Past 30-day E-cigarette Research Articles

Associations Between Perceptions of e-Cigarette Harmfulness and Addictiveness and the Age of E-Cigarette Initiation Among the Population Assessment of Tobacco and Health (PATH) Youth.

IntroductionYouth perceptions of harmfulness and addictiveness of e-cigarettes may impact the age that they initiate e-cigarette use, but this has not been investigated previously.MethodsYouth (12-17 years old) never e-cigarette users at their first wave of PATH participation (waves 1-3, 2013-2016) were included. PATH questions on absolute perceptions of e-cigarette harmfulness and addictiveness were used as exposures. Interval-censored Cox proportional hazards models were used to estimate the impact of perceptions of harmfulness, and perceptions of addictiveness on (i) the age of initiation of e-cigarette use and (ii) age of first reporting past 30-day e-cigarette use, while controlling for covariates.ResultsYouth who perceive e-cigarettes as having no/little harm had increased risk of initiating both ever e-cigarette use (AHR = 2.04; 95%CI = 1.74-2.40) and past 30-day e-cigarette use (AHR = 2.64; 95%CI = 2.07-3.37) at earlier ages compared to youth who perceive e-cigarettes as having a lot of harm. Youth who perceive the likelihood of becoming addicted to e-cigarettes to be very/somewhat unlikely had increased risk of an earlier age of both ever (AHR = 1.28; 95%CI = 1.07-1.52) and past 30-day (AHR = 1.36; 95%CI = 1.04-1.79) e-cigarette initiation compared to youth who perceived the likelihood of becoming addicted to e-cigarettes to be somewhat/very likely.ConclusionThese results highlight the importance of communicating to youth the potential for health harms and addiction from e-cigarette use in prevention and intervention campaigns, as those with the lowest perceptions of harmfulness and addictiveness had the earliest ages of e-cigarette initiation.

E-cigarette, cannabis and combustible tobacco use: associations with xerostomia among California adolescents.

Xerostomia (subjective experience of dry mouth), while less common in younger populations, can contribute to caries and oral discomfort. Use of e-cigarettes and cannabis among adolescents is increasing and may be a xerostomia risk factor. This study evaluates xerostomia prevalence in an adolescent population, overall and by e-cigarette, cannabis and combustible tobacco use. Cross-sectional analyses of 12-month follow-up data (N=976; collected 2020-2021) from a cohort of adolescents recruited from public high schools in Northern California (USA) compared self-reported past 30-day e-cigarette, cannabis and other tobacco use and dry mouth (overall dry mouth experience; shortened xerostomia inventory, SXI). Dry mouth experience (never, occasionally, frequently/always) was modelled using ordered logistic regression with school-level clustering and adjustment for gender, race/ethnicity, alcohol use, asthma, physical activity and mutually for e-cigarette, cannabis and tobacco use. Past 30-day use prevalence was 12% for e-cigarettes, 16% for cannabis and 3% for combustible tobacco. Occasional dry mouth experience (54%) was more common than frequent/always experience (5%). Frequent/always dry mouth was more prevalent among frequent (>5days/month) e-cigarette (14%) and cannabis (19%) users and combustible tobacco users (19%) than non-users of those respective products (all comparisons p<0.001). In covariable-adjusted models, frequent e-cigarette use was no longer significantly associated with dry mouth experience (OR: 1.40; 95% CI: 0.69, 2.84), while frequent cannabis use (OR: 3.17; 95% CI: 1.47, 6.82) and combustible tobacco use (OR: 1.92; 95% CI: 1.38, 2.68) were associated with greater odds of reporting more frequent dry mouth. Findings were qualitatively similar using the SXI. In this study, xerostomia was not independently associated with e-cigarette use but was one potential health concern of adolescent cannabis and combustible tobacco use.

Role of Mental Health in the Association Between E-Cigarettes and Cannabis Use

E-cigarette use may be associated prospectively with subsequent cannabis use among U.S. adolescents. However, it remains unclear whether this association differs by individual mental health status. This longitudinal study examines effect modifications by mental health status. The first 4 waves (2013-2017) of the Population Assessment of Tobacco and Health study were analyzed in 2020. Adolescents (aged 12-17 years) who reported never using cannabis at baseline waves were included. Waves 1-3 were each considered as baseline for their 12-month follow-up waves. Generalized estimating equations were used to evaluate the effect modification of internalizing mental health and externalizing mental health problems on the associations between baseline past 30-day e-cigarette use and past 30-day cannabis use at follow-up, controlling for individual characteristics and state recreational cannabis laws. Baseline e-cigarette use was significantly associated with cannabis use at follow-up (AOR=4.81, 95% CI=2.93, 7.90). Adolescents with high severity of internalizing mental health/externalizing mental health problems were significantly more likely to initiate cannabis use. However, current e-cigarette users who reported high severity of internalizing mental health symptoms were less likely to initiate cannabis use (AOR=2.51, 95% CI=0.92, 6.83) than those who reported low severity of internalizing mental health problems (AOR=8.84, 95% CI=4.19, 18.65). There were no differences by the severity of externalizing mental health problems. Baseline e-cigarette use and endorsement of severe internalizing mental health/externalizing mental health problems were significantly associated with subsequent cannabis use among U.S. adolescents. Efforts to reduce youth vaping and improve youth mental health could help curb cannabis initiation. Tailored interventions may be warranted for e-cigarette‒using adolescents with internalizing mental health problems.

Age of e-cigarette initiation in USA young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study (2013-2017).

IntroductionThere is a lack of research prospectively estimating the age of e-cigarette initiation in U.S. young adults.MethodsSecondary analysis of PATH young adults across 2013–2017 (waves 1–4) were conducted. We prospectively estimated age of initiation of: ever, past 30-day, and fairly regular e-cigarette use using weighted interval-censoring survival analyses. Interval-censoring Cox proportional hazard models adjusting for sex, race/ethnicity, and previous use of six other tobacco products (cigarettes, traditional cigars, filtered cigars, cigarillos, hookah, and smokeless tobacco) were fitted for each of the three e-cigarette initiation outcomes.ResultsAmong never e-cigarette users, by age 21, 16.8% reported ever use, 7.2% reported past 30-day use, and 2.3% reported fairly regular e-cigarette use. Males had increased risk of initiating ever, past 30-day, and fairly regular e-cigarette use at earlier ages compared to females. Hispanic young adults had increased risk of initiating ever and past 30-day e-cigarette use at earlier ages compared to Non-Hispanic White young adults. Previous use of other tobacco products before e-cigarette initiation increased the risk of an earlier age of e-cigarette initiation.ConclusionPrevention and education campaigns should focus on young adults in order to alleviate the public health burden of initiating e-cigarette use at earlier ages.

Does warning language impact perceptions? Results from an exploratory experiment comparing English, Spanish, and Dual language E-Cigarette warnings among Spanish speakers in the US

Tobacco warnings written in English may not be as effective among Spanish speakers. We explored whether warning perceptions differ based on exposure to English, Spanish, or dual language warnings. From November 2, 2020 – December 29, 2020, we conducted an online experiment with a convenience sample of 776 Spanish-speaking adults in the US, randomizing each to one of three warning conditions: English only, Spanish only, or dual (both English and Spanish). Multivariable linear and logistic regressions examined associations between warning exposure and perceptions. Of 776 participants, 291 preferred to read in Spanish, 55.5% were male, 62.5% were Hispanic, and 48.1% reported past 30-day e-cigarette use. Negative affect (β = 1.79, p = 0.007), perceived message effectiveness (β = 0.84, p = 0.007), and psychological reactance (β = 1.55, p < 0.001) were greater among participants exposed to the dual language warnings compared to those exposed to the English warnings. Results of this exploratory study suggest that e-cigarette warning statements presented in both English and Spanish may result in stronger reactions among Spanish speakers. With increasing prevalence of Spanish speakers in the US, future work should continue to examine this topic.

Polygenic score for cigarette smoking is associated with ever electronic-cigarette use in a college-aged sample.

Electronic cigarette use has escalated rapidly in recent years, particularly among youth. Little is known about the genetic influences on e-cigarette use. This study aimed to determine whether genetic risk for regular use of combustible cigarettes or for number of cigarettes smoked per day confers risk for ever e-cigarette use or frequency of e-cigarette use. We used data from 9541 young adults from the Spit for Science longitudinal cohort study (2011-2019). Polygenic scores (PGS) of regular combustible cigarette use (PGS-RCU) and cigarettes per day (PGS-CPD) were constructed using summary statistics from the two largest available genome-wide association study (GWAS) meta-analysis of European ancestry and East Asian ancestry of combustible cigarette use and used to test whether the PGS of RCU or CPD predicted lifetime e-cigarette use and frequency of past 30-day e-cigarette use in a diverse sample of young adults of African (AFR), Admixed American (AMR), East Asian (EAS), European (EUR), and South Asian (SAS) ancestry. The PGS-RCU was associated with lifetime e-cigarette use in the EUR sample (OR = 1.27, 95% CI = 1.19-1.36, P= 7.53 × 10-12 ), but not in the other subsamples (ps > 0.12). This association remained significant after excluding regular combustible cigarette smokers (OR = 1.21, 95% CI = 1.12-1.31, P = 3.36 × 10-6 ). There was no statistically significant association between PGS-CPD and lifetime e-cigarette use and neither the PGS-RCU nor the PGS-CPD were associated with frequency of e-cigarette use in the past 30 days in any of the subsamples. Genetic factors associated with regular combustible cigarette use appear to be associated with ever e-cigarette use in young adults. We did not find evidence for shared genetic factors influencing heaviness of use of combustible cigarettes and current e-cigarette use frequency.

Use frequency and symptoms of nicotine dependence among adolescent E-cigarette users: Comparison of JUUL and Non-JUUL users

ObjectiveNicotine exposure among adolescent e-cigarette users remains a public health concern. JUUL, a popular e-cigarette brand among youth, is particularly alarming given the high nicotine delivery (59 mg/mL). This study compares e-cigarette use frequency and symptoms of nicotine dependence among adolescent JUUL and non-JUUL users. MethodsWe analyzed data from the 2020 National Youth Tobacco Survey. Participants were n = 1713 U.S. middle and high school students who reported past 30-day e-cigarette use. We compared adolescent e-cigarette users who reported JUUL use to those who did not. Outcomes were: (1) symptoms of nicotine dependence (i.e. nicotine cravings; use within 30 min of waking); (2) past 30-day e-cigarette use frequency, categorized as 1–5 days, 6–19 days, and 20–30 days. Covariates were sex, race/ethnicity, other tobacco product use, primary e-cigarette device type (i.e., disposable; pod; mod/tank). ResultsOverall, 49.5% of adolescent e-cigarette users reported using JUUL in the past 30 days, 40.1% reported symptoms of nicotine dependence, and 36.2% reported using an e-cigarette on 20–30 days. JUUL users were 1.77 (95% CI: 1.36–2.31) times as likely to report symptoms of nicotine dependence and 1.43 (95% CI: 1.02–2.01) time as likely to report using e-cigarettes on 20–30 days, compared to 1–5 days, relative to non-JUUL users, controlling for covariates. ConclusionJUUL use was associated with greater odds of nicotine dependence and more frequent e-cigarette use among adolescents. Greater prevention and regulatory efforts should be made to prevent adolescent use of high dose nicotine devices such as JUUL.

E-cigarette device and liquid characteristics and E-cigarette dependence: A pilot study of pod-based and disposable E-cigarette users

BackgroundE-cigarette device and liquid characteristics, such as electrical power output and liquid nicotine concentration, determine the rate at which nicotine is emitted from the e-cigarette (i.e., nicotine flux), and thus are likely to influence user nicotine dependence. We hypothesize that nicotine flux would be associated with the E-cigarette Dependence Scale (EDS) among pod-based and disposable e-cigarette products. MethodsData were obtained from online panel participants between 18 and 65 years of age, who had indicated that they were either former or current e-cigarette users and resided within the United States (N = 1036). To be included in these analyses, participants had to provide information regarding device type (pod-based or disposable), power (watts), and nicotine concentration (mg/mL), from which we could determine nicotine flux (µg/s) (N = 666). To assess the relationship between nicotine flux and EDS, a series of multivariable linear regressions were conducted. Each model was separated by device type and adjusted for by age and past 30-day e-cigarette use. ResultsGreater nicotine flux was associated with higher EDS scores among pod-based e-cigarette users (beta = 0.19, SE = 0.09, p-value = 0.043), but not users of disposable e-cigarettes. Neither power nor nicotine concentration were associated with EDS scores among users of either e-cigarette device type. ConclusionResults support the hypothesis that nicotine flux is positively associated with nicotine dependence in a sample of current users of pod-based and disposable e-cigarettes.

Cooling e-cigarette flavors and the association with e-cigarette use among a sample of high school students.

IntroductionE-liquid flavor is typically presented by flavor category (e.g. menthol, mint, fruit, dessert). Cooling sensations produced by flavor additives such as menthol enhance appeal of e-cigarettes among youth, but not all e-liquids that produce cooling sensations are labeled as menthol. Sensory experiences produced by flavors may allow for a new way to capture e-cigarette flavor use. This study aims to examine use of flavors that produce cooling sensations among youth and its association with e-cigarette use behaviors.MethodsA 2019 survey of high school students (n = 4875) examined use of e-cigarette flavors that produced cooling sensations (cooling flavors) among past 30-day e-cigarette users. E-cigarette use behaviors (flavor use, nicotine use, frequency of use) were examined between those who did and did not use cooling flavors. A binary logistic regression was used to examine associations between vaping frequency, nicotine (vs. non-nicotine) use, and vaping cooling flavors while controlling for demographics, number of flavors vaped in the past month, and vaping age of onset.Results51.6% (n = 473/916) of the analytic sample endorsed vaping cooling flavors. There were no demographic differences by vaping cooling flavors. Vaping cooling flavors was associated with vaping more frequently (AOR:1.04,95% CI:1.03,1.05) and vaping nicotine (AOR:2.37,95% CI:1.53,3.67).ConclusionVaping cooling flavors was associated with greater nicotine vaping and frequency of e-cigarette use. Assessing sensory experience, such as cooling, in addition to flavor category may more fully capture e-cigarette flavor use and its impacts on youth e-cigarette use behaviors.

E-cigarette use and adverse respiratory symptoms among adolescents and Young adults in the United States

E-cigarette use among adolescents and young adults has been associated with adverse respiratory symptoms, including symptoms of asthma and bronchitis. This investigation examined whether such associations differ by primary type of e-cigarette device used. This cross-sectional study included data from four study populations in California and Connecticut, United States, ages 13–21 years (N = 10,483), who self-reported their tobacco use behaviors and health status from 2018 to 2020. Adverse respiratory symptoms were grouped as bronchitis, asthma exacerbation, and shortness of breath. Associations with e-cigarette use were examined by frequency of e-cigarette use (regardless of device type) and most-frequently use device type in the past 30 days (pod, pen/tank, disposable, or mod). Multivariable modeling accounted for demographic variables and use of other tobacco and cannabis. Results were pooled at the study level via random-effects meta-analysis. Across the four studies, e-cigarette use >5 days/month versus never use was associated with bronchitic symptoms (summary odds ratio, sOR: 1.56; 95% confidence interval, CI: 1.37, 1.77) and shortness of breath (sOR: 1.68; 95% CI: 1.35, 2.08) but not statistically significantly with asthma exacerbations (sOR: 1.36; 95% CI; 0.95, 1.95). Among past 30-day e-cigarette users, associations with respiratory symptoms did not differ by device type. In these populations, e-cigarette use was positively associated with symptoms of bronchitis and shortness of breath, but adjusted odds of symptoms did not differ meaningfully by device type. These findings suggest that risk of these respiratory outcomes is elevated among more frequent e-cigarette users regardless of device type used.

Stealth Vaping Among College Students on Four Geographically Distinct Tobacco-Free College Campuses: Prevalence and Practices.

To offset tobacco use among college students, many universities have implemented tobacco-free campus policies. Given how easily e-cigarette users can discreetly vape in places where it is prohibited without being detected (ie, stealth vape), it is important to assess whether students are subverting these policies. This study examined the prevalence of stealth vaping on-campus among students at multiple universities, including frequency and methods for stealth vaping. A convenience sample of college students was obtained from four geographically distinct, large, public universities with established policies prohibiting all forms of tobacco use on campus. Participants (N = 863 current e-cigarette users) reported on demographics and e-cigarette use. Those who previously stealth vaped on-campus (n = 422) completed additional questions, including common locations, techniques, and devices/e-liquids used for stealth vaping. Nearly half (48.9%) of past 30-day e-cigarette users reported previously stealth vaping on-campus. Among stealth vapers, 48.1% owned a smaller device for stealth vaping and 38.9% used e-liquids with low visibility vapors. Common on-campus stealth vaping locations included bathrooms, libraries, parking garages, and classrooms. Techniques used for stealth vaping included deep inhale, blowing a hit into one's clothes, and swallowing a hit. A large percentage of respondents commonly violated campus tobacco-free policies by stealth vaping. For such policies to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications. This sample of college student e-cigarette users commonly violated campus smoke- and tobacco-free policies by stealth vaping on campus. Respondents used a range of methods (eg, smaller device and low visibility e-liquids) and locations (eg, bathrooms, libraries, and parking garages) for stealth vaping. If campus policies are to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. E-cigarette devices specifically designed and marketed to facilitate stealth vaping (eg, resembling USB flash drives and pens) may require regulatory action. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications.

Subjective experiences at e-cigarette initiation: Implications for e-cigarette and dual/poly tobacco use among youth

BackgroundSubjective experiences (SEs) at initiation of cigarettes, cigars, and smokeless tobacco have been established as predictors of continued use. To date, less is known about the relationships between SEs at e-cigarette initiation and subsequent e-cigarette use behaviors. MethodsThis study used data from Waves 1–6 of the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system; a population-based rapid response study of adolescents in major metropolitan areas of Texas. Participants were adolescents who self-reported ever using e-cigarettes across all 6 waves (n = 1,104; N = 460,069). Factor analyses examined structure of SEs at e-cigarette initiation. Weighted, multilevel, multivariate regression models examined role of SEs at e-cigarette initiation on subsequent past 30-day e-cigarette use behaviors. ResultsFactor analyses identified a positive (i.e., euphoria, relaxation) and a negative (i.e., dizziness, cough, nausea) domain of SEs. Positive SEs at e-cigarette initiation predicted 1.20 (95% CI: 1.02–1.42) greater odds of subsequent past 30-day e-cigarette use. Similarly, positive SEs at e-cigarette initiation predicted greater relative risk of dual/poly e-cigarette use, relative to non-use (RRR: 1.61; 95% CI: 1.24–2.10) and exclusive e-cigarette use (RRR: 1.68; 95% CI: 1.26–2.24). ConclusionThis is the first study to observe longitudinal relationships between SEs at e-cigarette initiation and subsequent e-cigarette use behaviors. Findings highlight the importance of preventing initial e-cigarette use among adolescents.

E-cigarette and marijuana use and the attainment of obesity prevention guidelines among U.S. adolescents.

The study objectives were to examine the associations of exclusive and dual use of e-cigarettes and marijuana and the attainment of the "Let's Go! 5-2-1-0" obesity prevention guidelines and perceptions of weight status among U.S. adolescents. Data from the 2017 Youth Risk Behavior Survey, a school-based nationally representative cross-sectional study, were analyzed (N=12,578). Participants were categorized based on their past 30-day e-cigarette and marijuana use as: non-users, exclusive e-cigarette users, exclusive marijuana users, and dual users. Adjusted logistic regression models were conducted. Of adolescents, 5.2% were exclusive e-cigarette users, 10.3% were exclusive marijuana users, and 7.4% were dual users. Compared to non-users, exclusive e-cigarette users were more likely (aOR=1.55, 95%CI=1.16-2.07) to meet the physical activity recommendation. Compared to dual-users, exclusive e-cigarette users were more likely (aOR=1.47, 95%CI=1.10-1.97) to meet the screen time recommendation. Compared to non-users, exclusive marijuana users were at increased odds to meet the fruit/vegetable recommendation (aOR=1.33, 95%CI=1.03-1.71), but were at decreased odds to meet the sugar-sweetened beverages recommendation (aOR=0.81, 95%CI=0.65-0.99). Compared to exclusive e-cigarette users, exclusive marijuana users were less likely to meet the screen time (aOR=0.71, 95%CI=0.54-0.93) and physical activity recommendations (aOR=0.60, 95%CI=0.43-0.84). Compared with dual users, exclusive marijuana users were more likely (aOR=1.38, 95%CI=1.01-1.88) to perceive themselves as slightly/very overweight. Compared to non-users, dual users were less likely to meet the sugar-sweetened beverages recommendation (aOR=0.63, 95%CI=0.46-0.87). Adolescent current marijuana users and dual users were less likely to meet obesity prevention guidelines. Prevention efforts are needed to reduce e-cigarette and marijuana use and increase adherence to these guidelines.

Adverse Childhood Experiences and Past 30-Day Cigarette and E-Cigarette Use Among Sexual and Gender Minority College Students.

Purpose: Sexual and gender minority (SGM) young adults report disproportionately higher rates of tobacco and nicotine product use. This study assessed the role of adverse childhood experiences (ACEs) in nicotine and tobacco product use among SGM young adults. Methods: A cross-sectional survey was administered to 11,694 college students (ages 18-29 years) between 2017 and 2018 in California, Minnesota, and Texas. Results: For every additional ACE reported, the odds of cigarette, e-cigarette, and dual use increased for all students, with significantly higher past 30-day cigarette use among ACE-exposed SGM students. Conclusion: ACEs are an important contributing factor to tobacco-related disparities facing SGM groups.

It’s Not All Smoke and Mirrors: The Role of Social Norms, Alcohol Use, and Pandemic Partying in e-Cigarette Use During COVID-19

Background E-cigarette use among college students is increasing. In the era of COVID-19, such usage is especially dangerous given that the virus can be deadly for those with impaired respiratory systems. A small but growing body of research suggests that social norms may predict e-cigarette use. However, one’s perception of e-cigarette use behaviors (descriptive norms) and approval by peers (injunctive norms) have yet to be studied in college students. The overarching purpose of this study is to determine whether descriptive and injunctive norms for e-cigarette use contribute unique variance to past 30-day e-cigarette use. Methods: Using a sample of 191 students (138 women) surveyed from introductory-level courses at a university in the northeastern United States, we explored the relationships between student demographic characteristics, alcohol use, binge drinking, COVID-19 non-compliant party attendance on and off campus, and social norms with past 30-day e-cigarette use using sequential regression. Two models were utilized to determine if descriptive and injunctive e-cigarette use norms predicted e-cigarette use after controlling for demographic characteristics in the social norms model, and above and beyond demographics and COVID-19 noncompliant party attendance, alcohol use, and binge drinking in the party behaviors model. Results: The results demonstrated that descriptive and injunctive norms for e-cigarette use significantly predicted e-cigarette use in both models, controlling for all covariates. Conclusions/Importance: Findings highlight the importance of social norms in predicting e-cigarette use during the COVID-19 pandemic, identifying areas for prevention and intervention for public health officials and higher education administrators.

Nicotine and Tobacco Product Use and Dependence Symptoms Among US Adolescents and Adults: Differences by Age, Sex, and Sexual Identity.

Sexual minorities are at increased risk for tobacco use; however, there is heterogeneity in this risk by sociodemographic factors. This study sought to understand if vulnerability to tobacco use among US sexual minorities varies by age group. For this study we used data from wave 4 of the Population Assessment of Tobacco and Health adolescent and adult surveys (n = 37 959), a nationally representative survey. We examined five nicotine/tobacco use outcomes by sex and sexual identity across four age groups. The five outcomes included past 30-day e-cigarette use, past 30-day cigarette use, past 30-day other tobacco use, the number of tobacco products used, and nicotine dependence symptoms. For males, sexual identity differences were greatest in middle adulthood, particularly for bisexual males; adjusted odds ratios and adjusted incident rate ratios ranged from 2.08 to 5.59 in middle adulthood compared to 0.83-1.62 in adolescence. For females, sexual identity differences were persistent from adolescence through middle adulthood. We found significant differences most consistently for nicotine dependence symptoms when comparing gay/lesbian and bisexual females across multiple age groups; adjusted incident rate ratios ranged from 1.90 in middle adulthood to 3.26 in adolescence. Risk among sexual minorities varied considerably across age groups and by nicotine/tobacco product and severity of symptoms. Our findings underscore the importance of looking beyond single tobacco products when examining nicotine/tobacco differences related to sexual identity and in examining differences by age group. Our results demonstrating age-varying risk among sexual minorities have important implications for tobacco prevention and cessation efforts. This study identifies important age variation in sexual minority differences in tobacco use, particularly among males. This study also shows that many sexual minorities not only have higher risk for tobacco and nicotine product use but also use significantly more tobacco products and have higher nicotine dependence symptom scores. These results have important implications for implementation of nicotine and tobacco prevention and cessation strategies for sexual minority adolescents and adults.

Characteristics of e-Cigarette Use Behaviors Among US Youth, 2020

Comprehensive surveillance of e-cigarette use behaviors among youth is important for informing strategies to address this public health epidemic. To characterize e-cigarette use behaviors among US youth in 2020. The 2020 National Youth Tobacco Survey, a nationally representative, cross-sectional, school-based survey of middle school (grades 6-8) and high school (grades 9-12) students, was conducted from January 16, 2020, to March 16, 2020. A total of 14 531 students from 180 schools participated in the 2020 survey, yielding a corresponding student-level participation rate of 87.4% and school-level participation rate of 49.9%. The overall response rate, a product of the school-level and student-level participation rates, was 43.6%. Current (past 30-day) e-cigarette use. Self-reported current e-cigarette use behaviors (frequency of use, usual e-cigarette brand, and access source) by school level and flavored e-cigarette use and flavor types among current e-cigarette users by school level and device type. Prevalence estimates were weighted to account for the complex survey design. Overall, 14 531 students completed the survey, including 7330 female students and 7133 male students with self-reported grade level and sex. In 2020, 19.6% (95% CI, 17.2%-22.2%) of high school students and 4.7% (95% CI, 3.6%-6.0%) of middle school students reported current e-cigarette use. Among them, 38.9% (95% CI, 35.2%-42.6%) of high school users and 20.0% (95% CI, 16.0%-24.8%) of middle school users reported e-cigarette use on 20 to 30 days within the past 30 days. Among current users, JUUL was the most commonly reported usual brand (high school: 25.4%; 95% CI, 18.8%-33.4%; middle school: 35.1%; 95% CI, 27.9%-43.1%). Among current users, the most common source of obtaining e-cigarettes was from a friend (high school: 57.1%; 95% CI, 52.6%-61.4%; middle school: 58.9%; 95% CI, 51.4%-66.1%). Among current users, 84.7% (95% CI, 82.2%-86.9%) of high school students and 73.9% (95% CI, 66.9%-79.8%) of middle school students reported flavored e-cigarette use. Fruit-flavored e-cigarettes were the most commonly reported flavor among current exclusive e-cigarette users of prefilled pods or cartridges (67.3%; 95% CI, 60.9%-73.0%), disposable e-cigarettes (85.8%; 95% CI, 79.8%-90.3%), and tank-based devices (82.7%; 95% CI, 68.9%-91.1%), followed by mint-flavored e-cigarettes. These results suggest that although current e-cigarette use decreased during 2019 to 2020, overall prevalence, frequent use, and flavored e-cigarette use remained high. Continued actions are warranted to prevent and reduce e-cigarette use among US youth.

Longitudinal trajectories of E-cigarette use among adolescents: A 5-year, multiple cohort study of vaping with and without marijuana

E-cigarette use harms adolescent health, yet it continues to escalate rapidly among teens nationwide. This longitudinal study sought to identify and differentiate between developmental trajectories of past 30-day e-cigarette use with and without marijuana (i.e., liquid THC) across adolescence (11–19 years old). Three population-based cohorts of adolescents (n = 3907; N = 461,069) living in major metropolitan areas of Texas (Houston, Dallas-Ft. Worth, San Antonio, Austin) completed up to 9 Waves of an e-cigarette use survey, from 2014 to 2019. Growth curve models (GCMs) were used to identify average trajectories of past 30-day e-cigarette use, by cohort. Growth mixture models (GMMs) were used to investigate developmental patterns in these trajectories, by cohort. Sociodemographic differences in trajectories were also investigated. Stable trajectories of e-cigarette use with and without marijuana were identified, from 11 through 19 years of age. Trajectories varied by age of onset; frequency and escalation in use; and substance used. With one exception, all trajectories of e-cigarette use escalated with age. Moreover, age of onset and progression in use were positively related. The most problematic trajectories, corresponding to more frequent use, were observed among the younger cohorts compared to the oldest. Primary prevention is critical. Interventions to prevent the onset and progression in e-cigarette use among teens must begin early (e.g., in middle school) and be sustained throughout adolescence.

Effect of a hypothetical modified risk tobacco product claim on heated tobacco product use intention and perceptions in young adults

IntroductionModified risk tobacco product (MRTP) claims for heated tobacco products (HTPs) that convey reduced exposure compared with conventional cigarettes may promote product initiation and transition among young people. We assessed...

Effectiveness of a Vaping Cessation Text Message Program Among Young Adult e-Cigarette Users

e-Cigarettes are the most commonly used tobacco product among young adults (YAs). Despite the harms of nicotine exposure among YAs, there are few, if any, empirically tested vaping cessation interventions available. To determine the effectiveness of a text message program for vaping cessation among YAs vs assessment-only control. A parallel, 2-group, double-blind, individually randomized clinical trial was conducted from December 2019 to November 2020 among YA e-cigarette users. Eligible individuals were US residents aged 18 to 24 years who owned a mobile phone with an active text message plan, reported past 30-day e-cigarette use, and were interested in quitting in the next 30 days. Participants were recruited via social media ads, the intervention was delivered via text message, and assessments were completed via website or mobile phone. Follow-up was conducted at 1 and 7 months postrandomization; follow-up data collection began January 2020 and ended in November 2020. The study was prespecified in the trial protocol. All participants received monthly assessments via text message about e-cigarette use. The assessment-only control arm (n = 1284) received no additional intervention. The active intervention arm (n = 1304) also received This is Quitting, a fully automated text message program for vaping cessation that delivers social support and cognitive and behavioral coping skills training. The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 7 months analyzed under intention-to-treat analysis, which counted nonresponders as vaping. Secondary outcomes were 7-day ppa under intention-to-treat analysis and retention weighted complete case analysis of 30-day and 7-day ppa. Of the 2588 YA e-cigarette users included in the trial, the mean (SD) age was 20.4 (1.7) years, 1253 (48.4%) were male, 2159 (83.4%) were White, 275 (10.6%) were Hispanic, and 493 (19.0%) were a sexual minority. Most participants (n = 2129; 82.3%) vaped within 30 minutes of waking. The 7-month follow-up rate was 76.0% (n = 1967), with no differential attrition. Abstinence rates were 24.1% (95% CI, 21.8%-26.5%) among intervention participants and 18.6% (95% CI, 16.7%-20.8%) among control participants (odds ratio, 1.39; 95% CI, 1.15-1.68; P < .001). No baseline variables moderated the treatment-outcome relationship, including nicotine dependence. Results of this randomized clinical trial demonstrated that a tailored and interactive text message intervention was effective in promoting vaping cessation among YAs. These results establish a benchmark of intervention effectiveness. ClinicalTrials.gov Identifier: NCT04251273.