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Ahuja NA, Kedia SK, Regmi S, Dillon PJ. Disparities in E-Cigarette Harm and Addiction Perceptions Among Adolescents in the United States: a Systematic Review of the Literature. J Racial Ethn Health Disparities 2024; 11:696-709. [PMID: 36877379 DOI: 10.1007/s40615-023-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Health disparities associated with e-cigarette use are increasingly apparent among US adolescents. Perceptions of e-cigarette harm and addiction play an important role in understanding adolescents' e-cigarette use behavior. The objective of this systematic review is to examine racial/ethnic and socio-economic disparities in e-cigarette harm and addiction perceptions among US adolescents. METHODS We searched five databases to identify cross-sectional or longitudinal studies that focused on adolescents (≤ 18 years of age) who were ever, current, or never e-cigarettes users; we then examined how race/ethnicity and/or socio-economic status (SES) impacted e-cigarette harm and/or addiction perceptions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. RESULTS Adhering to PRISMA guidelines, eight of 226 identified studies met the inclusion criteria. These eight studies examined either perceptions regarding absolute e-cigarette harm and/or addiction (i.e., assessing perception of only e-cigarette) or relative e-cigarette harm and/or addiction (i.e., comparative perceptions to traditional cigarettes) by race and ethnicity. Two of the eight studies assessed absolute harm and/or addiction perceptions of e-cigarettes by SES. Our results indicate that, compared to all other racial/ethnic groups, relative e-cigarette harm and addiction perceptions were lower among Non-Hispanic White adolescents; however, absolute e-cigarette harm perception was higher among these groups. No clear patterns of racial/ethnic differences in absolute e-cigarette addiction perceptions and SES differences in absolute e-cigarette harm perceptions were reported. CONCLUSION More research is needed to explicitly assess perceptions of e-cigarette harm and addiction among US adolescents by race/ethnicity and SES to develop subgroup appropriate public health messaging.
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Affiliation(s)
- Nikhil A Ahuja
- Department of Public Health, College of Health Professions, Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Sanjaya Regmi
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Duan Z, Romm KF, Wang Y, Huang J, Berg CJ. Exposure to E-Cigarette Advertisements or Reviews and E-Cigarette Use Progression: A Longitudinal Examination of Short-Term and Long-Term Associations among US Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:123. [PMID: 38397614 PMCID: PMC10887947 DOI: 10.3390/ijerph21020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Limited research has investigated the impact of e-cigarette advertising and reviews on the progression of e-cigarette use among young adults in the US. This study utilized five-wave longitudinal data (2018-2020) with 3006 young adults aged 18-34, reporting exposure to e-cigarette advertisements or reviews at Wave 1 (W1) and W3. Generalized estimating equations (GEE) were used to examine the prospective associations between frequent exposure to e-cigarette advertisements or reviews and e-cigarette use progression in four groups: never users (n = 1271 at W1), former users (previously used but quit ≥ 6 months ago, n = 422 at W1), recent former users (used in the past 6 months but not in the past month, n = 186 at W1), and current users (used in the past month, n = 1127 at W1). Among baseline former users, frequent exposure to e-cigarette reviews was associated with current use at 6-month follow-up (aOR = 4.40, 95%CI = 1.46-13.29). Among baseline current users, frequent exposure to e-cigarette reviews was associated with increased days of use at 6-month follow-up (IRR = 1.20, 95%CI = 1.07-1.34) and 12-month follow-up (IRR = 1.18, 95%CI = 1.03-1.35). E-cigarette reviews may contribute to relapse among recent former users and increased usage frequency among current users, highlighting the need for enhanced e-cigarette promotional activity regulation.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Katelyn F. Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA;
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (Y.W.); (C.J.B.)
| | - Jidong Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA;
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (Y.W.); (C.J.B.)
- George Washington Cancer Center, George Washington University, Washington, DC 20052, USA
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Bares CB, Sharma V, Lopez-Quintero C. Socio-demographic Correlates of Electronic Cigarette and Cannabis Co-use Among Naïve and Tobacco Adolescent Users. JOURNAL OF PREVENTION (2022) 2023; 44:457-475. [PMID: 37038010 PMCID: PMC11101152 DOI: 10.1007/s10935-023-00729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Abstract
The increasing co-use of e-cigarette and cannabis among youth has become a public health challenge. The present analyses aimed to identify prevalence and correlates of past-month co-use of e-cigarettes and cannabis among adolescents with and without prior tobacco use. For this panel study, 5 years of cross-sectional data (2014-2018) were used from 8th, 10th-, and 12th-grade adolescents in the Monitoring the Future study, a nationally representative survey of U.S. students. We examined prevalence and correlates of e-cigarettes and cannabis co-use among adolescents who had ever used tobacco (n = 15,136) and among those who had never used tobacco (n = 56,525). Adolescents who had ever used tobacco showed significantly higher rates of e-cigarettes and cannabis co-use compared to adolescents who had never used tobacco (17.1% vs. 2.2%, p < 0.01). Results from adjusted multinomial regression models showed that overall, Black and Hispanic adolescents tobacco users were less likely than Whites to co-use e-cigarettes and cannabis. Black adolescents who had used tobacco previously were more likely than Whites to have used cannabis exclusively. Black and Hispanic tobacco-naïve adolescents were more likely than Whites to have used cannabis exclusively, while Black tobacco-naïve adolescents were less likely to use e-cigarettes exclusively or co-use e-cigarettes and cannabis. Overall, males and twelve graders were more likely than males and eight graders to use or co-use cannabis or e-cigarettes, respectively. Among lifetime tobacco users, higher levels of parental education were associated with co-use of cannabis and e-cigarettes. Racial/ethnic-specific patterns of e-cigarette and cannabis co-use depends on adolescents' prior experience with tobacco. The higher rates of use and co-use of e-cigarettes and cannabis among prior tobacco users suggest that targeted interventions are needed for this group. Identified socio-demographic groups at higher risk of co-use of e-cigarettes and cannabis need to be further studied.
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Affiliation(s)
- Cristina B Bares
- School of Social Work, University of Michigan, 1080 South University, Ann Arbor, MI, 48109, USA.
| | - Vinita Sharma
- School of Public and Population Health, Boise State University, Boise, ID, 83725, USA
| | - Catalina Lopez-Quintero
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
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Ogwa OA, Abiola AO, Kanma-Okafor OJ, Olufunlayo TF, Shopeyin-Dosunmu AO, Akodu BA, Ogwa OD. Electronic cigarettes use in COVID-19 era among students of a tertiary institution in Nigeria. Afr J Prim Health Care Fam Med 2023; 15:e1-e10. [PMID: 36744451 PMCID: PMC9900243 DOI: 10.4102/phcfm.v15i1.3704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use is becoming popular among undergraduate students in Nigeria with a tendency for escalation because of the coronavirus disease 2019 (COVID-19) pandemic. AIM The aim of this study was to assess electronic cigarette use in COVID-19 era among undergraduate students of a tertiary institution in Lagos state, Southwestern Nigeria. SETTING A tertiary institution in Southwestern Nigeria. METHODS The study design was a descriptive cross-sectional study with a pretested, structured, close- and open-ended self-administered questionnaire used for collection of data on knowledge, attitude and use of e-cigarettes. RESULTS Data from 183 respondents were analysed. The mean age of respondents was 24.8 ± 3.38 years, most (63%) of whom were males. The prevalence of ever-use of e-cigarettes was 15.3% of which 60.7% reported increased use of e-cigarettes since the COVID-19 pandemic. Age, education, tribe and religion (p 0.001) were significantly associated with higher odds of use of e-cigarettes. CONCLUSION This study found an increase in the quantity of e-cigarettes used and online purchase of the same by respondents since the COVID-19 pandemic. Paying attention to the rate of use and having control measures in place for online purchase of e-cigarettes by youths in Nigeria may be necessary in the years to come.Contribution: This study addresses a gap in the availability of knowledge of use of e-cigarettes among a growing population of youths in Nigeria.
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Affiliation(s)
- Oluwafunmike A. Ogwa
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria,Department of Medical Services, Doctorkk Health International Ltd, Lagos, Nigeria
| | - Abdulhakeem O. Abiola
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria,Department of Community Health, Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria
| | - Oluchi J. Kanma-Okafor
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
| | - Tolulope F. Olufunlayo
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria,Department of Community Health, Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria
| | | | - Babatunde A. Akodu
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
| | - Omonigho D. Ogwa
- Department of Medical Services, Doctorkk Health International Ltd, Lagos, Nigeria
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Selamoglu M, Erbas B, Kasiviswanathan K, Barton C. General practitioners' knowledge, attitudes, beliefs and practices surrounding the prescription of e-cigarettes for smoking cessation: a mixed-methods systematic review. BMC Public Health 2022; 22:2415. [PMID: 36550439 PMCID: PMC9784030 DOI: 10.1186/s12889-022-14696-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND General practitioners (GPs) play an important role in providing patients who smoke with health information, support and treatment to encourage them to quit smoking. Despite conflicting evidence on the effectiveness of electronic cigarettes (e-cigarettes) as a smoking cessation aid, there is growing interest in the role e-cigarettes might play as an alternative to smoking tobacco. This systematic review aims to synthesise evidence from qualitative, quantitative and mixed-methods studies of the knowledge, attitudes, beliefs and social norms of GPs with respect to the use of e-cigarettes as smoking cessation aids. METHODS This study adhered to the PRISMA guidelines. Studies from MEDLINE, CINAHL, SCOPUS, PsycINFO, EMBASE and grey literature were searched. Two independent reviewers screened abstracts and full-text articles to identify studies that met the inclusion criteria. A data extraction form was used to extract relevant data from included papers and were quality appraised using the MMAT checklist. A PRISMA flow diagram was used to record the flow of papers and reasons for exclusion. Studies were included if they collected quantitative, qualitative or mixed methods data to determine knowledge, attitudes, beliefs and social norms of GPs for use of e-cigarettes as smoking cessation aids. RESULTS A total of 4056 abstracts were screened and 25 articles were included. Our findings showed that GPs had mixed views on recommending e-cigarettes as a smoking cessation aid. Some GPs were optimistic and had recommended e-cigarettes to their patients. Others were reluctant and disagreed that e-cigarettes are an effective method to quit smoking. Most GPs lacked knowledge and confidence in having discussions with patients around e-cigarette safety and efficacy as smoking cessation alternatives. CONCLUSION This systematic review shows there are mixed views on e-cigarettes as smoking cessation aids. Clear guidance on the role of e-cigarettes is needed to inform and upskill GPs about e-cigarettes for smoking cessation. PROSPERO REGISTRATION CRD42021227612.
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Affiliation(s)
- Melis Selamoglu
- grid.1002.30000 0004 1936 7857Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia ,Level 5, 553 St Kilda Road, Prahan, VIC 3181 Australia
| | - Bircan Erbas
- grid.1018.80000 0001 2342 0938Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Karthika Kasiviswanathan
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Chris Barton
- grid.1002.30000 0004 1936 7857Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ogwa OA, Abiola AO, Kanma-Okafor OJ, Olufunlayo TF, Shopeyin-Dosunmu AO, Akodu BA, Ogwa OD. Electronic cigarettes use in COVID-19 era among students of a tertiary institution in Nigeria. Afr J Prim Health Care Fam Med 2022. [DOI: 10.4102/phcfm.v14i1.3704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Vaihekoski A, Lagström H, Eloranta S, Bäärs S, Hannula A, Lehvikkö M, Salakari M. Influencing adolescents’ attitudes towards nicotine products: A systematic review. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:568-584. [PMID: 36284743 PMCID: PMC9549219 DOI: 10.1177/14550725221096908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background and aim: Use of nicotine can harm adolescents’ brains and
increase risk for future addiction to other drugs. Several international studies
show that an acceptable attitude towards nicotine products increases the
initiation or use of the products. Adolescents have limited or distorted
knowledge about nicotine products. Many of them have a positive image of the
properties and effects of nicotine products, which increases the chances of
smoking or using snus. Yet, we know little about the relationship between youth
nicotine use, youth attitudes towards nicotine products and the interventions to
influence these attitudes. This systematic review synthesised adolescents’
attitudes towards nicotine products and the ways to influence them.
Methods: Systematic searches were carried out from PubMed,
MEDLINE, CINAHL, and MEDIC databases and were targeted to randomised controlled
trial (RCT) studies published in 2010–2021. Results: A total of
seven RCT studies were reviewed with a total population (age range 9–17 years,
adolescents 11–17 years) of 15,974. Findings were classified into four
categories: school-based interventions, tobacco prevention campaigns,
advertisements’ influence on adolescents’ opinions towards nicotine products,
and their responses to cigarette pack warnings. Conclusion: Based
on this systematic literature review, particularly school-based interventions
have an effect on adolescents’ attitudes towards smoking and preventing them
from starting to smoke, when they are targeted before the age of puberty.
School-based interventions should be further implemented and strengthened, as
the school has been shown to have significant potential to support youth’s
health. There is a need for further information about the most effective
interventions in the different age groups and the qualitative studies on the
topic.
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Affiliation(s)
| | - Hanna Lagström
- University of Turku, Turku, Finland; and Turku University Hospital, Turku, Finland
| | - Sini Eloranta
- University of Turku, Turku, Finland; University of Oulu, Oulu, Finland; and Turku University of Applied Science, Turku, Finland
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PALMES MADONNA, TRAJERA SHEILLAM, SAJNANI ANANDK. Knowledge and attitude related to use of electronic cigarettes among undergraduate nursing students in an urban university setting in Philippines. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E770-E775. [PMID: 34909507 PMCID: PMC8639113 DOI: 10.15167/2421-4248/jpmh2021.62.3.1709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 06/23/2021] [Indexed: 11/07/2022]
Abstract
Background Electronic cigarette (e-cigarette) use has risen dramatically since its introduction in 2004. Nurses play a critical role in screening, disease prevention and smoking cessation for their patient. Their knowledge and attitude related to e-cigarettes will play a major part in development of tobacco control activities. Aim Thus, this study was conducted to determine the knowledge and attitude toward e-cigarettes among undergraduate nursing students in the Philippines. Methods The participants of the study were 122 level four nursing students of West Visayas State University, Iloilo city, Philippines. A standardized self-administered questionnaire was used to collect the data and statistical analyses were performed. Results Majority of the participants were female, were never smokers and were aware or conscious of the existence of the e-cigarettes but had poor knowledge on e-cigarettes. Furthermore, in terms of attitude the students as an entire group had a positive attitude opposing e-cigarette use. Never and former smokers had positive attitude opposing e-cigarette use while current smokers had negative attitude supporting e-cigarette use. There was no significant relationship between knowledge and attitude of nursing students towards e-cigarettes. Conclusion Nursing students did not have adequate knowledge regarding e-cigarettes but maintained a positive attitude opposing e-cigarette use. Poor knowledge did not influence the attitude of participants towards e-cigarettes.
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Affiliation(s)
- MADONNA PALMES
- College of Nursing, West Visayas State University, Iloilo City, Philippines
| | - SHEILLA M. TRAJERA
- College of Nursing, University of St. La Salle, Bacolod City, Philippines
| | - ANAND K. SAJNANI
- Department of Pediatric Dentistry KIMS Qatar Medical Centre, Wakra, Qatar
- Correspondence: Anand K. Sajnani, KIMS Qatar Medical Centre, Abdulrahman Bin Jassim Al Thani Street, 82125 Wakra, Qatar - Tel.: +974-30181952 - E-mail:
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Examining potential risk factors for early age of nicotine vaping initiation in a sample of Florida youth. Addict Behav 2021; 120:106962. [PMID: 33964584 DOI: 10.1016/j.addbeh.2021.106962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022]
Abstract
Previous research has examined risk factors for nicotine vaping in young adults and older adolescents. Even so, significantly less research has examined risk factors for initiating nicotine vaping in early adolescence. This paper addresses this gap in the literature by examining risk factors for initiating nicotine vaping in a sample of middle- and high-school students. In order to do so, we analyze data from the 2019 cohort of the Florida Youth Substance Abuse Survey (FYSAS). We employ multinomial logistic regression and logistic regression to examine potential risk factors for early age of nicotine vaping initiation. Our findings reveal that early age of nicotine vaping initiation is associated with cigarette use, alcohol use, having substance using peers, lifetime incidence of arrest, and lifetime incidence of school suspension. In conclusion, our findings reveal that early age of nicotine vaping initiation is associated with other forms of risky behavior in adolescence (i.e., substance use, misbehavior leading to arrest and/or school suspension). We discuss the implications of these findings for future research.
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Mahajan SD, Homish GG, Quisenberry A. Multifactorial Etiology of Adolescent Nicotine Addiction: A Review of the Neurobiology of Nicotine Addiction and Its Implications for Smoking Cessation Pharmacotherapy. Front Public Health 2021; 9:664748. [PMID: 34291026 PMCID: PMC8287334 DOI: 10.3389/fpubh.2021.664748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Nicotine is the primary pharmacologic component of tobacco, and its highly addictive nature is responsible for its widespread use and significant withdrawal effects that result in challenges to smoking cessation therapeutics. Nicotine addiction often begins in adolescence and this is at least partially attributed to the fact that adolescent brain is most susceptible to the neuro-inflammatory effects of nicotine. There is increasing evidence for the involvement of microglial cells, which are the brain's primary homeostatic sensor, in drug dependence and its associated behavioral manifestations particularly in the adolescent brain. A hallmark of neuro-inflammation is microglial activation and activation of microglia by nicotine during adolescent development, which may result in long-term addiction to nicotine. This non-systematic review examines multifactorial etiology of adolescent nicotine addiction, neurobiology of nicotine addiction and the potential mechanisms that underlie the effects of nicotine on inflammatory signaling in the microglia, understanding how nicotine affects the adolescent brain. We speculate, that modulating homeostatic balance in microglia, could have promising therapeutic potential in withdrawal, tolerance, and abstinence-related neural adaptations in nicotine addiction, in the adolescent brain. Further, we discuss nicotine addiction in the context of the sensitization-homeostasis model which provides a theoretical framework for addressing the potential role of microglial homeostasis in neural adaptations underlying nicotine abuse.
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Affiliation(s)
- Supriya D. Mahajan
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, United States
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, United States
| | - Amanda Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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Lazard AJ, Nicolla S, Darida A, Hall MG. Negative Perceptions of Young People Using E-cigarettes on Instagram: An Experiment with Adolescents. Nicotine Tob Res 2021; 23:1962-1966. [PMID: 33990843 DOI: 10.1093/ntr/ntab099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/10/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although e-cigarette marketing on social media increases positive attitudes and experimentation, little is known about non-influencer e-cigarette portrayals of young people. METHODS High school adolescents (n=928, 15-18) were recruited by Lightspeed Health for an online experiment and randomized to view an Instagram post with or without e-cigarette use. Outcomes were positive and negative perceptions (prototypes), social distance, and willingness to use. RESULTS Half (50%) of participants were susceptible to e-cigarette use. E-cigarettes shown (vs. not) led to less positive prototypes, p=.017, more negative prototypes, p=.004, and more social distance, p<.001. Negative prototypes and social distance were moderated by susceptibility (both p<.05); effects among non-susceptible adolescents only. Showing e-cigarettes did not impact willingness to use if offered. DISCUSSION Negative perceptions of e-cigarettes use challenge assumptions that vaping online is universally admirable. Highlighting unfavorable opinions of vaping or negative impacts for adolescents' social image are potential strategies for tobacco counter-marketing. IMPLICATIONS Despite daily use of visual-based social media by most adolescents, little is known about the influence of e-cigarette use among young people online. Adolescent negative perceptions and desired distance from non-influencers using e-cigarettes on Instagram indicate digital e-cigarette portrayals are not universally accepted. Negative impacts for adolescents' social image present a counter-marketing strategy.
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Affiliation(s)
- Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Sydney Nicolla
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill
| | - Avery Darida
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill
| | - Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill.,Carolina Population Center, University of North Carolina at Chapel Hill
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12
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Duan Z, Wang Y, Emery SL, Chaloupka FJ, Kim Y, Huang J. Exposure to e-cigarette TV advertisements among U.S. youth and adults, 2013-2019. PLoS One 2021; 16:e0251203. [PMID: 33961669 PMCID: PMC8104405 DOI: 10.1371/journal.pone.0251203] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/21/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION E-cigarette advertising has been shown to increase e-cigarette awareness and use. Although e-cigarette marketing in the early 2010s has been well-documented, little is known about how it has changed in recent years in response to the regulatory scrutiny from the FDA and the Congress to combat youth vaping epidemic. This study aims to examine the exposure to e-cigarette TV advertising among youth and adults in the U.S. from 2013 to 2019, overall and by media market and brand. METHODS Quarterly data on e-cigarette TV advertising exposure, measured by target rating points (TRPs), and expenditures from 2013 to 2019 were compiled from the StradegyTM of Kantar Media. Trends of quarterly e-cigarette advertising TRPs were reported by age group, market, and brand. RESULTS Over the study period, overall exposure to e-cigarette TV advertising was higher among adults than among youth. E-cigarette advertising TRPs and expenditures were relatively stable, despite intermittent fluctuations, between 2013 Q1 and 2017 Q1 except for a one-time dip in 2015 Q3, followed by a sharp decline in 2017 Q2 and stayed low till the end of 2018. A resurgence of e-cigarette advertising TRPs occurred in 2019 Q1, led by the advertising from JUUL, Blu, and Vuse, which peaked in the third quarter of 2019, with quarterly TRPs reaching 316.8 for youth and 1,701.9 for adults, and quarterly advertising expenditure totaling $31 million. CONCLUSIONS Significant variations, both over time and across media markets and brands, were observed for e-cigarette televised advertising between 2013 and 2019. Following a lull in TV advertising in 2017/18, major e-cigarette companies have substantially increased advertising of their products on American television since early 2019, resulting in a surge in exposure to e-cigarette advertising among both youth and adults. Our findings highlighted the importance of continued monitoring of e-cigarette advertising in the U.S.
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Affiliation(s)
- Zongshuan Duan
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Yu Wang
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Sherry L. Emery
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Frank J. Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Yoonsang Kim
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
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Amin S, Dunn AG, Laranjo L. Why do people start or stop using e-cigarettes in Australia? A qualitative interview-based study. Health Promot J Austr 2020; 32 Suppl 2:358-366. [PMID: 33251638 DOI: 10.1002/hpja.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED E-cigarette awareness and use has increased globally, but little is known about the social factors that influence uptake in Australia. We explored the reasons why people started, continued and stopped using e-cigarettes in Australia. METHODS This was a qualitative study comprising 14 semi-structured interviews with past and current e-cigarette users in Australia. Interview transcripts were analysed thematically to explore reasons why people started, continued or stopped using e-cigarettes. RESULTS The following three themes emerged from interviews: "social" reasons, including issues of peer influence and social norms; "health" reasons, with aspects related to the reduction in use of cigarettes and health effects of using e-cigarettes; and "access and other personal" reasons, including the cost of e-cigarettes, the ability to access e-cigarettes and participants' experiences with e-cigarettes. CONCLUSIONS The study revealed that social norms and peer influence were reasons why people started and stopped using e-cigarettes. Smokers often cited health reasons for starting, while non-smokers cited social reasons for both starting and stopping. SO WHAT?: The social and non-social reasons for why people say they start or stop using e-cigarettes appear to vary between smokers and non-smokers. Future studies may benefit from measuring these factors, differentiating between smokers and non-smokers, and considering these factors as part of interventions for limiting e-cigarette uptake among non-smokers.
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Affiliation(s)
- Samia Amin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Adam G Dunn
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Corona R, Dvorsky MR, Romo S, Parks AM, Bourchtein E, Smith ZR, Avila M, Langberg J. Integrating Tobacco Prevention Skills into an Evidence-Based Intervention for Adolescents with ADHD: Results from a Pilot Efficacy Randomized Controlled Trial. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1439-1453. [PMID: 32778992 PMCID: PMC7565255 DOI: 10.1007/s10802-020-00689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for tobacco use, but tobacco use prevention strategies are not regularly incorporated into evidence-based ADHD interventions. We conducted a pilot randomized-controlled trial to determine the feasibility of integrating tobacco use prevention skills into a behavioral treatment for ADHD and to provide preliminary efficacy data comparing a combined (ADHD + tobacco) intervention (N = 40) to an ADHD only intervention (N = 23) on tobacco risk outcomes. Sixty-three adolescents (72% male; 13-17 years) with ADHD and their caregivers were randomly assigned to condition and families were masked to condition. Parent and adolescent ratings were collected at baseline, immediate post-intervention, and at 3- and 9-month follow-up assessments. The combined intervention was (1) implemented with high fidelity (94%), (2) well received by parents and adolescents as evidenced by high levels of treatment attendance (82%) and satisfaction with the intervention, and (3) associated with parent- and adolescent-reported reductions in tobacco use risk. Relative to the ADHD intervention, the combined intervention buffered against increases in tobacco risk, including reduced intentions to smoke and maladaptive social normative beliefs, and increased parental control, family cohesion, and family communication about substance use. Effect sizes at post-treatment were in the small to moderate range. Overall, this study provides preliminary support for a parent-adolescent behavioral treatment supplemented with family-based tobacco prevention strategies. This approach targets families already in treatment for ADHD, reducing barriers that occur when families attend multi-session prevention programs in addition to ADHD treatment.
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Affiliation(s)
- Rosalie Corona
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA.
| | - Melissa R Dvorsky
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Stephanie Romo
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Amanda M Parks
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Elizaveta Bourchtein
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Zoe R Smith
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Melissa Avila
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Joshua Langberg
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
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15
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Confirmatory factor analysis comparing incentivized experiments with self-report methods to elicit adolescent smoking and vaping social norms. Sci Rep 2020; 10:15818. [PMID: 32978471 PMCID: PMC7519107 DOI: 10.1038/s41598-020-72784-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
Many adolescent smoking prevention programmes target social norms, typically evaluated with self-report, susceptible to social desirability bias. An alternative approach with little application in public health are experimental norms elicitation methods. Using the Mechanisms of Networks and Norms Influence on Smoking in Schools (MECHANISMS) study baseline data, from 12–13 year old school pupils (n = 1656) in Northern Ireland and Bogotá (Colombia), we compare two methods of measuring injunctive and descriptive smoking and vaping norms: (1) incentivized experiments, using monetary payments to elicit norms; (2) self-report scales. Confirmatory factor analysis (CFA) examined whether the methods measured the same construct. Paths from exposures (country, sex, personality) to social norms, and associations of norms with (self-reported and objectively measured) smoking behavior/intentions were inspected in another structural model. Second-order CFA showed that latent variables representing experimental and survey norms measurements were measuring the same underlying construct of anti-smoking/vaping norms (Comparative Fit Index = 0.958, Tucker Lewis Index = 0.951, Root Mean Square Error of Approximation = 0.030, Standardized Root Mean Square Residual = 0.034). Adding covariates into a structural model showed significant paths from country to norms (second-order anti-smoking/vaping norms latent variable: standardized factor loading [β] = 0.30, standard error [SE] = 0.09, p < 0.001), and associations of norms with self-reported anti-smoking behavior (β = 0.40, SE = 0.04, p < 0.001), self-reported anti-smoking intentions (β = 0.42, SE = 0.06, p < 0.001), and objectively measured smoking behavior (β = − 0.20, SE = 0.06, p = 0.001). This paper offers evidence for the construct validity of behavioral economic methods of eliciting adolescent smoking and vaping norms. These methods seem to index the same underlying phenomena as commonly-used self-report scales.
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16
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Scheier LM, Komarc M. Are E-cigarette Users a Unique Group of Smokers? Latent Class Analysis of the National Youth Tobacco Survey. JOURNAL OF DRUG EDUCATION 2020; 49:87-114. [PMID: 33307768 DOI: 10.1177/0047237920980483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We used data from the 2014 National Youth Tobacco Survey to examine patterns of cigarette smoking behavior and tobacco use. In light of the recent upsurge in e-cigarette use, we modeled current use and future intentions to use vape products along with combustible cigarette smoking and other tobacco products (i.e., cigars, cigarillos, chew, snuff, and dip). Latent class analyses indicated four discrete classes of smokers including a nominally involved class with very modest levels of tobacco product use, a class blending e-cigarette and cigars, a class of youth who predominantly use combustible cigarettes, and a group reporting indiscriminate use of almost all tobacco products excluding chew. Tests of invariance in item response probabilities and latent class proportions showed little variation across race and gender, albeit a new class of combustible cigarette and e-cigarette users emerged when examined by grade. Members of the heavy smoking and tobacco use class were more likely to be male, White, and older. Predictors of class membership included expectancies (perceived benefits of use), perceived harm (risk), media exposure, tobacco dependence, and the desire to quit. Findings are discussed in terms of characterizing risk among already smoking youth and how actionable prevention measures can be incorporated into existing universal and indicated programs that target reducing tobacco use and smoking behaviors.
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Affiliation(s)
| | - Martin Komarc
- Department of Kinanthropology and Humanities, Faculty of Physical Education and Sport, Charles University in Prague, Prague, Czech Republic
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17
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Butler EN, Hall MG, Chen MS, Pepper JK, Blanton H, Brewer NT. The Prototypes of Tobacco Users Scale (POTUS) for Cigarette Smoking and E-Cigarette Use: Development and Validation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6081. [PMID: 32825565 PMCID: PMC7503746 DOI: 10.3390/ijerph17176081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
Endorsing prototypes of cigarette smokers predicts cigarette smoking, but less is known about prototypes of users of other tobacco products. Our study sought to establish the reliability and validity of a measure of prototypes of smokers and e-cigarette users. Participants were from a national survey of smokers and non-smokers (n = 1414), a randomized clinical trial (RCT) of adult smokers (n = 2149), and adolescent children of adults in the trial (n = 112). The Prototypes of Tobacco Users Scale (POTUS) has four positive adjectives (cool, sexy, smart, and healthy) and four negative adjectives (disgusting, unattractive, immature, and inconsiderate) describing cigarette smokers and e-cigarette users. Confirmatory factor analyses identified a two-factor solution. The POTUS demonstrated strong internal consistency reliability in all three samples (median α = 0.85) and good test-retest reliability among adults in the RCT (median r = 0.61, 1-4 weeks follow-up). In the RCT, smokers more often agreed with negative prototypes for smokers than for e-cigarette users (mean = 2.03 vs. 1.67, p < 0.05); negative prototypes at baseline were also associated with more forgoing of cigarettes and making a quit attempt at the end of the trial (Week 4 follow-up). The POTUS may be useful to public health researchers seeking to design interventions that reduce tobacco initiation or cessation through the manipulation of tobacco user prototypes.
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Affiliation(s)
- Eboneé N. Butler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA;
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (M.G.H.); (M.S.C.)
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - May S. Chen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (M.G.H.); (M.S.C.)
| | | | - Hart Blanton
- Department of Communication, Texas A&M University, College Station, TX 77843, USA;
| | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (M.G.H.); (M.S.C.)
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
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18
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Exploring Associations between Susceptibility to the Use of Electronic Nicotine Delivery Systems and E-Cigarette Use among School-Going Adolescents in Rural Appalachia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145133. [PMID: 32708622 PMCID: PMC7399914 DOI: 10.3390/ijerph17145133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/06/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
Electronic nicotine delivery systems (ENDS) use, including e-cigarettes, has surpassed the use of conventional tobacco products. Emerging research suggests that susceptibility to e-cigarette use is associated with actual use among adolescents. However, few studies exist involving adolescents in high-risk, rural, socioeconomically distressed environments. This study examines susceptibility to and subsequent usage in school-going adolescents in a rural distressed county in Appalachian Tennessee using data from an online survey (N = 399). Relying on bivariate analyses and logistic regression, this study finds that while 30.6% of adolescents are ever e-cigarette users, 15.5% are current users. Approximately one in three adolescents are susceptible to e-cigarettes use, and susceptibility is associated with lower odds of being a current e-cigarette user (OR = 0.03; CI: 0.01–0.12; p < 0.00). The age of tobacco use initiation was significantly associated with decreased current use of e-cigarettes (OR = 0.89; CI: 0.83–0.0.97; p < 0.01). Overall, the results of this exploratory study suggest the need for larger studies to identify unique and generalizable factors that predispose adolescents in this high-risk rural, socioeconomically disadvantaged region to ENDS use. Nevertheless, this study offers insight into e-cigarette usage among U.S adolescents in rural, socioeconomically disadvantaged environments and provides a foundation for a closer examination of this vulnerable population.
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Patten T, De Biasi M. History repeats itself: Role of characterizing flavors on nicotine use and abuse. Neuropharmacology 2020; 177:108162. [PMID: 32497589 DOI: 10.1016/j.neuropharm.2020.108162] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
The popularity of e-cigarettes has skyrocketed in recent years, and most vapers use flavored e-cigarette products. Consumption of flavored e-cigarettes exceeds that of combustible cigarettes and other tobacco products among adolescents, who are particularly vulnerable to becoming nicotine dependent. Flavorings have been used by the tobacco industry since the 17th century, but the use of flavors by the e-cigarette industry to create products with "characterizing" flavors (i.e. flavors other than tobacco or menthol) has sparked a public health debate. This review addresses the possibility that characterizing flavors make nicotine more appealing, rewarding and addictive. It also discusses ways in which preclinical and clinical studies could improve our understanding of the mechanisms by which flavors may alter nicotine reward and reinforcement. This article is part of the special issue on 'Contemporary Advances in Nicotine Neuropharmacology'.
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Affiliation(s)
- Theresa Patten
- Pharmacology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Mariella De Biasi
- Pharmacology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
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20
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Dunbar MS, Martino SC, Setodji CM, Shadel WG. Exposure to the Tobacco Power Wall Increases Adolescents' Willingness to Use E-cigarettes in the Future. Nicotine Tob Res 2020; 21:1429-1433. [PMID: 29868869 DOI: 10.1093/ntr/nty112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Adolescents' e-cigarette use is now more prevalent than their combustible cigarette use. Youth are exposed to e-cigarette advertising at retail point-of-sale (POS) locations via the tobacco power wall (TPW), but no studies have assessed whether exposure to the TPW influences susceptibility to future e-cigarette use. METHODS The study was conducted in the RAND Store Lab (RSL), a life-sized replica of a convenience store developed to experimentally evaluate how POS advertising influences tobacco use risk under simulated shopping conditions. In a between-subjects experiment, 160 adolescents (M age = 13.82; 53% female, 56% white) were randomized to shop in the RSL under one of two conditions: (1) TPW located behind the cashier (n = 80); or (2) TPW hidden behind an opaque wall (n = 80). Youths rated willingness to use e-cigarettes ("If one of your best friends were to offer you an e-cigarette, would you try it?"; 1 = definitely not, 10 = definitely yes) before and after exposure. Linear regression assessed differences in pre-post changes in willingness to use across conditions. RESULTS Ever-use of e-cigarettes was 5%; use of cigarettes was 8%; use of both e-cigarettes and cigarettes was 4%. There were no differences between TPW conditions on these or other baseline variables (eg, age, gender). Compared to the hidden condition, TPW exposure was associated with greater increases in willingness to use e-cigarettes in the future (B = 1.15, standard error [SE] = 0.50, p = .02). CONCLUSIONS Efforts to regulate visibility of the TPW at POS may help to reduce youths' susceptibility to initiating e-cigarettes as well as conventional tobacco products like cigarettes. IMPLICATIONS Past work suggests that exposure to the TPW in common retail settings, like convenience stores, may increase adolescents' susceptibility to smoking cigarettes. This experimental study builds upon prior research to show that exposure to the TPW at retail POS similarly increases adolescents' willingness to use e-cigarettes in the future. Efforts to regulate the visibility of the TPW in retail settings may help to reduce youths' susceptibility to initiating nicotine and tobacco products, including e-cigarettes.
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21
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Al-Nimr YM, Farhat G, Alwadey A. Factors Affecting Smoking Initiation and Cessation Among Saudi Women Attending Smoking Cessation Clinics. Sultan Qaboos Univ Med J 2020; 20:e95-e99. [PMID: 32190376 PMCID: PMC7065701 DOI: 10.18295/squmj.2020.20.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 01/28/2019] [Accepted: 07/24/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives Smoking is one of the most adaptable risk behaviours associated with increased mortality rates, yet over one billion individuals worldwide are smokers. This study aimed to examine self-reported reasons for starting and quitting smoking among women attending smoking cessation clinics in Saudi Arabia. Methods This cross-sectional study took place between January 2014 and January 2017 in Saudi Arabia using previously collected data. A survey was distributed to 3,000 female smokers attending smoking cessation programmes in 18 clinics from different regions in Saudi Arabia to determine self-reported reasons for smoking initiation and willingness/unwillingness to quit. Results A total of 2,190 women participated in the study (response rate = 73%). Overall, the most common reason for starting to smoke was friends (31.1%), while the predominant reason for willingness to quit was health concerns (45.5%). The most frequent reason for being unwilling to quit smoking was a fear of mood changes (28%). Conclusion Most Saudi women are socially-driven to start smoking, while the most common reason for quitting is health concerns. The latter finding is promising in that it shows that smokers are gaining awareness of the adverse effects of smoking.
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Affiliation(s)
- Yumn M Al-Nimr
- Department of Public Health, Ministry of Heath, Riyadh, Saudi Arabia
| | - Ghada Farhat
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ali Alwadey
- Tobacco Control Program, Ministry of Health, Riyadh, Saudi Arabia
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22
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Soteriades S, Barbouni A, Rachiotis G, Grevenitou P, Mouchtouri V, Pinaka O, Dadouli K, Hadjichristodoulou C. Prevalence of Electronic Cigarette Use and its Determinants among 13-to-15-Year-Old Students in Greece: Results from the 2013 Global Youth Tobacco Survey (GYTS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1671. [PMID: 32143414 PMCID: PMC7084902 DOI: 10.3390/ijerph17051671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
Abstract
Electronic cigarette use has increased over the past decade. Its potential role in smoking cessation, in addiction and as a 'gateway' to tobacco smoking is subject to intense research. This cross-sectional study, carried out in 2013, aims to present the habits of students aged 13-15 in Greece with regard to e-cigarettes and investigate potential risk factors and the relationship between e-cigarettes, tobacco smoking and other nicotine products. It is the first such study to be carried out in Greece. The survey was based on the standardized methodology of the Global Youth Tobacco Survey. All potential associations were investigated using multiple logistic regression. In total 2.8% of the 4096 participating students were current e-cigarette users and 12.3% of them were ever users. E-cigarette use was associated with male gender, being older, current use of combustible tobacco products and e-cigarette use in the family. Ever e-cigarette use, being older, female gender and higher pocket money were associated with an increased susceptibility to tobacco smoking. E-cigarette prevalence in Greece in 2013 was similar to that of other, developed countries. The smoking and vaping habits of adolescents must be monitored in order to assess trends over time and whether any policy alterations are necessary.
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Affiliation(s)
- Soteris Soteriades
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Anastasia Barbouni
- Department of Public Health, University of West Attica, 196 Alexandras Ave., 11521 Athens, Greece
| | - George Rachiotis
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Panoraia Grevenitou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Varvara Mouchtouri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Ourania Pinaka
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Christos Hadjichristodoulou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
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Pilin MA, Pike J, Xie B, Stacy AW. Working Memory and Response Inhibition Effects on At-Risk Youth's Willingness to Use Multiple Nicotine and Tobacco Products. Subst Use Misuse 2020; 55:1867-1874. [PMID: 32460575 DOI: 10.1080/10826084.2020.1771595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Past research has suggested that executive functions, such as working memory and response inhibition, predict the use of nicotine and tobacco products (NTPs). The current study extends prior research by assessing whether response inhibition and working memory are associated with at-risk youth's willingness to use NTPs. Methods: A sample of 1060 at-risk youth were recruited from alternative high schools in southern California. Participants were randomly assigned to complete the Symmetry Span Task, an indicator of working memory ability, or the cued Go/No-Go task, an indicator of response inhibition. Participants who reported never using NTPs (n = 348) indicated how willing they would be try NTPs. Results: Results from a cross-sectional zero-inflated negative binomial (ZINB) regression suggest that females with stronger working memory skills and individuals with weaker response inhibition skills were more likely to be unwilling to use NTPs. Conclusion: While further research is needed to determine whether executive functions can prospectively predict NTP use among at-risk youth, the current study indicates that both working memory and response inhibition may play a significant role.
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Affiliation(s)
- Maya A Pilin
- Psychology Department, University of British Columbia, Kelowna, British Columbia, Canada
| | - James Pike
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA
| | - Alan W Stacy
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA
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Meernik C, Baker HM, Kowitt SD, Ranney LM, Goldstein AO. Impact of non-menthol flavours in e-cigarettes on perceptions and use: an updated systematic review. BMJ Open 2019; 9:e031598. [PMID: 31619431 PMCID: PMC6797351 DOI: 10.1136/bmjopen-2019-031598] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Given the exponential increase in the use of e-cigarettes among younger age groups and in the growth in research on e-cigarette flavours, we conducted a systematic review examining the impact of non-menthol flavoured e-cigarettes on e-cigarette perceptions and use among youth and adults. DESIGN PubMed, Embase, PyscINFO and CINAHL were systematically searched for studies published and indexed through March 2018. ELIGIBILITY CRITERIA Quantitative observational and experimental studies that assessed the effect of non-menthol flavours in e-cigarettes on perceptions and use behaviours were included. Specific outcome measures assessed are appeal, reasons for use, risk perceptions, susceptibility, intention to try, initiation, preference, current use, quit intentions and cessation. DATA EXTRACTION AND SYNTHESIS Three authors independently extracted data related to the impact of flavours in tobacco products. Data from a previous review were then combined with those from the updated review for final analysis. Results were then grouped and analysed by outcome measure. RESULTS The review included 51 articles for synthesis, including 17 published up to 2016 and an additional 34 published between 2016 and 2018. Results indicate that non-menthol flavours in e-cigarettes decrease harm perceptions (five studies) and increase willingness to try and initiation of e-cigarettes (six studies). Among adults, e-cigarette flavours increase product appeal (seven studies) and are a primary reason many adults use the product (five studies). The role of flavoured e-cigarettes on smoking cessation remains unclear (six studies). CONCLUSION This review provides summary data on the role of non-menthol flavours in e-cigarette perceptions and use. Consistent evidence shows that flavours attract both youth and adults to use e-cigarettes. Given the clear findings that such flavours increase product appeal, willingness to try and initiation among youth, banning non-menthol flavours in e-cigarettes may reduce youth e-cigarette use. Longitudinal research is needed to examine any role flavours may play in quit behaviours among adults.
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Affiliation(s)
- Clare Meernik
- Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hannah M Baker
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah D Kowitt
- Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah M Ranney
- Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam O Goldstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Selya AS, Dierker L, Rose JS, Hedeker D, Mermelstein RJ. The Role of Nicotine Dependence in E-Cigarettes' Potential for Smoking Reduction. Nicotine Tob Res 2019; 20:1272-1277. [PMID: 29065204 DOI: 10.1093/ntr/ntx160] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/05/2017] [Indexed: 12/27/2022]
Abstract
Introduction E-cigarettes (Electronic Nicotine Delivery Systems, or ENDS) are an increasingly popular tobacco product among youth. Some evidence suggests that e-cigarettes may be effective for harm reduction and smoking cessation, although these claims remain controversial. Little is known about how nicotine dependence may contribute to e-cigarettes' effectiveness in reducing or quitting conventional smoking. Methods A cohort of young adults were surveyed over 4 years (approximately ages 19-23). Varying-coefficient models (VCMs) were used to examine the relationship between e-cigarette use and conventional smoking frequency, and how this relationship varies across users with different nicotine dependence levels. Results Lifetime, but not recent, e-cigarette use was associated with less frequent concurrent smoking of conventional cigarettes among those with high levels of nicotine dependence. However, nondependent e-cigarette users smoked conventional cigarettes slightly more frequently than those who had never used e-cigarettes. Nearly half of ever e-cigarette users reported using them to quit smoking at the last measurement wave. For those who used e-cigarettes in a cessation attempt, the frequency of e-cigarette use was not associated with reductions in future conventional smoking frequency. Conclusions These findings offer possible support that e-cigarettes may act as a smoking reduction method among highly nicotine-dependent young adult cigarette smokers. However, the opposite was found in non-dependent smokers, suggesting that e-cigarette use should be discouraged among novice tobacco users. Additionally, although a substantial proportion of young adults used e-cigarettes to help them quit smoking, these self-initiated quit attempts with e-cigarettes were not associated with future smoking reduction or cessation. Implications This study offers potential support for e-cigarettes as a smoking reduction tool among highly nicotine-dependent young adult conventional smokers, although the extent and nature of this remains unclear. The use of e-cigarettes as a quit aid was not associated with reductions in conventional smoking, consistent with most other quit aids in this sample except for nicotine replacement therapy, which was only effective for the most dependent smokers. Notably, these findings highlight the necessity of accounting for smokers' nicotine dependence levels when examining tobacco use patterns.
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Affiliation(s)
- Arielle S Selya
- Department of Population Health, University of North Dakota, Grand Forks, ND
| | - Lisa Dierker
- Psychology Department, Wesleyan University, Middletown, CT
| | | | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Robin J Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
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Robert Lourdes TG, Abd Hamid HA, Mohd Yusoff MF, Rodzlan Hasani WS, Mat Rifin H, Saminathan TA, Ab Majid NL, Ling JMY, Ismail H, Aris T. Factors Associated With E-Cigarette Usage and the Reasons for Initiation Among Malaysian Adolescents. Asia Pac J Public Health 2019; 31:44S-52S. [PMID: 31522514 DOI: 10.1177/1010539519870663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electronic cigarettes (e-cigarettes) are handheld devices that deliver an aerosol by heating a solution made up of propylene glycol and/or glycerol with or without flavoring agents and nicotine. This nationwide cross-sectional survey examined factors associated with e-cigarette usage and reasons for its initiation among 13 162 Malaysian adolescents. Data from TECMA (Tobacco and E-Cigarette Survey among Malaysian Adolescents) were used. Nine percent of adolescents had used e-cigarettes in the past month. Males (adjusted odds ratio [aOR] = 4.08; 95% confidence interval [CI] = 3.36-4.95), 16 to 19 year olds (aOR = 2.64; 95% CI = 2.13-3.26), Malays (aOR = 2.25; 95% CI = 1.79-2.83), Sabah and Sarawak Bumiputeras (aOR = 2.25; 95% CI = 1.61-3.15), and cigarette smokers (aOR = 13.16; 95% CI = 11.14-15.54) were more likely to use e-cigarettes. Three main reasons for e-cigarette initiation among adolescents were its taste and smell, experimentation, and popularity. Sale of e-cigarettes with or without nicotine to people aged younger than 18 years should be banned. Flavored e-cigarettes should also be banned since there is evidence suggesting increased appeal among the younger generation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hasimah Ismail
- Institute for Public Health, Ministry of Health, Malaysia
| | - Tahir Aris
- Institute for Public Health, Ministry of Health, Malaysia
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Nicksic NE, Snell LM, Barnes AJ. Reasons to use e-cigarettes among adults and youth in the Population Assessment of Tobacco and Health (PATH) study. Addict Behav 2019; 93:93-99. [PMID: 30703668 DOI: 10.1016/j.addbeh.2019.01.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/03/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND While e-cigarette use is increasing, reasons to use e-cigarettes are poorly summarized in the literature. The objective of this study was to organize reasons to use e-cigarette items into factors and determine associations between these factors and e-cigarette user characteristics. METHODS Data were drawn from youth (12-17) and adults (18+) in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) study. Exploratory factor analysis was conducted on 13 reasons to use survey items from experimental and established adult e-cigarette users and past 30 day youth e-cigarette users to determine two factors - "alternative to cigarettes" and "larger social environment". Weighted linear regression models tested the associations between e-cigarette user group and sociodemographics and reasons to use factors among youth and adults. RESULTS Adult current established e-cigarette users were associated with both alternative to cigarettes (β = 0.128, p < .001) and larger social environment (β = 0.063, p < .001) factors, while former established e-cigarette users were associated with alternative to cigarettes (β = 0.064, p < .001). Several adult sociodemographic characteristics were associated with one but not the other factor, or both but in opposite directions. Youth that used e-cigarettes earlier today were also associated with both reasons to use factors (β = 0.127-0.130, p < .01, each); however, youth using any other day in the past 30 days was not associated with either factor. CONCLUSIONS Reasons to use are associated with patterns of e-cigarette use among youth and adults. These factors could support a comprehensive approach to addressing rising e-cigarette use among youth and adults and target certain user populations.
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Berry KM, Fetterman JL, Benjamin EJ, Bhatnagar A, Barrington-Trimis JL, Leventhal AM, Stokes A. Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths. JAMA Netw Open 2019; 2:e187794. [PMID: 30707232 PMCID: PMC6484602 DOI: 10.1001/jamanetworkopen.2018.7794] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE The use of electronic cigarettes (e-cigarettes) and other noncigarette tobacco products may increase the odds of cigarette initiation, even among low-risk youths. OBJECTIVE To evaluate the associations of prior e-cigarette use and other tobacco product use with subsequent cigarette initiation within 2 years of follow-up. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study, data from waves 1 through 3 of the Population Assessment of Tobacco and Health Study (2013-2016) were used to assess youths aged 12 to 15 years who had never used cigarettes, e-cigarettes, or other tobacco products at wave 1. This was a nationally representative study of the US population. Data analysis was conducted in 2018. EXPOSURES First noncigarette tobacco product used (none, e-cigarette, or other tobacco product) between wave 1 and wave 3. MAIN OUTCOMES AND MEASURES Ever cigarette use and current cigarette use at wave 3. RESULTS In the sample (N = 6123), respondents were 49.5% female; 54.1% non-Hispanic, white; and the mean (SD) age was 13.4 (1.2) years. Of these, 8.6% reported e-cigarettes as their first tobacco product, while 5.0% reported using another noncigarette product first; 3.3% reported using cigarettes first. Cigarette use at wave 3 was higher among prior e-cigarette users (20.5%) compared with youths with no prior tobacco use (3.8%). Prior e-cigarette use was associated with more than 4 times the odds of ever cigarette use (odds ratio, 4.09; 95% CI, 2.97-5.63) and nearly 3 times the odds of current cigarette use (odds ratio, 2.75; 95% CI, 1.60-4.73) compared with no prior tobacco use. Prior use of other tobacco products was similarly associated with subsequent ever cigarette use (OR, 3.84; 95% CI, 2.63-5.63) and current cigarette use (OR, 3.43; 95% CI, 1.88-6.26) compared with no prior tobacco use. The association of prior e-cigarette use with cigarette initiation was stronger among low-risk youths (OR, 8.57; 95% CI, 3.87-18.97), a pattern not seen for prior other product use. Over the 2 years between 2013 and 2014 and 2015 and 2016, 21.8% of new cigarette ever use (178 850 youths) and 15.3% of current cigarette use (43 446 youths) among US youths aged 12 to 15 years may be attributable to prior e-cigarette use. CONCLUSIONS AND RELEVANCE This study's findings support the notion that e-cigarette use is associated with increased risk for cigarette initiation and use, particularly among low-risk youths. At the population level, the use of e-cigarettes may be a contributor to the initiation of cigarette smoking among youths.
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Affiliation(s)
- Kaitlyn M. Berry
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jessica L. Fetterman
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emelia J. Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | | | - Adam M. Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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Adolescents have unfavorable opinions of adolescents who use e-cigarettes. PLoS One 2018; 13:e0206352. [PMID: 30403731 PMCID: PMC6221340 DOI: 10.1371/journal.pone.0206352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/11/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction While evidence suggests positive opinions of smokers are associated with tobacco use, research exploring adolescents’ opinions of e-cigarette users is nascent. We hypothesized that adolescents harbor positive opinions of e-cigarette users, and that these opinions will be more positive among adolescents willing to try or who have used e-cigarettes. Methods Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015–2016. Analyses examined whether these variables were associated with willingness to try and use (ever vs. never) of e-cigarettes. Results The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users. Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users. Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users (all p < .01). Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users. Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users (all p < .01). Conclusions Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents’ negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.
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Sampasa-Kanyinga H, Hamilton H. Use of social networking sites, electronic cigarettes, and waterpipes among adolescents. Public Health 2018; 164:99-106. [DOI: 10.1016/j.puhe.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/29/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
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Unger M, Unger DW. E-cigarettes/electronic nicotine delivery systems: a word of caution on health and new product development. J Thorac Dis 2018; 10:S2588-S2592. [PMID: 30345095 PMCID: PMC6178300 DOI: 10.21037/jtd.2018.07.99] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/12/2018] [Indexed: 01/03/2023]
Abstract
This paper describes the introduction, development, and proliferation of new electronic nicotine delivery systems (ENDS). The use of non-combustible tobacco products is considered a means for improving public health and reducing the mortality attributed to cigarette smoking. The effects and use of ENDS are described, with studies to date indicating that, despite differences in toxicity, there is insufficient evidence that ENDS leads to smoking cessation. Finally, research questions are proposed to address key unanswered questions about the effects of such systems.
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Peterson EB, Fisher CL, Zhao X. Pediatric primary healthcare providers’ preferences, experiences and perceived barriers to discussing electronic cigarettes with adolescent patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/17538068.2018.1460960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Emily B. Peterson
- Department of Communication, George Mason University, Fairfax, VA, USA
| | - Carla L. Fisher
- Department of Communication, George Mason University, Fairfax, VA, USA
- Department of Advertising, STEM Translational Communication Center, University of Florida, UF Health Cancer Center, UF Center for Arts in Medicine, Gainesville, FL, USA
| | - Xiaoquan Zhao
- Department of Communication, George Mason University, Fairfax, VA, USA
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Perikleous EP, Steiropoulos P, Paraskakis E, Constantinidis TC, Nena E. E-Cigarette Use Among Adolescents: An Overview of the Literature and Future Perspectives. Front Public Health 2018; 6:86. [PMID: 29632856 PMCID: PMC5879739 DOI: 10.3389/fpubh.2018.00086] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/05/2018] [Indexed: 12/15/2022] Open
Abstract
Background Electronic cigarettes (e-cigarettes) are rapidly emerging into a new trend among adolescents, signaling a new époque, that of vapers. E-cigarettes are battery-powered nicotine delivery devices that heat a typically flavoring liquid solution into an aerosol mist that users inhale, allowing them to imitate the act of conventional smoking. There are concerns about the impact of e-cigarettes at both individual and public health level. Aim To discuss the characteristics of the most vulnerable, to become e-cigarette users, group of adolescents and to further highlight their behaviors and characteristics. Methods An electronic search in PubMed, EMBASE, and Google Scholar databases was conducted, using combinations of the following keywords: adolescents, teenagers, e-cigarettes, vaping. The search included all types of articles written in English until August 2017. A total of 100 articles were found, and 25 were finally included in the present review. Results Older age, male gender, conventional smokers, peer influence, daily smoking, and heavier smoking are the most common characteristics of adolescent e-cigarette users. Conclusion E-cigarette use is common, especially between certain subgroups in the adolescent population. Since e-cigarette use is increasing and considering that the long term health effects are still under investigation, targeted interventions towards more susceptible individuals may be an effective prevention strategy.
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Affiliation(s)
| | - Paschalis Steiropoulos
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Emmanouil Paraskakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodoros C Constantinidis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Zare S, Nemati M, Zheng Y. A systematic review of consumer preference for e-cigarette attributes: Flavor, nicotine strength, and type. PLoS One 2018; 13:e0194145. [PMID: 29543907 PMCID: PMC5854347 DOI: 10.1371/journal.pone.0194145] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Systematic review of research examining consumer preference for the main electronic cigarette (e-cigarette) attributes namely flavor, nicotine strength, and type. Method A systematic search of peer-reviewed articles resulted in a pool of 12,933 articles. We included only articles that meet all the selection criteria: (1) peer-reviewed, (2) written in English, and (3) addressed consumer preference for one or more of the e-cigarette attributes including flavor, strength, and type. Results 66 articles met the inclusion criteria for this review. Consumers preferred flavored e-cigarettes, and such preference varied with age groups and smoking status. We also found that several flavors were associated with decreased harm perception while tobacco flavor was associated with increased harm perception. In addition, some flavor chemicals and sweeteners used in e-cigarettes could be of toxicological concern. Finally, consumer preference for nicotine strength and types depended on smoking status, e-cigarette use history, and gender. Conclusion Adolescents could consider flavor the most important factor trying e-cigarettes and were more likely to initiate vaping through flavored e-cigarettes. Young adults overall preferred sweet, menthol, and cherry flavors, while non-smokers in particular preferred coffee and menthol flavors. Adults in general also preferred sweet flavors (though smokers like tobacco flavor the most) and disliked flavors that elicit bitterness or harshness. In terms of whether flavored e-cigarettes assisted quitting smoking, we found inconclusive evidence. E-cigarette users likely initiated use with a cigarette like product and transitioned to an advanced system with more features. Non-smokers and inexperienced e-cigarettes users tended to prefer no nicotine or low nicotine e-cigarettes while smokers and experienced e-cigarettes users preferred medium and high nicotine e-cigarettes. Weak evidence exists regarding a positive interaction between menthol flavor and nicotine strength.
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Affiliation(s)
- Samane Zare
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States of America
- * E-mail:
| | - Mehdi Nemati
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Yuqing Zheng
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States of America
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Selya AS, Rose JS, Dierker L, Hedeker D, Mermelstein RJ. Evaluating the mutual pathways among electronic cigarette use, conventional smoking and nicotine dependence. Addiction 2018; 113:325-333. [PMID: 28841780 PMCID: PMC5760290 DOI: 10.1111/add.14013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/12/2017] [Accepted: 08/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS The implications of the rapid rise in electronic cigarette (e-cigarette) use remain unknown. We examined mutual associations between e-cigarette use, conventional cigarette use and nicotine dependence over time to (1) test the association between e-cigarette use and later conventional smoking (both direct and via nicotine dependence), (2) test the converse associations and (3) determine the strongest pathways predicting each product's use. DESIGN Data from four annual waves of a prospective cohort study were analyzed. Path analysis modeled the bidirectional, longitudinal relationships between past-month smoking frequency, past-month e-cigarette frequency and nicotine dependence. SETTING Chicago area, Illinois, USA. PARTICIPANTS A total of 1007 young adult smokers and non-smokers (ages 19-23 years). MEASUREMENTS Frequency of (1) cigarettes and (2) e-cigarettes was the number of days in the past 30 on which the product was used. The Nicotine Dependence Syndrome Scale measured nicotine dependence to cigarettes. FINDINGS E-cigarette use was not associated significantly with later conventional smoking, either directly (β = 0.021, P = 0.081) or through nicotine dependence (β = 0.005, P = 0.693). Conventional smoking was associated positively with later e-cigarette use, both directly (β = 0.118, P < 0.001) and through nicotine dependence (β = 0.139, P < 0.001). The strongest predictors of each product's use was prior use of the same product; this pathway was strong for conventional cigarettes (β = 0.604, P < 0.001) but weak for e-cigarettes (β = 0.120, P < 0.001). Nicotine dependence moderately strongly predicted later conventional smoking (β = 0.169, P < 0.001), but was a weak predictor of later e-cigarette use (β = 0.069, P = 0.039). CONCLUSIONS Nicotine dependence is not a significant mechanism for e-cigarettes' purported effect on heavier future conventional smoking among young adults. Nicotine dependence may be a mechanism for increases in e-cigarette use among heavier conventional smokers, consistent with e-cigarettes as a smoking reduction tool. Overall, conventional smoking and, to a lesser extent, its resulting nicotine dependence, are the strongest drivers or signals of later cigarette and e-cigarette use.
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Affiliation(s)
- Arielle S. Selya
- Department of Population Health, University of North Dakota, Grand Forks, ND, USA
| | | | - Lisa Dierker
- Psychology Department, Wesleyan University, Middletown, CT, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Robin J. Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
BACKGROUND Health warnings may be less effective if they elicit reactance, a motivation to resist a threat to freedom, yet we lack a standard measure of reactance. PURPOSE We sought to validate a new health warning reactance scale in the context of pictorial cigarette pack warnings. METHODS A national sample of adults (n = 1413) responded to reactance survey questions while viewing randomly assigned pictorial or text warnings on images of cigarette packs. A separate longitudinal sample of adult smokers received the warnings on their own cigarette packs (n = 46). RESULTS Factor analyses identified a reliable and valid 27-item Reactance to Health Warnings Scale. In our experimental study, smokers rated pictorial warnings as being able to motivate quitting more than text warnings. However, five reactance scale factors weakened the warnings' impact (anger, exaggeration, government, manipulation, and personal attack; all p < .05). CONCLUSIONS The Reactance to Health Warnings Scale had good psychometric properties. Reactance weakened the impact of pictorial warnings on smokers' evaluation of the warning's ability to motivate quitting.
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Hartwell G, Thomas S, Egan M, Gilmore A, Petticrew M. E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups. Tob Control 2017; 26:e85-e91. [PMID: 28003324 PMCID: PMC5739861 DOI: 10.1136/tobaccocontrol-2016-053222] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess whether electronic cigarette (e-cigarette) awareness, 'ever use' and current use vary significantly between different sociodemographic groups. DESIGN Systematic review. DATA SOURCES Published and unpublished reports identified by searching seven electronic databases (PubMed, MEDLINE, Web of Science, EMBASE, Global Health, PsycINFO, CINAHL Plus) and grey literature sources. STUDY SELECTION Systematic search for and appraisal of cross-sectional or longitudinal studies that assessed e-cigarette awareness, 'ever use' or current use, and included subgroup analysis of 1 or more PROGRESS Plus sociodemographic groups. No geographical or time restrictions imposed. Assessment by multiple reviewers, with 17% of full articles screened meeting the selection criteria. DATA EXTRACTION Data extracted and checked by multiple reviewers, with quality assessed using an adapted tool developed by the Joanna Briggs Institute. DATA SYNTHESIS Results of narrative synthesis suggest broadly that awareness, 'ever use' and current use of e-cigarettes may be particularly prevalent among older adolescents and younger adults, males, people of white ethnicity and-particularly in the case of awareness and 'ever use'-those of intermediate or high levels of education. In some cases, results also varied within and between countries. CONCLUSIONS E-cigarette awareness, 'ever use' and current use appear to be patterned by a number of sociodemographic factors which vary between different countries and subnational localities. Care will therefore be required to ensure neither the potential benefits nor the potential risks of e-cigarettes exacerbate existing health inequalities.
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Affiliation(s)
- Greg Hartwell
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Sian Thomas
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Anna Gilmore
- Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK
| | - Mark Petticrew
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
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Drope J, Cahn Z, Kennedy R, Liber AC, Stoklosa M, Henson R, Douglas CE, Drope J. Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine. CA Cancer J Clin 2017; 67:449-471. [PMID: 28961314 DOI: 10.3322/caac.21413] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 12/20/2022] Open
Abstract
Answer questions and earn CME/CNE Over the last decade, the use of electronic nicotine delivery systems (ENDS), including the electronic cigarette or e-cigarette, has grown rapidly. More youth now use ENDS than any tobacco product. This extensive research review shows that there are scientifically sound, sometimes competing arguments about ENDS that are not immediately and/or completely resolvable. However, the preponderance of the scientific evidence to date suggests that current-generation ENDS products are demonstrably less harmful than combustible tobacco products such as conventional cigarettes in several key ways, including by generating far lower levels of carcinogens and other toxic compounds than combustible products or those that contain tobacco. To place ENDS in context, the authors begin by reviewing the trends in use of major nicotine-containing products. Because nicotine is the common core-and highly addictive-constituent across all tobacco products, its toxicology is examined. With its long history as the only nicotine product widely accepted as being relatively safe, nicotine-replacement therapy (NRT) is also examined. A section is also included that examines snus, the most debated potential harm-reduction product before ENDS. Between discussions of NRT and snus, ENDS are extensively examined: what they are, knowledge about their level of "harm," their relationship to smoking cessation, the so-called gateway effect, and dual use/poly-use. CA Cancer J Clin 2017;67:449-471. © 2017 American Cancer Society.
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Affiliation(s)
- Jeffrey Drope
- Vice President, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Zachary Cahn
- Director, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Rosemary Kennedy
- Program Consultant, Global Cancer Prevention and Early Detection, American Cancer Society, Atlanta, GA
| | - Alex C Liber
- Data Analyst, Economic and Health Policy Research, American Cancer Society, Atlanta, GA
| | - Michal Stoklosa
- Senior Economist, Taxation and Health, American Cancer Society, Atlanta, GA
| | - Rosemarie Henson
- Senior Vice President for Prevention and Early Detection, American Cancer Society, Atlanta, GA
| | - Clifford E Douglas
- Vice President, Tobacco Control and Director, Center for Tobacco Control, American Cancer Society, Atlanta, GA
| | - Jacqui Drope
- Managing Director, Global Cancer Prevention and Early Detection, American Cancer Society, Atlanta, GA
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Abstract
BACKGROUND Electronic cigarettes
(e-cigarettes) are a psychosocial phenomenon of the 21st century with serious implications to public and individual health. The significant increase of their popularity and use has raised concerns in the healthcare community regarding their potential benefits and harm, particularly their use as a smoking cessation methodology. OBJECTIVES Current knowledge is presented about e-cigarettes, including the clinical implications of their use, and associated controversies are analyzed. In addition, practice recommendations and communication guidance are provided. METHODS An integrative review was performed. FINDINGS The long-term effect of e-cigarettes on individual and public health is unknown. Evidence from short-term studies, although limited, shows that e-cigarette use is less harmful than smoking. However, the evidence does not support the use of e-cigarettes as a smoking cessation methodology. Such recommendation remains a judgment call for the clinician based on each individual case.
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Hemmerich N, Klein EG, Berman M. Evidentiary Support in Public Comments to the FDA's Center for Tobacco Products. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2017; 42:645-666. [PMID: 28483810 PMCID: PMC5522345 DOI: 10.1215/03616878-3856121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Electronic Nicotine Delivery Systems (ENDS) were introduced into the US market in 2007, and until recently these devices were unregulated at the federal level. In 2014, the US Food and Drug Administration (FDA) published a Notice of Proposed Rulemaking asserting its intention to regulate ENDS and requesting public comments on numerous related issues, including potential limits on the sale of flavored ENDS. This article analyzes key comments submitted to the FDA on the issue of flavor regulation in ENDS and examines the weight and credibility of the evidence presented by both supporters and opponents of regulation. It also describes the final deeming rule, published in May 2016, and the FDA's response to the evidence submitted. This is the first study to examine public comments submitted to the FDA's Center for Tobacco Products, and it concludes that opponents of regulation were more likely to rely on sources that were not peer reviewed and that were affected by conflicts of interest. In light of these findings, the FDA and the research community should develop processes to carefully and critically analyze public comments submitted to the FDA on issues of tobacco regulation.
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Pilot Experiment: The Effect of Added Flavorants on the Taste and Pleasantness of Mixtures of Glycerol and Propylene Glycol. CHEMOSENS PERCEPT 2017; 11:1-9. [PMID: 29755639 DOI: 10.1007/s12078-017-9231-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction The US Food and Drug Administration banned most "sweet" flavorants for use in cigarettes due to the concern that sweet flavors appeal to young, beginning smokers. However, many of the same flavors, including fruity and confection-associated aromas (e.g. vanilla) are still used in e-cigarettes. Sweet flavors may have a number of effects, including enhancement of the taste of other ingredients. The current work focused on the impact of model flavorants on the taste of a mixture of propylene glycol and vegetable glycerine, solvents used in most e-cigarettes and related products. Methods A device delivered mixtures of propylene glycol and vegetable glycerine into the mouth in parallel with puffs of clean air (control) or odorized air. Aromas included two "fruity" esters ("pineapple" and "banana"), two confection-associated aromas ("vanilla" and "caramel/malty"), menthol (not a "sweet" aroma, but commonly used in e-cigarettes), and a "burnt" aroma not expected enhance flavor. Twenty young adults, aged 18-25, rated the sweetness, bitterness, and pleasantness of all stimuli (within-subjects design). Results Both fruity aromas significantly enhanced sweetness, both confection-associated aromas significantly enhanced pleasantness, and the caramel/malty aroma significantly reduced bitterness. Menthol and the "burnt" aroma had no measurable effects on the taste of solvent mixtures. Conclusion Some flavorants modulated the taste of solvents commonly used in e-cigarettes in ways consistent with an enhanced sensory profile. Implications If similar effects occur in actual products, improved flavor profiles could facilitate continued use, particularly in non-smokers experimenting with e-cigarettes and related products.
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Hennessy M, Bleakley A, Ellithorpe M. Prototypes reflect normative perceptions: implications for the development of reasoned action theory. PSYCHOL HEALTH MED 2017; 23:245-258. [PMID: 28612624 DOI: 10.1080/13548506.2017.1339896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The reasoned action approach is one of the most successful behavioral theories in the history of social psychology. This study outlines the theoretical principles of reasoned action and considers when it is appropriate to augment it with a new variable. To demonstrate, we use survey data collected from a 4 to 17 year old U.S. adolescents to test how the 'prototype' variables fit into reasoned action approach. Through confirmatory factor analysis, we find that the prototype measures are normative pressure measures and when treated as a separate theoretical construct, prototype identity is not completely mediated by the proximal predictors of behavioral intention. We discuss the assumptions of the two theories and finally consider the distinction between augmenting a specific theory versus combining measures derived from different theoretical perspectives.
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Affiliation(s)
- Michael Hennessy
- a Annenberg School for Communication , University of Pennsylvania , Philadelphia , PA , USA
| | - Amy Bleakley
- a Annenberg School for Communication , University of Pennsylvania , Philadelphia , PA , USA
| | - Morgan Ellithorpe
- b Department of Advertising and Public Relations , Michigan State University , East Lansing , MI , USA
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Park S, Lee H, Min S. Factors associated with electronic cigarette use among current cigarette-smoking adolescents in the Republic of Korea. Addict Behav 2017; 69:22-26. [PMID: 28110154 DOI: 10.1016/j.addbeh.2017.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/25/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Despite a rapid increase in electronic cigarette (e-cigarette) use and substantial dual use of cigarettes and e-cigarettes among adolescents, little is currently known about adolescent e-cigarette use. Thus, this study aimed to investigate (a) rates of e-cigarette use and (b) significant factors associated with e-cigarette use among current cigarette users in adolescence. METHODS We analyzed secondary data collected from a nationally representative sample of Korean adolescents. Our study sample included 6307 current smokers. Our dependent variable was e-cigarette use and consisted of three categories (nonuse, former use, and current use); independent variables included demographics, perceived stress, parental and friends' smoking, three characteristics of cigarette smoking, and other health risk behaviors. Descriptive statistics was used for the first aim; multinomial logistic regression analysis was performed for the second aim. RESULTS Of current cigarette users, 20% smoked e-cigarettes in their lifetime but not within the past 30days (former users), and 42% smoked e-cigarettes in their lifetime and within the past 30days (current users). Both former and current e-cigarette use were significantly associated with male gender, higher grades, higher weekly allowance, residence in urban areas, friends' smoking, daily smoking, a higher number of cigarettes smoked, and quit attempts. In addition, current e-cigarette use was significantly associated with at-risk drinking, lifetime drug use, and lifetime sexual intercourse. CONCLUSIONS E-cigarette use should be included in intervention strategies for smoking prevention and cessation. Strict regulations should be implemented in order to prohibit easy access to e-cigarettes and forbid advertising of e-cigarettes as well.
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Case K, Loukas A, Harrell M, Wilkinson A, Springer A, Pérez A, Creamer M, Perry CL. The association between sensation seeking and e-cigarette use in Texas young adults: A cross-sectional study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:277-285. [PMID: 28095126 PMCID: PMC5422121 DOI: 10.1080/07448481.2017.1282487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the associations between sensation seeking and ever and current e-cigarette use in Texas young adults (18-29 years old). Current cigarette use was examined as a potential effect modifier of the associations. PARTICIPANTS Participants included college students enrolled in four-year and two-year colleges in four metropolitan areas in Texas (n = 5,418) who completed the survey between November 2014 and February 2015. METHODS This cross-sectional study utilized mixed effects logistic regression to determine the associations between mean sensation seeking scores and ever and current e-cigarette use after controlling for covariates. RESULTS After controlling for covariates, significant associations between sensation seeking and both ever and current e-cigarette use were observed; however, these associations were significant for noncurrent smokers only (adjusted odds rations [AOR] = 1.55, 95% confidence interval (CI) = 1.39, 1.73; AOR = 1.82, 95% CI = 1.54, 2.15, respectively). CONCLUSIONS Sensation seeking is an important factor in identifying college students who may be at increased risk for e-cigarette use behaviors.
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Affiliation(s)
- Kathleen Case
- University of Texas School of Public Health- Austin Regional Campus
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, University of Texas at Austin
| | - Melissa Harrell
- University of Texas School of Public Health- Austin Regional Campus
| | - Anna Wilkinson
- University of Texas School of Public Health- Austin Regional Campus
| | - Andrew Springer
- University of Texas School of Public Health- Austin Regional Campus
| | - Adriana Pérez
- University of Texas School of Public Health- Austin Regional Campus
| | - MeLisa Creamer
- University of Texas School of Public Health- Austin Regional Campus
| | - Cheryl L. Perry
- University of Texas School of Public Health- Austin Regional Campus
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Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci 2017; 1394:5-30. [PMID: 26774031 PMCID: PMC4947026 DOI: 10.1111/nyas.12977] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
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Affiliation(s)
| | - Eric Soule
- Virginia Commonwealth University, Richmond, Virgina
| | - Alexa Lopez
- Virginia Commonwealth University, Richmond, Virgina
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Saitta D, Chowdhury A, Ferro GA, Nalis FG, Polosa R. A Risk Assessment Matrix for Public Health Principles: The Case for E-Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E363. [PMID: 28362360 PMCID: PMC5409564 DOI: 10.3390/ijerph14040363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 11/21/2022]
Abstract
Besides nicotine replacement therapies, a realistic alternative for smoking cessation or for smoking substitution may come from electronic cigarettes (ECs), whose popularity has been steadily growing. As for any emerging behaviour associated with exposure to inhalational agents, there is legitimate cause for concern and many health organizations and policy makers have pushed for restrictive policy measures ranging from complete bans to tight regulations of these products. Nonetheless, it is important to reframe these concerns in context of the well-known harm caused by cigarette smoking. In this article, we discuss key public health principles that should be considered when regulating ECs. These include the concept of tobacco harm reduction, importance of relative risk and risk continuum, renormalization of smoking, availability of low-risk product, proportionate taxation, and reassessment of the role of non-tobacco flavours. These public health principles may be systematically scrutinized using a risk assessment matrix that allows: (1) to determine the measure of certainty that a risk will occur; and (2) to estimate the impact of such a risk on public health. Consequently, the ultimate goal of responsible ECs regulation should be that of maximizing the favourable impact of these reduced-risk products whilst minimizing further any potential risks. Consumer perspectives, sound EC research, continuous post-marketing surveillance and reasonable safety and quality product standards should be at the very heart of future regulatory schemes that will address concerns while minimizing unintended consequences of ill-informed regulation.
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Affiliation(s)
- Daniela Saitta
- Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95121 Catania, Italy.
| | - Azim Chowdhury
- Keller and Heckman LLP, 1001 G Street N.W., Suite 500W, Washington, DC 20001, USA.
| | | | - Federico Giuseppe Nalis
- School of Specialization in Occupational Medicine, University of Messina, Via Consolare Valeria 1, 98122 Messina, Italy.
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95121 Catania, Italy.
- Centre for Tobacco Cessation and Prevention, Teaching Hospital "Policlinico-V. Emanuele", Via S. Sofia 78, 95123 Catania, Italy.
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Jannat-Khah DP, Reynolds SA, Dill LJ, Joseph MA. A Comparison of Alternative Tobacco Product Usage, Knowledge and Beliefs Between the New York City Lesbian, Gay, Bisexual, and Transgendered Community and Heterosexuals. J Community Health 2017; 42:903-910. [DOI: 10.1007/s10900-017-0332-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wilson FA, Wang Y. Recent Findings on the Prevalence of E-Cigarette Use Among Adults in the U.S. Am J Prev Med 2017; 52:385-390. [PMID: 27988090 DOI: 10.1016/j.amepre.2016.10.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study uses a recent source of nationally representative data from in-person surveys to examine national estimates of e-cigarette use among adults and their relationship with demographic, socioeconomic, and health behavior measures. METHODS Data were provided by the National Health Interview Survey, conducted by the Centers for Disease Control and Prevention. A total of 34,356 respondents aged ≥18 years were examined for 2014, the most recent and only year in which the National Health Interview Survey included questions on e-cigarette use. E-cigarette information included ever and current use. Univariate and multivariable logistic regression analyses were performed, adjusting for age, sex, race/ethnicity, education level, marital status, poverty, and smoking status. Analyses were conducted in 2016. RESULTS Compared with those who had never tried e-cigarettes, e-cigarette users were more likely to be younger, male, non-Hispanic white, non-married, poorer, and current smokers. Multivariable logistic regression suggested that respondents with high school or some college education had significantly higher adjusted odds of ever using e-cigarettes relative to those with less than high school education. However, the adjusted odds were not significantly different for college or graduate school education. CONCLUSIONS The results suggest that, unlike tobacco use, ever using e-cigarettes is positively related to income. Interestingly, e-cigarette use exhibits a non-linear relationship with education. Reasons for the relationship of e-cigarettes with education are unclear and warrant further research.
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Affiliation(s)
- Fernando A Wilson
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Yang Wang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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Abstract
BACKGROUND Information on e-cigarettes among youth in the Russian Federation is lacking. OBJECTIVE We examined prevalence of and factors associated with youth e-cigarette use in the Russian Federation. METHODS A cross-sectional, anonymous survey, conducted among 716 (females 51.5%) high school students in three cities (i.e., Ufa, Sterlitamak, Karagaevo) within the Republic of Bashkortostan, Russian Federation in 2015, assessed e-cigarette use and its correlates (i.e., sex, age, ethnicity, family structure, parents' highest degrees, antisocial behaviors, stress coping strategies, lifetime cigarette, hookah, alcohol, and marijuana use). RESULTS Lifetime use of e-cigarettes was 28.6% and past-30-day use was 2.2%. Multilevel modeling showed that belonging to Tatar/Bashkir ethnicity relative to Russian ethnicity (OR = 1.60) and lifetime use of cigarettes (OR = 21.64), hookah (OR = 4.21), and alcohol (OR = 1.90) was associated with greater odds of lifetime use of e-cigarettes. Furthermore, use of social support coping strategies (i.e., utilizing parents for support) were associated with lower odds of lifetime use of e-cigarettes (OR = 0.94). CONCLUSIONS Despite high lifetime e-cigarette use, past-30-day use was low. Greater knowledge of the reasons for e-cigarette discontinuation through continued surveillance is needed in the Russian Federation. Social coping strategies involving parents may inform e-cigarette use prevention.
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Affiliation(s)
- Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bulat Idrisov
- Section of General Internal Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, USA
- Department of Preventive Medicine, Bashkir State Medical University, Ufa, Russian Federation
| | - Artur Galimov
- Department of Preventive Medicine, Bashkir State Medical University, Ufa, Russian Federation
| | - Radik Masagutov
- Department of Psychiatry and Narcology, Bashkir State Medical University, Ufa, Russian Federation
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- School of Social Work, University of Southern California, Los Angeles, California, USA
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Clarke TN, Lusher JM. Willingness to Try Electronic Cigarettes Among UK Adolescents. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017. [DOI: 10.1080/1067828x.2016.1242098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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