, Afolabi A, White JS, Ling PM. Perceptions and Aspirations Toward Peer Mentoring in Social Media-Based Electronic Cigarette Cessation Interventions for Adolescents and Young Adults: Focus Group Study. JMIR Form Res 2022; 6:e42538. [PMID: 36454628 PMCID: PMC9756117 DOI: 10.2196/42538] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Social media offer a promising channel to deliver e-cigarette cessation interventions to adolescents and young adults (AYAs); however, interventions delivered on social media face challenges of low participant retention and decreased engagement over time. Peer mentoring has the potential to ameliorate these challenges. OBJECTIVE The aim of this study was to understand, from both the mentee and potential mentor perspective, the needs, expectations, and concerns of AYAs regarding peer mentoring to inform the development of social media-based peer mentoring interventions for e-cigarette cessation among AYAs. METHODS Seven focus groups, including four mentee groups and three potential mentor groups, were conducted with 26 AYAs who had prior experience with e-cigarette use and attempts to quit in the context of a social media-based e-cigarette cessation intervention. Discussion focused on preferred characteristics of peer mentors, expectations about peer mentoring, mentoring mode, mentor training, incentives for peer mentors, preferred social media platforms for intervention delivery, supervision, and concerns. Focus group transcripts were coded and analyzed using a thematic analysis approach. RESULTS Overall, participants were receptive to peer mentoring in social media-based cessation interventions and believed they could be helpful in assisting e-cigarette cessation. Participants identified the most important characteristics of peer mentors to be of similar age and to be abstinent from e-cigarette use. Participants expected peer mentors would share personal experiences, provide emotional support, and send check-ins and reminders. Peer mentors supporting a group of mentees in combination with one-on-one mentoring as needed was the preferred mentoring mode. A group of 10 mentees with a mentor:mentee ratio of 1:3-5 was deemed acceptable for most participants. Participants expressed that mentor training should include emotional intelligence, communication skills, and the scientific evidence about e-cigarettes. Although monetary incentives were not the main motivating factor for being a peer mentor, they were viewed as a good way to compensate mentors' time. Instagram was considered an appropriate social media platform to deliver a peer-mentored intervention due to its functionality. Participants did not express many privacy concerns about social media-based peer mentoring, but mentioned that boundaries and community agreements should be set to keep relationships professional. CONCLUSIONS This study reflects the needs and preferences of young people for a peer mentoring intervention to complement a social media program to support e-cigarette cessation. The next step will be to establish the feasibility, acceptability, and preliminary efficacy of such a peer mentoring program.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, United States
| | - Aliyyat Afolabi
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, United States
| | - Justin S White
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, United States
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, United States
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18
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Benowitz NL, Goniewicz ML, Halpern-Felsher B, Krishnan-Sarin S, Ling PM, O'Connor RJ, Pentz MA, Robertson RM, Bhatnagar A. Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research. Lancet Respir Med 2022; 10:900-915. [PMID: 35985357 PMCID: PMC9381032 DOI: 10.1016/s2213-2600(22)00182-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/27/2022] [Accepted: 05/03/2022] [Indexed: 01/11/2023]
Abstract
Heterogeneity in the clinical presentation of SARS-CoV-2 infection and COVID-19 progression underscores the urgent need to identify individual-level susceptibility factors that affect infection vulnerability and disease severity. Tobacco product use is a potential susceptibility factor. In this Personal View, we provide an overview of the findings of peer-reviewed, published studies relating tobacco product use to SARS-CoV-2 infection and COVID-19 outcomes, with most studies focusing on cigarette smoking in adults. Findings pertaining to the effects of tobacco product use on the incidence of SARS-CoV-2 infection are inconsistent. However, evidence supports a role for cigarette smoking in increasing the risk of poor COVID-19 outcomes, including hospital admission, progression in disease severity, and COVID-19-related mortality. We discuss the potential effects of tobacco use behaviour on SARS-CoV-2 transmission and infection, and highlight the pathophysiological changes associated with cigarette smoking that could promote SARS-CoV-2 infection and increased disease severity. We consider the biological mechanisms by which nicotine and other tobacco product constituents might affect immune and inflammatory responses to SARS-CoV-2 infection. Finally, we identify current knowledge gaps and suggest priorities for research to address acute and post-acute health outcomes of COVID-19 during and after the pandemic.
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Affiliation(s)
- Neal L Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | | | - Pamela M Ling
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mary Ann Pentz
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Rose Marie Robertson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, KY, USA.
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19
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Nguyen N, Keyhani S, Ling PM, Hoggatt KJ, Hasin D, Cohen BE. Self-reported Changes in Cannabis Use Due to the COVID-19 Pandemic among US Adults. J Psychoactive Drugs 2022; 54:295-299. [PMID: 35356866 PMCID: PMC9522913 DOI: 10.1080/02791072.2022.2058897] [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: 01/11/2022] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Cannabis use may confer high COVID-19 risk. This study examined self-reported changes in cannabis use that US adults attributed to the pandemic and factors associated with any changes. We conducted a national, cross-sectional survey among US adults in August 2020. The analytic sample included 957 past-year cannabis users (Mage = 43 years old; 51% male). Weighted multinomial regression examined associations between forms and reasons of cannabis used, perceived addictiveness and safety, co-use of cannabis with tobacco/alcohol, state legalization, and the outcome (self-reported increase/decrease in cannabis use vs. no change). Overall, 14.8% reported decreasing cannabis use due to the pandemic, 16.1% reported increasing, and 65.4% reported not changing. Factors associated with increased cannabis use included past-year use of vaporized (AOR = 1.7, 95% CI = 1.0, 3.0) or edible cannabis (AOR = 2.4, CI = 1.3, 4.3), and simultaneous use of cannabis and tobacco (AOR = 2.6; CI = 1.4, 5.2). Young adults (18-29 years old) had higher odds of self-reporting both increased (AOR = 4.8; CI = 1.8, 13.1) and decreased use (AOR = 3.3; CI = 1.5, 7.5). The pandemic has had a mixed impact on cannabis use, with participants reporting both increased and decreased use. Efforts may target users of vaporized and edible cannabis, co-users of cannabis and tobacco, and young adults to prevent increased cannabis use during the pandemic.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, and Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Salomeh Keyhani
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, and Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Katherine J. Hoggatt
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Deborah Hasin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
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20
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Caleb Alexander G, Mix LA, Choudhury S, Taketa R, Tomori C, Mooghali M, Fan A, Mars S, Ciccarone D, Patton M, Apollonio DE, Schmidt L, Steinman MA, Greene J, Ling PM, Seymour AK, Glantz S, Tasker K. The Opioid Industry Documents Archive: A Living Digital Repository. Am J Public Health 2022; 112:1126-1129. [PMID: 35830677 PMCID: PMC9342819 DOI: 10.2105/ajph.2022.306951] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 05/15/2022] [Indexed: 11/04/2022]
Affiliation(s)
- G Caleb Alexander
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Lisa A Mix
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Sayeed Choudhury
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Rachel Taketa
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Cecília Tomori
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Maryam Mooghali
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Anni Fan
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Sarah Mars
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Dan Ciccarone
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Mark Patton
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Dorie E Apollonio
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Laura Schmidt
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Michael A Steinman
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Jeremy Greene
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Pamela M Ling
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Anne K Seymour
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Stanton Glantz
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
| | - Kate Tasker
- At the time of the writing, G. Caleb Alexander, Lisa A. Mix, and Anni Fan were with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sayeed Choudhury and Mark Patton are with the Sheridan Libraries, Johns Hopkins University, Baltimore, MD. Rachel Taketa and Kate Tasker are with the University of California, San Francisco Library, San Francisco. Cecília Tomori is with the Johns Hopkins School of Nursing, Baltimore, MD. Maryam Mooghali is with the Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Sarah Mars and Dan Ciccarone are with the Department of Family and Community Medicine, University of California, San Francisco (UCSF). Dorie E. Apollonio is with the School of Pharmacy, UCSF. Laura Schmidt, Michael A. Steinman, Pamela M. Ling, and Stanton Glantz are with the School of Medicine, UCSF. Jeremy Greene is with the Johns Hopkins School of Medicine. Anne K. Seymour is with the Welch Libraries, Johns Hopkins University
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21
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Watkins SL, Pieper F, Chaffee BW, Yerger VB, Ling PM, Max W. Flavored Tobacco Product Use Among Young Adults by Race and Ethnicity: Evidence From the Population Assessment of Tobacco and Health Study. J Adolesc Health 2022; 71:226-232. [PMID: 35550331 PMCID: PMC9854272 DOI: 10.1016/j.jadohealth.2022.02.013] [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] [Received: 08/20/2021] [Revised: 02/04/2022] [Accepted: 02/24/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Describe racial/ethnic patterns of flavored tobacco use to illuminate equity implications of flavored tobacco policies. METHODS Using data on US young adults (ages 18-34; n = 8,114) in the Population Assessment of Tobacco and Health Study Wave 5 (2018-2019) and survey-weighted logistic regression, we estimated any flavors (regular brand) and mint/menthol (vs. other flavors) use by race/ethnicity among cigarette, e-cigarette, cigar, blunt, hookah, smokeless tobacco, and any tobacco product users. RESULTS Any flavored tobacco use was common and was significantly higher for Black (75.1%; OR: 1.4; 95% CI: 1.2, 1.7) and Hispanic/Latinx (77.2%; OR: 1.4; 95% CI: 1.1, 1.7) users than White users (73.5%). The most pronounced difference across products was in menthol cigarette use between Black and White smokers (OR: 4.5; 95% CI: 3.5, 5.9). Among flavored product users, mint/menthol use was significantly higher for Latinx blunt and hookah users. DISCUSSION Racial/ethnic disparities in flavored tobacco use include and extend beyond menthol cigarettes. Comprehensive flavored tobacco restrictions that include mint/menthol and non-cigarette products will likely have more equitable impact.
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Affiliation(s)
- Shannon Lea Watkins
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa.
| | - Felicia Pieper
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa
| | - Benjamin W Chaffee
- School of Dentistry, University of California San Francisco, San Francisco, California
| | - Valerie B Yerger
- School of Nursing, University of California San Francisco, San Francisco, California; African American Tobacco Control Leadership Council, San Francisco, California
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Wendy Max
- Department of Social and Behavioral Sciences, Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California
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22
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Lyu JC, Huang P, Jiang N, Ling PM. A Systematic Review of E-Cigarette Marketing Communication: Messages, Communication Channels, and Strategies. IJERPH 2022; 19:ijerph19159263. [PMID: 35954623 PMCID: PMC9367763 DOI: 10.3390/ijerph19159263] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Marketing plays a key role in increasing the popularity of e-cigarettes. We conducted a systematic review of the existing literature published between 2003 and 2019 in eight databases to describe e-cigarette marketing communication messages by communication channels and marketing communication strategies. Forty-one articles were included in the analysis after screening. Ten key messages were identified. Cessation and health-related benefits (each n = 31, 75.6%) were the most reported marketing communication messages, followed by sociability/lifestyle and use experience. The Internet (n = 32, 78.0%) was the most studied communication channel compared to print, TV/movie/radio, and point-of-sales (POS)/retail stores. The most studied marketing communication strategies were advertising (n = 28, 68.3%), followed by public relations and sales promotion. Published research studies reported consistent messages about e-cigarettes across communication channels and marketing communication strategies. Claims of smoking cessation and health-related benefits were widely identified in the existing literature. While therapeutic claims are prohibited, soft sell messages, such as social appeals, for which regulatory reach may be limited, may require educational campaigns. Internet marketing has attracted much attention, with limited studies on messages in print, TV/movie/radio, and POS/retail stores. The lack of studies of direct marketing messaging indicates a big gap between industry spending and academic research; more studies of messaging utilizing this strategy are needed.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA;
- Correspondence:
| | - Peiyi Huang
- Department of Psychology, School of Social Sciences, University of Mannheim, 68159 Mannheim, Germany;
| | - Nan Jiang
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA;
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA;
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23
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Nguyen N, Neilands TB, Lisha NE, Lyu JC, Olson SS, Ling PM. Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment. J Addict Med 2022; 16:413-419. [PMID: 34619713 PMCID: PMC8980109 DOI: 10.1097/adm.0000000000000920] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Cannabis use is common among people who use tobacco. However, little is known about the relationship between change in use of tobacco and cannabis over time. We examined the longitudinal associations between use of the two substances in a realworld smoking cessation context. METHODS This study analyzed data from a 3-month smoking cessation program delivered via Facebook in the San Francisco Bay Area, USA during 2016-2020. The sample included 487 participants who smoked cigarettes ( Mage = 25.4 years old, 39.6% Male, 40.3% White). The regressors (ie, frequency or number of days during the past 30 days using cigarettes, e-cigarettes, and cigars) and the outcome (ie, frequency of cannabis use) were measured at both baseline and 3-month follow-up. Random-effects modeling examined the longitudinal associations between the regressors and the outcome controlling for alcohol use and baseline demographics. RESULTS Participants who increased (or decreased) their frequency of use of cigarettes (β = 0.17, 95% confidence interval [CI] = 0.10, 0.24), e-cigarettes (β = 0.11, 95% CI = 0.05, 0.17), or cigars (β = 0.19, 95% CI = 0.06, 0.32) also increased (or decreased) their frequency of cannabis use after 3 months. Sexual minority participants (vs heterosexuals) (β = 2.12, 95% CI = 0.01, 4.24) and those whose education attainment being high school or less (vs higher education) (β = 3.89, 95% CI = 1.25, 6.53) were more likely to increase their frequency of cannabis use over time. CONCLUSIONS The findings indicated positive associations between change in use of tobacco and cannabis use. Promoting cessation among people who use tobacco may help to reduce their cannabis use.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA
| | - Nadra E. Lisha
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Sarah S. Olson
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
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24
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Lee A, Chang AA, Lyu JC, Ling PM, Hsia SL. Characterizing Participant Perceptions about Smoking-Cessation Pharmacotherapy and E-Cigarettes from Facebook Smoking-Cessation Support Groups. Int J Environ Res Public Health 2022; 19:7314. [PMID: 35742557 PMCID: PMC9224383 DOI: 10.3390/ijerph19127314] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 01/25/2023]
Abstract
The prevalence of smoking among young adults aged 19-28 years old in the United States persists at rates of 14.3%. Young adults underutilize pharmacotherapy for smoking cessation, and the use of e-cigarettes has increased. We analyzed comments from online smoking-cessation support groups to understand young-adult smokers' views of pharmacotherapy and e-cigarettes, to provide a more in-depth insight into the underutilization of pharmacotherapy. A qualitative analysis was performed on comments about pharmacotherapy and e-cigarettes from participants enrolled in online smoking-cessation support groups in 2016-2020. A codebook was developed with a deductive approach to code the comments, followed by thematic analysis. Eighteen themes were identified, with four dominant themes: interest, benefit, knowledge, and flavor. Participants expressed less interest in both nicotine-replacement therapy and e-cigarettes; moreover, they expressed unfamiliarity with and misconceptions about pharmacotherapy, and recognized the enticing flavors of e-cigarettes. Participants often felt e-cigarettes were not useful for smoking cessation, but the flavors of e-cigarettes were appealing for use. Participants had mixed opinions about the use of e-cigarettes for smoking cessation, but predominantly felt e-cigarettes were not useful for smoking cessation. The use of social media may be an effective way to address misconceptions about pharmacotherapy for smoking cessation and increase willingness to accept assistance.
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Affiliation(s)
- Allison Lee
- School of Pharmacy, University of California, San Francisco, CA 94143, USA; (A.L.); (A.A.C.)
| | - Angela A. Chang
- School of Pharmacy, University of California, San Francisco, CA 94143, USA; (A.L.); (A.A.C.)
| | - Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (J.C.L.); (P.M.L.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (J.C.L.); (P.M.L.)
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California, San Francisco, CA 94143, USA
| | - Stephanie L. Hsia
- School of Pharmacy, University of California, San Francisco, CA 94143, USA; (A.L.); (A.A.C.)
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Harvanko A, Koester KA, Helen GS, Olson S, Kim HC, Ling PM. A Mixed-Methods Study on Use of Different Tobacco Products among Younger and Older Adults with Lower and Higher Levels of Nicotine Exposure in California in 2019-2020. Int J Environ Res Public Health 2022; 19:5563. [PMID: 35564958 PMCID: PMC9106024 DOI: 10.3390/ijerph19095563] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 12/04/2022]
Abstract
An increasing number of tobacco products are entering the market, offering a variety of options to attain desired nicotine intake. However, little is known about the effect of this diverse marketplace on the experiences and nicotine exposure among tobacco users. A mixed-methods study examined experiences with tobacco products among individuals with relatively lower or higher levels of biomarkers of nicotine exposure. Semi-structured interviews were conducted with younger and older adults to examine tobacco use behaviors, addiction to tobacco products, and nicotine effects. Younger and older adults provided similar narratives about addiction and nicotine effects, which were similar across age groups, product types (i.e., ENDS, combustible cigarettes, or oral tobacco products), and having lower or higher nicotine exposure. Some individuals with higher nicotine exposure who switched from combustible cigarettes to another product (e.g., ENDS) found similar or greater access and perceived addiction to nicotine. Adults with higher and lower levels of nicotine exposure provided narratives consistent with features of nicotine addiction, regardless of age and products used. Availability of multiple tobacco products may be associated with greater access and exposure to nicotine. Addiction may occur at low levels of use and with non-cigarette products.
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Affiliation(s)
- Arit Harvanko
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Kimberly A. Koester
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Gideon St. Helen
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Sarah Olson
- Divison of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94143-1390, USA;
| | - Hyunjin Cindy Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143-1390, USA; (A.H.); (K.A.K.); (G.S.H.); (H.C.K.)
- Divison of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94143-1390, USA;
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Ling PM, Crosbie E, Holmes LM, Hoang C, Hoeper S. Cannabis dispensary online marketing practices in response to COVID-19 lockdowns. Subst Abuse 2022; 43:1116-1119. [DOI: 10.1080/08897077.2022.2060434] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pamela M. Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Dept of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Eric Crosbie
- School of Public Health, Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
| | - Louisa M. Holmes
- Department of Geography and Social Science Research Institute, Pennsylvania State University, University Park, PA, USA
| | - Christine Hoang
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Dept of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Samantha Hoeper
- School of Public Health, Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
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Holmes LM, Lempert LK, Ling PM. Flavored Tobacco Sales Restrictions Reduce Tobacco Product Availability and Retailer Advertising. Int J Environ Res Public Health 2022; 19:3455. [PMID: 35329145 PMCID: PMC8953832 DOI: 10.3390/ijerph19063455] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study examined differences in the availability and advertising of flavored tobacco products before and after flavored tobacco sales restrictions were enacted in Alameda and San Francisco Counties in California. MAIN OUTCOME MEASURES Data were collected from a sample of tobacco retailers in Alameda and San Francisco Counties at two time points: 2015, before flavored tobacco policies were enacted, and in 2019-2020, after some cities had enacted policies. Retailers were separated by city into Category 1 (n = 442)-retailers in cities that enacted a flavored tobacco policy between the two data collection periods, and Category 2 (n = 89), those that had not. Means comparison tests were conducted to evaluate significant differences over time and by category. RESULTS There was significantly reduced availability of menthol cigarettes, flavored little cigars, smokeless tobacco, vape pens, and Blu brand menthol e-cigarettes between 2015 and 2020 in Category 1 retailers. Category 2 retailers had reduced availability only for Blu menthol e-cigarettes and demonstrated an increase in smokeless tobacco availability. Exterior store advertising for cigarettes, little cigars, cigars, and e-cigarettes also decreased significantly in Category 1 cities relative to Category 2 cities; 8.1% of Category 1 stores were advertising flavored tobacco products in 2019-2020 compared to 36.2% of Category 2 stores. There was also a 78% reduction in flavored ads between 2015-2019 in Category 1 cities compared to a 38% decrease in Category 2 cities. Tobacco advertising inside Category 2 stores increased. Finally, Category 2 cities had significantly greater availability of cigalikes, mod or tank vapes, flavored e-cigarettes, and e-liquids compared to Category 1 cities. CONCLUSIONS Comprehensive flavored sales restriction policies reduce flavored tobacco availability and tobacco advertising, which may help prevent youth tobacco initiation and exposure.
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Affiliation(s)
- Louisa M. Holmes
- Departments of Geography and Demography, The Pennsylvania State University, University Park, PA 16802, USA
| | - Lauren Kass Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA; (L.K.L.); (P.M.L.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA; (L.K.L.); (P.M.L.)
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Lyu JC, Huang P, Ling PM. Electronic cigarette related topics with conflicting arguments
in Chinese newspapers. Tob Induc Dis 2022; 20:25. [PMID: 35342381 PMCID: PMC8895478 DOI: 10.18332/tid/145929] [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: 10/05/2021] [Revised: 12/20/2021] [Accepted: 01/18/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION While debates on e-cigarettes are mainly conducted in scientific fora, media are the most accessible information source for the public, shaping their perceptions of health issues. This study is the first to examine e-cigarette related topics with conflicting arguments presented in Chinese newspapers. METHODS The Chinese terms for ‘e-cigarettes’ were searched in a widely used Chinese news database Wisenews. Content analysis of the full text of 639 news articles was conducted to identify topics with conflicting arguments and examine whether the dominant argument in each topic changed across four time periods from 2004 to 2019. RESULTS Twelve e-cigarette related topics with conflicting arguments were identified. The most frequently reported topic was health impact of e-cigarettes, followed by impact of secondhand aerosol exposure, smoking cessation, relative health impact of e-cigarettes compared to cigarettes, and e-cigarette policies outside China. At the same time, the price was the least frequently reported topic. Overall, negative arguments outnumbered positive arguments in the study period. The dominant arguments within many topics changed across time periods; however, within the topics of relative health impact of e-cigarettes compared to cigarettes, taste/flavor, and economic prospects of the industry, positive arguments were more frequently reported in almost all periods. Within the topics of addiction, policies in China, and policies outside China, negative arguments were more frequently reported in virtually all periods. CONCLUSIONS Though overall the dominant argument about e-cigarettes and health was ‘e-cigarettes are harmful’, in the early time periods, e-cigarettes were reported as ‘harmless’ or even ‘healthy’. As China began to regulate e-cigarettes, the reporting on e-cigarettes more frequently included the ‘e-cigarettes are harmful’ argument. The consistent, more frequent reporting of ‘good e-cigarette taste/flavor’ has the potential to attract young people to e-cigarette products. The increased reporting on policies unfavorable to e-cigarettes aligned with the growing number of regulations restricting e-cigarettes.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, United States
| | - Peiyi Huang
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, United States
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Ling PM, Kim M, Egbe CO, Patanavanich R, Pinho M, Hendlin Y. Moving targets: how the rapidly changing tobacco and nicotine landscape creates advertising and promotion policy challenges. Tob Control 2022; 31:222-228. [PMID: 35241592 PMCID: PMC9233523 DOI: 10.1136/tobaccocontrol-2021-056552] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 10/12/2021] [Accepted: 12/01/2021] [Indexed: 01/18/2023]
Abstract
Tobacco, nicotine and related products have and continue to change rapidly, creating new challenges for policies regulating their advertising, promotion, sponsorship and sales. This paper reviews recent commercial product offerings and the regulatory challenges associated with them. This includes electronic nicotine delivery systems, electronic non-nicotine delivery systems, personal vaporisers, heated tobacco products, nicotine salts, tobacco-free nicotine products, other nicotine products resembling nicotine replacement therapies, and various vitamin and cannabis products that share delivery devices or marketing channels with tobacco products. There is substantial variation in the availability of these tobacco, nicotine, vaporised, and related products globally, and policies regulating these products also vary substantially between countries. Many of these products avoid regulation by exploiting loopholes in the definition of tobacco or nicotine products, or by occupying a regulatory grey area where authority is unclear. These challenges will increase as the tobacco industry continues to diversify its product portfolio, and weaponises 'tobacco harm reduction' rhetoric to undermine policies limiting marketing, promotion and taxation of tobacco, nicotine and related products. Tobacco control policy often lags behind the evolution of the industry, which may continue to sell these products for years while regulations are established, refined or enforced. Policies that anticipate commercial tobacco, nicotine and related product and marketing changes and that are broad enough to cover these product developments are needed.
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Affiliation(s)
- Pamela M Ling
- Department of Medicine and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Roengrudee Patanavanich
- Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Mariana Pinho
- Tobacco Control Project, ACT Health Promotion (Brazil), Rio de Janeiro, Brazil
| | - Yogi Hendlin
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Cohen JE, Krishnan-Sarin S, Eissenberg T, Gould TJ, Berman ML, Bhatnagar A, Barnett TE, Soule E, Popova L, Tan AS, Blank MD, Ling PM, O’Connor R. Balancing Risks and Benefits of E-Cigarettes in the Real World. Am J Public Health 2022; 112:e1-e2. [PMID: 35080942 PMCID: PMC8802586 DOI: 10.2105/ajph.2021.306607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Joanna E. Cohen
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Suchitra Krishnan-Sarin
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Thomas Eissenberg
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Thomas J. Gould
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Micah L. Berman
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Aruni Bhatnagar
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Tracey E. Barnett
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Eric Soule
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Lucy Popova
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Andy S. L. Tan
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Melissa D. Blank
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Pamela M. Ling
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
| | - Richard O’Connor
- Joanna E. Cohen is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Suchitra Krishnan-Sarin is with the Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT. Thomas Eissenberg is with the Department of Psychology, Virginia Commonwealth University, Richmond. Thomas J. Gould is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Micah L. Berman
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Lyu JC, Wang D, Mao Z, Ling PM. Evolution of media frames about e-cigarettes from 2004 to 2019: a content analysis of newspapers in China. Health Educ Res 2022; 36:456-466. [PMID: 33997888 PMCID: PMC9115326 DOI: 10.1093/her/cyab019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
This study conducted a content analysis of 639 news articles about e-cigarettes in China from 2004-2019 to examine longitudinal changes in media frames and media tones about e-cigarettes in Chinese newspapers. Results indicated that policy frame was the most frequently used frame, followed by human impact frame, information frame, and uncertainty frame. Dividing the time period of 2004-2019 into four phases (i.e., 2004-2006, 2007-2010, 2011-2017 and 2018-2019), the study found that the frequency of the information frame significantly decreased over time, while the policy frame and uncertainty frame significantly increased, with the policy frame being the dominant frame in recent years. In contrast, the use of the economic frame and morality frame fluctuated, both reaching peaks in the phase of 2007-2010 and decreasing in the most recent phase. Overall, the tone of the large majority of news articles was unfavorable, and the turning point occurred in the phase of 2007-2010 when the percentage of news articles with negative tone exceeded those with positive tone for the first time. Framing of e-cigarette news articles in China demonstrated the pivotal role of policy makers in defining the e-cigarette issue, and the influence of the international public health community, as an important and reliable information source, on defining the health risk of e-cigarettes, which has implication for not only e-cigarette control, but tobacco control in China in general.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California, San Francisco, USA
| | - Di Wang
- * Correspondence to: D. Wang. E-mail:
| | - Zhifei Mao
- School of Media and Communication, Shenzhen University, China
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, USA
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Hoeper S, Crosbie E, Holmes LM, Godoy L, DeFrank V, Hoang C, Ling PM. "The Perfect Formula:" Evaluating Health Claims, Products and Pricing on Cannabis Dispensary Websites in Two Recently Legalized States. Subst Use Misuse 2022; 57:1207-1214. [PMID: 35532143 DOI: 10.1080/10826084.2022.2069267] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction: Many cannabis dispensaries market and sell their products online through websites designed to attract and maintain customers; often, these websites incorporate a variety of product claims and other marketing tactics. This study evaluated website content, product pricing and discounts on dispensary websites in California and Nevada, states that legalized recreational cannabis in 2016. Methods: We content coded product availability, marketing claims and discounts on cannabis dispensary websites in the San Francisco Bay Area (N = 34) and Reno (N = 15) from March to June 2020 using a web crawler to scrape pricing information for four product types. We conducted bivariate analyses comparing both locations. Results: Prices were significantly lower for flower, edibles, and concentrates in Reno compared to the Bay Area, but not cartridges. In both areas, a range of marketing claims were made regarding the health effects of certain products. The most common were that cannabis products treated pain, nausea/vomiting, spasms, anxiety, insomnia, and depression. Products were also said to promote creativity and euphoria. Other marketing claims related to potency, pleasure enhancement, and improved social interactions. Discounts targeted to senior citizens and veterans were found on over half of all websites. Conclusions: Dispensary websites in the Bay Area and Reno frequently make health-related claims which should not be allowed in absence of scientific evidence. Non-health related claims are similar to those used for selling e-cigarettes and other tobacco products. Monitoring cannabis dispensary websites provides insight into local sales tactics and may help identify subpopulations for research on behavioral impacts of cannabis marketing activities.
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Affiliation(s)
- Samantha Hoeper
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Eric Crosbie
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA.,Ozmen Institute for Global Studies, University of Nevada, Reno, Reno, Nevada, USA
| | - Louisa M Holmes
- Departments of Geography and Demography, Penn State University, University Park, Pennsylvania, USA
| | - Lindsey Godoy
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Vincent DeFrank
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Christine Hoang
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, USA.,Division of General Internal Medicine, Dept of Medicine, University of California, San Francisco, San Francisco, California, USA
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Affiliation(s)
- Mary Hrywna
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco
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Abstract
BACKGROUND With the spread of COVID-19, significant concerns have been raised about the potential increased risk for electronic cigarette (e-cigarette) users for COVID-19 infection and related syndromes. Social media is an increasingly popular source for health information dissemination and discussion, and can affect health outcomes. OBJECTIVE This study aims to identify the topics in the public vaping discussion in COVID-19-related Twitter posts in order to get insight into public vaping-related perceptions, attitudes and concerns, and to discern possible misinformation and misconceptions around vaping in the COVID-19 pandemic. METHODS Using the tweets ID database maintained by Georgia State University's Panacea Lab, we downloaded the tweets related to COVID-19 from March 11, 2020, when the World Health Organization declared COVID-19 a pandemic, to February 12, 2021. We used R to analyze the tweets that contained a list of 79 keywords related to vaping. After removing duplicates and tweets created by faked accounts or bots, the final data set consisted of 11,337 unique tweets from 7,710 different users. We performed the latent Dirichlet allocation (LDA) algorithm for topic modeling and carried out a sentiment analysis. RESULTS Despite fluctuations, the number of daily tweets was relatively stable (average number of daily tweets = 33.4) with a sole conspicuous spike happening on a few days after August 11, 2020 when a research team published findings that teenagers and young adults who vape face a much higher risk of COVID-19 infection than their peers who do not vape. Topic modeling generated 8 topics: linkage between vaping and risk of COVID-19 infection, vaping pneumonia and the origin of COVID-19, vaping and spread of COVID-19, vaping regulation, calling for quitting vaping, protecting youth, similarity between e-cigarette or vaping-associated lung injury (EVALI) and COVID-19, and sales information. Daily sentiment scores showed that the public sentiment was predominantly negative, but became slightly more positive over the course of the study time period. CONCLUSIONS While some content in the public discourse on vaping before the COVID-19 pandemic continued in Twitter posts during the COVID-19 time period, new topics emerged. We found a substantial amount of anti-vaping discussion and dominantly negative sentiment around vaping during COVID-19, a sharp contrast to the predominantly pro-vaping voice on social media in the pre-COVID-19 period. Continued monitoring of social media conversations around vaping is needed, and the public health community may consider using social media platforms to actively convey scientific information around vaping and vaping cessation.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, United States of America
| | - Garving K. Luli
- Department of Mathematics, University of California, Davis, California, United States of America
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, United States of America
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Holmes LM, McQuoid J, Shah A, Cruz T, Akom A, Ling PM. Piloting a spatial mixed method for understanding neighborhood tobacco use disparities. Soc Sci Med 2021; 291:114460. [PMID: 34655940 PMCID: PMC8671214 DOI: 10.1016/j.socscimed.2021.114460] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/21/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.
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Affiliation(s)
- Louisa M Holmes
- Departments of Geography and Demography, And the Social Science Research Institute, Pennsylvania State University, 302 Walker Building, University Park, PA, 16802, USA.
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, OK, 73104, USA
| | - Aekta Shah
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Tessa Cruz
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Antwi Akom
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, 94143-1390, USA
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Watkins SL, Karliner-Li P, Lee YO, Koester KA, Ling PM. A mixed-methods study to inform the clarity and accuracy of cannabis-use and cannabis-tobacco co-use survey measures. Drug Alcohol Depend 2021; 224:108697. [PMID: 33930639 PMCID: PMC8180503 DOI: 10.1016/j.drugalcdep.2021.108697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/30/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Legalization of medical and recreational cannabis in US states has been accompanied by increases in availability, acceptability, and diversity in methods of cannabis use, as well as an increase in devices and methods for cannabis-tobacco co-use. Updated and specific survey measures of cannabis and cannabis-tobacco co-use are needed. METHODS We employed a mixed-methods approach to identify sources of specification and measurement error in cannabis and cannabis-tobacco co-use measures. We surveyed and interviewed 36 young adult (age 18-29) cannabis and tobacco co-users in California (2017-2018), triangulated with document analysis of online cannabis websites and forums. We investigated how survey reports of cannabis use and cannabis-tobacco co-use compared to narrative descriptions provided during in-depth interviews. We identify key strategies for researchers collecting self-reported survey data to enhance accuracy and comprehensiveness of measures. FINDINGS Potential sources of survey error included: broad variation in cannabinoid content and concentration, inconsistent interpretation of questions between participants and researchers (e.g. blunts were not considered co-use), and substantial variation in dosage within and between products. No evidence of survey recall bias or response editing was detected. CONCLUSION To enhance survey accuracy, we recommend surveys specify which cannabis delivery methods and forms are included and excluded in each measure, differentiate between cannabis products, and explicitly include or exclude CBD product use.
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Affiliation(s)
- Shannon Lea Watkins
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 530 Parnassus Ave. Ste 366, San Francisco, CA, 94143, United States.
| | | | - Youn Ok Lee
- Center for Health Policy Science and Tobacco Research, RTI International, United States.
| | - Kimberly A Koester
- University of California, Department of Medicine, San Francisco, United States.
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 530 Parnassus Ave. Ste 366, San Francisco, CA, 94143, United States.
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McQuoid J, Thrul J, Lopez-Paguyo K, Ling PM. Exploring multiple drug use by integrating mobile health and qualitative mapping methods - An individual case study. Int J Drug Policy 2021; 97:103325. [PMID: 34175527 DOI: 10.1016/j.drugpo.2021.103325] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple drug use involves particular pleasures and risks, and is disproportionately practiced by some minority and socially marginalized groups. The unique patterns, intentions, and social contexts of multiple drug use for these groups are poorly understood. METHODS Our mixed method integrates geo-enabled smartphone survey data collection with a qualitative mapping interview method. This brief report presents data from one study participant to demonstrate this method's potential contributions to multiple drug use research for priority groups in different settings. RESULTS 'Jason's' data revealed the interrelated dynamics within his drug use repertoire and links between his substance use to rural life as a transgender person with autism spectrum disorder (ASD). Cigarettes played a role in coping with acute stress from repeatedly being misgendered. Cannabis intoxication helped manage social interactions as a person with ASD, while 'chasing' with cigarettes calibrated cannabis intoxication. Methamphetamine use related to managing body dysmorphia in a rural context with poor access to transgender health services. CONCLUSION This mixed method can integrate reliable and ecologically valid assessments of multiple drug use repertoires and combination patterns with the place-embedded experiences, intersecting identities, structural barriers, and intentions related to multiple drug use for different priority groups.
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Affiliation(s)
- Julia McQuoid
- TSET Health Promotion Research Center, Department of Preventive and Family Medicine, University of Oklahoma Health Sciences Center and 2 Center for Tobacco Control Research and Education, University of California, San Francisco; Center for Tobacco Control Research and Education, University of California, San Francisco; TSET Health Promotion Research Center, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center.
| | - Johannes Thrul
- Department of Mental Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Kekoa Lopez-Paguyo
- Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco and School of Public Health, University of California, Berkeley; School of Public Health, University of California, Berkeley; Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco; Center for Tobacco Control Research and Education, University of California, San Francisco
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Li Z, Benowitz-Fredericks C, Ling PM, Cohen JE, Thrul J. Assessing Young Adults' ENDS Use via Ecological Momentary Assessment and a Smart Bluetooth Enabled ENDS Device. Nicotine Tob Res 2021; 23:842-848. [PMID: 33031497 DOI: 10.1093/ntr/ntaa205] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/01/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The assessment of electronic nicotine delivery systems (ENDS) use poses unique challenges that go beyond established assessment methods for tobacco cigarettes. Recent studies have proposed using ecological momentary assessment (EMA), a method to collect self-reported data on mobile devices, or data passively collected by "smart" Bluetooth enabled ENDS to assess use. The current study sought to compare ENDS use data using EMA and puff counts collected from a smart device. AIMS AND METHODS We recruited 18 young adult ENDS users (age M = 23.33; 44.4% female) from the San Francisco Bay Area. For a total of 30 days, participants completed daily diaries by EMA and used a second-generation smart Bluetooth enabled ENDS that collected puff data. Repeated measures correlations, multilevel regressions, and paired t tests assessed concordance of EMA reports and ENDS data. A subset of four highly compliant participants were selected for sensitivity analyses. RESULTS Among all 18 participants, completion of EMA daily diaries was high (77.4%). The ENDS device collected approximately twice as many puffs per day as participants reported. Compared with self-reported number of sessions and amount of e-liquid used, self-reported puff counts had the highest correlation with device-collected puff counts (rrm = 0.49; p < .001). Correlations between self-reported and device-collected puff counts improved among the subset of four highly compliant participants (rrm = 0.59; p < .001). CONCLUSIONS Self-reports potentially underestimate use of ENDS. Puff counts appear to be the best self-reported measure to assess ENDS use compared with number of sessions or liquid volume. IMPLICATIONS The comparison of EMA self-reports and passively collected ENDS device data can inform future efforts to assess ENDS use. Self-reported puff counts are preferable over number of sessions or amount of liquid used, but compared with objective usage data, self-reported puff counts may still underestimate actual use. ENDS use behavior is likely higher than users estimate and report. Future research on improved measures of ENDS use is needed.
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Affiliation(s)
- Zehan Li
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Pamela M Ling
- Department of General Internal Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Abstract
Purpose. Peer crowd-targeted campaigns are a novel approach to engage high-risk young adults in tobacco use prevention and cessation. We elicited the perspectives of young adult key informants to understand how and why two social branding interventions were effective: (1) "COMMUNE," designed for "Hipsters" as a movement of artists and musicians against Big Tobacco, and (2) "HAVOC," designed for "Partiers" as an exclusive, smoke-free clubbing experience. Design. Qualitative study (27 semistructured qualitative phone interviews). Setting. Intervention events held in bars in multiple U.S. cities. Participants: Twenty-seven key informants involved in COMMUNE or HAVOC as organizers (e.g., musicians, event coordinators) or event attendees. Measures. We conducted semistructured, in-depth interviews. Participants described intervention events and features that worked or did not work well. Analysis. We used an inductive-deductive approach to thematically code interview transcripts, integrating concepts from intervention design literature and emergent themes. Results: Participants emphasized the importance of fun, interactive, social environments that encouraged a sense of belonging. Anti-tobacco messaging was subtle and nonjudgmental and resonated with their interests, values, and aesthetics. Young adults who represented the intervention were admired and influential among peers, and intervention promotional materials encouraged brand recognition and social status. Conclusion. Anti-tobacco interventions for high-risk young adults should encourage fun experiences; resonate with their interests, values, and aesthetics; and use subtle, nonjudgmental messaging.
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Affiliation(s)
- Gabriela Toledo
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Julia McQuoid
- University of California San Francisco, San Francisco, CA, USA
| | - Pamela M. Ling
- University of California San Francisco, San Francisco, CA, USA
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Affiliation(s)
- Raglan Maddox
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Billie-Jo Hardy
- Well Living House, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mike Daube
- Health Sciences, Curtin University, Perth, Western Australia, Australia
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Holmes LM, Thrul J, Warren NK, Ling PM. Local variation in cannabis use patterns among young adults in the San Francisco Bay Area. Spat Spatiotemporal Epidemiol 2021; 37:100418. [PMID: 33980412 DOI: 10.1016/j.sste.2021.100418] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
This study evaluated whether neighborhood-level disorder, social cohesion, and perceived safety, were associated with days of cannabis use in the prior month in a representative sample of young adults in Alameda and San Francisco Counties in California (N = 1272). We used multiscale geographically weighted regression, modeled by county, to measure associations between cannabis use days and neighborhood attributes, adjusting for sociodemographic characteristics and self-rated health. Positive associations were found between number of cannabis use days and neighborhood disorder, and greater perceived safety. Higher levels of social cohesion predicted fewer cannabis use days. Racial/ethnic, sex and, socioeconomic compositions of participants residing in areas with significant neighborhood-level associations varied substantially, suggesting that risk factors for young adult cannabis use may be highly localized. Public health efforts in cannabis education and intervention should be tailored to fit the culture and composition of local neighborhoods.
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Affiliation(s)
- Louisa M Holmes
- Department of Geography & Social Science Research Institute, Pennsylvania State University, 302 Walker Building, University Park, PA 16802, United States.
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Natalie K Warren
- School of Public Health, University of California, Berkeley, 50 University Hall #7360, Berkeley, CA 94720, United States
| | - Pamela M Ling
- Center for Tobacco Control & Research Education, Department of General Internal Medicine, University of California San Francisco, 530 Parnassus Avenue, San Francisco, CA 94143, United States
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Nguyen N, McQuoid J, Neilands TB, Dermody SS, Holmes LM, Ling PM, Thrul J. Same-day use of cigarettes, alcohol, and cannabis among sexual minority and heterosexual young adult smokers. Psychol Addict Behav 2021; 35:215-223. [PMID: 32804517 PMCID: PMC7887119 DOI: 10.1037/adb0000678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 01/20/2023]
Abstract
OBJECTIVE Sexual minority (SM) young adults have higher rates of substance use than heterosexuals, but little is known about daily use of multiple substances, which confer numerous health risks for this population. Using daily diary data from a smartphone-based study, we examined the associations between sexual identity (i.e., SM vs. heterosexual) and patterns of same-day multiple substance use (i.e., cigarettes and alcohol, cigarettes and cannabis, alcohol and cannabis, and all 3 substances). METHOD Young adult smokers (N = 147, aged 18-26, 51.7% female, 41.5% SM, 40.8% White) reported consecutive daily assessments on substance use over 30 days. We used generalized estimating equations to examine associations between sexual identity and patterns of same-day multiple substance use, controlling for demographic factors and psychological distress. RESULTS Of 2,891 daily assessments, 16.7% reported same-day use of cigarettes and alcohol, 18.1% cigarettes and cannabis, 1.5% alcohol and cannabis, and 15.0% use of all 3 substances. SM participants (vs. heterosexuals) had significantly greater odds of reporting days with use of cigarettes and cannabis [Adjusted Odds Ratio (AOR) = 2.05, 95% Confidence Interval (CI) [1.04, 4.01]] and use of all three substances (AOR = 2.79, 95% CI [1.51, 5.14]) than days with single substance use or no use. CONCLUSIONS These findings warrant tailored interventions addressing multiple substance use among SM young adults and temporally accurate measures of multiple substance use patterns. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Julia McQuoid
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, San Francisco, CA
| | - Sarah S. Dermody
- School of Psychological Science, Oregon State University, Corvallis, OR
| | - Louisa M. Holmes
- Social Science Research Institute, Penn State University, University Park, PA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Thrul J, Gubner NR, Nguyen N, Nguyen C, Goodell EA, Holmes LM, Vandrey RG, Ling PM. Perceived reward from using cigarettes with alcohol or cannabis and concurrent use: A smartphone-based daily diary study. Addict Behav 2021; 114:106747. [PMID: 33307406 PMCID: PMC7806245 DOI: 10.1016/j.addbeh.2020.106747] [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: 05/09/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Smoking cigarettes under the influence of alcohol or cannabis is associated with perceived pleasure. However, it is unclear whether these changes in perceived reward impact the extent of concurrent use of cigarettes with alcohol or cannabis. The current study investigated if self-reported changes in perceived reward from concurrent use of cigarettes with alcohol or cannabis are related to the extent of concurrent use in real-world contexts using a smartphone-based Ecological Momentary Assessment (EMA) study. METHODS The sample included 126 diverse young adult smokers in the San Francisco Bay Area who reported current alcohol or cannabis use at baseline (M = 22.8 years, 50.8% male, 40.5% sexual minority, 39.7% Non-Hispanic White). Participants completed an online baseline survey and 30 days of smartphone-based daily EMA surveys of cigarette, alcohol, and cannabis use. The baseline assessed self-reported changes in perceived pleasure of smoking cigarettes while using alcohol or cannabis separately. EMA surveys included detailed questions about concurrent use (i.e., the extent of smoking while using another substance) covering the previous day. A total of 2,600 daily assessments were analyzed using mixed models. RESULTS Higher perceived pleasure from smoking cigarettes while drinking alcohol or using cannabis at baseline were both associated with a greater extent of concurrent use of cigarettes with alcohol (b = 0.140; SE = 0.066; t = 2.1; p = .035) and cannabis (b = 0.136; SE = 0.058; t = 2.4; p = .019) on a given day. CONCLUSIONS Results suggest that perceived reward from concurrently using cigarettes with alcohol or cannabis is associated with the extent of concurrent use. Findings can inform tailored smoking cessation interventions.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, United States; Centre for Alcohol Policy Research, La Trobe University, Australia.
| | - Noah R Gubner
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, United States
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, United States
| | - Charlie Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Erin Anderson Goodell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Louisa M Holmes
- Department of Geography, Penn State University, United States
| | - Ryan G Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, United States
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Abstract
This study evaluated young adults' exposure to drifting secondhand smoke in San Francisco County housing units using the 2014 Bay Area Young Adult Health Survey (N = 1363). Logistic and geographically weighted regression models were used to determine whether residing in multiunit housing or in areas with greater neighborhood disorder were risk factors for exposure, and how drifting smoke exposure varied spatially within San Francisco County. Residing in buildings with five or more units significantly increased the odds of reporting drifting smoke exposure [OR (3.5 1.3, 9.9)], but neighborhood disorder did not have a significant association in the fully adjusted logistic regression model. At the local level, however, neighborhood disorder was significantly associated with exposure in lower income residential and downtown areas. Multiunit housing was significantly associated with exposure across all neighborhoods.
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Affiliation(s)
- Louisa M Holmes
- Department of Geography, State University of New York at Binghamton, 4400 Vestal Parkway E, Binghamton, NY, 13850, USA.
| | - Jasmin D Llamas
- School of Education and Counseling, Santa Clara University, Santa Clara, CA, USA
| | - Derek Smith
- Tobacco Free Project, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research & Education, Department of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
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Watkins SL, Thrul J, Max W, Ling PM. Real-World Effectiveness of Smoking Cessation Strategies for Young and Older Adults: Findings From a Nationally Representative Cohort. Nicotine Tob Res 2021; 22:1560-1568. [PMID: 31807784 DOI: 10.1093/ntr/ntz223] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/05/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Young adults have high combustible cigarette and e-cigarette use rates, and low utilization of evidence-based smoking cessation strategies compared to older adults. It is unknown whether young adults who try to quit smoking without assistance, with evidence-based strategies, or with e-cigarettes, are equally successful compared to older adults. AIMS AND METHODS This analysis used a population-based sample from the Population Assessment of Tobacco and Health study of young adult (aged 18-24, n = 745) and older adult (aged 25-64, n = 2057) established cigarette smokers at Wave 1 (2013-2014) who reported having made a quit attempt at Wave 2 (2014-2015). Cessation strategies were: behavioral therapy, pharmacotherapy, product substitution, 2+ strategies, and unassisted. Logistic regression estimated associations between cessation strategy and short-term cessation status at Wave 2 (quit, no quit); multinomial logistic regression predicted long-term cessation patterns at Waves 2 and 3 (sustained quit, temporary quit, delayed quit, no quit). RESULTS No cessation strategy (ref: unassisted) significantly predicted short-term cessation. No cessation strategy (ref: unassisted) significantly predicted long-term cessation patterns for young adults. Substitution with e-cigarettes predicted short-term cessation for older daily smokers of ≥5 cigarettes/day (adjusted odds ratio [AOR]: 1.70; 95% confidence interval: 1.08, 2.67) but did not predict long-term cessation patterns. CONCLUSIONS Despite differences in cessation strategy use between young and older adult smokers, strategy effectiveness largely did not differ by age group. No strategy examined, including e-cigarettes, was significantly associated with successful cessation for young adults. More work is needed to identify effective interventions that help young adult smokers quit. IMPLICATIONS (1) Neither behavioral support, pharmacotherapy, nor product substitution was associated with short-term cessation for young or older adults compared to quitting unassisted. (2) Neither behavioral support, pharmacotherapy, nor product substitution was associated with longer-term cessation for young or older adults compared to quitting unassisted. (3) Substitution with e-cigarettes predicted short-term cessation for older daily smokers of ≥5 cigarettes/day but was not associated with longer-term cessation.
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Affiliation(s)
- Shannon Lea Watkins
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Wendy Max
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, CA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
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Kim M, Watkins SL, Koester KA, Mock J, Kim HC, Olson S, Harvanko AM, Ling PM. Unboxed: US Young Adult Tobacco Users' Responses to a New Heated Tobacco Product. Int J Environ Res Public Health 2020; 17:E8108. [PMID: 33153143 PMCID: PMC7662359 DOI: 10.3390/ijerph17218108] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022]
Abstract
The heated tobacco product (HTP) IQOS was authorized for sale in the US in 2019. We investigated how young adults with experience using multiple tobacco products reacted to, perceived, and developed interest in IQOS, informing policies that might prevent HTPs from becoming ubiquitous. We used a novel qualitative method in which 33 young adult tobacco users in California (fall 2019) "unboxed" an IQOS device, tobacco sticks, and marketing materials and narrated their impressions and opinions. We conducted content and thematic analyses of participants' reactions, sensory experiences, and interest. Multiple attributes influenced appeal for participants, including sleek electronic design, novel technology, perceived harmfulness, complexity, and high cost. The "no smoke" claim and heating technology suggested that smoking IQOS was safer than smoking cigarettes. Public health programs should closely monitor HTP marketing and uptake, particularly as "reduced exposure" claims were authorized in July 2020. Evidence-based regulations (e.g., requiring plain packaging for tobacco sticks), actions addressing IQOS' unique attributes (e.g., regulating device packaging to reduce high-tech appeal), and public education might help to counter the appeal generated by potentially misleading IQOS marketing tactics.
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Affiliation(s)
- Minji Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
| | - Shannon Lea Watkins
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Kimberly A. Koester
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Jeremiah Mock
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA 94143, USA;
| | - Hyunjin Cindy Kim
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Sarah Olson
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Arit Michael Harvanko
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
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Nguyen N, Holmes LM, Kim M, Ling PM. Using Peer Crowd Affiliation to Address Dual Use of Cigarettes and E-Cigarettes among San Francisco Bay Area Young Adults: A Cross Sectional Study. Int J Environ Res Public Health 2020; 17:E7643. [PMID: 33092106 PMCID: PMC7588881 DOI: 10.3390/ijerph17207643] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
Given the emerging tobacco landscape, dual use of cigarettes and e-cigarettes has increased among young adults, but little is known about its associated factors. Peer crowds, defined as macro-level connections between individuals with similar core values (e.g., "Hip Hop" describing a group that prefers hip hop music and values strength, honor, and respect), are a promising way to understand tobacco use patterns. We examined associations between peer crowds and tobacco use patterns by using data from a cross sectional survey of 1340 young adults in the San Francisco Bay Area in 2014. Outcomes were the past 30-day use of: neither cigarettes nor e-cigarettes; cigarettes but not e-cigarettes; e-cigarettes but not cigarettes; and both cigarettes and e-cigarettes. Peer crowds included Hipster, Hip Hop, Country, Partier, Homebody, and Young Professional. Multinomial regression analysis indicated that peer crowds were significantly associated with different tobacco use patterns. Compared to Young Professionals, Hip Hop and Hipster crowds were more likely to dual use; Hipsters were more likely to use e-cigarettes only, and Country participants were more likely to smoke cigarettes only. These findings suggest that tobacco control campaigns and cessation interventions should be tailored to different young adult peer crowds and address poly-tobacco use.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94143, USA; (M.K.); (P.M.L.)
| | - Louisa M. Holmes
- Departments of Geography & Demography, and the Social Science Research Institute, Penn State University, University Park, PA 16802, USA;
| | - Minji Kim
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94143, USA; (M.K.); (P.M.L.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94143, USA; (M.K.); (P.M.L.)
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Abstract
OBJECTIVES Instagram influencers have many followers and are often paid to promote products, including e-cigarettes. This experimental study assessed effects of sponsorship disclosures on perceptions of e-cigarette Instagram influencer posts. METHODS Young adult e-cigarette users (age 18-29; N = 917) were randomly assigned to 3 experimental conditions varying the clarity of sponsorship disclosure on simulated Instagram influencer posts: clear (eg, "#sponsored") ambiguous (eg, "#sp"), or no disclosure (ie, vaping-related hashtags only). After viewing each of 4 Instagram posts featuring a fictitious e-cigarette brand, participants reported hashtag recognition, ad recognition, ad trust, influencer credibility, and post engagement intentions. After viewing all posts, participants reported brand attitudes, brand use intentions, and vaping intentions. RESULTS With greater recognition of clear (but not ambiguous) disclosure hashtags, ad recognition increased (p = .001), perceptions of influencer credibility decreased (p = .022), and intentions to engage with posts decreased (p = .008). Ad trust was lower with greater hashtag recognition regardless of disclosures (p < .001). Sponsorship disclosures did not significantly affect brand attitudes, brand use intentions, or vaping intentions. CONCLUSIONS Recognizing clear sponsorship disclosures may influence young adults' perceptions of and engagement with e-cigarette Instagram posts but may not affect perceptions or use of products.
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Affiliation(s)
- Erin A Vogel
- Stanford Prevention Research Center, Stanford University, Stanford, CA
| | | | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA
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Pasetes SV, Ling PM, Apollonio DE. Cognitive performance effects of nicotine and industry affiliation: a systematic review. Subst Abuse 2020; 14:1178221820926545. [PMID: 32547048 PMCID: PMC7271274 DOI: 10.1177/1178221820926545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Studies assessing the cognitive performance effects of nicotine show inconsistent results and tobacco industry funding has been correlated with study outcomes. We conducted a systematic review of the primary literature assessing the cognitive performance effects of nicotine and assessed potential associations between tobacco and pharmaceutical industry affiliation and reported study conclusions. METHODS We searched PubMed, EMBASE, PsycINFO, BIOSIS, and Web of Science for peer-reviewed journal articles published between 2009 and 2016 that: (1) were randomized controlled trials; (2) investigated the effects of nicotine on cognitive performance in a laboratory setting; (3) administered nicotine to healthy adults (18-60 years); and (4) included participants were nonsmokers or minimally deprived smokers (⩽2 hours of abstaining from smoking). Study disclosures and tobacco industry documents were reviewed to determine industry funding. RESULTS Searches yielded 3,771 abstracts; 32 studies were included in the review. The majority of studies investigated the effects of nicotine on attention (n = 22). Nicotine had a non-uniform effect on attention: studies reported positive (41%; n = 9), mixed (41%; n = 9), and no effect (18%; n = 4). The majority of study authors had received prior tobacco industry funding (59%; n = 19), however over half of tobacco-industry funded authors did not report this (53%; n = 10). CONCLUSIONS Nicotine does not appear to be associated with consistent cognitive performance effects. Although no association was found between reported outcomes and tobacco or pharmaceutical industry funding, findings likely underestimate the influence of industry funding due to strict inclusion criteria and incomplete data on pharmaceutical industry funding. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Sarah V. Pasetes
- Department of Clinical Pharmacy,
University of California, San Francisco, USA
| | - Pamela M. Ling
- Department of Medicine, Division of
General Internal Medicine, Center for Tobacco Control Research and Education,
University of California, San Francisco, USA
| | - Dorie E. Apollonio
- Department of Clinical Pharmacy,
University of California, San Francisco, USA
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50
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Blank ML, Hoek J, George M, Gendall P, Conner TS, Thrul J, Ling PM, Langlotz T. An Exploration of Smoking-to-Vaping Transition Attempts Using a "Smart" Electronic Nicotine Delivery System. Nicotine Tob Res 2020; 21:1339-1346. [PMID: 29878179 DOI: 10.1093/ntr/nty093] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 05/07/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Electronic nicotine delivery systems (ENDS) are used to aid smoking cessation attempts; however, many smokers continue to smoke while using an ENDS (dual use). Although uncertainty remains regarding whether specific ENDS patterns hinder or support successful smoking cessation, recent advances in "smart" technology allow passive and active recording of behaviors in real time, enabling more detailed insights into how smoking and vaping patterns may coevolve. We describe patterns of ENDS initiation, and subsequent use, including any changes in cigarette consumption, among daily smokers using a "smart" ENDS (S-ENDS) to quit smoking. METHOD An 8-week long mixed-methods feasibility study used Bluetooth-enabled S-ENDS that passively recorded real-time device use by participants (n = 11). Daily surveys administered via smartphones collected data on self-reported cigarette consumption. RESULTS All 11 participants were dual users, at least initially, during their quit attempt. We observed three provisional vaping and smoking patterns: immediate and intensive ENDS initiation coupled with immediate, dramatic, and sustained smoking reduction, leading to smoking abstinence; gradual ENDS uptake with gradual smoking reductions, leading to daily dual use throughout the study period; and ENDS experimentation with return to exclusive smoking. For six participants, the patterns observed in week 1 were similar to the vaping and smoking patterns observed throughout the rest of the study period. CONCLUSION Technological advances now allow fine-grained description of ENDS use and smoking patterns. Larger and longer studies describing smoking-to-vaping patterns, and estimating associations with smoking outcomes, could inform ENDS-specific cessation advice promoting full transition from smoking to exclusive ENDS use. IMPLICATIONS The use of an S-ENDS that recorded real-time device use among daily smokers engaged in a quit attempt provides insight into patterns and trajectories of dual use (continuing to smoke while using ENDS), and the possible associations between ENDS initiation, subsequent use, and smoking cessation outcomes. Such work could support more targeted cessation counseling and technical advice for smokers using ENDS to quit smoking, reduce the risk of users developing long-term dual use patterns, and enhance the contributions ENDS may make to reducing smoking prevalence.
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Affiliation(s)
| | - Janet Hoek
- University of Otago, Dunedin, New Zealand
| | | | | | | | | | - Pamela M Ling
- University of California San Francisco, San Francisco, CA
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