Use Of Other Tobacco Products Research Articles

Cannabis use and patterns among middle and older aged Canadians prior to legalization: a sex-specific analysis of the Canadian Tobacco, Alcohol and Drugs Survey

BackgroundThe recreational use of cannabis was legalized across Canada in October 2018. While many people use cannabis without harm, adverse outcomes have been noted in a few populations, including middle-aged and older adults. Given that the current literature has neglected to study cannabis use among this population and between sexes, the objective of our study was to identify the prevalence, characteristics, and patterns of cannabis use among middle and older aged males and females prior to legalization in Canada.MethodsSecondary analysis was conducted on the Canadian Tobacco, Alcohol and Drugs Survey 2017, with the sample restricted to adults ages 40 and above. The main outcome was defined as past-year cannabis use and statistical analysis was conducted separately for males and females. Bivariate and multivariable logistic regression was performed to identify associations between the main outcome and various sociodemographic, health, and substance use variables. Explanatory supplementary variables were also explored.ResultsIn 2017, 5.9% of females and 9.0% of males over the age of 40 reported past-year cannabis use. Almost 62% of males who used cannabis in the past-year reported a failed attempt at reducing or stopping their cannabis use. Over half (56%) of older females, self-reported using cannabis for medical purposes. Additionally, over one in five older adults reported using a vaporizer or e-cigarette as a delivery method for cannabis. Significant characteristics of male cannabis use included having no marital partner, cigarette smoking, and illegal drug use. Furthermore, significant predictors of past-year cannabis use in females included residing in an urban community, Eastern- Atlantic provinces or British Columbia, having fair/poor mental health, smoking cigarettes, use of other tobacco products, and illegal drugs.ConclusionTo our such knowledge, this is the first nationally representative study to outline the prevalence, characteristics, and patterns of past-year cannabis use prior to Canadian legalization, among middle and older aged Canadians. Results from this study are expected to be used to reliably to track changes in usage, behaviours, and related disorders in the years to come.

Dripping Technology Use Among Young Adult E-Cigarette Users.

Background:Young adults are increasingly using electronic nicotine delivery systems (ENDS). The standard ENDS device involves an electric coil that heats a wick to vaporize an e-liquid solution. “Dripping” is another method that involves applying e-liquid directly to the coil. Dripping increases risk of harmful toxic compounds in vapor aerosols. Despite evidence of high levels of dripping among adolescents, young adult prevalence is unknown.Methods:Young adults aged 18 to 24 completed an online survey assessing vaping and dripping status, type of devices used, tobacco use, and vaping expectancies. Among ever-vapers, univariate and multivariate logistic regression models assessed whether demographics predicted dripping and use of dripping devices. Multivariate Analysis of Variance compared never- and ever-drippers on expectancies for vaping outcomes.Results:Over 2 in 5 young adult ever-vapers (43.7%) reported dripping. A multivariate regression model found that male gender (AOR = 1.83), identifying as White (AOR = 2.37), and use of other tobacco products (hookah; AOR = 1.91; cigars; AOR = 2.26; cigarettes; AOR = 2.51) were associated with dripping. E-cigarette users who reported lifetime dripping were more likely to consider vaping stimulating, socially facilitating, and flavorful. They ascribed lower health risks to vaping and felt it could reduce negative affect, weight gain, nicotine cravings, and boredom (all P < .05).Conclusion:Dripping was a highly prevalent behavior among this sample of young adults, particularly among White males. These findings point to the importance of gaining a greater understanding of the drivers and consequences of vaping and dripping behavior.

Association between observing peers vaping on campus and E-cigarette use and susceptibility in middle and high school students

BackgroundThis study examines the association between exposure to e-cigarette use on school campus and e-cigarette use behaviors among adolescents in the United States. MethodsData were obtained from the 2019 National Youth Tobacco Survey. First, two multivariate logistic regression models examined the association between in-school exposure to e-cigarette use and ever and past 30-day (i.e., current) e-cigarette use. Next, a multivariate logistic regression model to examine the relationship between in-school exposure to e-cigarette use and susceptibility to use was conducted among a subsample (n = 11,958) of never e-cigarette users. Covariates included grade, race/ethnicity, marketing exposure, and ever use of other tobacco products. ResultsApproximately 64.3 % of adolescents reported seeing someone use an e-cigarette on school campus; the most common locations being in the bathroom/locker room (34.4 %) and parking lot (34.0 %). In-school exposure to e-cigarette use was associated with greater odds of ever (Adj OR: 2.06; 95 % CI: 1.82–2.33) and current (Adj OR: 1.70; 95 % CI: 1.46–1.98) e-cigarette use among adolescents as well as greater odds of susceptibility to use (Adj OR: 2.00; 95 % CI: 1.82–2.20) among never e-cigarette users. ConclusionsObserving e-cigarette use on school campus was associated with greater odds of e-cigarette use and susceptibility. It is plausible that observing e-cigarette use on campus reinforces the social acceptability of adolescent e-cigarette use. Findings inform on the prevalence of e-cigarettes use on-campus as well as how this phenomenon may influence e-cigarette use/susceptibility among youth. The observed relationship highlights the role of schools in the efforts to reduce adolescent e-cigarette use.

Trends in Tobacco Use Among Adolescents by Grade, Sex, and Race, 1991-2019

Use of e-cigarettes increased among adolescents between 2011 and 2019. However, whether these changes are affecting patterns of use of other tobacco products, especially cigarettes, remains unclear. To examine the long-term and recent trends in cigarette smoking and smokeless tobacco product use among US adolescents by grade (8th, 10th, and 12th), sex (male and female), and race (White and Black). In this cross-sectional study, joinpoint regression analyses were performed to characterize trends in tobacco product use for key sociodemographic groups, identifying change of trend years (joinpoints). Students in the 8th, 10th, and 12th grades at US secondary schools and high schools who participated in the nationally representative Monitoring the Future survey from January 7, 1991, to June 3, 2019, were evaluated. Cigarette smoking and smokeless tobacco product use during the past 30 days. Past 30-day and daily prevalence of cigarette smoking and smokeless tobacco product use by year, grade, sex, and race. The prevalence trend segments, change of trend years (joinpoints), and annual percentage change (APC) in prevalence within each trend segment were estimated using joinpoint regression. Since 1991, 487 335 8th-grade, 447 310 10th-grade, and 424 236 12th-grade students have completed the Monitoring the Future survey (including 663 663 girls and 632 698 boys [those who did not respond to the sex question in the survey were excluded from the sex analyses]). Past 30-day and daily smoking prevalence increased in all groups analyzed from 1991 until 1996 and 1997 and has been decreasing ever since, with more rapid reductions in recent years. For example, daily smoking among 12th-grade boys increased at an APC of 4.9% (95% CI, 3.5%-6.3%) from 1991 to 1998, decreased at an APC of -8.0% (95% CI, -9.3% to -6.7%) from 1998 to 2006, decreased at an APC of -1.6% (95% CI, -4.6% to 1.5%) from 2006 to 2012, and decreased at an APC of -17.4% (95% CI, -19.4% to -15.4%) from 2012 to 2019. Similar results were observed for boys in the 8th grade (5.0% [95% CI, 0.1%-10.2%] for 1991-1996, -8.8% [95% CI, -10.0% to -7.6%] for 1996-2011, and -17.3% [95% CI, -22.2% to -12.0%] for 2011-2019) and 10th grade (7.1% [95% CI, 3.7%-10.7%] for 1991-1997, -11.1% [95% CI, -13.9% to -8.2%] for 1997-2005,-0.7% [95% CI, -5.9% to 4.9%] for 2005-2011, and -17.9 [95%, -21.7% to -13.9%] for 2011-2019), for girls in 8th grade (10.9% [95% CI, 5.0%-17.2%] for 1991-1996 and -10.8% [95% CI, -11.7% to -10.0% for 1996-2019), 10th grade (7.2% [95% CI, 3.9%-10.7%] for 1991-1997, -9.5% [95% CI, -10.5% to -8.6%] for 1997-2012, and -16.3% [95% CI, -21.8% to -10.4%] for 2012-2019), and 12th grade (6.5% [95% CI, 3.6%-9.5%] for 1991-1997, -7.2% [95% CI, -8.1% to -6.3%] for 1997-2012, and -17.5% [95% CI, -21.2% to -13.6%] for 2012-2019). Results were similar, too, for Black adolescents (2015-2019 average annual percentage change: -8.6% [95% CI, -10.3% to -6.8%] for 8th graders; -17.7% [95% CI, -26.3% to -8.2%] for 10th graders; and -18.3% [95% CI, -23.9% to -12.2%] for 12th graders) and White adolescents (2015-2019 average annual percentage change: -17.3% [95% CI, -20.6% to -13.7%] for 8th graders; -16.9% [95% CI, -20.5% to -13.2%] for 10th graders; and -17.0% [95% CI, -20.5% to -13.2%] for 12th graders). Smokeless tobacco was used more variably through 2012, followed by consistent decreases in the past 5 years. For instance, smokeless tobacco use in the past 30 days in 10th-grade boys decreased at an APC of -6.5% (95% CI, -7.5% to -5.4%) from 1991 to 2004, increased at an APC of 3.1% (95% CI, -0.8% to 7.1%) from 2004 to 2012, and decreased at an APC of -11.6% (95% CI, -15.7% to -7.4%) from 2012 to 2019. Similarly, daily smokeless tobacco use in 12th-grade boys decreased at an APC of -3.8% (95% CI, -5.4% to -2.1%) from 1992 to 2005, increased at an APC of 3.1% (95% CI, -0.2% to 6.5%) from 2005 to 2015, and decreased at an APC of -23.0% (95% CI, -33.3% to -11.0%) from 2015 to 2019. This cross-sectional study suggests that, despite the increase in the prevalence of e-cigarette use among adolescents between 2011 and 2019, the prevalence of cigarette and smokeless tobacco use has decreased more rapidly during the same period compared with earlier years.

Cross-sectional study on the awareness, susceptibility and use of heated tobacco products among adolescents in Guatemala City, Guatemala

ObjectivesHeated tobacco products (HTPs) are increasingly marketed worldwide, yet limited research on HTPs has been conducted in low and middle-income countries (LMICs) or among adolescents. Guatemala is one of the...

E-cigarette susceptibility among U.S. middle and high school students: National Youth Tobacco Survey Data Trend Analysis, 2014–2018

Youth e-cigarette use has rapidly increased in the last few years. Susceptibility is a validated measure associated with future tobacco use. We examined trends in e-cigarette susceptibility across five years (2014–2018) of the National Youth Tobacco Survey among youth e-cigarette never users. We observed increases in overall e-cigarette susceptibility from 2014 to 2016 and decreases from 2016 to 2018. Generally, sociodemographic variables were not associated with trend effects; however, there was an interaction between linear trends with both race/ethnicity and other tobacco product (OTP) use. The percentage of youth who were susceptible to using e-cigarettes ranged from 32.9% in 2014 to 33.2% in 2018 with a high of 36.7% in 2016. We also examined the prevalence of e-cigarette susceptibility by race/ethnicity, sex, school level, OTP use, and e-cigarette harm perception. E-cigarette susceptibility was associated with race, school level, OTP ever use, and e-cigarette harm perceptions. Hispanic youth, those in high school, and OTP ever users were more likely to be susceptible to e-cigarette use compared to their counterparts across all years. E-cigarette susceptibility was most prevalent among those who perceived e-cigarettes to pose “no harm” in 2014 and “little harm” in 2018 when compared to other item response options in 2014 and 2018, respectively. This study is the first to document trends in e-cigarette susceptibility among youth. Understanding antecedents of e-cigarette use and identifying youth subgroups vulnerable to e-cigarette use is valuable to developing effective prevention efforts.Disclaimer: The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the Food and Drug Administration or the Centers for Disease Control and Prevention.

E-cigarette, combustible, and smokeless tobacco product use combinations among youth in the united states, 2014–2019

IntroductionYouth e-cigarette use has been rising, however U.S. prevalence data are generally reported without disaggregating by individuals’ use of other tobacco products. It is not clear how the proportion of youth e-cigarette users naïve to all combustible tobacco is changing. MethodsAnnual prevalence estimates of ever and current (defined as past 30-day use) tobacco use prevalence by school type are reported using the 2014–2019 National Youth Tobacco Surveys (NYTS) with mutually exclusive categories of e-cigarette, smokeless tobacco, and/or combustible tobacco product use. T-tests were used to compare annual estimates with the preceding year. The annual percent change (APC) for each category from 2014 to 2018 were analyzed using JoinPoint regression. Data for 2019 were reported separately due to the change in survey format from paper to electronic. ResultsCurrent use of only e-cigarettes among HS students who never used combustible tobacco increased significantly from 2014 to 2018 (APC = +42.4%, 95% CI: 0.7, 101.3); by 2019, prevalence peaked at 9.2% (95% CI: 8.2, 10.2) among never combustible users and 8.3% (95% CI: 7.3, 9.3) among former combustible users. This coincided with significant declines in use of only combustible tobacco (APC = −14.5%, 95% CI: −18.3, −10.5). ConclusionsUse of only e-cigarettes among US youth with no history of combustible tobacco use has increased substantially over time, even as combustible tobacco use continues to decline. Of the 17.5% (95% CI: 15.7, 19.0) of HS students who currently used only e-cigarettes (but not other tobacco) in 2019, more than half have no history of combustible tobacco use.

Smoke-Free Ordinances and Policies Protect Youth, but Ordinances Appear to Have Little Impact on Non-Combustible Tobacco Use

Background: Smoke-free ordinances and policies protect youth from exposure to secondhand smoke (SHS) and cigarette use. This study investigated whether they also protect from use of other tobacco products. Methods: We compared the prevalence of SHS exposure, cigarette smoking, cigar …

Association of Electronic Nicotine Delivery System Use With Cigarette Smoking Relapse Among Former Smokers in the United States

Relapse to smoking among former smokers is a serious clinical concern, and use of electronic nicotine delivery systems (ENDS) has been proposed as a new risk factor for relapse. Understanding the specificity of this risk can help guide clinical practice and lead to improved health outcomes. To assess the associations of ENDS use with cigarette smoking relapse among adult former cigarette smokers. This cohort study examined data from the Population Assessment of Tobacco and Health Study, waves 1 to 4 (2013-2018). Cox proportional hazards models were developed. This is an ongoing, nationally representative, longitudinal cohort study in the US. Participants included adult (≥18 years) former cigarette smokers who reported no tobacco product use at wave 1 (unweighted n = 2273), separated into recent former cigarette smokers (last smoked ≤12 months previously) and long-term former smokers (last smoked >12 months previously). Data analysis was conducted from July to August 2019. Self-reported use of cigarettes, ENDS, and other tobacco products (ie, cigars, pipe tobacco, hookah, snus tobacco, other smokeless tobacco, and dissolvable tobacco) was assessed. Self-reported current (every day or some days) use of cigarettes at follow-up interviews. Of 2273 adult former cigarette smokers, 51.8% (95% CI, 49.7%-53.8%) were women, 65.0% (95% CI, 62.6%-67.4%) were older than 50 years, and 79.5% (95% CI, 77.8%-81.2%) were non-Hispanic white participants. Use of ENDS was associated with significant risk of cigarette smoking relapse among recent former smokers (adjusted hazard ratio [AHR], 1.63; 95% CI, 1.04-2.53; unweighted n = 304) and among long-term former smokers (AHR, 3.79; 95% CI, 1.75-8.20; unweighted n = 1554). Use of other tobacco products was also associated with significant risk for cigarette smoking relapse among recent former smokers (AHR, 1.97; 95% CI, 1.27-3.05) and among long-term former smokers (AHR, 3.82; 95% CI, 1.91-7.66). In this study, use of ENDS and other tobacco products was associated with increased risk of cigarette smoking relapse among former cigarette smokers who did not use any tobacco product at wave 1 of the PATH Study. For clinicians treating former smokers who have successfully quit all nicotine products, the implications are that use of ENDS products should be discouraged, just as use of all other tobacco products is discouraged.

Doctors' Knowledge of Shisha and Attitudes Toward Clinical Counseling of Shisha Smokers: Nigerian Study

Introduction: The knowledge and attitude of a doctor towards shisha and tobacco cessation counseling goes a long way in achieving a successful quit for smokers. This study was conducted with the aim of assessing the knowledge of doctors in Nigeria, using Kebbi State as a case study, on shisha and also exploring their attitudes and willingness towards clinical tobacco cessation counseling of shisha smokers.&#x0D; Methods: This study was a questionnaire-based survey of 78 doctors in Kebbi State, Nigeria. The collected data was analyzed using SPSS version 20 software.&#x0D; Results: Only 63 (80.8%) of the respondents were aware of shisha. Among these 63 respondents that were aware of shisha, 4.8% of them were shisha smokers, 46.0% knew that shisha smoking can lead to periodontal disorder, 65.1% agreed that shisha smoking is a gateway to the use of other tobacco products, and 53.2% had had an encounter with a shisha smoker, of which only 63.6% of them (i.e. those 33 respondents who had the encounter) engaged themselves in a discussion on smoking cessation with the encountered shisha smokers. The majority of the surveyed doctors, irrespective of their age, gender, specialization, departmental affiliation, years of practice and shisha smoking history, were positively disposed towards clinical counseling of shisha smokers on tobacco cessation.&#x0D; Discussion: This study shows that the surveyed doctors are positively disposed towards counseling their shisha-smoking patients on the importance of tobacco cessation; despite their inadequate knowledge on shisha.&#x0D; Conclusion: Clinical counseling on tobacco cessation among shisha smokers should be encouraged in Nigeria.

Agent-based Modeling in Tobacco Regulatory Science: Exploring 'What if' in Waterpipe Smoking.

Waterpipe tobacco smoking (WTS) is an emerging public health crisis, particularly among youth and young adults. Different from the use of other tobacco products and e-cigarettes, WTS tends to be a social activity occurring among friends or persons associated with social networks. In this paper, we review a potential strategy for WTS-related research. As a bottom-up computational model, agent-based modeling (ABM) can simulate the actions and interactions of agents, as well as the dynamic interactions between agents and their environments, to gain an understanding of the functioning of a system. ABM is particularly useful for incorporating the influence of social networks in WTS, and capturing people's space-time activity and the spatial distribution of WTS venues. Comprehensive knowledge of WTS-related behaviors at the individual level is needed to take advantage of ABM and use it to examine policies such as the interaction between WTS and cigarette smoking and the effect of flavors used in waterpipe tobacco. Longitudinal and WTS-specific surveys and laboratory experiments are particularly helpful to understand WTS basic mechanisms and elicit individual preferences, respectively. We argue that the uniqueness of WTS makes ABM a promising tool to be used in WTS-related research, as well as understanding use of other tobacco products.

Dripping and vape tricks: Alternative e-cigarette use behaviors among adolescents

IntroductionE-cigarettes appeal to adolescents because of alternative uses, such as dripping (i.e., applying e-liquid directly on the atomizer) and conducting vape tricks (i.e., creating shapes from exhaled aerosol). However, little is known about these behaviors and adolescents who engage in these behaviors. MethodsUsing cross-sectional surveys from 4 high schools in Connecticut in 2017 (N = 2945), we assessed the frequency of dripping and conducting vape tricks, product characteristics (e.g., nicotine, flavor) used for these behaviors, and where adolescents learn about these behaviors. We also conducted multinomial logistic regression analysis to assess whether demographics, age of e-cigarette use onset, past-month-use of e-cigarettes, and lifetime use of other tobacco products were associated with dripping and/or vape tricks. ResultsAmong ever e-cigarette users (N = 1047), 20.5% ever dripped and 54.9% ever conducted vape tricks. The most frequently endorsed 1) flavors used for both behaviors were fruit, candy, and mint, 2) nicotine concentrations used for dripping was 3 mg and for vape tricks was 0 mg, and 3) the top source for learning these behaviors were friends. The multinomial model showed that earlier age of e-cigarette use onset, past-month-use of e-cigarettes, and lifetime use of other tobacco products were associated with dripping and vape tricks. DiscussionEngaging in dripping and vape tricks was associated with risky tobacco use behaviors (e.g., earlier age of onset, other tobacco use), and involved exposure to nicotine and flavors. Reducing appeal of dripping and vape tricks and preventing product characteristics that facilitate these behaviors may reduce harm to adolescents.

Does use of other tobacco products change when cigarette smoking status changes: A descriptive study of young adults

BackgroundWhether polytobacco use or nicotine dependence (ND) change when cigarette smoking status changes in young adults is an understudied issue. Our objective was to describe use of other tobacco products (OTPs) and ND according to change in cigarette smoking status over four years in young adults. MethodsWe drew data from a longitudinal study of 1294 adolescents age 12–13 at inception in 1999–2000 and followed into young adulthood. Among 790 participants with data at age 20 and 24, 22% had never smoked cigarettes; 37% were “sustained smokers”; 9% were “relapsers”; 10% had quit 1–3 years ago; and 22% had quit ≥4 years ago. We described past-year OTP (i.e., cigars/cigarillos, waterpipe, sundry tobacco products (i.e., pipe, bidis, chewing tobacco, snuff)) use and ND over 4 years in these groups. ResultsAt age 20, sustained smokers reported using a mean(SD) of 1.1(0.9) OTP in the past-year; relapsers reported 0.5(0.6); shorter-term quitters reported 0.9(0.7); longer-term quitters reported 0.3(0.6); and never smokers reported 0.2(0.4). There was no change in OTP use or ND in never smokers and longer-term quitters. Shorter-term quitters reduced the number of OTPs by −0.5(95% confidence interval: −0.7,−0.3) on average over 4 years; sustained smokers decreased by −0.2(−0.3,−0.1). Relapsers increased by 0.6(0.4,0.7) on average. ConclusionsOTP use and ND were stable in early adulthood among never smokers, sustained smokers and longer-term quitters, but fluctuated in parallel with stopping and starting to smoke. Research is needed to ascertain the underpinnings of these fluctuations and whether they help or hinder cessation.

Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors

Use of electronic cigarettes (e-cigarettes) is high among adolescents, but the extent to which the JUUL e-cigarette brand accounts for the high prevalence has not been explored using population-based surveys. To examine e-cigarette and JUUL use among adolescents in New Jersey. Survey study using data from the 2018 New Jersey Youth Tobacco Survey, a cross-sectional statewide representative survey of tobacco use. The survey was school based and sampled New Jersey students in grades 9 to 12. Use of tobacco products; JUUL as first tobacco product tried; exposure to JUUL at school; number of friends perceived as JUUL users; liking or following a tobacco brand on social media; and buying or receiving tobacco-branded merchandise. Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL. In this sample of 4183 adolescents, respondents were 49.6% female and 49.6% non-Hispanic white. Students were evenly distributed across grades 9 through 12. Overall, the estimate for current use of e-cigarettes inclusive of JUUL was higher (24.2%; 95% CI, 22.5%-25.9%) compared with current use assessed by use of e-cigarettes only (17.8%; 95% CI, 16.4%-19.4%) or JUUL use only (21.3%; 95% CI, 19.7%-23.0%). Divergence in e-cigarette use estimates was higher for certain subgroups, including female respondents and non-Hispanic black respondents. Also, 88.8% (95% CI, 86.6%-91.1%) of current e-cigarette users reported JUUL as a brand they used. Hispanic students (PR, 0.78; 95% CI, 0.69-0.89) and non-Hispanic students of other races (PR, 0.64; 95% CI, 0.51-0.81) were significantly less likely than non-Hispanic white students to be current e-cigarette users, and students in 12th grade were more likely than those in 9th grade to be current users (PR, 1.29; 95% CI, 1.11-1.48). Current e-cigarette use was positively associated with current use of other tobacco products (PR, 2.57; 95% CI, 2.24-2.95), endorsing a tobacco brand on social media (PR, 1.43; 95% CI, 1.19-1.72), having tobacco-branded merchandise (PR, 1.70; 95% CI, 1.46-1.97), having close friends who used JUUL (PR, 3.81; 95% CI, 3.17-4.58), and seeing JUUL used on school grounds (PR, 1.43; 95% CI, 1.24-1.65). Estimates of prevalence were greater when modeling frequent use. This study found that prevalence of current and frequent e-cigarette use among adolescents was higher when inclusive of JUUL use, and JUUL was by far the most common e-cigarette brand used, providing support for inclusion of brand-specific questions when assessing e-cigarette use. The results also identify characteristics of adolescents who may be more likely to use e-cigarettes.

Doctors' Knowledge of Shisha and Attitudes Toward Clinical Counseling of Shisha Smokers: Nigerian Study

Introduction: The knowledge and attitude of a doctor towards shisha and tobacco cessation counseling goes a long way in achieving a successful quit for smokers. This study was conducted with the aim of assessing the knowledge of doctors in Nigeria, using Kebbi State as a case study, on shisha and also exploring their attitudes and willingness towards clinical tobacco cessation counseling of shisha smokers.&#x0D; Methods: This study was a questionnaire-based survey of 78 doctors in Kebbi State, Nigeria. The collected data was analyzed using SPSS version 20 software.&#x0D; Results: Only 63 (80.8%) of the respondents were aware of shisha. Among these 63 respondents that were aware of shisha, 4.8% of them were shisha smokers, 46.0% knew that shisha smoking can lead to periodontal disorder, 65.1% agreed that shisha smoking is a gateway to the use of other tobacco products, and 53.2% had had an encounter with a shisha smoker, of which only 63.6% of them (i.e. those 33 respondents who had the encounter) engaged themselves in a discussion on smoking cessation with the encountered shisha smokers. The majority of the surveyed doctors, irrespective of their age, gender, specialization, departmental affiliation, years of practice and shisha smoking history, were positively disposed towards clinical counseling of shisha smokers on tobacco cessation.&#x0D; Discussion: This study shows that the surveyed doctors are positively disposed towards counseling their shisha-smoking patients on the importance of tobacco cessation; despite their inadequate knowledge on shisha.&#x0D; Conclusion: Clinical counseling on tobacco cessation among shisha smokers should be encouraged in Nigeria.

Tobacco use in school students in Afghanistan, Oman and Kuwait and association with parental monitoring: analysis of data from Global School-based Student Health surveys.

Nationally representative data are lacking on cigarette smoking in adolescents in Afghanistan, Oman and Kuwait, which are considered low-income, middle-income and high-income countries respectively of the World Health Organization Eastern Mediterranean Region. This study examined the effect of parental monitoring on the tobacco use of adolescent school students in Afghanistan, Oman and Kuwait. Using data from the 2014 Afghanistan, 2015 Oman and 2015 Kuwait Global School-based Student Health surveys, factors associated with cigarette smoking and tobacco use among the students in the 30 days before the survey were analysed. These factors included: parental understanding of their problems/worries, parental awareness of how they spent their free time, parents searching their belongings without their approval, and parents checking if homework was done. Logistic regression analysis was used to determine the association between tobacco use and parental monitoring. The prevalence of cigarette smoking and/or use of other tobacco products by the students on one or more days in the 30 days before the survey was 10.6% in Afghanistan, 9.3% in Oman and 28.8% in Kuwait. Adolescents whose parents understood their problems, were aware of how they spent their free time, and checked if their homework was done were less likely to be current tobacco users in all three countries (P < 0.05). Adolescents in Oman and Kuwait whose parents searched their belongings were more likely to use tobacco (P < 0.01). The prevalence of tobacco use in the adolescents, especially in Kuwait, suggests the need for better schoolbased health education and promotion programmes in these countries.

E-Cigarette Use Among Youth in the United States, 2019

The prevalence of e-cigarette use among US youth increased from 2011 to 2018. Continued monitoring of the prevalence of e-cigarette and other tobacco product use among youth is important to inform public health policy, planning, and regulatory efforts. To estimate the prevalence of e-cigarette use among US high school and middle school students in 2019 including frequency of use, brands used, and use of flavored products. Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12 participating in the 2019 National Youth Tobacco Survey. The survey was conducted from February 15, 2019, to May 24, 2019. Self-reported current (past 30-day) e-cigarette use estimates among high school and middle school students; frequent use (≥20 days in the past 30 days) and usual e-cigarette brand among current e-cigarette users; and use of flavored e-cigarettes and flavor types among current exclusive e-cigarette users (no use of other tobacco products) by school level and usual brand. Prevalence estimates were weighted to account for the complex sampling design. The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3%-29.7%) of high school students and 10.5% (95% CI, 9.4%-11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2%-37.3%) of high school students and 18.0% (95% CI, 15.2%-21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3%-67.8%) of high school students and 65.4% (95% CI, 60.6%-69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8%-63.2%) of high school students and 54.1% (95% CI, 49.1%-59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days; among current e-cigarette users, 13.8% (95% CI, 12.0%-15.9%) of high school students and 16.8% (95% CI, 13.6%-20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1%-75.1%) of high school students and 59.2% (95% CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors. In 2019, the prevalence of self-reported e-cigarette use was high among high school and middle school students, with many current e-cigarette users reporting frequent use and most of the exclusive e-cigarette users reporting use of flavored e-cigarettes.

Awareness, current use of electronic cigarettes and associated smoking factors in Zhejiang Chinese adolescents.

ObjectivesThe present study aims at examining the prevalence of awareness and current use of electronic cigarettes (e-cigarettes) among middle and high school students from Zhejiang, China. Smoking-related factors associated with e-cigarettes use will also be explored.MethodsThis cross-sectional study was based on 2017 Zhejiang Youth Risk Behavior Survey. A total of 24,157 adolescents were recruited and relevant data of e-cigarettes and smoking-related factors were collected via a self-reported questionnaire. Logistic regression models were used to examine the association between e-cigarettes current use and the smoking-related factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were reported.ResultsOverall, 70.61% of middle and high school students reported hearing of e-cigarettes, while only 2.15% reported using e-cigarettes in the past month. Among smoking-related factors, cigarette smoking (ever and current), use of other tobacco products, second hand smoke exposure and previous attempts to quit smoking were significantly associated with higher current e-cigarettes use in adolescents.ConclusionsThese results presented high awareness of e-cigarettes while relatively low use in Chinese adolescents. Smoking-related factors were significantly associated with increased e-cigarettes use.

Differential Trends in Hookah Use Among New Jersey Youth.

IntroductionUse of 2 or more types of tobacco products is common among youth and young adults, highlighting the need for monitoring and intervention activities to encompass products beyond combustible cigarettes. This study documented patterns and trends of ever, current, and frequent hookah use among high school students in New Jersey by other tobacco product use status.MethodsWe analyzed data from the 2008, 2010, 2012, 2014, 2016 waves of the New Jersey Youth Tobacco Survey. Point estimates and 95% confidence intervals described hookah use stratified by use of other tobacco products. Multivariable logistic regression models assessed trends and correlates of hookah use, controlling for the use of other tobacco products and users’ sociodemographic characteristics. Negative binomial regression models examined the association between total number of tobacco products used and hookah use while controlling for sociodemographic variables and survey year.ResultsThe adjusted odds of current and frequent hookah use among New Jersey high school students were significantly higher in 2014, but not in 2016, compared to 2008. In recent years, hookah use among students who had ever smoked hookah, currently smoked hookah, or frequently smoked hookah was more common among students who had ever or currently smoked cigarettes or e-cigarettes. Hookah users consumed a wider variety of other tobacco products than those who did not use hookah.ConclusionHookah use remains a public health concern for adolescents; it is more common among users of other tobacco products, especially cigarette and e-cigarette smokers. Questions remain as to whether users of multiple tobacco products are being adequately reached by existing policies and regulations.

Factors Associated with Cigarette Use During Airmen's First Year of Service in the United States Air Force.

Despite declines of cigarette use in the civilian population, military personnel report alarmingly high rates of cigarette use. Enlisted Air Force recruits are required to remain tobacco-free for the first 12 weeks of training, and the majority express confidence they will not use tobacco after the ban; however, most previous smokers return to smoking and many nonsmokers initiate. Understanding the factors associated with cigarette-smoking initiation among non-users and re-initiation among former users is critical for the development of successful tobacco control efforts. The current study examines predictors of cigarette smoking among a sample of 2,188 USAF personnel after their first year of service. Logistic regression analyses examined associations between baseline predictors and initiation and re-initiation of cigarette smoking at a one-year follow-up. Compared to never smokers at both time points, the strongest predictor of smoking initiation over the past 12 months was having owned cigarette-branded merchandise (OR 3.81, 95% CI 1.67, 8.71). Compared to former smokers who remained abstinent, the strongest predictor of re-initiation was intention to use tobacco (OR 2.08, 95% CI 1.53, 2.83). Compared to individuals who initiate, the strongest predictors of re-initiation were prior use of other tobacco products and tobacco use intentions (ORs range 1.85 to 4.63). Multiple risk factors are associated with tobacco use. Given that Airmen are tobacco-free for the first 12 weeks of training, tobacco interventions during this period might be more effective. Our findings can be used to tailor interventions to prevent tobacco use in the U.S. military.