Nonsmoking Youth Research Articles

Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study

BackgroundAlthough electronic cigarettes (e-cigarettes) appear to be effective in helping people who smoke to stop smoking, concerns about use of e-cigarettes among young people have led to restrictions on non-tobacco flavoured e-liquids in some countries and some US states. These restrictions could reduce the appeal of these products to non-smoking youth but could have negative consequences for people who smoke or use e-cigarettes.MethodsIn this mixed methods study, we recruited UK adults who smoked or used to smoke and subsequently vaped to explore their opinions of unflavoured e-liquids and their beliefs about how they would be impacted by hypothetical e-liquid flavour restrictions. Participants trialled an unflavoured e-liquid instead of their usual nicotine product for four hours and completed a survey and an online interview.ResultsUsing Interpretive Phenomenological Analysis and graphically presented data, we found differences in participants’ opinions of unflavoured e-liquid. If only unflavoured, tobacco flavoured, and menthol flavoured e-liquids remained on the UK market, some people who smoke or vape may be unaffected, but some may relapse to smoking or continue smoking. Despite most wanting to prevent young people from initiating vaping, participants had varying opinions on whether flavour restrictions would be an effective method.ConclusionsThe findings highlight that people who smoke and vape could be impacted by flavour restrictions in a range of ways, some of which could have a potential adverse impact on harm reduction efforts in the UK (e.g., by making smoking more appealing than vaping).

Prevalence of Electronic Cigarette Smoking Among Students of Shaqra University, Saudi Arabia.

Background Electronic cigarettes are devices that use a flavored nicotine solution instead of burning tobacco leaves. Since their emergence, e-cigarettes have gained popularity in Saudi Arabia, particularly among young adults. Recently, many non-smoking youths have begun to use e-cigarettes as an alternative social behavior. Recent studies have confirmed that e-cigarettes have harmful effects on the respiratory system. Approximately 48.5 million Europeans have used an e-cigarette at least oncewhile 7.5 million Europeans currently use e-cigarettes. This study aims to assess the prevalence of e-cigarette use and possible addictiveness among Shaqra University students. Methodology This is a cross-sectional studyconducted at Shaqra University in 2021. A total of 290 students (18 years old and older) from Shaqra University were included in our study. The subjects were selected through simple random sampling. A self-administered online questionnaire related to e-cigarettes was used. Results Completed questionnaires were obtained from 290 students (average age of 20.2 ± 1.8 years). A total of 58 (20.1%) of the respondents were e-cigarette users. The obtained results showed that the mean age of e-cigarette smokers was 20.5 years, e-cigaretteusage significantly differed between age groups (p < 0.001), and the highest prevalence of e-cigarette smoking was in Shaqra Governorate (i.e., 13.1%). Conclusion It's vital to acknowledge that the capacity for addiction to e-cigarettes is comparable to traditional smoking and other nicotine-containing items. It's essential to consistently observe students and smokers to better understand the effects of vaping patterns on this specific group.

Causal inference in tobacco research: a public health challenge

Causal inference represents a rapidly expanding interdisciplinary subfield that involves various assumptions, study designs, and estimation strategies, allowing researchers to establish causal relationships from both clinical trials and observational data. In tobacco research, numerous studies address causal questions, including the contentious issue of whether vaping in nonsmoking youth leads to smoking initiation, known as the “gateway effect.” Determining the effectiveness and safety of many health interventions will continue to rely on observational [mainly longitudinal] data because randomized trials are not always feasible, ethical, or timely. Therefore, review articles that are synthesizing evidence on the gateway effects of electronic nicotine delivery systems [ENDS] on subsequent cigarette smoking must also consider observational studies as first-rate evidence that can help bring together the polarized tobacco research community and help better understand the “gateway effect.” In addition, this will help ongoing efforts to rigorously prevent ENDS use by youth while expanding the cessation potential of ENDS among adult established smokers who are unwilling to quit otherwise. In this commentary, we discuss causal inference tobacco research as one of the public health challenges and provide some recommendations/implications.

Reducing the number and types of tobacco retail outlets in the Netherlands: Study protocol for a comprehensive mixedmethods policy evaluation.

Clinical Trials ID NCT05554120, Protocol ID KWF140282021-2. FOIA: Freedom of Information Act. SES-WOA: socioeconomic scores of private households. MCID: minimal clinically important difference.

Commentary on Tattan-Birch et al.: How might the rise in popularity of disposable vapes among young adults impact policy in the United Kingdom?

Commentary on Tattan-Birch et al.: How might the rise in popularity of disposable vapes among young adults impact policy in the United Kingdom?

A content analysis of website marketing for cooling flavored e-liquids in a sample of brick-and-mortar vape shops in the Greater Los Angeles area.

INTRODUCTIONMenthol is a characterizing flavor in combustible cigarettes and electronic nicotine delivery systems (ENDS). E-liquids are recognized as an important reason for ENDS use. Yet, compared to menthol cigarettes, menthol flavored e-liquids and other cooling flavors, including mint and ‘ice’ for ENDS, are an understudied area of investigation. The present study examined cooling flavored e-liquid website marketing among brick-and-mortar vape shops in Greater Los Angeles Area.METHODSA total of 104 brick-and-mortar vape shops were identified, and 38 had active websites. Over a 30-day period (28 September – 28 October 2020), we collected marketing for all flavored refillable e-liquids (photos/images) from each website. Data were collected for 1330 products. Only refillable e-liquid bottles were selected for this study, excluding prefilled pod vapes and disposable vapes. Each e-liquid per website was coded (e.g. menthol or not) and grouped into categories (e.g. type of menthol). The three flavor descriptor categories that the e-liquids were grouped into were menthol, mint, or ice. An ‘other’ category was also created for identified e-liquids with flavor descriptors that did not mention menthol, mint, or ice.RESULTSA total of 1330 e-liquid flavors were identified from 38 active websites. Among them, 219 were coded as menthol/mint/ice flavor e-liquids. Frequencies included ice/iced/icy (n=123; 56%), menthol (n=32; 15%), mint (n=23; 11%), and other (n=41; 19%). Of the 123 ice-flavor e-liquids, 70.3% (n=83) were in combination with fruit (e.g. ‘Apple Ice’, ‘Grape Iced’, ‘Icy Mango’). Of the 32 menthol-flavored e-liquids, 63.3% (n=19) were in combination with fruit (e.g. ‘Dragon Fruit Menthol’, ‘Blue Raspberry Menthol’, ‘Fresh Peach Menthol’). Flavors in the other category were ice-related flavor descriptors (e.g. ‘Arctic Air’, ‘Brain Freeze’, ‘Frozen Hulk Tears’).CONCLUSIONSBrick-and-mortar vape shops in the Greater Los Angeles Area market a variety of cooling flavor e-liquids on their websites. Such marketing focused largely on ice fruit flavor combinations. Future research is needed to understand how exposure to and appeal of cooling flavored e-liquid marketing differs among diverse consumer groups, including adult menthol cigarette smokers and non-smoking youth.

USING THE THEORY OF REASONED ACTION TO PREDICT SMOKING INTENTION AMONG NON-SMOKING SECONDARY SCHOOL GOING ADOLESCENTS IN PENINSULAR MALAYSIA

The study aims to determine the relationship of attitude and social-norm with the intention to smoke in the future among non-smoking youth. Data were derived from a study on smoking among form four students in a selected secondary school in Peninsular Malaysia, which utilised a pre-validated questionnaire to obtain data from the selected respondents. Descriptive statistics and structural equation modelling (SEM) were used in data analysis. The study revealed independent variables accounted for 22.6% of the variance in intention to initiate smoking and the model had a good fit. A significant relationship was observed between subjective norm and intention to initiate smoking (R=0.46). The study revealed that attitude and social norm substantially explained intention to smoke among non-smoking adolescents. Future measures should concentrate on correcting the subjective norms to reduce the intention to initiate smoking among non-smoking youth.

High School Seniors Who Used E-Cigarettes May Have Otherwise Been Cigarette Smokers: Evidence From Monitoring the Future (United States, 2009–2018)

Abstract Introduction Studies have indicated that youth who use e-cigarettes are more likely to progress to cigarette smoking; however, the likelihood that these youth would have used tobacco products in the pre-vaping era is unclear. Aims and Methods This study sought to determine whether youth who used e-cigarettes in 2014–2018 would have likely been smokers in the period preceding e-cigarette availability. Analyzing Monitoring the Future 12th grade data (United States, 2009–2018), we forecasted the prevalence of current smoking with logistic regression-derived propensity scores. Models predicted smoking for all subsequent years, incorporating sociodemographic, family, alcohol, and school-related variables, and a linear time trend. We compared forecasted to observed smoking prevalence annually, and prevalence of current e-cigarette use among nonsmokers across smoking propensity tertiles. Results Until 2014, observed smoking prevalence mirrored forecasted prevalence. Afterward, forecasted rates consistently overestimated prevalence. Among nonsmoking youth, e-cigarette use was lowest among those with lowest predicted probability of cigarette smoking (3.8%; 95% confidence interval [CI]: 3.3, 4.4) and highest among those with highest probability (23.5%; 95% CI: 22.2, 24.9). Conclusions Youth e-cigarette use has increased rapidly, with high prevalence among nonsmoking youth. However, the decline in current smoking among 12th graders has accelerated since e-cigarettes have become available. E-cigarette use is largely concentrated among youth who share characteristics with smokers of the pre-vaping era, suggesting e-cigarettes may have replaced cigarette smoking. Implications Among nonsmoking youth, vaping is largely concentrated among those who would have likely smoked prior to the introduction of e-cigarettes, and the introduction of e-cigarettes has coincided with an acceleration in the decline in youth smoking rates. E-cigarettes may be an important tool for population-level harm reduction, even considering their impact on youth.

AN EXAMINATION ABOUT EVALUATION OF BLOOD PRESSURE AND PULSE WAVE VELOCITY IN HEALTHY YOUTHS WITH FITNESS HABITS

Objective: Pulse Wave Velocity (PWV) was an examination to measure the level of atherosclerosis in many medical institution. Previous report showed that Risk factor of atherosclerosis as hypertension, diabetes mellitus, hyperlipidemia, aging, smoking made the PWV fast. On the other hand, PWV in non-smoking youths were correlative with obese and hyperlipidemia (Internal Med. 2005), and familial history (our data at ESH 2013). Correlation PWV with other risk factors and its preventional methods were not elucidated. Here, in this study, first, we paid attention to the relationship between PWV and Familial History (FH) and Blood Pressure (BP) in Healthy, non-smoking youths without abnormal data of blood test in medical examination (blood sugar, lipid, liver and renal function). And next, we noticed to the difference in risk mitigation due to the presence or absence of exercise habits. Design and method: Non-smoking healthy youths, 72 men and 30 women with chance fitness habits (CFH), 36 men and 15 women with daily fitness habits (DFH), without abnormal data of blood test in medical examination was entry in this study. Medical examination by interview was done to all of them. If he or she had a familial history of hypertension, diabetes mellitus, hyperlipidemia, ischemic heart disease, cerebrovascular disease in parents, it counted as two point, and also in grandparents, as one point by each risk factor. And in this study, called three former risk factors as “disease risk (DR)”, two latter risk factors as “outbreak risk (OR)”. Results: Mean PWV was faster in men and women with CFH than those with DFH. Next these data into ascending-order, and devided into “low PWV (LP)” and “high PWV (HP)” bound on the median. PWV recorded HP is faster than recorded LP with CFH and DFH, recorded HP is faster than recorded LP with CFH but these difference in men and women with DFH has tendency to shirink statistically. Conclusions: We conclude that familial history and BP may correlate with PWV in healthy youths with chance fitness habits especially in HP. But daily fitness habits pretend to rise their BP.

Both Nonsmoking Youth and Smoking Adults Like Sweet and Minty E-liquid Flavors More Than Tobacco Flavor

Smokers may reduce their health risk by switching to electronic cigarette (e-cigarette) use. As e-cigarettes are not harmless, concerns exist about e-cigarette use by nonsmokers and youth. E-liquids are available in many different flavors that increase sensory appeal. Flavor preferences may differ between user groups, which could open doors for product regulation. We investigated which e-liquid flavors are attractive to specific user groups by comparing liking between adolescent nonsmokers (n = 41; mean age 16.9 ± 0.8), young adult nonsmokers (n = 42; mean age 22.7 ± 1.7), and adult smokers (n = 56; mean age 39.7 ± 11.1). Participants smelled tobacco- (n = 6) and nontobacco (n = 24)-flavored e-liquids and rated liking on a 9-point labeled hedonic scale, and familiarity, overall intensity, perceived sweetness, perceived bitterness, and irritation of the odors on a 100-unit Visual Analog Scale. Mean liking ranged from 2.3 (whiskey) to 6.7 (peppermint). Within all groups, the typically sweet and minty flavors (e.g., wine gum, watermelon, peppermint, menthol) were liked significantly more than the tobacco-flavored e-liquids. The set of tobacco-flavored e-liquids was significantly, but slightly, less disliked by adult smokers (3.9 ± 0.2) than adolescent (3.1 ± 0.3) and young adult (3.4 ± 0.3) nonsmokers (P < 0.001). No between-group differences were observed for sweet and minty flavors. Liking correlated significantly positively with odor sweetness (R = 0.49) and familiarity (R = 0.48) and negatively with odor bitterness (R = −0.58), irritation (R = −0.47), and overall intensity (R = −0.27). Thus, sweet- and minty-flavored e-liquids are liked equally by young nonsmokers and adult smokers, and more than tobacco flavors. Banning all flavors except tobacco will likely reduce e-cigarette appeal; potentially more for young nonsmokers than adult smokers.

Do Longitudinal Trends in Tobacco 21-Related Media Coverage Correlate with Policy Support? an Exploratory Analysis Using Supervised and Unsupervised Machine Learning Methods

ABSTRACT Media coverage can impact support for health policies and, ultimately, compliance with those policies. Prior research found consistent, high support for Tobacco 21 policies, which raise the minimum legal age of tobacco purchase to 21, among adults and nonsmoking youth. However, a recent study found support (i.e., agreement with the statement: “The legal age to buy tobacco cigarettes should be increased from 18 to 21”) among 13–20-year-old smokers increased from 2014 until mid-2016 and then declined steadily through mid-2017. To assess whether media coverage could be related to young smokers’ changing support, we conducted an exploratory content analysis to identify texts about Tobacco 21 in a large corpus of tobacco texts (N = 135,691) published in four popular media sources from 2014 to 2017. For this content analysis, we developed a novel methodological approach that combined supervised and unsupervised machine learning methods and could be useful in other areas of communication research. We found that the prevalence of Tobacco 21 media coverage and Tobacco 21 support among young smokers exhibited similar temporal patterns for much of the study period. These findings highlight the need for continued research into the effects of media coverage on Tobacco 21 support among young smokers, a group that must comply with Tobacco 21 policies in order to ensure maximum effectiveness. This research is of particular utility following the 2019 passage of a federal Tobacco 21 regulation, as the public health impact of this regulation could be limited by low public support, and thus low rates of policy compliance.

Should Graphic Warning Labels Proposed for Cigarette Packages Sold in the United States Mention the Food and Drug Administration?

Under the US Family Smoking Prevention and Tobacco Control Act, the US Food and Drug Administration (FDA) has the authority to implement graphic warning labels (GWLs) on cigarette packages. Neither the original labels proposed by the FDA nor the revised labels include a source to indicate sponsorship of the warnings. This study tests the potential impact of adding a sponsor to the content of GWLs. We recruited adult smokers (N = 245) and middle-school youth (N = 242) from low-income areas in the Northeastern US. We randomly assigned participants to view one of three versions of the original FDA-proposed warning labels in a between-subjects experiment: no sponsor, "US Food and Drug Administration," or "American Cancer Society" sponsor. We tested the effect of varying sponsorship on source attribution and source credibility. Compared to unsponsored labels, FDA sponsorship increased source attributions that the FDA sponsored the labels among both middle-school, largely nonsmoking youth and adult smokers. However, sponsorship had no effect on source credibility among either population. We found no evidence that adding FDA as the source is likely to boost source credibility judgments, at least in the short term; though doing so would not appear to have adverse effects on credibility judgments. As such, our data are largely consistent with the Tobacco Control Act's provisions that allow, but do not require, FDA sponsorship on the labels. This study addresses the FDA's regulatory efforts by informing the possible design and content of future cigarette warning labels. Our results do not offer compelling evidence that adding the FDA name on GWLs will directly increase source credibility. Future work may test more explicit FDA source labeling and continue to examine the credibility of tobacco message content among high-priority populations.

Framing and scientific uncertainty in nicotine vaping product regulation: An examination of competing narratives among health and medical organisations in the UK, Australia and New Zealand

AimsTo compare the policy positions of health and medical organisations across Australia, New Zealand, and the UK as they relate to sale and supply of nicotine vaping products (NVPs) and evaluate factors that have informed the differences in policy recommendations among these countries. MethodsWe used mixed methods to analyse data from position or policy statements published by health and medical organisations regarding NVPs (n = 30) and consultation documents submitted to government committees regarding policy options for the regulation of NVPs (n = 26). Quality assessment of included documents was conducted using the six-item Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers, and findings were presented narratively. Qualitative data were coded using NVivo 12 software and analysed using thematic analysis. ResultsAn overwhelming majority of health bodies, charities and government agencies in the UK and New Zealand portrayed NVPs as a life-saving harm reduction tool. In contrast, concerns about addicting non-smoking youth to nicotine, a perceived lack of clear and convincing evidence of safety and efficacy and the potential to undermine tobacco control progress continues to define attitudes and recommendations towards NVPs among Australian health and medical organisations. Although the profoundly divided views among stakeholders seem to arise from empirical uncertainties and disagreements over the level and credibility of evidence, the source of most of these disagreements can be traced back to the fundamental and irreconcilable differences in the framing of the NVP debate, and varied tolerability of risk trade-offs associated with NVPs. ConclusionProgress in resolving the controversy surrounding NVP policy requires stakeholders to be frame-reflective and engage in a meaningful dialogue of risk trade-offs, as well as both intended and unintended consequences of proposed policies.

Impact of The Real Cost Media Campaign on Youth Smoking Initiation

The purpose of this study was to assess the relationship between youth exposure to the U.S. Food and Drug Administration's national tobacco public education campaign, The Real Cost, and changes in smoking initiation. From November 2013 to November 2016, a longitudinal study of youth was conducted with a baseline and 4 post-campaign follow-up surveys. The sample consisted of nonsmoking youths from 75 U.S. media markets (n=5,103) who completed a baseline and at least 1 follow-up survey. Exposure was measured by media market-level target rating points and self-reported ad exposure frequency. Smoking initiation was examined among youths who had never smoked at baseline and defined as first trial of a cigarette. Discrete-time survival models using logistic regression and controlling for confounding influences were estimated. Analyses were conducted in 2018. The odds of reporting smoking initiation at follow-up was lower among youths in media markets with higher levels of campaign advertisements than among those with less. Both between-wave and cumulative target rating points were associated with decreased risk of smoking initiation (AOR=0.69 [p<0.01] and AOR=0.89 [p<0.05], respectively); for every 3,500 between-wave target rating points on air, there was an associated 30% reduction in the hazard of smoking initiation among youths. Results from self-reported recall of the campaign advertisements found similar dose-response effects. The campaign is associated with an estimated 380,000-587,000 youths aged 11-19 years being prevented from initiating smoking nationwide. Sustained national tobacco public education campaigns like The Real Cost can change population-level smoking initiation among youths, preventing future generations from tobacco-related harms.

EVALUATION OF BLOOD PRESSURE AND PULSE WAVE VELOCITY IN HEALTHY YOUTHS WITH/WITHOUT SPORTS CUSTOMS

Objective: Pulse Wave Velocity (PWV) was an examination to measure the level of atherosclelosis. Previous report showed that risk factor of atherosclelosis as hypertension, diabetes mellitus, hyperlipidemia, aging, smoking made PWV faster. On other studies, PWV in non-smoking youths were associated with obese and hyperlipidemia (Intern Med. 2005; 44:696–701.). Aim: Correlation PWV with other risk factors were not elucidated. In this study, first, we featured to the relationship between PWV and Familial History (FH) and Blood Pressure (BP) in Healthy, non-smoking youths without abnormal data of blood test in medical examination (blood sugar, lipid, liver and renal function). And next, we paid attention to the difference in risk mitigation due to the presence or absence of sports customs. Design and method: Non-smoking healthy youths,72 men and 30 women with chance sports customs (CSC), 36 men and 15 women with daily sports customs (DSC), without abnormal data of blood test in medical examination was entry in this study. If he or she had a familial history of hypertension, diabetes mellitus, hyperlipidemia, ischemic heart disease, cerebrovascular disease in father or mother, it counted as two point, and also in grandfather or grandmother, as one point by each risk factor. And in this study, called three former risk factors as “disease risk (DR)”, two latter risk factors as “outbreak risk (OR)”. Results: Mean PWV was faster in men and women with CSC than those with DSC. Next we sort these data into ascending-order, and devided into “low PWV (LP)” and “high PWV (HP)” bound on the median. Both PWV of Men and women recorded HP is faster than recorded LP with CSC and DSC, however in BP, both Men and women recorded HP is faster than recorded LP with CSC but these difference in men and women with DSC has tendency to shirink statistically. Conclusions: We conclude that familial history and BP may correlate with PWV in healthy youths with chance sports customs especially in HP. But daily sports customs pretend to rise their BP.

Intention to Try Tobacco Among Middle School Students in a Predominantly Rural Environment of Central Appalachia

Background: Disparities in tobacco use exist across regions in the United States. The Central Appalachian region carries some of the very high rates of tobacco use prevalence but research on tobacco use initiation is sparse. Objective: To investigate the intention to try tobacco and its associated factors among nonsmoking youth. Method: Data were obtained from school-based tobacco surveys (n = 539) conducted in 11 middle schools (6th–8th grades; aged 10–15 years) in Northeast Tennessee in 2015–2016. Nonsmoking participants without firm commitment to abstain from trying tobacco in the next year were considered to have an intention to try tobacco. The Full Information Maximum Likelihood estimation (FIML) method in Mplus was employed to conduct a multivariable logistic regression analysis to delineate correlates of intention to try tobacco. Results: Overall, 20.0% of participants had intention to try tobacco. Among participants with intention to try tobacco, 53.7% owned tobacco-branded item(s), 86.1% believed that tobacco users have more friends, and 88.9% lived with tobacco users. In the adjusted logistic model, ever use of tobacco products, home smoking rules, owning tobacco-branded item(s), living with tobacco users, believing that tobacco users have more friends, and perception of easy access to tobacco products were significantly associated with intention to try tobacco (p < .02). Conclusion: This study suggests that individual, interpersonal, and community level factors influence intention to try tobacco in this environment where tobacco pre-emption laws impede development of local tobacco control policies and regulations. Thus, efforts should focus on tobacco use initiation preventive programs, including school-based tobacco control programs.

Students’ Cigarette Smoking and the Perceived Nicotine Content of Their E-cigarettes

There is concern that youth e-cigarette use may serve as a gateway to cigarette smoking, and that nicotine exposure may harm brain development. It is therefore important to know how much nonsmoking youth perceive being exposed to nicotine through e-cigarettes. Data on smoking and vaping from the 2016 Monitoring the Future survey of eighth, tenth, and 12th grade students were analyzed in 2017. The weighted percentage distributions of self-reported e-cigarette mist last inhaled were calculated according to ever-smoking status and past 30-day smoking frequency. Chi-square tests of the association between smoking status and use of e-cigarettes perceived to contain nicotine, marijuana or hash oil, or just flavoring were performed. Never smokers and regular smokers were compared regarding the type of e-cigarette mist they believe they last used. A significant relationship exists between smoking behavior and reportedly vaping nicotine (p<0.01) or just flavors (p<0.01). With increasing smoking intensity, an increasing proportion of students report they are vaping nicotine; a decreasing proportion report just flavors. Among 12th graders, prevalence of vaping nicotine is lowest among never smokers and non-current smokers (14.3% and 18.1%) and highest among current and frequent smokers (61.3% and 60.9%, p<0.01). Substantially larger proportions of never smokers and 30-day nonsmokers report vaping just flavors (76.0% and 69.6%) compared with regular or frequent smokers (31.0% and 29.3%, p<0.01). Most nonsmoking students perceive limited nicotine exposure from vaping. Future research should evaluate the accuracy of self-reported e-cigarette nicotine content and monitor students who are consciously using nicotine-based e-cigarettes.

Trends in cannabis use disorder by cigarette smoking status in the United States, 2002–2016

BackgroundCannabis use is on the rise in the United States (US) and is disproportionately common among cigarette smokers. Cannabis use disorder (CUD) occurs among a small subset of cannabis users and may impact cigarette use. The objective of this study was to estimate trends in the prevalence of CUD among daily, non-daily, former, and never cigarette smokers from 2002 to 2016. MethodsData were drawn from cross-sectional, nationally representative samples of individuals ages 12 and older in the US that were collected annually. The prevalence of past 12-month CUD was estimated each year from 2002 to 2016 among daily, non-daily, former, and never cigarette smokers (total analytic N = 837,326). ResultsOverall, the prevalence of CUD decreased from 2002 to 2016. Yet, trends differed by cigarette smoking status. Adjusting for demographics, the prevalence of CUD increased significantly among non-daily smokers (aOR = 1.02; 95% CI = 1.01–1.03) from 2002 to 2016 and did not change among daily, former, or never smokers. CUD was significantly more common among non-daily (4.32%) and daily cigarette smokers (2.92%) compared with former (0.99%) and never smokers (1.11%) in 2016. Approximately one in five (18.11%–22.87%) youth ages 12–17 who smoke cigarettes met criteria for CUD in 2016, compared with approximately 2% of non-smoking youth. ConclusionsDespite downward trends in CUD observed at the general population level, the prevalence of CUD significantly increased among non-daily cigarette smokers from 2002 to 2016. In the US, CUD remains significantly higher among cigarette smokers relative to non-cigarette smokers.

청소년과 젊은 성인의 담배광고, 판촉, 후원의 노출 정도와 구매 경험, 구매 충동, 흡연/금연 의도와의 관계 연구

Objectives: To examine (1) smoking and nonsmoking youth exposure to tobacco advertising, promotion, and sponsorships (TAPS), (2) the differences of the level of TAPS exposure by gender and smoking status, and (3) the associations between TAPS and each of purchase experience, purchase impulsivity, smoking intention (for nonsmokers)/quitting intention (for smokers). Methods: The online survey was conducted among 528 youths with ages of 14-24 nationwide: male nonsmokers (N=138), male smokers (N=144), female nonsmokers (N=134), and female smokers (N=112). For statistical tests, one-way ANOVA, Pearson correlation, and hierarchical multiple regression analyses were performed. Results: The level of exposure to TAPS ranged from 35.4% (online promotions) to 80.9% (display ads). Male smokers had a significantly higher level of exposure to promotion and sponsorships than female nonsmokers. Purchase experience and purchase impulsivity were significantly correlated with promotions and sponsorships among male nonsmokers and female smokers, while point-of-purchase ads were correlated with male smokers. Purchase impulsivity was the most significant predictor of smoking susceptibility and quitting intention. Conclusions: TAPS may make youths buy cigarettes on impulse, and such impulsivity may lead them to heighten smoking intention or lower quitting intention. Stricter TAPS regulations are needed to protect our youths.

Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

RationaleThe United States courts have blocked the implementation of graphic warning labels on cigarette packages (GWLs). This decision was based, in part, on the premise that GWLs are unnecessarily emotional and are meant to scare rather than inform consumers about smoking's health effects. However, research in judgment and decision-making suggests these relationships are more complex. ObjectiveIn this article, we draw on several theoretical frameworks that lead to competing hypotheses about the relationships between negative affect, health risk beliefs, and quit intentions (among adult smokers) or susceptibility to start smoking (among non-smoking youth). MethodWe tested these competing mediation models using data from two experiments with two populations each—adult smokers (Ns = 313 and 238) and primarily non-smoking middle-school youth (Ns = 340 and 237). Using mobile recruitment methods, we focused specifically on individuals from socioeconomically disadvantaged communities in rural and urban areas of the Northeastern United States. ResultsThe best fitting model across all four datasets was one in which label-induced negative affect (a) directly predicted intentions/susceptibility but also (b) indirectly predicted intentions/susceptibility via risk beliefs. Although mediation analyses did not demonstrate significant serial mediation effects of label exposure on intentions/susceptibility through negative affect then risk beliefs, there was some evidence that label exposure indirectly promoted adults' quit intentions through negative affect. Additionally, negative affect consistently mediated the indirect effect of label exposure on strengthened risk beliefs among adults and youth. ConclusionsThese results speak to the importance of negative affect in directly motivating adult smokers' quit intentions but also serving an informational function, directing adult smokers and non-smoking youth to accept the health risks of smoking.