Perceptions of Alternative Tobacco Products, Anti-tobacco Media, and Tobacco Regulation among Young Adults: A Qualitative Study

E-cigarette cessation interest and quit attempts among young adults reporting exclusive e-cigarette use or dual use with other tobacco products: How can we reach them?

INTRODUCTION

There is limited evidence to inform e-cigarette quitting interventions. This mixed-methods study examined: 1) e-cigarette and other tobacco product perceptions and cessation-related factors; and 2) potential behavioral intervention strategies among young adults reporting exclusive e-cigarette use or dual use with other tobacco products.

METHODS

We analyzed Fall 2020 survey data from 726 participants reporting past 6-month e-cigarette use (mean age=24.15 years, 51.1% female, 38.5% racial/ethnic minority) from 6 US metropolitan areas and Spring 2021 qualitative interview data from a subset (n=40), comparing tobacco-related perceptions and cessation-related factors among those reporting exclusive use versus dual use.

RESULTS

Among survey participants (35.5% exclusive e-cigarette use, 64.5% dual use), those reporting dual use indicated greater importance of quitting all tobacco or nicotine products (mean=5.28, SD=3.44 vs mean=4.65, SD=3.75, p=0.033), whereas those reporting exclusive use expressed greater confidence in quitting e-cigarettes (mean=7.59, SD=3.06 vs mean=7.08, SD=3.01, p=0.029) and all tobacco and nicotine products (mean=7.00, SD=3.16 vs mean=6.31, SD=3.13, p=0.008), as well as less favorable perceptions (i.e. more harmful to health and addictive, less socially acceptable) of cigarettes, cigars, and smokeless tobacco (p<0.05). Interview participants (50.0% exclusive e-cigarette use; 50.0% dual use) attributed previous failed e-cigarette quit attempts to their inability to cope with social influences, stress, and withdrawal symptoms. Although most expressed disinterest in quitting due to belief of eventually outgrowing e-cigarettes (among those reporting exclusive use) or unreadiness to abstain from nicotine (among those reporting dual use), many acknowledged the need for quitting interventions.

CONCLUSIONS

Young adult e-cigarette cessation interventions should target risk perceptions, cessation barriers, and social influences/support.

Nicotine Use During Pregnancy: Cessation and Treatment Strategies

Abstract

The use of tobacco and nicotine products during pregnancy is known to increase the risk of adverse effects on the fetus. Increased education and research have resulted in greater rates of smoking cessation during pregnancy, with a decline from 13.2% of pregnant individuals smoking in 2006 to 7.2% in 2016. However, smoking while pregnant still proves to be a prevalent issue that is associated with numerous adverse outcomes, including low birth weight, preterm birth, and developmental delays. Smoking cessation before or during pregnancy can help mitigate these effects, but the appropriate treatment can be challenging to ascertain. Accordingly, clinicians should look to provide individualized care composed of behavioral counseling in conjunction with pharmacotherapies when indicated, combined with ongoing support and education.

The Reshaping of the E-Cigarette Retail Environment: Its Evolution and Public Health Concerns

E-cigarette use represents a public health controversy in the US and globally. Despite the potential of e-cigarettes to support cigarette cessation, their use increases health risks and risk for addiction, particularly in young people. Various federal, state, and local laws have impacted tobacco retail in general and e-cigarettes in particular. In the US, 2019–2020 federal laws increased in the minimum legal sales age for tobacco to 21 and banned flavored cartridge-based e-cigarettes. Many states and localities were early adopters of Tobacco 21 and implemented more comprehensive flavor restrictions than the federal ban. Meanwhile, cannabis retail is increasingly being legalized in the US—while cannabis-based product regulation has notable gaps at the federal, state, and local levels. These regulatory complexities have impacted specialized retailers selling e-cigarettes, including “vape shops” that exclusively sell e-cigarettes, “smoke shops” that sell e-cigarettes and other tobacco (and potentially CBD/THC and other un- or under-regulated products), and online retail. This commentary outlines public health concerns related to: (1) youth access; (2) consumer exposure to a broader range of tobacco products and marketing in retail settings where they may seek products to aid in cigarette cessation (i.e., such broad product exposure could hinder cessation attempts); (3) consumer exposure to un-/under-regulated products (e.g., delta-8-THC, kratom); and (4) federal, state, and local regulations being undermined by consumer access to prohibited products online and via the mail. These concerns underscore the need for ongoing surveillance of how retailers and consumers respond to regulations.

Psychosocial predictors of longitudinal changes in tobacco and cannabis use among young adults

INTRODUCTION

In recent years, cigarette use has decreased, but alternative tobacco product and cannabis use has increased in young adults. Thus, research regarding intraindividual changes in tobacco product and cannabis use in this population, and related psychosocial predictors, is warranted.

METHODS

We analyzed data from 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 60.2% racial/ethnic minority) in a 2-year, 5-wave longitudinal study (2018-2020). Latent growth modeling analyzed the outcomes of past 6-month use of cigarettes, e-cigarettes, traditional cigars, little cigars/cigarillos, smokeless tobacco (SLT), hookah, and cannabis across Waves 1-5 among all participants; psychosocial predictors included depressive symptoms, adverse childhood experiences (ACEs), and personality traits.

RESULTS

Results indicated decreases in likelihood of using each tobacco product over time, but no significant change in likelihood of cannabis use. Psychosocial predictors of baseline use across products included depressive symptoms and extraversion, as well as ACEs and openness for nearly all products (e.g., except traditional cigars). Psychosocial predictors of less decreases in use likelihood over time included: for cigarettes and traditional cigars, ACEs; for e-cigarettes, extraversion; for little cigars/cigarillos, depressive symptoms and extraversion; for SLT, openness; and for hookah, neuroticism (controlling for sociodemographics). Predictors of greater decreases in likelihood of use over time included: for e-cigarettes and hookah, conscientiousness; and for cannabis, agreeableness.

CONCLUSIONS

Interventions to reduce young adults' use might target distinct risk/protective factors for using different products (and combinations). Moreover, results regarding decreasing likelihood of using tobacco products but not cannabis over time warrant replication and explanation in other samples.

Upstream Approaches to Addressing Prescription Stimulant Misuse and Diversion: Exploring Perspectives of College Students Who Misuse and Divert

Background

We interviewed college students who engage in prescription stimulant misuse and diversion to better understand perspectives on prevention and intervention strategies.

Methods

Trained student researchers at one southern California university completed 32 face-to-face interviews with students who had a history of misuse and/or diversion. Participants provided insights on programs, policies, and practices that have the potential to deter behavior. Data were analyzed inductively via thematic analysis.

Results

Students were often misinformed or unaware of existing programs, policies and practices. Additionally, some students felt their behaviors would not be detected, whereas other students felt the fear of being detected would lead them to change their behaviors. Harm reduction and treatment-based approaches to address misuse were also recommended.

Conclusions

Our findings emphasize the importance of better educating students about, and enforcing, existing policies. In addition, the need to better inform students of existing campus programs is warranted.

Responses to e-cigarette health messages among young adult sexual minoritized women and nonbinary people assigned female at birth: Assessing the influence of message theme and format

BACKGROUND

Young adult sexual minority women (YSMW) report disproportionate e-cigarette (EC) use and low EC harm perceptions. Health messages that effectively communicate EC harms to YSMW are needed. We tested the effect of culturally targeted EC health messages with varying themes and image formats on attitudes and intentions to use ECs in this population.

METHODS

N = 501 YSMW and nonbinary people assigned female at birth (AFAB) aged 18-30 years-old completed an online experiment. Participants were randomized into a control or one of nine experimental conditions in a 3 (theme: harms, wellness, pride) by 3 (image format: individual, couple, cartoon) study design. We modeled associations between message condition and message effectiveness, discouragement from vaping, change in feelings toward vaping, perceived threat, and intentions to abstain from vaping.

RESULTS

Among YSMW and nonbinary people AFAB, harm and wellness themes discouraged vaping more than pride-themed messages (p's < 0.001). Harms messages resulted in worse feelings about vaping than wellness and pride messages (p's < 0.02). Images of couples were perceived as more effective than cartoon images (p = .008). Among current EC users, viewing images of individuals resulted in greater readiness to avoid ECs and higher intentions to abstain than the couple or cartoon conditions (p's < 0.001).

CONCLUSIONS

Message theme and image format were associated with YSMW and nonbinary people AFAB's EC attitudes and behavioral intentions. Future studies should evaluate how to optimize harms messages; including if wellness or pride messages can be re-framed to better affect EC use in this population.

Youth Demographic Characteristics and Risk Perception of Using Alternative Tobacco Products: An Analysis of the 2014-2015 Canadian Student Tobacco, Alcohol, and Drugs Survey (CSTADS)

Background

There is a growing attraction by youth to alternative tobacco products (ATPs) such as e-cigarettes and hookahs. This study investigated risk perceptions and demographic characteristics associated with ATP use in grade 8-10 students.

Methods

Data were drawn from the 2014/15 cycle of the CSTADS. The analytic sample included 1819 students from a total pool of 42 094 students who completed the survey. Logistic regression models were used to examine factors (demographic characteristics and risk perception) associated with ATP use in the past 30 days.

Results

12% of students in grade 8-10 self-identified as having used ATPs in the past 30-days, with a majority of students in grade 10 (56%). Male students had higher odds of reporting ATP use when compared to females. Although a lesser proportion of Indigenous students reported ATP use in comparison to White students (31% vs 61%), Indigenous students were 2.42 (1.49, 3.93) times as likely to use ATPs as White students. Students who perceived smoking hookah once in a while as "no to slight risk" were 1.58 (1.09, 2.28) times more likely to report ATP use than students who perceived "moderate to great risk." Also, students who perceived using e-cigarettes on a regular basis as "no to slight risk" were 2.21 (1.53, 3.21) times more likely to report ATP use as students who perceived "moderate-great risk."

Conclusion

A significant number of grade 8-10 students use ATPs, especially e-cigarettes, with the misconception of minimal health risks. There remains the need to do more to counteract the rise in social and epidemiological alternative tobacco use trends among the youth.

Health Information on Waterpipe Lounge Menus to Educate Young Adults: Pilot Study Findings

BACKGROUND

For years, tobacco risk communication has largely focused on cigarette smoking. New strategies must be developed to adapt to emerging tobacco products, such as waterpipe tobacco smoking (WTS).

AIMS

The purpose of this pilot study was to determine the preliminary effects of health information on waterpipe lounge menus on the perceptions of harm and risk from WTS and inform future efficacy interventions for health communication (i.e., educating populations on the risks, harms, and health consequences of WTS).

METHOD

Participants aged 18 to 24 years (n = 213) who smoked waterpipe at least monthly were randomized to one of four waterpipe lounge menu groups using a two-by-two experimental design with "warning message" and "nicotine content" as factors.

RESULTS

Those who viewed waterpipe lounge menus that included a warning message had greater perceived relative harm to health and perceived risk of decreased lung function from WTS. Those who viewed waterpipe lounge menus that included nicotine content had greater perceived risk of heart attack from WTS.

DISCUSSION

Participants who were exposed to health warnings of WTS and information on the nicotine content of waterpipe tobacco increased on measures of perceived relative harm and risk of health consequences.

CONCLUSION

The pilot test results indicate promise for providing health information on waterpipe lounge menus to educate young adults on the harms and risks of WTS.

Young Adults' Vaping, Readiness to Quit, and Recent Quit Attempts: The Role of Co-use With Cigarettes and Marijuana

INTRODUCTION

E-cigarette cessation intervention research is limited. Young adult e-cigarette use and cessation is particularly nuanced, given various user profiles (ie, polytobacco use, co-use with marijuana) warranting different intervention approaches.

METHODS

The current study is an analysis of baseline survey data (collected September-December 2018) among 1133 young adult (aged 18-34) e-cigarette users in a 2-year longitudinal study. We examined (1) e-cigarette user profiles (ie, e-cigarette only; e-cigarette/other tobacco; e-cigarette/marijuana; e-cigarette/other tobacco/marijuana) and (2) correlates of readiness to quit e-cigarette use in the next 6 months and past-year e-cigarette quit attempts.

RESULTS

In this sample (Mage = 23.91, 47.3% male, 35.5% sexual minority, 75.2% White, 13.7% Hispanic), e-cigarette user profiles were as follows: 16.8% e-cigarettes-only, 23.4% e-cigarette/other tobacco, 18.0% e-cigarette/marijuana, and 41.8% e-cigarette/other tobacco/marijuana. Multinomial logistic regression (referent: e-cigarette-only use) indicated that all polyuse groups were more likely to use high-nicotine e-liquids (containing ≥9 mg of nicotine). Other predictors included e-cigarettes/other tobacco users being older and male; e-cigarettes/marijuana users using closed systems; and e-cigarettes/other tobacco/marijuana users being sexual minority (p's < .01). Readiness to quit e-cigarettes and past-year quit attempts were reported by 20.8% and 32.3%, respectively. Per multilevel regression, readiness to quit and quit attempts correlated with using fewer days, high-nicotine e-liquids, and closed systems, but not marijuana, as well as being heterosexual and Black (vs White); readiness to quit also correlated with being single; past-year quit attempts correlated with other tobacco use and being Hispanic.

CONCLUSIONS

Young adult e-cigarette users demonstrate distinct user profiles and cessation-related experiences that should be considered in developing cessation interventions.

IMPLICATIONS

The vast majority of young adult e-cigarette users use other tobacco products and marijuana. Unfortunately, few reported readiness to quit or attempting quit. Moreover, certain subgroups (eg, sexual/racial/ethnic minorities) are more likely to be ready or attempt to quit, but may not be successful. Vaping cessation interventions must attend to these nuances.

Vape Shop Owners/Managers' Opinions About FDA Regulation of E-Cigarettes

INTRODUCTION

In the United States, prominent sources of vaping products are specialty vape shops, which are subject to Food and Drug Administration (FDA) regulation. This study interviewed vape shop owners/managers to assess: (1) reasons for entering into or engaging in vape shop retail; (2) personnel training, particularly with regard to FDA and state regulations; and (3) how existing regulations are perceived and the anticipated impact of future regulation.

AIMS AND METHODS

The current study involved phone-based semi-structured interviews of 45 vape shop owners/managers in six metropolitan statistical areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle) during Summer 2018 as FDA regulations regarding minimum age verification, bans on product sampling, and health warnings (among others) were first being implemented.

RESULTS

Vape shop owners/managers reported: (1) entering the industry with positive intentions for their customers, (2) training their personnel to adhere to regulations and provide good customer service, and (3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors.

CONCLUSIONS

These findings indicate the complexities in implementing tobacco regulations, particularly from the perspective of the vape shop industry. Current findings should inform future regulatory actions and efforts to assess compliance with regulations.

IMPLICATIONS

Current and impending FDA regulation of vaping products present a critical period for examining regulatory impact on the vape shop industry. Current results indicated that many vape shop owners/managers reporting positive intentions for engaging in the vaping product industry and in training vape shop personnel to adhere to regulations. However, the majority reported concerns about FDA regulation and other state/local regulations that could have negative implications for their industry. Particular concerns include difficulty understanding the regulations due to complexity, vagueness, and changes in language and/or interpretation over time. These issues have implications for compliance that must be addressed.

Exploring the Point-of-Sale Among Vape Shops Across the United States: Audits Integrating a Mystery Shopper Approach

INTRODUCTION

Vape shops represent prominent, unique retailers, subject to Food and Drug Administration (FDA) regulation in the United States.

AIMS AND METHODS

This study assessed compliance of US vape shop retail marketing strategies with new regulations (eg, required age verification, prohibited free samples) and pre-implementation conditions for other regulations (eg, health warning labels on all nicotine products, required disclosures of e-liquid contents).

RESULTS

95.0% of shops displayed minimum-age signage; however, mystery shoppers were asked for age verification at 35.6% upon entry and at 23.4% upon purchase. Although 85.5% of shops had some evidence of implementing FDA health warnings, 29.1% had signage indicating prohibited health claims, 16.3% offered free e-liquid samples, 27.4% had signage with cartoon imagery, and 33.3% were within two blocks of schools. All shops sold open-system devices, 64.8% sold closed-system devices, 68.2% sold their own brand of e-liquids, 42.5% sold e-liquids containing cannabidiol, 83.2% offered price promotions of some kind, and 89.9% had signage for product and price promotions.

CONCLUSIONS

Results indicated that most shops complied with some implementation of FDA health warnings and with free sampling bans and minimum-age signage. Other findings indicated concerns related to underage access, health claims, promotional strategies, and cannabidiol product offerings, which call for further FDA and state regulatory/enforcement efforts.

"Taking Up a New Problem": Context and Determinants of Pod-Mod Electronic Cigarette Use Among College Students

In this article, we explore the context and determinants of pod-mod electronic cigarette (ECIG) use among college students aged 18 to 24 in the United States. We conducted semi-structured interviews with 55 students (M age = 20 years, 56% female, 65% White) on three campuses in the Northwest, Midwest, and Southeast. We performed a thematic analysis. Students described ECIG use by peers, increased ECIG exposure and prevalence in college, and school-related stress as reasons for vaping. Pod-mod features such as convenience, design, easy concealment, and flavors made vaping more appealing. Negative aspects of vaping included addiction, cost, and possible health consequences. Most viewed vaping as a college behavior and intended to quit after graduation. Our results show that the college environment plays a major role in young adult ECIG use. These findings can inform the development of targeted interventions to prevent and control uptake of ECIGs by young adults.

Inside the adolescent voice: A qualitative analysis of the appeal of different tobacco products

INTRODUCTION

While cigarette use has decreased, adolescents’ overall use of tobacco (e.g. e-cigarettes, cigars, and hookah) has increased. The purpose of this qualitative study is to highlight the decision-making process of adolescents to use certain products over others and why certain tobacco products appeal to them.

METHODS

Twenty-five participants were recruited from a larger study surveying adolescents’ perceptions and tobacco use (772 high school students). The participants were involved in one-on-one semi-structured phone interviews on the appeal of different tobacco products. Interviews were recorded, transcribed verbatim, and analyzed by identifying relevant codes and themes.

RESULTS

Participants for this study had a mean age of 16.4 (SD=1.2) years; over half (14/25) were female. Three major themes emerged from the interviews: 1) social context and circumstances to use, including using and sharing with peers, and reducing boredom; 2) importance of flavors, smell, taste, smoke tricks, and accessibility of products; and 3) misperceptions and misinformation of product risks.

CONCLUSIONS

The findings that emerged showed why participants favored certain tobacco products, especially e-cigarettes, over others. The results support areas for future research and practice, and inform how interventions can better address the appeal of different tobacco products to ultimately prevent adolescent use.

Young Adult E-cigarette Use and Retail Exposure in 6 US Metropolitan Areas

Objectives

Given the need to understand e-cigarette retail and its impact, we examined sociodemographic, tobacco and marijuana use, and e-cigarette retail experiences as correlates of (1) past 30-day e-cigarette use, (2) past 30-day advertising/media exposure, and (3) point-of-sale age verification among young adults.

Methods

We analyzed baseline survey data (September-December, 2018) among 3006 young adults (ages 18-34) in 6 metropolitan areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, Seattle) in a 2-year longitudinal study.

Results

In this sample (M_age = 24.6, 42.3% male, 71.6% white, 11.4% Hispanic), 37.7% (N = 1133) were past 30-day e-cigarette users; 68.6% (N = 2062; non-users: 66.0%, users: 72.9%) reported past 30-day e-cigarette-related advertising/media exposure. Among e-cigarette users, vape shops were the most common source of e-cigarettes (44.7%) followed by online (18.2%). Among users, 34.2% were "almost always" asked for age verification. In multilevel logistic regression, e-cigarette use and advertising/media exposure were correlated (and both correlated with being younger). E-cigarette use also correlated with other tobacco product and marijuana use (and being male and white). Infrequent age verification correlated with commonly purchasing e-cigarettes online (and being older and black).

Conclusions

Increased efforts are needed to reduce young adult advertising/media exposure and increase retailer compliance among retailers, particularly online and vape shops.

Vape shop identification, density and place characteristics in six metropolitan areas across the US

Vaping is increasingly prevalent and controversial. Vape shops and convenience stores are common but distinct sources of vaping products, and where they locate may reflect likely target markets. This study examined the density and neighborhood demographics of vape shops and convenience stores in six metropolitan statistical areas (MSAs): Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, Seattle. We identified 459 vape shops using Yelp and Google application programming interfaces and 10,777 convenience stores using ReferenceUSA and Dun & Bradstreet. Retailers were geocoded to census tracts (n = 4,442), and logistic regressions were conducted using as predictors percent non-White, percent youth (5-17 years or 5-20 years), and median household income from the American Community Survey, 2013-2017. Per 10,000 young adults, vape shop density ranged from 0.6 (Boston, San Diego) to 1.7 (Oklahoma City), and convenience store density ranged from 12.6 (San Diego) to 26.3 (Oklahoma City). Logistic regressions indicated that vape shops more likely resided in tracts with lower percentages of youth in Boston, but higher percentages of youth in Atlanta, as well as with lower incomes in Boston and Seattle. Convenience stores more likely resided in tracts with lower percentages of non-Whites in Atlanta and Boston; lower incomes in Atlanta, Boston, San Diego, and Seattle; and higher percentages of youth in Atlanta, Boston, and Minneapolis. These common retail sources of vaping products differentially locate in relation to neighborhood sociodemographics across MSAs. Findings suggest that, in some MSAs, vape shops and convenience stores may target youth and lower income populations.

What Does It Meme? A Qualitative Analysis of Adolescents' Perceptions of Tobacco and Marijuana Messaging

OBJECTIVES

With the increasing popularity of electronic cigarettes and legalization of recreational marijuana, messaging from websites and social media is shaping product perceptions and use. Quantitative research on the aesthetic appeal of these advertisements from the adolescent and young adult perspective is lacking. We evaluated (1) how adolescents and young adults perceived tobacco and marijuana messaging online and through social media platforms and (2) interactive behaviors related to these messages.

METHODS

We interviewed 24 participants from the Tobacco Perceptions Study, a longitudinal study of adolescents' and young adults' (aged 17-21) tobacco-related perceptions and tobacco use. We collected qualitative data from October 2017 through February 2018, through individual semi-structured interviews, on participants' experiences and interactions with online tobacco and marijuana advertisements and the advertisements' appeal. Two analysts recorded, transcribed, and coded interviews.

RESULTS

Themes that emerged from the interviews focused on the direct appeal of online messaging to adolescents and young adults; the value of trusting the source; the role of general attitudes and personal decision-making related to using tobacco and/or marijuana; the appeal of messaging that includes colors, interesting packaging, and appealing flavors; and the preference of messages communicated by young people and influencers rather than by industry.

CONCLUSION

These findings suggest the need for increased regulation of social media messaging and marketing of tobacco and marijuana, with a particular focus on regulating social media, paid influencers, and marketing that appeals to adolescents and young adults. The findings also suggest the importance of prevention programs addressing the role of social media in influencing the use of tobacco and marijuana.

Impact of Graphic Warning Messages on Intentions to Use Alternate Tobacco Products

Graphic cigarette warnings increase quit attempts. Perceived message effectiveness and message avoidance are predictive of later quit attempts. We sought to examine whether randomized exposure to warning messages would inadvertently increase intentions to use alternate tobacco products while enhancing attempts to quit cigarettes. An online survey of 1392 adult smokers in the US asked participants to rate six randomly selected tobacco warnings (from a set of 319) on perceived effectiveness and avoidance intentions. These two indicators of message effectiveness were calculated at the message-level and then at the individual campaign-level to facilitate causal inference. After viewing a message campaign of six warning messages, participants indicated their intentions to use alternate tobacco products. Sixty-eight percent of participants reported some intention to use e-cigarettes and intentions to use other alternate tobacco products ranged from 31% to 40%. Campaigns of messages eliciting higher avoidance increased the odds of intending to use hookah (aOR: 4.32), smokeless tobacco (aOR: 4.88), and snus (aOR: 8.06), but not the intention to use electronic cigarettes. These relationships are mediated by intentions to quit smoking (all p <.05). Viewing campaigns with higher campaign-level perceived effectiveness increased the intentions to quit, which in turn increased intentions to try alternate tobacco products. Our findings increase the tobacco control community's understanding of unintended consequences of graphic tobacco warnings.

Smokers' and Nonsmokers' Receptivity to Smoke-Free Policies and Pro- and Anti-Policy Messaging in Armenia and Georgia

Garnering support for smoke-free policies is critical for their successful adoption, particularly in countries with high smoking prevalence, such as Armenia and Georgia. In 2018, we surveyed 1456 residents (ages 18–64) of 28 cities in Armenia (n = 705) and Georgia (n = 751). We examined support for cigarette and electronic nicotine delivery systems (ENDS)/heated tobacco product (HTP) smoke-free policies in various locations and persuasiveness of pro- and anti-policy messaging. Participants were an average age of 43.35, 60.5% female, and 27.3% current smokers. Nonsmokers versus smokers indicated greater policy support for cigarette and ENDS/HTP and greater persuasiveness of pro-policy messaging. Armenians versus Georgians generally perceived pro- and anti-policy messaging more persuasive. In multilevel linear regression, sociodemographics (e.g., female) and tobacco use characteristics (e.g., smoking less frequently, higher quitting importance) correlated with more policy support. Greatest policy support was for healthcare, religious, government, and workplace settings; public transport; schools; and vehicles carrying children. Least policy support was for bar/restaurant outdoor areas. The most compelling pro-policy message focused on the right to clean air; the most compelling anti-policy message focused on using nonsmoking sections. Specific settings may present challenges for advancing smoke-free policies. Messaging focusing on individual rights to clean air and health may garner support.

Exposure and engagement with tobacco-related social media and associations with subsequent tobacco use among young adults: A longitudinal analysis

BACKGROUND

This study examines whether self-reported exposure to cigarette, e-cigarette, cigar, and hookah advertising, and engagement with pro-tobacco and anti-tobacco social media, are associated with past 30-day tobacco use one-year later, among young adults.

METHODS

Data were from two waves of the Marketing and Promotions Across Colleges in Texas study, a multi-wave study of two- and four-year Texas college students (N = 3947; M age = 23.3, SD = 2.3; 64% female; 35% white, 31% Hispanic, 19% Asian, 8% African-American/black, 7% multi-racial/other) from 24 urban-area schools. Multiple logistic regression examined longitudinal associations between recall of exposure and engagement at baseline (wave 6, spring 2017) and tobacco use at one-year follow-up (wave 7, spring 2018), accounting for baseline demographic characteristics and tobacco use.

RESULTS

Self-reported exposure to and engagement with tobacco-related social media were significantly associated with past 30-day use of e-cigarettes, cigars, and hookah at one-year follow up; engagement was also associated with cigarette use. Controlling for other social media, exposure to any product advertising via Reddit increased risk for e-cigarette use (AOR = 1.92 [95% CI: 1.17-3.14]). Pinterest exposure increased risk for cigar use (2.92 [1.24-6.85]). Snapchat exposure increased risk for hookah use (2.94 [1.70-5.11]). Pro-tobacco engagement increased risk for future use of all products (1.77 [1.29-2.42]). Anti-tobacco engagement increased risk for use of cigars (1.59 [1.12-2.27]) and hookah (1.69 [1.27-2.25]).

CONCLUSIONS

Findings demonstrate that encountering tobacco-related social media is an important risk factor for future tobacco use among young people. Social media should be a focus of federal regulation, counter-marketing and health communication campaigns, and intervention.

Motivation to quit cigarettes and alternative tobacco products: prevalence and correlates among youth experiencing homelessness

Use of alternative tobacco products, as well as regular cigarettes, is widespread among unaccompanied youth experiencing homelessness. However, little is known about their level of motivation for quitting use of these products, factors associated with motivation to quit, or how these might vary by type of tobacco product. Unaccompanied homeless youth were sampled from 25 street and service sites in Los Angeles County (N = 469). All participants were past month tobacco users who completed a survey on their tobacco-related behaviors and cognitions, including motivation to quit, as well as background characteristics. Among self-reported users of each product, motivation to quit in the next 30 days was highest for regular cigarettes (33%), followed by e-cigarettes/vaporizers (30%), little cigars/cigarillos (25%), cigars (20%), and natural cigarettes (20%). Between 33 and 49% of youth, depending on product, were not thinking about quitting at all. Correlates of lower motivation to quit differed somewhat by product type, with the most consistent being race, more frequent use, lower perceived riskiness of the product, and using the product because of its good taste or smell. Results from this study identify a set of psychosocial and behavioral factors, some that are common across tobacco products and others that are product-specific, that may be particularly important to address in efforts to reduce tobacco use among youth experiencing homelessness. Future regulations on the sale of flavored tobacco products may also serve to increase motivation to quit in this population.

E-cigarette Use, Tobacco Product Polyuse, and Motivations for Use among Baltimore Young Adults

Objective

We examined reasons for e-cigarette use, tobacco product polyuse, and tobacco cessation interest among tobacco-using young adults from an urban setting.

Methods

Participants (N = 97) completed a risk factor survey. Descriptive statistics and prevalence estimates of polytobacco use patterns, motivations for tobacco use, tobacco cessation interest, and beliefs and risk perceptions about tobacco use were explored.

Results

All participants had a history of polyuse, and 85% were current polyusers. Stress was the primary reason reported for tobacco use. Compared to single-product users, current polyusers also were more likely to mention environment and cheap cost as reasons for use. Most participants perceived cigarettes to be as addictive as cocaine or heroin, although this perception was less common among e-cigarette users than non-users. Among study participants, 59% reported wanting to stop using tobacco completely. Among current polyusers, those that used e-cigarettes were more likely to report cessation attempts during the past year and express interest in enrolling in a quit smoking text messaging program.

Conclusion

In our sample there was a high prevalence of polytobacco product use and complex tobacco use patterns among young adults, both in and out of college, from an urban community.

Psychological Risk Factors for Alcohol, Cannabis, and Various Tobacco Use among Young Adults: A Longitudinal Analysis

BACKGROUND

Alcohol, cannabis, and tobacco use are prevalent in young adults and may be differentially related to psychological symptoms characterized as externalizing or internalizing.

OBJECTIVES

This study examined the use of alcohol, cannabis, and various tobacco products in relation to externalizing (ADHD) versus internalizing factors (depression, anxiety), hypothesizing alcohol and cannabis use are associated with externalizing factors whereas tobacco use is related to internalizing factors.

METHODS

Data from a 2-year longitudinal study of 2,397 US college students (aged 18-25) launched in 2014 were analyzed. Adult ADHD Self-Report Scale, Patient Health Questionnaire-9 item (assessing depressive symptoms), and the Zung Self-Rating Anxiety Scale scores were examined in relation to subsequent past 30-day use of alcohol, cannabis, and tobacco products (cigarettes, little cigars/cigarillos, smokeless tobacco, e-cigarettes, hookah), as well as nicotine dependence per the Hooked on Nicotine Checklist.

RESULTS

Participants were 20.49 (SD = 1.93) years old, 64.7% female, and 65.5% White. In multivariable analyses, greater ADHD symptoms predicted alcohol and cannabis use (p = .042 and p = .019, respectively). Cigarette and little cigar/cigarillo use were predicted by greater depressive (p = .001 and p = .002, respectively), and anxiety symptoms (p = .020 and p = .027, respectively). Nicotine dependence was correlated with greater anxiety symptoms (p = .026). Counter to hypotheses, smokeless tobacco use was predicted by greater ADHD symptoms (p = .050); neither e-cigarette nor hookah use were predicted by these psychological symptoms. Conclusions/Importance: Research examining risk factors for tobacco use must distinguish among the various tobacco products. Moreover, interventions may need to differentially target use of distinct substances, including among the range of tobacco products.