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Zhang L, Ao SH, Zhao X. A four-year longitudinal analysis examining the effects of e-cigarette advertisements and disparities among youth with internalizing problems. Addict Behav 2024; 153:108002. [PMID: 38430643 DOI: 10.1016/j.addbeh.2024.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Prior research indicates a direct, short-term effect of e-cigarette advertising on e-cigarette use among youth. This study seeks to investigate the long-term effects of e-cigarette advertisements and disparities in exposure among adolescents with different levels of internalizing problems. METHODS Panel data of the Population Assessment of Tobacco and Health (PATH) Study Waves 3-5 (2015-2019) were analyzed. Youth aged 12-17 who were non-e-cigarette users at the time of Wave 3 were included (n = 4,678). A moderated mediation model was employed to examine the mediating role of perceived harm of e-cigarettes and the moderating effect of internalizing problems. RESULTS Exposure to e-cigarette advertisements in Wave 3 predicted lower harm perception of e-cigarette in Wave 4 (bp = -0.055, p <.01), leading to more e-cigarette use in Wave 5 (bp = -0.042, p <.001). While e-cigarette advertisements exhibited a lasting indirect effect (bp = 0.002, p <.05), there was no long-term direct effect (bp = 0.017, p >.05) on youth e-cigarette use. Furthermore, a moderating effect of internalizing problems was observed (bp = 0.107, p <.05). CONCLUSIONS E-cigarette advertisements can exert a lasting influence indirectly by diminishing harm perception, particularly among those with lower internalizing problems. Adolescents with higher internalizing problems exhibit lower susceptibility to advertisement influence, yet their perceived harm of e-cigarettes is notably lower than their peers with fewer internalizing problems. These disparities underscore the need for tailored prevention strategies: implementing anti-e-cigarette education programs for adolescents with low internalizing problems and providing mental health care for those facing internalizing challenges. Regulatory measures targeting e-cigarette advertising are also crucial.
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Affiliation(s)
- Luxi Zhang
- Department of Communication / Institute of Collaborative Innovation, University of Macau, Macau
| | - Song Harris Ao
- Department of Communication / Institute of Collaborative Innovation / Center for Research in Greater Bay Area, University of Macau, Macau
| | - Xinshu Zhao
- Department of Communication / Institute of Collaborative Innovation / Center for Research in Greater Bay Area, University of Macau, Macau.
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Yan R, Liu Y, Huang L, Li Y, Huang Y, Tong J, Deng Y, Yuan Q. Susceptibility to e-cigarette adoption among tobacco-naïve youths: a cross-sectional study in Shenzhen, China. Front Public Health 2024; 12:1320863. [PMID: 38818444 PMCID: PMC11137244 DOI: 10.3389/fpubh.2024.1320863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Background The rise in e-cigarette use among youth is a significant global public health issue. It is important to identify those at increased risk and implement effective strategies to reduce e-cigarette popularity among the youth. Objective This study aims to identify predictors of e-cigarette uptake in youths with no prior tobacco use, considering individual, familial and the broader societal environmental factors. Methods For this investigation, a group of 2,487 tobacco-free youths was selected from 15 high schools in Shenzhen, China. Susceptibility to e-cigarettes was determined by assessing the possibility of future use and the openness to trying e-cigarettes if presented by friends. Both chi-square tests and logistic regression were applied to identify factors linked to susceptibility to e-cigarette use. Results Among the respondents, 5.5% (n = 136) were found to be susceptible to e-cigarette use. The analysis revealed factors tied to this risk: perceptions of e-cigarettes, the impact of vaping peers, paternal parenting styles, the extent of social support, exposure to messages both for and against e-cigarettes use, and secondhand smoke (SHS) exposure. Youths who downplayed the addictive nature of e-cigarettes (aOR = 2.01; 95% CI: 1.14-3.55; p = 0.016), those with friends who engaged in vaping (aOR = 3.43-7.64; 95%CI: 2.36-20.42; p < 0.001), those experiencing over-protective or rejective maternal parenting (aOR = 1.68-3.01; 95%CI: 1.11-5.77; p = 0.001-0.014) or rejective paternal parenting (aOR = 3.63; 95%CI: 1.99-6.59; p < 0.001), those aware of e-cigarette advertisements (aOR = 1.82; 95%CI: 1.28-2.60; p = 0.001), and those exposed to SHS at home (aOR = 1.68; 95%CI: 1.17-2.41; p = 0.005) or at public places (aOR = 1.72-1.79; 95%CI: 1.21-2.57; p = 0.002-0.003) were more prone to e-cigarettes. In contrast, youths who believed using e-cigarettes reduces one's attractiveness (aOR = 0.34; 95%CI: 0.16-0.72; p = 0.005) or perceived that vaping made social interactions less enjoyable (aOR = 0.26; 95%CI: 0.12-0.58; p = 0.001), those who benefited from high social support (aOR = 0.30-0.60; 95%CI: 0.17-0.97; p < 0.001), and those who noticed message about e-cigarettes' adverse consequence (aOR = 0.54; 95%CI: 0.38-0.77; p = 0.001) were less likely to be inclined toward e-cigarette use. Conclusion The propensity of the youth to e-cigarette usage is shaped by a multiple element. An all-encompassing strategy that addresses the individual, familial, and the broader societal aspects is imperative for the effective prevention of e-cigarette initiation among youth.
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Affiliation(s)
- Ruilin Yan
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Yanhong Liu
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Li Huang
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Yanrou Li
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Yun Huang
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Jing Tong
- Bao'an Public Health Service Center of Shenzhen, Shenzhen, China
| | - Yongzheng Deng
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
| | - Qing Yuan
- Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, China
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Chaffee BW, Couch ET, Donaldson CD, Farooq O, Cheng NF, Ameli N, Zhang X, Gansky SA. Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations. Subst Use Misuse 2024; 59:1240-1248. [PMID: 38509707 PMCID: PMC11045304 DOI: 10.1080/10826084.2024.2330912] [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: 03/22/2024]
Abstract
BACKGROUND Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.
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Affiliation(s)
- Benjamin W. Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Elizabeth T. Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Candice D. Donaldson
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Omara Farooq
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Nancy F. Cheng
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Niloufar Ameli
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Xueying Zhang
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Stuart A. Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
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Ng L, Ng XY, van der Eijk Y. Vaping in a heavily regulated setting: cross-sectional survey of e-cigarette use, perceptions and social media exposure. Tob Control 2024; 33:e11-e17. [PMID: 36813571 DOI: 10.1136/tc-2022-057805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Singapore has completely banned e-cigarettes and the government's cautious stance against vaping has been consistent. Despite this, vaping appears to have gained popularity in Singapore, especially among younger people. With the heavy marketing of vaping products on social media, it is possible that such marketing, due to its cross-border nature, is reaching younger Singaporeans and driving changes in vaping-related perceptions or behaviours. This study examines their exposure to vaping-related content on social media, and whether such exposure is associated with more positive perceptions of vaping or e-cigarette ever use. METHODS Analysis of cross-sectional survey data of 550 adult (age 21-40 years) Singaporeans recruited via convenience methods in May 2022, using descriptive statistics, bivariate analyses, and multiple linear and logistic regression models. RESULTS 16.9% of participants reported they had ever used e-cigarettes. 18.5% of those who used social media recalled seeing vaping-related content on a social media platform in the past 6 months, mostly from influencers or friends, and on Instagram, Facebook, TikTok and/or YouTube. Reporting exposure to such content was not associated with e-cigarette ever use. It was associated with having a more positive overall perception of vaping (β=1.47; 95% CI: 0.17 to 2.78), although no significant difference was observed when examining only health-related perceptions. CONCLUSION Even in a heavily regulated environment such as Singapore's, people appear to be exposed to vaping-related content on social media platforms and this exposure is, in turn, associated with more positive perceptions of vaping, but not e-cigarette ever use.
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Affiliation(s)
- Lionel Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xian Yi Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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La Capria K, Uriarte C, Elhabashy M, Menkevich M, Maxton O, Awadalla J, Tan ASL, Moran MB, Chen-Sankey J. Exploring the Influence of E-cigarette Ad Features on Perceived Product Appeal and Use Interest Among Young Adults of Varying Tobacco-Use Behaviors. Nicotine Tob Res 2024; 26:361-369. [PMID: 37594249 PMCID: PMC10882433 DOI: 10.1093/ntr/ntad150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Exposure to certain features in commercial e-cigarette ads may influence e-cigarette use perceptions. This study explored the reactions toward common features in e-cigarette ads among young adults of various tobacco-use behaviors. AIMS AND METHODS We used data from in-depth interviews with U.S. young adults (ages 18-29) who do not use tobacco (n = 26) and who currently smoke cigarettes (n = 26). Participants viewed 30 print e-cigarette ads that included multiple features (eg, fruit flavors, price promotions, smoker-targeted messages) before discussing their perceived influence of memorable ad features. We used reflective thematic analysis to analyze interview data. RESULTS Participants from both groups generally noticed fruit and multiple flavors displayed in the ads, which were seen as appealing and were reported to generate product-use interest because of bright colors, sensory appeal, and a variety of flavor options. Participants who smoke perceived price promotions and positive experience testimonials to be appealing, and some reported this generated use interest. Participants from both groups perceived smoker-targeted messages to be unconvincing, and reported this dampened ad and product appeal and use interest. Participants who do not use tobacco perceived nicotine warnings to be unappealing, resulting in reduced perceived appeal of other attractive features (eg, fruit flavors) appearing in the same ads. CONCLUSIONS Marketing features appearing in e-cigarette ads may be perceived by young adults of various tobacco-use behaviors in both similar and different ways. Communication and policy strategies that account for these differential perceptions towards various marketing features are needed to reduce the negative impact of e-cigarette marketing. IMPLICATIONS This study revealed evidence related to young adults' reactions to and perceived influence of commonly used marketing features (eg, fruit flavors, nicotine warnings, price promotions, smoker-targeted messages) in commercial e-cigarette ads. The results highlight the similar and differential perceived appeal and use interest of e-cigarette products promoted with various marketing features among young adults of different tobacco-use behaviors. The results have implications for informing the design of communication strategies and policies related to e-cigarette marketing aimed at promoting complete product switching among young adults who smoke while simultaneously deterring e-cigarette use interest among those who do not use tobacco.
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Affiliation(s)
- Kathryn La Capria
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Caitlin Uriarte
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Maryam Elhabashy
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Madison Menkevich
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Olivia Maxton
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Josephine Awadalla
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Meghan B Moran
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
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James SA, White AH, Kahn FF, Mushtaq N, Chen S, Beebe LA. Susceptibility to e-cigarette use and associated factors in high school youth, Oklahoma Youth Tobacco Survey, 2021-2022. Front Public Health 2024; 12:1348926. [PMID: 38362222 PMCID: PMC10867248 DOI: 10.3389/fpubh.2024.1348926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Susceptibility predicts subsequent uptake of e-cigarettes (EC) by youth. This study identified factors associated with EC susceptibility among high school students who have never used a tobacco/nicotine product. Methods The Oklahoma Youth Tobacco Survey was administered to a random sample of 36 Oklahoma High Schools during the 2021-2022 school year (n = 1,220 participating students). Associations between EC susceptibility and covariates were identified using stepwise logistic regression for weighted survey data. Results More than one third of Oklahoma high school students who had never used tobacco or nicotine products (36.4%) were susceptible, and males had higher susceptibility than females (38.8 and 33.9%, respectively). In males, EC susceptibility was associated with race (Black, American Indian, and other were less susceptible), psychological distress (aOR = 2.4, 95% CI = 1.1, 4.8), disagreement that all tobacco products are dangerous (aOR = 3.1, 95% CI = 1.2, 7.9), and perception of little/no harm from secondhand vapor (aOR = 3.4, 95% CI = 2.1, 5.3). In females, identifying as gay, lesbian, or bisexual (aOR = 2.1, 95% CI = 1.1, 3.9), poor academic performance (aOR = 4.5, 95% CI = 1.6, 12.6), psychological distress (aOR = 2.6, 95% CI = 1.2, 5.5) and interacting with EC content on social media (aOR = 5.9, 95% CI = 1.9, 18.1) were associated with EC susceptibility. Conclusion Males and females had different patterns of susceptibility to EC use. Understanding groups of adolescents most susceptible to using nicotine products can help target prevention efforts at home, in schools, and within communities.
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Affiliation(s)
- Shirley A. James
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ashley H. White
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Fahad F. Kahn
- Oklahoma State Department of Health, Oklahoma City, OK, United States
| | - Nasir Mushtaq
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Laura A. Beebe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Ylitörmänen T, Tarasenko Y, Hiilamo H, Ruokolainen O, Puska P, Ollila H. Cross-sectional study of the associations between the implementation of the WHO FCTC tobacco advertising, promotion and sponsorship bans and current e-cigarette use among youth from countries with different income levels. Tob Control 2024:tc-2023-058160. [PMID: 38286590 DOI: 10.1136/tc-2023-058160] [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: 05/16/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The WHO Framework Convention on Tobacco Control (WHO FCTC) Article 13 requires countries to ban tobacco advertising, promotion and sponsorship (TAPS), and bans are recommended to cover electronic cigarettes (e-cigarettes). We examined youth e-cigarette prevalence by TAPS regulations in countries with different income levels. METHODS We analysed data on 165 299 respondents from 48 countries with 2016/2018 WHO FCTC implementation reports and 2016-2019 Global Youth Tobacco Survey. We used multilevel logistic regressions to examine associations between TAPS regulations and current e-cigarette use, stratified by country income. RESULTS About 1 in 10 respondents was currently using e-cigarettes. Respondents in countries with TAPS bans on the internet were less likely to use e-cigarettes (adjOR=0.58; 95% CI 0.39 to 0.86) than youth in countries without such bans. In lower middle-income and low-income countries, bans on displaying tobacco products at the point of sale (adjOR=0.55; 95% CI 0.34 to 0.90), bans on product placement (adjOR=0.44; 95% CI 0.28 to 0.69) and strength of additional TAPS measures were associated with lower prevalence of e-cigarette use among students. Being taught about the dangers of the use of tobacco in school was associated with lower odds of e-cigarette use. No differences in the use of e-cigarettes were observed by types of TAPS among respondents in high-income countries. CONCLUSIONS Strengthening implementation of TAPS policies and assuring they cover new and emerging products, online channels and points of sales are essential, especially in lower income countries. Maintaining tobacco health education is also important to protect youth from e-cigarette use.
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Affiliation(s)
- Tuija Ylitörmänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Yelena Tarasenko
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Heikki Hiilamo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Puska
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Czaplicki L, Patel D, Jewler K, Moran MB. Use of Brand Engagement Appeals in US Cigarette and E-Cigarettes Ads (2019-2020). Subst Use Misuse 2024; 59:832-839. [PMID: 38247155 DOI: 10.1080/10826084.2024.2305791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background: The tobacco industry has historically used brand engagement - communication tactics companies use to increase customer attachment to a brand and brand loyalty - to recruit and retain consumers. Limited information is available to assess the brand engagement tactics used to promote the two most popular tobacco products in the US - cigarettes and electronic cigarettes (e-cigarettes) - across different advertising platforms (e.g., direct-to-consumer (DTC), social media). Material and methods: We acquired 520 cigarette and 5,502 e-cigarette ads that ran in the US January 2019 to December 2020 from market research firms (Kantar, Numerator), Rutger's University ad surveillance website (trinketsandtrash.org), and branded social media accounts. Ads were double-coded for eight types of brand engagement tactics: Price Promotion, Sweepstakes, Mobile App, Email/Mail List, Free Gift, Social Media engagement request, Sponsored Events, and Auto-Ship subscription program. We report presence of brand engagement tactics by product type and advertising platform. Results: Overall, 62.9% of cigarette ads and 49.9% of e-cigarette ads contained at least one brand engagement tactic. For cigarette ads, the most common tactics were Sweepstakes and Mobile App requests, which were most commonly featured in DTC ads. For e-cigarettes, the most common tactic was Price Promotion which was featured in most DTC and online e-cigarette ads. Conclusions: Brand engagement was common in this sample of cigarette and e-cigarette ads. Our findings highlight key differences in the type of brand engagement tactic used to promote each product on different advertising platforms. Results can inform continued advertising surveillance studies and regulatory efforts.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kay Jewler
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Li S, Zeng X, Di X, Liu S. Association between e-cigarette use and susceptibility to tobacco product use: findings from the 2019 China National Youth Tobacco Survey. Front Public Health 2024; 11:1272680. [PMID: 38288432 PMCID: PMC10823011 DOI: 10.3389/fpubh.2023.1272680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/11/2023] [Indexed: 01/31/2024] Open
Abstract
Background There is an ongoing debate about whether e-cigarettes act as a gateway to tobacco smoking or contribute to smoking cessation, and relevant studies are limited among Chinese adolescents. This cross-sectional study therefore aimed to explore the relationship between e-cigarette use and susceptibility to tobacco product use among Chinese high school students. Methods The study population comprised 107,633 never smokers and 19,377 former smokers, generated from the 2019 China National Youth Tobacco Survey. The primary independent variables of interest were ever e-cigarette use, current e-cigarette use, and the frequency of current e-cigarette use. The main outcome was the susceptibility to tobacco product use. Multilevel logistic regression was used to estimate the association between the primary independent variables of interest and the outcome variable. Moreover, two additional multilevel logistic regression models were fitted using two alternative definitions of the outcome as the sensitivity analyses. Results Among never smokers, students who ever used e-cigarettes were more likely to be susceptible to tobacco product use compared to students who never used e-cigarettes (AOR = 2.83, 95%CI = 2.59-3.08). Students who currently used e-cigarettes were more likely to be susceptible to tobacco product use than those who did not currently use e-cigarettes (AOR = 3.89, 95%CI = 3.21-4.72). Among former smokers, with the same settings of modeling, the AORs were 1.76 (95%CI = 1.62-1.91) and 3.16 (95%CI = 2.52-3.97), respectively. Similar results were obtained from the two sensitivity analyses. Conclusion Among Chinese high school students, both never smokers and former smokers, e-cigarette use, especially current e-cigarette use, was positively associated with susceptibility to tobacco product use. It is recommended to strengthen the monitoring of e-cigarettes and to provide targeted health education to adolescents.
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Affiliation(s)
- Sixuan Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinying Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
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Sun T, Lim CCW, Rutherford BN, Johnson B, Connor J, Gartner CE, Hall WD, Leung J, Chan G. Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis. Tob Control 2023; 33:21-29. [PMID: 35667834 DOI: 10.1136/tobaccocontrol-2022-057266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple tobacco and e-cigarette product (MTEP) use, the concurrent use of two or more different types of tobacco and/or e-cigarettes products, is common among young people in the US. Changes in patterns of MTEP use among US youth between 2014 and 2020 were identified and the determinants of MTEP use were examined. METHODS Four years of repeated cross-sectional data from the US National Youth Tobacco Survey of middle and high school students from grade 6 to 12 (Ntotal=77 402). Multigroup latent class analysis (LCA) was applied to the data series to allow for simultaneous identification of MTEP use patterns between 2014 and 2020. Logistic regression was used to predict class membership on demographic and tobacco-related variables. FINDINGS Over the 7-year period, LCA identified three patterns: minimal/non-users (MNU: ~89.8%), mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%). From 2014 to 2020, MNU increased from 86.4% to 92% (p<0.05), while MOEC and POLY decreased from 11.2% to 7.9% and from 2.4% to 0.1%, respectively. The probability of regular e-cigarette use increased from 0 to 2.3% among MNU, 6% to 31.9% among MOEC and 29.6% to 67.6% among POLY (p<0.05). In binomial logistic regression, being male, in high school, non-heterosexual, living with someone who uses tobacco at home, having cognitive difficulties, having lower perceptions of tobacco's danger and exposure to tobacco marketing were associated with greater odds of MOEC and POLY than MNU. CONCLUSIONS There was an increase in regular e-cigarette use in all three classes, but a corresponding decrease in the proportion of MTEP use. Public health interventions to discourage uptake of e-cigarettes, such as tighter restrictions on marketing to minors, are warranted and there is a need to consider disparities in the determinants of MTEP use.
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Affiliation(s)
- Tianze Sun
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Carmen C W Lim
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Brienna N Rutherford
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Benjamin Johnson
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
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Jongenelis MI, Thoonen KAHJ. Factors associated with susceptibility to e-cigarette use among Australian adolescents. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104249. [PMID: 37918316 DOI: 10.1016/j.drugpo.2023.104249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Preventing uptake of e-cigarette use among adolescents is critical to minimizing vaping-related harms. To inform the development of effective prevention programs and policies, this study explored potential determinants of susceptibility to e-cigarette use among young Australians. METHODS A cross-sectional online survey was administered to 12- to 17-year-old Australians who had never smoked nor vaped (N = 973; 53 % women). The survey assessed susceptibility to e-cigarette use (curiosity about use, willingness to use, and intentions to use) and a comprehensive range of potential correlates that included individual, social, and environmental factors. Regression analyses were conducted to identify factors significantly correlated with each of the dependent variables. RESULTS Susceptibility to e-cigarette use was observed in 45 % of respondents. Individual factors associated with susceptibility included respondents' (i) overall opinion of e-cigarettes, (ii) attitudes toward e-cigarettes, (iii) affect regulation expectancies, and (iv) quitting perceptions. Significant social factors included both descriptive and injunctive norms, specifically: perceiving that use is ok for people of one's age, approval from important others to use, and having at least one family member or close friend who vapes. CONCLUSION Susceptibility to vaping was observed in a substantial proportion of adolescents who have never smoked. Shifting attitudes and social norms around e-cigarette use appears critical to reducing susceptibility. Recommended prevention efforts include the development of communications addressing misperceptions about the benefits of vaping on affect regulation and stricter regulations on e-cigarette advertising to reduce young Australians' exposure to claims that may result in favourable attitudes to e-cigarette use.
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Affiliation(s)
- Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Karlijn A H J Thoonen
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
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12
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Pettigrew S, Santos JA, Pinho-Gomes AC, Li Y, Jones A. Exposure to e-cigarette advertising and young people's use of e-cigarettes: A four-country study. Tob Induc Dis 2023; 21:141. [PMID: 37881174 PMCID: PMC10594952 DOI: 10.18332/tid/172414] [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: 07/16/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION The World Health Organization recommends banning all forms of e-cigarette advertising, promotion, and sponsorship. The aims of the present study were to: 1) examine young people's exposure to e-cigarette advertising across a wide range of media in four diverse countries; and 2) identify any association between the number of different types of media exposures and e-cigarette use. METHODS A cross-sectional online survey was administered to approximately 1000 people aged 15-30 years in Australia, China, India, and the United Kingdom (n=4107). The survey assessed demographic characteristics, e-cigarette and tobacco use, numbers of friends and family members who vape, and exposure to multiple forms of e-cigarette advertising (e.g. television, radio, print, and various types of social media). Descriptive analyses were conducted on those who had heard of e-cigarettes (n=3095, significance threshold p<0.001) and a logistic regression analysis was used to identify factors associated with e-cigarette ever use (significance threshold p<0.05). RESULTS The majority (85%) of respondents who had heard of e-cigarettes reported being exposed to e-cigarette advertising on at least one type of media, and the average number of types of media to which respondents were exposed was 5 (range: 0-17). The number of media types was significantly associated with ever use of e-cigarettes (OR=1.05; 95% CI: 1.02-1.08, p=0.001). CONCLUSIONS Despite advertising restrictions in place in all four countries, large majorities of young people reported being exposed to e-cigarette advertising. Social media and advertising on/around vape shops and other retailers appear to be key exposure locations. Urgent attention is needed to address these forms of exposure given their apparent association with e-cigarette use.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Joseph A. Santos
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, London, United Kingdom
- School of Public Health, Imperial College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Yuan Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Beijing, China
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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13
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Pettigrew S, Santos JA, Li Y, Jun M, Anderson C, Jones A. Short report: Factors contributing to young people's susceptibility to e-cigarettes in four countries. Drug Alcohol Depend 2023; 250:109944. [PMID: 37316389 DOI: 10.1016/j.drugalcdep.2023.109944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Identifying young people who are susceptible to e-cigarettes is important for developing interventions designed to discourage uptake. Current evidence in a broader range of national contexts is needed given recent surges in youth e-cigarette use in many countries and the constantly evolving nature of vaping products and the promotional strategies used by the industry to increase their appeal. METHODS A cross-sectional online survey was administered to around 1000 15-30 year olds in each of four countries: Australia, China, India, and the United Kingdom (total n = 4007). The survey assessed demographic characteristics, e-cigarette and tobacco use, exposure to e-cigarette advertising, and number of friends and family members who vape. Those who had never used e-cigarettes (n = 1589) were assessed for susceptibility (curiosity about e-cigarettes, intentions to use in the next 12 months, and likely use if offered by a friend). Mixed effects logistic regression analysis was used to identify factors associated with susceptibility to e-cigarette use. RESULTS Susceptibility to e-cigarette use was apparent among 54% of respondents from Australia, 61% from India, 62% from the UK, and 82% from China. Factors positively associated with susceptibility were tobacco use, exposure to advertising, higher income, and having friends and family members who vape. Factors negatively associated with susceptibility were perceptions of harmfulness and education. CONCLUSION The results indicate the need across a diverse range of countries for interventions designed to address substantial proportions of young people who are likely to be susceptible to e-cigarette use.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, 1 King StNewtown2042, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, 1 King StNewtown2042, Australia.
| | - Yuan Li
- The George Institute for Global Health, Beijing, China.
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, 1 King StNewtown2042, Australia.
| | - Craig Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, 1 King StNewtown2042, Australia.
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, 1 King StNewtown2042, Australia.
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Pettigrew S, Santos JA, Li Y, Miller M, Anderson C, Raj TS, Jones A. E-cigarette-related beliefs, behaviors, and policy support among young people in China. Tob Induc Dis 2023; 21:09. [PMID: 36741540 PMCID: PMC9869085 DOI: 10.18332/tid/156836] [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: 09/24/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION China has recently introduced a range of e-cigarette control policies with a focus on addressing an increase in youth vaping. This study aimed to investigate a wide range of e-cigarette-related attitudes and behaviors in a national sample of Chinese adolescents and young adults to obtain insights into their exposure to, experiences with, and attitudes to e-cigarettes on the cusp of new regulations coming into force. METHODS An online survey was administered to a sample of 1062 adolescents and young adults (aged 15-30 years) in China in November-December 2021. Quotas were applied to achieve an approximately equal gender split, representation across age sub-groups (15-17, 18-20, 21-23, 24-26, and 27-30 years), and approximately two-thirds representing low- and middle-income groups. Adjusted odds ratios (AORs) were also calculated. RESULTS Just under half (47%) reported no knowledge of e-cigarettes and/or vaping. One in five reported ever using e-cigarettes ('even once or twice'), 8% reported being current users, and 3% reported being daily users. Around twothirds of those who had heard of e-cigarettes/vaping had friends who vaped and had seen e-cigarette advertising. Fruit flavors were most popular, and the most frequently nominated reasons for vaping were to cut down on cigarette smoking and because a friend used them. The factors positively associated with ever use of e-cigarettes were current tobacco smoking (AOR=68.26) or previous tobacco smoking (AOR=39.15) and having friends who vape (AOR=1.76). Perceptions of addictiveness were negatively associated with ever use (AOR=0.47). Strong support was evident for most assessed e-cigarette control policies. CONCLUSIONS The results indicate that young people in China have been able to access and use e-cigarettes, although rates of regular use are low. Generally, high levels of expressed support for a range of e-cigarette control policies among members of this age group suggest the new regulatory environment is consistent with their policy preferences.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Yuan Li
- The George Institute for Global Health, Beijing, China
| | - Mia Miller
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Craig Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Thout S. Raj
- The George Institute for Global Health, Hyderabad, India
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Murukutla N, Magsumbol MS, Raskin H, Kuganesan S, Dini S, Martinez-Mejia C, Rachfiansyah, Aguilar BGR. A content analysis of e-cigarette marketing on social media: Findings from the Tobacco Enforcement and Reporting Movement (TERM) in India, Indonesia and Mexico. Front Public Health 2022; 10:1012727. [PMID: 36424977 PMCID: PMC9679495 DOI: 10.3389/fpubh.2022.1012727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background The use of e-cigarettes is proliferating globally, especially among youth and even children. Marketing is a known risk factor for e-cigarette initiation, yet little is known of e-cigarette marketing on social media in low- and middle-income countries. This study compares e-cigarette social media marketing in India, Indonesia, and Mexico, three such countries with different regulatory environments. Methods Instances of e-cigarette marketing on social media platforms were identified via the Tobacco Enforcement and Reporting Movement (TERM), a digital tobacco marketing monitoring system. Through systematic keyword-based searches, all tobacco marketing posts observed between 15 December 2021 and 16 March 2022 were included in the analysis. The final sample included 1,437 e-cigarette-related posts on Instagram, Facebook, Twitter, YouTube, and TikTok, which were systematically content analyzed by independent coders after inter-reliability (Cohen's Kappa K > 0.79) was established using a theory-derived codebook. The final data is represented in percentages and frequencies for ease of presentation. Results We observed e-cigarette marketing online in all countries studied, yet there was variation in the volume of marketing and types of accounts identified. In India, where e-cigarettes were comprehensively banned, we identified 90 (6%) posts; in Mexico, where e-cigarettes were partially restricted, 318 (22%) posts were observed; and in Indonesia, where there were no restrictions, 1,029 (72%) posts were observed. In both India and Mexico, marketing originated from retailer accounts (100%), whereas in Indonesia, it was primarily product brand accounts (86%). Across countries, e-cigarettes were mostly marketed directly to sell products (India: 99%, Indonesia: 69% and Mexico: 93%), though the sales channels varied. Product features, including e-liquid flavors, device colors and technical specifications, was the most prominent message framing (India: 86%; Mexico: 73%; Indonesia: 58%). Harm reduction messaging was most popular in Mexico (8%) and was not common in Indonesia (0.3%) or India (0%). Conclusion Our study provides important insights for tobacco control stakeholders on the evolving nature of e-cigarette marketing in low- and middle-income countries. It underscores the presence of e-cigarette marketing, including in countries where comprehensive regulations exist, and suggests the importance of continuous monitoring to keep up with industry practices and strengthen tobacco control stakeholder efforts to counter them.
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Affiliation(s)
- Nandita Murukutla
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Melina S Magsumbol
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Hana Raskin
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Sharan Kuganesan
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Silvia Dini
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Carlos Martinez-Mejia
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Rachfiansyah
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
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Dai L, Lu W, Wang J, Zhang L, Zhu J. Social environment exposure to electronic cigarettes and its association with e-cigarette use among adolescents in Shanghai, China. Front Public Health 2022; 10:1005323. [PMID: 36407975 PMCID: PMC9669338 DOI: 10.3389/fpubh.2022.1005323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Objective This study investigated adolescents' social-environmental exposure to e-cigarettes in association with e-cigarette use in Shanghai, China. We also explored these differences by gender and school type. Methods Sixteen thousand one hundred twenty-three students were included by a stratified random cluster sampling, and the number was weighted according to selection probability. Association between social environment exposure and e-cigarette use was examined by multivariate logistic regressions. Results There were 35.07, 63.49, 75.19, 9.44, and 18.99% students exposed to secondhand e-cigarette aerosol (SHA), e-cigarette sales, e-cigarette information, parents' and friends' e-cigarette use. Students exposed to SHA (aOR = 1.73, 95% CI 1.40-2.14), e-cigarette sales from ≥2 sources (aOR = 1.55, 95% CI 1.18-2.03), e-cigarette information exposure from ≥2 sources (aOR = 1.39, 95% CI 1.05-1.83), and having a social e-smoking environment (friends' e-cigarette use: aOR = 2.56, 95% CI 2.07-3.16; parents' e-cigarette use: aOR = 1.54, 95% CI 1.17-2.02) were significantly associated with their intention to use e-cigarettes. More girls were exposed to e-cigarette sales in the malls, e-cigarette information at points of sale and on social media (P < 0.01), and exposure to sales from ≥2 sources were associated with girls' intention to use e-cigarettes (aOR = 1.84, 95% CI 1.22-2.78). However, boys were more likely to be exposed to friends' e-cigarette use (P < 0.001), and having friends using e-cigarettes was associated with greater intention to use them in boys (aOR = 2.64, 95% CI 1.97-3.55). Less vocational high school students were exposed to parents' e-cigarette use (P < 0.001), but they were more likely to use e-cigarettes in the future after being exposed (aOR = 2.27, 95% CI 1.50-3.43). A similar phenomenon was observed between junior high students and their exposure to SHA. Conclusions This study reported adolescents' high exposure rates to the social environment of e-cigarettes. Exposure to SHA, e-cigarette sales from ≥2 sources, e-cigarette information from ≥2 sources and having a social e-smoking environment were related to adolescents' intention to use e-cigarettes. Differences in gender and school type were observed. More attention should be paid to girls, and different interventions should be designed for different types of school students. Additionally, comprehensive tobacco control policies are needed.
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Do VV, Nyman AL, Kim Y, Emery SL, Weaver SR, Huang J. Association between E-Cigarette Advertising Exposure and Use of E-Cigarettes among a Cohort of U.S. Youth and Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912640. [PMID: 36231939 PMCID: PMC9566774 DOI: 10.3390/ijerph191912640] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 06/02/2023]
Abstract
Youth and young adult (YYA) use of e-cigarettes increased rapidly between 2010 and 2019 in the United States, during which exposure to e-cigarette advertising was also increased. We aimed to examine whether exposure to e-cigarette advertising among YYAs may lead to subsequent e-cigarette use. A cohort of 3886 YYAs ages 13-24 was recruited from two survey panels in 2018 and followed up until 2019. Survey data were collected online and by telephone. The primary outcome was past 30-day use of e-cigarettes at the follow-up survey. Among 2304 YYAs who retained at the follow-up survey and were not past 30-day e-cigarette users at baseline, both youth and young adults exposed to e-cigarette advertising at baseline had elevated odds of past 30-day e-cigarette use at follow-up (Youth adjusted odds ratio (aOR): 2.77, 95% CI: 1.23, 6.24; Young adults aOR: 2.34, 95% CI: 1.08, 5.11) compared with those not reporting baseline advertising exposure. The majority of YYAs reported exposure to e-cigarette advertising at baseline (Youth: 63.7%, 95% CI: 59.8, 67.4; Young adults: 58.3%, 95% CI: 53.6, 62.8). Our findings suggest that exposure to e-cigarette advertising was associated with an increase in subsequent past 30-day use of e-cigarettes among YYAs. Restricting advertising targeted at YYAs may reduce the likelihood of e-cigarette use among YYAs.
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Affiliation(s)
- Vuong V. Do
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Amy L. Nyman
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Yoonsang Kim
- NORC at University of Chicago, Chicago, IL 60637, USA
| | | | - Scott R. Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Jidong Huang
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
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Marrocco A, Singh D, Christiani DC, Demokritou P. E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs. Crit Rev Toxicol 2022; 52:188-220. [PMID: 35822508 PMCID: PMC9716650 DOI: 10.1080/10408444.2022.2082918] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.
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Affiliation(s)
- Antonella Marrocco
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - David C. Christiani
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
- Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, 170 Piscataway, NJ 08854, USA
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Heng PP, Daud F, Yusoff MFM, Lim KH. Susceptibility to e-cigarette initiation among tobacco product naïve adolescents in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian adolescents (TECMA). Tob Induc Dis 2021; 19:89. [PMID: 34887718 PMCID: PMC8611510 DOI: 10.18332/tid/142900] [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: 06/29/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Predicting susceptibility to e-cigarette (EC) initiation among adolescents is crucial to optimize preventive measures before the health risk behavior persists through adulthood. The identification of susceptible groups is needed in response to the surge of EC use. This study aimed to determine the prevalence and determinants associated with EC susceptibility among tobacco product naïve (never users of any single tobacco product) school-going adolescents in Malaysia. METHODS Data were derived from the Tobacco and EC Survey among Malaysians (TECMA), which recruited a total of 13162 school-going adolescents aged 10– 19 years from 138 randomly selected schools via a two-stage stratified cluster sampling design. A validated self-administered questionnaire adapted from the Global Youth Tobacco Survey was utilized as the study instrument. The data were analyzed using SPSS version 22.0 descriptively and with multivariable logistic regression to determine the associated factors of EC susceptibility. RESULTS About 15.7% of the tobacco naïve adolescents were susceptible to EC initiation, with the proportion of susceptibility significantly higher among males, mid-adolescents, rural adolescents, those reporting exposure to tobacco advertisement and those not taught in school about the danger of tobacco use. Multivariable logistic regression revealed that the male students (AOR=2.20; 95% CI: 1.86–2.59) from a rural locality (AOR=1.45; 95% CI: 1.23–1.71), those reporting no lessons on the danger of tobacco use at school (AOR=1.66; 95% CI: 1.39–1.99) and those exposed to tobacco advertisement (AOR=1.67; 95% CI: 1.07–2.61), were more susceptible to EC initiation, while no significant association was found between secondhand smoke exposure and EC susceptibility. CONCLUSIONS Comprehensive EC preventive strategies are critically needed together with the implementation of targeted, gender, and culturally impressionable interventions. In addition, future studies should focus on the evaluation of the impacts of the preventive and control efforts to ensure their effectiveness in preventing EC initiation among Malaysian adolescents.
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Affiliation(s)
- Pei Pei Heng
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.,Institute for Public Health, National Institutes of Health, Setia Alam, Malaysia
| | - Faiz Daud
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Kuang Hock Lim
- Institute for Public Health, National Institutes of Health, Setia Alam, Malaysia
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Malhotra CK, Gunge D, Advani I, Boddu S, Nilaad S, Crotty Alexander LE. Assessing the potential impact of age and inhalant use on sleep in adolescents. J Clin Sleep Med 2021; 17:2233-2239. [PMID: 34027889 PMCID: PMC8636377 DOI: 10.5664/jcsm.9414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Targeted marketing has caused a recent surge in teen electronic cigarette usage. In all-age surveys, we isolated adolescent data (13-20 years) to assess age alongside electronic cigarettes, traditional tobacco, and dual usage of both with sleep quality and cough. Based on existing adult literature, we hypothesized an association between dual usage and increased sleep latency. METHODS Participants were recruited to complete surveys via social media sites. We performed 3 surveys: Survey 1 (n = 347) in 2018, Survey 2 (n = 1198) in 2019, Survey 3 (n = 554) in 2020. Surveys 1 and 2 had 3 sections: UCSD Inhalant Use Survey, Pittsburgh Sleep Quality Index, and Leicester Cough Questionnaire. Survey 3 did not include the Leicester Cough Questionnaire, instead the Hospital Anxiety and Depression Scale and Patient Health Questionnaire were used. The adolescent data were isolated (n = 609). RESULTS Adolescents reported longer sleep duration with increasing age by one-way analysis of variance. By Tukey's multiple comparisons test, females slept more at ages 19 and 20 years than at age 14 years (P < .01). Female dual users slept more than nonsmokers, (P = .01; mean difference 43.8 minutes; confidence interval = 0.11 to 1.36). We observed an association between dual use and sleep latency vs nonsmokers (P = .0008; mean difference 6.27 minutes; confidence interval = 1.40 to 11.13). We saw no correlation between inhalant use and cough. CONCLUSIONS In females, we observed a peak in sleep hours at age 19 years. College-aged females may wake later than younger adolescent females. The data also raised concern for sleep disruption and nicotine-induced wakefulness. Further data are required to guide public health strategies. CITATION Malhotra CK, Gunge D, Advani I, Boddu S, Nilaad S, Crotty Alexander LE. Assessing the potential impact of age and inhalant use on sleep in adolescents. J Clin Sleep Med. 2021;17(11):2233-2239.
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Affiliation(s)
- Clare Kamini Malhotra
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, California
| | - Deepti Gunge
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, California
| | - Ira Advani
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, California
| | - Shreyes Boddu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, California
| | - Sedtavut Nilaad
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, California
| | - Laura E. Crotty Alexander
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, California,Address correspondence to: Laura E. Crotty Alexander, MD, UCSD 9500 Gilman Dr, MC 9111J, San Diego, CA 92093;
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Wang L, Chen J, Leung LT, Ho SY, Lam TH, Wang MP. Use patterns of cigarettes and alternative tobacco products and socioeconomic correlates in Hong Kong secondary school students. Sci Rep 2021; 11:17253. [PMID: 34446733 PMCID: PMC8390664 DOI: 10.1038/s41598-021-96452-y] [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: 02/08/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Smoking is a major cause of health inequities. However, sociodemographic differences in adolescent tobacco use are unclear. In a territory-wide school-based anonymous survey in 2018/19, we investigated tobacco use and sociodemographic correlates in 33,991 students (mean age 14.8 ± 1.9 years) in Hong Kong. Tobacco use prevalence and current-ever use ratios by sociodemographic factors were calculated. Generalised linear mixed models were used in association analyses. Current use was highest for cigarettes (3.2%), closely followed by alternative tobacco products (3.0%). Current-ever use ratios were highest for heated tobacco products (HTPs, 0.60), followed by nicotine e-cigarettes (0.52), waterpipe (0.51), and cigarettes (0.35). Use prevalence and current-ever use ratios of all products showed curvilinear relations with perceived family affluence (P values < 0.01), being highest in the richest families. Tobacco use was also associated with more senior grades, the lowest parental education, and boys, but current-ever use ratios of HTPs and waterpipe were higher in girls (P values < 0.05). The results suggested that adolescent ever users of nicotine-containing alternative tobacco products were more likely to keep using them than cigarettes, and the richest adolescents were at the highest risks of tobacco use. Diverse tobacco control measures are needed to improve health equity, especially on alternative tobacco products.
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Affiliation(s)
- Lijun Wang
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Jianjiu Chen
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China ,grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Lok Tung Leung
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Sai Yin Ho
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Tai Hing Lam
- grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong, People’s Republic of China
| | - Man Ping Wang
- grid.194645.b0000000121742757School of Nursing, University of Hong Kong, Hong Kong, People’s Republic of China
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