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Whaley RC, Harlow AF, Krueger EA, Stone MD, Dimofte CV, Strong DR, Barrington-Trimis JL. Importance of Various E-Cigarette Device and E-Liquid Characteristics by Smoking Status among Young Adults Who Vape. Subst Use Misuse 2024:1-8. [PMID: 38816913 DOI: 10.1080/10826084.2024.2360097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND E-cigarette product characteristics are known to influence appeal among young adults. Understanding which characteristics appeal to individuals with (vs. without) a history of combusted tobacco use is essential for developing effective tobacco control policies. METHODS Anonymous, self-report data were collected from young adults (18-30 years) who had used e-cigarettes in the past 30 days (n = 295) online via Prolific from September-October 2019. Using a visual analogue scale (range: 0-100), participants rated the importance of ten e-cigarette device and nine e-liquid characteristics. Adjusted linear regression models were used to evaluate the association of combusted tobacco use status (never, former, current) with mean rating scores for each of the nineteen characteristics. RESULTS The most important e-cigarette device characteristics were price (Mean = 81.1; [SD = 17.9]), size (Mean = 75.5 [SD = 20.9]), and hit strength (Mean = 73.8 [SD = 20.4]) while the most important e-liquid characteristics were flavor (M = 85.1 [SD = 16.3]), price (M = 80.9 [SD = 18.4]), and nicotine level (M = 77.8 [18.9]). Differences by combusted tobacco use status were observed for device brand, temperature/voltage, customizability, color, and popularity, with the highest ratings generally observed among those concurrently using combustible tobacco products. For e-liquids, differences by use status were observed for flavor, price, and bottle type. Notably, those concurrently using combusted products rated flavor as less important than those with no history of combustible tobacco use (B=-5.01[95%CI=-9.97, -0.05]). CONCLUSIONS The self-rated importance of e-cigarette device and e-liquid attributes varies by combustible tobacco use status among young adults which may be used to inform regulatory decisions regarding e-cigarette product characteristics.
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Affiliation(s)
- Reid C Whaley
- Department of Population and Public Health Sciences, Keck School of Medicine at USC, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, Keck School of Medicine at USC, University of Southern California, Los Angeles, California, USA
| | - Alyssa F Harlow
- Department of Population and Public Health Sciences, Keck School of Medicine at USC, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, Keck School of Medicine at USC, University of Southern California, Los Angeles, California, USA
| | - Evan A Krueger
- School of Social Work, Tulane University, New Orleans, Los Angeles, USA
| | - Matthew D Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, USA
- Moores Cancer Center, University of California, San Diego, San Diego, California, USA
| | - Claudiu V Dimofte
- Department of Marketing, Fowler College of Business, San Diego State University, San Diego, California, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, USA
- Moores Cancer Center, University of California, San Diego, San Diego, California, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine at USC, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, Keck School of Medicine at USC, University of Southern California, Los Angeles, California, USA
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O'Neal RA, Carpenter MJ, Wahlquist AE, Leavens ELS, Smith TT, Fahey MC. The prospective relationship between a-priori intentions for and patterns of e-cigarette use among adults who smoke cigarettes. Addict Behav 2024; 156:108067. [PMID: 38823347 DOI: 10.1016/j.addbeh.2024.108067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Electronic (e-)cigarettes may help adult cigarette smokers achieve cigarette cessation, depending on patterns of e-cigarette use. Among cigarette smokers who do not use e-cigarettes, it is unclear if and how a-priori intentions for use are related to uptake patterns. Longitudinal studies have focused on established e-cigarette users or adolescent and young adult populations exclusively. METHODS Within a nationwide randomized clinical trial (N = 638), adult cigarette smokers not currently using e-cigarettes were randomized (2:1) to receive (or not) one-month sampling of e-cigarettes. An exploratory factor analysis (EFA) was performed on an established 15-item measure assessing a-priori intentions for e-cigarette use to identify latent variables. Among those receiving e-cigarette products, regression models examined relationships between intentions and: 1) uptake (yes/no), 2) frequency (number of days per week), and 3) amount (puffing episodes per day) of e-cigarette use at one-month follow-up. RESULTS Two factors emerged from the EFA: 1) cigarette-related intentions (e.g., cigarette cessation, no smell) and 2) novel appeal of e-cigarettes (e.g., flavors). Three items remained and were treated as separate intentions: "feels like cigarette smoking", "curiosity", and "affordability". In the final multivariable models, "feel like cigarette smoking" predicted more frequent e-cigarette use (β = 0.187, SE = 0.086, p = 0.03); however, none of the five factors/intentions were significantly associated with uptake or amount of use. CONCLUSIONS For adult cigarette smokers not currently using e-cigarettes, a-priori intentions for using e-cigarettes might not be predictive of if or how these products will be used in the future, suggesting that motives may not drive use behavior.
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Affiliation(s)
- Riley A O'Neal
- Arnold School of Public Health, University of South Carolina, United States
| | - Matthew J Carpenter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), United States; Department of Public Health Sciences, MUSC, United States; Hollings Cancer Center, MUSC, United States
| | - Amy E Wahlquist
- Center for Rural Health Research, East Tennessee State University, United States
| | - Eleanor L S Leavens
- Department of Population Health, The University of Kansas School of Medicine, United States; The University of Kansas Comprehensive Cancer Center, United States
| | - Tracy T Smith
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), United States; Hollings Cancer Center, MUSC, United States
| | - Margaret C Fahey
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC), United States.
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Hair EC, Do EK, Liu SM, Tulsiani S, Vallone DM, Pierce JP. Patterns of Daily Cigarette and E-cigarette Use among United States Youth and Young Adults: Insights from the Truth Longitudinal Cohort between 2018 and 2019. Prev Med Rep 2023; 36:102416. [PMID: 37753384 PMCID: PMC10518703 DOI: 10.1016/j.pmedr.2023.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Temporal patterns of daily tobacco product use among ever users from the Truth Longitudinal Cohort (TLC) between 2018 and 2019 were explored. Methods The sample (N = 5274) includes individuals (15-36 years), residing in the United States, who had ever used any tobacco product at Wave 7 (February - May 2018) and provided tobacco use information at Wave 9 (September - December 2019). Results There was a nonsignificant 1.1 percentage point increase in daily tobacco use (on at least 25 of the past 30 days), from 14.6% (95% CI: 12.8, 16.6) to 15.7% (95% CI: 13.8, 17.7). Tobacco product use remained stable over time, as 65.3% (95% CI: 56.4, 73.3) of daily cigarette smokers, 57.0% (95% CI: 43.6, 69.4) of daily e-cigarette vapers, and 8.5% (95% CI: 2.0, 29.3) of daily dual users stayed with their primary tobacco product. There was also some evidence of switching, as 7.5% (95% CI: 3.7, 14.8) of daily cigarette smokers became daily e-cigarette vapers and 2.3% (95% CI: 0.7, 6.8) of daily e-cigarette vapers became daily cigarette smokers. Discussion Although most daily tobacco users were likely to continue using their primary product, some daily users transitioned to daily use of other products - suggesting that policies and public education focused on reducing overall nicotine use are essential for addressing the nicotine epidemic among young people.
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Affiliation(s)
- Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth K. Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Donna M. Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego Cancer, La Jolla, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
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Gravely S, Yong HH, Reid JL, East KA, Liber AC, Michael Cummings K, Quah AC, Fong GT, Hammond D. An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey. Prev Med Rep 2023; 33:102201. [PMID: 37223550 PMCID: PMC10201827 DOI: 10.1016/j.pmedr.2023.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/25/2023] Open
Abstract
Several nicotine vaping product (NVP) device types are available to consumers, and many people who smoke report vaping to help them quit. This study included data from the Wave 3 (2020) ITC Smoking and Vaping Survey in the US, Canada, and England and included 2324 adults who were smoking cigarettes and vaping at least weekly. Device types currently used most often (disposables, cartridges/pods, or tank systems) were assessed using weighted descriptive statistics. Multivariable regression analyses were used to compare differences between respondents who reported vaping to quit smoking ('yes' vs. 'no/don't know') by device type, overall and by country. Overall, 71.3% of respondents reported vaping to help them quit smoking, with no country differences (p = 0.12). Those using tanks (78.7%, p < 0.001) and cartridges/pods (69.5%, p = 0.02) were more likely to report this reason for vaping than those using disposables (59.3%); respondents using tanks were also more likely than those using cartridges/pods (p = 0.001) to report this reason. By country, respondents in England using cartridges/pods or tanks (vs. disposables) were more likely to report vaping to quit smoking (with no difference between cartridges/pods and tanks). In Canada, respondents using tanks were more likely to report vaping to quit smoking than those using cartridges/pods or disposables (no difference between disposables and cartridges/pods). No significant differences by device type were found in the US. In conclusion, most adult respondents who smoked and vaped reported using either cartridges/pods or tanks, which were associated with greater odds of vaping for the purpose of quitting smoking versus disposables, with some country variations.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Hua-Hie Yong
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Jessica L. Reid
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Katherine A. East
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA
| | - Anne C.K. Quah
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- Ontario Institute for Cancer Research, 661 University Ave., Toronto, ON M5G 0A3, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
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Romm KF, Cohn AM, Wang Y, Berg CJ. Psychosocial predictors of trajectories of dual cigarette and e-cigarette use among young adults in the US. Addict Behav 2023; 141:107658. [PMID: 36812780 PMCID: PMC10154740 DOI: 10.1016/j.addbeh.2023.107658] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/13/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Young adults have the highest prevalence of cigarette and e-cigarette use, warranting research to identify psychosocial correlates of their use trajectories. METHODS Repeated measures latent profile analyses (RMLPAs) examined past 6-month cigarette and e-cigarette trajectories across 5 waves of data (2018-2020) among 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 60.2% racial/ethnic minority). Multinomial logistic regression models examined associations among psychosocial factors (i.e., depressive symptoms, adverse childhood experiences [ACEs], personality traits) and trajectories of cigarette and e-cigarette use, controlling for sociodemographics and past 6-month alcohol and cannabis use. RESULTS RMLPAs yielded a 6-profile solution, which were uniquely associated with predictors: stable low-level or nonusers of cigarettes and e-cigarettes (66.3%; referent group), stable low-level cigarette and high-level e-cigarette use (12.3%; greater depressive symptoms, ACEs, openness; male, White, cannabis use), stable mid-level cigarette and low-level e-cigarette use (6.2%; greater depressive symptoms, ACEs, extraversion; less openness, conscientiousness; older age, male, Black or Hispanic, cannabis use), stable low-level cigarette and decreasing e-cigarette use (6.0%; greater depressive symptoms, ACEs, openness; younger age, cannabis use), stable high-level cigarette and low-level e-cigarette use (4.7%; greater depressive symptoms, ACEs, extraversion; older age, cannabis use), and decreasing high-level cigarette and stable high-level e-cigarette use (4.5%; greater depressive symptoms, ACEs, extraversion, less conscientiousness; older age, cannabis use). CONCLUSIONS Cigarette and e-cigarette prevention and cessation efforts should be targeted both toward specific trajectories of use and their unique psychosocial correlates.
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Affiliation(s)
- Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, Univeristy of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, Univeristy of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington Cancer Center, George Washington University, Washington, DC, USA
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Kim S, Shiffman S, Sembower MA. US adult smokers' perceived relative risk on ENDS and its effects on their transitions between cigarettes and ENDS. BMC Public Health 2022; 22:1771. [PMID: 36123722 PMCID: PMC9484256 DOI: 10.1186/s12889-022-14168-8] [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: 05/04/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Perceived risk reduction motivates smokers to switch to electronic nicotine delivery systems (ENDS). This research examines US smokers’ relative risk perceptions and their prospective association with various behavioral stages of switching to ENDS. Methods Data from the nationally representative, longitudinal Population Assessment of Tobacco and Health (PATH) Adult survey, Waves 1 (2014) through 5 (2019), were analyzed. We assessed the association between the perceived risk of ENDS relative to cigarettes (“less harmful” vs. “equally harmful” or “more harmful”) and 1) adoption of ENDS (among never-ENDS-using smokers), 2) complete switching to ENDS (i.e., stopping smoking, among ever-ENDS-using smokers), and 3) avoiding reversion to smoking (among smokers who had switched to ENDS), at the next wave. Results The proportion of US smokers perceiving ENDS as less harmful than cigarettes continually decreased, reaching 17.4% in Wave 5 (2019). Current smokers with such belief were more likely to adopt ENDS (aOR 1.31; 95% CI 1.15–1.50) and switch completely to ENDS (aOR 2.24; 95% CI 1.89–2.65) in the subsequent wave. Among smokers who had switched within the past year, such beliefs predicted avoidance of resumption of smoking in the next wave (aOR 0.55; 95% CI 0.33–0.93). Conclusions Smokers’ beliefs about the relative risk of ENDS compared to cigarettes had a strong and consistent association with transitions between smoking and ENDS use. Addressing the growing misperception about ENDS has the potential to contribute to public health by encouraging smokers’ switching to ENDS. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14168-8.
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Affiliation(s)
- Sooyong Kim
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA.
| | - Saul Shiffman
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA
| | - Mark A Sembower
- PinneyAssociates Inc, 201 N. Craig St, Ste 320, Pittsburgh, PA, 15213, USA
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Kinchen G, Cox S, Kale D, Shahab L. Facilitators and barriers for harm reduction after first use of novel nicotine delivery devices: a qualitative investigation of cigarette smokers. BMC Psychol 2022; 10:190. [PMID: 35906688 PMCID: PMC9336076 DOI: 10.1186/s40359-022-00874-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Novel nicotine delivery devices (NNDDs) are a safer alternative to combustible tobacco smoking. Understanding what factors can facilitate people who smoke to use NNDDs can inform intervention design and public health messaging. This study aims to explore the facilitators and barriers to NNDD use from the perspective of smokers without prior use, after trialling two NNDDs. METHOD UK adults who smoke combustible cigarettes (n = 11) were recruited from a larger quantitative study after trialling two NNDDs, an electronic cigarette and a heated tobacco product (order randomly allocated). Semi-structured interviews were conducted, transcribed and thematically analysed, using the COM-B model of behaviour and NVivo12 pro software. RESULTS Five main themes were identified: health knowledge, availability of and accessibility to NNDD products, cost, social acceptance, and NNDD use experience. There was curiosity and interest in the uptake and use of NNDDs, but the absence of centralised product information was identified as a barrier. Other themes were related to the design and functionality of the NNDD products. For example, the e-cigarette with its low maintenance was seen as easier to use than the heated tobacco product, which offered too short a single use duration and was described as 'cumbersome'. Throat discomfort and high anticipated cost were among additional barriers identified for both product types. CONCLUSION This study highlights the need for reliable objective information on the health effects of NNDDs compared with combustible cigarettes, which could facilitate their regular use. Product adjustment such as single use duration alignment with combustible cigarette smoking duration may encourage uptake. Interventions offering opportunity for experience of NNDD use and knowledge dissemination of NNDDs could increase motivation to adopt harm reducing behaviours as demonstrated in this study.
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Affiliation(s)
- Gill Kinchen
- Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London, WC1E 6BT UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London, WC1E 6BT UK
| | - Dimitra Kale
- Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London, WC1E 6BT UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London, WC1E 6BT UK
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Moustafa AF, Rodriguez D, Pianin SH, Testa SM, Audrain-McGovern JE. Dual Use of Nicotine and Cannabis Through Vaping Among Adolescents. Am J Prev Med 2022; 63:60-67. [PMID: 35365396 PMCID: PMC9232951 DOI: 10.1016/j.amepre.2021.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study seeks to identify adolescent nicotine and cannabis vaping patterns and the characteristics of those adolescents who comprised each pattern. METHODS This prospective longitudinal survey study measured the relationship between nicotine and cannabis vaping among 1,835 adolescents from 4 public high schools outside of Philadelphia, Pennsylvania. Adolescents completed in-classroom surveys, including questions of lifetime and past 30-day nicotine and cannabis vaping, at Wave 1 (fall 2016, ninth grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). Data were analyzed in 2021. RESULTS A sequential processes growth mixture model revealed 4 latent conjoint classes of nicotine and cannabis vaping: early, declining dual use (Class 1: n=259); rapidly increasing dual use (Class 2: n=128); later, slower dual use (Class 3: n=313); and no use (Class 4: n=1,136). Increased odds of belonging to Class 1 and Class 2 versus belonging to Class 4 were significantly associated with cigarette smoking (OR=3.71, OR=2.21), alcohol use (OR=2.55, OR=4.39), peer vaping (OR=1.24, OR=1.20), sensation seeking (OR=1.03, OR=1.11), positive E-cigarette expectations (OR=1.21, OR=1.17), and cigar smoking (OR=2.39 Class 2 only). Increased odds of belonging to Class 3 versus Class 4 were significantly associated with alcohol use (OR=1.66), perceived benefits of E-cigarette use (OR=1.03), positive E-cigarette expectations (OR=1.08), depressive symptoms (OR=1.02), and sensation seeking (OR=1.03). CONCLUSIONS From middle to late adolescence, vaping of nicotine and cannabis develop in close parallel. Regulatory policy and prevention interventions should consider the interplay between these 2 substances during this period of adolescence.
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Affiliation(s)
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania
| | - Stephen H Pianin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shannon M Testa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janet E Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Pérez A, Bluestein MA, Kuk AE, Chen B. Age of e-cigarette initiation in USA young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study (2013-2017). PLoS One 2021; 16:e0261243. [PMID: 34898629 PMCID: PMC8668126 DOI: 10.1371/journal.pone.0261243] [Citation(s) in RCA: 4] [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: 05/14/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There is a lack of research prospectively estimating the age of e-cigarette initiation in U.S. young adults. METHODS Secondary analysis of PATH young adults across 2013-2017 (waves 1-4) were conducted. We prospectively estimated age of initiation of: ever, past 30-day, and fairly regular e-cigarette use using weighted interval-censoring survival analyses. Interval-censoring Cox proportional hazard models adjusting for sex, race/ethnicity, and previous use of six other tobacco products (cigarettes, traditional cigars, filtered cigars, cigarillos, hookah, and smokeless tobacco) were fitted for each of the three e-cigarette initiation outcomes. RESULTS Among never e-cigarette users, by age 21, 16.8% reported ever use, 7.2% reported past 30-day use, and 2.3% reported fairly regular e-cigarette use. Males had increased risk of initiating ever, past 30-day, and fairly regular e-cigarette use at earlier ages compared to females. Hispanic young adults had increased risk of initiating ever and past 30-day e-cigarette use at earlier ages compared to Non-Hispanic White young adults. Previous use of other tobacco products before e-cigarette initiation increased the risk of an earlier age of e-cigarette initiation. CONCLUSION Prevention and education campaigns should focus on young adults in order to alleviate the public health burden of initiating e-cigarette use at earlier ages.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
| | - Baojiang Chen
- Department of Biostatistics and Data Science, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas, United States of America
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10
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Moustafa AF, Rodriguez D, Mazur A, Audrain-McGovern J. Adolescent perceptions of E-cigarette use and vaping behavior before and after the EVALI outbreak. Prev Med 2021; 145:106419. [PMID: 33422576 PMCID: PMC8474118 DOI: 10.1016/j.ypmed.2021.106419] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023]
Abstract
This study sought to determine whether adolescents' e-cigarette risk perceptions, perceived benefits, and positive expectations, and vaping behavior changed after the electronic-cigarette or vaping product use-associated lung injury (EVALI) outbreak. This longitudinal survey studied 1539 high school students in suburban Philadelphia, PA in 11th and 12th grade, before and after the outbreak of EVALI cases in 2019. Adolescents who reported current nicotine vaping at baseline (versus those who did not) had a greater increase in risk perceptions (B = -0.31, p = 0.04) and a greater decrease in positive expectations (B = -1.30, p = 0.003) at follow-up. Adolescents who reported current marijuana vaping at baseline (versus those who did not) had greater perceived benefits (B = 2.19, p < 0.001), lower risk perceptions (B = 0.39, p < 0.001), and greater positive expectations of e-cigarette use (B = 1.43, p < 0.001) across time. Odds of current nicotine vaping at follow-up increased (OR = 1.61, 95% CI = 1.08, 2.41) for adolescents who maintained lower risk perceptions. Odds of current nicotine vaping at follow-up decreased (OR = 0.33, 95% CI = 0.21, 0.50) for adolescents whose positive expectations of e-cigarette use decreased. The odds of current marijuana vaping at follow-up decreased (OR = 0.64, 95% CI = 0.42, 0.98) for adolescents whose positive expectations of e-cigarette use decreased. Perceptions of the risks of e-cigarette use increased and positive expectations of e-cigarette use decreased after the EVALI outbreak. Adolescent risk perceptions and positive expectations of e-cigarette use are two potential targets to impact vaping behavior. Emphasizing the risks of e-cigarette use while decreasing positive expectations of use have the potential to reduce vaping behavior, and perhaps subsequent EVALI cases.
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Affiliation(s)
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, LaSalle University, Philadelphia, PA, USA
| | - Alexa Mazur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Ashley DL, Spears CA, Weaver SR, Huang J, Eriksen MP. E-cigarettes: How can they help smokers quit without addicting a new generation? Prev Med 2020; 140:106145. [PMID: 32473270 PMCID: PMC7680279 DOI: 10.1016/j.ypmed.2020.106145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/01/2020] [Accepted: 05/24/2020] [Indexed: 12/17/2022]
Abstract
The dramatic increase in youth use of electronic nicotine delivery systems (ENDS; e.g., e-cigarettes) in the United States has focused regulatory efforts to address this concern while still encouraging smokers to switch completely to lower risk products or quit all tobacco product use. Increases in the minimum age for purchase of all tobacco products and changes in enforcement policy for ENDS have been recently enacted in an effort to address the youth vaping epidemic. Since all ENDS marketed after February 15, 2007 will be required to meet the "appropriate for the protection of public health" standard for marketing authorization of new products, ENDS manufacturers will have to demonstrate, in part, that their products help lessen the adverse impact on youth use. Some, such as disallowing flavors other than tobacco or menthol or limiting nicotine delivery, may help reduce youth use but could also inhibit smokers from quitting smoking. Other approaches, including reducing the high-tech appearance and discreteness of ENDS, discontinuing use of coupons and two-for-one type price incentives for ENDS, limiting retail sales of these products to adult-only facilities, and incorporating technological innovations such as biometrics or geofencing into ENDS, may help manufacturers demonstrate that marketing of their products would help reduce youth use of ENDS and lessen the epidemic, while still assuring adult smokers have access to products that encourage discontinuing combusted product use.
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Affiliation(s)
- David L Ashley
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America; Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America.
| | - Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Scott R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America; Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Jidong Huang
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Michael P Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America
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Pérez A, Bluestein M, Chen B, Perry CL, Harrell MB. PROSPECTIVELY ESTIMATING THE AGE OF INITIATION OF E-CIGARETTES AMONG U.S. YOUTH: FINDINGS FROM THE POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH) STUDY, 2013-2017. JOURNAL OF BIOMETRICS & BIOSTATISTICS 2020; 11:https://www.hilarispublisher.com/open-access/prospectively-estimating-the-age-of-initiation-of-ecigarettes-among-us-youth-findings-from-the-population-assessment-of-.pdf. [PMID: 33552669 PMCID: PMC7861570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT There is a lack of research that prospectively estimates the age of initiation of electronic cigarette use in U.S. youth. Younger ages of initiation of tobacco product use are associated with greater exposure to nicotine, and recently e-cigarette use has been associated with subsequent cigarette initiation. This study sought to estimate the distribution of the age of first reporting of e-cigarette use outcomes among youth never e-cigarette users overall, by sex and by race/ethnicity, prospectively. METHODS Secondary analysis of the Population Assessment of Tobacco and Health (PATH) youth dataset (ages 12-17) across waves 1 (2013-2014), 2 (2014-2015), 3 (2015-2016), and 4 (2016-2017) were conducted. Four outcomes are presented, age of first report of: (i) susceptibility to use, (ii) ever use, (iii) past 30-day use, and (iv) "fairly regular" e-cigarette use. Each outcome was prospectively estimated using participant age when they entered the study and the number of weeks between the last report of never use and the first report of each outcome across waves. Weighted survival analyses for interval censoring accounting for the complex survey design were implemented. RESULTS Among youth non-susceptible to e-cigarettes, 50.2% became susceptible to e-cigarette use by age 18. There were no statistically significant differences in the age of first report of susceptibility to e-cigarette use by sex or by race/ethnicity in this nationally representative sample of U.S. youth. Among never users, 41.7%, 23.5% and 10.3% initiated ever, past 30-day and "fairly regular" e-cigarette use by the age of 18, respectively. Less than 10% initiated ever e-cigarette use between the ages of 18 and 21. Boys had a higher risk of first reporting ever, past 30-day and "fairly regular" e-cigarette use at earlier ages than girls. Non-Hispanic Blacks and Other racial/ethnic groups were less likely than Non-Hispanic Whites to initiate ever e-cigarette use at earlier ages, and there was no difference between Non-Hispanic Whites and Hispanics. Hispanic, Non-Hispanic Black and Other racial/ethnic youth were less likely to first report past 30-day use and "fairly regular" e-cigarette use at earlier ages than Non-Hispanic White youth. CONCLUSION This paper provides information on specific ages of the first report of e-cigarette use behaviors by sex and by race/ethnicity that can be used to culturally tailor e-cigarette interventions on specific windows of opportunity before youth begin using e-cigarettes or escalating their use.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701
| | - Meagan Bluestein
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701
| | - Baojiang Chen
- Department of Biostatistics and Data Science, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701
| | - Cheryl L. Perry
- Department of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX 78701
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701
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Owusu D, Huang J, Weaver SR, Pechacek TF, Ashley DL, Nayak P, Eriksen MP. Patterns and trends of dual use of e-cigarettes and cigarettes among U.S. adults, 2015-2018. Prev Med Rep 2019; 16:101009. [PMID: 31763161 PMCID: PMC6861646 DOI: 10.1016/j.pmedr.2019.101009] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/20/2019] [Accepted: 10/20/2019] [Indexed: 11/30/2022] Open
Abstract
Prevalence of current e-cigarette use among smokers remained relatively stable from 2015 (29.8%) to 2018 (27.7%). Prevalence of current e-cigarette use among never and former smokers increased significantly. Among e-cigarettes users, prevalence of current cigarette smoking decreased from 56.9% (2015) to 40.8% (2018). Approximately 1 in 5 smokers with no plan to quit smoking were current e-cigarette users from 2015 to 2018. About 3 in 10 heavy smokers who were dual users frequently used e-cigarettes from 2015 to 2018.
Introduction If dual use of cigarettes and e-cigarettes is a transition state to tobacco and nicotine use cessation, it may be a tolerable temporary condition. But, if a long-term behavior, dual use may increase tobacco harm to the population as a whole, and efforts should aim to reduce it as much as possible. To develop effective tobacco control policy, the changes in dual use of e-cigarettes and cigarettes need to be better understood. Methods National probability samples of U.S. adults in 2015 (n = 6051), 2016 (n = 6014), 2017 (n = 5992), and 2018 (n = 5989) reported their smoking and e-cigarette use status, including frequency of use. Weighted multinomial logistic regression models were used to examine temporal trends and patterns of cigarette and e-cigarette use. Results Between 2015 and 2018, the prevalence of current e-cigarette use (29.8% in 2015, 22.3% in 2016, 29.1% in 2017, and 27.7% in 2018) did not change significantly among current smokers. This result was consistent among light, moderate, and heavy smokers, and did not change when stratified by sex, age and race. However, the prevalence of cigarette smoking in current e-cigarette users declined from 56.9% in 2015 to 40.8% in 2018 (p < 0.001). Among never (p = .012) and former (ps < 0.001) smokers the prevalence of current e-cigarette use increased significantly. Conclusion The continued high prevalence of dual use and increased prevalence of current e-cigarette use among never smokers highlight the need for better communication about the risks of prolonged dual use for e-cigarette users, and the risks of nicotine initiation and addiction for nonusers.
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Affiliation(s)
- Daniel Owusu
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Jidong Huang
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Scott R Weaver
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Terry F Pechacek
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - David L Ashley
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Pratibha Nayak
- Public Health Center for Tobacco Research, Battelle, Atlanta, GA, USA
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Leventhal AM, Goldenson NI, Barrington-Trimis JL, Pang RD, Kirkpatrick MG. Effects of non-tobacco flavors and nicotine on e-cigarette product appeal among young adult never, former, and current smokers. Drug Alcohol Depend 2019; 203:99-106. [PMID: 31434028 PMCID: PMC7489757 DOI: 10.1016/j.drugalcdep.2019.05.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND E-cigarette regulations targeting products that disproportionately appeal to never-smokers may optimize population health. This laboratory study of young adults tested whether differences in appeal between e-cigarettes with non-tobacco-flavored (vs. tobacco-flavored) and nicotine-containing (vs. nicotine-free) solutions varied by smoking history. METHODS Current (N = 53), former (N = 25), and never (N = 22) cigarette smokers who vape (Mean[SD] age = 25.4[4.4] years) administered standardized e-cigarette doses varied by a Flavor (fruit, menthol, tobacco) × Nicotine (nicotine-containing [6 mg/mL], nicotine-free) within-subject double-blind design. Participants rated each dose's appeal (0-100 scale). Covariate-adjusted interactions tested whether smoking history moderated flavor and nicotine effects. RESULTS Appeal was higher for fruit and menthol than tobacco flavors in each group. The fruit vs. tobacco appeal difference was greater in never smokers (fruit-tobacco estimate = 19.6) than current smokers (estimate = 12.1) but not former smokers (estimate = 12.6). The menthol vs. tobacco difference was greater in never smokers (menthol-tobacco estimate = 17.3) than former (estimate = 6.0) and current (estimate = 7.2) smokers. Appeal was lower for nicotine-containing than nicotine-free solutions in each group; this difference was greater in never smokers (nicotine-nicotine-free estimate = -17.3) than former (estimate = -7.0) and current (estimate = -10.6) smokers. Compared to tobacco flavors, nicotine's appeal-reducing effects were suppressed by fruit and menthol flavors in never smokers. CONCLUSIONS Higher appeal of non-tobacco-flavored (vs. tobacco-flavored) and lower appeal of nicotine-containing (vs. nicotine-free) e-cigarettes may be widespread in young adults but disproportionately amplified in never smokers. Non-tobacco flavors may suppress nicotine's appeal-lowering qualities in never smokers. The impact of regulating non-tobacco flavors in e-cigarettes may vary by smoking history.
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Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Matthew G Kirkpatrick
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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