Social influence of e-cigarette smoking prevalence on smoking behaviours among high-school teenagers: Microsimulation experiments

Social influence and advocacy pathways during a web-based program for adolescent smoking prevention

Introduction

Exposure to smokers has been identified as a predictor of adolescent tobacco use. Conversely, adolescents who tend to be advocates against smoking may become less likely to initiate smoking themselves. Several digital tobacco prevention programs have been developed to include social strategies. This study aimed to identify (1) whether programs can motivate adolescents to become advocates against smoking, and (2) if being an advocate against smoking and exposure to friends who smoke can predict smoking while controlling for a program's effect.

Methods

We conducted a non-prespecified secondary analysis using data from a randomized controlled trial (RCT) with 18-month follow-up. High schools were randomized to either receive ASPIRE or a tobacco education booklet. We conducted a cross-lagged linear path model to allow for reciprocal associations, estimating a two-time-points, three-variable panel model with logistic regression.

Results

Receiving ASPIRE was associated with a lower likelihood of smoking, but it did not predict becoming an advocate against smoking or changing adolescents' proportion of friends who smoke. After controlling for the effect of ASPIRE, the study shows that adolescents who were advocates against smoking had a decreased risk of smoking by follow-up, and smoking at baseline significantly predicted having a higher proportion of friends who smoke at follow-up.

Discussion

Being an advocate against smoking can be a key predictor of lower odds of smoking, even when controlling for an individual-based intervention. Future research can study the mechanisms and long-term effects of advocacy and incorporate social strategies that can leverage social networks for tobacco prevention.

A literature review addressing midwakh and e-cigarette use in the Gulf region

A notable decrease in conventional cigarette smoking has been witnessed on a global scale. However, this decrease has been accompanied by an equally striking global increase in the consumption of alternative tobacco products (ATPs), namely e-cigarettes and midwakh in the Arabian Gulf region. A literature review was used to outline the chemical composition of these two ATPs and review their impacts on health. The study was conducted using databases like PubMed, Google Scholar, MDPI, and WorldCat. The literature search included terms such as "e-cigarettes," "midwakh," "dokha," "heath impacts," "psychological effects," "social influences," and "cigarette smoking" with emphasis on literature from the Arabian Gulf region. Data shows that midwakh contains markedly high levels of tar, nicotine, and various compounds of notable effects on the human body. Similarly, it was found that e-cigarettes contain non-negligible amounts of nicotine and other chemical compounds that may not have been extensively investigated. Alarming reports of system-specific effects brought about by midwakh, and e-cigarette consumption, have been reported, although further research is needed to deduce the mechanism. We also discussed some of the social and psychological factors leading to their consumption within this population. Hence, this review raises questions around the safety of these two types of ATPs and encourages comprehensive studies globally and regionally.

The long-term effectiveness and cost-effectiveness of public health interventions; how can we model behavior? A review

The effectiveness and cost of a public health intervention is dependent on complex human behaviors, yet health economic models typically make simplified assumptions about behavior, based on little theory or evidence. This paper reviews existing methods across disciplines for incorporating behavior within simulation models, to explore what methods could be used within health economic models and to highlight areas for further research. This may lead to better-informed model predictions. The most promising methods identified which could be used to improve modeling of the causal pathways of behavior-change interventions include econometric analyses, structural equation models, data mining and agent-based modeling; the latter of which has the advantage of being able to incorporate the non-linear, dynamic influences on behavior, including social and spatial networks. Twenty-two studies were identified which quantify behavioral theories within simulation models. These studies highlight the importance of combining individual decision making and interactions with the environment and demonstrate the importance of social norms in determining behavior. However, there are many theoretical and practical limitations of quantifying behavioral theory. Further research is needed about the use of agent-based models for health economic modeling, and the potential use of behavior maintenance theories and data mining.

Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies

OBJECTIVE

To systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation.

DATA SOURCE AND STUDY SELECTION

Four databases were searched for modelling studies of e-cigarette use on population health published between 2010 and 2023. A total of 32 studies were included.

DATA EXTRACTION

Data on study characteristics, model attributes and estimates of population impacts including health outcomes and smoking prevalence were extracted from each article. The findings were synthesised narratively.

DATA SYNTHESIS

The introduction of e-cigarettes was predicted to lead to decreased smoking-related mortality, increased quality-adjusted life-years and reduced health system costs in 29 studies. Seventeen studies predicted a lower prevalence of cigarette smoking. Models that predicted negative population impacts assumed very high e-cigarette initiation rates among non-smokers and that e-cigarette use would discourage smoking cessation by a large margin. The majority of the studies were based on US population data and few studies included factors other than smoking status, such as jurisdictional tobacco control policies or social influence.

CONCLUSIONS

A population increase in e-cigarette use may result in lower smoking prevalence and reduced burden of disease in the long run, especially if their use can be restricted to assisting smoking cessation. Given the assumption-dependent nature of modelling outcomes, future modelling studies should consider incorporating different policy options in their projection exercises, using shorter time horizons and expanding their modelling to low-income and middle-income countries where smoking rates remain relatively high.

E-cigarette use and cigarette smoking initiation among Australian women who have never smoked

INTRODUCTION AND AIM

Evidence regarding the association between e-cigarette use and subsequent initiation of smoking mostly relates to the US population. In Australia, no studies are available investigating the association between the uses of e-cigarettes and smoking initiation among young adults who have never smoked. This study aimed to determine the association between lifetime e-cigarette use and subsequent initiation of cigarette smoking among tobacco-naïve Australian women aged 20-27.

DESIGN AND METHODS

The current study used data (n = 5398) from the third (2015) and fourth (2016) surveys collected from a cohort of Australian women born in 1989-1995 who participated in the Australian Longitudinal Study on Women's Health. Multivariable logistic regression was used to identify the association between lifetime e-cigarette use at the baseline survey and initiation of cigarette smoking (smoked 100 cigarettes or more in the last year) at the follow up adjusting for possible confounders. Effects were expressed as odds ratios with 95% confidence interval.

RESULTS

The mean (± SD) age of the study participants at baseline (third survey) was 22.5 (±1.7). Ever e-cigarette use at baseline was positively associated with smoking initiation at follow up (adjusted odds ratio 3.71; 95% confidence interval 2.33, 5.93). History of depression, binge drinking and higher childhood adversity score were also risk factors for subsequent smoking initiation in the follow up.

DISCUSSION AND CONCLUSIONS

This study identified a strong association between e-cigarette use and subsequent initiation of smoking. Enforcing the existing restriction of sale and supply of e-liquid containing nicotine is essential to prevent never smokers from nicotine addiction via e-cigarettes.

A qualitative study of e-cigarette use among young people in Ireland: Incentives, disincentives, and putative cessation

BACKGROUND

Smoking prevalence in Ireland is falling in all age groups, but e-cigarette use is rising among young people. This qualitative study explores young people's accounts of e-cigarette use in Ireland.

METHODS

Semi-structured individual (22) and focus group (8) interviews were conducted with 62 young people aged 18-22 years, recruited from a higher-education institution and youth organisations working with early school-leavers across Dublin. All were smokers or ex-smokers; 41 had tried e-cigarettes, 11 continued as dual users. We identified themes using thematic data analysis.

RESULTS

Three broad themes were identified: incentivising features, disincentivising features, and ambivalent and unsuccessful cessation, named putative smoking cessation. Incentivising features included price, pleasing taste/ flavours, and the possibility of indoor use. Disincentivising features related to adverse health effects (pain, discomfort, sore throat, coughing, headache) and unpleasant physical effects (bad taste, problems resulting from device faults). Other disincentives were over-consumption arising from inability to control intake, "greater addictiveness", product taste, and device faults. Putative cessation refers to the conflict between participants' expected use of e-cigarettes as a smoking cessation/reduction aid and their observed reality of e-cigarettes' failure in this regard, with reported outcomes including: failure to quit or reduce; continued or resumed cigarette and/or roll-your-own smoking; dual use of e-cigarettes and other tobacco products; and inability to quit e-cigarettes.

CONCLUSIONS

Participants were sceptical about e-cigarettes' "purported relative healthiness", concerned about addictiveness and potential long-term health consequences, and critically aware of advertising and industry strategies. E-cigarettes were viewed as being less denormalised, in part because they could be used in indoor spaces where smoking is banned in Ireland. Although price, taste, and perceived renormalisation were important motivators for young people's use of e-cigarettes, they wanted to quit smoking. The regulation of e-cigarettes through age restriction of access, licensing of outlets, pricing, point of sale and advertising restrictions as well as through the banning of indoor use should be considered by legislators and tobacco control policymakers.