Tobacco Marketing Receptivity and Other Tobacco Product Use Among Young Adult Bar Patrons

Exploring factors associated with smokeless tobacco use among young people: A systematic scoping review

PURPOSE

While smoking is declining among young people, smokeless tobacco use is increasing. Identifying who is using smokeless tobacco and why is essential in preventing smokeless tobacco use. This study aimed to comprehensively explore the factors of young people's use of smokeless tobacco in western countries and identify research gaps.

METHODS

We conducted a systematic scoping review of studies that examined factors associated with smokeless tobacco use among young people (ages 13-29) from western countries published between January 2011 and September 2021. Searches were conducted in CINAHL, Medline, and Scopus. Studies on adults, total tobacco use (i.e., did not differentiate between tobacco product types), dual and multiple uses of tobacco, and studies on smokeless tobacco cessation programs were excluded.

RESULTS

A total of 160 studies were included in this scoping review. The studies were primarily undertaken in the US and the Scandinavian countries, and the majority explored smokeless tobacco use without distinguishing between the specific types. Smokeless tobacco users were more likely to be male, non-Hispanic white, engaging in physical activity, and using other substances, including cigarettes and alcohol. The role of friends and family were identified as critical factors that were related to the use of smokeless tobacco.

CONCLUSIONS

This scoping review suggests that preventative measures against smokeless tobacco use should focus on peer and family members' roles and that these measures may benefit from targeting males. Additional research, including systematic reviews on this area to validate the identified associated factors, would improve the understanding of smokeless tobacco use.

Alcohol and cannabis use during the COVID-19 pandemic among transgender, gender-diverse, and cisgender adults in Canada

BACKGROUND

This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults.

METHODS

Successive waves of web-based cross-sectional surveys.

SETTING

Canada, May 2020 to March 2021.

PARTICIPANTS

6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years.

MEASUREMENTS

Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement.

RESULTS

Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected.

CONCLUSIONS

Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.

Exposure to tobacco marketing in bars predicts subsequent use of multiple tobacco products among non-tobacco-using college students

BACKGROUND

Due to other marketing restrictions, one venue where tobacco companies concentrate their marketing efforts to reach young adults is bars/nightclubs.

OBJECTIVE

This study examined the relationship between exposure to tobacco marketing in bars/nightclubs and number of alternative tobacco/nicotine products used 6 months later among college students.

METHODS

Participants were 1,406 students aged 18-29 years old who reported going to bars or nightclubs at least rarely (M age=21.95; 67% female; 46% non-Hispanic white). Students completed an online survey in fall 2014/spring 2015 (wave 1) and again 6 months later (wave 2). Multilevel Poisson regression models were used to assess the relationship between exposure to three types of marketing at bars/nightclubs at wave 1 (tobacco/nicotine product advertisements; free samples; industry representatives) and number of tobacco products used (range=0-5) at wave 2, controlling for school type (2 year vs 4 year), age, sex, race/ethnicity and frequency of bar visits. An interaction between the number of wave 1 products and each marketing variable was tested.

RESULTS

Greater exposure to free samples and tobacco industry representatives at bars/nightclubs predicted a greater number of products used 6 months later, but only among wave 1 non-tobacco users and not among tobacco users. Exposure to advertisements at bars/nightclubs did not predict the number of products used 6 months later.

CONCLUSION

Tobacco companies claim that marketing is targeted to those who already use the product, not to non-users. However, the current study indicates tobacco marketing in bars and nightclubs may encourage use among non-users and has no influence on current users.

What Does It Meme? A Qualitative Analysis of Adolescents' Perceptions of Tobacco and Marijuana Messaging

OBJECTIVES

With the increasing popularity of electronic cigarettes and legalization of recreational marijuana, messaging from websites and social media is shaping product perceptions and use. Quantitative research on the aesthetic appeal of these advertisements from the adolescent and young adult perspective is lacking. We evaluated (1) how adolescents and young adults perceived tobacco and marijuana messaging online and through social media platforms and (2) interactive behaviors related to these messages.

METHODS

We interviewed 24 participants from the Tobacco Perceptions Study, a longitudinal study of adolescents' and young adults' (aged 17-21) tobacco-related perceptions and tobacco use. We collected qualitative data from October 2017 through February 2018, through individual semi-structured interviews, on participants' experiences and interactions with online tobacco and marijuana advertisements and the advertisements' appeal. Two analysts recorded, transcribed, and coded interviews.

RESULTS

Themes that emerged from the interviews focused on the direct appeal of online messaging to adolescents and young adults; the value of trusting the source; the role of general attitudes and personal decision-making related to using tobacco and/or marijuana; the appeal of messaging that includes colors, interesting packaging, and appealing flavors; and the preference of messages communicated by young people and influencers rather than by industry.

CONCLUSION

These findings suggest the need for increased regulation of social media messaging and marketing of tobacco and marijuana, with a particular focus on regulating social media, paid influencers, and marketing that appeals to adolescents and young adults. The findings also suggest the importance of prevention programs addressing the role of social media in influencing the use of tobacco and marijuana.

E-Cigarette Marketing and Communication: How E-Cigarette Companies Market E-Cigarettes and the Public Engages with E-cigarette Information

Introduction

Given the lack of regulation on marketing of electronic cigarettes (e-cigarettes) in the United States and the increasing exchange of e-cigarette-related information online, it is critical to understand how e-cigarette companies market e-cigarettes and how the public engages with e-cigarette information.

Methods

Results are from a systematic review of peer-reviewed literature on e-cigarettes via a PubMed search through June 1, 2017. Search terms included: "e-cigarette*" or "electronic cigarette" or "electronic cigarettes" or "electronic nicotine delivery" or "vape" or "vaping." Experimental studies, quasi-experimental studies, observational studies, qualitative studies, and mixed methods studies providing empirical findings on e-cigarette marketing and communication (ie, nonmarketing communication in the public) were included.

Results

One hundred twenty-four publications on e-cigarette marketing and communication were identified. They covered topics including e-cigarette advertisement claims/promotions and exposure/receptivity, the effect of e-cigarette advertisements on e-cigarette and cigarette use, public engagement with e-cigarette information, and the public's portrayal of e-cigarettes. Studies show increases in e-cigarette marketing expenditures and online engagement through social media over time, that e-cigarettes are often framed as an alternative to combustible cigarettes, and that e-cigarette advertisement exposure may be associated with e-cigarette trial in adolescents and young adults.

Discussion

Few studies examine the effects of e-cigarette marketing on perceptions and e-cigarette and cigarette use. Evidence suggests that exposure to e-cigarette advertisements affects perceptions and trial of e-cigarettes, but there is no evidence that exposure affects cigarette use. No studies examined how exposure to e-cigarette communication, particularly misleading or inaccurate information, impacts e-cigarette, and tobacco use behaviors.

Implications

The present article provides a comprehensive review of e-cigarette marketing and how the public engages with e-cigarette information. Studies suggest an association between exposure to e-cigarette marketing and lower harm perceptions of e-cigarettes, intention to use e-cigarettes, and e-cigarette trial, highlighting the need to for advertising regulations that support public health goals. Findings from this review also present the methodological limitations of the existing research (primarily due to cross-sectional and correlational analyses) and underscore the need for timely, rigorous research to provide an accurate understanding of e-cigarette marketing and communication and its impact on e-cigarette and tobacco product use.

Receptivity to Tobacco Advertising among Young Adults with Internalizing Problems: Findings from the Population Assessment of Tobacco and Health Study

Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.

Marketing exposure and smokeless tobacco use initiation among young adults: A longitudinal analysis

OBJECTIVES

This study examines the relationships between self-reported exposure to smokeless tobacco marketing and initiation/onset of smokeless tobacco use/susceptibility at 6-month follow-up, among a cohort of young adults in urban Texas.

METHODS

Participants were 3597 18-25 year old never smokeless tobacco users, attending 24 Texas two-year colleges and four-year universities. A multi-level, multivariate logistic regression model, accounting for school clustering, examined the impact of self-reported recall of smokeless tobacco marketing exposure at baseline and subsequent initiation of smokeless tobacco use. A subsample analysis of non-susceptible never users (n = 3097) examined the impact of self-reported exposure to smokeless tobacco marketing at baseline and onset of susceptibility to use smokeless tobacco. Both outcomes were assessed at 6-month follow-up. Baseline covariates included age, race/ethnicity, sex, two-/four-year institution, and other tobacco use. For the full analysis, susceptibility to use smokeless tobacco at baseline was included as a covariate.

RESULTS

From baseline to 6-month follow-up, 6.1% of never users initiated smokeless tobacco use (n = 219) and 7.0% of non-susceptible never users became susceptible to smokeless tobacco use (n = 221). Self-reported recall of smokeless tobacco marketing exposure at baseline was associated with initiation of smokeless tobacco (Adj OR: 1.17; 95% CI: 1.08-1.27) and onset of susceptibility to use smokeless tobacco (Adj OR: 1.11; 95% CI: 1.02-1.21) at 6-month follow-up, controlling for all covariates.

CONCLUSIONS

Findings build on previous research by demonstrating an association between recall of smokeless tobacco marketing and subsequent use. Findings are concerning given the 300% increase in smokeless tobacco marketing expenditures from 2006 to 2016.

Tobacco use among lesbian, gay, bisexual and transgender young adults varies by sexual and gender identity

BACKGROUND

Research shows that tobacco products are disproportionately used by sexual and gender minorities, known collectively as those who are lesbian, gay, bisexual, and transgender (LGBT). While usage varies within this population by identity, differences in tobacco use patterns are not well understood. The present study uses evaluation data for This Free Life, a tobacco public education campaign from the FDA, to examine differences in tobacco use among LGBT young adults by subgroups based on sex at birth, gender and sexual identity.

METHODS

Data are from 4,057 18-24 LGBT young adults who completed the baseline This Free Life evaluation survey in 2016. Multivariable logistic regression models examined differences in tobacco use (cigarettes, cigars, hookah and electronic nicotine products) and poly use (2+ of any product, 2+ combustibles, at least one combustible and one noncombustible) between LGBT subgroups (cisgender gay males, cisgender bisexual males, cisgender lesbian/gay females, cisgender bisexual females and gender minorities).

RESULTS

Sexual minority females were more likely than gay males to use any tobacco product, electronic nicotine products and hookah. Cisgender bisexuals were more likely than gay males and gender minorities to use electronic nicotine products. Cisgender bisexual males were less likely than all other groups to use cigarettes. Cisgender sexual minority females were more likely than gender minorities to engage in poly use.

CONCLUSIONS

Findings suggest that sexual minority females are more likely to use tobacco than other subgroups. More research can help campaign developers better understand reasons for intragroup differences in tobacco use among LGBT subgroups.

Sexual and Gender Minority College Students and Tobacco Use in Texas

Introduction

Most research regarding sexual and gender minority (SGM) populations is limited to examination of cigarette or general tobacco use or does not examine heterogeneity across SGM groups other than lesbian or gay and bisexual individuals. This study examined differences in the odds of current use and age of initiation of five tobacco/nicotine products among three groups of SGM young adults who self-identified as (1) gay or lesbian, (2) bisexual, and (3) queer, transgender, or "other," compared to their heterosexual peers.

Methods

Participants were 4252 college students aged 18-29 years from 24 colleges in Texas who completed an online tobacco use survey. Multilevel logistic regression models were used to examine the odds of SGM participants currently using each tobacco product. Multilevel linear regression models were used to examine the association of current product users' SGM status with self-reported age of each product's initiation. All models were adjusted for sociodemographic factors and accounted for students clustered within each college.

Results

At least one SGM group had significantly greater odds of currently using every tobacco product type compared to heterosexual participants, except hookah. There were few differences across groups in age of initiation. However, queer, transgender, and "other-" identified participants initiated e-cigarettes 1.34 years younger than heterosexual participants, and bisexual participants initiated smokeless tobacco 3.66 years younger than heterosexual participants.

Conclusions

Findings highlight some significant tobacco use disparities among SGM young adults compared to their heterosexual peers. Longitudinal studies with larger group sizes will identify prospective predictors of sustained SGM-related tobacco use disparities.

Implications

This study extends the current literature by including the sexual and gender minority identity options of queer, transgender, and "other," highlighting disparities in tobacco use between young adults in these subgroups compared to their heterosexual peers, particularly in noncigarette tobacco product use. Findings underscore the need for the Food and Drug Association and other health agencies to tailor health communication efforts specific to sexual and gender minority populations pertaining to the risks and harms surrounding tobacco product use.

Association of Alternative Tobacco Product Initiation With Ownership of Tobacco Promotional Materials Among Adolescents and Young Adults

IMPORTANCE

Use of alternative tobacco products (ATPs) such as electronic cigarettes, chewing tobacco, pipes, cigars, cigarillos, little cigars, and hookah is rapidly increasing. Although marketing restrictions exist for cigarettes, marketing of ATPs is not yet fully regulated, and studies have not assessed the association between ownership of ATP promotional materials and subsequent ATP or cigarette initiation among adolescents and young adults.

OBJECTIVE

To estimate the association between marketing receptivity measured at baseline and ATP and any tobacco initiation 1 year later, including cigarettes, among adolescents and young adults.

DESIGN, SETTING, AND PARTICIPANTS

Longitudinal cohort study of adolescents and young adults aged 13 to 19 years recruited at high schools in California from July 2014 to October 2015, with follow-up 1 year later. Data were analyzed from January to March 2018.

EXPOSURES

Ownership of ATP-specific promotional material and ownership of any tobacco promotional materials (eg, samples, coupons, branded caps, t-shirts, or posters) assessed in wave 1.

MAIN OUTCOMES AND MEASURES

Outcomes were (1) ATP initiation and (2) either ATP or cigarette initiation in wave 2.

RESULTS

Of 757 participants (mean [SD] age at wave 1, 16.1 [1.1] years; 481 [63.5%] female; 166 [21.9%] Asian or Pacific Islander, 202 [26.7%] white, and 276 [36.4%] Latino), 129 (17.0%) initiated ATP use and 141 (18.6%) initiated ATP or cigarette use 1 year later. In unadjusted models, wave 2 ATP initiation was found to be significantly associated with wave 1 ownership of ATP promotional materials (odds ratio, 2.23; 95% CI, 1.26-3.97). After adjustment for wave 1 demographic covariates, the association between ownership of ATP promotional material and ATP initiation 1 year later yielded similar results (odds ratio, 2.13; 95% CI, 1.16-3.91). Results of models assessing a combined outcome variable of either ATP or cigarette ever use were not statistically significant.

CONCLUSIONS AND RELEVANCE

Ownership of ATP promotional materials was associated with subsequent initiation of ATPs. The results of this study are consistent with the suggestion that current marketing restrictions for cigarettes, including restrictions of the distribution of samples, coupons, and other promotional material, should extend to ATPs.

Latent Class Analysis to Examine Patterns of Smoking and Other Tobacco Products in Young Adult Bar Patrons

PURPOSE

Use of multiple tobacco products is increasing, particularly among young adults. Latent class analysis of substance-use patterns provides a framework for understanding the heterogeneity of use. We sought to identify different patterns of cigarette, e-cigarette, hookah, cigarillo, and smokeless tobacco use among young adult bar patrons.

METHODS

We conducted repeated cross-sectional surveys of randomized time location samples of young adult California bar patrons in 2013 and 2014. Latent class analysis was used to examine patterns of use among current (past 30-day) tobacco users. Classes were compared on demographic characteristics and tobacco use correlates.

RESULTS

Overall 84.4% of the current tobacco users were cigarette smokers, 38.7% used electronic cigarettes, 35.9% used hookah, 30.1% smoked cigars/cigarillos, and 15.4% used smokeless tobacco in the past 30 days. We extracted six latent classes: "Cigarette only" (n = 1690), "Hookah mostly" (n = 479), "High overall use" (n = 528), "Smokeless mostly" (n = 95), "E-cigarette mostly" (n = 439), "Cigars mostly" (n = 435). These classes differed in their risk profiles on both current use compared to no use, and number of days they used each tobacco product. Differences between classes emerged on demographics (age, sex, race/ethnicity) and tobacco correlates including perceived peer smoking, antitobacco industry attitudes, prioritizing social activities, and advertising receptivity.

CONCLUSIONS

Understanding different patterns of multiple tobacco product use may inform both prevention and cessation programming for young adults. It may be efficient to tailor messages to different latent classes and address the distinct demographic and attitudinal profiles of groups of multiple tobacco product users.

Soda intake and tobacco use among young adult bar patrons: A cross-sectional study in seven cities

Young adults are among the greatest consumers of sugar sweetened beverages, and they also have high smoking rates. However, few studies address the relationship between these risk behaviors; this study examined the relationship between soda consumption and smoking among young adult bar patrons, a high-risk understudied population. A cross-sectional survey of young adult bar patrons (between January 2014 and October 2015) was conducted using randomized time location sampling (N = 8712) in Albuquerque, NM, Los Angeles, CA Nashville, TN, Oklahoma City, OK, San Diego, CA, San Francisco, CA, and Tucson, AZ. The survey found the prevalences of daily regular soda intake ranged from 32% in San Diego to 51% in Oklahoma City and current smoking ranged from 36% in Los Angeles, CA to 49% in Albuquerque, NM. In multinomial multivariate models with no soda consumption as the reference group and controlling for demographics and location, non-daily (OR = 1.24, 95% CI = 1.05, 1.47) and daily smokers (OR = 1.34, 95% CI = 1.08, 1.66) were both more likely to drink regular soda compared to not drinking any soda. No effects were found for diet soda consumption. These linked risks suggest that comprehensive health promotion efforts to decrease sugar sweetened beverage consumption and tobacco use, among other risky behaviors, may be effective in this population.

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Young adult (YA) bar patrons who smoke consume more regular soda than nonsmokers.

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Being a non-daily or a daily-smoker increased odds of drinking regular soda.

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Prevalence of smoking among YA bar patrons who were regular soda drinkers varied by region.

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YA bar patrons attending or graduated from college were less likely to drink soda.

Comparison of Measures of E-cigarette Advertising Exposure and Receptivity

OBJECTIVES

We tested how various measures of e-cigarette advertising exposure and receptivity are related to each other and compare to each other in their associations with e-cigarette use susceptibility and behavior.

METHODS

Cross-sectional data were collected from young adult college students (N = 470; Mage = 20.9, SD = 2.1; 65% women). Measures of e-cigarette advertising exposure/receptivity compared included a cued recall measure, measures of marketing receptivity, perceived ad exposure, liking of e-cigarette ads, and frequency of convenience store visit, which is considered a measure of point-of-sale ad exposure.

RESULTS

The cued-recall measure was associated with e-cigarette use experimentation but not current e-cigarette use. Marketing receptivity was associated with current e-cigarette use but not e-cigarette use experimentation. Liking of e-cigarette ads was the only measure associated with e-cigarette use susceptibility. Frequency of convenience store visit was associated with current e-cigarette use but not e-cigarette use experimentation or susceptibility.

CONCLUSION

Inclusion of multiple measures of marketing exposure and receptivity is recommended for regulatory research concerning e-cigarette marketing. Marketing receptivity and cued recall measures are strong correlates of current and ever e-cigarette use, respectively.