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Yang Q. Understanding the Associations Between Adolescents' Exposure to E-Cigarette Information and Vaping Behavior Through the Theory of Planned Behavior. HEALTH COMMUNICATION 2024; 39:641-651. [PMID: 36823032 DOI: 10.1080/10410236.2023.2179715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Adolescents have actively looked for and passively scanned information about electronic cigarettes (e-cigarettes) from a variety of media and interpersonal sources. Despite the evidence that exposure to e-cigarette information is associated with youth's increased vaping intention, there is a paucity of scholarship that differentiates the sources where adolescents obtain e-cigarette information in their investigation, which limits our understanding of the unique association between vaping intention and e-cigarette information acquisition from specific sources. In addition, few studies have systematically examined the mechanism of the aforementioned associations. To fill the gap, an online national survey on a panel of adolescents between 13 to 17 years old was conducted. After controlling for potential confounders, several significant indirect effects were observed. Specifically, adolescents' vaping intention was negatively associated with e-cigarette information seeking from health professionals but positively with e-cigarette information exposure from family and friends, outdoors advertisements, social media, and other online channels, with the theory of planned behavior (TPB) constructs mediating these relationships. The findings not only contribute to the body of scholarship on TPB but also provide important suggestions for regulating outdoor and online e-cigarette information and designing persuasive interventions and campaigns.
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Affiliation(s)
- Qinghua Yang
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
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2
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Vogel EA, Barrington-Trimis JL, Vassey J, Soto D, Unger JB. Young Adults' Exposure to and Engagement With Tobacco-Related Social Media Content and Subsequent Tobacco Use. Nicotine Tob Res 2024; 26:S3-S12. [PMID: 38366337 PMCID: PMC10873498 DOI: 10.1093/ntr/ntad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/18/2023] [Accepted: 06/28/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Nicotine/tobacco social media content may increase young people's risk for use. This study examined prospective associations between exposure to and engagement with nicotine/tobacco-related social media content and nicotine/tobacco use among young adults. AIMS AND METHODS Young adults (N = 2080) originally recruited from Southern California high schools for a prospective cohort study reported frequency of viewing and posting nicotine/tobacco content on four social media platforms (Facebook, Instagram, Twitter, and YouTube). Participants also reported frequency of seeing nicotine/tobacco posts from friends, seeing nicotine/tobacco posts from influencers or celebrities, and liking nicotine/tobacco posts. Within subsamples of nicotine/tobacco never users (n = 794), past users (n = 897) and current users (n = 389), analyses examined associations of baseline (May-October 2020) social media content exposure and engagement with follow-up (January-June 2021) tobacco use initiation (among never users), resumption (among past users), and continuation (among current users), adjusting for sociodemographic and socioenvironmental characteristics. RESULTS Never users who saw nicotine/tobacco posts from friends (Adjusted Odds Ratio [AOR] = 2.91 [95% Confidence Interval [CI]: 1.46, 5.82], p = .002) or from celebrities or influencers (AOR = 2.77 [1.32, 5.84], p = .007) were significantly more likely to initiate nicotine/tobacco use than their peers. Among past users, posting nicotine/tobacco content at baseline was associated with use resumption (AOR = 1.77 [1.12, 2.80], p = .014). Content exposure and engagement were not associated with nicotine/tobacco use continuation among current users (p-values > .05). CONCLUSIONS Seeing nicotine/tobacco posts from friends, influencers, or celebrities was associated with greater odds of tobacco use initiation, but not resumption or continuation, 6 months later. Young adults with past nicotine/tobacco use who post about nicotine/tobacco may be at elevated risk for resuming use. IMPLICATIONS Young adults with exposure to nicotine/tobacco social media content were more likely than their peers to initiate nicotine/tobacco use 6 months later. Past nicotine/tobacco users who reported posting about nicotine/tobacco on social media at baseline were more likely than their peers to resume nicotine/tobacco use. Among young adults with current nicotine/tobacco use at baseline, social media activity did not predict odds of nicotine/tobacco use continuation at follow-up. Nicotine/tobacco content on social media should be restricted to reduce young people's chances of nicotine/tobacco use initiation or resumption.
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Affiliation(s)
- Erin A Vogel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
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Johannes BL, Ortiz SE. How Facebook is used to promote ENDS products near four Big 10 universities: A qualitative analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:210-218. [PMID: 35171078 PMCID: PMC9378756 DOI: 10.1080/07448481.2022.2027425] [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: 02/03/2021] [Revised: 11/04/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Objective: Electronic Nicotine Delivery System (ENDS) proprietors strategically placed near college campuses and pervasive marketing on social media platforms, such as Facebook, are critical to the tobacco industry's effort to acquire new young adult users. Understanding the themes used on Facebook to promote ENDS products to college students is necessary to develop public health messaging to combat the vaping epidemic.Methods: We identified 15 ENDS proprietors located near four Big 10 universities and qualitatively analyzed a random sample of their Facebook posts (n = 405) to identify emerging themes using a grounded theory approach.Results: ENDS proprietors in college towns use Facebook to deploy promotional messaging (n = 319), to market ENDS products as a means of celebration (n = 40), to establish a sense of community (n = 155) among ENDS users, to make marijuana references (n = 36), and to advocate (n = 27) for ENDS products.Conclusions: These themes may increase social acceptability and use of ENDS products among college students.
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Affiliation(s)
- Bobbie L. Johannes
- Population Studies Center, University of Michigan, Ann Arbor, United States
| | - S. E. Ortiz
- Department of Health Policy and Administration, Penn State University, University Park, United States
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Dobbs PD, Schisler E, Colditz JB, Primack BA. Miscommunication about the US federal Tobacco 21 law: a content analysis of Twitter discussions. Tob Control 2023; 32:696-700. [PMID: 35173067 PMCID: PMC9378749 DOI: 10.1136/tobaccocontrol-2021-057099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/03/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Tobacco 21 is a law that sets the minimum legal sales age of tobacco products to 21. On 20 December 2019, the USA passed a federal Tobacco 21 law. The objective of this study is to explore Twitter discussions about the federal Tobacco 21 law in the USA leading up to enacted. METHODS Twitter messages about Tobacco 21 posted between September and December 2019 were collected via RITHM software. A 2% sample of all collected tweets were double coded by independent coders using a content analysis approach. RESULTS Findings included three content categories of tweets (news, youth and young adults and methods of avoiding the law) with eight subcodes. Most news tweets incorrectly described the law as a purchase law (54.7%). However, Tobacco 21 is in fact a sales law-it only includes penalties for tobacco retailers who sell to under-age purchasers. About one-fourth (27%) of the tweets involved youth and young adults, with some claiming the law would reduce youth smoking and others doubting its ability to limit youth access to tobacco products. Few tweets (2.5%) mentioned methods of circumventing the policy, such as having an older peer purchase tobacco. CONCLUSIONS As several countries explore raising their age of sale of tobacco laws to 21, they should couple policy enactment with clear and accurate communication about the law. Compliance agencies at all levels (eg, local, regional, national) can use social media to identify policy loopholes and support vulnerable populations throughout the policy implementation process.
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Affiliation(s)
- Page D Dobbs
- Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Eric Schisler
- Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Jason B Colditz
- Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian A Primack
- College of Education and Health Professions, University of Arkansas, Fayetteville, AR, USA
- College of Public Health and Human Science, Oregona State University, Corvallis, OR, USA
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Smith MJ, Hilton S. Youth's exposure to and engagement with e-cigarette marketing on social media: a UK focus group study. BMJ Open 2023; 13:e071270. [PMID: 37612101 PMCID: PMC10450076 DOI: 10.1136/bmjopen-2022-071270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Electronic-cigarettes (e-cigarette) are promoted creatively through social media and considering the potential influence of social media marketing on young people, we explored young people's exposure to and engagement with social media marketing of e-cigarettes. DESIGN Semistructured discussion groups. SUBJECTS Twenty focus groups with 82 young people aged 11-16 living in the Central belt of Scotland. METHODS Youths were asked about smoking and vaping behaviours, social media use, vaping advertisement exposure and were shown illustrative examples of social media content (eg, images and videos) about different messages, presentations and contextual features. Transcripts were imported into NVivo V.12, coded thematically and analysed. RESULTS Youths highlighted a variety of tactics e-cigarette companies use, including influencer or celebrity endorsement, attractive youth flavours, bright colours and emotional appeal to advertise and promote their products directly to young people. Social media influencers who advertise e-cigarettes were described as portraying e-cigarettes as 'cool' and 'fashionable' to entice viewers to try the products. Youths considered that there is a need for more restrictions on social media content to protect youths while also still allowing smokers to purchase them as a cessation device. CONCLUSIONS Our study highlights that the e-cigarette industry is using previously employed tactics similar to the tobacco industry to advertise and promote its products on social media. These findings suggest the growing need for governments to work together to develop and implement policies to restrict the advertising and marketing of e-cigarettes on social media.
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Affiliation(s)
- Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Hoffman BL, Wolynn R, Barrett E, Manganello JA, Felter EM, Sidani JE, Miller E, Burke JG, Primack BA, Chu KH. Viewer Reactions to EVALI Storylines on Popular Medical Dramas: A Thematic Analysis of Twitter Messages. JOURNAL OF HEALTH COMMUNICATION 2023; 28:282-291. [PMID: 37057592 PMCID: PMC10330130 DOI: 10.1080/10810730.2023.2201814] [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] [Indexed: 06/15/2023]
Abstract
Previous research has found an association between awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) and lower intention to use e-cigarettes among young people. This study utilized Twitter data to evaluate if the January 2020 depiction of EVALI on New Amsterdam, Chicago Med, and Grey's Anatomy-three popular primetime medical dramas-could be a potential innovative avenue to raise awareness of EVALI. We obtained tweets containing e-cigarette-related search strings from 1/21/2020 to 02/18/2020 and filtered these with storyline-specific keywords, resulting in 1,493 tweets for qualitative coding by two trained human coders. Content codes were informed by prior research, theories of narrative influence, and e-cigarette related outcomes. Of 641 (42.9%) relevant tweets, the most frequent content codes were perceived realism (n = 292, 45.6%) and negative response (n = 264, 41.2%). A common theme among these tweets was that storylines were unrealistic because none of the characters with EVALI used THC-containing products. Approximately 12% of tweets (n = 78) mentioned e-cigarette knowledge and 28 (4.4%) mentioned behavior, including quitting e-cigarettes because of viewing the storylines. Implications for health communication research utilizing social media data and maximizing the achievement of positive health-related outcomes for storylines depicting current health topics are discussed.
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Affiliation(s)
- Beth L. Hoffman
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Social Dynamics and Community Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Riley Wolynn
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erica Barrett
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer A. Manganello
- School of Public Health, University at Albany, State University of New York, Albany, New York, USA
| | - Elizabeth M. Felter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jaime E. Sidani
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Social Dynamics and Community Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Social Dynamics and Community Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian A. Primack
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Kar-Hai Chu
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Social Dynamics and Community Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Smith MJ, Buckton C, Patterson C, Hilton S. User-generated content and influencer marketing involving e-cigarettes on social media: a scoping review and content analysis of YouTube and Instagram. BMC Public Health 2023; 23:530. [PMID: 36941553 PMCID: PMC10029293 DOI: 10.1186/s12889-023-15389-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Evidence suggests that experimentation with e-cigarettes among young people is increasing. Social media is widely used by young people with user-generated content and influencer marketing particularly influential in promoting products. This paper documents a snapshot of online user-generated content and influencer marketing related to e-cigarettes on YouTube and Instagram. METHODS Scoping review of relevant e-cigarette-related content on two social media platforms popular with youths, YouTube and Instagram, between June and August 2021. Content analysis was undertaken to examine text, audio, and video content, recording age restrictions, health warnings, page characteristics, and post characteristics. Narrative post content was coded using a coding frame that was developed inductively in response to emergent categories. RESULTS Vaping was portrayed positively on social media; of the posts analysed, 86.5% (n = 90 of 104) of Instagram posts and 66.0% (n = 64 of 97) of YouTube videos. Warnings about age restrictions and health (e.g., nicotine addiction/toxicity) did not feature in the majority of posts; 43.3% (n = 42) of YouTube videos (n = 42) contained an age warning compared to 20.2% of Instagram posts (n = 21). While 25.8% (n = 25) of YouTube videos and 21.2% of Instagram (n = 22) posts contained a health warning. CONCLUSION Of concern is the fact that the vast majority of YouTube and Instagram content about e-cigarettes promoted their use, and typically the content does not contain age and/or health warnings. These findings may highlight a priority for governmental policy to restrict the ability of marketers to reach youths with social media content promoting e-cigarettes.
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Affiliation(s)
- Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Christina Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Valente TW, Piombo SE, Edwards KM, Waterman EA, Banyard VL. Social Network Influences on Adolescent E-cigarette Use. Subst Use Misuse 2023; 58:780-786. [PMID: 36924165 PMCID: PMC10112417 DOI: 10.1080/10826084.2023.2188429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background: Determine if individual adolescent vaping is associated with the vaping behavior of their school-based friendships; whether that association stems from peer influence or peer selection; and whether it varies by age. Methods: Two wave longitudinal survey of 1,208 students in one Midwestern US school district. Students were asked if they ever vaped and to name their seven closest friends within the school district. A roster of all eligible students was pre-loaded into the survey to facilitate network data collection. Terms for network exposure, the proportion of vaping friends; and selection, the number of new friends who vape, were created. Logistic regression and Stochastic Actor Oriented Models were used to test both influence and selection effects. Results: A cross-sectional logistic regression model indicated that friend vaping was associated with individual vaping (AOR = 4.96, p < 0.01); and lagged logistic models indicated that increased friend vaping was associated with individual vaping initiation (AOR = 1.72, p < 0.05). Selecting new friends who vape was also associated with becoming a vaper (AOR = 1.25, p < 0.01). Both influence and selection were present for those less than 14 years old. Conclusions: This is the first study to use social network analysis to show that adolescents who vape or initiate vaping are more likely to do so if their friends vape, and/or they make new friends who vape. Prevention and cessation programs should address the role of friend influence and selection on e-cigarette use; particularly at younger ages.
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Affiliation(s)
- Thomas W. Valente
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N. Soto St., Los Angeles CA 90034 USA
| | - Sarah E. Piombo
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N. Soto St., Los Angeles CA 90034 USA
| | - Katie M. Edwards
- Nebraska Center for Research on Children, Youth, Families, and Schools, 160 Prem S. Paul Research Center at Whittier School, Lincoln, NE 68583
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Lee EWJ, Bekalu MA, McCloud RF, Viswanath K. Toward an Extended Infodemiology Framework: Leveraging Social Media Data and Web Search Queries as Digital Pulse on Cancer Communication. HEALTH COMMUNICATION 2023; 38:335-348. [PMID: 34266333 DOI: 10.1080/10410236.2021.1951957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study aims to extend the infodemiology framework by postulating that effective use of digital data sources for cancer communication should consider four components: (a) content: key topics that people are concerned with, (b) congruence: how interest in cancer topics differ between public posts (i.e., tweets) and private web searches, (c) context: the influence of the information environment, and (d) information conduits. We compared tweets (n = 36, 968) and Google web searches on breast, lung, and prostate cancer between the National Cancer Prevention Month and a non-cancer awareness month in 2018. There are three key findings. First, reliance on public tweets alone may result in lost opportunities to identify potential cancer misinformation detected from private web searches. Second, lung cancer tweets were most sensitive to external information environment - tweets became substantially pessimistic after the end of cancer awareness month. Finally, the cancer communication landscape was largely democratized, with no prominent conduits dominating conversations on Twitter.
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Affiliation(s)
- Edmund W J Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University
| | - Mesfin A Bekalu
- Center for Community-Based Research, Dana-Farber Cancer Institute
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
| | - Rachel F McCloud
- Center for Community-Based Research, Dana-Farber Cancer Institute
| | - K Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
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Stanton CA, Pasch KE, Pericot-Valverde I, Cruz-Cano R, Moran MB, Abadi MH, Mays D, Mercincavage M, Tang Z, Chen-Sankey J. Longitudinal associations between U.S. youth exposure to E-cigarette marketing and E-cigarette use harm perception and behavior change. Prev Med 2022; 164:107266. [PMID: 36152822 PMCID: PMC9691545 DOI: 10.1016/j.ypmed.2022.107266] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/28/2022] [Accepted: 09/17/2022] [Indexed: 10/31/2022]
Abstract
E-cigarette marketing tactics to reach and appeal to youth are rapidly changing. This study examined to what extent youth e-cigarette marketing exposure was associated with e-cigarette use behavior change one year later, during a time when youth e-cigarette use was starting to surge in the U.S. Using nationally representative longitudinal public-use data from the Population Assessment of Tobacco and Health (PATH) Study, we examined associations between recalled e-cigarette marketing exposure (2016-2018) at Wave (W) 4 and e-cigarette use harm perception and behavior change (ever, current, and regular use) one year later (W4.5; 2017-2018) among W4 never tobacco users (n = 9405). Recall of exposure to e-cigarette marketing through different channels was also examined in multivariable models controlling for socio-demographic factors and established e-cigarette use risk factors. Results show that the most frequently recalled channels of e-cigarette marketing exposure were retail stores (50.3%), television (22.2%), and websites/social media (20.2%). Over one year, 21.2%, 7.8%, 3.4%, and 1.2% of respondents reported reduced harm perceptions, and ever, current, and regular use of e-cigarettes, respectively, at follow-up. Recalled exposure to e-cigarette marketing was associated with reduced e-cigarette harm perception (AOR = 1.20; 95% CI = 1.05-1.37) and ever (AOR = 1.26; 95% CI = 1.01-1.56) and current use (AOR = 1.40; 95% CI = 1.02-1.92) at follow-up. E-cigarette marketing exposure through websites/social media was associated with reduced harm perceptions and all stages of e-cigarette use change, including regular use. Identifying marketing techniques and channels that change youth e-cigarette harm perceptions and influence e-cigarette use progression is essential to inform e-cigarette regulatory policies and prevention campaigns.
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Affiliation(s)
- Cassandra A Stanton
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Keryn E Pasch
- Department of Kinesiology and Health Education at the University of Texas, Austin, TX, United States of America
| | - Irene Pericot-Valverde
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics Indiana University School of Public Health-Bloomington, University of Maryland, College Park, MD, United States of America
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa H Abadi
- Pacific Institute for Research & Evaluation, Louisville, KY, United States of America
| | - Darren Mays
- Department of Internal Medicine, College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Zhiqun Tang
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States of America; School of Public Health, Rutgers University, Piscataway, NJ, United States of America.
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Wu YS, Chan HL, Ho SY, Zhao SZ, Luk TT, Lam TH, Wang MP. A content analysis of heated tobacco product business in Hong Kong on Facebook. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5685-e5692. [PMID: 36062525 DOI: 10.1111/hsc.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Heated tobacco products (HTPs) are increasingly popular in Hong Kong (HK) even though they have not been formally launched and the sale of duty-not-paid tobacco sticks is illegal. We investigated how Facebook was used against regulations to sell HTPs in HK. We screened Facebook pages run by HTP businesses targeting HK users in June 2019 and included pages with over 300 "Likes" for inductive content analysis by coding their "About" descriptions and all posts including comments published since January 2017. HTPs included heating devices, accessories, and tobacco sticks. Various attributes were recorded including methods of customer inquiries (telephone, Instant Messaging [IM], address), business responses (comments or private messages, PM), and services provided (warranty/repair). Among 30 pages (50.9% of all 59 eligible pages with related information on HTPs), two-thirds provided phone numbers (66.7%), IM accounts (65.5%), and addresses (66.7%). Most pages sold heating devices (26, 86.7%) and accessories (22, 73.3%) with over 72% providing phone numbers, IM accounts, or addresses. Only 8 pages (26.7%) sold tobacco sticks with 75.0% providing telephone numbers but fewer provided IM accounts (62.5%) and addresses (50.0%). All pages responded using PMs and only 12.5% also used comments. Warranty/repair services were provided by 43.3% of the pages. We found Facebook pages were used as dedicated stores to promote and sell HTPs including heating devices, accessories, and even illicit tobacco sticks in HK, a non-official market.
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Affiliation(s)
| | - Hiu Laam Chan
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
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Russell AM, Colditz JB, Barry AE, Davis RE, Shields S, Ortega JM, Primack B. Analyzing Twitter Chatter About Tobacco Use Within Intoxication-related Contexts of Alcohol Use: "Can Someone Tell Me Why Nicotine is So Fire When You're Drunk?". Nicotine Tob Res 2022; 24:1193-1200. [PMID: 34562100 PMCID: PMC9278832 DOI: 10.1093/ntr/ntab195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Alcohol and tobacco are commonly used together. Social influences within online social networking platforms contribute to youth and young adult substance use behaviors. This study used a sample of alcohol- and tobacco-related tweets to evaluate: (1) sentiment toward co-use of alcohol and tobacco, (2) increased susceptibility to tobacco use when consuming alcohol, and (3) the role of alcohol in contributing to a failed attempt to quit tobacco use. METHODS Data were collected from the Twitter API from January 1, 2019 through December 31, 2019 using tobacco-related keywords (e.g., vape, ecig, smoking, juul*) and alcohol-related filters (e.g., drunk, blackout*). A total of 78,235 tweets were collected, from which a random subsample (n = 1,564) was drawn for coding. Cohen's Kappa values ranged from 0.66 to 0.99. RESULTS Most tweets were pro co-use of alcohol and tobacco (75%). One of every ten tweets reported increased susceptibility to tobacco use when intoxicated. Non-regular tobacco users reported cravings for and tobacco use when consuming alcohol despite disliking tobacco use factors such as the taste, smell, and/or negative health effects. Regular tobacco users reported using markedly higher quantities of tobacco when intoxicated. Individuals discussed the role of alcohol undermining tobacco cessation attempts less often (2.0%), though some who had quit smoking for prolonged periods of time reported reinitiating tobacco use during acute intoxication episodes. CONCLUSIONS Tobacco cessation interventions may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts. IMPLICATIONS Sentiment toward co-use of alcohol and tobacco on Twitter is largely positive. Individuals reported regret about using tobacco, or using more than intended, when intoxicated. Those who had quit smoking or vaping for prolonged periods of time reported reinitiating tobacco use when consuming alcohol. While social media-based tobacco cessation interventions like the Truth Initiative's "Ditch the Juul" campaign demonstrate potential to change tobacco use behaviors, these campaigns may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts.
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Affiliation(s)
- Alex M Russell
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Jason B Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Robert E Davis
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Shelby Shields
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Juanybeth M Ortega
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Brian Primack
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
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Chu KH, Hershey TB, Hoffman BL, Wolynn R, Colditz JB, Sidani JE, Primack BA. Puff Bars, Tobacco Policy Evasion, and Nicotine Dependence: Content Analysis of Tweets. J Med Internet Res 2022; 24:e27894. [PMID: 35333188 PMCID: PMC8994141 DOI: 10.2196/27894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 02/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Puff Bars are e-cigarettes that continued marketing flavored products by exploiting the US Food and Drug Administration exemption for disposable devices. OBJECTIVE This study aimed to examine discussions related to Puff Bar on Twitter to identify tobacco regulation and policy themes as well as unanticipated outcomes of regulatory loopholes. METHODS Of 8519 original tweets related to Puff Bar collected from July 13, 2020, to August 13, 2020, a random 20% subsample (n=2661) was selected for qualitative coding of topics related to nicotine dependence and tobacco policy. RESULTS Of the human-coded tweets, 2123 (80.2%) were coded as relevant to Puff Bar as the main topic. Of those tweets, 698 (32.9%) discussed tobacco policy, including flavors (n=320, 45.9%), regulations (n=124, 17.8%), purchases (n=117, 16.8%), and other products (n=110, 15.8%). Approximately 22% (n=480) of the tweets referenced dependence, including lack of access (n=273, 56.9%), appetite suppression (n=59, 12.3%), frequent use (n=47, 9.8%), and self-reported dependence (n=110, 22.9%). CONCLUSIONS This study adds to the growing evidence base that the US Food and Drug Administration ban of e-cigarette flavors did not reduce interest, but rather shifted the discussion to brands utilizing a loophole that allowed flavored products to continue to be sold in disposable devices. Until comprehensive tobacco policy legislation is developed, new products or loopholes will continue to supply nicotine demand.
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Affiliation(s)
- Kar-Hai Chu
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tina B Hershey
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Beth L Hoffman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Riley Wolynn
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jason B Colditz
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jaime E Sidani
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brian A Primack
- College of Education and Health Professions, University of Arkansas, Fayetteville, AR, United States
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Dobbs PD, Colditz JB, Shields S, Meadows A, Primack BA. Policy and Behavior: Comparisons between Twitter Discussions about the US Tobacco 21 Law and Other Age-Related Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2613. [PMID: 35270306 PMCID: PMC8910197 DOI: 10.3390/ijerph19052613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 01/25/2023]
Abstract
To combat the e-cigarette epidemic among young audiences, a federal law was passed in the US that raised the minimum legal sales age of tobacco to 21 years (commonly known as Tobacco 21). Little is known about sentiment toward this law. Thus, the purpose of our study was to systematically explore trends about Tobacco 21 discussions and comparisons to other age-restriction behaviors on Twitter. Twitter data (n = 4628) were collected from September to December of 2019 that were related to Tobacco 21. A random subsample of identified tweets was used to develop a codebook. Two trained coders independently coded all data, with strong inter-rater reliability (κ = 0.71 to 0.93) found for all content categories. Associations between sentiment and content categories were calculated using χ2 analyses. Among relevant tweets (n = 955), the most common theme—the disjunction between ages for military enlistment and tobacco use—was found in 17.8% of all tweets. Anti-policy sentiment was strongly associated with the age of military enlistment, alcohol, voting, and adulthood (p < 0.001 for all). Opposition to Tobacco 21 propagates on social media because the US federal law does not exempt military members. However, the e-cigarette epidemic may have fueled some support for this law.
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Affiliation(s)
- Page D. Dobbs
- Health, Human Performance and Recreation Department, University of Arkansas, Fayetteville, AR 72701, USA; (S.S.); (A.M.)
| | - Jason B. Colditz
- Center for Research on Media, Technology and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Shelby Shields
- Health, Human Performance and Recreation Department, University of Arkansas, Fayetteville, AR 72701, USA; (S.S.); (A.M.)
| | - Anna Meadows
- Health, Human Performance and Recreation Department, University of Arkansas, Fayetteville, AR 72701, USA; (S.S.); (A.M.)
| | - Brian A. Primack
- College of Education and Health Professions, University of Arkansas, Fayetteville, AR 72701, USA;
- College of Public Health and Human Science, Oregon State University, Corvallis, OR 97331, USA
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15
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Conceptual model for the evaluation of attractiveness, addictiveness and toxicity of tobacco and related products: The example of JUUL e-cigarettes. Regul Toxicol Pharmacol 2021; 127:105077. [PMID: 34748878 DOI: 10.1016/j.yrtph.2021.105077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/06/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022]
Abstract
Many new tobacco and related products (nTRP) have emerged on the market, with unknown health risks. Here, we present a conceptual model containing the factors and relations between them that contribute to the nTRP's health effects. Factors that determine attractiveness, addictiveness and toxicity of nTRP were defined based on previous assessments, literature, and expert discussions. Our model will aid in identifying key risk factors contributing to increased risk of adverse health effects for a product in a qualitative manner. Additionally, it can gauge attractiveness for specific user groups, as a determinant for population prevalence of use. Our model can be used to identify aspects of nTRP that require attention for public information or product regulation. As an example, we applied this to JUUL, a popular e-cigarette in the US. Aspects of concern for JUUL are its attractive and discrete shape, user-friendly prefilled pods, flavors, high aerosol nicotine levels, and liquids containing nicotine salts instead of free-based nicotine. The addictiveness and especially attractiveness are sufficiently high to have a large potential impact on population health due to its contribution to use and hence exposure. Products and their use can change over time; therefore market research and monitoring are crucial.
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16
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Struik L, Yang Y. e-Cigarette Cessation: Content Analysis of a Quit Vaping Community on Reddit. J Med Internet Res 2021; 23:e28303. [PMID: 34694229 PMCID: PMC8576600 DOI: 10.2196/28303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 07/19/2021] [Indexed: 01/20/2023] Open
Abstract
Background e-Cigarette use, also known as vaping, has increased dramatically over the past few years, especially among younger demographics. However, researchers have found that a large number of e-cigarette users want to quit. Little is known about the unique aspects of vaping cessation, which is critical to informing the development of relevant resources and interventions for e-cigarette users who want to quit. Social media forums such as Reddit provide opportunities to understand the experiences of behavior change such as quitting vaping from the perspective of end users. Objective This study aims to examine a quit vaping subreddit to understand how e-cigarette users are experiencing and approaching vaping cessation. Specifically, we examine methods used to approach quitting, reasons for quitting, and barriers and facilitators to quitting. Methods A total of 1228 posts were collected. The posts were inductively coded to generate categories and subcategories using conventional content analysis. Data were analyzed using the NVivo 12 qualitative data analysis software. Results Most users reported a preference for approaching quitting through gradual reduction, particularly through the use of their own devices by tapering the nicotine content. Their reasons for quitting were primarily related to experiencing negative physical consequences associated with vaping, especially in relation to their lungs (eg, tight chest), and tired of feeling stuck to the vape because of nicotine addiction. Top barriers to quitting were related to withdrawal symptoms and intensity of addiction. The top facilitators to quitting were related to using distraction techniques (eg, hobby, gaming, and mindfulness exercises), as well as having a positive mindset. Conclusions The findings of this study reveal unique aspects that encompass the process of quitting vaping. These findings have significant implications for both policy and intervention development.
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Affiliation(s)
- Laura Struik
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Youjin Yang
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
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17
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Sargent JD, Stoolmiller M, Dai H, Barrington-Trimis JL, McConnell R, Audrain-McGovern J, Leventhal AM. First e-cigarette flavor and device type used: Associations with vaping persistence, frequency, and dependence in young adults. Nicotine Tob Res 2021; 24:380-387. [PMID: 34460934 DOI: 10.1093/ntr/ntab172] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Type of e-cigarette flavoring and device during first use might differentiate later e-cigarette use and dependence. This retrospective cross-sectional study examined associations of recalled first nicotine vaping device and flavor used with current vaping frequency/dependence. METHODS A young adult cohort from Los Angeles, California, USA completed web-based surveys (N=2553). Using cross-sectional data from 971 reporting ever vaping nicotine, multivariable hurdle regressions tested associations between recalled first flavor (fruit/sweet, menthol/mint, other) and device (Juul, disposable, mod, box, pod, pen, other) vaped with past-30-day vaping status (yes/no) and frequency (1-30 days), and with any vaping dependence symptoms (yes/no) and count (1-10 symptoms). RESULTS The most common first-flavor was sweet (71%); the most common first-device was a vape pen (37%), then Juul (22%). First-flavor of mint/menthol (vs. other; adjusted odds ratio [AOR]: 2.22[95%CI=1.16-4.25]), and first-device mod (AOR=2.40[95%CI=1.34-4.31]) and non-Juul pod (2.64[95% CI=1.41-4.92]) (vs. pen) were associated with past-30-day vaping, and twice as many vaping days (ARRs [Adjusted rate ratios] range: 1.96-2.12;ps<0.05). First flavor of mint/menthol (vs. other; AOR: 1.95[95% CI=1.003-3.79) and first device mod, box, non-juul pod and other (AORs range: 2.36-4.01;ps<0.05) were associated with nicotine dependence. First device Juul, mod, box and non-Juul pod were also associated with more dependence symptoms (ARRs range:1.38-1.59;ps<0.05). CONCLUSIONS Exposure to mint/menthol and certain devices (mod, box, Juul and non-juul pods) at first e-cigarette use may be associated with more frequent e-cigarette use and nicotine dependence symptoms in young adulthood. Mint/menthol and certain devices warrant consideration in regulation of e-cigarettes based on product characteristics. IMPLICATIONS Characteristics (flavor and device type) of first e-cigarette product used were associated with higher usage and more dependence. Pending replication with prospective designs, the findings suggest certain flavors (mint/menthol) and devices (pods, mods) merit consideration in regulation because of their possible link with continued use and dependence among young people.
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Affiliation(s)
- James D Sargent
- C. Everett Koop Institute at Dartmouth, Geisel School of Medicine
| | | | - Hongying Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.,Institute for Addiction Science, University of Southern California, Los Angeles, CA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.,Institute for Addiction Science, University of Southern California, Los Angeles, CA
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18
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Vogel EA, Ramo DE, Rubinstein ML, Delucchi KL, Darrow SM, Costello C, Prochaska JJ. Effects of Social Media on Adolescents' Willingness and Intention to Use E-Cigarettes: An Experimental Investigation. Nicotine Tob Res 2021; 23:694-701. [PMID: 31912147 DOI: 10.1093/ntr/ntaa003] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/06/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION This study examined the effects of experimentally manipulated social media exposure on adolescents' willingness and intention to use e-cigarettes. AIMS AND METHODS Participants were 135 adolescents of age 13-18 (52.6% female, mean age = 15.3) in California. Participants viewed six social media posts online in a 2 (post source: peer or advertisement) × 2 (e-cigarette content exposure: heavy or light) between-subjects design. Analyses were weighted to population benchmarks. We examined adolescents' beliefs, willingness, and intention to use e-cigarettes in association with social media use intensity in daily life and with experimentally manipulated exposure to social media posts that varied by source (peer or advertisement) and content (e-cigarette heavy or light). RESULTS Greater social media use in daily life was associated with greater willingness and intention to use e-cigarettes and more positive attitudes, greater perceived norms, and lower perceived danger of e-cigarette use (all p-values <.01). In tests of the experimental exposures, heavy (vs. light) e-cigarette content resulted in greater intention (p = .049) to use e-cigarettes and more positive attitudes (p = .019). Viewing advertisements (vs. peer-generated posts) resulted in greater willingness and intention (p-values <.01) to use e-cigarettes, more positive attitudes (p = .003), and greater norm perceptions (p = .009). The interaction effect of post source by post content was not significant for any of the outcomes (all p-values >.529). CONCLUSIONS Greater social media use and heavier exposure to advertisements and e-cigarette content in social media posts are associated with a greater risk for e-cigarette use among adolescents. Regulatory action is needed to prohibit sponsored e-cigarette content on social media platforms used by youth. IMPLICATIONS Adolescents who use social media intensely may be at higher risk for e-cigarette use. Even brief exposure to e-cigarette content on social media was associated with greater intention to use and more positive attitudes toward e-cigarettes. Regulatory action should be taken to prohibit sponsored e-cigarette content on social media used by young people, including posts by influencers who appeal to young people.
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Affiliation(s)
- Erin A Vogel
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA.,Hopelab, San Francisco, CA
| | - Mark L Rubinstein
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, CA
| | - Kevin L Delucchi
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Sabrina M Darrow
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Caitlin Costello
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
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19
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Wagoner KG, King JL, Alexander A, Tripp HL, Sutfin EL. Adolescent Use and Perceptions of JUUL and Other Pod-Style e-Cigarettes: A Qualitative Study to Inform Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094843. [PMID: 34062740 PMCID: PMC8125112 DOI: 10.3390/ijerph18094843] [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] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
JUUL, a discrete pod-style e-cigarette, popular among adolescents, delivers high levels of nicotine. Limited research has assessed social and environmental influences that contribute to use of JUUL and other pod-style devices. We examined how these factors, as well as individual characteristics, shape adolescent use. Twenty-nine middle and high school students participated in six focus groups in June 2019 (58.6% female, 65.5% White, 27.6% Hispanic). Groups were stratified by e-cigarette use status and grade to understand perceptions and experiences among groups. Transcripts were coded using thematic analysis for individual, social, and environmental factors contributing to use. Users (n = 13) described their first experience with JUUL as mostly negative, mentioning reactions such as burning in the throat, coughing, wheezing, and headaches. Despite a negative first experience, stress relief and addiction were mentioned as reasons for continued use. Users and non-users identified vaping as a source of disruption to their daily life. Social factors included peer and parental influences, lack of support for quitting, and accessibility. Environmental factors included contrasting messages about long- and short-term health effects of e-cigarettes, as well as a lack of school vaping policy enforcement, health education, medical screenings, and cessation resources. Findings highlight the complex social system that influences adolescent e-cigarette use and have important implications for school and community responses. Strategies to prevent or reduce use may include reviewing existing school tobacco policies, providing counseling and cessation resources, training staff, and increasing knowledge through public education campaigns.
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Affiliation(s)
- Kimberly G. Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA;
- Correspondence: ; Tel.: +1-336-713-4223
| | - Jessica L. King
- College of Health, University of Utah, Salt Lake City, UT 84112, USA;
| | - Amir Alexander
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA;
| | - Hollie L. Tripp
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA;
| | - Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA;
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20
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Williams MA, Reddy G, Quinn MJ, Millikan Bell A. Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army. Drug Chem Toxicol 2021; 45:2049-2085. [PMID: 33906535 DOI: 10.1080/01480545.2021.1905657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
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Affiliation(s)
- Marc A Williams
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gunda Reddy
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Michael J Quinn
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Amy Millikan Bell
- Office of the Director - Medical Advisor, U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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21
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Levy DT, Tam J, Sanchez-Romero LM, Li Y, Yuan Z, Jeon J, Meza R. Public health implications of vaping in the USA: the smoking and vaping simulation model. Popul Health Metr 2021; 19:19. [PMID: 33865410 PMCID: PMC8052705 DOI: 10.1186/s12963-021-00250-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/31/2021] [Indexed: 12/05/2022] Open
Abstract
Background Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), a user-friendly model which estimates the public health implications of NVPs in the USA. Methods SAVM adopts a cohort approach. We derive public health implications by comparing smoking- and NVP-attributable deaths and life-years lost under a No-NVP and an NVP Scenario. The No-NVP Scenario projects current, former, and never smoking rates via smoking initiation and cessation rates, with their respective mortality rates. The NVP Scenario allows for smoking- and NVP-specific mortality rates, switching from cigarette to NVP use, separate NVP and smoking initiation rates, and separate NVP and smoking cessation rates. After validating the model against recent US survey data, we present the base model with extensive sensitivity analyses. Results The SAVM projects that under current patterns of US NVP use and substitution, NVP use will translate into 1.8 million premature smoking- and vaping-attributable deaths avoided and 38.9 million life-years gained between 2013 and 2060. When the NVP relative risk is set to 5%, the results are sensitive to the level of switching and smoking cessation rates and to a lesser extent smoking initiation rates. When the NVP relative risk is raised to 40%, the public health gains in terms of averted deaths and LYL are reduced by 42% in the base case, and the results become much more sensitive to variations in the base case parameters. Discussion Policymakers, researchers, and other public health stakeholders can apply the SAVM to estimate the potential public health impact of NVPs in their country or region using their own data sources. In developing new simulation models involving NVPs, it will be important to conduct extensive sensitivity analysis and continually update and validate with new data. Conclusion The SAVM indicates the potential benefits of NVP use. However, given the uncertainty surrounding model parameters, extensive sensitivity analysis becomes particularly important. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00250-7.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Jamie Tam
- School of Public Health, Yale University, New Haven, CT, USA
| | - Luz María Sanchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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22
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Han DH, Lee SH, Lee S, Seo DC. Identifying emerging predictors for adolescent electronic nicotine delivery systems use: A machine learning analysis of the Population Assessment of Tobacco and Health Study. Prev Med 2021; 145:106418. [PMID: 33422574 DOI: 10.1016/j.ypmed.2021.106418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
Intervention strategies to prevent adolescents from using electronic nicotine delivery systems (ENDS) should be based on robust predictors of ENDS use that may differ from predictors of conventional cigarette use. Literature points to the need for uncovering emerging predictors of ENDS use. This study identified emerging predictors of adolescent ENDS use using machine learning (ML) techniques. We analyzed nationally representative multi-wave longitudinal survey data (2013-2018) drawn from the Population Assessment of Tobacco and Health Study. A sample of adolescents (12-17 years) who never used any tobacco products at baseline and completed Wave 2 (n = 7958), Wave 3 (n = 6260) and Wave 4 (n = 4544) were analyzed. We developed a supervised ML prediction model using the penalized logistic regression to assess self-reported past-month ENDS use (i.e., current use) at Waves 2-4 based on the variables measured at the previous wave. We then extracted important predictors from each model. The penalized logistic regression models showed suitable capability to discriminate between ENDS uses and non-uses at each wave based on the area under the receiver operating characteristic curve and the area under the precision-recall curve. Interestingly, social media use emerged as an important variable in predicting adolescent ENDS use. ML models appear to be a promising method to identify unique population-level predictors for U.S. adolescent ENDS use behaviors. More research is warranted to investigate emerging predictors of ENDS use and experimentally examine the mechanism by which these emerging predictors affect ENDS use behavior across different spectrum of populations.
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Affiliation(s)
- Dae-Hee Han
- Indiana University School of Public Health, Bloomington, IN, USA
| | - Shin Hyung Lee
- Indiana University School of Public Health, Bloomington, IN, USA
| | - Shieun Lee
- Indiana University School of Public Health, Bloomington, IN, USA
| | - Dong-Chul Seo
- Indiana University School of Public Health, Bloomington, IN, USA.
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23
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Villanti AC, LePine SE, West JC, Cruz TB, Stevens EM, Tetreault HJ, Unger JB, Wackowski OA, Mays D. Identifying message content to reduce vaping: Results from online message testing trials in young adult tobacco users. Addict Behav 2021; 115:106778. [PMID: 33341530 PMCID: PMC8085990 DOI: 10.1016/j.addbeh.2020.106778] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Young adults' e-cigarette use is associated with perceptions that e-cigarettes are less harmful or addictive than cigarettes, socially acceptable, and appealing. This study developed and tested vaping educational messages addressing these factors: 1) Harm Perceptions, 2) Addictiveness, 3) Social Use, and 4) Flavors. METHODS Two message trials were conducted in U.S. Amazon Mechanical Turk workers aged 18-24 using a 2 (content: addiction, harm) × 3 (theme: alone, + flavors, + social) design with multiple messages in each of the six categories. Participants were assigned to view a random subset of messages and report on likeability and perceived message effectiveness (PME). Phase 1 (n = 200) tested 33 messages and 32 images. Phase 2 (n = 769) tested combinations of Phase 1's 24 most effective messages with 6 images rated most likeable or effective. Linear mixed effects models assessed the effect of content, theme, image, and their interactions on message response. RESULTS In both trials, most participants were past 30-day tobacco users. Harm content messages produced higher PME ratings than addiction content messages, and flavor theme messages were correlated with higher likeability scores than "content alone" theme messages. In Phase 2, flavor and social message themes decreased the PME of harm messages. There was no effect of images on either outcome controlling for the independent or interaction effects of content, theme, and image. CONCLUSIONS Messages conveying the harms of vaping may be best for reducing vaping in young adult tobacco users; flavor and social themes may diminish their effectiveness.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA.
| | - S Elisha LePine
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
| | - Tess Boley Cruz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, USA
| | - Elise M Stevens
- Harvard TH Chan School of Public Health and Dana-Farber Cancer Institute, Harvard University, USA
| | - Haley J Tetreault
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, USA
| | - Darren Mays
- Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, USA
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24
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Colditz JB, Tulikangas MC, Sidani JE, Dodson ZM, Woods MS, James AE, Primack BA. Vape Shop Proliferation and Noncompliance in Pennsylvania: A Pre- and Post-tax Analysis. Tob Use Insights 2021; 14:1179173X20927389. [PMID: 33746518 PMCID: PMC7905483 DOI: 10.1177/1179173x20927389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/26/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The growing use of electronic nicotine delivery systems (ENDS) among
adolescents is a public health concern. Taxation of these products is a
viable approach to reduce ENDS use, particularly among adolescents.
Opponents of taxation posit that it puts specialty retailers (ie, vape
shops) out of business, thereby reducing availability of ENDS for adult
smokers seeking harm reduction. Pennsylvania enacted substantial ENDS taxes
in October 2016. This study sought to examine (1) the prevalence of
Pennsylvania vape shops before and after ENDS taxes were enacted and (2)
ENDS retail licensing compliance among vape shops. Methods: We employed standardized searches for vape shops in Pennsylvania on the Yelp
business-listing platform a month prior to and for 18 consecutive months
following the imposition of ENDS taxes. We then compared listings to a
public database of ENDS-related retail licenses to determine compliance
status. Results: The number of listed vape shops increased in a linear fashion by a magnitude
of 23%. In addition, when we compared a final listing of retailers to data
from the state tax authority, we found roughly a quarter (22%-29%) of vape
shops to be noncompliant with maintaining a valid ENDS retail license. Conclusions: Overall, ENDS taxation in Pennsylvania has not appeared to reduce prevalence
of vape shops as anticipated. However, stricter enforcement of the tax law
is necessary to ensure compliance among retailers. These findings have
implications for implementation and enforcement of ENDS tax policy
nationwide, including states that currently lack such policies.
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Affiliation(s)
- Jason B Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan C Tulikangas
- Bureau of Public Policy and Community Relations, Allegheny County Health Department, Pittsburgh, PA, USA
| | - Jaime E Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zan M Dodson
- American Association of Geographers, Washington, DC, USA
| | - Michelle S Woods
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A Everette James
- Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Brian A Primack
- College of Education and Health Professions, University of Arkansas, Fayetteville, AR, USA
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25
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Chu KH, Matheny SJ, Sidani JE, Allem JP, Unger JB, Cruz TB. Instagram's #JUUL: who's posting what. Transl Behav Med 2021; 11:257-261. [PMID: 31912873 PMCID: PMC7877305 DOI: 10.1093/tbm/ibz169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Exposure to e-cigarette (e-cig) marketing through traditional and online media can increase the risk of e-cig use among adolescents. Though popular e-cig brand JUUL has scaled back its social media promotions, outside vendors and individual users create posts about JUUL unregulated. Instagram's image-focus offers an opportunity to document promotions that may appeal to adolescents. To assess the visual representation of JUUL on social media, we systematically classified discussion topics and themes of posts to Instagram. Of 25,428 unique Instagram images using the hashtag #JUUL retrieved between June 18 and July 18, 2018, a random subsample of 3,000 images (approximately 12% of the full data set) was drawn for human coding and analyses. Coded categories included relevance to JUUL, type of image, image appeal, and user type. Based on the number of relevant images, percentages of image type and appeal for each user type were calculated. There were 583 images that were coded as relevant. The majority of image types (64%) were classified as product (n =; 374). The most frequently coded type of appeal was flavors, found in 54% of images with appeal (n =; 149), followed by cartoons, found in 21% (n =; 57). Vendors were responsible for posting most of the images (n =; 291), followed by e-cig enthusiasts (n =; 99). Continued surveillance of e-cig products, such as JUUL, remains necessary to provide a foundation for potential regulatory protections against marketing and promotions that may appeal to youth.
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Affiliation(s)
- Kar-Hai Chu
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara J Matheny
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jaime E Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon-Patrick Allem
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tess Boley Cruz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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26
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Ragavan MI, Culyba AJ, Randell KA, Miller E, Chu KH. Electronic Vapor Product Use and Violence Victimization Among a Nationally Representative Sample of Adolescents. J Adolesc Health 2021; 68:422-425. [PMID: 32693986 PMCID: PMC8088778 DOI: 10.1016/j.jadohealth.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined associations between electronic vapor product use (vaping) and violence victimization (adolescent relationship abuse (ARA), youth violence, bullying, and experiencing all three types of violence). METHODS Data were drawn from the 2017 National Youth Risk Behavioral Survey. Logistic regression examined associations between vaping and violence victimization, adjusting for sex, age, race, identification as a sexual minority, and use of other substances. RESULTS After adjusting for demographic characteristics, vaping was significantly and positively associated with ARA, youth violence, bullying, and experiencing all three types of violence (ARA: adjusted odds ratio (aOR) 3.0, 95% CI: 2.5-3.5; youth violence: aOR 3.0, CI: 2.4-3.6; bullying: aOR 1.5, CI: 1.4-1.7; all three types of violence: 10, CI: 6.3, 15.8). When use of other substances was added into the model, these associations attenuated, and, for bullying, lost significance. CONCLUSIONS Vaping is associated with increased violence victimization, particularly for youth experiencing ARA, youth violence, and polyvictimization. Further longitudinal studies are needed to determine directionality of these associations and guide prevention efforts.
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Affiliation(s)
- Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh/Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania,Address correspondence to: Maya I. Ragavan, M.D., Division of General Academic Pediatrics, University of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA 15213. (M.I. Ragavan)
| | - Alison J. Culyba
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh/Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kimberly A. Randell
- Division of Emergency Medicine, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh/Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kar-Hai Chu
- Division of General Internal Medicine, University of Pittsburgh/University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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27
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Dobbs PD, Lu Y, Dunlap CM, Newcombe KV, Baer CM, Hodges E, Cheney MK. Young adults' intention to quit using JUUL. Drug Alcohol Depend 2021; 218:108399. [PMID: 33250381 DOI: 10.1016/j.drugalcdep.2020.108399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND With research indicating some young audiences may desire to quit using JUUL, a high-nicotine e-cigarette, we sought to explore factors that may motivate them to quit. METHODS This sequential, mixed methods study included a cross-sectional online survey of college students (n = 631) followed by in-person interviews (n = 51) with survey participants. Data were collected March-April 2019. The survey asked about intention to quit using JUUL. A latent class analysis (LCA) identified participant groups who would quit for various reasons. Participants were also asked 'Can you be too old to JUUL?' during the survey. During the interviews, participants were provided preliminary survey findings and asked about their perceptions of the data. Interview participants were also asked about their expectations for future use of JUUL. RESULTS Four classes emerged from the LCA, indicating costs to self (i.e., harm to lungs/brain, price; 46.8%), financial costs (36.6%), all costs (e.g., social, monetary, health; 9.3%), and harm to self (7.3%) may have influenced our sample's decision to quit using JUUL. Interviewees affirmed desires to quit using JUUL, especially after leaving college. Only 27.19% of survey participants reported an age threshold for using JUUL (M = 31.8 years, SD = 10.0); however, several interviewees explained that although someone could not be too old to JUUL, it would be 'immature' or 'childish' for adults who were not trying to quit smoking to use JUUL socially. DISCUSSION Comprehensive tobacco control strategies such as taxing e-cigarettes, marketing campaigns, and nicotine cessation programs are needed to help nicotine dependent young adults quit using high-nicotine e-cigarettes.
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Affiliation(s)
- P D Dobbs
- Health, Human Performance and Recreation Department, University of Arkansas, 308A HPER Building, Fayetteville, AR, 72701, United States.
| | - Y Lu
- Health and Exercise Science Department, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States
| | - C M Dunlap
- Health and Exercise Science Department, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States
| | - K V Newcombe
- Health and Exercise Science Department, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States
| | - C M Baer
- Health and Exercise Science Department, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States
| | - E Hodges
- Health and Exercise Science Department, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States
| | - M K Cheney
- Health and Exercise Science Department, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States
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28
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Unger JB, Rogers C, Barrington-Trimis J, Majmundar A, Sussman S, Allem JP, Soto DW, Cruz TB. "I'm using cigarettes to quit JUUL": An analysis of Twitter posts about JUUL cessation. Addict Behav Rep 2020; 12:100286. [PMID: 32637562 PMCID: PMC7330876 DOI: 10.1016/j.abrep.2020.100286] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/20/2020] [Accepted: 05/15/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION JUUL, a small pod-based vaping device that aerosolizes nicotine salts, is popular among adolescents and young adults. Because of JUUL's high nicotine content, JUUL users can become nicotine dependent very quickly and have difficulty quitting. Nicotine-dependent JUUL users might turn to Twitter to seek advice, share their cessation struggles, or report their success rather than confiding in friends or family. METHOD This study analyzed Twitter tweets (N = 3192) posted in 2018-2019 to identify common themes about quitting JUUL. Tweets containing the keywords "JUUL" and "quit" or "quitting" were analyzed qualitatively and grouped into themes. RESULTS The most common themes were Methods to quit (25.4%), Have quit (17.8%), Want to quit (16.1%), Reasons to quit (9.6%), Difficulty quitting (7.9%), Barriers to quitting (2.9%), and Curious about quitting (2.1%). Methods to quit included evidence-based tobacco cessation methods such as nicotine replacement therapy and enrolling in a text-to-quit program, but they also included non-evidence-based strategies such as buying lower-nicotine pods online or switching to other tobacco products including cigarettes. Former JUUL users who had quit successfully generally expressed pride but also acknowledged that quitting was very difficult. Reasons for quitting included adverse health effects such as breathing problems and the financial cost of a JUUL habit. Posters mentioned their extreme difficulty quitting JUUL, numerous failed quit attempts, and numerous barriers to quitting including intense physical and emotional withdrawal symptoms. Some posters joked about switching to cigarettes or other drugs to quit JUUL. CONCLUSION Results indicate that JUUL cessation is difficult and that some JUUL users want to quit. Health communication messages are needed to direct JUUL users to effective cessation strategies.
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Affiliation(s)
- Jennifer B. Unger
- University of Southern California, Tobacco Center of Regulatory Science, United States
| | - Christopher Rogers
- University of Southern California, Tobacco Center of Regulatory Science, United States
| | | | - Anuja Majmundar
- University of Southern California, Tobacco Center of Regulatory Science, United States
| | - Steve Sussman
- University of Southern California, Tobacco Center of Regulatory Science, United States
| | - Jon-Patrick Allem
- University of Southern California, Tobacco Center of Regulatory Science, United States
| | - Daniel W. Soto
- University of Southern California, Tobacco Center of Regulatory Science, United States
| | - Tess Boley Cruz
- University of Southern California, Tobacco Center of Regulatory Science, United States
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29
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Hair E, Niaura RS, Rath JM. Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults. Prev Med 2020; 140:106285. [PMID: 33068605 PMCID: PMC7779116 DOI: 10.1016/j.ypmed.2020.106285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022]
Abstract
Low harm perceptions of tobacco products have been associated with use of those products in youth and adults, but this relationship has not been assessed for nicotine beliefs. This study used data from a national sample of adults aged 18-40 in Wave 9 (Spring 2016) of the Truth Initiative Young Adult Cohort Study to examine correlations and prospective associations between the latent classes of nicotine beliefs and susceptibility, curiosity, and use of tobacco products in 3122 adults who also completed Wave 10 (Fall 2016). At Wave 9, four latent classes of beliefs characterized the role of nicotine in the health risks of smoking: Class 1, large role, 51%; Class 2, large role/don't know, 9.4%; Class 3, small role in health, 32.5%; and Class 4, none/small role in cancer, 7.5%. Latent classes of nicotine beliefs were highly correlated with susceptibility and curiosity to use cigarettes, e-cigarettes, and hookah, as well as past 30-day use of a range of tobacco products at Wave 9 among never users. Classes 3 and 4 had the highest prevalence of past 30-day tobacco use; never users in these classes reported the greatest susceptibility to try cigarettes, hookah, and e-cigarettes at Wave 9. Class 4 had higher odds of increased e-cigarettes use at follow-up compared to Class 1. There were few prospective associations between nicotine beliefs latent class, susceptibility, and curiosity at Wave 10. Nicotine beliefs are associated with tobacco-related outcomes and, if assessed, may provide novel information to guide tobacco prevention and intervention efforts.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, United States of America
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Jennifer L Pearson
- Division of Social and Behavioral Sciences, Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, United States of America
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, United States of America
| | - Elizabeth Hair
- Schroeder Institute at Truth Initiative, United States of America
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, United States of America
| | - Jessica M Rath
- Schroeder Institute at Truth Initiative, United States of America
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30
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Bhatt JM, Ramphul M, Bush A. An update on controversies in e-cigarettes. Paediatr Respir Rev 2020; 36:75-86. [PMID: 33071065 PMCID: PMC7518964 DOI: 10.1016/j.prrv.2020.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
E-cigarettes are electronic nicotine delivery systems (ENDS) which mimic tobacco smoking without the combustion of tobacco. These devices have been misleadingly marketed as "less harmful" alternatives to conventional smoking tobacco products. The e-liquid in e-cigarettes include nicotine, a humectant and other additives including flavourings, colourants, or adulterants such as bacterial and fungal products. In this review, we discuss the contrasting views of the tobacco lobby and most professional societies. We describe the epidemiology of the use of these devices, with a widespread and significant rise in youth e-cigarette use seen in both the USA and Europe. We also describe what is known about the toxicity and mechanisms of EVALI (e-cigarette or vaping associated lung injury). This characterised by respiratory failure with an intense inflammatory response. The presentations are diverse and clinicians should consider vaping as a possible cause of any unusual respiratory illness in patients who have a history of vaping or other use of e-cigarette-related products. Second hand exposure to e-cigarettes is also harmful through respiration and transdermal absorption. E-cigarettes have a worse acute toxicity than tobacco and their long-term toxicity is unknown, and we advocate for the immediate, most vigorous anti-vaping legislation possible.
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Affiliation(s)
- Jayesh Mahendra Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Manisha Ramphul
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, United Kingdom; Paediatric Chest Physician, Royal Brompton & Harefield NHS Foundation Trust, United Kingdom; Imperial Centre for Paediatrics and Child Health, United Kingdom; Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
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31
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Lombardi M, Nunes JP, Carbone S. Cardiovascular effects of heat-not-burn and electronic-vaping-cigarettes in smokers. Minerva Cardioangiol 2020; 68:545-547. [PMID: 32996307 DOI: 10.23736/s0026-4725.20.05337-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - José P Nunes
- Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA -
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32
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Wang L, Chen J, Ho SY, Leung LT, Wang MP, Lam TH. Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes. BMC Public Health 2020; 20:1349. [PMID: 32887586 PMCID: PMC7650221 DOI: 10.1186/s12889-020-09422-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry. Methods The School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses. Results Among 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%). Conclusions Even exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China.
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
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33
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Benson R, Hu M, Chen AT, Nag S, Zhu SH, Conway M. Investigating the Attitudes of Adolescents and Young Adults Towards JUUL: Computational Study Using Twitter Data. JMIR Public Health Surveill 2020; 6:e19975. [PMID: 32876579 PMCID: PMC7495253 DOI: 10.2196/19975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 01/22/2023] Open
Abstract
Background Increases in electronic nicotine delivery system (ENDS) use among high school students from 2017 to 2019 appear to be associated with the increasing popularity of the ENDS device JUUL. Objective We employed a content analysis approach in conjunction with natural language processing methods using Twitter data to understand salient themes regarding JUUL use on Twitter, sentiment towards JUUL, and underage JUUL use. Methods Between July 2018 and August 2019, 11,556 unique tweets containing a JUUL-related keyword were collected. We manually annotated 4000 tweets for JUUL-related themes of use and sentiment. We used 3 machine learning algorithms to classify positive and negative JUUL sentiments as well as underage JUUL mentions. Results Of the annotated tweets, 78.80% (3152/4000) contained a specific mention of JUUL. Only 1.43% (45/3152) of tweets mentioned using JUUL as a method of smoking cessation, and only 6.85% (216/3152) of tweets mentioned the potential health effects of JUUL use. Of the machine learning methods used, the random forest classifier was the best performing algorithm among all 3 classification tasks (ie, positive sentiment, negative sentiment, and underage JUUL mentions). Conclusions Our findings suggest that a vast majority of Twitter users are not using JUUL to aid in smoking cessation nor do they mention the potential health benefits or detriments of JUUL use. Using machine learning algorithms to identify tweets containing underage JUUL mentions can support the timely surveillance of JUUL habits and opinions, further assisting youth-targeted public health intervention strategies.
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Affiliation(s)
- Ryzen Benson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Mengke Hu
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | - Subhadeep Nag
- University Information Technology Infrastructure and Operations, University of Utah, Salt Lake City, UT, United States
| | - Shu-Hong Zhu
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, United States
| | - Mike Conway
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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Chen-Sankey JC, Tan ASL, Moran MB, Soneji S, Lee SJ, Choi K. Sources of awareness, perceptions, and use of JUUL e-cigarettes among adult cigarette smokers. PLoS One 2020; 15:e0238377. [PMID: 32870924 PMCID: PMC7462288 DOI: 10.1371/journal.pone.0238377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Given JUUL e-cigarettes’ potential for smoking cessation and its drastically increased sales in the U.S., more evidence is needed to understand the antecedents of JUUL use among adult cigarette smokers. This study assessed the relationships between awareness sources, perceptions about using JUUL, and JUUL use behavior. Methods In an online study with adult smokers who were aware of JUUL e-cigarettes (n = 341), respondents reported their sources for learning about JUUL, perceptions of using JUUL versus Vuse (a competitor brand), and ever and past-30-day (current) JUUL use. Multivariable logistic regressions were used to examine the associations between awareness sources, perceptions, and JUUL use, adjusting for covariates. Results Learning about JUUL through internet ads was associated with positive perceptions about JUUL compared to Vuse, including JUUL was more fun to use (AOR = 2.04, 95% CI = 1.21, 3.42) and tastier (AOR = 1.96, 95% CI = 1.19, 3.22). Perceiving JUUL as being tastier (AOR = 2.07, 95% CI = 1.23, 3.49), more helpful for quitting smoking (AOR = 2.07, 95% CI = 1.22, 3.53), and cooler (AOR = 2.07, 95% CI = 1.21, 3.56) than Vuse was associated with ever using JUUL. Only perceiving JUUL as being tastier (AOR = 1.98, 95% CI = 1.10, 3.59) than Vuse was associated with current use of JUUL. Discussion Adult smokers may be more likely to focus on the sensory and social experience of using JUUL rather than JUUL’s smoking cessation benefits. These positive perceptions are likely to be influenced by internet ads in general instead of JUUL’s official marketing outlets. They are also more likely to sustain JUUL use than JUUL’s perceived smoking cessation benefits.
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Affiliation(s)
- Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States of America
- * E-mail:
| | - Andy S. L. Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Samir Soneji
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Stella J. Lee
- Department of Media and Communication, Konkuk University, Seoul, Republic of Korea
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States of America
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Kikut A, Williams S, Hornik R. A Toxic Blend: Assessing the Effects of Cross-Source Media Coverage of Flavored E-Cigarettes on Youth and Young Adult Perceptions. JOURNAL OF HEALTH COMMUNICATION 2020; 25:640-649. [PMID: 33104493 PMCID: PMC9447990 DOI: 10.1080/10810730.2020.1834032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Flavored e-cigarettes have received high attention across social and news media. How does exposure to e-cigarette flavors across multiple sources in the media environment influence youth e-cigarette perceptions? To address this question, we identified e-cigarette flavor mentions on 24.3 million Twitter posts and 11,691 longform texts (newspapers, broadcast news, and websites) disseminated over 3 years (2014-2017). During the same period, we measured e-cigarette beliefs through a nationally representative randomly sampled rolling survey of 13-26-year-olds (N = 4,470, 1013 days). We estimated the association between flavor-specific content on Twitter and longform sources in the 28 days prior to each survey date and perceptions that e-cigarettes taste good. The interaction of coverage on Twitter and longform sources was significantly associated with more favorable perceptions of e-cigarette taste (OR = 1.21; 95% CI, 1.04-1.41); the main effects of each source type were not significant. This study presents a novel approach to evaluating the effects of cross-source coverage in today's complex media landscape and may strengthen claims for media influence on e-cigarette use.
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Affiliation(s)
- Ava Kikut
- Corresponding Author: 3620 Walnut St., Annenberg School for Communication, University of Pennsylvania, Philadelphia, 19104, United States, (; phone: 802-777-0456)
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Liu H, Li Q, Zhan Y, Zhang Z, Zeng DD, Leischow SJ. Characterizing Social Media Messages Related to Underage JUUL E-Cigarette Buying and Selling: Cross-Sectional Analysis of Reddit Subreddits. J Med Internet Res 2020; 22:e16962. [PMID: 32706661 PMCID: PMC7400041 DOI: 10.2196/16962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/26/2020] [Accepted: 06/25/2020] [Indexed: 01/18/2023] Open
Abstract
Background Stopping the epidemic of e-cigarette use among youth has become the common goal of both regulatory authorities and health departments. JUUL is currently the most popular e-cigarette brand on the market. Young people usually obtain and exchange information about JUUL with the help of social media platforms. Along with the rising prevalence of JUUL, posts about underage JUUL buying and selling have appeared on social media platforms such as Reddit, which sharply increase the risk of minors being exposed to JUUL. Objective This study aims to analyze Reddit messages about JUUL buying and selling among the users of the UnderageJuul subreddit, and to further summarize the characteristics of those messages. The findings and insights can contribute to a better understanding of the patterns of underage JUUL use, and help public health officials provide timely education and guidance to minors who have intentions of accessing JUUL. Methods We used a novel cross-subreddit method to analyze the Reddit messages on 2 subreddits. From July 9, 2017, to January 7, 2018, we collected data from the UnderageJuul subreddit, which was created for underage JUUL use discussion. The data set included 716 threads, 2935 comments, and 844 Reddit users (ie, Redditors). We collected our second data set, comprising 23,840 threads and 162,106 comments posted between July 9, 2017, and January 8, 2019, from the JUUL subreddit. We conducted analyses including the following: (1) annotation of users with buying/selling intention, (2) posting patterns discovery and topic comparison, and (3) posting activeness observation of discovered Redditors. Term frequency–inverse document frequency and regular expression-enhanced keyword search methods were applied during the content analysis to extract the posting patterns. The public posting records of the discovered users on the JUUL subreddit during the year after the UnderageJuul subreddit was shut down were analyzed to determine whether they were still active and interested in obtaining JUUL. Results Our study revealed the following: (1) Among the 716 threads on the UnderageJuul subreddit, there were 214 threads related to JUUL sale and 168 threads related to JUUL purchase, which accounted for 53.5% (382/714) of threads. (2) Among the 844 Redditors of the UnderageJuul subreddit, 23.82% (201/844) of users were annotated with buying intention, and 21.10% (178/844) of users were annotated with selling intention. There were 34 users with buying/selling intention that self-reported as being <21 years old. (3) The most common key phrases used in selling threads were “WTS,” “want to sell,” “for sale,” and “selling” (154/214, 72.0%). The most common key phrases used in buying threads were “look for/get JUUL/pods” (58/168, 34.5%) and “WTB” (53/168, 31.5%). (4) The most important concern that UnderageJuul Redditors had in obtaining JUULs was the price (311/1306, 23.81%), followed by the delivery service (68/1306, 5.21%). (5) The most popular flavors among the users with buying/selling intention were mango, cucumber, and mint. The flavor preferences remained consistent on both subreddits. Adverse symptoms related to the mango flavor were reported by 3 users on the JUUL subreddit. (6) In total, 24.4% (49/201) of users wanted to buy JUULs and 46.6% (83/178) of users wanted to sell JUULs, including 11 self-reported underage users, who also participated in the discussions on the JUUL subreddit. (7) Within one year of the UnderageJuul subreddit shutting down, there were 40 users who continued to post 186 threads on the JUUL subreddit, including 10 threads indicating buying/selling willingness that were posted shortly after the UnderageJuul subreddit was closed. Conclusions There were overlapping users active in the JUUL and UnderageJuul subreddits. The buying/selling-related content appeared in multiple venues with certain posting patterns from July 9, 2017, to January 7, 2018. Such content might lead to a high risk of health problems for minors, such as nicotine addiction. Based on these findings, this study provided some insights and suggestions that might contribute to the decision-making processes of regulators and public health officials.
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Affiliation(s)
- Hejing Liu
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Qiudan Li
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Shenzhen Artificial Intelligence and Data Science Institute (Longhua), Shenzhen, China
| | - Yongcheng Zhan
- Orfalea College of Business, California Polytechnic State University, San Luis Obispo, CA, United States
| | - Zhu Zhang
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Shenzhen Artificial Intelligence and Data Science Institute (Longhua), Shenzhen, China
| | - Daniel D Zeng
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Shenzhen Artificial Intelligence and Data Science Institute (Longhua), Shenzhen, China
| | - Scott J Leischow
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Lee EW, Bekalu MA, McCloud R, Vallone D, Arya M, Osgood N, Li X, Minsky S, Viswanath K. The Potential of Smartphone Apps in Informing Protobacco and Antitobacco Messaging Efforts Among Underserved Communities: Longitudinal Observational Study. J Med Internet Res 2020; 22:e17451. [PMID: 32673252 PMCID: PMC7381035 DOI: 10.2196/17451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 01/23/2023] Open
Abstract
Background People from underserved communities such as those from lower socioeconomic positions or racial and ethnic minority groups are often disproportionately targeted by the tobacco industry, through the relatively high levels of tobacco retail outlets (TROs) located in their neighborhood or protobacco marketing and promotional strategies. It is difficult to capture the smoking behaviors of individuals in actual locations as well as the extent of exposure to tobacco promotional efforts. With the high ownership of smartphones in the United States—when used alongside data sources on TRO locations—apps could potentially improve tobacco control efforts. Health apps could be used to assess individual-level exposure to tobacco marketing, particularly in relation to the locations of TROs as well as locations where they were most likely to smoke. To date, it remains unclear how health apps could be used practically by health promotion organizations to better reach underserved communities in their tobacco control efforts. Objective This study aimed to demonstrate how smartphone apps could augment existing data on locations of TROs within underserved communities in Massachusetts and Texas to help inform tobacco control efforts. Methods Data for this study were collected from 2 sources: (1) geolocations of TROs from the North American Industry Classification System 2016 and (2) 95 participants (aged 18 to 34 years) from underserved communities who resided in Massachusetts and Texas and took part in an 8-week study using location tracking on their smartphones. We analyzed the data using spatial autocorrelation, optimized hot spot analysis, and fitted power-law distribution to identify the TROs that attracted the most human traffic using mobility data. Results Participants reported encountering protobacco messages mostly from store signs and displays and antitobacco messages predominantly through television. In Massachusetts, clusters of TROs (Dorchester Center and Jamaica Plain) and reported smoking behaviors (Dorchester Center, Roxbury Crossing, Lawrence) were found in economically disadvantaged neighborhoods. Despite the widespread distribution of TROs throughout the communities, participants overwhelmingly visited a relatively small number of TROs in Roxbury and Methuen. In Texas, clusters of TROs (Spring, Jersey Village, Bunker Hill Village, Sugar Land, and Missouri City) were found primarily in Houston, whereas clusters of reported smoking behaviors were concentrated in West University Place, Aldine, Jersey Village, Spring, and Baytown. Conclusions Smartphone apps could be used to pair geolocation data with self-reported smoking behavior in order to gain a better understanding of how tobacco product marketing and promotion influence smoking behavior within vulnerable communities. Public health officials could take advantage of smartphone data collection capabilities to implement targeted tobacco control efforts in these strategic locations to reach underserved communities in their built environment.
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Affiliation(s)
- Edmund Wj Lee
- Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard TH Chan School of Public Health, Boston, MA, United States.,Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Mesfin Awoke Bekalu
- Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Rachel McCloud
- Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Donna Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, United States.,College of Global Public Health, New York University, New York, NY, United States.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Monisha Arya
- Baylor College of Medicine, Houston, TX, United States.,Center for Innovation in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, United States
| | - Nathaniel Osgood
- Department of Computer Science, College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Xiaoyan Li
- Department of Computer Science, College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara Minsky
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Kasisomayajula Viswanath
- Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard TH Chan School of Public Health, Boston, MA, United States
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Kahnert S, Driezen P, Balmford J, Kyriakos CN, Demjén T, Fernández E, Katsaounou PA, Trofor AC, Przewoźniak K, Zatoński WA, Fong GT, Vardavas CI, Mons U. Impact of the Tobacco Products Directive on self-reported exposure to e-cigarette advertising, promotion and sponsorship in smokers-findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii55-iii61. [PMID: 32918820 PMCID: PMC7526780 DOI: 10.1093/eurpub/ckaa055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advertising, promotion and sponsorship of electronic cigarettes (ECAPS) have increased in recent years. Since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) prohibits ECAPS in various advertising channels, including media that have cross-border effects. The objective of this study was to investigate changes in exposure to ECAPS in a cohort of smokers from six European Union member states after implementation of TPD2. METHODS Self-reported exposure to ECAPS overall and in various media and localities was examined over two International Tobacco Control Policy Evaluation survey waves (2016 and 2018) in a cohort of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal generalized estimating equations models. RESULTS Self-reported ECAPS exposure at both timepoints varied between countries and across examined advertising channels. Overall, there was a significant increase in ECAPS exposure [adjusted odds ratio (aOR): 1.25, 95% CI: 1.09-1.44]. Between waves, no consistent patterns of change in ECAPS exposure across countries and different media were observed. Generally, ECAPS exposure tended to decline in some channels regulated by TPD2, particularly on television and radio, while exposure tended to increase in some unregulated channels, such as at points of sale. CONCLUSIONS The findings suggest that the TPD2 was generally effective in reducing ECAPS in regulated channels. Nonetheless, further research is warranted to evaluate its role in reducing ECAPS exposure, possibly by triangulation with additional sources of data.
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Affiliation(s)
- Sarah Kahnert
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Esteve Fernández
- Department of Cancer Epidemiology and Prevention, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
- European Respiratory Society, Lausanne, Switzerland
| | - Antigona C Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
- European Respiratory Society, Lausanne, Switzerland
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
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McKelvey K, Halpern-Felsher B. How and Why California Young Adults Are Using Different Brands of Pod-Type Electronic Cigarettes in 2019: Implications for Researchers and Regulators. J Adolesc Health 2020; 67:46-52. [PMID: 32192827 PMCID: PMC7311231 DOI: 10.1016/j.jadohealth.2020.01.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/22/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of the study was to describe young adult use and perceptions of different brands of pod-based electronic cigarettes (e-cigarettes) and compare with earlier types of non-pod-based e-cigarettes (e.g., mods and tanks). METHODS Data were collected from January to March 2019 and derive from the final wave of a cohort study recruited in 2013-2014 using a convenience sample from 10 large California high schools with racially/ethnically and socioeconomically diverse populations. A total of 445 participants completed an online survey (mean age = 20.1 years [SD = 1.66], 64.8% female [n = 278], 38.8% white [n = 161], 23.9% each for Asian and "more than one race" [n = 99], 13.5% other [n = 56], and 36.9% Hispanic [n = 160]). The main outcomes were description of and reasons to use pods, perceived nicotine content, and use patterns. RESULTS Although <25% of participants reported smoking cigarettes and using non-pod-based e-cigarettes, >25% reported ever use of JUUL. Similarly, <33% of cigarette smokers and non-pod-based e-cigarette users reported use in the past 30 days, and >50% of JUUL ever users did. The most agreed upon reason (58%) for using pods was because they are "easy to hide." About half of pod users "do not know" if they mix brands of e-juice and pods, the nicotine concentration in their e-juice cartridges, nor time to finish a cartridge. Of the 50% of participants who shared their pod, 23 (15%) did "sometimes," 20 (13%) "always," and 16 (11% each) "about half the time" or "often." There was no consensus about how to refer to different brands of pods. CONCLUSIONS Our findings indicate young adults harbor confusion about pod-based e-cigarettes, including nicotine content, usage patterns, and labeling, and that pod use is largely because of the ease with which they can "stealth" vape. The findings suggest needed regulation and education about these products.
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Affiliation(s)
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
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Hendricks KJ, Temples HS, Wright ME. JUULing Epidemic Among Youth: A Guide to Devices, Terminology, and Interventions. J Pediatr Health Care 2020; 34:395-403. [PMID: 32564873 DOI: 10.1016/j.pedhc.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
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Lee SJ, Rees VW, Yossefy N, Emmons KM, Tan ASL. Youth and Young Adult Use of Pod-Based Electronic Cigarettes From 2015 to 2019: A Systematic Review. JAMA Pediatr 2020; 174:714-720. [PMID: 32478809 PMCID: PMC7863733 DOI: 10.1001/jamapediatrics.2020.0259] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The use of electronic cigarettes (e-cigarettes) has rapidly increased among youth and young adults, but knowledge gaps exist on the potential health effects of using recently introduced pod-based e-cigarettes. OBJECTIVE To conduct a systematic review of recent peer-reviewed scientific literature on pod-based e-cigarettes. EVIDENCE REVIEW A search of online databases, including PubMed, Web of Science, Embase, and EBSCO HOST, was conducted to identify pod-based e-cigarette-associated articles from June 2015 (the time when JUUL [JUUL Labs] was introduced) to June 2019. We included English-language articles that presented primary data on pod-based e-cigarettes. FINDINGS Pod-based e-cigarettes represent a substantial evolution in design by increasing the efficient delivery of nicotine. While these products may contain less harmful constituents than other types of e-cigarettes and cigarettes, there is no evidence that the levels found are safe among youth. There is evidence for higher nicotine dependence associated with their use. Pod-based e-cigarette brands, compared with other e-cigarette brands, have targeted youth and young adults with social media marketing. There was less discussion about the use of these products as smoking cessation devices or their health risks on social media. The social acceptability and favorable perceptions of pod-based e-cigarettes may underlie the use of these products. CONCLUSIONS AND RELEVANCE The appeal and dependence potential of pod-based e-cigarettes for youth emphasize the need for stronger regulations on product design, social media, marketing channels, and youth access together with health communications that emphasize the risks of nicotine dependence.
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Affiliation(s)
- Stella Juhyun Lee
- Department of Media and Communication, Konkuk University, Seoul, South Korea
| | - Vaughan W. Rees
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Noam Yossefy
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Karen M. Emmons
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Andy S. L. Tan
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts,Dana-Farber Cancer Institute, Population Sciences Division, Center for Community Based Research, Boston, Massachusetts
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Jun J. Age restriction and warnings for minor viewing and health risk in heated tobacco product videos on YouTube. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1779832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jungmi Jun
- School of Journalism and Mass Communication, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
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Amin S, Dunn AG, Laranjo L. Exposure to e-cigarette information and advertising in social media and e-cigarette use in Australia: A mixed methods study. Drug Alcohol Depend 2020; 213:108112. [PMID: 32574981 DOI: 10.1016/j.drugalcdep.2020.108112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to explore how e-cigarette users in Australia accessed e-cigarette information and advertising on social media platforms. METHODS The mixed-methods study design included a survey and semi-structured interviews. Data were collected from March 2019 to July 2019 in Australia. Interviews were conducted following survey participation. Analysis of survey results examined associations between social media and advertising factors and use of e-cigarettes. Thematic analysis methods were applied to interview responses to explore e-cigarette information search and advertising exposure in different social media channels. RESULTS The survey had 185 respondents and 14 participated in the interviews. The average social media use time was 11.4 h/week (SD ± 2.05). A total of 91 (49.2 %) participants sought out relevant information and 104 (56.2 %) were exposed to e-cigarette advertisements on social media platforms. Participants who searched for e-cigarette information on social media were more likely to report past (OR = 5.04; 95 % CI 2.23-11.42; p = 0.001) or current e-cigarette use (OR = 9.27; 95 % CI 4.22-20.34; p = 0.001), compared to participants who had never used e-cigarettes. The same relationship was observed for exposure to e-cigarette advertising. Thematic analysis of interviews revealed the diversity of sources of information for e-cigarettes, the pervasiveness of advertising, and the importance of peer recommendations. CONCLUSIONS Australian e-cigarette users seek or are exposed to e-cigarette information on a variety of social media platforms. Access to e-cigarette information was concentrated among e-cigarette users but peer influence may be a risk for 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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Biondi Zoccai G, Carnevale R, Vitali M, Tritapepe L, Martinelli O, Macrina F, Bullen C, Peruzzi M, Cavarretta E, Marullo AG, Abbate A, Romagnoli E, Sciarretta S, Casati R, Visconti G, Versaci F, Frati G. A randomized trial comparing the acute coronary, systemic, and environmental effects of electronic vaping cigarettes versus heat-not-burn cigarettes in smokers of combustible cigarettes undergoing invasive coronary assessment: rationale and design of the SUR-VAPES 3 trial. Minerva Cardioangiol 2020; 68:548-555. [PMID: 32492988 DOI: 10.23736/s0026-4725.20.05181-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Traditional combustible cigarette (TCC) smoking remains a major cause of preventable cardiovascular morbidity and mortality. Modified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) may be safer than TCC but may still have detrimental oxidative, platelet and vascular effects of particular importance to people with symptomatic coronary artery disease (CAD). METHODS We aimed to compare the acute coronary, systemic and environmental effects of two leading MRP in 20 TCC smokers admitted for invasive coronary assessment of CAD and willing to quit or after prior failed quitting attempts. After confirmation at angiography of an intermediate coronary stenosis, coronary flow reserve (CFR) will be appraised. Patients will then be randomized 1:1 to use a single EVC or a single HNBC in the catheterization laboratory, followed by repeat CFR measurement. The primary endpoint will be the change in CFR before and after product use. Quantitative coronary angiography, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) will also be measured. RESULTS We expected to accrue results able to: 1) test whether MRP have in general a detrimental impact on coronary vascular function in TCC smokers; 2) test whether EVC have a different impact than HNBC on coronary function; 3) provide ancillary pathophysiologic and translational insights on the acute risk and safety profile of MRP in TCC smokers with established cardiovascular disease, including complex correlations between coronary, cardiac, systemic and environmental effects. In addition, by directly informing participants of their individual results, they will be further empowered to quit TCC. CONCLUSIONS The Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking (SUR-VAPES) 3 trial will provide important insights into the pathophysiologic cardiovascular impact of EVC and HNBC, also suitable to inform patients and individualize their smoking cessation strategy.
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Affiliation(s)
- Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy -
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Luigi Tritapepe
- Unit of Anesthesiology and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Francesco Macrina
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Chris Bullen
- School of Population Health, National Institute for Health Innovation, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonino G Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Antonio Abbate
- Pauley Heart Center, Wright Center for Clinical and Translation Research, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Naples, Italy
| | - Rebecca Casati
- UOC UTIC Emodinamica e Cardiologia, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Santa Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Naples, Italy
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45
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Kim Y, Emery SL, Vera L, David B, Huang J. At the speed of Juul: measuring the Twitter conversation related to ENDS and Juul across space and time (2017-2018). Tob Control 2020; 30:137-146. [PMID: 32198278 PMCID: PMC7907568 DOI: 10.1136/tobaccocontrol-2019-055427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 11/12/2022]
Abstract
Background Electronic nicotine delivery systems (ENDS) are the most-used tobacco product by adolescents, and Juul has rapidly become the most popular ENDS brand. Evidence indicates that Juul has been marketed heavily on social media. In light of recent lawsuits against the FDA spurred by claims that the agency responded inadequately to this marketing push, measuring the social media conversation about ENDS like Juul has important public health implications. Methods We employed search filters to collect Juul-related and other ENDS-related data from Twitter in 2017–2018 using Gnip Historic PowerTrack. Trained coders labelled random samples for Juul and ENDS relevance, and the labelled samples were used to train a supervised learning classifier to filter out irrelevant tweets. Tweets were geolocated into US counties and their fitness for use was assessed. Results The amount of Juul-related tweets increased 67 times over the study period (from 18 849 in the first quarter of 2017 to 1 287 028 in the last quarter of 2018), spreading widely across US counties. By the last quarter 2018, 34% of US counties had more than 6 Juul-related posts per 10 000 people, up from 0% in the first quarter 2017. However, during the same period, the total of non-Juul ENDS-related tweets decreased by 25%. Conclusions Juul-related content grew exponentially on Twitter and spread across the entire country during the time when the brand was gaining market share. This social media buzz continued to increase even after FDA’s multiple interventions to curb promotions targeting minors.
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Affiliation(s)
- Yoonsang Kim
- Social Data Collaboratory, Public Health, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Sherry L Emery
- Social Data Collaboratory, Public Health, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Lisa Vera
- VeraCite Inc, La Jolla, California, USA
| | - Bryn David
- Center for Excellence in Survey Research, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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46
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Mallock N, Trieu HL, Macziol M, Malke S, Katz A, Laux P, Henkler-Stephani F, Hahn J, Hutzler C, Luch A. Trendy e-cigarettes enter Europe: chemical characterization of JUUL pods and its aerosols. Arch Toxicol 2020; 94:1985-1994. [PMID: 32189038 PMCID: PMC7303078 DOI: 10.1007/s00204-020-02716-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
The popularity and the high nicotine content of the American pod e-cigarette JUUL have raised many concerns. To comply with European law, the nicotine concentration in the liquids of the European version, which has been recently released on the market, is limited to below 20 mg/mL. This limit can possibly be circumvented by technological adjustments that increase vaporization and consequently, elevate nicotine delivery. In this study, we compare vapor generation and nicotine delivery of the initial European version, a modified European version, and the original American high-nicotine variant using a machine vaping set-up. Additionally, benzoic acid and carbonyl compounds are quantified in the aerosol. Further, concentrations of nicotine, benzoic acid, propylene glycol, and glycerol, along with the density and pH value of JUUL e-liquids have been assessed. Whereas the initial European version did not compensate for the low nicotine content in the liquid, we provide evidence for an increased vaporization by the modified European version. As a consequence, nicotine delivery per puff approximates the American original. Notably, this is not associated with an increased generation of carbonyl compounds. Our data suggest a similar addictiveness of the enhanced European version and the original American product.
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Affiliation(s)
- Nadja Mallock
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany.
- Department of Biology, Chemistry, Pharmacy, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany.
| | - Hai Linh Trieu
- Official Chemical and Veterinary Surveillance Institute Sigmaringen (CVUA), Sigmaringen, Germany
| | - Miriam Macziol
- Official Chemical and Veterinary Surveillance Institute Sigmaringen (CVUA), Sigmaringen, Germany
| | - Sebastian Malke
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Aaron Katz
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Peter Laux
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Frank Henkler-Stephani
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Jürgen Hahn
- Official Chemical and Veterinary Surveillance Institute Sigmaringen (CVUA), Sigmaringen, Germany
| | - Christoph Hutzler
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
- Department of Biology, Chemistry, Pharmacy, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
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47
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Neal JW. A systematic review of social network methods in high impact developmental psychology journals. SOCIAL DEVELOPMENT 2020. [DOI: 10.1111/sode.12442] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Abstract
This chapter reviews the array of methods used in contemporary research on population-level research on substance use and its consequences. We argue that there are critical questions that can best - or in some cases, only - be addressed at the level of a population. We then describe the major categories of data collection methods used in population research, including surveys, ecological momentary assessment, administrative data, audit methods, and unobtrusive assessment of substance use. Two categories of measures are then discussed: measures of an individual's use of substances and related problems and measures of harm to others caused by one's use. We then review factors that may be considered causes or correlates of substance use and consequences, including both individual and environmental factors. We close with a few thoughts on the accumulation of knowledge and its translation to policy and practice.
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49
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Sidani JE, Colditz JB, Barrett EL, Chu KH, James AE, Primack BA. JUUL on Twitter: Analyzing Tweets About Use of a New Nicotine Delivery System. THE JOURNAL OF SCHOOL HEALTH 2020; 90:135-142. [PMID: 31828791 PMCID: PMC7034811 DOI: 10.1111/josh.12858] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/21/2019] [Accepted: 05/11/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND Initial reports suggest that JUUL, a popular e-cigarette, is being used in schools and other locations in which cigarette smoking is illegal or discouraged. However, there is little scholarly research documenting this. We aimed to make a systematic analysis of JUUL use themes and sentiment on Twitter. METHODS Data were collected from Twitter's Filtered Streams Application Programming Interface from April 12, 2018 to May 10, 2018. This yielded 67,934 tweets, from which a random sample of 2% was selected for coding. The final dataset included 1209 tweets. Inter-rater reliability ranged κ = 0.64-0.85. RESULTS The majority (71.5%) of tweets expressed positive sentiment toward JUUL. JUUL use in places where cigarette smoking is illegal or discouraged appeared in 111 tweets (9.2%); approximately one-third of these tweets referring to using the device in school. Nearly 20% of tweets mentioned using the device at home and/or directly in front of responsible adults. CONCLUSIONS This study confirms anecdotal reports of JUUL use in places where cigarette smoking is illegal or discouraged. Positive sentiment about use of JUUL suggests that the product is being normalized among young people. It may be valuable for educators to discuss the addictive nature of nicotine delivered through JUUL with younger populations.
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Affiliation(s)
- Jaime E Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Jason B Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Erica L Barrett
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Kar-Hai Chu
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - A Everette James
- Health Policy Institute, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261
| | - Brian A Primack
- University of Arkansas College of Education and Health Professions, 1 University of Arkansas, Fayetteville, AR, 72701
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50
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Stalgaitis CA, Navarro MA, Wagner DE, Walker MW. Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes. Subst Use Misuse 2020; 55:1045-1053. [PMID: 32024418 DOI: 10.1080/10826084.2020.1722698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.
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Affiliation(s)
| | - Mario A Navarro
- Center for Tobacco Products, Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | | | - Matthew W Walker
- Center for Tobacco Products, Food and Drug Administration (FDA), Silver Spring, Maryland, USA
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