Understanding contexts of smoking and vaping among dual users: analysis of ecological momentary assessment data

Exposure to vaping and smoking prohibitions and nicotine and cannabis vaping in a California-based sample of young adults: An ecological momentary assessment study

BACKGROUND

Localities have extended smoke-free policies to prohibit use of combustible and vaping products for nicotine/tobacco and cannabis (THC), but little is known about how this affects vaping behavior. We used Ecological Momentary Assessment to examine perceived exposure to smoking- and vaping-specific prohibitions and nicotine and THC vaping.

METHODS

Young adults (n = 178; age 25; 55 % male; 47 % Hispanic, 21 % Asian, 21 % White) in California who endorsed past-month use of nicotine and/or THC vaping products were recruited from an existing longitudinal study. In 2023, individuals completed up to five brief surveys each day over 21 days to assess vaping behavior and momentary context (e.g., vaping/smoking prohibitions) of vaping and non-use (random prompt) events. Multilevel generalized linear mixed models assessed associations between exposure to prohibitions and likelihood of vaping nicotine or THC (vs. non-use events).

RESULTS

Young adults showed reduced likelihood of vaping nicotine (aOR = 0.60, 95 % CI 0.42 - 0.85; p = 0.004) and THC (aOR = 0.48, 95 % CI 0.33 - 0.69; p < 0.0001) in settings where vaping and smoking were prohibited compared to settings in which vaping and smoking were allowed. Exposure to settings in which only smoking was prohibited (vaping allowed) was associated with increased likelihood of vaping nicotine (aOR = 2.13, 95 % CI 1.34 - 3.39; p = 0.002), but unrelated to vaping THC (aOR = 0.87, 95 % CI 0.53 - 1.44; p = 0.59).

CONCLUSIONS

Efforts to increase young people's awareness of and compliance with vaping prohibitions may help reduce both nicotine and THC vaping in real-world settings.

Evolution of the substance use landscape: Implications for contingency management

Contingency management (CM), which involves the delivery of incentives upon meeting behavioral goals, has the potential to improve substance use treatment outcomes. The intervention allows for flexibility through numerous modifiable components including changes to incentive magnitude and schedule, target behavior, and intervention structure. Unfortunately, numerous changes in the substance use landscape have occurred in the past 10 to 15 years: Substances are more potent, overdose risk has increased, new substances and methods of use have been introduced, and substance classes are increasingly being intentionally and unintentionally mixed. These developments potentially undermine CM outcomes. We explored recent substance use changes due to legislative, regulatory, social, and economic factors for four substance classes: stimulants, opioids, tobacco, and cannabis. We discuss potential adjustments to the modifiable components of CM for future research in response to these changes. By continually adapting to the shifting substance use landscape, CM can maintain optimal efficacy.

Reasons for multiple tobacco product and cannabis co-use among Texas young adults

OBJECTIVE

This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users.

METHODS

Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use.

RESULTS

26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users.

CONCLUSIONS

Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.

Feasibility of and reactivity to ecological momentary assessment (EMA) during electronic cigarette use initiation in adults who smoke daily

Background and objectives

This pilot study tested the feasibility of tracking e-cigarette initiation over three months using a burst-of-measurement approach and examined reactivity to the ecological momentary assessment (EMA) data capture technique in this context.

Methods

Adults who smoked daily and were interested in trying e-cigarette use received an e-cigarette starter kit and were randomized to complete EMA reports (n=30) vs. not (n=29). Participants (M age =44.1 years [SD=12.6], 61.0% male, 54.3% White, 38.9% Black/African American) smoked 13.0 cigarettes per day on average (SD=8.4) and reported mild-tomoderate nicotine dependence (M FTND =4.0 [SD=2.3]). Biochemical assessment and surveys were conducted at enrollment, e-cigarette initiation (1 week later), and 1-week, 1-month, and 3-month post e-cigarette initiation.

Results

A subset (17%) of participants did not achieve the minimum 75% EMA adherence at Week 1. The remaining participants showed excellent adherence with the EMA protocol, with a consistently high response rate to audibly prompted mini-surveys during screening (93%) and follow-up weeks (93%, 93%, and 92%, respectively). No consistent trend emerged in comparing the two randomized groups, either on variables relevant to the public health impact of e-cigarette initiation (i.e., cigarettes/day, exposure to smoke, exposure to nicotine, motivation to quit smoking), or in e-cigarette use (i.e., bouts/day, puffs/bout), with average Cohen's d values across timepoints ranging from d=0.02 for exposure to smoke to d=0.06 for cigarettes per day.

Conclusions

Conducting EMA with adults who smoke daily and are initiating e-cigarette use appears feasible, with some caveats. Reactivity to EMA during e-cigarette initiation appears to be small or non-significant.

An Evaluation of the Contextual Factors Associated With the Use of Either Tobacco or Electronic Cigarettes in Individuals Who Dual Use

INTRODUCTION

Little is known about patterns of dual use of tobacco and electronic cigarettes (e-cigarettes), especially regarding the factors that lead people to choose either product in particular situations. Identifying contextual factors that are associated with product use would enhance understanding of the maintenance of dual product use.

METHODS

Individuals who dual use (N = 102) completed ecological momentary assessment surveys via text message regarding the recent use of tobacco and e-cigarettes for 2 weeks. Product legality, availability, craving, the presence of other people who smoke/vape, and social disapproval were assessed. Data were analyzed using hierarchical logistic regression to identify factors associated with the likelihood of tobacco versus e-cigarette use.

RESULTS

Contexts associated with increased likelihood of using tobacco rather than e-cigarettes included being in the presence of other people who smoke (odds ratio [OR] = 3.50, p < .0001) and experiencing elevated tobacco cigarette craving (OR = 3.51, p < .0001). Decreased likelihood of tobacco over e-cigarette use was associated with smoking restrictions (OR = 0.26, p = .003), the presence of other people who vape (OR = 0.38, p < .001), and experiencing elevated e-cigarette craving (OR = 0.23, p < .0001). The legality of e-cigarettes, social disapproval, and the availability of the alternative product were not significantly associated with the use of one product over the other. An individual difference score of relative tobacco (vs. e-cigarette) use pattern did not significantly moderate these effects.

CONCLUSIONS

This study provided essential information regarding behavioral patterns of dual use, which informs our understanding of people who dual use. Contexts such as smoking restrictions, craving, and social context significantly differentiated between the use of tobacco and e-cigarettes. This suggests product-specific motivations for dual use of tobacco and e-cigarettes in people who use both.

IMPLICATIONS

This study assessed the relationship between momentary contextual factors and dual use in a nationally recruited sample of people who dual use. Assessments of dual use in daily life provided novel information regarding patterns of dual use as well as differential use-motivations for each product. This information will be essential to build a theoretical framework of dual use of tobacco and e-cigarettes.