Abstract P124: Mental Health Differences by Vaping Behavior Observed Among Youth and Young Adults

Introduction: Previous studies have identified associations between nicotine and marijuana vaping among youth. Studies also have identified associations between vaping and both anxiety and depression among young adults.

Hypothesis: We hypothesized that mental health differences would be evident across current nicotine-only vapers, current vapers of both nicotine and THC, and never vapers.

Methods: A national online survey was conducted among 2,505 youth and young adults aged 13-24 during June and July 2022. The participants were recruited via an online panel and received an incentive to complete the survey. Parent consent was obtained for minors and informed consent was obtained from participants. Quotas were established for vaping and THC use. This analysis focuses on current vapers and never vapers (n=1,762). Current use was defined as having vaped in the past 30 days. Of the participants, 1,200 were current nicotine vapers (370 nicotine-only vapers and 830 dual vapers of nicotine and THC); 562 have never vaped nicotine or THC.

Results: Dual vapers were significantly more likely than nicotine-only vapers to indicate addiction to nicotine, as defined as waking up at night to vape (55% vs. 45%, p<0.05). Both vaping groups were significantly more likely than never vapers to report mental health concerns. Anxiety was more prevalent among dual vapers (60%) and nicotine-only vapers (58%) than never vapers (43%) (p<0.05). Depression was more prevalent among dual vapers (52%) and nicotine-only vapers (53%) than never vapers (25%) (p<0.05). And having suicidal thoughts was more prevalent among dual vapers (51%) and nicotine-only vapers (53%) than never vapers (33%) (p<0.05). About one in four dual vapers (24%) and nicotine-only vapers (28%) started vaping nicotine to calm down/feel less stressed or anxious; one in three dual vapers (30%) and nicotine-only vapers (35%) currently vaped nicotine for this reason. One in five vapers (19% of dual vapers and nicotine-only vapers) started vaping to help feel less depressed, and currently vaped for this reason (20% of dual vapers and 21% of nicotine-only vapers). Dual vapers were significantly more likely than nicotine-only vapers to say they were less depressed after starting vaping (46% vs. 31%, p<0.05); nicotine-only vapers were more likely to say vaping had no impact on their depression (38% vs. 27%, p<0.05).

Conclusions: In conclusion, our analysis shows an association between mental health symptoms with vaping nicotine and THC. Dual use may either compound the addictive nature of vaping or attract those more prone to addiction, as well as have an impact on depression. Anxiety and depression symptoms were notable among both groups, compared with never vapers, and were cited as reasons for nicotine vaping. These findings suggest the importance of addressing the use of THC and the need for building resilience skills in vaping prevention efforts.

Perceptions of electronic cigarettes among ethno-culturally diverse Latino adults in four US urban centers

OBJECTIVE

The aim of this study was to examine perceptions including knowledge, attitudes, and beliefs about e-cigarettes among ethno-culturally diverse Latino adults living in the US, a rapidly growing minority group for which we know little about their e-cigarette perceptions.

DESIGN

A total of 25 focus groups with Latinos (n = 180; ages 18-64 years) were conducted in 2014. E-cigarettes users and non-users were recruited via purposive sampling techniques. Participants completed brief questionnaires on sociodemographic factors and tobacco use. Focus group discussions were conducted in English and Spanish, audio-recorded, and transcribed. Data were analyzed using thematic analysis procedures.

RESULTS

Participants were of diverse Latino backgrounds. Over one-third (35%) reported current cigarette smoking and 8% reported current e-cigarette or hookah use. Nonsmokers reported experimenting with e-cigarettes and hookah during social occasions. Participants' perceptions towards e-cigarettes were generally formed in comparison to conventional cigarettes. Perceived benefits of using e-cigarettes included their utility as a smoking cessation aid, higher social acceptability, and lower harm compared to conventional cigarettes. Negative perceptions of e-cigarettes included lower overall satisfaction compared to conventional cigarettes and high content of toxins. Socio-cultural factors (e.g. gender roles, familismo, and simpatía) also influenced perceptions of e-cigarette of study participants.

CONCLUSIONS

Overall, Latino adults knew relatively little about the potential health risks associated with e-cigarette use. The limited knowledge about and misinformation of e-cigarettes among this rapidly growing minority group have important public health implications. Findings may inform culturally tailored health communication campaigns, which are much needed among underserved US Latino populations in light of low effectiveness of tobacco control and regulatory efforts.

The Influence of Friends on Teen Vaping: A Mixed-Methods Approach

Vaping is popular among adolescents. Previous research has explored sources of information and influence on youth vaping, including marketing, ads, family, peers, social media, and the internet. This research endeavors to expand understanding of peer influence. Our hypothesis is that friends’ influence on teen vapers’ first electronic nicotine delivery systems (ENDS) use varies by demographic variables and awareness of ENDS advertising. In August–October 2017, youth (n = 3174) aged 13–18 completed an online survey to quantify ENDS behaviors and attitudes and were invited to participate in follow-up online research in November-December 2017 to probe qualitative context around perceptions and motivations (n = 76). This analysis focused on the ENDS users, defined as having ever tried any ENDS product, from the survey (n = 1549) and the follow-up research (n = 39). Among survey respondents, friends were the most common source of vapers’ first ENDS product (60%). Most survey respondents tried their first ENDS product while “hanging out with friends” (54%). Among follow-up research participants, the theme of socializing was also prominent. ENDS advertising and marketing through social media had a strong association with friend networks; in fact, the odds of friends as source of the first vaping experience were 2 times higher for those who had seen ENDS ads on social media compared with other types of media. The influence of friends is particularly evident among non-Hispanic Whites, Hispanics/Latinos, those living in urban areas, those living in high-income households, those with higher self-esteem, and those who experiment with vaping. These findings support the premise that peer influence is a primary social influencer and reinforcer for vaping. Being included in a popular activity appears to be a strong driving force.

Associations between tobacco use patterns and demographic characteristics of sexual minority and heterosexual youth: Results from a nationwide online survey

INTRODUCTION

Youth are at risk for tobacco use, and previous research has pointed to increased vulnerabilities associated with sexual minority identity. For example, LGB youth have increased odds for using tobacco than their heterosexual peers, and bisexual youth have higher odds of smoking than other sexual identity groups. As new tobacco products proliferate and health risks from dual/poly use grow, increased understanding of tobacco use patterns by sexual minority youth is needed.

METHODS

For 3117 youth, aged 13–18 years, who completed an online questionnaire in 2017 and identified their sexual orientation [minority (e.g. lesbian/gay, bisexual, or pansexual) vs majority (heterosexual)] and gender, we classified current tobacco use into four categories: e-cigarette only, other product only (such as cigarette, cigar, or smokeless tobacco; not an e-cigarette), dual/poly use, and no use. Analyses were conducted separately for male and female participants. Multinomial logistic regression was employed.

RESULTS

Female sexual minority youth had nearly twofold odds of dual/ poly tobacco use (OR=1.95; 95% CI: 1.12–3.40), compared to their heterosexual counterparts. For male youth, sexual minority identification was not significantly associated with dual/poly use. No significant differences were found in sexual minority and heterosexual youth e-cigarette only or other tobacco only use groups. Tobacco use patterns also significantly differed by age, race, place of residence, and parental education level.

CONCLUSIONS

Study findings reveal greater odds of dual/poly tobacco use for female sexual minority youth. Tailored tobacco prevention and cessation programs or interventions are needed for sexual minority youth most at risk of tobacco use, especially multiple product use.

Socioeconomic and Demographic Status and Perceived Health Risks of E-Cigarette Product Contents Among Youth: Results From a National Survey

Background. The prevalence of e-cigarette use among youth is rising and may be associated with perceptions of health risks for these products. We examined how demographic factors and socioeconomic status (SES) are correlated with the perceived health risks of e-cigarette product contents among youth. Method. Data were from a national online survey of youth aged 13 to 18 between August and October 2017, weighted to be representative of the overall U.S. population in age, sex, race/ethnicity, and region. Survey analysis procedures were used. Results. Of 1,549 e-cigarette users and 1,451 never-e-cigarette users, 20.9% were Hispanic, 13.7% Black, 21.7% LGBTQ (lesbian/gay/bisexual/transgender/queer), and 49.3% in low-income families. With adjustment for e-cigarette use status, perceived health risks of nicotine and toxins/chemicals in e-cigarettes significantly differed by gender, race, sexual orientation, and SES (ps < .05). For example, adjusted odds of perceiving harm from nicotine were 60% higher in girls versus boys, 34% lower in non-Hispanic Blacks versus non-Hispanic Whites, 33% lower in urban versus suburban residents, 40% higher in LGBTQ versus straight-identifying individuals, and 28% lower in low-income versus high-income families. Lower parental education level also was associated with children's lower health risk perception of e-cigarette product contents. Conclusions. For youth, the perceived health risks of e-cigarette product contents were associated with demographics, sexual orientation, and SES. The findings may have relevance for developing communication and education strategies addressing specific youth audiences, especially those in vulnerable groups. These strategies could improve awareness among youth concerning the health risks of e-cigarettes, helping to prevent or reduce e-cigarette uptake and continued use.

Cigarette smoking, ENDS use and dual use among a national sample of lesbians, gays and bisexuals

INTRODUCTION

Historically, lesbian, gay and bisexual (LGB) individuals have higher rates of cigarette smoking, often attributed to targeted tobacco advertising, exposure to stressors, and psychological distress. Elevated use of electronic nicotine delivery systems (ENDS) among LGB individuals has been documented recently. However, the LGB groups are not homogeneous and differences may exist between the use of tobacco by men and women within the LGB groups. The purpose of this research was to examine cigarette smoking, ENDS use and dual use (cigarettes plus ENDS) among LGB subgroups.

METHODS

We classified 2087 participants completing a national online survey based on tobacco-use status (i.e. cigarette only, ENDS only, dual use) and sexual orientation. Multinomial logistic regression was employed to assess group differences.

RESULTS

After adjusting for demographics and socioeconomic status, bisexual women were 1.85 times (95% CI: 1.19–2.87) more likely to report current dual use, in contrast to cigarette only use, compared to heterosexual women. No significant differences were found between lesbian and heterosexual women, or between gay or bisexual men and their heterosexual counterparts.

CONCLUSIONS

This study describes significantly greater dual use by bisexual women and is one of the first reports of elevated dual use in this group compared to heterosexual women. These findings suggest that targeted health messages may be needed to raise awareness of risk in specific LGB groups and that future research with these populations is necessary to better understand differences in tobacco perceptions and use.

Correlates of youth vaping flavor preferences

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ENDS were the tobacco products most likely to be tried first.

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Fruit was the favorite flavor, followed by menthol/mint/wintergreen.

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Preference for flavor varied by age, sex and racial/ethnic background.

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Those who preferred fruit flavor were twice as likely to have tried ENDS first.

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Those who preferred menthol/mint/wintergreen were less likely to have tried ENDS first.

Among youth who use electronic nicotine delivery systems (ENDS), e-cigarettes are often the first tobacco product tried. Flavor is a common reason for experimentation with e-cigarettes. This study assessed flavor preferences and the choice of ENDS as an initial product among youth by selected demographic characteristics. The analysis sample included 1549 participants who had ever tried ENDS, drawn from a national online survey of youth aged 13–18 in 2017. Fruit was the most common favorite flavor among ENDS users, followed by menthol/mint/wintergreen. Preference for flavor varied by age, sex and racial/ethnic background. ENDS were the tobacco products most likely to be tried first, particularly among participants under age 17. Those who preferred fruit flavor were twice as likely to have tried ENDS first, compared to those with other flavor preferences, while those who preferred menthol/mint/wintergreen flavor were half as likely to have tried ENDS first. Our findings support an association between flavor and ENDS use. Our research supports previous findings indicating that: 1) flavor is one of the primary reasons for experimentation with ENDS among youth; 2) fruit flavor is strongly associated with use of ENDS as the first tobacco product; and 3) preference of fruit flavor varies by age, sex and racial/ethnic background. These findings have relevance for developing targeted messages for specific youth audiences and implications for tobacco regulatory policies. In addition to January 2020 federal regulations, the authors recommend tighter restrictions, specifically that the marketing and sale of all e-cigarette flavors other than tobacco be eliminated.

Age differences in electronic nicotine delivery systems (ENDS) usage motivations and behaviors, perceived health benefit, and intention to quit

INTRODUCTION

Data from comprehensive studies are sparse regarding age differences in issues related to electronic nicotine delivery systems (ENDS) usage. This study examined age differences in usage motivations and behaviors, perceived health benefit, and quit intentions in a large and diverse sample recruited online.

METHODS

The sample included 1,432 current ENDS users, ages 18-64, drawn from a national online survey conducted in 2016. Descriptive and multivariable analyses were used.

RESULTS

The sample included participants in the following age groups: 18-24 (17.5%), 25-34 (38.6%), 35-44 (23.3%), and 45-64 (20.7%). With multiple adjustments, the 18-24 age group was more likely to vape for reasons such as flavors or friends' use, and to use multiple flavors and products with varying nicotine content. For example, the odds (95% CI) of vaping initiation due to flavor attraction vs. other reasons in the 18-24 age group were 1.40 (1.02-1.92), 2.73 (1.85-3.99), and 2.12 (1.41-3.18) compared to the 25-34, 35-44, and 45-64 age groups, respectively. In contrast, compared to older age groups, the 18-24 age group was less likely to use ENDS as an alternative to cigarettes or as a quitting device; they also used ENDS less frequently and perceived less health benefit of ENDS use. The 18-24 age group, especially those who had only used ENDS, had the lowest odds of likely quitting use of tobacco/nicotine products compared to other groups (lower by 44-73%).

CONCLUSION

There were significant age differences in ENDS usage motivations and behaviors, perceived health benefit, and quit intentions.

Perceived health risks of electronic nicotine delivery systems (ENDS) users: The role of cigarette smoking status

INTRODUCTION

Use of electronic nicotine delivery systems (ENDS) has increased markedly. We examined how current ENDS users differ in perceptions of tobacco and ENDS-related health risks as a function of cigarette smoking status.

METHODS

We classified 1329 current ENDS users completing a national online survey based on cigarette smoking status, and employed linear and logistic regression to assess group differences in perceptions of tobacco-related health risks.

RESULTS

The sample consisted of 38% Current Cigarette Smokers, 40% Former Cigarette Smokers, and 22% Non-Smokers. Our targeted recruitment strategy yielded a balance of key descriptive variables across participants. Significant differences were observed in race, employment and marital status across cigarette smoking status, but not in gender, education, income, or sexual orientation. Participants reported considerable perceived knowledge about health risks associated with tobacco use, but less regarding ENDS use. Current Smokers rated ENDS use as riskier than Non-Smokers, and considered cigarette use less risky for both users and bystanders. Current Smokers were more likely to perceive cardiovascular diseases, diabetes and cancer as the health risks associated with ENDS use. Former Smokers were more likely to perceive such risks with traditional tobacco use. Further, regardless of smoking status, perceived knowledge about the health risks of tobacco or ENDS use was positively associated with perceived likelihood of high risks of cardiovascular diseases and cancer.

CONCLUSIONS

Among current ENDS users, there were significant differences in perceived health risks based on cigarette smoking history. Improved health messaging can be achieved when cigarette smoking status is taken into account.