Perceptions Of Harm Research Articles

Young people's support for various forms of e-cigarette regulation in Australia and the UK.

The aim of this study was to examine young people's support for e-cigarette policies in two countries with very different e-cigarette regulatory environments - Australia and the UK. An online survey was administered to 1,185 15-24 year olds (590 from Australia, 595 from the UK). Survey items assessed demographics, use of vaping and tobacco products, exposure to others' vaping behaviours, exposure to e-cigarette advertising, perceptions of harms associated with e-cigarettes, and support for 14 e-cigarette policies. Frequencies for support were calculated for each policy by country and overall, and a mixed effects negative binomial regression was performed to identify factors associated with support. Majority support was expressed for 10 of the 14 policies in the Australian sample and six in the UK sample. Significantly higher levels support were found among Australian respondents compared to UK respondents for all policies except one where the difference failed to reach statistical significance. Support was strongest for policies relating to preventing access by minors, including warnings on packages, and prohibiting misleading advertising. Support was weakest for policies restricting access to e-cigarettes and flavours. Factors associated with higher levels of support were harm perceptions, never having used e-cigarettes, and older age. The results suggest general support for a broad range of e-cigarette control policies among young people in Australia and the UK, despite very different e-cigarette regulatory environments in these countries. Enhancing awareness of the potential harms associated with e-cigarette use appears to be key to optimising support for the assessed policies among members of this age group.

Ice Flavor-Related Discussions on Twitter: Content Analysis.

The US Food and Drug Administration (FDA) recently restricted characterizing flavors in tobacco products. As a result, ice hybrid-flavored e-cigarettes, which combine a cooling flavor with fruit or other flavors (eg, banana ice), emerged on the market. Like menthol, ice-flavored e-cigarettes produce a cooling sensory experience. It is unclear if ice hybrid-flavored e-cigarettes should be considered characterizing flavors or menthol, limiting regulatory action. Monitoring the public's conversations about ice-flavored e-cigarettes on Twitter may help inform the tobacco control community about these products and contribute to the US FDA policy targets in the future. This study documented the themes pertaining to vaping and ice flavor-related conversations on Twitter. Our goal was to identify key conversation trends and ascertain users' recent experiences with ice-flavored e-cigarette products. Posts containing vaping-related (eg, "vape," "ecig," "e-juice," or "e-cigarette") and ice-related (ie, "Ice," "Cool," "Frost," and "Arctic") terms were collected from Twitter's streaming application programming interface from January 1 to July 21, 2021. After removing retweets, a random sample of posts (N=2001) was selected, with 590 posts included in the content analysis. Themes were developed through an inductive approach. Theme co-occurrence was also examined. Many of the 590 posts were marked as (or consisted of) marketing material (n=306, 51.9%), contained positive personal testimonials (n=180, 30.5%), and mentioned disposable pods (n=117, 19.8%). Other themes had relatively low prevalence in the sample: neutral personal testimonials (n=45, 7.6%), cannabidiol products (n=41, 7%), negative personal testimonials (n=41, 7%), "official" flavor description (n=37, 6.3%), ice-flavored JUUL (n=19, 3.2%), information seeking (n=14, 2.4%), and comparison to combustible tobacco (n=10, 1.7%). The most common co-occurring themes in a single tweet were related to marketing and disposable pods (n=73, 12.4%). Our findings offer insight into the public's experience with and understanding of ice-flavored e-cigarette products. Ice-flavored e-cigarette products are actively marketed on Twitter, and the messages about them are positive. Public health education campaigns on the harms of flavored e-cigarettes may help to reduce positive social norms about ice-flavored products. Future studies should evaluate the relationship between exposure to personal testimonials of ice-flavored vaping products and curiosity, harm perceptions, and experimentation with these products among priority populations.

Correlates of Perceived Harmfulness of Regular Cannabis Use among Canadian University Students Before and After Legalization.

Among a prospective sample of Canadian university students, this study aimed to: 1) document changes in cannabis use and perceived harmfulness of use before and after the legalization of recreational cannabis; 2) examine correlates of perceived harmfulness; and 3) explore changes in perceived harmfulness as a function of cannabis use patterns. A random sample of 871 students at one western Canadian university were assessed pre- and post-legalization of recreational cannabis. Descriptive and inferential statistics were used to explore changes in cannabis use and perceived harmfulness. A random effects model was developed to assess whether cannabis legalization was associated with perceptions of harmfulness of regular cannabis use. Twenty-six percent of the sample used cannabis during the past three months at both timepoints. The majority of the sample perceived regular cannabis use as a high-risk behaviour at each timepoint (57.3% and 60.9%, respectively). Results from the random effects model showed that after controlling for covariates, cannabis legalization was not associated with changes in perceived harmfulness. Perceptions of harm remained relatively stable regardless of cannabis use pattern. Respondents who endorsed cannabis use at both timepoints reported a significant increase in their frequency of cannabis use post-legalization. Legalization of cannabis for recreational use was not associated with substantive changes in perceptions of harm among post-secondary students, yet it might lead to increases in cannabis use among those who already use the substance. Ongoing monitoring of policies is needed, as are targeted public health initiatives to identify post-secondary students who are at risk for cannabis-related consequences.

Young Adults' Knowledge of State Cannabis Policy: Implications for Studying the Effects of Legalization in Vermont.

Cannabis policy evaluations commonly assume equal policy exposure across a state's population using date of implementation as the key independent variable. This study aimed to explore policy knowledge as another measure of exposure and describe the sociodemographic, cognitive, and behavioral correlates of cannabis policy knowledge in young adults in Vermont. Data are from the PACE Vermont Study (Spring 2019), an online cohort study of Vermonters (12-25). Bivariate and multivariable analyses estimated prevalence ratios (PR) for correlations between knowledge of Vermont's cannabis policy (allowed possession for adults 21 and older) and sociodemographics, cannabis use, and harm perceptions in 1,037 young adults (18-25). Overall, 60.1% of participants correctly described the state's cannabis policy. Being younger, Hispanic, non-White race, and less educated were inversely correlated with policy knowledge. Ever (PR=1.37; 95% CI 1.16-1.63) and past-30-day cannabis use (PR=1.27; 95% CI 1.12-1.45) were positively correlated with policy knowledge. Policy knowledge was more prevalent among young adults who perceived slight risk of harm from weekly cannabis use (vs. no risk; aPR=1.28; 95% CI 1.11-1.48) or agreed that regular cannabis use early in life can negatively affect attention (vs. disagree; aPR=1.55; 95% CI 1.22-1.97). Findings suggest that 40% of Vermont young adults in the study were unaware of current state cannabis policy and that policy knowledge was lower in younger, less educated, Hispanic, and non-White young adults. Future research should explore using a measure of policy knowledge as an exposure or moderator variable to better quantify the effects of changes in cannabis legal status on perceptions and use in young people.

Identifying misleading corporate narratives: The application of linguistic and qualitative methods to commercial determinants of health research.

Narratives are key to the way corporations represent themselves to the outside world, are important to the development of shared understandings and ultimately determine whether and how corporations are able to influence societal norms and participate in policy debates. A leaked corporate affairs strategy document, from the world's largest transnational tobacco company, Philip Morris International (PMI), suggests a company concerned about credibility; it highlights "normalization" as a key strategic priority until at least 2024. This suggests that the PMI are seeking to rehabilitate their image and alter perceptions of their business. We designed a mixed-methods analysis of corporately authored content, combining quantitative querying of large bodies of text (Corpus Linguistics) with inductive coding of key themes to critically examine PMI's corporate language and how these themes might impact public health debates. We systematically analysed a sample of PMI's corporate communications (n = 170), comparing investor-facing (investor reports, slides and presentations as well as annual reports) and public-facing (YouTube content and Webpage content) communications covering a period of eight years (2012-2019). Our analysis identifies how PMI's misleading external communication contradicts its core business focus and may threaten public health. In public-facing communications, PMI stress their commitment to transformation and change, while in investor-facing communications, they focus on cigarettes and reiterate the strength of their existing cigarette brand portfolios. This suggests that webpage and YouTube content provide a means through which PMI attempt to neutralise negative public perception of tobacco-product related harms and to present themselves as advocates of "better" consumer choice and even public health. The recurrence of transformation, sustainability, and science, as well as the co-option of united-nations terminology in their external-facing communications may serve to legitimise their involvement in policy arenas from which they currently excluded. We present a novel method through which corporate narratives can be monitored and critically assessed.

Factors affecting tobacco, nicotine, and cannabis product use among California young adults during the COVID-19 pandemic: A qualitative study

The effects of COVID-19 on tobacco and cannabis use have been variable, and it is unclear the extent to which factors affecting changes in tobacco and cannabis use differ. The purpose of this study was to identify the COVID-19-related factors that affect changes in tobacco and cannabis use during the pandemic. Focus groups with 114 young adults in California in April 2021 were held to discuss tobacco and cannabis use patterns, adverse events, and the effect of COVID-19 on tobacco and cannabis product use. Factors affecting changes in use were largely similar between tobacco products and cannabis products. Increases in product use were a result of changing social environment, coping with emotional and psychological distress, and product related factors. Decreases in product use were a result of social isolation, COVID-19-related health concerns, disruptions in daily patterns of living, and reduced access. Drivers of increased cannabis use distinct from tobacco or nicotine product use included feeling greater freedom to disengage and perceptions of less harm. Improved understanding of how the pandemic has affected tobacco and cannabis use can inform tailored interventions to both support those who have decreased or quit and assist those who have increased use during the pandemic to reduce or cease their consumption.

Perceptions of alcohol health harm among midlife men in England: a qualitative interview study

In recent years attention has been directed at harmful levels of alcohol consumption among middle-aged and older people. In England, midlife men are over-represented in the social patterning of risk of alcohol harm. Insights into midlife men’s understandings of alcohol harm are limited, and research suggests poor effectiveness of existing alcohol education messaging and guidance. A better understanding of the ‘lay epidemiology’ of alcohol health harm can inform and thus enhance the effectiveness of public health and alcohol education measures. In-depth individual interviews were undertaken with 42 men aged 45–60 drinking over 240 grams (30 UK units) of alcohol per week. The men’s perceptions reflected three dimensions of how alcohol health harm: 1) is experienced and perceived, 2) is understood to work and 3) is best managed and communicated. The harmful bodily effects from alcohol were recognised in ‘problem drinkers’ and as acute effects. The men understood the effect of alcohol as a poison linked to excessive consumption or when consumption was continuous. Alcohol health harms were understood in relation to wider lifestyle behaviours and the men requested that public health advice should give them choices, and not simply tell them what to do. The men had a limited understanding of how alcohol affected their bodies and, drawing on the medical anthropological concept of ‘explanatory models’, it is suggested that providing clear and accessible explanations of how specific alcohol-related health harms occur may help people to make informed choices of moderation and improve the effectiveness of public health messages.

Women's Perspectives on Harm and Justice after Online Harassment

Social media platforms aspire to create online experiences where users can participate safely and equitably. However, women around the world experience widespread online harassment, including insults, stalking, aggression, threats, and non-consensual sharing of sexual photos. This article describes women's perceptions of harm associated with online harassment and preferred platform responses to that harm. We conducted a survey in 14 geographic regions around the world (N = 3,993), focusing on regions whose perspectives have been insufficiently elevated in social media governance decisions (e.g. Mongolia, Cameroon). Results show that, on average, women perceive greater harm associated with online harassment than men, especially for non-consensual image sharing. Women also prefer most platform responses compared to men, especially removing content and banning users; however, women are less favorable towards payment as a response. Addressing global gender-based violence online requires understanding how women experience online harms and how they wish for it to be addressed. This is especially important given that the people who build and govern technology are not typically those who are most likely to experience online harms.

Polysubstance Use Plays a Key Role in Midlife Structural Brain Alterations in Long-term Cannabis Users

Approximately 147 million people across the world consume cannabis annually, making it the most commonly used illicit drug globally ( 1 World Health Organization Alcohol, Drugs, and Addictive Behaviours Unit. Cannabis.. https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabisDate accessed: August 8, 2022 Google Scholar ). Although the use of cannabis has generally become more accepted and perceptions of harm have been decreasing in recent years ( 2 Patrick M.E. Schulenberg J.E. Miech R.A. Johnston L.D. O’Malley P.M. Bachman J.G. Monitoring the Future Panel Study annual report: National data on substance use among adults ages 19 to 60, 1976-2021. Monitoring the Future Monograph Series. University of Michigan Institue for Social Research, Ann Arbor, MI2022 Google Scholar ), negative effects of cannabis use on health and well-being have been identified. Cannabis use has been found to be associated with neurocognitive deficits in memory, learning, and attention and to contribute to alterations to both brain function and structure [see Volkow et al. ( 3 Volkow N.D. Swanson J.M. Evins A.E. DeLisi L.E. Meier M.H. Gonzalez R. et al. Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: A review. JAMA Psychiatry. 2016; 73: 292-297 Crossref PubMed Scopus (480) Google Scholar ) for review]. However, existing studies examining the neural correlates of cannabis use have produced mixed findings in relation to cannabis-specific effects. The question of whether—and to what extent—cannabis use produces unique neural detriments compared with other psychoactive substances remains largely unknown. A possible reason for this knowledge gap is that there are likely other variables at play, variables that are often unaccounted for, that confound direct associations between cannabis use and neural outcomes. Pulling from literature at the intersection of developmental science, addiction research, and neuroscience, two likely targets are age and polysubstance use. SEE CORRESPONDING ARTICLE ON PAGE 861 Diminished Structural Brain Integrity in Long-term Cannabis Users Reflects a History of Polysubstance UseBiological PsychiatryVol. 92Issue 11PreviewCannabis legalization and use are outpacing our understanding of its long-term effects on brain and behavior, which is fundamental for effective policy and health practices. Existing studies are limited by small samples, cross-sectional measures, failure to separate long-term from recreational use, and inadequate control for other substance use. Here, we address these limitations by determining the structural brain integrity of long-term cannabis users in the Dunedin Study, a longitudinal investigation of a population-representative birth cohort followed to midlife. Full-Text PDF

Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis.

Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed. Fourteen databases were searched for eligible studies from the Inception of database until March 2022 to examine the effect estimates of the association between perceptions of harmfulness and addictiveness and overall e-cigarette usage among adolescents and youth. The meta-analysis showed that in comparison to non-users, young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful (OR: 2.20, 95% CI: 1.41-3.43) and perceived e-cigarettes as less harmful than tobacco cigarettes (OR: 2.01, 95% CI 1.47-2.75). Youths who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive (OR: 2.28, 95% CI: 1.81-2.88) or perceive e-cigarettes as more addictive (OR: 1.82, 95% CI: 1.22-2.73) than tobacco cigarettes, as compared with non-users. The subgroup analysis reported that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise. the risk perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth and could be the focus of health promotion to prevent and curb the uptake of e-cigarettes among young people.

Standard smokeless tobacco packaging: potential impact on perceived attractiveness, warning label visibility and harm perceptions among adults in Bangladesh

BackgroundIn Bangladesh, smokeless tobacco (SLT) is available in a variety of pack shapes and sizes. Lack of standard packaging could limit compliance with pictorial health warning label (HWL) requirements. We...

Harm perceptions of secondhand e-cigarette aerosol among youth in the United States

E-cigarette use among youth remains a public health concern. Although extant literature has examined the perceived harms of cigarette use and secondhand smoke, perceptions of harms associated with secondhand e-cigarette aerosol (SHA) are not well understood. Therefore, we used data from the 2020 U.S. National Youth Tobacco Survey (n = 13,292) in which participants indicated whether SHA caused no harm, little harm, some harm, or a lot of harm. We dichotomized SHA harm perceptions as harmless vs harmful. We included sociodemographics (i.e., age, sex, race/ethnicity, sexual orientation, urbanicity), e-cigarette use characteristics, and SHA exposure as covariates and estimated associations between SHA harm perceptions and each covariate using adjusted logistic regression. Most youth perceived SHA as harmful (87.9 %) compared to harmless (12.1 %). Older youth (vs younger youth) had higher odds of perceiving SHA as harmless, whereas male (vs female) youth had 49 % higher odds (95 % CI: 1.29–1.72) of perceiving SHA as harmless. As the number of days of e-cigarette use in the past 30 days increased (vs non-users), odds of perceiving SHA as harmless increased. Youth exposed to SHA (vs no exposure) in the past 30 days had 35 % higher odds of perceiving SHA as harmless (95 % CI: 1.16–1.57). To conclude, youth SHA harm perceptions varied overall and by sociodemographic characteristics, e-cigarette use, and SHA exposure. Educational campaigns to inform youth of the health risks associated with e-cigarettes and SHA are needed to reduce overall nicotine intake and disparities in nicotine exposure.

Pain-related fear of movement dynamics in individuals with and without low back pain participating in weightlifting and/or powerlifting training.

Pain-free adults in the general population have been shown to possess unhelpful beliefs that certain movements and postures are harmful to the spine, potentially reinforcing fear-avoidance behaviour. Whether such beliefs occur in individuals undertaking regular powerlifting (PL) and Olympic weightlifting (OWL) training is unclear. In a cross-sectional study design, 67 individuals who participate in OWL and PL training completed an online survey. Demographic characteristics, training history, and self-reported perceptions of harm, on the 40-item Photograph Series of Daily Activities shortened electronic version (PHODA-SeV), were collected. After removing collinear variables, 13 items were entered into a network analysis, in which the adjusted correlations between items, and the centrality indices of each item (i.e., the degree of connection with other symptoms in the network) were quantified. Twenty-one (31.3%) participants had LBP symptoms. The pairwise correlations with the greatest magnitudes were between images of 'leg stretch' and 'jumping' (0.32 [95%CI 0.08 to 0.45]) and two images depicting ironing (0.32 [95%CI 0.05 to 0.54]) respectively. The three most Central (connected) items were 'stair ascend', 'walking with groceries', and 'mopping with spine flexion'. For individuals training in OWL and PL, images reflecting walking, rather than those depicting high spinal flexion angle, had greater connectivity to other activity items. In addition, the strongest correlations were not between items reflecting high spinal flexion angle. Future studies that investigate the relationship between different intensities of OWL and PL training and the dynamics of pain-related fear are warranted.

State-Level Recreational Cannabis Legalization Is Not Differentially Associated with Cannabis Risk Perception Among Children: A Multilevel Regression Analysis.

Introduction: As more states pass recreational cannabis laws (RCLs) for adults, there is concern that increasing (and state-sanctioned) cannabis acceptance will result in a reduced perception of risk of harm from cannabis among children. We aimed to discover whether children in states with RCLs had decreased perception of risk from cannabis compared with children in states with illicit cannabis. Methods: We analyzed data from the multisite multistate Adolescent Brain and Cognitive Development Study to determine how the perception of cannabis harm among children (age at baseline: 9-10; N=10,395) changes over time in states with and without RCLs. Using multilevel modeling, we assessed survey responses from children longitudinally across 3 years, adjusting for state-, family-, and participant-level clustering and child-level factors, including demographics (sex, race, and socioeconomic status), religiosity, and trait impulsivity. Results: There was no significant main effect of state RCLs on perceived risk of cannabis use, and no differences in change over time by state RCLs, even after controlling for demographic factors and other risk (e.g., impulsivity) and protective (e.g., religiosity) factors. Conclusions: This analysis indicates that state-level RCLs are not associated with differential perception of cannabis risk among children, even after controlling for demographics, trait impulsivity, and religiosity. Future studies could assess how perception of risk from cannabis changes as children and adolescents continue to mature in states with and without RCLs.

‘Facebook is the Devil’: Exploring Officer Perceptions of Cyber-based Harms Facing Youth in Rural and Remote Communities

Policing research, still largely concentrated on urban contexts, is increasingly recognizing the unique features of police work in rural regions. Beyond notable differences such as lower overall levels crime and fewer (though more sporadically distributed) people, little is also known regarding rural police understandings and responses to online mediated harms, including relatively serious forms of cyberbullying, non-consensual ‘sexting’, and other forms of crime mediated online. Interviews with police officers (N = 42) here focus on their views regarding police work in response to cyber-mediated harm facing youth in rural and remote Atlantic Canada. Responses center on how rural regions play a role in mediating the nature of online conflict and police respond to such conflict. Officers highlight several related challenges, such as lack of parental support, and how some youth ‘define deviancy down’, referring to a lack of recognition regarding the harm caused by cyberbullying and non-consensual sexting (including issues related to the distribution of child pornography). Implications are discussed for research on rural policing where evidence-based practices remain lacking.

Disparities in Nicotine Addictiveness and Cancer Harm Perceptions Among U.S. Adults: A Trend Analysis Using the Health Information National Trends Survey.

Recent research has found widespread misperceptions about nicotine. This study tests perceptions among U.S. adults with respect to nicotine addictiveness and cancer harm, while distinguishing between nicotine misperceptions (ie an incorrect response) and "don't know" (DK) responses. Data from three cycles of the Health Information National Trends Survey, fielded in 2015, 2017, and 2019 were merged for analysis. Weighted multinominal logistic regression models were conducted where nicotine addictiveness and cancer harm beliefs (DK, incorrect, and correct responses) were regressed on survey year and demographic variables. We also tested for interactions between survey year and demographic variables to assess if previously identified disparities had evolved during these years. Analyses showed lower odds of misperceptions about nicotine addictiveness, but higher odds of misperceptions about nicotine cancer harm in 2019 compared to 2015. There was no change in DK responses during these years. Disparities by sociodemographics and tobacco use status were observed, mostly for cancer harm. Survey year significantly interacted with age in the model for cancer harm, which was driven primarily by increased incorrect responses and decreased DK responses over time among the youngest age group (18-34 years). There were no significant interactions between survey year and race and ethnicity or level of educational attainment. Disparities in nicotine addictiveness and cancer harm perceptions reflect the uneven distribution of knowledge in the U.S. adult population. Nicotine cancer harm misperceptions are increasing and educational efforts to address this misperception are warranted. Future educational efforts targeting nicotine addictiveness beliefs may benefit by focusing on DK responders. The growing trend of misperceptions of nicotine's role in cancer harm may negatively impact perceptions about nicotine replacement therapy and low nicotine content cigarettes. Future efforts should focus on correcting nicotine cancer harm misperception, particularly among young adults.

Current loot box warnings are ineffective for informing consumers

Loot boxes - a form of in-game purchase within video games (i.e., “microtransactions”) - have received research attention due to their similarities with conventional gambling activities. A consistent positive correlation has been demonstrated between spending on loot boxes and problem gambling symptomatology. In April 2020, the video game regulatory boards across the United States (ESRB) and Europe (PEGI) announced a new warning label would be implemented for games than include loot boxes: “In-Game Purchases (Includes Random Items)”. Such warnings may mitigate spending-related harms to consumers if they effectively inform consumers’ spending decisions. Here, we summarise findings from three preregistered studies showing that (1) consumers perceive that engaging with loot boxes has a potential for harm greater than non-randomised microtransactions, but lower than most gambling activities, (2) the perception of harm inferred by consumers from existing warning labels does not align closely to the potential harms perceived to be associated with loot box engagement, and, perhaps most importantly, (3) consumers do not appear to understand the ESRB/PEGI loot box warning. Thus, current warnings may fail to adequately inform consumer spending decisions.

Changes in Harm Perception for E-Cigarettes Among Youth in the United States, 2014-2019.

To evaluate the trend of harm perception for e-cigarettes and the trend of the association between harm perception for e-cigarettes and for cigarettes among US youth from 2014 to 2019. The National Youth Tobacco Survey is an annual, cross-sectional, school-based survey done among youth selected using three-stage probability sampling. Data were drawn from the 2014 to 2019 Surveys. A Multinomial logistic regression model was used to assess the association between harm perception for e-cigarettes and harm perception for cigarettes for each year. The percentage of youth who perceived e-cigarettes as harmless decreased from 2014 to 2019 (17.2% to 5.8%). From 2015 to 2018, the percentage of smokers who perceived e-cigarettes as a little harmful increased (33.6% to 41.2%). The positive association between harm perception for e-cigarettes and harm perception for cigarettes became stronger with time. In 2014, the odds of perceiving e-cigarettes as harmless relative to very harmful were 19.55 times greater for youth who perceived cigarettes as harmless, compared to those who perceived cigarettes as very harmful (OR = 19.55; 95% CI: 14.19-26.94). These odds increased to 77.65 times in 2019 (OR = 77.65; 95% CI: 41.48-107.85). This study suggests a stronger relationship between perceived harm of cigarettes and e-cigarettes with time. Interventions to prevent smoking have the potential to change e-cigarette use.

Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence.

E-cigarette use (vaping) among adults has increased, and various patterns of concurrent smoking and vaping (i.e., "dual use") have emerged. Understanding dual use is important for mitigating tobacco-related harm. This narrative review summarizes recent research on dual use, including prevalence and types of dual use, sociodemographic and psychiatric characteristics, nicotine dependence, reasons for dual use, harm perceptions, toxicant exposure, trajectories of dual use, and emerging treatments for dual use. Nearly half of e-cigarette users concurrently use cigarettes, and many smoke more frequently than they use e-cigarettes. This is concerning because dual users are exposed to both cigarette and potential e-cigarette toxicants and the data are mixed regarding the ability of e-cigarettes to promote smoking cessation. Further work is needed to identify ways to increase complete smoking abstinence and optimize harm reduction among dual users, including strategies to encourage e-cigarette cessation after stopping smoking.

Short-Term Effects of Recreational Cannabis Legalization on Youth Cannabis Initiation

PurposeAs recreational cannabis is legalized, it is critical to know the impacts of legalization on youth cannabis use. Existing research generates conflicting results and does not shed light on channels of effects. This study investigates the impacts of legalization on youth cannabis initiation and overall cannabis use prevalence. MethodsWe used Interrupted Time Series design and data from nationally-representative repeated cross-sectional Canadian surveys spanning 16 years. The primary outcomes were cannabis initiation rates and cannabis use prevalence among youths. The secondary outcomes were self-reported age of first cannabis use, ease of cannabis access, and perception of cannabis harm among youths. ResultsAfter legalization, cannabis initiation rate among youths was 2.7 percentage points (95% confidence interval: 1.7–3.7; p < .01) or 69% higher, although there was no significant increase in the overall prevalence of cannabis use. Furthermore, there was a 4-month delay in the average age of first cannabis use among youths aged 17–18 years (95% confidence interval: 2.6–5.5 months; p < .01). The legalization was associated with greater perception of cannabis harm but also easier access to cannabis. DiscussionThe impacts of legalization on youth cannabis use after 1 year are mixed. Although we observed an increase in cannabis initiation among youths who had never used cannabis, there was no change in the overall prevalence of cannabis use, implying a possible offsetting increase in cannabis cessation among existing users. To achieve legalization's goal of reducing youth cannabis use, policy measures are needed to curb youth cannabis access and initiation.