High school students' use of flavored e-cigarette e-liquids for appetite control and weight loss

Bidirectional relationships between nicotine vaping and maladaptive eating behaviors among young adults

Background

Past research indicates that young adult cigarette smokers are at risk of engaging in maladaptive eating behaviors (MEBs); however, whether this relationship extends to nicotine vaping is unclear. The current study assessed bidirectional associations between four types of MEBs and nicotine vaping among young adults.

Methods

1,303 young adults (20.5 ± 2.3 years; 63 % female) from a public, urban university were recruited and completed online surveys at six-month intervals from spring 2021 (W1) to spring 2023 (W5). Past 30-day nicotine vaping and four types of MEBs (susceptibility to external cues, emotional eating, routine restraint, and compensatory restraint) were evaluated.

Results

Longitudinal cross-lagged models examined the bidirectional relationships between past 30-day nicotine vaping and each type of MEB across five waves. Nicotine vaping predicted both susceptibility to external cues (β = 0.10, p <.05; Wave 2 to 3) and emotional eating (β = 0.08, p <.05; Wave 1 to 2). A significant cross-lag regression (Wave 4 to 5) showed nicotine vaping predicted to routine restraint (β = 0.08, p <.05), and routine restraint predicted to nicotine vaping (β = 0.12, p <.05).

Conclusions

Results indicated that nicotine vaping predicted MEBs; however, the type of MEB differed across waves, which may have been due to the COVID-19 pandemic context. Nicotine vaping predicted to MEBs reflecting vulnerability to the external environment and emotion regulation during a period of heightened restrictions, whereas later when pandemic restrictions had ceased nicotine vaping predicted only to routine restraint. Integrating research and practice on nicotine vaping and MEBs may inform public health efforts to decrease co-occurring health-risks in young adulthood.

Exploring Vaping Patterns and Weight Management-Related Concerns among Adolescents and Young Adults: A Systematic Review

Background: Electronic cigarettes or vapes are battery-operated devices that heat a liquid, often containing nicotine and flavouring substances, to produce an inhalable aerosol. Despite being used as an alternative to traditional smoking, many studies have reported their health risks and ineffectiveness in smoking cessation. The impact of e-cigarettes on weight control behaviours, a known effect of traditional cigarette smoking, is unclear. Herein, a systematic review was conducted to explore the relationship between e-cigarette use and body weight changes in adolescents and young adults. Methods: The existing literature from databases such as PubMed, Cochrane Library, Embase, Science Direct, Web of Science, Scopus, and Google Scholar until October 2023 was searched and included in the review. The methodological quality of all selected studies was assessed using the Joanna Briggs Institute's (JBI) Critical Appraisal Checklists for Studies. Results: Out of 5117 citations, 20 publications featuring cross-sectional studies with adolescent participants were qualitatively analysed. The high rates of e-cigarette usage seemed to correlate with increased weight concerns, particularly among females. Regular e-cigarette users who reported being overweight and used calorie restriction for weight reduction were more likely to view vaping as a weight loss or control strategy. Young adults (<24 years) may consume more flavoured e-cigarettes than older users (>25 years). Conclusions: This study revealed a significant use of e-cigarettes among high school students, driven by taste preferences, weight management, and perceived harm reduction. Particularly among girls facing body image pressures, vaping serves as a weight control method. This highlights the need to assess cardiovascular risks and advocate for further research, including longitudinal studies, to inform public health strategies effectively.

E-cigarette dependence and cooling flavor use are linked among youth

BACKGROUND

E-cigarette flavors that produce cooling sensations may reduce nicotine harshness and enhance appeal among youth. While previous research has shown that use of cooling flavors is associated with more frequent vaping among youth, it is unknown whether the same holds true for e-cigarette dependence. This study examines the relationship between cooling flavor use and e-cigarette dependence among youth accounting for vaping frequency.

METHODS

In Fall 2022, a survey was conducted among Connecticut high school students to assess past-month nicotine e-cigarette use, ever use of cooling flavors, cooling flavor types (e.g., fruit-cooling), and e-cigarette dependence. Analyses were restricted to those with past-month nicotine and nicotine-free e-cigarette use and complete data (n=204). Multivariable linear regressions were run to examine the association between cooling flavor use and e-cigarette dependence, adjusting for demographics, e-cigarette use characteristics, and other tobacco product use.

RESULTS

78.4% of the sample used cooling e-cigarette flavors, with 55.0% using mint-cooling flavors and 52.5% using fruit-cooling flavors. Regression results observed that cooling flavor use was associated with higher e-cigarette dependence (ꞵ=1.53, SE=0.63, p=0.017), with those who used cooling flavors having higher e-cigarette dependence than those who did not (M=5.78 [SD=5.33] vs. 2.84 [3.19]).

CONCLUSIONS

Our results suggest that cooling flavor use is significantly associated with e-cigarette dependence among youth. While regulations often target menthol flavor, tobacco control agencies should consider restricting any flavor that can produce cooling sensations, even if they are not traditional menthol products, as cooling flavors is associated with youth e-cigarette dependence.

Trajectories of body mass index and combustible and electronic cigarette use across adolescence: Findings from the PATH study

PURPOSE

Associations between empirically-generated body mass index (BMI) trajectories and risk of current use of combustible cigarettes and e-cigarettes across adolescence were examined using longitudinal data from the Population Assessment of Tobacco and Health (PATH) study.

METHODS

The PATH study is an ongoing annual longitudinal population-based study of adolescents. We utilized Waves 1-4 conducted from 2013 to 2017. Adolescents completed self-reported surveys of their height, weight, and current tobacco use at Waves 1-4 and their tobacco weight control beliefs at Waves 1-2.

RESULTS

Using latent growth mixture modeling, six trajectories of BMI were identified. The largest group ("normal weight increasing;" n = 4,858; 86.6 %), which was used as the comparator in subsequent analyses, consisted of adolescents ages 12-17 who were normal weight at Wave 1 with a significant increase in BMI across Waves 2--4. The "overweight early increasing," "overweight late increasing," and "obesity stable" classes had greater likelihood of current combustible cigarette use during the study compared to the "normal weight increasing class." The "overweight early increasing," "overweight late increasing," and "overweight increasing then decreasing" classes showed elevated risk for e-cigarette use during the study. Compared to those in the "normal weight increasing" class, those in the "overweight increasing then decreasing" and "obesity stable" classes had greater weight control beliefs at Wave 1 and those in the "obesity stable" class had greater weight control beliefs at Wave 2.

CONCLUSIONS

Findings highlight the importance of weight trajectories and weight control beliefs by tobacco product use across adolescence and the need for mechanistic and intervention research.

Analysis of illicit drugs in purchased and seized electronic cigarette liquids from the United Kingdom 2014-2021

Increasing popularity and known shortfalls in the regulation of electronic cigarettes (ECs) emphasises the urgent need for closer content monitoring and for comprehensible information on their possible health effects. This study investigated components of EC liquids in samples submitted from 2014 to 2021 and discussed the trends driven by legislation changes. Samples originating from prisoners, teenagers and 'test purchases' of commercially available ECs were analysed by gas chromatography-mass spectrometry (GC-MS). For those containing delta-9-tetrahydrocannabinol (THC) and/or cannabidiol (CBD), the content of these components was quantified by liquid chromatography with quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) to show variation of these compounds in EC liquids; 112 EC liquids were included in this study. Nicotine was detected in 87 (78%) of the EC liquids analysed. Twenty-two, including samples from before and after introduction of the UK Psychoactive Substances Act (2016), contained one or more synthetic cannabinoid receptor agonist (SCRA). THC was detected in only 11 samples, whereas a single sample was found to contain CBD only. Six samples contained a mixture of THC and CBD. In all cases where information was available, the THC/CBD content was less than that stated on the product label. The data collected showed great variation in EC liquid content. Therefore, it is important that users are educated regarding risks associated with EC use. Additionally, substances now controlled under both the UK Misuse of Drugs Act and Psychoactive Substances Act were present. These substances each carry a potential risk to health, which is possibly exacerbated if multiple compounds are inhaled concomitantly.

E-cigarette weight and appetite control beliefs and e-cigarette initiation in young adults

E-cigarette use has increased among young adults, and emerging research suggests a subset of young adults report using e-cigarettes for appetite control/weight loss. The current article examined the association of e-cigarette weight control beliefs with subsequent e-cigarette initiation. Data were collected via online surveys from a prospective cohort study of young adults in Southern California (N = 1,368) at baseline (May-October 2020; M [SD]age = 21.2 [0.4]) and 6 months later (January-May 2021). Binary logistic regression models were used to evaluate the association of e-cigarette weight control beliefs (i.e., perceptions that e-cigarettes help people lose weight and satisfy hunger and desire to eat unhealthy foods) with new onset e-cigarette use at follow-up. All models were adjusted for sociodemographic characteristics. Among individuals who had never used e-cigarettes at baseline, those who agreed (vs. disagreed) that e-cigarettes help people lose weight had more than three times the odds of initiating e-cigarette use by follow-up (OR [95% CI]: 3.24 [1.52, 6.62]). Similarly, those who agreed (vs. disagreed) that vaping certain e-cigarette flavors help satisfy hunger and desire to eat unhealthy foods had more than twice the odds of initiating e-cigarette use by follow-up (OR [95% CI]: 2.40 [1.15, 4.82]). Findings highlight that e-cigarette weight control beliefs are an important risk factor for vaping initiation. Future interventions and policies aiming to prevent vaping among young adults should address e-cigarette weight control beliefs and long-term health consequences from related use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of electronic cigarette e-liquid flavouring on cigarette craving

BACKGROUND

E-liquid flavour restrictions may discourage electronic cigarette (e-cigarette) uptake among youth. However, possible unintended consequences may include reduced appeal and effectiveness of e-cigarettes for smoking cessation. Non-tobacco flavours appear to be important for smoking cessation, but how and why are currently unclear.

METHODS

We conducted an experimental study in a UK sample of adult daily smokers using an independent groups design (N=84). Participants were randomised to use an e-cigarette with nicotine-containing fruit/sweet-flavoured e-liquid (blackcurrant, strawberry, vanilla, caramel) or unflavoured e-liquid for 1 week. The primary outcomes were average, peak and cue-elicited cigarette craving (the latter was assessed using a cue exposure task). The secondary outcomes were smoking lapse occurrence, enjoyment of the e-cigarette, ease of transitioning from smoking to using an e-cigarette, intentions to continue using an e-cigarette, intentions and motivation to quit smoking, return to smoking, and continuation of e-cigarette use.

RESULTS

E-liquid flavouring did not appear to have an effect on average cigarette craving (b 0.18, 95% CI -0.44 to 0.79, p=0.57), peak cigarette craving (b -0.12, 95% CI -0.59 to 0.35, p=0.62) or cue-elicited cigarette craving (b -0.21, 95% CI -3.86 to 3.43, p=0.91). We did not find evidence of a difference in secondary outcomes.

CONCLUSIONS

We did not find evidence to suggest that nicotine-containing fruit/sweet-flavoured and unflavoured e-liquids have different effects on cigarette cravings after 1 week of use. Further research is needed to establish if differences emerge over longer periods of exposure and extend to smoking cessation outcomes.

Age-Varying Associations Between Attempts to Lose Weight and Nicotine Vaping Across Adolescence: Results From a Nationally Representative Sample

PURPOSE

The prevalence of nicotine vaping is increasing among adolescents and emerging evidence suggests weight concerns may promote risk for vaping. The aims of this study were to investigate whether there is an association between attempting to lose weight and nicotine vaping during adolescence, when this association emerges and is strongest, and whether there are sex differences in this link.

METHODS

This study used time-varying effect modeling, an analytic method that estimates regression coefficients as a continuous function of age, to model dynamic associations between weight loss behavior and nicotine vaping across adolescence and sex differences in these links. Data were from 13,677 adolescents (aged 14-18 years, 49.4% female) who participated in the 2019 National Youth Risk Behavior Survey, a nationally representative U.S.

SAMPLE

RESULTS

Results revealed an age-varying association that differed by sex. Girls who were trying to lose weight were at a higher risk for past 30-day vaping from ages 14.2-15.9 years, with the strongest association at 14.8 years (odds ratio [OR] = 1.92, 95% confidence interval [CI] [1.25, 2.95]). For boys, this association was nonsignificant across age (OR = 1.76, 95% CI [0.91, 3.41] at age 14.0 years). Girls who were trying to lose weight were at a higher risk for frequent vaping (vaping on 20-30 of the past 30 days) from ages 15.2-17.1 years, with the strongest association at 16.1 years (OR = 2.59, 95% CI [1.45, 4.62]). This link was not meaningfully significant at any age for boys (OR = 3.26, 95% CI [0.86, 12.33] at age 14.0 years).

DISCUSSION

Girls, but not boys, who are trying to lose weight appear vulnerable to nicotine vaping during adolescence.

Associations between muscle-building exercise and concurrent e-cigarette, cigarette, and cannabis use among U.S. adolescents

Physical activity and team sports may be protective of substance use among adolescents, although there is mixed evidence on whether muscle-building exercise is associated with patterns of e-cigarette use (i.e., vaping), cigarette use, and cannabis use. Therefore, this study aimed to determine the association between muscle-building exercise and patterns of concurrent substance use among U.S. adolescents. Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 8,474) were analyzed in 2022. Muscle-building exercise was assessed by number of days of the behavior in the past week and categorized based on level of engagement (none, low, medium, and high). Concurrent vaping, cigarette use, and cannabis use within the past 30 days were assessed using a combined, four-category variable (no use, any single use, any dual use, and triple use). Multinomial logistic regressions, with coefficients transformed to relative risk ratios (RRR), were conducted to estimate the associations between muscle-building exercise and concurrent substance use among the overall sample, and by sex, while adjusting for relevant sociodemographic variables. Among the overall sample, high engagement (6-7 days) in muscle-building exercise was associated with greater relative risk of any single use (RRR 1.36, 95% confidence interval [CI] 1.06-1.72), any dual use (RRR 1.46, 95% CI 1.10-2.94), and triple use (RRR 1.81, 95% CI 1.05-3.12). While muscle-building exercise was associated with greater relative risk of concurrent patterns of vaping, cigarette use, and cannabis use among adolescent males, there were no significant relationships found among adolescent females. Healthcare professionals should consider this association when treating adolescent males, particularly given the high prevalence of muscle-building exercise and substance use among this group. More research is needed to understand the experiences of adolescent males who report high engagement in muscle-building exercise and substance use to uncover mechanisms of association.

Vaping motivations: Association of behavioral inhibition and behavioral activation systems with nicotine and cannabis vaping among adolescents

BACKGROUND

Despite copious information on the hazards of nicotine and cannabis, many adolescents report vaping nicotine and cannabis. To advance knowledge on the precursors of vaping behaviors, this study examined the association of behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivities with nicotine and cannabis vaping among adolescents.

METHODS

Data were part of a longitudinal survey on substance use and mental health among adolescents and included 2,467 11th grade students from 10 public high schools in California. Participants completed a 20-item scale assessing BIS (one aspect) and BAS (three aspects: drive, fun-seeking, reward responsiveness) sensitivities at baseline and reported their past 30-day nicotine and cannabis vaping at baseline and again at 6-month follow-up. Unadjusted and adjusted (controlled for demographic characteristics and product-specific baseline vaping) regression models estimated vaping risk at follow-up by BIS/BAS scores at baseline.

RESULTS

Bivariate analyses showed participants who vaped nicotine had significantly higher drive and fun-seeking scores (p < 0.05); and cannabis vapers had lower BIS and reward responsiveness scores (p < 0.05) compared to non-users. Higher fun seeking scores was associated with increased odds (OR = 1.15, 95 %CI = 1.03-1.29) of nicotine vaping and higher reward responsiveness scores reduced odds (OR = 0.89, 95 %CI = 0.79-0.99) of nicotine vaping. Higher scores on BIS was associated with decreased the odds (OR = 0.91, 95 %CI = 0.84-0.99) of cannabis vaping.

CONCLUSION

Different behavioral motivations should be targeted when developing interventions designed to reduce nicotine and cannabis vaping among diverse adolescents.

Self-Reported Medical and Nonmedical Cannabis Use: Results from the 2018 Behavioral Risk Factor Surveillance System in 14 States

As policies legalizing adult cannabis use increase in the United States, understanding and characterizing the proportion of individuals consuming cannabis for medical and nonmedical purposes is important to inform targeted health education efforts. Data came from 7672 adults (> = 18 years) with past month cannabis use who responded to questions about reason for cannabis use on the 2018 Behavioral Risk Factor Surveillance System survey in 14 states. State and aggregated data were analyzed using weighted frequencies for descriptive analyses, and prevalence ratios were computed to identify demographic and substance use characteristics associated with medical only use or use for both medical and nonmedical reasons (vs. nonmedical use). Overall, 28.6% (95% CI: 26.7, 30.4) of adults who use cannabis reported using cannabis medically, 34.2% (95% CI: 32.3, 36.2) nonmedically, and 37.2% (95% CI: 35.2, 39.2) both medically and nonmedically. Characteristics associated with medical only use (compared with nonmedical only use) included being female; aged > 45 years; out of work, a homemaker, or unable to work; having daily or near daily cannabis use; having past month cigarette use; having no past month alcohol use; self-reporting poor health; and ever having been diagnosed with certain chronic diseases. Medical only use of cannabis is the least prevalent reason for use; use for both medical and nonmedical reasons is the most prevalent. Monitoring reasons for cannabis use can aid states in understanding differences between medical and nonmedical cannabis users, providing context to use patterns, and targeting health education messages to appropriate audiences.

A chocolate cake or a chocolate vape? Young adults describe their relationship with food and weight in the context of nicotine vaping

INTRODUCTION

Emerging research has found that some young adults report vaping nicotine to control appetite and lose weight. Yet, there is little research on how young adults use vaping to manage weight, where they learn about weight-motivated vaping, and the role that food and weight motivations play in decisions to vape.

METHODS

We conducted one-on-one qualitative interviews with young adults aged 18-25 years old in Los Angeles, California (N = 62) from June 2018 to June 2019, who self-reported using e-cigarettes on a weekly basis or more for at least 5 months prior to study enrollment. Interviews examined participants' thoughts, feelings, and experiences related to e-cigarette use, including their understanding of the relation of vaping with eating behaviors and weight management. We analyzed the interviews using the rigorous and accelerated data reduction (RADaR) technique.

RESULTS

Participants reported pairing nicotine vaping with caffeinated beverages like coffee, pop/soda, tea, and after every meal (like patterns of combustible cigarette use). Participants also reported vaping nicotine as a tool to avoid binge eating and increase concentration while studying. Reports of vaping effecting appetite and eating behaviors also emerged. Vaping nicotine to suppress appetite and/or achieve weight loss was often reported in conjunction with an eating disorder. Participants reported learning about weight-motivated vaping from peers or deducing from cigarette effects and their own experiences with nicotine. Others mentioned controlling food cravings by vaping a similar e-liquid flavor.

CONCLUSION

Nicotine vaping was used as a tool to control weight and suppress appetite, paralleling food- and weight-related behaviors associated with cigarette use. Findings suggest a need for targeted interventions that address the role of nicotine vaping in eating/weight-related behaviors.

Prospective Associations of Tobacco Weight Control Beliefs with E-Cigarette Use Patterns in the PATH Study

INTRODUCTION

Some adolescents report using e-cigarettes (EC) for weight-related reasons, but longitudinal studies are lacking. This study examined associations between tobacco weight control beliefs and body mass index (BMI) with EC use patterns over one year.

METHODS

Data from Waves 1 and 2 (September 2013 to October 2015) of the Population Assessment of Tobacco and Health (PATH) study were used. Questions about tobacco weight control beliefs, EC use patterns (never, ever, never to current, ever to current, current to current), cigarette and other tobacco product use, demographics, and BMI were examined among adolescent respondents across Wave 1 and Wave 2.

RESULTS

Most adolescents were never EC users (85.8%). Prevalence of EC use patterns was low across categories of use (0.6%-5.3%). Higher BMI was associated with transition from ever but not current use at Wave 1 to current use at Wave 2. Greater baseline tobacco weight control beliefs and increases in tobacco weight control beliefs were associated with most EC use patterns compared to never use.

CONCLUSIONS

Greater tobacco weight control beliefs were risk factors for e-cigarette initiation and maintenance among a nationally representative sample of adolescents. BMI was minimally associated with e-cigarette use patterns. Additional studies are needed to replicate and further examine these preliminary prospective associations between weight control beliefs and EC use.

Inhaled or Ingested, Which Is Worse, E-Vaping or High-Fat Diet?

Long term e-cigarette vaping induces inflammation, which is largely nicotine independent. High-fat diet (HFD) consumption is anoter cause of systemic low-grade inflammation. The likelihood of using e-cigarettes as a weight control strategy is concomitant with the increase in obesity. In Australia, only nicotine-free e-fluid is legal for sale. Therefore, this study aimed to investigate how nicotine-free e-cigarette vapour exposure affects inflammatory responses in mice with long term HFD consumption. Mice were fed a HFD for 16 weeks, while in the last 6 weeks, half of the chow and HFD groups were exposed to nicotine-free e-vapour, while the other half to ambient air. Serum, lung, liver and epididymal fat were collected to measure inflammatory markers. While both e-vapour exposure and HFD consumption independently increased serum IFN-γ, CX3CL1, IL-10, CCL20, CCL12, and CCL5 levels, the levels of IFN-γ, CX3CL1, and IL-10 were higher in mice exposed to e-vapour than HFD. The mRNA expression pattern in the epididymal fat mirrors that in the serum, suggesting the circulating inflammatory response to e-vapour is from the fat tissue. Of the upregulated cytokines in serum, none were found to change in the lungs. The anti-inflammatory cytokine IL-10 was increased by combining e-vapour and HFD in the liver. We conclude that short-term nicotine-free e-vapour is more potent than long term HFD consumption in causing systemic inflammation. Future studies will be needed to examine the long-term health impact of nicotine-free e-cigarettes.

Compulsive exercise and vaping among a sample of U.S. College students aged 18-26 years

PURPOSE

To determine the association between compulsive exercise and vaping among college students aged 18-26 years, and to characterize the type of vaping used among participants who report compulsive exercise.

METHODS

Cross-sectional, pooled data from two survey years (2018-2020; N = 2125) of the national (U.S.) Healthy Minds Study were analyzed. Compulsive exercise was measured based on number of occurrences in the past 28 days (analyzed continuously and among those who reported  ≥ 1 and ≥ 20 occurrences). Vaping was measured based on reported use in the past 30 days. Most recent type of vaping was assessed only among participants who reported vaping. Logistic regression analyses were conducted to estimate the associations between compulsive exercise and vaping, while adjusting for covariates.

RESULTS

For every additional occurrence of compulsive exercise reported by participants, their odds of also reporting vaping increased by 5% (95% CI 1.01-1.09). Participants who reported 20 or more occurrences of compulsive exercise in the past 28 days, a clinical threshold, had 3.71 (95% CI 1.28-10.76) higher odds of vaping in the past 30 days. Among participants who endorsed vaping, nicotine vaping was the most common recent type for those who reported any (76.2%) or 20 or more (50.2%) occurrences of compulsive exercise.

CONCLUSION

Compulsive exercise is associated with vaping in a national, U.S. sample of college students, with nicotine vaping being the most common type used. Screening for both compulsive exercise and vaping, particularly if either is reported, among college-age young adults is necessary to implement prevention and intervention strategies.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Associations between vaping and eating disorder diagnosis and risk among college students

Vaping is common among college-age young adults. Preliminary research has shown associations between vaping and eating disorder symptoms, however, there remain gaps in this knowledge among college students. The aim of this study was to determine the associations between vaping and a self-reported lifetime eating disorder diagnosis and eating disorder risk among a large sample of college students. Cross-sectional data from the 2018-2019 national (U.S.) Healthy Minds Study (n = 51,231) were analyzed. Multiple logistic regression analyses were conducted to determine the unadjusted and adjusted associations between vaping or e-cigarette use in the past 30 days and a self-reported lifetime eating disorder diagnosis (any diagnosis, anorexia nervosa, bulimia nervosa, binge-eating disorder) and eating disorder risk (SCOFF). Among the sample, 19.0% of participants reported vaping or e-cigarette use in the past 30 days, 3.7% self-reported any lifetime eating disorder diagnosis, and 25.0% were at elevated risk for an eating disorder. Vaping or e-cigarette use was associated with higher odds of all eating disorder measures, including the self-reported lifetime eating disorder diagnosis items (any diagnosis, anorexia nervosa, bulimia nervosa, binge-eating disorder) and elevated eating disorder risk, while adjusting for demographic and confounding variables. Among a large sample of college students, vaping or e-cigarette use was associated with a self-reported lifetime eating disorder diagnosis and elevated eating disorder risk, which may exacerbate the many medical complications associated with eating disorder behaviors. Clinical professionals should screen for eating disorder behaviors among college students who report vaping or e-cigarette use to monitor symptoms and medical complications.

The developmental course of the link between weight concerns and cigarette use across adolescence: Differences by gender

OBJECTIVE

This study aimed to illuminate developmental changes and gender differences in the link between weight concerns and cigarette use across adolescence. Specifically, we examined whether and how the strength of the association between weight concerns and cigarette use changed across adolescence, and whether patterns of association differed between boys and girls.

METHOD

Participants were 397 predominately White adolescents ages 11-18 years (50.5% female) from a longitudinal observational study conducted in the United States.

RESULTS

Time-varying effect modeling revealed that even after adjusting for BMI, the association between weight concerns and cigarette use was positive and significant for girls from age 11.3 to 15.9, with the strongest association at 12.7 years. For boys, this association was non-significant throughout adolescence.

DISCUSSION

Results suggest a sensitive period in early- to mid-adolescence during which girls with weight concerns may be at heightened risk for cigarette use. Findings have implications for the developmental timing of interventions to prevent cigarette use and weight concerns and suggest that tailored interventions for girls may be warranted.

E-Cigarette Dependence and Weight-Related Attitudes/Behaviors Associated With Eating Disorders in Adolescent Girls

Background: Although numerous motivations for vaping have been identified in adolescents, no study to date has examined a possible link between vaping and attitudes/behaviors that are associated with eating disorders in adolescent females. Examining this question in adolescent females is especially relevant given the higher prevalence of eating disorders in adolescent girls and women compared to adolescent boys and men. Methods: We recruited 299 girls (between 13 to 17 years old) via Facebook advertisement to complete a REDCap survey, which included the Electronic Cigarette Dependence Index (ECDI), Minnesota Eating Behavior Survey (MEBS), and demographic questions. Data were analyzed using nonparametric Spearman rank correlation test in R. Results: Electronic Cigarette Dependence Index (ECDI) scores were correlated with weight preoccupation (WP), binge eating (BE) and compensatory behavior (CB), but not body dissatisfaction (BD). The following were the results of Spearman correlation tests: (1) WP: rho = 0.13, p = 0.02; (2) BD: rho = 0.06, p = 0.28; (3) BE: rho = 0.15, p = 0.0095; (4) CB: rho = 0.021, p = 0.00027. Conclusion: The present study adds to the current literature examining motivations for e-cigarette use in adolescent girls. As eating disorders and e-cigarette dependence are significant public health concerns, our results highlight the need for intervention development.

Psychosocial Factors Associated with E-Cigarette Use among Young Adults in a 4-Year University in Appalachia

OBJECTIVES

In order to determine methods to reduce vaping prevalence, motivations for use and co-occurring health behaviors and disorders need to be determined. This study investigated vaping characteristics and associated health behaviors in a young adult Appalachian college population.

METHODS

Students attending an Appalachian university were invited to participate in an online survey measuring their use of e-cigarettes, motivations for use, mental health, and Adverse Childhood Experiences (ACEs). Analysis included prevalence of e-cigarette use and associations between e-cigarette use and Appalachian identity, mental health, and ACEs.

RESULTS

Participants (N = 3398) stated that the most common motivator for using e-cigarettes was to decrease stress, followed by the good taste, friends' usage, and wanting to quit cigarettes. E-cigarette use was associated with alcohol use, anxiety, depression, stress, and Adverse Childhood Experiences (ACEs) and these variables were placed into a full logistic regression model, in which anxiety and stress were no longer significant, and alcohol use was the strongest association (OR 1.36 95% CI 1.35-1.42, p<.0001).Conclusions/importance: Findings demonstrate a need for efforts to reduce e-cigarette use to focus on the co-use of alcohol, co-occurring mental health disorders, and the social and enjoyment motivations for use.

Electronic cigarette use is negatively associated with body mass index: An observational study of electronic medical records

Objective

Vaping is advertised as a method to mitigate weight gain after smoking cessation; however, while there is an established inverse association between conventional tobacco use and body mass index (BMI), there is little research on the relationship between e‐cigarettes and BMI. This research tested whether e‐cigarette use was associated with BMI.

Methods

A secondary data analysis of 207,117 electronic medical records from the UAB was conducted. Patient data from 1 September 2017 through 1 June 2018 were extracted. To be included in the analysis, a patient's record had to include measures of e‐cigarette use and key sociodemographic information. Ordinary least squares regression was used to test the association between e‐cigarette use and BMI, controlling for covariates; unconditional quantile regression was used to determine whether the association varied by BMI quantile. For comparison with tobacco smoking, the association between current tobacco smoking and BMI was estimated in a sample from the same population.

Results

Respondents in the sample had an average BMI of 30.8 and average age of 50.0 years when BMI was measured. The sample was 51% female, 49.7% white, 46.7% black, and 1.0% Hispanic; 16.4% of the sample had less than a college education and approximately 5% reported currently using e‐cigarettes. Individuals who reported using e‐cigarettes had, on average, a lower BMI compared to those who did not report currently using e‐cigarettes; results indicated that this association did not significantly vary by BMI quantile. Individuals who reported being current smokers had a lower BMI, on average.

Conclusion

These findings suggest that using e‐cigarettes is associated with a lower BMI in a population of individuals seeking health care, consistent with the association between conventional tobacco use and BMI. This study is a springboard for future research investigating the associations between e‐cigarette use, BMI, and risk of obesity in the general population.

Electronic Cigarette Use Among Youth: Understanding Unique Risks in a Vulnerable Population

PURPOSE OF REVIEW

This review discusses prevalence rates of electronic (e-)cigarette use among youth and factors that likely contribute to their growing popularity among this population. Trends shaping the e-cigarette landscape, the appeal of e-cigarettes among youth, perceptions contributing to the initiation of e-cigarettes, available assessments capturing the usage of and attitudes towards e-cigarettes, and e-cigarette policies and regulations are reviewed.

RECENT FINDINGS

E-cigarette use among this vulnerable group may relate to factors associated with the promotion of social status, individuality, and enjoyment, along with low perceptions of risk and harm. Measures assessing factors unique to e-cigarette use among youth (e.g., individuality) still need to be developed and validated. Effects of existing regulations to limit youth access to e-cigarettes may be limited, and shortcomings of current policy measures are discussed with recommendations.

SUMMARY

The rise of e-cigarette use among youth culminated through a perfect storm of clever marketing targeting youth appeal, innovations in more effective nicotine delivery systems, capitalizing on increased susceptibility of the adolescent brain, and regulatory gaps. Understanding risk and protective factors specific to this vulnerable group, which can be gleaned in part by psychometrically valid assessments, could inform regulatory strategies and prevention programming efforts. Yet, few validated measures exist that assess attitudes, behaviors, and patterns of e-cigarette use that are specific to youth. Ultimately, it is incumbent upon policymakers to create comprehensive regulations that prioritize harm reduction and can evolve in lockstep with the constantly changing e-cigarette product landscape.