Past 30-day Smoking Research Articles

Trends and Associations of Menthol Cigarette Smoking Among US Middle and High School Students-National Youth Tobacco Survey, 2011-2018.

Youth cigarette smoking decreased significantly over the last two decades in the United States. This study provides estimates and trends from 2011 to 2018 and factors associated with youth menthol and non-menthol smoking from 2016 to 2018. Using data from the 2011-2018 National Youth Tobacco Surveys, past 30-day (current) menthol and non-menthol cigarette smoking were estimated for all youth (prevalence) and youth smokers (proportions). Trends were examined using Joinpoint regression, calculating the annual percent change (APC). Multivariate logistic regression analyses identified factors associated with menthol smoking. From 2011 to 2018, menthol cigarette smoking among current youth cigarette smokers significantly decreased from 57.3% to 45.7% (APC: -3.0%), while non-menthol (38.2% to 47.3% [APC: 2.9%]) and unknown menthol status (not sure\missing) (4.5% to 7.0% [APC: 7.1%]) significantly increased. Menthol cigarette smoking among high school, male, female, and non-Hispanic white current cigarette smokers decreased, but remained unchanged among middle school, non-Hispanic black, and Hispanic smokers. Significantly higher proportions of menthol cigarette smokers smoked on ≥20 days, ≥2 cigarettes per day, and ≥100 cigarettes in their lifetime compared to non-menthol smokers. Among current cigarette smokers, non-Hispanic blacks, Hispanics, flavored non-cigarette tobacco users, frequent smokers (≥20 days), those smoking 2-5 cigarettes per day, and those living with someone who uses tobacco had higher odds of menthol cigarette smoking. In 2018, nearly half of current youth cigarette smokers smoked menthol cigarettes. While menthol cigarette smoking declined from 2011 to 2018 among all youth and among youth smokers, there was no change in menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school cigarette smokers. This study finds that overall cigarette and menthol cigarette smoking declined in youth from 2011 to 2018. However, menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school youth cigarette smokers did not change. Information from this study can help inform efforts to reduce menthol cigarette smoking among US youth, particularly racial/ethnic minority populations.

Taxation reduces smoking but may not reduce smoking disparities in youth

ObjectiveThis study examines the extent to which cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity.MethodsWe used US nationally representative, repeated...

Waterpipe tobacco smoking: nicotine dependence and smoking control strategies among youth

ABSTRACT Objective: Waterpipe smoking has significantly increased in prevalence among youth in recent years. A great number of studies have reported youth efforts in resisting and controlling cigarette smoking. But not for waterpipe smoking, prompting this study to explore actions and strategies used by youth to stop waterpipe smokers. Methods: A cluster-randomized controlled school-based trial was conducted among school students. Adolescents who reported past 30-day waterpipe smoking and interest in quitting smoking answered questions about their smoking habits, strategies used to stop smoking, nicotine dependence, and symptoms experience after starting smoking. Results: A total of 100 youth in grades 9th–12th participated in the study. Thirty-five percent of participants smoked waterpipe once weekly over the last 30 days with 18% reported having more than one session per day or once daily. Twenty-five percent of participants showed mild to moderate nicotine dependence. Walking or exercising, talking to a friend, and listening to music were among the most frequent strategies used by participants to control smoking. A significant inverse linear relationship was found between waterpipe smoking control strategies and nicotine dependence. Conclusion: This study indicates that youth level of nicotine dependence is negatively related to their use of strategies to control waterpipe smoking.

Prevalence of and factors associated with violations of a campus smoke-free policy: a cross-sectional survey of undergraduate students on a university campus in the USA

ObjectiveThe aim of this study is to estimate the prevalence of smoking behaviour on campus and to identify the key factors that influence adherence to a campus smoke-free policy.Design &...

Association of invitation to lung cancer screening and tobacco use outcomes in a VA demonstration project.

A potential unintended consequence of lung cancer screening (LCS) is an adverse effect on smoking behaviors. This has been difficult to assess in previous randomized clinical trials. Our goal was to determine whether cessation and relapse behaviors differ between Veterans directly invited (DI) to participate in LCS compared to usual care (UC). We conducted a longitudinal survey of tobacco use outcomes among Veterans (Minneapolis VA) from 2014 to 2015, randomized (2:1) to DI versus UC and stratified by baseline smoking status (current/former). Within the DI group, we explored differences between those who did and did not choose to undergo LCS. A total of 979 patients (n = 660 DI, n = 319 UC) returned the survey at a median of 484 days. Among current smokers (n = 488), smoking abstinence rates and cessation attempts did not differ between DI and UC groups. More baseline smokers in DI were non-daily smokers at follow-up compared to those in UC (25.3% vs 15.6%, OR 1.97 95%CI 1.15–3.36). A significant proportion of former smokers at baseline relapsed, with 17% overall indicating past 30-day smoking. This did not differ between arms. Of those invited to LCS, smoking outcomes did not significantly differ between those who chose to be screened (161/660) versus not. This randomized program evaluation of smoking behaviors in the context of invitation to LCS observed no adverse or beneficial effects on tobacco cessation or relapse among participants invited to LCS, or among those who completed screening. As LCS programs scale and spread nationally, effective cessation programs will be essential.

Factors associated with past 30-day abstinence from cigarette smoking in adult established smokers who used a JUUL vaporizer for 6\xa0months

BackgroundJUUL is the fastest growing and highest selling brand of e-cigarette/vapor products in the USA. Assessing the effect of JUUL vapor products on adult smokers’ use of conventional tobacco cigarettes can help inform the potential population health impact of these products.MethodsParticipants were 15,456 US adult established current smokers aged 21 years who had purchased their first JUUL Starter Kit from a retail store or online within the past 7 days. Online surveys assessed past 30-day use of conventional cigarettes, JUUL vapor products, and other e-cigarettes/vapor products at 3 and 6 months after their first JUUL purchase. Logistic regression models examined factors associated with smokers’ odds of self-reporting past 30-day abstinence from cigarette smoking at 6 months.ResultsPast 30-day point prevalence abstinence from smoking at 6 months was 31.6% in the intent-to-treat (ITT) sample and 54.0% among those who responded at 6 months (n = 9040; 58.5% of ITT). Consecutive past 30-day smoking abstinence outcomes at 3 and 6 months were reported by 20.3% of the ITT sample and 40.6% of responders to both assessments (n = 7726). Covariate-adjusted odds for reporting past 30-day smoking abstinence at 6 months were significantly higher among primary users of mint- or mango-flavored JUULpods (compared to primary users of Virginia tobacco-flavored JUULpods), exclusive users of JUULpods in characterizing flavors (compared to exclusive users of tobacco-flavored JUULpods), daily users of the JUUL vaporizer (compared to less-than-daily), initial retail purchasers (compared to initial e-commerce purchasers), and those who first purchased a JUUL to help to quit smoking completely. Odds for reporting past 30-day smoking abstinence were significantly lower among those who, at study enrolment, had smoked regularly for ≥ 20 years, smoked ≥ 10 cigarettes per day, and smoked on all 30 of the previous 30 days.ConclusionsAround one third of enrolled smokers and one half of smokers who responded to a 6-month follow-up reported being past 30-day abstinent from cigarette smoking after using a JUUL vaporizer for 6 months. More frequent use of a JUUL vaporizer and primary use of JUULpods in characterizing flavors, particularly mint and mango, appeared to be important to smokers’ chances of quitting. The impact of suspending retail sales of flavored JUULpods on adult smokers’ likelihood of quitting should be closely assessed.

PMH52 FACTORS ASSOCIATED WITH REGULAR NICOTINE SALT POD SYSTEM USE AMONG SMOKERS ABSTAINING FROM COMBUSTIBLE CIGARETTES

Previous studies have found a positive association between regular use of Nicotine Salt Pod Systems (NSPS) and abstinence from combustible cigarette use among smokers. This study assessed factors associated with daily use of NSPS among smokers who abstained from cigarette smoking 6 months after initiating NSPS use and those who continued smoking. Adult current smokers (age≥21) who bought an NSPS starter kit and completed baseline and 180-day follow-up assessments (N=18,834) reported demographic characteristics, smoking history and motivations for NSPS purchase at baseline and past 30-day cigarette smoking and NSPS use at 180-day assessment. The sample was stratified by switching (past 30-day abstinence from smoking) status at 180 days; differences in baseline characteristics among daily/non-daily NSPS users in each subgroup were assessed. The sample was divided into independent training and validation sets, and logistic regression models examined associations between baseline characteristics and daily/non-daily NSPS use at 180-days. Among switchers, daily NSPS users (vs. non-daily users) were more likely to be daily smokers, have a smoking history of >10 years, and cite quitting smoking as reasons for purchase. Smoking for >20 years (aOR = 2.7, CI = 1.5-4.9), smoking for 10-20 years (aOR = 1.6, CI = 1.0-2.6), believing NSPS to be less harmful than cigarettes (aOR = 1.4. CI = 1.1-1.8) and daily smoking at baseline (aOR = 1.8, CI = 1.5-2.4) were associated with daily NSPS use at 180-days in the switching subgroup. Logistic models from training samples performed well in validation samples (accuracy scores ranging from 0.68 – 0.73). This study provides new longitudinal data on attributes associated with regular NSPS use among smokers who switch from combustible cigarettes. Identifying factors associated with NSPS use and switching behavior may inform likelihood of behavior change or support development of techniques to aid switching away from cigarettes.

Menthol Smoking and Subjective Response To the First Cigarette Smoked

Objectives: Using the Population Assessment of Tobacco and Health (PATH) study, this study examined whether pleasant and unpleasant subjective responses to the first cigarette smoked differed by initiation with a menthol versus non-menthol cigarette and whether subjective response was associated with current tobacco use behaviors, independent of, and in interaction with menthol initiation. Methods: Data were from youth and young adult ever smokers in Wave 2 (2014-2015) of the PATH study. Results: In adjusted multivariable logistic regression models, menthol initiators reported a more pleasant first smoking experience compared to non-menthol initiators and increased odds of past 30-day smoking, non-cigarette tobacco use, and menthol smoking. In adjusted models, pleasant experience was associated with increased odds of past 30-day smoking, non-cigarette tobacco use, and heavy smoking. Unpleasant experience was associated with decreased odds of past 30-day smoking. Interactions of menthol initiation with subjective response were not significant. Conclusions: Smokers who initiate with a menthol cigarette experience a more pleasant first smoking experience, and pleasant experience is associated with regular smoking and use of non-cigarette tobacco products. Findings underscore the potential abuse liability of menthol cigarettes and provide further evidence that a ban on menthol may help reduce tobacco use among young people.

Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check

BackgroundThe 2018 National Academies of Sciences, Engineering, and Medicine Report found substantial evidence that electronic cigarette use (vaping) by youth is strongly associated with an increased risk of ever using...

Smoking patterns and preferences for technology assisted smoking cessation interventions among adults with opioid and alcohol use disorders

ABSTRACTBackground: Smoking remains a major public health burden among persons with opioid and/or alcohol use disorder.Methods: A 49-item semi-structured survey was conducted among urban, inpatient detoxification program patients eliciting demographic and clinical characteristics, smoking profile, technology use patterns, and preferences for adopting technology-based smoking cessation interventions. Multivariate logistic regression models further evaluated the association between participant demographic and clinical characteristics and technology preferences.Results: Participants were mostly male (91%), and admitted for detoxification for alcohol (47%), heroin (31%), or both alcohol and heroin (22%). Past 30-day smoking was reported by 78% of the sample. Mobile phone ownership was common (89%); with an average past-year turnover of 3 mobile phones and 3 phone numbers. Computer ownership was low (28%) and one third reported daily internet use (34%). Telephone (41%) and text message-based interventions (40%) were the most popular platforms to facilitate smoking cessation.Conclusions: Despite concurrent AUD-OUD, most respondents had attempted to quit smoking in the last year and preferred telephone- and text message-based interventions to facilitate smoking cessation. High turnover of mobile phones, phone numbers, and limited access to computers pose barriers to dissemination of technology-based smoking cessation interventions in this vulnerable population.

Tobacco‐21 laws and young adult smoking: quasi‐experimental evidence

To estimate the impact of tobacco-21 laws on smoking among young adults who are likely to smoke, and consider potential social multiplier effects. Design Quasi-experimental, observational study using new 2016-17 survey data. United States. A total of 1869 18-22-year-olds who have tried a combustible or electronic cigarette. Tobacco-21 laws raise the minimum legal sales age of cigarettes to 21years. Logistic regressions compared the association between tobacco-21 laws and smoking among 18-20-year-olds with that for 21-22-year-olds. The older age group served as a comparison group that was not bound by these restrictions, but could have been affected by correlated factors. Age 16 peer and parental tobacco use were considered as potential moderators. Self-reported recent smoking (past 30-day smoking) and current established smoking (recent smoking and life-time consumption of at least 100 cigarettes). Exposure to tobacco-21 laws yielded a 39% reduction in the odds of both recent smoking [odds ratio (OR)=0.61; 95% confidence interval (CI)=0.42, 0.89] and current established smoking (OR=0.61; 95% CI=0.39, 0.97) among 18-20-year-olds who had ever tried cigarettes. This association exceeded the policy's relationship with smoking among 21-22-year-olds. For current established smoking, the tobacco-21 reduction was amplified among those whose closest friends at age 16 used cigarettes (OR=0.50; 95% CI=0.29, 0.87), consistent with peer effects moderating the policy's impact on young adult smoking. Tobacco-21 laws appear to reduce smoking among 18-20-year-olds who have ever tried cigarettes.

Explaining sexual minority young adult cigarette smoking disparities.

Sexual minority (SM) young adults, such as those who identify as lesbian, gay, or bisexual (LGB), have well documented smoking disparities compared to heterosexual young adults. However, no studies have simultaneously tested the role of three risk factors (depressive symptoms, recalling tobacco marketing in bars, and cigarette-related social norms) to explain SM tobacco use disparities. Longitudinal structural equation modeling was used to explore if the association between SM identity and past 30-day cigarette smoking one year later was mediated by these three risk factors. Starting in fall 2015, three surveys were administered every 6 months to 3,972 young adult college students. Surveys assessed SM identity, depressive symptoms, tobacco marketing in bars, normative perceptions of cigarettes, and tobacco use behaviors. Greater depressive symptoms, recalling more tobacco marketing in bars, and more accepting cigarette-related social norms were each hypothesized to explain a unique portion of the association between SM identity and subsequent cigarette use. SM young adults reported higher prevalence of cigarette use, depressive symptom scores reflecting elevated risk for major depressive disorder, and more accepting cigarette-related social norms than their heterosexual peers. Results indicated that only cigarette-related social norms mediated the association between SM identity and subsequent past 30-day smoking, while controlling for depressive symptoms, recalling tobacco marketing in bars, sociodemographic factors, and previous tobacco use. Findings reflect a need for tailored tobacco control messaging that shift the more accepting cigarette-related norms of SM young adults, as doing so may ultimately lead to decreased smoking for this high-risk subgroup. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Factors associated with past 30-day abstinence from cigarette smoking in a non-probabilistic sample of 15,456 adult established current smokers in the United States who used JUUL vapor products for three months

BackgroundJUUL is the fastest growing and highest selling brand of e-cigarette/vapor products in the USA. Assessing the effect of JUUL vapor products on adult smokers’ use of conventional tobacco cigarettes can help inform the potential population health impact of these products.MethodsOnline surveys assessed past 30-day use of conventional cigarettes, JUUL vapor products, and other e-cigarettes/vapor products, monthly for 3 months, in a non-probabilistic sample of 15,456 US adults (21+ years). Participants were established current smokers of conventional cigarettes and recruited at their first purchase of a JUUL Starter Kit in a retail store or through JUUL’s website. Logistic regression models examined factors associated with participants’ odds of reporting past 30-day abstinence from cigarette smoking at the 3-months assessment.ResultsPast 30-day smoking abstinence at the 3-months assessment was reported by 28.3% of the intent-to-treat (ITT) sample (n = 15,456) and 47.1% of an efficacy subset sample that completed the 3-months assessment (n = 9272). Covariate-adjusted odds for reporting past 30-day smoking abstinence at the 3-months assessment were significantly higher among participants who primarily used Mint or Mango flavored JUULpods (versus Virginia Tobacco flavor) in the past 30 days; exclusively used JUULpods in characterizing flavors (versus tobacco flavors) in the past 30 days; used a JUUL vaporizer on all 30 of the past 30 days; purchased their first JUUL vaporizer in a retail store (versus online); and first purchased a JUUL Starter Kit to help quit smoking completely. Odds for reporting past 30-day smoking abstinence were significantly lower among participants who, at study enrolment, had smoked regularly for ≥ 20 years, smoked ≥ 20 cigarettes per day, and smoked on all 30 of the previous 30 days.ConclusionsAt least 28.3% of adult smokers had quit smoking cigarettes completely after using a JUUL vaporizer for 3 months. More frequent use of a JUUL vaporizer and primary use of JUULpods containing characterizing flavors, particularly Mint and Mango, appears to be important to new JUUL users’ chances of quitting smoking. The impact of banning retail sales of flavored JUULpods on adult smokers’ likelihood of quitting should be closely assessed.

Menthol Smoking Patterns and Smoking Perceptions Among Youth: Findings From the Population Assessment of Tobacco and Health Study

Youth may be attracted to menthol cigarettes because they are perceived as less harmful and harsh to smoke relative to non-menthol cigarettes. This study examined demographic factors and menthol cigarette smoking patterns as correlates of youth harm perceptions of cigarette smoking and ease of smoking menthol versus non-menthol cigarettes. Data were from the Wave 1 (2013-2014) youth sample of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regression models were used to examine correlations between demographic factors and menthol cigarette smoking patterns (menthol initiation, past 30-day menthol cigarette smoking, and menthol cigarette brand preference), with harm perceptions of cigarette smoking and ease of smoking a menthol cigarette. Nearly half of ever cigarette smoking youth (43%) first used a menthol cigarette; 21% reported past 30-day menthol cigarette smoking; and 42% of past 30-day smokers providing brand information used a menthol cigarette as their preferred brand. In bivariate analyses, initiation with a menthol cigarette and menthol brand preference (versus non-menthol) were correlated with black race, older age at initiation, and past 30-day menthol cigarette smoking. In adjusted models, past 30-day menthol cigarette smoking and menthol cigarette brand preference, but not menthol initiation, were correlated with the perception that menthol cigarettes are easier to smoke. Youth who smoke menthol cigarettes perceive them as easier to smoke, even after adjusting for other factors. Age of initiation and black race emerged as correlates of menthol cigarette initiation, brand preference, and cigarette harm perceptions, and may inform future prevention campaigns.

Dependence motives of young adult users of electronic nicotine delivery systems

IntroductionNicotine dependence contributes to changes in tobacco use among young adults. However, research examining salient dependence motives in young adult users of electronic nicotine delivery systems (ENDS) is limited. This study examined the association of dependence motives with ENDS use or lifetime quit attempt, and tests sex moderation in these relationships. MethodsYoung adults (N = 304; age 18–24) self-identifying as regular ENDS users and self-reporting vaping within a week of data collection completed an online survey. They reported demographics, past 30-day vaping and smoking days and frequency, and lifetime quit attempt. Dependence motives were measured with the 14-item Wisconsin Inventory for Smoking Dependency Motives. Backward-stepwise models regressed ENDS use behaviors or lifetime quit attempt onto dependence motives, and separately onto the interactions between motives and sex. ResultsTolerance was positively associated with daily ENDS use frequency (b = 0.34, p < .001) past 30-day vaping days (b = 1.50, p < .001), and negatively associated with lifetime quit attempt (OR = 0.58, p = .005). Loss of control was negatively associated with daily ENDS use frequency (b = −0.24, p < .001) and past 30-day vaping days (b = −1.48, p < .001), and positively associated with lifetime quit attempt (OR = 1.56, p = .002). Craving was positively associated with lifetime quit attempt among males (OR = 1.83, p = .006) but not females (OR = 0.84, p = .51). ConclusionTolerance and loss of control were uniquely associated with ENDS use behaviors across all analytic models, although effects for loss of control were counter-intuitive. Understanding the relationship between dependence motives and ENDS use behaviors or attempts to quit may provide targets for preventive interventions against increased or continued ENDS use.

School-level electronic cigarette use prevalence and student-level tobacco use intention and behaviours

Prevalent electronic cigarette (e-cigarette) use in schools may undermine tobacco denormalisation, and thus increase tobacco use in students. We investigated the associations of school-level e-cigarette use prevalence with student-level intention and behaviours related to e-cigarettes, cigarettes, and other tobacco products. In a 2014-15 school-based cross-sectional survey of 41035 secondary school students (grade 7–12; age 11–18 years) in Hong Kong, information was collected on the use of e-cigarettes, cigarettes, and non-cigarette tobacco products (NCTPs), susceptibility to e-cigarette and cigarette use, intention to quit cigarette smoking, and sociodemographic characteristics. The adjusted odds ratio (AOR) of e-cigarette use susceptibility in relation to high (vs low) school-level e-cigarette use prevalence was 1.40 (95% CI 1.05–1.87) in never e-cigarette users. The AORs of cigarette smoking susceptibility in relation to medium and high (vs low) school-level e-cigarette use prevalence were 1.24 (1.01–1.52) and 1.34 (1.02–1.75), respectively, in never cigarette smokers. School-level e-cigarette use prevalence was associated with ever and past 30-day cigarette smoking, but not with intention to quit (in past 30-day cigarette smokers) or past 30-day NCTP use. The findings highlight the importance of strictly banning e-cigarettes in schools, and add to the evidence that prevalent e-cigarette use in adolescents may increase cigarette smoking prevalence.

Gender Differences in Smoking Among an Urban Emergency Department Sample.

Background:Urban emergency department (ED) patients have elevated smoking and substance use compared with the general population. We analyzed gender differences in smoking among an urban ED sample and assessed the contribution of substance use, demographic, and couple factors.Methods:We conducted a secondary analysis of data obtained from a cross-sectional, observational survey (N = 1037 participants) on drinking, drug use, and intimate partner violence (IPV). Gender-specific logistic regression models for current (past 30-day) smoking and multinomial regression models for smoking intensity (light: ⩽5 cigarettes per day [CPD]; moderate: 6 to 10 CPD; heavier: >10 CPD) were estimated.Results:Smoking prevalence was higher among men than women (35.5% vs 18.9%; P < .001). Substance use (frequency of intoxication, marijuana, amphetamine, and cocaine use), demographic (food insufficiency, unemployment), and couple-related factors (having a spouse/partner who smoked, IPV involvement, being in a same-gender couple) were differentially associated with current smoking and level of intensity among men and women.Conclusions:Emergency department staff should consider the impact of polysubstance use, food insufficiency, unemployment, and whether both partners in the couple smoke when screening patients for smoking and formulating cessation treatment plans. Women in same-gender relationships and those who have experienced IPV involvement may require additional referral.

Social Aspects of Hookah Smoking Among US Youth

Data were from the 2016 National Youth Tobacco Survey of US sixth- to 12th-graders (n = 20 675). Hookah smoking frequency was classified as never, former, current occasional, and current frequent. Places where past 30-day hookah smoking occurred and students' perceptions of their classmates' hookah smoking prevalence were assessed. Descriptive and multivariable analyses were performed (P < .05). Overall, 10.5% reported smoking hookah ≥1 time in their lifetime. Of these, 65.8% were former, 26.3% were current occasional, and 7.9% were current frequent smokers. Overall, 59.3% of students overestimated hookah smoking prevalence in their grade. Current occasional smoking was predicted by female sex (adjusted odds ratio [aOR] = 1.54) and peer hookah-smoking overestimation (aOR = 9.30). Current frequent smoking was most strongly predicted by living with a hookah smoker (aOR = 20.56), speaking a second language other than English (aOR = 2.17), and co-use of mentholated cigarettes (aOR = 19.94) or other flavored noncigarette tobacco products (aOR = 17.59). The top 3 places hookah was smoked were a friend's house (47.7%), the respondent's own house (31.8%), and another family member's house (20.8%). The home environment was the most common place for youth hookah smoking. Home-tailored interventions that encourage voluntary smoke-free rules and warn about the dangers of social smoking could help denormalize hookah smoking.

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.

Patterns and Correlates of Tobacco and Cannabis co-use by Tobacco Product Type: Findings from the Virginia Youth Survey

ABSTRACTBackground: Cannabis use is more common among tobacco users than nonusers, and co-use (i.e., use of both substances individually) may be increasing. Better understanding of patterns and correlates of co-use is needed. The current study aimed to compare rates and correlates of tobacco and cannabis co-use by tobacco product among youth. Methods: High school students who completed the 2013 Virginia Youth Survey and reported past 30-day tobacco use (cigarette, smokeless tobacco, cigar) were included (n = 1390). Prevalence of past 30-day tobacco-only and cannabis co-use was calculated. Demographic, tobacco, and other substance use characteristics were compared by co-use status. Multivariate logistic regression models examined correlates of co-use overall and by tobacco product. Results: Over half of tobacco users were co-users. Poly-tobacco use, particularly combusted tobacco, was more prevalent among co-users. Past 30-day alcohol use and lifetime other illegal drug use/prescription drug misuse were common correlates of co-use. Black Non-Hispanic (NH) race/ethnicity was associated with co-use when restricted to cigarette users. “Other” race/ethnicity was associated with co-use in the overall model and when restricted to cigar users. Past 30-day cigarette smoking was associated with co-use in all models except among cigar smoking co-users. Conclusions/Importance: Rates and correlates of tobacco and cannabis co-use were not uniform and differed by tobacco product type. Tobacco and cannabis co-users may be at greater risk for negative health effects associated with inhaled tobacco and other risky substance use. The efficacy of prevention efforts may be improved if risk factors associated with product-specific co-use are considered.